Subjective sleep quality and objective sleep physiology in migraineurs: a meta-analysis

AbstractObjectivesSleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in migraineurs. This meta-analysis aims to determine whether there are differences in subjective sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep physiology measured using polysomnography between adult and pediatric migraineurs, and healthy controls.MethodsA systematic search of five databases was conducted to find case-controlled studies which measured polysomnography and/or PSQI in migraineurs. Effect sizes (Hedges’ g) were entered into a random effects model meta-analysis.Results32 separate studies were eligible. Overall, adult migraineurs had higher PSQI scores than healthy controls (g = 0.75, p < .001). This effect was larger in chronic than episodic migraineurs (g = 1.03, p < .001, g = 0.63, p < .001 respectively). For polysomnographic studies, adult and pediatric migraineurs displayed a lower percentage of REM sleep (g = −0.22, p = 0.017, g = −0.71, p = 0.025 respectively) than healthy controls. Pediatric migraineurs also displayed less total sleep time (g = −1.37, p = 0.039), more wake (g = 0.52, p < .001) and shorter sleep onset latency (g = −0.37, p < .001) than healthy controls.ConclusionMigraineurs have significantly poorer subjective sleep quality, and altered sleep compared to healthy individuals – a finding which is particularly evident in children. This has implications for developing appropriate treatments. Further longitudinal empirical studies are required to enhance our understanding of this relationship.

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Subjective Sleep Quality and Sleep Architecture in Patients With Migraine: A Meta-analysis

Neurology ◽

10.1212/wnl.0000000000012701 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012701

Author(s):

Emily Charlotte Stanyer ◽

Hannah Creeney ◽

Alexander David Nesbitt ◽

Philip Robert Robert Holland ◽

Jan Hoffmann

Keyword(s):

Sleep Quality ◽

Publication Bias ◽

Pediatric Patients ◽

Meta Analysis ◽

Sleep Architecture ◽

Lower Percentage ◽

Healthy Controls ◽

Study Quality ◽

Subjective Sleep Quality ◽

Subjective Sleep

Objectives:Sleep disturbance is often associated with migraine. However, there is a paucity of research investigating objective and subjective measures of sleep in migraine patients. This meta-analysis aims to determine whether there are differences in subjective sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI), and objective sleep architecture measured using polysomnography between adult and pediatric patients, and healthy controls.Methods:This review was pre-registered on PROSPERO (CRD42020209325). A systematic search of five databases (Embase, MEDLINE®, Global Health, APA PsycINFO, APA PsycArticles, last searched: 12/17/2020) was conducted to find case-controlled studies which measured polysomnography and/or PSQI in patients with migraine. Pregnant participants and those with other headache disorders were excluded. Effect sizes (Hedges’ g) were entered into a random effects model meta-analysis. Study quality was evaluated with the Newcastle Ottawa Scale, and publication bias with Egger’s regression test.Results:32 studies were eligible, of which 21 measured PSQI and/MIDAS in adults, 6 measured PSG in adults and 5 in children. The overall mean study quality score was 5/9, and this did not moderate any of the results, and there was no risk of publication bias. Overall, adults with migraine had higher PSQI scores than healthy controls (g=0.75, p < .001, 95% confidence interval [95%CI]: 0.54 - 0.96). This effect was larger in those with chronic rather than episodic condition (g=1.03, p < .001, 95%CI: 0.37 - 1.01, g = 0.63, p < .001, 95%CI: 0.38 - 0.88 respectively). For polysomnographic studies, adults and children with migraine displayed a lower percentage of REM sleep (g=-0.22, p = 0.017, 95%CI: -0.41 - -0.04, g = -0.71, p = 0.025, 95%CI: -1.34 - -0.10 respectively) than controls. Pediatric patients displayed less total sleep time (g=-1.37, p = 0.039, 95%CI: -2.66 - -0.10), more wake (g=0.52, p < .001, 95%CI: 0.08 – 0.79) and shorter sleep onset latency (g=-0.37, p < .001, 95%CI: -0.54 - -0.21) than controls.Discussion:People with migraine have significantly poorer subjective sleep quality and altered sleep architecture compared to healthy individuals. Further longitudinal empirical studies are required to enhance our understanding of this relationship.

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Adults Consuming an Energy-Restricted US Healthy-Style Eating Pattern at Either the Recommended or a Higher Protein Quantity Perceive a Shift from “Poor” to “Good” Sleep

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_028 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 528-528

Author(s):

Joshua Hudson ◽

Jing Zhou ◽

Wayne Campbell

Keyword(s):

Sleep Quality ◽

Dietary Protein ◽

Sleep Onset ◽

Sleep Onset Latency ◽

Quality Indices ◽

Subjective Sleep Quality ◽

Eating Pattern ◽

Subjective Sleep ◽

Good Sleep ◽

Over Time

Abstract Objectives Limited evidence from secondary analyses suggests consuming a higher protein diet during weight loss improves subjective indices of sleep in adults who are overweight and obese. We sought to a priori assess the effects consuming a U.S. Healthy–Style Eating Pattern with the recommended versus a higher amount of protein and moderate energy-restriction on sleep quality indices. Methods Using of a randomized, parallel-design, 51 men and women (mean ± SEM; age: 47 ± 1 y; BMI: 32.6 ± 0.5 kg/m2) consumed a controlled U.S. Healthy-Style Eating Pattern containing 750 kcal/d less than their estimated energy requirement for 12 wk. The additional dietary protein (7.5 oz-eq/d) came from animal-based protein sources and displaced primarily whole and reined grains. Objective and subjective sleep quality indices were measured using wrist-worn actigraphy and questionnaires (Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale), respectively, at pre-, mid- (week 6), and post-intervention (week 12). Results Among all participants, body mass decreased (-6.2 ± 0.4 kg). Dietary protein intake did not affect any of the objective or subjective sleep quality outcomes measured. Over time, objective measures of time spend in bed, time spent sleeping, sleep efficiency, sleep onset latency, and time awake after sleep onset did not change. Subjective measures of global sleep score (GSS, −3.8 ±0.4 au) and daytime sleepiness score (−3.8 ± 0.4 au; both P < 0.001) improved over time. The GSS improvement transitioned the group of participants from being categorized with a poor to a good sleep condition (GSS >5 versus ≤5 au of 0–21 au scale; Pre 7.9 ± 0.5 au, Post: 4.0 ± 0.6 au). Conclusions Although objective sleep quality may not improve, adults with poor sleep may perceive becoming good sleepers while consuming a moderately energy-restricted U.S. Healthy-Style Eating Pattern containing either the recommended or a higher amount of protein. Funding Sources The Beef Checkoff and American Egg Board-Egg Nutrition Center.

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Associations of Subjective Sleep Quality with Depression Score, Anxiety, Physical Symptoms and Sleep Onset Latency in Young Students

Central European Journal of Public Health ◽

10.21101/cejph.a3647 ◽

2011 ◽

Vol 19 (2) ◽

pp. 115-117 ◽

Cited By ~ 37

Author(s):

Christoph Augner

Keyword(s):

Sleep Quality ◽

Sleep Onset ◽

Physical Symptoms ◽

Depression Score ◽

Sleep Onset Latency ◽

Onset Latency ◽

Subjective Sleep Quality ◽

Subjective Sleep ◽

Young Students

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Assessing sleep-wake survival dynamics in relation to sleep quality in a placebo-controlled pharmacological intervention study with people with insomnia and healthy controls

Psychopharmacology ◽

10.1007/s00213-020-05660-3 ◽

2020 ◽

Vol 238 (1) ◽

pp. 83-94

Author(s):

Lieke W. A. Hermans ◽

Marta Regis ◽

Pedro Fonseca ◽

Sebastiaan Overeem ◽

Tim R. M. Leufkens ◽

...

Keyword(s):

Sleep Quality ◽

Sleep Onset ◽

Sleep Fragmentation ◽

Pharmacological Intervention ◽

Segment Length ◽

Prediction Errors ◽

Sleep Onset Latency ◽

Healthy Controls ◽

Subjective Sleep Quality ◽

Double Blind

Abstract Rationale The mechanisms underlying impaired sleep quality in insomnia are not fully known, but an important role for sleep fragmentation has been proposed. Objectives The aim of this study is to explore potential mechanisms of sleep fragmentation influencing alterations of perceived sleep quality. Methods We analyzed polysomnography (PSG) recordings from a double-blind crossover study with zopiclone 7.5 mg and placebo, in elderly participants with insomnia complaints and age-matched healthy controls. We compared survival dynamics of sleep and wake across group and treatment. Subsequently, we used a previously proposed model to estimate the amount of sleep onset latency (SOL) misperception from PSG-defined sleep fragmentation. Self-reported and model-estimated amount of SOL misperception were compared across group and treatment, as well as model prediction errors. Results In the zopiclone night, the average segment length of NREM sleep was increased (group F = 1.16, p = 0.32; treatment F = 8.89, p< 0.01; group x treatment F = 0.44, p = 0.65), while the segment length of wake was decreased (group F = 1.48, p = 0.23; treatment F = 11.49, p< 0.01; group x treatment F = 0.36, p = 0.70). The self-reported and model-estimated amount of SOL misperception were lower during the zopiclone night (self-reported group F = 6.08, p< 0.01, treatment F = 10.8, p< 0.01, group x treatment F = 2.49, p = 0.09; model-estimated F = 1.70, p = 0.19, treatment F = 16.1, p< 0.001, group x treatment F = 0.60, p = 0.55). The prediction error was not altered (group F = 1.62, p = 0.20; treatment F = 0.20, p = 0.65; group x treatment F = 1.01, p = 0.37). Conclusions Impaired subjective sleep quality is associated with decreased NREM stability, together with increased stability of wake. Furthermore, we conclude that zopiclone-induced changes in SOL misperception can be largely attributed to predictable changes of sleep architecture.

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Optimisation and Validation of a Nutritional Intervention to Enhance Sleep Quality and Quantity

Nutrients ◽

10.3390/nu12092579 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2579

Author(s):

Shona L. Halson ◽

Gregory Shaw ◽

Nathan Versey ◽

Dean J. Miller ◽

Charli Sargent ◽

...

Keyword(s):

Sleep Quality ◽

Cognitive Performance ◽

Postural Sway ◽

Sleep Onset ◽

Nutritional Intervention ◽

Sleep Architecture ◽

Sleep Onset Latency ◽

Onset Latency ◽

Subjective Sleep Quality ◽

Subjective Sleep

Background: Disturbed sleep may negatively influence physical health, cognitive performance, metabolism, and general wellbeing. Nutritional interventions represent a potential non-pharmacological means to increase sleep quality and quantity. Objective: (1) Identify an optimal suite of nutritional ingredients and (2) validate the effects of this suite utilising polysomnography, and cognitive and balance tests. Methods: The optimal and least optimal combinations of six ingredients were identified utilising 55 male participants and a Box–Behnken predictive model. To validate the model, 18 healthy, male, normal sleepers underwent three trials in a randomised, counterbalanced design: (1) optimal drink, (2) least optimal drink, or (3) placebo were provided before bed in a double-blinded manner. Polysomnography was utilised to measure sleep architecture. Cognitive performance, postural sway, and subjective sleep quality, were assessed 30 min after waking. Results: The optimal drink resulted in a significantly shorter sleep onset latency (9.9 ± 12.3 min) when compared to both the least optimal drink (26.1 ± 37.4 min) and the placebo drink (19.6 ± 32.0 min). No other measures of sleep, cognitive performance, postural sway, and subjective sleep quality were different between trials. Conclusion: A combination of ingredients, optimised to enhance sleep, significantly reduced sleep onset latency. No detrimental effects on sleep architecture, subjective sleep quality or next day performance were observed.

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Impact of Treatment for Nasal Cavity Disorders on Sleep Quality: Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/01945998211029527 ◽

2021 ◽

pp. 019459982110295

Author(s):

Jacob Fried ◽

Erick Yuen ◽

Kathy Zhang ◽

Andraia Li ◽

Nicholas R. Rowan ◽

...

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Nasal Obstruction ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Life Questionnaire ◽

Subjective Sleep Quality ◽

Subjective Sleep ◽

The Impact

Objective To determine the impact of treatment for patients with nasal obstruction secondary to allergic rhinitis (AR) and nasal septal deviation (NSD) on sleep quality. Data Sources Primary studies were identified though PubMed, Scopus, Cochrane Library, and Web of Science. Review Methods A systematic review was performed by querying databases for articles published through August 2020. Studies were included that reported on objective sleep parameters (apnea-hypopnea index) and sinonasal and sleep-specific patient-reported outcome measures: Rhinoconjunctivitis Quality of Life Questionnaire, Nasal Obstruction Symptom Evaluation, Epworth Sleepiness Scale (EpSS), and Pittsburgh Sleep Quality Index (PSQI). Results The database search yielded 1414 unique articles, of which 28 AR and 7 NSD studies were utilized for meta-analysis. A total of 9037 patients (8515 with AR, 522 with NSD) were identified with a mean age of 35.0 years (35.3 for AR, 34.0 for NSD). Treatment for AR and NSD significantly improved subjective sleep quality. For AR, the EpSS mean difference was −1.5 (95% CI, –2.4 to –0.5; P = .002) and for the PSQI, –1.7 (95% CI, –2.1 to –1.2; P < .00001). For NSD, the EpSS mean difference was −3.2 (95% CI, –4.2 to –2.2; P < .00001) and for the PSQI, –3.4 (95% CI, –6.1 to –0.6; P = .02). Conclusion Subjective sleep quality significantly improved following treatment for AR and NSD. There were insufficient data to demonstrate that objective metrics of sleep quality similarly improved.

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778 Poor Sleep Quality is Associated with Reduced Myelination in Patients with Psychotic Disorders

SLEEP ◽

10.1093/sleep/zsab072.775 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A303-A303

Author(s):

Cagri Yuksel ◽

Xi Chen ◽

Lauren Watford ◽

Margaret Gardner ◽

Kathryn Lewandowski ◽

...

Keyword(s):

White Matter ◽

Sleep Quality ◽

Psychotic Disorders ◽

Sleep Onset ◽

Sleep Loss ◽

Magnetization Transfer Ratio ◽

Poor Sleep ◽

Sleep Onset Latency ◽

Healthy Controls ◽

Poor Sleep Quality

Abstract Introduction Recent studies show that sleep favors oligodendrocyte proliferation and myelination, and sleep loss is associated with alterations in white matter structure and decreased myelination. Psychotic disorders are characterized by disrupted white matter integrity, and abnormal axon and myelin structure. Despite common sleep disturbances in these disorders, little is known about the relationship between sleep quality and white matter findings. A novel in vivo neuroimaging technique that combines diffusion tensor spectroscopy (DTS) and magnetization transfer ratio (MTR) allows separately examining the axon structure and glial function, and myelin content, respectively. Using this method, we examined the association of sleep quality with white matter biology in a sample of patients with psychotic disorders and matched healthy controls. Methods Participants included patients diagnosed with bipolar disorder with psychotic features (euthymic or depressed, n=12) and schizophrenia spectrum disorders (n=9), and age and sex matched healthy controls (n=20). DTS and MTR data was collected from the right prefrontal white matter at 4T. DTS measures included apparent diffusion coefficients of water, NAA, creatine and choline. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI). Results PSQI total score was significantly higher in patients. and patient sample included a higher percentage of poor sleepers (PSQI total score>5). In patients, total PSQI score and sleep onset latency were significantly and negatively associated with MTR (F=6.9, p=0.02 and F=9.7, p=0.007, respectively). There was no difference in any DTS measures between groups. Conclusion Our preliminary results show that poor sleep quality is associated with decreased myelin content in the frontal lobe, in patients with psychotic disorders. This finding suggests that sleep loss may be a mediator of white matter alterations in psychosis. Support (if any) This work is supported by National Institute of Mental Health K23MH119322 to Cagri Yuksel

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The Effect of Uncoupled Sleep and Dysfunctional Sleep Beliefs on Sleep Outcomes in Older Adults following Online Cognitive Behavioral Therapy for Insomnia: A Single-Group Non-randomized Trial (Preprint)

10.2196/preprints.35964 ◽

2021 ◽

Author(s):

Yvonne Kutzer ◽

Lisa Whitehead ◽

Eimear Quigley ◽

Shih Ching Fu ◽

Mandy Stanley

Keyword(s):

Older Adults ◽

Cognitive Behavioral Therapy ◽

Sleep Quality ◽

Mixed Model ◽

Linear Mixed Model ◽

Behavioral Therapy ◽

Sleep Onset ◽

Poor Sleep ◽

Subjective Sleep Quality ◽

Subjective Sleep

BACKGROUND The current Covid-19 pandemic has brought about a marked interest in sleep health, as well as an increased demand for telehealth services, such as online Cognitive Behavioral Therapy for insomnia (CBT-I). Older adults in particular report a high rate of sleep problems. Recent studies have suggested that dysfunctional sleep beliefs could contribute to the high rates of self-reported insomnia in this age group. In addition, older adults have an increased rate of uncoupled sleep, e.g. displaying an insomnia complaint in the absence of objectively measured poor sleep. It is essential to determine the prevalence of coupled and uncoupled sleep in older adults and to examine the efficacy of online CBT-I to improve sleep outcomes. OBJECTIVE This study aims to assess objective and subjective sleep quality and dysfunctional sleep beliefs in a sample of community-dwelling older adults aged 60-80 years with and without uncoupled sleep in Western Australia following digitally delivered CBT-I. METHODS Objective sleep was measured using wrist actigraphy, and subjective sleep quality via sleep diaries and the Pittsburgh Sleep Quality Index (PSQI). Dysfunctional sleep beliefs were assessed by the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16) prior to and following a four-week online CBT-I programme. Linear mixed model and generalised linear mixed model analyses were conducted to examine objective and subjective sleep onset latency, total sleep time, wake after sleep onset and number of awakenings as well as PSQI and DBAS16 scores, respectively. RESULTS 62 participants (55 females; 88.7%) completed the study. CBT-I effectively reduced dysfunctional sleep beliefs and PSQI scores across all sleep classifications, even in good sleepers without a sleep complaint. Objective and self-reported changes in sleep parameters were mainly demonstrated in complaining poor sleepers. Complaining good sleepers reported a decrease in the number of subjective sleep awakenings only. CONCLUSIONS Online CBT-I was effective in improving the sleep outcomes of individuals who had both subjective and objective poor sleep. However, as the online CBT-I reduced dysfunctional sleep beliefs in all sleep groups, further examination of dysfunctional sleep beliefs and whether they mediate the outcomes of digital CBT-I in older adults will need to be conducted. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451 INTERNATIONAL REGISTERED REPORT RR2-32705

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