Diurnal Rhythm Robustness in Individuals With PTSD and Insomnia and The Association With Sleep

Posttraumatic stress disorder (PTSD) and insomnia are characterized by sleep disturbances and daytime functional impairments. Actigraphy metrics can quantify diurnal rhythms via interdaily stability, intradaily variability, relative amplitude, and sleep regularity. Here, we (a) compared diurnal rhythms in PTSD, insomnia, and healthy control samples using linear mixed modeling; (b) compared inter-individual variability of diurnal rhythms between groups using variance ratio tests; and (c) examined correlations between diurnal rhythms and sleep measures within the clinical samples. Participants ( N = 98) wore wrist-activity monitors for one week and completed the Insomnia Severity Index and Pittsburgh Sleep Quality Index. Both clinical samples displayed significantly lower interdaily stability, relative amplitude, and sleep regularity compared with controls. Individuals with PTSD and insomnia did not differ on mean diurnal rhythm metrics. Both clinical samples showed more inter-individual variability in relative amplitude compared with controls, and the individuals with PTSD were distinguished from those with insomnia by greater inter-individual variability in interdaily stability and relative amplitude. Relative amplitude in the clinical samples was positively correlated with objective sleep efficiency and total sleep time. This is the first study to compare individuals with PTSD and insomnia on measures of diurnal rhythms, revealing those with PTSD and insomnia to have less robust and more variable diurnal rhythms compared with controls. Individuals with PTSD differed from those with insomnia in inter-individual variability of diurnal rest-activity stability and amplitude, highlighting this population as particularly heterogenous. Diurnal rhythm robustness might be considered an intervention target in insomnia and PTSD populations.

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Objective Assessment of Walking Impairments in Myotonic Dystrophy by Means of a Wearable Technology and a Novel Severity Index

Electronics ◽

10.3390/electronics10060708 ◽

2021 ◽

Vol 10 (6) ◽

pp. 708

Author(s):

Giovanni Saggio ◽

Alessandro Manoni ◽

Vito Errico ◽

Erica Frezza ◽

Ivan Mazzetta ◽

...

Keyword(s):

Myotonic Dystrophy ◽

Plantar Flexion ◽

Objective Assessment ◽

Endocrine System ◽

Severity Index ◽

Motor Tasks ◽

Sensing Technology ◽

Fast Pace ◽

Dominant Disease ◽

Healthy Control

Myotonic dystrophy type 1 (DM1) is a genetic inherited autosomal dominant disease characterized by multisystem involvement, including muscle, heart, brain, eye, and endocrine system. Although several methods are available to evaluate muscle strength, endurance, and dexterity, there are no validated outcome measures aimed at objectively evaluating qualitative and quantitative gait alterations. Advantageously, wearable sensing technology has been successfully adopted in objectifying the assessment of motor disabilities in different medical occurrences, so that here we consider the adoption of such technology specifically for DM1. In particular, we measured motor tasks through inertial measurement units on a cohort of 13 DM1 patients and 11 healthy control counterparts. The motor tasks consisted of 16 meters of walking both at a comfortable speed and fast pace. Measured data consisted of plantar-flexion and dorsi-flexion angles assumed by both ankles, so to objectively evidence the footdrop behavior of the DM1 disease, and to define a novel severity index, termed SI-Norm2, to rate the grade of walking impairments. According to the obtained results, our approach could be useful for a more precise stratification of DM1 patients, providing a new tool for a personalized rehabilitation approach.

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Sleep Disturbances in Individuals Quarantined Due to SARS-CoV-2 Pandemic in Poland: A Mixed Methods Design Study

Global Advances in Health and Medicine ◽

10.1177/21649561211020707 ◽

2021 ◽

Vol 10 ◽

pp. 216495612110207

Author(s):

Sabina Krupa ◽

Witt Paweł ◽

Wioletta Mędrzycka-Dąbrowska ◽

Agnieszka Lintowska ◽

Dorota Ozga

Keyword(s):

Mixed Methods ◽

Sleep Disturbances ◽

Acute Stress ◽

Sleep Problems ◽

Severity Index ◽

Structured Interview ◽

Mixed Methods Design ◽

Design Study ◽

Insomnia Severity Index ◽

Insomnia Severity

Objectives The study aimed to assess sleep disturbances in patients subjected to home quarantine due to suspected SARS-CoV-2 infection. The study used a mixed methods design study as a research methodology. Methods A semi-structured interview and the scale for Insomnia Severity Index (ISI) were used to achieve the aim of the study. The survey was conducted from 16 to 20 April 2020 and 1 to 2 September 2020 in Poland, at the during of SARS-CoV-2 epidemic in this country. The data were coded and cross-processed. The (COREQ) checklist was followed. Results Interviews with patients and a thorough analysis of recordings revealed commonly used phrases in the following categories: “anxiety”, “ Am I going crazy?”, “Sleep problems”. 10 out of 11 respondents reported sleep disorders of varying severity according to the Insomnia Severity Index scale. Patients presented a fear related to the return to society and normal functioning after quarantine. Additionally, some study participants voiced concerns related to their mental health; some cases of hallucinations were reported. Conclusions Further global population studies should be conducted to analyse this phenomenon. Acute Stress Disorder should be understood as a threat to life and health of an isolated society in quarantine. Further research in this area should be promoted and the need for global guidelines for the entire population should be developed.

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Effects of work organization on the occurrence and resolution of sleep disturbances among night shift workers: a longitudinal observational study

Scientific Reports ◽

10.1038/s41598-021-85017-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Seungho Lee ◽

Jae Bum Park ◽

Kyung-Jong Lee ◽

Seunghon Ham ◽

Inchul Jeong

Keyword(s):

Work Experience ◽

Sleep Disturbances ◽

Sleep Problems ◽

Night Shift ◽

Work Organization ◽

Severity Index ◽

Estimating Equation ◽

Health Examination ◽

Related Factors ◽

Shift Workers

AbstractThis study aimed to investigate the association between work organization and the trajectories of insomnia patterns among night shift workers in a hospital. The health examination data of hospital workers, recorded from January 2014 to December 2018, were collected; 6765 records of 2615 night shift workers were included. Insomnia was defined as a score of ≥ 15 on the Insomnia Severity Index (ISI). Participants were categorized into five groups according to insomnia patterns derived from the analysis of their ISI scores. Work organization and socio-demographic characteristics were also investigated. Generalized estimating equation models and linear mixed models were constructed to analyze the longitudinal data. Of the total participants, 53.0% reported insomnia at least once during the follow-up period. The lack of nap opportunities and work-time control was associated with the occurrence of insomnia, whereas more than 5 years of shift work experience was related to the resolution of insomnia. All work-related factors were significantly related to insomnia risk; however, the effects were not significant in the sustained insomnia group. Although sleep problems are inevitable in night shift workers, well-designed work schedules and better work organization can help reduce the occurrence of insomnia among them.

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631 Sleep SMART in Adolescents with Neurodevelopmental Disorders

SLEEP ◽

10.1093/sleep/zsab072.629 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A247-A248

Author(s):

Alyson Hanish ◽

Abbey Jo Klein ◽

Therese Mathews ◽

Ann Berger ◽

Kevin Kupzyk ◽

...

Keyword(s):

Sleep Disturbance ◽

Neurodevelopmental Disorders ◽

Sleep Disturbances ◽

Immediate Release ◽

Sleep Time ◽

Normative Values ◽

Exogenous Melatonin ◽

Contingency Contracting ◽

Sleep Questionnaires ◽

The Impact

Abstract Introduction: Introduction Sleep disturbances are common in adolescents with neurodevelopmental disorders (NDDs). Inclusion of vulnerable populations such as adolescents with NDDs into sleep intervention efforts is essential as they are at high-risk for poor physical/mental health outcomes. The objective of this study is to pilot a sequential, multiple assignment, randomized trial (SMART) design to compare the impact of a sequence of sleep interventions, based on treatment response, to optimize sleep health in adolescents with NDDs. Methods: Methods Recruitment began June 2019 using convenience sampling. The SMART pilot feasibility study includes 1-week of baseline sleep data, and two 4-week periods of a sleep intervention (9-week total study enrollment). Interventions include exogenous melatonin, The Bedtime Bank, and their combination. Exogenous melatonin (liquid, immediate release, 3mg) is administered 30 minutes before bedtime. The Bedtime Bank, a behavioral sleep intervention, is based upon contingency contracting that relies on a credit- or debt-based system to hold adolescents accountable for maintaining a consistent bedtime. At baseline participants completed demographics, PROMIS pediatric sleep questionnaires, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), salivary & urinary endogenous melatonin measurement, and one week of actigraphy. Upon enrollment, participants were randomly assigned to either melatonin or The Bedtime Bank. Participants who respond (nightly increase in total sleep time (TST) ≥18 minutes) remain on the assigned intervention; if non-responsive participants are re-randomized to a different sleep intervention or combination. Results: Results At baseline, participants (n=29, aged 10–18 years) had an average TST of 7 hours 11 minutes. PROMIS Sleep Disturbance (M=64.3, SE=2.5), PROMIS Sleep-Related Impairment scores (M=58.9, SE=2.2), and CASQ scores (M=40.0, SD= 10.5) were higher than reported normative values. Salivary DLMO & urinary 6-sulfatoyxmelatonin analysis is ongoing. For participants who completed the full 9-week trial, nearly 30% (n=7/24) were responsive (increased baseline TST ≥18 minutes) to one of the 4-week interventions. Conclusion: Conclusion Baseline data of the enrolled participants demonstrates poor indicators of TST, sleep disturbance, and sleep related impairment. Preliminary results of this SMART indicate some adolescents are responsive to sleep interventions aimed to improve their TST. Support (if any) Support: This clinical trial is funded by the National Institute of Nursing Research, National Institutes of Health (1K01NR017465-01A1).

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Long-COVID Syndrome? A Study on the Persistence of Neurological, Psychological and Physiological Symptoms

Healthcare ◽

10.3390/healthcare9050575 ◽

2021 ◽

Vol 9 (5) ◽

pp. 575

Author(s):

Graziella Orrù ◽

Davide Bertelloni ◽

Francesca Diolaiuti ◽

Federico Mucci ◽

Mariagrazia Di Giuseppe ◽

...

Keyword(s):

Quality Of Life ◽

Sleep Disturbances ◽

Online Survey ◽

Clinical Presentation ◽

Demographic Data ◽

Severity Index ◽

Long Term Effects ◽

Targeted Treatments ◽

Euroqol 5D

Background: Emerging aspects of the Covid-19 clinical presentation are its long-term effects, which are characteristic of the so-called “long COVID”. The aim of the present study was to investigate the prevalence of physical, psychological, and sleep disturbances and the quality of life in the general population during the ongoing pandemic. Methods: This study, based on an online survey, collected demographic data, information related to COVID-19, sleep disturbances, and quality of life data from 507 individuals. The level of sleep disturbances and quality of life was assessed through the Insomnia Severity Index (ISI) and the EuroQol-5D (EQ-5D), respectively. Results: In total, 507 individuals (M = 91 and F = 416 women) completed the online survey. The main symptoms associated with “long COVID” were headache, fatigue, muscle aches/myalgia, articular pains, cognitive impairment, loss of concentration, and loss of smell. Additionally, the subjects showed significant levels of insomnia (p < 0.05) and an overall reduced quality of life (p < 0.05). Conclusions: The results of the study appear in line with recent publications, but uncertainty regarding the definition and specific features of “long COVID” remains. Further studies are needed in order to better define the clinical presentation of the “long COVID” condition and related targeted treatments.

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The Cycle of Daily Stress and Sleep: Sleep Measurement Matters

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa053 ◽

2020 ◽

Author(s):

Danica C Slavish ◽

Justin Asbee ◽

Kirti Veeramachaneni ◽

Brett A Messman ◽

Bella Scott ◽

...

Keyword(s):

Sleep Disturbances ◽

Multilevel Models ◽

Single Channel ◽

Sleep Onset ◽

Sleep Time ◽

Sleep Diary ◽

Sleep Onset Latency ◽

Daily Stress ◽

Sleep Diaries ◽

Sleep Measurement

Abstract Background Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress. Purpose We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG). Methods Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]). Results Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (β = −0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (β = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity. Conclusions Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary—not redundant—sleep measurement approaches.

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217 Sleep in heavy marijuana users after smoking differing THC doses compared to controls

SLEEP ◽

10.1093/sleep/zsab072.216 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A87-A87

Author(s):

Mohammad Sibai ◽

Timothy Roehrs ◽

Gail Koshor ◽

Jelena Verkler ◽

Leslie Lundahl

Keyword(s):

Drug Use ◽

Rem Sleep ◽

Sleep Disturbances ◽

Fixed Time ◽

Sleep Time ◽

Sleep Efficiency ◽

Medical Illness ◽

Time In Bed ◽

Henry Ford ◽

History Of

Abstract Introduction Sleep disturbances are commonly reported by chronic marijuana (MJ) users and often identified as reasons for MJ relapse and/or other drug use. In the current study we compared the sleep architecture of 12 heavy MJ users to 11 normal controls. Methods Participants in the marijuana group met DSM-V criteria for cannabis use disorder but were otherwise healthy individuals. On the first study day, individuals smoked (1330-1400 hr) 11 puffs from a cannabis cigarette (7% THC). During the next four days, under varying experimental contingencies participants smoked an average of 4.58 (±3.48) day 1, 4.92 (±3.62) day 2, 4.75 (±3.52) day 3, and 4.17 (±3.56) day 4 puffs from cannabis cigarettes (7% THC). Their sleep was recorded the first four study nights using standard polysomnography procedures at Henry Ford Sleep and Research Center Hospital, under an 8-hr fixed time in bed (2300-0700 hr). Controls (n=11) had no history of illicit drug use or medical illness and were not shift workers. Neither group reported a history of sleep-related disorders. PSG recordings were scored using Rechtschaffen and Kales standard criteria. Sleep measures included sleep efficiency (total sleep time/time in bed * 100), latency to persistent sleep, and percent of time spent in Stage 1, 2, 3/4, and rapid eye movement (REM). Results PSGs taken across all four nights of inpatient stay showed that MJ users spent significantly more time in REM sleep compared to controls (means 24.91, 24.64, 24.42, 24.13 vs 18.81, p<.001) and less time in stage 3/4 sleep (means 4.33, 4.79, 4.53, 6.91 vs 15.68, p<.001). MJ users showed reduced sleep efficiency compared to controls on night 4 (means 82.03 vs 90.32, p=0.039), and increased latency to persistent sleep on night 1 (means 6.04 vs 17.77, p=0.026). Conclusion These data show reduced sleep efficiency, lightened sleep (reduced stage 3/4), as well as an increased duration during REM sleep in heavy MJ users during decreased use, findings that are predictive of relapse in other drug abuse populations. Support (if any) NIH/NIDA R21 DA040770 (LHL)

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Delayed Lactogenesis II is Associated With Lower Sleep Efficiency and Greater Variation in Nightly Sleep Duration in the Third Trimester

Journal of Human Lactation ◽

10.1177/0890334419830991 ◽

2019 ◽

Vol 35 (4) ◽

pp. 713-724

Author(s):

Theresa Casey ◽

Hui Sun ◽

Helen J. Burgess ◽

Jennifer Crodian ◽

Shelley Dowden ◽

...

Keyword(s):

Body Mass Index ◽

Blood Glucose ◽

Sleep Duration ◽

Body Mass ◽

Sleep Disturbances ◽

Sleep Onset ◽

Sleep Time ◽

Sleep Efficiency ◽

Delayed Onset ◽

Wrist Actigraphy

Background: Metabolic and hormonal disturbances are associated with sleep disturbances and delayed onset of lactogenesis II. Research aims: The aim of this study was to measure sleep using wrist actigraphy during gestation weeks 22 and 32 to determine if sleep characteristics were associated with blood glucose, body mass index, gestational related disease, delayed onset of lactogenesis II, or work schedule. Methods: Demographic data were collected at study intake from primiparous women who wore a wrist actigraph during gestation weeks 22 ( n = 50) and 32 ( n = 44). Start and end sleep time, total nighttime sleep, sleep efficiency, wake after sleep onset, and sleep fragmentation were measured. Night to night variability was assessed with the root mean square of successive difference. Blood glucose levels, body mass index, and gestational disease data were abstracted from medical charts. Timing of lactogenesis II was determined by survey. Results: Between gestation week 22 and 32, sleep efficiency decreased and fragmentation increased ( p < .05). During gestation week 32, blood glucose was negatively correlated with sleep duration, and positively related to fragmentation ( p < .05). Women who experienced delayed lactogenesis II had lower sleep efficiency and greater fragmentation ( p < .05), and greater night-to-night variability in sleep start and end time, efficiency, and duration during gestation week 32 ( p < .05). Conclusion: Women with better sleep efficiency and more stable nightly sleep time are less likely to experience delayed onset of lactogenesis II. Interventions to improve sleep may improve maternal health and breastfeeding adequacy.

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Study of correlation between perceived sleep disturbances in depressed patients with objective changes in sleep architecture using polysomnography before and after antidepressant therapy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202894 ◽

2020 ◽

Vol 8 (7) ◽

pp. 2551

Author(s):

Ganesh Ingole ◽

Harpreet S. Dhillon ◽

Bhupendra Yadav

Keyword(s):

Sleep Disturbances ◽

Total Sleep Time ◽

Antidepressant Treatment ◽

Sleep Onset ◽

Sleep Time ◽

Sleep Efficiency ◽

Sleep Architecture ◽

Wake Time ◽

Depressed Patients ◽

Before And After

Background: A prospective cohort study to correlate perceived sleep disturbances in depressed patients with objective changes in sleep architecture using polysomnography (PSG) before and after antidepressant therapy.Methods: Patients were recruited into the study after applying strict inclusion and exclusion criterion to rule out other comorbidities which could influence sleep. A diagnosis of Depressive episode was made based on ICD-10 DCR. Psychometry, in the form of Beck Depressive inventory (BDI) and HAMD (Hamilton depression rating scale) insomnia subscale was applied on Day 1 of admission. Patients were subjected to sleep study on Day 03 of admission with Polysomnography. Patients were started on antidepressant treatment post Polysomnography. An adequate trial of antidepressants for 08 weeks was administered and BDI score ≤09 was taken as remission. Polysomnography was repeated post remission. Statistical analysis was performed using Kruskal Wallis test and Pearson correlation coefficient.Results: The results showed positive (improvement) polysomnographic findings in terms of total sleep time, sleep efficiency, wake after sleep onset, percentage wake time and these findings were statistically significant. HAM-D Insomnia subscale was found to correlate with total sleep time, sleep efficiency, wake after sleep onset, total wake time and N2 Stage percentage.Conclusions: Antidepressant treatment effectively improves sleep architecture in Depressive disorder and HAM-D Insomnia subscale correlates with objective findings of total sleep time, sleep efficiency, wake after sleep onset, total wake time and duration of N2 stage of NREM.

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Sleep disturbance and quality of life in Rheumatoid Arthritis: a prospective mobile health study (Preprint)

10.2196/preprints.32825 ◽

2021 ◽

Author(s):

John McBeth ◽

William G Dixon ◽

Susan Mary Moore ◽

Bruce Hellman ◽

Ben James ◽

...

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Sleep Disturbance ◽

Mobile Health ◽

Sleep Disturbances ◽

Total Sleep Time ◽

Sleep Onset ◽

Sleep Time ◽

Domain Scores

BACKGROUND Sleep disturbance and poor health related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of non-restorative sleep, may be a driver of HRQoL. However, understanding if these sleep disturbances reduce HRQoL has, to date, been challenging due to the need to collect complex time-varying data in high resolution. Such data collection has now been made possible by the widespread availability and use of mobile health (mHealth) technologies. OBJECTIVE In a mobile health (mHealth) study we tested whether sleep disturbance (both absolute values and variability) caused poor HRQoL. METHODS The Quality of life, sleep and rheumatoid arthritis (QUASAR) study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, and for 30 days wore a triaxial accelerometer to objectively assess sleep, and provided daily reports via a smartphone app of sleep (Consensus Sleep Diary (CSD)), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multi-level modelling tested the relationship between sleep variables and WHOQoL-BREF domains (physical, psychological, environment and social). RESULTS Of 268 recruited participants, 254 were included in this analysis. Across all WHOQoL-BREF domains, participant’s scores were lower than the population average. CSD sleep parameters predicted WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points (β = 1.11 (0.07, 2.15)) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, levels of anxiety, sleep quality, or clinical sleep disorders. They were, however, attenuated and no longer significant when pain, fatigue and mood were included in the model. Increased variability in the total time asleep, was associated with poorer physical and psychological domain scores independently of all covariates. There were no patterns of association between actigraphy measured sleep and WHOQoL-BREF. CONCLUSIONS Optimising total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing the variability in total sleep time could improve HRQoL in people with RA.

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