Measure of Atopic Dermatitis Disease Severity Using Actigraphy

Background: Analyzing adherence to treatment and outcomes in atopic dermatitis is limited by methods to assess continual disease severity. Atopic dermatitis significantly impacts sleep quality, and monitoring sleep through actigraphy may capture disease burden. Purpose: To assess if actigraphy monitors provide continuous measures of atopic dermatitis disease severity and to preliminarily evaluate the impact of a short-course, high-potency topical corticosteroid regimen on sleep quality. Methods: Ten patients with mild to moderate atopic dermatitis applied topical fluocinonide 0.1% cream twice daily for 5 days. Sleep data were captured over 14 days using wrist actigraphy monitors. Investigator Global Assessment (IGA) and secondary measures of disease severity were recorded. Changes in quantity of in-bed time sleep were estimated with random effects models. Results: The mean daily in-bed time, total sleep time, and wake after sleep onset (WASO) were 543.7 minutes (SEM 9.4), 466.0 minutes (SEM 7.7), and 75.0 minutes (SEM 3.4), respectively. WASO, a marker of disrupted sleep, correlated with baseline (ρ = .75) and end of treatment IGA (ρ = .70). Most patients did not have marked changes in sleep. IGA scores declined by a median change of 1 point at days 7 ( p = .02) and 14 ( p = .008). Conclusions: Using actigraphy, atopic dermatitis disease severity positively correlated with sleep disturbances. Actigraphy monitors were well tolerated by this cohort of atopic dermatitis subjects.

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The Impact of Tryptophan Supplementation on Sleep Quality: A Systematic Review, Meta-Analysis and Meta-Regression

Current Developments in Nutrition ◽

10.1093/cdn/nzab037_083 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 373-373

Author(s):

Clarinda Sutanto ◽

Wen Wei Loh ◽

Jung Eun Kim

Keyword(s):

Sleep Quality ◽

Sleep Disturbances ◽

Meta Analysis ◽

Random Effect ◽

Sleep Onset ◽

Sleep Time ◽

P Value ◽

Post Intervention ◽

Meta Regression ◽

The Impact

Abstract Objectives Sleep disturbances have been associated with higher risk of developing a range of health conditions such as impaired cognition, type 2 diabetes mellitus and cardiovascular disease. L-tryptophan (Trp) has been documented to aid sleep, but a systematic compilation of its effect on sleep quality is still limited. This study aimed to assess the effect of Trp supplementation on sleep quality via meta-analysis and meta-regression. The effects of Trp dose (<1 g and ≥ 1 g) was also assessed. Methods A database search was done in PubMed, Medline (Ovid), CINAHL and COCHRANE and a total of 18 articles were collected. Sleep outcomes that were observed include total sleep time (TST), sleep latency (SL), wake after sleep onset (WASO) and sleep efficiency (SE). Extracted data from four articles were also analyzed using random-effect meta-analysis and meta-regression. Standardized mean difference (SMD) was used in meta-analysis. To investigate the dose-dependent efficacy of Trp, the post-intervention sleep outcomes from 18 articles were extracted and categorized into two Trp dose groups: <1g and ≥1g. This was then followed by an independent t-test comparison. Results Results from the study suggested that Trp supplementation can shorten WASO [SMD − 1.08 min, 95%CI (−1.89, −0.28); −81.03 min/g, P-value = 0.017]. In addition, the group with ≥ 1g Trp supplementation displayed a shorter WASO than the group with Trp < 1g supplementation (Trp < 1g vs. Trp ≥ 1g: 56.55 mins vs. 29.91 mins; P-value: 0.001). However, Trp supplementation did not affect other sleep components. Conclusions Trp supplementation, especially at ≥ 1g, can aid in improving sleep. Funding Sources National University of Singapore, NUS iHealthtech Microbiome in Health, Disease and Ageing.

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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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1071 Subjective Measures Of Hyperarousal Predict Subjective Longitudinal And Retrospective Measures Of Sleep Quality In Individuals Exposed To Trauma

SLEEP ◽

10.1093/sleep/zsaa056.1067 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A408-A408

Author(s):

A Kram Mendelsohn ◽

C Daffre ◽

K I Oliver ◽

J Seo ◽

N B Lasko ◽

...

Keyword(s):

Sleep Quality ◽

Sleep Disturbances ◽

Traumatic Event ◽

Behavioral Therapy ◽

Sleep Onset ◽

Sleep Time ◽

Sleep Onset Latency ◽

Wake Time ◽

Sleep Diaries ◽

Dsm 5

Abstract Introduction Hyperarousal and disturbed sleep are intrinsic symptoms of posttraumatic stress disorder (PTSD). We explored whether self-reported indices of hyperarousal predict longitudinally measured objective, subjective, and retrospective evaluations of sleep quality in trauma-exposed individuals. Methods Individuals exposed to a DSM-5 PTSD Criterion-A traumatic event within the past two years (N=130, 91 females), aged 18-40 (mean 24.43, SD 5.30), 51.54% of whom met DSM-5 criteria for PTSD, completed 14 days of actigraphy and sleep diaries. Participants also completed the PTSD Checklist for DSM-5 (PCL-5), the Clinician-Administered PTSD Scale (CAPS-5), published Hyperarousal (HAS) and Hypervigilance (HVQ) scales, and the Pittsburgh Sleep Quality Index (PSQI) (N=108-125 for different scales). Mean total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE) and sleep midpoint were calculated from actigraphy and subjective SOL, SE, number of awakenings, and time spent awake from diaries. Simple regressions were used to predict associations of the PCL-5, HAS, and HVQ scores with measures of sleep quality. Results Hyperarousal indices predicted diary but not actigraphy measures of sleep quality. Longer diary-reported SOL was predicted by higher scores for: PCL-5 total score (R=0.290, p=0.001), PCL-5 hyperarousal items without the sleep item (R=0.261, p=0.004), and HAS without sleep items (R=0.220, p=0.016). Diary-reported number of awakenings and wake time after sleep onset were predicted by higher HAS scores without the sleep question: (R=0.373, p<0.001; r=0.352, p<0.001). Similarly, all hyperarousal indices significantly predicted PSQI global score (PCL-5: R=0.482, p<0.001; PCL-5 hyperarousal: R=0.389, p<0.001; HVQ: R=0.214, p=0.017; HAS without sleep question: R=0.415, p<0.001). Conclusion Self-reported hyperarousal measures predict subjective longitudinal (especially SOL) and retrospective measures, but not objective measurements of sleep quality. Similar discrepancies between self-reported and objective measures of sleep quality have been reported in patients with insomnia disorder. Cognitive-behavioral therapy for insomnia may be especially effective in treating post-traumatic sleep disturbances. Support R01MH109638

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The Negative Effect of Carpal Tunnel Syndrome on Sleep Quality

Sleep Disorders ◽

10.1155/2014/962746 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 21

Author(s):

Ashish Patel ◽

Maya Deza Culbertson ◽

Archit Patel ◽

Jenifer Hashem ◽

Jinny Jacob ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Sleep Quality ◽

Carpal Tunnel ◽

Sleep Disturbances ◽

Sleep Latency ◽

Sleep Time ◽

Quality Parameters ◽

Negative Effect ◽

Tunnel Syndrome ◽

The Impact

Objective. Sleep disturbances are common in patients with carpal tunnel syndrome (CTS). This study investigates the impact of CTS on sleep quality and clarifies the magnitude of this relationship.Methods. This is a prospective investigation of patients with CTS. Patients responded to the Levine-Katz Carpal Tunnel and the Pittsburgh Sleep Quality Index (PSQI) questionnaires to assess symptom severity and quality, respectively. Descriptive and bivariate analyses summarized the findings and assessed the correlations between CTS severity and sleep quality parameters.Results. 66 patients (53F, 13M) were enrolled. Patients reported a sleep latency of 30.0 (±22.5) minutes, with a total sleep time of 5.5 (±1.8) hours nightly. Global PSQI score was 9.0 (±3.8); 80% of patients demonstrated a significant reduction in sleep quality (global PSQI score>5). Increased CTS symptom and functional severity both resulted in a significant reduction in quality and time asleep. Both significantly correlated with subjective sleep latency, sleep disturbance, use of sleep promoting medications, daytime dysfunction, and overall global PSQI score.Conclusions. The findings confirm the correlation of sleep disturbances to CTS, that is, significant reduction of sleep duration and a correlation to sleep quality. Patients sleep 2.5 hours less than recommended and are at risk for comorbid conditions.

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Nighttime Variability in Wrist Actigraphy

Journal of Nursing Measurement ◽

10.1891/1061-3749.19.2.105 ◽

2011 ◽

Vol 19 (2) ◽

pp. 105-114 ◽

Cited By ~ 9

Author(s):

Julie L. Otte ◽

Judith K. Payne ◽

Janet S. Carpenter

Keyword(s):

Repeated Measures ◽

Sleep Disturbances ◽

Breast Cancer Survivors ◽

Sleep Latency ◽

Sleep Onset ◽

Sleep Time ◽

Sleep Efficiency ◽

Sleep Diary ◽

Repeated Measures Design ◽

Wrist Actigraphy

Wrist actigraphy measures sleep activity and circadian rhythm. This study examined nighttime variability in Actiwatch parameters in a sample of breast cancer survivors (BCSs) to determine a minimum number of nights needed to obtain an accurate picture of objective sleep. A descriptive, quantitative, and repeated measures design was used. Consenting participants wore an actigraph and completed a sleep diary across 7 nights. There were no significant differences in wake after sleep onset (WASO), total sleep time (TST), sleep latency, or sleep disturbances across nights of week (Monday to Sunday) or monitoring nights (1st to 7th). Sleep efficiency was significantly better at Night 6 compared with Night 7. The coefficients of variation (CVs) for WASO ranged from 46% to 86%, TST 23%–34%, sleep latency 154%–246%, sleep efficiency 12%–22%, and sleep disturbances 33%–41%. Although the CVs indicated high variability across women, there was little internight variability in WASO or TST during across 7 nights of sleep. This suggests that in BCSs, Actiwatch data could be collected and evaluated from any single night for an accurate measure of usual sleep.

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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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1142 Comprehensive Phenotyping Of Ambulatory Sleep Patterns In Multiple Sclerosis

SLEEP ◽

10.1093/sleep/zsaa056.1136 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A435-A435

Author(s):

T J Braley ◽

A L Kratz ◽

D Whibley ◽

C Goldstein

Keyword(s):

Multiple Sclerosis ◽

Sleep Quality ◽

Extreme Values ◽

Sleep Onset ◽

External Support ◽

Poor Sleep ◽

Sleep Patterns ◽

Poor Sleep Quality ◽

Historical Cohort ◽

The Impact

Abstract Introduction The majority of sleep research in persons with multiple sclerosis (PwMS) has been siloed, restricted to evaluation of one or a few sleep measures in isolation. To fully characterize the impact of sleep disturbances in MS, multifaceted phenotyping of sleep is required. The objective of this study was to more comprehensively quantify sleep in PwMS, using a recently developed multi-domain framework of duration, continuity, regularity, sleepiness/alertness, and quality. Methods Data were derived from a parent study that examined associations between actigraphy and polysomnography-based measures of sleep and cognitive function in MS. Actigraphy was recorded in n=55 PwMS for 7-12 days (Actiwatch2®, Philips Respironics). Sleep metrics included: duration=mean total sleep time (TST, minutes); continuity=mean wake time after sleep onset (minutes), and regularity=stddev wake-up time (hours). ‘Extreme’ values for continuity/regularity were defined as the most extreme third of the distributions. ‘Extreme’ TST values were defined as the lowest or highest sixth of the distributions. Sleepiness (Epworth Sleepiness Scale score) and sleep quality [Pittsburgh Sleep Quality Index (PSQI) sleep quality item] were dichotomized by accepted cutoffs (>10 and >1, respectively). Results Sleep was recorded for a mean of 8.2 days (stddev=0.95). Median (1st, 3rd quartile) values were as follows: duration 459.79 (430.75, 490.60), continuity 37.00 (23.44, 52.57), regularity 1.02 (0.75, 1.32), sleepiness/alertness 8 (4, 12), and sleep quality 1.00 (1.00, 2.00). Extreme values based on data distributions were: short sleep <=426.25 minutes (18%), long sleep >515.5 minutes (16%), poor sleep continuity ≥45 minutes (33%), and poor sleep regularity ≥1.17 hours (33%). Sleepiness and poor sleep quality were present in 36% and 40% respectively. For comparison, in a historical cohort of non-MS patients, the extreme third of sleep regularity was a stddev of 0.75 hours, 13% had ESS of >10, and 16% had poor sleep quality. Conclusion In this study of ambulatory sleep patterns in PwMS, we found greater irregularity of sleep-wake timing, and higher prevalence of sleepiness and poor sleep quality than published normative data. Efforts should be made to include these measures in the assessment of sleep-related contributions to MS outcomes. Support The authors received no external support for this work.

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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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Non-pharmacological sleep interventions for pediatric cancer patients and survivors: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-021-01724-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Peter L. Stavinoha ◽

Ineke M. Olsthoorn ◽

Maria C. Swartz ◽

Sara Nowakowski ◽

Stephanie J. Wells ◽

...

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Cancer Patients ◽

Pediatric Cancer ◽

Sleep Disturbances ◽

Sleep Onset ◽

Standard Of Care ◽

Sleep Diary ◽

Pharmacological Interventions ◽

Pediatric Cancer Patients

Abstract Background Sleep disturbances constitute a common complication in pediatric cancer patients and survivors and are frequently severe enough to warrant treatment. Suboptimal sleep has been associated with decreased emotional well-being and cognitive functioning and increased behavioral problems. Standardized guidelines for non-pharmacological sleep interventions for adults with cancer exist, but no standard of care intervention or standard guidelines are available to guide such intervention in pediatric cancer patients and survivors. Therefore, effective behavioral interventions for improving sleep quality need to be identified. The objective of the review is to evaluate the effect of non-pharmacological sleep interventions on sleep quality in pediatric cancer patients and survivors. Methods The review will consider studies that include children and adolescents between 0 and 18 years diagnosed with cancer or who have a history of cancer who have non-respiratory sleep disturbance. We will include experimental and quasi-experimental studies evaluating non-pharmacological interventions such as psychological interventions, technical/device interventions, interventions targeting physical activity, and complementary and alternative medicine interventions (e.g., yoga, massage, music). Interventions involving medications, ingestible supplements, products purported to work through absorption, and medical devices will be excluded. Primary outcome will be sleep quality as measured by methods including retrospective ratings, daily sleep diary, and validated questionnaires. Secondary outcomes will include total sleep time, sleep onset latency, wake after sleep onset, daytime sleepiness, and daytime sleep duration (naps) as measured by retrospective ratings, daily sleep diary, validated questionnaires, and/or actigraphy. Databases will include MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, CINAHL (Ebsco), and PsycINFO (Ovid) and will be queried from database inception to present. Two reviewers will independently screen all citations, full-text articles, and extract data. The study methodological quality will be assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Data will be extracted and findings pooled and synthesized using a meta-aggregation approach via the JBI System for the Unified Management, Assessment, and Review of Information (SUMARI). If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., methodological quality, study design, outcome measures). Discussion This systematic review will synthesize and consolidate evidence on existing non-pharmacological interventions to improve sleep in pediatric cancer patients and survivors. Findings may help inform practitioners working with pediatric cancer patients and survivors experiencing sleep disturbances and is intended to identify gaps and opportunities to improve methodical quality of further non-pharmacological sleep intervention research in this population toward developing an eventual standard of care. Systematic review registration PROSPERO CRD42020200397.

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