Sleep quality and architecture in COPD: the relationship with lung function abnormalities

Objective: Impaired respiratory mechanics and gas exchange may contribute to sleep disturbance in patients with COPD. We aimed to assess putative associations of different domains of lung function (airflow limitation, lung volumes, and gas exchange efficiency) with polysomnography (PSG)-derived parameters of sleep quality and architecture in COPD. Methods: We retrospectively assessed data from COPD 181 patients = 40 years of age who underwent spirometry, plethysmography, and overnight PSG. Univariate and multivariate linear regression models predicted sleep efficiency (total sleep time/total recording time) and other PSG-derived parameters that reflect sleep quality. Results: The severity of COPD was widely distributed in the sample (post-bronchodilator FEV1 ranging from 25% to 128% of predicted): mild COPD (40.3%), moderate COPD (43.1%), and severe-very severe COPD (16.6%). PSG unveiled a high proportion of obstructive sleep apnea (64.1%) and significant nocturnal desaturation (mean pulse oximetry nadir = 82.2% ± 6.9%). After controlling for age, sex, BMI, apnea-hypopnea index, nocturnal desaturation, comorbidities, and psychotropic drug prescription, FEV1/FVC was associated with sleep efficiency (ß = 25.366; R2 = 14%; p < 0.001), whereas DLCO predicted sleep onset latency (ß = -0.314; R2 = 13%; p < 0.001) and rapid eye movement sleep time/total sleep time in % (ß = 0.085; R2 = 15%; p = 0.001). Conclusions: Pulmonary function variables reflecting severity of airflow and gas exchange impairment, adjusted for some potential confounders, were weakly related to PSG outcomes in COPD patients. The direct contribution of the pathophysiological hallmarks of COPD to objectively measured parameters of sleep quality seems to be less important than it was previously assumed.

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1092 Attention-deficit/hyperactivity Disorder Symptoms And Sleep Characteristics Within A Seasonal Affective Disorder Spectrum

SLEEP ◽

10.1093/sleep/zsaa056.1087 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A415-A416

Author(s):

K N Kim ◽

D L Wescott ◽

P L Franzen ◽

B P Hasler ◽

K A Roecklein

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Adhd Symptom ◽

Symptom Severity ◽

Daytime Sleepiness ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Onset Latency ◽

Adhd Symptoms ◽

Depression Severity

Abstract Introduction Seasonal affective disorder (SAD) increases risk for attention-deficit/hyperactivity disorder (ADHD), although the mechanism linking SAD and ADHD is unknown. Prior research has identified insomnia and delayed sleep phase in both ADHD and SAD. We hypothesized that sleep duration and timing in SAD would be associated with the severity of ADHD symptoms. Methods Adults with SAD (n = 45) and subsyndromal SAD (S-SAD; n = 18) aged 19-66 years from Pittsburgh, PA., were assessed for ADHD symptoms, self-report sleep quality, depression severity, and daytime sleepiness in the Winter. Participants wore an Actiwatch for 4-14 days, from which we calculated sleep-onset latency, total sleep time, sleep midpoint, and sleep efficiency. We conducted a hierarchical multivariate linear regression to determine if sleep characteristics predict ADHD symptom severity in our sample while controlling for depressive symptoms. Age and gender were added in Step 1, seasonal depression severity in Step 2, actigraphy-based total sleep time, sleep onset latency, midpoint, and efficiency in Step 3, and self-reported sleep quality and daytime sleepiness in Step 4. Results Participants mostly scored in the “likely” or “highly likely” ADHD range (87.30%, n=55), higher than the national prevalence rate (4.4%). When controlling for age, gender, and depression severity, only shorter actigraphy-based total sleep time was associated with higher ADHD symptom severity (β=-0.30, p<0.05). However, when self-reported sleep quality and daytime sleepiness were added as predictors, total sleep time was no longer a statistically-significant predictor of ADHD symptom severity and only daytime sleepiness predicted ADHD symptom severity (β=0.31, p<0.05). Conclusion Our results suggest that individuals with SAD who experience daytime sleepiness and/or possibly shorter actigraphy-based sleep duration experience higher ADHD symptom severity. Treatments like Trans-C or CBT-I to improve daytime sleepiness and sleep duration may be indicated for SAD patients who present with comorbid ADHD symptoms. Support NIMH K.A.R. MH103303

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Characteristics of Obstructive Sleep Apnea Patients With Hypertension and Factors Associated With Autotitration Acceptance

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.706275 ◽

2022 ◽

Vol 12 ◽

Author(s):

Xuan Zhang ◽

Ning Zhang ◽

Yang Yang ◽

Shuo Wang ◽

Ping Yu ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Eye Movement ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Efficiency ◽

Apnea Hypopnea Index ◽

Rapid Eye Movement ◽

Obstructive Sleep ◽

Severe Group

In order to explore the characteristics and treatment status of obstructive sleep apnea (OSA) patients with hypertension, a retrospective study was conducted on 306 patients admitted from October 2018 to December 2019. According to the apnea hypopnea index (AHI), OSA patients with hypertension were divided into three groups. 69 cases were mild OSA (5 ≤ AHI < 15), 86 cases were moderate (15 ≤ AHI < 30), and 151 cases were severe (AHI ≥ 30). Compared with patients in the mild and moderate groups, the severe group had more male patients, with higher body mass index (BMI) and non-rapid eye movement stage 1 accounted for total sleep time (N1%), and lower non-rapid eye movement stage 2 accounted for total sleep time (N2%), average and minimum blood oxygen. Among all the patients, those who underwent the titration test accounted for 20.6% (63/306). Multivariate analysis showed that sleep efficiency (p < 0.001) and AHI (p < 0.001) were independent factors for patients to accept titration test. OSA patients with hypertension had a low acceptance of titration therapy. These people with higher sleep efficiency and AHI were more likely to receive autotitration.

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Does media use before bedtime affect the sleep of psychosomatic rehabilitation patients?

Somnologie - Schlafforschung und Schlafmedizin ◽

10.1007/s11818-020-00282-5 ◽

2020 ◽

Vol 24 (4) ◽

pp. 253-258

Author(s):

Jasmin Faber ◽

Indra Steinbrecher-Hocke ◽

Peter Bommersbach ◽

Angelika A. Schlarb

Keyword(s):

Sleep Quality ◽

Media Use ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Efficiency ◽

Subjective Sleep Quality ◽

Psychosomatic Rehabilitation ◽

Sleep Parameters ◽

Rehabilitation Clinic ◽

The Relationship

Abstract Objective Media use can affect sleep. However, research regarding various populations is sparse. The objective of this study was to examine the relationship between media use directly before bedtime and various sleep parameters in patients of a psychosomatic rehabilitation clinic. Methods Patients from a German psychosomatic rehabilitation clinic were tested regarding subjective sleep quality and insomnia symptoms based on questionnaires such as the Pittsburgh Sleep Quality Index (PSQI). Eligible patients also completed an additional sleep log over a period of 1 week. A total of 347 insomnia patients were enrolled, with a mean age of 49.77 years (range 22–64 years; median = 52 years). 57.5% of the patients were 50 years or older. Results Analysis showed that media use and various sleep diary parameters such as total sleep time (r = −0.386, p = 0.042; rTST2 = 0.149) and sleep efficiency (r = −0.507, p = 0.006; rSE2 = 0.257) were significantly associated. In detail, more media consumption was associated with less total sleep time and a lower sleep efficiency. The same result was found for media use and sleep efficiency on weekdays (r = −0.544, p = 0.002; rSE2 = 0.296), but not for other sleep parameters. However, media use time and subjective sleep quality were not significantly correlated, r = −0.055, p = 0.768. Conclusion This study, which is the first to examine the relation between media use and sleep in patients of a psychosomatic rehabilitation clinic, suggests a significant association between media use and sleep duration as well as sleep efficiency. However, more research is needed to investigate the relationship between media use and sleep in more detail, to increase patients’ quality of life and to incorporate these findings into the daily life of clinicians and therapists as well as into sleep hygiene education and sleep trainings.

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Home-Based Sleep Sensor Measurements in an Older Australian Population: Before and during a Pandemic

Sensors ◽

10.3390/s21185993 ◽

2021 ◽

Vol 21 (18) ◽

pp. 5993

Author(s):

Mahnoosh Kholghi ◽

Claire M. Ellender ◽

Qing Zhang ◽

Yang Gao ◽

Liesel Higgins ◽

...

Keyword(s):

Older Adults ◽

Time Course ◽

Total Sleep Time ◽

Sleep Onset ◽

Sleep Time ◽

Community Dwelling ◽

Sleep Efficiency ◽

Sleep Onset Latency ◽

Onset Latency ◽

Short Sleep Duration

Older adults are susceptible to poor night-time sleep, characterized by short sleep duration and high sleep disruptions (i.e., more frequent and longer awakenings). This study aimed to longitudinally and objectively assess the changes in sleep patterns of older Australians during the 2020 pandemic lockdown. A non-invasive mattress-based device, known as the EMFIT QS, was used to continuously monitor sleep in 31 older adults with an average age of 84 years old before (November 2019–February 2020) and during (March–May 2020) the COVID-19, a disease caused by a form of coronavirus, lockdown. Total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, time to bed, and time out of bed were measured across these two periods. Overall, there was no significant change in total sleep time; however, women had a significant increase in total sleep time (36 min), with a more than 30-min earlier bedtime. There was also no increase in wake after sleep onset and sleep onset latency. Sleep efficiency remained stable across the pandemic time course between 84–85%. While this sample size is small, these data provide reassurance that objective sleep measurement did not deteriorate through the pandemic in older community-dwelling Australians.

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Effects of melatonin on sleep disturbances in multiple sclerosis: A randomized, controlled pilot study

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/20552173211048756 ◽

2021 ◽

Vol 7 (4) ◽

pp. 205521732110487

Author(s):

Wan-Yu Hsu ◽

Annika Anderson ◽

William Rowles ◽

Katherine E. Peters ◽

Vicki Li ◽

...

Keyword(s):

Multiple Sclerosis ◽

Sleep Quality ◽

Sleep Disturbances ◽

Total Sleep Time ◽

Low Cost ◽

Sleep Time ◽

Sleep Efficiency ◽

Double Blind ◽

Randomized Controlled ◽

Patient Reported

Background Sleep disturbances are commonly reported by people with multiple sclerosis (PwMS). However, optimal management of sleep disturbances is uncertain, and objective studies of sleep quality in PwMS are scarce. Objectives To determine the effect of exogenous melatonin on sleep quality and sleep disturbances in PwMS. Methods Thirty adult PwMS reporting sleep difficulties were recruited in a randomized, controlled, double-blind cross-over study. They took either melatonin or placebo for 2 weeks, and the opposite for the following 2 weeks. During weeks 2 and 4, an actigraph was used to capture mean total sleep time and sleep efficiency. Patient-reported outcomes (PROs) were collected at weeks 0, 2 and 4. Results Melatonin use significantly improved mean total sleep time ( p = 0.03), with a trend towards higher sleep efficiency ( p = 0.06). No PROs were significantly different; there was a trend for melatonin use to decrease mean Insomnia Severity Index score ( p = 0.07), improve Pittsburgh Sleep Quality Index sleep quality component ( p = 0.07), and improve NeuroQoL-Fatigue ( p = 0.06). No other PROs showed differences between melatonin and placebo; nor did step count measured by actigraphy (all p > 0.45). Conclusion These results provide preliminary evidence that melatonin, a low-cost, over-the-counter supplement, could improve objective measures of sleep quality in PwMS.

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Sleep Quality in Family Caregivers and Matched Non-Caregiving Controls: The REGARDS Study

Innovation in Aging ◽

10.1093/geroni/igab046.2982 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 818-818

Author(s):

Marcela Blinka ◽

Adam Spira ◽

Orla Sheehan ◽

Tansu Cidav ◽

J David Rhodes ◽

...

Keyword(s):

Sleep Quality ◽

Family Caregivers ◽

Total Sleep Time ◽

Sleep Onset ◽

Sleep Time ◽

Care Recipient ◽

Sleep Onset Latency ◽

Onset Latency ◽

Time In Bed ◽

Regards Study

Abstract The high levels of stress experienced by family caregivers may affect their physical and psychological health, including their sleep quality. However, there are few population-based studies comparing sleep between family caregivers and carefully-matched controls. We evaluated differences in sleep and identified predictors of poorer sleep among the caregivers, in a comparison of 251 incident caregivers and carefully matched non-caregiving controls, recruited from the national REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Incident caregivers and controls were matched on up to seven demographic and health factors (age, sex, race, education level, marital status, self-rated health, and self-reported serious cardiovascular disease history). Sleep characteristics were self-reported and included total sleep time, sleep onset latency, wake after sleep onset, time in bed, and sleep efficiency. Family caregivers reported significantly longer sleep onset latency, before and after adjusting for potential confounders, compared to non-caregiving controls (ps < 0.05). Depressive symptoms in caregivers predicted longer sleep onset latency, greater wake after sleep onset, and lower sleep efficiency. Longer total sleep time in caregivers was predicted by employment status, living with the care recipient, and number of caregiver hours. Employed caregivers and caregivers who did not live with the care recipient had shorter total sleep time and spent less time in bed than non-employed caregivers. Additional research is needed to evaluate whether sleep disturbances contributes to health problems among caregivers.

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Misperception of sleep in bipolar disorder: an exploratory study using questionnaire versus actigraphy

International Journal of Bipolar Disorders ◽

10.1186/s40345-020-00198-x ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Henrik Myhre Ihler ◽

Manon Meyrel ◽

Vincent Hennion ◽

Julia Maruani ◽

Gregory Gross ◽

...

Keyword(s):

Bipolar Disorder ◽

Obstructive Sleep Apnea ◽

Sleep Latency ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Efficiency ◽

Objective Measures ◽

Obstructive Sleep

Abstract Background The concept of misperception of sleep refers to the estimated discrepancy between subjective and objective measures of sleep. This has been assessed only in a few prior studies in individuals with Bipolar Disorder (BD) as compared to Healthy Controls (HC) and with mixed results. Methods We assessed a sample of 133 euthymic individuals with BD and 63 HC for retrospective subjective (Pittsburgh Sleep Quality Index) and objective (21 days of actigraphy recording) measures of total sleep time, sleep latency and sleep efficiency. We first investigated the correlations between these subjective and objective measures in the two groups. We then compared individuals with BD and HC for the absolute values of the differences between subjective and objective sleep parameters, used as a proxy of the magnitude of misperception of sleep. Finally, we undertook regression analyses to assess associations between clinical groups, core demographics, clinical factors and misperception of sleep. Results The correlation coefficients between subjective and objective measures of sleep did not differ between groups (total sleep time: rho = .539 in BD and rho = .584 in HC; sleep latency: rho = .190 in BD and rho = .125 in HC; sleep efficiency: rho = .166 in BD and rho = .222 in HC). Individuals with BD did not differ from HC in the magnitude of misperception of total sleep time, sleep latency nor sleep efficiency. Individuals with BD type 1 misperceived their sleep efficiency significantly more than individuals with BD type 2, with no further difference between BD type 1 and BD type 2 regarding sleep latency and sleep duration misperceptions. Three factors (age, symptoms of obstructive sleep apnea, and mild depressive symptoms), were the main contributors to the magnitude of misperception of sleep. Conclusions Misperception of sleep was not associated with a diagnosis of BD. In this sample, mild depressive symptoms, older age, or symptoms of obstructive sleep apnea may be related to greater sleep misperception. In that case, the reliability of subjective measures may decrease as the misperception of sleep increases. This study may help guide clinicians in selecting the best approach for assessing sleep (objective versus subjective measures) in individuals with BD.

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0828 Descriptive Model of Sleep Quality in the Older Adults

SLEEP ◽

10.1093/sleep/zsaa056.824 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A315-A316

Author(s):

P K Morelhao ◽

G L Fernandes ◽

V Dokkedal-Silva ◽

G N Pires ◽

S Tufik ◽

...

Keyword(s):

Older Adults ◽

Sleep Quality ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Efficiency ◽

Poor Sleep ◽

Descriptive Model ◽

Subjective Sleep ◽

Sleep Parameters ◽

The City

Abstract Introduction Poor sleep quality is a health condition that impacts the quality of life of the older population. In the literature, there are questions about which objective sleep parameters should be considered to describe precisely the definition of sleep quality. There is ongoing debate with this term usually being used in relation to subjective sleep perception. This study aimed to investigate which objective and subjective sleep parameters contribute to a measurement of sleep quality in older adults. Methods A cross-sectional study using a representative sample of adults from the city of São Paulo, Brazil was performed. We used a dataset from the 2015 Epidemiological Study of Sleep from the City of São Paulo (EPISONO), including only individuals aged 60 years or more. We used exploratory factor analysis and structural equation modelling to identify relevant variables to a descriptive model of sleep quality. Results A total of 152 older adults were included. The final model consists of two factors, objective sleep quality which comprises sleep efficiency, total sleep time and sleep latency, and poor sleep perception, constituted by scores in the Pittsburgh Sleep Quality Index and Insomnia Severity Index. Conclusion The results suggested that sleep quality had both an objective (sleep efficiency, total sleep time, latency of sleep onset) and subjective dimensions (subjective questionnaires). These results may be useful in the clinical scenario, serving as leads for a better understanding of the sleep quality in aging patients. Future studies may also benefit from this descriptive model to further researches other associations, such as sleep and pain in this population. Support The study was supported by Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Nível Superior (CAPES). ST and MLA received support from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

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Comparative efficacy and safety of hypnotics for insomnia in older adults: a systematic review and network meta-analysis

SLEEP ◽

10.1093/sleep/zsaa260 ◽

2020 ◽

Author(s):

Hsiao-Yean Chiu ◽

Hsin-Chien Lee ◽

Jen-Wei Liu ◽

Shi-Jun Hua ◽

Pin-Yuan Chen ◽

...

Keyword(s):

Older Adults ◽

Low Dose ◽

Total Sleep Time ◽

Meta Analysis ◽

Sleep Onset ◽

Sleep Time ◽

Sleep Efficiency ◽

Sleep Onset Latency ◽

Efficacy And Safety ◽

Onset Latency

Abstract Study Objectives To compare the efficacy and safety of various hypnotics for identifying the best treatments for insomnia in older adults. Methods We searched the EMBASE, PubMed, ClinicalTrials.gov, and ProQuest Dissertations and Theses A&I databases from the inception to September 12, 2020. Only randomized controlled trials comparing hypnotics with either another hypnotic or placebo for insomnia treatment in elderly people were included. Sleep outcomes, including total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, were derived from polysomnography, valid questionnaires, or sleep diaries. Results We identified 24 articles with 5917 older adults. Eszopiclone and low-dose doxepin were ranked the optimal therapy for prolonging objective and subjective total sleep time (26.69 and 28.19 min), respectively, compared to placebo. Zaleplon was the most effective therapy in reducing objective and subjective sleep onset latency (–21.63 and –15.86 min) compared with control. Temazepam was the best treatment for objective and subjective wake after sleep onset (–25.29 and –22.25 min) compared with control. Low-dose doxepin appeared to be the effective treatment for increasing objective sleep efficiency (6.08%) Triazolam showed the higher risk of overall adverse events (odds ratio, 1.96, 95% confidence interval 1.03–3.74) when compared to zaleplon. Conclusions Considering study quality and the potential adverse effects of benzodiazepines and nonbenzodiazepines, low-dose doxepin seems to be the optimal pharmacotherapy for the improvements in total sleep time and sleep efficiency. Future RCTs investigating the treatment effects of hypnotics, particularly low-dose doxepin, on insomnia in older adults are warranted. PROSPERO Registration number: CRD42016046301.

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Differential Effects of DHA- and EPA-Rich Oils on Sleep in Healthy Young Adults: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu13010248 ◽

2021 ◽

Vol 13 (1) ◽

pp. 248

Author(s):

Michael J. Patan ◽

David O. Kennedy ◽

Cathrine Husberg ◽

Svein Olaf Hustvedt ◽

Philip C. Calder ◽

...

Keyword(s):

Sleep Quality ◽

Controlled Trial ◽

Sleep Time ◽

Sleep Efficiency ◽

Omega 3 ◽

Double Blind ◽

Differential Effects ◽

Positive Effects ◽

Time In Bed ◽

Oily Fish

Emerging evidence suggests that adequate intake of omega-3 polyunsaturated fatty acids (n-3 PUFAs), which include docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), might be associated with better sleep quality. N-3 PUFAs, which must be acquired from dietary sources, are typically consumed at suboptimal levels in Western diets. Therefore, the current placebo-controlled, double-blind, randomized trial, investigated the effects of an oil rich in either DHA or EPA on sleep quality in healthy adults who habitually consumed low amounts of oily fish. Eighty-four participants aged 25–49 years completed the 26-week intervention trial. Compared to placebo, improvements in actigraphy sleep efficiency (p = 0.030) and latency (p = 0.026) were observed following the DHA-rich oil. However, these participants also reported feeling less energetic compared to the placebo (p = 0.041), and less rested (p = 0.017), and there was a trend towards feeling less ready to perform (p = 0.075) than those given EPA-rich oil. A trend towards improved sleep efficiency was identified in the EPA-rich group compared to placebo (p = 0.087), along with a significant decrease in both total time in bed (p = 0.032) and total sleep time (p = 0.019) compared to the DHA-rich oil. No significant effects of either treatment were identified for urinary excretion of the major melatonin metabolite 6-sulfatoxymelatonin. This study was the first to demonstrate some positive effects of dietary supplementation with n-3 PUFAs in healthy adult normal sleepers, and provides novel evidence showing the differential effects of n-3 PUFA supplements rich in either DHA or EPA. Further investigation into the mechanisms underpinning these observations including the effects of n-3 PUFAs on sleep architecture are required.

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