Manual Annotation of Time in Bed Using Free-Living Recordings of Accelerometry Data

With the emergence of machine learning for the classification of sleep and other human behaviors from accelerometer data, the need for correctly annotated data is higher than ever. We present and evaluate a novel method for the manual annotation of in-bed periods in accelerometer data using the open-source software Audacity®, and we compare the method to the EEG-based sleep monitoring device Zmachine® Insight+ and self-reported sleep diaries. For evaluating the manual annotation method, we calculated the inter- and intra-rater agreement and agreement with Zmachine and sleep diaries using interclass correlation coefficients and Bland–Altman analysis. Our results showed excellent inter- and intra-rater agreement and excellent agreement with Zmachine and sleep diaries. The Bland–Altman limits of agreement were generally around ±30 min for the comparison between the manual annotation and the Zmachine timestamps for the in-bed period. Moreover, the mean bias was minuscule. We conclude that the manual annotation method presented is a viable option for annotating in-bed periods in accelerometer data, which will further qualify datasets without labeling or sleep records.

Testing an early online intervention for the treatment of disturbed sleep during the COVID-19 pandemic in self-reported good and poor sleepers (Sleep COVID-19): study protocol for a randomised controlled trial

Background Theoretical models of insomnia suggest that stressful life events, such as the COVID-19 pandemic, can cause acute insomnia (short-term disruptions to sleep). Early interventions may prevent short-term sleep problems from progressing to insomnia disorder. Although cognitive behavioural therapy for insomnia (CBT-I) is effective in treating insomnia disorder, this can be time and resource-intensive. Further, online interventions can be used to deliver treatment to a large number of individuals. The objective of this study is to investigate if an online behavioural intervention, in the form of a leaflet, which has been successfully used alongside CBT-I for acute insomnia, can reduce symptoms of acute insomnia in poor sleepers. Methods A total of 124 self-reported good and poor sleepers will be enrolled in an online stratified randomised controlled trial. After baseline assessments (T1), participants will complete a 1-week pre-intervention sleep monitoring period (T2) where they will complete daily sleep-diaries. Poor sleepers (n = 62) will be randomly allocated to an invention or wait-list group, where they will receive the intervention (T3), or will do so after a 28-day delay. Good sleepers (n = 62) will be randomly assigned to an intervention or no intervention group. All participants will complete a 1-week post intervention sleep monitoring period using daily sleep diaries (T4). Participants will be followed up at 1 week (T5), 1 month (T6) and 3 months (T7) post intervention. The primary outcome measure will be insomnia severity, measured using the Insomnia Severity Index. Secondary outcome measures will include subjective mood and subjective sleep continuity, measured using sleep diaries. Data will be analysed using an intention-to-treat approach. Discussion It is expected that this online intervention will reduce symptoms of acute insomnia in self-reported short-term poor sleepers, and will also prevent the transition to poor sleep in good sleepers. We expect that this will demonstrate the feasibility of online interventions for the treatment and prevention of acute insomnia. Specific advantages of online approaches include the low cost, ease of administration and increased availability of treatment, relative to face-to-face therapy. Trial registration ISRCTN43900695 (Prospectively registered 8th of April 2020).

Daily Stress and Sleep Associations Vary by Work Schedule: A Between- and Within-Person Analysis in Nurses

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by shift worker status and daily work schedule. 392 nurses (92% female, mean age = 39.54) completed 14 days of sleep diaries and actigraphy, plus daily assessments of stress and work schedule upon awakening. Nurses were classified as recent night shift workers if they worked 1+ night during the past 14 days. Greater daily stress predicted shorter diary sleep duration and lower diary sleep efficiency. Shorter diary and actigraphy sleep duration and lower diary sleep efficiency predicted higher next-day stress. Compared to recent night workers, day workers had higher stress after nights with shorter sleep. Associations did not vary by daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime intervention targets among nurses.

Effect of long-haul transmeridian travel on recovery and performance in international level swimmers

This study holistically examined the effects of long-haul transmeridian travel (LHTT) on physiological, perceptual, sleep and performance markers in nine international level swimmers preparing for the 2019 FINA World Long Course Championships in Gwangju, South Korea. Baseline (BL) measurements were taken over two days during the week before a long-haul eastward flight across eight time-zones. Following the flight, measurements were taken over a six-day holding camp in Japan (C1-C6), and over four days at the competition venue in Gwangju before the Championships commenced (PR1-PR4). Salivary cortisol (sCort), immunoglobulin A (sIgA), alpha-amylase (sAA) concentrations and perceptual measures via the Liverpool John Moore's University Jetlag Questionnaire were assessed. Sleep was monitored using wrist activity monitors and self-report sleep diaries. Performance was assessed via squat jump (SJ), countermovement jump (CMJ) and a 4 × 100 m swim test. Participants perceived themselves to be significantly more fatigued and jet lagged than BL for five- and nine-days post-travel, respectively. Morning sCort decreased by 70% on C1 and remained significantly lower than BL until C6 ( p < 0.05). Sleep ratings improved significantly in comparison to BL from C5 onwards ( p < 0.05). Compared with BL, there was no significant change in swim performance or SJ height following travel; however, there was a 3.8 cm improvement ( p < 0.001) in CMJ height on C5. It took ten days for elite swimmers to perceive themselves recovered from jet lag following LHTT in an eastward direction across eight time-zones. LHTT did not negatively affect sleep or physical performance in the swimmers in comparison to BL.

A direct comparison of wrist actigraphy and sleep diaries in measuring sleep in healthy adults.

Measuring sleep and sleep quality is an important diagnostic and monitoring tool, and a number of different methods for measurement have been developed over the last half-century. Two prevalent methods include wrist actigraphy and sleep diaries. Both methods can be applied in different circumstances, but both have strengths and weaknesses. This study aimed to identify the extent to which there is congruence in the scores achieved by each method of sleep measurement. Sixty-eight respondents were asked to wear a wrist actigraphy and complete a sleep diary over the course of five days. There was a significant difference between the mean scores achieved using each measurement method, with actigraphy scores indicating lower total sleep time (TST) than diaries. However, this difference was not consistently present when the scores were compared on a day by day basis. Participant adherence is likely to fluctuate over the course of a sleep study and may undermine the accuracy of sleep diaries.

Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial

Objective: An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD. Method: Fourteen adolescents (ages 13–17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up. Results: Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively. Conclusion: This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.

Polysomnography and Other Sleep Testing

Multiple methods are available for evaluating sleep concerns: clinical screening instruments, sleep diaries, polysomnography with multiple sleep latency test and maintenance of wakefulness test, and actigraphy. This chapter reviews the tools used to assess patients with sleep concerns. Screening tools such as questionnaires are used to stratify patients on the basis of their clinical characteristics and risk factors for sleep difficulties. Patients at high risk may need urgent polysomnography or further treatment.

Associations of sleep measures with neural activations accompanying fear conditioning and extinction learning and memory in trauma-exposed individuals

Study Objectives Sleep disturbances increase risk of posttraumatic stress disorder (PTSD). Sleep effects on extinction may contribute to such risk. Neural activations to fear extinction were examined in trauma-exposed participants and associated with sleep variables. Methods Individuals trauma-exposed within the past 2 years (N=126, 63 PTSD) completed 2 weeks actigraphy and sleep diaries, 3 nights ambulatory polysomnography and a 2-day fMRI protocol with Fear-Conditioning, Extinction-Learning and, 24h later, Extinction-Recall phases. Activations within the anterior cerebrum and regions of interest (ROI) were examined within the total, PTSD-diagnosed and trauma-exposed control (TEC) groups. Sleep variables were used to predict activations within groups and among total participants. Family wise error was controlled at p&lt;0.05 using nonparametric analysis with 5000 permutations. Results Initially, Fear Conditioning activated broad subcortical and cortical anterior-cerebral regions. Within-group analyses showed: (1) by end of Fear Conditioning activations decreased in TEC but not PTSD; (2) across Extinction Learning, TEC activated medial prefrontal areas associated with emotion regulation whereas PTSD did not; (3) beginning Extinction Recall, PTSD activated this emotion-regulatory region whereas TEC did not. However, the only between-group contrast reaching significance was greater activation of a hippocampal ROI in TEC at Extinction Recall. A greater number of sleep variables were associated with cortical activations in separate groups versus the entire sample and in PTSD versus TEC. Conclusions PTSD non-significantly delayed extinction learning relative to TEC possibly increasing vulnerability to pathological anxiety. The influence of sleep integrity on brain responses to threat and extinction may be greater in more symptomatic individuals.

An observational study investigating the CRY1Δ11 variant associated with delayed sleep–wake patterns and circadian metabolic output

We conducted an observational research study to collect information on sleep–wake patterns from participants with a confirmed status of the cryptochrome circadian clock 1 (CRY1) splicing variant, CRY1Δ11 c.1657 + 3A > C, and their controls, defined as wild-type (WT) family members. Altogether, 67 participants were enrolled and completed this study in Turkey, recruited from a list of families with at least one CRY1-confirmed member. We measured sleep–wake patterns and metabolic output, specifically time and frequency of bowel movements, for all participants by daily post-sleep diaries over 28 days. The sleep diary measured self-reported bed time, wake time, midpoint of sleep, and latency to persistent sleep (LPS), and accounted for naps and awakenings for religious purposes. Wake time and midpoint of sleep were significantly later in the CRY1Δ11 variant group versus WT, and LPS was significantly greater in participants in the CRY1Δ11 variant group. The mean bed time on all nights of sleep was later in participants with a CRY1Δ11 variant versus WT. Additionally, participants with a CRY1Δ11 variant had significantly affected metabolic outputs, measured by later bowel movements than WT participants. These results demonstrate that, on average, individuals with the studied splicing variant experience pronounced delays in sleep period and circadian-related metabolic processes.