Cognitive Performance Trajectories Before and After Sleep Treatment Initiation in Middle-Aged and Older Adults: Results from the Health and Retirement Study

BACKGROUND Sleep disturbances are associated with risk of cognitive decline but it is not clear if treating disturbed sleep mitigates decline. We examined differences in cognitive trajectories before and after sleep treatment initiation. METHODS Data came from the 2006-2014 Health and Retirement Study. At each of five waves, participants were administered cognitive assessments and scores were summed. Participants also reported if, in prior two weeks, they had taken medications or used other treatments to improve sleep. Our sample (N=3,957) included individuals who at HRS 2006 were >50 years, had no cognitive impairment, reported no sleep treatment, and indicated experiencing sleep disturbance. We identified differences between those receiving vs. not receiving treatment in subsequent waves, and among those treated (N=1,247), compared cognitive trajectories before and after treatment. RESULTS At baseline, those reporting sleep treatment at subsequent waves were more likely to be younger, female, Caucasian, to have more health conditions, to have higher BMI, and more depressive symptoms (all p’s≤0.015). Decline in cognitive performance was mitigated in periods after sleep treatment vs. periods before (B=-0.20, 95% CI=-0.25, -0.15, p<0.001; vs., B=-0.26, 95% CI=-0.32, -0.20, p<0.001), and this same trend was seen for self-initiated and doctor-recommended treatments. Trends were driven by those with higher baseline cognitive performance—those with lower performance saw cognitive declines following sleep treatment. CONCLUSIONS In middle-aged and older adults with sleep disturbance, starting sleep treatment may slow cognitive decline. Future research should assess types, combinations, and timing of treatments most effective in improving cognitive health in later life.

The treatment of sleep problems in autistic adults in the United Kingdom

Sleep problems are one of the most common complaints in autistic adults. This study aimed to report the perspectives of autistic adults in the United Kingdom on treatment of their sleep problems. A total of 288 autistic adults living in the United Kingdom completed an online survey including assessments of their sleep quality using the Pittsburgh Sleep Quality Index, reporting their experiences and preferences of sleep treatment with UK healthcare professionals and, their experiences of self-management of their sleep. Self-report data revealed 58% of participants had not attended a consultation with a healthcare professional regarding their sleep problem despite 90% meeting the criteria for poor sleep quality (based on the Pittsburgh Sleep Quality Index). Of the participants who attended a consultation for their sleep, 72% were prescribed medication and 60% were not satisfied with the outcome. Self-management of sleep problems was not effective for 80% of participants; 41% reported a preference for non-medication options such as education, advice and talking therapies for sleep treatment. This report highlights the need for a fundamental shift in the consideration of sleep problems in autistic adults given the high levels of co-morbidity. The development of successful management strategies in adulthood that importantly considering autistic adults’ preferences could reduce sleep problems and overall improve quality of life for autistic adults. Long term this could also reduce the need for prescribed medication in this population. Lay abstract Sleep problems are one of the most common complaints by autistic adults. This study aimed to report the perspectives of autistic adults on treatment of their sleep problems; 288 autistic adults living in the United Kingdom completed an online survey which assessed their sleep quality. We also gathered data on experiences and preferences of sleep treatment with UK healthcare professionals and their experiences of self-management of their sleep; 58% of autistic adults never had a visit with a healthcare professional regarding their sleep problem, despite 90% meeting the criteria for poor sleep quality. Some of those who attended a consultation for their sleep were prescribed medication (72%), but 60% were not satisfied with the outcome. The participants also reported that sleep self-management was not effective (80%); 41% reported a preference for non-medication including education, advice and talking therapies for sleep treatment. This report highlights the need for a fundamental shift in treatment of sleep problems in autistic adults. The current treatments are not resolving sleep issues; hence, it is imperative to develop management strategies that considers autistic adults’ preferences, reduces sleep problems and thus improves quality of life for autistic adults.

Sleep Treatment Improves Neuropsychological Symptoms and Reduces Blood Aβ42/pTau Protein in Alzheimer's Disease Patients: a Longitudinal Study

The authors have requested that this preprint be withdrawn due to a need to make corrections.

Sleep Treatment Improves Neuropsychological Symptoms and Reduces Blood Aβ42/pTau Protein in Alzheimer's Disease Patients: a Longitudinal Study

Background: Amyloid β peptide-42 (Aβ42) and phosphorylated Tau on Threonine 181 (Tau-pT181) are the core biomarkers in Alzheimer’s disease. Accumulated evidence showed an aberrant elevation of these biomarkers due to sleep disturbance. However, it is not clear if improving sleep quality reduces Aβ42 and Tau-pT181 in Alzheimer’s disease patients.Methods: A longitudinal study was conducted on 126 patients with mild-moderate dementia due to Alzheimer’s disease. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Behavioral and neuropsychological assessment was conducted using multiple self-reporting questionnaire score systems. Aβ42 and Tau-pT181 levels in blood specimens were measured using an ELISA assay kit. All patients received Donepezil treatment for Alzheimer’s disease. Sleep disorders were individually managed with either medication or physical therapy according to their symptom categories.Results: Of the 126 cases, 93 (73.8%) patients were diagnosed with sleep disorders. The PSQI scores significantly correlated with depression and anxiety scores, as well as Aβ42 and Tau-pT181 levels. Also, a significant correlation was found among depression, anxiety, Aβ42 and Tau-pT181 in all patients. Sleep intervention drastically reduced PSQI score, as well as Aβ42 and Tau-pT181 levels, in parallel with improved cognition, deterioration and anxiety scores. Dementia and depression scores were improved only in patients who completely recovered (PSQI < 7) after sleep treatment. There was a 35.9% reduction of Aβ42 levels and a 32.8% reduction of Tau-pT181 levels in this subgroup of patients (56 cases). Conversely, the reduction extent was only 6.9% for Aβ42 and 12.2% for Tau-pT181 in patients who did not completely recover (PSQI ≥ 7 post treatment, 37 cases). Multiple logistic regression analysis revealed that Aβ42 level is the strongest risk factor for sleep disorder incidence and incomplete recovery after sleep treatment.Conclusion: Sleep quality score is associated with patient depression and anxiety status, as well as blood Aβ42 and Tau-pT181 levels. A complete recovery is critical for a full improvement of all behavioral and neuropsychological assessments, which is also associated with a deep reduction of Aβ42 and Tau-pT181 levels. Aβ42 level is a prognostic factor for a diagnosis of sleep disorder and treatment responsiveness.

Online cognitive behavioral group therapy (iCBT-I) for insomnia for school children and their parents

Background Due to the SARS-CoV‑2 crisis, online adaptation of sleep trainings is necessary. As sleep disturbances in school children are common, prevention of chronification is essential. The aim of this study was to adapt an established age-oriented cognitive behavioral therapy for insomnia (CBT-I) group training for 5–10-year-old children with insomnia and their parents to an online version (group iCBT-I). Methods The adaptation procedure and structure of the iCBT‑I are described. To assess acceptance the Online Sleep Treatment Acceptance questionnaire (OSTA) and the Online Sleep Treatment Feedback questionnaire (OSTF) were implemented. In addition, trainers filled in the Adherence and Feasibility Questionnaire for Online Sleep Treatment (AFOST). Sleep problems were assessed using a structured interview for sleep disorders in children and clinical interview, and the Children’s Sleep Habit Questionnaire (CSHQ-DE). Emotional problems were evaluated with the Child Behavior Checklist (CBCL 4-18). Results This pilot study included 12 parents and 6 children fulfilling insomnia criteria prior to online training. The adapted online version consisted of three parental sessions, whereas child-oriented sessions were transferred into videoclips. The new group iCBT‑I was well accepted by parents. Parents scored the online version as helpful and time saving based on the OSTA and trainers estimated the adapted version to be feasible and effective. According to AFOST, adherence was given. After training, 67% of children showed reduced sleep problems according to parental rating. Conclusion Parental acceptance of a group iCBT‑I for school children and their parents was very good and parents scored the videos for their children as very helpful. Trainers declared the adapted version to be feasible. A further study with a larger sample is necessary.

Sebuah Analisis Tingkat Stres dan Performansi serta Hubungannya pada Kecepatan Respon dan Jumlah Kesalahan Pengemudi Mobil Pribadi di Bandung

Driving involve activities some components including drivers, vehicles, passenger, roads, and the surrounding environment that interact with each other. Based on the website Badan Intelegensi Negara (BIN), it is said that one of the main causes of traffic accidents is the diver’s negligence. Data of Polrestabes Bandung City for the February 2014 to February 2015 showed that the rate of accidents, especially personal cars, had fluctuated. The driver factor that is the cause of the accident is most likely due to fatigue. The risk of work fatigue is on of them is stress. The impact of stress can disrupt driving performance arising from negative moods. Aim of this study was to analyze the stress and performance levels of driver personal car using salivary alpha amylase and stroop test parameters. The results of the study for sleep adequate treatment and lack of sleep treatment before and after simulation on stress levels (p-value (sig.) > α, 0,174; 0,351 > 0,05) and performance levels (p-value (sig.) > α, 0,546; 0,904 > 0,05) showed a significant distinction. While for stress level (p-value (sig.) > α, 0,365 > 0,05) about adequate sleep and lack of sleep treatment before and after simulation showed a significant distinction and performance level (p-value (sig.) > α, 0,915 > 0,05) showed a significant distinction. The coefitient correlation between stress level and performance level are 0.4, which mean there is strong correlation between stress level and performance level.

COGNITIVE TRAJECTORIES BEFORE AND AFTER SLEEP TREATMENT INITIATION IN U.S. OLDER ADULTS WITH SLEEP DISTURBANCE

Sleep disturbances are associated with cognitive decline but it is not clear if initiation of sleep treatments mitigates decline. We used the 2006-2014 Health and Retirement Study. At each wave, participants were administered cognitive assessments and scores were summed (values=0-35; higher=better cognition). All participants also reported if, in the past two weeks, they had taken medications or used other treatments to improve sleep. Our sample (N=4,650) included individuals who at baseline were cognitively normal and untreated for sleep, and at any wave reported some sleep disturbance. We characterized cognitive performance over study period with comparisons before and after sleep treatment initiation. Between 2006-2014, participants exhibited declines in cognitive performance (B=-2.40; 95% CI=-2.73, -2.06; p&lt;0.001) after controlling for confounders. Following sleep treatment, cognitive decline became less pronounced (interaction B=0.94; 95% CI=0.21, 1.67; p=0.013). Results suggest that in older adults with sleep disturbance, initiation of sleep treatment may slow cognitive decline.

SLOW WAVE SLEEP AND PAIN AFTER BEHAVIORAL INSOMNIA TREATMENT IN ADULTS OVER AGE 50 WITH KNEE OSTEOARTHRITIS

Sleep disturbance can aggravate pain, and we recently found that insomnia treatment improved osteoarthritis (OA) pain, lowered inflammation, and improved quality of life in middle-to-older aged adults. Inadequate slow wave sleep (SWS), known as deep or restorative sleep, can decline with aging and is linked to pain and inflammation. We examined how insomnia treatment affects SWS, and the relationship between SWS and pain. In a pilot trial, 33 adults, ages 51 to 74 years with OA-related knee pain and insomnia, were randomized to 6-session CBTi (n=16) or a weekly phone contact control group (n=17). The CBT-I group showed significantly more laboratory-measured SWS across a study night than controls after controlling for baseline SWS. Greater SWS intensity was associated with lower OA-related pain among the CBT-I group, but not among controls. These preliminary data suggest that behavioral sleep treatment may strengthen the beneficial influence of restorative sleep on pain.