Efficacy of acupuncture and its influence on the emotional network in adult insomnia patients: protocol for a randomized controlled clinical trial

Introduction Insomnia disorder (ID) is characterized by dissatisfaction with the quantity or quality of sleep and is often accompanied by negative emotions such as anxiety and depression. Patients with insomnia become trapped in a vicious circle of bad moods and poor sleep. Resting-state functional magnetic resonance imaging (r-fMRI) studies have shown abnormalities in emotion-related brain networks in patients with ID. And it has been proven that reducing negative emotions improves sleep quality. As a traditional alternative therapy, acupuncture has been demonstrated to be effective not only in improving sleep quality but also in stabilizing emotions; however, the mode of action needs to be further explored. Therefore, a clinical trial was designed to explore the effect of acupuncture in improving sleep and mood and to intuitively investigate the regulation of the emotional network using fMRI. Methods and analysis A total of 60 participants with ID will be randomly allocated to a spirit-regulating group or a control group using non-effective acupoints acupuncture at a ratio of 1:1. All participants will receive 3 acupuncture treatment sessions per week for 4 weeks. In addition, 30 healthy individuals will be included in the healthy group. The primary outcome is the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes are the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HAMD), the Hyperarousal Scale (HAS), and the Fatigue Scale-14 (FS-14), r-fMRI data, sleep diary, and actigraphy. The data will be collected prior to treatment, following treatment, and during the 12-week follow-up period; a sleep diary will be kept during the entire process. Ethics and dissemination This protocol has been approved by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine (Bejing TCM Hospital). The results will be published in peer-reviewed journals or presented at academic conferences. Trial registration Chinese Clinical Trials Register ChiCTR1800015282. Protocol version: Version 1.0. Date: Dec.2020

Epilepsy and Sleep in the ATR-X Syndrome

Background This study explores the prevalence, clinical characteristics, and treatment of epilepsy and sleep disorders in α thalassemia mental retardation (ATR-X) syndrome. Design In this cross-sectional study, 37 participants with ATR-X syndrome aged 1.8 to 44 years were studied using a customized epilepsy questionnaire, review of electroencephalography (EEG) findings, the modified Sleep Questionnaire of Simonds and Parraga and 2-week sleep diary. Results Eleven participants had a clinical diagnosis of generalized epilepsy (29.7%). Seizure types were generalized tonic-clonic seizures, absences, and myoclonia. Interictal EEG recordings in participants with GTCS showed no epileptic discharges in 78%. Similarly, EEG recordings during myoclonia and absences often demonstrated no epileptic discharges. Sleep problems (difficulty falling or maintaining sleep, and early awakening) were reported in 70%. Participants with reported sleep problems went to bed earlier (p = 0.027) and had a lower sleep efficiency (p < 0.01) than participants without sleep problems, but as a group they both had a sufficient total sleep time (9 hours and 52 minutes vs. 10 hours and 55 minutes). Sixteen participants (43.2) used medication to improve sleep (predominantly melatonin n = 10), being effective in only two. Conclusion One-third of participants with ATR-X syndrome had a clinical diagnosis of epilepsy, but the absence of EEG abnormalities in suspected epileptic seizures questions this diagnosis in these patients. EEG recording during seizure like symptoms is warranted before making an epilepsy diagnosis. Seventy percent experienced sleep problems, although total sleep time was normal in most participants. Long bedtimes might have a negative influence on sleep efficiency.

The effect of wind turbine noise on polysomnographically-measured and self-reported sleep latency in wind turbine noise naïve participants

Study Objectives Wind turbine noise exposure could potentially interfere with the initiation of sleep. However, effects on objectively assessed sleep latency are largely unknown. This study sought to assess the impact of wind turbine noise on polysomnographically-measured and sleep diary-determined sleep latency compared to control background noise alone in healthy good sleepers without habitual prior wind turbine noise exposure. Methods Twenty-three wind turbine noise naïve urban residents (mean±standard deviation age: 21.7±2.1 years, range 18-29, 13 females) attended the sleep laboratory for two polysomnography studies, one week apart. Participants were blind to noise conditions and only informed that they may or may not hear noise during each night. During the sleep onset period, participants were exposed to counterbalanced nights of wind turbine noise at 33 dB(A), the upper end of expected indoor values; or background noise alone as the control condition (23 dB(A)). Results Linear mixed model analysis revealed no differences in log10 normalized objective or subjective sleep latency between the wind turbine noise versus control nights (median [interquartile range] objective 16.5 [11.0 to 18.5] versus 16.5 [10.5 to 29.0] minutes, p = 0.401; subjective 20.0 [15.0 to 25.0] versus 15.0 [10.0 to 30.0] minutes, p = 0.907). Conclusions Although undetected small effects cannot be ruled out, these results do not support that wind turbine noise extends sleep latency in young urban dwelling individuals without prior wind turbine noise exposure.

Circadian rhythm for female entering old age: exploration on the effect of eating behavior

Unhealthy lifestyle and eating behavior are associated with circadian rhythm disruption which contributes to numerous harmful outcomes. The relationship between circadian rhythm and eating behavior remains unclear. The study aims to investigate different types of eating behavior in middle-aged women and their variation in circadian rhythm. A descriptive, cross-sectional design was used. We recruited a convenience sample of 150 female aged 45 years or over from the community in southern Taiwan. Sociodemographic status, sleep diary and eating behavior were collected by questionnaires; behavioral circadian rhythm were monitored with the wrist-worn application. Four middle-aged participants were interviewed. Preliminary data show three main findings: (1) Sleep efficiency was decrease with age, (2) First meal within 2 hours after waking up was associated with higher amplitude (2.24 vs 1.43 log count), relative amplitude (0.92 vs 0.71), middle to vigorous physical activity time (101.22 vs 58.41 minute), lower lowest active 5 hr midpoint (2.63 vs 4.34 hour) and acrophase (13.67 vs 15.75), (3) Participants with morning chronotype have less sedentary behavior and higher most active 10 hr during wake time. Age and timing of first meal after waking up seem dominating circadian rhythm. Chronotype might be a significant factor for physical activity level. More data is needed to further confirm the association.

Prevalence of Uncoupled Sleep and Dysfunctional Sleep Beliefs in a Sample of Community-Dwelling Older Adults in Western Australia: A Cross-Sectional Study

Objectives: Individuals who complain of insomnia may not always have objectively measured poor sleep, and vice versa, a phenomenon which is referred to as uncoupled sleepers. This study assessed the prevalence of uncoupled sleepers and levels of dysfunctional sleep beliefs in a sample of older adults in Western Australia.Method: 80 adults aged 60-80 years (71 females, 89%) completed a questionnaire, sleep diary and actigraphy measurements. Sleep related dysfunctional beliefs and self-rated sleep quality were assessed using the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16). Objective sleep quality was measured using an ActigraphTM model wGT3X-BT activity monitor and subjective sleep quality was assessed using a modified version of the Consensus Sleep Diary.Results: 52 of 80 participants (65%) were uncoupled sleepers. Individuals who complained of insomnia in the absence of objectively measured poor sleep showed worse self-reported sleep outcomes and higher dysfunctional beliefs, even though on actigraphy measurements there were no significant differences. Discussion: Future research should examine subjective and objective sleep parameters in older individuals. Interindividual differences in the relationship between perceived and measured sleep quality could present a target for potential therapeutic intervention.Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451

Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care

Suicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.

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 Recent Job Loss on Sleep, Energy Consumption and Diet

To examine how sleep quality and sleep duration affect caloric intake among those experiencing involuntary job loss. Methods Adequate sleep and self-reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analyzed. Primary sleep indices used were total sleep time, time spent in bed after final awakening, and sleep quality as measured by the Daily Sleep Diary (DSD). Mean Energy consumption (MEC) was the primary nutritional index. Secondary indices included diet quality using the Health Eating Index 2015 (HEI), and self-reported intake of protein, carbohydrates and fats. Results The study participants were comprised mainly of women (61%) and non-Hispanic white. The participants had at least 2 years of college education and mean body mass index of 30.2±8.08 (kg/m 2 (). The average time in bed was 541.8 (9 hrs) ±77.55 minutes and total sleep time was 461.1 (7.7 hrs) ±56.49 minutes. Mean sleep efficiency was 91±6%, self-reported sleep quality was 2.40±0.57 (0-4 scale, 4 = very good), and minutes earlier than planned morning awakening were 14.36±24.15. Mean HEI score was 47.41±10.92. Although the MEC was below national average for both men and women, male sex was associated with higher MEC. In a fully adjusted model sleep quality was positively associated with MEC. Conclusion Daily overall assessments of sleep quality among recently unemployed persons were positively associated with mean energy consumption. Additionally, the diet quality of unemployed persons was found to unhealthier than the average American and consistent with the relationship between poor socioeconomic status and lower diet quality.

How do occupants rate bedroom air quality?

Poor air quality has been shown to reduce sleep quality. There is a limited number of studies reporting how occupants rate the air quality in their bedrooms. The present study sheds the light on this issue. It was conducted in actual bedrooms and asked occupants to rate air quality once awake in the morning using an online sleep diary. The study was done in Denmark during the heating season. 178 responses from 82 subjects were received. Nearly all respondents rated air quality as acceptable. 28% indicated that the air was stuffy. Measuring CO2 and description of bedrooms would help to explain these results. They are analysed at the moment and will be reported in the subsequent papers.

Genetic and Environmental Influences on Sleep-Wake Behaviours in Adolescence

Study Objectives To investigate the influence of genetic and environmental factors on sleep-wake behaviours across adolescence. Methods Four hundred and ninety-five participants (aged 9 to 17; 55% females), including 93 monozygotic (MZ) and 117 dizygotic (DZ) twin pairs, and 75 unmatched twins, wore an accelerometry device and completed a sleep diary for two weeks. Results Individual differences in sleep onset, wake time, and sleep midpoint were influenced by both additive genetic (44-50% of total variance) and shared environmental (31-42%) factors, with a predominant genetic influence for sleep duration (62%) and restorative sleep (43%). When stratified into younger (aged 9-14) and older (aged 16-17) subsamples, genetic sources were more prominent in older adolescents. The moderate correlation between sleep duration and midpoint (rP = -.43, rG = .54) was attributable to a common genetic source. Sleep-wake behaviours on school and non-school nights were correlated (rP = .44-.72) and influenced by the same genetic and shared environmental factors. Genetic sources specific to night-type were also identified, for all behaviours except restorative sleep. Conclusions There were strong genetic influences on sleep-wake phenotypes, particularly on sleep timing, in adolescence. Moreover, there may be common genetic influences underlying both sleep and circadian rhythms. The differences in sleep-wake behaviours on school and non-school nights could be attributable to genetic factors involved in reactivity to environmental context.