Sleep and Biological Rhythms

Revisit epoch duration for sake of patient-friendly sleep studies

Significance of early morning insomnia for keeping the work continuity of shift workers

Relationship with excessive daytime sleepiness and serum substance P levels in OSAS patients and the effect of PAP treatment Abstract Obstructive sleep apnea syndrome (OSAS) is a commonly seen disorder characterized by repeated episodes of upper airway obstruction during sleep leading to intermittent hypoxemia or arousal. We aim to evaluate the effects of positive airway pressure (PAP) treatment on daytime sleepiness and serum Substance P (SP) levels in OSAS patients. Seventy-one consecutive patients with newly diagnosed OSAS and 19 non-apneic control subjects were enrolled to the study. PAP treatment indicated subjects were re-evaluated after 3 months of treatment. Morning SP levels of OSAS patients and Epworth sleepiness scale (ESS) were assessed at the beginning and then after 3 months of PAP treatment. Of the patients 71 (78.9%) were male and 19 (21.1%) were female, with a median age of 45 [20–62]. The levels of SP in the OSAS group were significantly lower than the snorer group and a significant correlation was not found between serum levels of SP and ESS. SP levels were negatively correlated with AHI. The baseline SP median was 336.1 pg/mL [121.6–536.1], while the 3rd month SP median was 213.1 pg/mL [103.5–727.6]. Serum SP values were found to have significantly decreased at 3 months (p < 0.0001). Statistically significant correlation was not found between percentage of ESS change and the percentage of SP change. It can be assumed that the SP level is reduced as part of the compensation mechanism in OSAS cases and supporting this mechanism, the PAP therapy further reduces the SP value by relieving the cases from apnea and the intermittent hypoxia burden.

The effects of chronotype and social jetlag on medical students Abstract The aim of our study is (1) to identify chronotypes and social jetlag of Korean medical students and (2) to investigate the effect of chronotypes and social jetlag on sleep, quality of life (QoL), and academic performance of medical students. The final sample consisted of 424 students of a single medical school, assessed by 8 questionnaires: demographic questionnaire, Morningness–Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Short Form (SF)-8 health survey, Warwick–Edinburgh Mental Well-Being Scale (WEMWBS), and Beck Depression Index (BDI)-2. Eight (1.9%) were "morning type (MT)", 247 (58.3%) were "intermediate type (IT)", and 169 (39.9%) were "evening-type (ET)". The social jetlag of the ET group was longest (1.75 h) compared to the other groups. In the ET group, social jetlag of medical course (MC, 4 years) was significantly longer than in pre-med course (PM, 2 years). Curriculum changes from PM to MC and chronotypes show interactions in bedtime during weekend and subjective sleep quality/sleep latency subscore of PSQI. In the MT + IT group, compared with pre-med students, the top 25% of academic performance in medical school students significantly increased (19.7% vs. 30.2%), while the ET group did not show such a difference. The chronotype was related to social jetlag, sleep quality, daytime sleepiness, and academic performance of medical students. ET students are more vulnerable to lower sleep quality to curriculum change from PM to MC.

Psychometric properties of Youth Self-Rating Insomnia Scale (YSIS) in Chinese adolescents Abstract Insomnia is prevalent in adolescents. Although several insomnia scales/questionnaires are available to assess insomnia symptoms and severity for adults, no insomnia scale has been specifically developed for adolescents. This study assessed the psychometric properties of the Youth Self-Rating Insomnia Scale (YSIS) in a large sample of Chinese adolescents. The YSIS consists of 8 items assessing insomnia symptoms, perceived sleep quality and insufficiency, and impaired daytime functioning. Each item is rated on a 5-point scale. A sample of 11,626 adolescents in China completed the YSIS and a structured questionnaire to assess sleep duration, sleep problems, hypnotic use, and behavioral/emotional problems. A subsample of 242 adolescents completed retest questionnaire 2 weeks later. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a receiver operating characteristic (ROC) curve analysis were performed. The YSIS score ranged from 8 to 40 (M = 19.1, SD= 6.2). Internal consistency reliability coefficient was 0.80 and 2-week test–retest reliability coefficient was 0.82. Both EFA and CFA yielded 2 dominant factors defined as insomnia symptoms (3 items) and daytime distress or impairment (5 items). The YSIS score was significantly correlated with short nocturnal sleep duration, depression, hypnotic use, sleep disordered breathing problems, restless legs syndrome, and daytime sleepiness. Similar results were obtained between male and female adolescents. The YSIS appears to be a simple, reliable and valid scale for assessing insomnia severity in adolescents. Further research is warranted to assess its psychometric properties with clinical samples and non-Chinese adolescents.

Evaluation of the feasibility and preference of Nox-A1 type 2 ambulatory device for unattended home sleep test: a randomized crossover study Abstract There is an increasing need for portable sleep monitoring in clinical practice, but there is no comparative study that used the same device for home and in-laboratory sleep monitoring and device close to full polysomnography (PSG) to evaluate the feasibility and preference of home unattended sleep monitoring. Twenty male participants with high risk for moderate to severe OSA based on the STOP-BANG questionnaire were included. The participants were randomly assigned to group A (home unattended monitoring after in-laboratory monitoring) or group B (in-laboratory monitoring after home unattended monitoring). A 2-week washout period was implemented between the sleep tests. All hook-up procedures were performed in laboratory. Participants were asked to complete a questionnaire after finishing each sleep test. There was no difference in sleep efficiency, arousal index, or time spent in each sleep stage between the two monitoring modes using Nox-A1. Additionally, other respiratory parameters such as apnea–hypopnea index (AHI), supine AHI, and snoring time did not differ. A high and similar sensor quality for airflow, oxygen, and respiratory effort was observed in both monitoring groups. Patient's feelings and satisfaction with the test were similar between in-laboratory and home monitoring, but preference rate for the in-laboratory test was higher than that for home monitoring (70% vs. 30%, respectively). These data suggest that home unattended monitoring with Nox-A1 type 2 ambulatory device is a feasible alternative diagnostic mode for high risk of moderate to severe OSA, yielding reliable quality recordings and high patient satisfaction.

Treatment effect of cognitive-behavior therapy for insomnia combined with usual medication Abstract While the efficacy of cognitive behavior therapy for insomnia (CBT-I) has been established with well-controlled studies, its effectiveness in typical clinical practice remains to be determined. We examined the effect of CBT-I combined with usual medication on night-time sleep, daytime functioning, and the discontinuation of hypnotic drugs. The study recruited 103 patients with insomnia, who were divided into three groups: CBT-I only (CBT-I, N = 30), CBT-I combined with usual medication (COM, N = 48), and usual medication only (TAU, N = 25). A six-session CBT-I program was delivered in the CBT and COM groups, and patients in the COM and TAU groups continued to take the medication prescribed by their physicians. All groups showed significant improvements in the Insomnia Severity Inventory. The CBT-I and COM groups showed significant improvements on two subscales (vitality and physical role functioning) of the 36-item Short Form Health Survey. There was no significant improvement in the daytime functioning of the TAU group. Moreover, significantly more participants in the COM group discontinued their use of hypnotics. CBT-I in addition to regular medication is an effective treatment option in clinical settings. It can improve not only night-time sleep, but also daytime functioning. Furthermore, it can be helpful in facilitating the discontinuation of medication. Our results support the utility of CBT-I in clinical settings, and it can be integrated into the patients' usual treatment protocol.

Effect of sleep environment of preschool children on children's sleep problems and mothers' mental health Abstract We evaluated the sleep environment factors that influence children's sleep, and the relationship between co-sleeping and parenting stress and parents' mental health. A survey was conducted in 115 parents of preschool children and a total of 60 questionnaires completed for children aged 12–84 months were analyzed. The mother's mental health was evaluated using the Insomnia Severity Index (ISI), the Korean-Parenting Stress Index-Short Form (K-PSI-SF), and the Patient Health Questionnaire-9 (PHQ-9). The children's sleeping environment and quality were assessed using the Child Sleep Habit Questionnaire (CSHQ) and a sleep environment survey. Children were 28 males and 32 females, with a mean age of 48 ± 20 months. The high score of K-PSI-SF was significantly correlated with the frequency of a child sharing a bed with other children, and Difficult Child subcategory was correlated with the frequency of a child sharing a room with other children or sleeping in a too bright place. The high CSHQ score was correlated with the high K-PSI-SF score, mother's young age and high PHQ-9 score. In the path analysis, sleeping in the same space with parents can induce sleep problems in the child, resulting in the mother perceiving the child's behavior as difficult. Also, the mother perceiving her child as difficult was found to correlate with the mother's insomnia. Our study suggests that sleeping problems occur more often in preschool children co-sleeping with parents than in children sleeping alone. The mother's parenting stress is likely to be related to the children's sleeping problems and their sleep environment.

Predictors of objectively measured snoring in a working population Abstract Although there have been many epidemiological studies of snoring, most did not assess snoring objectively. The aim of this study was to identify predictive factors for snoring measured objectively in a working population in Japan. We used IC recorders for the overnight tracheal sound monitoring of 191 employees of two facilities for two nights. Snoring was characterized by two variables: snoring time (%ST) as a percentage of recording time, and the mean tracheal sound energy during recording time (Leq, the equivalent sound pressure level). After excluding those with insufficient data, 172 subjects were included in the final analysis [124 men; age, 44.3 ± 9.9 years; body mass index (BMI), 22.9 ± 3.7 kg/m2]. Relationships between the two snoring variables and age, sex, BMI, drinking, smoking, and night nasal congestion were evaluated, and the predictors of snoring were identified using multiple regression analysis with %ST and Leq as the dependent variables. The mean values of %ST and Leq were 7.4 ± 7.4% and 102.1 ± 5.2 dB, respectively. Multiple regression analysis revealed that BMI (p < 0.001), night nasal congestion (p = 0.007), habitual drinking (p = 0.014) were significant predictors of %ST and that being male (p < 0.001) and BMI (p = 0.007) were significant predictors of Leq. These results suggested that being male, obesity, habitual alcohol consumption, and night nasal congestion are predictors of objectively measured snoring in a working population.

Brief behavioral treatment for insomnia in older adults with late-life treatment-resistant depression and insomnia: a pilot study Abstract Brief behavioral treatment for insomnia (BBTI) is an efficacious treatment of insomnia in older adults. Behavioral treatments for insomnia can also improve depression. However, it is unknown if BBTI is feasible or has an effect in patients with insomnia and late-life treatment-resistant depression (LLTRD). The aims of this study were twofold: to test (1) the feasibility (defined by acceptability and retention rates) of BBTI and (2) the therapeutic potency of BBTI on symptoms of insomnia and depression. Eleven older Veterans with LLTRD and insomnia were recruited in a randomized control trial to receive immediate (4 weeks of BBTI followed by 3 weeks of phone call check-ins and a final in-person 8-week assessment) or delayed [3 weeks of treatment as usual (wait-list control) followed by 4 weeks of BBTI and a final in-person 8-week assessment] BBTI. The primary outcome measures included the Patient Health Questionnaire (minus the sleep item) and the Insomnia Severity Index. BBTI was found to be feasible in older Veterans with insomnia and LLTRD; all participants recommended BBTI and retention rates were 90.9%. There was no difference in treatment effect between the immediate BBTI and delayed BBTI groups at week 4. After both groups (immediate and delayed) received BBTI, improvements were seen in both insomnia (d = 1.06) and depression (d = 0.54) scores. BBTI is a feasible treatment for insomnia in older adults with LLTRD. BBTI may be an effective adjunctive treatment for depression. Larger adequately powered trials are required to confirm these preliminary findings.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
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6948891480

alsfakia@gmail.com