16:51
Characterizing Pediatric Inpatient Sleep Duration and Disruptions
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Publication date: Available online 31 January 2019
Source: Sleep Medicine
Author(s): Amarachi I. Erondu, Nicola M. Orlov, Leah B. Peirce, Samantha L. Anderson, Michael Chamberlain, Kelsey Hopkins, Christopher Lyttle, David Gozal, Vineet M. Arora
Abstract
Objective
To contextualize inpatient sleep duration and disruptions in a general pediatric hospital ward by comparing in-hospital and at-home sleep durations to recommended guidelines and objectively measure nighttime room entries.
Methods
Caregivers of patients 4 weeks - 18 years of age reported patient sleep duration and disruptions in anonymous surveys. Average at-home and in-hospital sleep durations were compared to National Sleep Foundation recommendations. Objective nighttime traffic was evaluated as the average number of room entries between 11:00pm and 7:00am using GOJO hand-hygiene room entry data.
Results
Among 246 patients, patients slept less in the hospital than at home with newborn and infant cohorts experiencing 7- and 4-hour sleep deficits respectively (Newborn: 787 ± 318 min at home vs. 354 ± 211 min in hospital, p<0.001; Infants: 530 ± 115 min at home vs. 412 ± 152 min in hospital, p<0.01). Newborn children also experienced >2 hour sleep deficits at home when compared to NSF recommendations (Newborns: 787 ± 318 min at home vs. 930 min recommended, p< 0.05). Objective nighttime traffic measures revealed that hospitalized children experienced 10 room entries/night (10 ± 5.9 entries). Nighttime traffic was significantly correlated with caregiver-reported nighttime awakenings (Spearman Rank Correlation Coefficient: 0.58, p=.04).
Conclusion
Hospitalization is a missed opportunity to improve sleep both in the hospital and at home.
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16:51
Insomnia Treatment Response as a Function of Objectively Measured Sleep Duration
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Publication date: Available online 31 January 2019
Source: Sleep Medicine
Author(s): Amélie Rochefort, Denise C. Jarrin, Lynda Bélanger, Hans Ivers, Charles M. Morin
Abstract
Objectives
To examine the potential moderating effect of objectively measured sleep duration at baseline on the response to cognitive behavioral therapy for insomnia (CBT-I), administered singly or combined with medication (CBT-I+Med).
Methods
Based on the average PSG-derived sleep duration across two baseline nights and the type of treatment received, 159 adults with insomnia (50.3 ± 10.1 years; 61.0% women) were classified into one of four groups: participants with short sleep duration (i.e., ≤ 6h) treated with CBT-I (n = 26) or CBT-I+Med (n = 25), and participants with normal sleep duration (i.e., > 6h) treated with CBT-I (n = 54) or CBT-I+Med (n = 54). Primary outcome measures were sleep/wake parameters derived from a sleep diary and insomnia severity and secondary outcomes were beliefs about sleep, fatigue, depression and anxiety.
Results
Patients with both short and normal sleep durations at baseline improved significantly on most sleep continuity parameters with CBT-I administered singly or combined with medication. Irrespective of treatment received, participants with short sleep duration also showed significantly greater improvements in subjective sleep (i.e., reduced wake after sleep onset, increased sleep efficiency) relative to those with normal sleep duration. Conversely, participants with normal sleep duration showed greater improvements on some measures of daytime functioning and sleep satisfaction.
Conclusions
There was no moderating effect of baseline sleep duration on treatment response to cognitive behavioral therapy. Despite some marginal differential treatment response on selected daytime functioning outcomes, the benefits from CBT-I were not significantly different as a function of short or normal sleep duration at baseline. Further prospective investigation of insomnia phenotypes taking into account other variables than sleep duration is warranted in order to develop more targeted insomnia therapies.
Trial registration
www.clinicaltrials.gov (#NCT 00042146)
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Thu Jan 31, 2019 12:40
Association of change in physical activity and sleep complaints: Results from a 6-year longitudinal study with Swedish health care workers
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Publication date: Available online 31 January 2019
Source: Sleep Medicine
Author(s): Markus Gerber, Mats Börjesson, Ingibjörg H. Jonsdottir, Magnus Lindwall
Abstract
Objective
To increase our understanding of patterns of change in physical activity and sleep complaints and to test whether intra-individual changes in physical activity are correlated with intra-individual changes in sleep complaints across four measurement time-points over six years, adopting both a between-person and within-person perspective.
Methods
Data from a longitudinal cohort study were used in this research. At baseline, 3187 participants took part in the study (86% women, Mage=46.9 years). The response rate was 84% (n=3136) after two years, 60% (n=2232) after four years, and 40% (n=1498) after six years. Physical activity was assessed with the [51] widely used 4-level physical activity scale (SGPALS), and sleep complaints, with three items from the Karolinska Sleep Questionnaire (KSQ). Patterns and correlations of change between physical activity and sleep complaints were examined with latent growth curve modeling.
Results
Changes in physical activity were associated with changes in sleep complaints across the six years. More specifically, significant associations occurred between baseline levels, correlated (between-person) change, and coupled (within-person change). These associations indicate that higher physical activity levels are not only cross-sectionally linked with fewer sleep complaints, but that increases in physical activity over time (either in comparison to others or to oneself) are paralleled by decreases in sleep complaints.
Conclusions
Given that changes in physical activity and sleep are correlated, our findings indicate that it is both worthwhile to initiate more physically active lifestyles in physically inactive individuals and to ensure that those who are already physically active maintain their physical activity levels over longer periods.
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Continuous positive airway pressure alters brain microstructure and perfusion patterns in patients with obstructive sleep apnea
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Publication date: Available online 31 January 2019
Source: Sleep Medicine
Author(s): Hillel S. Maresky, Isaac Shpirer, Miriam M. Klar, Max Levitt, Efrat Sasson, Sigal Tal
Abstract
Objectives
To assess the effects of continuous positive airway pressure (CPAP) treatment on brain structure and function in patients with obstructive sleep apnea (OSA).
Methods
A prospective study of seven OSA patients recruited from the sleep center at our institution was carried out. Patients were treated with 6 weeks of CPAP treatment. Pre-treatment and post-treatment magnetic resonance imaging (MRI) perfusion scans were obtained and compared to assess for treatment-induced changes. Microstructural changes were quantified using functional anistrophy (FA) and mean diffusivity (MD), and brain perfusion was quantified using cerebral blood flow (CBF) and cerebral blood volume (CBV).
Results
Of the seven patients included the in study, six (85.7%) were male, and the mean age of the study population was 51 years (standard deviation = 13.14). Increased FA and decreased MD were found in the hippocampus, temporal lobes, fusiform gyrus, and occipital lobes. Decreased FA and increased MD were found in frontal regions for all patients (p<0.05). Increased CBF and CBV were also observed following treatment (p<0.05).
Conclusion
In addition to symptom resolution, CPAP treatment may allow for healing of OSA-induced brain damage as seen by restoration of brain structure and perfusion.
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Thu Jan 31, 2019 12:40
Postpartum fatigue, daytime sleepiness, and psychomotor vigilance are modifiable through a brief residential early parenting program
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Publication date: Available online 31 January 2019
Source: Sleep Medicine
Author(s): Nathan Wilson, Karen Wynter, Clare Anderson, Shantha.M.W. Rajaratnam, Jane Fisher, Bei Bei
Abstract
Objective
/Background: In the months after childbirth, women are vulnerable to sleep disturbances and sleep-related deficits in functioning, such as fatigue, daytime sleepiness, and attentional lapses. Currently there is limited evidence that these deficits are modifiable. Using both self-report and objective measures, this study examined changes in sleep-related daytime functioning among women attending a residential early parenting program for assistance with unsettled infant behavior and mild to moderate postpartum distress.
Methods
Participants were 78 women (age M=34.16, SD=4.16 years) attending a 5-day program with their infants (age M=8.67, SD=4.82 months). Sleep was assessed via self-report. Sleep-related daytime functioning was operationalized as fatigue, sleepiness, and sustained attention, and measured using validated questionnaires (all women) and the 10-min visual Psychomotor Vigilance Test (PVT; subgroup of 47 women). All measures were administered on both admission (baseline) and discharge.
Results
On admission, participants reported elevated sleep disturbance (94%), fatigue (91%), as well as trait (54%) and state (67%) sleepiness. From admission to discharge, there were medium effect size reductions in fatigue and sleepiness, and large effect size improvements in sleep quality related domains such as increased sleep efficiency and reduced nighttime awakenings (all p<.001); changes in total sleep time were nonsignificant (p=.22). PVT reciprocal mean reaction times were also significantly faster (p=.001; medium effect size).
Conclusions
This study demonstrated that among women attending a brief residential early parenting program, fatigue, daytime sleepiness, and objectively measured psychomotor vigilance can be improved. Implications for further research and potential treatments are discussed.
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Thu Jan 31, 2019 12:40
Poor sleep quality and lipid profile in a rural cohort (The Baependi Heart Study)
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Publication date: Available online 30 January 2019
Source: Sleep Medicine
Author(s): Glaucylara Reis Geovanini, Geraldo Lorenzi-Filho, Lilian K. de Paula, Camila Maciel Oliveira, Rafael de Oliveira Alvim, Felipe Beijamini, André Brooking Negrão, Malcolm von Schantz, Kristen L. Knutson, José Eduardo Krieger, Alexandre Costa Pereira
Abstract
Aim
To test the association between cardiometabolic risk factors and subjective sleep quality assessed by the Pittsburgh sleep quality index (PSQI), independent of obstructive sleep apnea (OSA) and sleep duration.
Methods
A total of 573 participants from the Baependi Heart Study, a rural cohort from Brazil, completed sleep questionnaires and underwent polygraphy for OSA evaluation. Multivariable linear regression analysis tested the association between cardiovascular risk factors (outcome variables) and sleep quality measured by PSQI, adjusting for OSA and other potential confounders (age, sex, race, salary/wage, education, marital status, alcohol intake, obesity, smoking, hypertension, and sleep duration).
Results
The sample mean age was 43±16 years, 66% were female, and mean body mass index (BMI) was 26±5 kg/m2. Only 20% were classified as obese (BMI ≥30). Fifty per cent of participants reported poor sleep quality as defined by a PSQI score ≥5. A high PSQI score was significantly associated with higher very-low-density lipoprotein (VLDL) cholesterol levels (beta=0.392, p=0.012) and higher triglyceride levels (beta=0.017, p=0.006), even after adjustments, including the apnea–hypopnea index. Further adjustments accounting for marital status, alcohol intake, and medication use did not change these findings. No significant association was observed between PSQI scores and glucose or blood pressure. According to PSQI components, sleep disturbances (beta=1.976, p=0.027), sleep medication use (beta=1.121, p=0.019), and daytime dysfunction (beta=1.290, p=0.024) were significantly associated with higher VLDL serum levels. Only the daytime dysfunction domain of the PSQI components was significantly associated with higher triglyceride levels (beta=0.066, p=0.004).
Conclusion
Poorer lipid profile was independently associated with poor sleep quality, assessed by the PSQI questionnaire, regardless of a normal sleep duration and accounting for OSA and socio-economic status.
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Thu Jan 31, 2019 12:40
The journal on a new trajectory
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Publication date: January 2019
Source: Sleep Medicine, Volume 53
Author(s): Sudhansu Chokroverty
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