Pub Date : 2024-02-05DOI: 10.1093/sleepadvances/zpae011
Nesrine Adly Ibrahim, Abdulghani Sankari, A. Aldwaikat, Nishtha Pandya, S. Chowdhuri, A. Salloum, Jennifer L Martin, S. Zeineddine, M. S. Badr
Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans. Veterans were screened from a single VA medical center who had a polysomnography (PSG) study from 2017-2021 to ascertain the presence, severity, and type of SDB by measuring the Apnea-Hypopnea Index (AHI) and Central Apnea Index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/ hour. Diagnostic “CSA only” was defined as AHI ≥ 10 events/ hour and CAI ≥ 50% of AHI. “OSA only” was defined if AHI≥ 10 events/ hour and CAI < 5 events/ hour. Comorbid central and obstructive sleep apnea (COSA) was defined if AHI≥ 10 events/ hour and CAI > 5 events/ hour but <50% of AHI. The responsiveness to PAP therapy was determined based on the CAI < 5 events/h on the titration study. A total of 90 patients met the inclusion criteria and from those 64 Veterans were found to have COSA (71%), 18 (20%) were CSA only, and 8 (9%) were OSA only. A total of 22 (24.4%) Veterans diagnosed with CSA or COSA were responsive to PAP therapy. Sixty days after treatment initiation, both responsive and nonresponsive groups had significant decreases in AHI and CAI (p<0.05). Comorbid central and obstructive SDB is common among Veterans. The response to PAP therapy is suboptimal but improves over time.
睡眠呼吸障碍 (SDB) 在退伍军人中很常见。在这项回顾性研究中，我们调查了退伍军人中合并中枢性和阻塞性 SDB 的患病率以及对 PAP 的响应率。 我们从一个退伍军人医疗中心筛选出 2017-2021 年间进行过多导睡眠图（PSG）检查的退伍军人，通过测量呼吸暂停-低通气指数（AHI）和中枢性呼吸暂停指数（CAI）来确定 SDB 的存在、严重程度和类型。如果患者没有完整的研究（诊断和 PAP 滴定研究），则将其排除在外。这些分析的纳入标准是中枢性睡眠呼吸暂停（CSA），即 AHI ≥ 10 次/小时和 CAI ≥ 5 次/小时。诊断性 "仅 CSA "是指 AHI ≥ 10 次/小时且 CAI ≥ AHI 的 50%。如果 AHI ≥ 10 次/小时且 CAI < 5 次/小时，则定义为 "仅 OSA"。如果 AHI ≥ 10 次/小时且 CAI > 5 次/小时但低于 AHI 的 50%，则定义为合并中枢性和阻塞性睡眠呼吸暂停（COSA）。在滴定研究中，根据 CAI < 5 事件/小时来确定对 PAP 治疗的反应性。 共有 90 名患者符合纳入标准，其中 64 名退伍军人（71%）患有 COSA，18 名（20%）仅患有 CSA，8 名（9%）仅患有 OSA。共有 22 名（24.4%）被诊断为 CSA 或 COSA 的退伍军人对 PAP 治疗有反应。治疗开始 60 天后，有反应组和无反应组的 AHI 和 CAI 均显著下降（P<0.05）。 中枢性和阻塞性 SDB 合并症在退伍军人中很常见。对 PAP 治疗的反应并不理想，但随着时间的推移会有所改善。
{"title":"Prevalence of Central Sleep Apnea among Veterans and Response Rate to Continuous Positive Airway Pressure Therapy","authors":"Nesrine Adly Ibrahim, Abdulghani Sankari, A. Aldwaikat, Nishtha Pandya, S. Chowdhuri, A. Salloum, Jennifer L Martin, S. Zeineddine, M. S. Badr","doi":"10.1093/sleepadvances/zpae011","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae011","url":null,"abstract":"\u0000 \u0000 \u0000 Sleep-disordered breathing (SDB) is common in the Veteran population. In this retrospective study, we investigated the prevalence of comorbid central and obstructive SDB and the response rate to PAP among Veterans.\u0000 \u0000 \u0000 \u0000 Veterans were screened from a single VA medical center who had a polysomnography (PSG) study from 2017-2021 to ascertain the presence, severity, and type of SDB by measuring the Apnea-Hypopnea Index (AHI) and Central Apnea Index (CAI). Patients were excluded if they did not have complete studies (diagnostic and PAP titration studies). The inclusion criteria for these analyses were central sleep apnea (CSA) defined as AHI ≥ 10 events/hour and CAI ≥ 5 events/ hour. Diagnostic “CSA only” was defined as AHI ≥ 10 events/ hour and CAI ≥ 50% of AHI. “OSA only” was defined if AHI≥ 10 events/ hour and CAI < 5 events/ hour. Comorbid central and obstructive sleep apnea (COSA) was defined if AHI≥ 10 events/ hour and CAI > 5 events/ hour but <50% of AHI. The responsiveness to PAP therapy was determined based on the CAI < 5 events/h on the titration study.\u0000 \u0000 \u0000 \u0000 A total of 90 patients met the inclusion criteria and from those 64 Veterans were found to have COSA (71%), 18 (20%) were CSA only, and 8 (9%) were OSA only. A total of 22 (24.4%) Veterans diagnosed with CSA or COSA were responsive to PAP therapy. Sixty days after treatment initiation, both responsive and nonresponsive groups had significant decreases in AHI and CAI (p<0.05).\u0000 \u0000 \u0000 \u0000 Comorbid central and obstructive SDB is common among Veterans. The response to PAP therapy is suboptimal but improves over time.\u0000","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139865510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-04DOI: 10.1093/sleepadvances/zpae006
Barbara Robles-Ramamurthy, Saadia Zaki, Jessica Sandoval, Anish R Dube, Steven Hlozek, Lisa R Fortuna, Ariel A Williamson
Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e., insomnia) and promoting sleep health (i.e., improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and wellbeing in these contexts.
{"title":"Improving Adolescent Sleep in Long-Term Juvenile Correctional Settings: Case Examples with Clinical, Research, and Policy Implications","authors":"Barbara Robles-Ramamurthy, Saadia Zaki, Jessica Sandoval, Anish R Dube, Steven Hlozek, Lisa R Fortuna, Ariel A Williamson","doi":"10.1093/sleepadvances/zpae006","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae006","url":null,"abstract":"\u0000 Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e., insomnia) and promoting sleep health (i.e., improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and wellbeing in these contexts.","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139807386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-04DOI: 10.1093/sleepadvances/zpae006
Barbara Robles-Ramamurthy, Saadia Zaki, Jessica Sandoval, Anish R Dube, Steven Hlozek, Lisa R Fortuna, Ariel A Williamson
Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e., insomnia) and promoting sleep health (i.e., improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and wellbeing in these contexts.
{"title":"Improving Adolescent Sleep in Long-Term Juvenile Correctional Settings: Case Examples with Clinical, Research, and Policy Implications","authors":"Barbara Robles-Ramamurthy, Saadia Zaki, Jessica Sandoval, Anish R Dube, Steven Hlozek, Lisa R Fortuna, Ariel A Williamson","doi":"10.1093/sleepadvances/zpae006","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae006","url":null,"abstract":"\u0000 Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e., insomnia) and promoting sleep health (i.e., improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and wellbeing in these contexts.","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139867018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-23DOI: 10.1093/sleepadvances/zpae007
V. A. Ansu Baidoo, S. Alexandria, Phyllis C Zee, Kristen L. Knutson
The objective of this study was to examine the association between the timing of dietary macronutrients and sodium intake and sleep quantity and quality This was a cross-sectional study that included 34 adults between 21 and 50 years of age. The main outcome measures were objective sleep measures assessed from 3 nights of wrist actigraphy including sleep duration, fragmentation, and wake after sleep onset (WASO), and one night of polysomnography (PSG), including rapid eye movement (REM) sleep, non-REM stage 2 (N2), stage 3 (N3), and WASO. Multiple linear regression models and linear mixed models were used to estimate the associations between sleep measures and dietary measures (carbohydrates, fats, saturated fats, proteins, and sodium). Dietary timing was examined in two ways: (1) the average amount of each nutrient consumed within three hours of sleep start, and (2) the interval between the final intake of each nutrient and sleep. Average fat intake within 3 hours of sleep was associated with greater WASO from PSG (β=4.48, p=0.01). No other associations were found between the macronutrients or sodium intake (p>0.05) within 3 hours of sleep and the sleep parameters from PSG or actigraphy. Similarly, no associations were found between any of the PSG or actigraphy sleep measures and the interval between final nutrient intakes and sleep with sleep duration. The study suggests that greater fat but not carbohydrate, protein, saturated fat, or sodium intake close to sleep may be associated with greater sleep disruption, however, no other associations were observed.
{"title":"The Association between Timing of Dietary Macronutrient and Sodium Consumption and Sleep Duration and Quality","authors":"V. A. Ansu Baidoo, S. Alexandria, Phyllis C Zee, Kristen L. Knutson","doi":"10.1093/sleepadvances/zpae007","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae007","url":null,"abstract":"\u0000 \u0000 \u0000 The objective of this study was to examine the association between the timing of dietary macronutrients and sodium intake and sleep quantity and quality\u0000 \u0000 \u0000 \u0000 This was a cross-sectional study that included 34 adults between 21 and 50 years of age. The main outcome measures were objective sleep measures assessed from 3 nights of wrist actigraphy including sleep duration, fragmentation, and wake after sleep onset (WASO), and one night of polysomnography (PSG), including rapid eye movement (REM) sleep, non-REM stage 2 (N2), stage 3 (N3), and WASO. Multiple linear regression models and linear mixed models were used to estimate the associations between sleep measures and dietary measures (carbohydrates, fats, saturated fats, proteins, and sodium). Dietary timing was examined in two ways: (1) the average amount of each nutrient consumed within three hours of sleep start, and (2) the interval between the final intake of each nutrient and sleep.\u0000 \u0000 \u0000 \u0000 Average fat intake within 3 hours of sleep was associated with greater WASO from PSG (β=4.48, p=0.01). No other associations were found between the macronutrients or sodium intake (p>0.05) within 3 hours of sleep and the sleep parameters from PSG or actigraphy. Similarly, no associations were found between any of the PSG or actigraphy sleep measures and the interval between final nutrient intakes and sleep with sleep duration.\u0000 \u0000 \u0000 \u0000 The study suggests that greater fat but not carbohydrate, protein, saturated fat, or sodium intake close to sleep may be associated with greater sleep disruption, however, no other associations were observed.\u0000","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-20DOI: 10.1093/sleepadvances/zpae004
Nathan Hoeft, Kelsie M. Full, Jeffrey R Misialek, K. Lakshminarayan, Srishti Shrestha, Jennifer A Deal, P. Lutsey
Retinal microvascular pathology (RMP) and obstructive sleep apnea (OSA) are both cardiovascular disease risk factors. Limited data exists on their interrelationship. We tested the hypotheses that OSA and nocturnal hypoxemia would be associated with retinal microvascular pathology and vessel calibers. We conducted a quasi-cross-sectional analysis of 1,625 participants in the Atherosclerosis Risk in Communities (ARIC) Sleep Heart Health Study (SHHS). Participants completed in-home polysomnography monitoring (1996-1998) and were categorized by OSA severity (apnea-hypopnea index (AHI): <5, 5-14.9, ≥15) and proportion of total sleep time with oxygen saturation <90% (T90). Retinal photography (1993-1995) was used to assess RMP and measure vascular diameters (central retinal arteriolar and venular equivalent; CRAE and CRVE). Logistic and linear models were adjusted for demographics, behaviors and BMI. Of the participants, 19% had OSA (AHI>15) and 4% had RMP. Severe OSA was not associated with RMP [OR (95% CI): 1.08 (0.49-2.38)] or CRAE in adjusted models. OSA severity showed a positive linear relationship with CRVE; adjusted mean CRVE for those with OSA was 195.8 μm compared to 193.2 μm for those without OSA (Ptrend = 0.03). T90 was strongly associated with CRVE, but not with RMP or CRAE. Adjusted mean CRVE for T90 ≥5% was 199.0 and 192.9 for T90 <1% (Ptrend <0.0001). OSA and T90 were not associated with RMP or CRAE. However, both OSA and T90 ≥5% were associated with wider venules, which may be early and indicative changes of increased inflammation and future risk of stroke and CHD.
视网膜微血管病变（RMP）和阻塞性睡眠呼吸暂停（OSA）都是心血管疾病的危险因素。关于它们之间相互关系的数据十分有限。我们测试了 OSA 和夜间低氧血症与视网膜微血管病变和血管口径相关的假设。 我们对1625名社区动脉粥样硬化风险（ARIC）睡眠心脏健康研究（SHHS）参与者进行了准横断面分析。参与者完成了家庭多导睡眠监测（1996-1998 年），并按 OSA 严重程度进行了分类（呼吸暂停-低通气指数（AHI）：15），4% 的参与者患有 RMP。在调整模型中，严重 OSA 与 RMP [OR (95% CI)：1.08 (0.49-2.38)]或 CRAE 无关。OSA 严重程度与 CRVE 呈正线性关系；OSA 患者的调整后平均 CRVE 为 195.8 μm，而非 OSA 患者为 193.2 μm（Ptrend = 0.03）。T90与CRVE密切相关，但与RMP或CRAE无关。T90≥5%的调整后平均CRVE为199.0，T90＜1%的调整后平均CRVE为192.9（Ptrend＜0.0001）。 OSA 和 T90 与 RMP 或 CRAE 无关。然而，OSA和T90≥5%与静脉增宽有关，这可能是炎症增加和未来中风和冠心病风险的早期和指示性变化。
{"title":"Obstructive sleep apnea, nocturnal hypoxemia and retinal microvasculature: The Atherosclerosis Risk in Communities Study","authors":"Nathan Hoeft, Kelsie M. Full, Jeffrey R Misialek, K. Lakshminarayan, Srishti Shrestha, Jennifer A Deal, P. Lutsey","doi":"10.1093/sleepadvances/zpae004","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae004","url":null,"abstract":"\u0000 \u0000 \u0000 Retinal microvascular pathology (RMP) and obstructive sleep apnea (OSA) are both cardiovascular disease risk factors. Limited data exists on their interrelationship. We tested the hypotheses that OSA and nocturnal hypoxemia would be associated with retinal microvascular pathology and vessel calibers.\u0000 \u0000 \u0000 \u0000 We conducted a quasi-cross-sectional analysis of 1,625 participants in the Atherosclerosis Risk in Communities (ARIC) Sleep Heart Health Study (SHHS). Participants completed in-home polysomnography monitoring (1996-1998) and were categorized by OSA severity (apnea-hypopnea index (AHI): <5, 5-14.9, ≥15) and proportion of total sleep time with oxygen saturation <90% (T90). Retinal photography (1993-1995) was used to assess RMP and measure vascular diameters (central retinal arteriolar and venular equivalent; CRAE and CRVE). Logistic and linear models were adjusted for demographics, behaviors and BMI.\u0000 \u0000 \u0000 \u0000 Of the participants, 19% had OSA (AHI>15) and 4% had RMP. Severe OSA was not associated with RMP [OR (95% CI): 1.08 (0.49-2.38)] or CRAE in adjusted models. OSA severity showed a positive linear relationship with CRVE; adjusted mean CRVE for those with OSA was 195.8 μm compared to 193.2 μm for those without OSA (Ptrend = 0.03). T90 was strongly associated with CRVE, but not with RMP or CRAE. Adjusted mean CRVE for T90 ≥5% was 199.0 and 192.9 for T90 <1% (Ptrend <0.0001).\u0000 \u0000 \u0000 \u0000 OSA and T90 were not associated with RMP or CRAE. However, both OSA and T90 ≥5% were associated with wider venules, which may be early and indicative changes of increased inflammation and future risk of stroke and CHD.\u0000","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139610630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-20DOI: 10.1093/sleepadvances/zpae003
L. Dewa, B. Thibaut, Natalie Pattison, Sean James Campbell, Thomas Woodcock, Paul Aylin, Stephanie Archer
Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardised, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomised controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-subjects pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioural therapy for insomnia (CBTi). Assessment measures for insomnia, wellbeing, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to post-treatment in insomnia severity (d=-1.81, 95% CIs 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, wellbeing, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted.
{"title":"Treating insomnia in people who are incarcerated: a feasibility study of a multi-component treatment pathway","authors":"L. Dewa, B. Thibaut, Natalie Pattison, Sean James Campbell, Thomas Woodcock, Paul Aylin, Stephanie Archer","doi":"10.1093/sleepadvances/zpae003","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae003","url":null,"abstract":"\u0000 Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardised, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomised controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-subjects pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioural therapy for insomnia (CBTi). Assessment measures for insomnia, wellbeing, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to post-treatment in insomnia severity (d=-1.81, 95% CIs 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, wellbeing, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted.","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139610978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-17DOI: 10.1093/sleepadvances/zpae001
P. Borker, B. Macatangay, Joseph B Margolick, Naresh M Punjabi, Charles R. Rinaldo, Valentina Stosor, Joshua Hyong-Jin Cho, Heather McKay, Sanjay R Patel
Although poor sleep quality is associated with lower CD4+ T cell counts among people living with HIV (PLWH), the association between objective sleep metrics and T lymphocyte subset counts is unknown. We evaluated the association between polysomnography (PSG) derived sleep metrics and T lymphocyte subpopulations in a cohort of men living with HIV. Virally suppressed men living with HIV participating in the Multicenter AIDS Cohort Study underwent home overnight PSG. We assessed the association of PSG parameters with CD4+ and CD8+ T cell counts and the CD4+/CD8+ T cell ratio. Overall, 289 men with mean (±SD) age 55.3 ±11.3 years and mean CD4+ T cell count 730 ±308 cells/mm3 were evaluated. Total sleep time (TST) was significantly associated with CD8+ but not CD4+ T cell counts. After adjusting for age, race, depressive symptoms, antidepressant use, and non-nucleoside reverse transcriptase inhibitors use, every hour of shorter TST was associated with an additional 33 circulating CD8+ T cells/mm3 (p=0.05) and a 5.6% (p=0.0007) decline in CD4+/CD8+ T cell ratio. In adjusted models, every hour of shorter REM sleep was associated with an additional 113 CD8+ T cells/mm3 (p=0.02) and a 15.1% lower CD4+/CD8+ T cell ratio (p=0.006). In contrast, measures of sleep efficiency and sleep-disordered breathing were not associated with differences in T lymphocyte subpopulations. Our findings suggest that shorter TST and REM sleep durations are associated with differences in T lymphocyte subpopulations among men living with HIV. Addressing sleep may reflect a novel opportunity to improve immune function in PLWH.
虽然在艾滋病病毒感染者（PLWH）中，睡眠质量差与 CD4+ T 细胞计数较低有关，但客观睡眠指标与 T 淋巴细胞亚群计数之间的关系尚不清楚。我们在一组男性 HIV 感染者中评估了多导睡眠图（PSG）得出的睡眠指标与 T 淋巴细胞亚群之间的关联。 参加多中心艾滋病队列研究（Multicenter AIDS Cohort Study）的病毒已被抑制的男性艾滋病病毒感染者接受了家庭通宵 PSG 检查。我们评估了 PSG 参数与 CD4+ 和 CD8+ T 细胞计数以及 CD4+/CD8+ T 细胞比率的关系。 共有 289 名男性接受了评估，他们的平均（±SD）年龄为 55.3 ±11.3 岁，平均 CD4+ T 细胞计数为 730 ±308 cells/mm3。总睡眠时间（TST）与 CD8+ T 细胞数量有显著相关性，但与 CD4+ T 细胞数量无关。在对年龄、种族、抑郁症状、抗抑郁药的使用和非核苷类逆转录酶抑制剂的使用进行调整后，总睡眠时间每缩短一小时，循环中的 CD8+ T 细胞数就会增加 33 个/mm3（p=0.05），CD4+/CD8+ T 细胞比下降 5.6%（p=0.0007）。在调整后的模型中，每缩短一个小时的快速动眼期睡眠就会增加 113 个 CD8+ T 细胞/mm3（p=0.02），CD4+/CD8+ T 细胞比率降低 15.1%（p=0.006）。相比之下，睡眠效率和睡眠呼吸紊乱与 T 淋巴细胞亚群的差异无关。 我们的研究结果表明，较短的TST和快速动眼期睡眠时间与男性艾滋病感染者T淋巴细胞亚群的差异有关。解决睡眠问题可能是改善艾滋病毒携带者免疫功能的一个新机会。
{"title":"Shorter total sleep time is associated with lower CD4+/CD8+ T cell ratios in virally suppressed men with HIV","authors":"P. Borker, B. Macatangay, Joseph B Margolick, Naresh M Punjabi, Charles R. Rinaldo, Valentina Stosor, Joshua Hyong-Jin Cho, Heather McKay, Sanjay R Patel","doi":"10.1093/sleepadvances/zpae001","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae001","url":null,"abstract":"\u0000 \u0000 \u0000 Although poor sleep quality is associated with lower CD4+ T cell counts among people living with HIV (PLWH), the association between objective sleep metrics and T lymphocyte subset counts is unknown. We evaluated the association between polysomnography (PSG) derived sleep metrics and T lymphocyte subpopulations in a cohort of men living with HIV.\u0000 \u0000 \u0000 \u0000 Virally suppressed men living with HIV participating in the Multicenter AIDS Cohort Study underwent home overnight PSG. We assessed the association of PSG parameters with CD4+ and CD8+ T cell counts and the CD4+/CD8+ T cell ratio.\u0000 \u0000 \u0000 \u0000 Overall, 289 men with mean (±SD) age 55.3 ±11.3 years and mean CD4+ T cell count 730 ±308 cells/mm3 were evaluated. Total sleep time (TST) was significantly associated with CD8+ but not CD4+ T cell counts. After adjusting for age, race, depressive symptoms, antidepressant use, and non-nucleoside reverse transcriptase inhibitors use, every hour of shorter TST was associated with an additional 33 circulating CD8+ T cells/mm3 (p=0.05) and a 5.6% (p=0.0007) decline in CD4+/CD8+ T cell ratio. In adjusted models, every hour of shorter REM sleep was associated with an additional 113 CD8+ T cells/mm3 (p=0.02) and a 15.1% lower CD4+/CD8+ T cell ratio (p=0.006). In contrast, measures of sleep efficiency and sleep-disordered breathing were not associated with differences in T lymphocyte subpopulations.\u0000 \u0000 \u0000 \u0000 Our findings suggest that shorter TST and REM sleep durations are associated with differences in T lymphocyte subpopulations among men living with HIV. Addressing sleep may reflect a novel opportunity to improve immune function in PLWH.\u0000","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139527333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-12DOI: 10.1093/sleepadvances/zpae002
K. Reid, Louis T Ingram, M. Jimenez, Z. Orban, Sabra M. Abbott, Daniela Grimaldi, Kristen L. Knutson, Phyllis C Zee, Igor Koralnik, Mathew B Maas
Fatigue, brain fog and sleep disturbance are among the most common symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC). We sought to determine the impact of sleep disruption on cognition and quality-of-life in patients with neurologic manifestations of PASC (Neuro-PASC). Thirty-nine patients were recruited from Neuro-COVID-19 clinic. Mean age was 48.1 years, 71.8% were female, and 82% were never hospitalized for COVID-19. Patients were evaluated via clinical assessment, quality-of-life measures in domains of cognitive function, fatigue, sleep disturbance, anxiety, and depression, NIH toolbox cognitive tests, and 7 days of wrist actigraphy. The median number of neurologic symptoms attributed to PASC was 6, with brain fog being the most common in 89.7%. Regarding non-neurologic symptoms, 94.9% complained of fatigue and 74.4% of insomnia. Patients reported significant impairment in all quality-of-life domains and performed worse in a task of attention compared to a normative US population. Actigraphy showed Neuro-PASC patients had lower sleep efficiency, longer sleep latency (both p<0.001) and later sleep midpoint (p=0.039) compared to 71 age-matched healthy controls with no PASC history. Self-reported cognitive symptoms correlated with severity of fatigue (p<0.001), anxiety (p=0.05), and depression (p<0.01). Objective evidence of sleep disruption measured by wakefulness after sleep onset, sleep efficiency and latency were associated with decreased performance in attention and processing speed. Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep disruption on the cognitive function and quality of life of patients with PASC.
{"title":"Impact of sleep disruption on cognitive function in patients with post-acute sequelae of SARS-CoV-2 infection: Initial findings from a Neuro-COVID-19 clinic","authors":"K. Reid, Louis T Ingram, M. Jimenez, Z. Orban, Sabra M. Abbott, Daniela Grimaldi, Kristen L. Knutson, Phyllis C Zee, Igor Koralnik, Mathew B Maas","doi":"10.1093/sleepadvances/zpae002","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpae002","url":null,"abstract":"\u0000 \u0000 \u0000 Fatigue, brain fog and sleep disturbance are among the most common symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC). We sought to determine the impact of sleep disruption on cognition and quality-of-life in patients with neurologic manifestations of PASC (Neuro-PASC).\u0000 \u0000 \u0000 \u0000 Thirty-nine patients were recruited from Neuro-COVID-19 clinic. Mean age was 48.1 years, 71.8% were female, and 82% were never hospitalized for COVID-19. Patients were evaluated via clinical assessment, quality-of-life measures in domains of cognitive function, fatigue, sleep disturbance, anxiety, and depression, NIH toolbox cognitive tests, and 7 days of wrist actigraphy.\u0000 \u0000 \u0000 \u0000 The median number of neurologic symptoms attributed to PASC was 6, with brain fog being the most common in 89.7%. Regarding non-neurologic symptoms, 94.9% complained of fatigue and 74.4% of insomnia. Patients reported significant impairment in all quality-of-life domains and performed worse in a task of attention compared to a normative US population. Actigraphy showed Neuro-PASC patients had lower sleep efficiency, longer sleep latency (both p<0.001) and later sleep midpoint (p=0.039) compared to 71 age-matched healthy controls with no PASC history. Self-reported cognitive symptoms correlated with severity of fatigue (p<0.001), anxiety (p=0.05), and depression (p<0.01). Objective evidence of sleep disruption measured by wakefulness after sleep onset, sleep efficiency and latency were associated with decreased performance in attention and processing speed.\u0000 \u0000 \u0000 \u0000 Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep disruption on the cognitive function and quality of life of patients with PASC.\u0000","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139624165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-30DOI: 10.1093/sleepadvances/zpad057
S. Vincent, M. Madani, D. Dikeman, K. Golden, N. Crocker, C. Jackson, S. Wimmer, M. Dover, A. Tucker, C. A. Ghiani, C. S. Colwell, T. W. LeBaron, A. Tarnava, K. Paul
Sleep loss contributes to various health issues and impairs neurological function. Molecular hydrogen has recently gained popularity as a non-toxic ergogenic and health promoter. The effect of molecular hydrogen on sleep and sleep-related neural systems remains unexplored. This study investigates the impact of hydrogen-rich water (HRW) on sleep behavior and neuronal activation in sleep-deprived mice. Adult C57BL/6J mice were implanted with electroencephalography (EEG) and electromyography (EMG) recording electrodes and given HRW (0.7 -1.4 mM) or regular water for 7 days ad libitum. Sleep-wake cycles were recorded under baseline conditions and after acute sleep loss. Neuronal activation in sleep- and wake-related regions was assessed using cFos immunostaining. HRW increased sleep consolidation in undisturbed mice and increased non-rapid eye movement (NREM) and rapid-eye movement (REM) sleep amount in sleep-deprived mice. HRW also decreased the average amount of time for mice to fall asleep after light onset. Neuronal activation in the lateral septum, medial septum, ventrolateral preoptic area, and median preoptic area was significantly altered in all mice treated with HRW. HRW improves sleep consolidation and increases neuronal activation in sleep-related brain regions. It may serve as a simple, effective treatment to improve recovery after sleep loss.
{"title":"Hydrogen-rich water improves sleep consolidation and enhances forebrain neuronal activation in mice","authors":"S. Vincent, M. Madani, D. Dikeman, K. Golden, N. Crocker, C. Jackson, S. Wimmer, M. Dover, A. Tucker, C. A. Ghiani, C. S. Colwell, T. W. LeBaron, A. Tarnava, K. Paul","doi":"10.1093/sleepadvances/zpad057","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpad057","url":null,"abstract":"Sleep loss contributes to various health issues and impairs neurological function. Molecular hydrogen has recently gained popularity as a non-toxic ergogenic and health promoter. The effect of molecular hydrogen on sleep and sleep-related neural systems remains unexplored. This study investigates the impact of hydrogen-rich water (HRW) on sleep behavior and neuronal activation in sleep-deprived mice. Adult C57BL/6J mice were implanted with electroencephalography (EEG) and electromyography (EMG) recording electrodes and given HRW (0.7 -1.4 mM) or regular water for 7 days ad libitum. Sleep-wake cycles were recorded under baseline conditions and after acute sleep loss. Neuronal activation in sleep- and wake-related regions was assessed using cFos immunostaining. HRW increased sleep consolidation in undisturbed mice and increased non-rapid eye movement (NREM) and rapid-eye movement (REM) sleep amount in sleep-deprived mice. HRW also decreased the average amount of time for mice to fall asleep after light onset. Neuronal activation in the lateral septum, medial septum, ventrolateral preoptic area, and median preoptic area was significantly altered in all mice treated with HRW. HRW improves sleep consolidation and increases neuronal activation in sleep-related brain regions. It may serve as a simple, effective treatment to improve recovery after sleep loss.","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139140877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-27DOI: 10.1093/sleepadvances/zpad056
Jeanna T Ryan, Heather Day, Marlene J Egger, Jiqiang Wu, Christopher M Depner, Janet M Shaw
Approximately 75% of women weigh more at 1-year postpartum than pre-pregnancy. More than 47% retain >10 lbs at 1-year postpartum, which is associated with adverse health outcomes for mother and child. Disturbed sleep may contribute to risk of postpartum weight retention (PWR) as short sleep duration is associated with increased risk of obesity. Thus, we investigated whether night-time sleep duration is associated with risk for excessive PWR. We also explored night-time sleep duration and change in postpartum waist circumference. This is an ancillary analysis from a prospective cohort study. Participants were healthy primiparous adults with a singleton birth. Excessive PWR at 1-year postpartum was defined as ≥7% of pre-pregnancy weight. Log-binomial and linear regression assessed associations between night-time sleep duration at 6 months postpartum and PWR at 1-year postpartum. Linear regression assessed association between night-time sleep duration and change in postpartum waist circumference. Mean age of participants (N=467) was 29.51 (SD±4.78) years. Night-time sleep duration by actigraphy or self-report was not associated with risk for excessive PWR (Risk Ratio 0.96, [95%CI 0.87-1.06]; Risk Ratio 0.95 [95%CI 0.83-1.07], respectively) or change in waist circumference. Night-time sleep duration at 6 months postpartum was not associated with PWR at 1-year postpartum. Mixed findings among our results and previous research could be due to our focus on night-time sleep, and differences in sleep measurement methods and timeframes across studies. More comprehensively assessing sleep, including multiple sleep dimensions, may help advance our understanding of potential links between sleep and PWR.
{"title":"Night-time Sleep Duration and Postpartum Weight Retention in Primiparous Women","authors":"Jeanna T Ryan, Heather Day, Marlene J Egger, Jiqiang Wu, Christopher M Depner, Janet M Shaw","doi":"10.1093/sleepadvances/zpad056","DOIUrl":"https://doi.org/10.1093/sleepadvances/zpad056","url":null,"abstract":"Approximately 75% of women weigh more at 1-year postpartum than pre-pregnancy. More than 47% retain >10 lbs at 1-year postpartum, which is associated with adverse health outcomes for mother and child. Disturbed sleep may contribute to risk of postpartum weight retention (PWR) as short sleep duration is associated with increased risk of obesity. Thus, we investigated whether night-time sleep duration is associated with risk for excessive PWR. We also explored night-time sleep duration and change in postpartum waist circumference. This is an ancillary analysis from a prospective cohort study. Participants were healthy primiparous adults with a singleton birth. Excessive PWR at 1-year postpartum was defined as ≥7% of pre-pregnancy weight. Log-binomial and linear regression assessed associations between night-time sleep duration at 6 months postpartum and PWR at 1-year postpartum. Linear regression assessed association between night-time sleep duration and change in postpartum waist circumference. Mean age of participants (N=467) was 29.51 (SD±4.78) years. Night-time sleep duration by actigraphy or self-report was not associated with risk for excessive PWR (Risk Ratio 0.96, [95%CI 0.87-1.06]; Risk Ratio 0.95 [95%CI 0.83-1.07], respectively) or change in waist circumference. Night-time sleep duration at 6 months postpartum was not associated with PWR at 1-year postpartum. Mixed findings among our results and previous research could be due to our focus on night-time sleep, and differences in sleep measurement methods and timeframes across studies. More comprehensively assessing sleep, including multiple sleep dimensions, may help advance our understanding of potential links between sleep and PWR.","PeriodicalId":21861,"journal":{"name":"SLEEP Advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139153166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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