Sleep advances : a journal of the Sleep Research Society最新文献

The focus of my research efforts rests with determining dysfunctional neural systems underlying disorders of sleep, and identifying interventions to overcome those disorders. Aberrant central and physiological control during sleep exerts serious consequences, including disruptions in breathing, motor control, blood pressure, mood, and cognition, and plays a major role in sudden infant death syndrome, congenital central hypoventilation, and sudden unexpected death in epilepsy, among other concerns. The disruptions can be traced to brain structural injury, leading to inappropriate outcomes. Identification of failing systems arose from the assessment of single neuron discharge in intact, freely moving and state-changing human and animal preparations within multiple systems, including serotonergic action and motor control sites. Optical imaging of chemosensitive, blood pressure and other breathing regulatory areas, especially during development, were useful to show integration of regional cellular action in modifying neural output. Identification of damaged neural sites in control and afflicted humans through structural and functional magnetic resonance imaging procedures helped to identify the sources of injury, and the nature of interactions between brain sites that compromise physiological systems and lead to failure. Interventions to overcome flawed regulatory processes were developed, and incorporate noninvasive neuromodulatory means to recruit ancient reflexes or provide peripheral sensory stimulation to assist breathing drive to overcome apnea, reduce the frequency of seizures, and support blood pressure in conditions where a failure to perfuse can lead to death.

Drowsiness associated with sleep loss and circadian misalignment is a risk factor for accidents and human error. The percentage of time that the eyes are more than 80% closed (PERCLOS) is one of the most validated indices used for the passive detection of drowsiness, which is increased with sleep deprivation, after partial sleep restriction, at nighttime, and by other drowsiness manipulations during vigilance tests, simulated driving, and on-road driving. However, some cases have been reported wherein PERCLOS was not affected by drowsiness manipulations, such as in moderate drowsiness conditions, in older adults, and during aviation-related tasks. Additionally, although PERCLOS is one of the most sensitive indices for detecting drowsiness-related performance impairments during the psychomotor vigilance test or behavioral maintenance of wakefulness test, no single index is currently available as an optimal marker for detecting drowsiness during driving or other real-world situations. Based on the current published evidence, this narrative review suggests that future studies should focus on: (1) standardization to minimize differences in the definition of PERCLOS between studies; (2) extensive validation using a single device that utilizes PERCLOS-based technology; (3) development and validation of technologies that integrate PERCLOS with other behavioral and/or physiological indices, because PERCLOS alone may not be sufficiently sensitive for detecting drowsiness caused by factors other than falling asleep, such as inattention or distraction; and (4) further validation studies and field trials targeting sleep disorders and trials in real-world environments. Through such studies, PERCLOS-based technology may contribute to preventing drowsiness-related accidents and human error.

Narrated in this article are accounts of the many contributions Howard P. Roffwarg, MD, made to the field of sleep research and sleep medicine across his entire professional career as a student, a mentor, a leader in the Sleep Research Society, a sleep medicine clinician, and a scientist who performed experimental investigations in humans and animals. Dr Roffwarg was the originator of what is known as the "Ontogenetic Hypothesis" of sleep. His research over many years on physiology has contributed greatly to much of the experimental support substantiating a role for rapid eye-movement sleep (REMS) in the early development of the brain. Though much is still unknown, the Ontogenetic Hypothesis, still to this day, inspires many neuroscientists in their investigations. These studies have demonstrated roles for both REMS and NREMS in development as well as on brain function throughout his life span. Dr Howard P. Roffwarg, is one of the legends in the field of sleep research.

Study objectives: Lumbar spinal stenosis is an age-related spine condition that contributes to pain and disability. Decompressive laminectomy (DL) is regularly performed to alleviate symptoms. Insomnia symptoms are common among people living with chronic pain and may affect key DL outcomes, such as healthcare utilization. We examined associations of insomnia symptom severity with post-DL healthcare utilization in veterans with lumbar spinal stenosis.

Methods: Veterans (N = 200) with lumbar spinal stenosis undergoing DL were recruited into a prospective cohort study and self-reported insomnia symptom severity on the Insomnia Severity Index prior to DL. Post-DL, veterans reported on pain and non-pain-related monthly healthcare office visits, emergency room visits, hospitalizations, and mental health visits for 1 year. Incident rate ratios (IRRs) obtained via negative binomial regression evaluated associations of insomnia symptom severity with healthcare utilization rates.

Results: Approximately 51% of participants endorsed insomnia symptoms of at least mild severity. Participants who reported at least mild insomnia symptoms had more healthcare office visits (IRR = 1.23, p = .04), general mental health visits (IRR = 3.98, p < .0001), and pain-related mental health visits (IRR = 9.55, p = .01) than those without insomnia symptoms. Adjusting for covariates, rates of mental health visits, overall (IRR = 3.13, p = .001) and pain-related (IRR = 6.93, p = .02), remained statistically significantly higher.

Conclusions: Insomnia symptoms are associated with postoperative healthcare utilization lending support for future work to examine the value of assessing and intervening on insomnia symptoms prelaminectomy.

Study objectives: This study evaluated the utility and ecological validity of the 3-minute psychomotor vigilance test (PVT) completed by safety-critical personnel in an air medical transport operation as part of a fatigue risk management program.

Methods: Crewmembers in an air medical transport operation self-administered an alertness assessment incorporating a 3-minute PVT at different time points during their duty schedule. The prevalence of alertness deficits was evaluated based on a failure threshold of 12 errors considering both lapses and false starts. To evaluate the ecological validity of the PVT, the relative frequency of failed assessments was evaluated relative to crewmember position, timing of the assessment within the duty schedule, time of day, and sleep quantity in the last 24 h.

Results: 2.1% of assessments were associated with a failing PVT score. Crewmember position, timing of assessment within the duty shift, time of day, and sleep quantity in the last 24 h were found to affect the relative frequency of failed assessments. Obtaining less than 7-9 h of sleep was associated with systematic increases in the failure rate (F[1, 54 612] = 168.1, p < .001). Obtaining less than 4 h of sleep was associated with a frequency of a failed assessment 2.99 times higher than the frequency of a failed assessment when obtaining 7-9 h of sleep.

Conclusions: Results provide evidence for the utility and ecological validity of the PVT as well as the suitability of the PVT failure threshold to support fatigue risk management in safety-critical operations.

Study objectives: The purpose of this study was to (1) estimate trauma associated sleep disorder (TASD) prevalence among post-9/11 era veterans and to describe differences in service and comorbid mental health clinical characteristics among individuals with and without probable TASD, and (2) estimate TASD prevalence and characteristics of reported traumatic experiences stratified by sex.

Methods: We used cross-sectional data from the post-deployment mental health study of post-9/11 veterans, which enrolled and collected baseline data from 2005 to 2018. We classified veterans as having probable TASD using self-reported measures: traumatic experiences from the traumatic life events questionnaire (TLEQ) and items from the Pittsburgh sleep quality index with Addendum for posttraumatic stress disorder (PTSD) mapped to TASD diagnostic criteria and ascertained mental health diagnoses (PTSD, major depressive disorder [MDD]) via Structured Clinical Interview for DSM-IV. We calculated effect sizes as prevalence ratios (PR) for categorical variables and Hedges' g for continuous variables.

Results: Our final sample included 3618 veterans (22.7% female). TASD prevalence was 12.1% (95% CI: 11.1% to 13.2%) and sex-stratified prevalence was similar for female and male veterans. Veterans with TASD had a much higher comorbid prevalence of PTSD (PR: 3.72, 95% CI: 3.41 to 4.06) and MDD (PR: 3.93, 95% CI: 3.48 to 4.43). Combat was the highest reported most distressing traumatic experience among veterans with TASD (62.6%). When stratifying by sex, female veterans with TASD had a wider variety of traumatic experiences.

Conclusions: Our results support the need for improved screening and evaluation for TASD in veterans, which is currently not performed in routine clinical practice.

Study objectives: This exploratory study assessed the impact of sex and hormonal contraceptives (HC) use on the homeostatic and diurnal variation of alertness, fatigue, sleepiness, psychomotor performance, and sleep behavior in police officers working rotating shifts.

Methods: A total of 56 men and 20 women (6 using, 11 not using, and 3 with unknown use of HC) participated in an observational study throughout a month-long work cycle. Participants wore an actigraph, filled out a sleep and work log, answered questionnaires (Samn-Perelli, KSS, Visual Analogue Scales), and completed 5-min Psychomotor Vigilance Tasks (PVT) according to an ecological momentary assessment approach. Linear mixed-effects models were used to analyze the effects of group (men, women, and HC use), time awake, and time of day on the dependent variables.

Results: Self-reported parameters and performance significantly varied with time awake and time of day. Women were more fatigued and sleepier than men, when considering both time awake and time of day. Compared to men, women using HC were more fatigued, less alert, and sleepier. Women had less attention lapses than men after 7 and 17 h awake, although no main effect of HC was detected.

Conclusions: Women tended to rate themselves as more fatigued than men, especially when using HC. Surprisingly, psychomotor performances of women were sometimes better than those of men. This exploratory study indicates that sex and HC are important factors to consider in occupational medicine.

Insomnia confers a 2.5-to-3-fold risk of developing posttraumatic stress disorder (PTSD) after a traumatic event. The mechanism underlying this increased risk, however, remains unknown. We postulate insomnia may contribute to PTSD by disrupting rapid eye movement (REM) sleep, as REM sleep disruption has been shown to impair fear inhibitory processes, which are central to the natural recovery from trauma. To test this hypothesis, the following protocol aims to: (1) examine the relationship between REM sleep and fear inhibition in insomnia, and (2) examine whether reducing REM fragmentation by treating insomnia, in turn, improves fear inhibition. Ninety-two adults with Insomnia Disorder will be block randomized (1:1; stratified by sex) to an active treatment (7 weekly sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) via telehealth) or waitlist control condition. REM sleep (latent variable derived from REM %, REM efficiency, and REM latency) and fear inhibition (i.e. safety signal and extinction recall) will be assessed pre- and post-treatment in a 4 night/3 day testing protocol via at-home polysomnography and the fear-potentiated startle paradigm, respectively. Fear extinction recall will serve as the primary outcome, while safety signal recall will serve as the secondary outcome. In summary, this study aims to test an underlying mechanism potentially explaining why insomnia greatly increases PTSD risk, while demonstrating an existing clinical intervention (CBT-I) can be used to improve this mechanism. Findings will have potential clinical implications for novel approaches in the prevention, early intervention, and treatment of PTSD.

Study objectives: We sought to develop behavioral sleep measures from passively sensed human-smartphone interactions and retrospectively evaluate their associations with sleep disturbance, anxiety, and depressive symptoms in a large cohort of real-world patients receiving virtual behavioral medicine care.

Methods: Behavioral sleep measures from smartphone data were developed: daily longest period of smartphone inactivity (inferred sleep period [ISP]); 30-day expected period of inactivity (expected sleep period [ESP]); regularity of the daily ISP compared to the ESP (overlap percentage); and smartphone usage during inferred sleep (disruptions, wakefulness during sleep period). These measures were compared to symptoms of sleep disturbance, anxiety, and depression using linear mixed-effects modeling. More than 2300 patients receiving standard-of-care virtual mental healthcare across more than 111 000 days were retrospectively analyzed.

Results: Mean ESP duration was 8.4 h (SD = 2.3), overlap percentage 75% (SD = 18%) and disrupted time windows 4.85 (SD = 3). There were significant associations between overlap percentage (p < 0.001) and disruptions (p < 0.001) with sleep disturbance symptoms after accounting for demographics. Overlap percentage and disruptions were similarly associated with anxiety and depression symptoms (all p < 0.001).

Conclusions: Smartphone behavioral measures appear useful to longitudinally monitor sleep and benchmark depressive and anxiety symptoms in patients receiving virtual behavioral medicine care. Patterns consistent with better sleep practices (i.e. greater regularity of ISP, fewer disruptions) were associated with lower levels of reported sleep disturbances, anxiety, and depression.

My long day's journey into sleep began as an adolescent trying to manage my evening chronotype. The relief, I felt when my undergraduate finals were scheduled at night and as a medical student being able to select psychiatry over surgery deepened my interest in sleep and chronobiology. That interest was allowed to flourish at the National Institute of Mental Health and then at Yale Medical School in setting up a sleep laboratory. The decision to move to the University of Pittsburgh in 1973 led to a 42-year adventure in which we were able to initiate research efforts on the psychobiology of depression. Our interest in social zeitgebers (daily routines) led directly to the development and testing of a treatment intervention for mood disorders, interpersonal, and social rhythm therapy. Our continued emphasis on sleep and circadian rhythms convinced us that sleep and circadian factors were central to all of health, based on the importance of connectivity between sleep and major metabolic and cell functions. This ongoing research motivated our strong desire to study the developmental aspects of sleep. Our success was influenced immensely by the presence of young scientists and a strong subsequent interest in career mentoring. Finally, as we left Pittsburgh in 2015, we became involved in the field of continuous objective monitoring using the commercial smartphone's behavioral sensing capabilities. Our journey is not over. We hope to explore the potential of these remarkable devices to improve our understanding of sleep/wake and circadian factors across all of health.