Validity of Actigraphy in Young Adults With Insomnia
BEHAVIORAL SLEEP MEDICINE
2020; 18 (1): 91–106
Actigraphy is an inexpensive and objective wrist-worn activity sensor that has been validated for the measurement of sleep onset latency (SOL), number of awakenings (NWAK), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) in both middle-aged and older adults with insomnia. However, actigraphy has not been evaluated in young adults. In addition, most previous studies compared actigraphy to in-lab polysomnography (PSG), but none have compared actigraphy to more ecologically valid ambulatory polysomnography.21 young adults (mean age = 19.90 ± 2.19 years; n = 13 women) determined to have chronic primary insomnia through structured clinical interviews.Sleep diaries, actigraphy, and ambulatory PSG data were obtained over a single night to obtain measures of SOL, NWAK, WASO, time spent in bed after final awakening in the morning (TWAK), TST, and SE.Actigraphy was a valid estimate of SOL, WASO, TST, and SE, based on significant correlations (r = 0.45 to 0.87), nonsignificant mean differences between actigraphy and PSG, and inspection of actigraphy bias from Bland Altman plots (SOL α = 1.52, WASO α = 7.95, TST α = -8.60, SE α = -1.38).Actigraphy was a valid objective measure of SOL, WASO, TST, and SE in a young adult insomnia sample, as compared to ambulatory PSG. Actigraphy may be a valid alternative for assessing sleep in young adults with insomnia when more costly PSG measures are not feasible.
View details for DOI 10.1080/15402002.2018.1545653
View details for Web of Science ID 000501298700008
View details for PubMedID 30472879
Insomnia, Psychosocial Well-Being, and Weight Control Behaviors Among Healthy-Weight Adolescent Females: Brief Report.
International journal of behavioral medicine
Weight control behaviors (WCBs) typically involve appearance- or health-driven behaviors that may be influenced by physiological, psychological, or social factors. Sleep disturbances like insomnia are an important area of research for adolescent populations, as early intervention may result in improvements in other physical and mental health domains. The purpose of this study was to investigate the relationship of insomnia, psychosocial well-being, and current WCBs in healthy-weight female adolescents.Female adolescents (N = 323; Mage = 12.33 ± .04) who had healthy body mass index (BMI) levels completed self-report items on insomnia, depression, self-esteem, and physical self-concept. Multivariate analysis of covariance (MANCOVA), controlling for age, was conducted to further examine differences in insomnia and psychosocial variables among the WCB groups.Compared to those who were trying to stay the same weight or not trying to do anything about their weight, the girls who were trying to lose weight had significantly greater insomnia and depression symptoms, and lower self-esteem, with small to medium effect sizes.Clinicians working with adolescent girls should include assessments of WCBs in addition to measures of insomnia symptoms, even for adolescent girls within a normal BMI range, as these are common and frequently co-occurring phenomena. Additional research is needed to further disentangle these complicated relationships.
View details for DOI 10.1007/s12529-020-09872-x
View details for PubMedID 32140933
Intraindividual variability in sleep and perceived stress in young adults
2019; 5 (6): 572–79
Research suggests strong associations between habitual sleep parameters (eg, mean duration, timing, efficiency), perceived stress, and insomnia symptoms. The associations between intraindividual variability (IIV; night-to-night within-person variation) in sleep, perceived stress, and insomnia have not been explored. This study examined associations between IIV in subjectively and objectively determined sleep parameters and to perceived stress in young adults with and without insomnia.Prospective longitudinal.Participants were 149 college students (mean age = 20.2 [SD = 2.4], 59% female) either with insomnia (n = 81; 54%) or without insomnia (n = 68; 46%).Participants completed 1 week of daily sleep diaries and actigraphy (to assess total sleep time [TST], sleep efficiency [SE], and circadian midpoint [CM]), the Perceived Stress Scale, and a diagnostic interview for determination of insomnia as part of a parent study.Greater IIV in actigraphy-determined TST (but not SE or CM) was independently associated with greater perceived stress, regardless of insomnia status. Greater IIV in sleep diary-determined TST, SE, or CM was not associated with perceived stress. Insomnia status was the most robust predictor of elevated perceived stress. There was a significant interaction between IIV in sleep diary-determined TST and insomnia status on perceived stress: Only in those without insomnia was greater IIV in sleep diary-determined TST associated with higher perceived stress.Maintaining a more consistent sleep duration may be associated with lower stress in college students. Future research is needed to clarify the directionality and implications of this association for treatment.
View details for DOI 10.1016/j.sleh.2019.07.009
View details for Web of Science ID 000502998900007
View details for PubMedID 31575485
View details for PubMedCentralID PMC6917884
Posttraumatic Stress Disorder Symptoms and Sleep in the Daily Lives of World Trade Center Responders
JOURNAL OF OCCUPATIONAL HEALTH PSYCHOLOGY
2019; 24 (6): 689–702
Sleep disturbances are common in posttraumatic stress disorder (PTSD) and can have major impacts on workplace performance and functioning. Although effects between PTSD and sleep broadly have been documented, little work has tested their day-to-day temporal relationship particularly in those exposed to occupational trauma. The present study examined daily, bidirectional associations between PTSD symptoms and self-reported sleep duration and quality in World Trade Center (WTC) responders oversampled for PTSD. WTC responders (N = 202; 19.3% with current PTSD diagnosis) were recruited from the Long Island site of the WTC health program. Participants were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; SCID; First, Spitzer, Gibbon, & Williams, 1997) and completed daily assessments of PTSD symptoms, sleep duration and sleep quality for 7 days. PTSD symptoms on a given day were prospectively associated with shorter sleep duration (β = -.13) and worse sleep quality (β = -.18) later that night. Reverse effects were also significant but smaller, with reduced sleep duration (not quality) predicting increased PTSD the next day (β = -.04). Effects of PTSD on sleep duration and quality were driven by numbing symptoms, whereas effects of sleep duration on PTSD were largely based on intrusion symptoms. PTSD symptoms and sleep have bidirectional associations that occur on a daily basis, representing potential targets to disrupt maintenance of each. Improving PTSD numbing symptoms may improve sleep, and increasing sleep duration may improve intrusion symptoms in individuals with exposure to work-related traumatic events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
View details for DOI 10.1037/ocp0000158
View details for Web of Science ID 000498807800004
View details for PubMedID 31204820
Validity of two retrospective questionnaire versions of the Consensus Sleep Diary: the whole week and split week Self-Assessment of Sleep Surveys
2019; 63: 127–36
Prospective, daily sleep diaries are the gold standard for assessing subjective sleep but are not always feasible for cross-sectional or epidemiological studies. The current study examined psychometric properties of two retrospective questionnaire versions of the Consensus Sleep Diary.College students (N = 131, mean age = 19.39 ± 1.65; 73% female) completed seven days of prospective sleep diaries then were randomly assigned to complete either the Self-Assessment of Sleep Survey (SASS), which assessed past week sleep (n = 70), or the SASS-Split (SASS-Y), which assessed weekday/weekend sleep separately (n = 61). Participants also completed psychosocial/sleep questionnaires including the Pittsburgh Sleep Quality Index (PSQI). Sleep parameters derived from SASS, SASS-Y, PSQI, and sleep diaries were assessed via Bland Altman plots, limits of agreement, mean differences, and correlations.SASS-Y demonstrated stronger correlations with prospective sleep diaries and slightly less biased estimates (r = 0.51 to 0.85, α = -0.43 to 1.70) compared to SASS (r = 0.29 to 0.84, α = -1.63 to 2.33) for terminal wakefulness (TWAK), sleep onset latency (SOL), sleep efficiency (SE), and quality (QUAL). SASS resulted in slightly less bias for total sleep time (TST) and wake after sleep onset (WASO) (α = -0.65 and 0.93, respectively) compared to SASS-Y (α = 14.90 and 1.05, respectively). SASS and SASS-Y demonstrated greater convergence with sleep diary than PSQI.Results demonstrated good psychometric properties for the SASS and SASS-Y. When prospective sleep diaries are not feasible, the SASS and SASS-Y are acceptable substitutes to retrospectively estimate sleep parameters. Retrospective estimation of sleep parameters separately for weekdays/weekends may offer advantages compared to whole week estimation.
View details for DOI 10.1016/j.sleep.2019.05.015
View details for Web of Science ID 000496765000021
View details for PubMedID 31622954
- The enigma of objective and subjective measurement of response to cognitive behavioral therapy for insomnia: Call to action SLEEP MEDICINE REVIEWS 2019; 47: 119–21
Associations Between Objective Sleep and Ambulatory Blood Pressure in a Community Sample
2019; 81 (6): 545–56
Epidemiologic data increasingly supports sleep as a determinant of cardiovascular disease risk. Fewer studies have investigated the mechanisms underlying this relationship using objective sleep assessment approaches. Therefore, the aim of this study was to examine associations between daily blood pressure and both objectively assessed sleep duration and efficiency.A diverse community sample of 300 men and women ages 21-70, enrolled in the North Texas Heart Study, participated in the study. Actigraphy assessed sleep was monitored over 2 consecutive nights with ambulatory blood pressure sampled randomly within 45-min blocks on the first and second day as well as the second night.Overall, sleep duration results paralleled those of sleep efficiency. Individuals with lower sleep efficiency had higher daytime systolic (B=-0.35, SE=0.11, p=.0018, R=0.26) but not diastolic BP (B=-0.043, SE=0.068, p=.52, R=0.17) and higher nighttime BP (systolic: B=-0.37, SE=0.10, p<.001, R=.15; diastolic: B=-0.20, SE=0.059, p<.001, R=.14). Moreover, lower sleep efficiency on one night was associated with higher systolic (B=-0.51, SE=0.11, p<.001, R=0.23) and diastolic BP (B=-0.17, SE=0.065, p=.012, R =.16) the following day. When both sleep duration and efficiency were assessed together, sleep efficiency was associated with daytime systolic BP, while sleep duration was associated with nighttime BP.Lower sleep duration and efficiency are associated with higher daytime systolic BP and higher nighttime BP when assessed separately. When assessed together, sleep duration and efficiency diverge in their associations with BP at different times of day. These results warrant further investigation of these possible pathways to disease.
View details for DOI 10.1097/PSY.0000000000000711
View details for Web of Science ID 000475406800008
View details for PubMedID 31083055
EXAMINING THE ASSOCIATIONS BETWEEN OBJECTIVE SLEEP AND AMBULATORY BLOOD PRESSURE IN A COMMUNITY SAMPLE OVER TIME
LIPPINCOTT WILLIAMS & WILKINS. 2019: A113
View details for Web of Science ID 000467560700324
VALIDITY OF SURVEY MEASURES OF SLEEP DURATION, EFFICIENCY, AND TIMING
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071001103
ASSOCIATIONS BETWEEN PAIN, DEPRESSION, STRESS, AND SUBSTANCE USE IN NURSES WITH AND WITHOUT INSOMNIA
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071001195
EFFECTS OF CHRONOTYPE, INSOMNIA, DEPRESSION, AND AGE ON MARKERS OF SYSTEMIC INFLAMMATION IN NURSES
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071000042
INSOMNIA SEVERITY IS ASSOCIATED WITH POSITIVE AND NEGATIVE AFFECT: NHST AND BAYESIAN MULTILEVEL APPROACHES
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071000163
Position statement: start middle and high schools at 8:30 AM or later to promote student health and learning
TRANSLATIONAL BEHAVIORAL MEDICINE
2019; 9 (1): 167–69
The Society of Behavioral Medicine recommends school officials start middle and high school classes at 8:30 am or later. Such a schedule promotes students' sleep health, resulting in improvements in physical health, psychological well-being, attention and concentration, academic performance, and driving safety. In this position statement, we propose a four-tiered approach to promote later school start times for middle and high schools.
View details for DOI 10.1093/tbm/iby0200
View details for Web of Science ID 000492961800018
View details for PubMedID 29546285
The role of sleep dysfunction in the relationship between trauma, neglect and depression in methamphetamine using men.
Neurology, psychiatry, and brain research
2018; 30: 30–34
Background: Childhood abuse and neglect, or childhood trauma (CT), has been associated with methamphetamine use, HIV, and depression. This study explored the potential for sleep dysfunction to influence the relationship between CT and depression in methamphetamine using men.Methods: A total of N = 347 men were enrolled: 1) HIV-uninfected, non-methamphetamine (MA) using heterosexual and homosexual men (HIV- MA-; n = 148), 2) MA-using MSM living with HIV (HIV + MA +; n = 147) and 3) HIV-uninfected, MA using MSM (HIV- MA +; n = 52). Participants completed measures of demographic characteristics, sleep dysfunction, childhood trauma, and depression.Results: Participants were on average 37 years old (SD = 9.65). Half of participants were Hispanic, and 48.1% had a monthly personal income of less than USD$500. Controlling for sleep dysfunction and control variables, the impact of CT on depression decreased significantly, b = 0.203, p < 0.001, and the indirect effect of CT on depression was significant according to a 95% bCI, b = 0.091, bCI (95% CI 0.057, 0.130). That is, sleep dysfunction partially explained the relationship between CT on depression.Limitations: Important limitations included the cross-sectional design of the study, and the self-reported measure of sleep.Conclusions: Results highlight the use of sleep interventions to prevent and treat depression, and the utility of assessing sleep disturbances in clinical care.
View details for DOI 10.1016/j.npbr.2018.05.002
View details for PubMedID 30643354
- Special Considerations in the Adaptation of Cognitive Behavioral Therapy for Insomnia With Active-Duty US Army Personnel COGNITIVE AND BEHAVIORAL PRACTICE 2018; 25 (4): 515–30
- Integration of Cognitive Behavioral Therapy for Insomnia JOURNAL OF PSYCHOTHERAPY INTEGRATION 2018; 28 (3): 269–74
Computer-Guided Problem-Solving Treatment for Depression, PTSD, and Insomnia Symptoms in Student Veterans: A Pilot Randomized Controlled Trial
2018; 49 (5): 756–67
Depression is a highly prevalent psychological disorder experienced disproportionately by college student military veterans with many deleterious effects including risk for suicide. Treatment can help, but the debilitating nature of depression often makes seeking in-person treatment difficult and many are deterred by stigma, inconvenience, concerns about privacy, or a preference to manage problems themselves. The current study examines the efficacy of a computer-guided Problem-Solving Treatment (ePST®) for reducing symptoms of depression, posttraumatic stress disorder (PTSD), and insomnia in student military veterans. Twenty-four student veterans (Meanage = 32.7) with symptoms of depression were randomly assigned either to a treatment group receiving six weekly sessions of ePST or to a minimal contact control group (MCC). Participants completed the Patient Health Questionnaire-9 (PHQ-9) depression scale at baseline and then weekly through post-ePST or post-MCC. PTSD and insomnia questionnaires were also completed at baseline and posttreatment. A linear mixed model regression showed a statistically significant Group (ePST vs. MCC) × Time (pretreatment through posttreatment) interaction for depression, with the ePST showing substantial improvements in depressive symptoms over the 6-week period. Significant improvements were also seen in PTSD and insomnia symptoms. Results suggest that ePST can effectively treat depression, PTSD, and insomnia symptoms in student military veterans and may be a viable alternative for those who are not able to access live therapy. Future work should examine the durability of treatment effects and utility for more severe depression and suicide prevention.
View details for DOI 10.1016/j.beth.2017.11.010
View details for Web of Science ID 000445300700010
View details for PubMedID 30146142
TRAIT ANXIETY AND RESTRICTIVE EATING AS PREDICTORS OF SLEEP ONSET LATENCY AND SLEEP QUALITY
OXFORD UNIV PRESS INC. 2018: S64
View details for Web of Science ID 000431185200142
Gender and racial/ethnic differences in sleep duration in the North Texas heart study
2017; 3 (5): 324–27
Short sleep duration has been linked with a wide array of poor mental and physical health outcomes. Such risks, however, may be moderated by demographic factors such as gender and race/ethnicity. In a diverse community sample, the current study examined the relationship between gender, race/ethnicity and objectively measured sleep duration, controlling for select potential confounds.Participants were 300 community adults (50% female), aged 21 to 70 years, and included 60% non-Hispanic Whites, 15% non-Hispanic Blacks, 19% Hispanic/Latino, and 6% other. As part of a larger study, participants wore an actigraphy device over two nights to assess sleep duration (averaged across both nights). Gender and race/ethnicity were used as grouping variables in a two-way analysis of covariance (ANCOVA) predicting objectively assessed total sleep time, with age, income, and employment status as covariates.On average, males slept 34 min less than females (P=.002). After controlling for socioeconomic factors, there was a gender by race/ethnicity interaction (P=.030). Within males, Hispanics slept 45 min less than non-Hispanic Whites (P=.002) and 57 min less than non-Hispanic others (P=.008). Males also slept significantly less than females within the non-Hispanic White (difference=-22.9; P=.016) and the Hispanic (difference=-77.1; P<.001) groups.Extending previous research, the current study provides additional evidence for differences in objective sleep duration based on gender and race/ethnicity in daily life. These data suggest that risk associated with sleep duration is patterned in important ways across gender and race/ethnicity; such information can be used to tailor prevention efforts.
View details for DOI 10.1016/j.sleh.2017.07.002
View details for Web of Science ID 000425612500004
View details for PubMedID 28923187
View details for PubMedCentralID PMC5679291
Psychometric Evaluation of the PSQI in US College Students
JOURNAL OF CLINICAL SLEEP MEDICINE
2016; 12 (8): 1121–29
Examine the psychometric properties of the PSQI in two U.S. college samples.Study I assessed convergent and divergent validity in 866 undergraduates who completed a sleep diary, PSQI, and other sleep and psychosocial measures. Study II assessed PSQI insomnia diagnostic accuracy in a separate sample of 147 healthy undergraduates with and without insomnia.The PSQI global score had only moderate convergent validity with sleep diary sleep efficiency (prospective global measure of sleep continuity; r = 0.53), the Insomnia Severity Index (r = 0.63), and fatigue (r = 0.44). The PSQI global score demonstrated good divergent validity with measures of excessive daytime sleepiness (r = 0.18), circadian preference (r = -0.08), alcohol (r = 0.08) and marijuana (r = 0.05) abuse scales, and poor divergent validity with depression (r = 0.48), anxiety (r = 0.40), and perceived stress (r = 0.33). Examination of other analogous PSQI and sleep diary components showed low to moderate convergent validity: sleep latency (r = 0.70), wake after sleep onset (r = 0.37), sleep duration (r = 0.51), and sleep efficiency (r = -0.32). Diagnostic accuracy of the PSQI to detect insomnia was very high (area under the curve = 0.999). Sensitivity and specificity were maximized at a cutoff of 6.The PSQI demonstrated moderate convergent validity compared to measures of insomnia and fatigue and good divergent validity with measures of daytime sleepiness, circadian phase preference, and alcohol and marijuana use. The PSQI demonstrated considerable overlap with depression, anxiety, and perceived stress. Therefore, caution should be used with interpretation.
View details for DOI 10.5664/jcsm.6050
View details for Web of Science ID 000389989600009
View details for PubMedID 27166299
View details for PubMedCentralID PMC4957190
Adolescent sleep disparities: sex and racial/ethnic differences
2015; 1 (1): 36–39
During adolescence, significant changes occur in sleep (eg, decreased sleep duration and increased sleep problems). To date, few studies have examined whether self-reported sleep duration differences exist between races/ethnicities in early adolescence (ages 11-14 years).This study compared sexes and race/ethnicity groups on self-reported sleep duration in a large (n = 1543; 48.9% boys) racially/ethnically diverse (62.7% White, 23.7% Hispanic/Latino, 10.4% African American, and 3.2% Asian) sample of young adolescents (mean age, 12.31) drawn from local middle schools.A 2-way analysis of variance revealed that there was a trend for a significant sex effect (P = .067, partial χ2 = .002), with boys reporting more sleep than girls and significant race/ethnicity effects (P < .001, partial χ2 = .012), with Hispanic and African American students reporting shorter sleep duration than White and Asian students. The interaction between sex × race/ethnicity was significant (P = .014, partial χ2 = .002), with post hoc tests revealing that Hispanic males demonstrated significantly shorter sleep duration than White and Asian males and African American females demonstrating significantly shorter sleep duration than White females.Given the literature showing short sleep duration is related to various negative health outcomes and all-cause mortality, more research is needed to determine the factors involved in these disparities. Adolescent sleep disparities: sex and racial/ethnic differences.
View details for DOI 10.1016/j.sleh.2014.12.003
View details for Web of Science ID 000437195100009
View details for PubMedID 29073411