Adolescent Nocturnal Fears: a psychometric evaluation of the fear of sleep inventory (FoSI).

Objective: Nocturnal fears are associated with trauma-related sleep disturbance in adults, yet research is limited addressing this relationship in adolescents. This study evaluated the validity of the Fear of Sleep Inventory (FoSI) as a measure of nocturnal fears broadly and in relation to trauma exposure in adolescents. Participants: Students ages 14-18 from two urban school-based health centers were the participants. Methods: De-identified clinical data were utilized from a mental health screening battery. Two exploratory factor analyses (EFA) were conducted using the full 23-item FoSI and the 13-item short form. Cronbach's α and Pearson correlation coefficients were employed to examine the convergent and divergent validity of the total scores and the factors derived from the EFA with Insomnia Severity, probable PTSD, and parental monitoring respectively. Results: The 23-item FoSI showed high internal consistency (α = .84); however, EFA yielded an unclear factor structure. Further analysis indicated that an 11-item FoSI yielded a clear 2-factor structure with subscales conceptualized as (a) Fear of Sleep and (b) Vigilant Behavior. Conclusions: The FoSI-11 demonstrates promise as a measure of nocturnal fears in adolescents and can help reveal distinctions between trauma-related nocturnal fears and nocturnal fears associated with psychological or environmental factors. It can be utilized as a screener to highlight adolescent nocturnal fears in large group settings, while also identifying individuals in need of further assessment of trauma exposure. Future studies should include the FoSI-11 to provide a more thorough examination of the role of adolescent nocturnal fears in the relationship between trauma and sleep disturbance.

How consumer physical activity monitors could transform human physiology research.

A sedentary lifestyle and lack of physical activity are well-established risk factors for chronic disease and adverse health outcomes. Thus, there is enormous interest in measuring physical activity in biomedical research. Many consumer physical activity monitors, including Basis Health Tracker, BodyMedia Fit, DirectLife, Fitbit Flex, Fitbit One, Fitbit Zip, Garmin Vivofit, Jawbone UP, MisFit Shine, Nike FuelBand, Polar Loop, Withings Pulse O2, and others have accuracies similar to that of research-grade physical activity monitors for measuring steps. This review focuses on the unprecedented opportunities that consumer physical activity monitors offer for human physiology and pathophysiology research because of their ability to measure activity continuously under real-life conditions and because they are already widely used by consumers. We examine current and potential uses of consumer physical activity monitors as a measuring or monitoring device, or as an intervention in strategies to change behavior and predict health outcomes. The accuracy, reliability, reproducibility, and validity of consumer physical activity monitors are reviewed, as are limitations and challenges associated with using these devices in research. Other topics covered include how smartphone apps and platforms, such as the Apple ResearchKit, can be used in conjunction with consumer physical activity monitors for research. Lastly, the future of consumer physical activity monitors and related technology is considered: pattern recognition, integration of sleep monitors, and other biosensors in combination with new forms of information processing.

Trauma exposure and sleep disturbance in a sample of youth from the National Child Traumatic Stress Network Core Data Set.

OBJECTIVE: Adverse childhood experiences are prevalent and have been associated with sleep disturbance. However, there are limited data examining factors that influence this relationship. The purpose of this study was to extend the current literature by characterizing the relationship between adverse childhood experiences and sleep disturbance in a sample of trauma-exposed youth and to identify factors that may influence this relationship. STUDY DESIGN: Data were collected from 56 mental health centers across the National Child Traumatic Stress Network. For the current study, secondary data analysis was conducted using de-identified data from the National Child Traumatic Stress Network Core Data Set. The present study included 4043 children and adolescents who met eligibility criteria. RESULTS: Sixteen percent of the sample (n=634) met criteria for a sleep disturbance as determined through clinician assessment and collateral report. Posttraumatic stress disorder (PTSD) symptom severity influenced the risk of disturbed sleep (ages 7-12: t=-4.33, ages 13-18: t=-7.12, P≤.001 for both analyses), with those meeting full criteria for PTSD at greatest risk (age 7-12: odds ratio [OR]=1.95; 95% confidence interval [CI], 1.17-3.24; age 13-18: OR=3.18; 95% CI, 1.87-5.43). Exposure to sexual assault and community violence also contributed independently to the risk of disturbed sleep (age 7-12, sexual assault: OR=1.76; 95% CI, 1.21-2.57; age 13-18, community violence: OR=1.61; 95% CI, 1.19-2.18). CONCLUSIONS: Comprehensive treatment strategies should include assessment of disturbed sleep in youth exposed to trauma, particularly those with elevated PTSD symptoms and exposure to sexual trauma or community violence.

The Role of Trauma Type in the Risk for Insomnia.

OBJECTIVE: Insomnia is common following exposure to trauma and can occur independently or as a feature of posttraumatic stress disorder (PTSD). However, there is limited research identifying risk factors associated with the development of insomnia following exposure to a traumatic event. The goal of this study was to evaluate the role of specific trauma types in the risk for insomnia in a community sample of urban African Americans young adults. METHODS: A sample of 554 nonclinical, urban, young adult African Americans was recruited for a larger study from which 465 participants were utilized for this study based on their completion of all study self-report measures. Participants were initially screened by phone to determine whether they provisionally met study criteria. Once selected, participants underwent informed consent and then completed a battery of self-report measures that included the Life Events Checklist, the PTSD Checklist, the Insomnia Severity Index, and the Fear of Sleep Index. RESULTS: Of the seven trauma categories that were endorsed by at least 20% of the sample, results from logistic regression models indicated that sexual trauma, physical assault, accidents, natural disasters, and sudden violent death predicted insomnia independent of sex. However, PTSD symptom severity and nocturnal fears differentially influenced the relationship between trauma type and risk for insomnia. CONCLUSIONS: Exposure to specific types of trauma increases the odds of insomnia twofold to threefold. Additionally, PTSD symptom severity and nocturnal fears contribute differentially to the relationship between trauma exposure and insomnia suggesting the possibility of multiple underlying pathways.

A relationship between REM sleep measures and the duration of posttraumatic stress disorder in a young adult urban minority population.

STUDY OBJECTIVE: To determine relationships of polysomnographic (PSG) measures with posttraumatic stress disorder (PTSD) in a young adult, urban African American population. DESIGN: Cross-sectional, clinical and laboratory evaluation. SETTING: Community recruitment, evaluation in the clinical research unit of an urban University hospital. PARTICIPANTS: Participants (n = 145) were Black, 59.3% female, with a mean age of 23.1 y (SD = 4.8). One hundred twenty-one participants (83.4%) met criteria for trauma exposure, the most common being nonsexual violence. Thirty-nine participants (26.9%) met full (n = 19) or subthreshold criteria (n = 20) for current PTSD, 41 (28.3%) had met lifetime PTSD criteria and were recovered, and 65 (45%) were negative for PTSD. MEASUREMENTS AND RESULTS: Evaluations included the Clinician Administered PTSD Scale (CAPS) and 2 consecutive nights of overnight PSG. Analysis of variance did not reveal differences in measures of sleep duration and maintenance, percentage of sleep stages, and the latency to and duration of uninterrupted segments of rapid eye movement (REM) sleep by study group. There were significant relationships between the duration of PTSD and REM sleep percentage (r = 0.53, P = 0.001), REM segment length (r = 0.43, P = 0.006), and REM sleep latency (r = -0.34, P < 0.03) among those with current PTSD that persisted when removing cases with, or controlling for, depression. CONCLUSIONS: The findings are consistent with observations in the literature of fragmented and reduced REM sleep with posttraumatic stress disorder (PTSD) relatively proximate to trauma exposure and nondisrupted or increased REM sleep with chronic PTSD. CITATION: Mellman TA, Kobayashi I, Lavela J, Wilson B, Hall Brown TS. A relationship between REM sleep measures and the duration of posttraumatic stress disorder in a young adult urban minority population.

Validation of the Fear of Sleep Inventory (FOSI) in an urban young adult African American sample.

The Fear of Sleep Inventory (FOSI) was developed to identify factors that contribute to sleep disturbances in individuals exposed to trauma. This investigation examined the psychometric properties of the FOSI in a sample of African American young adults residing in urban areas. A 5-factor structure was derived from an exploratory factor analysis and then verified by confirmatory factor analysis. FOSI factors were positively correlated with the severity of PTSD (rs = .30 to .58, all ps < .001) and insomnia symptoms (rs = .36 to .64, all ps < .001). Individuals with probable PTSD or insomnia had higher scores on the total FOSI and each of the factors compared to those without probable PTSD (all ps < .001; effect sizes: r = .32 to .62) or insomnia (all ps < .001; effect sizes: r = .42 to .70). These data expand the evidence that the FOSI identifies factors contributing to sleep disturbances in trauma-exposed individuals.