Assessing Sleep-Related Safety Behaviors: Adaptation and Validation of a French Version of the Sleep-Related Behaviors Questionnaire in a Nonclinical Sample.

Objective/Background: Safety behaviors play a prominent role in the development and maintenance of insomnia. The Sleep-Related Behaviors Questionnaire (SRBQ) is a self-report questionnaire designed to assess safety behaviors employed to cope with fatigue or to improve sleep. Despite its frequent use in insomnia, no systematic psychometric validation of the SRBQ has been conducted; its factor structure has never been explored. Furthermore, there is no French version of this scale. The goal of this study was to empirically validate a French version of the SRBQ. Participants/Methods: A total of 539 French-speaking community-dwelling participants from the general population completed a face-to-face clinical interview to determine insomnia disorder against DSM-5 criteria and several questionnaires including the French SRBQ. Results: SRBQ items with poor psychometric properties were removed, thus leading to a 20-item version (SRBQ-20). Exploratory factor analysis and parallel analysis revealed three distinct factors with good internal consistency. The results supported the internal temporal stability of the SRBQ-20. The construct validity of that instrument was underpinned by correlations obtained with various measures of insomnia and related constructs. Adequate discriminative validity was established by comparing individuals with insomnia and individuals without insomnia. Conclusions: This study demonstrated that the French version of the SRBQ-20 has good psychometric properties.

Presleep Cognitive Arousal and Insomnia Comorbid to Parkinson Disease: Evidence for a Serial Mediation Model of Sleep-Related Safety Behaviors and Dysfunctional Beliefs About Sleep.

STUDY OBJECTIVES: Insomnia disorder (ID) is highly associated with Parkinson disease (PD) with great negative effect on health-related quality of life. Nonetheless, the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in the context of this neurological condition. Our aim was to examine a serial meditation model of sleep-related safety behaviors and dysfunctional beliefs about sleep in association with presleep cognitive arousal and ID in patients with PD. METHODS: A total of 68 patients with PD completed self-report measures including the Sleep-Related Behaviors Questionnaire (SRBQ-20), Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), and the cognitive subscale of the Presleep Arousal Scale (PSAS-C). ID was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Bootstrapped serial mediation analyses were conducted to test indirect effects. RESULTS: Overall, 55.6% of patients with PD met diagnostic criteria for ID. The association between presleep cognitive arousal (PSAS-C) and ID was serially mediated by sleep-related safety behaviors (SRBQ-20) and strong endorsement of dysfunctional beliefs about sleep (DBAS-16) (bias-corrected 95% confidence interval for the indirect effect = 0.013, 0.093). An alternate serial mediation model in which dysfunctional beliefs about sleep precede sleep-related safety behaviors was not statistically significant (bias-corrected 95% confidence interval for the indirect effect = -0.001, 0.046). CONCLUSIONS: ID comorbid to PD is associated with the classic psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Target-oriented interventions for instance cognitive behavioral therapy for chronic insomnia should be considered as a treatment approach for ID comorbid to PD. CITATION: Lebrun C, Gély-Nargeot M-C, Maudarbocus KH, Rossignol A, Geny C, Bayard S. Presleep cognitive arousal and insomnia comorbid to parkinson disease: evidence for a serial mediation model of sleep-related safety behaviors and dysfunctional beliefs about sleep. J Clin Sleep Med. 2019;15(9):1217-1224.

Psychological processes associated with insomnia in patients with multiple sclerosis.

Study Objectives: Despite the high comorbidity of insomnia disorder (ID) with multiple sclerosis (MS), the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in this neurological disorder. This study aimed to ascertain to what extent the suggested emotional, cognitive, and behavioral processes maintaining insomnia are relevant in people with insomnia and MS. Methods: A between-subjects design was used to compare 26 patients with insomnia and MS, with 31 patients with MS only, and with 26 matched neurological disease-free individuals with insomnia. All patients participated in a standardized clinical interview and completed a battery of self-reported measures of cognitive and somatic presleep arousal experienced at bedtime, sleep- or insomnia-related unhelpful beliefs, and sleep-related safety behaviors. All patients with MS underwent a neurological examination. Results: ID comorbid to MS was strongly associated with increased levels of cognitive and somatic arousal, higher endorsement of dysfunctional beliefs about the consequences of insomnia on daytime functioning, and worry about insomnia and more frequent engagement in sleep-related safety behaviors. Patients with MS with ID did not differ from neurological disease-free individuals with insomnia on these measures. No link was found between MS clinical peculiarities and ID diagnosis. Conclusions: ID comorbid to MS is associated with the classical psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Primary care providers and neurologists should consider target-oriented therapies like cognitive behavioral therapy for chronic insomnia as a treatment approach for ID comorbid to MS.

Validation of a French version of the Sleep Condition Indicator: a clinical screening tool for insomnia disorder according to DSM-5 criteria.

Insomnia disorder is frequent in the population, yet there is no French screening instrument available that is based on the updated DSM-5 criteria. We evaluated the validity and reliability of the French version of an insomnia screening instrument based on DSM-5 criteria, the Sleep Condition Indicator, in a population-based sample of adults. A total of 366 community-dwelling participants completed a face-to-face clinical interview to determine insomnia disorder against DSM-5 criteria and several questionnaires including the French Sleep Condition Indicator version. Three-hundred and twenty-nine participants completed the Sleep Condition Indicator again after 1 month. Statistical analyses were performed to determine the reliability, construct validity, divergent validity and temporal stability of the French translation of the Sleep Condition Indicator. In addition, an explanatory factor analysis was performed to assess the underlying structure. The internal consistency (α = 0.87) and temporal stability (r = 0.86, P < 0.001) of the French Sleep Condition Indicator were high. When using the previously defined cut-off value of ≤ 16, the area under the receiver operating characteristic curve was 0.93 with a sensitivity of 95% and a specificity of 75%. Additionally, good construct and divergent validity were demonstrated. The factor analyses showed a two-factor structure with a focus on sleep and daytime effects. The French version of the Sleep Condition Indicator demonstrates satisfactory psychometric properties while being a useful instrument in detecting cases of insomnia disorder, consistent with features of DSM-5, in the general population.