A psychological view on the effectiveness of psychosocial interventions on positive airway pressure treatment adherence and sleep quality in patients with obstructive sleep apnea.

Positive airway pressure treatment (CPAP) is the gold standard for obstructive sleep apnea syndrome (OSAS). CPAP is highly effective, but its issue lays in poor adherence rates mainly caused by its invasive nature and related stigma. In accordance with a biopsychosocial model of CPAP adherence, psychosocial interventions have been implemented to alleviate low rates of adherence with promising results. The increase in the number of psychosocial interventions has highlighted the need to systematically evaluate their effectiveness. This review aims to identify psychosocial interventions used to increase CPAP adherence, to compile available data on their effectiveness, and the reasons why they are effective. Moreover, the review evaluates the impact of the interventions on sleep quality. Experimental and quasi-experimental studies testing psychosocial interventions (excluding educational only interventions) that aimed to increase CPAP adherence in adults with obstructive sleep apnea vs. no intervention or control group were included. A literature search in PsycINFO, MEDLINE, COCHRANE, EMBASE, CINAHL, and Web of Science was performed for studies published in English and French between 1980 and January 2020. Risk of bias and methodological quality were assessed using the Joanna Briggs Institute Critical Appraisal Tools. Fourteen studies were included involving 1923 participants, six trials tested a motivational intervention, three trials tested a cognitive behavioral intervention and five others tested one of the following: relaxation, exposition therapy, phone coaching, audiotape or stage-matched intervention. Thirteen studies reported a positive effect of the intervention on CPAP adherence, while one reported no effect. Psychosocial interventions for CPAP adherence appear effective at increasing sleep quality, but more studies are needed to test this hypothesis. Reasons for the effectiveness of the interventions were pooled into five categories: time related, the intervention's adaptability, the patient's characteristics, the intervention's nature and characteristics and the intervention's specifics and target. The current review raises a significant gap between the biomedical and psychosocial domains. In fact, even in a psychosocial intervention study, the interpretation of the results revolves around biomedical models and very little consideration is given to biopsychosocial models. Our findings demonstrate the importance of examining the relationship between psychosocial variables and CPAP adherence to better tailor interventions to increase CPAP adherence.

Insomnia and sleep misperception.

Sleep misperception is often observed in insomnia individuals (INS). The extent of misperception varies between different types of INS. The following paper comprised sections which will be aimed at studying the sleep EEG and compares it to subjective reports of sleep in individuals suffering from either psychophysiological insomnia or paradoxical insomnia and good sleeper controls. The EEG can be studied without any intervention (thus using the raw data) via either PSG or fine quantitative EEG analyses (power spectral analysis [PSA]), identifying EEG patterns as in the case of cyclic alternating patterns (CAPs) or by decorticating the EEG while scoring the different transient or phasic events (K-Complexes or sleep spindles). One can also act on the on-going EEG by delivering stimuli so to study their impact on cortical measures as in the case of event-related potential studies (ERPs). From the paucity of studies available using these different techniques, a general conclusion can be reached: sleep misperception is not an easy phenomenon to quantify and its clinical value is not well recognized. Still, while none of the techniques or EEG measures defined in the paper is available and/or recommended to diagnose insomnia, ERPs might be the most indicated technique to study hyperarousal and sleep quality in different types of INS. More research shall also be dedicated to EEG patterns and transient phasic events as these EEG scoring techniques can offer a unique insight of sleep misperception.

Behavioural correlates of the P3b event-related potential in school-age children.

The latency and amplitude of the P3b component of event-related potentials (ERPs) have been related to behavioural performance on several attention and memory tasks in adult populations. However, the extent to which these results apply to children is unknown. This study examined the neurobehavioral correlates of the P3b component in a longitudinal sample of school-age children from Arctic Québec. Children (N=110; mean age=11.3years) were assessed on an ERP auditory oddball paradigm and a neurobehavioral evaluation targeting several aspects of cognition, including the Stewart Extended Continuous Performance Test (E-CPT), California Verbal Learning Test (CVLT), Stroop Color-Word Interference Test, and five subtests from the Wechsler Intelligence Scale for Children-Fourth edition (WISC-IV). P3b latency was positively related to reaction time measures and negatively associated with performance on the WISC-IV Digit Span Forward subtest. Amplitude of the P3b was associated with shorter completion time on the Stroop test and better delayed recognition memory performance among children who did not use semantic strategies on the CVLT. Profile analyses revealed no difference in scalp distribution of the P3b according to performance on these tests. The results are consistent with previous studies with older participants and suggest that, despite age-related differences in waveform and scalp distribution, the P3b component relates to similar neurocognitive processes in children and adults.

Validation of the Insomnia Severity Index as an outcome measure for insomnia research.

Background: Insomnia is a prevalent health complaint that is often difficult to evaluate reliably. There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints.Objective: This paper reports on the clinical validation of the Insomnia Severity Index (ISI) as a brief screening measure of insomnia and as an outcome measure in treatment research. The psychometric properties (internal consistency, concurrent validity, factor structure) of the ISI were evaluated in two samples of insomnia patients.Methods: The first study examined the internal consistency and concurrent validity of the ISI in 145 patients evaluated for insomnia at a sleep disorders clinic. Data from the ISI were compared to those of a sleep diary measure. In the second study, the concurrent validity of the ISI was evaluated in a sample of 78 older patients who participated in a randomized-controlled trial of behavioral and pharmacological therapies for insomnia. Change scores on the ISI over time were compared with those obtained from sleep diaries and polysomnography. Comparisons were also made between ISI scores obtained from patients, significant others, and clinicians.Results: The results of Study 1 showed that the ISI has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties. The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment. In addition, there is a close convergence between scores obtained from the ISI patient's version and those from the clinician's and significant other's versions.Conclusions: The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity. The ISI is likely to be a clinically useful tool as a screening device or as an outcome measure in insomnia treatment research.

Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults.

This study evaluated the impact of insomnia and chronic use of benzodiazepines on the cognitive and psychomotor performance of older adults. Three conditions, matched on age, gender, and education, were compared: 20 prolonged users of benzodiazepines for insomnia, 20 unmedicated insomniacs, and 20 good sleepers. The participants completed neuropsychological tests of memory, attention/concentration, psychomotor speed, and executive functions, as well as subjective evaluations of their actual performance. Individuals with insomnia, both medicated and unmedicated, performed worse than good sleepers on the attention/concentration factor. There was no other objective evidence of performance impairments. However, unmedicated insomniacs had lower performance expectancies and subjectively rated their performance more negatively relative to medicated insomniacs and good sleepers. Both insomnia conditions also rated their performance as lower compared with their perceived potential. It is suggested that the attention/concentration difficulties experienced by medicated and unmedicated older adults with insomnia may be linked to a state of hyperarousal. The discrepancies between subjective reports of daytime deficits and objective impairments may reflect a generalized faulty appraisal of sleep and daytime functioning among individuals with insomnia complaints. The implications of those findings for the assessment and treatment of late-life insomnia are discussed.

Familial incidence of insomnia.

This study evaluated the familial incidence of sleep disturbances among individuals with insomnia complaints. The sample consisted of 285 patients evaluated for insomnia at a sleep disorders clinic. All patients completed a sleep survey and underwent a semistructured clinical interview as part of their initial evaluation of insomnia. Information on the presence and nature of sleep disturbances among their family members (first- and second-degree relatives) was obtained from a sleep survey. The findings indicate that 35% of patients consulting for insomnia had a positive family history of sleep disturbances. Insomnia was the most common type of sleep disturbance identified (76%) and the mother was the most frequently afflicted family member. Reports of sleep disturbances among a family member were more prevalent when the onset of insomnia was before 40-years-old than when it was later in life. A positive family history was slightly higher when the insomnia complaint involved sleep-onset difficulties relative to sleep-maintenance or mixed insomnias. Although the present findings suggest that a positive family history of insomnia may be a potential risk factor for insomnia, it is unclear whether this reflects a genetic predisposition or a social learning phenomenon.

EEG characteristics prior to and following the evoked K-Complex.

This study was designed to determine if the K-Complex reflects an arousal from sleep or a sleep protection mechanism. Ten participants were presented auditory stimuli every 20 s while asleep. Trials were sorted according to the presence or absence of a K-Complex. A fast Fourier Transformation of the data was computed on EEG segments prior to and following stimulus onset. The log power of activity in delta, theta, alpha, sigma, and beta bandwidths was computed. When a K-Complex was elicited, there were no differences in EEG activity prior to and following the stimulus. However, during slow wave sleep, when a K-Complex was not elicited, there was a significant overall increase in theta, alpha, sigma, and beta activity following stimulus. These results tend to support the notion that the K-Complex appears to prevent arousal.