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1.
Sleep ; 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34788453

RESUMO

STUDY OBJECTIVES: Insomnia has been on the rise during the 2019 coronavirus disease (COVID-19) pandemic, which may disproportionately affect racial minorities. This study characterized racial disparities in insomnia during the pandemic and evaluated mechanisms for such disparities. METHODS: Participants included 196 adults (48 Black) from a 2016-2017 clinical trial of insomnia treatment who were reevaluated in April 2020. Race was evaluated as a predictor of change in insomnia, impact of COVID-19, and COVID-19 stress. Mediation models using the PRODCLIN method evaluated the extent to which: (1) COVID-19 impact accounted for Black-White disparities in change in insomnia, and (2) COVID-19 stress accounted for associations between discrimination and change in insomnia. RESULTS: Increases in insomnia symptoms during COVID-19 were greater in Black compared to White participants, with 4.3 times the odds of severe insomnia (Insomnia Severity Index ≥ 22). Symptom severity was associated with pre-pandemic experiences of discrimination. Black participants were also disproportionately impacted by COVID-19, with twice the odds of irreparable loss of income/employment and four times the rate of COVID-19 diagnoses in their sociofamilial network compared to White participants. The disproportionate impact of COVID-19 accounted for 69.2% of the relationship between race and change in insomnia severity, and COVID-19 related stress accounted for 66.5% of the relationship between prior history of racial discrimination and change in insomnia severity. CONCLUSIONS: Black-White disparities in insomnia severity during COVID-19 may be driven by structural inequities resulting in the disproportionate impact of COVID-19 on Black Americans. Results lend support for the minority stress model in the context of sleep health. CLINICAL TRIAL REGISTRATION: Sleep to Prevent Evolving Affecting Disorders (SPREAD). NCT number: NCT02988375. https://clinicaltrials.gov/ct2/show/NCT02988375.

2.
J Clin Sleep Med ; 17(11): 2283-2306, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34666885

RESUMO

CITATION: Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

3.
Behav Sleep Med ; : 1-11, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511016

RESUMO

STUDY OBJECTIVES: Digital cognitive behavioral therapy for insomnia (dCBT-I) can reduce acute insomnia and depressive symptoms and prevent symptom recurrence. The current study evaluated self-efficacy in managing insomnia symptoms as a potential mediator of the relationship between prior dCBT-I and subsequent insomnia and depressive symptoms assessed during the coronavirus 2019 (COVID-19) pandemic. METHOD: Participants were 208 adults who completed a randomized controlled trial of dCBT-I versus sleep education in 2016-2017 and also completed self-report assessments of insomnia, depression, and self-efficacy in managing insomnia symptoms. Data were collected in May 2020, five weeks into state-wide COVID-19 stay-at-home orders. Regression and mediation analyses were used to evaluate the extent to which self-efficacy accounted for the relationship between treatment condition and improvement in insomnia and depressive symptoms from pre-treatment to COVID-19 follow-up. RESULTS: Prior dCBT-I predicted greater self-efficacy in managing insomnia symptoms. Self-efficacy accounted for 49% and 67% of the protective effect of dCBT-I against COVID-era insomnia and depressive symptoms, respectively. CONCLUSIONS: This study affirms the importance of self-efficacy as a key intervention outcome and potential mechanism by which dCBT-I predicts future sleep and mental health. Future studies that evaluate the role of self-efficacy in treatment effectiveness and resilience can provide additional clues about how to optimize dCBT-I for maximum benefit to public health.

4.
Sleep ; 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34373924

RESUMO

Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

5.
Mil Med ; 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34424328

RESUMO

INTRODUCTION: Sleep disorders' are highly prevalent among U.S. active duty service members (ADSMs) and present well-documented challenges to military health, safety, and performance. In addition to increased need for sleep medicine services, a major barrier to effective sleep management has been a lack of alignment among patients, health providers, and economic-decision-makers. To address this gap in knowledge, the purpose of the present study was to engage diverse stakeholders vested in improving sleep disorders' management in the military. MATERIALS AND METHODS: We elicited feedback from ADSMs with sleep disorders (five focus group discussion, n = 26) and primary care managers (PCMs) (11 individual semi-structured interview) in two military treatment facilities (MTFs) in the National Capitol Region, in addition to national level military and civilian administrative stakeholders (11 individual semi-structured interview) about their experiences with sleep disorders' management in U.S. MTFs, including facilitators and barriers for reaching a definitive sleep diagnosis, convenience and effectiveness of sleep treatments, and key desired outcomes from interventions designed to address effectively sleep disorders in the U.S. military health care system (MHS). Recordings from focus groups and semi-structured interviews were transcribed verbatim and analyzed using QSR International's NVivo 12 software using inductive thematic analysis. The study was approved by Walter Reed National Military Medical Center Department of Research Programs. RESULTS: Active duty service members with sleep disorders often fail to recognize their need for professional sleep management. Whereas PCMs identified themselves as first-line providers for sleep disorders in the military, patients lacked confidence that PCMs can make accurate diagnoses and deliver effective sleep treatments. Active duty service members cited needs for expeditious treatment, educational support and care coordination, and support for obtaining sleep treatments during deployment. Challenges that PCMs identified for effective management include insufficient time during routine care visits, delays in scheduling testing procedures, and limited number of sleep specialists. Primary care managers suggested offering evidence-based telehealth tools and enhanced care coordination between PCMs and specialists; standardized medical education, materials, and tools; patient preparation before appointments; self-administered patient education; and including behavioral sleep specialists as part of the sleep management team. For administrative stakeholders, key outcomes of enhanced sleep management included (1) improved resource allocation and cost savings, and (2) improved ADSM safety, productivity, and combat effectiveness. CONCLUSION: Current military sleep management practices are neither satisfactory nor maximally effective. Our findings suggest that solving the military sleep problem will require sustained effort and ongoing collaboration from ADSM patients, providers, and health systems leaders. Important potential roles for telehealth and technology were identified. Future research should seek to enhance implementation of sleep management best practices to improve outcomes for patients, providers, MHS, and the military as a whole.

6.
Neuropsychiatr Dis Treat ; 17: 2549-2566, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34393484

RESUMO

Chronic insomnia disorder, which affects 6-10% of the population, is diagnostically characterized by ongoing difficulties with initiating or maintaining sleep occurring at least three times per week, persisting for at least 3 months, and associated with daytime impairment. While chronic insomnia is often considered a condition primarily related to impaired sleep, the disorder can also adversely affect domains of physical and mental health, quality of life, and daytime function, which highlights the importance of treating the multidimensional sleep disorder. Owing to misperceptions about the safety and effectiveness of treatment options, many individuals with insomnia may not seek professional treatment, and alternatively use ineffective home remedies or over-the-counter medications to improve sleep. Some physicians may even believe that insomnia is remediated by simply having the patient "get more sleep". Unfortunately, treatment of insomnia is not always that simple. The disorder's complex underlying pathophysiology warrants consideration of different nonpharmacologic and pharmacologic treatment options. Indeed, recent insights gained from research into the pathophysiology of insomnia have facilitated development of newer treatment approaches with more efficacious outcomes. This narrative review provides a summary of the diagnostic criteria and pathophysiology of insomnia and its subtypes. Further, this review emphasizes new and emerging nonpharmacologic and pharmacologic treatments for chronic insomnia, including recent enhancements in approaches to cognitive behavioral therapy for insomnia (CBT-I) and the new dual orexin receptor antagonist (DORA) pharmacologics. These advances in treatment have expanded the treatment options and are likely to result in improved outcomes in patients with chronic insomnia.

7.
Sleep ; 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34263305

RESUMO

Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: 1) a recognition of the factors contributing to fatigue and fatigue-related risks; 2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and 3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

8.
J Clin Sleep Med ; 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34180805

RESUMO

Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: 1) a recognition of the factors contributing to fatigue and fatigue-related risks; 2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and 3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.

9.
Nat Sci Sleep ; 13: 729-737, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34113200

RESUMO

Purpose: Insufficient nocturnal sleep is a primary source of excessive daytime sleepiness. Most previous research has focused on the disparity between sleep demands and study start times in adolescents. Fewer studies have focused on elementary schoolchildren. We hypothesize that late sleep timing is connected to excessive daytime sleepiness in a sample of Russian children and adolescents. The major goals of our study were to evaluate excessive daytime sleepiness in Russian schoolchildren and adolescents using the Russian version of the Pediatric Daytime Sleepiness Scale (PDSS) and to estimate its relationship with sleep-wake parameters using the Munich Chronotype Questionnaire (MCTQ). Materials and Methods: Student subjects were from public educational facilities in the Republic of Karelia. They completed both the PDSS and the Munich Chronotype Questionnaire to estimate sleep parameters and chronotype (MSFsc). Five hundred and eleven students provided data for the PDSS and sleep-wake variables, and 479 for the full MCTQ data. Results: The overall prevalence of Excessive Daytime Sleepiness (EDS) in our sample was 18%. The total PDSS score was inversely correlated with sleep length on school nights and was independent of respondents' sex. Higher PDSS scores were associated with later bedtimes on school days and free days, and shorter sleep duration on school days. Late chronotype and more pronounced social jetlag were both positively correlated with high PDSS scores. A negative correlation was found between chronotype and the duration of the sleep period on weekdays (p < 0.001) and a positive correlation was found on weekends (p < 0.001). Longer average sleep duration was positively related to less daytime sleepiness. Conclusion: This study suggests that excessive daytime sleepiness is chronotype-dependent. School start times could be shifted to a later hour to prolong sleep and reduce EDS.

10.
Nat Sci Sleep ; 13: 625-633, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34040471

RESUMO

Purpose: Sleep problems pose serious public health concerns, and evidence suggests that the problem is worsening. Both sufficient sleep quantity and quality are needed for optimal health, particularly among older adults, but access to sleep care can be difficult. This study examined the efficacy of a six-week sleep behavior change program designed for older adults that was delivered virtually by health educators. Participants and Methods: This quasi-experimental pilot study (intervention n = 22; control n = 31) explored the effects of the Sleep Education for Elders Program (SLEEP) on sleep outcomes, which included: 1) sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI); 2) sleep duration, extracted from the PSQI; 3) insomnia symptoms, measured by the Insomnia Severity Index; 4) sleep hygiene behaviors, obtained from the Sleep Hygiene Index; and 5) excessive daytime sleepiness, measured by the Epworth Sleepiness Scale. Results: After SLEEP, the intervention group experienced significantly improved sleep quality (p < 0.001), a reduction in maladaptive sleep hygiene behaviors (p = 0.007), and reduced daytime sleepiness (p < 0.027) compared to the control group. Effect sizes for all five sleep measures were medium or large. In the intervention group, all changes were judged to be clinically meaningful (≥ 0.5 SD) except for improvements in daytime sleepiness. Conclusion: These data support the efficacy of a group-based, virtual behavior change intervention in improving sleep outcomes among older adults.

11.
Behav Sleep Med ; : 1-17, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34047659

RESUMO

Objective: Emerging evidence links maternal and infant sleep problems to impairments in the mother-to-infant bond, but the independence and directionality of these associations remain unclear. The present study characterized concurrent and prospective effects of maternal sleep disturbances and poor infant sleep on the mother-infant relationship. As common sequalae of problematic sleep, nocturnal cognitive hyperarousal and daytime sleepiness were investigated as facilitating mechanisms.Participants: Sixty-seven pregnant women enrolled in a prospective study on maternal sleep.Methods: Sociodemographic information and clinical symptoms were measured prenatally then weekly across the first two postpartum months. Women reported insomnia symptoms, sleep duration, snoring, daytime sleepiness, nocturnal cognitive arousal (broadly focused and perinatal-specific), perseverative thinking, depression, infant colic, infant sleep quality, and mother-infant relationship quality. Mixed effects models were conducted to test hypotheses.Results: Prenatal snoring and weak maternal-fetal attachment augured poorer postpartum bonding. Poor infant sleep was associated with increased odds for maternal insomnia and short sleep. Impairments in the mother-to-infant bond were linked to maternal insomnia, nocturnal perinatal-focused rumination, daytime sleepiness, depression, and poor infant sleep. Postnatal insomnia predicted future decreases in mother-infant relationship quality, and nocturnal cognitive hyperarousal partially mediated this association.Conclusions: Both maternal and infant sleep problems were associated with poorer mother-to-infant bonding, independent of the effects of maternal depression and infant colic. Perseverative thinking at night, particularly on infant-related concerns, was linked to impaired bonding, rejection and anger, and infant-focused anxiety. Improving maternal and infant sleep, and reducing maternal cognitive arousal, may improve the maternal-to-infant bond.

12.
Sleep ; 44(6)2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-33830248

RESUMO

STUDY OBJECTIVES: Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. METHODS: Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. RESULTS: Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23-43% of the effect of insomnia on depression. Insomnia mediated 12%-18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. CONCLUSION: Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Nível de Alerta , Cognição , Depressão/epidemiologia , Feminino , Humanos , Gravidez , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia
13.
Sleep Med ; 81: 439-442, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33839373

RESUMO

OBJECTIVES: This prospective study explored associations among insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with depression. METHODS: From late pregnancy through early postpartum, 39 depressed women completed 17 weekly surveys assessing SI, insomnia, depression, stress, and cognitive arousal. RESULTS: Women with nocturnal cognitive hyperarousal at baseline, relative to those with low cognitive arousal, were at greater risk for new onset SI (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR = 5.66, p = 0.037) or perinatal-focused rumination (OR = 11.63, p = 0.018). Daytime perseverative thinking was not uniquely associated with SI. CONCLUSIONS: Nocturnal cognitive arousal predicts the development of new onset SI, and perinatal-focused rumination is also uniquely associated with SI-risk in late pregnancy and early parenting. Critically, SI-risk is highest when perinatal women endorsed insomnia and high cognitive arousal at the same time. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Nível de Alerta , Cognição , Depressão , Feminino , Humanos , Gravidez , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/complicações , Ideação Suicida
14.
Behav Sleep Med ; : 1-20, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33719795

RESUMO

Objective: Insomnia affects over half of pregnant and postpartum women. Early evidence indicates that cognitive-behavioral therapy for insomnia (CBTI) improves maternal sleep and mood. However, standard CBTI may be less efficacious in perinatal women than the broader insomnia population. This study sought to identify patient characteristics in a perinatal sample associated with poor response to CBTI, and characterize patient feedback to identify areas of insomnia therapy to tailor for the perinatal experience.Participants: Secondary analysis of 46 pregnant women with insomnia symptoms who were treated with digital CBTI in a randomized controlled trial.Methods: We assessed insomnia, cognitive arousal, and depression before and after prenatal treatment, then 6 weeks postpartum. Patients provided feedback on digital CBTI.Results: Residual cognitive arousal after treatment was the most robust factor associated with treatment non-response. Critically, CBTI responders and non-responders differed on no other sociodemographic or pretreatment metrics. After childbirth, short sleep (<6 hrs/night) was associated with maternal reports of poor infant sleep quality. Patient feedback indicated that most patients preferred online treatment to in-person treatment. Although women described digital CBTI as convenient and helpful, many patients indicated that insomnia therapy would be improved if it addressed sleep challenges unique to pregnancy and postpartum. Patients requested education on maternal and infant sleep, flexibility in behavioral sleep strategies, and guidance to manage infant sleep.Conclusions: Modifying insomnia therapy to better alleviate refractory cognitive arousal and address the changing needs of women as they progress through pregnancy and early parenting may increase efficacy for perinatal insomnia.Name: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum DepressionURL: clinicaltrials.govRegistration: NCT03596879.

15.
Behav Sleep Med ; : 1-16, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33618569

RESUMO

Background: Poor sleep quality is associated with a broad range of psychopathology and is a common problem among college students. This study aimed to investigate the mediating role of metacognitive beliefs related to sleep, emotion regulation and a negative cognitive style related to anxiety (looming cognitive style) in the relation between neuroticism and reported sleep quality.Participants: Participants were 343 undergraduates from three universities in Tehran (56.3% females, Mean age = 22.01 ± 2.74 years).Method: Data were gathered with a questionnaire packet that included the Pittsburgh Sleep Quality Index (PSQI), Metacognitions Questionnaire-Insomnia (MCQ-I), Emotion Regulation Questionnaire (ERQ), Looming Maladaptive Style Questionnaire (LMSQ) and Neuroticism subscale of NEO-PI-R.Results: Structural equation modeling analyses supported a proposed model (R2 = 37%) which proposed that neuroticism both directly and indirectly linked to reported sleep quality through metacognitions related to sleep, cognitive reappraisal and looming cognitive style (χ2 = 1194.87, p < .001; CFI = 0.93, NFI = 0.90, RMSEA = 0.065, GFI = 0.92, SRMR = 0.069, IFI = 0.93).Conclusions: The results provide evidence for the impact of neuroticism on reported sleep quality through metacognitive, cognitive and emotional factors. The result suggest that special attention should be paid to these factors in the treatment and psychopathology of sleep quality.

16.
Sleep ; 44(2)2021 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-32918087

RESUMO

STUDY OBJECTIVES: A critical barrier to successful treatment of circadian misalignment in shift workers is determining circadian phase in a clinical or field setting. Light and movement data collected passively from wrist actigraphy can generate predictions of circadian phase via mathematical models; however, these models have largely been tested in non-shift working adults. This study tested the feasibility and accuracy of actigraphy in predicting dim light melatonin onset (DLMO) in fixed night shift workers. METHODS: A sample of 45 night shift workers wore wrist actigraphs before completing DLMO in the laboratory (17.0 days ± 10.3 SD). DLMO was assessed via 24 hourly saliva samples in dim light (<10 lux). Data from actigraphy were provided as input to a mathematical model to generate predictions of circadian phase. Agreement was assessed and compared to average sleep timing on non-workdays as a proxy of DLMO. Model code and an open-source prototype assessment tool are available (www.predictDLMO.com). RESULTS: Model predictions of DLMO showed good concordance with in-lab DLMO, with Lin's concordance coefficient of 0.70, which was twice as high as agreement using average sleep timing as a proxy of DLMO. The absolute mean error of the predictions was 2.88 h, with 76% and 91% of the predictions falling with 2 and 4 h, respectively. CONCLUSION: This study is the first to demonstrate the use of wrist actigraphy-based estimates of circadian phase as a clinically useful and valid alternative to in-lab measurement of DLMO in fixed night shift workers. Future research should explore how additional predictors may impact accuracy.


Assuntos
Melatonina , Dispositivos Eletrônicos Vestíveis , Actigrafia , Adulto , Ritmo Circadiano , Humanos , Luz , Fotometria , Sono , Punho
17.
Sleep ; 44(4)2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33249492

RESUMO

STUDY OBJECTIVES: Stressful life events contribute to insomnia, psychosocial functioning, and illness. Though individuals with a history of insomnia may be especially vulnerable during stressful life events, risk may be mitigated by prior intervention. This study evaluated the effect of prior digital cognitive-behavioral therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic. METHODS: COVID impact, insomnia, general- and COVID-related stress, depression, and global health were assessed in April 2020 in adults with a history of insomnia who completed a randomized controlled trial of dCBT-I (n = 102) versus sleep education control (n = 106) in 2016-2017. Regression analyses were used to evaluate the effect of intervention conditions on subsequent stress and health during the pandemic. RESULTS: Insomnia symptoms were significantly associated with COVID-19 related disruptions, and those who previously received dCBT-I reported less insomnia symptoms, less general stress and COVID-related cognitive intrusions, less depression, and better global health than those who received sleep education. Moreover, the odds for resurgent insomnia was 51% lower in the dCBT-I versus control condition. Similarly, odds of moderate to severe depression during COVID-19 was 57% lower in the dCBT-I condition. CONCLUSIONS: Those who received dCBT-I had increased health resilience during the COVID-19 pandemic in adults with a history of insomnia and ongoing mild to moderate mental health symptoms. These data provide evidence that dCBT-I is a powerful tool to promote mental and physical health during stressors, including the COVID-19 pandemic. CLINICAL TRIAL REGISTRATION: NCT02988375.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Adulto , Depressão/epidemiologia , Depressão/terapia , Humanos , Pandemias , SARS-CoV-2 , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento
18.
Sleep Health ; 6(5): 543-549, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32928711

RESUMO

STUDY OBJECTIVES: Racial and ethnic minorities are more likely to suffer from insomnia that is more severe; however, few studies have examined mechanisms by which racial disparities in severity of insomnia disorder may arise. One potential mechanism for disparities in insomnia severity is perceived discrimination. This study tested discrimination as a mediator in the relationship between race and insomnia. METHODS: Participants were recruited from communities in the Detroit metropolitan area and were diagnosed with insomnia disorder using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). The final sample included 1,458 individuals. Insomnia symptom severity was assessed via the Insomnia Severity Index and self-reported racial discrimination was evaluated using a single item. Racial discrimination was tested as a mediator in the relationship between race and insomnia symptom severity. Individuals were categroized as either White or a racial minority (i.e., non White individuals), with sensitivity analyses examining Black individuals and non-Black racial minority groups. RESULTS: Consistent with our hypothesis, racial discrimination was a significant mediator accounting for 57.3% of the relationship between race and insomnia symptom severity. Sensitivity analyses indicated that the indirect effect of racial discrimination was stronger in the non-Black racial minority group compared to Black individuals. CONCLUSIONS: These results provide support that racial discrimination is likely an important mechanism by which racial and ethnic sleep disparities exist. Implications for prevention, intervention, and treatment of insomnia in racial minorities to reduce health disparities are discussed.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Grupos Minoritários/estatística & dados numéricos , Racismo , Distúrbios do Início e da Manutenção do Sono/etnologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato
19.
Sleep Med ; 73: 82-92, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32799029

RESUMO

STUDY OBJECTIVES: To determine whether insomnia patients with objective sleep disturbance are less responsive to cognitive and behavioral treatments than those without objective sleep disturbance, characterize effects of insomnia therapy on objective sleep, and determine whether reductions in nocturnal cognitive arousal correspond to changes in objective sleep. METHODS: Secondary analysis of a single-site, randomized controlled trial. 113 postmenopausal women (56.40 ± 5.34 years) with menopause-related insomnia disorder were randomized to three treatment conditions: cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy (SRT), or sleep education control. Primary outcomes were the Insomnia Severity Index (ISI) and polysomnography (PSG) sleep parameters and were collected at pretreatment, posttreatment, and six-month follow-up. RESULTS: Patients with lower pretreatment PSG sleep efficiency had lower rates of insomnia remission after active treatment relative to those with higher sleep efficiency (37.8% vs 61.8%). Neither CBTI and SRT produced clinically meaningful effects on PSG sleep. Exploratory analyses revealed that reductions in nocturnal cognitive arousal were associated with decreases in PSG sleep latency, but not wake after sleep onset. CONCLUSIONS: Our findings support an emerging literature suggesting that insomnia patients with objective sleep disturbance may have blunted response to insomnia therapy. Research is needed to enhance treatments to better improve insomnia in patients with objective sleep disturbance. A lack of observed CBTI and SRT effects on PSG sleep suggests that these therapies may be presently ill-designed to improve objective sleep. Nocturnal cognitive arousal may represent an entry point to improve objective sleep latency in insomnia. NAME: Behavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov. Registration: NCT01933295.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Cognição , Feminino , Humanos , Pós-Menopausa , Sono , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento
20.
Sleep Med ; 72: 82-92, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32559716

RESUMO

OBJECTIVE: Despite high rates of prenatal insomnia, efficacious treatment options for this population are quite limited. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy internet-based digital CBTI in pregnant women with insomnia. METHODS: Single-site RCT. A total of 91 pregnant women (29.03 ± 4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale's Cognitive factor (PSAS-C) served as study outcomes, which were collected before treatment and after treatment during pregnancy, then six weeks after childbirth. RESULTS: From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p < 0.001) and PSQI (-2.98 points, p < 0.001) and increases in nightly sleep duration by 32 min (p = 0.008). Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 min per night (p = 0.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed. CONCLUSIONS: Digital CBTI improves sleep quality and sleep duration during pregnancy and after childbirth. To better optimize outcomes, CBTI should be tailored to meet the changing needs of women as the progress through pregnancy and early parenting. NAME: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum Depression. URL: clinicaltrials.gov. Registration: NCT03596879.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Feminino , Humanos , Gravidez , Gestantes , Sono , Distúrbios do Início e da Manutenção do Sono/terapia , Resultado do Tratamento
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