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1.
J Ethnopharmacol ; 264: 113276, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-32818573

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Ashwagandha (Withania somnifera (L.) Dunal.) is long known for its sleep-inducing effects. Ashwagandha can be proposed as an alternative to the recommended present treatments for insomnia. This study aimed to evaluate the pharmacological effect of Ashwagandha root extract on sleep in healthy subjects and also in the subjects having insomnia. MATERIAL AND METHODS: We performed a randomized, parallel-group, stratified design, placebo-controlled study. A total of 80 eligible participants, 40 in Arm-A (healthy) and 40 in Arm-B (insomnia) were assigned to two groups, either Ashwagandha or placebo and studied for 8-weeks. The assessment was done based on the sleep parameters (Sleep Onset Latency, Total Sleep Time, Wake After Sleep Onset, Total time in bed, and Sleep Efficiency), Pittsburgh Sleep Quality Index and Hamilton Anxiety scale-A questionnaire, mental alertness on rising assessment, and sleep quality questionnaire. Safety and adverse events along with the concomitant medication were also assessed. RESULTS: In both healthy and insomnia subjects, there was a significant improvement in the sleep parameters in the Ashwagandha root extract supplemented group. The improvement was found more significant in insomnia subjects than healthy subjects. Repeat measure Analysis of variance (ANOVA) confirmed the significant improvement in SOL (p 0.013), HAM-A outcomes (p < 0.05), mental alertness (p 0.01), and sleep quality (p < 0.05) of the insomnia patients. A two-way ANOVA was used to confirm the outcomes that denoted sleep onset latency (p < 0.0001) and sleep efficiency (p < 0.0001) as the most improved parameters, followed by TST (p < 0.002) and WASO(p < 0.040). All these parameters (SOL, TST, WASO, TIB, SE, PSQI, HAM-A, Mental Alertness, and Sleep quality) were also statistically assessed for the significant improvement within the group both for the treatment, and the placebo groups in the healthy and the insomnia datasets. Obtained results suggest statistically significant (p < 0.0001) changes between the baseline values and the end of the study results except for the HAM-A and the mental alertness scoresn the healthy subject group. CONCLUSION: The present study confirms that Ashwagandha root extract can improve sleep quality and can help in managing insomnia. Ashwagandha root extract was well tolerated by all the participants irrespective of their health condition and age. Additional clinical trials are required to generalize the outcome.


Assuntos
Extratos Vegetais/uso terapêutico , Raízes de Plantas , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Sono/efeitos dos fármacos , Actigrafia/métodos , Adulto , Método Duplo-Cego , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/isolamento & purificação , Extratos Vegetais/farmacologia , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia
2.
Rev. neurol. (Ed. impr.) ; 71(12): 438-446, 16 dic., 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-199337

RESUMO

INTRODUCCIÓN: El trastorno por déficit de atención/hiperactividad (TDAH) es uno de los trastornos mentales más comunes en la infancia. Los síntomas nucleares del TDAH se tratan con estimulantes como el metilfenidato; aun así, existe mucha controversia respecto a sus efectos secundarios. OBJETIVOS: Analizar los patrones de actividad en niños con TDAH durante un período de 24 horas durante siete días, antes y después de tomar tratamiento farmacológico estimulante (metilfenidato), y observar si existen diferencias entre las diferentes presentaciones del trastorno (subtipo inatento y combinado). PACIENTES Y MÉTODOS: Un total de 30 niños y adolescentes (recién diagnosticados de TDAH según los criterios diagnósticos del DSM-IV) fueron evaluados a través de un actígrafo, un instrumento que permite monitorizar los movimientos corporales analizando los patrones de movimiento y las diferencias entre sueño y vigilia. RESULTADOS: Existen diferencias significativas antes y después de realizar el tratamiento, con niveles de actividad más altos en los pacientes con TDAH antes de empezar el tratamiento y un decrecimiento de esta actividad tras el tratamiento farmacológico. También existen diferencias entre los subtipos inatento y combinado, y el último grupo muestra un nivel de actividad mayor. CONCLUSIONES: El nivel de activación que presentan los sujetos con TDAH es mayor antes de tomar tratamiento, e influye en los patrones circadianos, el sueño y la calidad de vida. El tratamiento farmacológico ayuda a disminuir el nivel de activación


INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood. The nuclear symptoms of ADHD are treated with stimulant medication such as methylphenidate; however, there's a lot of controversy regarding its side effects. AIMS. To analyse the activity patterns in children with ADHD during a period of 24 hours for seven days, before and after taking pharmacological treatment with stimulants (methylphenidate) and observe the differences between the different presentations of ADHD (inattentive and combined subtype). PATIENTS AND METHODS: A total of 30 children and adolescents (newly diagnosed with ADHD according to DSM-IV). Analyses were carried out through actigraphy, an instrument that allows us to monitor body movements by analysing movement patterns and differences between sleep and wakefulness. RESULTS: There were significant differences before and after treatment showing higher activity levels in patients with ADHD before treatment, and a decrease in this situation after taking pharmacological treatment. There are also differences between inattentive and combined subtype, showing the last group, higher activity levels. CONCLUSIONS: The level of activation presented by ADHD subjects is higher before taking stimulant treatment, influencing circadian patterns, sleep and quality of life. Pharmacological treatments help to decrease the level of activation


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Ritmo Circadiano/efeitos dos fármacos , Resultado do Tratamento , Polissonografia/métodos , Sono/fisiologia , Transtornos do Sono-Vigília/fisiopatologia , Vigília/fisiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Fatores de Tempo , Actigrafia/métodos
3.
PLoS One ; 15(9): e0238772, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946454

RESUMO

CONTEXT: Metabolic syndrome (MetS) is a complex condition comprising a 'clustering' of components representing cardiometabolic risk factors for heart disease and diabetes; its prevalence rate is high and consequences serious. Evidence suggests that light exposure patterns and misalignment of circadian rhythms might contribute to MetS etiology by impacting energy metabolism and glucose regulation. OBJECTIVE: We hypothesised that individuals with MetS would show disrupted circadian and sleep parameters alongside differences in light exposure profiles. We investigated this using data from a cohort study in Brazil. METHODS: Data from 103 individuals from the Baependi Heart Cohort Study aged between 50 and 70 were analysed. Motor activity and light exposure were measured using wrist-worn actigraphy devices. Cardiometabolic data were used to calculate the number of MetS components present in each participant, and participants grouped as MetS/non-MetS according to standard guidelines. Between-group comparisons were made for the actigraphy measures; additionally, correlation analyses were conducted. RESULTS: Motor activity and circadian profiles showed no differences between groups. However, the MetS group presented lower light exposure during the day and higher light exposure at night. Correlation analyses, including all participants, showed that greater daytime light exposure and greater light exposure difference between day and night were associated with reduced MetS risk (a lower number of MetS components). Also, the light exposure difference between day and night correlated with body mass index across all participants. CONCLUSIONS: The observed results suggest a direct association between light exposure and MetS which appears to not be attributable to disruptions in circadian activity rhythm nor to sleep parameters. This link between light exposure patterns and MetS risk could inform possible prevention strategies.


Assuntos
Luz , Síndrome Metabólica/etiologia , Actigrafia/métodos , Idoso , Brasil/epidemiologia , Ritmo Circadiano , Estudos de Coortes , Correlação de Dados , Feminino , Glucose/metabolismo , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Sono
4.
Stroke ; 51(8): 2297-2306, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32576090

RESUMO

BACKGROUND AND PURPOSE: Disabling anxiety affects a quarter of stroke survivors but access to treatment is poor. We developed a telemedicine model for delivering guided self-help cognitive behavioral therapy (CBT) for anxiety after stroke (TASK-CBT). We aimed to evaluate the feasibility of TASK-CBT in a randomized controlled trial workflow that enabled all trial procedures to be carried out remotely. In addition, we explored the feasibility of wrist-worn actigraphy sensor as a way of measuring objective outcomes in this clinical trial. METHODS: We recruited adult community-based stroke patients (n=27) and randomly allocated them to TASK-CBT (n=14) or relaxation therapy (TASK-Relax), an active comparator (n=13). RESULTS: In our sample (mean age 65 [±10]; 56% men; 63% stroke, 37% transient ischemic attacks), remote self-enrolment, electronic signature, intervention delivery, and automated follow-up were feasible. All participants completed all TASK-CBT sessions (14/14). Lower levels of anxiety were observed in TASK-CBT when compared with TASK-Relax at both weeks 6 and 20. Mean actigraphy sensor wearing-time was 33 days (±15). CONCLUSIONS: Our preliminary feasibility data from the current study support a larger definitive clinical trial and the use of wrist-worn actigraphy sensor in anxious stroke survivors. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03439813.


Assuntos
Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Estudo de Prova de Conceito , Acidente Vascular Cerebral/terapia , Telemedicina/métodos , Actigrafia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia de Relaxamento/métodos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia
5.
JAMA Netw Open ; 3(6): e206614, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32484552

RESUMO

Importance: Many shift workers have difficulty sleeping during the daytime owing to an inappropriately timed circadian drive for wakefulness. Objective: To determine whether a dual hypocretin receptor antagonist would enable shift workers to have more daytime sleep. Design, Setting, and Participants: This double-blind, placebo-controlled randomized clinical trial included 2 weeks of baseline data and 3 weeks of intervention data, from March 2016 to December 2018. Individuals were recruited through poster advertisements in the broader San Francisco Bay area in California. From an initial voluntary recruitment cohort of 38 shift workers, 19 individuals with self-reported difficulty sleeping during the daytime following night work shift were included. Data were analyzed from Janaury to March 2019. Interventions: 1 week of 10 mg suvorexant or placebo, titrated upward to 20 mg suvorexant or placebo for 2 additional weeks. Main Outcomes and Measures: Objective (ie, actigraphy) and subjective (ie, sleep logs) measures of sleep. Results: Among 19 participants who completed the study (mean [SD] age, 37.7 [11.1] years; 13 [68%] men), 8 participants (42%) were assigned to the suvorexant group and 11 participants (58%) were assigned to the placebo group. Compared with individuals in the placebo group, individuals in the suvorexant group increased their objective total sleep time by a mean (SE) of 1.04 (0.53) hours (P = .05) at the end of 1 week of 10-mg doses and by 2.16 (0.75) hours (P = .004) by the end of the 2 weeks of 20-mg doses. Subjective sleep was similarly improved as, compared with the placebo group, individuals in the suvorexant group increased their subjective total sleep time by a mean (SE) of 2.08 (0.47) hours (P < .001) at the end of 1 week of 10-mg doses and by 2.97 (0.56) hours (P < .001) by the end of the 2 weeks of 20-mg doses. Physician ratings of daytime sleep aligned with these measures, as there was no change in the placebo group and a much improved change in the suvorexant group. No adverse events were reported in the suvorexant group. Conclusions and Relevance: This pilot study found that the use of a dual hypocretin receptor antagonist in shift workers under real-world conditions resulted in more than 2 extra hours of daytime sleep per episode. Future research should confirm this pilot finding in a larger sample size and examine whether, over the long term, use of this medication has a concomitant improvement in medical and psychiatric health as well as workplace performance and safety. Trial Registration: ClinicalTrials.gov Identifier: NCT02491788.


Assuntos
Azepinas/uso terapêutico , Antagonistas dos Receptores de Orexina/uso terapêutico , Transtornos do Sono do Ritmo Circadiano/tratamento farmacológico , Sono/efeitos dos fármacos , Triazóis/uso terapêutico , Actigrafia/métodos , Adulto , California/epidemiologia , Estudos de Casos e Controles , Ritmo Circadiano/fisiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Transtornos do Sono do Ritmo Circadiano/epidemiologia , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia
6.
Respir Med ; 162: 105878, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32056676

RESUMO

BACKGROUND: Technology-based physical activity (PA) interventions have been shown to improve daily step counts and health-related quality of life, but their effect on long-term clinical outcomes like acute exacerbations (AEs) is unknown in persons with COPD. METHODS: U.S. Veterans with stable COPD were randomized (1:1) to either pedometer alone (control) or pedometer plus a website with feedback, goal-setting, disease education, and a community forum (intervention) for 3 months. AEs were assessed every 3 months over a follow-up period of approximately 15 months. Pedometer-assessed daily step counts, health-related quality-of-life (HRQL), and self-efficacy were assessed at baseline, end-of-intervention at 3 months, and during follow-up approximately 6 and 12 months after enrollment. Zero-inflated Poisson models assessed the effect of the intervention on risk for AEs, compared to controls. Generalized linear mixed-effects models for repeated measures examined between-group and within-group changes in daily step count, HRQL, and self-efficacy. RESULTS: There were no significant differences in age, FEV1% predicted, baseline daily step count, AEs the year prior to enrollment, or duration of follow-up between the intervention (n = 57) and control (n = 52) groups. The intervention group had a significantly reduced risk of AEs (rate ratio = 0.51, [95%CI 0.31-0.85]), compared to the control group. There were no significant between-group differences in change in average daily step count, HRQL, or self-efficacy at 6 and 12 months after enrollment. CONCLUSIONS: A 3-month internet-mediated, pedometer-based PA intervention was associated with reduced risk for AEs of COPD over 12-15 months of follow-up. ClinicalTrials.gov identifier: NCT01772082.


Assuntos
Actigrafia/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Caminhada , Idoso , Progressão da Doença , Feminino , Seguimentos , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/psicologia , Qualidade de Vida , Risco , Autoeficácia , Fatores de Tempo
7.
Artigo em Inglês | MEDLINE | ID: mdl-32046302

RESUMO

Physical activity is essential for physical and mental health, and its absence is highly associated with severe health conditions and disorders. Therefore, tracking activities of daily living can help promote quality of life. Wearable sensors in this regard can provide a reliable and economical means of tracking such activities, and such sensors are readily available in smartphones and watches. This study is the first of its kind to develop a wearable sensor-based physical activity classification system using a special class of supervised machine learning approaches called boosting algorithms. The study presents the performance analysis of several boosting algorithms (extreme gradient boosting-XGB, light gradient boosting machine-LGBM, gradient boosting-GB, cat boosting-CB and AdaBoost) in a fair and unbiased performance way using uniform dataset, feature set, feature selection method, performance metric and cross-validation techniques. The study utilizes the Smartphone-based dataset of thirty individuals. The results showed that the proposed method could accurately classify the activities of daily living with very high performance (above 90%). These findings suggest the strength of the proposed system in classifying activity of daily living using only the smartphone sensor's data and can assist in reducing the physical inactivity patterns to promote a healthier lifestyle and wellbeing.


Assuntos
Actigrafia/métodos , Atividades Cotidianas/classificação , Algoritmos , Exercício Físico , Smartphone , Aprendizado de Máquina Supervisionado , Actigrafia/instrumentação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Reprodutibilidade dos Testes
8.
Artigo em Inglês | MEDLINE | ID: mdl-32046311

RESUMO

BACKGROUND: Exercise has beneficial effects on older adults, but controversy surrounds the purported "compensatory effects" that training may have on total daily physical activity and energy expenditure in the elderly. We wanted to determine whether 8 weeks of high-intensity interval training (HIIT) induced such effects on physical activity and energy expenditure in healthy, active older adult men. METHODS: Twenty-four healthy elderly male volunteers were randomized to two groups. The experimental group performed HIIT (7 × 2 min cycling repetitions, 3 d/w); the control group performed continuous moderate-intensity training (20-30 min cycling, 3 d/w). Physical activity and energy expenditure were measured with a multisensor activity monitor SenseWear Armband Mini. RESULTS: During HIIT, significant changes were observed in moderate and vigorous physical activity, average daily metabolic equivalents (METs), physical activity level, and activity energy expenditure (p < 0.05) but not in total energy expenditure. Sleep and sedentary time, and levels of light physical activity remained constant during the training period. CONCLUSIONS: The findings suggest that HIIT induced no compensatory effect: HIIT does not adversely affect lifestyle, as it does not reduce daily energy expenditure and/or increase sedentary time.


Assuntos
Metabolismo Energético , Treinamento Intervalado de Alta Intensidade/efeitos adversos , Comportamento Sedentário , Actigrafia/instrumentação , Actigrafia/métodos , Idoso , Exercício Físico/fisiologia , Exercício Físico/psicologia , Estilo de Vida Saudável , Voluntários Saudáveis , Treinamento Intervalado de Alta Intensidade/métodos , Treinamento Intervalado de Alta Intensidade/psicologia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Sono
9.
BMC Pregnancy Childbirth ; 20(1): 99, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046663

RESUMO

BACKGROUND: Sedentary behavior (SED) is a potential risk factor for poor pregnancy outcomes. We evaluated the validity of several common and one new method to assess SED across three trimesters of pregnancy. METHODS: This cohort study of pregnant women measured objective and self-reported SED each trimester via thigh-worn activPAL3 micro (criterion), waist-worn Actigraph GT3X, and self-report from the Pregnancy Physical Activity Questionnaire (PPAQ) and the de novo Sedentary Behavior Two Domain Questionnaire (SB2D). SED (hours per day) and percent time in SED (SED%) from activPAL were compared to GT3X, SB2D, and PPAQ using Pearson's r, ICC, Bland-Altman analysis, and comparison of criterion SED and SED% across tertiles of alternative methods. RESULTS: Fifty-eight women (mean age 31.5 ± 4.8 years; pre-pregnancy BMI 25.1 ± 5.6 kg/m2; 76% white) provided three trimesters of valid activPAL data. Compared to activPAL, GT3X had agreement ranging from r = 0.54-0.66 and ICC = 0.52-0.65. Bland-Altman plots revealed small mean differences and unpatterned errors, but wide limits of agreement (greater than ±2 h and ± 15%). The SB2D and PPAQ had r < 0.5 and ICC < 0.3 vs. activPAL SED, with lower agreement during the 2nd and 3rd trimesters, and performed poorly in Bland-Altman analyses. SED% from the modified SB2D performed best of the self-reported instruments with modest mean differences, r ranging from 0.55 to 0.60, and ICCs from 0.31-0.33; though, limits of agreement were greater than ±35%. Significant trends in activPAL SED were observed across increasing tertiles of SB2D SED in the 1st and 3rd trimesters (both p ≤ 0.001), but not the 2nd trimester (p = 0.425); and for PPAQ SED in the 1st and 2nd trimesters (both p < 0.05), but not the 3rd trimester (p = 0.158). AcitvPAL SED and SED% increased significantly across tertiles of GT3X SED and SED% as well as SB2D SED% (all p-for-trend ≤ 0.001). CONCLUSIONS: Compared to activPAL, waist-worn GT3X produced moderate agreement, though similar mean estimates of SED across pregnancy. Self-report questionnaires had large absolute error and wide limits of agreement for SED hr./day; SB2D measurement of SED% was the best self-report method. These data suggest activPAL be used to measure SED when possible, followed by GT3X, and - when necessary - SB2D assessing SED% in pregnancy. TRIAL REGISTRATION: www.clinicaltrials.gov NCT03084302 on 3/20/2017.


Assuntos
Actigrafia/normas , Gestantes/psicologia , Diagnóstico Pré-Natal/normas , Comportamento Sedentário , Autorrelato/normas , Actigrafia/métodos , Actigrafia/psicologia , Adulto , Feminino , Humanos , Gravidez , Trimestres da Gravidez , Diagnóstico Pré-Natal/métodos , Reprodutibilidade dos Testes
10.
Sensors (Basel) ; 20(2)2020 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-31963889

RESUMO

Wrist actigraphy has been used to assess sleep in older adult populations for nearly half a century. Over the years, the continuous raw activity data derived from actigraphy has been used for the characterization of factors beyond sleep/wake such as physical activity patterns and circadian rhythms. Behavioral activity rhythms (BAR) are useful to describe individual daily behavioral patterns beyond sleep and wake, which represent important and meaningful clinical outcomes. This paper reviews common rhythmometric approaches and summarizes the available data from the use of these different approaches in older adult populations. We further consider a new approach developed in our laboratory designed to provide graphical characterization of BAR for the observed behavioral phenomenon of activity patterns across time. We illustrate the application of this new approach using actigraphy data collected from a well-characterized sample of older adults (age 60+) with osteoarthritis (OA) pain and insomnia. Generalized additive models (GAM) were implemented to fit smoothed nonlinear curves to log-transformed aggregated actigraphy-derived activity measurements. This approach demonstrated an overall strong model fit (R2 = 0.82, SD = 0.09) and was able to provide meaningful outcome measures allowing for graphical and parameterized characterization of the observed activity patterns within this sample.


Assuntos
Actigrafia/métodos , Ritmo Circadiano/fisiologia , Atividades Humanas , Processamento de Sinais Assistido por Computador , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sono/fisiologia
11.
Sci Rep ; 10(1): 509, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-31949189

RESUMO

Sleep deprivation and disorders are linked to reduced DMN connectivity. Less is known about how naturalistic sleep patterns - specifically sleep irregularity - relate to the DMN, particularly among adolescents and young adults. Additionally, no studies have utilized graph theory analysis to clarify whether sleep-related decreases in connectivity reflect global or local DMN changes. Twenty-five healthy adolescents and young adults (age range = 12-22; mean = 18.08; SD = 2.64, 56% female) completed 7 days of actigraphy and resting-state fMRI. Sleep regularity was captured by the Sleep Regularity Index (SRI) and the relationship between the SRI and DMN was examined using graph theory analysis. Analogous analyses explored relationships between the SRI and additional resting-state networks. Greater sleep regularity related to decreased path length (increased network connectivity) in DMN regions, particularly the right and left lateral parietal lobule, and the Language Network, including the left inferior frontal gyrus and the left posterior superior frontal gyrus. Findings were robust to covariates including sex and age. Sleep and DMN function may be tightly linked during adolescence and young adulthood, and reduced DMN connectivity may reflect local changes within the network. Future studies should assess how this relationship impacts cognitive development and neuropsychiatric outcomes in this age group.


Assuntos
Actigrafia/métodos , Imagem por Ressonância Magnética/métodos , Vias Neurais/diagnóstico por imagem , Descanso/fisiologia , Sono/fisiologia , Adolescente , Feminino , Voluntários Saudáveis , Humanos , Masculino , Vias Neurais/fisiologia , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiologia , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiologia , Adulto Jovem
12.
Matern Child Health J ; 24(2): 196-203, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31834605

RESUMO

OBJECTIVES: This study examined the prevalence and correlates of maternal and infant sleep problems among low-income families receiving home visiting services. METHODS: The study sample includes 1142 mother-infant dyads in Wisconsin, United States. Women completed a survey when their infants were between two weeks and one year old. Outcome data were collected using the PROMIS® sleep disturbance short form-4a and the Brief Infant Sleep Questionnaire. Correlates of sleep problems were assessed in two domains: maternal health and home environment quality. Descriptive analyses produced prevalence estimates, and multivariate regressions were performed to test hypothesized correlates of maternal and infant sleep problems. Subgroup analyses were conducted to examine the prevalence and correlates of sleep problems across different infant age groups. RESULTS: Approximately 24.5% of women reported poor or very poor sleep in the past week; 13% reported an infant sleep problem and 11% reported more than three infant wakings per night. Reported night wakings were more prevalent among younger infants but maternal and infant sleep problems were not. Multivariate results showed that poor maternal physical and mental health and low social support were associated with maternal sleep disturbance but not infant sleep problems. Bed sharing and smoking were associated with infant sleep outcomes but not maternal sleep. There was limited evidence that the correlates of maternal and infant sleep varied by infant age. CONCLUSIONS FOR PRACTICE: The findings point to alterable factors that home visiting programs and other interventions may target to enhance maternal and infant sleep.


Assuntos
Mães/psicologia , Pobreza/estatística & dados numéricos , Transtornos do Sono-Vigília/diagnóstico , Actigrafia/métodos , Adulto , Correlação de Dados , Estudos Transversais , Feminino , Visita Domiciliar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Mães/estatística & dados numéricos , Gravidez , Prevalência , Transtornos do Sono-Vigília/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
13.
Dev Sci ; 23(5): e12933, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31863619

RESUMO

Detecting threat cues in the environment is an important aspect of social functioning. This is particularly true for adolescents as social threats become more salient and they navigate increasingly complex relationships outside of the family. Sleep relates to socioemotional processing throughout development, but the neurobiological relevance of sleep for threat perceptions in adolescence remains unknown. In the present study, 46 human adolescents (aged 14-18 years; 26 female) made judgments while undergoing a brain scan about whether unfamiliar, affectively neutral, computer-generated faces were threatening. Prior to the scan, several indices of sleep were assessed nightly for two-weeks using actigraphy. Sleep duration and poor sleep quality (defined as less efficiency, more awakenings, longer awakenings), factors influenced by biological and psychosocial changes during adolescence, elicited distinct neural activation patterns. Sleep duration was positively associated with activation in visual and face processing regions (occipital cortex, occipital fusiform gyrus), and this activation was linked to increased threat detection during the threat perception task. Sleep quality was negatively related to dorsolateral prefrontal cortex activation, which moderated the relation between reaction time (RT) and exposure to faces. Findings suggest reduced threat perception for adolescents with shorter sleep durations and more impulsive responding (as evinced by less consistent RT) for adolescents experiencing worse quality sleep. This study identifies an association between sleep and neural functioning relevant for socioemotional decision making during adolescence, a time when these systems undergo significant development.


Assuntos
Sinais (Psicologia) , Percepção/fisiologia , Sono/fisiologia , Actigrafia/métodos , Adolescente , Mapeamento Encefálico , Face , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Imagem por Ressonância Magnética/métodos , Masculino , Vias Neurais/crescimento & desenvolvimento , Córtex Pré-Frontal/fisiologia , Tempo de Reação/fisiologia
14.
J Sleep Res ; 29(1): e12933, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31617625

RESUMO

Actigraphy is a versatile tool for evaluating sleep-wake cycles over time in the home-environment. Patients using the Phillips Actiwatch place an event marker when going to sleep and upon awakening. We investigate compliance in pressing the Actiwatch event marker button for patients referred for insomnia, hypersomnia and disorders of circadian rhythm. We retrospectively analysed event markers from 150 patients undergoing actigraphy for 2,117 nights combined. Compliance was evaluated from inspection of actigraphy records, and coded as full or partial. From patient records, a construct called the C-factor, designed to describe poor social resources and chronic unemployment, was used together with age and sex to predict compliance. We found a mean compliance between 54.0% and 76.3% for a median monitoring duration of 14 days. There was an overall insignificant effect of age (p = .081), but when analysed only for females there was a significant effect of 0.56% pr. year (p = .0038). Compliance was higher for women, Cohen's d = 0.65 (p = .01). The C-factor predicts 18.3% (confidence interval 9%-27.5%) lower compliance. Morning and evening compliance are correlated at r = .65. In conclusion, actigraphy event marker compliance is generally moderate or high, with older women exhibiting the highest compliance. C-factor predicts lower compliance, and this pattern may further translate to other circumstances. If compliance is important, clinicians may want to consider the effects of age, sex and C-factor.


Assuntos
Actigrafia/métodos , Cooperação do Paciente/psicologia , Transtornos do Sono-Vigília/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
J Sleep Res ; 29(1): e12926, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31621129

RESUMO

Clinical actigraphy devices provide adequate estimates of some sleep measures across large groups. In practice, providers are asked to apply clinical or consumer wearable data to individual patient assessments. Inter-individual variability in device performance will impact such patient-specific interpretation. We assessed two devices, clinical and consumer, to determine the magnitude and predictors of this individual-level variability. One hundred and two patients (55 [53.9%] female; 56.4 [±16.3] years old) undergoing polysomnography wore Jawbone UP3 and/or Actiwatch2. Device total sleep time, sleep efficiency, wake after sleep onset and sleep latency were compared with polysomnography. Demographics, sleep architecture and clinical measures were compared to device performance. Actiwatch overestimated total sleep time by 27.2 min (95% confidence limits [CL], 138.3 min over to 84.0 under), overestimated sleep efficiency by 6.8% (95% CL, 34.1% over to 20.5% under), overestimated sleep onset latency by 2.6 min (95% CL, 63.3 over to 58.2 under) and underestimated wake after sleep onset by 50.7 min (95% CL, 162.5 under to 61.2 over). Jawbone overestimated total sleep time by 59.1 min (95% CL, 208.6 min over to 90.5 under) and overestimated sleep efficiency by 14.9% (95% CL, 52.6% over to 22.7% under). In multivariate models, age, sleep onset latency, wake after sleep onset, % N1 and apnea-hypopnea index explained only some of the variance in device performance. Gender also affected performance. Actiwatch and Jawbone mis-estimate sleep measures with very wide confidence limits and accuracy varies with multiple patient-level characteristics. Given these large individual inaccuracies, data from these devices must be applied only with extreme caution in clinical practice.


Assuntos
Actigrafia/métodos , Polissonografia/métodos , Sono/fisiologia , Dispositivos Eletrônicos Vestíveis/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
J Sleep Res ; 29(1): e12931, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31626361

RESUMO

Consumer activity trackers claiming to measure sleep/wake patterns are ubiquitous within clinical and consumer settings. However, validation of these devices in sleep disorder populations are lacking. We examined 1 night of sleep in 42 individuals with insomnia (mean = 49.14 ± 17.54 years) using polysomnography, a wrist actigraph (Actiwatch Spectrum Pro: AWS) and a consumer activity tracker (Fitbit Alta HR: FBA). Epoch-by-epoch analysis and Bland-Altman methods evaluated each device against polysomnography for sleep/wake detection, total sleep time, sleep efficiency, wake after sleep onset and sleep latency. FBA sleep stage classification of light sleep (N1 + N2), deep sleep (N3) and rapid eye movement was also compared with polysomnography. Compared with polysomnography, both activity trackers displayed high accuracy (81.12% versus 82.80%, AWS and FBA respectively; ns) and sensitivity (sleep detection; 96.66% versus 96.04%, respectively; ns) but low specificity (wake detection; 39.09% versus 44.76%, respectively; p = .037). Both trackers overestimated total sleep time and sleep efficiency, and underestimated sleep latency and wake after sleep onset. FBA demonstrated sleep stage sensitivity and specificity, respectively, of 79.39% and 58.77% (light), 49.04% and 95.54% (deep), 65.97% and 91.53% (rapid eye movement). Both devices were more accurate in detecting sleep than wake, with equivalent sensitivity, but statistically different specificity. FBA provided equivalent estimates as AWS for all traditional actigraphy sleep parameters. FBA also showed high specificity when identifying N3, and rapid eye movement, though sensitivity was modest. Thus, it underestimates these sleep stages and overestimates light sleep, demonstrating more shallow sleep than actually obtained. Whether FBA could serve as a low-cost substitute for actigraphy in insomnia requires further investigation.


Assuntos
Actigrafia/métodos , Monitores de Aptidão Física/normas , Polissonografia/métodos , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto Jovem
17.
Am J Phys Med Rehabil ; 99(4): 300-304, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31592879

RESUMO

OBJECTIVE: The aim of this study was to determine whether the arm subscore of the Motricity Index 1 wk after stroke can predict recovery of upper limb function according to the Action Research Arm Test before inpatient rehabilitation facility discharge and at 3-mo outpatient follow-up. DESIGN: This was a prospective cohort study of patients with acute ischemic stroke admitted to a single acute care hospital and affiliated inpatient rehabilitation facility between 2016 and 2018. Upper limb dexterity of the impaired limb was assessed using the arm subscore of the Motricity Index and Action Research Arm Test. Receiver operating characteristic curve analysis was used to determine optimal cutoffs of the initial arm subscore of the Motricity Index for a good functional outcome defined as Action Research Arm Test score of 45 or higher. RESULTS: Ninety-five patients were evaluated at median 6, 26, and 98.5 days after stroke. The median (interquartile range) arm subscore of the Motricity Index at 1 wk was 77 (20.3-93). The median (interquartile range) Action Research Arm Test scores before inpatient rehabilitation facility discharge and at 3-mo outpatient follow-up were 33 (3.5-52) and 52 (34-55.8), respectively. The optimal arm subscore of the Motricity Index to predict Action Research Arm Test score of 45 or higher before inpatient rehabilitation facility discharge and at 3-mo outpatient follow-up were 71 and 58, respectively. CONCLUSIONS: Early arm subscore of the Motricity Index at 1 wk predicts upper limb functional capacity before inpatient rehabilitation facility discharge and at 3-mo outpatient follow-up.


Assuntos
Actigrafia/estatística & dados numéricos , Avaliação da Deficiência , Índice de Gravidade de Doença , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Acidente Vascular Cerebral/fisiopatologia , Actigrafia/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Extremidade Superior/fisiopatologia , Adulto Jovem
18.
J Sleep Res ; 29(1): e12938, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31638298

RESUMO

Cognitive models of insomnia highlight the role of biased cognition in sleep-related information, which is proposed to underlie pre-sleep worry, which in turn results in both subjective and objective sleep deficits. To test this hypothesis, the current study investigated interpretational bias, which is a tendency to interpret ambiguous stimuli in a threat-related (here: insomnia-related) manner. We specifically hypothesized that interpretational bias would be associated with (a) pre-sleep worry and (b) poor subjective and objective sleep. Interpretational bias was measured using the ambiguous scenario task, in which participants (n = 76, community sample) were presented with two types of scenarios (insomnia and anxiety related) that could be alternatively interpreted in a neutral manner. Participants additionally completed questionnaires to assess global sleep quality and pre-sleep worry, which were followed by 1-week sleep assessments (via diaries and actigraphy) to estimate specific, daily subjective and objective sleep parameters. The results showed that insomnia-related (but not anxiety-related) interpretational bias was positively associated with pre-sleep worry as well as overall sleep quality. However, these associations could be explained by general trait anxiety. We also found no connection to specific subjective or objective parameters of daily sleep, such as sleep onset latency. These findings support the cognitive-hyperarousal mechanism, where biased cognition (together with trait anxiety) underlies pre-sleep worry. The association with overall sleep quality, but not with specific, daily subjective or objective sleep parameters, may suggest that interpretational bias is specifically relevant for how individuals judge and describe their sleep quality.


Assuntos
Actigrafia/métodos , Ansiedade/etiologia , Distúrbios do Início e da Manutenção do Sono/complicações , Adolescente , Adulto , Ansiedade/psicologia , Viés , Feminino , Humanos , Masculino , Distúrbios do Início e da Manutenção do Sono/psicologia , Adulto Jovem
19.
J Sleep Res ; 29(1): e12937, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31674088

RESUMO

People with Insomnia Disorder tend to underestimate their sleep compared with polysomnography or actigraphy, a phenomenon known as paradoxical insomnia or sleep-state misperception. Previous studies suggested that night-to-night variability could be an important feature differentiating subtypes of misperception. This study aimed for a data-driven definition of misperception subtypes revealed by multiple sleep features including night-to-night variability. We assessed features describing the mean and dispersion of misperception and objective and subjective sleep duration from 7-night diary and actigraphy recordings of 181 people with Insomnia Disorder and 55 people without sleep complaints. A minimally collinear subset of features was submitted to latent class analysis for data-driven subtyping. Analysis revealed three subtypes, best discriminated by three of five selected features: an individual's shortest reported subjective sleep duration; and the mean and standard deviation of misperception. These features were on average 5.4, -0.0 and 0.5 hr in one subtype accommodating the majority of good sleepers; 4.1, -1.4 and 1.0 hr in a second subtype representing the majority of people with Insomnia Disorder; and 1.7, -2.2 and 1.5 hr in a third subtype representing a quarter of people with Insomnia Disorder and hardly any good sleepers. Subtypes did not differ on an individual's objective sleep duration mean (6.9, 7.2 and 6.9 hr) and standard deviation (0.8, 0.8 and 0.9 hr). Data-driven analysis of naturalistic sleep revealed three subtypes that markedly differed in misperception features. Future studies may include misperception subtype to investigate whether it contributes to the unexplained considerable individual variability in treatment response.


Assuntos
Actigrafia/métodos , Polissonografia/métodos , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
J Sleep Res ; 29(1): e12944, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31680327

RESUMO

Accurate assessment of sleep can be fundamental for monitoring, managing and evaluating treatment outcomes within diseases. A proliferation of consumer activity trackers gives easy access to objective sleep. We evaluated the performance of a commercial device (Fitbit Alta HR) relative to a research-grade actigraph (Actiwatch Spectrum Pro) in measuring sleep before and after a cognitive behavioural intervention in insomnia disorder. Twenty-five individuals with DSM-5 insomnia disorder (M = 50.6 ± 15.9 years) wore Fitbit and Actiwatch and completed a sleep diary during an in-laboratory polysomnogram, and for 1 week preceding and following seven weekly sessions of cognitive-behavioural intervention for insomnia. Device performance was compared for sleep outcomes (total sleep time, sleep latency, sleep efficiency and wake after sleep onset). The analyses assessed (a) agreement between devices across days and pre- to post-treatment, and (b) whether pre- to post-treatment changes in sleep assessed by devices correlated with clinical measures of change. Devices generally did not significantly differ from each other on sleep variable estimates, either night to night, in response to sleep manipulation (pre- to post-treatment) or in response to changes in environment (in the laboratory versus at home). Change in sleep measures across time from each device showed some correlation with common clinical measures of change in insomnia, but not insomnia diagnosis as a categorical variable. Overall, the Fitbit provides similar estimates of sleep outside the laboratory to a research grade actigraph. Despite the similarity between Fitbit and Actiwatch performance, the use of consumer technology is still in its infancy and caution should be taken in its interpretation.


Assuntos
Actigrafia/métodos , Monitores de Aptidão Física/normas , Polissonografia/métodos , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
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