Wrist actigraphic measures of sleep and rhythms.

With a piezo-electric activity transducer, wrist activity recordings were made simultaneously with EEG, EOG and EMG recordings. Wrist activity alone was used to estimate Total Sleep Time and blind independent scoring of sleep and wakefulness by EEG-EOG-EMG was done. Correlations between the two methods were termined for minutes of Sleep (r = 0.98), Total Sleep Period (r = 0.95) and minutes of Wake Time Within Sleep (r = 0.85). Continuous wrist activity recordings may thus provide inexpensive but very accurate estimates of Sleep Time.     

Relationship between apathy and sleep disturbance in mild and moderate Alzheimer's disease: an actigraphic study

Apathy is the most frequently reported neuropsychiatric symptom across all stages of Alzheimer's disease (AD). Both apathy and sleep disorders are known to have independent negative effects on the quality of life in individuals with AD. The aim of this study was to assess the relationship between apathy and sleep/wake patterns in individuals with AD using ambulatory actigraphy. One hundred and three non-institutionalized individuals with AD wore a wrist actigraph continuously over seven consecutive 24-h periods. Apathy was assessed using the Neuropsychiatric Inventory. Daytime mean motor activity (dMMA) was calculated from daytime wrist actigraphy data. Actigraphic parameters of sleep included total sleep time (TST), wake after sleep onset (WASO), time in bed (TIB), WASO normalized by TIB, sleep latency, and nighttime mean motor activity (nMMA). Among the 103 individuals with AD (aged 76.9 ± 7.2 years; MMSE = 21.4 ± 4.3), those with apathy had significantly lower dMMA, higher WASO (both raw and normalized), and spent more time in bed during the night than those without apathy. Sleep latency, nMMA and TST did not differ significantly between the two subgroups. To our knowledge, this study is the first to identify a relationship between apathy and sleep disturbance in those with mild or moderate AD: apathy was associated with increased TIB during the night and more WASO. These results suggest that AD patients with apathy have less consolidated nocturnal sleep than those without apathy.     

The relationship between psychotic-like experiences and sleep disturbances in adolescents

ObjectiveWe investigated the relationships between sleep disturbances and psychotic-like experiences (PLEs) among adolescents.MethodsA total of 8530 students (grades 7–11) were recruited in the Republic of Korea, and 7172 students who completed all of the relevant questionnaires participated in the current study. The survey included the Eppendorf Schizophrenia Inventory (ESI), the Youth Psychosis At Risk Questionnaire (Y-PARQ), the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale and questionnaires about sleep disturbances (insomnia, cataplexy and snoring).ResultsSubjects with insomnia, excessive daytime somnolence (EDS), or probable cataplexy had higher ESI and Y-PARQ scores after controlling for age, sex and BDI scores (all p < 0.001). Insomnia (OR = 4.40), EDS (OR = 3.84) and probable cataplexy (OR = 2.97) predicted clinical high risk of psychosis. Insomnia, EDS and probable cataplexy remained as significant predictors of clinical high risk for psychosis, even after controlling for depressive symptoms or when analyses were confined to non-depressive adolescents.ConclusionsInsomnia and EDS were found to predict PLEs in adolescents, independent of depression. Our findings suggest that adolescents complaining of insomnia or sleepiness may require further assessment regarding potential risk of psychosis.     

An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults

We compared the efficacy of sleep restriction therapy combined with sleep hygiene, nap modification of sleep restriction therapy combined with sleep hygiene, and sleep hygiene alone as treatments for insomnia in 39 community-dwelling men and women 55 years and older. We used the wrist actigraph as an objective outcome measure for all subjects at baseline, end of treatment, and 3-month follow-up; polysomnography (PSG) was conducted in a subgroup of subjects. Although subjects appeared to follow restriction instructions through follow-up, we found few between-group differences in treatment efficacy. Lack of treatment effect might be explained by the efficacy of HYG as a treatment in itself and the relatively low symptom level in these healthy older poor sleepers. At baseline, actigraphic results were found to correlate more highly than sleep log data with PSG in our sample. Actigraphic total sleep time, in particular, was highly correlated with PSG.     

Evaluating sleep in bipolar disorder: comparison between actigraphy,polysomnography, and sleep diary

Kaplan KA, Talbot LS, Gruber J, Harvey AG. Evaluating sleep in bipolar disorder: comparison between actigraphy, polysomnography, and sleep diary.
Bipolar Disord 2012: 14: 870–879. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd. Objectives: Bipolar disorder is an illness characterized by sleep and circadian disturbance, and monitoring sleep in this population may signal an impending mood change. Actigraphy is an important clinical and research tool for examining sleep, but has not yet been systematically compared to polysomnography or sleep diary in bipolar disorder. The present study compares actigraphy, polysomnography, and sleep diary estimates of five standard sleep parameters in individuals with bipolar disorder and matched controls across two nights of assessment. Methods: Twenty‐seven individuals who met diagnostic criteria for bipolar disorder type I or II and were currently between mood episodes, along with 27 matched controls with no history of psychopathology or sleep disturbance, underwent two nights of research laboratory monitoring. Sleep was estimated via polysomnography, actigraphy, and sleep diary. Results: Over the 108 nights available for comparison, sleep parameter estimates from actigraphy and polysomnography were highly correlated and did not differ between the two groups or across the two nights for sleep onset latency, wake after sleep onset, number of awakenings, total sleep time, or sleep efficiency percentage. The medium wake threshold algorithm in the actigraphy software was the most concordant with polysomnography and diaries across the five sleep parameters. Concordance between actigraphy, polysomnography, and sleep diary was largely independent of insomnia presence and medication use. Conclusions: Actigraphy is a valid tool for estimating sleep length and fragmentation in bipolar disorder.     

Validity of sleep log compared with actigraphic Sleep-wake state

Abstract Seven women and 11 men, mean age 30.1 years, kept a sleep log for 5–7 days, and their wrist activity was monitored each minute. Sleep-wake state in the sleep log and actigraphic sleep-wake state were compared, and the sensitivity and specificity of the sleep log were calculated for each subject. The ratio of agreement between these two parameters was computed for each subject. The sensitivity and specificity of the sleep log were 72.73–97.56% (mean 86.71%) and 92.85–99.68% (mean 97.04%), respectively. The agreement ratio was 87.30–97.85% (93.48%), but 1-h agreement ratios from midnight dropped during the sleep onset period.     

The relationship between subjective happiness and sleep problems in Japanese adolescents

ObjectivesLow sleep quality in adolescents is an important public health concern, as it relates to both their current and future physical and mental health. Furthermore, subjective happiness is also often regarded as a major life goal. Although Japan is an economically powerful country, the reported levels of subjective happiness among Japanese adolescents is low. Thus, this study aims to examine the relationship between subjective happiness and sleep problems in Japanese adolescents.MethodsWe conducted a nationally representative cross-sectional study of adolescents enrolled in junior and senior high schools in Japan. We used a questionnaire to determine the prevalence of sleep problems (eg, insomnia, short sleep duration (SSD) and poor sleep quality) and to evaluate the participants' reported levels of subjective happiness. Multivariable logistic regression analyses were used to examine the associations between subjective happiness and sleep problems. Adjusted variables were basic demographic characteristics (eg, gender and school grade), lifestyle behaviors, and mental health status.ResultsData from 64,329 students were analyzed (age range 12–18 years, mean age 15.7 years, 53.9% male). The results indicated that reported levels of subjective happiness were strongly associated with the prevalence of sleep problems. Linear relationships can be observed between sleep problems and subjective happiness scores. The multivariable logistic regression analysis showed that dose–response association of subjective happiness score was observed with all three sleep problems.ConclusionsDue to these findings, we recommend that policy makers and school officials educate adolescents on the importance of both subjective happiness and good sleep hygiene.     

Agreement between sleep diary and actigraphy in a highly educated Brazilian population

ObjectiveThis study evaluated the agreement between a sleep diary and actigraphy on the assessment of sleep parameters among school teachers from Brazil.MethodsA total of 163 teachers (66.3% women; aged 45 ± 9 years) filled out a sleep diary and wore a wrist actigraph device for seven consecutive days. Data were collected from August 2014 to March 2015 in Londrina, a large city in southern Brazil. Intraclass correlation coefficients (ICC) and Pearson correlation coefficients (r) were used to compare self-reported and actigraphic data.ResultsSelf-reported total sleep time (TST), sleep onset latency (SOL), and sleep efficiency were higher than measured by actigraphy (mean difference: 22.6 ± 46.9 min, 2.6 ± 13.3 min, and 7.3± 5.7%, respectively). Subjective total time in bed (TIB) and wake-up time were lower than measured by actigraphy (mean difference: −10.7 ± 37.6 and −19.7 ± 29.6, respectively). Moderate or good agreement and correlation were found between the sleep diary and the actigraphic data for TST (ICC = 0.70; r = 0.60), TIB (ICC = 0.83; r = 0.73), bedtime (ICC = 0.95; r = 0.91), sleep start time (ICC = 0.94; r = 0.88), and wake-up time (ICC = 0.87; r = 0.78). However, SOL (ICC = 0.49; r = 0.38) and sleep efficiency (ICC = 0.16; r = 0.22) showed only fair or poor agreement and correlation.ConclusionIn this highly educated population, the sleep diary and the actigraphy showed moderate or good agreement to assess several sleep parameters. However, these methods seemed to measure different dimensions of sleep regarding sleep onset latency and efficiency. These findings moderately varied according to the individual's subjective sleep quality.     

Association between circadian rhythms, sleep and cognitive impairment in healthy older adults: an actigraphic study

There is increasing evidence for the relationship between circadian rhythm disturbance and cognitive decline in the older adult. This study measured circadian activity rhythms in a small group of healthy community-dwelling older adults (n?=?26). Each participant completed a battery of neuropsychological tests and completed sleep diaries and 6?days of actigraphy. Ten participants were identified as having very early signs of cognitive decline as indicated by their performance on the memory tests. Results showed minimal differences on the sleep/activity and circadian parameters across the two groups (declined vs. intact), although there was a significant difference in the acrophase between the declined and intact groups. These findings, although exploratory, suggest that very subtle changes in circadian rhythm may be detected in older adults showing pre-clinical changes in cognitive performance.     

A comparison of idiopathic hypersomnia and narcolepsy-cataplexy using self report measures and sleep diary data.

Eighteen patients with idiopathic hypersomnia (IH) were compared with 50 patients with the narcoleptic syndrome of cataplexy and daytime sleepiness (NLS) using self report questionnaires and a diary of sleep/wake patterns. The IH group reported more consolidated nocturnal sleep, a lower propensity to nap, greater refreshment after naps, and a greater improvement in excessive daytime sleepiness since onset than the NLS group. In IH, the onset of excessive daytime sleepiness was predominantly associated with familial inheritance or a viral illness. Two variable--number of reported awakenings during nocturnal sleep and the reported change in sleepiness since onset--provided maximum discrimination between the IH and NLS groups. Confusional arousals, extended naps or nocturnal sleep, autonomic nervous system dysfunction, low ratings of medication effectiveness, or side effects of medication were not associated differentially with either IH or NLS.     

A comparison of polysomnographic and actigraphic evaluation of periodic limb movements in sleep

OBJECTIVE: As a standard method, periodic limb movements in sleep (PLMS) are detected by means of polysomnography (PSG). Actigraphic detection of PLMS is a recently developed method for performing of multiple-night recordings in an outpatient setting. The aim of our study was to assess sensitivity-related parameters of actigraphic detection of PLMS in comparison to the PSG, when mounted at ankles and at the base of the big toe. METHODS: We simultaneously performed PSG and actigraphic recordings at both ankles and at the bases of both big toes (Cambridge Actiwatch AW-64) for 40 nights. The PLM index (PLMI), number of periodic movements per hour of sleep, was the primary output of both methods. RESULTS: We have proven significant correlation of all resulting parameters when comparing actigraphy at either position to the PSG; however, the PLMI values obtained by the actigraphy at toes were significantly higher than by PSG (sign test, p<0.0001). At bases of the big toes, threshold of PLMI=7.6 was used as a cut off for positivity, while PLMI=5 at ankles was used for PSG. Comparing ankle versus toe actigraphic placement, sensitivity was 67% versus 94%, specificity was 95% versus 91% and negative predictive value was 78% versus 95%. The correlation of the results from actigraphy and PSG was not affected by presence of respiratory events. DISCUSSION: Our results suggest good validity of actigraphic PLM evaluation at the base of big toe using AW-64 devices and therefore, actigraphy seems suitable for screening purposes in both clinical and research usage.     

Evidence for similarities between adolescents and parents in sleep patterns

ObjectiveSleep in adolescence may vary according to strain and environmental factors. In particular, parents’ behavior may affect their children’s psychological functioning and sleep. However, no data have been gathered with respect to parents and their adolescent children’s concurrent sleep patterns. This was the aim of the present study, together with exploration of the possible influence of parenting style on adolescents’ sleep.MethodsA total of 293 adolescents (mean age: 17.55; 214 females, 79 males) completed several questionnaires regarding their own psychological functioning as well as a sleep log for seven consecutive days. Additionally, adolescents rated parents’ sleep and parenting styles.ResultsAdolescents’ and parents’ sleep patterns proved to be correlated. Moreover, mother’s sleep was related to adolescents’ psychological functioning. However, SEM showed that mother’s sleep influenced adolescents’ sleep not directly, but indirectly, via parenting style and adolescents’ psychological functioning.ConclusionsSleep patterns of parents and their adolescent children show similarities. Moreover, mother’s poor sleep has a direct impact on parenting style, which in turn affects adolescents’ psychological functioning and sleep. Therefore, sleep problems in adolescents may mirror an unfavorable parenting style and sleep complaints among mothers. These conclusions might usefully inform family counseling and treatment of adults’ and adolescents’ sleep complaints.     

An actigraphic study of the sleep patterns of younger and older school-age children

ObjectiveSleep is viewed as being relatively consistent across the school-age period (6–13 years of age), however this claim has not been empirically supported. The objective of this study was to document the duration, schedule, variability, and week versus weekend discrepancies of sleep in three distinct age groups within the school-age period.MethodsParticipants were divided by age: Cycle 1, 6 and 7 years; Cycle 2, 8 and 9 years; and Cycle 3, 10 and 11 years. For seven consecutive nights, sleep was assessed in the home environment using an actigraph.ResultsCompared to children of Cycle 1, those of Cycles 2 and 3 showed increasing and significant delays in sleep start time, increasingly shorter assumed and actual sleep durations, and larger night-to-night variability of sleep. Of the children in Cycles 1, 2, and 3, 96%, 87.7%, and 51.3%, respectively, were found to spend the recommended 9–11 h in bed. However, the actigraphic ‘true sleep’ measure revealed that only 17%, 7%, and 2.5% of these children, respectively, obtained the recommended amount of sleep.ConclusionSleep duration, schedule, and variability change significantly across the school-age period.     

Wrist activity rhythm and sleep diary of delayed sleep phase syndrome

Abstract Wrist activity rhythm and sleep diary data in a case of delayed sleep phase syndrome were investigated. The sleep self-estimation was nearly compatible with the activity levels of the actigraph. The actigraphic data were also analyzed. The subject's most fixed period of activity was 24.31 h, and acrophase (time of day) that fixed the data to a 24 h period was 03.25 h. The subject has had reversed night and day sleep patterns for more than 7 years. It was very difficult to advance the sleep phase when the delayed phase has been continuous long-term under the state of poor social cues.     

Monitoring sleep hours using a sleep diary and errors in rotating shiftworkers

The sleep hours of male workers on rotating shift schedules were measured using a sleep diary. The mean age of workers was 40.3 years. Work shifts were rotated on a weekly basis and fell into three periods: morning, evening, and night. One working week consisted of 5 days. Errors that occurred during the work were also evaluated. A significant difference in the mean length of sleep was observed for each of the three shifts. Compared with the morning shift, the length of sleep for workers working evening and night shifts were significantly longer. The error of workers was not recognized in three rotating shift schedules in the survey period. Rotating shiftwork affects the amount of sleep, but not the event of error.     

青少年睡眠问题与自杀的相关性研究现状

本文目的是对青少年睡眠问题与自杀的相关性研究现状进行综述,以期为青少年自杀的早期临床干预提供新的方向。研究表明,睡眠问题与青少年自杀密切相关,睡眠可能成为自杀干预的潜在靶点。本文对青少年睡眠问题与自杀的相关性研究进行综述,并从改善睡眠问题着手,寻找可能的自杀干预措施。     

Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients

OBJECTIVE: Comparison of polysomnography (PSG)-derived sleep parameters (total sleep time, sleep efficiency, and number of awakenings) to those derived from actigraphy and subjective questionnaires. BACKGROUND: Actigraphy is commonly used to assist sleep specialists in the diagnosis of various sleep and circadian-rhythm disorders. However, few validation studies incorporate large sample sizes, typical sleep clinic patients, or comparisons with subjective reports of sleep parameters. METHODS: Clinical series with 100 consecutive sleep-disordered patients (69 men, 31 women, mean age of 49+/-14.7 years) at a tertiary sleep disorders center. Sensitivity, specificity, and accuracy measures were obtained from epoch-by-epoch comparison of PSG and actigraphic data. Subjective sleep parameter data were derived from questionnaires given to subjects in the morning following their recording night. RESULTS: We found that total sleep time and sleep efficiency did not significantly differ between PSG data and the combined data obtained from actigraphy and subjective reports. Using a high-threshold (low-wake-sensitivity) actigraphic algorithm, the number of awakenings was not significantly different from those detected by PSG. CONCLUSIONS: We recommend the use of subjective data as an adjunct to actigraphic data in estimating total sleep time and sleep efficiency in sleep-disordered patients, especially those with disorders of excessive somnolence.     

Validity of sleep log compared with actigraphic sleep–wake state II

Twenty-five young people (Y group), three elderly people and seven people with various sleep disorders (SD group) kept a sleep log for 2-7 days, and their wrist-activity was monitored simultaneously. The sensitivity and specificity of the sleep log, and the ratio of agreement between the sleep log and actigraphic sleep-wake state were calculated. The sensitivity and specificity in Y group were 87.93+/-6.49% and 96.51+/-2.37%, respectively. The sensitivity in SD group was significantly lower than in Y group. Even in Y group one-hour agreement ratios dropped during the sleep onset period.     

Relationship between insomnia and pain in major depressive disorder: A sleep diary and actigraphy study

ObjectivesInsomnia and pain are frequent complaints during the course of a major depressive episode. We analyzed the association between insomnia and pain symptoms using subjective and objective sleep measures.MethodsThis is a prospective, naturalistic follow-up study in a university-based psychiatric unit. Ninety-one Chinese patients were enrolled during an acute episode of major depressive disorder (mean age = 48 years, 73 women); 82 of them were reassessed 3 months later using the same assessment on sleep, pain, depressive, and anxiety symptoms. Clinician-rated insomnia symptoms were obtained using the insomnia items of the Hamilton Rating Scale for Depression. Subjective sleep disturbances were assessed using the Insomnia Severity Index (ISI). Detailed sleep pattern was acquired using sleep diary and actigraphy. Pain intensity was evaluated using a verbal rating scale, a visual analog scale, and a multidimensional pain scale.ResultsCross-sectional analyses found that insomnia symptoms and quantitative sleep parameters were related to pain symptoms. The correlations between sleep and pain scores were more significant after 3 months of pharmacotherapy as compared to baseline. After controlling for the severity of anxiety and depression, the ISI total score and actigraphy-derived wake after sleep onset and total sleep time remained significant in predicting pain.ConclusionThis study supports specific role of subjective sleep disturbances and actigraphic measures in predicting pain symptoms in major depressive disorder. Further studies using a micro-longitudinal design are necessary to find out the causal relationship between sleep and pain in depressed patients.     

Convergent validity of the Child Behavior Checklist sleep items with validated sleep measures and sleep disorder diagnoses in children and adolescents referred to a sleep disorders center

ObjectiveThe Child Behavior Checklist (CBCL) is a commonly used measure of child and adolescent functioning, and a handful of items from the CBCL are often used to measure sleep functioning. The objective of this study was to examine the convergent, discriminant, and external validity of the individual CBCL sleep items and a CBCL sleep composite with validated measures of sleep functioning and youth adjustment as well as sleep disorder diagnoses.MethodsThe participants were 383 youths (ages 6–18 years; 52.5% male; 80% non-Hispanic White) evaluated in a behavioral sleep medicine clinic. A sleep psychologist diagnosed sleep disorders following a comprehensive evaluation. Parents completed the CBCL in addition to the Children's Sleep Habits Questionnaire (CSHQ) and the Sleep Disorders Inventory for Students (SDIS). Adolescents completed the Adolescent Sleep–Wake Scale (ASWS).ResultsIndividual CBCL sleep items were generally associated with sleep scales on validated sleep measures and with sleep disorder diagnoses. The CBCL sleep composite was associated with total scores on each of the sleep-specific measures, as well as with the CBCL attention, social, internalizing, and externalizing problems scales.ConclusionsAlthough the CBCL is inadequate for thoroughly assessing sleep problems and disorders, sleep items on the CBCL may be useful in epidemiological/archival studies that lack a more comprehensive sleep measure or to clinicians who do not use other validated sleep measures in their typical practice. Individual CBCL sleep items may be optimal when assessing specific facets of sleep functioning whereas the CBCL sleep composite may be optimal when examining overall sleep functioning and external correlates of sleep.