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Becker, Stephen P; Burns, G Leonard; Montaño, Juan José; Servera, Mateu
doi: 10.1093/sleep/zsae215pmid: 39276369
Study ObjectivesTo use a nationally representative sample to (1) evaluate the factor structure of the patient-reported outcome measurement information system (PROMIS) parent proxy pediatric sleep scales (Spanish translation), (2) examine the invariance of these scales across sex and across different developmental periods of childhood and adolescence, (3) confirm the information and precision of the scales using item response theory (IRT), and (4) provide age-based normative information.MethodsParents of a nationally representative sample of 5525 Spanish children and adolescents ages 5–16 years (56.1% boys) completed the Spanish translation parent proxy short versions of the sleep disturbance and sleep-related impairment scales. We conducted confirmatory factor analyses, invariance analyses, and graded-response IRT analyses.ResultsCFAs conducted separately on males and females within three age groups (early childhood: ages 5–8 years; middle childhood: ages 9–12 years; adolescence: ages 13–16 years) indicated all items had a substantial loading with one exception (the sleep continuity item [“my child slept through the night”] had a substantially lower loading and was removed for subsequent analyses). The scores on the two scales demonstrated invariance across sex within each age group. Using IRT analyses, both scales showed a high degree of information and precision from slightly below the trait means to slightly above two standard deviations above the trait means.ConclusionsThe strong psychometric properties of the short versions of the parent proxy PROMIS pediatric sleep disturbance and sleep-related impairment scales, coupled with age-based norms, suggest these scales are likely to be useful for research and clinical applications.
Beaudin, Andrew E; Younes, Magdy; Gerardy, Bethany; Raneri, Jill K; Hirsch Allen, A J Marcus; Gomes, Teresa; Gakwaya, Simon; Sériès, Frédéric; Kimoff, John; Skomro, Robert P; Ayas, Najib T; Smith, Eric E; Hanly, Patrick J
doi: 10.1093/sleep/zsae141pmid: 38943546
Study ObjectivesObstructive sleep apnea (OSA) increases the risk of cognitive impairment. Measures of sleep microarchitecture from EEG may help identify patients at risk of this complication.MethodsParticipants with suspected OSA (n = 1142) underwent in-laboratory polysomnography and completed sleep and medical history questionnaires, and tests of global cognition (Montreal Cognitive Assessment, MoCA), memory (Rey Auditory Verbal Learning Test, RAVLT) and information processing speed (Digit–Symbol Coding, DSC). Associations between cognitive scores and stage 2 non-rapid eye movement (NREM) sleep spindle density, power, frequency and %-fast (12–16Hz), odds-ratio product (ORP), normalized EEG power (EEGNP), and the delta:alpha ratio were assessed using multivariable linear regression (MLR) adjusted for age, sex, education, and total sleep time. Mediation analyses were performed to determine if sleep microarchitecture indices mediate the negative effect of OSA on cognition.ResultsAll spindle characteristics were lower in participants with moderate and severe OSA (p ≤ .001, vs. no/mild OSA) and positively associated with MoCA, RAVLT, and DSC scores (false discovery rate corrected p-value, q ≤ 0.026), except spindle power which was not associated with RAVLT (q = 0.185). ORP during NREM sleep (ORPNREM) was highest in severe OSA participants (p ≤ .001) but neither ORPNREM (q ≥ 0.230) nor the delta:alpha ratio were associated with cognitive scores in MLR analyses (q ≥ 0.166). In mediation analyses, spindle density and EEGNP (p ≥ .048) mediated moderate-to-severe OSA’s negative effect on MoCA scores while ORPNREM, spindle power, and %-fast spindles mediated OSA’s negative effect on DSC scores (p ≤ .018).ConclusionsAltered spindle activity, ORP and normalized EEG power may be important contributors to cognitive deficits in patients with OSA.
Alkalame, Lawra; Ogden, Jessica; Clark, Jacob W; Porcheret, Kate; Risbrough, Victoria B; Drummond, Sean P A
doi: 10.1093/sleep/zsae203pmid: 39235362
Intrusive memories are a common experience following trauma exposure but can develop into a symptom of posttraumatic stress disorder (PTSD). Recent research has observed a relationship between sleep disturbance and intrusive memory frequency following analog trauma exposure and disruptions in rapid eye movement (REM) sleep are found to contribute to emotional dysregulation and an amplified reaction to negative emotional stimuli. The current study examined the association between REM sleep prior to analog trauma and intrusive memories. To manipulate REM sleep, 27 healthy adults (MAge = 25.4, standard deviation = 2.89) were randomized to either a circadian misalignment (CM) condition or normal control (NC) condition for 4 nights. In CM, participants slept normally for 2 nights followed by a 4-hour phase advance on night 3 and an additional 4-hour phase advance on night 4. In NC, participants had 8-hour sleep opportunities each night. On day 5, participants watched a trauma film and kept an intrusive memory diary for the next 3 days. Greater REM sleep percentage (p = .004) and REM efficiency (p = .02) across 4 nights prior to analog trauma, independent of the group, were significantly associated with fewer intrusive memories in the 3 days after viewing the film. Findings suggest REM sleep may serve to protect individuals against experiencing intrusive memories. This is consistent with evidence suggesting REM sleep influences emotional memory regulation. Occupations (e.g. emergency services/military personnel) who experience circadian disruptions likely to decrease REM sleep (e.g. from shift work) may be at heightened risk of experiencing intrusive memories after trauma exposure, and thus at increased risk of developing PTSD.
Choi, Jae Won; Koo, Dae Lim; Kim, Dong Hyun; Nam, Hyunwoo; Lee, Ji Hyun; Hong, Seung-No; Kim, Baekhyun
doi: 10.1093/sleep/zsae184pmid: 39115132
Study ObjectivesThe demand for cost-effective and accessible alternatives to polysomnography (PSG), the conventional diagnostic method for obstructive sleep apnea (OSA), has surged. In this study, we have developed and validated a deep learning model for detecting apnea-hypopnea events using radar data.MethodsWe conducted a single-center prospective cohort study, dividing participants with suspected sleep-disordered breathing into development and temporally independent test sets. Utilizing a hybrid CNN-Transformer architecture, we performed fivefold cross-validation on the development set to develop and subsequently validate the model. Evaluation metrics included sensitivity for event detection, mean absolute error (MAE), intraclass correlation coefficient (ICC), and Pearson correlation coefficient (r) for apnea-hypopnea index (AHI) estimation. Linearly weighted kappa statistics (κ) assessed OSA severity.ResultsThe development set comprised 54 participants (July 2021–May 2022), while the test set included 35 participants (June 2022–June 2023). In the test set, our model achieved an event detection sensitivity of 67.2% (95% CI = 65.8% to 68.5%) and demonstrated a MAE of 7.54 (95% CI = 5.36 to 9.72), indicating good agreement (ICC = 0.889 [95% CI = 0.792 to 0.942]) and a strong correlation (r = 0.892 [95% CI = 0.795 to 0.945]) with the ground truth for AHI estimation. Furthermore, OSA severity estimation showed substantial agreement (κ = 0.780 [95% CI = 0.658 to 0.903]).ConclusionsOur study highlights radar sensors and advanced AI models’ potential to improve OSA diagnosis, paving the path for future radar-based diagnostic models in sleep medicine research.
Li, Xianlan; Ye, Qin; Liu, Qianqian; Peng, Jie; Li, Nanyan; Deng, Qian; Hu, Julinling; Yong, Chan; Li, Shiyi; Wang, Yufei; Zhu, Jingjie; Zhao, Xing; Zhou, Junmin
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sStudy ObjectivesTo examine the longer-term effect of physical activity (PA) intervention on sleep quality and whether the effect was heterogeneous between daytime nappers and non-nappers.MethodsThis study was a secondary analysis of a cluster randomized controlled trial in China. Eight villages were randomized 1:1 to intervention or control group. The intervention group received an 8-week PA intervention, while the control group did not. The primary outcome of this study was the change in the Pittsburgh Sleep Quality Index (PSQI) global score at 24 months.ResultsThe 511 participants had a mean age of 70.94 years (SD 5.73) and 55.6% were female. The intervention showed improvements in the PSQI global score at 8 weeks (adjusted mean difference −1.05; p = .002), and the effect diminished at 24 months (−0.64; p = .06). There were statistically significant improvements in the PSQI global score for daytime nappers, but not for non-nappers at 8 weeks (adjusted mean difference −0.98; p = .01 vs. −1.27; p = .05), 12 months (−0.86; p = .03 vs. −0.84; p = .21), and 24 months (−0.80; p = .04 vs. −0.14; p = .84), although these improvements were below the minimum detectible level of the PSQI which is 1 point.ConclusionsThe 8-week PA intervention was effective in improving sleep quality, while the effect was diminished and below the minimum detectible level of the PSQI which is 1 point after 24 months. The effect of PA intervention on sleep quality was more pronounced in daytime nappers. Additional interventions (e.g. focusing on multiple behavioral interventions such as PA and a healthy diet) are needed to maintain the beneficial effect of PA on sleep quality in the general older populations. Further research is required to confirm the mechanisms of the effect of napping and develop tailored interventions.Trial RegistrationConceptualizing a physical activity intervention model among rural older adults in China: a socio-ecological model-based approach, https://www.chictr.org.cn/showprojEN.html?proj=123704, registered at Chinese Clinical Trial Registry on April 20, 2021 (identifier: ChiCTR2100045653).