Actigraphy and Sleep Diary Measurements in Breast Cancer Survivors: Discrepancy in Selected Sleep Parameters
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This analysis examined the discrepancy between sleep diary and actigraphy measurements in breast cancer survivors (BCS) with insomnia. BCS from communities in Western U.S. provided demographic/medical information, insomnia, mood, and fatigue data at baseline. Averaged over 5 weeks, actigraphy measured 55.75 minutes (SD = 112.42) less total sleep time (TST), and 85.19 minutes (SD = 81.36) more wake after sleep onset (WASO) than diaries. Some women showed agreement between measures; others were more variable. There were no significant relationships between TST and WASO discrepancy and participant characteristics. There may be sleep differences in BCS that results in greater perceived TST and less WASO reported in diaries. Measurements discrepancy is a significant concern needing further evaluation of medical populations with insomnia.Keywords:
Sleep
Sleep diary
Sleep onset latency
Abstract Introduction Sleep-wake state discrepancy is a common phenomenon identified among people with insomnia where greater sleep difficulties are self-reported in comparison with estimates obtained from objective assessment. This study provides the investigation into the sleep-wake state discrepancy and correlation between sleep diary (subjective) and actigraphy-derived (objective) sleep measures. Methods Participants included 136 cancer survivors with insomnia symptoms (M age = 63.8 ± 10.0; 55.9% female; 87.5% White) from baseline data in an ongoing clinical trial. Demographics, Insomnia Severity Index (ISI), 7-consecutive days of sleep diary and actigraphy data were obtained. Sleep measures included time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE%). Mean bias was defined as the discrepancy between sleep diary and actigraphy-derived sleep measures. The agreement between sleep diary and actigraphy-derived sleep measures were graphically assessed using the Bland-Altman plot. Using the mixed linear model approach, the estimated bias and 95% limits of agreement (LOA) were computed. Further, the Pearson correlation coefficient and concordance correlation coefficient (CCC), computed via maximum likelihood methods, were obtained. Results Self-reported TST and SE were shorter than derived by actigraphy (TST: 6.8 min. [95%CI: -18.7, 5.13]; and SE%: 0.7% [95%CI: -3.0, 2.0], respectively). Self-reported TIB, SOL, and WASO were longer than derived by actigraphy (TIB: 8.6 min. [95%CI: 3.7, 13.5]; SOL: 14.8 min. [95%CI: 9.4, 20.2]; and WASO: 20.7 min. [95%CI: 9.4, 20.2], respectively). Moderate to high agreement and correlation were found between the sleep diary and actigraphy-derived TIB (CCC=0.78; r=0.73) and TST (CCC=0.58; r=0.51). In contrast, SOL (CCC=0.48; r=0.35), WASO (CCC=0.36; r=0.18), and SE% (CCC=0.39; r=0.22) showed only fair or poor agreement and correlation. Calculated Bland-Altman LOA between sleep diary and actigraphy derived measures were as follows: TIB (95%LOA: -121.5, 138.7), TST (95%LOA: -197.9, 184.3), SOL (95%LOA: -82.5, 112.1), WASO (95%LOA: -123.5, 164.8), and SE% (95%LOA: -0.37, 0.36). Conclusion Among a heterogeneous sample of cancer survivors with insomnia symptoms, average self-reported sleep duration and efficiency were shorter and self-reported TIB, SOL, and WASO were longer than objectively measured sleep measures. Agreement between two methods varied across different measures. Support (if any) NIH/NINR R01NR018215 (Dean), ClinicalTrials-NCT03810365
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Abstract Introduction Women may enter in breast cancer (BCa) treatment with poor sleep, or it may begin during treatment. We assessed how subjective and objective sleep changes during the first year of treatment for women with BCa. Further, we examined whether this differs between previously good and poor sleepers and whether there was agreement between subjective and objective measures of sleep. Methods Sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) were measured among 100 patients with newly diagnosed, non-metastatic BCa using 7 days of diary and actigraphy collected at 4 time points: pre-treatment, 4, 8, and 12 months. Women with a score ≥5 on the Pittsburgh Sleep Quality Index at treatment onset were classified as poor sleepers. A 4 (time: 0-, 4-, 8-, 12-months) by 2 (sleep measure: sleep diary, actigraphy) by 2 (group: good, poor sleepers) mixed model ANOVAs was performed for each sleep parameter. Results There was a time by sleep measure by group interaction for TST, [F(3,294)= 3.014, p = .03). Good sleepers reported greater TST on diaries- than actigraphy at pre-treatment and 12 months, whereas there were no differences in poor sleepers. There was a group by time effect for good vs. poor sleepers [F(3,294)= 2.909, p = .035]. Good sleepers experienced decreased TST and SE from pre-treatment through 4-mo, followed by increases. Poor sleepers showed the opposite pattern. Neither group returned to pre-treatment levels. Sleep diaries and actigraphy are concordant over time for TST, but not SOL, WASO, or SE. Conclusion Sleep parameters worsen during the first year following onset of BCa and concordance between sleep diaries and actigraphy differ between good or poor sleepers. Support Dr. Garland is supported by a Scotiabank New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).
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Recently, the use of multicomponent insomnia treatment has increased. This study compares the effect of single component and multicomponent behavioral treatments for insomnia in older adults after intervention and at 3 months and 1 yr posttreatment.
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Background/Objective: Some older adults with insomnia experience sleep discrepancy, often characterized by greater subjective sleep difficulties and shorter subjective sleep duration than the estimates derived from objective measures. The present study examined whether a brief behavioral therapy for insomnia (BBTi) is efficacious for reducing sleep discrepancy in older adults.Methods: This study is a secondary analysis of a randomized controlled trial of BBTi for community dwelling older adults with chronic insomnia (N = 62). Thirty-two participants received BBTi, delivered in four individual face-to-face sessions. Thirty received the self-monitoring control (SMC). They all completed daily sleep diaries and wore an actigraph from baseline to posttreatment, and for 2 weeks at 3-month follow-up. Sleep discrepancy was calculated by subtracting diary from actigraphy estimates of sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Mixed modeling was used to analyze data. SOL discrepancy decreased significantly in BBTi participants compared to SMC participants. The decreases in SOL discrepancy were explained by changes in diary-assessed SOL and subjective sleep quality but not changes in actigraphy-assessed SOL. Although WASO discrepancy and TST discrepancy decreased from baseline to posttreatment and follow-up, the Time by Group interaction effects were not significant indicating that BBTi participants did not experience greater reductions in WASO discrepancy and TST discrepancy than SMC participants. In conclusion, BBTi is efficacious for reducing SOL discrepancy in older adults with chronic insomnia.
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Summary Although sleep diary and actigraphy data are usually collected daily for 1 or 2 weeks, traditional analytical approaches aggregate these data into mean values. Internight variability of sleep often accompanies insomnia. However, few studies have explored the relevance of this ‘construct’ in the context of diagnosis, clinical impact, treatment effects and/or whether having ‘variable sleep’ carries any prognostic significance. We explored these questions by conducting secondary analyses of data from a randomized clinical trial. The sample included primary (PI: n = 40) and comorbid insomnia (CMI: n = 41) sufferers receiving four biweekly sessions of cognitive–behavioural therapy (CBT) or sleep hygiene education. Using the within‐subject standard deviations of diary‐ and actigraphy‐derived measures collected for 2‐week periods [sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE)], we found that CMI sufferers displayed more variable self‐reported SOLs and SEs than PI sufferers. However, higher variability in diary and actigraphy‐derived measures was related to poorer sleep quality only within the PI group, as measured by the Pittsburgh Sleep Quality Index (PSQI). Within both groups, the variability of diary‐derived measures was reduced after CBT, but the variability of actigraphy‐derived measures remained unchanged. Interestingly, the variability of actigraphy measures at baseline was correlated with PSQI scores at 6‐month follow‐up. Higher SOL variability was associated with worse treatment outcomes within the PI group, whereas higher WASO variability was correlated with better treatment outcomes within the CMI group. Sleep variability differences across insomnia diagnoses, along with their distinctive correlates, suggest that mechanisms underlying the sleep disruption/complaint and treatment response in both patient groups are distinct. Further studies are warranted to support variability as a useful metric in insomnia studies.
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Chronic sleep onset insomnia with late melatonin onset is prevalent in childhood, and has negative daytime consequences. Melatonin treatment is known to be effective in treating these sleep problems. Bright light therapy might be an alternative treatment, with potential advantages over melatonin treatment. In this study, we compare the effects of melatonin and bright light treatment with a placebo condition in children with chronic sleep onset insomnia and late melatonin onset.Eighty-four children (mean age 10.0 years, 61% boys) first entered a baseline week, after which they received melatonin (N = 26), light (N = 30), or placebo pills (N = 28) for 3 to 4 weeks. Sleep was measured daily with sleep diaries and actigraphy. Before and after treatment children completed a questionnaire on chronic sleep reduction, and Dim Light Melatonin Onset (DLMO) was measured. Results were analyzed with linear mixed model analyses.Melatonin treatment and light therapy decreased sleep latency (sleep diary) and advanced sleep onset (sleep diary and actigraphy), although for sleep onset the effects of melatonin were stronger. In addition, melatonin treatment advanced DLMO and had positive effects on sleep latency and sleep efficiency (actigraphy data), and sleep time (sleep diary and actigraphy data). However, wake after sleep onset (actigraphy) increased with melatonin treatment. No effects on chronic sleep reduction were found.We found positive effects of both melatonin and light treatment on various sleep outcomes, but more and stronger effects were found for melatonin treatment.
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Abstract Introduction Sleep disruption is a common complaint for firefighters, largely thought to emanate from work and personal demands that prohibit recovery sleep. These disruptions increase the risk of sleep disorders, cardiovascular disease, cancer, and other disorders. Given the significance of sleep on health and the high frequency of sleep disruption in the fire service, we sought to examine the concordance between actigraphic and daily diary sleep assessments. The purpose of this analysis was to contribute information on the use of actigraphy and sleep diaries in shift workers individuals prone to insufficient sleep. Methods The sleep of 60 firefighters (n = 329 observations) working 24-hour shifts was assessed on a 6-day recovery period. Objective sleep was assessed via the Actiwatch-2, a research-grade, wrist-worn actigraph that measures motor activity in 30 sec intervals. Subjective sleep was assessed via the research consensus daily sleep diary, a self-reported measure collected upon awakening. Major sleep indices compared were: sleep onset latency (SOL), total sleep time (TST), sleep efficiency (SE), and wake time after sleep onset (WASO). Results Repeated effects Bland-Altman analysis using a mixed effects technique (measurement = fixed effect; participant = random effect) found that firefighters underestimated WASO (M = 32 min) and overestimated SE (M = 10%) at a level greater than the a priori clinical significance thresholds set by the American Academy of Sleep Medicine for insomnia. The limits of agreement for all sleep indices were very broad. For instance, 95% of the differences between self-report and actigraphic TST fell within a 4.7h range. The majority of the variability could be attributed to within-subject sources of variability versus between-subject sources of variability. Conclusion In firefighters, actigraphy and sleep diaries showed substantial disagreement in major sleep indices, with a systematic underestimation of WASO and overestimation of SE. The wide range of differences suggest that daily assessments of SOL, WASO, SE, or TST in on-call shift workers should be compared against a feasible gold-standard. Further research is needed to understand within-subject factors (e.g., daily differences) that predict a discrepancy between actigraphic and self-reported sleep in different working populations. Support (if any) #1R01HL117995-01A1
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Self-reported symptoms of insomnia are often inconsistent with objective measures of sleep, including measures derived from actigraphy. Cognitive behavioural therapy for insomnia (CBT-I) effectively improves insomnia symptoms, but whether it reduces subjective-objective sleep discrepancy is not well understood. This study examined whether CBT-I reduces subjective-objective sleep discrepancy against a control condition, and explored associations between changes in discrepancy and changes in sleep-related attitudes. Participants were 112 (age M±SD=47.1 ± 12.3, 67.9% female) adults with comorbid insomnia and major depressive disorder from the TRIAD (Treatment of Insomnia and Depression) study. They were randomized to 7-session CBT-I or control interventions to augment antidepressant pharmacotherapy over 16 weeks. 2-week actigraphy and sleep diary were collected at baseline, in the middle, and at the end of the trial. Subjective-objective sleep discrepancy was operationalised as the discrepancy between self-report and actigraphy time-in-bed (TIB), total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO). The Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) was administered at baseline and mid-intervention. At baseline, self-report TIB and TST were significantly shorter, whilst SOL and WASO longer than those from actigraphy. Multilevel models using daily data showed that after controlling for age and sex, the CBT-I group showed significantly greater reduction in subjective-objective sleep discrepancy in all (except TIB) domains compared to the control group (all p-values<.01). Improvements were evident from mid-intervention. The differential effects of the two interventions on the overall reduction of subjective-objective sleep discrepancy in TST, SOL, and SE (but not WASO) was significantly associated with changes in DBAS from baseline to mid-intervention (all p-values<.05). CBT-I was effective in reducing the subjective-objective sleep discrepancy in patients with comorbid insomnia and major depression. Improvements in subjective-objective sleep discrepancy was associated with improved sleep-related attitudes, a therapeutic target of CBT-I. MH078924, MH078961, MH079256.
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