Subjective versus objective sleep in men with Klinefelter syndrome
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To investigate sleep among men with Klinefelter syndrome (KS).We compared the sleep domains latency, disturbance, and efficiency in 30 men with KS (M age = 36.7 years, SD = 10.6) to 21 age-matched non-KS controls (M age = 36.8 years, SD = 14.4). Actigraphs were used to objectively measure sleep across 7 days and nights. Participants also completed a sleep diary over the same period, and the Pittsburgh Sleep Quality Index (PSQI).The mean correlation between the objective and subjective sleep measures was lower for the KS sample (M r = .15) than for controls (M r = .34). Sleep disturbance was significantly larger in the KS sample, as measured by actigraphy (p = .022, d = 0.71) and the PSQI (p = .037, d = 0.61). In regression models predicting sleep domains from KS status, age, educational level, vocational status, IQ, and mental health, KS status was not a significant predictor. Higher age was associated with more actigraphy-measured sleep disturbance. Higher educational level and being employed were associated with better sleep efficiency.Sleep disturbance may be a particular problem for men with KS and should be measured with complimentary methods.Keywords:
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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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Introduction Sleep is a necessary part of life. Assessment of sleep patterns enables the nurse to intervene immediately by implementing interventions with the client, or by referring the client for further assessment. Method The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument created by Buysse et al in 1989. It differentiates ‘poor’ from ‘good’ sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbances, use of sleep medication and daytime dysfunction over the last month. The client self relates each of these seven areas of sleep. Scoring of the answers is based on a 0 to 3 scale, three reflects the negative extreme on the Likert scale. A sum of ‘5’or greater indicates a ‘poor’ sleeper. Result Seven patients who had sleeping problems were assessed. Data using the PSQI was collected from the 18th of June till the 18th of July 2010. Out of these seven patients, four of them were found to a sum of 5 to 6 as their global PSQI score. Two of them were given sleep medication to improve their sleeping patterns and the other two of them were referred to a psychologist. Three of the patients were found to have subjective sleep problems; two of them were overweight and were asked to start an exercise program. The other patient was found to lead a sedentary lifestyle and was encouraged to be more active. Conclusion The PSQI can be used for both initial assessment and ongoing comparative measurements with older adults across all health settings.
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This article examined associations between preschoolers' daytime and nighttime sleep parameters. A total of 63 preschoolers (65% boys; age: M = 4.15, SD = 0.62) participated. Sleep was assessed via actigraphy for 4 days and nights. Results are among the first to demonstrate significant associations between sleep parameters (especially sleep quality indexes) examined actigraphically at home and in child care contexts. Findings indicate that poor sleep quality indexed by greater sleep activity and awakenings, as well as less efficient sleep, were associated across nighttime sleep at home and daytime sleep in child care. Understanding connections between sleep across contexts has important implications for child care providers and parents as they attempt to facilitate child sleep during a developmental period of rapidly changing sleep patterns.
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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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Self-report retrospective estimates of sleep behaviors are not as accurate as prospective estimates from sleep diaries, but are more practical for epidemiological studies. Therefore, it is important to evaluate the validity of retrospective measures and improve upon them. The current study compared sleep diaries to two self-report retrospective measures of sleep, the commonly used Pittsburgh Sleep Quality Index (PSQI) and a newly developed sleep questionnaire (SQ), which assessed weekday and weekend sleep separately. It was hypothesized that the new measure would be more accurate than the PSQI because it accounts for variability in sleep throughout the week. The relative accuracy of the PSQI and SQ in obtaining estimates of total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) was examined by comparing their mean differences from, and correlations with, estimates obtained by the sleep diaries. Correlations of the PSQI and SQ with the sleep diaries were moderate, with the SQ having significantly stronger correlations on the parameters of TST, SE, and sleep quality ratings. The SQ also had significantly smaller mean differences from sleep diaries on SOL and SE. The overall pattern of results indicated that the SQ performs better than the PSQI when compared to sleep diaries.
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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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Sleep disturbance relates to various disorders and is a significant public health issue. Evaluation of sleep quality is necessary to analyze and improve sleep quality. Polysomnography (PSG) is an efficient method for sleep analysis. However, complicated systems are required for the analysis. Also, PSG can be stressful for participants and is, therefore, not suitable for long term sleep monitoring. Sleepscan is a non-invasive mattress type sleep measuring device developed by TANITA. Sleepscan measures the participant's heart rate, respiration, and body movement during sleep, and evaluates sleep quality objectively. We measured the sleep quality of healthy university students with Sleepscan and a widely-used sleep measuring device, actigraph. We also discussed the efficacy of using Sleepscan daily. Sleepscan detected longer sleep latency and shorter awake episodes during sleep than actigraph. Although these devices showed quite different results for some sleep variables, the sleep score recorded by Sleepscan and sleep efficiency by actigraph correlates well. Since sleep efficiency is used as a representative index for comprehensive sleep quality in actigraphy, the sleep score by Sleepscan can be an alternative index used to evaluate sleep quality objectively. Sleepscan can also analyze the depth of sleep. The deep sleep variables recorded by Sleepscan did not correlate with the sleep variables by actigraph, suggesting that these variables may represent aspects of sleep quality that cannot be detected by actigraphy. Sleepscan may be useful in analyzing sleep quality objectively more comprehensively over a long period.
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