Sleep medicine

Recent documents in Sleep Medicine Articles
  1. STUDY OBJECTIVES: Insomnia is associated with elevated levels of suicidal thoughts and behaviors. Emerging evidence suggests that cognitive behavioral therapy for insomnia (CBTI) may reduce suicidal ideation (SI). However, the role of digital therapeutics in both the alleviation and prevention of SI remains unclear, and treatment mechanisms facilitating SI reductions have not been clearly identified.

    METHOD: 658 adults with DSM-5 insomnia disorder enrolled into a single-site randomized controlled trial evaluating the efficacy of digital CBTI relative to attention control. Outcomes were measured at pretreatment, posttreatment, and 1-year follow-up.

    RESULTS: Before treatment, 126 patients endorsed SI (19.1% prevalence). Among those with baseline SI, CBTI patients reported lower SI rates at posttreatment (30.0% vs 54.5%, p=.005) and 1-year follow-up (29.6% vs 46.8%, p=.042) relative to control. PRODCLIN analysis estimated that half of suicidolytic effects of CBTI were mediated through insomnia remission. Among those without baseline SI, CBTI did not directly prevent new onset SI. However, insomnia remitters reported lower rates of new onset SI at posttreatment relative to non-remitters (1.5% vs 6.5%, p=.009). Mediation analysis supported a significant indirect effect wherein CBTI increased likelihood of insomnia remission, which was associated with SI prevention (αβ=-3.13=5, 95%CI=-5.28, -0.96).

    CONCLUSION: Digital CBTI reduces insomnia symptoms, which promotes SI alleviation and prevention. For non-suicidal patients, digital CBTI may serve as a highly accessible monotherapy for improving sleep, thereby reducing risk for SI. For suicidal patients, digital CBTI may be appropriately administered as an adjunct treatment to support mainline intervention more directly targeting suicidogenic thoughts.

  2. Background and Objectives: Adequate sleep and an effective immune system are both essential to maintain a good health status. The current study aimed to determine the nature of insomnia complaints and perceived immune fitness among Dutch young adults with and without self-reported impaired wound healing.

    Materials and Methods: A total of (n = 2033) Dutch students (83.8% women) completed an online survey. Perceived immune fitness was assessed with a single-item scale and insomnia complaints with the SLEEP-50 insomnia subscale. The sample comprised a control group without self-reported impaired wound healing (n = 1622), a wound infection (WI) group (n = 69), a slow healing wounds (SHW) group (n = 250), and a COMBI group that experienced both WI and SHW (n = 92).

    Results: Comparisons with the control group revealed that individuals of the SHW and COMBI groups reported significantly poorer perceived immune functioning, increased insomnia complaints and daytime fatigue, and poorer sleep quality.

    Conclusions: Individuals with self-reported impaired wound healing have a poorer perceived immune functioning, increased insomnia complaints, daytime fatigue, and poorer sleep quality.

  3. STUDY OBJECTIVES: To examine the role of sleep reactivity as a predictor of insomnia in patients diagnosed with breast cancer.

    METHODS: One hundred and seventy three women with breast cancer participated and were followed up over a period of 9 months. At baseline participants were assigned to a high (n=114) or low (n=59) sleep reactivity group, based on their responses to the Ford Insomnia Response to Stress Test (FIRST). We assessed whether these FIRST groupings (high/low sleep reactivity) predicted changes in insomnia over time using the Insomnia Severity Index (ISI). We also tested if these FIRST groupings predicted insomnia disorder (using ISI index cut-offs) at three different time points (T3, T6 and T9).

    RESULTS: Individuals with high sleep reactivity were more likely to experience a worsening of insomnia. Using logistic regression we also found that FIRST grouping predicted insomnia disorder. Results remained significant after controlling for estimated pre-morbid sleep, age and whether someone had chemotherapy.

    CONCLUSIONS: Our study shows that sleep reactivity may be a robust predictor of insomnia within breast cancer populations. Sleep reactivity should be considered in routine clinical assessments as a reliable way to identify patients at risk of developing insomnia. This would facilitate early sleep intervention for those patients who are considered high risk.