Objective vs. subjective measurements of sleep in depressed insomniacs: first night effect or reverse first night effect?
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ABSTRACT:
SUBMITTER: McCall C
PROVIDER: S-EPMC3266334 | biostudies-literature | 2012 Feb
REPOSITORIES: biostudies-literature
Publications
Objective vs. subjective measurements of sleep in depressed insomniacs: first night effect or reverse first night effect?
McCall Catherine C McCall W Vaughn WV
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 20120215 1
<h4>Study objectives</h4>This study examined changes in sleep parameters between the laboratory and the home setting before and after laboratory monitoring in depressed insomniacs undergoing treatment.<h4>Methods</h4>This study was a post hoc analysis of a double-blind, randomized, placebo-controlled clinical trial performed with 60 depressed, insomniac outpatients. Patients underwent actigraphic monitoring along with sleep diaries over a continuous 2-week period. After one week of baseline moni ...[more]
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Project description:ObjectivesOur prior work has shown that there is improvement in self-reported sleep in persons receiving placebo in hypnotic clinical trials. We examined the components of the "placebo response" in a hypnotic clinical trial.MethodsThis was an exploratory analysis of a randomized, double-blind clinical trial of eszopiclone versus placebo in the treatment of persons with depression and insomnia who were also receiving fluoxetine at a clinic of a teaching hospital. Sixty adults with both depression and insomnia symptoms, who were free of significant primary sleep disorders, received open-label fluoxetine for 9weeks. Patients were further randomized 1:1 to receive either masked eszopiclone 3mg or placebo at bedtime after the first week of fluoxetine. We examined the respective contributions of three factors associated with the "placebo effect": (1) regression to the mean, (2) expectancy, and (3) social desirability.ResultsThere was evidence for regression to the mean for the continuous measurement of the Insomnia Severity Index (ISI) and the Hamilton Depression Rating Scale. There was evidence for expectancy in self-reported Wake After Sleep Onset, continuous measurement of ISI, and dichotomous remission/non-remitter measurement of ISI. There was evidence of social desirability affecting self-reported Total Sleep Time.ConclusionsFactors that have been associated with the "placebo effect" are operating in hypnotic clinical trials. However, the role of each factor differs depending upon which self-reported variable is being considered. The findings have implications for clinical trial design in insomnia.
| S-EPMC3110560 | biostudies-literature
Project description:Actigraphy is increasingly used in the assessment and treatment of various clinical conditions, being a convenient and cost-effective method of capturing bodily movements over long periods of time. This study examined the use of actigraphy in the measurement of sleep of patients with depression and insomnia. Fifty-four patients diagnosed with a current major depressive episode and chronic insomnia underwent a baseline overnight study with concurrent actigraphic and polysomnography (PSG) monitoring, as well as subjective sleep diaries. Agreement between PSG, actigraphy and sleep diary measurements was evaluated using two-tailed t-tests, Pearson's correlations and the Bland-Altman concordance technique. The only significant difference found between actigraphy and PSG was in latency to persistent sleep, in which actigraphy underestimated sleep latency relative to PSG (P < 0.05). There were moderate positive correlations between actigraphy and PSG for all variables. In contrast, significant differences were observed between sleep diaries and PSG for all sleep variables. Bland-Altman concordance diagrams also demonstrated that, while bias was limited between PSG and the other two measurement types, there were somewhat broad 95% limits of agreement for all sleep variables with both sleep diaries and actigraphy. In summary, actigraphic measurements of sleep more closely approximated those of PSG than did sleep diaries in this sample of depressed insomniacs.
| S-EPMC3134551 | biostudies-literature
Project description:OBJECTIVE:Neurocognitive deficits are common and serious consequences of obstructive sleep apnea (OSA). Currently, the gold standard treatment is continuous positive air pressure (CPAP) therapy, although the clinical responses to this intervention can be variable. This study examined the effect of one night of CPAP therapy on sleep-dependent memory consolidation, attention, and vigilance as well as subjective experience. METHODS:Fifteen healthy controls and 29 patients with obstructive sleep apnea of whom 14 underwent a full-night CPAP titration completed the psychomotor vigilance test (PVT) and motor sequence learning task (MST) in the evening and the morning after undergoing overnight polysomnography. All participants also completed subjective evaluations of sleep quality. RESULTS:Participants with OSA showed significantly less overnight improvement on the MST compared to controls without OSA, independent of whether or not they had received CPAP treatment, while there was no significant difference between the untreated OSA and CPAP-treated patients. Within the OSA group, only those receiving CPAP exhibited faster reaction times on the PVT in the morning. Compared to untreated OSA patients, they also felt subjectively more rested and reported that they slept better. CONCLUSION:Our results demonstrate an instant augmentation of subjective experience and, based on PVT results, attention and vigilance after one night of CPAP, but a lack of an effect on offline sleep-dependent motor memory consolidation. This dissociation may be explained by different brain structures underlying these processes, some of which might require longer continued adherence to CPAP to generate an effect.
| S-EPMC5238960 | biostudies-literature
Project description:ObjectivesThe aim of this study was to assess the objective and subjective image characteristics of monoenergetic images (MEI[+]), using a noise-optimized algorithm at different kiloelectron volts (keV) compared to polyenergetic images (PEI), in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsThis retrospective, institutional review board-approved study included 45 patients (18 male, 27 female; mean age 66 years; range, 42-96 years) with PDAC who had undergone a dual-energy CT (DECT) of the abdomen for staging. One standard polyenergetic image (PEI) and five MEI(+) images in 10-keV intervals, ranging from 40 to 80 keV, were reconstructed. Line-density profile analysis, as well as the contrast-to-noise ratio (CNR) of the tumor, the signal-to-noise ratio (SNR) of the regular pancreas parenchyma and the tumor, and the CNR of the three main peripancreatic vessels, was calculated. For subjective quality assessment, two readers independently assessed the images using a 5-point Likert scale. Reader reliability was evaluated using an intraclass correlation coefficient.ResultsLine-density profile analysis revealed the largest gradient in attenuation between PDAC and regular tissue in MEI(+) at 40 keV. Low-keV MEI(+)reconstructions at 40 and 50 keV increased CNR and SNR compared to PEI (40 keV: CNR 46.8 vs. 7.5; SNRPankreas 32.5 vs. 15.7; SNRLesion 13.5 vs. 8.6; p?<?0.001). MEI(+) at 40 keV and 50 keV were consistently preferred by the observers (p?<?0.05), showing a high intra-observer 0.937 (0.92-0.95) and inter-observer 0.911 (0.89-0.93) agreement.ConclusionMEI(+) reconstructions at 40 keV and 50 keV provide better objective and subjective image quality compared to conventional PEI of DECT in patients with PDAC.Key points• Low-keV MEI(+) reconstructions at 40 and 50 keV increase tumor-to-pancreas contrast compared to PEI. • Low-keV MEI(+) reconstructions improve objective and subjective image quality parameters compared to PEI. • Dual-energy post-processing might be a valuable tool in the diagnostic workup of patients with PDAC.
| S-EPMC6554239 | biostudies-literature
Project description:In human sleep studies, the probability of discomfort from the electrodes and the change in environment usually results in first-night recordings being discarded. Sleep recordings from the first night in human subjects often differ in amount of REM (rapid eye movement) sleep and the overall sleep architecture. This study investigated whether recordings of sleep states in dairy cows also show a first-night effect. Non-invasive electrophysiological recordings were carried out on nine cows of the Swedish Red breed during three consecutive 24-hour periods (recording days 1-3). Overall, cows spent 12.9 ± 1.4 hours awake, 8.2 ± 1 hours ruminating, 57.2 ± 20.3 min drowsing, 44.1 ± 20.2 min in REM sleep and 64.3 ± 38.1 min in NREM (non-rapid eye movement) sleep (mean ± SD) and there were no significant differences between recording days in total duration for any of the sleep and awake states. However, the bouts of REM sleep and rumination were longer, and the awake bouts were shorter, at night time compared to daytime, regardless of recording day. The awake bouts also showed an interaction effect with longer bouts at daytime during day 1 compared to daytime on day 3. Data on sleep and awake states recorded in adult dairy cows during three consecutive 24-h periods showed great variation in sleep time between cows, but total time for each state was not significantly affected by recording day. Further and more detailed studies of how sleep architecture is affected by recording day is necessary to fully comprehend the first-night effect in dairy cows.
| S-EPMC5898734 | biostudies-literature
Project description:Study objectivesThe goal of this study was to clarify whether ginseng fermented by lactic acid bacteria (fermented ginseng, FG), can improve the first-night effect (FNE) in humans.DesignBehavioral tests and quantification of mRNA expression related to GABAergic neurotransmission in brain (glutamic acid decarboxylase 1, gamma-aminobutyrate aminotransferase [Abat], gamma-aminobutyric acid transporter 1 [GAT1], gamma-aminobutyric acid transporter 4, gamma-aminobutyric acid A receptor subunit alpha 1 and gamma-aminobutyric acid A receptor subunit alpha 2) were carried out in FG-treated mice. We also performed double-blind sleep recordings of human subjects given FG or placebo.SettingA university-based sleep laboratory.Patients or participantsSixteen healthy male volunteers (aged 20.69 +/- 0.44 years) were observed in the human study.InterventionsAt the end of administration, 2 consecutive all-night polysomnography recordings were performed. Subjects also completed psychological questionnaires, and urine and saliva samples were taken to analyze stress-sensitive markers.Measurements and resultsThe light-dark transition test demonstrated that FG had some anxiolytic effect in mice, but other anxiety measures were unaffected. The hippocampal mRNA expression showed a decrease of Abat and GAT1 suggesting an increase of GABA. Other regions (amygdala and cerebellum) showed no differences. Furthermore, there was some evidence (using simple pairwise comparisons but not supported in the full ANOVA model) that administration of FG tended to diminish decreases in total sleep time and sleep efficiency (seen as first night effects in the placebo group) without affecting sleep architecture.ConclusionsOur results suggest the administration of FG could improve the FNE in humans. The improvement may be related to an anxiolytic effect of FG which acts via GABAergic modification.
| S-EPMC2647796 | biostudies-literature
Project description:We experience disturbed sleep in a new place, and this effect is known as the first-night effect (FNE) in sleep research. We previously demonstrated that the FNE is associated with a surveillance system in one brain hemisphere during NREM sleep, which manifests as interhemispheric asymmetry in sleep depth in the default-mode network (DMN) and increased vigilance toward monitoring external stimuli. This surveillance system may be useful for protecting vulnerable sleepers from abnormal events in unfamiliar environments. The present study investigated whether a similar surveillance system is exhibited during rapid eye movement (REM) sleep. The impacts of the FNE could be different between the phasic period, in which eyes move rapidly, and the tonic period, in which eye movement ceases, of REM sleep; without the FNE, vigilance to external stimuli is generally reduced during the phasic period but not the tonic period. Thus, REM sleep was split into phasic and tonic periods. First, we replicated previous findings showing interhemispheric asymmetry in delta activity in the DMN associated with the FNE during NREM sleep. However, during REM sleep, interhemispheric asymmetry in delta activity or theta activities, two oscillatory activities during REM sleep, was not found during the phasic or tonic periods. Next, we tested whether vigilance, as measured by evoked brain responses (P2) to deviant tones, associated with the FNE was increased in one hemisphere during REM sleep. The P2 amplitudes during the phasic period were augmented by the FNE on day 1 and were significantly larger than those on day 2 when the FNE was not present. In contrast, the P2 amplitudes during the tonic period were not different across days. The P2 amplitudes showed no interhemispheric asymmetry during the phasic or tonic periods. These results suggest that while the surveillance system exhibits interhemispheric asymmetry in sleep depth and vigilance during NREM sleep, this system shows no interhemispheric asymmetry in oscillatory activities and exhibits increased vigilance in both hemispheres only during the phasic period of REM sleep. Therefore, the surveillance system associated with the FNE may involve different mechanisms during NREM and REM sleep.
| S-EPMC6828645 | biostudies-literature
Project description:BackgroundEven though the nutritional assessment of chronically ill patients has a significant effect on outcomes, nurses' time constraints in clinical encounters may make the process impractical. Also, cultural background has an effect on nutritional assessment. Patient nutritional self-assessment can ease some of the nurses' workload.ObjectivesTo compare tools for subjective and objective nutritional assessment and to examine cultural differences in nutritional assessment between Jews and Arabs living in Israel.MethodsThe research design was cross-sectional; data were collected from Jews and Arabs with chronic illnesses living in the community during their visit to a public health clinic. The admitting nurse performed an objective nutritional assessment (Mini Nutritional Assessment (MNA)) after the patients completed the Subjective Nutritional Assessment (SANS). The data were analyzed using descriptive statistics, Pearson's correlation coefficients were calculated to test the relationships between the variables, and independent student t-tests were used to compare the means and differences between groups. The diagnostic accuracy of the MNA and of the SANS was determined using the area under the curve (AUC) analysis of receiver operating characteristic (ROC) curves. The agreement between the MNA and SANS measurements was estimated by a Bland Altman plot. The level of significance employed throughout the analysis was 0.05.ResultsThe sample was a convenience sample of 228 chronically ill patients, consisting of 121 Arabs and 107 Jews. A significant correlation was found between the subjective and objective nutritional assessments. The Bland-Altman plot demonstrated that the SANS and the MNA have a high level of agreement. Using the area under the curve (AUC) analysis of receiver operating characteristic (ROC) curves, showed an moderate diagnostic accuracy (73 % sensitivity and 30 % specificity).ConclusionsSince the patient-completed nutritional assessment requires minimal time investment by nurses and we found a significant correlation and evidence for the accuracy and agreement of the objective and subjective assessments, further studies should assess and validate the possibility of replacing the objective nutritional assessment by the subjective assessment. Cultural background has a significant effect on patients' nutritional self-assessment; hence, culture should be considered as part of the nutritional assessment.
| S-EPMC8414867 | biostudies-literature
Project description:ImportanceTo date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed.ObjectiveTo investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential BiCIs.Design, setting, and participantsA multicenter randomized clinical trial was conducted between January 12, 2010, and September 2, 2012, at 5 tertiary referral centers among 40 participants eligible for BiCIs. Main inclusion criteria were postlingual severe to profound hearing loss, age 18 to 70 years, and a maximum duration of 10 years without hearing aid use in both ears. Data analysis was conducted from May 24 to June 12, 2016.InterventionsThe simultaneous BiCI group received 2 cochlear implants during 1 surgical procedure. The sequential BiCI group received 2 cochlear implants with an interval of 2 years between implants.Main outcomes and measuresFirst, the results 1 year after receiving simultaneous BiCIs were compared with the results 1 year after receiving sequential BiCIs. Second, the results of 3 years of follow-up for both groups were compared separately. The primary outcome measure was speech intelligibility in noise from straight ahead. Secondary outcome measures were speech intelligibility in noise from spatially separated sources, speech intelligibility in silence, localization capabilities, and self-reported benefits assessed with various hearing and quality of life questionnaires.ResultsNineteen participants were randomized to receive simultaneous BiCIs (11 women and 8 men; median age, 52 years [interquartile range, 36-63 years]), and another 19 participants were randomized to undergo sequential BiCIs (8 women and 11 men; median age, 54 years [interquartile range, 43-64 years]). Three patients did not receive a second cochlear implant and were unavailable for follow-up. Comparable results were found 1 year after simultaneous or sequential BiCIs for speech intelligibility in noise from straight ahead (difference, 0.9 dB [95% CI, -3.1 to 4.4 dB]) and all secondary outcome measures except for localization with a 30° angle between loudspeakers (difference, -10% [95% CI, -20.1% to 0.0%]). In the sequential BiCI group, all participants performed significantly better after the BiCIs on speech intelligibility in noise from spatially separated sources and on all localization tests, which was consistent with most of the participants' self-reported hearing capabilities. Speech intelligibility-in-noise results improved in the simultaneous BiCI group up to 3 years following the BiCIs.Conclusions and relevanceThis study shows comparable objective and subjective hearing results 1 year after receiving simultaneous BiCIs and sequential BiCIs with an interval of 2 years between implants. It also shows a significant benefit of sequential BiCIs over a unilateral cochlear implant. Until 3 years after receiving simultaneous BiCIs, speech intelligibility in noise significantly improved compared with previous years.Trial registrationtrialregister.nl Identifier: NTR1722.
| S-EPMC5710290 | biostudies-literature
Project description:We often experience troubled sleep in a novel environment [1]. This is called the first-night effect (FNE) in human sleep research and has been regarded as a typical sleep disturbance [2-4]. Here, we show that the FNE is a manifestation of one hemisphere being more vigilant than the other as a night watch to monitor unfamiliar surroundings during sleep [5, 6]. Using advanced neuroimaging techniques [7, 8] as well as polysomnography, we found that the temporary sleep disturbance in the first sleep experimental session involves regional interhemispheric asymmetry of sleep depth [9]. The interhemispheric asymmetry of sleep depth associated with the FNE was found in the default-mode network (DMN) involved with spontaneous internal thoughts during wakeful rest [10, 11]. The degree of asymmetry was significantly correlated with the sleep-onset latency, which reflects the degree of difficulty of falling asleep and is a critical measure for the FNE. Furthermore, the hemisphere with reduced sleep depth showed enhanced evoked brain response to deviant external stimuli. Deviant external stimuli detected by the less-sleeping hemisphere caused more arousals and faster behavioral responses than those detected by the other hemisphere. None of these asymmetries were evident during subsequent sleep sessions. These lines of evidence are in accord with the hypothesis that troubled sleep in an unfamiliar environment is an act for survival over an unfamiliar and potentially dangerous environment by keeping one hemisphere partially more vigilant than the other hemisphere as a night watch, which wakes the sleeper up when unfamiliar external signals are detected.
| S-EPMC4864126 | biostudies-literature