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Journal of Critical Care Oct 2022To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients.
MATERIALS AND METHODS
We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible.
RESULTS
132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ).
CONCLUSIONS
Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.
Topics: Adult; Critical Illness; Humans; Intensive Care Units; Prospective Studies; Retrospective Studies; Sleep
PubMed: 35849874
DOI: 10.1016/j.jcrc.2022.154102 -
Neuroscience and Biobehavioral Reviews Mar 2024This systematic review of 52 studies provides a quantitative synthesis of the empirical literature on social and circadian rhythm correlates of suicidal thoughts and... (Meta-Analysis)
Meta-Analysis Review
This systematic review of 52 studies provides a quantitative synthesis of the empirical literature on social and circadian rhythm correlates of suicidal thoughts and behaviors (STB). Small-to-medium pooled effect sizes were observed for associations between evening chronotype and STB and suicidal ideation (SI), although the pooled effect size diminished when accounting for publication bias. Three studies employed longitudinal designs and suggested eveningness was predictive of future STB, with a small-to-medium effect size. Social rhythm irregularity was also a significant correlate of STB with pooled effect sizes in the medium range. Overall circadian rhythm disruption was not associated with STB, although certain circadian rhythm metrics, including mean daytime activity, circadian rhythm sleep-wake disorder diagnosis, and actigraphy-assessed amplitude were associated with STB. Pooled effect sizes for these indices were in the medium to large range. There is a need for additional longitudinal research on actigraphy-based circadian parameters and objective markers of circadian phase (i.e., dim-light melatonin onset) to gain a clearer understanding of associations of endogenous circadian function and STB beyond that which can be captured via self-report.
Topics: Humans; Sleep; Suicide; Circadian Rhythm; Chronobiology Disorders; Suicidal Ideation; Melatonin
PubMed: 38272337
DOI: 10.1016/j.neubiorev.2024.105560 -
European Journal of Psychotraumatology Jul 2020Sleep disturbance has been described as a 'hallmark' symptom of posttraumatic stress disorder (PTSD). Although there are robust findings of self-reported sleep... (Review)
Review
BACKGROUND
Sleep disturbance has been described as a 'hallmark' symptom of posttraumatic stress disorder (PTSD). Although there are robust findings of self-reported sleep disturbance in PTSD, evidence of sleep disturbance measured using actigraphy is less certain.
OBJECTIVE
To conduct a systematic review and meta-analysis to determine whether there are any significant differences between individuals with and without PTSD in actigraph-derived sleep measures.
METHOD
Case-control studies comparing participants with current PTSD to those without PTSD were eligible for inclusion. Sleep parameters of interest were: (1) total sleep time; (2) sleep onset latency; (3) wake after sleep onset (WASO); and (4) sleep efficiency. Data were meta-analysed as standardised mean differences (SMDs) and potential sources of heterogeneity were explored through meta-regression. Six actigraphy studies with 405 participants were included.
RESULTS
There was no evidence of a statistically significant difference between those with and without PTSD in total sleep time (SMD 0.09, 95%CI -0.23 to 0.42); WASO (SMD 0.18, 95%CI -0.06 to 0.43); sleep latency (SMD 0.32, 95%CI -0.04 to 0.69); or sleep efficiency (SMD -0.28, 95%CI -0.78 to 0.21).
CONCLUSIONS
Further high-quality research is required to determine whether there is a true difference in sleep between those with and without PTSD.
PubMed: 33029311
DOI: 10.1080/20008198.2020.1767349 -
Sleep Medicine Reviews Oct 2014Periodic limb movements of sleep (PLMS) are repetitive, stereotyped movements that can disrupt sleep and result in insomnia, non-restorative sleep, and/or daytime... (Meta-Analysis)
Meta-Analysis Review
Periodic limb movements of sleep (PLMS) are repetitive, stereotyped movements that can disrupt sleep and result in insomnia, non-restorative sleep, and/or daytime sleepiness. Currently, polysomnography is the gold standard and only clinically acceptable means of quantifying PLMS. Leg-worn actigraphy is an alternative method of measuring PLMS, which may circumvent many of the economic and technical limitations of polysomnography to quantify nocturnal leg movements. However, the use of leg actigraphy as a diagnostic means of assessing PLMS has not been systematically evaluated. In this review, the use of leg-worn actigraphy to measure PLMS is systematically evaluated, using both qualitative and quantitative assessment. Findings demonstrate significant heterogeneity among a limited number of studies in terms of type of actigraph utilized, position of the device on the lower extremity, and methods employed to count PLMS. In general, common accelerometers vary in their sensitivity and specificity to detect PLMS, which is likely related to the technical specifications of a given device. A current limitation in the ability to combine data from actigraphs placed on both legs is also a significant barrier to their use in clinical settings. Further research is required to determine the optimal methods to quantify PLMS using leg actigraphy, as well as specific clinical situations in which these devices may prove most useful.
Topics: Actigraphy; Humans; Leg; Nocturnal Myoclonus Syndrome; Polysomnography
PubMed: 24726711
DOI: 10.1016/j.smrv.2014.02.004 -
The Journal of Rheumatology May 2023The aim of this systematic review and metaanalysis is to summarize evidence regarding the relationship between psoriatic arthritis (PsA) and sleep problems.
OBJECTIVE
The aim of this systematic review and metaanalysis is to summarize evidence regarding the relationship between psoriatic arthritis (PsA) and sleep problems.
METHODS
We identified 36 eligible studies-26 cross-sectional, 7 cohort, and 3 interventional studies-in PubMed and Embase.
RESULTS
The prevalence of self-reported sleep problems in patients with PsA ranged from 30% to 85%. A metaanalysis of 6 studies that used the Pittsburgh Sleep Quality Index revealed a prevalence of poor sleep quality for patients with PsA of 72.9% (95% CI 63-81.8; = 78%), which was statistically higher than in healthy controls (26.9%, 95% CI 11.7-45.4; = 81%) but not significantly different than in patients with psoriasis (59.8%, 95% CI 46.9-72.1; = 51%). Sleep disturbance was ranked in the top 4 health-related quality of life domains affected by PsA. One study suggested a bidirectional relationship between PsA and obstructive sleep apnea. Predictors of sleep problems included anxiety, pain, erythrocyte sedimentation rate, depression, fatigue, physical function, and tender or swollen joint count. Tumor necrosis factor inhibitors, guselkumab, and filgotinib (a Janus kinase inhibitor) were associated with improved sleep outcomes.
CONCLUSION
Poor sleep quality is prevalent in patients with PsA. Objective sleep measures (ie, actigraphy and polysomnography) have not been used in PsA studies, and evidence on the validity of patient-reported sleep measures in PsA is lacking. Future studies should validate self-reported sleep measures in PsA, explore how sleep quality relates to PsA disease activity and symptoms using both objective and subjective sleep measures, assess the efficacy of strategies to manage sleep problems, and assess the effects of such management on symptoms and disease signs in patients with PsA.
PubMed: 37127321
DOI: 10.3899/jrheum.2022-1169 -
Annals of the American Thoracic Society Sep 2017Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after... (Review)
Review
RATIONALE
Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful.
OBJECTIVES
This Systematic Review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors.
DATA SOURCES
PubMed (January 4, 2017), MEDLINE (January 4, 2017), and EMBASE (February 1, 2017).
DATA EXTRACTION
Databases were searched for studies of critically ill adult patients after hospital discharge, with sleep disturbance measured as a primary outcome by standardized questionnaire or objective measurement tools. From each relevant study, we extracted prevalence and severity of sleep disturbance at each time point, objective sleep parameters (such as total sleep time, sleep efficiency, and arousal index), and risk factors for sleep disturbance.
SYNTHESIS
A total of 22 studies were identified, with assessment tools including subjective questionnaires, polysomnography, and actigraphy. Subjective questionnaire studies reveal a 50-66.7% (within 1 mo), 34-64.3% (>1-3 mo), 22-57% (>3-6 mo), and 10-61% (>6 mo) prevalence of abnormal sleep after hospital discharge after critical illness. Of the studies assessing multiple time points, four of five questionnaire studies and five of five polysomnography studies show improved aspects of sleep over time. Risk factors for poor sleep varied, but prehospital factors (chronic comorbidity, pre-existing sleep abnormality) and in-hospital factors (severity of acute illness, in-hospital sleep disturbance, pain medication use, and ICU acute stress symptoms) may play a role. Sleep disturbance was frequently associated with postdischarge psychological comorbidities and impaired quality of life.
CONCLUSIONS
Sleep disturbance is common in critically ill patients up to 12 months after hospital discharge. Both subjective and objective studies, however, suggest that sleep disturbance improves over time. More research is needed to understand and optimize sleep in recovery from critical illness.
Topics: Critical Illness; Humans; Intensive Care Units; Patient Discharge; Quality of Life; Randomized Controlled Trials as Topic; Severity of Illness Index; Sleep; Sleep Wake Disorders; Survivors
PubMed: 28644698
DOI: 10.1513/AnnalsATS.201702-148SR -
Neuroscience and Biobehavioral Reviews Apr 2022Sleep and circadian rhythms disturbances (SCRD) in young people at high risk or with early onset of bipolar disorders (BD) are poorly understood. We systematically... (Meta-Analysis)
Meta-Analysis Review
Sleep and circadian rhythms disturbances (SCRD) in young people at high risk or with early onset of bipolar disorders (BD) are poorly understood. We systematically searched for studies of self, observer or objective estimates of SCRD in asymptomatic or symptomatic offspring of parents with BD (OSBD), individuals with presentations meeting recognised BD-at-risk criteria (BAR) and youth with recent onset of full-threshold BD (FT-BD). Of 76 studies eligible for systematic review, 35 (46%) were included in random effects meta-analyses. Pooled analyses of self-ratings related to circadian rhythms demonstrated greater preference for eveningness and more dysregulation of social rhythms in BAR and FT-BD groups; analyses of actigraphy provided some support for these findings. Meta-analysis of prospective studies showed that pre-existing SCRD were associated with a 40% increased risk of onset of BD, but heterogeneity in assessments was a significant concern. Overall, we identified longer total sleep time (Hedges g: 0.34; 95% confidence intervals:.1, .57), especially in OSBD and FT-BD and meta-regression analysis indicated the effect sizes was moderated by the proportion of any sample manifesting psychopathology or receiving psychotropic medications. This evolving field of research would benefit from greater attention to circadian rhythm as well as sleep quality measures.
Topics: Adolescent; Bipolar Disorder; Circadian Rhythm; Humans; Prospective Studies; Sleep; Sleep Wake Disorders
PubMed: 35182537
DOI: 10.1016/j.neubiorev.2022.104585 -
Sleep Medicine Reviews Feb 2017Sleep disturbances are common in people with a diagnosis of schizophrenia and have been associated with increased symptom severity, neurocognitive deficits and reduced... (Review)
Review
Sleep disturbances are common in people with a diagnosis of schizophrenia and have been associated with increased symptom severity, neurocognitive deficits and reduced quality of life. Despite a significant body of literature in this field, there has been limited investigation of sleep disturbance in the early course of the illness. This systematic review aims to synthesise and evaluate the available data exploring sleep in early psychosis, with two key research questions: 1) What is the nature of sleep disturbance in early psychosis? and 2) What are the correlates of sleep disturbance in early psychosis? From an initial search, 16,675 papers were identified, of which 21 met inclusion/exclusion criteria. The preliminary evidence suggests that self-reported sleep disturbances are prevalent in early psychosis and may be associated with symptom severity, as well as elevated rates of both help-seeking and suicidality. Abnormalities in sleep architecture and sleep spindles are also commonly observed and may correlate with symptom severity and neurocognitive deficits. However, due to significant methodological limitations and considerable heterogeneity across studies, evidence to support the reliability of these associations is limited. We outline a research agenda, emphasising the prospective use of gold-standard sleep measurement to investigate the prevalence and nature of sleep disturbances in early psychosis, as well as how these may be related to the onset and persistence of psychotic symptoms.
Topics: Humans; Polysomnography; Psychotic Disorders; Reproducibility of Results; Risk Factors; Self Report; Severity of Illness Index; Sleep Wake Disorders
PubMed: 26920092
DOI: 10.1016/j.smrv.2016.01.001 -
International Journal of Environmental... Dec 2021Since seafarers are known to be exposed to numerous job-related stress factors that can cause fatigue, sleepiness, and disturbed sleep behaviour, the aim of this review... (Review)
Review
Since seafarers are known to be exposed to numerous job-related stress factors that can cause fatigue, sleepiness, and disturbed sleep behaviour, the aim of this review was to provide an overview of the subjective and objective measurement methods of these strains. Using a systematic review, 166 studies were identified within the period of January 2010 to December 2020 using the PubMed database. Of the 21 studies selected, 13 used both subjective and objective measurement methods. Six studies used only subjective and two studies only objective methods. For subjective assessment, 12 different questionnaires could be identified as well as activity and sleeping logs. Actigraphy and reaction time tests (RTT) were the most common objective methods. In single cases, electrooculography (EOG), pupillometry and ambulatory polysomnography (PSG) were used. Measurement-related limitations due to vessel-related impacts were less often reported than expected. No restrictions of daily routines on board were described, and only single-measurement disturbances due to ship movements were mentioned. The present literature review reveals that there are various routines to measure fatigue, sleepiness, and sleep behaviour on board. A combination of subjective and objective methods often appears to be beneficial. The frequent use of actigraphy and RTT on board suggests good feasibility and reliable measurements with these methods. The use of ambulatory PSG in maritime-like contexts suggests that this method would also be feasible on board.
Topics: Fatigue; Humans; Ships; Sleep; Sleepiness; Surveys and Questionnaires; Wakefulness
PubMed: 35010383
DOI: 10.3390/ijerph19010120 -
Current Psychiatry Reports Jun 2013Actigraphy has become increasingly recognized as a useful method to study sleep/wake patterns and activity monitoring. It is a reliable tool for confirming a diagnosis... (Review)
Review
Actigraphy has become increasingly recognized as a useful method to study sleep/wake patterns and activity monitoring. It is a reliable tool for confirming a diagnosis and evaluating the effect of treatments for sleep problems in patients with primary psychiatric diagnoses such as schizophrenia. In addition, actigraphy is an objective measure that circumvents the lack of insight and often unreliable self-reporting of mental health related problems. However, the literature regarding the use of actigraphy in research and clinical applications related to severe psychiatric populations is scarce. Amalgamation of the evidence is needed to advance the use of actigraphy in psychiatry. We summarized the literature to date related to the use of actigraphy in patients with psychotic disorders, specifically schizophrenia. We conducted a systematic review of journal databases. Sixty-six studies emerged from the search of the electronic search engines, 14 were RCTs/case-control studies and 14 were review/guideline papers and others were case studies. Results of the RCT/case-control studies comparing the use of actigraphy with patients versus control were summarized. Actigraphy not only allows for the objective evaluation of sleep habits and circadian rhythm disorders, but also helps to clarify and compare sleep and activity patterns among severe psychiatric disorders such as schizophrenia. Additionally, actigraphy data can be used as an outcome measure for changes in sleep patterns either when primary psychotic disorders are treated and/or when the sleep disturbance associated with the psychotic disorder is treated. Finally, actigraphy serves as a supplementary tool to study neuropathology of movement-related psychiatric disorders including schizophrenia.
Topics: Actigraphy; Circadian Rhythm; Humans; Psychotic Disorders; Schizophrenia; Sleep Wake Disorders
PubMed: 23686258
DOI: 10.1007/s11920-013-0359-2