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Sleep Initiation and Maintenance Disorders: HELP
Articles by Dr. Colin Espie
Based on 67 articles published since 2009
(Why 67 articles?)
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Between 2009 and 2019, C. Espie wrote the following 67 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline European guideline for the diagnosis and treatment of insomnia. 2017

Riemann, Dieter / Baglioni, Chiara / Bassetti, Claudio / Bjorvatn, Bjørn / Dolenc Groselj, Leja / Ellis, Jason G / Espie, Colin A / Garcia-Borreguero, Diego / Gjerstad, Michaela / Gonçalves, Marta / Hertenstein, Elisabeth / Jansson-Fröjmark, Markus / Jennum, Poul J / Leger, Damien / Nissen, Christoph / Parrino, Liborio / Paunio, Tiina / Pevernagie, Dirk / Verbraecken, Johan / Weeß, Hans-Günter / Wichniak, Adam / Zavalko, Irina / Arnardottir, Erna S / Deleanu, Oana-Claudia / Strazisar, Barbara / Zoetmulder, Marielle / Spiegelhalder, Kai. ·Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · University Hospital for Neurology, Inselspital Bern, Bern, Switzerland. · Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. · Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia. · Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK. · Sleep Research Institute Madrid, Madrid, Spain. · Stavanger University Hospital, Stavanger, Norway. · Centro de Medicina de Sono, Hospital Cuf, Porto, Portugal. · Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. · Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. · Centre du Sommeil et de la Vigilance et EA 7330 VIFASOM, Université Paris Descartes, Clinic Hotel-Dieu, Sorbonne Paris Cité, APHP, HUPC, Hotel Dieu de Paris, Paris, France. · University Hospital of Psychiatry, Bern, Switzerland. · Department of Medicine and Surgery, University of Parma, Parma, Italy. · National Institute for Health and Welfare Helsinki, Helsinki, Finland. · Sleep Medicine Centre, Kempenhaeghe Foundation, Heeze, The Netherlands. · Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Wilrijk, Belgium. · Sleep Center Pfalzklinikum, Klingenmünster, Germany. · Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland. · Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency, Moscow, Russia. · Sleep Measurements, National University Hospital of Iceland, Reykjavik, Iceland. · Institute for Pneumology, Medical Faculty, University of Bucharest, Bucharest, Romania. · Centre for Sleep Disorders in Children and Adolescents, General Hospital Celje, Ljubljana, Slovenia. · Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. ·J Sleep Res · Pubmed #28875581.

ABSTRACT: This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

2 Editorial The HUNT continues and gathers pace: shedding light on the relationship between insomnia and ill health. 2014

Kyle, Simon D / Espie, Colin A. ·School of Psychological Sciences, University of Manchester, Manchester, UK. ·J Sleep Res · Pubmed #24628696.

ABSTRACT: -- No abstract --

3 Review Sleep-related attentional bias in insomnia: A state-of-the-science review. 2015

Harris, Kamelia / Spiegelhalder, Kai / Espie, Colin A / MacMahon, Kenneth M A / Woods, Heather Cleland / Kyle, Simon D. ·School of Psychological Sciences, Faculty of Medical and Human Sciences, The University of Manchester, Brunswick Street, Manchester M13 9PL, United Kingdom. · Department of Psychiatry and Psychotherapy, University of Freiburg Medical Centre, Hauptstraße 5, Freiburg 79104, Germany. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. · Clinical Psychology, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Row, Edinburgh EH8 9AG, United Kingdom. · School of Psychology, University of Glasgow, 58 Hillhead Street, Glasgow G12 8QB, United Kingdom. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: simon.kyle@ndcn.ox.ac.uk. ·Clin Psychol Rev · Pubmed #26284598.

ABSTRACT: Prominent models of insomnia posit that sleep-related attentional bias plays an important role in the development and maintenance of insomnia. Here we conduct the first systematic review of the sleep-related attentional bias construct, indexed through reaction time-based experimental tasks. Literature search identified 13 studies that met pre-defined inclusion/exclusion criteria. Included studies involved between-group comparisons (poor sleepers versus controls), as well as sleep manipulations and correlational investigations with healthy sleepers. For studies involving comparisons between poor sleepers and healthy controls, effect size estimates were computed for task-relevant dependent variables. Six of the nine studies comparing poor sleepers and controls revealed statistically significant group differences in support of a differential sleep-related attentional bias (medium-to-large effect sizes), with flicker, dot-probe and Posner tasks being most sensitive to group effects. Due to the paucity of studies and variability in design and measurement, no conclusions could be reached regarding manipulation or induction of attentional bias in good sleepers. Results from the relatively small number of studies support the presence of sleep-related attentional bias in insomnia; however, its role in the development and/or maintenance of insomnia remains to be elucidated. We set out a research agenda aimed at advancing the understanding of sleep-related attention bias.

4 Review How are normal sleeping controls selected? A systematic review of cross-sectional insomnia studies and a standardized method to select healthy controls for sleep research. 2015

Beattie, Louise / Espie, Colin A / Kyle, Simon D / Biello, Stephany M. ·School of Psychology, University of Glasgow, Glasgow, UK. Electronic address: l.beattie.1@research.gla.ac.uk. · Nuffield Department of Clinical Neurosciences/Sleep & Circadian Neuroscience Institute, University of Oxford, Oxford, UK. · School of Psychological Sciences, University of Manchester, Manchester, UK. · School of Psychology, University of Glasgow, Glasgow, UK. ·Sleep Med · Pubmed #25953299.

ABSTRACT: There appears to be some inconsistency in how normal sleepers (controls) are selected and screened for participation in research studies for comparison with insomnia patients. The purpose of the current study is to assess and compare methods of identifying normal sleepers in insomnia studies, with reference to published standards. We systematically reviewed the literature on insomnia patients, which included control subjects. The resulting 37 articles were systematically reviewed with reference to the five criteria for normal sleep specified by Edinger et al. In summary, these criteria are as follows: evidence of sleep disruption, sleep scheduling, general health, substance/medication use, and other sleep disorders. We found sleep diaries, polysomnography (PSG), and clinical screening examinations to be widely used with both control subjects and insomnia participants. However, there are differences between research groups in the precise definitions applied to the components of normal sleep. We found that none of the reviewed studies applied all of the Edinger et al. criteria, and 16% met four criteria. In general, screening is applied most rigorously at the level of a clinical disorder, whether physical, psychiatric, or sleep. While the Edinger et al. criteria seem to be applied in some form by most researchers, there is scope to improve standards and definitions in this area. Ideally, different methods such as sleep diaries and questionnaires would be used concurrently with objective measures to ensure normal sleepers are identified, and descriptive information for control subjects would be reported. Here, we have devised working criteria and methods to be used for the assessment of normal sleepers. This would help clarify the nature of the control group, in contrast to insomnia subjects and other patient groups.

5 Review Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: A systematic examination of CBT-I trial content. 2015

Kyle, Simon D / Aquino, Maria Raisa Jessica / Miller, Christopher B / Henry, Alasdair L / Crawford, Megan R / Espie, Colin A / Spielman, Arthur J. ·School of Psychological Sciences, University of Manchester, UK. Electronic address: simon.kyle@manchester.ac.uk. · School of Health Sciences, City University London, UK. · Woolcock Institute of Medical Research, University of Sydney, Australia. · Institute of Inflammation & Repair, University of Manchester, UK. · Rush University Medical Center, Chicago, USA. · Sleep & Circadian Neuroscience Institute, University of Oxford, UK. · Weill Cornell Medical College, Center for Sleep Medicine, NY, USA. ·Sleep Med Rev · Pubmed #25771293.

ABSTRACT: Sleep restriction therapy is a core element of contemporary cognitive-behavioural therapy for insomnia and is also effective as a single-component therapeutic strategy. Since its original description, sleep restriction therapy has been applied in several different ways, potentially limiting understanding of key therapeutic ingredients, mode of action, evidence synthesis, and clinical implementation. We sought to examine the quality of reporting and variability in the application of sleep restriction therapy within the context of insomnia intervention trials. Systematic literature searches revealed 88 trials of cognitive-behavioural therapy/sleep restriction therapy that met pre-defined inclusion/exclusion criteria. All papers were coded in relation to their description of sleep restriction therapy procedures. Findings indicate that a large proportion of papers (39%) do not report any details regarding sleep restriction therapy parameters and, for those papers that do, variability in implementation is present at every level (sleep window generation, minimum time-in-bed, sleep efficiency titration criteria, and positioning of sleep window). Only 7% of papers reported all parameters of sleep restriction treatment. Poor reporting and variability in the application of sleep restriction therapy may hinder progress in relation to evidence synthesis, specification of mechanistic components, and refinement of therapeutic procedures for patient benefit. We set out guidelines for the reporting of sleep restriction therapy as well as a research agenda aimed at advancing understanding of sleep restriction therapy.

6 Review The evidence base of sleep restriction therapy for treating insomnia disorder. 2014

Miller, Christopher B / Espie, Colin A / Epstein, Dana R / Friedman, Leah / Morin, Charles M / Pigeon, Wilfred R / Spielman, Arthur J / Kyle, Simon D. ·Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, Australia; Institute of Neuroscience & Psychology, University of Glasgow, UK. Electronic address: chris.miller@sydney.edu.au. · Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK. · Phoenix Veterans Affairs Health Care System, USA; Arizona State University College of Nursing and Health Innovation, USA. · Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. · Université Laval, Québec City, Québec, Canada. · Sleep & Neurophysiology Research Lab, University of Rochester Medical Center, USA; Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, USA. · Cognitive Neuroscience Doctoral Program, The City College of the City University of New York, USA; Weill Cornell Medical College, Center for Sleep Medicine, NY, USA. · School of Psychological Sciences, University of Manchester, UK. ·Sleep Med Rev · Pubmed #24629826.

ABSTRACT: Sleep restriction therapy is routinely used within cognitive behavioral therapy to treat chronic insomnia. However, the efficacy for sleep restriction therapy as a standalone intervention has yet to be comprehensively reviewed. This review evaluates the evidence for the use of sleep restriction therapy in the treatment of chronic insomnia. The literature was searched using web-based databases, finding 1344 studies. Twenty-one were accessed in full (1323 were deemed irrelevant to this review). Nine were considered relevant and evaluated in relation to study design using a standardized study checklist and levels of evidence. Four trials met adequate methodological strength to examine the efficacy of therapy for chronic insomnia. Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement. Standalone sleep restriction therapy is efficacious for the treatment of chronic insomnia for sleep diary continuity variables. Studies are insufficient to evaluate the full impact on objective sleep variables. Measures of daytime functioning in response to therapy are lacking. Variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy. A future research agenda is outlined.

7 Review Who is predisposed to insomnia: a review of familial aggregation, stress-reactivity, personality and coping style. 2014

Harvey, Christopher-James / Gehrman, Phil / Espie, Colin A. ·Nuffield Department of Clinical Neurosciences, Sleep & Circadian Neuroscience Institute, University of Oxford, Level 6 West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK. Electronic address: Christopher-james.harvey@ndcn.ox.ac.uk. · Department of Psychiatry, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA. · Nuffield Department of Clinical Neurosciences, Sleep & Circadian Neuroscience Institute, University of Oxford, Level 6 West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK. ·Sleep Med Rev · Pubmed #24480386.

ABSTRACT: Insomnia is a common health complaint world-wide. Insomnia is a risk factor in the development of other psychological and physiological disorders. Therefore understanding the mechanisms which predispose an individual to developing insomnia has great transdiagnostic value. However, whilst it is largely accepted that a vulnerable phenotype exists there is a lack of research which aims to systematically assess the make-up of this phenotype. This review outlines the research to-date, considering familial aggregation and the genetics and psychology of stress-reactivity. A model will be presented in which negative affect (neuroticism) and genetics (5HTTLPR) are argued to lead to disrupted sleep via an increase in stress-reactivity, and further that the interaction of these variables leads to an increase in learned negative associations, which further increase the likelihood of poor sleep and the development of insomnia.

8 Review Acute insomnia: current conceptualizations and future directions. 2012

Ellis, Jason G / Gehrman, Philip / Espie, Colin A / Riemann, Dieter / Perlis, Michael L. ·Northumbria Centre for Sleep Research, School of Psychology and Sports Science, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK. jason.ellis@northumbria.ac.uk ·Sleep Med Rev · Pubmed #21596596.

ABSTRACT: Despite significant contributions made in the area of persistent/chronic insomnia, especially with regard to the underlying mechanisms driving its maintenance, the area of acute insomnia has received comparatively little attention. The aim of this paper is to review the literature with regard to understanding the situational and personaological circumstances that surround the development of acute insomnia. The review begins by examining how the existing diagnostic systems conceptualise acute insomnia. Theoretical models that explain, or inferentially explain, the transition between normal sleep and acute insomnia are then explored and evaluated. The review then examines the current evidence base in terms of the pathogenesis of acute insomnia from naturalistic and experimental studies. Overall, the findings from the review confirm the paucity of evidence available but perhaps more importantly highlight the need for a structured diagnosis of acute insomnia as the first step in a research and treatment strategy. To this end a diagnostic system, drawing on the existing literature on stress and the systems used to diagnose depression, is forwarded and justified and a research agenda advanced.

9 Review Chronic insomnia: clinical and research challenges--an agenda. 2011

Riemann, D / Spiegelhalder, K / Espie, C / Pollmächer, T / Léger, D / Bassetti, C / van Someren, E. ·Department of Psychiatry and Psychotherapy of Freiburg University Medical Center, Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Pharmacopsychiatry · Pubmed #21161882.

ABSTRACT: Chronic insomnia afflicts up to 10% of the population in Western industrialized countries. It is characterized by delayed sleep onset, problems in maintaining sleep, early morning awakening or the feeling of non-restorative sleep coupled with significant daytime impairments on an emotional, social or professional level. It can occur as a co-morbid condition in any other medical or mental disorder, but also as a primary condition. Within the last decade new diagnostic and differential diagnostic approaches have been suggested that enhance diagnostic precision. Epidemiological data and data relating to the health care and cost situation of chronic insomnia suggest a huge burden for society. Chronic insomnia leads to a clear-cut increased risk for psychopathology (i. e., affective disorders) and probably also for cardiovascular and metabolic dysfunction. The pathophysiology of the condition is still poorly understood and will profit from integrating modern neuroscientific approaches (animal studies, molecular biology, neuroimaging, neurophysiology, etc.). Current treatment strategies are mainly based on cognitive behavioural interventions (CBT-I) and hypnotic treatment with benzodiazepine receptor agonists and sedating antidepressants. Although the effectiveness of these treatments has been clearly demonstrated, a substantial proportion of patients proves to be treatment-resistant or profits only poorly. The question of long-term pharmaceutical treatment of chronic insomnia, at least in Europe, is unresolved and urgently needs answers. Novel rational treatment avenues require clues on causes and mechanisms from integrated neuroscientific approaches. The important issues concerning insomnia treatment in the future especially in Europe will be reviewed and discussed critically.

10 Review British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. 2010

Wilson, S J / Nutt, D J / Alford, C / Argyropoulos, S V / Baldwin, D S / Bateson, A N / Britton, T C / Crowe, C / Dijk, D-J / Espie, C A / Gringras, P / Hajak, G / Idzikowski, C / Krystal, A D / Nash, J R / Selsick, H / Sharpley, A L / Wade, A G. ·Psychopharmacology Unit, University of Bristol, Bristol, UK. Sue.Wilson@bristol.ac.uk ·J Psychopharmacol · Pubmed #20813762.

ABSTRACT: Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.

11 Review Insomnia and health-related quality of life. 2010

Kyle, Simon D / Morgan, Kevin / Espie, Colin A. ·University of Glasgow Sleep Centre, Sackler Institute of Psychobiological Research, Faculty of Medicine, Southern General Hospital, Glasgow G51 4TF, Scotland. s.d.kyle@clinmed.gla.ac.uk ·Sleep Med Rev · Pubmed #19962922.

ABSTRACT: Health-related Quality of Life (HRQoL) has become an important construct in contemporary medicine and health care, permitting assessment of disorder burden and evaluation of interventions on various aspects of functioning, in a standardized manner. Here we review literature on the measurement of HRQoL in insomnia populations, and the extent to which insomnia treatment improves domains of HRQoL. It is concluded from the relatively small literature that insomnia impacts on diverse areas of HRQoL, and that both pharmacological and non-pharmacological interventions can produce, to varying degrees, improvements in domains spanning physical, social and emotional functioning. Limitations of the current literature are identified; with particular emphasis on measurement and conceptual shortcomings. Suggestions are made in relation to improving the quality of future research, and how to further shed light on the impact of insomnia - and treatment thereof - on both HRQoL and global quality of life.

12 Review "Stepped care": a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. 2009

Espie, Colin A. ·University of Glasgow Sleep Centre, Sackler Institute of Psychobiological Research, Section of Psychological Medicine, Faculty of Medicine, Southern General Hospital, Glasgow G 51 4TF, Scotland, UK. c.espie@clinmed.gla.ac.uk ·Sleep · Pubmed #20041590.

ABSTRACT: There is a large body of evidence that Cognitive Behavioral Therapy for insomnia (CBT) is an effective treatment for persistent insomnia. However, despite two decades of research it is still not readily available, and there are no immediate signs that this situation is about to change. This paper proposes that a service delivery model, based on "stepped care" principles, would enable this relatively scarce healthcare expertise to be applied in a cost-effective way to achieve optimal development of CBT services and best clinical care. The research evidence on methods of delivering CBT, and the associated clinical leadership roles, is reviewed. On this basis, self-administered CBT is posited as the "entry level" treatment for stepped care, with manualized, small group, CBT delivered by nurses, at the next level. Overall, a hierarchy comprising five levels of CBT stepped care is suggested. Allocation to a particular level should reflect assessed need, which in turn represents increased resource requirement in terms of time, cost and expertise. Stepped care models must also be capable of "referring" people upstream where there is an incomplete therapeutic response to a lower level intervention. Ultimately, the challenge is for CBT to be delivered competently and effectively in diversified formats on a whole population basis. That is, it needs to become "scalable". This will require a robust approach to clinical governance.

13 Clinical Trial Clusters of Insomnia Disorder: An Exploratory Cluster Analysis of Objective Sleep Parameters Reveals Differences in Neurocognitive Functioning, Quantitative EEG, and Heart Rate Variability. 2016

Miller, Christopher B / Bartlett, Delwyn J / Mullins, Anna E / Dodds, Kirsty L / Gordon, Christopher J / Kyle, Simon D / Kim, Jong Won / D'Rozario, Angela L / Lee, Rico S C / Comas, Maria / Marshall, Nathaniel S / Yee, Brendon J / Espie, Colin A / Grunstein, Ronald R. ·CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia. · Sydney Medical School, University of Sydney, Australia. · Sydney Nursing School, University of Sydney, Australia. · Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK. · Department of Respiratory and Sleep Medicine, RPAH, Sydney Local Health District, Sydney, NSW, Australia. · Clinical Research Unit, Brain & Mind Centre, University of Sydney, Australia. ·Sleep · Pubmed #27568796.

ABSTRACT: STUDY OBJECTIVES: To empirically derive and evaluate potential clusters of Insomnia Disorder through cluster analysis from polysomnography (PSG). We hypothesized that clusters would differ on neurocognitive performance, sleep-onset measures of quantitative ( METHODS: Research volunteers with Insomnia Disorder (DSM-5) completed a neurocognitive assessment and overnight PSG measures of total sleep time (TST), wake time after sleep onset (WASO), and sleep onset latency (SOL) were used to determine clusters. RESULTS: From 96 volunteers with Insomnia Disorder, cluster analysis derived at least two clusters from objective sleep parameters: Insomnia with normal objective sleep duration (I-NSD: n = 53) and Insomnia with short sleep duration (I-SSD: n = 43). At sleep onset, differences in HRV between I-NSD and I-SSD clusters suggest attenuated parasympathetic activity in I-SSD (P < 0.05). Preliminary work suggested three clusters by retaining the I-NSD and splitting the I-SSD cluster into two: I-SSD A (n = 29): defined by high WASO and I-SSD B (n = 14): a second I-SSD cluster with high SOL and medium WASO. The I-SSD B cluster performed worse than I-SSD A and I-NSD for sustained attention (P ≤ 0.05). In an exploratory analysis, CONCLUSIONS: Two insomnia clusters derived from cluster analysis differ in sleep onset HRV. Preliminary data suggest evidence for three clusters in insomnia with differences for sustained attention and sleep-onset CLINICAL TRIAL REGISTRATION: Insomnia 100 sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR) identification number 12612000049875. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347742.

14 Clinical Trial Physiological Markers of Arousal Change with Psychological Treatment for Insomnia: A Preliminary Investigation. 2015

Miller, Christopher B / Kyle, Simon D / Gordon, Christopher J / Espie, Colin A / Grunstein, Ronald R / Mullins, Anna E / Postnova, Svetlana / Bartlett, Delwyn J. ·Centre for Integrated Research and Understanding of Sleep (CIRUS), NeuroSleep and Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. · Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom. · Sydney Nursing School, University of Sydney, Sydney, Australia. · Department of Respiratory and Sleep Medicine, RPAH, Sydney Local Health District, Sydney, Australia. · School of Physics, University of Sydney, Sydney, Australia. ·PLoS One · Pubmed #26683607.

ABSTRACT: OBJECTIVES: The aim of this preliminary study was to evaluate if Sleep Restriction Therapy for insomnia is associated with modifications to physiological arousal, indexed through overnight measures of plasma cortisol concentrations and core body temperature. METHODS: In a pre-to-post open label study design, eleven patients with chronic and severe Psychophysiological Insomnia underwent 5 weeks of Sleep Restriction Therapy. RESULTS: Eight (73%) patients out of 11 consented completed therapy and showed a decrease in insomnia severity pre-to-post treatment (mean (SD): 18.1 (2.8) versus 8.4 (4.8); p = .001). Six patients were analyzed with pre-to-post overnight measures of temperature and cortisol. Contrary to our hypothesis, significantly higher levels of plasma cortisol concentrations were found during the early morning at post-treatment compared to baseline (p < .01), while no change was observed in the pre-sleep phase or early part of the night. Core body temperature during sleep was however reduced significantly (overall mean [95% CI]: 36.54 (°C) [36.3, 36.8] versus 36.45 [36.2, 36.7]; p < .05). CONCLUSIONS: Sleep Restriction Therapy therefore was associated with increased early morning cortisol concentrations and decreased core body temperature, supporting the premise of physiological changes in functioning after effective therapy. Future work should evaluate change in physiological variables associated with clinical treatment response. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTR 12612000049875.

15 Clinical Trial Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. 2014

Kyle, Simon D / Miller, Christopher B / Rogers, Zoe / Siriwardena, A Niroshan / Macmahon, Kenneth M / Espie, Colin A. ·School of Psychological Sciences, University of Manchester, Manchester, UK. · Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. · Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK. · School of Health and Social Care, University of Lincoln, Lincoln, UK. · Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK. · Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK. ·Sleep · Pubmed #24497651.

ABSTRACT: STUDY OBJECTIVES: To investigate whether sleep restriction therapy (SRT) is associated with reduced objective total sleep time (TST), increased daytime somnolence, and impaired vigilance. DESIGN: Within-subject, noncontrolled treatment investigation. SETTING: Sleep research laboratory. PARTICIPANTS: Sixteen patients [10 female, mean age = 47.1 (10.8) y] with well-defined psychophysiological insomnia (PI), reporting TST ≤ 6 h. INTERVENTIONS: Patients were treated with single-component SRT over a 4-w protocol, sleeping in the laboratory for 2 nights prior to treatment initiation and for 3 nights (SRT night 1, 8, 22) during the acute interventional phase. The psychomotor vigilance task (PVT) was completed at seven defined time points [day 0 (baseline), day 1,7,8,21,22 (acute treatment) and day 84 (3 mo)]. The Epworth Sleepiness Scale (ESS) was completed at baseline, w 1-4, and 3 mo. MEASUREMENT AND RESULTS: Subjective sleep outcomes and global insomnia severity significantly improved before and after SRT. There was, however, a robust decrease in PSG-defined TST during acute implementation of SRT, by an average of 91 min on night 1, 78 min on night 8, and 69 min on night 22, relative to baseline (P < 0.001; effect size range = 1.60-1.80). During SRT, PVT lapses were significantly increased from baseline (at three of five assessment points, all P < 0.05; effect size range = 0.69-0.78), returning to baseline levels by 3 mo (P = 0.43). A similar pattern was observed for RT, with RTs slowing during acute treatment (at four of five assessment points, all P < 0.05; effect size range = 0.57-0.89) and returning to pretreatment levels at 3 mo (P = 0.78). ESS scores were increased at w 1, 2, and 3 (relative to baseline; all P < 0.05); by 3 mo, sleepiness had returned to baseline (normative) levels (P = 0.65). CONCLUSION: For the first time we show that acute sleep restriction therapy is associated with reduced objective total sleep time, increased daytime sleepiness, and objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia.

16 Clinical Trial The Glasgow Sleep Impact Index (GSII): a novel patient-centred measure for assessing sleep-related quality of life impairment in Insomnia Disorder. 2013

Kyle, Simon D / Crawford, Megan R / Morgan, Kevin / Spiegelhalder, Kai / Clark, Ailie A / Espie, Colin A. ·University of Glasgow Sleep Centre, Institute of Neuroscience & Psychology, University of Glasgow, Scotland, United Kingdom. simon.kyle@manchester.ac.uk ·Sleep Med · Pubmed #23347908.

ABSTRACT: OBJECTIVES: Daytime dysfunction and quality of life impairment are important and salient consequences of poor sleep in those with insomnia. Existing measurement approaches to functional impact tend to rely on non-specific generic tools, non-validated scales, or ad hoc single scale items. Here we report the development and validation of the Glasgow Sleep Impact Index (GSII), a novel self-report measure which asks patients to generate, and assess, three domains of impairment unique to their own individual context. These three patient-generated areas of impairment are ranked in order of concern (1-3; i.e. 1=the most concerning impairment), and then rated on a visual analogue scale with respect to impact in the past two weeks. Patients re-rate these specified areas of impairment, post-intervention, permitting both individual and group-level analyses. METHODS: One-hundred and eight patients (71% female; Mean age=45 yrs) meeting Research Diagnostic Criteria for Insomnia Disorder completed the GSII, resulting in the generation of 324 areas (ranks) of sleep-related daytime and quality of life impairment. Fifty-five patients also completed the GSII pre- and post-sleep restriction therapy. The following psychometric properties were assessed: content validity of generated domains; relationship between ranks of impairment; and sensitivity to change post-behavioural intervention. RESULTS: Content analysis of generated domains support recent DSM-5 proposals for specification of daytime consequences of insomnia; with the most commonly cited areas reflecting impairments in energy/motivation, work performance, cognitive functioning, emotional regulation, health/well-being, social functioning and relationship/family functioning. Preliminary results with 108 patients indicate the GSII to have excellent face and construct validity. The GSII was found to be sensitive to change, post-behavioural treatment (p<0.001; Cohen's d≥0.85 for all three ranks of impairment), and improvements were associated with reductions in insomnia severity in both correlational (range of r=0.28-0.56) and responder versus non-responder analyses (all p<0.05). CONCLUSIONS: The development of the GSII represents a novel attempt to capture and measure sleep-related quality of life impairment in a valid and meaningful way. Further psychometric and clinical evaluation is suggested.

17 Article How does sleep restriction therapy for insomnia work? A systematic review of mechanistic evidence and the introduction of the Triple-R model. 2018

Maurer, Leonie F / Espie, Colin A / Kyle, Simon D. ·Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK. Electronic address: simon.kyle@ndcn.ox.ac.uk. ·Sleep Med Rev · Pubmed #30177248.

ABSTRACT: For over 30 y sleep restriction therapy (SRT) has been used to treat insomnia but we know very little about how this therapy exerts its effects. When SRT was first described, it was hypothesised to treat insomnia by addressing four key factors: strengthening homeostatic sleep pressure, inhibiting perpetuating practices (excessive time in bed), attenuating hyperarousal and tightening regulatory control of sleep by the endogenous circadian pacemaker. We conducted a systematic literature review in search of evidence for these putative mechanisms-of-action. A total of 15 randomised and non-randomised studies investigating SRT met inclusion criteria. For each study, we extracted all variables associated with the proposed mechanisms and assessed study quality using a structured appraisal tool. The extracted variables were: time in bed (TIB), napping, variability in sleep, markers of circadian rhythmicity, measurements of sleep pressure/sleepiness, and assessments of arousal. Overall study quality was poor as indicated by a mean quality score of 17 (out of a possible range of 0-31). No study indicated, or indeed was designed to test, whether changes in the proposed mechanisms act as mediators of treatment outcomes. Of all reviewed studies, most reported a reduction in TIB (10/10) and/or revealed a decrease in sleep onset latency (10/14), indexing increased sleep pressure. However, such changes were most often reported at the end of treatment, reflecting an outcome and not a mechanism of SRT per se. Evidence for reduction in arousal (4/4) and night-to-night sleep variability (2/2) was found in only a small number of uncontrolled studies while there was no evidence for change in circadian phase or periodicity (0/1). Our review suggests that SRT targets some of the hypothesised processes but specifically-designed mechanistic evaluations are needed. We introduce a new testable model of SRT mechanism-of-action (Triple-R) and set out a research agenda aimed at stimulating prospective investigations.

18 Article Insomnia symptoms and their association with workplace productivity: cross-sectional and pre-post intervention analyses from a large multinational manufacturing company. 2018

Espie, Colin A / Pawlecki, Brent / Waterfield, Dickon / Fitton, Kit / Radocchia, Michael / Luik, Annemarie I. ·Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, USA. Electronic address: colin.espie@ndcn.ox.ac.uk. · The Goodyear Tire & Rubber Company, Akron, OH, USA. · Big Health Inc, San Francisco, USA. · Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, USA. ·Sleep Health · Pubmed #29776626.

ABSTRACT: BACKGROUND: Symptoms of insomnia are common and might impact work productivity. We investigated the relationship between insomnia symptoms and workplace productivity in a global manufacturing company. METHODS: Within an uncontrolled, cross-sectional study, employees from a US-based company were invited to participate in an online evaluation comprising the Sleep Condition Indicator (SCI) measuring symptoms of insomnia (high score indicating better sleep), 2 items of the Work Productivity and Impairment Index (WPAI) measuring 'presenteeism' and 'absenteeism' (high score indicating loss of work productivity) and 1 item of the Perceived Stress Scale (PSS) from January 2015 onwards. Pre-post, within-subject data were collected to preliminary test effects of 'sleep tips' and digital cognitive behavioral therapy (dCBT). RESULTS: In 2798 employees [72% male; mean age 46.3(SD11.8) yrs] sleep was poorest in plant staff [SCI = 3.70(2.73)], then retail staff [4.34(3.02)], then office staff [4.95(2.83): overall F(2,2786) = 43.7, P < .0001]. More insomnia symptoms were associated with WPAI presenteeism (r = -.489, P < .0001; R CONCLUSION: Symptoms of insomnia are associated with poor work productivity. Additionally, targeted insomnia interventions may offer potential to improve sleep and work productivity.

19 Article Adapted CBT to Stabilize Sleep on Psychiatric Wards: a Transdiagnostic Treatment Approach. 2018

Sheaves, Bryony / Isham, Louise / Bradley, Jonathan / Espie, Colin / Barrera, Alvaro / Waite, Felicity / Harvey, Allison G / Attard, Caroline / Freeman, Daniel. ·Sleep and Circadian Neuroscience Institute,Department of Psychiatry,University of Oxford,Oxford,UK. · Oxford Health NHS Foundation Trust,Oxford,UK. · Sleep and Circadian Neuroscience,Nuffield Department of Clinical Neurosciences,University of Oxford,Oxford,UK. · University of California,Berkeley,USA. · Berkshire Health NHS Foundation Trust,Berkshire,UK. ·Behav Cogn Psychother · Pubmed #29615140.

ABSTRACT: BACKGROUND: Almost all patients admitted at acute crisis to a psychiatric ward experience clinically significant symptoms of insomnia. Ward environments pose challenges to both sleep and the delivery of therapy. Despite this, there is no description of how to adapt cognitive behavioural therapy (CBT) for insomnia to overcome these challenges. AIMS: (i) To describe the key insomnia presentations observed in the Oxford Ward Sleep Solution (OWLS) trial and (ii) outline key adaptations aimed to increase accessibility and hence effectiveness of CBT for insomnia for a ward setting. METHODS: Trial therapists collaboratively agreed the key insomnia presentations and therapy adaptations based on their individual reflective logs used during the trial. RESULTS: Three key insomnia presentations are outlined. These are used to illustrate the application of 10 CBT for insomnia therapy adaptations. These include use of sleep monitoring watches to engage patients in treatment, stabilizing circadian rhythms, reducing the impact of night-time observations and managing discharge as a sleep challenge. CONCLUSIONS: Whilst inpatient wards bring challenges for sleep and therapy delivery, creative adaptations can increase the accessibility of evidence based CBT for insomnia techniques. This therapy has proven popular with patients.

20 Article European Portuguese Adaptation of Glasgow Content of Thoughts Inventory (GCTI): Psychometric Characterization in Higher Education Students. 2018

Marques, Daniel R / Meia-Via, Mariana S / Espie, Colin A / da Silva, Carlos F / Allen Gomes, Ana. ·a Department of Education , University of Aveiro and the Institute for Biomedical Imaging and Life Sciences. · b Department of Education and Psychology , University of Aveiro. · c Nuffield Department of Clinical Neurosciences / Sleep & Circadian Neuroscience Institute, University of Oxford. · d Department of Education and Psychology , University of Aveiro; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto. · e Department of Education and Psychology , University of Aveiro; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto. ·Behav Med · Pubmed #27115473.

ABSTRACT: Persistent cognitive activity is an important factor in disturbing sleep-onset both during bedtime and when attempting to get back to sleep after nocturnal awakenings. One of the most specific self-report measures designed to assess this feature is the Glasgow Content of Thoughts Inventory (GCTI). In this study, we investigated the preliminary psychometric properties of GCTI in a large sample of higher education European Portuguese students (N = 2995). Our results suggest that there is evidence of good internal consistency (α = 0.93) and validity indicators. Moreover, we found an interpretable factorial structure comprising 5 correlated factors that needs to be confirmed in future studies. The European Portuguese version of the GCTI appears to be a reliable and valid instrument for measurement of sleep-onset disturbing cognitions.

21 Article Sleep Treatment Outcome Predictors (STOP) Pilot Study: a protocol for a randomised controlled trial examining predictors of change of insomnia symptoms and associated traits following cognitive-behavioural therapy for insomnia in an unselected sample. 2017

Denis, Dan / Eley, Thalia C / Rijsdijk, Fruhling / Zavos, Helena M S / Keers, Robert / Espie, Colin A / Luik, Annemarie I / Badini, Isabella / Derveeuw, Sarah / Romero, Alvin / Hodsoll, John / Gregory, Alice M. ·Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. · School of Biological and Chemical Sciences, Queen Mary University of London, London, UK. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. · Big Health Ltd, London, UK. · Department of Psychology, Goldsmiths, University of London, London, UK. · SLaM BioResource for Mental Health, South London and Maudsley NHS Foundation Trust, King's College London, London, UK. · Department of Biostatistics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. ·BMJ Open · Pubmed #29196479.

ABSTRACT: INTRODUCTION: Cognitive-behavioural therapy for insomnia (CBT-I) leads to insomnia symptom improvements in a substantial proportion of patients. However, not everyone responds well to this treatment, and it is unclear what determines individual differences in response. The broader aim of this work is to examine to what extent response to CBT-I is due to genetic and environmental factors. The purpose of this pilot study is to examine feasibility of a design to test hypotheses focusing on an unselected sample, that is, without selection on insomnia complaints, in order to plan a larger behavioural genetics study where most participants will likely not have an insomnia disorder. METHODS AND ANALYSIS: A two parallel-group randomised controlled trial is being conducted across three London universities. Female students (minimum age 18 years) enrolled on a psychology programme at one of the three sites were invited to participate. The target number of participants to be recruited is 240. Following baseline assessments, participants were randomly allocated to either the treatment group, where they received weekly sessions of digital CBT-I for 6 weeks, or the control group, where they completed an online puzzle each week for 6 weeks. Follow-up assessments have taken place mid-intervention (3 weeks) and end of intervention (6 weeks). A 6-month follow-up assessment will also occur. Primary outcomes will be assessed using descriptive statistics and effect size estimates for intervention effects. Secondary outcomes will be analysed using multivariate generalised estimating equation models. ETHICS AND DISSEMINATION: The study received ethical approval from the Research Ethics and Integrity subcommittee, Goldsmiths, University of London (application reference: EA 1305). DNA sample collection for the BioResource received ethical approval from the NRES Committee South Central-Oxford (reference number: 15/SC/0388). The results of this work shall be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03062891; Results.

22 Article Sleep and cognitive performance: cross-sectional associations in the UK Biobank. 2017

Kyle, Simon D / Sexton, Claire E / Feige, Bernd / Luik, Annemarie I / Lane, Jacqueline / Saxena, Richa / Anderson, Simon G / Bechtold, David A / Dixon, William / Little, Max A / Ray, David / Riemann, Dieter / Espie, Colin A / Rutter, Martin K / Spiegelhalder, Kai. ·Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, UK. Electronic address: simon.kyle@ndcn.ox.ac.uk. · FMRIB Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK. · Clinic for Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, UK. · Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA. · Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA; Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA; Department of Anesthesia, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA. · Cardiovascular Research Group, Institute of Cardiovascular Sciences, The University of Manchester, Manchester, UK. · Faculty of Life Sciences, University of Manchester, Manchester, UK. · Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, UK. · Engineering and Applied Science, Aston University, Birmingham, UK; Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA. · Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, UK. · Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, UK; Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. ·Sleep Med · Pubmed #29031762.

ABSTRACT: OBJECTIVE: The relationship between insomnia symptoms and cognitive performance is unclear, particularly at the population level. We conducted the largest examination of this association to date through analysis of the UK Biobank, a large population-based sample of adults aged 40-69 years. We also sought to determine associations between cognitive performance and self-reported chronotype, sleep medication use and sleep duration. METHODS: This cross-sectional, population-based study involved 477,529 participants, comprising 133,314 patients with frequent insomnia symptoms (age: 57.4 ± 7.7 years; 62.1% female) and 344,215 controls without insomnia symptoms (age: 56.1 ± 8.2 years; 52.0% female). Cognitive performance was assessed by a touchscreen test battery probing reasoning, basic reaction time, numeric memory, visual memory, and prospective memory. Adjusted models included relevant demographic, clinical, and sleep variables. RESULTS: Frequent insomnia symptoms were associated with cognitive impairment in unadjusted models; however, these effects were reversed after full adjustment, leaving those with frequent insomnia symptoms showing statistically better cognitive performance over those without. Relative to intermediate chronotype, evening chronotype was associated with superior task performance, while morning chronotype was associated with the poorest performance. Sleep medication use and both long (>9 h) and short (<7 h) sleep durations were associated with impaired performance. CONCLUSIONS: Our results suggest that after adjustment for potential confounding variables, frequent insomnia symptoms may be associated with a small statistical advantage, which is unlikely to be clinically meaningful, on simple neurocognitive tasks. Further work is required to examine the mechanistic underpinnings of an apparent evening chronotype advantage in cognitive performance and the impairment associated with morning chronotype, sleep medication use, and sleep duration extremes.

23 Article An Objective Short Sleep Insomnia Disorder Subtype Is Associated With Reduced Brain Metabolite Concentrations In Vivo: A Preliminary Magnetic Resonance Spectroscopy Assessment. 2017

Miller, Christopher B / Rae, Caroline D / Green, Michael A / Yee, Brendon J / Gordon, Christopher J / D'Rozario, Angela L / Kyle, Simon D / Espie, Colin A / Grunstein, Ronald R / Bartlett, Delwyn J. ·Woolcock Institute of Medical Research, CIRUS, Centre for Sleep and Chronobiology, Sydney, New South Wales, Australia. · Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. · Neuroscience Research Australia, Randwick, New South Wales, Australia. · School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia. · Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia. · Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia. · School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia. · Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, UK. ·Sleep · Pubmed #28958033.

ABSTRACT: Objectives: To evaluate brain metabolites in objective insomnia subtypes defined from polysomnography (PSG): insomnia with short sleep duration (I-SSD) and insomnia with normal sleep duration (I-NSD), relative to good sleeping controls (GSCs). Methods: PSG empirically grouped insomnia patients into I-SSD (n = 12: mean [SD] total sleep time [TST] = 294.7 minutes [30.5]) or I-NSD (n = 19: TST = 394.4 minutes [34.9]). 1H magnetic resonance spectroscopy (MRS) acquired in the left occipital cortex (LOCC), left prefrontal cortex, and anterior cingulate cortex was used to determine levels of creatine, aspartate, glutamate, and glutamine (referenced to water). Glutathione, glycerophosphocholine, lactate, myoinositol, and N-acetylaspartate measurements were also obtained. Sixteen GSCs were included for comparison. Multivariate analysis of variance was used to evaluate differences in creatine, aspartate, glutamate, and glutamine. Results: Aspartate and glutamine concentrations were reduced in the LOCC in I-SSD compared with I-NSD (both p < .05, d = .80-.99). Creatine displayed a nonsignificant mean reduction in I-SSD compared with I-NSD (p = .05, d = .58). Glutamine was reduced in I-SSD compared with controls (p < .05, d = .93). There were no differences in metabolites between all (I-SSD and I-NSD) insomnia patients and controls. In patients with insomnia, LOCC glutamine concentrations were found to be positively correlated with TST (r = .43, p < .05) and negatively correlated with wake-time after sleep onset (r = -.40, p < .05). Conclusions: Results indicate that I-SSD is associated with reduced brain metabolites in the LOCC compared with I-NSD and control concentrations of aspartate, glutamine, and creatine. Clinical Trial Registration: Insomnia MRS imaging sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000050853. Trial Identification Number: 12612000050853.

24 Article The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. 2017

Freeman, Daniel / Sheaves, Bryony / Goodwin, Guy M / Yu, Ly-Mee / Nickless, Alecia / Harrison, Paul J / Emsley, Richard / Luik, Annemarie I / Foster, Russell G / Wadekar, Vanashree / Hinds, Christopher / Gumley, Andrew / Jones, Ray / Lightman, Stafford / Jones, Steve / Bentall, Richard / Kinderman, Peter / Rowse, Georgina / Brugha, Traolach / Blagrove, Mark / Gregory, Alice M / Fleming, Leanne / Walklet, Elaine / Glazebrook, Cris / Davies, E Bethan / Hollis, Chris / Haddock, Gillian / John, Bev / Coulson, Mark / Fowler, David / Pugh, Katherine / Cape, John / Moseley, Peter / Brown, Gary / Hughes, Claire / Obonsawin, Marc / Coker, Sian / Watkins, Edward / Schwannauer, Matthias / MacMahon, Kenneth / Siriwardena, A Niroshan / Espie, Colin A. ·Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK. Electronic address: daniel.freeman@psych.ox.ac.uk. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. · Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK; Big Health Ltd, London, UK. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK. · Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK. · Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK. · School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK. · Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK. · Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK. · Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK. · Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK. · Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, Centre for Medicine, University of Leicester, Leicester, UK. · Department of Psychology, University of Swansea, Swansea, UK. · Department of Psychology, Goldsmiths, University of London, London, UK. · Department of Psychology, University of Strathclyde, Glasgow, UK. · Department of Psychology, Institute of Health and Society, University of Worcester, Worcester, UK. · Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK. · National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK. · Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK. · School of Psychology and Therapeutic Studies, University of South Wales, Treforest, UK. · Department of Psychology, School of Science and Technology, University of Middlesex, London, UK. · Department of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, UK. · Sussex Partnership NHS Foundation Trust, Worthing, UK. · Department of Clinical, Educational and Health Psychology, University College London, London, UK. · School of Psychology, University of Central Lancashire, Preston, UK. · Psychology Department, Royal Holloway, Egham, UK. · University of Cambridge Centre for Family Research, Cambridge, UK. · School of Psychological Sciences and Health, University of Strathclyde, Glasgow UK. · Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK. · SMART Lab, College of Life and Environmental Sciences, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK. · School of Health in Social Sciences, University of Edinburgh, Medical School, Edinburgh, UK. · Community and Health Research Unit, University of Lincoln, Lincoln, UK. ·Lancet Psychiatry · Pubmed #28888927.

ABSTRACT: BACKGROUND: Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. METHODS: We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. FINDINGS: Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (-2·22, -2·98 to -1·45, Cohen's d=0·19; p<0·0001), and hallucinations (-1·58, -1·98 to -1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. INTERPRETATION: To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. FUNDING: Wellcome Trust.

25 Article Effects of digital Cognitive Behavioural Therapy for Insomnia on cognitive function: study protocol for a randomised controlled trial. 2017

Kyle, Simon D / Hurry, Madeleine E D / Emsley, Richard / Luik, Annemarie I / Omlin, Ximena / Spiegelhalder, Kai / Espie, Colin A / Sexton, Claire E. ·Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE, UK. simon.kyle@ndcn.ox.ac.uk. · Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE, UK. · Oxford Nuffield Department of Clinical Neurosciences, Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK. · Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. · Big Health Ltd., London, UK. · Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. ·Trials · Pubmed #28623947.

ABSTRACT: BACKGROUND: The daytime effects of insomnia pose a significant burden to patients and drive treatment seeking. In addition to subjective deficits, meta-analytic data show that patients experience reliable objective impairments across several cognitive domains. While Cognitive Behavioural Therapy for Insomnia (CBT-I) is an effective and scalable treatment, we know little about its impact upon cognitive function. Trials of CBT-I have typically used proxy measures for cognitive functioning, such as fatigue or work performance scales, and no study has assessed self-reported impairment in cognitive function as a primary outcome. Moreover, only a small number of studies have assessed objective cognitive performance, pre-to-post CBT-I, with mixed results. This study specifically aims to (1) investigate the impact of CBT-I on cognitive functioning, assessed through both self-reported impairment and objective performance measures, and (2) examine whether change in sleep mediates this impact. METHODS/DESIGN: We propose a randomised controlled trial of 404 community participants meeting criteria for Insomnia Disorder. In the DISCO trial (D efining the I mpact of improved S leep on CO gnitive function (DISCO)) participants will be randomised to digital automated CBT-I delivered by a web and/or mobile platform (in addition to treatment as usual (TAU)) or to a wait-list control (in addition to TAU). Online assessments will take place at 0 (baseline), 10 (post-treatment), and 24 (follow-up) weeks. At week 25, all participants allocated to the wait-list group will be offered digital CBT-I, at which point the controlled element of the trial will be complete. The primary outcome is self-reported cognitive impairment at post-treatment (10 weeks). Secondary outcomes include objective cognitive performance, insomnia severity, sleepiness, fatigue, and self-reported cognitive failures and emotional distress. All main analyses will be carried out on completion of follow-up assessments and will be based on the intention-to-treat principle. Further analyses will determine to what extent observed changes in self-reported cognitive impairment and objective cognitive performance are mediated by changes in sleep. The trial is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) based at Oxford University Hospitals NHS Trust and University of Oxford, and by the NIHR Oxford Health BRC. DISCUSSION: This study will be the first large-scale examination of the impact of digital CBT-I on self-reported cognitive impairment and objective cognitive performance. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN89237370 . Registered on 17 October 2016.

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