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Sleep Initiation and Maintenance Disorders: HELP
Articles from Manchester, UK
Based on 35 articles published since 2008
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These are the 35 published articles about Sleep Initiation and Maintenance Disorders that originated from Manchester, UK during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 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 --

2 Review Does cognitive behavioural therapy for insomnia improve cognitive performance? A systematic review and narrative synthesis. 2018

Herbert, Vanessa / Kyle, Simon D / Pratt, Daniel. ·Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK. · Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, UK. Electronic address: simon.kyle@ndcn.ox.ac.uk. · Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, UK. Electronic address: daniel.pratt@manchester.ac.uk. ·Sleep Med Rev · Pubmed #28918315.

ABSTRACT: Individuals with insomnia report difficulties pertaining to their cognitive functioning. Cognitive behavioural therapy for insomnia (CBT-I) is associated with robust, long-term improvements in sleep parameters, however less is known about the impact of CBT-I on the daytime correlates of the disorder. A systematic review and narrative synthesis was conducted in order to summarise and evaluate the evidence regarding the impact of CBT-I on cognitive functioning. Reference databases were searched and studies were included if they assessed cognitive performance as an outcome of CBT-I, using either self-report questionnaires or cognitive tests. Eighteen studies met inclusion criteria, comprising 923 individuals with insomnia symptoms. The standardised mean difference was calculated at post-intervention and follow-up. We found preliminary evidence for small to moderate effects of CBT-I on subjective measures of cognitive functioning. Few of the effects were statistically significant, likely due to small sample sizes and limited statistical power. There is a lack of evidence with regards to the impact of CBT-I on objective cognitive performance, primarily due to the small number of studies that administered an objective measure (n = 4). We conclude that adequately powered randomised controlled trials, utilising both subjective and objective measures of cognitive functioning are required.

3 Review Nocturia Work Productivity and Activity Impairment Compared with Other Common Chronic Diseases. 2016

Miller, Paul S J / Hill, Harry / Andersson, Fredrik L. ·Miller Economics Ltd., BioHub Alderley Edge, Alderley Park, SK10 4TG, UK. paul@millereconomicsltd.com. · Centre for Health Economics, Institute of Population Health/School of Dentistry, University of Manchester, 4.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. · Global Health Economics and Outcomes Research, Ferring Pharmaceuticals A/S, Kay Fiskers Plads 11, 2300, Copenhagen, Denmark. · Center for Medical Technology Assessment (CMT), Linköping University, 581 83, Linköping, Sweden. ·Pharmacoeconomics · Pubmed #27581788.

ABSTRACT: OBJECTIVES: The International Continence Society defines nocturia as the need to void one or more times during the night, with each of the voids preceded and followed by sleep. The chronic sleep disturbance and sleep deprivation experienced by patients with nocturia affects quality of life, compromising both mental and physical well-being. This paper aims to characterise the burden of nocturia by comparing published data from patients with nocturia with data from patients with any of 12 other common chronic conditions, specifically focusing on its impact on work productivity and activity impairment, as measured by the instrument of the same name (WPAI). METHODS: A systematic literature review of multiple data sources identified evaluable studies for inclusion in the analysis. Study eligibility criteria included use of the WPAI instrument in patients with one of a predefined list of chronic conditions. We assessed the quality of each included study using the Newcastle-Ottawa scale and extracted basic study information, work and activity impairment data. To assess how work and activity impairment from nocturia compares with impairment from other common chronic diseases, we conducted two data syntheses (pooled and unpooled). RESULTS: The number of evaluable studies and the range of overall work productivity impairment reported, respectively, were as follows: nocturia (3; 14-39 %), overactive bladder (5; 11-41 %), irritable bowel syndrome/constipation (14; 21-51 %), gastroesophageal reflux disease (GERD) (13; 6-42 %), asthma/allergies (11; 6-40 %), chronic obstructive pulmonary disease (COPD) (7; 19-42 %), sleep problems (3; 12-37 %), arthritis (13; 21-69 %), pain (9; 29-64 %), depression (4; 15-43 %) and gout (2; 20-37 %). CONCLUSIONS: The overall work productivity impairment as a result of nocturia is substantial and was found to be similar to impairment observed as a result of several other more frequently researched common chronic diseases. Greater awareness of the burden of nocturia, a highly bothersome and prevalent condition, will help policy makers and healthcare decision makers provide appropriate management of nocturia.

4 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.

5 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.

6 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.

7 Review Prevalence, associated factors and management of insomnia in prison populations: An integrative review. 2015

Dewa, Lindsay H / Kyle, Simon D / Hassan, Lamiece / Shaw, Jenny / Senior, Jane. ·Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, Oxford Road, M13 9PL England, United Kingdom. Electronic address: lindsay.dewa@manchester.ac.uk. · School of Psychological Sciences, University of Manchester, Manchester, Oxford Road, M13 9PL England, United Kingdom. · Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, Oxford Road, M13 9PL England, United Kingdom. ·Sleep Med Rev · Pubmed #25644983.

ABSTRACT: Prisoners have many potential risk factors for insomnia including mental ill health and substance misuse. However, literature on prevalence, associated factors and management of insomnia in prison has yet to be systematically examined in this group. The paper objective was to synthesise and appraise the research that examines insomnia in a prison environment. An integrative literature review using thematic analysis was conducted to critically reflect on the current evidence base and outline a prospective research agenda. From the original 384 sourced papers, 33 met the inclusion criteria and were subsequently included for review. Definitions of insomnia and assessment tools used in studies varied considerably making the overall validity of findings uncertain. Notably, no studies used a recommended measure to assess insomnia disorder (ID). Thematic analysis yielded five themes: 1) the varied prevalence of insomnia; 2) the comorbidity of insomnia, psychiatric disorder and substance misuse; 3) the negative influence of prison-related situational and environmental factors on insomnia; 4) the role of hypnotic medication, and, 5) preliminary indications that non-pharmacological treatment can improve sleep. The methodological heterogeneity and variable quality across studies in the assessment of insomnia means conclusive data on prevalence, associated factors and management is lacking. Nonetheless, sleep problems are common and impairing in prison, are linked to comorbid conditions and negatively influenced by the prison environment, which routinely provides limited scope for effective management. Future research in prison populations is needed to reliably identify insomnia prevalence and determine how it can be managed effectively.

8 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.

9 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.

10 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.

11 Article Biological and clinical insights from genetics of insomnia symptoms. 2019

Lane, Jacqueline M / Jones, Samuel E / Dashti, Hassan S / Wood, Andrew R / Aragam, Krishna G / van Hees, Vincent T / Strand, Linn B / Winsvold, Bendik S / Wang, Heming / Bowden, Jack / Song, Yanwei / Patel, Krunal / Anderson, Simon G / Beaumont, Robin N / Bechtold, David A / Cade, Brian E / Haas, Mary / Kathiresan, Sekar / Little, Max A / Luik, Annemarie I / Loudon, Andrew S / Purcell, Shaun / Richmond, Rebecca C / Scheer, Frank A J L / Schormair, Barbara / Tyrrell, Jessica / Winkelman, John W / Winkelmann, Juliane / Anonymous3411197 / Hveem, Kristian / Zhao, Chen / Nielsen, Jonas B / Willer, Cristen J / Redline, Susan / Spiegelhalder, Kai / Kyle, Simon D / Ray, David W / Zwart, John-Anker / Brumpton, Ben / Frayling, Timothy M / Lawlor, Deborah A / Rutter, Martin K / Weedon, Michael N / Saxena, Richa. ·Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. · Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Broad Institute, Cambridge, MA, USA. · Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK. · Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA. · Netherlands eScience Center, Amsterdam, the Netherlands. · K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. · FORMI and Department of Neurology, Oslo University Hospital, Oslo, Norway. · Division of Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway. · Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA. · Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA. · MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK. · Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. · College of Science, Northeastern University, Boston, MA, USA. · Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. · Farr Institute of Health Informatics Research, University College London, London, UK. · Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. · Department of Mathematics, Aston University, Birmingham, UK. · Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. · Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. · Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. · School of Social and Community Medicine, University of Bristol, Bristol, UK. · Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK. · Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. · Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA, USA. · Cluster for Systems Neurology (SyNergy), Munich, Germany. · Institute of Human Genetics, Technische Universität München, Munich, Germany. · Neurogenetics, Technische Universität München, Munich, Germany. · Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. · Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA. · Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA. · Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Clinic for Psychiatry and Psychotherapy, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, OX37LE/NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK. · Department of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. · Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. rsaxena@partners.org. · Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. rsaxena@partners.org. · Broad Institute, Cambridge, MA, USA. rsaxena@partners.org. ·Nat Genet · Pubmed #30804566.

ABSTRACT: Insomnia is a common disorder linked with adverse long-term medical and psychiatric outcomes. The underlying pathophysiological processes and causal relationships of insomnia with disease are poorly understood. Here we identified 57 loci for self-reported insomnia symptoms in the UK Biobank (n = 453,379) and confirmed their effects on self-reported insomnia symptoms in the HUNT Study (n = 14,923 cases and 47,610 controls), physician-diagnosed insomnia in the Partners Biobank (n = 2,217 cases and 14,240 controls), and accelerometer-derived measures of sleep efficiency and sleep duration in the UK Biobank (n = 83,726). Our results suggest enrichment of genes involved in ubiquitin-mediated proteolysis and of genes expressed in multiple brain regions, skeletal muscle, and adrenal glands. Evidence of shared genetic factors was found between frequent insomnia symptoms and restless legs syndrome, aging, and cardiometabolic, behavioral, psychiatric, and reproductive traits. Evidence was found for a possible causal link between insomnia symptoms and coronary artery disease, depressive symptoms, and subjective well-being.

12 Article Are sleep disturbances causally linked to the presence and severity of psychotic-like, dissociative and hypomanic experiences in non-clinical populations? A systematic review. 2018

Barton, Jack / Kyle, Simon D / Varese, Filippo / Jones, Steven H / Haddock, Gillian. ·Division of Psychology and Mental Health, School of Health Sciences, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom. Electronic address: Jack.barton@manchester.ac.uk. · Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, United Kingdom. · Division of Psychology and Mental Health, School of Health Sciences, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom. · Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, LA1 4YG, United Kingdom. ·Neurosci Biobehav Rev · Pubmed #29452128.

ABSTRACT: The present review aimed to 1) identify what sleep disturbances co-occur alongside psychotic-like, dissociative and hypomanic experiences; 2) assess the strength of potential associations between the severity of sleep disturbances and of the experiences studied; and 3) appraise evidence for a causal link. MedLine and PsycInfo were searched and 44 studies were deemed eligible. Results showed that insomnia was associated with all individual psychotic-like, dissociative and hypomanic experiences reviewed (effect size range: small-to-large). Parasomnias were associated with all psychotic-like experiences; however, there was evidence of variation in magnitude between individual experiences. An eveningness chronotype was associated with dissociative and hypomanic experiences, and circadian dysrhythmia was found alongside hypomania but not the other experiences reviewed. Finally, experimental sleep manipulation studies revealed a potential causal link between sleep loss and psychotic-like and dissociative experiences, although size and consistency of effects varied by specific experience. Future research, using experimental manipulations of sleep to address putative mechanisms, will enable questions of causality to be answered with more confidence.

13 Article Disrupting Sleep: The Effects of Sleep Loss on Psychotic Experiences Tested in an Experimental Study With Mediation Analysis. 2018

Reeve, Sarah / Emsley, Richard / Sheaves, Bryony / Freeman, Daniel. ·Department of Psychiatry, University of Oxford, Oxford, UK. · Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. ·Schizophr Bull · Pubmed #28981834.

ABSTRACT: Our view is that insomnia may be a causal factor in the occurrence of psychotic experiences such as paranoia and hallucinations. However, the causal relationship is not established. The aim of the study was to investigate the causal role of insomnia in psychotic experiences via a sleep restriction manipulation. The study was a within-subjects crossover design that included a planned mediation analysis. Sixty-eight nonclinical volunteers underwent a sleep loss condition (restricted to 4 h sleep for 3 nights) and a control condition (standard sleep) in randomized order in 2 consecutive weeks, with a weekend washout period. Psychotic experiences (paranoia, hallucinations, grandiosity, and cognitive disorganization) and candidate mediating variables (negative affect and related processes, working memory, decision making, and perceptual processing) were assessed before and after each condition. Actigraphy verified an average sleep duration of 5 h 15 min in the sleep loss condition, vs 6 h 58 min in the control condition. After the sleep loss condition, relative to the control condition, participants reported significant increases in paranoia, hallucinations, and cognitive disorganization, with no significant changes in grandiosity. The sleep loss condition was also associated with significant increases in negative affect, negative self and other cognitions, worry, and working memory impairment. Mediation analyses indicated that changes in psychotic experiences were mediated by changes in negative affect and related processes, but not memory impairment. The overall conclusion is that insomnia has a causal role in the occurrence of certain psychotic experiences, and that a key route is via negative affect.

14 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.

15 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.

16 Article Patient perceptions of glucocorticoid side effects: a cross-sectional survey of users in an online health community. 2017

Costello, Ruth / Patel, Rikesh / Humphreys, Jennifer / McBeth, John / Dixon, William G. ·Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. · NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Health eResearch Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. ·BMJ Open · Pubmed #28373256.

ABSTRACT: OBJECTIVES: To identify the side effects most important to glucocorticoid (GC) users through a survey of a UK online health community (Healthunlocked.com). DESIGN: Online cross-sectional survey. SETTING: Participants were recruited through Healthunlocked.com, an online social network for health. PARTICIPANTS: Adults who were currently taking GCs, or had taken GCs in the past month. METHOD: Responders scored the importance of listed side effects from 1 to 10, with 10 being of high importance to them. For each side effect, histograms were plotted, and the median rating and IQR were determined. Side effects were ranked by median ranking (largest to smallest) and then IQR (smallest to largest). The scores were categorised as low (scores 1-3), medium (scores 4-7) and high (scores 8-10) importance. RESULTS: 604 responders completed the survey. Histograms of side effect scores showed a skew towards high importance for weight gain, a U-shaped distribution for cardiovascular disease (CVD), diabetes, eye disease and infections, and a skew towards low importance for acne. When ranked, the side effect of most importance to responders was weight gain (median score=9, IQR 6-10) followed by insomnia and moon face with equal median score (8) and IQR (5-10). Three serious side effects, CVD, diabetes and infections, were ranked of lower importance overall but had wide ranging scores (median score=8, IQR 1-10). CONCLUSIONS: The three most highly rated side effects were not clinically serious but remained important to patients, perhaps reflecting their impact on quality of life and high prevalence. This should be taken into consideration when discussing treatment options and planning future GC safety studies.

17 Article Trouble sleeping inside: a cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England. 2017

Dewa, Lindsay H / Hassan, Lamiece / Shaw, Jenny J / Senior, Jane. ·NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK. Electronic address: l.dewa@imperial.ac.uk. · Division of Imaging, Informatics and Data Sciences, The University of Manchester, Manchester, UK. · Division of Psychology and Mental Health, The University of Manchester, UK. ·Sleep Med · Pubmed #28366324.

ABSTRACT: OBJECTIVE: To investigate the prevalence of insomnia and identify associated demographic, clinical and forensic risk factors in adult prisoners in England. METHODS: A cross-sectional study of 237 prisoners aged 18-72 years, across two male prisons and one female prison in North England. We used the Sleep Condition Indicator to measure probable DSM-V insomnia disorder (ID) and the Pittsburgh Sleep Quality Index to examine sleep quality. Multiple demographic, sleep, clinical and forensic self-reported measures were recorded to identify any associations with insomnia. RESULTS: Overall, the prevalence of possible DSM-V ID was 61.6% (95% CI, 55.5%-67.8%). Subjective poor sleep quality was reported by 88.2% (95% CI, 84.1%-92.3%). Seven in ten (70.6%) female prisoners had possible DSM-V ID (95% CI, 64.8%-76.4%). Multivariable logistic regression analysis, adjusting for gender and age, indicated odds of having possible ID in prison were increased for the following factors: history of physical ill-health (OR = 3.62, 95% CI, 1.31-9.98); suicidality (OR = 2.79, 95% CI, 1.01.7.66), previously asked for help for insomnia (OR = 2.58, 95% CI, 1.21-5.47), depression (OR = 2.06, 95% CI 1.31-3.24), greater endorsement of dysfunctional beliefs about sleep (OR = 1.50, 95% CI, 1.21-1.87), poor sleep hygiene (OR = 1.11, 95% CI, 1.04-1.19), and problematic prison environment (eg, noise, light or temperature) (OR = 1.07, 95% CI, 1.02-1.12). CONCLUSIONS: For the first time we have established the prevalence and associated factors of insomnia in a large sample of adult English prisoners. ID and poor sleep quality are common, especially in female prisoners. These findings emphasize/amplify the need for dedicated treatment pathways to improve screening, assessment and treatment of insomnia in prison.

18 Article Insomnia management in prisons in England and Wales: a mixed-methods study. 2017

Dewa, Lindsay H / Hassan, Lamiece / Shaw, Jenny J / Senior, Jane. ·INIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK. · Division of Imaging, Informatics and Data Sciences, The University of Manchester, Manchester, UK. · Division of Psychology and Mental Health, The University of Manchester, Manchester, UK. ·J Sleep Res · Pubmed #28239925.

ABSTRACT: Insomnia in prison is common; however, research is limited regarding the management strategies that prison establishments employ. To address this knowledge gap, we conducted a survey to identify how insomnia is detected, diagnosed and treated in adult prisons in England and Wales. Telephone interviews with a purposive sample of health-care managers were then conducted. The survey was sent to all establishments holding adult prisoners, covering screening and assessment methods to detect insomnia; treatment options, both pharmacological and non-pharmacological; the importance of insomnia as a treatable condition; and staff training available. Eighty-four (73%) prisons completed the survey. Few had a stepped approach to insomnia management, as recommended by National Institute for Health and Care Excellence (NICE) guidelines. The most common treatments available were sleep hygiene education and medication, offered by 94 and 88% of respondents, respectively. Analysis of telephone interviews revealed four main themes: insomnia as a normal occurrence in prison; the problem of medication in prison; the negative impact of the prison environment; and effective management of insomnia in prison. The current findings suggest that logistical, ethical and security barriers and a lack of staff knowledge and training impact negatively on the management of insomnia in prison.

19 Article Musculoskeletal pain and co-morbid insomnia in adults; a population study of the prevalence and impact on restricted social participation. 2017

Baker, Shula / McBeth, John / Chew-Graham, Carolyn A / Wilkie, Ross. ·Research Institute for Primary Care & Health Sciences, Keele University, ST5 5BG, Keele, UK. s.baker1@keele.ac.uk. · Research Institute for Primary Care & Health Sciences, Keele University, ST5 5BG, Keele, UK. · Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, M13 9PT, UK. · Collaboration for Leadership in Applied Health Research and Care, West Midlands, Birmingham, UK. ·BMC Fam Pract · Pubmed #28173767.

ABSTRACT: BACKGROUND: Comorbidity is common in patients consulting in primary care. Musculoskeletal pain and insomnia each increase the risk of the other. Co-occurrence may pose an increased burden on well-being. However, the prevalence and impact of co-existing pain and insomnia in adults living in the community who may present to primary care is unclear. The aim of this study was to report the prevalence of pain and insomnia in adults registered with primary care, and to examine the impact of co-occurrence on social activities. METHODS: This population-based prospective cohort study of adults aged ≥18 years (n = 1181) used health survey data collected via baseline and 12 month follow-up questionnaires. Baseline data on pain, insomnia (4 symptoms: delayed sleep onset, difficulty maintaining sleep, early waking and non-restorative sleep) and putative confounders and social activity restriction at follow up was collected. Associations between baseline pain, insomnia and restricted social activities (RSA) at 12 months were examined using logistic regression, with adjustment for confounders. Interaction terms between pain and each insomnia symptom were examined in final models. RESULTS: Mean respondent age was 49.6 (SD ± 15.2) years, 55.7% were female. At baseline, 880 (74.5%) reported pain, 122 (10.3%) delayed sleep onset, 298 (25.2%) difficulty maintaining sleep, 188 (15.9%) early wakening, and 215 (18.2%) reported non-restorative sleep. At follow-up 200 (16.9%) reported RSA. Pain and each insomnia symptom were associated with RSA at 12 month follow-up; pain [unadjusted odds ratio (OR:2.3;95%CI:1.5,3.5), delayed sleep onset (OR:6.1;95%CI:4.0,9.1), difficulty maintaining sleep (OR:3.2;95%CI:2.3,4.4), early wakening (OR:4.1;95%CI:2.9,5.9), and non-restorative sleep (OR:4.0; 95%CI:2.8,5.8). Only delayed sleep onset (OR:2.6;95%C:1.5,4.5) remained significantly associated with restricted social activities in the fully adjusted model. There was a significant interaction between pain and delayed sleep onset (OR:0.3;95%CI:0.1,0.99; p = .049) and restricted social activity at 12 months in the final multivariable model. CONCLUSIONS: Pain and insomnia commonly co-occur, resulting in greater impact upon subsequent functional ability. Delayed sleep onset is the insomnia symptom most strongly associated with reduced functional ability. Clinicians should be aware of the common co-occurrence of insomnia symptoms, inquire about sleep in patients consulting with pain, and offer interventions that target both sleep and pain.

20 Article During early to mid adolescence, moderate to vigorous physical activity is associated with restoring sleep, psychological functioning, mental toughness and male gender. 2017

Brand, Serge / Kalak, Nadeem / Gerber, Markus / Clough, Peter J / Lemola, Sakari / Sadeghi Bahmani, Dena / Pühse, Uwe / Holsboer-Trachsler, Edith. ·a Center for Affective-, Stress- and Sleep Disorder , Psychiatric Clinics of the University of Basel , Basel , Switzerland. · b Department of Sport, Exercise and Health, Sport Science Section , University of Basel , Basel , Switzerland. · c Department of Psychology , Manchester Metropolitan University , Manchester , UK. · d Department of Psychology , University of Warwick , Coventry , UK. ·J Sports Sci · Pubmed #27033183.

ABSTRACT: Numerous studies showed that regular physical activity (PA) is associated with both favourable and restorative sleep and improved psychological functioning (PF). However, there is little research on the topic covering the early to mid-adolescence period. Moreover, curiosity and exploratory behaviour (CEB) and mental toughness (MT) as a result of PA remains thus far uninvestigated, as do possible gender differences. The aim of the present study was to explore the associations between PA, subjective sleep (sS), PF, CEB, and MT during early to mid-adolescence. A total of 1361 participants (mean age = 13.37 years; range: 11-16 years; 51.2% female) took part in the study. They completed questionnaires covering PA, sS, PF, CEB, and MT. Greater PA was related to improved PF, better sS, and increased CEB and MT. Compared to male participants, females reported less PA, poorer sS, and had lower PF and MT scores. The present pattern of results suggests that during early and mid-adolescence greater PA was associated with more favourable sS and better PF, including CEB and MT, and that female participants reported lower scores in PA, sS, and PF. Accordingly, if PA has a favourable impact on sleep and psychological functioning, then data suggest that sports participation should be more tailored to increase motivation among female adolescents.

21 Article Tinnitus and Sleep Difficulties After Cochlear Implantation. 2016

Pierzycki, Robert H / Edmondson-Jones, Mark / Dawes, Piers / Munro, Kevin J / Moore, David R / Kitterick, Pádraig T. ·1NIHR Nottingham Hearing Biomedical Research Unit, The Ropewalk, Nottingham, United Kingdom; 2Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; 3School of Psychological Sciences, University of Manchester, Manchester, United Kingdom; 4Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and 5Cincinnati Children's Hospital Medical Center and Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. ·Ear Hear · Pubmed #27438865.

ABSTRACT: OBJECTIVES: To estimate and compare the prevalence of and associations between tinnitus and sleep difficulties in a sample of UK adult cochlear implant users and those identified as potential candidates for cochlear implantation. DESIGN: The study was conducted using the UK Biobank resource, a population-based cohort of 40- to 69-year olds. Self-report data on hearing, tinnitus, sleep difficulties, and demographic variables were collected from cochlear implant users (n = 194) and individuals identified as potential candidates for cochlear implantation (n = 211). These "candidates" were selected based on (i) impaired hearing sensitivity, inferred from self-reported hearing aid use and (ii) impaired hearing function, inferred from an inability to report words accurately at negative signal to noise ratios on an unaided closed-set test of speech perception. Data on tinnitus (presence, persistence, and related distress) and on sleep difficulties were analyzed using logistic regression models controlling for gender, age, deprivation, and neuroticism. RESULTS: The prevalence of tinnitus was similar among implant users (50%) and candidates (52%; p = 0.39). However, implant users were less likely to report that their tinnitus was distressing at its worst (41%) compared with candidates (63%; p = 0.02). The logistic regression model suggested that this difference between the two groups could be explained by the fact that tinnitus was less persistent in implant users (46%) compared with candidates (72%; p < 0.001). Self-reported difficulties with sleep were similar among implant users (75%) and candidates (82%; p = 0.28), but participants with tinnitus were more likely to report sleep difficulties than those without (p < 0.001). The prevalence of sleep difficulties was not related to tinnitus persistence (p = 0.28) or the extent to which tinnitus was distressing (p = 0.55). CONCLUSIONS: The lack of association between tinnitus persistence and sleep difficulties is compatible with the notion that tinnitus is suppressed in implant users primarily during active electrical stimulation and may return when the implant is switched off at night time. This explanation is supported by the similar prevalence of sleep problems among implant users and potential candidates for cochlear implantation, despite differences between the groups in tinnitus persistence and related emotional distress. Cochlear implantation may therefore not be an appropriate intervention where the primary aim is to alleviate sleep difficulties.

22 Article Digital Cognitive Behavioural Therapy for Insomnia versus sleep hygiene education: the impact of improved sleep on functional health, quality of life and psychological well-being. Study protocol for a randomised controlled trial. 2016

Espie, Colin A / Luik, Annemarie I / Cape, John / Drake, Christopher L / Siriwardena, A Niroshan / Ong, Jason C / Gordon, Christopher / Bostock, Sophie / Hames, Peter / Nisbet, Mhairi / Sheaves, Bryony / G Foster, Russell / Freeman, Daniel / Costa-Font, Joan / Emsley, Richard / Kyle, Simon D. ·Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK. colin.espie@ndcn.ox.ac.uk. · Big Health Ltd., London, UK. colin.espie@ndcn.ox.ac.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. · Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK. · Department of Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA. · School of Health and Social Care, University of Lincoln, Lincoln, UK. · Rush University Medical Center, Chicago, IL, USA. · CIRUS Centre for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. · Sleep and Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK. · The London School of Economics and Political Science, London, UK. · Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. ·Trials · Pubmed #27216112.

ABSTRACT: BACKGROUND: Previous research has demonstrated that digital CBT (dCBT), delivered via the Internet, is a scalable and effective intervention for treating insomnia in otherwise healthy adults and leads to significant improvements in primary outcomes relating to sleep. The majority of people with insomnia, however, seek help because of the functional impact and daytime consequences of poor sleep, not because of sleep discontinuity per se. Although some secondary analyses suggest that dCBT may have wider health benefits, no adequately powered study has investigated these as a primary endpoint. This study specifically aims to investigate the impact of dCBT for insomnia upon health and well-being, and will investigate sleep-related changes as mediating factors. METHODS/DESIGN: We propose a pragmatic, parallel-group, randomised controlled trial of 1000 community participants meeting criteria for insomnia disorder. In the DIALS trial (Digital Insomnia therapy to Assist your Life as well as your Sleep), participants will be randomised to dCBT delivered using web and/or mobile channels (in addition to treatment as usual (TAU)) or to sleep hygiene education (SHE), comprising a website plus a downloadable booklet (in addition to TAU). Online assessments will take place at 0 (baseline), 4 (mid-treatment), 8 (post-treatment), and 24 (follow-up) weeks. At week 25 all participants allocated to SHE will be offered dCBT, at which point the controlled element of the trial will be complete. Naturalistic follow-up will be invited at weeks 36 and 48. Primary outcomes are functional health and well-being at 8 weeks. Secondary outcomes are mood, fatigue, sleepiness, cognitive function, productivity and social functioning. All main analyses will be carried out at the end of the final controlled follow-up assessments and will be based on the intention-to-treat principle. Further analyses will determine whether observed changes in functional health and well-being are mediated by changes in sleep. The trial is funded by Big Health Ltd. DISCUSSION: This study will be the first large-scale, specifically designed investigation of the health and well-being benefits of CBT for insomnia, and the first examination of the association between CBT-mediated sleep improvement and health status. TRIAL REGISTRATION: ISRCTN60530898 .

23 Article Subjective but Not Actigraphy-Defined Sleep Predicts Next-Day Fatigue in Chronic Fatigue Syndrome: A Prospective Daily Diary Study. 2016

Russell, Charlotte / Wearden, Alison J / Fairclough, Gillian / Emsley, Richard A / Kyle, Simon D. ·School of Psychological Sciences, University of Manchester, United Kingdom. · Department of Clinical Health Psychology, Salford Royal NHS Foundation Trust, United Kingdom. · Centre for Biostatistics, Institute of Population Health, University of Manchester, United Kingdom. · Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, Sir William Dunn School of Pathology, University of Oxford, United Kingdom. ·Sleep · Pubmed #26715232.

ABSTRACT: STUDY OBJECTIVES: This study aimed to (1) examine the relationship between subjective and actigraphy-defined sleep, and next-day fatigue in chronic fatigue syndrome (CFS); and (2) investigate the potential mediating role of negative mood on this relationship. We also sought to examine the effect of presleep arousal on perceptions of sleep. METHODS: Twenty-seven adults meeting the Oxford criteria for CFS and self-identifying as experiencing sleep difficulties were recruited to take part in a prospective daily diary study, enabling symptom capture in real time over a 6-day period. A paper diary was used to record nightly subjective sleep and presleep arousal. Mood and fatigue symptoms were rated four times each day. Actigraphy was employed to provide objective estimations of sleep duration and continuity. RESULTS: Multilevel modelling revealed that subjective sleep variables, namely sleep quality, efficiency, and perceiving sleep to be unrefreshing, predicted following-day fatigue levels, with poorer subjective sleep related to increased fatigue. Lower subjective sleep efficiency and perceiving sleep as unrefreshing predicted reduced variance in fatigue across the following day. Negative mood on waking partially mediated these relationships. Increased presleep cognitive and somatic arousal predicted self-reported poor sleep. Actigraphy-defined sleep, however, was not found to predict following-day fatigue. CONCLUSIONS: For the first time we show that nightly subjective sleep predicts next-day fatigue in CFS and identify important factors driving this relationship. Our data suggest that sleep specific interventions, targeting presleep arousal, perceptions of sleep and negative mood on waking, may improve fatigue in CFS.

24 Article Determinants of depression and somatisation symptoms in low back pain patients and its treatment: global burden of diseases. 2015

Bener, Abdulbari / Dafeeah, Elnour Elnaem / Salem, Mohamad Omar. ·Department of Medical Statistics & Epidemiology, Hamad Medical Corporation & Dept. of Public Health, Weill Cornell Medical College, Doha, Qatar, Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, England, United Kingdom. · Department of Psychiatry, Rumeilah Hospital, Hamad Medical Corporation, Doha, Qatar. · Department of Psychiatry, Al-Ahli Hospital, Doha, Qatar. ·J Pak Med Assoc · Pubmed #26028379.

ABSTRACT: OBJECTIVE: To determine the prevalence of Low Back Pain in primary care setting population and to examine its association with symptoms of depression and somatisation. METHODS: The cross-sectional study was conducted at 13 Primary Healthcare Centres (throughout Qatar from March to December, 2012. A General Health Questionnaire was used to identify the probable cases. A specially designed questionnaire with three parts was used for data collection: socio-demographic information of the studied subjects, modified version of the Roland-Morris scale for evaluating back-related functional disability, and Symptom Cheklist-90-Revised for depression and somatisation subscales. RESULTS: A representative sample of 2,600 patients was approached and 1,829(70.0%) of them participated in the study. The prevalence of low back pain in the study sample was 56.5%. There were statistically significant differences between subjects with and without low back pain in terms of body mass index (p< 0.025), gender (p< 0.003) and housing condition (p< 0.001). There was a significant difference between subjects with and without the pain in terms of all aspects of functional disability. Somatisation disorder in low back pain was 203 (19.6%) and depression disorder was 265 (25.4%). Most of the patients with LBP reported pain in the arms and legs (p< 0.001); shortness of breath (p< 0.028) palpitations (p=0.004); gastrointestinal complaints such as abdominal pain (p< 0.001), diarrhoea (p< 0.001) and vomiting (p< 0.001); feeling tired (p< 0.001); trouble with sleeping (p< 0.001); headache (p< 0.001) and fainting (p=0.043). The mode of treatment taken by the patients for relief were bed rest 695 (67.2%) followed by warm compression 480 (47.6%), physiotherapy 491 (47.5%), regular exercise 414 (40%), and back plasters 346 (33.5%). CONCLUSIONS: The present study showed that the symptoms of depression and somatisation were prevalent among low back pain patients. Functional disability was higher in the patients. Recognising this problem may lead to better patient-treatment matching and improved clinical outcomes.

25 Article Effects of cognitive behavioural therapy for insomnia on the mental health of university students: study protocol for a randomized controlled trial. 2015

Freeman, Daniel / Sheaves, Bryony / Goodwin, Guy M / Yu, Ly-Mee / Harrison, Paul J / Emsley, Richard / Bostock, Sophie / Foster, Russell G / Wadekar, Vanashree / Hinds, Christopher / Espie, Colin A. ·Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK. daniel.freeman@psych.ox.ac.uk. · Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK. bryony.sheaves@psych.ox.ac.uk. · Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK. guy.goodwin@psych.ox.ac.uk. · Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. ly-mee.yu@phc.ox.ac.uk. · Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK. Paul.harrison@psych.ox.ac.uk. · Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 1.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. Richard.Emsley@manchester.ac.uk. · Sleepio Ltd, 60-62 Commercial Street, London, E1 6LT, UK. Sophie@sleepio.com. · Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 5-6 West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK. russell.foster@eye.ox.ac.uk. · Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK. vanashree.wadekar@psych.ox.ac.uk. · Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK. Chris.hinds@psych.ox.ac.uk. · Sleepio Ltd, 60-62 Commercial Street, London, E1 6LT, UK. colin.espie@ndcn.ox.ac.uk. · Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 5-6 West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK. colin.espie@ndcn.ox.ac.uk. ·Trials · Pubmed #26016697.

ABSTRACT: BACKGROUND: Insomnia, defined as repeated difficulties getting or staying asleep, is common in the general population. Such sleep difficulties are a problem in their own right, but increasingly it is being recognised that they may also be a contributory factor in the development of a wide range of mental health problems. Our focus is upon the relationship between insomnia and psychotic experiences, such as paranoia and hallucinations. Psychotic experiences commonly occur in mild forms in the general population and have been linked to disrupted sleep. These psychotic-like experiences raise the risk of development of a clinical disorder. Our aim is to reduce insomnia in a large general population group, and examine the effect on paranoia and hallucinations at the age when mental health problems typically emerge. The primary hypotheses are that cognitive behaviour therapy (CBT) for insomnia will reduce insomnia and also levels of paranoia and hallucinations. The theoretical links will be substantiated by a planned mediation analysis. Improvements in a number of other mental health outcomes are also predicted. METHODS/DESIGN: We will carry out a parallel group, randomised controlled trial of 2,614 students with insomnia in universities across the UK. In the Oxford Access for Students Improving Sleep (OASIS) trial, participants will be randomised to digital CBT for insomnia (in addition to treatment as usual) or treatment as usual. Online assessments will take place at zero, three, 10 (post-treatment), and 22 (follow-up) weeks. Primary outcomes are insomnia and psychotic-like experiences (paranoia or hallucinatory experiences) at 10 weeks. Secondary outcomes are levels of mania, depression, anxiety, nightmares, psychological wellbeing, and the development of mental health disorders. All main analyses will be carried out at the end of the last follow-up assessment and will be based on the intention-to-treat principle. The trial is funded by the Wellcome Trust. DISCUSSION: This study will be the first large-scale causal test of the relationship between sleep disturbance and psychotic experiences. It will provide evidence concerning the clinical effects of treating insomnia in young adults. TRIAL REGISTRATION: This trial was registered with Current Controlled Trials (identifier: ISRCTN61272251 ) on 29 January 2015.

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