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Item Associations of objectively measured and self-reported sleep duration with carotid artery intima media thickness among police officers(Wiley, 2013-11) Ma, Claudia C.; Burchfiel, Cecil M.; Charles, Luenda E.; Dorn, Joan M.; Andrew, Michael E.; Kook Gu, Ja; Joseph, Parveen Nedra; Fekedulegn, Desta; Slaven, James E.; Hartley, Tara A.; Mnatsakanova, Anna; Violanti, John M.; Biostatistics, School of MedicineBACKGROUND: We aimed to examine the association of objectively measured and self-reported sleep duration with carotid artery intima media thickness (IMT) among 257 police officers, a group at high risk for cardiovascular disease (CVD). METHODS: Sleep duration was estimated using actigraphic data and through self-reports. The mean maximum IMT was the average of the largest 12 values scanned bilaterally from three angles of the near and far wall of the common carotid, bulb, and internal carotid artery. Linear and quadratic regression models were used to assess the association of sleep duration with IMT. RESULTS: Officers who had fewer than 5 or 8 hr or more of objectively measured sleep duration had significantly higher maximum IMT values, independent of age. Self-reported sleep duration was not associated with either IMT measure. CONCLUSION: Attainment of sufficient sleep duration may be considered as a possible strategy for atherosclerosis prevention among police officers.Item Classification and Prediction of Post-Trauma Outcomes Related to PTSD Using Circadian Rhythm Changes Measured via Wrist-Worn Research Watch in a Large Longitudinal Cohort(IEEE, 2021) Cakmak, Ayse S.; Perez Alday, Erick A.; Da Poian, Giulia; Rad, Ali Bahrami; Metzler, Thomas J.; Neylan, Thomas C.; House, Stacey L.; Beaudoin, Francesca L.; An, Xinming; Stevens, Jennifer S.; Zeng, Donglin; Linnstaedt, Sarah D.; Jovanovic, Tanja; Germine, Laura T.; Bollen, Kenneth A.; Rauch, Scott L.; Lewandowski, Christopher A.; Hendry, Phyllis L.; Sheikh, Sophia; Storrow, Alan B.; Musey, Paul I., Jr.; Haran, John P.; Jones, Christopher W.; Punches, Brittany E.; Swor, Robert A.; Gentile, Nina T.; McGrath, Meghan E.; Seamon, Mark J.; Mohiuddin, Kamran; Chang, Anna M.; Pearson, Claire; Domeier, Robert M.; Bruce, Steven E.; O’Neil, Brian J.; Rathlev, Niels K.; Sanchez, Leon D.; Pietrzak, Robert H.; Joormann, Jutta; Barch, Deanna M.; Pizzagalli, Diego A.; Harte, Steven E.; Elliott, James M.; Kessler, Ronald C.; Koenen, Karestan C.; Ressler, Kerry J.; Mclean, Samuel A.; Li, Qiao; Clifford, Gari D.; Emergency Medicine, School of MedicinePost-Traumatic Stress Disorder (PTSD) is a psychiatric condition resulting from threatening or horrifying events. We hypothesized that circadian rhythm changes, measured by a wrist-worn research watch are predictive of post-trauma outcomes. Approach: 1618 post-trauma patients were enrolled after admission to emergency departments (ED). Three standardized questionnaires were administered at week eight to measure post-trauma outcomes related to PTSD, sleep disturbance, and pain interference with daily life. Pulse activity and movement data were captured from a research watch for eight weeks. Standard and novel movement and cardiovascular metrics that reflect circadian rhythms were derived using this data. These features were used to train different classifiers to predict the three outcomes derived from week-eight surveys. Clinical surveys administered at ED were also used as features in the baseline models. Results: The highest cross-validated performance of research watch-based features was achieved for classifying participants with pain interference by a logistic regression model, with an area under the receiver operating characteristic curve (AUC) of 0.70. The ED survey-based model achieved an AUC of 0.77, and the fusion of research watch and ED survey metrics improved the AUC to 0.79. Significance: This work represents the first attempt to predict and classify post-trauma symptoms from passive wearable data using machine learning approaches that leverage the circadian desynchrony in a potential PTSD population.Item Correspondence between actigraphy and PSG measures of sleep onset latency in young children(Associated Professional Sleep Societies, LLC, 2012-06-12) Craven, Hannah J.; Seifer, Ronald; LeBourgeois, Monique K.INTRODUCTION: Actigraphy is a non-invasive tool providing objective measurement of sleep onset, offset, and efficiency for extended periods of time based upon wrist-activity levels. Whether actigraphy may also provide an adequately-valid estimate of sleep-onset latency (SOL) in young children is not well-established. This study examined concordance between the gold standard of SOL, polysomnography (PSG), and actigraphy in a cohort of 2-5 year-olds studied at five different levels of prior wakefulness. METHODS: Participants were 8 healthy children (3 males) studied at three longitudinal time points (2.5-3.0y, 3.5-4.0y, 5.5-6.0y). Children followed a strict sleep schedule for at least 5 days before each of five home-based, PSG recordings in which they also wore an actigraph (AW64). Sleep assessments occurred after 4h, 7h, 10h, 13h, and 16h of prior wakefulness, reflecting different levels of sleep pressure. Visual stage scoring used 30-sec epochs from C3/A2. Lights-out time was simultaneously marked on PSG and actigraphy with event markers. Sleep-onset was the first epoch of stage 2 sleep (PSG) and the first of three consecutive epochs of scored sleep after lights-out (actigraphy). RESULTS: Analysis included 9-14 sleep assessments per child of SOL (concurrent PSG and ACT). Averaged SOL varied across sleep assessments and age (PSG range: 4.9+3.1 to 26.9+13.7; ACT range 4.2+3.1 to 19.3+15.9). We performed a nested correlation between PSG- and actigraphy-derived measures of SOL, covarying sleep pressure and age of assessment, nested within subject. The median partial correlation was r=.874 (p<.001), with a range of r=.243 to r=.969. Two children had very-low, non-significant correlations resulting from an outlier in which actigraphy underestimated SOL. CONCLUSION: Overall, these findings suggest actigraphy has adequate validity for estimating SOL in young children when using tightly-controlled data collection and analysis procedures. Future analyses should address methods for establishing the minimum number of nights for a reliable estimate of SOL.Item Ecological momentary assessment versus traditional retrospective self-reports as predictors of health-relevant outcomes(2013-09-05) Zielke, Desiree Joy; Stewart, Jesse C.; Rand, Kevin L.; Williams, Jane R.; Cyders, Melissa A.; Hazer, JohnEcological momentary assessment (EMA) has been asserted by proponents of the technique as being superior to standard paper-and-pencil measurements in terms of the reliability and validity of the information obtained; however, this claim has not yet been fully evaluated in the literature. Accordingly, the purpose of this study was to evaluate one aspect of this assertion by comparing the utility of EMA and retrospective measures of depressive symptoms in predicting health-relevant biological and behavioral outcomes. It was hypothesized that (1) the EMA measure will have better predictive utility when examining objective sleep quality (a biological outcome), and that (2) the retrospective measure will have better predictive utility when examining blood donation intention (a behavioral outcome). Ninety-six undergraduate females participated in this 2-week study. Depressive symptoms were measured momentarily and retrospectively using the Center for Epidemiological Studies-Depression Scale (CES-D). The biological outcome was assessed by actigraphy, whereas the behavioral outcome was measured via a self-report questionnaire. Unfortunately, it was not possible to fully test these hypotheses due to the failure to observe relationships between the predictor variables and the outcomes. The reported results, although limited, did not provide support for the hypotheses. Supplemental analyses revealed a moderate to high amount of shared variance between the EMA and retrospective measures, a similar extent of random error in both measures, and potentially a greater degree of systematic error in the retrospective measure. Due to the paucity of literature examining the claim of superior reliability and validity of EMA versus retrospective measures, as well as the failure of the current study to evaluate this assertion sufficiently, it appears that this claim remains unfounded. Therefore, suggestions for future research are provided.Item Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes(Elsevier, 2017-10) Facco, Francesca L.; Grobman, William A.; Reid, Kathryn J.; Parker, Corette B.; Hunter, Shannon M.; Silver, Robert M.; Basner, Robert C.; Saade, George R.; Pien, Grace W.; Manchanda, Shalini; Louis, Judette M.; Nhan-Chang, Chia-Ling; Chung, Judith H.; Wing, Deborah A.; Simhan, Hyagriv N.; Haas, David M.; Iams, Jay; Parry, Samuel; Zee, Phyllis C.; Medicine, School of MedicineBACKGROUND: Experimental and epidemiologic data suggest that among nonpregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly report poor sleep, few studies objectively evaluated the quality of sleep in pregnancy or explored the relationship between sleep disturbances and maternal and perinatal outcomes. OBJECTIVE: Our objective was to examine the relationship between objectively assessed sleep duration, timing, and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. STUDY DESIGN: This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks' gestation. They were asked to wear a wrist actigraphy monitor and complete a daily sleep log for a period of 7 consecutive days. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (<7 h/night), late sleep midpoint (midpoint between sleep onset and sleep offset >5 am), and top quartile of minutes of wake time after sleep onset and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes mellitus. We used χ2 tests to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and gestational diabetes. For associations significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. RESULTS: In all, 901 eligible women consented to participate; 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of gestational diabetes (odds ratio, 2.24; 95% confidence interval, 1.11-4.53; and odds ratio, 2.58; 95% confidence interval, 1.24-5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with gestational diabetes remained significant (adjusted odds ratio, 2.06; 95% confidence interval, 1.01-4.19; and adjusted odds ratio, 2.37; 95% confidence interval, 1.13-4.97, respectively). Additionally, after adjusting separately for age, body mass index, and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with gestational diabetes. No associations were demonstrated between the sleep quality measures (wake after sleep onset, sleep fragmentation) and hypertensive disorders or gestational diabetes. CONCLUSION: Our results demonstrate a relationship between short sleep duration and later sleep midpoint with gestational diabetes. Our data suggest independent contributions of these 2 sleep characteristics to the risk for gestational diabetes in nulliparous women.Item Screen Use before Bedtime: Consequences for Nighttime Sleep in Young Children(Elsevier, 2021) Staples, Angela D.; Hoyniak, Caroline; McQuillan, Maureen E.; Molfese, Victoria; Bates, John E.; Pediatrics, School of MedicineThere is increasing interest in the relation between screen use and sleep problems in early childhood. In a sample of 30-month-old children, this study used observational measures of screen use during the hour or so leading up to bedtime, parent reports of screen use during the child’s bedtime routine, and actigraphic measures of toddler sleep to complement parent-reported sleep problems. Whether screen use was observed during the pre-bedtime period or was reported by the parents as part of the nightly bedtime routine, greater screen use in either context was associated with more parent-reported sleep problems. Additionally, more frequent parent-reported screen use during the bedtime routine was also associated with actigraphic measures of later sleep, shorter sleep, and more night-to-night variability in duration and timing of sleep. These associations suggest the negative consequences of screen use for children’s sleep extend both to aspects of sleep reported by parents (e.g., bedtime resistance, signaled awakenings) and to aspects measured by actigraphy (e.g., shorter and more variable sleep).Item Sibling sleep-What can it tell us about parental sleep reports in the context of autism?(American Psychological Association, 2016-06) Schwichtenberg, A. J.; Hensle, Tara; Honaker, Sarah; Miller, Meghan; Ozonoff, Sally; Anders, Thomas; Pediatrics, School of MedicineSleep problems are common in families raising children with Autism Spectrum Disorder (ASD). Clinicians often depend on parent reports of child sleep but minimal research exists to address the accuracy or biases in these reports. To isolate parent-report accuracy (from differences in sleep behaviors), the sleep of younger siblings were assessed within a two-group design. The present study compared parent diary reports of infant sibling sleep to videosomnography and actigraphy. In the high-risk group, families had at least one child with ASD and a younger sibling (n = 33). The low-risk comparison group had no family history of ASD (n = 42). We confirmed comparable sleep behaviors between the groups and used paired t tests, two-one-sided-tests (TOST), and Bland-Altman plots to assess parent report accuracy. The parameters of sleep onset, nighttime sleep duration, awakenings, morning rise time, and daytime sleep duration were evaluated. Diary and videosomnography estimates were comparable for nighttime sleep duration, morning rise time, and awakenings for both groups. Diary and actigraph estimates were less comparable for both groups. Daytime sleep duration estimates had the largest discrepancy with both groups reporting (on average) 40 additional minutes of sleep when compared to actigraphy estimates. In the present study, families raising children with ASD were just as accurate as other families when reporting infant sleep behaviors. Our findings have direct clinical implications and support the use of parent nighttime sleep reports.Item Using Clinical Scales and Digital Measures to Explore Falls in Patients with Lewy Body Dementia(Karger, 2023-06-21) Battioui, Chakib; Man, Albert; Pugh, Melissa; Wang, Jian; Dang, Xiangnan; Zhang, Hui; Ardayfio, Paul; Munsie, Leanne; Hake, Ann Marie; Biglan, Kevin; Neurology, School of MedicineIntroduction: PRESENCE was a phase 2 clinical trial assessing the efficacy of mevidalen, a D1 receptor positive allosteric modulator, for symptomatic treatment of Lewy body dementia (LBD). Mevidalen demonstrated improvements in motor and non-motor features of LBD, global functioning, and actigraphy-measured activity and daytime sleep. Adverse events (AEs) of fall were numerically increased in mevidalen-treated participants. Methods: A subset of PRESENCE participants wore a wrist actigraphy device for 2-week periods pre-, during, and posttreatment. Actigraphy sleep and activity measures were derived per period and analyzed to assess for their association with participants' reports of an AE of fall. Prespecified baseline and treatment-emergent clinical characteristics were also included in the retrospective analysis of falls. Independent-samples t test and χ2 test were performed to compare the means and proportions between individuals with/without falls. Results: A trend toward more falls was observed with mevidalen treatment (31/258 mevidalen-treated vs. 4/86 in placebo-treated participants: p = 0.12). Higher body mass index (BMI) (p < 0.05), more severe disease measured by baseline Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part II (p < 0.05), and a trend toward improved Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-Cog13) (p = 0.06) were associated with individuals with falls. No statistically significant associations with falls and treatment-emergent changes were observed. Conclusion: The association of falls with worse baseline disease severity and higher BMI and overall trend toward improvements on cognitive and motor scales suggest that falls in PRESENCE may be related to increased activity in mevidalen-treated participants at greater risk for falling. Future studies to confirm this hypothesis using fall diaries and digital assessments are necessary.