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2 pages, 183 KiB

Open AccessEditorial

How Sleep Affects Daytime Functioning: The Latest Insights from Different Patient and Age Groups

by Ellemarije Altena and Jason G. Ellis

Brain Sci. 2021, 11(9), 1163; https://doi.org/10.3390/brainsci11091163 - 31 Aug 2021

Cited by 1 | Viewed by 1813

Abstract

Sleep problems can have a major impact on daytime functioning across all domains (i [...] Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

Research

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12 pages, 1038 KiB

Open AccessArticle

The Sleep Impact on Activity Diary (SIAD): A Novel Assessment of Daytime Functioning in Insomnia

by Kelsey Bickley, Nicole Lovato and Leon Lack

Brain Sci. 2021, 11(2), 219; https://doi.org/10.3390/brainsci11020219 - 11 Feb 2021

Cited by 6 | Viewed by 1814

Abstract

Daytime impairments feature in the diagnostic criteria for insomnia disorder yet are rarely assessed comprehensively in clinical practice and tend to focus on mood and subjective assessment of cognitive competence. In order to gain more information about the engagement in daily activities we [...] Read more.

Daytime impairments feature in the diagnostic criteria for insomnia disorder yet are rarely assessed comprehensively in clinical practice and tend to focus on mood and subjective assessment of cognitive competence. In order to gain more information about the engagement in daily activities we developed the Sleep Impact on Activity Diary (SIAD). This initial investigation included 22 insomnia patients (15 females, aged 49.9 years, SD = 17.6) and 19 normal sleeper controls (13 females, aged 30.9 years, SD = 8.9). For 14 consecutive evenings, participants rated how their prior night-time sleep impacted their participation in 12 common daytime activities (e.g., work, self-care, leisure). They also rated how much effort each activity required (Range: 0–4). Overall, insomnia patients participated in only one fewer activity type per day (M = 7.48, SD = 1.34) than controls (M = 8.39, SD = 1.43) (p = 0.041, d = 0.66). More noteworthy, they reported that sleep negatively affected their participation more than controls (M = 1.56, SD = 0.92 versus M = 0.23, SD = 0.35; p = < 0.001, d = 1.90), and that activities required more effort (M = 1.58, SD = 0.64 versus M = 0.81, SD = 0.76; p = 0.001, d = 1.10). This pilot study with the SIAD suggests that, compared to good sleepers, insomnia patients participate in somewhat fewer activities but that their activities require considerably more effort and are adversely affected by their sleep. The SIAD tool promises to provide a more comprehensive picture of the everyday impact of insomnia. It remains to be validated on a much larger sample in a clinical treatment study. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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23 pages, 1074 KiB

Open AccessArticle

Developmental Profile of Sleep and Its Potential Impact on Daytime Functioning from Childhood to Adulthood in Sickle Cell Anaemia

by Melanie Kölbel, Fenella J. Kirkham and Dagmara Dimitriou

Brain Sci. 2020, 10(12), 981; https://doi.org/10.3390/brainsci10120981 - 14 Dec 2020

Cited by 10 | Viewed by 3160

Abstract

Young individuals with sickle cell anaemia (SCA) experience sleep disturbances and often experience daytime tiredness, which in turn may impact on their daytime functioning and academic attainment, but there are few longitudinal data. Methods: Data on sleep habits and behaviour were taken on [...] Read more.

Young individuals with sickle cell anaemia (SCA) experience sleep disturbances and often experience daytime tiredness, which in turn may impact on their daytime functioning and academic attainment, but there are few longitudinal data. Methods: Data on sleep habits and behaviour were taken on the same day as an in-hospital polysomnography. This study assesses the developmental sleep profiles of children and young adults aged 4–23 years old with SCA. We examined retrospective polysomnography (PSG) and questionnaire data. Results: A total of 256 children with a median age of 10.67 years (130 male) were recruited and 179 returned for PSG 1.80–6.72 years later. Later bedtimes and a decrease in total sleep time (TST) were observed. Sleep disturbances, e.g., parasomnias and night waking, were highest in preschool children and young adults at their first visit. Participants with lower sleep quality, more movement during the night and increased night waking experienced daytime sleepiness, potentially an indicator of lower daytime functioning. Factors influencing sleep quantity included age, hydroxyurea prescription, mean overnight oxygen saturation, sleep onset latency, periodic limb movement, socioeconomic status and night waking. Conclusion: Sleep serves an important role for daytime functioning in SCA; hence, quantitative (i.e., PSG for clinical symptoms, e.g., sleep-disordered breathing, nocturnal limb movement) and qualitative (i.e., questionnaires for habitual sleep behaviour) assessments of sleep should be mutually considered to guide interventions. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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13 pages, 428 KiB

Open AccessArticle

The Association between Diurnal Sleep Patterns and Emotions in Infants and Toddlers Attending Nursery

by Valeria Bacaro, Bernd Feige, Fee Benz, Anna F. Johann, Paola De Bartolo, Alessandra Devoto, Caterina Lombardo, Dieter Riemann and Chiara Baglioni

Brain Sci. 2020, 10(11), 891; https://doi.org/10.3390/brainsci10110891 - 22 Nov 2020

Cited by 4 | Viewed by 2456

Abstract

Background: Childcare programs often include mandatory naptime during the day. Loss of daytime sleep could lead to a moderate-to-large decrease in self-regulation, emotion processing, and learning in early childhood. Nevertheless, daytime sleep has been less accurately studied than nighttime sleep. This study aims [...] Read more.

Background: Childcare programs often include mandatory naptime during the day. Loss of daytime sleep could lead to a moderate-to-large decrease in self-regulation, emotion processing, and learning in early childhood. Nevertheless, daytime sleep has been less accurately studied than nighttime sleep. This study aims to explore the relationship between diurnal sleep habits in nursery settings, nocturnal sleep quality, and post-nap emotional intensity in infants and toddlers. Methods: Data of 92 children (52 girls, 40 boys) aged 6 to 36 months were obtained. Sleep habits as well as positive and negative emotions were monitored by educators during nursery times through a sleep and emotion diary for two weeks. Results: Explorative analyses showed that diurnal sleep hours decreased across age groups (except for females aged 25–36 months) and that all age groups had a lower amount of nocturnal sleep than is recommended by the National Sleep Foundation. Partial correlation analysis showed significant correlation between daytime sleep onset latency and positive emotions. Mediation analyses showed that daytime napping is relevant for emotional functioning independently of nocturnal sleep quality. Conclusions: Daytime sleep in early childhood seems to be linked to the management of positive and negative emotions and could play a role in healthy development of emotional processes. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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20 pages, 1780 KiB

Open AccessArticle

Sleep and Cognition in Children with Fetal Alcohol Spectrum Disorders (FASD) and Children with Autism Spectrum Disorders (ASD)

by Rabya Mughal, Catherine M. Hill, Anna Joyce and Dagmara Dimitriou

Brain Sci. 2020, 10(11), 863; https://doi.org/10.3390/brainsci10110863 - 16 Nov 2020

Cited by 17 | Viewed by 4484

Abstract

Children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing peers. However, little is known about the association between sleep and the cognitive phenotype in these clinical populations. Structural damage [...] Read more.

Children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing peers. However, little is known about the association between sleep and the cognitive phenotype in these clinical populations. Structural damage affecting cortical and subcortical connectivity occurs as a result of prenatal alcohol exposure in children with FASD, whilst it is believed an abundance of short-range connectivity explains the phenotypic manifestations of childhood ASD. These underlying neural structural and connectivity differences manifest as cognitive patterns, with some shared and some unique characteristics between FASD and ASD. This is the first study to examine sleep and its association with cognition in individuals with FASD, and to compare sleep in individuals with FASD and ASD. We assessed children aged 6–12 years with a diagnosis of FASD (n = 29), ASD (n = 21), and Typically Developing (TD) children (n = 46) using actigraphy (CamNTech Actiwatch 8), digit span tests of working memory (Weschler Intelligence Scale), tests of nonverbal mental age (MA; Ravens Standard Progressive Matrices), receptive vocabulary (British Picture Vocabulary Scale), and a choice reaction time (CRT) task. Children with FASD and ASD presented with significantly shorter total sleep duration, lower sleep efficiency, and more nocturnal wakings than their TD peers. Sleep was significantly associated with scores on the cognitive tests in all three groups. Our findings support the growing body of work asserting that sleep is significant to cognitive functioning in these neurodevelopmental conditions; however, more research is needed to determine cause and effect. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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21 pages, 2260 KiB

Open AccessArticle

Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome

by Elizabeth A Hill, Donna M Fairley, Linda J Williams, Goffredina Spanò, Sally-Ann Cooper and Renata L Riha

Brain Sci. 2020, 10(11), 844; https://doi.org/10.3390/brainsci10110844 - 12 Nov 2020

Cited by 10 | Viewed by 3074

Abstract

Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial [...] Read more.

Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m²; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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16 pages, 2124 KiB

Open AccessArticle

The Sustained Attention to Response Task Shows Lower Cingulo-Opercular and Frontoparietal Activity in People with Narcolepsy Type 1: An fMRI Study on the Neural Regulation of Attention

by Jari K. Gool, Ysbrand D. van der Werf, Gert Jan Lammers and Rolf Fronczek

Brain Sci. 2020, 10(7), 419; https://doi.org/10.3390/brainsci10070419 - 01 Jul 2020

Cited by 7 | Viewed by 3365

Abstract

Vigilance complaints often occur in people with narcolepsy type 1 and severely impair effective daytime functioning. We tested the feasibility of a three-level sustained attention to response task (SART) paradigm within a magnetic resonance imaging (MRI) environment to understand brain architecture underlying vigilance [...] Read more.

Vigilance complaints often occur in people with narcolepsy type 1 and severely impair effective daytime functioning. We tested the feasibility of a three-level sustained attention to response task (SART) paradigm within a magnetic resonance imaging (MRI) environment to understand brain architecture underlying vigilance regulation in individuals with narcolepsy type 1. Twelve medication-free people with narcolepsy type 1 and 11 matched controls were included. The SART included four repetitions of a baseline block and two difficulty levels requiring moderate and high vigilance. Outcome measures were between and within-group performance indices on error rates and reaction times, and functional MRI (fMRI) parameters: mean activity during the task and between-group activity differences across the three conditions and related to changes in activation over time (time-on-task) and error-related activity. Patients—but not controls—made significantly more mistakes with increasing difficulty. The modified SART is a feasible MRI vigilance task showing similar task-positive brain activity in both groups within the cingulo-opercular, frontoparietal, arousal, motor, and visual networks. During blocks of higher vigilance demand, patients had significantly lower activation in these regions than controls. Patients had lower error-related activity in the left pre- and postcentral gyrus. The time-on-task activity differences between groups suggest that those with narcolepsy are insufficiently capable of activating attention- and arousal-related regions when transitioning from attention initiation to stable attention, specifically when vigilance demand is high. They also show lower inhibitory motor activity in relation to errors, suggesting impaired executive functioning. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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22 pages, 1406 KiB

Open AccessArticle

The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment

by Paola Angelelli, Luigi Macchitella, Domenico Maurizio Toraldo, Elena Abbate, Chiara Valeria Marinelli, Michele Arigliani and Michele De Benedetto

Brain Sci. 2020, 10(6), 325; https://doi.org/10.3390/brainsci10060325 - 27 May 2020

Cited by 19 | Viewed by 2734

Abstract

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim [...] Read more.

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim to improve attention assessment, with a possible impact on clinical and medical-legal practices, in terms of which attention subdomains and parameters need consideration and which one is a high-risk OSA phenotype for attention dysfunctions. Method: For this purpose, we assessed 32 previously untreated OSA patients (26 men and 6 women) under 65 years of age (mean age 53.2 ± 7.3; mean education level 10.4 ± 3.4 years) suffering from moderate to severe sleep apnea and hypopnea (mean apnea-hypopnea index (AHI) 45.3 ± 22.9, range 16.1–69.6). A control group of 34 healthy participants matched with OSA patients for age, education level, and general cognitive functioning were also enrolled. The OSA patients and healthy participants were tested through an extensive computerized battery (Test of Attentional Performance, TAP) that evaluated intensive (i.e., alertness and vigilance) and selective (i.e., divided and selective) dimensions of attention and returned different outcome parameters (i.e., reaction time, stability of performance, and various types of errors). Data analysis: The data were analyzed by ANCOVA which compared the speed and accuracy performance of the OSA and control participants (cognitive reserve was treated as a covariate). The possible mechanisms underlying attention deficits in OSA patients were examined through correlation analysis among AHI, oxygenation parameters, sleepiness scores, and TAP outcomes and by comparing the following three phenotypes of patients: severe OSA and severe nocturnal desaturators (AHI⁺⁺D⁺), severe OSA nondesaturators (AHI⁺⁺D⁻), and moderate OSA nondesaturators (AHI⁺D⁻). Results: The results suggest that the OSA patients manifest deficits in both intensive and selective attention processes and that reaction time (RT) alone is ineffective for detecting and characterizing their problems, for which error analysis and stability of performance also have to be considered. Patients with severe OSA and severe hypoxemia underperformed on alertness and vigilance attention subtests. Conclusions: The data suggest the importance of evaluating attention deficits among OSA patients through several parameters (including performance instability). Moreover, the data suggest a multifaceted mechanism underlying attention dysfunction in OSA patients. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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16 pages, 1167 KiB

Open AccessReview

The Sleeping Brain: Harnessing the Power of the Glymphatic System through Lifestyle Choices

by Oliver Cameron Reddy and Ysbrand D. van der Werf

Brain Sci. 2020, 10(11), 868; https://doi.org/10.3390/brainsci10110868 - 17 Nov 2020

Cited by 96 | Viewed by 15179

Abstract

The glymphatic system is a “pseudo-lymphatic” perivascular network distributed throughout the brain, responsible for replenishing as well as cleansing the brain. Glymphatic clearance is the macroscopic process of convective fluid transport in which harmful interstitial metabolic waste products are removed from the brain [...] Read more.

The glymphatic system is a “pseudo-lymphatic” perivascular network distributed throughout the brain, responsible for replenishing as well as cleansing the brain. Glymphatic clearance is the macroscopic process of convective fluid transport in which harmful interstitial metabolic waste products are removed from the brain intima. This paper addresses the glymphatic system, its dysfunction and the major consequences of impaired clearance in order to link neurodegeneration and glymphatic activity with lifestyle choices. Glymphatic clearance can be manipulated by sleep deprivation, cisterna magna puncture, acetazolamide or genetic deletion of AQP4 channels, but how lifestyle choices affect this brain-wide clearance system remains to be resolved. This paper will synthesize existing literature on glymphatic clearance, sleep, Alzheimer’s disease and lifestyle choices, in order to harness the power of this mass transport system, promote healthy brain ageing and possibly prevent neurodegenerative processes. This paper concludes that 1. glymphatic clearance plays a major role in Alzheimer’s pathology; 2. the vast majority of waste clearance occurs during sleep; 3. dementias are associated with sleep disruption, alongside an age-related decline in AQP4 polarization; and 4. lifestyle choices such as sleep position, alcohol intake, exercise, omega-3 consumption, intermittent fasting and chronic stress all modulate glymphatic clearance. Lifestyle choices could therefore alter Alzheimer’s disease risk through improved glymphatic clearance, and could be used as a preventative lifestyle intervention for both healthy brain ageing and Alzheimer’s disease. Full article

(This article belongs to the Special Issue Effects of Sleep Disruption on Daytime Functioning)

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