Christina S. McCrae

Fibromyalgia patients have reduced hippocampal volume compared with healthy controls

Objective Fibromyalgia patients frequently report cognitive abnormalities. As the hippocampus plays an important role in learning and memory, we determined whether individuals with fibromyalgia had smaller hippocampal volume compared with healthy control participants. Methods T1-weighted structural magnetic resonance imaging (MRI) scans were acquired from 40 female participants with fibromyalgia and 22 female healthy controls. The volume of the hippocampus was estimated using the software FreeSurfer. An analysis of covariance model controlling for potentially confounding factors of age, whole brain size, MRI signal quality, and Beck Depression Inventory scores were used to determine significant group differences. Results Fibromyalgia participants had significantly smaller hippocampi in both left (F[1,56]=4.55, P=0.037, η2p=0.08) and right hemispheres (F[1,56]=5.89, P=0.019, η2p=0.10). No significant effect of depression was observed in either left or right hemisphere hippocampal volume (P=0.813 and P=0.811, respectively). Discussion Potential mechanisms for reduced hippocampal volume in fibromyalgia include abnormal glutamate excitatory neurotransmission and glucocorticoid dysfunction; these factors can lead to neuronal atrophy, through excitotoxicity, and disrupt neurogenesis in the hippocampus. Hippocampal atrophy may play a role in memory and cognitive complaints among fibromyalgia patients.

Temporal Associations Between Sleep and Physical Activity Among Overweight/Obese Youth.

OBJECTIVEnExamine average interindividual and temporal intraindividual associations between time of sleep onset (sleep onset), total sleep time (TST), and minutes in moderate-to-very-vigorous physical activity per hour (MVPA/h) among overweight/obese youth.nnnMETHODSnOverweight/obese youth (nu2009=u2009134; 7-12 years) wore an accelerometer for 16+u2009hr/day, 5-7 days, which provided daily objective estimates of MVPA/h, TST, and sleep onset.nnnRESULTSnMultilevel models revealed an intraindividual effect of TST, such that nights with longer TST preceded less MVPA/h during the midnight-to-midnight monitoring period; a significant random effect qualified this relationship. Average interindividual TST did not predict mean MVPA/h, whereas sleep onset significantly predicted mean MVPA/h.nnnCONCLUSIONSnLater time of sleep onset (as opposed to TST) was the strongest predictor of group-level decreased physical activity. At the individual level, longer TST than usual predicted less MVPA/h than usual. Results suggest the need for more person-centered research and a greater focus on sleep timing among youth.

Sleep and Pain in Mid- to Late-Life: An Exploration of Day-to-Day Pain Inconsistency

ABSTRACT Objectives: This study examined how different quantifications of pain (average vs. day-to-day inconsistency) are related to sleep in older adults beyond known predictors. Methods: Baseline measures from the Active Adult Mentoring Project were used for secondary analyses. Participants included 82 adults in mid- to late-life. Depression was assessed with the BDI-II. Pain intensity was assessed over seven days on a 11-point Likert-scale, while sleep efficiency (SE), total sleep time (TST), and total wake time (TWT) were assessed using a self-report diary. Results: Regression analyses revealed that pain inconsistency was associated with both SE and TWT and accounted for significant variance over age, gender, and depression. In contrast, average pain was not associated with SE, TST, or TWT. Conclusions: The findings indicate that pain inconsistency may be a more meaningful predictor of sleep disturbance than average pain level, suggesting that one’s ability to regulate pain may be related to one’s ability to engage in optimal sleep in mid- to late-life. Clinical Implications: Pain inconsistency appears to contribute more to sleep disturbance than average pain. Pain inconsistency in late-life warrants greater attention and may be an area of clinical intervention through activity-pacing or coping skills training.

Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes

OBJECTIVEnThe aim of the present study was to examine the effects of a brief behavioral intervention for insomnia (BBTi) on sleep parameters, mood, and cognitive functioning in older adults.nnnMETHODSnOlder adults (aged 65 years or more) underwent four weekly sessions of BBTi or self-monitoring control (SMC). Participants completed 14 days of sleep diaries and actigraphy measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep quality ratings at baseline, post-treatment, and three month follow-up. Participants also completed mood scales (Geriatric Depression Scale [GDS]; Beck Depression Inventory-II; and State Trait Anxiety Inventory) and neuropsychological testing (measuring global cognition, language, memory, attention and processing speed, and executive function) at the three timepoints.nnnRESULTSnSignificant condition (BBTi vs. SMC) x time (baseline vs. post-treatment vs. follow-up) interactions revealed that BBTi improved relative to baseline in sleep diary-reported SOL, WASO, SE, and sleep quality, and these improvements were maintained at follow-up. SMC showed no change in these measures. A main effect of time showed that actigraphy-measured WASO improved from baseline for both BBTi and SMC at post-treatment. A main effect of time revealed that both BBTi and SMC patients endorsed fewer GDS symptoms relative to baseline at post-treatment and follow-up. We observed no change in performance on neuropsychological measures.nnnCONCLUSIONSnA four-week BBTi is an efficacious intervention for reducing insomnia symptoms in older adults. BBTi does not selectively improve mood or cognitive functioning. Future work should examine effects of BBTi on physiological measures of sleep architecture and day-to-day cognition.nnnCLINICAL TRIAL IDENTIFERnNCT02967185.

A meta-analysis of associations between obesity and insomnia diagnosis and symptoms

Recent research suggests that sleep plays an important role in obesity (OB). No systematic reviews have investigated the association between OB and insomnia specifically. The present study reviewed the past 10xa0yxa0of findings on the association between insomnia diagnosis (IND) and insomnia symptoms (INS) with OB. A total of 67 studies were included in the meta-analyses. Multilevel random effects models showed that the odds of having OB among those who had IND was not significantly greater than the odds of having OB among those who did not have IND (odds ratio (OR)xa0=xa0.80, pxa0=xa0.61). A small, significant cross-sectional correlation (rxa0=xa0.06, pxa0=xa0.03) was found between INS and body mass index. Longitudinal data were limited. Based on three studies, the odds of developing future INS among those who had OB were not significantly greater than those who were normal-weight (NW) (ORxa0=xa01.07, pxa0=xa0.40). Longitudinal data on the association between INS and future incidence of OB are inconclusive. We found no indication of systematic publication biases and high heterogeneity in the effect sizes across studies. Meta-regressions showed that some of the heterogeneity was explained by the types of measures of insomnia symptoms, publication year, and regions where a study was conducted.

Pain Intensity as a Moderator of the Association between Opioid Use and Insomnia Symptoms among Adults with Chronic Pain

OBJECTIVEnResearch documenting the impact of opioid use on sleep among individuals with chronic pain has been mixed. This study aimed to determine if pain intensity moderates the association between opioid use and insomnia symptoms among adults with comorbid symptoms of insomnia and chronic widespread pain.nnnMETHODSnParticipants (Nxa0=xa0144; 95% female; mean agexa0=xa051.6, SDxa0=xa011.4) completed assessments of insomnia symptoms, pain and use of sleep/pain medication. Multiple regression was used to determine if pain intensity moderates the association between opioid use (yes/no) sleep onset latency (SOL), wake after sleep onset (WASO), sleep quality, or time in bed. Analyses controlled for gender, symptoms of sleep apnea, symptoms of depression, use of sleep medication (yes/no), and use of non-opioid pain medication (yes/no).nnnRESULTSnStronger pain intensity was associated with longer self-reported WASO and worse sleep quality, independent of opioid use. Conversely, opioid use was associated with longer time in bed, independent of pain intensity. Opioid use and pain intensity interacted in the prediction of SOL, such that opioid use (vs. non-use) was associated with longer SOL in the context of mild but not moderate to severe pain intensity.nnnCONCLUSIONSnOpioid use was associated with more difficulty falling asleep among adults with chronic pain; however, this cross-sectional effect was only significant among those reporting lower pain intensity. Authors speculate that this effect is masked among those with severe pain because the pain-related sleep debt they acquire throughout the night then facilitates sleep onset the next day.

Discrepancies in sleep diary and actigraphy assessments in adults with fibromyalgia: Associations with opioid dose and age

Sleep diary and actigraphy assessments of insomnia symptoms in patients with fibromyalgia (FM) are often discrepant. We examined whether opioid dose and age interact in predicting magnitude or direction of discrepancies. Participants (N = 199, M = 51.5 years, SD = 11.7) with FM and insomnia completed 14 days of diaries and actigraphy. Multiple regressions determined whether average opioid dose and its interaction with age predicted magnitude or direction of diary/actigraphy discrepancies in sleep onset latency (SOL), wake after sleep onset (WASO) and sleep efficiency (SE), controlling for sex, use of sleep medication, evening pain and total sleep time. Higher opioid dose predicted greater magnitude of discrepancy in SOL and SE. Opioid dose interacted with age to predict direction but not magnitude of discrepancy in SOL and SE. Specifically, higher opioid use was associated with better subjective (shorter SOL, higher SE) than objective reports of sleep among younger adults, and longer subjective than objectively measured SOL among older adults. Opioid dose did not predict magnitude or direction of WASO discrepancies. In FM, a higher opioid dose increases diary/actigraphy SOL and SE discrepancies, and direction of discrepancies may depend on age. We speculate that increased opioid use combined with age‐related factors, such as slow wave sleep disruption, increased awakenings and/or cognitive decline, may impact perceived sleep.

Dynamic daily associations between insomnia symptoms and alcohol use in adults with chronic pain

Individuals with chronic pain are at risk for sleep disruption and heavy alcohol use, yet the daily associations between these behaviours are not well characterized. This study aimed to determine the extent to which alcohol use affects insomnia symptoms and vice versa in adults reporting symptoms of chronic pain. Participants were 73 individuals (93% women) reporting alcohol use in addition to symptoms of insomnia and chronic pain. They completed daily diaries assessing insomnia symptoms and alcohol use for 14 days. Multilevel modelling was used to evaluate the bidirectional associations between alcohol use and insomnia symptoms at the daily level. Consistent with laboratory‐based research, alcohol use was associated with decreased sleep‐onset latency the same night but increased sleep‐onset latency 2 nights later. Specifically, for every alcoholic drink consumed, time to sleep onset decreased by 5.0 min in the same night but increased by 4.3 min 2 nights later. Alcohol use was not significantly associated with subsequent wake after sleep onset or total sleep time, and insomnia symptoms were not significantly associated with subsequent alcohol use. To our knowledge, these data provide the first evidence that alcohol use negatively affects insomnia symptoms up to 2 days post‐consumption in patients reporting symptoms of insomnia and chronic pain. Findings suggest that one drink will have minimal impact on sleep, but heavier drinking (e.g. four–five drinks) may have a clinically significant impact (16–25‐min increase in sleep‐onset latency). Future studies may assess alcohol use as a point of intervention within this population.

Pain inconsistency and sleep in mid to late-life: the role of depression

Abstract Objectives: Inconsistency in pain may lead to depression, which may then influence sleep. Thus, the purpose of this study was to examine whether depression mediates the relationship between day-to-day inconsistency in pain and sleep in middle aged to older adults. Methods: Baseline measures from the Active Adult Mentoring Project were used for secondary data analysis. Participants included 82 adults in mid- to late-life. Pain was assessed for seven consecutive days on an 11-point Likert-scale, with pain inconsistency defined as the seven-day individual standard deviation. A self-report daily diary was used to assess sleep efficiency (SE), total wake time (TWT), total sleep time (TST), and sleep quality (SQ), and depression was assessed using the BDI-II. Results: Mediation analyses revealed that depression partially mediated the relationship between pain inconsistency and SE, TWT, and SQ but not TST. Conclusions: Results indicate that depression may be an important factor through which pain inconsistency influences sleep. Although further research is warranted, these preliminary findings suggest that intervening on both pain inconsistency and depression may be one way to improve sleep in older adults.

Influence of asthma status on sleep variability in overweight/obese youth

ABSTRACT Objective: Pediatric asthma and overweight/obesity (OV/OB) frequently co-occur and youth with both conditions exhibit poor sleep/bedtime habits. This study assessed differences in week-to-weekend bedtime/wake time variability among OV/OB youth with/without comorbid asthma, and tested whether variability predicted weekday sleep. Methods: OV/OB youth (n = 142; 28% comorbid asthma; 7–12 years) wore an Accelerometer for 5 days (2 weekend days), providing estimates of week-to-weekend bedtime/wake-time variability, weekday Total Sleep Time (TST), weekday time in bed (TIB), and weekday wake after sleep onset (WASO). Results: There were no demographic differences between groups beyond lower family income for the OV/OB+asthma group. The OV/OB+asthma group exhibited later weekday (mean OV/OB+asthma = 10:39 pm, mean OV/OB only = 10:30pm) and weekend (mean OV/OB+asthma = 11:41 pm, mean OV/OB only = 11:17pm) bedtimes, earlier weekday waketimes (mean OV/OB+asthma = 6:40 am, mean OV/OB only = 6:51 am), and similar weekend waketimes (mean OV/OB+asthma = 7:54 pm, mean OV/OB only = 7:52 pm. Univariate MANOVA follow-ups indicated a main effect of asthma group for week-to-weekend bedtime and waketime variability, with the OV/OB+asthma group evidencing approximately 30 minutes greater bedtime (OV/OB+asthma mean = 90 minutes) and waketime (OV/OB+asthma mean = 108 minutes) variability. Within the OV/OB+asthma group, greater waketime variability predicted fewer minutes of weekday TIB and WASO. Within the OV/OB only group, wake time variability predicted fewer minutes of weekday TIB. Conclusion: Findings suggest that asthma status confers risk for more week-to-weekend variability among currently OV/OB youth, and that greater variability shortens the weekday sleep period. Further research on reasons for greater week-to-weekend sleep variability in asthma is needed.