Daniel Ruivo Marques

Assessing Stress-Induced Sleep Reactivity in College Students: The European Portuguese Version of the Ford Insomnia Response to Stress Test (FIRST)

ABSTRACT Objective and Background: Over the past few years, the comprehensive models of insomnia have exhibited impressive developments. However, there is scarce knowledge on predisposing or vulnerability factors for insomnia. One of the most promising constructs to aid in filling this gap is stress-induced sleep reactivity assessed through self-report. Our aim was to study the psychometric properties of the European Portuguese version of the Ford Insomnia Response to Stress Test (FIRST). Participants: We recruited a large sample of students attending medical school (N = 699). Methods: Several analyses were carried out such as internal consistency, construct validity, and discriminant groups’ analysis. Results: It was observed that FIRST-PT shows good internal consistency (Cronbach´s alpha = .81) and validity indicators. Interestingly, and contrary to what was observed in the previously published studies on psychometric properties of the FIRST, it was observed that a two-factor solution (Factor I = rumination, Factor II = worry) was the most adequate one to explain the correlation matrix, accounting for approximately 44% of the total variance. Conclusions: The FIRST-PT proved to be a useful and reliable tool to measure stress-induced sleep reactivity. However, these results should be replicated in other groups, particularly clinical samples, in order to verify the stability of its factorial dimension.

Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS): reliability, initial validity and normative scores in higher education students.

Based on successive samples totaling more than 5000 higher education students, we scrutinized the reliability, structure, initial validity and normative scores of a brief self-report seven-item scale to screen for the continuum of nighttime insomnia complaints/perceived sleep quality, used by our team for more than a decade, henceforth labeled the Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS). In study/sample 1 (n = 1654), the items were developed based on part of a larger survey on higher education sleep–wake patterns. The test–retest study was conducted in an independent small group (n = 33) with a 2–8 week gap. In study/sample 2 (n = 360), focused mainly on validity, the BaSIQS was completed together with the Pittsburgh Sleep Quality Index (PSQI). In study 3, a large recent sample of students from universities all over the country (n = 2995) answered the BaSIQS items, based on which normative scores were determined, and an additional question on perceived sleep problems in order to further analyze the scale’s validity. Regarding reliability, Cronbach alpha coefficients were systematically higher than 0.7, and the test–retest correlation coefficient was greater than 0.8. Structure analyses revealed consistently satisfactory two-factor and single-factor solutions. Concerning validity analyses, BaSIQS scores were significantly correlated with PSQI component scores and overall score (r = 0.652 corresponding to a large association); mean scores were significantly higher in those students classifying themselves as having sleep problems (p < 0.0001, d = 0.99 corresponding to a large effect size). In conclusion, the BaSIQS is very easy to administer, and appears to be a reliable and valid scale in higher education students. It might be a convenient short tool in research and applied settings to rapidly assess sleep quality or screen for insomnia complaints, and it may be easily used in other populations with minor adaptations.

Associations between sleep quality and domains of quality of life in a non-clinical sample: results from higher education students

Objective: The association between sleep quality and quality of life (QoL) in clinical samples diagnosed with sleep disorders, mental disorders, or other medical conditions has been widely investigated. However, few studies focused on this relationship in samples of mostly young and healthy adults. This study analyzed the associations between sleep quality and several dimensions of QoL in higher education students and examined whether or not sleep quality would significantly predict QoL after statistically controlling for psychopathological symptoms. Design: Observational and transversal. Setting: Non‐clinical; higher education. Participants: A sample of 324 college students, aged 17 to 47 years (M = 20.89 ± 2.85) were enrolled. Measurements: European Portuguese versions of the Pittsburgh Sleep Quality Index (PSQI), the WHOQOL‐Bref to measure QoL, and the Brief Symptom Inventory (BSI) to measure psychopathological symptoms. Results: All PSQI components were significantly associated with general QoL and the psychological and physical QoL domains. The subjective sleep quality and daytime dysfunction PSQI components were consistently associated with all WHOQOL‐Bref domains and general QoL. Hierarchical regression analyses further showed that the PSQI components as a whole, and in particular subjective sleep quality, added significant contributions to the general QoL facet and to the psychological, physical, and environmental QoL domains, after controlling for psychopathological symptoms. Conclusions: Several components of sleep quality and different facets/domains of QoL are associated in higher education students, particularly subjective sleep quality, which remains a significant predictor of most aspects of QoL, regardless of the presence of psychopathological symptoms.

Self-Referential Dysfunction and Default-Mode Hyperactivation in Psychophysiological Insomnia Patients

Psychophysiological insomnia (PI) is one of the most frequent sleep disorders. In this study we tested whether differences in terms of neural activation are present between a group of PI patients and a healthy-control group while they are exposed to idiosyncratic ruminations and worries, evoked visually by words, so as to explore their hypothetical link with default-mode network (DMN) dysfunction in PI. We recruited five PI patients diagnosed according to the International Classification of Sleep Disorders, version 2 (ICSD-2) of American Academy of Sleep Medicine (AASM) and five age- and sex-matched healthy controls. Patients were recruited at the outpatient Sleep Medicine Centre of the Coimbra University Hospital Centre. We used a functional magnetic resonance imaging (fMRI) block-design paradigm where the participants visualized lists of words related to past/present and future concerns and also emotionally neutral words. The results suggested that the PI patients showed a failure of the DMN to deactivate. Moreover, when these patients were exposed to words concerning both past/present ruminations and future worries, there was a pronounced and significant over-recruitment of brain areas related to DMN and self-referential processing when they were compared to healthy volunteers. The differences between the patient and control groups were also evident in self-report measures. In sum, despite the relatively small sample size, our study clearly suggests that in PI there is a dysfunction in brain regions pertaining to self-referential processing, which is corroborated by an overall pattern of hyperarousal in brain regions comprising the DMN. These data may be useful in the improvement of pathophysiological models, diagnostic and therapeutic interventions for insomnia.

Psychometric properties of Glasgow Sleep Effort Scale in Portuguese language.

Sleep effort is generally defined as the attempt to force and induce sleep in a voluntary manner. This study aimed to document the psychometric properties of a brief measure of sleep effort--the Glasgow Sleep Effort Scale--in its European (Portuguese) version using a large sample (N = 2,995). The results supported the good internal consistency of the overall scale scores (α = .79). Potential construct validity was evaluated with various methods, including criterion validity. There was also a convergent validity indicator. Principal components analysis revealed a 1-dimensional structure that accounted for 45% of the total variance. This preliminary study suggests that this Portuguese version of the Glasgow Sleep Effort Scale is a measure of sleep behavior suitable for research and clinical purposes. However, more studies are needed, particularly with clinical groups.

Insomnia in College Students: Specificities Regarding Psychological Treatment

Cognitive and behavioral techniques for insomnia ́s treatment have solid empirical evidence. Generally, when psychologists treat insomniac college students they face important challenges in the implementation of standard techniques. This paper aims to present a script of cognitive-behavioral therapy for insomnia (CBT-I) adapted to college students based on our clinical experience. We discuss the most frequently strategies recommended for the treatment of insomnia in adults taking into account the adjustments that might be necessary to do in order to maximize its effectiveness and efficiency for a college student population. In the end, we highlight the main points that should be explored in future empirical studies. CBT-I seems to be relevant for treating insomnia in college settings, however, the study of adaptation of the well-known techniques seems necessary to maximize its therapeutic effect.

Portuguese Version of the Arousal Predisposition Scale: Preliminary Evidence for a Two-Factor Structure in a Nonclinical Sample:

It is known that there is significant variability in arousal levels of the individuals. The Arousal Predisposition Scale (APS) is a questionnaire intended to measure individual differences in arousability. In the current work, our aim was to present the initial psychometric properties of the Portuguese version of the APS. Three hundred forty-five undergraduate medical students from both genders were enrolled. All participants filled out a set of questionnaires—which contained the APS—at the end of their lectures and out of the evaluation period. The APS showed good internal consistency (α = .85) and discriminated individuals with extreme scores. Further, in general, the scale discriminated as well both genders pertaining to the individual items and total score. In terms of scale structure, two related factors were extracted (F1 = emotional reactivity and F2 = trait anxiety). Significant associations among APS and other sleep and psychological self-report variables were also observed. The APS seems to be a reliable and valid instrument to assess self-reported physiological arousability, at least in a sample of young adults. The two-factor composition will require more studies to be replicated in similar groups and, particularly, in clinical samples.

Insomnia Disorder and Brain’s Default-Mode Network

Purpose of ReviewInsomnia disorder (ID) is a prevalent sleep disorder that significantly compromises the physical and mental health of individuals. This article reviews novel approaches in the study of brain networks and impaired function in ID through the application of modern neuroimaging techniques such as functional magnetic resonance imaging (fMRI).Recent FindingsThe default-mode network (DMN) is presumed to be correlated with self-referential information processing, and it appears to be altered or unbalanced in insomnia.SummaryA growing body of evidence suggests the lack of deactivation of brain regions comprising the DMN when insomnia patients are at rest. Moreover, core areas of the DMN demonstrate greater activation in insomnia patients when compared to healthy controls in self-referential related tasks. Despite the few studies on the topic, underpinning the correlation between abnormal DMN activity and ID deserves further attention in the future. Implications for therapeutics are briefly outlined.

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

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

Circadian preferences in young adults: Psychometric properties and factor structure of the Portuguese version of the Preferences Scale (PS-6)

ABSTRACT Morningness is a trait-like variable which has been extensively studied within chronobiology. Despite the number of existing measures to assess morningness, there is a need for brief instruments that are psychometrically sound to be used in applied settings. Accordingly, the modified version of the Preferences Scale (PS-6) comprises six items and was reported to have adequate reliability and satisfactory validity indicators. In this article, the psychometric properties of the Portuguese version of the PS-6 are reported. A total of 700 students attending medical school were recruited, and this sample was randomly divided into two groups. In the first group (n = 352), we assessed the internal consistency calculations and conducted a principal component analysis of the posited structure. In the second group (n = 348), we conducted a confirmatory factor analysis (CFA) using structural equation modeling. Overall, the results indicated that the PS-6 has adequate reliability (α = .75) and is constituted by two components: (I) preferred cognitive activities timings and (II) preferred sleeping–eating timings, respectively. In conclusion, the Portuguese version of the PS seems suitable for use in research and applied settings such as shift work schedules management. However, the applicability of the PS-6 in other samples and further validity indicators should be both investigated. The use of actigraphy and biological measures should also be collected to enhance the robustness of the PS-6.