Monica Martoni

The Consensus Sleep Diary: Quantitative Criteria for Primary Insomnia Diagnosis

Objective The aim of the study was to put forward quantitative criteria for the Consensus Sleep Diary, to differentiate people with insomnia from normal sleepers. Methods In this retrospective study, we analyzed 295 sleep diaries of patients with primary insomnia (43% were male, ages ranging between 17 and 76 years) collected in two clinical centers for insomnia and 536 sleep diaries of normal sleepers (47% were male, ages ranging between 15 and 82 years). We considered the following sleep parameters: time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, terminal wakefulness, and subjective feeling of rest. Using the Youden index, we calculated the quantitative criteria that performed best for each sleep parameter. Finally, we created receiver operating characteristic curves to test the accuracy of each identified criterion. Results Individuals with insomnia significantly differed from controls on all sleep indices (p < .001). Differentiation between individuals with insomnia from controls was optimal for terminal wakefulness (>15 minutes, area under the curve [AUC] = 0.83), wake after sleep onset (cutoff >20 minutes, AUC = 0.81), total sleep time (<390 minutes, AUC = 0.80), and particularly sleep efficiency (<87.5%, AUC = 0.92, sensitivity = 0.80, specificity = 0.90). Time in bed was the least differentiating variable (<500 minutes, AUC = 0.57). Conclusions The quantitative criteria of the sleep diary in this study agree with the few available data in the literature. This confirms that the sleep diary could be a useful screening tool for assessing patients with primary insomnia.

Remember to Do: Insomnia Versus Control Groups in a Prospective Memory Task

Primary insomnia is characterized by difficulty in falling asleep and/or remaining asleep, by early morning awakening and/or nonrestorative sleep, and resultant daytime dysfunction in the absence of specific physical, mental, or substance-related causes. However, the studies on daytime cognitive functioning of insomnia patients report inconclusive results. This retrospective study aimed to compare the performance of insomnia patients (N = 54) to that of controls (N = 113) in a naturalistic prospective memory task. Task performance was defined by the percentage of times the event-marker button of an actigraph was pressed, at lights-off time and at wake-up time. The performance pattern in the prospective memory task was similar in both groups. In addition, the task was performed better at lights-off time than at wake-up time regardless of group. Post-hoc subgroup analysis showed that there were more insomnia patients who performed the task perfectly (i.e., 100%) than controls. Performance at wake-up time was significantly correlated to objective sleep quality (i.e., sleep efficiency) only in insomnia patients.

Psychometric goodness of the Mini Sleep Questionnaire

The current study was conducted to evaluate the psychometric properties and analyze the convergent validity of the Italian version of the Mini Sleep Questionnaire (MSQ). In addition, it was aimed to put forward cut‐off values to be used in screening protocols.

Association between seasonal affective disorder and subjective quality of the sleep/wake cycle in adolescents

The relationship between seasonal affective disorder (SAD) and subjective quality of sleep/wake cycle in adolescents was explored. The Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) and Mini Sleep Questionnaire (MSQ) were administered to 345 adolescents living in the city of Cesena (Emilia-Romagna region, Italy) (299 females; age range: 14-18 years), to determine SAD and perceived quality of the sleep/wake cycle. The response rate was 92% for females and 90.2% for males. The MSQ includes two factors, sleep and wake, with lower scores corresponding to a lower quality of sleep and wake. The MSQ includes cut-off criteria to detect a good or bad sleep and wake quality. Adolescents with SAD (16 ± 5.7) scored significantly lower than those not affected on wake factor (19.5 ± 4.3), while no effect has been observed on sleep factor. SAD was the only one significant predictor of good/bad wake quality, while it did not reach significant level with reference to good/bad sleep quality. Present results are indications of a possible influence of SAD on wake quality and further studies are necessary to confirm them.

Sleep and prospective memory

A positive sleep effect has been recently observed on prospective memory. In this retrospective study (N = 254, 30.64 ± 13.79 years, 55.10% of females), we investigated the relationship between sleep and prospective memory, comparing the performance of “good” and “bad” sleepers in a naturalistic prospective memory task (to remember to press the event-marker button of actigraphy at wake-up time). The “good” and “bad” sleepers were defined according to following sleep parameters: Sleep Onset Latency(SOL), Total Sleep Time (TST), Wake After Sleep Onset (WASO), Sleep Efficiency (SE), and Number of Awakenings (NA > 5). The results showed that the good sleepers performed the prospective memory task better than the bad sleepers. Specifically, the performance of prospective memory task at wake-up time was influenced by the quantity (TST) and the quality (WASO, SE%, and NA > 5) of the sleep.

Economic decision-making in morning/evening-type people as a function of time of day

ABSTRACT Decision-making is affected by psychological factors like emotional state or cognitive control, which may also vary with circadian rhythmicity. Here, we tested the influence of chronotype (32 morning-type versus 32 evening-type) and time of day (9 a.m. versus 5 p.m.) on interpersonal decision-making as measured by the Ultimatum Game. Participants had to accept or reject different economic offers proposed by a virtual participant. Acceptance involved distribution of gains as proposed, whereas rejection resulted in no gain for either player. The results of the game showed a deviation from rational performance, as participants usually rejected the unfair offers. This behaviour was similar for both chronotype groups, and in both times of day. This result may reflect the robustness of decision-making strategies across standard circadian phases under ecological conditions. Furthermore, morning-types invested more time than evening-types to respond to high-uncertainty offers. This more cautious decision-making style of morning-types fits with our finding of higher proactive control as compared to evening-types when performing the AX-Continuous Performance Task. In line with the literature on personality traits, our results suggest that morning-types behave with more conscientiousness and less risk-taking than evening-type individuals.

Effects of dawn simulation on attentional performance in adolescents

PurposeThis study aimed at examining the effects of 2xa0weeks of dawn simulation on attentional performance in adolescents.MethodsOn the whole, 56 adolescents (24 females and 32 males) took part to the study, with a mean age of 17.68xa0±xa00.97xa0years (age ranging between 15 and 20xa0years). Each adolescent was requested to participate for 5 consecutive weeks and the research design included the baseline and two counterbalanced conditions, dawn simulator and control (no dawn simulator). Attentional performance of adolescents was measured through the attention network test (ANT) that allowed assessing the efficiency of three separable attentional networks, namely alerting, orienting and executive. Overall, participants performed the ANT three times (i.e., one time for each condition), while sleep quality, sleep duration and sleep timing were concurrently monitored by means of actigraphy and were treated as potential confounders.ResultsThe only improvement of the attentional performance attributable to the use of dawn simulator was observed for the efficiency of alerting network (45.97xa0±xa032.76xa0ms) that significantly increased in comparison to the baseline (31.57xa0±xa026.97xa0ms) (pxa0<xa00.05). On the contrary, the sleep quality, sleep quantity and sleep timing did not significantly change.ConclusionThese results show for the first time that, controlling for sleep quality, sleep duration and sleep timing, the use of dawn simulator across 2xa0weeks is able to determine an alerting effect in adolescents.

What patients’ complaints and praise tell the health practitioner: implications for health care quality. A qualitative research study

ObjectivenIn order to identify which health care aspects play a role in patient satisfaction and quality of health care, the present study analyses a large number of instances of complaint and praise.nnnDesign and settingnOne thousand two hundred and thirty-five instances of complaint and one thousand five hundred thirty-six of praise submitted from patients or other souces (i.e. a patients family member or a legal representative) to a northern-Italian hospital were analysed.nnnMain outcome measuresnWe adopted Reader and colleagues (2014) patients complaint taxonomy, in conjunction with a detailed content analysis of relationship and communication of information aspects.nnnResultsnThe most frequent causes of complaint concerned care system management (68.1%), particularly the time taken to access treatment, and relationship aspects (52.8%). The importance of relationship aspects was confirmed by the expression of gratitude through praise (89%). The most critical factor of the relationship domain was effective communication of information to the patient (39.3%). Frequently patients complained of: (i) having received information that was inconsistent with the truth, (ii) having had difficulty in obtaining information, and (iii) untimely communication of information. Clinical aspects did not seem to be the main factors that triggered a complaint (36,8%), and, when indicated, they were almost always associated with relationship issues.nnnConclusionsnThis study indicates that not only complaints, but also instances of praise, are a potentially important source of information regarding health care aspects that play a role in patient satisfaction and quality of care. Our findings underline the relevance of relationship aspects in determining patients satisfaction with the care received. In particular, health practitioners should focus their attention on how information is understood, translated and applied by patients.

Influence of time-of-day on joint Navon effect

The shared attention theory suggests that people devote greater cognitive resources to those features co-attended simultaneously with others, determining better performance in several types of tasks. When co-actors performed a go/no-go Navon task attending different features of target letters, the performance was impaired, reflecting a joint Navon effect (the representation of a co-actor’s attentional focus made it more difficult to select and apply one’s own focus of attention), probably due to asynchronous co-attention with a decrease in cognitive resources involved. Researches in chronobiology and chronopsychology demonstrated that not only selective attention (involved in a Navon task), but also cognitive resources have a daily fluctuations, mainly paralleling the circadian rhythm of body temperature (i.e. increasing values from the morning to evening with a subsequent decline in the night). The study was conducted to assess whether the presence of joint attention, as measured by the joint Navon effect, was influenced by the time-of-day. Sixteen pairs of participants sitting next to each other were required to respond to the identity letters in a go/no-go Navon task twice: in the morning (09:00–10:00) and early afternoon (13:00–14:00). The results showed a joint Navon effect in the morning session only, suggesting that joint attention was affected by the time-of-day effect on cognitive resources.

Physical self-efficacy is associated to body mass index in schoolchildren,

OBJECTIVEnThe present study aimed to investigate the relationship between physical self-efficacy and body mass index in a large sample of schoolchildren.nnnMETHODSnThe Perceived Physical Ability Scale for Children was administered to 1560 children (50.4% boys; 8-12 years) from three different countries. Weight and height were also recorded to obtain the body mass index.nnnRESULTSnIn agreement with the literature, the boys reported greater perceived physical self-efficacy than girls. Moreover, the number of boys who are obese is double that of girls, while the number of boys who are underweight is half that found in girls. In the linear regression model, the increase in body mass index was negatively related to the physical self-efficacy score, differently for boys and girls. Furthermore, age and nationality also were predictors of low physical self-efficacy only for girls.nnnCONCLUSIONnThe results of this study reinforce the importance of psychological aspect of obesity, as the perceived physical self-efficacy and body mass index were negatively associated in a sample of schoolchildren for boys and girls.