Sleep in the Laboratory and Sleep at Home: Comparisons of Older Insomniacs and Normal Sleepers

Study Objectives:Previous studies have demonstrated pronounced reduction of REM sleep on the fi rst nights following major surgery which may infl uence pain, analgesic use, and recovery. This placebo-controlled, randomized, doubleblind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days. Methods: Twenty patients (≥ 60 years) undergoing THA or TKA in a standardized setup with spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included. Polysomnography measures were performed for 2 nights, 1 night at home prior to surgery and on the fi rst night after surgery, when the patient received placebo or zolpidem 10 mg. Analgesic use, pain levels, and subjective measures of fatigue and sleep quality were recorded. Analysis of sleep data was performed according to the American Academy of Sleep Medicine manual. Results:Objective sleep data did not show a signifi cant difference between groups in any of the sleep stages. However, subjective data on sleep quality and fatigue showed signifi cantly less fatigue and better sleep quality in the zolpidem group (p < 0.05), and reduced objectively recorded number of arousals (p = 0.004). Levels of pain and opioid use were similar in the 2 groups. Conclusions: Our objective data did not support the primary hypothesis that one night's treatment with zolpidem would signifi cantly improve sleep architecture following major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals. S C I E N T I F I C I N V E S T I G A T I O N SF ollowing major surgery most patients experience a pronounced change in their sleep architecture and sleep quality. 1-3 Typically, the amount of deep sleep (slow wave sleep [SWS]) and REM sleep is markedly reduced or even lacking immediately after surgery . 3,4 Sleep in the postoperative period is affected by many factors, and postoperative pain has a major negative impact. 5,6 In addition an intricate relationship exists between sleep, opioids, and pain, where reduced sleep can lead to hyperalgesia and increased opioid demand, and opioid per se has a negative impact on sleep architectur e. 7-10 Finally, postoperative sleep disturbances may contribute to delirium and cognitive dysfuncti on. 11,12 Since previous studies have shown that sleep, especially REM sleep, is severely disturbed immediately after major surge ry, 1-4 we hypothesized that a short-acting hypnotic might play a role in preserving sleep architecture immediately after sur gery, 13-15 and possibly affect pain and overall well-being following major joint replacement surgery in an elderly population. This randomized, placebo-controlled, clinical trial set out to evaluate the effect of zolpidem treatment on sleep the fi rst night following major arthroplasty surgery in elderly patients using polysomnographic recordings. The primary endpoint was change in REM sleep duration on the ...

Section: Discussionsupporting

confidence: 90%

Postoperative Sleep Disturbances after Zolpidem Treatment in Fast-Track Hip and Knee Replacement

Krenk

Jennum

Kehlet

2014

“…The study sample included independent groups of age-and gendermatched non-complaining normal sleepers and persons with primary insomnia. The participants for this report were drawn from a larger parent study [9][10][11] conducted to compare the nighttime sleep and daytime functioning of adult insomnia sufferers and normal sleepers. All study procedures were reviewed and approved by the institutional review boards of the VA Medical Center and Duke University Medical Center in Durham, NC.…”

Section: Methods Designmentioning

confidence: 99%

Sensitivity and Specificity of Polysomnographic Criteria for Defining Insomnia

Edinger

Ulmer

Means

2013

Self Cite

Study Objectives: In recent years, polysomnography-based eligibility criteria have been increasingly used to identify candidates for insomnia research, and this has been particularly true of studies evaluating pharmacologic therapy for primary insomnia. However, the sensitivity and specifi city of PSG for identifying individuals with insomnia is unknown, and there is no consensus on the criteria sets which should be used for participant selection. In the current study, an archival data set was used to test the sensitivity and specifi city of PSG measures for identifying individuals with primary insomnia in both home and lab settings. We then evaluated the sensitivity and specifi city of the eligibility criteria employed in a number of recent insomnia trials for identifying primary insomnia sufferers in our sample. Design: Archival data analysis. Settings: Study participants' homes and a clinical sleep laboratory.Participants: Adults: 76 with primary insomnia and 78 noncomplaining normal sleepers. Measurements and Results: ROC and cross-tabs analyses were used to evaluate the sensitivity and specifi city of PSG-derived total sleep time, latency to persistent sleep, wake after sleep onset, and sleep effi ciency for discriminating adults with primary insomnia from normal sleepers. None of the individual criteria accurately discriminated PI from normal sleepers, and none of the criteria sets used in recent trials demonstrated acceptable sensitivity and specifi city for identifying primary insomnia. Conclusions:The use of quantitative PSG-based selection criteria in insomnia research may exclude many who meet current diagnostic criteria for an insomnia disorder. keywords: Insomnia, PSG, research, sensitivity, specifi city Citation: Edinger JD; Ulmer CS; Means MK. Sensitivity and specifi city of polysomnographic criteria for defi ning insomnia.

“…[8][9][10][11][12] The FNE has been associated with less total sleep time (TST), lower sleep efficiency (SE), more intermittent waking time, and longer REM latency (RL) 9 in clinical or in-home studies. 13,14 The SWAN Sleep Study evaluated sleep characteristics in 368 African American, Caucasian, and Chinese women across the menopause transition using 3 nights of in-home PSG. Sleep stage scoring and electrocardiograms were used on all study nights while sleep disordered breathing and leg movements (Night 1) as well as skin temperature and snoring sensors (Night 2 only) were used on selected nights.…”

Section: Brief Summarymentioning

confidence: 99%

Sources of Variability in Epidemiological Studies of Sleep Using Repeated Nights of In-Home Polysomnography: SWAN Sleep Study

Zheng

Sowers

Buysse

et al. 2012

Study Objective: To quantify sources of night-to-night variability. Methods: This project was conducted in 285 middle-aged African American, Caucasian, and Chinese women from the Study of Women's Health Across the Nation (SWAN) Sleep Study living in Chicago, the Detroit area, Oakland, and Pittsburgh. The study used 3 repeated nights of in-home polysomnography (PSG) measures. Night 1 data included assessment of sleep staging, sleep apnea, and periodic limb movements, while Nights 2 and 3 focused on sleep staging. Results: Mean total sleep time (TST) increased substantially from 365 minutes on Night 1 to 391 minutes and 380 minutes, respectively, on Nights 2 and 3. Mean percent sleep effi ciency (SE%) for the 3 nights were 83%, 85%, and 85%, respectively. Night 1 sleep values were signifi cantly different than Nights 2 and 3 measures except for S2 (%), S1 (min), and Delta (S3+4)%. Nights 2 and 3 differences in variability were negligible. Obesity, past smoking, and fi nancial strain measures were associated with greater Night 1 vs. Night 2 or Night 3 differences. We concluded that there was signifi cant Night 1 vs. Nights 2 and 3 variability and, though relatively modest, it was suffi cient to bias estimates of association. Additionally, personal characteristics including smoking, obesity, and fi nancial strain increased night-to-night variability. Conclusions: This reports adds new information about between and within person sources of variation with in-home PSG and identifi es elements that are essential in the design and planning of future sleep studies of multi-ethnic groups in social and physiological transition states such as the menopause. Keywords S C I E N T I F I C I N V E S T I G A T I O N SP olysomnography (PSG) is widely used in clinical and epidemiological research settings to provide objective sleep measures.1-6 PSG can be conducted using in-home settings or sleep laboratories considering the advantages afforded by variability in the closeness of monitoring, the ability to correct technical problems in a timely manner, and control temperature, noise and other environmental factors to minimize systematic bias. Use of PSG in the home or laboratory setting has substantial costs for data acquisition and the time required for data processing while potentially imposing physical and psychological burdens on the participant.7 Given these considerations, it is important to ascertain how much and what kind of data must be collected, determine if more than a single night's data collection is required to describe sleep behaviors; and, identify personal characteristics associated with substantially increased within-person variation in sleep behaviors.Considering the number of data collection nights that are needed to provide unbiased estimates of sleep characteristics is often made more complex because of the impact of the "fi rst night" effect (FNE), generated from changes in the sleep envi-BRIEF SUMMARY Current Knowledge/Study Rationale: Use of repeated polysomnography (PSG) in the home or laboratory to descr...