Publications by authors named "Cathy Goldstein"

32 Publications

Objective sleep duration and timing predicts completion of in vitro fertilization cycle.

J Assist Reprod Genet 2021 Aug 10. Epub 2021 Aug 10.

Division of Sleep Medicine, Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI, 48109-5845, USA.

Purpose: To examine associations between objectively measured sleep duration and sleep timing with odds of completion of an in vitro fertilization (IVF) cycle.

Methods: This prospective cohort study enrolled 48 women undergoing IVF at a large tertiary medical center between 2015 and 2017. Sleep was assessed by wrist-worn actigraphy, 1-2 weeks prior to initiation of the IVF cycle. Reproductive and IVF cycle data and demographic and health information were obtained from medical charts. Sleep duration, midpoint, and bedtime were examined in relation to IVF cycle completion using logistic regression models, adjusted for age and anti-Müllerian hormone levels. A sub-analysis excluded women who worked non-day shifts to control for circadian misalignment.

Results: The median age of all participants was 33 years, with 29% of women >35 years. Ten women had an IVF cycle cancelation prior to embryo transfer. These women had shorter sleep duration, more nocturnal awakenings, lower sleep efficiency, and later sleep timing relative to those who completed their cycle. Longer sleep duration was associated with lower odds of uncompleted IVF cycle (OR = 0.88; 95%CI 0.78, 1.00, per 20-min increment of increased sleep duration). Women with later sleep midpoint and later bedtime had higher odds of uncompleted cycle relative to those with earlier midpoint and earlier bedtime; OR = 1.24; 95%CI 1.09, 1.40 and OR = 1.33; 95%CI 1.17, 1.53 respectively, for 20-min increments. These results were independent of age, anti-Müllerian hormone levels, or sleep duration, and remained significant after exclusion of shift-working women.

Conclusions: Shorter sleep duration and later sleep timing increase the odds of uncompleted cycles prior to embryo transfer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10815-021-02260-8DOI Listing
August 2021

Genomic heterogeneity affects the response to Daylight Saving Time.

Sci Rep 2021 Jul 20;11(1):14792. Epub 2021 Jul 20.

Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, 48109, USA.

Circadian clocks control the timing of many physiological events in the 24-h day. When individuals undergo an abrupt external shift (e.g., change in work schedule or travel across multiple time zones), circadian clocks become misaligned with the new time and may take several days to adjust. Chronic circadian misalignment, e.g., as a result of shift work, has been shown to lead to several physical and mental health problems. Despite the serious health implications of circadian misalignment, relatively little is known about how genetic variation affects an individual's ability to entrain to abrupt external changes. Accordingly, we used the one-hour advance from the onset of daylight saving time (DST) as a natural experiment to comprehensively study how individual heterogeneity affects the shift of sleep/wake cycles in response to an abrupt external time change. We found that individuals genetically predisposed to a morning tendency adjusted to the advance in a few days, while genetically predisposed evening-inclined individuals had not shifted. Observing differential effects by genetic disposition after a one-hour advance underscores the importance of heterogeneity in adaptation to external schedule shifts. These genetic differences may affect how individuals adjust to jet lag or shift work as well.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-94459-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292316PMC
July 2021

Predicting circadian phase across populations: a comparison of mathematical models and wearable devices.

Sleep 2021 May 20. Epub 2021 May 20.

Department of Mathematics, University of Michigan, Ann Arbor, MI, USA.

From smart work scheduling to optimal drug timing, there is enormous potential in translating circadian rhythms research results for precision medicine in the real world. However, the pursuit of such effort requires the ability to accurately estimate circadian phase outside of the laboratory. One approach is to predict circadian phase non-invasively using light and activity measurements and mathematical models of the human circadian clock. Most mathematical models take light as an input and predict the effect of light on the human circadian system. However, consumer-grade wearables that are already owned by millions of individuals record activity instead of light, which prompts an evaluation of the accuracy of predicting circadian phase using motion alone. Here, we evaluate the ability of four different models of the human circadian clock to estimate circadian phase from data acquired by wrist-worn wearable devices. Multiple datasets across populations with varying degrees of circadian disruption were used for generalizability. Though the models we test yield similar predictions, analysis of data from 27 shift workers with high levels of circadian disruption shows that activity, which is recorded in almost every wearable device, is better at predicting circadian phase than measured light levels from wrist-worn devices when processed by mathematical models. In those living under normal living conditions, circadian phase can typically be predicted to within 1 hour, even with data from a widely available commercial device (the Apple Watch). These results show that circadian phase can be predicted using existing data passively collected by millions of individuals with comparable accuracy to much more invasive and expensive methods.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsab126DOI Listing
May 2021

Day-to-day variability in sleep parameters and depression risk: a prospective cohort study of training physicians.

NPJ Digit Med 2021 Feb 18;4(1):28. Epub 2021 Feb 18.

Department of Neurology, University of Michigan, Ann Arbor, MI, USA.

While 24-h total sleep time (TST) is established as a critical driver of major depression, the relationships between sleep timing and regularity and mental health remain poorly characterized because most studies have relied on either self-report assessments or traditional objective sleep measurements restricted to cross-sectional time frames and small cohorts. To address this gap, we assessed sleep with a wearable device, daily mood with a smartphone application and depression through the 9-item Patient Health Questionnaire (PHQ-9) over the demanding first year of physician training (internship). In 2115 interns, reduced TST (b = -0.11, p < 0.001), later bedtime (b = 0.068, p = 0.015), along with increased variability in TST (b = 0.4, p = 0.0012) and in wake time (b = 0.081, p = 0.005) were associated with more depressive symptoms. Overall, the aggregated impact of sleep variability parameters and of mean sleep parameters on PHQ-9 were similar in magnitude (both r = 0.01). Within individuals, increased TST (b = 0.06, p < 0.001), later wake time (b = 0.09, p < 0.001), earlier bedtime (b = - 0.07, p < 0.001), as well as lower day-to-day shifts in TST (b = -0.011, p < 0.001) and in wake time (b = -0.004, p < 0.001) were associated with improved next-day mood. Variability in sleep parameters substantially impacted mood and depression, similar in magnitude to the mean levels of sleep parameters. Interventions that target sleep consistency, along with sleep duration, hold promise to improve mental health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41746-021-00400-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892862PMC
February 2021

Miles to go before we sleep…a step toward transparent evaluation of consumer sleep tracking devices.

Sleep 2021 02;44(2)

Department of Health and Kinesiology, University of Utah, Salt Lake City, UT.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsab020DOI Listing
February 2021

The prevalence and impact of pre-existing sleep disorder diagnoses and objective sleep parameters in patients hospitalized for COVID-19.

J Clin Sleep Med 2021 05;17(5):1039-1050

Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.

Study Objectives: Obstructive sleep apnea and other sleep disorders overlap with comorbidities associated with poor outcomes related to severe acute respiratory syndrome coronavirus 2 infection. However, the prevalence of obstructive sleep apnea among patients hospitalized for COVID-19 and relationship to outcomes is poorly characterized, and the relevance of other sleep disorders remains unknown. The objective of this study was to identify the prevalence of pre-existing sleep disorders and association with outcomes related to severe COVID-19 illness.

Methods: Patients with severe acute respiratory syndrome coronavirus 2 infection admitted to the University of Michigan Hospital System were included. Electronic medical records were queried for sleep disorders diagnostic codes. Data were extracted from polysomnography and home sleep testing in a subgroup with previous diagnostic testing at our center. Logistic regression was used to examine the association of sleep disorders with mechanical ventilation requirement, treatment with vasopressors, and death and Cox proportional hazards regression for time to discharge.

Results: Among n = 572 adult patients hospitalized for COVID-19, 113 (19.8%) patients had obstructive sleep apnea, 4 patients had central sleep apnea (0.7%), 5 had hypoventilation (0.9%), 63 had insomnia (11.0%), and 22 had restless legs syndrome or periodic limb movements disorder (3.9%). After adjusting for age, sex, body mass index, and race, no significant relationship was apparent between sleep disorders diagnoses or indices of sleep-disordered breathing severity and outcomes.

Conclusions: This is the first study to determine the prevalence of obstructive sleep apnea and other sleep disorders in a well-characterized cohort of patients hospitalized for COVID-19. Once hospitalized, a significant contribution of sleep disorders to outcomes was not identified. Therefore, future evaluations should focus on earlier outcomes, such as infection or clinical manifestations after exposure to severe acute respiratory syndrome coronavirus 2.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.9132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320480PMC
May 2021

The differential effects of stay-at-home orders on mood and sleep.

J Clin Sleep Med 2021 02;17(2):345-346

Michigan Medicine, Department of Neurology, Sleep Disorders Center, Ann Arbor, Michigan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.8982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853215PMC
February 2021

Hit or miss: the use of melatonin supplements.

J Clin Sleep Med 2020 12;16(S1):29-30

Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.8896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792888PMC
December 2020

The effects of COVID-19 stay-at-home order on sleep, health, and working patterns: a survey study of US health care workers.

J Clin Sleep Med 2021 Feb;17(2):185-191

Department of Neurology, Sleep Disorders Center, Michigan Medicine, Ann Arbor, Michigan.

Study Objectives: By March 2020, COVID-19 forced much of the world to stay at home to reduce the spread of the disease. Whereas some health care workers transitioned to working from home, many continued to report to work in person as essential employees. We sought to explore changes in sleep, health, work, and mood in health care workers during the stay-at-home orders.

Methods: We developed a cross-sectional online survey administered to health care workers. The survey assessed changes in sleep, work, screen time, media exposure, diet, exercise, substance use, and mood. The survey data were collected between March 28, 2020, and April 29, 2020.

Results: A total of 834 of 936 individuals completed the entire survey. Respondents were from 41 US states. Mood after the stay-at-home orders worsened, and screen time and substance use increased. Total sleep time shortened in those continuing to work in person (P < .001), whereas it was unchanged in those working from home (P = .73). Those working from home went to bed later, woke up later, and worked fewer hours. Reduced total sleep time and increased screen time before bed were associated with worse mood and screen time. Longer sleep time was associated with better mood.

Conclusions: Health care workers' mood worsened regardless of whether work was in person or remote, although total sleep time was shorter for those working in person. Those working from home may have shifted their sleep time to be more in line with their endogenous circadian phase. Peer or other support services may be indicated to address sleep, mood, and health behaviors among health care workers during these unprecedented times.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.8808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853204PMC
February 2021

The influence of opioids and nonopioid central nervous system active medications on central sleep apnea: a case-control study.

J Clin Sleep Med 2021 01;17(1):55-60

Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan.

Study Objectives: Opioids are known to contribute to central sleep apnea (CSA), but the influence of nonopioid central nervous system active medications (CNSAMs) on CSA remains unclear. In light of the hypothesized impact of nonopioid CNSAMs on respiration, we examined the relationships between the use of opioids only, nonopioid CNSAMs alone, and their combination with CSA.

Methods: Among all adults who underwent polysomnography testing at the University of Michigan's sleep laboratory between 2013 and 2018 (n = 10,606), we identified 212 CSA cases and randomly selected 300 controls. Participants were classified into four groups based on their medication use: opioids alone, nonopioid CNSAMs only, their combination, and a reference group, including those who did not use any of these medications. We defined CSA as a binary outcome and as a continuous variable using central apnea index data. Logistic and linear regression were used to examine associations between medication use, CSA diagnosis, and central apnea index.

Results: Study participants included 58% men, and mean age was 50 (± 14 standard deviation years. Nearly half of the study participants did not use opioids or nonopioid CNSAMs, 6% used opioids alone, 27% nonopioid CNSAMs alone, and 16% used a combination of these medications. In adjusted analyses, opioids-only users had a nearly twofold increase in CSA odds, whereas those who used a combination of opioids and nonopioid CNSAMs had fivefold higher odds of CSA relative to the reference group. In contrast, the use of nonopioid CNSAMs alone had protective associations with CSA.

Conclusions: This report showed increased odds of CSA, particularly among patients with sleep complaints who were prescribed opioids in combination with nonopioid CNSAMs compared with those who did not use any of these medications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.8826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849633PMC
January 2021

Current and Future Roles of Consumer Sleep Technologies in Sleep Medicine.

Authors:
Cathy Goldstein

Sleep Med Clin 2020 Sep 8;15(3):391-408. Epub 2020 Jul 8.

University of Michigan Sleep Disorders Center, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109, USA. Electronic address:

Consumer sleep technologies have rapidly evolved from wrist-worn activity trackers to multisensory products. These technologies reflect a widespread interest in sleep health, and their ubiquitous ownership allows for remote sleep monitoring. Therefore, these technologies may play a valuable role in telemedicine. However, clinical usefulness remains contested and is limited by a lack of transparency in data acquisition and analysis, and uncertain accuracy of consumer sleep technology-derived sleep metrics. Collaboration between manufacturers, sleep scientists, and clinical sleep medicine teams is required to produce useable, verified technologies that can enhance and personalize the care of patients with sleep disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsmc.2020.05.001DOI Listing
September 2020

Artificial intelligence in sleep medicine: background and implications for clinicians.

J Clin Sleep Med 2020 04;16(4):609-618

Neurology Department, Massachusetts General Hospital, Boston, Massachusetts.

None: Polysomnography remains the cornerstone of objective testing in sleep medicine and results in massive amounts of electrophysiological data, which is well-suited for analysis with artificial intelligence (AI)-based tools. Combined with other sources of health data, AI is expected to provide new insights to inform the clinical care of sleep disorders and advance our understanding of the integral role sleep plays in human health. Additionally, AI has the potential to streamline day-to-day operations and therefore optimize direct patient care by the sleep disorders team. However, clinicians, scientists, and other stakeholders must develop best practices to integrate this rapidly evolving technology into our daily work while maintaining the highest degree of quality and transparency in health care and research. Ultimately, when harnessed appropriately in conjunction with human expertise, AI will improve the practice of sleep medicine and further sleep science for the health and well-being of our patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.8388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161463PMC
April 2020

Artificial intelligence in sleep medicine: an American Academy of Sleep Medicine position statement.

J Clin Sleep Med 2020 04;16(4):605-607

Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan.

None: Sleep medicine is well positioned to benefit from advances that use big data to create artificially intelligent computer programs. One obvious initial application in the sleep disorders center is the assisted (or enhanced) scoring of sleep and associated events during polysomnography (PSG). This position statement outlines the potential opportunities and limitations of integrating artificial intelligence (AI) into the practice of sleep medicine. Additionally, although the most apparent and immediate application of AI in our field is the assisted scoring of PSG, we propose potential clinical use cases that transcend the sleep laboratory and are expected to deepen our understanding of sleep disorders, improve patient-centered sleep care, augment day-to-day clinical operations, and increase our knowledge of the role of sleep in health at a population level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.8288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161449PMC
April 2020

Sleep stage prediction with raw acceleration and photoplethysmography heart rate data derived from a consumer wearable device.

Sleep 2019 12;42(12)

Department of Neurology, University of Michigan, Ann Arbor, MI.

Wearable, multisensor, consumer devices that estimate sleep are now commonplace, but the algorithms used by these devices to score sleep are not open source, and the raw sensor data is rarely accessible for external use. As a result, these devices are limited in their usefulness for clinical and research applications, despite holding much promise. We used a mobile application of our own creation to collect raw acceleration data and heart rate from the Apple Watch worn by participants undergoing polysomnography, as well as during the ambulatory period preceding in lab testing. Using this data, we compared the contributions of multiple features (motion, local standard deviation in heart rate, and "clock proxy") to performance across several classifiers. Best performance was achieved using neural nets, though the differences across classifiers were generally small. For sleep-wake classification, our method scored 90% of epochs correctly, with 59.6% of true wake epochs (specificity) and 93% of true sleep epochs (sensitivity) scored correctly. Accuracy for differentiating wake, NREM sleep, and REM sleep was approximately 72% when all features were used. We generalized our results by testing the models trained on Apple Watch data using data from the Multi-ethnic Study of Atherosclerosis (MESA), and found that we were able to predict sleep with performance comparable to testing on our own dataset. This study demonstrates, for the first time, the ability to analyze raw acceleration and heart rate data from a ubiquitous wearable device with accepted, disclosed mathematical methods to improve accuracy of sleep and sleep stage prediction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/sleep/zsz180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930135PMC
December 2019

Consumer Sleep Technology: An American Academy of Sleep Medicine Position Statement.

J Clin Sleep Med 2018 05 15;14(5):877-880. Epub 2018 May 15.

Wayne State University, Detroit, Michigan.

Abstract: Consumer sleep technologies (CSTs) are widespread applications and devices that purport to measure and even improve sleep. Sleep clinicians may frequently encounter CST in practice and, despite lack of validation against gold standard polysomnography, familiarity with these devices has become a patient expectation. This American Academy of Sleep Medicine position statement details the disadvantages and potential benefits of CSTs and provides guidance when approaching patient-generated health data from CSTs in a clinical setting. Given the lack of validation and United States Food and Drug Administration (FDA) clearance, CSTs cannot be utilized for the diagnosis and/or treatment of sleep disorders at this time. However, CSTs may be utilized to enhance the patient-clinician interaction when presented in the context of an appropriate clinical evaluation. The ubiquitous nature of CSTs may further sleep research and practice. However, future validation, access to raw data and algorithms, and FDA oversight are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.7128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940440PMC
May 2018

The effect of repeated light-dark shifts on uterine receptivity and early gestation in mice undergoing embryo transfer.

Syst Biol Reprod Med 2018 Apr 30;64(2):103-111. Epub 2017 Nov 30.

e Transgenic Animal Model Core, Department of Internal Medicine , University of Michigan Medical School , Ann Arbor , MI , USA.

Female shift workers are at increased risk for negative reproductive outcomes, and animal evidence suggests that manipulation of the light-dark cycle is detrimental to early gestation in female mice. Specifically, failure of implantation may be responsible for these findings. The objective of this study was to better delineate which reproductive processes are vulnerable to detrimental effects of maternal circadian disturbance. We exposed mice undergoing embryo transfer to repetitive phase advances of the photoperiod. Embryos were derived from donor sperm and eggs from mice living in normal light-dark conditions to isolate the effects of photoperiod disruption on uterine receptivity and early gestation. Twenty-eight mice receiving embryo transfer underwent an experimental light-dark condition (advance of lights on and lights off by 6 hours every 4 days). Twenty-eight mice remained in a normal light-dark condition. Animals lived in their assigned light-dark condition beginning 2 weeks prior to embryo transfer and ending the day of uterine necropsy (post-coitus day 14.5). Wilcoxon-Mann-Whitney test demonstrated no significant differences between control and experimental light-dark conditions in pups (Z=0.10, p=.92), resorptions (Z=0.20, p=.84), or implantations (Z=-0.34, p=.73). Pup and placental weights were similar between groups. In this investigation, uterine receptivity and maintenance of early gestation were preserved despite recurrent phase advances in photoperiod. This finding, in the context of the current literature, suggests that the negative effects of circadian disruption are mediated by reproductive processes upstream of implantation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/19396368.2017.1408715DOI Listing
April 2018

The utility of home sleep apnea tests in patients with low versus high pre-test probability for moderate to severe OSA.

Sleep Breath 2018 09 22;22(3):641-651. Epub 2017 Nov 22.

Sleep Disorders Center, Department of Neurology, University of Michigan, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI, 48109, USA.

Purpose: Home sleep apnea tests (HSATs) are an alternative to attended polysomnograms (PSGs) when the pre-test probability for moderate to severe OSA is high. However, insurers often mandate use anytime OSA is suspected regardless of the pre-test probability. Our objective was to determine the ability of HSATs to rule in OSA when the pre-test probability of an apnea hypopnea index (AHI) in the moderate to severe range is low.

Methods: Patients who underwent HSATs were characterized as low or high pre-test probability based on the presence of two symptoms of the STOP instrument plus either BMI > 35 or male gender. The odds of HSAT diagnostic for OSA dependent on pre-test probability was calculated. Stepwise selection determined predictors of non-diagnostic HSAT. As PSG is performed after HSATs that do not confirm OSA, false negative results were assessed.

Results: Among 196 individuals, pre-test probability was low in 74 (38%) and high in 122 (62%). A lower percentage of individuals with a low versus high pre-test probability for moderate to severe OSA had HSAT results that confirmed OSA (61 versus 84%, p = 0.0002) resulting in an odds ratio (OR) of 0.29 for confirmatory HSAT in the low pre-test probability group (95% CI [0.146, 0.563]). Multivariate logistic regression demonstrated that age ≤ 50 (OR 3.10 [1.24-7.73]), female gender (OR 3.58[1.50-8.66]), non-enlarged neck circumference (OR 11.50 [2.50-52.93]), and the absence of loud snoring (OR 3.47 [1.30-9.25]) best predicted non-diagnostic HSAT. OSA was diagnosed by PSG in 54% of individuals with negative HSAT which was similar in both pre-test probability groups.

Conclusion: HSATs should be reserved for individuals with high pre-test probability for moderate to severe disease as opposed to any individual with suspected OSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-017-1594-2DOI Listing
September 2018

Laboratory Polysomnography or Limited-Channel Sleep Studies for Obstructive Sleep Apnea.

Authors:
Cathy Goldstein

Ann Intern Med 2017 10;167(7):521

From University of Michigan, Ann Arbor, Michigan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/L17-0282DOI Listing
October 2017

Author Reply.

Urology 2017 08 13;106:43-44. Epub 2017 Jun 13.

Department of Urology, University of Michigan, Ann Arbor, MI.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2017.03.063DOI Listing
August 2017

Determining Resident Sleep During and After Call With Commercial Sleep Monitoring Devices.

Urology 2017 08 10;106:39-44. Epub 2017 May 10.

Department of Urology, University of Michigan, Ann Arbor, MI.

Objective: To demonstrate that commercial activity monitoring devices (CAMDs) are practical for monitoring resident sleep while on call. Studies that have directly monitored resident sleep are limited, likely owing to both cost and difficulty in study interpretation. The advent of wearable CAMDs that estimate sleep presents the opportunity to more readily evaluate resident sleep in physically active settings and "home call," a coverage arrangement familiar to urology programs.

Methods: Twelve urology residents were outfitted with Fitbit Flex devices during "home call" for a total of 57 (out of 64, or 89%) call or post-call night pairs. Residents were surveyed with the Stanford Sleepiness Scale (SSS), a single-question alertness survey. Time in bed (TIB) was "time to bed" to "rise for day." Fitbit accelerometers register activity as follows: (1) not moving; (2) minimal movement or restless; or (3) above threshold for accelerometer to register steps. Total sleep time (TST) was the number of minutes in level 1 activity during TIB. Sleep efficiency (SE) was defined as TST divided by TIB.

Results: While on call, 10 responding (of 12 available, 83%) residents on average reported TIB as 347 minutes, TST as 165 minutes, and had an SE of 47%. Interestingly, SSS responses did not correlate with sleep parameters. Post-call sleep demonstrated increases in TIB, SE, and TST (+23%, +15%, and +44%, respectively) while sleepiness was reduced by 22%.

Conclusion: We demonstrate that urologic residents can consistently wear CAMDs while on home call. SSS did not correlate with Fitbit-estimated sleep duration. Further study with such devices may enhance sleep deprivation recognition to improve resident sleep.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2017.03.059DOI Listing
August 2017

Sleep in women undergoing in vitro fertilization: a pilot study.

Sleep Med 2017 Apr 21;32:105-113. Epub 2016 Dec 21.

Sleep Disorders Center, Department of Neurology, University of Michigan Health System, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109-5845, USA; Department of Obstetrics & Gynecology, University of Michigan Health System, Von Voigtlander Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.

Objective: Sleep disturbances are thought to be frequent in women undergoing IVF despite minimal research of this hypothesis. Our goal was to longitudinally assess sleep duration and disturbances in women undergoing IVF and assess impact of habitual sleep duration on oocytes retrieved, an important outcome in IVF.

Methods: Actigraphy and questionnaire batteries containing sleep and psychometric instruments were performed prior to and throughout 24 IVF cycles.

Results: TST <7 h was present in 46%, 57%, 69%, and 42% of baseline, stimulation, post-oocyte retrieval, and post-embryo transfer recordings. ESS >10 was noted in 24%, 33%, and 36% of cycles during baseline, stimulation, and post-embryo transfer. PSQI >5 was noted in 57%, 43%, and 29% of cycles during baseline, stimulation, and post-embryo transfer. TST (F = 2.95, p = 0.04) and ESS (F = 4.36, p = 0.02) were the only sleep metrics in which a significant main effect of time was found by mixed models analysis. The final linear regression model chosen by stepwise selection to best explain the variability in oocytes retrieved included anti-mullerian hormone, day three follicle stimulating hormone, and baseline TST and explained 40% of the variance in oocytes retrieved (adjusted R = 0.40, p = 0.03). Although not statistically significant, a trend towards a linear association between baseline TST and oocytes retrieved was seen with an increase of oocytes retrieved by 1.5 for every hour increase in TST (p = 0.09).

Conclusions: This is the first study to describe, with subjective and objective measures, sleep disturbances present throughout the IVF cycle. Importantly, a trend towards a linear relationship between TST and oocytes retrieved was found in this pilot study. Sleep may be a modifiable target to improve outcomes in women undergoing IVF and further investigations are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.sleep.2016.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380145PMC
April 2017

Waking up to sleep research in 2015.

Lancet Neurol 2016 Jan 8;15(1):15-7. Epub 2015 Dec 8.

Sleep Disorders Center, Med Inn Building, 1500 E Medical Center Dr, Ann Arbor, MI, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1474-4422(15)00344-0DOI Listing
January 2016

Management of Restless Legs Syndrome/Willis-Ekbom Disease in Hospitalized and Perioperative Patients.

Authors:
Cathy Goldstein

Sleep Med Clin 2015 Sep 23;10(3):303-10, xiv. Epub 2015 Jun 23.

Department of Neurology, University of Michigan Sleep Disorders Center, C728 Med Inn Building, SPC 5845, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5845, USA. Electronic address:

Restless legs syndrome (RLS) is a sensorimotor disorder that can cause significant discomfort, impaired quality of life, poor mood, and disturbed sleep. Because the disorder is chronic and associated with multiple comorbidities, RLS can be seen in an inpatient or perioperative setting. Certain characteristics of the hospitalized or surgical context can exacerbate or unmask RLS. Importantly, RLS and the associated discomfort and insomnia can prolong hospital stay and negatively impact outcomes. RLS medications should be continued during the hospital admission when possible. Avoidance of excessive phlebotomy and medications known to trigger RLS is helpful. Patients should increase activity when acceptable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsmc.2015.05.003DOI Listing
September 2015

Sleep Related Scratching: A Distinct Parasomnia?

J Clin Sleep Med 2016 Jan;12(1):139-42

Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI.

Abstract: Pruritus (itching) during the sleep period can present as a symptom of dermatological or systemic disease, or as a parasomnia. Sleep related scratching as a primary parasomnia, exclusively confined to sleep in the absence of coexisting dermatological disorders, has not been well described. This case series describes three such patients, and discusses potentially relevant pathophysiology that can underlie itching or pain. Such cases of sleep related scratching may merit nosologic classification apart from previously defined parasomnias.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.5416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702205PMC
January 2016

Quality measures for the care of adult patients with restless legs syndrome.

J Clin Sleep Med 2015 Mar 15;11(3):293-310. Epub 2015 Mar 15.

Department of Neurology, University of Michigan Health System, Ann Arbor, MI.

Abstract: The American Academy of Sleep Medicine (AASM) commissioned several Workgroups to develop quality measures for the care of patients with common sleep disorders, including adults with restless legs syndrome (RLS). Using the AASM process for quality measure development, the RLS Work-group developed three target outcomes for RLS management, including improving the accuracy of diagnosis, reducing symptom severity, and minimizing treatment complications. Seven processes were developed to support these outcomes. To achieve the outcome of improving accuracy of diagnosis, the use of accepted diagnostic criteria and assessment of iron stores are recommended. To realize the outcome of decreasing symptom severity, routine assessment of severity and provision of evidence-based treatment are recommended. To support the outcome of minimizing treatment complications, counseling about potential side effects and assessing for augmentation and impulse control disorders, when indicated, are recommended. Further research is needed to validate optimal practice processes to achieve best outcomes in adult patients with RLS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.4550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346652PMC
March 2015

Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea.

J Clin Sleep Med 2015 Jun 15;11(6):597-602. Epub 2015 Jun 15.

Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.

Study Objective: Esophageal manometry (Pes) is the gold standard to detect repetitive episodes of increased respiratory effort followed by arousal (RERAs). Because RERAs are not included in the apnea-hypopnea index (AHI), we often refer patients with symptoms of sleep disordered breathing (SDB) and AHI < 5 for a second polysomnogram (PSG) with Pes. Often, the second PSG will demonstrate AHI > 5, confirming a diagnosis of OSA. We speculate that in most cases of suspected SDB, Pes does not add further diagnostic data and that night-to-night variability in OSA severity results in a first false-negative study.

Methods: We conducted a retrospective review of PSGs between 2008 and 2012 in adults with initial PSG negative for OSA followed by a second study (with or without Pes) within 6 mo.

Results: Of 125 studies that met inclusion criteria, a second study was completed with Pes in 105 subjects. SDB was diagnosed in 73 subjects (68.5%) completing a second PSG with Pes: 49 (46.7%) received a diagnosis based on AHI, and 24 (22.8%) received a diagnosis based on Pes (p = 0.003). There were no statistically significant differences in the mean AHI change between the two PSGs in subjects who completed the second study with or without Pes.

Conclusions: In patients with symptoms of SDB and initial PSG with AHI < 5, the majority met criteria for OSA on second PSG by AHI without additional information added by Pes. Because Pes is not widely available and is somewhat invasive, a repeat study without Pes may be sufficient to diagnose SDB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.4764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442219PMC
June 2015

The emergence of central sleep apnea after surgical relief of nasal obstruction in obstructive sleep apnea.

J Clin Sleep Med 2012 Jun 15;8(3):321-2. Epub 2012 Jun 15.

Sleep Disorders Center, NorthShore University Health System, Evanston, IL, USA.

By the current definition, complex sleep apnea (CompSA) refers to the emergence of central sleep apnea (CSA) during the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). However, new-onset CSA has been described with use of other treatments for OSA, including tracheostomy, maxillofacial surgery, and mandibular advancement device. We present a patient with CSA beginning after endoscopic sinus and nasal surgery for nasal obstruction in the setting of mild OSA. This case highlights the importance of non-PAP mechanisms in the pathogenesis of CompSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5664/jcsm.1926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365092PMC
June 2012

Parasomnias.

Dis Mon 2011 Jul;57(7):364-88

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.disamonth.2011.04.007DOI Listing
July 2011
-->