Publications by authors named "Knut Langsrud"

21 Publications

  • Page 1 of 1

The effect of sleep-wake intraindividial variability in digital cognitive behaviour therapy for insomnia: A mediation analysis of a large-scale RCT.

Sleep 2021 May 8. Epub 2021 May 8.

Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.

Study Objectives: Digital Cognitive Behavioural Therapy for Insomnia (dCBT-I) is an effective treatment for insomnia. However, less is known about mediators of its benefits. The aim of the present study was to test if intraindividual variability in sleep (IIV) was reduced with dCBT-I, and whether any identified reduction was a mediator of dCBT-I on insomnia severity and psychological distress.

Methods: In a two-arm randomized controlled trial (RCT), 1720 adults with insomnia (dCBT-I = 867; patient education about sleep = 853) completed the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and sleep diaries, at baseline and 9-week follow-up. Changes in IIV were analysed using linear mixed modelling followed by mediation analyses of ISI, HADS, and IIV in singular sleep metrics and composite measures (Behavioural Indices (BI-Z) and Sleep-disturbance Indices (SI-Z)).

Results: dCBT-I was associated with reduced IIV across all singular sleep metrics, with the largest between-group effect sizes observed for sleep onset latency (SOL). Reduced IIV for SOL and wake after sleep onset had the overall greatest singular mediating effect. For composite measures, SI-Z mediated change in ISI (b = -0.74; 95% Confidence Interval (CI) -1.04 to -0.52; 13.3%) and HADS (b = -0.40; 95% CI -0.73 to -0.18; 29.2%), whilst BI-Z mediated minor changes.

Conclusion: Reductions in IIV in key sleep metrics mediate significant changes in insomnia severity and especially psychological distress when using dCBT-I. These findings offer important evidence regarding the therapeutic action of dCBT-I and may guide the future development of this intervention.
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http://dx.doi.org/10.1093/sleep/zsab118DOI Listing
May 2021

Distinguishing sleep from wake with a radar sensor A contact-free real-time sleep monitor.

Sleep 2021 Mar 11. Epub 2021 Mar 11.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks, Trondheim, Norway.

This work aimed to evaluate if a radar sensor can distinguish sleep from wakefulness in real-time. The sensor detects body movements without direct physical contact with the subject, and can be embedded in the roof of a hospital room for completely unobtrusive monitoring. We conducted simultaneous recordings with polysomnography, actigraphy, and radar, on two groups: healthy young adults (n=12, four nights per participant), and patients referred to a sleep exam (n=28, one night per participant). We developed models for sleep/wake classification based on principles commonly used by actigraphy, including real-time models, and tested them on both datasets. We estimated a set of commonly reported sleep parameters from this data, including total-sleep-time, sleep-onset-latency, sleep-efficiency, and wake-after-sleep-onset, and evaluated the inter-method reliability of these estimates. Classification results were on-par with, or exceeding, those often seen for actigraphy. For real-time models in healthy young adults, accuracies were above 92%, sensitivities above 95%, specificities above 83%, and all Cohen's kappa values were above 0.81 compared to polysomnography. For patients referred to a sleep exam, accuracies were above 81%, sensitivities about 89%, specificities above 53% and Cohen's kappa values above 0.44. Sleep variable estimates showed no significant inter-method bias, but the limits of agreement were quite wide for the group of patients referred to a sleep exam. Our results indicate that the radar has the potential to offer the benefits of contact-free real-time monitoring of sleep, both for in-patients and for ambulatory home monitoring.
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http://dx.doi.org/10.1093/sleep/zsab060DOI Listing
March 2021

Effects of digital cognitive behavioural therapy for insomnia on insomnia severity: a large-scale randomised controlled trial.

Lancet Digit Health 2020 08;2(8):e397-e406

Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway.

Background: Although several large-scale randomised controlled trials have shown the efficacy of digital cognitive behavioural therapy for insomnia (dCBT-I), there is a need to validate widespread dissemination of dCBT-I using recommended key outcomes for insomnia. We investigated the effect of a fully automated dCBT-I programme on insomnia severity, sleep-wake patterns, sleep medication use, and daytime impairment.

Methods: We did a parallel-group superiority randomised controlled trial comparing dCBT-I with online patient education about sleep. The interventions were available through a free-to-access website, publicised throughout Norway, which incorporated automated screening, informed consent, and randomisation procedures, as well as outcome assessments. Adults (age ≥18 years) who had regular internet access and scored 12 or higher on the Insomnia Severity Index (ISI) were eligible for inclusion, and were allocated (1:1) to receive dCBT-I (consisting of six core interactive sessions to be completed over 9 weeks) or patient education (control group). Participants were masked to group assignment and had no contact with researchers during the intervention period. The primary outcome was the change in ISI score from baseline to 9-week follow-up, assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02558647) and is ongoing, with 2-year follow-up assessments planned.

Findings: Between Feb 26, 2016, and July 1, 2018, 5349 individuals commenced the online screening process, of which 1497 were ineligible or declined to participate, 2131 discontinued the screening process, and 1721 were randomly allocated (868 to receive dCBT-I and 853 to receive patient education). At 9-week follow-up, 584 (67%) participants in the dCBT-I group and 534 (63%) in the patient education group completed the ISI assessment. The latent growth model showed that participants in the dCBT-I group had a significantly greater reduction in ISI scores from baseline (mean score 19·2 [SD 3·9]) to 9-week follow-up (10·4 [6·2]) than those in the patient education group (from 19·6 [4·0] to 15·2 [5·3]; estimated mean difference -4·7 (95% CI -5·4 to -4·1; Cohen's d -1·21; p<0·001). Compared with patient education, the number needed to treat with dCBT-I was 2·7 (95% CI 2·4 to 3·2) for treatment response (ISI score reduction ≥8) and 3·2 (2·8 to 3·8) for insomnia remission (ISI score <8). No adverse events were reported to the trial team.

Interpretation: dCBT-I is effective in reducing the severity of symptoms associated with the insomnia disorder. These findings support the widespread dissemination of dCBT-I. Future research is needed to identify the moderators of response and to improve targeting.

Funding: Norwegian Research Council; Liaison Committee for Education, Research and Innovation in Central Norway.
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http://dx.doi.org/10.1016/S2589-7500(20)30135-7DOI Listing
August 2020

Chronobiologically informed inpatient milieu in psychiatric institutions.

Lancet Psychiatry 2020 12;7(12):1013-1014

Department of Mental Health, Norwegian University of Science and Technology, Institutt for psykisk helse, Trondheim, Norway; Division of Mental Health Care, St Olavs University Hospital, Trondheim 7006, Norway. Electronic address:

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http://dx.doi.org/10.1016/S2215-0366(20)30459-4DOI Listing
December 2020

Validation of insomnia questionnaires in the general population: The Nord-Trøndelag Health Study (HUNT).

J Sleep Res 2021 02 27;30(1):e13222. Epub 2020 Oct 27.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.

The primary aim was to validate questionnaire-based insomnia diagnoses from a modified Karolinska Sleep Questionnaire (KSQ) and the Insomnia Severity Index (ISI), by age category (< or >65 years), against a semi-structured face-to-face interview. Secondary aims were to split validity by diagnostic certainty of the interview and to compare prevalence estimates of questionnaire- and interview-based diagnoses. A total of 232 out of 1,200 invited (19.3%) from the fourth Nord-Trøndelag Health Study (HUNT4) completed questionnaires, including the KSQ and ISI, shortly before attending a face-to-face diagnostic interview for insomnia based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Both a tentative (DSM-5 criteria A-E) and a definite (criteria A-H) interview diagnosis was evaluated. Cohen's kappa statistic quantified questionnaire validity. In all, 33% (95% confidence interval 27-39%) of participants had definite insomnia: 40% of women and 21% of men. The ISI (cut-off 12) and several KSQ-based diagnoses showed very good validity (κ ≤0.74) against the tentative, versus good validity (κ ≤0.61) against the definite interview diagnosis. Short questionnaires, requiring a daytime symptom at least three times a week, may underestimate insomnia prevalence. Validity was consistently higher for persons aged below versus above 65 years (definite insomnia: κ ≤0.64 vs. κ ≤0.56). Our results have implications for epidemiological population-based studies utilising insomnia questionnaires.
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http://dx.doi.org/10.1111/jsr.13222DOI Listing
February 2021

The evening light environment in hospitals can be designed to produce less disruptive effects on the circadian system and improve sleep.

Sleep 2021 03;44(3)

Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.

Study Objectives: Blue-depleted lighting reduces the disruptive effects of evening artificial light on the circadian system in laboratory experiments, but this has not yet been shown in naturalistic settings. The aim of the current study was to test the effects of residing in an evening blue-depleted light environment on melatonin levels, sleep, neurocognitive arousal, sleepiness, and potential side effects.

Methods: The study was undertaken in a new psychiatric hospital unit where dynamic light sources were installed. All light sources in all rooms were blue-depleted in one half of the unit between 06:30 pm and 07:00 am (melanopic lux range: 7-21, melanopic equivalent daylight illuminance [M-EDI] range: 6-19, photopic lux range: 55-124), whereas the other had standard lighting (melanopic lux range: 30-70, M-EDI range: 27-63, photopic lux range: 64-136), but was otherwise identical. A total of 12 healthy adults resided for 5 days in each light environment (LE) in a randomized cross-over trial.

Results: Melatonin levels were less suppressed in the blue-depleted LE (15%) compared with the normal LE (45%; p = 0.011). Dim light melatonin onset was phase-advanced more (1:20 h) after residing in the blue-depleted LE than after the normal LE (0:46 h; p = 0.008). Total sleep time was 8.1 min longer (p = 0.032), rapid eye movement sleep 13.9 min longer (p < 0.001), and neurocognitive arousal was lower (p = 0.042) in the blue-depleted LE. There were no significant differences in subjective sleepiness (p = 0.16) or side effects (p = 0.09).

Conclusions: It is possible to create an evening LE that has an impact on the circadian system and sleep without serious side effects. This demonstrates the feasibility and potential benefits of designing buildings or hospital units according to chronobiological principles and provide a basis for studies in both nonclinical and clinical populations.
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http://dx.doi.org/10.1093/sleep/zsaa194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953207PMC
March 2021

The Effect of Reducing Insomnia Severity on Work- and Activity-Related Impairment.

Behav Sleep Med 2021 Jul-Aug;19(4):505-515. Epub 2020 Jul 30.

Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.

Objective/background: The effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) for alleviating sleep problems is well established. However, few studies have explored its impact on work productivity and activity.

Participants: Seventy-seven currently employed adults with insomnia disorder (59 females) recruited to a randomized trial of digital versus face-to-face CBT-I.

Methods And Materials: The general health version of the Work Productivity and Activity Impairment questionnaire was used to measure absenteeism, presenteeism, total work impairment, and activity impairment. We assessed changes in work productivity and activity pre-to-post-therapy for the total sample and then for subgroups categorized according to response or remission of insomnia disorder (evaluated using the Insomnia Severity Index).

Results: Study participants showed significant improvements in presenteeism ( = .001; Cohen's = 0.46), total work impairment ( < .001; = 0.48), and activity ( < .001; = 0.66), but not absenteeism ( = .51; = 0.084) between baseline and follow-up assessment. Individuals meeting criteria for remission showed significantly greater improvement in presenteeism ( = .002), total work impairment ( < .001), and activity ( = .006), but not absenteeism ( = .064).

Conclusion: This study suggests that the benefits of CBT-I extend beyond improvement in sleep to encompass moderate-to-large improvements in work productivity and activity levels particularly for individuals who achieve remission from insomnia. Given the importance of these behaviors, there is a need for future large-scale randomized trials and cohort studies which should strive to include objective measurement of daytime activity and work performance more frequently.
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http://dx.doi.org/10.1080/15402002.2020.1799792DOI Listing
July 2020

A pragmatic effectiveness randomized controlled trial of the duration of psychiatric hospitalization in a trans-diagnostic sample of patients with acute mental illness admitted to a ward with either blue-depleted evening lighting or normal lighting conditions.

Trials 2019 Aug 1;20(1):472. Epub 2019 Aug 1.

Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.

Background: There is increasing recognition of the need to stabilize sleep-wake cycles in individuals with major mental disorders. As such, clinicians and researchers advocate the use of interventions targeted at sleep and circadian dysrhythmias as an adjunct to the standard treatments offered for acute illness episodes of a broad range of diagnoses. To determine the trans-diagnostic generalizability of chronotherapy, we explore the benefits of admitting individuals with an acute illness episode to a psychiatric inpatient unit where changes in light exposure are integrated into the therapeutic environment.

Methods/design: A two-arm, pragmatic effectiveness, randomized controlled treatment trial, where individuals admitted for acute inpatient psychiatric care will be allocated to a ward with blue-depleted evening light or to a ward with the same layout and facilities but lacking the new lighting technology. The trial will test whether the experimental lighting conditions offer any additional benefits beyond those associated with usual treatment in an acute psychiatric inpatient unit. The main objectives are to examine any differences between groups in the mean duration of hospitalization in days. Additional analyses will compare group differences in symptoms, functioning, medication usage, and side effects and whether length of stay is associated with stability of sleep-wake cycles and circadian rhythms. Ancillary investigations should determine any benefits according to diagnostic subgroups and potential drawbacks such as any adverse effects on the well-being of professionals working across both wards.

Discussion: This unit offers a unique opportunity to explore how exposure to different lighting conditions may modify sleep-wake cycles and how any changes in sleep-wake cycle may impact on the clinical and functional outcomes of individuals experiencing an acute episode of a severe mental disorder that requires inpatient care. The findings could influence the future design of hospital units offering care to patients with mental or physical disorders.

Trial Registration: ClinicalTrials.gov, ID: NCT03788993 . Retrospectively registered on 28 December 2018.
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http://dx.doi.org/10.1186/s13063-019-3582-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676579PMC
August 2019

The Predictive Properties of Violence Risk Instruments May Increase by Adding Items Assessing Sleep.

Front Psychiatry 2019 9;10:323. Epub 2019 May 9.

Department of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.

The psychometric instruments developed for short-term prediction of violence in psychiatric inpatients do not include variables assessing sleep. Disturbances in sleep may precede aggression in this setting. We investigated whether adding information on sleep improved the predictive properties of the Brøset Violence Checklist (BVC). The study population consists of all patients admitted to a psychiatric intensive care unit (PICU) over a 6-month period who were hospitalized for at least one night ( = 50). Sleep observed by staff (521 nights), behavior assessed with the BVC (433 days), and aggressive incidents recorded by the Staff Observation Scale-Revised ( = 14) were included in the analysis. The ability of the BVC to predict aggressive incidents improved from AUC 0.757 to AUC 0.873 when a combined sleep variable including both sleep duration and night-to-night variations of sleep duration was added to the BVC recordings. The combined sleep variable did not significantly predict aggressive incidents (AUC 0.653, = 0.051). A sleep disturbance variable improves the predictive properties of the BVC in PICUs. Further studies of sleep duration, night-to-night variations in duration of sleep, and aggression are needed.
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http://dx.doi.org/10.3389/fpsyt.2019.00323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520612PMC
May 2019

Cognitive performance in DSWPD patients upon awakening from habitual sleep compared with forced conventional sleep.

J Sleep Res 2019 10 13;28(5):e12730. Epub 2018 Aug 13.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.

Difficult early morning awakening is one of the defining symptoms of delayed sleep-wake phase disorder. It is accompanied by low cognitive arousal and drowsiness resulting in difficulty concentrating and focusing attention upon awakening. We designed the current study to quantitate cognitive performance (i.e. omissions, commissions, reaction time [average and variability]) and cognitive domains (i.e. focused attention, sustained attention, impulsivity and vigilance) with Conners' Continuous Performance Test II during both habitual and conventional (00:00-07:00 hr) sleep-wake schedule in young adult patients with delayed sleep-wake phase disorder (n = 20, mean age = 24.8 years, SD = 3.0) and controls (n = 16, mean age = 24.4 years, SD = 3.4). Conners' Continuous Performance Test II was administered after awakening and in the afternoon during both habitual and conventional conditions. In-laboratory polysomnography was performed for 2 nights. We assessed sleep, tiredness, chronotype and depression using questionnaires. Saliva was sampled for dim light melatonin onset measurements. Repeated-measures ANOVAs were applied for the Conners' Continuous Performance Test II measures with group (patient/control), time (afternoon/morning) and condition (habitual/conventional schedule) as fixed factors. Patients with delayed sleep-wake phase disorder had reduced reaction times, especially in the morning, greater response speed variability, and made more omission and commission errors compared with controls. Patients with delayed sleep-wake phase disorder also had reduced focused attention, especially upon forced early awakening. The short total sleep time of patients with delayed sleep-wake phase disorder could not statistically explain this outcome. In conclusion, we observed a state-dependent reduced ability to focus attention upon early morning awakening in patients with delayed sleep-wake phase disorder. Patients also had more omissions, longer reaction time and increased RT variability after habitual sleep, suggesting a possible small cognitive trait dysfunction in delayed sleep-wake phase disorder.
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http://dx.doi.org/10.1111/jsr.12730DOI Listing
October 2019

Sleep structure and awakening threshold in delayed sleep-wake phase disorder patients compared to healthy sleepers.

Sleep Med 2018 06 9;46:61-68. Epub 2018 Mar 9.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, N-7491, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital HF, Trondheim University Hospital, Norway.

Study Objectives: Difficult early morning awakening is a primary symptom of delayed sleep-wake phase disorder (DSWPD), however, it remains poorly investigated. Our main objective was to quantify the awakening threshold in DSWPD-patients and healthy controls as well as investigate a possible relationship with sleep stages. A secondary objective was to compare habitual sleep measured by polysomnography and actigraphy between patients and controls.

Methods: Twenty DSWPD patients and 16 controls had two polysomnographic recordings at a sleep laboratory. Participants followed their habitual sleep-wake schedule on the first night and a forced sleep-wake schedule (00:00-07:00 h) on the second night. We used a custom-made alarm clock was for the forced-night awakening, starting at 72 dB sound intensity which increased up to 104 dB.

Results: Mean awakening threshold in dB was higher in patients compared to controls; 75.5 vs. 72.6, p = 0.01, and the difference could not be explained statistically by sleep-time. Patients who were in REM sleep upon attempted awakening had a higher awakening threshold compared to patients who were in NREM sleep; 80.0 vs 74.7, F = 6.4, p = 0.02. Patients had increased sleep onset latency both at home with actigraphy and by PSG during the first laboratory night (20.6 vs 12.1 min, p = 0.004), however no further differences between the groups were observed regarding sleep structure.

Conclusions: A high early-morning forced awakening threshold in DSWPD was related to REM sleep. Sleep onset problems, even with habitual bedtimes, may also be an integral feature of DSWPD.
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http://dx.doi.org/10.1016/j.sleep.2018.03.001DOI Listing
June 2018

Sleep at night and association to aggressive behaviour; Patients in a Psychiatric Intensive Care Unit.

Psychiatry Res 2018 05 6;263:275-279. Epub 2018 Mar 6.

Department of Psychiatry, St. Olavs University Hospital, Trondheim, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.

Evaluations of associations between sleep at night and aggressive behaviour in Psychiatric Intensive Care Units (PICU) are lacking. The aims were to explore if sleep duration or night-to-night variations in sleep duration correlated with aggressive behaviour and aggressive incidents the next day and through the whole admission. Fifty consecutive patients admitted to a PICU were included (521 nights) and the nurses registered the time patients were sleeping, aggressive behaviour with The Brøset Violence Checklist (BVC) and aggressive incidents with The Staff Observation Aggression Scale-Revised (SOAS-R). At admission, short sleep duration the first night correlated with aggressive behaviour the next day and admissions with violent incidents had a median of 4.0 h difference in sleep from night one to night two compared to 2.1 h for the rest of the admissions. During the stay, large absolute difference in sleep duration between two nights correlated with aggressive behaviour the next day and short sleep duration was associated with violent incidents. Short sleep duration and night-to-night variations in sleep duration are both associated with increased risk for aggression in PICUs. This observation might help to predict and prevent aggressive incidents.
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http://dx.doi.org/10.1016/j.psychres.2018.03.012DOI Listing
May 2018

Mood and motor activity in euthymic bipolar disorder with sleep disturbance.

J Affect Disord 2016 Sep 24;202:23-31. Epub 2016 May 24.

Department of Neuroscience, NTNU, the Norwegian University of Science and Technology, Trondheim, Norway and Department of Psychiatry, St. Olav's University Hospital, P.O. box 3008 Lade, N-7441 Trondheim, Norway.

Background: The aims of this observational study of patients with euthymic bipolar disorder and sleep disturbance were to 1) compare characteristics related to mood and sleep between two groups with stable and unstable rest-activity cycles and 2) detect between-group differences in motor activity patterns.

Methods: 43 patients wore an actigraph for 6-8 days while reporting daily mood and sleep. Patients were defined as having an unstable rest-activity cycle if their diurnal active period duration presented variation above 2h from the mean during one week: 22 patients had stable and 21 unstable rest-activity cycles. Mood variability was defined as at least moderate symptoms and a change across two levels on a 7-point mood scale during one week.

Results: Patients with unstable rest-activity cycles were younger (37 vs. 48 years, p=0.01) and displayed more mood variability (p=0.02). Ten of 11 patients diagnosed with delayed sleep phase disorder were in the unstable group (p<0.01), and the unstable group had later and more variable get-up-times and bedtimes. In actigraphy recordings, the mean activity counts per minute did not differ between groups, but the minute-to-minute variability was elevated (p=0.04) and increased relative to the overall variability (p=0.03).

Limitations: A relatively small study sample and a 1-week study period prevent exploration of long-term clinical implications of results.

Conclusions: A subgroup of euthymic patients with bipolar disorder displayed unstable rest-activity cycles combined with mood variability and motor activity patterns that resemble findings in affective episodes.
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http://dx.doi.org/10.1016/j.jad.2016.05.012DOI Listing
September 2016

Sleep patterns as a predictor for length of stay in a psychiatric intensive care unit.

Psychiatry Res 2016 Mar 16;237:252-6. Epub 2016 Jan 16.

Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Systematic evaluations of the relationship between sleep patterns and length of stay in psychiatric intensive care units (PICUs) are lacking. The aims of the present study were to explore if sleep duration or night-to-night variations in sleep duration the first nights predict length of stay in a PICU. Consecutive patients admitted to a PICU were included (N=135) and the nurses registered the time patients were observed sleeping. In the three first nights, the mean sleep duration was 7.5 (±3.2)h. Sleep duration the first night correlated negatively with the length of stay for patients with schizophrenia. The mean difference in sleep duration from night one to night two were 3.3 (±3.0)h and correlated with length of stay for the whole group of patients, but especially for patients with schizophrenia. Patients of all diagnostic groups admitted to a PICU had pronounced intra-individual night-to-night variations in sleep duration. Stabilizing night-to-night variations of sleep duration might be a major goal in treatment.
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http://dx.doi.org/10.1016/j.psychres.2016.01.032DOI Listing
March 2016

Difficult morning awakening from rapid eye movement sleep and impaired cognitive function in delayed sleep phase disorder patients.

Sleep Med 2014 Oct 3;15(10):1264-8. Epub 2014 Jul 3.

Department of Clinical Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway.

Objectives: Difficult awakening is a key symptom of delayed sleep phase disorder (DSPD), but no studies have quantified awakening thresholds in a sleep laboratory. This study assessed whether cognitive function was impaired after awakening and whether difficult awakening was associated with specific polysomnographic features such as slow wave sleep stage N3.

Methods: Nine patients with DSPD and nine sex- and age-matched healthy controls were included. Polysomnography was performed at our university hospital from midnight. An alarm clock was activated at 07:00 with sound intensity increasing from 72 to 104 dB. Participants performed a continuous performance test (CPT) the previous afternoon and immediately upon awakening.

Results: Three DSPD patients and zero controls did not wake up to the maximum 104 dB alarm sound; all three patients were in rapid eye movement (REM) sleep when the alarm clock went off (difference in proportions, P = 0.047). In patients, CPT reaction time was prolonged in the morning compared to the afternoon [analysis of variance (ANOVA) interaction, P = 0.01]. DSPD patients made more omission errors than controls regardless of time of the day (ANOVA main effect, P = 0.046).

Conclusion: Difficult awakening from slow wave sleep was not observed. A subgroup of DSPD patients may have a severe problem waking up from REM sleep. DSPD patients may also have a state-like impairment in cognitive function in the morning and a trait-like impairment not depending on time of day, compared to normal sleepers.
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http://dx.doi.org/10.1016/j.sleep.2014.05.024DOI Listing
October 2014

Cognitive behavioral therapy for insomnia in euthymic bipolar disorder: study protocol for a randomized controlled trial.

Trials 2014 Jan 16;15:24. Epub 2014 Jan 16.

Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Background: Patients with bipolar disorder experience sleep disturbance, even in euthymic phases. Changes in sleep pattern are frequent signs of a new episode of (hypo)mania or depression. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for primary insomnia, but there are no published results on the effects of CBT-I in patients with bipolar disorder. In this randomized controlled trial, we wish to compare CBT-I and treatment as usual with treatment as usual alone to determine its effect in improving quality of sleep, stabilizing minor mood variations and preventing new mood episodes in euthymic patients with bipolar disorder and comorbid insomnia.

Methods: Patients with euthymic bipolar I or II disorder and insomnia, as verified by the Structured Clinical Interview for DSM Disorders (SCID-1) assessment, will be included. The patients enter a three-week run-in phase in which they complete a sleep diary and a mood diary, are monitored for seven consecutive days with an actigraph and on two of these nights with polysomnography in addition before randomization to an eight-week treatment trial. Treatment as usual consists of pharmacological and supportive psychosocial treatment. In this trial, CBT-I will consist of sleep restriction, psychoeducation about sleep, stabilization of the circadian rhythm, and challenging and correcting sleep state misperception, in three to eight sessions.

Discussion: This trial could document a new treatment for insomnia in bipolar disorder with possible effects on sleep and on stability of mood. In addition, more precise information can be obtained about the character of sleep disturbance in bipolar disorder.

Trial Registration: ClinicalTrials.gov: NCT01704352.
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http://dx.doi.org/10.1186/1745-6215-15-24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3903553PMC
January 2014

Impact of sleep disturbance on patients in treatment for mental disorders.

BMC Psychiatry 2012 Oct 29;12:179. Epub 2012 Oct 29.

Division of Psychiatry, Department of Research and Development, St Olav's University Hospital, Trondheim, Norway.

Background: In clinical practice, sleep disturbance is often regarded as an epiphenomenon of the primary mental disorder. The aim of this study was to test if sleep disturbance, independently of primary mental disorders, is associated with current clinical state and benefit from treatment in a sample representative of public mental health care clinics.

Method: 2246 patients receiving treatment for mental disorders in eight public mental health care centers in Norway were evaluated in a cross-sectional study using patient and clinician reported measures. Patients reported quality of life, symptom severity, and benefit from treatment. Clinicians reported disorder severity, level of functioning, symptom severity and benefit from treatment. The hypothesis was tested using multiple hierarchical regression analyses.

Results: Sleep disturbance was, adjusted for age, gender, time in treatment, type of care, and the presence of any primary mental disorder, associated with lower quality of life, higher symptom severity, higher disorder severity, lower levels of functioning, and less benefit from treatment.

Conclusion: Sleep disturbance ought to be considered a stand-alone therapeutic entity rather than an epiphenomenon of existing diagnoses for patients receiving treatment in mental health care.
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http://dx.doi.org/10.1186/1471-244X-12-179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505143PMC
October 2012

Differences between patients' and clinicians' report of sleep disturbance: a field study in mental health care in Norway.

BMC Psychiatry 2011 Nov 23;11:186. Epub 2011 Nov 23.

Division of Psychiatry, Department of Research and Development, St Olav's University Hospital, Trondheim, Norway.

Background: The aims of the study was to assess the prevalence of diagnosed insomnia and the agreement between patient- and clinician-reported sleep disturbance and use of prescribed hypnotic medication in patients in treatment for mental disorders.

Methods: We used three cross-sectional, multicenter data-sets from 2002, 2005, and 2008. Data-set 1 included diagnostic codes from 93% of all patients receiving treatment in mental health care in Norway (N = 40261). Data-sets 2 (N = 1065) and 3 (N = 1181) included diagnostic codes, patient- and clinician-reported sleep disturbance, and use of prescribed hypnotic medication from patients in 8 mental health care centers covering 10% of the Norwegian population.

Results: 34 patients in data-set 1 and none in data-sets 2 and 3 had a diagnosis of insomnia as a primary or comorbid diagnosis. In data-sets 2 and 3, 42% and 40% of the patients reported sleep disturbance, whereas 24% and 13% had clinician-reported sleep disturbance, and 7% and 9% used hypnotics. Patients and clinicians agreed in 29% and 15% of the cases where the patient or the clinician or both had reported sleep disturbance. Positive predictive value (PPV) of clinicians' evaluations of patient sleep disturbance was 62% and 53%. When the patient reported sleep disturbance as one of their most prominent problems PPV was 36% and 37%. Of the patients who received hypnotic medication, 23% and 29% had neither patient nor clinician-rated sleep disturbance.

Conclusion: When patients meet the criteria for a mental disorder, insomnia is almost never diagnosed, and sleep disturbance is imprecisely recognized relative to the patients' experience of sleep disturbance.
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http://dx.doi.org/10.1186/1471-244X-11-186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3231868PMC
November 2011

Psychometric properties and the predictive validity of the insomnia daytime worry scale: a pilot study.

Cogn Behav Ther 2010 ;39(2):150-7

St. Olav's University Hospital, Trondheim, Norway.

The relationship between presleep worry and insomnia has been investigated in previous studies, but less attention has been given to the role of daytime worry and symptoms of insomnia. The aims of the current study were (a) to assess the psychometric properties of a novel scale measuring insomnia-specific worry during daytime and (b) to examine whether levels of daytime worry predict severity of insomnia symptoms. Participants (N = 353) completed the Insomnia Daytime Worry Scale (IDWS) and the Insomnia Severity Index. An explorative principal-axis factor analysis extracted two factors from the IDWS, accounting for 70.5% of the variance. The IDWS demonstrated good reliability. The total score of IDWS and both factors predicted levels of insomnia severity in two separate hierarchical regression analyses. This preliminary evidence suggests that the IDWS is a valid and reliable scale to measure daytime worry in insomnia.
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http://dx.doi.org/10.1080/16506070903115317DOI Listing
August 2010

[Sleep deprivation as antidepressive treatment].

Tidsskr Nor Laegeforen 2007 May;127(10):1360-3

St. Olavs Hospital Psykiatrisk divisjon, avdeling Østmarka, 7006 Trondheim.

Background: Sleep deprivation, i.e. keeping patients awake for approximately 35 hours, is an antidepressive treatment that is rarely used in Norway.

Material And Methods: Review of a selection of publications from Medline, ISI, and psychINFO. The treatment is illustrated with two clinical vignettes.

Results And Interpretation: Sleep deprivation is a well documented treatment of depression. The effect is transient but can be prolonged by sleep phase advancement, concurrent pharmacological treatment, and light therapy. The effect is comparable to other standard treatments for depression, but is reported to occur within hours rather than weeks. There are few studies with follow-up results for more than two weeks and there is uncertainty regarding the mechanisms of change that are involved in sleep deprivation. Our two pilot patients experienced over 50% symptom reduction in three days. Results from these patients indicate that it may be of interest to study the course of response to sleep deprivation and three day sleep phase advancement for several weeks, and whether the treatment has the additional effect of improving sleep quality and stabilizing diurnal rhythm.
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May 2007

Staff injuries after patient-staff incidences in psychiatric acute wards.

Nord J Psychiatry 2007 ;61(2):121-5

St. Olavs Hospital, Department of Psychiatry, Østmarka, Trondheim, Norway.

The aim of the study was to describe the pattern of injuries to various body parts in patient-staff incidents; 507 patient-staff incidents in a psychiatric acute ward during the period 1990-1997 were included. Staff members registered 193 injuries in the head, 112 in the trunk, 265 in the upper extremities and 69 in the lower extremities. No differences between the two sexes or between different levels of education among the nurses were found in the pattern of injuries. Doctors were more often injured in the head and less often injured in the upper extremity than the nurses. The head was more often injured when there was no understandable provocation before the incident and seldom injured when the patients were denied something. Injuries to the trunk were more frequently followed by use of parenteral medication. Parenteral medication and holding the patient with force were more frequently used in incidents where more than one body part was injured. The knowledge of injures after patient-staff incidences may contribute to the education and protective training of the staff of psychiatric acute wards.
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http://dx.doi.org/10.1080/08039480701226104DOI Listing
July 2007