First-Night Effect in Normal Subjects and Psychiatric Inpatients

Toussaint, Michel; Luthringer, R.; Schaltenbrand, Nicolas; Carelli, Gabriella; Lainey, Eric; Jacqmin, Anne; Muzet, Alain; Mâcher, Jean-Paul

doi:10.1093/sleep/18.6.463

Cited by 174 publications

(130 citation statements)

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“…Due to adaptation effects, it is a common practice to exclude the first sleep laboratory night from the analysis. 36 However, in the current study, we analyzed both nights because the adaptation to the lab environment might be associated with increased arousal levels, possibly emphasizing our effects of interest.…”

Section: Discussionmentioning

confidence: 97%

Sleep-Related Arousal Versus General Cognitive Arousal in Primary Insomnia

Spiegelhalder

Regen

Feige

et al. 2012

Journal of Clinical Sleep Medicine

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have investigated attentional preference for sleep-related cues in primary insomnia using computerized tasks. [20][21][22][23][24][25][26] The majority of this work supports the notion that poor sleepers show an attentional bias for sleep-related stimuli relative to good sleeper controls. Consistent with these results, altered emotional responses to sleep-related stimuli have been reported in people with insomnia as compared to good sleepers. 27 Of note, studies on anxiety suggest a direct causal link from facilitated selective attention to worry. 28Although an enhanced attentional focus towards sleep-related cues may be involved in the development and maintenance of chronic insomnia, several important questions have not been answered up to now. First, little effort has been made to investigate the relationship between cognitive arousal and objectively determined sleep parameters, and the studies that have been carried out have reported inconsistent results. For example, van Egeren et al.14 found no signifi cant correlation between pre-sleep cognitive activity and polysomnographiStudy Objectives: The present study aimed at further investigating trait aspects of sleep-related cognitive arousal and general cognitive arousal and their association with both objective and subjective sleep parameters in primary insomnia patients. Methods: A clinical sample of 182 primary insomnia patients and 54 healthy controls was investigated using 2 nights of polysomnography, subjective sleep variables, and a questionnaire on sleep-related and general cognitive arousal. Results: Compared to healthy controls, primary insomnia patients showed both more sleep-related and general cognitive arousal. Furthermore, sleep-related cognitive arousal was closely associated with measures of sleep-onset and sleep-maintenance problems, while general cognitive arousal was not. Conclusions: Cognitive-behavioral treatment for insomnia might benefi t from dedicating more effort to psychological interventions that are able to reduce sleep-related cognitive arousal. Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany S C I E N T I F I C I N V E S T I G A T I O N SI nsomnia is one of the most prevalent health complaints worldwide. It is defi ned by diffi culties initiating or maintaining sleep or non-restorative sleep, accompanied by signifi cant daytime impairments.1 Chronic insomnia affects up to 22% of the population 2 and commonly occurs as a comorbid condition in other medical or mental disorders. Primary insomnia, an exclusionary diagnosis of poor sleep, ruling out psychiatric, medical, and additional sleep-related pathology, 3 is estimated to affect up to 3% of the population. 4 Current models of primary insomnia highlight the role of cognitive, emotional, and physiological hyperarousal for the development and maintenance of the disorder. [5][6][7][8][9] With respect to cognitive processes, patients' cognitions are often dominated by worries and ruminations that are associated with a level of arousal that ...

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Section: Discussionmentioning

confidence: 97%

Sleep-Related Arousal Versus General Cognitive Arousal in Primary Insomnia

Spiegelhalder

Regen

Feige

et al. 2012

Journal of Clinical Sleep Medicine

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“…36 Also, studies reporting a RFNE in insomniacs have largely excluded patients with significant psychiatric illnesses such as depression; however, it has been shown that insomnia and depression are frequently comorbid conditions, with over 90% of depressed patients suffering from sleep complaints. 21,22 Some studies on first night adaptation effects in depressed patients have observed a reduced or absent FNE 2,9,23 ; however, it is unknown whether patients suffering from both insomnia and depression exhibit similar laboratory adaptation effects as those suffering from only one of these disorders.…”

Section: Psgmentioning

confidence: 99%

“…[4][5][6] It has been suggested that factors such as the location of monitoring or pleasantness of the laboratory environment may attenuate this effect, or that individual variability may cancel out differences for entire samples. 5,[7][8][9][10] Many studies observing a FNE have also noted a "paradoxical" or "reverse" fi rst night effect (RFNE) in some of their subjects. [11][12][13][14] The RFNE is characterized by the observation of decreased sleep onset latency, decreased REM latency, a higher percentage of REM, and greater sleep effi ciency in the fi rst night at the laboratory relative to successive nights, as measured by PSG.…”

mentioning

confidence: 99%

Objective vs. Subjective Measurements of Sleep in Depressed Insomniacs: First Night Effect or Reverse First Night Effect?

McCall

2012

Journal of Clinical Sleep Medicine

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Study Objectives: This study examined changes in sleep parameters between the laboratory and the home setting before and after laboratory monitoring in depressed insomniacs undergoing treatment. Methods: This study was a post hoc analysis of a double-blind, randomized, placebo-controlled clinical trial performed with 60 depressed, insomniac outpatients. Patients underwent actigraphic monitoring along with sleep diaries over a continuous 2-week period. After one week of baseline monitoring, subjects spent one night in the laboratory with concurrent actigraphic and PSG monitoring with sleep diaries. Actigraphic monitoring and sleep diaries were continued for another week at home, along with initiation of open-label fl uoxetine (FLX). Results: Actigraphically recorded laboratory sleep during the night in the laboratory was found to be improved relative to actigraphically recorded sleep at home, with less wake time and greater sleep time and sleep effi ciency occurring in the laboratory. In contrast, sleep diaries indicated a slight worsening of sleep in the laboratory compared to home, with signifi cantly more awakenings in the laboratory compared to the week at home before and after the laboratory night. Conclusions S C I E N T I F I C I N V E S T I G A T I O N SM any individuals experience worse sleep during their fi rst night in a sleep laboratory than on successive nights. This "fi rst night effect" (FNE) is typically characterized by increased sleep onset latency, increased REM latency, a lower percentage of REM stage sleep, and lower sleep effi ciency as measured by polysomnography (PSG). While many studies have observed the FNE phenomenon in normal subjects and in those with depression or insomnia, 1-3 others have observed a reduced or absent FNE. [4][5][6] It has been suggested that factors such as the location of monitoring or pleasantness of the laboratory environment may attenuate this effect, or that individual variability may cancel out differences for entire samples. 5,7-10Many studies observing a FNE have also noted a "paradoxical" or "reverse" fi rst night effect (RFNE) in some of their subjects.11-14 The RFNE is characterized by the observation of decreased sleep onset latency, decreased REM latency, a higher percentage of REM, and greater sleep effi ciency in the fi rst night at the laboratory relative to successive nights, as measured by PSG.13 For insomniacs who demonstrate this phenomenon, several explanations have been proposed. Hauri et al. suggested that maladaptive reinforcements are formed between the insomniac's sleeping problems and their normal sleep environment. 13,15 This conditioned arousal reaction to their normal sleep environment does not generalize to the novel sleep environment of the laboratory, where they fall asleep more easily. Alternatively, de la Pena proposed that some insomniacs require a higher level of waking sensory stimulation to induce sleep, and the greater sensory stimulation of the novel laboratory environment improves their sleep. 16Studies investigating sleep ...

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“…CHEDIAK et al [14] observed that the AHI varied byw10 per hour of sleep in 32% of their patients during 2 PSG nights. This variation may be caused by alterations in the sleep pattern [15,16], which are usually most pronounced in the first study night [17].…”

Section: Variability Studymentioning

confidence: 99%

Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome

Fietze

Dingli²,

Diefenbach³

et al. 2004

European Respiratory Journal

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The current study investigated the night-to-night variability and diagnostic accuracy of the oxygen desaturation index (ODI), as measured by ambulatory monitoring, in the diagnosis of mild and moderate obstructive sleep apnoea-hypopnoea syndrome.To assess the variability of the ODI, 35 patients were monitored at home during 7 consecutive nights by means of a portable recording device, the MESAM-IV1. The ODI variability factor and the influence of age, body mass index (BMI), alcohol, and body position were assessed. Furthermore, the diagnostic accuracy of the MESAM-IV was measured by comparison with polysomnographical outcomes in 18 patients.During home recording, the median ODI was 10.9 (interquartile range: 5.8-16.1) across the patients. Although the reliability of the ODI was adequate, the probability of placing the patient in the wrong severity category (ODI f15 or ODI w15) when only one single recording was taken is 14.4%. ODI variability was not significantly influenced by age, BMI, time spent in a supine position, or mild dosages of alcohol. A good correlation was found between the apnoea-hypopnoea index and the ODI.In conclusion, the findings suggest that the diagnostic accuracy of the MESAM-IV is strong, since the oxygen desaturation index is correlated with the apnoea-hypopnoea index. In most obstructive sleep apnoea-hypopnoea syndrome patients, oxygen desaturation index variability is rather small, and screening could be reliably based on single 1-night recordings. Eur Respir J 2004; 24: 987-993.

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First-Night Effect in Normal Subjects and Psychiatric Inpatients

Cited by 174 publications

References 0 publications

Sleep-Related Arousal Versus General Cognitive Arousal in Primary Insomnia

Sleep-Related Arousal Versus General Cognitive Arousal in Primary Insomnia

Objective vs. Subjective Measurements of Sleep in Depressed Insomniacs: First Night Effect or Reverse First Night Effect?

Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome

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