Paradoxical insomnia: The role of CAP and arousals in sleep misperception

Parrino, Liborio; Milioli, Giulia; Paolis, Fernando De; Grassi, Andrea; Terzano, Mario Giovanni

doi:10.1016/j.sleep.2008.12.014

Cited by 87 publications

(73 citation statements)

References 47 publications

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“…Importantly, CAP was associated with both subjective fatigue and sleepiness ratings, as has been found previously in other sleep disordered populations. 70 Taken together, these studies indicate that conventional sleep stage scoring methods use may not be sensitive enough to detect microstructural changes in CFS/ME patients. Consideration of these microstructure methods for analyzing the sleep EEG may provide a fruitful alternative for uncovering subtle differences during sleep in individuals reporting non-restorative sleep and daytime fatigue.…”

Section: Microstructure Measures Of Sleep In Cfs/mementioning

confidence: 91%

“…69 Clinical studies of insomniacs have found strong correlations between CAP rate (ratio of total CAP time to total NREM sleep time) and subjective reports of sleep quality. 70 This measure may therefore provide a more specific marker of sleep quality that the arousal index derived from PSG. Only one study to date has examined CAP rate in CFS/ME patients.…”

Section: Microstructure Measures Of Sleep In Cfs/mementioning

confidence: 99%

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Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review

Jackson

Bruck

2012

Journal of Clinical Sleep Medicine

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Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ ME) is a chronic, disabling illness that affects approximately 0.2% of the population. Non-restorative sleep despite sufficient or extended total sleep time is one of the major clinical diagnostic criteria; however, the underlying cause of this symptom is unknown. This review aims to provide a comprehensive overview of the literature examining sleep in CFS/ ME and the issues surrounding the current research fi ndings. Polysomnographic and other objective measures of sleep have observed few differences in sleep parameters between CFS/ME patients and healthy controls, although some discrepancies do exist. This lack of signifi cant objective differences contrasts with the common subjective complaints of disturbed and unrefreshed sleep by CFS/ME patients. The emergence of new, more sensitive techniques that examine the microstructure of sleep are showing promise for detecting differences in sleep between patients and healthy individuals. There is preliminary evidence that alterations in sleep stage transitions and sleep instability, and other physiological mechanisms, such as heart rate variability and altered cortisol profi les, may be evident. Future research investigating the etiology of non-restorative sleep in CFS/ME may also help us to undercover the causes of non-restorative sleep and fatigue in other medical conditions. keywords: Chronic fatigue syndrome, myalgic encephalomyelitis, sleep, non-restorative sleep, sleep disorders, fatigue, sleepiness Citation: Jackson ML; Bruck D. Sleep abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a review.

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Section: Microstructure Measures Of Sleep In Cfs/mementioning

confidence: 91%

Section: Microstructure Measures Of Sleep In Cfs/mementioning

confidence: 99%

Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review

Jackson

Bruck

2012

Journal of Clinical Sleep Medicine

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“…29,32 Psychological factors such as personality characteristics and mood disorders have been linked to misperception. 9,33,34 Aspects of sleep physiology have been associated with misperception, including hyperarousal, 35 alpha frequency intrusion into slow wave sleep, 11 and the cyclic alternating pattern 12 (but this has not been seen in other work). 36 In addition, in regards to the hyperarousal theory of insomnia, 35 insomnia patients have increased basal metabolic rate and longer sleep latencies during nap studies, among other physiological changes.…”

Section: Perception Of Total Sleep Timementioning

confidence: 99%

“…For example, misperception has been linked with anxiety and mood, 3,8 personality traits, and sleep physiology measures such as electroencephalogram patterns of alpha-delta sleep or cyclic alternating pattern and high frequency electroencephalography (EEG) content. [9][10][11][12][13] In addition, we previously investigated possible relations between sleep architecture and misperception of TST as a means to test the hypothesis that sleep fragmentation is associated with misperception. Using metrics such as The difficulty in linking sleep metrics to misperception could be due to insensitivity of the metrics for capturing the relevant physiology and/or the manner in which misperception is quantified.…”

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confidence: 99%

Sleep Fragmentation Does Not Explain Misperception of Latency or Total Sleep Time

Saline

Goparaju

Bianchi

2016

Journal of Clinical Sleep Medicine

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Study Objectives: Perception of sleep-wake times may differ from objective measures, although the mechanisms remain elusive. Quantifying the misperception phenotype involves two operational challenges: defining objective sleep latency and treating sleep latency and total sleep time as independent factors. We evaluated a novel approach to address these challenges and test the hypothesis that sleep fragmentation underlies misperception. Methods: We performed a retrospective analysis on patients with or without obstructive sleep apnea during overnight diagnostic polysomnography in our laboratory (n = 391; n = 252). We compared subjective and objective sleep-wake durations to characterize misperception. We introduce a new metric, sleep during subjective latency (SDSL), which captures latency misperception without defining objective sleep latency and allows correction for latency misperception when assessing total sleep time (TST) misperception. Results:The stage content of SDSL is related to latency misperception, but in the opposite manner as our hypothesis: those with > 20 minutes of SDSL had less N1%, more N3%, and lower transition frequency. After adjusting for misperceived sleep during subjective sleep latency, TST misperception was greater in those with longer bouts of REM and N2 stages (OSA patients) as well as N3 (non-OSA patients), which also did not support our hypothesis. Conclusions: Despite the advantages of SDSL as a phenotyping tool to overcome operational issues with quantifying misperception, our results argue against the hypothesis that light or fragmented sleep underlies misperception. Further investigation of sleep physiology utilizing alternative methods than that captured by conventional stages may yield additional mechanistic insights into misperception. I NTRO DUCTI O NAssessment of sleep often includes subjective reports of sleepwake durations, in clinical practice as well as epidemiological studies of sleep duration.1 However, when concurrent objective sleep measurements are available, it is not uncommon to observe that the subjective responses may differ. Underestimation of total sleep time has been previously observed in healthy adults under experimental circumstances, as well as insomnia patients during polysomnography (PSG).2-4 This phenomenon, sometimes termed misperception, may manifest as either overestimating sleep latency (SL) or underestimating total sleep time (TST), or both.4 Some patients with obstructive sleep apnea (OSA) may also exhibit misperception, though perhaps not to the same extent as those with insomnia symptoms. 5-7Several hypotheses have arisen regarding the basis for misperception, although a unified explanation remains elusive. For example, misperception has been linked with anxiety and mood, 3,8 personality traits, and sleep physiology measures such as electroencephalogram patterns of alpha-delta sleep or cyclic alternating pattern and high frequency electroencephalography (EEG) content. [9][10][11][12][13] In addition, we previously investigated possible relat...

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“…b) Investigation of paradoxical insomnia: Previous studies identified microstructure abnormalities in patients with paradoxical insomnia (Krystal et al 2002;Perlis et al 2001;Parrino et al 2009). All reported abnormalities (increased beta activity (Perlis et al 2001), decreased delta and increased alpha/beta activity (Buysse et al 2008), and cyclic alternating pattern (Parrino et al 2009)) result in a higher ORP during non-REM sleep (Younes et al 2015a). Thus, having ORP NR available in clinical studies may help identify patients with abnormal sleep quality from those in whom the problem is in perception of sleep.…”

Section: Arousability Index (%)mentioning

confidence: 99%

The case for using digital EEG analysis in clinical sleep medicine

Younes

2017

Sleep Science Practice

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Evaluation of sleep in clinical polysomnograms continues to rely almost exclusively on visual scoring that implements rules proposed by Rechtschaffen and Kales nearly 50 years ago. Apart from its cost and timeconsuming nature, visual scoring has limitations including: A) Sleep depth, which is a continuous variable, is treated as if it changes in a stepwise fashion from light (stage 1), to intermediate (stage 2) to deep (stage 3). B) Even with this limited scale, there is considerable inter-scorer variability, particularly in scoring stages 1 and 3 of non-REM sleep, thereby adding uncertainty to %time spent in these stages as a reliable metric for evaluating sleep depth. C) Limitation in scoring some of EEG features, including 1) arousal intensity, 2) extent of Alpha intrusion and 3) frequency, and characteristics of sleep spindles and K complexes. Digital analysis can solve these problems but producing a reliable system has been a challenge. In this review I begin with recent advances in digital scoring of sleep according to the Rechtschaffen and Kales rules and conclude that this technology has progressed enough to make it possible to obtain reliable, reproducible scoring, comparable in accuracy to scoring by highly experienced technologists, with minimal editing. This is followed by description of several new metrics that can be obtained if digital scoring systems were to be used routinely in clinical studies. The scientific evidence supporting the potential of these metrics to positively impact sleep medicine practice and the wide range of such metrics in patients studied in the sleep laboratory are highlighted.

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Paradoxical insomnia: The role of CAP and arousals in sleep misperception

Cited by 87 publications

References 47 publications

Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review

Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review

Sleep Fragmentation Does Not Explain Misperception of Latency or Total Sleep Time

The case for using digital EEG analysis in clinical sleep medicine

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