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Interactive effect of depressive symptoms and nap on valence judgment in individuals with insomnia
Abstracts/Sleep Medicine 16 (2015) S2–S199
S157
More stable emotional perception after daytime nap in individuals with insomnia K. Lau, D. Cheng, C. Tseng, E. Lau The University of Hong Kong, Hong Kong
Interactive effect of depressive symptoms and nap on valence judgment in individuals with insomnia K. Yee, K. Lau, C. Tseng, E. Lau The University of Hong Kong, Hong Kong
Introduction: Previous studies showed that both people with lifetime depression and individuals with insomnia would have altered intensity ratings of emotional expressions. This preliminary study aimed to investigate how emotional processing in individuals insomnia with and without history of depression would change across the day after a period wakefulness or nap. Materials and methods: Thirty-two young adults (mean age = 18.97, SD = 3.82, 62% female) were recruited from the university and assessed by the Brief Insomnia Questionnaire, and all of them fulfilled the diagnostic criteria of Insomnia. They were also assessed by Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM IV]. 43.75% of them had history of Major Depressive Disorder (MDD) and the remaining had no lifetime history of psychiatric disorders. Depression Anxiety Stress Scale (DASS-21) was used to assess participant’s current depressive symptoms. On the experimental day, participants completed a facial expression recognition task, to rate the intensity of different emotional expressions. Participants were first presented with faces of a male and a female that expressed increasing degrees of emotional intensity, slowly changing from neutral to a full-intensity happy, sad, fearful, and angry expression. The faces then appeared again in random order and participants were instructed to judge the intensity of the facial expressions. Both groups with and without a history of MDD were randomly assigned to either the Nap or the Wake Condition for 90 min. Afterwards, participants completed the ERT again to assess the changes in intensity judgment of emotional faces. Results: Two-way analysis of covariance with Group (with and without History of MDD) and Condition (nap and wake) as between group variables and current depressive symptoms as covariate was conducted to investigate the changes in intensity rating. For the 60% happy face, significant main effect of Condition was found, F(1,27) = 5.47, p = 0.027, with the wake group rating significantly more negative than the nap group in post-test. For neutral face (0% happy face), Group*Condition interaction was significant, F(1,27) = 9.87, p = 0.004. For the group with history of MDD, they rated the neutral faces significantly less happy across wakefulness whereas intensity rating did not change significantly after nap. No changes after wakefulness or nap were found in the group without history of MDD. For 60% sad face, significant Group*Condition interaction was found, F(1,27) = 5, p = 0.034. While the insomnia individuals with history of MDD rated the sad expression less intense and those without history of MDD had more intense rating across wakefulness, both groups did not change their intensity ratings after nap. Current depressive symptoms were not a significant covariate for all the analyses. Conclusion: While insomniac individuals with and without history of MDD had either amplified or reduced emotional intensity ratings toward happy, neutral and sad faces across wakefulness, napping was found to preserve such ratings. This study provided the first evidence on the potential stabilizing effects of napping on emotional perception in insomnia. Acknowledgements: The University of Hong Kong Seed Funding Programme for Basic Research.
Introduction: While previous studies showed that napping would affect emotional processing in healthy populations, such effect in people with insomnia and depressive symptoms has yet to be explored. This study aimed to investigate the interactive effect of depressive symptoms and nap on valence judgment of emotional face in individuals with insomnia. Materials and methods: Twenty-nine young adults aged 18–23 (18 female, 11 male) recruited from the university joined this study. All of them were assessed with the Brief Insomnia Questionnaire and fulfilled the diagnostic criteria of insomnia. Depression Anxiety Stress Scale (DASS-21) and Pittsburgh Sleep Quality Index (PSQI) were used to assess participant’s depressive symptoms and sleep quality, respectively. Sixteen participants (eight Nap, nine Wake) formed the insomnia group without depressive symptoms, while the remaining 11 (seven Nap, eight Wake) formed the insomnia group with depressive symptoms. On the experimental day, participants completed an Emotional Recognition Task (ERT) to test the baseline valence judgment on emotional faces. In the beginning of the task, participants were presented with faces of a male and a female that expressed increasing degrees of emotional intensity, slowly changing from neutral to a full intensity happy, sad, fearful, and angry expression. The presented faces appeared in random order, and participants were instructed to judge the emotional valence of the faces. After the pre-test, participants in each group were randomly assigned to either have a polysomnography-monitored nap or stay awake for 90 minutes. Afterwards, participants completed the ERT again to assess changes in valence judgment of emotional faces so as to examine the effect of napping in each group. Results: Two-way analysis of covariance with Group (normal and mild-to-severe depressive symptoms) and Condition (nap and wake) as between group variables and sleep quality as covariate were conducted to investigate the changes in valence rating. When judging the 80% happy faces, significant Group*Condition interaction was found, F(1,27) = 5.37, p = 0.028, after controlling the effect of sleep quality. Post-doc analyses showed that positive ratings decreased in the wake condition but maintained after nap in the group with mild-to-severe depressive symptoms. However, no difference valence ratings was found in the group with normal depressive symptoms. Significant Group*Condition interaction was also found for 40% happy faces, F(1,27) = 9.06, p = 0.006. Positive ratings were increased across wake but maintained after nap in the Insomnia group with mild-to-severe depressive symptoms. However, no significant difference was found in those with normal depressive symptoms. For angry faces of the full range of emotional intensity, significant Group*Condition interaction was found, F = (1,27) = 7.77, p = 0.01. Negative rating was increased across wakefulness but maintained after nap in the insomnia group with normal depressive symptoms. No significant changes were found in the group with mild-to-severe depressive symptoms. No other significant interactions were found for sad or fearful faces. Conclusion: Our results show that depressive symptoms modulated the effect of napping on valence judgment of happy and angry faces in individuals with insomnia. Changes in valence rating toward emotional faces across the day were blunted after a nap, suggesting that napping might stabilize emotional judgment in depressed individuals with insomnia.
http://dx.doi.org/10.1016/j.sleep.2015.02.1522
S158
Abstracts/Sleep Medicine 16 (2015) S2–S199
Acknowledgements: The University of Hong Kong Seed Funding Programme for Basic Research.
Acknowledgements: This research was funded by the Canadian Institutes of Health Research (CIHR).
http://dx.doi.org/10.1016/j.sleep.2015.02.1523
http://dx.doi.org/10.1016/j.sleep.2015.02.1524
What determines perceived sleep quality in people with and without insomnia? E. Libman 1, C. Fichten 2, M. Jorgensen 3, D. Tran 4, K. Conrod 5, L. Creti 1 1 Jewish General Hospital, McGill University, Canada 2 Jewish General Hospital, McGill University, Dawson College, Canada 3 Adaptech, Canada 4 Jewish General Hospital, Université de Montréal, Canada 5 Jewish General Hospital, Canada
Help-seeking behaviors for insomnia and their correlates among adults and adolescents in Hong Kong Chinese Y. Liu, J. Zhang, S. Lam, J. Zhou, S. Li, M. Yu, N. Chan, Y. Wing Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
Introduction: Although sleep quality is a construct widely used and measured, we have little idea of how the appraisal of sleep quality is derived. Is it based on nocturnal or daytime experience? We gathered descriptions of what constitutes both poor and good sleep quality by individuals with and without insomnia. Materials and methods: Two groups included 23 individuals seeking or already enrolled in cognitive behavior insomnia therapy (CBT-I) (8 male, 15 female, mean age = 51, range = 19–83, median = 51) and a convenience sample of 29 non-treatment seeking individuals (Control Group: 12 male, 17 female, mean age = 50, range = 19–73, median = 48). CBT-I participants had to meet the following criteria: presenting for insomnia treatment at our clinic and a diagnosis of insomnia based on the Sleep Questionnaire. None of the participants in the Normal Sleeper Control Group met either of these criteria. Participants in the CBT-I group had experienced insomnia for a mean of 9 years (SD = 10, range = 5– 30 years, median = 12 years). All participants completed the Sleep Questionnaire and responded to an open-ended Sleep Quality Measure (“How do you tell if you have had a good night’s sleep?” “How do you tell if you have had a poor night’s sleep?”). The open-ended responses were coded independently by two trained coders blind to the participant’s group in accordance with a coding manual. This yielded 21 Good and 21 corresponding Poor Sleep Quality categories. Results: Scores on the Sleep Questionnaire indicate that the CBT-I participants were significantly worse on almost all variables compared with Controls. On the Open-Ended Sleep Quality Measure, chisquare tests on the raw frequency scores showed no significant differences between the CBT-I and Control groups on any of the 21 categories. Both good and poor sleep quality descriptor frequencies were similar among participants with and without insomnia. However, poor sleep quality-related responses were represented in significantly more descriptive categories than good, F(1,50) = 15.21, p = 0.000, and more responses fell into the daytime than the nocturnal categories, F(1,50) = 8.74, p = 0.005. Moreover, there was a significant interaction between time of day and sleep quality: more participants mentioned aspects of poor than of good sleep quality in the night, F(1,50) = 4.51, p = 0.039. Among the six good sleep quality categories with responses by at least 10% of participants, five (83%) relate to the daytime. On the other hand, of the 14 poor sleep quality categories with responses by at least 10% of participants, only nine (64%) were related to the day. Conclusion: The nature of perceived sleep quality, both good and poor, is similar among individuals with and without insomnia. Daytime experience is most important for judging sleep quality; sleep continuity is the most important nocturnal variable. Individuals use a wider range of descriptors related to poor than of good sleep.
Introduction: There were limited data of help-seeking behaviors for insomnia among community-based population. We aimed to determine the prevalence and correlates of help-seeking behaviors for insomnia in Hong Kong Chinese adults and adolescents. Materials and methods: A total of 2293 adults (mean [SD] = 46.6 [16.0] years old, range: 30–74 years old, 46.5% males) and their 2186 offsprings (mean [SD] = 13.4 [2.6] years old, range: 6–18 years old, 48.1% males) were recruited into this study in 2008. Among them, 219 adults and 146 adolescents with insomnia were included into the analysis. Insomnia was defined as difficulty in initiating sleep (DIS), difficulty in maintaining sleep and early morning awakening up to three times/week over the past 12 months. Sociodemographic, other sleep problems, daytime symptoms, and chronic medical problems in the past 1 year were also measured. Results: The percentage of help-seeking behaviors for insomnia were 3.8% in adults and 0.7% in adolescents, respectively (p < 0.001). Adults with insomnia had the highest percentage of seeking help from Western medicine practitioners (34.1%), followed by traditional Chinese medicine practitioners (28.4%), selftreatment (15.9%), leave it alone (15.9%), and alternative treatment (5.7%). However, adolescents with insomnia had the highest percentage of leave it alone (60.0%), followed by alternative treatment (20.0%) and Western medicine practitioners (13.3%), traditional Chinese medicine practitioners (6.7%), and self-treatment (0%). Among adults with insomnia, higher family income (adjusted odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6–6.3, p = 0.001), DIS (adjusted OR: 3.3, 95% CI: 1.6–6.6, p = 0.001), chronic medical conditions (adjusted OR: 4.6, 95% CI: 2.0–10.8, p < 0.001), and higher ISI total score (adjusted OR: 2.6, 95% CI: 1.4–5.1, p = 0.004) were associated with help-seeking behaviors. However, only morning headache was found significantly associated with help-seeking behaviors in adolescents with insomnia. Conclusion: There was a high percentage of insomnia subjects (nearly 60% of adults and 90% of adolescents) who did not seek help for their insomnia. More studies are needed to explore the determinants of help-seeking for insomnia, especially for adolescents, and to find effective ways for improving their help-seeking behaviors. http://dx.doi.org/10.1016/j.sleep.2015.02.1525
Determinants of self efficacy for sleep in insomnia disorder: Preliminary results L. Caccavale, L. Palagini, A. Gronchi, M. Mauri Sleep Clinic, Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
Introduction: Elevated sleep-related self-efficacy has been associated with both successful hypnotic tapering and adherence to cognitive-behavioral therapy in insomnia. To identify factors impacting self-efficacy for sleep in insomnia, the aim was to examine
S157
More stable emotional perception after daytime nap in individuals with insomnia K. Lau, D. Cheng, C. Tseng, E. Lau The University of Hong Kong, Hong Kong
Interactive effect of depressive symptoms and nap on valence judgment in individuals with insomnia K. Yee, K. Lau, C. Tseng, E. Lau The University of Hong Kong, Hong Kong
Introduction: Previous studies showed that both people with lifetime depression and individuals with insomnia would have altered intensity ratings of emotional expressions. This preliminary study aimed to investigate how emotional processing in individuals insomnia with and without history of depression would change across the day after a period wakefulness or nap. Materials and methods: Thirty-two young adults (mean age = 18.97, SD = 3.82, 62% female) were recruited from the university and assessed by the Brief Insomnia Questionnaire, and all of them fulfilled the diagnostic criteria of Insomnia. They were also assessed by Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM IV]. 43.75% of them had history of Major Depressive Disorder (MDD) and the remaining had no lifetime history of psychiatric disorders. Depression Anxiety Stress Scale (DASS-21) was used to assess participant’s current depressive symptoms. On the experimental day, participants completed a facial expression recognition task, to rate the intensity of different emotional expressions. Participants were first presented with faces of a male and a female that expressed increasing degrees of emotional intensity, slowly changing from neutral to a full-intensity happy, sad, fearful, and angry expression. The faces then appeared again in random order and participants were instructed to judge the intensity of the facial expressions. Both groups with and without a history of MDD were randomly assigned to either the Nap or the Wake Condition for 90 min. Afterwards, participants completed the ERT again to assess the changes in intensity judgment of emotional faces. Results: Two-way analysis of covariance with Group (with and without History of MDD) and Condition (nap and wake) as between group variables and current depressive symptoms as covariate was conducted to investigate the changes in intensity rating. For the 60% happy face, significant main effect of Condition was found, F(1,27) = 5.47, p = 0.027, with the wake group rating significantly more negative than the nap group in post-test. For neutral face (0% happy face), Group*Condition interaction was significant, F(1,27) = 9.87, p = 0.004. For the group with history of MDD, they rated the neutral faces significantly less happy across wakefulness whereas intensity rating did not change significantly after nap. No changes after wakefulness or nap were found in the group without history of MDD. For 60% sad face, significant Group*Condition interaction was found, F(1,27) = 5, p = 0.034. While the insomnia individuals with history of MDD rated the sad expression less intense and those without history of MDD had more intense rating across wakefulness, both groups did not change their intensity ratings after nap. Current depressive symptoms were not a significant covariate for all the analyses. Conclusion: While insomniac individuals with and without history of MDD had either amplified or reduced emotional intensity ratings toward happy, neutral and sad faces across wakefulness, napping was found to preserve such ratings. This study provided the first evidence on the potential stabilizing effects of napping on emotional perception in insomnia. Acknowledgements: The University of Hong Kong Seed Funding Programme for Basic Research.
Introduction: While previous studies showed that napping would affect emotional processing in healthy populations, such effect in people with insomnia and depressive symptoms has yet to be explored. This study aimed to investigate the interactive effect of depressive symptoms and nap on valence judgment of emotional face in individuals with insomnia. Materials and methods: Twenty-nine young adults aged 18–23 (18 female, 11 male) recruited from the university joined this study. All of them were assessed with the Brief Insomnia Questionnaire and fulfilled the diagnostic criteria of insomnia. Depression Anxiety Stress Scale (DASS-21) and Pittsburgh Sleep Quality Index (PSQI) were used to assess participant’s depressive symptoms and sleep quality, respectively. Sixteen participants (eight Nap, nine Wake) formed the insomnia group without depressive symptoms, while the remaining 11 (seven Nap, eight Wake) formed the insomnia group with depressive symptoms. On the experimental day, participants completed an Emotional Recognition Task (ERT) to test the baseline valence judgment on emotional faces. In the beginning of the task, participants were presented with faces of a male and a female that expressed increasing degrees of emotional intensity, slowly changing from neutral to a full intensity happy, sad, fearful, and angry expression. The presented faces appeared in random order, and participants were instructed to judge the emotional valence of the faces. After the pre-test, participants in each group were randomly assigned to either have a polysomnography-monitored nap or stay awake for 90 minutes. Afterwards, participants completed the ERT again to assess changes in valence judgment of emotional faces so as to examine the effect of napping in each group. Results: Two-way analysis of covariance with Group (normal and mild-to-severe depressive symptoms) and Condition (nap and wake) as between group variables and sleep quality as covariate were conducted to investigate the changes in valence rating. When judging the 80% happy faces, significant Group*Condition interaction was found, F(1,27) = 5.37, p = 0.028, after controlling the effect of sleep quality. Post-doc analyses showed that positive ratings decreased in the wake condition but maintained after nap in the group with mild-to-severe depressive symptoms. However, no difference valence ratings was found in the group with normal depressive symptoms. Significant Group*Condition interaction was also found for 40% happy faces, F(1,27) = 9.06, p = 0.006. Positive ratings were increased across wake but maintained after nap in the Insomnia group with mild-to-severe depressive symptoms. However, no significant difference was found in those with normal depressive symptoms. For angry faces of the full range of emotional intensity, significant Group*Condition interaction was found, F = (1,27) = 7.77, p = 0.01. Negative rating was increased across wakefulness but maintained after nap in the insomnia group with normal depressive symptoms. No significant changes were found in the group with mild-to-severe depressive symptoms. No other significant interactions were found for sad or fearful faces. Conclusion: Our results show that depressive symptoms modulated the effect of napping on valence judgment of happy and angry faces in individuals with insomnia. Changes in valence rating toward emotional faces across the day were blunted after a nap, suggesting that napping might stabilize emotional judgment in depressed individuals with insomnia.
http://dx.doi.org/10.1016/j.sleep.2015.02.1522
S158
Abstracts/Sleep Medicine 16 (2015) S2–S199
Acknowledgements: The University of Hong Kong Seed Funding Programme for Basic Research.
Acknowledgements: This research was funded by the Canadian Institutes of Health Research (CIHR).
http://dx.doi.org/10.1016/j.sleep.2015.02.1523
http://dx.doi.org/10.1016/j.sleep.2015.02.1524
What determines perceived sleep quality in people with and without insomnia? E. Libman 1, C. Fichten 2, M. Jorgensen 3, D. Tran 4, K. Conrod 5, L. Creti 1 1 Jewish General Hospital, McGill University, Canada 2 Jewish General Hospital, McGill University, Dawson College, Canada 3 Adaptech, Canada 4 Jewish General Hospital, Université de Montréal, Canada 5 Jewish General Hospital, Canada
Help-seeking behaviors for insomnia and their correlates among adults and adolescents in Hong Kong Chinese Y. Liu, J. Zhang, S. Lam, J. Zhou, S. Li, M. Yu, N. Chan, Y. Wing Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
Introduction: Although sleep quality is a construct widely used and measured, we have little idea of how the appraisal of sleep quality is derived. Is it based on nocturnal or daytime experience? We gathered descriptions of what constitutes both poor and good sleep quality by individuals with and without insomnia. Materials and methods: Two groups included 23 individuals seeking or already enrolled in cognitive behavior insomnia therapy (CBT-I) (8 male, 15 female, mean age = 51, range = 19–83, median = 51) and a convenience sample of 29 non-treatment seeking individuals (Control Group: 12 male, 17 female, mean age = 50, range = 19–73, median = 48). CBT-I participants had to meet the following criteria: presenting for insomnia treatment at our clinic and a diagnosis of insomnia based on the Sleep Questionnaire. None of the participants in the Normal Sleeper Control Group met either of these criteria. Participants in the CBT-I group had experienced insomnia for a mean of 9 years (SD = 10, range = 5– 30 years, median = 12 years). All participants completed the Sleep Questionnaire and responded to an open-ended Sleep Quality Measure (“How do you tell if you have had a good night’s sleep?” “How do you tell if you have had a poor night’s sleep?”). The open-ended responses were coded independently by two trained coders blind to the participant’s group in accordance with a coding manual. This yielded 21 Good and 21 corresponding Poor Sleep Quality categories. Results: Scores on the Sleep Questionnaire indicate that the CBT-I participants were significantly worse on almost all variables compared with Controls. On the Open-Ended Sleep Quality Measure, chisquare tests on the raw frequency scores showed no significant differences between the CBT-I and Control groups on any of the 21 categories. Both good and poor sleep quality descriptor frequencies were similar among participants with and without insomnia. However, poor sleep quality-related responses were represented in significantly more descriptive categories than good, F(1,50) = 15.21, p = 0.000, and more responses fell into the daytime than the nocturnal categories, F(1,50) = 8.74, p = 0.005. Moreover, there was a significant interaction between time of day and sleep quality: more participants mentioned aspects of poor than of good sleep quality in the night, F(1,50) = 4.51, p = 0.039. Among the six good sleep quality categories with responses by at least 10% of participants, five (83%) relate to the daytime. On the other hand, of the 14 poor sleep quality categories with responses by at least 10% of participants, only nine (64%) were related to the day. Conclusion: The nature of perceived sleep quality, both good and poor, is similar among individuals with and without insomnia. Daytime experience is most important for judging sleep quality; sleep continuity is the most important nocturnal variable. Individuals use a wider range of descriptors related to poor than of good sleep.
Introduction: There were limited data of help-seeking behaviors for insomnia among community-based population. We aimed to determine the prevalence and correlates of help-seeking behaviors for insomnia in Hong Kong Chinese adults and adolescents. Materials and methods: A total of 2293 adults (mean [SD] = 46.6 [16.0] years old, range: 30–74 years old, 46.5% males) and their 2186 offsprings (mean [SD] = 13.4 [2.6] years old, range: 6–18 years old, 48.1% males) were recruited into this study in 2008. Among them, 219 adults and 146 adolescents with insomnia were included into the analysis. Insomnia was defined as difficulty in initiating sleep (DIS), difficulty in maintaining sleep and early morning awakening up to three times/week over the past 12 months. Sociodemographic, other sleep problems, daytime symptoms, and chronic medical problems in the past 1 year were also measured. Results: The percentage of help-seeking behaviors for insomnia were 3.8% in adults and 0.7% in adolescents, respectively (p < 0.001). Adults with insomnia had the highest percentage of seeking help from Western medicine practitioners (34.1%), followed by traditional Chinese medicine practitioners (28.4%), selftreatment (15.9%), leave it alone (15.9%), and alternative treatment (5.7%). However, adolescents with insomnia had the highest percentage of leave it alone (60.0%), followed by alternative treatment (20.0%) and Western medicine practitioners (13.3%), traditional Chinese medicine practitioners (6.7%), and self-treatment (0%). Among adults with insomnia, higher family income (adjusted odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6–6.3, p = 0.001), DIS (adjusted OR: 3.3, 95% CI: 1.6–6.6, p = 0.001), chronic medical conditions (adjusted OR: 4.6, 95% CI: 2.0–10.8, p < 0.001), and higher ISI total score (adjusted OR: 2.6, 95% CI: 1.4–5.1, p = 0.004) were associated with help-seeking behaviors. However, only morning headache was found significantly associated with help-seeking behaviors in adolescents with insomnia. Conclusion: There was a high percentage of insomnia subjects (nearly 60% of adults and 90% of adolescents) who did not seek help for their insomnia. More studies are needed to explore the determinants of help-seeking for insomnia, especially for adolescents, and to find effective ways for improving their help-seeking behaviors. http://dx.doi.org/10.1016/j.sleep.2015.02.1525
Determinants of self efficacy for sleep in insomnia disorder: Preliminary results L. Caccavale, L. Palagini, A. Gronchi, M. Mauri Sleep Clinic, Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy
Introduction: Elevated sleep-related self-efficacy has been associated with both successful hypnotic tapering and adherence to cognitive-behavioral therapy in insomnia. To identify factors impacting self-efficacy for sleep in insomnia, the aim was to examine