An end-to-end framework for real-time automatic sleep stage classification.

Sleep staging is a fundamental but time consuming process in any sleep laboratory. To greatly speed up sleep staging without compromising accuracy, we developed a novel framework for performing real-time automatic sleep stage classification. The client-server architecture adopted here provides an end-to-end solution for anonymizing and efficiently transporting polysomnography data from the client to the server and for receiving sleep stages in an interoperable fashion. The framework intelligently partitions the sleep staging task between the client and server in a way that multiple low-end clients can work with one server, and can be deployed both locally as well as over the cloud. The framework was tested on four datasets comprising ≈1700 polysomnography records (≈12000 hr of recordings) collected from adolescents, young, and old adults, involving healthy persons as well as those with medical conditions. We used two independent validation datasets: one comprising patients from a sleep disorders clinic and the other incorporating patients with Parkinson's disease. Using this system, an entire night's sleep was staged with an accuracy on par with expert human scorers but much faster (≈5 s compared with 30-60 min). To illustrate the utility of such real-time sleep staging, we used it to facilitate the automatic delivery of acoustic stimuli at targeted phase of slow-sleep oscillations to enhance slow-wave sleep

Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults.

ObjectiveDelirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000-3000 lux; 6-10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients.MethodA total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini-Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient's GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed.ResultsThe mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep-wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype.ConclusionThis study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies

Reported light in the sleep environment: enhancement of the sleep diary.

BackgroundLight is the primary synchronizing cue for the circadian timing system, capable of exerting robust physiological effects, even with very dim and/or brief photic exposure. Mammals, including humans, are particularly susceptible to light at night. As such, measures of light in the sleeping environment are critical for evaluating sleep health. Sleep diaries provide inexpensive measures of sleep, but do not typically include light information.MethodsFour questions probing visual perception of light in the bedtime and waking environments were added to the Consensus Sleep Diary for Morning administration. As part of a lighting intervention study, 18 hospital Labor and Delivery Department personnel completed the sleep diary for 1 week in each of two experimental conditions while wearing Actiwatch devices equipped with photosensors. Diary responses were evaluated against photosensor values from the beginning and end of each rest interval (n=194 rest intervals), as well as against sleep measures, utilizing linear mixed models.ResultsResponses to light questions were related to actual light measures at bedtime, controlling for shift type and experimental condition. In addition, subjective light information at bedtime and waking was related to both objective and subjective sleep parameters, with data generally indicating poorer sleep with light in the sleeping environment.ConclusionQuestions addressing perception of light in the sleeping environment may provide a crude yet affordable metric of relative photic intensity. Further, as responses relate to sleep outcomes, subjective light information may yield valuable insights regarding mechanisms and outcomes of clinical significance in sleep and circadian research

Effect of a 2 week CPAP treatment on mood states in patients with obstructive sleep apnea: a double-blind trial

Obstructive sleep apnea (OSA) is a common disease with significant medical and psychiatric comorbidities. The literature documenting the effects of continuous positive airway pressure (CPAP) treatment on mood in OSA patients is mixed. We previously observed that 1week of CPAP treatment did not result in improvements in mood beyond those observed in a group treated with placebo-CPAP. This study examined the effect of a 2week CPAP treatment on mood in a placebo-controlled design in OSA patients. Fifty patients with untreated sleep apnea were evaluated by polysomnography and completed the Profile of Mood States (POMS) pre-/post-treatment. The patients were randomized for 2weeks to either therapeutic CPAP or placebo-CPAP (at insufficient pressure). Both the therapeutic CPAP and the placebo-CPAP groups showed significant improvements in POMS total score, tension, fatigue, and confusion. No significant time × treatment effect was observed for either group. We could not show a specific beneficial impact of CPAP treatment on mood in OSA patient

The relationship between dementia severity and rest/activity circadian rhythms

Patients with dementia have been shown to have disturbed sleep/wake rhythms. There is evidence of impairment in endogenous generation of rhythms and deficient environmental cues in this population. This study sought to examine patterns of rest/activity rhythms as they relate to dementia severity. Three days of actigraphy were collected from 150 nursing-home patients with dementia and used to compute rhythm parameters. Dementia severity was estimated with the Mini-Mental State Examination (MMSE). The relationship between rhythm parameters and dementia severity was examined. Rhythm parameters were not associated with dementia in the sample as a whole, but relationships emerged when the sample was divided on the basis of overall rhythm robustness (F-statistic). Within the group with less robust rhythms, those with stronger rhythms had less severe dementia. In the group with more robust rhythms, milder dementia was associated with having an earlier acrophase (timing of the peak of the rhythm) and narrower peak of the rhythm (shorter duration of peak activity). These results suggested a three-stage model of rest/activity rhythm changes in dementia in which dementia patients have a rapid decline in rhythmicity followed by a slight return to stronger rhythms. In the later stages of dementia, rhythms decline even further

Stress, subjective wellbeing and self-knowledge in higher education teachers: A pilot study through bodyfulness approaches.

Work-related stress is a major cause of health problems worldwide. Faculty in educational institutions, including universities, also face high levels of stress, which undoubtedly affects their performance, level of personal satisfaction and wellbeing, and the relationship with students. Training interventions based on embodied learning can promote self-knowledge, emotional regulation and stress reduction, thereby increasing levels of psychological well-being. The present pilot study analyzed the impact of body awareness training in 31 university teachers using a controlled, randomized pre-post experimental design, with two experimental groups and a control group (n = 10). The two interventions were: Hatha Yoga (n = 11) and Dance Movement Therapy/Body Mind Centering (n = 10), which we have termed Body Movement Awareness. Variables related to body awareness, mindfulness, wellbeing, life satisfaction and stress were measured using self-perception tests. Cortisol levels, heart rate variability and sleep quality were also analyzed. Finally, participants’ reflections were analyzed according to a qualitative approach. The results showed significant differences between the control group and the Hatha Yoga group in terms of stress reduction and wellbeing. The Body Movement Awareness group exhibited evidence of contributions on self-knowledge, communication and kinesthetic empathy, key elements in the educational field. Despite the inherent limitations of the study, the conclusions are encouraging and open new lines of research from embodied approaches that introduce creative movement and group experience as part of the process of emotional regulation and self-knowledge.post-print2831 K