TY - JOUR AU - Blomenkamp, Maja AU - Kiesel, Andrea AU - Baumeister, Harald AU - Lehr, Dirk AU - Unterrainer, Josef AU - Sander, B. Lasse AU - Spanhel, Kerstin PY - 2025/4/3 TI - Assessing the Cultural Fit of a Digital Sleep Intervention for Refugees in Germany: Qualitative Study JO - JMIR Form Res SP - e65412 VL - 9 KW - Ukraine KW - eHealth KW - sleep disturbances KW - low-threshold treatment KW - culturally sensitive treatment KW - refugee KW - digital sleep KW - Germany KW - digital intervention KW - interview KW - content analysis KW - qualitative study KW - mental burden KW - mental health care KW - electronic health KW - digital health N2 - Background: Digital interventions have been suggested to facilitate access to mental health care for refugees, who experience structural, linguistic, and cultural barriers to mental health care. Sleep-e, a digital sleep intervention originally developed for German teachers, has been culturally adapted for refugees in Germany mainly coming from African and Middle East countries. With the increasing number of refugees from Ukraine and the associated diversity of cultural backgrounds among refugees in Germany, it is essential to assess whether existing digital interventions are culturally appropriate for this target group as well. Objective: The study aimed to investigate the perceived cultural appropriateness of Sleep-e in both its original and culturally adapted versions among refugees in Germany, hereby exploring and possibly contrasting the needs of refugees coming from Ukraine and other countries of origin. Methods: Overall, 13 refugees (6 from Ukraine, 23-66 years old; and 7 from other countries, 26-41 years old) participated in the study. Each participant went through parts of the original or culturally adapted version of the digital sleep intervention, with 5 participants going through both versions. A total of 17 semistructured interviews (11 for the adapted, 6 for the nonadapted intervention version) and 9 think-aloud sessions (6 for the adapted, 3 for the nonadapted intervention version) were conducted to assess cultural appropriateness, suggestions for adaptations, and perceived relevance. Data were transcribed, categorized, and analyzed using structured qualitative content analysis. Results: The findings showed key differences in the perceived appropriateness and identification between the 2 refugee groups and the 2 intervention versions. Ukrainian participants expressed positive (n=70) and negative (n=56) feedback on the adapted intervention version, which revealed identity conflicts, as the adapted intervention version was targeted at a refugee population with whom they could not fully identify (18 negative feedback quotes concerning the refugee example characters). Whereas they identified with the European context in the original version, they found the problems described less relevant to their experiences. In contrast, participating refugees from other countries found the culturally adapted version more comprehensible and culturally appropriate (55 positive and 5 negative feedback quotes). No significant usability issues were reported, but several participants highlighted the need for an individualization of the intervention content. Conclusions: Neither the original nor culturally adapted version of the digital sleep intervention fully met the needs of all refugee groups, highlighting the complexity of culturally adapting digital interventions for this population. Particularly, the identity conflict of participating Ukrainian refugees regarding the refugee context suggests that adaptation should go beyond regional considerations and consider the dynamics of social identity. These findings emphasize the relevance of including co-design processes with different refugee populations to ensure broad identification and, herewith, cultural appropriateness of digital interventions. Trial Registration: German Clinical Trials Register DRKS00036484; https://drks.de/search/de/trial/DRKS00036484 UR - https://formative.jmir.org/2025/1/e65412 UR - http://dx.doi.org/10.2196/65412 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65412 ER - TY - JOUR AU - Khaksar, Sajjad AU - Jafari-Oori, Mehdi AU - Sarhangi, Forogh AU - Moayed, Sadat Malihe PY - 2025/1/28 TI - Pediatric Sleep Quality and Parental Stress in Neuromuscular Disorders: Descriptive Analytical Study JO - Asian Pac Isl Nurs J SP - e56667 VL - 9 KW - spinal muscular atrophy KW - neuromuscular disorders KW - sleep quality KW - pediatrics KW - parental stress KW - children KW - parents KW - muscular atrophy KW - muscular disorders N2 - Background: Neuromuscular disorders (NMDs) constitute a heterogeneous group of disorders that affect motor neurons, neuromuscular junctions, and muscle fibers, resulting in symptoms such as muscle weakness, fatigue, and reduced mobility. These conditions significantly affect patients? quality of life and impose a substantial burden on caregivers. Spinal muscular atrophy (SMA) is a relatively common NMD in children that presents in various types with varying degrees of severity. Objective: This study aimed to evaluate the sleep quality of children with NMDs, particularly SMA types 1, 2, and 3 and assess the stress levels experienced by their parents. Methods: A descriptive analytical study was conducted from February to October 2023, in selected hospitals and dystrophy associations in Tehran and Isfahan, Iran. A total of 207 children aged 1?14 years with various NMDs were included in the study. Data were collected using a web-based questionnaire with 3 parts: demographic information, the Children?s Sleep Habits Questionnaire to assess children?s sleep, and the Stress Response Inventory to measure parental stress. Statistical analyses were performed using SPSS version 22, with an ? level of .05. Results: Significant differences in sleep quality were found among SMA types, with mean scores of 74.76 (SD 7.48) for SMA type 1, 76.4 (SD 7.29) for SMA type 2, 72.88 (SD 6.73) for SMA type 3, and 75.87 (SD 5.74) for other NMDs (P=.02). A correlation was found between sleep and length of hospital stay (r=0.234, P<.001)and between sleep and the child?s sex (r=?0.140, P=.04). Parental stress scores averaged 95.73 (SD 32.12). There was not a statistically significant difference in parental stress scores among the 4 groups (P=.78). This suggests that parental stress levels were similar across different NMD groups. Conclusions: Sleep disorders are prevalent among children with NMDs, especially SMA. Parents experience high levels of stress that can affect the care they provide. Therefore, interventions to improve children?s sleep and address parental stress are crucial. Regular screening, counseling, and tailored support are recommended to enhance the well-being of children with NMDs and their families. UR - https://apinj.jmir.org/2025/1/e56667 UR - http://dx.doi.org/10.2196/56667 ID - info:doi/10.2196/56667 ER - TY - JOUR AU - Scharf, Tamara AU - Huber, A. Carola AU - Näpflin, Markus AU - Zhang, Zhongxing AU - Khatami, Ramin PY - 2025/1/7 TI - Trends in Prescription of Stimulants and Narcoleptic Drugs in Switzerland: Longitudinal Health Insurance Claims Analysis for the Years 2014-2021 JO - JMIR Public Health Surveill SP - e53957 VL - 11 KW - prescription trends KW - claims data KW - cross-sectional data KW - narcolepsy KW - prescribers KW - prescribing practices KW - medical care KW - stimulants KW - stimulant medication N2 - Background: Stimulants are potent treatments for central hypersomnolence disorders or attention-deficit/hyperactivity disorders/attention deficit disorders but concerns have been raised about their potential negative consequences and their increasing prescription rates. Objective: We aimed to describe stimulant prescription trends in Switzerland from 2014 to 2021. Second, we aimed to analyze the characteristics of individuals who received stimulant prescriptions in 2021 and investigate the link between stimulant prescriptions and hospitalization rates in 2021, using hospitalization as a potential indicator of adverse health outcomes. Methods: Longitudinal and cross-sectional data from a large Swiss health care insurance were analyzed from all insureds older than 6 years. The results were extrapolated to the Swiss general population. We identified prescriptions for methylphenidate, lisdexamfetamine, modafinil, and sodium oxybate and calculated prevalences of each drug prescription over the period from 2014 to 2021. For 2021 we provide detailed information on the prescribers and evaluate the association of stimulant prescription and the number and duration of hospitalization using logistic regression models. Results: We observed increasing prescription rates of all stimulants in all age groups from 2014 to 2021 (0.55% to 0.81%, 43,848 to 66,113 insureds with a prescription). In 2021, 37.1% (28,057 prescriptions) of the medications were prescribed by psychiatrists, followed by 36.1% (n=27,323) prescribed by general practitioners and 1% (n=748) by neurologists. Only sodium oxybate, which is highly specific for narcolepsy treatment, was most frequently prescribed by neurologists (27.8%, 37 prescriptions). Comorbid psychiatric disorders were common in patients receiving stimulants. Patients hospitalized in a psychiatric institution were 5.3 times (odds ratio 5.3, 95% CI 4.63?6.08, P<.001) more likely to have a stimulant prescription than those without hospitalization. There were no significant associations between stimulant prescription and the total length of inpatient stay (odds ratio 1, 95% CI 1?1, P=.13). Conclusions: The prescription of stimulant medication in Switzerland increased slightly but continuously over years, but at lower rates compared to the estimated prevalence of central hypersomnolence disorders and attention-deficit/hyperactivity disorders/attention deficit disorders. Most stimulants are prescribed by psychiatrists, closely followed by general practitioners. The increased odds for hospitalization to psychiatric institutions for stimulant receivers reflects the severity of disease and the higher psychiatric comorbidities in these patients. UR - https://publichealth.jmir.org/2025/1/e53957 UR - http://dx.doi.org/10.2196/53957 ID - info:doi/10.2196/53957 ER - TY - JOUR AU - Oh, Taek Kyue AU - Ko, Jisu AU - ­Jin, Nayoung AU - Han, Sangbin AU - Yoon, Yul Chan AU - Shin, Jaemyung AU - Ko, Minsam PY - 2024/11/29 TI - Understanding Morning Emotions by Analyzing Daily Wake-Up Alarm Usage: Longitudinal Observational Study JO - JMIR Hum Factors SP - e50835 VL - 11 KW - morning emotion KW - wake-up alarm usage KW - morning context KW - emotion monitoring KW - longitudinal observational study N2 - Background: Morning emotions can significantly affect daily wellness. While many studies have analyzed daily survey responses to identify factors influencing morning emotions, these methods require additional time and effort from individuals for emotional monitoring. Objective: This study aims to identify daily alarm usage patterns related to morning emotions. Methods: We recruited 373 users of the Alarmy app (DelightRoom) in the United States and South Korea and surveyed their demographics and usual behaviors related to morning emotions. Participants described their morning emotions over a 2-week period, during which we collected daily alarm app logs. We used a generalized estimating equation (GEE) method to identify factors affecting morning emotions. Results: The findings indicate that varied alarm usage is related to morning emotions. Alarm set time was positively associated with feelings of peacefulness and refreshment in the morning, while task-based alarms were related to nervousness. The time taken to deactivate the alarm after it rang was negatively correlated with happiness. In addition, usual behaviors and demographic factors were found to be related to morning emotions, consistent with previous studies. Conclusions: The study reveals that daily alarm usage is related to morning emotions, suggesting that daily alarm logs can supplement survey methods to facilitate daily emotion monitoring. UR - https://humanfactors.jmir.org/2024/1/e50835 UR - http://dx.doi.org/10.2196/50835 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50835 ER - TY - JOUR AU - Bennett, E. Sarah AU - Johnston, H. Milly AU - Treneman-Evans, Georgia AU - Denison-Day, James AU - Duffy, Anthony AU - Brigden, Amberly AU - Kuberka, Paula AU - Christoforou, Nicholas AU - Ritterband, Lee AU - Koh, Jewel AU - Meadows, Robert AU - Alamoudi, Doaa AU - Nabney, Ian AU - Yardley, Lucy PY - 2024/10/31 TI - Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study JO - JMIR Hum Factors SP - e63341 VL - 11 KW - behavior change KW - digital intervention KW - insomnia KW - depression KW - anxiety KW - sleep KW - qualitative research KW - mobile phone N2 - Background: Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. Objective: This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. Methods: Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. Results: A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported ?prefer not to say.? Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. Conclusions: Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout. UR - https://humanfactors.jmir.org/2024/1/e63341 UR - http://dx.doi.org/10.2196/63341 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63341 ER - TY - JOUR AU - Moghadam, Shokraneh AU - Husted, Margaret AU - Aznar, Ana AU - Gray, Debra PY - 2024/10/23 TI - A Person-Based Web-Based Sleep Intervention Aimed at Adolescents (SleepWise): Randomized Controlled Feasibility Study JO - JMIR Form Res SP - e51322 VL - 8 KW - web-based health interventions KW - sleep KW - adolescence KW - behavior change KW - person-based approach KW - sleep intervention KW - detrimental health outcome KW - SleepWise N2 - Background: Adolescents are advised to sleep 8-10 hours per night; however, most do not sleep for this recommended amount. Poor adolescent sleep is associated with detrimental health outcomes, including reduced physical activity, risk-taking behaviors, and increased depression and anxiety levels, making this an important public health concern. Existing interventions targeting adolescent sleep are often unsuccessful or their effectiveness unclear, as they are frequently noninteractive, time-consuming, and lack a strong theoretical foundation; highlighting an urgent need for innovative interventions deemed acceptable by adolescents. Objective: The main objective of this study was to determine the acceptability, feasibility, and preliminary impact of a web-based person-based sleep intervention (SleepWise) on adolescent sleep quality. Participant incentivization was also explored to understand its impact on engagement, acceptability, and sleep quality. Methods: A feasibility trial was conducted to test the feasibility, acceptability, and preliminary impact of SleepWise on adolescent sleep quality, developed based on the person-based approach to intervention development. In total, 90 participants (aged 13-17 years) from further education institutions and secondary schools were recruited for two 2-arm randomized controlled trials. One trial (trial 1) was incentivized to understand the impact of incentivization. Acceptability and sleep quality were assessed via questionnaires, and a mixed methods process evaluation was undertaken to assess participant engagement and experience with SleepWise. Engagement was automatically tracked by SleepWise, which collected data on the date and time, pages viewed, and the number of goals and sleep logs completed per participant. Semistructured interviews were carried out to gain participant feedback. Results: Participants in both trials reported high levels of acceptability (trial 1: mean 21.00, SD 2.74; trial 2: mean 20.82, SD 2.48) and demonstrated similar levels of engagement with SleepWise. Participants in trial 1 viewed slightly more pages of the intervention, and those in trial 2 achieved their set goals more frequently. Improvements in sleep quality were found in both trials 1 and 2, with medium (trial 1) and large (trial 2) effect sizes. A larger effect size for improvement in sleep quality was found in the nonincentivized trial (d=0.87), suggesting that incentivization may not impact engagement or sleep quality. Both trials achieved acceptable recruitment (trial 1, N=48; trial 2, N=42), and retention at 5 weeks (trial 1: N=30; trial 2: N=30). Qualitative findings showed that adolescents lead busy lifestyles, which may hinder engagement; however, participants deemed SleepWise acceptable in length and content, and made attempts at behavior change. Conclusions: SleepWise is an acceptable and potentially efficacious web-based sleep intervention aimed at adolescents. Findings from this study showed that incentivization did not greatly impact engagement, acceptability, or sleep quality. Subject to a full trial, SleepWise has the potential to address the urgent need for innovative, personalized, and acceptable sleep interventions for adolescents. Trial Registration: OSF Registries osf.io/yanb2; https://osf.io/yanb2 UR - https://formative.jmir.org/2024/1/e51322 UR - http://dx.doi.org/10.2196/51322 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51322 ER - TY - JOUR AU - Liang, Zilu AU - Melcer, Edward AU - Khotchasing, Kingkarn AU - Chen, Samantha AU - Hwang, Daeun AU - Hoang, Huyen Nhung PY - 2024/10/8 TI - The Role of Relevance in Shaping Perceptions of Sleep Hygiene Games Among University Students: Mixed Methods Study JO - JMIR Serious Games SP - e64063 VL - 12 KW - serious games KW - sleep hygiene KW - sleep technologies KW - co-design KW - relevance KW - self-determination theory KW - digital health KW - persuasive technology KW - behavior change N2 - Background: Sleep games are an emerging topic in the realm of serious health game research. However, designing features that are both enjoyable and effective at engaging users, particularly university students, to develop healthy sleep habits remains a challenge. Objective: This study aims to investigate user preferences for 3 sleep game prototypes, that is, Hero?s Sleep Journey, Sleep Tamagotchi, and Sleepland, and to explore their popularity and perceived utility in promoting sleep health. Methods: A mixed methods approach was used in this study. Quantitative and qualitative data were collected through a co-design workshop involving 47 university students. Participants were presented with storyboard cards of game features and were asked to provide an overall rating on each game, as well as ratings for individual features. They were also encouraged to provide free-form comments on the features and suggest improvements. In addition, participants were asked to express their preferences among the 3 games regarding which game they would most like to play and which one they found most useful for promoting sleep health. Results: Surprisingly, while Hero?s Sleep Journey was the most popular choice among participants, Sleep Tamagotchi was perceived as the most beneficial for improving sleep health. Relevance emerged as an overarching theme in the qualitative data analysis, with 3 interconnected dimensions: psychological relevance to users? personal lives, logical relevance to sleep health, and situational relevance to users? circumstantial context. We discussed how the 3 dimensions of relevance address the autonomy and relatedness constructs outlined in the self-determination theory and proposed 3 design recommendations. Conclusions: Our serious sleep game prototypes demonstrated the potential to engage university students to develop healthy sleep hygiene. Future sleep game designs should aim to create a sense of relevance to users? personal lives, sleep health goals, and situational contexts. Rather than a one-size-fits-all approach, it is essential to develop a wide range of game genres and features to cater to diverse users. Aligning game features with sleep health goals and educating users on the design rationale through sleep knowledge are also important aspects. Furthermore, allowing users to customize their game experience and manage technology boundaries is necessary to nurture a sense of control and autonomy in the process of forming good sleep hygiene. UR - https://games.jmir.org/2024/1/e64063 UR - http://dx.doi.org/10.2196/64063 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64063 ER - TY - JOUR AU - Jackson, Rosie AU - Gu, Chao AU - Haszard, Jillian AU - Meredith-Jones, Kim AU - Galland, Barbara AU - Camp, Justine AU - Brown, Deirdre AU - Taylor, Rachael PY - 2024/8/20 TI - The Effect of Prebedtime Behaviors on Sleep Duration and Quality in Children: Protocol for a Randomized Crossover Trial JO - JMIR Res Protoc SP - e63692 VL - 13 KW - screen time KW - digital device KW - diet KW - physical activity KW - objective measurement KW - wearable camera KW - sleep KW - mobile phone N2 - Background: It is recommended that children should avoid eating dinner, being physically active, or using screens in the hour before bed to ensure good sleep health. However, the evidence base behind these guidelines is weak and limited to cross-sectional studies using questionnaires. Objective: The aim of this randomized crossover trial was to use objective measures to experimentally determine whether recommendations to improve sleep by banning electronic media, physical activity, or food intake in the hour before bed, impact sleep quantity and quality in the youth. Methods: After a baseline week to assess usual behavior, 72 children (10-14.9 years old) will be randomized to four conditions, which are (1) avoid all 3 behaviors, (2) use screens for at least 30 minutes, (3) be physically active for at least 30 minutes, and (4) eat a large meal, during the hour before bed on days 5 to 7 of weeks 2 to 5. Families can choose which days of the week they undertake the intervention, but they must be the same days for each intervention week. Guidance on how to undertake each intervention will be provided. Interventions will only be undertaken during the school term to avoid known changes in sleep during school holidays. Intervention adherence and shuteye latency (time from getting into bed until attempting sleep) will be measured by wearable and stationary PatrolEyes video cameras (StuntCams). Sleep (total sleep time, sleep onset, and wake after sleep onset) will be measured using actigraphy (baseline, days 5 to 7 of each intervention week). Mixed effects regression models with a random effect for participants will be used to estimate mean differences (95% CI) for conditions 2 to 4 compared with condition 1. Results: Recruitment started in March 2024, and is anticipated to finish in April 2025. Following data analysis, we expect that results will be available later in 2026. Conclusions: Using objective measures, we will be able to establish if causal relationships exist between prebedtime behaviors and sleep in children. Such information is critical to ensure appropriate and achievable sleep guidelines. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12624000206527; https://tinyurl.com/3kcjmfnj International Registered Report Identifier (IRRID): DERR1-10.2196/63692 UR - https://www.researchprotocols.org/2024/1/e63692 UR - http://dx.doi.org/10.2196/63692 UR - http://www.ncbi.nlm.nih.gov/pubmed/39163119 ID - info:doi/10.2196/63692 ER - TY - JOUR AU - Togo, Eiichi AU - Takami, Miki AU - Ishigaki, Kyoko PY - 2024/6/12 TI - Evaluation of Autonomic Nervous System Function During Sleep by Mindful Breathing Using a Tablet Device: Randomized Controlled Trial JO - JMIR Nursing SP - e56616 VL - 7 KW - mindfulness KW - sleep KW - cardiac potential KW - low frequency KW - high frequency KW - mobile phone N2 - Background: One issue to be considered in universities is the need for interventions to improve sleep quality and educational systems for university students. However, sleep problems remain unresolved. As a clinical practice technique, a mindfulness-based stress reduction method can help students develop mindfulness skills to cope with stress, self-healing skills, and sleep. Objective: We aim to verify the effectiveness of mindful breathing exercises using a tablet device. Methods: In total, 18 nursing students, aged 18-22 years, were randomly assigned and divided equally into mindfulness (Mi) and nonmindfulness (nMi) implementation groups using tablet devices. During the 9-day experimental period, cardiac potentials were measured on days 1, 5, and 9. In each sleep stage (sleep with sympathetic nerve dominance, shallow sleep with parasympathetic nerve dominance, and deep sleep with parasympathetic nerve dominance), low frequency (LF) value, high frequency (HF) value, and LF/HF ratios obtained from the cardiac potentials were evaluated. Results: On day 5, a significant correlation was observed between sleep duration and each sleep stage in both groups. In comparison to each experimental day, the LF and LF/HF ratios of the Mi group were significantly higher on day 1 than on days 5 and 10. LF and HF values in the nMi group were significantly higher on day 1 than on day 5. Conclusions: The correlation between sleep duration and each sleep stage on day 5 suggested that sleep homeostasis in both groups was activated on day 5, resulting in similar changes in sleep stages. During the experimental period, the cardiac potentials in the nMi group showed a wide range of fluctuations, whereas the LF values and LF/HF ratio in the Mi group showed a decreasing trend over time. This finding suggests that implementing mindful breathing exercises using a tablet device may suppress sympathetic activity during sleep. Trial Registration: UMIN-CTR Clinical Trials Registry UMIN000054639; https://tinyurl.com/mu2vdrks UR - https://nursing.jmir.org/2024/1/e56616 UR - http://dx.doi.org/10.2196/56616 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865177 ID - info:doi/10.2196/56616 ER - TY - JOUR AU - Luo, Minjing AU - Dong, Yue AU - Fan, Bingbing AU - Zhang, Xinyue AU - Liu, Hao AU - Liang, Changhao AU - Rong, Hongguo AU - Fei, Yutong PY - 2024/6/10 TI - Sleep Duration and Functional Disability Among Chinese Older Adults: Cross-Sectional Study JO - JMIR Aging SP - e53548 VL - 7 KW - sleep duration KW - functional disability KW - activity of daily living disability KW - instrumental activity of daily living KW - older population N2 - Background: The duration of sleep plays a crucial role in the development of physiological functions that impact health. However, little is known about the associations between sleep duration and functional disability among older adults in China. Objective: This study aimed to explore the associations between sleep duration and functional disabilities in the older population (aged?65 years) in China. Methods: The data for this cross-sectional study were gathered from respondents 65 years and older who participated in the 2018 survey of the China Health and Retirement Longitudinal Study, an ongoing nationwide longitudinal investigation of Chinese adults. The duration of sleep per night was obtained through face-to-face interviews. Functional disability was assessed according to activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. The association between sleep duration and functional disability was assessed by multivariable generalized linear models. A restricted cubic-spline model was used to explore the dose-response relationship between sleep duration and functional disability. Results: In total, 5519 participants (n=2471, 44.77% men) were included in this study with a mean age of 73.67 years, including 2800 (50.73%) respondents with a functional disability, 1978 (35.83%) with ADL disability, and 2299 (41.66%) with IADL disability. After adjusting for potential confounders, the older adults reporting shorter (?4, 5, or 6 hours) or longer (8, 9, or ?10 hours) sleep durations per night exhibited a notably increased risk of functional disability compared to that of respondents who reported having 7 hours of sleep per night (all P<.05), which revealed a U-shaped association between sleep duration and dysfunction. When the sleep duration fell below 7 hours, increased sleep duration was associated with a significantly lower risk of functional disability (odds ratio [OR] 0.85, 95% CI 0.79-0.91; P<.001). When the sleep duration exceeded 7 hours, the risk of functional disability associated with a prolonged sleep duration increased (OR 1.16, 95% CI 1.05-1.29; P<.001). Conclusions: Sleep durations shorter and longer than 7 hours were associated with a higher risk of functional disability among Chinese adults 65 years and older. Future studies are needed to explore intervention strategies for improving sleep duration with a particular focus on functional disability. UR - https://aging.jmir.org/2024/1/e53548 UR - http://dx.doi.org/10.2196/53548 UR - http://www.ncbi.nlm.nih.gov/pubmed/38771907 ID - info:doi/10.2196/53548 ER - TY - JOUR AU - Roberge, Patrice AU - Ruel, Jean AU - Bégin-Drolet, André AU - Lemay, Jean AU - Gakwaya, Simon AU - Masse, Jean-François AU - Sériès, Frédéric PY - 2024/4/15 TI - Preliminary Assessment of an Ambulatory Device Dedicated to Upper Airway Muscle Training in Patients With Sleep Apnea: Proof-of-Concept Study JO - JMIR Biomed Eng SP - e51901 VL - 9 KW - obstructive sleep apnea/hypopnea syndrome KW - OSAHS KW - myofunctional therapy KW - myotherapy KW - oral KW - orofacial KW - myology KW - musculature KW - labial KW - buccal KW - lingual KW - speech therapy KW - physiotherapy KW - physical therapy KW - oropharyngeal exercises KW - oropharyngeal KW - pharyngeal KW - pharynx KW - hypopnea KW - lip KW - home-based KW - portable device KW - devices KW - ambulatory KW - portable KW - monitoring KW - apnea KW - mouth KW - lips KW - tongue KW - facial KW - exercise KW - exercises KW - myofunctional KW - continuous monitoring KW - sleep-disordered breathing KW - sleep KW - breathing KW - tongue exercise KW - lip exercise KW - mHealth KW - muscle KW - muscles KW - muscular KW - airway KW - sleep apnea N2 - Background: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability. Objective: Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips, tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session. Methods: This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes. Results: Ten participants were enrolled in the study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91% (175/192 sessions). For the tongue exercise, the success rate increased from 66% (211/320 exercises; SD 18%) on the first day to 85% (272/320 exercises; SD 17%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=?0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants? performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program. Conclusions: The study?s portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation. UR - https://biomedeng.jmir.org/2024/1/e51901 UR - http://dx.doi.org/10.2196/51901 UR - http://www.ncbi.nlm.nih.gov/pubmed/38875673 ID - info:doi/10.2196/51901 ER - TY - JOUR AU - Xie, Fangfang AU - You, Yanli AU - Gu, Yuanjia AU - Xu, Jiatuo AU - Yao, Fei PY - 2024/2/26 TI - Effects of the Prolong Life With Nine Turn-Method Qigong on Fatigue, Insomnia, Anxiety, and Gastrointestinal Disorders in Patients With Chronic Fatigue Syndrome: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53347 VL - 13 KW - chronic fatigue syndrome KW - prolong life with nine turn method Qigong KW - fMRI KW - gut microbiota KW - gastrointestinal KW - fatigue KW - insomnia KW - CFS KW - study protocol KW - Qigong KW - efficacy KW - safety KW - cognitive behavioral therapy KW - CBT KW - randomized trial N2 - Background: Chronic fatigue syndrome (CFS) is a debilitating multisystem disorder that can lead to various pathophysiological abnormalities and symptoms, including insomnia, gastrointestinal disorders, and anxiety. Due to the side effects of currently available drugs, there is a growing need for safe and effective nondrug therapies. The Prolong Life With Nine Turn (PLWNT) Qigong method is a system of mind-body exercise with restorative benefits that can alleviate the clinical symptoms of CFS and impart a significant inhibitory effect. Various studies have proven the treatment efficacy of PLWNT; however, the impact on insomnia, gastrointestinal disorders, and anxiety in patients with CFS has not yet been investigated. Objective: This study aims to evaluate the efficacy and safety of the PLWNT method in terms of its effects on fatigue, insomnia, anxiety, and gastrointestinal symptoms in patients with CFS. Methods: We will conduct a randomized, analyst-blinded, parallel-controlled trial with a 12-week intervention and 8-week follow-up. A total of 208 patients of age 20-60 years will be recruited. The patients will be randomly divided into a PLWNT Qigong exercise group (PLWNT Group) and a control group treated with cognitive behavioral therapy at a ratio of 1:1. Participants from the treatment groups will be taught by a highly qualified professor at the Shanghai University of Traditional Chinese Medicine once a week and will be supervised via web during the remaining 6 days at home, over 12 consecutive weeks. The primary outcome will be the Multidimensional Fatigue Inventory 20, while the secondary outcomes include the Pittsburgh Sleep Quality Index, Gastrointestinal Symptom Rating Scale, Hospital Anxiety and Depression Scale, functional magnetic resonance imaging, gut microbiota, and peripheral blood. Results: The study was approved by the ethics committee of Shanghai Municipal Hospital of Traditional Chinese Medicine in March 2022 (Ethics Approval Number 2022SHL-KY-05). Recruitment started in July 2022. The intervention is scheduled to be completed in December 2024, and data collection will be completed by the end of January 2025. Over the 3-year recruitment period, 208 participants will be recruited. Data management is still in progress; therefore, data analysis has yet to be performed. Conclusions: This randomized trial will evaluate the effectiveness of the PLWNT method in relieving fatigue, insomnia, anxiety, and gastrointestinal symptoms in patients with CFS. If proven effective, it will provide a promising alternative intervention for patients with CFS. Trial Registration: China Clinical Trials Registry ChiCTR2200061229; https://www.chictr.org.cn/showproj.html?proj=162803 International Registered Report Identifier (IRRID): PRR1-10.2196/53347 UR - https://www.researchprotocols.org/2024/1/e53347 UR - http://dx.doi.org/10.2196/53347 UR - http://www.ncbi.nlm.nih.gov/pubmed/38407950 ID - info:doi/10.2196/53347 ER - TY - JOUR AU - Ito-Masui, Asami AU - Sakamoto, Ryota AU - Matsuo, Eri AU - Kawamoto, Eiji AU - Motomura, Eishi AU - Tanii, Hisashi AU - Yu, Han AU - Sano, Akane AU - Imai, Hiroshi AU - Shimaoka, Motomu PY - 2023/8/22 TI - Effect of an Internet?Delivered Cognitive Behavioral Therapy?Based Sleep Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, Nonrandomized Trial JO - J Med Internet Res SP - e45834 VL - 25 KW - shift worker sleep disorder KW - internet-based cognitive behavioral therapy KW - mobile apps KW - fitness tracker KW - subjective well-being KW - machine learning KW - mobile phone N2 - Background: Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders. Objective: This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning?based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit. Methods: A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ?5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network?based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data. Results: In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance. Conclusions: The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work?related sleep disorders. International Registered Report Identifier (IRRID): RR2-10.2196/24799. UR - https://www.jmir.org/2023/1/e45834 UR - http://dx.doi.org/10.2196/45834 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606971 ID - info:doi/10.2196/45834 ER - TY - JOUR AU - Fonseca, Catarina AU - Cavadas, Francisca AU - Fonseca, Patrícia PY - 2023/5/5 TI - Upper Airway Assessment in Cone-Beam Computed Tomography for Screening of Obstructive Sleep Apnea Syndrome: Development of an Evaluation Protocol in Dentistry JO - JMIR Res Protoc SP - e41049 VL - 12 KW - cone-beam computed tomography KW - three-dimensional image KW - 3D image KW - airway obstructions KW - sleep medicine specialty KW - dentistry KW - obstructive sleep apnea KW - protocol N2 - Background: The upper airways are formed by the nasal cavities, pharynx, and larynx. There are several radiographic methods that allow evaluation of the craniofacial structure. Upper airway analysis in cone-beam computed tomography (CBCT) may be useful in diagnosing some pathologies such as obstructive sleep apnea syndrome (OSAS). OSAS prevalence has increased significantly in recent decades, justified by increased obesity and average life expectancy. It can be associated with cardiovascular, respiratory, and neurovascular diseases, diabetes, and hypertension. In some individuals with OSAS, the upper airway is compromised and narrowed. Nowadays, CBCT is widely used in dentistry by clinicians. Its use for upper airway assessment would be an advantage for screening some abnormalities related to an increased risk of pathologies such as OSAS. CBCT helps to calculate the total volume of the airways and their area in different anatomical planes (sagittal, coronal, and transverse). It also helps identify regions with the highest anteroposterior and laterolateral constriction of the airways. Despite its undoubted advantages, airway assessment is not routinely performed in dentistry. There is no protocol that allows comparisons between studies, which makes it difficult to obtain scientific evidence in this area. Hence, there is an urgent need to standardize the protocol for upper airway measurement to help clinicians identify at-risk patients. Objective: Our main aim is to develop a standard protocol for upper airway evaluation in CBCT for OSAS screening in dentistry. Methods: To measure and evaluate the upper airways, data are obtained using Planmeca ProMax 3D (Planmeca). Patient orientation is performed in accordance with the manufacturer's indications at the time of image acquisition. The exposure corresponds to 90 kV, 8 mA, and 13,713 seconds. The software used for upper airway analysis is Romexis (version 5.1.O.R; Planmeca). The images are exhibited in accordance with the field of view of 20.1×17.4 cm, size of 502×502×436 mm, and voxel size of 400 ?m. Results: The protocol described and illustrated here allows for automatic calculation of the total volume of the pharyngeal airspace, its area of greatest narrowing, its location, and the smallest anteroposterior and laterolateral dimensions of the pharynx. These measurements are carried out automatically by the imaging software whose reliability is proven by the existing literature. Thus, we could reduce the possible bias of manual measurement, aiming at data collection. Conclusions: The use of this protocol by dentists will allow for standardization of the measurements and constitutes a valuable screening tool for OSAS. This protocol may also be suitable for other imaging software. The anatomical points used as reference are most relevant for standardizing studies in this field. International Registered Report Identifier (IRRID): RR1-10.2196/41049 UR - https://www.researchprotocols.org/2023/1/e41049 UR - http://dx.doi.org/10.2196/41049 UR - http://www.ncbi.nlm.nih.gov/pubmed/37145857 ID - info:doi/10.2196/41049 ER - TY - JOUR AU - Carney, E. Colleen AU - Carmona, E. Nicole PY - 2022/6/13 TI - Authors? Response to: Additional Measurement Approaches for Sleep Disturbances. Comment on ?Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study? JO - JMIR Form Res SP - e39198 VL - 6 IS - 6 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone KW - smartphone KW - polysomnography UR - https://formative.jmir.org/2022/6/e39198 UR - http://dx.doi.org/10.2196/39198 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699990 ID - info:doi/10.2196/39198 ER - TY - JOUR AU - Tsai, Wan-Tong AU - Liu, Tzung-Liang PY - 2022/6/13 TI - Additional Measurement Approaches for Sleep Disturbances. Comment on ?A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study? JO - JMIR Form Res SP - e35959 VL - 6 IS - 6 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone KW - smartphone KW - polysomnography UR - https://formative.jmir.org/2022/6/e35959 UR - http://dx.doi.org/10.2196/35959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700003 ID - info:doi/10.2196/35959 ER - TY - JOUR AU - Moreno, P. Jennette AU - Dadabhoy, Hafza AU - Musaad, Salma AU - Baranowski, Tom AU - Thompson, Debbe AU - Alfano, A. Candice AU - Crowley, J. Stephanie PY - 2022/5/16 TI - Evaluation of a Circadian Rhythm and Sleep-Focused Mobile Health Intervention for the Prevention of Accelerated Summer Weight Gain Among Elementary School?Age Children: Protocol for a Randomized Controlled Feasibility Study JO - JMIR Res Protoc SP - e37002 VL - 11 IS - 5 KW - summer KW - circadian rhythms KW - sleep KW - child obesity KW - elementary school N2 - Background: The i?rhythm project is a mobile health adaptation of interpersonal and social rhythm therapy designed to promote healthy sleep and behavioral rhythms among 5-8-year olds during summer for the prevention of accelerated summer weight gain. Objective: This pilot study will examine the feasibility, acceptability, and preliminary efficacy of the i?rhythm intervention. This will ensure that the research protocol and procedures work as desired and are acceptable to families in preparation for the fully powered randomized controlled trial. The proposed study will examine the willingness of participants to participate in the intervention and determine whether modifications to the intervention, procedures, and measures are needed before conducting a fully powered study. We will assess our ability to (1) recruit, consent, and retain participants; (2) deliver the intervention; (3) implement the study and assessment procedures; (4) assess the reliability of the proposed measures; and (5) assess the acceptability of the intervention and assessment protocol. Methods: This study will employ a single-blinded 2-group randomized control design (treatment and no-treatment control) with randomization occurring after baseline (Time 0) and 3 additional evaluation periods (postintervention [Time 1], and 9 months [Time 2] and 12 months after intervention [Time 3]). A sample of 40 parent-child dyads will be recruited. Results: This study was approved by the institutional review board of Baylor College of Medicine (H-47369). Recruitment began in March 2021. As of March 2022, data collection and recruitment are ongoing. Conclusions: This study will address the role of sleep and circadian rhythms in the prevention of accelerated summer weight gain and assess the intervention?s effects on the long-term prevention of child obesity. Trial Registration: ClinicalTrials.gov NCT04445740; https://clinicaltrials.gov/ct2/show/NCT04445740. International Registered Report Identifier (IRRID): DERR1-10.2196/37002 UR - https://www.researchprotocols.org/2022/5/e37002 UR - http://dx.doi.org/10.2196/37002 UR - http://www.ncbi.nlm.nih.gov/pubmed/35576573 ID - info:doi/10.2196/37002 ER - TY - JOUR AU - Staffini, Alessio AU - Fujita, Kento AU - Svensson, Kishi Akiko AU - Chung, Ung-Il AU - Svensson, Thomas PY - 2022/3/18 TI - Statistical Methods for Item Reduction in a Representative Lifestyle Questionnaire: Pilot Questionnaire Study JO - Interact J Med Res SP - e28692 VL - 11 IS - 1 KW - item reduction KW - surveys and lifestyle questionnaires KW - feedback measures KW - questionnaire design KW - variance inflation factor KW - factor analysis KW - mobile phone N2 - Background: Reducing the number of items in a questionnaire while maintaining relevant information is important as it is associated with advantages such as higher respondent engagement and reduced response error. However, in health care, after the original design, an a posteriori check of the included items in a questionnaire is often overlooked or considered to be of minor importance. When conducted, this is often based on a single selected method. We argue that before finalizing any lifestyle questionnaire, a posteriori validation should always be conducted using multiple approaches to ensure the robustness of the results. Objective: The objectives of this study are to compare the results of two statistical methods for item reduction (variance inflation factor [VIF] and factor analysis [FA]) in a lifestyle questionnaire constructed by combining items from different sources and analyze the different results obtained from the 2 methods and the conclusions that can be made about the original items. Methods: Data were collected from 79 participants (heterogeneous in age and sex) with a high risk of metabolic syndrome working in a financial company based in Tokyo. The lifestyle questionnaire was constructed by combining items (asked with daily, weekly, and monthly frequency) from multiple validated questionnaires and other selected questions. Item reduction was conducted using VIF and exploratory FA. Adequacy tests were used to check the data distribution and sampling adequacy. Results: Among the daily and weekly questions, both VIF and FA identified redundancies in sleep-related items. Among the monthly questions, both approaches identified redundancies in stress-related items. However, the number of items suggested for reduction often differed: VIF suggested larger reductions than FA for daily questions but fewer reductions for weekly questions. Adequacy tests always confirmed that the structural detection was adequate for the considered items. Conclusions: As expected, our analyses showed that VIF and FA produced both similar and different findings, suggesting that questionnaire designers should consider using multiple methods for item reduction. Our findings using both methods indicate that many questions, especially those related to sleep, are redundant, indicating that the considered lifestyle questionnaire can be shortened. UR - https://www.i-jmr.org/2022/1/e28692 UR - http://dx.doi.org/10.2196/28692 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302507 ID - info:doi/10.2196/28692 ER - TY - JOUR AU - O'Hora, Patricia Kathleen AU - Osorno, A. Raquel AU - Sadeghi-Bahmani, Dena AU - Lopez, Mateo AU - Morehouse, Allison AU - Kim, P. Jane AU - Manber, Rachel AU - Goldstein-Piekarski, N. Andrea PY - 2022/3/14 TI - Viability of an Early Sleep Intervention to Mitigate Poor Sleep and Improve Well-being in the COVID-19 Pandemic: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e34409 VL - 11 IS - 3 KW - insomnia KW - COVID-19 KW - pandemic KW - telehealth KW - cognitive behavioral therapy KW - CBT-I KW - sleep KW - depression KW - well-being KW - telemedicine KW - impact KW - mental health KW - therapy N2 - Background: The COVID-19 pandemic has led to drastic increases in the prevalence and severity of insomnia symptoms. These increases in insomnia complaints have been paralleled by significant decreases in well-being, including increased symptoms of depression, anxiety, and suicidality and decreased quality of life. However, the efficacy and impact of early treatment of insomnia symptoms on future sleep and well-being remain unknown. Objective: Here, we present the framework and protocol for a novel feasibility, pilot study that aims to investigate whether a brief telehealth insomnia intervention targeting new insomnia that developed during the pandemic prevents deterioration of well-being, including symptoms of insomnia, depression, anxiety, suicidality, and quality of life. Methods: The protocol details a 2-arm randomized controlled feasibility trial to investigate the efficacy of a brief, telehealth-delivered, early treatment of insomnia and evaluate its potential to prevent deterioration of well-being. Participants with clinically significant insomnia symptoms that began during the pandemic were randomized to either a treatment group or a 28-week waitlist control group. Treatment consists of 4 telehealth sessions of cognitive behavioral therapy for insomnia (CBT-I) delivered over 5 weeks. All participants will complete assessments of insomnia symptom severity, well-being, and daily habits checklist at baseline (week 0) and at weeks 1-6, 12, 28, and 56. Results: The trial began enrollment on June 3, 2020 and closed enrollment on June 17, 2021. As of October 2021, 49 participants had been randomized to either immediate treatment or a 28-week waitlist; 23 participants were still active in the protocol. Conclusions: To our knowledge, this protocol would represent the first study to test an early sleep intervention for improving insomnia that emerged during the COVID-19 pandemic. The findings of this feasibility study could provide information about the utility of CBT-I for symptoms that emerge in the context of other stressors before they develop a chronic course and deepen understanding of the relationship between sleep and well-being. Trial Registration: ClinicalTrials.gov NCT04409743; https://clinicaltrials.gov/ct2/show/NCT04409743 International Registered Report Identifier (IRRID): DERR1-10.2196/34409 UR - https://www.researchprotocols.org/2022/3/e34409 UR - http://dx.doi.org/10.2196/34409 UR - http://www.ncbi.nlm.nih.gov/pubmed/34995204 ID - info:doi/10.2196/34409 ER - TY - JOUR AU - Sato, Daisuke AU - Sekizawa, Yoichi AU - Sutoh, Chihiro AU - Hirano, Yoshiyuki AU - Okawa, Sho AU - Hirose, Motohisa AU - Takemura, Ryo AU - Shimizu, Eiji PY - 2022/2/9 TI - Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy and the Three Good Things Exercise for Insomnia: 3-Arm Randomized Controlled Trial JO - J Med Internet Res SP - e28747 VL - 24 IS - 2 KW - insomnia KW - internet-based treatment KW - cognitive behavioral therapy KW - positive psychology KW - randomized controlled trial KW - mobile phone N2 - Background: The treatment of insomnia with sleep medication causes problems such as long-term use, dependence, and significant economic losses, including medical expenses. Evidence-based lifestyle guidance is required to improve insomnia symptoms not only in person but also in easy-to-use web-based formats. Objective: This study aims to clarify whether unguided internet-based cognitive behavioral therapy (ICBT) or the Three Good Things (TGT) exercise, both administered as self-help internet interventions without email support, could improve insomnia symptoms compared with a waiting list control (WLC) group. Methods: A 4-week program was implemented, and participants were randomly allocated to 1 of the 3 groups. The primary outcome measure was the Pittsburgh Sleep Questionnaire (PSQI) score at 4 weeks compared with baseline. Results: Of the 21,394 individuals invited to participate, 312 (1.46%) met the eligibility criteria and were randomly assigned to 1 of the 3 groups. Of these 312 individuals, 270 (86.5%; ICBT 79/270, 29.3%; TGT 88/270, 32.6%; and WLC 103/270, 38.1%) completed a postintervention survey at 4 and 8 weeks. The adjusted mean changes of the primary outcome measure (PSQI) in the ICBT (?1.56, 95% CI ?2.52 to ?0.59; P<.001) and TGT (?1.15, 95% CI ?2.08 to ?0.23; P=.002) groups at 4 weeks from baseline showed a significant improvement compared with the WLC group. The adjusted mean changes in the secondary outcome measures of sleep onset latency, total sleep time, Athens Insomnia Scale score, and Patient Health Questionnaire-9 score at 4 weeks from baseline, as well as in the PSQI at 8 weeks from baseline, showed significant improvement for ICBT. Moreover, total sleep time, Athens Insomnia Scale, and Patient Health Questionnaire-9 scores at 4 weeks from baseline showed a significant improvement in the TGT group compared with the WLC group. Conclusions: A total of 4 weeks of unguided ICBT and TGT exercises improved insomnia. Trial Registration: University Hospital Medical Information Network Clinical Trial Registry UMIN000034927; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000039814 UR - https://www.jmir.org/2022/2/e28747 UR - http://dx.doi.org/10.2196/28747 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138259 ID - info:doi/10.2196/28747 ER - TY - JOUR AU - Carmona, E. Nicole AU - Usyatynsky, Aleksandra AU - Kutana, Samlau AU - Corkum, Penny AU - Henderson, Joanna AU - McShane, Kelly AU - Shapiro, Colin AU - Sidani, Souraya AU - Stinson, Jennifer AU - Carney, E. Colleen PY - 2021/11/1 TI - A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study JO - JMIR Form Res SP - e25392 VL - 5 IS - 11 KW - youth KW - sleep KW - technology KW - mHealth KW - self-management KW - adolescents KW - young adults KW - mobile phone N2 - Background: Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz?s with Empirical Support). Objective: This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods: Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results: In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode?4) on the items ?easy to use,? ?easy to understand,? ?time commitment,? and ?overall satisfaction? and was rated as credible (mode?4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions: Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration: ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294 UR - https://formative.jmir.org/2021/11/e25392 UR - http://dx.doi.org/10.2196/25392 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723820 ID - info:doi/10.2196/25392 ER - TY - JOUR AU - Qanash, Sultan AU - Al-Husayni, Faisal AU - Falata, Haneen AU - Halawani, Ohud AU - Jahra, Enas AU - Murshed, Boshra AU - Alhejaili, Faris AU - Ghabashi, Ala?a AU - Alhashmi, Hashem PY - 2021/10/6 TI - Effect of Electronic Device Addiction on Sleep Quality and Academic Performance Among Health Care Students: Cross-sectional Study JO - JMIR Med Educ SP - e25662 VL - 7 IS - 4 KW - electronic devices KW - addiction KW - sleep quality KW - grade point average KW - academic performance KW - health care students KW - medical education KW - sleep KW - student performance KW - screen time KW - well-being N2 - Background: Sleep quality ensures better physical and psychological well-being. It is regulated through endogenous hemostatic, neurogenic, and circadian processes. Nonetheless, environmental and behavioral factors also play a role in sleep hygiene. Electronic device use is increasing rapidly and has been linked to many adverse effects, raising public health concerns. Objective: This study aimed to investigate the impact of electronic device addiction on sleep quality and academic performance among health care students in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted from June to December 2019 at 3 universities in Jeddah. Of the 1000 students contacted, 608 students from 5 health sciences disciplines completed the questionnaires. The following outcome measures were used: Smartphone Addiction Scale for Adolescents?short version (SAS-SV), Pittsburgh Sleep Quality Index (PSQI), and grade point average (GPA). Results: The median age of participants was 21 years, with 71.9% (437/608) being female. Almost all of the cohort used smartphones, and 75.0% (456/608) of them always use them at bedtime. Half of the students (53%) have poor sleep quality, while 32% are addicted to smartphone use. Using multivariable logistic regression, addiction to smartphones (SAS-SV score >31 males and >33 females) was significantly associated with poor sleep quality (PSQI >5) with an odds ratio of 1.8 (1.2-2.7). In addition, male gender and older students (age ?21 years) were significantly associated with lower GPA (<4.5), with an odds ratio of 1.6 (1.1-2.3) and 2.3 (1.5-3.6), respectively; however, addiction to smartphones and poor sleep quality were not significantly associated with a lower GPA. Conclusions: Electronic device addiction is associated with increased risk for poor sleep quality; however, electronic device addiction and poor sleep quality are not associated with increased risk for a lower GPA. UR - https://mededu.jmir.org/2021/4/e25662 UR - http://dx.doi.org/10.2196/25662 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612827 ID - info:doi/10.2196/25662 ER - TY - JOUR AU - Kuczy?ski, Wojciech AU - Wibowo, Erik AU - Hoshino, Tetsuro AU - Kudrycka, Aleksandra AU - Ma?olepsza, Aleksandra AU - Karwowska, Urszula AU - Pruszkowska, Milena AU - Wasiak, Jakub AU - Kuczy?ska, Aleksandra AU - Spa?ka, Jakub AU - Pruszkowska-Przybylska, Paulina AU - Mokros, ?ukasz AU - Bia?as, Adam AU - Bia?asiewicz, Piotr AU - Sasanabe, Ryujiro AU - Blagrove, Mark AU - Manning, John PY - 2021/10/6 TI - Understanding the Associations of Prenatal Androgen Exposure on Sleep Physiology, Circadian Proteins, Anthropometric Parameters, Hormonal Factors, Quality of Life, and Sex Among Healthy Young Adults: Protocol for an International, Multicenter Study JO - JMIR Res Protoc SP - e29199 VL - 10 IS - 10 KW - digit ratio KW - sleep KW - sex hormones KW - testosterone KW - estrogen KW - circadian proteins KW - circadian rhythm KW - chronotype KW - miRNA N2 - Background: The ratio of the second finger length to the fourth finger length (2D:4D ratio) is considered to be negatively correlated with prenatal androgen exposure (PAE) and positively correlated with prenatal estrogen. Coincidentally, various brain regions are sensitive to PAE, and their functions in adults may be influenced by the prenatal actions of sex hormones. Objective: This study aims to assess the relationship between PAE (indicated by the 2D:4D ratio) and various physiological (sex hormone levels and sleep-wake parameters), psychological (mental health), and sexual parameters in healthy young adults. Methods: This study consists of two phases. In phase 1, we will conduct a survey-based study and anthropometric assessments (including 2D:4D ratio and BMI) in healthy young adults. Using validated questionnaires, we will collect self-reported data on sleep quality, sexual function, sleep chronotype, anxiety, and depressive symptoms. In phase 2, a subsample of phase 1 will undergo polysomnography and physiological and genetic assessments. Sleep architecture data will be obtained using portable polysomnography. The levels of testosterone, estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, prolactin, melatonin, and circadian regulatory proteins (circadian locomotor output cycles kaput [CLOCK], timeless [TIM], and period [PER]) and the expression levels of some miRNAs will be measured using blood samples. The rest and activity cycle will be monitored using actigraphy for a 7-day period. Results: In Poland, 720 participants were recruited for phase 1. Among these, 140 completed anthropometric measurements. In addition, 25 participants joined and completed phase 2 data collection. Recruitment from other sites will follow. Conclusions: Findings from our study may help to better understand the plausible role of PAE in sleep physiology, mental health, and sexual quality of life in young adults. International Registered Report Identifier (IRRID): DERR1-10.2196/29199 UR - https://www.researchprotocols.org/2021/10/e29199 UR - http://dx.doi.org/10.2196/29199 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612837 ID - info:doi/10.2196/29199 ER - TY - JOUR AU - Borrmann, Francisca Paz AU - O'Connor-Reina, Carlos AU - Ignacio, M. Jose AU - Rodriguez Ruiz, Elisa AU - Rodriguez Alcala, Laura AU - Dzembrovsky, Florencia AU - Baptista, Peter AU - Garcia Iriarte, T. Maria AU - Casado Alba, Carlos AU - Plaza, Guillermo PY - 2021/8/6 TI - Muscular Assessment in Patients With Severe Obstructive Sleep Apnea Syndrome: Protocol for a Case-Control Study JO - JMIR Res Protoc SP - e30500 VL - 10 IS - 8 KW - myofunctional therapy KW - sleep apnea KW - sleep disordered breathing KW - speech therapy KW - phenotype KW - sleep KW - therapy KW - protocol KW - muscle KW - assessment KW - case study KW - exercise KW - airway KW - respiratory N2 - Background: Myofunctional therapy is currently a reasonable therapeutic option to treat obstructive sleep apnea-hypopnea syndrome (OSAHS). This therapy is based on performing regular exercises of the upper airway muscles to increase their tone and prevent their collapse. Over the past decade, there has been an increasing number of publications in this area; however, to our knowledge, there are no studies focused on patients who can most benefit from this therapy. Objective: This protocol describes a case-control clinical trial aimed at determining the muscular features of patients recently diagnosed with severe OSAHS compared with those of healthy controls. Methods: Patients meeting set criteria will be sequentially enrolled up to a sample size of 40. Twenty patients who meet the inclusion criteria for controls will also be evaluated. Patients will be examined by a qualified phonoaudiologist who will take biometric measurements and administer the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES), Friedman Staging System, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index questionnaires. Measures of upper airway muscle tone will also be performed using the Iowa Oral Performance Instrument and tongue digital spoon devices. Evaluation will be recorded and reevaluated by a second specialist to determine concordance between observers. Results: A total of 60 patients will be enrolled. Both the group with severe OSAHS (40 patients) and the control group (20 subjects) will be assessed for differences between upper airway muscle tone and OMES questionnaire responses. Conclusions: This study will help to determine muscle patterns in patients with severe OSAHS and can be used to fill the gap currently present in the assessment of patients suitable to be treated with myofunctional therapy. Trial Registration: ISRCTN Registry ISRCTN12596010; https://www.isrctn.com/ISRCTN12596010 International Registered Report Identifier (IRRID): PRR1-10.2196/30500 UR - https://www.researchprotocols.org/2021/8/e30500 UR - http://dx.doi.org/10.2196/30500 UR - http://www.ncbi.nlm.nih.gov/pubmed/34115605 ID - info:doi/10.2196/30500 ER - TY - JOUR AU - Woolf, B. Thomas AU - Goheer, Attia AU - Holzhauer, Katherine AU - Martinez, Jonathan AU - Coughlin, W. Janelle AU - Martin, Lindsay AU - Zhao, Di AU - Song, Shanshan AU - Ahmad, Yanif AU - Sokolinskyi, Kostiantyn AU - Remayeva, Tetyana AU - Clark, M. Jeanne AU - Bennett, Wendy AU - Lehmann, Harold PY - 2021/7/23 TI - Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing JO - JMIR Form Res SP - e26297 VL - 5 IS - 7 KW - mhealth KW - circadian KW - sleep KW - ecological momentary assessment KW - timing of eating KW - mobile applications KW - habits KW - body weight KW - surveys and questionnaires N2 - Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ?4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. UR - https://formative.jmir.org/2021/7/e26297 UR - http://dx.doi.org/10.2196/26297 UR - http://www.ncbi.nlm.nih.gov/pubmed/34296999 ID - info:doi/10.2196/26297 ER - TY - JOUR AU - Laursen, Hjorth Ditte AU - Rom, Gitte AU - Banghøj, Margareta Anne AU - Tarnow, Lise AU - Schou, Lone PY - 2021/7/20 TI - Improving Diabetes Self-management by Providing Continuous Positive Airway Pressure Treatment to Patients With Obstructive Sleep Apnea and Type 2 Diabetes: Qualitative Exploratory Interview Study JO - JMIR Form Res SP - e27062 VL - 5 IS - 7 KW - diabetes KW - diabetes self-management KW - obstructive sleep apnea KW - continued positive airway pressure KW - sleep patterns KW - sleepiness in daily life KW - sleep apnea KW - elderly KW - sleep N2 - Background: There is a high prevalence of unexplained and unexplored obstructive sleep apnea (OSA) among patients with type 2 diabetes. The daytime symptoms of OSA include severe fatigue, cognitive problems, a decreased quality of life, and the reduced motivation to perform self-care. These symptoms impair the management of both diabetes and daily life. OSA may therefore have negative implications for diabetes self-management. Continuous positive airway pressure (CPAP) therapy is used to treat OSA. This treatment improves sleep quality, insulin resistance, and glycemic control. Although the benefits of using CPAP as a treatment for OSA are clear, the noncompliance rate is high, and the evidence for the perceived effect that CPAP treatment has on patients with type 2 diabetes and OSA is poor. Objective: The purpose of this study was to analyze the impacts that comorbid diabetes and OSA have on the daily lives of older adults and to investigate the perceived effect that CPAP treatment for OSA has on patients? diabetes self-management. Methods: A qualitative follow-up study that involved in-depth, semistructured dyad interviews with couples before and after CPAP treatment (N=22) was conducted. Patients were recruited from the Hilleroed Hospital in Denmark and were all diagnosed with type 2 diabetes, aged >18 years, and had an apnea-hypopnea index of ?15. All interviews were coded and analyzed via thematic analysis. Results: The results showed that patients and their partners did not consider OSA to be a serious disorder, as they believed that OSA symptoms were similar to those of the process of aging. Patients experienced poor nocturnal sleep, took frequent daytime naps, exhibited reduced cognitive function, and had low levels of physical activity and a high-calorie diet. These factors negatively influenced their diabetes self-management. Despite the immediate benefit of CPAP treatment, most patients (11/12, 92%) faced technical challenges when using the CPAP device. Only the patients with severe OSA symptoms that affected their daily lives overcame the challenges of using the CPAP device and thereby improved their diabetes self-management. Patients with less severe symptoms rated CPAP-related challenges as more burdensome than their symptoms. Conclusions: If used correctly, CPAP has the potential to significantly improve OSA, resulting in better sleep quality; improved physical activity; improved diet; and, in the end, better diabetes self-management. However, there are many barriers to undergoing CPAP treatment, and only few patients manage to overcome these barriers and comply with correct treatment. UR - https://formative.jmir.org/2021/7/e27062 UR - http://dx.doi.org/10.2196/27062 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283032 ID - info:doi/10.2196/27062 ER - TY - JOUR AU - Ferreira-Santos, Daniela AU - Rodrigues, Pereira Pedro PY - 2021/6/22 TI - Enhancing Obstructive Sleep Apnea Diagnosis With Screening Through Disease Phenotypes: Algorithm Development and Validation JO - JMIR Med Inform SP - e25124 VL - 9 IS - 6 KW - obstructive sleep apnea KW - screening KW - risk factors KW - phenotypes KW - Bayesian network classifiers N2 - Background: The American Academy of Sleep Medicine guidelines suggest that clinical prediction algorithms can be used in patients with obstructive sleep apnea (OSA) without replacing polysomnography, which is the gold standard. Objective: This study aims to develop a clinical decision support system for OSA diagnosis according to its standard definition (apnea-hypopnea index plus symptoms), identifying individuals with high pretest probability based on risk and diagnostic factors. Methods: A total of 47 predictive variables were extracted from a cohort of patients who underwent polysomnography. A total of 14 variables that were univariately significant were then used to compute the distance between patients with OSA, defining a hierarchical clustering structure from which patient phenotypes were derived and described. Affinity from individuals at risk of OSA phenotypes was later computed, and cluster membership was used as an additional predictor in a Bayesian network classifier (model B). Results: A total of 318 patients at risk were included, of whom 207 (65.1%) individuals were diagnosed with OSA (111, 53.6% with mild; 50, 24.2% with moderate; and 46, 22.2% with severe). On the basis of predictive variables, 3 phenotypes were defined (74/207, 35.7% low; 104/207, 50.2% medium; and 29/207, 14.1% high), with an increasing prevalence of symptoms and comorbidities, the latter describing older and obese patients, and a substantial increase in some comorbidities, suggesting their beneficial use as combined predictors (median apnea-hypopnea indices of 10, 14, and 31, respectively). Cross-validation results demonstrated that the inclusion of OSA phenotypes as an adjusting predictor in a Bayesian classifier improved screening specificity (26%, 95% CI 24-29, to 38%, 95% CI 35-40) while maintaining a high sensitivity (93%, 95% CI 91-95), with model B doubling the diagnostic model effectiveness (diagnostic odds ratio of 8.14). Conclusions: Defined OSA phenotypes are a sensitive tool that enhances our understanding of the disease and allows the derivation of a predictive algorithm that can clearly outperform symptom-based guideline recommendations as a rule-out approach for screening. UR - https://medinform.jmir.org/2021/6/e25124 UR - http://dx.doi.org/10.2196/25124 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156340 ID - info:doi/10.2196/25124 ER - TY - JOUR AU - Schütz, Narayan AU - Saner, Hugo AU - Botros, Angela AU - Pais, Bruno AU - Santschi, Valérie AU - Buluschek, Philipp AU - Gatica-Perez, Daniel AU - Urwyler, Prabitha AU - Müri, M. René AU - Nef, Tobias PY - 2021/6/11 TI - Contactless Sleep Monitoring for Early Detection of Health Deteriorations in Community-Dwelling Older Adults: Exploratory Study JO - JMIR Mhealth Uhealth SP - e24666 VL - 9 IS - 6 KW - sleep restlessness KW - telemonitoring KW - digital biomarkers KW - contactless sensing KW - pervasive computing KW - home-monitoring KW - older adults KW - toss and turns KW - sleep monitoring KW - body movements in bed N2 - Background: Population aging is posing multiple social and economic challenges to society. One such challenge is the social and economic burden related to increased health care expenditure caused by early institutionalizations. The use of modern pervasive computing technology makes it possible to continuously monitor the health status of community-dwelling older adults at home. Early detection of health issues through these technologies may allow for reduced treatment costs and initiation of targeted preventive measures leading to better health outcomes. Sleep is a key factor when it comes to overall health and many health issues manifest themselves with associated sleep deteriorations. Sleep quality and sleep disorders such as sleep apnea syndrome have been extensively studied using various wearable devices at home or in the setting of sleep laboratories. However, little research has been conducted evaluating the potential of contactless and continuous sleep monitoring in detecting early signs of health problems in community-dwelling older adults. Objective: In this work we aim to evaluate which contactlessly measurable sleep parameter is best suited to monitor perceived and actual health status changes in older adults. Methods: We analyzed real-world longitudinal (up to 1 year) data from 37 community-dwelling older adults including more than 6000 nights of measured sleep. Sleep parameters were recorded by a pressure sensor placed beneath the mattress, and corresponding health status information was acquired through weekly questionnaires and reports by health care personnel. A total of 20 sleep parameters were analyzed, including common sleep metrics such as sleep efficiency, sleep onset delay, and sleep stages but also vital signs in the form of heart and breathing rate as well as movements in bed. Association with self-reported health, evaluated by EuroQol visual analog scale (EQ-VAS) ratings, were quantitatively evaluated using individual linear mixed-effects models. Translation to objective, real-world health incidents was investigated through manual retrospective case-by-case analysis. Results: Using EQ-VAS rating based self-reported perceived health, we identified body movements in bed?measured by the number toss-and-turn events?as the most predictive sleep parameter (t score=?0.435, P value [adj]=<.001). Case-by-case analysis further substantiated this finding, showing that increases in number of body movements could often be explained by reported health incidents. Real world incidents included heart failure, hypertension, abdominal tumor, seasonal flu, gastrointestinal problems, and urinary tract infection. Conclusions: Our results suggest that nightly body movements in bed could potentially be a highly relevant as well as easy to interpret and derive digital biomarker to monitor a wide range of health deteriorations in older adults. As such, it could help in detecting health deteriorations early on and provide timelier, more personalized, and precise treatment options. UR - https://mhealth.jmir.org/2021/6/e24666 UR - http://dx.doi.org/10.2196/24666 UR - http://www.ncbi.nlm.nih.gov/pubmed/34114966 ID - info:doi/10.2196/24666 ER - TY - JOUR AU - Haq, Ul Irfan AU - Hameed, Ali Mansoor AU - Thomas, Marry Merlin AU - Syed, Shahzada Khezar AU - Othman, Mahmoud Ahmad Mohammad AU - Ahmed, Shakeel AU - Alabbas, Abdallah Abbas AU - Ahmad, Mushtaq PY - 2021/5/12 TI - Knowledge of Sleep Disorders Among Physicians at a Tertiary Care Hospital in Qatar: Cross-sectional Study JO - Interact J Med Res SP - e25606 VL - 10 IS - 2 KW - sleep disordered breathing KW - obstructive sleep apnea KW - sleep KW - physician KW - physician knowledge KW - sleep disorder KW - survey method KW - attitudes KW - practice N2 - Background: Sleep disorders constitute a major health problem because of their relatively high and rising prevalence. Several studies worldwide have analyzed health care providers? knowledge of sleep disorders. Objective: In this study, we aimed to assess the knowledge of sleep disorders among physicians in Qatar. Methods: A total of 250 physicians were surveyed regarding their knowledge of sleep medicine by using the validated 30-item Assessment of Sleep Knowledge in Medical Education (ASKME) Survey. The participants included residents, fellows, and consultants in medicine and allied subspecialties. A high score was defined as ?60% of correctly answered questions, implying the respondent has adequate knowledge of sleep disorders. Results: Responses were received from 158 of the 250 physicians, with a response rate of 63.2%. This included responses from 34 residents, 74 clinical fellows, and 50 consultants. The overall mean score was 15.53 (SD 4.42), with the highest possible score of 30. Only 57 of 158 (36.1%) respondents were able to answer ?60% of the questions correctly. No statistically significant difference was found in the scores of participants with regard to their ranks (ie, residents, fellows, or consultants) or years of medical training. Conclusions: This study demonstrates that health care providers in Qatar have decreased awareness and knowledge about sleep medicine, which may reflect reduced emphasis on sleep disorders during medical school and training. Increasing awareness regarding sleep medicine among nonspecialist physicians will allow early detection and treatment of sleep disorders, thereby reducing the morbidity associated with these disorders. UR - https://www.i-jmr.org/2021/2/e25606 UR - http://dx.doi.org/10.2196/25606 UR - http://www.ncbi.nlm.nih.gov/pubmed/33978594 ID - info:doi/10.2196/25606 ER -