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Sleep structure and awakening threshold in delayed sleep-wake phase disorder patients compared to healthy sleepers

Solheim, Brandy; Langsrud, Knut; Kallestad, Håvard; Engstrøm, Morten; Bjorvatn, Bjørn; Sand, Trond
Journal article, Peer reviewed
Accepted version
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Solheim (627.9Kb)
URI
http://hdl.handle.net/11250/2596338
Date
2018
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  • Institutt for nevromedisin og bevegelsesvitenskap [2286]
  • Institutt for psykisk helse [760]
  • Publikasjoner fra CRIStin - NTNU [26703]
Original version
Sleep Medicine. 2018, 46 61-68.   10.1016/j.sleep.2018.03.001
Abstract
Study Objectives

Difficult early morning awakening is a primary symptom of delayed sleep-wake phase disorder (DSWPD), however, it remains poorly investigated. Our main objective was to quantify the awakening threshold in DSWPD-patients and healthy controls as well as investigate a possible relationship with sleep stages. A secondary objective was to compare habitual sleep measured by polysomnography and actigraphy between patients and controls.

Methods

Twenty DSWPD patients and 16 controls had two polysomnographic recordings at a sleep laboratory. Participants followed their habitual sleep-wake schedule on the first night and a forced sleep-wake schedule (00:00–07:00 h) on the second night. We used a custom-made alarm clock was for the forced-night awakening, starting at 72 dB sound intensity which increased up to 104 dB.

Results

Mean awakening threshold in dB was higher in patients compared to controls; 75.5 vs. 72.6, p = 0.01, and the difference could not be explained statistically by sleep-time. Patients who were in REM sleep upon attempted awakening had a higher awakening threshold compared to patients who were in NREM sleep; 80.0 vs 74.7, F = 6.4, p = 0.02. Patients had increased sleep onset latency both at home with actigraphy and by PSG during the first laboratory night (20.6 vs 12.1 min, p = 0.004), however no further differences between the groups were observed regarding sleep structure.

Conclusions

A high early-morning forced awakening threshold in DSWPD was related to REM sleep. Sleep onset problems, even with habitual bedtimes, may also be an integral feature of DSWPD.
Publisher
Elsevier
Journal
Sleep Medicine

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