David A Kalmbach1, Daniel J Buysse2, Philip Cheng1, Thomas Roth1, Alexander Yang1, Christopher L Drake3. 1. Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA. 2. Center for Sleep and Circadian Science, Departments of Psychiatry and Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA. 3. Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA. Electronic address: cdrake1@hfhs.org.
Abstract
BACKGROUND: Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia. METHODS: In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal. RESULTS: Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency. CONCLUSIONS: Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.
BACKGROUND: Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia. METHODS: In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal. RESULTS: Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency. CONCLUSIONS: Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.
Authors: Elizabeth J Mezick; Karen A Matthews; Martica Hall; Thomas W Kamarck; Daniel J Buysse; Jane F Owens; Steven E Reis Journal: Psychoneuroendocrinology Date: 2009-05-17 Impact factor: 4.905
Authors: David A Kalmbach; Philip Cheng; Louise M O'Brien; Leslie M Swanson; Roopina Sangha; Srijan Sen; Constance Guille; Andrea Cuamatzi-Castelan; Alasdair L Henry; Thomas Roth; Christopher L Drake Journal: Sleep Med Date: 2020-03-21 Impact factor: 3.492
Authors: Ana Ribeiro; Rachel Gabriel; Bernardo Garcia; Casey Cuccio; William Aqeel; Alejandro Moreno; Colby Landeen; Arlene Hurley; Neil Kavey; Donald Pfaff Journal: Proc Natl Acad Sci U S A Date: 2022-06-13 Impact factor: 12.779
Authors: Peter M Kreuzer; Stefan Günther; Jorge Simoes; Michael Ziereis; Berthold Langguth Journal: BMC Health Serv Res Date: 2020-11-13 Impact factor: 2.655
Authors: David A Kalmbach; Philip Cheng; Andrea Roth; Thomas Roth; Leslie M Swanson; Louise M O'Brien; David M Fresco; Nicholas C Harb; Andrea S Cuamatzi-Castelan; Anthony N Reffi; Christopher L Drake Journal: Sleep Adv Date: 2022-03-11