Comparative analysis of sleep physiology using qualitative and quantitative criteria for insomnia symptoms

Ruda Lee; Olivia Larson; Sammy Dhaliwal; Kibum Moon; Bethany Gerardy; Philip de Chazal; Peter A Cistulli; Ning-Hung Chen; Fang Han; Qing Yun Li; Greg Maislin; Nigel McArdle; Thomas Penzel; Richard J Schwab; Sergio Tufik; Ulysses J Magalang; Bhajan Singh; Thorarinn Gislason; Allan I Pack; Brendan T Keenan; Magdy Younes; Philip Gehrman

doi:10.1093/sleep/zsae301

Comparative analysis of sleep physiology using qualitative and quantitative criteria for insomnia symptoms

Sleep. 2024 Dec 23:zsae301. doi: 10.1093/sleep/zsae301. Online ahead of print.

Authors

Ruda Lee¹, Olivia Larson¹, Sammy Dhaliwal², Kibum Moon³, Bethany Gerardy⁴, Philip de Chazal⁵, Peter A Cistulli^{6

7}, Ning-Hung Chen⁸, Fang Han⁹, Qing Yun Li¹⁰, Greg Maislin¹¹, Nigel McArdle^{12

13}, Thomas Penzel¹⁴, Richard J Schwab¹¹, Sergio Tufik¹⁵, Ulysses J Magalang¹⁶, Bhajan Singh^{12

13}, Thorarinn Gislason^{17

18}, Allan I Pack¹¹, Brendan T Keenan¹¹, Magdy Younes^{4

19}, Philip Gehrman^{2

20}

Affiliations

¹ Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
³ Department of Psychology, Georgetown University, Washington, DC, USA.
⁴ YRT Limited, Winnipeg, Manitoba, Canada.
⁵ Charles Perkins Centre, Faculty of Engineering, University of Sydney, Sydney, Australia.
⁶ Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁷ Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia.
⁸ Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁹ Division of Sleep Medicine, Peking University People's Hospital, Beijing, China, Faculty of Medicine, Department of Medicine, University of Iceland, Reykjavik, Iceland.
¹⁰ Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaSleep Department, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
¹¹ Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA.
¹² Western Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
¹³ Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, AustraliaDivision of Pulmonary, Critical Care, and Sleep Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
¹⁴ Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany.
¹⁵ Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
¹⁶ Division of Pulmonary, Critical Care, and Sleep Medicine, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
¹⁷ Faculty of Medicine, Department of Medicine, University of Iceland, Reykjavik, Iceland.
¹⁸ Sleep Department, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
¹⁹ Sleep Disorders Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
²⁰ Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.

PMID: 39713965
DOI: 10.1093/sleep/zsae301

Abstract

Despite decades of research, defining insomnia remains challenging due to its complex and variable nature. Various diagnostic systems emphasize the chronic nature of insomnia and its impact on daily functioning, relying heavily on patient self-reporting due to limitations in objective measures like polysomnography (PSG). Discrepancies between subjective experiences and objective PSG results highlight the need for more nuanced approaches, such as electroencephalogram (EEG) spectral analysis, which reveals distinct patterns of high-frequency activity in individuals with insomnia. This study explores EEG markers of insomnia by integrating subjective reports with objective physiological markers, specifically ORP (Odds-Ratio-Product) and spectral features, to address inconsistencies found in previous research and clinical settings. Qualitative and quantitative definitions of insomnia are contrasted to highlight differences in sleep architecture and EEG characteristics. The research aims to determine whether groups defined by weekly frequency and daily duration of symptoms have different distribution patterns and which physiological characteristics best distinguish insomnia patients from controls. Our findings suggest that ORP, as a dependent variable, captures the most significant differences in the independent variables across the model. Elevated beta power in insomnia patients indicates increased cortical arousal, supporting the perspective of insomnia as a hyperarousal disorder. Future research should focus on using ORP to enhance the understanding of sleep disturbances in insomnia. Comprehensive evaluation of insomnia requires integrating qualitative, quantitative, and neurophysiological data to fully understand its impact on sleep architecture and quality.

Keywords: EEG Spectral analysis; Hyperarousal; Insomnia; Odds-Ratio-Product (ORP); Sleep Architecture; Sleep/Wake Physiology.

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