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Eivind Schjelderup Skarpsno,1,2 Melanie Rae Simpson,1 Arnfinn Seim,1,3 Maria Hrozanova,1 Marthe Alida Bakøy,3 Nina Elisabeth Klevanger,1 Lene Aasdahl1,3 1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway; 3Unicare Helsefort Rehabilitation Centre, Rissa, NorwayCorrespondence: Eivind Schjelderup Skarpsno, Department of Public Health and Nursing, NTNU, Trondheim, Norway, Tel +47 97521297, Email eivind.s.skarpsno@ntnu.noBackground: Insomnia is prevalent among patients receiving treatment for long-term musculoskeletal complaints in inpatient rehabilitation settings. Cognitive-behavioral therapy for insomnia (CBT-I) is effective for improving sleep quality in patients with pain, but a lack of therapists often limits the capacity to use this therapy in rehabilitation programs. The aim of this randomized clinical trial (RCT) is to evaluate the effectiveness of app-delivered CBT-I adjunct to inpatient multimodal rehabilitation for individuals with comorbid musculoskeletal complaints and insomnia, compared with rehabilitation (usual care) only.Methods: This RCT has two parallel arms: 1) inpatient multimodal rehabilitation and 2) app-delivered CBT-I adjunct to inpatient multimodal rehabilitation. Patients referred to Unicare Helsefort (Norway) with long-term chronic musculoskeletal complaints are invited to the study. Eligible and consenting participants will be randomized to the intervention and usual care at a ratio of 2:1. Assessments will be carried out at baseline (prior to randomization), 6 weeks (at the end of rehabilitation), 3 months (primary outcome), as well as 6 and 12 months after the rehabilitation. The primary outcome is insomnia severity measured at 3 months. Secondary outcomes include pain intensity, health-related quality of life, fatigue, physical function, work abilit

DesignProspective, observational.SettingBaseline monitoring at <500 m for 2 weeks and altitude monitoring at 1800 m for 17-22 days. ParticipantsThirty-three senior national-team endurance athletes (mean age 25.8 ± S.D. 2.8 years, 16 women). MeasurementsDaily measurements of sleep (using a microwave Doppler radar at baseline and altitude), oxygen saturation (SpO2), training load and subjective recovery (at altitude). ResultsAt altitude vs. baseline, sleep duration (P = .036) and light sleep (P < .001) decreased, while deep sleep (P < .001) and respiration rate (P = .020) increased. During the first altitude week vs. baseline, deep sleep increased (P = .001). During the first vs. the second and third altitude weeks, time in bed (P = .005), sleep duration (P = .001), and light sleep (P < .001) decreased. Generally, increased SpO2 was associated with increased deep sleep while increased training load was associated with increased respiration rate. ConclusionThis is the first study to document changes in sleep from near-sea-level baseline and during a training camp at 1800 m in elite endurance athletes. Ascending to altitude reduced total sleep time and light sleep, while deep sleep and respiration rate increased. SpO2 and training load at altitude were associated with these responses. This research informs our understanding of the changes in sleep occurring in elite endurance athletes attending training camps at competition altitudes.

DesignProspective, observational.SettingBaseline monitoring at <500 m for 2 weeks and altitude monitoring at 1800 m for 17-22 days. ParticipantsThirty-three senior national-team endurance athletes (mean age 25.8 ± S.D. 2.8 years, 16 women). MeasurementsDaily measurements of sleep (using a microwave Doppler radar at baseline and altitude), oxygen saturation (SpO2), training load and subjective recovery (at altitude). ResultsAt altitude vs. baseline, sleep duration (P = .036) and light sleep (P < .001) decreased, while deep sleep (P < .001) and respiration rate (P = .020) increased. During the first altitude week vs. baseline, deep sleep increased (P = .001). During the first vs. the second and third altitude weeks, time in bed (P = .005), sleep duration (P = .001), and light sleep (P < .001) decreased. Generally, increased SpO2 was associated with increased deep sleep while increased training load was associated with increased respiration rate. ConclusionThis is the first study to document changes in sleep from near-sea-level baseline and during a training camp at 1800 m in elite endurance athletes. Ascending to altitude reduced total sleep time and light sleep, while deep sleep and respiration rate increased. SpO2 and training load at altitude were associated with these responses. This research informs our understanding of the changes in sleep occurring in elite endurance athletes attending training camps at competition altitudes.

DesignProspective, observational.SettingBaseline monitoring at <500 m for 2 weeks and altitude monitoring at 1800 m for 17-22 days. ParticipantsThirty-three senior national-team endurance athletes (mean age 25.8 ± S.D. 2.8 years, 16 women). MeasurementsDaily measurements of sleep (using a microwave Doppler radar at baseline and altitude), oxygen saturation (SpO2), training load and subjective recovery (at altitude). ResultsAt altitude vs. baseline, sleep duration (P = .036) and light sleep (P < .001) decreased, while deep sleep (P < .001) and respiration rate (P = .020) increased. During the first altitude week vs. baseline, deep sleep increased (P = .001). During the first vs. the second and third altitude weeks, time in bed (P = .005), sleep duration (P = .001), and light sleep (P < .001) decreased. Generally, increased SpO2 was associated with increased deep sleep while increased training load was associated with increased respiration rate. ConclusionThis is the first study to document changes in sleep from near-sea-level baseline and during a training camp at 1800 m in elite endurance athletes. Ascending to altitude reduced total sleep time and light sleep, while deep sleep and respiration rate increased. SpO2 and training load at altitude were associated with these responses. This research informs our understanding of the changes in sleep occurring in elite endurance athletes attending training camps at competition altitudes.

DesignProspective, observational.SettingBaseline monitoring at <500 m for 2 weeks and altitude monitoring at 1800 m for 17-22 days. ParticipantsThirty-three senior national-team endurance athletes (mean age 25.8 ± S.D. 2.8 years, 16 women). MeasurementsDaily measurements of sleep (using a microwave Doppler radar at baseline and altitude), oxygen saturation (SpO2), training load and subjective recovery (at altitude). ResultsAt altitude vs. baseline, sleep duration (P = .036) and light sleep (P < .001) decreased, while deep sleep (P < .001) and respiration rate (P = .020) increased. During the first altitude week vs. baseline, deep sleep increased (P = .001). During the first vs. the second and third altitude weeks, time in bed (P = .005), sleep duration (P = .001), and light sleep (P < .001) decreased. Generally, increased SpO2 was associated with increased deep sleep while increased training load was associated with increased respiration rate. ConclusionThis is the first study to document changes in sleep from near-sea-level baseline and during a training camp at 1800 m in elite endurance athletes. Ascending to altitude reduced total sleep time and light sleep, while deep sleep and respiration rate increased. SpO2 and training load at altitude were associated with these responses. This research informs our understanding of the changes in sleep occurring in elite endurance athletes attending training camps at competition altitudes.

DesignProspective, observational.SettingBaseline monitoring at <500 m for 2 weeks and altitude monitoring at 1800 m for 17-22 days. ParticipantsThirty-three senior national-team endurance athletes (mean age 25.8 ± S.D. 2.8 years, 16 women). MeasurementsDaily measurements of sleep (using a microwave Doppler radar at baseline and altitude), oxygen saturation (SpO2), training load and subjective recovery (at altitude). ResultsAt altitude vs. baseline, sleep duration (P = .036) and light sleep (P < .001) decreased, while deep sleep (P < .001) and respiration rate (P = .020) increased. During the first altitude week vs. baseline, deep sleep increased (P = .001). During the first vs. the second and third altitude weeks, time in bed (P = .005), sleep duration (P = .001), and light sleep (P < .001) decreased. Generally, increased SpO2 was associated with increased deep sleep while increased training load was associated with increased respiration rate. ConclusionThis is the first study to document changes in sleep from near-sea-level baseline and during a training camp at 1800 m in elite endurance athletes. Ascending to altitude reduced total sleep time and light sleep, while deep sleep and respiration rate increased. SpO2 and training load at altitude were associated with these responses. This research informs our understanding of the changes in sleep occurring in elite endurance athletes attending training camps at competition altitudes.