Search

Objectives: Evidence suggests that emotion regulation difficulty may play an important role in the association between life stress, sleep disturbance and depressive symptoms. We proposed two models depicting the possible moderating roles of prefrontal cortex activation during emotion regulation in the associations among these variables and tested them. We hypothesized that (1) the association between stress and sleep disturbance would differ across prefrontal cortex activation during emotion regulation (moderation model) and (2) the indirect effects of stress on depressive symptoms through sleep disturbance would depend on prefrontal cortex activation during emotion regulation (moderated mediation model). Methods: Forty-eight healthy adults without sleep disorders based on nocturnal polysomnography participated in this study. They received functional magnetic resonance imaging scans while performing an emotion regulation task. They also completed questionnaires assessing life stress, sleep disturbance and depressive symptoms. The proposed models were tested using the PROCESS macro for SPSS. Results: As hypothesized, there was a significant moderating effect of prefrontal cortex activation during emotion regulation on the association between life stress and sleep disturbance. Furthermore, right lateral prefrontal cortex activation had a moderating role in the indirect effect of life stress on depressive symptoms through sleep disturbance. Conclusion: These findings highlight the important role of prefrontal cortex function during emotion regulation in the associations between stress, sleep disturbance and depressive symptoms. Increasing lateral prefrontal cortex recruitment when regulating the emotional response to negative life events may be critical for the prevention and intervention of depression as well as sleep problems. [ABSTRACT FROM AUTHOR]

Summary This study investigated the altered neural activation underlying cognitive control under emotional and sleep‐related interference conditions and its role in subjective sleep disturbance in patients with chronic insomnia disorder. In total, 48 patients with chronic insomnia disorder, and 48 age‐, sex‐ and body mass index‐matched controls were included in this study. They completed self‐reported questionnaires to assess subjective sleep and emotional distress. A sleep diary was used to evaluate subjective sleep parameters. All participants performed the emotional Stroop task (three blocks each of negative emotional, sleep‐related, and neutral words) during functional magnetic resonance imaging assessments. We compared brain activation during the emotional Stroop task between the two groups. We also analysed the correlations between altered neural activation and sleep variables. Less neural activation was detected in the right anterior prefrontal cortex of patients with chronic insomnia disorder than in controls when performing the emotional Stroop task with negative emotional words. The decrease in neural activation was negatively correlated with scores on Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Dysfunctional Beliefs and Attitudes about Sleep Scale. In contrast, they were positively correlated with subjective total sleep time and sleep efficiency as reported in sleep diaries. A decrease in right anterior prefrontal cortex activity under the negative emotional words condition of the emotional Stroop task in patients with chronic insomnia disorder suggests a failure of top‐down inhibition of negative emotional stimuli. This failure induces disinhibition of cognitive hyperarousal, manifested as rumination or intrusive worries, and potentially causing subjective sleep disturbances. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioral therapy for insomnia (CBTi) is the first-line therapy for chronic insomnia. Mobile app-based CBTi (MCBTi) can enhance the accessibility of CBTi treatment; however, few studies have evaluated the effectiveness of MCBTi using a multicenter, randomized controlled trial design., Objective: We aimed to assess the efficacy of Somzz, an MCBTi that provides real-time and tailored feedback to users, through comparison with an active comparator app., Methods: In our multicenter, single-blind randomized controlled trial study, participants were recruited from 3 university hospitals and randomized into a Somzz group and a sleep hygiene education (SHE) group at a 1:1 ratio. The intervention included 6 sessions for 6 weeks, with follow-up visits over a 4-month period. The Somzz group received audiovisual sleep education, guidance on relaxation therapy, and real-time feedback on sleep behavior. The primary outcome was the Insomnia Severity Index score, and secondary outcomes included sleep diary measures and mental health self-reports. We analyzed the outcomes based on the intention-to-treat principle., Results: A total of 98 participants were randomized into the Somzz (n=49, 50%) and SHE (n=49, 50%) groups. Insomnia Severity Index scores for the Somzz group were significantly lower at the postintervention time point (9.0 vs 12.8; t 95 =3.85; F 2,95 =22.76; η p 2 =0.13; P<.001) and at the 3-month follow-up visit (11.3 vs 14.7; t 68 =2.61; F 2,68 =5.85; η p 2 =0.03; P=.01) compared to those of the SHE group. The Somzz group maintained their treatment effect at the postintervention time point and follow-ups, with a moderate to large effect size (Cohen d=-0.62 to -1.35; P<.01 in all cases). Furthermore, the Somzz group showed better sleep efficiency (t 95 =-3.32; F 2,91 =69.87; η p 2 =0.41; P=.001), wake after sleep onset (t 95 =2.55; F 2,91 =51.81; η p 2 =0.36; P=.01), satisfaction (t 95 =-2.05; F 2,91 =26.63; η p 2 =0.20; P=.04) related to sleep, and mental health outcomes, including depression (t 95 =2.11; F 2,94 =29.64; η p 2 =0.21; P=.04) and quality of life (t 95 =-3.13; F 2,94 =54.20; η p 2 =0.33; P=.002), compared to the SHE group after the intervention. The attrition rate in the Somzz group was 12% (6/49)., Conclusions: Somzz outperformed SHE in improving insomnia, mental health, and quality of life. The MCBTi can be a highly accessible, time-efficient, and effective treatment option for chronic insomnia, with high compliance., Trial Registration: Clinical Research Information Service (CRiS) KCT0007292; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22214&search&#95;page=L., (©Jiyoon Shin, Sujin Kim, Jooyoung Lee, Hyerin Gu, Jihye Ahn, Chowon Park, Mincheol Seo, Jeong Eun Jeon, Ha Young Lee, Ji Won Yeom, Sojeong Kim, Yeaseul Yoon, Heon-Jeong Lee, Seog Ju Kim, Yu Jin Lee. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 26.07.2024.)