Sleep-Wake Survival Dynamics in People with Insomnia

Lieke WA Hermans,1 Marta Regis,2 Pedro Fonseca,1,3 Bertram Hoondert,4 Tim RM Leufkens,3 Sebastiaan Overeem,1,4 Merel M van Gilst1,4 1Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; 2Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, the Netherlands; 3Philips Research, Eindhoven, the Netherlands; 4Sleep Medicine Center Kempenhaeghe, Heeze, the NetherlandsCorrespondence: Lieke WA HermansDepartment of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600, MB Eindhoven, the NetherlandsEmail l.w.a.hermans@tue.nlIntroduction: Assessing objective measures of sleep fragmentation could yield important features reflecting impaired sleep quality in people with insomnia. Survival analysis allows the specific examination of the stability of NREM sleep, REM sleep and wake. The objective of this study was to assess the differences between survival dynamics of NREM sleep, REM sleep and wake between people with insomnia and healthy controls.Methods: We analyzed retrospective polysomnography recordings from 86 people with insomnia and 94 healthy controls. For each participant, survival dynamics of REM sleep, NREM sleep and wake were represented using Weibull distributions. We used lasso penalized parameter selection in combination with linear regression to analyze the difference between participant groups with respect to the Weibull scale and shape parameters, while correcting for age, sex, total sleep time and relevant interaction effects.Results: Significant effects of group were found for the NREM scale parameter, and for the wake scale and shape parameters. Results indicated that people with insomnia had less stable NREM sleep and more stable wake after sleep onset compared to healthy controls. Additionally, the altered distribution of wake segment lengths indicated an increased difficulty to fall asleep after longer awakenings in the insomnia group. However, these differences were mainly observed in younger participants. Significant effects of group for the survival parameters of REM sleep were not found.Conclusion: As illustrated by our results, survival analysis can be very useful for disentangling different types of sleep fragmentation in people with insomnia. For instance, the current findings suggest that people with insomnia have an increased fragmentation of NREM sleep, but not necessarily of REM sleep. Additional research into the underlying mechanisms of NREM sleep fragmentation could possibly lead to a better understanding of impaired sleep quality in people with insomnia, and consequently to improved treatment.Keywords: insomnia, survival analysis, sleep fragmentation