Impact of Hyperarousal on Simple and Complex Cognitive Task Performance Among Insomnia Sufferers

Conditions:Insomnia Sleep Studies, Insomnia Sleep Studies, Insomnia Sleep Studies
Therapuetic Areas:Psychiatry / Psychology
Age Range:21 - 80
Start Date:October 1, 2014
End Date:January 1, 2018
Contact:Jack Edinger, PhD

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The purpose of this study is to learn more about people with insomnia disorder and cognitive
impairment. Cognitive impairment is difficulty with mental abilities such as thinking,
knowing and remembering.

Primary insomnia (PI) sufferers typically complain of such daytime impairments as reduced
attention, concentration, memory and global mental acuity. Moreover, epidemiological studies
have shown PI contributes to reduced productivity, work and traffic accidents, and serious
falls among the elderly. Despite such findings, laboratory-based efforts to corroborate the
cognitive complaints of PI sufferers have produced mixed results. Indeed, many studies
comparing PI sufferers with non-complaining normal sleepers across a range of
neuropsychological tests have failed to show any relative deficits among the PI group. Such
findings, in turn, has led to the impression that PI patients cognitive complaints may be
over-stated and result from their attentional bias toward minor cognitive errors,
dysfunctional beliefs about the impact of insomnia on functioning or excessive self focus
rather than to any measurable daytime impairment.

However, many previous such studies were underpowered due to small sample sizes and employed
neuropsychological tests designed for detecting impairment resulting from brain
disease/damage rather than the more subtle albeit significant impairments of which PI
patients complain. In recent research, we and others have shown that PI sufferers do,
indeed, show greater deficits (slower and more variable reaction times) particularly on
complex switching attention tasks. Moreover, there is some preliminary evidence that the
subgroup of PI sufferers with elevated levels of physiological hyperarousal are most prone
to suffer from neuro-cognitive performance deficits than are matched groups of PI sufferers
who are not physiologically hyperaroused and normally alert individuals without insomnia.
For example, Fernandez-Mendoza recently showed that PI sufferers with a hyperarousal pattern
suggested by their objective short sleep duration on serial polysomnograms (PSG) performed
more poorly on a complex switching attention task than did both normal sleepers and PI
sufferers with normal objective sleep durations.

In our efforts to follow up on this latter work, we recently examined the error rates of
alert and sleepy PI sufferers and normal sleepers across a series of simple and complex
reaction time tasks. We employed age and gender matched samples of PI (N=89) sufferers and
normal sleepers-NS (N=95). Participants underwent three nights of PSG followed by daytime
testing with a four-trial Multiple Sleep Latency Test-MSLT. The PI and NS groups were each
subdivided into "alert" (e.g., MSLT mean onset latency > 8 minutes) and "sleepy" (e.g., MSLT
mean onset latency < 8 minutes) subgroups to allow for testing the main and interaction
effects of participant type and level of alertness. "Alert" participants had longer MSLT
latencies than "sleepy" participants (12.7 vs. 5.4 minutes). PI sufferers had fewer correct
responses on performance testing than did NS. However, as shown by the adjacent, figure we
found a significant group x alertness interaction (p = .0013) with greater error rates
occurring among alert (hyperaroused) PI sufferers (Mean=4.5±3.6 errors per trial) than among
alert NS (Mean=2.6±1.9 errors per trial). This was particularly true for the more complex
switching attention task.

Our work along with that of Fernandez-Mendoza serve to confirm that PI sufferers have
measureable objective neuro-cognitive deficits and provide some preliminary suggestion for
the types of testing approaches that should be used to detect them. The identification of
tests sensitive to PI sufferers' cognitive deficits are particularly relevant for testing
the effects of current and future insomnia therapies on patients' objective daytime
functioning. Measures of daytime dysfunction can and should serve as endpoints for assessing
benefits and detriments of insomnia therapies. In addition, our recent work suggests that
subgroups of PI sufferers may differ in their daytime deficits, with those showing
physiological hyperarousal being most prone to make errors. This finding suggests that
different types or doses of treatment may be needed to reverse the daytime impairments of
the hyperaroused and non-aroused PI patients. However, our line of research would benefit by
replication and extension findings to (1) further confirm the detrimental effects of
physiological hyperarousal on PI sufferer's neuro-cognitive functioning; and (2) identify a
broader range of tests that can be used for assessing diurnal cognitive impairments in both
physiologically hyperaroused and lesser aroused PI groups. The current project will address
these aims.

Inclusion Criteria:

- 21 to 80 years of age

- Insomnia sufferers enrolled, will meet Research Diagnostic Criteria for insomnia

- score > 14 on the Insomnia Severity Index

- report insomnia for > 3 months

- have sleep difficulties > 3 nights per week

- score < 3 on the Epworth Sleepiness Scale (ESS)

- score > 40 on the Hyperarousal Scale and report an inability to nap in the daytime

- The normal sleepers enrolled will report general satisfaction with sleep and no
sleep/wake complaints, score < 10 on the ESS, score < 35 on the Hyperarousal Scale,
and deny a practice of routine daytime napping

Exclusion Criteria:

- sleep-disruptive medical condition (e.g., rheumatoid arthritis)

- current major psychiatric (Axis I) condition on the basis of a Structured Clinical
Interview for Psychiatric Disorders (SCID)

- sedative hypnotic dependence and unwillingness/inability to abstain from these
medications while in the study

- use of anxiolytics, antidepressants, or any other psychotropic medication

- an apnea/hypopnea index (AHI) > 5 or a periodic limb movement-related arousal index >
5 during on screening PSG that includes a full sleep montage to allow for
detection/diagnosis of sleep-disordered breathing and PLMD

- female participants who have tested positive on urine pregnancy tests or planing on
becoming pregnant during the study

- Additionally, self-described NS who meet criteria for any sleep disorder and those
insomnia sufferers who meet criteria for a comorbid sleep disorder in addition to
insomnia disorder will also be excluded
We found this trial at
1400 Jackson St
Denver, Colorado 80206
(303) 388-4461
Phone: 303-398-1981
National Jewish Health National Jewish Health is known worldwide for treatment of patients with respiratory,...
Denver, CO
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