Clusters of insomnia disorder: An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability

Christopher B. Miller; Delwyn J. Bartlett; Anna E. Mullins; Kirsty L. Dodds; Christopher J. Gordon; Simon D. Kyle; Jong Won Kim; Angela L. D'Rozario; Rico S C Lee; Maria Comas; Nathaniel S. Marshall; Brendon J. Yee; Colin A. Espie; Ronald R. Grunstein

doi:10.5665/sleep.6230

Clusters of insomnia disorder: An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability

Christopher B. Miller^*, Delwyn J. Bartlett, Anna E. Mullins, Kirsty L. Dodds, Christopher J. Gordon, Simon D. Kyle, Jong Won Kim, Angela L. D'Rozario, Rico S C Lee, Maria Comas, Nathaniel S. Marshall, Brendon J. Yee, Colin A. Espie, Ronald R. Grunstein

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

39 Citations (Scopus)

Abstract

Study Objectives: To empirically derive and evaluate potential clusters of Insomnia Disorder through cluster analysis from polysomnography (PSG). We hypothesized that clusters would differ on neurocognitive performance, sleep-onset measures of quantitative (q)-EEG and heart rate variability (HRV). Methods: Research volunteers with Insomnia Disorder (DSM-5) completed a neurocognitive assessment and overnight PSG measures of total sleep time (TST), wake time after sleep onset (WASO), and sleep onset latency (SOL) were used to determine clusters. Results: From 96 volunteers with Insomnia Disorder, cluster analysis derived at least two clusters from objective sleep parameters: Insomnia with normal objective sleep duration (I-NSD: n = 53) and Insomnia with short sleep duration (I-SSD: n = 43). At sleep onset, differences in HRV between I-NSD and I-SSD clusters suggest attenuated parasympathetic activity in I-SSD (P < 0.05). Preliminary work suggested three clusters by retaining the I-NSD and splitting the I-SSD cluster into two: I-SSD A (n = 29): defined by high WASO and I-SSD B (n = 14): a second I-SSD cluster with high SOL and medium WASO. The I-SSD B cluster performed worse than I-SSD A and I-NSD for sustained attention (P ≤ 0.05). In an exploratory analysis, q-EEG revealed reduced spectral power also in I-SSD B before (Delta, Alpha, Beta-1) and after sleep-onset (Beta-2) compared to I-SSD A and I-NSD (P ≤ 0.05). Conclusions: Two insomnia clusters derived from cluster analysis differ in sleep onset HRV. Preliminary data suggest evidence for three clusters in insomnia with differences for sustained attention and sleep-onset q-EEG. Clinical Trial Registration: Insomnia 100 sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR) identification number 12612000049875. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347742.

Original language	English
Pages (from-to)	1993-2004
Number of pages	12
Journal	Sleep
Volume	39
Issue number	11
DOIs	https://doi.org/10.5665/sleep.6230
Publication status	Published - 1 Nov 2016
Externally published	Yes

Keywords

And phenotyping
Cluster analysis
Insomnia Disorder
Polysomnography
Sleep

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10.5665/sleep.6230

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Miller, C. B., Bartlett, D. J., Mullins, A. E., Dodds, K. L., Gordon, C. J., Kyle, S. D., Kim, J. W., D'Rozario, A. L., Lee, R. S. C., Comas, M., Marshall, N. S., Yee, B. J., Espie, C. A., & Grunstein, R. R. (2016). Clusters of insomnia disorder: An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability. Sleep, 39(11), 1993-2004. https://doi.org/10.5665/sleep.6230

@article{931c154d45f748de8a0be84516468684,

title = "Clusters of insomnia disorder: An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability",

abstract = "Study Objectives: To empirically derive and evaluate potential clusters of Insomnia Disorder through cluster analysis from polysomnography (PSG). We hypothesized that clusters would differ on neurocognitive performance, sleep-onset measures of quantitative (q)-EEG and heart rate variability (HRV). Methods: Research volunteers with Insomnia Disorder (DSM-5) completed a neurocognitive assessment and overnight PSG measures of total sleep time (TST), wake time after sleep onset (WASO), and sleep onset latency (SOL) were used to determine clusters. Results: From 96 volunteers with Insomnia Disorder, cluster analysis derived at least two clusters from objective sleep parameters: Insomnia with normal objective sleep duration (I-NSD: n = 53) and Insomnia with short sleep duration (I-SSD: n = 43). At sleep onset, differences in HRV between I-NSD and I-SSD clusters suggest attenuated parasympathetic activity in I-SSD (P < 0.05). Preliminary work suggested three clusters by retaining the I-NSD and splitting the I-SSD cluster into two: I-SSD A (n = 29): defined by high WASO and I-SSD B (n = 14): a second I-SSD cluster with high SOL and medium WASO. The I-SSD B cluster performed worse than I-SSD A and I-NSD for sustained attention (P ≤ 0.05). In an exploratory analysis, q-EEG revealed reduced spectral power also in I-SSD B before (Delta, Alpha, Beta-1) and after sleep-onset (Beta-2) compared to I-SSD A and I-NSD (P ≤ 0.05). Conclusions: Two insomnia clusters derived from cluster analysis differ in sleep onset HRV. Preliminary data suggest evidence for three clusters in insomnia with differences for sustained attention and sleep-onset q-EEG. Clinical Trial Registration: Insomnia 100 sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR) identification number 12612000049875. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347742.",

keywords = "And phenotyping, Cluster analysis, Insomnia Disorder, Polysomnography, Sleep",

author = "Miller, {Christopher B.} and Bartlett, {Delwyn J.} and Mullins, {Anna E.} and Dodds, {Kirsty L.} and Gordon, {Christopher J.} and Kyle, {Simon D.} and Kim, {Jong Won} and D'Rozario, {Angela L.} and Lee, {Rico S C} and Maria Comas and Marshall, {Nathaniel S.} and Yee, {Brendon J.} and Espie, {Colin A.} and Grunstein, {Ronald R.}",

year = "2016",

month = nov,

day = "1",

doi = "10.5665/sleep.6230",

language = "English",

volume = "39",

pages = "1993--2004",

journal = "Sleep",

issn = "0161-8105",

publisher = "The American Academy of Sleep Medicine",

number = "11",

}

Miller, CB, Bartlett, DJ, Mullins, AE, Dodds, KL, Gordon, CJ, Kyle, SD, Kim, JW, D'Rozario, AL, Lee, RSC, Comas, M, Marshall, NS, Yee, BJ, Espie, CA & Grunstein, RR 2016, 'Clusters of insomnia disorder: An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability', Sleep, vol. 39, no. 11, pp. 1993-2004. https://doi.org/10.5665/sleep.6230

Clusters of insomnia disorder : An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability. / Miller, Christopher B.; Bartlett, Delwyn J.; Mullins, Anna E. et al.

In: Sleep, Vol. 39, No. 11, 01.11.2016, p. 1993-2004.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Clusters of insomnia disorder

T2 - An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability

AU - Miller, Christopher B.

AU - Bartlett, Delwyn J.

AU - Mullins, Anna E.

AU - Dodds, Kirsty L.

AU - Gordon, Christopher J.

AU - Kyle, Simon D.

AU - Kim, Jong Won

AU - D'Rozario, Angela L.

AU - Lee, Rico S C

AU - Comas, Maria

AU - Marshall, Nathaniel S.

AU - Yee, Brendon J.

AU - Espie, Colin A.

AU - Grunstein, Ronald R.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Study Objectives: To empirically derive and evaluate potential clusters of Insomnia Disorder through cluster analysis from polysomnography (PSG). We hypothesized that clusters would differ on neurocognitive performance, sleep-onset measures of quantitative (q)-EEG and heart rate variability (HRV). Methods: Research volunteers with Insomnia Disorder (DSM-5) completed a neurocognitive assessment and overnight PSG measures of total sleep time (TST), wake time after sleep onset (WASO), and sleep onset latency (SOL) were used to determine clusters. Results: From 96 volunteers with Insomnia Disorder, cluster analysis derived at least two clusters from objective sleep parameters: Insomnia with normal objective sleep duration (I-NSD: n = 53) and Insomnia with short sleep duration (I-SSD: n = 43). At sleep onset, differences in HRV between I-NSD and I-SSD clusters suggest attenuated parasympathetic activity in I-SSD (P < 0.05). Preliminary work suggested three clusters by retaining the I-NSD and splitting the I-SSD cluster into two: I-SSD A (n = 29): defined by high WASO and I-SSD B (n = 14): a second I-SSD cluster with high SOL and medium WASO. The I-SSD B cluster performed worse than I-SSD A and I-NSD for sustained attention (P ≤ 0.05). In an exploratory analysis, q-EEG revealed reduced spectral power also in I-SSD B before (Delta, Alpha, Beta-1) and after sleep-onset (Beta-2) compared to I-SSD A and I-NSD (P ≤ 0.05). Conclusions: Two insomnia clusters derived from cluster analysis differ in sleep onset HRV. Preliminary data suggest evidence for three clusters in insomnia with differences for sustained attention and sleep-onset q-EEG. Clinical Trial Registration: Insomnia 100 sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR) identification number 12612000049875. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347742.

AB - Study Objectives: To empirically derive and evaluate potential clusters of Insomnia Disorder through cluster analysis from polysomnography (PSG). We hypothesized that clusters would differ on neurocognitive performance, sleep-onset measures of quantitative (q)-EEG and heart rate variability (HRV). Methods: Research volunteers with Insomnia Disorder (DSM-5) completed a neurocognitive assessment and overnight PSG measures of total sleep time (TST), wake time after sleep onset (WASO), and sleep onset latency (SOL) were used to determine clusters. Results: From 96 volunteers with Insomnia Disorder, cluster analysis derived at least two clusters from objective sleep parameters: Insomnia with normal objective sleep duration (I-NSD: n = 53) and Insomnia with short sleep duration (I-SSD: n = 43). At sleep onset, differences in HRV between I-NSD and I-SSD clusters suggest attenuated parasympathetic activity in I-SSD (P < 0.05). Preliminary work suggested three clusters by retaining the I-NSD and splitting the I-SSD cluster into two: I-SSD A (n = 29): defined by high WASO and I-SSD B (n = 14): a second I-SSD cluster with high SOL and medium WASO. The I-SSD B cluster performed worse than I-SSD A and I-NSD for sustained attention (P ≤ 0.05). In an exploratory analysis, q-EEG revealed reduced spectral power also in I-SSD B before (Delta, Alpha, Beta-1) and after sleep-onset (Beta-2) compared to I-SSD A and I-NSD (P ≤ 0.05). Conclusions: Two insomnia clusters derived from cluster analysis differ in sleep onset HRV. Preliminary data suggest evidence for three clusters in insomnia with differences for sustained attention and sleep-onset q-EEG. Clinical Trial Registration: Insomnia 100 sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR) identification number 12612000049875. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347742.

KW - And phenotyping

KW - Cluster analysis

KW - Insomnia Disorder

KW - Polysomnography

KW - Sleep

UR - http://www.scopus.com/inward/record.url?scp=84995685516&partnerID=8YFLogxK

U2 - 10.5665/sleep.6230

DO - 10.5665/sleep.6230

M3 - Article

C2 - 27568796

AN - SCOPUS:84995685516

VL - 39

SP - 1993

EP - 2004

JO - Sleep

JF - Sleep

SN - 0161-8105

IS - 11

ER -

Clusters of insomnia disorder: An exploratory cluster analysis of objective sleep parameters reveals differences in neurocognitive functioning, quantitative EEG, and heart rate variability

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