How should we measure delayed sleep phase shift in severe, refractory obsessive-compulsive disorder?

Area of Science:

• Sleep Medicine
• Psychiatry
• Medical Technology

Background:

• Previous studies indicated a high prevalence of delayed sleep phase shift in inpatients with severe, enduring Obsessive-Compulsive Disorder (OCD).
• Nursing observations suggested factors like patient demographics and symptom severity influenced sleep disturbances.
• The influence of the hospital environment on sleep patterns necessitated a more objective assessment method.

Purpose of the Study:

• To compare the accuracy of actigraphy with direct nursing observation and clinical sleep scales in patients with severe, enduring OCD.
• To evaluate actigraphy as a reliable, acceptable, and valid alternative for sleep/activity cycle measurement.

Main Methods:

• A cohort of patients admitted to a specialized OCD treatment unit over 29 months participated.
• Data collected included demographics, OCD and depression severity, social/occupational disability, sleep self-ratings, direct nursing sleep observations, and actigraphy records.

Main Results:

• Data from 36 patients with severe OCD were analyzed.
• Direct nursing observation identified delayed sleep phase shift in 33% of patients.
• Actigraphy showed good agreement with nursing observation (kappa = 0.63) and the St. George's Insomnia Questionnaire (kappa = 0.66).

Conclusions:

• Actigraphy is a reliable method for recording sleep/activity cycles in individuals with severe, enduring OCD.
• This supports the use of actigraphy as a valid and acceptable tool in clinical settings for this patient group.