We want to thank Ms Wanting Li for the digital technology support.&#160;This work was supported by&#160;Inner Mongolia Medical Fund (2022QNWN0010, 2023SGGZ047, 2023SGGZ0010).

The study was approved by the Academic Ethics Committee of the Inner Mongolia Mental Health Center (The Third Hospital of Inner Mongolia Autonomous Region, Brain Hospital of Inner Mongolia Autonomous Region) in Hohhot, China. An informed consent form was signed by all study participants.
1. PSG procedure
<ol>
	<li>Data collection
	<ol>
		<li>Include patients with MDD who were diagnosed according to the DSM-V. 
		NOTE: This study included 22 patients with MDD who were diagnosed according to the DSM-V. Due to the low educational level, 2 patients with MDD refused to participate. Because both of them found it was not easy to read characters while completing TMT-B in the cognitive screening tool.</li>
		<li>Exclude participants who were diagnosed with severe dementia, anxiety, delirium, and other diseases, which made them unable to complete PSG for the whole night.</li>
		<li>Collect participants&#39; demographics, including name, nationality, gender, age, date of birth, marriage, complaints, symptoms, main diagnosis, history, department, temperature, pulse, respiratory rate, blood pressure, height, weight, body mass index, abdominal circumference, and upper chest circumference, were collected.</li>
		<li>Each participant was instructed to complete the Epworth Sleeping Scale16.</li>
	</ol>
	</li>
	<li>Connecting derivations
	<ol>
		<li>After collecting the participants&#39; information, lead the participant to the sleep monitoring room.</li>
		<li>Collect all the derivations of electroencephalogram (EEG), electrooculogram (EOG), chin electromyogram (EMG), and electrocardiogram (ECG) step-by-step. 
		NOTE: The participant should keep his/her face, skin, and hair clean and dry.</li>
		<li>Connect 15 electrodes of EEG according to the international 10-20 system of electrode placement (Figure 1)17.</li>
		<li>Connect two derivations of EOG (E1, E2) as shown in Figure 2.</li>
		<li>Connect three derivations of chin EMG (Chin1, Chin2, ChinZ) as shown in Figure 3.</li>
		<li>Connect two derivations of ECG (+, &#8722;) as shown in Figure 4.</li>
	</ol>
	</li>
	<li>Starting the data acquisition system
	<ol>
		<li>Double-click Device Manager to start the software.</li>
		<li>Double-click the Room option and add the personal information of the participant. 
		NOTE: The personal information includes name, gender, date of birth, file name, file path, etc. More details can be added as needed (for example, height, body weight, neck circumference, doctor, technician, hospital, address, marital status, profession, and guardian [if the participant is a child]).</li>
		<li>Click the OK button.</li>
		<li>Click the Start Recording button.</li>
		<li>Click the Calibration button and instruct the participant to perform according to the step-by-step calibration procedure (see Supplementary Figure 1). 
		NOTE: The calibration step-by-step procedure is listed in Table 1. During the calibration, the remote call system should be turned on so the participant can be guided to perform according to the doctors&#39; instructions.</li>
	</ol>
	</li>
	<li>Collecting data all night long
	<ol>
		<li>Keep the derivations in the correct position all night long. 
		NOTE: This will be done by the duty technician. The duty technician should have emergency management training for conditions like asthma, unstable angina, etc.</li>
	</ol>
	</li>
	<li>Post calibration
	<ol>
		<li>Awaken the participant and turn on the light of the sleep monitoring room.</li>
		<li>The wake-up time is usually at 6:00 am. Stop the monitoring if the participant wakes up before 6:00 am and does not want to continue.</li>
		<li>If the participant is in a rapid eye movement (REM) sleep period at 6:00 am, continue monitoring until the REM sleep period ends.</li>
		<li>Repeat step 1.3.5 once again for post-calibration.</li>
		<li>Click the Close button to stop recording.</li>
	</ol>
	</li>
	<li>Remove all the derivations gently to avoid skin damage.</li>
	<li>Scoring
	<ol>
		<li>Double-click the ProFusion PSG4 button to start the scoring system.</li>
		<li>Double-click the name of the participant to select the participant.</li>
		<li>Click the Scoring button and select the Scoring Automatically option to score sleep phases and arousals. 
		NOTE: Sleep phases and arousals were scored according to The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Technical Specifications18. Scoring can be manually modified by a technician, too.</li>
		<li>Click the Create button and layout the results (Figure 5).</li>
	</ol>
	</li>
	<li>Definitions and equations
	<ol>
		<li>Get variables including time in bed (TIB), total sleep time (TST), sleep latency (SL), wake after sleep onset (WASO), sleep efficiency (SE, equals TST/TB), and REM latency according to the PSG data and waves (as shown in Table 2).</li>
	</ol>
	</li>
</ol>
2. Using the cognitive screening tool
<ol>
	<li>Double-click the THINC-it button to start the software on the computer, enter the personal information, and instruct the participant to complete each subtest step by step.
	<ol>
		<li>Click the Chinese button to select the simplified Chinese version.</li>
		<li>Click the Plus button to add a new participant.</li>
		<li>Type in name, age, gender, dominant hand, educational level, and location at the corresponding blanks.</li>
		<li>Click the BEGIN TEST button to begin the subtests step by step (see Supplementary Figure 2).</li>
	</ol>
	</li>
	<li>Complete the perception deficits questionnaire (PDQ-5, subjective cognitive deficits).
	<ol>
		<li>Read aloud, &#34;During the past 7 days, how often did you have trouble getting things organized?&#34; and instruct the participant to choose one of the 5 response options: Never in the past 7 days, Rarely (once or twice), Sometimes (3 - 5 times), Often (about once a day), and Very often (more than once a day).</li>
		<li>Read aloud, &#34;During the past 7 days, how often did you have trouble concentrating on what you were reading?&#34; and instruct the participant to choose one of the 5 response options described in step 2.2.1.</li>
		<li>Read aloud, &#34;During the past 7 days, how often did you forget the date unless you looked it up?&#34; and instruct the participant to choose one of the 5 response options described in step 2.2.1.</li>
		<li>Read aloud, &#34;During the past 7 days, how often did you forget what you talked about after a telephone conversation?&#34; and instruct the participant to choose one of the 5 response options described in step 2.2.1.</li>
		<li>Read aloud, &#34;During the past 7 days, how often did you feel like your mind went totally blank?&#34; and and instruct the participant to choose one of the 5 response options described in step 2.2.1.</li>
		<li>Click the OK button to start other subtests.</li>
	</ol>
	</li>
	<li>Complete the spotter test (SPO, reflection of attention).
	<ol>
		<li>Click the Tutorial button and the Next button to read the step-by-step instructions.</li>
		<li>Click the Start button to begin the SPO test. 
		NOTE: The SPO test is used to assess attention; the participant needs to touch the suddenly appearing symbol as quickly as possible. 
		NOTE: This software will automatically show the Best Reaction Time (milliseconds), Correct Responses, Longest Streak, and Index on screen.</li>
		<li>Click the OK button to begin the next subtest.</li>
	</ol>
	</li>
	<li>Complete the symbol check test (SC, reflection of working memory).
	<ol>
		<li>Click the Tutorial and Next buttons to read the step-by-step instructions.</li>
		<li>Click the Start button to begin the SC test. 
		NOTE: The SC test is used to assess working memory. The participant needs to identify the symbol hidden before the timer runs out and recall the next hidden symbol. This software will automatically show the Fastest Reaction Time (milliseconds), Correct Answers, Longest Streak, and Index on screen.</li>
		<li>Click the OK button to begin the next subtest.</li>
	</ol>
	</li>
	<li>Complete the code breaker test (CB, reflection of information processing speed).
	<ol>
		<li>Click the Tutorial and Next buttons to read the step-by-step instructions.</li>
		<li>Click the Start button to begin the CB test. 
		NOTE: The CB test is used to assess information processing speed. The participant needs to click the correct symbol to fit the indicated circle (each symbol is identified into a certain number inside the circle). This software will show the Fastest Reaction Time (milliseconds), Correct Nodes, Longest Streak, as well as Index automatically on the screen.</li>
		<li>Click the OK button to enter the next subtest.</li>
	</ol>
	</li>
	<li>Complete the TMT-B (trails, reflection of executive function).
	<ol>
		<li>Click the Tutorial and Next buttons to read the step-by-step instructions.</li>
		<li>Click the Start button to begin the CB test. 
		NOTE: Trails test is used to assess executive function. The participant needs to trace a line beginning from a character to number 1 without lifting his/her finger, then continue from the number 1 to another character, then continue from this character to number 2, and continue it till 9, as fast as possible. This software automatically shows the Completion Time (milliseconds), Errors, Longest Streak, and Index on screen.</li>
		<li>Click the OK button to complete the last subtest. 
		NOTE: The software will automatically show participant performance on each test; download these results.</li>
	</ol>
	</li>
</ol>
3. Statistical analysis
<ol>
	<li>Use the Students&#39; t-tests to assess group differences. Perform the Pearson correlation analysis to evaluate the relation between sleep quality and cognitive function. Consider P &#60; 0.05 as statistically significant. 
	NOTE: All statistical analyses were performed using SPSS version 25.0.</li>
</ol>

Assessing Sleep Quality and Cognitive Function in Patients with Major Depressive Disorder

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	<li>Liu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Altered+gamma+oscillations+and+beta-gamma+coupling+in+drug-naive+first-episode+major+depressive+disorder:+Association+with+sleep+and+cognitive+disturbance.">Altered gamma oscillations and beta-gamma coupling in drug-naive first-episode major depressive disorder: Association with sleep and cognitive disturbance.</a> J Affect Disord. 316, 99-108 (2022).</li><li>Cha, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perceived+sleep+quality+predicts+cognitive+function+in+adults+with+major+depressive+disorder+independent+of+depression+severity.">Perceived sleep quality predicts cognitive function in adults with major depressive disorder independent of depression severity.</a> Ann Clin Psychiatry. 31 (1), 17-26 (2019).</li><li>Waters, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+clinical+utility+of+newer+antidepressant+agents:+Understanding+the+role+in+management+of+MDD.">The clinical utility of newer antidepressant agents: Understanding the role in management of MDD.</a> Ment Health Clin. 12 (5), 309-319 (2022).</li><li>Chen, R. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sleep+disorder+as+a+clinical+risk+factor+of+major+depression:+associated+with+cognitive+impairment.">Sleep disorder as a clinical risk factor of major depression: associated with cognitive impairment.</a> Asian J Psychiatr. 76, 103228 (2022).</li><li>Pearson, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+relationship+between+sleep+disturbance+and+cognitive+impairment+in+mood+disorders:+A+systematic+review.">The relationship between sleep disturbance and cognitive impairment in mood disorders: A systematic review.</a> J Affect Disord. 327, 207-216 (2023).</li><li>Biddle, D. J., Naismith, S. L., Griffiths, K. M., Christensen, H., Hickie, I. B., Glozier, N. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Associations+of+objective+and+subjective+sleep+disturbance+with+cognitive+function+in+older+men+with+comorbid+depression+and+insomnia.">Associations of objective and subjective sleep disturbance with cognitive function in older men with comorbid depression and insomnia.</a> Sleep Health. 3 (3), 178-183 (2017).</li><li>Li, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sleep+1uality+evaluation+based+on+Single-Lead+wearable+cardiac+cycle+acquisition+device.">Sleep 1uality evaluation based on Single-Lead wearable cardiac cycle acquisition device.</a> Sensors. 23 (1), 328 (2022).</li><li>Withrow, D., Roth, T., Koshorek, G., Roehrs, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relation+between+ambulatory+actigraphy+and+laboratory+polysomnography+in+insomnia+practice+and+research.">Relation between ambulatory actigraphy and laboratory polysomnography in insomnia practice and research.</a> J Sleep Res. 28 (4), e12854 (2019).</li><li>Orsolini, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+and+future+perspectives+on+the+major+depressive+disorder:+Focus+on+the+new+multimodal+antidepressant+vortioxetine.">Current and future perspectives on the major depressive disorder: Focus on the new multimodal antidepressant vortioxetine.</a> CNS Neurol Disord Drug Targets. 16 (1), 65-92 (2017).</li><li>De Berardis, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adjunctive+vortioxetine+for+SSRI-resistant+major+depressive+disorder:+a+&amp;#34;real-world&amp;#34;+chart+review+study.">Adjunctive vortioxetine for SSRI-resistant major depressive disorder: a &amp;#34;real-world&amp;#34; chart review study.</a> Braz J Psychiatry. 42 (3), 317-321 (2020).</li><li>Fiorillo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+and+management+of+cognitive+and+psychosocial+dysfunctions+in+patients+with+major+depressive+disorder:+A+clinical+review.">Assessment and management of cognitive and psychosocial dysfunctions in patients with major depressive disorder: A clinical review.</a> Front Psychiatry. 9, 493 (2018).</li><li>Hou, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=PSYCHOMETRIC+properties+of+the+Chinese+version+of+the+THINC-it+tool+for+cognitive+symptoms+in+patients+with+major+depressive+disorder.">PSYCHOMETRIC properties of the Chinese version of the THINC-it tool for cognitive symptoms in patients with major depressive disorder.</a> J Affect Disord. 273, 586-591 (2020).</li><li>McIntyre, R. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+THINC-Integrated+Tool+(THINC-it)+screening+assessment+for+cognitive+dysfunction:+validation+in+patients+with+major+depressive+disorder.">The THINC-Integrated Tool (THINC-it) screening assessment for cognitive dysfunction: validation in patients with major depressive disorder.</a> J Clin Psychiatry. 78 (7), 873-881 (2017).</li><li>Han, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+relationship+between+cognitive+dysfunction+through+THINC-Integrated+Tool+(THINC-it)+and+psychosocial+function+in+Chinese+patients+with+major+depressive+disorder.">The relationship between cognitive dysfunction through THINC-Integrated Tool (THINC-it) and psychosocial function in Chinese patients with major depressive disorder.</a> Front Psychiatry. 12, 763603 (2021).</li><li>Chen, N. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+Chinese+version+of+the+Epworth+sleepiness+scale.">Validation of a Chinese version of the Epworth sleepiness scale.</a> Qual Life Res. 11 (8), 817-821 (2002).</li><li>Swarnkar, V., Abeyratne, U. R., Hukins, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inter-hemispheric+asynchrony+of+the+brain+during+events+of+apnoea+and+EEG+arousals.">Inter-hemispheric asynchrony of the brain during events of apnoea and EEG arousals.</a> Physiol Meas. 28 (8), 869-880 (2007).</li><li>Berry, R. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+AASM+Manual+for+the+Scoring+of+Sleep+and+Associated+Events:+Rules,+Terminology+and+Technical+Specifications.+Version+2.5.">The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.5.</a> American Academy of Sleep Medicine. , (2018).</li><li>McCall, C., McCall, W. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Objective+vs.+subjective+measurements+of+sleep+in+depressed+insomniacs:+first+night+effect+or+reverse+first+night+effect.">Objective vs. subjective measurements of sleep in depressed insomniacs: first night effect or reverse first night effect.</a> J Clin Sleep Med. 8 (1), 59-65 (2012).</li><li>Tamaki, M., Nittono, H., Hayashi, M., Hori, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Examination+of+the+first-night+effect+during+the+sleep-onset+period.">Examination of the first-night effect during the sleep-onset period.</a> Sleep. 28 (2), 195-202 (2005).</li><li>Wichniak, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+antidepressants+on+sleep.">Effects of antidepressants on sleep.</a> Curr Psychiatry Rep. 19 (9), 63 (2017).</li><li>Zuurbier, L. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+small+vessel+disease+is+related+to+disturbed+24-h+activity+rhythms:+a+population-based+study.">Cerebral small vessel disease is related to disturbed 24-h activity rhythms: a population-based study.</a> Eur J Neurol. 22 (11), 1482-1487 (2015).</li></ol>

The authors have nothing to disclose.

This two-part protocol has critical steps that demand attention. For PSG, scoring is the most important step; thus, PSG technicians need to be certified and experienced. In addition, before PSG, communication between technicians and participants is necessary because patients might feel uncomfortable and quit during PSG. For the cognitive screening tool, the critical step is evaluating the cognitive function with digitized equipment. Doctors need to introduce the procedures step by step to ensure the participant understan...

Major depressive disorder (MDD), a serious mood disorder that causes significant morbidity and mortality, affects over 300 million people worldwide1. MDD is characterized by low mood, reduced drive, loss of interest, and thoughts of self-harm or suicide2. Cognitive symptoms and sleep disturbance (SD) are two non-mood-related symptoms of MDD3,4. Previous studies have shown that the prevalence of SD is 60-90% in patients with MDD, while the prevalence of sleep disorders among these patients in the Chinese population is 85.22%5. 
Although few studies have investigated the causal relationship between cognitive symptoms and SD, preliminary evidence suggests a significant association between sleep disorders and cognitive symptoms in individuals with MDD6. For example, Cha et al.3 found that subjective sleep quality predicted both subjective cognitive performance and objective cognitive impairments, which were partially mediated by depression severity. Biddle et al.7 also found that among older men with MDD, poor sleep efficiency (SE), measured by actigraphy, was associated with worse cognitive function independent of depression severity. The observed discrepancies may be caused by methodological differences. 
Within this literature, researchers have used various tools to evaluate sleep and cognition. The Pittsburgh Sleep Quality Index (PSQI) was commonly selected as a subjective tool. Actigraphic devices have also been used. However, PSG, regarded as the gold standard for detecting sleep disorders8, is a sensitive, objective SD assessment9. To our knowledge, among the studies of the relationship between sleep and cognition in patients with MDD, few have used PSG to evaluate sleep quality.
Cognitive symptoms in MDD might be multidimensional and addressed in some cases by new pharmacological strategies10,11. Several cognitive assessment tools suitable for MDD have emerged in recent years12. THINC-integrated tool (THINC-it; henceforth referred to as the cognitive screening tool), a validated cognitive screening tool developed by Hou et al.13, is composed of a subjective questionnaire (perceived deficits questionnaire, PDQ-5) and four objective cognitive tests (choice reaction time, 1-back, digit symbol substitution, and trail making part-B). It is considered a time-efficient, acceptable method for detecting cognitive deficits in patients with MDD14. There are two other tools commonly used to assess cognitive function in patients with MDD: the Screen for Cognitive Impairments in Psychiatry-D (SCIP-D) and Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA)12. The former is an objective tool lacking self-instructed testing, and the latter is a subjective tool lacking an objective version. The constituent tests also differ between these tools. The SCIP-D is comprised of five objective tests: verbal learning, working memory, verbal fluency, delayed memory, and processing speed. The COBRA includes executive function, processing speed and attention, verbal learning and memory, and visual memory12. The recently developed Chinese version of the cognitive screening tool has been confirmed to be a good tool for evaluating cognitive deficits in Chinese patients with MDD15. Thus, using the cognitive screening tool software and PSG, the current study tried to reveal the relationship between cognitive symptoms and SD in MDD patients.

<table><tbody><tr><td>Computer</td><td>Surface</td><td>Surface pro2</td><td></td></tr><tr><td>Derivation</td><td>Compumedics</td><td>Grael</td><td></td></tr><tr><td>Electrode</td><td>Compumedics</td><td>Grael</td><td></td></tr><tr><td>Polysomnography</td><td>Compumedics</td><td>Grael</td><td></td></tr><tr><td>Software</td><td>Compumedics</td><td>Compumedics Profusion PSG4</td><td></td></tr></tbody></table>

association between sleep quality and cognitive symptoms in patients with major depressive disorder

Cognitive symptoms and sleep disturbance (SD) are common non-mood-related symptoms of major depressive disorder (MDD). In clinical practice, both cognitive symptoms and SD are related to MDD progression. However, there are only a few studies investigating the connection between cognitive symptoms and SD in patients with MDD, and only preliminary evidence suggests a significant association between cognitive symptoms and SD in patients with mood disorders. This study investigates the relationship between cognitive symptoms and sleep quality in patients with major depressive disorder. Patients (n = 20) with MDD were enrolled; their mean Hamilton Depression Scale-17 score was 21.95 (&plusmn;2.76). Gold standard polysomnography (PSG) was used to assess sleep quality, and the validated THINC-integrated tool (the cognitive screening tool) was used to evaluate cognitive function in MDD patients. Overall, the results showed significant correlations between the cognitive screening tool's total score and sleep latency, wake-after-sleep onset, and sleep efficiency. These findings indicate that cognitive symptoms are associated with poor sleep quality among patients with MDD.

The male/female ratio was 11/9 for the participants. For all the individuals, the age reached 35.35 &#177; 6.83 years, educational level was 14.80 &#177; 3.29 years, Hamilton depression scale-17 (HAMD-17) score was 21.95 &#177; 2.76 points, SE was 76.71 &#177; 8.57%. Regarding the cognitive screening tool scores, PDQ-5, SPO, SC, CB, TMT-B, and total scores were 1756.35 &#177; 395.49, 2046.75 &#177; 684.45, 852.15 &#177; 651.81, 845.75 &#177; 641.15, 911.45 &#177; 619.13 and 4140.80 &#177; 1298.14 points, respectively (<s...

Read this Scientific Article Protocol about Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression at JoVE.com

Author Spotlight: Unveiling the Connection Between Sleep Disorders and Cognitive Symptoms in Depression

Here, we present a protocol that investigates the relationship between cognitive symptoms and sleep quality in patients with major depressive disorder. The THINC-integrated tool and polysomnography were used to evaluate cognitive symptoms and sleep quality.

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

Cognitive symptoms and sleep disturbance (SD) are common non-mood-related symptoms of major depressive disorder (MDD). In clinical practice, both ...

association-between-sleep-quality-cognitive-symptoms-patients-with

Research

JoVE Journal

Medicine

548 Views.  Sleep Medicine Center of Inner Mongolia Mental Health Center (The Third Hospital of Inner Mongolia Autonomous Region, Brain Hospital of Inner Mongolia Autonomous Region). In deze studie werd gouden standaard polysomnografie gebruikt om de slaapkwaliteit te beoordelen en de gevalideerde cognitieve screeningtool werd gebruikt om de cognitieve functie bij patiënten met een depressieve stoornis te evalueren. Het is bevestigd dat het denken aan de recent ontwikkelde Chinese versie van de verbindende screeningsinstrumenten een goed hulpmiddel is voor het evalueren van bindstoornissen bij Chinese patiënten met een depressieve stoornis. De huidige studie onthult de ...

Video: Auteur in de schijnwerpers: onthulling van het verband tussen slaapstoornissen en cognitieve symptomen bij depressie

Eye Tracking, Cortisol, and a Sleep vs. Wake Consolidation Delay: Combining Methods to Uncover an Interactive Effect of Sleep and Cortisol on Memory

Although rises in cortisol can benefit memory consolidation, as can sleep soon after encoding, there is currently a paucity of literature as to how these two factors may interact to influence consolidation. Here we present a protocol to examine the interactive influence of cortisol and sleep on memory consolidation, by combining three methods: eye tracking, salivary cortisol analysis, and behavioral memory testing across sleep and wake delays. To assess resting cortisol levels, participants gave a saliva sample before viewing negative and neutral objects within scenes. To measure overt attention, participants&#8217; eye gaze was tracked during encoding. To manipulate whether sleep occurred during the consolidation window, participants either encoded scenes in the evening, slept overnight, and took a recognition test the next morning, or encoded scenes in the morning and remained awake during a comparably long retention interval. Additional control groups were tested after a 20&#160;min&#160;delay in the morning or evening, to control for time-of-day effects. Together, results showed that there is a direct relation between resting cortisol at encoding and subsequent memory, only following a period of sleep. Through eye tracking, it was further determined that for negative stimuli, this beneficial effect of cortisol on subsequent memory may be due to cortisol strengthening the relation between where participants look during encoding and what they are later able to remember. Overall, results obtained by a combination of these methods uncovered an interactive effect of sleep and cortisol on memory consolidation.

We present a protocol used to discover an interactive effect between sleep and cortisol on memory consolidation, particularly for negative arousing images. Specifically, the experimental design utilizes eye tracking, salivary cortisol analysis, and behavioral memory testing &#8211; methods that can be used with both healthy and clinical participants.

Although rises in cortisol can benefit memory consolidation, as can sleep soon after encoding, there is currently a paucity of literature as to how these ...

Behavior

A High-performance Liquid Chromatography Measurement of Kynurenine and Kynurenic Acid: Relating Biochemistry to Cognition and Sleep in Rats

The kynurenine pathway (KP) of tryptophan degradation has been implicated in psychiatric disorders. Specifically, the astrocyte-derived metabolite kynurenic acid (KYNA), an antagonist at both N-methyl-d-aspartate (NMDA) and &#945;7 nicotinic acetylcholine (&#945;7nACh) receptors, has been implicated in cognitive processes in health and disease. As KYNA levels are elevated in the brains of patients with schizophrenia, a malfunction at the glutamatergic and cholinergic receptors is believed to be causally related to cognitive dysfunction, a core domain of the psychopathology of the illness. KYNA may play a pathophysiologically significant role in individuals with schizophrenia. It is possible to elevate endogenous KYNA in the rodent brain by treating animals with the direct bioprecursor kynurenine, and preclinical studies in rats have demonstrated that acute elevations in KYNA may impact their learning and memory processes. The current protocol describes this experimental approach in detail and combines a) a biochemical analysis of blood kynurenine levels and brain KYNA formation (using high-performance liquid chromatography), b) behavioral testing to probe the hippocampal-dependent contextual memory (passive avoidance paradigm), and c) an assessment of sleep-wake behavior [telemetric recordings combining electroencephalogram (EEG) and electromyogram (EMG) signals] in rats. Taken together, a relationship between elevated KYNA, sleep, and cognition is studied, and this protocol describes in detail an experimental approach to understanding function outcomes of kynurenine elevation and KYNA formation in vivo in rats. Results obtained through variations of this protocol will test the hypothesis that the KP and KYNA serve pivotal roles in modulating sleep and cognition in health and disease states.

Alterations in the kynurenine pathway (KP) neuroactive metabolites are implicated in psychiatric illnesses. Investigating the functional outcomes of an altered kynurenine pathway metabolism in vivo in rodents may help elucidate novel therapeutic approaches. The current protocol combines biochemical and behavioral approaches to investigate the impact of an acute kynurenine challenge in rats.

The kynurenine pathway (KP) of tryptophan degradation has been implicated in psychiatric disorders. Specifically, the astrocyte-derived metabolite ...

A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment

Mild cognitive impairment (MCI) is the first sign of dementia among elderly populations and its early detection is crucial in our aging societies. Common MCI tests are time-consuming such that indiscriminate massive screening would not be cost-effective. Here, we describe a protocol that uses machine learning techniques to rapidly select candidates for further screening via a question-based MCI test. This minimizes the number of resources required for screening because only patients who are potentially MCI positive are tested further.
This methodology was applied in an initial MCI research study that formed the starting point for the design of a selective screening decision tree. The initial study collected many demographic and lifestyle variables as well as details about patient medications. The Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE) were used to detect possible cases of MCI. Finally, we used this method to design an efficient process for classifying individuals at risk of MCI. This work also provides insights into lifestyle-related factors associated with MCI that could be leveraged in the prevention and early detection of MCI among elderly populations.

This methodology produces decision trees that target population groups more prone to suffering from mild cognitive impairment and are useful for cost-effective selective screening of the disease.

Mild cognitive impairment (MCI) is the first sign of dementia among elderly populations and its early detection is crucial in our aging societies. Common ...

A Chronic Sleep Fragmentation Model using Vibrating Orbital Rotor to Induce Cognitive Deficit and Anxiety-Like Behavior in Young Wild-Type Mice

Sleep disturbance is generally common in populations as a chronic disease or a complained event. Chronic sleep disturbance is proposed to be closely linked to the pathogenesis of diseases, especially neurodegenerative diseases. We recently found that 2 months of sleep fragmentation initiated Alzheimer&#8217;s disease (AD)-like behavioral and pathological changes in young wild-type mice. Herein, we present a standardized protocol to achieve chronic sleep fragmentation (CSF). Briefly, CSF was induced by an orbital rotor vibrating at 110 rpm and operating with a repetitive cycle of 10 s-on, 110 s-off, during light-ON phase (8:00 AM&#8211;8:00 PM) continuously for up to 2 months. Impairments of spatial learning and memory, anxiety-like but not depression-like behavior in mice as consequences of CSF modeling, were evaluated with Morris water maze (MWM), Novel object recognition (NOR), Open field test (OFT) and Forced swimming test (FST). In comparison with other sleep manipulations, this protocol minimizes the handling labors and maximizes the modeling efficiency. It produces stable phenotypes in young wild-type mice and can be potentially generated for a variety of research purposes.

Presented here is a protocol for chronic sleep fragmentation (CSF) model achieved by an electrically controlled orbital rotor, which could induce confirmed cognitive deficit and anxiety-like behavior in young wild-type mice. This model can be applied to explore the pathogenesis of chronic sleep disturbance and related disorders.

Sleep disturbance is generally common in populations as a chronic disease or a complained event. Chronic sleep disturbance is proposed to be closely ...

Advancing Sleep Disorder Treatments: A Drosophila-Based Screening Approach

High-Throughput Small Molecule Drug Screening For Age-Related Sleep Disorders Using Drosophila melanogaster

Sleep, an essential component of health and overall well-being, often presents challenges for older individuals who frequently experience sleep disorders characterized by shortened sleep duration and fragmented patterns. These sleep disruptions also correlate with an increased risk of various illnesses in the elderly, including diabetes, cardiovascular diseases, and psychological disorders. Unfortunately, existing drugs for sleep disorders are associated with significant side effects such as cognitive impairment and addiction. Consequently, the development of new, safer, and more effective sleep disorder medications is urgently needed. However, the high cost and lengthy experimental duration of current drug screening methods remain limiting factors.
This protocol describes a cost-effective and high-throughput screening method that utilizes Drosophila melanogaster, a species with a highly conserved sleep regulation mechanism compared to mammals, making it an ideal model for studying sleep disorders in the elderly. By administering various small compounds to aged flies, we can assess their effects on sleep disorders. The sleep behaviors of these flies are recorded using an infrared monitoring device and analyzed with the open-source data package Sleep and Circadian Analysis MATLAB Program 2020 (SCAMP2020). This protocol offers a low-cost, reproducible, and efficient screening approach for sleep regulation. Fruit flies, due to their short life cycle, low husbandry cost, and ease of handling, serve as excellent subjects for this method. As an illustration, Reserpine, one of the tested drugs, demonstrated the ability to promote sleep duration in elderly flies, highlighting the effectiveness of this protocol.

Author Spotlight: Overcoming Challenges in Drosophila Sleep Measurement Using DAM System 

Presented is a protocol for high-throughput drug screening to improve sleep by monitoring the sleep behavior of fruit flies in an elderly Drosophila model.

Sleep, an essential component of health and overall well-being, often presents challenges for older individuals who frequently experience sleep disorders ...

Characterizing the Relationship Between Eye Movement Parameters and Cognitive Functions in Non-demented Parkinson's Disease Patients with Eye Tracking

Cognitive impairment is a common phenomenon in Parkinson&#8217;s disease that has implications on the prognosis. A simple, noninvasive and objective proxy measurement of cognitive function in Parkinson&#8217;s disease will be helpful in detecting early cognitive decline. As a physiological metric, eye movement parameter is not confounded by the subject&#39;s attributes and intelligence and can function as a proxy marker if it correlates with cognitive functions. To this end, this study explored the relationship between the eye movement parameters and performance in cognitive tests in multiple domains. In the experiment, a visual search task with eye tracking was set up, where subjects were asked to look for a number embedded in an array of alphabets scattered randomly on a computer screen. The differentiation between the number and the alphabet is an overlearned task such that the confounding effect of cognitive ability on the eye movement parameters is minimized. The average saccadic amplitude and fixation duration were captured and calculated during the visual search task. The cognitive assessment battery covered domains of frontal-executive functions, attention, verbal and visual memory. It was found that prolonged fixation duration was associated with poorer performance in verbal fluency, visual and verbal memory, allowing further exploration on the use of eye movement parameters as proxy markers for cognitive function in Parkinson&#8217;s disease patients. The experimental paradigm has been found to be highly tolerable in our group of Parkinson&#39;s disease patients and could be applied transdiagnostically to other disease entities for similar research questions.

Here, we present a protocol to study the relationship between the eye movement parameters and cognitive functions in non-demented Parkinson&#39;s disease patients. The experiment used an eye tracker to measure the saccadic amplitude and fixation duration in a visual search task. The correlation with performance in multi-domain cognitive tasks was subsequently measured.

Cognitive impairment is a common phenomenon in Parkinson&#8217;s disease that has implications on the prognosis. A simple, noninvasive and objective proxy ...

Neuroscience

Measuring Neural Mechanisms Underlying Sleep-Dependent Memory Consolidation During Naps in Early Childhood

Sleep is critical for daily functioning. One important function of sleep is the consolidation of memories, a process that makes them stronger and less vulnerable to interference. The neural mechanisms underlying the benefit of sleep for memory can be investigated using polysomnography (PSG). PSG is a combination of physiological recordings including signals from the brain (EEG), eyes (EOG), and muscles (EMG) that are used to classify sleep stages. In this protocol, we describe how PSG can be used in conjunction with behavioral memory assessments, actigraphy, and parent-report to examine sleep-dependent memory consolidation. The focus of this protocol is on early childhood, a period of significance as children transition from biphasic sleep (consisting of a nap and overnight sleep) to monophasic sleep (overnight sleep only). The effects of sleep on memory performance are measured using a visuospatial memory assessment across periods of sleep and wakeful-rest. A combination of actigraphy and parent report is used to assess sleep rhythms (i.e., characterizing children as habitual or non-habitual nappers). Finally, PSG is used to characterize sleep stages and qualities of those stages (such as frequencies and the presence of spindles) during naps. The advantage of using PSG is that it is the only tool currently available to assess sleep quality and sleep architecture, pointing to the relevant brain state that supports memory consolidation. The main limitations of PSG are the length of time it takes to prepare the recording montage and that recordings are typically taken over one sleep bought. These limitations can be overcome by engaging young participants in distracting tasks during application and combining PSG with actigraphy and self/parent-report measures to characterize sleep cycles. Together, this unique combination of methods allows for investigations into how naps support learning in preschool children.

This protocol describes methods used to examine neural mechanisms underlying sleep-dependent memory consolidation during naps in early childhood. It includes procedures for examining the effect of sleep on behavioral memory performance, as well as the application and recording of both polysomnography and actigraphy.

Sleep is critical for daily functioning. One important function of sleep is the consolidation of memories, a process that makes them stronger and less ...

Multi-Modal Home Sleep Monitoring in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.

Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

Meta-Analysis of the Effectiveness and Safety of Shugan Jieyu Capsules for the Treatment of Insomnia

A systematic review and meta-analysis were conducted to evaluate the clinical effectiveness and safety of Shugan Jieyu capsules for treating insomnia by searching seven databases up to February 21, 2022. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the studies was assessed using the risk of bias assessment tool. This article describes in detail how to retrieve and screen the literature. The detailed steps for conducting the meta-analysis are also included in the protocol. Fourteen studies were found to be eligible, including 1,283 insomnia patients (644 with and 639 without Shugan Jieyu capsules at baseline). The meta-analysis showed a better total clinical effectiveness (odds ratio [OR]: 5.71, 95% confidence interval [CI]: 3.56 to 9.15) and a lower Pittsburgh Sleep Quality Index (PSQI) score (mean difference [MD]: &#8722;2.95, 95% CI: &#8722;4.97 to &#8722;0.93) with combined Shugan Jieyu capsules and Western medicine compared to Western medicine alone. The secondary outcomes showed that the Shugan Jieyu capsule group had significantly reduced adverse reactions and improvements in sleep duration, night awakening, nightmares with excessive dreaming, daytime sleepiness, and low energy. Further multicenter randomized trials must be encouraged to provide more concrete evidence on whether Shugan Jieyu capsules are beneficial in routine clinical practice.

The presented protocol describes an investigation strategy and systematic review to evaluate the clinical effectiveness and safety of Shugan Jieyu capsules for treating insomnia.

A systematic review and meta-analysis were conducted to evaluate the clinical effectiveness and safety of Shugan Jieyu capsules for treating insomnia by ...

Acupuncture Stimulation of Ears to Alleviate Sleeping Disorders in COPD Patients

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome characterized by persistent and irreversible airflow limitation and chronic respiratory symptoms. It has a wide spectrum of complications, and sleep disorders, as part of it, are common in severe cases, especially in elderly patients. Long-term lack of sleep may lead to the aggravation of the original disease, reducing patients' quality of life. Benzodiazepines are mainly used for symptomatic treatment of COPD combined with sleep disorders. However, such drugs have the side effect of respiratory central inhibition and could probably aggravate hypoxia symptoms. Auricular acupuncture is a special method of treating physical and psychosomatic dysfunctions by stimulating specific points in the ear. This article explains the specific methods of clinical operation of auricular acupuncture in detail, including assessment of patient eligibility, medical devices used, acupuncture points, course of treatment, post-treatment care, responses to emergencies, etc. The Pittsburgh sleep quality index (PSQI) and chronic obstructive pulmonary disease assessment scale (CAT) were used as the observational index of this method. So far, clinical reports have proved that auricular acupuncture has a definite curative effect in the treatment of COPD combined with sleep disorders, and its advantages of simple operation, few adverse reactions are worthy of further study and promotion, which provide a reference for the clinical treatment of such diseases.

Author Spotlight: Utilizing Traditional Chinese Acupuncture of the Ear to Improve Sleep Disorders 

This protocol introduces an effective method to improve the sleep condition of patients with chronic obstructive pulmonary disease and alleviate cough symptoms by using auricular acupuncture techniques to percutaneously stimulate specific acupoints in the patients' ears.

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

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