Bernd Feige | Albert-Ludwigs-University of Freiburg (original) (raw)

Papers by Bernd Feige

Frontiers in Psychiatry, Jul 8, 2019

Brain Stimulation, May 1, 2019

Journal of Clinical Sleep Medicine, Apr 15, 2018

Journal of Sleep Research, May 6, 2020

Scientific Reports, May 30, 2018

Objectives: We previously (2008) found an association between REM sleep duration and perceived wa... more Objectives: We previously (2008) found an association between REM sleep duration and perceived wakefulness in 81 patients with primary insomnia (PI) in addition to a clearly increased arousal index in REM sleep. The current study aimed to replicate and extend the previous findings. Methods: Polysomnogram (PSG) and subjective sleep quality questionnaire (Schlaffragebogen A, SFA) data of PI patients and matched good sleeper controls (GSC) were evaluated for group differences. Results: One hundred and fifty-six new PI patients could be matched to the same number of GSC (GSC; 60M, 96F; Mean age PI: 42.6 ± 12.4 years, GSC: 42.2 ± 13.4 years). PI patients had a higher wake time within bed time as well as lower REM and sleep stage 2 time. The association between perceived wake time and REM sleep time could be replicated in this new and larger group, as well as a clearly increased arousal index in REM sleep, while the arousal index in NREM sleep was significantly but less strongly increased. Conclusion: We postulate that the psychophysiological hyperarousal characteristic for primary insomnia is particularly expressed as a REM sleep alteration. REM sleep appears to be particularly vulnerable to pre-sleep worries, leading to increased retrospective recall of this time as wake time and a lower restorative sleep quality

Study Objectives: Sleep has been demonstrated to significantly modulate brain plasticity and the ... more Study Objectives: Sleep has been demonstrated to significantly modulate brain plasticity and the manifestation of mental disorders. However, previous studies on the impact of disrupted sleep on brain structure have reported inconsistent results. The current study aimed at investigating brain morphometry in a well-characterized large sample of primary insomnia (PI) patients in comparison to good sleeper controls. Design: Automated parcellation and pattern recognition approaches were supplemented by voxel-wise analyses of gray and white matter volumes to analyze MR images. All analyses included age, sex, and total intracranial volume as covariates. Setting: Department of Psychiatry and Psychotherapy of the University of Freiburg Medical Center. Participants: 28 PI patients (10 males; 18 females; 43.7 ± 14.2 years) and 38 healthy good sleepers (17 males; 21 females; 39.6 ± 8.9 years). Interventions: N/A Results: No significant between-group differences were observed in any of the investigated brain morphometry variables. Conclusions: Altered brain function in insomnia does not seem to have a substantial impact on brain morphometry on a macroscopic level

Sleep, depression and insomnia have manifold associations. Psychiatric sleep research in affectiv... more Sleep, depression and insomnia have manifold associations. Psychiatric sleep research in affective disorders has demonstrated that sleep in depression is characterized by an impairment of sleep continuity, deficits in slow wave sleep and a disinhibition of REM sleep (including shortened REM latency and increased REM density). Traditionally, insomnia, i.e. prolonged latency to fall asleep and increased frequency of nocturnal wake periods, was considered as an unspecific symptom of affective disorders. In the meantime, a shift in clinical and scientific focus has taken place viewing insomnia in addition as an independent diagnostic entity and as a clinical predictor of depression. Unfortunately, the neurobiological processes underlying the relationships between sleep, insomnia and depression have not been fully identified yet. It is clear that both insomnia and depression are characterized by alterations in the arousal system in the CNS presenting as hyperarousal. Moreover, insomniac patients display reduced and fragmented REM sleep periods, which might interfere negatively with basal processes of emotion regulation. The alterations in the arousal system and the interaction of it with the affect-regulatory system over the course of time might influence cognitive systems and hence lead to the clinical picture of depression. Given the suggestion of insomnia symptoms as possibly involved in the causation and the maintenance of psychopathology in general, this type of sequence might also be found in relation to other mental disorders

Sleep Medicine, Dec 1, 2015

Scientific Reports, Mar 15, 2019

Behavior Therapy, Mar 1, 2023

Somnologie, Mar 1, 2013

ABSTRACT Current diagnostic concepts, i.e. ICD-10 or DSM IV, do not fully encompass the complexit... more ABSTRACT Current diagnostic concepts, i.e. ICD-10 or DSM IV, do not fully encompass the complexity and heterogeneity of insomnia disorders. Advances have been made with ICSD-2 and the Research Diagnostic Criteria (RDC). Further progress will be made with the DSM V, which will encompass a main diagnostic category of “insomnia disorder”. Concerning etiological and pathophysiological assumptions, the hyperarousal model has gained wide-spread attention. Nevertheless, many of its tenets have only been confirmed by single studies, so further clinical research will be necessary to fully support the model. Additionally, animal models of insomnia are needed to advance the understanding of basic mechanisms involved in insomnia. With respect to treatment, there is a lack of new developments in the field of hypnotics for Europe. Concerning cognitive behavioral therapy of insomnia (CBT-I), much empirical evidence underlines that this type of treatment should be the first line treatment for insomnia. Unfortunately, only a minority of patients seem to have access to the benefits of this treatment due to a lack of resources. Stepped-care models for insomnia suggest self-help programs, internet-based approaches, community-centered activities (specially trained nurses) and as a last resort medical specialists and sleep experts to treat insomnia.

Frontiers in Psychiatry, 2020

Journal of Sleep Research, 2020

According to the World Health Organization, cardiovascular diseases are the leading cause of deat... more According to the World Health Organization, cardiovascular diseases are the leading cause of death in the world. Therefore, early prevention of these diseases is a public health priority. Epidemiological data suggest that insomnia may be a modifiable risk factor for cardiovascular diseases. A randomized controlled trial in a sample of insomnia patients without cardiovascular disease was conducted to investigate the effects of insomnia treatment on early markers of cardiovascular diseases assessed by 24‐hr ambulatory blood pressure, heart rate and heart rate variability monitoring, and morning fasting blood samples. Forty‐six patients with insomnia disorder were randomized to cognitive behavioural therapy for insomnia (CBT‐I; n = 23) or a waitlist control condition (n = 23). Contrary to the hypothesis, intention‐to‐treat analyses did not show any significant treatment effects on early markers of cardiovascular disease (d = 0.0–0.6) despite successful insomnia treatment (d = 1.3). Pot...

Sleep Medicine Reviews, 2020

The first point highlighted by Tang et al. is about our search strategy. Particularly, the author... more The first point highlighted by Tang et al. is about our search strategy. Particularly, the authors demonstrate concerns on searching the literature only through PubMed. We totally agree with this concern, but we have to point out that this is not the case of our systematic review. We performed our systematic research in “Pubmed”, “PsycINFO” and “MEDLINE” databases. Cochrane Collaboration Guidelines for searching literature [1] were followed. Consistently, several search strategies were used in addition to the standard literature databases. We identified further studies from the references of the screened full-texts and we collected data from non-published studies (searching in the grey literature, non published literature and contacting authors in the field to obtain further data). This extensive search strategy was adopted by our group in several previous publications [3-5]. Indeed, we did not search relevant literature in Embase database. Nevertheless, evidences are available that indicate that low risks of biases are associated by searching literature in Medline but not Embase [2]. Furthermore, our keywords were chosen accurately and they were comprehensive of synonymous and “*” as to include all existing suffixes: (((pregnan*[Title/Abstract] OR “expect* mother*” [Title/Abstract] OR “mother*”[Title/Abstract])) AND ((insomnia*[Title/Abstract] OR sleep*[Title/Abstract])) AND ((treat* [Title/Abstract] OR therap*[Title/Abstract] OR intervention [Title/ Abstract]))). Indeed, these terms were not searched as “Keywords”, but as indicated as any word in the title or the abstract. For this reason the provided keywords search is actually much more extensive than the relatively broad categorization by MeSH. Finally, we include articles in the following languages: English, Italian, German, Spanish, and French. Indeed, we did not search relevant literature in Chinese databases as unfortunately we did not have the possibility to read in Chinese. Nevertheless, our systematic review was not focused on Chinese medicine treatments. A further comment by Tang et al. was on the inappropriateness of our interventions’ classification. As stated by the authors “Complementary medicine is not standard therapy, which, instead, is utilized along with standard medical therapy. Alternative medicine is considered as the replacement of standard medical therapy”. In our systematic review, only one study was found that evaluated the efficacy of Acupuncture on insomnia [6] and the authors used acupuncture in an alternative way (instead of conventional medical treatment) and not in a complementary way (in combination with conventional medical treatment) [7]. For this reason, this study was categorized in the alternative interventions section. Tang and colleagues also commented on the inappropriateness of our choice to evaluate with Risk of Bias Cochrane Collaboration’s tool [8] only for Randomized Controlled Trial and they stated that we have used the Newcastle-Ottawa Scale (NOS) for non-randomized clinical trial studies’ evaluation. Actually, we did not use the Newcastle-Ottawa Scale (NOS) for non-randomized studies, but we decided to provide a qualitative critical evaluation of the level of evidence of non-randomized controlled trials. That is, the risk of bias of the interpretation of the results of non-randomized trials included in our systematic review was qualitatively assessed and considered. The authors comment on the necessity to evaluate in our systematic review the safety of the interventions. This was actually done whenever information about safety was reported (e.g. for pharmacotherapy and acupuncture). Finally, Tang and colleagues commented on the similarity of two of the included studies in our systematic review [9,10]. These studies were conducted by the same research group. In one of this study [11], hospitalized pregnant women were evaluated, whether in the other study, non-hospitalized pregnant women were recruited

Sleep Medicine Reviews, 2019