Dreaming and Sleep-Related Metacognitions in Patients with Sleep Disorders

Round 1

Reviewer 1 Report

I have read the article by Schredl and Schilling with great interest. The authors studied sleep-related metacognitions in patients with sleep disorders.

Comments:

·       Abstract. Please, provide some figures to justify the conclusions.

·       Methods. What do you mean by probable sleep disorder? I am especially interested in the insomnia group as it is a symptoms-based diagnosis.

·       Methods. Could you please, comment how were these sleep disorders diagnosed (which standard were used)?

·       Methods. What was the minimal number of completed days when you considered the sleep diary valid? Was there anybody below this standard?

·       Line 138. I believe this is effect size rather than affect size.

·       Table 5. Could you please, comment if the SE is negative, the relationship is inverse?

·       Table 5. The table is very busy. Could you please highlight the significant associations in bold?

Author Response

Reviewer 1

I have read the article by Schredl and Schilling with great interest. The authors studied sleep-related metacognitions in patients with sleep disorders.

Comments:

Abstract. Please, provide some figures to justify the conclusions.

Answer: We added a sentence describing the results of the regression analysis. I hope that I understood the reviewer correctly (that figures meaning numbers, effect sizes).

Methods. What do you mean by probable sleep disorder? I am especially interested in the insomnia group as it is a symptoms-based diagnosis.

Answer: Probable has been chosen for the German “Verdachtsdiagnose”, that is, this diagnosis might be present but needs further evaluation. In the case on insomnia, the basic idea of the ICD-10 system is that F51.0 should be given if there is no other sleep disorder causing the sleep problems, e.g., PLMD or SBAS. Therefore, a substantial number of patients were classified as probable as no polysomnographic evaluation has been carried out, yet. We added a paragraph to the discussion section that the ICD-10 diagnosis of insomnia differ slightly from the ICSD-3 and the DSM-5.

• Methods. Could you please, comment how were these sleep disorders diagnosed (which standard were used)?

Answer: I am not sure at what the reviewer is aiming at. The certified sleep specialists diagnosed the patients based on the clinical interview. This was added in the method section.

• Methods. What was the minimal number of completed days when you considered the sleep diary valid? Was there anybody below this standard?

Answer: The minimal number was one, as some participants did not complete all nights, respective all items of the specific day (the dream questions were the last to complete). 95% had completed at least 3 nights, the majority 80% had completed 6 or 7 nights.

• Line 138. I believe this is effect size rather than affect size.

Answer: Typo was corrected.

• Table 5. Could you please, comment if the SE is negative, the relationship is inverse?

Answer: SE (Standard estimates) are comparable with standardized regression coefficients (ß) in parametric regression, that is, the reviewer is correct a negative coefficient is like a negative correlation.

• Table 5. The table is very busy. Could you please highlight the significant associations in bold?

Answer: We agree that Table 5 is very busy, but the main focus is at the last to rows, so we separated these rows from the rest of the table, the other variables were just included to control for possible confounders, so it would not make sense to highlight significant findings we are not interested in. This idea was addressed in the discussion.

Reviewer 2 Report

This is a well-written and succinct manuscript, and I only have a few questions (no concerns).

1.  Please describe in more detail how participants were solicited.  It is mentioned that they were referred to sleep clinic, but more detail is needed.  Was this a targeted sample?   A convenience sample?  Etc.

2. The measure of spread is needed for lines 61, 141, 142, 152, and 154.  Standard deviation?  Standard error?  Etc.

The English is mostly OK, but the manuscript would benefit from editing by a native speaker.

Author Response

Reviewer 2

This is a well-written and succinct manuscript, and I only have a few questions (no concerns).

1. Please describe in more detail how participants were solicited. It is mentioned that they were referred to sleep clinic, but more detail is needed.  Was this a targeted sample?   A convenience sample?  Etc.

Answer: The following information was added: The sample included all patients referred from February 2019 to February 2022. As the sleep diary and the questionnaires were part of the clinical routine almost all patients returned the materials; the percentage of missing data is very small (less than 5%), mainly due to language problems (non-German speakers).

2. The measure of spread is needed for lines 61, 141, 142, 152, and 154. Standard deviation? Standard error?  Etc.

Answer: We added the following information in the procedure section: For descriptive purposes, means and standard deviations (M ± SD) were used.

The English is mostly OK, but the manuscript would benefit from editing by a native speaker.

Answer: The revision was checked by a native speaker.