A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression

Stress and Sleep: Results from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

Hispanics/Latinos face specific sociocultural stressors associated with their marginalized status in the United States. While stress is known to cause poor sleep, the differential effects of the specific stressors faced by Hispanics/Latinos have not been evaluated. Using cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study, we conducted weighted generalized linear models to evaluate the associations of acculturation stress, ethnic discrimination, and chronic moderate/severe stress with self-reported sleep outcomes (insomnia symptoms, daytime sleepiness, sleep duration) in individual and aggregate models adjusted for site, socio-demographics, behavioral, and medical conditions. Participants included 5313 Hispanic/Latino adults; 43.5% ≥ age 45, 54.8% female, and 22.0% US-born. Chronic moderate/severe stress, ethnic discrimination, and acculturation stress were each positively associated with sleep. In the adjusted aggregate model, only chronic moderate/severe stress was associated with insomnia symptoms (exp(b) = 1.07 for each additional stressor, 95% CI = 1.05, 1.09). Both acculturation stress (exp(b) = 1.05 for each additional SD, 95% CI = 1.02, 1.10) and ethnic discrimination (exp(b) = 1.05 for each additional SD, 95% CI = 1.01, 1.08) were associated with daytime sleepiness. Each SD increase in ethnic discrimination related to a 16% and 13% increased prevalence of short (< 7 h) (RRR = 1.16, 95% CI = 1.02, 1.31) and long sleep duration (> 9 h) (RRR = 1.13, 95% CI = 1.00, 1.27), respectively. These associations were consistent across sex. Acculturation stress and ethnic discrimination are associated with poor sleep in Hispanics/Latinos. Future research should explore whether behavioral sleep interventions minimize the impact of sociocultural stressors on sleep.

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Latina/os face unique stressors associated with their marginalized status in the USA.

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We explored the association of sociocultural stressors with Latina/o sleep.

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Acculturation stress and ethnic discrimination were associated with daytime sleepiness.

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Only chronic psychosocial stress was associated with insomnia symptoms.

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Ethnic discrimination was associated with both short and long sleep duration.

Why might poor sleep quality lead to depression? A role for emotion regulation

Disordered sleep is strongly linked to future depression, but the reasons for this link are not well understood. This study tested one possibility - that poorer sleep impairs emotion regulation (ER), which over time leads to increased depressive symptoms. Our sample contained individuals with a wide range of depression symptoms (current depression, N = 54, remitted depression, N = 36, and healthy control, N = 53), who were followed clinically over six months and reassessed for changes in depressive symptom levels. As predicted, maladaptive ER mediated both cross-sectional and prospective relationships between poor sleep quality and depression symptoms. In contrast, an alternative mediator, physical activity levels, did not mediate the link between sleep quality and depression symptoms. Maladaptive ER may help explain why sleep difficulties contribute to depression symptoms; implications for interventions are discussed.

Sleep-related problems and minor psychiatric disorders among Brazilian shift workers

The aim of this study was to explore the association between sleep-related problems with the occurrence of minor psychiatric disorders in shift workers of southern Brazil. A cross-sectional study with 1202 workers (785 females) aged 18-50 years was carried out. Minor psychiatric disorders were assessed using the Self-Reporting Questionnaire (SRQ-20), and four sleep problems were collected and analyzed: sleep deprivation (≤ 5h), difficulty falling asleep, waking up during sleep, and sleep medication use. Results show that the overall prevalence of minor psychiatric disorders was 26.8%, but it was more prevalent among females than males (30.2% vs. 20.4%). Nightshift work was significantly associated with the occurrence of sleep-related problems. After adjusting for confounding factors, the number of sleep-related problems showed a positive linear trend with psychiatric disorders in both sexes. Having two or more sleep-related problems was associated with increased probability of psychiatric disorders approximately three-fold among males and two-fold among females, when compared with those without sleep problems. In conclusion, this study demonstrated that sleep-related problems have a strong and independent association with psychiatric disorders among shift workers. Furthermore, the prevalence of both conditions was higher among females than males; however, the strength of these associations was higher in males.

Staying Awake and Aware: The Importance of Sleep in Psychiatric Nursing Practice

Given that approximately 70 million Americans suffer from sleep-wake disorders and their under-recognized role in practice, psychiatric nurses may see, or may be already seeing, patients with undiagnosed sleep disorders. Assessment of sleep-wake disorders can and should be a part of psychiatric nursing education and practice. Many practicing clinicians lack formal training regarding sleep-wake issues and treatment. Even as sleep disturbances are common concerns among psychiatric populations, sleep-wake issues may go unrecognized. The article presents a stylized progression of care to enable clinicians to identify, address, and treat underlying sleep-wake disorders in psychiatric settings. The article recommends instituting screening procedures for sleep-wake issues and follow-up assessments, particularly overnight pulse oximetry and polysomnograms. Just as clinicians already screen for physical conditions that would affect psychiatric care, practitioners can evaluate patients for potential sleep-wake disorders as part of their existing practice and intake procedures. Further, the piece details implications for psychopharmacology as well as evidence from clinical practice. Psychiatric nurses should stay awake to the importance of sleep medicine and aware of how sleep-wake disorders can affect psychiatric populations.

Sleep-wake profiles and circadian rhythms of core temperature and melatonin in young people with affective disorders

While disturbances of the sleep-wake cycle are common in people with affective disorders, the characteristics of these disturbances differ greatly between individuals. This heterogeneity is likely to reflect multiple underlying pathophysiologies, with different perturbations in circadian systems contributing to the variation in sleep-wake cycle disturbances. Such disturbances may be particularly relevant in adolescents and young adults with affective disorders as circadian rhythms undergo considerable change during this key developmental period. This study aimed to identify profiles of sleep-wake disturbance in young people with affective disorders and investigate associations with biological circadian rhythms. Fifty young people with affective disorders and 19 control participants (aged 16-31 years) underwent actigraphy monitoring for approximately two weeks to derive sleep-wake cycle parameters, and completed an in-laboratory assessment including evening dim-light saliva collection for melatonin assay and overnight continuous core body temperature measurement. Cluster analysis based on sleep-wake cycle parameters identified three distinct patient groups, characterised by 'delayed sleep-wake', 'disrupted sleep', and 'long sleep' respectively. The 'delayed sleep-wake' group had both delayed melatonin onset and core temperature nadir; whereas the other two cluster groups did not differ from controls on these circadian markers. The three groups did not differ on clinical characteristics. These results provide evidence that only some types of sleep-wake disturbance in young people with affective disorders are associated with fundamental circadian perturbations. Consequently, interventions targeting endogenous circadian rhythms to promote a phase shift may be particularly relevant in youth with affective disorders presenting with delayed sleep-wake cycles.

Sleep Disturbance Mediates the Association of Post-Traumatic Stress Disorder Symptoms and Pain in Patients With Cancer

BACKGROUND

Sleep disturbance is a common complaint of patients with cancer and is well established in both pain conditions and post-traumatic stress disorder (PTSD). An estimated one-third of patients with cancer develop symptoms of PTSD at some point in their treatment. However, few studies have evaluated the contributions of PTSD and sleep disturbance to pain processes in cancer populations. The current study used mediation models to test the hypothesis that sleep disturbance would mediate the relationships between PTSD symptoms and pain intensity and PTSD symptoms and pain interference in a sample of patients with cancer.

METHODS

A cross-sectional, retrospective chart review was conducted of the electronic medical records of 85 adult patients with cancer (89.4% female; 59% white; 42% metastatic) who sought individual psychosocial support services at our institution.

RESULTS

Post-traumatic stress disorder symptoms, sleep disturbance, pain intensity, and pain interference were all positively correlated ( P < .01). Clinical levels of PTSD symptoms were reported by 30% to 60% of the sample. Even after controlling for metastatic disease, race, and cancer type, sleep disturbance mediated the relationships between PTSD symptoms and pain intensity ( B = 0.27; 95% CI: 0.10-0.44) and PTSD symptoms and pain-related interference ( B = 0.58; 95% CI: 0.28-0.87).

CONCLUSIONS

The relationships among PTSD symptoms, pain intensity, and pain interference could be explained by co-occurring sleep disturbance. Given the high frequency of PTSD symptoms among patients with cancer and PTSD's known links to sleep problems and pain, clinicians should be attentive to the role that traumatogenic processes may play in eliciting sleep and pain-related complaints among patients with cancer.

Socioeconomic status in childhood predicts sleep continuity in adult Black and White men

OBJECTIVES

Low socioeconomic status (SES) in childhood may be associated with sleep in adulthood. We evaluated the relationships between SES in childhood through adolescence and into adulthood and sleep in midlife men.

DESIGN

Prospective assessment of SES in childhood and adulthood.

SETTING

Population-based study of 139 Black and 105 White men enrolled since age 7 and evaluated for sleep characteristics at age 32.

MEASUREMENTS

Actigraphy and diary measures of sleep duration, continuity, and quality for 1 week. Their parents reported their SES (a combination of educational attainment and occupational status) annually when the boys were ages 7 to 16. We estimated SES intercept (age 7) and slope (age 7 to 16) using M-Plus and conducted linear regression analyses using those values to predict adult sleep measures, adjusting for covariates.

RESULTS

Men who had lower SES families at age 7, smaller increases in SES from ages 7 to 16, and lower SES in adulthood had more minutes awake after sleep onset. White men with greater increases in SES from ages 7 to 16 had shorter sleep.

CONCLUSIONS

SES in childhood and improvement in SES through adolescence are related to sleep continuity in midlife men. To our knowledge, this is the first report using prospectively measured SES in childhood in relation to adult sleep.

Insomnia and depression: risk factors for development of depression in male Japanese workers during 2011-2013

OBJECTIVES

This 3-year cohort study was conducted to investigate the relation between insomnia and development of depression in male workers, and to clarify the association between the severity of insomnia and the onset of depression.

METHODS

Self-administered questionnaire surveys on depression and insomnia were conducted on male workers for 3 years. Depression was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), and insomnia was examined using the Athens Insomnia Scale (AIS). The analysis was done with 840 men who had no depression at baseline.

RESULTS

Depression symptoms were newly found in 113 men during this study. Cox regression analyses showed that people with insomnia (AIS score of ≥ 1) at baseline had about a 7 times greater risk for onset of depression. Furthermore, compared with those with AIS score of 0 (no insomnia), people with AIS score of 1-3 had a 5.2-fold greater risk of depression and those with a score of 4 or higher indicated about tenfold greater risk.

CONCLUSIONS

A new finding was that the risk for onset of depression increased with the severity of insomnia.

Immigration and Sleep Problems in a Southern European Country: Do Immigrants Get the Best Sleep?

This study analyzes the differences in the prevalence of insomnia symptoms and nonrestorative sleep (NRS) between people born in Spain and immigrants from 7 countries with most immigrants in Spain. Data come from the 2006 Spanish National Health Survey. The sample was composed of all individuals aged 16 to 64 years from Spain and the 7 countries with most immigrants in Spain (N = 22,224). In both sexes, people from Bolivia had a higher prevalence of insomnia symptoms and NRS. Conversely, people from Ecuador, Morocco, and Romania had less insomnia symptoms and NRS than Spanish-born participants. No differences were found between Spanish-born participants and Colombian, Peruvian, and Argentinian women. Poor living conditions in the country of origin and in the host country, discrimination, and culturally related lifestyles could be related to poorer sleep health among Bolivian men. Acculturation may explain the similar sleep health patterns noted between Spanish-born participants and long-term immigrants.

Primary Cardiovascular Disease Risk Factors Predicted by Poor Working Conditions in the GAZEL Cohort

The mechanisms by which work environment might influence cardiovascular disease (CVD) risk are still a matter of debate. In particular, the involvement of the main behavioral and clinical risk factors and their relationships with working conditions are not always clear, despite an abundant body of literature. Most studies have investigated the impact of a limited number of characteristics of the work environment on the occurrence of 1 or a few risk factors. In contrast, in this study we used a global approach in which 30 objective and subjective indicators of working conditions were tested as predictors of 9 modifiable CVD risk factors in a well-characterized cohort of 20,625 middle-aged French workers who were followed from the 1990s until they retired or until December 31, 2013. The incidence of 3 CVD risk factors (obesity, sleep complaints, and depression) was predicted by a large number of indicators of working conditions in both age- and sex-adjusted and multivariate-adjusted Cox regression models, whatever the significance threshold retained. These results suggest the existence of close relationships between a poor work environment and a higher risk of developing obesity, sleep complaints, or depression. These risk factors may contribute to increased CVD risk not only when workers are exposed to poor working conditions but also after retirement, as predictors of the appearance of other risk factors.

Poor sleep in adults with pediatric-onset spinal cord injury: associations with pain, health, and activity

OBJECTIVE

To investigate medical complications that increase risk for poor sleep in adults with pediatric-onset spinal cord injury (SCI) and explore the relation of poor sleep to psychosocial outcomes.

METHOD

This was a cross-sectional study of individuals with pediatric-onset SCI interviewed between 2011-2015. Participants were recruited from a pediatric specialty hospital and answered questions about demographics, injury characteristics, pain, and medical complications and completed standardized outcome measures, including: Pittsburgh Sleep Quality Index, SF12v2 Health Survey, Craig Handicap Assessment and Recording Technique (CHART), and Subjective Happiness Scale.

RESULTS

The study included 180 participants between the ages of 19 and 51 (M=34.20 y; SD=7.28) who sustained their SCI before the age of 19 (M=13.48y; SD=4.59). Participants were predominantly male (62%) and Caucasian (84%). A majority had tetraplegia (56%) and complete injuries (74%). Poor sleep occurred with greater frequency in those with tetraplegia and who were unemployed. Neck (OR=2.80, P = 0.001), shoulder (OR=2.15, P = 0.011), arm (OR=3.06, P = 0.004), and lower extremity pain (OR=2.72, P = 0.004) were associated with increased risk of poor sleep. In a logistic regression analysis, chronic medical conditions and continuous pain were most likely to be associated with poor sleep. Individuals with poor sleep reported lower levels of mobility, perceived health, and subjective happiness.

CONCLUSION

Pain and secondary complications significantly increase the odds of poor sleep. Furthermore, poor sleep is associated with decreased mobility and measures of well-being. Preventive measures to reduce risk factors and improve sleep quality after pediatric-onset SCI should be considered.

Sleep Trajectories Before and After the Final Menstrual Period in The Study of Women's Health Across the Nation (SWAN)

PURPOSE OF REVIEW

Longitudinal studies show that the menopausal transition (MT) is associated with poorer self-reported sleep. Increases in sleep disturbances across and beyond the MT are strongly associated with vasomotor symptoms (VMS) but occur even without VMS. We analyzed data from baseline through 13 annual or biennial follow-up assessments from SWAN's multi-racial/ethnic cohort of midlife women, specifically focusing on patterns of sleep problems in the years preceding and following the final menstrual period (FMP). The FMP demarcated the MT and the postmenopausal period. We addressed the following questions: (1) are there distinct trajectory patterns of sleep problems across the MT, and (2) do pre-FMP sleep trajectories predict sleep problems around the time of FMP (trans-FMP) and post-FMP? Group-based trajectory modeling using repeated measures log-binomial regression with generalized estimating equation methods was used to describe trajectory patterns of the most prevalent sleep problem, waking several times at least 3 nights weekly during the previous 2 weeks, in 1,285 naturally menopausal women.

RECENT FINDINGS

We found (1) 4 distinct trajectories for waking several times per night across the MT [low prevalence (n=487; 37.9%), moderate prevalence (n=365; 28.4%), increasing prevalence (n=197; 15.3%), and high prevalence (n=236; 18.4%)], (2) the prevalence of sleep problems increased overall, but in one trajectory group (increasing prevalence) more than in the other three, and (3) trouble falling asleep, early morning awakening, and frequent VMS were strongly associated with problems waking several times that persist into postmenopause.

SUMMARY

Using trajectory analysis, we showed that, in general, awakenings were stable from pre-FMP to post-FMP.

Resting state functional connectivity in primary insomnia, generalized anxiety disorder and controls

Sleep abnormalities are extremely common in anxiety disorders and may contribute to their development and persistence. Their shared pathophysiological mechanisms could thus serve as biomarkers or targets for novel therapeutics. Individuals with Primary Insomnia were age- and sex-matched to controls and to persons with Generalized Anxiety Disorder. All underwent fMRI resting-state scans at 3-T. In Primary Insomnia and controls, sleep was recorded for 2 weeks using diaries and actigraphy. All participants completed state-anxiety and neuroticism inventories. Whole-brain connectivity of 6 fear- and extinction-related seeds were compared between the 3 groups using ANOVA. The only significant between-group main effect was seen for connectivity between the left amygdala seed and a bilateral cluster in the rostral anterior cingulate cortex. The latter is believed to exert top-down control over amygdala activity and their interaction may thus constitute an emotion regulatory circuit. This connectivity was significantly greatest in controls while Primary Insomnia was intermediate between that of controls and Generalized Anxiety Disorder. Across Primary Insomnia and control subjects, mean connectivity decreased with poorer sleep. Across all 3 groups, connectivity decreased with greater neuroticism and pre-scan anxiety. Decreased top-down control of the amygdala may increase risk of developing an anxiety disorder with preexisting Primary Insomnia.

Sleep disturbance as a predictor of affective functioning and symptom severity among individuals with PTSD: An ecological momentary assessment study

Recent research has highlighted the etiological role of sleep disturbance in posttraumatic stress disorder (PTSD); however it is currently unknown how daily changes in sleep are associated with next-day PTSD symptoms. Furthermore, sleep is critical for maintaining appropriate affect, leading some to hypothesize that affective dysfunction may account for the link between sleep disturbances and PTSD symptoms. Thus, the current study tested the relationship between sleep disturbances, affective valence, and PTSD symptoms utilizing an ecological momentary assessment (EMA) design among individuals with PTSD (n=30) who participated in 4 EMA-based assessments daily over 8 days. Multilevel modeling indicated that, after accounting for prior evening's PTSD symptoms, poor sleep quality and reduced sleep efficiency were associated with increased PTSD symptoms and negative affect. Furthermore, results supported the indirect effect of poor sleep quality on elevated PTSD symptoms through increased negative affect in the morning. Findings add to the body of research demonstrating the negative impact of poor sleep for individuals with PTSD by indicating that daily variations in sleep can affect next-day PTSD symptoms, and identifying negative affect as a mechanism of this relationship.

Predictors of insomnia onset in adolescents in Japan

OBJECTIVE

The objective of this study was to clarify the incidence rate and predictive factors of insomnia in Japanese junior and senior high school students.

METHODS

We conducted a baseline survey on first year junior and senior high school students (seventh and 10th graders) throughout the nation. A follow-up survey was then conducted two years later. For both surveys, we used self-administered questionnaires inquiring about sleep, mental health status, lifestyle, participation in club activities, and study hours.

RESULTS

A total of 3473 students (776 junior high and 2697 senior high) were suitable for analysis. During the two years leading to the follow-up study, the incidence rate of newly developed insomnia was 7.8% among junior high and 9.2% among senior high school students. Multiple logistic regression analyses revealed that factors associated with new insomnia onset were 'sleep paralysis experience' and 'poor mental health status' in junior high school students, and 'being woken by a nightmare', 'poor mental health status', '≥2 h of extracurricular learning per day' and 'mobile phone use for ≥2 h per day' in senior high school students.

CONCLUSIONS

In junior and senior high school students, parasomnias such as nightmares and sleep paralysis, and mental health status can be predictors of insomnia onset. For senior high school students, longer use of mobile phones can be a predictor of insomnia onset. The present findings suggest that sleep health must be promoted among junior and senior high school students in the future.

Association between elder abuse and poor sleep: A cross-sectional study among rural older Malaysians

Objectives

To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI).

Design

This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome.

Setting

Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia.

Participants

1648 community-dwelling older Malaysians.

Results

The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach’s Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for “no abuse”, “1 type of abuse” and “2 types or more”. Generalized linear models revealed six variables as significant determinants of sleep quality–abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep.

Conclusion

The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed.

Correlates of sleep quality and sleep duration in a sample of urban-dwelling elderly Nigerian women

OBJECTIVES

Aging, female sex, and urbanization increase the risk of sleep impairment. Sleep in urban-dwelling elderly African women has been sparsely studied. We studied the characteristics and correlates of sleep quality and habitual sleep duration in a primary care population of urban-living Nigerian women.

METHODS

Sleep quality and sleep duration over the previous 1 month were estimated using the Pittsburgh Sleep Quality Index (PSQI). Excessive daytime sleepiness, risk of obstructive sleep apnea (OSA), and depressive symptoms were also assessed.

RESULTS

Of the 428 subjects included, 117 (27.3%) were poor sleepers endorsing PSQI scores >5, whereas 126 (29.4%) slept <7 hours. The poor sleepers were more likely to be obese (P = .022), to have a high risk for OSA (P = .013), and to have clinically significant depressive symptoms (P = .001) compared with the good sleepers. Habitual sleep duration of <7 hours was associated with past oral contraceptive use (P = .025) and a trend toward a higher likelihood of high risk for OSA (P = .05) and coffee consumption (P = .05). On regression, the odds of high risk for OSA were higher with poor sleep quality and sleep duration <7 hours, respectively, whereas the odds of coffee consumption were higher with sleep duration <7 hours.

CONCLUSIONS

Poor sleep quality and inadequate sleep are common in our population of elderly women. High risk for OSA independently predicts poor sleep quality and, along with report of coffee consumption, independently predicts habitual sleep duration of <7 hours.

Sleep and somatic complaints in university students

BACKGROUND

Sleep problems are common among university students. Poor sleep is associated with impaired daily functioning, increased risk of psychiatric symptoms, and somatic complaints such as pain. Previous results suggest that poor sleep exacerbates pain, which in turn negatively affects sleep. The purpose of the present study was to determine prevalence rates, comorbidity, and role of depression as a factor of moderating the relationship between sleep and physical complaints in German university students.

SAMPLES AND METHODS

In total, 2443 German university students (65% women) completed a web survey. Self-report measures included the Pittsburg Sleep Quality Index, three modules of the Patient Health Questionnaire, and a questionnaire on the functional somatic syndromes (FSSs).

RESULTS

More than one-third (36.9%) reported poor sleep as assessed by the Pittsburgh Sleep Quality Index. Somatoform syndrome was identified in 23.5%, and the prevalence of any FSS was 12.8%. Self-reported sleep quality, sleep onset latency, sleep disturbances, use of sleep medications, and daytime dysfunctioning were significant predictors of somatoform syndrome, whereas sleep efficiency and sleep duration influenced somatic complaints indirectly. Moderate correlations were found between stress, anxiety, somatoform syndrome, depression, and overall sleep quality. The effect of somatic complaints on sleep quality was associated with the severity of depression. Anxiety shows direct effects on somatization and depression but only indirect associations with sleep quality.

Exercise as a Positive Modulator of Brain Function

Various forms of exercise have been shown to prevent, restore, or ameliorate a variety of brain disorders including dementias, Parkinson's disease, chronic stress, thyroid disorders, and sleep deprivation, some of which are discussed here. In this review, the effects on brain function of various forms of exercise and exercise mimetics in humans and animal experiments are compared and discussed. Possible mechanisms of the beneficial effects of exercise including the role of neurotrophic factors and others are also discussed.

Anxiety sensitivity and racial differences in sleep duration: Results from a national survey of adults with cardiovascular disease

Although Blacks sleep between 37 and 75min less per night than non-Hispanic Whites, research into what drives racial differences in sleep duration is limited. We examined the association of anxiety sensitivity, a cognitive vulnerability, and race (Blacks vs. White) with short sleep duration (<7h of sleep/night), and whether anxiety sensitivity mediated race differences in sleep duration in a nationally representative sample of adults with cardiovascular disease. Overall, 1289 adults (115 Black, 1174 White) with a self-reported physician/health professional diagnosis of ≥1 myocardial infarction completed an online survey. Weighted multivariable logistic regressions and mediation analyses with bootstrapping and case resampling were conducted. Anxiety sensitivity and Black vs. White race were associated with 4%-84% increased odds, respectively, of short sleep duration. Anxiety sensitivity mediated Black-White differences in sleep duration. Each anxiety sensitivity subscale was also a significant mediator. Implications for future intervention science to address sleep disparities are discussed.

Sleep functioning in adults with trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and a non-affected comparison sample

The present study assessed sleep functioning in Trichotillomania (TTM; Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder (ExD), and a non-affected comparison group, and examined the prevalence and correlates of bedtime and sleep-related hair pulling and skin picking. Participants were adult internet survey respondents, who met diagnostic criteria for TTM (N=259), ExD (N=182), or did not meet criteria for these disorders (N=148). Individuals with TTM and ExD endorsed significantly greater sleep disturbance relative to the comparison group, even after controlling for internalizing (anxiety and depression) symptoms. Hair pulling and skin picking severity were not significantly correlated with sleep disturbance after controlling for internalizing symptoms. Pulling and picking during sleep occurred at rates of 13% and 27%, respectively. Picking severity, anxiety and depressive symptoms, and sleep disturbance were significantly increased in those who engaged in picking during sleep relative to those who did not endorse this behavior. No significant differences were found between those endorsing pulling during sleep and those not endorsing this on demographic, clinical, or sleep variables. The present study highlights the potential role of sleep disturbance in TTM and ExD, and the need for further research in this area.

Sleep disturbances and mental strain in university students: results from an online survey in Luxembourg and Germany

OBJECTIVES

This study examined the prevalence of sleep disturbances and mental strain in students from two European countries, Luxembourg and Germany.

METHODS

A total of 2831 students took part in an online survey, with 2777 students from Germany and 184 students from Luxembourg. Sleep disturbances were assessed with the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, and aspects of mental strain using the Patient Health Questionnaire, the Social-Interactive-Anxiety Scale, the self-efficacy questionnaire and the test anxiety questionnaire. In addition, we also assessed students' chronotypes.

RESULTS

Across the whole sample mean scores on the sleep questionnaires were above the cut-off for clinically relevant sleep problems, indicating an increased prevalence of sleep disturbances in students from both countries. Sleep quality was impaired in 42.8%, and 17.9% showed clinically relevant scores. Overall 25.5% reported elevated depression and 13.3% social phobia symptoms, while 45% indicated elevated stress levels. Sleep quality, daytime sleepiness, chronotype, depression scores, stress levels, test anxiety, and self-efficacy differed significantly between men and women, but there were no differences between countries.

CONCLUSIONS

Sleep disturbances and mental strain in students are common, with the current results replicating previous findings. Students from Luxembourg and Germany are affected equally.

Sleep Quality in an Adult American Indian Community Sample

STUDY OBJECTIVES

Epidemiological studies have found that insufficient sleep (< 7 h/night) is more common among American Indians/Alaska Natives (AI/AN). In this study we sought to identify specific demographic, clinical, and cultural factors that may be associated with reduced sleep quality in an American Indian community sample.

METHODS

Information on demography along with personal medical, psychiatric, and drinking history was obtained using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The adult participants (n = 386, 54% women) had a mean ± standard deviation age of 31.35 ± 14.4 y. Higher degrees of AI ancestry, but not cultural identification, being older than 30 y, and having a high school diploma all were factors predictive of having a short sleep duration (< 6 h). The global score on the PSQI was significantly higher in those participants with a lifetime diagnosis of substance use disorders, anxiety disorders, and affective disorders. Alcohol use disorders and affective disorders were significant predictors of sleep latency whereas anxiety and affective disorders were correlated with waking more often in the night/early morning. Nicotine dependence was associated with having trouble breathing, and alcohol use disorders and anxiety disorders with bad dreams.

CONCLUSIONS

Alcohol use disorders are associated with poorer quality of sleep in this population and substance use disorders were associated with different aspects of sleep than anxiety and depressive disorders. These findings add to the understanding of the interactions between sleep and substance use, anxiety, and affective disorders in an understudied and underserved population.

ADHD and Sleep Quality: Longitudinal Analyses From Childhood to Early Adulthood in a Twin Cohort

Attention-deficit/hyperactivity disorder (ADHD) is associated with poor sleep quality, but there is more to learn about the longitudinal association and aetiology of this association. We investigated the following: (a) Is there an association between childhood ADHD and poor sleep quality in young adulthood? (b) Is this driven by the long-term effects of childhood ADHD or concurrent associations with ADHD in young adulthood? (c) To what extent do genetic and environmental influences explain the overlap between symptoms of ADHD and poor sleep quality? Participants were from the Environmental Risk Longitudinal Twin Study of 2,232 twin children born in the United Kingdom in 1994-1995. We ascertained ADHD diagnoses at ages 5, 7, 10, 12, and 18. We assessed sleep quality using the Pittsburgh Sleep Quality Index at age 18. We used regression models to examine longitudinal associations and bivariate twin modelling to test genetic and environmental influences. Children with ADHD had poorer sleep quality in young adulthood, but only if their ADHD persisted. Adults with ADHD had more sleep problems than those without ADHD, over and above psychiatric comorbidity and maternal insomnia. ADHD and sleep problems in young adulthood were associated because of genetic (55%) and nonshared environmental influences (45%). Should ADHD remit, children with ADHD do not appear to have an increased risk of later sleep problems. Good quality sleep is important for multiple areas of functioning, and a better understanding of why adults with ADHD have poorer sleep quality will further the goal of improving treatments.

Depression and Anxiety Screens as Simultaneous Predictors of 10-Year Incidence of Diabetes Mellitus in Older Adults in Primary Care

OBJECTIVES

To examine depression and anxiety screens and their individual items as simultaneous predictors of incident diabetes mellitus.

DESIGN

Ten-year follow-up study of individuals screened for the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial.

SETTING

Two large urban primary care clinics in Indianapolis, Indiana.

PARTICIPANTS

Diverse sample (53% African American, 80% of lower socioeconomic status) of 2,156 older adults initially free of diabetes mellitus.

MEASUREMENTS

Depression and anxiety screens were completed during routine primary care visits between 1999 and 2001. Incident diabetes mellitus data were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytical files though 2009.

RESULTS

Over the 10-year period, 558 (25.9%) participants had diabetes mellitus onset. Cox proportional hazards models adjusted for demographic and diabetes mellitus risk factors revealed that a positive screen for anxiety, but not for depression, predicted incident diabetes mellitus when entered into separate models (anxiety: hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.15-1.61, P < .001; depression: HR = 1.18, 95% CI = 0.95-1.46, P = .13) and when entered simultaneously into one model (anxiety: HR = 1.35, 95% CI = 1.12-1.61, P < .001; depression: HR = 1.04, 95% CI = 0.83-1.31, P = .73). The feeling anxious (P = .03) and the worry (P = .02) items predicted incident diabetes mellitus independent of the depression screen.

CONCLUSION

These findings suggest that screening positive for anxiety is a risk factor for diabetes mellitus in older adults independent of depression and traditional diabetes mellitus risk factors. Anxiety requires greater consideration and awareness in the context of diabetes mellitus risk assessment and primary prevention.

Variation in common preschool sleep problems as an early predictor for depression and anxiety symptom severity across time

BACKGROUND

Child and adolescent psychopathology has been linked to increased sleep problems, but there has been less investigation of this relationship in younger samples with early-onset psychopathology. This study examined three specific but commonly observed aspects of sleep behaviors in young children - (i) Sleep onset latency, (ii) Refusal to sleep alone, and (iii) Nighttime awakenings - measured during preschool, and investigated whether these sleep problems predicted anxiety and/or depression across the next 6 years until school age (ages 9-13).

METHODS

Data were analyzed from N = 292 participants from a prospective longitudinal study of preschool-age children (ages 3-6). At baseline, parent-reported clinical interviews of psychiatric symptoms, as well as sleep problems were conducted using the Preschool-Age Psychiatric Assessment (PAPA). Follow-up clinical interviews were also conducted annually through school age using the Childhood and Adolescent Psychiatric Assessment (CAPA).

RESULTS

Parent-reported sleep onset latency and refusal to sleep alone were significant independent predictors of MDD and anxiety severity, but not ADHD severity across time, even after controlling for family income-to-needs ratio and maternal internalizing psychopathology. In exploratory analyses using only healthy preschoolers, parent-reported sleep onset latency and refusal to sleep alone also predicted anxiety severity.

CONCLUSIONS

We demonstrate that specific, yet relatively common sleep problems predict diagnostic severity of depression and anxiety across time, but not ADHD. Increased clinical attention to and screening for sleep onset latency and refusal to sleep alone during preschool may be warranted.

Sleep problems and pain: a longitudinal cohort study in emerging adults

Sleep and pain are thought to be bidirectional related on a daily basis in adolescents with chronic pain complaints. In addition, sleep problems have been shown to predict the long-term onset of musculoskeletal pain in middle-aged adults. Yet, the long-term effects of sleep problems on pain duration and different types of pain severity in emerging adults (age: 18-25) are unknown. This study investigated the cross-sectional and longitudinal relationship between sleep problems and chronic pain, and musculoskeletal pain, headache, and abdominal pain severity in a general population of emerging adults. We studied whether these relationships were moderated by sex and whether symptoms of anxiety and depression, fatigue, or physical inactivity mediated these effects. Data of participants from the longitudinal Dutch TRacking Adolescents' Individual Lives Survey were used. Follow-up data were collected in 1753 participants who participated in the fourth (N = 1668, mean age: 19.0 years [SD = 0.6]) and/or fifth (N = 1501, mean age: 22.3 years [SD = 0.6]) assessment wave. Autoregressive cross-lagged models were used for analyses. Sleep problems were associated with chronic pain, musculoskeletal pain, headache and abdominal pain severity, and predicted chronic pain and an increase in musculoskeletal pain severity at 3 years of follow-up. This prospective effect was stronger in females than in males and was mediated by fatigue but not by symptoms of anxiety and depression or physical inactivity. Only abdominal pain had a small long-term effect on sleep problems. Our results suggest that sleep problems may be an additional target for treatment in female emerging adults with musculoskeletal pain complaints.

The direction of the relationship between symptoms of insomnia and psychiatric disorders in adolescents

BACKGROUND

This study assessed the direction of the relationship between symptoms of insomnia disorder, depression, various anxiety disorders and obsessive compulsive disorder (OCD) in adolescents after controlling for age, gender, chronotype, and outcome variable at baseline.

METHODS

Data was collected in eight high schools in Adelaide, South Australia, at two time-points approximately 6 months apart. The study was completed by 318 and 255 high school students at baseline and follow-up, respectively, aged 12-18 (M=14.96, SD=1.34) in grades 7-11 at baseline. Hierarchical regression analyses were used to assess each relationship, the first model controlling for age, gender and chronotype, and the second controlling for outcome variable at baseline.

RESULTS

Insomnia symptoms predicted and were predicted by symptoms of each psychiatric disorder in model 1. In model 2, insomnia symptoms predicted symptoms of depression, and vice-versa. Symptoms of insomnia also predicted symptoms of separation anxiety disorder (SAD) once SAD, but not vice-versa, in model 2. Symptoms of obsessive compulsive disorder (OCD) and social phobia (SP) predicted symptoms of insomnia disorder in model 2, but not vice-versa. Insomnia symptoms were no longer related to symptoms of other anxiety disorders in model 2.

LIMITATIONS

The use of self-report measures, and potential predisposing, precipitating, perpetuating or preventative factors were not assessed.

CONCLUSIONS

Symptoms of insomnia disorder are bidirectionally related to depressive symptoms independent from baseline symptoms, and unidirectionally related to symptoms of OCD and SP where OCD and SP are independent risk-factors of the development of insomnia symptoms.

Charlotte Attitudes Towards Sleep (CATS) Scale: A validated measurement tool for college students

OBJECTIVE

Using a 4-phase study design, the present study developed and tested the Charlotte Attitudes Towards Sleep (CATS) Scale, a measurement tool for assessing sleep attitudes in college students.

PARTICIPANTS

Participants were 706 undergraduate students recruited at a southeastern university and on a national recruitment Web site between October 2013 and April 2015.

METHODS

All participants completed the CATS Scale. Participants then completed either a measure of social desirability, faulty sleep beliefs, or measures of sleep and sleep hygiene. Phase 3 participants (N = 168) completed the CATS Scale 2 weeks later to examine test-retest reliability.

RESULTS

Analyses indicated that the scale was content valid, internally consistent, and independent of social desirability, yielded acceptable temporal stability, and demonstrated concurrent validity in relation to sleep behaviors and outcomes.

CONCLUSIONS

The CATS Scale is a theoretically driven instrument with promising psychometric properties that may prove beneficial for future research and application efforts among college students.

Social and emotional loneliness and self-reported difficulty initiating and maintaining sleep (DIMS) in a sample of Norwegian university students

Social and emotional loneliness negatively impact several areas of health, including sleep. However, few comprehensive population-based studies have evaluated this relationship. Over 12,000 students aged 21-35 years who participated in the student survey for higher education in Norway (the SHoT study) were assessed. Loneliness was assessed using the Social and Emotional Loneliness Scale. Difficulty initiating and maintaining sleep (DIMS) was assessed by a single-item subjective response on the depression scale of the Hopkins Symptoms Checklist (HSCL-25). Social loneliness was associated with more serious DIMS (unadjusted proportional odds-ratio [OR] = 2.69, 95% CI = 2.46-2.95). This association was attenuated following adjustment for anxiety (adjusted OR = 1.92, 95% CI = 1.75-2.10) and depression (adjusted OR = 1.48, 95% CI = 1.34-1.63), however was not substantially altered when all demographics and psychological distress were accounted for (fully adjusted OR = 1.46, 95% CI = 1.30-1.63). Emotional loneliness was also associated with more serious DIMS (unadjusted proportional OR = 2.33, 95% CI = 2.12-2.57). Adjustment for anxiety (adjusted OR = 1.96, 95% CI = 1.78-2.15) and depression (adjusted OR = 1.64, 95% CI = 1.48-1.80) attenuated, but did not extinguish this relationship in the fully adjusted model (adjusted OR = 1.22, 95% CI = 1.09-1.31). Mediation analyses revealed that the social loneliness-DIMS association was fully attributed to psychological distress, while the emotional loneliness-DIMS association was only partially mediated, and a direct association was still observed. Associations between social and emotional loneliness and subjective DIMS were embedded in a larger pattern of psychological distress. Mitigating underlying feelings of loneliness may reduce potentially deleterious effects on sleep health and psychological wellbeing in young adults.

Sleep Disruption in Pediatric Cancer Survivors: Conceptual Framework and Opportunities for Clinical Assessment and Behavioral Treatment

Sleep disruption is a commonly reported consequence of cancer and its treatment in pediatric patients and survivors. This review summarizes common sleep concerns in this population and introduces a multidimensional framework of risk factors specific to childhood cancer that may interact to develop and maintain disrupted sleep. Based on the extant literature, parameters of the cancer and its treatment, physical and social environmental conditions both during and after treatment, changes to family behavior and norms, psychological factors and traumatic stress, and reduced physical activity are hypothesized to be the most pertinent risk factors for disrupted sleep in this population. Potential clinical assessment strategies and behavioral interventions relevant to these considerations are discussed, with reference to the behavioral model of insomnia. The review concludes by offering directions for research and clinical practice, including developing and testing comprehensive assessment tools, intervention effectiveness studies in both oncology and primary care clinics, and efforts to increase patient-provider communication about sleep in pediatric oncology.

Maternal depressed mood moderates the impact of infant sleep on mother-infant bonding

Parent-infant bonding has long-term consequences for the psychological wellbeing of the child. Considering the centrality of infant sleep patterns in infant-caregiver interactions in the first year of life, we propose that infant sleep patterns act as a catalyst or disruptor for mother-infant relationship, such that infant sleep patterns contribute to maternal mood, maternal sleep quality, perception of infant temperament, and her bonding experience. One hundred fifty-two Israeli mothers, of 5-8-month-old infants, responded to Internet-based questionnaires regarding their sleep, their mood, their infant's sleep, the infant's temperament, and their bonding experience. Eight percent of the mothers reported clinically significant depression, while 67 % reported significant sleep difficulties. Infant sleep difficulties correlated with maternal mood and sleep quality, infant fussiness, and bonding. Structural equation modeling demonstrated that maternal sleep partially mediated the relationship between infant sleep and maternal mood. Additionally, 22 % of the variance in bonding was explained by infant sleep problems and temperament. Notably, maternal depression moderated this effect such that infant sleep problems correlated with bonding only in those mothers who were depressed. The results suggest that infant sleep is a vector by which maternal cognitions and mood are transmitted to her child, with long-term implications for psychological development.

Developmental Trajectories of Sleep Problems from Childhood to Adolescence Both Predict and Are Predicted by Emotional and Behavioral Problems

Although the prevalence rates of sleep disorders at different stages of childhood and adolescence have been well established, little is known about the developmental course of general sleep problems. This also holds true for the bidirectional relationship between sleep problems and emotional as well as behavioral difficulties. This longitudinal study investigated the general pattern and the latent trajectory classes of general sleep problems from a large community sample aged 5–14 years. In addition, this study examined the predictive value of emotional/behavioral difficulties (i.e., anxiety/depression, attention problems, and aggressive behavior) on sleep problems latent trajectory classes, and vice-versa. Participants (N = 1993) were drawn from a birth cohort of Western Australian children born between 1989 and 1991 who were followed until 14 years of age. Sleep problems were assessed at ages 5, 8, 10, and 14, respectively, whereas anxiety/depression, attention problems, and aggressive behavior were assessed at ages 5 and 17 years. Latent growth curve modeling revealed a decline in an overall pattern of sleep problems during the observed 10-year period. Anxiety/depression was the only baseline factor that predicted the longitudinal course of sleep problems from ages 5 to 14 years, with anxious and depressed participants showing faster decreasing patterns of sleep problems over time than those without anxiety or depression. Growth mixture modeling identified two classes of sleep problem trajectories: Normal Sleepers (89.4%) and Troubled Sleepers (10.6%). Gender was randomly distributed between these groups. Childhood attention problems, aggressive behavior, and the interaction between gender and anxiety/depression were significantly predictive of membership in the group of Troubled Sleepers. Group membership in Troubled Sleepers was associated with higher probability of having attention problems and aggressive behavior in mid-adolescence. Boys and girls with behavioral difficulties, and girls with emotional difficulties were at increased risk of having sleep problems during later childhood and adolescence. Developmental trajectories of sleep problems were also predictive of behavioral difficulties in later life. Findings from this study provide empirical evidence for the heterogeneity of sleep problems and their development, and emphasize the importance of understanding sleep problems and their relationship to children and adolescents’ mental health.

The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline

Currently, there are no effective pharmaceutical treatments to reduce cognitive decline or prevent dementia. At the same time, the global population is aging, and rates of dementia and mild cognitive impairment (MCI) are on the rise. As such, there is an increasing interest in complementary and alternative interventions to treat or reduce the risk of cognitive decline. Depression is one potentially modifiable risk factor for cognitive decline and dementia. Notably, exercise and yoga are two interventions known to both reduce symptoms of depression and improve cognitive function. The current review discusses the efficacy of exercise and yoga to ameliorate depression and thereby reduce the risk of cognitive decline and potentially prevent dementia. Potential mechanisms of change, treatment implications, and future directions are discussed.

Network analysis of depression and anxiety symptom relationships in a psychiatric sample

BACKGROUND

Researchers have studied psychological disorders extensively from a common cause perspective, in which symptoms are treated as independent indicators of an underlying disease. In contrast, the causal systems perspective seeks to understand the importance of individual symptoms and symptom-to-symptom relationships. In the current study, we used network analysis to examine the relationships between and among depression and anxiety symptoms from the causal systems perspective.

METHOD

We utilized data from a large psychiatric sample at admission and discharge from a partial hospital program (N = 1029, mean treatment duration = 8 days). We investigated features of the depression/anxiety network including topology, network centrality, stability of the network at admission and discharge, as well as change in the network over the course of treatment.

RESULTS

Individual symptoms of depression and anxiety were more related to other symptoms within each disorder than to symptoms between disorders. Sad mood and worry were among the most central symptoms in the network. The network structure was stable both at admission and between admission and discharge, although the overall strength of symptom relationships increased as symptom severity decreased over the course of treatment.

CONCLUSIONS

Examining depression and anxiety symptoms as dynamic systems may provide novel insights into the maintenance of these mental health problems.

A Longitudinal Twin and Sibling Study of Associations between Insomnia and Depression Symptoms in Young Adults

STUDY OBJECTIVES

To estimate genetic and environmental influences on the associations between insomnia and depression symptoms concurrently and longitudinally.

METHODS

Behavioral genetic analyses were conducted on data from the British longitudinal G1219 twin/sibling study. One thousand five hundred fiftysix twins and siblings participated at Time 1 (mean age = 20.3 years, SD = 1.76). Eight hundred sixty-two participated at Time 2 (mean age = 25.2 years, SD = 1.73 years). Participants completed the Insomnia Symptoms Questionnaire and the Short Mood and Feelings Questionnaire to assess symptoms of insomnia and depression respectively.

RESULTS

Genetic effects accounted for 33% to 41% of the variance of the phenotypes. The phenotypic correlations were moderate (r = 0.34 to r = 0.52). The genetic correlations between the variables were high (0.73-1.00). Genetic effects accounted for a substantial proportion of the associations between variables (50% to 90%). Non-shared environmental effects explained the rest of the variance and covariance of the traits.

CONCLUSIONS

While genetic effects play a modest role in insomnia and depression symptoms separately, they appear to play a more central role in concurrent and longitudinal associations between these phenotypes. This should be acknowledged in theories explaining these common associations.

Sleep Complaints and the 24-h Melatonin Level in Individuals with Smith-Magenis Syndrome: Assessment for Effective Intervention

AIMS

Individuals with Smith-Magenis syndrome (SMS) are reported to have a disrupted circadian rhythm. Our aim was to examine problematic sleeping in those attending our sleep clinic for the first time.

METHODS

At intake, caregivers of 50 children and nine adults with SMS were surveyed about the sleep pattern and potential melatonin administration. Sampling of salivary melatonin levels was performed.

RESULTS

At intake, exogenous melatonin was used by 16 children (27.1% of sample; 56.3% male) with mean age 6.8 ± 2.8 years, whereas 34 children (57.6%; 7.5 ± 4.8 years old; 64.7% male) and nine adults (15.3%; 36.8 ± 15.3 years old; 44.4% male) were not taking melatonin at intake. Participants were reported to have problems with night waking and early awakenings regardless of melatonin administration. Overall, moderate to high levels of salivary melatonin at noon were found in individuals with SMS. In particular, children with SMS showed a disrupted melatonin pattern. Furthermore, the endogenous melatonin level, age, and gender may potentially interact, yielding the severity range of sleep disturbances reported in SMS.

CONCLUSION

Treatment of sleep problems in SMS is complex, and our findings may support person-centered sleep and medication management. Future clinical trials including larger groups may shed light on such approaches.

Sleep Architecture Relates to Daytime Affect and Somatic Complaints in Clinically Anxious but Not Healthy Children

It is increasingly clear that seminal sleep-affective relationships begin to take root in childhood, yet studies exploring how nighttime sleep characteristics relate to daytime affective symptoms, both in clinical and healthy populations of children, are lacking. The current study sought to explore these relationships by investigating whether trait-like and/or daily reports of affective and somatic symptoms of children with generalized anxiety disorder and matched controls relate to sleep architecture. Sixty-six children (ages 7-11; 54.4% female; 56.1% Caucasian; 18.2% biracial; 6.1% African American; 3% Asian; 16.7% Hispanic) participated including 29 with primary generalized anxiety disorder (without comorbid depression) and 37 healthy controls matched on age and race/ethnicity. Participants underwent structured diagnostic assessments including child-report measures and subsequently reported on their negative affect and somatic symptoms over the course of 1 week. Children also completed 1 night of polysomnography. Among children with generalized anxiety disorder only, greater amounts of slow wave sleep corresponded with less negative affect, and greater amounts of rapid eye movement sleep was related to more somatic complaints across the week. Similarly, for trait-like measures, more rapid eye movement sleep and shorter latency to rapid eye movement sleep were related to greater depressive symptoms in the anxious group only. The current findings suggest that physiologic sleep characteristics may contribute in direct ways to the symptom profiles of clinically anxious children. The functional relevance of such findings (e.g., how specific sleep characteristics serve to either increase or reduce long-term risk) is a vital direction for future research.

Daily Social Contact in Relation to Sleep: The Role of Age

OBJECTIVES

To examine how social contact during daily activities differs by age and relates to sleep outcomes.

METHODS

Fifty younger (M = 19.9 years, SD = 2.76) and 48 older (M = 67.6 years, SD = 6.63), community-dwelling adults completed the Social Rhythm Metric-17 and daily sleep diary online for 14 days.

RESULTS

Younger adults completed a greater proportion of activities with active others than older adults. Age significantly interacted with the proportion of activities completed alone, β = -.77, p = .04. Alone activities negatively predicted total sleep time in older, not younger adults.

DISCUSSION

Social contact, or lack thereof, is important for sleep, particularly for older adults who may be more prone to aloneness due to life course events.

Sleep duration and RSA suppression as predictors of internalizing and externalizing behaviors

Although the conceptual interplay among the biological and clinical features of sleep, arousal, and emotion regulation has been noted, little is understood about how indices of sleep duration and parasympathetic reactivity operate jointly to predict adjustment in early childhood. Using a sample of 123 toddlers, the present study examined sleep duration and RSA reactivity as predictors of internalizing and externalizing behaviors. Parents reported on children's sleep duration and adjustment. RSA reactivity was assessed via children's responses to fear-eliciting stimuli and an inhibitory control challenge. Findings demonstrated that greater RSA suppression to both types of tasks in combination with longer sleep duration was concurrently associated with less internalizing. In contrast, greater RSA augmentation to an inhibitory control task in the context of shorter sleep duration predicted more externalizing 1 year later. The significance of duration of toddlers' sleep as well as the context in which physiological regulatory difficulties occurs is discussed.

Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults

BACKGROUND

Many adults are insufficiently physically active, have prolonged sedentary behaviour and report poor sleep. These behaviours can be improved by interventions that include education, goal setting, self-monitoring, and feedback strategies. Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods.

METHODS/DESIGN

This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objectively measured physical activity, sedentary, and sleep behaviours, in a 9 week 2-arm randomised trial. Participants will be adults (n = 64) who report being physically inactive, sitting >8 h/day and frequent insufficient sleep (≥14 days out of last 30). The "Balanced" intervention is delivered via a smartphone 'app', and includes education materials (guidelines, strategies to promote change in behaviour), goal setting, self-monitoring and feedback support. Participants will be randomly allocated to either a device-entered or user-entered self-monitoring method. The device-entered group will be provided with a activity tracker to self-monitor behaviours. The user-entered group will recall and manually record behaviours. Assessments will be conducted at 0, 3, 6, and 9 weeks. Physical activity, sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer. Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01.

DISCUSSION

This study will evaluate an app-based multi-behavioural intervention to improve physical activity, sedentary behaviour and sleep; and the relative efficacy of two different approaches to self-monitoring these behaviours. Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours.

TRIAL REGISTRATION

ACTRN12615000182594 (Australian New Zealand Clinical Trials Registry. Registry URL: www.anzctr.org.au ; registered prospectively on 25 February 2015).

Putting Children's Sleep Problems to Bed: Using Behavior Change Theory to Increase the Success of Children's Sleep Education Programs and Contribute to Healthy Development

Sleep is critical for the healthy development of children, yet most children simply don’t get enough. Whilst school based sleep education programs have been developed for parents and their children, they have had mixed success. We consider how existing school-based sleep education programs can be improved by applying a broader model to behaviour change theory. We find that the mixed success of school-based sleep education programs may be due to a plausible but misleading assumption that simply increasing information about the importance of sleep and the risks of insufficient and/or inefficient sleep, will necessarily result in improved sleep behaviours. We identify the potential benefits of using a more inclusive behavior change theory in the development of sleep education programs with a particular need for theories that incorporate the multiple biological, environmental and social impacts on children’s sleep. Bronfenbrenner’s Bioecological model is presented to illustrate how one such inclusive behavior change theory could significantly improve the success of sleep education programs and ultimately support the healthy development of children.

Examining Dark Triad traits in relation to sleep disturbances, anxiety sensitivity and intolerance of uncertainty in young adults

BACKGROUND

The Dark Triad (DT) describes a set of three closely related personality traits, Machiavellianism, narcissism, and psychopathy. The aim of this study was to examine the associations between DT traits, sleep disturbances, anxiety sensitivity and intolerance of uncertainty.

METHOD

A total of 341 adults (M=29years) completed a series of questionnaires related to the DT traits, sleep disturbances, anxiety sensitivity, and intolerance of uncertainty.

RESULTS

A higher DT total score was associated with increased sleep disturbances, and higher scores for anxiety sensitivity and intolerance of uncertainty. In regression analyses Machiavellianism and psychopathy were predictors of sleep disturbances, anxiety sensitivity, and intolerance of uncertainty.

CONCLUSIONS

Results indicate that specific DT traits, namely Machiavellianism and psychopathy, are associated with sleep disturbances, anxiety sensitivity and intolerance of uncertainty in young adults.

Melatonin rhythms in renal transplant recipients with sleep-wake disturbances

We assessed salivary melatonin levels in renal transplant (RTx) recipients who participated in a randomised, multicentre wait-list controlled trial on the effect of bright light therapy on their sleep and circadian rhythms. A large proportion of RTx recipients in our cohort had unexpectedly low melatonin values, which precluded calculation of the dim-light melatonin onset (DLMO) as a circadian marker. Thus, the aim of this post hoc analysis was to describe the melatonin profile of home-dwelling RTx recipients diagnosed with sleep-wake disturbances (SWDs). The participants were characterised by means of sleep questionnaires, validated psychometric instruments [Pittsburgh sleep quality Index (PSQI), Epworth sleepiness scale (ESS), Morningness-Eveningness Questionnaire (MEQ) and Depression, Anxiety and Stress Scale (DASS)] in addition to melatonin assay in saliva. Data were analysed with descriptive statistics and group comparisons made with appropriate post hoc tests. RTx recipients [n = 29 (aged 54.83 ± 13.73, transplanted 10.62 ± 6.84 years ago)] were retrospectively grouped into two groups: RTx recipients whose dim light melatonin onset (DLMO) could be calculated (n = 11) and those whose DLMO could not be calculated (n = 18). RTx recipients having a measurable DLMO had a number of differences from those without DLMO: they were younger [46.4 ± 14.9 compared to 60.0 ± 10.3 (p = .007)], had higher haemoglobin values [135.36 ± 12.01 versus 122.82 ± 11.56 (p = .01)], less anxiety [4 (0;8) versus 12 (6.5;14) (p = .021)] and a better overall sense of coherence [SOC Score: 71.09 ± 12.78 versus 56.28 ± 15.48 (p = 0.013)]. These results suggest that RTx recipients whose DLMO could be calculated have less health impairments, underlying the relevance of a stable circadian system.