Reciprocal relationships between daily sleep and mood: A systematic review of naturalistic prospective studies

Physical activity, sleep and affective wellbeing on the following day: An experience sampling study

This study aims to investigate the temporal links between physical activity, sleep and affective wellbeing in young adults. In particular, the aim was to examine whether physical activity is associated with sleep indicators in subsequent nights and, in turn, whether sleep was associated with improved affective wellbeing the next morning. Relatedly, moderation by baseline levels of depressive symptoms, sleep quality, habitual physical activity and gender was analysed. One-hundred and forty-seven individuals (85.7% female) aged 18-25 years old participated in an experience sampling study over 14 consecutive days. Participants received seven prompts per day, and answered questions about their physical activity and affective states. Every morning, participants also reported their sleep. Physical activity throughout the day was not related to sleep during the following night or to affective wellbeing the next morning. An exception to that pattern was that physical activity before 14:00 hours was associated with longer subsequent sleep duration. Better subjective sleep quality predicted affective wellbeing the next morning. Associations of physical activity, sleep and affective wellbeing were not moderated by baseline depressive symptoms, sleep quality or habitual physical activity. However, investigation of gender as a moderator revealed that moderate physical activity was associated with better subsequent sleep quality for males, but not for females. Overall, we found that physical activity is associated with better subsequent sleep for males, but not for females. Also, our study provides further evidence that better sleep quality is associated with the next morning's affective wellbeing.

Self-reported insomnia symptoms are associated with urinary incontinence among older Indian adults: evidence from the Longitudinal Ageing Study in India (LASI)

BACKGROUND

Insomnia and urinary incontinence (UI) are both diseases burdening older adults. However, the association between them has not been well elucidated. The purpose of this study is to assess the correlation between insomnia symptoms and UI in a large community-dwelling sample of older Indian adults.

METHODS

Data were from Wave 1 (2017-2018) of the Longitudinal Ageing Study of India (LASI). Male and female participants aged ≥ 60 years who provided complete information on insomnia symptoms, UI, stress UI (SUI), and covariates were included. Insomnia symptoms were identified by a report of: trouble falling asleep, waking up at night, or waking too early, ≥ 5 times/week. UI was defined by self-reported diagnosis. SUI was identified by self-report of involuntary urine leakage when sneezing, coughing, laughing, or lifting weights. Multivariable logistic regression analyses evaluated the associations between insomnia symptoms and UI and SUI. Stratified linear regression evaluated for interactions in prespecified subgroups.

RESULTS

Twenty-six thousand eight hundred twenty-one LASI participants met entry criteria. 2979 (11.11%) reported insomnia symptoms, 976 (3.64%) UI, and 2726 (10.16%) SUI. After full adjustment, insomnia symptoms were associated with both UI and SUI among males (OR 1.53; 95%CI 1.20-1.96 and OR 1.51; 95%CI 1.25-1.83) and females (OR 1.53; 95% CI 1.21-1.92 and OR 1.50; 95% CI 1.31-1.73). A significant interaction effect by age was observed between insomnia symptoms and SUI among both males (p = 0.048) and females (p = 0.042).

CONCLUSIONS

Insomnia symptoms were associated with UI and with SUI in both male and female older Indian adults. Further prospective study is called for to better characterize these associations and to explore underlying mechanisms.

Lifestyle and work-related correlates of psychosocial health among Australian teachers: a cross-sectional study

Aim

This study examined the psychosocial (psychological distress, job-specific wellbeing, burnout) health of a large sample of teachers in New South Wales (NSW), Australia, specifically the association between psychosocial health, work-related factors, and lifestyle behaviours.

Subject & methods

An online survey collected lifestyle behaviours, work-related factors, and socio-demographics from primary and secondary school teachers in NSW from February to October 2021. Associations between work-related factors, lifestyle behaviours, and psychosocial health were modelled using logistic regression in R and adjusted for gender, age, and geographic location.

Results

In our sample (n = 1136), 75% were women and 28% of the sample worked in rural or remote areas. Women reported higher levels of psychological distress (51%), compared with men (42%), and over 30% of teachers reported high levels of burnout. Teachers who engaged in three or more positive health-related behaviours had lower odds of psychological distress and burnout as well as higher odds of job-specific wellbeing. Multiple work-related factors such as hours worked, teaching load, teaching experience, teacher type, and teacher role were associated with one or more aspects of psychosocial health after adjusting for socio-demographic variables.

Conclusion

More is needed to support the psychosocial health of teachers in NSW. Future lifestyle programs for this population should include psychosocial outcomes to further explore the relationship between teachers' health-related behaviour and their psychosocial health.

Supplementary information

The online version contains supplementary material available at 10.1007/s10389-023-01874-9.

Application of Ecological Momentary Assessment in Studies with Rotation Workers in the Resources and Related Construction Sectors: A Systematic Review

Whilst Ecological momentary assessment (EMA) can provide important insights over time and across contexts among rotation workers whose work periods alternate with leave at home, it can also be challenging to implement in the resources and construction sectors. This review aimed to provide a summary of the methodological characteristics of EMA studies assessing health outcomes and related behaviors in rotation workers. Systematic searches in PubMed, Medline, EMBASE, CINAHL, PsycINFO, and Scopus were done to include 23 studies using EMA methods in assessing health-related outcomes and behaviors. EMA designs included daily diary: assessments once per day typically fixed at the end of day (47.8%), within day fixed interval time-based design: assessments on multiple times per day at certain times of day (17.4%) and combination of both designs (34.8%). Studies employed paper and pencil diaries (73.9%) and one or more electronic methods (60.9%): wrist-worn actigraphy device (52.2%) and online-based diaries (26.1%) for data collection. Most of the studies (91.3%) did not report prompting -EMAs by schedule alerts or compliance. Daily diary and within day fixed interval dairies designs are common, with the increasing use of electronic EMA delivery techniques. It is unclear how well participants adhere to assessment schedules, as these are inadequately reported. Researchers should report compliance-related information.

The role of positive affect processes in the association between posttraumatic stress disorder symptoms and sleep: A multi-study design

OBJECTIVES

Posttraumatic stress disorder (PTSD) symptoms have been linked to sleep disturbances. Limited work has explored how positive affect processes may account for this relationship. Advancing research in this area, we utilized a multi-study design to investigate the role of positive affect processes (levels of positive affect, positive emotionality, hedonic deficits, negative affect interference) in the PTSD-sleep association.

METHODS

Data from 149 trauma-exposed firefighters (M_age = 38.93 ± 9.65, 5.40 % women) were collected between September 2021 and November 2021, and data from 119 trauma-exposed community members (M_age = 29.60 ± 8.67, 68.10 % women) were collected between February 2021 and December 2021. Participants completed an online survey on PTSD symptoms, sleep disturbances, and positive affect processes.

RESULTS

Positive affect levels (b = 0.03, 95 % confidence interval [CI] [0.01, 0.06]; firefighter sample), positive emotionality (b = 0.07, CI [0.03, 0.13]; community sample), and negative affect interference (b = 0.06, CI [0.01, 0.14]; community sample) significantly accounted for the associations between PTSD symptom severity and sleep disturbances controlling for the effects of gender and age.

CONCLUSION

Findings highlight the role of positive affect processes in the link between PTSD and sleep, and support addressing positive affect processes as potential targets in clinical interventions for co-occurring PTSD-sleep problems.

Investigating sleep, stress, and mood dynamics via temporal network analysis

OBJECTIVE/BACKGROUND

Prior research has emphasized the bidirectional relationships between sleep, stress, and affective states, such as depression. Given the inherent variability and fluctuations associated with sleep, assessing how sleep and affective variables function within a dynamic system may help further uncover possible causes and consequences of sleep disturbances, as well as find candidate targets for intervention. To this end, we examined dynamic relationships between self-reported stress, depressed mood, and clinically-relevant sleep parameters via temporal network analysis.

METHODS

Participants were 401 nurses (92% female, 78% White, Mage = 39.47 years) who completed 14 days of sleep diaries incorporating self-reported stress and depression, as well as total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset.

RESULTS AND CONCLUSIONS

Overall, total sleep time emerged as a highly influential variable in the context of "outstrength centrality," meaning total sleep time had numerous outward connections with other variables (e.g., stress and sleep efficiency). The high outstrength centrality of total sleep time suggests this variable is a source of activation within this dynamic system. Conversely, stress showed high "instrength centrality," suggesting this variable was highly impacted by other variables in the system, such as depressed mood and sleep efficiency. These findings emphasize the importance of assessing unfolding sleep processes within a naturalistic setting, and implicate the role of total sleep time in fueling depressed mood and stress. Discussion emphasizes implications of these results for understanding the connections between sleep, stress, and depression as well as clinical relevance of these findings.

Many faces of sleep regulation: beyond the time of day and prior wake time

The two-process model of sleep regulation posits two main processes regulating sleep: the circadian process controlled by the circadian clock and the homeostatic process that depends on the history of sleep and wakefulness. The model has provided a dominant conceptual framework for sleep research since its publication ~ 40 years ago. The time of day and prior wake time are the primary factors affecting the circadian and homeostatic processes, respectively. However, it is critical to consider other factors influencing sleep. Since sleep is incompatible with other behaviors, it is affected by the need for essential behaviors such as eating, foraging, mating, caring for offspring, and avoiding predators. Sleep is also affected by sensory inputs, sickness, increased need for memory consolidation after learning, and other factors. Here, we review multiple factors influencing sleep and discuss recent insights into the mechanisms balancing competing needs.

Pre-sleep affect predicts subsequent REM frontal theta in nonlinear fashion

Pre-sleep affect is thought to influence sleep, but associations with both sleep architecture and the electroencephalographic (EEG) power spectrum are mixed. In this pre-registered study, we assessed negative valence and arousal 1 h pre-sleep in 52 adults drawn from the community, then recorded one night of polysomnography (PSG) in participants' own homes. Pre-sleep affect was not associated with nonrapid eye movement (NREM) or rapid eye movement (REM) sleep architecture parameters, but we did observe inverted U-shaped relationships between both negative valence and arousal and REM frontal theta power, such that theta power was highest at moderate negative valence and arousal, and lowest at either affective extreme. When entered into a model together, both valence and arousal accounted for independent variance. Secondary analyses revealed a similar quadratic association with pre-sleep positive valence, suggesting a nonspecific effect of pre-sleep valence on REM frontal theta. Robustness checks confirmed that effects were not explained by homeostatic sleep pressure or sleep timing. Our results suggest that mixed findings in the literature may reflect different ends of a quadratic function, underscoring the importance of assessing how different components of pre-sleep affect relate to sleep.

Sleep influences daily suicidal ideation through affective reactivity to interpersonal events among high-risk adolescents and young adults

BACKGROUND

Identifying proximal risk factors for suicidal ideation that are modifiable and relevant for adolescents and young adults is critical for suicide prevention. This study used an intensive monitoring approach to examine whether objectively- and subjectively- measured sleep characteristics predict next-day suicidal ideation occurrence and intensity through affective reactivity to interpersonal events in young people at high risk for suicide.

METHODS

Participants included 59 (13-23 years; 76% White; 75% female) adolescents and young adults undergoing intensive outpatient program treatment for depression and suicidality. Participants completed daily ratings of suicidal ideation, sleep quality, and affective reactivity to positive and negative interpersonal events for up to 3 months (M = 56 days, SD = 24.13). Actigraphy captured behavioral sleep duration and timing. Multilevel modeling was used to evaluate within-person fluctuations in sleep and affective reactivity as predictors of suicidal ideation, and multilevel mediation tested the indirect effects of sleep on suicidal ideation via affective reactivity to interpersonal events.

RESULTS

Results indicate significant indirect effects of objectively measured sleep duration and subjective sleep quality on next-day suicidal ideation via affective reactivity to negative and positive interpersonal events, respectively. Shorter-than-usual sleep predicted the presence and intensity of next-day suicidal ideation via heightened affective reactivity to negative interpersonal events. Worse sleep quality than usual predicted next-day suicidal ideation via reduced affective reactivity to positive interpersonal events.

CONCLUSIONS

Affectivity reactivity is a proximal mechanism through which sleep indices may influence risk for suicidal thinking on a daily basis. Findings highlight the utility of targeting sleep and emotion regulation in suicide prevention among adolescents and young adults at high-risk for suicide.

Sleep, Circadian Rhythms, and Cognitive Dysfunction in Huntington's Disease

BACKGROUND

In healthy people, sleep and circadian disruption are linked to cognitive deficits. People with Huntington's disease (HD), who have compromised brain function and sleep and circadian disturbances, may be even more susceptible to these cognitive effects.

OBJECTIVE

To conduct a comprehensive review and synthesis of the literature in HD on the associations of cognitive dysfunction with disturbed sleep and circadian rhythms.

METHODS

We searched MEDLINE via OVID, CINAHL Plus, EMBASE via OVID, and PubMed in May 2023. The first author then screened by title and abstract and conducted a full review of remaining articles.

RESULTS

Eight studies investigating the influence of sleep and/or circadian rhythms on cognitive function in HD were found. In manifest HD, poorer sleep was associated with worse cognitive function. For behavioral 24-hour (circadian) rhythms, two studies indicated that later wake times correlated with poorer cognitive function. No reported studies in HD examined altered physiological 24-hour (circadian) rhythms and cognitive impairment.

CONCLUSION

Some associations exist between poor sleep and cognitive dysfunction in manifest HD, yet whether these associations are present before clinical diagnosis is unknown. Whether circadian disturbances relate to cognitive impairment in HD also remains undetermined. To inform sleep and circadian interventions aimed at improving cognitive symptoms in HD, future research should include a range of disease stages, control for external factors, and utilize robust cognitive batteries targeted to the aspects of cognitive function known to be adversely affected in HD.

Sleep and Daily Positive Emotions – Is Heart Rate Variability a Mediator?

Abstract. Sleep quality is considered a basic dimension of emotional health. The psychophysiological mechanisms underlying the associations between sleep quality and positive emotions are still largely unknown, yet autonomic regulation may play a role. This study employed a two-day ecological momentary assessment methodology in a sample of young adults to investigate whether subjective sleep quality reported in the morning was associated with daily positive emotional experience and whether this association was mediated by heart rate variability (HRV), a measure of cardiac vagal tone. Sleep quality was assessed using an electronic sleep diary upon awakening, while resting HRV and positive emotions were inspected at random times throughout the day using photoplethysmography and an electronic diary, respectively. Relevant confounding variables such as smoking, alcohol intake, and physical exercise between each measurement were also assessed. The sample included 121 participants (64.8% females, Mage = 25.97 ± 5.32 years). After controlling for relevant confounders including health behaviors and psychiatric comorbidities, mediation analysis revealed that greater sleep quality positively predicted daily HRV (β = .289, p < .001) which, in turn, had a direct influence on positive emotions (β = .244, p = .006). Also, sleep quality directly predicted positive emotional experience (β = .272, p = .001). Lastly, the model showed an indirect effect between sleep quality and positive emotions via HRV (β = .071, 95% BCI [.011, .146]). Results support the view of HRV as a process variable linking sleep to positive emotions. Experimental data is needed to consolidate the present findings.

Repetitive transcranial magnetic stimulation (rTMS) for post-stroke sleep disorders: a systematic review of randomized controlled trials

OBJECTIVE

Survivors of stroke often experience post-stroke sleep disorders (PSSDs), but pharmacotherapy risks adverse side effects. Transcranial magnetic stimulation (TMS) is potentially a nonpharmacotherapeutic option. This meta-analysis investigated the effects of rTMS to treat PSSD.

METHODS

Databases were searched for randomized controlled trials (RCTs) of rTMS to treat PSSD, conducted in accordance with the PRISMA 2020 guidelines. Risk-of-bias assessments were performed using the Cochrane risk-of-bias tool. A meta-analysis of the following indexes was performed using RevMan 5.4 software: Pittsburgh sleep quality index; effective rate of sleep improvement; Hamilton Anxiety Rating Scale (for mood); and National Institute of Health Stroke Scale (NIHSS, stroke severity). Mean differences (MDs) and confidence intervals (CIs) were calculated.

RESULTS

The meta-analysis included 17 RCTs, with 1411 patients overall. The indexes indicated that rTMS could improve the sleep quality, mood, and stroke severity of patients with PSSD: Pittsburgh sleep quality index (12 studies; MD =  - 2.51, 95% CI [- 3.24, - 1.79], P < 0.00001); effective rate of sleep improvement (7 studies; MD = 4.03, 95% CI [2.43, 6.68], P < 0.0001); Hamilton Anxiety Rating Scale (2 studies; MD =  - 4.05, 95% CI [- 4.77, - 3.32], P < 0.00001); and NIHSS (2 studies; MD = -2.71, 95% CI [- 3.36, - 2.06], P < 0.00001).

CONCLUSION

The results suggest that rTMS may have positive effects on the sleep quality, mood, and stroke severity of patients with PSSD.

Determinants of natural adult sleep: An umbrella review

BACKGROUND

Sleep has a major impact on health, which makes it a relevant topic for research and health practitioners. Research on sleep determinants, i.e. factors that positively or negatively influence sleep, is fragmented.

OBJECTIVE

The purpose of this umbrella review is to provide an overview of the current evidence on determinants of natural adult sleep.

METHODS

A comprehensive literature search was performed on determinants of sleep. Reviews and meta-analyses on natural adult sleep were included. Six electronic databases (PubMed, WoS, Embase, CINAHL, PsycInfo and Cochrane) were used for the search, last accessed September 2021. The quality of the selected articles was assessed using the AMSTAR2 tool. Results were categorized in four main categories: biological, behavioral, environmental and personal/socio-economical determinants.

RESULTS

In total 93 reviews and meta-analyses resulted in a total of 30 identified determinants. The impact of each determinant differs per individual and per situation. Each determinant was found to affect different sleep parameters and the relationship with sleep is influenced by both generic and specific moderators.

DISCUSSION

A comprehensive overview on relevant sleep determinants provides a practical and scientifically based starting point to identify relevant intervention approaches to secure or improve individual sleep quality. The difference in aggregation level of the determinants and in measurement methods are the major limitations of this umbrella review. Extending existing generic sleep hygiene rules with an overview of all types of potential determinants will enhance the awareness of the complexity and can be used to improve the effect of sleep interventions in health promotion.

TRIAL REGISTRATION

The umbrella review was registered with PROSPERO (registration ID CRD42020149648) https://www.google.com/search?client=firefox-b-d&q=CRD42020149648.

The Influence of Sleep Talking on Nocturnal Sleep and Sleep-Dependent Cognitive Processes

BACKGROUND

Sleep talking (ST) is characterized by the production of unaware verbal vocal activations (VBs) during sleep. ST seems potentially linked to linguistic and memory consolidation processes. However, sleep and dream characteristics and the relationship between verbal vocalizations (VBs) and cognitive functions are still unknown. Our study aimed to investigate qualitative sleep and dream features in sleep talkers (STs) compared to healthy subjects (CNTs) through retrospective and longitudinal measures and explore the relationship between ST and memory consolidation.

METHODS

We recruited N = 29 STs and N = 30 CNTs (age range of 18-35). Participants recorded their dreams and filled out sleep logs for seven consecutive days. Vocal activations of STs were audio-recorded. On the eighth day, we administered a word-pair task.

RESULTS

We showed that STs had significantly worse self-reported sleep quality. VBs were positively correlated with sleep fragmentation and negatively associated with the oneiric emotional load. No difference between groups was found in the memory consolidation rate.

CONCLUSIONS

Although ST is a benign phenomenon, we revealed that ST is associated with more sleep alterations and lower emotional intensity of dreams. In this vein, we support that ST depends on sleep fragmentation and could represent a potential window into sleep-dependent cognitive processes.

Daily Associations of Sleep Quality and Sleep Duration with Anxiety in Young Adults: The Moderating Effect of Alexithymia

OBJECTIVES

The present study examined the daily, within-individual associations of anxiety with sleep quality and sleep duration and the moderating effects of alexithymia on these associations in community-dwelling young adults. It was hypothesized that daily anxiety and sleep parameters would be bidirectionally related and alexithymia would moderate these relationships.

METHOD

Participants completed morning and evening diaries assessing daily anxiety and sleep parameters for 30 consecutive days. They also completed questionnaires assessing baseline sleep parameters, anxiety, and alexithymia. Multilevel modeling was used to evaluate the within-individual associations between daily anxiety and sleep parameters and whether between-individual differences in alexithymia moderated these associations.

RESULTS

Higher anxiety relative to personal averages across the study period was associated with shorter sleep duration at night. Poorer sleep quality and shorter sleep duration relative to personal averages were associated with higher next-day anxiety. A significantly stronger association between poorer sleep quality and higher next-day anxiety was observed in individuals with higher levels of alexithymia.

CONCLUSION

Daily anxiety and sleep quantity are bidirectionally associated within individuals in community-dwelling young adults. Poorer sleep quality was associated with higher next-day anxiety but not vice versa. Individuals with higher levels of alexithymia might be more vulnerable to the effects of poor sleep on next-day anxiety.

Negative dream affect is associated with next-day affect level, but not with affect reactivity or affect regulation

There is increasing evidence that sleep plays an important role in affective processing. However, it is unclear whether dreaming-the subjective experiences we have during sleep-also serves an affect regulation function. Here, we investigated the within-person relationship between negative affect experienced in dreams and next-day waking affect level, affect reactivity, and affect regulation. For 5 days, 40 participants reported their dreams and rated their dream affect and post-sleep waking affect level upon morning awakening. Thereafter, they performed an affect reactivity and regulation task which involved viewing neutral and negative pictures with the instruction either to simply view the pictures or to down-regulate the affect evoked by these pictures. Multilevel regression analyses showed that the more negative affect people experienced in their dreams at night, the more negative affect and the less positive affect they reported the next morning. However, negative dream affect was associated neither with affect reactivity to the pictures nor with the ability to down-regulate negative affect in response to these pictures. In fact, Bayesian analyses favored the null hypotheses. These findings fail to provide support for the affect regulation function of dreaming and, instead, speak for affective continuity between dreaming and post-sleep wakefulness.

Sleep and affect: A conceptual review

Everyday experience suggests that sleep and affect are closely linked, with daytime affect influencing how we sleep, and sleep influencing subsequent affect. Yet empirical evidence for this bidirectional relationship between sleep and affect in non-clinical adult samples remains mixed, which may be due to heterogeneity in both construct definitions and measurement. This conceptual review proposes a granular framework that deconstructs sleep and affect findings according to three subordinate dimensions, namely domains (which are distinct for sleep and affect), methods (i.e., self-report vs. behavioral/physiological measures), and timescale (i.e., shorter vs. longer). We illustrate the value of our granular framework through a systematic review of empirical studies published in PubMed (N = 80 articles). We found that in some cases, particularly for sleep disturbances and sleep duration, our framework identified robust evidence for associations with affect that are separable by domain, method, and timescale. However, in most other cases, evidence was either inconclusive or too sparse, resulting in no clear patterns. Our review did not find support for granular bidirectionality between sleep and affect. We suggest a roadmap for future studies based on gaps identified by our review and discuss advantages and disadvantages of our granular dimensional framework.

Objective and subjective sleep and caregiving feelings in mothers of infants: a longitudinal daily diary study

Study Objectives

This study explored the links between mothers’ objective and subjective sleep and their caregiving feelings toward their infant (i.e. patience for the infant, desire to be with the infant, and anger toward the infant), using a diary study design. We were particularly interested in examining whether nights of lower sleep quality within individual mothers predict more negative maternal caregiving feelings the following day.

Methods

The sample included 151 women, who were recruited during pregnancy. Data were collected at 4 and 8 months after delivery. Maternal sleep was monitored at home for seven nights using actigraphy and sleep diaries. Mothers rated their caregiving feelings each evening.

Results

Multilevel modeling (controlling for depressive symptoms, feeding method, and background variables) revealed that actigraphic and subjective sleep variables were associated with maternal caregiving feeling, both at the between- and within-person levels. For example, lower sleep percent predicted reduced levels of maternal patience for the infant at 4 and 8 months (between-person effect). Moreover, when a mother had a lower sleep percent on a given night (compared to her average), she reported lower levels of patience for her infant the following day (within-person prospective effect).

Conclusions

The findings demonstrate, for the first time, that maternal nightly variations in objective and subjective sleep quality predict daily changes in maternal feelings toward her infant at two different assessment points. Improving maternal sleep quality might be an important target for future interventions which may help mothers to feel more positively toward their infants.

Prevalence and correlates of depressive and anxiety symptoms among adults in Guangdong Province of China: A population-based study

AIMS

To examine the prevalence and health correlates of depressive and anxiety symptoms among adults living in Guangdong province of China with a large population and rapid urbanization.

METHODS

The Guangdong Sleep and Psychosomatic Health Survey was conducted from September to November in 2019, which was a population-based study with a representative sample of adults aged 18-85 years. Multistage stratified cluster sampling was used. A total of 13,768 inhabitants were included and face-to-face interviewed using standardized assessment tools. Depressive and anxiety symptoms were evaluated using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7), respectively.

RESULTS

The weighted prevalence rates of depressive and anxiety symptoms were 8.6% (95% confidence interval [CI]: 8.0%-9.3%) and 6.0% (95%CI, 5.4%-6.5%) respectively. People who have never married, irregular diet rhythm, hardly exercise, poorer sleep, alcohol consumption, chronic diseases and being unemployment and retirement were more likely to suffer depressive and anxiety symptoms. Moreover, the prevalence of depressive symptoms was significantly higher in those suffering from cardiovascular disease (Odds ratio[OR]:3.89, 95%CI: 1.77-8.54), chronic nephrosis (OR:3.89, 95%CI: 1.52-9.94), hyperlipidemia (OR:2.68, 95%CI: 1.57-4.59), anemia (OR:1.96, 95%CI: 1.33-2.89) and arthritis (OR:1.93, 95%CI: 1.17-3.16). The prevalence of anxiety symptoms was evidently greater within patients with cardiovascular disease (OR:3.15, 95%CI: 1.39-7.14), chronic nephrosis (OR: 2.89, 95%CI: 1.22-6.83), hyperlipidemia (OR:2.27, 95%CI: 1.20-4.29) and diabetes (OR:1.99, 95%CI: 1.15-3.44).

CONCLUSIONS

Depressive and anxiety symptoms are commonly found in patients with chronic diseases. Given these adverse outcomes on health, health professionals should pay more attention to depressive and anxiety problems in health care for high-risk population.

Evidence-based lifestyle medicine interventions to enhance the mental health of law enforcers in Hong Kong: A pilot randomized controlled trial

Law enforcers are stressed, but they may be reluctant to seek psychological support due to the stigmatization of mental illness in the law enforcement culture. Given the relatively stigma-free lifestyle medicine intervention, a two-arm pilot randomized controlled trial was conducted in the Hong Kong police force to examine the efficacy of integrated lifestyle medicine practices in enhancing the mental health of law enforcers. A total of 18 participants were randomly assigned to the intervention and waitlist control groups. The intervention group attended a 6-week lifestyle medicine program consisting of five lifestyle factors. On analyzing the results of the Patient Health Questionnaire using a paired sample t-test, a statistically significant intervention effect was found. This implies that participants had significantly better general psychological well-being after the intervention in this pilot study. In conclusion, the present findings provide preliminary support to promote the relatively stigma-free lifestyle medicine interventions in law enforcement. Nevertheless, further research effort with a larger sample size is warranted to provide empirical support for the efficacy of integrated lifestyle medicine programme.

Asymmetrical Effects of Sleep and Emotions in Daily Life

Sleep is an important process that can influence and be influenced by daily events and emotions. We examined the bidirectional relationships between sleep, daily events, and emotions with a daily diary method completed by 181 mothers (M _age = 41.91, SD = 5.06). They answered morning and evening questionnaires for 1 week at three different points in time separated by nine months each, 21 days in total. Measures of sleep quality and emotional experiences each morning were assessed, and they reported on their best and worst experience of the day, peak emotional responses to these events, and affect in the evening. Sleep behavior, including total sleep time and sleep efficiency, was objectively quantified using wrist actigraphy. Multilevel modeling analyses showed that longer sleep duration and better subjective quality predicted greater positive emotions and lower negative emotions upon waking, and lower levels of peak perceived stressfulness, but not peak positivity ratings. Daily experiences did not predict sleep duration. Conversely, negative affect in the evening and greater peak perceived stressfulness during the day predicted worse sleep quality that night, whereas positive affect and positive events were not related to sleep. Although correlational, these findings suggest that good sleep can improve waking affect and help mitigate the impact of stressful experiences but does not amplify responses to the positive events of the day. In turn, daily perceived stress reactivity impairs sleep quality. These novel findings show stronger bidirectional relationships between sleep with daily stress, than sleep with daily positivity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00112-x.

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

PURPOSE OF REVIEW

Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD.

RECENT FINDINGS

Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.

Sleep, Emotions, and Sense of Belonging: A Daily Experience Study

Sleep has strong influences on affective and social experiences. However, less is known about the reciprocal effects of sleep, affect, and social experiences at a daily level, and little work has considered racial/ethnic minorities at high risk for social disconnection and discrimination. A 7-day daily experience study assessed the bidirectional relationships between daily sleep quality, affect, social experiences, and overall well-being among a sample of Latinx undergraduates (N = 109). Each morning, participants reported on their previous night's sleep. Each evening, they reported their positive and negative affect, experiences of belonging and unfair treatment, and overall well-being that day. Results indicate that, at a daily level, sleep quality predicts next-day affect, belonging, and well-being. Reciprocally, only daily well-being predicts sleep quality. Findings highlight sleep as a potentially powerful antecedent of affective and social experiences likely to be particularly potent for underrepresented minority groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-021-00088-0.

Bidirectional associations between nightly sleep and daily happiness and negative mood in adolescents

This study examined bidirectional associations between daily happiness and negative mood and subjective and objective sleep measures. Participants were 311 adolescents (M_age = 17.37 years; 51.8% female; 59.2% White/European American, 38.6% Black/African American, 1% Hispanic/Latinx American, 1.4% multi‐racial; 19.3% below poverty line) observed over a 7‐day period (2017–2018) using sleep diaries and actigraphy. Daily negative mood was related to greater subjective sleep/wake problems, and happiness was related to lower subjective sleep/wake problems. Conversely, shorter self‐reported sleep duration was related to higher negative mood the next day. For actigraphy measures, daily negative mood was related to greater sleep duration and efficiency, whereas happiness was related to lower sleep efficiency. Differences in associations based on subjective versus objective sleep measures are discussed.

Daily Sleep and Anxious and Depressive Symptoms among Dementia Caregivers - The Mediation of Cortisol Total Output on High- and Low-stress Days

OBJECTIVES

Dementia family caregivers report poor sleep and mood, typically attributed to chronic stress and managing frequent daily stressors. While many studies use global retrospective reports of these indicators, the current study examines mechanisms linking sleep, negative affect, stress biomarkers, and high/low stress contexts at the daily level, from the biopsychosocial perspective of stressor exposure and reactivity.

METHOD

173 caregivers (Mage = 61.97, sd = 10.66) were providing care at home and used adult day services (ADS) at least 2 days a week. Caregivers reported their bedtime, wake time, sleep quality, and nighttime problems of the person with dementia (PwD) daily for eight consecutive days, concurrently reporting non-care stressors, negative affect, and providing five salivary cortisol samples per day. We conducted multilevel analysis to examine whether caregiver sleep characteristics overnight (i.e., total time in bed, quality, and PwD sleep problems) were associated with their anxious and depressive symptoms on days where adult day services (ADS) were utilized versus non-ADS days (i.e., low- versus high-stress), and whether cortisol daily total output as area under the curve (AUCg) mediated the direct associations, at the within- and between-person levels.

RESULTS

On high-stress (i.e., non-ADS) days when caregivers had longer time in bed than usual the night before, they were less anxious on the following day; the direct association was statistically mediated through lower cortisol AUCg during the day.

DISCUSSION

Staying longer in bed than usual before an upcoming high-stress day may help dementia family caregivers better regulate cortisol stress reactivity and anxious symptoms.

Daily associations between affect and cognitive performance in older adults with depression and cognitive impairment: a series of seven single-subject studies in the Netherlands

Background

Comorbidity between depression and cognitive impairment is common in older adults, increases the disease burden disproportionally, and leads to diagnostic uncertainty. Insight into individual daily associations between affect and cognitive performance may help in personalizing diagnosis and treatment decisions. Our objective was to get insight into the daily associations between affect and cognitive performance within individual older adults.

Methods

In this single-subject study seven older adults with both depression and cognitive impairment filled in electronic diaries daily for 62-93 consecutive days evaluating positive affect (PA), negative affect (NA), working memory (WM) and visual learning (VL). Time-series analyses using vector autoregressive modelling, Granger causality tests and cumulative orthogonalized impulse response function analyses were performed for each individual separately.

Results

In one patient higher NA was associated with better WM the next day. For another patient days with higher NA and lower PA were days with worse WM. For a third patient better VL was associated with lower NA and higher PA the next day. No associations were found for four patients.

Conclusions

These results highlight heterogeneity in the daily associations between affect and cognitive performance and stress the relevance of single-subject studies. These studies may be an important step towards personalized diagnosis and treatment in old age psychiatry.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02797-y.

Daily associations between family interaction quality, stress, and objective sleep in adolescents

OBJECTIVE

To better understand the short-term impact of family interactions on adolescent sleep, this study examined daily associations between family interaction quality and sleep duration, sleep maintenance efficiency, and subjective sleep quality.

METHODS

Participants were 517 diverse youth (M_age = 15.4 years, Range = 15-18) in the Fragile Families and Child Wellbeing Study who completed daily reports of family interaction quality, mood and subjective sleep quality and provided actigraphy-based estimates of sleep duration and sleep maintenance efficiency.

RESULTS

Following days when youth reported that they got along with their parents, they slept 26 minutes (95% CI [2.93, 49.88]) longer. Youth who reported greater quality interactions with other family members on average had longer sleep duration, and youth who reported higher levels of family stress perceived lower sleep quality.

CONCLUSIONS

Findings highlight the importance of considering daily family life, including the quality of brief family interactions, as an entry point for future sleep interventions for adolescents.

Temporal dynamics of depression, cognitive performance and sleep in older persons with depressive symptoms and cognitive impairments: a series of eight single-subject studies

OBJECTIVES

To investigate the presence, nature and direction of the daily temporal association between depressive symptoms, cognitive performance and sleep in older individuals.

DESIGN, SETTING, PARTICIPANTS

Single-subject study design in eight older adults with cognitive impairments and depressive symptoms.

MEASUREMENTS

For 63 consecutive days, depressive symptoms, working memory performance and night-time sleep duration were daily assessed with an electronic diary and actigraphy. The temporal associations of depressive symptoms, working memory and total sleep time were evaluated for each participant separately with time-series analysis (vector autoregressive modeling).

RESULTS

For seven out of eight participants we found a temporal association between depressive symptoms and/or sleep and/or working memory performance. More depressive symptoms were preceded by longer sleep duration in one person (r = 0.39; p < .001), by longer or shorter sleep duration than usual in one other person (B = 0.49; p < .001), by worse working memory in one person (B = -0.45; p = .007), and by better working memory performance in one other person (B = 0.35; p = .009). Worse working memory performance was preceded by longer sleep duration (r = -.35; p = .005) in one person, by shorter or longer sleep duration in three other persons (B = -0.76; p = .005, B = -0.61; p < .001; B = -0.34; p = .002), and by more depressive symptoms in one person (B = -0.25; p = .009).

CONCLUSION

The presence, nature and direction of the temporal associations between depressive symptoms, cognitive performance and sleep differed between individuals. Knowledge of personal temporal associations may be valuable for the development of personalized intervention strategies in order to maintain their health, quality of life, functional outcomes and independence.

Hybrid Sleep Stage Classification for Clinical Practices across Different Polysomnography Systems Using Frontal EEG

Automatic bio-signal processing and scoring have been a popular topic in recent years. This includes sleep stage classification, which is time-consuming when carried out by hand. Multiple sleep stage classification has been proposed in recent years. While effective, most of these processes are trained and validated against a singular set of data in uniformed pre-processing, whilst in a clinical environment, polysomnography (PSG) may come from different PSG systems that use different signal processing methods. In this study, we present a generalized sleep stage classification method that uses power spectra and entropy. To test its generality, we first trained our system using a uniform dataset and then validated it against another dataset with PSGs from different PSG systems. We found that the system achieved an accuracy of 0.80 and that it is highly consistent across most PSG records. A few samples of NREM3 sleep were classified poorly, and further inspection showed that these samples lost crucial NREM3 features due to aggressive filtering. This implies that the system’s effectiveness can be evaluated by human knowledge. Overall, our classification system shows consistent performance against PSG records that have been collected from different PSG systems, which gives it high potential in a clinical environment.

Between-person and within-person associations of sleep and working-memory in the everyday lives of old and very old adults: initial level, learning, and variability

STUDY OBJECTIVES

Sleep duration affects various aspects of cognitive performance, such as working-memory and learning, among children and adults. However, it remains open, whether similar or even stronger associations exist in old and very old age when changes in sleep and cognitive decrements are common.

METHODS

Using repeated daily-life assessments from a sample of 121 young-old (66-69 years old) and 39 old-old adults (84-90 years old), we assessed links between sleep duration and different aspects of working-memory (initial level, practice-related learning, and residualized variability) between and within persons. Participants reported their sleep durations every morning and performed a numerical working-memory updating task six times a day for seven consecutive days.

RESULTS

Both people who slept longer and those who slept shorter than the sample average showed lower initial performance levels, but a stronger increase of WM over time (i.e. larger learning effects), relative to people with average sleep. Sleep duration did not predict performance variability. Within-person associations were found for people sleeping relatively little on average: For them, working-memory performance was lower on days with shorter than average sleep, yet higher on days with longer than average sleep. Except for lower initial levels of working-memory in old-old adults, no differences between young-old and old-old adults were observed.

CONCLUSION

We conclude that sufficient sleep remains important for working-memory performance in older adults and that it is relevant to include different aspects of working-memory performance, because effects differed for initial performance and learning.

Modelling the relationship between poor sleep and problem anger in veterans: A dynamic structural equation modelling approach

OBJECTIVE

Problem anger and poor sleep are common, particularly in military and veteran populations, but the nature of the relationship is poorly understood, and treatment approaches would benefit from improved understanding of how these constructs interact. Ecological momentary assessment (EMA) is suitable for monitoring day-to-day fluctuations in symptoms, and modelling dynamic relationships between variables.

METHODS

This study aimed to examine these fluctuations and relationships involving sleep quality and anger experiences among veterans. A sample of n = 60 veterans with problem anger as assessed by the recommended cut off on the Dimensions of Anger Reactions 5 scale (DAR-5) completed daily assessments of sleep quality and four times daily assessments of anger frequency, over a 10-day period.

RESULTS

A Dynamic Structural Equation Model (DESM) estimated and revealed a unidirectional relationship across daily measurements, in that previous night poor sleep quality was associated with more frequent anger on the next day (φASi Estimate -0.791, one-tailed p = .075), but not the reverse.

CONCLUSIONS

These are the first longitudinal, naturalistic findings in relation to anger and sleep in a sample self-identifying with significant anger problems. The observed patterns point to the need for further research on mechanisms underpinning this relationship, and raises potential for early intervention for problem anger to include a focus on improving sleep quality.

Circadian preference and sleep quality in healthy controls and psychiatric inpatients with major depressive disorder - An actigraphy study incorporating morning and evening mood assessments

Major depressive disorder (MDD) is frequently accompanied by sleep disturbance. Regarding diurnal preference (chronotype), sleep problems and low mood have been associated with evening orientation. Considering diurnal preference, we investigated subjective restorative value of sleep and actigraphy sleep parameters together with mood assessments twice a day, i.e. in the morning and evening, during weekdays and weekends in MDD psychiatric inpatients and healthy controls (HCs). The restorative value of sleep was higher during the weekend in HC, and bedtimes and risetimes were delayed during the weekend compared to weekdays in HC and MDD. Morning mood affected subjective sleep ratings in both groups, while association with symptom severity (BDI) in MDD remained insignificant. In HC, better evening mood was associated with later bedtimes. Regarding the chronotype in HC, evening orientation was associated with relatively low restorative value of sleep during weekdays, and morning orientation was associated with relatively higher actigraphy sleep efficiency during weekdays compared to weekend. In MDD, an association of evening orientation with later rise times could be observed, while no chronotype dependent effect emerged regarding the restorative value of sleep or sleep efficiency. Our results emphasize that research on sleep in MDD should incorporate weekdays as well as weekends, chronotype assessment, and measures of morning and evening mood, as these can be associated with ratings of the subjective restorative value of sleep (i.e. in our study, better morning mood was associated with higher restorative values), but also with behavioral sleep parameters (i.e. in our study, more positive evening mood was associated with later bedtimes). Potentially, the restorative value of sleep in MDD evening types can be improved by maintaining a regular sleep schedule, which needs to be investigated in an experimental design.

Negative Emotion Differentiation Attenuates the Within-Person Indirect Effect of Daily Stress on Nightly Sleep Quality Through Calmness

The ability to differentiate between negative emotional states [negative emotion differentiation (NED)] has been conceptualized as a trait that facilitates effective emotion regulation and buffers stress reactivity. In the present research, we investigated the role of NED in within-person processes of daily affect regulation and coping during times of stress (the first COVID-19-related pandemic lockdown in April 2020). Using intensive longitudinal data, we analyzed whether daily stress had an indirect effect on sleep quality through calmness in the evening, and we tested whether NED moderated this within-person indirect effect by buffering the link between daily stress and calmness in the evening. A non-representative community sample (n = 313, 15–82 years old) participated in a 21-day ambulatory assessment with twice-daily surveys. The results of multilevel mediation models showed that higher daily stress was related to within-day change in calmness from morning to evening, resulting in less calmness in the evening within persons. Less calmness in the evening, in turn, was related to poorer nightly sleep quality within persons. As expected, higher NED predicted a less negative within-person link between daily stress and calmness in the evening, thereby attenuating the indirect effect of daily stress on nightly sleep quality through calmness. This effect held when we controlled for mean negative emotions and depression. The results provide support for a diathesis-stress model of NED, and hence, for NED as a protective factor that helps to explain why some individuals remain more resilient during times of stress than others.

Short sleep, insomnia symptoms, and evening chronotype are correlated with poorer mood and quality of life in adolescent transgender males

OBJECTIVE

Poor sleep is common among adolescents and associated with impaired mood and health-related quality of life (HRQOL). Transgender individuals are at increased risk of mood problems hypothesized to be due to minority stress; however, no research has investigated associations between sleep and mood in this population. We aimed to examine sleep, mood, and HRQOL in transgender adolescent males.

DESIGN & SETTING

Transgender males age 13-16 were recruited from a U.S. gender diversity clinic.

MEASUREMENTS

Participants completed one week of home actigraphy monitoring. Questionnaires assessed insomnia symptoms, chronotype, mood, and HRQOL. Pearson correlations between sleep, mood, and HRQOL were examined.

RESULTS

A total of 10 participants completed study measures during the school year. Participants obtained less than the recommended 8-10 hours of sleep per night, and half of participants endorsed insomnia symptoms. Greater insomnia symptoms were correlated with higher anxiety (P = .04) and depression (P = .04) symptoms, and poorer Psychosocial HRQOL (P = .03). Earlier weekday and weekend bed and wake times and earlier weekday sleep midpoint were associated with better Wellbeing HRQOL. No other significant correlations between sleep and mood or HRQOL variables were found.

CONCLUSIONS

Anxiety and depression symptoms were associated with self-reported insomnia symptoms, while HRQOL was associated with both insomnia symptoms and objective sleep timing in this sample of adolescent transgender males. Clinicians should assess both sleep and mood symptoms in this population and future research should evaluate the impact of improved sleep and gender-affirming care on mood and HRQOL for transgender adolescents.

The effects of bright light treatment on affective symptoms in people with dementia: a 24-week cluster randomized controlled trial

BACKGROUND

The majority of people with dementia have behavioral and psychological symptoms of dementia (BPSD), including depression, anxiety and agitation. These may be elicited or aggravated by disrupted circadian rhythms. Bright light treatment (BLT) is a promising non-pharmacological approach to the management of BPSD, but previous research has yielded mixed results.

METHODS

Eight nursing home dementia units (1 unit = 1 cluster) with 78 patients were invited to participate in a cluster randomized controlled trial from September 2017 to April 2018 investigating the effects of BLT on sleep and circadian rhythms (primary outcome) and BPSD (secondary outcome). Ceiling mounted LED-panels were installed in the intervention group (four units), providing light at 1000 lx and 6000 K (vertically at 1.2 m) between 10 a.m. and 3 p.m., with lower values in the mornings and evenings. Standard indoor light was used in the control group (four units). BPSD were assessed with The Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory Nursing Home Version (NPI-NH). Data collection took place at baseline and after 8, 16 and 24 weeks. Multilevel regression models with and without false discovery rate correction were used for the analysis, with baseline values and dementia stage entered as covariates.

RESULTS

Sixty-nine patients were included in the study at baseline. Compared to the control group, the intervention group had a larger reduction on the composite scores of both the CSDD (95% CI = - 6.0 - - 0.3) and the NPI-NH (95% CI = - 2.2 - - 0.1), as well as on the NPI-NH Affect sub-syndrome, and the CSDD Mood related signs sub-scale at follow-up after 16 weeks. With FDR correction, the group difference was significant on the CSDD Mood related signs sub-scale (95% CI = - 2.7 - - 0.8) and the NPI-NH Affect sub-syndrome (95% CI = - 1.6 - - 0.2). No differences were found between conditions at weeks 8 or 24.

CONCLUSION

Compared to the control condition, affective symptoms were reduced after 16 weeks in the group receiving BLT, suggesting BLT may be beneficial for nursing home patients with dementia.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03357328 . Retrospectively registered on November 29, 2017.

Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey

The COVID-19 pandemic has had far-ranging consequences for general physical and mental health. Country-specific research reveals a general reduction in mental and physical well-being, due to measures undertaken to stop the spread of COVID-19 disease. However, research is yet to examine the impact of the pandemic on global psychological distress and its effects upon vulnerable groups. Exploration of the factors that potentially mediate the relationship between stress and mental health during this period is needed, to assist in undertaking concrete measures to mitigate psychological distress and support vulnerable groups. Therefore, this study examined the impact of the COVID-19 pandemic on psychological distress globally, and identified factors that may exacerbate decline in mental health. N = 1653 participants (mean age 42.90 ± 13.63 years; 30.3% males) from 63 countries responded to the survey. Depression and anxiety were assessed using the Patient Health Questionnaire and State Trait Anxiety Inventory, respectively. Other measures included the Perceived Stress Scale, the Pittsburgh Sleep Quality Index, 3-item UCLA Loneliness Scale and the Brief Resilient Coping Scale. Globally, consistently high levels of stress, anxiety, depression and poor sleep were observed regardless of number of COVID-19 cases. Over 70% of the respondents had greater than moderate levels of stress, with 59% meeting the criteria for clinically significant anxiety and 39% reporting moderate depressive symptoms. People with a prior mental health diagnosis experienced greater psychological distress. Poor sleep, lower levels of resilience, younger age and loneliness significantly mediated the links between stress and depression, and stress and anxiety. Age-based differences revealed that younger age-groups were more vulnerable to stress, depression and anxiety symptoms. Results show that these vulnerable individuals need more support. Age-specific interventions for modifiable factors that mediate the psychological distress need to urgently deployed to address the global mental health pandemic.

Worry among Latinx college students: relations to anxious arousal, social anxiety, general depression, and insomnia

OBJECTIVE

Latinx young adults in college (ages 18-25 years) are at a heightened risk for health disparities and there is a need to understand individual-based characteristics that are related to such health inequalities including anxiety, depression, and sleep disturbances. The cross-sectional current study investigated the role of worry in relation to anxious arousal, social anxiety, general depression, and insomnia among Latinx college students. Participants/Method: Participants included 401 (Mage = 21 years; SD =2.01; 83% female) Latinx students at a large, southwestern university. Results: Results indicated that greater levels of worry were related to increased levels of anxious arousal, social anxiety, general depression, and insomnia. These findings were evident above and beyond variance accounted for by age, sex, and subjective social status. Conclusions: The current investigation suggests that elevated levels of worry among Latinx young adults may be associated with greater levels of anxiety, depression, and insomnia.

Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

Background. Stroke survivors commonly complain of difficulty sleeping. Poor sleep is associated with reduced quality of life and more understanding of long-term consequences of stroke on sleep is needed. Objective. The primary aims were to (1) compare sleep measures between chronic stroke survivors and healthy controls and (2) test for a relationship between motor impairment, time since stroke and sleep. Secondary aims were to explore mood and inactivity as potential correlates of sleep and test the correlation between self-reported and objective sleep measures. Methods. Cross-sectional sleep measures were obtained for 69 chronic stroke survivors (mean 65 months post-stroke, 63 years old, 24 female) and 63 healthy controls (mean 61 years old, 27 female). Self-reported sleep was assessed with the sleep condition indicator (SCI) and sleep diary ratings, objective sleep with 7-nights actigraphy and mood with the Hospital Anxiety and Depression Scale. Upper extremity motor impairment was assessed with the Fugl-Meyer assessment. Results. Stroke survivors had significantly poorer SCI score (P < .001) and higher wake after sleep onset (P = .005) than controls. Neither motor impairment, nor time since stroke, explained significant variance in sleep measures for the stroke group. For all participants together, greater depression was associated with poorer SCI score (R²_adj = .197, P < .001) and higher age with more fragmented sleep (R²_adj = .108, P < .001). There were weak correlations between nightly sleep ratings and actigraphy sleep measures (r_s = .15-.24). Conclusions. Sleep disturbance is present long-term after stroke. Depressive symptoms may present a modifiable factor which should be investigated alongside techniques to improve sleep in this population.

Naturalistic Partial Sleep Deprivation Leads to Greater Next-Day Anxiety: The Moderating Role of Baseline Anxiety and Depression

The detrimental effects of insufficient sleep on emotional functioning have been well established. Total sleep deprivation usually leads to increased anxiety and depressive symptoms the following day. However, no study has yet examined the relationships between unmanipulated partial sleep deprivation and next-day symptoms of anxiety and depression in everyday life, which this study sought to characterize. Participants (N = 94) completed daily diary surveys twice per day for 2 weeks without instructions to alter their sleep in any way. Nights of spontaneous, naturally occurring partial sleep deprivation were followed by increased levels of self-reported symptoms of anxious arousal the next day, but were unrelated to next-day symptoms of anhedonic depression or general distress. The relationship between partial sleep deprivation and next-day anxious arousal was found to be moderated by both baseline depressive symptoms and anxiety such that individuals reporting higher levels of depression or anxiety at baseline showed relatively greater increases in symptoms of anxiety following partial sleep deprivation. These results suggest that partial sleep deprivation occurring in everyday life can lead to higher next-day levels of anxious arousal, a relationship that is particularly deleterious for individuals with higher overall levels of anxiety or depressive symptoms.

Insomnia symptoms mediate the association between eveningness and suicidal ideation, defeat, entrapment, and psychological distress in students

Chronotype describes a person's general preference for mornings, evenings, or neither. It is typically conceptualized as a continuous unidimensional spectrum from morningness to eveningness. Eveningness is associated with poorer outcomes across a myriad of physical and mental health outcomes. This preference for later sleep and wake times is associated with increased risk of depression, anxiety, and suicidal ideation in both clinical and community samples. However, the mechanisms underlying the negative consequences of this preference for evenings are not fully understood. Previous research has found that sleep disturbances may act as a mediator of this relationship. The present study aimed to explore the associations between chronotype and affective outcomes in a sample of students. Additionally, it aimed to investigate the potential role of insomnia as a mediator within these relationships. Participants (n = 190) completed an anonymous self-report survey of validated measures online which assessed chronotype, insomnia symptoms, and a range of affective outcomes (defeat, entrapment, suicide risk, stress, and depressive and anxious symptomology). Eveningness was associated with more severe or frequent experiences of these outcomes, with participants that demonstrated a preference for eveningness more likely to report poorer affective functioning and increased psychological distress. Mediation analysis found the relationship between chronotype and these outcome measures was completely or partially mediated by insomnia symptom severity measured by the validated Sleep Condition Indicator insomnia scale. Taken together, these findings add further evidence for the negative consequences of increased eveningness. Additionally, our results show that chronotype and sleep disturbances should be considered when assessing mental well-being. Implementing appropriate sleep-related behavior change or schedule alterations can offer a tool for mitigation or prevention of psychological distress in students that report a preference for later sleep and wake times.

Changes in sociocultural attitudes towards appearance, body image, eating attitudes and behaviours, physical activity, and quality of life in students before and during COVID-19 lockdown

BACKGROUND

The coronavirus pandemic resulted in national lockdowns that are associated with a rise in important macro-stressors for populations worldwide. The aim of the present study was to assess the impact of the COVID-19-related lockdown period on the sociocultural attitudes towards appearance, body image, eating attitudes and behaviours, physical activity, and quality of life of Lithuanian university-aged students of both genders.

METHOD

A total of 1850 students completed the body image, health-related behaviour and quality of life assessments three months before the first lockdown, of which 959 provided consent and an e-mail to be contacted by for further surveys. Of these 959, 230 completed the same questionnaire during the second lockdown providing the informed consent for the participation in the COVID-19-impact for the lifestyle study and use their first round data for the comparison with the lockdown. The age of the participants was 23.9 ± 5.4 years. Independent comparisons were used to test lifestyle and body image differences between men and women before and during the lockdown. Paired-sample statistics were conducted to evaluate any changes in the male and female groups separately with Cohen's d employed to represent effect sizes.

RESULTS

No body image or disordered eating changes were found, however, body appearance evaluation increased in women (effect size 0.15). Significant increases in media pressures (in women, effect size 0.16) and the internalization of thin/low body fat beauty ideals (effect size 1.18-1.46) were observed during the lockdown when compared to baseline. No changes in quality of life were evident for men, however, for women, an increase in general and psychological domain was observed (effect size 0.17). We observed a significant decrease in physical activity (in men, effect size 0.46), an increase in internet browsing time (effect size 0.52-0.8), a decrease in unhealthy eating habits (effect size 0.49-0.60), an increase in sleep duration (in women, effect size 0.40) and lower self-rated health (in men, effect size 0.42) during the lockdown when compared to baseline.

CONCLUSIONS

These findings suggest that the majority of students cope with lockdown-related situation well. However, based on the Tripartite influence model, we can speculate that a drastic increase in the internalization of stereotyped thin/low body fat ideals might trigger body image concerns and increase disordered eating after the lockdown. Specific interventions helping students to decrease internalization of stereotyped body ideals, to promote positive body image and physical activity may be beneficial during and after the COVID-19-related lockdown.

Effect of exercise training on improving sleep disturbances: a systematic review and meta-analysis of randomized control trials

OBJECTIVES

Exercise training has beneficial effects on various aspects of health. This study aimed to investigate the effect of exercise training on the improvement of sleep disturbances using systematic review and meta-analysis of randomized control trials.

METHOD

Four indexes of scientific information including PubMed, Web of Science, Scopus, and the Cochrane library were selected and all manuscripts of these sources were searched in English until January 2021. The studies were screened and finally, the studies were entered into meta-analysis and the Standardized Mean Difference (SMD) was calculated, and the analyzes were performed based on the random effects method. Publication bias and heterogeneity were examined in all analyzes.

RESULT

A total of 32 studies were included in the meta-analysis. Meta-analysis showed that exercise training is effective in improving sleep quality (SMD = -0.85 and confidence interval (CI) was -1.16-0.54; P < 0.001). Exercise training improving insomnia (SMD = -0.87 and CI was -1.68-0.06; P = 0.036). Exercise training improves sleepiness (SMD = -0.38 and CI was -0.68-0.07; P = 0.016), obstructive sleep apnea (SMD = -0.40 and CI was -0.67-0.14; P = 0.003) and restless legs syndrome (SMD = -1.02 and CI was -1.56-0.49; P < 0.001).

DISCUSSION

Exercise training has beneficial effects on a variety of sleep disturbances and therefore it can be said that providing the necessary conditions for exercise training can play a major role in promoting health, especially since this type of intervention is a non-pharmacological intervention.

Emotional Vulnerability to Short Sleep Predicts Increases in Chronic Health Conditions Across 8 Years

BACKGROUND

Sleep is a robust determinant of next-day emotions, but people vary in the extent that their emotions fluctuate on days following short sleep duration. These individual differences in day-to-day sleep and emotion dynamics may have long-term health implications.

PURPOSE

To evaluate emotional vulnerability to short sleep (within-person associations between sleep duration and next-day emotions) as a risk factor for future chronic conditions.

METHODS

Adults aged 33-84 (N = 1,426; 57% female) in the Midlife in the United States Study reported sleep duration and emotions by telephone for eight consecutive days. Chronic conditions were assessed via checklist at baseline and at a median follow-up of eight years (range: 5-10 years). Short sleep was examined in three ways: person-centered continuous variable, ≤6 hr, and <7 hr; long sleep was defined as ≥9 hr.

RESULTS

Multilevel structural equation models revealed that people with greater negative emotions following nights of sleep ≤6 hr (vs. their negative emotions after longer sleep) had increased chronic conditions at follow-up, compared to people who were less emotionally vulnerable to short sleep (Est. = 1.04, SE = .51, p < .028). Smaller declines in positive emotions following ≤6 hr of sleep were marginally predictive of lower risk for chronic conditions (Est. = -.77, SE = .44, p = .054). Emotional vulnerability to <7, ≥9, and continuous sleep hours were not associated with subsequent chronic conditions.

CONCLUSIONS

Emotional vulnerability to short sleep is a unique risk factor for the development of chronic conditions, independent of mean-level sleep duration and emotions.

Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty

BACKGROUND

Sleep disturbance is thought to aggravate acute postoperative pain. The influence of preoperative sleep problems on pain control in the long-term and development of chronic postsurgical pain is largely unknown.

METHODS

This prospective, observational study aimed to examine the links between preoperative sleep disturbance (Pittsburgh Sleep Quality Index, PSQI) and pain severity (Brief Pain Inventory, BPI) 6 months postoperative (primary outcome), objective measures of pain and postoperative pain control variables (secondary outcomes). Patients (n = 52) with disabling osteoarthritis (OA) pain undergoing total hip arthroplasty (THA) were included. Quantitative sensory testing (QST) was performed preoperatively on the day of surgery to evaluate pain objectively. Clinical data, as well as measures of sleep quality and pain, were obtained preoperatively and longitudinally over a 6-month period.

RESULTS

Preoperatively, sleep disturbance (i.e., PSQI score >5) occurred in 73.1% (n = 38) of THA patients, and pain severity was high (BPI pain severity 5.4 ± 1.3). Regression models, adjusting for relevant covariates, showed that preoperative PSQI score predicted pain severity 6 months postoperative (β = 0.091 (95% CI 0.001-0.181), p = .048, R²  = 0.35). Poor sleep quality was associated with increased pressure pain sensitivity and impaired endogenous pain inhibitory capacity (R² range 0.14-0.33, all p's < 0.04). Moreover, preoperative sleep disturbance predicted increased opioid treatment during the first 24 hr after surgery (unadjusted β = 0.009 (95% CI 0.002-0.015) mg/kg, p = .007, R²  = 0.15).

CONCLUSIONS

Preoperative sleep disturbance is prevalent in THA patients, is associated with objective measures of pain severity, and independently predicts immediate postoperative opioid treatment and poorer long-term pain control in patients who have undergone THA.

SIGNIFICANCE

Poor sleep quality and impaired sleep continuity are associated with heightened pain sensitivity, but previous work has not evaluated whether preoperative sleep problems impact long-term postoperative pain outcomes. Here, we show that sleep difficulties prior to total hip arthroplasty adversely predict postoperative pain control 6 months after surgery. Given sleep difficulties robustly predict pain outcomes, targeting and improving sleep may have salutary effects on postoperative pain reports and management.

Insomnia treatment effects among young adult drinkers: Secondary outcomes of a randomized pilot trial

BACKGROUND

Cognitive behavioral therapy for insomnia (CBT-I) has moderate-to-large effects on insomnia among young adult drinkers, with preliminary data indicating that improvements in insomnia may have downstream effects on alcohol-related consequences. However, the mechanism(s) by which insomnia treatment may facilitate reductions in alcohol-related problems is unclear. Secondary outcome data from a randomized pilot trial were used to examine CBT-I effects on four proposed mediators of the insomnia/alcohol link: alcohol craving, delay discounting, negative affect, and difficulties with emotion regulation.

METHODS

Young adults (ages 18 to 30 years) with insomnia who reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomized to receive CBT-I (n = 28) or to a sleep hygiene control (n = 28). Outcomes were assessed at baseline, after 5 weeks of treatment, and at 1-month posttreatment.

RESULTS

Relative to those in sleep hygiene, CBT-I participants reported greater decreases in alcohol craving (d = 0.33) at the end of treatment and greater 1-month posttreatment decreases in delay discounting of large rewards (d = 0.42). CBT-I did not have a significant effect on delay discounting of smaller rewards or momentary negative affect. There was also no significant treatment effect on difficulties with emotion regulation, although findings were confounded by a significant group difference at baseline in difficulties with emotion regulation.

CONCLUSIONS

Treatment of insomnia may lead to improvements in alcohol craving and delay discounting of large rewards among young adult drinkers with insomnia. Additional research examining whether improvement in insomnia is a mechanism for improvement in addiction domains is warranted.

Stress, Sleep, and Coping Self-Efficacy in Adolescents

Adults are thought to show a sleep-stress spiral in which greater stress worsens sleep quality, which amplifies stress, which leads to worse sleep. This study examined whether adolescents show a similar spiral, and if so, whether coping self-efficacy-believing one can cope with stress-interrupts the spiral. Temporal dynamics of perceived stress, sleep quality, and coping self-efficacy were tracked in 381 9th graders (49% female, mean age 14.43, age range 14-16) using daily surveys across two school weeks (3184 observations). Though expected associations were evident between individuals, only a unidirectional path was found within individuals from sleep quality to perceived stress via coping self-efficacy. This challenges the conventional bidirectional understanding of sleep-stress relations and suggests coping self-efficacy as an intervention target.

Micro Versus Macro Processes: How specific stress exposure impacts sleep, affect, and risk-related behavior on the path to disease in high-risk adults

BACKGROUND

The stress-to-disease association has been well-accepted for some time. However, the understanding of how stress exposure contributes to psychological disease progression remains unclear.

OBJECTIVE

To test the real-time impact of variable stress exposure on risk-related clinical phenomena and affective disease progression in a high-risk sample of active-duty firefighters.

METHODS

Participants completed weekly diaries reporting stressful event exposure, affect, sleep, and risk-related and healthy behaviors over six-months and were evaluated for lifetime and current psychiatric disease using clinical interviews before and after the sampling period.

RESULTS

Stress exposure impacted clinical phenomena in differing ways. Major personal events and day-to-day hassles predicted health-impairing shifts in sleep and behavior that were associated with increases in symptoms and psychological distress over the 6-month period. In contrast, highly aversive incidents predicted greater adaptive behaviors that were uniquely predictive of symptom decreases over the six-month period.

CONCLUSION

These findings shed new light on stress-to-disease processes, demonstrating how variable stress exposure influences critical shifts in behavior and sleep, contributing to psychological adjustment of firefighters over time. These data suggest practical ways to monitor risk in high-risk samples (e.g., monitoring sleep latency) and offer avenues for further explication of disease processes in real time.