Exploring Gender Difference in Sleep Quality of Young Adults: Findings from a Large Population Study

Affective Experience and Regulation via Sleep, Touch, and "Sleep-Touch" Among Couples

Touch associated with sleep (sleep-touch; reported physical contact during or shortly before/after sleep) is underexplored as a distinct contributor to affect regulatory processes associated with adult sleep. Given the affect-regulating effects of interpersonal touch, we theorized that among healthy co-sleeping adults, sleep-touch would add to sleep-related effects on affective "resetting," resulting in the experience of calmer, more regulated states. We studied 210 married heterosexual couples (aged 20-67 years, 79% non-Hispanic white, 13% Latinx) assigned 14 days of twice-daily (morning/evening) sleep/mood diaries. Multilevel daily (within-couple) mediation analyses showed that as hypothesized, more reported sleep-touch was associated with happier/calmer and less angry/irritable morning mood. In turn, happier/calmer mood was associated with greater enjoyment of time with spouse (for both spouses). Sleep-touch also was linked directly to both evening positive spousal events and enjoyment ratings. Sleep-touch was associated indirectly with fewer negative spousal events and less spouse-related stress via less angry/irritable morning mood (both spouses). Further, wives' sleep-touch was related to happier/calmer husband mood and evening enjoyment; husbands' sleep-touch was unrelated to wives' reports. All associations with sleep-touch were present while accounting for subjective sleep quality, prior evening mood, non-sleep-related physical affection, day in study, and weekend versus weekday. We speculate that among relatively healthy satisfied couples, physical touch during and surrounding sleep may add to sleep's restorative and affect-regulatory functions, suggesting a pathway through which co-sleeping can improve affect regulation and ultimately relationships and health.

Daily Relations Between Stress and Electroencephalography-Assessed Sleep: A 15-Day Intensive Longitudinal Design With Ecological Momentary Assessments

BACKGROUND

Recent studies have found bi-directional relations between stress and sleep. However, few studies have examined the daily associations between stress and electroencephalography (EEG) measured sleep.

PURPOSE

This study examined the temporal associations between repeated ecological momentary assessments of stress and EEG-estimated sleep.

METHODS

Ninety-eight international or interstate undergraduate students (Mage = 20.54 ± 1.64, 76.5% female, 84.7% Asian) reported their stress levels four times daily at morning awakening, afternoon, evening, and pre-bedtime across 15 consecutive days (>4,000 total observations). Next-day stress was coded as an average of morning, afternoon, and evening stress. Z-Machine Insight+ recorded over 1,000 nights EEG total sleep time (TST), sleep onset latency, wake after sleep onset, sleep efficiency (SE), slow-wave sleep (SWS), and rapid eye movement (REM) sleep duration. Multilevel models, adjusted for covariates (i.e., sociodemographic, health factors, and daily covariates) and lagged outcomes, tested the daily within- and between-level stress-sleep associations.

RESULTS

After adjusting for covariates, within-person shorter TST (b = -0.11 [-0.21, -0.01], p = .04), lower SE (b = -0.02 [-0.03, 0.00], p = .04), less SWS (b = -0.38 [-0.66, -0.10], p = .008), and less REM sleep (b = -0.32 [-0.53, -0.10], p = .004) predicted higher next-day stress. Pre-bedtime stress did not predict same-night sleep. No significant results emerged at the between-person level.

CONCLUSIONS

These findings demonstrate that poor or short sleep, measured by EEG, is predictive of higher next-day stress. Results for sleep architecture support the role of SWS and REM sleep in regulating the perception of stress. Given that only within-person effects were significant, these findings highlight the importance of examining night-to-night fluctuations in sleep affecting next-day stress and its impact on daytime functioning.

Bedtime procrastination predicts the prevalence and severity of poor sleep quality of Chinese undergraduate students

ObjectiveBedtime procrastination is a type of unhealthy sleep behavior, but whether it affects sleep quality remains unknown. The current study aimed to examine the relationship between bedtime procrastination and poor sleep quality among Chinese college students. Participants: A total of 1550 Chinese undergraduates participated and effectively completed the study. Methods: This cross-sectional study collected information on bedtime procrastination and self-reported sleep quality via the Bedtime Procrastination Scale and the Pittsburgh Sleep Quality Index. Results: The prevalence of poor sleep quality was 39.42% among Chinese undergraduates. Age, education, and bedtime procrastination independently predicted the prevalence of poor sleep quality. Bedtime procrastination was a unique contributor to the severity of poor sleep quality. Conclusions: This study highlighted the independent associations between bedtime procrastination and the prevalence and severity of self-reported poor sleep quality. These findings may be helpful in designing effective measures to improve the sleep quality of college students.

The Relationship between Living Arrangements and Sleep Quality in Older Adults: Gender Differences

(1) Background: This study examined the effects of living arrangements on the quality of sleep among older adults and analyzed related gender differences; (2) Methods: A total of 4756 older adults in Seoul were included. After adjusting for socio-demographic factors, older adults living alone showed a poorer sleep quality compared with those living with others; (3) Results: When we analyzed the effects of living arrangements on sleep quality by gender, there was no difference in the risk of poor sleep quality between male older adults living alone and those living with others (OR = 1.089, 95% CI = 0.729–1.628), whereas the risk of poor sleep quality was higher for female older adults living alone than those living with others (OR = 1.359, 95% CI = 1.088–1.696); (4) Conclusions: In this study, we have confirmed that older women living alone had poor sleep quality compared to older men. Hence, gender-based approaches will be helpful when providing social support resources to older adults living alone.

The Effect of Worktime Control on Overtime Employees' Mental Health and Work-Family Conflict: The Mediating Role of Voluntary Overtime

Overtime has become a widespread phenomenon in the current information age that creates a high speed working pace and fierce competition in the high technology global economy. Based on the time-regulation mechanism and effort-recovery model, we examined the effect of worktime control (WTC) on mental health and work-family conflict (WFC) among overtime employees, and whether voluntary overtime mediated the relationships. We also examined two separate dimensions of WTC (control over time-off and control over daily hours). The results showed that control over time-off was related to decreased depression, anxiety, stress and WFC, while control over daily hours was related to decreased stress and WFC. Generally, control over time-off was beneficial to females and employees with dependents. Furthermore, mediation results showed that voluntary overtime was a complete mediator of relationships between WTC and depression and anxiety as well as a partial mediator of the relationship between WTC and stress. However, this study did not find a mediating effect of voluntary overtime on the WTC-WFC relationship. Limitations and practical implications are discussed.

Sex differences in the relationship between morningness-eveningness components, mood and well-being among Bangladeshi university students

On the Morningness/Eveningness (M/E) continuum, eveningness has been related to mood disorder and poor well-being. M/E differs between men and women throughout their lifespan. However, there is a lack of information on sex differences in the relationship between M/E, mood, and well-being. This study aimed to test sex differences in the M/E, mood, and well-being relationship with consideration of two components of M/E, morning affect, and morning preference. A sample of 981 Bangladeshi university students (607 men) aged 18 to 27 (M = 21.95) completed Bangla versions of the Composite Scale of Morningness (CSM), BRUnel Mood Scale (BRUMS), and Positive Mental Health scale (PMH-scale) through an online survey. Multiple regression analyses were used to test the relationship of M/E components with mood and well-being. The results showed that the relationship between M/E, mood, and well-being was greater in women than in men. A lower score on both M/E components was related to higher negative moods (anger, confusion, depression, fatigue, and tension) and poor well-being. In regression analysis, only morning affect was found to be significant, which means that morning affect mainly contributes to the relation between M/E, mood, and well-being. Finally, sex by morning affect interaction indicated that the relation was higher for women. Therefore, higher eveningness could be more hazardous for women than men. Greater insight into the independent contribution of morning affect may facilitate understanding of the chronotype effects on psychological outcomes in men and women.

Correlation Between Body Mass Index and Depression/Depression-Like Symptoms Among Different Genders and Races

Background

While being overweight is a risk factor for hyperlipidemia, type 2 diabetes, cancer, and heart disease, it can also be a risk factor for depression and vice versa. In this study, we aimed to evaluate the relationship between body mass index (BMI) and the prevalence of depression symptoms between genders and races.

Methodology

A nationally representative sample was utilized to explore the relationship between depression-related symptoms and BMI status by comparing different genders and racial identities. The National Health and Nutrition Examination Survey (NHANES) data, managed by the Centers for Disease Control and Prevention, was used in this study. Data from 2013 to 2016 were included in the analysis. The Patient Health Questionnaire was used to collect information regarding responses to eight primary questions based on gender, race, and BMI status. Statistical analysis was conducted using descriptive analysis and the chi-square test.

Results

Data were presented as percentages. A majority of both men and women who admitted to having depression or depression-like symptoms more than half the days or nearly every day were overweight or obese. However, men had a higher prevalence compared to women for most questions. Statistical analysis showed that among men and women who felt down, depressed, or hopeless nearly every day, 61.5% (χ² = 5.045, p = 0.992) and 50.9% (χ² = 17.186, p = 0.308) were overweight, respectively. Among the races, those who felt down, depressed, or hopeless nearly every day, non-Hispanic Asian individuals had the lowest percentage of being overweight at 47.7% (χ² = 7.099, p = 0.955), while Hispanic individuals other than Mexican Americans had the highest percentage of being overweight at 67.4% (χ² = 8.792, p = 0.721).

Conclusions

Being overweight or obese appears to have a positive relationship with depression and depression-like symptoms for each gender and race. Similarly, individuals who report having depression-like symptoms are likely to be overweight or obese. Further research is needed to determine other differences in etiologies between genders and races, along with determining whether more individuals become depressed due to being overweight or obese or whether more individuals become overweight or obese due to being depressed. The results of this study are limited to the data obtained through NHANES.

Preexisting Depression and Daytime Sleepiness in Women and Men

BACKGROUND

Sleep problems can persist following the treatment of depression and remission of symptoms. The extent to which having a previous history of depression may be associated with current daytime sleepiness is largely unknown.

METHODS

Data were obtained from the spring 2017 American College Health Association-National College Health Assessment (ACHA-NCHA) survey (92 institutions) which assessed self-reported health in U.S. college students (n = 41,670). Among the sample, 93.5% were 18-24 year of age, and 69.6% women. Logistic regression estimated the association between reported prior lifetime diagnosis of depression and daytime sleepiness from the past 7 days, while adjusting for depressive symptoms and antidepressant use from the past year. Unadjusted and adjusted logistic regression models stratified by gender were performed.

RESULTS

Among those who reported problems with sleepiness, 31.6% women and 19.4% men had a preexisting depression diagnosis. Individuals with preexisting depression were more likely than those without this diagnosis to report sleepiness problems (women: OR = 1.4, CI = 1.3-1.6, p < .001; men: OR = 1.2, CI = 1.0-1.4, p < .01). However, this association differed significantly by gender, with women with a preexisting depression diagnosis having a 13.0% greater likelihood of sleepiness compared to men.

CONCLUSIONS

Those with a preexisting depression diagnosis, and specifically women, may be at risk for daytime sleepiness even in the absence of current depressive mood-related symptoms. Given that many individuals are at risk for daytime sleepiness, mental health initiatives, including those on college campuses, should incorporate sleep hygiene within their programming.

Short-term and long-term associations with sleep onset latency in school children in Japan

BACKGROUND

This study aims to examine the relationships between sleep onset latency and multiple sleep-related factors of seventh and tenth graders during the transition from childhood to adolescence.

METHODS

Regarding sleep onset latency, we examined the short-term associations in Phase IV (2002) and long-term associations in Phase V (2005) of the Toyama Birth Cohort Study. In total, 4,673 boys and 4,694 girls in Phase IV and 2,969 boys and 3,108 girls in Phase V answered the questionnaire items regarding sleep, physical and mental health, lifestyle, socioeconomic status, and family and school factors. Considering sleep onset latency as the outcome and 13 sleep-related factors as independent variables, we calculated the odds ratio using binary logistic regression. The longitudinal study was conducted with 1,703 boys and 1,919 girls whose sleep onset latency was within 30 min in Phase IV.

RESULTS

The following factors were found to be related to longer sleep onset latency in the short term: sleep duration, physical activity, game time, and self-esteem in boys and sleep duration, bedroom environment, game time, abdominal pain, long-standing illness, onset of puberty, mental health difficulties, and school avoidance feelings in girls. Regarding its long-term effects, having a single parent and self-esteem in boys and breakfast, game time, long-standing illness, obesity, onset of puberty, and school avoidance feelings in girls were associated with longer sleep onset latency.

CONCLUSIONS

Education of adolescent health and sleep hygiene at home and school should include both short-term and long-term associations between sleep and a healthy lifestyle by gender.

Secondhand smoke is associated with poor sleep quality in self-reported never-smokers of Northwest China: a cross-sectional study

OBJECTIVE

To investigate the relationship between secondhand smoke (SHS) exposure and sleep quality in never-smokers of Northwest China.

METHODS

Never-smoking adults (≥ 15 years) from Xinjiang, Northwest China, were included in this cross-sectional survey between April and October 2019. SHS exposure in never-smokers was estimated using a structured questionnaire. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI), with PSQI score > 5 classified as poor sleep quality. Association of SHS exposure and frequency and duration of SHS exposure with poor sleep quality were analyzed by using a multivariate logistic regression after adjusting for potential confounding factors, including stratification by sex.

RESULTS

The mean age of participants was 48.0 years, and 77% were females. Of 21,198 never-smokers, 13% (n = 2703) reported SHS exposure and 35% (n = 7390) reported poor sleep quality. In multivariate logistic regression analysis, a significant association was observed between SHS exposure and poor sleep quality (adjusted odds ratio (OR), 1.36; 95% confidence interval (CI) 1.24-1.48). Subgroup analysis showed a negative association of SHS exposure with sleep quality in both sexes. However, a significant dose-response relationship of frequency and duration of SHS exposure per week with poor sleep quality was observed only in females. Consistent results were also observed in the aged ≥ 18 years.

CONCLUSION

Exposure to SHS is associated with poor sleep quality in never-smoking adults of Northwest China. A dose-response relationship between SHS exposure and poor sleep quality is found in women. Avoiding SHS exposure may have beneficial effects on sleep quality, especially for females.

Eating habits are associated with subjective sleep quality outcomes among university students: findings of a cross-sectional study

PURPOSE

This study investigated the relationships between eating habits and sleep quality among university students.

METHODS

In a cross-sectional study, university students completed a self-report questionnaire to assess eating habits and meal timing. We assessed subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and examined the associations between eating habits and overall sleep quality and its components.

RESULTS

Four hundred ninety-eight students participated in the study. Students who used to skip breakfast, ate late-night snacks, and replaced meals with snacks were at 1.20 times, 1.24 times, and 1.25 times higher likelihood of having poor overall sleep quality, respectively. Multiple logistic regression analysis showed that skipping breakfast (r =  - 0.111, P = 0.007), late-night snacks (r =  - 0.109, P = 0.007), replacing meals with snacks (r =  - 0.126, P = 0.002), and irregular mealtimes (r =  - 0.094, P = 0.018) were the best correlates with poor sleep quality. After adjustment to demographic variables, replacing meals with snacks followed by skipping breakfast were the best independent associations with poor sleep quality by the PSQI.

CONCLUSIONS

Eating habits and meal timing were significantly associated with sleep quality. We speculate that healthy eating habits may lead to improved sleep quality and sleep components among university students.

Adolescent psychopathological profiles and the outcome of the COVID-19 pandemic: Longitudinal findings from the UK Millennium Cohort Study

BACKGROUND

Public health measures to contain the spread of COVID-19 have resulted in adverse effects, including high level of psychological distress, anxiety, and depression.

AIMS

This study explored adolescent psychopathological profiles at age 17, and their role in predicting the impact of the COVID-19 pandemic at age 19.

METHODS

The analyses used a sample of 904 participants (mean age = 19.17 years) from the Millennium Cohort Study (MCS) sweep 7 who completed the mental health questions from January 2018 to March 2019 (mean age = 17.18 years) and the COVID-19 Survey in May 2020. Adolescent psychopathological profiles were identified by means of latent class analysis.

RESULTS

Four psychopathological profiles were identified: "low-symptom class" (60.17% of participants), "high-symptom class" (23.01% of participants), "substance/behavioural addictions class" (12.03% of participants), and "emotion-dysregulation class" (4.79% of participants). Adolescents in the high-symptom and emotional-dysregulation classes had the worst outcome during the lockdown. Specifically, they experienced more stress, conflict and loneliness, and lower levels of perceived social support than adolescents in the other psychopathological classes. Adolescents in the emotional-dysregulation class also consumed more alcohol and had worse financial situation during the lockdown compared to pre- lockdown period.

CONCLUSION

Adolescent psychopathological profiles predicted mental health impacts of the COVID-19 outbreak.

Sex differences in the factors associated with sleep duration in university students: A cross-sectional study

BACKGROUND

Insufficient sleep duration among university students was commonly associated with many detrimental effects. University students experience substantial environmental and psychological changes. Female and male university students may differ in many spheres. However, most research on sleep duration of university students is based on an aggregate sample rather than digging the sex-specific profiles. The objective of this study is to examine potential sex differences in the correlates of sleep duration and explore the underlying mechanism of correlations.

METHODS

This is a large-scale university-based mental health survey, which was conducted in university students in Qinghai Province in Northwest China in December 2019. A multi-stage logistic regression was separately fitted by sex to examine the factors associated with short sleep duration in university students.

RESULTS

A total of 5,552 university students with an average sleep duration of 6.88 h (SD = 1.04) were included, among which 35.0% of the participants may currently be sleeping less than the optimal duration. Female students (6.84 h, SD = 1.00) slept shorter than males (6.94 h, SD = 1.09). The only parallel between sexes was that both female and male students with 3-5 times weekly breakfast were less likely to have short sleep duration. Adjusting for depressive symptoms in the following step eliminated the association between anxiety symptoms and short sleep duration in the model for female students. Female-specific associated factors with short sleep duration were age, grade, academic pressure, weekly physical exercise, depressive symptoms. Male-specific characteristics were current smoking tobacco cigarette, self-perceived health, duration of daily Internet use.

CONCLUSION

Characteristic profiles of sleep duration differed between female and male university students; only a few male-specific factors were identified. Psychological guidance and education courses as well as other interventions to improve university students' sleep and related health should be designed and implemented based on sex differences.

Stressful life events and poor sleep quality: a cross-sectional survey in the Chinese governmental employees

Evidence has shown that stressful life events are associated with sleep quality, yet studies on employees are scarce. In the present study, we explored the association between stressful life events and sleep quality in Chinese governmental employees. The cross-sectional data on 10,994 Chinese governmental employees aged 20-60 years were derived from a cohort study on chronic diseases of governmental employees in Hunan Province, China. Logistic regression models were used to calculate the adjusted odds ratio (OR) and the 95% confidence interval (CI). Of the participants, 3517 (32.0%) reported poor sleep quality in the past month. Participants who experienced more than two life events in the past year were associated with 3 times (OR: 3.681, 95%CI:3.287-4.123) greater likelihood of poor sleep quality. Negative life events, but not positive life events, were significantly associated with poor sleep quality. Regarding the types of events, economic-related life events were associated with poor sleep quality only in employees aged 20-35 years. Regarding the specific life events, work stress, job dissatisfaction, pregnancy or wife pregnancy,quality in Chinese governmental employees. discord with spouse's parents, separation from spouse due to work, bad relationship between spouse, unsatisfied sex life, misunderstood, blamed, false accusation or argument, and lifestyle changes were significantly associated with poor sleep quality. When stratified by sex, age and occupational position, the association of specific events and sleep quality were different. The present study showed that cumulative life events, negative life events and several specific events were significantly associated with poor sleep quality on Chinese governmental employees.

Relationship between the fear of COVID-19 disease and sleep quality: the mediating role of stress

The whole world almost came to a standstill due to the COVID-19 pandemic. In response to this pandemic, most psychological responses have been at a higher prevalence such as stress, anxiety, depression, lower mental well-being, poor sleep quality, along with the fear of contracting the COVID-19 disease. Related to these psychological responses, previous studies have suggested an association between COVID-19 fear and stress as well as stress and sleep quality. The present study aimed to assess the association between COVID-19 fear and sleep quality and investigate the possible mediating effect of perceived stress during this pandemic. The data were collected, utilizing a self-report online questionnaire, from a sample of 521 Bangladeshi adults. Results showed significant gender differences in COVID-19 fear, stress, and sleep quality and also a significant association between these variables. Mediation results revealed that stress fully mediated the association between COVID-19 fear and sleep quality for males and partially mediated it for females. These results suggest that women are in a more vulnerable position in this pandemic. These findings would be helpful to mental health professionals and policy makers to address the psychological problems induced by the current pandemic.

Factors Influencing Sleep Quality among Female Staff Nurses during the Early COVID-19 Pandemic in the United States

This study aimed to assess the overall level of sleep quality among female staff nurses in the United States during the early COVID-19 pandemic. It also aimed to examine factors associated with sleep quality and its seven subcomponents: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medications, and daytime dysfunction. A descriptive, correlational, and cross-sectional study design was used. We performed descriptive, and regression analyses with a sample of 215 female staff nurses enrolled in post-licensure online nursing programs at a southeastern state university. Data collection was conducted using an online survey from April to May 2020. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Nurses working part time (p = 0.02), with lower perceived physical health (p = 0.01), a lower self-care self-regulation score (p < 0.001), and higher work stress (p < 0.05) showed poorer sleep quality. Factors associated with subcomponents of sleep quality varied. Poor sleep quality among nurses during the COVID-19 pandemic was reported. Various factors, including work environmental factors were associated with the sleep quality in this sample. Hospital administrators should consider developing intervention programs for improving the work environment, which would impact sleep quality, health status, and job performance.

Sex-specific association of poor sleep quality with gray matter volume

STUDY OBJECTIVES

Previous studies were inconsistent with regard to the association of sleep dysfunction on the brain's gray matter volume (GMV). The current study set out to investigate if there is a moderating effect of sex on the relationship between sleep quality in healthy individuals and GMV.

METHODS

We applied voxel-based morphometry in 1,074 young adults of the "Human Connectome Project." An analysis of variance with the factors "sleep quality" (good/poor according to the Pittsburgh Sleep Quality Index, cutoff >5) and "sex" (male, female) on GMV was conducted. Additionally, linear relationships between sleep quality and GMV were tested.

RESULTS

The analysis of variance yielded no main effect for sleep quality, but an interaction between sex and sleep quality for the right superior frontal gyrus. Post hoc t-tests showed that female good sleepers in comparison to female poor sleepers had larger GMV in the right parahippocampal gyrus extending to the right hippocampus (whole-brain family-wise error [FWE]-corrected), as well as smaller GMV in the right inferior parietal lobule (whole-brain FWE-corrected) and the right inferior temporal gyrus (whole brain FWE-corrected). There were no significant effects when comparing male good sleepers to male poor sleepers. Linear regression analyses corroborated smaller GMV in the right parahippocampal gyrus in women with poor sleep quality.

CONCLUSIONS

Poor sleep quality was associated with altered GMV in females, but not in males. Future studies are needed to investigate the neurobiological mechanisms that underlie the sex differences in the association of sleep quality and brain differences found in this study.

Bi-directional relations between stress and self-reported and actigraphy-assessed sleep: a daily intensive longitudinal study

STUDY OBJECTIVES

Stress is associated with poor and short sleep, but the temporal order of these variables remains unclear. This study examined the temporal and bi-directional associations between stress and sleep and explored the moderating role of baseline sleep complaints, using daily, intensive longitudinal designs.

METHODS

Participants were 326 young adults (Mage = 23.24 ± 5.46), providing >2,500 nights of sleep altogether. Prospective total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were measured using actigraphy and sleep diaries. Perceived stress was reported three times daily between: 11:00-15:00, 15:30-19:30, and 20:00-02:00. Sleep complaints were measured at baseline using the PROMIS sleep disturbance scale. Within- and between-person sleep and stress variables were tested using cross-lagged multilevel models.

RESULTS

Controlling for covariates and lagged outcomes, within-person effects showed that higher evening stress predicted shorter actigraphic and self-reported TST (both p < .01). Conversely, shorter actigraphic and self-reported TST predicted higher next-day stress (both p < .001). Longer self-reported SOL and WASO (both p < .001), as well as lower actigraphic (p < .01) and self-reported SE (p < .001), predicted higher next-day stress. Between-person effects emerged only for self-reported TST predicting stress (p < .01). No significant results were found for the moderating role of baseline sleep complaints.

CONCLUSIONS

Results demonstrated bi-directional relations between stress and sleep quantity, and a consistent direction of worse sleep quantity and continuity predicting higher next-day stress. Results highlighted within-individual daily variation as being more important than between-individual differences when examining sleep and daytime functioning associations.

Sleep and Awakening Quality during COVID-19 Confinement: Complexity and Relevance for Health and Behavior

Objective: The aim of this study was to evaluate sleep and awakening quality (SQ and AQ) during COVID-19 in a large and diversified population in order to identify significant associations and risks in terms of demography, health and health-related behaviors, sleep variables, mental health, and attitudes. Methods/Results:Online surveys were used for data collection, received from 5479 individuals from the general population, sleep disorder patients, and COVID-involved (medical doctors (MDs) and nurses) and COVID-affected professionals (teachers, psychologists, and dentists). SQ and AQ were worse in adults, females, and high-education subjects. Feeling worse, having economic problems, depression, anxiety, irritability, and a high Calamity Experience Check List (CECL) score during COVID were significantly associated with poor SQ and AQ. Shorter sleep duration, increased latency, poor nutrition, low physical activity, increased mobile and social network use, more negative and less positive attitudes and behaviors were associated with poor AQ. Conclusions: The SQ logistic regression showed gender, morbidities, CECL, and awakenings as relevant, whereas, for AQ, relevant variables further included age and physical activity. Aiming to have a high stress compliance, each individual should sleep well, have important control of their mood, practice positive behaviors while dismissing negative behaviors and attitudes, practice exercise, have adequate nutrition, and beware of technologies and dependences.

Gender Differences in the Relationship Between Exercise, Sleep, and Mood in Young Adults

Insufficient sleep is a serious public health problem in college students. Exercise is a widely prescribed behavioral treatment for sleep and mood issues; however, more focused and gender-specific prescriptions are needed. The present study examined relationships between exercise, sleep, and mood in undergraduate men and women. Students (N = 866, 19.6 ± 1.4 years, 38.7% women) were recruited from campus recreation facilities and completed demographic, the Pittsburgh Sleep Quality Index, mood (Patient-Reported Outcomes Measurement Information System), and exercise questionnaires. The Department of Health and Human Services Physical Activity Guidelines were used to dichotomize those who did and did not meet weekly aerobic and strength training exercise recommendations. In men, greater exercise frequency associated with less daytime dysfunction (β = 0.147) and less depressive mood (β = -0.64, ps < .05). In women, greater exercise frequency associated with earlier bedtime (β = -12.6), improved sleep quality (β = 0.17), increased positive affect (β = 0.91), less depressive mood (β = -0.71), and less anger (β = -1.24, ps < .05). Compared to men, women reported earlier bedtime, poorer sleep efficiency, and more anxiety and depressive mood (ps < .05, ηp2 range: 0.01-0.04). Compared to individuals who met physical activity guidelines, those who did not meet the guidelines reported later bedtimes, less positive affect, more anxiety, and more anger (ps < .05 ηp2s = 0.01). Among men, those who met physical activity guidelines reported falling asleep more quickly than those who did not meet guidelines (ηp2 = 0.01, p = .007); however, no relationship between guideline adherence and sleep latency was observed in women. Adhering to physical activity guidelines may be important for optimal sleep and emotional health. Clinicians should consider gender when creating exercise prescriptions for sleep issues.

How Is Indoor Air Quality during Sleep? A Review of Field Studies

This review aimed to provide an overview of the characterisation of indoor air quality (IAQ) during the sleeping period, based only on real life conditions’ studies where, at least, one air pollutant was considered. Despite the consensual complexity of indoor air, when focusing on sleeping environments, the available scientific literature is still scarce and falls to provide a multipollutants’ characterisation of the air breathed during sleep. This review, following PRISMA’s approach, identified a total of 22 studies that provided insights of how IAQ is during the sleeping period in real life conditions. Most of studies focused on carbon dioxide (77%), followed by particles (PM2.5, PM10 and ultrafines) and only 18% of the studies focused on pollutants such as carbon monoxide, volatile organic compounds and formaldehyde. Despite the high heterogeneity between studies (regarding the geographical area, type of surrounding environments, season of the year, type of dwelling, bedrooms’ ventilation, number of occupants), several air pollutants showed exceedances of the limit values established by guidelines or legislation, indicating that an effort should be made in order to minimise human exposure to air pollutants. For instance, when considering the air quality guideline of World Health Organisation of 10 µg·m−3 for PM2.5, 86% of studies that focused this pollutant registered levels above this threshold. Considering that people spend one third of their day sleeping, exposure during this period may have a significant impact on the daily integrated human exposure, due to the higher amount of exposure time, even if this environment is characterised by lower pollutants’ levels. Improving the current knowledge of air pollutants levels during sleep in different settings, as well as in different countries, will allow to improve the accuracy of exposure assessments and will also allow to understand their main drivers and how to tackle them.

Poor sleep quality among young adults: The role of anxiety, depression, musculoskeletal pain, and low dietary calcium intake

PURPOSE

This study examined the relationships between sleep quality, anxiety, depression, musculoskeletal pain (MSP), and calcium intake.

DESIGN AND METHODS

In this cross-sectional study (N = 1422), sleep was assessed using the Pittsburgh Sleep Quality Index, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and calcium intake and MSP were assessed by self-reporting.

FINDINGS

Poor sleep quality was reported by 62.66% of the participants. The participants with poor sleep quality reported lower calcium intake, higher anxiety and depression levels, more severe MSP, and multisite pain. Anxiety, depression, low calcium intake, and multisite pain were significant predictors of poor sleep quality. Anxiety was predicted by poor sleep quality, depression, multisite pain, and sex (ie, female). Depression was predicted by anxiety, poor sleep quality, and low calcium intake.

PRACTICAL IMPLICATIONS

The findings underscore the role of low calcium intake in the development of sleep problems, anxiety, depression, and MSP. Individuals with these conditions should be advised to increase their calcium intake.

Sex differences in the association between chronotype and risk of depression

Information on sex differences in the association between chronotype and depression is scarce. We aimed to investigate these differences using data from the Korea National Health and Nutrition Examination Survey in 2016. Chronotypes were categorised based on mid-sleep time on free days corrected by sleep debt accumulated on workdays (MSFsc): early type, < mean MSFsc - 1 standard deviation (SD); intermediate type, between mean MSFsc - 1 SD and MSFsc + 1 SD; and late type, > mean MSFsc + 1 SD. A Patient Health Questionnaire-9 score of ≥ 10 indicated depression. Among 5550 non-shift working adults aged 19-80 years, the prevalence rates of depression in the early, intermediate, and late chronotype groups were 7.4%, 4.5%, and 9.3%, respectively. Women with late chronotype (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.8-4.7) showed a higher risk of depression than women with intermediate chronotype after adjusting for covariates. Women with early chronotype did not show a significant difference in depression risk (OR = 1.3, 95% CI = 0.9-2.0). In conclusion, late chronotype is associated with an increased risk of depression in women but not in men. Early chronotype is not associated with depression in women or men.

Poorer sleep quality correlated with mental health problems in college students: A longitudinal observational study among 686 males

OBJECTIVE

Poor sleep quality and mental health problems are common in college students. The objective of this study is to examine whether sleep quality predicts the risk of future mental health problems, and vice versa.

METHODS

The sleep quality and mental health status of 686 male college students were estimated, and 582 of them were followed up a year later. Subjective sleep quality and mental health problems were measured with the Pittsburgh Sleep Quality Index (PSQI) and the Depression Anxiety Stress Scale-21 (DASS-21), respectively.

RESULTS

Either at baseline or during follow-up, the PSQI global score was positively associated with scores for depression, anxiety, and stress on the DASS-21 (p's < 0.001). Longitudinal analyses revealed that DASS-21 total score increased in line with increased of PSQI global score during the year (p < .001). More importantly, the cross-lagged analysis showed that (i) PSQI global score at baseline was positively related to depression (β = 0.261), anxiety (β = 0.321), and stress (β = 0.311) scores a year later (p's < 0.001) and (ii) depression (β = 0.259), stress (β = 0.245) and anxiety (β = 0.292) scores at baseline were related to PSQI global score a year later (p's < 0.001). Finally, we further found that among those without mental health problems at baseline, poorer baseline sleep quality predicted a higher risk of anxiety symptoms a year later (RR 3.07, 95% CI 1.36-6.97, p = .007).

CONCLUSIONS

These data may suggest a bidirectionally relationship between sleep quality and mental health problems.

Relationship of physical activity and sleep with depression in college students

Objectives: This study examined the relationship between physical activity, sleep and depression among college students and gender differences in physical activity, sleep and depression. Methods: Participants were 1143 students from a large public university in Beijing and completed three questionnaires to measure their physical activity habits, sleep patterns, and depression levels. Data from were analyzed using descriptive statistics, stepwise regression, and an independent t test. Results: Results indicated that vigorous physical activity and sleep variables significantly predicted depression levels for the overall sample (F = 77.286, p = .000). When examined by gender, vigorous and moderate physical activity variables significantly predicted depression for males (t = -2.772, p = .006; t = -2.622, p = .009), whereas no level of physical activity had a significant relationship with depression for females. Conclusions: Rigorous physical activity and quality sleep may be beneficial to helping college students reduce and regulate depressive symptoms, however may vary by gender.

Sleep Quality in Autism from Adolescence to Old Age

Background

Sleep problems are common in autism from early childhood. Although research suggests that poor sleep continues at least into early middle age, the pattern of sleep problems has rarely been characterized beyond childhood. The aim of this study was to examine sleep quality from adolescence to old age in autistic individuals as compared with age-matched non-autistic comparison groups from the general population.

Methods

Participants ranged from 15 to 80 years; there were 297 participants in the autistic group (mean [M]_age = 34.36 years, standard deviation [SD] = 15.24), and the comparison group had 233 participants (M_age  = 33.01 years, SD = 15.53). Sleep quality, sleep onset latency (SoL), total night sleep, and sleep efficiency as measured by Pittsburgh Sleep Quality Index were compared between groups and across age groups (15-19, 20-39, 40-59, 60+ years). Five predictors of sleep quality (autistic traits, mental health condition, medication, employment, and sex) were also examined.

Results

Overall, problematic sleep was more common for the autistic participants (63.7%) than the comparison group (46.4%), and autistic participants had poorer sleep quality and longer SoL (all p < 0.001). In early adulthood and middle age, autistic adults had significantly poorer sleep quality and longer SoL than similar age comparison group adults; autistic and comparison group adolescents and the elderly did not differ. In the autistic group, predictors accounted for 21% of sleep quality variance. Sex (p < 0.001) was the strongest predictor, with all predictors except employment contributing unique variance. In the comparison group, predictors accounted for 25% of the variance in sleep quality. The strongest predictor was mental health condition (p < 0.001), with all predictors except sex contributing unique variance.

Conclusions

Autistic adolescents and adults, particularly females, remain vulnerable to sleep problems, with early and middle adulthood being at times of particular risk. Targeted sleep interventions are required.

Lay summary

Why was this study done?: Difficulty sleeping is a common occurrence among autistic individuals, but we know very little about sleep in autistic adults.What was the purpose of the study?: To compare self-reported sleep quality in autistic and non-autistic people aged 15 to 80 years.What did the researchers do?: Online surveys were completed by 297 autistic individuals (average age 34.36 years) and 233 non-autistic individuals (average age 33.01 years). Participants were asked questions about their sleep quality, the time it takes them to fall asleep (sleep latency), and the number of hours of sleep they usually get each night (total sleep). Using information about how long they slept and their responses to questions about their bedtime and wake time we calculated the percentage of time they spent in bed asleep (sleep efficiency [SE]). We compared these sleep measures between the autistic and non-autistic participants. We also split the participants into four age groups (15-19, 20-39, 40-59, and 60+ years) to look at any differences at specific age points. Finally, we looked to see whether autistic symptoms, having a mental health problem, being on medication, being unemployed, and/or sex (male/female) predicted sleep quality.What were the results of the study?: Poor sleep quality was more common for the autistic participants (63.7%) than non-autistic participants (46.4%). On average, autistic participants also had poorer sleep quality scores and it took them longer to fall asleep than non-autistic participants. Autistic participants in early adulthood (20-39) and middle age (40-59) had poorer sleep quality and took longer to fall asleep than non-autistic adults of the same age. There were no differences between autistic and non-autistic adolescents (15-19) or older adults (60+). For autistic participants, the best predictor of poor sleep quality was being female; other predictors of poor sleep quality were having a mental health problem, more autistic symptoms, and being on medication. Among non-autistic participants, the best predictor of poor sleep quality was having a mental health problem; other predictors were more autistic symptoms, being on medication, and being unemployed.What do these findings add to what is already known?: Similar to the findings in autistic children, autistic adults are more likely to have poor sleep quality compared with non-autistic adults. Autistic females are particularly at risk for poor sleep, and autistic adults aged 20 to 59 years are more at risk for poor sleep quality.What are potential weaknesses in the study?: Sleep was measured by using a self-report questionnaire, which is not as reliable as using a sleep diary or other objective measures of sleep (e.g., actigraphy). In addition, this study only looked at data collected at one point in time, and as such it is not possible to examine changes over time in sleep quality among autistic adults.How will these findings help autistic adults now or in the future?: The findings in this study identified that sleep difficulties persist across the lifespan for autistic adults. Therefore, there is a critical need for future research to focus on understanding the cause of poor sleep quality in autism and develop sleep interventions for autistic adults.

Assessment of quality of sleep and its association with body mass index among medical consultants working in a medical college in northern India

BACKGROUND

Medical specialist/consultants are exposed to various factors such as long duty hours, call duties, academics, meetings and regulation of departmental work which has adversely affected their sleep quality.

OBJECTIVE

To assess sleep quality and association of body mass index with quality of sleep among medical consultants working in medical college.

METHOD AND TOOL

This is a cross-sectional study and was done by convenient sampling technique. Pittsburg Sleep Quality Index (PSQI) was used as the assessment tool which categorizes sleep as good or poor according to the score. Chi-square test was applied to establish an association with the variables.

RESULTS

A total of 67 responses were obtained, of which 28 showed good sleep on PSQI. Among consultants having good quality sleep, the majority were females (n=18); aged above 40 years (n=17). No relationship was seen with BMI and chronic disease. Consultants spending more than 85% of the time in bed sleeping (p< 0.006) and those going to bed before 10.30 pm (p<0.026) had good sleep quality.

CONCLUSION

Good quality of sleep was observed in females, people above 40 years and those who don't have any chronic disease, though this association of sleep quality with the factors was not significant. Going to bed early (before 10:30 pm) had a positive effect on sleep quality (p<0.026). In general, poor sleep quality was seen among medical consultants.

Impact of sleep problems on daytime function in school life: a cross-sectional study involving Japanese university students

BACKGROUND

The aims of this study were 1) to clarify the prevalence of sleep problems (insomnia, insufficient sleep, and delayed sleep-wake phase) among Japanese university students; 2) to examine sociodemographic characteristics, lifestyle, and sleep-related symptoms in each sleep problem; and 3) to evaluate the association between the above-mentioned sleep problems and daytime dysfunction in school life.

METHODS

Self-report questionnaire surveys were conducted at eight universities in Japan, and we received 1034 valid answers (78% female). The questionnaire consisted of socio-demographic characteristics, information on lifestyle, sleep pattern, sleep-related symptoms, and daytime dysfunction in school life. Groups with insomnia, behaviorally induced insufficient sleep syndrome (BIISS), delayed sleep-wake phase (DSWP), and BIISS + DSWP were defined. To identify the association between sleep problems and daytime dysfunction in school life, the generalized linear mixed effect model was conducted.

RESULTS

Sleep duration on weekdays was 5.9 ± 1.2 h, and 38.2% of the students had a sleep duration < 6.0 h. About 16% of the students were categorized as evening-type individuals. More than half of the students (56.1%) had excessive daytime sleepiness. Insomnia was associated with tardiness (aOR: 0.8, 95%CI: 0.7-0.9) and falling asleep during class (aOR: 1.6: 95%CI: 1.4-2.0). BIISS was associated with tardiness (aOR: 1.5, 95%CI: 1.1-2.2) and interference with academic achievement (aOR: 1.9, 95%CI: 1.3-2.6). DSWP and BIISS + DSWP were associated with absence (aOR: 3.4, 95%CI: 2.2-5.1 / aOR: 4.2, 95%CI: 3.2-5.6), tardiness (aOR: 2.7, 95%CI: 1.8-4.1 / aOR: 2.2, 95%CI: 1.6-2.8), falling asleep during class (aOR: 2.6, 95%CI: 1.4-4.8 / aOR: 7.6, 95%CI: 3.3-17.2), and interference with academic achievement (aOR: 2.6, 95%CI: 1.7-3.9 / aOR: 2.1, 95%CI: 1.6-2.8).

CONCLUSIONS

Students with DSWP and BIISS + DSWP were significantly associated with daytime dysfunction in school life, i.e. absence, tardiness, falling asleep during class and interference with academic achievement. Students displaying BIISS + DSWP were considered to have a relatively more serious condition compared with those with only insomnia, DSWP, or BIISS. It is therefore of utmost importance that university students aim to prevent DSWP and BIISS which were associated with daytime function in school life.

The Interplay Between Tobacco Dependence and Sleep Quality Among Young Adults

Objective/Background: Sleep disturbances are considered among the negative consequences of smoking. However, the relationship between sleep quality and smoking among young adults, a population in which the prevalence of smoking is highest, has scarcely been examined. The current study aimed at examining differences in sleep indices, assessed by both subjective and objective (actigraphy) measures, between smokers and nonsmokers, and whether such differences are associated with levels of nicotine dependence. Participants: Eighty-six young (19-28 years old) volunteers, of them 46 nonsmokers (69.6% women) and 40 regular smokers (70.0% women) smoking at least 10 cigarettes a day. Methods: The participants completed the State-Trait Anxiety Inventory, Beck Depression Inventory, Brief Questionnaire on Smoking Urges, the Fagerstrom Test for Nicotine Dependence, and the Pittsburgh Sleep Quality Index. Their sleep was monitored objectively for one week using an actigraph. Results: Smokers' self-reported sleep quality was similar to that of nonsmokers. However, actigraphy data pointed to lower sleep continuity in smokers compared to nonsmokers as reflected by increased wake time after sleep onset (Mean ± SD: 18.56 ± 15.29 vs. 11.21 ± 11.19, p < .01) and decreased sleep efficiency (Mean ± SD: 95.63 ± 3.53 vs. 97.23 ± 2.62, p < .012). Total sleep time and sleep onset latency did not differ between the groups. Notably, severity of nicotine dependence was negatively associated with sleep efficiency (β = -.32; p < .05). Conclusion: Young adult smokers have lower sleep continuity without necessarily subjectively experiencing their sleep as poor. Nevertheless, their lower sleep continuity is related to their level of nicotine dependence.

Dietary behaviors and poor sleep quality among young adult women: watch that sugary caffeine!

PURPOSE

Associations of dietary patterns with sleep quality have not been sufficiently studied, particularly among young adults. Studying factors associated with sleep quality among young adults are especially important given the significant life changes they are experiencing, which can influence not only sleep quality but also dietary behaviors.

METHODS

We examined the cross-sectional association of sleep quality among 462 women at age 23 years. We used the Pittsburg Sleep Quality Index (PSQI) to define sleep quality. Intake over the previous 7 days of fruits and vegetables, soda, sports drinks, other sweetened drinks, and coffee drinks was assessed by a self-report questionnaire. Linear regression analysis examined the association between PSQI scores and dietary intake.

RESULTS

About 47% of participants were White, 25% Black, 10% Hispanic, and 18% Other. Almost ½ (45%) reported poor sleep quality. Compared with participants reporting consuming no energy drinks, participants who reported consuming any energy drinks had PSQI scores that were 0.84 points higher (7.08 ± 0.51 vs 6.24 ± 0.39; p=0.04) (indicating poorer sleep quality). Participants who reported drinking one or more high-calorie coffee drinks had PSQI scores that were 1.00 points higher compared with those reporting drinking no high-calorie coffee drinks (7.14 ± 0.51 vs 6.14 ± 0.42; p=0.02). Fruit or vegetable intake was not associated with PSQI score.

CONCLUSIONS

Poor sleep quality is prevalent among young women. Young women with poor sleep quality should consider their sugary caffeine use to determine if it may be associated with their sleep.

Smartphone Use and Sleep Quality in Chinese College Students: A Preliminary Study

BACKGROUND

Chinese college students are at high risk of sleep problems, and smartphone use is common among this population. However, the relationship between smartphone use characteristics and sleep problems in Chinese college students has been inadequately studied. In this preliminary study, we examined the association of poor sleep quality with smartphone use in a sample of Chinese college students from a health vocational college in Changsha, China.

METHODS

A total of 439 college students completed a self-report questionnaire containing the Pittsburgh Sleep Quality Index (PSQI) and questions regarding demographic information, psychosocial factors, physical health, smartphone use characteristics, and mobile phone addiction (MPA).

RESULTS

The results showed that the prevalence of poor sleep quality (PSQI > 7) in Chinese college students was 9.8%. In multiple logistic regression analysis, poor sleep quality was significantly associated with male gender (OR: 2.80, P: 0.022), not having good physical health (OR: 2.61, P: 0.020), headache (OR: 2.47, P: 0.014), more severe depressive symptoms (OR: 2.17, P: 0.049), > four years of smartphone use (OR: 3.38, P: 0.001), > five hours of daily smartphone use (OR: 2.19, P: 0.049), and more severe inability to control MPA craving (OR: 2.04, P: 0.040).

CONCLUSION

Our findings suggest that excessive smartphone use and MPA are associated with poor sleep quality in a sample of Chinese college students from a health vocational college. Because of the limited sample representativeness and cross-sectional design of this study, large-scale prospective representative studies are warranted to confirm these associations.

Measurement Invariance and Sleep Quality Differences Between Men and Women in the Pittsburgh Sleep Quality Index

STUDY OBJECTIVES

Previous research has reported mixed results in terms of sex differences in sleep quality. We conducted an analysis of measurement invariance of the Pittsburgh Sleep Quality Index (PSQI) between men and women to provide a necessary foundation for examining sleep differences.

METHODS

The sample included 861 adults (mean age = 52.73 years, 47.85% male) from the 2012-2016 wave of the Midlife in the United States (MIDUS) Refresher Biomarker survey. We randomly divided the sample into two half samples for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. We conducted EFA with a weighted least squares mean and variance adjusted (WLSMV) estimator and Geomin rotation to explore the underlying structure of the PSQI. We then employed multiple-group CFA with the WLSMV estimator and theta parameterization to examine measurement invariance between males and females.

RESULTS

EFA suggested a two-factor structure of the PSQI, and the two-factor CFA model fit the data well. The finding that the two-factor PSQI model was invariant between males and females on configuration, factor loadings, thresholds for all but one measure, and residual variances for all but one measure provided evidence that the two-factor PSQI model was partially invariant between men and women. Females had higher means on latent factors, suggesting worse self-reports of sleep among women.

CONCLUSIONS

Overall, the measure of the PSQI assesses the same factors in a comparable way among men and women. Women reported worse sleep than men.

Association of Depression and Unhealthy Lifestyle Behaviors in Chinese Patients With Acute Coronary Syndromes

PURPOSE

This study sought to examine associations between depression and unhealthy lifestyle behaviors in Chinese patients with acute coronary syndromes (ACS).

METHODS

This cross-sectional study included 4043 ACS patients from 16 hospitals across China who participated in the I-Care (Integrating Depression Care in Acute Coronary Syndromes Patients) trial. Patients were enrolled between November 2014 and January 2017. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Five lifestyle behaviors were assessed: smoking, drinking, body mass index (BMI), physical activity, and sleep quality.

RESULTS

A total of 135 patients (3.3%) were considered clinically depressed (PHQ-9 ≥10). After adjusting for covariates, physical activity and sleep quality were inversely related to PHQ-9 scores. Adjusted logistic models showed that depressed patients were 1.7 times likely to be physically inactive (OR = 1.74; 95% CI, 1.15-2.64) and 4.6 times likely to have poor sleep quality (OR = 4.60; 95% CI, 3.07-6.88) compared with nondepressed patients. The association of depression with smoking, unhealthy drinking, and unhealthy BMI was not significant after adjustment for demographic characteristics. Higher depression scores were found to be associated with a greater number of unhealthy lifestyle behaviors (P for trend < .001).

CONCLUSIONS

The association of depression and unhealthy lifestyles in post-ACS patients suggests that reducing depressive symptoms and improving healthy lifestyle behaviors could potentially improve clinical outcomes in this vulnerable patient population.

Qualidade e duração de sono entre usuários da rede pública de saúde

Resumo Objetivo Avaliar a qualidade e tempo de sono entre usuários da rede pública de saúde e fatores associados. Métodos Estudo transversal, realizado com 775 indivíduos de ambos os sexos, em um município da região Centro-Oeste do Brasil. Aplicou-se questionário semiestruturado para avaliar as características sociodemográficas, os hábitos de vida, as condições de saúde, o binge drinking e qualidade e duração do sono, avaliadas pelo Índice de Qualidade de Sono de Pittsburgh. Aplicou-se a regressão de Poisson para identificação dos fatores associados à qualidade do sono ruim e à duração de sono (curta e longa). Resultados Na análise múltipla, os fatores associados à qualidade de sono ruim foram sexo feminino (razão de prevalência: 1,10; intervalo e confiança de 95% − IC95% 1,05-1,16; p<0,00), binge drinking (razão de prevalência: 1,08; IC95% 1,03-1,13; p<0,01), uso de substâncias ilícitas (razão de prevalência: 1.06, IC95% 1.00-1.12; p=0.03), angina (razão de prevalência: 1,10;, IC95% 1,03-1,18; p<0,01) e depressão (razão de prevalência: 1,07 IC95% 1,00-1,14; p=0,02). A obesidade associou-se à curta duração do sono (razão de prevalência: 1,10 IC95% 1,02-1,17; p<0,01). Idade > 55 anos associou-se à longa duração do sono (razão de prevalência: 1,39, IC95% 1,00-1,92; p=0,04). Conclusão Ser mulher, ter idade >55 anos, consumir bebida alcoólica, usar substâncias ilícitas, angina, obesidade e depressão foram fatores de risco para alterações na qualidade e duração de sono. Os resultados do presente estudo reforçam a necessidade do desenvolvimento de ações voltadas para a prevenção dos agravos relacionados às alterações no sono na população estudada.

Sleep reductions associated with illicit opioid use and clinic-hour changes during opioid agonist treatment for opioid dependence: Measurement by electronic diary and actigraphy

Sleep problems are commonly reported during opioid agonist treatment (OAT) for opioid use disorders. Inpatient studies have found both sleep disturbances and improved sleep during OAT. Illicit opioids can also disrupt sleep, but it is unclear how they affect sleep in outpatients receiving OAT. Therefore, we used electronic diary entries and actigraphy to measure sleep duration and timing in opioid-dependent participants (n = 37) treated with methadone (n = 15) or buprenorphine (n = 22). For 16 weeks, participants were assigned to attend our clinic under different operating hours in a crossover design: Early hours (07:00-09:00) vs. Late hours (12:00-13:00) for 4 weeks each in randomized order, followed for all participants by our Standard clinic hours (07:00-11:30) for 8 weeks. Throughout, participants made daily electronic diary self-reports of their sleep upon waking; they also wore a wrist actigraph for 6 nights in each of the three clinic-hour conditions. Drug use was assessed by thrice-weekly urinalysis. In linear mixed models controlling for other sleep-relevant factors, sleep duration and timing differed by drug use and by clinic hours. Compared to when non-using, participants slept less, went to bed later, and woke later when using illicit opioids and/or both illicit opioids and cocaine. Participants slept less and woke earlier when assigned to the Early hours. These findings highlight the role OAT clinic schedules can play in structuring the sleep/wake cycles of OAT patients and clarify some of the circumstances under which OAT patients experience sleep disruption in daily life.

Association of Physical Activity and Sleep Quality with Academic Performance Among Fourth-year MBBS Students of Rawalpindi Medical University

Background

Medical students face greater academic stress and devote more time to their studies due to the tough nature of medical education, at the cost of sleep and physical activity. Good sleep quality and physical activity improve the mental ability and academic performance of the students.

Objectives and rationale

The study aims to assess sleep quality and physical activity levels among fourth-year MBBS students of Rawalpindi Medical University. We compare these levels with gender and boarding status and correlate them with the academic performance of the students. This may provide new target areas to improve the academics of students performing below average.

Materials and methods

It was a descriptive, cross-sectional study conducted in March 2019 on 344 medical students enrolled in the fourth-year MBBS class of Rawalpindi Medical University. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), physical activity levels by the Global Physical Activity Questionnaire (GPAQ), and academic performance by the marks attained in the most recent pathology class test. The students who could not prepare for the test in the usual manner were excluded from the study. Two-hundred nineteen (219) students were part of the final study sample. Data analysis was performed using SPSS v.22.0 (IBM Corp, Armonk, NY, US). A chi-squared test, independent samples t-test, Pearson’s correlation, and a multiple linear regression model were used to assess the variables.

Results

Sleep quality and physical activity were significantly correlated with academic performance (p-values of the chi-square and t-test were <0.000). Pearson’s correlation coefficient was -0.69 for PSQI (p<0.000) and 0.62 for GPAQ (p 0.003) with test scores. Gender showed significant association with sleep and physical activity levels (male students had better physical activity level and poorer sleep quality than female students) but no association with test scores. Boarding status was significantly associated with all three variables. Boarders had lower mean test scores and poorer sleep and physical activity indices as compared to non-boarders. The multiple linear regression model was valid (p-value of the F test was <0.000), with beta coefficients of -2.53 ( p=0.002) for sleep quality and 1.37 (p=0.01) for physical activity. The R² value was 0.84 (84%).

Conclusions

Our study indicates an overall poor sleep quality and physical activity level among fourth-year medical students, particularly boarding students, who have lower test scores and worse sleep and physical activity levels. In general, male students have better GPAQ scores and female students have better PSQI scores. Both the PSQI and GPAQ scores are significantly correlated with test scores and provide potential target areas to improve the exam performance of the students.

Gender differences in latent classes of sleep quality in community-dwelling adults based on the Pittsburgh sleep quality index

This study investigated the latent classes of sleep quality based on the Pittsburgh Sleep Quality index (PSQI) in Chinese adults, and analyzed whether these latent classes differed between men and women. A total of 982 adults (age: 18-59 years) participated in the questionnaire survey, and the PSQI was used to assess sleep quality. Two latent classes of sleep quality were found in men, and the cut-off value of PSQI for predicting the poor sleep quality group was 6. Four latent classes were found in women, which were named 'good sleep', 'daytime dysfunction', 'inadequate sleep', and 'poor sleep', respectively. In women, the optimal cut-off values of the PSQI for predicting the poor and good sleep quality groups were 9 and 6, respectively. Women who were not included in the 'poor sleep' group but had a score not less than 2 in the 'sleep duration' or 'daytime dysfunction' dimensions of PSQI were classified into the 'inadequate sleep' group or the 'daytime dysfunction' group. The findings may benefit the identification of sleep problems and assist in more effective alleviation of these issues.

More than depression: a multi-dimensional assessment of postpartum distress symptoms before and after a residential early parenting program

INTRODUCTION

Parents are vulnerable to psychological distress symptoms in the postpartum period. It is routine to screen for depressive symptoms, but anxiety, stress, fatigue, irritability and insomnia symptoms are less often assessed despite their prevalence. This study aimed to assess multiple dimensions of psychological distress, and their reliable change and clinically significant change among women admitted to a residential program for assistance with unsettled infant behaviors (UIB).

METHOD

Women admitted to a five-night residential early parenting program completed self-report measures: the Depression Anxiety Stress Scale, Irritability Depression Anxiety Scale, Fatigue Severity Scale, and Insomnia Severity Index. A sub-group completed a computerized emotional Go-NoGo (EGNG) task as a measure of emotional impulsivity.

RESULTS

Seventy-eight women were recruited (Mage = 34.46, SDage = 4.16). On admission, 48% of women reported clinically elevated depressive symptoms and 97.5% of women not reporting elevated depressive symptoms reported clinical elevations in at least one other form of distress. Upon discharge, all self-report distress symptoms were significantly reduced (all p-values <.001), but reliable and clinically significant change only occurred in a subgroup of women. There were no significant changes in indicators of impulsivity based on the EGNG.

CONCLUSIONS

In addition to, and often in the absence of, depressive symptoms, women attending an early parenting program experienced a wide range of psychological distress, including fatigue, insomnia, anxiety and stress. Different forms of distress improved in different magnitudes to the treatment provided. These findings highlight the need for a multi-dimensional approach in the assessment and treatment of postpartum distress.

Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units

BACKGROUND

High noise levels in the intensive care unit (ICU) are a well-known problem. Little is known about the effect of noise on sleep quality in ICU patients. The study aim is to determine the effect of noise on subjective sleep quality.

METHODS

This was a multicenter observational study in six Dutch ICUs. Noise recording equipment was installed in 2-4 rooms per ICU. Adult patients were eligible for the study 48 h after ICU admission and were followed up to maximum of five nights in the ICU. Exclusion criteria were presence of delirium and/or inability to be assessed for sleep quality. Sleep was evaluated using the Richards Campbell Sleep Questionnaire (range 0-100 mm). Noise recordings were used for analysis of various auditory parameters, including the number and duration of restorative periods. Hierarchical mixed model regression analysis was used to determine associations between noise and sleep.

RESULTS

In total, 64 patients (68% male), mean age 63.9 (± 11.7) years and mean Acute Physiology And Chronic Health Evaluation (APACHE) II score 21.1 (± 7.1) were included. Average sleep quality score was 56 ± 24 mm. The mean of the 24-h average sound pressure levels (L_{Aeq, 24h}) was 54.0 dBA (± 2.4). Mixed-effects regression analyses showed that background noise (β = - 0.51, p < 0.05) had a negative impact on sleep quality, whereas number of restorative periods (β = 0.53, p < 0.01) and female sex (β = 1.25, p < 0.01) were weakly but significantly correlated with sleep.

CONCLUSIONS

Noise levels are negatively associated and restorative periods and female gender are positively associated with subjective sleep quality in ICU patients.

TRIAL REGISTRATION

www.ClinicalTrials.gov, NCT01826799 . Registered on 9 April 2013.

Associations between sleep quality and its domains and insufficient physical activity in a large sample of Croatian young adults: a cross-sectional study

OBJECTIVES

The main purpose of the present study was to explore the associations between sleep quality and insufficient physical activity.

DESIGN

Cross-sectional.

SETTING

Faculties in Croatia.

PARTICIPANTS

2100 university students (1049 men and 1051 women) aged 18-24 years were recruited.

PRIMARY OUTCOME

To assess the domains of sleep quality (independent variables) and 'insufficient' physical activity (dependent variable), we used previously validated Pittsburgh Sleep Quality Index and International Physical Activity questionnaires. Logistic regressions were used to calculate the associations between the sleep quality and 'insufficient' physical activity.

RESULTS

When sleep quality domains were entered separately into the model, very bad subjective sleep quality (OR 3.09; 95% CI 1.50 to 6.56), >60 min of sleep latency (OR 2.17; 95% CI 1.39 to 3.39), <7 hours of sleep (OR 1.56; 95% CI 1.24 to 1.96), <65% of habitual sleep efficiency (OR 2.26; 95% CI 1.26 to 4.05), sleep disturbances >1/week (OR 1.61; 95% CI 1.03 to 2.52), use of sleep medication >1/week (OR 3.35; 95% CI 1.83 to 6.10), very big daytime dysfunction problem (OR 2.78; 95% CI 1.57 to 4.93) and poor sleep quality (1.53; 95% CI 1.23 to 1.91) were associated with 'insufficient' physical activity. When all sleep quality domains were entered simultaneously into the model, the same significant associations remained, except for sleep disturbances. Both models were adjusted for gender, body mass index, self-rated health, life satisfaction, socioeconomic status, presence or absence of chronic diseases, smoking status, binge drinking and psychological distress.

CONCLUSIONS

Our results show that 'poor' sleep quality is associated with 'insufficient' physical activity in young adults. In order to improve, special strategies and policies that leverage 'good sleep' quality are warranted.

Quality of Sleep and Depression in College Students: A Systematic Review

Background

Nowadays, sleep-related problems are a prevalent occurrence among university students. Poor sleep quality is one of the most studied aspects of sleep complaints, affecting from 10% to 50% of this population. Poor sleep quality consequences are many and have a profound impact in the student's psychobiological health. University students live through a period of psychological challenge and adaptation, since the transition from high school to professional life. Abrupt autonomy challenges students to deal with many choices, from their academic and social life to their intimate habits. Frequently, sleep hygiene is neglected, or they are unable to use proper coping mechanisms, resulting in disturbing consequences that could impact their lives as adults. Research has found a significant association between sleep quality and depression or depressive symptoms, but this relationship is still somewhat difficult to interpret.

Objective

The objective of this review is to appraise the current knowledge around the relationship of sleep with depression in this group of young adults. Data Source: Articles included in Medline database.

Methods

After a careful search, the articles selected aimed mainly college students. The studies had sleep quality and depression objectively assessed, focused in the relationship between both, and addressed possible influencing factors.

Results

The current literature still supports a bidirectional relationship between sleep and depression, however, the importance of sleep quality is becoming a very relevant variable.

Conclusion

Education and the application of policies regarding sleep hygiene may prevent, in some cases, the development of depression and improve the quality of sleep in other cases. Future research should clarify the relationship between sleep problems and depression in a way they could be prevented or, at least, minimalized with effective and achievable interventions.

Japanese Sleep Questionnaire for Elementary Schoolers (JSQ-ES): validation and population-based score distribution

OBJECTIVE

The Japanese Sleep Questionnaire for Elementary Schoolers (JSQ-ES) was developed to measure the sleep habits and disturbances of Japanese children. The current study aimed to present psychometric properties and describe the score distribution of the JSQ-ES. In addition, it examined correlations between the sleep and daytime behavior of school-aged children.

METHOD

Guardians of 4369 elementary school children and 100 children diagnosed with sleep disorders in two clinics completed the JSQ-ES.

RESULTS

Exploratory factor analysis and confirmatory factor analysis suggested a nine-factor structure. The JSQ-ES internal consistency was 0.876 and 0.907 for the community and clinical groups, respectively. Score distribution differences were observed between the two groups. A cut-off point of 80 was identified for the total JSQ-ES score.

CONCLUSIONS

Exploratory factor analysis and confirmatory factor analysis suggested a nine-factor structure: (1) restless legs syndrome; (2) sleep-disordered breathing; (3) morning symptoms; (4) nighttime awakenings; (5) insomnia; (6) excessive daytime sleepiness; (7) daytime behavior; (8) sleep habits; and (9) irregular/delayed sleep phase. The study verified that the JSQ-ES is a valid and reliable instrument with which to evaluate Japanese sleep habits using a large population-based sample. The JSQ-ES may be useful in both clinical and academic settings.