Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

Association of elevated glycated hemoglobin and obesity with afternoon napping for more than 1 h in young and middle-aged healthy adults

INTRODUCTION

Sleep has different patterns followed worldwide and can be influenced by social, cultural, and environmental factors. Daytime napping is commonly practiced in different parts of the world with controversial results of its effect on glucose metabolism. The current study aims to examine the association of afternoon napping and night sleep duration with metabolic derangements.

METHODS

This is a cross-sectional study involving young adults and middle-aged subjects. Anthropometric measurements were taken for height and weight and hip and waist ratio. Consented subjects were asked to wear actigraphy for 1 week and run their usual daily activities. Home sleep apnea testing was performed to exclude obstructive sleep apnea. Subjects had been asked to come fasting on day seven for blood collection to test for fasting glucose, glycated hemoglobin, lipid profile, and insulin.

RESULTS

A total of 405 subjects were involved to complete the study (52% male, 48% female). The mean age of participants was 32.8 ± 11.5 years. The study indicated that the duration of afternoon napping was significantly associated with abnormal glycated hemoglobin (HbA1c > 5.7%) (p = 0.01) and body mass index (p = 0.046) independent of age, gender, and nocturnal sleep duration. Nocturnal sleep duration was associated with increased insulin level (p = 0.04).

CONCLUSION

Afternoon napping is associated with an increased level of glycated hemoglobin and obesity and that may predispose to the development of type 2 diabetes mellitus.

Insomnia and Related Factors During the Delta Wave of the COVID-19 Pandemic in the Kingdom of Bahrain: A Cross-Sectional Study

PURPOSE

This study aims to estimate the prevalence of insomnia and related risk factors during the Delta wave of the COVID-19 pandemic in the Kingdom of Bahrain.

METHODS

An analytical cross-sectional study included 646 individuals from the general population aged 18 years and over, living in the Kingdom of Bahrain during the Delta wave of the pandemic. Data were collected by an anonymous online questionnaire using the snowball-sampling technique between June and August 2021. We used the Insomnia Severity Index (ISI) and the generalized anxiety disorder scale (GAD-7) to measure the level of insomnia and anxiety, respectively.

RESULTS

A total of 646 individuals participated in the study. Most of the participants were females (86%). The mean age was 38.7 ± 12.7 years (age range 18-89) and around half of the participants were 35 years or older. Clinical insomnia was reported by 20% [95% CI, 16.9-20.0] of the participants, and 50.1% [95% CI, 46.2-50.1] had subclinical insomnia according to ISI. The proportion of insomnia was significantly higher among females, healthcare workers, participants with lower educational levels, a lower or decreased monthly income during the pandemic, or participants who reported anxiety symptoms (all P < 0.01). Scales of anxiety and insomnia revealed a high correlation (r² = 0.347, P< 0.01). The logistic regression model confirmed that factors independently associated with insomnia are female gender (OR=1.94, 95% CI, 1.00-3.76, P < 0.050) as well as presence of anxiety (GAD-7 score ≥ 5) [OR=12.98, 95% CI, 5.61-30.00, P < 0.001].

CONCLUSION

The burden of insomnia was significant among the general population in the Kingdom of Bahrain during the Delta wave of the COVID-19 pandemic despite the low severity of this variant. Mental health programs are a high priority during the pandemic and afterward. Detection of insomnia could be used to treat some mental health problems at an early stage.

COVID-19 Lockdowns: A Worldwide Survey of Circadian Rhythms and Sleep Quality in 3911 Athletes from 49 Countries, with Data-Driven Recommendations

Objective

In a convenience sample of athletes, we conducted a survey of COVID-19-mediated lockdown (termed ‘lockdown’ from this point forward) effects on: (i) circadian rhythms; (ii) sleep; (iii) eating; and (iv) training behaviors.

Methods

In total, 3911 athletes [mean age: 25.1 (range 18–61) years, 1764 female (45%), 2427 team-sport (63%) and 1442 elite (37%) athletes] from 49 countries completed a multilingual cross-sectional survey including the Pittsburgh Sleep Quality Index and Insomnia Severity Index questionnaires, alongside bespoke questions about napping, training, and nutrition behaviors.

Results

Pittsburgh Sleep Quality Index (4.3 ± 2.4 to 5.8 ± 3.1) and Insomnia Severity Index (4.8 ± 4.7 to 7.2 ± 6.4) scores increased from pre- to during lockdown (p < 0.001). Pittsburgh Sleep Quality Index was predominantly influenced by sleep-onset latency (p < 0.001; + 29.8%), sleep efficiency (p < 0.001; − 21.1%), and total sleep time (p < 0.001; − 20.1%), whilst Insomnia Severity Index was affected by sleep-onset latency (p < 0.001; + 21.4%), bedtime (p < 0.001; + 9.4%), and eating after midnight (p < 0.001; + 9.1%). During lockdown, athletes reported fewer training sessions per week (− 29.1%; d = 0.99). Athletes went to bed (+ 75 min; 5.4%; d = 1.14) and woke up (+ 150 min; 34.5%; d = 1.71) later during lockdown with an increased total sleep time (+ 48 min; 10.6%; d = 0.83). Lockdown-mediated circadian disruption had more deleterious effects on the sleep quality of individual-sport athletes compared with team-sport athletes (p < 0.001; d = 0.41), elite compared with non-elite athletes (p = 0.028; d = 0.44) and older compared with younger (p = 0.008; d = 0.46) athletes.

Conclusions

These lockdown-induced behavioral changes reduced sleep quality and increased insomnia in athletes. Data-driven and evidence-based recommendations to counter these include, but are not limited to: (i) early outdoor training; (ii) regular meal scheduling (whilst avoiding meals prior to bedtime and caffeine in the evening) with appropriate composition; (iii) regular bedtimes and wake-up times; and (iv) avoidance of long and/or late naps.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01601-y.

Hericium erinaceus mycelium ameliorate anxiety induced by continuous sleep disturbance in vivo

BACKGROUND

Sleep disruption is a major public health issue and may increase the risk of mortality by ten-folds if an individual is sleeping less than 6 h per night. Sleep has changed dramatically during to the COVID-19 pandemic because COVID symptoms can lead to psychological distress including anxiety. Hericium erinaceus mycelium has been widely investigated in both the in vivo studies and clinical trials for its neuroprotective functions because the mycelium contains hericenones and erinacines, which synthesize the nerve growth factor and brain-derived neurotrophic factor (BDNF). Recent in vivo reports have shown showed that erinacine A-enriched Hericium erinaceus mycelium can modulate BDNF/TrkB/PI3K/Akt/GSK-3β pathways to induce an antidepressant-like effect. A large body of evidence indicates that erinacine can pass the blood-brain barrier and suggests its neuroprotective function in both peripheral and central nervous systems. Thus, Hericium erinaceus mycelium may be a dual-function supplement for sleep disruption improvement while sustaining anxiolytic effects.

METHOD

To simulate the condition of sleep disruption, the mice were subjected to the tail suspension test (TST) for 15 min every day during the same period for nine consecutive days. Two different doses (75 and 150 mg/kg) of Hericium erinaceus mycelium were administered orally 20 min prior to the TSTs before entering the light period of 12:12 h L:D cycle. All sleep-wake recording was recorded for 24 h using electroencephalogram and electromyogram. The elevated-plus-maze and open-field tests were conducted to record the behavior activities.

RESULTS

Consecutive TSTs prior to the light period could cause significant sleep disturbance and anxiety behavior in the elevated-plus-maze experiments. Results showed that administration with Hericium erinaceus mycelium at 150 mg/kg ameliorated the rodent anxiety (p < 0.05) and reversed the TST-induced NREM sleep disturbance in the dark period.

CONCLUSION

This is the first in vivo study suggesting that Hericium erinaceus mycelium has a dual potential role for anxiety relief through improving sleep disruptions.

Does reading a book in bed make a difference to sleep in comparison to not reading a book in bed? The People's Trial-an online, pragmatic, randomised trial

BACKGROUND

The best way of comparing healthcare treatments is through a randomised trial. In a randomised trial, we compare something (a treatment or intervention) to something else, often another treatment. Who gets what is decided at random, meaning everyone has an equal chance of getting any of the treatments. This means any differences found can be put down to the treatment received rather than other things, such as where people live, or health conditions they might have. The People's Trial aimed to help the public better understand randomised trials by inviting them to design and carry out a trial. The question chosen by the public for The People's Trial was: 'Does reading a book in bed make a difference to sleep, in comparison to not reading a book in bed?' This paper describes that trial, called 'The Reading Trial'.

METHODS

The Reading Trial was an online, randomised trial. Members of the public were invited to take part through social media campaigns. People were asked to either read a book in bed before going to sleep (intervention group) or not read a book in bed before going to sleep (control group). We asked everyone to do this for 7 days, after which they measured their sleep quality.

RESULTS

During December 2019, a total of 991 people took part in The Reading Trial, half (496 (50%)) in the intervention group and half (495 (50%)) in the control group. Not everyone finished the trial: 127 (25.6%) people in the intervention group and 90 (18.18%) people in the control group. Of those providing data, 156/369 (42%) people in the intervention group felt their sleep improved, compared to 112/405 (28%) of those in the control group, a difference of 14%. When we consider how certain we are of this finding, we estimate that, in The Reading Trial, sleep improved for between 8 and 22% more people in the intervention group compared to the control group.

CONCLUSIONS

Reading a book in bed before going to sleep improved sleep quality, compared to not reading a book in bed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04185818. Registered on 4 December 2019.

Association between pesticide exposure and sleep health among a representative sample of US adults: evidence from NHANES 2009-2014

BACKGROUND

Data suggest that pesticides interact with the melatonin receptor, which may influence sleep. However, the link between pesticides and sleep remains unexplored among the general adult population. This study evaluated unstratified and sex-stratified associations between urinary pesticide exposure (N = 4,478) and self-reported acute household pesticide exposure (N = 14,956), with sleep health outcomes within a nationally representative sample of US adults.

METHODS

Data from the National Health and Nutrition Examination Surveys (NHANES) 2009-2014 were combined for analysis of aim 1 and aim 2. Urinary pesticide metabolite concentrations served as biomarkers of pesticide exposure. Acute household pesticide exposure (if any chemical products were used in the home in the past seven days to control pests) was self-reported (yes/no). Insufficient sleep duration (< 7 h/night) and trouble sleeping (yes/no) were self-reported. Log-binomial regression models that accounted for complex survey weights and adjusted for confounders were used to compute prevalence ratios and 95% CI.

RESULTS

Log urinary 3-phenoxybenzoic acid (3-PBA) was related to a higher probability of insufficient sleep [1.09 (95% CI: 1.00, 1.20), p = 0.04] and trouble sleeping [1.14 (95% CI: 1.02, 1.27), p = 0.02] among males. Self-reported acute household pesticide exposure was associated with a higher probability of insufficient sleep duration [1.16 (95% CI: 1.02, 1.32), p = 0.03] and trouble sleeping [1.20 (95% CI: 1.01, 1.44), p = 0.04] in the unstratified sample. Sex-stratified findings showed that associations between acute household pesticide exposure and trouble sleeping only persisted  among males [1.69 (95% CI: 1.27, 2.24), p < .001].

CONCLUSIONS

In summary, acute pesticide exposure may be detrimental to adult sleep health, particularly among US males.

Caregiver burden and influencing factors among family caregivers of patients with glioma: A cross-sectional survey

OBJECTIVE

The main responsibility of caring for patients with glioma is assumed by family caregivers who experience a considerable burden during the care process. This study aimed to investigate the level of caregiver burden and explore its associated factors among family caregivers of patients with glioma.

METHODS

We conducted a cross-sectional study among 131 family caregivers of glioma patients from October 2017 to November 2019. We used the following measurement tools: a demographic questionnaire, the Zarit Burden interview (ZBI), the Hamilton anxiety and depression scale, and the family APGAR index. We used multiple linear regression analysis to determine the factors related to caregiver burden.

RESULTS

The ZBI score for the family caregivers of glioma patients was 31.29 (SD = 13.54), and most caregivers (71.7%) reported moderate and severe caregiver burdens. Caregivers' daily sleep time and anxiety symptoms and patients' depressive symptoms independently predicted caregiver burden.

CONCLUSIONS

Family caregivers of glioma patients experienced a moderate burden. Personalised psychological intervention and sleep health guidance for patients and caregivers should be considered to reduce family caregiver burden and enhance the quality of life and mental health of both patients and their caregivers.

Role of sleep deprivation in immune-related disease risk and outcomes

Modern societies are experiencing an increasing trend of reduced sleep duration, with nocturnal sleeping time below the recommended ranges for health. Epidemiological and laboratory studies have demonstrated detrimental effects of sleep deprivation on health. Sleep exerts an immune-supportive function, promoting host defense against infection and inflammatory insults. Sleep deprivation has been associated with alterations of innate and adaptive immune parameters, leading to a chronic inflammatory state and an increased risk for infectious/inflammatory pathologies, including cardiometabolic, neoplastic, autoimmune and neurodegenerative diseases. Here, we review recent advancements on the immune responses to sleep deprivation as evidenced by experimental and epidemiological studies, the pathophysiology, and the role for the sleep deprivation-induced immune changes in increasing the risk for chronic diseases. Gaps in knowledge and methodological pitfalls still remain. Further understanding of the causal relationship between sleep deprivation and immune deregulation would help to identify individuals at risk for disease and to prevent adverse health outcomes.

Health-Related Behaviors and Odds of COVID-19 Hospitalization in a Military Population

INTRODUCTION

Understanding the impact of behaviors on COVID-19 severity can improve health promotion strategies. We investigated the association between health-related behaviors and odds of hospitalization for COVID-19 in a cohort of military personnel.

METHODS

This case-controlled study compared all active-duty US Air Force service members hospitalized for COVID-19 between March 5, 2020, and March 10, 2021 (cases), with their geographically matched peers who had COVID-19 and were treated as outpatients (controls). We used logistic regression to compare cases and controls according to self-reported sleep duration, physical activity, dietary factors, binge alcohol consumption, and tobacco use - with and without adjustment for sociodemographic factors, body mass index, physical fitness level, pertinent disease history, and psychological distress - resulting in crude and adjusted odds ratios (ORs) with 95% CIs. The trend between sugar-sweetened beverage (SSB) consumption and hospitalization odds was assessed by using the Cochran-Armitage test.

RESULTS

Ninety-three hospitalized cases were matched to 372 ambulatory controls. Adjusting for baseline characteristics and other health-related behaviors, cases were more likely than controls to report fewer than 7 hours of sleep, compared with 7 to 9 hours (OR = 1.84; 95% CI, 1.07-3.16), and were more likely than controls to consume 3 or more SSBs per week, compared with fewer than 3 SSBs (OR = 1.74; 95% CI, 1.03-2.92). In a dose-response relationship, higher SSB consumption was associated with greater odds of being hospitalized (P value for trend = .02).

CONCLUSION

Interventions that address short sleep duration and SSB consumption may reduce morbidity from COVID-19 among military service members and potentially in the broader US population.

Strategies for Promotion of a Healthy Lifestyle in Clinical Settings: Pillars of Ideal Cardiovascular Health: A Science Advisory From the American Heart Association

Engagement in healthy lifestyle behaviors is suboptimal. The vast majority of the US population does not meet current recommendations. A healthy lifestyle is defined by consuming a healthy dietary pattern, engaging in regular physical activity, avoiding exposure to tobacco products, habitually attaining adequate amounts of sleep, and managing stress levels. For all these health behaviors there are well-established guidelines; however, promotion in clinical settings can be challenging. It is critical to overcome these challenges because greater promotion of heathy lifestyle practices in clinical settings effectively motivates and initiates patient behavior change. The 5A Model (assess, advise, agree, assist, and arrange) was developed to provide a framework for clinical counseling with requisite attention to the demands of clinical settings. In this science advisory, we present strategies, based on the 5A Model, that clinicians and other health care professionals can use for efficient lifestyle-related behavior change counseling in patients at all levels of cardiovascular disease risk at every visit. In addition, we discuss the underlying role of psychological health and well-being in lifestyle-related behavior change counseling, and how clinicians can leverage health technologies when providing brief patient-centered counseling. Greater attention to healthy lifestyle behaviors during routine clinician visits will contribute to promoting cardiovascular health.

Shift work amongst older UK workers and job exit

BACKGROUND

Night/shift work may be increasing but there are few data about the prevalence amongst older workers. With governments encouraging people to work to older ages, it is important to know how feasible night/shift work is for them and whether there are any adverse health consequences.

AIMS

Amongst current older workers (aged 50-64 years), to explore the prevalence of night/shift working and evaluate its health impacts and sustainability over 4 years of follow-up.

METHODS

Data from the Health and Employment After Fifty cohort were used to describe the demographic, job and health characteristics of men and women undertaking night/shift work. Longitudinal data were used to examine the number and nature of exits annually thereafter.

RESULTS

Amongst the 5409 working at baseline, 32% reported night/shift work in sectors which differed by sex. Night/shift workers were more likely to be: current smokers; doing physically demanding work; struggling to cope at work; dissatisfied with their hours; depressed; sleeping poorly; rating their health poorly. Women whose job involves night work were more likely to exit the workforce over 4 years.

CONCLUSIONS

Almost one in three contemporary UK older workers report night/shift work. We found some evidence of adverse impacts on health, sleep and well-being and higher rates of job exit amongst women. More research is needed but night/shift work may be challenging to sustain for older workers and could have health consequences.

Sleep quality: An evolutionary concept analysis

AIM

To clarify the meaning of the concept sleep quality.

BACKGROUND

Sleep loss and sleep quality are global health concerns. Poor sleep quality has significant adverse health outcomes. A clarification of the term is necessary to inform patients and healthcare providers, promote consistent theoretical and operational definitions in research, and develop prevention and treatment strategies.

DESIGN

Concept analysis.

DATA SOURCES

Scientific literature from electronic databases (CINAHL, PsycINFO, PubMED, Web of Science, and JSTOR) and definitions from online dictionaries.

REVIEW METHODS

Rodgers' Evolutionary method was applied to guide the concept analysis to identify and determine the attributes, antecedents, and consequences.

RESULTS

Sleep quality is defined as an individual's self-satisfaction with all aspects of the sleep experience. Sleep quality has four attributes: sleep efficiency, sleep latency, sleep duration, and wake after sleep onset. Antecedents include physiological (e.g., age, circadian rhythm, body mass index, NREM, REM), psychological (e.g., stress, anxiety, depression), and environmental factors (e.g., room temperature, television/device use), and family/social commitments. Good sleep quality has positive effects such as feeling rested, normal reflexes, and positive relationships. Poor sleep quality consequences include fatigue, irritability, daytime dysfunction, slowed responses, and increased caffeine/alcohol intake.

CONCLUSIONS

Sleep quality is essential, and poor sleep quality contributes to disease and poor health outcomes. Given the extensive consequences of poor sleep quality, nurses and clinicians are vital in instructing the importance of good sleep.

Obesity and sleep disturbances: The "chicken or the egg" question

Obesity and sleep disturbances are common conditions in modern societies and accumulating evidence support a close bidirectional causal relationship between these two conditions. Indeed, from one side sleep loss seems to affect energy intake and expenditure through its direct effects on hormone-mediated sensations of satiety and hunger and through the influence on hedonic and psychological aspects of food consumption. Sleep deprived patients have been shown to experiment excessive daytime sleepiness, fatigue, and tiredness that, in a vicious circle, enhances physical inactivity and weight gain. On the other side, obesity is a well-known risk factor for several sleep disorders. This narrative review will discuss the main pathophysiological mechanisms that link sleep loss to obesity and metabolic syndrome with particular attention to the three most common sleep disorders (insomnia, obstructive sleep apnoea syndrome, restless leg syndrome).

Sleep is essential to health: an American Academy of Sleep Medicine position statement

CITATION

Sleep is a biological necessity, and insufficient sleep and untreated sleep disorders are detrimental for health, well-being, and public safety. Healthy People 2030 includes several sleep-related objectives with the goal to improve health, productivity, well-being, quality of life, and safety by helping people get enough sleep. In addition to adequate sleep duration, healthy sleep requires good quality, appropriate timing, regularity, and the absence of sleep disorders. It is the position of the American Academy of Sleep Medicine (AASM) that sleep is essential to health. There is a significant need for greater emphasis on sleep health in education, clinical practice, inpatient and long-term care, public health promotion, and the workplace. More sleep and circadian research is needed to further elucidate the importance of sleep for public health and the contributions of insufficient sleep to health disparities.

CITATION

Ramar K, Malhotra RK, Carden KA, et al. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2021;17(10):2115-2119.

Incremental health care utilization and expenditures for sleep disorders in the United States

STUDY OBJECTIVES

To determine the incremental increases in health care utilization and expenditures associated with sleep disorders.

METHODS

Adults with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) within the medical conditions file of the 2018 Medical Expenditure Panel Survey medical conditions file were identified. This dataset was then linked to the consolidated expenditures file and comparisons in health care utilization and expenditures were made between those with and without sleep disorders. Multivariate analyses, adjusted for demographics and comorbidities, were conducted for these comparisons.

RESULTS

Overall, 5.6% ± 0.2% of the study population had been diagnosed with a sleep disorder, representing approximately 13.6 ± 0.6 million adults in the United States. Those with sleep disorders were more likely to be non-Hispanic, White, and female, with a higher proportion with public insurance and higher Charlson Comorbidity Scores. Adults with sleep disorders were found to have increased utilization of office visits (16.3 ± 0.8 vs 8.7 ± 0.3, P < .001), emergency room visits (0.52 ± 0.03 vs 0.37 ± 0.02, P < .001), and prescriptions (39.7 ± 1.2 vs 21.9 ± 0.4, P < .001) vs those without sleep disorders. The additional incremental health care expenses for those with sleep disorders were increased in all examined measures: total health care expense ($6,975 ± $800, P < .001), total office-based expenditures ($1,694 ± $277, P < .001), total prescription expenditures ($2,574 ± $364, P < .001), and total self-expenditures for prescriptions ($195 ± $32, P < .001).

CONCLUSIONS

Sleep disorders are associated with significantly higher rates of health care utilization and expenditures. By using the conservative prevalence estimate found in this study, the overall incremental health care costs of sleep disorders in the United States represents approximately $94.9 billion.

CITATION

Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-1986.

Decreased Sleep and Subjective Well-Being as Independent Predictors of Injury in Female Collegiate Volleyball Players

Background:

The relationship among sleep duration, subjective well-being, and injury risk in athletes is poorly defined.

Purpose:

To evaluate the independent effects of sleep duration, sleep quality, and subjective well-being on in-season injuries in collegiate female volleyball athletes.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

During a 9-month competitive season, 17 female National Collegiate Athletic Association (NCAA) Division I volleyball players reported mood, fatigue, stress, soreness, sleep duration (hours), and sleep quality every morning. Well-being measures were recorded from 0 (worst) to 5 (best), and all time-loss injuries were recorded by the team athletic trainer. Separate mixed-effects logistic regression models were used to evaluate the effects of sleep and subjective well-being on in-season injury. Each well-being variable was also included in a separate mixed-effects logistic regression model with sleep duration as a covariate.

Results:

A total of 54 injuries were recorded during the study period. Compared with days without an injury, mood, fatigue, stress, soreness, sleep quality, and sleep duration were significantly worse the day before an injury occurred. In the separate prediction models, in-season injury was significantly predicted by fatigue (odds ratio [OR], 0.56 [95% CI, 0.36-0.86]; P = .008), mood (OR, 0.52 [95% CI, 0.35-0.78]; P = .002), stress (OR, 0.63 [95% CI, 0.42-0.94]; P = .023), soreness (OR, 0.54 [95% CI, 0.38-0.79]; P = .001), sleep quality (OR, 0.49 [95% CI, 0.34-0.7]; P < .001), and sleep duration (OR, 0.69 [95% CI, 0.55-0.87]; P = .001). In the multivariable models, sleep duration remained a significant independent predictor in each of the subsequent multivariable models (OR, 0.72-0.74; P < .05 for all), as did mood (OR, 0.55 [95% CI, 0.36-0.83); P = .005) and soreness (OR, 0.57 [95% CI, 0.39-0.83]; P = .003), while fatigue (OR, 0.65 [95% CI, 0.42-1]; P = .054) and stress (OR, 0.68 [95% CI, 0.45-1]; P = .061) no longer reached statistical significance.

Conclusion:

Increased sleep duration, mood, and decreased soreness were independently associated with a reduced risk of in-season injury in this cohort of female NCAA volleyball players.

The recommended amount of physical activity, sedentary behavior, and sleep duration for healthy Saudis: A joint consensus statement of the Saudi Public Health Authority

BACKGROUND:

The goal of the 24-h Movement Practice Guidelines for Saudi Arabia is to provide policymakers, health-care providers, researchers, sports professionals, and members of the public with recommendations on the duration of time they should spend engaged in physical activity, sedentary behavior, and sleep throughout all age groups.

METHODS:

A modified RAND appropriateness method and the “GRADE-ADOLOPMENT” approach of guideline recommendations were used by a guideline development panel to develop the present recommendations.

RESULTS:

The recommendations were based on the integrated needs of the following age groups: children (0–2 years), preschoolers (3–5 years), children and adolescents (6–17 years), adults (18–64 years), and older adults (≥65 years). The guidelines also include special considerations for sleep duration in the Saudi culture, such as dawn prayer and Ramadan.

CONCLUSIONS:

Several research gaps in physical activity, sedentary behavior, and sleep were identified and highlighted by the guideline development panel for potential future research.

Sleep duration, baseline cardiovascular risk, inflammation and incident cardiovascular mortality in ambulatory U.S. Adults: National health and nutrition examination survey

Introduction

The interplay between sleep duration and inflammation on the baseline and incident cardiovascular (CV) risk is unknown. We sought to evaluate the association between sleep duration, C-reactive protein (CRP), baseline CV risk, and incident CV mortality.

Methods

We used data from the National Health and Nutrition Examination Survey 2005–2010 linked with the cause of death data from the National Center for Health Statistics for adults aged ≥18 years. The associations between self-reported sleep duration and CRP, 10-year atherosclerotic CV disease risk score (ASCVD) and CV mortality were assessed using Linear, Poisson and Cox proportional hazard modeling as appropriate.

Results

There were 17,635 eligible participants with a median age of 46 years (interquartile range [IQR] 31, 63). Among them, 51.3% were women and 46.9% were non-Hispanic Whites. Over a median follow-up of 7.5 years (IQR 6.0, 9.1), 350 CV deaths occurred at an incident rate of 2.7 per 1000-person years (IQR 2.4, 3.0). We observed a U–shaped associations between sleep duration and incident CV mortality rate (P-trend=0.011), sleep duration and 10-year ASCVD risk (P-trend <0.001), as well as sleep duration and CRP (P-trend <0.001). A self-reported sleep duration of 6-7 hours appeared most optimal. We observed that those participants who reported <6 or >7 hours of sleep had higher risk of CV death attributable to inflammation after accounting for confounders.

Conclusions

There was a U-shaped relationship of incident CV mortality, 10-year ASCVD risk, and CRP with sleep duration. These findings suggest an interplay between sleep duration, inflammation, and CV risk.

How sleep can help maximize human potential: The role of leaders

OBJECTIVE

During multi-domain operations (MDO), soldiers need the physical supremacy, cognitive dominance, and emotional resilience to help defend and win our nation's wars. Optimal sleep has been shown to boost physical performance and cognitive processing. This manuscript will discuss how recent advances in sleep science strongly argue for the integration of sleep planning into military operations.

DESIGN

Review article.

METHODS

We reviewed the current understanding of how sleep affects Soldier readiness, how sleep and pain are interrelated, and unique challenges to obtaining adequate sleep in military training environments. We then address solutions that can be implemented by leaders and individuals to manage warfighter fatigue and optimize unit performance.

RESULTS

Since sleep is foundational to soldier health and readiness, improving warfighter fatigue management is a priority for leaders.

CONCLUSION

To succeed in MDO, military personnel require physical supremacy, cognitive dominance, and emotional resilience to fight and win. Sleep science is a rapidly emerging field, and the clear implications for maximizing human performance argue strongly for more deliberate integration into military training and operations. Leaders that incorporate sleep and fatigue management into the planning and execution phases of operations will help facilitate mission priorities and prove a powerful force multiplier.

Estradiol Influences Adenosinergic Signaling and NREM Sleep Need in Adult Female Rats

Gonadal steroids and gender are risk factors for sleep disruptions and insomnia in women. However, the relationship between ovarian steroids and sleep is poorly understood. In rodent models, estradiol (E2) suppresses sleep in females suggesting that E2 may reduce homeostatic sleep need. The current study investigates whether E2 decreases sleep need and the potential mechanisms that govern E2 suppression of sleep. Our previous findings suggest that the median preoptic nucleus (MnPO) is a key nexus for E2 action on sleep. Using behavioral, neurochemical and pharmacological approaches, we tested whether (1) E2 influenced the sleep homeostat and (2) E2 influenced adenosine signaling in the MnPO of adult female rats. In both unrestricted baseline sleep and recovery sleep from 6-hour sleep deprivation, E2 significantly reduced non-rapid eye movement sleep (NREM)-delta power, NREM-Slow Wave Activity (NREM-SWA, 0.5-4.0Hz), and NREM-delta energy suggesting that E2 decreases homeostatic sleep need. However, coordinate with E2-induced changes in physiological markers of homeostatic sleep was a marked increase in MnPO extracellular adenosine (a molecular marker of homeostatic sleep need) during unrestricted and recovery sleep in E2-treated but not oil control animals. While these results seemed contradictory, systemically administered E2 blocked the ability of CGS-21680 (adenosine A2A receptor agonist) microinjected into the MnPO to increase NREM sleep suggesting that E2 may block adenosine signaling. Together, these findings provide evidence that E2 may attenuate the local effects of the A2A receptors in the MnPO which in turn may underlie estrogenic suppression of sleep behavior as well as changes in homeostatic sleep need.

Clamping Cortisol and Testosterone Mitigates the Development of Insulin Resistance during Sleep Restriction in Men

CONTEXT

Sleep loss in men increases cortisol and decreases testosterone, and sleep restriction by 3 to 4 hours/night induces insulin resistance.

OBJECTIVE

We clamped cortisol and testosterone and determined the effect on insulin resistance.

METHODS

This was a randomized double-blind, in-laboratory crossover study in which 34 healthy young men underwent 4 nights of sleep restriction of 4 hours/night under 2 treatment conditions in random order: dual hormone clamp (cortisol and testosterone fixed), or matching placebo (cortisol and testosterone not fixed). Fasting blood samples, and an additional 23 samples for a 3-hour oral glucose tolerance test (OGTT), were collected before and after sleep restriction under both treatment conditions. Cytokines and hormones were measured from the fasting samples. Overall insulin sensitivity was determined from the OGTT by combining complementary measures: homeostasis model assessment of insulin resistance of the fasting state; Matsuda index of the absorptive state; and minimal model of both fasting and absorptive states.

RESULTS

Sleep restriction alone induced hyperinsulinemia, hyperglycemia, and overall insulin resistance (P < 0.001 for each). Clamping cortisol and testosterone alleviated the development of overall insulin resistance (P = 0.046) and hyperinsulinemia (P = 0.014) by 50%. Interleukin-6, high-sensitivity C-reactive protein, peptide YY, and ghrelin did not change, whereas tumor necrosis factor-α and leptin changed in directions that would have mitigated insulin resistance with sleep restriction alone.

CONCLUSION

Fixing cortisol-testosterone exposure mitigates the development of insulin resistance and hyperinsulinemia, but not hyperglycemia, from sustained sleep restriction in men. The interplay between cortisol and testosterone may be important as a mechanism by which sleep restriction impairs metabolic health.

What are the biopsychosocial risk factors associated with pain in postpartum runners? Development of a clinical decision tool

Background

In 2019, a majority of runners participating in running events were female and 49% were of childbearing age. Studies have reported that women are initiating or returning to running after childbirth with up to 35% reporting pain. There are no studies exploring running-related pain or risk factors for this pain after childbirth in runners. Postpartum runners have a variety of biomechanical, musculoskeletal, and physiologic impairments from which to recover from when returning to high impact sports like running, which could influence initiating or returning to running. Therefore, the purpose of this study was to identify risk factors associated with running-related pain in postpartum runners with and without pain. This study also aimed to understand the compounding effects of multiple associative risk factors by developing a clinical decision tool to identify postpartum runners at higher risk for pain.

Methods

Postpartum runners with at least one child ≤36 months who ran once a week and postpartum runners unable to run because of pain, but identified as runners, were surveyed. Running variables (mileage, time to first postpartum run), postpartum variables (delivery type, breastfeeding, incontinence, sleep, fatigue, depression), and demographic information were collected. Risk factors for running-related pain were analyzed in bivariate regression models. Variables meeting criteria (P<0.15) were entered into a multivariate logistic regression model to create a clinical decision tool. The tool identified compounding factors that increased the probability of having running-related pain after childbirth.

Results

Analyses included 538 postpartum runners; 176 (32.7%) reporting running-related pain. Eleven variables were included in the multivariate model with six retained in the clinical decision tool: runner type-novice (OR 3.51; 95% CI 1.65, 7.48), postpartum accumulated fatigue score of >19 (OR 2.48; 95% CI 1.44, 4.28), previous running injury (OR 1.95; 95% CI 1.31, 2.91), vaginal delivery (OR 1.63; 95% CI 1.06, 2.50), incontinence (OR 1.95; 95% CI 1.31, 2.84) and <6.8 hours of sleep on average per night (OR 1.89; 95% CI 1.28, 2.78). Having ≥ 4 risk factors increased the probability of having running-related pain to 61.2%.

Conclusion

The results of this study provide a deeper understanding of the risk factors for running-related pain in postpartum runners. With this information, clinicians can monitor and educate postpartum runners initiating or returning to running. Education could include details of risk factors, combinations of factors for pain and strategies to mitigate risks. Coaches can adapt running workload accounting for fatigue and sleep fluctuations to optimize recovery and performance. Future longitudinal studies that follow asymptomatic postpartum women returning to running after childbirth over time should be performed to validate these findings.

Features of age-related response to sleep deprivation: in vivo experimental studies

Insomnia is currently considered one of the potential triggers of accelerated aging. The frequency of registered sleep-wake cycle complaints increases with age and correlates with the quality of life of elderly people. Nevertheless, whether insomnia is actually an age-associated process or whether it acts as an independent stress-factor that activates pathological processes, remains controversial. In this study, we analyzed the effects of long-term sleep deprivation modeling on the locomotor and orienting-exploratory activity, spatial learning abilities and working memory of C57BL/6 female mice of different ages. We also evaluated the modeled stress influence on morphological changes in brain tissue, the functional activity of the mitochondrial apparatus of nerve cells, and the level of DNA methylation and mRNA expression levels of the transcription factor HIF-1α (Hif1) and age-associated molecular marker PLIN2. Our findings point to the age-related adaptive capacity of female mice to the long-term sleep deprivation influence. For young (1.5 months) mice, the modeled sleep deprivation acts as a stress factor leading to weight loss against the background of increased food intake, the activation of animals' locomotor and exploratory activity, their mnestic functions, and molecular and cellular adaptive processes ensuring animal resistance both to stress and risk of accelerated aging development. Sleep deprivation in adult (7-9 months) mice is accompanied by an increase in body weight against the background of active food intake, increased locomotor and exploratory activity, gross disturbances in mnestic functions, and decreased adaptive capacity of brain cells, that potentially increasing the risk of pathological reactions and neurodegenerative processes.

Joint consensus statement of the Saudi Public Health Authority on the recommended amount of physical activity, sedentary behavior, and sleep duration for healthy Saudis: Background, methodology, and discussion

The Saudi Public Health Authority recently prepared a Consensus Statement regarding how much time a person should spend engaged in physical activity, sedentary behavior, and sleep to promote optimal health across all age groups. This paper describes the background literature, methodology, and modified RAND Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach that guided the development process. A Leadership Group and Consensus Panels were formed, and credible existing guidelines were identified. The Panel identified clear criteria to choose the best practice guidelines for the set objectives after evaluation, based on GRADE table evidence, findings table summaries, and draft recommendations. Updating of the selected practice guidelines was performed, and the Consensus Panels separately reviewed the evidence for each behavior and decided to adopt or adapt the selected practice guideline recommendations or create de novo recommendations. Data related to cultural factors that may affect the studied behaviors, such as prayer times, midday napping or "Qailulah," and the holy month of Ramadan, were also reviewed. Two rounds of voting were conducted to reach a consensus for each behavior.

Associations between sleep duration, shift work, and infectious illness in the United States: Data from the National Health Interview Survey

OBJECTIVE

Insufficient sleep and circadian disruption have been linked to immune system dysregulation. The aim of this study was to examine the associations between self-reported sleep duration and work schedule with reports of head and chest colds among adults 18 years and older in the United States.

METHODS

Associations between self-reported habitual sleep duration and work schedule (regular daytime, regular evening, regular nighttime, rotating, other) with reports head and chest colds in the past 2 weeks were examined using data from the 2010 and 2015 National Health Interview Survey. Adults who slept 7-8 hours or reported a regular daytime work schedule were considered the reference group. Multivariate logistic regressions, incorporating sampling weights, were computed adjusting for sociodemographic and health characteristics.

RESULTS

Analyses revealed in fully adjusted models that compared to 7- 8 hours sleepers, those sleeping 5 or fewer hours were 44% more likely to report a cold (odds ratio [OR] = 1.44, 95% confidence interval [CI] 1.29-1.61) while those sleeping 9 or more hours were 20% more likely (OR = 1.20, 95% CI 1.06-1.36). Participants who reported a rotating work schedule were 20% more likely to report a cold (OR = 1.20, 95% CI 1.07-1.36) than those reporting a regular daytime work schedule.

CONCLUSIONS

Short and long sleep duration, as well as a rotating shift work schedule, were associated with increased reports of head and chest colds in a nationally representative sample of US adults. Sleep and circadian function may serve as relevant targets to reduce susceptibility to infectious illness.

Setting Objective Clinical Assessment Tools for Circadian Rhythm Sleep-Wake Disorders - A Community-Based Cross-Sectional Epidemiological Study

INTRODUCTION

Circadian rhythm sleep-wake disorder (CRSWD) is an often-misdiagnosed group of sleep disturbances with limited data concerning diagnostic and therapeutic algorithms in the general population. Therefore, reported prevalence varies in the literature due to different case definitions, methodological, and environmental factors.

OBJECTIVES

The purpose of our cross-sectional study was to estimate the prevalence of CRSWD in the general population of Cyprus and to suggest clinical parameters for the assessment of atypical sleep schedules. The estimation was carried out by introducing normal preset sleep time limits, according to the imposed local environment and by administering well-established questionnaires for symptoms and consequence dysfunction, as objective evaluation tools.

METHODS

In a nationwide epidemiological survey, 4118 Cypriot adult participants, selected and stratified to represent the general population, were interviewed on sleep habits and complaints by computer-assisted telephone interviewing (CATI). In the second stage, 250 adults were randomly selected from the initial representative sample, for a CRSWD assessment. According to the proposed diagnostic criteria, patients were interviewed about sleepiness and/or insomnia, and daytime dysfunction (fatigue, anxiety, and depression). They were also assessed by a weekly sleep diary for sleep schedules. Finally, all participants underwent a Type III Sleep Study, to rule out obstructive sleep apnea.

RESULTS

From 195 enrolled participants (response rate 78%), 25 individuals (12.8%) met the criteria for CRSWD. The two most prevalent disorders were delayed sleep-wake phase disorder (DSWPD) (10pts, 5.1%) and shift work sleep disorder (SWD) (13, 6.7%). Less prevalent disorders included irregular sleep-wake rhythm disorder (ISWRD) (1, 0.5%) and advanced sleep-wake phase disorder (ASWPD) (1, 0.5%).

CONCLUSIONS

According to our data, CRSWDs are common in the general population of Cyprus, especially DSWPD and SWD. Affected individuals usually suffer from sleep deprivation and complain about insomnia, sleepiness and depression.

The effects of Ramadan intermittent fasting on sleep-wake behaviour and daytime sleepiness in team sport referees

The aim of the present study was to evaluate the impact of Ramadan fasting on sleep quality and daytime sleepiness in team sport referees. Seventy-eight male amateur team sport referees (age: 31.1 ± 10.8 years) participated in this study. Participants responded to the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth sleepiness scale (ESS) questionnaires before (10-days prior) and during (last 7-days) the month of Ramadan.PSQI and ESS scores increased significantly during Ramadan (both p < .001, ES = 0.56 and 0.54, respectively) with 83.3% of participants scoring ≥5 in the PSQI. The percentage of participants suffering from severe excessive daytime sleepiness (ESS score ≥ 16) was 3.8% before vs. 7.7% during Ramadan (p < 0.001). Sleep duration decreased by ~ 1 h during Ramadan (p < .001, ES = 0.61) and was associated with a delay in bedtime of ~ 2 h (p < 0.001, ES = 0.7) and of wake-up time of ~ 1 h (p < 0.001, ES = 0.5). The score for daytime dysfunction and subjective sleep perception, as components of the PSQI, increased (both p < 0.001; ES = 0.79, ES = 0.57, respectively), whereas the score for the use of sleep medication decreased during vs. before Ramadan (p = 0.041, ES = 0.47). Ramadan fasting impaired sleep quality and increased daytime sleepiness in team sport referees. Future studies, using objective assessment tools, are warranted.

Review of the Efficacy and Safety of Lemborexant, a Dual Receptor Orexin Antagonist (DORA), in the Treatment of Adults With Insomnia Disorder

OBJECTIVE

To provide an overview of the efficacy and safety of lemborexant in the treatment of insomnia disorder by assessing the currently available literature.

DATA SOURCES

A literature search of PubMed was performed (2010 to March 2021) using the following search terms: lemborexant, sleep, orexin.

STUDY SELECTION AND DATA EXTRACTION

All relevant English-language studies were reviewed and considered, with a focus on phase 3 trials.

DATA SYNTHESIS

The efficacy and safety of lemborexant in the treatment of insomnia disorder in adults was demonstrated in 2 phase 3 trials. Lemborexant significantly reduced latency to persistent sleep compared with placebo. The first study also demonstrated a significant reduction compared with the active control zolpidem ER. Somnolence and headache were relatively common, but the marked adverse effects associated with other medications commonly used to treat insomnia, such as cognitive and psychomotor impairment and complex sleep-related behaviors, were not observed.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE

Although nonpharmacological therapy is considered first-line treatment for insomnia disorder, pharmacological treatment is most commonly utilized. Lemborexant is a viable pharmacological treatment option for patients who are unable to tolerate the adverse effects associated with the most commonly prescribed medications for insomnia, such as benzodiazepines and sedative-hypnotics (Z drugs). This is especially true for geriatric patients, who may be more sensitive to these adverse effects.

CONCLUSION

Lemborexant can be recommended to treat insomnia disorder when pharmacological treatment is warranted. It has demonstrated efficacy in clinical trials and is likely better tolerated than most currently available treatment options.

A systematic review of patient-reported outcome measures used to assess sleep in postpartum women using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines

STUDY OBJECTIVES

We performed a systematic review to identify the best patient-reported outcome measure (PROM) of postpartum sleep in women.

METHODS

We searched 4 databases for validated PROMs used to assess postpartum sleep. Studies were considered if they evaluated at least 1 psychometric measurement property of a PROM. An overall rating was assigned for each psychometric measurement property of each PROM based upon COSMIN criteria. A modified GRADE approach was used to assess the level of evidence and recommendations were then made for each PROM.

RESULTS

We identified 15 validation studies of 8 PROMs, in 9,070 postpartum women. An adequate number of sleep domains was assessed by 5 PROMs: Bergen Insomnia Scale (BIS), Pittsburgh Sleep Quality Index (PSQI), General Sleep Disturbance Scale (GSDS), Athens Insomnia Scale (AIS) and the Sleep Symptom Checklist (SSC). BIS and GSDS were the only PROMs to demonstrate adequate content validity and at least a low level of evidence of sufficient internal consistency, resulting in Class A recommendations. The BIS was the only PROM, which is easily accessible and free to use for non-commercial research, that achieved a Class A recommendation.

CONCLUSION

The BIS is the best currently available PROM of postpartum sleep. However, this PROM fails to assess several important domains such as sleep duration (and efficiency), chronotype, sleep-disordered breathing and medication usage. Future studies should focus on evaluating the psychometric measurement properties of BIS in the North American setting and in different cultural groups, or to develop a more specific PROM of postpartum sleep.

Association of sleep duration with mental health: results from a Spanish general population survey

PURPOSE

The purpose of the present study was to evaluate the association of sleep duration and mental health among the general population.

METHODS

A cross-sectional study was carried out with an adult Spanish population sample between 16 and 64 years old. The information was obtained from data provided by a randomly selected representative sample of 505 adults stratified by age, sex, and geographic area. Participants were interviewed face-to-face in their respective households with questions including sociodemographic characteristics, lifestyle, sleep duration, and the 12-item General Health Questionnaire to screen risk for poor mental health. The duration of sleep hours were grouped into the following categories: < 6 h, 6-7 h, and, > 7 h. Regression analysis was used to assess associations between sleep duration and risk of poor mental health.

RESULTS

A percentage of respondents 13.1% reported sleeping less than 6 h. The analysis demonstrated a significant (p = 0.001) negative (B = - 0.512) relationship between hours of sleep and risk of poor mental health (GHQ-12), demonstrating that reduced sleep duration increases the risk of poor mental health.

CONCLUSIONS

Sleep duration lower than 6 h is prevalent among the general population in Spain, especially among women and people who frequently use electronic devices. The results show that people who experience shorter sleep duration face a greater risk of poor mental health. These findings suggest that it is important to raise awareness of healthy sleeping habits, with emphasis on adequate sleep duration.

Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes

STUDY OBJECTIVES

The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7 - 14 days in young adults with type 1 diabetes (T1D). Additionally, person level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined.

METHODS

In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring (CGM) over 6-14 days. At baseline, participants completed a psychomotor vigilance test (PVT), Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries.

RESULTS

Forty-six participants (mean age 22.3 ± 3.2 years) wore a wrist actigraph and CGM concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences) (r = 0.33, p = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences) (r = 0.50, p = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for T1D duration (p > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, p = .010, pr² = .40) after controlling for T1D duration and accounting for higher daytime sleepiness.

CONCLUSIONS

Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with T1D. Sleep habits in this population may explain higher glucose variability and optimizing sleep may improve overall diabetes management.

Sleep and Performance during a Preseason in Elite Rugby Union Athletes

Background: Preseason training optimises adaptations in the physical qualities required in rugby union athletes. Sleep can be compromised during periods of intensified training. Therefore, we investigated the relationship between sleep quantity and changes in physical performance over a preseason phase in professional rugby union athletes. Methods: Twenty-nine professional rugby union athletes (Mean ± SD, age: 23 ± 3 years) had their sleep duration monitored for 3 weeks using wrist actigraphy. Strength and speed were assessed at baseline and at week 3. Aerobic capacity and body composition were assessed at baseline, at week 3 and at week 5. Participants were stratified into 2 groups for analysis: <7 h 30 min sleep per night (LOW, n = 15) and >7 h 30 min sleep per night (HIGH, n = 14). Results: A significant group x time interaction was determined for aerobic capacity (p = 0.02, d = 1.25) at week 3 and for skinfolds at week 3 (p < 0.01, d = 0.58) and at week 5 (p = 0.02, d = 0.92), in favour of the HIGH sleep group. No differences were evident between groups for strength or speed measures (p ≥ 0.05). Conclusion: This study highlights that longer sleep duration during the preseason may assist in enhancing physical qualities including aerobic capacity and body composition in elite rugby union athletes.

The Children's Sleep Habits Questionnaire: Identification of sleep dimensions, normative values, and associations with behavioral problems in Italian preschoolers

OBJECTIVE

To study the use of the Children's Sleep Habits Questionnaire (CSHQ) to evaluate sleep problems dimensions, norm values, and association of sleep problems with behavioral problems in Italian preschoolers.

DESIGN

Sleep dimensions in CSHQ were investigated via parallel and principal component analyses, norm and at-risk values were investigated by exploring the association between CSHQ and the CBCL sleep problems scale, and bivariate associations between CSHQ and internalizing and externalizing behavioral problems were computed.

PARTICIPANTS

A total of 725 mothers of preschool children (mean age = 4.59 years; SD = 0.97 years; range: 3-6 years) from 10 kindergartens in Central Italy.

MEASUREMENTS

CSHQ together with the Child Behavior Checklist 1 ½-5 (CBCL).

RESULTS

The analyses suggested the existence of 7 sleep dimensions, which were meaningfully interpretable. The CSHQ total score had good internal consistency and showed strong associations with the sleep problems scale of the CBCL. Children scoring in the normative range of the CBCL sleep problems scale had a mean value at the CSHQ total score of 47.03 (6.42), children scoring in the borderline and clinical range (4.4%) of 57.13 (5.11). Moderate associations were found between CSHQ total score and internalizing and CBCL externalizing behavioral problems.

CONCLUSIONS

CSHQ values were higher than those reported in other countries and with school-age children, but only a small number of children belonged to the at-risk group based on CBCL norms for the sleep problems scale. CSHQ moderately and comparably correlated with internalizing and externalizing problems. The CSHQ is a meaningful tool for the investigation of sleep problems in Italian preschoolers. Given the heterogeneity of item frequencies at a dimension level, considering scores along items and dimensions might be more informative at a clinical and applied level.

The influence of TCM constitutions and neurocognitive function in elderly Macau individuals

BACKGROUND

Traditional Chinese medicine (TCM) constitution contributes to predicating disease occurrence and pathological progress. In this study, we investigate the correlation between TCM constitution and neurocognitive function in elderly Macau individuals.

METHODS

A total of 313 older adults from elderly healthcare centers were recruited at random. The data of gender, age, education, sleeping hours, physical activities were collected, and the Geriatric Depression Scale, Hong Kong version of the Montreal Cognitive Assessment (MoCA) and categories of TCM constitution were administered.

RESULTS

Of the 313 elderly individuals enrolled in this study, 86 (27.48%) were of balanced constitution. Among the other categories of TCM constitution, the most was Yin-deficiency (23.32%), followed by 53 (16.93%) with Phlegm-dampness. The average neurocognitive score of all elderly individuals was 18.01 ± 6.25. After adjusting for all possible confounds, multiple linear regression analysis showed that Qi-depressed constitution and neurocognitive scores were negatively correlated (β = - 2.66, 95%CI - 4.99 ~ - 0.33), Meanwhile, Yin-deficient constitution and neurocognitive scores were negatively correlated (β = - 2.10, 95%CI - 3.73 ~ - 0.47). Compared with balanced constitution, Qi-depressed constitution mainly affected visual-spatial ability dimension (β = - 0.91, 95%CI - 1.54 ~ - 0.28) and naming dimension (β = - 0.64, 95%CI - 1.04 ~ - 0.25), Yin-deficient constitution mainly affected visual space dimension (β = - 0.53, 95%CI - 0.97 ~ - 0.08).

CONCLUSION

Qi-depressed and Yin-deficient constitutions are associated with and contributed to the decline of neurocognitive function in senior adults, especially visual-spatial ability and naming dimensions. Further investigations into how TCM constitutions interact with neurocognitive function are needed.

Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial

Manipulations to slow biological aging and extend healthspan are of interest given the societal and healthcare costs of our aging population. Herein we report on a randomized controlled clinical trial conducted among 43 healthy adult males between the ages of 50-72. The 8-week treatment program included diet, sleep, exercise and relaxation guidance, and supplemental probiotics and phytonutrients. The control group received no intervention. Genome-wide DNA methylation analysis was conducted on saliva samples using the Illumina Methylation Epic Array and DNAmAge was calculated using the online Horvath DNAmAge clock (2013). The diet and lifestyle treatment was associated with a 3.23 years decrease in DNAmAge compared with controls (p=0.018). DNAmAge of those in the treatment group decreased by an average 1.96 years by the end of the program compared to the same individuals at the beginning with a strong trend towards significance (p=0.066). Changes in blood biomarkers were significant for mean serum 5-methyltetrahydrofolate (+15%, p=0.004) and mean triglycerides (-25%, p=0.009). To our knowledge, this is the first randomized controlled study to suggest that specific diet and lifestyle interventions may reverse Horvath DNAmAge (2013) epigenetic aging in healthy adult males. Larger-scale and longer duration clinical trials are needed to confirm these findings, as well as investigation in other human populations.

Sleep Duration and Quality in Relation to Fruit and Vegetable Intake of US Young Adults: a Secondary Analysis

BACKGROUND

Sleep is gaining recognition as a determinant of diet, yet this relationship remains understudied among young adults. We sought to examine how sleep duration and quality were related to fruit and vegetable (FV) intake within a diverse sample of young adults.

METHODS

Participants (n = 1444) ages 21-30 (69% women, 15% African American, 35% full or part time in college) consuming < 5 servings/day of FV (eligibility criteria) completed a baseline survey to enroll in a randomized online FV intervention. Sleep questions included duration, perceived sleep quality, time to fall asleep, and insomnia symptoms. Overall and gender-stratified linear regression models compared average daily FV intake and sleep characteristics, adjusting for confounders.

RESULTS

One-third (32%) of the participants reported < 7 h of sleep per night, and 36% noted insomnia symptoms ≥ 3 times per week. Women, a BMI > 30, African American race/ethnicity, less education, unemployment, higher depression, and stress were related to suboptimal sleep. Bivariate analyses showed that better sleep was associated with higher FV intake. After accounting for confounders, men with better sleep quality and shorter time to fall asleep had higher intakes of FV (1.12 serving/day difference in highest versus lowest quality [95% CI 0.48, 1.75] and a 0.52 serving/day higher intake difference for shortest versus longest fall asleep time [95% CI 0.90, 0.15], respectively).

CONCLUSION

Sleep was highly prevalent in a diverse sample of community-based young adults and may contribute to lower FV intake among men. These associations highlight young adulthood as an important period for promoting healthy sleep habits.

[Sleep characteristics of a population of patients seeking bariatric surgery]

INTRODUCTION

Investigation for obstructive sleep apnea syndrome (OSAS) is mandatory before bariatric surgery. Data regarding chronic insomnia and chronic sleep deprivation are scarce in this population.

METHODS

A cross-sectional study assessing the prevalence of chronic insomnia, OSAS and chronic sleep privation in an obese population referred for bariatric surgery.

RESULTS

In all, 88 patients (74% women, median age 41 [33.5-50] years and median body mass index 42 [39.2-45.7] kg/m²) were included. The prevalence of chronic insomnia was 31% in the 87% suffering from OSAS that required continuous positive airway pressure therapy. Comorbid insomnia and sleep apnoea (COMISA) were found in 27% of our population. Chronic insomnia was associated with a lower quality of life (median EQ5D analogue visual scale: 60 [50-70] P=0.04) and a poor sleep quality (median Pittsburgh sleep quality index (PSQI): 8 (6-11 P<0.01) The deleterious combination of sleep privation and insomnia had a higher impact in terms of impairment of quality of life and sleep quality (median EQ5D analogue visual scale: 50 [40-65] P=0.02 et median PSQI: 11 [9-14, P<0.01) CONCLUSION: Chronic insomnia and sleep privation have synergistic deleterious effects in candidates for bariatric surgery. Further studies need to be conducted to evaluate the evolution after surgery.

Bidirectional relationship between sleep and sedentary behavior in adults with overweight or obesity: A secondary analysis

Study Objectives

The relationships between daytime sedentary behavior and that night’s sleep and sleep and next day’s sedentary behavior are unknown. The purpose of this analysis was to examine these potentially bidirectional associations.

Methods

This study was a secondary analysis of baseline data from an ecological momentary assessment study to determine the triggers for dietary lapses during a weight loss intervention. Sedentary behavior, physical activity, and sleep were objectively measured using accelerometers. Linear mixed modeling was used to examine the bidirectional multivariate associations between activity and sleep characteristics for each outcome examined separately. The models included sex, age, body mass index (BMI), education, and day of the week (weekday vs. weekend).

Results

Participants were predominantly white (81.5%) and female (88.9%) with a mean age of 51.2 ± 10.6 years. Longer previous night’s total sleep time (TST) (b = −0.320, standard error [SE] = 0.060; p < .001) and being a weekend (b = −63.845, SE = 9.406; p < .001) were associated with less sedentary time the next day. More daytime sedentary time was associated with less wake after sleep onset (b = −0.018, SE = 0.008; p = .016), fewer awakenings (b = −0.010, SE = 0.004; p = .016), and less TST (b = −0.060, SE = 0.028; p = .029) that night.

Conclusions

The bidirectional relationships between sedentary time and sleep characteristics are complex and may vary depending on participant characteristics and duration of sedentary and sleep time. Interventions to decrease sedentary behavior may benefit by targeting sleep duration and weekday activity.

New frontiers in pharmacologic obstructive sleep apnea treatment: A narrative review

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing characterized by intermittent partial or complete closure of the upper airway during sleep. If left untreated, OSA is associated with adverse cardiovascular outcomes such as hypertension, coronary heart disease, heart failure, cardiac arrhythmia, stroke, and death. Positive airway pressure (PAP) is often considered the first-line treatment for OSA. While PAP can be very effective in reducing the number of obstructive apneas and hypopneas, its impact on prevention of adverse cardiovascular consequences remains controversial, and treatment adherence is often poor. Hence, the necessity for novel treatment options to help those who cannot adhere to positive airway pressure treatment. Different classes of medications have been tested with regards to their effect on OSA severity. This review 1) provides an update on the epidemiology and pathophysiology of OSA, 2) outlines the mechanistic rationale for medication classes tested as OSA treatment and 3) discusses the effects of these medications on OSA. Several wake-promoting medications are approved for management of persistent sleepiness despite OSA treatment; discussion of these symptomatic treatments is outside the scope of this review. Herein, the authors review the current evidence for pharmacological management of OSA and provide future directions.

The Impact of Self-Reported Sleep Quantity on Perceived Decision-Making in Sports Officials During a Competitive Season

Objectives: While sleep research in athletes is extensive, no research has investigated sleep in sports officials during a competitive season. This study explored the (a) self-reported quantity and quality of sleep obtained by sports officials according to the time of competition (day or evening) and (b) impact of reduced sleep on perceived decision-making ability. Design: Sports officials (n = 371) from various sporting codes completed an online questionnaire that evaluated self-reported sleep quantity and quality on habitual nights, before competition, and after competition, as well as perceived decision-making constructs. Results: With sleep restriction defined as less than 7 h of sleep, mixed-effects logistic regression revealed that the estimated probability of reporting reduced sleep quantity increased (p< .05) on habitual nights (0.58), before competition (0.48), and after competition (0.56). The estimated probability of reporting poor sleep quality was 0.01-0.04 across all nights. When considering time of competition (day or evening), reduced sleep quantity was experienced after evening competition (odds ratio [OR] = 3.33, p < .05), while poorer sleep quality (p< .05) was experienced following day (OR = 2.1) and evening (OR = 12.46) competition compared to habitual nights. Furthermore, the impact of reduced sleep on perceived decision-making constructs was negative, with the estimated probability of reporting impaired perceived decision-making between 0.13 and 0.21. Conclusion: Overall, sports officials are vulnerable to reduced quantity and quality of sleep before and after competition, with impaired perceived decision-making ability following nights of less than average sleep.

What Factors Influence the Sleep of On-call Workers?

Objective: On-call work is becoming increasingly common in response to service demands. This study had two aims; 1) describe the demographic profile of on-call workers in Australia, and 2) establish the impacts of on-call work on workers' sleep. Methods: A cross-sectional study was conducted using an online questionnaire completed by Australian on-call workers (n = 228) from various professions. The questionnaire included items on i) demographic and work characteristics, ii) rumination about on-call factors, iii) sleep quantity and quality. Analyses were conducted using mixed effects ordinal regression and multivariable logistic regression. Results: Workers slept <7 hours per night when on-call (80%), and reported sleep was impacted on-call even when no-calls were received (56%). On-call workers rated interruptions to family/leisure time (70%), missing a call (69%), preplanning in case of a call (69%), and not able to make plans (67%) as the main factors they ruminated about. Female on-call workers were more likely to think about the likelihood of being called, report frequent thoughts about what they would need to do if called, and think about interruptions to family/leisure time as a result of a call. Younger workers were more likely to think about the likelihood of being called compared to older adults, however middle-aged workers were less likely to plan for a call compared to younger workers. Conclusions: This study is the first to describe Australia's on-call population, including factors that specifically impact sleep. Future studies should implement tailored education and support strategies to address the unique challenges facing on-call workers.

Subjective cognitive impairment in patients with transformed migraine and the associated psychological and sleep disturbances

PURPOSE

Migraines are associated with multiple comorbidities like depression, anxiety, poor sleep quality, and subjective cognitive impairment (SCI). This study aimed to evaluate the association of SCI with depression, anxiety, and modalities of sleep in those who have transformed migraines (TM).

SUBJECTS AND METHODS

The study was conducted on 120 participants with TM and 41 control group participants. The subjective cognitive decline questionnaire classified the participants as SCI and non-SCI. The Headache Impact Test-6, Migraine Disability Assessment, Montreal Cognitive Assessment, Mini-Mental State Examination, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Full Polysomnography, and Beck's Anxiety and the Depression Inventories were used and analyzed between patients with SCI and non-SCI.

RESULTS

Patients with TM who had SCI represented 34% with severe headache effects, disability, pain severity, increased depression, and increased anxiety. They showed shorter sleep duration during weekdays, lower sleep quality, less sleep time, lower efficiency, and less REM sleep along with greater sleep latency, periodic limb movements, a higher arousal index, snore index, and percent of NREM3. There was a positive correlation between certain polysomnography parameters like percent NREM3, sleep period, sleep index, sleep latency, sleep arousal index, and periodic limb movements, and an inverse correlation with the percent of REM sleep, total sleep time, and sleep efficiency.

CONCLUSION

Subjective cognitive complaints are common in patients with transformed migraine affecting about 34% of cases. TM patients with SCI had more sleep and psychological disturbances.

TRIAL REGISTRATION

Clinicaltrials.gov is NCT04413110.

The effect of phototherapy on sleep during acute rehabilitation after traumatic brain injury: a randomized controlled trial

Objective: To examine the impact of bright white light (BWL) exposure on sleep quality in persons with recent traumatic brain injury (TBI).Design: Randomized, controlled device-sham studySetting: 3 TBI Model System inpatient rehabilitation unitsParticipants: 131 participants (mean 40.9 years, 68% male)Intervention: Intervention group (N = 65) received BWL (1260 lux at 20 inches, 440-480 nanometers length) for 30 minutes each morning at 12-24 inches from the face. Control group (N = 66) received red light (<450 lux, no light between 440 and 480 nanometers) for the same period. Planned intervention was maximum of 10 treatments or until discharge.Main Outcome Measure: Sleep duration and quality using actigraphic recording.Results: There were no differences found between groups on the primary outcomes nor on the secondary outcomes (sleepiness, mood, cooperation with therapy).Conclusion: BWL treatment during acute rehabilitation hospitalization does not appear to impact sleep or measures commonly associated with sleep. While studies have indicated common complaints of sleep difficulties after TBI, we were unable to document an effect for phototherapy as a treatment. With growing evidence of the effect of sleep on neural repair and cognition, further study is needed to understand the nature and treatment of sleep disorders after TBI.Clinicaltrials.gov Identifier: NCT02214212.

Sickness and sleep health predict frustration and affective responses to a frustrating trigger

Fluctuations in health and sleep are common, but we know surprisingly little about how these daily life stressors affect one's level of frustration and sensitivity to becoming frustrated. In this pre-registered study, 517 participants (Mage = 30.4, SD = 10.4) reported their current sickness symptoms, health status, sleepiness, and sleep duration and quality the previous night. They also rated their general frustration and mood before and after a mild frustration-eliciting task. In the task, participants were instructed to copy geometric shapes onto a piece of paper, without lifting the pen from the paper. Participants were given three minutes to copy the eight shapes, but in order to induce frustration half of them were unsolvable. The study was subsequently repeated in an independent sample (N = 113). Frustration increased in response to the task; however, those with the worst sickness symptoms or sleep health reduced or did not change their frustration levels. Instead, across both studies, frustration was already high at baseline for these individuals. These findings indicate that being sick or having poor sleep is related to high general frustration, but resilience to further frustration due to mild frustrating situations.

The Self-perceived Mental Health Status and Factors That Influence the Mental Health of Chinese Submariners in the South China Sea: A Cross-sectional Study

INTRODUCTION

To assess the self-perceived mental health of soldiers and officers in the submarine force in the South China Sea, the result of this investigation was compared to the Chinese military male norms, and the factors that influence their mental health was further explored.

MATERIALS AND METHODS

A total of 580 male submariners agreed to participate. In the final analysis, 511 valid questionnaires were included; 69 incomplete questionnaires were excluded. The Symptom Checklist 90 (SCL-90) was used to measure the self-perceived mental health of the officers and soldiers.

RESULTS

The scores of four dimensions (somatization, anxiety, phobic anxiety, and paranoid ideation) and the average of the total SCL-90 scores for the submarine force in the South China Sea were significantly higher than the Chinese military norms. Age and length of service were found to be protective factors, with 26- to 30-year-old age group (adjusted odds ratio [AOR] = 0.365, 95% CI = 0.138-0.961) and individuals with 6 to 10 years of service (AOR = 0.357, 95% CI = 0.151-0.842) having lower odds of poor mental health. Education level (bachelor's degree) and workplace (nuclear submarine) were found to be risk factors.

CONCLUSIONS

This study demonstrates for the first time that soldiers and officers in the submarine force in the South China Sea are exposed to a number of mental health risks and are suffering from serious psychological problems. These findings provide a basis for military departments to effectively address these psychological problems.

A Blue-Enriched, Increased Intensity Light Intervention to Improve Alertness and Performance in Rotating Night Shift Workers in an Operational Setting

PURPOSE

This study examined the efficacy of a lighting intervention that increased both light intensity and short-wavelength (blue) light content to improve alertness, performance and mood in night shift workers in a chemical plant.

PATIENTS AND METHODS

During rostered night shifts, 28 workers (46.0±10.8 years; 27 male) were exposed to two light conditions each for two consecutive nights (~19:00-07:00 h) in a counterbalanced repeated measures design: traditional-spectrum lighting set at pre-study levels (43 lux, 4000 K) versus higher intensity, blue-enriched lighting (106 lux, 17,000 K), equating to a 4.5-fold increase in melanopic illuminance (24 to 108 melanopic illuminance). Participants completed the Karolinska Sleepiness Scale, subjective mood ratings, and the Psychomotor Vigilance Task (PVT) every 2-4 hours during the night shift.

RESULTS

A significant main effect of time indicated KSS, PVT mean reaction time, number of PVT lapses (reaction times > 500 ms) and subjective tension, misery and depression worsened over the course of the night shift (p<0.05). Percentage changes in KSS (p<0.05, partial η²=0.14) and PVT mean reaction time (p<0.05, partial η²=0.19) and lapses (p<0.05, partial η²=0.17) in the middle and end of night shift, expressed relative to start of shift, were significantly improved during the lighting intervention compared to the traditional lighting condition. Self-reported mood did not significantly differ between conditions (p>0.05).

CONCLUSION

Our findings, showing improvements in alertness and performance with exposure to blue-enriched, increased intensity light, provide support for light to be used as a countermeasure for impaired alertness in night shift work settings.

Non-contact Sleep/Wake Monitoring Using Impulse-Radio Ultrawideband Radar in Neonates

Background: The gold standard for sleep monitoring, polysomnography (PSG), is too obtrusive and limited for practical use with tiny infants or in neonatal intensive care unit (NICU) settings. The ability of impulse-radio ultrawideband (IR-UWB) radar, a non-contact sensing technology, to assess vital signs and fine movement asymmetry in neonates was recently demonstrated. The purpose of this study was to investigate the possibility of quantitatively distinguishing and measuring sleep/wake states in neonates using IR-UWB radar and to compare its accuracy with behavioral observation-based sleep/wake analyses using video recordings. Methods: One preterm and three term neonates in the NICU were enrolled, and voluntary movements and vital signs were measured by radar at ages ranging from 2 to 27 days. Data from a video camcorder, amplitude-integrated electroencephalography (aEEG), and actigraphy were simultaneously recorded for reference. Radar signals were processed using a sleep/wake decision algorithm integrated with breathing signals and movement features. Results: The average recording time for the analysis was 13.0 (7.0-20.5) h across neonates. Compared with video analyses, the sleep/wake decision algorithm for neonates correctly classified 72.2% of sleep epochs and 80.6% of wake epochs and achieved a final Cohen's kappa coefficient of 0.49 (0.41-0.59) and an overall accuracy of 75.2%. Conclusions: IR-UWB radar can provide considerable accuracy regarding sleep/wake decisions in neonates, and although current performance is not yet sufficient, this study demonstrated the feasibility of its possible use in the NICU for the first time. This unobtrusive, non-contact radar technology is a promising method for monitoring sleep/wake states with vital signs in neonates.

Impact of the novel coronavirus disease on treatment adherence and sleep duration in patients with obstructive sleep apnea treated with positive airway pressure

STUDY OBJECTIVES

The study objective was to examine the effect of coronavirus disease on treatment adherence and self-reported sleep duration among patients with obstructive sleep apnea (OSA) treated with positive airway pressure therapy.

METHODS

This was a retrospective review of medical records of patients seen in the Sleep and Circadian Clinic at Brigham Health during the immediate period of 1 month after the national lockdown was announced on March 15, 2020. Patients with OSA were included only if positive airway pressure adherence data were available in the 12 months before and in the month after the lockdown. Patients with other sleep disorders and patients with OSA without adherence data were excluded.

RESULTS

The mean age of the patients was 63.5 ± 13.9 years, 55% of the participants were men, and the mean body mass index was 31.8 ± 7.9 kg/m². Severe OSA was noted among 59.5% compared with 29.3% with moderate OSA, and 11.2% with mild OSA. An increased number of patients reported insomnia after the lockdown (41% vs 48%, P = .02). Sex stratification showed worsening insomnia only among women. There was no significant difference in positive airway pressure adherence as measured by hours of use, self-reported sleep duration, or use of sleep medications.

CONCLUSIONS

Post- coronavirus disease lockdown had a negative impact on sleep as evidenced by increased reporting of insomnia, particularly among women, but no impact on positive airway pressure adherence or self-reported sleep duration.

The association of occupational stress and sleep duration with anxiety symptoms among healthy employees: A cohort study

The aim of this study is to identify occupational stress associated with the development of new-onset anxiety symptoms and the dose-response relationship between sleep duration and the onset of anxiety symptoms. Data from 29,251 healthy employees who had undergone at least two comprehensive health examinations at Kangbuk Samsung Hospital Health Screening Center were analysed. Anxiety symptoms were assessed using the Beck Anxiety Inventory. Occupational stress and sleep duration were measured using a self-reported questionnaire about total sleep time and the Korean Occupational Stress Scale-Short Form (KOSS-SF), respectively. Flexible parametric proportional hazards model used to estimate the hazard ratios. Compared with the groups without case-level anxiety, discomfort in an organizational climate, high job demands, job insecurity, organizational injustice and lack of reward were associated with the onset of case-level anxiety. Compared with less than 6 hr of sleep per day, the beneficial level of sleep duration was 7 ≤ to <9 hr a day. Almost all subscales of job stress were associated with the development of anxiety symptoms. In addition, the efficacious level of sleep duration for reducing the onset of future anxiety symptoms was 7 ≤ to <9 hr a day.

Sleep problems worsen health-related quality of life and participation during the first 12 months of stroke rehabilitation

OBJECTIVE

Evaluate the impact of self-reported sleep problems on post-stroke recovery.

DESIGN

Cross-sectional secondary analysis of longitudinal data from the Locomotor Experience Applied Post-Stroke (LEAPS) rehabilitation and recovery study (phase-III single-blind randomized controlled clinical trial). Group medians were compared for three sleep problem groups across three time points.

SETTING

Outpatient and in-home physical therapy.

SUBJECTS

Adults during the first year following stroke (n = 408, 380, 360 at 2, 6, 12 months, respectively).

INTERVENTIONS

The original study compared effects of locomotor training with body weight support in the year post-stroke. This analysis evaluated function in three sleep/functional-impact groups: no sleep problems, sleep problems with no-to-minimal-impact and sleep problems with moderate-to-quite-a-bit of impact.

MAIN MEASURES

Participants' responses regarding if they had "a sleep problem, such as insomnia" and, if so, what the impact was on their function. Stroke Impact Scale subscales for strength, hand function, mobility, ADLs, memory, communication, emotion, participation, and percent recovery.

RESULTS

About 25% of people with stroke reported sleep difficulty, 10% perceived sleep problems negatively impact function. Groups self-reporting worse sleep performed worse in all functional subscales (except self-perceived percent recovery) during the first year post-stroke.

CONCLUSION

Self-reported poor sleep adversely effects post-stroke functional recovery.