Sleep difficulties are associated with increased symptoms of psychopathology

Frequency of Vigorous physical activity and sleep difficulty in adolescents: A multiply-country cross-sectional study

BACKGROUND

Sleep is an essential health behavior, and sleep difficulties are strongly associated with adolescent health, potentially leading to more severe sleep disorders. The beneficial effects of physical activity (PA) in alleviating sleep difficulties have been well-documented. Numerous investigations reveal influence in moderate to high-intensity physical activity (PA) positively influences sleep quality. Despite these findings, a gap in the literature exists, particularly regarding the association between frequency of vigorous-intensity physical activity (VPA) and sleep difficulties.

AIM

This study aims to bridge the knowledge gap by exploring the link between sleep difficulty and frequency of VPA among adolescents. Insights are derived from analyzing data accumulated from the Health Behavior in School-aged Children (HBSC) project.

METHODS

The analysis in this study utilized cross-sectional data from the HBSC (2017/2018). The study sample comprised a total of 171,233 respondents aged 11, 13, and 15 years, with males representing 51.1% of sample. Measurement instruments included a self-administered questionnaire, providing direct insight into sleep difficulty and frequency of VPA levels. Statistical analysis on the associaiton between frequency of VPA and sleep difficulties was conducted using Generalized Linear Models.

RESULTS

50.0% of adolescents reported no sleep difficulties, while 12.3% experienced sleep issues daily. Additionally, 17.1% of adolescents engaged in frequency of VPA on a daily basis, while 6.4% never participated in such activities. daily VPA was associated with fewer sleep difficulties (OR = 1.07 [1.00, 1.15]), 4-6 times a week (OR = 1.08 [1.01, 1.15]), and 2-3 times a week (OR = 1.08 [1.02, 1.16]). However, no significant association was found between sleep difficulties and frequency of VPA in girls. Furthermore, a negative association was observed between sleep difficulties and all frequencies of VPA (p < 0.05) in 11-year-old adolescents. For 13-year-olds, daily VPA was significantly associated with fewer sleep difficulties (OR = 1.10 [1.02, 1.19]), 4-6 times a week (OR = 1.15 [1.07, 1.24]), 2-3 times a week (OR = 1.19 [1.10, 1.27]), and once a week (OR = 1.13 [1.05, 1.22]). However, no significant association was found between sleep difficulties and frequency of VPA in 15-year-old adolescents.

CONCLUSION

More participations in VPA would be an effective approach to reduce sleep difficulties in adolescents. Insights gleaned from this research illustrate a discernible link between sleep difficulty and frequency of VPA, particularly notable in male and 13-year-old participants. It is also imperative to underscore the variability in the connection between sleep difficulty and frequency of VPA, distinctly influenced by factors such as gender and age. Consequently, tailoring sleep intervention methodologies to align with the specific needs dictated by these variables emerges as a pivotal recommendation.

The comparison of brief, online mindfulness and relaxation interventions to reduce stress and improve sleep-related outcomes in college students

OBJECTIVE

The current study aimed to examine whether brief online stress reduction exercises supplemented with sleep improvement strategies would reduce stress, arousal, and sleep difficulties in college students who were not required to use the sleep improvement strategies for participation.

PARTICIPANTS

A sample of 114 college student participants were enrolled because they were experiencing stress and/or wanted to improve their sleep.

METHODS

Participants were randomized into an abbreviated progressive muscle relaxation, a mindful breathing, or a self-monitoring control condition for the 4-week intervention. Measures of physical relaxation, mindfulness, perceived stress, pre-sleep arousal, and insomnia symptom severity were collected.

RESULTS

The APMR group improved on five of the six dependent measures and was significantly different than the SM group at posttest, but not different than the MB group.

CONCLUSION

The results suggests promise for brief, online, scaled back stress reduction interventions to reduce stress, arousal, and sleep difficulties in college students.

Attitudes and beliefs about sleep health among a racially and ethnically diverse sample of overweight/obese adults

OBJECTIVES

To identify and compare how sleep-related attitudes and beliefs vary among racially and ethnically diverse adults with risk factors for cardio-metabolic disease.

METHODS

This exploratory qualitative study used online focus group discussions (N = 4 groups among 17 individuals) to collect information about sleep attitudes, beliefs, and practices following participation in the Mindfulness Intervention to Improve Sleep and Reduce Diabetes Risk Among a Diverse Sample in Atlanta (MINDS) study. A rapid analyses approach was used to identify shared themes related to attitudes and beliefs about sleep health and sleep practices across participants.

RESULTS

Participants on average were 31years old, 88% female, and identified as Black/African American (52.9%), White (17.7%), Asian (11.8%), and Hispanic (17.7%). Three themes related to attitudes and beliefs about sleep health were identified: prioritization of sleep to improve one's overall health, re-evaluating sleep needs, and interpersonal barriers to sleep. For Black/African American participants prioritizing sleep was coupled with a want to minimize stress as a long-term health promotion strategy, whereas individuals of other races/ethnicities were more focused on the immediate benefits of getting sufficient sleep. Individuals had reappraised their sleep needs and worked to improve their sleep hygiene accordingly, yet still experienced barriers to sleep. The most common barrier to sleep was sharing a sleep environment with someone who had conflicting sleep routines and practices.

CONCLUSION

The results of this study suggest perceived benefits of and barriers to sleep vary by race/ethnicity, thus future interventions should be culturally tailored to enhance effectiveness.

Sleep Health at the Genomic Level: Six Distinct Factors and Their Relationships With Psychopathology

Background

Poor sleep is associated with many negative health outcomes, including multiple dimensions of psychopathology. In the past decade, sleep researchers have advocated for focusing on the concept of sleep health as a modifiable health behavior to mitigate or prevent these outcomes. Sleep health dimensions often include sleep efficiency, duration, satisfaction, regularity, timing, and daytime alertness. However, there is no consensus on how to best operationalize sleep health at the phenotypic and genetic levels. In some studies, specific sleep health domains were examined individually, while in others, sleep health domains were examined together (e.g., with an aggregate sleep health score).

Methods

Here, we compared alternative sleep health factor models using genomic structural equation modeling on summary statistics from previously published genome-wide association studies of self-reported and actigraphic sleep measures with effective sample sizes up to 452,633.

Results

Our best-fitting sleep health model had 6 correlated genetic factors pertaining to 6 sleep health domains: circadian preference, efficiency, alertness, duration, noninsomnia, and regularity. All sleep health factors were significantly correlated (|rgs| = 0.11-0.51), except for the circadian preference factor with duration and noninsomnia. Better sleep health was generally significantly associated with lower genetic liability for psychopathology (|rgs| = 0.05-0.48), yet the 6 sleep health factors showed divergent patterns of associations with different psychopathology factors, especially when controlling for covariance among the sleep health factors.

Conclusions

These results provide evidence for genetic separability of sleep health constructs and their differentiation with respect to associations with mental health.

Does workplace telepressure get under the skin? Protocol for an ambulatory assessment study on wellbeing and health-related physiological, experiential, and behavioral concomitants of workplace telepressure

BACKGROUND

The daily working life of many employees requires the use of modern information and communication technology (ICT) devices such as computers, tablets, and smartphones. The double-edged nature of digital work environments has been increasingly highlighted. Benefits such as increased flexibility come at a personal cost. One of the potential downsides is workplace telepressure, i.e., the experience of urge and preoccupation to quickly reply to work-related messages and demands using ICT. There is initial - mainly survey-based-evidence that workplace telepressure may have negative effects on a variety of wellbeing and health outcomes.

AIMS AND HYPOTHESES

Adopting the Effort-Recovery Model and the concept of allostatic load as theoretical frameworks, the present study aims to investigate the hypothesis that workplace telepressure is significantly associated with increased "wear and tear", in the form of more psychosomatic complaints, worse sleep quality (self-reported and actigraphy-based), worse mood, and biological alterations (lower cardiac vagal tone, lower anabolic balance defined as the ratio of salivary dehydroepiandrosterone to salivary cortisol, and higher salivary alpha-amylase). Additionally, the study aims to investigate the hypothesis that connection to work defined as work-related workload and work-related perseverative cognition plays a significant role in the mediation of these relationships.

METHODS

To test our hypotheses, we will conduct an ambulatory assessment study with a convenience sample of 120 healthy workers regularly using ICTs for job communication. For one week, participants will be asked to complete electronic diaries assessing their level of workplace telepressure, psychosomatic complaints, sleep quality, mood, work-related workload, and work-related perseverative cognition. They will also continuously wear the Bittium Faros 180L ECG monitor, the wrist-worn actigraph MotionWatch 8, and perform saliva sampling five times per day.

DISCUSSION

This study will be the most comprehensive ambulatory investigation of workplace telepressure and its psychophysiological concomitants to date and constitutes an important step towards understanding how high levels of workplace telepressure may lead in the long term to secondary alterations (e.g., hypertension, chronic inflammation) and disease (e.g., heart disease). The findings of this study are also anticipated to contribute to guiding the development and implementation of interventions, programs, and policies relevant to employees' digital wellbeing.

A systematic review with meta-analyses of the relationship between recurrent binge eating and sleep parameters

BACKGROUND

Sleep problems are known to compound the negative effects of other health issues, such as eating disorders and the associated behavior of binge eating. Previous studies suggested associations between binge eating and sleep problems, but the strength of the relationship is unknown.

METHODS

We conducted a systematic review with meta-analyses examining the relationship between binge eating and sleep parameters. We searched for studies in Scopus, PubMed, and PsycInfo. The quality of evidence, including risk of bias, was assessed with adaptations of the Newcastle-Ottawa Scale and the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies, depending on study design. Data was synthesized as the difference in sleep between people who did or did not have binge eating.

RESULTS

Thirty-one reports of studies met our eligibility criteria. Results are presented in 12 meta-analyses. In the 7 reports of studies (with 4448 participants) that assessed poor overall sleep quality, we found poorer overall sleep quality in people with binge eating compared to people without binge eating, with a standardized mean difference of 0.77 (95% confidence interval [CI] 0.61-0.92; P < 0.001), which is a large effect size. In addition, we found evidence that people with binge eating had significantly greater hypersomnia/daytime sleepiness (7 reports of studies with 4370 participants), insomnia (5 reports of studies with 12,733 participants), and difficulty falling asleep (3 reports of studies with 4089 participants) compared to people without binge eating, with moderate effect sizes (standardized mean differences of 0.57-0.66).

CONCLUSIONS

People with binge eating exhibit poorer overall sleep quality compared to people without binge eating, and may also exhibit greater hypersomnia/daytime sleepiness, insomnia, and difficulty falling asleep. It is recommended that healthcare professionals routinely screen for poor overall sleep quality when treating people with binge eating-and address sleep difficulties when present.

Associations between sleep-related heart rate variability and both sleep and symptoms of depression and anxiety: A systematic review

There is a bidirectional relationship between poor sleep and both mood- and anxiety-related disorders, which are among leading global health concerns. Additionally, both disordered sleep and these psychiatric disorders appear to be independently associated with altered autonomic nervous system (ANS) function. We hypothesise that ANS dysregulation during sleep may explain part of the relationship between poor sleep and mood- and anxiety-related disorders. Heart rate variability (HRV) is a frequently used marker of ANS function and gives an indication of ANS input to the heart - in particular, of the relative contributions of sympathetic and parasympathetic activity. A systematic review of PubMed, Scopus and Web of Science yielded 41 studies dealing with sleep, mood- and anxiety-related disorders and sleep-related HRV. Hyperarousal during sleep, reflecting a predominance of sympathetic activation and indicative of ANS dysregulation, may be an important factor in the association between poor sleep and mood-related disorders. Longitudinal studies and mediation analyses are necessary to further understand the potential mediating role of ANS dysregulation on the relationship between poor sleep and mood- and anxiety-related disorders.

The effect of wearable-delivered sleep interventions on sleep outcomes among adults: A systematic review and meta-analysis of randomized controlled trials

The aims of the review were to (i) evaluate the effectiveness of wearable-delivered sleep interventions on sleep outcomes among adults, and (ii) explore the effect of factors affecting total sleep time. Eight databases were searched to identify relevant studies in English from inception until December 23, 2021. The Cochrane Risk of Bias tool version 2.0 and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria were used to assess the risk of bias and certainty of the evidence, respectively. Twenty randomized controlled trials (RCTs) were included, involving 1608 adults across nine countries. Wearable-delivered sleep interventions elicited significant improvement of 1.96 events/h for the oxygen desaturation index and 3.13 events/h for the respiratory distress index. Meta-analyses found that wearable-delivered sleep interventions significantly decreased sleep disturbance (Hedges' g [g] = -0.37, 95% confidence interval [CI]: -0.59, -0.15) and sleep-related impairment (g = -1.06, 95% CI: -1.99, -0.13) versus the comparators. The wearable-delivered sleep interventions may complement usual care to improve sleep outcomes. More rigorous RCTs with a long-term assessment in a wide range of populations are warranted.

Factorial Structure and Psychometric Properties of the Spanish Version of the Pittsburgh Sleep Quality Index in Non-Professional Caregivers

Although sleep issues are among the symptoms commonly experienced by the non-professional caregiver population, and the Pittsburgh Sleep Quality Index (PSQI) is the most widely used instrument for the assessment of sleep quality, this has not been validated specifically for this population. The objective of this study was to analyze the factorial structure and psychometric properties of the Spanish version of the PSQI in a sample of Spanish non-professional caregivers. Trained clinical psychologists assessed sleep quality using the PSQI, as well as caregiver burden and psychological distress in 201 non-professional caregivers (87.1% female, Mage = 56.2 years). The internal consistency of the PSQI was 0.75. The two-factor model (Sleep quality and Disturbances) had an acceptable fit to the data, was found to be superior to the one-factor model, and more parsimonious than the three-factor model. There was a significant correlation between the PSQI and caregiver burden, as well as between the PSQI and psychological distress (p < 0.001 in all cases). A total score ≥ 9 allowed the identification of caregivers with possible anxiety and depression disorders (sensitivity 70.5%, specificity 71.9%). The results show that the PSQI is a reliable and valid instrument for the assessment of sleep quality in caregivers.

Sleep loss suicidal ideation: the role of trait extraversion

Background: It is known that sleep disturbance is associated with increased suicidal thinking. Moreover, completed suicides, when adjusted for the proportion of the populace that is awake at a given time, are more probable during the late night/early morning hours. Despite these concerns, no studies have examined the role of trait-like individual differences in vulnerability to suicidal ideation during sleep deprivation or insomnia. In two separate studies, we examined whether the trait of extraversion is predictive of changes in suicidal thinking following two nights of sleep deprivation and among individuals meeting the criteria for insomnia.

Methods:Study 1: Twenty-five healthy military personnel (20 males), ages 20–35 completed the NEO-PI-R Extraversion scale and the Suicidal Ideation (SUI) scale of the Personality Assessment Inventory (PAI). Participants completed 77 h of continuous sleep deprivation. After 56 h of sleep deprivation, participants completed the SUI scale a second time. We predicted a change in SUI scores from baseline extraversion. Study 2: 2,061 adults aged 18–79 (900 males) were divided into two groups based on the clinical threshold (≥ 10) on the Insomnia Severity Index (ISI) and completed measures of extraversion and depression, including the suicide item of the Patient Health Questionnaire-9 (PHQ9).

Results:Study 1: After controlling for the caffeine group and changes in PAI Depression, Extraversion scores were used to predict changes in SUI scores using stepwise multiple linear regression. Higher Extraversion was significantly associated with increased non-clinical suicidal ideation following sleep loss, β = 0.463, partial r = 0.512, p = 0.013. Study 2: After controlling for depression, the effect of insomnia on suicidal ideation was moderated by trait extraversion (p < 0.0001). Overall, the presence or absence of insomnia had little effect on individuals low in trait extraversion (i.e., introverts), but insomnia was associated with significantly higher suicidal ideation among high trait extraverted individuals.

Conclusions: Higher trait extraversion was associated with increased vulnerability to suicidal ideation between rested baseline and total sleep deprivation and was associated with greater suicidal ideation among those meeting criteria for clinically severe insomnia. These findings point to a potential trait-like vulnerability factor that may further our understanding of sleep disruption in the phenomenology of suicide.

Relationship between Nomophobia, Various Emotional Difficulties, and Distress Factors among Students

The concept of nomophobia is a relatively new and is defined as the fear of not being able to use all the features and benefits provided by smartphones. The main goal of this research was to examine the relationship between nomophobia and various emotional difficulties and distress factors. The following measuring instruments were used on a sample of 257 Croatian students whose average age was 22 years: Nomophobia Questionnaire (NMP-Q); Scales of Depression, Anxiety, and Stress (DASS); Social and Emotional Loneliness Scale (SELSA); and Emotional Skills and Competences Questionnaire (ESCQ-15). Significant correlations between nomophobia and all examined variables were determined. It was found that nomophobia and emotional skills and competence act as significant predictors in expression of distress factors: 30% of the variance in the severity of depression symptoms, 24% of the variance in the severity of anxiety symptoms, and 26% of the variance in the severity of stress symptoms were explained.

The Coronavirus Pandemic: A Possible Model of the Direct and Indirect Impact of the Pandemic on Sleep Quality in Italians

PURPOSE

This study aimed to assess the direct and indirect impact of COVID-19-related aspects on self-reported sleep quality, considering the moderator role of some psychological variables.

METHODS

During the first weeks of the lockdown in Italy, 2286 respondents (1706 females and 580 males; age range: 18-74 years) completed an online survey that collected sociodemographic information and data related to the experience with the COVID-19 pandemic. Some questionnaires assessed sleep quality, psychological well-being, general psychopathology, Post-Traumatic Stress Disorders symptoms, and anxiety. The path analysis was adopted.

RESULTS

The study confirms a direct effect of some aspects ascribable to the pandemic, with a mediator role of the psychological variables. Lower sleep quality was directly related to the days spent at home in confinement and the knowledge of people affected by the COVID-19. All the other aspects related to the COVID-19 pandemic influenced sleep quality through the mediator effect of psychological variables.

CONCLUSION

This study highlighted that the psychological condition of the population has been influenced by the COVID-19 pandemic and the government actions taken to contain it, but it has also played an important role in mediating the quality of sleep, creating a vicious circle on people's health. The results suggest that a health emergency must be accompanied by adequate social support programs to mitigate the fear of infection and promote adequate resilience to accept confinement and social distancing. Such measures would moderate psychological distress and improve sleep quality.

The path to dissociative experiences: A direct comparison of different etiological models

Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive-compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.

The association between nocturnal panic attacks and suicidal ideation, plans, and attempts

Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk factors. Only one study to date has examined this relationship, but measured suicidality as a unitary construct. This represents a significant gap in the literature, considering most individuals who think about suicide do not make a plan and most who make a plan never make an attempt. We sought to expand upon existing research by examining how nocturnal panic relates to suicidal ideation, plans, and attempts separately. We predicted nocturnal panic would be associated with more suicidal ideation, plan, and attempt history than daytime only panic and no panic. Participants recruited from an online community sample were thoroughly screened for nocturnal and daytime panic history and completed questionnaires about past suicidal ideation, plans, and attempts. Nocturnal and daytime panic groups did not differ in past suicidal ideation or plans, but both groups exceeded the non-panic group. The nocturnal panic group reported more suicide attempts than the daytime and non-panic groups and judged themselves as more likely to make an attempt in the future. These results indicate a promising avenue for future research and suicide prevention efforts.

Association between sleep disorder and quality of life in patients with type 2 diabetes: a cross-sectional study

BACKGROUND

We investigated the association between sleep symptoms, which cause sleep disorder, and quality of life (QoL) among people with type 2 diabetes (T2D).

METHODS

In this cross-sectional study of 342 people with T2D, the Japan National Health and Wellness Survey (NHWS) database 2016 were used. We treated the respondents who reported experiencing any of the sleep symptoms as having sleep disorders. To examine health-related QoL (HRQoL), we used the physical component summary (PCS) and the mental component summary (MCS) from the 36-Item short-form and the EuroQol 5 Dimension (EQ-5D) survey instruments. Overall activity impairment was used for assessment of the effect on the individual's ability to perform regular daily activities. We used t-test and one-way ANOVA test for comparison QoL scores between the participants with and without sleep disorders.

RESULTS

66.4% of the participants with T2D reported having a sleep disorder. The PCS, MCS, EQ-5D, and overall activity impairment of people with sleep disorder was significantly poorer than those of the people without. Specific sleep symptoms, such as waking up to go to the bathroom, daytime sleepiness, and waking up too early (before the alarm clock), had high prevalence (35.4, 27.8 and 20.2%). The participants who experienced waking up to go to the bathroom or daytime sleepiness demonstrated significantly poorer QoL on all scores related to QoL, but those who experienced waking up too early only demonstrated significantly poorer QoL on the EQ-5D.

CONCLUSIONS

Two-thirds of people with T2D in this study suffer from sleep disorders. The people who experience waking up to go to the bathroom or daytime sleepiness had significantly poorer QoL than those without these symptoms. Thus, sleep disorders, especially the symptoms of waking up to go to the bathroom or daytime sleepiness, might be the treatment targets for QOL of people with T2DM.

A Critical Role of Basolateral Amygdala-to-Nucleus Accumbens Projection in Sleep Regulation of Reward Seeking

BACKGROUND

Sleep impacts reward-motivated behaviors partly by retuning the brain reward circuits. The nucleus accumbens (NAc) is a reward processing hub sensitive to acute sleep deprivation. Glutamatergic transmission carrying reward-associated signals converges in the NAc and regulates various aspects of reward-motivated behaviors. The basolateral amygdala projection (BLAp) innervates broad regions of the NAc and critically regulates reward seeking.

METHODS

Using slice electrophysiology, we measured how acute sleep deprivation alters transmission at BLAp-NAc synapses in male C57BL/6 mice. Moreover, using SSFO (stabilized step function opsin) and DREADDs (designer receptors exclusively activated by designer drugs) (Gi) to amplify and reduce transmission, respectively, we tested behavioral consequences following bidirectional manipulations of BLAp-NAc transmission.

RESULTS

Acute sleep deprivation increased sucrose self-administration in mice and altered the BLAp-NAc transmission in a topographically specific manner. It selectively reduced glutamate release at the rostral BLAp (rBLAp) onto ventral and lateral NAc (vlNAc) synapses, but spared caudal BLAp onto medial NAc synapses. Furthermore, experimentally facilitating glutamate release at rBLAp-vlNAc synapses suppressed sucrose reward seeking. Conversely, mimicking sleep deprivation-induced reduction of rBLAp-vlNAc transmission increased sucrose reward seeking. Finally, facilitating rBLAp-vlNAc transmission per se did not promote either approach motivation or aversion.

CONCLUSIONS

Sleep acts on rBLAp-vINAc transmission gain control to regulate established reward seeking but does not convey approach motivation or aversion on its own.

Prevalence and predictors of mood disturbances in idiopathic REM sleep behaviour disorder

Depression and anxiety are commonly associated with synucleinopathies. Mood disturbances have also been reported in patients with idiopathic REM sleep behaviour disorder (iRBD) and are difficult to treat due to exacerbation of sleep symptoms with standard antidepressants. Despite this, detailed prevalence studies of mood symptomatology and contributors to mood disturbances in iRBD are limited. Mood, sleep, autonomic, cognitive and motor symptoms were assessed in 49 well-characterized patients with iRBD using a variety of clinical scales. Spearman correlations, factor analysis and multiple linear regression were used to uncover associations between mood and non-motor and motor symptoms. The prevalence of significant depression was 17.0% and that of anxiety was 14.6% in the iRBD cohort. Age and disease duration were not correlated with these affective symptoms in iRBD patients. We found depression was significantly predicted by the presence and severity of motor, sleep and cognitive symptoms. Anxiety was predicted by the severity of nocturnal and daytime sleep-related symptoms, cognitive symptoms and autonomic symptoms, with a differential effect depending on the questionnaire used. Depression and anxiety are common in iRBD patients and can be significantly explained by specific sets of non-motor and motor symptoms. These associations provide insight into the underlying pathophysiology and emphasize the importance of a holistic approach to mood disturbance in this population, which may circumvent the reliance on pharmacotherapy that can exacerbate dream enactment behaviour.

Pre- to post-inpatient treatment of subjective sleep quality in 5,481 patients with mental disorders: A longitudinal analysis

There is only limited evidence of the course of sleep quality and sleep disturbances during acute inpatient treatment and the prediction of/association with treatment outcome in mental disorders. Within this naturalistic study, 5,481 consecutively admitted inpatients completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI-II) at admission and at discharge. Treatment included both individual and group psychotherapy (but no specific interventions for sleep disturbances) and pharmacotherapy based on current national treatment guidelines. Correlation analyses, analyses of variance and linear models were calculated to analyse the datasets. The PSQI improved significantly (p < 0.001) from admission (mean score 9.51 [±4.11]) to discharge (mean score 8.08 [±4.20]) in all diagnostic subgroups. Despite this improvement, 47% of the patients still showed elevated PSQI scores (>5) at discharge. Patients with post-traumatic stress disorder showed the largest sleep disturbances at both time-points; patients with obsessive-compulsive disorder were the least impaired. An improvement of the PSQI was found to be significantly correlated (p < 0.001) to the change of BDI-II values (without the sleep item) during treatment. The likelihood of achieving remission of depressive symptoms (BDI-II total score <14) was significantly associated with less sleep disturbances at admission. The results suggest that almost half of inpatients with mental disorders treated successfully with state-of-the art specific psychotherapy and pharmacotherapy do not have remission of their sleep problems. Therefore, specific treatment programmes for insomnia should be evaluated and implemented in daily clinical routines.

The mediating role of mood in the relationship between perseverative cognition, sleep and subjective health complaints in music students

OBJECTIVE

Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations.

DESIGN

Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day.

MAIN OUTCOME MEASURES

Self-reported total sleep time (TST) and sleep quality were assessed 30 min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m.

RESULTS

PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality.

CONCLUSION

The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students.

Factor structure of the Night Eating Diagnostic Questionnaire (NEDQ) and an evaluation of the diagnostic criteria of the night eating syndrome

BACKGROUND

The Night Eating Diagnostic Questionnaire (NEDQ) is a validated assessment of the night eating syndrome (NES) based on the proposed diagnostic criteria. While past results show that NEDQ is associated with psychopathology and body mass index (BMI), the relationships between the proposed NES diagnostic criteria and psychopathology and BMI have not been investigated. Thus, the relationships between the proposed NES diagnostic criteria and factors previously associated with NES, namely depression, "food addiction" (FA), sleep quality, and BMI were examined. Finally, the NEDQ factor structure was examined for the first time in order to determine whether the NEDQ is assessing NES appropriately.

METHODS

The NEDQ, depression, sleep quality, and FA questionnaires were administered to a sample of older community members (n = 468) and a student sample (n = 254). Principal Components Analysis (PCA) was performed to examine the factor structure of the NEDQ. The relationships between the proposed diagnostic criteria and depression, sleep quality, FA, and BMI were examined using multiple regression.

RESULTS

The proposed NES criteria were highly intercorrelated. PCA revealed a single factor solution for the NEDQ. In the community sample, depression was associated with the presence of five of nine proposed diagnostic criteria while poor sleep quality and FA were associated with the presence of seven and six criteria respectively. In the community sample, only the sleep problems and impairment/distress criteria were positively associated with BMI. In the student sample, fewer criteria were associated with psychopathology, and no criteria were associated with BMI.

CONCLUSIONS

These findings support the proposed criteria for diagnosis of NES. All proposed criteria were associated with at least one psychopathology measure. BMI was only associated with the sleep problems and impairment/distress criteria in the community sample. The PCA finding of a single factor indicates that the NEDQ is a cohesive assessment of NES, and that the NEDQ is a good measure of NES criteria.

Sleep-amount differentially affects fear-processing neural circuitry in pediatric anxiety: A preliminary fMRI investigation

Insufficient sleep, as well as the incidence of anxiety disorders, both peak during adolescence. While both conditions present perturbations in fear-processing-related neurocircuitry, it is unknown whether these neurofunctional alterations directly link anxiety and compromised sleep in adolescents. Fourteen anxious adolescents (AAs) and 19 healthy adolescents (HAs) were compared on a measure of sleep amount and neural responses to negatively valenced faces during fMRI. Group differences in neural response to negative faces emerged in the dorsal anterior cingulate cortex (dACC) and the hippocampus. In both regions, correlation of sleep amount with BOLD activation was positive in AAs, but negative in HAs. Follow-up psychophysiological interaction (PPI) analyses indicated positive connectivity between dACC and dorsomedial prefrontal cortex, and between hippocampus and insula. This connectivity was correlated negatively with sleep amount in AAs, but positively in HAs. In conclusion, the presence of clinical anxiety modulated the effects of sleep-amount on neural reactivity to negative faces differently among this group of adolescents, which may contribute to different clinical significance and outcomes of sleep disturbances in healthy adolescents and patients with anxiety disorders.

The influence of hazardous drinking on psychological functioning, stress and sleep during and after treatment in patients with mental health problems: a secondary analysis of a randomised controlled intervention study

OBJECTIVES

Hazardous drinking could negatively affect health and lead to alcohol use disorders, but it is unclear how hazardous drinking affects treatment outcomes of depression and anxiety and stress-related mental health problems. The aim of this study was to examine whether hazardous drinking, measured by Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), influences the outcomes of repeated assessments of psychological functioning (Outcome Questionnaire-45), stress (Perceived Stress Scale) and sleep (Karolinska Sleep Questionnaire), during and after treatment in patients with mental ill health.

METHODS

The study was conducted within REGASSA, a randomised controlled trial aimed at comparing Internet-based cognitive-behaviour therapy and physical exercise with treatment as usual on primary care patients with mental ill health. The study involved 871 participants who completed the AUDIT at baseline and who were assessed repeatedly during and after treatment on psychological functioning, stress and sleep by interactive voice response, a computerised, automated telephone technology.

RESULTS

At baseline, hazardous drinkers were more depressed and had lower scores on psychological functioning than non-hazardous drinkers, while there were no differences on stress and sleep. During the follow-ups, hazardous drinking negatively influenced perceived stress, that is, hazardous drinkers seemed to have less treatment effect on stress, and the results remained after controlling for depression. There were no differences during the follow-ups regarding psychological functioning and sleep.

CONCLUSIONS

Hazardous drinking negatively influenced perceived stress. The findings of the study emphasise the importance of screening for alcohol habits in mental ill-health patients, since risky drinking may affect the outcomes of treatment.

TRIAL REGISTRATION NUMBER

DRKS00008745; Post-results.

Recent advances in understanding physical health problems in personality disorders

Personality disorders are associated with a range of adverse health outcomes, contributing to the high healthcare utilization seen in patients with these disorders. A growing literature supports a robust association of personality disorders and health problems. The primary aim of this article is to summarize the most recent research documenting the associations between personality disorders and health conditions. Extending past reviews, we discuss the association of personality disorders with chronic physical illnesses, sleep disturbances, pain conditions, and obesity. We provide recommendations for future research in this area.

Short- and long-term health consequences of sleep disruption

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption.

Stress, Sleep and Depressive Symptoms in Active Duty Military Personnel

BACKGROUND

The military is a unique occupational group and, because of this, military personnel face different kinds of stress than civilian populations. Sleep problems are an example. The purpose of this study was to investigate the relationship between sleep problems, depression level and coping strategies among military personnel.

MATERIALS AND METHODS

In this cross-sectional study, military personnel completed the Beck Depression Inventory, the Pittsburgh Sleep Quality Index and the Jalowiec Coping Scale.

RESULTS

An evaluation of the test scores showed that officers had better sleep quality and fewer depressive symptoms than enlisted personnel. Military personnel with higher educational levels and less physical illness also had fewer depressive symptoms. Officers and noncommissioned officers preferred problem-focused strategies. Those with higher Beck Depression Inventory and Pittsburgh Sleep Quality Index scores and those who drank alcohol frequently preferred affective-focused strategies.

CONCLUSIONS

Our results revealed that sleep quality, physical illness and alcohol consumption were associated with the mental health of military personnel. Treating these factors may improve the mental health of military personnel and enhance effective coping strategies.

Sleep disturbance and obsessive-compulsive symptoms: Results from the national comorbidity survey replication

A small body of developing research has found evidence for sleep disturbance in obsessive-compulsive disorder (OCD) and links between sleep disturbance and obsessive-compulsive symptoms (OCS) in unselected samples. However, the link between sleep disturbance and OCS is yet to be examined in a nationally representative sample. Furthermore, the extent to which the link between sleep disturbance and OCS is accounted for by symptoms of depression remains unclear. To address this gap in the literature, the present study examined the relationship between sleep disturbance and OCS in a nationally representative sample. Participants were assessed in the National Comorbidity Survey Replication (NCS-R; n = 2073). Consistent with predictions, results revealed that individuals with sleep disturbance reported increased OCS severity compared to individuals without sleep disturbance. Further, sleep disturbance severity was associated with OCS severity, even when controlling for depression (and other anxiety-related disorders). This study is the first to link sleep disturbance and OCS in a nationally representative sample, and these findings highlight the unique role of sleep disturbance in the experience of OCS. Future research is necessary to delineate specific mechanisms that may account for this relationship.

Decreased sleep duration is associated with increased fMRI responses to emotional faces in children

In adults and children, sleep loss is associated with affective dysregulation and increased responsivity to negative stimuli. Adult functional neuroimaging (fMRI) studies have demonstrated associations between restricted sleep and neural alterations in the amygdala and reward circuitry when viewing emotional picture and face stimuli. Despite this, few studies have examined the associations between short sleep duration and emotional responsivity in typically developing children, and no studies have investigated this relationship using fMRI. The current study examined the relationship between sleep duration and fMRI activation to emotional facial expressions in 15 male children (ages 7-11 years). During fMRI scanning, subjects viewed and made perceptual judgments regarding negative, neutral, and positive emotional faces. Maternal reported child sleep duration was negatively associated with (a) activation in the bilateral amygdala, left insula, and left temporal pole activation when viewing negative (i.e., fearful, disgust) vs. neutral faces, (b) right orbitofrontal and bilateral prefrontal activation when viewing disgust vs. neutral faces, and (c) bilateral orbitofrontal, right anterior cingulate, and left amygdala activation when viewing happy vs. neutral faces. Consistent with our prediction, we also noted that emotion-dependent functional connectivity between the bilateral amygdala and prefrontal cortex, cingulate, fusiform, and occipital cortex was positively associated with sleep duration. Paralleling similar studies in adults, these findings collectively suggest that decreased sleep duration in school-aged children may contribute to enhanced reactivity of brain regions involved in emotion and reward processing, as well as decreased emotion-dependent functional connectivity between the amygdala and brain regions associated with emotion regulation.

Internalizing and externalizing traits predict changes in sleep efficiency in emerging adulthood: an actigraphy study

Research on psychopathology and experimental studies of sleep restriction support a relationship between sleep disruption and both internalizing and externalizing disorders. The objective of the current study was to extend this research by examining sleep, impulsivity, antisocial personality traits, and internalizing traits in a university sample. Three hundred and eighty six individuals (161 males) between the ages of 18 and 27 years (M = 18.59, SD = 0.98) wore actigraphs for 7 days and completed established measures of disorder-linked personality traits and sleep quality (i.e., Personality Assessment Inventory (PAI), Triarchic Psychopathy Measure, Barratt Impulsiveness Scale-11, and the Pittsburgh Sleep Quality Index). As expected, sleep measures and questionnaire scores fell within the normal range of values and sex differences in sleep and personality were consistent with previous research results. Similar to findings in predominantly male forensic psychiatric settings, higher levels of impulsivity predicted poorer subjective sleep quality in both women and men. Consistent with well-established associations between depression and sleep, higher levels of depression in both sexes predicted poorer subjective sleep quality. Bidirectional analyses showed that better sleep efficiency decreases depression. Finally, moderation analyses showed that gender does have a primary role in sleep efficiency and marginal effects were found. The observed relations between sleep and personality traits in a typical university sample add to converging evidence of the relationship between sleep and psychopathology and may inform our understanding of the development of psychopathology in young adulthood.

Sleep quality in patients with dental anxiety

BACKGROUND

Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients.

OBJECTIVES

To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters.

METHODS

67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected.

RESULTS

49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores.

CONCLUSIONS

DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.

Adult neurogenesis and mental illness

Several lines of evidence suggest that adult neurogenesis, the production of new neurons in adulthood, may play a role in psychiatric disorders, including depression, anxiety, and schizophrenia. Medications and other treatments for mental disorders often promote the proliferation of new neurons; the time course for maturation and integration of new neurons in circuitry parallels the delayed efficacy of psychiatric therapies; adverse and beneficial experiences similarly affect development of mental illness and neurogenesis; and ablation of new neurons in adulthood alters the behavioral impact of drugs in animal models. At present, the links between adult neurogenesis and depression seem stronger than those suggesting a relationship between new neurons and anxiety or schizophrenia. Yet, even in the case of depression there is currently no direct evidence for a causative role. This article reviews the data relating adult neurogenesis to mental illness and discusses where research needs to head in the future.