Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence

Predicting long-term sleep deprivation using wearable sensors and health surveys

Sufficient sleep is essential for individual well-being. Inadequate sleep has been shown to have significant negative impacts on our attention, cognition, and mood. The measurement of sleep from in-bed physiological signals has progressed to where commercial devices already incorporate this functionality. However, the prediction of sleep duration from previous awake activity is less studied. Previous studies have used daily exercise summaries, actigraph data, and pedometer data to predict sleep during individual nights. Building upon these, this article demonstrates how to predict a person's long-term average sleep length over the course of 30 days from Fitbit-recorded physical activity data alongside self-report surveys. Recursive Feature Elimination with Random Forest (RFE-RF) is used to extract the feature sets used by the machine learning models, and sex differences in the feature sets and performances of different machine learning models are then examined. The feature selection process demonstrates that previous sleep patterns and physical exercise are the most relevant kind of features for predicting sleep. Personality and depression metrics were also found to be relevant. When attempting to classify individuals as being long-term sleep-deprived, good performance was achieved across both the male, female, and combined data sets, with the highest-performing model achieving an AUC of 0.9762. The best-performing regression model for predicting the average nightly sleep time achieved an R-squared of 0.6861, with other models achieving similar results. When attempting to predict if a person who previously was obtaining sufficient sleep would become sleep-deprived, the best-performing model obtained an AUC of 0.9448.

Associations between habitual sleep characteristics and cardiometabolic disease risk in corporate executives

OBJECTIVES

Corporate executive job demands may lead to poor sleep habits, increasing their risk for cardiometabolic disease. This study aimed to describe and explore associations between objectively measured habitual sleep characteristics and cardiometabolic disease risk of corporate executives, while accounting for occupational, psychological, and lifestyle factors.

METHODS

Habitual sleep was measured using wrist-worn actigraphy and a sleep diary over seven consecutive days in 61 (68.3% men) corporate executives aged 46.4 ± 8.7years. A composite cardiometabolic disease risk score was determined using body mass index, waist circumference, blood pressure and fasting glucose and lipid concentrations. Prediction models were built using a backward stepwise selection approach to explore associations between sleep characteristics and cardiometabolic disease risk factors adjusting for occupational, psychological, and lifestyle covariates.

RESULTS

Average total sleep time was 6.60 ± 0.75 hours, with 51.7% of participants reporting poor sleep quality and 26.2% extending their weekend sleep. Adjusted models showed that lower sleep efficiency (β = -0.25, 95%CI: -0.43; -0.08, P = .006), shorter weekday total sleep time (β = -1.37, 95% CI: -2.41, -0.32; P = .011) and catch-up sleep (β = 0.84, 95%CI: 0.08, 1.60, P = .002) were associated with higher cardiometabolic disease risk scores. Adjusted models also found that shorter average time-in-bed (ß=-2.00, 95%CI: -3.76; -0.18, P = .031), average total sleep time (ß=1.98, 95%CI: -3.70; -0.25, P = .025) and weekday total sleep time (β = -2.13, 95%CI: -3.56; -0.69, P = .025) as well as catch-up sleep (β = 1.67, 95% CI: 0.52; 2.83; P = .012) were all associated with a higher body mass index.

CONCLUSION

Corporate executives who compromise sleep duration during the working week may increase their risk for obesity and future cardiometabolic disease.

Sleep duration and biomarkers of fecundity in young men: a cross-sectional study from a population-based cohort

BACKGROUND

Poor male fecundity is of concern and warrants the identification of potential modifiable risk factors. Short and long sleep duration might be risk factors for poor male fecundity although evidence in this research field is inconsistent.

OBJECTIVES

To investigate the association between sleep duration and biomarkers of male fecundity in young men.

MATERIALS AND METHODS

We conducted a cross-sectional study of 1,055 young men from the Fetal Programming of Semen Quality (FEPOS) cohort, Denmark, 2017-2019. Sleep duration was obtained from an online survey answered by the participants prior to the clinical visit, where semen and blood samples were obtained, and testis volume was self-assessed using an Orchidometer. Percentage differences in semen characteristics, testes volume, and reproductive hormone levels were analysed according to sleep duration using multivariable negative binomial regression models. Sleep duration was dichotomised (recommended (6-9 h/night) versus deviant sleep) and visualised continuously as restricted cubic spline plots.

RESULTS

Deviation from recommended sleep duration was associated with higher high DNA stainability (HDS) of 5% (95% CI: -1%; 13%), higher testosterone of 3% (95% CI: 0%; 7%) and higher free androgen index (FAI) of 6% (95% CI: 0%; 13%). The spline plots overall supported these results, suggesting u-shaped associations between sleep duration and HDS, testosterone and FAI, a linear association between sleep duration and semen volume and sex hormone binding globulin (SHBG) and an inverse u-shaped association with normal morphology.

DISCUSSION

Information on sleep duration was obtained by self-report in broad categories with at least 3 h intervals. We were not able to investigate short or long sleep duration separately, since only few participants reported this.

CONCLUSION

Sleep duration was associated with some biomarkers of fecundity in young men. Maintaining a recommended sleep duration may thus be beneficial for young men with regard to reproductive health.

Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015

BACKGROUND

Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India.

METHODS

Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses.

RESULTS

Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085).

CONCLUSION

That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

Impact of sleeping in a forest on sleep quality and mental well-being

Forest ecosystems have been acknowledged as a viable intervention for mitigating mental stress. However, there is a scarcity of research investigating the impact of forest environments on sleep. This study primarily investigated the physiological and psychological effects of sleep in a forest environment. It included a sample of 50 Chinese young adult students. A comparative analysis was conducted to examine the impact of sleeping in a forest environment as opposed to a controlled room setting (control). The researchers collected data on blood pressure, electroencephalography (EEG), and psychological markers. There was a statistically significant decrease in systolic blood pressure after the participants slept in a forest environment compared to when they slept in a room (control). Moreover, a notable increase in alpha- and beta-wave frequencies was detected in the forest environment. A more pronounced reduction in anxiety scores was observed in those exposed to a forest environment compared to those in the control group. The physiological and psychological data presented in this study demonstrate that engaging in forest leisure positively affects both physical and mental relaxation in young adults.

High-Frequency Heart Rate Variability Is Prospectively Associated With Sleep Complaints in a Healthy Working Cohort

OBJECTIVE

Vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), has been implicated in a wide range of mental and physical health conditions, including sleep complaints. This study aimed to test associations between HF-HRV measured during sleep (sleep HF-HRV) and subjective sleep complaints 4 years later.

METHODS

One hundred forty-three healthy employees (91% male; MAge = 47.8 years [time 2], SD = 8.3 years) of an industrial company in Southern Germany completed the Jenkins Sleep Problems Scale, participated in a voluntary health assessment, and were given a 24-hour ambulatory heart rate recording device in 2007. Employees returned for a health assessment and completed the Jenkins Sleep Problems Scale 4 years later.

RESULTS

Hierarchical regression analyses showed that lower sleep HF-HRV measured in 2007 was associated with higher self-reported sleep complaints 4 years later after controlling for covariates (rab,c = -0.096, b = -0.108, 95% CI, -0.298 to 0.081, ΔR2 = 0.009, p = .050).

CONCLUSIONS

These data are the first to show that lower sleep HF-HRV predicted worse sleep 4 years later, highlighting the importance of vagus nerve functioning in adaptability and health.

Do Sleep Problems Exacerbate the Mental Health Consequences of Discrimination Among Adults?

OBJECTIVE

An emerging literature suggests that sleep may play an important role in moderating the association between discrimination and mental health problems among adolescents. However, few if any studies have considered this topic among adults. Addressing this knowledge gap, the current study examined multiple sleep parameters as moderating variables in the association between discrimination and mental health problems among adults.

METHODS

Participants were 874 adults residing in small towns and semirural contexts within the Southeastern region of the United States ( Mage = 41 years, SD = 7; 57% female; 31% Black, 69% White; 52% income-to-needs < 2). Sleep duration and night-to-night variability in duration were assessed using wrist actigraphy. Established self-report measures were used to assess global sleep problems, experiences of discrimination, and mental health problems (anxiety, depression, and externalizing symptoms).

RESULTS

Experiences of discrimination were associated with more depression, anxiety, and externalizing problems. Two out of three sleep parameters were found to moderate the effects of discrimination on mental health. The association between discrimination and externalizing problems (but not anxiety or depression) was attenuated among those with less night-to-night variability in sleep duration. The associations between discrimination and anxiety and externalizing problems (but not depression) were attenuated among those with fewer global sleep problems. Less variability in sleep duration and fewer global sleep problems were also directly associated with lower levels of depression, anxiety, and externalizing problems.

CONCLUSIONS

Greater consistency in sleep duration from night-to-night, and fewer overall sleep problems appear to mitigate risk of mental health problems among adults, particularly in contexts where discrimination is prevalent.

Can an intervention integrating sports and medicine improve children's health more effectively? Monitoring based on sleep, body mass index, and heart rate variability

Background

Theoretical studies have suggested that the integration of sports and medicine with one another could positively affect children's health. By monitoring the variation characteristics of children's sleep, body mass index (BMI), and heart rate variability (HRV), we explored and compared the influences of and differences between two interventions - physical exercise and an intervention integrating sports and medicine - on improving children's health.

Methods

We conducted a randomised controlled study, where we randomly divided 136 children into the physical exercise group (PEG), the integration of sports and medicine group (ISMG), and the control group. We measured sleep, BMI, and HRV at baseline and week eight.

Results

After the eight-week intervention, the sleep scores in the PEG and the ISMG were significantly lower than in the control group, while the scores in the ISMG were significantly lower than in the PEG. After the eight-week intervention, the BMI of both the PEG and the ISMG was significantly lower than that of the control group, without a significand difference between the two intervention groups. After the eight-week intervention, the standard deviation of normal-to-normal intervals (SDNN), root mean square differences of the standard deviation (RMSSD), low-frequency of normal (LFn), and high-frequency of normal (HFn) in the PEG and the ISMG were significantly higher than those in the control group, again without a significant difference between the two intervention groups. After intervention, sleep, BMI, and HRV of the three groups were correlated with one another to different degrees, but the correlation coefficient of the two exercise groups was higher.

Conclusions

Based on the interventions, we observed a significant correlation between sleep, BMI, and HRV in children. Regular physical exercise or an intervention integrating sports and medicine could synergistically improve sleep, BMI, and HRV in this population, with the latter having a better effect on improving sleep quality.

Dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers: A feasibility study

OBJECTIVES

Sleep disturbances are common among adult patients with cancer and their caregivers. To our knowledge, no sleep intervention to date has been designed to be provided to both patients with cancer and their caregivers simultaneously. This single-arm study aimed to pilot test the feasibility and acceptability, and to illustrate the preliminary efficacy on sleep efficiency of the newly developed dyadic sleep intervention, My Sleep Our Sleep (MSOS: NCT04712604).

METHODS

Adult patients who were newly diagnosed with a gastrointestinal (GI) cancer and their sleep-partner caregivers (n = 20 persons: 10 dyads, 64 years old, 60% female patients, 20% Hispanic, 28 years relationship duration), both of whom had at least mild levels of sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] ≥ 5) participated in this study. MSOS intervention consists of four 1-hour weekly sessions delivered using Zoom to the patient-caregiver dyad together.

RESULTS

We were able to enroll 92.9% of the eligible and screened patient-caregiver dyads within 4 months. Participants reported high satisfaction in 8 domains (average 4.76 on a 1-5 rating). All participants agreed that the number of sessions, interval (weekly), and delivery mode (Zoom) were optimal. Participants also preferred attending the intervention with their partners. Both patients and caregivers showed improvement in sleep efficiency after completing the MSOS intervention: Cohen's d = 1.04 and 1.47, respectively.

SIGNIFICANCE OF RESULTS

Results support the feasibility and acceptability, as well as provide the preliminary efficacy of MSOS for adult patients with GI cancer and their sleep-partner caregivers. Findings suggest the need for more rigorous controlled trial designs for further efficacy testing of MSOS intervention.

The effects of physical activity on sleep architecture and mood in naturalistic environments

Physical activity has been found to alter sleep architecture, but these effects have been studied predominantly in the laboratory and the generalizability of these findings to naturalistic environments and longer time intervals, as well as their psychological effects, have not been evaluated. Recent technological advancements in wearable devices have made it possible to capture detailed measures of sleep outside the lab, including timing of specific sleep stages. In the current study, we utilized photoplethysmography coupled with accelerometers and smartphone ambulatory assessment to collect daily measurements of sleep, physical activity and mood in a sample of N = 82 over multi-month data collection intervals. We found a robust inverse relationship between sedentary behavior and physical activity and sleep architecture: both low-intensity and moderate-to-vigorous physical activity were associated with increased NREM sleep and decreased REM sleep, as well as a longer REM latency, while higher levels of sedentary behavior showed the opposite pattern. A decreased REM/NREM ratio and increased REM latency were in turn associated with improved wellbeing, including increased energy, reduced stress and enhanced perceived restfulness of sleep. Our results suggest that physical activity and sleep account for unique variance in a person's mood, suggesting that these effects are at least partially independent.

Study Design and Protocol of the Multisite Pregnancy 24/7 Cohort Study

Hypertensive disorders of pregnancy and other adverse pregnancy outcomes (APOs) are associated with an increased risk of future maternal cardiovascular disease. Physical activity during pregnancy reduces the risk of these APOs, yet few meet physical activity guidelines during pregnancy. Little is known about the role of sedentary behavior or sleep in APOs, a critical gap in knowledge given these behaviors comprise the majority of a 24-hour day. To address this knowledge gap, the Pregnancy 24/7 cohort study (2020-2025) uses 2 devices for 24-hour activity assessment in each trimester of pregnancy to examine associations of sedentary behavior, sleep, and the 24-hour activity cycle (composition of sedentary behavior, physical activity, and sleep) with hypertensive disorders and other APOs. Participants (n = 500) are recruited from the University of Iowa, University of Pittsburgh, and West Virginia University in early pregnancy and followed through delivery. The activPAL3 micro and Actiwatch Spectrum Plus are worn in each trimester for 7 days of 24-hour wear to assess the 24-hour activity cycle. APOs are abstracted from medical charts. This study will provide critical data to fuel future research examining how modifying the 24-hour activity cycle in pregnancy can improve maternal health.

The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review

Sleep deficiency is a ubiquitous phenomenon among Americans. In fact, in the United States, ∼78% of teens and 35% of adults currently get less sleep than recommended for their age-group, and the quality of sleep appears to be getting worse for many. The consequences of sleep disruption manifest in a myriad of ways, including insulin resistance and disrupted nutrient metabolism, dysregulation of hunger and satiety, and potentially increased body weight and adiposity. Consequently, inadequate sleep is related to an increased risk of various cardiometabolic diseases, including obesity, diabetes, and heart disease. Exercise has the potential to be an effective therapeutic to counteract the deleterious effects of sleep disruption listed above, whereas chronic psychosocial stress may causally promote sleep disruption and cardiometabolic risk. Here, we provide a narrative review of the current evidence on the consequences of short sleep duration and poor sleep quality on substrate metabolism, circulating appetite hormones, hunger and satiety, and weight gain. Secondly, we provide a brief overview of chronic psychosocial stress and its impact on sleep and metabolic health. Finally, we summarise the current evidence regarding the ability of exercise to counteract the adverse metabolic health effects of sleep disruption. Throughout the review, we highlight areas where additional interrogation and future exploration are necessary.

The Association Between Short Sleep Duration and Metabolic Syndrome: A Case-Control Study

Purpose

Short sleep duration and quality are increasingly common in the Middle East and North Africa (MENA) region and has been linked to metabolic syndrome, which increases the risk of cardiovascular disease and diabetes. This study aimed to examine the link between short sleep duration and metabolic syndrome.

Patients and Methods

We conducted a case-control study using data from Qatar Biobank, with 1000 participants categorized into two groups: less than 7 hours of sleep (n=500) and 7 or more hours of sleep (n=500). Metabolic syndrome was defined using WHO criteria, and logistic regression analysis adjusted for age and gender.

Results

There was a higher proportion of individuals with MetS in the short sleep duration group compared to the normal sleep duration group (22.8% vs 15.8%, respectively). The multivariable regression showed that short sleep duration was associated with metabolic syndrome (OR 1.91, 95% CI: 1.14-3.20, P=0.014) and having 1-2 components of metabolic syndrome (OR 1.91, 95% CI: 1.14-3.20, P=0.014), particularly in males (OR: 2.30, 95% CI: 1.07-4.94, P=0.032). Being overweight (OR 2.17, 95% CI: 1.30-3.63, P=0.003) was also associated with a shorter sleep duration. BMI was identified as the main contributor to the association between short sleep duration and metabolic syndrome, while diabetes played a minor role.

Conclusion

Short sleep duration was associated with metabolic syndrome in Qatar, particularly in males.

Berry Consumption and Sleep in the Adult US General Population: Results from the National Health and Nutrition Examination Survey 2005-2018

INTRODUCTION

Poor sleep is associated with numerous adverse health outcomes. Berries are rich in micronutrients and antioxidants that may improve sleep quality and duration. We determined the association of berry consumption and sleep duration and sleep difficulty among adult participants in NHANES.

METHODS

We analyzed the diet of US adults aged ≥ 20 y using two non-consecutive 24 h recalls from the National Health and Nutrition Examination Survey 2005 to 2018 (N = 29,217). Poor sleep quality was measured by sleep duration (short sleep duration: <7 h), long sleep (≥9 h), and reported sleep difficulty. The relative risk of poor sleep outcomes for berry consumers vs. nonconsumers was modelled using population weight-adjusted multivariable general logistic regression.

RESULTS

About 46% of participants reported inadequate sleep duration, and 27% reported sleep difficulties. Twenty-two percent reported consuming berries. Berry consumers had a 10-17% decreased risk of short sleep. The findings were consistent for specific berry types including strawberries and blueberries (p < 0.05). No significant associations with long sleep were found for total berries and any berry types. A decreased risk of sleep difficulties was found to be linked to blackberry consumption (adjusted OR = 0.63, 95% CI: 0.40-0.97; p = 0.036) but not for other berries.

CONCLUSIONS

US adult berry consumers had a decreased risk of reporting short sleep compared to nonconsumers. Berries are underconsumed foods in the US adult population, and increased berry consumption may improve sleep quality.

Cardiovascular risk in adults with Delayed Sleep Phase Syndrome (DSPS) and Attention-Deficit/Hyperactivity Disorder (ADHD)

TRIAL REGISTRATION

FASE, https://www.trialregister.nl/, #NTR3831.

Who are the superheroes? A cross-sectional study on the determinants of good health among Italian older adults

BACKGROUND

People who reach old age enjoying good physical and mental health can be defined as (health) "superheroes", given their relatively low impact on healthcare expenditure and the desirable model they represent.

AIM

To evaluate prevalence and possible determinants of being "physical superheroes" (i.e., free from the ten major chronic conditions, plus obesity), "mental superheroes" (i.e., free from major mental symptoms), and "superheroes" (i.e., both mental and physical superheroes).

METHODS

A telephone-based cross-sectional study (LOST in Lombardia) was conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥ 65 years from Lombardy region, northern Italy. All participants provided both current data and data referring to one year before.

RESULTS

Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men, and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥ 80 years. Multivariable analysis showed that female sex, higher age, disadvantaged socio-economic status, and physical inactivity (p for trend < 0.001) were inversely related to being superheroes. People not smoking (adjusted odds ratio, aOR = 1.40), alcohol abstainers (aOR = 1.30), and those free from feelings of hopelessness (aOR = 5.92) more frequently met the definition of superheroes. During COVID-19 pandemic, the proportion of superheroes decreased by 16.3%.

CONCLUSIONS

Differences in the older adults' health status are largely attributable to their lifestyles but are also likely due to gender, educational, and socio-economic disparities, which should be properly addressed by public health policies.

Objective sleep and cardiometabolic biomarkers: results from the community of mine study

Study Objectives

Examining multiple dimensions of sleep health may better capture associations between sleep and health risks, including cardiometabolic disease (CMD). Hispanics have elevated risk for inadequate sleep and CMD biomarkers. Few studies have explored whether associations between sleep and CMD differ by Hispanic ethnicity.

Methods

Leveraging data from the Community of Mine (CoM) study, a cross-sectional investigation of 602 ethnically diverse participants, we derived accelerometer-measured sleep duration and efficiency, and self-reported sleep quality. Accelerometer-measured sleep exposures were analyzed both as continuous and categorical variables. Multivariate and quantile regression models were used to assess associations between sleep and CMD biomarkers (insulin resistance, systolic blood pressure, and low-density-lipoprotein cholesterol), controlling for age, sex, ethnicity, education, smoking status, and body mass index. We examined the potential effect modification of Hispanic ethnicity.

Results

We observed mixed results based on CMD biomarkers and sleep exposure. Increased sleep duration was significantly related to low-density lipoprotein cholesterol in adjusted models (estimate = 0.06; 95% CI: 0.02, 0.11). Poor sleep efficiency was associated with greater insulin resistance in the adjusted quantile (estimate = 0.20; 95% CI: 0.04, 0.36) model at the 90th percentile. Self-reported sleep quality was not associated with CMD outcomes. There was no evidence of effect modification by Hispanic ethnicity.

Conclusions

In this cohort, sleep health measures were found to have mixed and at times opposing effects on CMD outcomes. These effects did not demonstrate an interaction with Hispanic ethnicity.

Associations between weekend catch-up sleep and health-related quality of life with focusing on gender differences

This study investigated associations between weekend catch-up sleep (WCUS) and health-related quality of life (HRQoL) in 15,837 participants from the 7th (2016-2018) Korea National Health and Nutrition Examination Survey. We categorized WCUS durations into four groups: none (≤ 0 h [h]), short (> 0 h, ≤ 1 h), medium (> 1 h, ≤ 2 h), and long (> 2 h), and performed complex samples logistic regression and likelihood ratio χ2 test. The study found significant associations in women for the European Quality of Life-5 Dimensions (EQ-5D) index and three EQ-5D subdomains (self-care, usual activities, and anxiety/depression) with the WCUS durations, but no significant association in men. Compared to the non-WCUS, the short or medium WCUS was positively associated with the EQ-5D index and EQ-5D subdomains (usual activities and anxiety/depression) in women, while the long WCUS significantly reduced the quality of life in the self-care domain. In an additional subgroup analysis by age, middle-aged and elderly women had a more noticeable effect of WCUS on HRQoL than young women, and the short or medium WCUS improved HRQoL in middle-aged and elderly women in general. Therefore, we recommend appropriate WCUS durations to improve HRQoL, considering both gender and age.

Effects of traditional Chinese exercise on sleep quality: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The efficacy of traditional Chinese exercise (TCE)-based interventions in the improvement of sleep quality is controversial. In this systematic review, we aimed to summarize randomized controlled trials (RCTs) that outline the effects of TCE on sleep quality.

METHODS

Five databases (Web of Science, Embase, PubMed, Medline, and China National Knowledge Infrastructure) were searched for literature published before July 2022. RCTs examining TCE interventions were included. The treatment effects were estimated using a random-effect meta-analysis model with mean differences (MDs). There were 2 outcome scales for sleep quality; however, because they were extremely contrastive to be analyzed by standard MD, the scales were analyzed separately to ensure the accuracy of the results. This review was registered in the International Prospective Register of Systematic Reviews (identifier CRD42023421314).

RESULTS

Twenty studies were included for analysis at last. The outcome was calculated using the Verran and Snyder-Halpern Sleep Scale (MD: 344.17, 95% confidence interval: 316.95 to 371.39, P < .00001) and Pittsburgh Sleep Quality Index to measure sleep quality (MD: -2.24, 95% confidence interval: -3.05 to -1.43, P < .00001), both showed improvement effect. In subgroup analysis, for patients with fibromyalgia, normal older adults, and non-Hodgkin lymphoma, chronic fatigue syndrome-like illness, knee osteoarthritis, nasopharyngeal carcinoma, pausimenia, insomnia, TCE could improve sleep quality. However, there was no significant improvement in stroke patients, breast cancer patients, normal college students, and episodic migraine patients. Tai Chi had greater effects in improving sleep quality than Qigong. In addition, the participants practice site, duration, and age did not influence the effects of TCE.

CONCLUSION

TCE can improve sleep quality in specific populations in specific populations clinical applications. Tai chi should be considered first to improve sleep quality. However, further extensive trials and rigorous study designs should be conducted to strengthen the findings of this study. In addition, considering the large heterogeneity, the findings of our study should be interpreted cautiously.

Dietary amino acid intake and sleep duration are additively involved in future cognitive decline in Japanese adults aged 60 years or over: a community-based longitudinal study

BACKGROUND

Sleep duration and amino acid intake are independently associated with cognitive decline. This study aimed to determine the longitudinal association between sleep duration and cognitive impairment incidence and to examine the involvement of diet, particularly amino acid intake, in these associations in community dwellers.

METHODS

In this longitudinal study in a community-based setting, we analyzed data from 623 adults aged 60-83 years without cognitive impairment at baseline. Sleep duration was assessed using a self-report questionnaire. Amino acid intake was assessed using 3-day dietary records. Cognitive impairment was defined as a Mini-Mental State Examination score ≤ 27. Participants were classified into short-, moderate-, and long-sleep groups according to baseline sleep duration (≤ 6, 7-8, and > 8 h, respectively). Using moderate sleep as a reference, odds ratios (ORs) and 95% confidence intervals (CIs) of short- and long-sleep for cognitive-impairment incidence were estimated using the generalized estimating equation. Participants were classified according to sex-stratified quartiles (Q) of 19 amino acid intake: Q1 and Q2-Q4 were low- and middle to high-intake groups, respectively. Using middle- to high-intake as a reference, ORs and 95% CIs of low intake for cognitive impairment incidence were estimated using the generalized estimating equation in each sleep-duration group. Follow-up period, sex, age, body mass index, depressive symptoms, education, smoking status, employment status, sleep aids use, physical activity, medical history, and Mini-Mental State Examination score at baseline were covariates.

RESULTS

Mean follow-up period was 6.9 ± 2.1 years. Adjusted ORs (95% CIs) for cognitive impairment in short- and long-sleep groups were 0.81 (0.49-1.35, P = 0.423) and 1.41 (1.05-1.87, P = 0.020), respectively. Particularly in long sleepers (i.e., > 8 h), cognitive impairment was significantly associated with low cystine, proline, and serine intake [adjusted ORs (95% CIs) for cognitive impairment were 2.17 (1.15-4.11, P = 0.017), 1.86 (1.07-3.23, P = 0.027), and 2.21 (1.14-4.29, P = 0.019), respectively].

CONCLUSIONS

Community-dwelling adults aged ≥ 60 years who sleep longer are more likely to have cognitive decline, and attention should be paid to the low cystine, proline, and serine intake.

Modifications of 24-h movement behaviors to prevent obesity in retirement: a natural experiment using compositional data analysis

BACKGROUND

Retirement often leads to a more passive lifestyle and may therefore lead to weight gain. This study aims to investigate longitudinal associations between changes in 24-h movement behaviors and BMI and waist circumference in relation to the transition from work to retirement.

METHODS

The study population included 213 retiring public sector workers (mean age 63.5 years, standard deviation 1.1) from the Finnish Retirement and Aging study. Before and after retirement participants wore an Axivity accelerometer on their thigh and filled in a daily log for at least four days to measure daily time spent sleeping, in sedentary behavior (SED), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). Also, their body mass index (BMI) and waist circumference were measured repeatedly. Compositional linear regression analysis and isotemporal substitution analysis were used to study associations between one-year changes in 24-h movement behaviors and concurrent changes in BMI and waist circumference.

RESULTS

An increase in MVPA in relation to sleep, SED and LPA was associated with a decreasing BMI (β = -0.60, p = 0.04) and waist circumference (β = -2.14, p = 0.05) over one year from before retirement to after retirement. In contrast, increasing sleep in relation to SED, LPA and MVPA was associated with an increasing BMI (β = 1.34, p = 0.02). Reallocating 60 min from MVPA to SED or sleep was estimated to increase BMI by on average 0.8-0.9 kg/m2 and waist circumference by 3.0 cm during one year.

CONCLUSIONS

During the transition from work to retirement, increasing MVPA was associated with a slight decrease in BMI and waist circumference, whereas increasing sleep was associated with an increasing BMI. Common life transitions, like retirement, should be considered when giving recommendations and guidance for physical activity and sleep.

Dietary sodium intake and its relation to sleep duration, sleep quality and nocturnal urination in working-aged Korean adults

Both sodium intake and sleep have an important effect on cardiovascular health. However, few studies have looked at the association between sodium intake and sleep. Therefore, we analysed the association of sodium intake with sleep quality, sleep duration and nocturnal urination. The data for the present study were obtained from the Kangbuk Samsung Health Study. Study participants were 156 696 working-aged Korean adults (average age 38.0 years ±8.0 in men and 36.0 years ±8.1 in women). They were categorised into five groups by quintile of sodium intake, measured by food frequency questionnaire. Poor sleep quality and short sleep duration were determined by Pittsburgh Sleep Quality Index >5, and sleep duration <7 h, respectively. Nocturnal urination was defined as awakening to urinate more than three times a week. Multivariable adjusted logistic regression analysis was used in calculating the odds ratio (OR) and 95% confidence interval (CI) for poor sleep quality, short sleep duration and nocturnal urination (adjusted OR [95% CI]) across five study groups. In all study participants, increased sodium intake was significantly associated with poor sleep quality (quintile 1: reference, quintile 2: 1.07 [1.04-1.11], quintile 3: 1.12 [1.08-1.16], quintile 4: 1.15 [1.11-1.19] and quintile 5: 1.13 [1.09-1.18]). This pattern of relationship was similarly observed in association of sodium intake with short sleep duration (p for trend <0.001) and nocturnal urination (p for trend <0.001). In gender subgroup analysis, increased sodium intake had a significant association with poor sleep quality and short sleep duration in men and with poor sleep quality and nocturnal urination in women. In conclusion, high sodium intake is associated with an increased likelihood of poor sleep quality, short sleep duration and nocturnal urination.

Associations of multiple sleep dimensions with overall and abdominal obesity among children and adolescents: a population-based cross-sectional study

BACKGROUND

The relationship of insufficient sleep with the increased risk of obesity has been reported, but less is known about other sleep dimensions in the sleep-obesity associations.

OBJECTIVES

To assess the associations of multiple sleep dimensions with overall and abdominal obesity among Chinese students.

METHODS

This was a cross-sectional study involving 10,686 Han students aged 9-18 from Chinese National Survey on Students' Constitution and Health (CNSSCH). We collected sex, age, regions, parental educational levels, physical activity duration and sleep-related information by questionnaire survey, and also conducted anthropometric measurements including height, weight and waist circumference (WC). Unadjusted and adjusted binary logistic regression models were used to estimate the associations of sleep-related dimensions with obesity-related indicators.

RESULTS

Short sleep duration was associated with higher body mass index (BMI), larger WC and higher waist-to-height ratio (WHtR) in 9-12 and 16-18 age groups, whereas prolonged sleep duration on weekday was associated with higher BMI in 13-15 age group. Non-habitual midday napping and midday napping ≤0.5 h/d (vs 0.5 to 1 h/d) increased the risk of higher BMI in 13-15 age group, and the former was also associated with larger WC in 9-12 age group. Late bedtime was associated with larger WC and higher WHtR in 9-12 age group and with higher BMI and WHtR in 13-15 age group. Students aged 9-12 with social jet lag ≥2 h were found to have greater BMI after adjustment (Odds Ratio: 1.421; 95% confidence interval: 1.066-1.894).

CONCLUSIONS

Short or overlong sleep duration, late bedtime and great social jet lag were associated with higher prevalence of overall or abdominal obesity, while moderate midday napping can effectively decrease the risk. Those findings may assist in developing preventive strategies to combat obesity epidemic.

Racial/ethnic differences in the beneficial effect of social support on sleep duration

STUDY OBJECTIVES

Social support (SS) is associated with better health outcomes, including sleep health. However, the specific sources of SS that benefit sleep are unclear, and whether these associations vary by race/ethnicity or age is unknown. The aim of this study was to examine cross-sectional associations between sources of SS (number of friends, financial, church attendance, and emotional support) and self-reported short sleep duration (< 7 hours) overall and by race/ethnic groups and age among a representative sample.

METHODS

Using National Health and Nutrition Examination Survey (NHANES) data, logistic regression (marginal standardization) and linear regression models were fit accounting for survey design and weights to test associations between sources of SS (number of friends, financial, church attendance, emotional support) and self-reported short sleep duration (< 7 hours) overall and by race/ethnic groups (Black, Hispanic, and White) and age (< 65 vs ≥ 65 years).

RESULTS

Among 3,711 participants, the mean (standard error) age was 57 (0.3) years and 37% slept < 7 hours. Black adults had the highest prevalence of short sleep (55%). Overall, participants with financial support compared with those without financial support had a lower prevalence of short sleep: 23% (confidence interval [CI]: 0.68, 0.87). As the number of SS sources increased, the prevalence of short sleep duration decreased and the racial disparity in sleep duration narrowed. Associations between financial support and sleep were most pronounced among Hispanic and White adults and adults < 65 years.

CONCLUSIONS

In general, financial support was associated with a healthier sleep duration, particularly among those < 65 years of age. Individuals with numerous sources of SS were less likely to be short sleepers. The benefits of SS on sleep duration varied by race. Targeting specific sources of SS may help to improve sleep duration among those most at risk.

CITATION

Johnson DA, Prakash-Asrani R, Lewis BD, Bliwise DL, Lewis TT. Racial/ethnic differences in the beneficial effect of social support on sleep duration. J Clin Sleep Med. 2023;19(7):1231-1238.

Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis

Background and Objective This study undertook a systematic review and meta-analysis of the relationship between sleep duration, sleep quality, and insomnia in association with self-rated health.Methods Studies that had examined the relationship between sleep duration, sleep quality, and insomnia with self-rated health were eligible. PubMed and Scopus were the two main databases for searching for studies related to this meta-analysis. The Google Scholar database as a source of gray literature was also searched by hand. This search was from the beginning of the formation of databases until the end of January 2022, and the search language was limited to articles published in English. The Effective Public Health Practice Project Quality Assessment Tool was used to assess the quality of studies. For this meta-analysis, odds ratio and 95% confidence interval were extracted or calculated. The pool of studies was processed by the random effects method.Results Twenty-six studies were included in this meta-analysis. Sleep duration of ≤ 8 hours per day (h/d) (odds ratio = 1.58 and 95% confidence interval = [1.41–1.77]) and sleep duration of > 8 h/d (odds ratio = 1.32 and 95% confidence interval = [1.17–1.50]) are associated with poor self-rated health. Poor sleep quality and insomnia are associated with poor self-rated health. Conclusions Sleep problems have a negative effect on self-rated health, and therefore, effective interventions can help improve sleep.

Multiomics analysis of human peripheral blood reveals marked molecular profiling changes caused by one night of sleep deprivation

Sleep insufficiency is associated with various disorders; the molecular basis is unknown until now. Here, 14 males and 18 females were subjected to short-term (24 h) sleep deprivation, and donated fasting blood samples prior to (day 1) and following (days 2 and 3) short-term sleep deprivation. We used multiple omics techniques to examine changes in volunteers' blood samples that were subjected to integrated, biochemical, transcriptomic, proteomic, and metabolomic analyses. Sleep deprivation caused marked molecular changes (46.4% transcript genes, 59.3% proteins, and 55.6% metabolites) that incompletely reversed by day 3. The immune system in particular neutrophil-mediated processes associated with plasma superoxidase dismutase-1 and S100A8 gene expression was markedly affected. Sleep deprivation decreased melatonin levels and increased immune cells, inflammatory factors and c-reactive protein. By disease enrichment analysis, sleep deprivation induced signaling pathways for schizophrenia and neurodegenerative diseases enriched. In sum, this is the first multiomics approach to show that sleep deprivation causes prominent immune changes in humans, and clearly identified potential immune biomarkers associated with sleep deprivation. This study indicated that the blood profile following sleep disruption, such as may occur among shift workers, may induce immune and central nervous system dysfunction.

Sleep Duration and Metabolic Syndrome among Early Adolescents-A Cross-Sectional Study in Khartoum State, Sudan

Numerous studies have reported that sleep disorders are linked to poor health outcomes. However, studies on these associations in children and adolescents in an African context are limited. The aim of the present study was to analyze the relationship between sleep duration and the presence of metabolic syndrome among early adolescents in Sudan. Methods: A cross-sectional study was conducted on participants aged 10-15 years in Khartoum State, Sudan. Metabolic syndrome (MetS) was diagnosed by increased waist circumference and the presence of two or more metabolic abnormalities (triglycerides [TG], high-density lipoproteins [HDL-C], blood pressure [BP], and fasting plasma glucose [FBG]). Short sleep duration was defined based on National Sleep Foundation (NSF) classification. Data were collected by physical examinations, biochemical analyses, and self-developed standardized questionnaires. Data were analyzed with IBM SPSS Statistics Version 24. A generalized additive model (GAM) was used for the smoothing function between sleep duration and MetS. p < 0.05 was considered as significant. Results: The prevalence of MetS and short sleep among early adolescents aged 10-15 years in Sudan was 2.3% and 55.0%, respectively. A higher prevalence of short sleep was found among overweight and obese participants (p < 0.05). The prevalence of MetS among short sleepers was 2.8%. Binary logistic regression analysis showed that male short sleepers had higher odds of having MetS compared to female short sleepers. The relationship between short sleep and low HDL-C in boys and between short sleep and high TG in girls was statistically significant. The highest risk of MetS was observed at less than 6.5 h of sleep per night. Conclusions: Short sleep duration was significantly associated with overweight/obesity in the total population and with low HDL-C in boys and high triglycerides in girls. A nonlinear curve pattern was observed between sleep duration and prevalence of MetS. Longitudinal studies are needed to further determine the causal relationship between sleep habits and MetS and its components.

Can afternoon napping protect against the negative effect of short or long sleep duration on cognitive function? A prospective study

OBJECTIVES

Afternoon napping has been found to be able to compensate for the negative health effects of less optimal nighttime sleep duration. Our study aimed to investigate whether napping can protect against the negative effects of short or long sleep duration on cognitive function among middle-aged and older adults.

METHODS

A total of 8107 participants (men, 53.19%) aged 45 and older from the China Health and Retirement Longitudinal Study were followed prospectively for 7 years. The primary outcome was cognitive function (episodic memory and mental status). Afternoon napping was categorized into three groups including non- (0 min), moderate (1-30 min) and long (>30 min) duration. Nighttime sleep was also categorized into three groups including short (<7 h), normal (7-8 h), and long (>8 h) duration. Linear mixed models were used with napping and sleep duration at baseline as predictors. Potential confounders including baseline cognitive function were adjusted.

RESULTS

Shorter sleep duration (B = -0.01, p = 0.048) was independently associated with a faster decline in episodic memory. For participants with shorter sleep duration, either non-napping (B = -0.03, p = 0.017) or longer napping (B = -0.04, p = 0.018) showed a significant decline of episodic memory. For participants with longer sleep duration, non-napping was associated with a significant decline of episodic memory (B = -0.07, p = 0.003).

CONCLUSIONS

This study found that moderate napping could protect against the negative effects of short or long sleep duration on episodic memory, which implied that middle-aged and older adults who have a less optimal sleep duration might benefit from moderate napping for their cognitive function.

Joint Profiles of Sedentary Time and Physical Activity in Adults and Their Associations with Cardiometabolic Health

PURPOSE

This study aimed to identify and characterize joint profiles of sedentary time and physical activity among adults and to investigate how these profiles are associated with markers of cardiometabolic health.

METHODS

The participants included 3702 of the Northern Finland Birth Cohort 1966 at age 46 yr, who wore a hip-worn accelerometer during waking hours and provided seven consecutive days of valid data. Sedentary time, light-intensity physical activity, and moderate- to vigorous-intensity physical activity on each valid day were obtained, and a data-driven clustering approach ("KmL3D") was used to characterize distinct joint profiles of sedentary time and physical activity intensities. Participants self-reported their sleep duration and performed a submaximal step test with continuous heart rate measurement to estimate their cardiorespiratory fitness (peak heart rate). Linear regression was used to determine the association between joint profiles of sedentary time and physical activities with cardiometabolic health markers, including adiposity markers and blood lipid, glucose, and insulin levels.

RESULTS

Four distinct groups were identified: "active couch potatoes" ( n = 1173), "sedentary light movers" ( n = 1199), "sedentary exercisers" ( n = 694), and "movers" ( n = 636). Although sufficiently active, active couch potatoes had the highest daily sedentary time (>10 h) and lowest light-intensity physical activity. Compared with active couch potatoes, sedentary light movers, sedentary exercisers, and movers spent less time in sedentary by performing more physical activity at light-intensity upward and had favorable differences in their cardiometabolic health markers after accounting for potential confounders (1.1%-25.0% lower values depending on the health marker and profile).

CONCLUSIONS

After accounting for sleep duration and cardiorespiratory fitness, waking activity profiles characterized by performing more physical activity at light-intensity upward, resulting in less time spent in sedentary, were associated with better cardiometabolic health.

Nutritional Elements in Sleep

Sleep comprises one-third of our day and plays an integral role in human health and well-being. Many factors influence sleep, with nutrition being a key element that impacts various sleep parameters. Meal-timing through strategies like chrono-nutrition leads to positive sleep outcomes. In addition, consuming a high-protein diet with essential amino acids, low-glycemic-index foods, and certain fruits rich in antioxidants can all contribute to better sleep quality. Other facets of nutrition that can affect sleep outcomes include weight loss and limiting certain nutritional elements such as caffeine, nicotine, and alcohol. In this article, we will shed some light on how some of these factors can play a vital role in sleep quality.

Prevalence of sleep-related problems and risks in a community-dwelling older adult population: a cross-sectional survey-based study

Background

Despite evidence of adverse health consequences of inadequate restorative sleep for older adults, assessment of sleep quantity, quality, and use of sleep aids is not routinely done. We aimed to characterize sleep problems, sleep risks, and advice received about sleep in a community-dwelling older adult population, overall and in subgroups with health conditions and functional difficulties.

Methods

This cross-sectional study used weighted self-report data for 5074 Kaiser Permanente Northern California members aged 65-79y who responded to a 2017 or 2020 Member Health Survey. We estimated usual amount of sleep (< 6, 6 to < 7, ≥7 hours) and prevalence of sleep problems (frequent insomnia, frequent daytime fatigue, poor quality sleep, and potential sleep apnea (OSA) symptoms (frequent very loud snoring, apnea episodes)) for older adults overall, by self-rated health, and in subgroups reporting hypertension, diabetes, heart disease, frequent problems with balance/walking, and frequent memory problems. We also estimated percentages who regularly used sleep aids and had discussed sleep adequacy with a healthcare professional in the past year.

Results

Approximately 30% of older adults usually got less than the recommended ≥7 hours sleep per day, and 9% experienced frequent daytime fatigue, 13% frequent insomnia, 18% frequent insomnia/poor quality sleep, and 8% potential OSA symptoms. Prevalence of frequent insomnia was higher among women than men (16% vs. 11%). Higher percentages of those in fair/poor health and those with frequent balance/walking and memory problems reported sleeping < 6 hours per day and having all four types of sleep problems. Nearly 20% of all older adults (22% of women vs. 17% of men) and 45% of those with frequent insomnia (no sex difference) reported regular sleep aid use. Only 10% of older adults reported discussing sleep with a healthcare professional whereas > 20% reported discussing diet and exercise.

Conclusions

Large percentages of older adults experience sleep problems or get less sleep than recommended for optimal sleep health. Older patients should routinely be assessed on multiple components of sleep health (sleep hygiene, quantity, quality, problems, and sleep aid use) and educated about sleep hygiene and the importance of getting adequate restorative sleep for their overall health and wellbeing.

The temporal relationships between sleep disturbance and autonomic dysregulation: A co-twin control study

INTRODUCTION

Sleep disturbance is associated with autonomic dysregulation, but the temporal directionality of this relationship remains uncertain. The objective of this study was to evaluate the temporal relationships between objectively measured sleep disturbance and daytime or nighttime autonomic dysregulation in a co-twin control study.

METHODS

A total of 68 members (34 pairs) of the Vietnam Era Twin Registry were studied. Twins underwent 7-day in-home actigraphy to derive objective measures of sleep disturbance. Autonomic function indexed by heart rate variability (HRV) was obtained using 7-day ECG monitoring with a wearable patch. Multivariable vector autoregressive models with Granger causality tests were used to examine the temporal directionality of the association between daytime and nighttime HRV and sleep metrics, within twin pairs, using 7-day collected ECG data.

RESULTS

Twins were all male, mostly white (96%), with mean (SD) age of 69 (2) years. Higher daytime HRV across multiple domains was bidirectionally associated with longer total sleep time and lower wake after sleep onset; these temporal dynamics were extended to a window of 48 h. In contrast, there was no association between nighttime HRV and sleep measures in subsequent nights, or between sleep measures from previous nights and subsequent nighttime HRV.

CONCLUSIONS

Daytime, but not nighttime, autonomic function indexed by HRV has bidirectional associations with several sleep dimensions. Dysfunctions in autonomic regulation during wakefulness can lead to subsequent shorter sleep duration and worse sleep continuity, and vice versa, and their influence on each other may extend beyond 24 h.

Association between sleep quality and occupational factors in Brazilian correctional officers

OBJECTIVE

To analyze the occupational factors associated with poor sleep quality in correctional officers (COs).

METHOD

This is a cross-sectional study involving COs who work at four prison facilities in the state of São Paulo, Brazil. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic and linear regression models were used to calculate the odds ratio (OR) and beta coefficient (β) of poor sleep quality and the corresponding 95% confidence interval (CI), respectively. The analyses were adjusted for the main confounders.

RESULTS

Considering the 256 male COs who participated in the study, 148 (57.8%) had poor sleep quality. In the adjusted analyses, poor sleep quality was associated with higher mental demands (OR = 3.10; 95% CI: 1.40-6.85), having suffered psychological violence at work (OR = 2.13; 95% CI: 1.04-4.35), agreeing with the following statement: "I think about work-related issues in my free time" (OR = 5.13; 95% CI: 1.26-20.78), feeling partially dissatisfied (OR = 2.26; 95% CI: 1.09-4.68) or dissatisfied with work (OR = 4.52; CI: 1.32-15.46) and willingness to find another job (OR = 3.20; 95% CI: 1.53-6.71). The occupational factors dissatisfaction with work (β = 1.02; 95% CI: 0.05-1.98) and having health problems related to the work environment (β = 0.32; 95% CI: 0.24-2.41) were also associated with higher scores on the PSQI.

CONCLUSION

Poor quality of sleep is a highly frequent health problem among correctional officers, and this condition is associated with the perception of poor working conditions, professional dissatisfaction and the fact that such professionals think about work during their free time.

COVID‐19 related distress and sleep health among trauma‐exposed South Asians: Does generational status matter?

The COVID-19 pandemic has resulted in substantial changes in individual and socio-economic factors that may negatively impact sleep health. We examined associations between COVID-19 related distress and sleep among trauma-exposed South Asian adults in the United States. Since a health advantage among foreign-born individuals has been previously noted in the literature (the 'immigrant paradox'), we also explored if generational status (number of generations one's family has been in the U.S.) moderated associations between COVID-19 related distress and sleep health. Participants were 196 trauma-exposed South Asian adults residing in the U.S. (54% male, 63% U.S.-born citizens, average age = 34.51 years), who completed measures of generational status, COVID-19 related distress, trauma exposure, sleep-related impairment (SRI), and sleep disturbances. Greater COVID-19 distress was associated with more sleep disturbances (b = 0.15, p < 0.001) and SRI (b = 0.24, p < 0.001). Generational status was not associated with sleep, nor did it modify associations between COVID-19 distress and sleep. Findings highlight the potential importance of developing interventions to reduce stress and sleep difficulties during the pandemic. Our results did not support the immigration paradox. Future studies are needed to better understand the role of generational status on sleep health across immigrant subgroups.

Associations between night-time sleep duration and fasting glucose and ratio of triglyceride to high-density lipoprotein cholesterol among adults free of type 2 diabetes or without diagnosed type 2 diabetes: a multicentre, cross-sectional study in China

OBJECTIVES

We aimed to assess the associations between night-time sleep duration and fasting glucose (FG), triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and body mass index (BMI) among adults free of type 2 diabetes (T2D) or without diagnosed T2D.

DESIGN

Cross-sectional study.

SETTING

Medical examination centres at six hospitals in Beijing-Tianjin-Hebei region, China.

PARTICIPANTS

Participants were recruited via multistage, stratified cluster sampling. We included adults free of T2D or without diagnosed T2D who attended for physical examination and completed the validated questionnaire. 32 497 participants were included in the study, of whom 52.50% were men.

PRIMARY AND SECONDARY OUTCOME MEASURES

FG, TG, HDL-C, height and weight were measured.

RESULTS

Overall, 12.80% and 9.67% reported night sleep duration <7 hours and ≥9 hours, respectively; 6.91% had elevated FG and 3.57% had undiagnosed T2D. Sleep duration had an independent, U-shaped associated with FG (β₁ (linear term)=-0.111, p=0.047; β₂ (quadratic term)=0.008, p=0.026) with 6.9 hours of sleep associated with the lowest FG and a negative association with BMI (β=-0.154, p<0.001). BMI mediated a U-shaped association of sleep duration with TG/HDL-C (β₁=-0.040, p=0.017; β₂=0.003, p=0.023).

CONCLUSIONS

Both short and long night-time sleep was associated with elevated FG, and short sleep duration was associated with increased BMI. BMI mediated a U-shaped association between sleep duration and TG/HDL-C.

Association of insomnia and short sleep duration, alone or with comorbid obstructive sleep apnea, and the risk of chronic kidney disease

STUDY OBJECTIVES

Obstructive sleep apnea (OSA), sleep fragmentation, and short sleep duration (SD) have been associated with chronic kidney disease (CKD). However, these potential mechanisms for CKD have not been compared in the same cohort. This study investigated the independent and combined impact of OSA and insomnia with short sleep duration on the risk of CKD progression in a sleep clinic population.

METHODS

In a cross-sectional study design, adults with suspected OSA completed an overnight sleep study and a questionnaire that included the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). They also provided blood and urine samples for measurement of the glomerular filtration rate and urine albumin:creatinine ratio, from which the risk of CKD progression was determined.

RESULTS

Participants (n = 732, 41% female, 55 ± 13 years) were categorized into four groups: no/mild OSA without insomnia (NM-OSA, n = 203), insomnia with SD without OSA (Insomnia-SD, n = 104), moderate-to-severe OSA without insomnia (MS-OSA, n = 242), and comorbid insomnia and OSA with SD (COMISA-SD, n = 183). After stratification, 12.8% of NM-OSA, 15.4% of Insomnia-SD, 28.9% of MS-OSA, and 31.7% of the COMISA-SD participants had an increased risk of CKD progression. Compared to NM-OSA, the odds ratio (OR) for an increased risk of CKD progression was not increased in Insomnia-SD (OR 0.95, confidence interval [CI]: 0.45-1.99) and was increased to the same degree in MS-OSA (OR 2.79, CI: 1.60-4.85) and COMISA-SD (OR 3.04, CI: 1.69-5.47). However, the ORs were similar between the MS-OSA and COMISA-SD groups across all statistical models (p ≥ .883).

CONCLUSIONS

In a sleep clinic population, insomnia with short sleep duration does not increase the risk of CKD progression; nor does it further increase the risk of CKD progression associated with moderate-to-severe OSA.

Association of Insulin Resistance With Cardiovascular Risk Factors and Sleep Complaints: A 10-Year Follow-Up

The aim of the study was to investigate the association of insulin resistance (IR) with cardiovascular risk factors and sleep complaints among citizens of Palanga over a 10-year follow-up period. This epidemiological longitudinal cohort study was performed with 835 subjects.

Methods

All participants were evaluated for sociodemographic, clinical and cardiovascular risk factors, behavioral factors, self-perceived health and biochemical analysis. IR was evaluated using the homeostasis model assessment of IR (HOMA-IR).

Results

All study participants were stratified into two groups, without IR (HOMA-IR ≤ 2.7) and with IR (HOMA-IR > 2.7). The analysis of parameters between the two study groups showed statistically significant relationships between IR, cardiovascular risk factors and sleep complaints within the 10-year period. After adjusting for a 10-year period, sex, age, body mass index, physical activity, education, systolic and diastolic blood pressures, presence of disease, total cholesterol, triglyceride levels, metabolic syndrome (MetS) and diabetes mellitus (DM), IR was statistically significantly more frequent in subjects with increased sleep latency [odds ratio (OR) 1.37, 95% CI 1.01-1.93; p = 0.043], snoring frequency (OR 1.37, 95% CI 1.05-1.79; p = 0.020) and very loud snoring (OR 1.34, 95% CI 1.04-1.74, p = 0.026).

Conclusions

The incidence of obesity, MetS, DM, elevated fasting glucose level, triglyceridemia and sleep complaints became more frequent after a 10-year period in subjects with IR. Over a 10-year period, IR was significantly associated with an increase in sleep complaints: sleep latency reflecting difficulty to fall asleep, snoring and very loud snoring.

Identification of Smartwatch-Collected Lifelog Variables Affecting Body Mass Index in Middle-Aged People Using Regression Machine Learning Algorithms and SHapley Additive Explanations

Body mass index (BMI) plays a vital role in determining the health of middle-aged people, and a high BMI is associated with various chronic diseases. This study aims to identify important lifelog factors related to BMI. The sleep, gait, and body data of 47 middle-aged women and 71 middle-aged men were collected using smartwatches. Variables were derived to examine the relationships between these factors and BMI. The data were divided into groups according to height based on the definition of BMI as the most influential variable. The data were analyzed using regression and tree-based models: Ridge Regression, eXtreme Gradient Boosting (XGBoost), and Category Boosting (CatBoost). Moreover, the importance of the BMI variables was visualized and examined using the SHapley Additive Explanations Technique (SHAP). The results showed that total sleep time, average morning gait speed, and sleep efficiency significantly affected BMI. However, the variables with the most substantial effects differed among the height groups. This indicates that the factors most profoundly affecting BMI differ according to body characteristics, suggesting the possibility of developing efficient methods for personalized healthcare.

Dietary Patterns in Association with Sleep Duration in Iranian Adults: Results from YaHS-TAMYZ and Shahadieh Cohort Studies

Background

Little observational studies have been conducted on the association between diet and sleep. We conducted a cross-sectional study to evaluate the associations of dietary patterns with sleep duration in an Iranian population.

Methods

This study was conducted on the baseline data of two population-based Iranian cohorts: the YaHS-TAMYS and Shahedieh studies. Dietary intakes were assessed in 10451 Yazdi people aged 20-75 years. Dietary habits were derived from answers to a food frequency questionnaire, and a factor analysis using principal component analysis (PCA) was used to identify dietary patterns. The reported sleep duration was categorized as short (<6 h), normal (6-8 h) or long (>8 h). Multivariable logistic regression was used to determine the relationship between dietary patterns and the odds of short and long sleep duration.

Results

Four major dietary patterns were identified: "healthy," "western," "traditional," and "high-carbohydrate, high-fat." In the Shahedieh study, participants in the top quartile of the western dietary pattern had greater odds of short (<6 h) and long (>8 h) sleep duration (OR = 1.49; 95% CI: 1.17, 1.90; P trend <0.001 and OR = 1.46; 95% CI: 1.12, 1.90; P trend = 0.014, respectively) than those in the bottom quartile. Also, participants in the highest quartile of the high-carbohydrate, high-fat pattern had higher odds of long sleep duration compared with those in the lowest quartile (OR = 1.36; 95% CI: 1.05, 1.75; P trend = 0.005). Pooling the two studies revealed that the western dietary pattern was significantly associated with short sleep duration (OR = 1.31; 95% CI: 1.08, 1.59).

Conclusions

The western dietary pattern might inversely be associated with sleep duration. Future prospective studies are recommended to confirm these results.

Automatic Detection of the Cyclic Alternating Pattern of Sleep and Diagnosis of Sleep-Related Pathologies Based on Cardiopulmonary Resonance Indices

The cyclic alternating pattern is the periodic electroencephalogram activity occurring during non-rapid eye movement sleep. It is a marker of sleep instability and is correlated with several sleep-related pathologies. Considering the connection between the human heart and brain, our study explores the feasibility of using cardiopulmonary features to automatically detect the cyclic alternating pattern of sleep and hence diagnose sleep-related pathologies. By statistically analyzing and comparing the cardiopulmonary characteristics of a healthy group and groups with sleep-related diseases, an automatic recognition scheme of the cyclic alternating pattern is proposed based on the cardiopulmonary resonance indices. Using the Hidden Markov and Random Forest, the scheme combines the variation and stability of measurements of the coupling state of the cardiopulmonary system during sleep. In this research, the F1 score of the sleep-wake classification reaches 92.0%. In terms of the cyclic alternating pattern, the average recognition rate of A-phase reaches 84.7% on the CAP Sleep Database of 108 cases of people. The F1 score of disease diagnosis is 87.8% for insomnia and 90.0% for narcolepsy.

Impact of chronic sleep restriction on sleep continuity, sleep structure, and neurobehavioral performance

Chronic sleep restriction (CSR) has been associated with adverse effects including cognitive impairment and increased risk of diabetes and cardiovascular disease. Yet, sleep restriction therapy is an essential component of most behavioral treatments for insomnia. Moreover, little is known about the impact of CSR on sleep continuity and structure in healthy people whose need for sleep is satiated. We investigated the impact of CSR on sleep continuity and structure in nine healthy participants. They had 4 nights of sleep extension, 2 nights of post-extension sleep, 21 nights of CSR (5/5.6-hour time-in-bed), and 9 nights of recovery sleep. Compared to postextension sleep, during CSR sleep duration was reduced by 95.4 ± 21.2 min per night, Slow-Wave Activity was significantly increased, and sleep was more consolidated. During recovery, sleep duration was increased by 103.3 ± 23.8 min compared to CSR, and the CSR-induced increase in Slow-Wave Activity persisted, particularly after the 5-hour exposure. Yet, we found that sustained vigilant attention was not fully recovered even after nine nights of recovery sleep. Our results suggest that CSR improves traditional metrics of sleep quality and may have a persistent impact on sleep depth, which is consistent with the reported benefits on sleep continuity and structure of sleep restriction therapy. However, these improvements in traditional metrics of sleep quality were associated with deterioration rather than improvement in neurobehavioral performance, demonstrating that sleep duration should be included in assessments of sleep quality. These results have implications for the long-term use of sleep restriction in the behavioral treatment of insomnia. Clinical Trial Registration: Impact of Chronic Circadian Disruption vs. Chronic Sleep Restriction on Metabolism (https://clinicaltrials.gov/ct2/show/; #NCT02171273).

Sleep, substance misuse and addictions: a nationwide observational survey on smoking, alcohol, cannabis and sleep in 12,637 adults

For a good night's sleep, we consensually recommend avoiding alcohol, smoking and drugs. However, these addictions are highly prevalent in the general population, and it is difficult to estimate their real impact on sleep. The aim of this study is to clarify the association between sleep habits and disorders, and addictions. The design was a telephone crossover national recurrent health poll survey (Santé publique France, Baromètre santé, 2017; Questionnaire, pp. 53; Saint Maurice) in a representative sample of French adults. There were 12,367 subjects (18-75 years old) who answered the survey. Sleep log items assessed sleep schedules (total sleep time) on work and leisure days: at night, while napping, and over 24 hr using a sleep log. Retained items include: (1) short sleep (≤ 6 hr/24 hr); (2) chronic insomnia (International Classification of Sleep Disorders, 3^rd edition criteria); and (3) chronotype (evening-morning-neutral). Psychoactive substances retained included tobacco (current or former users), alcohol (daily consumption and weekly binge drinking), cannabis (Cannabis Abuse Screening Test), and other drugs (consumption during the past year). We found that: (1) daily smokers (lightly or heavily dependent) were more frequently short sleepers than occasional smokers and non-smokers; (2) heavily dependent daily smokers were more likely to suffer from insomnia than other smokers or non-smokers; (3) short sleep and insomnia were not significantly associated with the consumption of alcohol, cannabis or any other drug; (4) the evening chronotype was significantly associated with the consumption of tobacco, alcohol and cannabis. In conclusion, our study highlights significant relationships between the use of psychoactive substances and sleep characteristics among adults, emphasizing the need to take into account each subject individually.

A Time to Rest, a Time to Dine: Sleep, Time-Restricted Eating, and Cardiometabolic Health

Cardiovascular disease (CVD) poses a serious health and economic burden worldwide. Modifiable lifestyle factors are a focus of research into reducing the burden of CVD, with diet as one of the most investigated factors. Specifically, the timing and regularity of food intake is an emerging research area, with approaches such as time-restricted eating (TRE) receiving much attention. TRE involves shortening the time available to eat across the day and is associated with improved CVD outcomes compared with longer eating windows. However, studies that have examined TRE have not considered the impact of sleep on CVD outcomes despite recent evidence showing that sleep duration can influence the timing and amount of food eaten. In this article, we argue that as TRE and sleep influence each other, and influence the same cardiometabolic parameters, experiencing inadequate sleep may attenuate any positive impact TRE has on CVD. We examine the relationship between TRE and CVD, with sleep as a potential mediator in this relationship, and propose a research agenda to investigate this relationship. This will provide necessary evidence to inform future interventions aimed at reducing the burden of CVD.

Aerobic training with a self-selected or predetermined intensity on sleep parameters in adolescents with obesity: a randomized clinical trial

Objectives

To compare the effects of self-selected and predetermined intensity on sleep quality and duration, daytime sleepiness, and sleep efficiency of adolescents with obesity after 12 weeks of aerobic training.

Material and Methods

Thirty-seven adolescents (12 girls), 13-18 years old, with obesity (BMI = 95th) were randomized into a predetermined intensity group (PIG), exercise intensity around 60-70% of heart rate reserve; or self-selected intensity group (SIG), the adolescents chose the speed/intensity at the beginning of each session and were able to change it every 5 minutes. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to assess sleep outcomes.

Results

No differences were observed for PSQI [0.00 ± 2.00 vs 1.38 ± 2.7; p=0.195; d=0.60 (moderate effect)], sleep duration [-0.95 ± 1.2 vs -0.35 ± 1.6; p=0.358; d=0.41 (small effect)], ESS [(2.10 ± 3.9 vs 1.15 ± 4.5; p=0.195; d=0.23 (small effect)], and sleep efficiency [(81.5 ± 24.0 vs 79.4 ± 17.0; p=0.8.14; d=0.10 (trivial effect)] for the PIG and SIG groups, respectively.

Conclusion

Aerobic training at a self- selected or predetermined intensity does not modulate sleep quality, sleep duration and efficiency, and daytime sleepiness, independent of intensity.

The Role of Dietary Inflammatory Index on the Association Between Sleep Quality and Long-Term Cardiovascular Risk: A Mediation Analysis Based on NHANES (2005-2008)

OBJECTIVE

People with poor sleep quality have higher risk of cardiovascular disease (CVD), and one potential mechanism of CVD is chronic inflammation. The aim of this study was to investigate the role of dietary inflammation in the relationship between sleep quality and CVD risk.

METHODS

This study involved 5594 participants from the National Health and Nutrition Examination Survey (NHANES) in 2005-2008. Sleep quality, dietary inflammation, and 10-year CVD risk were evaluated via the Pittsburgh Sleep Quality Index (PSQI), the Energy-adjusted Dietary Inflammatory Index (E-DII), and the Framingham Risk Score (FRS), respectively. We used generalized additive model (GAM) and mediation analysis to investigate the relationship among sleep quality, 10-year CVD risk, and E-DII.

RESULTS

PSQI had a non-linear relationship with 10-year CVD risk (P < 0.001). Meanwhile, among the participants with poor sleep quality, PSQI was positively associated with increased 10-year CVD risk (P < 0.001) and E-DII (P < 0.001). Furthermore, the association between sleep quality and CVD risk was partially mediated by E-DII, and the mediated proportion was 14.6%, and the mediating effect of E-DII varied in different gender and age groups. However, in the subjects with good sleep quality, the association among PSQI, E-DII, and 10-year CVD risk was not existed.

CONCLUSION

Ten-year CVD risk could be reduced by controlling the intake of inflammatory food, especially for whom with sleep disorders. In general, the reduction of inflammatory diet could weaken the effect of sleep disorders on the CVD risk.

Socio-Ecological Context of Sleep: Gender Differences and Couples' Relationships as Exemplars

PURPOSE OF REVIEW

We summarized recent findings on insufficient sleep and insomnia, two prominent sleep issues that impact public health. We demonstrate the socio-ecologial impact of sleep health with findings on gender and couples' relationships as exemplars.

RECENT FINDINGS

Robust gender differences in sleep duration and insomnia are due to biological and socio-ecological factors. Gender differences in insufficient sleep vary by country of origin and age whereas gender differences in insomnia reflect minoritized identities (e.g., sexual, gender). Co-sleeping with a partner is associated with longer sleep and more awakenings. Gender differences and couples' sleep were affected by intersecting social and societal influences, which supports a socio-ecological approach to sleep. Recent and seminal contributions to sleep health highlight the importance of observing individual sleep outcomes in a socio-ecological context. Novel methodology, such as global measures of sleep health, can inform efforts to improve sleep and, ultimately, public health.

Factors associated with health-related quality of life in women using path analyses: mediation effect of the adiposity traits

Background

The current work aimed to investigate the mediating role of adiposity traits in the relationship between eating behaviors, sleep quality, socio-demographic factors, and the health-related quality of life in women of reproductive age in northwest of Iran.

Methods

In the current cross-sectional study, a total of 278 overweight and obese women of reproductive age (20–49 y) were enrolled. Anthropometric assessments were performed. Pittsburgh sleep quality index (PSQI) was used for assessment of sleep quality while Short Form 36 (SF-36) questionnaire was used to measure health-related quality of life (HRQoL). Three-Factor Eating Questionnaire-R18 (TFEQ-R18) was used to measure eating behaviors. Path analysis was used to test the relationships between parameters.

Results

Age was found to be indirectly and negatively associated with mental component score (MCS) (B = − 0.040; P = 0.049) and physical component score (PCS) (B = − 0.065; P = 0.036) through mediatory effects of obesity. Additionally, education was seen to be indirectly and positively related to MCS (B = 0.529; P = 0.045) and PCS (B = 0.870; P = 0.019), respectively. On the other hand, obesity (B = 0.608; P = 0.018) and PSQI score (B = − 0.240; P = 0.034) had direct associations with MCS. Age (B = − 0.065; P = 0.036) and education (B = 0.870; P = 0.019) were also directly associated with obesity.

Conclusions

Obesity seemed to mediate the effects of socio-demographic parameters on HRQoL. Poor sleep quality was also related to impairment of HRQoL. Further studies are needed to confirm these results.

Association of Daytime Napping with chronic diseases among Tibetan people in China: a cross-sectional study

BACKGROUND

Obesity, diabetes, and hypertension, as three of the most prevalent chronic diseases, remain a daunting health challenge. However, to our knowledge, no study has made a thorough examination of the association between the three chronic diseases and daytime napping, a widely accepted behavior in many countries. This is especially necessary among Tibetan populations, whose lifestyles and health outcomes may be unique, yet patterns of chronic diseases and napping are under-examined. Thus, we sought to explore the aforementioned association in the Tibetan population of China.

METHODS

A total of 2902 participants aged 45-79 in 2019 were included. Multivariate logistic regressions were conducted in 2020. The sex disparity was examined through interaction and stratified analyses.

RESULTS

Hypertension (40.7%) was more prevalent than obesity (20.2%) and diabetes (21.6%). Comparing to non-nappers, those who napped were more likely to have any conditions (OR = 1.30, 95% CI = 1.04-1.62 for 1-59 min/day group and OR = 1.40, 95% CI = 1.10-1.80 for ≥60 min/day group). Participants who had 1-59 min/day of napping were more likely to develop obesity (OR = 1.37, 95% CI = 1.07-1.75), and ≥ 60 min/day of napping was associated with diabetes (OR = 1.33, 95% CI = 1.01-1.74). The interactions between napping and sex were not statistically significant in the models.

CONCLUSIONS

The study revealed napping was unfavorably associated with obesity, diabetes, and any conditions in Tibetan people living on the Tibetan Plateau. Future interventions regarding the three chronic diseases may pay more attention to napping.

TRIAL REGISTRATION

Not applicable.

The association between neighborhood social cohesion and sleep duration in Latinos

OBJECTIVES

To examine the association between neighborhood social cohesion and sleep duration among Latinos, and whether this association varies by Latino subgroup.

DESIGN

We used cross-sectional data from the 2013-2015 National Health Interview Survey (NHIS) on 13,537 Latino adults aged ≥18 years originating from 5 countries/regions (i.e. Latinos of Mexican/Mexican-American, Puerto Rican, Dominican, Central or South American, and Cuban/Cuban-American origin). Multivariate logistic regression models were used to estimate the associations between neighborhood social cohesion and sleep duration, and whether associations varied by Latino subgroup.

RESULTS

Among Mexicans/Mexican-Americans, medium and high levels of neighborhood social cohesion were associated with normal sleep duration, relative to short sleep duration (Odds Ratio [OR]: 1.31; 95% Confidence Interval [CI]: 1.08-1.57, and OR: 1.46; 95% CI: 1.26-1.69, respectively). Among Puerto Ricans, Cubans/Cuban Americans, and Central or South Americans, high neighborhood social cohesion was significantly associated with normal sleep duration (OR: 1.53; 95% Confidence Interval [CI]: 1.10-2.11, OR: 1.94; 95% CI: 1.10-3.42, and OR: 1.78; 95% CI: 1.35-2.34, respectively).

CONCLUSIONS

The variation in the contribution of neighborhood social cohesion to sleep duration by Latino subgroup should be considered in health promotion programs aimed at improving sleep among Latinos.