Time of day effects on the relationship between daily sleep and anxiety: An ecological momentary assessment approach

A sensor-based study on the environmental determinants of sleep in older adults

INTRODUCTION

The residential environment is hypothesized to influence sleep quality within urban settings. Factors associated with the residential environment include air and noise pollution, area socioeconomic status, green and blue spaces, and other neighborhood features. This study seeks to quantify the association of selected environmental factors with sleep quality in the daily lives of 211 older adults residing in the Paris metropolitan area with sensor-based methods.

METHODS

Participants' sleep and physical activity were monitored over a 7-day period using 2 accelerometers. Ecological momentary assessment (EMA) surveys were administered 4 times a day to assess depressive and anxiety symptoms. Environmental factors surrounding participants' residential addresses, including noise and air pollution, walkability, green and blue space availability, median income, and population density, were computed using geoprocessing methods. Hierarchical mixed models with a random intercept at the individual level were fitted to estimate the adjusted association between residential environmental factors and sleep outcomes [total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO)]. Potential effect modification of or mediation by physical activity and depression and anxiety levels were explored in the analyses.

RESULTS

We observed an effect size of 1.4 more minutes of sleep for each increase of one thousand euro in neighborhood median income (Confidence Intervals: 0.35, 2.45). The average adjusted difference in total sleep time between the 10th and 90th percentiles of neighborhood median income was 23.6 minutes of sleep. Other environmental factors and depression and anxiety levels did not exhibit correlations with sleep outcomes.

CONCLUSIONS

The results reveal a positive association between median income at the residential level and TST, while no associations were identified for SE and WASO. In conclusion, these findings underscore the impact of neighborhood socioeconomic status on total sleep time within the context of urban living, highlighting the need for further research.

Insomnia symptoms as long-term predictors of anxiety symptoms in middle-aged and older adults from the English Longitudinal Study of Ageing (ELSA), and the role of systemic inflammation

Insomnia, i.e., difficulties in sleep onset and sleep maintenance, may increase the risk of anxiety symptoms, although long-term follow-up studies are rarely reported. Here, we examined whether insomnia symptoms may predict anxiety symptoms in a 9-year follow-up, and whether inflammation may play a mediating role. Data from 1355 participants (63.44 ± 7.47 years, 55.1 % females) from the English Longitudinal Study of Ageing (ELSA) were analysed. Insomnia symptoms were assessed in 2012/13. High-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, was measured in 2016/17. Anxiety symptoms were assessed in 2020/21. After adjusting for confounders and baseline levels, structural equation modelling (SEM) revealed that insomnia symptoms significantly predicted anxiety symptoms (β = 0.357, p < .001) but not hs-CRP (β = -0.016, p = .634). Similarly, hs-CRP was not related to anxiety symptoms (β = -0.024, p = .453). The hs-CRP mediation hypothesis was therefore rejected (β = 0.0004; 95 % BCI -0.001 to 0.005), and multi-group SEM showed that sex did not moderate these paths. However, baseline diagnoses of anxiety disorders prospectively predicted higher hs-CRP (B = 0.083, p = .030). Results of the current study suggest that individuals with baseline anxiety disorders may be at higher risk of developing low-grade chronic inflammation. Several alternative psychophysiological mechanisms linking insomnia and anxiety symptoms should be explored, including autonomic and cortical pre-sleep arousal, cortisol reactivity, and pro-inflammatory cytokines. Finally, insomnia symptoms may be a treatment target to lower the risk of anxiety symptoms in elderly.

Restless sleep is associated with increased anxiety in physical therapy students: a cross sectional survey study

BACKGROUND

Sleep and mental health are intimately related and shown to impact graduate students enrolled in health sciences programs, including physical therapy education. Doctorate of Physical Therapy (DPT) students' attitudes and behaviors surrounding sleep and whether these factors are associated with mental health are unknown. This study aimed to describe sleep behaviors and attitudes of entry-level DPT students and to explore the relationship between subjectively reported sleep quality and self-reported symptoms of anxiety in these students.

METHODS

A cross-sectional online survey consisting of the Sleep Practices and Attitudes Questionnaire (SPAQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and demographic questions were used. Analyses investigated sleep behaviors and attitudes, along with the relationship (unadjusted odds ratio) between restless sleep and anxiety in DPT students in hybrid and traditional DPT programs across the United States (US).

RESULTS

A total of 271 DPT students completed the survey. A majority of students reported feeling tired during most days (80.8%, n = 219), a quarter of participants (24.7%) reported having a history of trouble sleeping and four (1.5%) reported being diagnosed with a sleep disorder. Of those who reported their sleep duration, participants slept an average of 6.86 h. The mean GAD-7 score was 7.68 (SD = 4.90), suggestive of mild anxiety. Sixty-seven (24.7%) reported having a diagnosed anxiety disorder, with generalized anxiety being the most common diagnosis. Those who reported having restless sleep were 4.09 times more likely to have moderate to severe anxiety [unadjusted odds ratio = 4.09 (95% CI 2.27,7.35; p < 0.001)] compared to those who reported restful sleep.

CONCLUSIONS

DPT students who rated sleep as restless exhibit signs of poor subjective sleep quality associated with an increased risk of experiencing moderate to severe anxiety compared to students who had restful sleep. Students reported behaviors surrounding sleep that may contribute to anxiety. These findings have implications for including sleep and mental health education and practices within DPT programs.

Monitoring Daily Sleep, Mood, and Affect Using Digital Technologies and Wearables: A Systematic Review

Background: Sleep and affective states are closely intertwined. Nevertheless, previous methods to evaluate sleep-affect associations have been limited by poor ecological validity, with a few studies examining temporal or dynamic interactions in naturalistic settings. Objectives: First, to update and integrate evidence from studies investigating the reciprocal relationship between daily sleep and affective phenomena (mood, affect, and emotions) through ambulatory and prospective monitoring. Second, to evaluate differential patterns based on age, affective disorder diagnosis (bipolar, depression, and anxiety), and shift work patterns on day-to-day sleep-emotion dyads. Third, to summarise the use of wearables, actigraphy, and digital tools in assessing longitudinal sleep-affect associations. Method: A comprehensive PRISMA-compliant systematic review was conducted through the EMBASE, Ovid MEDLINE(R), PsycINFO, and Scopus databases. Results: Of the 3024 records screened, 121 studies were included. Bidirectionality of sleep-affect associations was found (in general) across affective disorders (bipolar, depression, and anxiety), shift workers, and healthy participants representing a range of age groups. However, findings were influenced by the sleep indices and affective dimensions operationalised, sampling resolution, time of day effects, and diagnostic status. Conclusions: Sleep disturbances, especially poorer sleep quality and truncated sleep duration, were consistently found to influence positive and negative affective experiences. Sleep was more often a stronger predictor of subsequent daytime affect than vice versa. The strength and magnitude of sleep-affect associations were more robust for subjective (self-reported) sleep parameters compared to objective (actigraphic) sleep parameters.

Daily worry, rumination, and sleep in late life

OBJECTIVE

Perseverative thinking (e.g., worry/rumination) is a common response to stress, and can be detrimental to well-being. Sleep may represent an important mechanism by which perseverative thinking is disrupted or amplified from day to day. This study examined the associations between older adults' everyday worry, rumination, and sleep.

METHODS

Older adults (N = 270) aged 65-89 completed a baseline interview and morning and evening assessments each day for 5-6 days. Every morning, they indicated their worry toward the day and their sleep duration and disturbances the prior night. Every evening, they rated worry and rumination experienced that day.

RESULTS

Multilevel models showed that perseverative thinking predicted worse sleep (i.e., fewer hours of sleep) at the between-person level (B = -0.29, p = .004) but better sleep (i.e., fewer sleep disturbances) at the within-person level (Bs < -0.18, ps < .003). At the within-person level, more hours of sleep (B = -0.06, p = .04) and fewer sleep disturbances (B = 0.10, p < .001) predicted less worry the next morning. Prior night's worry predicted greater next morning's worry, but this association was significant only when older adults reported fewer-than-usual hours of sleep (B = 0.24, p < .001), not when they reported more-than-usual hours of sleep (B = 0.04, p = .61).

CONCLUSION

Findings suggest that worry and rumination are intimately linked with sleep and highlight the protective role that better sleep may play in reducing older adults' everyday perseverative thinking.

Sleep quality and in-person versus online social interaction during the early COVID-19 pandemic lockdown: Impact on affect and interpersonal needs among young adults

We examined relationships among sleep quality and forms of social interaction (in-person vs. online) as predictors of change in affect and interpersonal needs (perceived burdensomeness, thwarted belongingness) - correlates of suicidal thoughts and behaviors - during the early COVID-19 pandemic lockdown. New York City undergraduates (N = 58) from four public colleges completed a baseline survey and daily diaries up to 30 days in April-June 2020. Adjusting for relevant covariates, better sleep quality and in-person communication predicted greater positive affect and lower negative affect over time, but online social interaction only predicted greater positive affect and did not predict negative affect. Better sleep quality predicted lower perceived burdensomeness but not thwarted belongingness. Both in-person and online social interaction - but not total hours on social media - predicted lower thwarted belonging and perceived burdensomeness. Greater hours spent on social media each day lessened the relationship between in-person interaction and positive affect and lessened the buffering effect of in-person interaction on perceived burdensomeness. Improving sleep quality and increasing in-person interaction may ameliorate psychological variables that increase risk for suicidal thoughts and behaviors. However, when in-person interaction is limited, such as during the COVID-19 pandemic, online social interaction might be encouraged - depending on the nature of the interactions - to increase positive affect and buffer against suicide-related factors.

Gut microbiota: Candidates for a novel strategy for ameliorating sleep disorders

The aim of this review was to evaluate the feasibility of treating sleep disorders using novel gut microbiota intervention strategies. Multiple factors can cause sleep disorders, including an imbalance in the gut microbiota. Studies of the microbiome-gut-brain axis have revealed bidirectional communication between the central nervous system and gut microbes, providing a more comprehensive understanding of mood and behavioral regulatory patterns. Changes in the gut microbiota and its metabolites can stimulate the endocrine, nervous, and immune systems, which regulate the release of neurotransmitters and alter the activity of the central nervous system, ultimately leading to sleep disorders. Here, we review the main factors affecting sleep, discuss possible pathways and molecular mechanisms of the interaction between sleep and the gut microbiota, and compare common gut microbiota intervention strategies aimed at improving sleep physiology.

Leveraging deep learning models to understand the daily experience of anxiety in teenagers over the course of a year

INTRODUCTION

Anxiety disorders are a prevalent and severe problem that are often developed early in life and can disrupt the daily lives of affected individuals for many years into adulthood. Given the persistent negative aspects of anxiety, accurate and early assessment is critical for long term outcomes. Currently, the most common method for anxiety assessment is through point-in-time measures like the GAD-7. Unfortunately, this survey and others like it can be subject to recall bias and do not fully capture the variability in an individual's day-to-day symptom experience. The current work aims to evaluate how point-in-time assessments like the GAD-7 relate to daily measurements of anxiety in a teenage population.

METHODS

To evaluate this relationship, we leveraged data collected at four separate three week intervals from 30 teenagers (age 15-17) over the course of a year. The specific items of interest were a single item anxiety severity measure collected three times per day and end-of-month GAD-7 assessments. Within this sample, 40 % of individuals reported clinical levels of generalized anxiety disorder symptoms at some point during the study. The first component of analysis was a visual inspection assessing how daily anxiety severity fluctuated around end-of-month reporting via the GAD-7. The second component was a between-subjects comparison assessing whether individuals with similar GAD-7 scores experienced similar symptom dynamics across the month as represented by latent features derived from a deep learning model. With this approach, similarity was operationalized by hierarchical clustering of the latent features.

RESULTS

The aim clearly indicated that an individual's daily experience of anxiety varied widely around what was captured by the GAD-7. Additionally, when hierarchical clustering was applied to the three latent features derived from the (LSTM) encoder (r = 0.624 for feature reconstruction), it was clear that individuals with similar GAD-7 outcomes were experiencing different symptom dynamics. Upon further inspection of the latent features, the LSTM model appeared to rely as much on anxiety variability over the course of the month as it did on anxiety severity (p < 0.05 for both mean and RMSSD) to represent an individual's experience.

DISCUSSION

This work serves as further evidence for the heterogeneity within the experience of anxiety and that more than just point-in-time assessments are necessary to fully capture an individual's experience.

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSION

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

Tobacco cigarette smokers who endorse greater intolerance for nicotine withdrawal also report more severe insomnia symptoms

It has been suggested that nighttime nicotine withdrawal may help to explain why tobacco cigarette smokers are more likely than nonsmokers to experience clinically significant insomnia. There is also reason to believe that intolerance for withdrawal symptoms could play a role in withdrawal-related sleep disturbance. However, we are not aware of any previous research that examined whether smokers who endorse greater intolerance for smoking abstinence also report greater difficulty initiating and/or maintaining sleep. To address this question, 224 adult cigarette smokers (42.9% female, Mcigarettes per day = 21.3) completed the baseline portion of an experimental study that included assessment of current/historical smoking behavior, perceived intolerance for smoking abstinence, and insomnia severity and impact on functioning. The results indicated that, after accounting for general distress intolerance and sociodemographic factors, smokers who endorsed greater intolerance for nicotine withdrawal also reported greater insomnia severity and impact. Logistic regression further revealed that, for every 1-point increase in nicotine withdrawal intolerance scores, smokers were nearly twice as likely to score above threshold for clinically significant insomnia (p = .001). Collectively, these initial findings suggest that intolerance for nicotine withdrawal may warrant consideration as a potentially modifiable mechanistic factor in comorbid insomnia and nicotine/tobacco dependence. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Changes in telomere length and serum neurofilament light chain levels in female patients with chronic insomnia disorder

STUDY OBJECTIVES

The aims of this study were to explore changes in the telomere length (relative telomere repeat copy/single-copy gene [T/S ratio]) and serum neurofilament light chain (sNfL) levels in female patients with chronic insomnia disorder (CID), examine their relationships with emotional abnormalities and cognitive impairment, and determine whether these 2 indicators were independently associated with sleep quality.

METHODS

The CID group contained 80 patients diagnosed with CID, and 51 individuals constituted a healthy control group. Participants completed sleep, emotion, and cognition assessments. Telomere length was detected through quantitative real-time polymerase chain reaction. Enzyme-linked immunosorbent assay was used to determine sNfL concentrations.

RESULTS

Relative to the healthy control group, the CID group had elevated Pittsburgh Sleep Quality Index, Hamilton Anxiety Scale-14, and Hamilton Depression Rating Scale-17 scores and reduced Montreal Cognitive Assessment scale scores, a decreased T/S ratio, and an increased sNfL concentration. Subgroup analysis according to various CID-associated sleep factors showed that poor sleep performance corresponded to a lower T/S ratio. Higher anxiety levels and more cognitive dysfunction correlated with shorter telomere lengths. The T/S ratio negatively correlated with age, whereas the sNfL concentration positively correlated with age in the CID group. The Pittsburgh Sleep Quality Index score negatively correlated with the T/S ratio but did not correlate with sNfL levels. Multiple linear regression analysis showed that the T/S ratio had a negative and independent effect on Pittsburgh Sleep Quality Index scores.

CONCLUSIONS

The CID group had shorter telomeres and higher sNfL concentrations, and reduced telomere length independently affected sleep quality.

CITATION

Ren C-Y, Liu P-P, Li J, et al. Changes in telomere length and serum neurofilament light chain levels in female patients with chronic insomnia disorder. J Clin Sleep Med. 2022;18(2):383-392.

Between- versus within-person emotional and cognitive reactivity in relation to depressive symptoms

BACKGROUND

Theories connecting depression to emotional reactivity (ER) or cognitive reactivity (CR) have not clearly indicated whether ER and CR are between-person or within-person constructs. Most empirical tests of these theories have focused on either between- or within-person operationalizations of these constructs, but not both. Between- and within-person studies address qualitatively different questions and often generate very different results. Consequently, the goals of the current study were to examine the relation of depressive symptoms to both between- and within-person operationalizations of both ER and CR.

METHODS

Participants were 160 undergraduate students who completed daily diary measures (assessing stress, negative emotions, and negative cognitions) and measures of depressive symptoms. Multilevel modeling (MLM) enabled examination of depressive symptoms to the within- and between-person components of ER and CR.

RESULTS

Depressive symptoms were positively related to within-person ER and CR but not to between-person operationalizations of ER and CR.

LIMITATIONS

The sample only included college students and only assessed depressive symptoms, not clinical diagnoses of major depression.

CONCLUSIONS

Important implications emerge for theory, practice, and future research. We recommend distinguishing between-person from within-person dimensions of ER and CR in future research.

The Associations Between Daily Activities and Affect: a Compositional Isotemporal Substitution Analysis

BACKGROUND

Daily activities are associated with affective experiences. A 24-h day can be separated into five mutually exclusive activity types: sleep, awake in bed, moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), and sedentary behavior (SB). Most research has examined these activities independently and not collectively, yet increased time in one activity must be offset by decreasing other activities. Using compositional isotemporal substitution analyses, this study examined the associations between time spent in daily activities and affect, including both high and low arousal positive and negative affect.

METHOD

Across three separate studies, daily activities and affect were measured throughout 7-15 days (M_days = 10) in 361 healthy community adults (72.5% females, M_age = 22.79 years). Activities were objectively assessed using accelerometry and self-reported affect was assessed using repeated ecological momentary assessments. Minutes spent in each activity and affect values across the three studies were averaged for each participant.

RESULTS

Longer sleep duration at the expense of time awake in bed was associated with lower high arousal negative affect (e.g., nervousness, b =  - 0.24, p = .007). More MVPA at the expense of LIPA or SB was associated with higher high arousal positive affect (e.g., happiness, b = 0.35, p = .027). Activity composition was not associated with low arousal positive or negative affect (all p ≥ .06).

CONCLUSION

Associations between 24-h activity composition and affect differed based on types of activities, types of affect, and the interrelationships between activities within the composition. Findings can aid interventions to develop integrated guidance on the optimal activity patterns for mental health.

Sharper in the morning: Cognitive time of day effects revealed with high-frequency smartphone testing

Decades of research has established a shift from an "eveningness" preference to a "morningness" preference with increasing age. Accordingly, older adults typically have better cognition in morning hours compared to evening hours. We present the first known attempt to capture circadian fluctuations in cognition in individuals at risk for Alzheimer disease (AD) using a remotely administered smartphone assessment that samples cognition rapidly and repeatedly over several days. Older adults (N = 169, aged 61-94 years; 93% cognitively normal) completed four brief smartphone-based testing sessions per day for 7 consecutive days at quasi-random time intervals, assessing associate memory, processing speed, and visual working memory. Scores completed during early hours were averaged for comparison with averaged scores completed during later hours. Mixed effects models evaluated time of day effects on cognition. Additional models included clinical status and cerebrospinal fluid (CSF) biomarkers for beta amyloid (Aβ42) and phosphorylated tau181 (pTau). Models with terms for age, gender, education, APOE ε4 status, and clinical status revealed significantly worse performance on associate memory in evening hours compared to morning hours. Contemporaneously reported mood and fatigue levels did not moderate relationships. Using CSF data to classify individuals with and without significant AD pathology, there were no group differences in performance in morning hours, but subtle impairment emerged in associate memory in evening hours in those with CSF-confirmed AD pathology. These findings indicate that memory is worse in evening hours in older adults, that this pattern is consistent across several days, and is independent of measures of mood and fatigue. Further, they provide preliminary evidence of a "cognitive sundowning" in the very earliest stages of AD. Time of day may be an important consideration for assessments in observational studies and clinical trials in AD populations.

Stress and Sleep Across the Onset of the COVID-19 Pandemic: Impact of Distance Learning on U.S. College Students' Health Trajectories

Study Objectives

This study examined associations between average and intraindividual trajectories of stress, sleep duration, and sleep quality in college students before, during, and after transitioning to online learning due to the COVID-19 pandemic.

Methods

One hundred and sixty-four first-year college students answered twice-weekly questionnaires assessing stress exposure and perception, sleep duration, and sleep quality from January until May, 2020 (N=4,269 unique observations).

Results

Multilevel growth modeling revealed that prior to distance learning, student stress was increasing and sleep duration and quality were decreasing. After transitioning online, students’ stress exposure and perception trajectories immediately and continuously decreased; sleep quality initially increased but decreased over time; and sleep duration increased but then plateaued for the remainder of the semester. Days with higher stress exposure than typical for that student were associated with lower sleep quality, and both higher stress exposure and perception at the transition were linked with simultaneous lower sleep quality. Specific groups (e.g., females) were identified as at-risk for stress and sleep problems.

Conclusion

Although transitioning to remote learning initially alleviated college students’ stress and improved sleep, these effects plateaued, and greater exposure to academic, financial, and interpersonal stressors predicted worse sleep quality on both daily and average levels. Environmental stressors may particularly dictate sleep quality during times of transition, but adaptations in learning modalities may help mitigate short-term detrimental health outcomes during global emergencies, even during a developmental period with considerable stress vulnerability. Future studies should examine longer-term implications of these trajectories on mental and physical health.

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

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

Day-to-day variability in sleep parameters and depression risk: a prospective cohort study of training physicians

While 24-h total sleep time (TST) is established as a critical driver of major depression, the relationships between sleep timing and regularity and mental health remain poorly characterized because most studies have relied on either self-report assessments or traditional objective sleep measurements restricted to cross-sectional time frames and small cohorts. To address this gap, we assessed sleep with a wearable device, daily mood with a smartphone application and depression through the 9-item Patient Health Questionnaire (PHQ-9) over the demanding first year of physician training (internship). In 2115 interns, reduced TST (b = -0.11, p < 0.001), later bedtime (b = 0.068, p = 0.015), along with increased variability in TST (b = 0.4, p = 0.0012) and in wake time (b = 0.081, p = 0.005) were associated with more depressive symptoms. Overall, the aggregated impact of sleep variability parameters and of mean sleep parameters on PHQ-9 were similar in magnitude (both r² = 0.01). Within individuals, increased TST (b = 0.06, p < 0.001), later wake time (b = 0.09, p < 0.001), earlier bedtime (b = - 0.07, p < 0.001), as well as lower day-to-day shifts in TST (b = -0.011, p < 0.001) and in wake time (b = -0.004, p < 0.001) were associated with improved next-day mood. Variability in sleep parameters substantially impacted mood and depression, similar in magnitude to the mean levels of sleep parameters. Interventions that target sleep consistency, along with sleep duration, hold promise to improve mental health.

Sleep quality and its clinical associations in trichotillomania and skin picking disorder

BACKGROUND

Trichotillomania (TTM) is characterized by recurrent hair pulling and associated hair loss. Skin picking disorder (SPD) is characterized by recurrent skin picking and associated scarring or tissue damage. Both disorders are also accompanied by psychological distress and poor sleep. Very little, however, is known about lifestyle variables that may contribute to symptom severity in these disorders.

METHODS

We recruited 87 adults as part of a cross-sectional study of 3 groups (TTM, SPD, and non-affected). Clinical subjects (n=69) were compared with controls (n=18) on sleep quality as measured by Pittsburgh Sleep Quality Index (PSQI). We used partial least squares regression to identify which variables were significantly associated with poor sleep quality among those participants with TTM or SPD.

RESULTS

Clinical subjects had significantly poorer sleep quality than controls. Sleep quality was significantly related to older age, worse perceived stress, lower distress tolerance and greater impulsivity in adults with BFRBs. Poor sleep quality was associated with worse hair pulling symptom severity but not skin picking severity. Higher levels of comorbid mental disorders was also associated with worse sleep, above and beyond the impact of these other variables.

CONCLSUIONS

Poor sleep quality appears to be related to multiple variables. Further research is needed to determine causality and to tailor treatment to specific patient needs.

Assessment of Variability in Irregularly Sampled Time Series: Applications to Mental Healthcare

Variability is defined as the propensity at which a given signal is likely to change. There are many choices for measuring variability, and it is not generally known which ones offer better properties. This paper compares different variability metrics applied to irregularly (nonuniformly) sampled time series, which have important clinical applications, particularly in mental healthcare. Using both synthetic and real patient data, we identify the most robust and interpretable variability measures out of a set 21 candidates. Some of these candidates are also proposed in this work based on the absolute slopes of the time series. An additional synthetic data experiment shows that when the complete time series is unknown, as it happens with real data, a non-negligible bias that favors normalized and/or metrics based on the raw observations of the series appears. Therefore, only the results of the synthetic experiments, which have access to the full series, should be used to draw conclusions. Accordingly, the median absolute deviation of the absolute value of the successive slopes of the data is the best way of measuring variability for this kind of time series.

Caring for anxiety among adults in the face of COVID-19: A cross-sectional online survey

•

Symptoms of anxiety were more prevalent among farmer, people staying out of Beijing during the epidemic, poor sleep, and those who did not exercise.

•

The status of anxiety symptoms were significantly higher than usually, but it were lower than that during Ebola, influenza A and SARS outbreak.

•

Knowledge and perceptions of COVID-19, physical activity, and sleeping time are the main factors affecting anxiety.

Background

The outbreak of COVID-19 poses a challenge to psychological resilience. The aim of this study was to evaluate the prevalence of anxiety and identify risk and protective factors associated with the presence of anxiety symptoms in the face of COVID-19 among adults.

Methods

A cross-sectional online survey was conducted in adults from March 2nd to March 16th 2020. The self-rating anxiety scale (SAS) was used to measure the status of anxiety. Unconditional multivariate logistic regression was performed to identify the factors associated with anxiety.

Results

Among the 7144 respondents, 9.3% met the criteria for anxiety risk based on the SAS. Symptoms of anxiety were more prevalent among farmer (OR=1.43, 95%CI: 1.03-1.99), respondents lived in urban out of Beijing during the COVID-19 outbreak (OR=1.73, 95%CI: 1.14-2.63), and slept less than six hours per day (OR=2.64, 95%CI: 1.96-3.57). Compared to participants who didn’t exercise, a lower risk of anxiety was observed in those exercised 30-60 minutes/day (OR=0.62, 95%CI: 0.41-0.94) and more than 60 minutes/day (OR=0.57, 95%CI: 0.37-0.88). And compared with participants whose knowledge and perceptions of COVID-9 scores in lower quartile, the OR (95%CI) for the second, third and upper quartile were 0.58 (0.46, 0.73), 0.48 (0.37, 0.61) and 0.42(0.33, 0.52), respectively.

Limitations

No diagnostic interview for mental disorders was administered in the original studies limiting analysis of sensitivity and specificity of the Swahili PHQ-9.

Conclusion

There was a high level of anxiety in the face of COVID-19 among adults. The results point to characteristics of adults in particular need for attention to anxiety and suggest possible targets for intervention such as strengthening of physical activity and knowledge and perceptions of COVID-19.

Effects of Presleep Cognitive Intrusions on Subjective Sleep and Next-Day Cognitive Performance in Insomnia

Presleep cognitive intrusions about next-day activities, or proprioceptive and environmental stimuli, are thought to trigger insomnia in neurocognitive models. Recent research showed that intrusive cognitions at bedtime may interact with sleep in influencing next-day emotional functioning; their effects on cognitive functioning, however, is largely unknown. We tested the effects of presleep cognitive intrusions on subjective sleep and next-day cognitive performance in 80 participants, either with chronic insomnia or good sleepers. Presleep intrusions were inspected using a validated questionnaire and sleep was assessed with a sleep diary. Cognitive functioning the following morning was measured using a task-switching paradigm assessing executive functions. Structural equation modeling with manifest variables (i.e., path analysis) shows that presleep cognitive intrusions predicted increased sleep onset latency and wake after sleep onset, and lowered sleep efficiency. Moreover, task-switching accuracy was independently predicted by presleep cognitive intrusions in the previous night in those with insomnia but not in controls, beyond the effects of trait anxiety, task-switching components, and previous night's sleep. Findings confirm detrimental effects of presleep intrusions on sleep continuity and suggest the presence of links between presleep conscious activity and next-day executive performance in patients with insomnia, with the need to better elucidate potential mediators.

Linking inhibition and anxiety symptoms following sleep restriction: The moderating role of prior sleep efficiency

Although sleep loss increases state anxiety, the effects of partial sleep restriction on specific anxiety symptoms and mechanisms that may influence this relation remain unknown. It is also unknown whether prior sleep buffers the impact of sleep restriction on anxiety symptoms. Thus, the present study examined the relations between inhibition and repetitive negative thinking (RNT), obsessions, and other OCD symptoms following sleep restriction and the moderating role of prior night's sleep efficiency. Healthy sleeping adults (n = 73) completed measures of inhibition, anxiety symptoms, and sleep before and after one night of sleep restriction (4 h between 4:00am and 8:00am). Results indicate significant associations between decreased post-sleep restriction inhibition and increased post-sleep restriction RNT and obsessions. Prior night's subjective and objective sleep efficiency significantly moderated these relations, such that the highest post-sleep restriction anxiety symptoms were reported by those with the lowest post-sleep restriction inhibition and the lowest pre-sleep restriction sleep efficiency. These findings suggest decreased inhibition may be one mechanism by which sleep loss affects anxiety, and those with worse sleep prior to acute sleep loss may be particularly vulnerable. The implications for the prevention and treatment of anxiety-related disorders characterized by intrusive cognition are discussed.

Differential associations between chronotype, anxiety, and negative affect: A structural equation modeling approach

BACKGROUND

Increasing evidence implicates circadian rhythms, including chronotype, in anxiety symptoms and disorders. However, it remains unclear whether this relation is accounted for by sleep disturbance. Likewise, given overlap between anxiety and negative affect, a unique link between chronotype and anxiety remains to be established. The present study addressed these questions using a multimethod approach to determine whether there is a unique relation between chronotype and anxiety symptoms, controlling for sleep disturbance.

METHODS

Indicators of chronotype, sleep disturbance, anxiety, and negative affect were collected in a sample of adults (N = 151) using a combination of subjective and behavioral measures both within and outside the laboratory over a 9-day period. Structural equation modeling was used to examine associations between latent constructs.

RESULTS

Results revealed significant associations between sleep disturbance and both anxiety and negative affect. A significant association was found between chronotype and anxiety, over and above the effect of sleep disturbance. In contrast, the relation between chronotype and negative affect was nonsignificant after controlling for sleep disturbance.

LIMITATIONS

Unselected sample, lack of experimental manipulation, cross-sectional design.

CONCLUSIONS

These findings suggest a unique role of chronotype in anxiety and point to circadian disruption as a potential biological mechanism in anxiety-related disorders.