Sleep debt and depression in female college students

Sleep quality and executive function in a diverse sample of healthy young adults

Few studies examine the relationship between sleep and executive function in diverse samples of young adults. Our research aims to fill this gap by analyzing how self-reported sleep quality is related to informant-rated executive function as a whole and its working memory component in a diverse sample of 29 healthy college students. Using the self-report measure, the Pittsburgh Sleep Quality Index (PSQI), we divided our sample into two groups based on cutoff criteria (score ≥5: poor sleep): good sleep quality (n = 11) and poor sleep quality (n = 18). Participants were on average 20.86 years old. Informants rated participants' executive functioning and working memory using the Frontal Systems Behavior Scale (FrSBe) and Behavior Rating Inventory of Executive Function (BRIEF). Individuals in the poor sleep quality group were reported as having significantly worse executive function and working memory scores. Young adult college students who report less than 7 hours of sleep per night have lower scores on informant measures of working memory and executive function. This study raises awareness about how self-reported sleep experiences are related to other's observation of cognitive abilities in everyday life in a diverse young adult sample.

Higher caffeine consumption is associated with insufficient sleep time in Brazilian adults (CUME study)

We aimed to evaluate the association between caffeine intake and sleep time in Brazilian adults. This cross-sectional study was conducted with 6,356 participants from the Cohort of Universities of Minas Gerais (CUME Study). Data was collected through an online self-report questionnaire. Of the total, 31.9% of the participants had insufficient sleep. Women were found to sleep less than men (64.1 vs. 35.9%; p < 0.001), as well as being more likely to consume higher doses of caffeine (55.2%, p < 0.001). Coffee (35.7%), dark chocolate (25.2%), milk chocolate (15.2%), and diet soda (11.0%) were the foods that more contributed to caffeine intake. Individuals in the highest quartile of caffeine intake (87.0 - 572.0 mg/day) had a 19% higher prevalence of insufficient sleep compared with the lowest quartile (PR: 1.19; 95%CI: 1.08 - 1.31). Future studies are needed to investigate the genetic and hormonal factors involved in the interindividual response in this population.

Prevalence of self-reported symptoms of temporomandibular disorders and associated factors in the period of distance learning

OBJECTIVE

Assess the prevalence of self-reported TMD symptoms and anxiety and check the quality of sleep and life during the distance learning period in university students at the University of Brasilia (UnB).

MATERIALS AND METHODS

The participants were students from the Health Sciences College and Medicine College at UnB. Self-administered questionnaires were used to evaluate symptoms of TMD, quality of life, and sleep quality. One-way analysis of variance, followed by Bonferroni test, and Kruskal-Wallis test, followed by Dunn's test, were performed (P < 0.05). For qualitative data analysis, the chi-square test was applied (P < 0.05).

RESULTS

Total 156 students were included; prevalence of TMD, anxiety, sleep disturbance, and poor sleep quality was 73.1%, 84%, 12.8%, and 62.8%, respectively. A greater prevalence of painful TMD was observed in students with severe anxiety (P = 0.007). Students with symptoms of painful TMD, severe anxiety, and sleep disorders had statistically worse quality of life.

CONCLUSIONS

The implementation of distance learning in health courses to replace classroom teaching during the COVID-19 pandemic has impacted TMD prevalence, anxiety, quality of life, and sleep quality.

CLINICAL RELEVANCE

Psychological factors are directly associated with TMD symptoms and quality of life, TMD conditions are related to quality of life as well. COVID-19 pandemic and the distance learning in health courses are new situations that can lead to a great impact on mental health and in consequence to TMD conditions and quality of life.

The impact of sleep–wake problems on health-related quality of life among Japanese nursing college students: a cross sectional survey

Aim

This study was conducted to examine the impact of sleep–wake problems on health-related quality of life of Japanese nursing college students. 

Methods

This cross-sectional study was conducted in 2019 on 150 third and fourth-year nursing college students from two locations in Japan. Insomnia severity was assessed using the Insomnia Severity Index (ISI) and health-related quality of life using the SF-8 questionnaire. The total sleep time (TST) was divided into 3 groups: < 6 h, 6–7 h (reference), and ≥ 7 h. The total ISI score was divided into 2 groups: ≥ 8 points and < 8 points (reference). Logistic regression analysis was performed to evaluate sleep–wake problems related to decline in mental health.

Results

The median mental health indicated in the SF-8 questionnaire was divided into two groups, and the factors causing decline in mental health were investigated. The odds ratios (95% confidence interval) for adjusted ISI ≥ 8 and TST on weekdays < 6 h was 6.51 (2.96–14.30) and 3.38 (1.40–8.17), respectively. Mental health status was significantly lower when ISI ≥ 8 and even lower when TST < 6 h.

Conclusion

Insomnia and short sleep duration are associated with decreased mental health status in nursing college students. Many tended to lack sleep on weekdays. Sleep–wake problems identified while in university should be comprehensively dealt with.

The effect of exercise on academic fatigue and sleep quality among university students

BACKGROUND

Routine academic events may cause fatigue and impair sleep quality. This research aimed to examine the prevalence and risk factors for academic fatigue among college students and its adverse effects on well-being and sleep. A brief exercise intervention was also evaluated.

METHODS

A total of 864 college students (33.5% female) filled out self-reported questionnaires with few open-ended questions. Fatigue and sleep quality were assessed using the translated version of the Smith Well-being Questionnaire and the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Spearman correlations, logistic regression analysis, and t-tests were used to test the hypotheses. In a second study, 29 female participants took part in an exercise intervention aimed at reducing fatigue and improving sleep.

RESULTS

Among the effective respondents, nearly 40% reported higher academic-related fatigue, and a few reported high-quality sleep. Negative coping styles, workload, stress, and disturbed surroundings had a significant positive predictive effect on academic fatigue. In addition, adverse consequences of fatigue were found for physical health and academic-life balance, and a significant, positive relationship was observed between the degree of fatigue and PSQI score (p < 0.01). The exercise study showed some beneficial effects of the intervention for both sleep and fatigue outcomes.

CONCLUSION

Fatigue is common and widely reported among Chinese college students, and it may have a major negative impact on their health. Increased awareness of daily academic fatigue and its impact on college students is important for individuals, schools, and society. Exercise may be a simple way to improve sleep and reduce fatigue.

Sport specialization, sleep, fatigue, and psychosocial ratings: do highly specialized athletes differ from their less specialized peers?

OBJECTIVES

To determine if sleep quality, fatigue, anxiety, depressive symptoms, or perceptions of sport participation differ between high-, moderate-, and low-specialized high school athletes with or without prior injuries.

METHODS

During pre-participation physical examinations (PPE), high school athletes completed questionnaires on sport specialization level, history of time-loss orthopedic injury, perceptions of sport participation, as well as sleep quality (Pittsburgh Sleep Quality Index (PSQI)), fatigue, anxiety, and depressive symptoms (Patient-Reported Outcomes Measurement Information System (PROMIS®)). Athletes were grouped according to sport specialization level and history of prior time-loss orthopedic injury.

RESULTS

A total of 186 athletes completed the study: 49% (n = 92; mean age = 15.3 ± 2.0 yrs; 50% female) were low specialized, 34% (n = 64; mean age = 15.3 ± 1.3 yrs; 47% female) were moderately specialized, and 16% (n = 30; mean age = 15.7 ± 1.1 yrs; 57% female) were highly specialized. Groups were similar for demographics, training volume, and injury history. Compared to the moderate-specialization group, highly specialized athletes reported higher levels of fatigue (3.1 ± 3.7 vs. 1.5 ± 2.2; p = 0.02), anxiety (3.6 ± 4.1 vs. 1.8 ± 2.6; p = 0.02), and depressive symptoms (2.4 ± 4.0 vs. 0.8 ± 2.0; p = 0.02). No differences in psychometric ratings, sleep quality, or perceptions of sport participation were observed between the low/moderate- or low/high-specialization groups. We did not observe any significant differences between groups who did and did not report a history of prior time-loss orthopedic injury.

CONCLUSIONS

Highly specialized high school athletes report higher levels of fatigue, more anxiety symptoms, and more depressive symptoms than their moderately specialized peers, despite no differences in training volume or injury history. Low specialized athletes did not differ from moderately specialized or highly specialized athletes in the aforementioned domains, and there were no differences in sleep quality across specialization groups. These findings add to the current body of literature on early sport specialization by illustrating the distinctive psychosocial implications of sport specialization and demonstrating the need for further prospective research.

Later school start time is associated with better academic performance, sleep-wake rhythm characteristics, and eating behavior

There are numerous studies which show that an early school start time has a negative impact on the sleep, well-being, and academic performance of students. There is not enough information on the association between school start time and eating disorders, however: the disruption of the circadian rhythm is known to be a risk factor for eating disorders. The aim of this study is to analyze the relationship between school start time (SST) and the sleep, well-being, academic performance, and eating behavior of children and adolescents. The study was conducted in April and May 2021 in two regions of Russia: the Komi Republic and Yekaterinburg. The online study involved the anonymous and voluntary participation of 6571 students in grades 6-11 (mean age: 14.5 ± 1.6 years, 60.1% female), who have morning classes. All participants were divided into three groups according to SST: 08:00 (n = 3661), 08:30 (n = 2020), and 09:00 (n = 890). Each participant of the study indicated their place of residence, SST, age, sex, height, weight, academic performance, and filled out the Munich Chronotype Questionnaire, the Zung Self-Rating Depression Scale, and the Yale Food Addiction Scale for Children. As a result of multiple regression analysis, it was shown that schoolchildren with SST of 09:00 wake up at a later time on school days (B = 0.432; ΔR² = 0.039), sleep more (B = 0.293; ΔR² = 0.004), have less pronounced social jetlag (B = -0.223; ΔR² = 0.005) and sleep loss (B = -0.292; ΔR² = 0.005), and higher academic performance (B = 0.113; ΔR² = 0.003) than schoolchildren with SST of 08:00. As a result of logistic regression analysis, it was found that the frequency of the detection of food addiction is ~30% lower in schoolchildren with SST of 09:00 (OR = 0.690; 95% CI = 0.485-0.981) than in their peers with SST of 08:00. Thus, an overly early SST in Russia has a negative impact on the sleep function, academic performance, and eating behavior of children and adolescents.

University Students' Sleep and Mental Health Correlates in South Korea

Sleep closely relates to emotional instability. Recent studies report an increase in young adults’ poor sleep and associated mental health problems, including attention deficit hyperactivity disorder (ADHD), anxiety, depression, and so on. However, the information on related modifiable factors of these variables is still lacking. This cross-sectional study examined the association of sleep patterns and sleep quality with ADHD and depression in university students. A total of 290 participants aged 18−27 (Mean = 22.0, SD = 2.1) completed a structured questionnaire consisting of the Pittsburgh Sleep Quality Index (PSQI), the Adult ADHD, and the Center for Epidemiologic Studies Depression scales (CES-D). Of the participants, more than half (52.7%) slept 6 to 8 h per night, and 37% slept less than 6 h. Only 10% reported they went to bed before midnight; 40% went to sleep after 2 am. The mean PSQI score was 5.9 (SD = 2.9) for total participants and significantly correlated with ADHD scores and with depression scores. After adjusting for covariates, PSQI significantly aligned with increased risk for ADHD (β = 0.29, p = 0.036) and depression (β = 0.67; p < 0.001). Late bedtime was a significant factor for depression only. Sleep quality rather than sleep pattern significantly related to ADHD scores, whereas both sleep quality and bedtime aligned with depression scores. Additional studies are needed to develop strategic interventions for university students with ADHD and depression as well as underlying mechanisms.

The Effects of Objective Push-type Sleep Feedback on Habitual Sleep Behavior and Momentary Symptoms in Daily Life: Mobile Health Intervention Trial using a Healthcare IoT System (Preprint)

Background

Sleep is beneficial for physical and mental health. Several mobile and wearable sleep-tracking devices have been developed, and personalized sleep feedback is the most common functionality among these devices. To date, no study has implemented an objective push-type feedback message and investigated the characteristics of habitual sleep behavior and diurnal symptoms when receiving sleep feedback.

Objective

We conducted a mobile health intervention trial to examine whether sending objective push-type sleep feedback changes the self-reported mood, physical symptoms, and sleep behavior of Japanese office workers.

Methods

In total, 31 office workers (mean age 42.3, SD 7.9 years; male-to-female ratio 21:10) participated in a 2-arm intervention trial from November 30 to December 19, 2020. The participants were instructed to indicate their momentary mood and physical symptoms (depressive mood, anxiety, stress, sleepiness, fatigue, and neck and shoulder stiffness) 5 times a day using a smartphone app. In addition, daily work performance was rated once a day after work. They were randomly assigned to either a feedback or control group, wherein they did or did not receive messages about their sleep status on the app every morning, respectively. All participants wore activity monitors on their nondominant wrists, through which objective sleep data were registered on the web on a server. On the basis of the estimated sleep data on the server, personalized sleep feedback messages were generated and sent to the participants in the feedback group using the app. These processes were fully automated.

Results

Using hierarchical statistical models, we examined the differences in the statistical properties of sleep variables (sleep duration and midpoint of sleep) and daily work performance over the trial period. Group differences in the diurnal slopes for mood and physical symptoms were examined using a linear mixed effect model. We found a significant group difference among within-individual residuals at the midpoint of sleep (expected a posteriori for the difference: −15, 95% credible interval −26 to −4 min), suggesting more stable sleep timing in the feedback group. However, there were no significant group differences in daily work performance. We also found significant group differences in the diurnal slopes for sleepiness (P<.001), fatigue (P=.002), and neck and shoulder stiffness (P<.001), which was largely due to better scores in the feedback group at wake-up time relative to those in the control group.

Conclusions

This is the first mobile health study to demonstrate that objective push-type sleep feedback improves sleep timing of and physical symptoms in healthy office workers. Future research should incorporate specific behavioral instructions intended to improve sleep habits and examine the effectiveness of these instructions.

Sleep Insufficiency and Baseline Preseason Concussion-Like Symptom Reporting in Youth Athletes

OBJECTIVE

To examine the association between insufficient sleep and baseline symptom reporting in healthy student athletes.

DESIGN

Cross-sectional cohort study.

SETTING

Preseason testing for student athletes.

PARTICIPANTS

Student athletes (n = 19 529) aged 13 to 19 years who completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), including the number of hours slept the night before, and denied having developmental/health conditions, a concussion in the past 6 months, and a previous history of 2 or more concussions.

INDEPENDENT VARIABLES

Total hours of sleep the night before testing (grouped by ≤5, 5.5-6.5, 7-8.5, and ≥9 hours), gender, and concussion history.

MAIN OUTCOME MEASURES

Symptom burden on the Post-Concussion Symptom Scale (modified to exclude sleep-related items), cognitive composite scores, and prevalence of athletes who reported a symptom burden resembling the International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS).

RESULTS

Fewer hours of sleep, gender (ie, girls), and 1 previous concussion (vs 0) were each significantly associated with higher total symptom scores in a multivariable model (F = 142.01, P < 0.001, R2 = 0.04). When a gender-by-sleep interaction term was included, the relationship between sleep and symptoms was stronger for girls compared with boys. In healthy athletes who slept ≤5 hours, 46% of girls and 31% of boys met the criteria for ICD-10 PCS compared with 16% of girls and 11% of boys who slept ≥9 hours. Sleep duration was not meaningfully associated with neurocognitive performance.

CONCLUSIONS

Insufficient sleep the night before testing is an important factor to consider when interpreting symptom reporting, especially for girls. It will be helpful for clinicians to take this into account when interpreting both baseline and postinjury symptom reporting.

The mediating effect of cognitive appraisal on the relationship between sleep habits and the stress response among Japanese female college students

Background

Undergraduate students tend to develop “evening-type” sleep patterns. Recent research has reported that evening-type and irregular sleep habits are related to physical and mental stress responses, particularly in female students. Although the connection between sleep habits and the stress response has been well documented, the mechanism behind this relationship is currently unknown. Using the transactional model as a framework and female students as our target population, we examined whether sleep habits predict the stress response through the mediation of cognitive appraisals of one’s own sleep habits.

Methods

Three hundred twenty-one Japanese female college students participated in this study. Participants completed measures of their sleep habits (sleep patterns and sleep irregularity), cognitive appraisals of their sleep habits (including four subscales: commitment, appraisal of influence, appraisal of threat, and controllability), stress responses (depression and anxiety), and control factors. The reliability and validity of the scales used in this study, except for sleep pattern and sleep irregularity, were confirmed in previous studies.

Results

Multiple-mediation-model analysis indicated that commitment mediates the relationship between sleep pattern and anxiety. Meanwhile, cognitive appraisals, as a whole, were found to have a mediating effect on the relationship between sleep irregularity and depression.

Conclusions

Our study revealed that cognitive appraisals mediated the relationship between sleep habits and the stress response. The findings also suggest that maintaining a low level of commitment might be effective for reducing anxiety, especially considering the difficulty associated with changing lifestyles. The findings of the present study should be useful for health education related to lifestyle.

Sleep health, diseases, and pain syndromes: findings from an electronic health record biobank

STUDY OBJECTIVES

Implementation of electronic health record biobanks has facilitated linkage between clinical and questionnaire data and enabled assessments of relationships between sleep health and diseases in phenome-wide association studies (PheWAS). In the Mass General Brigham Biobank, a large health system-based study, we aimed to systematically catalog associations between time in bed, sleep timing, and weekly variability with clinical phenotypes derived from ICD-9/10 codes.

METHODS

Self-reported habitual bed and wake times were used to derive variables: short (<7 hours) and long (≥9 hours) time in bed, sleep midpoint, social jetlag, and sleep debt. Logistic regression and Cox proportional hazards models were used to test cross-sectional and prospective associations, respectively, adjusted for age, gender, race/ethnicity, and employment status and further adjusted for body mass index.

RESULTS

In cross-sectional analysis (n = 34,651), sleep variable associations were most notable for circulatory system, mental disorders, and endocrine/metabolic phenotypes. We observed the strongest associations for short time in bed with obesity, for long time in bed and sleep midpoint with major depressive disorder, for social jetlag with hypercholesterolemia, and for sleep debt with acne. In prospective analysis (n = 24,065), we observed short time in bed associations with higher incidence of acute pain and later sleep midpoint and higher sleep debt and social jetlag associations with higher incidence of major depressive disorder.

CONCLUSIONS

Our analysis reinforced that sleep health is a multidimensional construct, corroborated robust known findings from traditional cohort studies, and supported the application of PheWAS as a promising tool for advancing sleep research. Considering the exploratory nature of PheWAS, careful interrogation of novel findings is imperative.

Sleep quality relates to emotional reactivity via intracortical myelination

A good quality and amount of sleep are fundamental to preserve cognition and affect. New evidence also indicates that poor sleep is detrimental to brain myelination. In this study, we test the hypothesis that sleep quality and/or quantity relate to variability in cognitive and emotional function via the mediating effect of interindividual differences in proxy neuroimaging measures of white matter integrity and intracortical myelination. By employing a demographically and neuropsychologically well-characterized sample of healthy people drawn from the Human Connectome Project (n = 974), we found that quality and amount of sleep were only marginally linked to cognitive performance. In contrast, poor quality and short sleep increased negative affect (i.e. anger, fear, and perceived stress) and reduced life satisfaction and positive emotionality. At the brain level, poorer sleep quality and shorter sleep duration related to lower intracortical myelin in the mid-posterior cingulate cortex (p = 0.038), middle temporal cortex (p = 0.024), and anterior orbitofrontal cortex (OFC, p = 0.034) but did not significantly affect different measures of white matter integrity. Finally, lower intracortical myelin in the OFC mediated the association between poor sleep quality and negative emotionality (p < 0.05). We conclude that intracortical myelination is an important mediator of the negative consequences of poor sleep on affective behavior.

Proceedings of the Sleep and Epilepsy Workgroup: Section 2 Comorbidities: Sleep Related Comorbidities of Epilepsy

Epilepsy is a chronic disease with multiple, complex comorbidities. Bidirectional relationships exist among seizures, sleep, circadian rhythms, and diseases within and outside of the central nervous system. Seizures fragment sleep and can contribute to development of sleep disorders, which in turn leads to worse overall health and more seizures. Moreover, treatment options are often limited by interactions with anti-seizure medications. Advances in the fields of epilepsy and in sleep medicine have been made separately, and therefore treating patients with these comorbidities necessitates interdisciplinary approach. The focus of this section of the Sleep and Epilepsy Workgroup was to identify methods of collaboration and outline investigational, educational, and treatment priorities to mutually advance what we consider a combined field.

Feasibility, acceptability and affective consequences of at-home sleep extension in young women with depressive symptoms: A pilot study

Insufficient sleep is common in young adults and has meaningful consequences for daytime functioning, including increased sleepiness, affective disruption and depressive symptoms. This study provides a preliminary evaluation of the feasibility, acceptability and affective consequences of extended sleep opportunity in young women with insufficient sleep and depressive symptoms. Participants were 32 women, 18-22 years of age, who regularly obtained less than 8-hr sleep/night and had daytime sleepiness and depressive symptoms at or above population averages. Participants were asked to maintain a sleep schedule of their typical duration for 7 days and were then randomly assigned to either extend sleep opportunity (ESO) by 90 min per night or maintain typical sleep opportunity (TSO), for the next 7 days. Sleep characteristics and daytime sleepiness were measured using continuous actigraphy and daily sleep diary, and affect, stress and depressive symptoms were assessed with daily and weekly questionnaires. Extended sleep opportunity increased sleep duration by over 1 hr, improved morning sleepiness and positive affect, and diminished anhedonia and depressive symptoms in study completers (n = 11 ESO, 11 TSO). However, 31.3% of participants (n = 10) were withdrawn from the study due to difficulty maintaining the sleep schedule. These results provide initial evidence that sleep extension is beneficial for young women who usually have inadequate sleep and mood disruption and can maintain a consistent sleep schedule. If extending sleep opportunity improves sleep, daytime sleepiness and affect in young adults who typically have insufficient sleep, it could broaden the range of interventions for sleep and mental wellness.

Estimating daytime sleepiness with previous night electroencephalography, electrooculography, and electromyography spectrograms in patients with suspected sleep apnea using a convolutional neural network

A common symptom of obstructive sleep apnea (OSA) is excessive daytime sleepiness (EDS). The gold standard test for EDS is the multiple sleep latency test (MSLT). However, due to its high cost, MSLT is not routinely conducted for OSA patients and EDS is instead evaluated using sleep questionnaires. This is problematic however, since sleep questionnaires are subjective and correlate poorly with the MSLT. Therefore, new objective tools are needed for reliable evaluation of EDS. The aim of this study was to test our hypothesis that EDS can be estimated with neural network analysis of previous night polysomnographic signals. We trained a convolutional neural network (CNN) classifier using electroencephalography, electrooculography, and chin electromyography signals from 2,014 patients with suspected OSA. The CNN was trained to classify the patients into four sleepiness categories based on their mean sleep latency (MSL); severe (MSL < 5min), moderate (5 ≤ MSL < 10), mild (10 ≤ MSL < 15), and normal (MSL ≥ 15). The CNN classified patients to the four sleepiness categories with an overall accuracy of 60.6% and Cohen's kappa value of 0.464. In two-group classification scheme with sleepy (MSL < 10 min) and non-sleepy (MSL ≥ 10) patients, the CNN achieved an accuracy of 77.2%, with sensitivity of 76.5%, and specificity of 77.9%. Our results show that previous night's polysomnographic signals can be used for objective estimation of EDS with at least moderate accuracy. Since the diagnosis of OSA is currently confirmed by polysomnography, the classifier could be used simultaneously to get an objective estimate of the daytime sleepiness with minimal extra workload.

The Effects of Circadian Rhythm Disruption on Mental Health and Physiological Responses among Shift Workers and General Population

Background: The effect of circadian disruption on the bio-psychological clock system has been widely studied. However, the mechanism and the association of circadian rhythm disruption with mental health and physiological responses are still unclear. Therefore, this study was conducted to investigate the effects of circadian rhythm disruption on mental health and physiological responses among shift workers and the general population. Methods: A total of 42 subjects participated in this quasi-experimental study. Participants were divided into a group of shift workers (n = 20) and a general population group (n = 22). Polysomnography tests, blood tests (cortisol, triglycerides and glucose), and psychological tests (Abbreviated Profile of Mood States, General Health Questionnaire-28, Working Memory and Processing Speed Indexes of the Wechsler Adult Intelligent Scale (WAIS-IV) were used to examine the effects of circadian rhythm disruption. Results: The results showed a significant relationship between circadian rhythm disruption and mood (r = 0.305, p < 0.05). The findings of this study also indicated that there was a significant effect of circadian rhythm disruption on mood (F(2,40) = 8.89, p < 0.001, η² =0.182), processing speed (F(2,40) = 9.17, p < 0.001, η² = 0.186) and working memory (F(2,40) = 4.963, p < 0.01, η² = 0.11) in shift workers and the general population. Conclusions: Our findings showed that circadian rhythm disruption affects mood and cognitive performance, but it does not significantly affect psychological wellbeing and physiological responses. Future studies are warranted to examine moderator and mediator variables that could influence the circadian rhythm disruption.

Self-reported depressive symptoms in dental students: Systematic review with meta-analysis

OBJECTIVE

This study aimed to systematically review the literature about the prevalence of self-reported depressive symptoms in dental students.

METHODS

PUBMED, SCOPUS, and EMBASE databases were search up to January 2020 with the following focused questions: "What is the prevalence of self-reported depression symptom in dental students?" and "Are sex and years of educational training associated with self-reported depressive symptom in dental students?". Observational studies that applied a questionnaire assessing depression were eligible. Standard mean differences (SMD) and pooled odds ratios (OR) were calculated for the questionnaires' scores and self-reported depressive symptom, respectively.

RESULTS

Fifty-eight studies were included, and 15 different questionnaires were used. The prevalence of self-reported depressive symptoms/at least mild depression ranged from 2.75% to 89.84%, and the pooled overall prevalence was 29% (95% confidence interval [CI]: 26-34). Meta-analysis showed significantly lower scores in the questionnaires for self-reported depressive symptoms of male students (SMD: -0.22; 95% CI: -0.42 - -0.03). Conversely, no significant difference was detected for the OR of self-reported depressive symptom in the comparison between sex (OR: 1.11 - 95% CI: 0.77-1.62). Similarly, no significant difference was observed for the different school years regardless of the analytical strategy used.

CONCLUSION

It was concluded that female dental students presented more self-reported depressive symptoms, but no difference is demonstrated during the years of dental education.

Sleep Quality, Sleep Structure, and PER3 Genotype Mediate Chronotype Effects on Depressive Symptoms in Young Adults

Depression and its related mood disorders are a major global health issue that disproportionately affects young adults. A number of factors that influence depressive symptoms are particularly relevant to the young adult developmental stage, including sleep loss, poor sleep quality, and the tendency toward eveningness in circadian preferences. However, relatively few studies have examined the relationship between sleep and circadian phenotypes, and their respective influences on mood, or considered potential molecular mechanisms driving these associations. Here, we use a multi-year, cross-sectional study of 806 primarily undergraduates to examine the relationships between sleep-wake chronotype, sleep disturbance, depression and genotypes associated with the PER3 variable number of tandom repeats (VNTR) polymorphism-circadian gene variants associated with both chronotype and sleep homeostatic drive. In addition, we use objective, Fitbit-generated sleep structure data on a subset of these participants (n = 67) to examine the relationships between chronotype, depression scores, actual measures of sleep duration, social jetlag, and the percent of deep and rapid eye movement (REM) sleep per night. In this population, chronotype is weakly associated with depressive symptoms and moderately correlated with self-reported sleep disturbance. Sleep disturbance is significantly associated with depression scores, but objective sleep parameters are not directly correlated with Beck Depression Inventory (BDI-II) scores, with the exceptions of a moderate correlation between social jetlag and depression scores in females and a marginal correlation between sleep duration and depression scores. Multiple regression and path analyses reveal that chronotype effects on depressive symptoms in this population are mediated largely by sleep disturbance. The PER3 VNTR genotype significantly predicts depressive symptoms in a model with objective sleep parameters, but it does not significantly predict depressive symptoms in a model with chronotype or subjective sleep disturbance. Interestingly, PER35,5 genotypes, in males only, are independently related to chronotype and depression scores. Our results support hypotheses linking subjective sleep quality and chronotype and provide a first step in understanding how objective sleep structure may be linked to chronotype and depressive symptoms. Our results also suggest that circadian gene variants may show sex-specific effects linking sleep duration and sleep structure to depression.

The effect of regular aerobic exercise on sleep quality and fatigue among female student dormitory residents

Background

Emerging research shows a high prevalence of fatigue and sleep problems among university students. The present study evaluates the effects of regular aerobic exercise on sleep quality and fatigue level among female students (ages 18–26) who reside in dormitories.

Methods

This quasi-experimental study involving 67 participants consisted of one experimental group (i.e., assigned aerobic exercise) and one control group (i.e., not assigned aerobic exercise). Participants in the experimental group received three one-hour sessions aerobic exercise weekly ranging from mild to moderate intensity for eight-week. Sleep quality and fatigue level were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and standard Multidimensional Fatigue Inventory (MFI-20), respectively. These variables were assessed at baseline, week four, and week eight of the study.

Results

After four and 8 weeks of the intervention, participants in the aerobic group showed improvement in the score of sleep quality (p < 0.001 and p < 0.0001, respectively) and its components (except for sleep duration after 4 weeks intervention). Also, aerobic exercise resulted in a significant reduction of the total score of fatigue and its dimensions in weeks four and eight, compared to the control group (p < 0.001).

Conclusions

Four-week aerobic exercise with mild intensity had no significant effect on sleep duration. Conversely, intensified aerobic exercise for 8 weeks influenced all components of sleep quality.

Trial registration

The study was registered on 6/2/2015 in the Iranian Registry of Clinical Trials (IRCT) with number IRCT201412282324N15.

The relationship between depressive symptoms, somatic complaints, and concussion history with poor sleep in collegiate athletes

OBJECTIVE

Ongoing exploration of factors related to poor sleep in collegiate athletes is important as understanding of the risks and consequences of poor sleep in this specific population increases.

DESIGN

Retrospective cohort study.

SETTING

University in the Pacific Northwest.

PARTICIPANTS

One-hundred thirty-seven male and female collegiate athletes across 5 collision, contact, and limited contact team sports.

MEASUREMENTS

Depressive symptoms (Patient Health Questionnaire 9; PHQ-9), anxiety symptoms (General Anxiety Disorder 7; GAD-7), and somatic complaints (Patient Health Questionnaire 15; PHQ-15). Sleep quality (Pittsburgh Sleep Quality Index; PSQI) used both a cutoff score ≥6 and a cutoff score of ≥8, indicating "poor sleep quality" to reduce threats to divergent validity.

RESULTS

Poor sleep quality as defined by PSQI ≥ 6 was present in 53% of athletes, and as defined by PSQI ≥ 8 was identified in 33.5% of the cohort. There were no differences in the incidence of poor sleepers between sport, race/ethnicity, or sex. Multiple regression analysis revealed that depressive symptoms, somatic complaints, Caucasian race, male sex, and number of concussions were significant predictors of poor sleep (P < .05). The model accounted for 43% of the variance in PSQI and primarily by depressive symptoms explaining 9% of reported sleep quality variability. Anxiety symptoms, sport category, and history of migraines were not significant predictors of poor sleep quality.

CONCLUSIONS

A high incidence of poor sleep among collegiate athletes was observed regardless of sport, and may be related to depressive symptoms, somatic complaints, Caucasian race, male sex, and historical number of concussions.

Relationships between sleep, exercise timing, and chronotype in young adults

To examine the relationships between exercise timing, chronotype, sleep, and mood, college students (N = 909, 19.6 ± 1.4 years, 38% female) completed questionnaires immediately after exercising. Evening exercisers had later bedtimes, poorer sleep quality, and lower sleep efficiency compared to morning exercisers. Evening chronotypes reported poorer sleep quality, greater daytime dysfunction, and less positive affect compared to morning/neither chronotypes. Chronotype moderated the relationship between exercise timing and bedtime; with each minute delay in exercise timing, bedtime was delayed by 6.1 minutes in morning-types and only 3.6 minutes in evening-types. University health initiatives should target evening exercisers to mitigate the consequences of prolonged insufficient sleep.

Sex-specific associations between sleep and mental health in university students: a large cross-sectional study

Objective: To examine the associations between sleep problems and mental health dimensions in university students, and the effect of sex on these associations. Participants: Self-reported survey data from 3,483 students aged 18-30 years was drawn from a larger web-based study (i-Share) conducted in France in the years 2013-2017. Methods: We performed logistic regression analyses stratified by sex using insufficient sleep duration, poor sleep quality, difficulty initiating sleep and excessive daytime sleepiness, in relation with stress, self-esteem, depression and anxiety. Results: All sleep problems were strongly associated with all mental health dimensions, particularly anxiety, in female students. Sleep and mental health problems were also associated in male students, with the exception of low self-esteem, but odds ratios were lower than for female students. Conclusions: Present findings warrant attention to propose early interventions targeting sleep and mental health in the university setting taking sex into account.

Insomnia Disorder and Behaviorally Induced Insufficient Sleep Syndrome: Prevalence and Relationship to Depression in College Students

Background: College students are at increased risk for sleep disorders, including insomnia disorder and obtaining less than 6.5 hr of sleep per night by choice, or behaviorally induced insufficient sleep syndrome (BIISS). These disorders can have deleterious daytime consequences, including depression. This study aims to establish the prevalence of insomnia and BIISS disorders and examine associations of insomnia and BIISS with other sleep characteristics and depression. Methods: A subset of data from Spit for Science, a college risk behaviors and health study (n = 989) was used. Insomnia and BIISS were defined as mutually exclusive disorders, based on diagnostic criteria. Results: A majority (68%) of students were categorized as normal sleepers, followed by insomnia (22%), and BIISS (10%). Sleep duration was comparable between BIISS and insomnia, while daytime sleepiness was significantly higher in BIISS, and sleep latency was longer in insomnia (m = 44 vs. m = 13 min). Insomnia was associated with the highest depression symptoms, followed by BIISS, and normal sleep, controlling for demographics. Insomnia was associated with twice the risk of moderate or higher depression compared to normal sleep (CI: 1.60, 2.70, p < .001). Conclusion: These findings highlight the sleep difficulties endemic to college populations. Further, this study provides the first prevalence estimation of BIISS in college students and the first comparison of insomnia and BIISS on sleep characteristics and depressive symptoms. This study underscores the importance of targeted screening and intervention to improve both sleep and depression in this vulnerable population.

Sleep debt and prevalence of proteinuria in subjects with short sleep duration on weekdays: a cross-sectional study

STUDY OBJECTIVE

Short sleep duration is a risk factor of chronic kidney disease, along with cardiovascular diseases and all-cause mortality. Several studies reported that many people sleep longer on weekends than on weekdays, suggesting that they should be compensated for their sleep debt on weekdays on the weekends. Few studies have reported the clinical impact of sleep debt on the kidney.

METHODS

This cross-sectional study included 5799 employees of Osaka University who visited its Health Care Center for their annual health examinations and answered ≤ 6 h of sleep duration on weekdays. The independent variable was the sleep debt index defined as a gap in self-reported sleep duration (≤ 5, 5-6, 6-7, 7-8, 8-9, and ≥ 9 h) between weekdays and weekends, which was categorized into ≤ 0, + 1, + 2, + 3 and ≥+4. An association between the sleep debt index and a prevalence of proteinuria defined as dipstick proteinuria of ≥ 1 + was assessed using logistic regression models adjusting for clinically relevant factors.

RESULTS

More than four-fifths of the subjects had a positive sleep debt index (≤ 0, + 1, + 2, + 3, and ≥+4 recorded for 19%, 36%, 28%, 11%, and 6%, respectively). The multivariable-adjusted logistic regression models showed the sleep debt index ≥ 3 + was significantly associated with the prevalence of proteinuria (sleep debt index ≤ 0, adjusted odds ratio 1.13 [0.77, 1.65]; + 1, 1.00 [reference]; + 2, 1.29 [0.93, 1.79]; + 3, 1.54 [1.02, 2.33]; ≥ + 4, 1.87 [1.15, 3.05]).

CONCLUSIONS

Sleep debt was associated with the prevalence of proteinuria in a dose-dependent manner.

Associations between sleep disturbances, mental health outcomes and burnout in firefighters, and the mediating role of sleep during overnight work: A cross-sectional study

This study investigated whether sleep disorder risk and mental health outcomes in firefighters were associated with burnout, particularly emotional exhaustion, and examined the mediating role of sleep at work in these relationships. A secondary aim was to investigate associations between habitual sleep characteristics and burnout. North American firefighters (n = 6,307) completed the Maslach Burnout Inventory (emotional exhaustion, depersonalisation, personal accomplishment), and were screened for sleep disorders and self-reported current mental health conditions and sleep characteristics. Multiple logistic regression analyses examined associations between sleep, mental health outcomes and burnout. Firefighters screening positive for a sleep disorder, particularly insomnia, had increased risk of emotional exhaustion (adjusted odds ratio 3.78, 95% confidence interval 2.97-4.79). Firefighters self-reporting a current mental health condition were at greater risk of emotional exhaustion (adjusted odds ratio 3.45, 95% confidence interval 2.79-4.27). Sleep during overnight work mediated the impact of having a sleep disorder and mental health condition on high burnout. Sleepiness and sleep deficit (difference between required and actual sleep), even in firefighters without sleep disorder risk, were associated with depersonalisation (adjusted odds ratio 1.65, 95% confidence interval 1.34-2.03 and adjusted odds ratio 1.29, 95% confidence interval 1.06-1.57, respectively) and low personal accomplishment (adjusted odds ratio 1.25, 95% confidence interval 1.07-1.47 and adjusted odds ratio 1.17, 95% confidence interval 1.01-1.35, respectively). Sleep and mental health problems were associated with increased risk of burnout in firefighters, and sleep during overnight work mediated these relationships. The results suggest the need to examine the effectiveness of occupational interventions that improve the opportunity for sleep, together with screening for and treating sleep disorders, to reduce burnout risk.

The relationships between self-efficacy, self-control, chronotype, procrastination and sleep problems in young adults

The main aim of our study was to examine whether there was a relationship between psychological characteristics such as self-efficacy, self-control and chronotype as well as procrastination on the one hand and sleep problems on the other. There were 315 young adults aged between 18 and 27 years (M = 20.57). We used the General Procrastination Scale, the General Self-Efficacy Scale (GSES), Brief Self-Control Scale, the Composite Scale of Morningness (CSM) and the Pittsburgh Sleep Quality Index (PSQI). Our results indicated that low self-efficacy, low self-control and eveningness were positive predictors of procrastination. The reciprocal relationship exists between procrastination and sleep problems. Procrastination positively contributed to sleep problems, whereas sleep problems were a negative predictor of procrastination.

Sleep mediates the association between adolescent screen time and depressive symptoms

OBJECTIVE

This study examined the associations between four types of screen-based activities and depressive symptoms among adolescents. We further investigated whether sleep characteristics (ie, insomnia symptoms and sleep duration) mediate these associations.

METHODS

Data come from 2865 U.S. adolescents (mean age = 15.53, SD = 0.73, 51.8% male) in the age 15 follow-up of the Fragile Families and Child Wellbeing Study. Adolescents completed surveys regarding sleep duration and insomnia symptoms, typical daily duration of four screen activities (social messaging, web surfing, TV/movie watching, and gaming), and depressive symptoms. We constructed a multiple mediation model to elucidate the associations between age 15 screen time, sleep and depressive symptoms, while adjusting for age 9 depressive symptoms.

RESULTS

Structural Equation Modeling analyses revealed that the association between screen time and depressive symptoms is partially or fully mediated by sleep. For social messaging, web surfing and TV/movie watching, the three sleep variables fully mediated the positive association between screen time and depressive symptoms. For gaming, the three sleep variables acted as partial mediators in the model, accounting for 38.5% of the association between gaming and depressive symptoms.

CONCLUSIONS

Our results highlight both screen-based activities and sleep behaviors as potential intervention targets to reduce depressive symptoms among adolescents.

Changes in the amount of sleep and daytime sleepiness: A follow-up study of schoolchildren from ages 10 to 15 years

AIM

This study examines the amount of sleep and daytime sleepiness, and how these change in a follow-up cohort study of school-aged children.

METHODS

A total of 1351 schoolchildren (aged 10) and their parents were invited to participate in the study and were studied again at ages 12 and 15 years. A survey put forth by the Health Behaviour of Schoolchildren research network was used.

RESULTS

The amount of sleep during weekdays dropped significantly from age 10 to 15. At weekends, the amount of sleep increased significantly. During weekdays, the proportion of children reporting having slept enough dropped from 71% at age 10 to 19% at age 15. Frequent daytime sleepiness occurred in 13% of children at age 10 and increased to 24% at the age of 15.

CONCLUSIONS

It is essential to promote adequate amount of sleep and prevent daytime sleepiness in children growing from age 10 to 15 years. Nurses and other health care professionals should systematically assess and promote healthy sleeping habits while caring for children between these ages.

Personal sleep debt and daytime sleepiness mediate the relationship between sleep and mental health outcomes in young adults

BACKGROUND

Sleep duration and chronotype (i.e., morningness-eveningness) are associated with increased depression and anxiety risk, but differences in individual sleep need and lifestyle may mean these sleep parameters do not present the same risk across all individuals. This study explored the mediating role of sleep debt and daytime sleepiness in the relationship between sleep and mental health symptoms in young adults, a particularly vulnerable population.

METHODS

Young adult university students (n = 2,218) and young adults from the general population in the United States (n = 992) provided estimates of actual and optimal sleep duration, and completed validated measures of sleepiness, chronotype, and depression and anxiety risk. Mediation models examining sleepiness and sleep debt (i.e., difference between optimal and actual sleep) as parallel mediators were tested.

RESULTS

Sleepiness and sleep debt mediated the relationship between short sleep and depression and anxiety risk in the university sample, while sleepiness mediated these relationships in the general population sample. Sleepiness and sleep debt also mediated the impact of evening-type preferences on depression and anxiety risk in university students, but no mediation of this effect was found in young adults from the general population.

CONCLUSIONS

This study reports potential mediating mechanisms related to the increased mental health risk conferred by short sleep and evening chronotype. These results have implications for how primary care physicians assess psychopathology risk, arguing for a focus on the assessment of daytime sleepiness and sleep debt in university populations, while for young adults in the general population, these factors may be less important.

Momentary experiential avoidance: Within-person correlates, antecedents, and consequences and between-person moderators

We used ecological momentary assessment to investigate momentary correlates, antecedents, and consequences of experiential avoidance (EA), and to explore whether depression and anxiety moderate these within-person relationships. Participants recorded their mood, thoughts, stress, and EA four times daily for one week. Baseline depression and anxiety were associated with EA. EA was lower when participants reported more positive mood and thoughts, and higher when participants reported more negative mood, negative thoughts, and stress. The EA-stress relationship was stronger for participants with higher depression. Lag analyses showed that negative mood, negative thoughts, and stress predicted subsequent EA. In turn, EA predicted subsequent negative mood, negative thoughts, and stress. The relationship between EA and subsequent negative thoughts was stronger for participants with higher anxiety. Participants with higher depression and anxiety had a less negative association between positive thoughts and subsequent EA. This study adds to a growing body of literature on the process of EA as it unfolds in vivo, in real-time. Findings highlight links between momentary negative internal experiences and EA (which may be especially strong for people with depression or anxiety) and suggest that certain positive subjective experiences may buffer against EA. Clinical implications and future research directions are discussed.

Correlations between Waist and Neck Circumferences and Obstructive Sleep Apnea Characteristics

PURPOSE

The body mass index (BMI), an estimate of body fat, provides a rather imprecise indication of risk for obstructive sleep apnea (OSA). We examined whether other measures, including waist and neck circumference, provide improved indicators of risk in treatment-naïve OSA subjects.

METHODS

We studied 59 OSA subjects [age, 48.8±10.0 years; BMI, 31.9±6.6 kg/m²; apnea-hypopnea-index (AHI), 38.5±23.0 events/hour; sleep efficiency index (SEI, n=52), 78.6±14.4%; lowest oxygen saturation (SaO₂ nadir), 79.5±8.0%; systolic blood pressure (BP), 127.4±15.7 mmHg; diastolic BP, 80.1±9.1 mmHg; 43 male), and determined waist and neck circumferences (waist, 107.4±15.3 cm; neck, 41.8±4.7 cm), daytime sleepiness [Epworth sleepiness scale (ESS), 8.7±4.6], sleep quality [Pittsburgh sleep quality index (PSQI), 8.5±4.1], depression levels [Beck depression inventory II (BDI-II), 6.6±5.7), and anxiety levels [Beck anxiety inventory (BAI), 6.2±7.2]. We used partial correlation procedures (covariates, age and gender) to examine associations between BMI, waist, and neck circumferences vs. AHI, sleep, and neuropsychological variables.

RESULTS

BMI, waist, and neck circumferences were significantly correlated with SaO₂ nadir (BMI; r=-0.423, p=0.001; waist; r=-0.457, p<0.001; neck; r=-0.263, p=0.048), AHI (BMI; r=0.349, p=0.008; waist; r=0.459, p<0.001; neck; r=0.276, p=0.038), and systolic BP (BMI; r=0.354, p=0.007; waist; r=0.321, p=0.015; neck; r=0.388, p=0.003). SEI was significantly correlated with waist circumference (r=0.28, p=0.049), but higher with BMI (r=0.291, p=0.04).

CONCLUSIONS

No other significant waist or neck correlations emerged. This study suggests that waist and neck measures correlate better than BMI with select disease severity (SaO₂ nadir and AHI) in OSA subjects. The findings offer an easily-measured, ancillary means to assess OSA risk.

Vasomotor and physical menopausal symptoms are associated with sleep quality

BACKGROUND

Sleep disturbance is one of the common complaints in menopause. This study investigated the relationship between menopausal symptoms and sleep quality in middle-aged women.

METHOD

This cross-sectional observational study involved 634 women aged 44-56 years attending a healthcare center at Kangbuk Samsung Hospitals. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).Multiple linear regression analysis was performed to assess the associations between Menopause-specific Quality of Life (MENQOL) scores and PSQI scores and Menopause-specific Quality of Life (MENQOL)scores.

RESULTS

The mean PSQI score was 3.6±2.3, and the rates of poor sleep quality(PSQI score > 5) in premenopausal, perimenopausal, and postmenopausal women were 14.4%, 18.2%, and 30.2%, respectively. Total PSQI score, specifically the sleep latency, habitual sleep efficiency and sleep disturbances scores, were significantly increased in postmenopausal women. Multiple linear regression analysis adjusted for age, BMI, hypertension, diabetes, smoking, marital status, family income, education, employment status, parity, physical activity, depression symptoms, perceived stress and menopausal status showed that higher PSQI score was positively correlated with higher vasomotor(ß = 0.240, P = 0.020)and physical(ß = 0.572, P<0.001) scores.

CONCLUSIONS

Vasomotor and physical menopause symptoms was related to poor sleep quality. Effective management strategies aimed at reducing menopausal symptoms may improve sleep quality among women around the time of menopause.

Perceived Stress Mediates the Associations between Sleep Quality and Symptoms of Anxiety and Depression among College Nursing Students

Mental illnesses, such as anxiety and depression, are top concerns among college students. Poor sleep quality intensifies the risk of mental illnesses. However, the mechanism for the associations between sleep quality and mental illnesses in college students is not well understood. Online surveys were collected with 242 undergraduate nursing students at a public university in the northeast United States. Multivariate linear regression models suggested that poor sleep quality was associated with an increased risk of symptoms of anxiety (β = 1.08, p < 0.01) and depression (β = 1.00, p < 0.01). Perceived stress mediated the association between sleep quality and symptoms of anxiety by 85.3 %, and mediated the association between sleep quality and symptoms of depression by 60.0 %. This study suggested that in addition to sleep promotion, effective interventions to identify unique stressors in nursing students and facilitate the development of appropriate coping strategies are needed to enhance their mental health and well-being.

Impact of a sleep course on sleep, mood and anxiety symptoms in college students: A pilot study

OBJECTIVE

To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students.

PARTICIPANTS

Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015.

METHODS

Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects.

RESULTS

In November, sleep course students reported significant differences in sleep hygiene (SHI; p < .001), perceived sleep latency (PSQI; p < .05), and circadian sleep phase (MEQ; p < .05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = .05) and anxiety (BAI; p < .05).

CONCLUSIONS

These positive preliminary results indicate that focused education has the potential to improve sleep among college students.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Relationships among sleep quality, coping styles, and depressive symptoms among college nursing students: A multiple mediator model

BACKGROUND

Poor sleep quality and depressive symptoms are common among college nursing students, and may be associated with each other. However, the mechanism for this association has not been well understood.

PURPOSE

The study is to examine the potential mediating role of coping styles in the association between sleep quality and depressive symptoms among college nursing students.

METHODS

242 undergraduate nursing students at a public university in the northeast United States completed an online survey delivered through SurveyMonkey® with self-reports of sleep quality, coping styles, and depressive symptoms from October to November 2015.

RESULTS

Multivariate linear regression models suggested that poor sleep quality was significantly associated with depressive symptoms (β=1.00, p<0.01) in nursing students. The four coping styles (problem engagement, emotion engagement, problem disengagement, and emotion disengagement) together reduced the strength of the association between sleep quality and depressive symptoms by 41%. Specifically, emotion disengagement coping plays an important mediating role in this association.

CONCLUSIONS

In addition to sleep promotion, effective interventions to facilitate the development of appropriate coping strategies among nursing students are needed to enhance their mental health and well-being.

Sleep indices and eating behaviours in young adults: findings from Project EAT

OBJECTIVE

To test the associations between sleep indices and eating behaviours in young adults, a group vulnerable to suboptimal sleep.

DESIGN

Cross-sectional analysis of survey measures of sleep (i.e. time in bed, variability, timing and quality) and dietary patterns (i.e. breakfast skipping, eating at fast-food restaurants, consumption of sports and energy drinks, and sugar-free, sugar-sweetened and caffeinated beverages).

SETTING

Minneapolis/St. Paul metropolitan area of Minnesota (USA).

SUBJECTS

A total of 1854 respondents (20-30 years, 55·6 % female) from the 2008-2009 survey conducted for the third wave of the population-based Project EAT (Eating and Activity in Teens and Young Adults) study.

RESULTS

After adjustment for demographic and behavioural covariates in linear regression models, those who went to bed after 00.30 hours consumed 0·3 more servings of sugar-sweetened beverages per day, consumed 1·7 times more energy drinks, skipped breakfast 1·8 more times per week and consumed fast food 0·3 more times per week compared with those who went to bed before 22.30 hours. Reported sleep quality in the lowest (Q1) v. highest (Q3) tertile was associated with more intake of energy drinks (Q3 v. Q1, prevalence ratio, 95 % CI: 1·79, 1·24, 2·34), sports drinks (1·28, 1·00, 1·55) and breakfast skipping (adjusted mean, 95 % CI: Q1: 4·03, 3·81, 4·26; Q3: 3·43, 3·17, 3·69). Time in bed and sleep variability were associated with few eating behaviours.

CONCLUSIONS

Some, but not all, sleep indices were related to problematic eating behaviours. Sleep habits may be important to address in interventions and policies that target improvements in eating patterns and health outcomes.

Sleep characteristics associated with drowsy driving

OBJECTIVE

The aim of this study was to evaluate sleep characteristics associated with drowsy driving in an adult population.

METHODS

The study subjects consisted of 1675 adults aged 19 years or older who completed a population-based questionnaire survey on sleep habits. Experiences of drowsy driving were obtained from self-reported data. We investigated sleep-related variables including sleep duration, sleep efficiency, chronotype, subjective sleep perception, daytime sleepiness, sleep quality, and snoring. We performed multivariate logistic regression analysis to determine sleep characteristics independently associated with drowsy driving.

RESULTS

The mean age of the subjects was 43.2 years, and 66.3% were men. The prevalence of self-reported drowsy driving was 23.6% (396 of 1675), and 33.1% of subjects experienced dozing at the wheel at least once a month. Multivariate analysis demonstrated that men, office and manual workers, excessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were independently associated with drowsy driving. Subgroup analyses revealed that reduced weekday sleep duration was a risk factor of drowsy driving in adults with perceived sufficient sleep. On the other hand, frequent alcohol drinking significantly increased risk of drowsy driving in the subgroup with perceived sleep insufficiency. Furthermore, ordinal regression analyses confirmed the association between sleep characteristics and drowsy driving across different drowsy driving frequencies.

CONCLUSION

Excessive daytime sleepiness, depression, habitual snoring, and perceived insufficient sleep were sleep-related risk factors for drowsy driving. In addition to maintaining healthy sleep habits, individuals at high risk should be encouraged to evaluate underlying sleep disorders or psychiatric problems to prevent drowsy driving.

Association between sleep quality and quality of life among students: a cross sectional study

Background Lack of sleep and on going sleep disorder can affect family health and interpersonal relationships. Objective The aim of study was to investigate the association between sleep quality and the probable determinants of quality of life among students of a public health faculty at Shahid Beheshti University of Medical Sciences (SBMU) in the 2015 academic year. Methods The data from a cross-sectional study of 275 students that randomly stratified sampling between different classes of college students of a public health faculty of Shahid Beheshti University of Medical Sciences were used in this study. The data were collected using a structured questionnaire consisted of modules on socio-demographic characteristics, the Petersburg Standardized Sleep Quality Questionnaire(PSQL) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Data analysis was done with descriptive and logistic regression. All analyses were carried out using SPSS software V.19. Results A total of 275 students participated in this study. The mean age ± standard deviation (SD) was 22.1 ± 3.6 years. In the univariable model, students that were living in their own homes had the odds of 2.18 times more than the others to have a higher quality of life level [95% confidence interval (CI): 1.07-4.45]. Moreover, sleep disorder was negatively associated with the quality of life [odds ratio (OR) = 0.23; 95% CI: 0.12-0.46]. Conclusion These results will help university administrators and policy makers to identify factors associated with poor sleep and provide approaches to enhance sleep hygiene and relevant knowledge in university students. Living in a dormitoy while also suffering from sleep problems could significantly reduce the quality of life.

Adolescent Sleepiness: Causes and Consequences

Insufficient sleep duration and poor sleep quality are common among adolescents. The multidimensional causes of insufficient sleep duration and poor sleep quality include biological, health-related, environmental, and lifestyle factors. The most common direct consequence of insufficient and/or poor sleep quality is excessive daytime sleepiness, which may contribute to poor academic performance, behavioral health problems, substance use, and drowsy driving. Evaluation of sleepiness includes a detailed sleep history and sleep diary, with polysomnography only required for the assessment of specific sleep disorders. Management involves encouraging healthy sleep practices such as having consistent bed and wake times, limiting caffeine and electronics at night before bed, and eliminating napping, in addition to treating any existing sleep or medical disorders. [Pediatr Ann. 2017;46(9):e340-e344.].

Associations among daytime sleepiness, depression and suicidal ideation in Korean adolescents

The aim of this study was to examine the effects of daytime sleepiness on depression and suicidal ideation in adolescent high-school students. A survey of 538 high school students aged 16-17 years attending two academic schools was conducted. The Epworth Sleepiness Scale (ESS), the Beck Depression Inventory and the Scale for Suicide Ideation were used to assess subjects' daytime sleepiness, depression and suicidal ideation. The mean score for daytime sleepiness was 8.52, which indicates a sleep deficit. Significant positive correlations were found between daytime sleepiness and depression, between daytime sleepiness and suicidal ideation and between depression and suicidal ideation. Gender and depression were significant predictors of suicidal ideation, accounting for 48% of the variance in this measure. Depression acts as a mediator of the relationship between daytime sleepiness and suicidal ideation. High school students in Korea generally have insufficient sleep time and feel sleepy during the day; insufficient sleep during adolescence may be associated with depression and suicidal ideation.

Social jet lag: Sleep-corrected formula

Social jet lag is a term describing misalignment between social and biological times. In this article, it is argued that the currently used formula for social jet lag captures not only this misalignment, but also sleep debt resulting from sleep deprivation during workdays. It is proposed to adopt the sleep-corrected formula for social jet lag, which takes the form of the difference between the sleep onset on free days and workdays in the case of subjects with longer sleep and later (or equal) sleep onset on free days compared to workdays; it takes the form of the difference between the sleep offset on free days and workdays for subjects with longer sleep and earlier (or equal) sleep offset on workdays compared to free days.