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Rawcliffe AJ, Tyson H, Hinde K, Jacka K, Holland R, Chapman S, Roberts AJ. Sleep duration and perceptions of sleep quality in British Army recruits during basic training - an observational analysis. Front Neurol 2024; 15:1321032. [PMID: 38426172 PMCID: PMC10903264 DOI: 10.3389/fneur.2024.1321032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Sleep is critical to the health, wellbeing and performance of military personnel during basic training. This two-part study evaluated sleep-wake patterns and sleep disturbances in junior soldiers (JS) and infantry recruits in Autumn 2021 (study 1), and non-infantry recruits in spring 2022 (study 2). Methods During studies 1 and 2, validated wearable technology combined with a sleep diary was used to quantify sleep-wake indices, sleep disturbances and perceptions of sleep quality. Sleep diary data was analysed descriptively. A series of repeated-measures ANOVAs examined differences in objective sleep-wake indices. Correlation analysis determined associations between time in bed (TIB) and total sleep time (TST). Results Significant (p < 0.05) differences in most sleep-wake indices were observed between weeks of basic training for all cohorts. Strong positive correlations between TIB and TST were observed for each cohort across basic training (r = 0.681 - 0.970, p < 0.001), with longer TST associated with greater TIB. The mean±SD sleep duration (hours and mins [hm]) for JS (06:22 ± 00:27hm), non-infantry (05:41 ± 00:47hm) and infantry (05:46 ± 00:34hm) recruits across basic training was consistently below national recommendations. The mean±SD bed and wake times for JS (bedtime: 23:01 ± 00:32hm; awake: 05:34 ± 00:10hm), non-infantry (bedtime: 23:38 ± 01:09hm; awake: 04:47 ± 00:58hm), and infantry (bedtime: 23:13 ± 00:29hm; awake: 05:38 ± 00:26hm) recruits varied across weeks of basic training, with over 80% reporting "fairly bad" or "very bad" sleep quality and frequent periods of "dozing off" during daytime activity. The most commonly reported sleep disturbing factors identified during basic training involved: late-night military admin (e.g., ironing, boot cleaning, kit set up etc), early morning wake times, extraneous noise, light and hot room temperatures within the primary sleeping environment, bed/mattress discomfort, muscle soreness and feelings of stress and anxiety. Discussion/Conclusion Our findings contribute to the existing evidence that long-term sleep loss is pervasive during initial military training programmes. The average sleep durations indicate chronic and unrecoverable sleep loss which would be expected to significantly impair physical and cognitive military performance, and increase the risk of injury, illness and attrition rates during basic training. Changes in the design and scheduling of basic training programmes to enable, at the least, minimum sleep recommendations to be met, and to improve sleep hygiene in the primary sleeping environment are warranted.
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Affiliation(s)
- Alex J. Rawcliffe
- Army Recruit Health and Performance Research, Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Upavon, United Kingdom
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
| | - Hayley Tyson
- Army Recruit Health and Performance Research, Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Upavon, United Kingdom
| | - Katrina Hinde
- Human Sciences Group, Defence Science and Technology Laboratory, Salisbury, United Kingdom
| | - Kimberley Jacka
- Army Recruit Health and Performance Research, Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Upavon, United Kingdom
| | - Rachel Holland
- Army Recruit Health and Performance Research, Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Upavon, United Kingdom
| | - Shaun Chapman
- Army Recruit Health and Performance Research, Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Upavon, United Kingdom
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Andrew J. Roberts
- Army Recruit Health and Performance Research, Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Upavon, United Kingdom
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Nakayasu ES, Gritsenko MA, Kim YM, Kyle JE, Stratton KG, Nicora CD, Munoz N, Navarro KM, Claborne D, Gao Y, Weitz KK, Paurus VL, Bloodsworth KJ, Allen KA, Bramer LM, Montes F, Clark KA, Tietje G, Teeguarden J, Burnum-Johnson KE. Elucidating regulatory processes of intense physical activity by multi-omics analysis. Mil Med Res 2023; 10:48. [PMID: 37853489 PMCID: PMC10583322 DOI: 10.1186/s40779-023-00477-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/28/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Physiological and biochemical processes across tissues of the body are regulated in response to the high demands of intense physical activity in several occupations, such as firefighting, law enforcement, military, and sports. A better understanding of such processes can ultimately help improve human performance and prevent illnesses in the work environment. METHODS To study regulatory processes in intense physical activity simulating real-life conditions, we performed a multi-omics analysis of three biofluids (blood plasma, urine, and saliva) collected from 11 wildland firefighters before and after a 45 min, intense exercise regimen. Omics profiles post- versus pre-exercise were compared by Student's t-test followed by pathway analysis and comparison between the different omics modalities. RESULTS Our multi-omics analysis identified and quantified 3835 proteins, 730 lipids and 182 metabolites combining the 3 different types of samples. The blood plasma analysis revealed signatures of tissue damage and acute repair response accompanied by enhanced carbon metabolism to meet energy demands. The urine analysis showed a strong, concomitant regulation of 6 out of 8 identified proteins from the renin-angiotensin system supporting increased excretion of catabolites, reabsorption of nutrients and maintenance of fluid balance. In saliva, we observed a decrease in 3 pro-inflammatory cytokines and an increase in 8 antimicrobial peptides. A systematic literature review identified 6 papers that support an altered susceptibility to respiratory infection. CONCLUSION This study shows simultaneous regulatory signatures in biofluids indicative of homeostatic maintenance during intense physical activity with possible effects on increased infection susceptibility, suggesting that caution against respiratory diseases could benefit workers on highly physical demanding jobs.
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Affiliation(s)
- Ernesto S Nakayasu
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA.
| | - Marina A Gritsenko
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Young-Mo Kim
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Jennifer E Kyle
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kelly G Stratton
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Carrie D Nicora
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Nathalie Munoz
- Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kathleen M Navarro
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Western States Division, Denver, CO, 80204, USA
| | - Daniel Claborne
- Computational Analytics Division, Pacific Northwest National Laboratory, Richland, WA, 99352, USA
| | - Yuqian Gao
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Karl K Weitz
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Vanessa L Paurus
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kent J Bloodsworth
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Kelsey A Allen
- National Security Directorate, Pacific Northwest National Laboratory, Richland, WA, 99352, USA
| | - Lisa M Bramer
- Biological Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA
| | - Fernando Montes
- Los Angeles County Fire Department, Los Angeles, CA, 90063, USA
| | - Kathleen A Clark
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, WV, 26505, USA
| | - Grant Tietje
- National Security Directorate, Pacific Northwest National Laboratory, Richland, WA, 99352, USA
| | - Justin Teeguarden
- Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA.
- Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, 97331, USA.
| | - Kristin E Burnum-Johnson
- Environmental and Molecular Sciences Division, Pacific Northwest National Laboratory, 902 Battelle Boulevard, Richland, WA, 99352, USA.
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Gibson N, Drain JR, Larsen P, Williams S, Groeller H, Sampson JA. Subjective Measures of Workload and Sleep in Australian Army Recruits; Potential Utility as Monitoring Tools. Mil Med 2023; 188:670-677. [PMID: 34986241 DOI: 10.1093/milmed/usab551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/05/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Subjective measures may offer practitioners a relatively simple method to monitor recruit responses to basic military training (BMT). Yet, a lack of agreement between subjective and objective measures may presents a problem to practitioners wishing to implement subjective monitoring strategies. This study therefore aims to examine associations between subjective and objective measures of workload and sleep in Australian Army recruits. MATERIALS AND METHODS Thirty recruits provided daily rating of perceived exertion (RPE) and differential RPE (d-RPE) for breathlessness and leg muscle exertion each evening. Daily internal workloads determined via heart rate monitors were expressed as Edwards training impulse (TRIMP) and average heart rate. External workloads were determined via global positioning system (PlayerLoadTM) and activity monitors (step count). Subjective sleep quality and duration was monitored in 29 different recruits via a customized questionnaire. Activity monitors assessed objective sleep measures. Linear mixed-models assessed associations between objective and subjective measures. Akaike Information Criterion assessed if the inclusion of d-RPE measures resulted in a more parsimonious model. Mean bias, typical error of the estimate (TEE) and within-subject repeated measures correlations examined agreement between subjective and objective sleep duration. RESULTS Conditional R2 for associations between objective and subjective workloads ranged from 0.18 to 0.78, P < 0.01, with strong associations between subjective measures of workload and TRIMP (0.65-0.78), average heart rate (0.57-0.73), and PlayerLoadTM (0.54-0.68). Including d-RPE lowered Akaike Information Criterion. The slope estimate between objective and subjective measures of sleep quality was not significant. A trivial relationship (r = 0.12; CI -0.03, 0.27) was observed between objective and subjective sleep duration with subjective measures overestimating (mean bias 25 min) sleep duration (TEE 41 min). CONCLUSIONS Daily RPE offers a proxy measure of internal workload in Australian Army recruits; however, the current subjective sleep questionnaire should not be considered a proxy measure of objective sleep measures.
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Affiliation(s)
- Neil Gibson
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
| | - Jace R Drain
- Land Division, Defence Science and Technology Group, Fishermans Bend, VIC 3207, Australia
| | - Penelope Larsen
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
| | - Sean Williams
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Herbert Groeller
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
| | - John A Sampson
- Centre for Medical and Exercise Physiology, Faculty of Science, Medicine and Health University of Wollongong, Wollongong, NSW 2522, Australia
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McGinnis GR, Thompson ST, Aguilar CD, Dial MB, Tandy RD, Radzak KN. Chronotype and Social Jetlag Influence Performance and Injury during Reserve Officers' Training Corps Physical Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13644. [PMID: 36294224 PMCID: PMC9603637 DOI: 10.3390/ijerph192013644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Sleep and circadian rhythms are critically important for optimal physical performance and maintaining health during training. Chronotype and altered sleep may modulate the response to exercise training, especially when performed at specific times/days, which may contribute to musculoskeletal injury. The purpose of this study was to determine if cadet characteristics (chronotype, sleep duration, and social jetlag) were associated with injury incidence and inflammation during physical training. Reserve Officers' Training Corps (ROTC) cadets (n = 42) completed the Morningness/Eveningness Questionnaire to determine chronotype, and 1-week sleep logs to determine sleep duration and social jetlag. Salivary IL-6 was measured before and after the first and fourth exercise sessions during training. Prospective injury incidence was monitored over 14 weeks of training, and Army Physical Fitness Test scores were recorded at the conclusion. Chronotype, sleep duration, and social jetlag were assessed as independent factors impacting IL-6, injury incidence, and APFT scores using ANOVAs, chi-squared tests, and the t-test where appropriate, with significance accepted at p < 0.05. Evening chronotypes performed worse on the APFT (evening = 103.8 ± 59.8 vs. intermediate = 221.9 ± 40.3 vs. morning = 216.6 ± 43.6; p < 0.05), with no difference in injury incidence. Sleep duration did not significantly impact APFT score or injury incidence. Social jetlag was significantly higher in injured vs. uninjured cadets (2:40 ± 1:03 vs. 1:32 ± 55, p < 0.05). Exercise increased salivary IL-6, with no significant effects of chronotype, sleep duration, or social jetlag. Evening chronotypes and cadets with social jetlag display hampered performance during morning APFT. Social jetlag may be a behavioral biomarker for musculoskeletal injury risk, which requires further investigation.
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Bulmer S, Aisbett B, Drain JR, Roberts S, Gastin PB, Tait J, Main LC. Sleep of recruits throughout basic military training and its relationships with stress, recovery, and fatigue. Int Arch Occup Environ Health 2022; 95:1331-1342. [PMID: 35226165 PMCID: PMC9273528 DOI: 10.1007/s00420-022-01845-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/14/2022] [Indexed: 12/22/2022]
Abstract
Objective Studies in basic military training (BMT) examining sleep are largely cross-sectional, and do not investigate relationships between sleep, stress, recovery and fatigue. The aims of this study were to (1a) quantify changes in recruits’ sleep quantity and quality over 12 weeks of BMT; (1b) quantify changes in recruits’ perceptions of stress, fatigue and recovery over BMT; and (2) explore relationships between sleep, and perceptions of stress, fatigue and recovery. Methods 45 recruits (37 male; 8 female, age: 25.2 ± 7.2 years, height: 176.2 ± 10.0 cm, mass: 76.8 ± 15.0 kg) wore ActiGraph GT9X’s for 12 weeks of BMT, collecting sleep duration, efficiency and awakenings. Subjective sleep quality, fatigue were measured daily, with stress and recovery measured weekly. Multi-level models assessed relationships between sleep, and stress, recovery, and fatigue. Results Objective daily means for sleep duration were 6.3 h (± 1.2 h) and 85.6% (± 5.5%) for sleep efficiency. Main effects were detected for all mean weekly values (p < 0.05). Sleep quality showed the strongest relationships with stress, recovery and fatigue. The best model to explain relationships between, stress, recovery and fatigue, included sleep quality, sleep duration, sleep efficiency and awakenings. Conclusions The reported mean sleep duration of 6.3 h per night may negatively impact training outcomes across BMT. Combining both subjective and objective measures of sleep best explained relationships between sleep metrics stress, fatigue and recovery. Perceived sleep quality was most strongly related to change in stress, recovery, or post-sleep fatigue.
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Affiliation(s)
- Sean Bulmer
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Sport Research, Geelong, VIC, Australia
| | - Brad Aisbett
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia
| | - Jace R Drain
- Defence Science and Technology Group, Fisherman's Bend, Melbourne, Australia
| | - Spencer Roberts
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia
| | - Paul B Gastin
- School of Allied Health, Human Services and Sport, La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, Melbourne, VIC, Australia
| | - Jamie Tait
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia
| | - Luana C Main
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia.
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Chronicity of sleep restriction during Army basic military training. J Sci Med Sport 2022; 25:432-438. [DOI: 10.1016/j.jsams.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
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Teyhen DS, Capaldi VF, Drummond SPA, Rhon DI, Barrett AS, Silvernail JL, Boland DM. How sleep can help maximize human potential: The role of leaders. J Sci Med Sport 2021; 24:988-994. [PMID: 34481741 DOI: 10.1016/j.jsams.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/23/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE During multi-domain operations (MDO), soldiers need the physical supremacy, cognitive dominance, and emotional resilience to help defend and win our nation's wars. Optimal sleep has been shown to boost physical performance and cognitive processing. This manuscript will discuss how recent advances in sleep science strongly argue for the integration of sleep planning into military operations. DESIGN Review article. METHODS We reviewed the current understanding of how sleep affects Soldier readiness, how sleep and pain are interrelated, and unique challenges to obtaining adequate sleep in military training environments. We then address solutions that can be implemented by leaders and individuals to manage warfighter fatigue and optimize unit performance. RESULTS Since sleep is foundational to soldier health and readiness, improving warfighter fatigue management is a priority for leaders. CONCLUSION To succeed in MDO, military personnel require physical supremacy, cognitive dominance, and emotional resilience to fight and win. Sleep science is a rapidly emerging field, and the clear implications for maximizing human performance argue strongly for more deliberate integration into military training and operations. Leaders that incorporate sleep and fatigue management into the planning and execution phases of operations will help facilitate mission priorities and prove a powerful force multiplier.
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Affiliation(s)
| | | | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | | | - Amelia S Barrett
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA
| | | | - David M Boland
- Army-Baylor University Doctoral Program in Physical Therapy, USA
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Mysliwiec V, Pruiksma KE, Brock MS, Straud C, Taylor DJ, Hansen S, Foster SN, Gerwell K, Moore BA, Carrizales FA, Young-McCaughan S, Vanecek R, Mintz J, Peterson AL. The Military Service Sleep Assessment: an instrument to assess factors precipitating sleep disturbances in U.S. military personnel. J Clin Sleep Med 2021; 17:1401-1409. [PMID: 33682675 DOI: 10.5664/jcsm.9206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Military personnel frequently experience sleep difficulties, but little is known regarding which military or life events most impact their sleep. The Military Service Sleep Assessment (MSSA) was developed to assess the impact of initial military training, first duty assignment, permanent change of station, deployments, redeployments, and stressful life events on sleep. This study presents an initial psychometric evaluation of the MSSA and descriptive data in a cohort of service members. METHODS The MSSA was administered to 194 service members in a military sleep disorders clinic as part of a larger study. RESULTS Average sleep quality on the MSSA was 2.14 (on a Likert scale, with 1 indicating low and 5 indicating high sleep quality), and 72.7% (n = 140) of participants rated their sleep quality as low to low average. The events most reported to negatively impact sleep were stressful life events (41.8%), followed by deployments (40.6%). Military leadership position (24.7%) and birth/adoption of a child (9.7%) were the most frequently reported stressful life events to negatively impact sleep. There were no significant differences in current sleep quality among service members with a history of deployment compared with service members who had not deployed. CONCLUSIONS The MSSA is the first military-specific sleep questionnaire. This instrument provides insights into the events during a service member's career, beyond deployments, which precipitate and perpetuate sleep disturbances and likely chronic sleep disorders. Further evaluation of the MSSA in nontreatment-seeking military populations and veterans is required.
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Affiliation(s)
- Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Matthew S Brock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Casey Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Shana Hansen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Shannon N Foster
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Kelsi Gerwell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brian A Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia
| | - F Alex Carrizales
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert Vanecek
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
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The association of sleep quality and aggression: A systematic review and meta-analysis of observational studies. Sleep Med Rev 2021; 59:101500. [PMID: 34058519 DOI: 10.1016/j.smrv.2021.101500] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
Poor sleep quality is closely related to aggression, but despite the promise of new therapeutic possibilities, a systematic synthesis of observational research on the association between sleep quality and aggression is lacking. This systematic review and meta-analysis examined the association between sleep quality and aggression, using the academic databases PubMed and PsycINFO. Subjective and objective measures of sleep quality were included, as well as multiple measures of aggression, assessing aggressive and externalizing behavior, anger, hostility and irritability. Ninety-two observational articles, containing 96 studies, encompassing a total of 58.154 children, adolescents and adults were sourced out of 7161 references identified. Methodological quality was moderate or strong in 76% of studies. Data for meta-analysis was available from 74 studies. Poorer sleep quality was associated with higher aggression in 80.8% of studies. Pooled results showed a correlation of 0.28 (95%CI 0.25-0.31; I2 = 90.1%) and odds ratio of 3.61 (95%CI 1.13-11.51; I2 = 88.3%). Effect estimates and heterogeneity varied according to population type and measurement instruments, but not according to article quality or age group. Our findings confirm that poor sleep quality is consistently associated with higher aggression. As most evidence is cross-sectional, more prospective and high-quality experimental evidence is required to elucidate cause-effect and optimize prevention and treatment of aggression.
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