Social interactions, emotion and sleep: A systematic review and research agenda

Associations between self-reported sleep, overnight memory consolidation, and emotion perception: A large-scale online study in the general population

Experimental studies suggest that short or disrupted sleep impairs memory consolidation, mood, and perception of emotional stimuli. However, studies have chiefly relied on laboratory-based study designs and small sample sizes. The aim of this fully online and pre-registered study was to investigate the association between sleep and overnight memory consolidation, emotion perception, and affect in a large, self-selected UK sample. A total of 1646 participants (473 completed) took part in an online study, where they completed a declarative (word-pairs) memory task, emotion perception task (valence ratings of images), and rated their affect within 2 h of bed-time. The following morning, participants reported on their state affect, sleep for the previous night, completed a cued recall task for the previously presented word-pairs, rated the valence of previously viewed images, and completed a surprise recognition task. Demographic data and habitual sleep quality and duration (sleep traits) were also recorded. Habitual sleep traits were associated with immediate recall for the word-pairs task, while self-reported sleep parameters for the specific night were not associated with overnight memory consolidation. Neither habitual sleep traits, nor nightly sleep parameters were associated with unpleasantness ratings to negative stimuli or overnight habituation. Habitual poor sleep was associated with less positive and more negative affect, and morning affect was predicted by the specific night's sleep. This study suggests that overnight emotional processing and declarative memory may not be associated with self-reported sleep across individuals. More work is needed to understand how findings from laboratory-based studies extrapolate to real-world samples and contexts.

Experience and caring needs of patients with psoriasis: A qualitative meta-synthesis

BACKGROUND

As a chronic skin disease, psoriasis often affects the physical, psychological and social status of the patient, which in turn impacts on their experience of illness and needs. However, there is no review of qualitative research that integrates and analyses the experiences and needs of these three influences from a holistic perspective.

METHODS

This review follows the ENTREQ guidelines. Six English databases (JBI, Cochrane Library, PubMed, PsyINFO, CINAHL and Embase) and three Chinese databases (CNKI, VIP and Wanfang) were searched from January 2012 to October 2022. Literature was included if it was relevant to the experience of illness and caring needs of patients with psoriasis. The JBI-QARI was used to rate the quality of included studies.

RESULTS

Eleven studies were included in the meta-synthesis. Four analytical themes were identified for analysis: physical challenges, psychological discomfort, social phenomena and caring needs.

CONCLUSIONS

The combined physical, psychological and social effects of psoriasis and the consequent caring needs should be emphasised. Health professionals, including doctors and nurses, should be aware of the multiple changes in patients and their coping strategies, provide information about psoriasis, monitor and follow-up regularly over time and obtain feedback to inform further treatment and care so as to develop high-quality therapeutic interventions to help and guide patients with their coping strategies.

RELEVANCE TO CLINICAL PRACTICE

These findings describe the physical, psychological and social experiences of illness and caring needs of patients with psoriasis. Healthcare professionals should be more aware of patients' easily overlooked psychological and social distress, providing prompt attention and recognition of patients' experiences and needs, offering relevant assistance and support and enhancing daily, regular follow-up to help them improve their understanding of and ability to manage their illness.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a meta-synthesis without direct patient involvement.

Effectiveness of continuous positive airway pressure therapy on romantic relationships and intimacy among individuals with obstructive sleep apnea: A systematic review and a meta-analysis

Obstructive sleep apnea is a common yet often overlooked chronic sleep disorder with significant health implications globally. Bedpartners play a vital role in motivating individuals with obstructive sleep apnea to seek medical help, though their sleep quality may suffer, straining the couple's relationship. From September 2023 to January 2024, utilizing PubMed, Scopus, BioMed Central, Cochrane Library, ScienceDirect and www.clinicaltrials.gov databases, this systematic review meticulously examined data from 27 studies to investigate how continuous positive airway pressure therapy, recognized as the gold-standard for treating obstructive sleep apnea, may positively influence psychological dynamics within couples. Additionally, a meta-analysis was conducted on nine studies, to assess the effect of continuous positive airway pressure on erectile function, which is often compromised in patients with obstructive sleep apnea. The PRISMA checklist and specific quality assessments were followed to ensure methodological rigour and transparency. Findings reveal positive changes in conflict resolution for patients with obstructive sleep apnea post- continuous positive airway pressure adaptation (p < 0.05). Emotional functioning (p = 0.002) and social relationships (p < 0.001) also show improvements in bedpartners. While six subjective assessments indicate enhancements in sexual quality of life for patients with obstructive sleep apnea, challenges related to continuous positive airway pressure use as a barrier to intimacy are acknowledged. Focusing on male patients with obstructive sleep apnea, findings demonstrated a substantial improvement in erectile function post-continuous positive airway pressure utilization, with a Z-score of 4.84 (p < 0.00001). Female patients with obstructive sleep apnea using continuous positive airway pressure show no significant improvements in sexual functioning, while female bedpartners report positive changes. These insights emphasize the importance of holistic approaches in addressing the impact of obstructive sleep apnea on both individuals and their relationships.

Sleep quality relates to language impairment in children with autism spectrum disorder without intellectual disability

OBJECTIVES

This study aimed to identify sleep quality profiles of children with autism spectrum disorder (ASD), to compare these profiles with those of typically developing (TD) children, and to verify whether there are differences between them in terms of language skills.

METHODS

We evaluated the sleep quality and language skills of 47 children with ASD without intellectual disability (ID) and 32 children with TD. Using a hierarchical cluster analysis, we identified two sleep quality ASD profiles (poor and good). We then performed a series of MANCOVAs and ANOVAs to compare the sleep quality and language skills of the two ASD clusters and the TD group.

RESULTS

A main group effect (TD, "poor" cluster, and "good" cluster) was found in the total sleep quality and all its dimensions. Significant differences were revealed between the "good" and "poor" clusters in the total structural language score (F1,46 = 10.75, p < 0.001) and three of its subscales (speech: F1,46 = 9.19, p < 0.001; syntax, F1,46 = 8.61, p = 0.001; coherence: F1,46 = 11.36, p < 0.001); the total pragmatic language score (F1,46 = 7.00, p = 0.001) and three of its subscales (inappropriate initiation: F1,46 = 8.02, p = 0.001; use of context: F1,46 = 8.07, p = 0.001; nonverbal communication: F1,46 = 7.35, p = 0.001); and the social relations score (F1,46 = 9.97, p = 0.003).

CONCLUSIONS

Sleep quality in children with ASD (especially a subgroup) is worse than in children with TD. There is an association between sleep quality and language skills, both at the pragmatic and structural levels.

Schizotypy Moderates the Relationship Between Sleep Quality and Social Cognition

ABSTRACT

Poor sleep quality has been tied to worse social cognition. Social cognitive deficits have been noted in those with high schizotypy. Yet, no study has assessed whether schizotypy moderates the relationship between sleep quality and social cognition, which may be vital to our understanding of contributors to social functioning. We conducted a cross-sectional analysis of associations of sleep quality and social cognition, with potential moderation by schizotypy. Participants ( n = 906) completed self-report measures of schizotypy, sleep quality, and social cognition. Levels of schizotypy significantly moderated some of the relationships between sleep and social cognition. For participants low in total or interpersonal schizotypy, worse sleep quality was associated with worse theory of mind scores. For participants low in total, disorganized, or cognitive perceptual schizotypy, worse sleep quality was associated with worse self-reported cognitive empathy. For those high in these facets of schizotypy, worse sleep quality was associated with better self-reported cognitive empathy. These results suggest that the individual facets of schizotypy provide additional information and, therefore, are important to assess when examining social cognition and sleep.

A sleepless night disrupts the resolution of emotional conflicts: Behavioural and neural evidence

The present study aims to investigate the influence of 24-hr sleep deprivation on implicit emotion regulation using the emotional conflict task. Twenty-five healthy young adults completed a repeated-measures study protocol involving a night of at-home normal sleep control and a night of in-laboratory sleep deprivation. Prior to the experimental session, all participants wore an actigraph watch and completed the sleep diary. Following each condition, participants performed an emotional conflict task with electroencephalographic recordings. Emotional faces (fearful or happy) overlaid with words ("fear" or "happy") were used as stimuli creating congruent or incongruent trials, and participants were instructed to indicate whether the facial expression was happy or fearful. We measured the accuracy and reaction time on the emotional conflict task, as well as the mean amplitude of the P300 component of the event-related potential at CPz. At the behavioural level, sleep-deprived participants showed reduced alertness with overall longer reaction times and higher error rates. In addition, participants in the sleep deprivation condition made more errors when the current trial followed congruent trials compared with when it followed incongruent trials. At the neural level, P300 amplitude evoked under the sleep-deprived condition was significantly more positive compared with the normal sleep condition, and this effect interacted with previous-trial and current-trial congruency conditions, suggesting that participants used more attentional resources to resolve emotional conflicts when sleep deprived. Our study provided pioneering data demonstrating that sleep deprivation may impair the regulation of emotional processing in the absence of explicit instruction among emerging adults.

Examining insomnia disorder and stress generation among individuals who have experienced involuntary job loss

OBJECTIVE

Depressed individuals generate more stressful life events than non-depressed individuals. Like depressive symptoms, the symptoms of insomnia disorder may lead to impaired decision-making, daytime sleepiness, fatigue, and emotion dysregulation, yet the prospective relationship with insomnia disorder and stress generation has not previously been investigated. We hypothesized that insomnia disorder within the first three months of involuntary job loss would lead to an increased number of stressful life events three-months later.

METHODS

This project employed a longitudinal design consisting of two timepoints occurring approximately 3 months apart. A sample 136 participants with complete data was sourced from the Assessing Daily Activity Patterns through Occupational Transitions study. Insomnia disorder was diagnosed using the Duke Structured Interview for Sleep Disorders, and the number of stressful life events was assessed using the Life Events and Difficulties Schedule.

RESULTS

A cross-lagged panel analysis utilizing Poisson and logistic regression techniques indicated that insomnia disorder at study baseline predicted an increased number of all stressful life events at follow-up (RR = 1.36, p = .01); conversely, stressful life events at baseline did not predict insomnia disorder (OR = 0.98, p = .87).

CONCLUSION

These results support a stress-generation hypothesis of insomnia disorder. Findings highlight insomnia disorder as a potential target for intervention in the prevention of additional stress exposure among recently unemployed individuals, who have been shown to be at increased risk for adverse health and health disparities.

The presence/absence of conspecifics modulates the circadian locomotor activity and body mass in spotted munia (Lonchura punctulata)

Biological clocks regulate the behavior and physiology of animals by tracking the local time using diverse time cues. Social cues are relevant in studying the behavior of gregarious animals, but these cues have not been widely studied in birds. Temporal information for circadian timekeeping is socially communicated through visual, physical, olfactory, and auditory means. We examined the efficacy of pulsatile social interactions on locomotor activity and its associated characteristics such as distribution profile of rest and activity, total counts, activity duration, phase shift in activity onset, and circadian periodicity in spotted munia. Besides, we analyzed the effect of such social interactions on their body mass. Spotted munia exhibited phase shift in the onset of activity when subjected to social isolation, but these cues could not affect their circadian periodicity. In Pair as well as in Group, social isolation led to increased activity and activity duration, and decreased body mass in guests relative to the host bird. Our results suggest that the circadian rhythm of locomotor activity in spotted munia is quite sensitive to socialization and isolation, and isolation is detrimental for the birds. Consistent with these observations, the decline in body mass revealed the physiological consequences of social isolation on spotted munia.

The relationship between alexithymia, emotion regulation, and sleep problems in school-aged children: A multicentric study

OBJECTIVES

Alexithymia, mood dysregulation, and sleep quality have complicated effects on children's development. The current study aimed to investigate the relationship between alexithymia, emotion regulation, psychiatric problems, and sleep problems among Egyptian school-aged children.

METHODS

A total of 564 Egyptian children, aged 6 to 14, were divided into two groups based on their total Children's Sleep Habits Questionnaire abbreviated score: group 1 (N = 300) with sleep problems and group 2 (N = 264) with non-sleep problems. Their parents completed the Strengths and Difficulties Questionnaire (SDQ) and subjectively assessed the children's emotions using the Children's Alexithymia Measure (CAM) and the Clinical Evaluation of Emotional Regulation-9 (CEER-9).

RESULTS

Males were more proportional in the sleep problems group than others. The sleep problem group was significantly younger and had a longer daily sleep duration than the non-sleep problem group. Alexithymia and emotion dysregulation had the highest mean in the sleep problem group. Furthermore, alexithymia, emotion dysregulation, emotion difficulty, conduct, and prosocial problems were the most significant contributing factors and risk factors for sleep problems in children.

CONCLUSION

Sleep problems in children were associated with younger male children with lengthy daily sleep duration and emotional, behavioural, and prosocial difficulties. Furthermore, alexithymia and emotion dysregulation are significant contributors and risk factors for sleep problems in school-aged children.

Insomnia-A risk factor for mental disorders

Longitudinal studies observed that individuals suffering from insomnia disorder have a higher vulnerability to develop symptoms of psychopathology compared with good sleepers. Particularly, insomnia disorder has been associated with an increased risk for depression. Previous studies indicate relatively stable effects; however, replication is needed as the last meta-analysis on the topic has been published 4 years ago. We conducted a replication of a previous systematic review and meta-analysis evaluating the longitudinal association between insomnia disorder and psychopathology, including original works published between 2018 and 2022. Literature search was conducted from April 2018 to August 2022 using key words identifying longitudinal studies that evaluate individuals with insomnia disorder compared with good sleepers at baseline, and the onset of all possible mental disorders at long-term follow-up. Only one work was added to the previous sample of studies published in 2019 looking at the longitudinal association between insomnia disorder and depression. Meta-analytic results confirmed the previous observation, with an even higher observed effect for the link between insomnia and depression. This again recognizes insomnia disorder as a possible transdiagnostic process in psychopathology, with consequent important clinical implications. Nevertheless, more longitudinal studies are needed evaluating the link between insomnia disorder and mental disorders.

Personality and insomnia: A systematic review and narrative synthesis

The inherent nature of personality serves as a predisposing, and possible maintaining, factor of insomnia. However, methodological differences limit the ability to draw causal conclusions regarding the specific traits involved in the aetiology of the disorder. This systematic review of the relationship between insomnia and personality provides a narrative synthesis of the literature to date. Here, we identified N = 76 studies meeting the inclusion/exclusion criteria. The outcomes reliably evidenced the experience of insomnia to be associated with personality traits that are typically considered to be negative or maladaptive in nature. More specifically, insomnia was related to neuroticism, introversion, perfectionistic doubts and concerns, elevated personal standards, negative affect, social inhibition and avoidance, hysteria, hypochondriasis, psychasthenia, impulsive behaviour, anger, hostility, and psychopathic tendencies, schizotypal and borderline traits, reduced conscientiousness and self-directedness, and negatively perceived perception of the self. Several studies examined the role that personality plays in predicting the treatment efficacy and adherence of CBTi. Moving forward, longitudinal research, methodological consistency, the mediating role of treatment outcomes and adherence, and clinical and population representative samples should be prioritised. Methodological strengths and limitations of the literature are discussed alongside the next steps that should be taken to advance our understanding of the literature.

Predictors of maternal satisfaction with labor induction: A prospective observational cohort study

OBJECTIVE

To identify independent predictors of maternal satisfaction with labor induction.

METHOD

In this prospective observational cohort study, 769 women prior to their labor induction had sleep and psychological well-being assessed using Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress Scales. Women were asked about the adequacy of labor induction information provided and their involvement and time pressure felt in the decision-making for their labor induction. Maternal characteristics, induction and intrapartum care measures, and labor and neonatal outcomes were also assessed. Prior to discharge, women rated their satisfaction with their birth experience.

RESULTS

A total of 34 variables were considered for bivariate analysis, with 15 found to have P < 0.05. Following adjusted analysis, 10 independent predictors of maternal satisfaction were identified: maternal education, previous cesarean delivery, maternal involvement, information provided, and decision-making time pressure regarding labor induction, amniotomy, induction to delivery interval, mode of delivery, postpartum hemorrhage, and neonatal admission. Maternal satisfaction was not associated with sleep, depression, anxiety, or stress.

CONCLUSION

The identification of independent predictors of maternal satisfaction allows for patient selection, targeting of specific preinduction and intrapartum care, and focus on induction methods that can reduce induction to delivery interval, cesarean birth, and delivery blood loss to maximize women's satisfaction with labor induction.

Disease-modifying therapies do not affect sleep quality or daytime sleepiness in a large Australian MS cohort

BACKGROUND

Poor sleep is common in multiple sclerosis (MS) and may impact daily functioning. The extent to which disease-modifying therapies (DMTs) contribute to sleep outcomes is under-examined.

OBJECTIVE

To compare the effects of DMTs on sleep outcomes in an Australian cohort of people with MS and investigate associations between DMT use and beliefs about sleep problems and daily functioning (social functioning and activity engagement).

METHODS

Sleep outcomes were assessed using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. DMT use and functioning were self-reported.

RESULTS

Of 1,715 participants, 64% used a DMT. No differences in sleep outcomes were detected between participants who did and did not use DMTs, the type of DMT used (lower vs higher efficacy, interferon-β vs other DMTs), the timing of administration, or adherence to standard administration recommendations. Beliefs that DMT use worsened sleep were associated with poorer sleep quality and perceptions that sleep problems interfered with daily functioning.

CONCLUSION

The use of a DMT does not appear to affect self-reported sleep outcomes in people with MS. However, beliefs that DMT use makes sleep worse were associated with poorer sleep quality and increased interference in daily functioning, suggesting a need for education to diminish negative perceptions of DMT use.

Electronic cigarette use and cigarette smoking associated with inadequate sleep duration among U.S. young adults

OBJECTIVE

Nicotine use can influence inadequate sleep, but less is known about the associations of exclusive and dual use of electronic cigarettes (e-cigarettes) with combustible cigarettes in U.S. young adults. This study assessed the associations between current exclusive e-cigarette use, exclusive cigarette smoking, and dual e-cigarette and combustible cigarette use and inadequate sleep duration among U.S. young adults.

METHODS

We performed a secondary analysis of 2020 Behavioral Risk Factor Surveillance System (BRFSS) data including 13,978 U.S. young adults ages 18-24 years. Inadequate sleep duration was assessed categorically using the National Sleep Foundation's age-specific recommendations that define <7 h as inadequate sleep. Weighted logistic regression models were performed while adjusting for participants' sex, race/ethnicity, education level, annual household income level, body mass index, current physical activity, mental health status, disability status, current alcohol use, and current smokeless tobacco use.

RESULTS

Concerning use patterns, 11.8% of young adults were exclusive e-cigarette users, 4.7% were exclusive cigarette smokers, and 3.8% were dual e-cigarette and combustible cigarette users. Exclusive e-cigarette users (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.16-1.72), exclusive cigarette smokers (AOR = 1.63, 95%CI = 1.22-2.18), and dual product users (AOR = 2.03, 95%CI = 1.44-2.86) were at increased odds of having inadequate sleep duration compared to non-users, while adjusting for the covariates. Additionally, dual product users were at increased odds (AOR = 1.52, 95%CI = 1.06-2.19) of reporting inadequate sleep duration compared to exclusive e-cigarette users, while adjusting for the covariates.

CONCLUSIONS

Current e-cigarette and cigarette use may influence inadequate sleep among U.S. young adults. Tobacco cessation efforts may encourage increased sleep health.

Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders

BACKGROUND

How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders.

PURPOSE

We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders.

METHODS

Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment.

RESULTS

Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one.

CONCLUSION

People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.

Insomnia and impacts on facial expression recognition accuracy, intensity and speed: A meta-analysis

Facial expressions provide nonverbal cues that are important for delivering and interpreting human emotions. Previous studies have shown that the ability to interpret facial emotions correctly could be partially impaired in sleep-deprived people. People with insomnia might also suffer from sleep loss, so we assumed that facial expression recognition ability might also be impaired in people with insomnia. Despite a growing body of research exploring insomnia's potential impacts on facial expression recognition, conflicting results have been reported, and no systematic review of this research body has been conducted. In this study, after screening 1100 records identified through database searches, six articles examining insomnia and facial expression recognition ability were included in a quantitative synthesis. The main outcomes were classification accuracy (ACC), reaction time (RT), and intensity rating-the three most studied facial expression processing variables. Subgroup analysis was performed to identify altered perceptions according to the facial expressions of four emotions-happiness, sadness, fear, and anger-used to examine insomnia and emotion recognition. The pooled standard mean differences (SMDs) and corresponding 95% confidence intervals (CIs) demonstrated that facial expression recognition among people with insomnia was less accurate (SMD = -0.30; 95% CI: -0.46, -0.14) and slower (SMD = 0.67; 95% CI: 0.18, -1.15) compared to good sleepers. The classification ACC of fearful expression was lower in the insomnia group (SMD = -0.66; 95% CI: -1.02, -0.30). This meta-analysis was registered using PROSPERO.

Sleep deprivation altered encoding of basolateral amygdala on fear acquisition

Sleep deprivation (SD) may lead to the development of fear- and anxiety-related emotional disorders. However, the neural mechanisms underlying the effects of SD on fear acquisition are unclear. Here, we tested whether and how SD influences the behavioral and neural manifestations of fear acquisition. We found that subjective fear ratings and objective fear indices (skin conductance response [SCR]) in the SD group were greater than those in the control group during fear acquisition, suggesting that SD facilitated fear acquisition (nSD = 18 and ncontrol = 23 for self-reported rating analysis; nSD = 10 and ncontrol = 10 for SCR analysis). Neuroimaging data showed that the SD group exhibited stronger activity in the left basolateral amygdala (BLA) and left superficial amygdala (SFA). Moreover, the left BLA activity, which positively correlated with the objective fear indices, significantly mediated the effect of SD on fear acquisition. Together, the present findings indicate that SD facilitates fear acquisition by augmenting threat-specific encoding in the BLA, which may be a potential biomarker of the risk of developing fear-related disorders under traumatic and distressing situations.

Putting the pieces together to understand anger in combat veterans and service members: Psychological and physical contributors

Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for the association between PTSD and anger, in addition to the association between pain interference and anger. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Additionally, treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference.

Bidirectional Daily Associations Between Accelerometer-Measured Sleep and Physical Activity in Brazilian High School Students

PURPOSE

This study analyzed day-to-day estimates of bidirectional associations between sleep parameters and intensity-specific physical activity and assessed whether the timing of physical activity influences these relationships.

METHODS

The sample was comprised of 651 high school students (51.2% female, 16.33 [1.0] y old) from southern Brazil. Physical activity and sleep were measured using accelerometers. Multilevel models were applied to test associations of nocturnal total sleep time, onset, and efficiency with moderate to vigorous and light (LPA) physical activity.

RESULTS

Higher engagement in moderate to vigorous physical activity and LPA was associated with increased total sleep time, and this effect was greater when physical activity was performed in the morning. Morning and evening LPA were associated with increased sleep efficiency and reduced total sleep time, respectively. Practice of LPA in the morning leads to early sleep onset, whereas evening LPA was associated with later onset. Higher total sleep time and later sleep onset were associated with lower moderate to vigorous physical activity and LPA on the following day. However, higher sleep efficiency was associated with increased LPA.

CONCLUSION

The relationship between sleep parameters and physical activity is bidirectional and dependent on physical activity intensity and timing.

Association between Suicidal Behaviors in Adolescence and Negative Emotions, the Level of Stress, Stress Coping Strategies and the Quality of Sleep

Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16-18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale-Modified, Perceived Stress Scale-10, How do you cope?-Questionnaire, Athens Insomnia Scale as well as the authors' own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13-6.06 and OR = 2.35, 95% CI: 1.60-3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93-14.80 and OR = 3.29, 95% CI: 2.07-5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13-4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide.

Sleep Dysfunction in Huntington's Disease: Impacts of Current Medications and Prospects for Treatment

Sleep dysfunction is highly prevalent in Huntington's disease (HD). Increasing evidence suggests that such dysfunction not only impairs quality of life and exacerbates symptoms but may even accelerate the underlying disease process. Despite this, current HD treatment approaches neither consider the impact of commonly used medications on sleep, nor directly tackle sleep dysfunction. In this review, we discuss approaches to these two areas, evaluating not only literature from clinical studies in HD, but also that from parallel neurodegenerative conditions and preclinical models of HD. We conclude by summarizing a hierarchical framework of current medications with regard to their impact on sleep, and by outlining key emerging sleep therapies.

Associations between compassion fatigue, burnout and secondary traumatic stress with lifestyle factors in mental health nurses: A multicenter study from Uganda

PURPOSE

This cross-sectional study aimed (a) to explore levels of compassion satisfaction, secondary traumatic stress, and symptoms of burnout among Ugandan mental health nurses working in regional referral hospitals in Uganda during the Covid-19 pandemic, and (b) to investigate associations between compassion satisfaction, secondary traumatic stress, and symptoms of burnout and sedentary levels, physical activity (PA) levels, sleep quality, and harmful drinking.

MATERIAL AND METHODS

In total 108 mental health nurses from 8 regional referral hospitals across Uganda (age = 34.8 ± 10.0 years; 55.6 % female) completed the Professional Quality of Life Scale-5, (PQoLS-5), the Simple Physical Activity Questionnaire (SIMPAQ), Physical Activity Vital Sign (PAVS), Pittsburgh Sleep Quality Index (PSQI), and Alcohol Use Disorder Identification Test - Concise (AUDIT-C). Spearman Rho correlations and Mann-Whitney U tests were applied.

RESULTS

ProQOL-5 compassion satisfaction correlated significantly with SIMPAQ walking, PSQI and AUDIT-C, ProQOL-5 burnout with SIMPAQ exercise and PSQI and ProQOL-5 traumatic with SIMPAQ walking and PSQI. Mental health nurses meeting PA guidelines reported higher ProQOL-5 compassion satisfaction and lower ProQOL-5 burnout and traumatic stress than those who did not. Those who reported a poor sleep quality reported significantly less ProQOL-5 compassion satisfaction and higher ProQOL-5 burnout than those who did not. Those who reported harmful drinking patterns reported a significantly lower compassion satisfaction versus those who did not.

DISCUSSION

In mental health nurses, a lower professional quality of life is associated with an unhealthy lifestyle. The effectiveness and efficacy of resilience and self-care programs for mental health nurses focusing on unhealthy lifestyle patterns should be explored.

Associations Between Sleep Health and Amygdala Reactivity to Negative Facial Expressions in the UK Biobank Cohort

BACKGROUND

Sleep health (SH) is considered a key determinant of human physiological and psychological well-being. In line with this, previous studies have found that poor sleep is associated with various psychiatric disorders, in particular, with anxiety and depression. Although little is known about the neural mechanisms underlying these associations, recent findings suggest that essential dimensions of SH are associated with altered amygdala reactivity (AR); however, evidence to date is inconsistent and reliant on small sample sizes.

METHODS

To address this problem, the current preregistered study investigated associations between SH and AR to negative facial expressions in the UK Biobank cohort (25,758 participants). Drawing on a large sample size and consistent data acquisition, 5 dimensions of SH (insomnia symptoms, sleep duration, daytime sleepiness, chronotype, and sleep medication) were examined.

RESULTS

Exploratory analyses revealed that short sleep duration was associated with decreased AR. The remaining SH dimensions and a composite measure of all SH dimensions were not associated with AR.

CONCLUSIONS

To our knowledge, this is the largest study to test associations between SH and AR. Habitual short sleep duration may be associated with decreased AR, possibly indicating compensation for impaired prefrontal processes and hampered emotion regulation.

Sleep impairments and quality of life in Thai adolescents with systemic lupus erythematosus

PURPOSE

Adolescents with systemic lupus erythematosus (SLE) are susceptible to sleep impairments. We aimed to determine the prevalence and factors related to sleep impairments, and the associations of sleep impairments with health-related quality of life (HRQOL) in Thai adolescents with SLE.

METHODS

Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire for Adolescents (PHQA), and Pediatric Quality of Life Inventory™ 4.0 Core Scales were administered to 57 participants with SLE aged 13-18 years to evaluate sleep, depression, and HRQOL, respectively. Participants were divided into "good sleep" (PSQI scores <5) and "poor sleep" groups (PSQI scores ≥5). Participants with body mass index (BMI) >23 kg/m² were classified into the high BMI group.

FINDINGS

Eighteen participants (31.6%) were in the poor sleep group. High BMI and PHQA scores were associated with sleep impairments with the odds ratio of 8.00 (95% CI 1.50-42.64; p = 0.02), and 1.25 (95% CI 1.01-1.54; p = 0.04), respectively. In terms of HRQOL, adolescents with SLE had the highest scores in social functioning and the lowest scores in school functioning. Good sleepers had better scores than poor sleepers across all sub-categories except for social functioning, and the difference was significant in emotional functioning (90% (IQR 75-100) vs. 70% (IQR 55-85); p = 0.03).

CONCLUSIONS

A substantial number of adolescents with SLE had sleep impairments, which decreased HRQOL, particularly in emotional functioning. Sleep impairments were associated with obesity and depression.

IMPLICATIONS

Proactive management in addressing weight, mood, and sleep problems should be included in the multidisciplinary care of adolescents with SLE to improve their health and well-being.

Neural activation underlying emotional interference of cognitive control in rotating shift workers: moderating effects of the prefrontal cortex response on the association between sleep disturbance and depressive symptoms

Study Objectives

This study investigated the altered neural function involved in emotional interference and its role in linking sleep disturbance and depressive/anxiety symptoms in rotating shift workers.

Methods

Sixty rotating shift workers and 61 controls performed the emotional Stroop task in three blocks (emotional-related, sleep-related, and neutral words) during functional magnetic resonance imaging (fMRI) assessments. Sleep disturbance and depressive/anxiety symptoms were assessed using self-report measures and sleep diaries. Actigraphy was used to assess the sleep and circadian variables. fMRI scans were performed to compare brain activation during the emotional Stroop task. The proposed moderating models were tested using the PROCESS macro in SPSS software.

Results

A significant condition effect on reaction time was detected. Regardless of the group, reaction times were longer in the negative emotional word and sleep-related conditions than in the neutral word condition. Whole-brain analysis revealed that rotating shift workers show greater neural activation in the left dorsolateral prefrontal cortex (DLPFC) compared with controls while performing the emotional Stroop task with negative emotional words. Sleep disturbance was more strongly associated with depressive symptoms when activation of the left DLPFC was higher during the emotional Stroop task with negative words.

Conclusions

The left DLPFC may play important roles in increased sensitivity to emotional information, possibly due to circadian misalignment, and has moderating effects on the association between sleep disturbance and depressive symptoms in rotating shift workers. These findings will help to identify possible brain regions where interventions can be performed to correct sleep and mood problems in rotating shift workers.

Neurobehavioral Associations with NREM and REM Sleep Architecture in Children with Autism Spectrum Disorder

Objective: Insomnia and daytime behavioral problems are common issues in pediatric autism spectrum disorder (ASD), yet specific underlying relationships with NonRapid Eye Movement sleep (NREM) and Rapid Eye Movement (REM) sleep architecture are understudied. We hypothesize that REM sleep alterations (REM%, REM EEG power) are associated with more internalizing behaviors and NREM sleep deficits (N3%; slow wave activity (SWA) 0.5–3 Hz EEG power) are associated with increased externalizing behaviors in children with ASD vs. typical developing controls (TD). Methods: In an age- and gender-matched pediatric cohort of n = 23 ASD and n = 20 TD participants, we collected macro/micro sleep architecture with overnight home polysomnogram and daytime behavior scores with Child Behavior Checklist (CBCL) scores. Results: Controlling for non-verbal IQ and medication use, ASD and TD children have similar REM and NREM sleep architecture. Only ASD children show positive relationships between REM%, REM theta power and REM beta power with internalizing scores. Only TD participants showed an inverse relationship between NREM SWA and externalizing scores. Conclusion: REM sleep measures reflect concerning internalizing behaviours in ASD and could serve as a biomarker for mood disorders in this population. While improving deep sleep may help externalizing behaviours in TD, we do not find evidence of this relationship in ASD.

Coronasomnia in Employees without a Direct Contact with COVID-19 Infected Patients in Their Workplace

Background: The aim of this analysis was to explore coronasomnia in second line workers. Methods: Data were collected via in an online questionnaire. Patients with new onset or aggravation of insomnia were defined as cases and those without insomnia as controls. Differences among groups were studied by nonparametric tests; the correlation among variables was assessed using regression, followed by Bonferroni adjustment. Results: There were 377 responders, grouped into 129 cases and 248 controls. Younger age (Odds Ratio = 0.97, p = 0.021), women (OR = 2.46, p = 0.016), workers belonging to a vulnerable group (OR = 2.36, p = 0.007), and those with previous history of insomnia (OR = 38.76, p = 0.00) were associated with coronasomnia. Increased home duties were directly related to insomnia (OR = versus home support which were indirectly associated). The constant preoccupation for SARS-CoV-2 media reports (OR = 3.6, p = 0.00009) and media consumption were components of the coronasomnia. In the adjusted models, the personal medical history, and the anxiety created by media alerts maintained their significance. Conclusion: Preventive measures to reduce the occurrence of insomnia in times of social stress in nonessential occupations should focus on health vulnerable groups, persons with previous history of insomnia and who develop anxiety from media.

Sleepy and Secluded: Sleep Disturbances are Associated With Connectedness in Early Adolescent Social Networks

Studies in adults suggest that sleep disturbances predict poorer socioemotional skills and impaired social interactions. However, little is known regarding how sleep disturbances are associated with social processes during adolescence, a period when both sleep neurobiology and social relationships are undergoing dramatic developmental changes. The current study examined associations among sleep disturbances and peer connectedness in a sample of middle-school students (N = 213, 11-15 years old, 57% female) using a social network approach. Findings suggested that youth with greater sleep disturbances reported having fewer social connections, were rated as a social connection by fewer peers, and were less likely to have reciprocated nominations, even after controlling for sociodemographic characteristics and mental health symptoms.

Sleep, Emotions, and Sense of Belonging: A Daily Experience Study

Sleep has strong influences on affective and social experiences. However, less is known about the reciprocal effects of sleep, affect, and social experiences at a daily level, and little work has considered racial/ethnic minorities at high risk for social disconnection and discrimination. A 7-day daily experience study assessed the bidirectional relationships between daily sleep quality, affect, social experiences, and overall well-being among a sample of Latinx undergraduates (N = 109). Each morning, participants reported on their previous night's sleep. Each evening, they reported their positive and negative affect, experiences of belonging and unfair treatment, and overall well-being that day. Results indicate that, at a daily level, sleep quality predicts next-day affect, belonging, and well-being. Reciprocally, only daily well-being predicts sleep quality. Findings highlight sleep as a potentially powerful antecedent of affective and social experiences likely to be particularly potent for underrepresented minority groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-021-00088-0.

Convergent validity of the child behavior checklist sleep items in children with moderate to severe traumatic brain injury

AIM

The Child Behavior Checklist (CBCL) includes several sleep items. We aimed to examine the convergent validity of CBCL sleep scores with validated sleep measures, and to explore their functional correlates.

METHODS

This cross-sectional study included 44 children with moderate to severe TBI, aged 6-15 years. Parents completed the CBCL and Sleep Disturbance Scale for Children (SDSC), and children wore actigraphy watches.

RESULTS

We found significant, albeit differential, associations between CBCL and SDSC sleep scores. Specifically: (i) "trouble sleeping" with SDSC total score, (ii) "trouble sleeping" and "nightmares" with SDSC initiating and maintaining sleep, (iii) "talks/walks in sleep" with SDSC arousal, and (iv) "overtired," "sleeps more" and CBCL sleep composite with SDSC excessive somnolence. The CBCL item "sleeps less" was the only significant predictor of functioning; children who slept less had lower social competence. No associations were found between CBCL sleep scores and actigraphy.

CONCLUSIONS

The CBCL does not provide a comprehensive assessment of sleep disturbances in children with moderate to severe TBI. Nevertheless, certain CBCL sleep items demonstrate initial convergent validity with subscales of the SDSC assessing select types of sleep disturbances. The CBCL may be useful in research and clinical situations when administration of more comprehensive assessment sleep tools is not viable.

The mediating role of gaze patterns in the association of child sleep disturbances and core symptoms of autism spectrum disorder

Children with autism spectrum disorder (ASD) are at high risk for sleep disturbances, but the mechanism underlying the association between sleep disturbances and ASD core symptoms is largely unknown. This study examined the relationship between sleep disturbances and ASD core symptoms, and the mediating role of gaze patterns during the facial emotion recognition (FER) task. The study included 57 children with ASD and 59 age- and intelligence-matched typically developing (TD) controls aged 3-7 years. Parents reported their children's sleep disturbances and ASD core symptoms using the Children's Sleep Habits Questionnaire (CSHQ) and Social Communication Questionnaire (SCQ). Children's gaze patterns during the FER task were recorded by an eye tracking method. We found (1) ASD children had more severe sleep disturbances than TD children; (2) ASD children had atypical gaze patterns and poor FER task performance as determined by lower accuracy and longer reaction time; (3) sleep disturbances were significantly associated with ASD core symptoms of social interaction, communication, and restricted, repetitive and stereotyped patterns of behavior; and (4) atypical gaze patterns partially mediated the association between sleep disturbances and ASD core symptoms. These findings suggest the need for more comprehensive clinical interventions and more effective sleep interventions to improve ASD core symptoms. LAY SUMMARY: Sleep disturbances are very common in children with autism spectrum disorder (ASD). The current study found that sleep disturbances were significantly associated with ASD core symptoms, and gaze patterns during facial emotion recognition task could partially mediate this relationship.

Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study

Background: Insomnia has been associated with decreased academic performance and unhealthy behaviors in university students. Although many studies have analyzed sleep phenomenology among this population, only few have focused on insomnia and its related variables. In addition, such studies do not always include a clinical interview or a specific and validated instrument for measuring insomnia. This study aimed to explore the prevalence of insomnia symptoms and the relationship between insomnia and health habits, mental health, and academic performance in a large university student sample. Methods: Five hundred and eighty-two students were recruited from the University of Granada, Spain. Data were collected through an online survey with questions on sociodemographic and academic data and health habits as well as the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleep Hygiene Index, and Sleepiness, Depression, Anxiety, and Stress Scales. A multiple regression analysis explored the relationship between academic performance, health habits, mood state, and insomnia symptoms. Results: The prevalence of students with symptoms of insomnia was high (39.7%). A multiple logistic regression analysis revealed that depression, sleep hygiene, stress and anxiety were significant predictors of insomnia symptoms. Multivariate analyses revealed that subjective insomnia symptoms, sleep efficiency, and depression were significantly correlated with academic performance in a dependent way. Conclusions: In university students, anxiety, stress, and poor sleep hygiene are risk factors for insomnia, which plays an important role in academic performance. Promoting sleep and mental health could be a potentially effective way to improve their academic performance.

Assessment of Sleep and Sleepiness in Patients With Mental Disorders: Applicability of the German Version of the SCOPA-Sleep Questionnaire

Sleep problems affect the majority of patients with mental disorders and are very clinically relevant. However, they are often not assessed and treated appropriately and, to date, there is no established screening routine for sleep disturbances in this specific patient group. For patients with Parkinson disease, the Scales for Outcomes in Parkinson's Disease-Sleep (SCOPA-Sleep) questionnaire is widely used. This questionnaire has excellent psychometric properties. It consists of 2 scales for assessing nighttime sleep problems (NS) and daytime sleepiness (DS). As the items in the scales are not disease-specific, the goal of this study was to validate the SCOPA-Sleep for use in patients with mental disorders. A total of 370 German patients with mental disorders completed the SCOPA-Sleep as well as a multitude of other instruments for assessment of validity [eg, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS)]. For validity estimation, 627 healthy subjects were also included in this study. Internal consistency was good with coefficients of 0.806 and 0.772 for the SCOPA-NS and the SCOPA-DS. Factor analysis revealed 2 factors which could each be assigned to one of the subscales. Convergent validity was high with correlations of 0.672 between the SCOPA-NS and the PSQI and 0.644 between the SCOPA-DS and the ESS. The German version of the SCOPA-Sleep showed good diagnostic accuracy, resulting in an area under the receiver operating curve of 0.959 for the SCOPA-NS and 0.728 for the SCOPA-DS. For patients with mental disorders, the SCOPA-Sleep proved to be an economical, reliable, and valid instrument for assessing NS and DS which is well accepted by patients. It can be recommended for routine assessment of both NS and DS.

Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in U.S. army service members seeking treatment for PTSD

STUDY OBJECTIVES

Characterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD.

METHODS

Ninety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State of the science sleep measurements included (1) retrospective, self-reported insomnia, (2) prospective sleep diaries assessing sleep patterns and nightmares, and (3) polysomnography (PSG) measured sleep architecture and obstructive sleep apnea-hypopnea (OSAH) severity. Dependent variables included self-report measures of PTSD severity and anger severity. Pearson correlations and multiple linear regression analyses examined if sleep symptoms, not generally measured in PTSD populations, were associated with PTSD and anger severity.

RESULTS

All participants met PTSD, insomnia, and nightmare diagnostic criteria. Mean sleep efficiency = 70%, total sleep time = 5.5 hours, obstructive sleep apnea/hypopnea (OSAH index ≥ 5) = 53%, and clinically significant anger = 85%. PTSD severity was associated with insomnia severity (β =.58), nightmare severity (β = .24), nightmare frequency (β = .31), and time spent in Stage 1 sleep (β = .27, all p < .05). Anger severity was associated with insomnia severity (β =37), nightmare severity (β = .28), and OSAH during rapid eye movement (β = .31, all p < .05).

CONCLUSIONS

Insomnia and nightmares were related to PTSD and anger severity, and OSAH was related to anger. Better assessment and evidence-based treatment of these comorbid sleep impairments in service members with PTSD and significant anger, should result in better PTSD, anger, and quality of life outcomes.

CLINICAL TRIALS REGISTRATION

Registry: ClinicalTrials.gov; Name: Treatment of Comorbid Sleep Disorders and Post Traumatic Stress Disorder; Identifier: NCT02773693; URL: https://clinicaltrials.gov/ct2/show/NCT02773693.

Variability in Sleep Is Associated with Trait-Based and Daily Measures of Bipolar Spectrum Psychopathology

INTRODUCTION

Although sleep disturbances are well documented in bipolar spectrum disorders (BSDs), significantly less research has examined whether these disturbances are present in those at risk for developing BSDs or with subsyndromal symptoms. The present study examined associations between risk for BSDs, as measured by the Hypomanic Personality Scale (HPS), and sleep assessed using experience sampling. We assessed whether intraindividual variability in sleep was associated with affect, cognition, and behavior in daily life and potential directionality of these relationships.

METHODS

233 young adults oversampled for high scores on the HPS completed 14 days of experience sampling assessing total sleep time (TST), bed/rise time, sleep quality, affect (negative and positive affect), cognition (difficulty concentrating, racing thoughts), and behavior (impulsivity) in daily life. We used Dynamic Structural Equation Modeling (DSEM) to assess within-person links between sleep and bipolar spectrum psychopathology.

RESULTS

HPS scores were associated with less TST, later bedtime, and more variable TST and bedtime. Variability in TST was associated with negative affect, difficulty concentrating/racing thoughts, and impulsivity. Within-person decreases in sleep were associated with next day increases in negative affect, stress, difficulty concentrating, and racing thoughts.

LIMITATIONS

Measurement of sleep was limited. Future studies should examine both objective measures of sleep (e.g., actigraphy) and fragmentation in sleep.

CONCLUSIONS

Risk for BSD was associated with similar patterns of sleep disruptions as seen in BSDs. Important dynamic links between sleep and bipolar spectrum psychopathology emerged indicating that sleep is an important target for improving symptoms of BSDs in daily life.

Sleep in an At Risk Adolescent Group: A Qualitative Exploration of the Perspectives, Experiences and Needs of Youth Who Have Been Excluded From Mainstream Education

The sleep needs, experiences and viewpoints were explored for UK adolescents who have been excluded from mainstream education. Qualitative data was gathered through interviews with 9 participants, aged 11–15 years, who also completed questionnaires. The participants had symptoms of inadequate sleep, poor sleep hygiene behaviours and were not getting the recommended amount of sleep on school nights. Participants described sleep patterns involving often staying up late and having different sleep timing on weekends than weekdays and having difficulties with their sleep. Use of technology and the relevance of family were identified as important and associated with facilitating and hindering factors for sleep. Participants communicated that they lack control over aspects of their sleep and their lives. The experiences and views of the participants can inform professionals’ understanding of how to collaborate with adolescents to improve their sleep and highlight that continued development of sleep education programmes is timely.

Geographical variations in the association between bullying victimization and sleep loss among adolescents: a population-based study of 91 countries

OBJECTIVE

To examine geographical variations in the association between bullying victimization and sleep loss over worry among adolescents.

METHODS

We used data from the Global School-based Student Health Survey conducted between 2003 and 2017 in 91 countries across the globe. Sleep loss was categorised as: none/minimum (reported never or rarely sleep loss), moderate (reported sometimes), and severe (reported most of the time or always). We obtained country-specific estimates from multiple multinomial logistic regression analyses and pooled estimates from meta-analyses.

RESULTS

Of 282,036 adolescents 13-17 years of age, 28.1% (male: 25.4%, female: 31.0%) and 8.4% (male: 7.3%, female: 9.5%) of adolescents reported moderate and severe sleep loss respectively. Adolescents who frequently experienced bullying (≥3 per 30 days) reported higher prevalence of severe sleep loss. Meta-analyses showed that increased frequency of bullying victimization is associated with increased odds of sleep loss, with adolescents who experienced bullying for ≥3 days in the past 30 days were 1.65 and 2.65 times more likely than adolescents without being bullied to experience respectively moderate (OR 1.65, 95% CI: 1.59-1.72) and severe (OR 2.65, 95% CI: 2.52-2.79) sleep loss. Irrespective of sex, the association between bullying victimization and sleep loss was significant in all regions, income groups, and in all but a few countries.

CONCLUSIONS

Increased frequency of bullying victimization is positively associated with increased sleep loss among adolescents. Appropriate policies and programmes to stop bullying at school could help downgrade the risk of sleep loss among adolescents.

Influence of shift work on rest-activity rhythms, sleep quality, and fatigue of female nurses

Female nurses working rotating shifts must change their daily routines often, which affects their biological circadian rhythms and could cause sleep disorders and fatigue. The objective of this study was to compare the sleep-wake rhythms, sleep quality, and fatigue of female nurses working rotating shifts and fixed day shifts and to analyze the factors that influence their fatigue. Participants comprised a shift worker group of 101 nurses and a day worker group of 76 nurses. Following the collection of basic information of the nurses and their scores in the various constructs of the Pittsburg Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS) questionnaire, each nurse wore an actigraph for seven consecutive days to collect for analysis the sleep-wake rhythm parameter dichotomy index (I < O) and durations of continuous sleep and wake. Multivariable linear regression was then used to determine whether the influence of various variables on fatigue differed between the two groups. Results revealed that the sleep-wake rhythm parameter I < O of the day worker group was significantly higher than that of the shift worker group (t = 5.08, p < .001). The shift worker group exhibited significantly higher PSQI global scores (t = -2.00, p = .047), longer total sleep time (t = 2.07, p = .040), poorer habitual sleep efficiency (t = -3.06, p = .003), and greater use of sleeping medication (t = -2.90, p = .004) than did the day worker group. Multivariable linear regression was performed to analyze the important predictors of the CIS score in the two groups with body mass index, age, work experience, marital status, educational background, department of employment, shift type at the time of recruitment, sleep-wake rhythm parameter I < O, and quality of sleep as independent variables. Results indicated that in the shift worker group, the overall explanatory power (R²) of the multivariable linear regression model was 22.9% (F = 3.01, p = .003), and only the PSQI global score (β = 0.33, p = .003) influenced the CIS score. In the day worker group, the various variables did not influence the CIS score in the multivariable linear regression model. Although the female nurses working rotating shifts spent more time in bed, their sleep-wake rhythms and sleep quality were poorer than those of the day worker group. Furthermore, the sleep quality of female nurses in the shift worker group had a significant impact on their fatigue. In other words, for female nurses who must work rotating shifts, sleep quality determines whether fatigue can be reduced. The shift-working nurses themselves should implement sleep management, such as avoiding disruptions to their sleep-wake rhythm and improving sleep quality, which should be effective strategies to reduce fatigue.

Impact of total sleep deprivation and related mood changes on approach-avoidance decisions to threat-related facial displays

STUDY OBJECTIVES

Total sleep deprivation is known to have significant detrimental effects on cognitive and socio-emotional functioning. Nonetheless, the mechanisms by which total sleep loss disturbs decision-making in social contexts are poorly understood. Here, we investigated the impact of total sleep deprivation on approach/avoidance decisions when faced with threatening individuals, as well as the potential moderating role of sleep-related mood changes.

METHODS

Participants (n = 34) made spontaneous approach/avoidance decisions in the presence of task-irrelevant angry or fearful individuals, while rested or totally sleep deprived (27 h of continuous wakefulness). Sleep-related changes in mood and sustained attention were assessed using the Positive and Negative Affective Scale and the psychomotor vigilance task, respectively.

RESULTS

Rested participants avoided both fearful and angry individuals, with stronger avoidance for angry individuals, in line with previous results. On the contrary, totally sleep deprived participants favored neither approach nor avoidance of fearful individuals, while they still comparably avoided angry individuals. Drift-diffusion models showed that this effect was accounted for by the fact that total sleep deprivation reduced value-based evidence accumulation toward avoidance during decision making. Finally, the reduction of positive mood after total sleep deprivation positively correlated with the reduction of fearful display avoidance. Importantly, this correlation was not mediated by a sleep-related reduction in sustained attention.

CONCLUSIONS

All together, these findings support the underestimated role of positive mood-state alterations caused by total sleep loss on approach/avoidance decisions when facing ambiguous socio-emotional displays, such as fear.

How Social Experience and Environment Impacts Behavioural Plasticity in Drosophila

An organism's behaviour is influenced by its social environment. Experiences such as social isolation or crowding may have profound short or long-term effects on an individual's behaviour. The composition of the social environment also depends on the genetics and previous experiences of the individuals present, leading to additional potential outcomes from each social interaction. In this article, we review selected literature related to the social environment of the model organism Drosophila melanogaster, and how Drosophila respond to variation in their social experiences throughout their lifetimes. We focus on the effects of social environment on behavioural phenotypes such as courtship, aggression, and group dynamics, as well as other phenotypes such as development and physiology. The consequences of phenotypic plasticity due to social environment are discussed with respect to the ecology and evolution of Drosophila. We also relate these studies to laboratory research practices involving Drosophila and other animals.

Emotion Regulation Failures Are Preceded by Local Increases in Sleep-like Activity

Emotion self-regulation relies both on cognitive and behavioral strategies implemented to modulate the subjective experience and/or the behavioral expression of a given emotion. Although it is known that a network encompassing fronto-cingulate and parietal brain areas is engaged during successful emotion regulation, the functional mechanisms underlying failures in emotion suppression (ES) are still unclear. In order to investigate this issue, we analyzed video and high-density EEG recordings of 20 healthy adult participants during an ES and a free expression task performed on two consecutive days. Changes in facial expression during ES, but not free expression, were preceded by local increases in sleep-like activity (1-4 Hz) in brain areas responsible for emotional suppression, including bilateral anterior insula and anterior cingulate cortex, and in right middle/inferior frontal gyrus (p < .05, corrected). Moreover, shorter sleep duration the night before the ES experiment correlated with the number of behavioral errors (p = .03) and tended to be associated with higher frontal sleep-like activity during ES failures (p = .09). These results indicate that local sleep-like activity may represent the cause of ES failures in humans and may offer a functional explanation for previous observations linking lack of sleep, changes in frontal activity, and emotional dysregulation.

Associations Between Social Media, Bedtime Technology Use Rules, and Daytime Sleepiness Among Adolescents: Cross-sectional Findings From a Nationally Representative Sample

BACKGROUND

Social media use is associated with poor sleep among adolescents, including daytime sleepiness, which affects adolescents' mental health. Few studies have examined the associations among specific aspects of social media, such as frequency of checking and posting, perceived importance of social media for social belonging, and daytime sleepiness. Identifying whether certain adolescents are more at risk or protected from the effects of social media on sleepiness may inform future interventions for social media, sleep, and mental health.

OBJECTIVE

This study aims to examine the association between social media use frequency and importance, daytime sleepiness, and whether the perceived importance of social media for social interactions and parental rules around bedtime technology moderated these relationships.

METHODS

This cross-sectional survey study was conducted with a sample of 4153 adolescents from across the United States. Qualtrics was used to collect data via panel recruitment from a national sample representing the US demographics of teens aged 12 to 17 years. Participants completed measures of daytime sleepiness, frequency of social media checking and posting, and the importance of social media for social interactions. Parents reported whether they had a household rule around bedtime media and screen use. Hierarchical regressions and moderation analyses were conducted, covarying for age, gender, and age at first smartphone use.

RESULTS

Participants had a mean age of 14.64 (SD 1.66) years in grades 6 to 12, 46.45% (1929/4153) identified as female, and 67.93% (2821/4153) identified as White. The results indicated that adolescents who posted (B=0.70, SE 0.04; P<.001) or checked (B=0.76, SE 0.04; P<.001) social media more frequently or who perceived social media to be more important for social belonging (B=0.36, SE 0.02; P<.001) had higher levels of daytime sleepiness. Moderation analyses indicated that the relationship between social media use frequency and daytime sleepiness was exacerbated by higher levels of perceived social media importance (B=0.04, SE 0.01; P<.001). Adolescents without household rules around bedtime technology use were more likely to be affected by social media checking (B=-0.34, SE 0.09; P<.001) and importance (B=-0.16, SE 0.04; P<.001) on daytime sleepiness.

CONCLUSIONS

The findings suggest that social media use frequency and perceived importance of social interactions are associated with daytime sleepiness among adolescents. It is important to consider youth's perceptions of social media when assessing the potential effects of social media use frequency on youth well-being. Furthermore, youth who did not have parental rules around bedtime technology use were most likely to be affected by social media use and perceived importance. The findings may extend to other mental health outcomes and may guide future prevention and intervention programs designed to improve social media use, sleep, and mental health.

What Is “Chronic” in “Chronic Sleep Reduction” and What Are Its Consequences? A Systematic Scoping Review of the Literature

Purpose of Review

In this scoping review, we aimed to (1) provide an overview of chronic sleep reduction by systematically reviewing the existing literature (limited to systematic reviews and meta-analyses), (2) investigate the evidence of the effects of short sleep duration on daytime functioning, and (3) identify research gaps in this field.

Recent Findings

The results showed that (1) clear definitions of chronicity of sleep reduction are lacking—none of the included reviews/meta-analyses provided a full definition—and (2) short sleep duration appeared to be related to obesity and diabetes, whereas relations with cardiovascular disease (CVD), cognitive functioning, emotional problems, general health, and mortality, showed either small effects and appeared to be complex (e.g., for CVD and cognitive functioning), or studies were scarce or completely lacking (e.g., mortality in children/adolescents and emotional problems in adults).

Summary

Although short or insufficient sleep is highly prevalent and is associated with impaired mental and physical wellbeing, as well as pervasive negative consequences for daytime functioning, the concepts of “chronicity” and “chronic sleep reduction” have not been clearly defined and its effects on health are therefore still largely unknown. Moreover, there are large research gaps concerning studies on the relations between short sleep and health consequences. Further studies are recommended to define and operationalize chronicity of sleep reduction and develop measurements that adequately represent the complexity of the concept.

At the intersection of sleep deficiency and opioid use: mechanisms and therapeutic opportunities

Due to the ongoing opioid epidemic, innovative scientific perspectives and approaches are urgently needed to reduce the unprecedented personal and societal burdens of nonmedical and recreational opioid use. One promising opportunity is to focus on the relationship between sleep deficiency and opioid use. In this review, we examine empirical evidence: (1) at the interface of sleep deficiency and opioid use, including hypothesized bidirectional associations between sleep efficiency and opioid abstinence; (2) as to whether normalization of sleep deficiency might directly or indirectly improve opioid abstinence (and vice versa); and (3) regarding mechanisms that could link improvements in sleep to opioid abstinence. Based on available data, we identify candidate sleep-restorative therapeutic approaches that should be examined in rigorous clinical trials.

'No Man is an Island': Effects of social seclusion on social dream content and REM sleep

Based on the Social Simulation Theory of dreaming (SST), we studied the effects of voluntary social seclusion on dream content and sleep structure. Specifically, we studied the Compensation Hypothesis, which predicts social dream contents to increase during social seclusion, the Sociality Bias - a ratio between dream and wake interactions - and the Strengthening Hypothesis, which predicts an increase in familiar dream characters during seclusion. Additionally, we assessed changes in the proportion of REM sleep. Sleep data and dream reports from 18 participants were collected preceding (n = 94), during (n = 90) and after (n = 119) a seclusion retreat. Data were analysed using linear mixed-effects models. We failed to support the Compensation Hypothesis, with dreams evidencing fewer social interactions during seclusion. The Strengthening Hypothesis was supported, with more familiar characters present in seclusion dreams. Dream social interactions maintained the Sociality Bias even under seclusion. Additionally, REM sleep increased during seclusion, coinciding with previous literature and tentatively supporting the proposed attachment function for social REM sleep.

A Time to Sleep Well and Be Contented: Time Perspective, Sleep Quality, and Life Satisfaction

A major aim of the present study was to examine the relationship between time perspective, i.e., habitual ways of relating to the past, present, and future, and sleep quality. A second aim was to test a model by which the expected negative relationship between deviation from a balanced time perspective (DBTP), a measure taking temporal biases across all three time frames into account, and life satisfaction was mediated by poor sleep quality. To these ends, a sample of young adults (N = 386) completed a version of the Zimbardo Time Perspective Inventory (S-ZTPI), Pittsburg Sleep Quality Index (PSQI), and the Satisfaction with Life Scale (SWLS). A measure of chronotype was in addition included for control purposes. Bivariate analyses revealed that the S-ZTPI subscales Past Negative, Future Negative and Present Fatalistic were associated with poorer sleep quality (higher PSQI scores), with significant associations in the opposite direction for Past Positive and Future Positive. However, DBTP was the strongest predictor of (poorer) sleep quality, suggesting that time perspective biases have an additive effect on sleep quality. Regression analyses with PSQI as the dependent variable and all six ZTPI subscales as the predictors indicated that time perspective accounted for about 20% of the variance in sleep quality (17% beyond chronotype), with Past Negative, Past Positive, and Future Negative as the unique predictors. The results additionally confirmed a strong relationship between DBTP and life satisfaction. Finally, data were consistent with the hypothesis that the association of DBTP and life satisfaction is mediated, in part, by sleep quality. Taken together, the results confirmed a substantial link between time perspective sleep-related problems, factors that may have a negative impact on life satisfaction.

The Role of Sleep in the Transition from Acute to Chronic Musculoskeletal Pain in Youth-A Narrative Review

Musculoskeletal pain is common in the general pediatric population and is a challenge to youth, their parents, and society. The majority of children experiencing musculoskeletal pain will recover; however, a small subgroup of youth develops chronic pain. There is limited understanding of the factors that affect the transition from acute to chronic pain in youth. This review introduces sleep deficiency in the acute to chronic pain transition, exploring the potential mediational or mechanistic role and pathways of sleep in this process, including the interaction with sensory, psychological, and social components of pain and highlighting new avenues for treatment. Biological mechanisms include the increased production of inflammatory mediators and the effect on the hypothalamus-pituitary-adrenal (HPA) axis and on the dopaminergic signaling. Psychological and social components include the effect of sleep on the emotional-affective and behavioral components of pain, the negative impact on daily and social activities and coping strategies and on the reward system, increased pain catastrophizing, fear of pain, pain-related anxiety, hypervigilance, and social isolation. Future longitudinal studies are needed to elucidate these mechanistic pathways of the effect of sleep on the transition from acute to chronic pain, which may lead to the development of new treatment targets to prevent this transition.