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O'Connor DB, Rogerson O. Loneliness, sleep and daily stress: Evidence of direct and indirect effects. Appl Psychol Health Well Being 2024. [PMID: 39219181 DOI: 10.1111/aphw.12586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
This study investigated: i) the effects of loneliness on self-reported sleep outcomes and daily stress/hassles, ii) whether the effects of loneliness on sleep outcomes were mediated through prior-day stress/hassles and iii) if the effects of loneliness on daily stress/hassles were mediated through prior-night sleep measures. Using a 7-day diary design, this study aimed to investigate relationships between loneliness, daily sleep outcomes and daily stress/hassles. Participants (N = 174, Mage 19.95, 86.2% female) completed the UCLA Loneliness Scale once before a 7-day online diary twice per day. Measures of daily stress and hassles were completed before bed and sleep outcomes the following day. Multilevel modelling found higher levels of loneliness were associated with poorer sleep quality, greater pre-sleep arousal, morning tiredness, fewer total hours slept and higher levels of daily stress and hassles across the 7-day study. Loneliness was found also to have indirect effects on sleep quality, pre-sleep arousal and morning tiredness through prior-day daily stress and hassles. In addition, loneliness also had indirect effects on daily stress and hassles through prior night sleep measures. The current findings suggest that interventions aimed at mitigating the effects of loneliness should also incorporate components that target modifiable risk factors such as sleep and stress.
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2
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Decker JE, Morales KH, Fair MA, Vallecorsa G, Subramanyam S, Fiks AG, Mayne S, Williamson AA, Mitchell JA. Classifying intervention components used in sleep duration interventions for children: A systematic review and meta-analysis. Sleep Med Rev 2024; 78:101995. [PMID: 39216182 DOI: 10.1016/j.smrv.2024.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
The Multiphase Optimization Strategy (MOST) is a three-phase iterative framework that could accelerate the development of behavioral interventions. This systematic review and meta-analysis was conducted within the MOST preparation phase and aimed to classify components included in pediatric sleep duration interventions, using the Behavior Change Technique (BCT) Taxonomy. Across 37 interventions, 46 out of 93 BCTs have been used, with an average of 8 techniques used per study. The most common BCTs used were instruction on how to perform the behavior (N = 29; code 4.1), practical social support (N = 22; code: 3.2), and behavioral practice/rehearsal (N = 22; code: 8.1). A latent class analysis identified two classes of interventions, distinguished by the presence of BCTs falling within the following behavior change groups: shaping knowledge, natural consequences, comparison of behavior, and repetition and substitution. Our meta-analysis revealed that interventions belonging to the latent class with these behavior change groups (N = 15) had a pooled positive intervention effect of 14 min (95 % CI: 8-21) versus 8 min (95 % CI: 1-15) for interventions without these behavior change groups (N = 19). This systematic review and meta-analysis will enhance the development of sleep promotion interventions and guide the selection of candidate intervention components for future optimization and randomized control trials.
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Affiliation(s)
- Jessica E Decker
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maddy A Fair
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Giuliana Vallecorsa
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sanjana Subramanyam
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Mayne
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel A Williamson
- The Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland, OR, USA; Department of Psychology, College of Arts and Sciences, University of Oregon, Eugene, OR, USA
| | - Jonathan A Mitchell
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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3
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Zheng YB, Huang YT, Gong YM, Li MZ, Zeng N, Wu SL, Zhang ZB, Tian SS, Yuan K, Liu XX, Vitiello MV, Wang YM, Wang YX, Zhang XJ, Shi J, Shi L, Yan W, Lu L, Bao YP. Association of lifestyle with sleep health in general population in China: a cross-sectional study. Transl Psychiatry 2024; 14:320. [PMID: 39098892 PMCID: PMC11298538 DOI: 10.1038/s41398-024-03002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024] Open
Abstract
The concept of a healthy lifestyle is receiving increasing attention. This study sought to identify an optimal healthy lifestyle profile associated with sleep health in general population of China. An online cross-sectional survey was conducted from June to July 2022. Six healthy lifestyle factors were assessed: healthy diet, regular physical exercise, never smoking, never drinking alcohol, low sedentary behavior, and normal weight. Participants were categorized into the healthy lifestyle (5-6 factors), average (3-4 factors), and unhealthy lifestyle groups (0-2 factors). The study's primary outcome was sleep health, which included sleep quality, duration, pattern, and the presence of any sleep disorder or disturbance, including insomnia, excessive daytime sleepiness, obstructive apnea syndrome, and narcolepsy. Multivariable logistic regression analysis was applied to explore lifestyles associated with the selected sleep health outcomes. 41,061 individuals were included, forming 18.8% healthy, 63.8% average, and 17.4% unhealthy lifestyle groups. After adjusting for covariates, participants with healthy lifestyle were associated with a higher likelihood of good sleep quality (OR = 1.56, 95% CI = 1.46-1.68), normal sleep duration (OR = 1.60, 95% CI = 1.49-1.72), healthy sleep pattern (OR = 2.15, 95% CI = 2.00-2.31), and lower risks of insomnia (OR = 0.66, 95% CI = 0.61-0.71), excessive daytime sleepiness (OR = 0.66, 95% CI = 0.60-0.73), and obstructive apnea syndrome (OR = 0.40, 95% CI = 0.37-0.43), but not narcolepsy (OR = 0.92, 95% CI = 0.83-1.03), compared to those with unhealthy lifestyle. This large cross-sectional study is the first to our knowledge to quantify the associations of a healthy lifestyle with specific aspects of sleep health. The findings offer support for efforts to improve sleep health by modulating lifestyle.
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Affiliation(s)
- Yong-Bo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Yue-Tong Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Yi-Miao Gong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Ming-Zhe Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Shui-Lin Wu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Zhi-Bo Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Shan-Shan Tian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Xiao-Xing Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Yu-Mei Wang
- Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, 250117, China
| | - Yong-Xiang Wang
- Institute of Brain Science and Brain-inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, 250117, China
| | - Xiu-Jun Zhang
- School of Psychology, College of Public Health, North China University of Science and Technology, Tangshan, 063210, Hebei Province, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China.
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China.
- Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
- Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing, China.
- Shandong Institute of Brain Science and Brain-inspired Research; Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, 271016, China.
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
- School of Public Health, Peking University, Beijing, China.
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Ito H, Tomura Y, Kitagawa Y, Nakashima T, Kobanawa S, Uki K, Oshida J, Kodama T, Fukui S, Kobayashi D. Effects of probiotics on sleep parameters: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 63:623-630. [PMID: 39094854 DOI: 10.1016/j.clnesp.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024]
Abstract
AIM Although sleep is essential for maintaining good health and well-being, sleep disorders are becoming increasingly prevalent. Probiotics may play a role in sleep regulation; therefore, this study aimed to provide a comprehensive overview of the effects of probiotics on sleep parameters. METHODS We conducted a systematic literature review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Relevant placebo-controlled randomized controlled trials examining the effects of probiotics on sleep outcomes were identified through systematic searches in the PubMed, Cochrane Library, and Ichushi databases. Data were extracted from eligible studies and the risk of bias was assessed. Statistical analyses were performed to assess the effects of probiotics on various sleep-related variables. RESULTS Fifteen randomized controlled trials were included in this review. The decrease in Pittsburgh Sleep Quality Index (PSQI) scores in the probiotics group was significantly lower than that in the placebo group after 4-6 weeks and 8-16 weeks, indicating improved sleep quality. The Oguri-Shirakawa-Azumi (OSA) sleep inventory score was also decreased in the probiotics group for Factor 1 "sleepiness on rising" and Factor 4 "refreshing," indicating improved sleep quality. Some studies however, showed a risk of bias. CONCLUSION This systematic review and meta-analysis indicated that probiotics may improve sleep quality, as measured by the PSQI and OSA sleep inventory. However, further research is needed to better understand the effects of probiotics on specific sleep parameters and address the limitations of existing studies.
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Affiliation(s)
- Hiroshi Ito
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan.
| | - Yuna Tomura
- Tokyo Medical University Library, Shinjuku, Tokyo, Japan
| | - Yuki Kitagawa
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Toshiya Nakashima
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Satoshi Kobanawa
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Kento Uki
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Jura Oshida
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Taisuke Kodama
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Sayato Fukui
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
| | - Daiki Kobayashi
- Division of General Internal Medicine, Department of Internal Medicine, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan
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Goodman ML, Lee M, Springer A, Schick V, Vaughan E, Markham C, Gitari S, Mukiri F. Sleep disturbance as a precursor to anxiety, depression, and PTSD among rural Kenyans: A cross-lagged panel analysis from a rural Kenyan interventional cohort. J Sleep Res 2024; 33:e14119. [PMID: 38083983 PMCID: PMC11164828 DOI: 10.1111/jsr.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 05/01/2024]
Abstract
Sleep quality is essential to biopsychosocial functioning, yet there remains limited longitudinal research on sleep and mental or social well-being within low- or middle-income countries. This study utilised longitudinal cohort data from a community-based empowerment programme in Meru County, Kenya to assess cross-lagged correlations between sleep disturbance, social support, symptoms of depression, anxiety, and posttraumatic stress. Participants (n = 373; 92% women; age range 18-86 years) who reported more sleep disturbance at T1 reported significantly more symptoms of depression, anxiety, and PTSD, and significantly less social support at T2 (average 11 weeks later), controlling for all within-time correlations across measures, within-measure correlations across time, and sociodemographic background characteristics. The findings are consistent with research across high-income countries, underscoring the need for more contextualised research into sleep behaviours across low- and middle-income countries. The findings may inform interventions to increase mental and social well-being within Kenya.
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Affiliation(s)
| | - Miryoung Lee
- University of Texas School of Public Health in Houston, TX, USA
| | - Andrew Springer
- University of Texas School of Public Health in Houston, TX, USA
| | - Vanessa Schick
- University of Texas School of Public Health in Houston, TX, USA
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Shimazaki T, Shimura Y, Ohashi T, Nakamura H, Asakawa Y, Takahashi K. Cross-sectional study to identify health literacy, health behavior, and quality of life in Chofu and Komae cities in Japan: Formative research in community-based nursing practice. Public Health Nurs 2024. [PMID: 39073094 DOI: 10.1111/phn.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/28/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024]
Abstract
The Jikei Academic Nursing Practice Center for the Community developed a community nursing practice that matched community health problems and concerns in Chofu and Komae cities, suburban areas of the Tokyo Metropolis. This study aimed to identify health problems and high-risk populations via an understanding of the practice of health behaviors, health literacy, and quality of life. This was an online, cross-sectional study conducted in September 2023. In total, 1520 (Chofu: n = 1170; Komae: n = 350) participants were enrolled. Participants' demographic characteristics, health literacy, health behaviors, and quality of life scores were obtained. Sleep quality was poor compared with national data. Younger participants had higher poor health literacy, did not practice health behaviors, and had a lower quality of life. In addition, parenting and informal nursing care for family members were associated with unhealthy eating, smoking, drinking, and poor quality of life. This study found that health problems and concerns before planning were significant in increasing the salience of interventions for community residents. Based on the findings of this study, an action plan for community-wide nursing practice was created.
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Affiliation(s)
- Takashi Shimazaki
- Jikei Academic Nursing Practice Center for the Community, The Jikei University School of Nursing, Tokyo, Japan
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuri Shimura
- Jikei Academic Nursing Practice Center for the Community, The Jikei University School of Nursing, Tokyo, Japan
- Department of Home Care Nursing, The Jikei University School of Nursing, Tokyo, Japan
| | - Toya Ohashi
- Jikei Academic Nursing Practice Center for the Community, The Jikei University School of Nursing, Tokyo, Japan
- Department of Human Health Science and Therapeutics, The Jikei University School of Nursing, Tokyo, Japan
| | - Hideki Nakamura
- Jikei Academic Nursing Practice Center for the Community, The Jikei University School of Nursing, Tokyo, Japan
- Department of Psychiatric Nursing, The Jikei University School of Nursing, Tokyo, Japan
| | - Yuiko Asakawa
- Jikei Academic Nursing Practice Center for the Community, The Jikei University School of Nursing, Tokyo, Japan
- Department of Maternity Nursing, The Jikei University School of Nursing, Tokyo, Japan
| | - Kinu Takahashi
- Jikei Academic Nursing Practice Center for the Community, The Jikei University School of Nursing, Tokyo, Japan
- Department of Human Health Science and Therapeutics, The Jikei University School of Nursing, Tokyo, Japan
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7
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Jung S, Takeuchi T, Kitahara M, Tsutsumi A, Nomura K. Effectiveness of mobile applications in improving insomnia symptoms among adults from multi-community: A systematic review and meta-analysis. Sleep Med 2024; 119:357-364. [PMID: 38761604 DOI: 10.1016/j.sleep.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE/BACKGROUND To clarify whether mobile sleep applications alleviate insomnia symptoms among adults from multi-community. PATIENTS/METHODS A literature search was conducted using the PubMed, Cochrane, PsycINFO, and Web of Science databases for articles related to mobile technology and sleep interventions published between database inceptions and March 27, 2023. We pooled relevant data using a random-effects model, and a meta-analysis was performed using a web version of the Cochrane Review Manager. The effect size was estimated and reported as the combined overall effect (weighted average). Forest plots were created, and the Cochrane risk-of-bias tool and Newcastle-Ottawa Scale were used to evaluate studies. RESULTS After an initial screening and full-text reviews, seven studies were identified with a total of 10,139 participants (females n = 8844, 87.2 %) recruited from multi-community and not diagnosed with sleep disorders or taking medications. These studies included one cross-sectional study investigating mindfulness meditation apps and six randomized-controlled trials (RCTs), including one with sleep-feedback messaging, one comparing sleep applications with or without a wearable device, and four with multicomponent interventions based on cognitive theory and subsequent behavioral change techniques. In a meta-analysis of three cognitive behavior therapy (CBT)-based RCTs, the intervention group showed statistically significant improvements in insomnia symptoms according to the Pittsburgh Sleep Quality Index but with high heterogeneity, while two CBT-based RCTs showed no significant improvements in the Insomnia Severity Index with low heterogeneity. CONCLUSIONS A small body of evidence supports the use of CBT-based sleep applications to improve insomnia symptoms among adults from multi-community.
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Affiliation(s)
- Songee Jung
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Takeaki Takeuchi
- Department of Psychosomatic Medicine, Toho University School of Medicine, 5-21-16 Omorinishi, Ota, Tokyo, 143-8540, Japan
| | - Minako Kitahara
- Department of Psychosomatic Medicine, Toho University School of Medicine, 5-21-16 Omorinishi, Ota, Tokyo, 143-8540, Japan
| | - Akizumi Tsutsumi
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
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8
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De Pasquale C, El Kazzi M, Sutherland K, Shriane AE, Vincent GE, Cistulli PA, Bin YS. Sleep hygiene - What do we mean? A bibliographic review. Sleep Med Rev 2024; 75:101930. [PMID: 38761649 DOI: 10.1016/j.smrv.2024.101930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 12/18/2023] [Accepted: 03/27/2024] [Indexed: 05/20/2024]
Abstract
There is no consensus on the definition of sleep hygiene and its components. We examined the definition of sleep hygiene based on its use in published studies. Four databases (Medline, EMBASE, PsycINFO and CINAHL) were searched from inception until December 31, 2021 for the phrase 'sleep hygiene' in the title or abstract. We identified 548 relevant studies in adults: 250 observational and 298 intervention studies. A definition of sleep hygiene was provided in only 44% of studies and converged on three themes: behavioural factors, environmental factors, and an aspect of control. Sleep hygiene components were explicitly defined in up to 70% of observational studies, but in only 35% of intervention studies. The most commonly considered components of sleep hygiene were caffeine (in 51% of studies), alcohol (46%), exercise (46%), sleep timing (45%), light (42%), napping (39%), smoking (38%), noise (37%), temperature (34%), wind-down routine (33%), stress (32%), and stimulus control (32%), although the specific details of each component varied. Lack of consistency in definitions of sleep hygiene and its components may hinder communication between researchers, clinicians, and the public, and likely limits the utility of sleep hygiene as an intervention.
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Affiliation(s)
- Carla De Pasquale
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia
| | - Mary El Kazzi
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia
| | - Alexandra E Shriane
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Australia; Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia.
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9
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Sobieraj J, Strzelecka K, Sobczak M, Oledzka E. How Biodegradable Polymers Can be Effective Drug Delivery Systems for Cannabinoids? Prospectives and Challenges. Int J Nanomedicine 2024; 19:4607-4649. [PMID: 38799700 PMCID: PMC11128233 DOI: 10.2147/ijn.s458907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Cannabinoids are compounds found in and derived from the Cannabis plants that have become increasingly recognised as significant modulating factors of physiological mechanisms and inflammatory reactions of the organism, thus inevitably affecting maintenance of homeostasis. Medical Cannabis popularity has surged since its legal regulation growing around the world. Numerous promising discoveries bring more data on cannabinoids' pharmacological characteristics and therapeutic applications. Given the current surge in interest in the medical use of cannabinoids, there is an urgent need for an effective method of their administration. Surpassing low bioavailability, low water solubility, and instability became an important milestone in the advancement of cannabinoids in pharmaceutical applications. The numerous uses of cannabinoids in clinical practice remain restricted by limited administration alternatives, but there is hope when biodegradable polymers are taken into account. The primary objective of this review is to highlight the wide range of indications for which cannabinoids may be used, as well as the polymeric carriers that enhance their effectiveness. The current review described a wide range of therapeutic applications of cannabinoids, including pain management, neurological and sleep disorders, anxiety, and cancer treatment. The use of these compounds was further examined in the area of dermatology and cosmetology. Finally, with the use of biodegradable polymer-based drug delivery systems (DDSs), it was demonstrated that cannabinoids can be delivered specifically to the intended site while also improving the drug's physicochemical properties, emphasizing their utility. Nevertheless, additional clinical trials on novel cannabinoids' formulations are required, as their full spectrum therapeutical potential is yet to be unravelled.
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Affiliation(s)
- Jan Sobieraj
- Department of Pharmaceutical Chemistry and Biomaterials, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Katarzyna Strzelecka
- Department of Pharmaceutical Chemistry and Biomaterials, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Marcin Sobczak
- Department of Pharmaceutical Chemistry and Biomaterials, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Ewa Oledzka
- Department of Pharmaceutical Chemistry and Biomaterials, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, 02-097, Poland
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10
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Allavena C, Bastides F, Moroy A, Occhipinti S, Durand F, Barriere G, Micoulaud-Franchi JA, Ghosn J. The screening and management of sleep disturbances in people living with HIV: Delphi consensus. J Sleep Res 2024; 33:e14070. [PMID: 37941027 DOI: 10.1111/jsr.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/27/2023] [Indexed: 11/10/2023]
Abstract
Sleep disturbances in people living with HIV (PLHIV) are frequent but their management remains insufficient. In the absence of specific recommendations, a DELPHI consensus research project was conducted in France to establish best practice. A multidisciplinary Steering Committee (STC) undertook a literature review and used it with clinical expertise to create statements that were voted on. Two profiles of healthcare professionals with significant experience in monitoring PLHIV were selected for the voting: physicians and nurses/psychologists. Votes were collected electronically, independently, and anonymously. The STC created 27 statements covering six areas: Screening of sleep disturbances, Investigation, First-line management, Referral to a specialist, Antiretroviral treatment (ARV), and Prevention. Two rounds of votes included 42 physicians and 32 nurses/psychologists. Consensus was reached for 24 out of 27 statements (89%) including: to assess quantity and quality of sleep among PLHIV at least annually, ideally using a common methodology within the medical department; to consider the temporary addition of a hypnotic treatment in cases of acute insomnia not improved by the rules of sleep hygiene, with full awareness of potential drug-drug interactions and risk of dependence; to correct ferritinaemia if <100 ng/mL before referral to a specialist when restless legs syndrome is suspected; to consider changing the time of ARV administration or an ARV switch within the same class when sleep disturbances are caused by an ARV. This DELPHI Consensus provides best practice for screening and managing sleep disturbances in PLHIV and optimising their quality of life.
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Affiliation(s)
- Clotilde Allavena
- Infectious Diseases Department, INSERM EA1413, CHU Nantes, Nantes, France
| | | | - Anne Moroy
- Centre du Sommeil et de la Vigilance, Hôtel Dieu Hospital, AP-HP, Paris, France
- Sleep Unit, Department of Psychiatry, CHU Lille, Lille, France
| | | | | | | | - Jean-Arthur Micoulaud-Franchi
- University Bordeaux, CNRS, SANPSY, UMR 6033, University Sleep Clinic, University Hospital of Bordeaux, Bordeaux, France
| | - Jade Ghosn
- APHP.Nord, Department of Infectious Diseases, Bichat University Hospital, Paris, France
- Université Paris Cité, INSERM, UMR 1137 IAME, Paris, France
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11
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Rogerson O, O'Connor RC, O'Connor DB. The effects of childhood trauma on stress-related vulnerability factors and indicators of suicide risk: An ecological momentary assessment study. J Affect Disord 2024; 352:479-489. [PMID: 38342320 DOI: 10.1016/j.jad.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Childhood trauma is experienced by approximately one third of young people in the United Kingdom and has been shown to confer an increased risk for mental health difficulties in adulthood. Understanding the associations between these factors before negative health outcomes manifest in adulthood is imperative to help inform the development of interventions. The aims of this study were two-fold; first, to investigate the effects of childhood trauma on daily stress-related vulnerability factors over a period of 7 days and to test whether any observed relationships were moderated by protective or risk factors. Second, to explore the indirect effects of childhood trauma on reasons for living, optimism, daily suicide ideation, defeat and entrapment through the daily stress-related vulnerability factors. METHODS 212 participants were recruited to an ecological momentary assessment study to complete three diaries per day for a 7-day period. Participants completed daily measures of stress, hassles, executive functioning, impulsivity, sleep quality (stress-related vulnerability factors) as well as measures of reasons for living, optimism, daily thoughts of suicide, defeat and entrapment. The Childhood Trauma Questionnaire was also completed at baseline. RESULTS Analyses found that childhood trauma was significantly associated with higher scores on the daily stress-related vulnerability factors and positively related to each of the daily indicators of suicide risk. The study also uncovered key pathways whereby trauma had indirect effects on reasons for living, optimism, daily thoughts of suicide, defeat and entrapment through executive functioning, impulsivity, sleep quality and stress. LIMITATIONS The measures of executive function and sleep were self-reported and future research ought to replicate the current findings using more objective methods. DISCUSSION The findings from this study highlight the complexity of childhood trauma and its damaging effects on stress-related vulnerability factors and poorer mental health outcomes. Greater understanding of pathways by which trauma may impact later health outcomes is essential for development of interventions.
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Affiliation(s)
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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12
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Oberther TJ, Moore AR, Kohler AA, Shuler DH, Peritore N, Holland-Winkler AM. Effect of Peanut Butter Intake on Sleep Health in Firefighters: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:571. [PMID: 38791786 PMCID: PMC11121285 DOI: 10.3390/ijerph21050571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024]
Abstract
Sleep is often impaired in firefighters due to the psychologically and physiologically intense nature of their work and working shift schedules. Peanut butter is affordable and a substantial source of monounsaturated fatty acids, which may aid sleep health. Thus, this study sought to determine if a daily serving of peanut butter consumed before bedtime for seven weeks altered sleep quality and quantity among full-time firefighters. Forty firefighters (peanut butter group = 20; control group = 20) participated in this eight-week randomized controlled trial. All participants completed a subjective questionnaire on mood, focus, and alertness twice daily and wore an Actigraph wristwatch to measure sleep variables, including latency, efficiency, time in bed, time asleep, wake after sleep onset, number of awakenings, and time spent awake. After a baseline week, the peanut butter group consumed two tablespoons of peanut butter two hours prior to bedtime for seven weeks. Compared to the control group, the peanut butter group did not demonstrate significant changes (p > 0.05) in sleep measures or subjective feelings of mood, focus, or alertness after consuming peanut butter for seven weeks. Therefore, peanut butter as a source of peanuts did not alter sleep quality or quantity in this group of firefighters.
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Affiliation(s)
| | | | | | | | | | - Angelia M. Holland-Winkler
- Department of Kinesiology, Augusta University, 3109 Wrightsboro Road, Augusta, GA 30909, USA; (T.J.O.); (A.R.M.); (A.A.K.); (D.H.S.); (N.P.)
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13
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Seaver C, Bowers C, Beidel D, Holt L, Ramakrishnan S. A game-based learning approach to sleep hygiene education: a pilot investigation. Front Digit Health 2024; 6:1334840. [PMID: 38680214 PMCID: PMC11045930 DOI: 10.3389/fdgth.2024.1334840] [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: 11/07/2023] [Accepted: 03/22/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Sleep hygiene education (SHE) consists of environmental and behavioral practices primarily intended to reduce sleep problems. Currently considered ineffective as a stand-alone treatment, the manner in which the education is typically delivered may be ineffective for the acquisition of new knowledge. The purpose of this study was to determine if a more engaging teaching medium may improve the efficacy of sleep hygiene education. This study examined the use of game-based learning to teach SHE to individuals with sleep problems. Methods 35 participants played the SHE games for 30 days. Differences in pre- and post-state anxiety and sleep quality measures were examined. Results Participants had significant improvements in sleep quality and state anxiety after using the app for 30 days, although scores for the majority of patients remained elevated. Discussion This pilot investigation provides initial evidence for the efficacy of a game-based approach to SHE.
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Affiliation(s)
- Christine Seaver
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Clint Bowers
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Deborah Beidel
- UCF RESTORES, University of Central Florida, Orlando, FL, United States
| | - Lisa Holt
- BlueHalo, Rockville, MD, United States
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14
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VoPham T, Ton M, Weaver MD. Spatiotemporal light exposure modeling for environmental circadian misalignment and solar jetlag. Environ Epidemiol 2024; 8:e301. [PMID: 38617425 PMCID: PMC11008630 DOI: 10.1097/ee9.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background Light exposure is the most powerful resetting signal for circadian rhythms. The objective of this study was to develop and validate a high-resolution geospatial light exposure model that measures environmental circadian misalignment (or solar jetlag) as the mismatch between the social clock and sun clock, which occurs from geographic variation in light exposure leading to delayed circadian phase from relatively less morning light exposure and greater evening light exposure with increasing westward position within a time zone. Methods The light exposure model (30 m2 spatial resolution) incorporated geospatial data across the United States on time zones, elevation (using Google Earth Engine), sunrise time, and sunset time to estimate solar jetlag scores (higher values indicate higher environmental circadian misalignment). The validation study compared the light exposure model in 2022, which was linked with geocoded residential addresses of n = 20 participants in Boston, MA (eastern time zone position) and Seattle, WA (western time zone position) using a geographic information system, with illuminance values captured from wearable LYS light sensors and with sun times from the Solar Calculator. Results Western versus eastern positions within a time zone were associated with higher solar jetlag scores from the light exposure model (P < 0.01) and relatively larger differences in sunset time measured using light sensors (social clock) and the Solar Calculator (sun clock) (P = 0.04). Conclusion We developed and validated a geospatial light exposure model, enabling high spatiotemporal resolution and comprehensive characterization of geographic variation in light exposure potentially impacting circadian phase in epidemiologic studies.
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Affiliation(s)
- Trang VoPham
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Mimi Ton
- Department of Epidemiology, University of Washington, Seattle, Washington
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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15
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Simon KC, Cadle C, Nakra N, Nagel MC, Malerba P. Age-associated sleep spindle characteristics in Duchenne muscular dystrophy. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae015. [PMID: 38525359 PMCID: PMC10960605 DOI: 10.1093/sleepadvances/zpae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/18/2023] [Indexed: 03/26/2024]
Abstract
Brain oscillations of non-rapid eye movement sleep, including slow oscillations (SO, 0.5-1.5 Hz) and spindles (10-16 Hz), mirror underlying brain maturation across development and are associated with cognition. Hence, age-associated emergence and changes in the electrophysiological properties of these rhythms can lend insight into cortical development, specifically in comparisons between pediatric populations and typically developing peers. We previously evaluated age-associated changes in SOs in male patients with Duchenne muscular dystrophy (DMD), finding a significant age-related decline between 4 and 18 years. While primarily a muscle disorder, male patients with DMD can also have sleep, cognitive, and cortical abnormalities, thought to be driven by altered dystrophin expression in the brain. In this follow-up study, we characterized the age-associated changes in sleep spindles. We found that age-dependent spindle characteristics in patients with DMD, including density, frequency, amplitude, and duration, were consistent with age-associated trends reported in the literature for typically developing controls. Combined with our prior finding of age-associated decline in SOs, our results suggest that SOs, but not spindles, are a candidate intervention target to enhance sleep in patients with DMD.
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Affiliation(s)
- Katharine C Simon
- Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, CA, USA
- Pulmonology Department, Children’s Hospital of Orange County, Orange, CA, USA
| | - Chelsea Cadle
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Neal Nakra
- Pulmonology Department, Children’s Hospital of Orange County, Orange, CA, USA
| | - Marni C Nagel
- Department of Pediatric Psychology, Children’s Hospital of Orange County, Orange, CA, USA
| | - Paola Malerba
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, School of Medicine, The Ohio State University, Columbus, OH, USA
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16
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Pfeiffer AM, Triplett C, Siengsukon CF. Examining the prevalence of sleep disturbances in patients seeking physical therapy services. Physiother Theory Pract 2024; 40:556-564. [PMID: 36259637 DOI: 10.1080/09593985.2022.2134754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the prevalence of sleep disturbances in adults seeking physical therapy services. METHODS Participants were issued an electronic survey to provide demographic information and the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), STOP-BANG (obstructive sleep apnea (OSA) risk), and restless leg syndrome (RLS) risk. Percentages were calculated to describe prevalence of sleep disturbances, and Spearman's correlations were used to identify associations between pain and sleep questionnaires. RESULTS Eighty-eight participants (47.9 ± 15.8 years, 68 females) completed the survey. Seventy-eight percent (n = 69) scored >5 on the PSQI; 32% (n = 28) scored ≥10 on the ESS; 52% (n = 46) scored ≥16 on the SHI; 51% (n = 45) scored ≥10 on the ISI; 28% (n = 25) had intermediate or high risk of OSA; and 40% (n = 35) indicated possible RLS. Pain level was significantly associated with PSQI (r(86) = 0.277, p = .009) and ISI (r(86) = 0.268, p = .012). CONCLUSIONS There was a higher prevalence of sleep disturbances in adults seeking physical therapy services than in the general population. Increased pain severity was associated with poorer sleep quality and increased insomnia symptoms. This study highlights the need to screen patients for sleep disturbances.
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Affiliation(s)
- Ashley M Pfeiffer
- Department of Exercise Science, School of Behavioral Sciences, Black Hills State University, Spearfish, SD, USA
| | - Craig Triplett
- Department of Exercise Science, School of Behavioral Sciences, Black Hills State University, Spearfish, SD, USA
| | - Catherine F Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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17
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Doi SK, Isumi A, Yamaoka Y, Shakagori S, Yamazaki J, Ito K, Shiomi M, Sumioka H, Fujiwara T. The effect of breathing relaxation to improve poor sleep quality in adults using a huggable human-shaped device: a randomized controlled trial. Sleep Breath 2024; 28:429-439. [PMID: 37428349 DOI: 10.1007/s11325-023-02858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE To examine whether or not breathing relaxation, using a huggable human-shaped device, improves poor sleep quality in adults. METHODS We conducted a randomized controlled trial using outpatients with sleep problems from two clinics in Japan. The intervention group conducted three minutes of breathing relaxation using a huggable human-shaped device before going to bed every night for four weeks. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), at pre-intervention, mid-intervention (2 weeks after pre-intervention), and post-intervention (4 weeks after pre-intervention). We employed intention-to-treat analysis. RESULTS A total of 68 participants (mean [SD] age, 41.7 [11.4] years; 64 female [95%]) were randomly assigned to the intervention group (n = 29, mean [SD] age, 43.6 [9.5] years; 28 female [97%]) and the control group (n = 36, mean [SD] age, 40.3 [12.7] years; 36 female [95%]). The intervention group showed a significant decrease in the PSQI score compared to the control group (F = 3.81, p = 0.025, effect size (η2) = 0.057). Furthermore, we found the intervention to be more effective in participants without suicide risk and with a lower number of adverse childhood experiences (effect size (η2) = 0.080 and 0.160, respectively). CONCLUSIONS A novel psychological intervention, breathing relaxation using a huggable human-shaped device, may be effective to improve sleep quality among people with sleep problems, especially those without severe psychological symptoms. TRIAL REGISTRATION UMIN000045262. (Registration Date: September 28th, 2021).
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Affiliation(s)
- Satomi Kato Doi
- Department of Health Policy, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Aya Isumi
- Department of Health Policy, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Shiori Shakagori
- Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Juri Yamazaki
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | | | - Masahiro Shiomi
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Hidenobu Sumioka
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
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18
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Benasi G, Malik A, Cheng B, Aggarwal B, Shechter A, St-Onge MP. Well-being therapy and sleep hygiene in a non-clinical population of adults reporting poor sleep quality and distress: A remote pilot randomized controlled study. Behav Sleep Med 2024; 22:115-128. [PMID: 37016730 PMCID: PMC10548351 DOI: 10.1080/15402002.2023.2197600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVES This pilot randomized controlled study evaluates the feasibility and preliminary efficacy of a 7-week remote intervention combining well-being therapy and sleep hygiene to improve sleep and psychological outcomes among adults reporting poor sleep and distress. METHODS Thirty-one participants (81% women, 40.2 ± 13.0 y, 48% racial/ethnic minority) were recruited from the community during the COVID-19 pandemic through online and local advertisement, and randomized to well-being therapy+sleep hygiene or sleep hygiene-only. Study outcomes were evaluated by self-reported questionnaires administered at baseline and post-intervention and a daily sleep diary. RESULTS Compared to sleep hygiene-only, well-being therapy+sleep hygiene led to greater improvements in wake after sleep onset (time-by-group interaction: 3.6 ± 1.5 min, p = .017), personal growth (β -3.0, 95%CI -5.2, -0.8, p = .01), and purpose in life (β -3.5, 95%CI -6.1, -0.9, p = .009). Anxiety, perceived stress, sleep quality, and insomnia symptoms improved similarly in both groups (between-group differences, p > .05). Improvements in sleep quality, insomnia, and sleep duration were associated with reductions in multiple measures of psychological distress (all p < .05). CONCLUSIONS These findings suggest that, in a non-clinical setting of individuals suffering from combined poor sleep and psychological distress, the addition of well-being therapy to sleep hygiene may provide additional benefits for sleep by promoting sleep continuity and well-being.
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Affiliation(s)
- Giada Benasi
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Amber Malik
- Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Bin Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Brooke Aggarwal
- Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ari Shechter
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Marie-Pierre St-Onge
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Huang H, Huang S, Chen S, Gao X, Cai J, Feng Y, Liu J, Su X, Qiu J, Zhang S, Xu Y, Liu Z, Wang T, Zeng F. Interventions for psychiatric disorders among university students: An umbrella review of systematic reviews and meta-analyses. Int J Clin Health Psychol 2024; 24:100431. [PMID: 38287943 PMCID: PMC10823073 DOI: 10.1016/j.ijchp.2023.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
Background Mental disorders are considered to be the main reason for the increase of the disease burden. College students seem to be more vulnerable to the adverse effects of stress, which makes them more at risk of suffering from mental disorders. This umbrella review aimed to evaluate the credibility of published evidence regarding the effects of interventions on mental disorders among university students. Methods To identify systematic reviews and meta-analyses investigating the effects of interventions on mental disorders in the university student population, extensive searches were carried out in databases including PubMed, Embase, and the Cochrane Database, spanning from inception to July 21, 2023. Subsequently, a thorough reanalysis of crucial parameters such as summary effect estimates, 95 % confidence intervals, heterogeneity I2 statistic, 95 % prediction intervals, small-study effects, and excess significance bias was performed for each meta-analysis found. Results Nineteen articles involving 74 meta-analyses were included. Our grading of the current evidence showed that interventions based on exercise, Cognitive-behavioural Intervention (CBI), mindfulness-based interventions (MBI), and other interventions like mood and anxiety interventions (MAI) were effective whereas exercise intervention had the highest effect size for both depression and anxiety among university students. However, the credibility of the evidence was weak for most studies. Besides, suggestive evidence was observed for the positive effects of CBI on sleep disturbance(SMD: -0.603, 95 % CI: -0.916, -0.290; P-random effects<0.01) and MAI on anxiety (Hedges'g = -0.198, 95 % CI: -0.302, -0.094; P-random effects<0.01). Conclusion Based on our findings, it appears that exercise interventions, CBI, and MAI have the potential to alleviate symptoms related to mental disorders. Despite the overall weak credibility of the evidence and the strength of the associations, these interventions offer a promising avenue for further exploration and research in the future. More high-quality randomized controlled trials should be taken into account to verify the effects of these interventions on various mental disorders.
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Affiliation(s)
- Huan Huang
- Political Security Department of the Party Committee/People's Armed Forces Department, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Shaofen Huang
- Shenzhen Qianhai Shekou Free Zone Hospital, 36 Gongye 7th Road, Shekou, Shenzhen 518067, Guangdong, PR China
| | - Shiyun Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Xuping Gao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), 51 Huayuan Bei Road, Beijing 100191, PR China
| | - Jun Cai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Yonghui Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Jiazi Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Xin Su
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Jiamin Qiu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Shiwen Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Ying Xu
- Baoan Center for Chronic Diseases Control, 332 Yu'an 2nd Road, Bao'an District, Shenzhen 518101, Guangdong, PR China
| | - Zheng Liu
- Baoan Center for Chronic Diseases Control, 332 Yu'an 2nd Road, Bao'an District, Shenzhen 518101, Guangdong, PR China
| | - Ting Wang
- School of Management, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No.601 Huangpu Road West, Guangzhou 510632, Guangdong, PR China
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20
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Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
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Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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21
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France-Ratcliffe M, Christie HE, Blunden S, Opie RS, Chua E, Karimi N, Markides B, Uldrich AC, Olander EK, White RL, van der Pligt P, Willcox J, Abbott G, Denton J, Lewis M, Apostolopoulos M, Love P, Lal A, Hallgren M, Costigan S, Duncan MJ, Teychenne M. Evaluating a multi-behavioural home-based intervention for reducing depressive symptoms in postnatal women : The food, move, sleep (FOMOS) for postnatal mental health randomised controlled trial protocol. Contemp Clin Trials 2024; 136:107383. [PMID: 37935305 DOI: 10.1016/j.cct.2023.107383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/22/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Postnatal depression (PND) is a leading cause of illness and death among women following childbirth. Physical inactivity, sedentary behaviour, poor sleep, and sub-optimal diet quality are behavioural risk factors for PND. A feasible, sustainable, and scalable intervention to improve healthy behaviours and reduce PND symptoms among women at postpartum is needed. This study aims to examine the effectiveness of a multi-behavioural home-based program Food, Move, Sleep (FOMOS) for Postnatal Mental Health designed to improve PND symptoms in women at postpartum. METHODS This randomised clinical trial will recruit 220 Australian women (2-12 months postpartum) experiencing heightened PND symptoms (Edinburgh Postnatal Depression Scale score ≥ 10). Participants will be randomised to FOMOS or wait-list control receiving standard clinical care. FOMOS is a 6-month mobile health (mHealth) intervention targeting diet quality, physical activity, sedentary behaviour, sleep, and mental health. The intervention, informed by the Social Cognitive Theory and incorporating behaviour change techniques defined in the CALO-RE taxonomy and Cognitive Behavioural Treatment of Insomnia, provides exercise equipment, and educational/motivational material and social support via mHealth and social media. Data collection pre-intervention and at 3, 6 and 12 months will assess the primary outcome of PND symptoms and secondary outcomes (diet quality, physical activity, sitting time, sleep quality) using self-report and device measures. Process evaluation will explore acceptability, appropriateness, cost-effectiveness, feasibility, and sustainability via analytic tools, record keeping, interviews, and surveys. DISCUSSION If effective, FOMOS could be a feasible and potentially scalable management strategy to support improvement of health behaviours and mental health for women with PND symptoms. TRIAL REGISTRATION https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001079730p.
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Affiliation(s)
- Madeleine France-Ratcliffe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Hannah E Christie
- School of Medical, Indigenous, and Health Sciences, University of Wollongong, Wollongong, Australia
| | - Sarah Blunden
- Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, Australia
| | - Rachelle S Opie
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elysha Chua
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nazgol Karimi
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Brittany Markides
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Alison C Uldrich
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rhiannon L White
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Department of Nutrition, Western Health, Footscray, Victoria, Australia
| | | | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jane Denton
- FOMOS Consumer and Stakeholder Advisory Committee, Melbourne, Australia
| | - Miriam Lewis
- FOMOS Consumer and Stakeholder Advisory Committee, Melbourne, Australia
| | - Maria Apostolopoulos
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Anita Lal
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institute, Sweden
| | - Sarah Costigan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Mitch J Duncan
- School of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Australia; Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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22
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Shriane AE, Rigney G, Ferguson SA, Bin YS, Vincent GE. Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology. Sleep 2023; 46:zsad182. [PMID: 37429599 PMCID: PMC10710992 DOI: 10.1093/sleep/zsad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
STUDY OBJECTIVES The unique requirements of shift work, such as sleeping and working at variable times, mean that current sleep hygiene guidelines may be inappropriate for shift workers. Current guidelines may also contradict fatigue management advice (e.g. advising against daytime napping). The present study utilized a Delphi methodology to determine expert opinion regarding the applicability of current guidelines for shift workers, the appropriateness of the term "sleep hygiene," and develop tailored guidelines for shift workers. METHODS The research team reviewed current guidelines and existing evidence to draft tailored guidelines. Seventeen individual guidelines, covering sleep scheduling, napping, sleep environment, bedtime routine, substances, light exposure, diet, and exercise were drafted. Experts from sleep, shift work, and occupational health fields (n = 155) were invited to review the draft guidelines using a Delphi methodology. In each round, experts voted on individual guidelines, with 70% agreement considered consensus. Where consensus was not reached, written feedback from experts was discussed and incorporated into subsequent iterations. RESULTS Of the experts invited, 68 (44%) agreed to participate, with 55 (35%) completing the third (final) round. Most experts (84%) agreed that tailored guidelines were required for shift workers. Consensus was reached on all guidelines after three rounds. One additional guideline (sleep inertia) and an introductory statement were developed, resulting in a final set of 18 individual guidelines, termed "healthy sleep practices for shift workers." CONCLUSIONS This is the first study to develop tailored sleep hygiene guidelines for shift workers. Future research should investigate the acceptability and effectiveness of these guidelines amongst shift workers.
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Affiliation(s)
- Alexandra E Shriane
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Gabrielle Rigney
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Yu Sun Bin
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
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23
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O'Connor DB, Branley-Bell D, Green JA, Ferguson E, O'Carroll RE, O'Connor RC. Effects of childhood trauma on sleep quality and stress-related variables in adulthood: evidence from two multilevel studies. Psychol Health 2023:1-22. [PMID: 37975565 DOI: 10.1080/08870446.2023.2281712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
Childhood trauma has been found to have serious negative consequences for mental and physical health. However, the precise mechanisms through which trauma influences health outcomes are unclear. Childhood trauma-related disruptions to sleep in adulthood represent an important potential mechanism. Two 7-day multilevel studies investigated the effects of childhood trauma on daily sleep outcomes and stress-related variables and whether the effects of trauma on sleep outcomes were mediated through these stress-related variables (or vice versa). Participants completed the Childhood Trauma Questionnaire before a 7-day online daily diary study. Measures of daily stress, perseverative cognition, and sleep were completed daily. Multi-level modelling found that higher levels of childhood neglect were associated with poorer daily sleep quality, shorter sleep duration, longer sleep onset latency, and higher daily stress and rumination levels. Higher childhood abuse was associated with shorter sleep duration, greater morning tiredness, and higher levels of daily stress, rumination, and worry. Childhood trauma was found also to have bidirectional, indirect effects on sleep quality and morning tiredness through daily stress-related variables. The current findings suggest that interventions aimed at mitigating the negative effects of childhood trauma should also incorporate components that target modifiable risk factors, such as sleep, stress, worry, and rumination.
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Affiliation(s)
| | - Dawn Branley-Bell
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | - Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK
| | | | - Rory C O'Connor
- Suicidal Behavior Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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24
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Lancaster BD, Sweenie R, Noser AE, Roberts CM, Ramsey RR. Sleep mHealth Applications and Behavior Change Techniques Evaluation. Behav Sleep Med 2023; 21:757-773. [PMID: 36628485 PMCID: PMC10330944 DOI: 10.1080/15402002.2022.2161548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Mobile health apps may be an effective way to increase sleep management skills. Although little has been documented about the content and quality of available sleep management apps, providers often make app recommendations to help with sleep self-management. The objective of this study was to systematically evaluate the content and quality of commercially available sleep apps. METHODS Following a systematic search of the Apple App and Google Play stores, 56 sleep management apps were evaluated. App content was evaluated using the taxonomy of behavior change techniques (BCTs), and app quality was assessed using the Mobile App Rating Scale. RESULTS Sleep management apps included 0-15 BCTs (M = 6.89) and 0-9 sleep BCTs (M = 4.87). App quality ranged from 2.51 to 4.80 (M = 3.78) out of 5.00. Sleepiest Sleep Sounds Stories, ShutEye: Sleep Tracker, and Mintal Tracker: Sleep Recorder included the highest number of sleep BCTs and highest quality scores. CONCLUSIONS While the content and quality of sleep management apps is variable, the findings are promising as many apps included a high number of BCTs and high quality. Although evidence of efficacy through randomized controlled trials is necessary to establish efficacy, this review can aid in app selection in the interim.
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Affiliation(s)
- Brittany D. Lancaster
- Center for Children’s Healthy Lifestyles & Nutrition, 610 E 22nd St, Kansas City, MO, 64108
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160
| | - Rachel Sweenie
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Amy E. Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Caroline M. Roberts
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine
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25
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van de Kamp MM, Scheffers M, Emck C, Fokker TJ, Hatzmann J, Cuijpers P, Beek PJ. Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis. J Trauma Stress 2023; 36:835-848. [PMID: 37702005 DOI: 10.1002/jts.22968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 09/14/2023]
Abstract
This study is an update of the meta-analysis we published in 2019 on the effectiveness of body- and movement-oriented interventions (BMOIs) for adults with posttraumatic stress disorder (PTSD) in decreasing PTSD symptoms and secondary outcomes of depressive symptoms, sleep disturbance, and interoceptive awareness. Search terms for BMOIs and PTSD were combined to identify eligible studies in four bibliographical databases. Articles were selected if they included adult participants with a primary diagnosis of PTSD, included BMOI as one of the investigated therapies, were designed as a comparative outcome trial with any control condition, and involved a standardized outcome measure for PTSD symptom severity. This resulted in the addition of 14 new studies compared to the 2019 study. The meta-analysis, which included 29 studies in total, resulted in a mean Hedges' g effect size of 0.50, 95% CI [0.22, 0.79], in decreasing PTSD symptoms, with very high heterogeneity, I2 = 89%. Meta-analyses of secondary outcomes resulted in Hedges' g effect sizes of 0.37, 95% CI [0.08, 0.66] for depressive symptoms; 0.62, 95% CI [0.42, 0.81] for sleep quality; and -0.10, 95% CI [-0.23, 0.43] for interoceptive awareness. The risk of bias analysis resulted in some concerns or high risk of bias in almost all included studies; only one study had a low risk of bias. We conclude that BMOIs may be valuable for patients with PTSD. There is, however, still a lack of high-quality studies with proper control conditions and long-term follow-up periods from which to draw conclusions.
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Affiliation(s)
- Minke M van de Kamp
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Mia Scheffers
- School of Health, Movement & Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Claudia Emck
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Ties J Fokker
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Janneke Hatzmann
- School of Health, Movement & Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Peter J Beek
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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26
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Jackson DB, Testa A, Semenza DC, Kaufmann CN, Spira AP. Sleep duration among adults exposed to family member incarceration during childhood. Sleep Health 2023; 9:680-687. [PMID: 37640628 DOI: 10.1016/j.sleh.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/26/2023] [Accepted: 07/16/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The current study examines the association between family member incarceration during childhood and sleep duration among a national sample of adults (ages 18-80+). METHODS We employ data from the 2020 Behavioral Risk Factor Surveillance System (N = 116,631). We use stepwise, multinomial logistic regression to examine associations between exposure to family member incarceration during childhood and sleep duration during adulthood. We also utilize the Karlson-Holm-Breen method to investigate whether indicators of socioeconomic disadvantage, and poor mental and physical health attenuate this relationship. Finally, to examine the robustness of associations between family member incarceration and sleep duration, we used a strategic comparison approach in which participants experiencing family member incarceration were compared to participants experiencing alternative adverse childhood experiences in the absence of family member incarceration. RESULTS Findings demonstrate a significant association between family member incarceration and sleep duration, with particularly strong associations with short and long sleep durations (relative to optimum sleep duration). However, poor mental and physical health during adulthood and socioeconomic disadvantage significantly attenuated these associations. Strategic comparison models also revealed that the association between family member incarceration during childhood and sleep duration is robust to the accumulation of other childhood adversities. CONCLUSIONS Findings suggest that strategies are needed among public health practitioners, physicians, and sleep professionals to mitigate the potential adverse effects of family member incarceration during childhood on sleep duration among adults.
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Affiliation(s)
- Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Alexander Testa
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
| | - Christopher N Kaufmann
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Adam P Spira
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Mental Health, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Mental Health, Johns Hopkins Center on Aging and Health, Baltimore, Maryland, USA
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27
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Subotic-Kerry M, Werner-Seidler A, Corkish B, Batterham PJ, Sicouri G, Hudson J, Christensen H, O'Dea B, Li SH. Protocol for a randomised controlled trial evaluating the effect of a CBT-I smartphone application (Sleep Ninja®) on insomnia symptoms in children. BMC Psychiatry 2023; 23:684. [PMID: 37730577 PMCID: PMC10510253 DOI: 10.1186/s12888-023-05185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Sleep is necessary for healthy development and mental wellbeing. Despite this, many children do not get the recommended duration of sleep each night, and many experience sleep problems. Although treatable, existing interventions for sleep disturbance are time-consuming, burdensome for families, and focus on providing behavioural strategies to parents rather than upskilling children directly. To address this gap, we modified Sleep Ninja®, an evidence-based cognitive behavioural therapy for insomnia (CBT-I) smartphone app for adolescent sleep disturbance, to be appropriate for 10 to 12 year olds. Here, we describe the protocol for a randomised controlled trial to evaluate the effect of Sleep Ninja on insomnia and other outcomes, including depression, anxiety, sleep quality, and daytime sleepiness, and explore effects on the emergence of Major Depressive Disorder (MDD), compared to an active control group. METHODS We aim to recruit 214 children aged 10 to 12 years old experiencing disturbed sleep. Participants will be screened for inclusion, complete the baseline assessment, and then be randomly allocated to receive Sleep Ninja, or digital psychoeducation flyers (active control) for 6-weeks. The primary outcome, insomnia symptoms, along with depression, anxiety, sleep quality, and daytime sleepiness will be assessed at 6-weeks (primary endpoint), 3-months, and 9-months post-baseline (secondary and tertiary endpoints, respectively). A mixed model repeated measures analytic approach will be used to conduct intention-to-treat analyses to determine whether reductions in insomnia and secondary outcomes are greater for those receiving Sleep Ninja relative to the control condition at the primary and secondary endpoints. The difference in relative risk for MDD onset will be explored at 9-months and compared between conditions. DISCUSSION This is the first clinical trial examining the effects of a CBT-I smartphone app in children experiencing sleep disturbance. Results will provide empirical evidence about the effects of Sleep Ninja on insomnia and other mental health outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12623000587606). UNIVERSAL TRIAL NUMBER U1111-1294-4167.
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Affiliation(s)
- M Subotic-Kerry
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Werner-Seidler
- Black Dog Institute and School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - B Corkish
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - P J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - G Sicouri
- Black Dog Institute and School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - J Hudson
- Black Dog Institute and School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - H Christensen
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - B O'Dea
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - S H Li
- Black Dog Institute and School of Psychology, University of New South Wales, Sydney, NSW, Australia.
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28
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Tadros M, Li S, Upton E, Newby J, Werner-Seidler A. Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study. JMIR Hum Factors 2023; 10:e44145. [PMID: 37616036 PMCID: PMC10485721 DOI: 10.2196/44145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. OBJECTIVE This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. METHODS Focus groups were conducted over 3 stages to examine students' views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. RESULTS In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep. CONCLUSIONS Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.
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Affiliation(s)
- Michelle Tadros
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Sophie Li
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Emily Upton
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Jill Newby
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
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29
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Morrison CL, Winiger EA, Rieselbach MM, Vetter C, Wright KP, LeBourgeois MK, Friedman NP. Sleep Health at the Genomic Level: Six Distinct Factors and Their Relationships With Psychopathology. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:530-540. [PMID: 37519468 PMCID: PMC10382696 DOI: 10.1016/j.bpsgos.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Poor sleep is associated with many negative health outcomes, including multiple dimensions of psychopathology. In the past decade, sleep researchers have advocated for focusing on the concept of sleep health as a modifiable health behavior to mitigate or prevent these outcomes. Sleep health dimensions often include sleep efficiency, duration, satisfaction, regularity, timing, and daytime alertness. However, there is no consensus on how to best operationalize sleep health at the phenotypic and genetic levels. In some studies, specific sleep health domains were examined individually, while in others, sleep health domains were examined together (e.g., with an aggregate sleep health score). Methods Here, we compared alternative sleep health factor models using genomic structural equation modeling on summary statistics from previously published genome-wide association studies of self-reported and actigraphic sleep measures with effective sample sizes up to 452,633. Results Our best-fitting sleep health model had 6 correlated genetic factors pertaining to 6 sleep health domains: circadian preference, efficiency, alertness, duration, noninsomnia, and regularity. All sleep health factors were significantly correlated (|rgs| = 0.11-0.51), except for the circadian preference factor with duration and noninsomnia. Better sleep health was generally significantly associated with lower genetic liability for psychopathology (|rgs| = 0.05-0.48), yet the 6 sleep health factors showed divergent patterns of associations with different psychopathology factors, especially when controlling for covariance among the sleep health factors. Conclusions These results provide evidence for genetic separability of sleep health constructs and their differentiation with respect to associations with mental health.
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Affiliation(s)
- Claire L. Morrison
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Evan A. Winiger
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maya M. Rieselbach
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Kenneth P. Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Naomi P. Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
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30
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Singh B, Olds T, Brinsley J, Dumuid D, Virgara R, Matricciani L, Watson A, Szeto K, Eglitis E, Miatke A, Simpson CEM, Vandelanotte C, Maher C. Systematic review and meta-analysis of the effectiveness of chatbots on lifestyle behaviours. NPJ Digit Med 2023; 6:118. [PMID: 37353578 DOI: 10.1038/s41746-023-00856-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/01/2023] [Indexed: 06/25/2023] Open
Abstract
Chatbots (also known as conversational agents and virtual assistants) offer the potential to deliver healthcare in an efficient, appealing and personalised manner. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of chatbot interventions designed to improve physical activity, diet and sleep. Electronic databases were searched for randomised and non-randomised controlled trials, and pre-post trials that evaluated chatbot interventions targeting physical activity, diet and/or sleep, published before 1 September 2022. Outcomes were total physical activity, steps, moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption, sleep quality and sleep duration. Standardised mean differences (SMD) were calculated to compare intervention effects. Subgroup analyses were conducted to assess chatbot type, intervention type, duration, output and use of artificial intelligence. Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment tool. Nineteen trials were included. Sample sizes ranged between 25-958, and mean participant age ranged between 9-71 years. Most interventions (n = 15, 79%) targeted physical activity, and most trials had a low-quality rating (n = 14, 74%). Meta-analysis results showed significant effects (all p < 0.05) of chatbots for increasing total physical activity (SMD = 0.28 [95% CI = 0.16, 0.40]), daily steps (SMD = 0.28 [95% CI = 0.17, 0.39]), MVPA (SMD = 0.53 [95% CI = 0.24, 0.83]), fruit and vegetable consumption (SMD = 0.59 [95% CI = 0.25, 0.93]), sleep duration (SMD = 0.44 [95% CI = 0.32, 0.55]) and sleep quality (SMD = 0.50 [95% CI = 0.09, 0.90]). Subgroup analyses showed that text-based, and artificial intelligence chatbots were more efficacious than speech/voice chatbots for fruit and vegetable consumption, and multicomponent interventions were more efficacious than chatbot-only interventions for sleep duration and sleep quality (all p < 0.05). Findings from this systematic review and meta-analysis indicate that chatbot interventions are efficacious for increasing physical activity, fruit and vegetable consumption, sleep duration and sleep quality. Chatbot interventions were efficacious across a range of populations and age groups, with both short- and longer-term interventions, and chatbot only and multicomponent interventions being efficacious.
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Affiliation(s)
- Ben Singh
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia.
| | - Timothy Olds
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Jacinta Brinsley
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Dot Dumuid
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Rosa Virgara
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Lisa Matricciani
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Amanda Watson
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Kimberley Szeto
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Emily Eglitis
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Aaron Miatke
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Catherine E M Simpson
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Carol Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
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Yu Z, Zhu X. The association between victimization experiences and suicidality: The mediating roles of sleep and depression. J Affect Disord 2023; 329:243-250. [PMID: 36858266 DOI: 10.1016/j.jad.2023.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Prior work suggests that multiple forms of victimization were associated with higher suicide risk among adolescents. However, the mechanisms underlying this association remain unclear. The present study aimed to understand the relationships between the multiple forms of victimization and suicidality by examining the potential mediators of sleep duration and depression. METHODS Data for this study came from the 2019 Youth Risk Behavior Survey (YRBS). The hypothesized mediation model included 13,677 American adolescents in 9th through 12th-grade students (48.6 % female) were analyzed using Mplus 7.4, and suicidality (including suicidal ideation, plan, and attempts) as the outcome variables and the multiple forms of victimization (including bullying at school, being threatened at school, electronic bullying, sexual victimization, sexual dating victimization, and physical dating victimization) as the main explanatory variable. RESULTS The relationships between the multiple forms of victimization and suicide risk were mediated by sleep duration, depression, and also serially mediated by sleep duration and depression. LIMITATIONS This is a cross-sectional study, and the results cannot inform the causality between these variables. This investigation only included adolescent sleep duration, and other specific sleep problem indicators should be included. CONCLUSIONS Longer sleep duration is an important protective factor, pointing the way forward for developing suicide prevention strategies and targeted interventions for adolescents.
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Affiliation(s)
- Zhuojun Yu
- Department of Applied Psychology, Guangdong University of Foreign Studies, 510006 Guangzhou, China
| | - Xinxin Zhu
- Department of Psychology, University of Edinburgh, UK.
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Edinborough L, Hill J, Jarvis M, Bruce-Low S, Pedlar CR. A bespoke sleep monitoring and sleep hygiene intervention improves sleep in an U18 professional football player: A case study. J Sports Sci 2023:1-8. [PMID: 37183452 DOI: 10.1080/02640414.2023.2213032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This case study reports on a professional football player (age: 17.6 years) who was referred for sleep monitoring and intervention after reporting excessive night-time awakenings. The player undertook a series of subjective sleep assessments and objective sleep monitoring (activity monitor). Based on the data presented, a sleep hygiene intervention was prescribed. Numerical comparisons were made between pre-intervention (Pre) and post-intervention (Post) values. Objective values were also compared to reference data from a similarly aged professional cohort from the same club (n = 11). Wake episodes per night (Pre: 7.9 ± 3, Post: 4.5 ± 1.9; -43%) and wake after sleep onset (WASO; Pre: 74.3 ± 31.8 mins, Post: 50.0 ± 22.8 mins, -33%) were improved from Pre to Post. Compared to the reference data, mean wake episodes per night (Pre: 7.9 ± 3.0, reference: 4.6 ± 2.6; -42%) and WASO (Pre: 74.3 ± 31.8 mins, reference: 44.3 ± 36.5 mins; -40%) were all lower compared to Pre levels. Whilst causality cannot be proven, we observed multiple sleep metrics improving following an intervention. This provides a potential framework for practitioners looking to provide targeted sleep assessment and intervention.
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Affiliation(s)
- Luke Edinborough
- Faculty of Sport, Allied Health and Performance Sciences, St Mary's University, Twickenham, UK
- Department of Sport Science, Southampton Football Club, Southampton, UK
| | - Jessica Hill
- Faculty of Sport, Allied Health and Performance Sciences, St Mary's University, Twickenham, UK
| | - Mark Jarvis
- Department of Sport Science, Southampton Football Club, Southampton, UK
| | - Stewart Bruce-Low
- School of Health Sport & Bioscience, University of East London, London, UK
| | - Charles R Pedlar
- Faculty of Sport, Allied Health and Performance Sciences, St Mary's University, Twickenham, UK
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, University College London (UCL), London, UK
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Winters B, Serpas D, Fullmer N, Hughes K, Kincaid J, Rosario ER, Schnakers C. Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study. Brain Sci 2023; 13:brainsci13050718. [PMID: 37239190 DOI: 10.3390/brainsci13050718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES In this preliminary, longitudinal study, our objective was to assess changes in sleep quality during an inpatient stay in a rehabilitation setting in the United States and to relate changes to patients' demographic and clinical characteristics (i.e., age, gender, BMI, ethnicity, reason for hospitalization, pre-hospital living setting, prior diagnosis of sleep disorders, and mental health status). METHODS A total of 35 patients participated in this preliminary study (age = 61 ± 16 years old, 50% <65; BMI = 30 ± 7 kg/m2; 51% female; 51% Caucasian). The average length of hospitalization was 18 ± 8 days. Reasons for hospitalization included orthopedic-related issues (28%), spinal cord injury (28%), stroke (20%), and other (23%). In this sample, 23% had prior sleep disorders (mostly sleep apnea), and 60% came from an acute care unit. Patients' sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) at admission and before discharge. Demographic and medical data were collected. Patients' mental health status was also assessed at the same intervals. Nighttime sound levels and the average number of sleep disturbances were also collected throughout the study (6 months). RESULTS Our data revealed that most patients had poor sleep (PSQI > 5) at admission (86%) and discharge (80%). Using a repeated ANOVA, a significant interaction was obtained between sleep quality and the presence of a diagnosed sleep disorder [F (1, 33) = 12.861, p = 0.001, η2p = 0.280]. The sleep quality of patients with sleep disorders improved over their stay, while the sleep of patients without such disorders did not. The mean nighttime sound collection level averages and peaks were 62.3 ± 5.1 dB and 86.1 ± 4.9 dB, respectively, and the average number of sleep disturbances was 2.6 ± 1.1. CONCLUSION The improved sleep observed in patients with vs. without sleep disorders might be related to the care received for treating such disorders over the stay. Our findings call for the better detection and management of poor sleep in acute inpatient rehabilitation settings. Furthermore, if our findings are replicated in the future, studies on the implementation of quiet times for medical staff, patients, and family should be performed to improve sleep quality in the inpatient rehabilitation setting.
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Affiliation(s)
- Benjamin Winters
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - Dylan Serpas
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Niko Fullmer
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Katie Hughes
- Department of Nursing, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Jennifer Kincaid
- Respiratory Care Services, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Emily R Rosario
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
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Lee J, Schwichtenberg A, Bliwise D, Ali SZ, Hayat MJ, Clark PC, Spratling R. Simultaneous Recording of Objective Sleep in Mothers and School-aged Children with Developmental Disabilities: A Pilot Study of Actigraphy and Videosomnography. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023:1-23. [PMID: 37361457 PMCID: PMC10088614 DOI: 10.1007/s10882-023-09896-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 06/26/2023]
Abstract
Mothers of school-aged children ages 3 to 17 years with developmental disabilities (DDs) commonly report sleep problems in their children associated with impaired maternal sleep. However, existing research relies heavily on mothers' self-reported sleep. This study aimed to determine the feasibility of objectively measuring child and mother sleep-wake patterns using actigraphy and videosomnography. This was an observational pilot study. Mothers wore actigraphy watches and video-recorded their child's sleep for 7 nights. Mothers also completed a 7-day sleep diary and questionnaires on sleep quality, depressive symptoms, stress, and child sleep problems. Ten mothers (32-49 years) and ten children with DDs (8-12 years) completed this study. Half of the children were boys with autism spectrum disorders. We successfully recruited 77% of eligible mothers for the study during the pandemic. Eight mothers successfully wore the actigraphy, and nine successfully video-recorded their child's sleep. Mothers rated their participation positively and considered the data collection protocol acceptable. While mothers' sleep patterns from actigraphy were mostly within recommendations, self-reported sleep quality was poor. Child's sleep estimates from videosomnography showed children slept substantially less than recommended sleep hours. Mothers also reported a high frequency of child sleep problems. Consistent with this pattern, mothers also endorsed elevated stress and depression. The use of actigraphy and videosomnography is feasible. Objective sleep measurement for mothers' and children's sleep is needed with self-report to measure multidimensional aspects of sleep and discrepancies between objective and self-report sleep measures. Future studies can use multi-methods sleep measures and work toward interventions that can improve family sleep and reduce mothers' stress and depression.
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Affiliation(s)
- Jiwon Lee
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur Stress Urban Life Building Room 911, Atlanta, GA 30303 USA
| | - A.J. Schwichtenberg
- Department of Human Development & Family Studies, College of Health and Human Sciences, Purdue University, West Lafayette, IN USA
| | - Donald Bliwise
- Sleep Center, School of Medicine, Emory University, Atlanta, GA USA
| | - Syeda Zahra Ali
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA USA
| | - Matthew J. Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA USA
| | - Patricia C. Clark
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur Stress Urban Life Building Room 911, Atlanta, GA 30303 USA
| | - Regena Spratling
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur Stress Urban Life Building Room 911, Atlanta, GA 30303 USA
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35
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Scott RQ, Rodríguez AJ. Improving Quality of Sleep in Healthy Adults. CURRENT PULMONOLOGY REPORTS 2023. [DOI: 10.1007/s13665-023-00304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Ricketts EJ, Swisher V, Greene DJ, Silverman D, Nofzinger EA, Colwell CS. Sleep Disturbance in Tourette's Disorder: Potential Underlying Mechanisms. CURRENT SLEEP MEDICINE REPORTS 2023; 9:10-22. [PMID: 37636897 PMCID: PMC10457082 DOI: 10.1007/s40675-022-00242-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 01/24/2023]
Abstract
Purpose of review Sleep disturbance is common in TD. However, our understanding of the pathophysiological mechanisms involved is preliminary. This review summarizes findings from neuroimaging, genetic, and animal studies to elucidate potential underlying mechanisms of sleep disruption in TD. Recent findings Preliminary neuroimaging research indicates increased activity in the premotor cortex, and decreased activity in the prefrontal cortex is associated with NREM sleep in TD. Striatal dopamine exhibits a circadian rhythm; and is influenced by the suprachiasmatic nucleus via multiple molecular mechanisms. Conversely, dopamine receptors regulate circadian function and striatal expression of circadian genes. The association of TD with restless legs syndrome and periodic limb movements indicates shared pathophysiology, including iron deficiency, and variants in the BTDB9 gene. A mutations in the L-Histidine Decarboxylase gene in TD, suggests the involvement of the histaminergic system, implicated in arousal, in TD. Summary These biological markers have implications for application of novel, targeted interventions, including noninvasive neuromodulation, iron supplementation, histamine receptor antagonists, and circadian-based therapies for tic symptoms and/or sleep and circadian rhythms in TD.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Valerie Swisher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Deanna J Greene
- Department of Cognitive Science, University of California, San Diego
| | - Daniel Silverman
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles
| | - Eric A Nofzinger
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Christopher S Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Jafar NKA, Bennett CJ, Moran LJ, Mansfield DR. Beyond Counting Sheep: Exploring the Link between Polycystic Ovary Syndrome and Sleep Health. Semin Reprod Med 2023; 41:45-58. [PMID: 38113883 DOI: 10.1055/s-0043-1777724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae that affects 8 to 13% of reproductive-aged women and 3 to 11% of adolescent girls. Sleep is often compromised in women with PCOS due to increased rates of sleep problems, with the most established problem being obstructive sleep apnea (OSA). OSA is highly prevalent in reproductive-aged adult women with PCOS, but not so in adolescence. The international evidence-based PCOS guideline to improve health outcomes in women with PCOS indicated routine screening to identify and alleviate symptoms of OSA. The guidelines, however, did not weigh other multidimensional constructs of sleep health such as sleep disturbances (e.g., sleep quality and quantity), beyond OSA. This is perhaps due to the lack of research and existing mixed findings in the area of PCOS and sleep health. This narrative review summarizes the current knowledge about OSA and expands further to include the limited knowledge about other sleep problems in PCOS among reproductive-aged women and adolescent girls. We broadly cover the prevalence, risk factors, and mechanisms of sleep problems in PCOS and their relationship with cardiometabolic and psychological health. A brief summary on treatment and intervention strategies for sleep problems in PCOS and future recommendations will be deliberated.
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Affiliation(s)
- Nur K Abdul Jafar
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christie J Bennett
- Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and Dietetics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Darren R Mansfield
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Efficacy of lifestyle medicine on sleep quality: A meta-analysis of randomized controlled trials. J Affect Disord 2023; 330:125-138. [PMID: 36863476 DOI: 10.1016/j.jad.2023.02.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Randomized controlled trials (RCTs) on the efficacy of multicomponent lifestyle medicine (LM) interventions for improving sleep quality have yielded inconsistent findings. This study marks the first meta-analysis to evaluate the efficacy of multicomponent LM interventions in improving sleep quality. METHODS We searched six online databases for RCTs that compared multicomponent LM interventions to an active or inactive control group in an adult population and assessed subjective sleep quality as a primary or secondary outcome using validated sleep measures at any post-intervention time-point. RESULTS A total of 23 RCTs with 26 comparisons involving 2534 participants were included in the meta-analysis. After excluding outliers, the analysis revealed that multicomponent LM interventions significantly improved sleep quality at immediate post-intervention (d = 0.45) and at short-term follow-up (i.e., <three months) (d = 0.50) relative to an inactive control group. Regarding the comparison with active control, no significant between-group difference was found at any time-point. No meta-analysis was conducted at the medium- and long-term follow-up due to insufficient data. Subgroup analyses supported that multicomponent LM interventions had a more clinically relevant effect on improving sleep quality in participants with clinical levels of sleep disturbance (d = 1.02) relative to an inactive control at immediate post-intervention assessment. There was no evidence of publication bias. CONCLUSION Our findings provided preliminary evidence that multicomponent LM interventions were efficacious in improving sleep quality relative to an inactive control at immediate post-intervention and at short-term follow-up. Additional high-quality RCTs targeting individuals with clinically significant sleep disturbance and long-term follow-up are warranted.
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Patterson PD, Martin SE, Brassil BN, Hsiao WH, Weaver MD, Okerman TS, Seitz SN, Patterson CG, Robinson K. The Emergency Medical Services Sleep Health Study: A cluster-randomized trial. Sleep Health 2023; 9:64-76. [PMID: 36372657 DOI: 10.1016/j.sleh.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Greater than half of emergency medical services (EMS) clinician shift workers report poor sleep, fatigue, and inadequate recovery between shifts. We hypothesized that EMS clinicians randomized to receive tailored sleep health education would have improved sleep quality and less fatigue compared to wait-list controls after 3 months. METHODS We used a cluster-randomized, 2-arm, wait-list control study design (clinicaltrials.gov identifier: NCT04218279). Recruitment of EMS agencies (clusters) was nationwide. Our study was powered at 88% to detect a 0.4 standard deviation difference in sleep quality with 20 agencies per arm and a minimum of 10 individuals per agency. The primary outcome was measured using the Pittsburgh Sleep Quality Index (PSQI) at 3-month follow-up. Our intervention was accessible in an online, asynchronous format and comprised of 10 brief education modules that address fatigue mitigation topics prescribed by the American College of Occupational Environmental Medicine. RESULTS In total, 36 EMS agencies and 678 individuals enrolled. Attrition at 3 months did not differ by study group (Intervention = 17.4% vs. Wait-list control = 18.2%; p = .37). Intention-to-treat analyses detected no differences in PSQI and fatigue scores at 3 months. Per protocol analyses showed the greater the number of education modules viewed, the greater the improvement in sleep quality and the greater the reduction in fatigue (p < .05). CONCLUSIONS While intention-to-treat analyses revealed no differences in sleep quality or fatigue at 3 months, per protocol findings identified select groups of EMS clinician shift workers who may benefit from sleep health education. Our findings may inform fatigue risk management programs.
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Affiliation(s)
- P Daniel Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA; University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, Pennsylvania, USA.
| | - Sarah E Martin
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Bridget N Brassil
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Wei-Hsin Hsiao
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, USA; Harvard Medical School, Division of Sleep Medicine, Boston, Massachusetts, USA
| | - Tiffany S Okerman
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Staci N Seitz
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Charity G Patterson
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Physical Therapy, Pittsburgh, Pennsylvania, USA
| | - Kathy Robinson
- National Association of State EMS Officials (NASEMSO), Falls Church, Virginia, USA
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Cowan S, Lim S, Alycia C, Pirotta S, Thomson R, Gibson-Helm M, Blackmore R, Naderpoor N, Bennett C, Ee C, Rao V, Mousa A, Alesi S, Moran L. Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity. BMC Endocr Disord 2023; 23:14. [PMID: 36647089 PMCID: PMC9841505 DOI: 10.1186/s12902-022-01208-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/09/2022] [Indexed: 01/18/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with reproductive, metabolic and psychological consequences. Weight and lifestyle (diet, physical activity and behavioural) management are first-line therapy in international evidence-based guidelines for PCOS. While these recommend following population-level diet and physical activity guidelines, there is ongoing interest and research in the potential benefit of including psychological and sleep interventions, as well as a range of traditional, complimentary and integrative medicine (TCIM) approaches, for optimal management of PCOS. There is limited evidence to recommend a specific diet composition for PCOS with approaches including modifying protein, carbohydrate or fat quality or quantity generally having similar effects on the presentations of PCOS. With regards to physical activity, promising evidence supports the provision of vigorous aerobic exercise, which has been shown to improve body composition, cardiorespiratory fitness and insulin resistance. Psychological and sleep interventions are also important considerations, with women displaying poor emotional wellbeing and higher rates of clinical and subclinical sleep disturbance, potentially limiting their ability to make positive lifestyle change. While optimising sleep and emotional wellbeing may aid symptom management in PCOS, research exploring the efficacy of clinical interventions is lacking. Uptake of TCIM approaches, in particular supplement and herbal medicine use, by women with PCOS is growing. However, there is currently insufficient evidence to support integration into routine clinical practice. Research investigating inositol supplementation have produced the most promising findings, showing improved metabolic profiles and reduced hyperandrogenism. Findings for other supplements, herbal medicines, acupuncture and yoga is so far inconsistent, and to reduce heterogeneity more research in specific PCOS populations, (e.g. defined age and BMI ranges) and consistent approaches to intervention delivery, duration and comparators are needed. While there are a range of lifestyle components in addition to population-recommendations for diet and physical activity of potential benefit in PCOS, robust clinical trials are warranted to expand the relatively limited evidence-base regarding holistic lifestyle management. With consumer interest in holistic healthcare rising, healthcare providers will be required to broaden their knowledge pertaining to how these therapies can be safely and appropriately utilised as adjuncts to conventional medical management.
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Affiliation(s)
- Stephanie Cowan
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
| | - Siew Lim
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Chelsea Alycia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, Monash University, Clayton, Victoria, Australia
| | - Rebecca Thomson
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Rebecca Blackmore
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Negar Naderpoor
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Christie Bennett
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Vibhuti Rao
- NICM Health Research Institute, Western Sydney University, Westmead, New South Wales, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Simon Alesi
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
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Van Hout E, Contreras M, Mioshi E, Kishita N. Examining the Impact of Different Components of Sleep Quality on Anxiety Among Family Carers of People with Dementia. J Geriatr Psychiatry Neurol 2023; 36:63-72. [PMID: 35437043 PMCID: PMC9755697 DOI: 10.1177/08919887221093359] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Existing interventions for family carers of people with dementia tend to be less effective for anxiety than for depression. Therefore, identifying factors affecting carer anxiety is important to inform future interventions. This study conducted 2 multiple regression analyses using a sample of 91 family carers. The first regression model (∆R2 = .24), exploring the impact of demographic variables and carer stressors, demonstrated that hours of caring (β = .33) and overall sleep quality (β = .28) were significant predictors of anxiety. To further investigate the impact of sleep quality, the second model (∆R2 = .24) focussed on exploring the differential impact of various components of sleep quality on anxiety. Findings demonstrated that subjective sleep quality (β = .33) and sleep disturbances (β = .22) were significant predictors. Hours of caring per week, subjective sleep quality and sleep disturbances seem to be critical for treating anxiety in family carers. Future studies should investigate whether targeting these variables could improve carer anxiety.
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Affiliation(s)
- Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Milena Contreras
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK,Dr. Naoko Kishita, School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
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Mohideen A, Bouvin C, Judah G, Picariello F, Gardner B. Feasibility and acceptability of a personalised script-elicitation method for improving evening sleep hygiene habits. Health Psychol Behav Med 2023; 11:2162904. [PMID: 36618889 PMCID: PMC9815428 DOI: 10.1080/21642850.2022.2162904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Attempts to improve evening sleep hygiene have overlooked that sleep preparation behaviours are often undertaken automatically with little awareness; that is, habitually. This mixed-methods study assessed aspects of the feasibility and acceptability of a novel behavioural intervention procedure ('script elicitation'), which encourages reflection on and reorganisation of the content and sequencing of habitual evening pre-sleep routines. Methods The study was advertised via social media, and circular lists at a UK university. Twenty-four UK-based adults, reporting <6 h/night sleep, were recruited. At baseline, they completed sleep hygiene and quality measures, then participated in an online, one-to-one script elicitation interview. This involved the interviewer working with the participant to generate a fine-grained description of the content, organisation and variability of their typical pre-sleep routine, and plan a more sleep-conducive alternative routine to follow over the next week. One week later, participants completed sleep quality and hygiene measures, and a semi-structured interview about the intervention. Feasibility was assessed using quantitative data on response rates and attrition, and acceptability via sleep hygiene and quality scores, and qualitative data on intervention experiences. Results All criteria were met. The target response rate was exceeded, none of the 24 participants dropped out, and sleep hygiene and quality scores either improved or remained stable. In interviews, all participants reported finding script elicitation useful. Script elicitation raised participants' awareness of habitual sleep hygiene routines, which gave many a newfound sense of autonomy over changing their sleep hygiene habits. While the habitual nature of existing routines obstructed change for some participants, most reported successfully changing aspects of their routine, and achieving behaviour, sleep and wellbeing improvements. Discussion Script elicitation is a promising and acceptable method for tackling poor evening sleep hygiene habits. A more rigorous trial is warranted.
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Affiliation(s)
- Anya Mohideen
- Department of Psychology, King's College London, London, UK
| | - Clara Bouvin
- Department of Psychology, King's College London, London, UK
| | - Gaby Judah
- Patient Safety Translational Research Centre, Imperial College London, London, UK
| | | | - Benjamin Gardner
- Department of Psychology, King's College London, London, UK,Department of Psychology, University of Surrey, Guildford, UK, Benjamin Gardner Department of Psychology, University of Surrey, Elizabeth Fry Building, GuildfordGU2 7XH, UK
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Alzhrani AM, Aboalshamat KT, Badawoud AM, Abdouh IM, Badri HM, Quronfulah BS, Mahmoud MA, Rajeh MT. The association between smartphone use and sleep quality, psychological distress, and loneliness among health care students and workers in Saudi Arabia. PLoS One 2023; 18:e0280681. [PMID: 36701337 PMCID: PMC9879389 DOI: 10.1371/journal.pone.0280681] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The use of smartphones among the general public and health care practitioners, in particular, is ubiquitous. The aim of this study was to investigate the relationship between smartphone addiction and sleep quality, psychological distress, and loneliness among health care students and workers in Saudi Arabia. METHODS This cross-sectional study used an online questionnaire to collect data on smartphone addiction, sleep quality, psychological distress, and loneliness as well as demographic information. RESULTS A total of 773 health care students and workers participated in the study, with an average age of 25.95 ± 8.35, and 59.6% female participants. The study found a positive significant association between smartphone addiction and psychological distress (F(1,771) = 140.8, P < 0.001) and emotional loneliness (F(1,771) = 26.70, P < 0.001). Additionally, a significant negative association between smartphone addiction and sleep quality was found (F(1,771) = 4.208, P = 0.041). However, there was no significant relationship between smartphone addiction and social loneliness (F (1,771) = 0.544, P < 0.461). CONCLUSION These findings suggest that smartphone addiction has a negative impact on psychological distress, sleep quality, and emotional loneliness among health care students and workers. It is important to promote strategies to reduce smartphone dependency in order to avoid the harmful consequences of smartphone addiction.
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Affiliation(s)
- Abdullah Muhammad Alzhrani
- Department of Occupation Health, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khalid Talal Aboalshamat
- Preventive Dentistry Department, College of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amal Mohammmad Badawoud
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- * E-mail:
| | - Ismail Mahmoud Abdouh
- Department of Oral Basic and Clinical Sciences, College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | - Hatim Matooq Badri
- Department of Environmental Health, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Baraa Sami Quronfulah
- Department of Health Promotion and Health Education, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Mona Talal Rajeh
- Department of Dental Public Health, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
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Zhu Y, Huang J, Yang M. Association between Chronotype and Sleep Quality among Chinese College Students: The Role of Bedtime Procrastination and Sleep Hygiene Awareness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010197. [PMID: 36612519 PMCID: PMC9820042 DOI: 10.3390/ijerph20010197] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 05/31/2023]
Abstract
Chronotype and sleep quality have been shown to play significant roles in influencing people's physical and mental health. The current study focuses on examining the relationship between chronotype and sleep quality among Chinese college students and exploring the mediating role of bedtime procrastination and the moderating role of sleep hygiene awareness. A sample of 2822 college students (female = 71.4%) aged between 17 and 29 years (M = 19.77, SD = 1.41) were included and completed the measures of the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), Bedtime Procrastination Scale (BPS) and Sleep Hygiene Awareness Scale (SHAS). The results showed that evening-type students reported the lowest sleep quality and highest levels of bedtime procrastination. In contrast, the highest sleep quality and lowest levels of bedtime procrastination were shown by morning-type, exhibiting the neither-type students' intermediate chronotype. Bedtime procrastination partially mediated the relationship between chronotype and sleep quality. Furthermore, sleep hygiene awareness moderated the direct effect of chronotype on sleep quality and the effect of chronotype in the path from chronotype to bedtime procrastination. Specifically, higher levels of sleep hygiene awareness could buffer the adverse effect of chronotype on self-reported sleep quality but bolstered the negative effect of chronotype on bedtime procrastination. Our results suggest that individuals with an evening preference are inclined to postpone their bedtime and further experience poorer sleep quality at night. Sleep hygiene awareness may serve as a protective factor for poor nocturnal sleep. Overall, the findings highlight the importance of reducing bedtime procrastination and improving sleep hygiene awareness in the interventions designed to help college students to own a better sleep quality, especially for those with evening chronotypes.
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Affiliation(s)
- Yingying Zhu
- Key Research Base of Humanities and Social Sciences of the Ministry of Education, Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300387, China
- Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
- Tianjin Social Science Laboratory of Students’ Mental Development and Learning, Tianjin 300387, China
| | - Jiahao Huang
- Faculty of Psychology, Tianjin Normal University, Tianjin 300387, China
| | - Minqi Yang
- School of Education, Zhengzhou University, Zhengzhou 450001, China
- School of Marxism, Zhengzhou University, Zhengzhou 450001, China
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Capon W, Hickie IB, Varidel M, Prodan A, Crouse JJ, Carpenter JS, Cross SP, Nichles A, Zmicerevska N, Guastella AJ, Scott EM, Scott J, Shah J, Iorfino F. Clinical staging and the differential risks for clinical and functional outcomes in young people presenting for youth mental health care. BMC Med 2022; 20:479. [PMID: 36514113 PMCID: PMC9749194 DOI: 10.1186/s12916-022-02666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical staging proposes that youth-onset mental disorders develop progressively, and that active treatment of earlier stages should prevent progression to more severe disorders. This retrospective cohort study examined the longitudinal relationships between clinical stages and multiple clinical and functional outcomes within the first 12 months of care. METHODS Demographic and clinical information of 2901 young people who accessed mental health care at age 12-25 years was collected at predetermined timepoints (baseline, 3 months, 6 months, 12 months). Initial clinical stage was used to define three fixed groups for analyses (stage 1a: 'non-specific anxious or depressive symptoms', 1b: 'attenuated mood or psychotic syndromes', 2+: 'full-threshold mood or psychotic syndromes'). Logistic regression models, which controlled for age and follow-up time, were used to compare clinical and functional outcomes (role and social function, suicidal ideation, alcohol and substance misuse, physical health comorbidity, circadian disturbances) between staging groups within the initial 12 months of care. RESULTS Of the entire cohort, 2093 young people aged 12-25 years were followed up at least once over the first 12 months of care, with 60.4% female and a baseline mean age of 18.16 years. Longitudinally, young people at stage 2+ were more likely to develop circadian disturbances (odds ratio [OR]=2.58; CI 1.60-4.17), compared with individuals at stage 1b. Additionally, stage 1b individuals were more likely to become disengaged from education/employment (OR=2.11, CI 1.36-3.28), develop suicidal ideations (OR=1.92; CI 1.30-2.84) and circadian disturbances (OR=1.94, CI 1.31-2.86), compared to stage 1a. By contrast, we found no relationship between clinical stage and the emergence of alcohol or substance misuse and physical comorbidity. CONCLUSIONS The differential rates of emergence of poor clinical and functional outcomes between early versus late clinical stages support the clinical staging model's assumptions about illness trajectories for mood and psychotic syndromes. The greater risk of progression to poor outcomes in those who present with more severe syndromes may be used to guide specific intervention packages.
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Affiliation(s)
- William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, 2751, Australia.,School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, 2751, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Shane P Cross
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, 2109, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | | | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, H3A 0G4, Canada
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, 2050, Australia.
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Al Ozairi E, Alsaeed D, Al Roudhan D, Voase N, Pell JP, Ho FK, Abdulla M, Gray SR. A comparison of physical activity, muscle strength, and sleep between people with type 2 diabetes in Kuwait and the UK: A cross-sectional study. Front Endocrinol (Lausanne) 2022; 13:1067227. [PMID: 36568114 PMCID: PMC9773192 DOI: 10.3389/fendo.2022.1067227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Background The aim of the current study was to determine the prevalence of low muscle strength and to evaluate physical activity and sleep characteristics in people with type 2 diabetes in Kuwait. Additionally, equivalent data from the UK Biobank cohort were compared. Methods People with type 2 diabetes from the UK Biobank (n = 23,570) and Kuwaiti cohorts (n = 3,135) were included in this cross-sectional study. Self-reported sleep, physical activity, and muscle strength were compared between the cohorts, using linear and logistic regression, with adjustments for age, sex, and duration of diabetes. Results Physical activity levels (-937 (-1,097, -851) Met-min/week: standardized B-coefficient -0.42 (-0.47, -0.37)) and grip strength (3.2 (-3.58, -2.82) kg: standardized B-coefficient (-0.29 (-0.32, -0.26)) were lower in the Kuwaiti cohort, and the odds of having short sleep (OR 1.32 (1.19,1.46), being classed as inactive (OR 8.70 (7.59, 9.98), and having muscle weakness (OR 1.88 (1.69, 2.09) were higher. These analyses were adjusted for age, sex, and duration of diabetes. Conclusions The aim of the current study was to determine the prevalence of low muscle strength and to evaluate physical activity and sleep characteristics in people with type 2 diabetes in Kuwait. Additionally, equivalent data from the UK Biobank cohort were compared.
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Affiliation(s)
- Ebaa Al Ozairi
- Clinical Research Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Dalal Alsaeed
- Clinical Research Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Dherar Al Roudhan
- Clinical Research Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Nia Voase
- Clinical Research Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Jill P. Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Frederick K. Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Mohammed Abdulla
- Clinical Research Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Stuart R. Gray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
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Chandler L, Patel C, Lovecka L, Gardani M, Walasek L, Ellis J, Meyer C, Johnson S, Tang NKY. Improving university students' mental health using multi-component and single-component sleep interventions: A systematic review and meta-analysis. Sleep Med 2022; 100:354-363. [PMID: 36198252 DOI: 10.1016/j.sleep.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023]
Abstract
University is a time of significant transitions during a young adult's life, with delayed and shortened sleep and poor mental health a common occurrence. This systematic review and meta-analysis examined the effect of both multi-component and single-component sleep interventions on improving university students' sleep and mental health. Five databases (MEDLINE, PsycINFO, Embase, CINAHL and Cochrane Library) were searched for relevant literature published until April 2022. Treatment studies including university students aged 18-24 years, participating in a sleep intervention (multi-component, e.g., CBT-I, or single-component, e.g., sleep hygiene) were eligible. Comparator groups were either active, i.e., alternative intervention, or passive, i.e., waitlist control or treatment-as-usual, with study outcomes to include measures of sleep and mental health. Of 3435 references screened, 11 studies involving 5267 participants, with and without insomnia symptoms, were included for a narrative synthesis on intervention designs and methodology. Six studies eligible for meta-analyses showed a moderate effect of sleep interventions in reducing sleep disturbance (SMD = -0.548 [CI: -0.837, -0.258]) at post-treatment, alongside a small effect in improving anxiety (SMD = -0.226 [CI: -0.421, -0.031]) and depression (SMD = -0.295 [CI: -0.513, -0.077]). Meta-regression examining study and intervention characteristics identified subpopulation (experiencing insomnia or not) as a significant moderator for effects on sleep (p = 0.0003) and depression (p = 0.0063), with larger effects in studies with participants experiencing insomnia. Comparison group type (active or passive) was also a significant moderator (p = 0.0474), with larger effects on sleep in studies using passive comparison groups. Study type, delivery format, and intervention duration were not identified as significant moderators. At follow-ups, small but significant effects were sustained for anxiety and depression. Protecting and promoting sleep amongst university students may help safeguard and advance mental health.
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Affiliation(s)
| | - Chloe Patel
- Warwick Manufacturing Group, University of Warwick, UK
| | - Lia Lovecka
- Department of Psychology, University of Warwick, UK
| | - Maria Gardani
- School of Health in Social Science, University of Edinburgh, UK
| | | | - Jason Ellis
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, UK
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Zagaria A, Ottaviani C, Lombardo C, Ballesio A. Perseverative Cognition as a Mediator Between Perceived Stress and Sleep Disturbance: A Structural Equation Modeling Meta-analysis (meta-SEM). Ann Behav Med 2022; 57:463-471. [DOI: 10.1093/abm/kaac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract
Background
According to the perseverative cognition (PC) hypothesis, the repetitive chronic activation of the cognitive representations of stressors are associated with a concomitant prolonged and sustained physiological stress response, including sleep disruption.
Purpose
We conducted a systematic review and structural equation modeling meta-analysis (meta-SEM) on PC as mediator of the association between perceived stress and subjective sleep disturbance (i.e., difficulties falling asleep or maintaining sleep).
Methods
PubMed, Scopus, Medline, CINAHL, and PsycInfo were searched up to September 2021. To test mediation, only longitudinal studies assessing the predictor (perceived stress) at T0, the mediator (PC) at T1, and the outcome (sleep disturbance) at T2, were eligible.
Results
Findings on 3,733 individuals (k = 8) showed a significant component effect of perceived stress on PC (β = 0.340, p < .001), which in turn was related to sleep disturbance (β = 0.258, p < .001). The direct effect of stress on sleep disturbance was significant (β = 0.133, p < .001). Lastly, the indirect effect between stress and sleep disturbance via PC supported the mediation hypothesis (β = 0.09, 95% CI 0.078–0.100). The mediation path remained significant (β = 0.03, 95% CI 0.020–0.036) after adjusting for baseline sleep disturbance. Further leave-one-out sensitivity and control analyses confirmed that all direct and indirect effects were not driven by any single study included in the meta-analysis, as well as their robustness when controlling for sex and age, respectively.
Conclusions
Overall, results of this meta-analysis indicate that PC may be one of the mechanisms explaining how perceived stressful experiences lead to subjective sleep disturbance.
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Affiliation(s)
- Andrea Zagaria
- Department of Psychology, Sapienza University of Rome , Rome , Italy
| | | | - Caterina Lombardo
- Department of Psychology, Sapienza University of Rome , Rome , Italy
| | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome , Rome , Italy
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Haggerty D, Contreras DA, Carter A, Drake C, Tucker RM. SLeep Education for Everyone Program (SLEEP) Results in Sustained Improvements in Sleep Outcomes at Six Months. Behav Sleep Med 2022:1-7. [PMID: 36377788 DOI: 10.1080/15402002.2022.2146693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Community-delivered sleep education interventions have been demonstrated to be effective in improving sleep outcomes, but whether these benefits persist once the program ends is not well characterized. This study sought to determine whether the previously reported positive effects attributed to the SLeep Education for Elders Program (SLEEP) were maintained six months after program completion. METHOD Nineteen participants were surveyed three times: at baseline, program completion (six weeks), and the six-month post-program timepoint. Sleep outcomes for quality, duration, insomnia symptoms, sleep hygiene behaviors, and excessive daytime sleepiness were assessed using validated surveys, including the Pittsburgh Sleep Quality Index (from which duration was also extracted), the Insomnia Severity Index, the Sleep Hygiene Index, and the Epworth Sleepiness Scale. RESULTS Longitudinal models adjusted for baseline sleep problems revealed the benefits achieved immediately after the program were retained at six months for sleep quality (estimate: -2.0 (95%CI: -2.7, -1.3)), sleep duration (estimate: 0.9 (95%CI: 0.6, 1.2)), insomnia symptoms (estimate: -3.5 95%CI: (-4.6, -2.3)), and sleep hygiene behaviors (estimate: -2.6 (-4.3, -0.9)). CONCLUSIONS These results suggest that a community-delivered sleep education intervention can produce sustained benefits for participants and should be considered as a tool to address uncomplicated sleep issues.
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Affiliation(s)
- Diana Haggerty
- Office of Research and Education, Spectrum Health West Michigan, Grand Rapids, Michigan
| | - Dawn A Contreras
- Michigan State University Extension. Michigan State University, East Lansing, Michigan
| | - Anita Carter
- Michigan State University Extension. Michigan State University, East Lansing, Michigan
| | - Christopher Drake
- Division of Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Robin M Tucker
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan
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Rugg CM, Cheah JW, Vomer RP, Lau B. Opiate Use Patterns Among Collegiate Athletes. Cureus 2022; 14:e31152. [DOI: 10.7759/cureus.31152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 11/07/2022] Open
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