The feasibility of at-home sleep extension in adolescents and young adults: A meta-analysis and systematic review

The effects of shared, depression-specific, and anxiety-specific internalizing symptoms on negative and neutral episodic memories following post-learning sleep

Emotional memory bias is a common characteristic of internalizing symptomatology and is enhanced during sleep. The current study employs bifactor S-1 modeling to disentangle depression-specific anhedonia, anxiety-specific anxious arousal, and the common internalizing factor, general distress, and test whether these internalizing symptoms interact with sleep to influence memory for emotional and neutral information. Healthy adults (N = 281) encoded scenes featuring either negative objects (e.g., a vicious looking snake) or neutral objects (e.g., a chipmunk) placed on neutral backgrounds (e.g., an outdoor scene). After a 12-hour period of daytime wakefulness (n = 140) or nocturnal sleep (n = 141), participants judged whether objects and backgrounds were the same, similar, or new compared with what they viewed during encoding. Participants also completed the mini version of the Mood and Anxiety Symptom Questionnaire. Higher anxious arousal predicted worse memory across all stimuli features, but only after a day spent being awake-not following a night of sleep. No significant effects were found for general distress and anhedonia in either the sleep or wake condition. In this study, internalizing symptoms were not associated with enhanced emotional memory. Instead, memory performance specifically in individuals with higher anxious arousal was impaired overall, regardless of emotional valence, but this was only the case when the retention interval spanned wakefulness (i.e., not when it spanned sleep). This suggests that sleep may confer a protective effect on general memory impairments associated with anxiety.

Time use and dimensions of healthy sleep: A cross-sectional study of Australian children and adults

BACKGROUND

Sleep is increasingly recognized as a multidimensional construct that occurs within the 24-hour day. Despite advances in our understanding, studies continue to consider the relationship between sleep, sedentary time and physical activity separately, and not as part of the 24-hour day.

AIMS

To determine the association between the 24-hour activity composition and dimensions of healthy sleep.

METHODS

This study examined data on 1168 children (mean age 12years; 49% female) and 1360 adults (mean age 44years; 87% female) collected as part of the Child Health CheckPoint study. Participants were asked to wear a GENEActiv monitor (Activinsights, Cambs, UK) on their nondominant wrist for eight consecutive days to measure 24-hour time-use. Compositional data analysis was used to examine the association between time use (actigraphy-derived sleep duration, sedentary time, light physical activity and moderate-vigorous physical activity) and dimensions of healthy sleep. Healthy sleep was conceptualized in terms of continuity/efficiency, timing, alertness/sleepiness, satisfaction/quality, and regularity. Time allocations were also examined.

RESULTS

The 24-hour activity composition was significantly associated with all objectively measured and self-report dimensions of healthy sleep in both children and adults. Allocating more time to sleep was associated with earlier sleep onsets, later sleep offsets, less efficient and more consistent sleep patterns for both children and adults.

CONCLUSION

This study highlights the integral relationship between daily activities and dimensions of sleep. Considering sleep within the 24-hour day activity composition framework may help inform lifestyle decisions to improve sleep health.

Sleep extension and cardiometabolic health: what it is, possible mechanisms and real-world applications

Short sleep duration is associated with heightened cardiometabolic disease risk and has reached epidemic proportions among children, adolescents and adults. Potential mechanisms underlying this association are complex and multifaceted, including disturbances in circadian timing, food intake and appetitive hormones, brain regions linked to control of hedonic eating, physical activity, an altered microbiome and impaired insulin sensitivity. Sleep extension, or increasing total sleep duration, is an emerging and ecologically relevant intervention with significant potential to advance our understanding of the mechanisms underlying the association between short sleep duration and the risk of cardiometabolic disease. If effective, sleep extension interventions have potential to improve cardiometabolic health across the lifespan. Existing data show that sleep extension is feasible and might have potential cardiometabolic health benefits, although there are limitations that the field must overcome. Notably, most existing studies are short term (2-8 weeks), use different sleep extension strategies, analyse a wide array of cardiometabolic health outcomes in different populations and, frequently, lack adequate statistical power, thus limiting robust scientific conclusions. Overcoming these limitations will require fully powered, randomized studies conducted in people with habitual short sleep duration and existing cardiometabolic risk factors. Additionally, randomized controlled trials comparing different sleep extension strategies are essential to determine the most effective interventions. Ongoing and future research should focus on elucidating the potential cardiometabolic health benefits of sleep extension. Such studies have high potential to generate crucial knowledge with potential to improve health and quality of life for those struggling with short sleep duration.

Sleep in young people: What works now and where to? A meta-review of behavioural and cognitive interventions and lifestyle factors

OBJECTIVES

1) Systematically review meta-analyses and systematic reviews that (a) explored health/lifestyle factors affecting sleep, and/or (b) investigated behavioral/psychological sleep interventions in young people (10-25-years); 2) Evaluate the quality of published literature, and, if an intervention; 3) Examine method and effectiveness of mode of delivery, to inform current clinical practice and research direction.

METHOD

A systematic search of Embase (n = 45), MEDLINE (n = 67), Web of Science (n = 375), Google Scholar (n = 138), and hand-searching was conducted. After full review, 12 papers were selected, 2 systematic reviews without, and 10 with, meta-analyses. Six examined associations between sleep and lifestyle/health, and six examined cognitive-behavioral (n = 4), or school education (n = 2), programs.

RESULTS

Electronic media use, type of day (week/end), sex, age, culture/geographical location, substance use, family environment, and evening light exposure were negatively associated with sleep, in young people. Only cognitive and/or behavioral interventions of at least 2 × 1-hr sessions improved sleep.

CONCLUSION

This paper informs sleep recommendations for young people and advises that ≥ 2 × 1-hr sessions of cognitive behavioral or behavioral therapy is the minimum to improve sleep in young people. School-based sleep interventions do not produce long-term change.

Interventions to increase sleep duration in young people: A systematic review

This systematic review explored the outcomes of current interventions to increase sleep duration in healthy young people (14-25 years). Nine databases were systematically searched, and 26 studies were included in this review. Quality assessment of the included studies was evaluated using two tools: the Newcastle-Ottawa scale, and Cochrane Risk of Bias. The interventions incorporated a range of strategies including behavioral (46.2%), educational (26.9%), a combination of behavioral and educational (15.4%), and other strategies such as physical therapy (11.5%). The findings indicate that behavioral and combination interventions were consistently effective in increasing sleep duration in healthy young people. Educational interventions alone were less effective at increasing young people's sleep duration. Of all the included studies, only one randomized control trial but none of the non-randomized trials were rated as good quality. Our findings suggest a combination of strategies with an emphasis on personalization of intervention could possibly maximize the chances of success at improving sleep duration in healthy young people. More high-quality studies with long-term assessments (≥ 6 months) should be conducted to test the efficacy and durability of interventions to increase sleep duration in young people, as well as the clinical implications to mental and physical health.

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

Aim

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

Methods

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

Results

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

Conclusion

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

Beneficial effects of sleep extension on daily emotion in short-sleeping young adults: An experience sampling study

OBJECTIVES

Short sleep duration has been linked to disrupted emotional experiences and poor emotion regulation. Extending sleep opportunity might therefore offer a means to improve emotion functioning. This study used experience sampling to examine the effect of sleep extension on daily emotion experiences and emotion regulation.

PARTICIPANTS

Participants were young adults (n = 72), aged 18-24 years who reported consistently sleeping less than 7 hours in a 24-hour period in the past 2 weeks.

DESIGN AND SETTING

For 14 consecutive days, participants completed experience sampling questions related to sleep, emotion, and emotion regulation via a smartphone application. Procedures were identical for all participants for the first 7 days ("baseline" assessments).

INTERVENTION

From days 8-14, participants were randomly assigned to either a "sleep extension" condition, in which they were instructed to increase their sleep opportunity by 90 minutes or a "sleep as usual" condition.

MEASUREMENTS

Duration and quality of the previous night's sleep were reported each morning and daytime experiences of positive and negative emotion and emotion regulation were measured at pseudorandom timepoints 6 times a day.

RESULTS

Multilevel modeling demonstrated that participants in the sleep extension condition reported significantly longer sleep times and improved sleep quality, as well as higher positive and lower negative daily emotion, compared to those in the sleep as usual condition.

CONCLUSION

A brief experimental paradigm to extend sleep length has the potential to improve sleep quality and to a minor extent mood, among young adults with short sleep.