Sleep-Wake Concordance in Couples Is Inversely Associated With Cardiovascular Disease Risk Markers

A narrative review of mechanisms linking romantic relationship experiences to sleep quality

Although a significant body of research has revealed associations between romantic relationship experiences and sleep quality, there has not been clarity regarding the mechanisms underlying such associations. Toward this end, we review the existing studies that have tested mechanisms linking romantic relationship experiences to sleep quality. Guided by both theory and existing research, we organize our review around five key categories of mechanisms that may explain associations between romantic relationship experiences and sleep quality: emotional/affective responses, self-perceptions, social perceptions, self-regulation, and biological functioning. Our review of the literature indicates strong evidence in support of the mediating effects of emotional/affective mechanisms (e.g. emotions and mood states) in explaining associations between various aspects of romantic relationships (e.g. relationship satisfaction, partner conflicts, and attachment orientation) and sleep quality. Although there is ample theoretical support for the other mechanisms proposed, and although all proposed mechanisms have been separately linked to both romantic relationship experiences and sleep quality, few studies have directly tested them, pointing to profitable directions for future research. Understanding underlying mechanisms will enable the development of wise, process-based interventions that target specific mechanisms to improve couple members' sleep quality and romantic relationship functioning.

Dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers: A feasibility study

OBJECTIVES

Sleep disturbances are common among adult patients with cancer and their caregivers. To our knowledge, no sleep intervention to date has been designed to be provided to both patients with cancer and their caregivers simultaneously. This single-arm study aimed to pilot test the feasibility and acceptability, and to illustrate the preliminary efficacy on sleep efficiency of the newly developed dyadic sleep intervention, My Sleep Our Sleep (MSOS: NCT04712604).

METHODS

Adult patients who were newly diagnosed with a gastrointestinal (GI) cancer and their sleep-partner caregivers (n = 20 persons: 10 dyads, 64 years old, 60% female patients, 20% Hispanic, 28 years relationship duration), both of whom had at least mild levels of sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] ≥ 5) participated in this study. MSOS intervention consists of four 1-hour weekly sessions delivered using Zoom to the patient-caregiver dyad together.

RESULTS

We were able to enroll 92.9% of the eligible and screened patient-caregiver dyads within 4 months. Participants reported high satisfaction in 8 domains (average 4.76 on a 1-5 rating). All participants agreed that the number of sessions, interval (weekly), and delivery mode (Zoom) were optimal. Participants also preferred attending the intervention with their partners. Both patients and caregivers showed improvement in sleep efficiency after completing the MSOS intervention: Cohen's d = 1.04 and 1.47, respectively.

SIGNIFICANCE OF RESULTS

Results support the feasibility and acceptability, as well as provide the preliminary efficacy of MSOS for adult patients with GI cancer and their sleep-partner caregivers. Findings suggest the need for more rigorous controlled trial designs for further efficacy testing of MSOS intervention.

Antibiotic exposure associated with nighttime sleep duration and daytime sleepiness in newlyweds

Few studies have explored the relationship between antibiotic exposure and sleep in newlyweds. We applied the actor-partner interdependence moderation model to estimate the relationships of antibiotic exposure with nighttime sleep duration (weekday, weekend, and average sleep durations) and daytime sleepiness in newlyweds. We found that 99.0% of the 2698 enrolled individuals were exposed to at least one antibiotic. Among the newlyweds, exposure to florfenicol (β, - 0.077; 95% confidence interval [CI], - 0.143, - 0.011), exposure to chloramphenicols (- 0.086 [- 0.160, - 0.011]), and exposure to veterinary antibiotics (VAs) (- 0.106 [- 0.201, - 0.010]) were negatively associated with weekday sleep duration. Florfenicol, chloramphenicols, and VAs were also inversely related to average sleep duration in the newlyweds. Ciprofloxacin and cyadox exposure was significantly associated with an increase of 0.264 (0.030, 0.497) and (0.375 [0.088, 0.663]) Epworth Sleepiness Scale (ESS) scores in the newlyweds, respectively. Gender moderated the actor-partner effects of erythromycin and tetracyclines on the newlyweds' weekday sleep duration and ESS scores. Overall, exposure to florfenicol, chloramphenicols, and VAs shortened weekday and average sleep durations of newlyweds. Exposure to ciprofloxacin and cyadox promoted daytime sleepiness. Gender moderated the actor-partner effects of specific antibiotics on the weekday sleep duration and ESS scores of the newlyweds.

Correlations in sleeping patterns and circadian preference between spouses

Spouses may affect each other's sleeping behaviour. In 47,420 spouse-pairs from the UK Biobank, we found a weak positive phenotypic correlation between spouses for self-reported sleep duration (r = 0.11; 95% CI = 0.10, 0.12) and a weak inverse correlation for chronotype (diurnal preference) (r = -0.11; -0.12, -0.10), which replicated in up to 127,035 23andMe spouse-pairs. Using accelerometer data on 3454 UK Biobank spouse-pairs, the correlation for derived sleep duration was similar to self-report (r = 0.12; 0.09, 0.15). Timing of diurnal activity was positively correlated (r = 0.24; 0.21, 0.27) in contrast to the inverse correlation for chronotype. In Mendelian randomization analysis, positive effects of sleep duration (mean difference=0.13; 0.04, 0.23 SD per SD) and diurnal activity (0.49; 0.03, 0.94) were observed, as were inverse effects of chronotype (-0.15; -0.26, -0.04) and snoring (-0.15; -0.27, -0.04). Findings support the notion that an individual's sleep may impact that of their partner, promoting opportunities for sleep interventions at the family-level.

Depression with obstructive sleep apnea lead to high cardiovascular disease morbidity/all-cause mortality: Findings from the SHHS cohort

The aim of this study is to explore the association between depression and obstructive sleep apnea, and cardiovascular disease morbidity/all-cause mortality using Sleep Heart Health Study data. This post hoc analysis of a prospective study used patient data from the Sleep Heart Health Study conducted between 1995 and 1998. The association between depression and obstructive sleep apnea, and cardiovascular disease morbidity/all-cause mortality was explored using multivariable Cox proportional hazard models. A total of 4918 participants, 656 (13.3%) with obstructive sleep apnea (obstructive sleep apnea group), 1614 (32.8%) with depression (depression group), 482 (9.8%) with depression and obstructive sleep apnea (depression and obstructive sleep apnea group), and 2166 (44%) with neither obstructive sleep apnea nor depression (health group), were included. The incidence of cardiovascular disease was 24.5%, 31.0%, 31.6% and 41.7% for healthy, depression, obstructive sleep apnea, and depression and obstructive sleep apnea groups, respectively. The risk of cardiovascular disease in depression and obstructive sleep apnea participants was increased compared with that in healthy participants, which was consistent across various definitions of obstructive sleep apnea (hazard ratio [95% confidence interval]: 1.24 [1.06-1.47]; 1.25 [1.05-1.49]; 1.28 [1.06-1.54]; 1.55 [1.22-1.96] for apnea-hypopnea index ≥ 10 per hr, 15 per hr, 20 per hr, 30 per hr, respectively). The risk of all-cause mortality was increased in the depression and obstructive sleep apnea participants (hazard ratio: 1.46; 95% confidence interval: 1.07-1.99) compared with that in healthy participants when the definition of obstructive sleep apnea was apnea-hypopnea index ≥ 30. Participants with depression and obstructive sleep apnea might be at a greater risk of cardiovascular disease, and those with higher apnea-hypopnea index might be at a greater risk of all-cause mortality.

Protocol of a dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers

Background

Sleep disturbance is common and problematic among both patients with cancer and their sleep partner caregivers. Although 70% of the general adult population sleep in the same bed with a significant other, as do adult cancer patients and their spousal/partner caregivers, and one's sleep affect the partner's sleep, existing psychobehavioral interventions have targeted patients' and caregivers' sleep problems independently.

Methods

We developed a new sleep intervention, My Sleep Our Sleep (MSOS), for both adult patients with cancer and their sleep-partner caregivers together. This protocol is to test the feasibility and acceptability as well as to provide preliminary efficacy of the MSOS intervention, which is a dyadic intervention designed to reduce sleep disturbance and improving sleep quality of both adult cancer patients and their sleep-partner caregivers (dyads). The intervention will be delivered weekly for 4 weeks. Questionnaire and daily sleep logs will be collected at baseline (T1) and one-week after conclusion of the intervention (T2). Satisfaction with the intervention will be assessed weekly for 4 weeks.

Results

We estimate 43 dyads be enrolled (43 patients and 43 sleep-partner caregivers). We expect >75% of eligible and screened dyads will enroll within the enrollment period, >80% of enrolled dyads will complete the intervention, and >80% of participants will report satisfaction across all acceptability measures. We also expect MSOS will reveal a small-to-medium effect on sleep efficiency (primary outcome), overall sleep disturbance, subjective sleep quality, and insomnia severity (secondary outcomes).

Conclusions

Results will inform the feasibility and acceptability of conducting a dyadic sleep intervention, and provide preliminary efficacy data to guide further refinement of the intervention content and procedure for adult patients with cancer and their sleep-partner caregivers.

Trial registration

NCT04712604 Clinicaltrials.gov.

Relationship satisfaction moderates links between poor sleep quality and psychological distress among couples coping with type 1 diabetes

OBJECTIVES

We examined links between sleep quality and psychological distress among couples dealing with type 1 diabetes (T1D) across cross-sectional and daily diary methods and investigated whether relationship satisfaction moderated these associations.

METHODS

199 persons with T1D and their spouses completed survey questionnaires reporting their own sleep quality, depressive symptoms, and relationship satisfaction. They also completed 14-day diaries reporting their own sleep quality and negative affect. Multi-level actor-partner interdependence models examined associations between sleep quality and psychological distress.

RESULTS

Cross-sectional and daily diary data revealed an association between poorer sleep quality and higher psychological distress for both persons with T1D and their spouses (ie, actor effects). Some partner effects were found. For example, poorer sleep quality of persons with T1D was associated with greater negative affect for spouses (within persons). Relationship satisfaction moderated the effects of sleep quality on psychological distress. For example, participants' poorer overall daily sleep quality was associated with greater negative affect for those with lower relationship satisfaction but not for those with higher relationship satisfaction (ie, actor effects). In contrast, partners' poorer overall daily sleep quality was associated with participants' greater negative affect for those with higher relationship satisfaction but not for those with lower relationship satisfaction (ie, partner-effects).

CONCLUSION

Links between sleep quality and psychological distress occur both within and between persons. Relationship satisfaction moderates the effect of poorer sleep quality on psychological distress in a nuanced way.

Affective Experience and Regulation via Sleep, Touch, and "Sleep-Touch" Among Couples

Touch associated with sleep (sleep-touch; reported physical contact during or shortly before/after sleep) is underexplored as a distinct contributor to affect regulatory processes associated with adult sleep. Given the affect-regulating effects of interpersonal touch, we theorized that among healthy co-sleeping adults, sleep-touch would add to sleep-related effects on affective "resetting," resulting in the experience of calmer, more regulated states. We studied 210 married heterosexual couples (aged 20-67 years, 79% non-Hispanic white, 13% Latinx) assigned 14 days of twice-daily (morning/evening) sleep/mood diaries. Multilevel daily (within-couple) mediation analyses showed that as hypothesized, more reported sleep-touch was associated with happier/calmer and less angry/irritable morning mood. In turn, happier/calmer mood was associated with greater enjoyment of time with spouse (for both spouses). Sleep-touch also was linked directly to both evening positive spousal events and enjoyment ratings. Sleep-touch was associated indirectly with fewer negative spousal events and less spouse-related stress via less angry/irritable morning mood (both spouses). Further, wives' sleep-touch was related to happier/calmer husband mood and evening enjoyment; husbands' sleep-touch was unrelated to wives' reports. All associations with sleep-touch were present while accounting for subjective sleep quality, prior evening mood, non-sleep-related physical affection, day in study, and weekend versus weekday. We speculate that among relatively healthy satisfied couples, physical touch during and surrounding sleep may add to sleep's restorative and affect-regulatory functions, suggesting a pathway through which co-sleeping can improve affect regulation and ultimately relationships and health.

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

PURPOSE OF REVIEW

Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD.

RECENT FINDINGS

Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.

Social baseline theory: State of the science and new directions

Social baseline theory (SBT) maintains that the primary human ecology is a social ecology. Because of this fact, the theory predicts that humans will find it easier and less energetically taxing to regulate emotion and act when in proximity to familiar and predictable others. This article reviews new empirical and theoretical work related to SBT and highlights areas of needed research. Among these exciting developments are investigations of the neural mechanisms of social emotion regulation, the creation of a model of social allostasis, and work investigating at the impact of social proximity in real-world contexts. SBT continues to accrue support and inspire new theoretical and empirical contributions.

Nightly sleep-wake concordance and daily marital interactions

OBJECTIVE

We and others have found that couples' sleep is a shared and dyadic process. Couples' sleep-wake concordance (whether couples are awake or asleep at the same time) is associated with couples' relationship factors; however, we know little of the temporal associations between concordance and daily relationship characteristics. The purpose of this study was to examine daily positive and negative interpersonal interactions to determine how they predict, and are predicted by, nightly sleep-wake concordance.

METHOD

Participants were 48 heterosexual couples between 18 and 45 years of age who shared a bed with their spouse. Couples completed questionnaires and daily assessments of positive and negative interactions. Each member of the dyad wore wrist actigraphs for 10 days. Sleep-wake concordance was calculated as the percentage of time couples were awake or asleep throughout the night at one-minute intervals. Multilevel modeling with lagged effects determined bidirectional and lagged associations between concordance and couples' daily interactions.

RESULTS

Couples had more negative interactions than their usual following nights with higher concordance than their usual (but not vice versa) and this was more pronounced for well-adjusted couples. In contrast, across all couples, more positive interactions and perceived warmth and support from partners were associated with higher concordance.

CONCLUSIONS

Our findings demonstrate that the valence of sleep-wake concordance depends on relationship quality characteristics (eg, marital adjustment). Future research on relationships, sleep, and health should consider couples' shared sleep behaviors as one mechanism by which relationships are associated with long-term health outcomes.

Co-Sleeping between Adolescents and Their Pets May Not Impact Sleep Quality

Pet–owner co-sleeping is increasingly common in some parts of the world. Adult owners often subjectively report benefits of co-sleeping with pets, although objective actigraphy reports conversely indicate sleep disruptions due to the pet. Because limited research is available regarding pet–owner co-sleeping in non-adult samples, the aim of this two-part study was to explore whether co-sleeping improves sleep quality in adolescents, an age group in which poor sleep patterns are well documented. In Study One, an online survey with 265 pet-owning 13-to-17-year-old participants found that over 78% co-slept with their pet. Average sleep quality scores for co-sleepers and non-co-sleepers indicated generally poor sleep, with no differences in sleep quality depending on age, gender, or co-sleeping status. Study Two consisted of two preliminary case studies, using actigraphy on dog–adolescent co-sleepers. In both cases, high sleep concordance was observed, but owners again experienced generally poor sleep quality. Future actigraphy research is needed, including larger sample sizes and a control group of non-co-sleepers, to validate the preliminary findings from this study, but our limited evidence suggests that co-sleeping with a pet may not impact sleep quality in adolescents.

Sleep problems in advanced cancer patients and their caregivers: Who is disturbing whom?

Background The aims of the study were to understand sleep problems and their effects in advanced cancer patients and spousal and intimate partner caregivers and to examine the directionality of the link between patients' and caregivers' sleep problems. Methods Fifty-four advanced cancer patients and their spousal and intimate partners were administered a battery of questionnaires that included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Studies at the patients' cancer diagnosis and at 2, 4, and 6 months after diagnosis. Results Patients' and caregivers' sleep duration was significantly related. Using cross-lagged panel analyses, caregivers' sleep quality significantly predicted patients' sleep quality and patients' sleep quality subsequently predicted caregivers' sleep quality. Patients' sleep latency significantly was found to significantly predict caregivers' sleep latency. Conclusion Patients diagnosed with cancer and their intimate partners have poor sleep quality and sleep patterns are related.

Vulnerability and resistance to sleep disruption by a partner: A study of bed-sharing couples

OBJECTIVES

Methods for analyzing sleep as a dyadic behavior remain relatively unexplored. We aimed to (1) characterize how bedpartners influence each other's sleep, and (2) identify factors that predict sensitivity to wake transmission between bedpartners.

DESIGN

Cross-sectional study.

SETTING

Community members in Melbourne, Australia.

PARTICIPANTS

Fifty-five couples without sleep disorders, aged 18-72 years.

MEASUREMENTS

Participants completed the Morningness-Eveningness Questionnaire, reduced version. Habitual sleep/wake patterns were monitored for seven nights via actigraphy and sleep diary. Epoch-by-epoch sleep/wake concordances (shared sleep/wake minutes), number of transmissions received (number of awakenings immediately preceded by bedpartner wakefulness), percent transmissions received (percentage of total awakenings that were transmissions), transmissibility (percentage of all bedpartner awakenings transmitted), and percent minutes resistant to transmission (percentage of bedpartner's wake minutes that an individual slept), were calculated. Mixed-effects modeling assessed predictors of dyadic sleep.

RESULTS

We described rates of sleep concordance (M = 66.8% ± 6.8%), wake concordance (M = 6.8% ± 3.1%), number of transmissions received (M = 6.0 ± 2.7), percent transmissions received (M = 18.9% ± 7.5%), transmissibility (M = 20.0% ± 6.2%), and percent minutes resistant (M = 52.1% ± 13.6%). Average couple-level percent transmissions received were highest and percent minutes resistant lowest in couples who had similar bedtime (within 30 minutes), compared to couples with greater differences in bedtime.

CONCLUSIONS

Wake transmission is a useful metric of dyadic sleep, which varies according to relative bedtimes, and chronotypes of bedpartners. Higher wake transmissions for couples with similar bedtimes suggest dyadic preferences for shared bedtimes may be due to psychosocial benefits of shared sleep timing, rather than minimization of bedpartner-driven sleep disruption.

Sleep and wake are shared and transmitted between individuals with insomnia and their bed-sharing partners

Patients with insomnia frequently report disturbing, or being disturbed by, their bedpartner. We aimed to (1) characterize how individuals with insomnia and their bedpartners influence each other’s sleep and (2) identify characteristics predicting vulnerability to wake transmission. Fifty-two couples (aged 19–82 years), where one individual was diagnosed with insomnia, participated. Sleep/wake patterns were monitored via actigraphy and sleep diaries for seven nights. Minute-by-minute sleep and wake concordance (simultaneous sleep/wake epochs), number of wake transmissions received (awakenings immediately preceded by wakefulness in the bedpartner), percent wake transmissions received (percentage of total awakenings that were transmitted), and percent of bedpartner’s wake minutes resistant to transmission (ability to sleep through bedpartner wakefulness) were calculated. Mixed-effects modeling assessed within-couple bedtime and chronotype differences as predictors of dyadic sleep. We described rates of sleep concordance (MPatient = 63.8%, MPartner = 65.6%), wake concordance (MPatient = 6.6%, MPartner = 6.6%), total transmissions received (MPatient = 5.5, MPartner = 6.9 per night), percent transmissions received (MPatient = 18.5%, MPartner = 23.4% of total awakenings), and percent minutes resistant (MPatient = 56.4%, MPartner = 58.6% of bedpartner’s wake time). Partners received wake transmissions at 1.25 times the rate of patients. Percent transmissions received was increased in couples with concordant bedtimes and individuals with later chronotype than their bedpartner. Patterns of chronotype and bedtime order predicting percent minutes resistant to transmission differed across the length of the rest interval. Transmission provides a novel characterization of how bedpartners influence sleep and provide insight into mechanisms of insomnia generation and maintenance. Understanding modifiable risk factors may provide ways to personalize insomnia treatments.

Clinical Trial Researching Effective Sleep Treatments (Project REST), ANZCTR Registration: ACTRN12616000586415

The role of couple sleep concordance in sleep quality: Attachment as a moderator of associations

Despite most American adults sharing a bed with a romantic partner, sleep research has examined sleep primarily as an individual behaviour. A growing body of research indicates that couple bed sharing may have an impact on sleep quality, but the current study is the first to examine whether such associations may differ based on attachment security. A sample of 179 cohabiting heterosexual couples completed daily sleep diaries and surveys of their attachment security, avoidance and anxiety. Data were analysed using multilevel modelling. Greater attachment security and lower attachment avoidance were associated with greater subjective sleep quality. Greater sleep concordance (time in bed with partners) was associated with better subjective sleep quality for women with lower attachment security and higher attachment avoidance. Findings suggest that couple bed sharing may benefit the subjective sleep quality of women who have lower attachment security.

Physical separation in adult attachment relationships

Attachment theory suggests that at all stages of life, regular contact with attachment figures fosters a fundamental sense of safety and security. Yet an increasing number of romantic couples undergo prolonged physical separations from one another, rangingfrom several weeks to several years, and involving widely varying opportunities for communication and contact. This article reviews contemporary research on the implications of such separations for attachment-related dynamics, including relationship satisfaction and psychobiological attunement between partners. Recent technological innovations in computer-mediated contact (such as video calls and electronic messaging) and their capacity to `stand in' for direct physical contact are also discussed, along with directions for future research in the diverse psychobiological mechanisms underlying attachment formation and functioning at different stages of life and in different contexts.