Sleep Disturbance and Short Sleep as Risk Factors for Depression and Perceived Medical Errors in First-Year Residents

Prevalence of sleep disturbances in people with mild cognitive impairment: A systematic review and meta-analysis

This review was performed to determine sleep disturbance prevalence in individuals with mild cognitive impairment (MCI). The MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science databases were systematically searched from inception to January 20, 2024. Fifty-two studies fulfilling the eligibility criteria were included. However, six of these studies were excluded from data synthesis due to poor methodological quality. The subjective sleep disturbance prevalence among all individuals with MCI was 35.8 % (95 % CI: 31.9-39.7) across 44 studies, and the objective sleep disturbance prevalence was 46.3 % (95 % CI: 36.3-56.3) across 6 studies. Five studies examined TST and WASO, while three assessed SE. Among all potential objective assessments of sleep disturbance prevalence, only TST, WASO, and SE could be meta-analyzed in MCI because of the limited number of studies available. The estimated sleep disturbance prevalence differed significantly according to measurement method, geographical region, and research design. However, the data source did not significantly influence prevalence estimates. In meta-regression analysis, publication year, participant age, percentage of females, and study quality did not predict prevalence. As subjective and objective sleep disturbances are common in people with MCI, effective intervention strategies should be developed to alleviate them.

Awakening Change-Embracing Disability in Medical Training

This essay describes the author’s experience as a medical trainee with narcolepsy with cataplexy, highlighting the toll of self-sacrifice and the need for a cultural shift in medicine to better support trainees with disabilities.

Examining bi-directional links between loneliness, social connectedness and sleep from a trait and state perspective

Greater loneliness as well as a lack of social connectedness have often been associated with poorer sleep. However, the temporal dynamics and direction of these associations remain unclear. Aim of the current study was to examine bi-directional associations between loneliness/social connectedness and sleep in 48 stress-exposed medical students during their first medical internship, considered a period of heightened stress. We obtained trait-level questionnaire data on loneliness and global sleep completed before and during the internship as well as state-level diary- and wearable-based data on daily changes in social connectedness and sleep collected twice over the period of seven consecutive days, once before and once during the internship. Bi-directional associations among greater loneliness and higher daytime dysfunction on trait-level were identified. In addition, several uni-directional associations between loneliness/social connectedness and sleep were found on trait- and state-level. In sum, findings of this study point at a bi-directional relation among loneliness/social connectedness and sleep, in which variables seem to reciprocally influence each other across longer-term periods as well as on a day-to-day basis.

Moderation by better sleep of the association among childhood maltreatment, neuroticism, and depressive symptoms in the adult volunteers: A moderated mediation model

BACKGROUND

Previously, we demonstrated that childhood maltreatment could worsen depressive symptoms through neuroticism. On the one hand, some studies report that sleep disturbances are related to childhood maltreatment and neuroticism and worsens depressive symptoms. But, to our knowledge, no reports to date have shown the interrelatedness between childhood maltreatment, neuroticism, and depressive symptoms, and sleep disturbance in the one model. We hypothesized that sleep disturbance enhances the influence of maltreatment victimization in childhood or neuroticism on adulthood depressive symptoms and the mediation influence of neuroticism between maltreatment victimization in childhood and adulthood depressive symptoms.

SUBJECTS AND METHODS

Total 584 Japanese volunteer adults recruited through convenience sampling from 4/2017 to 4/2018 were assessed regarding their characteristics of demographics, history of childhood maltreatment, sleep disturbance, neuroticism, and depressive symptoms with questionnaires self-administered. Survey data were analyzed using simple moderation models and a moderating mediation model.

RESULTS

The interaction of sleep disturbance with childhood maltreatment or neuroticism on depressive symptoms was significantly positive. Furthermore, the moderating effect of sleep disturbance on the indirect effect of childhood maltreatment to depressive symptoms through neuroticism was significantly positive.

LIMITATIONS

Because this was a cross-sectional study, a causal relationship could not be confirmed.

CONCLUSIONS

Our findings indicate that individuals with milder sleep disturbance experience fewer depressive symptoms attributable to neuroticism and childhood maltreatment. Additionally, people with less sleep disturbance have fewer depressive symptoms arising from neuroticism owing to childhood maltreatment. Therefore, improvement of sleep disturbance will buffer the aggravating effect of childhood maltreatment, neuroticism caused by various factors, and neuroticism resulting from childhood maltreatment on depressive symptoms.

Impact of COVID-19-Induced Academic Stress on Insomnia and Suicidal Ideation among Taiwanese Health Trainees and Junior Doctors

BACKGROUND Clinical training for allied health trainees (AHTs) and postgraduate-year (PGY) doctors needed to go online during the outbreak of coronavirus disease 2019 (COVID-19), which may have caused academic stress and consequent outcomes among this cohort. MATERIAL AND METHODS To evaluate academic-related stress, clinical confidence, psychological distress, and insomnia, an online survey-based study was conducted among Taiwanese AHTs and PGY doctors between July and December, 2022, during the COVID-19 pandemic. The survey included the 21-item Depression, Anxiety, and Stress Scale (DASS-21), the Insomnia Severity Index (ISI), and self-designed questions. It was distributed using convenience sampling and snowball sampling and was completed by 522 participants. RESULTS Structural equational modelling showed that academic stress was negatively associated with clinical confidence (standardized coefficient [ß]=-0.382, p<0.001). Clinical confidence was negatively associated with psychological distress (ß=-0.397, p<0.001), which was associated with insomnia (ß=0.648, p<0.001). Additionally, clinical confidence and psychological distress were the significant mediators. Results indicated that higher academic stress was associated with higher level of insomnia via the mediation of clinical confidence and psychological distress. CONCLUSIONS Academic stress related to changes in clinical training may have led to insomnia among AHTs and PGY doctors during the pandemic. Factors to reduce academic stress should be investigated to promote good mental health while providing sufficient clinical training, especially during events that can cause increased stress (eg, epidemics, pandemics).

Cross-sectional study of the association between burnout and work overload and work-life imbalance among medical personnel in Liaoning, China: role of specialty

OBJECTIVES

Burnout is common among medical personnel in China and may be related to excessive and persistent work-related stressors by different specialties. The aims of this study were to assess the prevalence of burnout, work overload and work-life imbalance according to different specialties and to explore the effect of specialty, work overload and work-life imbalance on burnout among medical personnel.

DESIGN

A cross-sectional study.

SETTING

This study was conducted in 1 tertiary general public hospital, 2 secondary general hospitals and 10 community health service stations in Liaoning, China.

PARTICIPANTS

A total of 3299 medical personnel participated in the study.

METHODS

We used the 15-item Chinese version of the Maslach Burnout Inventory General Survey (MBI-GS) to measure burnout. Multivariable logistic regression models were used to explore the association between medical specialty, work overload, work-life imbalance and burnout.

RESULTS

3299 medical personnel were included in this study. The prevalence of burnout, severe burnout, work overload and work-life imbalance were 88.7%, 13.6%, 23.4% and 23.2%, respectively. Compared with medical personnel in internal medicine, working in obstetrics and gynaecology (OR=0.61, 95% CI 0.38, 0.99) and management (OR=0.45, 95% CI 0.28, 0.72) was significantly associated with burnout, and working in ICU （Intensive Care Unit）(OR=2.48, 95% CI 1.07, 5.73), surgery (OR=1.66, 95% CI 1.18, 2.35) and paediatrics (OR=0.24, 95% CI 0.07, 0.81) was significantly associated with severe burnout. Work overload and work-life imbalance were associated with higher ORs for burnout (OR=1.64, 95% CI 1.16, 2.32; OR=2.79, 95% CI 1.84, 4.24) and severe burnout (OR=4.33, 95% CI 3.43, 5.46; OR=3.35, 95% CI 2.64, 4.24).

CONCLUSIONS

Burnout, work overload and work-life imbalance were prevalent among Chinese medical personnel but varied considerably by clinical specialty. Burnout may be reduced by decreasing work overload and promoting work-life balance across different specialties.

Duration of New-Onset Depressive Symptoms During Medical Residency

Importance

The implications of new-onset depressive symptoms during residency, particularly for first-year physicians (ie, interns), on the long-term mental health of physicians are unknown.

Objective

To examine the association between and persistence of new-onset and long-term depressive symptoms among interns.

Design, Setting, and Participants

The ongoing Intern Health Study (IHS) is a prospective annual cohort study that assesses the mental health of incoming US-based resident physicians. The IHS began in 2007, and a total of 105 residency programs have been represented in this national study. Interns enrolled sequentially in annual cohorts and completed follow-up surveys to screen for depression using the 9-item Patient Health Questionnaire-9 (PHQ-9) throughout and after medical training. The data were analyzed from May 2023 to March 2024.

Exposure

A positive screening result for depression, defined as an elevated PHQ-9 score of 10 or greater (indicating moderate to severe depression) at 1 or more time points during the first postgraduate year of medical training (ie, the intern year).

Main Outcomes and Measures

The main outcomes assessed were mean PHQ-9 scores (continuous) and proportions of physicians with an elevated PHQ-9 score (≥10; categorical or binary) at the time of the annual follow-up survey. To account for repeated measures over time, a linear mixed model was used to analyze mean PHQ-9 scores and a generalized estimating equation (GEE) was used to analyze the binary indicator for a PHQ-9 score of 10 or greater.

Results

This study included 858 physicians with a PHQ-9 score of less than 10 before the start of their internship. Their mean (SD) age was 27.4 (9.0) years, and more than half (53.0% [95% CI, 48.5%-57.5%]) were women. Over the follow-up period, mean PHQ-9 scores did not return to the baseline level assessed before the start of the internship in either group (those with a positive depression screen as interns and those without). Among interns who screened positive for depression (PHQ-9 score ≥10) during their internship, mean PHQ-9 scores were significantly higher at both 5 years (4.7 [95% CI, 4.4-5.0] vs 2.8 [95% CI, 2.5-3.0]; P < .001) and 10 years (5.1 [95% CI, 4.5-5.7] vs 3.5 [95% CI, 3.0-4.0]; P < .001) of follow-up. Furthermore, interns with an elevated PHQ-9 score (≥10) demonstrated a higher likelihood of meeting this threshold during each year of follow-up.

Conclusions and Relevance

In this cohort study of IHS participants, a positive depression screening result during the intern year had long-term implications for physicians, including having persistently higher mean PHQ-9 scores and a higher likelihood of meeting this threshold again. These findings underscore the pressing need to address the mental health of physicians who experience depressive symptoms during their training and to emphasize the importance of interventions to sustain the health of physicians throughout their careers.

Sleep, mental health and physical health in new shift workers transitioning to shift work: Systematic review and meta-analysis

This systematic review and meta-analysis (PROSPERO registration CRD42022309827) aimed to describe how shift work impacts new workers' sleep, mental health, and physical health during the transition to shift work and to consolidate information regarding predictors of shift work tolerance (SWT) during this transition period. Inclusion criteria included: new shift workers; sleep, mental health, or physical health outcomes; prospective study design with the first timepoint assessing workers within three months of starting shift work; and written in English. Searches from six databases returned 12,172 articles as of August 2023. The final sample included 48 papers. Publication quality and risk of bias was assessed using the critical appraisal skills program. Forty-five studies investigated longitudinal changes in sleep, mental health, or physical health outcomes and 29 studies investigated predictors of SWT (i.e., better sleep, mental and physical health). Sleep and mental health outcomes worsened following the onset of shift work, while physical health did not significantly change. Pre-shift work mental health, sleep, and work characteristics predicted SWT later in workers' careers. Shift work adversely impacts new workers' sleep and mental health early in their career, and interventions before beginning shift work are needed to promote better SWT.

Effects of childhood experiences of parental attitude, depressive rumination, and sleep disturbances on adulthood depressive symptoms

Aim

Various factors are thought to be involved in the development of depression, but the mechanisms are not yet clear. Although several reports have demonstrated that parental attitude experienced in childhood, depressive rumination, and sleep disturbances each influence depressive symptoms, and the association between two of these four variables, to our knowledge, no reports to date have investigated the association among the four variables.

Methods

A questionnaire survey was administered to 576 adults who agreed to participate in this study between April 2017 and April 2018. Questionnaires assessed parental attitudes experienced in childhood, depressive rumination, sleep disturbances, and depressive symptoms in adulthood. The associations among the four variables were tested by structural equation modeling.

Results

Regarding the direct effects, the parental attitude of "care" had a negative influence on depressive rumination and depressive symptoms, whereas "overprotection" had a positive influence on depressive rumination. Depressive rumination had a positive influence on sleep disturbance and depressive symptoms, whereas sleep disturbances had a positive influence on depressive symptoms. Regarding indirect effects, depressive rumination mediated the association between parental attitudes and sleep disturbances or depressive symptoms. Furthermore, sleep disturbances mediated the association between depressive rumination and depressive symptoms. Care and overprotection showed opposite effects. The goodness of fit of this model was high.

Conclusion

The results of this study demonstrated that there were associations among the four variables. Clinical assessment and intervention of depressive rumination and sleep disturbances that are closely associated with previous parental attitudes may lead to an improvement of depressive symptoms.

Factors influencing healthcare workers' performance before and after the coronavirus disease 2019 pandemic: A bibliometric analysis with supplementary comparative analysis

BACKGROUND

The performance of healthcare workers directly impacts patient safety and treatment outcomes. This was particularly evident during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVE

This study aimed to analyze research trends on factors influencing work performance among healthcare workers through bibliometric analysis and conduct a comparative analysis from macro and micro perspectives before and after the COVID-19 pandemic to complement the existing research.

METHODS

This study involved a bibliometric analysis of 1408 articles related to work performance in the healthcare field published between 2010 and 2023, using the Web of Science, Scopus, and PubMed databases, and 37 articles were selected to determine the factors influencing work performance.

RESULTS

By conducting a bibliometric analysis of the articles based on country, institution, journal, co-cited references, and keywords, this study identified a significant growth trend regarding the factors influencing work performance in the healthcare field, and research hotspots shifted from organizational factors like standard towards psychological factors such as burnout, anxiety, and depression following the outbreak of the COVID-19 pandemic. Subsequently, this study extracted 10 micro-level and 9 macro-level influencing factors from the selected articles for supplementary analysis. Furthermore, this study conducted a comparative analysis of the impact of these factors on work performance before and after the COVID-19 pandemic.

CONCLUSIONS

This study addressed the limitations of previous studies regarding incomplete extraction of factors influencing work performance and unclear comparisons of parameters before and after the COVID-19 pandemic. The findings provide insights and guidance for improving the performance of healthcare workers.

Psychological status and related factors of resident physicians during the release of COVID-19 pandemic restrictions in China

Background

Resident physicians at the standardized training stage had undergone significant physical and mental stress during the release of the COVID-19 pandemic restrictions at the end of 2022 in China. This study aimed to investigate the psychological status (including anxiety, depression, somatic symptoms, job burnout, and vicarious trauma) of resident physicians and identify its influencing factors under these special periods.

Methods

Survey was conducted one month after the release of the COVID-19 pandemic restrictions on resident training physicians from a tertiary first-class hospital in Zhejiang, China. Resident physicians completed the psychological status questionnaire. Chi-square tests, Mann-Whitney U tests, and logistic regression analyses were used to estimate the group differences and variable associations.

Results

The prevalence of anxiety, depression, and somatic discomfort in this study was 20.88, 28.53, and 41.47%, respectively. Female resident physicians were more likely to experience somatic symptoms [adjusted odds ratio (OR) = 2.36, 95% confidence interval (CI): 1.33-4.18]. Resident physicians with problem-focused coping styles were less prone to psychological health issues [depression (adjusted OR = 0.92, 95% CI: 0.88-0.96), anxiety (adjusted OR = 0.94, 95% CI: 0.90-0.98), somatic symptoms (adjusted OR = 0.93, 95% CI: 0.89-0.97), job burnout (adjusted OR = 0.91, 95% CI: 0.87-0.96) and vicarious trauma (adjusted OR = 0.94, 95% CI: 0.90-0.98)]. Inversely, resident physicians with emotion-focused coping styles and experienced negative life events were more prone to psychological health issues.

Conclusion

Resident training physicians had a high risk of anxiety, depression, and somatic symptoms under the special COVID-19 pandemic restriction release period. Females, with lower training stages, degrees, negative life events, and emotion-focused coping styles had a disadvantaged effect on psychological status. The medical teaching management department needs to monitor and reduce the workload and working hours of resident physicians, ensure sufficient sleep time, and pay attention to the psychological status of resident physicians. By strengthening regular communication and mental health education or intervention, which can help them improve their ability to cope with complex tasks.

Preventive noninvasive vagal nerve stimulation reduces insufficient sleep-induced depression by improving the autonomic nervous system

BACKGROUND

Depression is closely linked to an imbalance in the autonomic nervous system (ANS). However, the role of this imbalance in mediating the effects of sleep deprivation (SD) and vagus nerve stimulation (VNS) on emotional well-being is not fully understood.

METHODS

A population-based analysis was conducted to explore the relationship between sleep duration, depression scores, and heart rate variability (HRV). Additionally, the chronic SD mouse model was established to assess the impact of preventive transcutaneous auricular VNS (taVNS) on pathological and behavioral changes.

RESULTS

Our study found a significant link between sleep duration, depression severity, and HRV. Shorter sleep duration was associated with higher depression scores and lower RMSSD (a measure of HRV). In our rat model, insufficient sleep consistently impaired HRV. This effect was mitigated by taVNS, accompanied by corresponding changes in levels of IL-1β and IL-6, astrocyte and microglia activation, and tail suspension times.

CONCLUSIONS

Using VNS as a preventive treatment for depression-risk individuals with insufficient sleep shows promise. It not only broadens the potential applications of VNS but also sheds light on its mechanism-particularly its role in enhancing vagal nerve function and balancing the ANS, as evidenced by HRV measurements.

The Inverse Association between the Frequency of Forest Walking (Shinrin-yoku) and the Prevalence of Insomnia Symptoms in the General Japanese Population: A Japan Multi-Institutional Collaborative Cohort Daiko Study

Since a single forest walk (Shinrin-yoku or forest bathing) session is reported to improve sleep temporarily, occasional forest walks may have a positive effect on daily sleep. Therefore, this study aimed to examine whether more frequent forest walking is associated with better daily sleep conditions. Data from the second survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Daiko Study conducted among residents of Nagoya City, Japan, were used. The study design was a cross-sectional study. In total, 2044 participants (529 men and 1515 women; age, mean ± standard deviation: 58.8 ± 9.9 years) were included in the analysis. Frequent forest walks were associated with a low percentage of insomnia symptoms (Insomnia Severity Index ≥10) in women, but not in men. The adjusted odds ratio for the group that rarely took forest walks with reference to the group that engaged in the activity once a month or more often was 2.04 (95% confidence interval: 1.29-3.23) in women. Forest walk frequency was not significantly associated with sleep duration or sleep efficiency as measured by actigraphy in either men or women. In conclusion, the results suggested that increasing the frequency of forest walks or Shinrin-yoku may be effective in preventing insomnia in women.

Association between sleep health and rates of self-reported medical errors in intern physicians: an ancillary analysis of the Intern Health Study

STUDY OBJECTIVES

Reduced sleep duration and work hour variability contribute to medical error and physician burnout. This study assesses the relationships between physician performance, burnout, and the dimensions of sleep beyond hours slept.

METHODS

This was an ancillary analysis of 3 years of data from an international prospective cohort study: the Intern Health Study. Actigraphy data from 3,654 intern physicians capturing sleep timing, regularity, efficiency, and duration were used individually and combined as a composite sleep health index to measure the association of multidimensional sleep patterns on self-reported medical errors and burnout.

RESULTS

From 2017-2019, interns' work hours decreased by 4 hours per week and total sleep time also decreased (6.7 to 5.99 hours), and sleep efficiency, timing, and regularity all worsened (all P < .05). In the 21.2% of participants who committed an error, there was no difference in sleep duration, timing, or regularity. Lower sleep efficiency was associated with higher odds of committing an error (P = .003) and higher burnout scores (P < .001). Although overall sleep quality was poor in the entire cohort, interns in the lowest quintile of sleep duration, regularity, and efficiency had higher burnout scores than those in the best quintile.

CONCLUSIONS

Sleep efficiency, not duration, was associated with increased self-reported medical errors and burnout in intern physicians. Overall sleep quality and duration worsened despite fewer hours worked. Future studies on physician burnout should measure all aspects of sleep health.

CITATION

Hassinger AB, Velez C, Wang J, Mador MJ, Wilding GE, Mishra A. Association between sleep health and rates of self-reported medical errors in intern physicians: an ancillary analysis of the Intern Health Study. J Clin Sleep Med. 2024;20(2):221-227.

Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study

Long duty hours (DH) impair sleep and negatively affect residents' health and medical safety. This cross-sectional study investigated the association among residents' DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.

Changes in sleep disturbance among Chinese adolescents: A population-based online survey

OBJECTIVE

Sleep disturbance is prevalent among adolescents but little is known about the short-term changes among Chinese adolescents. The study aimed to explore the prevalence and change patterns of sleep disturbance and identify its risk and protective factors.

METHODS

Data were collected online from April 21st to May 12th, 2021 (Time 1, T1) and December 17th to 26th, 2021 (Time 2, T2). The final sample comprised 34,260 adolescents. Self-administrated questionnaires were used to assess socio-demographic variables, sleep disturbance, depression, anxiety, life events, family function, and resilience.

RESULTS

The prevalence of sleep disturbance was 12.0% at T1 and 11.8% at T2, with higher rates in females than males. Four groups of sleep disturbance change patterns were identified: non-sleep disturbance group (80.4%), persistent group (4.2%), new-onset group (7.6%), and remission group (7.8%). Risk factors for new-onset sleep disturbance included being in junior high school (AOR = 1.26, 95%CI = 1.15-1.38), family history of mental disorders (AOR = 1.49, 95%CI = 1.03-2.15), and moderate (AOR = 1.24, 95%CI = 1.13-1.36) and severe (AOR = 1.48, 95%CI = 1.27-1.72) family dysfunction. Risk factors for persistent sleep disturbance included being in junior (AOR = 1.25, 95%CI = 1.08-1.45) and senior (AOR = 1.53, 95%CI = 1.15-2.03) high school, parental currently unmarried status (AOR = 1.34, 95%CI = 1.05-1.73), moderate (AOR = 1.19, 95%CI = 1.02-1.39) and severe (AOR = 1.28, 95%CI = 1.06-1.55) family dysfunction. Medium (AOR = 0.48, 95%CI = 0.43-0.53) and high (AOR = 0.34, 95%CI = 0.29-0.40) levels of resilience were protective factors against new-onset sleep disturbance, as well as against persistent sleep disturbance (medium level: AOR = 0.51, 95%CI = 0.43-0.60; high level: AOR = 0.32, 95%CI = 0.25-0.43).

CONCLUSIONS

Interventions aimed at promoting family functions and enhancing resilience may improve sleep disturbance among adolescents.

Healthy sleep patterns and common mental disorders among individuals with cardiovascular disease: A prospective cohort study

BACKGROUND

Sleep behaviors are potentially modifiable risk factors for common mental disorders and cardiovascular disease (CVD). However, the associations between combined sleep behaviors and common mental disorders among individuals with CVD remain unclear.

METHODS

A total of 18,776 participants with a history of CVD from UK Biobank, who were free of depression or anxiety from 2006 to 2010 were included. A composite healthy sleep score was constructed based on five sleep behaviors (chronotype, sleep duration, insomnia, snoring, and excessive daytime sleepiness). Cox proportional hazard regression models were performed to calculate hazard ratios (HRs) and 95 % confidence intervals (CIs) for incident depression and anxiety.

RESULTS

During a median follow-up of 11.8 years, 965 depression and 812 anxiety cases were recorded. The adjusted HRs for participants with a healthy sleep pattern compared with a poor sleep pattern were 0.45 (95 % CI: 0.35-0.57) for depression and 0.77 (95 % CI: 0.58-1.03) for anxiety. There was a linear dose-response association of healthy sleep score with incident depression and anxiety (HR = 0.82, 95 % CI: 0.77-0.87; HR = 0.92, 95 % CI: 0.86-0.99 per 1-score increase, respectively). Likewise, these associations were observed among individuals with coronary heart disease, stroke, heart failure and atrial fibrillation.

CONCLUSIONS

A healthy sleep pattern is significantly associated with a lower risk of depression among individuals with CVD, highlighting the importance of monitoring and improving sleep health in the prevention of common mental disorders among individuals with CVD.

Resting-state EEG as a potential indicator to predict sleep quality in depressive patients

OBJECTIVES

To investigate the changes in sleep quality, heart rate variability (HRV) and resting-state electroencephalogram (rsEEG) in patients with major depressive disorder (MDD), and to explore whether HRV and rsEEG may be served as more convenient tools to assess sleep quality in MDD patients.

METHOD

We included a total of 91 subjects (46 healthy controls and 45 MDD patients) and compared their sleep quality, HRV and power spectra of rsEEG. Correlation analyses were conducted to discuss the relationship between HRV and seven factors of PSQI. Multiple linear regression model was used to examine whether absolute band power could predict sleep quality in MDD patients.

RESULTS

We found higher PSQI scores and lower levels of HRV in depressive individuals compared with healthy controls. In MDD patients, sleep latency was negatively correlated with RMSSD and HF. Delta, theta, and alpha band power of rsEEG were higher in MDD patients. Regression analyses showed delta band power of TP8, as well as theta, alpha band power of AF3 predicts PSQI score of MDD patients.

CONCLUSIONS

The findings of our study show that some aspects of sleep problems had negative correlations with parasympathetic activity and the regression model supports that the band power of rsEEG may be used as a potential indicator to evaluate the sleep quality in MDD patients.

SIGNIFICANCE

Cortical hyperarousal may be one of the reasons leading to poor sleep quality of MDD patients. And resting-state EEG can be used as a potential indicator for clinical assessment of MDD patients' sleep quality.

Sleep and mental health in recruit paramedics: a 6-month longitudinal study

STUDY OBJECTIVES

To explore potential relationships and longitudinal changes in sleep and mental health in recruit paramedics over the first 6 months of work, and whether sleep disturbances pre-emergency work predict future mental health outcomes.

METHODS

Participants (N = 101, 52% female, Mage = 26 years) completed questionnaires prior to (baseline), and after 6 months of emergency work to assess for symptoms of insomnia, obstructive sleep apnea, post-traumatic stress disorder (PTSD), depression, anxiety, and trauma exposure. At each timepoint, participants also completed a sleep diary and wore an actigraph for 14 days to assess sleep patterns. Correlations between baseline sleep and mental health were conducted and changes in these variables across timepoints were examined using linear mixed models. Hierarchical regressions assessed whether sleep at baseline predicted mental health at follow-up.

RESULTS

Insomnia and depression symptoms, and total sleep time increased while sleep onset latency decreased across the first 6 months of emergency work. Participants experienced an average of 1 potentially traumatic event during the 6-month period. Baseline insomnia predicted increased depression symptoms at the 6-month follow-up, while baseline wake after sleep onset predicted follow-up PTSD symptoms.

CONCLUSION

Results highlight an increase in insomnia and depression across the initial months of emergency work, while sleep disturbances before emergency work were identified as potential risk factors for the development of depression and PTSD among paramedics in their early career. Screening and early interventions targeting poor sleep at the beginning of emergency employment may assist in reducing the risk of future mental health outcomes in this high-risk occupation.

Assessment of sleep quality and its factors among clinicians working in critical care units and operation theaters at North West Ethiopia, 2022: a multicenter cross-sectional study

The quality of sleep has an effect on the health of clinicians and the quality of patient care. Maintaining cognitive function/mood, facilitation of glucose metabolism, and strengthening of the immune system are among the roles that adequate sleep may contribute. Poor sleep quality is multifactorial, and studies had shown inconsistencies in the factors that contribute to the development of this poor sleep quality. The prevalence of poor sleep quality among clinicians working in the critical care unit and operation theater in the study setting was not investigated yet.

OBJECTIVE

The objective of this study was conducted for the purpose of assessing the quality of sleep and associated factors among clinicians working in the critical care unit and operation theater.

METHODS

A cross-sectional study was conducted from 15 May to 15 June 2022. Data were collected using a self-administered questionnaire from 421 clinicians selected by simple random sampling techniques. Sleep quality was measured by the Pittsburg sleep quality index. The data were entered into Epi-data and exported to SPSS. Frequency and percentage were used for the descriptive analysis. Binary and multivariate logistic regression analysis were used to identify factors associated with poor quality of sleep. The strength of the association was measured with an OR within the 95% CI and P-value of <0.05.

RESULT

About half 220 (52.3%) of the study participants age between 25 and 30 year old and the majority 321 (76.2%) of them were males. The prevalence of poor sleeps quality was 81.5% (95% CI: 77.9-85.5). Working night shift (AOR: 3.37, 95% CI: 1.754-6.484), having depressive symptoms (AOR: 3.25, 95% CI: 1.485-7.147) and having no regular exercises (AOR: 0.299, 95% CI: 0.166-0.537) were predisposing factors for poor sleep quality.

CONCLUSION AND RECOMMENDATION

The prevalence of poor sleep quality among clinicians working in the ICU and operation room was high. Clinicians who had no regular exercise, who worked in night shift, and who had depressive symptoms were associated with poor quality of sleep. Clinicians should have an awareness on the symptoms of depression, implement sleep hygiene education programs and promoting regular exercise. The authors recommend healthcare policy makers for improving working schedules.

Sleep Quality and Nicotine Dependence Among Lebanese University Residents and Fellows: A Cross-Sectional Study

Background and objectives Sleep quality and nicotine addiction are important public health issues with significant negative impacts on individual well-being and the performance of healthcare professionals. This study aims to determine the prevalence and association of nicotine dependence and poor sleep quality among residents and fellows enrolled in the Lebanese University. Methods A cross-sectional study using the snowball-sampling technique was conducted in Lebanon between January and March 2023. Data were collected through an online survey that included information on socio-demographic characteristics, nicotine dependence, and sleep quality. A total of 350 residents and fellows were included in the study. Bivariate analysis and multivariable logistic regression were carried out to identify the factors associated with sleep quality. Adjusted odds ratio and 95% confidence intervals were reported. Results One quarter (25.1%) of the residents and fellows were smokers; among them, 44.3% smoked I Quit Ordinary Smoking (IQOS), 14.8% smoked cigarettes, 10.2% smoked waterpipe (WP), 12.5% smoked cigarettes and WP, and 18.2% smoked IQOS and WP. According to the Pittsburgh Sleep Quality Index (PSQI), 34.3% of participants had poor sleep quality. Smokers had 12.5 times higher odds of experiencing poor sleep quality compared to non-smokers (adjusted odds ratio ORadj = 12.58 with 95% confidence interval [CI] of 7.07-22.36; p-value <0.001). In addition, smoking a combination of two types of tobacco products (cigarettes with WP or IQOS with WP) posed the highest risk of poor sleep quality, with an adjusted odds ratio of 31.54 (95% CI of 9.15-45.74, p-value <0.001). Elevated Fagerström Test for Nicotine Dependence (FTND) and Lebanon Waterpipe Dependence Scale (LWDS-11) scores indicated an increased risk of poor sleep quality (adjusted odds ratio ORadj = 4.69 with 95% CI of 2.179-10.10; p-value <0.001; and adjusted odds ratio ORadj =1.27 with 95% CI of 1.04-1.55; p-value 0.019, respectively). Conclusion Our study found a significant association between nicotine dependence and poor sleep quality among medical residents and fellows, with smokers being more susceptible to sleep disturbances. The high prevalence of IQOS smoking among medical residents and fellows in Lebanon highlights the urgent need for comprehensive research investigating the effects of heated tobacco products. Furthermore, our study reveals a critical insight into the potential additive effects of nicotine, suggesting that the concurrent use of multiple tobacco products may further elevate the risk of poor sleep quality. Recognizing the implications of our findings, it is imperative to develop targeted interventions and educational programs that promote healthier sleep habits and facilitate smoking cessation among medical residents and fellows.

A narrative review of occupational scheduling that impacts fatigue and recovery relevant to veterinarian well-being

Background

Sleep insufficiency is a worldwide affliction with serious implications for mental and physical health. Occupational factors play a large role in determining sleep habits. Healthcare workers are particularly susceptible to job-mediated sleep insufficiency and inadequate rest in general. Little is published on sleep practices among veterinarians, and overall recognition of the impacts of inadequate rest within the veterinary profession is poor.

Objectives and procedures

This review describes occupational factors affecting sufficiency of rest and recovery, reviews veterinary-specific and relevant adjacent literature pertaining to sleep patterns, and discusses potential solutions for addressing occupational schedules contributing to sleep insufficiency and inadequate rest. Online databases were searched to extract contemporary literature pertaining to sleep, insufficient rest, and occupational factors, with a focus on veterinary medicine and other healthcare sectors.

Results

Occupational factors leading to inadequate rest among healthcare workers include excessive workloads, extended workdays, cumulative days of heavy work hours, and after-hours on-call duty. These factors are prevalent within the veterinary profession and may contribute to widespread insufficient rest and the resulting negative impacts on health and well-being among veterinarians.

Conclusion and clinical relevance

Sufficient sleep quantity and quality are critical to physical and mental health and are negatively affected by many aspects of the veterinary profession. Critical review of current strategies employed in clinical practice is essential to promote professional fulfillment, health, and well-being among veterinarians.

A narrative review of the impact of work hours and insufficient rest on job performance

OBJECTIVE

This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management.

STUDY DESIGN

Narrative review.

METHODS

Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar.

RESULTS

Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine.

CONCLUSION

Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur.

CLINICAL SIGNIFICANCE (OR IMPACT)

A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

Involvement of Paired Immunoglobulin-Like Receptor B in Cognitive Dysfunction Through Hippocampal-Dependent Synaptic Plasticity Impairments in Mice Subjected to Chronic Sleep Restriction

Sleep loss is often associated with cognitive dysfunction. Alterations in the structure and function of synapses in the hippocampus are thought to underlie memory storage. Paired immunoglobulin-like receptor B (PirB) plays a negative role in various neurological diseases by inhibiting axon regeneration and synaptic plasticity. However, the contributions of PirB to the mechanisms underlying the changes in synaptic plasticity after sleep loss that ultimately promote deficits in cognitive function have not been well elucidated. Here, we showed that chronic sleep restriction (CSR) mice displayed cognitive impairment and synaptic deficits accompanied by upregulation of PirB expression in the hippocampus. Mechanistically, PirB caused the dysregulation of actin through the RhoA/ROCK2/LIMK1/cofilin signalling pathway, leading to abnormal structural and functional plasticity, which in turn resulted in cognitive dysfunction. PirB knockdown alleviated synaptic deficits and cognitive impairment after CSR by inhibiting the RhoA/ROCK2/LIMK1/cofilin signalling pathway. Moreover, we found that fasudil, a widely used ROCK2 inhibitor, could mimic the beneficial effect of PirB knockdown and ameliorate synaptic deficits and cognitive impairment, further demonstrating that PirB induced cognitive dysfunction after CSR via the RhoA/ROCK2/LIMK1/cofilin signalling pathway. Our study sheds new light on the role of PirB as an important mediator in modulating the dysfunction of synaptic plasticity and cognitive function via the RhoA/ROCK2/LIMK1/cofilin signalling pathway, which indicated that hippocampal PirB is a promising therapeutic target for counteracting cognitive impairment after CSR. This illustration depicts the signalling pathway by PirB in mediating cognitive impairment and synaptic deficits in CSR mice. In the hippocampus of CSR mice, the expression level of PirB was significantly increased. In addition, CSR increases RhoA and ROCK2 levels and reduces levels of both LIMK1 and cofilin phosphorylation. PirB knockdown reverses cognitive impairment and synaptic plasticity disorders caused by CSR through the RhoA/ROCK2/LIMK1/cofilin signalling pathway.

Association between weekend catch-up sleep and the risk of depression among Korean middle-aged adults

Determining whether weekend catch-up sleep (CUS) is related to high risk of depression in the general middle-aged population in Korea. This study is a cross-sectional study analyzing data from 2016 to 2017 collected in the Korea National Health and Nutrition Examination Survey VII-1, 2; less than 35 years, and more than 65 years were excluded. Interviews on sociodemographic characteristics, mood and sleep-related profiles, and comorbid medical conditions were conducted. Participants were divided into three groups according to weekday sleeping time (< 6 h, 6 to ≤ 8 h, and ≥ 8 h). Weekend CUS was identified when nocturnal sleep extension occurred over the weekend. The risk of depression was evaluated using the PHQ-9. The PHQ-9 score differed among the three groups. The prevalence of moderate to severe depressive symptom and PHQ-9 score ≥ 10 was the highest in the group sleep over 8 h and the next highest in the group sleep less than 6 h. In the group sleep less than 6 h, PHQ-9 score ≥ 10 was significantly higher in the without CUS group than the with CUS group. The risk of depression in middle-aged individuals was associated with both short and long sleep duration, and the severity and prevalence of depression were lower in the group with CUS when a shortened sleep pattern was observed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-022-00415-3.

Physiological Role of Orexin/Hypocretin in the Human Body in Motivated Behavior: A Comprehensive Review

Neurohormones are neurosecretory materials released by neurosecretory cells that serve both as neuromodulators in the brain and spinal cord and as circulating regulatory hormones. They serve a wide range of functions, including homeostasis, development, and modulation of neuronal and muscle activity. In the hypothalamus, neurohormones called hypocretins are created that were discovered in the late nineties. Orexin receptors (OXRs) have been shown to enhance synaptic signaling in the central nervous system at the cellular level. The orexins improve stimulated neural activity in the hippocampus, which, in turn, aids with spatial memory, learning, and mood. They present themselves as mediators for the hypothalamic functions. They have been shown to regulate sleep-wake cycles, arousal mechanisms, addiction, sympathetic nerve activity (SNA), blood pressure, and thermogenesis. Its role in storing brown adipose tissue has implications for thermal homeostasis. The significant role of orexins is seen in tumorigenesis when orexin A (OrxA) and orexin B (OrxB) induce apoptosis in fast-growing tumor cells. Orexin-null subjects show clinical narcolepsy, indicating that orexins were responsible for keeping them awake. Orexin microinjections in mice brains stimulated increased physical activity, thus possibly countering diet-induced obesity. Physical activity significantly increased plasma orexin-A levels, which facilitated the process of energy homeostasis. The amount of adrenocorticotropic hormone (ACTH) increases in stress conditions, which further facilitates the release of the stress hormone cortisol. No increase in the ACTH hormone is seen in stressed mice administered with orexin receptor 2 (OX2R) antagonists thus showing orexin's role in stress reaction. As a result of linking hypocretin/orexin to various physiological procedures, increased research into the medicinal potential of drugs targeting these receptors is emerging. We summed up in this review the recent advances in our understanding of how orexin and its receptor system play an essential role in clinical and pathological functions. This research summarizes a new area for research in human medicine, providing the possibility of controlling a vast array of physiological functions through intra-cerebroventricular injections of a single neuropeptide.

Gender differences in the association between lifestyle behaviors and mental health among psychiatrists in China

INTRODUCTION

Mental health symptoms are common among health professionals and the influence of lifestyle behaviors on psychiatrists' mental health is insufficiently understood. Based on a nationwide sample, we aimed to survey the lifestyle behaviors and mental health status among psychiatrists, and to identify the co-occurrence and gender differences in lifestyle behaviors.

METHODS

Data were collected through an anonymous questionnaire among psychiatrists in China. Depression, Anxiety and Stress Scale - 21 (DASS-21) was used to evaluate mental health symptoms. Latent class analysis (LCA) was used to explore the co-occurrence of lifestyle behaviors. The multivariate logistic regression model was used to examine the effects of demographic and lifestyle factors.

RESULTS

4520 psychiatrists were included in the analysis with 11.5 % of them reporting smoking, 10 % reporting alcohol misuse, 35.2 % reporting physical inactivity, and 23.1 % reporting insomnia. The prevalence of depression, anxiety and stress symptoms were 29.2 %, 34.5 %, and 12.2 %, respectively. Significant gender differences were found in smoking (P < 0.001), alcohol misuse (P < 0.001), and physical inactivity (P < 0.001), but not in insomnia. Based on these four high-risk health behaviors above, three lifestyle behavior clusters with huge gender differences were identified through the LCA. Accordingly, the unhealthy lifestyle classes, though defined differently for males and females, were significantly associated with depression, anxiety, and stress.

CONCLUSIONS

The co-occurrence and significant gender differences in multiple lifestyle behaviors exist in this group, highlighting the need for gender-specific comprehensive interventions against mental health symptoms and the urgency of promoting their well-being.

Reduced sleep duration increases the risk of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in middle-aged and elderly males: a national cross-sectional study

BACKGROUND

The prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) remains high in men. However, whether reduced sleep duration enhances the risk of LUTS/BPH remains unknown.

MATERIALS AND METHODS

The 2015 China Health and Retirement Longitudinal Study was used in this study. Binary logistic regression was adopted to test the relationship between sleep duration and LUTS/BPH. Restricted cubic spline (RCS) regression was used to examine the non-linear association. In sensitivity analyses, propensity scores matching was performed to verify the robustness of the results.

RESULTS

In this study, 8,920 males aged 40 years above were enrolled. In the fully adjusted logistic model, across the quartiles of sleep duration, the odds ratios of LUTS/BPH were 1.00 (reference), 0.94 (95% CI 0.77-1.15), 0.74 (95% CI 0.58-0.94), 0.54 (0.37-0.75), respectively. The results of RCS indicated a non-linear inverted U-shaped association between sleep duration and LUTS/BPH (p for non-linearity <0.05). In the subgroup analyses, no significant effects of settlements, alcohol and cigarette consumption, depression, and hypertension on the association between sleep duration and prevalent LUTS/BPH were observed (p for interaction >0.05).

CONCLUSION

Reduced sleep duration is significantly associated with the increases of the LUTS/BPH risk in Chinese middle-aged and elderly males.

Coping strategies used by health-care workers during the SARS-COV2 crisis. A real-world analysis

The aim of this paper is to analyze the main coping strategies used by frontline teams during the first days of the COVID pandemic confinement in Spain. This information could be necessary in order to carry out training programs that allow a better handling of future emergency situations, as well as acting more effectively and with less negative emotional impact. A questionnaire was used to identify different psychological profiles for coping, and in turn, other relevant variables were analyzed. The most used strategies by health professionals were problem solving, desiderative thinking and social support. Emotional expression and social support were used more by women. Significantly different behaviors were found in desiderative thinking (lower in people of 35-50 years old, and social support, higher in people 35 years old). The symptoms most commonly experienced by medical personnel were: sleep disorders, anxiety, tension, depressive symptoms, gastrointestinal symptoms and general somatic muscular symptoms. A relationship could be determined between the age/gender of the workers and the participants' overall assessment of their ability to cope with the COVID-19 stress situation they had experienced (men 50 years old and women between 35 and 50 years old, who felt able or very able to cope with the stress caused by the health emergency. However, women <35 years old and >50 years old believed they were able to cope poorly with the circumstances. The advantage of specific training plans in order to help with some stress symptoms could be suggested, aimed at the acquisition of tools based on problem solving, and emotional management in stressful and emergency situations.

Sleep and Exercise among Young Doctors in a Tertiary Care Hospital in India: A Pilot Cross-Sectional Study

Background

Limited information is available on the sleep and propensity for daytime sleepiness in young medical doctors of India.

Methods

The 2-week self-reported data surrounding sleep and exercise habits, and the Epworth sleepiness scale (ESS) score obtained from volunteering doctors of a tertiary care hospital in India, were summarized as median (Q1-Q3). Comparisons with Mann-Whitney U test and correlations with Spearman's rank correlation were done.

Results

Forty-seven doctors (28 [26-33] years, 16 males) reported a total sleep duration (TSD) of 6.3 (6-6.7) hours, sleep latency of 9 (5.1-15.8) minutes, and ESS score of 8 (5-10). The number of days (out of 14) when the subjective feeling of 'refreshed', 'somewhat refreshed', and 'fatigued' was experienced was respectively 6 (2-9), 5 (3-8), and 1 (0-4). Junior-level doctors experienced more days of 'fatigue' than senior-level doctors (3 [0-4.3], 0 [0-0]; p = 0.002). Doctors who did not exercise reported greater days of fatigue than those who exercised (2 [0-4.8], 0 [0-2]; p = 0.047).

Conclusions

The young doctors of our study slept less than the recommended amount of 7 hours by the American Academy of Sleep Medicine. Their short sleep latency and normal propensity for daytime sleepiness, though encouraging, may be an effect of insufficient sleep and mentally alerting daytime schedule respectively. Notably, we found a positive association between exercise habits and subjective restoration following sleep in our study population. The sleep requirements and sleep structure among Indians are yet to be established. Our findings add to the data on sleep in the Indian context.

Resting and Recharging: A Narrative Review of Strategies to Improve Sleep During Residency Training

BACKGROUND

Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care.

OBJECTIVE

To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work.

METHODS

A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions.

RESULTS

Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited.

CONCLUSIONS

Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.

A higher incidence of diabetic peripheral neuropathy may be associated with decreased sleep and increased depression in older adults

Aim: Diabetes mellitus (DM) tends to increase with aging. Nearly half of the patients with DM develop neuropathy (DPN). Despite its high burden and morbidity, the conditions that DPN may be associated with have not been adequately studied in older adults. We aimed to identify sleep duration and comprehensive geriatric assessment components that may be associated with DPN. Material and Method: This is a cross-sectional retrospective study. DPN diagnosed with a medical history, neurologic examination, and electromyography (EMG). 125 diabetic older patients were included. All comprehensive geriatric assessment tests and questions about sleep quality and time were performed. We divided the patients into two groups those without neuropathy and with neuropathy and compared them. Results: The median age of 125 patients was 72 (min-max; 64-94). 58.8% of them were women. The percentage of married people and living with their spouse and slept for 6 hours or more had a lower percentage in the DPN group. Polypharmacy and the percentage of heart failure were significantly higher in the DPN group. Lawton-Brody score, which shows instrumental daily living activities (IADL) and geriatric depression score (GDS) was higher in the DPN group. In logistic regression, we found that depression scores were higher and sleep duration was shorter in the DPN group (respectively, odd ratio:265 p:.012; odd ratio:.1.917 p:.045) Conclusions: DPN in older adults may affect the functionality and be associated with fewer sleep hours and depression. Not only blood glucose regulation but also other factors such as sleep duration and depressed mood may be associated with DPN in older adults.

Getting on the Same Page: A Quality Improvement Project to Enhance Nurse-to-Resident Communications and Reduce Overnight Sleep Interruptions

BACKGROUND

Many residency programs utilize "home call" residents who answer hospital communications and place orders from home. Often, residents are required to live nearby and arrive in-person if needed. Residents work normal daytime work hours while on home call, which can last several nights. This disrupts sleep and creates the potential for increased resident fatigue and patient safety issues.

OBJECTIVE

To implement and evaluate a novel program to reduce non-urgent overnight pages from nurses to home call physical medicine and rehabilitation (PM&R) residents between 11 pm and 6 am.

METHODS

At an inpatient acute rehabilitation unit in a tertiary care university teaching hospital, we implemented a 2-step prospective quality improvement study with interventions derived from nurse-physician meetings implemented 9 months apart in 2018 and 2019. The first intervention was a centralized nightly handoff sheet. The second intervention was to display suggested PRN medication lists in resident workrooms. The primary outcome measure was the percentage of nights with non-urgent pages between 11 pm and 6 am. Tracking urgent pages and 7-10 am emergent pages were used as balancing measures.

RESULTS

A total of 1835 text-based nursing pages (366 pre- and 1469 post-intervention) were received and categorized by content, urgency, and timing over a 17-month period. Post-intervention, there was a stable 25% decrease in nighttime non-urgent pages. The most common hour to be paged shifted from 11 pm to 8 pm. Pain, constipation, insomnia, and nausea were the most common complaints overnight.

CONCLUSIONS

By characterizing and studying nighttime pages, residents collaborated with nighttime nursing staff through structured meetings to reduce non-urgent nighttime pages for more than 1 year.

Prevalence and risk factors for depression among training physicians in China and the United States

During their first year of medical residency (internship), 35% of training physicians in the United States suffer at least one depression episode. We assessed whether there is a similar increase of depression among first year residents in China, and identified predictors of depression in the two systems. 1006 residents across three cohorts (2016-2017, 2017-2018 and 2018-2019) at Shanghai Jiao Tong University and Peking Union Medical College were assessed in parallel with three cohorts of 7028 residents at 100 + US institutions. The Patient Health Questionnaire-9 (PHQ-9) depressive symptoms were measured at baseline and quarterly. Demographic, personal and residency factors were assessed as potential predictors of PHQ-9 depression scores. Similar to training interns in the US, the proportion of participants in China who met depression criteria at least once during the first year of residency increased substantially, from 9.1 to 35.1%. History of depression and symptoms at baseline were common factors significantly associated with depression during residency. By contrast, neuroticism, early family environment, female gender and not being coupled were associated with depression risk only in the US, while young age was a predictor of depression only in China. Fear of workplace violence also was a predictor in China. Long duty hours and reduced sleep duration emerged as training predictors of depression in both countries. The magnitude of depression increase and work-related drivers of depression were similar between China and the US, suggesting a need for effective system reforms in both systems.

Population-specific association of Clock gene polymorphism with annual cycle timing in stonechats

Timing is essential for survival and reproduction of organisms across the tree of life. The core circadian clock gene Clk is involved in the regulation of annual timing events and shows highly conserved sequence homology across vertebrates except for one variable region of poly-glutamine repeats. Clk genotype varies in some species with latitude, seasonal timing and migration. However, findings are inconsistent, difficult to disentangle from environmental responses, and biased towards high latitudes. Here we combine field data with a common-garden experiment to study associations of Clk polymorphism with latitude, migration and annual-cycle timing within the stonechat species complex across its trans-equatorial distribution range. Our dataset includes 950 records from 717 individuals from nine populations with diverse migratory strategies. Gene diversity was lowest in resident African and Canary Island populations and increased with latitude, independently of migration distance. Repeat length and annual-cycle timing was linked in a population-specific way. Specifically, equatorial African stonechats showed delayed timing with longer repeat length for all annual-cycle stages. Our data suggest that at low latitudes with nearly constant photoperiod, Clk genotype might orchestrate a range of consistent, individual chronotypes. In contrast, the influence of Clk on annual-cycle timing at higher latitudes might be mediated by its interactions with genes involved in (circadian) photoperiodic pathways.

The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study

Background

Shift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being.

Objective

We tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift.

Methods

Emergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights’ sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post–overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls.

Results

In total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights’ sleep quality increased by 0.5 points (P<.001, 95% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95% CI –0.90 to –0.34), and total daily tension decreased by 0.6 points (P<.001, 95% CI –0.81 to –0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores.

Conclusions

Nonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions’ effect on other populations of shift workers’ post–night shift alertness, users’ long-term physical and mental health, and patient outcomes.

One-Year Prevalence of Perceived Medical Errors or Near Misses and Its Association with Depressive Symptoms among Chinese Medical Professionals: A Propensity Score Matching Analysis

Objective: Medical errors or near misses (MENM) may cause serious negative outcomes for the patients. However, medical professionals with MENM may also be secondary victims. Although the association between MENM and depression among medical professionals has been explored in several previous studies, the possible causal relationship has been explored less, especially in China. In this study, our first aim was to determine the prevalence of MENM among Chinese medical professionals. We also wanted to explore the causal effect of MENM on depressive symptoms based on a propensity-score matching analysis. Methods: A cross-sectional study was conducted among medical professionals in Chinese public general hospitals, and 3426 medical professionals were analyzed in this study. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess depressive symptoms. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). MENM, social-demographic variables, occupational characteristics, and physical disease were also evaluated in this study. Results: The one-year prevalence of perceived MENM was 2.9% among medical professionals in Chinese public general hospitals. The results of logistic regressions showed that working hours/week (OR = 1.02, p < 0.05) and depressive symptoms (OR = 1.05, p < 0.001) were associated with MENM. After propensity score matching, depressive symptoms were associated with MENM (OR = 1.05, p < 0.001) among medical professionals. The associations between occupational characteristics, physical disease, social support, and MENM were not supported by this study. Conclusions: The one-year prevalence of MENM was low in Chinese public general hospitals, and based on our propensity score matching analyses, the occurrence of MENM may cause depressive symptoms in medical professionals. A bigger effort by health systems and organizations may be helpful for reducing MENM.

A cross sectional study: The association between sleeping quality and stress among second and third medical students at the University of Jordan

OBJECTIVE

Medicine is considered one if not the most stressful educational field. Thus, the aim of this study is to investigate the prevalence of stress and poor sleeping quality among medical students and the association between them.

METHOD

This cross-sectional study was conducted at the University of Jordan on second- and third-year medical students. The questionnaire consisted of: 1) Demographics; 2) The assessment tools which were Pittsburgh Quality of Sleep Index (PSQI) and Kessler Psychological Distress Status (K10). Binary logistic regression, chi-square and linear regression were used to investigate the association between PSQI, K10, and their determinants.

RESULTS

The mean for PSQI score was 6.76 ± 3.32. PSQI scores interpretation revealed that 61.7% of the 282 participants of this study were poor sleepers. Logistic regression results showed that only the category of not napping at all from the napping hours variable was significantly associated with sleeping quality. Furthermore, the mean of K10 scores was 24.5 ± 8.5. K10 scores revealed that 66.3% of the participants were stressed. Logistic regression results showed that gender and regular exercise were significantly associated with psychological distress. Additionally, chi-square test, logistic regression and linear regression showed that PSQI was significantly associated with K10 (P <0.01).

CONCLUSIONS

Stress and poor sleeping quality in medical students at the University of Jordan were highly prevalent and strongly associated. What determined PSQI was daytime napping, and for K10 were regular exercise and gender. Further investigations into stress and sleep quality in the Arabian region are needed.

Emergency Medicine Personnel's Preparation, Performance and Perception of Their Night Shifts: A Cross-Sectional Study from Saudi Arabia

PURPOSE

This study aimed to investigate the perceptions and habits of different emergency department (ED) workers (nurses, residents, and attending physicians) and their pre- or post-shift routines. The study also examined the effect of night shifts on personal life, social life, and health.

PATIENTS AND METHODS

An anonymous, online, cross-sectional, multiple-choice, self-rating (5-point Likert scale) survey was administered to the participants. All analyses were performed using the SPSS version 22.0. Ethical approval was obtained from the Institutional Review Board (IRB) of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia.

RESULTS

Thirty-three nurses, 51 residents, and 39 attending physicians participated in the survey (response rates of 21%, 100%, and 100%, respectively). A significant difference was noted in the need to use physical sleeping aids between the three groups (P < 0.003), with more nurses using humidifiers as a sleeping aid (21.2%) than residents or attending physicians. However, there was no difference in the use of pharmacological aids between the three groups. All groups utilized coffee as the preferred stimulant, especially residents (76.5%, P <0.032). Nurses and attending physicians wake up 2 hours before their shift, while residents prefer 3 hours (P <0.001). Attending physicians reported the highest accident rates post-night shifts of 17.9% (P < 0.001). Residents reported satisfaction while working night shifts and were least in agreement with night shifts reducing life span. Attending physicians were more in agreement with the increasing risk of drug/alcohol misuse and the incidence of depression in relation to night shifts.

CONCLUSION

Participants shared many commonalities, yet residents were less likely to use sleeping aids and enjoy night shifts more than the other groups. All groups consumed coffee for stimulation. Attending physicians reported the highest accident rates post night shifts.

A cross-sectional study on sleep disturbances and associated factors among nurses

BACKGROUND

Many studies have measured sleep disturbances among nurses globally, but none have addressed this issue in Vietnam. Therefore, this study aimed to assess the prevalence of sleep disturbance and identify associated factors among staff nurses in Vietnam. To identify sleep disturbances and associated factors among staff nurses in Vietnam.

METHODS

A cross-sectional design was used in this study. Participant nurses (n = 420) completed a general information questionnaire, the Vietnamese version of the General Sleep Disturbance Scale (GSDS), the Perceived Stress Scale, and the Short Form 12. Data were collected between July and September 2019 from three public hospitals located in southwestern Vietnam. Data were analyzed using Chi-square, independent Student's t-test, and multivariate logistic regression analysis.

RESULTS

The average GSDS score was 41.10 (SD = 19.48), indicating sleep disturbances among 46.9% of nurses. Age, health condition, stress, and quality of life had an impact on sleep disturbance. Multivariate logistic regression analysis confirmed that nurses with high stress and poor physical health status were more likely to experience sleep disturbances.

CONCLUSION

Vietnamese nursing staff suffers from a high rate of sleep disturbances. Significant predictors included high stress and poor physical health status. Administrators of healthcare services should carefully consider how to conduct interventions to help the nurses handle their sleep disturbances such as stress management and physical health promotion.

Association Between Perceived Medical Errors and Suicidal Ideation Among Chinese Medical Staff: The Mediating Effect of Depressive Symptoms

Both medical errors and suicidal behaviors are important problems for medical staff. Although the association between them was implied in previous studies, their association has not been built until now. In this study, the first aim was to build the association between perceived medical errors and suicidal ideation, and we also want to explore the mediating role of depression in the association between perceived medical errors and suicidal ideation among Chinese medical staff. In this study, we interviewed 3,338 medical staff in Chinese general hospitals. Questions about suicidal ideation (SI) and perceived medical errors were interviewed for medical staff. Depressive symptoms were evaluated by the Chinese version of Center for Epidemiologic Studies Depression Scale (CES-D). Social-demographic and occupation-related variables were also assessed in the data collection. This study found that the prevalence of suicidal ideation among medical staff was 9%. After the adjustment for controlling variables, suicidal ideation was significantly associated with a higher level of depression (OR = 1.10, p < 0.001) and perceived medical errors (OR = 2.41, p < 0.001). The other associated factors were female (OR = 2.21, p < 0.001), religious belief (OR = 2.66, p < 0.001), and weekly work hours (OR = 1.02 p < 0.001). The mediating effect of depressive symptoms on the association between perceived medical errors and suicidal ideation was also supported in this study, and it can explain the 38.73% of the total effects of the perceived medical errors on suicidal ideation. The medical staff, with perceived medical errors, were in higher risk of suicidal ideation, and depressive symptoms can partially mediate the association between perceived medical errors and suicidal ideation. For the medical staff who are experiencing medical errors, some scanning on their suicidal ideation and depressive symptoms are necessary to promote their mental health.

Sociodemographic and work-related factors influencing long working hours among cardiovascular surgeons in Japan: a cross-sectional study

The maximum limit on overtime working hours for physicians will be applied from 2024. To explore sociodemographic and work-related factors influencing overtime work among cardiovascular surgeons (CS) in Japan. This cross-sectional study included 607 CS who responded to an online survey. Working hours were categorized into ≤60 hours, 60-79 hours, and ≥80 hours per week according to Japan Ministry of Health, Labour and Welfare. Adjusted odds ratios (aOR) were calculated using a multinomial analysis with stepwise reduction after adjustment for potential confounders. Compared to ≤60 hours, significant factors related to 60-79 hours and ≥80 hours per week were age groups of 30s to 50s versus 60s (aOR: 7.48-3.22 and 23.64-4.87), management with cardiovascular drugs (aOR: 1.87 and 5.80), and postoperative wound management (aOR: 0.47 and 0.16), respectively. Significantly related informed consent for surgery (aOR: 3.29) was seen in 60-79 hours. Contrarily, CS who worked for ≥80 hours took on-duty 5 times or more per month (aOR: 3.89), performed night or holiday calls 20 times or more per month (aOR: 2.26), and attended the intensive care unit (aOR: 3.12). These findings suggest that younger, and some non-surgical work-related factors could influence long working hours among CS.

Resilience Moderates the Association of Sleep Disturbance and Sleep Reactivity with Depressive Symptoms in Adult Volunteers

PURPOSE

Depression poses a substantial burden worldwide. Therefore, elucidating the pathophysiological mechanism of depression is important. Sleep disturbance and sleep reactivity are symptoms of depression and are also known to exacerbate depressive symptoms. On the other hand, it is well known that resilience ameliorates depressive symptoms. To our knowledge, there have been no reports to date regarding the interaction effects among sleep disturbance, sleep reactivity, and resilience on depressive symptoms. We hypothesized that resilience buffers the aggravating effects of sleep disturbance and sleep reactivity on depressive symptoms. To test this hypothesis, we conducted hierarchical multiple regression analyses.

SUBJECTS AND METHODS

A total of 584 Japanese adult volunteers were recruited between April 2017 and April 2018 by convenience sampling. Their demographic characteristics, sleep disturbance, sleep reactivity, resilience, and depressive symptoms were investigated using self-administered questionnaires. The data were analyzed using hierarchical multiple regression analyses.

RESULTS

Sleep disturbance and sleep reactivity were significantly positively associated with depressive symptoms, whereas resilience was significantly negatively associated with depressive symptoms. Moreover, there was a significant interaction between sleep disturbance or sleep reactivity and resilience on depressive symptoms. Resilience significantly alleviated the aggravating effect of sleep disturbance and sleep reactivity on depressive symptoms.

CONCLUSION

Our results indicate that people with lower resilience have more severe depressive symptoms that are associated with sleep disturbance and sleep reactivity. Therefore, there is a possibility that the enhancement of resilience will buffer the aggravating effects of sleep disturbance and sleep reactivity on depressive symptoms, and that improving sleep quality might alleviate the negative effect of low resilience on depressive symptoms.

Asociación entre alteraciones en el sueño y problemas de salud mental en los estudiantes de Medicina durante la pandemia de la COVID-19

Introduction

Medical students are a population vulnerable to poor sleep quality and sleep deprivation; these problems were accentuated during the COVID-19 pandemic. The objective was to evaluate the association between sleep disturbances and the presence of depression and anxiety in medical students during the pandemic.

Materials and methods

Cross-sectional, analytical study in medical students of a private university in Peru. Data were collected from May 22 to June 14, 2020, after 3 months of mandatory social isolation. The Patient Health Questionnaire (PHQ-9; ≥ 10), the Generalized Anxiety Disorder (GAD-7; ≥ 10) scale and the Insomnia Severity Index (ISI; ≥ 8) were used to assess depression, anxiety and insomnia, respectively. Poisson regressions with robust variance were used to calculate prevalence ratios.

Results

The prevalence of depression, anxiety and insomnia was 28.5%, 29.5% and 60.1% respectively. It was found that those who had short sleep (RPa: 1.40, CI: 1.05-1.87, p: 0.024), who slept after 2:00 hours (RPa: 2.24, CI: 1.31-3.83, p: 0.003) and who presented insomnia (RPa: 7.12, CI: 3.70-13.73, p: < 0.001) had a higher prevalence of anxiety. Likewise, those who slept after 2:00 hours (RPa: 2.13, CI: 1.24-3.64, p: 0.006) and those who presented insomnia (RP: 8.82, CI: 4.17-18.68, p: < 0.001) had a higher prevalence of depression.

Conclusions

Short sleep, bedtime and insomnia are factors associated with the prevalence of depression and anxiety.

Insomnia Partially Mediates the Relationship of Occupational Stress with Mental Health Among Shift Working Nurses and Midwives in Polish Hospitals

PURPOSE

Insufficient sleep increases sensitivity to chronic stress and may be a precursor to the deterioration of mental health and the development of burnout. The aim of our study was to verify whether symptoms of insomnia mediate the relationship of occupational stress with mental health among nurses who work shifts.

MATERIALS AND METHODS

The analyses included 117 female nurses and midwives who work shifts. They filled in the 16-item Effort-Reward Imbalance Questionnaire (ERIQ) assessing occupational stress, the Insomnia Severity Index (ISI), the Patient Health Questionnaire (PHQ-9, the question about sleep was excluded from the analyses), the Generalized Anxiety Disorder Assessment (GAD-7), and the 16-item Oldenburg Burnout Inventory (OLBI) consisting of two scales - Disengagement and Exhaustion (OLBI-D and OLBI-E).

RESULTS

Insomnia partially mediated the association of the effort-reward imbalance ratio with depression, anxiety and the exhaustion dimension of burnout. We found no association of insomnia symptoms with the depersonalization dimension of burnout, but the effort-reward imbalance ratio was associated with the depersonalization scale.

CONCLUSION

The results showed that occupational stress has varying degrees of influence on mental health, partly depending on the severity of insomnia symptoms among nurses and midwives who work shifts.

Relationships Among Sleep Disturbance, Reward System Functioning, Anhedonia, and Depressive Symptoms

Recent models propose reward system dysfunction as a key mediator of the relationship between sleep and depression and anhedonia. This study explored interrelationships among sleep disturbance, depressive symptoms, anhedonia, and reward responsiveness. Two-hundred and sixty undergraduate students completed questionnaires and a daily diary paradigm assessing sleep, reward responsiveness, depression, anhedonia, and positive affect over 1 week. Baseline sleep disturbance was associated with depressive symptoms, anhedonia, and reward responsiveness. Daily diary sleep parameters showed differential associations with anticipatory versus consummatory reward responsiveness and positive affect. Poorer sleep quality, shorter sleep duration, and longer awakening after sleep onset predicted blunted anticipatory and consummatory reward responsiveness, while increased sleep onset latency and lower sleep efficiency predicted only decreased consummatory reward responsiveness. All sleep indices, except sleep onset latency, were associated with positive affect. Findings demonstrate unique associations between disparate sleep disturbance and reward responsiveness elements, highlighting new treatment mechanisms for anhedonia and depression.

Effect of occupation on sleep duration among daytime Japanese workers: A cross-sectional study

Occupation is one of the factors contributing to the loss of sleep. Although many studies have investigated sleep loss due to irregular and nighttime shifts, the causes of sleep loss in daytime workers remain unknown. The aims of the present study were to determine whether occupation is a dependent factor for sleep duration and whether working status and lifestyle are related to sleep duration.We examined the health check results of 17,519 (9028 men and 8491 women) workers who had at least 1 health check between the fiscal years 2013 and 2019. We asked about the workers' occupation, bedtime, dinner time, overtime work, and commuting time, using a self-administered questionnaire at their health check. The occupations were classified into 4 categories: high white-collar, low white-collar, pink-collar, and blue-collar. We conducted a linear regression model and analysis of covariance to investigate the effect of occupation on sleep duration.As a result of linear regression analysis, bedtime, overtime work and occupation were significantly associated with decreased sleep duration in males, and bedtime, age, and occupation were significantly associated with decreased sleep duration in females. Analysis of covariance revealed that both male and female blue-collar tended to sleep for significantly shorter durations than those in the other occupations.The results of the current study indicate that sleep duration is affected by occupation. When determining the cause of loss of sleep, medical personnel should consider their patient's lifestyles and how they have been affected by their occupation.

Biomathematical Modeling Predicts Fatigue Risk in General Surgery Residents

OBJECTIVE

To assess resident fatigue risk using objective and predicted sleep data in a biomathematical model of fatigue.

DESIGN

8-weeks of sleep data and shift schedules from 2019 for 24 surgical residents were assessed with a biomathematical model to predict performance ("effectiveness").

SETTING

Greater Washington, DC area hospitals RESULTS: As shift lengths increased, effectiveness scores decreased and the time spent below criterion increased. Additionally, 11.13% of time on shift was below the effectiveness criterion and 42.7% of shifts carried excess sleep debt. Sleep prediction was similar to actual sleep, and both predicted similar performance (p ≤ 0.001).

CONCLUSIONS

Surgical resident sleep and shift patterns may create fatigue risk. Biomathematical modeling can aid the prediction of resident sleep patterns and performance. This approach provides an important tool to help educators in creating work-schedules that minimize fatigue risk.

Overweight and Obesity are Potential Risk Factors for Disrupted Nocturnal Sleep in Iranian Adults: A Cross-Sectional Study

Objectives: Obesity is a risk factor for several chronic conditions, including sleep disorders. We aimed to analyze the relationship between BMI, body fat percentage (FAT%), hip and waist circumference, and weight on the duration of nocturnal sleep. Methods: This study was part of the MASHAD cohort study. In all participants BMI and FAT% were measured. BMI was used to categorize individuals as obese, overweight, and normal subjects. FAT% was used to categorize individuals into tertile: tertile 1 (low) < 27.5, tertile 2 (medium) 27.5-41, and tertile 3 (high) > 41. The level of nightly sleep duration was categorized into three groups: <6, 6-8 (reference group), and >8 h. Results: There was a significant inverse association between body weight and duration of sleep (p < 0.05). Obese and overweight participants had 1.152 OR (CI:1.083-1.225) and 1.126 OR (CI:1.063-1.194) for a short duration of nocturnal sleep, respectively, relative to those with a normal BMI. Conclusion: BMI was an independent determinant of nocturnal sleep duration; obesity and overweight may have negative consequences on sleep duration. Weight control should be considered as a factor in adjusting sleep quality.

Prevalence of sleep impairment in patients with tinnitus: a systematic review and single-arm meta-analysis

PURPOSE

This study aimed to comprehensively review the literature and synthesize relevant data to examine the pooled prevalence of poor sleep quality (sleep impairment) and assess overall sleep quality in patients with tinnitus.

METHODS

This meta-analysis systematically searched both English (PubMed, Embase, and Web of Science) and Chinese (Wanfang Data Chinese database, Veep Chinese Database, and Chinese National Knowledge Infrastructure) databases. Data extraction and quality assessment were independently performed by two authors. The pooled prevalence of sleep impairment and poor sleep quality was calculated via a random-effects model. Sub-group and sensitivity analyses were performed to explore the source of heterogeneity.

RESULTS

A total of seven studies were included with a total sample of 3041 tinnitus participants. The pooled prevalence of sleep impairment was 53.5% (95% confidence interval: 40.2-66.8%) and the I2 was 97.8% (Q = 7.90, p = 0.000). There were significant differences in the prevalence of poor sleep quality between males and females (39.1% vs. 44.6%, P = 0.034), between different PSQI cut-off values ≥ 7 and > 5 (53.1% vs. 53.8%, P = 0.000), and between sample sizes > 200 and ≤ 200 (54.0% vs. 52.7%, P = 0.000). In non-Asia area, the prevalence (56.6%, 95% CI: 42.6-70.5%) was lower than that in Asia areas (34.5%, 95% CI: 25.7-43.3%).

CONCLUSION

Sleep impairment is common among patients with tinnitus. Development of interventions for conditions associated with poor sleep quality should be recommended to offer a safe and efficacious solution for this population.