Occupational and socioeconomic differences in actigraphically measured sleep

A Cross-Sectional Study of the Social Work Environment and Black Registered Nurses' Sleep

INTRODUCTION

Workplace experiences may place Black nurses at higher risk for poor sleep and adverse health outcomes. This study aimed to identify poor sleep prevalence and associations of workplace discrimination and workplace social capital with sleep.

METHODOLOGY

Descriptive statistics and multiple linear regression with exploratory analyses were conducted of cross sectional survey data from US Black nurses.

RESULTS

On average, 63 respondents reported sleeping 6.15 h, 45 min less daily than 6.9 h reported nationally for nurses. Ninety-percent of respondents reported poor sleep quality. While no direct significance was found, respondents reporting sleep quality changes had lower workplace social capital and higher workplace discrimination.

CONCLUSION

Black nurses may have higher prevalence of poor sleep than the larger nursing workforce. A potential relationship between decreased sleep quality and negative perceptions of the work environment may exist. Organizations should examine sleep and potential occupational health inequities among Black nurses when considering worker health.

Wildfire-related smoke inhalation worsens cardiovascular risk in sleep disrupted rats

Introduction

As a lifestyle factor, poor sleep status is associated with increased cardiovascular morbidity and mortality and may be influenced by environmental stressors, including air pollution.

Methods

To determine whether exposure to air pollution modified cardiovascular effects of sleep disruption, we evaluated the effects of single or repeated (twice/wk for 4 wks) inhalation exposure to eucalyptus wood smoke (ES; 964 μg/m3 for 1 h), a key wildland fire air pollution source, on mild sleep loss in the form of gentle handling in rats. Blood pressure (BP) radiotelemetry and echocardiography were evaluated along with assessments of lung and systemic inflammation, cardiac and hypothalamic gene expression, and heart rate variability (HRV), a measure of cardiac autonomic tone.

Results and Discussion

GH alone disrupted sleep, as evidenced by active period-like locomotor activity, and increases in BP, heart rate (HR), and hypothalamic expression of the circadian gene Per2. A single bout of sleep disruption and ES, but neither alone, increased HR and BP as rats transitioned into their active period, a period aligned with a critical early morning window for stroke risk in humans. These responses were immediately preceded by reduced HRV, indicating increased cardiac sympathetic tone. In addition, only sleep disrupted rats exposed to ES had increased HR and BP during the final sleep disruption period. These rats also had increased cardiac output and cardiac expression of genes related to adrenergic function, and regulation of vasoconstriction and systemic blood pressure one day after final ES exposure. There was little evidence of lung or systemic inflammation, except for increases in serum LDL cholesterol and alanine aminotransferase. These results suggest that inhaled air pollution increases sleep perturbation-related cardiovascular risk, potentially in part by increased sympathetic activity.

Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research

STUDY OBJECTIVES

This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship.

METHODS

Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions.

RESULTS

Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship.

CONCLUSIONS

Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes.

CITATION

Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.

Sleep state of the elderly population in Korea: Nationwide cross-sectional population-based study

Objective

Interest in sleep disorders among the elderly, especially those in Korea, has increased. We aimed to describe the overall sleep status of the elderly population in Korea using survey data and to determine the risk factors concerning different aspects of sleep status.

Methods

We conducted a cross-sectional survey on 271 respondents aged 65-86 years old. We performed multistage clustered random sampling according to the population and socioeconomic distribution of all Korean territories. The survey questionnaire was used to perform a structural assessment of sociodemographic characteristics; medical comorbidities; psychiatric comorbidities; and sleep status, including sleep duration, sleep quality, presence of insomnia, excessive daytime sleepiness, sleep apnea, and restless legs syndrome.

Results

Approximately 12.5, 22.%, and 51.3% of the elderly population had poor sleep quality, excessive daytime sleepiness, and insomnia, respectively. Hypertension, dyslipidemia, insomnia, anxiety, and depression predicted poor sleep quality. Female sex, insomnia, and sleep apnea predicted excessive daytime sleepiness. Poor sleep quality and depression predicted insomnia.

Conclusion

A substantial proportion of the elderly Korean population have sleep problems, including poor sleep quality, excessive daytime sleepiness, and insomnia. Sleep status is influenced by various factors, including age, sex, and metabolic and psychiatric comorbidities.

Influence of socioeconomic status on objective sleep measurement: A systematic review and meta-analysis of actigraphy studies

Social inequities have many health effects; one of these is a potential relationship to sleep disturbances. Socioeconomic status (SES) is an important factor that contributes to social inequities. SES is a marker of living conditions and habits that influence health by way of different processes, including stress-related mechanisms. However, a systematic review of the relationship between SES and objectively measured sleep parameters has not been conducted. Therefore, a systematic review and meta-analysis were performed to examine the relationship between SES and sleep parameters measured with actigraphy in the general population. Nineteen articles were identified and included from a keyword search in Medline/PubMed, Web of Science, and SCOPUS, following PRISMA guidelines. For an article to be included, it had to have a measure of SES and also, an actigraphy-based measure of sleep. For, included studies, qualitative and quantitative data were extracted, and study quality was assessed with The National Institute of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Bivariate correlations were extracted and entered into a meta-analysis, along with a qualitative review of articles. These analyses revealed that SES was associated with sleep parameters in the predicted direction, with lower SES associated with worse sleep parameters. Specifically, lower SES was associated with lower total sleep time, longer sleep latency, greater sleep fragmentation, and higher variability in sleep onset and sleep latency. Higher education, higher perceived economic well-being, and higher income were significantly associated with improved sleep efficiency and longer sleep duration. For the 19 articles included, 10 were rated as fair or poor in study quality. Thus, higher quality studies in this area are needed. This meta-analysis and systematic review demonstrated that social inequities of sleep can be measured objectively, opening the path to the development and integration of methodologies combining actigraphy with current subjective measures for utilization in clinical practice.

Social capital and cognitive decline: Does sleep duration mediate the association?

Background

Studies have found that social capital (SC) is associated with the risk of cognitive decline; however, the mechanism explaining how SC leads to cognitive decline is unclear. The current study examines the mediation effect of sleep duration on the relationship between SC and cognitive decline in Chinese older adults.

Methods

A cross-sectional study of 955 community-dwelling aged 60 or over was conducted. The mini-mental state examination (MMSE), self-report sleep duration questionnaire, and social capital scales were administered during the face-to-face survey. The Bootstrap methods PROCESS program is employed to test the mediation model.

Results

After controlling for covariates, both social cohesion and social interaction were positively correlated with the MMSE score (p<0.001), and social cohesion was negatively correlated with sleep duration (p = 0.009); On the contrary, sleep duration was negatively correlated with MMSE score (p<0.001). Linear regression analysis showed social cohesion was positively associated with the MMSE score (β = 0.16, p = 0.005), while sleep duration was associated with an increased risk of cognitive decline (β = -0.72, p<0.001). Sleep duration has mediated the relationship between social cohesion and cognitive decline (explaining 21.7% of the total variance).

Conclusions

Social capital negatively associated with the risk of cognitive decline in this Chinese population, and sleep duration may partly explain this relationship. It may be a suggestive clue to identify those at a higher risk of progressing to cognitive impairment. Further prospective study in need to confirm this finding due to the cross-sectional design.

Meta-analysis of age and actigraphy assessed sleep characteristics across the lifespan

STUDY OBJECTIVES

Sleep quantity and continuity vary across the lifespan. Actigraphy is a reliable and widely-used behavioral measure of sleep in research and personal health monitoring. This meta-analysis provides a novel examination of whether age (in years) is associated with actigraphy-assessed sleep across the lifespan.

METHODS

A systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using "actigraphy" and "sleep" terms provided 7,079 titles/abstracts; studies of individuals with known psychiatric or medical comorbidities were excluded. Ninety-one articles (N = 23,365) provided data for six meta-analyses examining sleep duration (k = 89), sleep efficiency (k = 58), bedtime (k = 19) and waketime (k = 9) for individuals ages 6-21, and bedtime (k = 7) and waketime (k = 7) for individuals ages 22 and older.

RESULTS

At older ages, sleep duration was shorter (r = -0.12) and sleep efficiency was lower (r = -0.05). Older age was associated with later bedtime (r = 0.37) and wake-up time (r = 0.24) from ages 6-21, whereas older age was associated with earlier bedtime (r = -0.66) and wake-up time (r = -0.59) for ages 22 and above. The strength of these associations was modified by study continent, but not by any other moderator.

CONCLUSIONS

Age was negatively associated with actigraphy-assessed sleep duration and efficiency, but the effects were small in magnitude. On the other hand, large associations were observed between age and sleep timing, despite a smaller literature and the absence of analyzable data for ages 30-60. Changes in sleep timing, rather than changes in sleep duration or continuity, may better characterize the effects of age on human sleep.

Biopsychosocial factors associated to self-percepted sleep function in Brazilian elderly people: analysis of a national survey

BACKGROUND

Sleep is a dimension of well-being and health. Non-restful sleep is related to health dysfunctions, especially in vulnerable populations, considering that related factors change contextually. Thus, the objective of the present study was to measure the magnitude of the reduction in sleep restorative function (SRF) and related biopsychosocial factors in Brazilian elderly.

METHOD

Secondary data from the 2013 National Health Survey of cross-sectional design were analyzed. The sample consisted of individuals as from 60 years old. The outcome considered was the prevalence of reduced self-perceived sleep restorative function (SRF). Health and sleep characteristics, emotional behavior, lifestyle, social support, and urbanization were all investigated. The association with outcome was measured with the prevalence ratio (PR) and estimated with Cox regression, assuming α ≤ 0.05.

RESULTS

SRF was reduced by 29.2% (95%CI 27.2 - 30.6%). It is related to depression (PR = 3.37; 95%CI 2.87 - 3.97), insomnia/sleepiness (PR = 2.45; 95%CI 2.14 - 2.79); behavioral oscillation (PR = 1.75; 95%CI 1.53 - 1.99), negative health perception (PR = 1.50; 95%CI 1.23 - 1.82), computer and internet (PR = 1.44; 95%CI 1.01 - 2.07) and functional difficulty (PR = 1.13; 95%CI 1.01 - 1.27). Living in urban areas (PR = 1.32; 95%CI 1.14 - 1.52) and having a chronic condition (PR = 1.58; 95%CI 1.11 - 2.40) were only associated to the worst situation of reduced SRF.

CONCLUSION

The reduction in SRF affects one third of the elderly in Brazil and is closely related to biopsychosocial factors, requiring intersectoral public health promotion approaches.

Social capital: Implications for neurology

Social capital (SC) is a broad term that encompasses the many resources derived from social connections. The contemporary study of SC in public health has deep roots in the related fields of sociology, economics, and politics. Its multidisciplinary nature and the varying potential ways it could affect individuals have resulted in different but overlapping models to approach SC in the health field. There are currently no standardized measures of SC, and even more challenging its impact on health outcomes seems to vary according to the level of analysis. Despite the accumulating evidence that supports a protective effect of SC on mental and physical health, and mortality, not enough attention has been paid to the potential drawbacks of SC. The role of SC in neurological disease is just beginning to be explored. Concerted efforts are needed to ensure that empirical evidence on SC could be properly translated into interventions for health-promoting purposes. In this paper, we review the current state of scientific knowledge on the subject of SC, with a focus on its application in the field of neurology.

Association of workplace social capital with psychological distress: results from a longitudinal multilevel analysis of the J-HOPE Study

OBJECTIVES

Workplace social capital (WSC) is increasingly recognised as a social contextual determinant of workers' mental health, but longitudinal data are sparse. We aimed to evaluate the impact of changes in unit-level WSC on psychological distress among Japanese employees using a prospective multilevel repeated-measures design.

PARTICIPANTS AND STUDY DESIGN

We conducted a 2-year prospective cohort study with 1,944 men and 786 women aged 18-65 years. Participants worked at two manufacturing worksites in Japan and were free from mental illness from the first to third study waves. We used a three-level multilevel regression design to evaluate the prospective association of unit-level WSC with individual-level psychological distress. WSC was measured using a validated six-item instrument and individual-level psychological distress with the Kessler Psychological Distress Scale (K6).

RESULTS

The null model indicated a significant degree of between-work unit variation in psychological distress (intraclass correlation=0.1%, p<0.001). In the full model, each SD increase in unit-level WSC was associated with 0.69 point improvement in K6 scores (95% CI -1.12 to -0.26).

CONCLUSIONS

This prospective study builds on existing knowledge by showing an association between unit-level WSC and modest improvements in mental health among employees in Japan. We recommend that WSC is considered alongside other contextual influences when assessing employees' mental health risks.

Neighborhood social capital and sleep duration: a population based cross-sectional study in a rural Japanese town

Background

Studies on social capital and health outcomes have become common, but the relationship between neighborhood social capital and sleep duration by gender is still unclear. We examined the relationship between neighborhood social capital and sleep duration by gender in adults living in a rural community in Japan.

Method

We conducted a cross-sectional survey of 12,321 residents aged ≥20 years in a town in Mie Prefecture in January–March 2013. Self-completed questionnaires were collected from the residents (n = 7782; valid participation rate, 63.2%). We used five items to assess the neighborhood social capital (Cronbach’s α = 0.86). We summed up the scores of each item, and then divided the participants into four groups by quartile of total scores of neighborhood social capital (lowest, low, high, and highest). Sleep duration of < 7 h/day was defined as insufficient sleep duration according to previous studies. To adjust for potential confounders, we performed a multiple log-binominal regression analysis and estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) for insufficient sleep.

Results

Overall 42% of the men and 45% of the women had insufficient sleep. In the men, the lowest group of neighborhood social capital presented a 22% higher prevalence of insufficient sleep (PR 1.22; 95% CIs 1.08–1.38) compared to the highest group of neighborhood social capital. Similarly the low group of neighborhood social capital and the high group of neighborhood social capital had 20 and 19% higher prevalence of insufficient sleep (PR 1.20; 95% CIs 1.06–1.36; PR 1.19; 95% CIs 1.06–1.34, respectively) compared to the highest group of neighborhood social capital. For women there was no significant association between neighborhood social capital and insufficient sleep after controlling for all potential confounders.

Conclusion

Having lower neighborhood social capital was associated with insufficient sleep among Japanese adults, particularly in the men. This suggests that the context of neighborhood social capital by gender should be considered to promote healthier behaviors with regard to getting enough sleep.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5204-4) contains supplementary material, which is available to authorized users.

Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social jetlag

BACKGROUND

Sleep behavior is changing toward shorter sleep duration and a later chronotype. It results in a sleep debt that is acquitted on work-free days, inducing a small but recurrent sleep misalignment each week, referred to as "social jetlag". These sleep habits could affect health through misalignment with circadian rhythms.

OBJECTIVES

The primary objective is to address the impact of sleep behavior on glycemic control, assessed by HbA1c, in patients with type 1 diabetes, independently of other lifestyle or sleep-related factors. The secondary objective is to address whether circadian phase affects glycemic control.

DESIGN

In total, 80 adult patients with type 1 diabetes (46% female) were included in a clinical cohort study.

METHODS

Sleep behavior was addressed objectively by a 7-day actimetry, lifestyle by questionnaires, sleep breathing disorders by nocturnal oximetry and circadian phase by dim light melatonin onset (DLMO).

RESULTS

Univariate analyses showed that chronotype (r = 0.23, P = 0.042) and social jetlag (r = 0.30, P = 0.008) were significantly associated with HbA1c. In multivariable analysis, social jetlag was the only sleep habit independently associated with HbA1c (β = 0.012 (0.006; 0.017), P < 0.001). HbA1c was lower in patients with a social jetlag below versus above the median (7.7% (7.1-8.7) and 8.7% (7.6-9.8), P = 0.011). DLMO was not associated with HbA1c. However, the later the DLMO, the worse the sleep efficiency (r = -0.41, P < 0.001) and fragmentation index (r = 0.35, P = 0.005).

CONCLUSIONS

Social jetlag, a small but recurrent circadian misalignment, is associated with worse glycemic control in type 1 diabetes, whereas circadian phase is not. Further intervention studies should address the potential improvement of glycemic control by correcting social jetlag.

Age and work environment characteristics in relation to sleep: Additive, interactive and curvilinear effects

Although additive combinations of age and work environment characteristics have been found to predict sleep impairment, possible age x work environment interactions have been largely disregarded. The present study examined linear and curvilinear interactions of age with work environment measures in relation to sleep quality and duration. Survey data were collected from offshore day-shift personnel (N = 901). Main effects and interactions of the age terms with work environment measures (job demand, control, and social support, physical environment and strenuous work) were evaluated. Sleep duration was predicted by a curvilinear interaction, age(2) x job demand (p < .005), and by the age x social support interaction (p < .002); sleep quality was predicted by age x job demand (p < .002). Job control and physical environment showed significant additive effects. At a time when older employees are encouraged to remain in the workforce, the findings serve to increase understanding of how ageing and work demands jointly contribute to sleep impairment.

Change in psychological distress following change in workplace social capital: results from the panel surveys of the J-HOPE study

PURPOSE

Research on the longitudinal association of workplace social capital and mental health is limited. The purpose of the present study was to investigate the prospective association of social capital in the workplace with mental distress, measured by K6, adjusting for individuals factors as well as workplace-related factors among employees in Japan.

METHODS

The participants included 6387 men and 1825 women from 12 private companies in Japan. Questionnaires, inquiring about workplace social capital, K6, job strain and effort-reward imbalance were administered at the baseline survey between October 2010 and December 2011 (response rate=77.4%). At 1-year follow-up, social capital and K6 were assessed again (follow-up rate=79.5%), and a generalised linear model was used to estimate the association between changes in workplace social capital and change in K6.

RESULTS

After adjusting for baseline demographic characteristics and workplace-related factors (Job Content Questionnaire (JCQ), Effort-Reward Imbalance Questionnaire (ERIQ)), increased workplace social capital between waves was associated with improved psychological distress (β=-0.2327, p<0.0001). An inverse association was found in both men and women, all age groups, and among employees with high or low baseline mental health. The association was stronger among those who reported higher stress at baseline.

CONCLUSIONS

Boosting workplace social capital may promote mental health in the workplace.