Sleep duration and the risk of new-onset arthritis in middle-aged and older adult population: results from prospective cohort study in China

Background

The pain and sleep disorders caused by arthritis are health issues that have been re-emphasized with the aging population. However, the majority of research on arthritis and sleep disorders has focused on cases that have already been diagnosed with arthritis. This research aims to explore the correlation between sleep duration and new-onset arthritis in middle-aged and older adult individuals.

Methods

Utilizing data from the China Health and Retirement Longitudinal Study from baseline (2011) to the Wave 3 follow-up (2018), we conducted a 7-year longitudinal investigation targeting populations with valid sleep questionnaire records and without arthritis. Sleep duration was assessed from nighttime sleep and daytime nap records. The new-onset of arthritis was determined based on self-reported diagnosis. We employed different logistic regression models to consider the potential impact of sleep duration on arthritis and conducted mediation analyses to assess the involvement of BMI in the association between sleep duration and the new-onset risk of arthritis.

Results

Out of the 6,597 individuals analyzed in the cohort, 586 (8.9%) were diagnosed with new-onset arthritis. Median sleep duration was notably shorter in the new-onset arthritis group (6.63 vs. 6.41 h, p < 0.05). There was a notable negative correlation found between new-onset risk of arthritis and sleep duration, with each Interquartile Range (IQR) increment in sleep leading to a 16% risk reduction (OR: 0.864; 95% CI: 0.784-0.954). Stratified analyses revealed BMI as a potential modifier in the sleep-arthritis relationship (P for interaction = 0.05). Mediation analyses further showed that about 3.5% of the association was mediated by BMI. Additionally, the inclusion of sleep duration improved the arthritis predictive power of our model, with an IDI of 0.105 (0.0203, 0.1898) and an NRI of 0.0013 (0.0004, 0.0022) after adding sleep duration to the basic model.

Conclusion

In the middle-aged and older adult demographic of China, increased sleep duration is associated with a decreased new-onset risk of arthritis, with BMI potentially playing a role in mediating this connection.

Psychopathology, cortisol and testosterone responses to traumatic images: differences between urban and suburban citizens in a middle-income country

Background

Living in urban places has been associated with a higher risk of psychopathology as well as with altered hypothalamus-pituitary-adrenal (HPA) axis and consequently altered cortisol response, but studies have concentrated mainly in high-income countries population. The role of other hormones such as testosterone, implicated in stress response and with human social behaviors, have not yet been investigated. The aim of this study was to compare symptoms of psychopathology as well as cortisol and testosterone in response to traumatic images between urban and suburban people in a middle-income country.

Methods

A sample of 67 women and 55 men (N = 122, 18-45 years) from urban and suburban places of Mexico participated in the study. We quantified salivary cortisol and testosterone in response to images with traumatic and violent content (basal, 15, 30, and 45 min after images). Participants answered a general information questionnaire and the Symptom Checklist-90-R to assess their psychopathological traits. We performed Generalized Estimating Equation Models to analyze hormonal levels and MANOVAs to compare differences in participants' psychopathology symptoms. Area under the curve respect to ground (AUC_G) of hormonal levels and sex differences were also compared.

Results

Suburban citizens showed no cortisol response, whereas urban people showed a cortisol peak 15 min after the image's exposure; however, suburban people had higher AUC_G and basal levels compared to urban ones. Contrastingly, testosterone levels declined in all participants excepting the urban women, who showed no testosterone response. Although similar testosterone profile, AUC_G levels were higher in urban than suburban men. Participants living in suburban areas had higher scores of somatizations, obsessive-compulsive, and interpersonal sensitivity, as well as more sleep disorders than participants living in urban areas.

Conclusion

This study offers novel evidence about differences in cortisol and testosterone responses to a social stressor and in mental health indicators between a population of urban and suburban citizens, highlighting the impact of urbanization process on physiological and psychological outcomes in a middle-income country.

The role of sleep quality and perceived stress on depressive symptoms among tertiary hospital nurses: a cross-sectional study

BACKGROUND

Nurses in tertiary hospitals are at high risk for depression. Understanding sleep quality and perceived stress may contribute to nurses' mental health and health-related nursing productivity. The aim of this study was to investigate the role of sleep quality and perceived stress on depressive symptoms among nurses in tertiary hospitals.

METHODS

A total of 2,780 nurses (overall response rate = 91.1%) were recruited through a cross-sectional survey in 23 tertiary hospitals in China. Questionnaires included the Self-Rating Depression Scale, the Pittsburgh Sleep Quality Index, and the Chinese Perceived Stress Scale. Variables that were significant in Chi-square tests were further entered into binary logistic stepwise regression.

RESULTS

The prevalence of depressive symptoms was 60.3% (n = 1,676), of which 97.4% (n = 1,633) were female, and 77.8% were younger than 35 years (n = 1,304). Nurses who had moderate, poor, severe sleep quality and poor perceived pressure were more likely to be depressed. Master's degree, 6-10 years of work, and physical activity were protective factors, while the opposite was the case for shift work and high dissatisfaction.

CONCLUSIONS

More than half of nurses working in tertiary care hospitals reported depressive symptoms, and lower sleep quality and higher perceived stress were more associated with this. Perceived stress is an interesting concept, which may provide a new entry point for the well-known idea that there is a relationship between poor sleep quality and depression. It is possible to reduce depressive symptoms among public hospital nurses by providing information on sleep health and stress relief.

Lifetime discrimination, habitual and daily everyday discrimination, and diurnal cortisol among older African Americans adults

Experiences of discrimination can be major life events or daily chronic hassles that occur in various social contexts (e.g., housing, education, employment) and have been found to predict adverse health outcomes, including dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Previous work on daily cortisol dynamics has generally revealed an association between discrimination and flatter cortisol slopes, particularly among racial minorities. However, most of the existing studies have focused on youth and young adults, with little work among older adults. The current study aimed to investigate the relationship between three measures of discrimination (lifetime discrimination, habitual everyday discrimination, and daily everyday discrimination) and diurnal cortisol secretion in a sample of 203 older African Americans. Study results indicated that individuals reporting higher levels of lifetime discrimination experienced morning hypocortisolism and flatter diurnal cortisol slopes. Exploratory analyses also showed that prior daily everyday discrimination was significantly associated with blunted cortisol awakening response (CAR) the next day. Our findings underline the role of discrimination in modulating daily cortisol dynamics among older African American adults and advance knowledge on how social stressors influence healthy aging.

Effect of sleep disturbance on biomarkers related to the development of adverse health outcomes: A systematic review of the human literature

Literature suggests that unrestricted and undisturbed sleep is vital for basic human function and performance; however, it is unclear as to what amount of sleep disturbance leads to dysregulation in biomarkers, which may underscore the development of adverse health effects. This systematic review aims to identify the amount of sleep disturbance that contributes to biomarker changes as a potential precursor to the development of adverse health effects. English-language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from 1 January 1980 to 31 July 2021 were searched. Where possible, random-effects meta-analyses were used to examine the effect of sleep disturbances on adverse health effects. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool and the Risk of Bias of Nonrandomised Studies - of Exposures instruments and the certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The search identified 92 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, cardiac output, waist circumference, cortisol, adrenaline, noradrenaline, immune system markers, glucose, insulin, cholesterol, and triglyceride levels. Although some meta-analyses suggested there may be an association between sleep disturbances and certain outcomes, the certainty in the evidence was very low due to concerns with risk of bias, inconsistency across exposures, populations, and imprecision in the estimates of effects. Further research is needed to explore the point at which types, levels and duration of sleep disturbances may begin to increase the risk of developing adverse health outcomes to inform and tailor health interventions.

Associations of sleep problems with asthma and allergic rhinitis among Chinese preschoolers

The aim of this study was to examine the associations of sleep problems with asthma and allergic rhinitis among Chinese preschoolers. This cross-sectional survey was conducted in Guangzhou, China. Children aged 3–6 years were recruited from 32 kindergartens in 7 administrative districts. Asthma, allergic rhinitis and sleep problems were evaluated using a valid questionnaire. Binary logistic regression models were employed to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations of asthma and allergic rhinitis with short sleep duration, late bedtime and frequent nocturnal awakening. We included 4876 preschool children in the current analysis. Of these, 182 (3.7%) diagnosed as asthma, and 511 (10.5%) diagnosed as allergic rhinitis. Frequent nocturnal awakening was associated with asthma and allergic rhinitis, with adjusted OR were 1.49 (95% CI 1.05–2.13) and 1.59 (95% CI 1.27–1.99), respectively. Subgroup analysis showed the OR for frequent nocturnal awakening with asthma was higher in girls (1.68; 95% CI 1.02–2.78) than in boys (1.35; 95% CI 0.81–2.24), but the OR for frequent nocturnal awakening with allergic rhinitis were similar in girls (1.73; 95% CI 1.15–2.30) and boys (1.57; 95% CI 1.17–2.12). No significant associations of short sleep duration and late bedtime with asthma or allergic rhinitis were identified. Our data suggested that frequent nocturnal awakening was associated with asthma and allergic rhinitis among preschoolers, and the association of frequent nocturnal awakening with asthma differed by gender. Further studies are warranted to address the causal relationship between nocturnal awakening and asthma and allergic rhinitis.

The cortisol awakening response and the late positive potentials evoked by unpleasant emotional pictures in healthy adults

The cortisol awakening response (CAR) refers to a sharp rise in cortisol concentrations within the 45 min following morning awakening. Alterations in CAR have been associated with various internalizing symptoms and brain function. The current study aimed to investigate the association between CAR and neural activity in response to unpleasant emotional pictures. A total of 46 healthy adults (22.55 years ± 1.69) collected saliva samples at 0, 30, and 45 min post-awakening on two days to assess the CAR. In the afternoon after CAR measurement on the first day, electroencephalograms were recorded when the participants completed a passive viewing task. The results showed that a greater CAR was associated with a decreased late positive potential difference score between unpleasant and neutral stimuli. This finding indicates that a larger CAR may be associated with decreased attentional engagement to unpleasant emotional information in healthy adults.

Association between Stress and Metabolic Syndrome and its Mediating Factors in University Students

OBJECTIVES

In this study, we evaluated the association between perceived stress and indicators of metabolic syndrome and how this association is mediated by sleep problems, unhealthy eating habits, and night eating syndrome, in addition to serum levels of ghrelin and cortisol in university students.

METHODS

We recruited 192 students from a public university in Mexico. Weight, height, waist circumference and blood pressure were taken in accordance with standard protocols. Validated questionnaires were used to assess perceived stress, sleep quality and eating habits. Fasting blood samples were taken to measure ghrelin, cortisol, triglycerides, glucose and HDL-C.

RESULTS

Path Analysis indicated direct positive effects of stress over PSQI (β = 0.341) and NES (β = 0.443); PSQI over NES (β = 0.233) and NES over glucose (β = 0.170), triglycerides over LDL-C (β = 0.215), waist circumference over SBP (β = 0.259). Likewise, standardized negative regression weights of PSQI over Diet Quality Index (β = -0.239) and ghrelin concentrations (β = -0.132), ghrelin over Diet Quality Index (β = -0.188) and waist circumference (β = -0.147). Diet Quality Index over triglycerides (β = -0.184); sleep duration over systolic blood pressure (β = -0.242); waist circumference over HDL-C (β = -0.256).

CONCLUSION

Psychological stress leads to increased indicators of MetS via decreased sleep quality, inadequate eating habits and eating behavior in university students.

The lived experiences of frontline nurses during the coronavirus disease 2019 (COVID-19) pandemic in Qatar: A qualitative study

AIM

This study aims to explore the lived experiences of frontline nurses providing nursing care for COVID-19 patients in Qatar.

DESIGN

Qualitative, Phenomenological.

METHODS

Nurses were recruited from a designated COVID-19 facility using purposive and snowball sampling. The participants were interviewed face-to-face using semi-structured interview questions from 6 September-10 October 2020. The interviews were transcribed and analyzed using Colaizzi's phenomenological method.

RESULT

A total of 30 nurses were interviewed; (76.7%) were deployed for >6 months. Three major themes were drawn from the analysis: (a) Challenges of working in a COVID-19 facility (subthemes: working in a new context and new working environment, worn out by the workload, the struggle of wearing protective gear, fear of COVID-19, witnessing suffering); (b) Surviving COVID-19 (subthemes: keeping it safe with extra measures, change in eating habits, teamwork and camaraderie, social support); and (c) Resilience of Nurses (subthemes: a true calling, a sense of purpose).

Quality of Life, Sleep Quality, Depression, Anxiety, Stress, Eating Habits, and Social Bounds in Nurses during the Coronavirus Disease 2019 Pandemic in Qatar (The PROTECTOR Study): A Cross-Sectional, Comparative Study

There have been numerous concerns regarding the physical and mental health of nurses during the COVID-19 pandemic. Stress, sleep deprivation, anxiety, and depression potentiated nurses’ vulnerability to poor eating habits. Aims and Objectives: The purpose of this study was to explore the differences between nurses’ characteristics with COVID-19 facility designation, and sleep quality, depression, anxiety, stress, eating habits, social bonds, and quality of life. Design: A cross-sectional, comparative study. Methods: An online survey was sent using the corporation’s email to nurses working in three hospitals in Qatar from September to December 2020. One of them is a designated COVID-19 facility. The sleep quality, depression, eating habits, social bonds, and quality of life were measured using The Insomnia Severity Index (ISI), Depression Anxiety and Stress Scale 21 (DASS-21), Emotional Eater Questionnaire (EEQ), Oslo Social Support Scale (OSSS-3), and the World Health Organization Quality of Life (WHOQOL-BREF), respectively. Results: A total of 200 nurses participated in the study (RR: 13.3%). No statistically significant association was found between designated facility (COVID-19 vs. not COVID-19) or nurses’ characteristics and ISI categories (OR 1.15; 95% CI 0.54, 2.44). Nurses working in COVID-19 facilities had increased odds of having higher EEQ categories by 2.62 times (95% CI 1.18, 5.83). Similarly, no statistically significant associations were found between any of the nurses’ characteristics and OSSS-3 categories. On the other hand, no statistically significant associations were found between any of the nurses’ characteristics and QOL domains except for the gender and social relationships’ domain. Conclusion: Overall, the quality of life of nurses in Qatar is on a positive level whether they are assigned to a COVID-19 facility or not. Although no significant difference was found with regard to the sleep quality, stress, anxiety, depression, and eating habits between nurses in a COVID-19 facility and in a non-COVID-19 facility, special interventions to diminish stressors need to be implemented and maintained.

Salivary cortisol concentrations in hematogy/oncology nurses on working days and days off

OBJECTIVE

to assess salivary cortisol concentrations in hematology/oncology nurses on working days and days off.

METHODS

a cross-sectional study carried out with 28 nurses from a university hospital. A sociodemographic, employment and health profile questionnaire was applied. For saliva collection, Salivette® tubes were used. Descriptive and analytical analysis was used.

RESULTS

there was no significant difference in cortisol concentrations between working days and days off (p>0.05). The high cortisol concentration was associated with not having children (0.621±0.340; p=0.046), not using medication (0.623±0.133; p=0.017) and birth control pills (0.556 ± 0.228; p=0.047) and intention to leave work (0.951±0.154; p=0.001). A positive correlation was identified between cortisol and absence from work due to health issues (0.72; p=0.05) and weight gain (0.935; p=0.02).

CONCLUSION

in general, cortisol concentration is within the reference parameters, with no significant difference in its secretion on working days and days off.

The impact of prior day sleep and physical activity on the cortisol awakening response

The cortisol awakening response (CAR) describes the increase in cortisol within the first 30-60 min after waking from nocturnal sleep, and is a common biomarker used within psychoneuroendocrinology, but the effect of sleep on the CAR is currently unclear. A previous study suggested that reported discrepancies may be due to other lifestyle behaviors such as physical activity; given the role of the CAR in energy regulation and preparation for the day, it is theoretically plausible that activity level would influence the CAR. However, no study has yet utilized objective monitoring of day-to-day sleep and physical activity to investigate potential effects on the CAR. This study aimed to test the hypotheses that either sleep duration or sleep quality would interact with the prior 24 h' physical activity to predict the CAR on the following morning. Salivary samples were collected from 85 young adults (mean = 19.1 years, SD = 1.89) immediately after waking from nocturnal sleep and again 30 min after waking; two complete and consecutive days were used. Participants wore accelerometers (ActiGraph, wGT3X-BT) throughout this phase of a larger study, which provided objective measures of sleep duration, number of awakenings, and amount of physical activity. Mixed-effects models with post-hoc regions of significance decompositions tested the hypothesized interaction effects. Results demonstrated a significant interaction between prior day sleep duration and physical activity predicting the next day CAR, wherein short sleep duration and high levels of physical activity resulted in an augmented CAR. Although more sleep clearly predicted a smaller next day CAR in main effect, this study provides additional support that sleep duration effects are also moderated by prior day physical activity. Both behavioral factors should be considered when assessing the CAR and the association between the CAR other psychoneuroendocrine outcomes.

Immediate and lasting effects of aerobic exercise on the actigraphic sleep parameters of female nurses: A randomized controlled trial

Sleep disturbance is highly prevalent among shift-working nurses. We aimed to evaluate whether aerobic exercise (i.e., walking combined with jogging) improves objective sleep parameters among female nurses who met eligibility criterion as poor sleepers at the end of an 8-week exercise program and 4 weeks after study completion. This single-blinded, parallel-design, randomized controlled trial was conducted in a classroom of a hospital in northern Taiwan. Sixty eligible female nurses were randomly assigned to either the aerobic exercise (n = 30) or usual activity status (n = 30) group. A moderate-intensity aerobic exercise program was administered over 5 days (60 min per day) a week for 8 weeks after the nurses' day shifts. Objective sleep outcomes including total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were retrieved using an actigraph device. A generalized estimating equation model was used for data analysis. The aerobic exercise group exhibited improvements in TST and SE at 4 and 8 weeks compared with the baseline evaluation (TST: B = 70.49 and 55.96; SE: B = 5.21 and 3.98). Between-group differences were observed in SOL and WASO at 4 weeks but not 8 weeks compared with the baseline evaluation (SOL: B = -7.18; WASO: B = -11.38). Positive lasting effects for TST were observed only until the 4-week follow-up. To improve sleep quality and quantity, we encourage female nurses who sleep poorly to regularly perform moderate-intensity aerobic exercise.

Factors associated with insomnia among Chinese front-line nurses fighting against COVID-19 in Wuhan: A cross-sectional survey

Aim

To investigate the prevalence of insomnia among front‐line nurses fighting against COVID‐19 in Wuhan, China, and analyse its influencing factors.

Background

Insomnia is an important factor that can affect the health and work quality of nurses. However, there is a lack of big‐sample studies exploring factors that affect the insomnia of nurses fighting against COVID‐19.

Method

This cross‐sectional study using the Ascension Insomnia Scale, Fatigue Scale‐14 and Perceived Stress Scale took place in March 2020. Participants were 1,794 front‐line nurses from four tertiary‐level general hospitals.

Results

The prevalence of insomnia among participants was 52.8%. Insomnia was predicted by gender, working experience, chronic diseases, midday nap duration, direct participation in the rescue of patients with COVID‐19, frequency of night shifts, professional psychological assistance during the pandemic, negative experiences (such as family, friends or colleagues being seriously ill or dying due to COVID‐19), the degree of fear of COVID‐19, fatigue and perceived stress.

Conclusion

The level of insomnia among participants was higher than the normal level. Interventions based on influencing factors should be implemented to ensure nurses’ sleep quality.

Implications for Nursing Management

An in‐depth understanding of the influencing factors of insomnia among front‐line nurses can help nurse managers develop solutions to improve front‐line nurses’ sleep quality, which will enhance the physical and mental conditions of nurses and promote the quality of care.