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Hayajneh AA, Al-Younis MO, Rababa M. The effect of a mindfulness intervention (MI) on sleep disturbance (SD) among nurses. Sci Rep 2024; 14:5084. [PMID: 38429355 PMCID: PMC10907617 DOI: 10.1038/s41598-024-55748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
Sleep disturbance (SD) makes it difficult for nurses in intensive care units (ICUs) to perform activities that require focused and continual concentration, which raises the risk of medical errors, health issues, loss of sleep, and patient care mistakes. The mindfulness intervention (MI) was created to give participants the capacity to approach their own emotions with non-judgmental awareness and to become more conscious of their thoughts and feelings, and it reduced psychological symptoms. This study examined the effect of MI on SD among nurses. A randomized control trail (RCT) was conducted and recruited 100 nurses from intensive care and medical-surgical units from three hospitals located at the northern and middle regions of Jordan. Bivariate analysis including independent T-test and multiple linear regressions were used to study the differences between the interventional group (MI) and the comparison group (watching mindfulness videos) in terms of the impact on the SD. Nurses reported significant and high levels of SD. MI significantly reduced the level of SD and improved sleep quality among nurses. MI should be integrated into nursing competences to combat the negative impacts of poor sleep quality on nurses and organizational-sensitive outcomes.
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Affiliation(s)
- Audai A Hayajneh
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan.
| | - Malak O Al-Younis
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Mohammad Rababa
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
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Srinivasan V, Abathsagayam K, Suganthirababu P, Alagesan J, Vishnuram S, Vasanthi RK. Effect of vagus nerve stimulation (taVNS) on anxiety and sleep disturbances among elderly health care workers in the post COVID-19 pandemic. Work 2023:WOR231362. [PMID: 38143418 DOI: 10.3233/wor-231362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) have been significantly impacted by the pandemic. Elderly health care workers carry out a variety of duties at work and have years of clinical expertise. Anxiety and insomnia are among the more commonly encountered problems in senior physicians and other geriatric medical professional populations. OBJECTIVE The study aims to determine the effect of vagal nerve stimulation on anxiety and sleep disturbances among geriatric medical professionals. METHOD 42 Participants were enrolled in this study based on the inclusion and exclusion criteria. The participants were divided into two groups using the closed envelope approach, and they took part in therapy sessions lasting 30 minutes, three times per week for a period of four weeks. The Experimental group A received non-invasive transcutaneous auricular vagal nerve stimulation(taVNS) and Control group A received Jacobson's progressive muscle relaxation technique. RESULTS With a p value of 0.001, transcutaneous auricular vagal nerve (taVNS) stimulation significantly improved sleep quality and reduced anxiety after 4 weeks.The post-intervention assessment revealed a highly significant improvement in Group A, with a T value of 251 (p < 0.001). CONCLUSION The findings suggest that taVNS may be an effective intervention for addressing anxiety and sleep issues in geriatric medical professionals. These results contribute to the exploration of non-invasive strategies to enhance the well-being of healthcare professionals working in demanding environments.
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Affiliation(s)
- Vignesh Srinivasan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Kumaresan Abathsagayam
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Prathap Suganthirababu
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Jagatheesan Alagesan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Surya Vishnuram
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
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Srinivasan V, Abathsagayam K, Suganthirababu P, Alagesan J, Vishnuram S, Vasanthi RK. Anxiety's correlation with sleepiness and memory among security officers during the COVID-19 pandemic. Work 2023:WOR230144. [PMID: 38143408 DOI: 10.3233/wor-230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND In the working population especially among older adults, anxiety problems have grown dramatically. This element has a significant impact on employee absenteeism and problems with physical and mental health. It was widely known that security personnel had several physical and mental difficulties during their various work hours. It is important to investigate the effects of anxiety on them. OBJECTIVE The present study aims to provide insights into the prevalence of anxiety disorders and explore the correlations between anxiety symptoms, sleep, and memory during the COVID-19 pandemic. METHODS To conduct a cross-sectional study, 42 older adult participants between the ages of sixty to seventy years were chosen and the procedure was explained.Data were gathered by giving instructions on how to complete the self-reported Generalized Anxiety Disorder Assessment -7 (GAD-7), the Epworth Sleepiness Scale, and the revised Everyday Memory Questionnaire. RESULTS A total of 36 out of 42 participants (85.71%) experienced moderate to severe anxiety. Anxiety and sleep had a correlation of 0.8, while anxiety and memory had a correlation of 0.87 with a positive EMQ-R relationship. Moreover, there was a statistically significant association between sleep and memory, with a positive correlation of 0.73. CONCLUSION The study concludes that, there is a substantial prevalence of anxiety accompanied by notable insomnia and memory problems in elderly security officers. Our findings indicate a clear relationship between sleep disturbances, memory issues, and most prevalent anxiety symptoms. These results emphasize the importance of incorporating mental health assessments and addressing an effective treatment for anxiety.
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Affiliation(s)
- Vignesh Srinivasan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Kumaresan Abathsagayam
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Prathap Suganthirababu
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Jagatheesan Alagesan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
| | - Surya Vishnuram
- Saveetha College of Physiotherapy, Saveetha Institute of Medical & Technical Sciences, Chennai, India
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Rahman HH, Akinjobi Z, Gard C, Munson-McGee SH. Sleeping behavior and associated factors during COVID-19 in students at a Hispanic serving institution in the US southwestern border region. Sci Rep 2023; 13:11620. [PMID: 37464098 DOI: 10.1038/s41598-023-38713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Sleep is responsible for maintenance and regulatory functions in human physiology. Insufficient sleep has been associated with cardiovascular disease, weight gain, obesity, inflammation, and morbidity. University students are at high risk under normal circumstances of stress and anxiety due to extracurricular demands, competing pressures on student time, long study hours, and financial concerns. The COVID 19 pandemic has disrupted normal college students' lives adding stresses such as lost jobs and family responsibilities such as serving as caregivers, which disproportionally affect minority and rural student. This study aimed to assess the correlation of sleep disorders in New Mexico State University students during COVID 19 with selected variates including base demographics (e.g., gender, age, etc.), lifestyle metrics (e.g., employment status, discipline, class, etc.), living arrangements (e.g., housing type, number of children, etc.), alcohol and tobacco use, vaccination status, family COVID status, and family vaccination status. Single- and multi-factor logistic regressions were performed to analyze the data on the students. Qualtrics software was used to collect data on demographics and sleep disorders. R software was used for data analysis. Correlations were found between sleeping less, sleeping more, and disturbed sleep among several covariate categories. For all three responses, being married (sleeping less: OR = 0.342, 95% CI = 0.181-0.642, sleeping more: OR = 0.265, 95% CI = 0.111-0.591; disturbed sleeping: OR = 0.345, 95% CI = 0.182-0.650), frequency of feeling sleepy-very often (OR = 16.87, 95% CI = 6.571-47.434; OR = 8.393, 95% CI = 3.086-25.298; OR = 13.611, 95% CI = 5.409-36.975) and change in diet- quality decreased (OR = 7.304, 95% CI = 3.615-15.270; OR = 5.250, 95% CI = 2.309-12.558; OR = 4.181, 95% CI = 2.145-8.359) were all significant correlated to change in sleeping behavior. Other correlations were found among covariates and sleep changes. Several covariates were determined to be correlated with the effect of COVID-19 on sleeping.
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Affiliation(s)
- Humairat H Rahman
- Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, 88003, USA.
| | - Zainab Akinjobi
- Department of Economics, Applied Statistics and International Business, New Mexico State University, Las Cruces, NM, 88003, USA
| | - Charlotte Gard
- Department of Economics, Applied Statistics and International Business, New Mexico State University, Las Cruces, NM, 88003, USA
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Lu HR, Yang A, Li X, He MZ, Sun JY. A new nursing pattern based on ERAS concept for patients with lumbar degenerative diseases treated with OLIF surgery: A retrospective study. Front Surg 2023; 10:1121807. [PMID: 37091266 PMCID: PMC10116060 DOI: 10.3389/fsurg.2023.1121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
ObjectiveThe purpose of this study was to introduce enhanced recovery after surgery (ERAS) concept into patients with lumbar degenerative diseases who were treated with oblique lumbar interbody fusion (OLIF), and to assess whether it could increase clinical efficacy, reduce perioperative complications, shorten length of hospital stay (LHS), decrease readmission rate, and improve patient satisfaction.MethodsThe study included patients with lumbar degenerative diseases (LDDs) who underwent OLIF between July 2017 and October 2018 (non-ERAS group), and between November 2018 and July 2020 (ERAS group). The two groups were compared according to the demographic and clinical characteristics.ResultsThere was no significant difference in descriptive characteristics and concomitant diseases between the two groups. The preoperative Oswestry disability index (ODI) score (P = 0.191), lumbar visual analogue scale (VAS) score (P = 0.470), and leg VAS score (P = 0.657) did not significantly different. Most of the ERAS measures were also well implemented after surgery, except for early delivery (74.2%), early catheter removal (63.9%), and multimodal analgesia (80.6%). The LHS in the ERAS group was significantly shorter than that in the non-ERAS group (P = 0.004). Besides, Hamilton Anxiety Rating Scale (HAMA) score at 3 days after surgery showed a significant difference between the two groups (P = 0.019). The patient satisfaction in ERAS group was significantly higher than that in the non-ERAS group (P = 0.001).ConclusionThe new nursing pattern combined with ERAS in patients with LDDs who underwent OLIF did not improve the short-term prognosis of surgery, while it could effectively reduce postoperative complications, shorten the LHS, and improve patient satisfaction, and did not lead to additional adverse events.
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Cerebral Venous-Associated Brain Damage May Lead to Anxiety and Depression. J Clin Med 2022; 11:jcm11236927. [PMID: 36498502 PMCID: PMC9738348 DOI: 10.3390/jcm11236927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background and purpose: Anxiety and depression are common in patients with Cerebral venous outflow disturbance (CVOD). Here, we aimed to explore possible mechanisms underlying this phenomenon. Methods: We enrolled patients diagnosed with imaging-confirmed CVOD, including internal jugular venous stenosis (IJVS) and cerebral venous sinus stenosis (CVSS) between 2017 and 2020. All of them had MRI/PWI scans. The Hamilton Anxiety Scale (HAMA) and 24-item Hamilton Depression Scale (HAMD) were used to evaluate the degree of anxiety and depression at the baseline and three months post-stenting. In addition, the relationships between the HAMA and HAMD scores, white matter lesions, and cerebral perfusion were analyzed using multiple logistic regressions. Results: A total of 61 CVOD patients (mean age 47.95 ± 15.26 years, 59.0% females) were enrolled in this study. Over 70% of them reported symptoms of anxiety and/or depression. Severe CVOD-related anxiety correlated with older age (p = 0.046) and comorbid hyperlipidemia (p = 0.005). Additionally, head noise, sleep disturbances, and white matter lesions (WMLs) were common risk factors for anxiety and depression (p < 0.05). WMLs were considered an independent risk factor for anxiety based on multiple regression analysis (p = 0.029). Self-contrast displayed that CVOD-related anxiety (p = 0.027) and depression (p = 0.017) scores could be corrected by stenting, as the hypoperfusion scores in the limbic lobes of patients with anxiety and depression were significantly higher than those in patients without. Conclusions: CVOD-induced hypoperfusion-mediated changes in the white matter microstructure may represent an underlying mechanism of anxiety and depression in patients with chronic CVOD.
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Hailu Tesfaye A, Alemayehu M, Abere G, Kabito GG. Risk factors for the prevalence of poor sleep quality in lecturers during COVID-19 pandemic in Ethiopia: an institution-based cross-sectional study. BMJ Open 2022; 12:e066024. [PMID: 36198464 PMCID: PMC9534775 DOI: 10.1136/bmjopen-2022-066024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study was conducted to assess the prevalence and risk factors of poor sleep quality (SQ) among the academic staff at the University of Gondar, Northwestern Ethiopia. DESIGN An institution-based cross-sectional study was conducted from March to April 2021. A validated, self-administered, standardised Pittsburgh Sleep Quality Index (PSQI) was used to quantify the amount of self-reported poor SQ. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14 software. Binary logistic regressions were computed to determine the association between variables. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05. SETTING The study was conducted at the University of Gondar, Northwestern Ethiopia. PARTICIPANTS A total of 607 lecturers participated in this study. OUTCOME MEASURES The primary outcome is the prevalence of poor SQ, which was measured using the PSQI. RESULTS Overall response rate was 95.60% (N=607). The age of the participants ranges from 21 to 70 with a mean of 32.39 (SD±6.80) years. The magnitude of poor SQ during the COVID-19 pandemic in the last month was 60.30% (95% CI (56.28% to 64.21%)). Working greater than 10 hours per day (AOR=2.19, 95% CI (1.16 to 4.27)), electronic device use before bedtime (AOR=1.53, 95% CI (1.04 to 2.27)), high-risk perception of COVID-19 infections (AOR=1.60, 95% CI (1.04 to 2.46)) and perceived job stress (AOR=2.15 (95% CI (1.50 to 3.08)) were risk factors for poor SQ. CONCLUSION The study revealed that the prevalence of poor SQ was high during the COVID-19 pandemic. The finding highlights the importance of optimising the working hours per day, minimising electronic device use before bedtime, promoting risk perception toward COVID-19 infection and developing workplace coping strategies for stress, which play a substantial role in minimising poor SQ.
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Affiliation(s)
- Amensisa Hailu Tesfaye
- Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - M Alemayehu
- Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Giziew Abere
- Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Gebisa Guyasa Kabito
- Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Daniels BT, Howie EK. Relationships between physical fitness, health behaviors, and occupational outcomes in students, faculty, and staff of an American university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-8. [PMID: 35930403 DOI: 10.1080/07448481.2022.2107874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study examined relationships between physical fitness, health behaviors, and occupational outcomes of university affiliates. PARTICIPANTS 166 university affiliates of an American university (including students, faculty, and staff) participated between October 2018 and March 2020. METHODS Participants completed fitness measurements, wore a device to measure physical activity (PA) and sleep for one week, and completed a survey evaluating happiness and job satisfaction. Multiple regression models evaluated associations between physical fitness, health behaviors, and occupational outcomes. RESULTS 45% of participants had "poor" cardiorespiratory fitness (CRF) and unhealthy % fat. CRF, body composition, and muscular endurance were related to PA while body composition was related to sleep duration. Muscular endurance was related to GPA and job satisfaction. CONCLUSIONS Findings suggest 45% of university affiliates had deficient physical fitness and may benefit from increasing PA and sleep. Universities should evaluate fitness within holistic programs to improve affiliates' health and, ultimately, occupational success.
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Affiliation(s)
- Bryce T Daniels
- Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, USA
| | - Erin K Howie
- Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, USA
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FREQUENCY OF DAYTIME SLEEPINESS OF FACTORY WORKERS WORKING IN SHIFTS AND ITS EFFECT ON ANXIETY. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2020. [DOI: 10.33457/ijhsrp.720685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Jackson CL, Johnson DA. Sleep disparities in the era of the COVID-19 pandemic highlight the urgent need to address social determinants of health like the virus of racism. J Clin Sleep Med 2020; 16:1401-1402. [PMID: 32400388 DOI: 10.5664/jcsm.8570] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services.,Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University
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The onset of sleep disturbances and their associations with anxiety after acute high-altitude exposure at 3700 m. Transl Psychiatry 2019; 9:175. [PMID: 31332159 PMCID: PMC6646382 DOI: 10.1038/s41398-019-0510-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/30/2019] [Accepted: 05/31/2019] [Indexed: 11/22/2022] Open
Abstract
Sleep disturbances and psychiatric repercussions pose great challenges at high altitude; however, few studies have investigated sleep disturbance and anxiety profiles and their associations after acute exposure in consecutive patients. Thus, we aimed to study the profiles of sleep disturbances in consecutive patients after high-altitude exposure and the association of such disturbances with anxiety. A total of 668 participants were recruited at sea level and 3700 m. The trials were performed at sea level (1 week prior to a 2-h flight to a high-altitude destination) and at 3700 m (24, 72, and 168 h). Sleep disturbances were assessed by self-reported sleep patterns and scores on the Athens Insomnia Scale (AIS). State anxiety was assessed using the Self-Rating Anxiety Scale (SAS). In our study, the incidence of sleep disturbances increased significantly after acute high-altitude exposure (65.3%, 434/668) and then gradually decreased after 72 h (50%, 141/282) and 168 h (44%, 124/282). The sleep assessments AIS [2.0 (4.0) vs. 4.0 (5.0)] and ESS [4.0 (4.0) vs. 5.0 (5.0)] increased significantly (p < 0.05). Also, the SAS increased significantly from 26.25 (3.75) to 28.75 (7.5). The SAS was significantly high in sleep disturbance group [31.25 (7.5) vs. 27.5 (5), p < 0.001] than in the non-sleep- disturbance group. The baseline SAS and AIS scores were significantly higher in participants with sleep disturbances than in those without (p < 0.01). Age, baseline insomnia, sleepiness, fatigue, and higher SAS were predictors of sleep disturbances in univariate regression (all p values < 0.05). However, only an older age (p = 0.045) and a higher baseline SAS (p = 0.018) remained independent predictors of sleep disturbances. Our findings indicated that acute high-altitude exposure triggers the onset of sleep disturbances, which are closely associated with anxiety. Furthermore, baseline state anxiety and age are independent predictors of sleep disturbances at high altitude.
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Jehan S, Myers AK, Zizi F, Pandi-Perumal SR, Jean-Louis G, Singh N, Ray J, McFarlane SI. Sleep health disparity: the putative role of race, ethnicity and socioeconomic status. SLEEP MEDICINE AND DISORDERS : INTERNATIONAL JOURNAL 2018; 2:127-133. [PMID: 31179440 PMCID: PMC6553614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sleep plays a pivotal role in both physical and mental health. Sleep quality can be affected by many socio demographic factors, such as race and/or ethnicity, as well as socio economic status (SES). Chronic sleep deprivation is associated with unhealthy behaviors such as alcohol abuse and also places individuals at risk for chronic diseases including obesity, cardiovasculardisease (CVD), depression, and/or anxiety. This review explores the common socio demographic factors and SES that can lead to sleep disturbances. Among these factors are shift work, poor dietary habits, smoking and alcohol abuse. Such factors need to be considered by health care providers in the clinical assessment and management plans of patients with sleep disorders.
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Affiliation(s)
- Shazia Jehan
- Department of Population Health, New York University School of Medicine, USA
| | - Alyson K Myers
- Department of Medicine, North Shore University Hospital, USA
| | - Ferdinand Zizi
- Department of Medicine, North Shore University Hospital, USA
| | | | - Girardin Jean-Louis
- Department of Population Health, New York University School of Medicine, USA
| | - Navneet Singh
- Department of Medicine, SUNY Downstate Medical Center, USA
| | - Justina Ray
- Department of Medicine, SUNY Downstate Medical Center, USA
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