Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease?

'Let's talk about sleep health' within primary care: a qualitative study of patients' willingness to engage in psychological interventions for insomnia

BACKGROUND

Cognitive behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia yet remains underutilised in general practice. Understanding patient motivations and barriers to engaging in psychological interventions for insomnia is critical. Theoretical frameworks, such as the theory of planned behaviour, are needed to identify variables related to intentions and behaviour change.

AIM

To explore key influences that motivate individuals' intention to engage with psychological interventions for insomnia.

DESIGN AND SETTING

Qualitative study consisting of an online survey and interviews with 20 community-dwelling participants with insomnia aged 26-75 years residing in Victoria, Australia.

METHOD

Guided by the theory of planned behaviour, reflexive thematic analysis was used to identify factors influencing participants' intention to engage with psychological interventions for insomnia.

RESULTS

Participants reported positive attitudes towards psychological interventions for insomnia, stemming from negative beliefs about pharmacological sleep aids and the perceived benefits of a structured and evidence-based intervention. Important others positively influenced participants' intention to engage; however, the GP influence was less consistent and often indirect. Participants believed in the efficacy of psychological interventions, but several barriers hampered their ability to benefit from them. Accessibility was identified as a key facilitator, whereas lack of knowledge and clear referral pathways were the main barriers having an impact on uptake.

CONCLUSION

This study highlights key factors influencing patients' intention to engage in psychological interventions for insomnia as well as opportunities for GPs to support uptake and engagement. Routine conversations about sleep health are essential to reduce the burden of untreated insomnia in the community, and the active promotion of evidence-based psychological interventions is needed.

Move your feet and sleep: A longitudinal dynamic analysis of self-reported exercise, sedentary behavior, and insomnia symptoms

INTRODUCTION

Insomnia symptoms are associated with poor physical and mental health. Exercise is associated with good sleep while sedentary behavior is associated with poor sleep. This study investigated the longitudinal, dynamic associations among exercise, sedentary behavior, and insomnia symptoms.

METHODS

Seven hundred and fifty-six adults (Mage=47.2years, 54.9% female) took part in an online longitudinal study investigating sleep and health across the lifespan. Participants reported duration of moderate-to-strenuous exercise, percentage of day spent sitting, and insomnia symptoms (Insomnia Severity Index [ISI]). The ISI was scored as a total score and two-factor scores: (1) Sleep Disturbance (items 1, 2, 3) and (2) Daytime Dysfunction (items 4, 5, 6, 7). Multilevel modeling was used to examine the typical (i.e., between-persons) and individual (i.e., within-persons) associations among sedentary behavior, exercise, and insomnia symptoms.

RESULTS

Sedentary behavior was significantly associated with total ISI scores at both the between-person and within-person levels (β = 0.036, t = 3.23, p = .001; β = 0.014, t = 1.99, p = .048). Both between-persons and within-person levels of sedentary behavior were associated with Daytime Dysfunction (β = 0.028, t = 3.79, p < .001; β = 0.009, t = 2.08, p = .039). Exercise was associated with total ISI and Daytime Dysfunction scores at the between-persons level but not at the within-persons level (β = 0.028, t = 2.57, p = .01; β = -0.002, t = -3.02, p = .003).

CONCLUSIONS

Sedentary behavior was a more consistent and robust predictor of insomnia symptoms than exercise. The association between sedentary behavior and insomnia symptoms was dynamic in that when an individual reported being more sedentary than their norm, they also reported more insomnia symptoms. Future analyses should examine potential moderator variables and comorbid conditions.

Explanatory variables of objectively measured 24-h movement behaviors in people with prediabetes and type 2 diabetes: A systematic review

AIM

Physical activity (PA), sedentary behavior (SB) and sleep (i.e. 24-h movement behaviors) are associated with health indicators in people with prediabetes and type 2 diabetes (T2D). To optimize 24-h movement behaviors, it is crucial to identify explanatory variables related to these behaviors. This review aimed to summarize the explanatory variables of 24-h movement behaviors in people with prediabetes or T2D.

METHODS

A systematic search of four databases (PubMed, Web of Science, Scopus & Embase) was performed. Only objective measurements of 24-h movement behaviors were included in the search strategy. The explanatory variables were classified according to the levels of the socio-ecological model (i.e. intrapersonal, interpersonal and environmental). The risk of bias was assessed using the Joanna Briggs Institute appraisal checklist.

RESULTS

None of the 78 included studies investigated 24-h movement behaviors. The majority of the studies investigated PA in isolation. Most studied explanatory variables were situated at the intrapersonal level. Being male was associated with more moderate to vigorous PA but less light PA in people with T2D, and more total PA in people with prediabetes. An older age was associated with a decrease in all levels of PA in people with T2D. HbA1c was positively associated with sleep and SB in both groups. No associations were found at the interpersonal or environmental level.

CONCLUSION

The results of this review underscore the lack of a socio-ecological approach toward explanatory variables of 24-h movement behaviors and the lack of focus on an integrated 24-h movement behavior approach in both populations.

High levels of sleep disturbance across early childhood increases cardiometabolic disease risk index in early adolescence: longitudinal sleep analysis using the Health Outcomes and Measures of the Environment study

STUDY OBJECTIVES

This study examines the impact of sleep duration, bedtime, and sleep disturbance during early childhood on the risk of cardiometabolic disorder (CMD) in early adolescence.

METHODS

Within the Health Outcomes and Measures of Environment Study, we examined sleep patterns of 330 children from ages 2 to 8 years and the relationship of these sleep patterns with cardiometabolic risk measures at age 12 (N = 220). We used a group-based semi-parametric mixture model to identify distinct trajectories in sleep duration, bedtime timing, and sleep disturbance for the entire sample. We then examined the associations between sleep trajectories and CMD risk measures using general linear models using both an unadjusted model (no covariates) and an adjusted model (adjusting for child pubertal stage, child sex, duration of breastfeeding, household income, maternal education, and maternal serum cotinine).

RESULTS

In the unadjusted and adjusted models, we found significant differences in CMD risk scores by trajectories of sleep disturbance. Children in the "high" disturbance trajectory had higher CMD risk scores than those in the 'low' disturbance trajectory (p's = 0.002 and 0.039, respectively). No significant differences in CMD risk were observed for bedtime timing or total sleep time trajectories in the unadjusted or adjusted models.

CONCLUSIONS

In this cohort, caregiver-reported sleep disturbance in early childhood was associated with more adverse cardiometabolic profiles in early adolescence. Our findings suggest that trials to reduce CMD risk via sleep interventions-which have been conducted in adolescents and adults-may be implemented too late.

Childhood sleep: physical, cognitive, and behavioral consequences and implications

BACKGROUND

Sleep problems in children have been increasingly recognized as a major public health issue. Previous research has extensively studied and presented many risk factors and potential mechanisms for children's sleep problems. In this paper, we aimed to identify and summarize the consequences and implications of child sleep problems.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info published in the past two decades. Both relevant data-based articles and systematic reviews are included.

RESULTS

Many adverse consequences are associated with child sleep deficiency and other sleep problems, including physical outcomes (e.g., obesity), neurocognitive outcomes (e.g., memory and attention, intelligence, academic performance), and emotional and behavioral outcomes (e.g., internalizing/externalizing behaviors, behavioral disorders). Current prevention and intervention approaches to address childhood sleep problems include nutrition, exercise, cognitive-behavioral therapy for insomnia, aromatherapy, acupressure, and mindfulness. These interventions may be particularly important in the context of coronavirus disease 2019. Specific research and policy strategies can target the risk factors of child sleep as well as the efficacy and accessibility of treatments.

CONCLUSIONS

Given the increasing prevalence of child sleep problems, which have been shown to affect children's physical and neurobehavioral wellbeing, understanding the multi-aspect consequences and intervention programs for childhood sleep is important to inform future research direction as well as a public health practice for sleep screening and intervention, thus improving sleep-related child development and health.

Childhood sleep: assessments, risk factors, and potential mechanisms

BACKGROUND

Sleep problem is a highly prevalent health issue among pediatric populations across the world. In this review, we aimed to identify risk factors contributing to sleep deficiency and poor sleep hygiene in children. Potential biological, psychosocial, and environmental mechanisms as well as research gaps in the literature are also discussed.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info. Both relevant data based and systematic reviews are included.

RESULTS

This paper summarizes many risk factors for childhood sleep problems, including biological (e.g., genetics, gender, age and puberty, prenatal factors, postnatal factors); nutritional (e.g., macronutrients, micronutrients, omega-3 fatty acids, obesity); environmental (e.g., heavy metals, noise, light, air pollution); interpersonal (e.g., family, exposure to violence, screen media use, physical injury); and community/socioeconomic variables (e.g., racial/ethnicity and cultural factors, neighborhood conditions and socioeconomic status, school factors, public health disasters/emergencies), to better understand the development of sleep problems in children.

CONCLUSIONS

Poor childhood sleep is a multifactorial issue affected by a wide range of prenatal and early-life biological, environmental, and psychosocial risk factors and contributors. A better understanding of these risk factors and their mechanisms is an important first step to develop future research and prevention programs focusing on pediatric sleep problems.

Exploring factors that influence the cardiovascular health of bus drivers for the improvement of transit safety

The causes of traffic accidents include sudden cardiovascular disease events of drivers that go undetected in routine physical examinations of their health. While increased attention has been paid to proactive driver management by the frequent monitoring of drivers' mental and physical condition to avoid such events, very few studies have examined the deeper risk factors that influence the cardiovascular health of bus drivers represented by workload and scheduling. To fill this knowledge gap, this study adopts a data mining approach to exploring the factors influencing the cardiovascular health of intercity bus drivers using their daily cardiovascular measurement data along with their schedules and routine physical examination results. Ten influencing factors were identified, including medical history, late-night habits and afternoon and evening driving schedules. The present findings will be useful for preventing accidents where cardiovascular disease is involved, which in turn will help improve transit safety.

The motivation behind better sleep: self-determination as a framework for examining sleep outcomes in college students

OBJECTIVE

To examine sleep health within a self-determination framework across a diverse college sample.

PARTICIPANTS

A nonclinical sample of undergraduate students (n = 399) from a large, urban, public university in the Mid-Atlantic United States in Spring 2020.

METHODS

Participants were recruited via an online research participation portal and received extra credit for participation. All measures were administered via an online survey.

RESULTS

Basic psychological need satisfaction was associated with sleep health. This association was partially mediated by sleep hygiene but not by regulatory style. There were no racial/ethnic differences in sleep health, sleep hygiene, basic need satisfaction, or regulatory style. Men reported more maladaptive motivational styles for sleep health, and non-binary/transgender students reported worse sleep hygiene.

CONCLUSION

Basic psychological need satisfaction and sleep hygiene are critical targets for intervention across diverse college student populations. Motivation may be less critical for nonclinical interventions.

How Are You Sleeping? Why Nutrition Professionals Should Ask Their Patients About Sleep Habits

Current literature has identified relationships among sleep, nutrition, and diet-related chronic diseases; however, knowledge about how sleep influences diet-related diseases is lacking in dietetics practice. This narrative review briefly explains sleep physiology and outlines the relationships between sleep duration and quality and common nutrition-related diseases, including obesity, diabetes, cardiovascular disease, obstructive sleep apnea, and cancer. Additionally, the review discusses how sleep influences wound healing and pregnancy outcomes and why hospitalized patients are likely to experience sleep problems. Plausible mechanisms explaining the relationships between sleep and disease are presented. Finally, commonly used sleep assessment tools and interventions are reviewed. Given the importance of sleep to health, dietitians should not only be aware of the role sleep plays in disease development and prevention but also assess sleep when feasible and refer patients and clients who are at high risk for sleep problems to a sleep clinic or community program that can address sleep issues.Teaching points:Sleep duration and quality influence risk and outcomes of common nutrition-related diseases.Sleep health evaluation is a missing piece in dietetic practice.There are easy-to-use, validated tools that dietitians can use to screen for sleep problems in order to refer patients and clients to sleep experts.

Regular, intermittent, and spontaneous: Patterns of preschool Children's nap behavior and their correlates

BACKGROUND

Daytime sleep during the preschool years (i.e., 1-5-years-old) is characterized by high inter-child variability in several components of nap behavior, including nap duration, nap timing, and the proportion of sleep during daytime. We used an empirical approach to examine variations amongst children in these aspects of napping and investigated correlates of these components of nap behavior.

METHODS

A large, nationally representative sample (N = 702) of Canadian parents completed an online survey, including a one-month retrospective report of their 1.5-5 year old's daytime and nighttime sleep behavior and other questionnaires. To understand patterns of children's nap behaviors we applied Latent Profile Analysis (LPA) to typical nap duration, typical timing of naps, frequency of naps, proportion of sleep during the daytime, and the proportion of naps which were spontaneous (i.e., child just fell asleep). Then, multinominal logistic regression was used to examine correlates of profile membership.

RESULTS

Four profiles of children emerged: (1) regular nappers; (2) intermittent nappers; (3) spontaneous nappers; and (4) non-nappers. After controlling for demographic variables (e.g., child age, sex, ethnicity) and known correlates of napping behaviors (e.g., birthweight, nighttime sleep duration), profile membership was related to parents' beliefs about napping, parents' own nap behaviors, family functioning, and child nighttime sleep problems in a multinominal logistic regression.

CONCLUSIONS

An empirical approach aided in understanding the inter-child variability in napping amongst preschool-age children. Parental beliefs about napping and the home environment were shown to be critical factors influencing this variability.

Multidimensional Sleep and Cardiometabolic Risk Factors for Type 2 Diabetes: Examining Self-Report and Objective Dimensions of Sleep

Purpose:

The purpose of the study was to determine the association between objective and self-report measures of sleep and cardiometabolic risk factors for type 2 diabetes.

Methods:

This study examines data on Australian adults, collected as part of the Child Health CheckPoint study. Sleep was examined in terms of actigraphy-derived sleep duration, timing, efficiency and variability; and self-report trouble sleeping. Cardiometabolic risk factors for type 2 diabetes were examined in terms of body mass index and biomarkers of inflammation and dyslipidemia. Generalized estimating equations, adjusted for geographic clustering, were used to determine the association between measures of sleep and cardiometabolic risk factors.

Results:

Complete case analysis was conducted for 1017 parents (87% mothers). Both objective and self-report measures of sleep were significantly but weakly associated with cardiometabolic risk factors.

Conclusion:

Both objective and self-report measures of sleep are significantly associated with cardiometabolic risk factors for type 2 diabetes. Self-report troubled sleep is associated with poorer cardiometabolic health, independent of actigraphy-derived sleep parameters.

Lack of direct association between viral hepatitis and sleep disturbances

Background

Individuals with chronic viral hepatitis are at increased risk of experiencing poor sleep quality and sleep disturbances. However, it remains unclear whether the sleep disorders associated with viral hepatitis are secondary to the comorbidities related to viral hepatitis or the direct effect of hepatitis viruses on sleep. This study investigated the direct impact of viral hepatitis B and C on sleep quality.

Methods

Individuals with viral hepatitis B or C and their healthy counterparts were recruited for the present study, and they were evaluated with the Parkinson's Disease Sleep Scale-2, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index in the absence of common comorbidities associated with viral hepatitis.

Results

Neither hepatitis B nor hepatitis C was found to cause significant differences in insomnia symptoms or excessive daytime sleepiness. However, individuals with hepatitis C, but not hepatitis B, tended to be less likely to experience restlessness of the legs or arms at night.

Conclusions

This study suggests that hepatitis viruses B and C may not cause a significant impact on sleep quality and related disorders directly. Sleep disturbances in individuals with chronic viral hepatitis may instead be attributable to hepatic decompensation or the comorbid factors associated with viral hepatitis.

An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research

Simple Summary

This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care.

Abstract

Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.

Indoor air quality and sick building syndrome in a university setting: a case study in Greece

The perceived Indoor Air Quality (IAQ), the prevalence of Sick Building Syndrome (SBS) symptoms and its contributing risk factors were assessed in a university during the period of the economic crisis in Greece. Data was collected from 613 employees via questionnaires. Hierarchical linear regression analysis was performed. The most prevalent perceived IAQ complaints were 'Dust and dirt' (63.2%), 'Room temperature too low' (24.9%) and 'Varying room temperature' (24.4%). The most frequently reported SBS symptom was 'Fatigue' (34.1%). The prevalence of General, Mucosal and Dermal symptoms was 40.8%, 19.8% and 8.1%, respectively. Several contributing risk factors were identified, such as IAQ Discomfort Scale, atopy, sleep problems, female, exposure to biological and chemical agents, PC-use, Psychosocial Work Scale and job satisfaction. Poor perceived IAQ and high prevalence of SBS symptoms were reported from the university staff in a temperate climate country. SBS seemed to be multifactorial.

Sleep architecture of short sleep time in patients with obstructive sleep apnea: a retrospective single-facility study

PURPOSE

Sleep architecture consists of rapid eye movement (REM) sleep and non-REM sleep time. Non-REM sleep time is further classified into three stages by depth (stage N1-N3). Some studies have reported that short sleep time predicts all-cause mortality. Short sleep time can have characteristics of sleep architecture which contribute to poor prognosis. Obstructive sleep apnea (OSA) is a disease which causes cessation or decline of ventilation during sleep due to upper airway stenosis and affects sleep architecture. Few studies have reported on the sleep architecture of short sleep time in patients with OSA. Therefore, we aimed to observe this phenomenon.

METHODS

From May 2008 to September 2021, patients diagnosed with OSA at our facility were assessed for clinical history and underwent full-night polysomnography (PSG). These patients were classified into two groups: total sleep time (TST) recorded on PSG consisting of a short TST (< 7 h) group and a not short TST (≥ 7 h) group.

RESULTS

Of 266 patients with OSA, compared to the not short TST group (n = 131), the short TST group (n = 135) had a lower REM sleep time (%) and a higher stage N1 sleep time (%). There was a significant difference in age between the two groups, so sub-analyses classified the patients by age: non-elderly patients (< 65 years) and elderly patients (≥ 65 years) to adjust for age. Both sub-analyses showed similar results to the analysis for the combined ages regarding sleep architecture.

CONCLUSION

Patients with OSA who had short sleep time had disordered sleep architecture with a lower REM sleep time (%) and more stage N1 sleep time.

Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners

Background

Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice.

Methods

A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis. 

Results

Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited. 

Conclusions

General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice.

The Sleep Regularity Questionnaire: development and initial validation

BACKGROUND/OBJECTIVE

Sleep is a critically important behavior which influences diverse aspects of health, functioning, and longevity. An increasing literature suggests the importance of sleep regularity, also referred to as sleep inconsistency, sleep variability, or intraindividual variability in sleep. Given there is no brief, subjective measure of sleep regularity, the purpose of this study was to develop the Sleep Regularity Questionnaire (SRQ) and to begin the process of examining its psychometric properties using a construct-validation approach.

PARTICIPANTS/METHODS

In an online study of sleep and health, participants (n = 3249; M_age (SD) = 42.77 (16.73); 48.5% female; 77.3% white) completed the in-development SRQ, as well as the Insomnia Severity Index and the Pittsburgh Sleep Quality Index.

RESULTS

An exploratory factor analysis followed by a confirmatory factor analysis revealed a two factor structure, represented by circadian regularity and sleep continuity regularity, with good model fit indices (X² = 50.9, df = 7, p < 0.001; RMSEA = 0.06; CFI = 0.99; NFI = 0.99; IFI = 0.99; TLI = 0.98). Test-retest reliability, as well as concurrent, convergent and incremental validity were examined, with promising results.

CONCLUSIONS

Preliminary psychometrics suggest that the SRQ is a valid and stable instrument for the assessment of sleep regularity in adults that is related to, but distinct from, other established sleep constructs. Future research will benefit from assessing the validity of the SRQ in various clinical samples and how it compares to measures of sleep regularity calculated from prospective daily assessments.

Lifestyle Factors and Sleep Health across the Lifespan

Sleep health, operationalized as a multidimensional construct consisting of sleep regularity, satisfaction, alertness, timing, efficiency, and duration, is an emerging concept in the field of sleep medicine which warrants further investigation. The purpose of the present study was to: (1) compare sleep health across the lifespan, (2) determine lifestyle factors associated with sleep health, and (3) examine whether lifestyle factors associated with sleep health varied between and within age groups. Participants consisted of 3284 individuals (Mean age = 42.70; 45% male) who participated in a cross-sectional online survey of sleep and health. Sleep health was measured using the RU-SATED scale, while demographic and lifestyle factors (e.g., daily social media use, sedentary activity, fast food consumption, etc.) were all self-reported. Sleep health was the highest among older adults (M = 8.09) followed by middle-aged (M = 7.65) and younger adults (M = 7.16). Across age groups, fast-food consumption, daily regularity, and daily TV, social media, or internet use were all negatively correlated with sleep health (ps < 0.05). Few differences in the association between lifestyle factors and sleep health across age groups were found. Overall, these findings may help to inform sleep health promotion efforts by targeting the most pertinent lifestyle factors for promoting sleep health.

Modeling Risk Factors for Sleep- and Adiposity-Related Cardiometabolic Disease: Protocol for the Short Sleep Undermines Cardiometabolic Health (SLUMBRx) Observational Study

Background

Obesity and short sleep duration are significant public health issues. Current evidence suggests that these conditions are associated with cardiovascular disease, metabolic syndrome, inflammation, and premature mortality. Increased interest in the potential link between obesity and short sleep duration, and its health consequences, has been driven by the apparent parallel increase in the prevalence of both conditions in recent decades, their overlapping association with cardiometabolic outcomes, and the potential causal connection between the two health issues. The SLUMBRx (Short Sleep Undermines Cardiometabolic Health) study seeks to contribute to the development of a comprehensive adiposity-sleep model while laying the groundwork for a future research program that will be designed to prevent and treat adiposity- and sleep-related cardiometabolic disease risk factors.

Objective

This SLUMBRx study aims to address 4 topics pertinent to the adiposity-sleep hypothesis: the relationship between adiposity and sleep duration; sex-based differences in the relationship between adiposity and sleep duration; the influence of adiposity indices and sleep duration on cardiometabolic outcomes; and the role of socioecological factors as effect modifiers in the relationship between adiposity indices, sleep, and cardiometabolic outcomes.

Methods

SLUMBRx will employ a large-scale survey (n=1000), recruiting 159 participants (53 normal weight, 53 overweight, and 53 obese) to be assessed in 2 phases.

Results

SLUMBRx was funded by the National Institutes of Health, Heart, Lung, and Blood Institute through a K01 grant award mechanism (1K01HL145128-01A1) on July 23, 2019. Institutional Review Board (IRB) approval for the research project was sought and obtained on July 10, 2019. Phase 1 of SLUMBRx, the laboratory-based component of the study, will gather objective adiposity indices (air displacement plethysmography and anthropometrics) and cardiometabolic data (blood pressure, pulse wave velocity and pulse wave analysis, and a blood-based biomarker). Phase 2 of SLUMBRx, a 1-week, home-based component of the study, will gather sleep-related data (home sleep testing or sleep apnea, actigraphy, and sleep diaries). During phase 2, detailed demographic and socioecological data will be collected to contextualize hypothesized adiposity and sleep-associated cardiometabolic disease risk factors. Collection and analyses of these data will yield information necessary to customize future observational and intervention research.

Conclusions

Precise implementation of the SLUMBRx protocol promises to provide objective and empirical data on the interaction between body composition and sleep duration. The hypotheses that will be tested by SLUMBRx are important for understanding the pathogenesis of cardiometabolic disease and for developing future public health interventions to prevent its conception and treat its consequences.

International Registered Report Identifier (IRRID)

PRR1-10.2196/27139

Comprehensive Overview of Sleep Disorders in Patients with Chronic Liver Disease

The impact of sleep disorders (SDs) on patients with chronic liver diseases (CLD) is tremendous. SDs are frequently encountered among these patients and interfere with their quality of life. This review aims to present the data available so far about the prevalence, phenotypes, and proposed pathophysiological mechanisms of SDs in CLD. Moreover, we proposed to search the literature regarding the most reliable methods to assess SDs and the possible therapeutic options in patients with CLD. The main results of this review show that when it comes to prevalence, the percentages reported vary widely between studies performed among populations from the USA or Europe and those coming from Asian countries. Furthermore, it has been proven that SDs may also be present in the absence of neurocognitive disorders attributable to hepatic encephalopathy (HE), which contradicts traditional suppositions where SDs were considered part of the clinical scenario of HE. Currently, there are no specific recommendations or protocols to assess SDs in CLD patients and data about the therapeutic management are limited. Taking into consideration their impact, a protocol for diagnosing and managing SDs should be developed and included in the daily practice of hepatologists.

Suboptimal sleep and incident cardiovascular disease among African Americans in the Jackson Heart Study (JHS)

BACKGROUND

Suboptimal sleep, including insufficient/long sleep duration and poor sleep quality, is a risk factor for cardiovascular disease (CVD) common but there is little information among African Americans, a group with a disproportionate CVD burden. The current study examined the association between suboptimal sleep and incident CVD among African Americans.

METHODS

This study included 4,522 African Americans without CVD at baseline (2000-2004) of the Jackson Heart Study (JHS). Self-reported sleep duration was defined as very short (<6 h/night), short (6 h/night), recommended (7-8 h/night), and long (≥9 h/night). Participants' self-reported sleep quality was defined as "high" and "low" quality. Suboptimal sleep was defined by low quality sleep and/or insufficient/long sleep duration. Incident CVD was a composite of incident coronary heart disease and stroke. Associations between suboptimal sleep and incident CVD were examined using Cox proportional hazards models over 15 follow-up years with adjustment for predictors of CVD risk and obstructive sleep apnea.

RESULTS

Sample mean age was 54 years (SD = 13), 64% female and 66% reported suboptimal sleep. Suboptimal sleep was not associated with incident CVD after covariate adjustment [HR(95% CI) = 1.18(0.97-1.46)]. Long [HR(95%CI) = 1.32(1.02-1.70)] and very short [HR(95% CI) = 1.56(1.06-2.30)] sleep duration were associated with incident CVD relative to recommended sleep duration. Low quality sleep was not associated with incident CVD (p = 0.413).

CONCLUSIONS

Long and very short self-reported sleep duration but not self-reported sleep quality were associated with increased hazard of incident CVD.

Late and Instable Sleep Phasing is Associated With Irregular Eating Patterns in Eating Disorders

BACKGROUND

Sleep problems are common in eating disorders (EDs).

PURPOSE

We evaluated whether sleep-phasing regularity associates with the regularity of daily eating events.

METHODS

ED patients (n = 29) completed hourly charts of mood and eating occasions for 2 weeks. Locomotor activity was recorded continuously by wrist actigraphy for a minimum of 10 days, and sleep was calculated based on periods of inactivity. We computed the center of daily inactivity (CenDI) as a measure of sleep phasing and consolidation of the daily inactivity (ConDI) as a measure of daily sleep rhythm strength. We assessed interday irregularities in the temporal structure of food intake using the standard deviation (SD) of frequency (IFRQ), timing (ITIM), and interval (IINT) of food intake. A self-evaluation of other characteristics included mood, anxiety, and early trauma.

RESULTS

A later phasing of sleep associated with a lower frequency of eating (eating frequency with the CenDI rho = -0.49, p = .007). The phasing and rhythmic strength of sleep correlated with the degree of eating irregularity (CenDI with ITIM rho = 0.48, p = .008 and with IINT rho = 0.56, p = .002; SD of CenDI with ITIM rho = 0.47, p = .010, and SD of ConDI with IINT rho = 0.37, p = .048). Childhood Trauma Questionnaire showed associations with variation of sleep onset (rho = -0.51, p = .005) and with IFRQ (rho = 0.43, p = .023).

CONCLUSIONS

Late and variable phasing of sleep associated robustly with irregular pattern of eating. Larger data sets are warranted to enable the analysis of diagnostic subgroups, current medication, and current symptomatology and to confirm the likely bidirectional association between eating pattern stability and the timing of sleep.

Metabolomics of sleep disorders in HIV: a narrative review

PURPOSE

Sleep disturbances are prevalent among patients with human immunodeficiency virus (HIV), even those who are being treated on antiretroviral therapy. It is important to understand the metabolomic mechanisms underlying sleep disturbances among people living with HIV (PLWH).

METHODS

A review of recent literature was performed to explore the use of metabolomics in understanding sleep among PLWH.

RESULTS

We found only two studies that used metabolomics to explore sleep health among PLWH.

CONCLUSION

This paper reviews common sleep disorders in HIV, the existing metabolomic studies that may explain the relationship, and implications for future research. The use of metabolomics in exploring sleep disorders among PLWH will help to elucidate mechanistic links to improve patient outcomes.

Sleep Health in Women of Childbearing Age

The concept of sleep health (adequate sleep duration and continuity, regular timing, satisfaction with sleep, and ability to maintain wakefulness during the day) is consistent with a definition of health as more than the absence of disease. Yet past research on women's sleep focused primarily on biological influences (e.g., hormonal fluctuations) or specific sleep disorders. We reviewed the literature on sleep health in women of childbearing age from the perspectives of health promotion and the social ecological model and identified needs for future research and intervention. At least 40% of women of childbearing age report inadequate sleep, and sleep is associated with short- and long-term health and performance outcomes. Numerous sociodemographic, psychosocial, role, familial, and community factors contribute to sleep, but few studies have addressed the contributions of these factors to sleep health in women of childbearing age, aside from those who are pregnant. Understanding these factors may assist in identifying women at particular risk for sleep difficulty; some may be modifiable, and other may signal the need for sleep interventions tailored to specific circumstances. Low-income women and those in ethnic and racial minority groups are at particular risk for disparities in sleep health. There is a need for research that addresses these factors and the development of interventions at the individual, family, and community levels to promote sleep health. Screening and intervention to promote health sleep and decrease sleep difficulty should be a standard of care in clinical, community, and workplace settings frequented by women.

Prospective relationships of mentally passive sedentary behaviors with depression: Mediation by sleep problems

BACKGROUND

As distinct from mentally-active sedentary behaviors (e.g. reading), passive sedentary behaviors (e.g. TV-viewing) have been linked to a higher risk of depression, but the underlying mechanisms are unclear. We examined the potential mediating role of sleep problems in prospective relationships of passive sedentary behaviors with major depressive disorder (MDD).

METHOD

In 1997, 43 863 adults were surveyed and responses linked to clinician diagnoses of MDD until 2010. The questionnaire included items on sedentary behavior and sleep problems (Karolinska Sleep Questionnaire). Cox proportional hazard models and the 'counterfactual approach' were used to identify potential mediating effects of sleep problems in the association of passive sedentary behavior and MDD.

RESULTS

Of the total sample, 3,065 (7.6%) were excluded for having indications of depression at baseline. Of 33,116 participants with complete data (mean age = 51.3 years, SD = 15.7, 64% female); 472 (1.4%) incident cases of MDD were identified during the 13-year follow-up. In Cox regression analyses, higher durations of passive sedentary behavior (≥3 h/day versus <3 h/day) were associated with greater hazards of developing MDD (HR = 1.27; 95% CI = 1.01, 1.58). This relationship remained after adjusting for confounders (HR = 1.29; 95% CI = 1.03, 1.63). Adding sleep problems into the analysis significantly attenuated these relationships (HR = 1.25; 95% CI = 0.99, 1.57). The excess MDD relative risk of passive sedentary behaviors due to sleep problems was statistically significant.

LIMITATIONS

Measures of sedentary behavior, physical activity and sleep were self-reported.

CONCLUSION

Sleep problems appear to mediate detrimental associations of passive sedentary behavior with depression. Findings require further confirmation using objective measures.

Racial/Ethnic Disparities in Sleep Health and Potential Interventions Among Women in the United States

While essential for health and wellness, the various dimensions of sleep health are generally not equitably distributed across the population, and reasons for racial/ethnic sleep disparities are not fully understood. In this review, we describe racial/ethnic sleep disparities and subsequent implications for health from prior and recently conducted epidemiological and clinical studies as well as the potential sleep interventions presented at the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health. Given the clear connection between sleep and poor health outcomes such as cardiovascular disease, we concluded that future studies are needed to focus on sleep health in general, sleep disorders such as insomnia and obstructive sleep apnea in particular, and disparities in both sleep health and sleep disorders among women using an intersectional framework. Future research should also integrate sleep into interventional research focused on women's health as these results could address health disparities by informing, for example, future mobile health (mHealth) interventions prioritizing women beyond the clinical setting.

Dietary behaviors and poor sleep quality among young adult women: watch that sugary caffeine!

PURPOSE

Associations of dietary patterns with sleep quality have not been sufficiently studied, particularly among young adults. Studying factors associated with sleep quality among young adults are especially important given the significant life changes they are experiencing, which can influence not only sleep quality but also dietary behaviors.

METHODS

We examined the cross-sectional association of sleep quality among 462 women at age 23 years. We used the Pittsburg Sleep Quality Index (PSQI) to define sleep quality. Intake over the previous 7 days of fruits and vegetables, soda, sports drinks, other sweetened drinks, and coffee drinks was assessed by a self-report questionnaire. Linear regression analysis examined the association between PSQI scores and dietary intake.

RESULTS

About 47% of participants were White, 25% Black, 10% Hispanic, and 18% Other. Almost ½ (45%) reported poor sleep quality. Compared with participants reporting consuming no energy drinks, participants who reported consuming any energy drinks had PSQI scores that were 0.84 points higher (7.08 ± 0.51 vs 6.24 ± 0.39; p=0.04) (indicating poorer sleep quality). Participants who reported drinking one or more high-calorie coffee drinks had PSQI scores that were 1.00 points higher compared with those reporting drinking no high-calorie coffee drinks (7.14 ± 0.51 vs 6.14 ± 0.42; p=0.02). Fruit or vegetable intake was not associated with PSQI score.

CONCLUSIONS

Poor sleep quality is prevalent among young women. Young women with poor sleep quality should consider their sugary caffeine use to determine if it may be associated with their sleep.

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Geriatrics Society, the American Society of Preventive Cardiology, and the Preventive Cardiovascular Nurses Association

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.

2. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions.

3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. The presence or absence of additional risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning.

4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.

5. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity.

6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist.

7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.

8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit.

9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion.

10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.

Occupational health disparities among U.S. long-haul truck drivers: the influence of work organization and sleep on cardiovascular and metabolic disease risk

OBJECTIVE

The organization of work has undergone vast transformations over the past four decades in the United States and has had profound impacts on worker health and wellbeing. The profession of commercial truck driving is one of the best examples. Particularly for long-haul truck drivers, changes in work organization have led to disproportionately poor physiological, psychological, and sleep health outcomes.

METHODS

The present study examined disparities in cardiometabolic disease risk among long-haul truck drivers and the general population, and the influence of work organization and sleep in generating these outcomes. Researchers collected survey data from 260 drivers, and blood assay samples from 115 of those drivers, at a large highway truck stop in North Carolina. Comparisons were made for cardiovascular and metabolic risk against the 2011-2012 National Health and Nutrition Examination Survey (NHANES). In addition, logistic regression was used to explore predictive relationships between work organization and sleep and risk for cardiovascular and metabolic disease.

RESULTS

There were statistically significant mean differences between the long-haul truck driver sample and the NHANES sample for both cardiovascular (3.71 vs. 3.10; p <0.001) and metabolic (4.31 vs. 3.09; p <0.001) disease risk. The truck driver sample was less physically active and had lower HDL cholesterol along with greater levels of smoking, BMI, and metabolic syndrome diagnosis. More years of driving experience and poor sleep quality were statistically significant predictors for both cardiovascular and metabolic disease risk.

CONCLUSIONS

Study findings implicate elements of the occupational milieu experienced by long-haul truck drivers that induce disproportionate cardiometabolic disease risk. Sleep quality, largely compromised by poor work conditions and workplace environments, plays a significant role in increased risks for cardiometabolic disease. There is an urgent need for longitudinal studies of this critical occupational sector as well as intervention research centered on policy and systems level change.

Sociodemographic and behavioral correlates of insufficient sleep in Australian adults

OBJECTIVES

Insufficient sleep is being increasingly recognized as a public health issue. There is a need to identify correlates of insufficient sleep to guide future preventative health interventions. This study aims to determine the sociodemographic and behavioral correlates of frequent perceived insufficient sleep in the Australian population.

DESIGN

Pooled analyses of two cross-sectional, self-report national telephone surveys were conducted in 2015 (July-August) and 2016 (June-August).

SETTING

Adults living in Australia.

PARTICIPANTS

Data from participants (age 18 years and over) of both surveys were pooled for analysis (2015 n = 1041; 2016 n = 1170), with 2211 participants being included in the current study.

MEASUREMENTS

Participants self-reported their age, gender, education and employment level, language spoken at home, urbanization, chronic disease, and height and weight to calculate BMI. Self-reported physical activity, sitting time, smoking, and consumption of fruit, vegetables, fast food, alcohol and frequency of perceived insufficient sleep were also assessed. Binary logistic regression analysis examined the relationship between insufficient sleep (≥14 days out of 30), sociodemographic and behavioral variables.

RESULTS

The overall prevalence of insufficient sleep was 24%. Female gender, obesity, >8 h/d sitting time, smoking, and frequent consumption of fast food were positively associated with frequent insufficient sleep (P < .05). Higher levels of physical activity and being aged 51 years or older were negatively associated with frequent insufficient sleep (P < .05).

CONCLUSIONS

The sociodemographic and behavioral characteristics associated with frequent perceived insufficient sleep can be used to guide the development of future interventions to reduce sleep insufficiency.

Sleep: important considerations for the prevention of cardiovascular disease

PURPOSE OF REVIEW

Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors.

RECENT FINDINGS

Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities.

SUMMARY

Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice.

A Review of the Literature Regarding Sleep and Cardiometabolic Disease in African Descent Populations

In the twenty-first century, African descent populations on both the continent of Africa and throughout the world are experiencing a high rate of both sleep disturbances and cardiometabolic diseases. The most common sleep disturbances are reduced sleep duration, insomnia, disordered circadian rhythm, and obstructive sleep apnea. Cardiometabolic diseases include hypertension, coronary artery disease, diabetes, hyperlipidemia, and the metabolic syndrome. This review seeks to call attention to new insights regarding the impact of sleep disturbance on cardiometabolic risk factors and outcomes and then apply these concepts to African descent populations, a relatively understudied population. Initial data suggest disparities in sleep quality may have an important role in current and emerging patterns of cardiometabolic disease for African descent populations both in the United States and abroad.

CLINICALTRIALSGOV IDENTIFIER

Not applicable.

Smoking, Screen-Based Sedentary Behavior, and Diet Associated with Habitual Sleep Duration and Chronotype: Data from the UK Biobank

BACKGROUND

Sleep duration has been implicated in the etiology of obesity but less is known about the association between sleep and other behavioral risk factors for cardiovascular disease.

PURPOSE

The aim of this study was to examine the associations among sleep duration, chronotype, and physical activity, screen-based sedentary behavior, tobacco use, and dietary intake.

METHODS

Regression models were used to examine sleep duration and chronotype as the predictors and cardiovascular risk factors as outcomes of interest in a cross-sectional sample of 439,933 adults enrolled in the UK Biobank project.

RESULTS

Short sleepers were 45 % more likely to smoke tobacco than adequate sleepers (9.8 vs. 6.9 %, respectively). Late chronotypes were more than twice as likely to smoke tobacco than intermediate types (14.9 vs. 7.4 %, respectively). Long sleepers reported 0.61 more hours of television per day than adequate sleepers. Early chronotypes reported 0.20 fewer daily hours of computer use per day than intermediate chronotypes. Early chronotypes had 0.25 more servings of fruit and 0.13 more servings of vegetables per day than late chronotypes.

CONCLUSIONS

Short and long sleep duration and late chronotype are associated with greater likelihood of cardiovascular risk behaviors. Further work is needed to determine whether these findings are maintained in the context of objective sleep and circadian estimates, and in more diverse samples. The extent to which promoting adequate sleep duration and earlier sleep timing improves heart health should also be examined prospectively.

Sleep and obesity risk in adults: possible mechanisms; contextual factors; and implications for research, intervention, and policy

Obesity is a major public health problem among US adults. Insufficient sleep and sleep disorders are prevalent and may contribute to the public health problem of obesity. This review addresses several key questions regarding sleep and obesity in adults, including the following: (1) What constitutes adequate sleep in adults? (2) What are the consequences of inadequate sleep in adults? (3) What factors influence sleep in adults? (4) How can adults improve their sleep? (5) How can we implement these in adults? (6) How can these issues be addressed in future research and policy decisions? Although a comprehensive review of all of these is beyond the scope of this article, this review brings these concepts together toward a discussion of the role of sleep in the health of US adults.

Activity Trackers Implement Different Behavior Change Techniques for Activity, Sleep, and Sedentary Behaviors

Background

Several studies have examined how the implementation of behavior change techniques (BCTs) varies between different activity trackers. However, activity trackers frequently allow tracking of activity, sleep, and sedentary behaviors; yet, it is unknown how the implementation of BCTs differs between these behaviors.

Objective

The aim of this study was to assess the number and type of BCTs that are implemented by wearable activity trackers (self-monitoring systems) in relation to activity, sleep, and sedentary behaviors and to determine whether the number and type of BCTs differ between behaviors.

Methods

Three self-monitoring systems (Fitbit [Charge HR], Garmin [Vivosmart], and Jawbone [UP3]) were each used for a 1-week period in August 2015. Each self-monitoring system was used by two of the authors (MJD and BM) concurrently. The Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy was used to assess the implementation of 40 BCTs in relation to activity, sleep, and sedentary behaviors. Discrepancies in ratings were resolved by discussion, and interrater agreement in the number of BCTs implemented was assessed using kappa statistics.

Results

Interrater agreement ranged from 0.64 to 1.00. From a possible range of 40 BCTs, the number of BCTs present for activity ranged from 19 (Garmin) to 33 (Jawbone), from 4 (Garmin) to 29 (Jawbone) for sleep, and 0 (Fitbit) to 10 (Garmin) for sedentary behavior. The average number of BCTs implemented was greatest for activity (n=26) and smaller for sleep (n=14) and sedentary behavior (n=6).

Conclusions

The number and type of BCTs implemented varied between each of the systems and between activity, sleep, and sedentary behaviors. This provides an indication of the potential of these systems to change these behaviors, but the long-term effectiveness of these systems to change activity, sleep, and sedentary behaviors remains unknown.

Diet and Sleep Physiology: Public Health and Clinical Implications

This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.

Sleep, Health, and Society

Biological needs for sleep are met by engaging in behaviors that are largely influenced by the environment, social norms and demands, and societal influences and pressures. Insufficient sleep duration and sleep disorders such as insomnia and sleep apnea are highly prevalent in the US population. This article outlines some of these downstream factors, including cardiovascular and metabolic disease risk, neurocognitive dysfunction, and mortality, as well as societal factors such as age, sex, race/ethnicity, and socioeconomics. This review also discusses societal factors related to sleep, such as globalization, health disparities, public policy, public safety, and changing patterns of use of technology.

Reproducibility of an extensive self-report questionnaire used in secondary coronary prevention

Aims: Self-reported information from questionnaires is frequently used in clinical epidemiological studies, but few provide information on the reproducibility of instruments applied in secondary coronary prevention studies. This study aims to assess the test–retest reproducibility of the questionnaire applied in the cross-sectional NORwegian CORonary (NOR-COR) Prevention Study. Methods: In the NOR-COR study 1127 coronary heart disease (CHD) patients completed a self-report questionnaire consisting of 249 questions, of which there are both validated instruments and de novo questions. Test–retest reliability of the instrument was estimated after four weeks in 99 consecutive coronary patients. Intraclass Correlation Coefficient (ICC) and Kappa (κ) were calculated. Results: The mean interval between test and retest was 33 (±6.4) days. Reproducibility values for questions in the first part of the questionnaire did not differ from those in the latter. A good to very good reproducibility was found for lifestyle factors (smoking: κ = 1.0; exercise: ICC = 0.90), medical factors (drug adherence: ICC = 0.74; sleep apnoea: ICC = 0.87), and psychosocial factors (anxiety and depression: ICC = 0.95; quality of life 12-Item Short-Form Health Survey (SF12): ICC = 0.89), as well as for the majority of de-novo-created variables covering the patient’s perceptions, motivation, needs, and preferences. Conclusions: The present questionnaire demonstrates a highly acceptable reproducibility for all key items and instruments. It thus emerges as a valuable tool for evaluating patient factors associated with coronary risk factor control in CHD patients.

Epidemiology of sleep and sleep disorders in The Netherlands

OBJECTIVE

There is a surging public interest in The Netherlands concerning sleep, sleep disorders and associated health. For a proper perspective, it is necessary to have reliable information on the prevalence of sleep characteristics at the national level. This study set out to assess prevalence rates and key characteristics of sleep and sleep disorders in The Netherlands.

METHODS

In 2012, a nationally representative sample of 2089 individuals, aged 18-70 years, responded to a set of 48 questions, including the Holland Sleep Disorders Questionnaire, a validated questionnaire based on the International Classification of Sleep Disorders.

RESULTS

Prevalence rates were: 32.1% for a general sleep disturbance (GSD), 43.2% for insufficient sleep, 8.2 for insomnia, 5.3% for circadian rhythm sleep disorder, 6.1% for parasomnia, 5.9% for hypersomnolence, 12.5% for restless legs disorder and limb movements during sleep, 7.1% for sleep related breathing disorder, and 12.2% for the presence of comorbidity, ie, the presence of two or more concurrent sleep disorders. In addition, sleep onset time as well as sleep duration showed U-shaped relationships with GSD prevalence rates, with respectively the 22:00-24:00 period and seven to 8 h as optimal associates.

CONCLUSIONS

Sleep disorders and insufficient sleep have a high prevalence. As matter of concern, female adolescents reached the highest prevalence rates for most sleep disorders, insufficient sleep and daytime malfunctioning.

Sleep Duration and Diabetes Risk: Population Trends and Potential Mechanisms

Sleep is important for regulating many physiologic functions that relate to metabolism. Because of this, there is substantial evidence to suggest that sleep habits and sleep disorders are related to diabetes risk. In specific, insufficient sleep duration and/or sleep restriction in the laboratory, poor sleep quality, and sleep disorders such as insomnia and sleep apnea have all been associated with diabetes risk. This research spans epidemiologic and laboratory studies. Both physiologic mechanisms such as insulin resistance, decreased leptin, and increased ghrelin and inflammation and behavioral mechanisms such as increased food intake, impaired decision-making, and increased likelihood of other behavioral risk factors such as smoking, sedentary behavior, and alcohol use predispose to both diabetes and obesity, which itself is an important diabetes risk factor. This review describes the evidence linking sleep and diabetes risk at the population and laboratory levels.

Trouble Sleeping Associated With Lower Work Performance and Greater Health Care Costs: Longitudinal Data From Kansas State Employee Wellness Program

OBJECTIVE

To examine the relationships between employees' trouble sleeping and absenteeism, work performance, and health care expenditures over a 2-year period.

METHODS

Utilizing the Kansas State employee wellness program (EWP) data set from 2008 to 2009, multinomial logistic regression analyses were conducted with trouble sleeping as the predictor and absenteeism, work performance, and health care costs as the outcomes.

RESULTS

EWP participants (N = 11,698 in 2008; 5636 followed up in 2009) who had higher levels of sleep disturbance were more likely to be absent from work (all P < 0.0005), have lower work performance ratings (all P < 0.0005), and have higher health care costs (P < 0.0005). Longitudinally, more trouble sleeping was significantly related to negative changes in all outcomes.

CONCLUSIONS

Employees' trouble sleeping, even at a subclinical level, negatively impacts on work attendance, work performance, and health care costs.

Sleep disparity, race/ethnicity, and socioeconomic position

Sleep represents a set of biological functions necessary for the maintenance of life. Performing these functions, though, requires that an individual engage in behaviors, which are affected by social and environmental factors. Race/ethnicity and socioeconomic position represent categories of factors that likely play a role in the experience of sleep in the community. Previous studies have suggested that racial/ethnic minorities and the socioeconomically disadvantaged may be more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue.