Exploring Gender Difference in Sleep Quality of Young Adults: Findings from a Large Population Study

Mental Health, Sleep Quality, and Psychological Well-Being during the Holy Month of Ramadan

OBJECTIVES

Ramadan, a significant month for Muslims, presents unique challenges, particularly in the context of the USA. This study aimed to explore the relationship between mental health factors (depression, anxiety, and stress), sleep quality, and psychological well-being (subjective happiness and life satisfaction) during the month of Ramadan among participants and by gender.

METHODS

This study enlisted 163 participants (74% female, 25.7% male), with an average age of 36.8 years (SD = 13.1), mostly of Middle Eastern descent. Recruitment was conducted via flyers at local community mosques, social media, and outreach through local religious leaders. Data collection took place in the last three weeks of Ramadan, utilizing a Qualtrics survey that included the Depression Anxiety and Stress Scale (DASS-21), the Subjective Happiness Scale (SHS), Satisfaction with Life Scale (SWLS), and the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed by means of descriptive statistics and multiple linear regression models using SPSS version 28.

RESULTS

The study indicates that while mental health and psychological well-being remained within normal levels during Ramadan, sleep scores indicated significant sleep disturbance among participants. Multiple linear regression models revealed that subjective happiness, sleep duration, and the global PSQI score were significant predictors of stress for the total sample (F = 9.816, p = 0.001). Life satisfaction was the only significant predictor of anxiety (F = 7.258, p = 0.001), and it, alongside subjective happiness, significantly predicted depression (F = 12.317, p = 0.001). For men, subjective happiness alone predicted stress, while life satisfaction was a predictor for both anxiety and depression (F = 4.637, p = 0.001). In women, sleep duration and medication usage were linked to stress but not anxiety. Life satisfaction and subjective happiness were, however, predictors of depression (F = 6.380, p = 0.001).

CONCLUSION

Fostering positive affective states can serve as a protective mechanism against the potential psychological distress associated with altered sleep patterns and lifestyle changes that accompany Ramadan. This study highlights that Ramadan is a tool for bolstering happiness and life satisfaction, thereby lowering levels of stress, anxiety, and depression. In non-Muslim majority contexts like the USA, there is a need for accommodations to safeguard against potential psychological distress.

The impact of sleep quality on visual working memory varied with the duration of maintenance

Objective

Sleep quality can affect the performance of visual working memory. However, the effect of sleep quality on the maintenance stage, which is the key to maintain the quality and efficiency of visual working memory representation, remains unclear. This study is the first to explore the effect of sleep quality on the maintenance of visual working memory information.

Method

60 healthy college students completed the Pittsburgh Sleep Quality Index (PSQI) and color recall task of visual working memory. A mixed experimental design of sleep quality (high or low) and delay duration (1, 4, or 6 s) was used to assess the effect of sleep quality on the maintenance phase of visual working memory.

Results

The main effects of sleep quality were significant on visual working memory quantity, precision and offset indexes. Among the quantity index, the interaction between sleep quality and delay duration was also significant. This suggests that prolonging the delay time in the maintenance phase leads to difficulty in maintaining attention to the task for those with lower sleep quality, which results in poorer working memory quantitative representations.

Conclusion

Increases in the delay duration of the maintenance phase in visual working memory intensify the impact of sleep quality on task performance. Our study provides evidence to reveal the relationship between sleep quality and visual working memory and offers recommendations for improving sleep quality and cognitive functioning in individuals.

Postponing sleep after a stressful day: Patterns of stress, bedtime procrastination, and sleep outcomes in a daily diary approach

Sleep problems and stress are common among students and are associated with negative effects on academic performance as well as mental and physical health risks, but studies exploring mediating factors between stress and sleep on a daily basis are scarce. This study aimed to investigate the relationship of daily stress, Bedtime procrastination (BP) (i.e., postponing bedtime without external reasons), and sleep outcomes controlling for trait factors such as self-control. N = 96 students at a German university (M = 22.2 years, SD = 4.0) wore a sleep-tracking wearable (Fitbit Charge HR) for two weeks to assess sleep duration and to calculate the gap between the intended time to go to sleep and the objectively measured time of falling asleep. Stress, intended time to go to sleep, and sleep quality were assessed via daily diaries. Established questionnaires were used to measure trait self-control, trait BP, and smartphone addiction. Multilevel analyses indicated that more stress experienced during the day was associated with more BP (b = 2.32, p = 0.008), shorter sleep duration (b = -3.46, p = 0.003), and lower sleep quality (b = 1.03, p = 0.005) after controlling for several trait factors. The association of daily stress with sleep outcomes (quality and duration) was partly mediated by BP. Our findings indicate that BP might be one factor that contributes to stress-linked decreases in sleep duration and quality. Potential reasons for stress-related later time to fall asleep-like higher physiological arousal or stress-related worries-should be investigated in future studies.

Insight into sleep quality and its relationship with emotional intelligence: results of a cross-sectional study among Italian university students

Background

This study aimed to investigate sleep habits and examine the relationship between sleep quality and its potential predictors, namely Emotional Intelligence (EI) and perceived health status.

Methods

The present cross-sectional study was conducted between February 13 and February 28, 2023, at the "Magna Græcia" University of Catanzaro, in the Southern part of Italy. The study involved undergraduate students who were 18 years or older, proficient in the Italian language, and with no restrictions on the major attended. They completed a self-administered survey on socio-demographic information, health status, sleep quality (Pittsburgh Sleep Quality Index-PSQI), EI, and perceived health status.

Results

The majority of the sample (59.6%) was enrolled in medical or life science majors. The results showed a high prevalence of poor sleep quality and sleep latency was identified as the most affected aspect of it. The female gender and the self-perceived health status were the strongest predictors of poor sleep quality. Poor sleepers showed lower emotional clarity, emotional repair, and total EI scores. Moreover, as age increased, the odds of being classified as a poor sleeper increased by 7%.

Conclusion

The survey highlights that poor sleep health is still a significant issue and empowering individuals to make proactive decisions to adopt healthy lifestyles in the early phase of life is of paramount importance. The study exhibited the interesting role of EI in influencing sleep quality, highlighting that when emotional events are insufficiently regulated, it may result in sleep disturbances. Therefore, the promotion of sleep quality requires an integrated yet innovative approach including emotion regulation.

Sleep Patterns in Patients After Solid Organ Transplantation Including Gender and Age Differences. Survey Results From One Transplantation Centre in Poland

INTRODUCTION

Sleep plays a crucial role in maintaining health. Transplant patients are exposed to numerous stressors and are at risk of sleep disturbances. The aim of this study was to assess the sleep patterns of transplant patients.

METHODS

An anonymous paper survey was carried out among patients from one transplant center in Poland. Respondents were asked about the quality and quantity of sleep and the overall impact of the transplantation on their night rest. Data were collected from June to November 2023.

RESULTS

Data were obtained from 212 respondents (122 males and 90 females), aged 48.38 ± 13.68. The positive impact of transplantation on sleep hygiene was indicated by 57.4% of respondents, 28.9% observed no impact, and 13.6% rated the impact as negative. Our study showed that sleep is more satisfying in males than in females (62.8% of males and 46.7% of females). The analysis revealed that 38.9% of females need 30 minutes more than men to fall asleep. Additionally, females tend to get up half an hour later compared to men. About 71.9% of males declared good well-being the next day compared to 62.2% of females. Furthermore females declared more sleepiness the next day. The study also showed that older transplant recipients (over 50 years-of-age) report more frequent awakenings at night.

CONCLUSIONS

The data collected showed differences in sleep patterns according to gender and age. Females and older patients should be screened for sleep disturbances during post-transplantation care.

The Effect of a Cognitive Dual Task on Gait Parameters among Healthy Young Adults with Good and Poor Sleep Quality: A Cross-Sectional Analysis

Background: Sleep quality is known to affect automatic and executive brain functions such as gait control and cognitive processing. This study aimed to investigate the effect of dual tasks on gait spatiotemporal parameters among young adults with good and poor sleep quality. Methods: In total, 65 young adults with a mean age of 21.1 ± 2.5 were assessed for gait analysis during single-task and dual-task conditions. The participants' sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and gait was assessed using the BTS Gaitlab System. The participants were asked to walk at natural speed as a single-task condition, followed by walking while performing a cognitive task as a dual-task condition. The parameters assessed included the gait velocity (m/s), cadence (steps/min), step width (m), and stride length (m). The dual-task cost (DTC) on each gait parameter was calculated. The Mann-Whitney U test was used to compare the differences in the DTC on gait variables between the good and poor sleep quality groups and the Spearman correlation test was used to assess the correlation between total PSQI scores and the DTC. Results: At a significance level of p < 0.05, a significant difference in cadence between the two sleep quality groups was observed, in addition to a positive correlation between sleep quality and the DTC effect on gait mean velocity, cadence, and stride length. Our findings also revealed a greater DTC in participants with poorer sleep quality. Conclusions: These findings contribute to our perception of the significance of sleep quality in gait performance while multitasking in younger populations.

Nurses' level of sleepiness during night shift

AIMS

This study aimed to determine the peak hours of sleepiness and the factors affecting the sleepiness levels of nurses.

BACKGROUND

Sleepiness is commonly seen in individuals working night shifts. However, in case of nurses, this sleepiness can be a major threat to patient and staff safety.

METHOD

This was a prospective cross-sectional study. Data were collected between July and September 2023, and a stratified sampling method was used according to the departments in which the nurses worked. Data were collected using the Personal Information Form and Visual Analog Scale. Nurses reported their sleepiness levels at the beginning of each hour between midnight and 8:00 am.

EQUATOR CHECKLIST

The study adhered to the STROBE checklist for reporting.

RESULTS

The mean sleepiness levels of emergency department nurses, intensive care nurses, internal or surgical clinic nurses, and all nurses were 59.75 ± 15.50, 43.53 ± 20.49, 44.67 ± 18.88, and 49.15 ± 19.67, respectively. The highest sleepiness level of the nurses was at 05:00 am. A significant correlation was found between the variables of age, gender, marital status, sleep quality, number of patients cared, working style and satisfaction with working in the department, and sleepiness level (P < 0.05).

CONCLUSION

Nurses working night shifts experience sleepiness (highest at 5:00 am). In addition, the sleepiness levels of nurses are affected by some personal and clinical factors.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Based on the results, there is a need for necessary policies regarding nurses' working hours and working conditions. To protect patient and employee safety, necessary strategies should be devised regarding the hours when nurses experience the highest sleepiness and the factors affecting sleepiness levels.

Gender-specific link between sleep quality and body composition components: a cross-sectional study on the elderly

Sleep duration has been associated with overweight/obesity. Since sleep quality and body composition alter during aging, we conducted this study to determine if sleep quality is linked to body composition components in elderly people. This is a cross-sectional study conducted on 305 Iranian community-dwelling elderly aged ≥ 65 years. Sleep quality and body composition components were evaluated using Pittsburgh sleep quality index and bioelectric impedance analysis, respectively. The association of sleep quality and body composition components was examined using linear regression analysis. The prevalence of poor sleep quality and overweight/obesity was 48.9% and 54.4% in men and 77.0% and 79.3% in women, respectively. Women had significantly higher scores in most PSQI items than men, indicating their worse sleep quality compared to men. Women also had significantly higher body mass index (BMI), body fat percentage, and visceral adipose tissue and lower skeletal muscle and fat-free mass percentages than men. In the adjusted regression model, men showed positive associations between the third tertile of poor sleep quality and BMI (B = 1.35; 95% CI 0.08-2.61) and waist circumference (B = 4.14; 95% CI 0.39-7.89), but they did not demonstrate an association between sleep quality and body composition components. In the adjusted regression model for women, there were positive associations for BMI (B = 1.21; 95% CI 0.34-2.07), waist circumference (B = 2.95; 95% CI 0.99-4.91), body fat percentage (B = 2.75; 95% CI 1.06-4.45), and visceral adipose tissue (B = 7.80; 95% CI 1.73-13.87); also there were negative associations for skeletal muscle (B =  - 1.40; 95% CI - 2.39 - - 0.41) and fat-free mass (B =  - 2.76; 95% CI - 4.46 - -1.07) percentages. Except for waist circumference, other variables differed between men and women (P < 0.001). Weight management, prevention of muscle wasting, and improvement of sleep quality should be considered in a consortium when designing healthcare strategies for the elderly.

Parents' Sleep Multi-Trajectory Modelling from 3 to 36 Months Postpartum in the SEPAGES Cohort

Objective

We investigated maternal and paternal sleep evolution from 3 to 36 months postpartum, their interrelations and predictors in the SEPAGES cohort.

Methods

Sleep information (night sleep duration [NSD], weekend daytime sleep duration [DSD] and subjective sleep loss [SSL]) was collected by self-administered questionnaires at 3, 18, 24 and 36 months postpartum in the SEPAGES French cohort that included 484 mothers and 410 fathers. Group-based multi-trajectory modelling was used to identify maternal, paternal and couple sleep multi-trajectory groups among 188 couples reporting sleep data for at least 2 time points. Multinomial logistic regression was used to assess associations between parental sleep multi-trajectories and early characteristics such as sociodemographic, chronotypes, child sex, birth seasonality or breastfeeding duration.

Results

We identified three maternal (M1-M3), paternal (F1-F3) and couple (C1-C3) sleep multi-trajectory groups with similar characteristics: a group with short NSD and high SSL prevalence (M1, F2, C2), a group with long NSD but medium SSL prevalence (M2, F3, C3) and a group with long NSD and low SSL prevalence (M3, F1, C1). Mothers with the shortest NSD (M1) were less likely to have a partner with long NSD (F2). As compared with long NSD and low SSL prevalence (C1), couples with short NSD and high SSL prevalence (C2) were less likely to have had a first child born in the autumn and fathers in C2 had a later chronotype.

Conclusion

We identified distinct sleep multi-trajectory groups for mothers, fathers and couples from 3- to 36-month postpartum. Sleep patterns within couples were homogeneous.

Identity Fusion and Aggressive Behavior Among Chinese Freshmen: The Chain Mediating Role of Depressive Mood and Sleep Quality

Aggressive behavior is considered one of the indicators of maladjustment and increases during the transition to college. Previous studies have demonstrated that having identity fusion with particular social groups significantly predicts college adjustment among freshmen. However, the relationship between identity fusion and aggressive behavior in college freshmen has rarely been studied. Thus, guided by the frustration-aggression theory, this study aimed to explore the association between identity fusion with class and aggressive behavior among Chinese college freshmen and examine the potential mediating roles of depressive mood and sleep quality. A cross-sectional survey study was carried out among 1,037 Chinese college freshmen (Mage = 19.56, SD = 1.068, 29.12% males). Class identity fusion, depressive mood, sleep quality, and aggressive behavior were measured via four self-reported questionnaires. Structural equation modeling was used to test the mediation model. Analyses showed that identity fusion was negatively related to depressive mood and aggressive behavior and positively correlated with sleep quality. The results also revealed that the direct effect of identity fusion on aggressive behavior was significant, and identity fusion can indirectly affect aggressive behavior not only through the mediation effect of depressive mood but also through the chain mediation effect of depressive mood and sleep quality. Moreover, the mediating effect of depressive mood varied by gender. These findings suggest that strategies that help freshmen promote identity fusion and those that alleviate depressive mood and sleep problem may help reduce aggressive behavior.

Poor sleep quality and its associated neurocognitive function in children with obesity with or without obstructive sleep apnea

OBJECTIVE

To evaluate the associations of OSA severity, snoring symptoms, subjective sleep quality, and daytime sleepiness with executive functioning and behaviors in children with obesity.

METHODS

This was a cross-sectional study of children aged 8-18 years with obesity and symptoms suggestive of OSA. All participants underwent an overnight polysomnography and completed a set of questionnaires to assess their sleep-related breathing disordered (SRBD) symptoms [Pediatric Sleep Questionnaire (SRBD-PSQ)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], executive function [Behavior Rating Inventory of Executive Function (BRIEF)], and inattention and hyperactivity symptoms (Conners-3 Parent Short Form).

RESULTS

A total of 85 children (62% male, mean age: 13.9 ± 3.0 years) were included in this analysis, of whom 36, 16, and 33 were categorized into the non-OSA (obstructive apnea hypopnea index, OAHI < 1.5/h), mild OSA (OAHI 1.5-5/h), and moderate-severe OSA (OAHI ≥ 5/h) groups, respectively. Of 85 participants, 27 (32%) were classified with poor sleep quality (PSQI composite score ≥ 8). From multiple linear regression analyses, poor sleep quality and sleepiness were both independently associated with higher BRIEF behavioral regulation T-score, metacognition T-score, and global executive composite T-score in the fully adjusted model. In addition, poor sleep quality was also independently associated with higher Conners-3 inattention and executive functioning T-scores, while greater sleepiness was also associated with a higher learning problem T-score. The presence of OSA and snoring were not associated with any cognitive outcomes.

CONCLUSIONS

Subjective sleep quality and daytime sleepiness, but not OSA severity and snoring symptoms, were independently associated with executive functioning and behavioral problems in children with obesity.

Shorter self-reported sleep duration is associated with worse virtual spatial navigation performance in men

Sleep has been shown to impact navigation ability. However, it remains unclear how different sleep-related variables may be independently associated with spatial navigation performance, and as to whether gender may play a role in these associations. We used a mobile video game app, Sea Hero Quest (SHQ), to measure wayfinding ability in US-based participants. Wayfinding performance on SHQ has been shown to correlate with real-world wayfinding. Participants were asked to report their sleep duration, quality, daytime sleepiness and nap frequency and duration on a typical night (n = 766, 335 men, 431 women, mean age = 26.5 years, range = 18-59 years). A multiple linear regression was used to identify which self-reported sleep variables were independently associated with wayfinding performance. Shorter self-reported sleep durations were significantly associated with worse wayfinding performance in men only. Other self-reported sleep variables showed non-significant trends of association with wayfinding performance. When removing non-typical sleepers (< 6 or > 9 h of sleep on a typical night), the significant association between sleep duration and spatial navigation performance in men was no longer present. These findings from U.S.-based participants suggest that a longer self-reported sleep duration may be an important contributor to successful navigation ability in men.

Estimation bias and agreement limits between two common self-report methods of habitual sleep duration in epidemiological surveys

Accurate measurement of habitual sleep duration (HSD) is crucial for understanding the relationship between sleep and health. This study aimed to assess the bias and agreement limits between two commonly used short HSD self-report methods, considering sleep quality (SQ) and social jetlag (SJL) as potential predictors of bias. Data from 10,268 participants in the International COVID Sleep Study-II (ICOSS-II) were used. Method-Self and Method-MCTQ were compared. Method-Self involved a single question about average nightly sleep duration (HSDself), while Method-MCTQ estimated HSD from reported sleep times on workdays (HSDMCTQwork) and free days (HSDMCTQfree). Sleep quality was evaluated using a Likert scale and the Insomnia Severity Index (ISI) to explore its influence on estimation bias. HSDself was on average 42.41 ± 67.42 min lower than HSDMCTQweek, with an agreement range within ± 133 min. The bias and agreement range between methods increased with poorer SQ. HSDMCTQwork showed less bias and better agreement with HSDself compared to HSDMCTQfree. Sleep duration irregularity was - 43.35 ± 78.26 min on average. Subjective sleep quality predicted a significant proportion of variance in HSDself and estimation bias. The two methods showed very poor agreement and a significant systematic bias, both worsening with poorer SQ. Method-MCTQ considered sleep intervals without adjusting for SQ issues such as wakefulness after sleep onset but accounted for sleep irregularity and sleeping in on free days, while Method-Self reflected respondents' interpretation of their sleep, focusing on their sleep on workdays. Including an SQ-related question in surveys may help bidirectionally adjust the possible bias and enhance the accuracy of sleep-health studies.

The association between energy-adjusted dietary inflammatory index and physical activity with sleep quality: a cross-sectional study

BACKGROUND

The study aimed to assess the independent and interactive association of energy-adjusted dietary inflammatory index (E-DII) and physical activity (PA) with sleep quality.

METHOD

A cross-sectional study was conducted on the 2466 participants (60% women). A 116-item food frequency questionnaire (FFQ) was applied to calculate E-DII, the International Physical Activity Questionnaire (IPAQ) long form for PA, and the Pittsburgh sleep quality index (PSQI) to assess sleep quality were collected via interview. Multivariate logistic regression was applied to assess independent and interactive associations of E-DII and PA with sleep quality.

RESULT

No significant association was observed between E-DII and sleep quality (OR: 0.96, 95% CI: 0.92_1.01). Also, there was no significant association between the levels of PA and sleep quality. Women had 70% increased odds for poor sleep quality (OR: 1.7, 95% CI: 1.39_2.09) compared with men. No interactive association was observed between E-DII and PA levels with sleep quality.

CONCLUSION

No significant association was observed between E-DII and PA levels with sleep quality. The study indicates a gender difference in sleep quality. Future prospective studies are required to confirm these findings.

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

Comparison of sleep quality between clear aligner and fixed appliance orthodontic therapies

BACKGROUND

Although available evidence suggests that orthodontic appliances can impact quality of life, there is limited information on the impact of orthodontic appliances on sleep quality. This study aimed to compare sleep quality between patients undergoing orthodontic treatments using conventional fixed appliances and clear aligners.

METHODS

Adult patients attending clinics in Saudi Arabia participated in this cross-sectional study. Sleep quality was assessed using the validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Statistical significance was determined using inferential analysis, with a P < 0.05 considered statistically significant.

RESULTS

There were 69 patients included in the study. The average age of a patient (33.12 ± 8.1) who received the clear aligner was significantly higher than those who received the fixed appliance (27.7 ± 5.9) (P < 0.05). The variation in the average score of ESS because of the education level was found to be statistically significant (P < 0.05). No significant difference was observed between the mean average ESS and PSQI global scores across the two orthodontic treatment groups. The average sleep latency scores were significantly higher in females than males when analyzing the PSQI component score across sex (P < 0.05). In education, ESS, PSQI global, habitual sleep efficiency, the use of sleep medication, and daytime dysfunction had a positive, weak, but significant correlation.

CONCLUSIONS

Overall, this study concluded that regardless of the orthodontic appliances used, there was no statistically significant difference in sleep quality during the treatment.

Relationship between Problematic Smartphone Use, Sleep Quality and Bedtime Procrastination: A Mediation Analysis

The purpose of this investigation was to study the relationship between sleep quality, problematic smartphone use (PSU) and bedtime procrastination, as well as to assess gender and age differences. A total of 313 participants, aged 18-60 (M = 30 ± 10.1; 53.2% males), completed an online survey between February and May 2023 in Spain. The Pittsburgh Sleep Quality Index, Smartphone Addiction Scale-Short Version and Bedtime Procrastination Scale were used to measure sleep quality, PSU and bedtime procrastination, respectively. Additionally, smartphone use habits were evaluated through self-report questions. Pearson correlations, independent samples t-tests, one-way ANOVA, Bonferroni's post hoc tests and mediation analysis were conducted. Correlation analysis showed positive associations between the three main variables. Independent sample t-tests indicated females were more prone to PSU along with higher overall smartphone use. Post hoc analysis of one-way ANOVA exposed age differences between young adults (18-25 years old), adults (26-44 years old) and middle-aged adults (45-60 years old) in PSU and bedtime procrastination. Finally, mediation analysis revealed that PSU had indirect effects on sleep quality through bedtime procrastination, but no direct effects on sleep quality. Therefore, PSU, and especially bedtime procrastination, should be considered as targets in future campaigns or intervention programs to improve sleep quality among the young Spanish population.

Exposure to secondhand smoke is associated with poor sleep quality among non-smoking university students in Bangladesh: a cross-sectional survey

Although secondhand smoke (SHS) exposure is predominant in Bangladesh, the adverse effect of SHS exposure on health-related behaviors, such as sleep quality, have remained an under-investigated area of the country's public health landscape. Therefore, the purpose of this study was to examine the association between SHS exposure and poor sleep quality among non-smoking university students in Bangladesh. A cross-sectional survey was carried out between May and September 2022. SHS exposure (main predictor variable) and other covariates (e.g., age, sex, etc.) were measured using a self-reported questionnaire and sleep quality (outcome variable) was measured via the Pittsburgh Sleep Quality Index. Multiple logistic regression models investigated the association between SHS exposure and poor sleep quality. The study included 390 students (mean age: 22 years, 53.8% male). Approximately 41.8% of the participants reported SHS exposure, and 50.5% had poor sleep quality. Students exposed to SHS were more likely to have poor sleep quality compared to their counterparts (AOR = 1.61; 95% CI 1.01, 2.58). Subgroup analysis revealed poor sleep quality was 2-times higher among male students exposed to SHS than those male students without SHS exposure (AOR = 2.03; 95% CI 1.05, 3.93). No association was found in female students. Findings from this study warrant increased awareness and public health initiatives on the implications of SHS on health behaviors, such as sleep quality, in non-smoking Bangladeshi university students.

Factors Influencing Sleep Disturbances in Adolescent Smokers in South Korea

ABSTRACT

This study aimed to describe sleep disturbances and identify associated factors in adolescent smokers in South Korea. This study adopted a cross-sectional design and recruited 520 students aged 12-17 years from 35 schools to participate in a smoking cessation program. To compare demographic, smoking-related, psychological, and problem behavior characteristics between adolescent smokers with sleep disturbances and without sleep disturbances, chi-square tests and independent t tests were used. Logistic regression analysis was performed to identify the factors associated with sleep disturbances in adolescent smokers. Approximately 45.8% of adolescent smokers reported sleep disturbances. Sleep disturbances were more frequent among girls than among boys and more frequent among high school students than among middle school students. Other factors included cigarette use within 1 month, nicotine dependence, smoking cessation self-efficacy, depression, Internet addiction, and suicidal ideation. Gender (girls), school level (high school), depression, Internet addiction, and daily cigarette use (11 or more cigarettes) were significantly associated with sleep disturbances in adolescent smokers. To improve the sleep quality of adolescent smokers, health professionals should focus on sleep disturbances and associated factors and develop appropriate intervention programs.

Subjective Sleep Quality, Caffeine, and Dieting Behaviors Among University-Attending Young Adults

Background

Research has shown that university students engage in behaviors that are associated with poor sleep quality, such as higher caffeine and alcohol intake. Yet studies exploring eating habits and weight loss mechanisms related to sleep quality have generally been inconclusive. This study explored total daily caffeine consumption (along with different sources of caffeine) as well as dieting and exercising to lose weight in the last 30 days as risk factors for poor sleep quality among an undergraduate university population.

Methods

Full-time undergraduate students (n = 400) participated in an anonymous online survey about various health behaviors at a large, mid-Atlantic university. Multivariable linear regressions were run to consider subjective sleep quality in relation to caffeine consumption and dieting behavior along with other covariates. A sensitivity analysis was run to explore how different types of caffeinated beverages were associated with sleep quality as well. All analyses were conducted using SAS JMP Version 16.

Results

A stepwise multivariable linear regression controlling for alcohol use, grade point average, biological sex, and stress showed significant increases in sleep quality scores (indicating worsening sleep quality). Total caffeine consumption remained significant through the models until psychosocial factors were added (B = 0.003, p = 0.0035). The sensitivity analysis indicated that total caffeine consumption from soda remained significant across all models, significantly increasing sleep quality scores (B = 0.01; p = 0.0054).

Discussion

Higher amounts of caffeine from sodas were associated with more significant decreases in sleep quality than other types of caffeine, including energy drinks, coffee, and tea. Dieting or exercising to lose weight was not significantly associated with sleep quality. The results of this study can help to refine intervention efforts designed to improve sleep quality among undergraduate university students. Behavioral interventions specific to reducing caffeine intake, specifically from caffeinated sodas, may prove to be beneficial with this population.

Association of Sociodemographic Factors with Physical Activity and Sleep Quality in Arab and Non-Arab Individuals of Both Sexes during the COVID-19 Pandemic

We explored the association of sociodemographic and anthropometric factors with self-reported physical activity (PA) and sleep quality in Arab and non-Arab individuals of both sexes during the COVID-19 pandemic. In this cross-sectional study, 638 participants (those recovered from COVID-19 = 149, and non-infected = 489) of both sexes aged 18-55 years were recruited. Their sociodemographic and anthropometric information, PA (self-reported using the International Physical Activity Questionnaire Short-form [IPAQ-SF)]) and sleep quality (self-reported using the Pittsburgh Sleep Quality Index [PSQI]) were documented. The association between participants' characteristics, PA levels, and sleep quality were determined using the chi-squared test. Variables significantly associated with IPAQ and PSQI in bivariate analyses were included in a multivariate binary logistic regression model. Men were more active than women (odds ratio [OR] = 1.66, p = 0.010), and non-Arab participants were more active than Arab ones (OR = 1.49, p = 0.037). Participants ≥40 years, men, non-Arab participants, and those who were working were more likely to have a good sleep quality than those ≤40 years (OR 1.70, p = 0.048), women (OR 1.10, p = 0.725), Arab individuals (OR 1.95, p = 0.002), and unemployed people (OR 2.76, p = 0.007). Male and non-Arab participants seemed to have a better self-reported PA and sleep quality compared to female and Arab participants, during the pandemic.

Sex hormones, insomnia, and sleep quality: Subjective sleep in the first year of hormone use in transgender persons

STUDY OBJECTIVES

Transgender persons can use gender-affirming hormone therapy (GAHT) to align their physical appearance with their identified gender. Many transgender persons report poor sleep, but the effects of GAHT on sleep are unknown. This study examined the effects of a 12 months of GAHT use on self-reported sleep quality and insomnia severity.

METHODS

A sample of 262 transgender men (assigned female at birth, started masculinizing hormone use) and 183 transgender women (assigned male at birth, started feminizing hormone use), completed self-report questionnaires on insomnia (range 0-28), sleep quality (range 0-21) and sleep onset latency, total sleep time and sleep efficiency before start of GAHT and after 3, 6, 9, and 12 months of GAHT.

RESULTS

Reported sleep quality showed no clinically significant changes after GAHT. Insomnia showed significant but small decreases after 3 and 9 months of GAHT in trans men (-1.11; 95%CI: -1.82; -0.40 and -0.97; 95%CI: -1.81; -0.13, respectively) but no changes in trans women. In trans men, reported sleep efficiency decreased by 2.8% (95%CI: -5.5%; -0.2%) after 12 months of GAHT. In trans women, reported sleep onset latency decreased by 9 min (95%CI: -15; -3) after 12 months of GAHT.

CONCLUSIONS

These findings show that 12 months of GAHT use did not result in clinically significant changes in insomnia or sleep quality. Reported sleep onset latency and reported sleep efficiency showed small to modest changes after 12 months of GAHT. Further studies should focus on underlying mechanisms by which GAHT could affect sleep quality.

Longitudinal association between problematic smartphone use and sleep disorder among Chinese college students during the COVID-19 pandemic

BACKGROUND

Problematic smartphone use (PSU) and sleep disorders (SD) are common public health problems among college students. While previous cross-sectional studies have found a relationship between PSU and SD, the causal direction of this relationship remains unclear. This study aims to examine the longitudinal changes of PSU and SD during the COVID-19 pandemic, determine the causal relationship between them, and identify confounding factors that affect this association.

METHODS

The study sample consisted of 1186 Chinese college students (47.7% male) with a mean age of 18.08 years. Participants completed the Smartphone Addiction Scale - Short Version (SAS-SV) and the Pittsburgh Sleep Quality Index (PSQI) at both baseline and follow-up surveys, conducted one year apart. The cross-lagged panel model (CLPM) was used to examine the causal relationship between PSU and SD, stratified by gender and duration of daily physical activity. The fixed effect panel regression was used to confirm the findings of CLPM.

RESULTS

The results of the CLPM analysis showed a significant bidirectional relationship between PSU and SD for the overall sample, which was consistent with the fixed effects model findings. However, subgroup analyses revealed that the bidirectional association disappeared among males or those who engaged in daily physical activity for more than 1 h.

CONCLUSIONS

Our study shows a significant bidirectional association between PSU and SD, with variations across gender and daily physical activity levels. Encouraging physical activity may serve as a potential intervention to disrupt the bidirectional association between PSU and SD, which has important implications for public health strategies aimed at reducing the negative consequences of PSU and SD.

Associations of sleep quality with the skeletal muscle strength in patients with type 2 diabetes with poor glycemic control

AIMS/INTRODUCTION

Patients with type 2 diabetes mellitus are reported to be at a high risk for sarcopenia, and are known to have a poorer sleep quality. However, the association between sleep quality and skeletal muscle in patients with type 2 diabetes mellitus is not yet precisely understood.

MATERIALS AND METHODS

A total of 110 inpatients with type 2 diabetes mellitus aged 40-90 years were enrolled. The sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Skeletal muscle mass was measured using bioelectrical impedance analysis. Muscle strength was evaluated by measuring the grip strength. We also performed dietary surveys and measurements of the plasma amino acid levels.

RESULTS

A high total score on the PSQI was significantly associated with reduced muscle strength, and the association persisted even after adjustments for confounders. On the other hand, adjusted analysis did not reveal any significant associations between the PSQI total score and the skeletal muscle mass. In regard to the associations with subscores of the PSQI, the scores for sleep latency, sleep efficiency, and daytime dysfunction were significantly negatively associated with the muscle strength. Although poor sleep quality was associated with a high confectionery intake and low plasma arginine, citrulline, and ornithine levels, neither confectionery intake levels nor the plasma levels of these amino acids was associated with the muscle strength.

CONCLUSIONS

Our study revealed a significant association between the sleep quality and muscle strength in patients with type 2 diabetes mellitus. These results suggest that poor sleep quality is an important risk factor for sarcopenia in patients with type 2 diabetes mellitus.

Sleep habits and quality among war and conflict-affected Palestinian adults in the Gaza strip

OBJECTIVES/BACKGROUND

Sleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip.

PATIENTS/METHODS

A population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9.

RESULTS

Three out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality.

CONCLUSION

Poor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life.

Sedentary behaviour and sleep quality

High-quality sleep is an important factor in sustaining health and improving well-being. Previous evidence has demonstrated the positive associations between increased physical activity and reduced sedentary behaviour (SB) with sleep quality. The substitutional relationships between SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) need to be considered when examining how a particular behaviour may impact sleep quality. No studies, to our knowledge, have explored these substitutional relationships in middle-aged adulthood. Using an isotemporal substitution approach, this study examined the associations of replacing sedentary time with physical activity on sleep quality measures in a sample of middle-aged adults in Japan. Data from 683 adults aged 40-64 living in Japan were used. The average daily time spent in SB, LPA, and MVPA was objectively assessed by accelerometers. Two self-reported sleep quality measures were obtained using questionnaires, including rest by sleep and sleep quality. Multivariable linear regression models were used to assess the associations of SB, LPA, and MVPA with the sleep quality measures stratified by gender. We found that each 60 min unit of SB or LPA replaced with MVPA was favourably associated with rest by sleep among women (β = 0.16, 95% CI 0.07, 0.28, p < 0.001; β = 0.18, 95% CI 0.07, 0.32, p < 0.05, respectively). There were no significant associations between SB, LPA, and MVPA with sleep measures in men across all three models. These findings indicate that higher MVPA has a positive association with sleep quality in middle-aged women.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Mental health status and its associated factors among female nurses in the normalization of COVID-19 epidemic prevention and control in China

Objective

To investigate mental health status and its associated factors among female nurses in the normalization of COVID-19 epidemic prevention and control in China.

Methods

Random cluster sampling was applied to recruit 740 female nurses in China. The respondents completed the survey with mobile devices. Demographic questionnaire, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index, and The Impact of Event Scale-Revised were used to assess demographic Information, anxiety, depression, insomnia and PTSD symptoms, respectively. The associated factors of mental health status were identified by binary logistic regression analysis.

Results

The prevalence of anxiety and depression was 7.9 and 17.8%, respectively. Insomnia was an associated factor of anxiety (OR = 6.237, 95%CI = 6.055-23.761, P < 0.001) and depression (OR = 9.651, 95%CI = 5.699-22.370, P < 0.001), while PTSD was an associated factor of anxiety (OR = 11.995, 95%CI = 2.946-13.205, P < 0.001) and depression (OR = 11.291, 95%CI = 6.056-15.380, P < 0.001), Being married was a protective factor of depression (OR = 0.811, 95%CI = 1.309-6.039, P < 0.01).

Conclusion

Female nurses showed problems in mental health. Insomnia, PTSD and marital status were associated with mental health. The hospital management should pay more attention to the unmarried groups, and strive to improve the sleep quality of female nurses and reduce their stress caused by traumatic events.

Posttraumatic stress symptoms and substance use among college students: Exploring interactions with sleep quality and assigned sex

Substance use is widely recognized as a negative outcome following traumatic events and is tied to symptoms of posttraumatic stress (PTS). Sleep quality may influence the PTS and substance use association, particularly among college students who are at risk for poor sleep. The purpose of the present study was to examine the moderating effect of sleep quality on the relationship between PTS and substance use in a cohort of college students, with an exploratory aim of examining potential differences by assigned sex. A screening survey was completed by 2,767 students enrolled in a larger RCT examining various brief college student alcohol reduction strategies. Results found a significant two-way interaction between PTS symptoms and subjective sleep quality on weekly number of drinks and peak drinking occasion, where the significant positive association between PTS symptoms to weekly drinks and peak drinking occasion was only found for those who reported poor sleep quality. A similar pattern emerged for the significant two-way interaction between PTS symptoms and subjective sleep quality on cannabis use frequency. A significant three-way interaction (i.e., PTS Symptoms × Poor Subjective Sleep Quality × Assigned Sex) indicated the two-way interaction between PTS symptoms and sleep quality for both weekly drinks and cannabis use frequency was stronger among male compared to female participants. Study findings suggest sleep quality is an important factor contributing to the relation between PTS symptom severity and substance use among college students. Strategies for assessing and improving sleep quality and PTS symptoms can be incorporated into prevention and intervention efforts targeting substance use related harm for college students.

Primary and secondary cardiovascular disease prevention interventions targeting lifestyle risk factors in women: A systematic review and meta-analysis

BACKGROUND AND AIMS

Over seven million women die from cardiovascular disease (CVD) annually. While lifestyle modification is recommended for CVD prevention, there are no systematic reviews evaluating the effectiveness of interventions targeted to women. The primary aim of this systematic review is to determine the efficacy of primary and secondary CVD prevention interventions targeting lifestyle risk factors in women.

METHODS

Six electronic databases were searched up to January 2022. Eligible studies included randomized controlled trials of primary or secondary CVD prevention interventions targeting CVD lifestyle risk factors (diet, physical activity, sedentary behavior, smoking, alcohol, sleep, and weight management) in women (≥18 years) that reported CVD risk markers or lifestyle risk factors. Meta-analyses were conducted on CVD risk markers and body mass index (BMI), and the level of evidence was applied to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and reported.

RESULTS

Thirty-five RCTs were included (24 primary and 11 secondary prevention). Meta-analyses demonstrated that lifestyle CVD prevention interventions achieved statistically significant reductions in BMI at ≤ 6 months (0.95 kg/m2, 95% CI = 0.54 to 1.35, p < 0.0001), 12 months (0.61 kg/m2, 95% CI = 0.07 to 1.16, p = 0.03) and >12 months (0.58 kg/m2, 95% CI = 0.01 to 1.16, p = 0.05), and systolic blood pressure (mmHg) at ≤ 6 months (3.51, p < 0.001).

CONCLUSIONS

Lifestyle interventions are important for the prevention of CVD in women, specifically to reduce systolic blood pressure in the short term (≤ 6 months) and BMI long term (>12 months).

SYSTEMATIC REVIEW REGISTRATION

https://osf.io/bkwqm, identifier: osf-registrations-bkwqm-v1.

24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing

STUDY OBJECTIVES

To investigate the association of 24-hour urinary potassium excretion with self-reported sleep quality in the general population.

METHODS

In this cross-sectional study, a population of patients aged 18 years or older was randomly selected from Xinjiang, China in 2019, 24-hour urine samples collected, and Pittsburgh Sleep Quality Index (PSQI) questionnaires assessed. Participants were divided into 2 groups (upper and lower median of 24-hour urinary potassium excretion). Poor sleep quality was defined as PSQI global score ≥ 6. Associations between 24-hour urinary potassium excretion and [24.8 mmol/L] sleep quality were assessed by multiple logistic regression analysis in total participants and those stratified by sex.

RESULTS

In total, 24-hour urine samples were collected from 1,147 participants, of whom data for those with complete urine samples and PSQI data were analyzed (n = 727; mean age = 48.7 years; percentage of women = 62%). Compared with the upper median group for 24-hour urinary potassium excretion, the lower median group showed a significantly higher PSQI global score (6 vs 5, P = .011), and prevalence of poor sleep quality (51.7% vs 42.2%, P = .011). In a fully-adjusted model of multivariate logistic regression, the lower median group showed 1.50-fold increased odds for presence of poor sleep quality (95% confidence interval: 1.01-2.24, P = .045). Sex-specific analyses translated these results to women, but not to men.

CONCLUSIONS

These results suggest that low potassium intake, indicated by lower potassium excretion, is associated with poor sleep quality in the general population, especially among women. Therefore, additional research is necessary to clarify the effect of increasing potassium intake to improve sleep quality.

CITATION

Li M, Heizhati M, Wang L, et al. 24-hour urinary potassium excretion is negatively associated with self-reported sleep quality in the general population, independently of sleep-disordered breathing. J Clin Sleep Med. 2022;18(11):2589-2596.

The effect of exercise on academic fatigue and sleep quality among university students

BACKGROUND

Routine academic events may cause fatigue and impair sleep quality. This research aimed to examine the prevalence and risk factors for academic fatigue among college students and its adverse effects on well-being and sleep. A brief exercise intervention was also evaluated.

METHODS

A total of 864 college students (33.5% female) filled out self-reported questionnaires with few open-ended questions. Fatigue and sleep quality were assessed using the translated version of the Smith Well-being Questionnaire and the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Spearman correlations, logistic regression analysis, and t-tests were used to test the hypotheses. In a second study, 29 female participants took part in an exercise intervention aimed at reducing fatigue and improving sleep.

RESULTS

Among the effective respondents, nearly 40% reported higher academic-related fatigue, and a few reported high-quality sleep. Negative coping styles, workload, stress, and disturbed surroundings had a significant positive predictive effect on academic fatigue. In addition, adverse consequences of fatigue were found for physical health and academic-life balance, and a significant, positive relationship was observed between the degree of fatigue and PSQI score (p < 0.01). The exercise study showed some beneficial effects of the intervention for both sleep and fatigue outcomes.

CONCLUSION

Fatigue is common and widely reported among Chinese college students, and it may have a major negative impact on their health. Increased awareness of daily academic fatigue and its impact on college students is important for individuals, schools, and society. Exercise may be a simple way to improve sleep and reduce fatigue.

Do alexithymia and negative affect predict poor sleep quality? The moderating role of interoceptive sensibility

OBJECTIVES

Emotion-related hyperarousal is an important core pathology of poor sleep. Studies investigating the interplay of alexithymia and affective experiences in determining sleep quality have yielded mixed results. To disentangle the inconsistency, this study examined the concurrent predictive power of alexithymia, and negative and positive affect, while incorporating interoceptive sensibility (IS) as a possible moderator.

METHODS

A sample of 224 (70.10% were female) participants completed the Toronto Alexithymia Scale, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Interoceptive Awareness (MAIA), and Marlowe-Crowne Social Desirability Scale (for controlling response bias) using paper and pencil. A two-stage cluster analysis of the MAIA was used to capture IS characteristics. Stepwise regression was conducted separately for each IS cluster.

RESULTS

A three-group structure for IS characteristics was found. Higher alexithymia was predictive of poor sleep quality in the low IS group, while higher negative affect predicted poor sleep quality in the moderate and high IS groups. Additionally, alexithymia and positive affect were significantly different in the three IS groups, while negative affect and sleep quality were not.

CONCLUSIONS

Emotion and cognitive arousal may impact sleep quality differently in individuals with different levels of internal focusing ability, depending on physiological versus emotional self-conceptualization. The implications on pathological research, clinical intervention, study limitations and future directions are discussed.

Association between Sleep Quality and Physical Activity in Physical Education Students in Chile in the Pandemic Context: A Cross-Sectional Study

Background: Due to the health restrictions put in place to face the pandemic, a decrease in the levels of physical activity and an alteration in the quality of sleep have been observed. One group susceptible to these changes is represented by students of physical education pedagogy, who, under normal conditions, present high levels of physical activity. However, the correlation between these variables has not been studied in the context of a pandemic lockdown. Objective: The aim of this study was to determine the prevalence of the quality of sleep and physical activity level as a function of gender and evaluate the association between quality of sleep and physical activity level in physical education pedagogy students during the COVID-19 pandemic considering sociodemographic and health characteristics. Methods: This was a cross-sectional study. An online questionnaire was applied to 280 Chilean university students of physical education pedagogy. The survey considered sociodemographic information, healthy habits, and self-reported health and included the International Physical Activity Questionnaire (IPAQ) for physical activity levels and the Pittsburgh Sleep Quality Index (PSQI) for sleep quality. Results: The prevalence of good sleep quality was 20.4%. Furthermore, 52.9% of students had a high level of physical activity. Regression analysis between PSQI global score and age-adjusted physical activity levels indicated that being male and presenting a high level of physical activity favored a better PSQI global score. Conclusions: The prevalence of good sleep quality was low in general and significantly lower in women. Being male and having a high level of physical activity during quarantine benefits good sleep quality, regardless of age.

Factors Associated with Poor Sleep among Young People in Mauritius: A Survey-Based Study

Background: Poor sleep quality in young people is a global concern. This study was conducted to explore sleep quality and its contributory factors in young people of Mauritius. Methods: This cross-sectional study comprised 202 participants aged between 14 to 29 years. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Adolescent Sleep Hygiene Scale (ASHS) were used to measure sleep quality, daytime sleepiness, and sleep hygiene respectively. Chi-squared tests were conducted to evaluate relationships between the collected variables. Multivariate logistic regression was used to identify associated factors with poor sleep quality. Results: The mean global PSQI was 4.81 (95%CI: 4.4, 5.22). Prevalence of poor sleep quality (global PSQI score > 5) was 30.7%. The male gender reported better sleep (p=0.008). Sleep quality was significantly associated with longer sleep duration (p<0.0001), pre-bedtime relaxing activities (p=0.01), and daytime physical exercise (p=0.001). In contrast, alcohol consumption after 18:00 (p<0.0001), tobacco smoking after 18:00 (p<0.0001), pre-bedtime awakening activities (p=0.001), and poor sleep environment (p<0.0001) negatively influenced sleep quality. Multivariate logistic regression confirmed that female gender and sleep environment factors were associated with higher likelihood of poor sleep quality, while participants with longer duration of sleep (>7 hours), cognitive/emotional and sleep stability factors were found to be less likely to have poor sleep quality. Conclusion: This study showed that the prevalence of poor sleep in young people in Mauritius was 30.7%. Female gender and sleep environment factors were main contributory factors. These initial results can guide further research on sleep quality

Relationship between burnout, effort-reward imbalance, and insomnia among Informational Technology professionals

BACKGROUND

Work in informational technology (IT) professionals is highly competitive and stressful, leading to job stress. This can lead to burnout, effort-reward imbalance (ERI), and poor sleep quality.

MATERIALS AND METHODS

The present study examined associations of ERI, burnout, and poor sleep quality among IT professionals using data from 200 software engineers (mean age of 29.3 ± 4 years, 32% women). ERI and overcommitment were assessed using Siegrist's "effort-reward" questionnaire. The Oldenburg Burnout Inventory (OLBI) was used to assess burnout and Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality.

RESULTS

ERI, burnout and poor sleep quality were present in 72%, 60%, and 70%, respectively. Females had higher ERI, burnout, and poor sleep quality compared to males. ERI is significantly associated with burnout (r = 0.45, P < 0.01) and poor sleep quality (r = 0.31, P < 0.01). Linear regression to assess the ability of ERI to predict levels of burnout yielded a statistically significant (R ² = 0.206, P < 0.01) indicating ERI to be a unique incremental predictor of burnout (b = 0.454, t = 7.16, P < 0.01). ERI tends to be a predictive factor of poor sleep quality with Odd's ratio = 3.5, 95%CI (1.81-6.73), P < 0.01.

CONCLUSION

In summary, Intervention programs both at the individual and at the organization level have to be designed to combat ERI, burnout, and poor sleep quality among IT professionals.

Development and validation of mathematical nomogram for predicting the risk of poor sleep quality among medical students

Background

Despite the increasing prevalence of poor sleep quality among medical students, only few studies have identified the factors associated with it sing methods from epidemiological surveys. Predicting poor sleep quality is critical for ensuring medical Students’ good physical and mental health. The aim of this study was to develop a comprehensive visual predictive nomogram for predicting the risk of poor sleep quality in medical students.

Methods

We investigated medical Students’ association with poor sleep quality at JiTang College of North China University of Science and Technology through a cross-sectional study. A total of 5,140 medical students were randomized into a training cohort (75%) and a validation cohort (25%). Univariate and multivariate logistic regression models were used to explore the factors associated with poor sleep quality. A nomogram was constructed to predict the individual risk of poor sleep quality among the medical students studied.

Results

31.9% of medical students in the study reported poor sleep quality. We performed multivariate logistic analysis and obtained the final model, which confirmed the risk and protective factors of poor sleep quality (p < 0.05). Protective factors included the absence of physical discomfort (OR = 0.638, 95% CI: 0.546–0.745). Risk factors included current drinking (OR = 0.638, 95% CI: 0.546∼0.745), heavy study stress (OR = 2.753, 95% CI: 1.456∼5.631), very heavy study stress (OR = 3.182, 95% CI: 1.606∼6.760), depressive symptoms (OR = 4.305, 95% CI: 3.581∼5.180), and anxiety symptoms (OR = 1.808, 95% CI: 1.497∼2.183). The area under the ROC curve for the training set is 0.776 and the area under the ROC curve for the validation set is 0.770, which indicates that our model has good stability and prediction accuracy. Decision curve analysis and calibration curves demonstrate the clinical usefulness of the predictive nomograms.

Conclusion

Our nomogram helps predict the risk of poor sleep quality among medical students. The nomogram used includes the five factors of drinking, study stress, recent physical discomfort, depressive symptoms, and anxiety symptoms. The model has good performance and can be used for further research on and the management of the sleep quality of medical students.

Associations between sleep deficit and academic achievement - triangulation across time and subject domains among students and teachers in TIMSS in Norway

Background

Sufficient sleep is important to an individual’s health and well-being, but also for school achievement among adolescents. This study investigates the associations between sleepiness, sleep deficits, and school achievements among adolescents.

Methods

This trend study involved a representative sample of Norwegian adolescents based on the “Trends in International Mathematics and Science Study” (TIMSS), N = 4499 (2015) and N = 4685 (2019) and their teachers. The students were 9th graders from a Norwegian compulsory secondary school. The survey included questions on students’ sleepiness as students reported in 2019 and sleep deficits among students that limited teaching in class as their teachers reported in 2015 and 2019. Regression, triangulation, and mediation analyses were used. Mplus was used to perform the statistical analyses.

Results

The results revealed significant negative associations between sleep deficits and school achievements, adjusted for gender, socioeconomic status (SES), and minority status among Norwegian 9th graders. These results were found for both mathematics and science achievements in 2015 and 2019. Sleepiness that the students reported was negatively associated with school achievements in 2019. Trend and mediation analyses showed that sleep deficits explained 18 and 11% of the decrease in mathematics and science achievements, respectively, from 2015 to 2019.

Conclusions

Sleep deficits were associated with school achievements in mathematics and science among Norwegian 9th graders. Mediation analyses revealed that sleep deficits explained a significant part of the decline in academic achievements. Insufficient sleep may have negative public health implications and influence adolescents’ academic achievements and competences, and should therefore be discussed in both the educational and health systems.

Daily-level associations between sleep duration and next-day alcohol and cannabis craving and use in young adults

STUDY OBJECTIVES

To examine the effects of sleep duration on next-day alcohol and cannabis craving and use among young adults.

METHOD

A community sample of young adults who reported recent simultaneous alcohol and cannabis use at screening (N = 409; Mage = 21.61; 50.9% female) completed twice daily surveys (morning and afternoon) for five 14-day sampling bursts (i.e., 70 days total). Daily measurements included sleep duration, alcohol and cannabis craving, and alcohol and cannabis use (i.e., number of drinks, hours high). Multilevel models enabled examining associations between sleep duration and substance use/craving at three distinct levels: daily-level, burst-level, and person-level.

RESULTS

At the day-level, sleep duration was inversely associated with craving for both alcohol and cannabis: Stronger craving was reported on mornings and afternoons after relatively shorter sleep duration. At the burst-level, sleep duration was inversely associated with morning and afternoon alcohol craving indicating stronger alcohol craving, but not cannabis craving, during two-week periods when young adults have accumulated shorter sleep duration. Pertaining to alcohol and cannabis use, no daily-level effects were found, but the burst-level effect showed that participants engaged in greater alcohol use during two-week bursts with shorter sleep duration.

CONCLUSIONS

Based on a non-clinical sample of young adults reporting substance use, results suggest shorter sleep duration may be a modifiable risk factor as it pertains to substance use and cravings. Results highlight day-level effects of shorter sleep duration on substance use cravings and adverse effects of cumulative sleep deficit on alcohol use.

Smartphone Usage and Sleep Quality in Korean Middle School Students During the COVID-19 Pandemic

OBJECTIVE

This study evaluated the quality of sleep and smartphone addiction in Korean adolescents during the coronavirus disease 19 pandemic and analyzed their effects on perceived quality of life.

METHODS

An online survey system provided by the Gwangmyeong City Health Center located in Gyeonggi-do, Korea, was completed by 1,678 local middle school students from April 1 to June 30, 2021. We measured quality of life using the KIDSCREEN-27 health-related quality of life questionnaire, quality of sleep using the Korean version of the Pittsburgh Sleep Quality Index, and smartphone addiction using the Smartphone Addiction Self-Diagnosis Scale. Bed times, wake times, and total sleep hours were also recorded.

RESULTS

Sleep quality and quantity were directly associated with smartphone addiction. The results indicated that lower quality of life was associated with lower sleep quality, delayed onset of sleep, shorter total sleep time, and higher smartphone addiction. Female students reported lower quality of life, lower sleep quality, delayed sleep phases, shorter total sleep hours, and higher smartphone addiction scores than did male students.

CONCLUSION

Our results suggest that adolescents' quality of life is threatened by poor sleep, which in turn could be due to unhealthy smartphone usage. Girls were more heavily affected by this trend than were boys. Preparations to intervene for further mental health issues that might follow are necessary.

Impact of COVID-19 lockdown on sleep quality of pharmacy students in UiTM Puncak Alam

Due to the COVID-19 pandemic, the closure of educational institutions was executed during the period of lockdown. This subsequently led to alterations in daily routines and emotional distress, particularly among university students, affecting their sleep quality resulting in disturbance of immune functioning and mood regulation. Hence, the present study aimed to measure students' sleep quality during the first few months of the lockdown period. This study is a cross-sectional, single-centred survey that was done by distributed electronic questionnaire. The e-questionnaire was divided into 4 sections that assessed socio-demographic characteristics, sleep quality, psychological state and engagement in physical activity. Exactly 248 valid responses were received, 82 % female students. Students with poor sleep quality were three times greater than those with good sleep quality. No association were found between physical activity and sleep quality. However, a significant positive relationship between sleep quality and psychological state was observed (p < 0.01). In conclusion, this study suggests that the majority of pharmacy students in UiTM Puncak Alam are poor sleepers and psychological distress negatively affects sleep quality but, is mainly due to stress. Thus, interventions such as stress management programs and mental health support can be taken by the faculty's management to overcome this problem.

Clinical and Polysomnographic Features Associated with Poor Sleep Quality in Patients with Obstructive Sleep Apnea

Background and Objectives: Poor sleep quality in patients with obstructive sleep apnea (OSA) may be associated with different clinical and polysomnographic features. The aim of this study was to identify features associated with poor sleep quality in OSA patients. Materials and Methods: This was a cross-sectional study enrolling patients with OSA confirmed by polysomnography (PSG). In addition to gathering clinical data, patients were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Clinical Global Impression Scale. Univariate and multivariable analyses were performed to identify factors associated with an increased risk of poor sleep quality in this population. Results: Among 505 enrolled patients (mean age of 57.1 years, 69.7% male) poor quality of sleep (PSQI score ≥ 5) was confirmed in 68.9% of them. Multivariable analysis revealed the following factors associated with poor sleep quality: chronic heart failure (OR 3.111; 95% CI, 1.083−8.941, p = 0.035), male sex (OR 0.396; 95% CI, 0.199−0.787, p = 0.008), total ESS score (OR 1.193; 95% CI, 1.124−1.266, p < 0.001), minimal saturation during sleep (OR 1.034; 95% CI, 1.002−1.066, p = 0.036), and N3 percentage of total sleep time (OR 1.110; 95% CI, 1.027−1.200, p = 0.009). Conclusions: Our study suggests that both the female sex and coexistence of heart failure are independent risk factors for poor sleep quality. Moreover, we hypothesize that nocturnal hypoxia may lead to a misperception of sleep quality and may explain the counterintuitive association between a higher proportion of deep sleep and poor sleep quality.

Sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia

Introduction

Sleep plays an essential role in every individual’s life since it contributes greatly to their well-being and health. Poor sleep quality is one of the most common consequences of hypertension (HTN), which is a leading public health problem. In Ethiopia, it is the main health concern among hypertension patients. Thus, in the study area, there is limited information regarding the investigation of sleep quality among hypertension patients. Therefore, this study aimed to assess sleep quality and associated factors among adult hypertensive patients attending a chronic follow up care clinic in northwest Amhara regional state referral hospitals, Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted among adult HTN patients from March 15/2021 to May 15/2021 in Northwest Amhara Regional State Referral Hospitals. A systematic random sampling method was used to select the study participants. A face-to-face interviewer-administered questionnaire with chart review was used. The Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality was used in this study. A binary logistic regression was used to see the association between dependent and independent variables. Variables having a p-value < 0.05 with a 95% CI were considered statistically significant in the multivariable logistic regression analysis.

Results

In this study, 563 hypertensive patients were included, with a response rate of 96.9%. The overall prevalence of poor sleep quality was 37.7% (95% CI: 33.4%–41.6%). Female gender (AOR = 2.55, 95% CI: 1.55–4.18), age ≥ 65 years (AOR = 4.07, 95% CI: 2.07–7.97), overweight (BMI) ≥ 25 kg/m2 (AOR = 1.68, 95% CI: 1.06–2.65), WHO stage II hypertension (AOR = 1.78, 95% CI:1.01–3.12), poor physical activity (AOR = 2.39, 95% CI:1.41–4.05), participants who had depression (AOR = 2.03,95% CI:1.24–3.34) and participants who had anxiety (AOR = 1.89, 95% CI: 1.16–3.03) were factors associated with poor sleep quality.

Conclusions

In this study, more than one-third of the study participants had poor sleep quality. Female gender, age ≥ 65 years, overweight (BMI) ≥ 25 kg/m2, stage II hypertension, physical inactivity, depression, and anxiety were all associated with poor sleep quality. Managing depression and anxiety disorders, encouraging physical activity, and providing health education about weight loss are all necessary for HTN patients.

Changes in Sleep Patterns during Pregnancy and Predictive Factors: A Longitudinal Study in Saudi Women

This study aimed to assess sleep patterns during the three trimesters of pregnancy and whether vitamin D concentrations, along with other risk factors, are associated with these alterations. In a longitudinal study, 140 pregnant women (age 18 to 39 years) were followed throughout their first, second, and third trimesters. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) at each trimester, along with an assessment of biochemical parameters, including serum vitamin D levels. The information that was collected included anthropometric data, socio-economic status, dietary intake, and physical activity. The PSQI was higher in mid and late pregnancy than in early pregnancy (both p = 0.001), and the sleep duration was also higher in late versus early pregnancy. Linear regression analyses revealed independent predictors of deteriorating sleep quality from early to late pregnancy, including low income (B ± SE −0.60 ± 0.26, p = 0.03) and low serum vitamin D levels in the second trimester (B ± SE −0.20 ± 0.01, p = 0.04). Energy intake and sitting in the second half of pregnancy were positively associated with changes in the PSQI score from the second to third trimesters (B ± SE 0.15 ± 0.07, p = 0.048) and (B ± SE 0.01 ± 0.00, p = 0.044), respectively. Low socio-economic status, low serum vitamin D levels, greater energy intake, and sitting time were associated with worsening patterns of sleep quality from early to late pregnancy.

Are sleep quality judgments comparable across individuals, places, and spaces? An interdisciplinary analysis of data from 207,608 individuals across 68 countries

OBJECTIVES

Significant research has shown that health is a heterogeneous concept, and one person's poor health may not be comparable with another's. Yet, little consideration has been given to whether sleep quality judgments are also heterogeneous or whether they cohere between individuals. Another possibility is that there are group differences in the ways in which sleep quality is perceived. If this is the case, it is possible known inequalities in sleep are-in part-an artifact of social position influencing how we conceive of sleep problems. The current study explores this possibility.

DESIGN

Cross-sectional, using World Health Organization data from 207,608 individuals; aged between 15 and 101 years of age from 68 countries. Alongside a battery of sleep and demographic variables, data contained sleep and energy vignettes. Random effect anchoring vignette models were applied to investigate interpersonal incompatibility and whether sleep quality perceptions operate differently depending on social location, context, and function.

RESULTS

While sleep quality judgments are largely comparable across individuals, findings also highlight how the relationship between education and self-reported sleep changes following adjustment for reporting heterogeneity. Estimates of threshold parameters suggest that those with more years of education have a slightly increased threshold for reporting mild sleep problems (B 0.005; s.e. 0.001) but a lower threshold for reporting sleep problems as extreme (B -0.007; s.e. 0.001).

CONCLUSIONS

Sleep quality judgments occupy a complex position between heterogeneity and coherence. This has implications for both epidemiological methodologies and contemporary debates about social justice, public health and sleep.

Affective Experience and Regulation via Sleep, Touch, and "Sleep-Touch" Among Couples

Touch associated with sleep (sleep-touch; reported physical contact during or shortly before/after sleep) is underexplored as a distinct contributor to affect regulatory processes associated with adult sleep. Given the affect-regulating effects of interpersonal touch, we theorized that among healthy co-sleeping adults, sleep-touch would add to sleep-related effects on affective "resetting," resulting in the experience of calmer, more regulated states. We studied 210 married heterosexual couples (aged 20-67 years, 79% non-Hispanic white, 13% Latinx) assigned 14 days of twice-daily (morning/evening) sleep/mood diaries. Multilevel daily (within-couple) mediation analyses showed that as hypothesized, more reported sleep-touch was associated with happier/calmer and less angry/irritable morning mood. In turn, happier/calmer mood was associated with greater enjoyment of time with spouse (for both spouses). Sleep-touch also was linked directly to both evening positive spousal events and enjoyment ratings. Sleep-touch was associated indirectly with fewer negative spousal events and less spouse-related stress via less angry/irritable morning mood (both spouses). Further, wives' sleep-touch was related to happier/calmer husband mood and evening enjoyment; husbands' sleep-touch was unrelated to wives' reports. All associations with sleep-touch were present while accounting for subjective sleep quality, prior evening mood, non-sleep-related physical affection, day in study, and weekend versus weekday. We speculate that among relatively healthy satisfied couples, physical touch during and surrounding sleep may add to sleep's restorative and affect-regulatory functions, suggesting a pathway through which co-sleeping can improve affect regulation and ultimately relationships and health.

Daily Relations Between Stress and Electroencephalography-Assessed Sleep: A 15-Day Intensive Longitudinal Design With Ecological Momentary Assessments

BACKGROUND

Recent studies have found bi-directional relations between stress and sleep. However, few studies have examined the daily associations between stress and electroencephalography (EEG) measured sleep.

PURPOSE

This study examined the temporal associations between repeated ecological momentary assessments of stress and EEG-estimated sleep.

METHODS

Ninety-eight international or interstate undergraduate students (Mage = 20.54 ± 1.64, 76.5% female, 84.7% Asian) reported their stress levels four times daily at morning awakening, afternoon, evening, and pre-bedtime across 15 consecutive days (>4,000 total observations). Next-day stress was coded as an average of morning, afternoon, and evening stress. Z-Machine Insight+ recorded over 1,000 nights EEG total sleep time (TST), sleep onset latency, wake after sleep onset, sleep efficiency (SE), slow-wave sleep (SWS), and rapid eye movement (REM) sleep duration. Multilevel models, adjusted for covariates (i.e., sociodemographic, health factors, and daily covariates) and lagged outcomes, tested the daily within- and between-level stress-sleep associations.

RESULTS

After adjusting for covariates, within-person shorter TST (b = -0.11 [-0.21, -0.01], p = .04), lower SE (b = -0.02 [-0.03, 0.00], p = .04), less SWS (b = -0.38 [-0.66, -0.10], p = .008), and less REM sleep (b = -0.32 [-0.53, -0.10], p = .004) predicted higher next-day stress. Pre-bedtime stress did not predict same-night sleep. No significant results emerged at the between-person level.

CONCLUSIONS

These findings demonstrate that poor or short sleep, measured by EEG, is predictive of higher next-day stress. Results for sleep architecture support the role of SWS and REM sleep in regulating the perception of stress. Given that only within-person effects were significant, these findings highlight the importance of examining night-to-night fluctuations in sleep affecting next-day stress and its impact on daytime functioning.

Bedtime procrastination predicts the prevalence and severity of poor sleep quality of Chinese undergraduate students

ObjectiveBedtime procrastination is a type of unhealthy sleep behavior, but whether it affects sleep quality remains unknown. The current study aimed to examine the relationship between bedtime procrastination and poor sleep quality among Chinese college students. Participants: A total of 1550 Chinese undergraduates participated and effectively completed the study. Methods: This cross-sectional study collected information on bedtime procrastination and self-reported sleep quality via the Bedtime Procrastination Scale and the Pittsburgh Sleep Quality Index. Results: The prevalence of poor sleep quality was 39.42% among Chinese undergraduates. Age, education, and bedtime procrastination independently predicted the prevalence of poor sleep quality. Bedtime procrastination was a unique contributor to the severity of poor sleep quality. Conclusions: This study highlighted the independent associations between bedtime procrastination and the prevalence and severity of self-reported poor sleep quality. These findings may be helpful in designing effective measures to improve the sleep quality of college students.

The Relationship between Living Arrangements and Sleep Quality in Older Adults: Gender Differences

(1) Background: This study examined the effects of living arrangements on the quality of sleep among older adults and analyzed related gender differences; (2) Methods: A total of 4756 older adults in Seoul were included. After adjusting for socio-demographic factors, older adults living alone showed a poorer sleep quality compared with those living with others; (3) Results: When we analyzed the effects of living arrangements on sleep quality by gender, there was no difference in the risk of poor sleep quality between male older adults living alone and those living with others (OR = 1.089, 95% CI = 0.729–1.628), whereas the risk of poor sleep quality was higher for female older adults living alone than those living with others (OR = 1.359, 95% CI = 1.088–1.696); (4) Conclusions: In this study, we have confirmed that older women living alone had poor sleep quality compared to older men. Hence, gender-based approaches will be helpful when providing social support resources to older adults living alone.

The Effect of Worktime Control on Overtime Employees' Mental Health and Work-Family Conflict: The Mediating Role of Voluntary Overtime

Overtime has become a widespread phenomenon in the current information age that creates a high speed working pace and fierce competition in the high technology global economy. Based on the time-regulation mechanism and effort-recovery model, we examined the effect of worktime control (WTC) on mental health and work-family conflict (WFC) among overtime employees, and whether voluntary overtime mediated the relationships. We also examined two separate dimensions of WTC (control over time-off and control over daily hours). The results showed that control over time-off was related to decreased depression, anxiety, stress and WFC, while control over daily hours was related to decreased stress and WFC. Generally, control over time-off was beneficial to females and employees with dependents. Furthermore, mediation results showed that voluntary overtime was a complete mediator of relationships between WTC and depression and anxiety as well as a partial mediator of the relationship between WTC and stress. However, this study did not find a mediating effect of voluntary overtime on the WTC-WFC relationship. Limitations and practical implications are discussed.