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Mantua J, Ritland BM, Naylor JA, Simonelli G, Mickelson CA, Choynowski JJ, Bessey AF, Sowden WJ, Burke TM, McKeon AB. Physical sleeping environment is related to insomnia risk and measures of readiness in US army special operations soldiers. BMJ Mil Health 2023; 169:316-320. [PMID: 34301851 DOI: 10.1136/bmjmilitary-2021-001801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND US military service members have characteristically poor sleep, even when 'in garrison' or at one's home base. The physical sleeping environment, which is often poor in military-provided housing or barracks, may contribute to poor sleep quality in soldiers. The current study aimed to assess whether the sleeping environment in garrison is related to sleep quality, insomnia risk and military readiness. METHODS Seventy-four US army special operations soldiers participated in a cross-sectional study. Soldiers were queried on their sleeping surface comfort and the frequency of being awakened at night by excess light, abnormal temperatures and noise. Subjective sleep quality and insomnia symptoms were also queried, via the Pittsburgh Sleep Quality Index and Insomnia Severity Index, respectively. Lastly, measures of soldier readiness, including morale, motivation, fatigue, mood and bodily pain, were assessed. RESULTS Soldiers reporting temperature-related and light-related awakenings had poorer sleep quality higher fatigue and higher bodily pain than soldiers without those disturbances. Lower ratings of sleeping surface comfort were associated with poorer sleep quality and lower motivation, lower morale, higher fatigue and higher bodily pain. Each 1-point increase in sleeping surface comfort decreased the risk for a positive insomnia screen by 38.3%, and the presence of temperature-related awakenings increased risk for a positive insomnia screen by 78.4%. Those living on base had a poorer sleeping environment than those living off base. CONCLUSION Optimising the sleep environment-particularly in on-base, military-provided housing-may improve soldier sleep quality, and readiness metrics. Providers treating insomnia in soldiers should rule out environment-related sleep disturbances prior to beginning more resource-intensive treatment.
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Affiliation(s)
- Janna Mantua
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - B M Ritland
- Human Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - J A Naylor
- 75th Ranger Regiment, Ft. Benning, Georgia, USA
| | - G Simonelli
- Department of Psychology, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Psychology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - C A Mickelson
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - J J Choynowski
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - A F Bessey
- Department of Psychology, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - W J Sowden
- Department of Behavioral Health, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii, USA
| | - T M Burke
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - A B McKeon
- Operational Research Team, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Edgar DT, Beaven CM, Gill ND, Zaslona JL, Driller MW. Operation early-bird: Investigating altered light exposure in military barracks on sleep and performance-a placebo-controlled study. J Sleep Res 2023:e13837. [PMID: 36793180 DOI: 10.1111/jsr.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/31/2022] [Accepted: 12/07/2022] [Indexed: 02/17/2023]
Abstract
The manipulation of light exposure in the evening has been shown to modulate sleep, and may be beneficial in a military setting where sleep is reported to be problematic. This study investigated the efficacy of low-temperature lighting on objective sleep measures and physical performance in military trainees. Sixty-four officer-trainees (52 male/12 female, mean ± SD age: 25 ± 5 years) wore wrist-actigraphs for 6 weeks during military training to quantify sleep metrics. Trainee 2.4-km run time and upper-body muscular-endurance were assessed before and after the training course. Participants were randomly assigned to either: low-temperature lighting (LOW, n = 19), standard-temperature lighting with a placebo "sleep-enhancing" device (PLA, n = 17), or standard-temperature lighting (CON, n = 28) groups in their military barracks for the duration of the course. Repeated-measures ANOVAs were run to identify significant differences with post hoc analyses and effect size calculations performed where indicated. No significant interaction effect was observed for the sleep metrics; however, there was a significant effect of time for average sleep duration, and small benefits of LOW when compared with CON (d = 0.41-0.44). A significant interaction was observed for the 2.4-km run, with the improvement in LOW (Δ92.3 s) associated with a large improvement when compared with CON (Δ35.9 s; p = 0.003; d = 0.95 ± 0.60), but not PLA (Δ68.6 s). Similarly, curl-up improvement resulted in a moderate effect in favour of LOW (Δ14 repetitions) compared with CON (Δ6; p = 0.063; d = 0.68 ± 0.72). Chronic exposure to low-temperature lighting was associated with benefits to aerobic fitness across a 6-week training period, with minimal effects on sleep measures.
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Affiliation(s)
- David T Edgar
- Faculty of Health, University of Waikato, Hamilton, New Zealand.,New Zealand Defence Force, Wellington, New Zealand
| | - C Martyn Beaven
- Faculty of Health, University of Waikato, Hamilton, New Zealand
| | - Nicholas D Gill
- Faculty of Health, University of Waikato, Hamilton, New Zealand
| | | | - Matthew W Driller
- Faculty of Health, University of Waikato, Hamilton, New Zealand.,Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Mantua J, Shevchik JD, Chaudhury S, Eldringhoff HP, Mickelson CA, McKeon AB. Sleep and Infantry Battle Drill Performance in Special Operations Soldiers. Aerosp Med Hum Perform 2022; 93:557-561. [DOI: 10.3357/amhp.6040.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Although multiple studies have documented the impact of insufficient sleep on soldier performance, most studies have done so using artificial measures of performance (e.g., tablet or simulator tests). The current study sought to test the relationship between sleep
and soldier performance during infantry battle drill training, a more naturalistic measure of performance.METHODS: Subjects in the study were 15 junior Special Operations infantry soldiers. Soldiers wore an actigraph and reported their subjective sleep duration and quality prior
to close quarter battle (CQB) drills. Experienced leaders monitored each iteration of the CQB exercise and recorded the number of errors committed.RESULTS: The number of errors committed during the live ammunition iterations was negatively correlated with subjective number of hours
slept and subjective sleep efficiency/quality during the month prior. Soldiers with subjective sleep duration ≥7 h had a significantly lower number of errors than soldiers with subjective sleep duration <7 h (1.71 vs. 0.63 errors), and soldiers with sleep quality <85% committed more
errors than those with sleep quality ≥85% (1.50 vs. 0.40 errors).DISCUSSION: These data preliminarily suggest that sleep quality and duration may influence subsequent performance on infantry battle drill training, particularly for soldiers with limited experience in battle drill
conduction who have not yet perfected battle drill techniques. Future studies should enact sleep augmentation to determine the causal influence of sleep on performance in this setting.Mantua J, Shevchik JD, Chaudhury S, Eldringhoff HP, Mickelson CA, McKeon AB. Sleep and infantry
battle drill performance in Special Operations soldiers. Aerosp Med Hum Perform. 2022; 93(7):557–561.
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Gomez-Merino D, Drogou C, Debellemaniere E, Erblang M, Dorey R, Guillard M, Van Beers P, Thouard M, Masson R, Sauvet F, Leger D, Bougard C, Arnal PJ, Rabat A, Chennaoui M. Strategies to Limit Cognitive Impairments under Sleep Restriction: Relationship to Stress Biomarkers. Brain Sci 2022; 12:brainsci12020229. [PMID: 35203992 PMCID: PMC8869873 DOI: 10.3390/brainsci12020229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023] Open
Abstract
Adding relaxation techniques during nap or auditory stimulation of EEG slow oscillation (SO) during nighttime sleep may limit cognitive impairments in sleep-deprived subjects, potentially through alleviating stress-releasing effects. We compared daytime sleepiness, cognitive performances, and salivary stress biomarker responses in 11 volunteers (aged 18–36) who underwent 5 days of sleep restriction (SR, 3 h per night, with 30 min of daily nap) under three successive conditions: control (SR-CT), relaxation techniques added to daily nap (SR-RT), and auditory stimulation of sleep slow oscillations (SO) during nighttime sleep (SR-NS). Test evaluation was performed at baseline (BASE), the fifth day of chronic SR (SR5), and the third and fifth days after sleep recovery (REC3, REC5, respectively). At SR5, less degradation was observed for percentage of commission errors in the executive Go–noGo inhibition task in SR-RT condition compared to SR-CT, and for sleepiness score in SR-NS condition compared both to SR-CT and SR-RT. Beneficial effects of SR-RT and SR-NS were additionally observed on these two parameters and on salivary α-amylase (sAA) at REC3 and REC5. Adding relaxation techniques to naps may help performance in inhibition response, and adding nocturnal auditory stimulation of SO sleep may benefit daytime sleepiness during sleep restriction with persistent effects during recovery. The two strategies activated the autonomic nervous system, as shown by the sAA response.
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Affiliation(s)
- Danielle Gomez-Merino
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
- Correspondence: (D.G.-M.); (M.C.)
| | - Catherine Drogou
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | - Eden Debellemaniere
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
- Dreem SAS, 75009 Paris, France;
| | - Mégane Erblang
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | - Rodolphe Dorey
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | - Mathias Guillard
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | - Pascal Van Beers
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | | | - Robin Masson
- Ecole du Val de Grace, 75005 Paris, France; (M.T.); (R.M.)
| | - Fabien Sauvet
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | - Damien Leger
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
- Centre du Sommeil et de la Vigilance, APHP, Hôpital Hôtel-Dieu, 75004 Paris, France
| | - Clément Bougard
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | | | - Arnaud Rabat
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
| | - Mounir Chennaoui
- Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées (IRBA), 91223 Bretigny-sur-Orge, France; (C.D.); (E.D.); (M.E.); (R.D.); (M.G.); (P.V.B.); (F.S.); (C.B.); (A.R.)
- VIgilance FAtigue SOMmeil et Santé Publique, Université de Paris, 75004 Paris, France;
- Correspondence: (D.G.-M.); (M.C.)
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Keaton SA, Arnetz J, Jamil H, Dhalimi A, Stemmer PM, Ruden DM, Yamin J, Achtyes E, Smart L, Brundin L, Arnetz BB. IL-10: A possible immunobiological component of positive mental health in refugees. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 8:100097. [PMID: 35757662 PMCID: PMC9216633 DOI: 10.1016/j.cpnec.2021.100097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/23/2023] Open
Abstract
Objective As the number of refugees continues to rise, there is growing concern about the impact from trauma exposures on their mental health. However, there is a limited understanding of possible biological mechanisms contributing to the substantial inter-individual differences in trauma-related outcomes, especially as it relates to positive mental health. Only sparse work has focused on the biology of positive mental health, including energy and sleep, in trauma-exposed persons. In this study, we analyzed cytokines in blood from newly arrived refugees with differential trauma exposures in relationship to self-reported energy, as a key marker of positive mental health. Methods Within the first month of arrival in the USA, 64 refugees from Iraq and Syria were interviewed. Refugees completed the clinical DSM-IV PTSD-Checklist Civilian Version (PCL-C), the Beck Anxiety Inventory (BAI), and the Hospital Anxiety and Depression Scale (HADS). Ten psychiatrically healthy non-refugee persons were used as healthy controls to compare levels of cytokines. Blood samples were collected at the time of the interview and subsequently analyzed for IL-1β, IL-6, IL-8, IL-10, and TNF-α concentrations. Results Energy correlated positively with current concentration ability and sleep quality, and negatively with stress, PCL-C, BAI and HADS scores (Spearman correlations, all p<0.05). Refugees had lower levels of IL-10 compared to controls (p<0.05). IL-10 levels in refugees correlated with higher energy levels (p<0.01). Conclusions Results suggest that self-reported energy is a key component of positive mental health in newly arrived traumatized refugees. Additionally, the anti-inflammatory cytokine IL-10 could be a marker of, or causally associated with positive mental health. A better understanding of the balance between pro- and anti-inflammatory states in highly traumatized individuals has the potential to create more targeted and effective treatments with implications for long-term health outcomes.
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Affiliation(s)
- Sarah A. Keaton
- Department of Physiology, Michigan State University, East Lansing, MI, USA
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - Judy Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Hikmet Jamil
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Abir Dhalimi
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Paul M. Stemmer
- Institute of Environmental Health Science, Wayne State University, Detroit, MI, USA
| | - Douglas M. Ruden
- Institute of Environmental Health Science, Wayne State University, Detroit, MI, USA
| | - Jolin Yamin
- Institute of Environmental Health Science, Wayne State University, Detroit, MI, USA
| | - Eric Achtyes
- Pine Rest Christian Mental Health, Grand Rapids, MI, USA
- Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - LeAnn Smart
- Pine Rest Christian Mental Health, Grand Rapids, MI, USA
| | - Lena Brundin
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
- Division of Psychiatry & Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Bengt B. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Teyhen DS, Capaldi VF, Drummond SPA, Rhon DI, Barrett AS, Silvernail JL, Boland DM. How sleep can help maximize human potential: The role of leaders. J Sci Med Sport 2021; 24:988-994. [PMID: 34481741 DOI: 10.1016/j.jsams.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/23/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE During multi-domain operations (MDO), soldiers need the physical supremacy, cognitive dominance, and emotional resilience to help defend and win our nation's wars. Optimal sleep has been shown to boost physical performance and cognitive processing. This manuscript will discuss how recent advances in sleep science strongly argue for the integration of sleep planning into military operations. DESIGN Review article. METHODS We reviewed the current understanding of how sleep affects Soldier readiness, how sleep and pain are interrelated, and unique challenges to obtaining adequate sleep in military training environments. We then address solutions that can be implemented by leaders and individuals to manage warfighter fatigue and optimize unit performance. RESULTS Since sleep is foundational to soldier health and readiness, improving warfighter fatigue management is a priority for leaders. CONCLUSION To succeed in MDO, military personnel require physical supremacy, cognitive dominance, and emotional resilience to fight and win. Sleep science is a rapidly emerging field, and the clear implications for maximizing human performance argue strongly for more deliberate integration into military training and operations. Leaders that incorporate sleep and fatigue management into the planning and execution phases of operations will help facilitate mission priorities and prove a powerful force multiplier.
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Affiliation(s)
| | | | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | | | - Amelia S Barrett
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA
| | | | - David M Boland
- Army-Baylor University Doctoral Program in Physical Therapy, USA
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Mantua J, Pirner MC, Doyle ST, Bessey AF, Naylor JA, Ritland BM, Sowden WJ, Burke TM, McKeon AB. Sleep and occupational well-being in active duty special operations soldiers: A replication and expansion. Sleep Health 2021; 7:500-503. [PMID: 33685830 DOI: 10.1016/j.sleh.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the relationship between sleep quality and occupational well-being in active duty military Service Members. DESIGN Longitudinal prospective analysis. SETTING An annual military training event. PARTICIPANTS US Army special operations Soldiers (n = 60; 100% male; age 25.41 ± 3.74). INTERVENTION None. MEASUREMENTS The Pittsburgh Sleep Quality Index (PSQI) was administered prior to the training event, and the Emotional Exhaustion Scale, the Role Overload Scale, the Walter Reed Army Institute of Research Soldier-Specific Functional Impairment Scale, and the Perceived Stress Scale were administered after the event. Linear regression models were used to assess the relationship between sleep and occupational wellness measures, and the outcome measures of "good" and "poor" sleepers (per the PSQI scoring criteria) were compared with Student's t tests. RESULTS Higher (poorer) PSQI Global Scores predicted poorer occupational wellness of all measures (emotional exhaustion: B = 1.60, P < .001, R2 = 0.25; functional impairment: B = 0.29, P = .03, R2 = 0.14; role overload: B = 0.28, P = .008, R2 = 0.12; and perceived stress: B = 0.34, P = .004, R2 = 0.20). There were additional relationships between specific PSQI component scores and occupational wellness measures, which is a replication of This team's previous work. Furthermore, emotional exhaustion (t(58) = -4.18, P < .001), functional impairment (t(59)= -3.68, P = .001), role overload (t(58) = -3.20, P = .002), and perceived stress (t(58) = -2.43, P = .02) were all higher in poor sleepers. CONCLUSIONS The findings of this study suggest that US Army special operations Soldiers who have poorer sleep quality may be at increased risk for having poorer occupational well-being.
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
| | - Maddison C Pirner
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Scott T Doyle
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Alexxa F Bessey
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Jacob A Naylor
- 75th Ranger Regiment Headquarters, Ft. Benning, Georgia, USA
| | - Bradley M Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Walter J Sowden
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Tina M Burke
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Ashlee B McKeon
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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