Prevalence of sleep disorders by sex and ethnicity among older adolescents and emerging adults: relations to daytime functioning, working memory and mental health

Sleep and cognition in South African patients with non-functioning pituitary adenomas

Strong lines of evidence in the neuroscience literature indicate that (a) healthy sleep facilitates cognitive processing, and (b) sleep disruption is associated with cognitive dysfunction. Despite the fact that patients with pituitary disease often display both disrupted sleep and cognitive dysfunction, few previous studies investigate whether these clinical characteristics in these patients might be related. Hence, we explored whether sleep disruption in patients with pituitary disease mediates their cognitive dysfunction. We recruited 18 patients with non-functioning pituitary adenomas (NFPA) and 19 sociodemographically matched healthy controls. They completed the Global Sleep Assessment Questionnaire (thus providing self-report data regarding sleep disruption) and were administered the Brief Test of Adult Cognition by Telephone, which assesses cognitive functioning in the domains of processing speed, working memory, episodic memory, inhibition, and reasoning. We found no significant differences in cognition between patients and controls. Furthermore, spectra of sleep disturbance did not differ significantly between patients and controls. Our data suggest that NFPA patients' cognition and sleep quality is relatively intact, and that sleep disruption does not mediate cognitive dysfunction. Larger studies should characterize sleep and cognition in patients with NFPA (and other pituitary diseases) to confirm whether disruption of the former mediates impairment in the latter.

Neural mechanisms of working memory dysfunction in patients with chronic insomnia disorder

OBJECTIVE

This study aimed to investigate the neural mechanisms underlying working memory impairment in patients with chronic insomnia disorder (CID) using event-related potentials (ERP) and resting-state functional connectivity (rsFC) approaches.

METHODS

Participants, including CID patients and healthy controls (HCs), completed clinical scales and underwent electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). EEG analysis compared reaction times, P3 amplitudes, event-related spectral perturbations (ERSP), and inter-trial phase synchronisation (ITPS) between CID patients and HCs. Subsequently, frontal regions (i.e., the Superior Frontal Gyrus [SFG] and Middle Frontal Gyrus [MFG]) corresponding to the EEG were selected as seeds for rsFC analysis. Correlation analyses were conducted to further investigate the relationship between functional connectivity abnormalities in brain regions and clinical symptom severity and P3 amplitude in CID patients.

RESULTS

Compared to HCs, CID patients exhibited slower reaction times across all working memory conditions, with the deficits becoming more pronounced as memory load increased. ERP analysis revealed increased P3 amplitude, theta wave power, and reduced inter-trial synchrony in CID patients. rsFC analysis showed decreased connectivity of SFG-posterior cingulated cortex (PCC), SFG-MFG, and MFG-frontal pole (FP), and increased connectivity of MFG- Middle Temporal Gyrus (MTG)in CID patients. Importantly, a significant correlation was found between the rsFC of SFG-MTG and P3 amplitude during 1-back.

CONCLUSION

This study confirms deficits in working memory capacity in patients with CID, specifically in the neural mechanisms of cognitive processing that vary depending on the level of cognitive load. Alterations in connectivity patterns within and between the frontal and temporal regions may be the neural basis of the cognitive impairment.

U.S. Adolescent Rest-Activity patterns: insights from functional principal component analysis (NHANES 2011-2014)

BACKGROUND

Suboptimal rest-activity patterns in adolescence are associated with worse health outcomes in adulthood. Understanding sociodemographic factors associated with rest-activity rhythms may help identify subgroups who may benefit from interventions. This study aimed to investigate the association of rest-activity rhythm with demographic and socioeconomic characteristics in adolescents.

METHODS

Using cross-sectional data from the nationally representative National Health and Nutrition Examination Survey (NHANES) 2011-2014 adolescents (N = 1814), this study derived rest-activity profiles from 7-day 24-hour accelerometer data using functional principal component analysis. Multiple linear regression was used to assess the association between participant characteristics and rest-activity profiles. Weekday and weekend specific analyses were performed in addition to the overall analysis.

RESULTS

Four rest-activity rhythm profiles were identified, which explained a total of 82.7% of variance in the study sample, including (1) High amplitude profile; (2) Early activity window profile; (3) Early activity peak profile; and (4) Prolonged activity/reduced rest window profile. The rest-activity profiles were associated with subgroups of age, sex, race/ethnicity, and household income. On average, older age was associated with a lower value for the high amplitude and early activity window profiles, but a higher value for the early activity peak and prolonged activity/reduced rest window profiles. Compared to boys, girls had a higher value for the prolonged activity/reduced rest window profiles. When compared to Non-Hispanic White adolescents, Asian showed a lower value for the high amplitude profile, Mexican American group showed a higher value for the early activity window profile, and the Non-Hispanic Black group showed a higher value for the prolonged activity/reduced rest window profiles. Adolescents reported the lowest household income had the lowest average value for the early activity window profile.

CONCLUSIONS

This study characterized main rest-activity profiles among the US adolescents, and demonstrated that demographic and socioeconomic status factors may shape rest-activity behaviors in this population.

Sleep Hygiene, Daytime Sleepiness, and Coping Mechanisms Amongst US Adults

Background Excessive daytime sleepiness (EDS) can be measured by the Epworth Sleepiness Scale (ESS) and has been shown to be prevalent in the United States. This study aimed to survey the levels of EDS in US adults and explore factors related to sleep hygiene. Methods An anonymous web-based survey was conducted, polling the frequency of hypersomnia symptoms, sleep quality, and time spent in their occupation. Respondents were at least 21 years of age and United States residents. Participants reported information related to age, gender, education, income, and race in addition to their responses to the survey questions. All data were analyzed using JMP 16.0. Results In our cohort of 200 adults, the median age was 40, with an interquartile range of 34-50 years. 48% were female. More than half of the cohort (53%) had severe or higher-normal EDS. Race (p=0.112), sex (p=0.426), age (p=0.063) shift work/shift timing (p=0.260), and screen time before bed (p=0.785) were not statistically significant for excessive daytime sleepiness. However, the length of participants' workdays (p=0.001) and their income levels (p=0.008) were found to be significantly associated with EDS. In other words, longer workdays and lower income levels were associated with an increased likelihood of falling asleep during inactive periods of the day. Conclusion Sleep deprivation and excessive daytime sleepiness are intertwined with sleep hygiene. This study highlights some of the possible issues that could lead to potential solutions.

NLRP3 upregulation related to sleep deprivation-induced memory and emotional behavior changes in TRPV1-/- mice

Sleep deprivation, which is a common problem in modern society, impairs memory function and emotional behavior. TRPV1, a subfamily of transient receptor potential cation channels, is abundantly expressed in the central nervous system and is associated with animal behavior. In this article, we report that TRPV1 deficiency in mice alleviates sleep deprivation-induced abnormal behaviors. We found that in the sleep-deprived mice, TRPV1 knockout increased the duration and visits in the central area in the open field task and increased visits to the open arms in the elevated plus maze. The TRPV1^-/- mice performed better during the test stage in the Morris water maze phase after sleep deprivation. In the mPFC and hippocampus regions, western blotting results showed that TRPV1^-/- attenuated sleep deprivation-induced increases in GFAP, NLRP3, and ASC and increased the expression of the mitochondrial marker Tom20. Immunofluorescence results showed that the action of TRPV1 knockout on NLRP3 was negatively correlated with Tom20 after sleep deprivation. Our results confirm that TRPV1 knockout attenuates sleep deprivation-induced behavioral disorders. The effect of TRPV1 on the behavior of sleep-deprived mice may be related to the neuroinflammation associated with mitochondria in the mPFC and hippocampus.

Global prevalence and associated factors of sleep disorders and poor sleep quality among firefighters: A systematic review and meta-analysis

Lack of sleep can affect the health and performance of firefighters. This systematic review and meta-analysis estimated the global prevalence of sleep disorders and poor sleep quality among firefighters and reported associated factors. Four academic databases (Scopus, PubMed, Web of Science, and Embase) were systematically searched from January 1, 2000 to January 24, 2022. These databases were selected as they are known to index studies in this field. The search algorithm included two groups of keywords and all possible combinations of these words. The first group included keywords related to sleep and the second group keywords related to the firefighting profession. The relevant Joanna Briggs Institute checklist was used to evaluate study quality. Data from eligible studies were included in a meta-analysis. In total, 47 articles informed this review. The pooled prevalence of sleep disorders and poor sleep quality in firefighters were determined as 30.49% (95% CI [25.90, 35.06]) and 51.43% (95% CI [42.76, 60.10]), respectively. The results of a subgroup analysis showed that individuals in low- and middle-income countries (LMICs) had a higher prevalence of sleep disorders than those in high-income countries (HICs) but HICs had a higher prevalence of poor sleep quality than LMICs. Various factors, including shift work, mental health, injuries and pain, and body mass index were associated with sleep health. The findings of this review highlight the need for sleep health promotion programs in firefighters.

Worldwide estimation of restless legs syndrome: a systematic review and meta-analysis of prevalence in the general adult population

This systematic review, meta-analysis and meta-regression assessed the prevalence of restless legs syndrome (RLS) in the general adult population. Studies identified in Scopus, PubMed, Web of Science, and PsycInfo between January 2000 and February 2022 were included if they used a case-control or cross-sectional design and reported data regarding the prevalence of RLS. The protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022300709). A total of 97 studies including 483,079 participants from 33 different countries met the eligibility criteria. The Newcastle Ottawa Scale was used to evaluate the methodological quality, and the fill-and-trim method was used to correct probable publication bias, while the jack-knife method was performed to assess small study effect. The corrected overall pooled prevalence of RLS was 3% (95% confidence interval [CI] 1.4%-3.8%). The pooled prevalence of RLS syndrome was affected by methodological quality (no data from non-respondents in the included studies), gender (higher among women), study design (lower prevalence in case-control versus cohort and cross-sectional studies). The figures for corrected pooled prevalence among men, women, alcohol consumers and smokers were 2.8% (95% CI 2%-3.7%); 4.7% (95% CI 3.2%-6.3%); 1.4% (95% CI 0%-4.2%); and 2.7% (95% CI 0%-5.3%), respectively. The prevalence among male and female participants was lower in community-based versus non-community-based studies. Moreover, the prevalence was higher in developed versus developing countries and among elders versus adults. In conclusion, RLS is a common disorder in the general adult population, with a higher prevalence in women; however, prevalence data are affected by study design and quality.

The Role of Sleep Effort as a Mediator Between Anxiety and Depression

Depression, anxiety, and insomnia are all conditions that share a complex bidirectional relationship. Sleep effort is a construct with cognitive and behavioral components that perpetuates insomnia. Although many studies have examined the associations between these three variables, no studies have yet examined sleep effort as a mediating variable between anxiety and depression and vice versa. Online versions of the Hospital Anxiety and Depression Scale and the Glasgow Sleep Effort Scale were administered to a sample of 1927 higher education students aged 18-40 years (75.9% women and 76% from 18 to 23 years old). As part of the survey, participants also completed a sociodemographic questionnaire. Mediation analysis indicated that sleep effort mediates the relationship between depression and anxiety, when the former was the predictor and the latter was the criterion. Moreover, sleep effort also mediated the relationship between anxiety and depression when the former was the predictor and the latter was the criterion, albeit in a lesser extent. Sleep effort appears to play a bidirectional mediational role between depression and anxiety, being a potential target for intervention.

Gender identity and transition: relationships with sleep disorders in US youth

STUDY OBJECTIVES

Transgender or gender-nonconforming (TGNC) identity is associated with higher burden of sleep disorders relative to cisgender identity. However, the role of gender-affirming therapy (GAT) in sleep disorders is poorly understood. This study examined relationships between TGNC identity, transition, and sleep disorders among TGNC and cisgender youth.

METHODS

This retrospective cross-sectional study utilized a large US-based administrative claims database (deidentified Optum Clinformatics Data Mart Database) to identify youth aged 12-25 years who obtained a diagnosis of TGNC identity and those who pursued GAT. Descriptive statistics estimated distributions of demographic and health characteristics by gender identity. Unadjusted and age-adjusted logistic regression models were used to examine associations between TGNC identity, GAT, and sleep disorders.

RESULTS

This study included 1,216,044 youth, of which 2,603 (0.2%) were identified as TGNC. Among the 1,387 TGNC who pursued GAT, 868 and 519 were identified as transmasculine and transfeminine, respectively. Adjusted analysis showed increased odds of insomnia (odds ratio = 5.4, 95% confidence interval 4.7, 6.2), sleep apnea (odds ratio = 3.0, 95% confidence interval 2.3, 4.0), and other sleep disorders (odds ratio = 3.1, 95% confidence interval 2.5, 3.9) in TGNC relative to cisgender youth. Decreased odds of any sleep disorder were observed in the TGNC youth on GAT (odds ratio = 0.5, 95% confidence interval 0.4, 0.7) relative to those not on GAT.

CONCLUSIONS

This study demonstrated a high burden of sleep disorders in TGNC youth in comparison to cisgender. However, GAT may confer a protective effect on sleep disorders among TGNC youth. Longitudinal assessments of sleep disorders prior to and post-GAT are needed to uncover their temporal relationships.

CITATION

Gavidia R, Whitney DG, Hershner S, Selkie EM, Tauman R, Dunietz GL. Gender identity and transition: relationships with sleep disorders in US youth. J Clin Sleep Med. 2022;18(11):2553-2559.

Sleep in Young People With Features of Borderline Personality Disorder: A Scoping Review

Sleep disturbance is commonly reported in young people with features of borderline personality disorder (BPD). Examining sleep quality and sleep-wake patterns in young people with features of BPD is essential to inform the development of sleep-improvement interventions. A scoping review was conducted according to the Joanna Briggs Institute methodology. The objectives were to map the literature regarding sleep in young people with features of BPD, highlight areas for further investigation, and provide methodological recommendations for future research. Seven data sets were included in the review. Young people with features of BPD had poorer objective and subjective sleep quality, disturbed sleep architecture (particularly rapid-eye-movement sleep), an increased vulnerability to delayed sleep phase syndrome, and more nightmares and dream anxiety, compared with healthy individuals. Future research should use both objective and subjective sleep measures, include clinical comparison groups, and focus specifically on young people with BPD.

Social-ecological considerations for the sleep health of rural mothers

Using a social-ecological framework, we identify social determinants that interact to influence sleep health, identify gaps in the literature, and make recommendations for targeting sleep health in rural mothers. Rural mothers experience unique challenges and protective factors in maintaining adequate sleep health during the postpartum and early maternal years. Geographic isolation, barriers to comprehensive behavioral medicine services, and intra-rural ethno-racial disparities are discussed at the societal (e.g., public policy), social (e.g., community) and individual levels (e.g., stress) of the social-ecological model. Research on sleep health would benefit from attention to methodological considerations of factors affecting rural mothers such as including parity in population-level analyses or applying community-based participatory research principles. Future sleep health programs would benefit from using existing social support networks to disseminate sleep health information, integrating behavioral health services into clinical care frameworks, and tailoring culturally-appropriate Telehealth/mHealth programs to enhance the sleep health of rural mothers.

Racial Discrimination and Depressive Symptoms among Latina/o College Students: The Role of Racism-Related Vigilance and Sleep

INTRODUCTION

Latinx college students are at high risk of suffering from depressive symptoms. A factor posited to influence depressive symptoms among Latinx college students is racial/ethnic discrimination. However, the mechanisms which link racial/ethnic discrimination to depressive symptoms are not well understood. This study examined the mediating role of racism-related vigilance and sleep-related factors (i.e., sleep quality, sleep efficiency) on the relationship between perceived intergroup racial/ethnic discrimination and depressive symptoms.

METHODS

Participants were 194 Latinx college students enrolled at a Midwestern university designated as a Hispanic-Serving Institution. Path analysis was conducted to investigate whether racism-related vigilance and sleep-related factors (i.e. sleep quality, sleep efficiency) are potential pathways in the relationship between intergroup racial/ethnic discrimination and depressive symptoms.

RESULTS

Path analysis revealed that racism-related vigilance and sleep quality sequentially mediated the effect of perceived intergroup racial/ethnic discrimination on depressive symptoms. Sleep efficiency did not mediate the relationship between racial/ethnic discrimination and depressive symptoms.

DISCUSSION

This study is among the first to document that intergroup racial/ethnic discrimination is negatively related to mental health through both cognitive and behavioral mechanisms. This research has important implications for understanding how discrimination may influence mental health outcomes among Latinx college students.

The effects of seasons and weather on sleep patterns measured through longitudinal multimodal sensing

Previous studies of seasonal effects on sleep have yielded unclear results, likely due to methodological differences and limitations in data size and/or quality. We measured the sleep habits of 216 individuals across the U.S. over four seasons for slightly over a year using objective, continuous, and unobtrusive measures of sleep and local weather. In addition, we controlled for demographics and trait-like constructs previously identified to correlate with sleep behavior. We investigated seasonal and weather effects of sleep duration, bedtime, and wake time. We found several small but statistically significant effects of seasonal and weather effects on sleep patterns. We observe the strongest seasonal effects for wake time and sleep duration, especially during the spring season: wake times are earlier, and sleep duration decreases (compared to the reference season winter). Sleep duration also modestly decreases when day lengths get longer (between the winter and summer solstice). Bedtimes and wake times tend to be slightly later as outdoor temperature increases.

Sleep Quality and Duration in European Adolescents (The AdolesHealth Study): A Cross-Sectional, Quantitative Study

Sleep is a vital element of adolescents' overall health; it influences their body and mind and thus affects their quality of life. Adequate sleep quality and duration are essential for maintaining optimal metabolic health and lowering the risk of developing several medical conditions, such as cardiovascular disease. The current study aimed to assess the perceived sleep quality and duration of 1717 European adolescents from three different European countries (Spain, Iceland and Estonia) aged 13- to 16-years (900 boys, 817 girls) using the Pittsburgh Sleep Quality Index (PSQI). A multivariate analysis of variance (MANOVA) was performed to examine differences between groups and two-factor analysis of variance (ANOVA) was used to analyze city and age differences. The probability of having poor sleep quality and duration was calculated by Odd-Ratio (OR). Our study found poor sleep quality in 44% of the boys and 53% of the girls, whereas 68% and 69%, respectively did not get the recommended hours of sleep (i.e., 8-10 h). No difference was found between adolescents from Estonia, Iceland and Spain regarding sleep duration. In contrast, Spanish and Estonian adolescents reported higher probabilities of having poor sleep quality. Finally, girls had a significantly higher probability of poor sleep quality than boys.

The longitudinal relationship between sleep problems and school burnout in adolescents: A cross-lagged panel analysis

INTRODUCTION

Despite the growing body of cross-sectional research linking sleep problems and school burnout, hardly any research has investigated the longitudinal relationship between these two constructs. The aim of this study was to examine the bidirectional association between sleep problems and school burnout in middle school students.

METHODS

A prospective design was used incorporating four time points (approximately 6-month interval). The participants were 1226 (50.3% girls) middle school students from 4 public schools who were in 7th grade at baseline. On average, participants were approximately 12.5 years old at the beginning of the study (M_age = 12.73, SD = 0.68). All participants completed self-report measures in classrooms during regular school hours. The data were analyzed using a cross-lagged structural equation model. We also examined the stability of sleep problems and school burnout in time, and investigated the moderating role of gender.

RESULTS

The results indicated there is a moderate stability for both sleep problems and school burnout, and those students with sleep problems were more likely to develop school burnout, and vice versa. Gender did not moderate the bidirectional relationship.

CONCLUSIONS

These results suggest that future studies should investigate whether implementing intervention for sleep problems can decrease the occurrence of school burnout and whether interventions targeting school burnout can improve sleep problems.

The effect of sleep medications on prospective and retrospective memory: a population-based study

Sleep medications, especially benzodiazepines, are known to cause motor and cognitive impairments as side-effects from their use. However, an evaluation of the effects of sleep medications in general on prospective and retrospective memory remains to be seen. Thus, the effects of the different types of sleep medicines were assessed using the total score and the 8 subscales of the Prospective and Retrospective Memory Questionnaire (PRMQ) in a representative sample from the Municipality of São Paulo. The effects of each type of medication on these same parameters were evaluated afterwards. Each analysis was performed controlling for different covariates to observe their degree of interference on the observed results. Impairment due to use of sleep aid medication was observed in 6 of the 8 subscales, as well in the overall score of the PRMQ when compared to non-users. Prospective subscales were particularly affected, even when controlling for highly interfering covariates such as depression and anxiety, and objective sleep variables related to sleep architecture and wakefulness in the night. Few effects were detected between the various types of medication even when controlling for covariates, suggesting that a sample with higher power is necessary to conduct a more detailed analysis. Using pharmacological aids to improve sleep may impair prospective and (to some extent) retrospective memory. Therefore, the relationship between sleep impairment, memory deficits and medication use must be considered by physicians.

Obesity and sleep disorders: A nationwide study of 1.3 million Israeli adolescents

OBJECTIVES

To assess the association between sleep disorders prevalence and obesity in Israeli adolescents.

METHODS

A nationwide, population-based, cross-sectional study of 1,348,817 Israeli adolescents (57% males) who were medically examined prior to military service between 1997 and 2015; height and weight were measured along with assessment of medical status at age 17.3⬰±⬰0.4 years. The diagnosis of a sleep disorder was made based on objective diagnostic criteria. The prevalence and odds ratio (OR) for a sleep disorder were computed across BMI subgroups and were adjusted for socio-demographic confounders.

RESULTS

Overall sleep disorders prevalence was 1.8:1000 (males) and 0.45:1000 (females), with a total of 1601 cases. There was a gradual increase in the odds ratio for sleep disorders with increasing BMI. Multivariable-adjusted ORs for sleep disorders were 1.29 (95% CI 1.10⬜1.52), 1.44 (1.18⬜1.75), 3.03 (2.32⬜3.96) and 3.38 (1.98⬜5.75) for overweight, obese class I, II and III, respectively (5^th⬜49th BMI percentile was the reference). Results persisted in extensive sensitivity analyses including limiting the study sample to participants with unimpaired health.

CONCLUSIONS

We found a higher prevalence of sleep disorders in males and a dose-dependent association between sleep disorders and adolescent BMI in both sexes. Our findings warrant clinical awareness among healthcare providers, given the rise in obesity in teenagers, and particularly in light of the obesity epidemic that we are experiencing in this era. Sleep related complaints should be actively screened in adolescents who suffer obesity.

Prevalence of Mental Health Disorders Among Undergraduate University Students in the United States: A Review

The aim of the current review is to describe the prevalence and demographic correlates of mental health disorders among undergraduate university students in the United States. A search strategy was built and conducted using PubMed, PsycINFO, and CINAHL to identify studies published between 2009 and 2019 on the prevalence of mental health disorders, as defined in the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders, in undergraduate students in the United States. A total of 12 studies were included in the final data extraction. The highest prevalence rates were identified in eating disorders, which ranged from 19% to 48%, followed by compulsive disorders (2% to 12.27%), depression (22%), posttraumatic stress disorder (8%), and sleep disorders (9.4% to 36%). The identified prevalence of mental health disorders is high, and the subsequent impact on this population is worrying. There is an urgent need to develop strategies for early screening and management of mental health services in university settings. [Journal of Psychosocial Nursing and Mental Health Services, 59(2), 17-24.].

Nightmares in Treatment-Seeking Youth: the Role of Cumulative Trauma Exposure

Although nightmares are frequently endorsed symptoms in children who have experienced trauma, limited research has been conducted on how nightmares vary with different forms of trauma exposure. Our goal was to assess the relationship between nightmares, trauma exposure, and symptoms of Posttraumatic Stress Disorder (PTSD) in youth. A total of 4440 trauma exposed treatment-seeking youth (ages 7 to 18) were administered the UCLA PTSD Reaction Index. Different trauma types, total traumas experienced, and PTSD symptoms were analyzed with correlations and a logistic regression in relation to nightmare frequency. Overall, 33.1% of participants reported experiencing clinically-significant nightmares. 79.1% of the sample experienced more than one trauma type, with an average of 3.06 trauma types endorsed. A binary logistic regression demonstrated the odds of reporting clinically-significant nightmares increased by 1.3 times for every additional type of trauma experienced. Lastly, nightmares were positively correlated with all PTSD criterion. The current study provides prevalence rates of trauma exposure and nightmares in a large, statewide sample of treatment-seeking youth. Each new trauma type experienced resulted in a greater likelihood of endorsing clinically-significant nightmares. This study provides useful information related to assessing and addressing nightmares in youth who have experienced trauma.

Instability in daily life and depression: The impact of sleep variance between weekday and weekend in South Korean workers

South Korean workers have problems getting optimal sleep because they work excessively, and this affects their sleep duration and quality. To compensate for their lack of sleep on weekdays, South Korean workers have a different lifestyle on weekends, which is reflected by the terms 'Hot Friday' and 'Monday Sickness'. However, an irregular lifestyle may be a risk factor for poor health even if insufficient sleep during weekdays is supplemented by sleep on the weekend. The objective of this study was to analyse the association between depressive mood and sleep duration variance on weekdays and weekends among South Korean workers. Data from the 2016 Korea National Health and Nutrition Examination Surveys were used. Linear regression analysis was performed to determine the association between variance in sleep duration and the Patient Health Questionnaire-9 (PHQ-9) score. Additional sub-group analyses were performed to evaluate associations between variance in sleep duration and sex, marital status and perceived health status. The average sleep duration was 419.44 min on weekdays and 463.29 min on weekends. The average sleep duration on weekends was 11.73% longer than on weekdays. There was a positive association between variance in sleep and PHQ-9 score (per 1% increased, β = 0.002, p = .0074), and variance in sleep duration affected health regardless of the direction of the change (positive: increased sleep or negative: decreased sleep). Further, sub-group analyses showed that variances in sleep duration are associated with increased PHQ-9 scores in females and in individuals who were single or who had problems in their marriage. Our findings suggest that there is a relationship between variance in sleep duration and depressive symptoms among South Korean workers. Thus, healthcare professionals should suggest alternatives for optimal sleep duration and sleep methods to ensure the psychiatric health of workers.

Experimental sleep disruption and reward learning: moderating role of positive affect responses

STUDY OBJECTIVES

Sleep disturbances increase vulnerability for depression, but the mechanisms underlying this relationship are not well known. We investigated the effects of experimental sleep disruption on response bias (RB), a measure of reward learning previously linked to depression, and the moderating role of positive affect responses.

METHODS

Participants (N = 42) were healthy adults enrolled in a within-subject crossover sleep disruption experiment that incorporated one night of uninterrupted sleep (US) and one night of forced awakenings (FA) in random order. On the day following each experimental sleep night, participants completed a probabilistic reward task to assess RB, and the Positive and Negative Affect Schedule-X. Participants were subgrouped according to positive affect responses: Preserved Positive Affect (i.e. positive affect scores maintained or increased; n = 15) or Reduced Positive Affect (i.e. positive affect scores decreased; n = 27) following FA.

RESULTS

Contrary to our hypotheses, across participants, RB did not significantly differ between the US and FA sleep conditions (p = .67). However, the effect of sleep condition on RB was moderated by positive affect response (p = .01); those with preserved positive affect showed heightened RB following FA, whereas those with reduced positive affect showed diminished RB following FA. Changes in negative affect between US and FA did not moderate RB.

CONCLUSION

The inability to preserve positive affect through periods of sleep disruption may be a marker of diminished reward learning capability. Understanding how sleep disruption impacts positive affect responses and reward learning identifies a pathway by which sleep disturbances may confer risk for depression.

Exploding head syndrome, chronotype, parasomnias and mental health in young adults

Although inadequate sleep among young people is well documented in the literature, anomalous sleep experiences, such as the parasomnia termed exploding head syndrome (EHS), have received little empirical attention. The current study examined the association of sleep quality, symptoms of psychological distress and other unusual sleep experiences with EHS in a sample of young adults (n = 135, age M = 21.77, SD = 2.08). We also aimed to account for the possible effect of participant chronotype on sleep experiences. The lifetime prevalence of EHS among participants was 20.0%. Three-quarters (75.6%) of participants reported poor quality sleep according to the Pittsburgh Sleep Quality Index (PSQI). Univariate analysis showed that participants with a lifetime prevalence of EHS experienced more symptoms of anxiety and poorer sleep quality; age, gender and symptoms of depression were not significantly related to EHS. Parasomnias (OR [95% CI] = 1.62 [1.02-2.57], p = .040) and action-related sleep disorders (OR [95% CI] = 1.87 [1.09-3.20], p = .023) were associated with lifetime experience of EHS in a logistic regression analysis. Chronotype did not significantly impact mood, sleep quality or presence of EHS. Results suggest that EHS is more common in young people than previously considered and ought to be examined in conjunction with the presence of other unusual sleep disorders. This study provides valuable insight into young peoples' sleep experiences and key factors associated with EHS.

Pre-experimental sleep effects on directed forgetting

A directed forgetting (DF) paradigm was used to compare the remembering and forgetting of participants with good sleep quality to those with poor sleep quality and the presence of insomnia symptoms. This study implemented a point system in place of remember and forget instructions in a DF task with the goal of computing DF costs and benefits. Relations among memory, sleep, and working memory capacity (WMC) were also examined. DF benefits were observed in both groups, with negative costs found for participants without the presence of insomnia symptoms. WMC was found to be related to memory for positive point items only, and did not differ based on sleep quality. These results suggest that the presence of self-reported insomnia symptoms does not affect performance on a DF task.

Associations between Mental Workload and Sleep Quality in a Sample of Young Adults Recruited from a US College Town

OBJECTIVE

To evaluate associations between perceived mental workload (number of hours spent studying and perceived mental intensity) and sleep quality among young adults.

PARTICIPANTS

656 participants [62% male, median age (IQR) = 20 (19, 21) years] recruited from a US college town.

METHODS

As part of an online screener, participants answered questions about perceived workload and sleep quality (Pittsburgh Sleep Quality Index (PSQI)). Number of hours/day of mentally engaging work/study, and mental intensity score were the exposures, categorized into quartiles. Linear regression models were used for continuous sleep quality score, and modified Poisson models were used for poor quality sleep (>5 PSQI score) and individual sleep components, adjusting for sex, age, race, physical activity, and caffeine intake.

RESULTS

Higher mental work-hours were associated with lower-quality sleep; those in the highest quartile of mental work-hours had a 28% higher likelihood of poor sleep quality (95% CI 2% to 62%). Higher mental intensity scores were also related to lower quality sleep; comparing the highest to the lowest quartiles, there was a 45% higher probability of being a poor sleeper (95% CI 15% to 83%). Associations with PSQI components were partly sex-specific: while both sexes had associations between mental intensity and short sleep, males had positive associations with poor sleep quality and sleep medication use. Conversely, females with higher mental intensity reported higher-quality sleep overall and lower sleep medication use but lower sleep efficiency.

CONCLUSIONS

Higher mental workload is associated with lower overall sleep quality in young adults. Associations with individual sleep quality components differed by sex.

A Multimethod, Case-Controlled Study of Sleep-Wake Disturbances in Adolescents With Spina Bifida

Objective

This study aimed to compare sleep-wake disturbances in adolescents with spina bifida (SB) to typically developing (TD) peers. Exploratory analyses examined sex as moderator of disrupted sleep.

Methods

Adolescents with SB (ages 12-18 years; N = 37) and a demographically matched sample of TD adolescents (N = 37) completed validated sleep questionnaires and underwent 10 days of actigraphy monitoring.

Results

Adolescents with SB evidenced worse sleep quality, shorter sleep duration, greater sleep maintenance difficulties, and higher levels of fatigue compared with their TD peers. Exploratory analyses revealed females with SB were particularly vulnerable to developing sleep disturbances.

Conclusions

Adolescents with SB are at risk for nighttime sleep disturbances and daytime fatigue. Additional research will need to identify mechanisms and adverse consequences of poor sleep to develop interventions addressing sleep deficiency. Sex-specific disparities in sleep patterns in pediatric SB is a novel finding that requires assessment of etiological underpinnings to clarify clinical implications.

The mobile sleep lab app: An open-source framework for mobile sleep assessment based on consumer-grade wearable devices

BACKGROUND

Sleep disorders have a prevalence of up to 50% and are commonly diagnosed using polysomnography. However, polysomnography requires trained staff and specific equipment in a laboratory setting, which are expensive and limited resources are available. Mobile and wearable devices such as fitness wristbands can perform limited sleep monitoring but are not evaluated well. Here, the development and evaluation of a mobile application to record and synchronize data from consumer-grade sensors suitable for sleep monitoring is presented and evaluated for data collection capability in a clinical trial.

METHODS

Wearable and ambient consumer-grade sensors were selected to mimic the functionalities of clinical sleep laboratories. Then, a modular application was developed for recording, processing and visualizing the sensor data. A validation was performed in three phases: (1) sensor functionalities were evaluated, (2) self-experiments were performed in full-night experiments, and (3) the application was tested for usability in a clinical trial on primary snoring.

RESULTS

The evaluation of the sensors indicated their suitability for assessing basic sleep characteristics. Additionally, the application successfully recorded full-night sleep. The collected data was of sufficient quality to detect and measure body movements, cardiac activity, snoring and brightness. The ongoing clinical trial phase showed the successful deployment of the application by medical professionals.

CONCLUSION

The proposed software demonstrated a strong potential for medical usage. With low costs, it can be proposed for screening, long-term monitoring or in resource-austere environments. However, further validations are needed, in particular the comparison to a clinical sleep laboratory.

The effect of sleep disturbances and internet addiction on suicidal ideation among adolescents in the presence of depressive symptoms

Maladaptive use of internet and sleep problems is a significant health concern among adolescents. We aimed to understand better how sleep problems are related to suicidal ideation taking into account the presence of depression and internet addiction. 631 adolescents aged between 12 and 18 randomly recruited from different middle and high schools to complete self-report questionnaires assessing sleep disturbances, addictive use of the internet, depressive symptoms, and suicidal ideation. 22.9% of the sample reported on suicidal ideation during the month before the study, 42% of the sample suffer from sleep disturbances, 30.2% reported on the addictive use of the internet, and 26.5% exhibited severe symptoms of depression. Adolescents with suicidal ideation had higher rates of sleep disturbances, addictive use of internet and depressive symptoms. A confirmatory path analysis suggests that the effect of sleep disturbances on suicidal ideation moderated by the impact of internet addiction and mediated by the sleep effects on depressive symptoms. These results emphasize the importance to address the above risk behaviors in prevention curriculums programs. Future longitudinal studies are needed to determine the temporal order and to validate causal pathways.

Genetic Ancestry for Sleep Research: Leveraging Health Inequalities to Identify Causal Genetic Variants

Recent evidence has highlighted the health inequalities in sleep behaviors and sleep disorders that adversely affect outcomes in select populations, including African-American and Hispanic-American subjects. Race-related sleep health inequalities are ascribed to differences in multilevel and interlinked health determinants, such as sociodemographic factors, health behaviors, and biology. African-American and Hispanic-American subjects are admixed populations whose genetic inheritance combines two or more ancestral populations originating from different continents. Racial inequalities in admixed populations can be parsed into relevant groups of mediating factors (environmental vs genetic) with the use of measures of genetic ancestry, including the proportion of an individual's genetic makeup that comes from each of the major ancestral continental populations. This review describes sleep health inequalities in African-American and Hispanic-American subjects and considers the potential utility of ancestry studies to exploit these differences to gain insight into the genetic underpinnings of these phenotypes. The inclusion of genetic approaches in future studies of admixed populations will allow greater understanding of the potential biological basis of race-related sleep health inequalities.

Impact of a sleep course on sleep, mood and anxiety symptoms in college students: A pilot study

OBJECTIVE

To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students.

PARTICIPANTS

Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015.

METHODS

Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects.

RESULTS

In November, sleep course students reported significant differences in sleep hygiene (SHI; p < .001), perceived sleep latency (PSQI; p < .05), and circadian sleep phase (MEQ; p < .05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = .05) and anxiety (BAI; p < .05).

CONCLUSIONS

These positive preliminary results indicate that focused education has the potential to improve sleep among college students.

Relationships between school start time, sleep duration, and adolescent behaviors

OBJECTIVES

The objectives were 2-fold: (1) to examine how high school start times relate to adolescent sleep duration, and (2) to test associations between sleep duration and mental health- and substance use-related issues and behaviors in teens.

DESIGN

This study examines selected questions from survey data collected between 2010 and 2013 high school students.

SETTING

Respondents included more than 9000 students in grades 9 to 12 in 8 high schools in 5 school districts across the United States.

MEASUREMENTS

The survey instrument is the 97-item Teen Sleep Habits Survey. Logistic regression models were used to calculate adjusted odds ratios and 95% confidence intervals. Because of clustering within schools and the use of repeated measures, generalized estimating equations were used to account for variance inflation.

RESULTS

Greater sleep duration was associated with fewer reports of various mental health- and substance use-related issues and behaviors (all P values <.01). For instance, for each additional hour of sleep reported, there was a 28% reduction in the adjusted odds of a participant reporting that he or she felt "unhappy, sad, or depressed." Later wake-up times were associated with a reduction in risk for some, but not all factors. Later start times were significantly associated with greater sleep duration.

CONCLUSIONS

Given that later start times allow for greater sleep duration and that adequate sleep duration is associated with more favorable mental health- and substance use-related issues and behaviors, it is important that school districts prioritize exploring and implementing policies, such as delayed start times, that may increase the amount of sleep of adolescent students, which is needed for their optimal development.

Predictors of Stress in College Students

University students often face different stressful situations and preoccupations: the first contact with the university, the freedom of schedule organization, the selection of their master's degree, very selective fields, etc. The purpose of this study is to evaluate a model of vulnerability to stress in French college students. Stress factors were evaluated by a battery of six scales that was accessible online during 3 months. A total of 483 students, aged between 18 and 24 years (Mean = 20.23, standard deviation = 1.99), was included in the study. The results showed that 72.9, 86.3, and 79.3% of them were suffering from psychological distress, anxiety and depressive symptoms, respectively. More than half the sample was also suffering from low self-esteem (57.6%), little optimism (56.7%), and a low sense of self-efficacy (62.7%). Regression analyses revealed that life satisfaction, self-esteem, optimism, self-efficacy and psychological distress were the most important predictors of stress. These findings allow us to better understand stress-vulnerability factors in students and drive us to substantially consider them in prevention programs.

Influence of WeChat on sleep quality among undergraduates in Chongqing, China: a cross-sectional study

BACKGROUND

Previous studies showed that social media is associated with sleep quality. WeChat (a native social media in China) is very popular in China, especially among the youth. In the second quarter of 2016, Tencent's WeChat had 806 million monthly active users. The study sought to identify the influence of WeChat on the sleep quality among undergraduate students.

METHODS

A cross-sectional survey adopted a multi-stage stratified sampling survey to investigate undergraduates in Chongqing, China. Data were collected on 1979 eligible adults, aged 20.27 (SD: 1.26) years old, using Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality.

RESULTS

Respondents aged 20.27 ± 1.26 years included 535 (27.0%) males, and 1311 (66.3%) reported as having poor sleep quality. Of the 1979 participants, 1320 (66.70%) were WeChat users. In multivariable analyses, gender, grade, nationality, living costs, the student leader, the only child, type of university, WeChat usage was associated with domains of PSQI among undergraduates (p < 0.05 for all). Compared with non-users, WeChat users had a lower score of subjective quality of sleep, sleep latency, use of sleeping medication, daytime dysfunction, and global PSQI score (p < 0.05 for all).

CONCLUSIONS

WeChat users may have better sleep quality than non-WeChat users among undergraduates. To determine causal relationships, further longitudinal studies will be required to test for the association between WeChat users and sleep quality. This study may also provide some implications for health promotion on sleep quality of undergraduate students.

Adequate sleep moderates the prospective association between alcohol use and consequences

OBJECTIVE

Inadequate sleep and heavy alcohol use have been associated with negative outcomes among college students; however, few studies have examined the interactive effects of sleep and drinking quantity in predicting alcohol-related consequences. This study aimed to determine if adequate sleep moderates the prospective association between weekly drinking quantity and consequences.

METHOD

College students (N=568) who were mandated to an alcohol prevention intervention reported drinks consumed per week, typical sleep quantity (calculated from sleep/wake times), and perceptions of sleep adequacy as part of a larger research trial. Assessments were completed at baseline and one-, three-, and five-month follow-ups.

RESULTS

Higher baseline quantities of weekly drinking and inadequate sleep predicted alcohol-related consequences at baseline and one-month follow-up. Significant interactions emerged between baseline weekly drinking quantity and adequate sleep in the prediction of alcohol-related consequences at baseline, one-, three-, and five-month assessments. Simple slopes analyses revealed that weekly drinking quantity was positively associated with alcohol-related consequences for those reporting both adequate and inadequate sleep, but this association was consistently stronger among those who reported inadequate sleep.

CONCLUSION

Subjective evaluation of sleep adequacy moderates both the concurrent and prospective associations between weekly drinking quantity and consequences, such that heavy-drinking college students reporting inadequate sleep experience more consequences as a result of drinking. Research needs to examine the mechanism(s) by which inadequate sleep affects alcohol risk among young adults.

The Effects of Sleep Problems on the Trajectory of Antisocial Behavior from Adolescence through Early Adulthood in Taiwan: Family Functioning as a Moderator

STUDY OBJECTIVES

To examine the longitudinal relationship between sleep problems and development of antisocial behavior from adolescence through young adulthood, and to investigate whether family functioning moderates the association being examined. Potential sex differences were also explored.

METHODS

A total of 2,491 adolescents participated in a prospective study spanning 2009 through 2014 in northern Taiwan. Measures included sleep problems, family functioning (parental support, family interaction, and family conflict), antisocial behavior, and other individual characteristics (sex, age, parental education, family economic stress, depressive symptoms, and stressful life events). Random coefficient growth models were used to test study hypotheses.

RESULTS

Sleep problems were significantly and positively associated with antisocial behavior (B = 0.088 and 0.038 for males and females, respectively). Sex differences further emerged in the moderating effects of family functioning. Among males, those with high family interaction had a weaker association between sleep problems and antisocial behavior; among females, the examined association was weaker in those with high parental support. For both sexes, the association between sleep problems and antisocial behavior was stronger for those with high family conflict.

CONCLUSIONS

Our findings highlight the robust link between sleep problems and adolescent antisocial behavior over time. We also show for the first time that the association depends on family functioning. Prevention methods and treatment of sleep problems in youths that incorporate family functioning may yield significant benefits for decreasing antisocial behavior. Sex-specific intervention and prevention approaches should also be considered.

Pilot Study of a Sleep Health Promotion Program for College Students

OBJECTIVES

We conducted a pilot study of a sleep health promotion program for college students. The aims of the study were to 1) determine the feasibility of the program, and 2) explore changes in sleep knowledge and sleep diary parameters.

DESIGN

Open trial of a sleep health promotion program for college students.

SETTING

A small liberal arts university in southwestern Pennsylvania.

PARTICIPANTS

University students (primarily female).

INTERVENTION

Active intervention components included individualized email feedback based on each participant's baseline sleep diary and an in-person, group format presentation on sleep health.

MEASUREMENTS

Participants completed online questionnaires and sleep diaries before and after the health promotion intervention. Online questionnaires focused on sleep knowledge and attitudes toward sleep, as well as Patient Reported Outcomes Measurement Information System (PROMIS) sleep and psychosocial assessments.

RESULTS

Of participants who completed some aspect of the study, 89% completed at least one intervention component (in-person lecture and/or sleep diary). Participants reported significant improvement in sleep knowledge and changes in sleep diary parameters (decreased sleep onset latency and time spent in bed, resulting in greater sleep efficiency). Sleep duration also increased by 30 minutes among short sleepers who obtained <7 hours sleep at baseline.

CONCLUSIONS

Preliminary evaluation of a brief program to promote sleep health suggests that it is feasible and acceptable to implement, and that it can favorably alter sleep knowledge and behaviors reported on the sleep diary in college students. Controlled trials are warranted.

Risk of Common Mental Disorders in Relation to Symptoms of Obstructive Sleep Apnea Syndrome among Ethiopian College Students

BACKGROUND

The Berlin and Epworth Sleepiness Scale (ESS) are simple, validated, and widely used questionnaires designed to assess symptoms of obstructive sleep apnea syndrome (OSAS) a common but often unrecognized cause of morbidity and mortality.

METHODS

A cross-sectional study was conducted among 2,639 college students to examine the extent to which symptoms of OSAS are associated with the odds of common mental disorders (CMDs). The General Health Questionnaire (GHQ-12) was used to evaluate the presence of CMDs while the Berlin and ESS were used to assess high-risk for obstructive sleep apnea (OSA) and excessive daytime sleepiness, respectively. Logistic regression procedures were used to derive odds ratios (OR) and 95% confidence intervals (CI) assessing the independent and joint associations of high-risk for OSA and excessive daytime sleepiness with odds of CMDs.

RESULTS

Approximately 19% of students had high-risk for OSA while 26.4% had excessive daytime sleepiness. Compared to students without high-risk for OSA and without excessive daytime sleepiness (referent group), students with excessive daytime sleepiness only (OR=2.01; 95%CI: 1.60-2.52) had increased odds of CMDs. The odds of CMDs for students with high-risk OSA only was 1.26 (OR=1.26; 95%CI 0.94-1.68). Students with both high-risk for OSA and excessive daytime sleepiness, compared to the referent group, had the highest odds of CMDs (OR=2.45; 95%CI: 1.69-3.56).

CONCLUSION

Our findings indicate that symptoms of OSAS are associated with increased risk of CMDs. These findings emphasize the comorbidity of sleep disorders and CMDs and suggest that there may be benefits to investing in educational programs that extend the knowledge of sleep disorders in young adults.

Cortical Structural Connectivity Alterations in Primary Insomnia: Insights from MRI-Based Morphometric Correlation Analysis

The etiology and maintenance of insomnia are proposed to be associated with increased cognitive and physiological arousal caused by acute stressors and associated cognitive rumination. A core feature of such hyperarousal theory of insomnia involves increased sensory processing that interferes with the onset and maintenance of sleep. In this work, we collected structural magnetic resonance imaging data from 35 patients with primary insomnia and 35 normal sleepers and applied structural covariance analysis to investigate whether insomnia is associated with disruptions in structural brain networks centered at the sensory regions (primary visual, primary auditory, and olfactory cortex). As expected, insomnia patients showed increased structural covariance in cortical thickness between sensory and motor regions. We also observed trends of increased covariance between sensory regions and the default-mode network, and the salience network regions, and trends of decreased covariance between sensory regions and the frontoparietal working memory network regions, in insomnia patients. The observed changes in structural covariance tended to correlated with poor sleep quality. Our findings support previous functional neuroimaging studies and provide novel insights into variations in brain network configuration that may be involved in the pathophysiology of insomnia.

The great sleep recession: changes in sleep duration among US adolescents, 1991-2012

BACKGROUND

Average nightly sleep times precipitously decline from childhood through adolescence. There is increasing concern that historical shifts also occur in overall adolescent sleep time.

METHODS

Data were drawn from Monitoring the Future, a yearly, nationally representative cross-sectional survey of adolescents in the United States from 1991 to 2012 (N = 272 077) representing birth cohorts from 1973 to 2000. Adolescents were asked how often they get ≥7 hours of sleep and how often they get less sleep than they should. Age-period-cohort models were estimated.

RESULTS

Adolescent sleep generally declined over 20 years; the largest change occurred between 1991-1995 and 1996-2000. Age-period-cohort analyses indicate adolescent sleep is best described across demographic subgroups by an age effect, with sleep decreasing across adolescence, and a period effect, indicating that sleep is consistently decreasing, especially in the late 1990s and early 2000s. There was also a cohort effect among some subgroups, including male subjects, white subjects, and those in urban areas, with the earliest cohorts obtaining more sleep. Girls were less likely to report getting ≥7 hours of sleep compared with boys, as were racial/ethnic minorities, students living in urban areas, and those of low socioeconomic status (SES). However, racial/ethnic minorities and adolescents of low SES were more likely to self-report adequate sleep, compared with white subjects and those of higher SES.

CONCLUSIONS

Declines in self-reported adolescent sleep across the last 20 years are concerning. Mismatch between perceptions of adequate sleep and actual reported sleep times for racial/ethnic minorities and adolescents of low SES are additionally concerning and suggest that health education and literacy approaches may be warranted.