Sleep, stress and aggression: Meta-analyses investigating associations and causality

Associations Between Transdiagnostic Psychological Processes and Global Symptom Severity Among Outpatients With Various Mental Disorders: A Cross-Sectional Study

OBJECTIVE

Knowledge about transdiagnostic factors associated with global symptom severity among patients diagnosed with various mental disorders remains limited. This study examined the cross-sectional associations between transdiagnostic processes including global emotion regulation and specific emotion regulation strategies (i.e., amount of physical activity and sedentary behaviour, repetitive negative thinking and sleep routines) with global symptom severity, while controlling for sociodemographic data (age, gender, employment status, relationship status, and educational level) and fear of the coronavirus.

METHODS

Data from 401 outpatients, aged 42.08 years on average (SD = 13.26; 71.3% female), diagnosed with depressive disorders, non-organic primary insomnia, agoraphobia, panic disorder and/or post-traumatic stress disorder were examined. This study is a secondary analysis of a randomized controlled trial. Data were collected from 10 different study sites between March 2021 and May 2022 for cross-sectional analysis. The influence of predictors of global symptom severity was determined using three-step hierarchical multiple regression: (1) control variables, (2) global emotion regulation and (3) specific emotion regulation strategies. Global symptom severity was measured using the Global Severity Index, derived from the Brief Symptom Inventory-18. Predictors were measured using validated scales, and physical activity was additionally assessed via accelerometer-based sensors.

RESULTS

In the first step, control variables accounted for 4% of variance in global symptom severity. The inclusion of global emotion regulation in the second step explained 26% of the outcome variance, and the incorporation of specific emotion regulation strategies in the third step increased the explained variance to 37%. Significant predictors included global emotion regulation (β = 0.28), repetitive negative thinking (β = 0.26) and sleep routines (β = 0.25).

CONCLUSION

Global emotion regulation along with repetitive negative thinking and sleep routines as specific emotion regulation strategies are identified as transdiagnostic psychological processes that may serve as treatment targets for evidence-based interventions designed to enhance emotion regulation, particularly in transdiagnostic samples of stress-related disorders. Additional prospective longitudinal studies with transdiagnostic samples are necessary to explore possible causal relationships.

Association of baseline sleep duration and sleep quality with seizure recurrence in newly treated patients with epilepsy

OBJECTIVE

Although sleep duration and sleep quality are considered to be significant factors associated with epilepsy and seizure risk, findings are inconsistent, and their joint association remains uncertain. This study aimed to determine independent and joint associations of these two modifiable sleep features with seizure recurrence risk in newly treated patients with epilepsy (PWE).

METHODS

This is a prospective cohort study of newly treated PWE at a comprehensive epilepsy center in northeast China between June 2020 and December 2023. Self-reported sleep duration and sleep quality were collected at baseline. All patients were followed for 12 months for recurrent seizures. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) of seizure recurrence. Models fitted with restricted cubic spline were conducted to test for linear and nonlinear shapes of each association.

RESULTS

A total of 209 patients were included, and 103 experienced seizure recurrence during follow-up. Baseline short sleep was significantly associated with greater risk of seizure recurrence (adjusted HR = 2.282, 95% confidence interval [CI] = 1.436-3.628, p < .001). Sleep duration (h/day) and recurrent seizure risk showed a significant nonlinear U-shaped association, with a nadir at 8 h/day. Baseline poor sleep quality was significantly associated with greater risk of seizure recurrence (adjusted HR = 1.985, 95% CI = 1.321-2.984, p < .001). Pittsburgh Sleep Quality Index score and seizure recurrence risk exhibited a positive linear association. Participants with a combination of poor quality-short sleep showed the highest risk of seizure recurrence (adjusted HR = 3.13, 95% CI = 1.779-5.507, p < .001) compared to the referent good quality-intermediate sleep group.

SIGNIFICANCE

Baseline sleep duration and sleep quality were independently and jointly associated with risk of seizure recurrence in newly treated PWE. Our results point to an important potential role of baseline sleep duration and sleep quality in shaping seizure risk.

Exploring honey's potential as a functional food for natural sleep aid

Sleep disorders present significant challenges to public health, necessitating effective and sustainable solutions beyond conventional pharmacological interventions. This study aims to investigate the potential of honey and its compositions as a functional food for addressing sleep disorders. A comprehensive review of existing literature explores honey's intrinsic properties and impact on sleep quality. The findings suggest that honey, with its unique composition and soothing effects, offers a promising avenue for enhancing sleep patterns without relying on pharmaceutical drugs. This study also discusses the possible mechanism of action and the challenges of using honey in this field. While further research is needed to elucidate specific mechanisms and optimal utilisation, integrating honey into holistic sleep management strategies holds promise for improving overall well-being and quality of life.

The new science of sleep: From cells to large-scale societies

In the past 20 years, more remarkable revelations about sleep and its varied functions have arguably been made than in the previous 200. Building on this swell of recent findings, this essay provides a broad sampling of selected research highlights across genetic, molecular, cellular, and physiological systems within the body, networks within the brain, and large-scale social dynamics. Based on this raft of exciting new discoveries, we have come to realize that sleep, in this moment of its evolution, is very much polyfunctional (rather than monofunctional), yet polyfunctional for reasons we had never previously considered. Moreover, these new polyfunctional insights powerfully reaffirm sleep as a critical biological, and thus health-sustaining, requisite. Indeed, perhaps the only thing more impressive than the unanticipated nature of these newly emerging sleep functions is their striking divergence, from operations of molecular mechanisms inside cells to entire group societal dynamics.

The relationship between sleep disturbance and aggressive behaviour among community-dwelling schizophrenia patients: a moderated mesomeric effect model

OBJECTIVE

Sleep disturbance is the most common concern of patients with schizophrenia and can lead to a poor prognosis, a low survival rate and aggressive behaviour, posing a significant threat to social security and stability. The aim of this study was to explore the mediating role of depression in the relationship between sleep disturbance and aggressive behaviour in people with schizophrenia living in the community, as well as the regulatory role of family intimacy and adaptability. These findings, in turn, may provide a theoretical basis and constructive suggestions for addressing the physical and mental health problems of these patients.

METHOD

From September 2020 to August 2021, a convenience sampling method was used to select schizophrenia patients from the community attending follow-up appointments at the Fourth People's Hospital of Pengzhou City, China. The researchers conducted a survey in the form of a star questionnaire. The survey included questions about general demographic data and disease-related questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the revised Chinese version of the Modified Over Aggression Scale (MOAS), the Self-Rating Depression Scale (SDS), and the Family Adaptability and Cohesion Scale, Second Edition. FACES-II and SPSS 21.0 were used to organize and analyse the data.

RESULTS

A total of 818 schizophrenia patients living in the community participated in the survey, and 785 valid questionnaires were ultimately collected, for a response rate of 95.97%. The results of multivariate analysis indicated that sex, number of psychiatric medications used, outpatient follow-up, history of hospitalization for mental disorders and sleep disturbances were factors influencing aggressive behaviour. Depression played a partial mediating role between sleep disturbance and aggressive behaviour, and the indirect effect size was 0.043 (57.33% of the total). In addition to sleep disturbance, family intimacy (β=-0.009, P < 0.01) and adaptability (β=-0.145, P < 0.001) can significantly predict depression.

CONCLUSION

The findings indicate that sleep disturbance in schizophrenia patients in the community is a risk factor for aggressive behaviour, and depression plays a partial mediating role in the relationship among sleep disturbance, aggressive behaviour and family intimacy. In addition, adaptability plays a regulatory role in the relationship between depression and sleep disturbance.

Comparing the efficacy of traditional Chinese exercises and general aerobic exercises in university students with sleep disorders: A systematic review and meta-analysis

BACKGROUND

The objective of this study was to compare the impact of traditional Chinese exercise (TCEs) and general aerobic exercise (GAEs) on the sleep quality of university students and to determine which exercise is more effective in improving sleep quality in this specific population.

METHODS

We utilized Review Manager 5.3 to analyze data from 21 randomized controlled trials (RCTs), which included a total of 1252 participants. Effect sizes of TCEs and GAEs were compared using a random-effects model. Subgroup analyses were conducted on 3 modulating variables: times per session, frequency per week, and period.

RESULTS

A Meta-analysis of 14 RCTs showed that both TCEs (standard mean difference [SMD] = -0.89, 95% CI: -1.18 to -0.61; P < .00001) and GAEs (SMD = -1.53, 95% CI: -2.10 to -0.97; P < .00001) can significantly improve the sleep of university students, with a significant difference between TCEs and GAEs (P = .05). Both GAEs and TCEs had positive effects on various aspects of sleep quality, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction. A subgroup analysis of aerobic exercise showed that the effect size was larger in the 40 to 60 minutes group compared to the 60 to 90 minutes group (SMD = -1.89; 95% CI: -2.19 to -1.59; P < .00001). Furthermore, the effect size was larger in the 3 to 5 times per week group compared to the 2 times per week group (SMD = -1.56; 95% CI: -2.33 to -0.80; P < .0001). The effect size was also found to be larger in a period of 2 to 4 weeks compared to 6 to 18 weeks (SMD = -1.85; 95% CI: -2.17 to -1.54; P < .00001).

CONCLUSION

GAEs is more effective than TCEs in improving the sleep quality of university students. An optimal aerobic exercise regimen for enhancing sleep quality among university students involves engaging in sessions lasting 40~60 minutes, 3~5 times per week, over a duration of 4 weeks.

The effects of sustained mild sleep restriction on stress and distress among healthy adults: Findings from two randomized crossover studies

OBJECTIVE/BACKGROUND

Experimental studies suggest that sleep loss affects psychological outcomes. However, most studies focus on acute severe in-laboratory sleep restriction, with limited ecological validity. This study examines the impact of sustained mild sleep restriction (SR) on stress and distress among healthy adults in a naturalistic home environment.

PATIENTS/METHODS

We analyzed data from two randomized crossover studies. Individuals who regularly slept 7-9 h/night completed two 6-wk intervention phases separated by a 6-wk washout: habitual sleep (HS: maintenance of habitual bed and wake times) and SR (delayed bedtime by 1.5 h/night and maintenance of habitual wake time). Adherence to sleep duration requirements was verified with wrist actigraphy and daily sleep diaries during each intervention phase. Measures of perceived stress, subjective anxiety, subjective depression, rumination, and cortisol were collected at baseline and endpoint of each intervention phase.

RESULTS

Sixty-two participants (age 36.4 ± 14.0 y, 85.5 % women, 63.3 % racial/ethnic minority) were included in our analyses. Mean total sleep time was 7.4 ± 0.4 h/night during HS and 6.2 ± 0.4 h/night during SR (p < 0.001). Higher perceived stress (3.6 ± 1.0, p = 0.0007) and subjective anxiety (1.1 ± 0.5, p = 0.039) were observed after SR compared to HS. No effect of sleep condition was observed on subjective depression, rumination, and cortisol.

CONCLUSIONS

Our findings suggest that prolonged mildly insufficient sleep, similar to what commonly experienced in the real world, can lead to increased perceived stress and subjective anxiety in healthy adults. Addressing sleep loss, even if mild, should be a key component of interventions aimed at promoting mental health in the general population.

Examining correlates of aggression and mediating effect of psychological distress between exposure to media violence and aggression in lebanese adults

BACKGROUND

Violent media is the most consumed type of media in Lebanon. Many studies have linked exposure to media violence to increased aggression and psychological distress. As Lebanon is going through socio-political turmoil, we aimed to [1] explore the correlates of aggression (i.e., sociodemographic factors, BMI, loneliness, social competence, and psychological distress) in a sample of Lebanese adults from the general population, and [2] to examine the mediating effect of psychological distress in the association between exposure to media violence and aggression in this sample.

METHODOLOGY

Adults were recruited through online convenience sampling. We employed scales to assess content-based media exposure (C-ME), aggression (BPAQ-SF), psychological distress (DASS-8), loneliness (JGLS), and perceived social competence (PSCS).

RESULTS

Exposure to media violence was associated with all four aggression subtypes (verbal, physical, hostility, and anger). Psychological distress partially mediated all these associations; higher exposure to media violence was significantly associated with more psychological distress, which was significantly associated with higher levels of all types of aggression. Moreover, higher exposure to media violence was significantly associated with higher levels of all types of aggression.

CONCLUSION

In the sociopolitical context of Lebanon, violent media could be considered a public hazard. Psychological distress likely potentiates the association between exposure to violent media and aggression. Future research should focus on determining what components of psychological distress underpin this mediation.

Melatonin-related dysfunction in chronic restraint stress triggers sleep disorders in mice

Stress may trigger sleep disorders and are also risk factors for depression. The study explored the melatonin-related mechanisms of stress-associated sleep disorders on a mouse model of chronic stress by exploring the alteration in sleep architecture, melatonin, and related small molecule levels, transcription and expression of melatonin-related genes as well as proteins. Mice undergoing chronic restraint stress modeling for 28 days showed body weight loss and reduced locomotor activity. Sleep fragmentation, circadian rhythm disorders, and insomnia exhibited in CRS-treated mice formed sleep disorders. Tryptophan and 5-hydroxytryptamine levels were increased in the hypothalamus, while melatonin level was decreased. The transcription and expression of melatonin receptors were reduced, and circadian rhythm related genes were altered. Expression of downstream effectors to melatonin receptors was also affected. These results identified sleep disorders in a mice model of chronic stress. The alteration of melatonin-related pathways was shown to trigger sleep disorders.

Effects of stress on school bullying behavior among secondary school students: Moderating effects of gender and grade level

This study investigated the effects of stress on school bullying behaviors among middle school students, and the moderating role of gender and grade level in this relationship. To this end, the Olweus Child Bullying Questionnaire (OBVQ) secondary school version of the child bullying questionnaire and the stressor scale for secondary school students were used to survey 3,566 secondary school students in Guizhou Province, and the data were statistically analyzed. Results showed that stress was significantly and positively associated with school bullying among secondary school students. Furthermore, both gender and grade moderated the relationship between stress and school bullying, showing that boys and middle school children are more likely to engage in bullying than girls and high school students, respectively. The results of the study provide a theoretical basis for the prevention and intervention of school bullying behaviors among middle school students.

Factors Associated with Insomnia and Aggression among Healthcare Workers during COVID-19 Pandemic

(1) Healthcare workers are exposed to increased risks of insomnia and aggression during the COVID-19 pandemic. The aim of the study was to assess insomnia, sleep disturbances, and aggression and identify the associated risk factors among healthcare workers during the COVID-19 pandemic. (2) A total of 264 healthcare workers participated in the study. The study was conducted with the diagnostic survey method, using the Buss−Perry Aggression Questionnaire, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index, and a self-administered questionnaire. (3) The vast majority of the respondents (81.06%) suffered from insomnia and had poor sleep quality (78.03%). Education (p = 0.038), marital status (p = 0.043), and working with patients suffering from COVID-19 (p = 0.024) were statistically significant contributors to insomnia. Age was found to significantly correlate with total aggression (r = −0.133 p = 0.031), verbal aggression (r = −0.138 p = 0.025), and anger (r = −0.151 p = 0.014). The analysis demonstrated statistically significant relationships between gender and physical aggression (p = 0.017), anger (p = 0.032), and hostility (p = 0.002). A statistically significant positive correlation between the quality of sleep as per the PSQI and all subscales of the BPAQ was found (p < 0.001). (4) A considerable proportion of HCWs experienced sleep disturbances during the outbreak, stressing the need to establish ways to reduce long-term adverse outcomes associated with chronic insomnia and mental health problems and adjust interventions under pandemic conditions.

Emotion regulation mediates the effects of sleep on stress and aggression

It is well established that poor sleep directly increases stress and aggression, but potential mediators of this relationship remain poorly understood. The present study provided the first direct test of whether capacity for emotion regulation mediated the relationship between sleep with stress. It also aimed to extend current understanding of whether emotion regulation might mediate the association between sleep and aggression, by assessing four distinct subcomponents of aggression (anger, hostility, verbal aggression, and physical aggression). In service of these goals, 740 participants completed validated measures of sleep, stress, aggression, and emotion regulation. Results showed that emotion regulation partially mediated the relationship between sleep quality with stress, anger, hostility, and verbal aggression, and fully mediated the relationship between sleep with physical aggression. These data provide novel evidence that emotion regulation abilities may serve as a protective factor against the negative consequences of sleep disturbances.