False beliefs about sleep and their associations with sleep-related behavior

The Role of Health Psychology in Surgical Prehabilitation: Insights From REST, a Preoperative Sleep Intervention for Total Knee Replacement Patients

BACKGROUND

Approximately 10%-34% of people experience chronic pain after total knee replacement (TKR) surgery. Prehabilitation approaches that address pre-operative risk factors for chronic post-surgical pain are a key area for research. To be effective, prehabilitation requires substantial engagement and behaviour change by patients, which can be challenging in the pre-operative period. Health psychology theory plays a valuable role in understanding how best to support behaviour change to achieve maximum patient benefit. This study provides insights from REST, a pre-operative sleep intervention for TKR patients.

METHODS

In-depth semi-structured interviews were conducted with eight TKR patients who took part in the REST feasibility trial. An abductive analysis approach was used to identify the applicability of existing health psychology theories, and to explore new insights into the relationships between stages of behaviour change.

RESULTS

Three thematic areas related to intervention engagement and enactment were identified: (i) health beliefs and readiness to change; (ii) from contemplation to enactment: the role of behaviour change techniques; (iii) and behavioural maintenance.

CONCLUSION

Findings highlighted three key stages of behaviour change that participants need to be supported in to benefit fully from prehabilitation intervention. Complex behaviour change interventions that include aspects of tailoring should consider the boundaries of acceptable adaption while maintaining core causal mechanisms, and include methods to explore real-world implementation and usability during the development process. These findings are important for surgeons and multidisciplinary teams to consider when developing new prehabilitation care pathways or when implementing evidence-based prehabilitation practices.

What you believe is what you get? A systematic review examining how beliefs and attitudes about sleep are associated with sleep duration in non-clinical samples

A burgeoning area of research is investigating whether beliefs and attitudes about sleep are associated with sleep duration in individuals without clinical conditions (e.g., insomnia, depression, anxiety, chronic pain). This review sought to examine and synthesize the extant research in non-clinical samples. A systematic review of the literature following PRISMA guidelines was conducted between March 2024 and May 2024, with 2204 studies screened. Study quality was assessed using NIH's Quality Assessment Tool for Cohort and Cross-Sectional Studies and NIH's Quality Assessment Tool for Controlled Intervention Studies. Seventeen articles met eligibility criteria. All studies were classified as "fair" or "poor" quality. Studies generally demonstrated that more favorable attitudes and beliefs were associated with appropriate sleep duration. Specific beliefs related to sleep may be differentially associated with sleep duration. Preliminary evidence demonstrated that demographic factors may modify this association. Favorable attitudes toward sleep may be associated with more appropriate sleep duration among individuals without clinical conditions. However, the quality of the extant research was rated poorly, demonstrating a need for additional, higher quality studies. Future studies should consider this relationship while considering demographic factors as this may have important implications for public sleep health efforts.

The Complex Interaction Between Sleep-Related Information, Misinformation, and Sleep Health: Call for Comprehensive Research on Sleep Infodemiology and Infoveillance

The complex interplay between sleep-related information-both accurate and misleading-and its impact on clinical public health is an emerging area of concern. Lack of awareness of the importance of sleep, and inadequate information related to sleep, combined with misinformation about sleep, disseminated through social media, nonexpert advice, commercial interests, and other sources, can distort individuals' understanding of healthy sleep practices. Such misinformation can lead to the adoption of unhealthy sleep behaviors, reducing sleep quality and exacerbating sleep disorders. Simultaneously, poor sleep itself impairs critical cognitive functions, such as memory consolidation, emotional regulation, and decision-making. These impairments can heighten individuals' vulnerability to misinformation, creating a vicious cycle that further entrenches poor sleep habits and unhealthy behaviors. Sleep deprivation is known to reduce the ability to critically evaluate information, increase suggestibility, and enhance emotional reactivity, making individuals more prone to accepting persuasive but inaccurate information. This cycle of misinformation and poor sleep creates a clinical public health issue that goes beyond individual well-being, influencing occupational performance, societal productivity, and even broader clinical public health decision-making. The effects are felt across various sectors, from health care systems burdened by sleep-related issues to workplaces impacted by decreased productivity due to sleep deficiencies. The need for comprehensive clinical public health initiatives to combat this cycle is critical. These efforts must promote sleep literacy, increase awareness of sleep's role in cognitive resilience, and correct widespread sleep myths. Digital tools and technologies, such as sleep-tracking devices and artificial intelligence-powered apps, can play a role in educating the public and enhancing the accessibility of accurate, evidence-based sleep information. However, these tools must be carefully designed to avoid the spread of misinformation through algorithmic biases. Furthermore, research into the cognitive impacts of sleep deprivation should be leveraged to develop strategies that enhance societal resilience against misinformation. Sleep infodemiology and infoveillance, which involve tracking and analyzing the distribution of sleep-related information across digital platforms, offer valuable methodologies for identifying and addressing the spread of misinformation in real time. Addressing this issue requires a multidisciplinary approach, involving collaboration between sleep scientists, health care providers, educators, policy makers, and digital platform regulators. By promoting healthy sleep practices and debunking myths, it is possible to disrupt the feedback loop between poor sleep and misinformation, leading to improved individual health, better decision-making, and stronger societal outcomes.

Out of their control: College students' beliefs in sleep myths, sleep problems, and psychological flexibility

OBJECTIVES

College students suffer from deficient sleep, and the pernicious factors that support this phenomenon are diverse. The aim of the current study was to better understand the role of sleep-related myths in college students' sleep disturbance. A second aim was to examine if college students' levels of sleep disturbance were similarly associated with their belief in sleep-related myths or if their capacity to be psychologically flexible might moderate this process.

METHODS

The online sample consisted of 638 undergraduates (82.4% female; Mage=21.3, SD=1.6years), who reported on their level of belief in sleep-related myths, sleep disturbance, sleep environment, sleep hygiene, and psychological flexibility.

RESULTS

Controlling for critical sleep-related correlates, including melatonin usage, work hours and perceived sleep-related self-efficacy, we found that for students with below-average (-1 SD) psychological flexibility, the greater their belief in the myth that their sleep schedules were out of their control was associated with greater levels of sleep disturbance.

CONCLUSIONS

These results not only highlight another important source of college students' sleep problems, but they also speak to the widespread belief that college students have little control over their sleep. Findings from the current study raise the possibility that by developing students' capacities to be more psychologically flexible and by empowering students to prioritize their sleep, they will be able to decrease the likelihood of experiencing sleep and sleep-related problems.

Sleep Health

AbstractSleep is what we spend (or should spend) one third of our lives doing. Unfortunately, many individuals fall short of their biological need for sleep many nights of the week. The reasons for this are varied and include professional or personal obligations and social determinants, including loud noises or safety concerns in one's neighborhood. This article reviews the architecture of sleep; evidence for sleep health, including impacts of sleep health on mental and emotional health as well as cognitive function and performance; and strategies for improving sleep health.

Assessing the Accuracy of Generative Conversational Artificial Intelligence in Debunking Sleep Health Myths: Mixed Methods Comparative Study With Expert Analysis

BACKGROUND

Adequate sleep is essential for maintaining individual and public health, positively affecting cognition and well-being, and reducing chronic disease risks. It plays a significant role in driving the economy, public safety, and managing health care costs. Digital tools, including websites, sleep trackers, and apps, are key in promoting sleep health education. Conversational artificial intelligence (AI) such as ChatGPT (OpenAI, Microsoft Corp) offers accessible, personalized advice on sleep health but raises concerns about potential misinformation. This underscores the importance of ensuring that AI-driven sleep health information is accurate, given its significant impact on individual and public health, and the spread of sleep-related myths.

OBJECTIVE

This study aims to examine ChatGPT's capability to debunk sleep-related disbeliefs.

METHODS

A mixed methods design was leveraged. ChatGPT categorized 20 sleep-related myths identified by 10 sleep experts and rated them in terms of falseness and public health significance, on a 5-point Likert scale. Sensitivity, positive predictive value, and interrater agreement were also calculated. A qualitative comparative analysis was also conducted.

RESULTS

ChatGPT labeled a significant portion (n=17, 85%) of the statements as "false" (n=9, 45%) or "generally false" (n=8, 40%), with varying accuracy across different domains. For instance, it correctly identified most myths about "sleep timing," "sleep duration," and "behaviors during sleep," while it had varying degrees of success with other categories such as "pre-sleep behaviors" and "brain function and sleep." ChatGPT's assessment of the degree of falseness and public health significance, on the 5-point Likert scale, revealed an average score of 3.45 (SD 0.87) and 3.15 (SD 0.99), respectively, indicating a good level of accuracy in identifying the falseness of statements and a good understanding of their impact on public health. The AI-based tool showed a sensitivity of 85% and a positive predictive value of 100%. Overall, this indicates that when ChatGPT labels a statement as false, it is highly reliable, but it may miss identifying some false statements. When comparing with expert ratings, high intraclass correlation coefficients (ICCs) between ChatGPT's appraisals and expert opinions could be found, suggesting that the AI's ratings were generally aligned with expert views on falseness (ICC=.83, P<.001) and public health significance (ICC=.79, P=.001) of sleep-related myths. Qualitatively, both ChatGPT and sleep experts refuted sleep-related misconceptions. However, ChatGPT adopted a more accessible style and provided a more generalized view, focusing on broad concepts, while experts sometimes used technical jargon, providing evidence-based explanations.

CONCLUSIONS

ChatGPT-4 can accurately address sleep-related queries and debunk sleep-related myths, with a performance comparable to sleep experts, even if, given its limitations, the AI cannot completely replace expert opinions, especially in nuanced and complex fields such as sleep health, but can be a valuable complement in the dissemination of updated information and promotion of healthy behaviors.

Better characterizing sleep beliefs for personalized sleep health promotion: the French sleep beliefs scale validation study

Background

The Sleep Beliefs Scale (SBS) is a well-known tool to design and monitor personalized sleep health promotion at an individual and population level. The lack of an established French version limits the development of effective interventions targeting these populations. Thus, the aim of this study was to validate the French version of the SBS in a representative sample of the general population.

Methods

Quota sampling was used to recruit 1,004 participants (18-65 years, mean age: 43 years, 54% of female) who underwent an online survey to complete the SBS, and to assess sleep schedules, sleep quality and disorders, and mental health. Cronbach's α coefficient, confirmatory factor analysis, item-internal consistency (IIC), and item discriminant validity (IDV) of the SBS were computed to assess internal validity while bivariate associations with sleep schedules, sleep quality and disorders, and mental health were used to assess external convergent and discriminant validity.

Results

The mean score on the SBS was 12.3 ± 4.9. Item 19 ("Quiet & Dark") showed the highest rate of correct answers (n = 801, 79.8%), while item 20 ("Recovering sleep") showed the lowest rate of correct answers (n = 246, 24.5%). Overall, the SBS showed satisfactory internal consistency (α = 0.87) and confirmed the three-factor structure proposed by the original study. All items were found consistent (IIC > 0.4) and discriminant (IIC > IDV) except for item 20 ("recovering lost sleep by sleeping for a long time"). Females, older participants, and subjects with short time-in-bed, poor sleep quality, insomnia, and circadian rhythm disorder had higher SBS scores while participants with depressive symptoms had lower SBS scores.

Conclusion

We successfully translated and validated the French version of the SBS in a representative sample, making it a reliable instrument for researchers and clinicians to assess and target sleep beliefs. Correct answers vary from 25 to 80% which underlines the importance of continuing sleep health promotion campaigns by targeting poorly understood behaviors. Our findings also shed light on the fickleness of beliefs that are prone to vary within individuals across time, in step with societal changes. Several associated factors were identified, thus contributing to our understanding of sleep beliefs and offering insights for personalized approaches to enhance sleep health and overall well-being.

Racial and ethnic disparities in self-reported sleep duration: Roles of subjective socioeconomic status and sleep norms

OBJECTIVES

There are racial and ethnic disparities in sleep duration, with members of historically marginalized groups typically reporting shorter sleep than White Americans. This study examines subjective social status (SSS) as a moderator, and variation in ideal sleep norms as a mediator, of differences in sleep duration between racial/ethnic groups.

METHODS

Asian, Black, Hispanic, and non-Hispanic White respondents in an online survey reported their typical weeknight and weekend-night sleep duration, along with estimates of ideal sleep duration norms. Objective and subjective indicators of socioeconomic status were also assessed. A conditional process analysis was used to examine whether racial or ethnic differences in sleep duration were a) moderated by SSS and b) mediated by ideal sleep duration norms.

RESULTS

Racial/ethnic disparities in sleep duration varied by group. Hispanic participants reported shorter weeknight sleep than White participants. In Asian and Black participants, shorter weeknight sleep relative to White participants was only observed at medium (Black) or high (Black and Asian) levels of SSS. Shorter norms for ideal sleep duration partially mediated differences in sleep duration between Black and White adults, but not the other racial/ethnic groups. There was no evidence of moderated mediation. Neither income nor education moderated racial/ethnic disparities in sleep duration.

CONCLUSIONS

Racial and ethnic disparities in sleep duration may partially depend on SSS. Continued research into moderators and mediators of racial/ethnic differences in sleep duration is warranted.

Adolescent sleep myths: Identifying false beliefs that impact adolescent sleep and well-being

OBJECTIVE

Commonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents.

METHOD

We identified myths with a panel of adolescent sleep health experts (n = 12) using the Delphi method in three sequential steps: (1) focus groups; (2) online discussion; and (3) closed-ended questionnaires with which the experts rated myths on: (1) falseness and (2) public health significance using 5-point Likert scales ranging from 1 (not at all false/important for public health) to 5 (extremely false/important for public health). Next, we explored the prevalence of the myths among a demographically diverse sample of parents/caregivers of adolescents in the United States. Finally, we report the counterevidence to refute each myth.

RESULTS

Ten myths about adolescent sleep were identified by the experts using the Delphi method. The most prevalent myths were the beliefs that (1) "Going to bed and waking up late on the weekends is no big deal for adolescents, as long as they get enough sleep during that time," reported by 74% of parents/caregivers; (2) "If school starts later, adolescents will stay up that much later," reported by 69% of parents/caregivers; and (3) "Melatonin supplements are safe for adolescents because they are natural," reported by 66% of parents/caregivers.

CONCLUSION

Parents/caregivers have the potential to serve as sleep health advocates for their adolescent and support their adolescent's sleep health behaviors. Our study found that many parents/caregivers endorse myths about adolescent sleep that may hinder their ability to support their adolescent's sleep health. Future research may explore methods for promoting evidence-based beliefs about adolescent sleep among parents/caregivers.

Content and Validity of Claims Made about Food Parenting Practices in United Kingdom Online News Articles

The objective of this study was to qualitatively summarise the content of online news articles pertaining to food parenting practices and determine whether this content is substantiated by the scientific literature. News article data were identified and collected from United Kingdom online news published during 2010–2017 period using the News on the Web corpus. A coding framework was used to categorise the content of news articles to identify information related to food parenting practices. Then, claims made about food parenting practices were extracted from relevant news articles. Each claim was evaluated to determine the extent to which any claims were supported by the available scientific research evidence. The study identified ten claims across thirty-two relevant online news articles. Claims made across the news articles reported on the following food parenting practices: food restrictions, food-based threats and bribes, pressure to eat, use of food to control negative emotions, food availability, food preparation, and meal and snack routines. Eight out of the ten claims identified did not refer to scientific research evidence. News articles frequently lacked detail and information to explain to readers why and how the use of certain food parenting practices could have a lasting impact on children’s health outcomes. Considering the influence that news media has on parents, the reporting of food parenting practices in news articles should aim to provide a balanced view of the published scientific evidence and recognise the difficulties and barriers that prevent the use of helpful and healthy food parenting practices. The study results in this paper could be used to aid and structure of the dissemination of food parenting practice research findings in the media, inform public health education to influence perceptions of unhelpful food parenting practices, and promote parental use of responsive food parenting practices.