Interactions between sleep, stress, and metabolism: From physiological to pathological conditions

Short sleep duration and daytime outdoor activities effects on adolescents mental health: A stress susceptibility-recovery model analysis

BACKGROUND

Mental health disorders are a growing public health challenge globally. This study aimed to utilize the Stress Susceptibility-Recovery Model to identify the relationship between sleep duration, daytime outdoor activities, and major mental health outcomes among adolescents.

METHODS

Data from the Yunnan Students' Common Disease Survey was analyzed. Multi-factorial logistic regression assessed the impact of each variable on mental health, while subgroup analyses and interaction tests examined the stability of the association between sleep duration, daytime outdoor activity, and mental health. Mendelian Randomization analysis assessed causal effects.

RESULTS

The analysis included 204,158 participants aged 12-18 from 953 surveillance schools. After adjusting for covariates, the prevalence of depressive mood increased from 18.81 % (12-13 years) to 24.89 % (16-18 years); Females had a higher prevalence than males (1:1.36). Senior high school students (26.04 %) had a significantly higher rate than junior high school (21.41 %), and vocational high school students (18.42 %). Students with <2 h of daytime outdoor activity had a higher prevalence of depressive mood (24.40 %) compared to those with 2 or more hours of daytime outdoor activity (19.96 % for 2 h and 19.70 % for 3 or more hours). Short sleep duration mediated the association between reduced daytime outdoor activity and increased depressive mood or affective disorders risk, supporting the Stress Susceptibility-recovery Model.

CONCLUSIONS

Sleep duration and daytime outdoor activity were key determinants of emotional well-being, considering aging and gender disparities.

LIMITATIONS

Potential sampling bias due to differences in baseline characteristics between participants with and without missing data.

Latent class analysis for quality of life status, sleep quality and anxiety in patients with type 2 diabetes

INTRODUCTION

Type 2 diabetes (T2D) is a chronic metabolic disorder that is associated with reduced sleep quality and anxiety, and can cause a decrease in quality of life in these patients. Despite previous studies investigating these factors, few studies have examined their co-occurrence in these patients. To address this research gap, the present study aimed to determine the subgroups of patients with type 2 diabetes based on quality of life, sleep quality, and anxiety in the subgroups of using latent class analysis (LCA).

METHODS

This cross-sectional study was conducted using multistage random sampling. A total of 308 patients with type 2 diabetes were randomly selected from health centers in Ardabil. All participants completed four sets of checklists and questionnaires, (Demographic characteristics, 12-item Short Form survey, the Pittsburgh Sleep Quality Index and Generalized Anxiety Disorder 7-item). Data analysis was performed using Analysis of Variance (ANOVA), chi square and latent class analysis.

RESULTS

Three latent classes were identified: The first class (good status) included 56.4% of the participants. Also, the second (moderate status) and third (poor status) classes described 16.5% and 27.1% of the participants, respectively. In latent class 1, the probability of having good quality of life and good sleep quality was higher. In latent class 2, the probability of having moderate quality of life and poor sleep quality was higher. However, these patients revealed no anxiety. Those with third latent class membership were more likely to have moderate quality of life, poor sleep quality, and severe anxiety.

CONCLUSION

This study showed that sleep quality and anxiety is positively related to quality of life in patients with type 2 diabetes. In addition, this study indicated the co-occurrence of sleep quality and anxiety in these patients. Based on these findings, effective and targeted interventions can be designed to improve the health status and quality of life of these patients, taking into account sleep quality and anxiety.

Sleep deprivation in development of obesity, effects on appetite regulation, energy metabolism, and dietary choices

Sleep deprivation, which is a decrease in duration and quality of sleep, is a common problem in today's life. Epidemiological and interventional investigations have suggested a link between sleep deprivation and overweight/obesity. Sleep deprivation affects homeostatic and non-homoeostatic regulation of appetite, with the food reward system playing a dominant role. Factors such as sex and weight status affect this regulation; men and individuals with excess weight seem to be more sensitive to reward-driven and hedonistic regulation of food intake. Sleep deprivation may also affect weight through affecting physical activity and energy expenditure. In addition, sleep deprivation influences food selection and eating behaviours, which are mainly managed by the food reward system. Sleep-deprived individuals mostly crave for palatable energy-dense foods and have low desire for fruit and vegetables. Consumption of meals may not change but energy intake from snacks increases. The individuals have more desire for snacks with high sugar and saturated fat content. The relationship between sleep and the diet is mutual, implying that diet and eating behaviours also affect sleep duration and quality. Consuming healthy diets containing fruit and vegetables and food sources of protein and unsaturated fats and low quantities of saturated fat and sugar may be used as a diet strategy to improve sleep. Since the effects of sleep deficiency differ between animals and humans, only evidence from human subject studies has been included, controversies are discussed and the need for future investigations is highlighted.

Integrative sleep management: from molecular pathways to conventional and herbal treatments

Sleep is regarded as one of the most crucial factors in keeping a healthy lifestyle. To function normally, a person needs at least 6-8 h of sleep per day. Sleep influences not only our mood but also the efficiency with which we complete tasks. Sleep disorders exhibit diverse etiologies across different conditions and populations, with genetic and environmental factors playing a significant role in their development. Many issues emerge as a result of inadequate sleep. Unhealthy food and lifestyle choices have increased our susceptibility to sleep disorders. A well-balanced diet rich in essential vitamins and minerals can have a profound impact on sleep patterns, enhancing both the duration and quality of rest. The primary categories of sleep disorders include insomnia, sleep apnea (SA), narcolepsy, parasomnias, circadian rhythm disorders, and restless legs syndrome (RLS). The drugs used to treat sleep disorders are primarily habit-forming and have a history of withdrawal effects. This insufficiency in medication has prompted the hunt for newer, better options. Nutraceuticals are well-suited to the treatment of such illnesses. Its non-toxic, non-habit-forming properties, and practical efficiency have made it an outstanding choice. This review provides nutraceuticals used in sleep disorders. A comprehensive literature search was conducted utilizing several databases, including Google Scholar, Elsevier, Springer Nature, Wiley, PubMed, and EKB. Nutraceuticals are products that employ food or dietary components to treat or prevent disease. In the therapy of sleep disorders, nutraceuticals such as Artemisia annua, valerian, rosemary, jujube, Passionflower, lemon balm, ashwagandha, kava-kava, lavender, and chamomile have been shown to have remarkable benefits. These remedies exert their effects through multiple mechanisms, both directly by modulating neurotransmitter and hormonal pathways within sleep circuits, and indirectly by enhancing sleep quality through the alleviation of stress, inflammation, and oxidative stress. Clinical studies were piloted to validate the efficacy of natural sleep aids. Future research should focus on elucidating the precise mechanisms through which natural products influence sleep.

Perceived Stress and Clinical Insomnia in Primary Care: Associations with Lifestyle and Medication Use

Purpose

Insomnia and perceived stress are among the most prevalent health concerns in primary care, yet their complex relationship remains underexplored. This study examines the association between perceived stress and insomnia severity, while considering the potential moderating or mediating effects of lifestyle factors and medication use.

Methods

A cross-sectional study was conducted with 300 consecutive primary care patients who completed validated questionnaires assessing insomnia severity (Insomnia Severity Index, ISI) and perceived stress (Perceived Stress Scale, PSS). Logistic regression models were employed to identify predictors of clinical insomnia and explore key relationships.

Results

A moderate but statistically significant correlation (r = 0.460, p < 0.001) was observed between perceived stress and insomnia severity. In logistic regression analysis, higher perceived stress scores (OR = 1.134, p < 0.001) and hypnotic medication use (OR = 3.220, p < 0.001) were significant predictors of clinical insomnia. Interestingly, alcohol consumption was unexpectedly associated with insomnia (OR = 0.551, p = 0.048), warranting further exploration. No significant associations were found for caffeine intake, tobacco use, or demographic variables. The model explained 33% of the variance in insomnia (Nagelkerke R² = 0.328).

Conclusion

These findings highlight the significant role of perceived stress in insomnia severity and underscore the complex interplay between pharmacological interventions and sleep disturbances. While hypnotic medications are commonly used, their long-term impact and potential dependence require careful consideration. Integrating stress-reduction strategies into primary care may improve insomnia management while reducing reliance on pharmacological treatments. Future research should employ longitudinal designs to clarify causality and further explore additional factors influencing sleep disturbances.

The effects of controlled acute psychological stress on serum cortisol and plasma metanephrine concentrations in healthy subjects

BackgroundAs cortisol and metanephrine are involved in the stress response, it is often recommended that individuals are relaxed at the time of venepuncture, however, evidence behind these recommendations is lacking. We investigated the effects of acute psychological stress on serum cortisol and plasma metanephrine concentrations in healthy individuals exposed to varying levels of psychological stress and compared these results to self-reported measures of stress.MethodsTen medical students completed two medical in-person simulations (one low-complexity, one high-complexity) in a random order. At four times, participants completed the State-Trait Anxiety Inventory (STAI) and serum cortisol and plasma metanephrine/normetanephrine were tested.ResultsMedian (interquartile range) STAI prior to the low-complexity simulation was 44 (18) versus 33 (13) afterwards (P = 0.050). STAI prior to the high-complexity simulation was 33 (10) versus 48 (17) afterwards (P = 0.007). Cortisol prior to the low-complexity simulation was 272 nmol/L (115) versus 247 (115) afterwards (P = 0.333). Prior to the high-complexity simulation, cortisol was 246 (70) versus 261 (137) afterwards (P = 0.859). Metanephrine prior to the low-complexity simulation was 242 pmol/L (79) versus 247 (93) afterwards (P = 0.515). Metanephrine prior to the high-complexity simulation was 220 (81) versus 251 pmol/L (120) afterwards (P = 0.074). Normetanephrine prior to the low-complexity simulation was 593 pmol/L (247) versus 682 (281) afterwards (P = 0.047 for the difference). Normetanephrine prior to the high-complexity simulation was 696 (123) versus 705 pmol/L (224) afterwards (P = 0.169).ConclusionsThe trend in cortisol levels largely reflected changes in STAI. We outline some implications of these findings for current practice and future research.

Sleep disturbances in generalized anxiety Disorder: The central role of insomnia

Generalized anxiety disorder (GAD) is a chronic and disabling mental health condition characterized by excessive, uncontrollable worry and persistent psychological and somatic tension. Affecting approximately 3-6 % of the global population, GAD significantly impairs daily functioning and often coexists with other psychiatric conditions. Among its many symptoms, sleep disturbances-particularly insomnia-are among the most frequently reported and debilitating. Individuals with GAD commonly experience difficulties with sleep initiation, maintenance, and restorative rest, making insomnia one of the most pervasive features of the disorder. Emerging research highlights a bidirectional relationship between GAD and insomnia: while anxiety contributes to cognitive and physiological arousal that interferes with sleep, insomnia in turn exacerbates emotional dysregulation, amplifies worry, and may even precede the development of anxiety disorders. Neurobiological and neuroimaging studies support this reciprocal link, showing shared dysfunctions such as heightened hypothalamic-pituitary-adrenal (HPA) axis activity, increased amygdala reactivity, reduced prefrontal cortical control, and GABAergic deficits. These overlapping mechanisms underscore a common pathophysiological substrate that reinforces both conditions. Recognizing and addressing this interplay is critical, as untreated insomnia may perpetuate or intensify GAD symptoms. Notably, cognitive behavioral therapy for insomnia (CBT-I) has been effective in improving sleep and reducing anxiety severity-even without directly targeting anxiety-supporting a shift toward integrating sleep-focused interventions in the treatment of GAD. This review aimed to elucidate clinical and neurobiological evidence on the bidirectional link between insomnia and GAD, emphasizing shared mechanisms and treatment implications.

Greenspace proximity in relation to sleep health among a racially and ethnically diverse cohort of US women

Sleep is essential for overall health. Greenspace may contribute to sleep health through, for instance, improving mood, reducing sleep disruptors (e.g., poor air quality), and promoting physical activity. Although greenspace likely differs across populations, few studies have included diverse populations. To investigate greenspace-sleep health associations, overall and by age, race and ethnicity, and socioeconomic status, we used data collected at enrollment (2003-2009) from women in the Sister Study (n = 1612 Hispanic/Latina, n = 4421 non-Hispanic (NH)-Black, and n = 41,657 NH-White). Participants' geocoded home addresses were linked to NASA's Moderate Resolution Imaging Spectroradiometer Normalized Difference Vegetation Index data (250m resolution) to capture greenspace tertiles (further categorized as low/moderate vs. high). Participants reported seven sleep dimensions, which we assessed individually, along with a multidimensional sleep health measure (categories: favorable, moderate, poor). Adjusting for individual- and environmental/neighborhood-level characteristics, we used Poisson regression with robust variance to estimate prevalence ratios and 95 % confidence intervals (PR[CI]). We tested for interaction and estimated age-, race and ethnicity-, and educational attainment category-specific associations. Among participants (mean ± SD age = 55.7 ± 9.0 years), those with low/moderate vs. high greenspace had a lower prevalence of favorable sleep (58 % vs. 66 %). After adjustment, low/moderate vs. high greenspace was associated with a 32 % higher prevalence of moderate (PR = 1.32 [1.27-1.38]) and 12 % higher prevalence of poor (PR = 1.12 [1.07-1.16]) vs. favorable sleep health. Magnitudes of associations were higher among NH-White women vs. minoritized racial-ethnic groups and women with higher vs. lower educational attainment. Higher greenspace was associated with favorable sleep, with stronger associations among groups with more social advantages.

Exploring the Science of Shape: How Physical Activity, Sleep, and Stress Affect Body Composition

In the contemporary context of health challenges, the focus on physical health has become a social and individual priority. Within this framework, body composition emerges as one of the key determinants of physical health, with deviations from normal body composition being associated with numerous pathological conditions that can lead to serious health issues. Consequently, there is an urgent need to synthesize the available knowledge and increase awareness regarding healthy body composition and the factors that shape its components. This narrative review aims to summarize the knowledge regarding the main components of body composition and the key factors that influence their development. The fundamental morphological characteristics and functions of the primary components of body composition-including adipose tissue, muscle mass, and bone tissue-are addressed. Furthermore, the available methods for assessing body composition are outlined. The role of three key factors that influence body composition is outlined, including, but not limited to, physical activity, sleep quality, and stress levels. Additionally, hormonal fluctuations that determine body composition in relation to the variability of these factors are discussed. The review provides evidence-based information that will be valuable both for disease prevention related to non-communicable diseases and for the promotion of health strategies aimed at long-term physical well-being.

Cross-sectional and longitudinal trajectory analyses of sleep duration and frailty among middle-aged and older Chinese adults

The relationship between sleep duration and frailty remains unclear, particularly regarding their bidirectional nature and temporal dynamics in the Chinese population. This study aimed to investigate the cross-sectional association, developmental trajectories, and interactions between sleep duration and frailty in Chinese middle-aged and older adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which included 12,942 participants for cross-sectional analysis and 11,192 participants for the longitudinal trajectory study. Latent growth models and cross-lagged panel models were utilized to explore the temporal effects of sleep duration on frailty and vice versa. Participants' mean age was 59.29 ± 9.48 years, comprising 47.73% men and 52.27% women. Cross-sectional analysis revealed that, compared with participants with normal sleep duration (6-8 h), both Q1 (≤ 5 h, OR = 1.99, 95% CI 1.64-2.41, P < 0.001) and Q4 (> 8 h, OR = 1.50, 95% CI 1.12-2.02, P = 0.01) showed increased risks of frailty. The parallel latent growth model demonstrated that the initial level of sleep duration significantly negatively predicted the initial level of frailty (β = - 0.34, P < 0.001), while the rate of change in sleep duration negatively predicted the rate of change in frailty (β = - 0.61, P < 0.001). Conversely, the initial level of frailty significantly negatively predicted the initial level of sleep duration (β = - 0.36, P < 0.001), and the rate of change in frailty negatively predicted the rate of change in sleep duration (β = - 0.71, P < 0.001). Cross-lagged analysis indicated a bidirectional causal association between sleep duration and frailty, with the negative predictive effect of frailty on sleep duration being relatively stable, while sleep duration had a short-term effect on frailty. Our study revealed a U-shaped correlation between sleep duration and frailty risk in cross-sectional analysis and established a bidirectional relationship through longitudinal investigation. These findings underscore the importance of balanced sleep patterns and early screening for both conditions in middle-aged and older adults.

Insomnia increases the risk for specific autoimmune diseases: a large-scale retrospective cohort study

Objective

The global rise of autoimmune diseases presents a significant medical challenge, with inadequate treatment options, high morbidity risks, and escalating healthcare costs. While the underlying mechanisms of autoimmune disease development are not fully understood, both genetic predispositions and lifestyle factors, particularly sleep, play critical roles. Insomnia and circadian rhythm sleep disorders not only impair sleep but also disrupt multi-organ interactions by dysregulating sympathetic nervous system activity, altering immune responses, and influencing neuroendocrine function. These disruptions can contribute to immune system dysregulation, increasing the risk of autoimmune disease development.

Methods

To assess the impact of impaired sleep on the risk of developing autoimmune diseases, a global population-based retrospective cohort study was conducted using electronic health records from the TriNetX US Global Collaborative Network, including 351,366 subjects in each propensity score matched group. Twenty autoimmune diseases were examined, and propensity score matching was employed to reduce bias. Three sensitivity analyses were conducted to test the robustness of the results.

Results

The study identified significantly increased risks for several autoimmune diseases associated with impaired sleep, likely mediated by dysregulated neuroimmune and autonomic interactions. Specifically, cutaneous lupus erythematosus [hazard ratio (HR) = 2.119; confidence interval (CI) 1.674-2.682; p < 0.0001], rheumatoid arthritis (HR = 1.404; CI 1.313-1.501; p < 0.0001), Sjögren syndrome (HR = 1.84; CI 1.64-2.066; p < 0.0001), and autoimmune thyroiditis (HR = 1.348; CI 1.246-1.458; p < 0.0001) showed significantly increased risks. No diseases demonstrated reduced risks, and 4 out of 20 tested diseases did not show significant HR increases in any analysis.

Conclusion

This study highlights the integral role of sleep in maintaining immune homeostasis through multi-organ interactions involving the autonomic nervous system, immune signalling pathways, and endocrine regulation. Disruptions in these systems due to chronic sleep impairment may predispose individuals to autoimmune diseases by altering inflammatory responses and immune tolerance. These findings underscore the necessity of recognizing and treating sleep disorders not only for general wellbeing but also as a potential strategy to mitigate the long-term risk of autoimmune disease development.

Long sleep duration, cognitive performance, and the moderating role of depression: A cross-sectional analysis in the Framingham Heart Study

INTRODUCTION

We investigated whether depression modified the associations between sleep duration and cognitive performance.

METHODS

We examined the associations between sleep duration and cognition in 1853 dementia-and-stroke-free participants (mean age 49.8 years, [range 27-85]; 42.7% male). Participants were categorized into four groups: no depressive symptoms, no antidepressants; depressive symptoms without antidepressant use; antidepressant use without depressive symptoms; and depressive symptoms and antidepressant use.

RESULTS

Long sleep was associated with reduced overall cognitive function (β ± standard error = -0.25 ± 0.07, p < 0.001), with strongest effects in those with depressive symptoms using (-0.74 ± 0.30, p = 0.017) and not using antidepressants (-0.60 ± 0.26, p = 0.024). Weaker but significant effects were observed in those without depressive symptoms (-0.18 ± 0.09, p = 0.044). No significant associations were observed in participants using antidepressants without depressive symptoms.

DISCUSSION

Associations between sleep duration and cognitive performance are strongest in individuals with depressive symptoms, regardless of antidepressant use. Future research should elucidate underlying mechanisms and temporal relationships.

HIGHLIGHTS

Sleeping ≥ 9 hours/night was associated with worse cognitive performance. This association was stronger among those with depression. Long sleepers were more likely to report symptoms of depression. Sleep may be a modifiable risk for cognitive decline in people with depression.

Sleep Quality and Evening Salivary Cortisol Levels in Association with the Psychological Resources of Parents of Children with Developmental Disorders and Type 1 Diabetes

BACKGROUND

Sleep deprivation can decrease parental well-being and degrade mental and physical health in parents of children with chronic illness. The aim of this study was to explore the associations of sleep quality, psychological stress perception, and evening salivary cortisol concentration with self-esteem, optimism and happiness in parents of children with type 1 diabetes and developmental disorders compared to parents of healthy, typically developing children.

METHODS

We studied 196 parents of children with chronic conditions, including autistic spectrum disorder (N = 33), cerebral palsy (N = 18), Down syndrome (N = 33), and diabetes mellitus type 1 (N = 40) and parents of healthy children (N = 72). We evaluated parental sleep quality, evening salivary cortisol levels, self-esteem, optimism and happiness. Multiple linear regression models were used to assess associations between variables.

RESULTS

Compared with those of the control group, the parents of children with autistic spectrum disorders had higher evening cortisol concentrations (β = 0.17; p = 0.038) and lower perceptions of happiness (β=-0.17; p = 0.017), while parents of children with type 1 diabetes had disrupted sleep quality (β = 0.25; p = 0.003). Optimism was negatively associated with the evening cortisol concentration (β=-0.18; p = 0.023) and sleep quality index (β=-0.20; p = 0.012).

CONCLUSIONS

Public health programs aimed at lifestyle habit improvement, respite care, and relaxation for parents of children with chronic conditions would be useful for improving parental sleep quality, self-esteem, optimism and happiness.

Gastrodia elata, Polygonatum sibiricum, and Poria cocos as a Functional Food Formula: Cognitive Enhancement via Modulation of Hippocampal Neuroinflammation and Neuroprotection in Sleep-Restricted Mice

Gastrodia elata, Polygonatum sibiricum, and Poria cocos are traditional Chinese herbs commonly used as both medicinal and food ingredients, traditionally believed to improve liver and kidney functions, replenish vital energy (qi) and blood, and mitigate stress-induced damage. These herbs are combined in the Compound Gastrodia elata Formula (CGEF), a functional food formulation. Amidst growing interest in functional foods, this study explores the cognitive-enhancing effects of CGEF, focusing on cognitive function improvement. Cognitive impairment was induced in ICR mice via chronic sleep restriction. Behavioral assessments including the Y-maze test, object recognition test, Morris water maze test, and Passive avoidance test, were conducted to evaluate CGEF's effects. Serum levels of inflammatory markers and oxidative stress were quantified while in rat hippocampus tissue expressions of inflammatory, apoptotic, and neuroprotective-related protein markers were analyzed by Western blotting. Neurotransmitter concentrations in both the hippocampus and prefrontal cortex were determined by LC-MS/MS. CGEF significantly alleviated cognitive impairments across all behavioral tests. The underlying mechanisms likely involve a reduction in oxidative stress and peripheral inflammatory factors, and suppression of the TLR2/MyD88/NF-κB signaling cascade in the hippocampus, thereby mitigating neuroinflammation and neuronal apoptosis. Furthermore, CGEF modulated the PI3K/AKT/GSK3β signaling pathway, potentially contributing to neuronal integrity and synaptic plasticity maintenance. CGEF also restored neurotransmitter balance and regulated tryptophan metabolism, further alleviating cognitive deficits associated with sleep disruption. These findings suggest CGEF's potential as a functional food for reversing cognitive impairments caused by chronic sleep restriction, primarily through its anti-inflammatory and neuroprotective effects.

Psychosocial wellbeing and short sleep duration among U.S. adults

PURPOSE

Short sleep duration (SSD), defined as less than 7 h of sleep per day, can lead to various health problems. This study aims to assess whether psychosocial wellbeing is associated with short sleep duration in a nationally representative sample of adults in the United States.

METHODS

Data (N = 272,472) were from the 2022 Behavioral Risk Factor Surveillance System Survey. We estimated multivariable -binomial and -multinomial logistic regressions to examine the differential odds of SSD among individuals across three instruments of psychosocial wellbeing- life satisfaction, feeling of social isolation, and receipt of needed emotional support.

RESULTS

Prevalence of SSD in the study population was 35.5%. Compared to adults who were very satisfied with their lives, those who were dissatisfied were 1.63 (95% CI: 1.48-1.79) times more likely to have SSD. Adults who rarely/never received emotional support were 1.60 (95% CI: 1.48-1.73) times more likely to have SSD compared to those who always received support. The odds of having SSD were 1.38 (95% CI: 1.28-1.48) times higher among adults who usually/always felt socially isolated than that of adults who never felt isolated. These results were robust across sub-groups of generations and income.

CONCLUSION

These results showed a strong link between sleep deprivation and psychosocial wellbeing, after accounting for various demographic, socioeconomic, and health related attributes. Future research, therefore, may explore the role of psychosocial wellbeing as a potential avenue for improving sleep health at the population level.

Perceived stress mediates the longitudinal effect of sleep quality on internalizing symptoms

BACKGROUND

Numerous studies have explored the relationship between sleep quality and internalizing symptoms (i.e., depression and anxiety), but there is uncertainty about their directional pathways. Here, we investigated the longitudinal associations between sleep quality and internalizing symptoms and tested the potential mediation effect of perceived stress.

METHODS

A longitudinal survey of Chinese healthcare students (N = 343) was conducted at three time points: Time 1 (baseline), Time 2 (1 week later), and Time 3 (3 weeks after Time 2). Participants completed the Sleep Quality Questionnaire (SQQ), Perceived Stress Questionnaire-30 (PSQ-30), and the Patient Health Questionnaire-4 (PHQ-4) at each time point, where each asked about participants' experiences over the past week. A higher SQQ score indicated poorer sleep quality, while higher scores on the PHQ-4 and PSQ-30 indicated more severe internalizing symptoms and perceived stress. Using autoregressive cross-lagged panel modeling (CLPM), we examined the bidirectional relationships among sleep quality, internalizing symptoms, and perceived stress.

RESULTS

CLPM revealed that baseline sleep quality negatively predicted subsequent changes in internalizing symptoms, and vice versa. While perceived stress mediated the relationship between sleep quality and internalizing symptoms at the 3-week follow-up (β = 0.017, p = .038), it did not mediate the reverse relationship between internalizing symptoms and sleep quality.

CONCLUSIONS

There was a negative bidirectional relationship between sleep quality and internalizing symptoms. Furthermore, perceived stress mediated the effect of poor sleep quality on internalizing symptoms, suggesting that good-quality sleep may enhance stress resilience and alleviate symptoms of depression and anxiety, thereby improving overall wellbeing.

Glia: the cellular glue that binds circadian rhythms and sleep

Glia are increasingly appreciated as serving an important function in the control of sleep and circadian rhythms. Glial cells in Drosophila and mammals regulate daily rhythms of locomotor activity and sleep as well as homeostatic rebound following sleep deprivation. In addition, they contribute to proposed functions of sleep, with different functions mapping to varied glial subtypes. Here, we discuss recent findings in Drosophila and rodent models establishing a role of glia in circadian or sleep regulation of synaptic plasticity, brain metabolism, removal of cellular debris, and immune challenges. These findings underscore the relevance of glia for benefits attributed to sleep and have implications for understanding the neurobiological mechanisms underlying sleep and associated disorders.

Sleep Deprivation-Induced Anxiety Alleviated by Oral Administration of 4-Aminopyridine in Male Mice

PURPOSE

Insufficient sleep and insomnia are common issues associated with modern lifestyles that often contribute to the development of mental health disorders. 4-aminopyridine (4-AP), a voltage-gated potassium (Kv) channel antagonist, is commonly used in the treatment of multiple sclerosis (MS). It has been shown to improve nerve conduction velocity, strengthen myelin, and increase axonal area after injury. In addition, 4-AP has been reported to reduce behavioral disorders, including depression. The aim of this study was to investigate the effects of 4-AP on anxiety-like behavior in mice subjected to rapid eye movement (REM) sleep deprivation.

METHODS

Fifty male mice were randomly divided into five groups: control, normal saline (NS) (receiving normal saline via gavage), AP-0.25, AP-0.5, and AP-1 (receiving daily doses of 0.25, 0.5, and 1 mg/kg of 4-AP, respectively by gavage). All groups except the control group underwent SD for five consecutive days. The animals' locomotion and anxiety-like behavior were assessed using the open field and elevated plus maze tests. After behavioral testing, N-methyl-D-aspartate receptor (NMDA-R), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA-R), and tumor necrosis factor (TNF-α) were measured by western blotting, and also malondialdehyde (MDA) and total antioxidant capacity (TAC) were analyzed by ELISA in the hippocampus.

FINDING

AP-1 significantly reduced the levels of anxiety-like behavior compared to the NS group in both tests. In AP-1, a significant decrease in the levels of NMDA-R, AMPA-R, TNF-α, and MDA was observed. While these levels were increased in the NS group. In addition, AP-1 showed a higher level of TAC compared to the NS group, indicating an increase in antioxidant levels.

CONCLUSION

4-AP may be effective in reducing anxiety-like behavior in sleep-deprived mice by modifying the levels of NMDA-R, AMPA-R, and TNF-α, while simultaneously reducing oxidative stress induced by sleep deprivation in the hippocampus.

Oral health and sleep disorders: A systematic review and meta-analysis

Oral health and sleep quality are critical components of overall health, but their relationship remains poorly understood. The present meta-analysis therefore investigates the association between oral health and sleep quality, synthesizing evidence from diverse populations. To this aim, a comprehensive search strategy identified 311 articles, from which 8 studies encompassing 18 comparisons met the inclusion criteria. These studies, conducted between 2015 and 2023, included 36,559 participants across various countries. Oral health was assessed using indices such as the Decayed, Missing, and Filled Teeth Index and gingival indices. At the same time, sleep quality was measured using tools such as the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. The results of the meta-analysis revealed a significant association between poorer oral health and poorer sleep quality, with a standardized mean difference of 2.166 [95% confidence interval (95% CI), 0.677-3.655; P=0.004]. Sensitivity analyses confirmed the robustness of the findings, and publication bias assessments indicated no significant bias. Precision interval analysis showed a mean effect size of 2.17 with a 95% CI of -4.83 to 9.16, suggesting variability in the strength of the association across populations. In conclusion, the results of the present meta-analysis provide strong evidence for a significant link between oral health and sleep quality, highlighting the importance of considering oral health in the management of sleep disorders. Future research should focus on longitudinal studies and standardized measurement tools to further elucidate this relationship and inform public health strategies aimed at improving both oral health and sleep quality.

Stratification of orthognathic surgery patients for painful TMD and associated factors

OBJECTIVE

To identify clusters of patients with DFD based on variables related to TMD, psychological aspects, somatization, oral habits, and sleep.

METHOD

Ninety-two patients with DFD were evaluated before orthognathic surgery according to demographic data, facial profile, presence of painful TMD (DC/TMD), psychological aspects, oral habits, comorbidities, substance use, and sleep quality.

RESULTS

Eighty-six individuals comprised the final sample. The K-means cluster analysis identified two distinct but internally similar groups. One called "Vulnerable" with a higher prevalence of muscular TMD and associated factors with 43 (50%) participants, and another with 43 (50%) participants, called "Adaptive" with a lower prevalence of these variables (P<.01). The determining variables were signs and symptoms of anxiety and somatization, awake bruxism and self-reported sleep quality. The presence of arthralgia, comorbidities, or smoking did not influence the formation of the groups. The clusters were tested with gender, age, facial profile, maxillary excess, and deficiency. Only females were associated with the vulnerable group (P=.015). These results highlight the importance of multidimensional assessment of patients with DFD. The stratification of these individuals can help with personalized treatment, targeting specific strategies for each group, such as behavioral interventions and referrals to a multidisciplinary team.

Sleep and stress in athletes with disabilities around the 2021 Tokyo Paralympic games during the pandemic

This research evaluated the relation and fluctuations in stress and sleep quality in athletes with disabilities (AwD) during the period before and after the 2020 Tokyo Paralympics, amidst the COVID-19 pandemic. Assessments were conducted every 3 months over a period of 10 months, encompassing three distinct pandemic phases. Results showed significant variations in perceived stress (F = 9.41, ηp2 = 0.09, p < 0.01) and sleep quality (F = 10.55, ηp2 = 0.10, p < 0.001), with initial increased stress and poorer sleep, improving at the midpoint. Sleep quality components varied over time (p < 0.05), except for sleep medication use and daytime dysfunction. Results indicated a direct relationship where poor sleep potentially causes increased stress (β = 0.24, p < 0.01; β = 0.13, p < 0.05). The study underscores the need for regular stress assessments and development of sleep routines independent of external circumstances.

Twenty-four-hour movement guidelines and depressive symptoms: association, temporal trends and moderators over a ten-year period among 45,297 US adolescents

The aims of the present study were: (1) to examine the association between meeting the 24-h movement guidelines and depressive symptoms among U.S. adolescents; (2) to analyze the temporal trends of this association; and (3) to test whether sex, age, or race/ethnicity moderate these associations. This is a cross-sectional study using repeated data collection from the high school Youth Risk Behavior Surveys (YRBS), involving 45,297 adolescents in the US (49.7% females). Data were collected bi-annually between 2011 and 2021. These surveys represent cross-sectional snapshots rather than a longitudinal study, capturing data at distinct points in time across multiple years. The three 24-h movement guidelines, including guidelines for physical activity, screen time, and sleep duration were assessed by self-reported questions. Depressive symptoms were assessed by the question "During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing your usual activities?" with yes/no answer options. A generalized linear mixed model (GLMM) was employed to gauge the association between adherence to the 24-h movement guidelines (exposure) and the likelihood of having depressive symptoms (outcome). The year of data collection was included as a random intercept in the mixed-effects model to account for potential variations in depressive symptoms across different time points. The model was further adjusted for covariates, including sex, age, race/ethnicity, alcohol and tobacco consumption, school bullying, cyberbullying, and excess weight. Adolescents meeting all three 24-h movement guidelines (physical activity, screen time, and sleep) had the lowest probability of depressive symptoms (21.3%, 95% CI 17.3-25.3%) compared to those meeting none (37.6%, 95% CI 33.4-41.8%). Significant protective effects were observed across all adherence levels (p < 0.05). Over the 2011-2021 period, adherence remained consistently associated with reduced depressive symptoms, with the strongest effects seen in 2019 and 2021. Younger adolescents, males, and White individuals showed the greatest benefits, while females, older adolescents, Black, Hispanic/Latino, and individuals from other racial/ethnic groups exhibited weaker protective effects despite adherence. Findings from the present study highlight the importance of encouraging adherence to 24-h movement guidelines as a potential strategy to reduce depressive symptoms in adolescents. Notably, the protective effects of adherence varied across sociodemographic groups, with younger adolescents, females, and White individuals experiencing the greatest benefits.

Sleep deprivation-induced shifts in gut microbiota: Implications for neurological disorders

Sleep deprivation is a prevalent issue in contemporary society, with significant ramifications for both physical and mental well-being. Emerging scientific evidence illuminates its intricate interplay with the gut-brain axis, a vital determinant of neurological function. Disruptions in sleep patterns disturb the delicate equilibrium of the gut microbiota, resulting in dysbiosis characterized by alterations in microbial composition and function. This dysbiosis contributes to the exacerbation of neurological disorders such as depression, anxiety, and cognitive decline through multifaceted mechanisms, including heightened neuroinflammation, disturbances in neurotransmitter signalling, and compromised integrity of the gut barrier. In response to these challenges, there is a burgeoning interest in therapeutic interventions aimed at restoring gut microbial balance and alleviating neurological symptoms precipitated by sleep deprivation. Probiotics, dietary modifications, and behavioural strategies represent promising avenues for modulating the gut microbiota and mitigating the adverse effects of sleep disturbances on neurological health. Moreover, the advent of personalized interventions guided by advanced omics technologies holds considerable potential for tailoring treatments to individualized needs and optimizing therapeutic outcomes. Interdisciplinary collaboration and concerted research efforts are imperative for elucidating the underlying mechanisms linking sleep, gut microbiota, and neurological function. Longitudinal studies, translational research endeavours, and advancements in technology are pivotal for unravelling the complex interplay between these intricate systems.

Executive function is associated with behaviour problems in children and adolescents with cerebral palsy and intellectual disability

BACKGROUND

Children and adolescents with cerebral palsy (CP) commonly have behaviour problems. The present study aimed to determine which of the most common clinical features experienced by children and adolescents with CP and intellectual disability are associated with behaviour problems.

METHOD

We investigated 11 possible associated variables including epilepsy, visual and hearing impairments, motor difficulties, communication and speech difficulties, pain, sleep disturbance, executive function (EF) deficits, type of CP, and parent stress. Thirty-eight parents or guardians of children aged 6 to 17 years with CP and intellectual disability (parent informed) completed proxy and self-report standardised questionnaires.

RESULTS

EF deficits and parent stress were significantly associated with behavioural problems.

CONCLUSION

For children and adolescents with CP and intellectual disability, the present study suggests close attention should be placed on specific clinical features including EF deficits and parent stress when considering variables associated with behaviour problems.

Accelerometer-derived sleep metrics in adolescents reveal shared genetic influences with obesity and stress in a Brazilian birth cohort study

We aimed to test the association between sleep-related polygenic scores (PGSs) and accelerometer-based sleep metrics among Brazilian adolescents and to evaluate potential mechanisms underlying the association through the enrichment of obesity, and cortisol pathway-specific polygenic scores (PRSet). Utilizing data from The 2004 Pelotas (Brazil) Birth Cohort, sleep time window and sleep efficiency were measured at the 11-year-old follow-up using ActiGraph accelerometers. Three sleep PGSs were developed based on the most recent genome-wide association study of accelerometer-based sleep measures. PRSet, calculated using variants linked to body mass index (BMI) and plasmatic cortisol concentration, aimed to assess pleiotropic effects. Linear regression models, adjusted for sex and the first 10 principal components of ancestry, were employed to explore the impact of sleep PGS and specific-PRSet on sleep phenotypes. The number of nocturnal sleep episodes-PGS was positively associated with sleep time window (β = 2.306, SE: 0.92, p = .011). Nocturnal sleep episodes were also associated with sleep time window when restricted to BMI-PRSet (β = 2.682, SE: 0.912, competitive p = .003). Both the number of sleep episodes and sleep time window cortisol-PRSets were associated (β = .002, SE: 0.001, p = .013; β = .003, SE: 0.001, p = .003, respectively) and exhibited enrichment in molecular pathways (competitive p = .011; competitive p = .003, respectively) with sleep efficiency. Sleep polygenetic components observed in European adults may partially explain the accelerometer-based sleep time window in Brazilian adolescents. Specific BMI molecular pathways strengthened the association between sleep PGS and sleep time window, while the cortisol concentration pathway had a significant impact on the genetic liability for sleep efficiency. Our results suggest genetic overlap as a potential etiological pathway for sleep-related comorbidities, emphasizing common genetic mechanisms.

Pre-Type 1 Diabetes in Adolescents and Teens: Screening, Nutritional Interventions, Beta-Cell Preservation, and Psychosocial Impacts

Type 1 Diabetes (T1D) is a progressive autoimmune disease often identified in childhood or adolescence, with early stages detectable through pre-diabetic markers such as autoantibodies and subclinical beta-cell dysfunction. The identification of the pre-T1D stage is critical for preventing complications, such as diabetic ketoacidosis, and for enabling timely interventions that may alter disease progression. This review examines the multifaceted approach to managing T1D risk in adolescents and teens, emphasizing early detection, nutritional interventions, beta-cell preservation strategies, and psychosocial support. Screening for T1D-associated autoantibodies offers predictive insight into disease risk, particularly when combined with education and family resources that promote lifestyle adjustments. Although nutritional interventions alone are not capable of preventing T1D, certain lifestyle interventions, such as weight management and specific nutritional choices, have shown the potential to preserve insulin sensitivity, reduce inflammation, and mitigate metabolic strain. Pharmacological strategies, including immune-modulating drugs like teplizumab, alongside emerging regenerative and cell-based therapies, offer the potential to delay disease onset by protecting beta-cell function. The social and psychological impacts of a T1D risk diagnosis are also significant, affecting adolescents' quality of life, family dynamics, and mental health. Supportive interventions, including counseling, cognitive-behavioral therapy (CBT), and group support, are recommended for managing the emotional burden of pre-diabetes. Future directions call for integrating universal or targeted screening programs within schools or primary care, advancing research into nutrition and psychosocial support, and promoting policies that enhance access to preventive resources. Advocacy for the insurance coverage of screening, nutritional counseling, and mental health services is also crucial to support families in managing T1D risk. By addressing these areas, healthcare systems can promote early intervention, improve beta-cell preservation, and support the overall well-being of adolescents at risk of T1D.

Optimal Self-Care for Surgeons: Sleep, Diet, and Exercise

BACKGROUND

Surgeons face intense stress, causing hormonal imbalances that harm their health, leading to burnout, chronic illness, and shorter lifespans due to their demanding careers.

PURPOSE

This study explores self-care strategies focusing on sleep, nutrition, and exercise to help surgeons reduce stress and improve their overall well-being and quality of life.

RESEARCH DESIGN

A thorough literature review of physiological, metabolic, and psychological principles informed the development of a structured self-care approach.

DATA COLLECTION AND/OR ANALYSIS

We reviewed existing research on brain-body interactions, highlighting hormonal balance, nutrition, and exercise to mitigate chronic stress.

RESULTS

The review underscores the importance of quality sleep for hormonal balance and overall health. Proper nutrition, emphasizing balanced macronutrients and meal timing, supports health. Exercise should be 80% low-intensity aerobic activities, with 20% high-intensity. Combining these elements strengthens resistance to chronic stress and enhances health.

CONCLUSIONS

A structured self-care approach, prioritizing sleep, followed by nutrition and exercise, effectively reduces stress among surgeons. This sequence improves well-being and quality of life. Surgeons should focus on consistent sleep, balanced nutrition, and regular low-intensity exercise to enhance resilience and achieve a fulfilling professional life.

Appraising the role of biotics and fermented foods in gut microbiota modulation and sleep regulation

Sleep disturbances are increasingly prevalent, significantly impacting physical and mental health. Recent research reveals a bidirectional relationship between gut microbiota and sleep, mediated through the microbiota-gut-brain axis. This review examines the role of gut microbiota in sleep physiology and explores how biotics, including probiotics, prebiotics, synbiotics, postbiotics, and fermented foods, can enhance sleep quality. Drawing from animal and human studies, we discuss neurobiological mechanisms by which biotics may influence sleep, including modulation of neurotransmitters, immune responses, and hormonal regulation. Key microbial metabolites, such as short-chain fatty acids, are highlighted for their role in supporting sleep-related neurochemical processes. Additionally, this review presents dietary strategies and food processing technologies, like fermentation, as innovative approaches for sleep enhancement. Although promising, the available research has limitations, including small sample sizes, variability in biotic strains and dosages, and reliance on subjective sleep assessments. This review underscores the need for standardized protocols, objective assessments such as polysomnography, and personalized biotic interventions. Emerging findings highlight the therapeutic potential of gut microbiota modulation for sleep improvement, though further large-scale human trials are essential to refine strain selection, dosage, and formulation. This interdisciplinary exploration seeks to advance food-based interventions and holistic strategies for managing sleep disorders and improving quality of life.

Role of sleep and neurochemical biomarkers in synaptic plasticity related to neurological and psychiatric disorders: A scoping review

Sleep is vital for maintaining physical and mental well-being, impacting cognitive functions like memory and learning through neuroplasticity. Sleep disturbances prevalent in neurological and psychiatric disorders exacerbate cognitive decline, imposing societal burdens. Exploring the relationship between sleep and neuroplasticity elucidates the mechanisms influencing cognition, particularly amidst the prevalent sleep disturbances in these clinical populations. While existing reviews provide valuable insights, gaps remain in understanding the neurophysiological mechanisms underlying sleep and cognitive function. This scoping review aims to investigate the characteristic patterns of sleep parameters and neurochemical biomarkers in reflecting neuroplasticity changes related to neurological and psychiatric disorders and to explore how these markers interact and influence cognition at the molecular level. Studies involving adults and older adults were included, excluding animal models and the paediatric population. Selected studies explored the relationship between sleep parameter or neurochemical biomarker changes and cognitive impairment, reflecting underlying neuroplasticity changes. Peer-reviewed articles, clinical trials, theses, and dissertations in English were included while excluding secondary research and non-peer-reviewed sources. A three-step search strategy was executed following the updated Joanna Briggs Institute methodology for scoping reviews. Published studies were retrieved from nine databases, grey literature, expert recommendations, and hand-searching of the included studies' bibliography. A basic qualitative content synthesis of 34 studies was conducted per JBI's scoping review guidance. Slow-wave and Rapid-Eye Movement sleep, sleep spindles, sleep cycle disruption, K-Complex(KC) density, Hippocampal sEEG, BDNF, IL-6, iNOS mRNA expression, plasma serotonin, CSF Aβ-42, t-tau and p-tau proteins, and serum cortisol revealed associations with cognitive dysfunction. Examining the relationship between sleep parameters, neurochemical biomarkers, and cognitive function reveals neuronal mechanisms that guide potential therapeutic interventions and enhance quality patient care.

Unraveling the relationship between sleep behaviors and physical activity in the United States: insights from 2015 to 2020 NHANES data

BACKGROUND

Physical activity is an important component of metabolic health. However, little is known about the impact of specific types/intensities of physical activity on sleep health, especially among ethnically diverse populations. We examined the association of various sleep behaviors with moderate to vigorous work/recreational activity.

METHODS

Self-reported data from the National Health and Nutrition Examination Survey 2015-2020 were cross-sectionally analyzed for a sample of 11,039 participants in the United States (U.S.). Weighted univariate logistic regressions determined unadjusted associations, while weighted multivariable regression models adjusting for age, sex, ethnicity, BMI categories, and socio-economic status assessed the multivariable associations with moderate and vigorous work/recreational activity. Stratified analyses were performed to determine across-group differences by ethnicity and BMI categories.

RESULTS

Of 11,039 adults (mean age 41 years), 50.7% were female, 59.8% were Non-Hispanic White, 17.8% Hispanic/Latino, 12% Non-Hispanic Black, 6.3% Non-Hispanic Asian, and 4.1% other/multiple ethnicities. Moderate work activity increased the odds of short sleep duration [aOR = 1.42; 95% CI: 1.22, 1.65], snoring [aOR = 1.45; 95% CI: 1.21, 1.73], breath cessation [aOR = 1.37; 95% CI: 1.18, 1.59], and daytime sleepiness [aOR = 1.63; 95% CI: 1.39, 1.91]. Vigorous recreational activity reduced the odds of short sleep duration [aOR = 0.81; 95% CI: 0.71, 0.94] and trouble sleeping [aOR = 0.83; 95% CI: 0.73, 0.96]. Stratified analyses indicated significant ethnicity-based differences in the odds of sleep behaviors across physical activity groups and increased odds of poor sleep behaviors among participants who were underweight, overweight or had obesity.

CONCLUSION

Work-related activity was significantly associated with suboptimal sleep behaviors while recreational activity was associated with favorable sleep behaviors. These associations were more pronounced among certain ethnic groups. Further longitudinal investigation is needed to examine the mechanism driving the relationship between sleep behaviors and physical activity.

Cognitive benefits of sleep: a narrative review to explore the relevance of glucose regulation

Sleep is essential for maintaining optimal health. Both sleep duration and quality have been linked to various physiological functions and physical and mental health outcomes. Nutrition has been shown to impact sleep parameters, from the nutrient composition of foods, such as tryptophan levels, to the physiological response to foods, such as the glucose response. However, the relationship between glycemic control and sleep, and its impact on next-day benefits, particularly on cognitive performance, remains complex and is not fully understood. This narrative review aims to explore the relationship between glycemia and sleep, and how it may affect cognitive performance the following day. The review includes data from observational and interventional studies, discussing mechanisms of action that may explain the modulating effect of glycemia on sleep and cognition. The evidence suggests that lower postprandial glucose and low variation of nocturnal glucose are associated with better sleep quality and shorter sleep onset latency. Good sleep quality, in turn, is positively associated with cognitive processes such as sustained attention and memory consolidation measured the next day after sleep. Future research opportunities lie in investigating the effects of modulating the glycemic and insulinemic responses through evening meals on sleep quality and next-day cognitive performance. Well-designed clinical trials involving healthy individuals are necessary to establish the effects of these interventions. Controlling glycemic and insulinemic profiles through the evening meal may have significant implications for improving sleep quality and cognitive performance, with potential impact on individual mental health, productivity, and overall well-being.

Individual-level noise exposure and its association with sleep quality and duration: A cross-sectional study using real-time data

As urban populations grow, the problem of noise pollution becomes more significant. The limited number of epidemiological studies linking individual-level dynamic noise exposure to sleep highlights a gap in our understanding of how individual-level noise exposure impact sleep quality and duration. A cross-sectional survey was conducted in Hong Kong, and portable noise sensors were used to record participants' real-time noise exposure. The Pittsburgh Sleep Quality Index was used to assess their sleep quality. Logistic regression was used to examine the relationship of individual-level noise exposure with sleep quality and sleep duration. Among a total of 763 subjects included in the analysis, and a-weighted decibels [dB(A)] 24-h average exposure (L24) was 63.21 (58.85-67.85) dB(A) for workday and 63.52 (59.03-67.86) dB(A) for non-workday. A significant decrease in individual noise level was observed closer to bedtime (P < 0.05). Compared with the lowest noise exposure, exposure to the highest noise level was positively associated with the presence of poor sleep quality for L24, Ld and Ln, with an odds ratio (OR) and 95 % confidential interval (CI) of 1.53 (1.04-2.24), 1.65 (1.12-2.43), and 1.51 (1.03-2.21), respectively. Exposure to elevated noise level was associated with increased risk of shorter nocturnal sleep duration (< 7 h), the OR and 95 % CI was 1.87 (1.29-2.73) for L24, 1.58 (1.09-2.30) for Ld, 1.50 (1.03-2.18) for Le, and 1.60 (1.10-2.32) for Ln in the highest noise exposure group. Similar findings were observed both on workdays and non-workdays, respectively. Furthermore, the results showed that each 10 dB(A) increment in L24 and Ln was associated with a probable 29 % and 27 % increase in poor sleep quality and a 24 % and 24 % reduction in sleep duration. This study demonstrates that environmental noise exposure was associated with poor sleep quality and shorter sleep duration, posing a significant public health issue in Hong Kong.

Long Sleep Duration, Cognitive Performance, and the Moderating Role of Depression: A Cross-Sectional Analysis in the Framingham Heart Study

INTRODUCTION

We investigated whether depression modified the associations between sleep duration and cognitive performance.

METHODS

Multivariable linear regression models examined the associations between sleep duration and cognition in 1,853 dementia- and stroke-free participants from the Framingham Heart Study. Participants were categorized in four groups: no depressive symptoms, no antidepressants; depressive symptoms without antidepressants use; antidepressant use without depressive symptoms; both depressive symptoms and antidepressant use.

RESULTS

Long sleep was associated with reduced overall cognitive function. Strong associations between sleep duration and cognitive performance were found in individuals with depressive symptoms, regardless of antidepressant use. Weaker but significant effects were observed in those without depressive symptoms. No significant associations were observed in participants using antidepressants without depressive symptoms.

DISCUSSION

These findings provide new evidence that sleep duration may be a modifiable risk factor for cognitive decline, particularly in individuals with depressive symptoms. Future research should elucidate underlying mechanisms and temporal relationships.

Mental health conditions in patients with systemic lupus erythematosus: a systematic review and meta-analysis

OBJECTIVES

The reported prevalence of mental health conditions (MHCs) in people with systemic lupus erythematosus (SLE) ranges widely. Whether MHCs are associated with increased risk of SLE or the outcomes of the disease is unclear. This study aimed to conduct an umbrella and updated meta-analysis of MHCs in people with SLE and to identify whether MHCs are associated with the risk of SLE or patient outcomes.

METHODS

We comprehensively searched PubMed, Web of Science and Embase databases to identify relevant studies published before June 2023. Random-effect models were used to calculate the pooled prevalence and risk ratios (RR) for each MHC.

RESULTS

In total, 203 studies with 1 485 094 individuals were included. The most MHCs observed in patients with SLE were sleep disturbance (59.7% [95% CI, 52.4-66.8%]) among adults and cognitive dysfunction (63.4% [95% CI, 46.9-77.9%]) among children. We found that depressive disorders (RR = 2.30, 95% CI = 1.94-2.75) and posttraumatic stress disorder (RR = 1.93, 95% CI = 1.61-2.31) in the general population were significantly associated with an increased likelihood of developing SLE. Furthermore, concurrent MHCs were linked to unfavourable outcomes in patients with SLE, such as decreased quality of life, increased risk of unemployment and other somatic comorbidities.

CONCLUSION

Our study demonstrated a high prevalence of MHCs among patients with SLE. Individuals with pre-existing mental disorders exhibited an elevated susceptibility to developing SLE and patients presenting with MHCs were at increased risk of experiencing suboptimal health and functional outcomes. Therefore, evaluating and preventing MHCs should be considered as an integral component of the comprehensive treatment strategy for SLE.

The moderating role of conscientiousness in the temporal association of stress on sleep

Personality traits have been associated with sleep problems and stress experience. However, their impact on objective sleep and the temporal relationship of stress on sleep has remained elusive. This study examined whether daytime stress predicts sleep the following night, and the moderating role of neuroticism and conscientiousness in this relationship. To introduce stress variability in natural daily stressors, we measured college students (N = 92) during exams (e.g. high academic stress) and at the start of new course period (e.g. low academic stress). Both objective (actigraphy) and subjective sleep, and daily self-reported stress, were measured for 14 days and personality traits once. Reported daily stress was significantly higher in the exam period compared with baseline, suggesting that our natural manipulation did indeed result in variation in stress levels. Intra-individual daily variations in stress were not associated with the following night's sleep timing, duration or fragmentation, implying that more stress during the day did not affect sleep the following night. Higher levels of neuroticism were associated with poorer daily subjective sleep quality and higher stress levels over the complete period. Neuroticism did not moderate the temporal association of stress on sleep. Conscientiousness moderated the association between intra-individual stress and sleep fragmentation, and intra-individual stress and wake-up time. This implied that highly conscientious participants experienced less sleep fragmentation and woke-up earlier after more stressful days. These results suggest an interconnected relationship among stress, sleep and personality. Focusing on one aspect, like handling stress or enhancing sleep quality, might yield positive effects on the rest.

Association between sleep quality and duration during pregnancy and risk of gestational diabetes: A systematic review and meta-analysis

OBJECTIVE

Gestational diabetes mellitus (GDM) is associated with several adverse maternal and neonatal outcomes. Previous studies reported a link between altered sleep and risk of GDM. This systematic review aims to collate evidence on the association between impaired sleep quality and duration, and the risk of GDM.

METHODS

PubMed, Embase, Web of Science, and Scopus databases were searched up to January 20, 2024. Studies reporting the association between impaired sleep quality and duration and risk of GDM were included. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Random-effects meta-analysis was performed, and the results were reported as hazard ratio (HR) with 95% confidence interval (CI).

RESULTS

19 studies were included. Meta-analysis revealed a significant increase in the risk of GDM in pregnant women with poor sleep quality (i.e. <5 PSQI) (HR: 1.50, 95% CI: 1.26 - 1.78, p < .001). Sleep duration of <7 h (HR: 1.56, 95% CI.: 1.20 - 2.01, p < .001), and >8 h (HR: 2.32, 95% CI.: 1.19 - 4.50, p = .01) were also associated with a significantly higher incidence of GDM.

CONCLUSION

Sleep quality and duration emerge as critical risk factors of GDM. Healthcare practitioners should consider targeted interventions to improve sleep hygiene as a potential measure for GDM prevention.

A holistic approach to sustain and support lifelong practices of wellness among healthcare professionals: generating preliminary solid steps towards a culture of wellness

BACKGROUND

The COVID-19 pandemic has served as a catalyst for recognizing the challenging environments in which healthcare workers operate, underscoring the urgent need to enhance their wellness to better support themselves and others. The implementation of a culture of wellness within the context of healthcare education, with a particular emphasis on individual-level strategies, allows for the realization of its intrinsic value and significance as a foundation for broader organizational strategies. This approach facilitates the establishment of a sustainable culture of wellness that benefits both current and subsequent generations of healthcare professionals.

METHODS

We implemented our wellness program using a pragmatic pre-post study design for different settings. Our wellness intervention program was tested in three ways by creating combinations of different intensities (high, moderate, or low), delivery methods (face-to-face vs. virtual), different motivations (incentive, mandatory, or volunteer participation), and different timings (during medical programs or before entering into healthcare programs) among medical and nursing students. The effects of the wellness program were measured on quality of life, emotional intelligence, and efficacy scores among healthcare students. Statistical methods included repeated measures analysis of variance and paired t-tests.

RESULTS

A total of 224 students (13 in high, 145 in moderate, and 66 in low-dose interventions) participated in our study program. Most scores were significantly improved except for a few factors in the high-dose face-to-face Well-Teach intervention cohort. Among quality of life components, the average psychological scores were markedly increased after high (13.2 vs. 14.7, p = .018), moderate (13.9 vs. 14.8, p < .001), and low (12.8 vs. 13.4, p < .001) intensity intervention cohorts. The moderate and low intensity of wellness intervention cohorts had the highest impact on the total emotional intelligence scores (mean difference = 3.021, 95%CI:0.553-5.488, p = .008) and (mean difference = 5.197, 95%CI:3.057-7.337, p = < 0.001), respectively. The low-dose healthcare intervention program yielded improvements in all components of all scores to a greater extent than moderate-dose or high-dose with face-to-face intervention programs.

CONCLUSIONS

This study demonstrates that our multifaceted Well-Teach model can be used to improve the quality of life, emotional intelligence, and self-efficacy of healthcare students. Low- or moderate-intensity intervention programs integrated into the curriculum may be more practical in health sciences education to sustain and promote lifelong wellness practices as solid steps toward attaining a "culture of wellness". Our model should be considered to be beneficial, sustainable, cost-effective, comprehensive, and effective for current and future generations of healthcare providers.

Sleep and adjustment in foster environments for toddlers and preschoolers (SAFE-T): Initial efficacy of a trauma-informed sleep intervention for young children in foster care

BACKGROUND

This study presents findings from a randomized controlled trial of Sleep and Adjustment in Foster Environments for Toddlers and Preschoolers (SAFE-T), a telehealth-delivered, trauma-informed sleep intervention for children in or adopted from foster care.

METHODS

N = 45 caregivers of children aged 2 to 5 years (M = 4.01; SD = 1.04) were randomized to SAFE-T or Sleep Education Support (SES), an active control condition. Assessments, including one-week parent-report sleep diaries, were completed at pre- intervention, post- intervention, and 3 months follow-up.

RESULTS

Results indicated improvements in multiple sleep outcomes at post-intervention and three months later, including nighttime sleep duration, nighttime awakenings, and overall sleep problems in the SAFE-T group only. Sleep-based improvements were largely maintained or strengthened over time. Several secondary outcomes, including child emotional and behavior problems and parenting stress, also improved considerably in the SAFE-T but not the SES group.

CONCLUSIONS

Findings suggest SAFE-T to be a promising intervention for improving sleep health among children currently or previously placed in foster care.

Association of cardiometabolic index with sleep quality in adults: a population‑based study

The Cardiometabolic Index (CMI) represents an innovative metric that encompasses abdominal obesity and lipid levels, offering a comprehensive assessment of cardiometabolic health. It is derived through the multiplication of the waist-to-height ratio by the triglyceride-to-high-density lipoprotein cholesterol ratio. Although obesity and blood lipid levels are known factors affecting sleep quality, the direct correlation between CMI and sleep quality has yet to be elucidated. This study uses NHANES data to explore the potential correlation between CMI and sleep quality. Our research employed a cross-sectional design, utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011 to 2014. CMI was used as the exposure variable, with sleep quality assessed through three self-reported measures: trouble sleeping, sleep disorders, and sleep duration. We employed multivariate logistic regression models and linear regression model as well as subgroup analyses to explore the independent relationship between CMI and sleep quality. Additionally, interaction tests were conducted to examine differences across various subgroups. The study included 4298 participants, comprising 2134 males and 2164 females. There was a positive correlation between CMI and trouble sleeping (OR = 1.63, 95% CI 1.28-2.08) and sleep disorders (OR = 1.96, 95% CI 1.43-2.67), while there was a negative correlation between CMI and sleep duration (β = - 0.17, 95% CI - 0.31 to - 0.03), indicating that a higher CMI was associated with shorter sleep duration. Subgroup analyses and interaction tests revealed a consistently positive association between CMI and sleep difficulty across various populations, including gender, age, hypertension, diabetes, and cardiovascular disease history. However, the relationship between CMI and sleep disorders was more prominent among participants aged 50 and above. In American adults, a higher CMI is linked to an increased prevalence of sleep disturbances. In clinical practice, CMI can be considered as a supplementary factor in the assessment and management of sleep problems. Our study also provided new insights for improving sleep quality.

Association between sleep quality and uncertainty stress among healthcare professionals in hospitals in China: a nationwide cross-sectional survey

OBJECTIVES

Sleep quality is a critical concern among healthcare professionals, yet the role of uncertainty stress has been inadequately explored. This study aims to explore the associations between sleep quality and uncertainty stress among healthcare professionals working in Chinese hospitals.

DESIGN

Cross-sectional survey.

SETTING

Data were collected via a cross-sectional survey administered to healthcare professionals across three Chinese provinces from 29 September 2022 to 18 January 2023.

PARTICIPANTS

A total of 1902 participants contributed valid responses for analysis.

PRIMARY OUTCOME MEASURE

Sleep quality.

RESULTS

Out of 1902 respondents, 26.4% reported uncertainty stress and 50.5% experienced insomnia. Binary logistic regression analysis revealed that higher uncertainty stress significantly predicted poor sleep quality (OR=3.89; 95% CI 3.06, 4.95; p<0.001) while controlling for sociodemographic characteristics. Furthermore, linear regression analysis confirmed the similar relationship between uncertainty stress and sleep quality (β=3.10; 95% CI 2.67, 3.52; p<0.001).

CONCLUSIONS

The study highlights a significant association between uncertainty stress and impaired sleep quality among Chinese healthcare professionals. These findings suggest the necessity for targeted strategies to mitigate uncertainty stress, which may potentially promote better sleep and overall well-being in healthcare settings.

The effect of live-performed music therapy with physical contact in preterm infants on parental perceived stress and salivary cortisol levels

Introduction

Parents of preterm infants face a stressful life event which might have long term impact on the parent-child relation as well as on the infant's cognitive and socio-emotional development. Both music therapy (MT) and physical contact (PC) are stress-reducing interventions for parents and preterm infants on the neonatal intensive care unit (NICU). Meanwhile, especially close PC is considered as standard care (SC) in most NICUs. However, the effect of live performed MT with PC on parental perceived stress and cortisol levels has barely been investigated. We hypothesized that MT with PC leads to reduced stress levels and lower salivary cortisol concentrations compared to SC in parents of preterm infants during the first 4 weeks after birth.

Methods

Randomized-controlled trial enrolling the parents of 99 preterm infants (MT n = 50, SC n = 49 infants). The infants received either MT with PC or SC only. Perceived stress was measured with the perceived stress questionnaire 20 (PSQ-20) after birth and 4 weeks later. Salivary cortisol levels were obtained and measured weekly after birth for 4 weeks.

Results

Forty-two mothers and eight fathers of the intervention group (MT with PC) as well as n = 43 mothers and n = 6 fathers of the control group (SC) were enrolled. For the intervention group, salivary cortisol was reduced 4 weeks after birth [mothers 5.5 nmol/l (confidence interval (CI) 3.6-7.5); fathers 8.3 (CI 7.2-9.4)] compared to the control group [mothers 10.3 nmol/l (CI 5.4-15.3); fathers 14.8 (CI 8.9-20.7)]. Overall perceived stress scores decreased in the intervention group (mothers -17.6; fathers -12.6) and increased in the control group (mothers +6.1; fathers +21.4) over 4 weeks.

Discussion

Live-performed MT with PC in preterm infants might be an effective, non-invasive intervention to reduce parental stress and cortisol levels. Future studies should investigate the long-term effects of this intervention on the parent-infant relation as well as on the infants' cognitive and socio-emotional development.

Clinical trial registration

https://drks.de/search/en/trial/DRKS00025755 identifier [DRKS00025755].

Associations of Everyday Discrimination With Insomnia and Short Sleep Duration Among Older Women

BACKGROUND

Discrimination may contribute to sleep health disparities among women, yet limited research has investigated the association between discrimination and insomnia with short sleep.

METHODS AND RESULTS

Among a racially and ethnically diverse sample of women (N=25 920; mean age, 72.2±6.1 years), we investigated the relationship of discrimination with insomnia symptoms and sleep duration. Poisson models with robust variance were fit to examine discrimination with insomnia, sleep duration (short <7 hours or long >9 hours versus recommended 7-9 hours), and insomnia short sleep phenotype adjusted for covariates. Insomnia symptoms, short and long sleep, and high discrimination were reported by 53%, 11%, 15%, and 40% of women, respectively. Women reporting high versus low discrimination were more likely to report insomnia, short sleep, and insomnia short sleep phenotype (insomnia: adjusted prevalence ratio, 1.15 [95% CI, 1.13-1.18]; short sleep: adjusted prevalence ratio, 1.24 [95% CI, 1.16-1.34]; insomnia short sleep phenotype: adjusted prevalence ratio, 1.45 [95% CI, 1.31-1.61]). In exploratory analyses, the association between discrimination and insomnia symptoms was present among Asian and White women, whereas the association between discrimination and sleep duration was among Hispanic (long sleep) and White (short sleep) women. Further, the association between discrimination and insomnia symptoms was more pronounced among those with less than a bachelor's degree, whereas women with a bachelor's degree or higher were less vulnerable to the association between discrimination and long sleep.

CONCLUSIONS

Discrimination was associated with insomnia and short sleep, a more severe phenotype for adverse cardiovascular health. Discrimination may be a target for reducing sleep problems among older women.

Daily associations between salivary cortisol and electroencephalographic-assessed sleep: a 15-day intensive longitudinal study

STUDY OBJECTIVES

Current evidence suggests that cortisol levels are bi-directionally associated with sleep. However, the daily, naturalistic cortisol-sleep associations remain unclear, as current evidence is mostly cross-sectional. This study tested whether pre-sleep cortisol predicts sleep duration and quality, and whether these sleep parameters predict the following day's diurnal cortisol slope using a 15-day intensive longitudinal design with electroencephalographic measures and saliva sampling.

METHODS

Ninety-five young adults (Mage = 20.48 ± 1.59 years) provided saliva samples at awakening and pre-sleep over 14 consecutive days, providing 2345 samples (85% viable). The Z-Machine Insight + was used to record over 900 nights of total sleep time (TST) and sleep efficiency (SE). Multilevel models tested these data at the between- and within-person levels.

RESULTS

Higher pre-sleep cortisol predicted shorter TST (p < .001) and lower SE (p < .001) at the within-person level. Individuals with shorter average TST (p = .007) or lower average SE (p < .001) had flatter diurnal cortisol slopes, compared to those with longer average TST or higher average SE. Follow-up analyses showed that individuals with shorter average TST (vs. longer average TST) had higher pre-sleep cortisol levels (p = .01).

CONCLUSIONS

Our findings provide evidence that pre-sleep cortisol is associated with sleep duration and quality at the within-individual level. Furthermore, individuals with short or poor sleep had flatter diurnal cortisol slopes. Although the effect sizes are small, these findings show the naturalistic associations between sleep and cortisol in a relatively healthy sample. These findings suggest that sleep maintains the regulation of the stress-response system, which is protective against mental and physical disorders.

Physiological and Family-Level Correlates of Autistic Adolescents' Sleep Quality

PURPOSE

Autistic adolescents commonly experience sleep-related difficulties and prior studies have sought to separately examine physiological and family-level predictors of their sleep quality. The current study aimed to conceptually replicate and extend to an adolescent sample a prior study that found respiratory sinus arrhythmia was associated with sleep quality in autistic children. In addition, the current study also examined whether the quality of the family environment was associated with sleep quality in autistic adolescents.

METHODS

The sample consisted of 107 autistic adolescents who completed a baseline measure of respiratory sinus arrhythmia and then watched a video of their parents engaged in a discussion about a topic of disagreement while their respiratory sinus arrhythmia reactivity was measured. Adolescents also completed questionnaires measuring their sleep quality and family environment.

RESULTS

In regression models, adolescents' physiological functioning was not a significant predictor of their sleep quality; however, adolescents living in poorer quality family environments reported worse sleep quality after controlling for their physiological functioning. The interaction between physiological functioning and the family environment predicting sleep quality was non-significant.

CONCLUSION

Although the current study did not conceptually replicate prior work, the findings highlight the importance of the family environment for adolescents' sleep. Implications and future directions are discussed.

Low blood glucose and fatigue accumulation at peak hours of occupational trauma in secondary industry workers

Objectives. The incidence of occupational traumatic injuries caused by human error has been reported to occur at 11:00 and 8-9 h after commencing work. Impaired attention is closely related to the incidence of these accidents. Therefore, this study aimed to clarify the changes in blood glucose, fatigue and stress response hormone levels over time among workers in a secondary industry. Methods. The blood glucose and subjective fatigue levels of 26 male secondary-industry workers were measured on workdays. In addition, the cortisol and dehydroepiandrosterone levels in saliva were measured on one workday and one holiday. Results. Blood glucose levels at 11:00 and 17:30 on the workday were significantly lower than those at 09:30. Moreover, hypoglycemia was observed in some participants. A significant increase in subjective fatigue levels was observed during the workday. However, no significant differences in salivary cortisol levels were observed between the workday and the holiday at any time point. Conclusions. Blood glucose levels decreased and subjective fatigue levels increased at the time points that occupational accidents were reported to occur most frequently during work. These factors may contribute to human errors due to impaired attentional function.

Towards the standardisation of adult person-reported outcome domains in diabetes research: A Consensus Statement development panel

Diabetes is unique among chronic diseases because clinical outcomes are intimately tied to how the person living with diabetes reacts to and implements treatment recommendations. It is further characterised by widespread social stigma, judgement and paternalism. This physical, social and psychological burden collectively influences self-management behaviours. It is widely recognised that the individual's perspective about the impact of trying to manage the disease and the burden that self-management confers must be addressed to achieve optimal health outcomes. Standardised, rigorous assessment of mental and behavioural health status, in interaction with physical health outcomes is crucial to aid understanding of person-reported outcomes (PROs). Whilst tempting to conceptualise PROs as an issue of perceived quality of life (QoL), in fact health-related QoL is multi-dimensional and covers indicators of physical or functional health status, psychological and social well-being. This complexity is illuminated by the large number of person reported outcome measures (PROMs) that have been developed across multiple psychosocial domains. Often measures are used inappropriately or because they have been used in the scientific literature rather than based on methodological or outcome assessment rigour. Given the broad nature of psychosocial functioning/mental health, it is important to broadly define PROs that are evaluated in the context of therapeutic interventions, real-life and observational studies. This report summarises the central themes and lessons derived in the assessment and use of PROMs amongst adults with diabetes. Effective assessment of PROMs routinely in clinical research is crucial to understanding the true impact of any intervention. Selecting appropriate measures, relevant to the specific factors of PROs important in the research study will provide valuable data alongside physical health data.

How acute stress affects sleep: large-scale observations from continuous smart ring measurements in free-living conditions

Stress management may be crucial to improving sleep quality due to the intertwined relationship between stress and sleep. Commercial wearables offer both acute stress tracking and sleep tracking, yet the effects of acute physiological stress on sleep have not been widely studied in uncontrolled, free-living conditions. This study employs stress and sleep data from over 45,000 individuals collected with the Oura Ring during daily life. A group of stressed individuals were compared with a group of individuals with high daytime recovery. Sleep related data were analyzed with respect to the number of accumulated stressful or restorative days, respective to the group in question, within a one-week period. The results highlight the destructive effect that the accumulation of stressful days may have on sleep biometrics, indicating significant decrease in sleep quality. Vice versa, the results also imply the opposite effect from restorative days, emphasizing the importance of balancing acute stress with rest and the potential benefits from data driven stress management.

The Role of Sleep in Cardiovascular Disease

PURPOSE OF REVIEW

Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD.

RECENT FINDINGS

Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.

Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015

BACKGROUND

Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India.

METHODS

Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses.

RESULTS

Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085).

CONCLUSION

That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

Sleep fragmentation after traumatic brain injury impairs behavior and conveys long-lasting impacts on neuroinflammation

Traumatic brain injury (TBI) causes a prolonged inflammatory response in the central nervous system (CNS) driven by microglia. Microglial reactivity is exacerbated by stress, which often provokes sleep disturbances. We have previously shown that sleep fragmentation (SF) stress after experimental TBI increases microglial reactivity and impairs hippocampal function 30 days post-injury (DPI). The neuroimmune response is highly dynamic the first few weeks after TBI, which is also when injury induced sleep-wake deficits are detected. Therefore, we hypothesized that even a few weeks of TBI SF stress would synergize with injury induced sleep-wake deficits to promote neuroinflammation and impair outcome. Here, we investigated the effects of environmental SF in a lateral fluid percussion model of mouse TBI. Half of the mice were undisturbed, and half were exposed to 5 h of SF around the onset of the light cycle, daily, for 14 days. All mice were then undisturbed 15-30 DPI, providing a period for SF stress recovery (SF-R). Mice exposed to SF stress slept more than those in control housing 7-14 DPI and engaged in more total daily sleep bouts during the dark period. However, SF stress did not exacerbate post-TBI sleep deficits. Testing in the Morris water maze revealed sex dependent differences in spatial reference memory 9-14 DPI with males performing worse than females. Post-TBI SF stress suppressed neurogenesis-related gene expression and increased inflammatory signaling in the cortex at 14 DPI. No differences in sleep behavior were detected between groups during the SF stress recovery period 15-30 DPI. Microscopy revealed cortical and hippocampal IBA1 and CD68 percent-area increased in TBI SF-R mice 30 DPI. Additionally, neuroinflammatory gene expression was increased, and synaptogenesis-related gene expression was suppressed in TBI-SF mice 30 DPI. Finally, IPA canonical pathway analysis showed post-TBI SF impaired and delayed activation of synapse-related pathways between 14 and 30 DPI. These data show that transient SF stress after TBI impairs recovery and conveys long-lasting impacts on neuroimmune function independent of continuous sleep deficits. Together, these finding support that even limited exposure to post-TBI SF stress can have lasting impacts on cognitive recovery and regulation of the immune response to trauma.