Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials

Sharper minds: Feasibility and effectiveness of a mental health promotion package for university students targeting multiple health and self-care behaviours

OBJECTIVE

This study assessed the feasibility and effectiveness of the Sharper Minds package, a mental health intervention designed for university students, co-developed with student input. The program included a weekly self-monitoring e-tool and/or a short course targeting six self-care areas: physical activity, diet, sleep, music to aid study, mood regulation, and social connection.

METHOD

A non-randomised controlled trial involved 433 undergraduate students in three conditions: control, one-intervention (either e-tool or course), and two-intervention (both e-tool and course). Data were collected at baseline and after six weeks. Feasibility was measured by reach, retention, and acceptability, while primary outcomes focused on mental health indicators such as depression and anxiety, and secondary outcomes were somatic symptoms, wellbeing and academic motivation.

RESULTS

Results indicated good retention (72 %) and positive feedback on acceptability. Students receiving both interventions (two-intervention condition) showed a 17.6 % reduction in the proportion screening positive for mental health issues, a change not seen in other conditions. A MANCOVA analysis identified a significant interaction between condition and time across combined outcomes (depression, anxiety, somatic symptoms, wellbeing, and motivation), with a small effect size.

CONCLUSIONS

This is the first mental health promotion package for Australian university students addressing multiple health and self-care behaviours. Findings indicate students found the package components acceptable and experienced positive effects on mental health.

ANZ CLINICAL TRIAL REGISTRATION

Retrospectively registered 1/09/2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386141&isReview=true.

The association between financial strain and mental health: The mediating and moderating roles of sleep problems in the UK household longitudinal study (UKHLS)

BACKGROUND

Financial strain is a well-documented stressor that negatively affects mental health, yet the mechanisms underlying this relationship remain insufficiently understood. This study examines the roles of sleep problems as both mediators and moderators, utilizing the frameworks of stress proliferation and amplification as outlined in the stress process model.

METHODS

Data from four waves of the UK Household Longitudinal Study (UKHLS)-Wave 4 (2012-2013), Wave 7 (2015-2016), Wave 10 (2018-2019), and Wave 13 (2021-2022)-were used, covering 34,156 individuals and 103,589 person-years. Fixed effects regression models were employed to analyze changes within individuals over time.

RESULTS

Financial strain was associated with deteriorating mental health. Sleep problems-including poor sleep quality, frequent use of sleep medication, sleep disturbance, daytime dysfunction, and longer sleep latency-were also associated with poorer mental health. Importantly, these sleep problems not only mediated the impact of financial strain on mental health but also exacerbated its negative effects.

LIMITATIONS

The study could not eliminate the possibility of reverse causality, where deteriorating mental health may influence financial strain or worsen sleep problems.

CONCLUSIONS

These findings highlight the importance of addressing financial strain as a key driver of poor mental health. Interventions aimed at improving sleep health may simultaneously mitigate the harmful effects of financial strain, offering dual benefits for mental health. By reducing financial strain and promoting healthier sleep, public health strategies can bolster resilience in populations vulnerable to both financial and psychological stress.

The role of objective sleep duration, continuity, and architecture for subjective sleep perception: Findings from an intensive longitudinal study using heart-rate variability to infer objective sleep indicators

This study investigates the relationship between objective sleep indicators derived from heart rate variability (HRV) and sleep perception in young adults using an intensive longitudinal design over 14 consecutive nights. The sample included 178 participants aged 18-29 years from two separate studies, who provided data via daily sleep diaries. Using a multi-resolution convolutional neural network model, heart rate variability measured via ambulatory electrocardiography was used for sleep stage classification. Within-subject analyses revealed that longer total sleep time, higher sleep efficiency, more slow-wave sleep, and more rapid-eye-movement sleep were associated with better sleep perception, while longer wake after sleep onset was linked to poorer sleep perception. Notably, no significant associations were found on the between-subject level. The objective sleep indicators explained nearly five times as much variance in sleep perception at the within-subject level than at the between-subject level. Additionally, gender, as well as depressive symptoms and insomnia symptoms measured at baseline did not moderate the within-subject associations between objective sleep indicators and sleep perception. These findings underscore the importance of sufficient sleep duration, quality of sleep architecture, and sleep continuity for individuals' perceptions of their sleep on a nightly basis. The study's use of HRV-derived sleep staging over multiple nights represents a methodological strength, providing detailed and less intrusive assessment compared to traditional polysomnography. Furthermore, these results are particularly important for clinical applications, as they can be basis for individualized interventions to improve sleep perception.

Self-compassion and mental health: Examining the mediational role of health behaviour engagement in emerging adults

OBJECTIVES

This observational longitudinal study examines whether engagement in health behaviours (general health behaviours, sleep hygiene, comfort food snacking) mediate the link between self-compassion and mental health among emerging adults.

DESIGN/METHOD

Participants were 332 emerging adults recruited from a large U.S. University (Mage = 19.0; SD = 1.8) who completed two electronic surveys 7-10 weeks apart (T1 and T2). The Hayes PROCESS macro model #4 was used to test whether engagement in health behaviours at T2 health mediated the association between T1 self-compassion and T2 mental health (5000 bootstrap samples).

RESULTS

T1 self-compassion was significantly associated with all T2 health behaviours except for comfort food snacking. T2 sleep hygiene behaviours mediated the relationship between T1 self-compassion and both T2 depression and T2 anxiety (bootstrapped 95% CIs [-.085, -.029] and [-.064, -.016], respectively), although the total effect of self-compassion on anxiety was no longer significant when accounting for T1 sleep hygiene and T1 anxiety. Overall T2 health behaviour engagement mediated the relationship between T1 self-compassion and T2 depression only (bootstrapped 95% CI [-.044, -.006]), although the mediation was non-significant after accounting for T1 overall health behaviour engagement and T1 depression.

CONCLUSIONS

Findings suggest that individuals with higher self-compassion engage more in overall health behaviours and sleep hygiene practices, and that sleep hygiene and general engagement in health behaviours help to explain the link between self-compassion and mental health symptoms over time. These findings highlight the multiple positive downstream effects of fostering self-compassion and have important implications for mental health care providers utilizing self-compassion to support health behaviour engagement in order to promote mental health.

Dorsal root ganglion-pulsed neuromodulation radiofrequency treatment has significant clinical efficacy in chronic spinal-origin pain, bringing noticeable improvement in symptoms and sleep quality for patients

BACKGROUND

Chronic spinal-origin pain poses a substantial clinical challenge, prompting the investigation of novel treatment modalities. This study aims to evaluate the potential application of spinal nerve dorsal root ganglion (DRG) radiofrequency treatment in addressing chronic spinal-origin pain.

METHODS

The study encompassed patients undergoing treatment for chronic spinal-origin pain, with a particular focus on those experiencing pain localized in specific regions. Inclusion criteria comprised patients with conditions such as a herniated intervertebral disc or foraminal stenosis leading to compression of descending or exiting nerve roots, accompanied by reported radicular pain in the lower limb.

RESULTS

There was no significant difference in comparability between the two groups (p > 0.05). The clinical effective rate in the study group was significantly higher than that in the control group (p < 0.05). The VAS scores of the study group at 2 weeks and 1 month after treatment were significantly lower than those of the control group (p < 0.05). The PSQI index of the study group after treatment was significantly lower than that of the control group (p < 0.05). There was no significant difference in the incidence of complications between the two groups (p > 0.05).

CONCLUSION

Spinal nerve DRG radiofrequency treatment has significant clinical efficacy in chronic spinal-origin pain, bringing noticeable improvement in symptoms and sleep quality for patients. The occurrence of complications is relatively low, and it can be reduced through strict operational standards and preoperative and postoperative management. However, caution should be exercised in its widespread application, but it is worthy of broad clinical use.

Integrating lived experience to develop a tailored sleep intervention for people living with dementia and carepartners

ObjectivesSleep disturbances are highly prevalent and have adverse health consequences for both people living with dementia and their carepartners. Despite this, they are under-addressed caregiving settings. This study aimed to explore these sleep disturbances and co-design a multimodal sleep intervention for people living with dementia and their carepartners.MethodsWe conducted two focus groups and five semi-structured interviews (n = 4 people living with dementia, n = 6 carepartners). Active involvement of community advisors was sought throughout the design, development, and facilitation phases. Reflexive thematic analysis was used to explore sleep-related experiences and receive feedback to shape intervention development.FindingsPeople living with dementia reported disruptions to sleep and circadian rhythms, including sleep disturbances and confusion between day and night. Multiple sleep challenges were encountered by carepartners including insomnia, hypervigilance, and daytime impairment. The proposed sleep intervention was received positively, with significant insights emphasising the need for a multimodal toolkit approach, adaptation of the intervention across different dementia stages, and a focus on tailoring the program to carepartners.ConclusionSleep interventions for caregivers and care-recipients should target both sleep and daytime functioning to ensure holistic support. Participants were receptive towards time-friendly, online, multimodal sleep interventions that combine cognitive behaviour therapies, light therapy, mindfulness, and exercise elements.

Are sleep and awake bruxism associated with sleep quality and duration in adults? A systematic review and meta-analysis

The objective of this systematic review was to investigate the association between sleep quality with awake bruxism or sleep bruxism in adult individuals. Inclusion criteria comprised observational studies conducted in adults related to the research question, assessing bruxism by instrumental or non-instrumental approaches, and sleep quality by subjective or objective measures, or sleep duration. Sleep disorders, syndromes, neurological and psychiatric disorders, or psychotropic medications were excluded. PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were searched until August 2024. Risk of bias was assessed by the JBI Critical Appraisal Checklist tool for cross-sectional studies, and the Newcastle-Ottawa scale for case-control studies. Independent meta-analyses comparing awake or sleep bruxism individuals with control individuals were performed when there were at least two studies for each sleep outcome. Thirty-two studies assessing a total of 4706 individuals were included. Meta-analyses showed no differences between sleep bruxism and control individuals regarding polysomnography parameters (sleep efficiency, sleep latency, awakenings, wake after sleep onset, and sleep duration). Pittsburgh Sleep Quality Index showed higher scores for sleep bruxism individuals compared to control individuals (MD = 1.98; 95 % CI = 0.96-3.00) and for awake bruxism individuals compared to control individuals (MD = 1.99; 95 % CI = 0.42-3.57). In total, 12 studies were rated as low risk of bias, 15 as moderate risk of bias, and 5 as high risk of bias. The certainty of evidence was rated as very low. Objective sleep quality was not associated with sleep bruxism, while subjective sleep quality was associated with both sleep and awake bruxism.

Associations between body mass index and sleep duration in Brazilian children and adolescents: the moderating role of screen time

OBJECTIVES

To verify the moderating role of screen time in the relationship between body mass index (BMI) and sleep duration in children and adolescents.

METHODS

This cross-sectional study involved 1,338 children and adolescents (aged 6-17 years old; 761 girls) recruited from a municipality in south Brazil. Body weight and height were assessed to calculate BMI. Information regarding screen time, sleep duration, age, sex, sexual maturation, housing area, and socioeconomic status was obtained through a self-reported questionnaire. Moderation was tested using multiple linear regression modelling through an SPSS program extension. All models were adjusted for sex, age, sexual maturation, housing area, and socioeconomic status.

RESULTS

No association was found between BMI and sleep duration (β=0.830; 95 % CI=-0.943; 2.603). However, when the role of screen time was considered, it was observed that this variable significantly moderated the relationship between BMI and sleep duration (β=-0.006; 95 % CI=-0.011; -0.001). Specifically, children and adolescents who spent more than 360 min per day in front of the screens presented higher BMI and shorter sleep durations.

CONCLUSIONS

The more time children and adolescents spend in front of screens, the higher the likelihood it will negatively affect their BMI and sleep duration. These findings emphasize the need for interventions that promote healthy screen habits and encourage behaviors that support optimal sleep duration to mitigate the potential negative effects on body weight and overall health.

Virtual Group Medical Visits to Decrease Stress and Increase Sleep Quality in a Rural Community: A Quality Improvement Project

Group medical visits (GMVs) are effective in addressing care gaps for chronic diseases and patient education on healthy lifestyle interventions. This quality improvement project modified a previously piloted sleep and stress management GMV program, implemented the enhanced program, then evaluated its efficacy through pre- and post-surveys. Patients self-identified or were identified by a provider as having poor stress management skills, generalized anxiety disorders, insomnia, and/or poor sleep habits. The virtual GMV series compromised four 90-minute, biweekly visits from April to May 2024. Sleep was measured via the Pittsburgh Sleep Quality Index (PSQI) and stress with the Perceived Stress Scale (PSS). Twenty-two patients were initially enrolled, eight dropped out, four did not attend any visits, and one attended only one visit without completing surveys. Surveys included demographic questions, the PSQI, the PSS, and were completed before the first visit and after the last visit. The final sample included ten participants, and the majority (90%) attended 3 or 4 GMVs. The mean age (SD) was 53.10 (17.36) years, the majority were female (90%), and worked full-time (60%). Participants who attended 2-4 GMVs experienced a statistically significant increase in sleep quality; however, there was no significant improvement in perceived stress.

The Mediating Role of Negative Mood Affect in the Relationship Between Perceived Stress and Vulnerability to Insomnia Among Student Pharmacist Shift Workers

Background

Perceived stress and vulnerability to develop insomnia are closely linked, with negative mood affect playing a key role. Shift workers, particularly student pharmacists juggling academic demands and irregular work schedules, are at heightened risk for stress-related sleep disturbances. While previous studies have explored their direct relationships, limited evidence exists on the dual role of negative mood affect as both a mediator and a non-mediator in these pathways. This study investigates the mediating role of negative mood affect in the relationship between perceived stress and vulnerability to develop insomnia and assesses whether negative mood affect mediates the reverse relationship.

Methods

A cross-sectional study was conducted on 86 student pharmacist shift workers at Notre Dame of Maryland University. Participants completed validated self-report measures, including the Perceived Stress Scale (PSS), the Ford Insomnia Response to Stress Test (FIRST), and the Positive and Negative Affect Schedule (PANAS). Mediation analysis using Hayes' PROCESS macro (Model 4) examined the mediating role of negative mood affect in both pathways. Bias-corrected bootstrapping with 5000 iterations calculated confidence intervals for indirect effects, with significance set at p < 0.05.

Results

Negative mood affect partially mediated the relationship between perceived stress and vulnerability to develop insomnia. Higher stress levels were associated with increased negative mood affect (b = 0.49, SE = 0.05, p < 0.01), which, in turn, was linked to greater insomnia vulnerability (b = 0.39, SE = 0.04, p < 0.01). The indirect effect was significant (b = 0.19, 95% CI [0.06, 0.33]). In contrast, negative mood affect did not mediate the reverse pathway (p = 0.15).

Conclusion

Negative mood affect significantly mediates the relationship between perceived stress and insomnia vulnerability but not the reverse pathway. Interventions targeting emotional regulation may help reduce stress-related sleep disturbances. Longitudinal studies are needed to confirm these findings and refine interventions.

Effect of physical activity on sleep in women experiencing vasomotor symptoms during menopause: a systematic review and meta-analysis

Hot flashes and night sweats, common vasomotor symptoms (VMS) during menopause, are strongly associated with poor sleep quality and disorders. Physical activity is proposed as a strategy to improve menopausal health and sleep outcomes. This systematic review and meta-analysis synthesizes and evaluates evidence on the relationship between physical activity and sleep parameters in women experiencing VMS. Comprehensive searches were conducted in October 2024 across multiple databases, including MEDLINE/PubMed, Cochrane Library, and EMBASE, alongside manual backward and forward searches. Randomized controlled trials (RCTs) investigating physical activity or exercise interventions and their effects on subjective and objective sleep outcomes in women with VMS were included. The risk of bias was assessed using the revised Cochrane RoB 2 tool, and data were pooled for meta-analysis. Nine studies with a total of 1579 participants were analyzed. Physical activity interventions did not significantly improve sleep quality (-0.03 [-1.23, 1.18]; P = 0.96; I2 = 78 %) or insomnia (-1.65 [-3.52, 0.21]; P = 0.08; I2 = 0 %) but produced minor improvements in sleep problems (-0.08 [-0.16, -0.00]; P = 0.04; I2 = 0 %). Despite concerns regarding bias, none of the studies were classified as high-risk, supporting result reliability. The findings suggest heterogeneity in the effects of physical activity on sleep, influenced by intervention-specific factors like type, frequency, intensity, timing, and duration. Environmental variables may also moderate these outcomes, highlighting the complexity of sleep regulation and the need for tailored approaches to improve sleep in menopausal women. Review protocol is registered in PROSPERO: CRD42024599593.

Impact of chrono-nutrition profile on academic performance with reference to demographic characteristics of young adults: A cross-sectional study

BackgroundThe circadian rhythm, which governs sleep patterns and dietary habits, is crucial to people's metabolic health. Disruptions to these established routines can result in serious metabolic disorders and may impact youngster's academic performance.AimThis study aimed to assess the chrono-nutrition profile of university students and its impact on academic performance. It also explored the relationship between demographic characteristics, chrono-nutrition patterns, and academic scores.MethodsA cross-sectional study was conducted from May 2023 to July 2023 to assess how disruptions in eating and sleeping patterns may impact academic performance through data collected from 288 young adults (18-30 years). Participants completed the Chrono-nutrition Profile and Academic Performance Questionnaire ( Veronda et al., 2020) and also provided demographic information and responses to self-awareness questions.ResultsThe average age of participants was 21 years, with 19% being males and 81% females; 56.3% were day scholars and 42.4% were hostelites. The average sleep duration of the sample on the workdays was 7 h, compared to 9 h on days off. The mean academic performance score indicated excellent performance (score: 25-32). The relationship of the actual sleep window and eating window with academic performance was not statistically significant (p = 0.905). Similarly, skipping breakfast did not show a significant association with academic performance scores (p = 0.693).ConclusionThe chrono-nutrition profile was not associated with academic performance scores, as there was variability in sleep habits and eating windows on both workdays and days off. We recommend that future research gather prospective data to further investigate these findings.

Validation and the psychometric properties of the Persian version of the sleep quality scale for coronary care patients: a methodological survey

Sleep quality is crucial for recovery in coronary care patients, yet sleep disturbances are prevalent in intensive care settings. This study aimed to validate the Persian version of the Sleep Quality Scale for Coronary Care Patients (SQ-CC-P) in the Iranian population and ensure its psychometric robustness for clinical and research applications. A methodological study was conducted in the Coronary Care Unit (CCU) and heart unit of Imam Khomeini Hospital in Ardabil Province, Iran, from May to September 2024, involving 220 participants diagnosed with acute coronary conditions. The SQ-CC-P, which includes self-assessment and environmental factors, was assessed for content validity, construct validity, and reliability in accordance with COSMIN guidelines. The SQ-CC-P demonstrated strong content validity, with CVI (0.80-0.92), CVR (0.70-1.00), S-CVI/UA (0.85), S-CVI/Ave (0.91), and Adjusted Kappa (0.697) confirming item relevance and necessity. Construct validity was supported by exploratory factor analysis (EFA), which revealed a two-factor structure explaining 62.4% of the variance, and confirmatory factor analysis (CFA), which showed strong factor loadings (0.72-0.82) and excellent model fit. The scale exhibited high internal consistency (Cronbach's alpha = 0.862, McDonald's omega = 0.864) and test-retest reliability (ICC = 0.785, 95% CI [0.718, 0.841]). The SQ-CC-P is a valid and reliable tool for assessing sleep quality among coronary care patients, addressing a critical gap in sleep assessment in intensive care settings.

[Cannabidiol regulates circadian rhythm to improve sleep disorders following general anesthesia in rats]

OBJECTIVES

To assess the regulatory effect of cannabidiol (CBD) on circadian rhythm sleep disorders following general anesthesia and explore its potential mechanism in a rat model of propofol-induced rhythm sleep disorder.

METHODS

An electrode was embedded in the skull for cortical EEG recording in 24 male SD rats, which were randomized into control, propofol, CBD treatment, and diazepam treatment groups (n=6). Eight days later, a single dose of propofol (10 mg/kg) was injected via the tail vein with anesthesia maintenance for 3 h in the latter 3 groups, and daily treatment with saline, CBD or diazepam was administered via gavage; the control rats received only saline injection. A wireless system was used for collecting EEG, EMG, and body temperature data within 72 h after propofol injection. After data collection, blood samples and hypothalamic tissue samples were collected for determining serum levels of oxidative stress markers and hypothalamic expressions of the key clock proteins.

RESULTS

Compared with the control rats, the rats with CBD treatment showed significantly increased sleep time at night (20:00-6:00), especially during the time period of 4:00-6:00 am. Compared with the rats in propofol group, which had prolonged SWS time and increased sleep episodes during 18:00-24:00 and sleep-wake transitions, the CBD-treated rats exhibited a significant reduction of SWS time and fewer SWS-to-active-awake transitions with increased SWS aspects and sleep-wake transitions at night (24:00-08:00). Diazepam treatment produced similar effect to CBD but with a weaker effect on sleep-wake transitions. Propofol caused significant changes in protein expressions and redox state, which were effectively reversed by CBD treatment.

CONCLUSIONS

CBD can improve sleep structure and circadian rhythm in rats with propofol-induced sleep disorder possibly by regulating hypothalamic expressions of the key circadian clock proteins, suggesting a new treatment option for perioperative sleep disorders.

Digital cognitive behavioral therapy as a novel treatment for insomnia

BACKGROUND

As a substitute for traditional drug therapy, digital cognitive-behavioral therapy positively impacts the regulation of brain function, which can improve insomnia. However, there is currently a paucity of studies on digital cognitive behavioral therapy as a treatment for insomnia.

AIM

To assess digital cognitive behavioral therapy for insomnia regarding its positive impact on brain function.

METHODS

Participants were randomly assigned to either a go/no-go group or a dot-probe group. The primary outcome was quality of sleep as assessed by the actigraphy sleep monitoring bracelet, Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), and depression anxiety and stress scale (DASS-21).

RESULTS

Eighty patients were included in the analysis (go/no-go group: n = 40; dot-probe group: n = 40). We combined the total scale scores of the two groups before and after the intervention in the analysis of covariance. Our study explored whether insomnia symptoms in both groups can be improved by using digital cognitive behavioral therapy instead of trying to compare the two trials; therefore, only one P value is listed. In both groups, we found a short-term time effect on insomnia symptom severity (PSQI: P < 0.001, η² = 0.336; ISI: P < 0.001, η² = 0.667; DASS-depression: P < 0.001, η² = 0.582; DASS-anxiety: P < 0.001, η² = 0.337; DASS-stress: P < 0.001, η² = 0.443) and some effect on sleep efficiency (but it was not significant, P = 0.585, η² = 0.004).

CONCLUSION

Go/no-go task training of inhibitory function had a short-term positive effect on sleep efficiency, whereas dot-probe task training had a positive short-term effect on emotion regulation.

The Effects of Progressive Muscle Relaxation on Mental Health and Sleep Quality in Adults with Cystic Fibrosis: A Randomized Controlled Trial

Background/Objective: Cystic fibrosis (CF) is a chronic genetic disease affecting multiple body systems and having a significant impact on mental health and sleep. Patients with CF frequently suffer from anxiety, depression, and sleep disturbances, but non-pharmacological strategies are understudied. Although progressive muscle relaxation (PMR) has recognized benefits, its impact on CF remains insufficiently explored. The study aimed to analyze the effect of integrating PMR into a standard pulmonary rehabilitation (PR) program on mental health, sleep quality, and quality of life in adults with CF. Methods: A total of 22 adult patients with CF were randomly assigned to either the intervention group (PR + PMR) or the control group (PR only). Assessments were performed at baseline, after 21 days of intervention, and at the 48-day follow-up. Outcome measures included the CFQ-R for quality of life, the HADS for mental health, and the PSQI for sleep. Results: Compared to the control group, participants who practiced PMR experienced significant reductions in anxiety (p = 0.05) and depression (p = 0.02) at the final assessment. A significant improvement in sleep quality was also observed (p < 0.01). No relevant differences were found in pulmonary function or performance on the six-minute walk test. Conclusions: Integrating PMR into pulmonary rehabilitation programs may be an effective strategy for improving mental health and sleep in patients with CF. Due to its accessibility and ease of implementation, PMR could be adopted as a complementary method in the holistic care of these patients.

Group bright light therapy compared to treatment as usual for delayed sleep-wake phase disorder among patients in psychiatric care (the SIP trials): a protocol for a pragmatic, randomised controlled trial

INTRODUCTION

Circadian rhythm sleep-wake disturbances appear to be prevalent in psychiatric populations and may maintain and exacerbate psychiatric symptoms. Bright light therapy (BLT) is, in addition to exogenous melatonin, the treatment of choice for circadian rhythm disorders like delayed sleep-wake phase disorder (DSWPD) and has yielded promising results in patients with comorbid psychiatric illness. However, such patients are rarely offered this treatment in outpatient clinics. The aim of this randomised controlled trial is to investigate whether group BLT for psychiatric outpatients is superior to treatment as usual (TAU).

METHODS AND ANALYSIS

60 patients with moderate-to-severe psychiatric illness who meet the criteria for DSWPD will be recruited from an outpatient psychiatric clinic in Norway. They will be randomised (1:1) to a group-based Sleep School Wake Up! For Circadian (SSWU-C) programme conjointly with TAU or to TAU while on a wait list for SSWU-C. The SSWU-C will be delivered over four biweekly sessions, each lasting 120 min; hence treatment will last 6 weeks. Assessments will be collected at baseline (T1) and after the intervention (T2). The primary outcome will be changes in sleep timing using measures such as sleep diaries, actigraphy and dim light melatonin onset (DLMO) at 6 weeks postintervention. Secondary outcomes include changes in other sleep metrics, symptoms of depression, anxiety, fatigue, problems with work and social adjustment and well-being. Mixed models will be used for data analyses.

ETHICS AND DISSEMINATION

Ethical approval was granted in 2020 by the Regional Ethics Committee in Western Norway (REK 2020/66304). Findings will be published in peer-reviewed journals and be presented at research conferences and in relevant media. The results may document the need for more specific sleep-directed treatments in psychiatric clinics as a way of treating not only circadian rhythm sleep-wake disorders but also as a treatment to alleviate psychiatric symptoms.

TRIAL REGISTRATION NUMBER

NCT05177055.

Group cognitive behavioural therapy for insomnia compared with treatment as usual for sleep problems in psychiatric care (the SIP trials): a protocol for a pragmatic, randomised controlled trial

INTRODUCTION

Insomnia is prevalent in psychiatric populations and may contribute to maintain and exacerbate psychiatric symptoms. Cognitive behavioural therapy for insomnia (CBTi) is the treatment of choice also for insomnia comorbid to psychiatric illness. However, patients are rarely offered CBTi in psychiatric outpatient clinics. The aim of this randomised controlled trial is to investigate whether CBTi delivered in groups in a psychiatric outpatient clinic is superior to treatment as usual (TAU).

METHODS AND ANALYSIS

In the Sleep in Psychiatric Care trial, 60 patients with moderate to severe psychiatric illness who meet the criteria for insomnia disorder will be recruited from an outpatient psychiatric clinic in Norway. The patients will be randomised (1:1) either to group-based CBTi (Sleep School Wake Up for Insomnia; SSWU-I) or to a wait list (WL) while they are all receiving TAU for their psychiatric disorder. SSWU-I will comprise five bi-weekly sessions, each lasting 120 min, hence the treatment period is 8 weeks. Assessment will be conducted at baseline (T1) and after 8 weeks (T2). The primary outcome will be self-rated insomnia symptoms using the Insomnia Severity Index and the Bergen Insomnia Scale. Secondary outcomes include measures of symptoms of dysfunctional beliefs and attitudes about sleep, depression, anxiety, fatigue, problems with work and social adjustment and well-being. Mixed model analyses will be conducted to test the hypotheses.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Regional Committee for Medical and Health Research Ethics, in Western Norway (REK 2020/66304). Findings will be published in peer-reviewed journals and presented at research conferences and in relevant media. The results may document the need for specific sleep-directed treatments in psychiatric clinics as a way of treating insomnia disorder as well as to alleviate psychiatric symptoms.

TRIAL REGISTRATION NUMBER

NCT04463498.

EEG spectral analysis of nighttime sleep and daytime MSLTs and neurocognitive evaluations in subjects with co-morbid insomnia and OSA

BACKGROUND

Chronic insomnia and obstructive sleep apnea commonly co-occur. Few studies have explored the neurophysiological and neurocognitive characteristics of COMISA, which could help guide improving treatment diagnostic tools and determining novel therapeutic targets. This study aims to explore the neurophysiological and neurocognitive characteristics of COMISA using electroencephalographic (EEG) spectral analysis and subjective and objective neurocognitive measurements.

METHODS

Participants were from our community recruited OSA-insomnia-COMISA cohort with 206 included for our current analysis including 74 chronic insomniacs (CIs), 55 OSA patients and 77 COMISA patients. Standard polysomnography (PSG) and multiple sleep latency tests (MSLTs) were recorded and used to obtain relative EEG spectral power in each sleep stage during PSG and each session during MSLTs. A series of subjective and objective neurocognitive tests were conducted to evaluate executive function, attention, retrospective and prospective memory and meta-cognition.

RESULTS

In PSG and MSLTs, COMISA patients showed combined EEG power characteristics of both CIs and OSA. Specifically, COMISA patients exhibited similar EEG spectral characteristics to CIs, with decreased delta and increased alpha and beta power in NREM sleep stages, and increased beta power in REM and MSLTs. Similar to the EEG spectral power profile of OSA, COMISA patients showed increased delta power in REM and MSLTs. Compared to OSA patients, COMISA patients exhibited worse subjectively measured attention and meta-cognition related to negative beliefs about uncontrollability and danger of worry (NEG), which were positively associated with ISI scores.

CONCLUSIONS

The EEG spectral power characteristics of COMISA patients in overnight PSG and daytime MSLT appear to be the manifestation of elements of both CIs and OSA. However, the neurocognitive features of COMISA patients in subjectively measured attention and NEG meta-cognition were primarily affected by chronic insomnia.

An experimental investigation of daily mental contrasting with implementation intentions and goal motives in reducing bedtime procrastination: a registered report

OBJECTIVES

Mental contrasting with implementation intentions (MCII) is an effective self-regulation strategy for goal pursuit. Although it is a quick and cost-effective strategy, most of its applications have consisted of single-time training. Building on the existing research on bedtime procrastination, we propose that daily MCII applications can lead to more efficient pursuit of bedtime goals. Furthermore, we evaluate the conditions where MCII training could be more advantageous for people with different types of goal motives.

METHODS AND MEASURES

We recruited 297 participants via Prolific and randomly allocated participants into either daily MCII or single MCII groups for a week-long diary study. We measured goal motives, goal-regulatory variables, bedtime procrastination, and affect to test our hypotheses. We conducted a multilevel structural equation modelling using Mplus.

RESULTS

Participants who completed MCII daily reported less bedtime procrastination than individuals who performed MCII one-off at the start of the week. Participants experienced increased positive affect and decreased negative affect when they procrastinated less. Autonomous goal motives were not associated with bedtime procrastination.

DISCUSSION

Daily MCII appears as an effective and easy-to-implement strategy helps reducing bedtime procrastination. Future research should test the effectiveness of daily MCII in other contexts.

Associations of a multidimensional polygenic sleep health score and a sleep lifestyle index with disease outcomes and their interaction in a clinical biobank

OBJECTIVES

Sleep is a complex behavior regulated by genetic and environmental factors impacting disease outcomes. However, the effect of multidimensional sleep encompassing several sleep dimensions on common diseases, specifically mental health disorders, has yet to be fully elucidated. Using the Mass General Brigham Biobank, we examined the association of multidimensional sleep with disease outcomes and investigated whether sleep behaviors modulate genetic predisposition to unfavorable sleep on mental health diseases.

METHODS

We generated a Polygenic Sleep Health Score using previously identified single nucleotide polymorphisms and constructed a Sleep Lifestyle Index based on self-reported questions and electronic health records; tested their association; performed phenome-wide association analyses between these indexes and clinical phenotypes; and analyzed their interaction on prevalent mental health diseases. A total of 15,884 participants were included in the analysis (mean age 54.4; 58.6% female).

RESULTS

The Polygenic Sleep Health Score was associated with the Sleep Lifestyle Index (β=0.050, 95% CI=0.032, 0.068) and with 114 disease outcomes spanning 12 disease groups, including obesity, sleep, and substance use disease outcomes (p<3.3×10-5). The Sleep Lifestyle Index was associated with 458 disease outcomes spanning 17 groups, including sleep, mood, and anxiety disease outcomes (p<5.1×10-5). A total of 108 disease outcomes were associated with both indexes, spanning 12 disease groups. No interactions were found between the indexes on mental health diseases.

CONCLUSIONS

Favorable sleep behaviors and genetic predisposition to healthy sleep may independently protect against disease, underscoring the impact of multidimensional sleep on population health and the need for prevention strategies focused on healthy sleep habits.

A network approach to lifestyle behaviors and health outcomes in people with mental illness: the MULTI+ study III

BACKGROUND

Unhealthy lifestyle behaviors are prevalent among people with mental illness (MI), affecting their physical and mental health. Most research has focused on the isolated effects of lifestyle behaviors, leaving the interconnectedness between these behaviors and health outcomes unexplored. This study aimed to examine these relationships and identify the most strongly connected lifestyle behavior or health outcome within a network.

METHODS

We conducted a cross-sectional study with 423 inpatients with MI, receiving care as usual. Lifestyle behaviors, physical and mental health outcomes were assessed through questionnaires and routine data. A Gaussian Graphical Model was estimated, and strength centrality was calculated to identify the most influential nodes.

RESULTS

Mean age was 55.5 years, 42% were female, and 41% were diagnosed with schizophrenia. Psychological and physical quality of life (QoL), nighttime sleep problems, and overall sleep quality were the most strongly connected nodes. Sleep was strongly associated with physical QoL. Furthermore, there were negative associations between healthy food intake and cholesterol ratio, and positive associations between daily doses of antipsychotics and length of hospital stay. Node strength was stable (CS(cor = 0.7) = 0.75). No clear pattern emerged among other lifestyle behaviors and health outcomes.

CONCLUSIONS

This study offers insights into the interrelatedness of lifestyle behaviors and health outcomes. Addressing sleep problems could enhance QoL and potentially influence other health outcomes. Psychological and physical QoL were also strongly associated, emphasizing the importance of perceived well-being in health outcomes. Future research could explore causal pathways to identify treatment targets to improve care.

Chronotype as a potential risk factor for cognitive decline: The mediating role of sleep quality and health behaviours in a 10-year follow-up study

BACKGROUND

- With rising life expectancies and ageing populations worldwide, preserving cognitive health is an urgent global priority. Chronotype could be a potential risk factor for cognitive decline, potentially through mediators sleep quality, alcohol intake, physical activity, and smoking.

METHODS

- This study used data from participants aged 40 years and older from the Lifelines cohort study (n = 23,798). Chronotype, assessed with the Munich ChronoType Questionnaire, was included as a continuous score of mid-point sleep corrected for sleep debt on workdays. Multiple linear regression examined the association between chronotype and cognitive decline, including moderation by age, educational attainment, and sex. The KHB-method was applied to test mediation by sleep quality, alcohol intake, physical activity, and smoking.

OUTCOMES

- Cognition was assessed with the Ruff Figural Fluency Test (RFFT), measuring non-verbal fluency and executive functioning. Cognitive decline was calculated by subtracting the RFFT sum score at baseline from the 10-year follow-up score.

RESULTS

- Chronotype was associated with cognitive decline. Educational attainment, but not age or sex, moderated the relationship. No significant associations were observed in the low- (0.07, 95 % CI: -0.44, 0.57) or middle- (-0.41, 95 % CI: -0.88, 0.06) educational groups. In the high-educational group each one-hour increase in chronotype corresponded to a 0.80-point decline in cognition per decade (95 % CI: -1.34, -0.26). In this group, sleep quality and current smoking mediated 13.52 % and 18.64 % of the association, respectively.

INTERPRETATION

- Chronotype was associated with greater decline in non-verbal fluency and executive functioning among higher educated participants, highlighting the importance of targeted prevention strategies.

FUNDING

- This work is part of the BIRD-NL consortium funded by the Dutch Medical Research Council, ZonMw (Dementia research program) project number:10,510,032,120,005.

Does sunlight exposure predict next-night sleep? A daily diary study among U.S. adults

Poor sleep is becoming increasingly prevalent and is associated with adverse health outcomes. Sunlight exposure may improve sleep by regulating circadian rhythms, increasing vitamin D, and influencing melatonin production. However, research on the sunlight-sleep association is limited, especially outside of cross-sectional designs. This study examined associations between daily self-reported sunlight exposure and next-night sleep quality in 103 adults for up to 70 days. The timing of sunlight exposure predicted next-night sleep quality. Specifically, morning sunlight exposure, relative to no sunlight, predicted better sleep quality based on responses to the brief Pittsburg Sleep Quality Index. Duration of sunlight exposure was generally not associated with sleep quality. Morning sunlight may regulate circadian rhythms, subsequently improving sleep. Findings have potential implications for sleep interventions and daylight savings time policies. Future research should test whether morning sunlight exposure can enhance the effectiveness of sleep interventions.

The impact of different types of extreme temperature events on mental disorders: A case-crossover study in Anhui Province, China

BACKGROUND

Extreme temperatures are expected to be more frequent, intense, and complex in the context of climate change. However, epidemiologic evidence about associations between extreme temperature and mental disorders is limited.

METHODS

We conducted a case-crossover study in Anhui Province, China, focusing on outpatients diagnosed with mental and behavioral disorders (ICD-10 codes: F00-F99), further classified into schizophrenia (F20-F21), depression (F32-F33), and anxiety (F40-F41). Defining the day of each outpatient visit to the Anhui Mental Health Center as the case day, a total of 762,895 case days and 3,362,574 control days were included in the study, covering the period from 2019 to 2021. Each subject was geocoded based on their home address and matched with environmental exposures, including meteorological data and air pollutant data sourced from the CN05.1 and the TAP dataset, respectively. Extreme temperature events were categorized into heat and cold extremes, further divided into daytime, nighttime, and compound extremes.

RESULTS

Among the outpatient visits for mental disorders included in this study, the proportions were schizophrenia (28.9 %), depression (23.9 %), and anxiety (18.5 %). Exposure to extreme heat and cold was associated with increased risks of outpatient visits for mental disorders, with odds ratios (ORs) of 2.23 (95 %CI: 2.16-2.30) and 1.95 (95 %CI: 1.89-2.01), respectively. Compound heat extremes posed the highest risk of mental disorders (OR = 1.17, 95 %CI: 1.13-1.22), followed by nighttime (OR = 1.11, 95 %CI: 1.08-1.14) and daytime heat (OR = 1.05, 95 %CI: 1.04-1.07). Notably, the risk of mental disorders significantly elevated with the increased intensity and duration of extreme heat events. Besides, extreme heat was strongly associated with higher risks of depression, schizophrenia and anxiety, while extreme cold was notably linked to schizophrenia.

CONCLUSION

These findings indicate a significant correlation between extreme temperature exposure and elevated mental disorder risks, emphasizing the urgent need to address increased mental health risks posed by extreme temperatures in the changing climate.

Influence of tobacco smoking and alcohol drinking on anxiety in sample of 30 836 individuals in Taiwan Biobank

BACKGROUND

Anxiety disorders are among the most common mental disorders worldwide, and most previous studies have focused solely on alcohol drinking or tobacco smoking as risk factors for anxiety.

AIM

This study investigated the associations of alcohol drinking and tobacco smoking with anxiety.

METHOD

The data of 30 836 individuals in the Taiwan Biobank were retrieved and analysed in our study. To investigate the associations of tobacco and alcohol use with anxiety, we analysed Patient Health Questionnaire 4 (specifically scores for the first two questions assessing generalised anxiety disorder) results of the included participants and data on their tobacco and alcohol use, and other covariates.

RESULTS

Participants who used only tobacco and those using both tobacco and alcohol were more likely to experience anxiety than were those who did not use tobacco or alcohol. Among men, the use of alcohol and/or tobacco was associated with a significantly higher risk of anxiety. Among women, the use of both alcohol and tobacco was associated with a significantly higher risk of anxiety. Older age was associated with a lower risk of anxiety.

CONCLUSIONS

Tobacco and alcohol use significantly influence the risk of anxiety, particularly in men, and older age also influences this risk. The associations of anxiety with tobacco and alcohol use in women may change because of the increasing prevalence of their use among women in Taiwan in recent years.

Independent and Joint Associations of Physical Activity and Sleep on Mental Health Among a Global Sample of 200,743 Adults

BACKGROUND

Previous research has demonstrated that both sleep and physical activity (PA) are independently associated with various indicators of mental health among adults. However, their joint contribution to mental health has received limited attention. The present study used cross-sectional data from the Mental Health Million Project to examine the independent and joint effects of sleep and PA on mental health among a global sample of adults, and whether these effects differ among individuals receiving mental health treatment.

METHOD

The sample included 200,743 participants (33.1% young adults, 45.6% middle-aged adults, 21.3% older adults; 57.6% females, 0.9% other) from 213 countries, territories, and archipelagos worldwide that completed a comprehensive 47-item assessment of mental health including both problems (i.e., ill-being) and assets (i.e., well-being): the Mental Health Quotient. Participants also reported their weekly frequency of PA and adequate sleep, and mental health treatment status. A series of generalized linear mixed models were computed.

RESULTS

Independent dose-response associations were observed, whereby greater amounts of PA and adequate sleep were each associated with better mental health. In addition, a synergistic interaction was observed in which the positive correlation of PA with mental health was strengthened with greater frequency of adequate sleep. These benefits were less pronounced among adults receiving mental health treatment.

CONCLUSION

While findings suggest sleep can help to offset the negative influence of a physically inactive lifestyle (and vice versa), our results point to a "more is better" approach for both behaviors when it comes to promoting mental health.

The effect of social media use on suicidal ideation in college students: Mediation by daytime sleepiness and sleep quality

BACKGROUND

Social media use and daytime sleepiness are common among university students and have significant implications for their mental health. The aim of this study was to examine the effects of social media use on suicidal ideation among university students and to analyse the mediating effects of daytime sleepiness and sleep quality.

METHODS

A total of 5899 full-time undergraduate students were included in this study. Questionnaires were distributed and collected using the QuestionStar platform. Logistic regression analysis was used to examine the association between social media use, daytime sleepiness and sleep quality, and suicidal ideation among college students. The mediation model was tested using the bias-corrected percentile bootstrap method.

RESULTS

Among 4835 students, 612 (12.66 %) reported having had suicidal ideation. Regression analysis revealed that social media use (OR = 1.09, 1.05-1.12), daytime sleepiness (OR = 1.09, 1.06-1.11), general and poor sleep quality (OR = 1.89, 1.56-2.28; OR = 4.82, 3.76-6.18) were all significantly and positively associated with suicidal ideation. Furthermore, there was a chain-mediated effect of daytime sleepiness and sleep quality on the relationship between social media use and suicidal ideation.

LIMITATIONS

Causality could not be explored by cross-sectional studies, and future cohort studies are needed.

CONCLUSIONS

There was a chain-mediated effect between daytime sleepiness and sleep quality in the relationship between social media use and suicidal ideation. Therefore, it is recommended that students reduce their use of social media to improve their sleep quality and mental health.

Beneath the Surface: Mental Health in Commercial Fisheries

Commercial fishing is a dangerous occupation where injuries, stress, and traumatic events are common. This study determined probable Post-Traumatic Stress Disorder (PTSD) rates in a cohort of 142 commercial fishermen in the United States and assessed factors that influence PTSD outcomes and severity. Fishermen representing four fisheries were sampled: salmon gillnetters (Alaska), Dungeness crab (Oregon), scallopers and lobstermen (Massachusetts). Participants self-reported information on health, sleep, activity, and substance use through surveys, and responded to a brief PTSD screener (PC-PTSD-5) that assesses probable PTSD under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Positive PTSD screening rates in male fishermen were 12% (as compared to 10% for female fishermen), roughly three times the national average for US men (4%). Fishermen with self-reported depression, financial struggles, inability to control important things in their lives, difficulty going to (p = .0278) or staying (p = .038) asleep were significantly more likely to screen positive for PTSD. Factors influencing the severity of PTSD symptoms in those that have experienced a traumatic event included: financial insecurity, interpersonal concerns (family, crew), stress, and concern for safety on the vessel. Interestingly, sleep variables did not impact the severity of PTSD symptoms, only the outcome of probable PTSD. These results suggest the need to better understand the nature of traumatic events in fishing communities and to validate existing PTSD screening tools with fishermen to determine their accuracy in diagnosing PTSD in this population. Additionally, tailored behavioral health care for fishermen is essential to effective treatment and recovery from trauma.

How and when screens are used: comparing different screen activities and sleep in Norwegian university students

Introduction

Screen use in bed has become a widespread habit, particularly among young people. This behavior has been associated with poor sleep, with some studies indicating that social media use may be especially detrimental. However, there is a scarcity of research directly comparing the relationship between various screen activities and sleep, and most existing studies focus on adolescents rather than young adults. This study aims to explore the relationship between screen use in bed and sleep among students, specifically comparing social media use to other screen-based activities.

Methods

This study utilized data from the cross-sectional Students' Health and Wellbeing Study of 2022 and included n=45,202 participants aged 18-28 years. Regression analyses were used to assess the relationship between screen time in bed and sleep, comparing social media use with other activities.

Results

A one-hour increase of screen time after going to bed was associated with 59% higher odds of having symptoms of insomnia and a reduction in sleep duration of 24 minutes. The associations between screen time and sleep outcomes did not differ for social media use versus other activities. Independent of screen time, participants who exclusively used social media had lower odds of insomnia and longer sleep duration compared to those engaging in other activities or a mix of activities.

Discussion

The present study found that increased screen time in bed is linked to poorer sleep, across activity type. Future research should refine classifications, assess specific content, and employ experimental approaches to determine causal mechanisms.

Accuracy of Smartphone-Mediated Snore Detection in a Simulated Real-World Setting: Algorithm Development and Validation

Background

High-quality sleep is essential for both physical and mental well-being. Insufficient or poor-quality sleep is linked to numerous health issues, including cardiometabolic diseases, mental health disorders, and increased mortality. Snoring-a prevalent condition-can disrupt sleep and is associated with disease states, including coronary artery disease and obstructive sleep apnea.

Objective

The SleepWatch smartphone app (Bodymatter, Inc) aims to monitor and improve sleep quality and has snore detection capabilities that were built through a machine-learning process trained on over 60,000 acoustic events. This study evaluated the accuracy of the SleepWatch snore detection algorithm in a simulated real-world setting.

Methods

The snore detection algorithm was tested by using 36 simulated snoring audio files derived from 18 participants. Each file simulated a snoring index between 30 and 600 snores per hour. Additionally, 9 files with nonsnoring sounds were tested to evaluate the algorithm's capacity to avoid false positives. Sensitivity, specificity, and accuracy were calculated for each test, and results were compared by using Bland-Altman plots and Spearman correlation to assess the statistical association between detected and actual snores.

Results

The SleepWatch algorithm showed an average sensitivity of 86.3% (SD 16.6%), an average specificity of 99.5% (SD 10.8%), and an average accuracy of 95.2% (SD 5.6%) across the snoring tests. The positive predictive value and negative predictive value were 98.9% (SD 2.6%) and 93.8% (SD 14.4%) respectively. The algorithm performed exceptionally well in avoiding false positives, with a specificity of 97.1% (SD 3.5%) for nonsnoring files. Inclusive of all snoring and nonsnore tests, the aggregated accuracy for all trials in this bench study was 95.6% (SD 5.3%). The Bland-Altman analysis indicated a mean bias of -29.8 (SD 41.7) snores per hour, and the Spearman correlation analysis revealed a strong positive correlation (rs=0.974; P<.001) between detected and actual snore rates.

Conclusions

The SleepWatch snore detection algorithm demonstrates high accuracy and compares favorably with other snore detection apps. Aside from its broader use in sleep monitoring, SleepWatch demonstrates potential as a tool for identifying individuals at risk for sleep-disordered breathing, including obstructive sleep apnea, on the basis of the snoring index.

The applicability and effectiveness of the cognitive behavioral therapy for insomnia (Smart CBT-I plus) online program in patients with insomnia disorder combined with anxiety and depression: a randomized controlled trial protocol

Background

Insomnia is often accompanied by depression and anxiety, which can seriously affect people's quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment, but the existing CBT-I ignores the intervention for anxiety-depressive symptoms, and has poor efficacy due to the lack of artificial support, poor compliance, the inability to spread widely and high dropping rate. A balance is needed between the convenience and efficiency of web-based technology and patient needs. Again in this context, an online WeChat applet (Smart CBT-I plus) will be developed with CBT-I technology as the core, integrating cognitive behavioral intervention modules for depression and anxiety.

Objectives

This study will validate the effectiveness and applicability of Smart CBT-I plus by examining whether the Smart CBT-I plus study group will significantly reduce the distress of people suffering from insomnia with anxiety and/or depression symptoms compared to the psychoeducational group.

Methods

In this parallel-group, randomized controlled trial, 180 patients seeking help for insomnia combined with anxiety and/or depression will be recruited, and they will be randomized with 60 patients being assigned to the psychoeducation group (control group), and 120 patients being assigned to the Smart CBT-I plus group (study group). Measurements will be taken at baseline, post-intervention, 6 and 12 month follow-up, at the same time, semi-structured qualitative interviews about the experience of using Smart CBT-I plus will be conducted with randomly selected patients from the study group.

Results

The results will involve insomnia, depression and anxiety to explore its effectiveness, in-treatment dropout rates and subjective patient feedback to explore the applicability of Smart CBT-I plus.

Future recommendations

Self-help platforms need to be more individually designed to reach a wider audience. Research aimed at a wider audience, such as the general public, will make the research more universal and the platform more meaningful.

Prevalence and Associated Factors of Poor Sleep Quality Among Nurses in a Tertiary Care Hospital: A Cross-Sectional Study

Background

Poor sleep quality among nurses negatively impacts job performance, patient care, and mental well-being, leading to compromised cognitive ability, decision-making, and increased errors, which ultimately jeopardize patient care and safety. This study aimed to determine the prevalence of poor sleep quality and its associated factors among nurses at a tertiary care hospital in Mogadishu, Somalia.

Methods

A cross-sectional study was conducted among nurses working at a tertiary care hospital between May and August 2024. Data were collected using a standardized questionnaire, which included socio-demographic information, the Pittsburgh Sleep Quality Index (PSQI), the Depression, Anxiety, and Stress Scale (DASS-21), and the Oslo Social Support Scale (OSSS-3). Bivariate and multivariate logistic regression analyses were used to identify risk factors for poor sleep quality. A p-value of 0.05 was considered the threshold for statistical significance.

Results

A total of 280 nurses participated in the study, with 45.7% (95% CI: 39.8-51.7) reporting poor sleep quality. The odds of reporting poor sleep quality were higher among female nurses (AOR = 2.68; 95% CI: 1.35-5.32), those working night shifts (AOR = 4.76; 95% CI: 2.06-11.02), those with poor social support (AOR = 2.82; 95% CI: 1.09-7.27), and those experiencing depression (AOR = 5.35; 95% CI: 2.22-12.88), anxiety (AOR = 5.58; 95% CI: 2.61-11.92), and stress (AOR = 3.92; 95% CI: 1.11-13.90).

Conclusion

This study revealed a significantly high prevalence of poor sleep quality among nurses. These findings underscore the importance of addressing sleep quality as a key component of nursing well-being. It is recommended that nursing managers assess both the mental and physical health of their staff, implement targeted interventions such as stress management and counseling, and develop workplace strategies to improve sleep, including flexible scheduling and education on sleep hygiene.

Mental Health and Drug Use Patterns Among Men Who Have Sex with Men (MSM) Engaging in Chemsex in the UK

Background: Chemsex is a subtype of sexualized drug use which is increasingly more prevalent amongst gay, bisexual, and other men who have sex with men (MSM). This use of psychoactive substances in sexual contexts poses an emerging public health concern, since it has been associated with an array of health risks, including mental health risks. Objective: As Chemsex appears to be increasing in the UK, this study aimed to explore Chemsex patterns and mental health amongst Chemsex users in the UK. Methods: Chemsex/drug use patterns and the prevalence of coexisting depression and anxiety, based on the Hospital Anxiety and Depression Scale (HADS), were assessed in an MSM sample via an anonymous online survey between December 2023 and February 2024. Results: A total of 141 UK adults participated in the survey (age range: 26-41 years). High overall use of the three common Chemsex-related substances was reported, including γ-hydroxybutyrate/γ-butyrolactone (GHB/GBL) (77.3%), synthetic cathinones (64.5%), and methamphetamine (47.5%). Injecting ("slamming") was less prevalent (17.0%), although this practice was the most common amongst weekly Chemsex users (54.2%). Based on provided HADS responses, a high incidence of anxiety (49.9%) was reported among the study population, with the highest (abnormal) anxiety scores observed among weekly Chemsex users (44.4%). The incidence of depression was lower overall (27.0%), whilst the highest (abnormal) scores were also observed in weekly Chemsex users (61.5%). Conclusions: As relevant UK data remain limited, this study offers novel insight into Chemsex patterns and mental health challenges among MSM in the UK, suggesting unmet needs for targeted interventions on mental health issues among this population. Further large-scale and prospective studies are necessary to explore the nuanced interplay between the frequency of Chemsex use and its impact on mental health.

The relationship between frailty and depression in Chinese elderly prostate cancer patients following radical surgery: the mediating effect of sleep disturbances

OBJECTIVE

Depression is an important factor affecting long-term outcomes in prostate cancer patients. Frailty and sleep quality are associated with depressive symptoms, but the pathways through which frailty and sleep quality affect depression remain unclear. The aim of this study was to investigate the relationship between frailty and depression in older Chinese patients after radical prostate cancer surgery and to explore whether sleep disturbances mediate the effect of frailty on depression.

METHODS

A cross-sectional study was conducted with 277 elderly prostate cancer patients who underwent radical prostatectomy at a tertiary oncology center in Southern China (January 2022-March 2024). Inclusion criteria required ≥ 3 months postoperative recovery. Standardized instruments were administered: FRAIL Scale for frailty assessment, Pittsburgh Sleep Quality Index (PSQI) for sleep evaluation, and PHQ-9 for depression screening, supplemented by demographic questionnaires.

RESULTS

Clinically relevant depressive symptoms (PHQ-9 ≥ 5) were identified in 18.4% (n = 51). Depression scores showed positive correlations with frailty (r = 0.521, p < 0.01) and negative correlations with sleep quality (r = -0.521, p < 0.01). Mediation analysis revealed frailty directly predicted depression (β = 0.349, p < 0.001) and indirectly through sleep impairment (β = 0.119, p < 0.001), with the indirect pathway accounting for 25.43% of the total effect (95% CI:0.059-0.191).

CONCLUSION

Elderly prostate cancer survivors exhibit heightened post-prostatectomy depression risks. Frailty acts as a dual-pathway predictor-directly exacerbating depressive symptoms and indirectly via sleep deterioration. These findings advocate for multidimensional interventions targeting frailty management and sleep optimization to improve mental health outcomes in this vulnerable cohort.

A Randomized, Double Blind, Sham-Controlled Clinical Trial to Evaluate the Efficacy of Electrical Vestibular Nerve Stimulation (VeNS), Compared to a Sham Control for Generalized Anxiety Disorder

Aims and Objectives: It has been hypothesised that vestibular stimulation may have a modulatory effect on anxiety. The aim of this randomised, double blind, sham-controlled trial was to determine the efficacy and safety of a non-invasive electrical vestibular nerve stimulation (VeNS) device as a treatment for anxiety compared to a sham stimulation device. Materials and methods: A total of 60 participants (mean age [SD]: 35.6 [8.1]) with a generalized anxiety disorder assessment (GAD-7) score of ≥10 were randomised to receive either an active VeNS device (n = 34) or a sham control device (n = 26). Both groups were asked to complete 20 stimulation sessions (30 min duration) at a rate of 3-5 sessions per week at a research clinic. The primary outcome was change in GAD-7 score from baseline to the end of study (when each participant finished their 20 stimulation sessions). Secondary outcomes were change in Insomnia Severity Index (ISI), and the Short Form 36 Health Survey (SF-36) scores (8 domains). Results: One participant allocated to the sham group withdrew from the study. The mean (SD) number of weeks it took to complete the 20 stimulation sessions was 5.8. The active group had a statistically greater reduction in GAD-7 score compared to the sham group (-7.4 versus -2.2, P < .001; respectively). A total of 97% (n = 33) of the active group achieved a clinically meaningful reduction (defined as ≥4-point reduction) in GAD-7 from baseline to the follow up visit compared to 24% (n = 6) of the sham group (P < .001). Additionally, the active group showed a significant improvement in ISI (-4.9 versus 2.2, P < .001) and greater improvements on all eight SF36 domains (P < .001) compared with the sham group. There was no device related reported adverse events. Conclusion: Regular non-invasive electrical vestibular nerve stimulation appears to have a clinically meaningful benefit when used as an intervention for Generalized Anxiety Disorder.

Unmet needs and barriers to navigating care services in the low- and middle-income families with young children in Singapore: a qualitative study

INTRODUCTION

Children's health and health behaviours primarily depend on their parental socioeconomic status backgrounds. There is limited research seeking to understand in depth the health needs and challenges of low- to middle-income families in Singapore. Understanding this can help the healthcare professional identify vulnerable families at an early stage, allowing for targeted interventions and preventive measures to address socioeconomic comorbidities and their consequences during childhood.

OBJECTIVES

To explore the health needs of the low- and middle-income families with children aged 2 months to 6 years in Singapore, and their facilitators and barriers to engagement in existing health, social and education services.

METHODS

An interpretive qualitative approach was adopted in this study. We conducted 34 semi-structured one-to-one interviews with purposively sampled low- and middle-income families with children aged 2 months to 6 years. In addition, four focus group discussions comprising 19 service providers were conducted to complement the findings. All interviews were transcribed verbatim. Thematic analysis was conducted to identify key themes and subthemes.

RESULTS

The bottom two tiers of Maslow's Hierarchy of Needs (physical, safety and security needs) constituted the larger proportion of unmet needs expressed by families. Physical needs encompassed food, exercise, sleep, screen time as well as needs related to smoking and alcohol consumption, while safety and security needs included social security needs, educational needs and physical health. Themes identified as enablers of service engagement included accessibility and convenience, financial and policy support, health awareness and engagement, trust and relationship-based engagement, interagency and technological support, and holistic family and workforce support. Conversely, themes identified as barriers to service engagement consisted of access and utilisation barriers, financial and policy inequities, challenges in information management and service coordination, and service delivery and support gaps.

CONCLUSIONS

Our analysis assembled an objective picture of challenges and strengths in relation to the health status of caregivers and their children from low- and middle-income families. Good interpersonal relationships with families, improved health literacy, readily available competent healthcare professionals, better access to social services and financial assistance, and enhanced health information technology help overcome challenges faced by low- to middle-income households.

Sleep Health and Psychological Wellbeing in Adult Women: A Specific Focus on Endometriosis-A Survey Study

Background: Endometriosis is a chronic, oestrogen-sensitive inflammatory disease, which can have a significant impact on women's wellbeing. Nevertheless, the sleep health of this population has been poorly investigated. This exploratory study aimed at describing sleep health, psychological wellbeing, and prevalence of endometriosis among a sample of female students and at evaluating the impact of endometriosis on sleep health and psychological wellbeing in women suffering from the disease. Methods: Women were recruited with a two-stage procedure in a cross-sectional study using online questionnaires: Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Difficulties in Emotion Regulation Scale-Short form. Furthermore, specific questions were used to measure the five dimensions of sleep health: satisfaction, vigilance, efficiency, duration, and timing. Results: In the first stage of the enrolment procedure, 1068 students (18-45 years old) responded to the questionnaire, and 8.7% reported a physician diagnosis of endometriosis. Additionally, in the second stage of the enrolment procedure, 75 women were recruited through social media and reported a diagnosis of endometriosis. Then, all women with endometriosis (169) were age-matched with 169 women without the disease. Multivariate regression analyses showed a bidirectional association between sleep health and psychological wellbeing in the matched sample. Independent samples t-test showed that women with endometriosis reported more severe insomnia symptoms and lower psychological wellbeing than controls. Statistically significant differences were also found in global sleep health and satisfaction, vigilance, and efficiency. Among women with endometriosis, pain and anxiety symptoms were bidirectionally associated, while sleep health was significantly associated with disease stage and psychological difficulties. Conclusions: Considering and treating sleep difficulties in this population may contribute to an improvement in psychological wellbeing and quality of life.

Effect of solution focused approach on women aged 35 or over with in vitro fertilization-embryo transfer: A quasi-experimental trial

BACKGROUND

We aimed to explore the influence of solution-focused approach (SFA) on anxiety and depression, sleep quality, quality of life and clinical pregnancy rate among women aged 35 or over undergoing in vitro fertilization-embryo transfer (IVF-ET).

METHODS

The study was performed at the reproductive center in a public hospital in Lanzhou city. Totally, 112 women were enrolled in this study, and were divided into group SFA (n = 56) and group control (n = 56). The patients in the group SFA completed five sessions (30 minutes/turn), and patients in the group control received routine care.

RESULTS

The intervention group showed a significant decrease in anxiety (t =  11.906, P <  0.001) and depression scores (t =  14.991, P <  0.001), as well as PSQI scores (t =  7.055, P <  0.001), and increased FertiQoL scores (t =  -2.828, P <  0.001). Comparing the two groups after the intervention, the intervention group demonstrated significantly lower SAS scores (t =  -10.348, P <  0.001), SDS scores (t =  -8.416, P <  0.001), and PSQI scores (t =  -5.087, P <  0.001), while FertiQoL scores were higher than the control group (t =  2.389, P =  0.019). The intervention group reported a satisfaction rate of 96.2% to 100% with the SFA.

CONCLUSIONS

SFA can help relieve anxiety and depression, improve sleep quality and reproductive life quality. Improvement in psychological distress might not contribute to increasing female fecundity. Patients in the group SFA were satisfied with the intervention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300075444).

Socio-Demographic, Nutritional, and Lifestyle Factors Influencing Perceived Sleep Quality in Spain, with a Particular Focus on Women and Young People

Objectives: This study examines the relationship between nutrition, lifestyle habits, and perceived sleep quality in a cross-sectional analysis of 22,181 Spanish adults. Methods: Data were collected between August 2020 and November 2021 using the Nutritional and Social Healthy Habits (NutSo-HH) questionnaire, which assessed variables such as sleep duration, self-perceived restfulness, dietary patterns, and physical activity. Results: Findings indicate that 48.9% of participants sleep 7-8 h per night, while 8.6% sleep less than 6 h. Approximately 50% report frequently feeling rested, whereas 45.4% seldom or sometimes feel rested. Non-parametric Mann-Whitney and Kruskal-Wallis tests with Dwass-Steel-Critchlow-Fligner (DSCF) correction revealed that perceived sleep quality had an average score of 3.39 on a 0-5 scale, with significant differences based on socio-demographic and lifestyle factors (p < 0.001 for sex, age, education, income, and living in a family). Participants with sufficient sleep reported a lower BMI, a higher nutritional index, and more weekly physical activity. A network analysis demonstrated strong clustering between sleep variables and eating behaviors. Although causality cannot be established in this observational study, the results suggest that better sleep is associated with the lower consumption of sugary drinks and ultra-processed foods, as well as improved body image and mental health. Conclusions: These findings highlight the interconnectedness of sleep, nutrition, and lifestyle habits, suggesting that targeted interventions in any of these areas could positively influence the others, ultimately improving overall health outcomes.

Impact of insomnia: Cultural and societal aspects from a European survey

OBJECTIVES

This European study explored the cultural and societal aspects of chronic insomnia by means of a survey undertaken in France, Germany, Italy, Spain, and the United Kingdom. The primary objectives were to understand the impact of insomnia on the daily lives of patients, both personally and professionally, and to evaluate the patients' perceptions and coping strategies thus identifying cultural differences in the management of this disorder.

METHODS

Based on online panels targeting insomnia sufferers, the survey included 755 patients aged 35 to 65 years with moderate to severe insomnia for at least three months, occurring at least three times per week (DSM-5 criteria for insomnia disorder, ISI score 15-28). Topics covered included the impact of insomnia on daily life, strategies for coping and managing insomnia, and patients' perceptions and views of insomnia.

RESULTS

A total of 755 patients completed the questionnaire. Most respondents were women (70%) and between 35 and 49 years of age (50%). About half of the patients (49%) had severe insomnia, with 49% experiencing it for over three years. Nearly 70% did not initially consider their insomnia serious, and 73% believed their condition would improve over time. Stress (39%), difficulty relaxing in the evening (37%), and a rapid flow of thoughts (37%) were identified as the main causes of insomnia. Insomnia was shown to significantly affect daily life, particularly work performance, relationships, and maintaining healthy habits. British patients were the most affected, with 85% reporting decreased work performance. In France, only 51% reported difficulties maintaining relationships. There were 77% of Britons who felt exposed to dangerous situations, such as drowsiness while driving (47%). Coping strategies varied by country but, overall, breathing exercises (43%), meditation (32%), and reducing caffeine intake (44%) were the most popular. Healthcare consultation approaches also varied. French patients consulted general practitioners (89%) but rarely specialists, while Germans consulted sleep specialists (20%) and psychiatrists (19%). Overall, 61% reported that doctors recommended lifestyle changes.

CONCLUSIONS

The survey highlights cultural differences in insomnia perception and management in Europe. Insomnia is often trivialized, thus delaying management. The results underline the need to raise awareness among patients and healthcare professionals of the importance of insomnia and its consequences on mental and physical health. Addressing chronic insomnia requires a multifaceted approach that includes cultural sensitivity, patient education, and proactive healthcare engagement. By understanding and integrating these elements, healthcare providers can better support patients to manage their condition, ultimately improving their quality of life.

Association of sleep quality and its change with the risk of depression in middle-aged and elderly people: A 10-year cohort study from England

BACKGROUND

Persistently poor sleep quality in young adults is linked to a higher risk of depression. However, the impact of changes in sleep quality on depression risk in middle-aged and older adults remain unclear. This study investigates the association between sleep quality, its changes, and the risk of depression in middle-aged and elderly people.

METHODS

We included 4007 participants (mean age 63.0 ± 7.6 years, 53.0 % women) from the English Longitudinal Study of Ageing. Sleep quality was assessed using the Jenkins Sleep Problems Scale and a global sleep quality question. Depression was evaluated with the Center for Epidemiological Studies Depression Scale and self-reported doctor-diagnosed depression. Multivariable logistic regression, restricted cubic spline curve, and mediation analysis was employed.

RESULTS

After 10 years of follow-up, 777 individuals developed depression. Sleep quality scores positively correlated with depression risk. Among those with good sleep quality, worsening sleep quality increased depression risk (OR = 1.67, 95 % CI: 1.21-2.31). For those with intermediate sleep quality, improved sleep quality reduced depression risk (OR = 0.70, 95 % CI: 0.50-0.98). Conversely, worsening sleep quality increased depression risk (OR = 2.11, 95 % CI: 1.47-3.02). Pain and functional disability partially mediated the association between intermediate/poor sleep quality and depression (9.8 % and 4.2 %, respectively).

LIMITATIONS

Sleep quality is based on self-reported.

CONCLUSIONS

Intermediate, poor, and worsening sleep quality are linked to higher depression risk. Improving sleep quality mitigates depression risk in those with intermediate sleep quality. Sleep quality may influence depression indirectly through pain and functional disability.

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.

Improving access to help with poor sleep across youth mental health services: Interim implementation and clinical outcomes

OBJECTIVES

There is a high, unmet sleep need in young people with mental health difficulties. We took a whole-system approach to improving access to sleep support across a youth mental health system (14-25 years).

METHODS

We used the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to develop an implementation programme (The Better Sleep Programme) incorporating two levels of training: (i) therapeutic practitioners received training and supervision in CBT for insomnia (CBTi) adapted for young people with mental health difficulties, (ii) non-therapeutic practitioners received knowledge and skills workshops. Implementation and clinical outcome measures were collected.

DESIGN

Implementation outcomes of acceptability, adoption, appropriateness, accessibility and fidelity were considered for the programme and CBTi intervention within it. Clinical outcomes for the CBTi intervention covered sleep, wellbeing and personal goals and were evaluated using a pre-post comparison within-subject design.

RESULTS

High levels of attendance and uptake were seen for CBTi training (210 therapeutic practitioners from 18 services) and workshops (270 attendees from 29 services). Five of the six core service areas trained were routinely offering the CBTi intervention. Significant improvements were seen across all clinical outcome measures (n = 83, p ≤ 0.001 to p ≤ 0.05) with moderate to large effect sizes observed across measures of sleep (d = 0.61-1.35), mental health (d = 0.57-1.26) and personal goals (d = 1.77).

CONCLUSIONS

This centrally-funded, system-wide implementation programme shows significant promise as a means of improving sleep in young people with mental health difficulties. High uptake with encouraging clinical outcomes was seen across services. Further evaluation is required to establish sustainability and generalizability.

Protocol and design of the REPOSE study: a double-blinded, randomised, placebo-controlled trial to evaluate the efficacy of suvorexant to improve postoperative sleep and reduce delirium severity in older patients undergoing non-cardiac surgery

INTRODUCTION

Postoperative delirium occurs in up to 40% of older surgical patients and has been associated with prolonged hospital stays, long-term cognitive impairment and increased 1-year postoperative mortality. Postoperative sleep disturbances may increase the risk of delirium, but studies investigating pharmacotherapies to improve postoperative sleep to prevent delirium remain limited. Suvorexant is a selective antagonist of orexin 1 and 2 receptors and is approved for insomnia pharmacotherapy by the Food and Drug Administration. It has the potential to improve postoperative sleep and reduce postoperative delirium rates, but randomised controlled trials (RCTs) are needed to determine the efficacy of postoperative suvorexant administration. The REPOSE study (reducing delirium by enhancing postoperative sleep with suvorexant) is a single-centre, randomised, double-blinded RCT that aims to evaluate the efficacy of suvorexant in increasing total sleep time (TST) and decreasing delirium severity in older patients undergoing non-cardiac surgery.

METHODS AND ANALYSIS

REPOSE will enroll 130 patients (aged ≥65 years) undergoing non-cardiac surgery with a planned postoperative inpatient stay. Participants will be randomised to receive 20 mg oral suvorexant or placebo nightly on postoperative nights 0, 1 and 2. The primary endpoint is TST on the first postoperative night, as measured using an electroencephalography headband. The secondary endpoint is peak postoperative delirium severity as measured by the 3-minute diagnostic interview for the confusion assessment method severity scores. Primary endpoint data will be analysed with a two-sample t-test using an intent-to-treat approach to compare TST on the first night that a patient received a study drug dose. Secondary and exploratory endpoint data will be analysed using two-sample t-tests between groups.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Duke Institutional Review Board (protocol #00111869). Results of the REPOSE study will be published in a peer-reviewed journal and presented at academic conferences. Trial data will be deposited in ClinicalTrials.gov.

TRIAL REGISTRATION NUMBER

NCT05733286.

Temporomandibular disorders and mental health: shared etiologies and treatment approaches

The biopsychosocial model suggests that temporomandibular disorders (TMDs) often coexist with mental health disorders, particularly depression and anxiety, affecting a significant portion of the global population. The interplay between TMDs and mental health disorders contributes to a complex comorbidity, perpetuating a cycle of mutual influence and reinforcement. This review investigates the neurobiological mechanisms and epidemiological evidence supporting the shared etiology of TMDs and mental health disorders, exploring potential shared vulnerabilities and bidirectional causal relationships. Shared vulnerabilities between TMDs and mental health disorders may stem from genetic and epigenetic predispositions, psychosocial factors, and behavioral aspects. Inflammatory cytokines, neurotransmitters, neurotrophins, and neuropeptides play pivotal roles in both peripheral and central sensitization as well as neuroinflammation. Brain imaging studies suggest that TMDs and mental health disorders exhibit overlapping brain regions indicative of reward processing deficits and anomalies within the triple network model. Future research efforts are crucial for developing a comprehensive understanding of the underlying mechanisms and confirming the reciprocal causal effects between TMDs and mental health disorders. This review provides valuable insights for oral healthcare professionals, stressing the importance of optimizing treatment strategies for individuals dealing with concurrent TMDs and mental health issues through a personalized, holistic, and multidisciplinary approach.

Time trends and predictors of difficulties in getting to sleep among adolescents from six Nordic countries 2002-2018

AIMS

Sleep difficulties among adolescents are of a significant concern given its associations with adverse health outcomes. The aims of the present study were to examine trends and predictors of self-perceived difficulties in getting to sleep among adolescents in the Nordic countries.

METHODS

The study was based on cross-sectional data from 10- to 17- year-olds (N = 139,799) from six Nordic countries (Sweden, Iceland, Norway, Denmark, Greenland, and Finland) participating in the international Health Behaviour in School-aged Children (HBSC) study, collected via six survey rounds in the period 2002-2018.

RESULTS

Since 2002, the prevalence of self-perceived difficulties in getting to sleep has risen in all Nordic countries. However, from 2014 to 2018, the trend of adolescents reporting difficulty more than weekly increased in Denmark, Finland, Greenland, and Norway, whereas it was mostly stable in Sweden, and Iceland showed a reduction. Predictors of difficulties in getting to sleep varied across countries, but younger age, reduced life satisfaction, decreased physical activity, feeling low, and feeling nervous were common predictors across the six countries. Gender and perceived family wealth had different effects on difficulties getting to sleep in different countries.

CONCLUSIONS

Prevalence of and trends in difficulties getting to sleep varied by country, with a concerning rise identified in Greenland, 2006-2018. Predictors such as feeling low, feeling nervous, age, gender, life satisfaction, physical activity, and perceived family wealth varied by country and thus emphasize the need for tailored interventions to address diverse challenges in adolescent sleep health.

Raptin, a sleep-induced hypothalamic hormone, suppresses appetite and obesity

Sleep deficiency is associated with obesity, but the mechanisms underlying this connection remain unclear. Here, we identify a sleep-inducible hypothalamic protein hormone in humans and mice that suppresses obesity. This hormone is cleaved from reticulocalbin-2 (RCN2), and we name it Raptin. Raptin release is timed by the circuit from vasopressin-expressing neurons in the suprachiasmatic nucleus to RCN2-positive neurons in the paraventricular nucleus. Raptin levels peak during sleep, which is blunted by sleep deficiency. Raptin binds to glutamate metabotropic receptor 3 (GRM3) in neurons of the hypothalamus and stomach to inhibit appetite and gastric emptying, respectively. Raptin-GRM3 signaling mediates anorexigenic effects via PI3K-AKT signaling. Of note, we verify the connections between deficiencies in the sleeping state, impaired Raptin release, and obesity in patients with sleep deficiency. Moreover, humans carrying an RCN2 nonsense variant present with night eating syndrome and obesity. These data define a unique hormone that suppresses food intake and prevents obesity.