Estimating individual optimal sleep duration and potential sleep debt

The effects of daylight saving time clock changes on accelerometer-measured sleep duration in the UK Biobank

We explored the effects of daylight saving time clock changes on sleep duration in a large accelerometer dataset. Our sample included UK Biobank participants (n = 11,780; aged 43-78 years) with accelerometer data for one or more days during the 2 weeks surrounding the Spring and Autumn daylight saving time transitions from October 2013 and November 2015. Between-individual t-tests compared sleep duration on the Sunday (midnight to midnight) of the clock changes with the Sunday before and the Sunday after. We also compared sleep duration on all other days (Monday-Saturday) before and after the clock changes. In Spring, mean sleep duration was 65 min lower on the Sunday of the clock changes than the Sunday before (95% confidence interval -72 to -58 min), and 61 min lower than the Sunday after (95% confidence interval -69 to -53). In Autumn, the mean sleep duration on the Sunday of the clock changes was 33 min higher than the Sunday before (95% confidence interval 27-39 min), and 38 min higher than the Sunday after (95% confidence interval 32-43 min). There was some evidence of catch-up sleep after both transitions, with sleep duration a little higher on the Monday-Friday than before, although this was less pronounced in Autumn. Future research should use large datasets with longer periods of accelerometer wear to capture sleep duration before and after the transition in the same individuals, and examine other aspects of sleep such as circadian misalignment, sleep fragmentation or daytime napping.

Association of weekend catch-up sleep with depression: A systematic review and meta-analysis

BACKGROUND

Weekend catch-up sleep (WCS) may alleviate weekday sleep deprivation, but its relationship with depression risk remains unclear. This systematic review and meta-analysis aims to explore the association between WCS and depression risk.

METHODS

A comprehensive search was conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus for observational studies published up to June 1, 2024. Data extraction and bias assessment were independently performed by two reviewers. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated, with model selection based on the I2 statistic. Sensitivity analyses and publication bias tests were also conducted.

RESULTS

A total of ten cross-sectional studies (326,871 participants) were included. Meta-analysis showed that WCS was significantly associated with a reduced risk of depression (OR = 0.80, 95 % CI: 0.68-0.90). Subgroup analyses showed moderate amounts of WCS (0-2 h) may be protective, but WCS beyond 2 h had limited protective effects against depression. Qualitative analyses showed that the protective effect of WCS against depression was more pronounced in men and middle-aged adults, and was particularly applicable to those who were sleep-deprived on weekdays.

LIMITATIONS

The cross-sectional design of included studies limits causality inference, and the sample primarily represents populations from the United States and South Korea, potentially affecting generalizability.

CONCLUSIONS

Moderate WCS is associated with lower depression risk in those with weekday sleep deficits, while excessive WCS may have diminishing or adverse effects. Further research should examine optimal WCS duration and underlying mechanisms.

Daily sleep and physical activity from accelerometry in adults: Temporal associations and lag effects

OBJECTIVES

Insufficient sleep is linked to various health issues, while physical activity is a protective measure against chronic diseases. Despite the importance of sleep and physical activity for supporting public health, there remains scant research investigating daily and cumulative associations between objectively measured physical activity and sleep. Understanding the associations of physical activity and sleep behaviors over multiple days may inform the efficacy of interventions to synergistically support both behaviors.

METHOD

Data were from the Community of Mine study (N=367 with complete data). Participants wore ActiGraph GT3X+ accelerometers on their wrist and hip for 14days. Sleep was defined as total sleep time (h/night), wakefulness after sleep onset (min), and sleep efficiency (%). Moderate to vigorous physical activity was defined as ≥760 counts per minute. Mixed-effects linear models with distributed lag effects, adjusted for age, Hispanic/Latino ethnicity, body mass index, education, smoking, and residence type, investigated the effect of sleep on prospective moderate to vigorous physical activity (and moderate to vigorous physical activity on prospective sleep): on the same or previous day, 2-day lag, and 3-day lag.

RESULTS

An increase in same day, 2-day lag, and 3-day lag moderate to vigorous physical activity was associated with decreased total sleep time. Moderate to vigorous physical activity was not associated with sleep efficiency or wakefulness after sleep onset. An increase in same day and 3-day lag of total sleep time was associated with decreased moderate to vigorous physical activity. An increase in 3-day lag sleep efficiency was associated with decreased moderate to vigorous physical activity. wakefulness after sleep onset was not associated with moderate to vigorous physical activity.

CONCLUSIONS

These insights contribute to understanding the dynamic interplay between moderate to vigorous physical activity and sleep in adults, highlighting same day and cumulative associations.

Impact of exposure to extremely low-frequency magnetic fields on blood pressure, heart rate variation and disturbance to quality of sleep on industrial workers in Korea

OBJECTIVES

This study investigates the potential health risks associated with exposure to extremely low-frequency magnetic fields (ELF-MFs), focusing on the impact on sleep quality. The hypothesis is that increasing ELF-MF exposure will correlate with elevated blood pressure (BP), altered heart rate (HR) dynamics and poorer sleep quality among occupational workers in Korea.

METHODS

The study involved 85 participants. Assessment of ELF-MF exposure was carried out continuously for 24 h in the two groups. Measurements of BP parameters, HR and sleep quality were conducted accordingly.

RESULTS

The study found significant ELF-MF exposure levels in both working and sleeping times for industrial factory workers (0.19 ± 0.38 and 0.17 ± 0.23 µT, p < 0.05). Long-term exposure among industrial workers may contribute to a significant difference in systolic blood pressure (SBP) (125.61 ± 9.60 mm Hg, p < 0.05). Additionally, a significant difference in deep sleep analysis was observed between the high-exposure and low-exposure groups (67.13 ± 31.15 min, p < 0.05).

CONCLUSION

The hypothesis was confirmed, indicating possible effects of high ELF-MF exposure on SBP and deep sleep. However, further research on long-term exposure and its association with sleep quality disturbances is needed for validation.

Genome-wide identification and functional validation of the WW domain containing oxidoreductase gene associated with sleep duration

Individual differences in sleep duration have been reported, and genetic components of sleep duration have been identified showing various heritability. To identify genetic variants that contribute to sleep duration, we conducted a human genome-wide identification on sleep duration and performed confirmatory experiments using a Drosophila model. Genome-wide association study in human was analyzed to determine the association of the genetic variants with self-aware sleep duration from two community-based cohort, Ansan (cohort 1, n = 4635) and Ansung (cohort 2, n = 4205), recruited from the Korean Genome and Epidemiology Study. Individual single nucleotide variants (rs16948804 and rs4887991) in the WW domain containing oxidoreductase (WWOX) gene were associated with self-aware sleep duration in human (p-values, 1.11 × 10- 7 and 2.05 × 10- 7, retrospectively). To examine the functional relevance of the WWOX gene identified in the genome-wide association study, we analyzed the sleep duration of Drosophila loss-of-function mutants. The deletion of Wwox in flies reduced sleep duration and quality with average bout length during daytime and increased night-time sleep duration (all of p-values < 0.01). Our findings suggested that WWOX expression is associated with sleep duration in both humans and Drosophila and genetic factors play a role in inter-individual variability in sleep characteristics.

Discrepancies between subjective and objective sleep assessments revealed by in-home electroencephalography during real-world sleep

Sleep insufficiency and sleep disorders pose serious health challenges. This study aimed to determine the potential discrepancy between subjective and objective sleep assessments, including the latter made by physicians, by analyzing a 421-participant dataset in Japan comprising multiple nights of in-home sleep electroencephalogram (EEG) data and questionnaire responses on sleep habits or subjective experiences. We employed logistic regression models to examine which subjective and objective sleep parameters physicians are paying attention to when assessing sleep insufficiency, insomnia, sleep quality, and sleep apnea. Questionnaire responses, including subjective sleep assessments, exhibited poor performance predicting physicians' assessments, whereas objective data demonstrated good predictive performance, indicating a discrepancy between subjective and objective sleep assessments. Although the in-home sleep EEG measurements had minimal first night effects, incorporating measurements over multiple nights can improve the detection of objective insomnia. Moreover, we found that participants with severe sleep insufficiency overestimated their sleep duration, whereas those with subjective insomnia but without objective insomnia underestimated it. Additionally, subjective sleep quality reflected sleep efficiency but not the frequency of short awakenings or objective sleep depth. In particular, the effects of apnea on objective sleep quality were not subjectively perceived. Collectively, our findings suggest that subjective sleep assessments alone are insufficient for evaluating sleep health and that health checkups and advice based on sleep EEG measurements may be useful in improving sleep habits and for early detection of sleep disorders.

Biometrically measured sleep in medical students as a predictor of psychological health and academic experiences in the preclinical years

BACKGROUND

Student wellness is of increasing concern in medical education. Increased rates of burnout, sleep disturbances, and psychological concerns in medical students are well documented. These concerns lead to impacts on current educational goals and may set students on a path for long-term health consequences.

METHODS

Undergraduate medical students were recruited to participate in a novel longitudinal wellness tracking project. This project utilized validated wellness surveys to assess emotional health, sleep health, and burnout at multiple timepoints. Biometric information was collected from participant Fitbit devices that tracked longitudinal sleep patterns.

RESULTS

Eighty-one students from three cohorts were assessed during the first semester of their M1 preclinical curriculum. Biometric data showed that nearly 30% of the students had frequent short sleep episodes (<6 hours of sleep for at least 30% of recorded days), and nearly 68% of students had at least one episode of three or more consecutive days of short sleep. Students that had consecutive short sleep episodes had higher rates of stress (8.3%) and depression (5.4%) symptoms and decreased academic efficiency (1.72%).

CONCLUSIONS

Biometric data were shown to significantly predict psychological health and academic experiences in medical students. Biometrically assessed sleep is poor in medical students, and consecutive days of short sleep duration are particularly impactful as it relates to other measures of wellness. Longitudinal, biometric data tracking is feasible and can provide students the ability to self-monitor health behaviors and allow for low-intensity health interventions.

Metabolic and vascular imaging markers for investigating Alzheimer's disease complicated by sleep fragmentation in mice

Background

Sleep problem is a common complication of Alzheimer's disease (AD). Extensive preclinical studies have been performed to investigate the AD pathology. However, the pathophysiological consequence of AD complicated by sleep problem remains to be further determined.

Purpose

To investigate brain metabolism and perfusion in an AD mouse model complicated by sleep problem, and subsequently identify potential imaging markers to better understand the associated pathophysiology.

Methods

We examined the oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO2), and cerebral blood flow (CBF) using state-of-the-art MRI techniques in a cohort of 5xFAD model mice. Additionally, neuroinflammation, indicated by activated microglia, was assessed using histology techniques. Sleep fragmentation (SF) was utilized as a representative for sleep problems.

Results

SF was associated with significant increases in OEF (P = 0.023) and CMRO2 (P = 0.029), indicating a state of hypermetabolism. CBF showed a significant genotype-by-sleep interaction effect (P = 0.026), particularly in the deep brain regions such as the hippocampus and thalamus. Neuroinflammation was primarily driven by genotype rather than SF, especially in regions with significant interaction effect in CBF measurements.

Conclusion

These results suggest that brain metabolism and perfusion measurements are promising markers for studying the co-pathogenesis of AD and SF.

Re-Evaluating Recommended Optimal Sleep Duration: A Perspective on Sleep Literacy

A significant number of adolescents experience sleepiness, primarily due to sleep deprivation. The detrimental effects of inadequate sleep on both physical and mental health are well documented, particularly during adolescence-a critical developmental stage that has far-reaching implications for later life outcomes. The International Classification of Diseases 11th Revision recently introduced the disorder termed 'insufficient sleep syndrome,' characterized by a persistent reduction in sleep quantity. However, diagnosing this condition based solely on sleep duration is challenging due to significant individual variation in what constitutes optimal sleep. Despite this, managing sleep debt remains difficult without a clear understanding of individual optimal sleep needs. This review aims to reassess recommended sleep durations, with a focus on enhancing sleep literacy. Beginning with an exploration of insufficient sleep syndrome, this review delves into research on optimal sleep duration and examines foundational studies on sleep debt's impact on the developing brain. Finally, it addresses the challenges inherent in sleep education programs from the perspective of sleep literacy. By doing so, this review seeks to contribute to a deeper understanding of the chronic sleep debt issues faced by adolescents, particularly those affected by insufficient sleep syndrome.

Validation of the French version of the Munich ChronoType questionnaire and associations between chronotype and physiological parameters

Assessing chronotype is essential in clinical and research environments, but the Munich ChronoType Questionnaire (MCTQ), a widely utilised tool, is not available in French. Therefore, we carried out an observational monocentric study to validate the French MCTQ against the sleep diary for sleep schedules, the Morningness-Eveningness Questionnaire (MEQ) for chronotype, and polysomnography measures. We utilised the mid-sleep point on free days (MSF), adjusted for sleep debt (MSFsc), to gauge morningness/eveningness. The study included 80 participants (average age: 40.9 years, 50% female). The sleep schedules determined by the MCTQ and the sleep diary showed a high correlation. The MSFsc demonstrated a significant correlation with the MEQ, persisting even under sleep constraints such as an alarm on free days. The predictive accuracy was strong for a morning chronotype and moderate for an evening chronotype as assessed using the MEQ. In summary, the French MCTQ is a reliable tool for researchers and clinicians for assessing sleep schedules and chronotype in French-speaking populations. The MSFsc can effectively predict chronotype, even under sleep constraints. However, for the evening chronotype, self-assessment appears to be more accurate. The association with polysomnography measures enriches our understanding of the chronotype at the intersection of behaviour and physiology.

Presenteeism and sleep duration on workdays and days off

BACKGROUND

Presenteeism refers to being present at work but experiencing reduced productivity due to health problems, and has been known to be related to sleep loss. Workers commonly sleep longer on days off than on workdays, and presenteeism may be reduced with extended sleep on days off.

AIMS

This study aimed to determine the association between sleep duration both on workdays and days off and presenteeism.

METHODS

The participants were 1967 workers who engaged in work for 5 days and rested for 2 days weekly. Sleep duration was classified into less than 6 hours (short; S), 6-8 hours (medium; M), and 9 hours or longer (long; L), for workdays and days off, respectively. Presenteeism was assessed using the World Health Organization Health and Work Performance Questionnaire.

RESULTS

On both workdays and days off, compared to medium sleep duration, short sleep duration was significantly associated with increased odds of presenteeism. The odds of presenteeism were significantly increased for S-S (odds ratio [OR] 2.17, 95% confidence interval [CI]1.40-3.37), S-M (OR 1.59, 95% CI 1.14-2.22), S-L (OR 2.71, 95% CI 1.05-7.00), and M-S (OR 6.82, 95% CI 2.71-17.17) combined sleep duration for workdays and days off, respectively, compared to an M-M (reference).

CONCLUSIONS

Sleep loss on workdays cannot be compensated for with longer sleep on days off. This study suggests that sufficient sleep duration on both workdays and days off is important for reducing presenteeism.

Randomized Controlled Trial of Virtually Delivered Cognitive Behavioral Therapy for Insomnia to Address Perceived Cancer-Related Cognitive Impairment in Cancer Survivors

PURPOSE

Comorbid insomnia and cancer-related cognitive impairment (CRCI) are experienced by up to 26% of individuals diagnosed with cancer. This study examined the efficacy and durability of cognitive behavioral therapy for insomnia (CBT-I) on perceived CRCI in cancer survivors.

METHODS

Atlantic Canadian cancer survivors with insomnia and CRCI were randomly assigned to receive seven weekly virtual CBT-I sessions (n = 63) or placed in a waitlist control group (n = 69) to receive treatment after the waiting period. Participants completed assessments at baseline, 1 month (mid-treatment), and 2 months (post-treatment). Age- and education-adjusted mixed-effects models using intention-to-treat principles assessed change at post-treatment. Data from both groups were then pooled to assess the durability of effects at 3 and 6 months. A mediation analysis examined whether change in insomnia symptoms mediated the effect of CBT-I on cognitive outcomes.

RESULTS

The mean age of the sample was 60 years, 77% were women, and breast cancer was the most common diagnosis (41%). The treatment group reported an 11.35-point reduction in insomnia severity, compared with a 2.67-point reduction in the waitlist control group (P < .001). The treatment group had a greater overall improvement than the waitlist control on perceived cognitive impairment (P < .001; d = 0.75), cognitive abilities (P < .001; d = 0.92), and impact on quality of life (P < .001; d = 1.01). These improvements were maintained at follow-up. Change in insomnia symptoms fully mediated the effect of CBT-I on subjective cognitive outcomes.

CONCLUSION

Treating insomnia with CBT-I produces clinically meaningful and durable improvements in CRCI. There is an urgent need increase access to evidence-based treatment for insomnia in cancer centers and the community.

Evolution of Sleep Duration and Screen Time Between 2018 and 2022 Among Canadian Adolescents: Evidence of Drifts Accompanying the COVID-19 Pandemic

PURPOSE

We quantified the joint evolution of sleep duration and screen time between 2018 and 2022 in a large sample of adolescents from Quebec, Canada, to ascertain changes that occurred during the COVID-19 pandemic.

METHODS

A natural experiment design was used to compare variations from year to year and in association with the pandemic outbreak. Using structural equation modeling on data collected between 2018 and 2022 among adolescents attending 63 high schools, we analyzed the joint evolution of sleep duration and screen time while adjusting for previous year values, concurrent flourishing score, sex, age, and family level of material deprivation.

RESULTS

A total of 28,307 adolescents, aged on average 14.9 years, were included in the analyses. Between 2019 and 2022, sleep duration increased by 9.6 (5.7, 13.5) minutes and screen time by 129.2 (120.5, 138.0) minutes on average. In 2022, the adolescents spent almost equal amounts of time sleeping and using screens. Lower flourishing scores were associated with shorter sleep duration and lengthier screen time. Girls' screen time became similar to boys' over time.

DISCUSSION

Adolescents now spend almost equal amounts of time sleeping and using screens, a situation that calls for urgent public health actions. These findings highlight the importance of tracking changes in adolescents' behaviours over time, to design and implement interventions adapted to the changing health needs of different groups.

The effects of social jetlag and sleep variability on sleepiness in a population-based study: The mediating role of sleep debt

Sleepiness is a multicausal condition, and previous research has highlighted associations between this symptom and the circadian timing system, specifically concerning social jetlag and sleep variability. Recent inquiries have shown that the effects of social jetlag on sleepiness can be confounded with the consequences of sleep debt. In light of the current evidence, we aimed to assess the effects of social jetlag and sleep variability on sleepiness and the potential mediating role of sleep debt. We used data from the EPISONO study, a cross-sectional population-based study with a sample size of 1042 participants, representative of the city of Sao Paulo, Brazil. Participants completed the UNIFESP Sleep Questionnaire (self-reported bedtime and get-up time) and the Epworth Sleepiness Scale (subjective daytime sleepiness). Subsequently, sleep-corrected mid-sleep time (chronotype), total sleep time, social jetlag (absolute difference between the mid-sleep time on workdays and mid-sleep time on free days), sleep variability (standard deviation of mid-sleep time), and sleep debt (difference between total sleep time on workdays and free days) were calculated. Generalised linear models were used to test whether social jetlag and sleep variability affected sleepiness. Mediation models were used to determine if any observed significant effects were mediated by sleep debt. The prevalence of social jetlag was 23% for >1 h and 12% for >2 h. The mean sleep variability was 41 ± 30 min. Social jetlag had a significant effect on the Epworth Sleepiness Scale scores. This association was no longer statistically significant after controlling for age, sex, body mass index, work schedule, and chronotype. A significant indirect effect of social jetlag on sleep debt and subsequently on the Epworth Sleepiness Scale scores was found. No effect of sleep variability on sleepiness could be identified. In conclusion, the association between social jetlag and sleepiness was mediated by sleep debt but was not independent of demographic, work, and chronotype variables. This study provides new evidence on the importance of circadian misalignment and sleep debt for sleep health on a population level.

Reaction of the endogenous regulatory mechanisms to early weekday wakeups: a review of its popular explanations in light of model-based simulations

Introduction: Several widely held explanations of the mechanisms underlying the responses of endogenous sleep-wake-regulating processes to early weekday wakeups have been proposed. Here, they were briefly reviewed and validated against simulations based on the rhythmostatic version of a two-process model of sleep-wake regulation. Methods: Simulated sleep times on weekdays and weekends were compared with the times averaged over 1,048 samples with either earlier or later weekday risetimes. In total, 74 paired samples were collected before and during lockdown, and 93 paired samples were collected during early and later school start times. Results: The counterintuitive predictions of the simulations included the following: 1) only one night of ad lib sleep is sufficient to restore the endogenously determined sleep times after 1 day/5 days of larger/smaller reduction/extension of the sleep/wake phase of the circadian sleep-wake cycle; 2) sleep loss on weekdays is irrecoverable; 3) irrespective of the amount of such deadweight loss, sleep on weekends is not prolonged; and 4) the control of the circadian clocks over the sleep-wake cyclicity is not disrupted throughout the week. Discussion: The following popular explanations of the gaps between weekends and weekdays in sleep timing and duration were not supported by these simulations: 1) early weekday wakeups cause "social jetlag," viewed as the weekend and weekday (back and forth) shifts of the sleep phase relative to the unchanged phase of the circadian clocks, and 2) early weekday wakeups cause an accumulation of "sleep debt paid back" on weekends, or, in other terms, people can "catch-up" or "compensate" sleep on weekends.

The importance of sleep regularity: a consensus statement of the National Sleep Foundation sleep timing and variability panel

OBJECTIVE

To develop and present consensus findings of the National Sleep Foundation sleep timing and variability panel regarding the impact of sleep timing variability on health and performance.

METHODS

The National Sleep Foundation assembled a panel of sleep and circadian experts to evaluate the scientific evidence and conduct a formal consensus and voting procedure. A systematic literature review was conducted using the NIH National Library of Medicine PubMed database, and panelists voted on the appropriateness of 3 questions using a modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting.

RESULTS

The literature search and panel review identified 63 full text publications to inform consensus voting. Panelists achieved consensus on each question: (1) is daily regularity in sleep timing important for (a) health or (b) performance? and (2) when sleep is of insufficient duration during the week (or work days), is catch-up sleep on weekends (or non-work days) important for health? Based on the evidence currently available, panelists agreed to an affirmative response to all 3 questions.

CONCLUSIONS

Consistency of sleep onset and offset timing is important for health, safety, and performance. Nonetheless, when insufficient sleep is obtained during the week/work days, weekend/non-work day catch-up sleep may be beneficial.

Assessing 'readiness' by tracking fluctuations in daily sleep duration and their effects on daily mood, motivation, and sleepiness

STUDY OBJECTIVES

Consumer sleep trackers issue daily guidance on 'readiness' without clear empirical basis. We investigated how self-rated mood, motivation, and sleepiness (MMS) levels are affected by daily fluctuations in sleep duration, timing, and efficiency and overall sleep regularity. We also determined how temporally specific these associations are.

METHODS

119 healthy university students (64 female, mean age = 22.54 ± 1.74 years) wore a wearable sleep tracker and undertook twice-daily smartphone-delivered ecological momentary assessment of mood, motivation, and sleepiness at post-wake and pre-bedtime timings for 2-6 weeks. Naps and their duration were reported daily. Nocturnal sleep on 2471 nights were examined using multilevel models to uncover within-subject and between-subject associations between sleep duration, timing, efficiency, and nap duration on following day MMS ratings. Time-lagged analyses examined the temporal specificity of these associations. Linear regression models investigated associations between MMS ratings and sleep variability, controlling for sleep duration.

RESULTS

Nocturnal sleep durations were short (6.03 ± 0.71 h), and bedtimes were late (1:42AM ± 1:05). Within-subjects, nocturnal sleep longer than a person's average was associated with better mood, higher motivation, and lower sleepiness after waking. Effects of such longer sleep duration lingered for mood and sleepiness till the pre-bedtime window (all Ps < .005) but did not extend to the next day. Between-subjects, higher intraindividual sleep variability, but not sleep duration, was associated with poorer mood and lower motivation after waking. Longer average sleep duration was associated with less sleepiness after waking and lower motivation pre-bedtime (all Ps < .05). Longer naps reduced post-nap sleepiness and improved mood. Controlling for nocturnal sleep duration, longer naps also associated with lower post-waking sleepiness on the following day.

CONCLUSIONS

Positive connections between nocturnal sleep and nap duration with MMS are temporally circumscribed, lending credence to the construction of sleep-based, daily 'readiness' scores. Higher sleep duration variability lowers an individual's post waking mood and motivation.

CLINICAL TRIAL ID

ClinicalTrials.gov NCT04880629.

Emergence of different dimensions of sleepiness in a general population sample: An EPISONO study

INTRODUCTION

Recent evidence supports the idea that sleepiness has several dimensions, comprising psychophysiological phenomena, such as sleep propensity and sleepiness perception. The Epworth Sleepiness Scale (ESS) is among one of the most used sleepiness assessment tools, but recent data suggest that it might not detect problematic impairments in sleep health. More research is warranted investigating sleepiness dimensions with large sample sizes, using both objective and subjective methods of analyzing sleep.

METHODS

We used data from the Epidemiological Sleep Study (EPISONO), a major study carried out in Brazil using a representative sample of 1042 participants of the general population of Sao Paulo city, who completed questionnaires and underwent type I polysomnography. Sleepiness was measured by the ESS (sleep propensity) and the UNIFESP Sleep Questionnaire, which asked about the frequency of feeling sleepy during the day (sleepiness perception). The participants were distributed into 4 groups in respect of excessive daytime sleepiness (EDS) according to the following criteria: 1) having an ESS score >10 (ESS group). 2) feeling sleepy ≥3 times per week (Frequent EDS group). 3) the combined criteria (Combined EDS group). 4) having no evidence of EDS (no EDS group). The UNIFESP Sleep Questionnaire was used to obtain self-reported sleep duration, sleep debt, and sleep duration variability. Participants also completed the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and a pre-polysomnography sleep questionnaire.

RESULTS

After removing participants with missing data, there were 620 participants with no EDS, 255 individuals in the ESS group, 68 in the Frequent EDS group, and 73 in the Combined EDS group. Compared to the no EDS group, the ESS and Combined EDS groups had significantly increased sleep efficiency, diminished sleep latency, wake after sleep onset, and self-reported weekly sleep duration. The Frequent and Combined EDS groups had significantly higher scores in the Insomnia Severity Index and Pittsburgh Sleep Quality Index. All EDS groups had an increased likelihood of nonrestorative sleep. EDS frequency and the ESS scores were significantly correlated.

CONCLUSIONS

Participants with a high sleep propensity had a profile suggesting prior sleep deprivation, while high sleepiness perception was associated with impaired sleep quality. These findings indicated that, in the general population, these instruments evaluated separate sleepiness dimensions with different associations, highlighting that screening using a combination of instruments might be more effective in detecting impairments in sleep health.

Associations between weekend catch-up sleep and health-related quality of life with focusing on gender differences

This study investigated associations between weekend catch-up sleep (WCUS) and health-related quality of life (HRQoL) in 15,837 participants from the 7th (2016-2018) Korea National Health and Nutrition Examination Survey. We categorized WCUS durations into four groups: none (≤ 0 h [h]), short (> 0 h, ≤ 1 h), medium (> 1 h, ≤ 2 h), and long (> 2 h), and performed complex samples logistic regression and likelihood ratio χ2 test. The study found significant associations in women for the European Quality of Life-5 Dimensions (EQ-5D) index and three EQ-5D subdomains (self-care, usual activities, and anxiety/depression) with the WCUS durations, but no significant association in men. Compared to the non-WCUS, the short or medium WCUS was positively associated with the EQ-5D index and EQ-5D subdomains (usual activities and anxiety/depression) in women, while the long WCUS significantly reduced the quality of life in the self-care domain. In an additional subgroup analysis by age, middle-aged and elderly women had a more noticeable effect of WCUS on HRQoL than young women, and the short or medium WCUS improved HRQoL in middle-aged and elderly women in general. Therefore, we recommend appropriate WCUS durations to improve HRQoL, considering both gender and age.

A prospective study of the association of weekend catch-up sleep and sleep duration with mortality in middle-aged adults

Health effects of weekend catch-up sleep (CUS) could differ depending on both the ability to obtain sufficient sleep during weekdays and amount of weekend CUS required to compensate for sleep lost during the week. Using data from 3128 middle-aged (40-64 years) participants of the Sleep Heart Health Study, we examined the longitudinal association of these two aspects of sleep with all-cause mortality. CUS was calculated as the difference in self-reported habitual sleep duration between weekends and weekdays, and classified into no, short (1 h), and long (2 h or more) CUS. Polysomnography-measured total sleep time, representing the ability to obtain sufficient sleep, was classified into short (< 360 min) or normal (≥ 360 min) sleep durations. We estimated multivariable-adjusted mortality hazard ratios (HRs) and 95% confidence intervals (CIs) for six groups divided by the extent of CUS and sleep duration. Participants were followed up for a median (interquartile range) of 12.3 (11.3-13.5) years. Short weekend CUS with normal sleep duration was associated with lower mortality compared to no CUS with normal sleep duration (HR, 0.48; 95% CI 0.27-0.83). When stricter cutoffs were applied for sleep durations, while the protective effect of short CUS with normal sleep duration (≥ 390 min) was strengthened (HR, 0.36; 95% CI 0.17-0.78), the harmful effect of short CUS with short sleep duration (< 330 min) emerged (HR, 1.84; 95% CI 1.08-3.14). Results highlight the importance of balancing sleep ability and CUS. Sufficient sleep may reduce weekday sleep debt and only a short CUS would be required on weekends, improving mortality in middle-aged adults.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00460-6.

Country differences in nocturnal sleep variability: Observations from a large-scale, long-term sleep wearable study

STUDY OBJECTIVES

Country or regional differences in sleep duration are well-known, but few large-scale studies have specifically evaluated sleep variability, either across the work week, or in terms of differences in weekday and weekend sleep.

METHODS

Sleep measures, obtained over 50 million night's sleep from ∼220,000 wearable device users in 35 countries, were analysed. Each person contributed an average of ∼242 nights of data. Multiple regression was used to assess the impact country of residence had on sleep duration, timing, efficiency, weekday sleep variability, weekend sleep extension and social jetlag.

RESULTS

Nocturnal sleep was shorter and had a later onset in Asia than other regions. Despite this, sleep efficiency was lower and weekday sleep variability was higher. Weekend sleep extension was longer in Europe and the USA than in Asia, and was only partially related to weekday sleep duration. There were also cross-country differences in social jetlag although the regional differences were less distinct than for weekend sleep extension.

CONCLUSIONS

In addition to regional differences in sleep duration, cross-country differences in sleep variability and weekend sleep extension suggest that using the latter as an indicator of sleep debt may need to be reconsidered. In countries exhibiting both short sleep and high weekday sleep variability, a culturally different means of coping with inadequate sleep is likely. Country or region differences in culture, particularly those related to work, merit closer examination as factors influencing the variability in normative sleep patterns around the world.

Understanding the Need for Sleep to Improve Cognition

The restorative function of sleep is shaped by its duration, timing, continuity, subjective quality, and efficiency. Current sleep recommendations specify only nocturnal duration and have been largely derived from sleep self-reports that can be imprecise and miss relevant details. Sleep duration, preferred timing, and ability to withstand sleep deprivation are heritable traits whose expression may change with age and affect the optimal sleep prescription for an individual. Prevailing societal norms and circumstances related to work and relationships interact to influence sleep opportunity and quality. The value of allocating time for sleep is revealed by the impact of its restriction on behavior, functional brain imaging, sleep macrostructure, and late-life cognition. Augmentation of sleep slow oscillations and spindles have been proposed for enhancing sleep quality, but they inconsistently achieve their goal. Crafting bespoke sleep recommendations could benefit from large-scale, longitudinal collection of objective sleep data integrated with behavioral and self-reported data.

Do holidays change subjective sleep length or sleep debt in shift work disorder?

In shift work disorder (SWD), disturbed sleep acutely impairs employees' recovery, but little attention has been paid to sleep during longer recovery periods. We examined how holidays affect self-estimated sleep length, sleep debt, and recovery in cases of SWD. Twenty-one shift workers with questionnaire-based SWD and nine reference cases without SWD symptoms completed a questionnaire on recovery and sleep need. They also reported sleep length on two separate occasions: during a work period and after ≥ 2 weeks of holidays. Sleep debt was calculated by subtracting sleep length from sleep need. We used parametric tests to compare the groups and the periods. The groups reported shorter sleep on workdays than during holidays (median difference: SWD group 1.7 h, p<0.001; reference group 1.5 h; p<0.05). The SWD group's self-estimated sleep during holidays increased less above the sleep need (median 0.0 h) than the reference group's sleep (1.0 h, p<0.05). In addition, the SWD group reported good recovery from irregular working hours less often (14%) than the reference group (100%, p<0.001). Although holidays were generally associated with longer sleep estimates than workdays, employees with SWD experienced consistently less efficient recovery than those without SWD.

How the COVID-19 Pandemic Has Changed Adolescent Health: Physical Activity, Sleep, Obesity, and Mental Health

The purpose of this study is to provide essential data for the establishment of education and policy for the formation of healthy lifestyles of adolescents in the future by analyzing the patterns of changes in society due to the prolonged COVID-19 in the physical activities, sleeping habits, obesity, and mental health of Korean adolescents. To this end, a total of 147,346 adolescents were selected and analyzed according to the purpose of the study in the 2018 (14th), 2019 (15th), and 2020 (16th) raw data of the “Youth Health Behavior Online Survey,” an annual national approval statistical survey conducted by a Korean government agency. The study examined changes in the physical activity, obesity, sleep, and mental health of Korean adolescents due to COVID-19. The physical activity rate of Korean adolescents in 2019 decreased by 5.3% from 2018. In addition, the physical activity rate in 2020 decreased by 2.1% compared to 2019. It was found that physical activity steadily decreased (p < 0.001). The obesity rate increased by 0.9% in 2019 compared to 2018 and by 1.8% in 2020 compared to 2019. Although the obesity rate steadily increased, it was found that it was accelerated due to COVID-19 (p < 0.001). Looking at the subjective sleep satisfaction rate of Korean adolescents, in 2019, it was 0.1% lower than in 2018, while in 2020, when COVID-19 began, it increased by 3.5% compared to 2019. It was found that satisfaction with sleep increased after COVID-19. Finally, the mental health characteristics of Korean adolescents by year were divided into stress and depression. Stress decreased by 1% compared to 2019 and 2018 and by 6.2% compared to 2020 and 2019. Depression increased by 1% in 2019 compared to 2018 and decreased by 3.4% in 2020 compared to 2019. In other words, stress and depression decreased after COVID-19. In 2020, when COVID-19 occurred, it was confirmed that there was a change in the health behavior of adolescents compared to 2018 and 2019. Therefore, active responses from schools, families, and communities are required to foster healthy lifestyle habits in social changes such as COVID-19.

A feast-and-famine pattern of sleep: Do railway staff get the sleep they need?

The relationship between sleep and health and wellbeing is receiving increasing attention in our society, following decades of research that has demonstrated the impact of insufficient sleep on performance and health. Fatigue has been identified as a factor in 21% of high-risk incidents in the GB rail industry, and insufficient sleep and long periods of being awake are known to be two key contributors to fatigue. This paper presents evidence from a recent survey conducted in the GB rail industry, which enabled the sleep and wakefulness of railway workers to be quantified. There were 7807 responses to the survey, which represents a very large sample. Responses were primarily collected online, though paper copies were made available in some organisations. Respondents reported sleeping less when working nights, more when working days, and the most on days off, which suggests a feast-and-famine pattern of sleep. 41% were getting 6 h of sleep or less when working days, compared to 63% when working nights. Getting 6 h or less of sleep was associated with excessive daytime sleepiness. Although it is accepted that individuals' sleep requirements vary, the patterns that shift workers reported in this survey suggest that many are not achieving the amount of sleep they need. The findings of the survey presented in this paper highlight that there is work to be done to understand and address the causes of insufficient sleep in railway workers.

Ecological and social pressures interfere with homeostatic sleep regulation in the wild

Sleep is fundamental to the health and fitness of all animals. The physiological importance of sleep is underscored by the central role of homeostasis in determining sleep investment – following periods of sleep deprivation, individuals experience longer and more intense sleep bouts. Yet, most sleep research has been conducted in highly controlled settings, removed from evolutionarily relevant contexts that may hinder the maintenance of sleep homeostasis. Using triaxial accelerometry and GPS to track the sleep patterns of a group of wild baboons (Papio anubis), we found that ecological and social pressures indeed interfere with homeostatic sleep regulation. Baboons sacrificed time spent sleeping when in less familiar locations and when sleeping in proximity to more group-mates, regardless of how long they had slept the prior night or how much they had physically exerted themselves the preceding day. Further, they did not appear to compensate for lost sleep via more intense sleep bouts. We found that the collective dynamics characteristic of social animal groups persist into the sleep period, as baboons exhibited synchronized patterns of waking throughout the night, particularly with nearby group-mates. Thus, for animals whose fitness depends critically on avoiding predation and developing social relationships, maintaining sleep homeostasis may be only secondary to remaining vigilant when sleeping in risky habitats and interacting with group-mates during the night. Our results highlight the importance of studying sleep in ecologically relevant contexts, where the adaptive function of sleep patterns directly reflects the complex trade-offs that have guided its evolution.

An important link between the gut microbiota and the circadian rhythm: imply for treatments of circadian rhythm sleep disorder

Currently, gut microbiota living in the gastrointestinal tract, plays an important role in regulating host's sleep and circadian rhythms. As a tool, gut microbiota has great potential for treating circadian disturbance and circadian insomnia. However, the relationship between gut microbiota and circadian rhythms is still unclear, and the mechanism of action has still been the focus of microbiome research. Therefore, this article summarizes the current evidences associating gut microbiota with factors that impact host circadian rhythms neurology sleep disorder. Moreover, we discuss the changes to these systems in sleep disorder and the potential mechanism of intestinal microbiota in regulating circadian rhythms neurology sleep disorder via microbial metabolites. Meanwhile, based on the role of intestinal flora, it is provided a novel insight into circadian related insomnia and will be benefit the dietary treatment of circadian disturbance and the circadian related insomnia.

Mortality associated with nonrestorative short sleep or nonrestorative long time-in-bed in middle-aged and older adults

Associations of sleep duration with human health could differ depending on whether sleep is restorative. Using data from 5804 participants of the Sleep Heart Health Study, we examined the longitudinal association of sleep restfulness combined with polysomnography-measured total sleep time (TST) or time in bed (TIB), representing different sleeping behaviors, with all-cause mortality. Among middle-aged adults, compared with restful intermediate TST quartile, the lowest TST quartile with feeling unrested was associated with higher mortality (hazard ratio [HR], 1.54; 95% confidence interval [CI] 1.01–2.33); the highest TST quartile with feeling rested was associated with lower mortality (HR, 0.55; 95% CI 0.32–0.97). Among older adults, the highest TIB quartile with feeling unrested was associated with higher mortality, compared with restful intermediate TIB quartile (HR, 1.57; 95% CI 1.23–2.01). Results suggest a role of restorative sleep in differentiating the effects of sleep duration on health outcomes in midlife and beyond.

Feasibility of sleep extension and its effect on cardiometabolic parameters in free-living settings: a systematic review and meta-analysis of experimental studies

AIMS

Inadequate sleep is a global health issue and has been associated with an increased risk for cardiovascular diseases. As a part of sleep hygiene, intentional lengthening of night-time sleep duration (i.e. sleep extension) might be a behavioural intervention to improve cardiometabolic health. To examine the feasibility of sleep extension and its effects on cardiometabolic parameters in free-living settings.

METHODS AND RESULTS

This review was registered in PROSPERO (CRD42019146174). Five databases were searched. Only experimental studies conducted in adults without a diagnosis of sleep disorder were included. The pooled mean difference was calculated by the inverse variance method. Narrative summaries were also used. Thirteen studies from 11 trials were included. The intervention ranged from 3 days to 6 weeks. Sleep extension increased total sleep time by 51 min [95% confidence interval (CI) 39-63]. Overall, sleep extension did not result in significant changes in blood pressure. However, sub-group analysis revealed that when 24 h mean blood pressure was obtained among those with pre-hypertension or Stage 1 hypertension, sleep extension reduced systolic (weighted mean difference = -7.8 mm/Hg; 95% CI -10.6 to -4.9), and diastolic blood pressure (weighted mean difference = -4.2 mm/Hg; 95% CI -6.7 to -1.8). The pooled effects on fasting glucose and insulin resistance were not significant. The effect of sleep extension on other parameters (e.g. heart rate) was not consistent.

CONCLUSION

Sleep extension is feasible and could increase sleep in free-living settings. Sleep extension shows promise for reducing 24 h mean blood pressure among those with pre-hypertension or hypertension. More large-scale studies are needed to examine its long-term effects.

Association between sleep habits/disorders and emotional/behavioral problems among Japanese children

Actual sleep status and the association between sleep habits/disorders and emotional/behavioral problems among children in the development stage have not been fully clarified. A questionnaire survey was conducted on the sleep habits/disorders (Brief Child Sleep Questionnaire; BCSQ) and emotional/behavioral problems (Strengths and Difficulties Questionnaire; SDQ) of 87,548 children enrolled in ordinary classes in nine grade levels from the first grade of elementary school to the third grade of junior high school from December 2009 to April 2010. As school grade increased, children's bedtimes were delayed and sleep duration was reduced by 2.0 h over the nine grade levels. Based on the BCSQ, 18.3% of children were judged to have some type of sleep disorder, and about 30% to 40% of children had sleep symptoms at bedtime, during sleep, and at wake time. Multiple regression analysis showed that emotional and behavioral problems were associated with presence of any sleep symptom, longer sleep latency, and longer awake time after sleep onset, whereas total sleep time was not. Sleep symptoms at wake time were most strongly associated with emotional and behavioral problems. Status of sleep habits/disorders should be considered when interpreting emotional/behavioral problems in school-age children.

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

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

Work Habit-Related Sleep Debt; Insights From Factor Identification Analysis of Actigraphy Data

The present study investigates the factors of “Weekday sleep debt (WSD)” by comparing activity data collected from persons with and without WSD. Since it has been reported that the amount of sleep debt as well the difference between the social clock and the biological clock is associated with WSD, specifying the factors of WSD other than chronotype may contribute to sleep debt prevention. We recruited 324 healthy male employees working at the same company and collected their 1-week wrist actigraphy data and answers to questionnaires. Because 106 participants were excluded due to measurement failure of the actigraphy data, the remaining 218 participants were included in the analysis. All participants were classified into WSD or non-WSD groups, in which persons had WDS if the difference between their weekend sleep duration and the mean weekday sleep duration was more than 120 min. We evaluated multiple measurements derived from the collected actigraphy data and trained a classifier that predicts the presence of WSD using these measurements. A support vector machine (SVM) was adopted as the classifier. In addition, to evaluate the contribution of each indicator to WSD, permutation feature importance was calculated based on the trained classifier. Our analysis results showed significant importance of the following three out of the tested 32 factors: (1) WSD was significantly related to persons with evening tendency. (2) Daily activity rhythms and sleep were less stable in the WSD group than in the non-WSD group. (3) A specific day of the week had the highest importance in our data, suggesting that work habit contributes to WSD. These findings indicate some WSD factors: evening chronotype, instability of the daily activity rhythm, and differences in work habits on the specific day of the week. Thus, it is necessary to evaluate the rhythms of diurnal activities as well as sleep conditions to identify the WSD factors. In particular, the diurnal activity rhythm influences WSD. It is suggested that proper management of activity rhythm may contribute to the prevention of sleep debt.

Sleepiness, sleep deprivation, quality of life, mental symptoms and perception of academic environment in medical students

BACKGROUND

It has been previously shown that a high percentage of medical students have sleep problems that interfere with academic performance and mental health.

METHODS

To study the impact of sleep quality, daytime somnolence, and sleep deprivation on medical students, we analyzed data from a multicenter study with medical students in Brazil (22 medical schools, 1350 randomized medical students). We applied questionnaires of daytime sleepiness, quality of sleep, quality of life, anxiety and depression symptoms and perception of educational environment.

RESULTS

37.8% of medical students presented mild values of daytime sleepiness (Epworth Sleepiness Scale - ESS) and 8.7% presented moderate/severe values. The percentage of female medical students that presented ESS values high or very high was significantly greater than male medical students (p <  0.05). Students with lower ESS scores presented significantly greater scores of quality of life and perception of educational environment and lower scores of depression and anxiety symptoms, and these relationships showed a dose-effect pattern. Medical students reporting more sleep deprivation showed significantly greater odds ratios of presenting anxiety and depression symptoms and lower odds of good quality of life or perception of educational environment.

CONCLUSIONS

There is a significant association between sleep deprivation and daytime sleepiness with the perception of quality of life and educational environment in medical students.

Sleep interventions and glucose metabolism: systematic review and meta-analysis

OBJECTIVE

Sleep disturbances (insufficient or poor sleep quality) have been linked to abnormal glucose metabolism. This systematic review and meta-analysis aimed to explore the effects of behavioral and pharmacological sleep interventions on glucose metabolism.

METHODS

Medline and Embase were used for systematic search. Studies reporting behavioral or pharmacological interventions in population with sleep disturbances, with measured outcomes of glucose metabolism and sleep parameters were selected.

RESULTS

Twenty two studies were eligible for review (eight were conducted in people with type 2 diabetes). Studies were grouped into three types of intervention: sleep extension (n = 6), sleep education or cognitive behavioral therapy for insomnia (CBT-I, n = 6) and pharmacological interventions (n = 10). CBT-I and sleep education resulted in significantly improved self-reported sleep quality (Pittsburgh Sleep Quality Index, mean difference, MD, -1.31, 95% confidence interval (CI) -1.83, -0.80), non-significant reduction in hemoglobin A1c level (MD -0.35%, 95% CI -0.84, 0.13), and non-significant reduction in fasting glucose levels (MD -4.76 mg/dL, 95% CI -14.19, 4.67). Other studies were not eligible for meta-analysis due to heterogeneity of interventions or outcomes. Sleep extension was able to increase sleep duration by varying degrees in short sleepers, and five of six studies demonstrated relationships between the intervention and measures of insulin resistance. A majority of pharmacological intervention studies showed improved sleep but the effects on glucose metabolism were mixed.

CONCLUSIONS

Available sleep interventions were effective in improving sleep but the effects on glucose metabolism were inconclusive. Larger randomized studies with consistent outcome measurements are needed to demonstrate this potential causal relationship.

The Role of the Thalamus in the Neurological Mechanism of Subjective Sleepiness: An fMRI Study

PURPOSE

The thalamus, the region that forms the attentional network and transmits external sensory signals to the entire brain, is important for sleepiness. Herein, we examined the relationship between activity in the thalamus-seed brain network and subjective sleepiness.

MATERIALS AND METHODS

Fifteen healthy male participants underwent an experiment comprising a baseline evaluation and two successive interventions, a 9-day sleep extension followed by 1-night total sleep deprivation. Pre- and post-intervention tests included the Karolinska sleepiness scale and neuroimaging for arterial spin labeling and functional connectivity. We examined the association between subjective sleepiness and the functional magnetic resonance imaging indices.

RESULTS

The functional connectivity between the left or right thalamus and various brain regions displayed a significant negative association with subjective sleepiness, and the functional connectivity between the left and right thalamus displayed a significant positive association with subjective sleepiness. The graph theory analysis indicated that the number of positive functional connectivity related to the thalamus showed a strong negative association with subjective sleepiness, and conversely, the number of negative functional connectivity showed a positive association with subjective sleepiness. Arterial spin labeling analysis indicated that the blood flow in both the left and right thalami was significantly negatively associated with subjective sleepiness. Functional connectivity between the anterior cingulate cortex and salience network areas of the left insular cortex, and that between the anterior and posterior cingulate cortices showed a strong positive and negative association with subjective sleepiness, respectively.

CONCLUSION

Subjective sleepiness and the thalamic-cortical network dynamics are strongly related, indicating the application of graph theory to study sleepiness and consciousness. These results also demonstrate that resting functional connectivity largely reflects the "state" of the subject, suggesting that the control of sleep and conscious states is essential when using functional magnetic resonance imaging indices as biomarkers.

Daytime Workers with Longer Daily Rest Periods Have Smaller Sleep Debt and Social Jetlag: A Cross-Sectional Web Survey

Objectives: The work interval duration between the end of one workday and the start of the following workday is referred to as the daily rest period (DRP). The present study examined whether DRP - a proxy for sleep opportunity between work shifts - is associated with indicators of sleep debt and social jetlag among daytime workers. Methods: We used a web-based survey to gather data on demographics, average DRP in the previous month, time in bed (TIB), bedtime, wake-up time, and sleep timing on workdays and non-workdays. The Japanese daytime workers (n = 3,914) were divided into seven DRP groups (hours) as follows: <11, 11, 12, 13, 14, 15, and ≥16. Results: The two-way analyses of covariance (DRP group x day) for TIB, mid-sleep as sleep timing, bedtime, and wake-up time showed significant interactions (all p < .001). Specifically, TIB was significantly shorter, and mid-sleep and wake-up time were significantly earlier on workdays than on non-workdays, across all DRP groups (all p < .001). Additionally, the different values for TIB (sleep debt), sleep timing (social jetlag), bedtime, and wake-up time were calculated by subtracting workdays from non-workdays. The trend analysis showed that workers with longer DRP (sleep opportunity) had smaller differences in TIB, sleep timing, and wake-up time between workdays and non-workdays (all p < .001). Conclusions: Overall, daytime workers reported significant sleep debt and misalignment between work and free sleep-wake periods. However, workers with shorter DRPs (less sleep opportunity between shifts) reported significantly greater amounts of sleep debt and social jetlag than did workers with longer DRPs.

Nonpharmacologic Management of Excessive Daytime Sleepiness

Unlike other reviews written on this topic, the focus of this article is primarily on nonpharmacologic treatments for daytime sleepiness that is not secondary to other medical or psychological conditions. To provide an appropriate background on primary excessive daytime sleepiness, what is considered optimal sleep in terms of sleep duration, sleep insufficiency, and sleep need is discussed in detail. This discussion is followed by an examination of the behavioral strategy of banking sleep. After briefly discussing behavioral interventions for sleepiness associated with narcolepsy, a new behavioral method of treating daytime somnolence is proposed and described.

Evaluation of Sleep Quality in a Disaster Evacuee Environment

We aimed to evaluate sleep and sleep-related physiological parameters (heart rate variability and glucose dynamics) among evacuees by experimentally recreating the sleep environment of evacuation shelters and cars. Nine healthy young male subjects participated in this study. Two interventions, modeling the sleep environments of evacuation shelters (evacuation shelter trial) and car seats (car trial), were compared with sleep at home (control trial). Physiological data were measured using portable two-channel electroencephalogram and electrooculogram monitoring systems, wearable heart rate sensors, and flash glucose monitors. Wake after sleep onset (WASO) and stage shift were greater in both intervention trials than the control trial, while rapid-eye movement (REM) latency and non-rapid eye movement (NREM) 1 were longer and REM duration was shorter in the evacuation shelter trial than the control trial. Glucose dynamics and power at low frequency (LF.p) of heart rate variability were higher in the car trial than in the control trial. It was confirmed that sleep environment was important to maintain sleep, and affected glucose dynamics and heart rate variability in the experimental situation.

Factors associated with sleep duration among pupils

BACKGROUND

Sleep shortage has been pervasive among pupils.

METHODS

Multiple regression analysis was used to analyze 2,722 questionnaires obtained from grade 5 to 12 pupils, to determine factors associated with sleep duration.

RESULTS

Significant regression formulae for sleep duration were obtained for all school types: adjusted R² / P value were 0.14/<0.001 for elementary school; 0.11/<0.001 for junior high school; 0.06/<0.001 for high school. Longer after-school activities (standardized regression coefficient/ P value were -0.22/<0.001 for elementary school; -0.10/<0.01 for junior high school; -0.18/<0.001 for high school) and more sleepiness (-0.09/<0.001 for elementary school; -0.07/<0.05 for junior high school; -0.07/<0.05 for high school) were significantly associated with reduced sleep duration for all school types. In both elementary and junior high schools, the higher grade (-0.53/<0.001 for elementary school; -0.10/<0.01 for junior high school), and longer weekday screen time (-0.15/<0.001 for elementary school; -0.19/<0.001 for junior high school) were also significantly associated with sleep loss. In elementary school, irregular dinner (-0.07/<0.05), breakfast skipping (-0.11/<0.001), longer weekend screen time (-0.09/<0.05) and better self-reported academic performance (0.07/<0.05) also revealed significant associations with sleep loss. In high school, reduction of sleep duration was also significantly associated with higher standardized body mass index (-0.08/<0.05).

CONCLUSIONS

Excessive after-school activity might be considered in association with pupils' sleep reduction.

Association between work productivity and sleep health: A cross-sectional study in Japan

OBJECTIVES

To examine the impact of sleep health on work in Japan and to investigate the relationship between presenteeism and sleep health.

DESIGN

Cross sectional analysis of a questionnaire survey.

SETTING

Seventeen offices in Tokyo, Japan.

PARTICIPANTS

The study included 2897 participants, of which 1835 were men and 1062 women, aged between 18 and 76 years.

MEASUREMENTS

Productivity loss was measured using the Short Form of the Work Limitations Questionnaire (WLQ-SF).

RESULTS

The decline in productivity due to presenteeism of people with short sleep duration, between 5 and 6 h (β = 0.068, p = 0.004) and less than 5 h (β = 0.105, p < 0.001), was significantly greater compared with those with long sleep duration (7-8 h). Subjective sleep quality (β = 0.124, p < 0.001), sleep latency (β = 0.073, p < 0.001), sleep disturbance (β = 0.123, p < 0.001), use of sleep medication (β = 0.044, p = 0.007), and daytime dysfunction (β = 0.359, p = 0.001) significantly affected presenteeism. When adjusting for confounding factors, sleep duration on workdays, sleep duration on free days, mid-sleep on free days corrected for sleep debt on workdays (MSFsc), and social jet lag were not associated with presenteeism in the multiple regression analysis.

CONCLUSIONS

Sleep health is associated with presenteeism in Japan. Subjective sleep quality, daytime dysfunction, sleep disturbance, and use of sleep medicine are associated with presenteeism. Good sleep hygiene may be important for workers' productivity.

Effect of cognitive load and emotional valence of distractors on performance during sleep extension and subsequent sleep deprivation

Study Objectives

The purpose of the present study was to assess the extent to which sleep extension followed by sleep deprivation impacts performance on an attentional task with varying cognitive and attentional demands that influence decisions.

Methods

Task performance was assessed at baseline, after 1 week of sleep extension, and after 40 h of total sleep deprivation.

Results

One week of sleep extension resulted in improved performance, particularly for high cognitive load decisions regardless of the emotional salience of attentional distractors. Those who extended sleep the most relative to their habitual sleep duration showed the greatest improvement in general performance during sleep extension. However, a higher percentage of time spent in slow-wave sleep (SWS) on the last night of the sleep extension phase was negatively correlated with performance on more difficult high cognitive load items, possibly reflecting a relatively higher level of residual sleep need. Sleep deprivation generally resulted in impaired performance, with a nonsignificant trend toward greater performance decrements in the presence of emotionally salient distractors. Performance overall, but specifically for high cognitive load decisions, during total sleep deprivation was negatively correlated with longer sleep and higher SWS percentage during subsequent recovery sleep.

Conclusions

The present findings suggest two possibilities: those who performed relatively poorly during sleep deprivation were more vulnerable because (1) they utilized mental resources (i.e. accrued sleep debt) at a relatively faster rate during wakefulness, and/or (2) they failed to “pay down” pre-study sleep debt to the same extent as better-performing participants during the preceding sleep extension phase.

Sleep debt and prevalence of proteinuria in subjects with short sleep duration on weekdays: a cross-sectional study

STUDY OBJECTIVE

Short sleep duration is a risk factor of chronic kidney disease, along with cardiovascular diseases and all-cause mortality. Several studies reported that many people sleep longer on weekends than on weekdays, suggesting that they should be compensated for their sleep debt on weekdays on the weekends. Few studies have reported the clinical impact of sleep debt on the kidney.

METHODS

This cross-sectional study included 5799 employees of Osaka University who visited its Health Care Center for their annual health examinations and answered ≤ 6 h of sleep duration on weekdays. The independent variable was the sleep debt index defined as a gap in self-reported sleep duration (≤ 5, 5-6, 6-7, 7-8, 8-9, and ≥ 9 h) between weekdays and weekends, which was categorized into ≤ 0, + 1, + 2, + 3 and ≥+4. An association between the sleep debt index and a prevalence of proteinuria defined as dipstick proteinuria of ≥ 1 + was assessed using logistic regression models adjusting for clinically relevant factors.

RESULTS

More than four-fifths of the subjects had a positive sleep debt index (≤ 0, + 1, + 2, + 3, and ≥+4 recorded for 19%, 36%, 28%, 11%, and 6%, respectively). The multivariable-adjusted logistic regression models showed the sleep debt index ≥ 3 + was significantly associated with the prevalence of proteinuria (sleep debt index ≤ 0, adjusted odds ratio 1.13 [0.77, 1.65]; + 1, 1.00 [reference]; + 2, 1.29 [0.93, 1.79]; + 3, 1.54 [1.02, 2.33]; ≥ + 4, 1.87 [1.15, 3.05]).

CONCLUSIONS

Sleep debt was associated with the prevalence of proteinuria in a dose-dependent manner.

Anesthesiology Resident Night Float Duty Alters Sleep Patterns

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Residency programs utilize night float systems to adhere to duty hour restrictions; however, the influence of night float on resident sleep has not been described. The study aim was to determine the influence of night float on resident sleep patterns and quality of sleep. We hypothesized that total sleep time decreases during night float, increases as residents acclimate to night shift work, and returns to baseline during recovery.

Methods

This was a single-center observational study of 30 anesthesia residents scheduled to complete six consecutive night float shifts. Electroencephalography sleep patterns were recorded during baseline (three nights), night float (six nights), and recovery (three nights) using the ZMachine Insight monitor (General Sleep Corporation, USA). Total sleep time; light, deep, and rapid eye movement sleep; sleep efficiency; latency to persistent sleep; and wake after sleep onset were observed.

Results

Mean total sleep time ± SD was 5.9 ± 1.9 h (3.0 ± 1.2.1 h light; 1.4 ± 0.6 h deep; 1.6 ± 0.7 h rapid eye movement) at baseline. During night float, mean total sleep time was 4.5 ± 1.8 h (1.4-h decrease, 95% CI: 0.9 to 1.9, Cohen’s d = –1.1, P &lt; 0.001) with decreases in light (2.2 ± 1.1 h, 0.7-h decrease, 95% CI: 0.4 to 1.1, d = –1.0, P &lt; 0.001), deep (1.1 ± 0.7 h, 0.3-h decrease, 95% CI: 0.1 to 0.4, d = –0.5, P = 0.005), and rapid eye movement sleep (1.2 ± 0.6 h, 0.4-h decrease, 95% CI: 0.3 to 0.6, d = –0.9, P &lt; 0.001). Mean total sleep time during recovery was 5.4 ± 2.2 h, which did not differ significantly from baseline; however, deep (1.0 ± 0.6 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.6, P = 0.001 *, P = 0.001) and rapid eye movement sleep (1.2 ± 0.8 h, 0.4-h decrease, 95% CI: 0.2 to 0.6, d = –0.9, P &lt; 0.001 P &lt; 0.001) were significantly decreased.

Conclusions

Electroencephalography monitoring demonstrates that sleep quantity is decreased during six consecutive night float shifts. A 3-day period of recovery is insufficient for restorative sleep (rapid eye movement and deep sleep) levels to return to baseline.

Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work

A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.

Personal sleep debt and daytime sleepiness mediate the relationship between sleep and mental health outcomes in young adults

BACKGROUND

Sleep duration and chronotype (i.e., morningness-eveningness) are associated with increased depression and anxiety risk, but differences in individual sleep need and lifestyle may mean these sleep parameters do not present the same risk across all individuals. This study explored the mediating role of sleep debt and daytime sleepiness in the relationship between sleep and mental health symptoms in young adults, a particularly vulnerable population.

METHODS

Young adult university students (n = 2,218) and young adults from the general population in the United States (n = 992) provided estimates of actual and optimal sleep duration, and completed validated measures of sleepiness, chronotype, and depression and anxiety risk. Mediation models examining sleepiness and sleep debt (i.e., difference between optimal and actual sleep) as parallel mediators were tested.

RESULTS

Sleepiness and sleep debt mediated the relationship between short sleep and depression and anxiety risk in the university sample, while sleepiness mediated these relationships in the general population sample. Sleepiness and sleep debt also mediated the impact of evening-type preferences on depression and anxiety risk in university students, but no mediation of this effect was found in young adults from the general population.

CONCLUSIONS

This study reports potential mediating mechanisms related to the increased mental health risk conferred by short sleep and evening chronotype. These results have implications for how primary care physicians assess psychopathology risk, arguing for a focus on the assessment of daytime sleepiness and sleep debt in university populations, while for young adults in the general population, these factors may be less important.

Sleep debt at the community level: impact of age, sex, race/ethnicity and health

OBJECTIVES

Insufficient sleep has become recognized as a pervasive problem in modern society. Sleep debt is a novel measure of sleep adequacy that may be useful in describing those at risk for inadequate sleep. Our objective was to investigate factors that may be associated with sleep debt at the population level, as well as build upon previous data that showed that minority groups may be more likely to have sleep debt.

DESIGN

A cross-sectional population phone survey included questions regarding amount of sleep required and amount of sleep achieved. Sleep debt was calculated by subtracting sleep achieved from sleep required.

SETTING

This study was designed by the Philadelphia Health Management Corporation and conducted over landlines and cell phones.

PARTICIPANTS

The Random Digit Dialing method was used to randomly choose 8,752 adults older than 18 years from several counties in and around Philadelphia to answer questions about sleep.

MEASUREMENTS

Logistic regression was performed to test associations between sleep debt and various sociodemographic factors in different population subgroups to identify those at risk for sub-optimal sleep duration.

RESULTS

Sleep debt was seen to decrease with age, a novel finding that is in contrast with literature suggesting that older adults have poor sleep. Greater sleep debt was also associated with female gender, Hispanic/Latino ethnicity, <40 years of age, self-reported poor health, and increased stress.

CONCLUSIONS

Although older adults may sleep less as they age, they may also require less sleep to feel rested, resulting in less sleep debt. This and other demographic factors, such as female gender and Hispanic/Latino ethnicity, can be used to identify those at higher risk of inadequate sleep and potentially manage their sleep debt.