Association between smoking and drinking and sleep duration

Trends in sleep duration in the U.S. from 2004 to 2018: A decomposition analysis

Average sleep duration in the United States declined in recent years, and the decline may be linked with many biopsychosocial factors. We examine how a set of biopsychosocial factors have differentially contributed to the temporal trends in self-reported sleep duration across racial groups between 2004-2005 and 2017-2018. Using repeated nationally representative cross-sections from the National Health Interview Survey, we decompose the influence of biopsychosocial factors on sleep duration trends into two components. One component corresponds to coefficient changes (i.e., changes in the associations between behaviors or exposures and sleep duration) of key biopsychosocial factors, and the other part accounts for the compositional changes (i.e., changes in the distributions of exposures) in these biopsychosocial factors during the study period. We reveal that changes in the coefficients of some biopsychosocial factors are more important than compositional changes in explaining the decline in sleep duration within each racial/ethnic group. Our findings highlight racial differences manifest across multiple biopsychosocial domains that are shifting in terms of association and composition. Methodologically, we note that the standard regression approach for analyzing temporal trends neglects the role of coefficient changes over time and is thus insufficient for fully capturing how biopsychosocial factors may have influenced the temporal patterns in sleep duration and related health outcomes.

The relationship between alcohol- and sleep-related traits: Results from polygenic risk score and Mendelian randomization analyses

STUDY OBJECTIVES

We investigated whether genetic risk for insomnia and sleep duration abnormalities are associated with AUD and alcohol consumption. We also evaluated the causal relationships between sleep- and alcohol-related traits.

METHODS

Individual-level phenotype and genotype data from the Million Veteran Program were used. Polygenic risk scores (PRS) were computed using summary statistics from two recent discovery GWAS of insomnia (N= 453,379 European-ancestry (EA) individuals) and sleep duration (N= 446,118 EAs) and tested for association with lifetime AUD diagnosis (N= 34,658 EA cases) and past-year Alcohol Use Disorders Identification Test-Consumption scale scores (AUDIT-C, N= 200,680 EAs). Bi-directional two-sample Mendelian Randomization (MR) analyses assessed causal associations between the two sleep traits and the two alcohol-related traits.

RESULTS

The insomnia PRS was positively associated with AUD at 2/9 PRS thresholds, with p<0.01 being the most significant (OR = 1.02, p = 3.48 × 10-5). Conversely, insomnia PRS was negatively associated with AUDIT-C at 6/9 PRS thresholds (most significant threshold being p = 0.001 (β = -0.02, p = 5.6 × 10-8). Sleep duration PRS was positively associated with AUDIT-C at 2/9 PRS thresholds, with the most significant threshold being p = 1 × 10-6 (β = 0.01, p = 0.0009). MR analyses supported a significant positive causal effect of insomnia on AUD (14 SNPs; β = 104.14; SE = 16.19; p = 2.22 × 10-5), although with significant heterogeneity. MR analyses also showed that shorter sleep duration had a causal effect on the risk of AUD (27 SNPs; β = -63.05; SE = 3.54; p = 4.55 × 10-16), which was robust to sensitivity analyses.

CONCLUSION

The genetic risk for insomnia shows pleiotropy with AUD, and sleep continuity abnormalities have a causal influence on the development of AUD.

A Disentangled VAE-BiLSTM Model for Heart Rate Anomaly Detection

Cardiovascular diseases (CVDs) remain a leading cause of death globally. According to the American Heart Association, approximately 19.1 million deaths were attributed to CVDs in 2020, in particular, ischemic heart disease and stroke. Several known risk factors for CVDs include smoking, alcohol consumption, lack of regular physical activity, and diabetes. The last decade has been characterized by widespread diffusion in the use of wristband-style wearable devices which can monitor and collect heart rate data, among other information. Wearable devices allow the analysis and interpretation of physiological and activity data obtained from the wearer and can therefore be used to monitor and prevent potential CVDs. However, these data are often provided in a manner that does not allow the general user to immediately comprehend possible health risks, and often require further analytics to draw meaningful conclusions. In this paper, we propose a disentangled variational autoencoder (β-VAE) with a bidirectional long short-term memory network (BiLSTM) backend to detect in an unsupervised manner anomalies in heart rate data collected during sleep time with a wearable device from eight heterogeneous participants. Testing was performed on the mean heart rate sampled both at 30 s and 1 min intervals. We compared the performance of our model with other well-known anomaly detection algorithms, and we found that our model outperformed them in almost all considered scenarios and for all considered participants. We also suggest that wearable devices may benefit from the integration of anomaly detection algorithms, in an effort to provide users more processed and straightforward information.

Short sleep duration is associated with a wide variety of medical conditions among United States military service members

OBJECTIVES

This cross-sectional study investigated self-reported sleep duration and its association with a comprehensive range of clinically-diagnosed medical condition categories (CDMCs), as well as the relationship between short sleep duration (≤6 h) and demographic/lifestyle factors, among United States military service members (SMs).

METHODS

A stratified random sample of SMs (n = 20,819) completed an online questionnaire on usual daily hours of sleep and demographic/lifestyle characteristics. CDMCs for a six-month period prior to questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 33 CDMCs covering both broad and specific medical conditions. Prevalence of CDMCs was compared among three sleep duration categories (≤4, 5-6 and ≥7 h).

RESULTS

SMs reported a mean ± standard deviation of 6.3 ± 1.4 h of sleep per day. After adjustment for demographic/lifestyle characteristics, shorter sleep duration was associated with higher odds of a medical condition in 25 of 33 CDMCs, with most (n = 20) demonstrating a dose-response relationship. The five CDMCs with the largest differences between ≤4 vs ≥ 7 h sleep were: diseases of the nervous system (odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 2.4-3.4), mental/behavioral diseases (OR = 2.7, 95%CI = 2.3-3.2), diseases of the musculoskeletal system (OR = 1.9, 95%CI = 1.6-2.1), diseases of the circulatory system (OR = 1.7, 95%CI = 1.3-2.2), and diseases of the digestive system (OR = 1.6, 95%CI = 1.2-2.0). Six hours of sleep or less was independently associated with older age, less formal education, race, Hispanic ethnicity, higher body mass index, smoking, and military service branch.

CONCLUSIONS

In this young, physically active population, reporting shorter sleep duration was associated with a higher risk of multiple CDMCs.

Does smoking impair sleep hygiene?

BACKGROUND

Sleep architecture and sleep hygiene might be disrupted by several pathogenetic mechanisms, and the effect of smoking has not been evaluated.

OBJECTIVE

To investigate the effect of smoking on sleep hygiene behaviors that might be associated with the deterioration of quality-of-life (QoL) parameters.

METHODS

In a prospective cross-sectional study, smokers (n=114) and nonsmokers (n=119) were included. The Pittsburgh Sleep Quality İndex (PSQI), the Epworth Daytime Sleepiness Scale (ESS), the Sleep Hygiene Index (SHI), and the Short Form-36 quality of life scale (SF-36) were applied.

RESULTS

We found that none of the components, as well as the PSQI total score were affected in smokers compared with the nonsmoker controls (65.5% of smokers had poor sleep compared to 62.5% of nonsmokers). Although smokers tend to get out of bed at different times from day to day and do important work before bedtime (components of the SHI) more often than non-smokers, no significant differences were detected between groups in any component and SHI total score (27.91±6.72 for smokers and 29.23±8.0 for non-smokers). ESS, depression and anxiety symptoms, and SHI scores in smokers with poor sleep quality were significantly different compared with smokers that had normal sleep quality. Both PSQI and SHI scores were inversely associated with QoL parameters.

CONCLUSIONS

Our results suggest that smoking by itself is not associated with poor sleep hygiene or sleep quality. It can be concluded that worse SHI and quality of sleep negatively affect QoL, depression, and anxiety in smokers.

Sleep duration and risk of hyperlipidemia: a systematic review and meta-analysis of prospective studies

PURPOSE

Current studies indicate that the association between sleep duration and risk of hyperlipidemia is uncertain. This systematic review aimed to evaluate relevant prospective studies and make a definite conclusion.

METHODS

Three databases were searched for prospective studies on the relationship between sleep duration and hyperlipidemia risk from their inception to October 2020.

RESULTS

We identified twelve studies involving 114,439 participants. Follow-up for incident hyperlipidemia ranged from 200 days to 10 years. Neither long (RR:1.00, 95%CI:0.90-1.11, P > 0.05) nor short (RR:0.99, 95%CI:0.94-1.05, P > 0.05) sleep duration had a significant association with increased hyperlipidemia risk in adults. However, long sleep duration was decidedly associated with low HDL-C (RR:0.19, 95%CI: - 0.03-0.40, P < 0.05) and high triglycerides (RR: - 0.20, 95%CI: - 0.43-0.03, P < 0.05) in children and adolescents.

CONCLUSION

Long sleep duration has strong associations with risks of low HDL-C and high triglycerides in children and adolescents. The mechanisms underlying this association deserves to be explored in future studies.

Tobacco smoke exposure and sleep: estimating the association of urinary cotinine with sleep quality

INTRODUCTION

A majority of studies on tobacco smoke exposure and sleep quality have relied on self-reported smoking, resulting in potential exposure misclassification and biases related to self-report. The objective of this study was to investigate associations between urinary cotinine, a biological marker of tobacco smoke exposure, and sleep quality measures, including sleep duration, sleep continuity or efficiency, sleep satisfaction and alertness during normal waking hours.

METHODS

Using data on a national sample of 10 806 adults (aged 18-79 years) from the Canadian Health Measures Survey (2007-2013), we performed binary logistic regression analyses to estimate associations between urinary cotinine concentrations and sleep quality measures, while controlling for potential confounders. Additionally, we performed ordinal logistic regression to assess the association between urinary cotinine concentrations and increased number of sleep problems.

RESULTS

Overall, 28.7% of adult Canadian survey respondents had urinary cotinine concentrations above the limit of detection (LOD), nd the prevalence of each sleep problem ranged from 5.5% to 35.6%. Elevated urinary cotinine concentrations (quartile 4 vs. <LOD) were associated with significantly higher odds of short or long sleep duration (OR = 1.41; 95% CI: 1.02-1.95; p-trend = .021), trouble falling or staying asleep (OR = 1.71; 95% CI: 1.28-2.27; p-trend = .003), sleep dissatisfaction (OR = 1.87; 95% CI: 1.21-2.89; p-trend = .011), and increased number of sleep problems (OR = 1.64; 95% CI: 1.19-2.26; p-trend = .001). Stronger associations were observed among females compared to males.

CONCLUSION

Using a biological marker of tobacco smoke exposure, our study contributes to the body of literature of toxic environmental exposures on sleep quality by supporting an association between tobacco smoke exposure and poorer sleep quality. To address the limitations of a cross-sectional study design and to better assess the temporality of tobacco smoke exposure and sleep quality, longitudinal studies are recommended.

Night sleep duration and risk of each lipid profile abnormality in a Chinese population: a prospective cohort study

Background

To explore the associations between sleep duration and abnormalities in serum lipid levels in a Chinese population.

Methods

A prospective study was conducted with 34,260 participants from the general Chinese population. Sleep duration was categorized as ≤5, 6, 7, 8 or ≥ 9 h. Each lipid profile abnormality was defined according to the Chinese Guidelines for the Prevention and Treatment of Dyslipidemia in Adults (2016). The Cox proportional hazards model was used to assess the association between sleep duration and dyslipidemia.

Results

Compared with a 7 h sleep duration, long sleep duration (≥9 h) was significantly associated with low high-density lipoprotein cholesterol (HDL-C) levels (hazard ratio (HR): 1.24; 95% CI: 1.12–1.38). In subgroup analyses, the positive association between long sleep duration and low HDL-C level in men and in the different age groups was more pronounced than the association in women. No significant interactions were observed in the association between sleep duration and each abnormal serum lipid level by sex/age in the study population (P-interaction> 0.05).

Conclusions

These findings suggest that long sleep duration is associated with low HDL-C level among the Kailuan community population.

Predictors of persistent sleep problems among older disaster survivors: a natural experiment from the 2011 Great East Japan earthquake and tsunami

Study Objectives

To examine prospectively the associations of disaster experiences and social support with sleep problems in older adults.

Methods

Data came from a natural experiment caused by the 2011 Great East Japan earthquake and tsunami. Participants in an ongoing prospective cohort (3547 Japanese individuals aged 65 years or older) were inadvertently exposed to the disaster due to their residential location (Iwanuma city) after the 2010 baseline survey. We conducted a follow-up survey in 2013 to inquire about disaster-related experiences and short sleep duration, sleep insufficiency, poor sleep quality, insomnia symptoms, and sleep medication use. Poisson regression models adjusted for baseline socio-demographic and lifestyle covariates.

Results

Financial hardship predicted increased risks of short sleep duration (relative risk [RR] = 1.40; 95% confidence interval [CI] [1.03, 1.90]), sleep insufficiency (RR = 1.29; 95% CI [1.01, 1.66]), poor sleep quality (RR = 1.47; 95% CI [1.26, 1.70]), and insomnia symptoms (RR = 1.13; 95% CI [1.01, 1.28]). Home destruction predicted sleep medication use while health care disruption predicted poor sleep quality. Loss of close relatives or friends did not predict any sustained sleep problems. Additionally, having instrumental support reduced risks of all sleep problems while having emotional support reduced risk of poor sleep quality.

Conclusions

Approximately 2.5 years after the disaster, older survivors' sleep problems were more durably linked to material aspects of disaster damage than to loss of loved ones. Findings could inform targeted recovery efforts for groups with greatest need to promote older survivors' sleep health and overall well-being.

Tobacco exposure and sleep disturbance in 498 208 UK Biobank participants

Background

The prevalence of sleep disturbance is high and increasing. The study investigated whether active, former and passive smoking were associated with sleep disturbance.

Methods

This cross-sectional study used data from the UK Biobank: a cohort study of 502 655 participants, of whom 498 208 provided self-reported data on smoking and sleep characteristics. Multivariable multinomial and logistic regression models were used to examine the associations between smoking and sleep disturbance.

Results

Long-sleep duration (>9 h) was more common among current smokers [odds ratio (OR): 1.47; 95% confidence interval (CI): 1.17-1.85; probability value (P) = 0.001] than never smokers, especially heavy (>20/day) smokers (OR: 2.85; 95% CI: 1.66-4.89; P < 0.001). Former heavy (>20/day) smokers were also more likely to report short (<6 h) sleep duration (OR: 1.41; 95% CI: 1.25-1.60; P < 0.001), long-sleep duration (OR: 1.99; 95% CI: 1.47-2.71; P < 0.001) and sleeplessness (OR: 1.47; 95% CI: 1.38-1.57; P < 0.001) than never smokers. Among never smokers, those who lived with more than one smoker had higher odds of long-sleep duration than those not cohabitating with a smoker (OR: 2.71; 95% CI: 1.26-5.82; P = 0.011).

Conclusions

Active and passive exposure to high levels of tobacco smoke are associated with sleep disturbance. Existing global tobacco control interventions need to be enforced.

Transitioning from adequate to inadequate sleep duration associated with higher smoking rate and greater nicotine dependence in a population sample

INTRODUCTION

Inadequate sleep (≤6 and ≥9h) is more prevalent in smokers than non-smokers but the extent to which sleep duration in smokers relates to smoking behaviors and cessation outcomes, is not yet clear. To begin to address this knowledge gap, we investigated the extent to which sleep duration predicted smoking behaviors and quitting intention in a population sample.

METHODS

Data from current smokers who completed the baseline (N=635) and 5-year follow-up (N=477) assessment in the United Kingdom Biobank cohort study were analyzed. Multivariable regression models using smoking behavior outcomes (cigarettes per day, time to first cigarette, difficulty not smoking for a day, quitting intention) and sleep duration (adequate (7-8h) versus inadequate (≤6 and ≥9h) as the predictor were generated. All models adjusted for age, sex, race, and education.

RESULTS

Worsening sleep duration (adequate to inadequate) predicted a more than three-fold higher odds in increased cigarettes per day (OR=3.18; 95% CI=1.25-8.06), a more than three-fold increased odds of not smoking for the day remaining difficult (OR=3.90; 95% CI=1.27-12.01), and a >8-fold increased odds of higher nicotine dependence (OR=8.98; 95% CI=2.81-28.66). Improving sleep duration (i.e., inadequate to adequate sleep) did not predict reduced cigarette consumption or nicotine dependence in this population sample.

CONCLUSION

Transitioning from adequate to inadequate sleep duration may be a risk factor for developing a more "hard-core" smoking profile. The extent to which achieving healthy sleep may promote, or optimize smoking cessation treatment response, warrants investigation.

Does sleep quality affects the immediate clinical outcome in patients undergoing coronary artery bypass grafting: A clinico-biochemical correlation

Objective:

Poor sleep quality is emerging as high prevalence among the patients suffering from cardiometabolic disturbances. The vascular polypeptide endothelin 1 (ET-1) is involved in many of the health disorders. However, its potential involvement in patients having poor sleep quality along with cardiovascular problem is limited. The present study was formulated to conduct a prospective analysis of the relationship between ET-1 and in hospital outcome in sleep disorder patients undergoing routine coronary artery bypass grafting (CABG).

Methods:

A total of 156 patients were enrolled and divided into two groups based on the Pittsburg Sleep Quality Index (PSQI) of ≤5 (Group I, n = 101) or >5 (Group II, n = 55). Blood sample was collected before anesthesia induction (ET-1a) and at 48 h (ET-1b) to analyze the plasma ET-1 and blood sugar level. The patients were monitored for any intraoperative adverse events and postoperative complications during their hospital stay.

Results:

Both groups were comparable in relation to age, sex, incidence of smoking and alcohol consumption. The distribution of comorbid conditions was also similar in both groups. The ET-1 level was higher in Group II than Group I before anesthesia induction as well as 48 h postoperatively (4.5 ± 1.75 vs. 10.61 ± 9.3, P = 0.001; 2.08 ± 1.3 vs. 8.3 ± 9.86, P = 0.0001, respectively). The Group II patients had a longer duration of mechanical ventilation (14.6 ± 12.05 vs. 10.1 ± 8.19, P = 0.001), Intensive Care Unit stay (2.08 ± 0.95 vs. 2.7 ± 1.45, P = 0016) and hospital stay (5.98 ± 1.73 vs. 7.8 ± 3.66, P = 0.0001, respectively). The high number of patients from Group II required inotrope and intra-aortic balloon pump support while compared with Group I (P ≤ 0.05 in each). The overall postoperative complication rate was significantly higher among patients with PSQI of >5 (Group II) except the rate of infection and neurological complications which was similar among both group of patients. The postoperative in hospital mortality was nil in Group I and 3.6% in Group II (P = 0.05). There was a strong relationship between PSQI and ET-1 at both the time points.

Conclusion:

Poor sleep quality associated with a higher incidence of adverse perioperative events in patients undergoing elective CABG. There exists a potential link between poor sleep quality and ET-1 in these groups of patients.

Predictors of Change in Self-Reported Sleep Duration in Community-Dwelling Older Adults: The Shih-Pai Sleep Study, Taiwan

The present study aims to examine and compare the predictors of changes in self-reported sleep duration in older adults. A total of 2,294 participants over the age of 65 in the Shih-Pai Sleep Study were followed-up for an average of 3 years. According to the self-reported sleep duration at baseline and the results of a follow-up survey conducted 3 years later, participants were classified into three categories: mid-range sleepers (6–7 hours), short sleepers (≤5 hours), and long sleepers (≥8 hours). The main outcome variable was the sleep duration at the follow-up survey. A comparison of the results of the baseline and follow-up surveys revealed that only 45.9% of participants remained in the same spectrum of sleep duration in both surveys, with baseline long sleepers having the lowest consistency rate (27.6%). Only incident diseases, with the exception of prevalent diabetes and physical disability, predicted shortening of sleep duration. In contrast, prevalent morbidities or baseline characteristics correlated with the lengthening of sleep duration. The findings suggested that the self-estimated sleep duration fluctuated in a significant proportion of study participants over time. Predictors of lengthening of sleep duration were essentially different from predictors of shortening of sleep duration.

Determinants of Light and Intermittent Smoking in the United States: Results from Three Pooled National Health Surveys

BACKGROUND

Light and/or intermittent smokers have been the fastest growing segment of cigarette smokers in the United States over the past two decades. Defining their behavioral characteristics is a critical public health priority.

METHODS

Our sample included 78,229 U.S. adults from three pooled contemporary population-based surveys: the 2012 NHIS, 2012 NSDUH, and 2011-2012 NHANES. We classified current smokers into four categories (light and intermittent [LITS], light-daily, heavier-intermittent, and heavier-daily) and assessed smoking behaviors, illicit drug use, and mental health indicators using weighted analyses.

RESULTS

Analyses associated smoking categories with nicotine dependence, age of smoking initiation, race/ethnicity, and other demographic and behavioral factors. Compared with heavier-daily smokers, smokers who were LITS were most likely to have mild or no nicotine dependence (weighted odds ratio [OR], 16.92; 95% confidence interval [CI], 13.10-21.85), to start smoking cigarettes regularly after age 21 (OR, 3.42; 95% CI, 2.84-4.12), and to be Hispanic (OR, 5.38; 95% CI, 4.38-6.61). Additional significant results were found for other categories of smokers.

CONCLUSIONS

Based on pooled data from three large national surveys, light and/or intermittent smokers differed in smoking, drug use, and mental health behaviors from heavier-daily, former, and never smokers. Notable differences by level of smoking frequency and intensity were observed for nicotine dependence, age of smoking initiation, and race/ethnicity.

IMPACT

Our results may help focus preventive measures and policies for the growing number of light and/or intermittent smokers in the United States because smoking patterns vary by behavioral and socioeconomic factors. Cancer Epidemiol Biomarkers Prev; 26(2); 228-39. ©2016 AACR.

Daytime napping, sleep duration and increased 8-year risk of type 2 diabetes in a British population

BACKGROUND AND AIMS

Few studies have prospectively examined the relationship between daytime napping and risk of type 2 diabetes. We aimed to study the effects of daytime napping and the joint effects of napping and sleep duration in predicting type 2 diabetes risk in a middle- to older-aged British population.

METHODS AND RESULTS

In 1998-2000, 13 465 individuals with no known diabetes participating in the European Prospective Investigation into Cancer-Norfolk study reported daytime napping habit and 24-h sleep duration. Incident type 2 diabetes cases were identified through multiple data sources until 31 July 2006. After adjustment for age and sex, daytime napping was associated with a 58% higher diabetes risk. Further adjustment for education, marital status, smoking, alcohol intake, physical activity, comorbidities and hypnotic drug use had little influence on the association, but additional adjustment for BMI and Waist Circumference attenuated the Odds ratio (OR) (95% CI) to 1.30 (1.01, 1.69). The adjusted ORs (95% CI) associated with short and long sleep duration were 1.46 (1.10, 1.90) and 1.64 (1.16, 2.32), respectively. When sleep duration and daytime napping were examined together, the risk of developing diabetes more than doubled for those who took day naps and had less than 6 h of sleep, compared to those who did not nap and had 6-8 h of sleep.

CONCLUSION

Daytime napping was associated with an increased risk of type 2 diabetes, particularly when combined with short sleep duration. Further physiological studies are needed to confirm the interaction between different domains of sleep in relation to diabetes risk.

Cigarette smoking is associated with unhealthy patterns of food consumption, physical activity, sleep impairment, and alcohol drinking in Chinese male adults

OBJECTIVES

According to a recent national survey, tobacco use is a critical public health issue in China, with more than two-thirds of Chinese males smoking. Findings in Western populations suggest that smoking may cluster with other health-risk behaviors. To explore these relationships in Chinese male adults, we utilized baseline data from the China Seven Cities Study (CSCS).

METHODS

Male adults (n = 12,122) were included. Smoking status was defined as never smokers, ex-smokers, current smokers, and current heavy smokers. Logistic regression was employed to investigate the association of cigarette smoking and patterns of food consumption, physical activity, and alcohol drinking.

RESULTS

After controlling for age, socioeconomic status, and city residence, heavy smokers consumed significantly less vegetables, fruits, milk and other dairy products, spent significantly more time watching television, slept and exercised less, and got drunk or engaged in binge drinking more frequently compared to never, ex-, or current smokers (p < 0.05).

CONCLUSIONS

Findings suggest significant associations of heavy cigarette smoking with other health-risk behaviors in Chinese male adults, underscoring the need for tobacco control interventions for Chinese males.

Sleeping problems in Chinese illicit drug dependent subjects

BACKGROUND

Illicit drug use/dependence has been recognized as a major problem. Clinical studies demonstrate that poor sleep quality is associated with increased frequency of drug use and relapse. However, few studies have addressed the issue of sleep quality among illicit drug dependent subjects.

METHODS

This cross-sectional study explored sleep quality in drug dependent subjects in China. We studied 2178 illicit drug dependent subjects from drug rehabilitation centres in Changsha and 2236 non-drug-using subjects, all of whom completed the self-report Pittsburgh Sleep Quality Index (PSQI).

RESULTS

We found that the prevalence of sleep disturbance was much higher in drug users (68.5%, PSQI >5; specifically, 80.24% in heroin users, 54.16% in methamphetamine users and 81.98% in ketamine users with PSQI >5) than non-users (26.4%, PSQI >5). Drug users had approximately twice the sleep latency than nondrug users (37.7 minutes V.S 18.4 minutes). Although drug users and non-users reported similar sleep duration (about 7.4 hours), drug users showed poorer subjective sleep quality and habitual sleep efficiency. They reported more sleep disturbance and need for sleep medications, more daytime dysfunction and poorer subjective sleep quality compared with nondrug users. The total PSQI score positively correlated with the duration of drug use (rp = 0.164, p < 0.001). We also found a link between sleep problems and cigarette smoking, alcohol drinking, and duration of drug use.

CONCLUSIONS

Poor sleep quality is common among illicit drug dependent subjects. Long-term substance users had more sleep problems. Future research aiming at quantifying the benefits of treatment interventions should not neglect the influence of sleep problems. Gaining more insight into the impact of sleep quality on the addiction treatment could also help to target future intervention measures more effectively.

Impaired sleep quality and sleep duration in smokers-results from the German Multicenter Study on Nicotine Dependence

Cigarette smoking is a severe health burden being related to a number of chronic diseases. Frequently, smokers report about sleep problems. Sleep disturbance, in turn, has been demonstrated to be involved in the pathophysiology of several disorders related to smoking and may be relevant for the pathophysiology of nicotine dependence. Therefore, determining the frequency of sleep disturbance in otherwise healthy smokers and its association with degree of nicotine dependence is highly relevant. In a population-based case-control study, 1071 smokers and 1243 non-smokers without lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorder were investigated. Sleep quality (SQ) of participants was determined by the Pittsburgh Sleep Quality Index. As possible confounders, age, sex and level of education and income, as well as depressiveness, anxiety, attention deficit hyperactivity, alcohol drinking behaviour and perceived stress, were included into multiple regression analyses. Significantly more smokers than non-smokers (28.1% versus 19.1%; P < 0.0001) demonstrated a disturbed global SQ. After controlling for the confounders, impaired scores in the component scores of sleep latency, sleep duration and global SQ were found significantly more often in smokers than non-smokers. Consistently, higher degrees of nicotine dependence and intensity of smoking were associated with shorter sleep duration. This study demonstrates for the first time an elevated prevalence of sleep disturbance in smokers compared with non-smokers in a population without lifetime history of psychiatric disorders even after controlling for potentially relevant risk factors. It appears likely that smoking is a behaviourally modifiable risk factor for the occurrence of impaired SQ and short sleep duration.

Sleep duration and abnormal serum lipids: the China Health and Nutrition Survey

OBJECTIVE

To examine the associations between sleep duration and total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1), and lipoprotein (a) [Lp(a)].

METHODS

The present study analyzed 8574 adults from the China Health and Nutrition Survey (2009). Sleep duration was classified into < or = 6, 7, 8, 9, and > or = 10 h. Age, education, occupation, current smoking, current drinking, physical activity, body mass index, hypertension, and diabetes were adjusted as confounders in gender-stratified multiple logistic regression models.

RESULTS

Compared with women reporting 8h sleep duration, the odds ratios (ORs) and 95% confidence intervals (CIs) of high TC for those with < or = 6, 7, 9, and > or = 10 h were 1.65 (1.32-2.06), 1.19 (1.00-1.43), 1.11 (0.89-1.39), and 1.27 (1.02-1.60) after adjusting for confounders. Likewise, the ORs (95% CIs) of high LDL-C were 1.71 (1.28-2.29), 1.36 (1.05-1.76), 1.04 (0.74-1.46), and 1.09 (0.78-1.53), whereas those of high ApoB were 1.80 (1.34-2.42), 1.15 (0.88-1.52), 0.95 (0.66-1.35), and 1.00 (0.70-1.43) for women with < or = 6, 7, 9, and > or = 10 h sleep duration, respectively. These associations were not statistically significant in men.

CONCLUSIONS

Both shorter and longer sleep durations were associated with higher risks of abnormal serum lipid profiles in women but not in men.

Daytime sleepiness: associations with alcohol use and sleep duration in americans

The aim of the current analysis was to investigate the relationship of daytime sleepiness with alcohol consumption and sleep duration using a population sample of adult Americans. Data was analyzed from adult respondents of the National Health and Nutritional Examination Survey (NHANES) 2007-2008 (N = 2919) using self-reported variables for sleepiness, sleep duration, and alcohol consumption (quantity and frequency of alcohol use). A heavy drinking episode was defined as the consumption of ≥5 standard alcoholic beverages in a day. Logistic regression models adjusted for sociodemographic variables and insomnia covariates were used to evaluate the relationship between daytime sleepiness and an interaction of alcohol consumption variables with sleep duration. The results showed that daytime sleepiness was reported by 15.07% of the subjects. In univariate analyses adjusted for covariates, an increased probability of daytime sleepiness was predicted by decreased log drinks per day [OR = 0.74 (95% CI, 0.58–0.95)], a decreased log drinking frequency [0.90 (95% CI, 0.83–0.98)], and lower sleep duration [OR = 0.75 (95% CI, 0.67–0.84)]. An interaction between decreased sleep duration and an increased log heavy drinking frequency predicted increased daytime sleepiness (P = 0.004). Thus, the effect of sleep duration should be considered when evaluating the relationship between daytime sleepiness and heavy drinking.

Factors associated with health-related quality of life among operating engineers

BACKGROUND

Because health-related quality of life among blue-collar workers has not been well studied, the purpose of this study was to determine factors associated with health-related quality of life among Operating Engineers.

METHODS

With cross-sectional data from a convenience sample of 498 Operating Engineers, personal and health behavioral factors associated with health-related quality of life were examined.

RESULTS

Multivariate linear regression analysis revealed that personal factors (older age, being married, more medical comorbidities, and depression) and behavioral factors (smoking, low fruit and vegetable intake, low physical activity, high body mass index, and low sleep quality) were associated with poor health-related quality of life.

CONCLUSIONS

Operating Engineers are at risk for poor health-related quality of life. Underlying medical comorbidities and depression should be well managed. Worksite wellness programs addressing poor health behaviors may be beneficial.

Sleep duration and its correlates in middle-aged and elderly Chinese women: the Shanghai Women's Health Study

BACKGROUND

Abnormal sleep duration, either long or short, is associated with disease risk and mortality. Little information is available on sleep duration and its correlates among Chinese women.

METHODS

Using information collected from 68,832 women who participated in the Shanghai Women's Health Study (SWHS), we evaluated sleep duration and its correlations with sociodemographic and lifestyle factors, health status, and anthropometric measurements and their indexes using polynomial logistic regression.

RESULTS

The mean age of the study population was 59.6 years (SD=9.0; range: 44.6-79.9 years) at time of sleep duration assessment. Approximately 80% of women reported sleeping 6-8 h/day, 11.5% slept 5h or less, and 8.7% slept 9h or more. As expected, age was the strongest predictor for sleep duration and was negatively correlated with sleep duration. In general, sleep duration was positively associated with energy intake, intakes of total meat and fruits, body mass index (BMI), waist-hip ratio (WHR), and waist circumference (WC) after adjustment for age and other factors. Both short and long sleep duration were negatively associated with education level, family income, and leisure-time physical activity and positively associated with number of live births, history of night shift work, and certain chronic diseases, compared to sleep duration around 7 h/day (6.5-7.4h/day). Short sleep duration was related to tea consumption and passive smoking. Long sleep duration was related to menopausal status and marital status.

CONCLUSIONS

In this large, population-based study, we found that sleep duration among middle-aged and elderly Chinese women was associated with several sociodemographic and lifestyle factors and with disease status. The main limitation of the study is the cross-sectional design that does not allow us to draw any causal inference. However, this study provides information for future investigation into the nature of these associations so that recommendations can be developed to reduce sleep problems in middle-aged and elderly Chinese women. It also provides important information on potential confounders for investigation of sleep duration on health outcomes in this population.

Effects of lifestyle, personality, symptoms of anxiety and depression, and genetic predisposition on subjective sleep disturbance and sleep pattern

The effects on sleep pattern (‘short-sleep’ versus ‘long-sleep’) and subjective sleep disturbance of genotype, personality, symptoms of anxiety and depression, and lifestyle, were examined using survey data on a clinically unselected sample of adult Australian twin pairs, aged 17–88 years. When the effects of genotype, personality and symptoms were ignored, lifestyle variables appeared to account for roughly 4% of the variance in sleep disturbance, and 9% of the variance in sleep pattern. Significant genetic effects on sleep disturbance and sleep pattern were found, which were only partly explained by the effects of personality and symptoms of anxiety and depression. Much of the association between sleep disturbance and lifestyle appeared to be explained by separate effects of personality and symptoms of anxiety and depression on sleep and lifestyle (‘genotype – risk-factor correlation’). There was little evidence for genetically determined differences in sensitivity to the lifestyle variables (‘genotype × risk-factor interaction’).

The role of stress in the relationships between gender and health-promoting behaviours

Studies have shown that in Western societies, women live longer than men. Among other factors, this has been attributed to health behaviours; men engage in health-risking behaviours, while women perform health-promoting behaviours. These tendencies were argued to align with cultural notions of masculinity and femininity. There may be some evidence, however, that men and women engage in different types of health-promoting behaviours, and stress may play a role in these tendencies. This study attempts to examine the various types of health-promoting behaviours women engage in and compare them to the tendencies of men. Secondly, it examines the mediating role of stress in the relationships between gender and health-promoting behaviours. The sample was comprised of 402 young Israeli adults. Half were undergraduate university students majoring in social work. The remaining participants were sampled by 'snowball sampling'. Participants completed a questionnaire containing 63 closed-ended questions on various health issues. For the purpose of this study, gender, stress and health-promoting behaviours measures were used. Data were collected over three academic years by the teacher responsible for the course and were received by the author at the end of the data collection phase. The study was approved by the institution's internal review board. The results indicate that,-while women engage in 'type 2 behaviours'- refraining from smoking and drinking, eating breakfast regularly and sleeping 7-8 hours per night-men engage in 'type 1 behaviours'- physical exercise, refraining from snacking, and maintaining an appropriate body mass. We also found that, to some extent, women refrain from 'type 1 behaviours' because of their levels of general stress. Our study suggests that the social construction of masculinity and femininity which undermines individuals' health needs to be challenged and addressed. In particular, the enduring role of stress in women's health outcomes should be addressed.

Evening types are more often current smokers and nicotine-dependent-a study of Finnish adult twins

AIMS

To examine the association between diurnal type and smoking status and nicotine dependence (ND).

DESIGN

A cohort study using random-effects model regressions for repeated longitudinal panel data was used to analyse smoking status by diurnal type. Regression analyses examined the association between diurnal type and ND.

PARTICIPANTS

A total of 23, 289 same-sex adult twin individuals from Finnish Twin Cohort. Nicotine dependence was studied in a subsample of 676 twin individuals.

MEASUREMENTS

Subjects were classified by self-report into four categories: morning type, somewhat morning type, somewhat evening type, evening type (in 1981). Smoking status was defined as current and ever smoking (in 1975, 1981 and 1990). ND was measured by DSM-IV and Fagerström Test for Nicotine Dependence (FTND) (during 2001-05). Findings  Evening types of both genders were much more likely to be current (OR = 2.91, 95% CI 2.50, 3.38) and life-time smokers (OR = 2.67, 95% CI 2.96, 4.07) compared to morning types. Evening types were less likely to stop smoking. The risk of nicotine dependence assessed by DSM-IV criteria was higher among evening types (OR = 2.78, 95% CI 1.64, 4.72). Evening types scored 0.59 (95% CI 0.01, 1.17) points higher than morning types on the FTND. Adjustment for potential confounders did not change these associations.

CONCLUSIONS

Being an evening type is associated independently with a higher risk of being a current smoker, being more highly dependent upon cigarettes and a lower likelihood of stopping smoking. Understanding the cause of these associations could elucidate the causes of tobacco addiction.

A Life of Research in Biological Anthropology

I much appreciated being invited to write a contribution for this journal, but initially presumed that what was required was a comprehensive review of some major issue in biological anthropology. Indeed I drafted a contribution on the history of the subject during the second part of the twentieth century. I was then firmly told that this was not what was wanted, rather something much more autobiographical. Well that is what you have got: an extremely personal account of my own research career over some 50 years in biological anthropology. I have summarized the results of what I consider the main projects I and my colleagues have undertaken and tried to document successes and failures. I cannot claim any earth-shattering discovery but hope that we have contributed in a substantial way to the further understanding of the nature of human variation, a main concern of biological anthropology in the second half of the twentieth century.

Smoking and sleep disorders in Chinese adolescents

OBJECTIVE

To investigate the association between adolescent smoking and sleep disorders.

METHODS

In the Hong Kong student obesity surveillance project, 29,397 Chinese students, aged 12-18 years, completed a health survey. Insomnia was defined as having any of the following three symptoms: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA). The presence of snoring and difficulty breathing during sleep (DBS) was also reported. Logistic regression yielded adjusted odds ratios (ORs) for each sleep disorder by smoking status.

RESULTS

Compared with never smokers, the ORs (95% CI) of insomnia were 1.39 (1.25-1.54) for experimenters (smoked once or a few times) and 0.91 (0.83-1.00) for current smokers. The corresponding ORs were 1.42 (1.16-1.74) and 3.58 (3.15-4.06) for snoring (P for trend<0.001) and 1.40 (1.10-1.79) and 3.39 (2.97-4.03) for DBS (P for trend<0.001). Current smokers compared with never smokers were less likely to report DIS (OR=0.43, 95% CI=0.38-0.50, P<0.001) and EMA (OR=0.83, 95% CI=0.73-0.94, P=0.003), but more likely to report DMS (OR=1.45, 95% CI=1.28-1.63, P<0.001).

CONCLUSIONS

In terms of dosage, adolescent smoking was associated with snoring and DBS, with increasing ORs from never smokers to experimental and current smokers. Current smoking was associated positively with DMS, but negatively with DIS and EMA.

Effects of meal habits and alcohol/cigarette consumption on morningness-eveningness preference and sleep habits by Japanese female students aged 18-29

The relationship of meal habits and alcohol/cigarette consumption to circadian typology and sleep health in Japanese female students was studied from an epidemiological point of view. Questionnaires on Morningness-Eveningness by Torsvall and Akerstedt (1980), sleep habits, regularity of meal intake and meal amount, and style of alcohol and cigarette consumption were administered to 800 students aged 18-29 years, attending university or training schools for nutrition specialists (Aichi Prefecture, 35 degrees N). Points from ten questions were totaled to provide estimates of sleep habits given as the Unhealthy Sleep Index (UHSI). The average and standard deviation of Morningness-Eveningness scores were 16.07+/-3.53. Students who had breakfast at regular times showed significantly higher Morningness-Eveningness scores than those who ate at irregular times. Based on an integrated analysis (ANOVA) on the effect of regularity of breakfast intake on sleep health, regular breakfast intake may link to sleep health positively via the shifting to morning-type (i.e., the phase-advance of the circadian clock). However, a similar analysis promoted the hypothesis that alcohol consumption and cigarette smoking relate to sleep health negatively and directly, rather than via the shifting to evening-type (i.e., the phase-delaying of the circadian clock). In the case of young women, getting a good quality and quantity of sleep in normal life seems to be important for promoting their mental health, which may fluctuate throughout the menstruation cycle accompanied by mental symptoms as a part of premenstrual syndrome.

How disturbed sleep may be a risk factor for adverse pregnancy outcomes

Adverse pregnancy outcomes associated with significant maternal and infant morbidity are on the rise in Western society despite advances of medical technology. Current risk factors are insufficient to identify women at greatest risk of developing an adverse outcome. An attempt to identify novel contributors to increased risk is warranted. Sleep disturbances are frequent during pregnancy, yet are often dismissed as irrelevant. Emerging evidence indicates that sleep disturbances are associated with poor health outcomes, including cardiovascular disease. Disturbed sleep is also linked with an increased inflammatory response. Increased inflammation is proposed as a key biological pathway through which chronic disease and adverse pregnancy outcomes develop. In this paper, we propose a model and a testable hypothesis of how disturbed sleep in the first 20 weeks of pregnancy could contribute to adverse pregnancy outcomes such as preeclampsia, intrauterine growth restriction, and preterm birth via increased inflammation.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians Leaning Objectives: After completion of this article, the reader should be able to outline data linking sleep disturbances with an increased risk of some systemic disorders, recall characteristics of pregnancy complications which support the hypothesis that sleep disturbances may be related to these pregnancy outcomes, and summarize the likelihood and types of sleep disturbances that are common in pregnant women.

Relation of smoking and drinking to sleep disturbance among Japanese pregnant women

BACKGROUND

Pregnant women suffer from sleep disturbance, which may be aggravated by smoking and/or drinking. We investigate here the joint effect of smoking and drinking with respect to sleep disturbance during pregnancy.

METHODS

Survey of about 16,000 pregnant women in Japan, conducted in 2002 using a self-administered questionnaire.

RESULTS

Both smoking and drinking increased the odds of sleep disturbances, such as subjective insufficient sleep, difficulty in initiating or maintaining sleep, early-morning awakening, short sleep duration, excessive daytime sleepiness and restless legs syndrome. The joint odds ratios for smoking and drinking corresponded more or less to the products of the odds ratio for smoking or drinking.

CONCLUSION

Smoking and drinking are independently associated with increased sleep disturbance during pregnancy, in addition to their other well-known side-effects.

The rhythm of rest and excess

There is a stark contrast between our attitudes to sleep and those of the pre-industrial age. In Shakespeare's Julius Caesar we are told to "Enjoy the honey-heavy dew of slumber". There seems little chance of this today, as we crave more, work more and expect more, and, in the process, abandon sleep. Our occupation of the night is having unanticipated costs for both our physical and mental health, which, if continued, might condemn whole sectors of our society to a dismal future.

The relation between smoking and sleep: the influence of smoking level, health, and psychological variables

The relation between smoking and sleep was examined in a randomly selected sample of 769 individuals (379 men and 390 women, ages 20 to 98). Participants completed 2 weeks of sleep diaries, provided a global report on their sleep, indicated the number of cigarettes smoked per day, and supplied information on health, depressive symptoms, anxiety, and caffeine and alcohol use. After controlling for demographic, health, psychological, and behavioral variables, light smoking (< 15 cigarettes per day), but not heavier smoking, was associated with self-reported chronic insomnia and reduced sleep diary total sleep time and time in bed. Smokers did not differ significantly from nonsmokers on diary measures of sleep-onset latency, number of awakenings during the night, wake time after sleep onset, or sleep efficiency.

Sleeping Habit and Other Life Styles in the Prime of Life and Risk for Ossification of the Posterior Longitudinal Ligament of the Spine (OPLL): a Case-cotnrol Study in Japan

BACKGROUND: Although the average age of onset of ossification of the posterior longitudinal ligamen of the spine (OPLL) is at around 50 years, the onset of the symptoms is insidious and the progression is very slow. The etiology of OPLL has not been elucidated in detail. Previous studies have suggested that a high-salt diet and low consumption of animal protein, glucose intolerance and high body mass are risk factors for OPLL. However, there is little information about the relationship between OPLL and life styles in the prime of life (between 30 and 50 years).

METHODS: To facilitate early prediction and prevention of OPLL, we analyzed life styles such as sleeping habit, physical exercise, smoking, alcohol drinking and hangover in subjects in the prime of life. Self-administered questionnaires were obtained from patients with OPLL and their sex- and age-matched controls. Sixty-nine patients diagnosed with OPLL within 3 years previously and 138 sex- and age-matched controls without backbone diseases, randomly selected from participants in a health checkup in a local town, were enrolled.

RESULT: Moderate amount of sleep (6-8 hours vs. 5 hours or shorter and 9 hours or longer; odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.06, 0.54) and a regular sleeping habit (i.e., going to bed and getting up at regular time) (OR=0.44, 95% CI=0.22, 0.90) were associated with a decreased risk o OPLL even after adjusting for other factors. On the other hand, moderate physical exercise (once a week or more v.s. less than once a week: OR=0.97, 95% CI=0.42, 2.26), smoking (OR=1.41, 95% CI=0.67, 2.97), drinking (OR=1.08, 95% CI=0.53, 2.20) and hangover (OR=1.12, 95% CI=0.43, 2.94) in the prime of life showed no correlation with risk of OPLL.

CONCLUSION: Good sleeping habits in the prime of life may decrease the risk of OPLL.

Sleep, sleepiness, sleep disorders and alcohol use and abuse

The study of ethanol's effects on sleep has a long history dating back to the work of Nathaniel Kleitman. This paper reviews the extensive literature describing ethanol's effects on the sleep of healthy normals and alcoholics and the newer literature that describes its interactive effects on daytime sleepiness, physiological functions during sleep, and sleep disorders. Ethanol initially improves sleep in non-alcoholics at both low and high doses with disturbance in the second half of the night sleep at high doses. Tolerance develops to the initial beneficial effects. In alcoholics sleep is disturbed both while drinking and for months of abstinence and the nature of the abstinent sleep disturbance is predictive of relapse. Ethanol interacts to exacerbate daytime sleepiness and sleep-disordered breathing, even inducing apnea in persons at risk. Ethanol's effects on other physiological functions during sleep and other sleep disorders has yet to be documented. 2001 Harcourt Publishers Ltd

Age-related changes in initiation and maintenance of sleep: a meta-analysis

The purpose of this meta-analysis was to determine the magnitude of change over the adult life span in four key sleep characteristics and to explore research design features that may account for variability in reported age-related sleep change. Forty-one published studies (combined N = 3293) provided 99 correlational effect sizes. Waking frequency and duration increased with age as previously concluded by narrative reviewers. Although narrative reviewers were less certain whether nighttime sleep amount or the ability to initiate sleep decreased with age, the meta-analysis suggested that both decreased. When sleep variables were measured by polysomnography rather than self-report, larger age-related changes were found. Few researchers who studied normal sleep controlled for important health moderators or studied women.

Excessive daytime sleepiness associated with idiopathic alterations of consciousness

Sleep/wake patterns were recorded by continuous 24-hour ambulatory polysomnography in 339 patients, who had episodes of altered consciousness. Patients were recorded while they were outside the hospital. From a seven-channel montage of electrodes affixed below the hairline, sleep polygraphic EEG was easily read from T3-T4, EOG from F2-F8 and EMG from T3-T6. Sleep was staged by analysis of aural signals on 60 times real time playback, augmented by continuous visual display and selected frozen frames. Patient major sleep period patterns reflected those reported for general populations. Unexpectedly, 47% of the patients took daytime naps and 44% of the nappers took more than one nap. Naps had a mean duration of 71 minutes. Those who took no naps slept significantly longer at night by 23 min. Napping reduced night sleep much more in patients who did not take CNS-acting medications. We conclude that excessive sleepiness may in part explain complaints of episodically altered consciousness.

Does cigarette smoking increase sleep problems

Cigarette smoking has been associated with delayed sleep onset and diminished sleep duration, primarily on the bases of responses to one-shot questionnaires. This study used a survey format of daily diaries to observe sleep quality. 29 smokers were matched for age, ethnicity, and gender with 29 nonsmokers. Both groups recorded information on cigarette, alcohol, caffeine consumption, daily stress, and sleep quality. While the results showed that smokers were more likely to experience poor sleep than nonsmokers, these data are difficult to interpret because smokers also used significantly greater amounts of alcohol and caffeine.

EEG sleep studies in "pure" primary alcoholism during subacute withdrawal: relationships to normal controls, age, and other clinical variables

Electroencephalogram (EEG) sleep recordings were compared in 34 normal controls and 31 inpatients with relatively pure primary alcoholism who had been abstinent for about 17 days. Compared with normal controls, primary alcoholics took longer to fall asleep, slept less, and had poor sleep efficiency. Sleep loss reflected reduced non-rapid eye movement (NREM) sleep, especially stage 2 sleep, stage 4 sleep, and total delta (stage 3 and 4) sleep. Alcoholic patients had higher REM density of the first REM period. Sleep deteriorated with age in both normal controls and patients, with younger alcoholics showing sleep patterns typical of older controls. Among other clinical-demographic variables examined, the shorter the duration of sobriety at the time of the study, the later patients went to bed and fell asleep. The number of drinks per drinking day in the 3 months before admission was directly related to the duration of the first REM period. In addition, the maximum number of withdrawal symptoms the patient had ever experienced was inversely related to the amount of delta sleep. Sleep measures were not correlated with depression rating, liver enzymes, or other measures of alcohol consumption.

Bedtimes and sleep duration in relation to smoking behaviour in 14-year-old English schoolchildren

Data from a survey of 3727 14-year-old children from 31 secondary schools in England in 1984–85 were analysed to obtain information about smoking habits, bedtimes and times of rising in the morning, on a weekday during school term. Subjects completed a questionnaire, anonymously, in class. Twenty percent of respondents reported that they currently smoked cigarettes. Smokers went to bed significantly later, and spent significantly less time in bed, than non-smokers. Twice as many smokers as non-smokers went to bed at or after 22.30, went to bed after midnight, and spent 7·5 hr or less in bed. Possibly, some adolescent smokers may be at risk from loss of sleep.

Sleep in hospital

Although sleep has been identified as an activity generally considered necessary for normal functioning, the nursing literature on the subject is relatively scanty. This paper is an attempt to review sleep and its relationship to nursing practice. A discussion of nursing interventions that are likely to ensure that adequate sleep is maintained is included.

The effects of smoking on the health and sleep of sportswomen

This survey studied the health and sleeping patterns of 92 physical education and sports science students highly involved in sport. A strong correlation was found between smoking and various complaints of ill health as well as between smoking and sleep duration and quality of sleep. The results suggest that there is a strong relationship between the constituents of tobacco smoke and poor sleeping habits.

Sleep patterns and life style in Oxfordshire villages

Patterns of sleep are described among the adult inhabitants of a group of Oxfordshire villages as ascertained through a sleep questionnaire. Sleep duration during the main sleep period on working days, and perceived sleep quality, are then analysed in terms of associations with aspects of life style. In both men and women some 20 out of 50 responses to life style questions show significant associations with sleep duration but most of these associations differ by sex. Some show corresponding associations with sleep quality, but others, mainly related to what people actually do, rather than what they say about how they feel, do not. A principal components analysis of those life style variables which show significant associations with sleep duration, and the adjustment of individual values by these factors for entry into a multiple regression, identifies five factors in each sex which are significantly related to sleep duration. Together they account for 9·9% of the observed male variance and 12·4% of the female variance.