Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002

Causal effects of social media use on self-esteem, mindfulness, sleep and emotional well-being: a social media restriction study

Introduction

The question whether social media use (SMU) has a causal influence on mental health sparks a lot of interest. Empirical research to date shows no consensus on the causal effects of SMU on mental well-being. Therefore, the present study assessed if experimentally implemented restrictions in SMU led to improvements in well-being outcomes using a combination of self-report and passive sensing data.

Methods

After a 2 week baseline phase, participants (M age = 21.42 years) were randomly assigned to an experimental (N = 35) or a passive control (N = 32) condition. Participants in the experimental condition were asked to limit their SMU to a maximum of 30 min (divided across their preferred apps) per day for two consecutive weeks, while participants in the control condition were instructed to continue their SMU as usual. After the intervention phase, participants in both conditions were followed up for 2 weeks during which all restrictions were removed. During the experiment, we monitored self-esteem, mindfulness, sleep, and emotional well-being.

Results

Results indicate a main effect of time for most outcomes, but the implemented SMU restriction did not moderate these effects.

Discussion

In conclusion, this study found no benefits from a temporary social media reduction on mental health outcomes.

Wearable Intervention for Alcohol Use Risk and Sleep in Young Adults: A Randomized Clinical Trial

Importance

Young adults in the US have the highest prevalence of alcohol use disorder; technology-based interventions may help to reduce drinking.

Objective

To test the efficacy of a multimodal digital intervention of wearable feedback and coaching for improving at-risk drinking and sleep health in young adults.

Design, Setting, and Participants

This parallel phase 2 randomized clinical trial was conducted from December 17, 2018, to May 19, 2021, at a research clinic in Connecticut. Participants were young adults (aged 18-25 years) from the local community (web and social media ads, public flyers) with sleep concerns, 3 or more heavy drinking occasions (≥5 drinks/occasion for men; ≥4 drinks/occasion for women) in the past 2 weeks, and a positive Alcohol Use Disorders Identification Test risk score. Analyses were conducted from November 10, 2023, to September 19, 2024, using an intention-to-treat approach.

Interventions

Wearable feedback and coaching plus web-based sleep advice plus smartphone self-monitoring or 1 of 2 control conditions, consisting of advice alone (control A) or advice plus self-monitoring (control A plus SM) for 2 weeks and follow-up to week 12. All participants wore sleep and alcohol biosensors.

Main Outcomes and Measures

The primary outcome consisted of total number of drinks in weeks 4 to 12. Secondary outcomes included sleep disturbance, sleep-related impairment, and alcohol-related consequences in weeks 4 to 12. An exploratory outcome was also assessed, reduction of 1 or more levels in World Health Organization (WHO) drinking risk from baseline to week 4. Models compared the wearable feedback and coaching with advice and self-monitoring with each control condition and changes from weeks 4 to 8 and 12 within each condition on baseline-adjusted outcomes.

Results

A total of 120 participants were enrolled (61 [51%] women; 10 [8%] Asian; 9 [8%] Black; 19 [16%] Hispanic; 96 [80%] White; 1 [1%] multiracial; 4 [3%] other race or ethnicity), with a mean (SD) age of 21.16 (1.75) years. Sixty participants were randomized to the intervention, 30 to the control A group and 30 to the control A plus SM group. Total number of drinks (primary outcome) did not differ by condition or by condition × time, but number of drinks was significantly higher at weeks 4 vs 12 (49%) across conditions. For secondary outcomes, no condition effects were observed for drinking consequences and sleep disturbance, but sleep-related impairment and WHO risk-level reduction (exploratory outcome) differed by condition. Compared with the control A group, the intervention group reported clinically meaningful lower sleep-related impairment scores (mean [SE] least square mean difference, 3.09 [1.08]; 95% CI, 0.96-5.23) and were more than 3 times more likely to have reductions in WHO risk level (odds ratio, 3.85; 95% CI, 1.34-11.07; Cohen d = 0.72). Sleep disturbance improvement was associated with WHO risk-level reduction.

Conclusions and Relevance

This randomized clinical trial did not detect a significant effect of the intervention on the primary outcome of total drinks or secondary outcomes of sleep disturbance or drinking consequences. The intervention significantly improved other measures of sleep health and drinking reduction compared with the control A condition and warrants further testing in larger samples.

Trial Registration

ClinicalTrials.gov Identifier: NCT03658954.

Treatment of Insomnia in Forensic Psychiatric Patients: A Randomized Controlled Trial

Background: Insomnia is common in forensic psychiatric patients. Not only does insomnia severely impair general mental health, but it has specifically been associated with poor emotion regulation and self-control, potentially leading to problems in impulsivity, hostility, and even aggression. Cognitive behavioral therapy for insomnia (CBT-I) could therefore be beneficial in this patient group. Methods: We conducted a 14-week randomized controlled trial of the effects of cognitive behavioral therapy for insomnia (CBT-I) on sleep, general psychopathology, hostility, impulsivity, and aggression in 31 male forensic psychiatric patients. Results: The CBT-I group (n = 11) showed a stronger reduction in self-reported insomnia symptoms and hostility than the waitlist group (n = 11). No differences were found in post-treatment self-reported general psychopathology, impulsivity, or aggression, nor on actigraphy-measured sleep efficiency. Conclusions: This study demonstrates the effectiveness of CBT-I in forensic psychiatric patients and indicates the importance of insomnia treatment in this population, especially considering the effect on hostility.

Modulation mode of amygdala morphology and cognitive function under acute sleep deprivation in healthy male

The amygdala plays a crucial role in various behavioral functions and psychiatric conditions, with its morphology showing alterations in sleep disorders. While the impact of chronic sleep disorders on amygdala morphology has been studied, the effects of acute sleep deprivation (ASD) remain largely unexplored. The present study aimed to investigate the modulation between amygdala sub-region volumes and spatial working memory (SWM) performance under ASD conditions. Twenty-eight healthy male participants underwent MRI scanning and performed SWM tasks before and after 24 h of ASD. Amygdala sub-region volumes were segmented into nine sub-regions, and Granger causality analysis was employed to examine the relationship between amygdala morphology and SWM performance. Results revealed significant decreases in SWM accuracy and increases in reaction time following ASD. Localized changes in amygdala sub-regions were observed, with increased left cortico-amygdaloid transition area (CAT) volume and decreased right paralaminar nucleus (PL) volume. Granger causality analysis uncovered a bidirectional modulation between centromedial and cortical-like nuclei, and a progressive involvement of amygdala sub-regions in modulating SWM performance as task difficulty increased. These findings demonstrate a complex interplay between sleep, amygdala morphology, and cognitive function, suggesting that the amygdala plays a crucial role in modulating cognitive performance under ASD conditions. The differential involvement of amygdala sub-regions across varying cognitive loads indicates a flexible and adaptive system attempting to maintain performance in the face of sleep loss.

Morning vs. evening growth hormone injections and their impact on sleep-wake patterns and daytime alertness

Context

Physiological growth hormone is secreted during slow-wave sleep. Traditionally, growth hormone (GH) therapy is given in daily GH injections before sleep. While morning and evening GH injections produce comparable effects on growth and IGF-1 levels, the evening schedule better imitates the physiological diurnal pattern of GH secretion and action. However, the inflexibility of bedtime injection schedules, coupled with the discomfort and psychological distress associated with the injection and local reaction, may cause sleep disturbances in patients, and may significantly burden them and their families.

Objective

Our objective was to evaluate evening vs. morning daily GH injections with respect to sleep-wake pattern, duration, and activity index in children treated with growth hormone.

Design

An open-label, randomized crossover trial of 20 children (11 boys) 5-14 years of age with isolated growth hormone deficiency (n=12) and idiopathic short stature (n=8) treated with daily injections of median GH dose 33 (range13-46) mcg/kg/d was performed. Each subject received 2 weeks of evening injections and 2 weeks of morning injections. Patients' sleep-wake patterns and activity index were assessed by a 7-day actigraph covering the second week of each treatment schedule.

Results

All subjects slept well, within recommended ranges for sleep parameters, regardless of whether they were receiving morning or evening GH injections. Results were comparable for all measures: total time in bed (min), 526.0 ± 51.8 vs 516.9 ± 57.4 for evening and morning GH injections, respectively; total sleep time (min), 512.4 ± 51.1 vs 504.3 ± 57.7; sleep efficiency (%), 93.6 ± 2.6 vs 94.2 ± 2.3; sleep onset latency (min), 8.9 ± 8.1 vs 7.4 ± 6.8; number of arousals per night, 14.5 ± 5.4 vs 12.5 ± 5.2; and 24-hour activity index, 68.3 ± 4.0 vs 67.0 ± 5.0, respectively. No difference was found between the growth hormone deficient and idiopathic short stature group. No difference was found between boys and girls.

Conclusions

Sleep-wake patterns and activity index were not affected by treatment schedules. We recommend that growth hormone injections take place at any regular time according to the family's convenience.

Sleep discrepancy and cognitive function in community-dwelling older adults

This was the first study to use cluster analysis to characterise sleep discrepancy (the discordance between self-reported and objective sleep) across multiple sleep parameters, in community-dwelling older adults. For sleep efficiency, negative discrepancy (the tendency to self-report worse sleep than objectively-measured) was associated with poorer memory, independent of insomnia severity, depressive symptoms and objective sleep. This suggests a unique role for sleep discrepancy as a possible risk factor for future cognitive decline, and warrants the need for further research.

Circadian rhythm of heart rate and activity: A cross-sectional study

Circadian rhythms are governed by a biological clock, and are known to occur in a variety of physiological processes. We report results on the circadian rhythm of heart rate observed using a wrist-worn wearable device (Fitbit), consisting of over 17,000 individuals over the course of 30 days. We obtain an underlying heart rate circadian rhythm from the time series heart rate by modeling the circadian rhythm as a sum over the first two Fourier harmonics. The first Fourier harmonic accounts for the approximate 24-hour rhythmicity of the body clock, while the second harmonic accounts for non-sinusoidal perturbations. From the diurnal modulation of heart rate, we obtain the following circadian parameters: (i) amplitude of modulation, (ii) bathyphase, and (iii) acrophase. We also consider the circadian rhythm of activity and show that in most individuals, the circadian rhythm of heart rate lags the circadian rhythm of activity. The widespread availability of smartwatches and trackers may enable individuals who are interested in observing their circadian rhythms of numerous physiological parameters, and to measure longitudinal changes in circadian parameters in response to various changes in health-related variables such as diet, sleep, exercise, or illness.

Circadian rhythms and objective measures of physical activity among middle-aged and older adults in Taiwan

BACKGROUND

To identify the association between daytime activity with objectively monitor and subjective variables at a different time-zone of day as well as the sex differences.

METHODS

Participants aged 50 years and older living in the community in Taiwan were recruited. The activity was measured by wearable actigraphy devices, diaries, and self-reported questionnaires. The study used nonparametric analysis to examine the association between mean activity level and demographic and subjective measurement variables.

RESULTS

Among the 55 participants enrolled in the study, data of 34 (62 %) participants who meet the criteria that wore a wearable actigraphy device for at least 7 completed days were analyzed. There is no significant relationship between each demographics and subjective measurement variables. However, actigraphy counts are significantly related to female's nutrition (Z = -2.367, p = 0.017*), and male's retirement status (Z = -2.132, p = 0.033*).

CONCLUSIONS

The activity in morning is highest of the day with significant correlation to evening activities. Moreover, actigraphy counts that indicating objective measure of physical activity in female is significantly related to physiological variables (nutritional status), while male are predicted by social variables (retired status).

Chronotype and lifestyle in the transition to adulthood: Exploring the role of sleep health and circadian misalignment

OBJECTIVES

The present study aimed at exploring the association between eveningness and lifestyle-related variables, that is, body mass index, alcohol, and cigarette consumption, in adults (18-40years), focusing on the possible moderator effect of age and the role of sleep disturbances and circadian misalignment (social jetlag).

METHODS

A web-based survey was administered to 437 participants, covering demographics, lifestyle-related variables, chronotype, sleep quality, and daytime sleepiness. A subset of 206 participants wore a wrist actigraph for a week, allowing the creation of a sleep health index within the RU-SATED framework. Regression analysis was used to investigate the associations between chronotype and lifestyle-related outcomes, accounting for social jetlag and sleep health; and to explore the lifestyle trajectories over time.

RESULTS

Evening chronotypes showed higher body mass index levels, consumed more alcohol, and smoked more cigarettes than other circadian typologies, in particular after 25 years of age. Poor sleep health and social jetlag significantly contribute to explaining evening types smoking behavior, while not affecting body mass index levels. Social jetlag plays a more important role compared to sleep disturbances and eveningness in predicting more detrimental drinking and smoking behavior.

CONCLUSIONS

Participants who maintain the evening trait past the age of 25years are more prone to adopt an unhealthy lifestyle, especially if experiencing poor sleep health and circadian misalignment. Circadian preferences and sleep health should be considered when planning interventions aimed at promoting healthy lifestyles in adults aged 18-40years. Further investigations should explore the effect of modifications in lifestyle in the prevention of noncommunicable diseases.

Sleep discrepancy and brain glucose metabolism in community-dwelling older adults

Sleep discrepancy (negative discrepancy reflects worse self-reported sleep than objective measures, such as actigraphy, and positive discrepancy the opposite) has been linked to adverse health outcomes. This study is first to investigate the relationship between sleep discrepancy and brain glucose metabolism (assessed globally and regionally via positron emission tomography), and to evaluate the contribution of insomnia severity and depressive symptoms to any associations. Using data from cognitively unimpaired community-dwelling older adults (N = 68), cluster analysis was used to characterise sleep discrepancy (for total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE)), and logistic regression was used to explore sleep discrepancy's associations with brain glucose metabolism, while controlling for insomnia severity and depressive symptoms. Lower glucose metabolism across multiple brain regions was associated with negative discrepancy for WASO and SE, and positive discrepancy for WASO only (large effect sizes; β ≥ 0.5). Higher glucose metabolism in the superior parietal and posterior cingulate regions was associated with negative discrepancy for TST (large effect sizes; β ≥ 0.5). These associations remained when controlling for insomnia severity and depressive symptoms, suggesting a unique role of sleep discrepancy as a potential early behavioural marker of brain health.

Exploring the effects of multi-dimensional geographic environment on daily sleep and physical activity based on the Actigraph data

Understanding the interplay between people's daily sleep and physical activity and how geographic environment influences them are important for developing healthy cities. However, such research has been limited. This study aims to explore the bidirectional and nonlinear relationship between daily sleep and physical activity, and further investigate the comprehensive influences of multi-dimensional geographic environment on these health behaviors. Based on the objective data on sleep and physical activity over seven consecutive days using wrist-based accelerometers in Beijing, China, we developed a series of models to analyze the mutual influences between people's daily sleep and physical activity, and employed the generalized additive model (GAM) to examine their potential nonlinear relationships and how geographic environment - including meteorological conditions, built environment, and social environment - influences them. The results show that sleep and physical activity exhibit notable bidirectional relationship. Moderate-to-vigorous physical activity (MVPA) is observed to improve sleep quality, but it decreases sleep duration. In contrast, total sleep time (TST) exhibits an inverted U-shaped pattern with both MVPA and total step counts, with the optimal sleep duration at 5 h. Furthermore, meteorological factors, built environment characteristics, and social environment have significant linear or nonlinear effects on people's daily sleep and physical activity. The outcomes of this study offer valuable insights for enhancing residents' health and developing healthy cities.

The Effect of Acute Sleep Extension on Blood Pressure Is Dependent on the Change in Sleep Efficiency

The present study investigated the effect of acute sleep extension on blood pressure and microvascular vasodilation. Sleep and daily physical activity were objectively measured at home for two weeks using wrist actigraphy in 22 adults (60 ± 15 y). Vascular measurements were made in the morning on the 8th and 15th day. Participants spent at least 10 h in bed on the night prior to one of these testing days to extend sleep. Mean arterial blood pressure (MAP) and peak reactive hyperemia in the forearm were measured on each testing day. Reactive hyperemia and MAP were unaltered (p > 0.05) by sleep extension in the total sample. However, adults who experienced improved sleep efficiency with sleep extension (n = 10, 4.2 ± 1.4%) exhibited reduced MAP (-5.5 ± 4.6 mm Hg, p = 0.005) while adults who had little change or decreased sleep efficiency (n = 12, -1.7 ± 2.9%) showed no change in MAP. The reduction in MAP was significantly different between sleep efficiency groups (p = 0.005, Hedges' g = 1.21) after adjustment for sex and moderate-to-vigorous physical activity. The results of this study suggest that sleep extension has the potential to reduce blood pressure in midlife to older adults when the additional sleep time improves the quality of sleep.

Associations of Advanced Glycation End Products with Sleep Disorders in Chinese Adults

BACKGROUND

Advanced glycation end products (AGEs), a group of food processing byproducts, have been implicated in the development of various diseases. However, the relationship between circulating AGEs and sleep disorders remains uncertain.

METHODS

This cross-sectional study elucidated the association of plasma AGEs with sleep disorders among 1732 Chinese adults who participated in the initial visit (2019-2020) of the Tongji-Shenzhen Cohort (TJSZC). Sleep behavior was assessed using self-reported questionnaires and precise accelerometers. Plasma levels of AGEs, including Nε-(Carboxymethyl)lysine (CML), Nε-(Carboxyethyl)lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolone-2-yl)-ornithine (MG-H1), were quantified by ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS).

RESULTS

In logistic regression, per IQR increment in individual AGEs was associated with an increased odds ratio of short sleep duration (CML: 1.11 [1.00, 1.23]; CEL: 1.16, [1.04, 1.30]), poor sleep quality (CML: 1.33 [1.10, 1.60]; CEL: 1.53, [1.17, 2.00]; MG-H1: 1.61 [1.25, 2.07]), excessive daytime sleepiness (CML: 1.33 [1.11, 1.60]; MG-H1: 1.39 [1.09, 1.77]), and insomnia (CML: 1.29 [1.05, 1.59]). Furthermore, in weighted quantile sum regression and Bayesian kernel machine regression analyses, elevated overall exposure levels of plasma AGEs were associated with an increased risk of sleep disorders, including short sleep duration, poor sleep quality, excessive daytime sleepiness, and insomnia, with CML being identified as the leading contributor. Insufficient vegetable intake and higher dietary fat intake was associated with an increase in plasma CEL.

CONCLUSIONS

These findings support a significant association between plasma AGEs and sleep disorders, indicating that AGEs may adversely influence sleep health and reducing the intake of AGEs may facilitate preventing and ameliorating sleep disorders.

Changed sleep according to weighted blanket adherence in a 16-week sleep intervention among children with attention-deficit/hyperactivity disorder

STUDY OBJECTIVES

To examine differences in sample characteristics and longitudinal sleep outcomes according to weighted blanket (WB) adherence.

METHODS

Children with attention-deficit/hyperactivity disorder (n = 94), mean age 9.0 (standard deviation 2.2, range 6-14) participated in a 16-week sleep intervention with WBs. Children were classified as WB adherent (use of WB ≥ 4 nights/wk) or nonadherent (use of WB ≤ 3 nights/wk). Changes in objectively measured sleep by actigraphy, parent-reported sleep problems (Children's Sleep Habits Questionnaire) and child-reported Insomnia Severity Index were evaluated according to adherence with mixed effect models. Sex, age, and attention-deficit/hyperactivity disorder subtype were examined as potential moderators.

RESULTS

Children adherent to WBs (48/94) showed an early response in sleep outcomes and an acceptance of the WB after 4 weeks of use as well as a decrease in parent-reported (Children's Sleep Habits Questionnaire) (-5.73, P = .000) and child-reported (Insomnia Severity Index) (-4.29, P = .005) sleep problems after 16 weeks. The improvement in sleep was larger among WB adherent vs nonadherent (between-group difference: Children's Sleep Habits Questionnaire: -2.09, P = .038; Insomnia Severity Index: -2.58, P = .007). Total sleep time was stable for children adherent to WB but decreased for nonadherent (between-group difference: +16.90, P = .019).

CONCLUSIONS

An early response in sleep and acceptance of the WB predicted later adherence to WBs. Improvements in sleep were more likely among WB adherents vs nonadherents. Children with attention-deficit/hyperactivity disorder may thus benefit from using WBs to handle their sleep problems.

CITATION

Lönn M, Svedberg P, Nygren J, Jarbin H, Aili K, Larsson I. Changed sleep according to weighted blanket adherence in a 16-week sleep intervention among children with attention-deficit/hyperactivity disorder. J Clin Sleep Med. 2024;20(9):1455-1466.

Associations of actigraph sleep characteristics with blood pressure among older adults

OBJECTIVES

Many studies have examined links between sleep and blood pressure, with mixed findings, mostly using self-reported sleep data and cross-sectional designs. We examined whether actigraph-estimated sleep characteristics are associated with concurrent blood pressure or 5-year blood pressure change in a national cohort of older adults (National Social Life, Health and Aging Project), and whether these associations differ by hypertension medication use.

METHODS

Subjects were 669 older adults (62-90years), 471 with 5-year follow-up data. Sleep characteristics were duration (linear plus quadratic terms); sleep percentage; and categorical onset, midpoint, and waking times. Multivariable linear models adjusted for age, race, gender, obesity, smoking, daytime napping, and hypertension medication use. Interactions between sleep characteristics and hypertension medication were tested among the 401 subjects with consistent hypertension medication status over time.

RESULTS

We found U-shaped cross-sectional and longitudinal relationships between duration and blood pressure, with shorter and longer sleep times associated with higher blood pressure. Later onset times were cross-sectionally associated with higher systolic blood pressure, while earlier onset times were longitudinally associated with systolic blood pressure increase. Midpoint, wake time, and sleep percentage were not significantly associated with blood pressure. Significant interaction terms suggested hypertension medications attenuated associations of sleep onset and wake time with diastolic blood pressure.

CONCLUSIONS

These results with actigraph-estimated parameters confirm some, but not all, associations reported from research based on self-reported sleep data. Our findings are consistent with recommended intermediate sleep durations for cardiovascular health and suggest hypertension medication use may attenuate some associations between sleep timing and blood pressure.

Cross-cultural validation of the Jenkins Sleep Scale in Spanish-speaking countries

The study aimed to validate the Jenkins Sleep Scale (JSS-4) in six Spanish-Speaking countries. A total of 1726 people participated and were distributed between men (32.4%) and women (67.6%). Confirmatory factor analysis confirmed the unidimensional structure and high reliability of the JSS-4 overall (α = 0.85, ω = 0.81) and within each country. The invariance analysis revealed that JSS-4 exhibited complete invariance across countries, thus establishing a robust foundation for inter-group comparisons. Interestingly, a comparative analysis revealed significant differences in the average levels of sleep difficulties, with particularly high rates in Spain and Chile. Item Response Theory (IRT) showed sufficient discrimination parameters for all items, and a correlation of 0.998 between Confirmatory Factor Analysis (CFA) and IRT highlighted the robustness and reliability of the results obtained. In summary, JSS-4 exhibits strong evidence of validity and consistency in measurement invariance across the six countries.

Quantifying Apathy in Late-Life Depression: Unraveling Neurobehavioral Links Through Daily Activity Patterns and Brain Connectivity Analysis

BACKGROUND

Better understanding apathy in late-life depression would help improve prediction of poor prognosis of diseases such as dementia. Actimetry provides an objective and ecological measure of apathy from patients' daily motor activity. We aimed to determine whether patterns of motor activity were associated with apathy and brain connectivity in networks that underlie goal-directed behaviors.

METHODS

Resting-state functional magnetic resonance imaging and diffusion magnetic resonance imaging were collected from 38 nondemented participants with late-life depression. Apathy was evaluated using the diagnostic criteria for apathy, Apathy Evaluation Scale, and Apathy Motivation Index. Functional principal components (fPCs) of motor activity were derived from actimetry recordings taken for 72 hours. Associations between fPCs and apathy were estimated by linear regression. Subnetworks whose connectivity was significantly associated with fPCs were identified via threshold-free network-based statistics. The relationship between apathy and microstructure metrics was estimated along fibers by diffusion tensor imaging and a multicompartment model called neurite orientation dispersion and density imaging via tractometry.

RESULTS

We found 2 fPCs associated with apathy: mean diurnal activity, negatively associated with Apathy Evaluation Scale scores, and an early chronotype, negatively associated with Apathy Motivation Index scores. Mean diurnal activity was associated with increased connectivity in the default mode, cingulo-opercular, and frontoparietal networks, while chronotype was associated with a more heterogeneous connectivity pattern in the same networks. We did not find significant associations between microstructural metrics and fPCs.

CONCLUSIONS

Our findings suggest that mean diurnal activity and chronotype could provide indirect ambulatory measures of apathy in late-life depression, associated with modified functional connectivity of brain networks that underlie goal-directed behaviors.

Measures of fragmentation of rest activity patterns: mathematical properties and interpretability based on accelerometer real life data

Accelerometers, devices that measure body movements, have become valuable tools for studying the fragmentation of rest-activity patterns, a core circadian rhythm dimension, using metrics such as inter-daily stability (IS), intradaily variability (IV), transition probability (TP), and self-similarity parameter (named α ). However, their use remains mainly empirical. Therefore, we investigated the mathematical properties and interpretability of rest-activity fragmentation metrics by providing mathematical proofs for the ranges of IS and IV, proposing maximum likelihood and Bayesian estimators for TP, introducing the activity balance index (ABI) metric, a transformation of α , and describing distributions of these metrics in real-life setting. Analysis of accelerometer data from 2,859 individuals (age=60-83 years, 21.1% women) from the Whitehall II cohort (UK) shows modest correlations between the metrics, except for ABI and α . Sociodemographic (age, sex, education, employment status) and clinical (body mass index (BMI), and number of morbidities) factors were associated with these metrics, with differences observed according to metrics. For example, a difference of 5 units in BMI was associated with all metrics (differences ranging between -0.261 (95% CI -0.302, -0.220) to 0.228 (0.18, 0.268) for standardised TP rest to activity during the awake period and TP activity to rest during the awake period, respectively). These results reinforce the value of these rest-activity fragmentation metrics in epidemiological and clinical studies to examine their role for health. This paper expands on a set of methods that have previously demonstrated empirical value, improves the theoretical foundation for these methods, and evaluates their empirical use in a large dataset.

Objectively measured daytime sleepiness predicts weight change among adults: Findings from the Wisconsin Sleep Cohort Study

OBJECTIVE

Body mass index (BMI) trajectories are associated with night-time sleep, but it is not clear how they relate to daytime sleepiness in population data. This study aimed to examine longitudinal associations between levels and changes in daytime sleepiness and BMI trajectories among men and women.

METHODS

We estimated growth curve models among 827 participants in the Wisconsin Sleep Cohort Study (mean [sd] age = 55.2 [8.0] years at baseline). The outcome variable was BMI (kg/m2) and the key predictor was daytime sleepiness measured by Multiple Sleep Latency Test (MSLT) scores. Covariates included demographics, health behaviors, retirement status, stimulant use, and depressive symptoms. In sensitivity analyses, we evaluated the potential effects of cardiovascular disease, shift work status, and sleep apnea on the robustness of sleepiness and BMI associations.

RESULTS

At the between-person level, men who were sleepier had higher BMI levels. At the within-person level, age moderated the positive association between sleepiness and BMI among women. Specifically, young women who became sleepier over time gained more BMI than older women with comparable increases in sleepiness. Furthermore, while BMI tended to increase with age among women, BMI trajectories were steeper among sleepy women than among well-rested women, who experienced less increase in BMI over time.

CONCLUSION

The study suggested that levels and changes in daytime sleepiness as objectively measured by MSLT scores are associated with body mass among adults.

Validity and reliability of the Swedish version of the Children's Sleep Habits Questionnaire (CSHQ-SWE)

BACKGROUND

To translate and culturally adapt the Children's Sleep Habits Questionnaire (CSHQ) to a Swedish version, CSHQ-SWE, and to assess its validity and reliability for use with children with attention deficit hyperactivity disorder (ADHD).

METHODS

A total of 84 children with ADHD (51 boys and 33 girls; 6-12 years) and parents (7 men and 77 women; 28-51 years) were included in the study. CSHQ was translated and culturally adapted to Swedish, and assessed for concurrent validity with sleep actigraphy (analyzed by Kendall's Tau) and for reliability by internal consistency (analyzed by McDonald's Omega H). Face and content validity was evaluated by parents (n = 4) and healthcare professionals (n = 6) qualitatively (comprehensiveness, relevance, and comprehensibility assessed by interviews and analyzed by thematic analysis) and quantitatively (analyzed by content validity ratio and content validity index for 33 items and four non-scored inquiries).

RESULTS

Parent-reported sleep problems (CSHQ-SWE total score) were moderately correlated with less "Sleep Efficiency" (Tau = -0.305; p < 0.001) measured by sleep actigraphy. Parent-reported problems with "Sleep Onset Delay" was moderately correlated with measured time for "Sleep Onset Latency" (Tau = 0.433; p < 0.001). Parent-reported problems with "Night Wakings" were weakly correlated with measured time for "Wake After Sleep Onset" (Tau = 0.282; p < 0.001). Parents estimation of "Total daily sleep duration" was moderately correlated with measured "Total Sleep Time" (Tau = 0.386; p < 0.001). Five of the seven subscales reached an acceptable level for internal consistency (McDonald's Omega H > 0.700). Comprehensiveness, relevance, and comprehensibility of CSHQ-SWE were satisfactory overall. Content validity ratio was 0.80 to 1.00 for six items, 0.00 to 0.60 for 22 items, and < 0.00 for nine items. Content validity index was 0.22.

CONCLUSIONS

CSHQ-SWE demonstrated acceptable concurrent validity with objectively measured sleep and internal consistency, whereas the overall results of face and content validity assessment varied. The instrument needs to be further evaluated regarding construct validity, responsiveness, test-retest reliability, and its generalization to other populations.

Children and adolescents hospitalized with chronic conditions: sleep patterns, resilience and quality of life

OBJECTIVE

To evaluate the sleep pattern of children and adolescents with chronic conditions during hospitalization and correlate it with resilience, quality of life, clinical and sociodemographic data.

METHOD

Quantitative, descriptive and cross-sectional study. Data collection took place between May 2022 and January 2023, with children and adolescents with chronic conditions from two hospitals in Rio de Janeiro. The instruments used were the Actigraph, Sandra Prince-Embury's Resilience Scale for Children and Adolescents and the Pediatric Quality of Life Inventory. Data analysis involved descriptive statistics and correlation tests.

RESULTS

40 hospitalized children and adolescents between the ages of nine and 18 took part. The results showed compromised sleep, especially in terms of duration and time awake after sleep onset. Quality of life scores were low and resilience levels were classified as medium to high. Correlations were found between resilience and sleep. In addition, sleep was influenced by diagnosis and treatment.

CONCLUSION

Children and adolescents hospitalized with chronic conditions experience significant sleep disturbances and have a low quality of life, but have satisfactory levels of resilience.

State of the science and recommendations for using wearable technology in sleep and circadian research

Wearable sleep-tracking technology is of growing use in the sleep and circadian fields, including for applications across other disciplines, inclusive of a variety of disease states. Patients increasingly present sleep data derived from their wearable devices to their providers and the ever-increasing availability of commercial devices and new-generation research/clinical tools has led to the wide adoption of wearables in research, which has become even more relevant given the discontinuation of the Philips Respironics Actiwatch. Standards for evaluating the performance of wearable sleep-tracking devices have been introduced and the available evidence suggests that consumer-grade devices exceed the performance of traditional actigraphy in assessing sleep as defined by polysomnogram. However, clear limitations exist, for example, the misclassification of wakefulness during the sleep period, problems with sleep tracking outside of the main sleep bout or nighttime period, artifacts, and unclear translation of performance to individuals with certain characteristics or comorbidities. This is of particular relevance when person-specific factors (like skin color or obesity) negatively impact sensor performance with the potential downstream impact of augmenting already existing healthcare disparities. However, wearable sleep-tracking technology holds great promise for our field, given features distinct from traditional actigraphy such as measurement of autonomic parameters, estimation of circadian features, and the potential to integrate other self-reported, objective, and passively recorded health indicators. Scientists face numerous decision points and barriers when incorporating traditional actigraphy, consumer-grade multi-sensor devices, or contemporary research/clinical-grade sleep trackers into their research. Considerations include wearable device capabilities and performance, target population and goals of the study, wearable device outputs and availability of raw and aggregate data, and data extraction, processing, and analysis. Given the difficulties in the implementation and utilization of wearable sleep-tracking technology in real-world research and clinical settings, the following State of the Science review requested by the Sleep Research Society aims to address the following questions. What data can wearable sleep-tracking devices provide? How accurate are these data? What should be taken into account when incorporating wearable sleep-tracking devices into research? These outstanding questions and surrounding considerations motivated this work, outlining practical recommendations for using wearable technology in sleep and circadian research.

The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder-A randomized controlled crossover trial

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. -2.79 min, p = 0.015, Cohen's d = -0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11-14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions.

Examining the associations between attention-deficit/hyperactivity disorder, sleep problems, and other mental health conditions in adolescents

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience greater sleep difficulties compared to those without. However, findings are mixed, and other mental health conditions are often overlooked. This study aimed to examine the relationship between sleep problems, ADHD, and other mental health conditions in a sample of adolescents. Data from 373 adolescents aged 10-19 years was used as part of the wider 'Healthy Brain Network' study, which targets children and adolescents experiencing mental health and neurodevelopmental difficulties. Mental health conditions were assessed via a comprehensive assessment. Sleep was measured by self- and parent-report, as well as via up to a month of actigraphy data. Actigraphy data were analysed using mixed-methods modelling, while subjective sleep data were analysed using multiple regression. Subjectively-reported sleep was generally worse in adolescents who had ADHD and other mental health conditions compared to those with ADHD but no other conditions. There were no associations between ADHD status and objective sleep measures or self-reported measures, but a significant association was found between ADHD status and parent-reported sleep difficulties, even when accounting for other conditions. Parent-reported sleep problems were associated not only with ADHD, but also with anxiety, depression, and externalising disorders. The strength of association between ADHD and sleep problems is potentially not as strong as previously thought when considering the role of other mental health conditions. Clinicians should consider the role of other mental health conditions when sleep problems are present, and vice versa. The study also highlights the importance of comprehensive, multi-informant assessment of mental health conditions, including sleep.

Relevance of sleep for wellness: New trends in using artificial intelligence and machine learning

Sleep and well-being have been intricately linked, and sleep hygiene is paramount for developing mental well-being and resilience. Although widespread, sleep disorders require elaborate polysomnography laboratory and patient-stay with sleep in unfamiliar environments. Current technologies have allowed various devices to diagnose sleep disorders at home. However, these devices are in various validation stages, with many already receiving approvals from competent authorities. This has captured vast patient-related physiologic data for advanced analytics using artificial intelligence through machine and deep learning applications. This is expected to be integrated with patients' Electronic Health Records and provide individualized prescriptive therapy for sleep disorders in the future.

Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study

BACKGROUND

Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment.

OBJECTIVE

To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors.

METHODS

Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition.

RESULTS

Later onset of rest (B = 0.45; P = .008) and activity (B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = -0.42; P = .017; activity onset: B = -0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity (B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition (B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition (B = 0.39; P = .015).

CONCLUSIONS

We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.

Comparison of actigraphy with a sleep protocol maintained by professional caregivers and questionnaire-based parental judgment in children and adolescents with life-limiting conditions

BACKGROUND

Actigraphy offers a promising way to objectively assess pediatric sleep. Aim of the study was investigating the extent to which actigraphy used in children and adolescents with life-limiting conditions is consistent with two other measures of sleep diagnostics.

METHODS

In this monocentric prospective study N = 26 children and adolescents with life-limiting conditions treated on a pediatric palliative care unit were assessed. For three consecutive nights they wore an actigraph; the 24-hours sleep protocol documented by nurses and the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC) answered by parents were analyzed. Patient characteristics and the parameters sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency (SE) were descriptively examined. Percentage bend correlations evaluated the three measures' concordance.

RESULTS

Descriptively, and except for the number of waking episodes, the different measures' estimations were comparable. Significant correlations existed between actigraphy and the sleep protocol for sleep onset (r = 0.83, p = < 0.001) and sleep offset (r = 0.89, p = < 0.001), between actigraphy and SCAC for SE (r = 0.59, p = 0.02).

CONCLUSION

Agreement of actigraphy with the focused sleep measures seems to be basically given but to varying degrees depending on the considered parameters.

Sleep and Daily Affect and Risk for Major Depression: Day-to-day and Prospective Associations in Late Adolescence and Early Adulthood

PURPOSE

Poor sleep is associated with short-term dysregulation of mood and is a risk factor for major depressive disorder (MDD). This study examines whether objectively measured sleep in late adolescence prospectively predicts major depressive episode (MDE) onset in early adulthood as well as whether daily affect mediates this association.

METHODS

The present study draws on subjective and objective sleep data, ecological momentary assessment, and diagnostic data from the longitudinal Youth Emotion Project to examine whether: a) short sleep predicts dysregulated ecological momentary assessment-measured mood the next day; b) sleep predicts depressive episodes over the subsequent 5 years; and c) dysregulated daily moods mediate the associations between short sleep and later MDD. Fixed effects, logistic regression, and formal mediation analyses were employed.

RESULTS

Our results showed that nights with less sleep are followed by days with more negative affect; short sleep predicted MDEs over the subsequent 5 years (adjusting for prior MDD); and negative affect mediates the relationship between short sleep and later MDEs.

DISCUSSION

Overall, our findings show sleep to be an important risk factor and hence a promising point of intervention for improving mood and reducing the risk of future MDEs in adolescents and early adults.

The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T): protocol for a multidimensional dataset of health and lifestyle

BACKGROUND AND OBJECTIVES

Older adults keep transforming with Baby Boomers and Gen Xers being the leading older population. Their lifestyle, however, is not well understood. The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T) collected both objective and subjective data to depict the health and lifestyle of this population. The objectives, design, and measures of the MOCHA-T study are introduced, and the caveats and future directions related to the use of the data are presented.

METHODS

People aged 50 and over were recruited from the community, with a subset of women aged 45-49 invited to supplement data on menopause and aging. Four instruments (i.e., self-reported questionnaires, diary, wrist actigraphy recorder, and GPS) were used to collect measures of sociodemographic, health, psychosocial, behavioral, temporal, and spatial data.

RESULTS

A total of 242 participants who returned the informed consent and questionnaires were recruited in the MOCHA-T study. Among them, 94.6%, 95.0%, and 25.2% also completed the diary, actigraphy, and GPS data, respectively. There was almost no difference in sociodemographic characteristics between those with and without a completed diary, actigraphy, and GPS data, except for age group and educational level for those who returned completed actigraphy data.

CONCLUSION

The MOCHA-T study is a multidimensional dataset that allows researchers to describe the health, behaviors, and lifestyle patterns, and their interactions with the environment of the newer generation of middle-aged and older adults in Taiwan. It can be compared with other countries with actigraphy and GPS-based lifestyle data of middle-aged and older adults in the future.

Role of age, menopausal status, and symptoms in midlife women: Examination of sleep patterns and rest-activity circadian rhythms

BACKGROUND

Midlife women experience menopausal transition at different ages with a variety of symptoms. This study aimed to identify the effects of age, menopausal status, and symptoms in women on their actigraphy-based sleep patterns and circadian rhythms.

METHODS

A total of 87 women aged 45-60 from the community and a gynecology clinic in Taiwan who had their sleep and circadian rhythms recorded with a 7-day actigraphy were analyzed. Multiple linear regression was used to estimate the association of age, menopausal status, and symptoms with sleep parameters and circadian rhythms.

RESULTS

A sleep efficiency below 85 % was observed in 46.0 % of women, and those with severe somatic-vegetative or psychological symptoms tended to have problems with sleep latency (β = 0.22 and β = 0.42, respectively) and efficiency (β = -0.26 and β = -0.36, respectively). Women with more severe urogenital symptoms only experienced significantly longer sleep latency (β = 0.33). There was a weak correlation between circadian rhythms and symptoms. Additionally, perimenopausal (β = 0.30 and β = 0.35, respectively) and late postmenopausal (β = 0.67 and β = 0.59, respectively) women had higher relative amplitude and stability in circadian rhythms than premenopausal women. Age had no significant effect on sleep parameters or circadian rhythms.

CONCLUSIONS

Premenopausal women had the most unstable day-to-day rhythms compared to their peri- and postmenopausal counterparts. Women with higher somatic-vegetative, psychological, and urogenital symptoms showed greater sleep problems. Psychological symptoms (e.g., depression, irritability, anxiety, exhaustion) were the strongest predictors for all sleep parameters. The mechanisms underlying these associations warrant investigation.

Chronic Insufficient Sleep in Women Impairs Insulin Sensitivity Independent of Adiposity Changes: Results of a Randomized Trial

OBJECTIVE

Insufficient sleep is associated with type 2 diabetes, yet the causal impact of chronic insufficient sleep on glucose metabolism in women is unknown. We investigated whether prolonged mild sleep restriction (SR), resembling real-world short sleep, impairs glucose metabolism in women.

RESEARCH DESIGN AND METHODS

Women (aged 20-75 years) without cardiometabolic diseases and with actigraphy-confirmed habitual total sleep time (TST) of 7-9 h/night were recruited to participate in this randomized, crossover study with two 6-week phases: maintenance of adequate sleep (AS) and 1.5 h/night SR. Outcomes included plasma glucose and insulin levels, HOMA of insulin resistance (HOMA-IR) values based on fasting blood samples, as well as total area under the curve for glucose and insulin, the Matsuda index, and the disposition index from an oral glucose tolerance test.

RESULTS

Our sample included 38 women (n = 11 postmenopausal women). Values are reported with ±SEM. Linear models adjusted for baseline outcome values demonstrated that TST was reduced by 1.34 ± 0.04 h/night with SR versus AS (P < 0.0001). Fasting insulin (β = 6.8 ± 2.8 pmol/L; P = 0.016) and HOMA-IR (β = 0.30 ± 0.12; P = 0.016) values were increased with SR versus AS, with effects on HOMA-IR more pronounced in postmenopausal women compared with premenopausal women (β = 0.45 ± 0.25 vs. β = 0.27 ± 0.13, respectively; P for interaction = 0.042). Change in adiposity did not mediate the effects of SR on glucose metabolism or change results in the full sample when included as a covariate.

CONCLUSIONS

Curtailing sleep duration to 6.2 h/night, reflecting the median sleep duration of U.S. adults with short sleep, for 6 weeks impairs insulin sensitivity, independent of adiposity. Findings highlight insufficient sleep as a modifiable risk factor for insulin resistance in women to be targeted in diabetes prevention efforts.

Eye-mask and earplugs compared with sleep advice leaflet to improve night sleep duration in pregnancy: a randomized controlled trial

STUDY OBJECTIVES

To evaluate at-home use of eye-mask and earplugs (EMEP) versus sleep hygiene advice leaflet (AL) on actigraphy-derived night sleep duration in sleep-deprived pregnant women.

METHODS

A randomized controlled trial was conducted in the antenatal clinic of University Malaya Medical Centre from June 2021 to June 2022. Women at 34-36 weeks gestation with self-reported night sleep duration ≤6 hours were recruited. Participants wore an actigraphy device at night for seven consecutive nights (Observation/Baseline week). Only women whose actigraphy-derived night sleep duration was confirmed to be ≤360 minutes were randomized to use EMEP or AL. Actigraphy was continued for another week (Intervention week). Primary outcome was change in actigraphy-derived night sleep duration from observation to intervention week across trial arms. Secondary outcomes include participants' sleep quality, labor, and neonatal outcome. Comparisons were by Student t-test, Mann-Whitney U test, and chi-square test.

RESULTS

A total of 210 women were randomized: 105 each to EMEP and AL. The increase in night sleep duration over baseline was significantly longer with both EMEP (mean ± SD) 23 ± 41 minutes, p < .001, and AL 10 ± 35 minutes, p = .007. Night sleep duration was longer by 12.9 (95% CI = 2.2 to 23.7) minutes, p = .019 with EMEP over AL. Sleep quality (Global Pittsburgh Sleep Quality Index score) was significantly improved with EMEP (mean ± SD) -2.0 ± 2.5, p < .001, but not with AL -0.3 ± 2.2, p = .246. Labor and neonatal outcomes were not significantly different.

CONCLUSION

EMEP significantly lengthened night sleep duration in sleep-deprived women in late pregnancy and is superior to AL.

CLINICAL TRIAL INFORMATION

"Use of eye masks and earplugs compared with standard advice to improve sleep in pregnancy". https://doi.org/10.1186/ISRCTN19061849. Registered with ISRCTN on 07 May 2021, trial identification number: ISRCTN19061849.

Can lifelong endurance exercise improve ageing through beneficial effects on circadian timing function, muscular performance and health status in men? Protocol for a comparative cross-sectional study

A well-synchronized circadian system is a manifestation of an individual's health. A gradual weakening of the circadian timing function characterizes aging. Regular exercise has been suggested as a modality to improve many detrimental changes associated with aging. Therefore, we aim to examine the benefits and risks of lifelong endurance exercise on age-dependent changes in the circadian time-keeping function, the performance of the muscular system and health status. The study protocol has a comparative cross-sectional design, including groups of senior (65 to 75 years old, n=16) and young (20-30 years old, n=16) endurance runners and triathletes. Age-matched groups of young and elderly sedentary men are included as controls. The circadian function is evaluated mainly by measurement of urinary 6-sulphatoxymelatonin, a metabolite of the hormone melatonin shown to participate in the modulation of sleep cycles. The 6-sulphatoxymelatonin will be assessed in urine samples collected upon awakening in the morning and in the late evening, as a marker of melatonin production. In addition, sleep/activity rhythms and sleep quality will be measured by wrist actigraphy. Performance of the muscular system will be assessed by examination of muscular strength and quantifying of gene expression in the skeletal muscle tissue samples. Health status and age-induced reduction in immune function are to be analysed via the balance of pro- and anti-inflammatory immune markers in the plasma and skeletal muscle, body composition, bone density and physical fitness.

Validity and reliability of the Danish version of the Pittsburgh Sleep Quality Index

AIM

The Pittsburgh Sleep Quality Index is a widely used measure of sleep quality. The validity and reliability of the Danish version of the instrument has not yet been established. The aim of this study is to establish the internal consistency, test-retest reliability and convergent validity of the Danish version of the Pittsburgh Sleep Quality Index in adolescents.

METHODS

Data were collected from 719 students from 17 different upper secondary schools. The sample consisted of 55% women, and the mean age of the sample was 17.87 (2.52) years. Data was collected on two occasions approximately 6 weeks apart using online surveys. Apart from the Pittsburgh Sleep Quality Index, the students also completed the five-item World Health Organization Well-being Index and the 10-item Perceived Stress Scale. For internal consistency the Cronbach's alpha was calculated, for test-retest reliability the interclass correlation coefficient was computed, and for validity the Pearson's correlation was calculated.

RESULTS

The mean global Pittsburgh Sleep Quality Index score among Danish adolescents was 5.86 (3.13). The internal consistency for the Pittsburgh Sleep Quality Index was satisfactory with a Cronbach's alpha of 0.72. Test-retest reliability was adequate with an interclass correlation coefficient of 0.68. Finally, the Pittsburgh Sleep Quality Index showed large positive correlation with the 10-item Perceived Stress Scale (0.55) and a large negative correlation with the five-item World Health Organization Well-being Index (-0.59).

CONCLUSIONS

The Danish version of the Pittsburgh Sleep Quality Index showed adequate reliability and validity among Danish adolescents.

Objectively measured sleep continuity in children and adolescents with ADHD: A systematic review and meta-analysis

Sleep disturbances are often linked to attention-deficit/hyperactivity disorder (ADHD). Consistent findings document that children and adolescents with ADHD report more sleep problems than their typically developing (TD) peers across subjective sleep domains. However, few differences between these groups were observed in objectively measured sleep parameters, such as polysomnography (PSG) and actigraphy. This study synthesized empirical studies to identify objectively measured sleep continuity differences between children and adolescents with ADHD and TD. We included observational research and baseline data from intervention studies between 5- to 18-year-old individuals with ADHD and their TD peers at five databases from inception and September 2022. This systematic review and meta-analysis of 45 articles, including 1622 children and adolescents with ADHD and 2013 TD, found that compared with TD, children and adolescents with ADHD have higher sleep latency and moderately decreased sleep efficiency measured by actigraphy. Polysomnography-measured differences between ADHD and TD were not significant. Medication status and comorbid psychiatric status significantly moderated the group differences in sleep efficiency between ADHD and TD. Also, the group differences in sleep latency between ADHD and TD were moderated by actigraphy recorded nights. These findings highlight the importance of reducing disparities in sleep parameters among children and adolescents with and without ADHD.

Melatonin as a Coadjuvant in the Treatment of Patients with Fibromyalgia

Fibromyalgia syndrome (FMS) is a chronic widespread pain syndrome that is accompanied by fatigue, sleep disturbances, anxiety, depression, lack of concentration, and neurocognitive impairment. As the currently available drugs are not completely successful against these symptoms and frequently have several side effects, many scientists have taken on the task of looking for nonpharmacological remedies. Many of the FMS-related symptoms have been suggested to be associated with an altered pattern of endogenous melatonin. Melatonin is involved in the regulation of several physiological processes, including circadian rhythms, pain, mood, and oxidative as well as immunomodulatory balance. Preliminary clinical studies have propounded that the administration of different doses of melatonin to patients with FMS can reduce pain levels and ameliorate mood and sleep disturbances. Moreover, the total antioxidant capacity, 6-sulfatoxymelatonin and urinary cortisol levels, and other biological parameters improve after the ingestion of melatonin. Recent investigations have proposed a pathophysiological relationship between mitochondrial dysfunction, oxidative stress, and FMS by looking at certain proteins involved in mitochondrial homeostasis according to the etiopathogenesis of this syndrome. These improvements exert positive effects on the quality of life of FMS patients, suggesting that the use of melatonin as a coadjuvant may be a successful strategy for the management of this syndrome.

Effect of sleep ambient music on sleep quality and mental health in college students: a self-controlled study

To verify the effect of sleep ambient music intervention (SAMI) on sleep quality and mental status of college students, and to further explore the minimum effective duration of SAMI, this study was designed as a pre-and post-intervention self-controlled exploratory study. Participants were subjected to a one-week no-intervention test, then 4 weeks of music intervention followed. Subjective sleep quality data were collected using the Pittsburgh Sleep Quality Index (PSQI); objective sleep quality data were collected with Actigraphy; and mental status data were collected using the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory-II (BDI-II). Data were analyzed and processed using mixed-effects models and repeated measures. The results showed that compared with the no-intervention week, college students' subjective sleep quality, objective sleep onset latency (SOL), trait anxiety, and depression symptom were reduced at week 1; week 2; week 3; week 4 under SAMI; state anxiety of college students at week 3 and week 4 under SAMI were also reduced. And there were differences in sleep quality among college students of different genders too. Compared with females, males had worse sleep efficiency (SE), shorter total sleep time (TST), and more awaking times (AT). In addition, 3 days was the minimum effective length for SAMI to shorten objective SOL, and 2 days was the minimum effective length to shorten the subjective SOL of college students. The findings of this study suggest that SAMI can improve subjective sleep quality, shorten objective SOL, and reduce anxiety and depression in college students. Interventions for more than 3 days had a significant effect on shortening SOL and long-term effects seemed to emerge after 3 weeks.

Sleep Location and Its Association with Caregiver Sleep Quality During Patient Hospital Admission

During acute hospitalization, many caregivers decide to stay at the care recipient's bedside over the course of several days or months, coping with a stressful situation and a poor sleeping environment. Our objective was to characterize caregiver sleep-wake cycles during care recipient hospital admission and test the association between sleep location (home versus hospital) and caregiver sleep. Eighty-six informal caregivers (78.8% female; age 55.47 ± 12.43 years) were recruited. For seven consecutive days, caregivers wore actigraphy devices and filled a sleep diary indicating whether they had slept at the hospital or at home. Caregiver insomnia symptoms, anxiety, and depression along with patient dependence were also assessed. Nighttime total sleep time, wake after sleep onset, sleep efficiency, sleep latency, and fragmentation index were described. Mixed-model analyses were used to evaluate the effect of the overnight location (home versus hospital) on caregiver sleep quality. In total, 38.4% of caregivers exhibited poor objective sleep efficiencies (< 80%), and 43% of caregivers reported having moderate to severe insomnia symptoms. Caregivers mostly slept at the hospital (n = 53), but some slept at home (n = 14) or between both locations (n = 19). Mixed-model analyses using actigraphy showed that caregivers had significantly better sleep quality when resting at home regarding wake after sleep onset, fragmentation index, and sleep efficiency (p < .05). Caregivers experienced poor sleep quality during care recipients' hospitalization, specifically when sleeping at the hospital versus sleeping at home. Healthcare workers should ensure caregivers' well-being and strongly encourage caregivers to rest at home whenever possible.

Sleep-related predictors of cognition among adults with chronic insomnia and heart failure enrolled in a randomized controlled trial of cognitive behavioral therapy for insomnia

STUDY OBJECTIVES

Cognitive impairment and insomnia are common in chronic heart failure (HF). We examined the effects of cognitive behavioral therapy for insomnia (CBT-I) and the extent to which demographic, clinical, symptom, and functional characteristics predicted cognition among people with chronic HF and insomnia who participated in a randomized controlled trial of CBT-I.

METHODS

Participants with HF were randomized to group-based CBT-I or an attention control (HF self-management education). Outcomes were measured over 1 year. We measured psychomotor vigilance and self-reported cognitive ability (PROMIS Cognitive Abilities Scale), clinical and demographic characteristics, history of sleep apnea, fatigue, pain, insomnia (Insomnia Severity Index), sleepiness (Epworth Sleepiness Scale), Six Minute Walk, EuroQoL Quality of Life, and wrist actigraphy (sleep characteristics and rest-activity rhythms). We used cosinor analysis to compute rest-activity rhythms and general linear models and general estimating equations to test the effects of predictors over 1 year.

RESULTS

The sample included 175 participants (mean age = 63 SD = 12.9 Years; 43% women). There was a statistically significant group-time effect on self-reported cognitive function and increases in the proportion of participants, with < 3 psychomotor vigilance lapses in the CBT-I group. Controlling for group-time effects and baseline cognition, decreased sleepiness, improved rest-activity rhythms, and 6-minute walk distance predicted a composite measure of cognition (psychomotor vigilance lapses and self-reported cognition).

CONCLUSIONS

CBT-I may improve cognition in adults with chronic HF. A future fully powered randomized controlled trial is needed to confirm the extent to which CBT-I improves multiple dimensions of cognition.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Cognitive Behavioral Therapy for Insomnia: A Self-Management Strategy for Chronic Illness in Heart Failure; URL: https://clinicaltrials.gov/ct2/show/NCT02660385; Identifier: NCT02660385.

CITATION

Redeker NS, Conley S, O'Connell M, Geer JH, Yaggi H, Jeon S. Sleep-related predictors of cognition among adults with chronic insomnia and heart failure enrolled in a randomized controlled trial of cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2023;19(6):1073-1081.

Dimensions of sleep quality are related to objectively measured eating behaviors among children at high familial risk for obesity

OBJECTIVE

The aim of this study was to evaluate whether dimensions of sleep quality were associated with homeostatic and hedonic eating behaviors among children with healthy weight (BMI-for-age < 90%) but varying maternal weight status.

METHODS

A total of 77 children (mean [SD], age: 7.4 [0.6] years; BMI z score: -0.10 [0.7]) with healthy weight and high (n = 32) or low (n = 45) familial obesity risk based on maternal weight status were served an ad libitum meal (homeostatic eating) followed by palatable snacks to assess eating in the absence of hunger (EAH; hedonic eating). Habitual sleep quality was quantified from seven nights of wrist actigraphy. Partial correlations, adjusted for child energy needs, pre-meal hunger, food liking, and socioeconomic status, evaluated associations of sleep with meal intake and EAH. Additionally, sleep-by-obesity risk interactions were assessed.

RESULTS

Greater sleep fragmentation was associated with higher homeostatic meal energy intake, but only among children at high familial obesity risk (p value for interaction = 0.001; β high risk = 48.6, p = 0.001). Sleep fragmentation was not associated with total EAH but was related to higher and lower intake of carbohydrates (r = 0.33, p = 0.003) and fat (r = -0.33, p = 0.003), respectively.

CONCLUSIONS

Adverse associations of poor sleep with energy intake may be amplified among children already predisposed to obesity. Furthermore, that fragmented sleep relates to preferential intake of carbohydrates over fat during EAH may suggest alterations in taste preferences with poor sleep.

Method for Activity Sleep Harmonization (MASH): a novel method for harmonizing data from two wearable devices to estimate 24-h sleep-wake cycles

Background

Daily 24-h sleep-wake cycles have important implications for health, however researcher preferences in choice and location of wearable devices for behavior measurement can make 24-h cycles difficult to estimate. Further, missing data due to device malfunction, improper initialization, and/or the participant forgetting to wear one or both devices can complicate construction of daily behavioral compositions. The Method for Activity Sleep Harmonization (MASH) is a process that harmonizes data from two different devices using data from women who concurrently wore hip (waking) and wrist (sleep) devices for ≥ 4 days.

Methods

MASH was developed using data from 1285 older community-dwelling women (ages: 60-72 years) who concurrently wore a hip-worn ActiGraph GT3X + accelerometer (waking activity) and a wrist-worn Actiwatch 2 device (sleep) for ≥ 4 days (N = 10,123 days) at the same time. MASH is a two-tiered process using (1) scored sleep data (from Actiwatch) or (2) one-dimensional convolutional neural networks (1D CNN) to create predicted wake intervals, reconcile sleep and activity data disagreement, and create day-level night-day-night pairings. MASH chooses between two different 1D CNN models based on data availability (ActiGraph + Actiwatch or ActiGraph-only). MASH was evaluated using Receiver Operating Characteristic (ROC) and Precision-Recall curves and sleep-wake intervals are compared before (pre-harmonization) and after MASH application.

Results

MASH 1D CNNs had excellent performance (ActiGraph + Actiwatch ROC-AUC = 0.991 and ActiGraph-only ROC-AUC = 0.983). After exclusions (partial wear [n = 1285], missing sleep data proceeding activity data [n = 269], and < 60 min sleep [n = 9]), 8560 days were used to show the utility of MASH. Of the 8560 days, 46.0% had ≥ 1-min disagreement between the devices or used the 1D CNN for sleep estimates. The MASH waking intervals were corrected (median minutes [IQR]: -27.0 [-115.0, 8.0]) relative to their pre-harmonization estimates. Most correction (-18.0 [-93.0, 2.0] minutes) was due to reducing sedentary behavior. The other waking behaviors were reduced a median (IQR) of -1.0 (-4.0, 1.0) minutes.

Conclusions

Implementing MASH to harmonize concurrently worn hip and wrist devices can minimizes data loss and correct for disagreement between devices, ultimately improving accuracy of 24-h compositions necessary for time-use epidemiology.

School Attendance, Chronotype, and Day-of-the-Week Effect in Adolescent Male Basketball Players

Adolescents' conflict between circadian rhythm and early school start time is more pronounced in evening chronotypes, who tend to reduce sleep duration during school days compensating during the free days by oversleeping (i.e., social jetlag). Cumulative weekly sleep debt may impair sport performance, which relies on physical and cognitive skills modulated by sleep. We hypothesized that chronotype predicts sport performance, and that it may interact with the day of the week. Moreover, given the role sleep plays in motor memory consolidation, we tested the hypothesis that school attendance, and the related chronic sleep deprivation, might be detrimental for participants in a training phase. Ninety-three adolescent male basketball players performed multiple free throw sessions (n = 7880) during both the school and holiday periods. Chronotype and its interaction with the day of the week significantly predicted shooting accuracy when attending school, but not on holidays. Evening types' performance gradually decreased from Monday to Friday. Participants with a more unstable performance (i.e., who did not complete the acquisition of the free throw motor scheme) worsened their accuracy when attending school. Our results suggest that the impact of chronotype and day of the week on sport performance is related to the presence of an externally imposed sleep/wake schedule and is consistent with evening types' increased likelihood of experiencing social jetlag. Possibly due to early school start time, attending school worsened the performance of participants in a training phase. Further investigations are required to assess whether reducing the mismatch between biological and social clocks might improve sport performance, along with other aspects of adolescents' life.

A Wrinkle in Measuring Time Use for Cognitive Health: How should We Measure Physical Activity, Sedentary Behaviour and Sleep?

One new case of dementia is detected every 4 seconds and no effective drug therapy exists. Effective behavioural strategies to promote healthy cognitive ageing are thus essential. Three behaviours related to cognitive health which we all engage in daily are physical activity, sedentary behaviour and sleep. These time-use activity behaviours are linked to cognitive health in a complex and dynamic relationship not yet fully elucidated. Understanding how each of these behaviours is related to each other and cognitive health will help determine the most practical and effective lifestyle strategies for promoting healthy cognitive ageing. In this review, we discuss methods and analytical approaches to best investigate how these time-use activity behaviours are related to cognitive health. We highlight four key recommendations for examining these relationships such that researchers should include measures which (1) are psychometrically appropriate; (2) can specifically answer the research question; (3) include objective and subjective estimates of the behaviour and (4) choose an analytical method for modelling the relationships of time-use activity behaviours with cognitive health which is appropriate for their research question.

Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents

OBJECTIVE

This study examined associations between objective and subjective sleep parameters, and mental health symptoms (internalizing symptoms, externalizing symptoms, and irritability) and whether these relationships differed for adolescents with and without ADHD.

METHOD

Participants were 373 adolescents aged 10 to 19 years (M = 13.21, SD = 2.37). Sleep was measured both via actigraphy and self- and parent-report scales. Mental health symptoms were measured via a range of validated measures.

RESULTS

Few relationships were detected when examining actigraphy variables. Subjective sleep parameters were associated with almost all mental health variables. Some relationships were moderated by ADHD status, generally consistent with stronger relationships between subjective sleep quality and mental health in the non-ADHD group.

CONCLUSION

Sleep problems, particularly subjective difficulties, are associated with a range of mental health outcomes, regardless of the presence of ADHD. Sleep problems may be a beneficial intervention target for adolescents experiencing mental health issues.

Postpartum Behavioral Sleep Intervention for Smoking Relapse Prevention: A Pilot Trial

OBJECTIVES

Rates of postpartum smoking relapse are high (70-90%) but standard relapse prevention interventions are not effective postpartum. This pilot study evaluated effects of a combined relapse prevention and sleep intervention on sleep and relapse to smoking.

METHODS

Twenty-eight postpartum mothers were assigned to the intervention group-combined relapse prevention and behavioral sleep intervention-or to the comparison group-relapse prevention alone. Questionnaires and actigraphy were completed at baseline (1-week postpartum), post-treatment (8-weeks postpartum), and follow-up (12-weeks postpartum). Sleep diaries were completed weekly for the first 8 weeks postpartum and once at 12 weeks postpartum. To corroborate abstinence, CO levels in expired air were measured weekly for the first 8 weeks postpartum and at follow-up. Timeline Followback (TLFB) and salivary cotinine analysis were conducted at baseline, post-treatment, and follow-up to assess for nicotine and other substance use (TLFB) and to further corroborate abstinence (salivary cotinine analysis).

RESULTS

The sleep intervention lengthened maternal nighttime actigraphic sleep by an average of 48 minutes nightly; lengthened the longest bout of consolidated actigraphic sleep by an average of 42 minutes nightly; increased actigraphic sleep efficiency into the healthy range (> 85%); and lowered subjective ratings of sleep disturbance (ps < .05). Findings were inconclusive regarding whether better sleep was associated with abstinence. Post Hoc analyses identified the presence of an additional support person in the home as well as social and emotional support as being positively correlated with smoking abstinence (p < .05; p < .01).

CONCLUSIONS FOR PRACTICE

(1) Postpartum sleep can be improved with behavioral interventions in women with a history of smoking. (2) Social-emotional postpartum support is an important factor in preventing smoking relapse for these women.

Longitudinal associations between sleep and BMI in a low-income, predominantly Black American sample

OBJECTIVE

Black individuals and those experiencing socioeconomic disadvantage are at increased risk for sleep problems and obesity. This study adds to the limited extant literature examining longitudinal associations between objectively measured sleep and changes in body mass index (BMI) in Black Americans.

DESIGN

We focused on individuals with at least 1 observation of sleep and BMI at 1 of 3 study time points (2013, 2016, and 2018). We modeled longitudinal trends in BMI as a function of time, average of each sleep variable across assessments, and within-person deviations in each sleep variable over time.

SETTING

Data were collected via interviewer-administered at-home surveys and actigraphy in Pittsburgh, PA.

PARTICIPANTS

Our sample comprised 1115 low-income, primarily Black adults, including 862 women and 253 men.

MEASUREMENTS

Sleep measures included actigraphy-measured total sleep time, sleep efficiency, and wakefulness after sleep onset, as well as self-reported sleep quality. We also included objectively measured BMI.

RESULTS

In models adjusted for age, gender, and other sociodemographic covariates (eg, income, marital status), there were no significant longitudinal associations between total sleep time, sleep efficiency, wakefulness after sleep onset, or subjective sleep quality and changes in BMI.

CONCLUSIONS

This study provides further evidence that, among a sample of low-income Black adults, sleep problems are not longitudinally predictive of BMI. Although ample cross-sectional evidence demonstrates that sleep problems and obesity commonly co-occur, longitudinal evidence is mixed. Better understanding the overlap of sleep and obesity over time may contribute to prevention and intervention efforts.

The top 100 most cited papers in insomnia: A bibliometric analysis

Objective

The number of citations to a paper represents the weight of that work in a particular area of interest. Several highly cited papers are listed in the bibliometric analysis. This study aimed to identify and analyze the 100 most cited papers in insomnia research that might appeal to researchers and clinicians.

Methods

We reviewed the Web of Science (WOS) Core Collection database to identify articles from 1985 to 24 March 2022. The R bibliometric package was used to further analyze citation counts, authors, year of publication, source journal, geographical origin, subject, article type, and level of evidence. Word co-occurrence in 100 articles was visualized using VOS viewer software.

Results

A total of 44,654 manuscripts were searched on the Web of Science. Between 2001 and 2021, the top 100 influential manuscripts were published, with a total citation frequency of 38,463. The top countries and institutions contributing to the field were the U.S. and Duke University. Morin C.M. was the most productive author, ranking first in citations. Sleep had the highest number of manuscripts published in the top 100 (n = 31), followed by Sleep Medicine Reviews (n = 9). The most cited manuscript (Bastien et al., Sleep Medicine, 2001; 3,384 citations) reported clinical validation of the Insomnia Severity Index (ISI) as a brief screening indicator for insomnia and as an outcome indicator for treatment studies. Co-occurrence analyses suggest that psychiatric disorders combined with insomnia and cognitive behavioral therapy remain future research trends.

Conclusion

This study provides a detailed list of the most cited articles on insomnia. The analysis provides researchers and clinicians with a detailed overview of the most cited papers on insomnia over the past two decades. Notably, COVID-19, anxiety, depression, CBT, and sleep microstructure are potential areas of focus for future research.

Sleep Disturbances in Adolescents with Attention-Deficit/Hyperactivity Disorder

Introduction

Delayed sleep phase syndrome (DSPS) and insomnia disorders are prevalent in adolescents and are comorbid with attention-deficit/hyperactivity disorder (ADHD), but only limited information is available regarding the prevalence of DSPS and insomnia in adolescents with ADHD. Moreover, previous studies comparing objective sleep parameters averaged the findings across all participants of each group (ADHD, control) regardless of each individual's level of reported sleep disturbance. This might have resulted in inconsistency between information obtained by objective and subjective sleep measures in adolescents with ADHD. The objectives of the present study were 1) to compare the prevalence of risk for DSPS and insomnia in adolescents with ADHD and control adolescents in our samples; 2) to compare objectively measured sleep characteristics of adolescents with ADHD and controls while taking into consideration their levels of risk for DSPS or their level of insomnia; and 3) to compare the ADHD symptom levels of adolescents with moderate/high and low risk for DSPS or insomnia.

Methods

Seventy-three adolescents (37 ADHD, 36 controls) aged 12-15 years participated in a cross-sectional study. Actigraphy was used to characterize objective sleep parameters and parents' or adolescents' reports were used to characterize subjective sleep parameters.

Results

Of the participants in the ADHD and control groups, 33.33% and 27%, respectively, had moderate/high levels of risk for DSPS. Adolescents in the high-risk group for DSPS had an objectively measured delayed sleep schedule and more variable sleep duration, time in bed, and sleep efficiency compared to adolescents in the low-risk group for DSPS, regardless of their ADHD diagnosis. Adolescents with higher levels of insomnia spent more time in bed and had more variable sleep efficiency compared to adolescents with no insomnia, regardless of their diagnosis.

Conclusion

The prevalence of moderate/high risk for DSPS was similarly high in adolescents with ADHD and controls. Participants' subjective reports of sleep disturbances were consistent with their objective sleep parameters when the type and level of subjectively defined sleep disturbance were considered. ADHD symptom levels were not different in adolescents with moderate/high or low risk for DSPS or insomnia.

Eye Masks and Earplugs to Improve Night Sleep Duration in Nulliparas: A Randomized Trial

Background Women experience significant sleep disruption throughout pregnancy. Lack of sleep during the last month of pregnancy is associated with longer labor, a higher rate of Cesarean births, gestational diabetes, hypertension, and preterm birth. Eye-mask and earplugs through sensory deprivation increase sleep duration and quality in patients in the intensive care environment but their impact at home or during pregnancy is not known. We sought to evaluate eye-mask and earplugs compared to sham/placebo headbands on night sleep duration in pregnancy. Materials and methods A randomized trial was performed in a university hospital in Malaysia. Nulliparas between 34 and 36 weeks of gestation with self-reported night sleep of fewer than six hours were randomized to the use of eye-mask and earplugs or "sham" headbands during night sleep (both introduced as sleep aids). Night sleep duration was measured through a wrist actigraphy monitor during non-intervention week one and intervention week two with the allocated sleep aid. Results Data from 56 participants were analyzed on an intention-to-treat basis. Mean night sleep duration increased in intervention week two compared to non-intervention week one in both trial arms, which were 279 ± 19 vs. 304 ± 19 minutes (mean increase of 25 minutes) p = <0.001 and 286 ± 21 vs. 302 ± 22 minutes (mean increase of 16 minutes) p = <0.001 for eye-masks-earplugs and headband respectively. However, the mean increase in night sleep duration across trial arms (p=0.13) was not significant. A higher proportion of participants in the eye-masks and earplugs arm had their night sleep duration increased by at least 30 minutes, 13/29 (45%) vs. 5/26 (19%), relative risk (RR) 2.3 (95% CI 1.0-5.6) p = 0.04, more likely to agree that they slept better 19/29 (66%) vs. 7/27 (26%), RR 2.2 (95% CI 1.1-4.6) p = 0.03, expressed higher satisfaction score with their sleep aid 7 (7.0-7.5) vs. 6 (5-7), p = 0.003 and had lower induction of labor rates 4/29 (14%) vs. 12/27 (44%), RR 0.3 (95%CI 0.1-0.8) p = 0.02. Conclusion Eye masks and earplugs use in nulliparas with short night sleep duration in late pregnancy, lengthen their night sleep duration over baseline. Sleep is reportedly better and maternal satisfaction is higher with eye masks and earplugs use.