Agreement between self-reported and objectively measured sleep duration among white, black, Hispanic, and Chinese adults in the United States: Multi-Ethnic Study of Atherosclerosis

Effects of Trazodone on Sleep: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVES

Sleep problems and insomnia are common, challenging to treat, and transcend specific diagnoses. Although trazodone is a popular choice, robust meta-analytic evidence is lacking. This systematic review and meta-analysis investigates the efficacy and safety of trazodone for sleep disturbances, reflecting recent updates in insomnia diagnosis and treatment.

METHODS

We searched Medline, Embase, APA PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 1 May 2024, for Randomized Controlled Trials (RCTs) comparing trazodone with placebo and reporting sleep-related outcomes. The minimum pharmacotherapy duration was 5 days. Included were all RCTs regardless of blinding (open-label or single- or double-blind), while quasi-randomized studies were excluded. The Cochrane Risk of Bias Tool for Randomized Trials assessed bias. Analyses used a random-effects model on an intention-to-treat (ITT) basis. Risk ratio (RR) was used for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes. When different units or scales were used, Hedge's adjusted g standardized mean difference (SMD) was calculated. Subgroup and preplanned sensitivity analyses explored heterogeneity and evaluated findings' strength and consistency.

RESULTS

In total, 44 RCTs with 3935 participants were included. Trazodone did not significantly impact subjective total sleep time (TST) [WMD = 0.73 min, 95% confidence interval (CI) - 24.62; 26.07, p = 0.96] but improved sleep quality (SQ) (SMD = - 0.58, 95% CI - 0.87; - 0.28, p < 0.01) and secondary outcomes. These included the number of nocturnal awakenings (SMD = - 0.57, 95% CI - 0.85; - 0.30], p < 0.01), nocturnal time awake after sleep onset (WMD = - 13.47 min, 95% CI - 23.09; - 3.86], p < 0.01), objective TST by polysomnography (WMD = 27.98 min, 95% CI 4.02; 51.95, p = 0.02), and sleep efficiency (WMD = 3.32, 95% CI 0.53; 1.57, p = 0.02). Tolerability issues included more dropouts owing to adverse effects (RR = 2.30, 95% CI 1.45; 3.64, p < 0.01), any sleep-related adverse effects (RR = 3.67, 95% CI 1.07; 12.47, p = 0.04), more adverse effects in general (RR = 1.18, 95% CI 1.03; 1.33, p = 0.02), and more sleep-related adverse effects (RR = 4.31, 95% CI 2.29; 8.13, p < 0.01).

CONCLUSION

Trazodone extends total sleep time but does not affect perceived sleep duration. It may improve sleep quality and continuity but has minor effects on sleep latency, efficiency, and daytime impairment. Trazodone is associated with adverse effects, necessitating a careful risk-benefit assessment. Limited data restrict generalizability, underscoring the need for more research.

REGISTRATION

PROSPERO registration number,CRD42022383121.

Association between phthalate exposure and sleep quality in pregnant women: Results from the Korean Children's Environmental Health Study with repeated assessment of exposure

Background

Evidence linking environmental toxicants to sleep quality is growing; however, these associations during pregnancy remain unclear. We examined the associations of repeated measures of urinary phthalates in early and late pregnancy with multiple markers of sleep quality among pregnant women.

Methods

The study population included 2324 pregnant women from the Korean Children's Environmental Health Study. We analyzed spot urine samples collected at two time points during pregnancy for exposure biomarkers of eight phthalate metabolites. We investigated associations between four summary phthalates (all phthalates: ∑Phthalates; di-(2-ethylhexyl) phthalate: ∑DEHP; phthalates from plastic sources: ∑Plastic; and antiandrogenic phthalates: ∑AA) and eight individual phthalates and self-reported sleep measures using generalized ordinal logistic regression and generalized estimating equations models that accounted for repeated exposure measurements. The models were adjusted for age, body mass index, education, gestational age, income, physical activity, smoking, occupation, chronic diseases, depression, and urinary cotinine levels.

Results

Multiple individual phthalates and summary measures of phthalate mixtures, including ∑Plastic, ∑DEHP, ∑AA, and ∑Phthalates, were associated with lower sleep efficiency. To illustrate, every 1-unit log increase in ∑AA was associated with a reduction of sleep efficiency by 1.37 % (95% confidence interval [CI] = -2.41, -0.32). ∑AA and ∑Phthalates were also associated with shorter sleep duration and longer sleep latency. Associations between summary phthalate measures and sleep efficiency differed by urinary cotinine levels (P for subgroup difference < 0.05).

Conclusions

Findings suggest that higher phthalate exposure may be related to lower sleep efficiency, shorter sleep duration, and prolonged sleep latency during pregnancy.

The relationship between sleep and interoception

The present study aimed to characterise the relationship between sleep and interoception in two independent studies. Theoretical grounds for such a relationship include a weak relationship between subjectively- and objectively-measured sleep, the covariance of sleep with pain, as well as the mass regulation of a number of visceral biological systems. In addition, such a relationship is often reflected in our language (i.e., 'feeling' tired). In both studies (Study 1: N = 118, 73% female, mean age 20.98 years; Study 2: N = 830, 49% female, mean age 38.04 years) sleep over the last month was self-reported. Confidence in interoceptive accuracy, which is the precision with which a person can monitor visceral signals, was measured using the Interoceptive Accuracy Scale, while interoceptive attention, which is the dispositional tendency to attend to bodily signals, was measured using the Body Perception Questionnaire. Study 1 revealed a relationship between long sleep latency and low confidence in interoceptive accuracy (β = -0.222, p = 0.021) and poor sleep quality and less interoceptive attention (β = -0.226, p = 0.016). Study 2 replicated these results as well as made clear a more general pattern whereby poor sleep-characterised by short duration, poor quality, less efficiency, long latency, and more frequent nighttime awakenings-related to an interoceptive phenotype of less confidence in interoceptive accuracy and more interoceptive attention (all β ≥ 0.047, p ≤ 0.17). In conclusion, results from these two independent studies provide robust cross-sectional evidence for associations between various dimensions of poor sleep and greater interoceptive attention, but less confidence in interoceptive accuracy.

Sleep as a contributor to socioeconomic disparities in hypertension: The Midlife in the United States (MIDUS II) Study

STUDY OBJECTIVES

Hypertension is highly prevalent and is a major risk factor for cardiovascular disease. There is a higher burden of hypertension among individuals of lower socioeconomic status (SES), yet the role of sleep in understanding socioeconomic disparities in hypertension is unclear. We investigated whether sleep quality is a partial mediator of the association between SES and hypertension.

METHODS

We used data from the Midlife in the United States II Study, 2004-2009 (n = 426). Analyses were conducted in 2023. Participants underwent 7-day actigraphy and clinical assessments. Sleep quality measures included actigraphy-defined wakefulness after sleep onset (WASO) and sleep efficiency. Hypertension was measured via three consecutive blood pressure readings, and SES was measured via educational attainment. Models were fit adjusting for age, gender, race, body mass index, and perceived stress.

RESULTS

Participants had a mean age of 53.5 years (SD = 12.4) and 41.0% were African American. The prevalences of poor WASO (>30 minutes), low sleep efficiency (<85%), and hypertension were 77.7%, 67.1%, and 61.0%, respectively. Education was not associated with hypertension. However, individuals with low vs. high sleep efficiency had 24% higher prevalence of hypertension (aPR = 1.24, 95% CI: 1.02 to 1.51), higher systolic blood pressure (aβ = 4.61, 95% CI: 0.69 to 8.53), and higher diastolic blood pressure (aβ = 2.50, 95% CI: 0.10 to 4.89). Education was not significantly associated with sleep after adjustment. There was no evidence of sleep mediating the SES-hypertension relation.

CONCLUSIONS

Effective interventions to lower hypertension prevalence should consider targeting sleep quality. Future research should explore the intersectionality of SES and race in hypertension.

A Large-Scale Genome-Wide Gene-Sleep Interaction Study in 732,564 Participants Identifies Lipid Loci Explaining Sleep-Associated Lipid Disturbances

We performed large-scale genome-wide gene-sleep interaction analyses of lipid levels to identify novel genetic variants underpinning the biomolecular pathways of sleep-associated lipid disturbances and to suggest possible druggable targets. We collected data from 55 cohorts with a combined sample size of 732,564 participants (87% European ancestry) with data on lipid traits (high-density lipoprotein [HDL-c] and low-density lipoprotein [LDL-c] cholesterol and triglycerides [TG]). Short (STST) and long (LTST) total sleep time were defined by the extreme 20% of the age- and sex-standardized values within each cohort. Based on cohort-level summary statistics data, we performed meta-analyses for the one-degree of freedom tests of interaction and two-degree of freedom joint tests of the main and interaction effect. In the cross-population meta-analyses, the one-degree of freedom variant-sleep interaction test identified 10 loci (P int <5.0e-9) not previously observed for lipids. Of interest, the ASPH locus (TG, LTST) is a target for aspartic and succinic acid metabolism previously shown to improve sleep and cardiovascular risk. The two-degree of freedom analyses identified an additional 7 loci that showed evidence for variant-sleep interaction (P joint <5.0e-9 in combination with P int <6.6e-6). Of these, the SLC8A1 locus (TG, STST) has been considered a potential treatment target for reduction of ischemic damage after acute myocardial infarction. Collectively, the 17 (9 with STST; 8 with LTST) loci identified in this large-scale initiative provides evidence into the biomolecular mechanisms underpinning sleep-duration-associated changes in lipid levels. The identified druggable targets may contribute to the development of novel therapies for dyslipidemia in people with sleep disturbances.

Validity of self-reported sleep duration in the Cancer Prevention Study- 3

PURPOSE

We examined the one-year test re-test reliability and validity criterion of survey-assessed sleep duration collected from two separate questions.

METHODS

The Activity Validation Sub Study included 751 participants of the Cancer Prevention Study-3 study to further investigate rest/activity cycles. Sleep duration was collected using three methods: survey, Daysimeter device, and sleep diary. Survey-assessed sleep duration was collected using 2 different questions, each with different response options (categorical and continuous). Selected participants (n = 170) were asked to wear a Daysimeter device for seven consecutive days for two non-consecutive quarters. Participants were excluded from the current study due to incomplete/implausible survey or device data or reported working night shift. We calculated reliability of pre- and post-survey sleep duration for both survey question using Spearman correlation. We used the method of triads to estimate the validity coefficient (VC) between the three sleep duration measurements in the present study and the "true" latent sleep duration measure, and bootstrapping methods to calculate the 95% confidence intervals (95%CI).

RESULTS

Of 119 participants included in the study (52.10% male), test-retest correlation showed strong and moderate correlations for sleep duration collected continuously and categorically, respectively. The VC for survey-assessed continuous sleep duration was 0.82 (95%CI 0.71, 0.90) for weekday and 0.68 (95%CI 0.46, 0.83) for weekend. Performance of the VC was slightly weaker for survey-assessed categorical sleep duration (weekday VC = 0.57 95%CI 0.42, 0.71; weekend VC = 0.47 95%CI 0.29, 0.62).

CONCLUSION

The two survey-assessed sleep duration questions used in the AVSS and CPS-3 cohorts are valid approximations of sleep duration.

A central role of sulcal width in the associations of sleep duration and depression with cognition in mid to late life

Study Objectives

Evidence suggests that poor sleep impacts cognition, brain health, and dementia risk but the nature of the association is poorly understood. This study examined how self-reported sleep duration, napping, and subjective depression symptoms are associated with the brain-cognition relationship in older adults, using sulcal width as a measure of relative brain health.

Methods

A canonical partial least squares analysis was used to obtain two composite variables that relate cognition and sulcal width in a cross-sectional study of 137 adults aged 46-72. We used a combination of ANCOVA and path analyses to test the associations of self-reported sleep duration, napping, and subjective depression symptoms with the brain-cognition relationship.

Results

We observed a significant main effect of sleep duration on sulcal width, with participants reporting 7 hours showing narrower sulci than other durations. This effect remained significant after including subjective depression as a covariate, which also had a significant main effect on sulcal width in the model. There was no significant effect of napping on sulcal width. In path analyses where the effects of age, self-reported sleep duration and depression symptoms were investigated together, sulcal width mediated the relationship between age and cognition. We also observed a significant indirect effect of sulci width in the subjective depression-cognition relationship.

Conclusions

Findings suggest that self-reported sleep duration and subjective depression may each be independently associated with brain morphology, which is related to cognitive functions. Results could help inform clinical trials and related intervention studies that aim at delaying cognitive decline in adults at risk of developing dementia.

Sleep, 24-Hour Activity Rhythms, and Subsequent Amyloid-β Pathology

Importance

Sleep disturbances are common among older adults and have been associated with the development of Alzheimer disease (AD), such as amyloid-β (Aβ) pathology. For effective AD prevention, it is essential to pinpoint the specific disturbances in sleep and the underlying 24-hour activity rhythms that confer the highest risk of Aβ deposition.

Objective

To determine the associations of 24-hour activity rhythms and sleep with Aβ deposition in adults without dementia, to evaluate whether disrupted 24-hour activity and sleep may precede Aβ deposition, and to assess the role of the apolipoprotein E ε4 (APOE4) genotype.

Design, Setting, and Participants

This was an observational cohort study using data from the Rotterdam Study. Of 639 participants without dementia who underwent Aβ positron emission tomography (PET) from September 2018 to November 2021, 319 were included in the current study. Exclusion criteria were no APOE genotyping and no valid actigraphy data at the baseline visits from 2004 to 2006 or from 2012 to 2014. The mean (SD) follow-up was 7.8 (2.4) years. Data were analyzed from March 2023 to April 2024.

Exposures

Actigraphy (7 days and nights, objective sleep, and 24-hour activity rhythms), sleep diaries (self-reported sleep), Aβ42/40, phosphorylated tau (p-tau)181 and p-tau217 plasma assays, 18F-florbetaben PET (mean standard uptake value ratio [SUVR] in a large cortical region of interest), and APOE4 genotype.

Main Outcomes and Measures

Association of objective and self-reported sleep and 24-hour activity rhythms at baseline with brain Aβ PET burden at follow-up.

Results

The mean (range) age in the study population was 61.5 (48-80) years at baseline and 69.2 (60-88) years at follow-up; 150 (47%) were women. Higher intradaily variability at baseline, an indicator of fragmented 24-hour activity rhythms, was associated with higher Aβ PET burden at follow-up (β, 0.15; bootstrapped 95% CI, 0.04 to 0.26; bootstrapped P = .02, false discovery rate [FDR] P = .048). APOE genotype modified this association, which was stronger in APOE4 carriers (β, 0.38; bootstrapped 95% CI, 0.05 to 0.64; bootstrapped P = .03) compared to noncarriers (β, 0.07; bootstrapped 95% CI, -0.04 to 0.18; bootstrapped P = .19). The findings remained largely similar after excluding participants with AD pathology at baseline, suggesting that a fragmented 24-hour activity rhythm may have preceded Aβ deposition. No other objective or self-reported measure of sleep was associated with Aβ.

Conclusions and Relevance

Among community-dwelling adults included in this study, higher fragmentation of the 24-hour activity rhythms was associated with greater subsequent Aβ burden, especially in APOE4 carriers. These results suggest that rest-activity fragmentation could represent a modifiable risk factor for AD.

Disparities in sleep duration and quality by industry of employment and occupational class among Native Hawaiian/Pacific Islanders and non-Hispanic Whites in the United States

OBJECTIVE

To investigate disparities in the work-sleep relationship between Native Hawaiian/Pacific Islanders (NHPIs) and non-Hispanic (NH)-White populations.

METHODS

Using data from a nationally representative sample of U.S. adults (n = 20,828) in the 2014 National Health Interview Survey, we estimated prevalence of short sleep duration (<7 hours) among NHPIs (10%) and NH-Whites for each of 7 employment industry categories and 3 occupational classes. Mean age was 41 ± 0.5years for NHPIs and 49 ± 0.2years for NH-Whites. Women comprised 52% of both groups.

RESULTS

NHPIs were more likely than NH-Whites to report short sleep duration across all industry of employment categories (except for food and accommodation services) and occupational classes. The disparity was widest among NHPI and NH-White workers in the "professional/management" industry category, with NHPIs having higher prevalence of very short (<6 hours; 20% vs. 7%) and short sleep (30% vs. 22%) durations and lower prevalence of recommended sleep duration (45% vs. 68%) and waking up feeling rested (53% vs. 67%). Among the occupational classes, the NHPI-White disparity was widest among participants who held support service occupations. Although professionals had the lowest and laborers had the highest prevalence of short sleep among the three occupational classes in both NHPI and NH-White groups, short sleep duration prevalence was higher among NHPI professionals (35%) than NH-White laborers (33%). NH-White workers across industry and occupational classes had higher sleep medication use prevalence compared to NHPI workers.

CONCLUSIONS

The work environment via occupation type may contribute to racial/ethnic disparities in short sleep. Further investigations are warranted.

Prediction of Mild Cognitive Impairment Status: Pilot Study of Machine Learning Models Based on Longitudinal Data From Fitness Trackers

BACKGROUND

Early signs of Alzheimer disease (AD) are difficult to detect, causing diagnoses to be significantly delayed to time points when brain damage has already occurred and current experimental treatments have little effect on slowing disease progression. Tracking cognitive decline at early stages is critical for patients to make lifestyle changes and consider new and experimental therapies. Frequently studied biomarkers are invasive and costly and are limited for predicting conversion from normal to mild cognitive impairment (MCI).

OBJECTIVE

This study aimed to use data collected from fitness trackers to predict MCI status.

METHODS

In this pilot study, fitness trackers were worn by 20 participants: 12 patients with MCI and 8 age-matched controls. We collected physical activity, heart rate, and sleep data from each participant for up to 1 month and further developed a machine learning model to predict MCI status.

RESULTS

Our machine learning model was able to perfectly separate between MCI and controls (area under the curve=1.0). The top predictive features from the model included peak, cardio, and fat burn heart rate zones; resting heart rate; average deep sleep time; and total light activity time.

CONCLUSIONS

Our results suggest that a longitudinal digital biomarker differentiates between controls and patients with MCI in a very cost-effective and noninvasive way and hence may be very useful for identifying patients with very early AD who can benefit from clinical trials and new, disease-modifying therapies.

Exploring the association between sleep duration and cancer risk in middle-aged and older Chinese adults: observations from a representative cohort study (2011-2020)

BACKGROUND

This prospective cohort study aimed to investigate the relationship between sleep duration and cancer incidence among 9996 participants over a median follow-up period of 9 years.

METHODS

Participants without cancer at baseline were followed for over 88,790 person-years. The incidence of cancer and sleep duration was self-reported. The relationship between sleep duration and cancer incidence was analyzed using Cox proportional hazards models adjusted for various confounding factors, including age, gender, lifestyle factors, and comorbidities.

RESULTS

During the follow-up, 325 participants were diagnosed with incident cancer, resulting in an incidence rate of 20.49 per 1000 person-years. After adjusting for confounders, a total sleep duration of less than 6 h was significantly associated with an increased risk of cancer (HR: 1.27; 95% CI: 1.01-1.61). This association was particularly strong for cancers in the digestive and respiratory systems (HR: 1.41; 95% CI: 1.03-1.93). Longer sleep durations (> 9 h) showed a potential increase in cancer risk, but results were not consistently significant. Age-stratified analyses revealed a similar significant increase in cancer incidence among individuals aged 60 years or younger with less than 6 h of sleep per day, showing a 35% increase in overall cancer risk and an 83% increase in digestive and respiratory system cancer. No significant association was found between nocturnal sleep durations or daytime naps and cancer incidence. However, a significant interaction was observed between daytime naps longer than 30 min and cancer incidence in women (p = 0.041).

CONCLUSIONS

We observed that short sleep duration may increase the risk of cancer, particularly cancers in the digestive and respiratory systems. Additionally, while longer sleep durations might also increase cancer risk, this finding requires validation with larger sample sizes.

Nonlinear relationships between sleep duration, mental health, and quality of life: The dangers of less sleep versus more sleep

BACKGROUND

Recent research has found a non-linear relationship between sleep duration and mental health/quality of life. However, it is currently unclear which age group is more affected by sleep duration and what the optimal sleep duration is for each age group. Additionally, the underlying mechanisms of the non-linear relationship between sleep duration and quality of life are not well understood.

METHODS

Therefore, this study utilized questionnaire data from 20,962 participants in the Chinese PBICR-2022 database(Cross-sectional study) and constructed models to analyze the relationship between sleep duration and quality of life.

RESULTS

The results showed that the optimal sleep duration varied among different age groups: approximately 9 h for adolescents, 8 h for early/middle-aged adults, and 7 h for older adults. Compared to other age groups, less or more sleep duration had a greater impact on mental health and quality of life in adolescents. Furthermore, mental health was found to play a significant mediating role between sleep duration and quality of life in both the less sleep group and the more sleep group, but this mediating effect was not significant among the older adults in the less sleep group, whereas the mediating effect of mental health was not significant among the middle-aged adults in the more sleep group.

CONCLUSIONS

This suggests that different age groups have different optimal sleep duration, and age may be an important factor influencing the relationship between sleep duration and mental health/quality of life, with mental health playing a mediating role in the relationship between sleep duration and quality of life.

Impact of COVID-related Discrimination on Psychological Distress and Sleep Disturbances across Race-Ethnicity

COVID-related discrimination towards historically marginalized racial-ethnic groups in the United States has been well-documented; however, its impact on psychological distress and sleep (overall and within specific racial-ethnic groups) is largely unknown. We used data from our nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, conducted from 12/2020-2/2021. Participants were asked how often they experienced discriminatory behaviors "because they think you might have COVID-19" (modified Everyday Discrimination Scale). Psychological distress was captured as having experienced anxiety-depression symptoms (Patient Health Questionairre-4, PHQ-4), perceived stress (modified Perceived Stress Scale), or loneliness-isolation ("How often have you felt lonely and isolated?"). Sleep disturbances were measured using the Patient-Reported Outcomes Information System Short Form Sleep Disturbance scale (PROMIS-SF 4a). Overall, 22.1% reported COVID-related discriminatory behaviors (sometimes/always: 9.7%; rarely: 12.4%). 48.4% of participants reported anxiety-depression symptoms (moderate/severe: 23.7% mild: 24.8%), 62.4% reported feeling stressed (moderate/severe: 34.3%; mild: 28,1%), 61.0% reported feeling lonely-isolated (fairly often/very often: 21.3%; almost never/sometimes: 39.7%), and 35.4% reported sleep disturbances (moderate/severe:19.8%; mild: 15.6%). Discrimination was only associated with increased psychological distress among racial-ethnic minorities. For example, COVID-related discrimination was strongly associated with anxiety-depression among Black/African American adults (mild: aOR=2.12, 95% CI=1.43-5.17; moderate/severe: aOR=5.19, 95% CI=3.35-8.05), but no association was observed among White or multiracial adults. Mitigating pandemic-related discrimination could help alleviate mental and sleep health disparities occurring among minoritized racial-ethnic groups.

No evidence linking sleep traits with white blood cell counts: Multivariable-adjusted and Mendelian randomization analyses

BACKGROUND

Disturbances in habitual sleep have been associated with multiple age-associated diseases. However, the biological mechanisms underpinning these associations remain largely unclear. We assessed the possible involvement of the circulating immune system by determining the associations between sleep traits and white blood cell counts using multivariable-adjusted linear regression and Mendelian randomization.

METHODS

Cross-sectional multivariable-adjusted linear regression analyses were done using participants within the normal range of total white blood cell counts (>4.5 × 109 and <11.0 × 109/μL) from UK Biobank. For the sleep traits, we examined (short and long) sleep duration, chronotype, insomnia symptoms and daytime dozing. Two-sample Mendelian randomization analyses were done using instruments for sleep traits derived from European-ancestry participants from UK Biobank (over 410,000 participants) and using SNP-outcome data derived from European-ancestry participants from the Blood Cell Consortium (N = 563,946) to which no data from UK Biobank contributed.

RESULTS

Using data from 357,656 participants (mean [standard deviation] age: 56.5 [8.1] years, and 44.4% men), we did not find evidence that disturbances in any of the studied sleep traits were associated with differences in blood cell counts (total, lymphocytes, neutrophiles, eosinophiles and basophiles). Also, we did not find associations between disturbances in any of the studied sleep traits and white blood cell counts using Mendelian Randomization.

CONCLUSION

Based on the results from two different methodologies, disturbances in habitual sleep are unlikely to cause changes in blood cell counts and thereby differences in blood cell counts are unlikely to be underlying the observed sleep-disease associations.

Years of life lost due to insufficient sleep and associated economic burden in China from 2010-18

Background

Research on the health and economic costs due to insufficient sleep remains scant in developing countries. In this study we aimed to estimate the years of life lost (YLLs) due to short sleep and quantify its economic burden in China.

Methods

We estimated both individual and aggregate YLLs due to short sleep (ie, ≤6 hours) among Chinese adults aged 20 years or older by sex and five-year age groups in 2010, 2014, and 2018. YLL estimates were derived from 1) the prevalence of short sleep using three survey waves of the China Family Panel Studies, 2) relative mortality risks from meta-analyses, and 3) life tables in China. YLL was the difference between the estimated life expectancy of an individual in the short sleep category vs in the recommended sleep category. We estimated the economic cost using the human capital approach.

Results

The sample sizes of the three survey waves were 31 393, 31 207, and 28 618. Younger age groups and men had more YLLs due to short sleep compared to their counterparts. For individuals aged 20-24, men had an average YLL of nearly 0.95, in contrast to the approximate 0.75 in women across the observed years of 2010, 2014, and 2018. The trend in individual YLLs remained consistent over these years. In aggregate, China experienced a rise from 66.75 million YLLs in 2010 to 95.29 million YLLs in 2014, and to 115.05 million YLLs in 2018. Compared to 2010 (USD 191.83 billion), the associated economic cost in 2014 increased to USD 422.24 billion, and the cost in 2018 more than tripled (USD 628.15 billion). The percentage of cost to Chinese gross domestic product in corresponding years was 3.23, 4.09, and 4.62%.

Conclusions

Insufficient sleep is associated with substantial YLLs in China, potentially impacting the population's overall life expectancy. The escalating economic toll attributed to short sleep underscores the urgent need for public health interventions to improve sleep health at the population level.

Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer

U.S. racial and ethnic minoritized groups face disproportionate cancer burdens compared to White Americans. Investigating modifiable factors, such as sleep, that are socially patterned and inequitably distributed by race and ethnicity may advance understanding of cancer disparities and provide intervention opportunities. Emerging data suggest poor sleep health is associated with cancer. Yet, its contribution to racial and ethnic cancer disparities is understudied. In this narrative review, we explored the sleep-cancer relation through a disparities lens. We (i) summarized literature reporting on associations between sleep and cancer among racial and ethnic minority populations; (ii) examined potential sleep-cancer mechanisms; and (iii) discussed future directions. We identified five studies reporting on sleep-cancer associations among minoritized groups. Poor sleep health was associated with aggressive breast cancer among Black women, increased breast cancer risk among Asian women, and increased risk of breast and total cancer among Hispanic/Latinx Americans. Sleep and cancer disparities have similar socioeconomic and behavioral determinants, suggesting racial and ethnic minoritized groups may be vulnerable to poor sleep health and its adverse health impacts. Evidence indicates that the sleep-cancer disparities relation is an emerging, but important area of research that warrants further investigation, as sleep may be an avenue for reducing cancer disparities.

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Importance

Racial disparities in sleep health may mediate the broader health outcomes of structural racism.

Objective

To assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism.

Design, Setting, and Participants

Two distinct difference-in-differences analyses examined the changes in sleep duration for the US non-Hispanic Black (hereafter, Black) population before vs after exposure to officer-involved killings of unarmed Black people, using data from adult respondents in the US Behavioral Risk Factor Surveillance Survey (BRFSS; 2013, 2014, 2016, and 2018) and the American Time Use Survey (ATUS; 2013-2019) with data on officer-involved killings from the Mapping Police Violence database. Data analyses were conducted between September 24, 2021, and September 12, 2023.

Exposures

Occurrence of any police killing of an unarmed Black person in the state, county, or commuting zone of the survey respondent's residence in each of the four 90-day periods prior to interview, or occurence of a highly public, nationally prominent police killing of an unarmed Black person anywhere in the US during the 90 days prior to interview.

Main Outcomes and Measures

Self-reported total sleep duration (hours), short sleep (<7 hours), and very short sleep (<6 hours).

Results

Data from 181 865 Black and 1 799 757 White respondents in the BRFSS and 9858 Black and 46 532 White respondents in the ATUS were analyzed. In the larger BRFSS, the majority of Black respondents were between the ages of 35 and 64 (99 014 [weighted 51.4%]), women (115 731 [weighted 54.1%]), and college educated (100 434 [weighted 52.3%]). Black respondents in the BRFSS reported short sleep duration at a rate of 45.9%, while White respondents reported it at a rate of 32.6%; for very short sleep, the corresponding values were 18.4% vs 10.4%, respectively. Statistically significant increases in the probability of short sleep and very short sleep were found among Black respondents when officers killed an unarmed Black person in their state of residence during the first two 90-day periods prior to interview. Magnitudes were larger in models using exposure to a nationally prominent police killing occurring anywhere in the US. Estimates were equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity in very short sleep.

Conclusions and Relevance

Sleep health among Black adults worsened after exposure to officer-involved killings of unarmed Black individuals. These empirical findings underscore the role of structural racism in shaping racial disparities in sleep health outcomes.

Racial Discrimination and Metabolic Syndrome in Young Black Adults

Importance

Metabolic syndrome (MetS) is a common health condition that predisposes individuals to cardiovascular disease (CVD) and disproportionately affects Black and other racially and ethnically minoritized people. Concurrently, Black individuals also report more exposure to racial discrimination compared with White individuals; however, the role of discrimination in the development of MetS over time and associated mediators in these pathways remain underexplored.

Objective

To evaluate the association between racial discrimination and MetS in rural Black individuals transitioning from late adolescence into early adulthood and to identify potential mediating pathways.

Design, Setting, and Participants

This longitudinal cohort study included Black adolescents enrolled in the Strong African American Families Healthy Adults (SHAPE) Project between June 2009 and May 2021. Families resided in rural counties of Georgia, where poverty rates are among the highest in the nation. Analyses included 322 of the 500 participants who originally enrolled in SHAPE and who were eligible to participate. Guardians provided information about socioeconomic disadvantage. Analyses were conducted in April 2023.

Exposures

Youths reported exposure to racial discrimination annually from ages 19 to 21 years.

Main Outcomes and Measures

MetS was the main health outcome and was measured at ages 25 and 31 years. MetS was diagnosed according to the International Diabetes Federation guidelines, which requires central adiposity (ie, waist circumference ≥94 cm for males and ≥80 cm for females) and at least 2 of the 4 additional components: signs of early hypertension (ie, systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg); elevated triglyceride levels (ie, >150 mg/dL); elevated fasting glucose level (ie, ≥100 mg/dL); or lowered high-density lipoprotein levels (ie, <40 mg/dL in men and <50 mg/dL in women). At age 25 years, markers of inflammatory activity (ie, soluble urokinase plasminogen activator receptor [suPAR]) and sleep problems were collected to consider as potential mediators.

Results

In 322 participants (210 [65.2%] female) ages 19 to 21 years, more frequent exposure to racial discrimination was associated with higher suPAR levels (b = 0.006; 95% CI, 0.001-0.011; P = .01) and more sleep problems at age 25 years (b = 0.062; 95% CI, 0.028-0.097; P < .001) as well as a 9.5% higher risk of MetS diagnosis at age 31 years (odds ratio [OR], 1.10; 95% CI, 1.01-1.20; P = .03). Both suPAR (b = 0.015; 95% CI, 0.002-0.037) and sleep problems (b = 0.020; 95% CI, 0.002-0.047) at age 25 years were significant indirect pathways. No significant interactions between sex and discrimination emerged.

Conclusions and Relevance

This study suggests that racial discrimination in late adolescence is associated with MetS among Black young adults through biobehavioral pathways. Thus, health interventions for MetS in Black adults will need to contend with sleep behaviors and inflammatory intermediaries as well as address and reduce exposure to racial discrimination to narrow disparities and promote health equity.

Sleep Characteristics are Associated with Risk of Treated Diabetes Among Postmenopausal Women

OBJECTIVE

The purpose of this study was to determine whether sleep characteristics are associated with incidence of treated diabetes in postmenopausal individuals.

METHODS

Postmenopausal participants ages 50-79 years reported sleep duration, sleep-disordered breathing, or insomnia at baseline and again in a subsample 3 years later. The primary outcome was self-reported new diagnosis of diabetes treated with oral drugs or insulin at any time after baseline. Multivariable Cox proportional hazards models were used.

RESULTS

In 135,964 participants followed for 18.1 (± 6.3) years, there was a nonlinear association between sleep duration and risk of treated diabetes. Participants sleeping ≤5 hours at baseline had a 21% increased risk of diabetes compared with those sleeping 7 hours (adjusted hazard ratio [aHR] 1.21; 95% confidence interval [CI], 1.00-1.47). Those who slept for ≥9 hours had a nonsignificant 6% increased risk of diabetes compared with those sleeping 7 hours (aHR 1.06; 95% CI, 0.97-1.16). Participants whose sleep duration had decreased at 3 years had a 9% (aHR 1.09; 95% CI, 1.02-1.16) higher risk of diabetes than participants with unchanged sleep duration. Participants who reported increased sleep duration at 3 years had a risk of diabetes (HR 1.01; 95% CI, 0.95-1.08) similar to those with no sleep duration change. Participants at high risk of sleep-disordered breathing at baseline had a 31% higher risk of diabetes than those without (aHR 1.31; 95% CI, 1.26-1.37). No association was found between self-reported insomnia score and diabetes risk.

CONCLUSIONS

Sleep-disordered breathing and short or long sleep duration were associated with higher diabetes risk in a postmenopausal population.

Long sleep time and excessive need for sleep: State of the art and perspectives

The mechanisms underlying the individual need for sleep are unclear. Sleep duration is indeed influenced by multiple factors, such as genetic background, circadian and homeostatic processes, environmental factors, and sometimes transient disturbances such as infections. In some cases, the need for sleep dramatically and chronically increases, inducing a daily-life disability. This "excessive need for sleep" (ENS) was recently proposed and defined in a European Position Paper as a dimension of the hypersomnolence spectrum, "hypersomnia" being the objectified complaint of ENS. The most severe form of ENS has been described in Idiopathic Hypersomnia, a rare neurological disorder, but this disabling symptom can be also found in other hypersomnolence conditions. Because ENS has been defined recently, it remains a symptom poorly investigated and understood. However, protocols of long-term polysomnography recordings have been reported by expert centers in the last decades and open the way to a better understanding of ENS through a neurophysiological approach. In this narrative review, we will 1) present data related to the physiological and pathological variability of sleep duration and their mechanisms, 2) describe the published long-term polysomnography recording protocols, and 3) describe current neurophysiological tools to study sleep microstructure and discuss perspectives for a better understanding of ENS.

An Examination of Sleep as a Mediator of the Relationship between Childhood Adversity and Depression in Hispanic and Non-Hispanic Young Adults

The current study integrates previous research on adverse childhood experiences (ACEs) and long-term health outcomes to examine associations between ACEs, sleep duration, and depression in a diverse, mostly healthy, sample of young adults. We examine whether sleep duration mediates the association between ACEs and depression among young adults, and whether ethnicity may moderate observed relationships between ACEs, sleep duration and depression. Data were collected from 518 young adults (66.8% female, Mage=19.79 years, SDage=3.43 years) enrolled in undergraduate Psychology courses at a large Southwestern university. Participants primarily reported their racial/ethnic background as Non-Hispanic White (60.6%) and Hispanic/Latino (25.1%). Participants self-reported their ACEs exposure, sleep characteristics, and depressive symptoms. In addition to calculating overall exposure to ACEs, scores for the specific dimensions of adversity were also calculated (Abuse, Neglect, Exposure to Violence). Results supported a mediation model whereby higher reports of ACEs were associated with depressive symptoms both directly and through sleep duration. Results were not moderated by ethnicity. Findings provide support for sleep duration as one potential pathway through which ACEs may be associated with depressive symptoms in young adulthood, and suggest that this pathway is similar in Hispanic and non-Hispanic young adults.

Associations between actigraphy-measured sleep duration, continuity, and timing with mortality in the UK Biobank

STUDY OBJECTIVES

To examine the associations between sleep duration, continuity, timing, and mortality using actigraphy among adults.

METHODS

Data were from a cohort of 88 282 adults (40-69 years) in UK Biobank that wore a wrist-worn triaxial accelerometer for 7 days. Actigraphy data were processed to generate estimates of sleep duration and other sleep characteristics including wake after sleep onset (WASO), number of 5-minute awakenings, and midpoint for sleep onset/wake-up and the least active 5 hours (L5). Data were linked to mortality outcomes with follow-up to October 31, 2021. We implemented Cox models (hazard ratio, confidence intervals [HR, 95% CI]) to quantify sleep associations with mortality. Models were adjusted for demographics, lifestyle factors, and medical conditions.

RESULTS

Over an average of 6.8 years 2973 deaths occurred (1700 cancer, 586 CVD deaths). Overall sleep duration was significantly associated with risk for all-cause (p < 0.01), cancer (p < 0.01), and CVD (p = 0.03) mortality. For example, when compared to sleep durations of 7.0 hrs/d, durations of 5 hrs/d were associated with a 29% higher risk for all-cause mortality (HR: 1.29 [1.09, 1.52]). WASO and number of awakenings were not associated with mortality. Individuals with L5 early or late midpoints (<2:30 or ≥ 3:30) had a ~20% higher risk for all-cause mortality, compared to those with intermediate L5 midpoints (3:00-3:29; p ≤ 0.01; e.g. HR ≥ 3:30: 1.19 [1.07, 1.32]).

CONCLUSIONS

Shorter sleep duration and both early and late sleep timing were associated with a higher mortality risk. These findings reinforce the importance of public health efforts to promote healthy sleep patterns in adults.

Actigraphy-derived measures of sleep and risk of prostate cancer in the UK Biobank

BACKGROUND

Studies of sleep and prostate cancer are almost entirely based on self-report, with limited research using actigraphy. Our goal was to evaluate actigraphy-measured sleep and prostate cancer and to expand on findings from prior studies of self-reported sleep.

METHODS

We prospectively examined 34 260 men without a history of prostate cancer in the UK Biobank. Sleep characteristics were measured over 7 days using actigraphy. We calculated sleep duration, onset, midpoint, wake-up time, social jetlag (difference in weekend-weekday sleep midpoints), sleep efficiency (percentage of time spent asleep between onset and wake-up time), and wakefulness after sleep onset. Cox proportional hazards models were used to estimate covariate-adjusted hazards ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Over 7.6 years, 1152 men were diagnosed with prostate cancer. Sleep duration was not associated with prostate cancer risk. Sleep midpoint earlier than 4:00 am was not associated with prostate cancer risk, though sleep midpoint of 5:00 am or later was suggestively associated with lower prostate cancer risk but had limited precision (earlier than 4:00 am vs 4:00-4:59 am HR = 1.00, 95% CI = 0.87 to 1.16; 5:00 am or later vs 4:00-4:59 am HR = 0.79, 95% CI = 0.57 to 1.10). Social jetlag was not associated with greater prostate cancer risk (1 to <2 hours vs <1 hour HR = 1.06, 95% CI = 0.89 to 1.25; ≥2 hours vs <1 hour HR = 0.90, 95% CI = 0.65 to 1.26). Compared with men who averaged less than 30 minutes of wakefulness after sleep onset per day, men with 60 minutes or more had a higher risk of prostate cancer (HR = 1.20, 95% CI = 1.00 to 1.43).

CONCLUSIONS

Of the sleep characteristics studied, higher wakefulness after sleep onset-a measure of poor sleep quality-was associated with greater prostate cancer risk. Replication of our findings between wakefulness after sleep onset and prostate cancer are warranted.

Persistently short or long sleep duration increases the risk of sensory impairment in Chinese older adults

Background

Cross-sectional evidence suggests that persistently short or long sleep duration is associated with sensory impairment. Thus, this study was conducted to investigate the associations between sleep duration and altered sleep duration with sensory impairment in Chinese older adults.

Methods

Longitudinal data (2008-2014) obtained through the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed. Sleep duration was classified as normal (7-8 h), short (<7 h), or long (≥9 h). Sensory impairment was assessed using individuals' self-reported data on visual and hearing functions. Cox regression was performed to evaluate the effects of sleep duration and altered sleep duration on sensory impairment, including visual impairment (VI) and hearing impairment (HI).

Results

This study included 3,578 older adults (mean age: 78.12 ± 9.59 years). Among them, 2,690 (75.2%) were aged 65-84 years and 1798 (50.3%) were women. The risks of VI (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.02-1.29), HI (HR: 1.14; 95% CI: 1.00-1.30), and dual sensory impairment (both VI and HI; HR: 1.26; 95% CI: 1.03-1.55) were high in older adults with long sleep duration. In addition, the risks of VI, HI, and dual sensory impairment were high in individuals whose sleep duration changed from normal to short or long (HR: 1.20 [95% CI: 1.02-1.42], 1.26 [95% CI: 1.03-1.53], and 1.54 [95% CI: 1.11-2.12], respectively) and those with persistently short or long sleep duration (HR: 1.25 [95% CI: 1.07-1.46], 1.34 [95% CI: 1.11-1.61], and 1.67 [95% CI: 1.22-2.27], respectively).

Conclusion

A prospective association was identified between altered sleep duration and sensory impairment in Chinese older adults. Our findings highlight the importance of optimal sleep duration and healthy sleep habits in preventing sensory impairment in older adults.

Exposure to indoor light at night in relation to multiple dimensions of sleep health: findings from the Sister Study

STUDY OBJECTIVE

To examine the association between light at night (LAN) and multiple sleep health dimensions.

METHODS

Among 47 765 Sister Study participants, indoor LAN (TV on in the room, light(s) on in room, light from outside the room, nightlight, no light) and sleep dimensions were self-reported at baseline (2003-2009). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the cross-sectional associations between LAN and short sleep duration (<7 hours/night), insomnia symptoms (difficulty falling or staying asleep), frequent napping (≥3 naps/week), inconsistent sleep/wake time (differed day-to-day and week-to-week), sleep debt (≥2 hours between longest and shortest duration), recent sleep medication use, and a cumulative poor sleep score (≥3 poor sleep dimensions). Population-attributable risks (PARs) were determined for any light exposure vs. none by race/ethnicity.

RESULTS

Compared to sleeping with no light in the bedroom, sleeping with a TV on was associated with a higher prevalence of most dimensions of poor sleep (e.g. short sleep duration: PR = 1.38, 95% CI: 1.32 to 1.45; inconsistent sleep/wake time: PR = 1.55, 95% CI: 1.44 to 1.66; sleep debt: PR = 1.36, 95% CI: 1.29 to 1.44; poor sleep score: PR = 1.58, 95% CI: 1.48-1.68). PARs tended to be higher for non-Hispanic black women compared to non-Hispanic white women.

CONCLUSIONS

Sleeping with a TV on was associated with poor sleep health among US women, and non-Hispanic black women may be disproportionately burdened.

Are we getting enough sleep? Frequent irregular sleep found in an analysis of over 11 million nights of objective in-home sleep data

OBJECTIVES

Evidence-based guidelines recommend that adults should sleep 7-9 h/night for optimal health and function. This study used noninvasive, multinight, objective sleep monitoring to determine average sleep duration and sleep duration variability in a large global community sample, and how often participants met the recommended sleep duration range.

METHODS

Data were analyzed from registered users of the Withings under-mattress Sleep Analyzer (predominantly located in Europe and North America) who had ≥28 nights of sleep recordings, averaging ≥4 per week. Sleep durations (the average and standard deviation) were assessed across a ∼9-month period. Associations between age groups, sex, and sleep duration were assessed using linear and logistic regressions, and proportions of participants within (7-9 hours) or outside (<7 hours or >9 hours) the recommended sleep duration range were calculated.

RESULTS

The sample consisted of 67,254 adults (52,523 males, 14,731 females; aged mean ± SD 50 ± 12 years). About 30% of adults demonstrated an average sleep duration outside the recommended 7-9 h/night. Even in participants with an average sleep duration within 7-9 hours, about 40% of nights were outside this range. Only 15% of participants slept between 7 and 9 hours for at least 5 nights per week. Female participants had significantly longer sleep durations than male participants, and middle-aged participants had shorter sleep durations than younger or older participants.

CONCLUSIONS

These findings indicate that a considerable proportion of adults are not regularly sleeping the recommended 7-9 h/night. Even among those who do, irregular sleep is prevalent. These novel data raise several important questions regarding sleep requirements and the need for improved sleep health policy and advocacy.

Racial/ethnic and sex differences in the association between light at night and actigraphy-measured sleep duration in adults: NHANES 2011-2014

OBJECTIVE

Historically minoritized individuals experience greater exposure to light at night, yet it is unclear whether the association between light at night and sleep duration vary by race/ethnicity or sex. We examined the association between light at night and sleep duration by race/ethnicity and sex.

METHODS

Participants (N = 6089, mean age=49.5, 52% women, 13% Asian, 27% Black, 14% Mexican, 46% White) in the 2011-2014 National Health and Nutrition Examination Survey underwent 9-day of actigraphy. Light at night was defined as light exposure within the 5-hour activity nadir (L5). Sleep duration within a 24-hour period was analyzed as short (<7 hours) or long (>9 hours) compared to recommended (≥7 and <9 hours). Poisson models were fit to estimate the association between light at night and sleep duration after adjustment for covariates.

RESULTS

Light at night was most common among Black participants, who also had the shortest sleep duration. Overall, light at night was associated with 80% higher prevalence of short sleep duration [1.80 (1.49, 2.18)]. Compared to no-light at night, low and high light at night were associated with higher prevalence of short sleep duration, [1.61 (1.31, 1.98) and 2.01 (1.66, 2.44), respectively]. Associations varied by race/ethnicity and sex. Light at night was associated with shorter sleep duration in Black, Mexican and White females and Mexican and White males only. Black males exposed to light at night vs. no-light at night had lower prevalence of long sleep duration. There were no associations between light at night and sleep duration among Asian participants.

CONCLUSION

Light at night was associated with shorter sleep duration, particularly among females. Targeting light exposure may help to improve sleep duration.

Objectively regular sleep patterns and mortality in a prospective cohort: The Multi-Ethnic Study of Atherosclerosis

Irregular sleep and non-optimal sleep duration separately have been shown to be associated with increased disease and mortality risk. We used data from the prospective cohort Multi-Ethnic Study of Atherosclerosis sleep study (2010-2013) to investigate: do aging adults whose sleep is objectively high in regularity in timing and duration, and of sufficient duration tend to have increased survival compared with those whose sleep is lower in regularity and duration, in a diverse US sample? At baseline, sleep was measured by 7-day wrist actigraphy, concurrent with at-home polysomnography and questionnaires. Objective metrics of sleep regularity and duration from actigraphy were used for statistical clustering using sparse k-means clustering. Two sleep patterns were identified: "regular-optimal" (average duration: 7.0 ± 1.0 hr obtained regularly) and "irregular-insufficient" (duration: 5.8 ± 1.4 hr obtained with twice the irregularity). Using proportional hazard models with multivariate adjustment, we estimated all-cause mortality hazard ratios. Among 1759 participants followed for a median of 7.0 years (Q1-Q3, 6.4-7.4 years), 176 deaths were recorded. The "regular-optimal" group had a 39% lower mortality hazard than did the "irregular-insufficient" sleep group (hazard ratio [95% confidence interval]: 0.61 [0.45, 0.83]) after adjusting for socio-demographics, lifestyle, medical comorbidities and sleep disorders. In conclusion, a "regular-optimal" sleep pattern was significantly associated with a lower hazard of all-cause mortality. The regular-optimal phenotype maps behaviourally to regular bed and wake times, suggesting sleep benefits of adherence to recommended healthy sleep practices, with further potential benefits for longevity.

Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging

OBJECTIVES

Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited.

METHODS

We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex.

RESULTS

Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex.

CONCLUSIONS

Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

The efficacy of sleep lifestyle interventions for the management of overweight or obesity in children: a systematic review and meta-analysis

BACKGROUND

Childhood obesity remains a significant public health concern. Sleep duration and quality among children and youth are suboptimal worldwide. Accumulating evidence suggests an association between inadequate sleep and obesity risk, yet it is unclear whether this relationship is causal. This systematic review examines the efficacy of sleep interventions alone or as a part of lifestyle interventions for the management of overweight or obesity among children and adolescents.

METHODS

A keyword/reference search was performed twice, in January 2021 and May 2022 in MEDLINE/PubMed, EMBASE/Ovid, PsycINFO/EBSCO, The Cochrane Library, Web of Science Core Collection/Web of Science, SciELO/Web of Science, and CINAHL/EBSCO. Study eligibility criteria included youth with overweight or obesity between 5 and 17, were RCTs or quasi-randomized, and focused on the treatment of overweight and obesity with a sleep behavior intervention component. Risk of bias was assessed using the Cochrane Risk of Bias assessment tool (RoB2). A Meta-analysis was conducted to estimate the effect of interventions with a sleep component on BMI. The study protocol was registered in PROSPERO (CRD42021233329).

RESULTS

A total of 8 studies (2 quasi-experiments, 6 RCTs) met inclusion criteria and accounted for 2,231 participants across 7 countries. Only one study design isolated the effect of sleep in the intervention and reported statistically significant decreases in weight and waist circumference compared to control, though we rated it at high risk of bias. Our meta-analysis showed no significant overall effect on children's BMI as a result of participation in an intervention with a sleep component (Cohen's d = 0.18, 95% CI= -0.04, 0.40, Z = 1.56, P = .11), though caution is warranted due to substantial heterogeneity observed across studies (Tau2 = 0.08; X2 = 23.05, df = 7; I2 = 83.73%).

CONCLUSIONS

There were mixed results on the effect of sleep interventions across included studies on BMI, other weight-related outcomes, diet, physical activity, and sleep. Except for one study at low risk of bias, three were rated as 'some concerns' and four 'high risk of bias'. Findings from this study highlight the need for additional RCTs isolating sleep as a component, focusing on children and adolescents living with overweight and obesity.

Stability and Volatility of Human Rest-Activity Rhythms: Insights from Very Long Actograms (VLAs)

Importance

Wrist-worn activity monitors provide biomarkers of health by non-obtrusively measuring the timing and amount of rest and physical activity (rest-activity rhythms, RARs). The morphology and robustness of RARs vary by age, gender, and sociodemographic factors, and are perturbed in various chronic illnesses. However, these are cross-sectionally derived associations from recordings lasting 4-10 days, providing little insights into how RARs vary with time.

Objective

To describe how RAR parameters can vary or evolve with time (~months).

Design Setting and Participants

48 very long actograms ("VLAs", ≥90 days in duration) were identified from subjects enrolled in the STAGES (Stanford Technology, Analytics and Genomics in Sleep) study, a prospective cross-sectional, multi-site assessment of individuals > 13 years of age that required diagnostic polysomnography to address a sleep complaint. A single 3-year long VLA (author GD) is also described.

Exposures/Intervention

None planned.

Main Outcomes and Measures

For each VLA, we assessed the following parameters in 14-day windows: circadian/ultradian spectrum, pseudo-F statistic ("F"), cosinor amplitude, intradaily variability, interdaily stability, acrophase and estimates of "sleep" and non-wearing.

Results

Included STAGES subjects (n = 48, 30 female) had a median age of 51, BMI of 29.4kg/m2, Epworth Sleepiness Scale score (ESS) of 10/24 and a median recording duration of 120 days. We observed marked within-subject undulations in all six RAR parameters, with many subjects displaying ultradian rhythms of activity that waxed and waned in intensity. When appraised at the group level (nomothetic), averaged RAR parameters remained remarkably stable over a ~4 month recording period. Cohort-level deficits in average RAR robustness associated with unemployment or high BMI (>29.4) also remained stable over time.

Conclusions and Relevance

Through an exemplary set of months-long wrist actigraphy recordings, this study quantitatively depicts the longitudinal stability and dynamic range of human rest-activity rhythms. We propose that continuous and long-term actigraphy may have broad potential as a holistic, transdiagnostic and ecologically valid monitoring biomarker of changes in chronobiological health. Prospective recordings from willing subjects will be necessary to precisely define contexts of use.

Associations between social jetlag trajectories and body mass index among young adults

STUDY OBJECTIVES

This study employed longitudinal data collected repeatedly from individuals over the course of several years to examine the trajectories of social jetlag from ages 11 to 22 years and their associations with subsequent body mass index (BMI). Potential sex differences were also investigated.

METHODS

Data were obtained from two longitudinal studies conducted in Taiwan (N = 4287). Social jetlag was defined as ≥ 2 hours of absolute difference in sleep midpoint between weekdays and weekends. BMI was calculated using weight (kg)/height(m)2 and categorized as underweight (<18 kg/m2), normal weight (18 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 27 kg/m2), and obese (≥27 kg/m2). Group-based trajectory modeling and multinomial logistic regression were applied to investigate study objectives.

RESULTS

Four distinct trajectories of social jetlag throughout the adolescent years were identified, with corresponding proportions as follows: low-stable (42%), moderate-decreasing (19%), low-increasing (22%), and chronic (17%) trajectories. Among males, the risk of being underweight (aOR, 1.96; 95% CI: 1.35 to 2.84) or obese (aOR, 1.40; 95% CI: 1.02 to 1.92) was higher in individuals with a low-increasing trajectory than in those with a low-stable trajectory. Among females, those with a low-increasing (aOR, 1.61; 95% CI: 1.02 to 2.54) or chronic (aOR, 2.04; 95% CI: 1.27 to 3.25) trajectory were at a higher risk of being obese relative to those with a low-stable trajectory.

CONCLUSIONS

Addressing the development of increasing or chronic social jetlag during adolescence can help prevent abnormal BMI in young adulthood. Practitioners should consider sex differences in treatment or consultation.

Sleep duration and brain MRI measures: Results from the SOL-INCA MRI study

INTRODUCTION

Sleep duration has been associated with dementia and stroke. Few studies have evaluated sleep pattern-related outcomes of brain disease in diverse Hispanics/Latinos.

METHODS

The SOL-INCA (Study of Latinos-Investigation of Neurocognitive Aging) magnetic resonance imaging (MRI) study recruited diverse Hispanics/Latinos (35-85 years) who underwent neuroimaging. The main exposure was self-reported sleep duration. Our main outcomes were total and regional brain volumes.

RESULTS

The final analytic sample included n = 2334 participants. Increased sleep was associated with smaller brain volume (βtotal_brain  = -0.05, p < 0.01) and consistently so in the 50+ subpopulation even after adjusting for mild cognitive impairment status. Sleeping >9 hours was associated with smaller gray (βcombined_gray  = -0.17, p < 0.05) and occipital matter volumes (βoccipital_gray  = -0.18, p < 0.05).

DISCUSSION

We found that longer sleep duration was associated with lower total brain and gray matter volume among diverse Hispanics/Latinos across sex and background. These results reinforce the importance of sleep on brain aging in this understudied population.

HIGHLIGHTS

Longer sleep was linked to smaller total brain and gray matter volumes. Longer sleep duration was linked to larger white matter hyperintensities (WMHs) and smaller hippocampal volume in an obstructive sleep apnea (OSA) risk group. These associations were consistent across sex and Hispanic/Latino heritage groups.

Neighborhood and Household Environment as Contributors to Racial Disparities in Sleep Duration among U.S. Adolescents

Objective

Racial disparities in adolescent sleep duration have been documented, but pathways driving these disparities are not well understood. This study examined whether neighborhood and household environments explained racial disparities in adolescent sleep duration.

Methods

Participants came from Waves I and II of Add Health (n=13,019). Self-reported short sleep duration was defined as less than the recommended amount for age (<9 hours for 6-12 years, <8 hours for 13-18 years, and <7 hours for 18-64 years). Neighborhood factors included neighborhood socioeconomic disadvantage, perceived safety and social cohesion. Household factors included living in a single parent household and household socioeconomic status (HSES). Structural equation modeling was used to assess mediation of the neighborhood and household environment in the association between race/ethnicity and short sleep duration.

Results

Only HSES mediated racial disparities, explaining non-Hispanic (NH) African American-NH White (11.6%), NH American Indian-NH White (9.9%), and Latinx-NH White (42.4%) differences. Unexpectedly, higher HSES was positively associated with short sleep duration.

Conclusion

Household SES may be an important pathway explaining racial disparities in adolescent sleep duration. Future studies should examine mechanisms linking household SES to sleep and identify buffers for racial/ethnic minority adolescents against the detrimental impacts that living in a higher household SES may have on sleep.

Sleep Deficiency by Caregiving Status: Findings From Nationally Representative Data

OBJECTIVE

Caregiving demands may influence caregivers' sleep duration and quality, which are essential for optimal health. We aimed to examine the association between caregiving status and sleep deficiency (i.e., short sleep duration and/or poor quality) and identify factors associated with sleep deficiency among caregivers.

METHODS

This secondary analysis used data from 3870 adults living in the United States, obtained from the 2019 Health Information National Trends Survey. Multinomial logistic regressions were performed to examine the association between caregiving status (i.e., caregivers vs. non-caregivers) and sleep status (i.e., normal duration-good quality [optimal sleep, reference], short duration-good quality, normal duration-poor quality, and short duration-poor quality), and to identify caregiving-related factors associated with sleep deficiency in the caregiver group.

RESULTS

Compared to non-caregivers, caregivers were more likely to report short sleep duration (<7 hours) with good quality sleep (relative risk ratio [RRR] = 1.566, 95% CI [1.238, 1.980]) or poor quality sleep (RRR = 1.376, 95% CI [1.034, 1.832]) than the optimal sleep status. Caregivers providing care for ≥20 hours per week (vs. <20 hours) and providing care to individuals with dementia (vs. no dementia caregiving) were 2.8 times more likely to report normal sleep duration with poor sleep quality than optimal sleep (RRR = 2.796, 95% CI [1.125, 6.950]; RRR = 2.776, 95% CI [1.154, 6.675], respectively).

CONCLUSION

The findings of a higher risk of sleep deficiency among caregivers suggest that health care providers need to assess both caregivers' sleep duration and quality status. Interventions tailored to the caregiving context are also warranted.

No phenotypic or genotypic evidence for a link between sleep duration and brain atrophy

Short sleep is held to cause poorer brain health, but is short sleep associated with higher rates of brain structural decline? Analysing 8,153 longitudinal MRIs from 3,893 healthy adults, we found no evidence for an association between sleep duration and brain atrophy. In contrast, cross-sectional analyses (51,295 observations) showed inverse U-shaped relationships, where a duration of 6.5 (95% confidence interval, (5.7, 7.3)) hours was associated with the thickest cortex and largest volumes relative to intracranial volume. This fits converging evidence from research on mortality, health and cognition that points to roughly seven hours being associated with good health. Genome-wide association analyses suggested that genes associated with longer sleep for below-average sleepers were linked to shorter sleep for above-average sleepers. Mendelian randomization did not yield evidence for causal impacts of sleep on brain structure. The combined results challenge the notion that habitual short sleep causes brain atrophy, suggesting that normal brains promote adequate sleep duration-which is shorter than current recommendations.

Sleep Behaviors and Progression of Multimorbidity in Middle-Aged and Older Adults: A Prospective Cohort Study From China

BACKGROUND

Sleep behavior (eg, sleep duration, sleep quality, and nap) is closely related to many chronic conditions. However, less is known about its association with multiple chronic conditions (multimorbidity), particularly evidence from cohort studies.

METHODS

Data were collected from a cohort of 8 937 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (2011-2018). Sleep duration, sleep quality, and nap duration were collected in 2011 and 2013. Progression of multimorbidity was defined as the first report of 2 or more chronic conditions for participants without multimorbidity or the new report of 1 or more conditions for those with multimorbidity. Cox regression models were performed to calculate the hazard ratios and 95% confidence intervals (CIs) of the associations between sleep behaviors and the progression of multimorbidity.

RESULTS

Short sleep duration and poor sleep quality were associated with the progression of multimorbidity independently and jointly, especially in those less than 65 years and females. The U-shaped dose-response relationships were observed between nighttime and total sleep duration and the progression of multimorbidity. Persistent short and unsteadily changed sleep behaviors increased the risk of multimorbidity progression. Individuals sleeping ≤5 h/night with 5-7 restless days/week had 1.53 times higher risk of multimorbidity progression (95% CI: 1.37-1.71), compared to those sleeping 7-8 h/night with <1 restless day/week.

CONCLUSIONS

Short sleep duration and poor sleep quality were independently and jointly associated with a higher risk of multimorbidity progression in a mid-to-older population. Optimal sleep duration and sleep quality should be emphasized in multimorbidity prevention and control.

A longitudinal examination of psychosocial mechanisms linking discrimination with objective and subjective sleep

OBJECTIVE

Although chronic discrimination negatively impacts sleep, the cross-sectional nature of most research limits the understanding of how changes in discrimination over time are associated with sleep health. Therefore, the aims of this study were to explore the: (1) longitudinal association between daily discrimination and subjective and objective sleep; (2) mediating roles of anxiety and social well-being; and (3) moderating role of change in discrimination over time.

METHODS

An archival analysis was completed using data from the Midlife in the United States study across 3 timepoints. Participants were primarily female-identifying, white, and college-educated. Measures included Pittsburgh Sleep Quality Index (N = 958), sleep diaries (N = 307), and actigraphy (N = 304). Daily discrimination, the Social Well-Being Scale, and the Mood and Anxiety Symptom Questionnaire were also administered. Moderated parallel mediations were performed using the PROCESS macro controlling for depressive symptoms.

RESULTS

More discrimination at time 1 was associated with worse global sleep quality (b = 0.10 and p = .001) and daily sleep quality (b = 0.03 and p = .02) and worse objective sleep-onset latency (b = 0.93 and p = .02), wake after sleep onset (b = 1.09 and p = .002), and sleep efficiency (b = -0.52 and p < .001) at time 3. Social well-being mediated the associations between discrimination and subjective global sleep quality 95% CI [0.00, 0.03] and daily sleep quality 95% CI [0.00, 0.01] and objective TST 95% CI [0.00, 0.96] when discrimination was increasing or chronic. Anxiety mediated the discrimination-global sleep quality association regardless of changes in discrimination.

CONCLUSIONS

Discrimination showed durable associations with a broad array of sleep outcomes across a 10-year period. Anxiety and social well-being linked discrimination to subjective sleep outcomes, illustrating the importance of psychosocial well-being for sleep health in those experiencing discrimination.

Racial and Ethnic Differences in Sleep Duration Life Expectancies among Men and Women in Mid-to-Late Life

This analysis documents U.S. racial/ethnic and gender differences in life expectancies with different self-reported sleep durations among adults aged 50 and older. We used self-reported sleep duration and linked mortality information from the 2004-2015 National Health Interview Survey (n = 145,015) to calculate Sullivan Method Lifetables for life expectancies with different self-reported sleep duration states: short (≤6 hours), optimal (seven to 8 hours), and long (≥9 hours) sleep duration per-day by race/ethnicity and gender. Non-Hispanic Black men (35.8%, 95% CI: 34.8%-36.8%) and women (36.5%, 95% CI: 35.7%-37.1%) exhibited the highest proportion of years lived with short sleep duration followed by Hispanic men (31.1%, 95% CI: 29.9%-32.3%) and women (34.1%, 95% CI: 33.1%-35.1%) and Non-Hispanic White men (25.8%, 95% CI: 25.4%-26.2%) and women (27.4%, 95% CI: 27.0%-27.7%). These results highlight how race/ethnic inequality in sleep duration and life expectancy are intertwined among older adults in the U.S.

Poor Sleep Quality Increases Gestational Weight Gain Rate in Pregnant People: Findings from the MADRES Study

Background

Poor sleep quality is associated with weight gain in non-pregnant populations, but evidence in pregnant people is lacking. Our study examined the association between early-to-mid pregnancy sleep quality and weekly gestational weight gain (GWG) rate during mid-to-late pregnancy by pre-pregnancy body mass index (BMI).

Method

Participants were 316 pregnant participants from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study. During early-to-mid pregnancy, participants reported their sleep quality which was used to construct four categories: very poor, poor, good, and very good. Linear growth curve models examined the association between early-to-mid pregnancy sleep quality and weekly rate of GWG (kg/week) during mid-to-late pregnancy (> 20 weeks gestation), with a three-way cross-level interaction between gestational age, sleep quality, and pre-pregnancy BMI category. Models adjusted for ethnicity by birthplace, hypertensive disorders, perceived stress score, and physical activity level.

Results

Overall, poorer early-to-mid pregnancy sleep quality was associated with increased weekly weight gain during mid-to-late pregnancy. For example, amongst normal weight participants, mid-to-late pregnancy weight gain was, on average, 0.39 kg (95% CI: 0.29, 0.48) per week for those with very good sleep quality, 0.53 kg (95% CI: 0.44, 0.61) per week for those with poor sleep quality, and 0.54 kg (95% CI: 0.46, 0.62) per week for those with very poor sleep quality during early-to-mid pregnancy. This difference in GWG rate was statistically significantly comparing very good to poor sleep (0.14 kg/week, 95% CI: 0.01, 0.26) and very good to very poor sleep (0.15kg/week, 85% CI: 0.02, 0.27). This association between sleep quality and GWG rate did not statistically differ by pre-pregnancy BMI.

Conclusion

Our study found very poor early-to-mid pregnancy sleep quality was associated with higher mid-to-late pregnancy GWG rate. Incorporating pregnancy-specific sleep recommendations into routine obstetric care may be a critical next step in promoting healthy GWG.

The perceived neighborhood walking environment and self-reported sleep health in a nationally representative sample of the United States

Neighborhood environment can influence sleep health; yet, there is a lack of data on specific environment features in nationally representative samples. We used the 2020 National Health Interview Survey to determine associations between perceived built and social environment factors related to pedestrian access (walking paths, sidewalks), amenities (shops, transit stops, entertainment/services, places to relax), and unsafe walking conditions (traffic, crime) and self-reported sleep duration and disturbances. Places to relax and pedestrian access were associated with better sleep health while unsafe walking conditions were associated with worse sleep health. Access to amenities (shops, transit stops, entertainment venues) had null associations with sleep health.

Interactive association between insomnia symptoms and sleep duration for the risk of dementia-a prospective study in the Swedish National March Cohort

OBJECTIVE

Given the importance of sleep in maintaining neurocognitive health, both sleep duration and quality might be component causes of dementia. However, the possible role of insomnia symptoms as risk factors for dementia remain uncertain.

METHODS

We prospectively studied 22,078 participants in the Swedish National March Cohort who were free from dementia and stroke at baseline. Occurrence of dementia was documented by national registers during a median follow-up period of 19.2 years. Insomnia symptoms and sleep duration were ascertained by Karolinska Sleep Questionnaire. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

Compared to participants without insomnia at baseline, those who reported any insomnia symptom experienced a greater incidence of dementia during follow-up (HR 1.08, 95% CI: 1.03, 1.35). Difficulty initiating sleep versus non-insomnia (HR 1.24, 95% CI: 1.02, 1.52), but not difficulty maintaining sleep or early morning awakening was associated with an increased risk of dementia. Short sleep duration was associated with increased risk of dementia (6 h vs. 8 h, HR 1.29, 95% CI: 1.11-1.51; 5 h vs. 8 h, HR 1.26, 95% CI: 1.00-1.57). Stratified analyses suggested that insomnia symptoms increased the risk of dementia only amongst participants with ≥7 h sleep (vs. non-insomnia HR 1.24, 95% CI: 1.00-1.54, P = 0.05), but not amongst short sleepers (<7 h). Short sleep duration also did not further inflate the risk of dementia amongst insomniacs.

CONCLUSION

Insomnia and short sleep duration increase the risk of dementia amongst middle-aged to older adults.

Association between all-cause mortality and trajectories across quality and duration of sleep and cognitive function: based on Group-Based Multivariate Trajectory modeling

BACKGROUND

Sleep duration and quality are associated with cognition, but the interaction of the 3 indicators and their association with all-cause mortality is unclear.

METHODS

We used data from the Chinese Longitudinal Healthy Longevity Survey from 2005-2018 to identify latent trajectories of sleep duration, sleep quality, and cognitive function. Secondly, the multinomial logistic model was adopted to determine predictors of trajectory groups. Finally, the Cox regression model was used to examine the association between these trajectory groups and all-cause mortality.

RESULTS

A total of 5046 adults (49% women) with an average age of 76.34 were included in the study. The median follow-up period was 11.11 years, during which 1784 (35%) participants died. We identified 4 latent groups among older adults: 'Good-performance' (51%), 'Decreasing' (26%), 'Oversleep & cognitive impairment' (12%), and 'Sleep-deprived' (11%). Individuals in the 'Decreasing' had a 51% increased risk of all-cause mortality (HR = 1.51, 95% CI: 1.25 - 1.81, p < .001). Individuals in the 'Oversleep & cognitive impairment' had a 170% increased risk of all-cause mortality (HR = 2.7 95% CI: 2.13 - 3.43, p < .001). Women had a higher risk of all-cause mortality regardless of trajectory group (47-143% men VS. 74-365% women). Both urban and rural areas have a similarly increased risk of all-cause mortality (48-179%).

CONCLUSIONS

Our study reveals the latent trajectories across sleep duration, sleep quality, and cognitive function in older Chinese and further explores their association with death. These findings provide a rational basis for cognitive interventions and reduce all-cause mortality.

Association of Subjective Sleep Pattern with Self-reported Diabetes in China

There is limited research investigating the relationship between self-reported diabetes mellitus and subjective sleep patterns. Our study aims to explore this association by analyzing trends in a cohort study conducted in China using data from the China Health and Nutrition Survey longitudinal research (CHNS). We used multilevel logistic regression models to analyze the relationship. Our findings indicate that the prevalence of self- reported diabetes in China increased from 1.10% in 2004 to 3.36% in 2015, with an increase in the prevalence of short-term sleep from 7.03-10.24%. The prevalence of self-reported diabetes increased with increasing BMI levels (Normal and below: 0.67-2.16%, Overweight: 1.58-4.35%, Obesity: 2.68-6.57%, p < 0.01). The short-term sleep subgroup had the highest prevalence (2.14-5.64%). Additionally, we found significant associations between age, education level, ethnicity, coffee, smoking, drinking and the self-reported diabetes. Interestingly, the risk ratios for self-reported diabetes differed between sleep durations. With 6-8hours as the reference group, the risk ratios for self-reported diabetes in the short-term, and long-term sleep subgroups were 1.80 (95% CI: 1.23-2.63), and 1.41 (95%CI: 1.01-1.96), respectively. Raising awareness about the impact of irregular sleep duration on diabetes risk is essential, and these initiatives may serve as effective policies for diabetes control.

Is exposure to chemical pollutants associated with sleep outcomes? A systematic review

Environmental exposures may influence sleep; however, the contributions of environmental chemical pollutants to sleep health have not been systematically investigated. We conducted a systematic review to identify, evaluate, summarize, and synthesize the existing evidence between chemical pollutants (air pollution, exposures related to the Gulf War and other conflicts, endocrine disruptors, metals, pesticides, solvents) and dimensions of sleep health (architecture, duration, quality, timing) and disorders (sleeping pill use, insomnia, sleep-disordered breathing)). Of the 204 included studies, results were mixed; however, the synthesized evidence suggested associations between particulate matter, exposures related to the Gulf War, dioxin and dioxin-like compounds, and pesticide exposure with worse sleep quality; exposures related to the Gulf War, aluminum, and mercury with insomnia and impaired sleep maintenance; and associations between tobacco smoke exposure with insomnia and sleep-disordered breathing, particularly in pediatric populations. Possible mechanisms relate to cholinergic signaling, neurotransmission, and inflammation. Chemical pollutants are likely key determinants of sleep health and disorders. Future studies should aim to evaluate environmental exposures on sleep across the lifespan, with a particular focus on developmental windows and biological mechanisms, as well as in historically marginalized or excluded populations.

Estimating sleep duration: performance of open-source processing of actigraphy compared to in-laboratory polysomnography in the community

Comparisons of actigraphy findings between studies are challenging given differences between brand-specific algorithms. This issue may be minimized by using open-source algorithms. However, the accuracy of actigraphy-derived sleep parameters processed in open-source software needs to be assessed against polysomnography (PSG). Middle-aged adults from the Raine Study (n = 835; F 58%; Age 56.7 ± 5.6 years) completed one night of in-laboratory PSG and concurrent actigraphy (GT3X+ ActiGraph). Actigraphic measures of total sleep time (TST) were analyzed and processed using the open-source R-package GENEActiv and GENEA data in R (GGIR) with and without a sleep diary and additionally processed using proprietary software, ActiLife, for comparison. Bias and agreement (intraclass correlation coefficient) between actigraphy and PSG were examined. Common PSG and sleep health variables associated with the discrepancy between actigraphy, and PSG TST were examined using linear regression. Actigraphy, assessed in GGIR, with and without a sleep diary overestimated PSG TST by (mean ± SD) 31.0 ± 50.0 and 26.4 ± 69.0 minutes, respectively. This overestimation was greater (46.8 ± 50.4 minutes) when actigraphy was analyzed in ActiLife. Agreement between actigraphy and PSG TST was poor (ICC = 0.27-0.44) across all three methods of actigraphy analysis. Longer sleep onset latency and longer wakefulness after sleep onset were associated with overestimation of PSG TST. Open-source processing of actigraphy in a middle-aged community population, agreed poorly with PSG and, on average, overestimated TST. TST overestimation increased with increasing wakefulness overnight. Processing of actigraphy without a diary in GGIR was comparable to when a sleep diary was used and comparable to actigraphy processed with proprietary algorithms in ActiLife.

Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan

OBJECTIVE

Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood.

METHODS

We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable.

RESULTS

Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia.

CONCLUSIONS

It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.

Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan

OBJECTIVE

Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood.

METHODS

We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable.

RESULTS

Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia.

CONCLUSIONS

It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.

Racial/ethnic differences in the beneficial effect of social support on sleep duration

STUDY OBJECTIVES

Social support (SS) is associated with better health outcomes, including sleep health. However, the specific sources of SS that benefit sleep are unclear, and whether these associations vary by race/ethnicity or age is unknown. The aim of this study was to examine cross-sectional associations between sources of SS (number of friends, financial, church attendance, and emotional support) and self-reported short sleep duration (< 7 hours) overall and by race/ethnic groups and age among a representative sample.

METHODS

Using National Health and Nutrition Examination Survey (NHANES) data, logistic regression (marginal standardization) and linear regression models were fit accounting for survey design and weights to test associations between sources of SS (number of friends, financial, church attendance, emotional support) and self-reported short sleep duration (< 7 hours) overall and by race/ethnic groups (Black, Hispanic, and White) and age (< 65 vs ≥ 65 years).

RESULTS

Among 3,711 participants, the mean (standard error) age was 57 (0.3) years and 37% slept < 7 hours. Black adults had the highest prevalence of short sleep (55%). Overall, participants with financial support compared with those without financial support had a lower prevalence of short sleep: 23% (confidence interval [CI]: 0.68, 0.87). As the number of SS sources increased, the prevalence of short sleep duration decreased and the racial disparity in sleep duration narrowed. Associations between financial support and sleep were most pronounced among Hispanic and White adults and adults < 65 years.

CONCLUSIONS

In general, financial support was associated with a healthier sleep duration, particularly among those < 65 years of age. Individuals with numerous sources of SS were less likely to be short sleepers. The benefits of SS on sleep duration varied by race. Targeting specific sources of SS may help to improve sleep duration among those most at risk.

CITATION

Johnson DA, Prakash-Asrani R, Lewis BD, Bliwise DL, Lewis TT. Racial/ethnic differences in the beneficial effect of social support on sleep duration. J Clin Sleep Med. 2023;19(7):1231-1238.

A high sense of coherence can mitigate suicidal ideation associated with insomnia

BACKGROUND

The present study aimed to investigate whether insomnia is associated with suicidal ideation (SI) among Japanese workers by conducting a multi-level analysis with sense of coherence (SOC) as a random effect.

PARTICIPANTS AND PROCEDURE

A cross-sectional survey was conducted among 19,481 workers in Tsukuba, Japan. Data from 7,175 participants aged 20-65 years were included in the analysis. The Athens Insomnia Scale (AIS) was used as the independent variable, and SI over the past year was used as the dependent variable. SOC was measured using the five-point SOC-13 scale, and socioeconomic and health factors were investigated as covariates. Participants were divided into three groups (low, medium, and high) based on their SOC scores. Multilevel logistic regression analysis was performed to calculate odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

In the high-SOC group, only one person had SI. In a multi-level logistic analysis that excluded the high SOC group, insomnia was found to be associated with SI (OR = 2.26, 95% CI [1.75, 2.93]). Furthermore, the AIS sub-items "Final awakening earlier than desired" (OR = 1.26, 95% CI [1.05, 1.50]) and "Sense of well-being during the day" (OR = 1.63, 95% CI [1.34, 1.99]) were associated with SI. 8.95% or 11% of the variation in the presence or absence of SI was found to be explained by differences between SOC groups.

CONCLUSIONS

The study highlights that insomnia is associated with SI, and that high SOC may reduce SI even under insomnia. Future longitudinal studies are needed to confirm whether high SOC reduces SI due to insomnia.