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Khot SP, Taylor BL, Longstreth WT, Brown AF. Sleep Health as a Determinant of Disparities in Stroke Risk and Health Outcome. Stroke 2023; 54:595-604. [PMID: 36345822 PMCID: PMC9870956 DOI: 10.1161/strokeaha.122.039524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sleep is essential to human survival and overall vascular health. Sleep health encompasses the objective and subjective qualities associated with one's daily pattern of sleep and wakefulness and has become a growing clinical and public health concern. Impaired sleep duration and quality can increase stroke risk and mediate the relationship between the physical aspects of an individual's environment and disparities in stroke incidence. Here, we review observational studies evaluating the association between sleep health and cerebrovascular disease. We assess the influence on sleep of the physical environment, including the ambient environment with noise levels and the built environment. We also describe the influences on sleep health and stroke risk of social determinants of health, including the chronic stressor of racial discrimination. Finally, we discuss how changes in historical neighborhood characteristics or societal policies can influence the social factors affecting sleep health and stroke risk among socioeconomically disadvantaged groups or ethnic and racial minorities. Given the regional and racial or ethnic differences in stroke risk across the United States, an understanding of novel vascular risk factors, such as the multifaceted role of sleep health, will be critical to develop effective public policies to improve population health.
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Affiliation(s)
- Sandeep P Khot
- Department of Neurology (S.P.K., B.L.T., W.T.L.), University of Washington, Seattle
| | - Breana L Taylor
- Department of Neurology (S.P.K., B.L.T., W.T.L.), University of Washington, Seattle
| | - W T Longstreth
- Department of Neurology (S.P.K., B.L.T., W.T.L.), University of Washington, Seattle
- Department of Epidemiology (W.T.L.), University of Washington, Seattle
| | - Arleen F Brown
- Department of Medicine, University of California, Los Angeles (A.F.B.)
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Gradisar M, Kahn M, Micic G, Short M, Reynolds C, Orchard F, Bauducco S, Bartel K, Richardson C. Sleep’s role in the development and resolution of adolescent depression. NATURE REVIEWS PSYCHOLOGY 2022; 1:512-523. [PMID: 35754789 PMCID: PMC9208261 DOI: 10.1038/s44159-022-00074-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/03/2022]
Abstract
Two adolescent mental health fields — sleep and depression — have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents. Sleep problems are both a symptom and precursor of adolescent depression. In this Review, Gradisar et al. describe how the combination of adolescent sleep biology and psychology predisposes adolescents to develop depression, and describe interventions that improve sleep and depression symptoms in this population.
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Grandner MA. Sleep, Health, and Society. Sleep Med Clin 2022; 17:117-139. [DOI: 10.1016/j.jsmc.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meltzer LJ, Saletin JM, Honaker SM, Owens JA, Seixas A, Wahlstrom KL, Wolfson AR, Wong P, Carskadon MA. COVID-19 instructional approaches (in-person, online, hybrid), school start times, and sleep in over 5,000 U.S. adolescents. Sleep 2021; 44:6350476. [PMID: 34401922 PMCID: PMC8385997 DOI: 10.1093/sleep/zsab180] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
Study Objectives To examine associations among instructional approaches, school start times, and sleep during the COVID-19 pandemic in a large, nationwide sample of U.S. adolescents. Methods Cross-sectional, anonymous self-report survey study of a community-dwelling sample of adolescents (grades 6–12), recruited through social media outlets in October/November 2020. Participants reported on instructional approach (in-person, online/synchronous, online/asynchronous) for each weekday (past week), school start times (in-person or online/synchronous days), and bedtimes (BT) and wake times (WT) for each identified school type and weekends/no school days. Sleep opportunity was calculated as BT-to-WT interval. Night-to-night sleep variability was calculated with mean square successive differences. Results Respondents included 5,245 racially and geographically diverse students (~50% female). BT and WT were earliest for in-person instruction; followed by online/synchronous days. Sleep opportunity was longer on individual nights students did not have scheduled instruction (>1.5 h longer for online/asynchronous than in-person). More students obtained sufficient sleep with later school start times. However, even with the same start times, more students with online/synchronous instruction obtained sufficient sleep than in-person instruction. Significantly greater night-to-night variability in sleep-wake patterns was observed for students with in-person hybrid schedules versus students with online/synchronous + asynchronous schedules. Conclusions These findings provide important insights regarding the association between instructional approach and school start times on the timing, amount, and variability of sleep in U.S. adolescents. Given the public health consequences of short and variable sleep in adolescents, results may be useful for education and health policy decision-making for post-pandemic secondary schools.
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Affiliation(s)
| | - Jared M Saletin
- Alpert Medical School of Brown University/E. P. Bradley Hospital, Sleep for Science Research Lab, Providence, RI, USA
| | - Sarah M Honaker
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Azizi Seixas
- NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Patricia Wong
- Alpert Medical School of Brown University/E. P. Bradley Hospital, Sleep for Science Research Lab, Providence, RI, USA
| | - Mary A Carskadon
- Alpert Medical School of Brown University/E. P. Bradley Hospital, Sleep for Science Research Lab, Providence, RI, USA
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Fitzpatrick JM, Silva GE, Vana KD. Perceived Barriers and Facilitating Factors in Implementing Delayed School Start Times to Improve Adolescent Sleep Patterns. THE JOURNAL OF SCHOOL HEALTH 2020; 91:94-101. [PMID: 33289083 DOI: 10.1111/josh.12983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Most adolescents in the United States do not obtain sufficient sleep. Early school start times play a significant role in adolescent sleep deprivation. Most primary and secondary schools begin classes earlier than the 8:30 am. Perceived barriers to implementing a delayed school start time have been suggested in the literature but have not been quantified. This study explored perceived barriers and facilitating factors for implementing delayed high-school start times. METHODS A cross-sectional study. School administrators who had delayed their school start times were invited to complete an online questionnaire ranking the perceived barriers and facilitating factors for implementing the delayed start times. RESULTS Most commonly cited perceived barriers were lack of a tiered bus system, school athletes missing more afternoon classes, and less time after school for athletics. Most commonly cited facilitating factors were school-administrator involvement in the decision-making process and sleep education for family members and school administrators. CONCLUSIONS Participants found that providing sleep education to fellow administrators, teachers, school staff members, families, and students and including them in the decision-making process positively facilitated the implementation of delayed school start times. Perceived barriers to implementation may be overcome with support from stakeholders and planning committees.
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Affiliation(s)
- Julia M Fitzpatrick
- Family Nurse Practitioner, , Benefis Healthcare System, 1101 26th Street South, Great Falls, MT 59405
| | - Graciela E Silva
- Clinical Associate Professor, , The University of Arizona, College of Nursing, 1305 N. Martin, Tucson, AZ 85721
| | - Kimberly D Vana
- Clinical Professor, Arizona State University, Edson College of Nursing and Health Innovation, , 550 North 3rd Street, Phoenix, AZ 85004
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Nahmod NG, Lee S, Master L, Chang AM, Hale L, Buxton OM. Later high school start times associated with longer actigraphic sleep duration in adolescents. Sleep 2020; 42:5160034. [PMID: 30395345 DOI: 10.1093/sleep/zsy212] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 01/30/2023] Open
Abstract
Study Objectives High school start times (SSTs) directly impact adolescents' sleep timing and duration. This study investigated the associations between SSTs and actigraphically-measured 24-hour sleep duration, sleep onset, sleep offset and sleep quality. Methods This study included 383 adolescents (Mage = 15.5, SDage = 0.6 years) participating in the age 15 wave of the Fragile Families & Child Wellbeing Study, a national birth cohort study sampling from 20 large US cities. Multilevel models used daily observations (N = 1116 school days, Mdays = 2.9, SDdays = 1.4 per adolescent) of sleep and SSTs from concordant daily diary and actigraphy. Results A diverse range of SSTs were included in our analyses (MSST = 08:08, SDSST = 39 minutes, RangeSST = 06:00-11:05), and are presented in the following categories for ease of interpretation: before 07:30, 07:30-07:59, 08:00-08:29, and 08:30 or later. Adolescents starting school at 08:30 or later exhibited significantly longer actigraphically-assessed 24-hour sleep duration (by 21-34 minutes, p < .05) and later sleep offset (by 32-64 minutes, p < .001) when compared with the adolescents grouped by earlier SSTs. SSTs were also analyzed continuously for comparison with existing literature, and results indicated that every 1-hour delay in SST was significantly associated with 21 minutes longer 24-hour sleep duration (p < .001), 16 minutes later sleep onset (p < .01), and 39 minutes later sleep offset (p < .001). All models controlled for covariates including socioeconomic status. Conclusion These findings support pediatric and public health expert recommendations for SSTs after 08:30. In our diverse national urban sample, adolescents with SSTs at 08:30 or later, compared with adolescents with earlier SSTs, had significantly longer actigraphy-measured sleep.
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Affiliation(s)
- Nicole G Nahmod
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Soomi Lee
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Lindsay Master
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Anne-Marie Chang
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Lauren Hale
- Program in Public Health; Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Orfeu M Buxton
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Sleep Health Institute, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, MA
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Grannon KY, Nanney MS, Wang Q, Larson N, Hearst MO, Berge J, Caspi CE. Do High School Students Participate in Second Chance Breakfast Programs? THE JOURNAL OF SCHOOL HEALTH 2020; 90:119-126. [PMID: 31828805 PMCID: PMC7788574 DOI: 10.1111/josh.12857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 01/02/2019] [Accepted: 01/12/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Breakfast consumption often decreases as youth get older. The School Breakfast Program (SBP) provides an opportunity to intervene and increase breakfast consumption, especially among high school students. METHODS Project breakFAST implemented an expanded breakfast service at 12 high schools. In this longitudinal evaluation, school administrators provided SBP participation and demographic data on all ninth and 10th graders for two full consecutive school years. Students screened for eating breakfast <3 times/week were randomly selected to participate in the cohort study. The cohort completed a survey on perceived barriers, benefits, and breakfast habits. RESULTS At baseline, all 12 schools had only traditional before school cafeteria SBP service. Mean participation was 16.3% and ranged from 7.9 to 38.1%. After the intervention, there was an increase in participation to 25.7% (p = .004) ranging from 14.1 to 47.5%. There was no change in breakfast participation before school (13.3%, p = .06). Students who traveled to school by car, bike, or walking at baseline were 4.5% less likely to participate in second chance breakfast at follow-up than those who took the bus to school (p = .006). CONCLUSION Second chance breakfast is an option for increasing high school breakfast participation, especially for those riding the bus.
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Affiliation(s)
- Katherine Y Grannon
- University of Minnesota, Department of Family Medicine and Community Health, Program in Health Disparities Research, 717 Delaware Ave, Minneapolis, MN, 55454
| | - Marilyn S Nanney
- University of Minnesota, Department of Family Medicine and Community Health, Program in Health Disparities Research, 717 Delaware Ave, Minneapolis, MN, 55454
| | - Qi Wang
- University of Minnesota, Biostatistical Design and Analysis Center, Clinical and Translational Science Institute717 Delaware Street S.E., Minneapolis, MN, 55414
| | - Nicole Larson
- University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN, 55454
| | - Mary O Hearst
- St. Catherine University, Henrietta Schmoll School of Health, 2004 Randolph Ave, St. Paul, MN, 55105
| | - Jerica Berge
- University of Minnesota, Department of Family Medicine & Community Health, 717 Delaware Street SE
| | - Caitlin E Caspi
- University of Minnesota, Department of Family Medicine and Community Health, 717 Delaware St. SE, Minneapolis, MN, 55414
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Mazzilli Louzada F, Isabel Ribeiro Pereira S. Adolescents’ sleep/wake patterns and school schedules: towards flexibility. BIOL RHYTHM RES 2018. [DOI: 10.1080/09291016.2018.1491263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Fernando Mazzilli Louzada
- Human Chronobiology Laboratory, Department of Physiology, Federal University of Paraná, Curitiba, Paraná, Brazil
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Berger AT, Widome R, Troxel WM. SCHOOL START TIME AND PSYCHOLOGICAL HEALTH IN ADOLESCENTS. CURRENT SLEEP MEDICINE REPORTS 2018; 4:110-117. [PMID: 30349805 PMCID: PMC6195354 DOI: 10.1007/s40675-018-0115-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW Later school start times are associated with a number of benefits for adolescents. The purpose of the current review is to summarize the literature regarding the effects of delaying school start times on adolescent psychological health. RECENT FINDINGS We identified eight observational studies that examined the relationship between schools' starting times and psychological outcomes. Of these, three were longitudinal studies that reported measures of adolescent mental health improved following a start time delay. Two cross-sectional studies showed that mental health scores were higher in schools with later compared to earlier start times. Three studies found no relationship between start time and mental health. SUMMARY In the majority of studies reviewed, later school start times were associated with greater adolescent psychological health. However, inherent design drawbacks in the studies prevent us from concluding that these associations are causal. There are a wide range of potential benefits, beyond mental health, that later high school start times offer. This encouraging, emergent literature on delayed start times has led many school districts to consider changes to their start times.
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Affiliation(s)
- Aaron T. Berger
- Division of Epidemiology and Community Health, University of Minnesota, Twin Cities, Minneapolis MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota, Twin Cities, Minneapolis MN, USA
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Lee CJ, Nolan DM, Lockley SW, Pattison B. Law-based arguments and messages to advocate for later school start time policies in the United States. Sleep Health 2017; 3:486-497. [DOI: 10.1016/j.sleh.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/24/2017] [Accepted: 09/08/2017] [Indexed: 11/28/2022]
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Nahmod NG, Lee S, Buxton OM, Chang AM, Hale L. High school start times after 8:30 am are associated with later wake times and longer time in bed among teens in a national urban cohort study. Sleep Health 2017; 3:444-450. [PMID: 29157638 DOI: 10.1016/j.sleh.2017.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/20/2017] [Accepted: 09/09/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES High school start times are a key contributor to insufficient sleep. This study investigated associations of high school start times with bedtime, wake time, and time in bed among urban teenagers. DESIGN Daily-diary study nested within the prospective Fragile Families and Child Wellbeing Study. SETTING Twenty US cities. PARTICIPANTS Four hundred thirteen teenagers who completed ≥1 daily diary report on a school day. MEASUREMENTS Participating teens were asked to complete daily diaries for 7 consecutive days. School-day daily diaries (3.8±1.6 entries per person) were used in analyses (N=1555 school days). High school start time, the main predictor, was categorized as 7:00-7:29 am (15%), 7:30-7:59 am (22%), 8:00-8:29 am (35%), and 8:30 am or later (28%). Multilevel modeling examined the associations of school start times with bedtime, wake time, and time in bed. Models adjusted for age, sex, race/ethnicity, household income, caregiver's education, and school type. RESULTS Teens with the earliest high school start times (7:00-7:29 am) obtained 46 minutes less time in bed on average compared with teens with high school start times at 8:30 am or later (P<.001). Teens exhibited a dose-response relationship between earlier school start times and shorter time in bed, primarily due to earlier wake times (P<.05). Start times after 8:30 am were associated with increased time in bed, extending morning sleep by 27-57 minutes (P<.05) when compared with teens with earlier school start times. CONCLUSION Later school start times are associated with later wake times in our large, diverse sample. Teens starting school at 8:30 am or later are the only group with an average time in bed permitting 8 hours of sleep, the minimum recommended by expert consensus for health and well-being.
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Affiliation(s)
- Nicole G Nahmod
- Department of Biobehavioral Health, Pennsylvania State University.
| | - Soomi Lee
- Department of Biobehavioral Health, Pennsylvania State University
| | - Orfeu M Buxton
- Department of Biobehavioral Health, Pennsylvania State University; Division of Sleep Medicine, Harvard Medical School; Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital; Department of Social and Behavioral Sciences, Harvard Chan School of Public Health
| | - Anne-Marie Chang
- Department of Biobehavioral Health, Pennsylvania State University
| | - Lauren Hale
- Program in Public Health; Department of Family, Population and Preventive Medicine, Stony Brook University
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Bowers JM, Moyer A. Effects of school start time on students' sleep duration, daytime sleepiness, and attendance: a meta-analysis. Sleep Health 2017; 3:423-431. [PMID: 29157635 DOI: 10.1016/j.sleh.2017.08.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/28/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
Research conducted over the past three decades finds that many children and adolescents do not meet recommended sleep guidelines. Lack of sleep is a predictor of a number of consequences, including issues at school such as sleepiness and tardiness. Considering the severity of this public health issue, it is essential to understand more about the factors that may compromise children's and adolescents' sleep. This meta-analysis examined the effects of school start time (SST) on sleep duration of students by aggregating the results of five longitudinal studies and 15 cross-sectional comparison group studies. Results indicated that later starting school times are associated with longer sleep durations. Additionally, later start times were associated with less daytime sleepiness (7 studies) and tardiness to school (3 studies). However, methodological considerations, such as a need for more longitudinal primary research, lead to a cautious interpretation. Overall, this systematic analysis of SST studies suggests that delaying SST is associated with benefits for students' sleep and, thus, their general well-being.
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Caia J, Halson SL, Scott TJ, Kelly VG. Intra-individual variability in the sleep of senior and junior rugby league athletes during the competitive season. Chronobiol Int 2017; 34:1239-1247. [DOI: 10.1080/07420528.2017.1358736] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Johnpaul Caia
- Performance Sciences Department, Brisbane Broncos Rugby League Club, Red Hill, Queensland, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Shona L. Halson
- Department of Physiology, Australian Institute of Sport, Belconnen, Australian Capital Territory, Australia
| | - Tannath J. Scott
- Performance Sciences Department, Brisbane Broncos Rugby League Club, Red Hill, Queensland, Australia
| | - Vincent G. Kelly
- Performance Sciences Department, Brisbane Broncos Rugby League Club, Red Hill, Queensland, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
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Abstract
Biological needs for sleep are met by engaging in behaviors that are largely influenced by the environment, social norms and demands, and societal influences and pressures. Insufficient sleep duration and sleep disorders such as insomnia and sleep apnea are highly prevalent in the US population. This article outlines some of these downstream factors, including cardiovascular and metabolic disease risk, neurocognitive dysfunction, and mortality, as well as societal factors such as age, sex, race/ethnicity, and socioeconomics. This review also discusses societal factors related to sleep, such as globalization, health disparities, public policy, public safety, and changing patterns of use of technology.
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Affiliation(s)
- Michael A Grandner
- Department of Psychiatry, College of Medicine, University of Arizona, 1501 North Campbell Avenue, PO Box 245002, BUMC Suite 7326, Tucson, AZ 85724-5002, USA.
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