Gender differences in the relationship between alcohol consumption and insomnia in the northern Chinese population

Indirect effects of perceived stress and depression on the relationship between insomnia symptoms and hazardous drinking

Insomnia is a risk factor for hazardous drinking, yet the mechanisms underlying this risk are not well characterized. Two factors that might contribute to the relationship between insomnia and drinking are stress and depression. Insomnia is strongly associated with increased stress and depression, which are, in turn, strongly linked to hazardous drinking. Here we conducted a preliminary investigation to determine whether perceived stress and depression indirectly explain the relationship between insomnia and hazardous drinking. Heavy drinkers with self-reported insomnia (n = 405: 270 women, 134 men, 1 non-binary) completed self-report measures of hazardous drinking, insomnia, perceived stress, and depression. Results from our primary cross-sectional parallel mediation model with insomnia as the predictor and hazardous drinking as the outcome showed that, when accounting for the influence of both perceived stress and depression, there was a partial indirect effect of insomnia on hazardous drinking through perceived stress, 95% CI [0.014, 0.205], but not depression, 95% CI [-0.080, 0.172]. In our competing cross-sectional parallel mediation model with hazardous drinking as the predictor and insomnia as the outcome, there was a partial indirect effect of hazardous drinking on insomnia through depression 95% CI [0.016, 0.059], but not perceived stress 95% CI: [-0.026, 0.011]. Results suggest that insomnia may be related to hazardous drinking through its effects on stress and that hazardous drinking may be related to insomnia through its effects on depression. These findings lay the groundwork for future longitudinal studies assessing the causal roles of stress and depression in the insomnia-AUD relationship.

A narrative review on alcohol use in women: insight into the telescoping hypothesis from a biopsychosocial perspective

Background: There has been a dramatic rise in alcohol consumption and alcohol use disorder (AUD) among women. Recently, the field has made substantial progress toward better understanding sex and gender differences in AUD. This research has suggested accelerated progression to AUD and associated health consequences in women, a phenomenon referred to as "telescoping."Objective: To examine evidence for the telescoping hypothesis from a biopsychosocial perspective.Methods: This narrative review examined and integrated research on biological, psychological, and socio-environmental factors that may contribute to the development and progression of AUD in women.Results: Biopsychosocial research has revealed sex- and gender-specific risk factors and pathways to AUD onset and progression. Biological sex differences render females more vulnerable to alcohol-related toxicity across various biological systems, including the brain. Notably, sex and gender differences are consistently observed in the neural circuitry underlying emotional and stress regulation, and are hypothesized to increase risk for an internalizing pathway to AUD in women. Psychological research indicates women experience greater negative emotionality and are more likely to use alcohol as a means to alleviate negative emotions compared with men. Socio-environmental factors, such as familial and peer isolation, appear to interact with biological and psychological processes in a way that increases risk for negative emotionality and associated alcohol use in women.Conclusion: There appears to be a complex interplay of biopsychosocial factors that increase risk for AUD onset and progression in women through an internalizing pathway. Developing targeted interventions for women with AUD that specifically target internalizing processes is critical.

Association between alcohol consumption and sleep difficulty in a nationwide Korean survey

Background

The data on the association between alcohol intake and sleep quality in a community-based setting are lacking. This study examined overall sleep difficulty according to alcohol habits among Korean adults.

Materials and Methods

We analyzed data from 4937 adults who responded to questions about sleep difficulty and drinking habits from the 2019 Korea National Health and Nutrition Examination Survey. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for substantial sleep difficulty based on the frequency or amount of alcohol consumption in total and age- and sex-stratified subgroup analyses.

Results

Approximately 8.5% of the study population had substantial sleep difficulty. Individuals who drank <1 per week (frequency) or 1-2 cups per time (amount) had the lowest prevalence of substantial sleep difficulty, even compared with nondrinkers. Among drinkers, the association between alcohol use and sleep difficulty was significant in a dose-dependent manner (P for trend: 0.003 in frequency and < 0.001 in amount). Subgroup analysis revealed that significant linear relationships were robust for adults aged <50 years ([ORs] 1.20 [95% CIs 1.03-1.40] for frequency and 1.25 [1.10-1.42] for amount) and females (1.26 [1.10-1.44] for amount).

Conclusion

Alcohol consumption is associated with increased sleep difficulties, especially in younger adults and women, underscoring the need for targeted interventions and in-depth research on the effects of alcohol on sleep.

Dietary patterns and insomnia symptoms: A systematic review and meta-analysis

We aimed to systematically review and synthesize the available evidence regarding the link between dietary patterns and insomnia symptoms among the general population using observational studies. We reviewed 16,455 references, of which 37 studies met inclusion criteria with a total sample size of 591,223. There was a significant association of the Mediterranean diet (OR: 0.86; 95 % CI, 0.79, 0.93; P < 0.001; I2 = 32.68 %), a high-quality diet (OR: 0.66; 95 % CI, 0.48, 0.90; P = 0.010; I2 = 84.62 %), and an empirically-derived healthy dietary pattern (OR: 0.91; 95 % CI, 0.85, 0.98; P = 0.010; I2 = 57.14 %) with a decreased risk of insomnia symptoms. Moreover, the dietary glycemic index (OR: 1.16; 95 % CI, 1.08, 1.25; P < 0.001; I2 = 0.0 %), the dietary glycemic load (OR: 1.10; 95 % CI, 1.01, 1.20; P = 0.032; I2 = 74.36 %), and an empirically-derived unhealthy dietary pattern (OR: 1.20; 95 % CI, 1.01, 1.42; P = 0.040; I2 = 68.38 %) were linked with a higher risk of insomnia symptoms. Most individual studies were of good quality (NOS) but provided very low certainty of evidence (GRADE). Consistent data reveals that following healthy diets is associated with decreased insomnia symptoms prevalence, while adherence to an unhealthy pattern is associated with an increased prevalence of insomnia symptoms.

Risk factors for incident falls in Singaporean community-dwelling adult men and women: a prospective cohort study

OBJECTIVES

Our study aimed to identify the risk factors of incident falls between men and women.

DESIGN

Prospective cohort study.

SETTING

The study recruited participants from the Central region of Singapore. Baseline and follow-up data were collected via a face-to-face survey.

PARTICIPANTS

Community-dwelling adults aged 40 years and above from the Population Health Index Survey.

OUTCOME MEASURE

Incident falls were defined as the experience of a fall between the baseline and 1-year follow-up but having no falls 1 year prior to baseline. Multiple logistic regressions were performed to determine the association of sociodemographic factors, medical history and lifestyle with incident falls. Sex subgroup analyses were conducted to examine sex-specific risk factors for incident falls.

RESULTS

1056 participants were included in the analysis. At 1-year follow-up, 9.6% of the participants experienced an incident fall. Incidence of falls in women was 9.8% compared with 7.4% in men. In the multivariable analysis for the overall sample, older age (OR: 1.88, 95% CI: 1.10 to 2.86), being pre-frail (OR: 2.13, 95% CI: 1.12 to 4.00) and having depression or feeling depressed/anxious (OR: 2.35, 95% CI: 1.10 to 4.99) were associated with higher odds for incident falls. In subgroup analyses, older age was a risk factor for incident falls in men (OR: 2.68, 95% CI: 1.21 to 5.90) and pre-frail was a risk factor for incident falls in women (OR: 2.82, 95% CI: 1.28 to 6.20). There was no significant interaction effect between sex and age group (p value=0.341) and sex and frailty status (p value=0.181).

CONCLUSION

Older age, presence of pre-frailty and having depression or feeling depressed/anxious were associated with higher odds of incident falls. In our subgroup analyses, older age was a risk factor for incident falls in men and being pre-frail was a risk factor for incident falls in women. These findings provide useful information for community health services in designing falls prevention programmes for community-dwelling adults in a multi-ethnic Asian population.

Emotional Dysregulation and Time Structure Mediate the Link between Perceived Stress and Insomnia among Unemployed Young People in China: A Cross-Sectional Study

In recent years, the problem of youth unemployment in China has become a great concern. Unemployed young people often find themselves under tremendous stress and vulnerable to sleep problems. The link between perceived stress and insomnia has been widely documented, but the potential mechanisms underlying this relationship have not been thoroughly revealed. The objective of this study was to examine the underlying mechanisms linking perceived stress to insomnia through testing the mediating effects of emotional dysregulation and time structure. Through a multiple-stage convenience sampling, 511 unemployed young people (38.6% women; mean age = 21.51; SD = 2.22) were measured using the 10-item Perceived Stress Scale (PSS-10), Insomnia Severity Index (ISI), 16-item Difficulties in Emotion Regulation Scale (DERS-16), and Time Structure Questionnaire (TSQ). Based on the statistical description of the sample, chi-squared tests, bivariate correlation analyses, and mediation analyses were performed. The study indicated that 53.0% (95% CI: 48.7-57.4%) of the participants reported probable insomnia, and both insomnia and perceived stress demonstrated strong associations with emotional dysregulation and time structure, which served as partial mediators between perceived stress and insomnia symptoms according to mediation analyses. Path analysis further revealed that, after controlling for age and gender, emotional dysregulation and time structure accounted for 31.8 and 17.6% of the effect of perceived stress on insomnia, respectively. This study provides empirical support for the association among perceived stress, emotional dysregulation, time structure, and insomnia symptoms. To improve the sleep quality and general wellbeing of unemployed young people, emotional dysregulation and time structure must be taken into consideration.

Poor subjective sleep predicts compromised quality of life but not cognitive impairment in abstinent individuals with Alcohol Use Disorder

How disrupted sleep contributes to cognitive dysfunction over the dynamic course of Alcohol Use Disorder (AUD) is an emerging topic of investigation. Here, the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate subjective sleep in 90 individuals with AUD sober for an average of 3 months and in 50 healthy controls. Relative to controls, AUD individuals had higher global PSQI scores (worse sleep), higher scores on the Beck Depression Inventory (BDI), worse Quality of Life (QoL) indicators, and poorer performance on cognitive composite tests (executive functioning, attention and working memory, visual and verbal learning or memory). Among AUD individuals, a higher PSQI score correlated with a higher BDI scores and worse QoL, but not with cognitive scales. Also noted in the AUD group were higher global PSQI scores in individuals also diagnosed with major depressive (MDD) or generalized anxiety (GAD) disorders. Together, the 4 variables explained 29.8% of the variance in AUD PSQI scores. In women with AUD, the 4 factors explained 39.3% of the variance in PSQI scores; in AUD men, the 4 measures explained 19.9% of the variance: MDD was salient in women, QoL in men with AUD suggesting differential factors associate with poor sleep in men and women with AUD even with sustained alcohol abstinence. Here, global PSQI scores were related to clinical diagnoses and life functioning but failed to predict cognitive performance in abstinent AUD individuals.

Severity of alcohol use disorder influences sex differences in sleep, mood and brain functional connectivity impairments

Growing evidence suggests greater vulnerability of women than men to the adverse effects of alcohol on mood and sleep. However, the underlying neurobiological mechanisms are still poorly understood.

Here we examined sex difference in resting state functional connectivity in alcohol use disorder using a whole-brain data driven approach and tested for relationships with mood and self-reported sleep. To examine whether sex effects vary by severity of alcohol use disorder, we studied two cohorts: non-treatment seeking n = 141 participants with alcohol use disorder (low severity; 58 females) from the Human Connectome project, and recently detoxified n = 102 treatment seeking participants with alcohol use disorder (high severity; 34 females) at the National Institute on Alcohol Abuse and Alcoholism.

For both cohorts, participants with alcohol use disorder had greater sleep and mood problems than HC, whereas sex by alcohol use effect varied by severity. Non-treatment seeking females with alcohol use disorder showed significant greater impairments in sleep but not mood compared to non-treatment seeking males with alcohol use disorder, whereas treatment-seeking females with alcohol use disorder reported greater negative mood but not sleep than treatment-seeking males with alcohol use disorder. Greater sleep problems in non-treatment seeking females with alcohol use disorder were associated with lower cerebello-parahippocampal functional connectivity, while greater mood problems in treatment-seeking females with alcohol use disorder were associated with lower fronto-occipital functional connectivity during rest.

The current study suggests that changes in resting state functional connectivity may account for sleep and mood impairments in females with alcohol use disorder. The effect of severity on sex differences might reflect neuroadaptive processes with progression of alcohol use disorder and needs to be tested with longitudinal data in the future.

Epidemiology of comorbid hazardous alcohol use and insomnia in 19 185 women and men attending the population-based Tromsø Study 2015-2016

Background

Hazardous alcohol use is known to be comorbid with insomnia problems. The present study examined the prevalence of insomnia and if the odds of insomnia differed between women and men with a hazardous alcohol use.

Methods

Cross-sectional data from the seventh survey of the Norwegian population-based Tromsø Study 2015–2016 (participation 65%). The sample included 19 185 women and men 40–96 years. Hazardous alcohol use was defined by the Alcohol Use Disorder Identification Test (AUDIT) and insomnia by the Bergen Insomnia Scale. Covariates included socio-demographics, shift work, somatic conditions and mental distress defined by Hopkins Symptom Check List-10 (HSCL-10). Mental distress was also included as a moderator.

Results

Insomnia was more prevalent among participants with a hazardous alcohol use (24.1%) than without (18.9%), and participants who had hazardous alcohol use had higher odds of insomnia (odds ratio = 1.49, 95% CI = 1.20, 1.85). The association turned non-significant after adjustment for mental distress. Adding mental distress as a moderator variable revealed a higher odds of insomnia among hazardous alcohol users having no or low-to-medium levels of mental distress, but not among participants with high levels of mental distress.

Conclusion

Insomnia was more prevalent among women and men reporting hazardous alcohol use. When mental distress was treated as a moderator, hazardous alcohol use did not yield higher odds for insomnia among those with high levels of mental distress. This suggests that mental distress may play an important role in the association between hazardous alcohol use and insomnia. And that the impact of alcohol on insomnia may differ depending on the severity of mental distress.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13250-5.

Lifetime and 1-Month Prevalence of Mental Disorders in Hebei Province, China: A Community-Based Cross-Sectional Study

Background: The prevalence of mental disorders is an important topic, which has been reported in different countries in the world. In China, some studies were also conducted to get the prevalence of mental disorders at the national level and in some metropolitan cities. However, the prevalence of mental disorders in Chinese underdeveloped provinces has not been reported internationally in recent decades. Due to the discrepancy in the social-economic development of different Chinese provinces, we also have reasons to believe the different prevalence of mental disorders between underdeveloped provinces and other provinces. Method: A community-based cross-sectional study was conducted among community residents aged 18 years and older in Hebei province, China. We screened 20,884 community residents in this study, and a Structured Clinical Interview for Diagnostic and Statistical Manual (DSM-IV) Axis I disorders was used to make the diagnoses of mental disorders. Results: The weighted lifetime prevalence of mental disorders was 15.87% (95% CI 15.38-16.38%), and the 1-month prevalence was 10.79% (95% CI 10.37-11.22%). Anxiety disorder ranked first in the classification of mental disorders for both lifetime (6.56%) and 1-month prevalence (6.25%). The weighted lifetime and 1-month region-gender-age-specific prevalence of mental disorders was also analyzed in this study. Conclusions: Mental disorders have been an important issue in Chinese economically underdeveloped regions, and the prevalence was at a high level compared with the results in the 2000s. There are several serious challenges in the work of Chinese mental disorders, which should be paid more attention to.

Alcohol consumption and sleep quality: a community-based study

OBJECTIVE

To assess the association between total alcohol intake, specific alcoholic beverages and sleep quality in a community-based cohort.

DESIGN

A cross-sectional study.

SETTING

The Kailuan community, China.

PARTICIPANTS

Included were 11 905 participants who were free of a history of CVD, cancer, Parkinson's disease, dementia and head injury in or prior to 2012. Alcohol consumption (amount and frequency intake) and alcoholic beverage type were collected in 2006 (baseline) and 2012. Participants were grouped into non-, light- (women: 0-0·4 serving/d; men: 0-0·9 serving/d), moderate- (women: 0·5-1·0 serving/d; men: 1·0-2·0 servings/d) and heavy- (women: >1·0 servings/d; men: >2·0 servings/d) drinkers. Overall sleep quality was measured in 2012 and included four sleep parameters (insomnia, daytime sleepiness, sleep duration, snoring/obstructive sleep apnoea).

RESULTS

We observed a dose-response association between higher alcohol consumption in 2006 and worse sleep quality in 2012 (Ptrend < 0·001), after adjusting for age, sex, socio-economic status, smoking status, physical activity, obesity, plasma lipid profiles, diabetes and hypertension. A similar association was observed when alcohol consumption in 2012 was used as exposure. Alcohol was associated with higher odds of having short sleep duration (adjusted OR for heavy- v. non-drinkers = 1·31; 95 % CI: 1·09, 1·57) and snoring (adjusted OR for heavy- v. non-drinkers: 1·38; 95 % CI: 1·22, 1·57). Consumption of hard liquor, but not beer or wine, was significantly associated with poor sleep quality.

CONCLUSIONS

Higher alcohol consumption was associated with poorer sleep quality and higher odds of having snoring and short sleep duration.

Binge drinking and insomnia in students from health sciences at one university in Rio de Janeiro, Brazil

In spite of the many studies examining alcohol consumption, recent reviews have indicated that binge drinking has not been extensively studied. Furthermore, it is becoming increasingly clear that sleep is associated with many physiological functions and to drug addictions. The present study aimed to evaluate the relationship between alcohol binge drinking and insomnia in college students of health sciences. All first-year health sciences students (n=286) were evaluated in a cross-sectional study. Envelopes containing the Insomnia Severity Index (ISI), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and questions capturing sociodemographic data were distributed and collected in classes. It was found that most non-drinkers were female (70.6%), although there were no sex-related differences in the number of binge drinkers (more than 5 drinks on each occasion at least once a week), allowing statistical comparison. The Mann-Whitney U test indicated that the ISI scores were significantly greater in female than male binge drinkers (P=0.014). Moderate or severe insomnia was reported by 23% of the sample, with alcohol being the most frequently associated substance. A specialized intervention was suggested by ASSIST: brief for marijuana (19.2%) and tobacco (23.3%) use, and moderate (31.5%) or intensive (1.4%) for alcohol consumers. The data highlighted the need to pay attention to the habits of college students beyond obtaining scientific information. New data suggesting the influence of genetics on insomnia may be of importance when performing additional studies on the sex differences in alcohol binge drinking.

Alcohol consumption and incidence of sleep disorder: A systematic review and meta-analysis of cohort studies

OBJECTIVE

To investigate the association between alcohol consumption and incidence of sleep disorder.

METHODS

PubMed, EMBASE and OVID were searched systematically until March 2020 for cohort studies quantitatively investigating the effect of alcohol on incident sleep disorder. We conducted a random-effects meta-analysis to calculate the summary ORs (odds ratios) and 95 %CIs (confidence intervals) on the incidence of sleep disorder in relation to alcohol consumption.

RESULTS

The pooled analysis of eleven included cohort studies demonstrated that general drinking was significantly associated with incidence of sleep disorder (OR:1.37, 95 %CI:1.22,1.54,I² = 0.0 %) while heavy drinking was not (OR:1.22, 95 %CI:0.94,1.60, I² = 81.1 %). (general drinking (women <24 g/day; men <48 g/day; < 4 times/week), heavy drinking (women ≥24 g/day; men ≥48 g/day; ≥ 4times/week)).

CONCLUSIONS

Findings from the present systematic review and meta-analyses showed that there was no evidence that alcohol consumption diminished sleep problems, and some evidence that general drinking might increase the sleep problems, but further study is necessary.

Analysis of the evidence of related factors, associated conditions and at-risk populations of the NANDA-I nursing diagnosis insomnia

Objectives

To summarize evidence in the literature on the predictors of insomnia in adults and to determine correspondences with diagnostic indicators of the NANDA-I diagnosis Insomnia.

Methods

An integrative review performed in Pubmed, Virtual Health Library and CINAHL. Forty-eight articles published in Portuguese, English or Spanish from 2011 to 2018 were included. An analysis of correspondence between the predictors and the NANDA-I related factors and associated conditions for Insomnia was performed.

Results

There was a correspondence of the predictors found in this review with NANDA-I related factors and associated conditions, except for grieving and frequent naps during the day. Smoking, caffeine intake, dysfunctional sleep beliefs, obesity and caregiver role strain are possible new related factors; chronic illness is a possible new associated condition and individuals going through changes in marital status, economically disadvantaged, female gender, increasing age and night shift worker are possible new at-risk populations.

Conclusion

The predictors of insomnia that had a correspondence with the NANDA-I elements can support the evidence base of the nursing diagnosis. The predictors found without a correspondence with the diagnosis can be considered for inclusion in the NANDA-I classification, thereby supporting the clinical reasoning of nurses and students.