Considering cross-cultural differences in sleep duration between Japanese and Canadian university students

Impact of seasons and temperatures on the sleep-wake cycle in a French elderly rural population

Sleep is known to be affected by season changes in a temperate climate. Temperature changes are known to affect sleep directly, but in this context, season-related changes in the circadian rhythm may play an important role as well. The objectives of this study were to verify the effect of season and temperature on sleep parameters of elderly French subjects and to focus on the sleep-wake cycle. Sleep parameters and sleep-wake cycle parameters were analyzed through actigraphy while seasonality and temperature were acquired from recording dates and weather records from online scientific archives. ANOVAs were carried out to investigate the effect of seasons on actigraphic parameters and to calculate regression models for temperature. A sample of 157 subjects (49.7 % women) participated in the study with a mean age of 76.9 ± 4.5 years. Inter-daily stability of the sleep-wake cycle was higher in autumn and winter with a higher mean activity during those months. Time in bed was significantly longer in autumn and winter while there was a similar trend for total sleep time. Those variables changing with the seasons were negatively linked to ambient temperature. Not only sleep but also the sleep-wake cycle is impacted by seasonal changes in elderly French subjects. Seasons should be taken into consideration when planning sleep-wake cycle recordings in temperate climates, in particular for longitudinal protocols. Clinical interventions should take season-related sleep-wake cycle problems into account, particularly in the elderly, who suffer more often from sleep disorders than other age groups. Since elderly also suffer more from climate change effects, this study further adds to the demand for clinical monitoring and housing adaptations for the elderly in the future.

Healthy sleep durations appear to vary across cultures

Past research finds that sleep duration is reliably linked with health yet sleep durations differ substantially between countries. We investigated whether countries with shorter sleep durations have worse health. Study 1 analyzed national sleep durations from 14 past investigations (k = 353) and found that they were not associated with national health. Study 2 collected sleep duration and health data from people from 20 different countries (N = 4,933). Average sleep durations varied substantially between countries (range = 1.57 h). A quadratic relation between sleep duration and health was found in all countries, although the turning points varied between countries. Individuals whose sleep duration was closer to their country's perceived ideal reported better health. The results suggest that the amount of sleep associated with optimal health varies across countries.

The relationship between chronotype, sleep quality, and smartphone addiction in health sciences students in Morocco and Spain

Poor sleep quality can cause various health problems. Despite this evidence, much research demonstrates significant heterogeneity in the amounts that people sleep across cultures. This suggests that despite serving fundamental biological functions, sleep is also subject to cultural influence. Variations in chronotype and problematic smartphone use influence sleep quality, and both poor sleep and smartphone addiction can result in poor health and academic performance. This study aimed to measure the associations between chronotype, sleep quality, and smartphone addiction in a population of 1210 health sciences university students in Morocco and Spain. The Horne and Ostberg Morningness-Eveningness Questionnaire, Pittsburgh Sleep Quality Index, and Smartphone Addiction Scale were used to assess the study variables. The study found that the majority of students belonged to the "Neutral" chronotype (73.9%), that the prevalence of smartphone addiction was fairly high (46.3%), and that the prevalence of poor sleep quality was high (74.0%). Associations were found between chronotype and smartphone addiction (p < 0.001), subjective sleep quality (p = 0.006), sleep duration (p = 0.005), sleep disturbances (p = 0.013), and use of sleep medications (p = 0.003). Chronotype was also associated with gender (p = 0.009), country of study (p < 0.001), field of study (p < 0.001), and chronic health problems (p = 0.001). Associations between chronotype and field of study (p < 0.001 for the evening chronotype), sleep disturbance (p < 0.001 and p = 0.026 for both the evening and morning chronotypes), and smartphone addiction (p < 0.001 for the morning chronotype) were confirmed in the multivariate analysis. Our study highlights associations with chronotype that affect sleep quality and addictive behavior when young health sciences students use smartphones. This implies the need to teach or develop strategies to prevent or minimize the negative consequences of the chronotype on mental health and its effects on production. Educational activities on sleep hygiene strategies, the healthy use of smartphones taking into account the chronotype in health sciences students, are needed in order to benefit mental health offuture healthcare professionals.

Relationship of Social Jetlag and Chronotype With the Risk of Diabetes Among Predominantly Male Japanese Daytime Workers: A Prospective Study

Greater social jetlag and late chronotypes have been linked to poor glucose metabolism, but their effects on diabetes risk in Asians remain unclear. This study investigated the prospective association between social jetlag, chronotype and diabetes risk among Japanese workers. We included 1681 workers (73% were daytime workers) aged 18-78 years who attended a nutritional survey in 2015 and 2016 and were followed for diabetes incidence until May 31, 2022. Social jetlag was defined as the absolute difference in the midpoint of sleep times between weekdays and weekends. Chronotype was estimated using the mid-sleep time on weekends that was corrected with sleep debt on weekdays. Following the American Diabetes Association criteria, diabetes onset was defined as the time when the participant first met any of the following conditions: HbA1c ≥ 6.5%, fasting plasma glucose ≥ 126 mg/dL, random plasma glucose ≥ 200 mg/dL or current use of antidiabetic medication. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for diabetes incidence. Among the study participants, 88.8% were male, 5.0% experienced ≥ 2 h of social jetlag, and 7.6% were classified as having a late chronotype. During the 7-year follow-up, 107 individuals (6.4%) developed diabetes. Among daytime workers, social jetlag was not associated with diabetes risk: multivariable-adjusted HRs (95% CI) for diabetes were 1.00, 0.90 (0.52-1.55) and 1.08 (0.43-2.75) in participants with < 1.0, 1.0 to 1.9, and ≥ 2.0 h of social jetlag, respectively. Late chronotype was associated with higher diabetes risk, although not statistically significant, compared to early chronotype; multivariable-adjusted HRs (95% CI) were 1.32 (0.80-2.18) for intermediate chronotype and 1.98 (0.77-5.10) for late chronotype. In conclusion, this study suggests an association between late chronotypes and increased risk of diabetes among daytime workers and also highlights a mediating role of lifestyle-related behaviours on chronotype and their impact on metabolic health.

A systematic review and meta-analysis of group-based trajectory modeling of sleep duration across age groups and in relation to health outcomes

STUDY OBJECTIVES

To shed light on understanding sleep duration trajectories (SDTs) using different classification methods and their outcomes, this study aimed to (1) identify common SDTs among different age groups, (2) investigate the alignment versus differences between SDTs identification by group-based trajectory modeling (GBTM) and clinical standards, and (3) examine the impacts of SDTs on health outcomes.

METHODS

A systematic literature search from four databases yielded 34 longitudinal SDT studies with GBTM analyses spanning three or more data waves. Apart from the proportion meta-analysis, a three-level meta-analysis was conducted with 14 of the studies that examined the association between SDT groups and health outcomes. Assessment of study quality was performed using the Guidelines for Reporting on Latent Trajectory Studies checklist.

RESULTS

Qualitative analysis identified four age-related SDT classes based on longitudinal trends: "persistent sleepers," "increase sleepers," "decrease sleepers," and "variable sleepers." Meta-analysis also showed differential proportions of "GBTM-defined shortest sleepers" across age groups and sample regions, as well as significant discrepancies in the prevalence of short sleep identified by clinical standards (=50% vs. 15% per GBTM). Overall, SDTs predicted emotional and behavioral outcomes, neurocognitive problems, and physical health (OR = 1.538, p < 0.001), in GBTM-defined "short," "fluctuating," "long," and "decreasing" sleepers as compared to the "adequate" group. The effects were stronger in adolescents and in datasets with more waves.

CONCLUSIONS

The identification of the GBTM-defined "short," "fluctuating," "long," and "decreasing" SDT groups and their associations with various health outcomes supported longitudinal investigations, as well as the development of interventions focusing on both the length and stability of sleep durations, especially in younger populations. Study registration: PROSPERO registration number CRD42023412201.

Insomnia and risk of all-cause dementia: A systematic review and meta-analysis

BACKGROUND

The evidence on the relationship between insomnia and risk of dementia, Alzheimer's disease (AD), and Vascular dementia (VD) is not consistent. We conducted this meta-analysis to examine the evidence for the risk of developing dementia, AD, or VD in patients with all subtypes of insomnia.

METHODS

A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted using the following search strings: 'Insomnia OR Sleep initiation and Maintenance disorders OR Early morning awakening' AND 'Dementia OR Alzheimer's Disease OR Vascular Dementia' AND 'Risk'. Data extraction was done independently by two researchers. Pooled odds ratio (OR) accompanied by 95% confidence interval (CI) were calculated using either a random-effects model or a fixed-effects model. Sensitivity analyses were performed to assess the robustness of the findings. The potential for publication bias was evaluated through Egger's test and Begg's test.

RESULTS

This meta-analysis included 16 studies with a combined sample size of over 9 million individuals. Pooled analyses revealed a significant association between insomnia and dementia risk (OR = 1.36; 95% CI: 1.01-1.84), with increased risks for AD (OR = 1.52; 95% CI: 1.19-1.93) and VD (OR = 2.10; 95% CI = 2.06-2.14). Subgroup analyses showed no evidence of associations between initial insomnia (OR = 1.01; 95% CI = 0.71-1.31), sleep-maintenance insomnia (OR = 0.88; 95% CI = 0.66-1.17), and early morning awakening (OR = 0.94; 95% CI = 0.83-1.07) with dementia risk. Insomnia patients from Europe (OR = 1.24; 95% CI = 1.14-1.35), Asia (OR = 2.19; 95% CI = 2.06-2.32), and the Americas (OR = 1.05; 95% CI =  1.04-1.07) had varying risks of dementia. Subgroups with less than five years of follow-up (OR = 2.16; 95% CI = 1.81-2.60) exhibited higher dementia risks in insomnia patients, while those with more than five years of follow-up (OR = 1.17; 95% CI = 1.03-1.33) showed a lower risk.

CONCLUSION

Our meta-analysis reveals that insomnia is linked to the risk of dementia, AD, and VD. These findings suggest that insomnia may significantly contribute to the risk of all-cause dementia, highlighting the importance of early intervention and management of insomnia. Despite our efforts to minimize and explore the sources of heterogeneity, it still remained, and therefore our results should be interpreted with caution.

An investigation of racial and socioeconomic factors related to sleep in a Brazilian population sample

OBJECTIVES

The relationship of sleep, race, and socioeconomic status has become the focus of discussion in several studies. Investigation of these connections in sleep studies has identified substantial associations between these factors. However, most research output on this subject comes from higher-income countries with specific social issues, which warrants evaluations in countries with other socioeconomic backgrounds. This study aimed at performing an assessment of sleep, race, and socioeconomic status in the Brazilian population.

METHODS

This manuscript examined data from a large-scale Brazilian epidemiological study, comprising 1042 participants. Self-declared race/skin color could be reported from five options (Black, White, Indigenous, Asian, Pardo) or as an open-ended question. Socioeconomic status was assessed using the Brazil Economic Classification Criteria, a questionnaire that evaluates possession of domestic appliances, educational level, and house structure.

RESULTS

Self-declared Black Brazilians with lower socioeconomic status presented significantly lower objective total sleep time; conversely, they also presented lower wake after sleep onset time and higher sleep efficiency. Mid-to-high socioeconomic status Pardo Brazilians had less total sleep time and higher sleep latency.

CONCLUSIONS

The sleep disparities in our findings, compared with those from studies from other countries, suggest that sociodemographic and racial/ethnic factors may vary in nature from one population to another. Therefore, the social and racial construction of each specific nation or culture must be considered in epidemiological sleep assessments and comparisons with other studies.

Risk Factors and Prevalence of Sleep Disturbance in Degenerative Cervical Myelopathy

BACKGROUND

Sleep disturbances, especially those lasting more than one hour, are under-researched in patients with degenerative cervical myelopathy (DCM). This study aims to investigate the prevalence and risk factors for such disturbances in DCM patients undergoing decompression surgery and to identify factors contributing to poor postoperative improvement.

METHODS

A multicenter retrospective observational study was conducted on consecutive patients diagnosed with DCM who underwent cervical decompression surgery between April 2018 and August 2022. The Neck Disability Index sleep component was assessed at baseline and 12 months postsurgery. Univariate and multivariable logistic regression analyses were used to identify risk factors for persistent sleep disturbances and poor improvement.

RESULTS

Of the 1912 patients included, 54.8% reported sleep disturbances, with 33.0% experiencing disturbances of more than one hour at baseline. Multivariable analysis identified male sex, high body mass index, high Numerical Rating Scale for arm pain, high Neck Disability Index, and high Core Outcome Measures Index Neck as significant risk factors for sleep disturbances. At 12 months, 35.2% of these patients continued to experience significant sleep issues. The presence of ossification of the posterior longitudinal ligament and high baseline Numerical Rating Scale for neck pain were significant predictors of poor improvement.

CONCLUSIONS

The study highlights that ossification of posterior longitudinal ligament and high baseline neck pain are significant risk factors for persistent sleep disturbances postsurgery in DCM patients. Early identification and targeted interventions may be necessary to improve outcomes.

Tracking continuous positive airway pressure adherence in obstructive sleep apnea patients before, during, and after the COVID-19 lockdown

BACKGROUND

This study aimed to examine the impact of the COVID-19 lockdown on adherence to continuous positive airway pressure (CPAP) therapy among Saudi patients with obstructive sleep apnea (OSA). It also sought to assess the influence of demographic variables and comorbidities on CPAP adherence.

METHODS

A prospective cohort study was conducted at the University Sleep Disorders Center at King Saud University Medical City. The study included 67 OSA patients who exclusively used CPAP for treatment across three distinct intervals: prelockdown, during lockdown, and postlockdown. Adherence to CPAP therapy was objectively measured using "mask-on on-time monitoring" data from the CPAP machines.

RESULTS

The study found a significant decrease in the number of days with CPAP usage during the lockdown period, which persisted postlockdown. Approximately half of the patients adhered to CPAP treatment throughout the three study intervals. The decrease in CPAP usage days during lockdown was particularly noticeable among patients younger than 50 and older than 65 years of age. The presence of comorbidities, body mass index, and sex did not significantly influence CPAP treatment adherence.

CONCLUSION

The COVID-19 lockdown significantly impacted CPAP treatment adherence among OSA patients, with a decrease in adherence persisting postlockdown. This highlights the need for interventions to support CPAP adherence during challenging times such as a pandemic. Further research is needed to understand the long-term effects of the pandemic on CPAP therapy adherence.

A systematic and meta-analytic review of the impact of sleep restriction on memory formation

Modern life causes a quarter of adults and half of teenagers to sleep for less than is recommended (Kocevska et al., 2021). Given well-documented benefits of sleep on memory, we must understand the cognitive costs of short sleep. We analysed 125 sleep restriction effect sizes from 39 reports involving 1234 participants. Restricting sleep (3-6.5 hours) compared to normal sleep (7-11 hours) negatively affects memory formation with a small effect size (Hedges' g = 0.29, 95 % CI = [0.13, 0.44]). We detected no evidence for publication bias. When sleep restriction effect sizes were compared with 185 sleep deprivation effect sizes (Newbury et al., 2021) no statistically significant difference was found, suggesting that missing some sleep has similar consequences for memory as not sleeping at all. When the analysis was restricted to post-encoding, rather than pre-encoding, sleep loss, sleep deprivation was associated with larger memory impairment than restriction. Our findings are best accounted for by the sequential hypothesis which emphasises complementary roles of slow-wave sleep and REM sleep for memory.

The effects of digital CBT intervention on attentional bias and sleep quality of poor sleepers with insomnia symptoms

BACKGROUND

Attentional bias is a salient manifestation of insomnia. Digital cognitive therapy for insomnia (dCBT-I) has been validated as effective in alleviating this cognitive dysfunction. However, the effect of dCBT-I on attentional bias among Chinese individuals with insomnia remains undiscussed. This research sought to investigate this effect via a pictorial dot-probe task.

METHODS

In Study 1, the pattern of attentional bias among poor sleepers (N = 52) and normal sleepers (N = 56) was assessed by the dot-probe task. In study 2, dCBT-I and conventional education were received by the experimental group (N = 42) and control group (N = 25), respectively. The dot-probe tasks and sleep quality assessments were completed at baseline and post-test.

RESULTS

The results of Study 1 indicated that poor sleepers exhibited significant attentional bias, characterized by increased attentional vigilance. Compared to normal sleepers, they showed heightened attentional vigilance toward sleep-related cues. The results of Study 2 showed that both dCBT-I and conventional education led to improvements in PSQI scores. However, only dCBT-I training alleviated attentional vigilance toward sleep-related cues. Additionally, dCBT-I was uniquely effective in reducing feelings of fatigue.

CONCLUSIONS

Poor sleepers had a significant attentional bias, marked by heightened vigilance toward sleep-related cues. Digital CBT-I effectively reduced attentional vigilance and fatigue, suggesting that dCBT-I targets the cognitive distortions associated with insomnia.

TRIAL REGISTRATION

ChiCTR2100053172 (registered 13/11/2021).

Post traumatic stress and sleep disorders in long COVID: Patient management and treatment

Post traumatic stress disorder (PTSD) and sleep disorders are prevalent among patients with long COVID. The intersection of PTSD and/or sleep disorders with long COVID is complex. Thus, use of a biopsychosocial lens for assessment and treatment along with a trauma-informed approach to clinical care is recommended. This review provides an overview of the literature on PTSD and sleep disorders among patients with long COVID, including prevalence rates, risk factors, and potential pathophysiology. Pharmacological and non-pharmacological treatment options are reviewed. Also, we provide actionable steps clinicians can integrate into their practice to help effectively assess and treat PTSD and sleep disorders, including validated symptom assessments, recommended referrals, and specific components of non-pharmacological interventions.

Vestibular control of standing balance following 24 h of sleep deprivation

Sleep deprivation alters cognitive and sensorimotor function, but its effects on the control of standing balance are inconclusive. The vestibular system is critical for standing balance, and is modified by sleep deprivation; however, how sleep deprivation affects vestibular-evoked balance responses is unknown. Thus, this study aimed to examine the effect of 24 h of sleep deprivation on the vestibular control of standing balance. During both a well-rested (i.e., control) and sleep deprivation condition, nine females completed two 90-s trials of bilateral, binaural stochastic electrical vestibular stimulation (EVS) and two 120-s trials of quiet stance on a force plate. Quiet stance performance was assessed by center of pressure displacement parameters. Mediolateral ground reaction force (ML force) and surface electromyography (EMG) of the right medial gastrocnemius (MG) were sampled simultaneously with the EVS signal to quantify vestibular control of balance within the frequency (gain and coherence) and time (cumulant density) domains. Twenty-four hours of sleep deprivation did not affect quiet stance performance. Sleep deprivation also had limited effect on EVS-MG EMG and EVS-ML Force coherence (less than control at 8-10.5 Hz, greater at ~ 16 Hz); however, gain of EVS-MG EMG (< 8, 11-24 Hz) and EVS-ML force (0.5-9 Hz) was greater for sleep deprivation than control. Sleep deprivation did not alter peak-to-peak amplitude of EVS-MG EMG (p = 0.51) or EVS-ML force (p = 0.06) cumulant density function responses. Despite no effect on quiet stance parameters, the observed increase in vestibular-evoked balance response gain suggests 24-h sleep deprivation may lead to greater sensitivity of the central nervous system when transforming vestibular-driven signals for standing balance control.

A qualitative systematic review of adolescent's perceptions of sleep: Awareness of, barriers to and strategies for promoting healthy sleep patterns

AIMS

To consolidate adolescents' perspectives regarding various aspects of sleep and offer insights to promote healthier sleep habits during their critical developmental years.

METHODS/DATA SOURCES

Six electronic databases (PubMed, CINAHL, Embase, Scopus, PsycINFO and Web of Science) were searched from their inception dates to June 2023. Data were extracted and meta-summarised using Sandelowski and Barroso's approach and synthesised using Thomas and Harden's thematic analysis framework.

RESULTS

Meta-synthesis from 11 peer-reviewed published studies identified four main themes: (1) Awareness and understanding of sleep's significance, (2) The shadows and radiance of slumber, (3) Traversing the sleepscape: trouble bubbles and (4) Illuminating the path: Guiding lights to enhanced sleep.

CONCLUSION/IMPLICATIONS

Our review findings suggest a lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Identified barriers to adequate sleep encompass various factors, including overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. Strategies to improve adolescents' sleep health involve multiple sleep strategies, including sleep education, workshops/seminars, parental involvement, incorporating digital well-being practices, the promotion of relaxation techniques and the provision of essential resources. Prioritising sleep health and implementing targeted interventions are key steps to empower adolescents, create supportive environments and shape a healthier future generation. Future research endeavours should focus on evaluating the effectiveness of interventions and exploring the influence of cultural factors.

IMPACT

There exists a notable lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Barriers to achieving adequate sleep among adolescents include overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. The collaboration between healthcare institutions, professionals and educational institutions is crucial to facilitate (1) the implementation of sleep education workshops/seminars targeting adolescents, (2) increased parental involvement and role-modelling to instil good sleep practices among adolescents and (3) enhanced integration of digital well-being practices, the promotion of relaxation techniques and accessibility to essential sleep hygiene resources.

REPORTING METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

TRIAL AND PROTOCOL REGISTRATION

This review was registered on the Prospective Register of Systematic Reviews (CRD42023403775).

Dietary inflammation, sleep and mental health in the United Kingdom and Japan: A comparative cross‐sectional study

Diet has been repeatedly shown to affect mental and sleep health outcomes. However, it is well known that there are cross‐cultural differences in dietary practices as well as the prevalence of mental and sleep health outcomes. Given that the dietary inflammatory potential of diets has been linked to mental and sleep health outcomes, in the current study we sought to assess the inflammatory status of habitual diets and examine its relationship with mental and sleep health outcomes in both the United Kingdom and Japan. Our aim was to determine if the associations between the dietary inflammation index (DII) score and these health outcomes could elucidate any potential cross‐cultural differences in health. Online survey data was collected from 602 participants (aged 18–40 years) in the United Kingdom (n = 288) and Japan (n = 314). Participants self‐reported their dietary intakes, as well as current mental health and sleep patterns. The DII score was calculated (score range − 2.79 to 3.49) We found that although participants in the United Kingdom reported better overall mental wellbeing, participants in Japan reported less severe depression, anxiety and stress and better subjective sleep quality, less sleep disturbances and daytime dysfunction, despite sleeping shorter, and a better adherence to an anti‐inflammatory diet. Moreover, across the United Kingdom and Japan, adherence to more anti‐inflammatory diets predicted higher levels of subjective sleep quality, fewer sleep disturbances, less use of sleep medicine and less daytime dysfunction. In conclusion, there are several differences between mental and sleep health outcomes in the United Kingdom and Japan, which could be attributable to the inflammatory potential of respective regional diets. Future studies are warranted to examine the mental and sleep health benefits of adhering to anti‐inflammatory traditional Japanese diets in clinical and subclinical cohorts.

A Comprehensive Assessment of Bedtime Routines and Strategies to Aid Sleep Onset in College Students: A Web-Based Survey

College students often experience sleep-wake alterations. Different factors can contribute to insomnia symptoms in this population. The present study aims at investigating pre-sleep behaviours and strategies used to aid sleep onset in young college students and their association with insomnia symptoms. A total of 548 Italian college students (mean age = 23.48 years, range = 19-30 years, 80.5% female) completed a web-based survey on pre-sleep behaviours and sleep-onset facilitators, insomnia symptoms and sleep hygiene, anxiety and depression, and coping strategies. The use of electronic devices at bedtime and as a sleep-onset facilitator was predominant. Students using specific behaviours as sleep-onset facilitators were characterised by more psychological difficulties and poorer sleep. In multivariable linear regression analysis, the frequency of using medications and melatonin, regardless of motivations, was associated with higher insomnia symptoms. The use of specific sleep-onset facilitators positively correlated with the severity of insomnia symptoms. Many students engage in behaviours that are considered sleep-interfering and that are often employed in an attempt to facilitate sleep onset without benefits. Overall, the motivational factors behind pre-sleep behaviours need to be addressed in preventive programs targeting young college students.

Determinants of sleep quality among pregnant women in a selected institution in the Southern province, Sri Lanka

BACKGROUND

Sleep is a vital requirement during pregnancy for the betterment of the fetus and the mother. Sleep quality could vary due to pregnancy-specific psychological and physiological changes. To introduce a tailored programme to enhance the sleep quality of mothers, it is paramount to assess the sleep quality and determinants of sleep. Therefore, this study aimed to assess the determinants of sleep quality among pregnant women in a selected institution in the Southern province of Sri Lanka.

METHODS

Hospital-based cross-sectional study was carried out with 245 antenatal women, selected using a systematic random sampling method. A pretested self-administered questionnaire was used to collect data which contains four parts. Below variables were involved and both continuous and categorical data were collected as required. 'Maternal sleep quality, socio-demographic data and gestational age, maternal depression and anxiety.' Data were analyzed using IBM SPSS version 25.0 for Windows by using descriptive statistics, Pearson's Chi-square test, and independent sample T-test (p < 0.05). Logistic regression analysis was used to find the relationship with sleep quality and other variables. P-value of less than 0.05 was considered statistically significant, at 95% CI.

RESULTS

The majority of women (60.8%) had good sleep quality and they didn't have either depressive symptoms (63.4%) or anxiety (64.2%). Aged between 34-41 years and third-trimester women had higher rates of poor sleep quality. Varying quality of sleep was identified among three-trimesters with subjective sleep quality, sleep latency, habitual sleep efficiency, and sleep disturbances. In comparison with the first and second trimester, pregnant women in the third trimester had higher score of global PSQI (5.22 ± 2.35), subjective sleep quality (1.23 ± 0.70), sleep latency (1.25 ± 0.86), habitual sleep efficiency (0.14 ± 0.43), and sleep disturbances (1.39 ± 0.58). There was a significant association between gestational age (P = .006), maternal age (P = .009), antenatal depression (P = .034), and anxiety (P = .013) with sleep quality. However, multinomial logistic regression revealed that only gestational age affected on quality of sleep. The first trimester was a protective factor for good quality sleep (Adjusted OR = 3.156) compared to the other two trimesters.

CONCLUSION

This study revealed that the majority of women had good sleep quality but quality of sleep was deprived with gestational age. It is expected that the findings of this research will be helpful for health and social care policymakers when formulating guidelines and interventions regarding improving the quality of sleep among pregnant women in Sri Lanka.

Factors associated with poor sleep quality among dental students in Malaysia

Background

Good sleep quality is crucial for dental students as they must have optimal cognitive function, memory, and decision-making to accomplish their learning requirements. This study aims to determine sleep quality, its associated factors, and the association between sleep quality and academic performance among dental students in Malaysia.

Methods

This cross-sectional study involved dental students at four public universities in Malaysia. A validated Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess their sleep quality. An additional self-administered questionnaire was employed to obtain the students' sociodemographic profile, lifestyle, and academic performance. The data were analysed using descriptive, chi-square, and multiple logistic regression.

Results

Three hundred eighty-four dental students participated in this study. About half of the dental students (51.6%) have poor sleep quality. The mean of sleep hours per night was 5.72 (SD 1.06). The sleep quality was significantly poor among Malay students (P = 0.023), students who stayed at hostel (P = 0.002), and those who consumed caffeinated drinks (P = 0.028). Multiple logistic regression analysis revealed that the poor sleep quality was significantly associated with self-perceived poor academic performance (Adjusted Odds Ratio (AOR) 2.95, 95% CI [1.25-6.96], P-value = 0.013) and students skipping class (AOR 1.70, 95% CI [1.00-2.91], P-value = 0.046).

Conclusions

Most of the dental students in Malaysia have poor sleep quality. Ethnicity, accommodation, and caffeine consumption were significantly associated with sleep quality. Awareness to sleep quality among dental students is needed to ensure they are able to cope with the challenging dental school learning environment.

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.

Individual sleep need is flexible and dynamically related to cognitive function

Given that sleep deprivation studies consistently show that short sleep causes neurocognitive deficits, the effects of insufficient sleep on brain health and cognition are of great interest and concern. Here we argue that experimentally restricted sleep is not a good model for understanding the normal functions of sleep in naturalistic settings. Cross-disciplinary research suggests that human sleep is remarkably dependent on environmental conditions and social norms, thus escaping universally applicable rules. Sleep need varies over time and differs between individuals, showing a complex relationship with neurocognitive function. This aspect of sleep is rarely addressed in experimental work and is not reflected in expert recommendations about sleep duration. We recommend focusing on the role of individual and environmental factors to improve our understanding of the relationship between human sleep and cognition.

Promotion of Para Athlete Well-being (PROPEL II): A Cross-sectional Study of Sleep in Para Athletes Across Two Nations

OBJECTIVE

Limited research exists on the sleep profiles of South African Para athletes. The aims of this study are to describe sleep quality, day-time sleepiness, and chronotype of South African Para athletes and to compare the relationship between sleep-related outcomes and demographic factors to athletes from a higher-resource country.

DESIGN

A descriptive, cross-sectional survey was conducted. Sleep-related characteristics were assessed with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire. Multiple regression models were run with and without country as independent variable.

RESULTS

One hundred twenty-four South African athletes and 52 Israeli athletes were included. Thirty percent of South African athletes presented with excessive daytime sleepiness, 35% slept 6 hrs or less per night, and 52% reported poor sleep quality. Thirty-three percent of Israeli athletes reported excessive daytime sleepiness, 29% slept 6 hrs or less, and 56% reported poor sleep quality. Chronotype was the only variable that differed significantly between countries (overrepresentation of morning types in South African athletes, and intermediate types in Israeli athletes). Intermediate chronotypes had significantly greater odds of excessive daytime sleepiness ( P = 0.007) and poor sleep quality ( P = 0.002) than morning types, irrespective of country.

CONCLUSIONS

The high prevalence of poor sleep among both South African and Israeli Para athletes warrants further investigation.

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.

Better characterizing sleep beliefs for personalized sleep health promotion: the French sleep beliefs scale validation study

Background

The Sleep Beliefs Scale (SBS) is a well-known tool to design and monitor personalized sleep health promotion at an individual and population level. The lack of an established French version limits the development of effective interventions targeting these populations. Thus, the aim of this study was to validate the French version of the SBS in a representative sample of the general population.

Methods

Quota sampling was used to recruit 1,004 participants (18-65 years, mean age: 43 years, 54% of female) who underwent an online survey to complete the SBS, and to assess sleep schedules, sleep quality and disorders, and mental health. Cronbach's α coefficient, confirmatory factor analysis, item-internal consistency (IIC), and item discriminant validity (IDV) of the SBS were computed to assess internal validity while bivariate associations with sleep schedules, sleep quality and disorders, and mental health were used to assess external convergent and discriminant validity.

Results

The mean score on the SBS was 12.3 ± 4.9. Item 19 ("Quiet & Dark") showed the highest rate of correct answers (n = 801, 79.8%), while item 20 ("Recovering sleep") showed the lowest rate of correct answers (n = 246, 24.5%). Overall, the SBS showed satisfactory internal consistency (α = 0.87) and confirmed the three-factor structure proposed by the original study. All items were found consistent (IIC > 0.4) and discriminant (IIC > IDV) except for item 20 ("recovering lost sleep by sleeping for a long time"). Females, older participants, and subjects with short time-in-bed, poor sleep quality, insomnia, and circadian rhythm disorder had higher SBS scores while participants with depressive symptoms had lower SBS scores.

Conclusion

We successfully translated and validated the French version of the SBS in a representative sample, making it a reliable instrument for researchers and clinicians to assess and target sleep beliefs. Correct answers vary from 25 to 80% which underlines the importance of continuing sleep health promotion campaigns by targeting poorly understood behaviors. Our findings also shed light on the fickleness of beliefs that are prone to vary within individuals across time, in step with societal changes. Several associated factors were identified, thus contributing to our understanding of sleep beliefs and offering insights for personalized approaches to enhance sleep health and overall well-being.

Reallocating time between device-measured 24-hour activities and cardiovascular risk in Asian American immigrant women: An isotemporal substitution model

The 24-hour day consists of physical activity (PA), sedentary behavior, and sleep, and changing the time spent on one activity affects the others. Little is known about the impact of such changes on cardiovascular risk, particularly in Asian American immigrant (AAI) women, who not only have a higher cardiovascular risk but also place greater cultural value on family and domestic responsibilities compared to other racial/ethnic groups. The purpose of this study was to evaluate the effects of reallocating 30 minutes of each 24-hour activity component for another on BMI, waist circumference, and blood pressure in AAI women. Seventy-five AAI women completed 7 days of hip and wrist actigraphy monitoring and were included in the analysis (age = 61.5±8.0 years, BMI = 25.5±3.6 kg/m2, waist circumference = 85.9±10.2 cm). Sleep was identified from wrist actigraphy data, and moderate-to-vigorous PA (MVPA), light PA, and sedentary behavior identified from hip actigraphy data. On average, the women spent 0.5 hours in MVPA, 6.2 hours in light PA, 10 hours in sedentary activities, and 5.3 hours sleeping within a 24-hour day. According to the isotemporal substitution models, replacing 30 minutes of sedentary behavior with MVPA reduced BMI by 1.4 kg/m2 and waist circumference by 4.0 cm. Replacing that same sedentary time with sleep reduced BMI by 0.5 kg/m2 and waist circumference by 1.4 cm. Replacing 30 minutes of light PA with MVPA decreased BMI by 1.6 kg/m2 and waist circumference by 4.3 cm. Replacing 30 minutes of light PA with sleep also reduced BMI by 0.8 kg/m2 and waist circumference by 1.7 cm. However, none of the behavioral substitutions affected blood pressure. Considering AAI women's short sleep duration, replacing their sedentary time with sleep might be a feasible strategy to reduce their BMI and waist circumference.

Regional cultures and insufficient sleep in the United States

BACKGROUND

Insufficient sleep can increase the risk of health problems and chronic conditions including cognitive problems, increased inflammation, diabetes and cardiovascular disease, and overall mortality. In this report, insufficient sleep, as a cultural experience, was tracked across the United States according to the American Nations model of U.S. regional cultures.

METHODS

County Health Rankings & Roadmaps program data relating to insufficient sleep were matched at the zip-code level with the American Nations dataset from the Nationhood Lab. Percentages for the insufficient sleep metric were then estimated using the population of each of the American Nations.

RESULTS

High levels of sleep insufficiency across all regional cultures indicate considerable room for improvement and a potential need to prioritize sleep hygiene as a health concern. ANOVA results show significant differences among the 13 American Nations and indicate variation in sleep outcomes between cultural regions. Follow-up post hoc analyses appear to support the notion that those regional cultures that place a higher value on social investments tend to report lower levels of sleep insufficiency. Furthermore, the insufficient sleep pattern noted in this report is consistent with those reported earlier for physical inactivity, obesity, and diabetes.

CONCLUSIONS

Factors and circumstances occurring in the Midwest and the South-Central states appear to be responsible for the observed patterns. Future research should consider reviews of policies and related practices adopted across the American Nations to identify causal patterns.

Racial and ethnic disparities in self-reported sleep duration: Roles of subjective socioeconomic status and sleep norms

OBJECTIVES

There are racial and ethnic disparities in sleep duration, with members of historically marginalized groups typically reporting shorter sleep than White Americans. This study examines subjective social status (SSS) as a moderator, and variation in ideal sleep norms as a mediator, of differences in sleep duration between racial/ethnic groups.

METHODS

Asian, Black, Hispanic, and non-Hispanic White respondents in an online survey reported their typical weeknight and weekend-night sleep duration, along with estimates of ideal sleep duration norms. Objective and subjective indicators of socioeconomic status were also assessed. A conditional process analysis was used to examine whether racial or ethnic differences in sleep duration were a) moderated by SSS and b) mediated by ideal sleep duration norms.

RESULTS

Racial/ethnic disparities in sleep duration varied by group. Hispanic participants reported shorter weeknight sleep than White participants. In Asian and Black participants, shorter weeknight sleep relative to White participants was only observed at medium (Black) or high (Black and Asian) levels of SSS. Shorter norms for ideal sleep duration partially mediated differences in sleep duration between Black and White adults, but not the other racial/ethnic groups. There was no evidence of moderated mediation. Neither income nor education moderated racial/ethnic disparities in sleep duration.

CONCLUSIONS

Racial and ethnic disparities in sleep duration may partially depend on SSS. Continued research into moderators and mediators of racial/ethnic differences in sleep duration is warranted.

Country differences in nocturnal sleep variability: Observations from a large-scale, long-term sleep wearable study

STUDY OBJECTIVES

Country or regional differences in sleep duration are well-known, but few large-scale studies have specifically evaluated sleep variability, either across the work week, or in terms of differences in weekday and weekend sleep.

METHODS

Sleep measures, obtained over 50 million night's sleep from ∼220,000 wearable device users in 35 countries, were analysed. Each person contributed an average of ∼242 nights of data. Multiple regression was used to assess the impact country of residence had on sleep duration, timing, efficiency, weekday sleep variability, weekend sleep extension and social jetlag.

RESULTS

Nocturnal sleep was shorter and had a later onset in Asia than other regions. Despite this, sleep efficiency was lower and weekday sleep variability was higher. Weekend sleep extension was longer in Europe and the USA than in Asia, and was only partially related to weekday sleep duration. There were also cross-country differences in social jetlag although the regional differences were less distinct than for weekend sleep extension.

CONCLUSIONS

In addition to regional differences in sleep duration, cross-country differences in sleep variability and weekend sleep extension suggest that using the latter as an indicator of sleep debt may need to be reconsidered. In countries exhibiting both short sleep and high weekday sleep variability, a culturally different means of coping with inadequate sleep is likely. Country or region differences in culture, particularly those related to work, merit closer examination as factors influencing the variability in normative sleep patterns around the world.

Reliability and validity of the Chinese version of the Athens insomnia scale for non-clinical application in Chinese athletes

Purpose

This study aimed to revise and examine the reliability and validity of the Chinese version of the Athens Insomnia Scale for Non-clinical Application (AIS-NCA) among Chinese athletes. Additionally, the study tested the scale in non-athlete individuals with similar sleep management practices to further analyze its cultural specificity among Chinese athletes and make preliminary inferences about its applicability in other Chinese populations.

Methods

Four hundred twenty-six Chinese professional athletes and 779 high school students participated in this research. Both athletes and students were divided into two parallel groups for exploratory and confirmatory factor analyses. Additionally, three athlete samples and one student sample were established for reliability and validity assessments. Among athletes, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Athlete Sleep Screening Questionnaire, and the Warwick-Edinburgh Mental Well-Being Scale were employed to evaluate convergent and discriminant validity. Re-test reliability was evaluated at intervals of 1 and 2 weeks. In the case of students, convergent and discriminant validity were tested using the Pittsburgh Sleep Quality Index and the General Self-Efficacy Scale, with re-test reliability assessed at two-week intervals.

Results

The Chinese version of the AIS-NCA consists of six items, categorized into two dimensions: sleep problems and daytime functioning. This structure explained 65.08% (athletes) and 66.22% (students) of the variance. Confirmatory factor analysis revealed good model fit, with values of χ2/df = 2.217, CFI = 0.975, AGFI = 0.929, TLI = 0.953, and RMSEA = 0.076 among athletes, and χ2/df = 3.037, CFI = 0.979, AGFI = 0.947, TLI = 0.961, and RMSEA = 0.072 among students. The scale demonstrated a reasonable degree of measurement invariance. The overall scale and two subscales exhibited strong reliability and validity among athletes. Similar results in terms of reliability and validity were also observed within the student sample.

Conclusion

The Chinese version of the AIS-NCA shows promise as an assessment tool for evaluating the sleep quality of Chinese athletes. It effectively captures both sleep-related concerns and daytime functionality within the athlete population. The scale demonstrates solid reliability and validity in professional athletes and holds potential for application across various other demographic groups in China.

Daily consumption of Lactobacillus gasseri CP2305 improves quality of sleep in adults - A systematic literature review and meta-analysis

BACKGROUND & AIM

The gut-brain axis is one of the proposed interactions between the brain and peripheral intestinal functions; of particular interest is the influence of food components on the gut-brain axis mediated via the gut microbiome. Probiotics and paraprobiotics have been proposed to interact with the intestinal environment and provide health benefits such as improving sleep quality. The aim of this research was to undertake a systematic literature review and meta-analysis to evaluate the current evidence regarding the effects of Lactobacillus gasseri CP2305 on sleep quality for the general population.

METHODS

A systematic literature search was conducted of peer-reviewed articles published up to 04 November 2022. Randomised controlled trials were identified that investigated the effects of Lactobacillus gasseri CP2305 on sleep parameters in adults. Meta-analysis of the change in the Pittsburgh Sleep Quality Index (PSQI) global score was conducted. Quality assessments of individual studies were conducted using the Cochrane Risk of Bias and Health Canada tools.

RESULTS

Seven studies were included in the systematic literature review; six studies included data for meta-analysis to quantify the effect of L. gasseri CP2305 on sleep quality. The ingestion of L. gasseri CP2305 resulted in significant improvement in the PSQI global score compared to control (-0.77, 95% CI: -1.37 to -0.16, P = 0.01). In the two studies that included electroencephalogram (EEG) data, output was significantly improved for at least half of the measured EEG outcomes after consumption of L. gasseri CP2305. No serious concerns were found in the potential biases of included studies, indirectness of the included evidence, and other methodological issues.

CONCLUSION

The present systematic review and meta-analysis indicates significant improvement in sleep quality of adults with mild to moderate stress as an effect of daily consumption of L. gasseri CP2305. Based on existing evidence, the relationship between L. gasseri CP2305 and enhanced sleep quality is plausible, however further investigations are required to confirm the mechanisms of actions for this effect.

The RU_SATED as a measure of sleep health: cross-cultural adaptation and validation in Chinese healthcare students

BACKGROUND

The RU_SATED scale is a multidimensional instrument measuring sleep health, consisting of Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration dimensions. We adapted and validated the Chinese RU_SATED (RU_SATED-C) scale.

METHODS

The RU_SATED-C scale was developed through a formal linguistic validation process and was validated in an observational longitudinal survey design. Healthcare students completed the RU_SATED scale, Sleep Quality Questionnaire, and Patient Health Questionnaire-4 among two sites of Hangzhou and Ningbo, China. Psychometric assessments included structural validity, longitudinal measurement invariance, convergent and divergent validity, internal consistency, and test-retest reliability.

RESULTS

A total of 911 healthcare students completed the RU_SATED-C scale at baseline (Time 1, T1) and follow-up (Time 2, T2) with an average time interval of 7 days + 5.37 h. Confirmatory factor analysis (CFA) confirmed a single-factor model and resulted in an acceptable model fit. The two-factor model previously found in the Japanese version fit better than the one-factor model, whereas the one-factor model fit had a better fit than the two-factor model found in the English version. Longitudinal CFA resulted in negligible changes in fit indices for four forms of increasingly restrictive models and supported that a single-factor model was equivalent over time. The data also endorsed longitudinal measurement invariance among the two-factor models found in the English and Japanese samples. The RU_SATED-C scale total score displayed a moderately strong negative correlation with sleep quality; however, negligible associations were observed with anxiety and depression. Ordinal Cronbach's alpha and Ordinal McDonald's omega at T1 and T2 ranged from suboptimal to acceptable. The RU_SATED-C scale and all items were significantly correlated across time intervals.

CONCLUSION

The RU_SATED-C scale is an easy-to-use instrument with potentially valid data for the measurement of multidimensional sleep health. Use of the RU_SATED-C scale can help raise awareness of sleep health and could pave the way for important efforts to promote healthy sleep.

Cognitive control, bedtime patterns, and testing time in female adolescent students: behavioral and neuro-electrophysiological correlates

Introduction

Shorter and/or disrupted sleep during adolescence is associated with cognitive and mental health risks, particularly in females. We explored the relationship between bedtime behavior patterns co-varying with Social Jet Lag (SJL) and School Start Times (SST) and neurocognitive performance in adolescent female students.

Methods

To investigate whether time of day (morning vs. afternoon), early SSTs and days of the school week can be correlated with neurocognitive correlates of sleep insufficiency, we recruited 24 female students aged 16-18 to report sleep logs, and undergo event-related electroencephalographic recordings on Monday, Wednesday, mornings, and afternoons. Using a Stroop task paradigm, we analyzed correlations between reaction times (RTs), accuracy, time of day, day of week, electroencephalographic data, and sleep log data to understand what relationships may exist.

Results

Participants reported a 2-h sleep phase delay and SJL. Stroop interference influenced accuracy on Monday and Wednesday similarly, with better performance in the afternoon. For RTs, the afternoon advantage was much larger on Monday than Wednesday. Midline Event-Related Potentials (ERPs) yielded higher amplitudes and shorter latencies on Wednesday morning and Monday afternoon, in time windows related to attention or response execution. A notable exception were delayed ERP latencies on Wednesday afternoon. The latter could be explained by the fact that delta EEG waves tended to be the most prominent, suggesting heightened error monitoring due to accumulating mental fatigue.

Discussion

These findings provide insights into the interaction between SJL and SST and suggest evidence-based criteria for planning when female adolescents should engage in cognitive-heavy school activities such as tests or exams.

The Impact of Sleep Disturbances on Health-Related Quality of Life in Children With Acquired Brain Injury After Critical Care

BACKGROUND

Over 60,000 children with acquired brain injury (ABI) in the United States require admission to pediatric intensive care units annually. Over 50% suffer sleep-wake disturbances (SWDs) months after discharge. Given the importance of sleep to brain repair, we hypothesized that SWD would be associated with poorer health-related quality of life (HRQOL).

METHODS

Cross-sectional analysis of prospectively collected data in children with ABI aged 3 to 18 years evaluated 1 to 3 months after critical care hospitalization (N = 151). SWD measured by Sleep Disturbances Scale for Children and defined as T-score ≥60 signifying moderate-severe risk of sleep disorders. HRQOL measured by Pediatric Quality of Life Inventory, which defines minimal clinically important difference as 4.5 points in total score. Secondary outcomes included scores for Physical, Emotional, Social, and School Function domains. SWD groups were compared with Mann-Whitney tests. Multiple linear regression evaluated association between SWD and HRQOL controlling for patient and ABI characteristics. Significance was defined as P < 0.05.

RESULTS

SWDs were present in 66% (n = 100). HRQOL total score was significantly lower in children with SWD (median = 70; interquartile range [IQR] = 54, 80) versus without (median = 85; IQR = 67, 94; P < 0.001). Median scores in emotional, social, and school domains were significantly lower in SWD group (all P < 0.01). When controlling for age, sex, critical care interventions, preadmission comorbidities, and decline from preadmission Functional Status Scale, presence of SWD significantly reduced HRQOL total score nearly three times minimal clinically important difference (β-coefficient = -12.1; 95% confidence Interval = -17.9, -6.2).

CONCLUSIONS

SWD following ABI significantly decreased HRQOL overall and across multiple health domains. Sleep is potentially modifiable. Our data support future studies targeting sleep to improve outcomes after ABI.

An exploratory study of sleep habits in school-aged survivors of retinoblastoma

OBJECTIVE/BACKGROUND

Retinoblastoma is an ocular cancer diagnosed in early childhood. Previous research has indicated the impact of cancer treatment on sleep, but little is known about how sleep is impacted among survivors of retinoblastoma. The current study aimed to describe sleep habits of school-age survivors of retinoblastoma, to examine associations between sleep and quality of life, and to examine concordance between parent and child reports of sleep habits.

PATIENTS/METHODS

Sixty-nine survivors of retinoblastoma (Mage = 10.89, SD = 1.07, 50.7% female; 56.5% unilateral disease) and their caregivers participated, providing information on both self- and parent-reported sleep habits, quality of life, and demographic data.

RESULTS

Greater sleep concerns than national norms were reported by parents (bedtime resistance (t(58) = 2.69, p = .009), greater sleep onset delay (t(66) = 2.46, p = .017), shorter sleep duration (t(57) = 2.12, p = .038), increased daytime sleepiness (t(53) = 6.45, p= <.001)) and children (sleep location (t(61) = 2.39, p = .02), restless legs syndrome (t(62) = -2.21, p = .03), parasomnias (t(64) = 19.19, p=<.001)) . Both children and parents of children who received enucleation endorsed greater sleep concerns across several domains (e.g., electronic use before bed, sleep-disordered breathing). Child- and parent-reported sleep concerns were generally associated with decreased quality of life. Finally, child- and parent-report of sleep habits appeared generally consistent.

CONCLUSIONS

Survivors of retinoblastoma experience sleep difficulties. As such, assessment and targeted intervention is important to mitigate any effects on quality of life. Future research should examine sleep habits of survivors of retinoblastoma across cultures and developmental periods.

Cross-cultural adaptation and validation of the Chinese version of the Sleep Health Index

OBJECTIVE

To generate the Chinese Sleep Health Index (SHI-C) in Mandarin with cross-cultural adaptations and test its psychometric properties.

METHODS

This study used a cross-sectional design. Health science students were included (N = 271) and a sub-set (n = 74) was invited for the re-test. Cross-cultural adaptation of the SHI-C was performed prior to formal validation. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Bedtime Procrastination Scale, and Sleep Hygiene Index were used to measure variables of interest. Exploratory factor analysis was used to evaluate the structure validity. Bivariate analyses were used to evaluate the construct validity.

RESULTS

Exploratory factor analysis identified 3 factors (ie, sleep quality, sleep duration, and disordered sleep) accounting for 55.6% of the total variance. The SHI-C total and sleep quality sub-index scores were significantly associated with both PSQI global score (r = -0.132, p < .05; r = -0.182, p < .01, respectively) and ISI score (r = -0.655, p < .05; r = -0.820, p < .05, respectively). SHI-C total, sleep quality sub-index, and sleep duration sub-index scores were significantly associated with Bedtime Procrastination Scale and Sleep Hygiene Index scores (r = -0.238 to -0.368, p < .05). Students with insomnia (ISI > 9) or poor sleep quality (PSQI > 5) had significantly lower SHI-C scores than those without (73.5 vs. 89.0, p < .01; 84.1 vs. 86.7, p < .05, respectively). SHI-C showed good internal consistency (Cronbach's alpha = 0.73) and test-retest reliability (intraclass correlation coefficient = 0.82).

CONCLUSIONS

The SHI-C demonstrated good validity and adequate reliability in a Chinese sample of health science students. It could be used to measure sleep health in future research and practice. Psychometric properties of the SHI-C among other Chinese populations remain to be confirmed.

Associations between the composition of daily time spent in physical activity, sedentary behaviour and sleep and risk of depression: Compositional data analyses of the 1970 British cohort Study

BACKGROUND

The benefits of moderate to vigorous physical activity(MVPA) in lowering depression risk are well established, but there is mixed evidence on sleep, sedentary behaviour(SB), and light-intensity physical activity(LIPA). These behaviours are often considered in isolation, neglecting their behavioural and biological interdependences. We investigated how time spent in one behaviour relative to others was associated with depression risk.

METHODS

We included 4738 individuals from the 1970 British Cohort study (age 46 wave). Depression status was ascertained using self-reported doctor visits and prescribed anti-depressant use. MVPA, LIPA, SB and sleep were ascertained using thigh-worn accelerometers worn consecutively for 7 days. Compositional logistic regression was used to examine associations between different compositions of time spent in movement behaviours and depression.

RESULTS

More time spent in MVPA, relative to SB, sleep or LIPA, was associated with a lower risk of depression. When modelling reallocation of time (e.g. replacing time in one behaviour with another), replacing sleep, SB or LIPA with MVPA time was strongly associated with lower depression risk. Reallocating time between SB, sleep or LIPA had minimal to no effect.

LIMITATIONS

Data was cross-sectional, therefore causality cannot be inferred. Accelerometers do not capture SB context (e.g. TV watching, reading) nor separate biological sleep from time spent in bed.

CONCLUSIONS

Displacing any behaviour with MVPA was associated with a lower risk of depression. This study provides promising support that increasing MVPA, even in small doses, can have a positive impact on prevention, mitigation and treatment of depression.

Results from the Japan 2022 report card on physical activity for children and youth

Background/Objective: The 2020 Tokyo Olympics and Paralympic was held in 2021, although postponed due to the spread of COVID-19. This event might have an impact on physical activity (PA) of children and adolescents, but the national data on PA during the pandemic were not available. Therefore, the goal of the 2022 Japan Report Card on Physical Activity for Children and Youth (The 2022 Japan Report Card) is to assess and track levels of health behaviors related to PA, and health outcomes in Japanese children and adolescents, and environments and government strategy for PA just before the pandemic.

Methods

The 2022 Japan Report Card consists of health behaviors and outcomes (8 indicators), and influences on health behaviors (4 indicators). Nationally representative data were used to score the indicators.

Results

The key five health behaviors and outcomes (Overall PA: B⁻; Organized Sport: B⁻; Active Transportation: A⁻; Physical fitness: B, Weight status: A) were favorable. Sedentary Behavior and Sleep received C⁻ and D⁻ grades, respectively. Active Play could not be graded (INC). In the influences domain, Family and Peers was graded as C⁻, while School (B⁺), Community and Environment (B), and Government (B) were favorable.

Conclusions

The 2022 Japan Report Card shows that Japanese children and adolescents had favorable levels of overall PA, active transportation to and from school, and weight status, and there was a generally favorable environment for PA and health, though sedentary behavior and sleep were unfavorable. Future nationally representative surveys on active play are needed.

Optimal movement behaviors: correlates and associations with anxiety symptoms among Chinese university students

Background

The Canadian 24-Hour Movement Guidelines for Adults was released in 2020. There is a dearth of evidence on the association between adherence to the 24 h movement guidelines and health indicators. This study aims to (a) explore the associations between potential correlates and meeting the 24 h movement guidelines using a sample of Chinese university students; and (b) examine if meeting 24 h movement guidelines is associated with the severity of anxiety symptoms.

Methods

Cross-sectional findings are based on 1846 Chinese university students (mean age = 20.7 years, 64.0% female). Movement behaviors (physical activity, sedentary behavior, and sleep duration), possible correlates, and anxiety symptoms were measured through self-reported online questionnaires. Logistic regression models were performed to examine the associations.

Results

We found that male students and those who had a mother with a master’s degree or above, more close friends and higher perceived family affluence were more likely to meet the overall 24 h guidelines. Meeting all 24 h movement guidelines presented the lower odds for severe anxiety symptoms than those meeting fewer recommendations in the 24 h movement guidelines.

Conclusions

As one of the first to examine the correlates of adherence to the 24 h movement guidelines and the relationship between anxiety symptoms and meeting the guidelines among Chinese university students, our findings contribute to the growing body of evidence linking movement behaviors, psychosocial correlates, and heath indicators. Schools and health providers can encourage movement behaviors that follow the guidelines on campus.