Adaptation and Validation of the Turkish Version of the Ford Insomnia Response to Stress Test in University Students

Sleep Patterns Alterations in Professional Tennis Players

Sleep is a fundamental physiological process for maintaining physical health, cognitive function and overall wellbeing. For athletes, its restorative properties are essential for optimal recovery and performance. Emerging evidence highlights the intricate relationship between circadian rhythms, recovery processes and sport-specific performance outcomes. This study aimed to investigate the sleep quality and characteristics of professional tennis players, and how sleep patterns and circadian rhythms might influence athletic performance and wellbeing. Twenty professional tennis players (10 men, 10 women; mean age: 27.6 ± 6.06 years) were recruited through the Italian Tennis Federation during competitions in Tallinn, Estonia and Tirrenia, Italy. Sleep quality and disturbances were assessed using validated questionnaires, including the Pittsburgh sleep quality index, insomnia severity index, morningness-eveningness questionnaire and Ford insomnia response to stress test. Descriptive and t-test analyses were performed. Poor sleep quality was prevalent among professional tennis players, with gender differences suggesting worse outcomes for women. Despite the absence of clinical insomnia, subjective dissatisfaction and high stress-related sleep reactivity may negatively impact recovery and performance. The predominance of morning chronotypes aligns with structured training schedules, highlighting the potential benefits of aligning sleep strategies with circadian preferences. Professional tennis players face significant challenges related to sleep quality and stress-induced disturbances, emphasising the need for targeted interventions. Tailored approaches focusing on sleep hygiene, stress management, and chronotype-aligned schedules may enhance recovery, performance and wellbeing. Future longitudinal studies are needed to explore the dynamic relationships between sleep, performance and circadian alignment.

Unraveling the insomnia puzzle: sleep reactivity, attention deficit hyperactivity symptoms, and insomnia severity in ADHD Patients

Introduction

Insomnia is the most common sleep problem among adults with attention deficit hyperactivity disorder (ADHD). The severity of insomnia can exacerbate the symptoms of ADHD. Identifying the predictive factors that contribute to insomnia severity may be crucial in treating insomnia among adults with ADHD. One potential factor contributing to insomnia is sleep reactivity, which refers to the tendency to experience insomnia triggered by stress. This phenomenon, also known as vulnerability to stress-related insomnia, reflects the extent to which individuals are prone to developing insomnia in response to stressful situations. To date, sleep reactivity in adults with ADHD has not been studied. This study aimed to investigate the relationship between sleep reactivity, attention deficit hyperactivity symptoms, and the severity of insomnia in adults with ADHD.

Methods

This study included 61 adults with ADHD with no comorbid psychiatric or medical diseases and 61 adult healthy controls (HCs) matched for age, sex, body mass index, and years of education. All participants completed the sociodemographic data form, Ford Insomnia Response to Stress Test (FIRST), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Adult ADHD Self-Report Scale (ASRS), and Wender Utah Rating Scale (WURS).

Results

Sleep reactivity, insomnia severity, and poor sleep quality were higher in adults with ADHD compared to HCs. Higher sleep reactivity was associated with worse sleep outcomes in both groups, whereas higher sleep reactivity was associated with severe ADHD symptoms in the HCs group. In the ADHD group, insomnia severity was predicted by higher sleep reactivity, ASRS, and being female (R2 = 0.32, F (6, 61) = 4.36, p = 0.001), not age, ADHD medication use, and WURS.

Conclusion

Our findings suggest that higher sleep reactivity, increased ADHD symptoms, and being female may predict the severity of insomnia in adults with ADHD.

Assessment of anxiety in children with neurodevelopment disorders: Rasch analysis of the Spence Children's Anxiety Scale

Anxiety is common in neurodevelopmental disorders (NDD). The parent version of the Spence Children's Anxiety Scale (SCAS-P) is a widely used measure to assess anxiety across a broad range of childhood populations. However, assessment of the measurement properties of the SCAS-P in NDDs have been limited. The present study aimed to assess the psychometric properties of the SCAS-P in children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) using Rasch Measurement Theory. Data from the Province of Ontario Neurodevelopmental Disorders Network Registry were used in the analysis. Children (ages 6-13 years old) with a primary diagnosis of ADHD (n=146) or ASD (n=104) were administered the SCAS-P. Rasch Measurement Theory was used to assess measurement properties of the SCAS-P, including unidimensionality and item-level fit, category ordering, item targeting, person separation index and reliability and differential item functioning. The SCAS-P fit well to the Rasch model in both ADHD and ASD, including unidimensionality, satisfactory category ordering and goodness-of-fit. However, item-person measures showed poor precision at lower levels of anxiety. Some items showed differential item functioning, including items within the obsessive-compulsive, panic/agoraphobia and physical injury fears domains, suggesting that the presentation of anxiety may differ between ADHD and ASD. Overall, the results generally support the use of the SCAS-P to screen and monitor anxiety symptoms in children with ADHD and ASD. Future studies would benefit from examination of more severely anxious NDD cohort, including those with clinically diagnosed anxiety.

Validity and Reliability of the Turkish Version of the Sleep Condition Indicator: A Clinical Screening Instrument Based on the DSM-5 Criteria for Insomnia

Purpose

We aimed to adapt the Turkish Sleep Condition Indicator (SCI) version and examine its psychometric properties among the general population.

Methods

This study was a cross-sectional study. The item-total correlation, standard error of measurement, Cronbach's α, and McDonald's ω were used for internal consistency. We ran confirmatory factor analysis (CFA) and network analysis to confirm the factor structure. Multigroup CFA was run to assess the measurement invariance across gender, whether clinical insomnia or not, and poor sleep quality. We correlated SCI scores with Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) scores to evaluate construct validity. A receiver operating characteristic (ROC) curve analysis was conducted to calculate the cut-off score of the SCI. The temporal stability was examined with the intraclass correlation coefficient.

Results

Eight hundred thirty-four participants attended. Over half of the participants were women (63.2% n = 527); the mean age was 36.15 ± 9.64. Confirmatory factor and network analysis results show that the two-factor correlated model had a good model fit for the SCI. The SCI had scalar level invariance across gender, having clinical insomnia and poor sleep quality in the Multigroup CFA. ROC curve analysis shows that the SCI has good sensitivity (90.3%) and specificity (91.8%) for cut-off ≤ 15. The intraclass correlation coefficient computed between the first and second SCI total scores was significant (r=0.80 with a 95% confidence interval from 0.78 to 0.87; p < 0.001).

Conclusion

The Turkish SCI is a practical self-reported insomnia scale with good psychometric properties that can be used to screen for insomnia disorder.

Common sleep disorders in pregnancy: a review

In this review, we provide a comprehensive overview of common sleep disorders during pregnancy, including their characterization, prevalence, risk factors, and possible contribution to maternal and fetal outcomes. We conducted a quasi-systematic literature search of the MEDLINE database and identified 744 studies from 1991 through 2021, inclusive, that met our inclusion criteria. We synthesized the existing literature on sleep disorders during pregnancy and highlighted controversies, research gaps, and needed clinical developments. Our review covers a range of sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disorders. We discuss the prevalence of these disorders in pregnancy and their potential impact on maternal and fetal health outcomes. We also explore the relationship between sleep disorders, pre-pregnancy comorbidities such as obesity, and pregnancy-related conditions such as gestational diabetes mellitus and preeclampsia. In addition to summarizing the existing literature on sleep disorders during pregnancy, we also highlight opportunities for further research in this area. We suggest that future studies should strive to employ validated and objective measurement tools for sleep disorders and prioritize utilization of longitudinal methods with participant follow-up through postpartum, mid-life, menopause, and beyond. We also put forward investigation into the impact of circadian rhythm disruption on reproductive physiology and early pregnancy outcomes as an area of important work. Overall, our review provides valuable insights on sleep and reproduction and into common sleep disorders during pregnancy and their potential impact on maternal and fetal health outcomes.

The assessment and validation of the depression, anxiety, and stress scale (DASS-21) among frontline doctors in Pakistan during fifth wave of COVID-19

Objective

The study aims to document sociodemographic features, address the symptoms and levels of depression, anxiety, and stress among frontline doctors in Pakistan, and validate the depression, anxiety, stress scale (DASS-21) on the context of Pakistan.

Method

A cross-sectional survey was conducted throughout the regions of Pakistan on frontline doctors to document their sociodemographic patterns and the levels of depression, anxiety, and stress while dealing with the fifth wave (Omicron-variant) of the coronavirus (SARS-CoV-2) pandemic in Pakistan (December 2021-April 2022). Respondents (N = 319) were recruited through a snowball sampling process.

Results

Though previous literature reported declines in psychological symptoms after earlier waves of COVID-19, these DASS-21 findings show that as the pandemic has worn on, frontline doctors in Pakistan are having considerable personal symptoms of depression (72.7%), anxiety (70.2%), and stress (58.3%). Though specifically related to the COVID-19 pandemic, they rated only moderate levels of depression and stress, however they reported severe levels of anxiety. The results also revealed a positive correlation between depression and anxiety (r = 0.696, p < 0.001), depression and stress (r = 0.761, p < 0.001), and anxiety and stress (r = 0.720, p < 0.001).

Conclusion

Through the application of all required statistical procedures, DASS-21 is validated in the cultural context of Pakistan among this group of frontline doctors. The findings of this study can provide new directions for the policy makers (government and hospitals' administration) of Pakistan to focus on the mental wellbeing of the doctors under similar enduring public health crises and to protect them from short- or long-term disorders.

Type D personality to insomnia: Sleep reactivity, sleep effort, and sleep hygiene as mediators

Background

Insomniacs are heterogenous group with very diverse personalities. We aimed to investigate the mediating role of sleep reactivity (SR), sleep hygiene (SH), and sleep effort (SE) in the relationship between Type D personality and insomnia.

Materials and methods

We conducted a cross-sectional survey among 474 participants. The survey comprised the sociodemographic data form, Insomnia Severity Index (ISI), D Type Personality Scale (DS-14), Ford Insomnia Response to Stress Test (FIRST), Glasgow Sleep Effort Scale (GSES), and Sleep Hygiene Index (SHI). We conducted hierarchical multiple regression analysis to identify the associations between age, sex, SR, Type D personality traits, SE, SH, and insomnia severity. We subsequently conducted mediation analyses to examine whether SR, SH, and SE mediated the relationship between Type D personality and insomnia.

Results

ISI, DS-14, FIRST, SHI, and GSES scores were significantly higher in individuals with Type D personality. Female sex, SR, Type D personality traits, SE, and SH explained 45% of the variance in insomnia severity. When age, sex, insomnia response to stress, and Type D personality traits were controlled, SE and SH significantly explained 25% of the variance in insomnia severity (R ² = 0.45, R ² change = 0.25, F (6.474) = 65.58, p < 0.001). SR, SE, and SH each played a partial mediating role between Type D personality and insomnia.

Conclusion

The findings showed that individuals with Type D personality had high SR and that individuals with a higher number of these personality traits exhibited more severe insomnia symptoms through high SR, greater SE, and worse SH.