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Batterham PJ, Thorndike FP, Gerwien R, Botbyl J, Ritterband LM, Maricich Y, Christensen H. Sleep-specific outcomes attributable to digitally delivered cognitive behavioral therapy for insomnia in adults with insomnia and depressive symptoms. Behav Sleep Med 2024; 22:410-419. [PMID: 38018031 DOI: 10.1080/15402002.2023.2285799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) of digitally delivered Cognitive Behavioral Therapy for insomnia (CBT-I) have demonstrated reductions in insomnia severity, depression symptoms, anxiety symptoms, and suicidal ideation. The present study aimed to evaluate the effectiveness of self-guided, digital CBT-I to improve sleep-specific outcomes. METHOD An RCT of Australian adults with insomnia and depressive symptoms (N = 1149) compared SHUTi, a digital CBT-I intervention, with HealthWatch, an attention-matched control internet program, at baseline, posttest (9 weeks) and at 6-, 12-, and 18-month follow-ups. Online sleep diaries were used to derive measures of sleep-onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), number of awakenings, sleep quality, and total sleep time (TST). RESULTS Participants in the SHUTi condition had greater improvements at posttest compared with control for: SOL, WASO, SE, number of awakenings, and sleep quality. These improvements were sustained at every follow-up (p < .02 for all outcomes except TST, in which statistically significant increases were observed only at 12- and 18-months). CONCLUSIONS Digitally delivered CBT-I produced lasting improvements in sleep outcomes among adults with insomnia and depressive symptoms. Findings provide further evidence of long-term improvements associated with a digital therapeutic for insomnia, compared to an attention-control condition.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Frances P Thorndike
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
- Nox Health, Alpharetta, GA, USA
| | | | | | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - Helen Christensen
- Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
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Smokovski I, Steinle N, Behnke A, Bhaskar SMM, Grech G, Richter K, Niklewski G, Birkenbihl C, Parini P, Andrews RJ, Bauchner H, Golubnitschaja O. Digital biomarkers: 3PM approach revolutionizing chronic disease management - EPMA 2024 position. EPMA J 2024; 15:149-162. [PMID: 38841615 PMCID: PMC11147994 DOI: 10.1007/s13167-024-00364-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/07/2024]
Abstract
Non-communicable chronic diseases (NCDs) have become a major global health concern. They constitute the leading cause of disabilities, increased morbidity, mortality, and socio-economic disasters worldwide. Medical condition-specific digital biomarker (DB) panels have emerged as valuable tools to manage NCDs. DBs refer to the measurable and quantifiable physiological, behavioral, and environmental parameters collected for an individual through innovative digital health technologies, including wearables, smart devices, and medical sensors. By leveraging digital technologies, healthcare providers can gather real-time data and insights, enabling them to deliver more proactive and tailored interventions to individuals at risk and patients diagnosed with NCDs. Continuous monitoring of relevant health parameters through wearable devices or smartphone applications allows patients and clinicians to track the progression of NCDs in real time. With the introduction of digital biomarker monitoring (DBM), a new quality of primary and secondary healthcare is being offered with promising opportunities for health risk assessment and protection against health-to-disease transitions in vulnerable sub-populations. DBM enables healthcare providers to take the most cost-effective targeted preventive measures, to detect disease developments early, and to introduce personalized interventions. Consequently, they benefit the quality of life (QoL) of affected individuals, healthcare economy, and society at large. DBM is instrumental for the paradigm shift from reactive medical services to 3PM approach promoted by the European Association for Predictive, Preventive, and Personalized Medicine (EPMA) involving 3PM experts from 55 countries worldwide. This position manuscript consolidates multi-professional expertise in the area, demonstrating clinically relevant examples and providing the roadmap for implementing 3PM concepts facilitated through DBs.
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Affiliation(s)
- Ivica Smokovski
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders, Skopje, North Macedonia
- Faculty of Medical Sciences, University Goce Delcev, Stip, North Macedonia
| | - Nanette Steinle
- Veteran Affairs Capitol Health Care Network, Linthicum, MD USA
- University of Maryland School of Medicine, Baltimore, MD USA
| | - Andrew Behnke
- Endocrinology Section, Carilion Clinic, Roanoke, VA USA
- Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Sonu M. M. Bhaskar
- Department of Neurology, Division of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Centre (NCVC), Suita, Osaka Japan
- Department of Neurology & Neurophysiology, Liverpool Hospital, Ingham Institute for Applied Medical Research and South Western Sydney Local Health District, Sydney, NSW Australia
- NSW Brain Clot Bank, Global Health Neurology Lab & NSW Health Pathology, Sydney, NSW Australia
| | - Godfrey Grech
- Department of Pathology, Faculty of Medicine & Surgery, University of Malta, Msida, Malta
| | - Kneginja Richter
- Faculty of Medical Sciences, University Goce Delcev, Stip, North Macedonia
- CuraMed Tagesklinik Nürnberg GmbH, Nuremberg, Germany
- Technische Hochschule Nürnberg GSO, Nuremberg, Germany
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Günter Niklewski
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Colin Birkenbihl
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Paolo Parini
- Cardio Metabolic Unit, Department of Medicine Huddinge, and Department of Laboratory Medicine, Karolinska Institute, and Medicine Unit of Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Russell J. Andrews
- Nanotechnology & Smart Systems Groups, NASA Ames Research Center, Aerospace Medical Association, Silicon Valley, CA USA
| | - Howard Bauchner
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalized (3P) Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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Fink AM. Shift Work Sleep Disorder and Mental Health: An Integrative Review of Neurobiological, Sociological, and Psychological Perspectives With Public Policy Implications. Policy Polit Nurs Pract 2024; 25:94-102. [PMID: 38509807 DOI: 10.1177/15271544241238752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Shift workers support critical 24-hr operations; their health can be impaired by disrupted circadian rhythms and dysfunctional sleep. Shift work sleep disorder (SWSD) is a prevalent condition with significant psychological consequences. Nurse leaders have not yet implemented effective policies to prevent SWSD and optimize shift workers' mental health. The purpose of this integrative review was to examine research about SWSD within the context of neurobiological, sociological, and psychological perspectives that can inform policy changes. The Centers for Disease Control and Prevention Policy Analytic Framework was used to determine the priority recommendations. A search of three databases provided 19 research articles about SWSD and mental health, which illustrated how SWSD is common around the world in many occupations. Backward-rotating schedules and quick returns were risk factors for SWSD. In addition, SWSD was associated with circadian languidity, sleep reactivity, depressive symptoms, and anxiety. Collectively, the studies lacked objective measures of sleep and circadian rhythms, which has hindered the ability to devise interventions that will target the neurobiological causes of SWSD. The research also lacked attention to important sociological factors, such as workers' pay and benefits. Using these findings, nurse leaders can contribute to public policy reforms that increase funding for more rigorous SWSD research. Lawmakers should be advised by nurse leaders to enforce new regulations that provide incentives for employers to create healthier workplaces, such as prohibiting the overuse of schedules that make employees vulnerable to SWSD and providing funds for interventions to prevent SWSD and support mental health.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, USA
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Vallières A, Pappathomas A, Garnier SDB, Mérette C, Carrier J, Paquette T, Bastien CH. Behavioural therapy for shift work disorder improves shift workers' sleep, sleepiness and mental health: A pilot randomised control trial. J Sleep Res 2024:e14162. [PMID: 38443322 DOI: 10.1111/jsr.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 03/07/2024]
Abstract
The present study evaluates the efficacy of behavioural therapy adapted for shift work disorder with a randomised control design in a healthcare population. Forty-three night shift workers (m. age: 34 years; 77% women) experiencing shift work disorder were randomised to either the behavioural therapy for shift work disorder (BT-SWD) or a waiting-list control group offered after the waiting period. Participants completed questionnaires on insomnia, sleepiness and mental health pre- and post-treatment, pre- and post-waiting, and at follow-up, and a sleep diary. As night shift workers alternate between sleeping during the day after their night shifts and transitioning to nighttime sleep on days off, insomnia severity and sleep variables were analysed for daytime and nighttime sleep. The BT-SWD involved sleep restriction therapy, stimulus control and fixed sleep periods in the dark. Statistical analyses were performed under intent-to-treat and per-protocol approaches. Repeated-measures two-way ANCOVA analysis, controlling for age, sex and pre-treatment daytime total sleep time, was performed with Bonferroni corrections, and between-group effect sizes computed. Fourteen participants dropped out after randomisation. Under the intent-to-treat analysis, BT-SWD participants had a significant greater decrease in daytime insomnia severity and an increase in daytime total sleep time at post-treatment than the control group, with large between-group effect sizes (-1.25 and 0.89). These corresponding results were also significant with large effect sizes under the per-protocol analysis. Sleepiness, anxiety and depression levels improved at post-treatment and maintained at follow-up when the BT-SWD treated controls were added to the BT-SWD group. The behavioural therapy for shift work disorder can be used to improve the sleep and mental health of healthcare night workers.
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Affiliation(s)
- Annie Vallières
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | - Alric Pappathomas
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | | | - Chantal Mérette
- Centre de recherche CERVO, Québec, Québec, Canada
- Département de psychiatrie et de neurosciences, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Julie Carrier
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
- Centre d'étude avancée en médecine du sommeil, CIUSSS-NIM, Montréal, Québec, Canada
| | - Tyna Paquette
- Centre d'étude avancée en médecine du sommeil, CIUSSS-NIM, Montréal, Québec, Canada
| | - Célyne H Bastien
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
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Hinterberger A, Eigl ES, Schwemlein RN, Topalidis P, Schabus M. Investigating the subjective and objective efficacy of a cognitive behavioural therapy for insomnia (CBT-I)-based smartphone app on sleep: A randomised controlled trial. J Sleep Res 2023:e14136. [PMID: 38156655 DOI: 10.1111/jsr.14136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
Due to insufficient treatment options for insomnia, effective solutions are urgently needed. We evaluated the effects of a CBT-I-based app combining sleep training with subjective and objective sleep monitoring on (i) sleep and (ii) subjective-objective sleep discrepancies (SOSD). Fifty-seven volunteers (20-76 years; MAge = 45.67 ± 16.38; 39 female) suffering from sleep problems were randomly assigned to an experimental group (EG, n = 28) or a waitlist control group (CG, n = 29). During the 6-week app phase, the EG used the CBT-I-based programme and a heart rate sensor for daily sleep monitoring and -feedback, while the CG used sleep monitoring only. Sleep was measured (i) subjectively via questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), (ii) objectively via ambulatory polysomnography (PSG), and (iii) continuously via heart-rate sensor and sleep diaries. Data revealed interactions for ISI (p = 0.003, ƞ2 part = 0.11) and PSQI (p = 0.050, ƞ2 part = 0.05), indicating training-specific improvements in EG, yet not in CG. While PSG-derived outcomes appear to be less training-specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p = 0.061, d = 0.55). Regarding changes in SOSD, the results indicate improvements during the app phase (EG) for sleep efficiency, sleep onset latency, and WASO (p ≤ 0.022, d ≥ 0.46); for total sleep time both groups showed a SOSD reduction. The findings indicate beneficial effects of a novel smartphone app on sleep and SOSD. More scientific evaluation of such digital programmes is needed to ultimately help in reducing the gap in non-pharmacological insomnia treatment.
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Affiliation(s)
- Alexandra Hinterberger
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Esther-Sevil Eigl
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Robyn Nina Schwemlein
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Pavlos Topalidis
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
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6
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Shriane AE, Rigney G, Ferguson SA, Bin YS, Vincent GE. Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology. Sleep 2023; 46:zsad182. [PMID: 37429599 PMCID: PMC10710992 DOI: 10.1093/sleep/zsad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
STUDY OBJECTIVES The unique requirements of shift work, such as sleeping and working at variable times, mean that current sleep hygiene guidelines may be inappropriate for shift workers. Current guidelines may also contradict fatigue management advice (e.g. advising against daytime napping). The present study utilized a Delphi methodology to determine expert opinion regarding the applicability of current guidelines for shift workers, the appropriateness of the term "sleep hygiene," and develop tailored guidelines for shift workers. METHODS The research team reviewed current guidelines and existing evidence to draft tailored guidelines. Seventeen individual guidelines, covering sleep scheduling, napping, sleep environment, bedtime routine, substances, light exposure, diet, and exercise were drafted. Experts from sleep, shift work, and occupational health fields (n = 155) were invited to review the draft guidelines using a Delphi methodology. In each round, experts voted on individual guidelines, with 70% agreement considered consensus. Where consensus was not reached, written feedback from experts was discussed and incorporated into subsequent iterations. RESULTS Of the experts invited, 68 (44%) agreed to participate, with 55 (35%) completing the third (final) round. Most experts (84%) agreed that tailored guidelines were required for shift workers. Consensus was reached on all guidelines after three rounds. One additional guideline (sleep inertia) and an introductory statement were developed, resulting in a final set of 18 individual guidelines, termed "healthy sleep practices for shift workers." CONCLUSIONS This is the first study to develop tailored sleep hygiene guidelines for shift workers. Future research should investigate the acceptability and effectiveness of these guidelines amongst shift workers.
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Affiliation(s)
- Alexandra E Shriane
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Gabrielle Rigney
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Yu Sun Bin
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
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7
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Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, Bastien C, Berzina N, Bjorvatn B, Dikeos D, Dolenc Groselj L, Ellis JG, Garcia-Borreguero D, Geoffroy PA, Gjerstad M, Gonçalves M, Hertenstein E, Hoedlmoser K, Hion T, Holzinger B, Janku K, Jansson-Fröjmark M, Järnefelt H, Jernelöv S, Jennum PJ, Khachatryan S, Krone L, Kyle SD, Lancee J, Leger D, Lupusor A, Marques DR, Nissen C, Palagini L, Paunio T, Perogamvros L, Pevernagie D, Schabus M, Shochat T, Szentkiralyi A, Van Someren E, van Straten A, Wichniak A, Verbraecken J, Spiegelhalder K. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023; 32:e14035. [PMID: 38016484 DOI: 10.1111/jsr.14035] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).
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Affiliation(s)
- Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | | | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Chiara Baglioni
- Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy
| | | | - Celyne Bastien
- École de Psychologie, Université Laval, Québec, Québec, Canada
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dimitris Dikeos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leja Dolenc Groselj
- Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jason G Ellis
- Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK
| | | | | | | | | | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kerstin Hoedlmoser
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tuuliki Hion
- East-Viru Central Hospital, Kohtla-Järve, Estonia
| | | | - Karolina Janku
- Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic
| | - Markus Jansson-Fröjmark
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Poul Jørgen Jennum
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia
| | - Lukas Krone
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
- Department of Neurology, Inselspital, University of Bern, Berne, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Damien Leger
- Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France
| | - Adrian Lupusor
- Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova
| | - Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Christoph Nissen
- Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland
| | - Laura Palagini
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Tiina Paunio
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Dirk Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Manuel Schabus
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tamar Shochat
- The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel
| | - Andras Szentkiralyi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adam Wichniak
- Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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8
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Crowther ME, Saunders WJ, Sletten TL, Drummond SPA, Bei B. Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go? J Sleep Res 2023; 32:e14023. [PMID: 37641983 DOI: 10.1111/jsr.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.
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Affiliation(s)
- Meagan E Crowther
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - William J Saunders
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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9
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Kalkanis A, Demolder S, Papadopoulos D, Testelmans D, Buyse B. Recovery from shift work. Front Neurol 2023; 14:1270043. [PMID: 38020633 PMCID: PMC10651732 DOI: 10.3389/fneur.2023.1270043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
One fifth of today's workforce is engaged in shift work and exposed to various mental and physical health risks including shift work disorder. Efficiently recovering from shift work through physical and mental interventions allows us to mitigate negative effects on health, enables a better work-life balance and enhances our overall wellbeing. The aim of this review is to provide a state-of-the-art overview of the available literature. The role of sleep timing and naps, light therapy and psychotherapy, diet and exercise in recovery from shift work is presented here. We further review the impact of shift schedules and social support on post-shift unwinding.
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Affiliation(s)
- Alexandros Kalkanis
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Saartje Demolder
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dimitrios Papadopoulos
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Dries Testelmans
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium
| | - Bertien Buyse
- Department of Respiratory Diseases, Louvain University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium
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Ito-Masui A, Sakamoto R, Matsuo E, Kawamoto E, Motomura E, Tanii H, Yu H, Sano A, Imai H, Shimaoka M. Effect of an Internet-Delivered Cognitive Behavioral Therapy-Based Sleep Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, Nonrandomized Trial. J Med Internet Res 2023; 25:e45834. [PMID: 37606971 PMCID: PMC10481224 DOI: 10.2196/45834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders. OBJECTIVE This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning-based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit. METHODS A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ≥5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network-based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data. RESULTS In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance. CONCLUSIONS The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work-related sleep disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/24799.
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Affiliation(s)
- Asami Ito-Masui
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Ryota Sakamoto
- Department of Medical Informatics, Mie University Hospital, Tsu, Japan
| | - Eri Matsuo
- Department of Molecular Pathology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiji Kawamoto
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Eishi Motomura
- Department of Neuropsychiatry, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hisashi Tanii
- Center for Physical & Mental Health, Mie University, Tsu, Japan
| | - Han Yu
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Akane Sano
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University, Tsu, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathology & Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
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11
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Hung HM, Kuo PL, Lee CS, Chen CH. Effectiveness of mental health website intervention on stress and depression for women with recurrent miscarriage: A randomized controlled trial. Health Care Women Int 2023; 44:496-508. [PMID: 36856797 DOI: 10.1080/07399332.2022.2141744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We aimed to investigate the effect of a mental health website intervention on perceived stress, depression, sleep quality, and social support in women with recurrent miscarriage (RM). Performing a randomized controlled trial, the participants in the experimental group (n = 31) received a 12-week mental health website intervention; the participants in the control group (n = 31) received RM standard medical care only. The paired t-tests results for the mean posttest scores for depression (p = .023) and perceived stress (p = .041) in the experimental group showed a significant decrease, but did not in the control group.
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Affiliation(s)
- Hsuan-Man Hung
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - ChihChen Sophia Lee
- Director of Music Therapy, Southwestern Oklahoma State University, Weatherford, OK, USA
| | - Chung-Hey Chen
- Department of Nursing, Hungkuang University, Taichung, Taiwan.,Department of Nursing & Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
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12
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Reynolds AC, Sweetman A, Crowther ME, Paterson JL, Scott H, Lechat B, Wanstall SE, Brown BW, Lovato N, Adams RJ, Eastwood PR. Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis. Sleep Med Rev 2023; 67:101716. [PMID: 36459948 DOI: 10.1016/j.smrv.2022.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia.
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Meagan E Crowther
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia; Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Jessica L Paterson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Bastien Lechat
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Sian E Wanstall
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Brandon Wj Brown
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Bedford Park, South Australia, Australia
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
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13
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Li Y, Nazari N, Sadeghi M. Internet delivered, non-inferiority, two-arm, assessor-blinded intervention comparing mindfulness-based stress reduction and cognitive-behavioral treatment for insomnia: a protocol study for a randomized controlled trial for nursing staff with insomnia. Trials 2022; 23:1020. [PMID: 36527137 PMCID: PMC9756716 DOI: 10.1186/s13063-022-06986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/06/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insomnia and poor sleep quality are highly prevalent conditions related to coronavirus disease 2019 (COVID-19) complications among clinical nurses. Although cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment, CBT-I suffers from several major drawbacks. This study investigates whether the application of the internet-delivered mindfulness-based stress reduction (iMBSR) intervention will produce effects that are non-inferior to the internet-delivered CBT-I (iCBT-I) intervention in reducing the severity of insomnia in clinical nurses with insomnia at the end of the study. METHODS This study protocol presents an internet-delivered, parallel-groups, assessor-blinded, two-arm, non-inferiority randomized controlled trial. The primary outcome is sleep quality, assessed by the Insomnia Severity Index. Secondary outcomes include depression, dysfunctional beliefs, five facets of mindfulness, and client satisfaction. CONCLUSION It is expected that this study may address several gaps in the literature. The non-inferiority study design is a novel approach to evaluating whether a standardized, complementary treatment (i.e., MBSR) is as practical as a gold standard treatment rather than its potential benefits. This approach may lead to expanded evidence-based practice and improve patient access to effective treatments. TRIAL REGISTRATION Trial registration number: ISRCTN36198096 . Registered on 24th May 2022.
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Affiliation(s)
- Yaling Li
- grid.499351.30000 0004 6353 6136Mental Health Education and Counseling Center, Shenzhen Technology University, Shenzhen, 518118 Guangdong China
| | - Nabi Nazari
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Masoud Sadeghi
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
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14
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Yu Y, Chen Y, Ma L, Qu YY, Li YN, Peng Y, Zhu YL, He J, Gou HY, Zhu YM. Efficacy of agomelatine with cognitive behavioral therapy for delayed sleep-wake phase disorder in young adults: A randomized controlled study. Behav Sleep Med 2022:1-11. [PMID: 36263691 DOI: 10.1080/15402002.2022.2136178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Delayed sleep-wake phase disorder (DSWPD) is common and easily misdiagnosed in young people, and to date, there is no evidence-based treatment. PURPOSE A nonblinded randomized controlled study evaluated the effect of agomelatine therapy (AT) and cognitive behavior therapy (CBT) on DSWPD in young adults. METHODS Sixty adolescents and young adults (range = 19-24 years, mean = 22 years, 52% female) diagnosed with DSWPD were randomized to receive 4 weeks of agomelatine therapy with or without cognitive behavior therapy. Sleep diaries, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and World Health Organization wellbeing questionnaire (WHO-5) were measured pre-treatment and post-treatment. RESULTS Agomelatine therapy for 4 weeks shifted the sleep-wake rhythm (p < .001) forward in both groups at the week 4 assessment. There were no significant differences in sleep onset (p = .099) and sleep offset (p = .959) between the CBT group and the no treatment (NT) group at the follow-up visits. However, significant differences were found in sleep duration (p = .002), sleep quality (p=0.005), sleep difficulties (p < .001), daytime sleepiness (p = .001), and wellbeing (p = .007) between groups. CONCLUSIONS The improvements were received largely through the sleep-promoting effects of agomelatine therapy, and combining with cognitive behavior therapy on maintenance of altered sleep rhythms might be feasible.
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Affiliation(s)
- Ying Yu
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
| | - Yan Chen
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
| | - Long Ma
- Department of Cardiology, Second Hospital of Heilongjiang Province, 209 Jiangdu Road, 150028, Harbin, China
| | - You-Yang Qu
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
| | - Yu-Nong Li
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
| | - Ying Peng
- Department of Neurology, Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Road, 150006, Harbin, China
| | - Yu-Lan Zhu
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
| | - Jia He
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
| | - Hai-Yan Gou
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
| | - Yan-Mei Zhu
- Department of Neurology, Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150086, Harbin, China
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15
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Scott J, Vedaa Ø, Sivertsen B, Langsrud K, Kallestad H. Using network intervention analysis to explore associations between participant expectations of and difficulties with cognitive behavioural therapy for insomnia and clinical outcome: A proof of principle study. J Psychiatr Res 2022; 148:73-83. [PMID: 35121271 DOI: 10.1016/j.jpsychires.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research about predictors of response to cognitive behaviour therapy for insomnia (CBT-I) is ongoing. We examined any whether pre-intervention expectations or post-intervention appraisals of difficulties in utilizing face to face (FtF) or digital (dCBT-I) versions of the therapy were associated with outcome. METHODS Self-rating data were extracted on 101 adult participants in a recent randomized controlled trial of FtF versus dCBT-I. Network intervention analyses were used to explore any associations between expectations of CBT-I at response at 9 weeks and between post-intervention ratings of difficulties, modality of therapy and response at 9-weeks and at 6-months. RESULTS Anticipated and actual difficulties in employing sleep restriction techniques predicted response in all network models. Modality of therapy played a more overt role in the 9-week outcome network, with FtF therapy more robustly associated with response. However, the direct association between FtF therapy and response was not found in the 6-month outcome network. Notable predictors of poor outcome at 9-weeks and 6-month follow-up were difficulties in accommodating CBT-I into work and daily routines and applying the rules of CBT-I. CONCLUSIONS This network intervention analysis highlights that self-confidence and ability in undertaking sleep restriction is a key active ingredient of CBT-I. Also, benefits and gains from access to the FtF version of this multi-component therapy were more apparent in the short than the longer term. However, it is important that findings from this proof of principle study are confirmed in further studies.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, UK; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Øystein Vedaa
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research & Innovation, Helse Fonna, HF, Haugesund, Norway; Haukeland University Hospital, Bjørgvin District Psychiatric Center, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research & Innovation, Helse Fonna, HF, Haugesund, Norway
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Havard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
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Hwang H, Kim SM, Netterstrøm B, Han DH. The Efficacy of a Smartphone-Based App on Stress Reduction: Randomized Controlled Trial. J Med Internet Res 2022; 24:e28703. [PMID: 35166687 PMCID: PMC8889477 DOI: 10.2196/28703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/12/2021] [Accepted: 12/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background Stress management in the workplace is essential for a healthy mental and physical state. Due to technological advancements, individually tailored therapy and online cognitive behavioral therapy (CBT) are on the rise. Objective This study analyzed the efficacy of a smartphone app based on third-wave CBT tailored to an individual. Methods A randomized controlled trial was conducted with 126 participants who were divided into 2 groups. The intervention group used the smartphone app BetterLife for 10 weeks, while the control group was placed on a waiting list for the same duration. The Perceived Stress Scale–10 (PSS), Korean Utrecht Work Engagement Scale–9 (UWES), World Health Organization Quality of Life Assessment (WHOQOL), Beck Depression Inventory–II (BDI), and Beck Anxiety Inventory (BAI) were administered at baseline and after 10 weeks to both groups. Results Of the 126 participants, 11 dropped out during the trial. A 2-way repeated measure analysis of covariance was conducted, controlling for baseline BDI. There were greater improvements in PSS (F=24.33, P<.001, η2=0.17) and UWESK scores (F=8.32, P=.0046, η2=0.06) in the intervention group than in the control group. WHOQOL scores exhibited statistically significant improvement in the intervention group in the overall quality of life (F=8.19, P=.0049, η2=0.06), physical health (F=8.87, P=.003, η2=0.07), psychological health (F=13.32, P<.001, η2=0.10), social relationships (F=19.43, P<.001, η2=0.14), and environmental domains (F=10.14, P=.002, η2=0.08) but not overall health (F=1.68, P=.20). BDI (F=7.17, P=.008, η2=0.06) and BAI (F=6.00, P=.02, η2=0.05) showed a statistically significant improvement in the intervention group, but this significance did not survive the Bonferroni correction (P<.005). Conclusions These results provide evidence that smartphone-based CBT is a viable option for reducing stress in the workplace. Trial Registration Clinical Research Information Service KCT0003231; https://cris.nih.go.kr/cris/search/detailSearch.do/15137
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Affiliation(s)
- Hyunchan Hwang
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Bo Netterstrøm
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Doug Hyun Han
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Sleep Disorders in Cancer-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111696. [PMID: 34770209 PMCID: PMC8583058 DOI: 10.3390/ijerph182111696] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/07/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment. METHODS A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis. RESULTS The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%. DISCUSSION Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states.
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18
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Semsarian CR, Rigney G, Cistulli PA, Bin YS. Impact of an Online Sleep and Circadian Education Program on University Students' Sleep Knowledge, Attitudes, and Behaviours. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910180. [PMID: 34639484 PMCID: PMC8507829 DOI: 10.3390/ijerph181910180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
University students consistently report poor sleep. We conducted a before-and-after study to evaluate the impact of an online 10-week course on undergraduate students' sleep knowledge, attitudes, and behaviours at 6-month follow-up. Data were collected via baseline course surveys (August-September 2020) and follow-up surveys distributed via email (February-March 2021). n = 212 students completed baseline surveys and n = 75 (35%) completed follow-up. Students retained to follow-up possessed higher baseline sleep knowledge and received higher course grades. At the 6-month follow-up, sleep knowledge had increased (mean score out of 5: 3.0 vs. 4.2, p < 0.001). At baseline, 85% of students aimed to increase their sleep knowledge and 83% aimed to improve their sleep. At follow-up, 91% reported being more knowledgeable and 37% reported improved sleep. A novel Stages of Change item revealed that 53% of students' attitudes towards their sleep behaviours had changed from baseline. There was a reduction in sleep latency at follow-up (mean 33.3 vs. 25.6 min, p = 0.015), but no change in the total Pittsburgh Sleep Quality Index score. In summary, completion of an online course led to increased sleep and circadian knowledge and changed sleep attitudes, with no meaningful change in sleep behaviours. Future interventions should consider components of behavioural change that go beyond the knowledge-attitudes-behaviour continuum.
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Affiliation(s)
- Caitlin R. Semsarian
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia; (C.R.S.); (P.A.C.)
| | - Gabrielle Rigney
- Appleton Institute of Behavioural Science, Central Queensland University, Wayville, SA 5034, Australia;
| | - Peter A. Cistulli
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia; (C.R.S.); (P.A.C.)
- Northern Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia
| | - Yu Sun Bin
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia; (C.R.S.); (P.A.C.)
- Northern Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW 2006, Australia
- Correspondence:
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Richter K, Kellner S. ["Coronasomnia"-promoting resilience through insomnia treatment]. SOMNOLOGIE 2021; 25:170-175. [PMID: 34456621 PMCID: PMC8381348 DOI: 10.1007/s11818-021-00322-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 01/18/2023]
Abstract
Hintergrund Der Begriff „Coronasomnia“ beschreibt populärwissenschaftlich Schlafstörungen, die im Zusammenhang mit der COVID-19-Pandemie in Erscheinung treten. Diese können auch im Anschluss der Pandemie einen Teil der Bevölkerung betreffen. Erste wissenschaftliche Hinweise deuten darauf hin, dass durch die Pandemie entstandene Insomniebeschwerden sich nach dem Ende der Pandemie chronifizieren und somit die schlafmedizinische Gemeinschaft weiterhin beschäftigen werden. Methoden Es wurde eine orientierende Literaturrecherche in Medline und Google Scholar mit folgender Kombination an Keywords durchgeführt: „Insomnia and COVID-19“; „Insomnia and Long-COVID“; „Insomnia, PTSD and COVID-19“; „Fatigue and Insomnia in Long-COVID“. Darüber hinaus lagen den Autoren mehrere kürzlich erschienene Artikel vor, welche durch Mitglieder des „European Insomnia Network“ veröffentlicht wurden. Ergebnisse Studien zu dem Thema Insomnie und COVID-19 zeigen signifikante Assoziationen zwischen akuter Infektion und Insomnie bei betroffenen Personen. Die Prävalenz von Insomniesymptomen bei Personen mit COVID-19 lag bei 36–88 % und somit deutlich über die Prävalenz in der Bevölkerung mit 10–40 %. Fazit Digitale Therapieangebote als aktuelle Behandlungsmöglichkeit von Insomnie können Patienten unabhängig von der räumlichen Entfernung angeboten werden. Demnach wäre nicht nur eine baldige Zulassung von mobilen Therapieapplikationen, sondern auch von personengeleiteten, digitale Therapieangeboten für Insomnie zu empfehlen. Die Aufnahme personalisierter und schlafedukativer Maßnahmen im Bereich des betrieblichen Gesundheitsmanagements wird nahegelegt.
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Affiliation(s)
- Kneginja Richter
- Sleep Ambulance, University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, Nürnberg, Deutschland.,Fakultät für Sozialwissenschaften, Technische Hochshule Nürnberg, Nürnberg, Deutschland.,Fakultät für Medizin, Universität Goce Delcev, Štip, Nordmazedonien
| | - Stefanie Kellner
- Institut für E-Beratung, Technische Hochshule Nürnberg, Nürnberg, Deutschland
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Retzer L, Feil M, Reindl R, Richter K, Lehmann R, Stemmler M, Graessel E. Anonymous online cognitive behavioral therapy for sleep disorders in shift workers-a study protocol for a randomized controlled trial. Trials 2021; 22:539. [PMID: 34399824 PMCID: PMC8369659 DOI: 10.1186/s13063-021-05437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample. Methods Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness. Conclusions The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers. Trial registration German Clinical Trials Register DRKS DRKS00017777. Registered on 14 January 2020—retrospectively registered.
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Affiliation(s)
- Lukas Retzer
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany. .,University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| | - Monika Feil
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany
| | - Richard Reindl
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany
| | - Kneginja Richter
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany.,University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Robert Lehmann
- Faculty for Social Sciences, University of Applied Sciences Nuremberg Georg-Simon-Ohm, Nuremberg, Germany
| | - Mark Stemmler
- Department of Psychology, Friedrich-Alexander University Erlangen Nuremberg, Nuremberg, Germany
| | - Elmar Graessel
- Department of Medical Psychology and Medical Sociology, University Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
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Small GW, Lee J, Kaufman A, Jalil J, Siddarth P, Gaddipati H, Moody TD, Bookheimer SY. Brain health consequences of digital technology use
. DIALOGUES IN CLINICAL NEUROSCIENCE 2021; 22:179-187. [PMID: 32699518 PMCID: PMC7366948 DOI: 10.31887/dcns.2020.22.2/gsmall] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Emerging scientific evidence indicates that frequent digital technology use has a
significant impact—both negative and positive—on brain function and behavior. Potential
harmful effects of extensive screen time and technology use include heightened
attention-deficit symptoms, impaired emotional and social intelligence, technology
addiction, social isolation, impaired brain development, and disrupted sleep. However,
various apps, videogames, and other online tools may benefit brain health. Functional
imaging scans show that internet-naive older adults who learn to search online show
significant increases in brain neural activity during simulated internet searches.
Certain computer programs and videogames may improve memory, multitasking skills, fluid
intelligence, and other cognitive abilities. Some apps and digital tools offer mental
health interventions providing self-management, monitoring, skills training, and other
interventions that may improve mood and behavior. Additional research on the positive
and negative brain health effects of technology is needed to elucidate mechanisms and
underlying causal relationships.
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Affiliation(s)
- Gary W Small
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Jooyeon Lee
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Aaron Kaufman
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Jason Jalil
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Prabha Siddarth
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Himaja Gaddipati
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Teena D Moody
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience and Human Behavior, the UCLA Longevity Center, David Geffen School of Medicine at the University of California, Los Angeles, California, US
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Richter K, Kellner S, Hillemacher T, Golubnitschaja O. Sleep quality and COVID-19 outcomes: the evidence-based lessons in the framework of predictive, preventive and personalised (3P) medicine. EPMA J 2021; 12:221-241. [PMID: 34122671 PMCID: PMC8185312 DOI: 10.1007/s13167-021-00245-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023]
Abstract
Sleep quality and duration play a pivotal role in maintaining physical and mental health. In turn, sleep shortage, deprivation and disorders are per evidence the risk factors and facilitators of a broad spectrum of disorders, amongst others including depression, stroke, chronic inflammation, cancers, immune defence insufficiency and individual predisposition to infection diseases with poor outcomes, for example, related to the COVID-19 pandemic. Keeping in mind that COVID-19-related global infection distribution is neither the first nor the last pandemic severely affecting societies around the globe to the costs of human lives accompanied with enormous economic burden, lessons by predictive, preventive and personalised (3P) medical approach are essential to learn and to follow being better prepared to defend against global pandemics. To this end, under extreme conditions such as the current COVID-19 pandemic, the reciprocal interrelationship between the sleep quality and individual outcomes becomes evident, namely, at the levels of disease predisposition, severe versus mild disease progression, development of disease complications, poor outcomes and related mortality for both - population and healthcare givers. The latter is the prominent example clearly demonstrating the causality of severe outcomes, when the long-lasting work overload and shift work rhythm evidently lead to the sleep shortage and/or deprivation that in turn causes immune response insufficiency and strong predisposition to the acute infection with complications. This article highlights and provides an in-depth analysis of the concerted risk factors related to the sleep disturbances under the COVID-19 pandemic followed by the evidence-based recommendations in the framework of predictive, preventive and personalised medical approach.
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Affiliation(s)
- Kneginja Richter
- Outpatient Clinic for Sleep Disorders, University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, 90419 Nuremberg, Germany
- Faculty for Social Work, Technical University of Applied Sciences Nuremberg Georg Simon Ohm, 90489 Nuremberg, Germany
- Faculty for Medical Sciences, University Goce Delcev Stip, 2000 Stip, North Macedonia
| | - Stefanie Kellner
- Faculty for Social Work, Technical University of Applied Sciences Nuremberg Georg Simon Ohm, 90489 Nuremberg, Germany
| | - Thomas Hillemacher
- Outpatient Clinic for Sleep Disorders, University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, 90419 Nuremberg, Germany
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
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Du C, Wang W, Hsiao PY, Ludy MJ, Tucker RM. Insufficient Sleep and Poor Sleep Quality Completely Mediate the Relationship between Financial Stress and Dietary Risk among Higher Education Students. Behav Sci (Basel) 2021; 11:bs11050069. [PMID: 34063082 PMCID: PMC8147970 DOI: 10.3390/bs11050069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic worsened financial stress for higher education students in the U.S. Financial stress is associated with poor dietary behaviors; however, factors that might influence this relationship are not well characterized. The present cross-sectional study investigated the associations between financial stress and dietary intake and dietary risk scores among higher education students (undergraduate and graduate students) in the U.S. and examined whether poor sleep quality and short sleep duration mediated the relationship between financial stress and dietary risk score. Validated tools were used to assess financial stress, sleep quality, sleep duration, dietary intake, and dietary risk. A total of 1280 students from three large U.S. universities completed the study. Results indicated that higher financial stress was associated with lower vegetable, fruit, fiber, and calcium intake, higher added sugar intake from sugar sweetened beverages, and higher dietary risk score. Further, the positive relationship between financial stress and dietary risk score was completely mediated by poor sleep quality among students who reported poor sleep quality and by short sleep duration among students who slept less than 7 h per night. These findings suggest that students might benefit from both financial management training and sleep education services to reduce undesirable dietary behaviors.
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Affiliation(s)
- Chen Du
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (C.D.); (W.W.)
| | - Wenyan Wang
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (C.D.); (W.W.)
| | - Pao Ying Hsiao
- Department of Food and Nutrition, Indiana University of Pennsylvania, Indiana, PA 15705, USA;
| | - Mary-Jon Ludy
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH 43403, USA;
| | - Robin M. Tucker
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (C.D.); (W.W.)
- Correspondence: ; Tel.: +1-517-353-3408
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Improved Sleep Quality and Work Performance Among Shift Workers Consuming a "Foods with Function Claims" Containing Asparagus Extract. J UOEH 2021; 43:15-23. [PMID: 33678782 DOI: 10.7888/juoeh.43.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to examine whether Foods with Function Claims (FFC) containing asparagus extract effectively improved sleep quality and work performance in shift workers. An intervention study with a before-and-after intervention design was conducted on nurses engaged in two-shift work at a hospital, ingesting a FFC containing asparagus extract. The evaluation period lasted at least two weeks, including three nights shifts during the period. Before and after ingestion, Pittsburgh Sleep Questionnaire Index (PSQI), Utrecht Work Engagement Scale (UWES), Sleep quality (VAS-rated), impaired work functioning, and psychiatric symptoms were evaluated. A diary record, wearing of an activity meter, and a Psychomotor vigilance test were also performed at baseline and after intervention. Data were analyzed by the paired t-test or the Wilcoxon rank sum test. Among 34 participants, 33 completed the study. The results of the primary outcome measures showed significant improvements in PSQI and Sleep Quality in the night of the day after a night shift (PSQI total score: base line 7.41/ post intervention 6.03: P < 0.001; sleep quality: base line 4.48/post intervention 6.00: P < 0.001). The results of the secondary outcome measures showed significant improvements in UWES and feeling of fatigue. There was also trend of improvement in sleep efficiency and the reaction time. There was no significant improvement in impaired work functioning. This study showed that regular consumption of an FFC containing asparagus extract could improve sleep quality, feeling of fatigue, and work engagement among shift workers. Some caution, however, is needed when interpreting the results because of the before-and-after intervention design without a control group.
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Retzer L, Reindl R, Zauter S, Richter K. Bevorzugen Frauen Face-to-Face-Beratung bei Insomnie? SOMNOLOGIE 2021. [DOI: 10.1007/s11818-020-00292-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Chao LL, Kanady JC, Crocker N, Straus LD, Hlavin J, Metzler TJ, Maguen S, Neylan TC. Cognitive behavioral therapy for insomnia in veterans with gulf war illness: Results from a randomized controlled trial. Life Sci 2021; 279:119147. [PMID: 33549595 PMCID: PMC8217272 DOI: 10.1016/j.lfs.2021.119147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/08/2023]
Abstract
Aims: To examine whether cognitive behavioral therapy for insomnia (CBT-I), delivered by telephone, improves sleep and non-sleep symptoms of Gulf War Illness (GWI). Main methods: Eighty-five Gulf War veterans (21 women, mean age: 54 years, range 46–72 years) who met the Kansas GWI case definition, the Centers for Disease Control and Prevention (CDC) case definition for Chronic Multisymptom Illness (CMI), and research diagnostic criteria for insomnia disorder were randomly assigned to CBT-I or monitor-only wait list control. Eight weekly sessions of individual CBT-I were administered via telephone by Ph.D. level psychologists to study participants. Outcome measures included pre-, mid-, and post-treatment assessments of GWI and insomnia symptoms, subjective sleep quality, and continuous sleep monitoring with diary. Outcomes were re-assessed 6-months post-treatment in participants randomized to CBT-I. Key findings: Compared to wait list, CBT-I produced significant improvements in overall GWI symptom severity, individual measures of fatigue, cognitive dysfunction, depression and anxiety, insomnia severity, subjective sleep quality, and sleep diary outcome measures. The beneficial effects of CBT-I on overall GWI symptom severity and most individual GWI symptom measures were maintained 6-months after treatment. Significance: GWI symptoms have historically been difficult to treat. Because CBT-I, which is associated with low stigma and is increasingly readily available to veterans, improved both sleep and non-sleep symptoms of GWI, these results suggest that a comprehensive approach to the treatment of GWI should include behavioral sleep interventions.
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Affiliation(s)
- Linda L Chao
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA.
| | | | - Nicole Crocker
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Jennifer Hlavin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
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Zhao X, Zhang T, Li B, Yu X, Ma Z, Cao L, Gu Q, Dong C, Jin Y, Fan J, He G. Job-related factors associated with changes in sleep quality among healthcare workers screening for 2019 novel coronavirus infection: a longitudinal study. Sleep Med 2020; 75:21-26. [PMID: 32853914 PMCID: PMC7403128 DOI: 10.1016/j.sleep.2020.07.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sleep disorders may exacerbate many physical and mental health conditions, causing difficulty function in a healthcare setting. Workers screening for the 2019 novel coronavirus (2019-nCoV) infection have a high risk of not only occupational exposure to the virus but also sleep disorders. However, the job-related factors associated with reduced sleep quality remain unclear. METHODS All healthcare workers temporarily scheduled to screen the 2019-nCoV patients were asked to complete a self-administered questionnaire that included questions on demographics, job-related factors, and sleep quality as assessed using the Pittsburgh Sleep Quality Index (PSQI). Sleep quality was assessed over a one-month follow-up period. RESULTS A total of 116 doctors and 99 nurses were recruited for this study. The total scheduled work time was 14.78 ± 6.69 days during follow-up. Some job-related factors, such as number of work days, years of work experience, and subjective psychological stress, were associated with changes in the PSQI score. During the study, some workers tried out cognitive behavioral therapy (CBT) for sleep disorders using methods that were available online and easily accessible. Adopting online CBT was shown to be associated with scores of components of sleep quality, sleep latency, and sleep disturbance (β = -0.152, P = 0.01; β = -0.175, P = 0.008; and β = -0.158, P = 0.011, respectively). CONCLUSIONS Healthcare workers involved in screening for 2019-nCoV experienced reduced sleep quality, and a reasonable work schedule may help with maintaining sleep quality. In addition, interventions for healthcare workers should target self-help sleep assistance.
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Affiliation(s)
- Xiaolong Zhao
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China.
| | - Tong Zhang
- Department of Clinical Laboratory, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Li
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiaoxu Yu
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhiyue Ma
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Luhong Cao
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Qingjia Gu
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Chuan Dong
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China
| | - Yunhua Jin
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China.
| | - Jiangang Fan
- Department of Otolaryngology Head and Neck Surgery, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Chengdu, China.
| | - Gang He
- Chengdu Tian Fu New District People's Hospital, Chengdu, China
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Chow CM. Sleep and Wellbeing, Now and in the Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082883. [PMID: 32331237 PMCID: PMC7216147 DOI: 10.3390/ijerph17082883] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Chin Moi Chow
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney 2006, Australia;
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
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Brooks AT, Raju S, Barb JJ, Kazmi N, Chakravorty S, Krumlauf M, Wallen GR. Sleep Regularity Index in Patients with Alcohol Dependence: Daytime Napping and Mood Disorders as Correlates of Interest. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010331. [PMID: 31947749 PMCID: PMC6982308 DOI: 10.3390/ijerph17010331] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 01/06/2023]
Abstract
Alcohol use disorder (AUD) is often accompanied by comorbid conditions, including sleep disturbances related to sleep regularity and timing. The Sleep Regularity Index (SRI) is a novel measure that assesses the probability that an individual is awake (vs. asleep) at any two time points 24 h apart. We calculated actigraphy-based SRI on 124 participants with alcohol dependence to capture the effects of changes in sleep timing and duration among patients enrolled in an inpatient alcohol treatment program. During the course of the study, the mean SRI increased between weeks 1 and 3 (75.4 to 77.8), thus indicating slightly improved sleep quality and regularity during alcohol treatment. Individuals within the bottom quartile of SRI scores at week 1 improved significantly over time. Average total SRI for individuals with no mood disorders was slightly higher than that for individuals with one or more mood disorders. Increased SRI scores were associated with lower total nap duration from week 1 to week 3. Increased SRI scores were associated with decreased mental/physical exhaustion scores from week 1 to week 3. The SRI could be a target for assessment/intervention in certain sub-groups of individuals undergoing inpatient treatment for AUD.
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Affiliation(s)
- Alyssa T. Brooks
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
- Correspondence:
| | - Shravya Raju
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Jennifer J. Barb
- Mathematical and Statistical Computing Lab/CIT/NIH, 12 South Drive Bldg 12A Room 2001, Bethesda, MD 20892, USA;
| | - Narjis Kazmi
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Perelman School of Medicine, MIRECC, 2nd Floor, Mail stop 116, 3900 Woodland Avenue, Philadelphia, PA 19104, USA;
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
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Järnefelt H, Härmä M, Sallinen M, Virkkala J, Paajanen T, Martimo KP, Hublin C. Cognitive behavioural therapy interventions for insomnia among shift workers: RCT in an occupational health setting. Int Arch Occup Environ Health 2019; 93:535-550. [PMID: 31853633 PMCID: PMC7260280 DOI: 10.1007/s00420-019-01504-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
Introduction The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. We also studied whether the features of shift work disorder (SWD) affected the results. Methods A total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. The outcomes were assessed before and after the interventions and at 6-month follow-up using questionnaires, a sleep diary, and actigraphy. Results Perceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Non-SWD participants had more mental diseases and symptoms, used more sleep-promoting medication, and had pronounced insomnia severity and more dysfunctional beliefs than those with SWD. After the interventions, non-SWD participants showed more prominent improvements than those with SWD. Conclusions Our results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Alleviation of mood symptoms seemed to be the main added value of the group-based CBT-I intervention compared to the control intervention. The clinical condition of the non-SWD participants was more severe and these participants benefitted more from the interventions than the SWD participants did. Trial registration ClinicalTrials.gov, NCT02523079.
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Affiliation(s)
- Heli Järnefelt
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland. .,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Mikko Härmä
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi Virkkala
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland.,Department of Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Paajanen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Kari-Pekka Martimo
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Christer Hublin
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
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Pérez-Fuentes MDC, Molero Jurado MDM, Simón Márquez MDM, Gázquez Linares JJ. Analysis of Sociodemographic and Psychological Variables Involved in Sleep Quality in Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3846. [PMID: 31614622 PMCID: PMC6843758 DOI: 10.3390/ijerph16203846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sleep quality is related to health and quality of life and can lead to the development of related disorders. This study analyzed the sociodemographic and psychological factors related to sleep quality in nurses. METHODS The sample comprised 1094 nurses who were assessed according to the Pittsburgh Sleep Quality Index, the Rosenberg Self-esteem Questionnaire, the Goal Content for Exercise Questionnaire, the Brief Emotional Intelligence Inventory, and the Three-Factor Eating Questionnaire-R18. RESULTS The results confirm the impacts of diet, motivation for physical exercise, emotional intelligence, and overall self-esteem on sleep quality in nurses. CONCLUSIONS Sleep quality in healthcare professionals is vitally important for performance at work; therefore, appropriate strategies should be applied to improve it.
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