The Pittsburg Sleep Quality Index (PSQI) and Associated Factors in Middle-school Students: A Cross-sectional Study

Does notifying clinicians about poor sleep quality influence patient-perceived empathy? Results from a randomized controlled trial

BACKGROUND

Evidence suggests that greater levels of comfort and capability are associated with lower levels of distress (feelings of anxiety or depression) and lower levels unhelpful thinking (common misconceptions) about bodily sensations. Given the social stigma associated with mental health, patients and clinicians may be hesitant to talk about thoughts and emotions in the setting of musculoskeletal specialty care. Given the relationship between sleep quality and mental health, an alternative may be discussion of sleep quality. Among people presenting for musculoskeletal specialty care, we enrolled people with sleep disturbance, and asked: 1) Is clinician awareness of a patient's poor sleep quality associated with patient perceived clinician empathy? 2) What factors are associated with worse sleep quality? And 3) Is clinician awareness of a sleep disturbance related to discussion of sleep quality interventions?

METHODS

In a randomized controlled trial, we enrolled 114 patients seeking musculoskeletal specialty care with a score of 3 or higher on the Pittsburg Sleep Quality Index (PSQI) questionnaire and randomized whether to inform their clinician of their sleep score or not. At the end of the visit, patients completed a demographic survey, the Jefferson Scale of Patient's Perception of Physician Empathy (JSPPPE), and indicated whether or not their clinician discussed sleep quality. Factors associated with perceived empathy, sleep quality, and discussion of sleep intervention were sought in multivariable analysis.

RESULTS

Accounting for potential confounders including misconceptions about symptoms, lower perceived clinician empathy was associated with the clinician being informed of the patient's sleep quality (Regression Coefficient [RC] = -0.14 95 % Confidence Interval [95 %CI] = -0.24 to -0.03l; p = 0.011) and greater misinterpretation of symptoms (RC = -0.14 95 %CI = -0.24 to -0.03; p = 0.04). Worse sleep quality was associated with distress regarding symptoms (RC = 0.048 95 %CI = 0.024 to 0.072; p < 0.001). Clinician discussion of sleep intervention was not associated with clinician awareness of sleep quality or any other factors.

CONCLUSIONS

The finding that clinician awareness of poor sleep quality was associated with modestly lower perceived clinician empathy whether or not the clinician discussed sleep quality, suggests that addressing sleep may not be more acceptable than addressing mental health. Clinicians can choose to address sleep or mental health as part of fostering a more comprehensive and effective biopsychosocial approach to musculoskeletal illness.

LEVEL OF EVIDENCE

Level I Prognostic Study.

Association between sleep duration and obesity in patients with type 2 diabetes: A longitudinal study

BACKGROUND

Obesity is prevalent in patients with type 2 diabetes (T2D) and negatively impacts diabetes outcomes. While studies in the general population have established a link between sleep duration and obesity, this relationship in T2D remains unclear.

OBJECTIVES

To assess the association between sleep duration and adiposity in patients with T2D.

METHODS

This prospective study of adults enrolled in the SLEEP T2D study from 13 UK NHS Trusts. Sleep duration was self-reported using the Pittsburgh Sleep Quality Index (PSQI) and categorized as short (≤ 6 h/ night), long (> 9 h/night) or (normal > 6-9 h/night). Adiposity was assessed using body mass index (BMI) and waist circumference.

RESULTS

Among 229 patients (61% male, mean age 61.2 (± 11.7) years, 63.7% with BMI ≥ 30 kg/m2). At baseline, sleep duration negatively correlated with BMI (r = -0.27, p < 0.001) and waist circumference (r = -0.25, p = 0.001). After adjusting for potential confounders in different models, short sleep duration was associated with higher BMI (β = -1.01; p = 0.006) and waist circumference (β = -1.91; p = 0.01). Following a median follow-up of 26.5 months, short sleep at baseline was associated with a 5% or more gain in BMI (adjusted OR 10.03; 95% CI 1.55-64.84; p = 0.01).

CONCLUSION

Short sleep duration is associated with higher adiposity measures (BMI and waist circumference) and weight gain in patients with T2D. Addressing sleep duration may reduce the burden of obesity in T2D, and future studies in this area are warranted.

Analysis of sleep disorders and their influencing factors in patients with ankylosing spondylitis

OBJECTIVES

Sleep disorders are a common symptom in Ankylosing Spondylitis (AS) patients. In this cross-sectional study, we aimed to understand the current status of sleep disorders in AS patients and to analyze potential factors influencing sleep disorders.

METHODS

A total of 205 AS patients were recruited in the survey. The content included the self-designed demographic data questionnaire, The MOS 36-Item Short Form Health Survey (SF-36), Visual Analogue Scale (VAS), Multidimensional Fatigue Inventory (MF-20), Self-Rating Anxiety and Depression Scale, Pittsburgh Sleep Quality Index questionnaire (PSQI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI). These data were analyzed using chi-square test, independent sample t-test, Mann-Whitney U test, Pearson correlation analysis, single-factor linear regression analysis, and multiple linear stepwise regression analysis.

RESULTS

The results showed that the average sleep total score was 8.82 ± 4.146, and the prevalence of sleep disorders was approximately 66.8% in AS patients. Age (F = 29.710, P < 0.001), disease duration (F = 13.025, P < 0.001), anxiety (F = 36.060, P < 0.001), depression (F = 11.808, P < 0.001), and quality of life (t = 6.665, P < 0.001) significantly impacted the sleep total score. Pearson correlation analysis revealed a significant negative correlation between SF-36 total score and sleep total score (r = ‒0.449, P < 0.01), while positive correlations were observed for VAS score, fatigue, anxiety, depression, BASDAI, BASFI, BASMI, age, and disease duration (all P < 0.01). Multivariate analysis showed that age, disease duration, nocturnal pain VAS score, total back pain VAS score, peripheral joint pain VAS score, total fatigue score, total anxiety score, and BASMI total score significantly predicted sleep total score (R² = 0.755, F = 45.334, P < 0.001).

CONCLUSION

These findings suggest that medical professionals should pay increased attention to the observed associations between sleep disorders and clinical factors in AS patients, and consider implementing targeted interventions to address sleep-related issues.

Sleep quality of college students in Fujian and its influencing factors: A cross-sectional study

AIM

This study aims to investigate college students' sleep quality, explore the factors influencing it, and provide data support for further studies.

METHODS

College students in Fujian Province were chosen as the study sample using snowball sampling. Data was gathered from the participants through the utilization of a self-designed personal questionnaire, the Pittsburgh Sleep Quality Index(PSQI) scale, and the Mobile Phone Addiction Index (MPAI) scale. Binary logistic regression is utilized to assess the sleep quality of college students and identify risk factors.

RESULTS

A total of 971 participants were included in this study. The mean total PSQI score was 4.52 ± 3.17. There were 310 students with poor sleep quality and the detection rate was 32.0%. The multivariate logistic regression analysis showed that smoking (OR(Odds ratio):1.832(1.076,3.118)), electronic product addiction(OR:2.861(1.928,4.246)), personal history of acute illness(OR:2.328(1.671,3.244)) were identified as independent risk factors.In turn, education (OR:0.594(0.456,0,772)) and parents without sleep problems (OR:0.533(0.361,0.787)) were protective factors.

CONCLUSION

College students in Fujian have some sleep problems. We should pay attention to the relationship between smoking, electronic product addiction, personal history of acute illness and sleep quality. Health policymakers should consider these factors to improve college students' sleep quality.

Association between sleep disorders and myopia in Shanghai adolescents: a cross-sectional survey conducted among junior school students

BACKGROUND

Numerous research suggest that longer sleep duration correlates with a reduced likelihood of myopia onset in adolescents. Does total sleep quality influence myopia? This study aims to examine the relationship between sleep disorders in adolescents and their effects on myopia and the risk of acquiring high myopia.

METHODS

Data from second-grade middle school students across 16 districts in Shanghai were studied. A total of 2,337 valid observations collected. Two study samples were established: the entire student population and students diagnosed with myopia. Propensity score matching (PSM) was conducted to equilibrate the confounding variables between the sleep disorder and non-sleep disorder groups in each sample. Odds ratios (OR) were computed to assess the effect size. A generalized additive model was used to analyze the relationship between SE and sleep disorder.

RESULTS

Prior to PSM, the likelihood of myopia among students was significantly correlated with a higher prevalence of sleep disorders (OR = 1.40, 95%CI: 1.02-1.91). but this significance diminished after matching (OR = 1.24, 95%CI: 0.82-1.85). In the examination of myopic students, before to PSM, sleep disorders were recognized as a potential risk factor for high myopia. Nonetheless, this correlation did not reach statistical significance (OR = 1.21; 95%CI:0.80-1.84). Comparable outcomes were achieved after the matching process (OR = 1.08; 95%CI:0.62-1.87). The modelling outcomes of the generalized additive model also revealed no correlation between sleep disrder and myopia or high myopia.

CONCLUSION

This study found no significant correlation between myopia or high myopia and sleep disorder. However, the residual effect sizes post-PSM still indicate potential biological interactions.

Relationship between psychological empowerment, physical activity enjoyment, and response to a HIIT Program in physically inactive young women: a prospective multicentre study

BACKGROUND

This study aimed to investigate the relationship of psychological empowerment and enjoyment of physical activity with changes in physical activity levels, sleep quality, and muscular endurance following a high-intensity interval training (HIIT) program in physically inactive young women.

METHODS

A total of 61 physically inactive young women (age: 20.1 ± 2.7 y) were recruited to participate in a six-month HIIT intervention delivered via a smartphone app. Outcome measures included physical activity levels (MET-min/week), muscular endurance (plank test), and sleep quality through the Pittsburgh Sleep Quality Index (PSQI). The Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) and the Physical Activity Enjoyment Scale (PACES) were used to assess psychological empowerment and enjoyment, respectively. Repeated measures ANOVA and covariate analyses were performed to evaluate the impact of the intervention and the role of psychological empowerment and enjoyment.

RESULTS

At 6 months, significant improvements in physical activity (p < 0.001; ηp²=0.336) and muscular endurance (p = 0.005; ηp²=0.085) were observed, with large and moderate effect sizes, respectively. The PACES showed a significant interaction with time for MET-min/week (F = 11.67, p = 0.001, ηp²=0.129), suggesting that enjoyment influenced the increase in physical activity. No significant differences in sleep quality were observed (p > 0.05).

CONCLUSION

Enjoyment plays a crucial role in the response to HIIT programs among physically inactive young women, particularly in improving weekly physical activity levels. Psychological training showed no significant relationship with the outcomes studied.

[The state of mental health of migrant workers and citizens of the Russian Federation: A comparative analysis as illustrated by the Moscow region]

OBJECTIVE

To compare the prevalence of mental disorders (neuropsychiatric symptoms of depression, anxiety, concomitant insomnia, and the likelihood of developing somatic comorbidity) among migrant workers and citizens of the Russian Federation in the Moscow region.

MATERIAL AND METHODS

A survey was conducted using the most common scales and a cohort methodology: migrant workers (main group) and citizens of the Russian Federation residing in the Moscow region (control group) who sought outpatient medical care. The random sample included 120 migrant workers and 120 citizens of the Russian Federation aged 18 to 65, mostly males in both cohorts, with a mean age of 27±8.66 years.

RESULTS

High anxiety was identified in respondents in both groups. Non-Russian citizen patients had a higher prevalence of depressive states (p<0.05). Also, in the main group, the scores for insomnia severity were higher (p<0.05). In addition, difficulties in information perception were identified in survey participants, even without a language barrier.

CONCLUSION

The implementation of measures to protect the mental health of migrant workers is necessary and should include both prevention and adaptation of the healthcare system to new demands.

Relationship of sleep quality, chronotype, and obstructive sleep apnea with migraine in the elderly population

PURPOSE

Disturbances of sleep have frequently been reported in individuals with migraine. On top of this, an elderly patient with migraine also suffers from sleep disturbances due to changes in physiologic and mental health associated with aging. This study aimed to compare several sleep factors, namely sleep quality, chronotype, and obstructive sleep apnea (OSA) risk, between elderly people with and without migraine.

METHODS

This was a multicenter cross-sectional study conducted in 10 neurologic clinics located in Tehran, Iran, over 2 years. The sample size was calculated as 189, including 63 migraine and 126 non-migraine patients.

RESULTS

A significant difference was observed in the mean score of the global Pittsburgh Sleep Quality Index (PSQI) between migraine and non-migraine groups (p-value = 0.002), and in the individual components of the PSQI. However, there were no significant differences in the frequency of different types of chronotype (p-value = 0.125, T = 1.541) or OSA risk between the two groups (p-value = 0.568, T = -0.573). The binary logistic regression model showed that the relationship between global PSQI and migraine was significant (p = 0.002).

CONCLUSION

Sleep quality is a problem for elderly migraine sufferers. Meanwhile, certain factors such as chronotype and OSA have no significant relationship with migraine among community-dwelling seniors. Further studies are required to enhance our understanding of this observation.

Adherence Patterns and Health Outcomes in Spanish Young Women Participating in a Virtual-Guided HIIT Program: Insights from the Randomized Controlled WISE Trial

BACKGROUND/OBJECTIVES

A notable decline in physical activity from late adolescence to early adulthood affects young women especially. This study aimed to investigate adherence to an unsupervised virtual-guided high-intensity interval training (HIIT) exercise program among young women in Spain.

METHODS

A total of 106 participants were recruited and randomized to the Women's Involvement in Steady Exercise (WISE) trial exercise program, administered remotely via a mobile app, and a control group. The primary outcome was adherence measured through daily steps. Secondary variables were patient-reported outcomes of physical activity, quality of sleep, and quality of life, assessed with the International Physical Activity Questionnaire (IPAQ), the Pittsburgh Sleep Quality Index (PSQI), and the Health Lifestyle and Personal Control Questionnaire (HLPCQ), respectively. The assessments were performed over 6 months, before the intervention (T0), at the halfway of the program (T1), and at the end (T2).

RESULTS

Daily steps revealed a decrease from baseline to final assessment in both groups. Secondary outcomes indicated a shift in physical activity levels, showing a transition from low to moderate and high activity perception. While sleep quality deteriorated post-intervention, quality of life showed no changes.

CONCLUSIONS

The WISE trial highlights the potential and challenges of an unsupervised virtual-guided HIIT program for young women. While an improvement in physical activity levels was noticed, it also led to a decrease in daily steps and poorer sleep quality. These findings suggest a complex relationship between exercise and lifestyle factors, which could potentially have the greatest impact.

Prevalence of thyroid nodule and relationship with physiological and psychosocial factors among adults in Zhejiang Province, China: a baseline survey of a cohort study

BACKGROUND

Thyroid nodules have attracted much attention due to their high incidence and potential for malignant transformation. Compared with the clinical assessment and diagnosis of thyroid nodules, there are relatively few studies on the epidemiological risk factors for thyroid nodules. The aim of this study was to investigate the prevalence of thyroid nodule among adults in Zhejiang province and to explore their relationship with physiological and psychosocial factors.

METHODS

The data used in this study were obtained from the baseline survey of the Zhejiang Provincial Cohort Study on Environment and Health. From June 2022 to December 2023, a total of 21,712 participants from five representative cities in Zhejiang were recruited for the baseline survey. Based on the inclusion and exclusion criteria, 15,595 adults were included in the analysis. The data were collected via self-report questionnaires and physical examinations. Multivariate logistic regression analysis was subsequently performed.

RESULTS

The detection rate of thyroid nodules was 50.98% among adults in Zhejiang province. Age, gender, education level, BMI, tea and alcohol consumption all had a statistically significant association with thyroid nodules (p < 0.05). After adjusting for sociodemographic factors, results of logistic regression analysis showed that good life satisfaction (OR = 0.854, 95% CI: 0.780-0.934) had a lower risk of thyroid nodules, however, poor life satisfaction (OR = 1.406, 95% CI: 1.014-1.951), social isolation (OR = 1.294, 95% CI: 1.089-1.538) and a family history of thyroid nodules (OR = 1.334, 95% CI: 1.064-1.672) had a greater risk of thyroid nodules.

CONCLUSION

The detection rate of thyroid nodules in adults of Zhejiang province was an increasing trend compared with that in previous years. In addition to the sensitive thyroid nodule screening technology, influencing factors mentioned in this study might also represent credible candidates for this increase. As variable influence factors, weight management, good interpersonal relationships and life satisfaction should be the focus of health interventions.

The measured healthy lifestyle habits among Saudi university females in Medina, Saudi Arabia: A cross-sectional study

Lifestyle plays a crucial role in shaping an individual's health outcomes, we aim to calculate the prevalence of lifestyle habits among female populations in the College of Medicine, Taibah University including poor dietary habits, lack of physical activity (PA), poor coping with stress, and impaired sleep patterns and to find factors that are correlated to them. A cross-sectional study was conducted among Saudi females at the College of Medicine, Taibah University, from January 1 to June 1, 2023. Data were collected through interviewing them using validated questionnaires assessing 5 different lifestyle domains. Statistical analysis was performed using Statistical Package for the Social Sciences version 21.0. A total of 263 cases were interviewed. The mean age was 22 ± 8.4 years old. The average sleep quality measured by the Pittsburgh Sleep Quality Index of 2.6 ± 1.1, suggesting relative difficulty in sleep quality. A total of 68.6% participated in moderate PA. Dietary habits indicated a high prevalence of consumption of sweets, and fast meals, alongside low intake of fruits and vegetables. Emotional well-being, as assessed by the World Health Organization-5 questionnaire, yielded an average score of 7.8 ± 5.7, 58.9% moderate stress, and 8% high perceived stress. Adequate sleep quality is crucial for well-being, necessitating lifestyle modifications, particularly weight management, to address sleep disorders. Varied PA levels (46% meeting recommendations) highlight the need for standardized guidelines and tailored interventions. The high prevalence of unhealthy dietary habits underscores the importance of targeted nutritional interventions. Stress prevalence (40%) emphasizes the need for individualized stress management strategies.

Effect of exercise on sleep quality in Parkinson's disease: a mini review

The growing incidence of Parkinson's Disease (PD) is a major burden on the healthcare system. PD is caused by the degeneration of dopaminergic neurons and is known for its effects on motor function and sleep. Sleep is vital for maintaining proper homeostasis and clearing the brain of metabolic waste. Adequate time spent in each sleep stage can help maintain homeostatic function; however, patients with PD appear to exhibit sleep impairments. Although medications enhance the function of remaining dopaminergic neurons and reduce motor symptoms, their potential to improve sleep is still under question. Recently, research has shifted towards exercise protocols to help improve sleep in patients with PD. This review aims to provide an overview of how sleep is impaired in patients with PD, such as experiencing a reduction in time spent in slow-wave sleep, and how exercise can help restore normal sleep function. A PubMed search summarized the relevant research on the effects of aerobic and resistance exercise on sleep in patients with PD. Both high and low-intensity aerobic and resistance exercises, along with exercises related to balance and coordination, have been shown to improve some aspects of sleep. Neurochemically, sleeping leads to an increase in toxin clearance, including α-synuclein. Furthermore, exercise appears to enhance the concentration of brain-derived neurotrophic factors, which has preliminary evidence to suggest correlations to time spent in slow-wave sleep. More research is needed to further elucidate the physiological mechanism pertaining to sleep and exercise in patients with PD.

Short sleep time may be the main reason for irregular breakfast to cause overweight-a cross-sectional study

Introduction

In recent years, the relationship between circadian rhythm and overweight and obesity has attracted the attention of many scholars.

Methods

To evaluate association between the duration of sleep and the regularity of breakfast and overweight. A total of 1,178 students from Qingdao University were selected by stratified cluster sampling. There were 601 males (24.69 ± 0.80 years old) and 569 females (24.54 ± 0.70 years old). We used body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) to define overweight levels. Chi-square test, Pearson correlation test, and logistic regression were applied to test association among overweight, sleep duration, sleep onset time, and breakfast regularity. Pittsburgh sleep quality index was used to assess the overall sleep quality of the study subjects. Mediation effect and Sobel test were used to analyze the effect of sleep duration on breakfast regularity and overweight.

Results

Only 34.1% of the population ate breakfast every day, and eating breakfast 1-3 times per week was associated with a higher risk of overweight (BMI: OR = 2.183, 95%CI: 1.369,3,481; WC: OR = 2.101, 95%CI: 1.232,3,583; WHR: OR = 2.108, 95%CI: 1.331,3,337). The effects of all types of Usual Breakfast Consumption Frequency on overweight were fully mediated by sleep duration (p < 0.05). In particular, the subjects exercised outdoors more than five times per week slept longer (p < 0.05).

Conclusion

Short sleep duration may be the main reason for irregular breakfast leading to overweight. Adequate outdoor exercise is essential for weight maintenance.

Comparison Between High School Youth and College Freshmen Toward Their Psychological Disorders Under the Influence of Sleep Hygiene During COVID-19 Pandemic

OBJECTIVE

Adolescents experience the critical period for physical and psychological growth. Few studies focus on the influence of sleep hygiene on the psychological health of adolescence aging from high school to freshmen year. Also, the influence from the COVID-19 pandemic has a public health significance.

METHODS

A total of 698 students from high schools and colleges were included in the manuscript, and a cross-sectional procedure was conducted, objective to make an epidemiological comparison of the social phobia/depression prevalence, and discuss the effects of potential determinants.

RESULTS

Psychological problems including social phobia and depression were prevalent especially among the high school students, with the female gender showing higher possibilities. Current results also indicated that the association between sleep status and the occurrence of social phobia is most obvious among high school students, while relatively higher MMR risks was found both for high school students showing symptoms of social phobia and college freshmen with depressive symptoms. Moreover, the interaction between social phobia and depression was obvious for both populations.

CONCLUSIONS

Psychological problems including social phobia symptoms and depression are more prevalent among the high school females when compared with their male and freshemen peers. Sgnificant influencial factors for the risk of psychological problems among 2 populations are different, but media multitasking status should be paid attention to for both.

Epidemiology of Sleep Disturbances Among Primary School Students in Kerman, Iran, in 2019

Primary sleep disturbances are common in both children and adults and can lead to cognitive problems and educational and psychological disorders. In this study, we evaluated the epidemiology of sleep disturbances among children in Kerman, Iran, in 2019. This cross-sectional study was done in 2019 with 561 children in elementary schools of Kerman, Iran. Data were collected by a Pittsburgh Sleep Quality Index (PSQI) questionnaire that was filled out by parents and analyzed statistically. A total of 561children with a mean age of 9.54 ± 1.55 years were enrolled. The ratio of boys to girls was 1.01 and consistent across age groups. The prevalence of sleep disturbances in this population study was 26.7% (150 patients); 51.3% of them were girls. Sleep disturbances were associated with mothers' lower education level and parents' higher job positions (P < .05). This study showed the relatively high prevalence of sleep disturbances among children in this region. It can be reduced by a program such as sleep training or by promoting the level of parents' education. We recommend some educational programs and preschool screening to evaluate sleep disturbances and educating the parents to increase their responsiveness.