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Crowther ME, Ferguson SA, Gupta CC, Reynolds AC. The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale. Behav Sleep Med 2024; 22:353-377. [PMID: 37807653 DOI: 10.1080/15402002.2023.2265520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale. METHODS The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire. RESULTS The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis. CONCLUSIONS The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.
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Affiliation(s)
- Meagan E Crowther
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Sally A Ferguson
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Charlotte C Gupta
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, South Australia, Australia
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Kaambwa B, Woods TJ, Natsky A, Bulamu N, Mpundu-Kaambwa C, Loffler KA, Sweetman A, Catcheside PG, Reynolds AC, Adams R, Eckert DJ. Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review. Pharmacoeconomics 2024; 42:507-526. [PMID: 38340220 DOI: 10.1007/s40273-023-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions. OBJECTIVES This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences. RESULTS Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression. CONCLUSIONS This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Taylor-Jade Woods
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Andrea Natsky
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Norma Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Kelly A Loffler
- Health Data and Clinical Trials, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Peter G Catcheside
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (Sleep Health)/formerly Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA, Australia
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Scott H, Muench A, Appleton S, Reynolds AC, Loffler KA, Bickley K, Haycock J, Lovato N, Micic G, Lack L, Sweetman A. Sex differences in response to cognitive behavioural therapy for insomnia: A chart review of 455 patients with chronic insomnia. Sleep Med 2024; 116:123-128. [PMID: 38460417 DOI: 10.1016/j.sleep.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Insomnia is more prevalent in females, however studies examining sex differences in response to insomnia treatment are scarce. This study assessed sex-specific differences in cognitive behavioural therapy for insomnia (CBT-I)-related changes in insomnia symptoms in a large clinical cohort. METHODS A chart review was conducted of a clinical cohort (females n = 305, males n = 150) referred to a sleep clinic. Participants had a registered psychologist confirm diagnosis of chronic insomnia according to DSM-IV/V criteria and a Level 1 or 2 sleep study. Daily sleep diaries and questionnaires including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), the Daytime Feelings and Functioning Scale (DFFS), and the Depression, Anxiety and Stress Scale-21 items (DASS), were administered at baseline, post-treatment, and three-month follow-up. Linear mixed models determined interactions between sex and timepoint on symptoms. RESULTS Mean (SD) age was 51.7 yrs (15.7, range = 18-90 yrs), and mean BMI was 26.3 kg/m2 (4.9), neither of which differed by sex. At pre-treatment, females demonstrated higher objective total sleep time (min) [343.5 (97.6) vs 323.8 min (92.1), p = 0.044], ISI [19.7 (4.2) vs 18.6 (4.4), p = 0.033], and FFS scores [19.2 (6.0) vs 16.9 (7.2), p = 0.003]. Compared to males, females experienced a greater reduction in FFS and DFFS scores and DASS depressive symptoms (p for interaction: 0.017, 0.043, 0.016 respectively) from baseline to follow-up. The greater reduction in depressive symptoms did not persist after controlling for age, BMI, and sleep apnea severity. Subjective total sleep time similarly increased across treatment for both males [baseline: 335.7 (15.1), post: 357.9 (15.5)] and females [baseline: 318.3 (10.4), post: 354.4 (10.7)], p for interaction: 0.22. CONCLUSION Females and males experience similar, substantial benefits from CBT-I after accounting for comorbidities, suggesting the same treatment can resolve insomnia in both sexes.
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Affiliation(s)
- Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia.
| | - Alexandria Muench
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Sarah Appleton
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Kelly A Loffler
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Jenny Haycock
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
| | - Gorica Micic
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Leon Lack
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
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Scott H, Naik G, Lechat B, Manners J, Fitton J, Nguyen DP, Hudson AL, Reynolds AC, Sweetman A, Escourrou P, Catcheside P, Eckert DJ. Are we getting enough sleep? Frequent irregular sleep found in an analysis of over 11 million nights of objective in-home sleep data. Sleep Health 2024; 10:91-97. [PMID: 38071172 DOI: 10.1016/j.sleh.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES Evidence-based guidelines recommend that adults should sleep 7-9 h/night for optimal health and function. This study used noninvasive, multinight, objective sleep monitoring to determine average sleep duration and sleep duration variability in a large global community sample, and how often participants met the recommended sleep duration range. METHODS Data were analyzed from registered users of the Withings under-mattress Sleep Analyzer (predominantly located in Europe and North America) who had ≥28 nights of sleep recordings, averaging ≥4 per week. Sleep durations (the average and standard deviation) were assessed across a ∼9-month period. Associations between age groups, sex, and sleep duration were assessed using linear and logistic regressions, and proportions of participants within (7-9 hours) or outside (<7 hours or >9 hours) the recommended sleep duration range were calculated. RESULTS The sample consisted of 67,254 adults (52,523 males, 14,731 females; aged mean ± SD 50 ± 12 years). About 30% of adults demonstrated an average sleep duration outside the recommended 7-9 h/night. Even in participants with an average sleep duration within 7-9 hours, about 40% of nights were outside this range. Only 15% of participants slept between 7 and 9 hours for at least 5 nights per week. Female participants had significantly longer sleep durations than male participants, and middle-aged participants had shorter sleep durations than younger or older participants. CONCLUSIONS These findings indicate that a considerable proportion of adults are not regularly sleeping the recommended 7-9 h/night. Even among those who do, irregular sleep is prevalent. These novel data raise several important questions regarding sleep requirements and the need for improved sleep health policy and advocacy.
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Affiliation(s)
- Hannah Scott
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia.
| | - Ganesh Naik
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | - Bastien Lechat
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | - Jack Manners
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | - Josh Fitton
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | - Duc Phuc Nguyen
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | - Anna L Hudson
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia; Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Amy C Reynolds
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | - Alexander Sweetman
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | | | - Peter Catcheside
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, Flinders University, Adelaide, Australia
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Reynolds AC, Loffler KA, Grivell N, Brown BW, Adams RJ. Diagnosis and management of sleep disorders in shift workers, with patient informed solutions to improve health services research and practice. Sleep Med 2024; 113:131-141. [PMID: 38016359 DOI: 10.1016/j.sleep.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The combination of shift work and an unmanaged sleep disorder carries health and safety risks. Yet, diagnosis rates for sleep disorders are low in shift workers. The aim of this study was to understand the experience of sleep disorder diagnosis and treatment in shift workers, and consider patient informed solutions to improve access to health services. METHODS Semi-structured interviews were conducted with 16 Australian shift workers with a diagnosed sleep disorder. Patient journey mapping and reflexive thematic analysis were used to understand diagnosis and management experiences. RESULTS There were highly variable experiences with diagnosis and management, often taking >5 years to seek help from a health care provider (HCP) after noticing symptoms of a sleep disorder. Three themes were constructed, including 'the cause of the problem', 'prioritising work', and '(dis)satisfaction and (dis)connection'. Extent of patient and HCP awareness of sleep disorders, and a prevailing attitude of shift work being 'the problem' impacted diagnosis, as did organisational needs (including rostering, which had both positive and negative influences on help seeking). Relationships with HCPs were important, and living on non-standard time was both a barrier and an enabler to sleep disorder care. Participants identified the need for education and awareness, prompts and easy access to screening and referral pathways, and tailored models of care. CONCLUSION Education and awareness initiatives for shift workers, their employers and HCPs, together with development of a model of care for shift workers with sleep disorders may address some of the unique barriers to diagnosis and management.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.
| | - Kelly A Loffler
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia; Health Data and Clinical Trials, Flinders University, Bedford Park, SA, Australia
| | - Nicole Grivell
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Brandon Wj Brown
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
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Lechat B, Scott H, Manners J, Adams R, Proctor S, Mukherjee S, Catcheside P, Eckert DJ, Vakulin A, Reynolds AC. Multi-night measurement for diagnosis and simplified monitoring of obstructive sleep apnoea. Sleep Med Rev 2023; 72:101843. [PMID: 37683555 DOI: 10.1016/j.smrv.2023.101843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
Substantial night-to-night variability in obstructive sleep apnoea (OSA) severity has raised misdiagnosis and misdirected treatment concerns with the current prevailing single-night diagnostic approach. In-home, multi-night sleep monitoring technology may provide a feasible complimentary diagnostic pathway to improve both the speed and accuracy of OSA diagnosis and monitor treatment efficacy. This review describes the latest evidence on night-to-night variability in OSA severity, and its impact on OSA diagnostic misclassification. Emerging evidence for the potential impact of night-to-night variability in OSA severity to influence important health risk outcomes associated with OSA is considered. This review also characterises emerging diagnostic applications of wearable and non-wearable technologies that may provide an alternative, or complimentary, approach to traditional OSA diagnostic pathways. The required evidence to translate these devices into clinical care is also discussed. Appropriately sized randomised controlled trials are needed to determine the most appropriate and effective technologies for OSA diagnosis, as well as the optimal number of nights needed for accurate diagnosis and management. Potential risks versus benefits, patient perspectives, and cost-effectiveness of these novel approaches should be carefully considered in future trials.
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Affiliation(s)
- Bastien Lechat
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia.
| | - Hannah Scott
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Jack Manners
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Simon Proctor
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Sutapa Mukherjee
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
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Reynolds AC, Kyle SD, Sletten TL, Adams RJ. Cognitive behavioural therapy for insomnia: Can we make it work for shift work? Sleep Med Rev 2023; 72:101864. [PMID: 37864915 DOI: 10.1016/j.smrv.2023.101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.
| | - Simon D Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Tracey L Sletten
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton VIC, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, Flinders University, Bedford Park SA, Australia
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Melaku YA, Appleton S, Reynolds AC, Milne RL, Lynch BM, Eckert DJ, Adams R. Healthy lifestyle is associated with reduced cardiovascular disease, depression and mortality in people at elevated risk of sleep apnea. J Sleep Res 2023:e14069. [PMID: 37867414 DOI: 10.1111/jsr.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/04/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
We assessed: (1) the independent and joint association of obstructive sleep apnea risk and healthy lifestyle with common consequences (excessive daytime sleepiness, depression, cardiovascular disease and stroke) of obstructive sleep apnea; and (2) the effect of healthy lifestyle on survival in people with increased obstructive sleep apnea risk. Data from 13,694 adults (median age 46 years; 50% men) were used for cross-sectional and survival analyses (mortality over 15 years). A healthy lifestyle score with values from 0 (most unhealthy) to 5 (most healthy) was determined based on diet, alcohol intake, physical activity, smoking and body mass index. In the cross-sectional analysis, obstructive sleep apnea risk was positively associated with all chronic conditions and excessive daytime sleepiness in a dose-response manner (p for trend < 0.001). The healthy lifestyle was inversely associated with all chronic conditions (p for trend < 0.001) but not with excessive daytime sleepiness (p for trend = 0.379). Higher healthy lifestyle score was also associated with reduced odds of depression and cardiovascular disease. We found an inverse relationship between healthy lifestyle score with depression (p for trend < 0.001), cardiovascular disease (p for trend = 0.003) and stroke (p for trend = 0.025) among those who had high obstructive sleep apnea risk. In the survival analysis, we found an inverse association between healthy lifestyle and all-cause mortality for all categories of obstructive sleep apnea risk (moderate/high- and high-risk groups [p for trend < 0.001]). This study emphasises the crucial role of a healthy lifestyle in mitigating the effects of obstructive sleep apnea risk in individuals with an elevated obstructive sleep apnea risk.
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Affiliation(s)
- Yohannes Adama Melaku
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sarah Appleton
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Amy C Reynolds
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Danny J Eckert
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Robert Adams
- FHMRI Sleep (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
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Reynolds AC, Coenen P, Lechat B, Straker L, Zabatiero J, Maddison KJ, Adams RJ, Eastwood P. Insomnia and workplace productivity loss among young working adults: a prospective observational study of clinical sleep disorders in a community cohort. Med J Aust 2023; 219:107-112. [PMID: 37357134 DOI: 10.5694/mja2.52014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To examine associations between three clinically significant sleep disorders (chronic insomnia, obstructive sleep apnoea, restless legs syndrome) and workplace productivity losses among young Australian adults. DESIGN, SETTING Prospective, observational study; 22-year follow-up of participants in the longitudinal birth cohort Raine Study (Perth, Western Australia). PARTICIPANTS Currently employed 22-year-old Raine Study participants who underwent in-laboratory sleep disorder screening for moderate to severe obstructive sleep apnoea (apnoea-hypopnea index of more than fifteen events/hour or obstructive sleep apnoea syndrome) and were assessed for insomnia and restless legs syndrome using validated measures. MAIN OUTCOME MEASURES Total workplace productivity loss over twelve months, assessed with the World Health Organization Health and Work Performance Questionnaire. RESULTS Of 1235 contactable 22-year-old Raine Study cohort members, 554 people (44.9%; 294 women [53%]) underwent overnight polysomnography, completed the baseline sleep questionnaire, and completed at least three quarterly workplace productivity assessments. One or more clinically significant sleep disorders were identified in 120 participants (21.7%); 90 participants had insomnia (17%), thirty clinically significant obstructive sleep apnoea (5.4%), and two restless legs syndrome (0.4%). Seventeen people (14% of those with sleep disorders) had previously been diagnosed with a sleep disturbance by a health professional, including fourteen with insomnia. Median total workplace productivity loss was greater for participants with sleep disorders (164 hours/year; interquartile range [IQR], 0-411 hours/year) than for those without sleep disorders (30 hours/year; IQR, 0-202 hours/year); total workplace productivity loss was 40% greater for participants with sleep disorders (adjusted incidence rate ratio, 1.40; bias-corrected and accelerated 95% confidence interval, 1.10-1.76). The estimated population total productivity loss (weighted for disorder prevalence) was 28 644 hours per 1000 young workers per year, primarily attributable to insomnia (28 730 hours/1000 workers/year). CONCLUSION Insomnia is a risk factor for workplace productivity loss in young workers. Tailored interventions are needed to identify and manage sleep disorders, particularly as most of the sleep disorders detected in the Raine Study had not previously been diagnosed.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
| | - Pieter Coenen
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
| | | | | | - Kath J Maddison
- The University of Western Australia, Perth, WA
- West Australian Sleep Disorders Research Institute, Perth, WA
- Sir Charles Gairdner Hospital, Perth, WA
| | | | - Peter Eastwood
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA
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10
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Russell DI, Reynolds AC, Appleton SL, Adams RJ, Correia H, Bowman JA, Gill TK, Metse AP. Use of Insomnia Treatments and Discussions About Sleep with Health Professionals Among Australian Adults with Mental Health Conditions. Nat Sci Sleep 2023; 15:623-637. [PMID: 37577358 PMCID: PMC10417743 DOI: 10.2147/nss.s412468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background Insomnia is a common issue among individuals with mental health conditions, yet the frequency of insomnia treatment remains unclear. The purpose of this study was to investigate the prevalence of probable insomnia, discussions regarding sleep with health professionals, and the utilisation of commonly delivered insomnia treatments in Australian adults diagnosed with mental health conditions. Methods This study represents a secondary analysis of data collected through a cross-sectional, national online survey conducted in 2019. A subset included participants (n = 624, age 18-85y) who self-reported a diagnosis of depression, bipolar disorder, anxiety, panic disorder, or post-traumatic stress disorder. Participants were classed as having probable insomnia based on self-reported symptoms and a minimum availability of 7.5 hours in bed. Results Among individuals with probable insomnia (n = 296, 47.4%), 64.5% (n = 191) reported discussing sleep with one or more health professionals, predominantly with general practitioners (n = 160, 83.8%). However, 35.4% (n = 105) of people with probable insomnia had not discussed their sleep with a health professional. Additionally, 35.1% (n = 104) used prescribed medication for sleep, while only 15.9% (n = 47) had used the first line recommended treatment of cognitive-behavioral therapy for insomnia in the last 12 months. Conclusion Although most participants who met the criteria for probable insomnia had engaged in discussions about sleep with health professionals, utilisation of first line recommended treatment was low. Interventions that promote routine assessment of sleep and first line treatment for insomnia by health professionals would likely benefit people with mental health conditions.
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Affiliation(s)
- Daniel I Russell
- College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Freemasons Centre for Male Health & Wellbeing, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Freemasons Centre for Male Health & Wellbeing, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Helen Correia
- Psychological Sciences, Australian College of Applied Professions Perth, Northbridge, Western Australia, 6003, Australia
| | - Jenny A Bowman
- School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Alexandra P Metse
- School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, 4556, Australia
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Yuan H, Plekhanova T, Walmsley R, Reynolds AC, Maddison KJ, Bucan M, Gehrman P, Rowlands A, Ray DW, Bennett D, McVeigh J, Straker L, Eastwood P, Kyle SD, Doherty A. Self-supervised learning of accelerometer data provides new insights for sleep and its association with mortality. medRxiv 2023:2023.07.07.23292251. [PMID: 37461532 PMCID: PMC10350137 DOI: 10.1101/2023.07.07.23292251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Background Sleep is essential to life. Accurate measurement and classification of sleep/wake and sleep stages is important in clinical studies for sleep disorder diagnoses and in the interpretation of data from consumer devices for monitoring physical and mental well-being. Existing non-polysomnography sleep classification techniques mainly rely on heuristic methods developed in relatively small cohorts. Thus, we aimed to establish the accuracy of wrist-worn accelerometers for sleep stage classification and subsequently describe the association between sleep duration and efficiency (proportion of total time asleep when in bed) with mortality outcomes. Methods We developed and validated a self-supervised deep neural network for sleep stage classification using concurrent laboratory-based polysomnography and accelerometry data from three countries (Australia, the UK, and the USA). The model was validated within-cohort using subject-wise five-fold cross-validation for sleep-wake classification and in a three-class setting for sleep stage classification wake, rapid-eye-movement sleep (REM), non-rapid-eye-movement sleep (NREM) and by external validation. We assessed the face validity of our model for population inference by applying the model to the UK Biobank with 100,000 participants, each of whom wore a wristband for up to seven days. The derived sleep parameters were used in a Cox regression model to study the association of sleep duration and sleep efficiency with all-cause mortality. Findings After exclusion, 1,448 participant nights of data were used to train the sleep classifier. The difference between polysomnography and the model classifications on the external validation was 34.7 minutes (95% limits of agreement (LoA): -37.8 to 107.2 minutes) for total sleep duration, 2.6 minutes for REM duration (95% LoA: -68.4 to 73.4 minutes) and 32.1 minutes (95% LoA: -54.4 to 118.5 minutes) for NREM duration. The derived sleep architecture estimate in the UK Biobank sample showed good face validity. Among 66,214 UK Biobank participants, 1,642 mortality events were observed. Short sleepers (<6 hours) had a higher risk of mortality compared to participants with normal sleep duration (6 to 7.9 hours), regardless of whether they had low sleep efficiency (Hazard ratios (HRs): 1.69; 95% confidence intervals (CIs): 1.28 to 2.24 ) or high sleep efficiency (HRs: 1.42; 95% CIs: 1.14 to 1.77). Interpretation Deep-learning-based sleep classification using accelerometers has a fair to moderate agreement with polysomnography. Our findings suggest that having short overnight sleep confers mortality risk irrespective of sleep continuity.
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Affiliation(s)
- Hang Yuan
- Nuffield Department of Population Health, University of Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
| | | | - Rosemary Walmsley
- Nuffield Department of Population Health, University of Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
| | - Amy C Reynolds
- College of Medicine and Public Health, Flinders University, Australia
| | - Kathleen J Maddison
- Centre of Sleep Science, School of Human Sciences, University of Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Australia
| | - Maja Bucan
- Department of Genetics, University of Pennsylvania, USA
| | - Philip Gehrman
- Department of Psychiatry, University of Pennsylvania, USA
| | - Alex Rowlands
- Diabetes Research Centre, University of Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, UK
| | - David W Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Derrick Bennett
- Nuffield Department of Population Health, University of Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, UK
| | - Joanne McVeigh
- Curtin School of Allied Health, Curtin University, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Australia
| | | | - Simon D Kyle
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Aiden Doherty
- Nuffield Department of Population Health, University of Oxford, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
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12
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Balfour D, Melton PE, McVeigh JA, Huang R, Eastwood PR, Wanstall S, Reynolds AC, Cohen‐Woods S. Childhood sleep health and epigenetic age acceleration in late adolescence: Cross-sectional and longitudinal analyses. Acta Paediatr 2023; 112:1001-1010. [PMID: 36808764 PMCID: PMC10952569 DOI: 10.1111/apa.16719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/14/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
AIM Investigate if childhood measures of sleep health are associated with epigenetic age acceleration in late adolescence. METHODS Parent-reported sleep trajectories from age 5 to 17, self-reported sleep problems at age 17, and six measures of epigenetic age acceleration at age 17 were studied in 1192 young Australians from the Raine Study Gen2. RESULTS There was no evidence for a relationship between the parent-reported sleep trajectories and epigenetic age acceleration (p ≥ 0.17). There was a positive cross-sectional relationship between self-reported sleep problem score and intrinsic epigenetic age acceleration at age 17 (b = 0.14, p = 0.04), which was attenuated after controlling for depressive symptom score at the same age (b = 0.08, p = 0.34). Follow-up analyses suggested this finding may represent greater overtiredness and intrinsic epigenetic age acceleration in adolescents with higher depressive symptoms. CONCLUSION There was no evidence for a relationship between self- or parent-reported sleep health and epigenetic age acceleration in late adolescence after adjusting for depressive symptoms. Mental health should be considered as a potential confounding variable in future research on sleep and epigenetic age acceleration, particularly if subjective measures of sleep are used.
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Affiliation(s)
- David Balfour
- College of Education, Psychology, and Social WorkFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Phillip E. Melton
- Menzies Institute for Medical Research, College of Health and MedicineUniversity of TasmaniaHobartTasmaniaAustralia
- School of Population and Global HealthThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Joanne A. McVeigh
- Curtin School of Allied HealthCurtin UniversityPerthWestern AustraliaAustralia
- Movement Physiology Laboratory, School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Rae‐Chi Huang
- Nutrition and Health Innovation Research Institute (NHIRI)Edith Cowan UniversityPerthWestern AustraliaAustralia
| | - Peter R. Eastwood
- Flinders Health and Medical Research Institute (Sleep Health)Flinders UniversityAdelaideSouth AustraliaAustralia
| | - Sian Wanstall
- Flinders Health and Medical Research Institute (Sleep Health)Flinders UniversityAdelaideSouth AustraliaAustralia
| | - Amy C. Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)Flinders UniversityAdelaideSouth AustraliaAustralia
| | - Sarah Cohen‐Woods
- College of Education, Psychology, and Social WorkFlinders UniversityAdelaideSouth AustraliaAustralia
- Flinders University Institute for Mental Health and WellbeingFlinders UniversityAdelaideSouth AustraliaAustralia
- Flinders Centre for Innovation in CancerFlinders UniversityAdelaideSouth AustraliaAustralia
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13
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Paterson JL, Thomas MJ, Reynolds AC, Sprajcer M, Gupta C, Gibson RH, Vincent GE, Ferguson SA. "I need to be alert at night to provide care": Factors associated with problematic sleep among young Australian caregivers. Behav Sleep Med 2023; 21:322-331. [PMID: 35762128 DOI: 10.1080/15402002.2022.2093879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES There is increased recognition that young people (<25 years) may occupy a carer role for family or others with health conditions or disability. This is often in addition to study and social activities. This means competing demands on time, and insufficient sleep. Our aim was to determine the contribution of caring duties to problematic sleep in young carers. METHODS A survey of Australian carers was conducted, including questions on demographics, characteristics of the carer and care recipient, and sleep quality and quantity. Participants were eligible if they reported sleep time <7 hr or dissatisfaction with their sleep, and were aged 15-24 years. RESULTS A total of 110 participants (71.8%_female = 79, 15-17 years = 62, 18-24 years = 48) were included in analysis; 55.5% (n= 61) reporting dissatisfaction with their sleep and 62.7% (n= 69) reporting typically less than 7 hr sleep per night. Sleep duration was significantly shorter for those who reported 1-2 or ≥3 awakenings to provide care, compared with no awakenings (p_< .05). Sleep quality, as described by scores on the Pittsburgh Sleep Quality Index (PSQI) was also significantly worse for those who were frequently awoken by their care recipient (p < .05). Worrying about the care recipient, being woken by the care recipient, and listening out for the care recipient were the most frequently identified factors impacting on sleep. CONCLUSION Young carers experience reduced sleep duration and poor sleep quality. Strategies to alleviate the burden of care work on young carer's sleep would benefit the health and safety of this group.
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Affiliation(s)
- Jessica L Paterson
- Flinders Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Australia
| | - Matthew Jw Thomas
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, Australia
| | - Amy C Reynolds
- Adelaide Institute for Sleep Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Australia
| | - Madeline Sprajcer
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, Australia
| | - Charlotte Gupta
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, Australia
| | - Rosemary H Gibson
- Sleep/Wake Research Centre, School of Health Sciences, Massey University, Wellington, and School of Psychology, Massey University Palmerston North, New Zealand
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, Australia
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14
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Manners J, Appleton SL, Reynolds AC, Melaku YA, Gill TK, Lovato N, Sweetman A, Bickley K, Adams R, Lack L, Scott H. The Good Sleeper Scale-15 items: a questionnaire for the standardised assessment of good sleepers. J Sleep Res 2023; 32:e13717. [PMID: 36065002 DOI: 10.1111/jsr.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/13/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale-15 items (GSS-15). Data were derived from a population-based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut-off scores and test associations with sleep, daytime functioning, health, and quality-of-life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS-15 global scores and outcomes, including 'a good night's sleep' (r = 0.7), 'feeling un-refreshed' (r = -0.59), and 'experienced sleepiness' (r = -0.51), p < 0.001. Cut-off scores were derived to categorise individuals likely to be a good sleeper (GSS-15 score ≥40) and those very likely to be a good sleeper (GSS-15 score ≥45). The GSS-15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples.
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Affiliation(s)
- Jack Manners
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leon Lack
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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15
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Lechat B, Loffler KA, Reynolds AC, Naik G, Vakulin A, Jennings G, Escourrou P, McEvoy RD, Adams RJ, Catcheside PG, Eckert DJ. High night-to-night variability in sleep apnea severity is associated with uncontrolled hypertension. NPJ Digit Med 2023; 6:57. [PMID: 36991115 DOI: 10.1038/s41746-023-00801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Obstructive sleep apnea (OSA) severity can vary markedly from night-to-night. However, the impact of night-to-night variability in OSA severity on key cardiovascular outcomes such as hypertension is unknown. Thus, the primary aim of this study is to determine the effects of night-to-night variability in OSA severity on hypertension likelihood. This study uses in-home monitoring of 15,526 adults with ~180 nights per participant with an under-mattress sleep sensor device, plus ~30 repeat blood pressure measures. OSA severity is defined from the mean estimated apnea-hypopnoea index (AHI) over the ~6-month recording period for each participant. Night-to-night variability in severity is determined from the standard deviation of the estimated AHI across recording nights. Uncontrolled hypertension is defined as mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥90 mmHg. Regression analyses are performed adjusted for age, sex, and body mass index. A total of 12,287 participants (12% female) are included in the analyses. Participants in the highest night-to-night variability quartile within each OSA severity category, have a 50-70% increase in uncontrolled hypertension likelihood versus the lowest variability quartile, independent of OSA severity. This study demonstrates that high night-to-night variability in OSA severity is a predictor of uncontrolled hypertension, independent of OSA severity. These findings have important implications for the identification of which OSA patients are most at risk of cardiovascular harm.
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Affiliation(s)
- Bastien Lechat
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ganesh Naik
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Garry Jennings
- Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | | | - R Doug McEvoy
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Peter G Catcheside
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health and FHMRI Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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16
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Scott H, Lechat B, Guyett A, Reynolds AC, Lovato N, Naik G, Appleton S, Adams R, Escourrou P, Catcheside P, Eckert DJ. Sleep Irregularity Is Associated With Hypertension: Findings From Over 2 Million Nights With a Large Global Population Sample. Hypertension 2023; 80:1117-1126. [PMID: 36974682 DOI: 10.1161/hypertensionaha.122.20513] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Irregularities in sleep duration and sleep timing have emerged as potential risk factors for hypertension. This study examined associations between irregularity in sleep duration and timing with hypertension in a large, global sample over multiple months. METHODS Data from 12 287 adults, who used an under-mattress device to monitor sleep duration and timing and also provided blood pressure recordings on ≥5 separate occasions, were analyzed. Sleep duration irregularity was assessed as the SD in total sleep time across the ≈9-month recording period. Sleep timing irregularity was assessed as SDs in sleep onset time, sleep midpoint, and sleep offset time. Logistic regressions were conducted to investigate associations between sleep irregularity and hypertension, defined as median systolic blood pressure ≥140 mm Hg or median diastolic blood pressure ≥90 mm Hg. RESULTS Participants were middle-aged (mean±SD, 50±12 years), mostly men (88%) and overweight (body mass index, 28±6 kg/m-2). Sleep duration irregularity was consistently associated with an ≈9% to 17% increase in hypertension independently of the total sleep time. A ≈34-minute increase in sleep onset time irregularity was associated with a 32% increase in hypertension (1.32 [1.20-1.45]). A 32-minute increase in sleep midpoint irregularity was associated with an 18% increase in hypertension (1.18 [1.09-1.29]), while a 43-minute increase in sleep offset time irregularity was associated with an 8.9% increase in hypertension (1.09 [1.001-1.18]). CONCLUSIONS These findings support that sleep irregularity, both in duration and timing, is a risk marker for poor cardiovascular health. Further mechanistic investigations of temporal relationships between day-to-day fluctuations in sleep duration and timing, next-day blood pressure, and other cardiovascular outcomes are warranted.
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Affiliation(s)
- Hannah Scott
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Bastien Lechat
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Alisha Guyett
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Amy C Reynolds
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Nicole Lovato
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Ganesh Naik
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Sarah Appleton
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Robert Adams
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | | | - Peter Catcheside
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
| | - Danny J Eckert
- Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute (FHMRI) Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia (H.S., B.L., A.G., A.C.R., N.L., G.N., S.A., R.A., P.C., D.J.E.)
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Scott H, Lechat B, Manners J, Lovato N, Vakulin A, Catcheside P, Eckert DJ, Reynolds AC. Emerging applications of objective sleep assessments towards the improved management of insomnia. Sleep Med 2023; 101:138-145. [PMID: 36379084 DOI: 10.1016/j.sleep.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Self-reported sleep difficulties are the primary concern associated with diagnosis and treatment of chronic insomnia. This said, in-home sleep monitoring technology in combination with self-reported sleep outcomes may usefully assist with the management of insomnia. The rapid acceleration in consumer sleep technology capabilities together with their growing use by consumers means that the implementation of clinically useful techniques to more precisely diagnose and better treat insomnia are now possible. This review describes emerging techniques which may facilitate better identification and management of insomnia through objective sleep monitoring. Diagnostic techniques covered include insomnia phenotyping, better detection of comorbid sleep disorders, and identification of patients potentially at greatest risk of adverse outcomes. Treatment techniques reviewed include the administration of therapies (e.g., Intensive Sleep Retraining, digital treatment programs), methods to assess and improve treatment adherence, and sleep feedback to address concerns about sleep and sleep loss. Gaps in sleep device capabilities are also discussed, such as the practical assessment of circadian rhythms. Proof-of-concept studies remain needed to test these sleep monitoring-supported techniques in insomnia patient populations, with the goal to progress towards more precise diagnoses and efficacious treatments for individuals with insomnia.
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Affiliation(s)
- Hannah Scott
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia.
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Jack Manners
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
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Bawden L, Gerace A, Reynolds AC, Anderson JR. Psychological and demographic predictors of support for same-sex marriage: An Australian survey. Psychology & Sexuality 2022. [DOI: 10.1080/19419899.2022.2158363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Lisa Bawden
- College of Psychology, School of Health, Medical and Applied Sciences, CQUniversity
| | - Adam Gerace
- College of Psychology, School of Health, Medical and Applied Sciences, CQUniversity
| | - Amy C. Reynolds
- College of Psychology, School of Health, Medical and Applied Sciences, CQUniversity
- College of Medicine and Public Health, Flinders University
| | - Joel R. Anderson
- School of Behavioural and Health Sciences, Australian Catholic University
- Australian Centre for Sex, Health, and Society, La Trobe University
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20
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Reynolds AC, Lechat B, Melaku YA, Sansom K, Brown BWJ, Crowther ME, Wanstall S, Maddison KJ, Walsh JH, Straker L, Adams RJT, McArdle N, Eastwood PR. Shift work, clinically significant sleep disorders and mental health in a representative, cross-sectional sample of young working adults. Sci Rep 2022; 12:16255. [PMID: 36171220 PMCID: PMC9519578 DOI: 10.1038/s41598-022-20308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
Mental health conditions confer considerable global disease burden in young adults, who are also the highest demographic to work shifts, and of whom 20% meet criteria for a sleep disorder. We aimed to establish the relationship between the combined effect of shift work and sleep disorders, and mental health. The Raine Study is the only longitudinal, population-based birth cohort in the world with gold-standard, Level 1 measurement of sleep (polysomnography, PSG) collected in early adulthood. Participants (aged 22y) underwent in-laboratory PSG and completed detailed sleep questionnaires. Multivariable adjusted robust linear regression models were conducted to explore associations with anxiety (GAD7) and depression (PHQ9), adjusted for sex, health comorbidities, and work hours/week. Data were from 660 employed young adults (27.3% shift workers). At least one clinically significant sleep disorder was present in 18% of shift workers (day, evening and night shifts) and 21% of non-shift workers (p = 0.51); 80% were undiagnosed. Scores for anxiety and depression were not different between shift and non-shift workers (p = 0.29 and p = 0.82); but were higher in those with a sleep disorder than those without (Md(IQR) anxiety: 7.0(4.0-10.0) vs 4.0(1.0-6.0)), and depression: (9.0(5.0-13.0) vs 4.0(2.0-6.0)). Considering evening and night shift workers only (i.e. excluding day shift workers) revealed an interaction between shift work and sleep disorder status for anxiety (p = 0.021), but not depression (p = 0.96), with anxiety scores being highest in those shift workers with a sleep disorder (Md(IQR) 8.5(4.0-12.2). We have shown that clinical sleep disorders are common in young workers and are largely undiagnosed. Measures of mental health do not appear be different between shift and non-shift workers. These findings indicate that the identification and treatment of clinical sleep disorders should be prioritised for young workers as these sleep disorders, rather than shift work per se, are associated with poorer mental health. These negative mental health effects appear to be greatest in those who work evening and/or night shift and have a sleep disorder.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia.
| | - Bastien Lechat
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia
| | - Kelly Sansom
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Human Sciences, Centre for Sleep Science, The University of Western Australia, Perth, WA, Australia
| | - Brandon W J Brown
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia
| | - Meagan E Crowther
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia.,Appleton Institute, CQ University Australia, Adelaide, South Australia, Australia
| | - Sian Wanstall
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia
| | - Kathleen J Maddison
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Human Sciences, Centre for Sleep Science, The University of Western Australia, Perth, WA, Australia
| | - Jennifer H Walsh
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Human Sciences, Centre for Sleep Science, The University of Western Australia, Perth, WA, Australia
| | - Leon Straker
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Robert J T Adams
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia
| | - Nigel McArdle
- Department of Pulmonary Physiology and Sleep Medicine, West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Human Sciences, Centre for Sleep Science, The University of Western Australia, Perth, WA, Australia
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, Adelaide, South Australia, 5039, Australia.,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, Adelaide, Australia
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21
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Reynolds AC. How can I help my children understand my chronic autoimmune conditions and their management? BMJ 2022; 377:o1449. [PMID: 35697362 DOI: 10.1136/bmj.o1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
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22
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C Gupta C, Dominiak M, Kovac K, C Reynolds A, A Ferguson S, J Hilditch C, Sprajcer M, E Vincent G. On-call work and sleep: the importance of switching on during a callout and switching off after a call. Ind Health 2022; 60:91-96. [PMID: 34690251 PMCID: PMC8980688 DOI: 10.2486/indhealth.2021-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Due to the unpredictable nature of working time arrangements, on-call workers experience regular disruption to sleep, particularly if woken by calls. Sleep disruption can impact long term physical and mental health, next day performance, and importantly, performance immediately after waking. To reduce the impact of performance impairments upon waking (i.e., reducing sleep inertia), research has investigated strategies to promote alertness (e.g., bright light, caffeine, and exercise). This review puts forth on-call workers who are likely to return to sleep after a call, it is also important to consider the impact of these sleep inertia countermeasures on subsequent sleep. Future research should build on the preliminary evidence base for sleep inertia countermeasures by examining the impact on subsequent sleep. This research is key for both supporting alertness and performance during a call ("switching on") and for allowing the on-call worker to return to sleep after a call ("switching off").
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Affiliation(s)
- Charlotte C Gupta
- Central Queensland University, Appleton Institute for Behavioural Science, Australia
| | - Michelle Dominiak
- Central Queensland University, Appleton Institute for Behavioural Science, Australia
| | - Katya Kovac
- Central Queensland University, Appleton Institute for Behavioural Science, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Australia
| | - Sally A Ferguson
- Central Queensland University, Appleton Institute for Behavioural Science, Australia
| | - Cassie J Hilditch
- San José State University, Fatigue Countermeasures Laboratory, Department of Psychology, USA
| | - Madeline Sprajcer
- Central Queensland University, Appleton Institute for Behavioural Science, Australia
| | - Grace E Vincent
- Central Queensland University, Appleton Institute for Behavioural Science, Australia
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23
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Brown BWJ, Crowther ME, Appleton SL, Melaku YA, Adams RJ, Reynolds AC. Shift work disorder and the prevalence of help seeking behaviors for sleep concerns in Australia: A descriptive study. Chronobiol Int 2022; 39:714-724. [PMID: 35253569 DOI: 10.1080/07420528.2022.2032125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help seeking behaviours for sleep in shift workers is limited. The primary aim of this study was to examine the help seeking behaviours of Australian workers who meet criteria for SWD. Of the 448 (46% of sample, n = 964 total) Australian workers reporting non-standard work hours, 10.5% (n = 41) met the criteria for probable shift work disorder (pSWD). Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD. Of the small proportion of workers with pSWD who sought help, general practitioners were the most common healthcare professionals for sleep problems. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of 'accept it and keep going' as a sleepiness management strategy, highlighting a potential barrier to help seeking behaviour in workers with pSWD. These findings provide novel insight into the help seeking behaviours of those with pSWD. There is a need for further research to understand why individuals at risk for SWD are not actively seeking help, and to develop health promotion and intervention strategies to improve help seeking when needed.
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Affiliation(s)
- Brandon W J Brown
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | | | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
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Melaku YA, Reynolds AC, Appleton S, Sweetman A, Shi Z, Vakulin A, Catcheside P, Eckert DJ, Adams R. High quality and anti-inflammatory diets and a healthy lifestyle are associated with lower sleep apnea risk. J Clin Sleep Med 2022; 18:1667-1679. [PMID: 35232539 DOI: 10.5664/jcsm.9950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Most studies on diet and sleep apnea focus on calorie restriction. Here we investigate potential associations between dietary quality [healthy eating index (HEI), dietary inflammatory index (DII)] and overall healthy lifestyle with sleep apnea risk. METHODS National Health and Nutrition Examination Survey data (waves 2005-2008, and 2015-2018; N=14,210) were used to determine HEI, DII and their quintiles, with the fifth quintile indicating highest adherence to each dietary construct. A healthy lifestyle score was determined using diet, smoking, alcohol intake and physical activity level. STOP-BANG questionnaire was used to define sleep apnea risk. Generalized linear regression models with binomial family and logit link were used to investigate potential associations. The models were adjusted for socioeconomic status, lifestyle factors and chronic conditions. RESULTS Prevalence of high sleep apnea risk was 25.1%. Higher DII was positively associated with sleep apnea (odds ratio (OR)Q5 vs. Q1=1.55; 95% CI: 1.24-1.94; p for trend <0.001) whereas higher HEI was associated with reduced sleep apnea risk (ORQ5 VS. Q1=0.72: 0.59-0.88; p for trend=0.007). Higher healthy lifestyle score was also associated with decreased odds of sleep apnea (p for trend <0.001). There was a significant interaction between healthy lifestyle and sex with sleep apnea risk (p for interaction=0.049) whereby females with higher healthy lifestyle scores had lower risk of sleep apnea versus males. CONCLUSIONS Higher quality and anti-inflammatory diets and a healthier overall lifestyle are associated with lower sleep apnea risk. These findings underline the importance of strategies to improve overall diet quality and promote healthy behavior, not just calorie restriction, to reduce sleep apnea risk.
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Affiliation(s)
- Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sarah Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha Qatar
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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25
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Crowther ME, Ferguson SA, Reynolds AC. Longitudinal studies of sleep, physical activity and nutritional intake in shift workers: A scoping review. Sleep Med Rev 2022; 63:101612. [DOI: 10.1016/j.smrv.2022.101612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
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26
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McArdle N, Reynolds AC, Hillman D, Moses E, Maddison K, Melton P, Eastwood P. Prevalence of common sleep disorders in a middle-aged community sample. J Clin Sleep Med 2022; 18:1503-1514. [DOI: 10.5664/jcsm.9886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nigel McArdle
- University of Western Australia, School of health sciences, Nedlands, Western Australia
- West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Amy C. Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine & Public Health, Flinders University, South Australia
| | - David Hillman
- University of Western Australia, School of health sciences, Nedlands, Western Australia
- West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Eric Moses
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart Tasmania
- School of Biological Sciences, University of Western Australia, Crawley, Western Australia
| | - Kath Maddison
- University of Western Australia, School of health sciences, Nedlands, Western Australia
- West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Phillip Melton
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart Tasmania
- School of Global and Population Health, University of Western Australia, Nedlands, Western Australia
| | - Peter Eastwood
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine & Public Health, Flinders University, South Australia
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Appleton SL, Reynolds AC, Gill TK, Melaku YA, Adams RJ. Insomnia Prevalence Varies with Symptom Criteria Used with Implications for Epidemiological Studies: Role of Anthropometrics, Sleep Habit, and Comorbidities. Nat Sci Sleep 2022; 14:775-790. [PMID: 35478719 PMCID: PMC9037734 DOI: 10.2147/nss.s359437] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Estimating insomnia prevalence in epidemiological studies is hampered by variability in definitions and interpretation of criteria. We addressed the absence of a population-based estimate of insomnia in Australia using the widely accepted contemporary International Classification of Sleep Disorders (ICSD-3) criteria, which includes sleep opportunity, and has not been applied in studies to date. Consistent use of these criteria across epidemiological studies, however, requires evidence of the clinical utility of a sleep opportunity criterion for targeting strategies. METHODS A cross-sectional national on-line survey (2019 Sleep Health Foundation Insomnia Survey) of Australian adults (18-90 years, n = 2044) was conducted. Chronic insomnia was defined as sleep symptoms and daytime impairment experienced ≥3 times per week, and present for ≥3 months, with adequate sleep opportunity (time in bed (TIB) ≥7.5 hrs). Self-rated general health (SF-1) and ever diagnosed health conditions (including sleep disorders) were assessed. RESULTS Chronic difficulties initiating and maintaining sleep and daytime symptoms (n = 788) were more common in females (41.5%) than males (35.3%), p = 0.004. Excluding participants reporting frequent pain causing sleep disruption and TIB <7.5 hrs generated an insomnia disorder estimate of 25.2% (95% CI: 22.5-28.2) in females and 21.1% (18.4-23.9) in males [23.2% (21.2-25.2) overall]. This compares with 8.6% (7.3-10.0) with insomnia symptoms and TIB <7.5 hrs and 7.5% (6.4-8.7%) ever diagnosed with insomnia. Insomnia symptom groups with TIB <7.5 and ≥7.5 hours demonstrated similar odds of reporting fair/poor health [odds ratio (OR): 3.2 (95% CI: 2.1-4.8) and 2.9 (95% CI: 2.2-3.9) respectively], ≥1 mental health condition, ≥1 airway disease, and multimorbidity. CONCLUSION Adults with significant sleep and daytime symptomatology and TIB <7.5 hrs did not differ clinically from those with insomnia disorder. Consideration of criteria, particularly adequate sleep opportunity, is required to consistently identify insomnia, and establish health correlates in future epidemiological studies. Further evaluation of the clinical utility of the sleep opportunity criterion is also required.
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Affiliation(s)
- Sarah L Appleton
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,The Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tiffany K Gill
- The Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Sprajcer M, Appleton SL, Adams RJ, Gill TK, Ferguson SA, Vincent GE, Paterson JL, Reynolds AC. Who is 'on-call' in Australia? A new classification approach for on-call employment in future population-level studies. PLoS One 2021; 16:e0259035. [PMID: 34735465 PMCID: PMC8568115 DOI: 10.1371/journal.pone.0259035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/11/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND On-call research and guidance materials typically focus on 'traditional' on-call work (e.g., emergency services, healthcare). However, given the increasing prevalence of non-standard employment arrangements (e.g., gig work and casualisation), it is likely that a proportion of individuals who describe themselves as being on-call are not included in current on-call literature. This study therefore aimed to describe the current sociodemographic and work characteristics of Australian on-call workers. METHODS A survey of 2044 adults assessed sociodemographic and work arrangements. Of this population, 1057 individuals were workforce participants, who were asked to provide information regarding any on-call work they performed over the last three months, occupation type, weekly work hours, and the presence or absence of non-standard work conditions. RESULTS Of respondents who were working, 45.5% reported working at least one day on-call in the previous month. There was a high prevalence of on-call work in younger respondents (63.1% of participants aged 18-24 years), and those who worked multiple jobs and more weekly work hours. Additionally, high prevalence rates of on-call work were reported by machinery operators, drivers, community and personal service workers, sales workers, and high-level managers. CONCLUSIONS These data suggest that on-call work is more prevalent than previously recorded and is likely to refer to a broad set of employment arrangements. Current classification systems may therefore be inadequate for population-level research. A taxonomy for the classification of on-call work is proposed, incorporating traditional on-call work, gig economy work, relief, or unscheduled work, and out of hours work.
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Affiliation(s)
- Madeline Sprajcer
- Central Queensland University, Appleton Institute, Adelaide, South Australia, Australia
| | - Sarah L. Appleton
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
| | - Robert J. Adams
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany K. Gill
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Sally A. Ferguson
- Central Queensland University, Appleton Institute, Adelaide, South Australia, Australia
| | - Grace E. Vincent
- Central Queensland University, Appleton Institute, Adelaide, South Australia, Australia
| | - Jessica L. Paterson
- Central Queensland University, Appleton Institute, Adelaide, South Australia, Australia
| | - Amy C. Reynolds
- Flinders Health and Medical Research Institute (Sleep Health) / Adelaide Institute for Sleep Health, Flinders University, Bedford Park, South Australia, Australia
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29
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Appleton SL, Melaku YA, Reynolds AC, Gill TK, de Batlle J, Adams RJ. Multidimensional sleep health is associated with mental well-being in Australian adults. J Sleep Res 2021; 31:e13477. [PMID: 34622511 DOI: 10.1111/jsr.13477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/13/2021] [Accepted: 08/21/2021] [Indexed: 01/18/2023]
Abstract
The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well-being in Australian adults. A cross-sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18-90 years. Composite scores of self-reported healthy sleep were based on Ru-SATED (R-SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 (<1 hr). Mental well-being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ-5D-5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well-being with sleep dimensions, and total R-SATED (range 0-11) and SATED scores (0-10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well-being. A 1 unit increase in the total SATED score (mean [SD] 6.6 [2.1]) was associated with less problems on the EQ-5D-5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08-1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17-1.23). These estimates did not differ when the total R-SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well-being.
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Affiliation(s)
- Sarah L Appleton
- Flinders Health and Medical Research Institute (FHMRI) Sleep (formerly Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (FHMRI) Sleep (formerly Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (FHMRI) Sleep (formerly Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain.,Centre for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Robert J Adams
- Flinders Health and Medical Research Institute (FHMRI) Sleep (formerly Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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New-Tolley J, Reynolds AC, Appleton SL, Gill TK, Lester S, Adams RJ, Hill CL. Sleep disorders and gout in Australian adults. BMC Rheumatol 2021; 5:30. [PMID: 34452639 PMCID: PMC8400849 DOI: 10.1186/s41927-021-00199-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/29/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aims of our study were two-fold. Firstly, to determine if there is an association between gout and OSA in a representative Australian adult population. Secondly, to explore associations between gout and patient reported sleep outcomes. METHODS A cross-sectional national online survey of a representative sample of Australian adults > 18 years assessed self-reported doctor-diagnosed OSA, insomnia and patient reported sleep outcomes. Possible undiagnosed OSA was estimated using self-reported frequent loud snoring and witnessed apnoeas. Participants self-reported physician-diagnosed gout and other health conditions. Multivariable logistic regression analyses were performed for both objectives. Odds ratios with 95% confidence intervals were reported. RESULTS There were 1948 participants of whom 126 (6.5%) had gout and 124 (6.4%) had diagnosed sleep apnoea. After adjusting for age, body mass index (BMI), sex, alcohol intake and the presence of arthritis, those with obstructive sleep apnoea diagnosed on polysomnography were twice as likely to report having gout compared to those without. (OR = 2.6, 95% CI 1.5-4.6). Additionally, participants with symptoms suggestive of sleep apnoea were also twice as likely to have gout compared to those without (OR = 2.8, 95%CI 1.6-5.1). There was also a higher likelihood of restless legs syndrome, insomnia and worry about sleep in patients with gout. CONCLUSION Diagnosed and suspected OSA are associated with higher likelihood of gout. Participants with gout are also more likely to report suffering from restless legs syndrome, insomnia and worry about their sleep. Given the morbidity associated with sleep problems, we should be vigilant regarding sleep health in our patients with gout.
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Affiliation(s)
- Julia New-Tolley
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Susan Lester
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia.
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Reynolds AC, Crowther ME, Ferguson SA, Paterson JL, Howie C, Adams RJ. Protecting the health and safety of the paramedic workforce in Australia: The role of cohort studies with new recruits. Emerg Med Australas 2021; 33:935-937. [PMID: 34056839 DOI: 10.1111/1742-6723.13808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/29/2022]
Abstract
Research related to the paramedic workforce is increasing, particularly given the associations with physical and mental health outcomes. However, it is clear that the evidence base to support future paramedic workforce initiatives lacks longitudinal data in cohorts of paramedics. We identify gaps in the epidemiological evidence base for this workforce, and provide insight into the role that prospective cohorts can, and should, play in future research in the paramedic workforce in order to identify health and safety changes over time, and the associations with job requirements, particularly shift work.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Meagan E Crowther
- Appleton Institute, CQUniversity, Adelaide, South Australia, Australia
| | - Sally A Ferguson
- Appleton Institute, CQUniversity, Adelaide, South Australia, Australia
| | | | - Chris Howie
- SA Ambulance Service, Adelaide, South Australia, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Vincent GE, Kovac K, Sprajcer M, Jay SM, Reynolds AC, Dorrian J, Thomas MJW, Ferguson SA. Sleep disturbances in caregivers of children with medical needs: A systematic review and meta-analysis. Health Psychol 2021; 40:263-273. [PMID: 33856833 DOI: 10.1037/hea0001062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The sleep of individuals who provide unpaid care for children with medical needs is likely to be significantly impacted by this role. Sleep may be affected by the practical tasks undertaken during the night (e.g., administering medication), in addition to the emotional impact (e.g., worry, rumination). The aim of this systematic review was to examine the available literature on the impact of caregiving for children with medical needs on caregivers' sleep. METHOD Electronic databases, including PubMed, Medline, and Web of Science, were searched using predetermined criteria. Studies were included if they used validated subjective or objective measures of caregiver sleep, in contexts where caregivers were providing care for one or more children with medical needs. Data on study population, research design, and outcome measures were extracted, and study quality was reviewed by two authors. RESULTS Search criteria produced 2,172 studies for screening. Based on inclusion criteria, 40 studies were included in the final review. Sleep of caregivers of children with medical needs was poorer than that for noncaregivers. Poor sleep included reduced sleep duration, impaired sleep efficiency, increased wake after sleep onset, and perceived poorer sleep quality. CONCLUSIONS Providing unpaid care for children with medical needs is associated with sleep disturbances, including less total sleep, and poorer sleep quality. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Withrow D, Bowers SJ, Depner CM, González A, Reynolds AC, Wright KP. Sleep and Circadian Disruption and the Gut Microbiome-Possible Links to Dysregulated Metabolism. Curr Opin Endocr Metab Res 2021; 17:26-37. [PMID: 34805616 PMCID: PMC8597978 DOI: 10.1016/j.coemr.2020.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Insufficient sleep and circadian misalignment are associated with adverse metabolic health outcomes. Alterations in gut microbial diversity occur with insufficient sleep and circadian misalignment, which can lead to modifications in microbial structure and function. Changes in microbially produced and modified metabolites such as short chain fatty acids and secondary bile acids may contribute to chronic inflammation, positive energy balance and endocrine changes, and represent potential mechanisms linking insufficient sleep and circadian misalignment with metabolic dysregulation. Literature primarily from the last two years is reviewed here, examining the impact of sleep and circadian rhythms and their disruption on the gut microbiome in human and non-human models, with an emphasis on the hypothesis that the altered gut microbiome may be one pathway by which insufficient sleep and circadian misalignment dysregulate metabolism.
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Affiliation(s)
- Dana Withrow
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado-Boulder, Boulder, CO, USA
| | - Samuel J. Bowers
- Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL, USA
| | - Christopher M. Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado-Boulder, Boulder, CO, USA
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Antonio González
- Department of Pediatrics, University of California at San Diego, La Jolla, CA, USA
| | - Amy C. Reynolds
- The Appleton Institute, CQUniversity Australia, Adelaide, Australia
| | - Kenneth P. Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado-Boulder, Boulder, CO, USA
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Bunjo LJ, Reynolds AC, Appleton SL, Dorrian J, Vetter C, Gill TK, Adams RJ. Sleep Duration Moderates the Relationship Between Perceived Work-Life Interference and Depressive Symptoms in Australian Men and Women from the North West Adelaide Health Study. Int J Behav Med 2021; 28:29-38. [PMID: 32096098 DOI: 10.1007/s12529-020-09866-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mental health disorders are prevalent and costly to workplaces and individuals in Australia. Work-life interference is thought to contribute negatively. The interplay between work-life interference, depressive symptoms and sleep has not been explored to date in population data. The aims of this study were to establish whether sleep duration moderates the relationship between work-life interference and depressive symptoms, and whether this is expressed differentially in male and female respondents. METHODS Data were drawn from the North West Adelaide Health Study (NWAHS) longitudinal, representative population-based cohort study. Working members of the cohort were invited to participate in a telephone survey about their work conditions, with an 86.7% response rate achieved. Data from 823 respondents were analysed after employing purposeful selection of covariates, using multivariable regression analysis. RESULTS Sleep duration was found to moderate the relationship between work-life interference and depressive symptoms (F7,815 = 26.60, p < 0.001), and accounted for 19% of the variance observed in depressive symptoms. The strongest effect of work-life interference on depressive symptoms was observed in habitual short sleepers, with the effect weakening as sleep duration increased. The relationship was observed in male and female respondents, but was stronger in females. CONCLUSIONS Supporting and educating workers about the benefits of sleep for managing the relationship between work-life interference and depressive symptoms may offer a novel strategy for improving worker well-being, particularly when negative facets of work-life interference are not easily remedied or 'reduced'. There is a need for education and support strategies around sleep in Australian workplaces.
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Affiliation(s)
- Layla J Bunjo
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Amy C Reynolds
- The Appleton Institute, CQUniversity, Adelaide, SA, Australia.
| | - Sarah L Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.,The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, Adelaide, SA, 5011, Australia.,Freemason's Centre for Men's Health, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Jill Dorrian
- Behaviour, Brain and Body (BBB) Research Group, Division of Health Science, University of South Australia, Adelaide, Australia
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.,The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, Adelaide, SA, 5011, Australia
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Abstract
Objective: On-call work is becoming increasingly common in response to service demands. This study had two aims; 1) describe the demographic profile of on-call workers in Australia, and 2) establish the impacts of on-call work on workers' sleep. Methods: A cross-sectional study was conducted using an online questionnaire completed by Australian on-call workers (n = 228) from various professions. The questionnaire included items on i) demographic and work characteristics, ii) rumination about on-call factors, iii) sleep quantity and quality. Analyses were conducted using mixed effects ordinal regression and multivariable logistic regression. Results: Workers slept <7 hours per night when on-call (80%), and reported sleep was impacted on-call even when no-calls were received (56%). On-call workers rated interruptions to family/leisure time (70%), missing a call (69%), preplanning in case of a call (69%), and not able to make plans (67%) as the main factors they ruminated about. Female on-call workers were more likely to think about the likelihood of being called, report frequent thoughts about what they would need to do if called, and think about interruptions to family/leisure time as a result of a call. Younger workers were more likely to think about the likelihood of being called compared to older adults, however middle-aged workers were less likely to plan for a call compared to younger workers. Conclusions: This study is the first to describe Australia's on-call population, including factors that specifically impact sleep. Future studies should implement tailored education and support strategies to address the unique challenges facing on-call workers.
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Affiliation(s)
- Grace E Vincent
- Appleton Institute, Central Queensland University , Adelaide, Australia
| | - Katya Kovac
- Appleton Institute, Central Queensland University , Adelaide, Australia
| | - Leigh Signal
- Sleep/Wake Research Centre, Massey University , Wellington, New Zealand
| | - Amy C Reynolds
- Appleton Institute, Central Queensland University , Adelaide, Australia
| | - Jessica Paterson
- Appleton Institute, Central Queensland University , Adelaide, Australia
| | - Madeline Sprajcer
- Appleton Institute, Central Queensland University , Adelaide, Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University , Adelaide, Australia
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Crowther ME, Ferguson SA, Vincent GE, Reynolds AC. Non-Pharmacological Interventions to Improve Chronic Disease Risk Factors and Sleep in Shift Workers: A Systematic Review and Meta-Analysis. Clocks Sleep 2021; 3:132-178. [PMID: 33525534 PMCID: PMC7930959 DOI: 10.3390/clockssleep3010009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Shift work is associated with adverse chronic health outcomes. Addressing chronic disease risk factors including biomedical risk factors, behavioural risk factors, as well as sleep and perceived health status, affords an opportunity to improve health outcomes in shift workers. The present study aimed to conduct a systematic review, qualitative synthesis, and meta-analysis of non-pharmacological interventions targeting chronic disease risk factors, including sleep, in shift workers. A total of 8465 records were retrieved; 65 publications were eligible for inclusion in qualitative analysis. Random-effects meta-analysis were conducted for eight eligible health outcomes, including a total of thirty-nine studies. Interventions resulted in increased objective sleep duration (Hedges' g = 0.73; CI: 0.36, 1.10, k = 16), improved objective sleep efficiency (Hedges' g = 0.48; CI: 0.20, 0.76, k = 10) and a small increase in both subjective sleep duration (Hedges' g = 0.11; CI: -0.04, 0.27, k = 19) and sleep quality (Hedges' g = 0.11; CI: -0.11, 0.33, k = 21). Interventions also improved perceived health status (Hedges' g = 0.20; CI: -0.05, 0.46, k = 8), decreased systolic (Hedges' g = 0.26; CI: -0.54, 0.02, k = 7) and diastolic (Hedges' g = 0.06; CI: -0.23, 0.36, k = 7) blood pressure, and reduced body mass index (Hedges' g = -0.04; CI: -0.37, 0.29, k = 9). The current study suggests interventions may improve chronic disease risk factors and sleep in shift workers; however, this could only be objectively assessed for a limited number of risk factor endpoints. Future interventions could explore the impact of non-pharmacological interventions on a broader range of chronic disease risk factors to better characterise targets for improved health outcomes in shift workers.
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Affiliation(s)
- Meagan E Crowther
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Sally A Ferguson
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Grace E Vincent
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health (AISH): A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
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Reynolds AC, Ferguson SA, Appleton SL, Crowther ME, Melaku YA, Gill TK, Rajaratnam SMW, Adams RJ. Prevalence of Probable Shift Work Disorder in Non-Standard Work Schedules and Associations with Sleep, Health and Safety Outcomes: A Cross-Sectional Analysis. Nat Sci Sleep 2021; 13:683-693. [PMID: 34104021 PMCID: PMC8178694 DOI: 10.2147/nss.s301493] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE We aimed to estimate the prevalence of probable shift work disorder (pSWD) in a representative sample of Australian workers and identify sleep, health and safety correlates. PATIENTS AND METHODS In 2019, data were collected from working respondents as part of a cross-sectional national sleep health survey conducted online (n=964 total; n=448 individuals on non-standard work schedules). We established the prevalence of pSWD according to International Classification of Sleep Disorders criteria (ICSD-R, ICSD-2 and ICSD-3). Poisson regression was used to determine crude and adjusted prevalence association (prevalence ratio, PR) of pSWD with sleep, health and safety outcomes. RESULTS Overall prevalence of pSWD in workers on non-standard work schedules was 10.5%, ranging from 9.6% in early morning workers to 12.7% in rotating shift workers. In adjusted models, workers who met the criteria for pSWD were 1.8 times more likely to report both depression/bipolar disorder, and anxiety/panic disorder, and 1.7 times more likely to report work errors due to a sleep problem. CONCLUSION The prevalence of pSWD in employees engaged in non-standard work schedules is influenced by selection of factors used to quantify pSWD, including sleep/wake patterns. Higher likelihoods of mental health problems and workplace errors in those with pSWD highlight the importance of intervention and management of this under-recognised sleep disorder.
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Affiliation(s)
- Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia.,Appleton Institute, CQ University Australia, Wayville, SA, Australia
| | - Sally A Ferguson
- Appleton Institute, CQ University Australia, Wayville, SA, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Meagan E Crowther
- Appleton Institute, CQ University Australia, Wayville, SA, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Shantha M W Rajaratnam
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
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Kovac K, Vincent GE, Paterson JL, Aisbett B, Reynolds AC, Ferguson SA. Can an increase in noradrenaline induced by brief exercise counteract sleep inertia? Chronobiol Int 2020; 37:1474-1478. [PMID: 32946288 DOI: 10.1080/07420528.2020.1803900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Emergency responders often credit 'adrenaline' (i.e. sympathetic activity) as the reason they respond quickly upon waking, unimpaired by sleep inertia. Movement upon waking may promote sympathetic activity in this population. This pilot study (n = 4 healthy males) tested the effects of a 30 s exercise bout (maximal sprint) upon waking during the night (02:00 h) on sympathetic activity and sleep inertia. When compared to sedentary conditions, exercise reduced subjective sleepiness levels and elicited a temporary increase in sympathetic activity, measured by plasma noradrenaline levels. These findings provide preliminary support for exercise as a potential sleep inertia countermeasure.
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Affiliation(s)
- Katya Kovac
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Jessica L Paterson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Brad Aisbett
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Amy C Reynolds
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, Adelaide, Australia
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Dominiak M, Kovac K, Reynolds AC, Ferguson SA, Vincent GE. The effect of a short burst of exercise during the night on subsequent sleep. J Sleep Res 2020; 30:e13077. [PMID: 32495463 DOI: 10.1111/jsr.13077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/12/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
When on-call workers wake during the night to perform work duties, they may experience reduced alertness and impaired performance as a result of sleep inertia. After performing their duties, on-call workers may have the opportunity to return to sleep. Thus, it is important that sleep inertia countermeasures do not affect subsequent sleep. Exercise may be a suitable countermeasure; however, the impact on subsequent sleep is untested. Healthy participants (n = 15) completed three conditions in a counterbalanced order: sedentary, low-intensity exercise or high-intensity exercise, performed for 2 min upon awakening. Sleep was recorded 2 hr later using polysomnography, the Karolinska Sleepiness Scale was administered to measure subjective sleepiness, and core body temperature was measured continuously. Results indicate there was no effect of condition on most sleep variables; however, three variables had small differences, with longer total sleep time (p = .006), higher sleep efficiency (p = .006) and shorter N3 latency (p < .001) in the low-intensity exercise condition. There was no difference in subjective sleepiness (p = .124) or core body temperature (p = .216) 90 min after the exercise intervention. These results indicate that using a short burst of exercise to counteract sleep inertia when woken during the night may be a suitable countermeasure for on-call workers who not only need to be alert upon waking but also need quality sleep when returning to bed. Future research could include participants of other ages and health statuses to investigate whether the results are generalizable.
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Affiliation(s)
- Michelle Dominiak
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Katya Kovac
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Amy C Reynolds
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Grace E Vincent
- Appleton Institute, Central Queensland University, Adelaide, SA, Australia
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Kovac K, Ferguson SA, Paterson JL, Aisbett B, Hilditch CJ, Reynolds AC, Vincent GE. Exercising Caution Upon Waking-Can Exercise Reduce Sleep Inertia? Front Physiol 2020; 11:254. [PMID: 32317980 PMCID: PMC7155753 DOI: 10.3389/fphys.2020.00254] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
Sleep inertia, the transitional state of reduced alertness and impaired cognitive performance upon waking, is a safety risk for on-call personnel who can be required to perform critical tasks soon after waking. Sleep inertia countermeasures have previously been investigated; however, none have successfully dissipated sleep inertia within the first 15 min following waking. During this time, on-call personnel could already be driving, providing advice, or performing other safety-critical tasks. Exercise has not yet been investigated as a sleep inertia countermeasure but has the potential to stimulate the key physiological mechanisms that occur upon waking, including changes in cerebral blood flow, the cortisol awakening response, and increases in core body temperature. Here, we examine these physiological processes and hypothesize how exercise can stimulate them, positioning exercise as an effective sleep inertia countermeasure. We then propose key considerations for research investigating the efficacy of exercise as a sleep inertia countermeasure, including the need to determine the intensity and duration of exercise required to reduce sleep inertia, as well as testing the effectiveness of exercise across a range of conditions in which the severity of sleep inertia may vary. Finally, practical considerations are identified, including the recommendation that qualitative field-based research be conducted with on-call personnel to determine the potential constraints in utilizing exercise as a sleep inertia countermeasure in real-world scenarios.
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Affiliation(s)
- Katya Kovac
- 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
| | - Jessica L Paterson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Brad Aisbett
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Cassie J Hilditch
- Fatigue Countermeasures Laboratory, San José State University Research Foundation, Moffett Field, CA, United States
| | - Amy C Reynolds
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, SA, Australia
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Rebar AL, Reynolds AC, Ferguson SA, Gardner B. Accounting for automatic processes in sleep health. J Sleep Res 2020; 29:e12987. [DOI: 10.1111/jsr.12987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Amanda L. Rebar
- Motivation of Health Behaviours Laboratory Appleton Institute School of Health, Medical, and Applied Sciences Central Queensland University Rockhampton Qld Australia
| | - Amy C. Reynolds
- Appleton Institute School of Health, Medical, and Applied Sciences Central Queensland University Rockhampton Qld Australia
| | - Sally A. Ferguson
- Appleton Institute School of Health, Medical, and Applied Sciences Central Queensland University Rockhampton Qld Australia
| | - Benjamin Gardner
- Department of Psychology Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
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Vincent GE, Karan S, Paterson J, Reynolds AC, Dominiak M, Ferguson SA. Impacts of Australian Firefighters' On-Call Work Arrangements on the Sleep of Partners. Clocks Sleep 2020; 2:39-51. [PMID: 33089189 PMCID: PMC7445837 DOI: 10.3390/clockssleep2010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/29/2020] [Indexed: 11/30/2022] Open
Abstract
On-call work arrangements are commonly utilised in the emergency services sector and are consistency associated with inadequate sleep. Despite sleep being a common shared behaviour, studies are yet to assess the impact of on-call work on the sleep of co-sleeping partners. This study aimed to investigate whether frequent 24/7 on-call work impacted the sleep and relationship happiness of firefighters' partners. Two key research questions were investigated: (1) Does the frequency of calls impact sleep and relationship happiness? and, (2) Does the (a) sleep quantity and (b) sleep quality of partners impact perceived relationship happiness? A cross-sectional study was conducted using an online questionnaire completed by partners of on-call workers (n = 66; 93% female). The questionnaire included items on (i) sleep quantity and quality, (ii) on-call sleep disturbances and, (iii) relationship happiness. Responses were analysed using logistic regression models. Higher overnight call frequency was associated with greater self-reported levels of inadequate sleep (<7 h per night; p = 0.024). Support for continuance of a firefighter's role was less likely if the partner reported they regularly had trouble falling asleep within 30 min (p < 0.001). There were no other significant relationships between the frequency of calls or other sleep quantity or quality variables and relationship happiness. This study provides important first insights into how firefighters' on-call work arrangements impact partners' sleep. Future research is needed across periods of high and low call demand, using objective measures of sleep to further define the impacts of on-call work on partners' sleep.
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Affiliation(s)
- Grace E Vincent
- Central Queensland University, Appleton Institute of Behavioural Science, Adelaide, SA 5034, Australia; (S.K.); (J.P.); (A.C.R.); (M.D.); (S.A.F.)
| | - Simone Karan
- Central Queensland University, Appleton Institute of Behavioural Science, Adelaide, SA 5034, Australia; (S.K.); (J.P.); (A.C.R.); (M.D.); (S.A.F.)
| | - Jessica Paterson
- Central Queensland University, Appleton Institute of Behavioural Science, Adelaide, SA 5034, Australia; (S.K.); (J.P.); (A.C.R.); (M.D.); (S.A.F.)
| | - Amy C Reynolds
- Central Queensland University, Appleton Institute of Behavioural Science, Adelaide, SA 5034, Australia; (S.K.); (J.P.); (A.C.R.); (M.D.); (S.A.F.)
- Central Queensland University, School of Health, Medical, and Applied Sciences, Adelaide, SA 5034, Australia
| | - Michelle Dominiak
- Central Queensland University, Appleton Institute of Behavioural Science, Adelaide, SA 5034, Australia; (S.K.); (J.P.); (A.C.R.); (M.D.); (S.A.F.)
| | - Sally A Ferguson
- Central Queensland University, Appleton Institute of Behavioural Science, Adelaide, SA 5034, Australia; (S.K.); (J.P.); (A.C.R.); (M.D.); (S.A.F.)
- Central Queensland University, School of Health, Medical, and Applied Sciences, Adelaide, SA 5034, Australia
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Appleton SL, Reynolds AC, Gill TK, Melaku YA, Adams R. Waking to use technology at night, and associations with driving and work outcomes: a screenshot of Australian adults. Sleep 2020; 43:5727773. [DOI: 10.1093/sleep/zsaa015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/31/2020] [Indexed: 01/03/2023] Open
Abstract
Abstract
The use of smartphones/electronic devices and their relationship with outcomes are understudied in adult populations. We determined daytime functional correlates of using technology during the night in a population sample of Australian adults. A cross-sectional, national online survey of sleep health was conducted in 2019 (n = 1984, 18–90 years). Nocturnal technology use was assessed with: “In the past seven days, how often did you wake or were woken to send or receive text messages, emails or other electronic communications?” Waking to use technology during all/most nights was reported by 4.9%, with 13.8% reporting two to three nights per week, and 12.7% reporting just one night per week. Technology users were more likely to be younger, employed, experience financial stress, and speak English as a second language. In adjusted analyses, compared to no use, technology use at least two to three nights per week was significantly associated with daytime problems (sleepiness, fatigue and impaired mood, motivation, and attention) and was more evident in participants not reporting/perceiving a sleep problem. Technology use was independently associated with at least one drowsy driving-related motor vehicle accidents/near miss per month (odds ratio [OR] = 6.4, 95% CI = 3.8 to 10.7) and with missing work (OR = 4.8, 95% CI: 3.2 to 7.2) and making errors at work (OR = 2.2, 95% CI = 1.5 to 3.3) at least 1 day in the past 3 months due to sleepiness/sleep problem. These associations were not significantly modified by age. Public health implications of waking to engage with electronic devices at night may be significant in terms of safety, productivity, and well-being. Limiting sleep-disrupting technology use will require innovative language-diverse strategies targeted broadly across age groups.
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Affiliation(s)
- Sarah L Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- The Adelaide Medical School, University of Adelaide, Woodville, Australia
- Freemason’s Centre for Men’s Health, Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Amy C Reynolds
- Appleton Institute, CQUniversity Australia, Wayville, Australia
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Wayville, Australia
| | - Tiffany K Gill
- The Adelaide Medical School, University of Adelaide, Woodville, Australia
| | - Yohannes A Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- The Adelaide Medical School, University of Adelaide, Woodville, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- The Adelaide Medical School, University of Adelaide, Woodville, Australia
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Crowther ME, Reynolds AC, Ferguson SA, Adams R. Perceptions of the impact of non-standard work schedules on health in Australian graduates: an exploratory study. Ind Health 2020; 58:54-62. [PMID: 31178540 PMCID: PMC6997719 DOI: 10.2486/indhealth.2019-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/30/2019] [Indexed: 06/09/2023]
Abstract
Non-standard working hours are associated with negative health outcomes. However, little is known about the early years of exposure to non-standard work hours, or whether workers new to these work schedules perceive their work as impacting their health. This limits our ability to develop meaningful intervention strategies for transitioning into non-standard work hour schedules. This exploratory study investigated whether recent Australian graduates in various non-standard workhour schedules perceive that their work schedule negatively impacts their health. The responses of 120 graduates within four years of completing their tertiary qualification collected from an online survey were analysed. Graduates were asked whether they perceived their work arrangements as impacting their health. Significantly more of those who were engaged in non-standard work schedules or worked beyond contracted hours perceived their working arrangements as having an impact on their health. This study highlights the importance of studying workers' perceptions of the impact of work hours on health, particularly when workers may be experiencing good global health but be at risk for negative health outcomes in future.
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Affiliation(s)
- Meagan E Crowther
- School of Health, Medical and Applied Sciences, CQUniversity, Australia
- Appleton Institute, CQUniversity, Australia
| | - Amy C Reynolds
- School of Health, Medical and Applied Sciences, CQUniversity, Australia
- Appleton Institute, CQUniversity, Australia
| | - Sally A Ferguson
- School of Health, Medical and Applied Sciences, CQUniversity, Australia
- Appleton Institute, CQUniversity, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Australia
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Reynolds AC, Marshall NS, Hill CL, Adams RJ. Systematic review of the efficacy of commonly prescribed pharmacological treatments for primary treatment of sleep disturbance in patients with diagnosed autoimmune disease. Sleep Med Rev 2020; 49:101232. [PMID: 31911367 DOI: 10.1016/j.smrv.2019.101232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 01/19/2023]
Abstract
Sleep disturbances are commonly reported by patients with autoimmune disease, and are negatively related to both disease activity and quality of life. Despite the potential for sleep disturbance to exacerbate inflammatory pathways, acute management of sleep disturbance with pharmacological aids is not well understood in this patient group. The objective of this review was to determine the efficacy of pharmacological treatments for sleep disturbance to improve sleep outcomes in adult patients with diagnosed autoimmune disease. Four databases and grey literature were searched for randomized controlled trials which used a pharmacological treatment specifically to treat sleep disturbance in patients with diagnosed autoimmune disease, both in hospitalized and non-hospitalized settings. A sleep outcome was required to be the primary endpoint of the study. Of the 409 studies identified, a total of six were included in the systematic review. Risk of bias across the studies was largely unclear, making an assessment challenging; meta-analysis was not undertaken due to clinical and methodological heterogeneity between studies. While there appeared to be perceived improvement in self-reported sleep quantity and quality in existing studies with pharmacological treatment, there was also evidence of placebo effect on some measures. Relatively small numbers of patients have undergone gold-standard polysomnographic (PSG) recording of sleep which limits our knowledge of objectively determined sleep quantity and quality in patients with autoimmune disease receiving pharmacological treatment for sleep disturbance. Presently there is insufficient evidence to determine whether pharmacological treatment of sleep disturbance is beneficial for improving sleep quantity and quality in this patient group beyond rheumatoid arthritis.
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Affiliation(s)
- Amy C Reynolds
- The Appleton Institute, CQ University Australia, 44 Greenhill Road, Wayville, SA, Australia; School of Health, Medical and Applied Sciences, CQUniversity Australia Adelaide Campus, Wayville, SA, Australia.
| | - Nathaniel S Marshall
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Bedford Park, SA, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
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Melaku YA, Reynolds AC, Gill TK, Appleton S, Adams R. Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study. Nutrients 2019; 11:nu11102374. [PMID: 31590356 PMCID: PMC6835535 DOI: 10.3390/nu11102374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/21/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
Epidemiological evidence on the association between macronutrient intake and excessive daytime sleepiness (EDS) is scarce. Using data from the North West Adelaide Health Study, we aimed to determine the association between iso-caloric substitution of macronutrients and EDS. Data from 1997 adults aged ≥ 24 years were analyzed. Daytime sleepiness was measured using the Epworth Sleepiness Scale, a score ≥ 11 was considered EDS. Dietary intake data were collected using a food frequency questionnaire. We determined absolute and relative energy intake based on consumption of saturated and unsaturated fats, protein, and carbohydrate. Odds ratios (ORs) were used to determine the associations using log-binomial logistic regression with and without iso-caloric substitution methods, and models were adjusted for confounders. The prevalence of EDS in the sample was 10.6%. After adjusting for potential confounders, substituting 5% energy intake from protein with an equal amount of saturated fat (OR = 1.57; 95% CI: 1.00–2.45) and carbohydrate (OR = 1.23; 95% CI: 0.92–1.65) increased the odds of EDS. When carbohydrate was substituted with saturated fat (OR = 1.27; 95% CI: 0.93–1.59), the odds of EDS were increased. The odds of EDS were lower when saturated fat was substituted with unsaturated fat (OR = 0.74; 95% CI: 0.51–1.06), protein (OR = 0.63; 95% CI: 0.41–0.99) or carbohydrate (OR = 0.79; 95% CI: 0.57–1.08). While these results were consistent over different iso-caloric substitution methods, inconsistent results were found with standard regression. While substitution of fat and carbohydrate with protein was inversely associated with EDS, substitution of protein with fat and carbohydrate was positively associated with EDS. Randomized trials are needed to confirm if dietary interventions can be used to improve daytime alertness in those with EDS.
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Affiliation(s)
- Yohannes Adama Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia.
| | - Amy C Reynolds
- The Appleton Institute, CQ University Australia, Adelaide 5034, SA, Australia.
- School of Health, Medical and Applied Sciences, CQ University Australia Adelaide Campus, Adelaide 5034, SA, Australia.
| | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide 5005, SA, Australia.
| | - Sarah Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia.
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide 5011, SA, Australia.
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia.
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park 5042, SA, Australia.
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide 5011, SA, Australia.
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide 5005, SA, Australia.
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Melaku YA, Appleton S, Reynolds AC, Sweetman AM, Stevens DJ, Lack L, Adams R. Association Between Childhood Behavioral Problems and Insomnia Symptoms in Adulthood. JAMA Netw Open 2019; 2:e1910861. [PMID: 31490538 PMCID: PMC6735491 DOI: 10.1001/jamanetworkopen.2019.10861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
Importance Life-course determinants of insomnia, particularly the long-term association of childhood behavioral problems with insomnia later in life, are unknown. As childhood behaviors are measurable and potentially modifiable, understanding their associations with insomnia symptoms may provide novel insights into early intervention strategies to reduce the burden. Objective To investigate the association between behavioral problems at 5, 10, and 16 years of age and self-reported insomnia symptoms at 42 years of age. Design, Setting, and Participants This cohort study used data from the United Kingdom 1970 Birth Cohort Study, an ongoing large-scale follow-up study. Participants were followed up from birth (1970) to age 42 years (2012). Missing data were imputed via multiple imputation. Statistical analysis was performed from February 1 to July 15, 2019. Exposures Behavior measured at 5, 10, and 16 years of age using the Rutter Behavioral Scale (RBS). Children's behavior was classified as normal (≤80th percentile), moderate behavioral problems (>80th to ≤95th percentile), and severe behavioral problems (>95th percentile) based on their RBS score. Main Outcomes and Measures Self-reported difficulties initiating or maintaining sleep (DIMS) were collected using a self-administered questionnaire at 42 years of age. Log-binomial logistic regression, adjusted for several potential confounders, was used to estimate the association of childhood behavioral problems with insomnia symptoms in adulthood. Sensitivity analyses were conducted to check robustness of the findings. Results Participants were followed up from a baseline age of 5 years (n = 8050; 3854 boys and 4196 girls), 10 years (n = 9090; 4365 boys and 4725 girls), or 16 years (n = 7653; 3575 boys and 4078 girls) until age 42 years. There was a 39% higher risk of DIMS (odds ratio [OR], 1.39; 95% CI, 1.04-1.84; P = .06 for trend) for participants with severe behavioral problems at 5 years of age compared with those with a normal RBS score. The odds of DIMS plus not feeling rested on waking (DIMS plus) in participants with severe behavioral problems at 5 years of age were 29% higher (odds ratio, 1.29; 95% CI, 0.97-1.70; P = .14 for trend) than participants with a normal RBS score, although this result was not statistically significant. Moderate and severe behavioral problems at 16 years of age were positively associated with DIMS and DIMS plus (moderate: OR, 1.28; 95% CI, 1.07-1.52; severe: OR, 1.67; 95% CI, 1.22-2.30; P < .001 for trend) and DIMS plus (moderate: OR, 1.32; 95% CI, 1.11-1.56; severe: OR, 1.47; 95% CI, 1.09-1.98; P < .001 for trend). Externalizing behavioral problems at 5 and 10 years of age were positively associated with insomnia symptoms at 42 years of age. Conclusions and Relevance This study is the first to show associations of early-life behavioral problems, particularly early- and middle-childhood externalizing problems, with insomnia symptoms in adulthood. These findings underline the importance of addressing insomnia from a life-course perspective and considering the benefits of early behavioral intervention to sleep health.
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Affiliation(s)
- Yohannes Adama Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, South Australia, Australia
- Freemason’s Centre for Men’s Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy C. Reynolds
- The Appleton Institute, The University of Central Queensland, Wayville, South Australia, Australia
- School of Health, Medical and Applied Sciences, The University of Central Queensland Adelaide Campus, Wayville, South Australia, Australia
| | - Alexander M. Sweetman
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David J. Stevens
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Leon Lack
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- College of Education, Psychology, and Social Work, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Freemason’s Centre for Men’s Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Affiliation(s)
- Amy C. Reynolds
- The Appleton Institute CQUniversity Australia Adelaide Australia
- School of Health Medical and Applied Sciences CQUniversity Adelaide Australia
| | - Robert J. Adams
- Adelaide Institute for Sleep Health Flinders University Adelaide Australia
- Respiratory and Sleep Service Southern Adelaide Local Health Network Adelaide Australia
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Ferguson SA, Appleton SL, Reynolds AC, Gill TK, Taylor AW, McEvoy RD, Adams RJ. Making errors at work due to sleepiness or sleep problems is not confined to non-standard work hours: results of the 2016 Sleep Health Foundation national survey. Chronobiol Int 2019; 36:758-769. [PMID: 31017005 DOI: 10.1080/07420528.2019.1578969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Almost one-third of Australians report having made errors at work that are related to sleep issues. While there is significant literature investigating the role of sleep in workplace health and safety in shiftworking and nightwork operations, long working hours, work-family conflict, and commute times getting longer also impact day workers' sleep behaviors and opportunities. The aim of this study was to examine the relationship between sleep duration and disorders, sleep health and hygiene factors, work-related factors and errors at work in Australian workers. From a sample of 1011 Australian adults, age-adjusted binary logistic regression analyses were conducted in 512 workers who provided responses to the question "Thinking about the past three months, how many days did you make errors at work because you were too sleepy or you had a sleep problem?" A number of sleep behaviors and poor sleep hygiene factors were linked with work errors related to sleepiness or sleep problems, with age-adjusted odds of errors (confidence intervals) up to 11.6 times higher (5.4-25.1, p < 0.001) in those that snored, 7.7 (4.6-12.9) times higher in those reporting more than three sleep issues (p < 0.001), 7.0 times higher (3.4-14.8) in short (≤5 hours/night) sleepers (p < 0.021), 6.1 times higher (2.9-12.7) in those staying up later than planned most nights of the week (p< 0.001) and 2.4 times higher (1.6-3.7) in those drinking alcohol ≥3 nights/week before bed (p < 0.001). More than 40% of participants working non-standard hours reported making errors at work, and they were more likely to be young (compared to the main sample of workers) and more likely to engage in work activities in the hour before bed. Sleep factors (other than clinical sleep disorders) were associated with an increased likelihood of sleep-related work errors. Both day workers and those working non-standard hours engage in work, sleep and health behaviors that do not support good sleep health, which may be impacting safety and productivity in the workplace through increased sleepiness-related errors.
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Affiliation(s)
- Sally A Ferguson
- a Appleton Institute, School of Health, Medical and Applied Sciences , CQUniversity , Adelaide , Australia.,b Deakin University , Burwood , Australia
| | - Sarah L Appleton
- c School of Exercise and Nutrition Sciences, Adelaide Institute of Sleep Health , Flinders University , Australia.,d University of Adelaide , Freemasons Foundation Centre for Men's Health , Adelaide , Australia
| | - Amy C Reynolds
- a Appleton Institute, School of Health, Medical and Applied Sciences , CQUniversity , Adelaide , Australia
| | - Tiffany K Gill
- e Population Research & Outcome Studies, Discipline of Medicine , University of Adelaide , Adelaide , Australia
| | - Anne W Taylor
- e Population Research & Outcome Studies, Discipline of Medicine , University of Adelaide , Adelaide , Australia
| | - R Douglas McEvoy
- c School of Exercise and Nutrition Sciences, Adelaide Institute of Sleep Health , Flinders University , Australia
| | - Robert J Adams
- c School of Exercise and Nutrition Sciences, Adelaide Institute of Sleep Health , Flinders University , Australia.,f Southern Adelaide Local Health Network , SA Health , Adelaide , Australia.,g Adelaide Medical School , University of Adelaide , Adelaide , Australia
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Lastella M, O'Mullan C, Paterson JL, Reynolds AC. Sex and Sleep: Perceptions of Sex as a Sleep Promoting Behavior in the General Adult Population. Front Public Health 2019; 7:33. [PMID: 30886838 PMCID: PMC6409294 DOI: 10.3389/fpubh.2019.00033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/08/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: The main aim of this study was to explore the perceived relationship between sexual activities, sleep quality, and sleep latency in the general adult population and identify whether any gender differences exist. Participants/methods: We used a cross-sectional survey to examine the perceived relationship between sexual activity and subsequent sleep in the general adult population. Seven-hundred and seventy-eight participants (442 females, 336 males; mean age 34.5 ± 11.4 years) volunteered to complete an online anonymous survey at their convenience. Statistical Analyses: Chi square analyses were conducted to examine if there were any gender differences between sexual activities [i.e., masturbation (self-stimulation), sex with a partner without orgasm, and sex with a partner with orgasm] and self-reported sleep. Results: There were no gender differences in sleep (quality and onset) between males and females when reporting sex with a partner [χ(2)2 = 2.20, p = 0.332; χ(2)2=5.73, p = 0.057] or masturbation (self-stimulation) [χ(2)2 = 1.34, p = 0.513; χ(2)2 = 0.89, p = 0.640] involved an orgasm. Conclusions: Orgasms with a partner were associated with the perception of favorable sleep outcomes, however, orgasms achieved through masturbation (self-stimulation) were associated with the perception of better sleep quality and latency. These findings indicate that the public perceive sexual activity with orgasm precedes improved sleep outcomes. Promoting safe sexual activity before bed may offer a novel behavioral strategy for promoting sleep.
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Affiliation(s)
- Michele Lastella
- Appleton Institute for Behavioural Science, Central Queensland University, Rockhampton, QLD, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Catherine O'Mullan
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Jessica L Paterson
- Appleton Institute for Behavioural Science, Central Queensland University, Rockhampton, QLD, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Amy C Reynolds
- Appleton Institute for Behavioural Science, Central Queensland University, Rockhampton, QLD, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
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