Baseline Sleep Duration Research Articles

Association of Snoring and Daytime Sleepiness With Subsequent Incident Hypertension: A Population-Based Cohort Study.

There is a strong association between obstructive sleep apnea and hypertension, but the effects of obstructive sleep apnea symptoms on the risk of incident hypertension are not well documented. The aim of this prospective study was to examine whether snoring and sleepiness are associated with incident hypertension. Data from the French population-based CONSTANCES cohort were analyzed. Normotensive participants, aged 18 to 69 years, were included between 2012 and 2016 and screened for snoring, morning fatigue, and daytime sleepiness in 2017 using items of the Berlin Questionnaire. We used Cox models, adjusted for multiple potential confounders, including body mass index, baseline blood pressure, sleep duration, and depressive symptoms, to compute hazards ratios of incidentally treated hypertension. Among 34 727 subjects, the prevalence of self-reported habitual snoring, morning fatigue, and excessive daytime sleepiness (≥3× a week for each) was 23.6%, 16.6%, and 19.1%, respectively. During a median follow-up of 3.1 years (interquartile range, 3.0-3.5), the incidence of treated hypertension was 3.8%. The risk of de novo treated hypertension was higher in participants who reported habitual snoring (adjusted hazard ratio, 1.17 [95% CI, 1.03-1.32]) and excessive daytime sleepiness (adjusted hazard ratio, 1.42 [95% CI, 1.24-1.62]), and increased with the weekly frequency of symptoms, with a dose-dependent relationship (Ptrend≤0.02 for all symptoms). Self-reported snoring and excessive daytime sleepiness are associated with an increased risk of developing hypertension. Identification of snoring and daytime sleepiness may be a useful public health screening tool in primary care for hypertension prevention.

Sleep duration, sleep disturbances and skeletal muscle mass change over time: A population-based longitudinal analysis in Peru

Background The skeletal muscle has mainly a structural function and plays a role in human’s metabolism. Besides, the association between sleep quality and muscle mass, in the form of sarcopenia, has been reported. This study aimed to assess whether changes of skeletal muscle mass (SMM) over time are associated with baseline sleep duration and disturbances in a resource-constrained adult Peruvian population. Materials and Methods Secondary analysis using information of a population-based intervention. The outcome was SMM assessed using bioimpedance and the second version of the Lee’s formula. The exposures were baseline self-reported sleep duration (normal, short and long sleepers) and disturbances (sleep difficulties and awakening at nights). Crude and adjusted linear mixed models were used to assess the associations of interest, and coefficients (β) and 95% confidence intervales (95% CI) were reported. Results Data from 2,310 individuals at baseline, mean age 43.4 (SD: 17.2), and 1,163 (50.4%) females were analyzed. Sleep duration was 7.8 (SD: 1.3) hours/day, with 15.3% short sleepers and 11.6% long sleepers, whereas 24.2% reported sleep difficulties and 25.1% awakening at nights. In multivariable model, SMM among short and long sleepers did not vary significantly over time using the Lee’s formula; however, SMM was lower at the end of follow-up for long sleepers using bioimpedance (-0.26 kg; 95% CI: -0.47 to -0.06). Sleep disturbances were associated with a gradual SMM reduction: 0.36 kg using bioimpedance and 0.25 kg using the formula at the end of follow-up. Conclusions Using bioimpedance and formula estimations, sleep disturbances were associated with a reduction of SMM over a period of 2.4 years. Regarding sleep duration, no SMM changes over time were seen in short sleepers, but findings were discordant in long sleepers: a reduction of SMM using bioimpedance, but no change using the formula.

Association of baseline sleep duration and sleep quality with seizure recurrence in newly treated patients with epilepsy.

Although sleep duration and sleep quality are considered to be significant factors associated with epilepsy and seizure risk, findings are inconsistent, and their joint association remains uncertain. This study aimed to determine independent and joint associations of these two modifiable sleep features with seizure recurrence risk in newly treated patients with epilepsy (PWE). This is a prospective cohort study of newly treated PWE at a comprehensive epilepsy center in northeast China between June 2020 and December 2023. Self-reported sleep duration and sleep quality were collected at baseline. All patients were followed for 12 months for recurrent seizures. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) of seizure recurrence. Models fitted with restricted cubic spline were conducted to test for linear and nonlinear shapes of each association. A total of 209 patients were included, and 103 experienced seizure recurrence during follow-up. Baseline short sleep was significantly associated with greater risk of seizure recurrence (adjusted HR = 2.282, 95% confidence interval [CI] = 1.436-3.628, p < .001). Sleep duration (h/day) and recurrent seizure risk showed a significant nonlinear U-shaped association, with a nadir at 8 h/day. Baseline poor sleep quality was significantly associated with greater risk of seizure recurrence (adjusted HR = 1.985, 95% CI = 1.321-2.984, p < .001). Pittsburgh Sleep Quality Index score and seizure recurrence risk exhibited a positive linear association. Participants with a combination of poor quality-short sleep showed the highest risk of seizure recurrence (adjusted HR = 3.13, 95% CI = 1.779-5.507, p < .001) compared to the referent good quality-intermediate sleep group. Baseline sleep duration and sleep quality were independently and jointly associated with risk of seizure recurrence in newly treated PWE. Our results point to an important potential role of baseline sleep duration and sleep quality in shaping seizure risk.

Short sleep duration and smoking initiation in university students: a retrospective cohort study.

The aim of this study was to clarify an association between short sleep duration and smoking initiation. Participants eligible for this retrospective cohort study were university students who were admitted to a single national university in Japan between 2007 and 2015. Baseline sleep duration and smoking status were measured using general questionnaires at health checkups at admission. During a 6-year observation period, smoking initiation was assessed using general questionnaires at annual health checkups. Cox proportional hazards models adjusted for clinically relevant factors were used to assess the association between sleep duration and smoking initiation. Of 17,493 men, including 540, 5,568, 8,458, 2,507, and 420 men with sleep duration of < 5, 5-6, 6-7, 7-8, and ≥ 8h, respectively, smoking initiation was observed in 16.1%, 12.5%, 11.2%, 10.0%, and 11.7%, respectively, during a median observation period of 3.0years. Men with shorter sleep duration were at a higher risk of smoking initiation (adjusted hazard ratio 1.49 [95% confidence interval 1.19-1.85], 1.11 [1.01-1.22], 1.00 [reference], 0.92 [0.80-1.06], and 1.00 [0.75-1.34], respectively). Of 8,880 women, including 267, 3,163, 4,220, and 1,230 women with sleep duration of < 5, 5-6, 6-7, and ≥ 7h, respectively, smoking initiation was observed in 4.9%, 2.3%, 2.0%, and 2.2%, respectively, during a median observation period of 3.0years. A similar dose dependent association was ascertained in women (2.50 [1.39-4.49], 1.18 [0.86-1.62], 1.00 [reference], and 1.22 [0.79-1.89], respectively). This study clarified that university students with short sleep duration were vulnerable to smoking initiation.

Abstract 2232: Association between sleep characteristics and cancer survival: Findings from the UK Biobank study

Abstract Background Sleep characteristics have been associated with patient outcomes after cancer. We aimed to appraise the causal relationship of chronotype, sleep duration, insomnia, and snoring with cancer survival. Methods This large prospective cohort study enrolled 38350 cancer survivors aged ≥40 years from the UK Biobank between 2004 and 2022. Habitual sleep characteristics were obtained from the self-reported baseline questionnaire, including chronotype, sleep duration, insomnia, and snoring. Cox proportional hazards regression models were applied to evaluate the association between sleep characteristics and cancer survival, then one sample Mendelian randomization (MR) analyses were further used to validate these causal relationships. In particular, restricted cubic splines (RCS) and non-linear MR analyses were applied to assess the possible nonlinear association between sleep duration and cancer survival. Results Among 38350 study participants (mean [SD] age, 59.8 [7.3] years; 24150 [63.0%] males; 35534 [92.7%] White individuals), 12671 (33.1%) reported evening preference chronotype; 9050 (23.6%) reported short and 3773 (9.8%) reported long sleep duration;12274 (32.0%) reported snoring; and 30426 (79.4%) reported experiencing insomnia sometimes or usually. During up to 18 years of follow-up, 6274 deaths occurred. Multivariable regression models showed that evening preference (HR = 1.09, 95% CI: 1.03 to 1.15), short (HR = 1.14, 95% CI: 1.07 to 1.21) and long sleep duration (HR = 1.37, 95% CI: 1.28 to 1.48), insomnia (HR = 1.14, 95% CI: 1.09 to 1.21) and snoring (HR = 0.83, 95% CI: 0.78 to 0.87) were associated with death among pan to cancer survivors. Restricted cubic splines suggested nonlinear associations between sleep duration and death after cancer (nonlinear P &amp;lt; 0.001). In the one-sample MR, genetically predicted sleep duration (HR = 0.71, 95% CI: 0.56 to 0.90) and snoring (HR = 1.18, 95% CI: 1.05 to 1.34) demonstrated a reversed cancer survival pattern compared to multivariable regressions. A nonlinear U-shape association between sleep duration and cancer survival was observed in restricted cubic spline analyses (P &amp;lt; 0.001) but not evident when evaluating by nonlinear MR (P &amp;gt; 0.05). Conclusions Evening preference chronotype, insomnia, snoring, and short sleep duration are likely to be causally associated with a higher risk of death among cancer survivors, whilst long sleep duration does not appear to be a causal factor. Citation Format: Jiajing Che, Jiali Lv, Keyu Pan, Tiantian Sun, Chao Cao, Shengxu Li, Tao Zhang, Fuzhong Xue, Lin Yang. Association between sleep characteristics and cancer survival: Findings from the UK Biobank study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2232.

Sleep duration in midlife and old age and risk of mortality over a 48-year follow-up: The Helsinki businessmen study (HBS) cohort

ObjectivesBoth short and long sleep duration have been associated with increased mortality, but there are few truly long-term studies. Study designThis is a cohort study of 2504 men born between 1919 and 1934. In 1974–1975 (mean age 48), participants underwent baseline clinical examinations and sleep duration assessments. A follow-up examination took place 35 years later, in 2010 (mean age 82). Main outcome measureAll-cause mortality data from baseline and from old age were collected through to December 31, 2022. ResultsAt baseline, short sleep duration (≤6 h per night), normal sleep duration (>6 and ≤ 8 h), and long sleep duration (>8 h) was reported by 266, 2019 and 219 men, respectively. Men with short sleep duration had higher levels of smoking, alcohol consumption, body mass index, and poorer self-rated health than those with normal sleep duration. During the 48-year follow-up, 2287 men died. The unadjusted hazard ratio for mortality was 1.20 (95 % confidence interval [CI] 1.05–1.37) for short compared with normal sleep duration, but this association vanished after adjustments (1.01, 95 % CI 0.87–1.17). In old age, the corresponding hazard ratios were 1.41 (1.16–1.72) and 1.19 (0.94–1.51) for short sleep duration and 1.33 (1.09–1.63) and 1.31 (1.02–1.67) for long sleep duration. ConclusionsIn a comprehensive lifespan follow-up, the modestly increased mortality among men with short sleep duration in midlife was attributed to unhealthy lifestyle factors. In old age both long and short sleep duration seemed to be associated with modestly increased mortality.ClinicalTrials.gov identifier for the HBS: NCT02526082

Temporary relationship between sleep duration and depression and its impact on future risk of cardiovascular disease

BackgroundAlthough sleep duration and depression were correlated, their temporal sequence and how the sequence influence on future risk of cardiovascular disease (CVD) remained undetermined. This study aimed to explore the temporal relationship between sleep duration and depression, and its association with future CVD risk. MethodsWe included 10,629 middle-aged and elderly participants with repeated measurements of sleep duration and depressive symptoms (measured by Center for Epidemiological Studies-Depression scale [CESD]) at the first two visits from the China Health and Retirement Longitudinal Study. Cross-lagged analysis and mediation analysis were used to examine the temporal relationship between sleep duration and depression and its impact on future risk of CVD. ResultsThe adjusted cross-lagged path coefficient from baseline sleep duration to follow-up CES-D (β1 = −0.191; 95 % confidence interval [CI], −0.239 to −0.142) was significantly greatly than that from baseline CES-D to follow-up sleep duration (β2 = −0.031; 95 % CI, −0.031 to −0.024) (Pdifference < 0.0001). Similarly, the path coefficient from baseline sleep duration to annual changes in CES-D was significantly greater than that from baseline CES-D to annual changes in sleep duration (β1 = −0.093 versus β2 = −0.015, Pdifference < 0.0001). The path coefficient from baseline sleep duration to follow-up CES-D in CVD group was significantly greater than that in those without CVD (Pdifference of β1 = 0.0378). Furthermore, 27.93 % of the total association of sleep duration with CVD was mediated by depression symptoms. ConclusionsThe findings provide evidence that decrease in sleep duration probably precedes the increased in depressive symptoms, and depression partially mediated the pathway from sleep duration to incident CVD.

Association of time-varying sleep duration and cognitive function with mortality in the elderly: a 12-year community-based cohort study

BackgroundSleeping problems and cognitive impairment are common in elders. Baseline sleep duration and cognitive status are predictors of mortality. But few studies have explored whether longitudinal changes in sleep duration and cognitive function are related to mortality in older adults. The present study investigated the time-varying relationships of sleep duration and cognitive function with subsequent mortality among community-dwelling elders by using 12 years of repeated-measure data.MethodsTaichung Community Health Study for Elders (TCHS-E) is a retrospective, population-based cohort that started in 2009 (wave 1) with a total of 912 elders aged 65 years or above. Follow up was conducted in 2010 (wave 2), 2018 (wave 3), and 2020 (wave 4). Sleep duration and Mini-Mental State Examination (MMSE) forms were executed at baseline and three visits during follow-up. Time-varying Cox proportional hazards regression estimated adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (CIs).ResultsDuring about 12 years (9,396 person-years) follow-up, 329 deaths from all causes were documented, including 102 deaths due to expanded cardiovascular disease (CVD). In the multivariable-adjusted, time-varying Cox proportional hazard model, the adjusted HR values of all-cause mortality were 1.47 (1.02–2.12) for sleep duration > 9 h/day (vs. 7 h/day) and 1.81 (1.26–2.59) for MMSE < 27 (vs. 30). The adjusted HR values of the expanded CVD mortality were 2.91 (1.24–6.83) for MMSE of 29; 2.69 (1.20–6.05) for MMSE of 27–28; and 4.32 (95% CI: 1.92–9.74) for MMSE < 27. The dose-dependent relationship was significant (p < 0.001). The combinations of sleep duration longer than 9 h/day and MMSE < 27 were linked with the highest risks for expanded CVD and all-cause mortality.ConclusionsLong sleep duration and low cognitive function were jointly and independently linked with higher risk of mortality in elders residing in community.

Association of daytime napping and nighttime sleep with all-cause mortality: A prospective cohort study of China Health and Retirement Longitudinal Study

Study objectivesThe correlation of daytime napping and nighttime sleep duration on mortality was inconsistent. We aimed to explore their separate links to all-cause/premature mortality, and evaluate their combined impact on all-cause mortality risk. MethodsAll of 20617 (mean age: 56.90 ± 10.19, 52.18 % females) participants from China Health and Retirement Longitudinal Study were followed for a median of 7 years (interquartile range: 4–7) to detect death status. Baseline self-reported napping and sleep duration was categorized: napping as none, <60 min, 60–90 min, and ≥90 min, sleep as <6 h/night, 6–8 h/night, and ≥8 h/night. Death event was tracked, and premature death was defined using 2015 China's average life expectancy (73.64 years for men, and 79.43 years for women). Cox regression models analyzed the data. ResultsDuring follow-up, 1621 participants (7.86 %) died, including 985 (4.78 %) premature deaths. Compared to none nappers, napping ≥90 min associated with a higher risk of all-cause mortality (Hazard ratio, [HR] 1.23, 95 % confidence interval [CI] 1.06-1.42) and premature mortality (HR 1.23, 95 % CI 1.02-1.49), while napping <60 min correlated with a lower risk of premature mortality (HR 0.71, 95 % CI 0.54-0.95), after adjustment. Compared to sleep 6–8 h/night, nighttime sleep ≥8 h was associated with an increased risk of all-cause mortality (HR 1.20, 95 % CI 1.04-1.37) and premature mortality (HR 1.28, 95 % CI 1.08-1.52). Participants napping ≥90 min and sleeping ≥8 h had a multi-adjusted HR (95%CI) of 1.50 (95 % CI 1.17-1.92) for all-cause mortality, versus no napping and 6–8 h/night sleep. ConclusionsProlonged napping and extended nighttime sleep linked to increased mortality risk, particularly in combination. Optimizing sleep patterns may have potential implication in mortality prevention.

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PurposeThe likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood. MethodsParticipants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9–11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified. ResultsIn females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4–0.8) and somatic complaints (OR 0.8, 95% CI 0.6–0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1–2.2) one year later. No other significant associations were observed. DiscussionLongitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

Dietary amino acid intake and sleep duration are additively involved in future cognitive decline in Japanese adults aged 60 years or over: a community-based longitudinal study

BackgroundSleep duration and amino acid intake are independently associated with cognitive decline. This study aimed to determine the longitudinal association between sleep duration and cognitive impairment incidence and to examine the involvement of diet, particularly amino acid intake, in these associations in community dwellers.MethodsIn this longitudinal study in a community-based setting, we analyzed data from 623 adults aged 60–83 years without cognitive impairment at baseline. Sleep duration was assessed using a self-report questionnaire. Amino acid intake was assessed using 3-day dietary records. Cognitive impairment was defined as a Mini-Mental State Examination score ≤ 27. Participants were classified into short-, moderate-, and long-sleep groups according to baseline sleep duration (≤ 6, 7–8, and > 8 h, respectively). Using moderate sleep as a reference, odds ratios (ORs) and 95% confidence intervals (CIs) of short- and long-sleep for cognitive-impairment incidence were estimated using the generalized estimating equation. Participants were classified according to sex-stratified quartiles (Q) of 19 amino acid intake: Q1 and Q2–Q4 were low- and middle to high-intake groups, respectively. Using middle- to high-intake as a reference, ORs and 95% CIs of low intake for cognitive impairment incidence were estimated using the generalized estimating equation in each sleep-duration group. Follow-up period, sex, age, body mass index, depressive symptoms, education, smoking status, employment status, sleep aids use, physical activity, medical history, and Mini-Mental State Examination score at baseline were covariates.ResultsMean follow-up period was 6.9 ± 2.1 years. Adjusted ORs (95% CIs) for cognitive impairment in short- and long-sleep groups were 0.81 (0.49–1.35, P = 0.423) and 1.41 (1.05–1.87, P = 0.020), respectively. Particularly in long sleepers (i.e., > 8 h), cognitive impairment was significantly associated with low cystine, proline, and serine intake [adjusted ORs (95% CIs) for cognitive impairment were 2.17 (1.15–4.11, P = 0.017), 1.86 (1.07–3.23, P = 0.027), and 2.21 (1.14–4.29, P = 0.019), respectively].ConclusionsCommunity-dwelling adults aged ≥ 60 years who sleep longer are more likely to have cognitive decline, and attention should be paid to the low cystine, proline, and serine intake.

Optimizing intervention components for sleep promotion in children in the context of obesity prevention: the SLEEPY 2.0 study protocol

BackgroundInsufficient sleep duration is highly prevalent in childhood and is associated with obesity, especially among middle school-aged children. The primary care setting has enormous potential to promote sleep, but limited time and sleep resources at in person appointments are key barriers. Digital health innovations offer solutions to these barriers. Mobile health platforms can be developed to deliver behavioral sleep promotion remotely in the home setting, with tailoring to individual and contextual factors to help ensure equitable effectiveness across sociodemographic groups. This paper presents the protocol for a randomized optimization trial using the Multiphase Optimization Strategy (MOST) to develop a mobile health platform for the pediatric care setting to promote longer sleep duration for childhood obesity prevention.MethodsThis is a single-site study being conducted at the Children's Hospital of Philadelphia. We will randomize 325 children, aged 8–12 y, with a body mass index (BMI) between the 50th−95th percentile, and who sleep &amp;lt;8.5 h per night. The Way to Health mobile platform will facilitate remote communication and data collection. A sleep tracker will estimate sleep patterns for 12-months (2-week run-in; 6-month intervention; ≈5.5-month follow-up). A randomized 24 factorial design will assess four components: sleep goal (≥9 h or ≥30 min above baseline sleep duration), digital guidance (active or active with virtual study visits), caregiver incentive (inactive or active), and performance feedback (inactive or active). Fat mass will be measured at baseline, 6-, and 12-months using dual energy X-ray absorptiometry. Total energy intake and the timing and composition of meals will be measured using 24-h dietary recalls at baseline, 6-, and 12-months. Sociodemographic data (e.g., sex, race, ethnicity) will be measured using self-report and home addresses will be geocoded for geospatial analyses.DiscussionWe anticipate that this innovative optimization trial will identify optimal component settings for sleep promotion in children, with clinically meaningful improvements in fat mass trajectories. Importantly, the platform will have broad impact by promoting sleep health equity across sociodemographic groups. With the optimal settings identified, we will be able to determine the effectiveness of the final intervention package under the evaluation phase of the MOST framework in a future randomized controlled trial. Our proposed research will greatly advance the field of behavioral sleep medicine and reimagine how insufficient sleep duration and obesity are prevented in pediatric healthcare.Trial registrationClinicalTrials.gov NCT05703347 registered on 30 January 2023.

Washed microbiota transplantation targeting both gastrointestinal and extraintestinal symptoms in patients with irritable bowel syndrome

ObjectiveFecal microbiota transplantation (FMT) has been reported with the treatment potential for irritable bowel syndrome (IBS). However, the knowledge of its effect on extraintestinal symptoms of IBS is limited. This study aimed to evaluate the efficacy of the improved methodology of FMT, washed microbiota transplantation (WMT), on sleep disturbances, and psychological and gastrointestinal symptoms among patients with IBS. MethodsThis was a prospective observational study involving patients with IBS who underwent WMT. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The Gastrointestinal Symptom Rating Scale (GSRS) and IBS Severity Scoring System (IBS-SSS) were used to evaluate gastrointestinal symptoms and IBS severity, respectively. The Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were used to evaluate depression and anxiety, respectively. All the symptoms were evaluated at baseline and one month after WMT. A multiple logistic regression model was used to determine the predictive factors of sleep improvement one month after WMT. ResultsSeventy-three patients with IBS were included in the study. Sleep quality (Z = −4.211, P < 0.001), anxiety (Z = −4.775, P < 0.001), depression (Z = −4.610, P < 0.001), gastrointestinal symptoms (Z = −5.364, P < 0.001), and IBS severity (Z = −6.468, P < 0.001) significantly improved one month after WMT in all patients. The scores of the five components of PSQI including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances decreased in 52 patients with poor sleep quality (all P < 0.05). Baseline sleep duration scores were identified as an independent predictive factor of sleep improvement one month after WMT in patients with poor sleep quality (OR 2.180 [95% CI = 1.017–4.673]; P = 0.045). Patients that experienced sleep improvement demonstrated greater alleviation in depression (Z = −1.990, P = 0.047) and IBS severity (Z = −2.486, P = 0.013) compared with patients without sleep improvement. ConclusionThis study suggested that WMT might be a promising therapy for patients with IBS, especially those with comorbid sleep and psychological disorders.

Time Spent on Private Tutoring and Sleep Patterns of Chinese Adolescents: Evidence from a National Panel Survey.

In recent decades, there has been a marked increase in private tutoring and a decline in sleep health among adolescents. This study aimed to outline the association between time spent on private tutoring and sleep patterns of Chinese adolescents. Participants were from a nationwide two-wave panel survey. We performed OLS regressions of sleep duration at wave 2 and Poisson regressions of sleep problems at wave 2 on tutoring time at wave 2, adjusting for baseline sleep duration and other covariates. Tutoring time was assessed by three items: daily hours of tutoring, daily hours of tutoring on weekdays, and daily hours of tutoring on weekends. Overall, more time spent on private tutoring was associated with shorter sleep duration and more sleep problems. Furthermore, both weekday and weekend tutoring can have a positive effect on the number of sleep problems. With regard to sleep duration, weekend tutoring time played a negative role, while the effect of weekday tutoring time was negligible. In the Chinese context, which is characterized by intense academic competition, participation in private tutoring plays a significant role in shaping students' sleep duration and sleep problems. To improve the sleep health of adolescents, the time spent on private tutoring should be carefully monitored and regulated.

Association of habitual sleep duration and its trajectory with the risk of cancer according to sex and body mass index in a population-based cohort.

The relationship between sleep duration and cancer in China remains inconclusive. The authors investigated the association between sleep duration and cancer from both static and dynamic perspectives. This study was based on the China Health and Retirement Longitudinal Study. We first tested the hazard ratios (HRs) with 95% confidence intervals (CIs) between baseline sleep duration and incident cancer using Cox proportional hazards regression analysis. Sleep duration trajectories from 2011 to 2015 were identified using group-based trajectory modeling to examine the subsequent risk of incident cancer from 2015 to 2018 using Cox proportional hazards regression model. The risk of incident cancer increased by 69% (HR, 1.69; 95% CI, 1.19-2.39) in individuals who slept for <7h per day (vs. 7 to ≤8h), 41% (HR, 1.41; 95% CI, 1.01-1.95) in those who slept for <6h per night (vs. 6 to ≤8h), and 60% (HR, 1.60; 95% CI, 1.01-2.55) in those who did not take any naps during the day (vs.>60min). Stratified by sex and body mass index, the risk of cancer was evident among women with night sleep of <6h (vs. 6-8h). However, the duration of <7h of total sleep among men and overweight individuals was associated with cancer risk. Moreover, individuals with a short night sleep duration but no napping had a higher risk of cancer. Furthermore, cancer risk was only observed in individuals with short stable trajectory of night sleep (HR, 2.01; 95% CI, 1.07-3.80) and among women with short stable trajectory of total sleep (HR, 2.26; 95% CI, 1.13-4.52). Cancer incidence risk was observed in participants with sleep duration of <7h and among women with short stable sleep trajectory. Short nights and total sleep duration were both associated with a high risk of incident cancer, but varied by sex. Interestingly, cancer risk was restricted to women with short stable sleep trajectory. This study showed that short nights and total sleep duration were associated with a high risk of cancer incidence in middle-aged and elderly Chinese population, with implications for early effective cancer prevention. Habitual sleep is a modifiable and dynamic lifestyle behavior, and long-term short sleep trajectories among women can predict cancer outcomes. Future studies should examine the association between the trajectory of sleep parameters based on objective measures and specific cancer types.

Sleep duration trajectories and all-cause mortality among Chinese elderly: A community-based cohort study

BackgroundChina is among the largest and fastest aging countries. The elderly population is more vulnerable, with higher proportion of inappropriate sleep duration and risk of mortality, compared with young and middle-aged adults. Single-measured sleep duration has been associated with mortality, but the health effects of long-term sleep duration trajectories remain unknown. This study aimed to explore the prospective associations between sleep duration trajectories and all-cause mortality among Chinese elderly.MethodsParticipants (n = 3,895; median age: 82 years; females: 53.3%) who reported sleep duration in all three surveys (2005, 2008, and 2011) from the community-based Chinese Longitudinal Healthy Longevity Survey (CLHLS) were followed up until 2019 (about 8 years). We identified sleep duration trajectories by latent class mixed model and explored their association with all-cause mortality using Cox hazard proportional regression and Laplace regression models. Further, stratified analysis by demographic characteristics and lifestyles and sensitivity analysis by lag effect, health-related factors, and inverse probability weighting were used to verify the robustness of the association. In addition, we explored the threshold effect of baseline sleep duration on the risk of all-cause mortality.ResultsWe documented 1,881 all-cause deaths during 16,689 person-years of follow-up. Five sleep duration trajectories were identified: moderately increased trajectory (28.1%), rapidly increased trajectory (7.2%), persistent sleep trajectory of 7 h (33.7%), moderately decreased trajectory (21.3%), and rapidly decreased trajectory (9.7%). Compared with the persistent sleep trajectory of 7 h, the multivariable-adjusted HRs (95%CI) for moderately increased trajectory, rapidly increased trajectory, moderately decreased trajectory, and rapidly decreased trajectory were 1.21 (1.08, 1.36), 1.21 (1.01, 1.44), 0.95 (0.82, 1.10), and 0.93 (0.78, 1.11), respectively; and the corresponding difference in median survival time (95%CI) were -0.53 (-1.01, -0.05), -0.43 (0.16, -1.02), 0.26 (-0.34, 0.86), and 0.25 (-0.51, 1.02), respectively. Stratified and sensitivity analyses showed consistent results. Threshold analysis indicated a sharply increased risk of mortality in participants whose sleep exceeds 9 h (HR = 1.20, 95%CI: 1.11, 1.30).ConclusionCompared with the persistent sleep trajectory of 7 h, moderately and rapidly increased sleep duration trajectories were associated with higher subsequent mortality in Chinese elderly. Those who report sleep exceeding 9 h may be at high risk for all-cause mortality.

Associations of time in bed and sleep timing with dementia and cognitive decline among Chinese rural‐dwelling older adults: A cohort study

AbstractBackgroundThe longitudinal associations of time in bed (TIB) (a composite indicator of sleep duration, latency, and fragmentation) and sleep timing (a marker of circadian rhythms) with dementia and cognitive decline in older adults are unclear.MethodThis population‐based cohort study used data from 1982 participants in the Shandong Yanggu Study of Aging and Dementia, who were aged ≥60 years, free of dementia, and living in the rural communities in western Shandong Province, China. At the baseline (2014) and follow‐up (2018) examinations, sleep parameters were assessed using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Global cognitive function was measured using the Mini‐Mental State Examination (MMSE). Dementia was diagnosed following the DSM‐IV criteria, and the NIA‐AA criteria for Alzheimer disease (AD). Data were analyzed using restricted cubic splines, Cox proportional‐hazards models, and general linear models.ResultDuring the mean follow‐up of 3.7 (standard deviation = 0.3) years, dementia was diagnosed in 97 participants (68 with AD). Restricted cubic spline curves showed J‐shaped associations of sleep duration, TIB, and rise time with dementia risk, and a reverse J‐shaped association with mid‐sleep time. When continuous sleep parameters were categorized into tertiles, the multivariable‐adjusted hazard ratio (HR) of incident dementia was 1.69 (95%CI 1.01‐2.83) for baseline sleep duration &gt;8 hours (vs. 7‐8 hours), 2.17 (1.22‐3.87) for bedtime before 9PM (vs. 10PM or later), and 2.00 (1.23‐3.24) for mid‐sleep time before 1AM (vs. 1‐1.5AM). Early bedtime and mid‐sleep time were significantly associated with incident AD (multivariable‐adjusted HR range: 2.25‐2.51; P&lt;0.05). Among individuals who were free of dementia at follow‐up, baseline long TIB, early bedtime and mid‐sleep time, early and late rise time, and prolonged TIB and advanced mid‐sleep time from baseline to follow‐up were associated with greater decline in MMSE score (P&lt;0.05). These associations with cognitive decline were statistically evident mainly among men or participants who were aged &lt;75 years.ConclusionLong TIB and early sleep timing are associated with an increased risk of dementia and AD, and their associations with greater cognitive decline are evident only among young‐old people and men.

0203 Time-In-Bed Classroom Challenges: Incentivizing Undergraduate Students to Improve Sleep During Final Exams Week

Abstract Introduction Late bedtimes and all-nighters are ingrained into student culture, especially during final exam week. We previously found that extra credit incentives “to sleep 8 hours” encouraged longer sleep durations in small-sized classes. The current work investigated whether a modified approach—extending one’s time-in-bed—was scalable to larger-sized classes and dependent on the size of the incentive. Methods Across two studies, 129 undergraduate students completed baseline actigraphy and sleep diary monitoring early in Fall 2021 or Fall 2022. At the end of the semester, students could opt to take a time-in-bed challenge to earn large-sized (8 points; Study 1) or medium-sized (5 points; Study 2) extra credit on their final exam if they maintained an average time-in-bed of nine hours (or average total sleep time of eight hours). A smaller-sized extra credit (2 points) could be earned if the overall benchmarks were not met but one still improved on their baseline sleep duration by 20 minutes or sleep efficiency by 3%. Participants provided informed consent and the class instructor was kept blinded until after exams were graded. Results Most students attempted the time-in-bed sleep challenge (Study 1: 86.79%; Study 2: 92.11%). In Study 1, large-sized extra credit encouraged a 66 minute/night improvement in actigraphy-defined total sleep time from early-semester baseline (6.72 ± 1.18 hours) to final exams week (7.82 ± 0.89 hours; p&amp;lt;.001). In Study 2, a medium-sized extra credit opportunity improved actigraphy-defined total sleep time by 46 minutes/night from baseline (6.69 ± 0.80 hours) to finals week (7.46 ± 1.12 hours; p&amp;lt;.001). The interaction with incentive size was non-significant (p&amp;gt;.05). Sleep efficiency was similar across timepoints in Study 1 (83.6 ± 5.35 to 82.8 ± 5.18, p&amp;gt;.10) and Study 2 (82.9 ± 6.1 to 82.9 ± 6.47, p&amp;gt;.10). Students did not have to sacrifice total sleep time to perform well on their final exams (rs&amp;lt;.10); interestingly, students with higher sleep efficiencies performed better on their final exams (r=.28, p&amp;lt;.05). Conclusion The all-nighter culture of final exam week can be overcome by creating incentives for students to prioritize nighttime sleep. Support (if any) National Science Foundation (1920730 and 1943323).

Sleep duration affects the sequential change of body mass index and muscle strength: a contribution to dynapenic obesity

BackgroundWith aging, body mass index (BMI) increases and muscle strength declines, resulting in dynapenic obesity. It remains unknown whether and how sleep duration contributes to the sequence of BMI and muscle strength change in the progression of dynapenic obesity.MethodsData were derived from the first two waves of China Health and Retirement Longitudinal Study. Sleep duration was self-reported. BMI was calculated and grip strength (GS) was measured to reflect muscle strength. The effect of baseline sleep duration on the sequential change of BMI and GS was assessed using two mediation models considering the nonlinear associations between them. The moderating effect of metabolic disorder was also tested.ResultsTotally 4986 participants aged ≥ 50 years (50.8% females) with complete information on variables were included. Baseline BMI fully mediated the nonlinear association between sleep duration and follow-up GS change, but baseline GS did not mediate between sleep duration and follow-up BMI change for older men and women. Short sleep duration positively affected BMI-induced GS change (β = 0.038; 95%CI, 0.015–0.074), while this favorable effect became nonsignificant for moderate sleep duration (β = 0.008; 95% CI, -0.003–0.024) and turned negative with prolonged sleep duration (β = − 0.022; 95%CI, − 0.051 to − 0.003). This nonlinear mediation effect was more pronounced in older women who are relatively metabolically healthy at baseline.ConclusionFor older adults in China, the influence of sleep duration on BMI-induced GS change but not the GS-induced BMI change suggested the contribution of sleep duration to the sequential course in the progression of dynapenic obesity. Sleep duration deviated either above or below normal range may confer adverse impact on GS through BMI. Strategies addressing sleep and obesity jointly to improve muscle function and delay the progression of dynapenic obesity are required.

Temporal relationship between sleep duration and obesity among Chinese Han people and ethnic minorities

BackgroundNo studies have assessed the association between sleep duration and obesity in Chinese ethnic minorities. Whether the relationship between sleep duration and obesity is different between Chinese Han people and Chinese ethnic minorities remains unclear. The study aimed to explore the relationship between sleep duration and obesity among Chinese Han people and Chinese ethnic minorities.MethodsWe applied data from the Guizhou Population Health Cohort Study (GPHCS), which 9,280 participants were recruited in the baseline survey from 2010 to 2012, and 8,163 completed the follow-up survey from 2016 to 2020. A total of 5,096 participants (3,188 Han Chinese and 1,908 ethnic minorities) were included in the ultimate analysis. Information on sleep duration (total 24-hour sleep time), body mass index (BMI), and waist circumference (WC) was collected at the baseline and follow-up survey, respectively. Cross-lagged panel analyses were conducted to explore the temporal relationship between sleep duration and obesity for Han people and ethnic minorities.ResultsFor Han people, the results from cross-lagged panel analyses indicated that baseline sleep duration was significantly associated with follow-up BMI (βBMI = -0.041, 95% CIBMI: -0.072 ~ -0.009) and follow-up WC (βWC = -0.070, 95%CIWC: -0.103 ~ -0.038), but baseline BMI (βBMI = -0.016, 95% CIBMI: -0.050 ~ 0.018) and baseline WC (βWC = -0.019, 95% CIWC: -0.053 ~ 0.016) were not associated with follow-up sleep duration. In addition, the relationship between baseline sleep duration and follow-up BMI was gender-specific and significant only in the Han people female (βBMI = -0.047, 95% CIBMI: -0.090 ~ -0.003) but not in the Han people male (βBMI = -0.029, 95% CIBMI: -0.075 ~ 0.016). For ethnic minorities, the results indicated that there was no relationship between sleep duration and obesity at all, either from sleep duration to obesity (βBMI = 0.028, 95%CIBMI: -0.012 ~ 0.068; βWC = 0.020, 95%CIWC: -0.022 ~ 0.062), or from obesity to sleep duration (βBMI = -0.022, 95%CIBMI: -0.067 ~ 0.022; βWC = -0.042, 95%CIWC: -0.087 ~ 0.003).ConclusionThe relationship pattern between sleep duration and obesity across Han people and ethnic minorities is different. Future sleep-aimed overweight and obesity intervention should be conducted according to population characteristics.