Effects Of Poor Sleep Research Articles

The bidirectional relationship between sleep disturbance and anxiety: Sleep disturbance is a stronger predictor of anxiety

BackgroundBoth sleep disturbance and anxiety are common problems that significantly affect human health, but little is known about their causal relationship. The aim of this study was to explore the causal relationship between them with a large sample of community-dwelling adults included. MethodsData for this study were extracted from the baseline survey of West China Natural Population Cohort Study (WCNPCS) and follow-up in the following year. The sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and anxiety was screened using the Generalized Anxiety Disorder Scale (GAD-7). Age, gender, educational level, marital status, smoking status, drinking status, depressive symptoms, loneliness and chronic diseases were taken as covariant factors. Logistic regression and cross-lagged models were used for data analyses. ResultsA total of 16699 participants (67.5 % females) were enrolled, with the average age of participants being 57.3 ± 12.7 years. A total of 40.50 % of participants experienced poor sleep quality at baseline and 40.52 % at follow-up. The prevalence of anxiety was 7.58 % at baseline and 4.62 % at follow-up. The results showed that the risk of developing anxiety in individuals with sleep disturbance at baseline was 1.89 times higher than those without (95%CI = 1.43–2.48). Similarly, anxiety increased the risk of developing sleep disturbance by 1.20-fold (95%CI = 1.03–1.39). These results were further supported by the cross-lagged panel models. ConclusionSleep disturbance and anxiety are mutually causal, and the effect of poor sleep on anxiety seems to be more significant. Timely interventions targeting sleep may help to break the vicious circle between sleep disturbance and anxiety symptoms, and improve the quality of life.

MECHANISMS UNDERLYING SLEEP AND DEVELOPMENT OF CHRONIC CONDITIONS IN OLDER ADULTS

Abstract Mounting evidence suggests poor sleep is associated with the development of chronic conditions. Numerous mechanisms for these links have been proposed, including inflammation, metabolic function, and brain structure. In this symposium, we will present five studies focused on links between poor sleep and subsequent development of chronic disease across adulthood. Specifically, we will examine this relationship at multiple levels from the cellular to the clinical level with the ultimate goal of identifying potential mechanisms and consequences of links between poor sleep and chronic conditions. Paper 1 will identify within-person patterns of various sleep experiences and link them to incident chronic conditions over a 10-year period. Paper 2 will examine associations between sleep parameters, measured via wrist actigraphy, and levels of adipokines, which are adipose-derived cytokines associated with development of metabolic disease. In Paper 3, we will shift our focus to examine the association between poor sleep and inflammatory biomarkers, specifically C-reactive protein, circulating and lipopolysaccharide-stimulated cytokines. Paper 4 will assess the impact of poor sleep health on fear of falling and actual falls. Paper 5 will focus on the effects of poor sleep and arousal with cognition and brain structure, specifically within a population of patients with chronic pain. As Discussant, Dr. Christina McCrae will integrate these findings and suggest directions for future research. In summary, our symposium will elucidate biological and psychological mechanisms linking poor sleep to manifestation of chronic disease. Better understanding of these mechanisms will inform the development of interventions to promote successful aging.

Sleep, Mental Health, and Cognition Across Diverse Adult Populations

Abstract Sleep is often impaired in late life, raising concerns about the effect of poor sleep on mental and cognitive health in aging individuals. This symposium brings together five rigorous studies that show how poor sleep may be an under-recognized risk factor for mental health and cognitive outcomes in the second half of life. Specifically, this symposium showcases data from a variety of study cohorts (including Midlife in the United Study, Einstein Aging Study, and Study of Muscle, Mobility, and Aging), using diverse indicators of subjective and objective sleep. Paper 1 focuses on healthcare workers (HCWs), a group critical for the delivery of quality patient care, and examines both individual and joint associations of poor sleep and pain with mental health in HCWs vs. non-HCWs. Paper 2 investigates the association between EEG-measured sleep and depressive symptoms in older adults. Paper 3 explores the relationship between intra-individual variability of sleep and mild cognitive impairment (MCI) and identifies gender differences in these associations. Paper 4 establishes the associations of actigraphy-measured sleep and circadian rest-activity rhythms with multiple domains of cognition in older adults. Paper 5 examines the effect of latent dose/duration patterns of common sleep medications on development of Alzheimer’s disease and related dementias. The discussant, Dr. Adam Spira, will integrate key findings from these studies, discuss their contributions to the literature, and consider opportunities for future research. This is a Sleep, Circadian Rhythms and Aging Interest Group Sponsored Symposium. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias, Geroscience, and Health Behavior Change Interest Groups.

Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study.

Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. Focus groups were conducted over 3 stages to examine students' views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep. Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.

Entrepreneurial Self-Efficacy as a Ward Against the Effects of Poor Sleep on Behaviors

Entrepreneurial Self-Efficacy as a Ward Against the Effects of Poor Sleep on Behaviors

Cognitive exertion affects the appraisal of one’s own and other people’s pain

Correctly evaluating others’ pain is a crucial prosocial ability. In both clinical and private settings, caregivers assess their other people’s pain, sometimes under the effect of poor sleep and high workload and fatigue. However, the effect played by such cognitive strain in the appraisal of others’ pain remains unclear. Fifty participants underwent one of two demanding tasks, involving either working memory (Experiment 1: N-Back task) or cognitive interference (Experiment 2: Stroop task). After each task, participants were exposed to painful laser stimulations at three intensity levels (low, medium, high), or video-clips of patients experiencing three intensity levels of pain (low, medium, high). Participants rated the intensity of each pain event on a visual analogue scale. We found that the two tasks influenced rating of both one’s own and others’ pain, by decreasing the sensitivity to medium and high events. This was observed either when comparing the demanding condition to a control (Stroop), or when modelling linearly the difficulty/performance of each depleting task (N-Back). We provide converging evidence that cognitive exertion affects the subsequent appraisal of one’s own and likewise others’ pain.

Effect of Sleep Changes on Health-Related Quality of Life in Healthy Children

Little is known regarding the effect of poor sleep on health-related quality of life (HRQOL) in healthy children. To determine the effect of induced mild sleep deprivation on HRQOL in children without major sleep issues. This prespecified secondary analysis focused on HRQOL, a secondary outcome of the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized crossover trial of children who underwent alternating weeks of sleep restriction and sleep extension and a 1-week washout in between. The DREAM trial intervention was administered at participants' homes between October 2018 and March 2020. Participants were 100 children aged 8 to 12 years who lived in Dunedin, New Zealand; had no underlying medical conditions; and had parent- or guardian-reported normal sleep (8-11 hours/night). Data were analyzed between July 4 and September 1, 2022. Bedtimes were manipulated to be 1 hour later (sleep restriction) and 1 hour earlier (sleep extension) than usual for 1 week each. Wake times were unchanged. All outcome measures were assessed during both intervention weeks. Sleep timing and duration were assessed using 7-night actigraphy. Children and parents rated the child's sleep disturbances (night) and impairment (day) using the 8-item Pediatric Sleep Disturbance and 8-item Sleep-Related Impairment scales of the Patient-Reported Outcomes Measurement Information System questionnaire. Child-reported HRQOL was assessed using the 27-item KIDSCREEN questionnaire with 5 subscale scores and a total score. Both questionnaires assessed the past 7 days at the end of each intervention week. Data were presented as mean differences and 95% CIs between the sleep restriction and extension weeks and were analyzed using intention to treat and an a priori difference in sleep of at least 30 minutes per night. The final sample comprised 100 children (52 girls [52%]; mean [SD] age, 10.3 [1.4] years). During the sleep restriction week, children went to sleep 64 (95% CI, 58-70) minutes later, and sleep offset (wake time) was 18 (95% CI, 13-24) minutes later, meaning that children received 39 (95% CI, 32-46) minutes less of total sleep per night compared with the sleep extension week in which the total sleep time was 71 (95% CI, 64-78) minutes less in the per-protocol sample analysis. Both parents and children reported significantly less sleep disturbance at night but greater sleep impairment during the day with sleep restriction. Significant standardized reductions in physical well-being (standardized mean difference [SMD], -0.28; 95% CI, -0.49 to -0.08), coping in a school environment (SMD, -0.26; 95% CI, -0.42 to -0.09), and total HRQOL score (SMD, -0.21; 95% CI, -0.34 to -0.08) were reported by children during sleep restriction, with an additional reduction in social and peer support (SMD, -0.24; 95% CI, -0.47 to -0.01) in the per-protocol sample analysis. Results of this secondary analysis of the DREAM trial indicated that even 39 minutes less of sleep per night for 1 week significantly reduced several facets of HRQOL in children. This finding shows that ensuring children receive sufficient good-quality sleep is an important child health issue. Australian New Zealand Clinical Trials Registry: ACTRN12618001671257.

Society of Anesthesia and Sleep Medicine Position Paper on Patient Sleep During Hospitalization.

This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation). All these changes negatively impact health status and are counterproductive to recovery from illness and operation. Hospitalization challenges sleep in a variety of ways. These challenges include environmental factors such as noise, bright light, and overnight awakenings for observations, interventions, and transfers; physiological factors such as pain, dyspnea, bowel or urinary dysfunction, or discomfort from therapeutic devices; psychological factors such as stress and anxiety; care-related factors including medications or medication withdrawal; and preexisting sleep disorders that may not be recognized or adequately managed. Many of these challenges appear readily addressable. The key to doing so is to give sleep greater priority, with attention directed at ensuring that patients' sleep needs are recognized and met, both within the hospital and beyond. Requirements include staff education, creation of protocols to enhance the prospect of sleep needs being addressed, and improvement in hospital design to mitigate environmental disturbances. Hospitals and health care providers have a duty to provide, to the greatest extent possible, appropriate preconditions for healing. Accumulating evidence suggests that these preconditions include adequate patient sleep duration and quality. The Society of Anesthesia and Sleep Medicine calls for systematic changes in the approach of hospital leadership and staff to this issue. Measures required include incorporation of optimization of patient sleep into the objectives of perioperative and general patient care guidelines. These steps should be complemented by further research into the impact of hospitalization on sleep, the effects of poor sleep on health outcomes after hospitalization, and assessment of interventions to improve it.

Perceived Sleep Quality and Quantity before Acute Myocardial Infarction

Background: Sleep plays a vital role in disease prevention and rejuvenation. Diet and exercise are emphasized in the prevention of diseases, whereas sleep is often overlooked. The consequences of poor sleep often go unnoticed. Insufficient and poor sleep has been associated with various health problems and is considered an important risk factor. The objective of this study was to explore the association between perceived sleep quality and quantity before acute myocardial infarction (MI). Materials and Methods: It was a prospective observational study. Thirty hospitalized patients of acute coronary syndrome with an index event of first-time MI satisfying the inclusion and exclusion criteria were enrolled. The Pittsburgh Sleep Quality Index (PSQI) was administered to the patients. Other basic investigations done for the diagnosis and work-up of the cases by the treating doctors were noted and data were analyzed. Results: In our study, the mean Global PSQI score was 7.16 (standard deviation = 3.79). In our study, based on Global PSQI scores (based on the details of the past 1 month before acute MI), sleep quality was found to be “POOR” (Global PSQI score >5) in 23 (76.7%) patients with acute MI which was statistically significant (Spearman's Rho: r = 1) and “Good” (Global PSQI score <5) in 7 (23.3%) patients. All the patients >60 years of age had poor sleep quality. The average duration of sleep was 5 h 30 min. The majority of the patients (71%) with acute MI slept for <6 h which was statistically significant (Spearman's Rho: r = –1). Conclusion: This pilot study, based on PSQI, establishes the association between perceived sleep quality and quantity and acute MI.

Association between poor sleep quality and emotional eating in US Latinx adults and the mediating role of negative emotions

ABSTRACT Introduction Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities. Objective To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions. Methods This cross-sectional analysis used data from the Latino Health and Well-being Study. Sleep quality was measured with the Pittsburgh Sleep Quality Index. EE was measured with the EE subscale of the Three Factor Eating Questionnaire R18-V2 (categorized as no EE, low EE, and high EE). Negative emotions were measured via a composite score that included depression, anxiety, and perceived stress. Poisson regression models with robust variance errors estimated prevalence ratios (PR) and 95% confidence intervals (CI). Mediation was evaluated with the Karlsson-Holm-Breen method. Results More individuals with poor (vs. good) sleep quality experienced high EE (39.1% vs. 17.9%). Individuals with poor (vs. good) sleep quality were more likely to experience high EE vs. no EE (total effect = 1.74; 95% CI = 1.34, 2.26). Controlling for negative emotions, the effect of poor sleep on high EE was reduced to 1.23 (95% CI = 0.92, 1.65), leaving an indirect effect of 1.41 (95% CI = 1.25, 1.60); 62.6% of the effect was explained by negative emotions. Conclusion Poor sleep quality was associated with high EE in US Latinx adults and negative emotions partially mediated this relationship. Longitudinal studies are needed. Interventions and clinical programs should concomitantly address sleep quality and negative emotions to help prevent dysfunctional eating behaviors.

Electrodermal Activity Moderates Sleep-Behavior Associations in Children with Autism Spectrum Disorder.

Relative to children without autism spectrum disorder (ASD), children with ASD experience elevated sleep problems that can contribute to behavioral comorbidities. This study explored the interaction between psychophysiology and sleep to determine which children with ASD may be at risk for, or resilient to, effects of poor sleep on daytime behavior. Participants included 48 children (aged 6-10years) with ASD. Measures of sympathetic nervous system activity (electrodermal activity; EDA) were collected during a baseline and in response to a laboratory challenge task. Parents reported on their children's sleep problems and behavioral functioning, including broad externalizing symptoms and situational noncompliance, using standardized questionnaires and a clinical interview. EDA moderated the significant positive associations between sleep problems and both behavioral outcomes. The link between sleep problems and broad externalizing symptoms and situational noncompliance was positive and significant in the context of lower baseline EDA and nonsignificant in the context of higher baseline EDA. Sleep problems also interacted with EDA reactivity in predicting situational noncompliance, but not broad externalizing symptoms. Findings highlight the complex interplay among sleep, daytime behavior, and psychophysiology in children with ASD. Results are interpreted in the context of differential susceptibility and dual-risk frameworks. This study underscores the importance of high-quality sleep for children with ASD, especially those with the biological sensitivity or vulnerability factors (i.e., EDA) identified in this study. Clinical implications are discussed, and directions for future research are provided.

Social Integration and Sleep Quality during the COVID-19 Pandemic: Prospective Evidence from a Study of Retired Older Adults

ABSTRACT Background Growing evidence has documented the adverse impact of the global COVID-19 pandemic on sleep quality among older adults. Given the negative consequences of poor sleep, it is critical to identify factors that provide older adults with resilience against worsening sleep quality. Social integration may represent one such resilience factor. Purpose This study evaluated the association of social integration and sleep quality during the COVID-19 pandemic. Methods 113 retired older adults completed assessments of their social integration after the onset of the COVID-19 pandemic, and of their sleep quality before and after the onset of the COVID-19 pandemic. Results Higher levels of social integration were associated with better sleep quality during the COVID-19 pandemic, even when statistically controlling for pre-pandemic sleep quality. Sex-stratified analyses showed that this association was driven by women in our sample. Conclusions Social integration may confer resilience against poor sleep quality, especially in older adult women. Additional research is warranted to assess candidate mechanisms and moderators of the link between social integration and sleep quality.

Effects of poor sleep on the immune cell landscape as assessed by single-cell analysis

Poor sleep has become an important public health issue. With loss of sleep durations, poor sleep has been linked to the increased risks for diseases. Here we employed mass cytometry and single-cell RNA sequencing to obtain a comprehensive human immune cells landscape in the context of poor sleep, which was analyzed in the context of subset composition, gene signatures, enriched pathways, transcriptional regulatory networks, and intercellular interactions. Participants subjected to staying up had increased T and plasma cell frequency, along with upregulated autoimmune-related markers and pathways in CD4+ T and B cells. Additionally, staying up reduced the differentiation and immune activity of cytotoxic cells, indicative of a predisposition to infection and tumor development. Finally, staying up influenced myeloid subsets distribution and induced inflammation development and cellular senescence. These findings could potentially give high-dimensional and advanced insights for understanding the cellular and molecular mechanisms of pathologic conditions related to poor sleep.

Sleep quality and neuropsychological functioning in bipolar I disorder

BackgroundIndividuals with bipolar I disorder (BD-I) experience both poor sleep and neuropsychological dysfunction relative to non-psychiatric populations, which limits functional recovery. Poor sleep adversely affects learning, memory, and executive functioning in healthy individuals; however, little is known about the role of poor sleep in neuropsychological functioning in BD-I. We tested whether sleep disturbance was greater in BD-I than healthy control participants (HC), and compared the effect of sleep quality on learning, memory, and executive functioning between BD-I and HC. MethodsParticipants with BD-I (N=250) and HC (N=206) completed the Pittsburgh Sleep Quality Index, neuropsychological testing, and clinician-administered mood measures as part of a naturalistic study of bipolar disorder. We examined effects of both diagnosis and sleep quality on neuropsychological functioning. ResultsRelative to HC, BD-I showed poorer sleep quality and neuropsychological functioning in verbal learning, verbal and visual memory, processing speed, psychomotor speed, inhibitory control, and selective attention (7/9 domains). Poor sleep quality was associated with poorer verbal learning, verbal fluency, processing speed, and interference control (4/9). Effects of poor sleep on neuropsychological functioning did not differ between BD-I and HC. LimitationsThe assessment of sleep quality using a self-report measure and the effects of medications/sleeping aids (given the naturalistic study design) should be considered when interpreting results. ConclusionsThose with BD-I experiencing poor sleep may also be more vulnerable to verbal learning and executive functioning impairments. The findings of poor sleep in relation to poorer neuropsychological functioning have implications for assessment and treatment of sleep disturbance in BD-I.

Impact of inflammatory markers on the relationship between sleep quality and diabetic kidney disease.

Both poor sleep and diabetic kidney disease are closely associated with inflammation. However, the correlation between poor sleep and diabetic kidney disease has not been wellclarified. Thus, the aim of this study was to determine the mediating role that inflammatory markers play in the pathogenic effectof poor sleep on the severity of diabetic kidney disease (DKD). A cross-sectional survey was conducted on 336 patients withtype 2 diabetes (T2D). DKD was diagnosed according to the guidelines of the National Kidney Foundation-Kidney Disease Outcome Quality Initiative (NKF-K/DOQI). The Pittsburg Sleep Quality Index (PSQI) score was applied to assess patients for the quality of their sleep. Patients with a PSQIscore of more than 5 were assigned to the poor sleep group, and the rest of the patients were assigned to the good sleep group. Circulating levels of six inflammatory biomarkers related to poor sleep and DKD were measured. The prevalence of DKD was higher in patients with poor sleepquality than in those with good sleepquality (42% vs. 25%, P = 0.002). After adjustment, poor sleepquality (PSQI score OR 1.075 [95%CI 1.018-1.135], P = 0.009) remained independently associated with DKD. PSQI score was found to be positively related to fibroblast growth factor (FGF23), interleukin 6 (IL-6), P-selectin, and intercellular adhesion molecule-1 (ICAM-1) (P < 0.01), rather than fibrinogen and C-reactive protein (CRP) in linear regression models. As revealed by multiple mediation analysis, FGF23 and IL-6 mediated 26% and 23% of the relationship between PSQI score and urinary microalbumin (UMA), respectively. Similarly, the FGF23 and ICAM-1, instead of IL-6 and P-selectin, mediated 32% and 24% of the association between PSQI and estimated glomerular filtration rate (eGFR), respectively. Poor sleepquality is independently associated with DKD. These results suggest that inflammatory markers contribute to a pathogenic connection between poor sleep and DKD.

Magnitude and correlates of sleep quality among undergraduate medical students in Ethiopia: cross \u2013sectional study

PurposePoor quality of sleep has a negative effect on academic performance of medical students. Quantity and quality of sleep in addition to average sleep time are strongly linked with students’ learning abilities, poor academic performance and poor interpersonal relationship which predispose them to mental illnesses. This study is aimed to assess magnitude and correlates of sleep quality among medical students in Ethiopia.MethodAn institutional based cross-sectional study was conducted among 576 undergraduate medical students. Data was collected by using interviewer administered structured questionnaires. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The collected data were entered in to Epi-data version 3.1and analyzed using SPSS version 20. Logistic regression was used to identify the potential determinants of quality of sleep among undergraduate medical students. P-values less than 0.05 were considered statistically significant and strength of the association was presented by adjusted odds ratio with 95% C.I.ResultThe prevalence of poor sleep quality among undergraduate medical students was 62% (95%CI, 57.9, 65.3). The mean age (±SD) of the respondents was 21.5(±2.4), with age ranging from 18 to 28 and about 310 (53.8%) were males. Factors like, being depressed (AOR = 1.92,95%CI 1.16,3.19), poor social support (AOR = 5.39,95%CI 2.33,2.49), being stressed (AOR = 2.04,95%CI 1.26,3.31), and poor sleep hygiene (AOR = 3.01,95%CI 1.75,5.18) were associated with poor sleep quality at p-value < 0.05. Findings also showed that, one unit increase in grade point average was associated with 81.5% decrease (AOR = 0.185, 95%CI 0.13, 0.28) in poor sleep quality.ConclusionA substantial proportion of medical students are affected by poor sleep quality. Routine screening of sleep quality, sleep hygiene, depression and stress is warranted. Moreover, it is better to educating medical students about proper sleep hygiene and the consequences of poor sleep.

Contributors to and Consequences of Poor Sleep in Older Adults: Biopsychosocial Perspectives

Sleep is a significant contributor to health and wellbeing across the lifespan, especially in later life. Poor sleep is common among older adults and can be both a risk factor for and consequence of numerous physical and mental health-related outcomes. In this symposium, we will present novel results from four studies that will advance understanding of the biological, psychological, and social factors that may contribute to or result from poor sleep in older adults. Specifically, Study 1 will present findings tying objectively measured sleep to performance on cognitive tasks administered using ecological momentary assessment (EMA) in the day-to-day lives of older adults with or without mild cognitive impairment (MCI). Study 2 will examine associations of personality dimensions and facets with insomnia symptoms in well-functioning older adults. Study 3 will examine psychological pathways linking parent-child relationships to subjective and objective sleep characteristics among older parents. Finally, study 4 will examine use patterns of cannabis for the treatment of sleep problems in older adults, and the ways in which this might differ from patients using cannabis for other reasons (e.g., pain). Together, this symposium will highlight novel links of an array of factors with sleep health in the aging population and their implications for prevention. Sleep, Circadian Rhythms and Aging Interest Group Sponsored Symposium.

Poor Sleep Health and Next Day Work Impairment: The Mediating Role of Fatigue

Nightly sleep impacts next-day alertness and cognitive functioning. For healthcare professions, work impairment can be life-threatening for patients. Thus, understanding how sleep affects work quality is imperative to promoting medical safety and overall health of workers. The current study investigated whether nightly sleep health is associated with next-day work impairment in nurses and whether this association is mediated by daily fatigue. Sixty nurses reported their sleep characteristics, fatigue, and work impairment using ecological momentary assessment for two weeks. We used a series of multilevel models (a path: sleep→fatigue, b path: fatigue→work impairment, c path: sleep→work impairment, c′ path: sleep and fatigue→work impairment), adjusting for sociodemographics and work shift. At the between-person level, poorer sleep quality was associated with greater work impairment (βc=-23.36, p<.001). This association was mediated by fatigue such that poorer sleep quality was associated with greater fatigue (βa=-19.54, p<.01), which was further associated with greater work impairment (βb=0.79, p<.001). After including fatigue, the association of sleep quality with work impairment was reduced (βc′ =-7.07, p=.08). Similarly, fatigue mediated the relationship between sleep sufficiency and work impairment (βa=-16.49; βb=0.79; βc=-19.36; p<.001; βc′ =-6.32, p=.05). At the within-person level, on days after long sleep duration (>8hrs), nurses reported greater work impairment (βc=10.08, p<.01), however, this was not mediated by fatigue. Our results suggest that poor sleep health may impair next-day work performance, mostly through increased fatigue. Future interventions for nurses can target daily fatigue to reduce the adverse effects of poor sleep on work impairment.

Associations between physical activity and energy and fatigue depend on sleep quality

ABSTRACT Objective: Sleep and physical activity are independent predictors of energy and fatigue, but whether poor sleep quality moderates the association between physical activity and energy and fatigue remains unclear. Methods: A sample of 675 young adults (median age 20 years) was recruited from a university town and completed questionnaires regarding sleep quality (Pittsburgh Sleep Quality Index), typical weekly physical activity (moderate and high-intensity), and feelings of mental and physical energy and fatigue. Linear regression analyses were run to evaluate the associations between physical activity and sleep with the energy and fatigue outcomes, adjusting for sex, age, and caffeine. Interaction analyses were run and models were stratified by sleep quality to evaluate effect modification. Results: Participants reported a weekly median (Q1, Q3) of 4 h (2,8) of high-intensity physical activity, and 1 h (0,3) of moderate-intensity physical activity, and 50% of the sample had poor sleep quality. Physical activity was positively associated with physical and mental energy, and sleep quality was associated with each of the 4 outcomes. Interaction analyses revealed that high-intensity physical activity was positively related to physical energy only among those with good quality sleep. Further, high-intensity physical activity was more strongly positively associated with physical energy among those with good quality sleep than those with poor quality sleep (β = 0.32 with 95% CI 0.18–0.46 compared to 0.14 with 95% CI −0.01, 0.29). Conclusion: Findings suggest that physical activity alone may not be able to overcome the deleterious effects of poor sleep on feelings of mental and physical energy and fatigue.

The relationship between depressive symptoms, somatic complaints, and concussion history with poor sleep in collegiate athletes

ObjectiveOngoing exploration of factors related to poor sleep in collegiate athletes is important as understanding of the risks and consequences of poor sleep in this specific population increases. DesignRetrospective cohort study. SettingUniversity in the Pacific Northwest. ParticipantsOne-hundred thirty-seven male and female collegiate athletes across 5 collision, contact, and limited contact team sports. MeasurementsDepressive symptoms (Patient Health Questionnaire 9; PHQ-9), anxiety symptoms (General Anxiety Disorder 7; GAD-7), and somatic complaints (Patient Health Questionnaire 15; PHQ-15). Sleep quality (Pittsburgh Sleep Quality Index; PSQI) used both a cutoff score ≥6 and a cutoff score of ≥8, indicating "poor sleep quality" to reduce threats to divergent validity. ResultsPoor sleep quality as defined by PSQI ≥ 6 was present in 53% of athletes, and as defined by PSQI ≥ 8 was identified in 33.5% of the cohort. There were no differences in the incidence of poor sleepers between sport, race/ethnicity, or sex. Multiple regression analysis revealed that depressive symptoms, somatic complaints, Caucasian race, male sex, and number of concussions were significant predictors of poor sleep (P < .05). The model accounted for 43% of the variance in PSQI and primarily by depressive symptoms explaining 9% of reported sleep quality variability. Anxiety symptoms, sport category, and history of migraines were not significant predictors of poor sleep quality. ConclusionsA high incidence of poor sleep among collegiate athletes was observed regardless of sport, and may be related to depressive symptoms, somatic complaints, Caucasian race, male sex, and historical number of concussions.