Daytime Activity Levels Research Articles

Assessing actigraphy performance for daytime sleep detection following stroke: insights from inpatient monitoring in a rehabilitation hospital.

Stroke can result in or exacerbate various sleep disorders. The presence of behaviors such as daytime sleepiness poststroke can indicate underlying sleep disorders which can significantly impact functional recovery and thus require prompt detection and monitoring for improved care. Actigraphy, a quantitative measurement technology, has been primarily validated for nighttime sleep in healthy adults; however, its validity for daytime sleep monitoring is currently unknown. Therefore this study aims to identify the best-performing actigraphy sensor and algorithm for detecting daytime sleep in poststroke individuals. Participants wore Actiwatch Spectrum and ActiGraph wGT3X-BT on their less-affected wrist, while trained observers recorded daytime sleep occurrences and activity levels (active, sedentary, and asleep) during non-therapy times. Algorithms, Actiwatch (Autoscore AMRI) and ActiGraph (Cole-Kripke, Sadeh), were compared with on-site observations and assessed using F2 scores, emphasizing sensitivity to detect daytime sleep. Twenty-seven participants from an inpatient stroke rehabilitation unit contributed 173.5 hours of data. The ActiGraph Cole-Kripke algorithm (minute sleep time = 15 minutes, bedtime = 10 minutes, and wake time = 10 minutes) achieved the highest F2 score (0.59). Notably, when participants were in bed, the ActiGraph Cole-Kripke algorithm continued to outperform Sadeh and Actiwatch AMRI, with an F2 score of 0.69. The study demonstrates both Actiwatch and ActiGraph's ability to detect daytime sleep, particularly during bed rest. ActiGraph (Cole-Kripke) algorithm exhibited a more balanced sleep detection profile and higher F2 scores compared to Actiwatch, offering valuable insights for optimizing daytime sleep monitoring with actigraphy in stroke patients.

Directional associations among real-time activity, sleep, mood, and daytime symptoms in major depressive disorder using actigraphy and ecological momentary assessment

Previous research has suggested that individuals with major depressive disorder (MDD) experienced alterations in sleep and activity levels. However, the temporal associations among sleep, activity levels, mood, and daytime symptoms in MDD have not been fully investigated. The present study aimed to fill this gap by utilizing real-time data collected across time points and days. 75 individuals with MDD and 75 age- and gender-matched healthy controls were recruited. Ecological momentary assessments (EMA) were adopted to assess real-time mood status for 7 days, and actigraphy was employed to measure day-to-day sleep-activity patterns. Multilevel modeling analyses were performed. Results revealed a bidirectional association between mood/daytime symptoms and activity levels across EMA intervals. Increased activity levels were predictive of higher alert cognition and positive mood, while an increase in positive mood also predicted more increase in activity levels in depressed individuals. A bidirectional association between sleep and daytime symptoms was also found. Alert cognition was found to be predictive of better sleep in the subsequent night. Contrariwise, higher sleep efficiency predicted improved alert cognition and sleepiness/fatigue the next day. A unidirectional association between sleep and activity levels suggested that higher daytime activity levels predicted a larger increase in sleep efficiency among depressed individuals. This study indicated how mood, activity levels, and sleep were temporally and intricately linked to each other in depressed individuals using actigraphy and EMA. It could pave the way for novel and efficacious treatments for depression that target not just mood but sleep and activity levels.

Livestock activity shifts large herbivore temporal distributions to their crepuscular edges

Abstract Wildlife species are transitioning to greater crepuscular and nocturnal activity in response to high human densities. This plasticity in temporal niches may partially mitigate the impacts of human activity but may also result in underestimating human effects on species foraging, predator–prey relationships and community‐level interactions. We deployed remote cameras to characterize shifts in herbivore diel activity in protected habitat versus pastoralist landscapes. We then compared species traits including body mass, dietary preferences and behavioural characteristics as potential predictors of species sensitivity to livestock. Our data capture a significant temporal shift away from core cattle activity for nearly every herbivore species in our study, leading to more crepuscular activity patterns. As livestock were primarily diurnal and predators primarily nocturnal in pastoralist habitat, species that decreased their overlap with livestock were more likely to increase their overlap with potential predators. Other than species' typical daytime activity levels, we found no evidence that any particular trait significantly predicted temporal shifts in response to livestock. Instead, species generally trended towards greater activity levels at dawn, suggesting that cattle have a homogenizing effect on community‐wide activity patterns. Our findings highlight how cohabitation with livestock can profoundly alter the temporal niches of wild herbivores. Shifts in diel activity patterns may reduce herbivore foraging time or efficiency and potentially have cascading shifts on predator–prey dynamics. Given that species traits could not predict responses to livestock, our analysis suggests that conservation strategies should consider each species separately when designing interventions for wildlife management.

Daytime activity levels impact sleep in brain injury rehabilitation

Daytime activity levels impact sleep in brain injury rehabilitation

Modafinil's effects on cognition and sleep quality in affectively-stable patients with bipolar disorder: a pilot study.

Despite advances in the treatment of bipolar disorder (BD), most patients do not achieve complete inter-episode recovery and functional disability is common. During periods of relative remission, many patients continue to experience neurocognitive dysfunction, reduced daytime activity levels, and sleep disturbances. This 8-week, randomized, placebo-controlled pilot study evaluated the feasibility, safety and preliminary efficacy of the wake-promoting drug, modafinil (Provigil®), on neurocognitive functioning, daytime sleepiness, and sleep quality in affectively-stable BD patients. Twelve individuals with affectively-stable BD were recruited and randomized to a flexible dose of modafinil (100 to 200 mg/day) or placebo, adjunctive to a therapeutic dose of a mood stabilizer. Weekly in-person visits tracked sleep quality and daytime sleepiness as well as side effects and mood symptoms. Neurocognitive functioning was assessed at baseline, week 4, and week 8. No serious adverse events were reported. Newly emergent side effects in the modafinil group included heart palpitations, itching, fatigue, and decreased energy. Two patients discontinued modafinil owing to side effects and one of these patients withdrew from the study. One patient discontinued placebo and was withdrawn from the study. Preliminary evaluations of clinical efficacy showed a marginally significant interaction between treatment group and time in two cognitive domains (speed of processing and verbal learning), indicating greater improvement in the modafinil group versus placebo. Additionally, there was a marginally significant effect of treatment group on daytime sleepiness, suggesting lower daytime sleepiness in the modafinil group versus placebo. Counterintuitively, we found a significant treatment group by time interaction effect on sleep quality, suggesting greater improvement in sleep quality in the placebo group versus the modafinil group. Results suggest that modafinil is a relatively safe medication for affectively-stable BD patients when given with adjunctive mood stabilizers. Results are suggestive of cognitive benefit and improved daytime sleepiness, but worse sleep quality in those patients prescribed modafinil. A fully powered clinical trial is warranted with specific attention to the characteristics of patients who are most likely to benefit from treatment with modafinil and other methodological lessons learned from this pilot. ClinicalTrials.gov, identifier NCT01965925.

Temporal associations between nightly sleep with daytime eating and activity levels in free-living young adults.

This study aimed to quantify the temporal associations between nightly sleep quantity and timing with daytime eating behavior and activity levels in free-living (i.e. non-experimental) settings. Generally healthy young adults (N = 63; 28.9 ± 7.1 years) completed concurrent sleep (wrist actigraphy), eating (photo-assisted diet records), and activity (waist actigraphy) assessments over 14 days. Multilevel models quantified the associations between nightly sleep (total sleep time, timing of sleep and wake onset) with next-day eating behavior (diet quality, caloric intake, timing of eating onset/offset, eating window duration) and activity levels (total physical activity, sedentary time). Associations in the reverse direction (i.e. eating and activity predicting sleep) were explored. Models adjusted for demographic and behavioral confounders and accounted for multiple testing. At within- and between-subject levels, nights with greater-than-average total sleep time predicted a shorter eating window the next day (all p ≤ 0.002). Later-than-average sleep and wake timing predicted within- and between-subject delays in next-day eating onset and offset, and between-subject reductions in diet quality and caloric intake (all p ≤ 0.008). At within- and between-subject levels, total sleep time was bidirectionally, inversely associated with sedentary time (all p < 0.001), while later-than-average sleep and wake timing predicted lower next-day physical activity (all p ≤ 0.008). These data underscore the complex interrelatedness between sleep, eating behavior, and activity levels in free-living settings. Findings also suggest that sleep exerts a greater influence on next-day behavior, rather than vice versa. While testing in more diverse samples is needed, these data have potential to enhance health behavior interventions and maximize health outcomes.

Depressive symptoms anticipate behavioral and emotional factors among older adults: A prospective cross-lagged panel design.

This study examined the temporal relationship among depression, anxiety, insomnia, perceived stress, and physical activity in adults aged 60+ years with a history of major depressive disorder. We conducted a longitudinal study with 12 weeks of follow-up. Assessments consisted of phone or video interviews and included questionnaires evaluating depression, anxiety, insomnia, perceived stress, and physical activity. Our analytic approach consisted of a depression-focused cross-lagged panel model (CLPM) to examine week-to-week correlations among the five measures. The depression-focused CLPM identified statistically significant week-to-week self-predictive effects for each of the five measures. Higher depressive symptom burden was a strong predictor of increased stress, greater insomnia, and less physical activity the following week. No other cross-measure predictions were statistically significant. Our analytical approach clarifies the directional relationship among variables that typically co-occur with depression showing that higher depression symptom burden predisposes older adults to poor sleep, a reduced level of daytime activity, and a greater sense of stress. These findings support the need for longitudinal assessments and targeted interventions for reducing symptoms of depression in older adults.

Non-pharmacological intervention in the treatment of insomnia – the efficacy of weighted blankets

Introduction Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or getting restful sleep. Research suggests that 30-50% of adults experience sleep problems. Chronic lack of sleep has been linked to a range of negative health outcomes, including obesity, hypertension, diabetes, stroke, coronary heart disease and increased mortality. One promising non-pharmacological treatment for sleep issues is the use of weighted blankets. Weighted blankets provide deep pressure stimulation that can relax the body and promote sleep, making them a useful tool for people with insomnia. Aim of the study The purpose of this study was to investigate the effectiveness of weighted blankets as a non-pharmacologic intervention for treating insomnia. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: weighted blankets; insomnia; sleep. Results Weighted blankets resulted in significant improvements in Insomnia Severity Scale scores. The blankets made it easier to fall asleep, improved sleep quality and provided a higher level of rest in the morning. They also reduced stress levels while falling asleep and increased feelings of relaxation. There was an increase in daytime activity levels and a reduction in daytime fatigue symptoms observed. The use of weighted blankets improved daytime functioning and reduced the consumption of sleep medications in people with psychiatric comorbidities who suffered from insomnia. No negative effects on vital signs or serious side effects were found. Conclusions Findings indicate that weighted blankets are an effective, safe and clinically meaningful treatment for insomnia.

Activity patterns throughout the annual cycle in a long-distance migratory songbird, the red-backed shrike Lanius collurio

BackgroundLong-distance migratory birds undergo complex annual cycles during which they must adjust their behaviour according to the needs and conditions encountered throughout the year. Yet, variation in activity throughout the entire annual cycle has rarely been studied in wild migratory birds.MethodsWe used multisensor data loggers to evaluate the patterns of activity throughout the complete annual cycle of a long-distance migratory bird, the red-backed shrike Lanius collurio. Accelerometer data was used to identify life-history stages and to estimate levels of activity during various phases of the annual cycle. In this study, we analysed the variation in daytime activity along the annual cycle and between migratory and non-migratory days.ResultsThe birds’ daytime activity varied throughout the annual cycle while night-time activity was almost exclusively restricted to migratory flights. The highest daytime activity levels were observed during the breeding season, while it remained low during autumn migration and the winter period. Daytime activity differed between sexes during the breeding period, when the males showed the highest level in activity. During migratory periods, both sexes exhibited a higher daytime activity in spring compared to autumn migration, being particularly high in the final migratory leg towards the breeding ground. The birds showed a lower daytime activity on migratory days (days when a migratory flight took place during the succeeding night) than on non-migratory days during both migratory seasons.ConclusionsActivity measured during daytime results from a combination of several behaviours, and a high daytime activity during spring migration and the breeding period is possibly reflecting particularly energy-demanding periods in the annual cycle of migratory birds. The use of multisensor data loggers to track annual activity provides us with a full annual perspective on variation in activity in long-distance migratory species, an essential approach for understanding possible critical life-history stages and migration ecology.

The effects of napping on night-time sleep in healthy young adults.

The discrepancies in the effects of napping on sleep quality may be due to differences in methodologies, napping behaviours, and daytime activity levels across studies. We determined whether napping behaviours and daytime activity levels are associated with night-time sleep fragmentation and sleep quality in young adults. A total of 62 healthy adults (mean [SD] age 23.5[4.2]years) completed screening questionnaires for sleep habits, physical activity, medical and psychological history. Actigraphy was used to record sleep including naps. The fragmentation algorithm (KRA ) was applied to the actigraphic data to measure night-time sleep fragmentation. We classified participants' nap frequency as "non-nappers" (0naps/8days), "moderate nappers" (1-2naps/8days) or "frequent nappers" (≥3naps/8days) naps. Nap duration was defined as "short" (≤60min) or "long" (>60min). Naps' proximity to the night sleep episode was defined as "early" (≥7h) and "late" (<7h) naps. Outcome variables were night-time KRA and actigraphic sleep variables. Frequent nappers had a significantly higher KRA than moderate nappers (p<0.01) and non-nappers (p<0.02). Late naps were associated with poorer measures of night sleep quality versus early naps (all p≤0.02). Nap duration and daytime activity were not associated with significant differences in the outcome variables (all p>0.05). KRA correlated with sleep duration, sleep efficiency, and awakenings (r=-0.32, -0.32, and 0.53, respectively; all p<0.05). Frequent napping and late naps may be associated with increased sleep fragmentation and poorer sleep quality, reflected in longer sleep onsets and increased awakenings. These findings have implications for public health sleep hygiene recommendations.

Do Daytime Activity, Mood and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?

Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, unit tumult, and mood were associated with sleep quality. A convenience sample of 53 long-term care (LTC) residents participated in this correlational study. Objective sleep quality was measured using actigraphy, and comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than 80% and was awake for more than 90 min at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor sleep. Findings suggest daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality.

Do Daytime Activity, Mood at Bedtime and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?

Sleep quality declines in old age and is particularly poor for long-term care (LTC) residents with dementia. Compromised sleep quality is associated with severe cognitive and neuropsychiatric symptoms, agitation, aggressiveness, and poor quality of life. Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, mood, and unit tumult were associated with sleep quality. A convenience sample of 53 LTC residents with dementia participated in this correlational study. Objective sleep quality and activity variables were measured using Actigraphy, and mood was measured by the Observed Emotion Rating Scale. Unit tumult was defined as events in the residents living area that are deviations from the typical day (i.e., census changes, being cared for by a certified nursing assistant from a temporary staffing agency, and lower than usual staffing level). Comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than .85 and were awake for more than 90 minutes at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor total sleep time and sleep efficiency. Findings suggest that daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality among LTC residents with dementia.

Habitat use and activity patterns of female Deacon Rockfish (Sebastes diaconus) at seasonal scales and in response to episodic hypoxia

We combined a high-resolution acoustic telemetry array with presence/absence receivers to conduct a preliminary study of the seasonal movements, activity patterns, and habitat associations of the newly described Deacon Rockfish (Sebastes diaconus). Eleven mature female Deacon Rockfish were tagged and monitored during an 11-month period, at a nearshore rocky reef off Seal Rock, Oregon, USA, an area of recurring seasonal hypoxia (defined as dissolved oxygen concentration [DO] < 2 mg l−1). Two tags were detected leaving the study area by day 35, indicating predation or emigration. Three tags became inactive within the array, indicating tag loss or fish death. Six “resident” fish inhabited the array for 246–326 days. Resident fish exhibited high site fidelity, small home ranges (mean 95% KDE = 4907 m2), and consistent activity patterns for the duration of the summertime high-resolution array (5 months), except during seasonal hypoxia. Resident fish were strongly diurnal in summer, with high levels of daytime activity above the bottom in relatively rugose habitat, followed by nighttime rest periods in deeper, less rugose habitat. During summertime hypoxia, resident fish exhibited less daytime activity during daytime hours with no rest periods at night, inhabited shallower water depths, and moved well away from their core activity areas on long, erratic forays. During the winter, diel patterns were less evident with higher activity levels at night (than in the summer) and lower activity levels in the day (than in the summer). We propose that some Deacon Rockfish continuously inhabit nearshore reefs throughout the year, but that daily/seasonal movement patterns, seasonally occurring hypoxia, and prey preferences for planktonic organisms influence relocation.

Differences in Daytime Activity Levels and Daytime Sleep Between Night and Day Duty: An Observational Study in Italian Orthopedic Nurses.

Working nonstandard work schedules is often associated with increased sedentary behavior and risk of sleep disorders. Night shift workers are prone to accumulating sleep debt, which they recover by sleeping during the day. The effect on daytime activity levels is unknown. The present study aims to objectively assess whether daytime sleep could affect daytime activity levels of shift worker nurses, resulting in an accumulation of their activity debt differently between working and rest periods. The study population (N = 37; mean age 41.7 ± 9.1 years) was composed of orthopedic nurses working on a rotating schedule, including either a night shift (NS) or only day/afternoon shift (DS). Actigraph monitoring lasted both on the working and the rest period. For the NS nurses, the working period recorded higher daytime activity levels than the rest period, while daytime sleep during the working and rest periods was similar. Conversely, DS nurses showed higher daytime activity levels and shorter daytime sleep during the working period. NS nurses were less active than DS nurses during the working period, probably because NS tended to have a longer daytime sleep. During the rest period, daytime activity levels for both groups were decreased. For NS nurses, sleep recorded the better sleep parameters during the rest period, while sleep parameters did not show significant differences between the working and the rest periods in DS. During the working period, NS nurses slept worse than the DS nurses. Both groups tended to accumulate a debt in daytime activity levels during the rest period. While daytime sleep may be an excellent way to counteract sleep debt and increase sleep duration over 24 h period, on the other hand, it makes nurses less active.

Effects of physical activity and sleep quality on well-being: A wrist actigraphy study during the pandemic.

Previous studies identified the effects of daytime activity, sleep quality and ambient light exposure on individual well-being. These factors have been greatly changed as people are required to stay home during the COVID-19 pandemic; thus, it is necessary to verify whether these factors effect well-being during the pandemic. We recruited 70 adults (females: 46; age range: 31-60) during a high incidence of COVID-19 in China (17-27 February 2020). Both subjective measurements based on self-report scales and objective measurements collected using wrist actigraphy were employed to investigate the effects of night-time sleep and daytime activity on subjective well-being. The actigraphy data show that participants' total sleep time (>8hr) is sufficient. Self-reported sleep quality was significantly worse than pre-pandemic, and self-reported daytime activity levels significantly decreased during the pandemic. Physical activity was positively related to well-being, both for self-reported daytime activity (r=.346, p=.003) and for objective measurements (r=.234, p=.051). Our study found that sleep and daytime activity levels were negatively affected by the pandemic. However, increased daytime physical activity could potentially reduce these negative effects.

Rest-activity rhythm disturbance in liver cirrhosis and association with cognitive impairment.

Cognitive impairment and disturbed sleep-wake rhythms are disabling complications of liver cirrhosis, yet there is limited understanding of how they are related. We tested the hypothesis that alterations of sleep, rest-activity, and light exposure patterns are associated with worse cognition in cirrhosis. A total of 54 ambulatory adult patients with cirrhosis and 41 age-/gender-matched healthy controls wore wrist actigraphy for rest-activity and light measurements and completed Patient-Reported Outcomes Measurement Information System sleep instruments for self-reported sleep quality. We used standard nonparametric descriptors to characterize rest-activity and light patterns, and wake after sleep onset and sleep efficiency to assess objective sleep quality. The NIH Toolbox cognition battery was used for objective cognitive evaluation using T-scores from a demographically adjusted population reference. Spearman's correlation and multivariable models were used to explore associations between measures of cognition, sleep, rest-activity, and light. Cognition was significantly impaired in cirrhosis patients. Sleep quality was worse in cirrhosis patients by subjective and objective measures compared with controls. Cirrhosis patients exhibited fragmented and dampened rest-activity rhythms, lower daytime and higher nighttime light exposure compared with controls. Worse working memory and processing speed was associated with lower daytime activity level, higher rest-activity fragmentation, lower day-to-day stability, and greater nocturnal light exposure. No association was found between cognition and sleep quality. Rest-activity fragmentation and abnormal light exposure patterns are common in patients with liver disease and are associated with the severity of cognitive impairment. Further research is needed to investigate the effects of timed bright light and exercise intervention on cognitive function in patients with liver disease.

Use of a wearable device to assess sleep and motor function in Duchenne muscular dystrophy

Rest-activity disruption is an important feature of Duchenne muscular dystrophy (DMD). We sought to describe sleep impairment and its relationship to quality of life (QOL) and to evaluate associations between rest-activity, sleep quality, and 6-minute walk test (6MWT) in DMD. Sleep impairment and its relationship to QOL was assessed by questionnaire in 54 children (33 ambulatory, 21 nonambulatory) with DMD. Rest-activity characteristics were calculated for 23 of these children (14 ambulatory, nine nonambulatory) by actigraphy. Pathologic sleep was reported in 11 (20%) participants and correlated with lower QOL but not with ambulatory status. In ambulatory participants who completed actigraphy, rest-activity rhythm fragmentation was associated with subjective sleep impairment. Habitual daytime activity level was associated with 6MWT performance. Children with DMD experience substantial sleep impairment that is related to QOL. Wrist actigraphy may be a parsimonious tool for monitoring both sleep and motor impairment in ambulatory children with DMD.

Can psychomotor disturbance predict ect outcome in depression?

Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE ≥ 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment.

Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce.

The purpose of this review is to synthesize the published literature that addresses employer-initiated interventions to improve the sleep of workers and in turn improve health, productivity, absenteeism, and other outcomes that have been associated with sleep disorders or sleep deficiency. We conducted a systematic search and a selective narrative review of publications in PubMed from 1966 to December 2017. We extracted study characteristics, including the workers' professions, workplace settings and shift work, and workplace interventions focused on worker sleep. Because of the high degree of heterogeneity in design and outcomes, we conducted a narrative review. We identified 219 publications. After restriction to publications with studies of workplace interventions that evaluated the outcomes of sleep duration or quality, we focused on 47 articles. An additional 13 articles were accepted in the pearling process. Most studies employed non-randomized or controlled pretest and posttest designs and self-reported measures of sleep. The most common workplace interventions were educational programs stressing sleep hygiene or fatigue management. Other interventions included timed napping before or after work, urging increased daytime activity levels, modifying workplace environmental characteristics such as lighting, and screening, and referral for sleep disorders treatment. Overall, most reports indicated that employer efforts to encourage improved sleep hygiene and healthier habits result in improvements in sleep duration, sleep quality, and self-reported sleepiness complaints. These studies suggest employer-sponsored efforts can improve sleep and sleep-related outcomes. The existing evidence, although weak, suggests efforts by employers to encourage better sleep habits and general fitness result in self-reported improvements in sleep-related outcomes, and may be associated with reduced absenteeism and better overall quality of life. Candidate workplace strategies to promote sleep health are provided.

Subjective and Objective Measures of Daytime Activity and Sleep Disturbance in Retinitis Pigmentosa.

Objectively measured limitations in daytime activity levels appear to be inextricably linked with sleep disturbances in retinitis pigmentosa (RP) patients, as well as associated with unemployment status and central vision loss. Innovative interventional strategies should be developed to help improve these issues and overall quality of life for RP patients. Novel sensor devices are emerging as valuable tools to objectively assess behavior. We used validated measures of wrist accelerometry to determine relationships between sleep, vision, and physical activity in RP subjects. For one week, 33 RP adults wore a wrist Actiwatch to detect movement during the day (average total activity counts) and disturbed sleep at night. They completed Early Treatment Diabetic Retinopathy Study visual acuity testing, Pelli-Robson contrast sensitivity, Goldmann V4e visual fields, and sleep diaries and validated questionnaires to assess their sleep and general health. Greater wake after sleep onset time measured with actigraphy (i.e., sleep disruption) (P = .01), loss of visual acuity (P = .009), and nonemployment/student status (P = .002) were all significant predictors of reduced daytime average total activity counts in a multiple linear regression model, after adjusting for contrast sensitivity as a cooperative suppressor variable (P = .01) (R = 0.54). Fragmentation measured with actigraphy (i.e., restlessness during sleep) (P = .07) and decreased sleep quality ratings reported upon awakening by the participants in a sleep diary (P = .06) were each marginally associated with reduced daytime average total activity counts, whereas nonemployment/student status, reduced visual acuity, and contrast sensitivity were still significant predictors. Objective and subjective measures of sleep or daytime activity were not statistically significantly correlated (P > .05). We find nonemployment/student status and sleep disturbances appear to be related to reduced daytime activity levels in adults with central vision loss due to RP. These findings underscore the importance of developing and evaluating interventions to help RP patients maintain engagement in productive activities and improve their disturbed sleep.