Higher Levels Of Sleep Disturbance Research Articles

Links between Savoring, Rumination, and Sleep-Related Experiences across Adulthood: Implications for Older Adults

ABSTRACT Objectives Sleep problems are pervasive, particularly in older adults. Much work examines psychological factors that adversely affect sleep; fewer studies examine those with a positive effect. Savoring is a form of positive repetitive thought that is linked to several aspects of health but has been understudied in relation to sleep. We examined cross-sectional associations of both savoring and rumination with subjective sleep experiences, and assessed if these associations vary by age. Methods Adults and older adults (N = 216) ranging from 20–80 years in age (M = 44.9 ± 15.6 years) completed an online survey of validated measures of savoring, rumination, sleep disturbance, and sleep-related impairment. Results Higher levels of savoring were significantly associated with lower levels of sleep-related impairment but not sleep disturbance in regression analyses. Higher levels of rumination were significantly associated with higher levels of sleep disturbance and sleep-related impairment. Associations of savoring and rumination with sleep-related experiences did not vary by age. Conclusions Savoring and rumination are relevant to sleep-related experiences in adults ranging from younger to older. Further investigation of the potential positive impact of savoring on sleep-related experiences is needed. Clinical Implications Engagement in savoring and rumination should be considered when assessing sleep and sleep-related impairment in adults.

The Role of the Circadian System in Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterised by the core symptoms of inattention, impulsivity and hyperactivity. Similar to many other neuropsychiatric conditions, ADHD is associated with very high levels of sleep disturbance. However, it is not clear whether such sleep disturbances are precursors to, or symptoms of, ADHD. Neither is it clear through which mechanisms sleep and ADHD are linked. One possible link is via modulation of circadian rhythms. In this chapter we overview the evidence that ADHD is associated with alterations in circadian processes, manifesting as later chronotype and delayed sleep phase in ADHD, and examine some mechanisms that may lead to such changes. We also interrogate how the circadian clock may be a substrate for therapeutic intervention in ADHD (chronotherapy) and highlight important new questions to be addressed to move the field forward.

0971 Mother’s Parenting Style As A Moderator In The Relationship Between Temperament And Sleep Problems In Children With Obesity

Abstract Introduction Based on past studies, a child’s temperament and parenting style greatly affect a child’s sleep. However, there are limited studies that have investigated how parenting styles and a child’s temperament interact and affect the child’s sleep in obese children. Thus, this study investigated parenting styles as a moderator in the relationship between temperament and sleep in obese children. Methods Seventy-seven obese children (male=66.2%, average BMI = 27.35±2.78) participated in the study. The mean age of the participants was 10.82(± 1.00) years. The primary caregiver (mother) of the participants completed the Junior Temperament and Character Inventory (J-TCI), and Parents as Social Context Questionnaire (K-PSCQ), and Children’s Sleep Habits Questionnaire (CSHQ). Among the different subscales, only Novelty Seeking (NS) and Reward Dependence (RD) were used for analysis among Junior Temperament and Character Inventory (J-TCI) components. Results In this sample, 66 children (85.7%) reported significant levels of sleep problems based on the CSHQ. Novelty seeking (NS) and reward dependence (RD) significantly predicted sleep problems (B=-.771, p<.05, B=-.683, p<.01). Additionally, mother’s negative parenting style moderated the relationship between NS and the child’s sleep problem [B=.03, 95% CI=.007, .049] and the relationship between RD and the child’s sleep problem [B=.031, 95% CI=.013, .049]. The more negative mother’s parenting style, the higher the child’s NS or RD scores had a negative effect on sleep. Conclusion The results of this study show that obese children experience high levels of sleep disturbance. Additionally, the mother’s negative parenting style moderated the relationship between temperament and sleep problems in obese children. The results suggest that sleep interventions for obese children should include the mother, especially in children with high novelty seeking and reward dependence. Support This work was supported by Korea Centers for Disease Control and Prevention & Korea National Research Institute of Health (2019020660E-00)

Neuropsychological Symptoms and Intrusive Thoughts Are Associated With Worse Trajectories of Chemotherapy-Induced Nausea

ContextAlthough chemotherapy-induced vomiting is well controlled with evidence-based antiemetic regimens, chemotherapy-induced nausea (CIN) remains a significant clinical problem. ObjectivesStudy purposes, in a sample of outpatients with breast, gastrointestinal, gynecological, or lung cancer who received two cycles of chemotherapy (CTX, n = 1251), were to evaluate for interindividual differences in the severity of CIN and to determine which demographic, clinical, symptom, and stress characteristics are associated with higher initial levels as well as with the trajectories of CIN. MethodsPatients were recruited during their first or second cycle of CTX. Patients completed self-report questionnaires a total of six times over two cycles of CTX. Hierarchical linear modeling was used to evaluate for interindividual differences in and characteristics associated with the severity of CIN. ResultsAcross the two cycles of CTX, higher levels of sleep disturbance, depression, and morning fatigue, as well as higher levels of intrusive thoughts, were associated with higher initial levels of CIN. In addition, lower functional status scores and shorter cycle lengths were associated with higher initial levels of CIN, and younger age and higher emetogenicity of the CTX regimen were associated with both higher initial levels as well as worse trajectories of CIN severity. ConclusionThese findings suggest that common symptoms associated with cancer and its treatment are associated with increased severity of CIN. Targeted interventions for these symptoms may reduce the burden of unrelieved CIN.

An exploration of adult attachment insecurity and psychiatric symptoms in individuals with obstructive sleep apnea

ObjectiveObstructive sleep apnea (OSA) is a common sleep disorder, often associated with multiple medical comorbidities as well as psychological difficulties. Among the latter, relationship difficulties as well as mood and anxiety symptoms have been reported, without a clear understanding of the mechanism. In the current study we wanted to further explore these aspects, while comparing groups of OSA individuals with good vs poor sleep. The primary goal of the study was to examine the relationship between sleep and adult attachment and secondly to explore the relationship between sleep and couple satisfaction as well as symptoms of depression and anxiety. MethodsFollowing diagnosis of OSA by overnight polysomnography, 102 participants completed several psychological measures (e.g. adult attachment, couple satisfaction, depression and anxiety symptoms) and sleep measures (sleep quality and daytime sleepiness). Variables of interest were compared between the OSA groups with either good/poor sleep quality or no/excessive daytime sleepiness. ResultsAdult attachment avoidance was higher in individuals with low sleep quality (mean difference = 0.33, p = .04, d = 0.46) while adult attachment anxiety was higher in individuals with high daytime sleepiness (mean difference = 0.46, p = .04, d = 0.43). Individuals with either poor sleep quality or excessive daytime sleepiness had greater severity of depression and anxiety (both p < .05). ConclusionsOSA patients with poor sleep quality and excessive daytime sleepiness have greater attachment insecurity and higher levels of depression and anxiety. A multidisciplinary approach including psychological interventions, should be considered in OSA cases with high levels of sleep disturbance.

Shift-work nurses' work environments and health-promoting behaviours in relation to sleep disturbance: A cross-sectional secondary data analysis.

To examine the association of nursing work environments and health-promoting behaviours with shift-work nurses' sleep disturbance. Shift-work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep-disturbed nurses, factors related to sleep disturbance among shift-work nurses should be investigated. A cross-sectional secondary data analysis. Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6months. To examine associations of nursing work environments and health-promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline. Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B=-4.01, p=0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B=-9.56, p<0.01) and higher health responsibility (B=9.30, p<0.01). To alleviate shift-work nurses' sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders. To improve shift-work nurses' sleep, collegial relations with physicians and healthy lifestyles should be promoted.

Central Processes Underlying Fibromyalgia

Fibromyalgia is a common chronic pain disorder characterised by a robust clinical phenotype with principal features that include widespread pain and tenderness, as well as high levels of sleep disturbance, fatigue, cognitive dysfunction, and emotional distress. Fibromyalgia symptoms occur along a spectrum ranging from mild to severe. The impact on the patient can be very high, with significant effects on personal, recreational, and work activities. The pathophysiology of fibromyalgia is complex and involves abnormal processing of pain and other sensory inputs from the periphery to the brain. In turn, central processes, which modulate this input, are the critical elements that initiate the sequence of events that lead to the clinical phenotype. The functioning of the stress response through its links to pain and other sensory neural processing is a key upstream component of the fibromyalgia cascade. Furthermore, emotional distress appears as a common everyday driver of this process. The mechanisms contributing to the clinical phenotype of fibromyalgia are driven by a top-down process. The aim of this review is to discuss the key central processes that underlie the fibromyalgia clinical phenotype and discuss how these should be the focus of both current management strategies and future research.

Sleep Disturbance Among Firefighters: Understanding Associations with Alcohol Use and Distress Tolerance

Sleep disturbance is related to a variety of health issues and represents a prominent occupational concern among firefighters. Two potential predictors relevant to disturbed sleep are alcohol use and distress tolerance, which refers to the perceived ability to withstand negative emotional states. Main and interactive effects of alcohol use and distress tolerance on sleep disturbance were examined, after controlling for the covariates of service years and occupational stress. Participants included 652 firefighters (93.7% male; 77.9% white; Mage = 38.4 years), of whom 23.5% screened positive for hazardous alcohol use and 48.6% for disturbed sleep. Results indicated that higher alcohol misuse and lower distress tolerance were each significantly associated with greater sleep disturbance. Distress tolerance moderated the association between alcohol misuse and sleep disturbance, and the total model accounted for 28% of variance. Results indicate that firefighters with higher levels of hazardous alcohol use and lower levels of distress tolerance may exhibit higher levels of sleep disturbance.

Understanding mental health among military veterans in the fire service

Firefighters who have previously served in the military may be at potentially higher risk for worsened mental health outcomes. This investigation examined the mental health of military veterans, as compared to non-veterans, in the fire service. We hypothesized that firefighters who endorsed military veteran status would have higher rates of mental health symptoms, in comparison to firefighters who did not endorse prior service in the military. Age, gender, and race/ethnicity were used as covariates. The sample was comprised of 910 career firefighters, 209 (23.0%) of whom endorsed military veteran status. One-way analyses of covariance were employed. The military veteran subsample reported significantly higher levels of sleep disturbance, depression, and posttraumatic stress symptom severity in comparison to the non-veteran subsample; however, effect sizes were small indicating that between group differences are actually negligible. Results highlight the need to improve our understanding of risk and resilience factors for firefighters who have served in the military, as this line of inquiry has potentially important mental health intervention implications for this exceptionally understudied population.

Sleep quality and psychosocial characteristics of patients with painful post-traumatic trigeminal neuropathies

The aim of this study was to explore how pain and psychological distress influence the sleep quality of patients with painful post-traumatic trigeminal neuropathy (PPTN). Thirty-two patients with a diagnosis of PPTN according to the International Classification for Headache Disorders of the International Headache Society were enrolled. All patients completed a number of questionnaires that examined sleep quality, psychological distress, and quality of life. The global Pittsburg Sleep Quality Index (PSQI) score was "5" or greater in 75% of the patients. Additionally, the Symptom Check List-90-Revised (SCL-90-R) global severity index (GSI) revealed that 71.9% of the study sample reported values of psychological distress over the level of clinical significance. Sleep quality was analyzed through a linear regression model of global PSQI (dependent variable) that included gender, age, pain intensity, and pain duration (independent variables). This model revealed a significant positive association between the PSQI global score and the SCL-90-R GSI that was independent of age, gender, pain intensity, and duration. Patients with PPTN present higher levels of sleep disturbance and psychological distress compared with the general population. Sleep quality disturbances and levels of psychological distress are strongly associated and seem to be independent of age, gender, medication use, pain intensity and duration.

Neurogenic inflammation in fibromyalgia.

Fibromyalgia is a high impact chronic pain disorder with a well-defined and robust clinical phenotype. Key features include widespread pain and tenderness, high levels of sleep disturbance, fatigue, cognitive dysfunction and emotional distress. Abnormal processing of pain and other sensory input occurs in the brain, spinal cord and periphery and is related to the processes of central and peripheral sensitization. As such, fibromyalgia is deemed to be one of the central sensitivity syndromes. There is increasing evidence of neurogenically derived inflammatory mechanisms occurring in the peripheral tissues, spinal cord and brain in fibromyalgia. These involve a variety of neuropeptides, chemokines and cytokines with activation of both the innate and adaptive immune systems. This process results in several of the peripheral clinical features of fibromyalgia, such as swelling and dysesthesia, and may influence central symptoms, such as fatigue and changes in cognition. In turn, emotional and stress-related physiological mechanisms are seen as upstream drivers of neurogenic inflammation in fibromyalgia.

The Relationship Between Sleep and Cognition in Children Referred for Neuropsychological Evaluation: A Latent Modeling Approach

Children with conditions affecting cognitive processes experience high levels of sleep disturbance, which may further compound the cognitive ramifications of their disorders. Despite this, existing studies in this area have been primarily confined to only particular diagnostic groups and/or a limited scope of sleep and cognitive parameters. The current study characterized the nature of sleep problems and examined the relationship between a wide range of sleep-related problems and cognitive functioning in a large (N = 103) diagnostically heterogeneous sample of youth (aged 6–16) referred for neuropsychological assessment. Structural equation modeling was used to examine the relationship between sleep-related problems (i.e., daytime sleepiness, sleep onset latency, sleep fragmentation, sleep time variability, sleep debt) and cognitive performance (i.e., executive functioning, sustained attention, memory, processing speed). Sleep fragmentation emerged as the most prominent sleep-related problem in the present sample. Structural equation modeling demonstrated a negative association between sleep-related problems and cognition that did not reach statistical significance (β = −0.084, p = 0.629). The current statistical approach may be used as a conceptual framework for future work examining these multi-dimensional constructs in a parsimonious fashion.

Gender differences in sleep symptoms after repeat concussions

ObjectivesThere are notable gender differences in concussion as well as sleep. Sleep disturbance is a major symptom of post-concussive syndrome. The interplay between sleep disturbance, concussion, and gender has yet to be examined. The objective of this study was to determine whether sleep disturbance plays a role in the known gender differences associated with concussion. MethodsMales and females (ages 10–35 years) completed a pre-concussion and post-concussion evaluation. Levels of sleep disturbance were assessed at baseline (N = 1284), after first concussion (N = 432) and after repeated concussions (one or more concussions, N = 296). Sleep disturbance levels were also compared among males and females with headaches, mood changes, and cognitive dysfunction. Analyses included group comparisons and correlations of post-concussive symptoms and cognitive dysfunction, respectively. Data was adjusted for age. ResultsCompared to males, females reported higher levels of sleep disturbance after a single concussion; however, levels of sleep disturbance equalized after repeated concussions. Females with higher levels of sleep disturbance had more headaches and more mood changes requiring medical treatment, compared to males. In addition, sleep disturbance was more strongly correlated with cognitive dysfunction in females compared to males. ConclusionGender differences in concussion recovery after repeat concussions may be primarily due to a difference in sleep disturbance between the genders. This difference in sleep appears to moderate the levels of other post-concussive symptoms. This indicates that sleep disturbance should be closely monitored and treated in females after a concussion. Further studies are required to determine the underlying reasons for these gender differences.

0924 GENDER DIFFERENCES IN SLEEP DISTURBANCE AMONG CHILDREN WITH CONCUSSION

There is increasing evidence that gender differences exist among children who sustain concussions. Furthermore, there is evidence that sleep quality plays a significant role in the experience/severity of concussion. It is unknown however if gender plays a modulatory role in the extent of sleep disturbance noted after sustaining a concussion. This study sought to determine whether there are gender differences in sleep disturbance associated with concussion severity in children and adolescents. Children and adolescents (ages 9 to 19, N=1971) with a recent history of concussion were evaluated prospectively through IMPACT testing and clinical evaluation. The data obtained included presence and absence of concussion related symptoms including mood changes, headache, and sleep quality measures including fatigue, daytime sleepiness, difficulty falling asleep, sleeping more or less than usual, and recent sleep duration. Composite scores of sleep quality and concussion related symptoms were log transformed and analyzed using univariate analysis. Females experienced significantly more sleep quality disturbance compared to males (F(2,1964)=13.28, p<0.001). In addition female participants with poor sleep quality were more likely to exhibit symptoms of depression and anxiety compared to male participants (F(1,1964)=3.64, p=0.04). Lastly, female participants with higher levels of sleep disturbance were more likely to experience headaches after a concussion compared to male participants with higher levels of sleep disturbance (F(2,1964)=8.24, p<0.001). Our study demonstrates that sleep quality differs by gender among children with concussion. This suggests that healthcare providers, schools, athletic trainers, and coaches may need to evaluate concussion differently, taking into account gender and extent of sleep disturbance as recovery may differ depending on these factors. Further evaluation is necessary to better understand these sleep-related gender differences. This research is supported by Georgetown University funds.

Risk Factors for Obstructive Sleep Apnea Are Prevalent in People with Psychosis and Correlate with Impaired Social Functioning and Poor Physical Health.

Obstructive sleep apnea (OSA) in the general community is associated with obesity, smoking, alcohol, and sedative medication use and contributes to depressed mood, daytime sedation, and sudden cardiovascular deaths. Poor cardiovascular health, impaired social functioning, and negative and cognitive symptoms are also among the common clinical features of psychotic disorders. People with psychosis have higher rates of sleep disturbance; however, OSA has not been extensively investigated in this population. This study aimed to determine the prevalence of OSA and general sleep disruption symptoms in a representative Australian sample of people with psychosis. We investigated the prevalence of potential risk factors for OSA, including obesity, psychotropic medications, and substance abuse in this population. Finally, we evaluated associations between symptoms of OSA, symptoms of general sleep disruption, and various clinical features in people with psychosis. Participants took part in the Second National Australian Survey of Psychosis, a population-based survey of Australians with a psychotic disorder aged 18-64 years. Symptoms associated with OSA (snoring and breathing pauses during sleep) in the past year were assessed using questions from the University of Maryland Medical Centre Questionnaire and symptoms associated with general sleep disruption in the past week using the Assessment of Quality of Life Questionnaire. Data collected included psychiatric diagnosis and symptoms, education, employment, medications, smoking status, physical activity, drug and alcohol use, and cognitive function. Physical health measures included body mass index, waist circumference, blood pressure, fasting blood glucose, and lipids. Snoring was reported by 41.9%; 7% stating they frequently stopped breathing (pauses) during sleep. Univariate logistic regressions show OSA symptoms (pauses and snoring) were associated with older age, female gender, lower levels of social participation or employment, cardiovascular risk factors, sedentary lifestyle, and poorer quality of life, while symptoms of general sleep disruption were more likely in people with depressive symptoms. Australians with psychosis have high levels of sleep disturbance, including OSA. OSA symptoms were associated with cardiovascular disease risk factors, reduced social participation and employment, and poorer quality of life. Whether correction of OSA can improve these factors in people with psychosis remains to be determined.

A Secondary Analysis of Sleep Quality Changes in Older Adults From a Randomized Trial of an MBSR Program.

This secondary analysis examined changes in sleep quality associated with participation in a Mindfulness-Based Stress Reduction (MBSR) program among healthy older adults. Data were collected at baseline, 8-weeks post-treatment, and a 6-month follow-up from adults aged ≥ 65 ( N = 200), randomly assigned to MBSR or a waitlist control. Group differences were examined using mixed analysis of covariance with repeated measures on the total Pittsburgh Sleep Quality Index (PSQI) score. A small-sized, significant effect was found on overall sleep among MBSR participants with baseline PSQI scores > 5, indicative of a sleep disturbance, F(2, 80) = 4.32, p = .02, ηp2 = .05. A medium-sized, significant effect was found for MBSR participants with baseline PSQI scores ≥ 10, F(2, 28) = 3.13, p = .04, ηp2 = .10. These findings indicate that improved sleep quality for older adults who have higher levels of sleep disturbance may be associated with participation in MBSR.

Trouble Sleeping Associated With Lower Work Performance and Greater Health Care Costs: Longitudinal Data From Kansas State Employee Wellness Program.

To examine the relationships between employees' trouble sleeping and absenteeism, work performance, and health care expenditures over a 2-year period. Utilizing the Kansas State employee wellness program (EWP) data set from 2008 to 2009, multinomial logistic regression analyses were conducted with trouble sleeping as the predictor and absenteeism, work performance, and health care costs as the outcomes. EWP participants (N = 11,698 in 2008; 5636 followed up in 2009) who had higher levels of sleep disturbance were more likely to be absent from work (all P < 0.0005), have lower work performance ratings (all P < 0.0005), and have higher health care costs (P < 0.0005). Longitudinally, more trouble sleeping was significantly related to negative changes in all outcomes. Employees' trouble sleeping, even at a subclinical level, negatively impacts on work attendance, work performance, and health care costs.

Rumination modulates stress and other psychological processes in fibromyalgia.

Fibromyalgia (FM) is characterized by widespread pain and high levels of sleep disturbance, fatigue, and altered cognition. Psychological stress can modulate these features. In this study, we examined the thinking style of rumination in women with FM to assess the effect of rumination on stress levels and other psychological variables in FM. Ninety-eight women with FM completed questionnaires to assess levels of rumination, stress, anxiety, depression, optimism, control, and coping. T-tests and bivariate (Pearson) analysis was performed to assess relationships between rumination and other psychological factors. We found that those with higher levels of rumination had increased the use of negative coping techniques (p<0.001), higher anxiety (p<0.001), depression (p<0.001), and poor sleep levels (p<0.05). Higher rumination correlated with lower optimism (p<0.001) and control (Mastery) (p<0.001). High rumination correlated strongest with stress (p<0.001). Rumination predicted 26% of variance for perceived stress. Rumination influenced several psychological processes deemed important in FM and was an important contributor to stress in FM. Specific interventions targeting rumination in FM may improve FM symptoms and outcomes.

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

ContextFatigue is a distressing persistent sense of physical tiredness that is not proportional to a person's recent activity. Fatigue impacts patients' treatment decisions and can limit their self-care activities. Although significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy. ObjectivesTo determine whether demographic, clinical, and symptom characteristics were associated with initial levels and the trajectories of evening fatigue. MethodsA sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N = 586) completed demographic and symptom questionnaires a total of six times over two cycles of chemotherapy. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling was used to answer the study objectives. ResultsA large amount of interindividual variability was found in the evening fatigue trajectories. A piecewise model fit the data best. Patients who were white, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, childcare responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment. ConclusionThis study identified both nonmodifiable (e.g., ethnicity) and modifiable (e.g., childcare responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

Sleep disruption in older informal caregivers.

Informal caregiving is a prevalent phenomenon in the United States. A review of the literature reveals that, although much research has been done regarding the areas of informal caregiver burden and the effect of sleep disruption on healthy adults, little has been done in the area of caregiving and sleep disruption, especially as it relates to older informal caregivers. Older informal caregivers represent a significant portion of the informal caregiving population and are a population at risk for high levels of sleep disturbance. Further research designed to investigate sleep disruption in older informal caregivers is needed to move toward the development of evidence-based assessment tools for practice and interventions aimed at restoring normal sleep patterns in this vulnerable population.