Multiple Sleep Characteristics Research Articles

Latent profiles of multi-dimensional sleep characteristics and association with overweight/obesity in Chinese preschool children

ObjectivesTo examine the association between latent profiles of multi-dimensional sleep characteristics and overweight/obesity (OWO) in Chinese preschool children. Study designThe cross-sectional analysis included 3204 preschool children recruited from 24 kindergartens in Shanghai. Parents reported children's demographics and sleep characteristics, including sleep duration, timing and disturbances. Latent profile analysis (LPA) was used to identify sleep subtypes. Logistic regression models were used to evaluate the associations between sleep characteristics/subtypes and OWO. ResultsShort sleep duration, late bedtime, long social jetlag and sleep disturbances were significantly associated with increased OWO. However, when considering the interplay of sleep duration and timing, there was no significant association between sleep duration and OWO for children sleeping later than 22:00. Three sleep subtypes were identified based on children's sleep duration, timing and disturbances: "Average Sleepers" (n = 2107, 65.8 %), "Good Sleepers" (n = 481, 15.0 %), and "Poor Sleepers" (n = 616, 19.2 %). "Good Sleepers" had reduced odds of being OWO (AOR, 0.72; 95 % CI, 0.56–0.93) compared to "Average Sleepers", while "Poor Sleepers" showed an increased risk of OWO (AOR, 1.36; 95 % CI, 1.11–1.67). ConclusionsThese findings highlight that improving multiple sleep characteristics simultaneously is a promising option to prevent and intervene childhood obesity.

Network analysis of smoking-related sleep characteristics in Chinese adults

The associations between multiple sleep characteristics and smoking behavior are inconsistent, and it is unclear which sleep characteristics are most crucial for tobacco prevention. This study aimed to explore the associations between smoking status/intensity and multiple sleep characteristics and to identify the potential core domain of smoking-related sleep using network analysis. Data were obtained from a survey of cancer-related risk factors among Chinese adults. Logistic regression models were used to quantify the associations between sleep characteristics and smoking status/intensity. Network analyses were employed to identify the core sleep characteristics. A total of 5,228 participants with a median age of 44 years old were included in the study. Current smoking was significantly positively associated with long nap time, difficulty falling asleep, late bedtime, getting up after 7 am, and waking up earlier than expected. There was significant positive association between current smoking and short sleep duration in young adults under 45 years old. Late bedtime and getting up after 7 am were only associated with current heavy smoking, but not current light smoking. Network analyses showed that multiple smoking-related sleep characteristics were interconnected, with difficulty falling asleep and late bedtime as central characteristics in the network. The study found that the associations between sleep characteristics and smoking varied by age and smoking intensity and highlights the potential benefits of sleep health promotion in smoking cessation, with a particular focus on difficulty falling asleep and late bedtime.

Multi-dimensional sleep and mortality: The Multi-Ethnic Study of Atherosclerosis.

Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes. We assessed the association between a sleep score reflecting multiple sleep dimensions, and mortality. We tested the hypothesis that more favorable sleep (higher sleep scores) is associated with lower mortality. The Multi-Ethnic Study of Atherosclerosis (MESA) is a racially and ethnically-diverse multi-site, prospective cohort study of US adults. Sleep was measured using unattended polysomnography, 7-day wrist actigraphy, and validated questionnaires (2010-2013). 1726 participants were followed for a median of 6.9 years (Q1-Q3, 6.4-7.4 years) until death (171 deaths) or last contact. Survival models were used to estimate the association between the exposure of sleep scores and the outcome of all-cause mortality, adjusting for socio-demographics, lifestyle, and medical comorbidities; follow-up analyses examined associations between individual metrics and mortality. The exposure, a sleep score, was constructed by an empirically-based Principal Components Analysis on 13 sleep metrics, selected a priori. After adjusting for multiple confounders, a 1 standard deviation (sd) higher sleep score was associated with 25% lower hazard of mortality (Hazard Ratio [HR]: 0.75; 95% Confidence interval: [0.65, 0.87]). The largest drivers of this association were: night-to-night sleep regularity, total sleep time, and the Apnea-Hypopnea Index. More favorable sleep across multiple characteristics, operationalized by a sleep score, is associated with lower risk of death in a diverse US cohort of adults. Results suggest that interventions that address multiple dimensions may provide novel approaches for improving health.

Effects of pharmacotherapy on sleep-related outcomes in adults with chronic low back pain: A systematic review and meta-analysis of randomised controlled trials.

Adults with chronic low back pain (CLBP) suffer impaired sleep. Medications for CLBP can impact sleep which in turn may influence treatment outcomes. This systematic review and meta-analysis examined the effects of pharmacotherapy (any type) on sleep in adults with CLBP. In this systematic review and meta-analysis, we searched PubMed, CINAHL, SPORTDiscus, PsycINFO, EMBASE, and CENTRAL from inception to 10 July 2022. Randomised controlled trials that investigated the effects of pharmacotherapy on sleep in adults with CLBP were included. Manual citation search of relevant systematic reviews and included studies were also conducted. Mean change from baseline for sleep outcomes (e.g., sleep quality, total sleep time, wake after sleep onset) was the effect of interest. Pairwise inverse-variance random effect meta-analysis was performed to impute pooled estimates (Hedges' g or risk ratios). The Hartung-Knapp-Sidik-Jonkman method was used where there were ≤5 studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for evaluating the certainty of evidence. This study was registered with PROSPERO (CRD42022309419). Assessment of 3959 records resulted in nine studies (n=2927) being included. Pharmacotherapy for CLBP management had a small, yet unlikely clinically significant, effect on improving sleep in adults with CLBP, when compared to placebo (g [95% CI]:-0.23 [-0.37,-0.09], p=.0009; I 2 =30.1%; n=1433; studies: n=8; GRADE: low). Notably, no eligible studies investigated the effect of sleep medications in this population, despite being within the scope of this review. Pharmacotherapy used to manage CLBP provided improvements in sleep in adults with CLBP. Given that these effects were small and unlikely clinically significant, clinicians could consider alternative treatments (e.g., non-pharmacological interventions) for managing sleep in adults with CLBP. However, low to very low certainty of evidence precluded strong conclusions. To improve certainty of evidence and confidence in the effect estimates, future research needs to use robust method to minimise bias. Additional research evaluating multiple sleep characteristics, using both validated objective and subjective measures, is also warranted to further investigate the influence of distinct sleep parameters. The Summer Research Scholarship from the Appleton Institute, Central Queensland University, Australia.

Associations between specific sleep and circadian characteristics and alcohol use disorder criteria and problems

Given the significant heterogeneity of alcohol use disorder (AUD) and the increasing priority to understand individual profiles of AUD, pursuing symptom-level examinations of AUD is important. Disturbances in sleep and circadian rhythms have demonstrated robust associations with alcohol consumption and AUD, yet little research has examined these associations at the symptom- or problem-levels and research to date has focused on one or two sleep/circadian characteristics. We sought to investigate the associations between (a) specific AUD symptoms and (b) domains of alcohol-related problems, and multiple sleep characteristics, collected at a daily level in the naturalistic environment. Young adult drinkers were recruited from the community (N = 159, Mage = 23.9, 58.5% female, 6.3% Asian, 35.9% Black or African American, 51.6% White, 5.0% multiracial) and completed a baseline visit as well as up to 18 days of naturalistic assessment. Several sleep/circadian characteristics, including eveningness, later midsleep timing, and shorter total sleep time, were consistently associated with the hazardous use symptom, above and beyond alcohol consumption. Eveningness (beta[SE] = 0.21[0.00], p <.01) was a significant predictor of the alcohol-related problem domain of role interference. Exploratory analyses did not find significant associations between sleep/circadian characteristics and cannabis-related problems. The relationship between sleep/circadian characteristics and AUD and related problems may be driven by a narrower set of symptoms, such as hazardous use and role interference. This may be due to shared mechanistic dysfunction in domains such as reward processing or cognitive control. Thus, these alcohol-related symptoms and problems may be addressed through transdiagnostic treatment approaches that target these underlying mechanisms.

Self-reported sleep and circadian characteristics predict alcohol and cannabis use: A longitudinal analysis of the National Consortium on Alcohol and Neurodevelopment in Adolescence Study.

Growing evidence indicates that sleep characteristics predict future substance use and related problems. However, most prior studies assessed a limited range of sleep characteristics, studied a narrow age span, and included few follow-up assessments. Here, we used six annual assessments from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study, which spans adolescence and young adulthood with an accelerated longitudinal design, to examine whether multiple sleep characteristics in any year predict alcohol and cannabis use the following year. The sample included 831 NCANDA participants (423 females; baseline age 12-21years). Sleep variables included circadian preference, sleep quality, daytime sleepiness, the timing of midsleep (weekday/weekend), and sleep duration (weekday/weekend). Using generalized linear mixed models (logistic for cannabis; ordinal for binge severity), we tested whether each repeatedly measured sleep characteristic (years 0-4) predicted substance use (alcohol binge severity or cannabis use) the following year (years 1-5), covarying for age, sex, race, visit, parental education, and previous year's substance use. Greater eveningness, more daytime sleepiness, later weekend sleep timing, and shorter sleep duration (weekday/weekend) all predicted more severe alcohol binge drinking the following year. Only greater eveningness predicted a greater likelihood of any cannabis use the following year. Post-hoc stratified exploratory analyses indicated that some associations (e.g., greater eveningness and shorter weekend sleep duration) predicted binge severity only in female participants, and that middle/high school versus post-high school adolescents were more vulnerable to sleep-related risk for cannabis use. Our findings support the relevance of multiple sleep/circadian characteristics in the risk for future alcohol binge severity and cannabis use. Preliminary findings suggest that these risk factors vary based on developmental stage and sex. Results underscore a need for greater attention to sleep/circadian characteristics as potential risk factors for substance use in youth and may inform new avenues to prevention and intervention.

Subjective and Perseverative Cognition Mediate the Relationship Between Sleep and Work Impairment

The study examined the mediating role of subjective and perseverative cognition on sleep and work impairment. Sixty nurses completed a background survey and 14-days of ecological momentary assessments (EMA) and sleep actigraphy. Each day, participants evaluated their subjective cognition (mental sharpness, memory, processing speed), perseverative cognition (rumination) and work impairment (how much did you cut back on normal paid work, how much did the quality of your work suffer). Multiple sleep characteristics were measured by EMA and actigraphy. Multilevel mediation models adjusted for sociodemographics and work shift. At the between-person and within-person levels, there were mediated associations of sleep quality and sufficiency (but not actigraphy-measured sleep) with work impairment through subjective and perseverative cognition. Better sleep quality or higher sleep sufficiency were associated with better subjective and perseverative cognition, which, in turn, were associated with less work impairment.

Disparities in multiple sleep characteristics among non-Hispanic White and Hispanic/Latino adults by birthplace and language preference: cross-sectional results from the US National Health Interview Survey

ObjectiveTo investigate whether sleep disparities vary by birthplace among non-Hispanic White (NHW) and Hispanic/Latino adults in the USA and to investigate language preference as an effect modifier.DesignCross-sectional.SettingUSA.Participants254 699 men and...

610 Self-Reported Sleep and Circadian Characteristics Predict Future Substance Use: A Longitudinal Analysis from the NCANDA Study

Abstract Introduction Growing evidence indicates that sleep characteristics predict later substance use and related problems during adolescence and young adulthood. However, most prior studies have assessed a limited range of sleep characteristics, studied only a narrow age span, and included relatively few follow-up assessments. Here, we used multiple years of data from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study, which spans the adolescent period with an accelerated longitudinal design, to examine whether multiple sleep characteristics in any year predict substance use the following year. Methods The sample included 831 participants (423 females; age 12–21 years at baseline) from NCANDA. Sleep variables included the previous year’s circadian preference, sleep quality, daytime sleepiness, timing of midsleep (weekday and weekend), and sleep duration (weekday and weekend). Each sleep variable’s association with the subsequent year’s substance use (cannabis use or alcohol binge severity) across years 1–5 was tested separately using generalized linear mixed models (zero-inflated Negative Binomial for cannabis; ordinal for binge severity) with age, sex, race, visit, parental education, previous year’s substance use (yes/no) as covariates and subject as a random effect. Results With regard to cannabis use, greater eveningness and shorter weekday sleep duration predicted an increased risk for additional days of cannabis use the following year, while greater eveningness and later weekend midsleep predicted a greater likelihood of any cannabis use the following year. With regard to alcohol binge severity, greater eveningness, greater daytime sleepiness, and shorter sleep duration (weekday and weekend) all predicted an increased risk for more severe alcohol bingeing the following year. Post-hoc stratified analyses indicated that some of these associations may differ between high school-age and college-age participants. Conclusion Our findings extend prior work, indicating that eveningness and later sleep timing, as well as shorter sleep duration, especially on weekdays, are risk factors for future cannabis use and alcohol misuse. These results underscore a need for greater attention to sleep characteristics as potential risk factors for substance use in adolescents and young adults and may inform future areas of intervention. Support (if any) Grants from NIH: R01AA025626 (Hasler) and U01AA021690 (Clark) and UO1 AA021696 (Baker &amp; Colrain)

Prevalent Insomnia Concerns and Perceived Need for Sleep Intervention Among Direct-Care Workers in Long-Term Care

This study examined sleep concerns among direct-care workers in long-term care and their perceived need for a sleep intervention. Thirty-five participants reported their sleep concerns and willingness to participate in a sleep intervention with preferred delivery forms/content. Multiple sleep characteristics were assessed via ecological momentary assessment and actigraphy for 2 weeks. Eighty percent reported at least one sleep concern with insomnia-related concerns being most prevalent. Those with insomnia-related concerns tended to have long sleep onset latency, frequent awakenings, suboptimal (long) sleep duration, and long naps. Most participants (66%) expressed interest in participating in a sleep intervention either online or in group sessions; interest was higher in those with insomnia-related concerns. Mindfulness strategies were most preferred, followed by cognitive-behavioral therapy and sleep hygiene education. The high prevalence of insomnia-related concerns in direct-care workers needs to be addressed for the well-being of these workers and for the quality of geriatric care delivery.

0361 Birthplace Moderates Racial/Ethnic Disparities in Multiple Sleep Characteristics Among Non-Hispanic Whites and Hispanic/Latino Heritage Groups in the United States

Abstract Introduction Sleep duration disparities by Hispanic/Latino heritage exist; however, few studies have additionally investigated sleep quality disparities by heritage and birthplace, nor have studies compared foreign-born to US-born Non-Hispanic Whites (NHWs). Methods Using pooled 2004-2017 National Health Interview Survey data, we investigated whether sleep disparities varied by birthplace among adult NHWs and Hispanic/Latino heritage groups. Adjusting for sociodemographic and behavioral/clinical characteristics, survey-weighted Poisson regressions with robust variance estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) of self-reported sleep characteristics. Sleep characteristics were compared among foreign-born NHWs and Hispanic/Latino heritage groups vs. US-born NHWs. Sleep characteristics were also compared across Hispanic/Latino heritage groups vs. foreign-born NHWs. Results Among 254,699 participants (Meanage±SE: 47±0.9 years; 49% female), 81% self-identified as NHW (n=207,154), 12% Mexican (n=30,100), 2% Puerto Rican n=5,077), 1% Cuban(n=2,518), 1% Dominican (n=1,658), and 3% Central/South American (n=8,162). Compared to US-born NHWs, foreign-born NHWs were more likely to report &amp;gt;9-hours sleep duration (PR=1.11[95% CI: 1.01-1.21]) and poor sleep quality (e.g., PRtrouble staying asleep=1.27[1.17-1.37]), and US-born Mexicans were no more likely to report shorter sleep duration while foreign-born Mexicans were less likely (PR&amp;lt;6-hours=0.52[0.47-0.57], PR6-&amp;lt;7-hours=0.72[0.68-0.76]). Although US-born and foreign-born Mexicans had lower prevalence of poor sleep quality compared to US-born NHWs, PRs were lowest for foreign-born Mexicans. Compared to foreign-born NHWs, US-born Mexicans were more likely to report shorter sleep duration, but foreign-born Mexicans were no more likely. Regardless of birthplace, Puerto Ricans were more likely (e.g., PR&amp;lt;6-hours=1.37[1.24-1.60]) and Cubans were less likely (e.g., PR&amp;lt;6-hours=0.81[0.68-0.96]) to report shorter sleep duration vs. US-born NHWs. Compared to US-born NHWs, Dominicans reported better sleep duration and quality. Sleep duration and quality did not differ among Dominicans vs. foreign-born NHWs. Conclusion Sleep disparities varied by birthplace and Hispanic/Latino heritage. Birthplace of both NHWs and racial/ethnic minority groups should be considered in disparities research. Support This work was funded by the Intramural Program at the National Institutes of Health (NIH), National Institute of Environmental Health Sciences (NIEHS, Z1AES103325-01) and the Division of Intramural Research, National Institute on Minority Health and Health Disparities.

Sleep Health: An Opportunity for Public Health to Address Health Equity.

The concept of sleep health provides a positive holistic framing of multiple sleep characteristics, including sleep duration, continuity, timing, alertness, and satisfaction. Sleep health promotion is an underrecognized public health opportunity with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease. Using a socioecological framework, we describe interacting domains of individual, social, and contextual influences on sleep health. To the extent that these determinants of sleep health are modifiable, sleep and public health researchers may benefit from taking a multilevel approach for addressing disparities in sleep health. For example, in addition to providing individual-level sleep behavioral recommendations, health promotion interventions need to occur at multiple contextual levels (e.g., family, schools, workplaces, media, and policy). Because sleep health, a key indicator of overall health, is unevenly distributed across the population, we consider improving sleep health a necessary step toward achieving health equity.

Bidirectional associations of sleep with cognitive interference in employees' work days

ObjectivesStudies have reported bidirectional associations of sleep with daily stressors and negative mood. Yet we know little about how sleep is associated with workers' daily cognitive interference, or the experience of off-task and distracting thoughts. This study examined whether nightly sleep was associated with next-day cognitive interference, and vice versa, during workdays and non-work days. DesignDaily telephone interviews. SettingUS information technology workplaces. Participants130 middle-aged employees. MeasurementsOn 8 consecutive days, participants reported the frequency of experiencing off-task and distracting thoughts during the day (0 = never to 4 = very often) and multiple sleep characteristics (bedtimes, wake times, sleep duration, sleep quality, and sleep latency). Covariates included sociodemographic characteristics and work hours. ResultsMultilevel models revealed that, on days following earlier wake times (B = −0.32, P < .01), shorter sleep duration (B = −0.27, P < .01), or poorer sleep quality (B = −0.17, P < .01), participants reported more cognitive interference than usual. That is, waking 19 minutes earlier and sleeping 16 minutes less were associated with one additional point on the cognitive interference scale the next day. With cognitive interference predicting nightly sleep, more same day's cognitive interference was associated with earlier bedtimes (B = −0.19, P < .05) and earlier wake times (B = −0.30, P < .01) than usual. The temporal associations of nightly sleep duration and sleep quality with the following day's cognitive interference were significant on work days, but not on non-work days. ConclusionOur results suggest bidirectional associations between poorer sleep and more cognitive interference, particularly on work days with implications for workday productivity and quality of life.

Abstract P279: Marijuana Use, Multiple Sleep Characteristics, and Hypertension Among White, Black, and Hispanic Adults in the United States

Introduction: Prior studies have found an association between marijuana use and hypertension. However, few consider the role of sleep as an explanatory factor or race/ethnicity as a moderator. Our objective was to investigate associations between marijuana use, sleep characteristics, and hypertension in a multiethnic population. Hypothesis: We hypothesized that the marijuana use and sleep association would vary by race/ethnicity and sleep would partially explain associations between marijuana use and hypertension. Methods: We used National Comorbidity Survey-Replication cross-sectional data (2001-2003) from white, black, and Hispanic participants aged ≥18 years who reported no current abuse of cocaine or prescription drugs. Participants self-reported marijuana use, multiple sleep characteristics (insomnia symptoms, early awakening, daytime sleepiness), and a physician’s diagnosis of hypertension (yes vs. no). Using Poisson regression with robust variance and sampling weights, we estimated the prevalence of poor sleep characteristics among participants who reported current or former use to never use adjusting for age, sex, and race/ethnicity. Sleep characteristics were added to adjusted models for associations between use and hypertension. Race/ethnicity*marijuana use interaction terms were tested for all models. Results: Among 3,928 participants, mean age±SE was 45±0.49 years, 79% were white, 11% black, and 10% Hispanic. Current users were younger (32±0.49 years), more likely to report black (17%) or Hispanic (13%) race/ethnicity and insomnia symptoms (31%), and less likely to report hypertension (12%) compared to former (40.6±0.45 years, 9.6% black, 9.9% Hispanic, 26% insomnia, 20% hypertension) and never (51.1±0.79 years, 10% black, 9.9% Hispanic, 22% insomnia, 29% hypertension) users. Estimates were similar across marijuana use categories for early awakening (16%) and daytime sleepiness (34%). Former and current marijuana use was associated with 22% (whites) to 38% (blacks) and 33% (Hispanics) to 85% (blacks, prevalence ratio (PR)=1.85 [95% confidence interval: 1.06-3.23]) higher prevalence of insomnia symptoms as well as 32% (blacks) to 49% (whites) and 46% (blacks) to 77% (whites, PR=1.77 [1.29-2.44]) higher prevalence of early awakening (p race/ethnicity*marijuana use &lt;0.05). Across all races/ethnicities, marijuana use was similarly associated with higher prevalence of daytime sleepiness (PR former =1.17 [1.03-1.33], PR current =1.20 [1.00-1.43]). Former marijuana use was associated with higher prevalence of hypertension only among blacks (PR=1.46 [1.04-2.05]) and sleep characteristics explained approximately 2% of this association on average. Conclusions: Marijuana use was associated with poor sleep and relationships varied by race/ethnicity, but relationships between marijuana use and hypertension were not explained by sleep.

Joint effects of multiple sleep characteristics on breast cancer progression by menopausal status

ObjectivesSleep has been closely linked to breast cancer risk. However, the association between sleep and breast cancer prognosis remains unclear. The aim of this study was to evaluate the separate and joint effects of multiple sleep characteristics on breast cancer prognosis among Chinese women. MethodsA total of 1580 breast cancer patients were recruited between October 2008 and December 2014 and followed up until December 31, 2017 in Guangzhou. Multivariate Cox models were conducted to estimate the hazard ratios (HR) and 95% confidence intervals (95%CI) for breast cancer prognosis in association with sleep characteristics. ResultsLong sleep duration at night (>9 h) (HR = 2.33, 95%CI: 1.01–5.42), poor sleep quality (HR = 3.08, 95%CI: 1.74–5.47), and impaired daytime function (HR = 2.49, 95%CI: 1.65–3.79) after diagnosis were associated with an increased risk of breast cancer progression. Both short sleep duration (<6 h) (HR = 2.00, 95%CI: 1.06–3.77, Pinteraction = 0.011) and long sleep duration (>9 h) (HR = 4.69, 95%CI: 1.31–16.78, Pinteraction = 0.187) increased the progression risk only among patients with impaired but not normal daytime function. In addition, daytime napping significantly modified the effect of short sleep duration on the progression (HR = 3.55, 0.59, 95%CI: 1.55–7.97, 0.23–1.53 for patients without and with daytime napping, respectively, Pinteraction = 0.005). Stratification results suggested that the associations were more evident among pre-menopausal patients, although no significant interaction was observed. ConclusionOur findings suggested that inadequate sleep duration to feel one's best and poor sleep quality after diagnosis were associated with an increased risk of breast cancer progression, particularly for pre-menopausal women.

Emerging Adults’ Text Message Use and Sleep Characteristics: A Multimethod, Naturalistic Study

Emerging adults use text messaging as a principal form of social communication, day and night, and this may compromise their sleep. In this study, a hypothetical model was tested linking daytime and nighttime text message use with multiple sleep characteristics. Subjective and objective measures of texting and sleep were utilized to assess 83 college students over a seven-day period during an academic term. Greater number of daily texts, awareness of nighttime cell phone notifications, and compulsion to check nighttime notifications were significantly associated with poorer subjective sleep quality. Awareness of nighttime notifications was significantly associated with higher self-reported global sleep problems and more sleep disruptions. Results suggest potential benefits of targeting nighttime texting habits in health promotion efforts for emerging adults.