Self-reported Sleep Quality Research Articles

QOL-19. IMPROVING SLEEP IN THOSE WITH PRIMARY BRAIN TUMORS (PBT): A GLIMPSE INTO THE CAREGIVER’S PERSPECTIVE FOLLOWING COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA (CBT-I)

Abstract BACKGROUND Sleep disturbance is commonly endorsed by individuals diagnosed with primary brain tumor (PBT), yet few providers in neuro-oncology assess for sleep disturbance, and even less recommend the gold standard treatment for insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I). In our pilot of a group-based, six-session, telehealth-delivered CBT-I program, PBT patients (N=44) demonstrated clinically significant improvements in self-reported insomnia, fatigue, and sleep quality. The aim of this secondary analysis was to examine informal caregivers’ perspectives of the CBT-I intervention and its impact on patients sleep. METHODS Caregivers (N=15, Mage=47.2±14; 53% female; 80% spouses; 93% cohabitating) of patients with PBT and insomnia completed a semi-structured exit interview, following their loved ones’ participation in CBT-I. Descriptive analysis included: perceived improvement in patient and caregiver sleep (rating 1-10; 1=no improvement, 10=great improvement), perceived benefits and drawbacks of CBT-I (open-ended), and caregivers’ recommendation of CBT-I to others with PBT and insomnia (Y/N). RESULTS Most caregivers (73%) noticed a moderate-to-great improvement (≥5/10) in the patient’s sleep and 20% endorsed improvements in their own sleep, following CBT-I. Observed patient benefits included: increased sleep, energy, motivation for change, use of a sleep regimen, and support. Caregivers noted minimal drawbacks of CBT-I, though some found the inflexible sleep schedule disrupted family plans and others wished to be more actively involved in the intervention. Nearly all (87%) would recommend CBT-I to others with PBT and insomnia. CONCLUSIONS Findings suggest that caregivers observed benefit in the patients’ sleep following a brief behavioral intervention for insomnia, further supporting the acceptability of CBT-I for patients with PBT and insomnia. Future directions include a randomized, two-arm pilot of CBT-I and encouraging caregiver participation in the intervention, both to increase their understanding of CBT-I intervention components for maximum benefit in the patient and to possibly improve their own sleep.

Does sleep moderate the effects of exercise training or complex mental and social activities on cognitive function in adults with chronic stroke? Secondary analysis of a randomized trial.

Exercise (EX) or cognitive and social enrichment (ENRICH) are two strategies for promoting cognition post-stroke. Whether sleep moderates the effects of EX or ENRICH on cognition in adults with chronic stroke is unknown. A three-arm parallel randomized clinical trial among community-dwelling adults aged 55+ years with chronic stroke (i.e., ≥12 months since stroke). Participants were randomized to 2x/week EX, ENRICH, or balance and tone control (BAT). At baseline, device-measured sleep duration and efficiency were measured using wrist-worn actigraphy; self-reported quality was measured by Pittsburgh Sleep Quality Index (PSQI). Participants were categorized at baseline as having good or poor device-measured duration, device-measured efficiency, or self-reported quality based on PSQI. The primary cognitive outcome was Alzheimer's Disease Assessment Scale Plus (ADAS-Cog-Plus) measured at baseline, 6 months (end of intervention), and 12 months (6-month follow-up). We examined if baseline sleep categorizations (i.e., good/poor) moderated effects of EX or ENRICH on ADAS-Cog-Plus. We enrolled 120 participants in the trial (EX=34; ENRICH=34; BAT=52). Sleep quality (i.e., device-measured sleep efficiency or self-reported sleep quality) categorization moderated effects of EX (but not ENRICH) on ADAS-Cog-Plus. Compared with BAT participants with poor sleep quality, EX participants with poor sleep quality had better ADAS-Cog-Plus performance at 6 months (estimated mean difference for those with poor device-measured sleep efficiency: -0.48; 95% CI:[-0.85, -0.10]; p=0.010); estimated mean difference for those with poor self-reported sleep quality: -0.38; 95% CI:[-0.70, -0.07]; p=0.014). There was no effect of EX on ADAS-Cog-Plus for participants with good sleep quality. Device-measured sleep duration did not moderate intervention effects. Exercise is particularly beneficial in improving cognitive function in adults with chronic stroke and poor sleep quality.

Social Pain Minimization Mediates Discrimination’s Effect on Sleep Health

ABSTRACT Objective Discrimination disrupts sleep and contributes to race-based health inequities for Black Americans, but less is known about the psychological mechanisms underlying this relation. The current work tests whether emotion invalidation, termed Social Pain Minimization (SPM), mediates discrimination’s negative effects on sleep quality. We focus on the experiences of Black Americans because of racism’s disproportionate effect on the health outcomes of Black individuals in the U.S. Methods Four studies with cross-sectional (Studies 1a-1b) and cross-lagged panel designs (Studies 2–3; N total = 1,176) were used. Discrimination and SPM were assessed with established measures and self-reported sleep quality was assessed with three different operationalizations including the short form Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep-Related Impairment (SRI) subscale and composites of the Insomnia Severity Index (ISI). Results Cross-sectional (Studies 1a-1b) and longitudinal mediation analyses (Studies 2–3) indicated discrimination’s negative effect on sleep quality partially operated through SPM (Study 1a, 95% CI = [−.24, −.016]); Study 1b, 95% CI = [−.22, −.03]; Study 2, 95% CI = [−.268, −.007]]; Study 3, 95% CI = [−0.043, −.002]). Conclusion Beyond its direct negative effect on sleep, discrimination also operates through SPM to reduce sleep quality. Emotion invalidation stemming from discrimination damages sleep.

Mobile Heart Rate Variability Biofeedback for Work-Related Stress in Employees and the Influence of Instruction Format (Digital or Live) on Training Outcome: A Non-Randomized Controlled Trial.

Work-related stress is a major health issue in most industrialized countries. Heart rate variability biofeedback (HRV-BfB) can promote resilience and stress coping capacity. Mobile HRV-BfB could contribute to stress prevention in the workplace. Little is known about whether the type of training, with digital or live instruction, has an impact on the training outcome. This study analyzes the psychophysiological effects of four-week workplace resilience training with mobile HRV-BfB and the influence of instruction format (digital or live) on training success. This was a prospective, three-arm, non-randomized controlled trial with parallel group design. 73 employees of a bearing and seal manufacturer (58.9% male, 86.3% full-time employment, 67.1% office workers) attended resilience training with HRV-BfB, live (n = 24) or digital (n = 19) format, or served as waitlist controls (n = 30). HRV-BfB training spanned four weeks. Participants applied resilience techniques to increase HRV using visual biofeedback. Data were collected at baseline (T0), post-intervention (T1), and another four weeks later (T2). Primary outcome measure was the Burnout scale of the Copenhagen Psychosocial Questionnaire (COPSOQ) at T1. Secondary outcome measures included further COPSOQ scales, self-reported sleep quality (Pittsburgh Sleep Quality Index, PSQI), and HRV parameters. Burnout parameters decreased significantly in HRV-BfB and waitlist. The decrease (T0-T1 and T0-T2) showed higher effect sizes in HRV-BfB (Cohen's d: 0.63; 0.69) than in waitlist (d: 0.27; 0.36). Sleep quality improved in HRV-BfB with small effect sizes (no change for waitlist). SDNN (standard deviation of beat-to-beat intervals) increased in HRV-BfB between T0 and T1 (d: 0.23;). In subgroup analysis, digital reached higher effect sizes for improvement in burnout (d: 0.87; 0.92) and sleep quality (d: 0.59; 0.64) than live learning (burnout: d: 0.43; 0.51; sleep quality: d: 0.28; 0.22). HRV-analysis revealed no differences between subgroups. Four-week mobile HRV-BfB resilience training reduced stress and burnout symptoms in employees. No significant differences were found between HRV-BfB digital or live. Hence, companies should choose the approach that fits their company profile or, if possible, offer both formats to accommodate the different needs of employees. However, findings were nonhomogeneous and should be verified by further studies.Trial Registration: ClinicalTrials.gov , NCT04897165, 05/18/2021, retrospectively registered.

Association of sleep disturbances with diminished ovarian reserve in women undergoing infertility treatment

With an aging population seeking infertility treatment, diminished ovarian reserve (DOR) is a prevalent indication for assisted reproductive technology (ART). This study aims to investigate the relationship between sleep parameters and DOR among women attending an infertility clinic. Methods We consecutively enrolled women attending an infertility clinic from July 2020 to June 2021. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale(ESS), and STOP-Bang Questionnaire to assess self-reported sleep quality. DOR-related indices including antral follicle count, anti-Müllerian hormone(AMH), follicle-stimulating hormone (FSH) were evaluated. A total of 979 women were enrolled, with 148 classified into the DOR group and 831 in the non-DOR group. The DOR group was notably older compared to the non-DOR group. Analysis showed that the DOR group exhibited significantly shorter sleep onset latency (p = 0.001) and shorter total sleep duration (p = 0.014) compared to the non-DOR group. Logistic regression analysis identified age, PSQI-sleep latency, and PSQI score as independent factors associated with an increased risk of DOR(all p < 0.05). Furthermore, stratified analysis by age group revealed that snoring and PSQI-sleep latency were particularly notable risk factors for DOR among women aged 35 years and older (OR = 2.489, p = 0.040; OR = 2.007, p = 0.008, respectively). Our study highlights that shorter sleep onset latency and shorter total sleep duration may be associated with DOR among women undergoing ART treatments. Particularly noteworthy, snoring and sleep latency were identified as additional risk factors for DOR among women aged 35 years and older.

Assessment of Self-reported Sleep Duration and Quality in Relation to the Cognitive Status of Older Adults: A Case-controlled Study

Assessment of Self-reported Sleep Duration and Quality in Relation to the Cognitive Status of Older Adults: A Case-controlled Study

Urban Green Spaces on Maternal Sleep Quality One Year Postpartum Amid COVID-19 Alert Level Changes

Abstract Background Benefits of green spaces (GS) on sleep quality were found, particularly for mothers, which, in turn, contributed to maternal health and offspring development. However, the COVID-19 pandemic imposed restrictions on environmental access, potentially altering the influence of urban GS on sleep quality. This study aims to explore the impact of urban GS on maternal sleep quality one year postpartum during the pandemic. Methods Participants were drawn from the Longitudinal Examination across Prenatal and Postpartum Health in Taiwan study, tracking individuals from early pregnancy across five hospitals in Taipei since 2011. We utilized data spanning from 2019 to 2024, with May 2021 (the initial soft lockdown due to community spread) serving as the cutoff point to delineate early and late pandemic stages. Self-reported sleep quality one year postpartum was assessed using the Pittsburgh Sleep Quality Index. Residential GS was evaluated using the Normalized Difference Vegetation Index (NDVI) within various radii (250m to 2000m). Multiple logistic regression was utilized. Results From the 311 participants, in the early stage of the pandemic, an increase of 0.1 units in NDVI within a 250m radius during both prenatal and postnatal periods (0-12 months) was associated with improved maternal sleep quality (OR = 1.57; 95% CI = 1.08, 2.32, and OR = 1.58; 95% CI = 1.07, 2.30) after adjustments. The impact diminished as the radius increased. Additionally, no significant association was found during the late stage of the pandemic across any of the studied radii. Conclusions The findings suggest a positive correlation between proximity to urban GS and maternal sleep quality during the early stages of the pandemic, with more significant benefits observed at shorter distances, likely due to restricted movement and access. These results underscore the importance of proximity in urban planning and environmental improvement initiatives aimed at enhancing maternal and child health. Key messages • Urban green spaces significantly enhance maternal sleep quality one year postpartum in the early stages of the pandemic, highlighting the importance of proximity for health benefits. • As the radius of green spaces decreased, their positive impact on maternal sleep quality during the early pandemic intensified, underscoring the need for adaptive urban planning strategies.

Time-Restricted Eating Versus Daily Calorie Restriction: Effect on Sleep in Adults with Obesity over 12 Months.

Objective: The aim of this secondary analysis was to compare the effects of time-restricted eating (TRE) versus daily calorie restriction (CR) on sleep quality, duration, insomnia severity, and risk of obstructive sleep apnea in adults with obesity over one year. Methods: A total of 90 participants were randomized to one of three groups for 12 months: 8 h TRE (eating only between 12 p.m. and 8 p.m.); CR (25% daily calorie restriction) or a no-intervention control group. Results: By the end of the study, weight loss was 4.61 kg (95% CI; 7.37 to 1.85 kg; p ≤ 0.01) for the TRE group and 5.42 kg (CI; 9.13 to 1.71 kg; p ≤ 0.01) for the CR group, with no statistically significant difference between TRE and CR (0.81 kg [CI; 3.07 to 4.69]; p = 0.68]). Self-reported sleep quality, sleep duration, insomnia severity, and risk of obstructive sleep apnea did not change in the TRE or CR groups versus controls by month 12. Conclusions: These findings suggest that the weight loss produced by TRE and CR does not have any impact on various sleep parameters in adults with obesity over one year.

The Self-Reported Quality of Sleep and Its Relationship with the Development of Arterial Hypertension: Perspectives from the Tlalpan 2020 Cohort.

Background/Objectives: A well-established association exists between the development of hypertension and sleep quality. The connection between self-reported sleep quality and the onset of hypertension is particularly significant in populations with metabolic deterioration, such as in Mexico. Methods: The Tlalpan 2020 Cohort was analyzed to explore this association. Clinical and anthropometric characteristics, along with the Medical Outcomes Study Sleep Scale (MOS-SS), were compared between participants who developed hypertension and those who did not over a follow-up period of 30.8 months. The potential role of poor sleep quality in the development of hypertension was assessed. Results: Among 1520 participants, 12% developed hypertension. These individuals had higher anthropometric and laboratory values and reported poorer sleep quality. An elevated sleep problems index was associated with a 50% higher relative risk of developing hypertension (OR: 1.5; 95% CI: 1.087 to 2.069). Additionally, self-reported snoring was associated with hypertension onset (36.3 vs. 43.3; p = 0.019). Conclusions: Poor sleep quality and respiratory disturbances during sleep increase the risk of developing hypertension. Furthermore, hypertension was associated with snoring, highlighting the importance of early interventions to improve sleep quality.

Effect of closed-loop vibration stimulation on sleep quality for poor sleepers.

Recent studies have investigated the autonomic modulation method using closed-loop vibration stimulation (CLVS) as a novel strategy for enhancing sleep quality. This study aimed to explore the effects of CLVS on sleep quality, autonomic regulation, and brain activity in individuals with poor sleep quality. Twenty-seven participants with poor sleep quality (Pittsburgh sleep quality index >5) underwent two experimental sessions using polysomnography and a questionnaire, one with CLVS (STIM) and the other without (SHAM). Sleep macrostructure analysis first showed that CLVS significantly reduced the total time, proportion, and average duration of waking after sleep onset. These beneficial effects were paralleled by significantly increased self-reported sleep quality. Moreover, there was a significant increase in the normalized high-frequency (nHF) and electroencephalography relative powers of delta activity during N3 sleep under STIM. Additionally, coherence analysis between nHF and delta activity revealed strengthened coupling between cortical and cardiac oscillations. This study demonstrated that CLVS significantly improves sleep quality in individuals with poor sleep quality by enhancing both subjective and objective measures. These findings suggest that CLVS has the potential to be a practical, noninvasive tool for enhancing sleep quality in individuals with sleep disturbances, offering an effective alternative to pharmacological treatments.

Aircraft noise effects in vulnerable populations

Vulnerable population groups (e.g. children, elderly people, shift workers) have not been the focus of investigations into the effects of transportation noise for a long time. In two field studies in the vicinity of Cologne/Bonn Airport, we therefore investigated the effects of nocturnal aircraft noise on sleep as recorded with polysomnography and self-reported sleep quality as well as short-term annoyance in 51 primary school children (8-10 years) and 44 elderly people (55 - 76 years). In a laboratory study, the effects of aircraft noise on the same outcome variables were compared between 17 participants who slept during the day (19 - 36 years) and 16 participants who slept at night (18 - 35 years). This article provides an overview of the results of these studies in vulnerable groups. Noise effects were more pronounced in participants who slept during the day than in those who slept at night. The findings for children and older people were less consistent and showed effects of nocturnal aircraft noise either on sleep (children) or on self-reported sleep quality and annoyance only (elderly people). Results of the vulnerable groups are discussed in comparison to findings in middle-aged adults.

6587 Circulating androgen and estrogen metabolites associated with self-reported sleep quality and vasomotor symptoms in the Women’s Health Initiative Observational Study

6587 Circulating androgen and estrogen metabolites associated with self-reported sleep quality and vasomotor symptoms in the Women’s Health Initiative Observational Study

Hematological and performance adaptations to altitude training (2,320m) in elite middle-distance and distance swimmers.

Elite swimmers often schedule altitude training camps ahead of major events in an attempt to maximize performance. However, the relationships between altitude-induced hematological changes, markers of training adaptation, and performance changes in such context are unclear. This study assessed hematological status, markers of daily adaptation, and swimming performance in elite middle-distance and distance swimmers during a 22-day altitude training camp at 2,320m, 2weeks prior to World Championship qualification competition. Venous blood was obtained and total hemoglobin mass (tHbmass) measured (CO rebreathing) in 7 elite swimmers (4 females, 3 males) 8days before and on day 22 of the altitude camp. Resting heart rate, peripheral oxygen saturation, urinary specific gravity, body mass, fatigue and self-reported sleep duration and quality were monitored daily during the altitude camp. Swimming performance was assessed through a standardized set (6 sets of 4 maximal repetitions of 100m front crawl) on days 3, 10 and 17 of the camp, and at sea level competitions (200m-1,500m) immediately after the camp, and 2weeks later. tHbmass (+5.6 ± 3.3%; range: 2.1%-11.0%; p < 0.05), red blood cell count, hemoglobin concentration, hematocrit increased at the end of the training camp (p < 0.05). Performance at altitude improved throughout the camp (+1.4 ± 0.4%; range: 0.7%-2.5%; p < 0.05). No significant relationship was noted between hematological changes, the change in altitude performance and any of the monitored daily markers of adaptation during the camp. Compared to the swimmers' previous personal best, competition performances did not improve immediately (2.5% ± 1.9% slower times) and 2weeks after altitude (1.2% ± 1.4% slower times). The 22-day altitude training camp at 2,320m was beneficial for elite swimmers' tHbmass, hematological status and performance at altitude, but these benefits did not clearly translate into enhanced sea level performance immediately after or 2weeks later. The present study confirms the large inter-individual variability in hematological responses to altitude training, and that the improvement in performance at altitude and sea level may depend on factors other than the increase in tHbmass alone.

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

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

Effect of depression treatment on health behaviors and cardiovascular risk factors in primary care patients with depression and elevated cardiovascular risk: data from the eIMPACT trial.

Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk. Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange. The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39). Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed. ClinicalTrials.gov Identifier: NCT02458690.

Chronic Cannabidiol Administration Mitigates Excessive Daytime Sleepiness and Fatigue in Patients with Primary Hypertension: Insights from a Randomized Crossover Trial.

Background: The chronic effects of cannabidiol (CBD) supplementation on factors that could impact the quality of life (anxiety, sleeping quality, memory, etc.) are poorly explored. Hence, the aim of this study was to establish whether chronic CBD supplementation will improve self-reported outcomes related to quality of life. Methods: In this randomized crossover trial, 64 patients with primary hypertension were assigned to receive CBD (225-450 mg) for 5 weeks followed by 5 weeks of placebo or vice versa, with a 2-week washout in-between the two. Self-reported outcomes were assessed using short form-36 (SF-36), Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), memory complaint questionnaire (MAC-Q), and state-trait anxiety inventory (STAI). Results: Five-week administration of CBD, but not of placebo, resulted in improvement of ESS score (F = 6.738, p = 0.011), as well as fatigue/vitality (ΔCBD = 5.0, p < 0.001) and psychological well-being dimensions of SF-36 (ΔCBD = 7.4, p = 0.039). No overall benefit of CBD on quality of life was noted (p = 0.674). No changes were seen in total scores of MAC-Q, PSQI, or STAI (p = 0.151, p = 0.862, p = 0.702, respectively). No significant correlations were found between plasma CBD concentrations and any of the scores. Conclusions: Chronic CBD administration reduced excessive daytime sleepiness, despite the fact that no change was observed in self-reported quality of sleep. Furthermore, self-reported fatigue and psychological well-being dimensions of quality of life also improved following chronic CBD use.

Effect of graduated drug therapy for moderate to severe chronic insomnia on the severity of disease: an observational study in Germany.

Severe chronic insomnia is a common sleep disorder that is mostly persistent and needs to be treated. Pharmacologic treatment options and guidelines are sparse, particularly for long-term treatment. Our study aims to investigate a graduated therapy scheme for moderate to severe chronic insomnia in practice, considering the effects on self-reported sleep quality and quality of life. Patients with moderate to severe chronic insomnia are given appropriate medication according to a graduated therapy scheme, ranging from L-tryptophan (as the first choice, least potent) to Z-drugs and combination therapies (as the last option, most potent). Each step of the graduated therapy scheme was tested for at least 4 weeks. Sleep- and quality of life-related data were collected in questionnaire form (ISI, PSQI, BDI-II, SF-36) at baseline and during the course of the treatment after 1, 3, 6, 9, and 12 months. Of 86 eligible patients, 60.5% started treatment with L-tryptophan and 8.1% with melatonin. After 3 months, 12.5% were still taking L-tryptophan and 12.5% were taking melatonin. There was a significant decrease in mean ISI, PSQI, BDI-II, and SF-36 scores after 3 months of treatment for all patients in the study (n=64). After 6 months, 22.2% were still taking L-tryptophan, melatonin, or agomelatine, and the remainder had switched to more potent drugs such as antidepressants, hypnotics, daridorexant, or combination therapies. A significant number of patients already responded favorably to mild sleep medications, while others demonstrated their need for more potent treatments. Ongoing monitoring will evaluate the long-term effectiveness of both approaches. Registy: German Clinical Trials Register; Title: Schlafqualität und Lebensqualität mit einer medikamentösen Langzeittherapie bei moderater bis schwerer Insomnie; Identifier: DRKS00033175; URL: https://drks.de/search/de/trial/DRKS00033175.

Stress Response to Winter Warfare Training: Potential Impact of Location.

Winter warfare training (WWT) is a critical component of military training that trains warfighters to operate effectively in extreme environments impacted by snow and mountainous terrain. These environmental factors can exacerbate the disruption to the hormone milieu associated with operating in multi-stressor settings. To date, there is limited research on the physiological responses and adaptations that occur in elite military populations training in arduous environments. The purpose of this study was to quantify hormone responses and adaptations in operators throughout WWT. Participants engaged in baseline laboratory metrics at their home station, Fort Carson, located in Colorado (CO) prior to WWT, for one week in Montana (MT) and one week in Alaska (AK). WWT periods were separated by approximately one month. Blood was collected upon wake at baseline (CO) and on the first and last day of WWT at each location (MT and AK). Plasma was analyzed for stress, metabolic, and growth-related hormones via enzyme-linked immunoassay (ELISA). Sleep quality was assessed via the Pittsburg Sleep Quality Index (PSQI) at baseline (CO) and on the first day of training in MT and AK. Cognitive function was evaluated using the Defense Automated Neurobehavioral Assessment (DANA) at baseline (CO) and on the first and last day of WWT in both MT and AK. Fourteen US Army operators in 10th Special Forces Group (SFG) Operational Detachment participated in winter warfare training (WWT; age: 31.5 years; 95%CI[28.1, 34.3]; height: 180.6 cm; 95%CI[177.3, 183.4]; weight: 87.4 kg.; 95%CI[80.6, 97.7]; body fat: 18.9%; 95%CI[13.7, 23.1]; male: n=13; female: n=1). Plasma adrenocorticotropic hormone (ACTH) levels increased from baseline (19.9 pg/mL; 95%CI[8.6, 24.2]) to pre-WWT (26.9 pg/mL; 95%CI [16.2, 37]; p=0.004), decreased from pre- (26.9 pg/mL; 95%CI [16.2, 37]) to post-WWT in MT (22.3 pg/mL; 95% CI [8, 23.7]; p=0.004;), and increased from pre- (25 pg/mL; 95%CI[ 28.4) to post-WWT (36.6 pg/mL; 95%CI [17.9, 48.9]) in AK (p=0.005). Plasma cortisol levels decreased from pre- (174 ng/mL; 95%CI[106.2, 233.6]) to post-WWT (94.5 ng/mL; 95%CI[54.8, 101.7]) in MT (p=0.001) and, conversely, increased from pre- (123.1 ng/mL; 95%CI[97.5, 143.9]) to post-WWT (162.8 ng/mL; 95%CI[128, 216.7]) in AK (p<0.001). Alterations in growth-related hormones (insulin-like growth factor 1 [IGF-1], insulin-like growth factor binding protein 3 [IGFBP-3], and sex hormone binding globulin [SHBG]) were observed throughout WWT (p<0.05). The Total Testosterone / Cortisol ratio (TT / CORT; molar ratio) was lower pre-WWT in MT (0.04; 95%CI[0.01,0.04) compared to baseline in CO (0.07; 95%CI[0.04, 0.07]; p=0.042). Triiodothyronine (T3) levels increased from pre- (101.7 ng/dL; 95%CI[93.7, 110.4]) to post-WWT (117.8 ng/dL; 95%CI[105.1, 129.4]) in MT (p=0.042). No differences in sleep quality were reported between locations (CO, MT, and AK). Alterations in cognitive function were exhibited between locations and during WWT in both MT and AK (p<0.05). Over the course of WWT, elite operators experienced alterations in stress, metabolic, and growth-related hormones, as well as cognitive performance. The increase in stress hormones (i.e., ACTH and cortisol) and reduction in cognitive performance following training in AK are suggestive of heightened physiological strain, despite similarities in physical workload, self-reported sleep quality, and access to nutrition. The variation in hormone levels documented between MT and AK may stem from differences in environmental factors, such as lower temperatures and harsh terrain. Further research is warranted to provide more information on the combined effects of military training in extreme environments on operator health and performance.

Self-reported sleep duration and quality and cardiovascular diseases among middle-aged and older Chinese: A 7-year longitudinal cohort study.

Cardiovascular disease (CVD) is a leading cause of death worldwide, and several studies have attempted to identify its risk factors. This study aimed to investigate the association between sleep duration and sleep quality, and the 7-year incidence of CVD among middle-aged and older Chinese individuals. A total of 6682 participants aged 45-90 years from the China Health and Retirement Longitudinal Study database were included in this study. The authors estimated sleep duration and quality based on self-reported data of night sleep hours and disturbance symptoms, and examined the associations between them and the composite outcome of CVD using logistic regression models. A total of 1692 participants (25.32%) reported new CVD events during follow-up. Short sleep duration (<6h/night) was significantly associated with a higher risk of CVD in all three models (p<.05). However, this was not observed for long sleep duration (>8h/night). Additionally, participants with mild sleep disturbance in all three models, and severe sleep disturbance in Models 2 and 3 had a significantly higher risk of CVD (p<.05). After stratification by age and daytime napping, we still found a significant association between short sleep duration and CVD in individuals aged 45-59 years, and between sleep disturbance and CVD in non-nappers (p<.05). However, these associations were not significant in individuals aged ≥60 years or in nappers (p>.05). In conclusion, short sleep duration and sleep disturbance are both associated with an increased risk of CVD in middle-aged and older Chinese individuals.

Adapting and Evaluating the Feasibility and Acceptability of a Behavioral Intervention to Promote Sleep Health in Cardiac Rehabilitation

ABSTRACT Objectives Study objectives were to: 1) iteratively adapt the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for patients in cardiac rehabilitation (CR; Phase 1) and 2) conduct a preliminary single group pre-post intervention test to a) evaluate procedural feasibility and intervention acceptability and b) to explore preliminary pre-post changes in self-reported sleep, disability, and health-related quality of life (HRQoL; Phase 2). Method In Phase 1, 12 individuals in CR and six content experts completed interviews to inform TranS-C adaptations. Interviews were analyzed using rapid qualitative analysis. In Phase 2, eight individuals in CR completed a baseline assessment, the adapted TranS-C intervention, and a post-intervention assessment. Intervention acceptability was assessed via questionnaire and interview. Sleep, disability, and HRQoL outcomes were assessed using questionnaires. Descriptive statistics were calculated for quantitative measures; interviews were analyzed using rapid qualitative analysis. Results Phase 1 participants were receptive to the premise and structure of the adapted intervention. In Phase 2, participants endorsed positive attitudes toward the intervention. Seven of eight participants demonstrated improvements in sleep outcomes. Disability and HRQoL results did not consistently improve. Conclusion The adapted TranS-C intervention was acceptable to CR patients and could yield improvements in subjective sleep outcomes. Larger-scale testing in CR is warranted.