Severe Clinical Insomnia Research Articles

The effect of cumulative night shift duties on insomnia, fatigue, and mental health in intensive care unit

BackgroundNight shift duties are crucial in the ICU to ensure care continuity, where critically ill patients require round-the-clock care. However, cumulative night shift duties may disturb circadian rhythm, insomnia, fatigue, and depression, and require further elucidation. ObjectivesThis study aims to examine the negative consequences of various night shift patterns on insomnia, fatigue, and mental health of ICU Workers. MethodsA cross-sectional study examined how cumulative night shift duty affects insomnia, fatigue, and mental health in critical care providers (CCPs). ResultsA total of 1006 participants completed this study between June 2022 and March 2023, including 54.5 % males. About 35 % were between 20 and 30 years of age, and Respiratory Therapists accounted for approximately 46.5 % of the entire sample. Most of our respondents (476; 47 %) reported working night shifts, with a monthly range of 8–15 nights. The prevalence rates for moderate to severe clinical insomnia, fatigue, and moderate to severe depression were 42 %, 48 %, and 32 %, respectively. CCPs working 8–15 nights had a 2-fold risk of clinical insomnia than those working fewer than eight nights with (AOR) and 95 % (CI) of 2.12 and 1.41–3.20, while those working ≥16 nights per month had a greater incidence of clinical insomnia compared to those working <8 nights per month, AOR (CI): 3.09 (1.90–5.03). Only those working ≥16-night shifts per month had a substantially higher fatigue risk compared to those working < 8-night shifts per month, with an AOR (CI) of 1.92 (1.19–3.08). Working 8–15-night shifts per month increases depression risks by 34 % compared to the <8-night shifts group, AOR (CI): 1.34 (0.87–2.08). Those working ≥16-night shifts per month showed a higher depression risk than those working <8-night shifts, AOR (CI): 2.53 (1.53–4.19). ConclusionA cumulative night shift above eight nights per month is linked with an increased risk of insomnia, fatigue, and depression. The risk of these conditions was significantly directly proportional to the number of night shifts performed per month.

Severe Clinical Insomnia Management with Ayurvedic Protocol - A Case Report

Insomnia is characterized by inability to sleep or lack of sleep. Severe clinical insomnia is a highly prevalent health concern faced by a wide majority of people across the globe due to the rise in stressful external environments. Often such cases require long term use of sedative hypnotics or tranquilizers which are habit forming. Ayurveda identifies insomnia as Nidranasa and is a disease which is caused predominantly by Vata Pitta increase and a dip in Kapha levels. Ayurvedic treatment protocol involves internal medication and topical procedures like Shirodhara and Abhyanga. This case report is intended to throw light to a positive outcome of Ayurvedic treatment protocol in severe clinical insomnia. A 34-year-old male presented with symptoms of severe clinical insomnia assessed by Insomnia Severity Index (ISI) associated with obesity and had a history of consuming hypnotics. The treatment protocol included Dhanyamladhara, Udvartana, Takradhara, Abhyanga and Shirodhara along with disease specific internal medicines. The ISI score before treatment of 26 came down to 1 after treatment and was maintained during 3 months follow up. This displays the complete remission of the disease without the use of habit-forming internal medication.

Fear of falling and associated factors in older adults with heart failure.

This study aimed to evaluate the prevalence of fear of falling and associated factors in older adults with heart failure. A prospective, cross-sectional study. The study included 100 geriatric patients who were hospitalised and treated in the cardiology department of our hospital with ventricular ejection fraction (LVEF) lower than 50% for at least 1 year. A series of geriatric assessments were performed by face-to-face interview on the day of admission. Electrocardiography (ECG) and transthoracic echocardiography (TTE) were also performed on the day of admission. The median age of the patients was 72 years, and 72.0% were men. Falls Efficacy Scale scores indicated a fear of falling in 46 (46.0%) of the patients. Charlson Comorbidity Index (CCI) was significantly higher in patients with fear of falling (P < 0.001). Severe depression, severe clinical insomnia, daytime sleepiness, and malnutrition were significantly more frequent among patients with fear of falling. Fear of falling was associated with significantly lower LVEF (P = 0.001). The presence of severe depression increased the risk of fear of falling by 13.97 times (95% CI: 3.064-63.707; P = 0.001), and the presence of daytime sleepiness increased the risk by 3.49 times (95% CI: 1.012-12.037; P = 0.048). A one-unit increase in CCI increased the risk of fear of falling by 1.56 times (95% CI: 1.093-2.238; P = 0.014). Heart failure patients with concomitant depression, sleep disorders, and high comorbidities have greater fear of falling.

Caregiver reported behavior, sleep and quality of life in children with Dravet syndrome: A population-based study

ObjectiveThe aim of this population-based study was to assess behavior, sleep, and quality of life, and explore factors associated with these in children with Dravet syndrome. MethodsThe Developmental Behavior Checklist, the Insomnia Severity Index, and a global question regarding quality of life from the Epilepsy and Learning Disabilities Quality of Life scale were completed by primary caregivers of 42/48 Swedish children with Dravet syndrome, born 2000–2018. Factors associated with problems with insomnia, behavior and quality of life were analyzed using multivariable linear regression. ResultsScores indicating significant behavioral problems were seen in 29/40 (72 %) children, scores indicating moderate or severe clinical insomnia in 18/42 (43 %) and scores indicating poor or very poor quality of life in 7/41 (17 %). On multivariable analysis, autistic symptoms were significantly associated with behavioral problems (p = 0.013), side-effects of anti-seizure medications (ASMs) were associated with insomnia (p = 0.038), whilst insomnia was significantly associated with poor quality of life (p = 0.016). SignificanceDravet syndrome in children is associated with significant problems with behavior, sleep and quality of life. There is a need to optimize treatment via ASMs and develop and evaluate interventions to treat behavioral and sleep difficulties to optimize outcomes.

Sleep disturbances in the memory clinic: Associations with clinical features and neuropsychological performance

AbstractBackgroundThe prevalence of sleep disturbances increases in ageing and may further increase in neurodegeneration. In a memory and cognition (MC) clinic setting, our study aims to: 1) determine the rates of various sleep disturbances including obstructive sleep apnoea (OSA), short and long sleep duration, insomnia, sleep quality, and rapid eye movement sleep behaviour disorder (RBD); and 2) examine whether these sleep disturbances are associated with neuropsychological performance in older adults without dementia.MethodWe captured data between 2009 and 2022 from a MC clinic for older adults aged over 50 with new cognitive and/or mood concerns. Self‐reported history, pulse oximetry, and polysomnography (PSG) captured rates of OSA. Actigraphy (&gt;7 days) was used to measure sleep duration (defined short duration as &lt;6 hours and long duration as &gt;9 hours). Validated self‐report questionnaires were used to capture insomnia, sleep quality, and RBD. We examined group differences between those with and without sleep disturbances in the following cognitive composites: verbal learning and memory, processing speed, executive function, and language skills.ResultsWe recruited 1016 participants (mean age = 66.9 (SD = 9.0), mean MMSE = 28.3 (SD = 2.2), male = 436 (43%)). For rates of OSA, 15% (n = 152/1016) self‐reported history of OSA, 76% (n = 383/504) had OSA as classified by PSG, 84% (n = 115/137) had OSA as classified by pulse oximetry. From actigraphy data, 10% (n = 55/566) had short sleep and 5% (n = 29/566) had long sleep duration. From self‐report data, 15% (n = 85/579) had moderate or severe clinical insomnia, 61% (n = 544/893) reported having poor sleep quality, 10% (n = 56/579) had RBD. Individuals with OSA (from PSG) performed worse in verbal learning compared to those without OSA (p&lt;0.05). Individuals who had long sleep duration performed worse on both verbal learning (p&lt;0.05) and memory (p&lt;0.05) than those with short sleep and normal sleep duration. There were no other significant group differences in cognition outcomes, amongst the other sleep disturbance groups (p&gt;0.05).ConclusionIn MC clinics, there are very high rates of sleep disturbance in this at‐risk population. The large discrepancy in rates of OSA between self‐reported history and PSG suggests OSA is under‐diagnosed. Sleep disturbances may be associated with cognitive outcomes, in particular learning and memory.

Assessment of Sleeping Disorders, Characteristics, and Sleeping Medication Use Among Pharmacy Students in Saudi Arabia: A Cross-Sectional Quantitative Study.

BACKGROUND Insomnia is a growing problem, especially among university students, and is associated with sleep disorders, poor academic performance, and quality of sleep. The purpose of this study was to assess the prevalence of insomnia sleeping characteristics, managing techniques, and attitudes toward sleeping pill usage among pharmacy students. MATERIAL AND METHODS A cross-sectional web-based study was conducted among pharmacy students of King Saud University, College of Pharmacy, Riyadh, Saudi Arabia between February and March 2023. SPSS version 26 was used for data analysis. A P value of <0.05 and was considered statistically significant. RESULTS In this study, 61.7% (n=108) of the students' slept an average of 6-10 h and 35.4% (n=62) slept an average of 6 h. Regarding sleeping patterns, nearly two-thirds (n=112, 64%) of the students had day and night sleeping patterns while more than one-third (n=63, 36%) had only night sleeping patterns. In this study, 2.9% (n=5) of the students had severe clinical insomnia, while 21.7% (n=38) reported moderately severe clinical insomnia, 44% (n=77) of them had subthreshold insomnia, and 31.4% (n= 55) had no clinically significant insomnia. The mean scores of the insomnia severity index were significantly related to the usage of stimulants (P=0.048), average hours of sleep (P=0.0001), and average minutes needed to fall asleep (P=0.0001). CONCLUSIONS The current findings demonstrated varying levels of insomnia among students, yet few students used sleeping pills.

Factors associated with benzodiazepines dependence in insomnia patients

The use of benzodiazepines as a treatment for insomnia can have side effects such as impaired coordination causing falls in adults and even dependence. To assess the factors associated with dependence on benzodiazepines in patients with insomnia. Observational, cross-sectional, prospective, and analytical study, at the first level of care. Patients older than 18 years with a diagnosis of insomnia and a benzodiazepine prescription were selected. The dependency was measured with the International Neuropsychiatric Interview. 107 patients were included. Median age 67 years, predominantly female (72%), 74% attended secondary school or more, 71% had more than 3 years of diagnosis, 84% used clonazepam. The 54% presented dependency. In the bivariate analysis, schooling RM 0.392 (95%CI: 0.15-0.96) p = 0.038, moderate and severe clinical insomnia RM 3.618 (95%CI: 1.44-9.08) p = 0.005 and more than 3 years of diagnosis RM 2.428 (95%CI: 1.03-5.71) p = 0.040. In the multivariate model, schooling (p = 0.084), years of diagnosis (p = 0.062) and frequency of consumption (p = 0.065) obtained an R2 of 0.13. Primary schooling showed a lower risk of presenting dependence on benzodiazepines. The risk was increased in those with more than 3 years of diagnosis, and in those with moderate and severe insomnia.

Quality and pattern of sleep and preexamination substance abuse-impact on academic performance in medical students

Abstract Background: Ambiguity persists regarding the role of chronotype, sleeping patterns, and afternoon naps on academic performance. Very little work has been done on the preexamination severity of insomnia leading to consequent substance abuse, which might further cause a decline in sleep quality, creating a vicious cycle. Aims: The aim of our study is to correlate the academic performance of medical students with the severity of preexamination insomnia and substance abuse and their general sleep quality and patterns. Methods: This is an observational and descriptive study with prospective longitudinal design. A semi-structured questionnaire, which included several scales pertaining to sleep quality and chronotype, was used to assess the relevant parameters among 710 medical students across several medical colleges of India just before their examinations. They were followed up after 1 month and then after 3 months to assess their academic performance and chronicity of insomnia according to Athens Insomnia Scale. Several statistical tests were conducted between the various dependent variables, and finally, linear logistic multivariate regression analysis was done between the predictors, variables, and the outcome. Results: About 78.6% of students were found to be having generalized poor quality of sleep, while 30.8% were found to be suffering from moderate–severe clinical insomnia before their examination. About 30.4% of the students claimed to be using stimulants while 10.7% claimed to be using some sort of depressant before their examination. Conclusion: Significant correlation was found between preexamination insomnia and substance abuse. No significant correlation was found between our predictor variables and academic outcome. Those with higher degrees of insomnia before examination were found to have a statistically significant chance of developing chronic insomnia.

Assessment of Insomnia Among Emergency Department Physicians in the Western Region of Saudi Arabia, 2023.

Background Sleep is essential for physical and mental health, and insomnia is the most common sleep disorder. Insomnia is associated with multiple health issues that may affect physicians' health and their decision-making, and subsequently affect patients in the emergency department (ED). This study aimed to assess insomnia and its associated factors among ED physicians in the western region of Saudi Arabia. Methods A cross-sectional study was conducted using a validatedonline questionnaire to collect data from the target population. The questionnaire included demographic characteristics, the nature of the job, shift characteristics, and the Insomnia Severity Index tool. Data were analyzed using the statistical package for the social sciences (SPSS, version 29.0), and the Chi-square test was used for bivariate analysis. Results The study involved 106 ED physicians, primarily from Saudi Arabia, who worked in government hospitals and were mostly aged from 20 to 29 years old. Of the participants, 35.8% had moderate to severe clinical insomnia, with younger physicians experiencing more severe insomnia than their older colleagues. This highlights the potential role of age in the development of insomnia. No significant associations were found between insomnia severity and other demographic or work-related factors. Conclusion This study found a high prevalence of insomnia among ED physicians in Saudi Arabia, emphasizing the need for further research and interventions to address this issue. Improving the sleep quality of ED physicians is crucial for their health and well-being, as well as for the safety and quality of care provided to their patients.

0358 Prevalence of Insomnia Symptoms and Insomnia Disorder within VA Subacute Rehabilitation

Abstract Introduction Approximately 40% of Veterans report insomnia symptoms and 12% of Veterans have a formal insomnia disorder diagnosis. While these numbers reflect outpatient prevalence rates, there is little data on the prevalence of insomnia symptoms and insomnia disorder among the 32,000 Veterans receiving care within VA Community Living Centers (CLC) (rehabilitation and long-term care facilities) each year. The present analysis provides an initial step in understanding the prevalence of insomnia disorder vs. insomnia symptoms within a local VA CLC subacute rehabilitation unit. This analysis is part of a clinical innovation project that evaluated Veterans’ sleep during admission for the purposes of informing clinical interventions. Methods 67 Veterans were admitted to a VA subacute rehabilitation unit following hospital discharge between March and August 2022. Veterans were asked to complete a brief evaluation within 7 days of admission, including the Insomnia Severity Index (ISI), Sleep Need Questionnaire (SNQ), and Epworth Sleepiness Scale (ESS). Sleep disorder diagnoses were obtained through chart reviews. Descriptive statistics were used to evaluate the prevalence of sleep disorders, insomnia severity, sleep need, and daytime sleepiness. Results 48 of 67 (71.6%) Veterans (Mage=72.8±12.0;97.9%male;79.2%white) completed evaluations within 7 days of admission. 52.1% of Veterans reported at least subthreshold insomnia (ISI≥8) with 22.9% reporting moderately severe clinical insomnia (ISI≥15). 50% reported not meeting their sleep need (SNQ≥13) and 33.3% reported at least mild levels of daytime sleepiness (ESS≥11). Chart reviews indicated only 25% of Veterans had a formal sleep disorder diagnosis in their chart and only 4.2% Veterans had a formal diagnosis of insomnia disorder. Conclusion The results of this preliminary analysis highlighted the discrepancy between national outpatient statistics and local inpatient statistics on the prevalence of insomnia symptoms and disorder. While the Veterans admitted to the CLC may be experiencing additional factors influencing their sleep (e.g., environmental disruptors), this does not wholly explain the discrepancy between the local and national ­samples. Future evaluations should include multiple VA sites to obtain a more representative sample of Veterans. Clinically, these findings suggest that insomnia disorder should be considered a standalone diagnosis and added to Veterans’ charts when clinically elevated symptomology is endorsed. Support (if any)

Insomnia and job stressors among healthcare workers who served COVID-19 patients in Bangladesh

BackgroundThe global outbreak of COVID-19 has created unprecedented havoc among health care workers, resulting in significant psychological strains like insomnia. This study aimed to analyze insomnia prevalence and job stressors among Bangladeshi health care workers in COVID-19 units.MethodologyWe conducted this cross-sectional study to assess insomnia severity from January to March 2021 among 454 health care workers working in multiple hospitals in Dhaka city with active COVID-dedicated units. We selected 25 hospitals conveniently. We used a structured questionnaire for face-to-face interviews containing sociodemographic variables and job stressors. The severity of insomnia was measured by the Insomnia Severity Scale (ISS). The scale has seven items to evaluate the rate of insomnia, which was categorized as the absence of Insomnia (0–7); sub-threshold Insomnia (8–14); moderate clinical Insomnia (15–21); and severe clinical Insomnia (22–28). To identify clinical insomnia, a cut-off value of 15 was decided primarily. A cut-off score of 15 was initially proposed for identifying clinical insomnia. We performed a chi-square test and adjusted logistic regression to explore the association of different independent variables with clinically significant insomnia using the software SPSS version 25.0.Results61.5% of our study participants were females. 44.9% were doctors, 33.9% were nurses, and 21.1% were other health care workers. Insomnia was more dominant among doctors and nurses (16.2% and 13.6%, respectively) than others (4.2%). We found clinically significant insomnia was associated with several job stressors (p < 0.05). In binary logistic regression, having sick leave (OR = 0.248, 95% CI = 0.116, 0.532) and being entitled to risk allowance (OR = 0.367, 95% CI = 0.124.1.081) showed lower odds of developing Insomnia. Previously diagnosed with COVID-19-positive health care workers had an OR of 2.596 (95% CI = 1.248, 5.399), pointing at negative experiences influencing insomnia. In addition, we observed that any training on risk and hazard increased the chances of suffering from Insomnia (OR = 1.923, 95% CI = 0.934, 3.958).ConclusionIt is evident from the findings that the volatile existence and ambiguity of COVID-19 have induced significant adverse psychological effects and subsequently directed our HCWs toward disturbed sleep and insomnia. The study recommends the imperativeness to formulate and implement collaborative interventions to help HCWs cope with this crisis and mitigate the mental stresses they experience during the pandemic.

5613459 PAIN IN YOUTH WITH SICKLE CELL DISEASE AND ASSOCIATION WITH SLEEP

Background: Acute episodes of pain are the most common cause of hospitalizations among individuals with sickle cell disease (SCD). Sleep disturbances are common in SCD. Sleep modulates mood, coping abilities, and cognition and have a potential to impact pain experience in SCD. Goal of our study was to explore relationship between sleep and pain burden in youth with SCD. Aims: To analyze the interaction between sleep and pain in a cohort of youth with SCD at Children’s National Hospital (CNH), which provides care to patients from Maryland, District of Columbia, and Virginia in the United States. Methods: Thirty-six individuals with SCD who participated in the studies approved by CNH IRB, including Integrative Clinic and Natural History of SCD, and completed surveys on sleep and pain burden were included in this analysis. Scores for a risk of chronic pain also known as “fibromyalgianess” were determined utilizing the Centralized Pain Index (CPI) and degree of sleep disturbances was assessed by Insomnia Severity Index (ISI) surveys as reported by patients. The number of pain admissions and total number of days hospitalized for pain were identified by reviewing electronic medical records (EMR). Results: Data from 36 patients was analyzed. The majority of patients were female (72.2%) and ranged 9-21 years in age. Seventy-two percent of patients were under the age of 18 years and HbSS was the dominant genotype (61.1%). Fifty-two percent of patients reported some degree of insomnia with 39% that met the definition of clinical insomnia. Seventeen % of patients met the criteria for fibromyalgianess. Patients with severe clinical insomnia (ISI scores 22-28) had the highest number of admissions and number of days hospitalized in 2 years following the initial evaluation. Patients meeting criteria for fibromyalgianess were more likely to report symptoms of clinical insomnia than those without (66 vs 34%). Summary-Conclusion: Sleep problems are common in youth with SCD and more than third of our study population had ISI scores suggestive of moderate or severe clinical insomnia. Patients with insomnia were more likely to have higher pain burden and CPI scores suggestive of fibromyalgianess suggesting likely association between sleep abnormalities and pain experience among youth with SCD. This association and impacts of interventions to improve sleep should further be investigated in SCD. - Characteristics of patients seen in integrative clinic at baseline visit and part of Natural History Study (N=36) Characteristics N(%) Gender Male 10 (27.8%) Female 26 (72.2%) Age in Years (9-21) < 18 26 (72.2%) ≥ 18 10 (27.8%) Genotype SS 22 (61.1%) SC 11 (30.6%) Sβ0 3 (8.3%) Insomnia Severity Index (ISI)4 0-7 No clinically significant insomnia 17 (47.2%) 8-14 Subthreshold insomnia 5 (13.9%) 15-21 Clinical insomnia (moderate) 10 (27.8%) 22-28 Clinical insomnia (severe) 4 (11.1%) Centralized Pain Index (CPI)1 0-12 W/O Fibromyalgianess 30 (83.3%) 13+ W/ Fibromyalgianess 6 (16.7%)

SLEEP DISTURBANCES AMONG UNIVERSITY STUDENTS : A TUNISIAN STUDY

IntroductionPoor sleep quality is a major health problem worldwide. University students tend to suffer from problems of sleep regularity, quantity and quality, which can affect their academic performance, and have a serious impact on their psychological and physical well-being.ObjectivesThe aim of this study was to assess the prevalence of insomnia among Tunisian university students, and to identify its associated factors.MethodsWe conducted a cross-sectional web-based study among university students from several Tunisian faculties. Data were collected using a questionnaire spread throughout social media (Facebook), using the Google Forms® platform, during September and October 2022.We used the “Insomnia Severity Index” (ISI) to assess the severity of insomnia.ResultsA total of 144 students completed the questionnaire. Their mean age was 23.38±3.27 years, with a sex-ration (F/M) of 2.8. Among them, 70.1% were single and 68.8% lived with family. Among our participants, 10.4% were followed for chronic somatic disease, 11.1% for chronic mental disease, while 29.2% have already been diagnosed and treated for sleep disturbances.ISI showed that 72.2% of students suffered from insomnia: 45.1% Subthreshold insomnia, 19.4% moderate clinical insomnia and 7.6% severe clinical insomnia. Insomnia was significantly more frequent among psychoactive substances users (75.7% vs 57.6%; p=0.043). ISI scores were significantly higher among cannabis users (17.4 vs 11.06; p=0.025).ConclusionsOur study highlighted that insomnia is prevalent within the university student population, and psychoactive substances consumption seems to worsen it. Thus, when designing interventions to improve sleep quality among students, the main determinants need to be taken into consideration.Disclosure of InterestNone Declared

POOR SLEEP COMMON AMONG HOSPICE FAMILY CAREGIVERS AND ASSOCIATED WITH WORSE CAREGIVER HEALTH

Abstract Over 1.2 million hospice family caregivers in the United States are at risk for interrupted, insufficient sleep due to overnight caregiving responsibilities, anxiety or intrusive thoughts, and inadequate caregiving support. Insomnia contributes to health inequities yet is underrecognized and undertreated. The prevalence of insomnia among hospice family caregivers is not well understood. The purpose of this preliminary study was to describe insomnia prevalence among hospice family caregivers and identify factors that differentiate caregivers with sleep difficulties from caregivers without sleep difficulties. This observational study included 57 hospice family caregivers of cancer patients enrolled in a randomized clinical trial for caregivers [NCT02929108]. Results showed 49.1% of hospice family caregivers had subthreshold insomnia to severe clinical insomnia, as measured by the Insomnia Severity Index. Although social determinant of health variables did not differ based on caregiver insomnia status, caregivers with insomnia (5.0, median) self-rated their physical health significantly lower than caregivers without insomnia (8.0, median) (P&amp;lt; 0.001). Directionally, the distance a caregiver lived from a care-recipient also differed by insomnia status, with 70% of caregivers with insomnia co-residing compared to 46% of caregivers without insomnia. Overall, 78.9% of hospice family caregivers had no caregiving support; anxiety and depression were highly prevalent. Clinicians should screen hospice family caregivers for sleep disorders and seek to improve caregiver health by offering sleep interventions tailored to the specific needs of hospice family caregivers and connecting caregivers to health resources for their own wellbeing. Policy makers must expand hospice benefits to include additional caregiver support.

0178 Examining Rates and Change in Insomnia Severity among Veterans Enrolled in an Outpatient Exercise Program

Abstract Introduction Exercise moderately improves middle insomnia and sleep quality in older adults. GeroFit is a national structured exercise program for Veterans over age 60 that offers 14 virtual classes per month. Each 60-minute class has a combination of cardiovascular, resistance, flexibility, and balance training and is modified to accommodate the range of functional abilities. The purpose of this analysis was to characterize insomnia symptoms (using the Insomnia Severity Index [ISI]) among GeroFit participants across different time points and examine the impact of attendance on change in insomnia symptoms over time. Methods Veterans in the VA Boston GeroFit program (n=69; 60-93years; Meanage=74.3±8.3; 80.6%male; 80.6%White) were administered the ISI at baseline (n=32), 3-months (n=38), 6-months (n=23), and 12-months (n=21) after enrollment. Participants were categorized by ISI scores: no clinically significant insomnia (ISI=0-7), subthreshold insomnia (ISI=8-14), moderate clinical insomnia (ISI=15-21), and severe clinical insomnia (ISI=22-28). A repeated measures ANOVA was performed to assess for ISI score change over time by attendance rate. Results Veterans attended 64% of the 14 classes per month and exhibited a range of functional ability (Physical Function Subscale [SF-36] scores ranged from 11-29 at baseline). The rates of subthreshold and moderate insomnia were: baseline (15.6%;6.3%), 3-months (26.3%;13.2%), 6-months (30.4%;8.7%), and 12-months (38.1%;9.5%), respectively. Overall, ISI scores remained consistent over time as there were no significant score changes over the first 6 months (p=.121); however, participants with &amp;lt;50% attendance demonstrated a significant increase in ISI scores from baseline to 3months (p=.002). Conclusion Of Veterans participating in the VA Boston GeroFit program, about 1 in 10 reported moderate insomnia and 1 in 4 had subthreshold insomnia. Increasing attendance rates is important for improving sleep quality and more research is needed to clarify the “dose” of exercise required to reap meaningful gains in insomnia symptoms, particularly among Veterans with more severe symptoms. Given that 1/3 of participants reported at least subthreshold insomnia, future studies are needed to better understand whether supplemental interventions (e.g., sleep psychoeducation, stimulus control) might be offered to GeroFit participants with clinically significant insomnia symptoms, to dually target sleep and physical functioning. Support (If Any)

Sleep Quality, Insomnia, Anxiety, Fatigue, Stress, Memory and Active Coping during the COVID-19 Pandemic.

Background: The current study aimed to evaluate the impact of the coronavirus (COVID-19) pandemic on sleep quality, insomnia, anxiety, stress, fatigue and active coping in the United States. Methods: This was a cross-sectional study using a publicly available database taken from the Boston College COVID-19 Sleep and Well-Being Dataset. We have selected the most recent data that included information about sleep quality and other measures, including insomnia, anxiety, stress, fatigue and coping, collected between 22 February–8 March 2021. Results: A total of 476 subjects were included in the analysis. The mean (SD) age of the study population was 38.8 (17.8) years, and there were more females (85%) than males. The population had a mean (SD) score of the Pittsburgh Sleep Quality Index (PSQI) of 6 (3.2), with 65% having the prevalence of poor sleep quality (defined as PSQ ≥ 5; n = 311). The mean (SD) score for Insomnia Severity Index (ISI) was 6.9 (5.2), with 55 subjects (11.5%) having clinical insomnia (defined as ISI ≥ 15); of whom 9% had severe clinical insomnia. There were positive correlations between PSQI and ISI (r = 0.76, p < 0.001), PROMIS fatigue scale (r = 0.53, p < 0.001), Generalized Anxiety Disorder-7 (GAD-7) (r = 0.46, p < 0.001), and Perceived Stress Scale (PSS) (r = 0.44, p < 0.001). The PSQI was inversely correlated with the John Henryism Active Coping Scale (JHACS) and memory scale. In the multivariate regression model, JHACS, ISI, fatigue, PSS and GAD-7 were significant predictors of PSQI, and these variables accounted for 62% of the variance of PSQI, adjusted for age and gender. Conclusion: An important contribution to the literature is made by this research, which demonstrates the significant prevalence of poor sleep quality and its association with insomnia and other mental and physical well-being. It also underlines the need to prioritise policy and public health efforts to address sleep issues that have substantial health and economic effects for both individuals and the population at large.

RETRACTED ARTICLE: Factors associated with insomnia among frontline nurses during COVID-19: a cross-sectional survey study

BackgroundResearch predominantly suggests that nurses are at high risk of developing psychopathology. The empirical data show that the occurrence rate of problem-related sleep quality among clinical nurses is high. Therefore, this study was conducted to address the lack of information on the relationship between the coronavirus disease 2019 (COVID-19) pandemic and insomnia.MethodsA convenience sample of nurses (n = 680) completed an online survey that included the Insomnia severity index, the COVID-19-related psychological distress scale, the general health questionnaire, neuroticism, dysfunctional beliefs, attitudes about sleep scale, and difficulties in emotion regulation scale.ResultsThe results showed that 35.8% (n = 253) of nurses were classified as individuals with moderate to severe clinical insomnia. The results showed that the psychological distress generated by COVID-19 predicted insomnia (β = .47, SE = 0.02, P < .001, t = 13.27, 95% CI 0.31–0.46). Additionally, the association is mediated by psychopathology vulnerabilities, emotion dysregulation, dysfunctional beliefs about sleep, and neuroticism. Moreover, female nurses exhibited higher levels of insomnia (Cohen’s d = .37), neuroticism (Cohen’s d = 30), psychopathology vulnerability (Cohen’s d = .26), and COVID-19-related psychological distress (Cohen’s d = .23).ConclusionThe present study’s findings help to explain how pandemic consequences can be associated with insomnia. Additionally, the findings make a significant contribution to better understanding the role of neuroticism, emotion dysregulation, beliefs, and psychopathology vulnerability in the development of insomnia among nurses. The findings suggest the potential influence of cognitive behavioral therapy for insomnia (CBT-I) and transdiagnostic integrated therapies that could be incorporated into therapeutic programs designed to develop as a way of inhibiting or preventing insomnia among clinical nurses.

INSOMNIA SEVERITY OF ACADEMICIANS WORKING IN HEALTH SCIENCES IN CORONAVİRUS PANDEMIC

Aim: The aim of this study is to determine the severity of insomnia of academicians working in the field of health sciences in the COVID-19 pandemic.&#x0D; Method: This research in descriptive design was conducted between 20 March - 31 May 2020 with 114 academic staff working in the field of Health Sciences of a university in the Black Sea Region. "Questionnaire form" and "Insomnia Severity Index (ISI)" were used to collect the data. Number, percentage distribution, mean, standard deviation, one way anova and unpaired t test were used to evaluate the data.&#x0D; Results: In the study, the average score of ISI of academicians was 10.40±5.50, female had 11.24±5.44, male had 9.77±5.50, research assistants had 13.46±3.92 and those with any ailments had an average score of 10.72±6.01. No statistically significant differences were found between gender, academic title, and having any ailment and ISI (p&gt;0.05). When evaluated according to the breakpoints of the scale, it was found that 44.7% of the academicians had the lower threshold of insomnia, 22.8% had moderate clinical insomnia, and 0.9% had severe clinical insomnia.&#x0D; Conclusion and Suggestions: In the study, it was found that female academicians, research assistants and academicians with any ailments were exposed to insomnia at a higher rate. In addition, it was determined that almost half of the academicians were at the lower threshold of insomnia.

Insomnia in Post-Hematopoietic Stem-Cell Transplant Patients in Jordan: Prevalence and Associated Factors

Background and Objective Insomnia is a common symptom that is experienced by the patients post hematopoietic stem cell transplant that interfere with recovery outcomes and patients’ quality of life. Little is known about insomnia among post hematopoietic stem cell transplant in Jordan and in other Arab countries. The purpose of the current study was to identify the levels of insomnia and the related factors in post hematopoietic stem cell transplant.Methods A descriptive cross-sectional correlational design was used to guide this study. Data was collected from 163 patients by the Arabic version of the Insomnia Severity Index (ISI).Results The participant’s average ISI was 14.06 ± 7.71 indicating sub-threshold insomnia. Regarding the insomnia levels, 23.9% of the participants reported no insomnia, 27.6% had subthreshold insomnia, 31.3% had moderate clinical insomnia, and 17.2% had severe clinical insomnia. A significant difference in insomnia levels in some related factors was reported including the higher educated patients (t = 2.40, p = 0.018), patients who received allogeneic transplants (t = -2.932, p = 0.004), and patients within a 30 days’ post-transplant (F (160, 2) = 61.03, p &lt; 0.001).Conclusions In conclusion, the overall prevalence of insomnia among post HSCT patients was 48.5% (n = 79) that suggested clinical insomnia, and it was affected by several clinical variables. Further studies are needed to provide appropriate interventions to decrease insomnia levels among patients.

Prevalence of sleep disturbance and the association between poor disease control in people with ankylosing spondylitis within the Australian clinical setting (ASLEEP study): a real-world observational study using the OPAL dataset

IntroductionSleep disturbance and fatigue are commonly reported in ankylosing spondylitis (AS) but specific prevalence and the relationship to disease control are unknown.MethodThis retrospective non-interventional observational study of data from the OPAL dataset included patients with AS (ICD code M45, M45.0 or M08.1), aged 18 to 95 years and had completed ≥ 1 sleep questionnaire between 1 January 2019 and 30 September 2020. The prevalence of insomnia and obstructive sleep apnoea were assessed using the Insomnia Severity Index (ISI) and Multivariate Apnoea Prediction Index (MAPI), respectively. Propensity score (PS) matching based on sex, age and symptom duration increased comparability between patients administered tumour necrosis factor inhibitors (TNFi) and interleukin 17A inhibitors (IL-17Ai).ResultsFour hundred ninety-five patients were included. The mean ISI total score in the overall population was 8.6 ± 6.2. Self-reported moderate or severe clinical insomnia was present in 16% and 3.2% of patients, respectively. The mean MAPI score was 0.4 ± 0.3, self-reported apnoea was identified in 31.5% of patients and the mean FACIT-Fatigue score was 36.1 ± 10.7. In the PS matched population, the only treatment-related difference was the mean MAPI score (IL-17Ai 0.4 ± 0.3 and TNFi 0.3 ± 0.2, p = 0.046). Those with poor disease control (BASDAI ≥ 4) were more likely (odds ratio [OR] 7.29, 95% CI 2.37 to 22.46, p = 0.001) to have a greater severity of insomnia symptoms than those with good disease control.ConclusionIn this real-world AS cohort, poor disease control was associated with sleep disturbance. Little difference in sleep disturbance was observed between biologic TNFi and IL-17Ai treatment.Key Points• Sleep disturbance and fatigue are common in patients with ankylosing spondylitis.• In our real-world cohort, self-reported apnoea was reported in one-third of patients; and one in five patients reported moderate to severe insomnia.• Those with poor disease control were more likely to experience greater sleep disturbance than those with good disease control.