Shorter Total Sleep Time Research Articles

Daily stress and sleep associations vary by work schedule: A between- and within-person analysis in nurses.

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work is common among nurses and may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by recent shift worker status and daily work schedule among nurses. Participants were 392 nurses (92% female; 78% White, mean age=39.54, SD=11.15) who completed 14days of electronic sleep diaries and actigraphy. They simultaneously completed assessments of daily stress and work schedule upon awakening (day shift vs. night shift [work between 9p.m.-6a.m.] vs. off work). Participants were classified as recent night shift workers if they worked at least one night shift during the past 14days (n=101; 26%). In the entire sample, greater daily stress predicted shorter self-reported total sleep time and lower self-reported sleep efficiency that night. Shorter self-reported and actigraphy total sleep time and lower self-reported sleep efficiency predicted higher next-day stress. Compared with recent night shift workers, day workers reported higher stress after nights with shorter total sleep time. Stress-sleep associations mostly did not vary by nurses' daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime targets for tailored interventions among nurses. Night shift workers may be less susceptible to the effects of short sleep on next-day stress. Research is needed to understand the short- and long-term effects of shift work and address the unique sleep challenges nurses face.

P086 The organization of sleep-wake patterns around daily schedules in college students

Abstract A potential contributor to insufficient sleep among college students is their daily schedule, with sleep sacrificed for other waking activities. We investigated how daily schedules predict day-to-day sleep-wake timing in college students. 223 undergraduate college students (M±SD = 19.2±1.4 years, 37% females) attending a Massachusetts university in the US between 2013–2016 were monitored for approximately 30 days during semester. Sleep-wake timing was measured using daily online sleep diaries and wrist-actigraphy. Daily schedules were measured using daily online diaries that included self-reported timing and duration of academic, exercise-based, and extracurricular activities, and duration of self-study. Linear mixed models were used to examine the association between sleep-wake patterns and daily schedules at both the between-person and within-person levels. An earlier start time of the first-reported activity predicted earlier sleep onset (between and within: p<.001) and shorter total sleep time (within: p<.001) for the previous night, as well as earlier wake onset on the corresponding day (between and within: p<.001). A later end time of the last-reported activity predicted later sleep onset (within: p=.002) and shorter total sleep time (within: p=.02) on that night. A more intense daily schedule (i.e., greater total duration of reported activities) predicted an earlier wake onset time (between: p=.003, within: p<.001), a later sleep onset time (within: p<.001), a shortened total night-time sleep duration (between: p=.03, within: p<.001), and greater sleep efficiency (within: p<.001). These results indicate that college students may organize their sleep and wake times based on their daily schedule.

Prevalence and correlates of total sleep time among the older adults during COVID-19 pandemic in Bangladesh

PurposeThe present study was aimed to identify inappropriate sleep duration and its correlates among the Bangladeshi older adults during the COVID-19 pandemic. Material and methodsThis cross-sectional study was carried out among 1030 older adults aged 60 years and above in Bangladesh. Information was collected through telephone interviews using a pretested semi-structures questionnaire installed in SurveyCTO mobile app. Sleep duration was defined as total sleep time (TST) in last 24 h including day and nighttime sleep. TST was further categorized into shorter (<7 h), recommended (7–8 h), and longer sleep (>8 h) according to 2015 National Sleep Foundation guideline. The multinomial logistic regression model identified the factors associated with sleep duration. ResultsMean TST was 7.9 h (SD=1.62). Of the total participants, 28.2% had longer and 17.8% shorter sleep duration. In the regression model, participants’ age of ≥80 years (OR: 3.36, 1.46–7.73), monthly family income of <5,000 Bangladeshi Taka (OR: 3.50, 1.79–6.82), difficulty in getting medicine during COVID-19 (OR: 1.72, 1.05–2.82), lack of communication during the pandemic (OR: 2.20, 1.43–3.40) and receiving COVID-19 related information from friends/family/neighbours (OR: 1.83, 1.11–3.01) were significantly associated with shorter TST. On the other hand, monthly family income of < 5,000 Bangladeshi Taka (OR: 2.00, 1.13–3.53), difficulty in getting medicine during COVID-19 pandemic (OR: 2.01, 1.33–3.03) and receiving COVID-19 related information from radio/TV (OR: 2.09, 1.22–3.59) were associated with longer TST. ConclusionsThe study findings suggest implementing sleep management program for older adults in Bangladesh, particularly during emergencies like COVID-19.

Blunted heart rate recovery to spontaneous nocturnal arousals in short-sleeping adults.

Chronic insufficient sleep is a common occurrence around the world and results in numerous physiological detriments and consequences, including cardiovascular complications. The purpose of the present study was to assess the relationship between habitual total sleep time (TST) measured objectively via at-home actigraphy and heart rate (HR) reactivity to nocturnal cortical arousals. We hypothesized that short habitual TST would be associated with exaggerated cardiac reactivity to nocturnal cortical arousals. Participants included 35 healthy individuals [20 men, 15 women, age: 24 ± 1 yr, body mass index (BMI): 27 ± 1 kg/m2], and were split using a median analysis into short-sleeping (SS; n = 17) and normal-sleeping (NS; n = 18) adults based on a minimum of 7 days of at-home actigraphy testing. All participants underwent a full overnight laboratory polysomnography (PSG) testing session, including continuous HR (electrocardiogram, ECG) sampling. HR reactivities to all spontaneous cortical arousals were assessed for 30 cardiac cycles following the onset of the arousal in all participants. Baseline HR was not significantly different between groups (P > 0.05). Spontaneous nocturnal arousal elicited an augmented HR response in the SS group, specifically during the recovery period [F(5.261,163.08) = 3.058, P = 0.01, ηp2 = 0.09]. There were no significant differences in HR reactivity between sexes [F(3.818,118.368) = 1.191, P = 0.318]. These findings offer evidence of nocturnal cardiovascular dysregulation in habitual short sleepers, independent from any diagnosed sleep disorders.NEW & NOTEWORTHY Short habitual sleep is associated with poor cardiovascular outcomes, but mechanisms remain equivocal. The present study used objectively measured habitual sleep via wrist actigraphy, and reports that habitual short sleepers have augmented heart rate recovery responses to spontaneous arousals as determined by gold-standard polysomnography. There were no reported sex differences. The augmented heart rate recovery to spontaneous cortical arousals may be an important mechanism contributing to the associations between insufficient sleep and cardiovascular risk.

Behavioral, neurocognitive, polysomnographic and cardiometabolic profiles associated with obstructive sleep apnea in adolescents with ADHD.

A high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obstructive sleep apnea (OSA) as well as similar impairments across neurobehavioral outcomes has been described in children. However, there is a paucity of research examining the comorbidity of these two disorders in adolescents. This study examined the association of OSA with sleep, neurobehavioral, and cardiometabolic outcomes in adolescents with ADHD from the general population. 421 adolescents (16.9 ± 2.3 years, 53.9% male) underwent 9-hr polysomnography, neurobehavioral, and physical evaluation. ADHD was ascertained by a parent-or-self-report of a lifetime diagnosis/treatment of ADHD. OSA was defined as an apnea hypopnea index of ≥2 events/hour. Groups of controls (n = 208), OSA-alone (n = 115), ADHD-alone (n = 54), and ADHD+OSA (n = 44) were studied. Multivariable-adjusted general linear models tested group differences in PSG parameters, neurobehavioral, and cardiometabolic outcomes after controlling for sex, race/ethnicity, age, and/or body mass index percentile. The ADHD+OSA group had significantly longer sleep onset latency, shorter total sleep time, lower sleep efficiency, and higher percent of stage 1 sleep, as compared with all other groups, however, these differences were diminished by excluding adolescents on psychoactive medication. The ADHD-alone group showed significantly higher periodic limb movements than controls. The ADHD+OSA and ADHD-alone groups did not significantly differ on any measure of neurocognitive or behavioral functioning. The ADHD+OSA and OSA-alone groups showed significantly worse cardiometabolic and inflammatory biomarkers when compared to controls or the ADHD-alone, but did not significantly differ between each other. Adolescents with a diagnosis ADHD+OSA showed phenotypic risk factors for OSA (i.e., overweight/obesity, visceral adiposity, metabolic syndrome, and inflammation) but not worse neurobehavioral outcomes when compared with ADHD-alone. While comorbidity is possible, these data support that adolescents with a suspicion of ADHD should be screened for OSA, before a diagnosis is reached and psychoactive medication initiated.

Premenstrual Syndrome as a Sleep Disturbing Factor: A Cross-Sectional Study

Objective: To evaluate the lifestyle factors possibly related with premenstrual syndrome which were body mass index, coffee intake, smoking, regular physical exercise, and alcohol consumption, and investigate the impact of these lifestyle factors and premenstrual syndrome on sleep quality.&#x0D; Methods and Methods: This cross-sectional study included 265 participants, and all applied Pittsburgh Sleep Quality Index and Premenstrual Syndrome Scale questionnaires.&#x0D; Results: The prevalence of premenstrual syndrome among the participants was 57% (n:150). Participants with premenstrual syndrome had shorter total sleep time (p:0.001). Also, they needed longer time to fall asleep (p:0.001). The Pittsburgh Sleep Quality Index scores of the participants with premenstrual syndrome were higher than those without premenstrual syndorme (p&lt;0.001), indicating poor sleep quality. It was observed that the participants with premenstrual syndrome had more coffee intake (p:0.040) and more regular physical activity (p:0.009), which were risk factors of premenstrual syndrome. premenstrual syndrome positivity was associated with increased poor sleep quality in both univariate and multivariate analyses (OR:5.93 95% CI: 3.46-10.15, p&lt;0.001; OR:5.61 95% CI: 3.19-9.88, p&lt;0.001, respectively). The remaining variables, which were risk factors of premenstrual syndrome, didn’t have any statistically significant association with sleep quality.&#x0D; Conclusion: The important relation between premenstrual syndrome and sleep quality is highlighted. Relief of premenstrual syndrome complaints may lead to better sleep quality and enhancement of quality of life for a woman.

Gender differences in BaYaka forager sleep-wake patterns in forest and village contexts

Sleep studies in small-scale subsistence societies have broadened our understanding of cross-cultural sleep patterns, revealing the flexibility of human sleep. We examined sleep biology among BaYaka foragers from the Republic of Congo who move between environmentally similar but socio-ecologically distinct locations to access seasonal resources. We analyzed the sleep–wake patterns of 51 individuals as they resided in a village location (n = 39) and a forest camp (n = 23) (362 nights total). Overall, BaYaka exhibited high sleep fragmentation (50.5) and short total sleep time (5.94 h), suggestive of segmented sleep patterns. Sleep duration did not differ between locations, although poorer sleep quality was exhibited in the village. Linear mixed effect models demonstrated that women’s sleep differed significantly from men’s in the forest, with longer total sleep time (β ± SE = − 0.22 ± 0.09, confidence interval (CI) = [− 0.4, − 0.03]), and higher sleep quality (efficiency; β ± SE = − 0.24 ± 0.09, CI = [− 0.42, − 0.05]). These findings may be due to gender-specific social and economic activities. Circadian rhythms were consistent between locations, with women exhibiting stronger circadian stability. We highlight the importance of considering intra-cultural variation in sleep–wake patterns when taking sleep research into the field.

Sleep pattern gender differences and fragmentation in postpartum parents of twins.

ObjectiveParents of newborn twins are at risk for both shortened sleep duration and sleep discontinuity. The purpose of this study was to characterize weekday and weekend sleep duration, sleep continuity, and awakenings in both mothers and fathers of newborn twins during the first 3 months at home.Material and MethodsSleep-wake parameters were assessed at two time points using self-report diaries and actigraphy in 75 families with newborn twins. To assess sleep on weekdays and weekends with minimal subject burden, actigraphy recordings of both parents commenced at 9:00 p.m. Saturday and terminated at 9:00 p.m. Tuesday.ResultsMean sleep duration over 24 hours for parents of twins ranged between 6.7 and 7.5 hours during the first 3 months postpartum and did not significantly differ on weekdays or weekends for mothers. Weekend sleep was more fragmented for fathers at both one month and three months with more awakenings, compared to weekday sleep. Mothers had more fragmented night sleep compared to fathers at one month. In contrast, at three months postpartum fathers had shorter total sleep time and night sleep time, but fewer night awakenings on weekdays than mothers. No differences were observed in weekend sleep duration or sleep patterns between mothers and fathers at three months.DiscussionConsolidated sleep periods for both parents averages three hours or less during the first three months postpartum and sleep for both parents is fragmented. In families with newborn twins, the extent of sleep disruption for mothers and fathers is similar.

Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference.

This study sought to examine the relationship between internet use, sleep, and internalizing disorder symptoms in adolescents with an evening circadian preference. One hundred seventy-two adolescents aged 10-18 years with an evening circadian preference completed a week of sleep diaries and questionnaires about internet use and internalizing disorder symptoms. Adolescents reported internet use for 3.81 hours on weekdays and 5.44 hours on weekends, with > 90% having access to both a computer with internet and a personal cell phone. A majority of adolescents used the internet from 4-8 pm (71%) and from 9-11 pm (62%). Common online activities included listening to music (77%), watching videos (64%), communicating with others (64%), and doing homework (58%). Late-night internet use (9-11 pm) was associated with more internalizing disorder symptoms. Middle-of-the-night internet use (midnight-5 am) was associated with a later bedtime, shorter total sleep time, and more internalizing disorder symptoms. Adolescents used the internet to fulfill social needs, to avoid or combat boredom, or for maladaptive activities. Using the internet for social interaction or avoidance/boredom was associated with higher internalizing disorder symptoms. Using the internet for maladaptive reasons was associated with more late-night and middle-of-the-night use. Adolescent internet use late at night and in the middle of the night is common. Internet use may be motivated by desires for social connection, by boredom/avoidance, or for maladaptive behaviors. Because middle-of-the-night internet use was associated with higher internalizing disorder symptoms and worse sleep, it presents as a potential target for intervention. Asarnow LD, Gasperetti CE, Gumport NB, Harvey AG. Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference. J Clin Sleep Med. 2021;17(10):2019-2027.

Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes.

The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7-14 days in young adults with type 1 diabetes. In addition, person-level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined. In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring over 6-14 days. At baseline, participants completed the Psychomotor Vigilance Test, the Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries. Forty-six participants (mean age, 22.3 ± 3.2 years) wore a wrist actigraph and underwent continuous glucose monitoring concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences; r = .33, P = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences; r = .50, P = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for type 1 diabetes duration (P > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, P = .010, pr2 = 0.40) after controlling for type 1 diabetes duration and accounting for higher daytime sleepiness. Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with type 1 diabetes. Sleep habits in this population may explain higher glucose variability, and optimizing sleep may improve overall diabetes management. Griggs S, Hickman RL Jr, Strohl KP, Redeker NS, Crawford SL, Grey M. Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes. J Clin Sleep Med. 2021;17(9):1865-1874.

188 Racial Disparities in Sleep During the COVID-19 Pandemic

IntroductionThe purpose of the present study was to estimate average sleep duration and sleep disturbance in the United States during the COVID-19 pandemic. In addition, we investigated whether sleep varied as a function of sociodemographic variables, in particular race. Long standing disparities in condition and available resources between racial demographics often lead to disparities in health. At the advent of a pandemic, which strains these systems further, it is important to assess whether or not racial disparities persist. This is important given that racial groups are likely affected by the pandemic, both directly and indirectly, in various ways. Here, we plan to at least assess whether there are any disparities with regard to sleep.Methods4,048 adults (Mage = 45.8 years; 79% women) completed an online survey during April – June 2020. The final sample’s self-reported race/ethnicity consisted of 84% White, 5.1% Black, 3.4% LatinX, 4.2% Asian or Asian American, and 2.9% Multi-racial. Sleep disturbance was assessed using a retrospective sleep diary and the Insomnia Severity Index (ISI).ResultsAverage sleep duration in the sample was 7.1 hours. Participants reported taking on average 32 minutes (SD = 38 mins) to fall asleep and reported waking up for 32 minutes (SD = 53 mins) during the night. Approximately 17% of the sample endorsed clinically elevated insomnia symptoms (based on the ISI ≥ 15 cut-off). With regard to racial differences, shorter total sleep time (TST), longer sleep latencies (SL), and greater total ISI scores were observed in Black (mean TST = 6.4 hours; SL = 37.7 minutes; ISI Total = 9.8) and LatinX (mean TST = 6.9 hours; SL = 37.1 minutes; ISI Total = 9.6) participants relative to White participants (Mean TST = 7.1 hours; SL = 30.9 minutes; ISI Total = 8.4). All p’s < 0.05.ConclusionSociodemographic variables, particularly race, should be considered when estimating the relative impact of sleep on overall health. These findings are significant as they may have implications for a number of health disparities observed in the United States, especially during the COVID-19 pandemic.Support (if any)Vargas: K23HL141581

065 Sleep and Gray Matter Volume: The Role of Physiological Arousal

Abstract Introduction Insomnia is associated with increased arousal. Brain regions involved in chronic insomnia are diffuse and the potential interactive role of physiological arousal in the association between insomnia symptoms and neural regions is unknown. This study examined whether physiological arousal (heart rate variability, HRV) moderated the association between sleep and gray matter (GM) volume of frontal [dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC)] and temporal [right/left (R/L) hippocampus] regions in adults with comorbid chronic widespread pain and insomnia (CWPI). Methods Forty-seven adults with CWPI (Mage=46.00, SD=13.88, 89% women) completed two weeks of diaries measuring sleep onset latency (SOL), wake time after sleep onset (WASO) and total sleep time (TST). Resting HRV was assessed via Holter monitoring (5 minutes). Root mean squared standard deviation of successive normal-to-normal heartbeats (RMSDNN) was computed. T1-weighted magnetic resonance images were obtained, segmented and co-registered to MNI space. GM volumes (DLPFC, ACC, R/L hippocampus) were estimated (FSL). Multiple regressions examined whether SOL, WASO or TST were independently associated with or interacted with RMSDNN in their associations with GM volumes, controlling for age. Results SOL interacted with RMSDNN in its association with ACC (B=-4.60, SE=2.06, p=.03, R-squared=.06). Longer SOL was associated with lower ACC volume at highest RMSDNN (lowest arousal; B=-103.54, SE=42.82, p=.02), not average/lowest RMSDNN (highest arousal, ps&amp;gt;.05). TST interacted with RMSDNN in its association with R hippocampus (B=-.22, SE=.10, p=.04, R-squared=.07). Shorter TST was associated with lower R hippocampal volume at lowest RMSDNN (highest arousal; B=7.39, SE=2.29, p=.002) and average RMSDNN (B=4.18, SE=1.50, p=.008), not highest RMSDNN (lowest arousal; p=.64). There was a trending association between WASO and R hippocampus volume (B=-13.67, SE=7.28, p=.07). Conclusion In patients with CWPI and highest physiological arousal, achieving longer TST may be important in terms of associations with right hippocampus volume. Improving (reducing) SOL may only impact ACC volume in those with lower physiological arousal. Trends of association between longer WASO and reduced right hippocampus volume warrant follow-up in larger samples. Findings highlight the interactive role of physiological arousal (HRV) in the neural mechanisms associated with sleep in CWPI. Support (if any) National Institute of Nursing Research (NR017168; Clinical trial: NCT02001077; PI: McCrae).

The intra-day link between sleep disturbance and pain severity among individuals with temporomandibular joint disorder: Pain expectancy as a potential mechanism

Most individuals with temporomandibular joint disorder (TMD) report experiencing sleep disturbance, which can maintain and exacerbate pain severity. However, the factors underlying the sleep-pain link, especially at the within-person level, have not been fully elucidated. Previous studies suggest that sleep disruption can induce biased attentional and interpretative processes, which can potentially elevate pain expectancy—a potent psychological factor that shapes pain experience. We examined whether morning pain expectancy serves as a mediator in the association between previous night sleep disturbance and pain severity the following evening. The sample included 170 women (mean age=36.3 [SD=11.4]) with co-morbid TMD and insomnia. Sleep was assessed for 14 days using actigraphy. Sleep parameters, including total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL), were extracted from the data. Subjective reports of previous night sleep and current pain expectancy were measured upon participant's waking, and subsequent pain-related reports were collected at end-of-day during the same 14-day period. Multilevel structural equation modeling was employed to analyze the nested data. The Rmediation software was used to test the significance of the mediated effects. Shorter previous night TST predicted higher pain expectancy (B=-.001, p=.021), such that shorter TST was associated with higher pain expectancy. TST (B=-.002, p=.007) and WASO (B=.002, p=.047) significantly predicted morning pain. Morning pain expectancy (B=.140, p

Effect of Dexmedetomidine on Postoperative Sleep Quality: A Systematic Review.

In this article, we conduct a systematic review of the literature to explore the specific role of dexmedetomidine (DEX) on postoperative sleep and its associated mechanisms at present. The electronic database Embase, MEDLINE/PubMed, the Cochrane Library, Web of Science, and Google Scholar were searched. The restriction terms included “dexmedetomidine”, “sleep” and “surgery”. The inclusion criteria were as following: 1) patients 18 years old or older; 2) DEX used in the perioperative period not just for critically ill patients in the intensive care unit (ICU); 3) prospective or retrospective studies. The review articles, conference abstracts, and animal studies were excluded. Out of the 22 articles which met the above criteria, 20 of them were randomized controlled studies and 2 of them were retrospective cohort studies. Infusion of DEX including during the surgery and after surgery at a low or high dose was shown to improve subjective and objective sleep quality, although 2 studies showed there is no evidence that the use of DEX improves sleep quality and 1 showed less sleep efficiency and shorter total sleep time in the DEX group. Other postoperative outcomes evaluated postoperative nausea and vomiting, pain, postoperative delirium bradycardia and hypotension. Outcomes of our systematic review showed that DEX has advantages in improving patients’ postoperative sleep quality. Combined with the use of general anesthetic, DEX provides a reliable choice for procedural sedation.

Association Between Short Sleep Duration and Increased Cardiovascular Reactivity to Nocturnal Arousal

Reduced habitual total sleep time (TST) is associated with an increased prevalence of hypertension, coronary heart disease, and other cardiovascular complications. Nocturnal arousal intensity, assessed by overnight polysomnography (PSG), and its subsequent impact on nocturnal heart rate (HR) reactivity have been implicated as a potential link between arousal strength and heightened cardiovascular strain. Despite evidence of a positive relationship between nocturnal arousal intensity and heart rate reactivity, little research has established if habitual sleep parameters are associated with these associations. The purpose of the present study was to examine the relationship between objectively measured TST and HR responsiveness to nocturnal arousal in stage 2 (N2) and stage 3 (N3) sleep. We hypothesized that short objective TST would be associated with an augmented HR reactivity to arousals in both N2 and N3 sleep. Habitual TST was measured in 17 adults (10 men, 7 women; 33±4 years; 26±1 kg/m2) using actigraphy monitoring over a duration of 7-14 days (mean, 13±1 days). On a separate occasion, participants underwent a full night of PSG testing, in addition to continuous HR recording (electrocardiogram) throughout the sleep period. Arousals were scored by a certified PSG technician, and verified by a board-certified sleep physician following American Academy of Sleep Medicine guidelines. Peak HR response to arousal was determined as the highest HR measured within 20 seconds following an arousal onset, while the peak change was identified as the post-arousal peak HR minus the average HR taken from 10 cardiac cycles prior to the arousal. Bivariate correlations were utilized to compare associations between the two parameters. The number of arousals varied from 4 - 47 (mean, 19±3 arousals) during N2 sleep, and 0 – 9 (mean, 4±1 arousals) during N3 sleep. There were no associations between habitual, actigraphy-based TST and number of arousals in either sleep stage (P > 0.05). Similarly, there were no significant correlations between pre-arousal HR and TST in either N2 or N3 sleep (P > 0.05). However, our results demonstrated a significant negative correlation between TST and both peak HR reactivity (R = -0.490, P < 0.05) and absolute change in peak HR (R = -0.487, P < 0.05) following arousals during N2 sleep. Similarly, peak HR (R = -0.542, P < 0.05) and change in peak HR (R = -0.577, P < 0.05) after arousals were significantly associated with habitual TST during N3 sleep. Our results indicate a relationship between poor sleep duration and heightened cardiovascular reactivity to nocturnal arousal during both N2 and N3 sleep. These findings suggest that short sleep duration and dysregulated HR reactivity may be underlying mechanisms propagating impaired cardiovascular functioning in chronically sleep restricted individuals. Further research is necessary to fully elucidate the direction of this relationship.

IL-6, sTNF-R2, and CRP in the context of sleep, circadian preference, and health in adolescents with eveningness chronotype: Cross-sectional and longitudinal treatment effects

BackgroundInflammation-related processes have emerged as a biological pathway related to adolescent development. This study examined cross-sectional and longitudinal associations of baseline inflammatory markers with sleep, circadian preference, and health at baseline and following treatment. MethodsParticipants included 165 adolescents (58.2% female, mean age 14.7 years, 42.4% taking medication) “at-risk” in at least one domain (emotional, cognitive, behavioral, social, and physical health) who received a sleep-based intervention. Self-reported eveningness as well as total sleep time (TST) and bedtime from sleep diary were assessed at baseline and following treatment. Baseline soluble tumor necrosis factor receptor-2 (sTNF-R2) and interleukin (IL)-6 were assayed from oral mucosal transudate. Baseline C-reactive protein (CRP) was assayed from saliva. ResultsAt baseline, shorter TST was associated with more emotional risk among adolescents with higher CRP (b = −0.014, p = 0.007). Greater eveningness was related to more behavioral risk in the context of lower IL-6 (b = −0.142, p = 0.005). Following treatment, lower baseline IL-6 was associated with reduced behavioral risk (Χ2 = 8.06, p = 0.045) and lower baseline CRP was related to reduced physical health risk (Χ2 = 9.34, p = 0.025). Baseline inflammatory markers were not significantly associated with sleep, circadian, or other health domain change following treatment. ConclusionsThere was cross-sectional evidence that sleep and circadian dysfunction differentially relate to emotional and behavioral health risk for high and low levels of inflammatory markers. Longitudinal analyses indicated that lower levels of baseline inflammatory markers may be related to better treatment response to a sleep-based intervention.

Effect of Sleep Bruxism Intensity on Blood Pressure in Normotensives.

The present research aimed to investigate the influence of sleep bruxism (SB) intensity on blood pressure parameters in normotensive subjects by using an ambulatory blood pressure device. The study group included 65 normotensive individuals suspected of having SB. All participants underwent one-night video-polysomnography, and ambulatory blood pressure monitoring was performed the next day; 86.15% of them were diagnosed with SB. Statistical analysis included correlation and regression analysis. The obtained results showed that systolic blood pressure variability during sleep significantly increased in individuals with BEI > 4 (bruxism episodes index; episodes/hour) compared to those with BEI ≤ 4 (8.81 ± 3.36 versus 10.57 ± 3.39, p = 0.05). Multivariable regression analysis showed that systolic blood pressure variability at nighttime was also associated with the following independent risk factors: higher apnea-to-bruxism index, male gender, BEI > 4 episodes/hour, body mass index (BMI) ≥ 25 kg/m2, higher arousal index, and shorter total sleep time. In summary, sleep bruxism intensity was associated with increased systolic blood pressure variability during sleep. Coincidental apnea, male gender, severe sleep bruxism (SB intensity with BEI > 4/hour), excess weight and obesity, higher arousal index, and shorter sleep time seem to be the main determinants that influence blood pressure in normotensive sleep bruxers.

Sleep time and efficiency in patients undergoing laboratory-based polysomnography.

Sleep quality in patients studied with laboratory-based polysomnography may differ from sleep quality in patients studied at home but remains clinically relevant and important to describe. We assessed objective sleep quality and explored factors associated with poor sleep in patients undergoing laboratory-based polysomnography. We reviewed diagnostic polysomnography studies from a 10-year period at a single sleep center. Total sleep time (TST) and sleep efficiency (SE) were assessed as markers of sleep quality. Poor sleep was defined as TST ≤ 4 hours or SE ≤ 50%. Multivariable analysis was performed to determine associations between objective sleep quality as an outcome and multiple candidate predictors including age, sex, race, body mass index, comorbidities, severity of obstructive sleep apnea, and central nervous system medications. Among 4957 patients (age 53 ± 15 years), average TST and median SE were 5.8 hours and 79%, respectively. There were 556 (11%) and 406 (8%) patients who had poor sleep based on TST and SE, respectively. In multivariable analysis, those who were older (per 10 years: 1.48 [1.34, 1.63]), male (1.38 [1.14,1.68]), and had severe obstructive sleep apnea (1.76 [1.28, 2.43]) were more likely to have short sleep. Antidepressant use was associated with lower odds of short sleep (0.77 [0.59,1.00]). Older age (per 10 years: 1.48 [1.34, 1.62]), male sex (1.34 [1.07,1.68]), and severe obstructive sleep apnea (2.16 [1.47, 3.21]) were associated with higher odds of poor SE. We describe TST and SE from a single sleep center cohort. Multiple demographic characteristics were associated with poor objective sleep in patients during laboratory-based polysomnography. Harrison EI, Roth RH, Lobo JM, et al. Sleep time and efficiency in patients undergoing laboratory-based polysomnography. J Clin Sleep Med. 2021;17(8):1591-1598.

The longitudinal association of actigraphy-estimated sleep with grief in middle-aged and elderly persons

Most people experience grief after a loss, about 10% develop complicated grief, often accompanied by sleep complaints. Yet, the role of objectively estimated poor sleep remains unclear. Therefore, we assessed the cross-sectional and longitudinal association of actigraphy-estimated sleep with grief. We included 1,776 participants (mean age: 61.8 ± 8.9 years, 55% women) of a prospective population-based cohort. Of 1,471 participants (83%) repeated measures of grief were available (median follow-up 6 years, inter quartile range 5.6–6.3). At baseline, sleep was objectively estimated using actigraphy (mean duration 6.0 ± 0.8days). At baseline and follow-up, participants were asked about significant losses and completed the Dutch Inventory of Complicated Grief (17 items, cut-off ≥22). At baseline 1,521 (86%) participants experienced no grief, 44 (2%) acute grief (<6 months, any grief score), 158 (9%) non-complicated grief (≥6 months, grief score<22), and 53 (3%) complicated grief (≥6 months, grief score≥22). In those indicating any grief (n = 255), low sleep efficiency (B = −0.16, 95%CI = −0.30;-0.02), long sleep onset latency (B = 0.07, 95%CI = 0.01; 0.14), and long wake after sleep onset (B = 0.06, 95%CI = 0.01; 0.10) were cross-sectionally associated with more grief symptoms. Over time, those with a short total sleep time (OR = 0.59, 95%CI = 0.39; 0.91), low sleep efficiency (OR = 0.95, 95%CI = 0.91; 0.99), long sleep onset latency (OR = 1.02, 95%CI = 1.00; 1.04), and long wake after sleep onset (OR = 1.02, 95%CI = 1.00; 1.03) at baseline more often experienced complicated grief than non-complicated grief at follow-up. This study suggests that objectively estimated poor sleep is associated with grief over time. Poor sleep might not only accompany grief, but also be a risk factor for developing complicated grief after a loss.

Sleep during COVID-19 lockdown: A cross-cultural study investigating job system relevance

Our study aimed to assess the change in the sleep patterns during the Coronavirus lockdown in five regions (Austria/Germany, Ukraine, Greece, Cuba and Brazil), using online surveys, translated in each language. Part of the cohort (age 25–65, well-educated) was collected directly during lockdown, to which retrospective cross-sectional data from and after lockdown (retrospective) questionnaires were added. We investigated sleep times and sleep quality changes from before to during lockdown and found that, during lockdown, participants had (i) worse perceived sleep quality if worried by COVID-19, (ii) a shift of bedtimes to later hours during workdays, and (iii) a sleep loss on free days (resulting from more overall sleep during workdays in non-system relevant jobs), leading to (iv) a marked reduction of social jetlag across all cultures.For further analyses we directly compared system relevant and system irrelevant jobs, because it was assumed that the nature of the lockdown’s consequences is dependent upon system relevance. System relevant jobs were found to have earlier wake-up times as well as shorter total sleep times on workdays, leading to higher social jetlag for people in system relevant jobs.Cultural differences revealed a general effect that participants from Greece and Ukraine had later bedtimes (on both work and free days) and wake-up times (on workdays) than Cuba, Brazil and Austria, irrespective of COVID-19 lockdown restrictions.