Sleep Difficulties Research Articles

Loneliness and its associations with demographic, lifestyle, social and parental factors among adolescents in Timor-Leste

ABSTRACT Adolescent loneliness is prevalent and has serious adverse impacts on mental and physical health outcomes. This study aimed at examining factors associated with loneliness among school-going adolescents. The country of interest is a low-income country, Timor-Leste, where empirical studies are lacking. Data from the Global School-Based Student Health Survey Timor-Leste 2015 (n = 3455) were used for secondary analyses. An ordered probit model was utilized to assess demographic, lifestyle, social, and parental factors correlated with different levels of loneliness (no loneliness, moderate loneliness, and severe loneliness). Approximately 46.3% of adolescents felt moderately lonely and about 13.5% felt severely lonely. Older adolescents were more likely to experience severe and moderate loneliness than younger adolescents. Going hungry and being bullied were associated with an increased likelihood of being severely and moderately lonely. Adolescents had a higher probability of experiencing moderate and severe loneliness if they had sleep difficulties and were physically active. Having understanding parents was positively associated with the likelihood of severe loneliness. In conclusion, a large proportion of adolescents in Timor-Leste have feelings of loneliness, which have been found to be associated with demographic, lifestyle, social, and parental factors. Policymakers should recognize the correlated factors of loneliness in order to formulate a more effective intervention strategy.

Omega-3 fatty acids for inflamed depression – A match/mismatch study

Despite decades of research on the pathophysiology of depression, the development of new therapeutic interventions has been slow, and no biomarkers of treatment response have been clinically implemented. Several lines of evidence suggest that the clinical and biological heterogeneity among patients with major depressive disorder (MDD) has hampered progress in this field. MDD with low-grade inflammation – “inflamed depression” – is a subtype of depression that may be associated with a superior antidepressant treatment response to anti-inflammatory compounds. Omega-3 fatty acid eicosapentaenoic acid (EPA) has anti-inflammatory properties, and preliminary data suggest that it may be particularly efficacious in inflamed depression. In this study we tested the hypothesis that add-on EPA has greater antidepressant efficacy in MDD patients with high baseline high-sensitivity C-reactive protein (hs-CRP) compared to MDD patients with low hs-CRP. All subjects received 2.2 g EPA, 400 mg docosahexaenoic acid and 800 mg of other fatty acids daily for 8 weeks, added to stable ongoing antidepressant treatment. The primary outcome was change in the 17-item Hamilton Depression Rating Scale (HAMD-17). Patients and raters were blind to baseline hs-CRP status. In an intention-to-treat analysis including all subjects with at least one post baseline visit (n = 101), ahs-CRPcut-off of ≥1 mg/L, but not ≥3 mg/L, was associated with a greater improvement in HAMD-17 total score. In addition to a general antidepressant effect among patients with hs-CRP ≥ 1 mg/L, adjuvant EPA treatment improved symptoms putatively related to inflamed depression such as fatigue and sleep difficulties. This adds to the mounting evidence that delineation of MDD subgroups based on inflammation may be clinically relevant to predict treatment response to anti-inflammatory interventions.

Sleep Patterns, Pain, and Emotional Functioning in Youth with Inflammatory Bowel Disease.

Youth with inflammatory bowel disease (IBD) may be at increased risk for sleep difficulties due to the painful and inflammatory nature of their disease. Moreover, children and adolescents with IBD experience impairment across a variety of psychosocial domains. However, researchers have yet to investigate the complex interplay between sleep, disease-related symptoms, and psychosocial factors in this population. The purpose of this study was to examine sleep patterns, pain, and mood in pediatric IBD. A sample of 25 children and adolescents with IBD (Mage = 14.24, Range = 10-18 years; 56% male) were recruited from a pediatric gastroenterology clinic. Youth wore an actigraphy watch and completed daily measures of affect and pain over the course of 14 days. Statistical analyses involved repeated measures general estimating equations. No significant association for sleep with negative affect was demonstrated. Despite majority of this sample being in disease remission, results revealed that increased sleep onset latency was associated with presence of next day pain and pain was associated with better next night sleep efficiency. Findings of the current study suggest youth with IBD experience poor sleep quality, which is significantly related to the pain they experience. Consequently, healthcare providers should screen for and address sleep quality to optimize outcomes in their pediatric patients. Objectively assessing sleep patterns (e.g., actigraphy) may prove useful for pediatric IBD samples; however, additional research is needed to determine actigraphy's feasibility and efficacy in assessing sleep patterns in real world settings (e.g., pediatric medical clinics).

Sex-related differential item functioning of the Jenkins Sleep Scale: a cross-sectional study among 77 967 employees in the Finnish public sector

ObjectivesTo investigate if the Jenkins Sleep Scale (JSS) demonstrates sex-related differential item functioning (DIF).DesignCross-sectional study.SettingSurvey data from the Finnish Public Sector study (2015–2017).Participants77 967 employees in the Finnish public sector,...

Untreated Allergy Among Middle School Students: Associations with Socioeconomic Adversities and Academic, Behavior, and Health Difficulties.

Many adolescents with allergy do not receive physician treatment (allergyuntreated). We explored its association with socioeconomic adversities and academic-behavior-health difficulties, which remain unaddressed. This cross-sectional school-based-population study compared the above factors of middle-school adolescents with allergyuntreated and those with treated allergy (allergytreated) (mean age = 13.5 ± 1.2) from north-eastern France. Participants completed a questionnaire collecting socioeconomic adversities (nonintact family, low parents' education, insufficient family income, poor social support, suffered verbal/physical violence, and sexual abuse), low academic performance, excessive screen time, substance use, sleep difficulty, poor physical health, depressive symptoms, suicide attempt, poor quality of life, and allergytreated/allergyuntreated. Logistic regression models showed that allergyuntreated was associated with all the factors considered (sex-age-class-level-adjusted odds ratio (saclOR) reaching 3.94, p < .001) and the risk score (number of main criteria: suffered sexual abuse, excessive screen time, poor quality of life, cannabis use, low parents' education, and poor social support): saclOR 4.75, 9.23, 15.64, and 31.73 (p < .001) for risk scores 1, 2, 3, and ≥4, versus risk score = 0 (pseudo-R2 = 11.1%). Socioeconomic adversities and academic-behavior-health difficulties may be used to detect adolescents with allergyuntreated for care.

Associations between muscle dysmorphia symptomatology and sleep duration and difficulty in the Canadian Study of Adolescent Health Behaviors

ObjectivesPrior research has shown links between mental health symptomatology and poor sleep. However, associations between muscle dysmorphia symptomatology and poor sleep remain unknown, which was the aim of this study. MethodsData from the Canadian Study of Adolescent Health Behaviors (2021-2022) were analyzed (N = 912). Multinomial logistic regression analyses and logistic regression analyses were used to determine the association between muscle dysmorphia symptomatology and average sleep duration (5 hours or less, 6 hours, 7 hours, and 8 or more hours) and difficulty falling or staying asleep over a 2-week period. ResultsFindings indicated significant associations between muscle dysmorphia symptomatology and shorter sleep duration and greater sleep difficulty in both cross-sectional and prospective analyses. ConclusionsThe findings from this study underscore poor sleep as a correlate of muscle dysmorphia symptomatology among adolescents and young adults, emphasizing the need for screening and interventions in healthcare settings.

Testing the reciprocal relationship between depressive symptoms and insomnia.

Although the importance of sleep difficulties in emotional disorders has long been acknowledged, the nature of the potential reciprocal relationship between sleep and depressive symptoms is not yet well understood. The coronavirus disease 19 pandemic provided a unique opportunity to study the interrelation of these symptoms over a period marked by increases in sleep and psychological difficulties. Using online data collection, we followed 1200 adults (59% male) through 1 year of the pandemic. Measures of sleep disturbance and depressive symptoms were assessed at eighttime points. Factor analysis of the items from these two measures suggested separate insomnia and depressive symptom factors. A random intercept cross-lagged panel model was used to assess within-person relationships between factor analysis-informed subscales of insomnia and depressive symptoms. Depressive symptoms predicted subsequent changes in insomnia symptoms; however, insomnia did not predict changes in depressive symptoms. Our findings suggest the impact of depressive symptoms on insomnia is evident, but the reverse is not. Implications of this finding along with the need for research addressing depressive symptoms and insomnia as treatment targets are discussed.

An evaluation of a stepped-care telehealth program for improving the sleep of autistic children

BackgroundSleep problems are prevalent in Autistic children, adversely affecting their development, well-being and quality of life. Traditional face-to-face behavioral interventions are hindered by accessibility. Using a single-case design, this study evaluated the efficacy of a stepped-care telehealth-delivered behavioral sleep intervention (TDBSI). MethodSeven Autistic children (aged 4–8) and their parents participated in a 12-week program consisting of baseline plus three sequential intervention phases: (1) self-directed online parent psychoeducation, (2) small group parent coaching via video conferencing, and (3) individualized parent coaching via video conferencing. Parent strategy selection and implementation fidelity were closely monitored and rated across intervention phases. Child sleep outcomes were assessed through daily parent-reported sleep diaries and the Children's Sleep Habits Questionnaire. ResultsFive of seven parents used online parent education to independently select antecedent strategies (e.g., sleep hygiene, stimulus control) and/or rewards that were appropriate for their child’s sleep and implemented them with high fidelity. This resulted in reductions in sleep onset latency, night wakings, early wakings, and bedsharing for their children. Parent implementation fidelity and child sleep outcomes were further improved for all participants with group or individualized coaching, and results were maintained at 12 weeks and six months post-intervention. ConclusionsTDBSIs show promise in addressing sleep difficulties in Autistic children, warranting further investigation and replication.

The use of psychotropic medications in autistic individuals (21 years and younger) in Western Australia: A preliminary investigation.

Prescriptions and use of medications to treat mental health conditions in young autistic populations are inconsistent worldwide. This makes it hard to compare findings from international studies to the Australian autistic population, where there are limited relevant studies. Apart from risperidone, there are no other medications specified for direct use in autistic persons. This study aims to gain initial broad understanding of the use of medications, commonly prescribed for mental health conditions, specifically by autistics under the age of 21 years. We analysed data that were previously collected as part of the Western Australian Autism Biological Registry between 2011 and 2015 which amounted to 239 surveys completed on young persons with diagnosed autism. The questionnaires included information on co-occurring conditions, current or previous use of medications and reasons for use of the medications. Only one-quarter of the participants in this study reported using at least one mental health-related medication in their lifetime. The most reported medications were stimulants, antidepressants and antiepileptics. The reasons for using medication included managing attention deficit hyperactivity disorder, challenging behaviours, seizures, sleep difficulties and symptoms of anxiety and depression. The number of individuals reporting medication use in this study was lower compared to other developed countries. Nevertheless, these medications should be monitored due to limited understanding of their use to manage co-occurring symptoms in young autistic persons. The findings highlight the importance of ongoing research to better understand mental health-related medications and inform best practice.

Self-Reported Health-Related Quality of Life and Residual Symptoms among Virologically Suppressed People Living with HIV in the Era of Single-Tablet Regimens in Taiwan: A Cross-Sectional Study.

This study assessed the health-related quality of life (HRQoL) and residual symptom burden among virologically suppressed people living with human immunodeficiency virus (HIV) (PLWH) using a single-tablet regimen in Taiwan. This cross-sectional study administered a self-reported online survey between July and October 2021 to anonymised virologically suppressed PLWH aged ≥20 years. Demographic, HIV-related variables, EuroQol-5-dimensions (EQ-5D), visual analogue scale (VAS), and HIV Symptom Index were analysed. Bivariate analyses were performed to compare HRQoL differences between PLWH and non-PLWH. Among 120 PLWH, 80.9% had HIV diagnosis for <15 years, median antiretroviral therapy (ART) duration of 7.0 years (Q1-Q3:4.0-11.0), and 62.5% had ≥1 comorbidity. The most common comorbidities were depression (26.7%) and hyperlipidaemia (15.8%). About one-fifth of PLWH received constant family support (25.8%) and peer support (21.7%). Married individuals or individuals with higher incomes had significantly better family support status. There was no significant difference across the five dimensions between PLWH and non-PLWH. PLWH perceived being bothered by fatigue/lack of energy (63.3%), sleep difficulties (63.3%), feeling sad/low/unhappy (51.7%), and appearance changes (51.7%). PLWH could achieve similar HRQoL as non-PLWH with stable treatment, highlighting an opportunity to focus on person-centred holistic care beyond HIV, especially on the psychological aspect, for the best possible HRQoL for PLWH.

Methylphenidate and Sleep Difficulties in Children and Adolescents With ADHD: Results From the 2-Year Naturalistic Pharmacovigilance ADDUCE Study

Objective: Short-term RCTs have demonstrated that MPH-treatment significantly reduces ADHD-symptoms, but is also associated with adverse events, including sleep problems. However, data on long-term effects of MPH on sleep remain limited. Methods: We performed a 2-year naturalistic prospective pharmacovigilance multicentre study. Participants were recruited into three groups: ADHD patients intending to start MPH-treatment (MPH-group), those not intending to use ADHD-medication (no-MPH-group), and a non-ADHD control-group. Sleep problems were assessed with the Children’s-Sleep-Habits-Questionnaire (CSHQ). Results: 1,410 participants were enrolled. Baseline mean CSHQ-total-sleep-scores could be considered clinically significant for the MPH-group and the no-MPH-group, but not for controls. The only group to show a significant increase in any aspect of sleep from baseline to 24-months was the control-group. Comparing the MPH- to the no-MPH-group no differences in total-sleep-score changes were found. Conclusion: Our findings support that sleep-problems are common in ADHD, but don’t suggest significant negative long-term effects of MPH on sleep.

Non-Pharmacological Intervention for Personalizing Sleep Quality through Gentle Rocking Motion.

Achieving restorative sleep is crucial for overall well-being, yet sleep difficulties affect a substantial portion of the adult population. Sleep disturbances are associated with diminished quality of life, physical complaints, cognitive impairment, and emotional regulation challenges. This study explores the influence of an innovative experimental bed designed to generate rocking motions on sleep parameters. A prospective observational study enrolled 60 adult participants, assessing their sleep on a regular stationary bed and the Inoveris bed, providing gentle rocking movements. Polysomnography was conducted, recording electroencephalography, electrooculogram, electromyogram, respiratory effort, and other parameters. The rocking bed significantly increased total sleep time (TST) and reduced N1 sleep stage duration (p < 0.001). Participants also experienced a quicker transition to the N2 sleep stage (p = 0.01), indicative of a faster shift from wakefulness to deeper sleep. Additionally, rocking led to a higher percentage of N1 sleep stages (p = 0.01) and a significant increase in N3 sleep stage duration (p = 0.004). While some results lacked statistical significance, notable trends in the rocking bed group have clinical relevance, consistently improving sleep parameters, including increased TST. The rocking bed also showed a trend towards higher sleep efficiency (SE) and sleep duration percentage, hinting at a potential overall enhancement in sleep quality. This study contributes valuable insights into the potential benefits of rocking motions on sleep architecture. Despite variations in outcomes across studies, our results underscore the potential of rocking beds as a non-pharmacological intervention for enhancing sleep quality. Notable improvements in total sleep time (TST), N1 sleep stage reduction, and accelerated transitions to deeper sleep stages highlight the clinical relevance of rocking interventions. Further research, collaboration, and addressing the identified limitations will advance our understanding of the therapeutic applications of rocking motions in sleep science.

Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia.

This study explores orthodontists' perspectives on risks associated with orthodontic treatment, as described by Greek and Slovak orthodontists. Informed by the foundational importance of effective communication of risk perspectives in health sciences, particularly in facilitating valid consent and shared decision-making, this research addresses gaps identified in the literature concerning the consistent communication of potential treatment risks based on demographic and cultural characteristics. This study identifies 15 potential critical risks during orthodontic treatment. These risks include root resorption; temporary undesired changes to the occlusion; sleep difficulties; not achieving an ideal result; development of black triangles between teeth; taking additional X-rays; speech difficulties; using a protective splint during sports; duration of treatment; number of visits; transmission of infectious diseases; and swallowing orthodontic appliances. A questionnaire, distributed electronically to orthodontists in Greece (N1 = 570) and Slovakia (N2 = 210) from September 2022 to December 2022, aimed to assess risk communication practices, taking into consideration socio-demographic factors, such as country, gender, age, and academic-degree-related variations. A total of 168 valid questionnaires (91 from Slovakia and 77 from Greece) were obtained, indicating significant disparities in the risks emphasized and preferred forms of consent. The Greek orthodontists focused more on the risks involved, such as relapse, root resorption, temporal occlusal changes, and failure of desired movement, while the Slovak practitioners tended to be more interested in sleeping difficulties, temporal occlusal changes, and not achieving an ideal result. They also obtained written or digital consent from patients or their parents/guardians more frequently than the Greek team. Male orthodontists discussed specific risks more frequently, including relapse and extractions, whereas females preferred written or digital consent. PhD-trained orthodontists prioritized certain risks, indicating the need for tailored approaches. This study underscores the dynamic nature of risk assessment in orthodontic practice, emphasizing its ethical and strategic dimensions. The findings advocate for tailored risk communication strategies that recognize individual, contextual, and cultural factors, and the need for an orthodontic informed consent protocol for a tailored communication approach for patients to elevate the standard of care in European orthodontics. The reliance on digital tools reflects contemporary trends in enhancing patient understanding, thereby supporting ongoing innovation in orthodontic practices.

Sleep Quality among Saudi Nurses: Cross-Sectional Study

Background: Sleep quality is one of the important aspects among nurses as it has a significant impact on nurses’ work productivity, and work quality and is found to be associated with quality of life for nurses. Purpose: This study aims to assess the sleep quality among Saudi nurses. Method: This cross-sectional study included 323 Saudi nurses to measure their sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Results: The study included 75% female and 25% male, with an advantage for age 25-34 (36.9%). The majority (61.61%) held a bachelor's degree in nursing, 49.11% were unmarried, 46.73% were married, 56.55% had fixed morning shifts, and 43.45% had shift days. 27.08% of participants had experienced 10 to 20 years of working experience. The study found that 67.86% had moderate sleep difficulty, followed by mild sleep difficulty, while only 2.08% had severe sleep difficulty. In addition, It was found that female (176.9) was significantly higher than male (143.3) in sleep difficulty (U=8467, p&lt;0.01=0.002). It was found the distribution is significantly different in terms of age (X2=10.52, p&lt;0.05=0.02), and the post hoc (pairwise test) found that the 25-34 group (185.81) was higher than the 35.44 group (143.79). It was found that shift day (189.32) was significantly higher than Fixed morning shift (152.5) in sleep difficulty (U=1083.5, p&lt;0.01=0.006). It was found that female (176.9) was higher than male (143.3) in sleep difficulty (U=8467, p&lt;0.01=0.006). Conclusion: This study examined Saudi nurses' sleep difficulties and related factors in a specific healthcare setting. The findings highlight sleep difficulties and their causes in this population. The study findings emphasize the need to treat sleep difficulties among Saudi nurses to improve their well-being and job effectiveness. Healthcare organizations should promote sleep hygiene and provide sleep management resources. This may involve mental health education, scheduling changes, and support.

Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series.

Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient's own general practitioner was supported by the participants. We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn.

The Lighter Touch: Less-Restriction in Sequentially Implemented Behavioral Sleep Interventions for Children with Rare Genetic Neurodevelopmental Conditions.

The prevalence of sleep difficulties among children with rare genetic neurodevelopmental conditions (RGNC) is high. Behavioral interventions are commonly used in the treatment of sleep difficulties in children with neurodevelopmental conditions such as autism, however, research is scarce in children with RGNC. The range of co-occurring complexities within this population, means there is a need for research to not only determine the effectiveness of behavioral sleep interventions, but also which components might be the least restrictive (i.e., intensive/aversive) and minimally sufficient. This study used a single-case multiple baseline design to investigate the effectiveness and acceptability of behavioral sleep interventions, indicated within a Functional Behavior formulation in eight children with RGNC (M = 7.3years). Intervention components were sequentially administered across up to three phases, based on the principle of less restriction (from least to relatively more intensive) to determine what might be minimally sufficient. Results showed an improvement in sleep onset latency, night wakings, early morning waking and unwanted bed-sharing for 7/7, 6/7, 3/3 and 3/3 children respectively. Improvement was observed for most participants following the less restrictive phases of intervention (circadian modifications, antecedent modifications and positive reinforcement), however, more restrictive, albeit modified, extinction procedures were still implemented for five participants. Improvements were maintained at follow-up and interventions were deemed acceptable to parents. Less restrictive function-based behavioral strategies are an effective, and in some cases sufficient, contribution to a sequence of interventions for a range of sleep difficulties. They should be implemented first, before more restrictive strategies.

Emotional and behavioral features associated with subclinical hypothyroidism in children and adolescents with Down syndrome.

Subclinical hypothyroidism (SH) is particularly frequent in individuals with Down syndrome (DS). Despite the amount of evidence suggesting SH is associated with psychopathological symptoms and sleep problems in general population, poor is known about the emotional and behavioral features associated with SH in children with DS. The first aim of the current study was to investigate differences in emotional and behavioral profiles between a group of children with DS exhibiting co-occurring SH and a group of age and BMI-matched children with DS without co-occurring SH. The second aim of the present study was to investigate differences in sleep disturbances between these groups. We included in this retrospective study 98 participants with DS aged 3-18 years with the aim to explore differences in emotional/behavioral problems as well as in sleep difficulties between children with DS with or without co-occurring SH. Participants with co-occurring SH exhibited significantly higher scores at several scales of the Conners' Parent Rating Scales Long Version - Revised. However, they did not exhibit more sleep problems than control group. These results provide specific indications for psychological and neuropsychiatric evaluation of children with DS with suspected or diagnosed SH, highlighting the importance of a multidisciplinary approach in clinical care for children and adolescents with DS.

Sleep and Caregiver Burden Among Caregivers of Persons Living With Dementia: A Scoping Review.

Caregivers of persons with dementia report worse sleep when compared to the general population. The objective of this review was to synthesize evidence regarding the link between caregiver burden and dementia caregivers' sleep. We conducted a scoping review using a systematic search for pertinent literature in PubMed, CINAHL, and Web of Science through March 2022. Keywords included content areas of dementia, caregiver burden, and sleep. Inclusion criteria were informal caregivers of persons living with dementia, a measured relationship between informal dementia caregiver sleep and subjective caregiver burden variables, and original research. Non-English studies were excluded. Extracted data were organized in tables, compared, and synthesized. The search yielded 540 nonduplicate articles screened by title and abstract; 118 full-text articles were reviewed; 24 were included. Most studies were cross-sectional, with variable sample sizes. Dementia caregivers had significantly poorer overall perceived sleep than noncaregivers across 4 studies that examined self-reported sleep measures. Eighteen studies investigated the association between caregiver burden and self-reported sleep quality, with 14 reporting a significant positive association between caregiver burden and self-reported sleep quality, and 4 finding null results. Only 2 of the 4 studies reporting the association between caregiver burden and objective sleep parameters (ie, actigraphy and polysomnography) reported a significant positive association for at least one sleep subdomain. Although subjective sleep quality is commonly affected by dementia caregiving burden, there is a lack of corresponding evidence on the relationship between burden and objective sleep metrics. Healthcare providers should consider the dementia caregiver burden's impact on sleep and regularly assess caregivers' sleep difficulties. Future studies should focus on consistently measuring caregiver burden and sleep to promote dementia caregiver health and well-being.

The Relationship Between Anxiety Levels and Pre-operative Sleep Quality Disorders for Spinal Anesthesia Patients

Background: According to data, the number of surgery patients has increased significantly over time. All hospitals worldwide recorded 140 million patients in 2017, 148 million in 2019, and 1.2 million in Indonesia. Surgery might threaten a person's body, integrity, or life and generate anxiety. Patients can be anxious before surgery under anaesthesia. Chronic anxiety can create stress and sleep difficulties. People with sleep issues are young adults. Sleep disorders are conditions that cause discomfort or interfere with a desirable lifestyle due to alterations in rest patterns. Purpose: Understanding how worry affects preoperative sleep quality in spinal anaesthesia patients at Hj. Anna Lasmanah Banjarnegara Hospital. Methods: This type of research is descriptive correlation using a cross sectional design by distributing questionnaires of anxiety level (APAIS) and sleep quality (AIS). Findings: the findings regarding the anxiety levels of the 65 participants indicated that among the total of 65 respondents, 23 individuals (or 35.4%) reported having moderate anxiety. Furthermore, in terms of sleep quality disorders, moderate insomnia was reported by most respondents, comprising 28 individuals (43.1%). The significance value of p = 0.000 (&lt;0.05) obtained from the Spearman's Rho correlation test indicates that anxiety levels and sleep quality disorders are significantly associated in preoperative spinal anaesthesia patients. Conclusion: There is a strong relationship between anxiety level and preoperative sleep quality disorders in spinal anesthesia patients.

Mental health issues and lifestyle changes associated with the COVID-19 pandemic in adolescents: A cross-sectional study in selected schools of Eastern India.

Due to coronavirus disease 2019 (COVID-19), adolescents from all over the world have higher rates of anxiety, depression, and stress. This study attempts to assess the effect of the COVID-19 pandemic on adolescent mental health and lifestyle issues. The study also focuses on coping strategies adopted by the participants during the pandemic. It was a cross-sectional study performed among school-going adolescents studying from classes VII to X of selected schools in Bhubaneswar. A semi-structured questionnaire was formed and validated by faculty members of the Departments of Pediatrics, Psychiatry and Community Medicine, IMS and SUM Hospital, Bhubaneswar, to obtain a detailed history regarding lifestyle changes, mental health issues, and coping strategies. Randomly, three schools were selected in Bhubaneswar. Permission from the principal, informed written consent from parents, and assent from students were obtained before the study. A total of 711 participants were enrolled in the study. All data were entered in an Excel spreadsheet and analyzed using Statistical package for social sciences (SPSS) version 26. Middle and high school students also experienced lifestyle changes; however, it was revealed that high school students experienced higher mental health problems, such as mood swings. Additionally, compared to males, girls substantially more frequently experienced academic stress, sleep difficulties, and worry, as well as the development of unhealthy habits. Various coping strategies developed by the students included development of a new hobby (45.4%), spending time with family members (12.8%), learning by playing indoor games (8.4%), computer skills (3.9%), and meditation (2.25%). The lockdown, apprehension of pandemic and associated morbidity, fear of losing loved ones, academic and peer pressures, and sudden adjustment to new study methods contributed to the changes experienced by adolescents physically and mentally; hence, all of these issues were addressed in this study. This study pointed toward the need for the propagation of adolescent mental health awareness during pandemics.