Sleep Extension Research Articles

Abstract 15693: Weekend Sleep Extension (Catch-up Sleep) is Associated With Lower Incidence of Coronary Calcium Score: The Elsa-Brasil Study

Background: Insufficient sleep is a worldwide public health problem with potential cardiovascular consequences. Therefore, strategies aiming at improving sleep patterns are highly desired. Cross-sectional studies showed that weekend sleep extension (catch-up sleep) is associated with better glucose metabolism and cognitive function profiles, but longitudinal studies are lacking. Hypothesis: Catch-up sleep may have protective effects on subclinical atherosclerosis. Methods: In this prospective cohort study, we performed a 7-days wrist actigraphy for monitoring sleep duration and a sleep study to detect sleep apnea. Catch-up-sleep was measured by calculating weekend sleep duration (Friday-Saturday nights) minus weekday sleep duration (Sunday-Thursday nights). Coronary artery calcium, CAC (64-slice multi-detector computed tomography) was measured at two different time points throughout the study (baseline, between 2010-2014, and follow-up, between 2016-2018). Incidence of subclinical atherosclerosis was defined as baseline CAC=0 followed by CAC>0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression adjusting for age, sex, race, body mass index, hypertension, diabetes mellitus, smoking, low- and high-density lipoprotein, use of statin, sleep apnea and interscan period). Analysis of incidence was Inverse probability censoring weighted. Results: We analyzed 1,832 participants with available CAC scores at baseline (age: 48.8±8.0years; 57.8% women; 32.1% with sleep apnea). The mean sleep duration was 6.6±1.0 hours. Catch-up-sleep >90 minutes was observed in 28.0%. Incidence of CAC was 27/141 (19.1%) among subjects with catch-up-sleep >90 minutes and 326/1029 (31.7%) among those with catch-up-sleep ≤90 minutes (P<0.001). In covariate-adjusted analyses (n=1,170, follow-up=5.4±0.90 years), we found a lower incidence of CAC in those participants with weekend sleep extension >90 minutes (OR=0.62; 95% CI 0.52-0.74). Conclusion: Catch-up sleep is independently associated with a lower incidence of CAC. These results underscore that catch-up sleep may mitigate the adverse cardiovascular effects of weekdays sleep restrictions frequently observed in our Society.

Chronotype predicts working memory-dependent regional cerebral oxygenation under conditions of normal sleep and following a single night of sleep extension

The aim of this study was to test the hypothesis that the association between sleep duration and brain activation as assessed by regional cerebral oxygenation using near-infrared spectroscopy (NIRS) is dependent on chronotype. Sleep was tracked across two weeks by actigraphy in 22 adults instructed to keep their normal sleep behavior. Chronotype was assessed by the midpoint of sleep on free days corrected for sleep debt on workdays (MSFsc). Prefrontal cerebral oxygenation (ΔHbDiff) during a visuospatial working memory task was measured in the morning after a night of normal sleep and after one night of extended sleep. Sleep extension was included to experimentally test the robustness of the association between sleep duration and ΔHbDiff. Habitual sleep duration (r = 0.43, p = 0.04) and MSFsc (r = − 0.66, p < 0.001) were significantly correlated with ΔHbDiff. After adjusting for MSFsc the relationship between sleep duration and ΔHbDiff was reduced to nonsignificant levels (r = 0.34, p = 0.11), while adjusting for sleep duration did not change the significant relationship between MSFsc and ΔHbDiff (r = − 0.62, p = 0.001). One night of sleep extension increased sleep duration by 140 min, on average, but no change in ΔHbDiff was observed. Dividing participants into earlier and later chronotypes revealed greater ΔHbDiff responses in earlier chronotypes that persisted after the night of sleep extension (mean ΔHbDiff difference = 1.35 μM, t = 2.87, p = 0.006, Hedges’ g = 0.89). These results find chronotype to predict regional cerebral oxygenation responses during working memory processing under conditions of normal sleep and following a single night of sleep extension.

Sleep Technology Intervention to Target Cardiometabolic Health (STITCH): a randomized controlled study of a behavioral sleep extension intervention compared to an education control to improve sleep duration, blood pressure, and cardiometabolic health among adults with elevated blood pressure/hypertension

BackgroundShort sleep duration, defined as < 7 h sleep on weeknights, affects 40% of the US adult population, contributing to the increased risk for cardiometabolic diseases, decreased safety, and poorer mental health. Despite the prevalence of short sleep duration, few studies have tested interventions to extend sleep duration. The objective of this study is to test the effects of a behavioral sleep extension intervention on sleep duration, blood pressure, and other measures of cardiometabolic health among adults with elevated blood pressure or hypertension.MethodsThis is a single-blind, randomized controlled trial to determine the impact of a behavioral sleep extension intervention on sleep duration and cardiometabolic health among individuals with short sleep duration (< 7 h per night) and elevated blood pressure or hypertension (SBP 120–150 mmHg or DBP 80–90 mmHg). After completing the screening, participants will be randomly assigned to either a sleep coaching (intervention) or health education (control) group. The participants will have weekly contact for either coaching or education for 8 weeks (intervention period) followed by monthly coaching or education for the next 2 months (maintenance period). Participants will complete assessment visits, actigraphy, and 24-h ambulatory blood pressure recording at baseline/screening, 8 weeks, and 6 and 12 months. The primary outcome is sleep duration at 8 weeks, and the secondary outcome is blood pressure at 8 weeks.DiscussionThe results of this study will determine the effects of behavioral sleep extension on sleep and cardiometabolic health among adults with short sleep duration and elevated BP/hypertension. The results will inform the feasibility and efficacy of behavioral sleep extension and provide information needed for future multi-site effectiveness studies.Trial registrationClinicalTrials.gov NCT04766424. Registered on 21 February 2021.

Feasibility, Acceptability, and Preliminary Effectiveness of a Sleep Intervention in Adults at Risk for Metabolic Syndrome With Short Sleep Duration.

The prevalence of short sleep duration is rising and is linked to chronic comorbidities, such as metabolic syndrome (MetS). Sleep extension interventions in adults with MetS comorbidities and short sleep duration are limited and vary widely in terms of approach and duration. This pilot study aimed to test the feasibility and acceptability of a personalized 12-week systematic sleep time extension intervention on post-intervention sleep outcomes in middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration. A single-arm, 12-week, 12-session systematic sleep time extension intervention was delivered weekly via videoconferencing. Feasibility and acceptability were assessed using retention rates and mean sleep diary completions. Sleep was estimated for 14 consecutive days prior to and immediately following the 12-week intervention using wrist actigraphy. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t -tests modeled changes in study outcomes. Study participants ( N = 41) had a mean age of 52 years and were mostly female and White; 86% attended >80% of sessions, and mean sleep diary completion was 6.7 diaries/week. Significant improvements in sleep from pre- to post-intervention included increased total sleep time, earlier sleep onsets, more regular sleep onsets, a higher sleep regularity index, and reduced daytime sleepiness. Extending sleep, as well as improving sleep timing and regularity in middle-aged adults with actigraphy-estimated short sleep duration and at risk for MetS, is feasible and acceptable. Behavioral sleep characteristics may be modifiable and present a novel behavioral paradigm for mitigating MetS risk. This pilot study provides a proof of concept for the feasibility, acceptability, and preliminary effectiveness of a systematic sleep time extension for middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration.

Sleep Deficiency and Cardiometabolic Disease.

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.

Country differences in nocturnal sleep variability: Observations from a large-scale, long-term sleep wearable study

Study objectivesCountry or regional differences in sleep duration are well-known, but few large-scale studies have specifically evaluated sleep variability, either across the work week, or in terms of differences in weekday and weekend sleep. MethodsSleep measures, obtained over 50 million night's sleep from ∼220,000 wearable device users in 35 countries, were analysed. Each person contributed an average of ∼242 nights of data. Multiple regression was used to assess the impact country of residence had on sleep duration, timing, efficiency, weekday sleep variability, weekend sleep extension and social jetlag. ResultsNocturnal sleep was shorter and had a later onset in Asia than other regions. Despite this, sleep efficiency was lower and weekday sleep variability was higher. Weekend sleep extension was longer in Europe and the USA than in Asia, and was only partially related to weekday sleep duration. There were also cross-country differences in social jetlag although the regional differences were less distinct than for weekend sleep extension. ConclusionsIn addition to regional differences in sleep duration, cross-country differences in sleep variability and weekend sleep extension suggest that using the latter as an indicator of sleep debt may need to be reconsidered. In countries exhibiting both short sleep and high weekday sleep variability, a culturally different means of coping with inadequate sleep is likely. Country or region differences in culture, particularly those related to work, merit closer examination as factors influencing the variability in normative sleep patterns around the world.

Effect of catch-up sleep on obesity in Korean adolescents: a nationwide cross-sectional study.

Adolescents have weekday/weekend sleep discrepancies and may compensate for weekday sleep debt through sleep extension on weekends. We investigated the effects of total sleep duration on weekdays/weekends on obesity and determined if weekend catch-up sleep has an ameliorating effect on obesity in Korean adolescents. Using data from the KNHANES VII, 1,306 middle and high school students were assessed for total sleep duration on weekdays, weekends, and the entire week, as well as weekend sleep extension. Participants were classified into four groups according to weekend sleep extension. Total sleep duration and weekend sleep duration were negatively associated with body mass index z-score. Increased weekend sleep duration and sleep extension on weekends decreased the relative risk of overweight/obesity with each 30 min increment, reducing the risk by a factor of 0.39 and 0.93, respectively. The risk of overweight/obesity in adolescents who slept less than 6 h on weekdays increased by a factor of 1.93 when they slept for less than 3 h on weekends. Weekend catch-up sleep had a negative dose-dependent association with obesity in Korean adolescents. Sleeping longer on weekends may be associated with a decreased risk of obesity, even if the adolescent obtains less sleep during weekdays. However, further prospective studies are needed to establish the causality between extended weekend sleep and obesity.

0770 The Effect of In-Home Sleep Extension on Insulin Sensitivity for Habitually Short-Sleeping Adolescents

Abstract Introduction The interplay of physiological and behavioral factors of adolescence that result in dramatically insufficient sleep may confer a notable cardiometabolic risk. Increasing sleep duration reverses the negative metabolic consequences of insufficient sleep in adults, but this has not been examined in youth. Thus, the current study aimed to evaluate the impact of in-home sleep extension on insulin sensitivity (Si) in habitually short-sleeping adolescents. Methods Twenty-six healthy adolescents obtaining ≤7h sleep on school nights (age=16.6±1.1, 69% female, 73% non-Hispanic White) completed a randomized crossover trial consisting of one week each of Typical Sleep (usual school schedule) and Sleep Extension (≥1h additional time in bed) during the academic year. Sleep was estimated via actigraphy, and an intravenous glucose tolerance test (IVGTT) measured Si following each condition. Spearman and Kendall correlations assessed associations and paired samples t-tests and Wilcoxon signed-rank tests examined change in variables from Typical Sleep to Sleep Extension. Results A significant association between sleep and insulin sensitivity was observed during Typical Sleep, with poorer Si associated with longer sleep onset latency (rho=-0.29, p=0.04), and greater variability in waketime (rho=-0.44, p=0.02) and sleep duration (rho=-0.43, p=0.03). During Sleep Extension, participants significantly increased sleep duration by 1.4±0.7h (Typical Sleep=5.59±0.82, Sleep Extension=6.95±0.83 h; p&amp;lt; 0.001) by shifting bedtimes to an earlier clock hour (Typical Sleep=00:34±01:12; Sleep Extension=23:10±00:57; p&amp;lt; 0.001). Si did not significantly change between conditions (p=0.52). However, a trend was observed for a decrease in fasting glucose during Sleep Extension compared to Typical Sleep (Typical Sleep=92.5±8.87; Sleep Extension=88.48±12.06 mg/dL; p=0.055). Conclusion Habitually short-sleeping adolescents were successful at increasing sleep duration during an in-home intervention, but Si did not change compared to Typical Sleep. Notably, sleep duration during Sleep Extension was still less than the 8-10 h of sleep per night recommended for adolescents. A sufficiently early bedtime that supports adequate sleep is a biological challenge for adolescents when wake times are fixed due to early school start times. Future research is recommended examining whether combining sleep extension with a circadian health intervention can have a larger impact on sleep and cardiometabolic outcomes in adolescents. Support (if any) NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1TR002535

0756 Amount and Timing of Sedentary Behavior and Physical Activity following Experimental Sleep Extension in Adolescents

Abstract Introduction Short sleep and sedentary behavior (SB) are both associated with negative health outcomes including increased risk of metabolic syndrome and obesity. Adolescence is a period characterized by decreased physical activity (PA), increased SB, and chronic short sleep. Literature about the impact of sleep duration on PA in adolescents is limited. The goal of this study was to examine changes in the amount and timing of PA and SB following a one-week sleep extension manipulation. Methods The sleep, PA, and SB of 34 short-sleeping (≤7h on school days) and habitually sedentary (&amp;lt; 3h of physical activity per week) healthy-weight adolescents (age=16.4±1.1 years; 68% female; 73% non-Hispanic White) were objectively measured in a randomized cross-over study during the academic year. Participants completed one week of Typical Sleep (usual school schedule) and one week of Sleep Extension (≥1h time in bed each school night). Sleep was estimated using wrist-worn actigraphy; PA and SB were measured using a thigh-worn accelerometer. Paired t-tests compared total minutes and time blocks of PA and SB during each condition. Results Total SB decreased from 750.4±109.08 to 699.32±91.76 min/day during Sleep Extension compared to Typical Sleep (p= 0.018). Specifically, SB significantly decreased during Sleep Extension in the 6PM-12AM (Typical Sleep=223.1±66.6, Sleep Extension=193.8±46.2 min; p=0.04) and 12AM-6AM (Typical Sleep=22.2±36.9, Sleep Extension=5.8±9.5 min; p=0.02) time frames. There were no significant changes in light, moderate, or vigorous PA between conditions (p&amp;gt;0.05). Conclusion Adolescents significantly decreased time spent in SB by nearly 1h per day during Sleep Extension with no change in PA, similar to prior research. Notably, the decrease in SB occurred during the 6PM-6AM time frame, suggesting that the additional sleep displaced time otherwise spent in SB. Reallocation of time spent in SB to PA is associated with positive health outcomes, but no research has examined reallocation to sleep time. Additional studies are needed to identify the related health effects of increased sleep duration and reduced SB in adolescents. Support (if any) NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1 TR002535

0198 Effects of a 1-hour nightly weeklong sleep extension pilot study in undergraduates on health

Abstract Introduction Sleep restriction impairs health, but less is known about the potential health benefits of extending sleep in undergraduate students with habitual short sleep. This study examined the effects of a 1-week, 1-hour per night sleep extension on cardiometabolic health, hydration status, sedentary behavior, and physical activity in undergraduate students. Methods Twelve healthy undergraduate students (83% female; mean±SD age 20.2±1.5; range 18-23 years) obtaining fewer than 7 hours of average nightly sleep completed a two-week study. The first week consisted of sleeping typically ("Habitual"), followed by a peer-delivered intervention to extend time in bed by ≥1 hour/night during the second week ("Extension"). Sleep and physical activity actigraphy were collected throughout. Following each week, participants completed in-person cardiometabolic assessments, including a standardized meal response procedure and blood pressure measurement. Blood samples for measurement of glucose and insulin were collected before, during, and following a standardized breakfast. Urine samples yielded markers of hydration (specific gravity and osmolality). Mixed-effects regression models with random intercepts for individuals compared outcomes after the Extension week to Habitual outcomes. Results Compared to Habitual sleep, average sleep duration across the Extension week increased (b±SEM, +42.6±.3 minutes; p=.005). After the breakfast meal, glucose area under the curve (AUC; −26.5±10.2 mg/dL*h; p=.025) and time to return to baseline levels (−83.0±46.4 minutes; p=.031) decreased following Extension. There was no change in insulin AUC. Systolic blood pressure decreased (−6.6±2.8 mmHg; p=.037) after Extension. Average time spent in sedentary behavior (−44.3±15.7 minutes; p=.018) and percentage of wake spent in moderate-to-vigorous physical activity (−1%±.4%; p=.030) decreased across the Extension week. Participants who increased average sleep duration ≥15 minutes (n=9) were better hydrated according to urine osmolality (−187.0±68.4 mOsm/kg; p=.026) and specific gravity (−.01±.002 g/mL; p=.012) and had lowered odds of dehydration according to urine osmolality (≥800 mOsm/kg; −67%; OR=.03; p=.035). Conclusion This pilot study provided evidence that sleep extension may improve cardiometabolic health and hydration and reduce both sedentary behavior and moderate-to-vigorous physical activity. Future research in randomized controlled trials should examine if such findings extrapolate to larger samples and older populations. Support (if any) CRC/CTSI: UL1-TR002014; pilot grant to AMC from the Department of Biobehavioral Health, Pennsylvania State University

0151 Modulating Emotion Regulation and the Late Positive Potential ERP Component through Sleep Extension

Abstract Introduction Sleep deprivation and poor sleep quality reduces functional connectivity between prefrontal cortical networks and the amygdala, thus causing emotional dysregulation. In contrast, sleep extension in the form of napping has been shown to impact emotional memory consolidation and emotional reactivity. To date, however, the role of napping in adult emotion regulation has yet to be determined. We hypothesize that sleep extension in the form of a nap will improve emotion regulation abilities in healthy adults. Methods In this within-subjects design, participants completed an emotion regulation task following either a nap or an equivalent bout of wake time (separated by ~1 week, order counterbalanced). In the task, participants were shown negative and neutral IAPS pictures, and were instructed to suppress, maintain, or enhance their emotional experience. During the task, the late positive potential was assessed at Pz, a component that may reflect downstream neurobiological effects of amygdala activation. Results Participants were able to use the cognitive reappraisal strategy to alter their emotional valence (F(2,14)= 17.781, p&amp;lt; 0.001, η2=0.718) and arousal (F(2,14),=36.995, p&amp;lt; 0.001, η2=0.841) according to the instructions. While not significant due to small sample size, participants showed greater mean amplitude in the late LPP component (1,900-3,000ms) for negative images compared to neutral images (F(1,5)=3.165, p=0.135, η2=0.367), and in the wake condition compared to the nap condition (F(1,5)=2.894, p=0.150, η2=0.388). Following instructions, there was a non-significant interaction between condition and the maintain and suppress instructions (F(1,5)=2.357, p=0.185, η2=0.320); compared to the nap condition, in the wake condition participants averaged greater mean amplitude of the LPP (300-5,000ms) in the suppress condition. Conclusion Data from this study followed predicted directions that sleep extension in the form of a nap may help to improve emotion regulation by increasing top-down control of amygdalar activation. Support (if any) This work was supported by the Merrimack College Zampell Family Faculty Fellowship, and the Merrimack College START Program.

0210 Conservation of Prior Slow Wave Sleep Does Not Provide Resilience to Neurobehavioral Impairment during Total Sleep Deprivation

Abstract Introduction Slow wave sleep (SWS) is thought to play a critical, if not unique, role in resilience and recovery of waking function. It has been posited that if SWS is preserved, the impact of sleep restriction on subsequent neurobehavioral functioning should be minimal. In this context, we investigated the effects of a delayed and restricted sleep opportunity on SWS and on neurobehavioral impairment during a subsequent period of total sleep deprivation (TSD). Methods N=21 healthy adults (21–38y, 9f) underwent three separate periods of 36h TSD, each preceded by one week of prior sleep extension to 12h time in bed (TIB) per night (PSE condition, twice), or prior sleep restriction to 6h TIB per night (PSR condition, once). The last night of each condition was spent inside the laboratory. TIB for the pre-TSD night was 22:00–10:00 (PSE) or 04:00–10:00 (PSR). During each 36h TSD period, subjects completed a neurobehavioral task battery every 2h including a digit-symbol substitution test (DSST) measuring cognitive throughput and the Karolinska Sleepiness Scale (KSS) measuring subjective sleepiness. Following TSD, subjects had a 12h sleep opportunity (22:00–10:00). Sleep was recorded polysomnographically during both pre- and post-TSD nights. Results The pre-TSD night in the PSR condition had less total sleep time, with significant reductions (p&amp;lt; 0.001) in N1, N2, and REM durations compared to the PSE condition. There were no significant differences between the PSE and PSR conditions in SWS duration (p=0.40). Moreover, in the post-TSD night, there were no significant differences (p&amp;gt;0.1) between the PSE and PSR conditions in any of the sleep stages, including SWS. Neurobehavioral functioning during TSD exhibited significant effects (p&amp;lt; 0.02) of prior sleep condition on DSST throughput and KSS sleepiness, with reduced throughput and increased sleepiness in the PSR condition relative to the PSE condition. Conclusion SWS was remarkably conserved in delayed, restricted sleep compared to extended sleep. However, this conservation of SWS did not prevent exacerbation of DSST throughput deficits or KSS sleepiness from prior sleep restriction during subsequent TSD. As such, other aspects of sleep besides SWS are also important in mediating sleep-induced resilience and recovery. Support (if any) NASA NAG9-1161, CDMRP W81XWH-20-1-0442, ARO W911NF2210223.

Effect of Sleep Changes on Health-Related Quality of Life in Healthy Children

Little is known regarding the effect of poor sleep on health-related quality of life (HRQOL) in healthy children. To determine the effect of induced mild sleep deprivation on HRQOL in children without major sleep issues. This prespecified secondary analysis focused on HRQOL, a secondary outcome of the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized crossover trial of children who underwent alternating weeks of sleep restriction and sleep extension and a 1-week washout in between. The DREAM trial intervention was administered at participants' homes between October 2018 and March 2020. Participants were 100 children aged 8 to 12 years who lived in Dunedin, New Zealand; had no underlying medical conditions; and had parent- or guardian-reported normal sleep (8-11 hours/night). Data were analyzed between July 4 and September 1, 2022. Bedtimes were manipulated to be 1 hour later (sleep restriction) and 1 hour earlier (sleep extension) than usual for 1 week each. Wake times were unchanged. All outcome measures were assessed during both intervention weeks. Sleep timing and duration were assessed using 7-night actigraphy. Children and parents rated the child's sleep disturbances (night) and impairment (day) using the 8-item Pediatric Sleep Disturbance and 8-item Sleep-Related Impairment scales of the Patient-Reported Outcomes Measurement Information System questionnaire. Child-reported HRQOL was assessed using the 27-item KIDSCREEN questionnaire with 5 subscale scores and a total score. Both questionnaires assessed the past 7 days at the end of each intervention week. Data were presented as mean differences and 95% CIs between the sleep restriction and extension weeks and were analyzed using intention to treat and an a priori difference in sleep of at least 30 minutes per night. The final sample comprised 100 children (52 girls [52%]; mean [SD] age, 10.3 [1.4] years). During the sleep restriction week, children went to sleep 64 (95% CI, 58-70) minutes later, and sleep offset (wake time) was 18 (95% CI, 13-24) minutes later, meaning that children received 39 (95% CI, 32-46) minutes less of total sleep per night compared with the sleep extension week in which the total sleep time was 71 (95% CI, 64-78) minutes less in the per-protocol sample analysis. Both parents and children reported significantly less sleep disturbance at night but greater sleep impairment during the day with sleep restriction. Significant standardized reductions in physical well-being (standardized mean difference [SMD], -0.28; 95% CI, -0.49 to -0.08), coping in a school environment (SMD, -0.26; 95% CI, -0.42 to -0.09), and total HRQOL score (SMD, -0.21; 95% CI, -0.34 to -0.08) were reported by children during sleep restriction, with an additional reduction in social and peer support (SMD, -0.24; 95% CI, -0.47 to -0.01) in the per-protocol sample analysis. Results of this secondary analysis of the DREAM trial indicated that even 39 minutes less of sleep per night for 1 week significantly reduced several facets of HRQOL in children. This finding shows that ensuring children receive sufficient good-quality sleep is an important child health issue. Australian New Zealand Clinical Trials Registry: ACTRN12618001671257.

Efficacy of sleep extension therapy using a remote support system in university students with increased social jetlag: a parallel, single-blind, randomized controlled trial.

The efficacy of sleep extension therapy using a remote support system (SET-R) was investigated in university students with increased social jetlag (SJL). For this two-arm parallel randomized controlled trial, we recruited Japanese university students with SJL ≥ 60min. The SET-R provided an individualized sleep schedule for gradual sleep extension using email and sleep hygiene education, stimulus control therapy, and progressive muscle relaxation as web content. The control group was sent an email that encouraged them to record their sleep. The duration of the intervention program was two weeks.The primary outcome was the mean change in SJL two weeks later, assessed using the Munich ChronoType Questionnaire (MCTQ). The other outcomes included Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Patient Health Questionnaire-9 (PHQ-9), and sleep quiz. A follow-up survey was conducted 6months after the intervention. Of 54 students, 26 were assigned to an intervention group and 28 to a control group. The difference in the mean change in SJL between the two groups (n = 26, n = 27) at two weeks was statistically significant (27.7min, P = 0.048). The scores for the ESS, PHQ-9, and sleep quiz were improved in the intervention group relative to the control group. At the 6-month follow-up point, the difference in the mean change in SJL between the two groups (n = 22, n = 27) was not statistically significant, but scores for the PHQ-9, and sleep quiz remained significant. This study demonstrated the efficacy of the SET-R among university students with increased SJL. The study was registered with the UMIN Clinical Trials Registry (UMIN000042634, 2021/02/01).

The effect of modest changes in sleep on dietary intake and eating behavior in children: secondary outcomes of a randomized crossover trial

BackgroundInsufficient sleep duration increases obesity risk in children, but the mechanisms remain unclear. ObjectivesThis study seeks to determine how changes in sleep influence energy intake and eating behavior. MethodsSleep was experimentally manipulated in a randomized, crossover study in 105 children (8–12 y) who met current sleep guidelines (8–11 h/night). Participants went to bed 1 h earlier (sleep extension condition) and 1 h later (sleep restriction condition) than their usual bedtime for 7 consecutive nights, separated by a 1-wk washout. Sleep was measured via waist-worn actigraphy. Dietary intake (2 24-h recalls/wk), eating behaviors (Child Eating Behavior Questionnaire), and the desire to eat different foods (questionnaire) were measured during or at the end of both sleep conditions. The type of food was classified by the level of processing (NOVA) and as core or noncore (typically energy-dense foods) foods. Data were analyzed according to ‘intention to treat’ and ‘per protocol,’ an a priori difference in sleep duration between intervention conditions of ≥30 min. ResultsThe intention to treat analysis (n = 100) showed a mean difference (95% CI) in daily energy intake of 233 kJ (−42, 509), with significantly more energy from noncore foods (416 kJ; 6.5, 826) during sleep restriction. Differences were magnified in the per-protocol analysis, with differences in daily energy of 361 kJ (20, 702), noncore foods of 504 kJ (25, 984), and ultraprocessed foods of 523 kJ (93, 952). Differences in eating behaviors were also observed, with greater emotional overeating (0.12; 0.01, 0.24) and undereating (0.15; 0.03, 0.27), but not satiety responsiveness (−0.06; −0.17, 0.04) with sleep restriction. ConclusionsMild sleep deprivation may play a role in pediatric obesity by increasing caloric intake, particularly from noncore and ultraprocessed foods. Eating in response to emotions rather than perceived hunger may partly explain why children engage in unhealthy dietary behaviors when tired.This trial was registered at Australian New Zealand Clinical Trials Registry; ANZCTR as CTRN12618001671257.

Is sleep a barrier to physical activity practice?

Is sleep a barrier to physical activity practice?

How Sleep Affects Recovery and Performance in Basketball: A Systematic Review.

Sleep is considered an essential component related to physiological and psychological recovery in athletes and particularly in basketball, given the impact of condensed travel and game schedules on player health and performance. The aim of this systematic review is to examine studies published to date on sleep and basketball performance. All scientific articles that reported a relationship between sleep and its possible impact on performance in basketball are included. The research processes followed the PRISMA criteria, and the relevant articles were extracted (PubMed, WOS, Scopus) as of December 31, 2021. Twenty-eight articles were selected for inclusion and data extraction, with 27 demonstrating that sleep is a vital component in the recovery of basketball players and their corresponding on-court performance. Three central themes that we identified: (1) the quality and extension of sleep (the better quality and more extension of sleep, better performance and lower probability of injury); (2) influence of the players circadian rhythm (travel and game scheduling do not currently facilitate or take this into account); and (3) higher training loads and/or increased stress may jeopardize a subsequent good night's sleep, which should be taken into account when scheduling practices and workouts. The current systematic review regarding sleep and basketball performance and highlights that there is a strong relationship between both variables. Collectively, the evidence supports the critical influence of sleep on player recovery and basketball performance and risk for injury.

P042 Actigraphy-derived sleep characteristics of healthy children who benefit the most from a sleep extension protocol

Abstract Introduction Although experimental manipulation of sleep can extend children’s sleep via earlier bedtimes, this is not always possible. We aimed to determine true sleep gains made with a one hour earlier bedtime, and which actigraphy variables at baseline predicted the best gains. Methods Secondary analysis within a randomised crossover trial (99 children; 49.5% female; mean age=10.3 years, range 8-12 years). Each child underwent one week of sleep restriction and extension in a random order (1h later or earlier bedtime respectively) separated by a one-week washout. Sleep data comparing baseline and extension weeks were analysed using linear or logistic regression, controlling for randomised order. Results The mean (SD) difference in total sleep time (TST) with sleep extension was 14.3 (44.1) min/night. Thirty-three percent extended their sleep by at least 30 min/night. At baseline, having lower sleep quantity (TST) and quality (efficiency, WASO, waking frequency) significantly predicted more sleep gain. For each 1 h lower TST at baseline, 29.7 min (95% CI 19.4, 40.1) more sleep was gained. At baseline, a TST below 8 h 49 min was the optimal cut-point to predict whether children could extend their sleep by at least 30 min/night (found in 40% of children). Adjusting for relevant demographics and sleep hygiene made little difference. Conclusion Children who slept less than 8 h 49 min/night obtained the most sleep gain from a 1 hour earlier bedtime maintained over a week. Maintenance over the longer term is unknown. Findings have implications for understanding the sleep requirements of children.

Sleep and Circadian Disturbance in Cardiovascular Risk.

We discuss the relationship between sleep and circadian factors with cardiovascular disease (CVD) risk, including physiologic, behavioral, and psychological mechanisms along this pathway. The relationship between short and long sleep duration, as well as insomnia, with CVD risk is well-established. Recent work has highlighted how other sleep factors, such as sleep regularity (i.e., consistency of sleep timing), multidimensional sleep health, and circadian factors like chronotype and social jetlag, relate to CVD risk. Sleep-focused interventions (e.g., cognitive behavioral therapy for insomnia and sleep extension) may be effective to reduce CVD risk and disease burden. Sleep is increasingly recognized as an integral component of cardiovascular health. This was underscored by the recent inclusion of sleep duration as a health behavior in the American Heart Association's Life's Essential 8 for defining optimal cardiovascular health.

1.126 Randomized Controlled Trial of Sleep Extension Therapy Using a Remote Support System in University Students With Increased Social Jetlag

1.126 Randomized Controlled Trial of Sleep Extension Therapy Using a Remote Support System in University Students With Increased Social Jetlag