Sleep Irregularity Research Articles

Longitudinal associations between accelerometry-assessed sleep clusters and obesity in adolescence and young adulthood: the German GINIplus and LISA birth cohorts study

Abstract Background Some studies have identified diverse sleep patterns in adolescents and adults by considering multidimensional objective sleep parameters. However, whether sleep patterns are consistent from adolescence to young adulthood and their long-term associations with obesity remain unknown. Purpose This study aimed to investigate the longitudinal associations of objectively measured and clustering-identified sleep patterns with body mass index (BMI) and overweight/obesity in adolescence and young adulthood, and to test whether these associations change over time or are modified by genetic risk. Methods A total of 1973 participants wearing 7-day accelerometers in either 15-year (n=1347, aged 14.3-16.4 years) and/or 20-year (n=1262, aged 19.5-22.4 years) follow-ups of German GINIplus and LISA birth cohorts were included. Sleep clusters were identified by K-means cluster analysis on 12 accelerometry-assessed sleep characteristics at each follow-up. BMI and overweight/obesity were measured by physical exams or self-/parent-reported questionnaires. Multivariable linear and logistic regression models with generalized estimating equations were tested. The interaction effects with time of follow-ups and polygenic risk scores (PRS, n=1087) for BMI were further examined. Results Although sleep characteristics changed from adolescence to young adulthood, such as shorter total sleep time (mean 7.2 to 6.6 hours), the consistent five sleep clusters were classified in both periods: good sleep, delayed sleep phase, sleep irregularity and variability, fragmented sleep, and prolonged sleep latency. Compared to the "good sleep" cluster, the "prolonged sleep latency" cluster showed significant associations with higher BMI (β=0.56, 95% confidence interval (CI) = [0.06, 1.05]) and increased odds of overweight/obesity (odds ratio (OR)=1.55, 95%CI= [1.02, 2.34]). PRS was associated with higher BMI (β=0.65, 95%CI= [0.39, 0.91]) and overweight/obesity (OR=1.52, 95%CI= [1.15, 2.00]), with no significant gene-sleep cluster interaction effect. Only among males, the interaction effects with time of follow-ups on overweight/obesity were observed in the "delayed sleep phase", "sleep irregularity and variability", and "fragmented sleep" clusters (p-interaction <0.05), showing more harmful effects with increasing age. Conclusions Five sleep patterns were identified consistently across adolescence and young adulthood, and the "prolonged sleep latency" pattern was associated with higher BMI and overweight/obesity, independent of genetic risk. For young adult males, "delayed sleep phase", "sleep irregularity and variability" and "fragmented sleep" patterns seemed to have more unfavorable impacts on overweight/obesity.

Regular sleep habits in toddlers are associated with social development and brain coherence

ObjectiveAlthough sleep habits are associated with the development of toddlers, factors affecting social development and brain function remain unclear. We aimed to elucidate the relationship between sleep habits and social development as well as brain coherence in toddlers. MethodsWe used the data set at 1.5–2 years old, in the longitudinal study until 6 years old. We evaluated sleep parameters, such as average wake-up time, bedtime, nighttime sleep duration, total sleep duration, and the standard deviation (SD) of sleep habits. We also examined the development, including the social stimuli fixation percentage using Gazefinder® and electroencephalography (EEG) coherence between brain regions. ResultsSeventy-two children (37 boys and 35 girls) were included. The fixation percentage for the human face was negatively correlated with the SD of the total sleep duration, nighttime sleep duration, nap duration, and bedtime (r = −0.516, p = 0.000; r = −0.331, p = 0.005; r = −0.330, p = 0.005; and r = −0.324, p = 0.005, respectively). The EEG analysis indicated that α-band coherence in the right centro-parietal area was negatively correlated with the total sleep duration (r = −0.283, p = 0.016). The path diagram demonstrated a direct significant effect of sleep duration irregularity on development including social communication and fixation percentage for human faces. Additionally, total sleep duration exhibited a direct effect on α cortical coherence in the right centro-parietal area. ConclusionsIn this study, we found an association between sleep irregularity and the development of social communication, preference for humans, and brain coherence in toddlers. We suggest that regular sleep plays an important role in promoting the development of social communication.

Sleep Irregularity and the Incidence of Type 2 Diabetes: A Device-Based Prospective Study in Adults.

To prospectively examine the association between device-measured sleep regularity and incidence of type 2 diabetes (T2D) in a population-based sample of adults. We also examined if meeting sleep duration recommendations attenuated or eliminated the effects of irregular sleep on T2D. We conducted a prospective cohort study of adults aged 40-79 years participating in the UK Biobank accelerometer substudy. Participants wore wrist-attached accelerometers for a duration of 7 days, which was used to compute the Sleep Regularity Index (SRI). Participants were categorized as irregular (SRI <71.6), moderately irregular (SRI between 71.6 and 87.3), and regular (SRI >87.3) sleepers. T2D diagnosis was obtained through self-reports and health records. We analyzed data from 73,630 individuals observed for 8 years, without a history of T2D and without an event in the first year of follow-up. Compared with regular sleepers, irregular (hazard ratio [HR] 1.38; 95% CI 1.20-1.59) and moderately irregular sleepers (HR 1.35; 95% CI 1.19-1.53) were at higher risk of T2D incidence. Dose-response analyses treating SRI as a continuous measure showed higher T2D incidence with SRI scores <80. Meeting current sleep duration recommendations did not counteract the adverse effects of irregular (HR 1.35; 95% CI 1.09-1.66) or moderately irregular (HR 1.29; 95% CI 1.08-1.54) sleep on T2D incidence. Moderate and high sleep irregularity were deleteriously associated with T2D risk, even in participants who slept ≥7 h per night. Future sleep interventions will need to pay more attention to consistency in bedtimes and wake-up times, in addition to sleep duration and quality.

From the Workroom to the Bedroom: Work-to-Home Spillover as a Mechanism Linking Work Characteristics to Sleep Health.

Work may influence the home domain and subsequently impact employee sleep. Past work found that negative spillover mediated the relationship between perceived unfairness about work and insomnia symptoms across 20 years. As an extension of past work, this study investigated whether negative spillover and positive spillover mediate the relationship between job demands (perceived unfairness, job discrimination) and job resources (coworker and supervisor support) on multidimensional sleep health. Two waves of survey data from a subset of full-time workers were obtained from the Midlife in the United States Study approximately 10 years apart. A sleep health composite captured irregularity, dissatisfaction, nap frequency, inefficiency, and suboptimal sleep duration (higher=more sleep health problems). PROCESS Macro evaluated cross-sectional (T1) and sequential (T1 exposureaT1 mediatoraT2 outcome) mediation pathways, adjusting for sociodemographic characteristics, physical health, neuroticism, and work hours. Both cross-sectionally and prospectively, higher negative spillover mediated the association of higher unfairness with more sleep health problems, and the association between higher discrimination and more sleep health problems. There was no support for positive spillover as a mediator between job resources and sleep health cross-sectionally or prospectively. Findings suggest that organizations should reduce the amount of negative spillover by limiting instances of unfairness and discrimination at work to promote specific aspects of employee sleep health such as sleep irregularity, dissatisfaction, efficiency, and nap frequency.

Sleep duration irregularity and risk for incident cardiovascular disease in the UK Biobank.

Emerging evidence supports a link between circadian disruption as measured by higher night-to-night variation in sleep duration and increased risk of cardiovascular disease (CVD). It remains unclear whether this association varies by CVD types or may be modified by average sleep duration and genetic risk for CVD. Our prospective analysis included 86,219 UK Biobank participants who were free from CVD when completing 7 days of accelerometer measurement in 2013-2016. Sleep irregularity was evaluated by the standard deviation (SD) of accelerometer-measured sleep duration over 7 days. Incident major CVD events, defined as fatal or nonfatal myocardial infarction (MI) and stroke, were identified through linkage to Hospital Episode Statistics data until May 31, 2022. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs for associations of sleep duration SD with risk for major CVD events overall and for MI and stroke separately. We documented 2,310 incident cases of major CVD events (MI: 1,183, stroke: 1,175) over 636,258 person-years of follow-up. After adjusting for sociodemographic factors and family history of CVD, the HR (95% CI) associated with a 1-hour increase in sleep duration SD was 1.19 (1.10, 1.27) for CVD (p-trend<0.0001), 1.23 (1.11, 1.35) for MI (p-trend<0.0001), and 1.17 (1.05, 1.29) for stroke (p-trend=0.003). Additional adjustment for lifestyle factors, co-morbidities and sleep-related factors modestly attenuated these associations. Higher sleep irregularity was associated with higher CVD risk irrespective of genetic risk (p-interaction=0.43), but this association was stronger among individuals with longer average sleep duration >8 hours (p-interaction=0.006). Higher night-to-night variation in accelerometer-measured sleep duration was associated with consistently higher risks for major CVD events. The association did not seem to be modified by genetic risk for CVD and was more pronounced in long sleepers.

Sleep patterns and risk of chronic disease as measured by long-term monitoring with commercial wearable devices in the All of Us Research Program

Poor sleep health is associated with increased all-cause mortality and incidence of many chronic conditions. Previous studies have relied on cross-sectional and self-reported survey data or polysomnograms, which have limitations with respect to data granularity, sample size and longitudinal information. Here, using objectively measured, longitudinal sleep data from commercial wearable devices linked to electronic health record data from the All of Us Research Program, we show that sleep patterns, including sleep stages, duration and regularity, are associated with chronic disease incidence. Of the 6,785 participants included in this study, 71% were female, 84% self-identified as white and 71% had a college degree; the median age was 50.2 years (interquartile range = 35.7, 61.5) and the median sleep monitoring period was 4.5 years (2.5, 6.5). We found that rapid eye movement sleep and deep sleep were inversely associated with the odds of incident atrial fibrillation and that increased sleep irregularity was associated with increased odds of incident obesity, hyperlipidemia, hypertension, major depressive disorder and generalized anxiety disorder. Moreover, J-shaped associations were observed between average daily sleep duration and hypertension, major depressive disorder and generalized anxiety disorder. These findings show that sleep stages, duration and regularity are all important factors associated with chronic disease development and may inform evidence-based recommendations on healthy sleeping habits.

Why circadian rhythmicity matters: Associations between sleep irregularity and mental health conditions during the Covid-19 health crisis

Objective To assess the association between sleep irregularity, anxiety, and depression while controlling for other sleep dimensions and using a longitudinal design. Methods Longitudinal cohort study which started in April 2020 during the first French lockdown in the general population. Follow-up questionnaires were completed in June 2020, a period without lockdown measures. Participants were asked about their sleep (regularity, duration, timing, complaints) and their anxiety (General Anxiety Disorder-7) and depressive (Patient Health Questionnaire-9) symptoms. Results A total of 3745 participants were included (mean age: 28.9 years) with 2945 women (78.6%). At baseline, 38.1% (1428) of participants reported irregular sleep timing, 23.8% (891) anxiety and 28.9% (1081) depressive symptoms. In cross-sectional analyses, irregular sleep timing was associated with a 2.5-fold higher likelihood of anxiety and a 4-fold higher likelihood of depressive symptoms compared to regular sleepers. Associations were not explained by the other sleep dimensions and persisted in a longitudinal analysis, with irregular sleep timing at baseline being associated with anxiety (OR = 3.27[1.58–6.76]) and depressive symptoms (OR = 3.45[1.66–7.19]) during follow-up. Conclusion The results show a strong association between sleep irregularity and mental health. Furthers studies are needed to explore how sleep regularity could promote good mental health in non-clinical populations.

Association between dysphagia risk and sleep quality in community-dwelling older adults: A cross-sectional study

ObjectivesExploring the effects of swallowing function on sleep quality could provide valuable insights into the potential impact of reduced swallowing function on sleep. However, pertinent studies are limited. Therefore, this study aimed to investigate the relationship between dysphagia risk and sleep health in community-dwelling older adults. MethodsData for this cross-sectional study were obtained from the Shizuoka and Daiko studies conducted as part of the Japan Multi-Institutional Collaborative Cohort Study. Information on demographics, overall lifestyle, dysphagia risk, as well as sleep quality, duration, satisfaction, and regularity, was obtained using a self-administered questionnaire. Dysphagia risk and sleep quality were assessed using the Dysphagia Risk Assessment Questionnaire for the Community-dwelling Elderly and the Japanese version of the Pittsburgh Sleep Questionnaire Index, respectively. Multivariate logistic regression, adjusted for covariates, was employed to assess the association between dysphagia risk and sleep health. ResultsAmong the 3058 participants (1633 males, 1425 females) aged ≥60 years, 28.0 % exhibited dysphagia risk, and 19.1 % reported poor sleep quality. Those with dysphagia risk were more likely to experience poor sleep quality than those without dysphagia risk. In male participants, dysphagia was significantly associated with poor sleep quality, unsatisfactory sleep, and sleep irregularity, but was not significantly associated with unsatisfactory or irregular sleep in female participants. The Japanese version of the Pittsburgh Sleep Questionnaire Index components—subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction—were associated with dysphagia risk in both sexes. ConclusionsDysphagia risk is associated with sleep quality in older individuals in Japan. Thus, preserving swallowing function may contribute to enhancing sleep quality.

Sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with and without childhood systemic lupus erythematosus.

We undertook a study to describe and compare sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with childhood systemic lupus erythematosus (cSLE) to a healthy comparison group of youth and test the associations between sleep and symptoms of pain, fatigue, and depressed mood in youth with cSLE. Forty-three youth (23 youth with cSLE; 20 age- and sex-matched healthy youth) wore actigraphs and completed sleep diaries for 10 days and completed self-report questionnaires on sleep quality, pain, fatigue, and depressed mood. On average, both groups had a total sleep time of less than 7 hours. Youth with cSLE had worse sleep efficiency (73.3%) and sleep regularity index scores (55.4) compared to the healthy comparison group of youth (79.2% and 60.1, respectively). Youth with cSLE had worse pain (P = .03) and fatigue (P = .004) compared to the healthy comparison group. Negative associations were found among self-reported sleep quality, sleep satisfaction, and symptoms of pain, fatigue, and depressed mood in youth with cSLE and wake after sleep onset was positively associated with fatigue. Poor sleep efficiency and sleep irregularity accompanied by symptoms of pain, fatigue, and depressed mood was prevalent in youth with cSLE. Youth with lupus should be encouraged to maintain a regular sleep schedule. Because this is the first study to incorporate objective sleep and sleep regularity measures in youth with cSLE, additional studies with objective and self-reported sleep measures are needed to replicate our findings. Wi D, Palermo TM, Stevens A, Ward TM. Sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with and without childhood systemic lupus erythematosus. J Clin Sleep Med. 2024;20(10):1607-1614.

Evening and Morning-After Aortic Wave Reflection Responses to Binge Alcohol Consumption

Binge alcohol consumption acutely increases blood pressure and disrupts sleep. Recently, sleep irregularity has been linked to increases in aortic blood pressure. Increases in aortic wave reflection (i.e., aortic augmentation index) are associated with hypertension and cardiovascular risk. The purpose of the present study was to investigate the acute and next morning effects of evening binge alcohol consumption on aortic wave reflection. We tested the hypothesis that aortic augmentation index normalized to 75 heart beats per minute (AIx@75) and aortic pulsatile load (APL) would be increased acutely after binge drinking in the evening (study 1), and also the morning-after binge drinking compared to the morning after fluid control (study 2). Participants (n=33; 52% women; age 25±1 years; BMI 27±1 kg/m2) arrived at the laboratory at 4:00pm for baseline blood pressure and SphygmoCor (CPVH, Sydney, Australia) measures, and were provided a standardized meal verified by a registered dietitian. In a randomized order, separated by one month, participants completed a binge alcohol protocol (4-5 alcoholic drink equivalents within 2 hours) or fluid control. Alcohol or fluid control doses were administered in two equal allocates at 8 and 9 pm, and participants were provided 15 min to consume during each period. Binge alcohol consisted of a 1:3 mixture of 190 proof grain ethanol and fruit juice (i.e., Orange or Cranberry Juice) based on body weight and sex (1g/kg men, 0.85g/kg women), while the fluid control was only fruit juice in equal volume. Study 1 examined blood pressure, heart rate, aortic pulse pressure, APL, and AIx@75 before the standardized meal and then thirty minutes post-consumption of each allocated beverage using repeated measures ANOVA with condition (alcohol vs. fluid control) and time (baseline, post-drink 1, and post-drink 2) as within-subjects factors. Study 2 examined the same variables as study 1, but within 15 minutes of waking the morning after binge alcohol or fluid control using paired T-tests. Means were considered significantly different when p&lt;0.05. In study 1, fluid control decreased HR and APL after doses one and two, while HR and APL were increased after the second dose of alcohol (time x cond. p&lt;0.001). In study 2, morning-after HR was increased with binge alcohol compared to fluid control (57±1 vs. 63±2 beats/min; p&lt;0.001). Morning-after APL (1857±66 vs. 2060±82 a.u.; p=0.012) and AIx@75 (2.9±2.5 vs. 6.5±2.4%; p=0.042) were also elevated in the binge alcohol condition. Our results indicate binge alcohol consumption acutely increases HR and APL the evening of consumption and increases HR, APL, and AIx@75 the morning after. These findings highlight a potential key physiological contributor to the known associations between binge alcohol consumption and cardiovascular risk. NIH (AA-024892). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

0208 Sleep Irregularity Predicts Emotional Change After Sleep Restriction Among School-aged Children

0208 Sleep Irregularity Predicts Emotional Change After Sleep Restriction Among School-aged Children

A Mixed-Methods, Multimedia Pilot Study to Investigate Sleep Irregularity Determinants Among Undergraduate Students.

To pilot a novel approach investigating the interplay of social and institutional determinants influencing university undergraduate student sleep patterns. A two-part, three-phase mixed-methods approach. A mid-size US university conducted in spring and fall 2020. 191 undergraduate students (69 first-years, 43 second-years, 48 third-years, 31 fourth-years). For Part A, participants texted their activities and emotions in real time, producing a data-rich, weeklong diary of comprehensive activity logs, emoticons, multimedia submissions, and juxtapositions of ideal vs real schedules. Semi-structured contextual interviews were also conducted. For Part B, a one-time survey examined Part A insights across all class years. These diverse datasets were triangulated using thematic, comparative, and content analyses through MAXQDA software and visual mapping methods. Three preliminary themes were identified as encouraging an irregular sleep schedule: a prevailing academic ethos emphasizing busyness, time management challenges, and the rhythm of institutional schedules and deadlines. An overarching theme suggests that perceptions of peer sleep habits and academic prioritization above all else could be influential across factors. This pilot study indicates that sleep regularity among undergraduates is potentially shaped by individual choices combined with broader institutional paradigms. While it is limited by its exploratory nature, timing, and small sample size, the results highlight the promise of this methodology for more extensive studies and suggest that future interventions should emphasize systemic changes that prioritize sleep.

Abstract MP39: Circadian Misalignment Increases the Impact of Visceral Adiposity on Metabolic Syndrome Independent of Nutrition and Physical Activity in Adolescents

Introduction: Although insufficient sleep is a known risk factor for metabolic syndrome (MetS), the circadian timing of sleep is also involved in cardiometabolic risk. Prior studies have shown that circadian misalignment, which is highly prevalent during adolescence, impacts the association of visceral adiposity (VAT) with MetS burden in youth. However, whether lifestyle behaviors mediate this effect remains unknown. Hypothesis: We hypothesize that diet and physical activity will mediate the impact of circadian misalignment on the relationship between VAT and MetS in adolescents. Methods: We analyzed data from 277 population-based adolescents from the Penn State Child Cohort (median 16.2 years; 48% female; 22% racial/ethnic minority) who had 5-night actigraphy (ACT) and were evaluated while in-school (n=177) or on-break (n=100). They also had 9-h polysomnography (PSG), a dual-energy X-ray absorptiometry (DXA) scan, ACT-measured physical activity, and dietary assessment (DA-80). DXA-measured VAT was the predictor. MetS score (i.e., age/sex-adjusted z-scores of waist circumference, blood pressure, HOMA-IR, triglycerides, and HDL cholesterol) was the outcome. ACT-measured sleep midpoint (SM), sleep irregularity (SI), and social jetlag (SJL) were the effect modifiers. Linear regression models were first adjusted for essential covariates (i.e., sex, race/ethnicity, age, ACT-sleep duration, ACT-sleep variability, and PSG-apnea/hypopnea index), and, thereafter, for potential mediators (i.e., total caloric intake, protein, fat, carbohydrates, bouts and amount of sedentary behavior, and moderate-to-vigorous physical activity). Results: Significant effect modifications were found between VAT and SM, SI and SJL while in-school on MetS after adjusting for essential covariates (interaction effects: 0.61 (0.25) p=0.014, 0.37 (0.16) p=0.018, and 0.58 (0.23) p=0.011, respectively). Despite SM, SI or SJL being associated with caloric intake (e.g., r=0.160, P=0.017 for carbohydrates) or physical activity (e.g., r=0.217, P=0.003 for bouts of sedentary behavior), these effect modifications were not significantly impacted by further adjusting for caloric intake, including carbohydrates [interaction effects: 0.52 (0.24) p=0.030, 0.36 (0.15) p=0.017, and 0.59 (0.21) p=0.005, respectively], or physical activity, including bouts of sedentary behavior [interaction effects: 0.61 (0.25) p=0.015, 0.38 (0.16) p=0.017, and 0.58 (0.23) p=0.012, respectively]. Conclusions: Lifestyle factors such as nutrition or physical activity do not significantly account for the role that circadian misalignment has in increasing the impact of VAT on MetS burden in adolescents. Therefore, other pathways, biological or behavioral, may be involved in how circadian misalignment contributes to the development of cardiometabolic sequelae associated with central obesity.

Abstract 24: Actigraphy-Measured Sleep Irregularity Increases the Risk of Incident Cardiovascular Disease and Cardiovascular Mortality in Older Women

Background: Cardiovascular disease (CVD) is the leading cause of death for U.S. women. Our understanding of how poor sleep health contributes to CVD is limited by reliance on cross-sectional studies, self-reported sleep measures, and predominately non-Hispanic white samples. Our objective was to prospectively investigate actigraphy-measured sleep health and incident CVD and CVD mortality in a cohort of older multiethnic women. Methods: Women (n=3,992; mean age: 78.5 years, 33% African American, 17% Hispanic/Latino) enrolled in the Women’s Health Initiative OPACH (Objective Physical Activity and Cardiovascular Health) study wore an Actigraph GT3X+ accelerometer for 7 days in May 2012-April 2014 and were followed through February 2022 for physician-adjudicated incident CVD (definition in Table footnote) and CVD mortality. Sleep duration, timing, efficiency, irregularity, and continuity were derived from accelerometers (definition in Table footnote). Women with prior CVD at baseline were excluded from analyses. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Minimally adjusted models included age, race and ethnicity. Models were additionally adjusted for education, smoking, alcohol consumption, comorbid conditions, self-rated health, and CVD risk factors. Results: Over a median of 8.3 years of follow-up, 636 incident CVD cases occurred, including 395 CVD deaths. In minimally adjusted models, longer sleep duration, greater sleep irregularity, and more wake after sleep onset were associated with increased CVD risk (Table 1). In models further adjusted for CVD risk factors, the HR (95% CI) for a 60-minute increase in sleep irregularity was 1.18 (1.01-1.37) for incident CVD and 1.30 (1.07-1.58) for CVD mortality. Conclusions: Greater sleep irregularity was associated with higher risk of incident CVD and CVD mortality in a diverse cohort of older women. These results support the importance of maintaining regular sleep for cardiovascular health.

Estimation bias and agreement limits between two common self-report methods of habitual sleep duration in epidemiological surveys

Accurate measurement of habitual sleep duration (HSD) is crucial for understanding the relationship between sleep and health. This study aimed to assess the bias and agreement limits between two commonly used short HSD self-report methods, considering sleep quality (SQ) and social jetlag (SJL) as potential predictors of bias. Data from 10,268 participants in the International COVID Sleep Study-II (ICOSS-II) were used. Method-Self and Method-MCTQ were compared. Method-Self involved a single question about average nightly sleep duration (HSDself), while Method-MCTQ estimated HSD from reported sleep times on workdays (HSDMCTQwork) and free days (HSDMCTQfree). Sleep quality was evaluated using a Likert scale and the Insomnia Severity Index (ISI) to explore its influence on estimation bias. HSDself was on average 42.41 ± 67.42 min lower than HSDMCTQweek, with an agreement range within ± 133 min. The bias and agreement range between methods increased with poorer SQ. HSDMCTQwork showed less bias and better agreement with HSDself compared to HSDMCTQfree. Sleep duration irregularity was − 43.35 ± 78.26 min on average. Subjective sleep quality predicted a significant proportion of variance in HSDself and estimation bias. The two methods showed very poor agreement and a significant systematic bias, both worsening with poorer SQ. Method-MCTQ considered sleep intervals without adjusting for SQ issues such as wakefulness after sleep onset but accounted for sleep irregularity and sleeping in on free days, while Method-Self reflected respondents’ interpretation of their sleep, focusing on their sleep on workdays. Including an SQ-related question in surveys may help bidirectionally adjust the possible bias and enhance the accuracy of sleep-health studies.

Obstructive Sleep Apnea, but not markers of Sleep Irregularity nor Sleep Duration, is associated with Metabolic Syndrome: the ELSA-Brasil study

Obstructive Sleep Apnea, but not markers of Sleep Irregularity nor Sleep Duration, is associated with Metabolic Syndrome: the ELSA-Brasil study

Temporal pathways between circadian rhythm, depression and anxiety in the transition from adolescence to early adulthood

BackgroundSleep and circadian rhythm problems intertwine with affective disorders. Adolescents are particularly vulnerable to developing sleep and affective problems. Yet, the temporal pathways between circadian rhythm, depression and anxiety in the transition phase from adolescence to early adulthood are not fully understood. Methods233 adolescents (76 % females) participated at two time points (T1 and T2) at an interval of 19-months (aged 16.8 and 18.4 years). We used The Beck Depression Inventory-II, Generalized Anxiety Disorder Assessment, GENEActiv actigraphy across 8 days (delayed sleep phase (DSP), sleep duration, midpoint, and regularity), and iButton 1922L thermologgers across 3 days (intrinsic circadian period length, amplitude, and mesor). ResultsA shorter sleep duration at T1 associated with an increase in affective problems at T2, and affective problems at T1 associated with an increase in sleep irregularity at T2. A longer circadian period at T1 associated with an increase in males' affective problems at T2. Moderate to severe depression and anxiety at T1 associated with a 2.69-fold risk (95 % CI 1.38–5.26, p = 0.004) and 2.11-fold risk (95 % CI 1.04–4.25, p = 0.038) of poor sleep quality at T2. Moderate to severe generalized anxiety associated with a 3.17-fold risk (95 % CI 1.35–7.41, p = 0.008) of DSP at T2. LimitationsThe follow-up period is short. ConclusionsThe results revealed bidirectional temporal links between sleep and affective problems. Novel observations include a heightened risk of future DSP following a current anxiety disorder and a heightened risk of affective problems following a longer circadian period measured from the 24-hour temperature variation in males.

The interrelationships between sleep regularity, obstructive sleep apnea, and hypertension in a middle-aged community population.

Little is known about the interrelationships between sleep regularity, obstructive sleep apnea (OSA) and important health markers. This study examined whether irregular sleep is associated with OSA and hypertension, and if this modifies the known association between OSA and hypertension. Six hundred and two adults (age mean(SD) = 56.96(5.51) years, female = 60%) from the Raine Study who were not evening or night shift workers were assessed for OSA (in-laboratory polysomnography; apnea-hypopnea index ≥ 15 events/hour), hypertension (doctor diagnosed, or systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg) and sleep (wrist actigraphy for ≥5 days). A sleep regularity index (SRI) was determined from actigraphy. Participants were categorized by tertiles as severely irregular, mildly irregular, or regular sleepers. Logistic regression models examined the interrelationships between SRI, OSA and hypertension. Covariates included age, sex, body mass index, actigraphy sleep duration, insomnia, depression, activity, alcohol, smoking, and antihypertensive medication. Compared to regular sleepers, participants with mildly irregular (OR 1.97, 95% confidence intervals [CI] 1.20 to 3.27) and severely irregular (OR 2.06, 95% CI: 1.25 to 3.42) sleep had greater odds of OSA. Compared to those with no OSA and regular sleep, OSA and severely irregular sleep combined had the highest odds of hypertension (OR 2.34 95% CI: 1.07 to 5.12; p for interaction = 0.02) while those with OSA and regular/mildly irregular sleep were not at increased risk (p for interaction = 0.20). Sleep irregularity may be an important modifiable target for hypertension among those with OSA.

A descriptive study of sleep patterns and knowledge among department of juvenile services staff

Abstract Study Objectives Little is known about sleep health among staff in the US juvenile justice system. Poor sleep health is associated with negative mental and physical health, which may impact daily interactions and treatment of detained youth. The current study explored sleep–wake patterns and sleep health knowledge of Department of Juvenile Services (DJS) staff in Maryland (MD). Methods DJS Staff (N = 218) were invited to complete a survey that queried staff on their own sleep–wake patterns, job role and schedule, and knowledge of youth sleep needs. Descriptive analyses and multivariate analyses of variance (MANCOVA) were conducted to summarize workers’ sleep–wake patterns and examine differences by staff position and schedule. Results Fifty-one percent of staff served as RAs who directly supervise the youth. Just over half (55%) worked in detention and 45% in treatment facilities. Staff reported sleeping 7.24 hours (SD = 4.10) on workdays and 8.59 hours (SD = 2.69) on non-workdays. RA staff working night/rotating versus day shifts reported the most sleep irregularity with larger weekend oversleep times. A little more than half of the staff (53.9%) were knowledgeable regarding youth sleep health with differences by position type. Conclusions Findings show that DJS staff are meeting recommended sleep duration guidelines but are still experiencing sleep schedule and time in bed irregularity. Knowledge variability of youth sleep health across staff may necessitate focused educational programming. Overall, this study may inform future development and prioritization of sleep and circadian health interventions and educational campaigns for staff who work with detained juveniles. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

Causal Association Between Subtypes of Excessive Daytime Sleepiness and Risk of Cardiovascular Diseases.

Excessive daytime sleepiness (EDS), experienced in 10% to 20% of the population, has been associated with cardiovascular disease and death. However, the condition is heterogeneous and is prevalent in individuals having short and long sleep duration. We sought to clarify the relationship between sleep duration subtypes of EDS with cardiovascular outcomes, accounting for these subtypes. We defined 3 sleep duration subtypes of excessive daytime sleepiness: normal (6-9 hours), short (<6 hours), and long (>9 hours), and compared these with a nonsleepy, normal-sleep-duration reference group. We analyzed their associations with incident myocardial infarction (MI) and stroke using medical records of 355 901 UK Biobank participants and performed 2-sample Mendelian randomization for each outcome. Compared with healthy sleep, long-sleep EDS was associated with an 83% increased rate of MI (hazard ratio, 1.83 [95% CI, 1.21-2.77]) during 8.2-year median follow-up, adjusting for multiple health and sociodemographic factors. Mendelian randomization analysis provided supporting evidence of a causal role for a genetic long-sleep EDS subtype in MI (inverse-variance weighted β=1.995, P=0.001). In contrast, we did not find evidence that other subtypes of EDS were associated with incident MI or any associations with stroke (P>0.05). Our study suggests the previous evidence linking EDS with increased cardiovascular disease risk may be primarily driven by the effect of its long-sleep subtype on higher risk of MI. Underlying mechanisms remain to be investigated but may involve sleep irregularity and circadian disruption, suggesting a need for novel interventions in this population.