Sleep Outcomes In Adults Research Articles

Protein intake and its effect on sleep outcomes: a systematic review and meta-analysis of randomized controlled trials.

Poor sleep is increasingly seen as an issue of public health concern. In recent years, there has been growing interest in protein as a route to improve sleep outcomes; however, the evidence is limited and inconclusive. To examine, using a systematic review and meta-analysis, the effect of increased protein intake (≥1 g/kg//d, ≥25% of total energy intake, or protein supplementation of ≥10 g/d/) on sleep outcomes in adults. On November 30, 2021, 5 electronic databases were searched to identify relevant randomized controlled trials (PubMed, Cochrane, Embase, Web of Science, and CINAHL Plus). Risk of bias was assessed using the Cochrane Risk-of-Bias tool, version 2.0. Five sleep outcomes were included in this systematic review (sleep quality [SQ], sleep latency [SL], sleep efficiency [SEff], sleep time [ST], wake episodes, and other sleep outcomes) and 4 in the meta-analysis (SQ, SL, SEff, and ST). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Twelve intervention studies reported on in 10 articles were included. The qualitative analyses showed that increased protein consumption has little influence on sleep outcomes. Only subjective SQ was positively associated with protein consumption in a few studies. Meta-analyses also showed no significant effect of increased protein intake on sleep outcomes (number of studies for SQ, ST, SL, and SEff: 8, 8, 7, and 6, respectively), with very low certainty of evidence. However, results from sensitivity analyses, excluding high-risk studies, suggest a small effect on SQ in favor of high protein intake (mean difference, -4.28; 95%CI, -7.77, -0.79; on a scale from 0 to 100). This systematic review and meta-analysis indicate there is no clear relationship between increased protein intake and sleep. However, the strength of the evidence is low and more randomized controlled trials that focus on this specific research question are warranted. Systematic Review Registration: PROSPERO registration no. CRD42020196021.

692 Longitudinal Stability of Sleep and Health Correlates in Adults with Autism Spectrum Disorder

Abstract Introduction Individuals with Autism Spectrum Disorder (ASD) experience sleep disturbances to a greater degree than the general population. The majority of research investigating sleep disturbances in ASD has focused on children and adolescents. The aim of the current study was to determine the stability and health correlates of self-reported sleep disturbances in adults with ASD. Methods Participants included 55 adults with ASD recruited from state-funded Pennsylvania programs (31.2±7.6 years old, 80% male, 10.9% minority). Patient-Reported Outcomes Measurement Information System (PROMIS) measures assessing Sleep Disturbances, Sleep-Related Impairment, Fatigue, Anxiety, Depression, Anger, and Physical Health, were completed at baseline and every 90 ± 14 days over a 2-year period. Intraclass correlation coefficients (ICC) were calculated for each sleep outcome, and interpreted as 0.00–0.20=“poor stability,” 0.21–0.40=“slight stability,” 0.41–0.60=“moderate stability,” 0.61–0.80=“substantial stability,” and 0.81–1.00=“almost perfect stability” across the first three time-points. Linear mixed models examined the independent association of sleep disturbances, sleep-related impairment, and fatigue on anxiety, depression, anger, and physical health over the two-year period. Results Sleep-related impairment (ICC=0.73) and fatigue (ICC=0.64) were substantially stable, while sleep disturbances were moderately stable (ICC=0.58). All three sleep-related outcomes were independently associated with anxiety (sleep-related impairment p=0.012; sleep disturbance p<0.001; fatigue p=<0.001) and anger (sleep-related impairment p=<0.001; sleep disturbance p=0.001; fatigue p<0.001) across the two-year period. Sleep disturbance (p=<0.001) and fatigue (p<0.001), but not sleep-related impairment (p=0.267), were associated with depression across the two-year period. In contrast, none of the sleep-related outcomes (sleep-related impairment p=0.285; sleep disturbance p=0.250; fatigue p=0.709) were associated with physical health over time. Conclusion Measures of sleep-related impairment, fatigue, and sleep disturbance remained stable over time, suggesting that they can provide clinicians and researchers with a brief, accurate, and reliable way to assess patient-reported sleep outcomes in adults with ASD. Furthermore, given the stability of these sleep measures and their independent association with elevated mental health outcomes, there is a need for evidence-based treatments targeting sleep difficulties and associated symptomology in adults with ASD, a particularly underserved population. Support (if any) Pennsylvania State Bureau of Autism Services through the Autism Services, Education, Resources, and Training (ASERT) grant

349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis

Abstract Introduction Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain. Methods A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs). Results The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue. Conclusion This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes. Support (if any):

Feasibility and efficacy of a physical activity intervention for managing restless legs syndrome in multiple sclerosis: Results of a pilot randomized controlled trial

BackgroundThis pilot randomized controlled trial examined the feasibility and efficacy of a physical activity behavior change intervention for improving restless legs syndrome (RLS) severity and secondary sleep outcomes among a sample of adults with multiple sclerosis (MS). MethodsParticipants with MS(N=15) were randomly assigned into intervention(n=8) or waitlist control(n=7) conditions. The physical activity intervention was delivered over a 16-week period and outcomes were assessed at baseline and immediately following the 16-week period in both conditions. ResultsThere was a significant, positive effect of the intervention on overall RLS severity (p=.01;ηρ2=.43), severity during the night(p=.03,ηρ2=.35), severity during the day while resting(p=.01,ηρ2=.44), and severity during the day while active(p<.01,ηρ2=.61), and non-significant improvements in RLS severity while falling asleep (p=.33,ηρ2=.09). There were significant positive effects on sleep satisfaction(p<.01,ηρ2=.49) and non-significant improvements in self-reported global sleep quality(p=.35,ηρ2=.08). There was a significant intervention effect on self-reported time in bed(p=.03,ηρ2=.37) and total sleep time(p=.03,ηρ2=.36), and non-significant improvements in self-reported sleep latency (p=.08,ηρ2=.25), sleep efficiency(p=.27,ηρ2=.11), and daytime sleepiness (p=.52,ηρ2=.04;p=.35,ηρ2=.08;p=.51,ηρ2=.04). There was no significant effect of the intervention on device-measured sleep quality. ConclusionsWe provide preliminary evidence for the feasibility and efficacy of a physical activity intervention for reducing RLS severity and potentially improving self-reported sleep outcomes in adults with MS. ClinicalTrials.gov Identification NumberNCT04061681

Food Insecurity Is Associated with Suboptimal Sleep Quality Among Low-income Head Start Preschool-aged Children (P04-071-19)

ObjectivesInsufficient and/or poor child sleep has long-term health impacts across the life span. Food insecurity is prevalent among low-income populations and it is associated with adverse mental health and sleep outcomes in adults. Little is known about its influence on sleep in young children. We examined the association between food insecurity and sleep outcomes, and investigated whether parent psychosocial factors mediated such associations in a sample of preschool-aged children from low-income families. MethodsEligible children enrolled in Head Start were included in the analytic sample (n = 362). Usual wake and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the 18-item USDA Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel test were applied to test the mediating effect of individual parent psychosocial factors. ResultsPrevalence of household, adult, and child food insecurity was 37.3%, 31.8% and 17.7%, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine frequency. Child food insecurity, but not household or adult food insecurity, was associated with 2.25 times increased odds (95%CI: 1.11, 4.55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy, and depressive symptomology mediated less than 2% of the observed effect (all Sobel test p-values > 0.6). ConclusionsFood insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse sleep outcomes in children. Funding SourcesNone.

The Effect of Mind-Body Therapies on Insomnia: A Systematic Review and Meta-Analysis.

Background/Purpose Sleep plays an important role in individuals' health. The functions of the brain, the cardiovascular system, the immune system, and the metabolic system are closely associated with sleep. As a prevalent sleep disorder, insomnia has been closely concerned, and it is necessary to find effective therapies. In recent years, a growing body of studies has shown that mind-body therapies (MBTs) can improve sleep quality and ameliorate insomnia severity. However, a comprehensive and overall systematic review has not been conducted. In order to examine the effect of MBTs on insomnia, we conducted a systematic review and meta-analysis evaluating the effects of MBTs on sleep quality in healthy adults and clinical populations. Methods PubMed, EMBASE, the Cochrane Library, and review of references were searched up to July 2018. English language studies of all designs evaluating the effect of MBTs on sleep outcomes in adults with or without diseases were examined. To calculate the SMDs and 95% CIs, we used a fixed effect model when heterogeneity was negligible and a random effect model when heterogeneity was significant. Results 49 studies covering 4506 participants published between 2004 and 2018 were identified. Interventions included meditation, tai chi, qigong, and yoga which lasted 4 to 24 weeks. The MBTs resulted in statistically significant improvement in sleep quality and reduction on insomnia severity but no significant effects on sleep quantity indices, which were measured by sleep diary or objective measures. We analyzed the effects of tai chi and qigong separately as two different MBTs for the first time and found that qigong had a slight advantage over tai chi in the improvement of sleep quality. Subgroup analyses revealed that the effect of MBTs on sleep quality in healthy individuals was larger than clinical populations. The effect of MBTs might be influenced by the intervention duration but not the frequency. Conclusions MBTs can be effective in treating insomnia and improving sleep quality for healthy individuals and clinical patients. More high-quality and well-controlled RCTs are needed to make a better conclusion in further study.

Exercise and sleep: a systematic review of previous meta-analyses.

Conduct a systematic review of previous meta-analyses on exercise and sleep outcomes in adults and a meta-analysis of studies nested within these meta-analyses. Meta-analyses of randomized controlled exercise interventions were included by searching nine electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality of meta-analyses was assessed using AMSTAR and quality of evidence using GRADE. Random-effects models were used to pool results from the individual studies included in each meta-analysis. Three meta-analyses representing 950 adults were included. Methodological quality ranged from 36% to 64% while quality of evidence was very low to low. Statistically significant improvements (P ≤ 0.05) were observed for the apnea-hypopnea index (AHI), overall sleep quality, global score, subjective sleep, and sleep latency. The number-needed-to-treat (NNT) and percentile improvements ranged from 4 to 7 and from 18.1 to 26.5, respectively. When overall sleep quality results from individual studies nested within different meta-analyses were pooled, statistically significant standardized mean difference (SMD) improvements were observed (-0.50, 95% CI -0.72 to -0.28). The NNT and percentile improvement were 7 and 19, respectively. Exercise improves selected sleep outcomes in adults. To increase public health reach, a large, well-designed, and more inclusive meta-analysis is needed.

A comparison of personality factors emerging within different English-speaking cultures

This pilot randomized controlled trial examined the feasibility and efficacy of a physical activity behavior change intervention for improving restless legs syndrome (RLS) severity and secondary sleep outcomes among a sample of adults with multiple sclerosis (MS).Participants with MS(N=15) were randomly assigned into intervention(n=8) or waitlist control(n=7) conditions. The physical activity intervention was delivered over a 16-week period and outcomes were assessed at baseline and immediately following the 16-week period in both conditions.There was a significant, positive effect of the intervention on overall RLS severity (p=.01;ηρ2=.43), severity during the night(p=.03,ηρ2=.35), severity during the day while resting(p=.01,ηρ2=.44), and severity during the day while active(p<.01,ηρ2=.61), and non-significant improvements in RLS severity while falling asleep (p=.33,ηρ2=.09). There were significant positive effects on sleep satisfaction(p<.01,ηρ2=.49) and non-significant improvements in self-reported global sleep quality(p=.35,ηρ2=.08). There was a significant intervention effect on self-reported time in bed(p=.03,ηρ2=.37) and total sleep time(p=.03,ηρ2=.36), and non-significant improvements in self-reported sleep latency (p=.08,ηρ2=.25), sleep efficiency(p=.27,ηρ2=.11), and daytime sleepiness (p=.52,ηρ2=.04;p=.35,ηρ2=.08;p=.51,ηρ2=.04). There was no significant effect of the intervention on device-measured sleep quality.We provide preliminary evidence for the feasibility and efficacy of a physical activity intervention for reducing RLS severity and potentially improving self-reported sleep outcomes in adults with MS.NCT04061681

Tai Chi Improves Sleep Quality in Healthy Adults and Patients with Chronic Conditions: A Systematic Review and Meta-analysis.

Physical activity and exercise appear to improve sleep quality. However, the quantitative effects of Tai Chi on sleep quality in the adult population have rarely been examined. We conducted a systematic review and meta-analysis evaluating the effects of Tai Chi on sleep quality in healthy adults and disease populations. Medline, Cochrane Central databases, and review of references were searched through July 31, 2013. English-language studies of all designs evaluating Tai Chi's effect on sleep outcomes in adults were examined. Data were extracted and verified by 2 reviewers. Extracted information included study setting and design, population characteristics, type and duration of interventions, outcomes, risk of bias and main results. Random effect models meta-analysis was used to assess the magnitude of treatment effect when at least 3 trials reported on the same sleep outcomes. Eleven studies (9 randomized and 2 non-randomized trials) totaling 994 subjects published between 2004 and 2012 were identified. All studies except one reported Pittsburg Sleep Quality Index. Nine randomized trials reported that 1.5 to 3 hour each week for a duration of 6 to 24 weeks of Tai Chi significantly improved sleep quality (Effect Size, 0.89; 95% confidence interval [CI], 0.28 to 1.50), in community-dwelling healthy participants and in patients with chronic conditions. Improvement in health outcomes including physical performance, pain reduction, and psychological well-being occurred in the Tai Chi group compared with various controls. Studies were heterogeneous and some trials were lacking in methodological rigor. Tai Chi significantly improved sleep quality in both healthy adults and patients with chronic health conditions, which suggests that Tai Chi may be considered as an alternative behavioral therapy in the treatment of insomnia. High-quality, well-controlled randomized trials are needed to better inform clinical decisions.