Sleep-related Problems Research Articles

Targeted Sleep Enhancement Reduces Residual Anxiety Symptoms in Peri-Adolescents Previously Treated for Anxiety Disorders

Sleep-related problems (SRPs) are a common precursor to anxiety disorders, especially during peri-adolescence, and may be a predictor of treatment response. However, evidence-based anxiety treatments do not alleviate SRPs to a clinically significant degree. The current study examines whether improving sleep in a sample of young adolescents previously treated for anxiety disorders can further reduce anxiety severity. Participants include 46 adolescents (65% female, ages 9–14 years) previously treated for anxiety disorders who self-selected to participate in a 6-week open trial of targeted sleep enhancement (TIGERS). Measures of parent- and child report on SRPs, and clinician-rated anxiety severity, were collected at several time points of the study: pre-, and postanxiety treatment, pre- and post-TIGERS, and at four yearly follow-ups. Two hierarchical mediation models were run using either parent- or child report on sleep. On the between-subjects level, participants with higher overall average SRPs also had higher overall anxiety severity over all time points. On the within-subjects level, participation in TIGERS was not directly associated with change in anxiety severity—however, participation in TIGERS was associated with a drop in SRPs, which was associated with a drop in anxiety severity. Improving sleep in anxious peri-adolescents further improves anxiety above and beyond anxiety treatment. Further research is needed to confirm the effects of improving sleep on clinical anxiety in a randomized controlled trial.

Caffeine and Sleep in Preventing Post-spinal Headache: Which One is More Effective?

The study aimed to determine the effects of caffeine consumption and sleep on post-spinal headache after spinal anesthesia. Post-spinal headache is among the most well-known and common complications of spinal anesthesia. Although caffeine consumption is recommended to prevent headache after spinal anesthesia, caffeine does not prevent headache and causes sleep-related problems. No study in the literature found a correlation between sleep and caffeine consumption after spinal anesthesia and post-spinal headache. The research is a descriptive and cross-sectional study. The study sample comprised 425 patients who underwent elective surgery in a research hospital. The research data were collected by face-to-face interviews between April 2021 and December 2023. The "Sociodemographic and Clinical Characteristics Form," "Richard-Campbell Sleep Scale," "Insomnia Severity Index," and "Visual Analog Scale" were used in data collection. Factors affecting post-spinal headache were determined using binary logistic regression analysis. According to the binary logistic regression, the insomnia severity score (OR = 1.234; p < .001), sleep quality score (OR = .992; p < .01), postoperative sleep duration (OR = .619; p < .05), and not consuming coffee (OR = .035; p < .001) are statistically significant predictors of post-spinal headache and explain 57.7% of the variance. A one-unit increase in patients' insomnia severity increased the probability of experiencing a post-spinal headache by 23.4%. With a one-unit increase in sleep quality, there was an 8% decrease in the probability of experiencing spinal headache, and a 3.81% decrease in the probability of experiencing post-spinal headache with an increase in sleep duration after surgery. The probability of experiencing post-spinal headache was 0.35 times higher in individuals who did not consume caffeine after surgery than in those who consumed it. The present study demonstrated that insomnia severity and sleep quality were more effective than caffeine consumption in preventing post-spinal headache. Insomnia and decreased sleep quality may cause a significant burden in developing post-spinal headache in patients and may cause post-spinal headache to be observed more frequently. Therefore, the use of caffeine in preventing or reducing post-spinal headache may adversely affect the duration and quality of sleep and increase the severity of insomnia.

Positive mental health accounts for the relationship between insomnia symptoms and suicide-related outcomes

Insomnia symptoms have been shown to be associated with suicide ideation/behavior. However, the underlying mechanism is unclear and studies on protective factors that might mitigate the association between sleep-related problems and suicide ideation/behavior are largely missing. On this background the aim of the current study was to investigate, whether positive mental health (PMH) accounts for the association between insomnia symptoms and suicidal ideation/behavior. A total of 913 participants (72.2% women; age: M(SD) = 25.91 (7.08)) completed measures on insomnia symptoms, PMH and suicide ideation/behavior via an online survey. The results reveal a significant association between insomnia symptoms and PMH. Both variables were significantly linked to lifetime suicide ideation/behavior and 12-month suicide ideation. Moreover, the association between insomnia symptoms and suicide-related outcomes was significantly mitigated by PMH. The current findings complement previous studies on the association between insomnia symptoms and suicide ideation/behavior. Furthermore, they demonstrate that PMH can mitigate the risk of suicide-related outcomes. Therapeutic intervention targeting insomnia symptoms and fostering PMH might be useful in the prevention of suicide ideation/behavior.

Age of Alzheimer's disease diagnosis in people with Down syndrome and associated factors: Results from the Horizon 21 European Down syndrome consortium.

People with Down syndrome (DS) have high risk of developing Alzheimer's disease (AD). This study examined mean ages of AD diagnosis and associations with co-occurring conditions among adults with DS from five European countries. Data from 1335 people with DS from the Horizon 21 European DS Consortium were used for the analysis. Mean ages of AD diagnosis ranged between 51.4 (SD 7.0) years (United Kingdom) and 55.6 (SD 6.8) years (France). Sleep-related and mental health problems were associated with earlier age of AD diagnosis. The higher number of co-occurring conditions the more likely the person with DS is diagnosed with AD at an earlier age. Mean age of AD diagnosis in DS was relatively consistent across countries. However, co-occurring conditions varied and impacted on age of diagnosis, suggesting that improvements can be made in diagnosing and managing these conditions to delay onset of AD in DS. Mean age of AD diagnosis was relatively consistent between countries Sleep problems and mental health problems were associated with earlier age of AD diagnosis APOE ε4 carriers were diagnosed with AD at an earlier age compared to non-carriers Number of co-occurring conditions was associated with earlier age of AD diagnosis No differences between level of intellectual disability and mean age of AD diagnosis.

Examination of Sleep Disturbance and Sleep-Related Problems in Children with Type 1 Diabetes

Examination of Sleep Disturbance and Sleep-Related Problems in Children with Type 1 Diabetes

The Reciprocal Relationship between Sleep and Epilepsy.

The relationship between sleep and epilepsy is bidirectional. Certain epilepsy syndromes predominantly or exclusively manifest during sleep, with seizures frequently originating from non-rapid eye movement (NREM) sleep. Interictal epileptiform discharges observed on electroencephalograms are most likely to be activated during the deep NREM sleep stage known as N3. Conversely, epileptiform discharges, anti-seizure medications (ASMs), as well as other anti-seizure therapies can exert detrimental effects on sleep architecture. Moreover, the co-occurrence of sleep disorders has the potential to exacerbate seizure control. Understating the relationship between sleep and epilepsy is crucial for healthcare providers. Addressing and managing sleep-related problems in individuals with epilepsy can potentially contribute to improved seizure control and overall well-being. At the same time, improving seizure control can improve sleep quality and quantity, thus further improving the health of individuals with epilepsy.

The Effectiveness of Cognitive Behavioral Therapy on Depression and Sleep Problems for Climacteric Women: A Systematic Review and Meta-Analysis.

(1) Background: Women in their middle years undergoing perimenopause encounter a range of physical and psychological alterations attributed to hormonal changes. The prominent symptoms among menopausal women are depressive symptoms and sleep-related problems. The aim of this study was to conduct a meta-analysis examining the effects of Cognitive Behavioral Therapy (CBT) on women going through menopause, specifically focusing on depressive symptoms and sleep problems. We analyzed studies conducted both within the country and across international settings over the last decade. (2) Methods: A search of the literature was conducted-a targeted search, exclusively considering randomized controlled trials (RCTs) that were published within the timeframe spanning from 15 June 2013 to 15 June 2023. (3) Findings: Upon reviewing nine studies that satisfied our inclusion criteria and involved a total of 923 participants, it was noted that four of these studies incorporated diverse cognitive-behavioral strategies. Among the nine studies, a total of four were included in the meta-analysis: two measured depressive symptoms, and two measured sleep quality. The combined effect size for depressive symptoms was found to be 3.55 (95% confidence interval: -5.48, -1.61; p < 0.05), and for sleep quality, it was 0.78 (95% confidence interval: -1.32, -0.25; p = 0.004). (4) Conclusions: Our review emphasizes the necessity for conducting larger-scale studies focused on the application of CBT for women experiencing menopausal symptoms. Additionally, it is recommended to approach the interpretation of these results with caution due to discrepancies in methodology and the overall quality of the studies. Further clinical trials are necessary to establish the ideal number of CBT sessions needed for the effective treatment of depression in menopausal women. Future studies should cover a wider range of geographical locations, including more countries, and focus on various outcomes such as depressive symptoms and sleep quality.

Clinical Implications and Genetic Basis of Sleep Deprivation in Children

AbstractSleep is a complex biological and physiological process that allows the body to rest in addition to playing an important role in proper homeostasis in different body systems such as immune, metabolic, cardiovascular, neurological, and hormonal. It is important to preserve the quality of sleep, for adequate vitality, since the alterations that occur in any of the phases of sleep have repercussions on several systems of an organism, whether they are short or long term, such as the negative effect of sleep deprivation on the hormonal and metabolic regulation of various pathophysiological processes that will contribute to the development of obesity in pediatric patients. It has been found that sleep-related problems are common in children, being a frequent reason for medical consultations. In addition to the aforementioned, there may also be alterations at the level of the cortex, which is associated with the nonregulation of emotions in preadolescent and adolescent pediatric patients. Finally, sleep could depend on polymorphisms that become risk alleles for having short-term sleep; likewise, there are genes that have a greater expression at the time of rest, which allows a relationship to be made with diseases developed in the face of sleep depletion. This article describes the clinical implications in pediatric patients as a consequence of sleep deprivation and its genetic bases.

Factors associated with workaholism in nurses' mental health: integrative review.

to synthesize the main scientific evidence available on the factors associated with workaholism in nurses' mental health. this is an integrative review carried out in seven databases. The sample consisted of 11 studies. The Level of Evidence classification followed the model described by Melnyk and Fineout-Overholt. Methodological quality was assessed using the Checklist for Analytical Cross-Sectional Studies. Data analysis and synthesis were carried out in a qualitative and descriptive manner, respectively. the factors associated with workaholism were burnout, stress, anxiety, depression, sleep-related problems, low ability to concentrate and negative incidents at work, which affected the mental health of nurses. the synthesis revealed that workaholism was related to perceived stress at work, emotional exhaustion, depersonalization and anxious and depressive symptoms, which resulted in low professional effectiveness and poor sleep quality among workaholic professionals.

Applicability of the Self-Evaluation Scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills to general nurses.

Many patients with dementia experience sleep-related problems. However, there is a lack of clarity regarding nursing practices that can address these issues. Thus, we developed a self-assessment scale for nursing practices to improve sleep quality among patients with dementia taking sleep medication and confirmed its validity and reliability. This study aimed to test the validity and reliability of this scale for adaptability to general nurses and test its applicability. The survey included basic attributes and questionnaire items related to nursing practices to improve sleep quality in patients with dementia taking sleeping pills. Data from 477 participants with no missing values in the survey items were used in the analysis. The self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills was based on a three-factor model, and confirmatory factor analysis was performed using structural equation modeling. Goodness-of-fit indices were satisfactory, supporting the construct validity of the scale. Cronbach's α coefficients for the total score and the three factors of the self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills exceeded 0.7. The development of this scale can improve the quality of nursing practice for patients with dementia who take sleeping pills. Moreover, it can serve as evidence for general nurses to participate in drug treatment and can be considered as basic research for appropriate drug treatment in nursing practice.

Adverse events following immunization among children during primary immunizations in selected health facility of Himachal Pradesh

Background: Vaccine related problems are commonly reported after immunizations and are a matter of concern for health care professionals. A study on the pattern and rate of incidences of vaccine related problems was conducted among children undergoing primary immunizations. Materials and methods: The study was conducted in Zonal hospital, Solan, Himachal Pradesh. 150 mothers and their children undergoing immunization were enrolled in the study using systematic random sampling and followed on every immunization event until nine months. Vaccine related problems were enquired at every immunization events namely birth, six weeks, ten weeks, fourteen weeks and nine months using a self-structured tool to assess vaccine related problems among children. Results: Pain at vaccination site, redness and swelling, excessive crying, fever, and sleep related problems, feeding problems and fever were common AEFIs reported by mothers among children. Conclusion: AEFIs are frequent and need to be reported. None of the child had any severe reaction or hospitalization after immunization.

The 4C model of healthy sleep for childhood interpersonal trauma

Restorative sleep is foundational for growth and development but remains a largely neglected area of health in the context of childhood trauma. This healthcare gap is especially great among child victims of interpersonal trauma who experience sleep disturbances at high rates. A trauma-informed framework is imperative both for understanding and addressing sleep-wake dysregulation in this vulnerable population. This article introduces the 4C Model of Healthy Sleep for Childhood Interpersonal Trauma as a resource and tool for professionals who provide services and support for these children in various settings (e.g., pediatricians, social workers, prevention specialists). Model components were developed and derived from evidence-based pediatric sleep practices, principles of attachment theory, reciprocal relationships between trauma and sleep disruption, and sleep intervention research among children with a history of foster care placement. Developed for use with infants and children up to 10 years of age, the trauma-informed model aims to educate and empower caregivers with behavioral tools for reducing sleep-related problems among child victims of interpersonal trauma including attachment disruptions. Although not intended to address complex sleep problems and disorders, the relevance and conciseness of the 4C model provides a needed resource for both research and practice.

Effects of insomnia on risky driving behavior among bus drivers: The mediating effect of mental health

Crashes caused by problems with bus drivers’ physical and mental health have increased in frequency in recent years. Insomnia, a common type of sleep problem, has significant positive relationships with both crash risk and mental health problems, especially anxiety and depression, which are themselves associated with driving behavior. However, few studies have conducted analysis on sleep-related problems and mental health exclusively on bus drivers, nor on how these problems influence driving performance. Thus, this study explored the effect of insomnia and mental health on bus drivers’ risky driving behavior and evaluated the interaction of four variables: insomnia, anxiety, depression, and risky driving behavior. The survey-based investigation was conducted in a bus company in Suzhou, China, with 1,295 bus drivers participating. Insomnia, anxiety, and depression were self-reported based on professional mental health scales and risky driving behaviors were measured by the Driver Behavior Questionnaire. Two mediation models and a chain mediation model were developed to examine relationships among the bus drivers’ insomnia, anxiety, depression, and risky driving behavior. Results revealed that (a) bus drivers less than 31 years old, drivers with more than 11 years’ experience driving buses, and those with crash and violation involvement within three years demonstrated more severe degrees of insomnia, anxiety, depression, and risky driving behavior; (b) there were significant positive correlations and interactions among the four variables. Results specifically related to the interaction among variables include findings that (a) anxiety mediated between insomnia and risky driving behavior; (b) depression mediated between insomnia and risky driving behavior; and (c) anxiety affected bus drivers' risky driving behavior primarily though depression. The findings in this study indicate the importance of regular physical and mental health examination of bus drivers and suggest that interventions focused on insomnia and mental health problems may be helpful to reduce risky driving behaviors of bus drivers both directly and indirectly.

Sleep quality and depression in mothers of children with epilepsy and its relation to their children’s sleep

ObjectiveThis study aimed to evaluate the relationship between sleep disturbances in children with epilepsy (CWE) and maternal sleep quality and depression severity. MethodsA Cross-sectional study was conducted in pediatric sleep disturbances using questionnaires on mother-reported sleep of CWE [Children's Sleep Habits Questionnaire (CSHQ)], maternal sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and maternal depression status [Self-Rating Depression Scale (SDS)]. 114 dyads consisting of CWE and their mothers were included in this study. ResultsOver three-quarters (78.9 %) of mothers reported poor sleep quality (total PSQI score ≥ 5), and nearly a third (29.8 %) met clinical criteria for moderate or severe depression levels. The mothers' total PSQI scores were between 5.93 ± 2.44 (range: 2–16 points). The most affected PSQI subcomponents were sleep latency (AUC = 0.826p < 0.001) and daytime dysfunction (AUC = 0.800p < 0.001). The majority of children (88.6 %) were stated by their mothers to have sleep-related problems. The total CSHQ scores of the children were between 49.06 ± 9.20 (range: 33–86 points). The most affected CSHQ subcomponents were detected sleep anxiety (AUC = 0.856, p < 0.001), bedtime resistance (AUC = 0.818, p < 0.001) and daytime sleepiness (AUC = 0.807, p < 0.001). There was a statistically significant positive correlation between maternal sleep quality and depression severity (rho = 0.842; p < 0.001). A statistically significant positive moderate correlation was detected between sleep problems in CWE and maternal sleep quality and depression severity (rho = 0.406; p < 0.001, rho = 0.399; p < 0.001, respectively). As a result of multiple stepwise logistic regression analysis, the presence of seizures during sleep and generalized epileptiform discharges on electroencephalography were associated risk factors with poor maternal sleep quality (OR:6.6, p = 0.014; OR:11.5, p = 0.018, respectively). A borderline insignificant relationship was observed between a less than 50 % decrease in seizure frequency and the poor maternal sleep quality (OR:20.59p = 0.059). Seizures during sleep was associated risk factor with children's sleep disturbances (OR:7.2, p = 0.02). ConclusionsSleep problems in CWE may lead to negative consequences such as sleep quality and/or depression in mothers. Interventions planned to correct sleep disturbances in mothers suggest that children's sleep problems should be optimally managed.

Temporal trends in sleep pattern among Chinese adults between 2010 and 2018: findings from five consecutive nationally representative surveys

ObjectivesThis study aimed to comprehensively analyze the time trends in average sleep duration and prevalence of short sleep, poor sleep quality, and high sleep debt among Chinese adults. Study designThis was a cross-sectional study. MethodsThe study used nationally representative data from Chinese Family Panel Survey (CFPS) among adults aged ≥18 years. Linear regression and logistic regression were used to calculate P-values for trends across waves, and absolute difference in prevalences were calculated by linear regression. Poisson regression analysis was used to calculate the prevalence ratios of sleep-related problems. ResultsIn 2018, the estimated average sleep duration in adults was 7.6 h/d. A shorter sleep duration, higher proportion of short sleep, and poor sleep quality were observed in people aged ≥65 years, women, people with primary school education or below, and residents in Liaoning province. The average sleep duration slightly decreased from 8.2 h/d in 2010 to 7.6 h/d in 2016, and then remained stable from 2016 to 2018. The prevalence of short sleep duration has markedly increased from 11.8% in 2010 to 24.1% in 2016, and then there was a decline in prevalence from 2016 to 2018, although this decrease was not significant. The prevalence of high sleep debt among employed people increased from 6.2% in 2010 to 8.6% in 2018 (absolute difference, 2.4 p.p; P trend = 0.063). In addition, the prevalence of poor sleep quality increased from 15.6% in 2012 to 21.3% in 2018 (absolute difference of 5.7 p.p; P trend<0.001). For all the sleep-related variables, the degree of changes varied by sociodemographic subgroups. ConclusionsIn this nationally representative survey of the Chinese population, the average sleep duration slightly decreased from 2010 to 2016, and then remained stable from 2016 to 2018. Poor sleep quality, and high sleep debt increased among most of the sociodemographic subgroups. Future studies are needed to understand the drivers of changes in sleep health among Chinese adults.

The Impact of Using Internet on the Behavior of the Students Enrolled at The University of Jordan

The present study aimed to identify the impact of using internet on BA students at The University of Jordan in the behavioral areas. It also aimed to identify the impact of using internet on students in terms of social and family relationships. In addition, it aimed to explore the psychological and social impacts of using internet on students. The researcher adopted the social survey-based approach and chose a random sample. The sample of the study consisted of fifty (50) female and male students who were enrolled at The University of Jordan. The researcher designed a survey to meet the goal of the study. The survey consists of sixteen (16) items, and it targets two areas, which are: the impact of using internet on the social areas, and the impact of using internet on the psychological areas. Some of the results shed light on the impact of using internet on university students in social aspects. Based on the latter results, the highest value belongs to the item suggesting that internet is used by the respondents as a means to run away from the problems and get rid of stress. They show negligence in doing family chores in order to use internet, as they spend more time talking to friends and relatives through internet more than talking to them face to face. Some of the results shed light on the impact of using internet on university students in psychological aspects. Based on the latter results, internet is a means for running away from problems and getting rid of stress. The respondents feel self-confident when using internet and communicating with others; however, they face sleep-related problems due to using internet, and feel less energetic when they don't use the internet. The results showed that most of the respondents use internet for a duration that is less than two hours, and most of them are males, and that the least percentage of respondents use internet for a duration that falls under the category: (four hours - less than 6 hours). Most of those respondents are females. Thirteen students use internet for six hours or more, and most of them are males. The results shed light on the relationships between academic programs and opinions about using internet, where the most positive results are shown by the fourth year students, while the most negative ones are shown by the first year students. The researcher offered a set of recommendations

A large-scale survey of cannabis use for sleep: preferred products and perceived effects in comparison to over-the-counter and prescription sleep aids

Aim: Cannabis use for sleep-related problems is on the rise; however, little is known about the cannabis products people are using for sleep or the perceived effects of cannabis in comparison to more conventional sleep aids. Therefore, the aim of this study was to examine the products cannabis users prefer to use for sleep as well as their experiences with cannabis relative to more conventional sleep aids. Methods: De-identified archival data from a Strainprint® survey of 1,216 individuals who use cannabis for sleep were analyzed. Results: Participants predominantly reported smoking joints or vaping flower as their methods of administration, and seeking tetrahydrocannabinol (THC), cannabidiol (CBD), and the terpene myrcene in the cannabis they use for sleep. Only a small minority reported using cannabis in conjunction with conventional sleep aids. Comparisons of the self-reported effects of cannabis to conventional sleep aids revealed that participants reported feeling more refreshed, focused, better able to function, fewer headaches, and less nausea the morning after using cannabis for sleep than after using more conventional sleep aids or no sleep aids. However, they indicated they were more sleepy, anxious, and irritable in the mornings following the use of cannabis relative to other sleep aids. Participants were more likely to report red eyes and thirst and less likely to report nausea, anxiety, paranoia, and racing heart as side effects of cannabis relative to other sleep aids. Conclusions: Knowledge gained from this survey will provide health professionals with a better understanding of why people are using cannabis for sleep and may help guide future more controlled research.

O039 A Novel Approach to Quantify Breathing effort in Obstructive Sleep Apnoea

Abstract Introduction Breathing effort is an important component of obstructed breathing and determinant of arousal in obstructive sleep apnoea (OSA). However, relative effects of hypopnoea versus apnoea on effort and work of breathing (WOB) are largely unknown. This study applied a novel modelling approach to quantify breathing effort, WOB and obstruction severity to evaluate differences between hypopnoea and apnoea events in OSA. Methods 1659 apnoea and hypopnea events from six obese males (BMI: 30-41 kg/m2; age: 34-56 years; AHI: 31-114 events/hr) with severe OSA were evaluated using conventional sleep measures and a 3-compartment (nasal, collapsible upper airway and lungs) respiratory mechanics model using mask airflow and pressure, and oesophageal and epiglottic pressures. Attempted airflow and WOB, and WOB loss to obstruction (attempted minus measured WOB), were estimated breath-by-breath via the model for comparisons between hypopnoea and apnoea events and sleep stages. Results The model explained most of the variance in attempted flow (Pearson r= 0.91 [95% CI 0.71 to 0.98]). Compared to hypopnoea events, WOB loss during obstructive apnoeas was 3.5 [95%CI 1.7 to 5.4] times higher. WOB losses were also higher during deep versus N2 sleep. Visualising breath-by-breath WOB loss revealed a significant number of flow- limited breaths not detected using traditional human scoring. Over 30% of breaths not classified as hypopnoeas or apnoeas exhibited WOB loss higher than for hypopnoea events. Conclusions Respiratory mechanics modelling is useful to assess breathing effort and upper airway obstruction severity and could provide novel mechanistic insights into sleep-related breathing problems and treatment outcomes.

Sleep and circadian hygiene practices association with sleep quality among Brazilian adults

ObjectiveTo investigate the association of sleep and circadian hygiene practices (sleep-promoting and sleep-disturbing behaviors) with sleep quality indicators. MethodsParticipants (n = 2050; 18–65 y) were part of virtual population-based research. Logistic regression models were fitted to assess differences in the OR (95% CI) of poor quality with sleep-promoting/disturbing practices (time-of-day of exercise, pre-bedtime routine, naps, electronic devices with illuminated screens, caffeine and alcohol consumption, and smoking). Linear regression analyses evaluated differences in sleep duration, latency, and awakenings associated with the same variables. Restricted cubic splines were used to study the shape of the association of screen time before bed with sleep duration, latency, and awakenings. Analyses were adjusted for age, sex, region, marital status, educational level, evening diet quality, and BMI. ResultsEvening use of electronic devices with illuminated screens showed a negative effect on all sleep parameters. Reporting dinner as the largest meal and evening caffeine consumption was associated with shorter sleep duration and longer sleep latency. Smokers had higher odds of longer latency. A protective effect of morning exercises was demonstrated on sleep quality, latency, and awakenings. Alcohol consumers presented lower odds of poor quality and lower frequency of awakenings. Pre-bedtime practices showed no or negative effect on sleep outcomes. ConclusionsRecommendations to promote sleep quality and prevent sleep-related problems, with corresponding circadian health benefits, should include engaging in regular exercise, preferably in the morning, and avoiding naps, heavy meals close to bedtime, caffeine, smoking, and evening screen exposure.

Validation of the Arabic version of Parkinson's Disease Sleep Scale-Revised Version (PDSS-2)

ObjectivesParkinson's disease sleep scale (PDSS) was recommended by the Movement Disorder Society task force for screening and grading the severity of sleep problems in Parkinson's disease (PD). This work aimed to examine the validity and reliability of an Arabic version of PDSS-2. MethodsThis cross-sectional study was carried out on 133 patients fulfilling diagnostic criteria for PD. The patients were clinically assessed using the following scales: Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), modified Hoehn and Yahr Scale (H&Y), non-motor symptoms scale (NMSS), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). PDSS-2 scale was translated according to approved translation standards into Arabic and back-translated into English. Patients were asked to respond based on their experience in the last week. ResultsThe mean PDSS2 score for the included PD patients was 17±10. Cronbach's α coefficient value was 0.89, indicating good internal consistency. Most items showed high item-total correlation; the lowest was 0.375, considered higher than the conventional cut-off of 0.3. Test-retest reliability showed good agreement (ICC: 0.848). The exploratory factor analysis showed that items had been loaded over four factors. Total PDSS-2 score was positively correlated to age, disease duration, modified H&Y scale, MDS-UPDRS, NMSS, BDI, and global PSQI score. A cut-off point of 13 could differentiate poor sleepers from good sleepers with 91% sensitivity and 70% specificity (AUC 0.893, P<0.001). ConclusionThe Arabic version of PDSS-2 has appropriate validity and can be reliably used for assessing sleep-related problems in Arabic-speaking patients with PD.