Subjective Sleep Research Articles

Effectiveness of galcanezumab on sleep quality, migraine outcome, and multidimensional patient-reported outcome measures: a real-world experience in Turkish patients with episodic and chronic migraine.

This real-world study aimed to investigate the impact of galcanezumab on sleep quality, migraine outcome and multidimensional patient-reported outcomes measures (PROMs) in patients with episodic migraine (EM) and chronic migraine (CM). Fifty-four patients with episodic migraine (n = 24) or chronic migraine (n = 30) received a 3-month series of galcanezumab injections and were evaluated for sleep quality, measured using the Pittsburgh Sleep Quality Index (PSQI), as well as migraine outcomes such as monthly headache days (MHDs), monthly migraine days (MMDs), and headache severity. Patient-reported outcome measures (PROMs) such as the Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), SF-36 Health-related Quality of Life (HRQoL), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were additionally included in the assessment. The percentage of patients with poor sleep quality (total PSQI scores ≥ 5) was 72.7% at baseline, decreasing to 57.5% and 56.2% at the 1st and 2nd months, respectively. By the 3rd month of galcanezumab injections, significant improvement was observed in the sleep disturbances domain in the overall study population (p = 0.016), and in subgroups of patients with low anxiety levels (p = 0.016) and none/minimal depression (p = 0.035) at baseline. Patients with sleep disorder at baseline exhibited marked improvements in total PSQI scores (p = 0.027) and in the subjective sleep quality (p = 0.034) and daytime dysfunction (p = 0.013) domains, by the 3rd month. Over the 1st, 2nd, and 3rd months, there were significant improvements in MHDs (p < 0.001), MMDs (p < 0.001), HIT-6 scores (p < 0.001 for each), BAI scores (p < 0.001 for each), BDI scores (p ranged from 0.048 to <0.001), and HRQoL scores (p ranged from 0.012 to <0.001). Galcanezumab demonstrates notable benefits in improving sleep quality, along with a comorbidity-based and domain-specific effect on sleep parameters, which involved sleep disturbances domain in patients without depression or anxiety at baseline but the total PSQI scores, subjective sleep quality and daytime dysfunction in those with sleep disorder at baseline. The treatment also facilitates rapid-onset enhancements in migraine outcomes as well as various PROMs.

Safety and Efficacy of Lemborexant in Insomnia Patients: Results of a Postmarketing Observational Study of Dayvigo® Tablets.

A prospective, postmarketing observational study was conducted to evaluate the safety and efficacy of lemborexant (LEM) tablets in daily clinical practice in Japan. No other studies of a similar size have been conducted since the marketing approval of LEM, making this the first report of its kind. Insomnia patients (n=550) administered LEM (5-10 mg daily) for the first time were enrolled. Adverse events were collected for target events (somnolence, parasomnia, narcolepsy and associated conditions, suicidal ideation and suicidal behavior). Overall improvement of insomnia symptoms was assessed by the investigator based on the patient's complaint. Subjective sleep onset latency (sSOL) and subjective total sleep time (sTST) were investigated as sleep parameters. A case report form was obtained from 539 patients. The incidence of adverse drug reactions (ADRs) was 7.65% for somnolence, 1.76% for nightmares, 0.59% for abnormal dreams, and 0.20% for sleep paralysis. No serious ADRs or ADRs related to suicidal ideation or suicidal behavior were observed. The efficacy rate at the final evaluation was 80.83%. Decreased sSOL and increased sTST were observed as assessed starting from Week 8 of treatment. Based on the results of this study, the safety result was consistent with the safety profile described in the current package insert. Efficacy results also indicated that LEM is clinically useful.

Digital cognitive–behavioural therapy application compared with zolpidem for the treatment of insomnia: protocol for an exploratory randomised controlled trial

IntroductionInsomnia is a common health problem and cognitive–behavioural therapy (CBT) is recommended as a treatment. As there is a critical shortage of CBT-trained therapists, we developed a digital CBT application...

Associations of Subjective Sleep Quality with Wearable Device-Derived Resting Heart Rate During REM Sleep and Non-REM Sleep in a Cohort of Japanese Office Workers.

Associations between subjective sleep quality and stage-specific heart rate (HR) may have important clinical relevance when aiming to optimize sleep and overall health. The majority of previously studies have been performed during short periods under laboratory-based conditions. The aim of this study was to investigate the associations of subjective sleep quality with heart rate during REM sleep (HR REMS) and non-REM sleep (HR NREMS) using a wearable device (Fitbit Versa). This is a secondary analysis of data from the intervention group of a randomized controlled trial (RCT) performed between December 3, 2018, and March 2, 2019, in Tokyo, Japan. The intervention group consisted of 179 Japanese office workers with metabolic syndrome (MetS), Pre-MetS or a high risk of developing MetS. HR was collected with a wearable device and sleep quality was assessed with a mobile application where participants answered The St. Mary's Hospital Sleep Questionnaire. Both HR and sleep quality was collected daily for a period of 90 days. Associations of between-individual and within-individual sleep quality with HR REMS and HR NREMS were analyzed with multi-level model regression in 3 multivariate models. The cohort consisted of 92.6% men (n=151) with a mean age (± standard deviation) of 44.1 (±7.5) years. A non-significant inverse between-individual association was observed for sleep quality with HR REMS (HR REMS -0.18; 95% CI -0.61, 0.24) and HR NREMS (HR NREMS -0.23; 95% CI -0.66, 0.21), in the final multivariable adjusted models; a statistically significant inverse within-individual association was observed for sleep quality with HR REMS (HR REMS -0.21 95% CI -0.27, -0.15) and HR NREMS (HR NREMS -0.21 95% CI -0.27, -0.14) after final adjustments for covariates. The present study shows a statistically significant within-individual association of subjective sleep quality with HR REMS and HR NREMS. These findings emphasize the importance of considering sleep quality on the individual level. The results may contribute to early detection and prevention of diseases associated with sleep quality which may have important implications on public health given the high prevalence of sleep disturbances in the population.

The relationship between sleep and quality of sexual life in pregnant women.

This study aimed to explore the relationship between sleep quality and quality of sexual life in pregnant women. This cross-sectional and correlational study was conducted with 362 pregnant women. Data were collected using a "Sociodemographic Information Form", the "Cumhuriyet Subjective Sleep Quality Scale (CSSQS)", and the "Sexual Quality of Life Questionnaire-Female (SQLQ-F)". Descriptive statistics, pearson correlation analysis, and simple linear regression analysis were used for data analysis. There was a statistically significant negative correlation between the mean scores of the pregnant women on CSSQS and its subscales and their mean scores on SQLQ-F (p<0.05). It was seen that the sleep quality of pregnant women had a significant negative effect on their quality of sexual life (p<0.001). In pregnant women, the level of sleep quality explained 30.4% of the quality of sexual life. It was concluded that their quality of sexual life was negatively affected as pregnant women sleep quality decreased.

Does overreaching from endurance-based training impair sleep: A systematic review and meta-analysis.

Overreaching is often linked to a deterioration in sleep quality, yet a comprehensive review is lacking. The aim of this systemic review and meta-analysis was to synthesise the literature and quantify the effect of overreaching from endurance-based training on sleep quality. The review was conducted following the PRISMA guidelines. The final search was conducted in May 2023 using four electronic databases (Web of Science Core Collection, MEDLINE, Cochrane Central Database, SPORTDiscus). Studies were included for a qualitative review, while random-effects meta-analyses were conducted for objective and subjective sleep. The search returned 805 articles. Fourteen studies were included in the systematic review; Three and eight articles were eligible for the meta-analyses (objective and subjective, respectively). On average, the overreaching protocols were sixteen days in length (6 to 28 days) and included exercise modalities such as cycling (number of studies [k] = 5), rowing (k = 4), triathlon (k = 3), running (k = 2), and swimming (k = 1). Actigraphy was the only form of objective sleep measurement used across all studies (k = 3), while various instruments were used to capture subjective sleep quality (k = 13). When comparing objective sleep quality following the overreaching intervention to baseline (or a control), there was a significant reduction in sleep efficiency (mean difference = -2.0%; 95% CI -3.2, -0.8%; Glass' Δ = -0.83; p < 0.01). In contrast, when comparing subjective sleep quality following the overreaching intervention to baseline (or a control), there was no effect on subjective sleep quality (Glass' Δ = -0.27; 95% CI -0.79, 0.25; p = 0.08). Importantly, none of the included studies were judged to have a low risk of bias. While acknowledging the need for more high-quality studies, it appears that overreaching from endurance-based training can deteriorate objective sleep without influencing the perception of sleep quality. This protocol was registered in The International Prospective Register of Systematic Reviews (PROSPERO) on 21st November 2022, with the registration number CRD42022373204.

Poor sleep quality may trigger cognitive deficits after recovery from COVID-19.

In the present study, we aimed to assess the cognition of post-COVID-19 condition (PCC) participants in relation to their subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) and to analyse possible moderators of this effect, such as quality of life (European Quality of Life-5 Dimensions, EQ-5D), fatigue (Chadler Fatigue Questionnaire, CFQ), cognitive reserve (Cognitive Reserve Questionnaire, CRC), and subjective cognitive complaints (Memory Failures of Everyday Questionnaire, MFE-30). We included 373 individuals with PCC and 126 healthy controls (HCs) from the NAUTILUS Project (NCT05307549 and NCT05307575) who were assessed with a comprehensive neuropsychological battery and various questionnaires. We found that PCC participants with poor sleep quality had a 4.3% greater risk of immediate verbal memory deficits than those with good sleep quality, as indicated by the greater odds ratio (OR) of 1.043 and confidence interval (CI) of 1.023-1.063. Additionally, their risk of immediate verbal memory disorders was multiplied by 2.4 when their EQ-5D score was low (OR 0.33; CI 0.145-0.748), and they had a lower risk of delayed visual memory deficits with a greater CRC (OR 0.963; CI 0.929-0.999). With respect to processing speed, PCC participants with poor sleep quality had a 6.7% greater risk of deficits as the MFE increased (OR 1.059; CI 1.024-1.096), and the risk of slowed processing speed tripled with a lower EQ-5D (OR 0.021; CI 0.003-0.141). These results indicate that poor subjective sleep quality is a potential trigger for cognitive deficits. Therapeutic strategies to maximize sleep quality could include reducing sleep disturbances and perhaps cognitive impairment in PCC individuals.

Perfect Enough to Sleep? Perfectionism and Actigraphy-Determined Markers of Insomnia

ABSTRACT Objectives Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism. Methods Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected. Results High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r = .26 to .88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions. Conclusions Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one’s vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia.

SLEEP QUALITY AND AVOIDANCE BEHAVIOR IN COMBATANTS WITH POST-TRAUMATIC STRESS DISORDER

Introduction. Post-traumatic stress disorder (PTSD) is often characterized by various symptoms that result in behavioral changes in patients, among which sleep disturbances and avoidant behavior are commonly observed. However, despite evidence indicating a complex bilateral relationship between emotions and sleep, only few studies have explored the associations between sleep disturbances and avoidant behavior in the context of PTSD. The aim of the study is to assess the severity of avoidant behaviour and insomnia in combatants with posttraumatic stress disorder. Materials and methods. We conducted a clinical study of 45 combatants who were divided into 2 groups: group 1 (n=24) included combatants with PTSD; group 2 (n=21) consisted of combatants without PTSD. The Pittsburgh Sleep Quality Questionnaire was used to analyse sleep quality, namely subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, sleep medication use, and daily dysfunction. Avoidance behavior was measured using a multidimensional experience avoidance questionnaire. Results. We found that group 1 demonstrated worse subjective sleep quality (p=0.002), longer sleep latency (p&lt;0.001), lower sleep efficiency (p=0.019) and more severe sleep disturbances (p&lt;0.001). There were no statistically significant differences between the groups in terms of sleep duration, severity of sleeping pills use, and daily dysfunction. The overall severity of sleep quality disorders was higher in group 1 compared to group 2 (p&lt;0.001). Avoidance behavior (p=0.007) and repression and denial (p&lt;0.001) were more pronounced in group 1 compared to group 2. At the same time, group 1 had lower stress endurance (p&lt;0.001). The overall level of experiental avoidance in group 1 was higher than in group 2 (p&lt;0.001). Numerous associations between sleep quality characteristics and experiental avoidance were found as well. Conclusions. The study has revealed that combatants with PTSD have more pronounced manifestations of behavioural avoidance, repression and denial, as well as a lower level of stress endurance. At the same time, combatants with PTSD demonstrate a deterioration in the subjective quality of sleep, a decrease in its effectiveness and an increase in the severity of its disturbances. It has been found that avoidance behavior in combatants has numerous connections with the characteristics of sleep quality that may be suggested as a potential factor for improving psychotherapeutic interventions.

Sleep "ON", sleep better! Positive effects of levodopa on sleep behaviour in people with Parkinson's disease.

People with Parkinson's disease experience reduced sleep quality compared with their peers. Levodopa may have a direct effect on sleep macrostructure or may improve sleep by enhancing nocturnal motor performance. Therefore, it is important to understand the acute effects of withdrawing levodopa on sleep measures in Parkinson's disease. The purpose of this study was to compare the estimated objective and subjective sleep measures of people with Parkinson's disease sleeping under (ON-night) versus without (OFF-night) the effects of the last daily dopaminergic medication before going to bed. A total of 23 people with Parkinson's disease were instructed to wear an actigraphy device for 4 consecutive nights to objectively measure the sleep behaviour. Subjective sleep measure was assessed each morning using a Likert scale. Participants slept for 3 nights on ON-night and 1 night on OFF-night. They were instructed not to take their last dose of levodopa before going to bed in OFF-night. Sleeping in ON- versus OFF-night increased total sleep time (7.8%, p = 0.032) and sleep efficiency (3.7%, p = 0.019), and decreased duration and number of wakes after sleep onset (22.3%, p = 0.050; and 29.2%, p = 0.013, respectively). However, subjective sleep analysis indicated no significant differences between the two conditions. From a clinical point of view, our results suggest that sleeping on ON-night resulted in an improvement in estimated objective sleep measures compared with sleeping on OFF-night. From a methodological point of view, our findings emphasize the importance of relying on objective sleep measurements to accurately assess OFF-night sleep behaviour in people with Parkinson's disease.

Sleep Quality Moderates the Associations between Cardiorespiratory Fitness and Hippocampal and Entorhinal Volume in Middle-Aged and Older Adults.

As individuals age, the entorhinal cortex (ERC) and hippocampus-crucial structures for memory-tend to atrophy, with related cognitive decline. Simultaneously, lifestyle factors that can be modified, such as exercise and sleep, have been separately linked to slowing of brain atrophy and functional decline. However, the synergistic impact of fitness and sleep on susceptible brain structures in aging adults remains uncertain. We examined both independent and interactive associations of fitness and subjective sleep quality with regard to ERC thickness and hippocampal volume in 598 middle-aged and older adults from the Human Connectome Lifespan Aging Project. Cardiorespiratory fitness was assessed using the 2-min walk test, whereas subjective sleep quality was measured with the continuous Pittsburgh Sleep Quality Index global score. High-resolution structural magnetic resonance imaging was used to examine mean ERC thickness and bilateral hippocampal volume. Through multiple linear regression analyses, we investigated the moderating effects of subjective sleep quality on the association between fitness and brain structure, accounting for age, sex, education, body mass index, gait speed, and subjective physical activity. We found that greater cardiorespiratory fitness, but not subjective sleep quality, was positively associated with bilateral hippocampal volume and ERC thickness. Notably, significant interaction effects suggest that poor subjective sleep quality was associated with a weaker association between fitness and both hippocampal volume and ERC thickness. Findings suggest the potential importance of both cardiorespiratory fitness and subjective sleep quality in preserving critical, age-vulnerable brain structures. Interventions targeting brain health should consider potential combined effects of sleep and fitness on brain health.

Clinical effectiveness of internet-based cognitive behavioral therapy for insomnia in routine secondary care: results of a randomized controlled trial.

Delivering cognitive behavioral therapy for insomnia over the internet bears the advantage of accessibility and uptake to many patients suffering from chronic insomnia. In the current study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy for insomnia (iCBT-I) in routine care. We conducted a two-arm non-blinded randomized controlled trial with care as usual (CAU) as a control condition. Participants were recruited in a specialized outpatient sleep medicine department. Both arms had access to other healthcare resources, and the intervention group had access to the iCBT-I program for 2 months. The primary outcome was insomnia severity, measured by the Insomnia Severity Index (ISI). Secondary outcomes were fatigue severity, daytime sleepiness, affective symptoms, dysfunctional beliefs and attitudes about sleep, sleep locus of control, sleep hygiene, sleep efficiency (SE), sleep onset latency, wake time after sleep onset (WASO), and total sleep time (TST). Linear mixed models for repeated measures were used to analyze the longitudinal data at baseline, post-treatment, and after 3 months of follow-up. The trial was registered at www.clinicaltrials.gov (NCT04300218 21.04.2020). The results showed a significant time*group interaction effect (p = 0.001) at post-treatment with between-group effect size (d = 0.51), indicating that the ISI decreased by a score of 3.8-fold in the iCBT-I group than in the CAU group. There was no significant difference in ISI between groups at follow-up. Regarding secondary outcomes, dysfunctional beliefs about sleep, SE, and WASO decreased significantly during treatment in the intervention group with between-group effect sizes d = 0.35, d = -0.51, and d = 0.47, respectively. At the follow-up, between-group effects on DBAS and SE remained significant: d = 0.36 and d = -0.63, respectively. For TST, we observed a significant time*group effect of d = -0.38 only after follow-up. Our findings suggest that iCBT-I has a significant effect on insomnia severity at post-treatment compared to CAU. iCBT-I further improved dysfunctional beliefs about sleep and improved subjective sleep characteristics, such as SE, WASO, and TST during 3 months after treatment. www.clinicaltrials.gov, identifier (NCT04300218).

Associations of dietary patterns with objective and subjective sleep duration and sleep quality in a population-based cohort study

ObjectiveTo examine cross-sectional and longitudinal associations of various types of dietary patterns with self-reported sleep quality and with actigraphy-estimated sleep parameters in the prospective, population-based Rotterdam Study. MethodsFor each participant, scores for five different dietary patterns were derived based on food frequency questionnaires; two pre-defined scores developed to estimate adherence to the Dutch dietary guidelines and to the Mediterranean diet; and three data-driven scores indicating a prudent, unhealthy and typical Dutch diet. In 2589 participants (median age 56.9 years; 58 % female), self-rated sleep quality was assessed with the Pittsburgh Sleep Quality Index. In 533 participants, actigraphs were worn for an average of 6.8 days (SD: 0.7) to estimate total sleep time, sleep onset latency, wake after sleep onset, and sleep efficiency. Sleep parameters were measured at baseline and 3–6 years later. Multiple linear regression was used to assess cross-sectional and longitudinal associations. ResultsNo statistically significant associations between dietary patterns and total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency and subjective sleep quality were observed in cross-sectional or longitudinal analyses. To illustrate, the effect estimate for sleep duration was 2.7 min per night (95 % CI -2.1, 7.5) per 5 point increase in Mediterranean diet score in the cross-sectional analyses. Furthermore, in longitudinal analyses, the effect estimate for sleep duration was −1.0 min per night (95 % CI -5.2, 3.1) per SD increase in the prudent diet. ConclusionsOur results suggest that dietary patterns are not associated with sleep in this population-based cohort study. Trial registrationNetherlands National Trial Register and WHO International Clinical Trials Registry Platform (ICTRP; https://apps.who.int/trialsearch/) shared catalogue number NL6645/NTR6831. Registered November 13th, 2017.

Poor subjective sleep quality and trait impulsivity in patients with bipolar disorder.

Sleep disturbance and impulsivity are key components of mood vulnerability in bipolar disorder (BD), but few studies have assessed the association between these two symptoms among patients with BD. Forty-seven euthymic patients with bipolar I disorder (BDI) or bipolar II disorder (BDII) and 58 age- and sex-matched healthy controls were enrolled in this cross-sectional study. Trait impulsivity was measured using the Barratt Impulsiveness Scale Version 11 (BIS-11), which yielded 3 second-order factors: attention, motor, and non-planning. Subjective sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index (PSQI). General linear models (GLMs) were used to assess the associations between subjective poor sleep and trait impulsivity with multiple testing corrections. Patients with BD scored higher in BIS-11 and PSQI than healthy controls. PSQI total scores positively correlated with BIS-11 total scores, while sleep disturbance and daytime dysfunction were associated with attentional impulsiveness after controlling for covariates. Participants with higher PSQI total scores (>10) had higher scores in BIS-11 total, attention, and non-planning than those with low PSQI scores (≤5). These findings support the hypothesis that poor sleep quality might lead to impulsivity and add to the growing evidence that improving sleep quality may be a therapeutic target for patients with BD.

Association between magnesium deficiency score and sleep quality in adults: A population-based cross-sectional study

BackgroundThe association between magnesium status and sleep quality is unclear. The aim of this study was to determine the relationship between renal reabsorption-related magnesium depletion score (MDS) and sleep quality. MethodsThis study was conducted through a cross-sectional survey of adults aged ≥20 years who participated in NHANES 2005–2014. We used weighted logistic regression to examine the association between MDS and sleep quality and performed trend tests to analyze for the presence of a dose-response relationship. Subgroup analyses were performed based on various sleep outcomes and covariates. ResultsA total of 20,585 participants were included in the study, with a mean age of 48.8 years and 50.7 % female. After adjusting for all covariates, we found a graded dose-response relationship between MDS and sleep trouble as well as sleep disorder. Further analyses revealed a significant positive association between MDS and sleep apnea (OR = 3.01; 95 % CI 1.37–6.62), but no association with restless legs, insomnia or insufficient sleep. In addition, subgroup analyses revealed that middle-aged, male, obese, low magnesium intake, and depressed patients were more prone to sleep trouble and sleep disorder; interestingly, MDS was positively associated with excessive sleep in subjects ≥60 years and without depression. ConclusionsOur study found a significant association between MDS and sleep quality, particularly sleep apnea, but adequate magnesium intake may be beneficial in mitigating this association. MDS may be associated with excessive sleep in older adults, but not with insufficient sleep or insomnia.

Association between sleep quality and habits of electronic media use among young adults with different circadian typology

Background: Circadian preference refers to individual differences for mental and physical activity in the morning and evening. We hypothesized, that inadvertent use of electronic media can cause circadian misalignment that influences sleeping habits and sleep quality of young adults. Aims and Objectives: The aim of the study was to investigate the effect of circadian preferences on sleeping habits and the association of electronic media use with sleep quality and sleep disturbances. Materials and Methods: A total of 188 subjects were enrolled and divided into three groups: Evening, intermediate, and morning chronotype based on the Morningness-Eveningness score. Electronic media use at bedtime and duration of use were assessed subjectively. Sleep quality and subjective sleep disturbances, daytime sleepiness, and chronotype were assessed by the Pittsburgh Sleep Quality Index, Epworth Sleepiness Score, and Morningness-Eveningness Questionnaire Self-assessment version, respectively. Results: The majority of subjects with the evening chronotypes suffered from poor sleep quality compared to other chronotypes and the difference was statistically significant. In evening-type subjects, electronic media use at bedtime, long sleep latency, short sleep duration, and daytime sleepiness were significantly associated with poor sleep quality with odds ratios of 2.34 (1.08–5.08), 11.42 (4.98–26.19), 8.54 (1.01–68.24), and 1.68 (1.03–2.73), respectively. Conclusion: The majority of evening-type subjects had poor sleep quality, altered sleeping habits, and electronic media use at bedtime is significantly associated with poor sleep quality. Hence, history regarding sleep habits and lifestyle, especially electronic media use, should be taken from young adults, who are coming to the outpatient department for other than sleep disorders, to prevent the development of health-related problems.

Determination of Factors Affecting Sleep Quality in Postoperative Patients and Improvement of Correctible Causes

Patients who had postoperative major abdominal surgery and major cardiovascular surgery were included in our study. A total of 103 patients were included in the study. Patients were evaluated with the Pitssburg sleep quality index questionnaire between five and seven days postoperatively. All questionnaires and scales were administered by the same researcher without specifying the participant's name in order to maintain consistency. After explaining the scope and purpose of the study, written consent of all participants was obtained. Pittsburg sleep quality index is a 19-item self-report scale that evaluates sleep quality and disorder. It consists of 24 questions, 19 questions are self-report questions, 5 questions are questions to be answered by the spouse or roommate. The 18 scored questions of the scale consist of 7 components. Subjective Sleep Quality, Sleep Latency, Sleep Duration, Habitual Sleep Efficiency, Sleep Disorder, Sleeping Drug Use, and Daytime Dysfunction. Each component is evaluated over 0-3 points. The total score of the 7 components gives the scale total score. The total score ranges from 0 to 21. A total score greater than 5 indicates "poor sleep quality". In our study, we aimed to investigate whether anesthetic agents, concomitant diseases, type of surgery, and some biochemical parameters affect sleep quality in postoperative patients. The diseases we investigated included hypertension, chronic obstructive pulmonary diseases, asthma, heart failure, cerebrovascular diseases, thyroid function disorders, diabetes mellitus, chronic kidney diseases, and chronic kidney failure. We also evaluated the sociocultural levels of the patients as an important part of the study. Educational status of our patients, literacy rates and occupations were also important to us. In our study, we showed that anesthetic agents [hypnotic and opioid] had no effect on sleep quality, and sleep quality was worse in cardiovascular surgery cases, although it was not statistically significant. We showed that a long operation time (5 hours and more) impairs postoperative sleep quality, thyroid diseases affect sleep quality badly, and sleep disorders are more common especially in patients with COPD. We think that sleep has a very important place in accelerating the recovery process of postoperative patients and that sleep disorders should be questioned better and that postoperative patients with sleep disorders should definitely seek psychological and medical help.

The moderating role of conscientiousness in the temporal association of stress on sleep.

Personality traits have been associated with sleep problems and stress experience. However, their impact on objective sleep and the temporal relationship of stress on sleep has remained elusive. This study examined whether daytime stress predicts sleep the following night, and the moderating role of neuroticism and conscientiousness in this relationship. To introduce stress variability in natural daily stressors, we measured college students (N = 92) during exams (e.g. high academic stress) and at the start of new course period (e.g. low academic stress). Both objective (actigraphy) and subjective sleep, and daily self-reported stress, were measured for 14 days and personality traits once. Reported daily stress was significantly higher in the exam period compared with baseline, suggesting that our natural manipulation did indeed result in variation in stress levels. Intra-individual daily variations in stress were not associated with the following night's sleep timing, duration or fragmentation, implying that more stress during the day did not affect sleep the following night. Higher levels of neuroticism were associated with poorer daily subjective sleep quality and higher stress levels over the complete period. Neuroticism did not moderate the temporal association of stress on sleep. Conscientiousness moderated the association between intra-individual stress and sleep fragmentation, and intra-individual stress and wake-up time. This implied that highly conscientious participants experienced less sleep fragmentation and woke-up earlier after more stressful days. These results suggest an interconnected relationship among stress, sleep and personality. Focusing on one aspect, like handling stress or enhancing sleep quality, might yield positive effects on the rest.

Factors associated with the fragmentation and stability of the rest-activity rhythm in adults and older adults

ABSTRACT This cross-sectional study aimed to identify factors related to the fragmentation and stability of the rest-activity rhythm (RAR) in adults and older adults. It is part of a larger research project investigating aspects concerning sleep duration, quality, and disorders in a representative subsample of the population. Sociodemographic data, lifestyle, health habits and subjective sleep variables were obtained; RAR records were collected by means of actigraphy and analyzed using non-parametric variables (IS, IV, M10, L5, RA, sL5, and sM10). Study participants were 313 individuals with complete actigraphy records. There was a prevalence of older adults (50.2%) and females (51.1%). Females, individuals with 4–8 y of education, and those who used alcohol abusively exhibited lower RAR fragmentation. Higher fragmentation was observed in individuals who napped and those reporting poor sleep quality. Greater rhythm stability was evident in females, older adults, those with 4–8 y of education, and those who had a partner. Smokers demonstrated lower RAR stability. These findings may contribute valuable insights for decision-making aimed at preventing and treating issues related to fragmentation and instability of the rhythm and its possible consequences to health.

Subjective-Objective Sleep Discrepancy in a Predominately White and Educated Older Adult Population: Examining the Associations With Cognition and Insomnia.

This study examined associations between various cognitive domains and sleep discrepancy (self-reported vs objectively measured sleep), and evaluated interactive associations with insomnia status (non-insomnia vs insomnia). Older adults (N = 65, Mage = 68.72, SD = 5.06, 43 insomnia/22 non-insomnia) aged 60+ reported subjective sleep (7 days of sleep diaries), objective sleep assessment (one-night polysomnography, PSG, via Sleep Profiler during the 7-day period), and completed cognitive tasks (National Institutes of Health Toolbox-Cognition Battery) measuring attention and processing speed, working memory, inhibitory control, cognitive flexibility, and episodic memory. The sleep diary variable corresponding to the same one night of PSG was used to calculate the sleep discrepancy (diary minus PSG parameter) variables for total sleep time (TST), sleep onset latency, wake after sleep onset, and sleep efficiency. Regression analyses determined independent and interactive (with insomnia status) associations between cognition and sleep discrepancy, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Working memory interacted with insomnia status in associations with sleep discrepancy related to TST and sleep efficiency. In those with insomnia, worse working memory was associated with shorter self-reported TST (p = .008) and lower sleep efficiency (p = .04) than PSG measured. In older adults with insomnia, worse working memory may be a contributing factor to sleep discrepancy. Future investigations of underlying neurophysiological factors and consideration of other objective sleep measures (actigraphy) are warranted. Prospective findings may help determine whether sleep discrepancy is a potential marker of future cognitive decline.