Total Sleep Quality Research Articles

Daily associations between sleep and opioid use among adults with comorbid symptoms of insomnia and fibromyalgia.

Disturbed sleep and use of opioid pain medication are common among individuals with chronic pain. Anecdotally, opioids are thought to promote sleep by relieving pain. This study aimed to determine whether opioid use is associated with daily sleep parameters (and vice versa) in adults with comorbid symptoms of insomnia and fibromyalgia. Individuals reporting symptoms of insomnia and opioid use for fibromyalgia (n = 65, 93% women, 79% White) wore wrist actigraphy and completed daily diaries for 14 days (910 observations). Analyses examined daily associations between opioid dose (measured in lowest recommended dosage units) and three sleep parameters (actigraphy/self-reported total wake time and self-reported sleep quality). Multilevel models were used to account for the clustering of daily sleep and opioid assessments (level 1) within individuals (level 2). Opioid use did not have a significant daily effect on total wake time or sleep quality, and sleep parameters did not significantly impact opioid use the next day; however, participants reported worse sleep quality and greater doses of opioids on evenings that they experienced greater pain. Among adults reporting symptoms of insomnia and opioid use for fibromyalgia pain, opioid use is not reliably associated with wake time or sleep quality that night, and these sleep parameters are not significantly associated with opioid use the next day; however, evening pain has an adverse daily impact on both sleep quality and opioid use. Studies identifying strategies to prevent and manage fibromyalgia pain are needed, especially for individuals reporting comorbid insomnia and opioid use.

Within-person associations between racial microaggressions and sleep among African American and Latinx young adults.

Emerging work suggests that experiences of racial discrimination may impact overall sleep health; however, there is limited work on the link between racial microaggressions and sleep. Using weekly diary data, the current study examined young adults' weekly reports of racial microaggressions across 4 weeks, and their relation to weekly reports of sleep-onset latency, reduced total sleep time and poorer sleep quality. This design allowed us to examine how within-person fluctuations in racial microaggressions corresponded with young adults' sleep. Data were collected among 140 African American (62.1%) and Latinx (37.9%) college students attending a Midwestern University. Students were randomly selected to participate; they were, on average, 20.70years old (SD=1.22) and the majority were female (69.3%). Participants self-reported their racial microaggressions and sleep behaviours (i.e. sleep-onset latency, total sleep time and sleep quality) each week (across 4weeks). Multilevel modelling showed significant within-person effects of racial microaggressions for sleep onset and sleep quality, but not for total sleep duration. Specifically, on weeks that individuals reported increases in racial microaggressions, they reported greater sleep-onset duration and poorer sleep quality. The current findings provide preliminary evidence that racial microaggressions are associated with sleep-onset durations and sleep quality among African American and Latinx young adults. Although racial microaggressions are often considered subtle, they may impact the sleep health of young adults in marginalized groups.

Habitual Night Eating Was Positively Associated With Progress of Arterial Stiffness in Chinese Adults.

BackgroundNight eating has been associated with an elevated risk of obesity, dyslipidemia, and cardiovascular disease. However, there is no longitudinal study on whether habitual night eating, regardless of diet quality and energy intake, is associated with arterial stiffness, a major etiological factor in the development of cardiovascular disease.Methods and ResultsThe study included 7771 adult participants without cardiovascular disease, cancer, or diabetes mellitus prior to dietary assessment by a validated food frequency questionnaire in 2014 through 2015. Participants were categorized into 3 groups based on self‐reported night‐eating habits: never or rarely, some days (1–5 times per week), or most days (6+ times per week). Arterial stiffness was assessed by brachial‐ankle pulse wave velocity at baseline and repeatedly during follow‐ups. Mean differences and 95% CIs in the yearly change rate of brachial‐ankle pulse wave velocity across the 3 groups were calculated, adjusting for age, sex, socioeconomic status, total energy intake, diet quality, sleep quality, and other cardiovascular disease risk factors. At baseline, 6625 (85.2%), 610 (7.8%), and 536 (6.9%) participants reported night eating as never or rarely, some days, or most days, respectively. During a mean 3.19 years, we observed a positive association between night‐eating frequency and progression of arterial stiffness (P trend=0.01). The adjusted difference in brachial‐ankle pulse wave velocity change rate between the group that ate at night most days and the group that never or rarely ate at night was 14.1 (95% CI, 0.6–27.5) cm/s per year. This association was only significant in women, but not in men (P interaction=0.03).ConclusionsIn an adult population free of major chronic diseases, habitual night eating was positively associated with the progression of arterial stiffness, a hallmark of arteriosclerosis and biological aging.RegistrationURL: https://www.chictr.org.cn; Unique identifier: ChiCTR‐TNRC‐11001489.

The impact of myo-inositol supplementation on sleep quality in pregnant women: a randomized, double-blind, placebo-controlled study

Background Myo-inositol, a glial marker which plays a critical role in some brain regions, can supposedly affect sleep processes. The purpose of randomized controlled trial was to evaluate the impact of myo-inositol supplementation on sleep quality of pregnant women. Methods The study enrolled 60 women with low risk singleton pregnancies, with a gestational age of at least 14 weeks, in Iran. The participants were block randomized to receive myo-inositol supplementation powder containing 2000 mg of myo-inositol and 200 μg of folic acid or placebo (400 μg of folic acid) for 10 weeks from the gestational age of 14–24. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). The primary outcome was the change in sleep quality from the first trimester to the second trimester (24–28 weeks). The ANCOVA with adjusted covariate variables in the first trimester was conducted to estimate the sleep quality between the two groups. Results The results of ANCOVA boot strapped showed that the mean difference of the total sleep quality score between the two groups was −1.537; 95% CI: −3.050 to −0.024, p = .047) in the second trimester at immediately post-intervention. Also, there were significant differences between the two groups in terms of subjective sleep quality (MD: −0.427; 95% CI: −0.725 to −0.128, p = .006, sleep duration (MD: −0.670; 95% CI: −1.240 to −0.101; p = .022) and habitual sleep efficiency (MD: −0.561; 95% CI: −1.038 to −0.085, p = .022). Conclusion The research confirmed that myo-inositol supplementation can improve global sleep quality, subjective sleep quality, and sleep duration during pregnancy. Therefore, these findings applied to minimize the rate of poor sleep quality in pregnant women.

Investigating the association between sleep quality and diffusion-derived structural integrity of white matter in early adolescence

IntroductionPoor sleep quality has been linked to reduced neural connectivity through decreased white matter (WM) structural integrity. WM tract development has been shown to continue throughout adolescence with studies reporting positive correlations between diffusion-derived estimates of structural integrity and reduced sleep quality in adult samples. Few studies have investigated this relationship exclusively within a sample of young adolescents. MethodsN = 51 participants aged 12 years (M = 151.5 months, SD = 4 months) completed a self-report questionnaire which included the Pittsburgh Sleep Quality Index (PSQI) and underwent Diffusion Tensor Imaging (DTI) as part of their baseline assessment in the Longitudinal Adolescent Brain Study (LABS) being undertaken in Queensland, Australia. Fractional anisotropy (FA) were extracted using Tract-Based Spatial Statistics (TBSS) to investigate associations between sleep quality and WM integrity across the brain. ResultsSignificant correlations were found between the posterior limb of the internal capsule and the PSQI total sleep quality and sleep latency scores. There was also a significant difference in sleep duration between male and female participants. ConclusionThese findings provide an important insight of the impact that sleep may have on early adolescent WM development. Ongoing longitudinal assessment of sleep on WM development across adolescence is likely to provide further important information about how WM maturation relates to variations in sleep quality as circadian rhythm changes occur during middle and late adolescence.

Association Between Sleep Complaints And Musculoskeletal Injuries In Adolescent Athletes

Sleep is a physiological process that plays a crucial role in human metabolic functions, being fundamental in muscle recovery. PURPOSE: To associate sleep complaints with musculoskeletal injuries in adolescent track and field athletes. METHODS: The sample consisted of 30 athletes, who are part of the athletics team of the Sports Training Center, aged between 13 and 22 years and average BMI of 21.21 ± 1.37 kg / m2. Participants completed the Sleep Complaints Questionnaire and retrospective data were collected on musculoskeletal injuries in the team's Physical Therapy sector (last six months). Spearman's correlation coefficient was used to obtain the association between the variables of the Sleep Complaints Questionnaire and the injuries. Finally, the linear regression model was used. The adopted significance level was α ≤ 5%. RESULTS: The results showed that 23.3% of athletes reported having bad sleep, 40% reported good sleep and 36.7% reported very good sleep. The average total sleep time of participants was 07h22min ± 63.55 min (recommended 9 to 10h sleep for athletes) and the average severity of injuries was 1.47 ± 1.24 AU (1=no clearance and 5=severe or withdrawal over 28 days). Significant negative correlations were found between the variables sleep complaint and total sleep time (r=-0.438; p=0.016), sleep complaint and sleep quality (r=-0.472; p=0.009) and significant positive correlation between sleepwalking. and injury severity (r = 0.577; p=0.006). Linear regression data showed that sleep complaints influence 45% of total sleep time (R=0.456; β=-0.456; p=0.011); that sleep complaints have a 49% influence on sleep quality (R=0.494; β=-0.494; p=0.006); and that sleepwalking has a 64% influence on the severity of injury (R=0.646; β=0.646; p=0.002). CONCLUSION: The presence of sleep complaints has negative implications on the duration and quality of sleep of the adolescent athlete, as well as increasing the severity of injury. Supported by CTE/EEFFTO/UFMG, FAPEMIG, CAPES and CNPQ.

Radiofrequency Ablation Versus Bipolar Electrocautery for the Treatment of Nasal Obstruction in Obstructive Sleep Apnea Patients Using Continuous Positive Airway Pressure

Objective: To investigate the treatment effect of radiofrequency ablation (RFA) on nasal obstruction, continuous positive airway pressure (CPAP) compliance, Epworth sleepiness scale (ESS) and sleep quality were compared with that of bipolar electrocautery (BEC) in patients using CPAP. Material and Methods: Participants were randomised into two groups and treated with either RFA or BEC. Data were collected regarding nasal obstruction, total nasal symptoms, CPAP compliance, daytime sleepiness and sleep quality before and after treatment at 1, 3 and 6 months. Results: Twenty-eight patients were enrolled in the study. Both methods relieved nasal obstruction at 1, 3 and 6 months. At 6 months, the symptom was improved by 83.4% and 64.2% in the RFA and BEC groups, respectively. The total nasal symptoms decreased at 3 and 6 months in both groups as well, exhibiting 75.7% and 40.6% improvement at 6 months in the RFA and BEC groups, respectively. Conclusion: Both RFA and BEC have the ability to relieve nasal obstruction in such patients.

Quantifying Physical Activity After Concussion: The Relationship Between Sleep Quality, Symptoms, And Steps.

BACKGROUND: Concussion management guidelines have evolved over recent years to include earlier introduction of physical activity. Determining optimal post-concussion physical activity levels with objective methods will further aid clinicians in counseling patients on the role of physical activity in concussion recovery. PURPOSE: Our aim was to investigate the relationship of physical activity, as measured by daily step count, with post-injury sleep quality, symptom rating, and dual-task gait measures among youth athletes with concussion. METHODS: We conducted a longitudinal investigation of youth athletes who sustained a concussion and were evaluated at 2 time points: within 2 weeks of injury and at clearance for return-to-play. Following the initial visit, athletes wore an activity tracking device (Fitbit Charge 3). Dual-task gait, Post-Concussion Symptom Inventory, and Pittsburgh Sleep Quality Index values were collected at both visits. We compared outcomes between those who recorded an average of ≥10,000 steps/day (high physical activity) and <10,000 steps day (low physical activity) between initial and return-to-play clearance visits. RESULTS: Six concussed athletes were classified as having high physical activity (33% female; 14.9±2.0 years of age; 13,900±3,390 steps/day), and five were classified as having low physical activity (40% female; 15.8±1.7 years of age; 8,415±1,775 steps/day). There were no significant differences found at initial visit for total symptom severity (44.3±30.8 vs. 58.2±28.4; p=0.46), sleep quality (6.8±4.4 vs. 8.8±2.0; p=0.38), or dual-task gait cost (-22.4±7.9% vs. -20.1±13.5%; p=0.73) between the high and low physical activity groups. At the time of return-to-play clearance, however, the high physical activity group reported significantly better sleep quality (1.3 ±1.9 vs. 6.7±1.5; p=0.009) and lower symptom severity (0.3±0.8 vs. 3.0±2.0; p=0.02) than the low physical activity group. CONCLUSIONS: Adolescents with a concussion who participated in more physical activity after their initial clinical visit reported better sleep quality and lower symptom severity at return-to-play clearance than the low physical activity group. These preliminary results further support the utility of physical activity in concussion management.

Efficacy, acceptability, and tolerability of all available treatments for insomnia in the elderly: a systematic review and network meta-analysis.

Symptoms of insomnia are highly prevalent in the elderly. A significant number of pharmacological and non-pharmacological interventions exist, but, up-to-date, their comparative efficacy and safety has not been sufficiently assessed. We integrated the randomized evidence from every available treatment for insomnia in the elderly (>65years) by performing a network meta-analysis. Several electronic databases were searched up to May 25, 2019. The two primary outcomes were total sleep time and sleep quality. Data for other 6 efficacy and 8 safety outcomes were also analyzed. Fifty-three RCTs with 6832 participants (75years old on average) were included, 43 of which examined the efficacy of one or more drugs. Ten RCTs examined the efficacy of non-pharmacological interventions and were evaluated only with pairwise meta-analyses because they were disconnected from the network. The overall confidence in the evidence was very low primarily due to the small amount of data per comparison and their sparse connectedness. Several benzodiazepines, antidepressants, and z-drugs performed better in both primary outcomes, but few comparisons had data from more than one trial. The limited evidence on non-pharmacological interventions suggested that acupressure, auricular acupuncture, mindfulness-based stress reduction program, and tart cherry juice were better than their control interventions. Regarding safety, no clear differences were detected among interventions due to large uncertainty. Insufficient evidence exists on which intervention is more efficacious for elderly patients with insomnia. More RCTs, with longer duration, making more direct interventions among active treatments and presenting more outcomes are urgently needed.

Specific Dietary (Poly)phenols Are Associated with Sleep Quality in a Cohort of Italian Adults.

Background: Diet has been the major focus of attention as a leading risk factor for non-communicable diseases, including mental health disorders. A large body of literature supports the hypothesis that there is a bidirectional association between sleep and diet quality, possibly via the modulation of neuro-inflammation, adult neurogenesis and synaptic and neuronal plasticity. In the present study, the association between dietary total, subclasses of and individual (poly)phenols and sleep quality was explored in a cohort of Italian adults. Methods: The demographic and dietary characteristics of 1936 adults living in southern Italy were analyzed. Food frequency questionnaires (FFQs) were used to assess dietary intake. Data on the (poly)phenol content in foods were retrieved from the Phenol-Explorer database. The Pittsburg Sleep Quality Index was used to measure sleep quality. Multivariate logistic regression analyses were used to test the associations. Results: A significant inverse association between a higher dietary intake of lignans and inadequate sleep quality was found. Additionally, individuals with the highest quartile of hydroxycinnamic acid intake were less likely to have inadequate sleep quality. When individual compounds were taken into consideration, an association with sleep quality was observed for naringenin and apigenin among flavonoids, and for matairesinol among lignans. A secondary analysis was conducted, stratifying the population into normal weight and overweight/obese individuals. The findings in normal weight individuals showed a stronger association between certain classes of, subclasses of and individual compounds and sleep quality. Notably, nearly all individual compounds belonging to the lignan class were inversely associated with inadequate sleep quality. In the overweight/obese individuals, there were no associations between any dietary (poly)phenol class and sleep quality. Conclusions: The results of this study suggest that a higher dietary intake of certain (poly)phenols may be associated with better sleep quality among adult individuals.

Brief Behavioral Treatment for Insomnia vs. Cognitive Behavioral Therapy for Insomnia: Results of a Randomized Noninferiority Clinical Trial Among Veterans

The goal of this study was to compare a brief behavioral treatment for insomnia (BBTI), which has fewer sessions (4), shorter duration (<30–45 minutes), and delivers treatment in-person plus phone calls to cognitive behavioral therapy for insomnia (CBTI), which has 5 in-person sessions. The hypothesis was BBTI would be noninferior to CBTI. The Reliable Change Index was used to establish a noninferiority margin (NIM) of 3.43, representing the maximum allowable difference between groups on the pre-post Insomnia Severity Index change (ΔISI). Sixty-three veterans with chronic insomnia were randomized to either BBTI or CBTI and veterans in both groups had significant reductions of their insomnia severity per the ISI and improved their sleep onset latency, total wake time, sleep efficiency, and sleep quality per sleep diaries. While CBTI had a larger pre-post ΔISI, this was not significantly different than ΔISI BBTI and was less than the NIM. However, the 95% confidence interval of the between group pre-post ΔISI extended beyond the NIM, and thus BBTI was inconclusively noninferior to CBTI. Limitations, such as small sample size and high rate of dropout, indicate further study is needed to compare brief, alternative yet complementary behavioral insomnia interventions to CBTI. Still, evidence-based brief and flexible treatment options will help to further enhance access to care for veterans with chronic insomnia, especially in non-mental-health settings like primary care.

Sleep and academic performance in university students: a systematic review

University students tend to suffer from problems of sleep regularity, quantity and quality, which can affect their academic performance. These problems are related to changes typical of the phase of the life cycle in which they find themselves due to maturational, psychosocial development (associated with the processes of individuation and socialisation) and academic factors. The study of the relationship between sleep and academic performance in university students is an area of research of growing interest, which has started to be studied over the last two decades. To conduct a systematic review of the existing literature on the relationship between sleep and academic performance in university students. The articles included in the PubMed database were selected, following the PRISMA guidelines. Studies evaluating samples of subjects with an average age between 18 and 26 years, published in English or Spanish during the period 2000-2019 were included. Subsequently, the quality of the selected articles was evaluated according to the STROBE standard. Thirty studies were identified, which were grouped according to different aspects of sleep: drowsiness, duration, experience of total sleep deprivation, sleep quality, chronotype, regularity and sleep disorders. The results of these studies suggest that inadequate sleep has a negative effect on the academic performance of university students.

Sleep characteristics and white matter hyperintensities among midlife women.

Sleep disturbance is common among midlife women. Poor self-reported sleep characteristics have been linked to cerebrovascular disease and dementia risk. However, little work has considered the relation of objectively assessed sleep characteristics and white matter hyperintensities (WMHs), a marker of small vessel disease in the brain. Among 122 midlife women, we tested whether women with short or disrupted sleep would have greater WMH, adjusting for cardiovascular disease (CVD) risk factors, estradiol, and physiologically assessed sleep hot flashes. We recruited 122 women (mean age = 58 years) without a history of stroke or dementia who underwent 72 h of actigraphy to quantify sleep, 24 h of physiologic monitoring to quantify hot flashes; magnetic resonance imaging to assess WMH; phlebotomy, questionnaires, and physical measures (blood pressure, height, and weight). Associations between actigraphy-assessed sleep (wake after sleep onset and total sleep time) and WMH were tested in linear regression models. Covariates included demographics, CVD risk factors (blood pressure, lipids, and diabetes), estradiol, mood, and sleep hot flashes. Greater actigraphy-assessed waking after sleep onset was associated with more WMH [B(SE) = .008 (.002), p = 0.002], adjusting for demographics, CVD risk factors, and sleep hot flashes. Findings persisted adjusting for estradiol and mood. Neither total sleep time nor subjective sleep quality was related to WMH. Greater actigraphy-assessed waking after sleep onset but not subjective sleep was related to greater brain WMH among midlife women. Poor sleep may be associated with brain small vessel disease at midlife, which can increase the risk for brain disorders.

Effect of Transcranial Alternating Current Stimulation for the Treatment of Chronic Insomnia: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Clinical Trial

Background: Not all adults with chronic insomnia respond to the recommended therapeutic options of cognitive behavioral therapy and approved hypnotic drugs. Transcranial alternating current stimulation (tACS) may offer a novel potential treatment modality for insomnia. Objectives: This study aimed to examine the efficacy and safety of tACS for treating adult patients with chronic insomnia. Methods: Sixty-two participants with chronic primary insomnia received 20 daily 40-min, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas in the laboratory on weekdays for 4 consecutive weeks, followed by a 4-week follow-up period. The primary outcome was response rate measured by the Pittsburgh Sleep Quality Index (PSQI) at week 8. Secondary outcomes were remission rate, insomnia severity, sleep onset latency (SOL), total sleep time (TST), sleep efficiency, sleep quality, daily disturbances, and adverse events at the end of the 4-week intervention and at the 4-week follow-up. Results: Of 62 randomized patients, 60 completed the trial. During the 4-week intervention, 1 subject per group withdrew due to loss of interest and time restriction, respectively. Based on PSQI, at 4-week follow-up, the active group had a higher response rate compared to the sham group (53.4% [16/30] vs. 16.7% [5/30], p = 0.009), but remission rates were not different between groups. At the end of the 4-week intervention, the active group had higher response and remission rates than the sham group (p < 0.001 and p = 0.026, respectively). During the trial, compared with the sham group, the active group showed a statistically significant decrease in PSQI total score, a shortened SOL, an increased TST, improved sleep efficiency, and improved sleep quality (p < 0.05 or p < 0.001). Post hoc analysis revealed that, in comparison with the sham group, the active group had improved symptoms, except for daily disturbances, at the end of the 4-week intervention, and significant improvements in all symptoms at the 4-week follow-up. No adverse events or serious adverse responses occurred during the study. Conclusion: The findings show that the tACS applied in the present study has potential as an effective and safe intervention for chronic insomnia within 8 weeks.

Sleep and HbA1c in Patients With Type 2 Diabetes: Which Sleep Characteristics Matter Most?

Poor sleep has been identified as a risk factor for poor glycemic control in individuals with type 2 diabetes (T2D). As optimal sleep can be characterized in several ways, we evaluated which sleep characteristics are most strongly associated with glycated hemoglobin A1c (HbA1c). A total of 172 patients with T2D completed 7-day wrist-actigraphy and sleep questionnaires. Linear regression was used to evaluate associations between sleep measures (total sleep duration, variability in sleep duration, midsleep time, variability in midsleep time, sleep efficiency, subjective sleep quality, and subjective insomnia symptoms) and HbA1c, individually and in concert. Variability in sleep duration was individually most strongly associated with HbA1c (β = 0.239; P = 0.002; R 2 = 4.9%), followed by total sleep duration (U-shaped: β = 1.161/β2 = 1.044; P = 0.017/0.032; R 2 = 4.3%), subjective sleep quality (β = 0.191; P = 0.012; R 2 = 3.6%), variability in midsleep time (β = 0.184; P = 0.016; R 2 = 3.4%), and sleep efficiency (β = -0.150; R 2 = 2.3%). Midsleep time and subjective insomnia symptoms were not associated with HbA1c. In combination, variability in sleep duration, total sleep duration, and subjective sleep quality were significantly associated with HbA1c, together explaining 10.3% of the variance in HbA1c. Analyses adjusted for covariates provided similar results, although the strength of associations was generally decreased and showing total sleep duration and subjective sleep quality to be most strongly associated with HbA1c, together explaining 6.0% of the variance in HbA1c. Sleep in general may be a modifiable factor of importance for patients with T2D. The prevention of sleep curtailment may serve as a primary focus in the sleep-centered management of T2D.

EXAMINING PSYCHOSOCIAL FACTORS, HEALTH BEHAVIORS, AND WHITE MATTER LESIONS IN OLDER ADULTS

Prior to the onset of dementia, subclinical indices of brain pathology may reliably predict cognitive decline, even among older adults with high cognitive reserve. Evidence suggests that positive psychosocial experiences and healthy behaviors buffer cognitive decline. However, their relationship with brain outcomes in cognitively intact older adults is not well understood. Therefore, the current study examined the cross-sectional association between perceived social support, generalized anxiety, psychosocial stress, physical activity, sleep quality, and magnetic resonance imaging (MRI)-assessed white matter lesions (WML), among a diverse sample of older adults. We also examined sex and race as effect modifiers. Data were analyzed from 129 participants (mean age=67.40y, 69% female, 43% African American) enrolled in the Healthy Heart & Mind Study. Participants completed psychosocial and health behavior measures and MRI-assessed periventricular and deep WML were ascertained. Multiple regression analyses assessed relations of psychosocial responses and physical activity to WML, adjusting for known covariates. Significant general anxiety x sex interactions on deep WML (p<.05), significant physical activity x race interactions on total WML, frontal lobe WML and deep WML, respectively, and total sleep quality x race interactions on deep WML, were observed (p<.05). Conditional effects showed greater physical activity and sleep quality were associated with lower WML in African-American women; greater social belonging was associated with lower WML in American-American men; and lower anxiety was associated with lower WML in African-American women and White men. Results suggest positive psychosocial factors and health behaviors may influence subclinical brain pathology via unique pathways.

Sleep coaching: non-pharmacological treatment of non-restorative sleep in Austrian railway shift workers

Sleep coaching by Holzinger & Klösch™ is a new, Gestalt therapy-based holistic approach to non-pharmacological treatment of non-restorative sleep. It includes psychotherapeutic aspects which enable participants to improve their sleep quality by developing their own coping strategies as a daily routine. Dream work and relaxation techniques are also part of the programme. The aim of this study was to measure the effectiveness of a two-day sleep coaching seminar on sleep quality, daytime sleepiness, and work and life quality in shift workers employed in an Austrian railway company (Österreichische Bundesbahnen, ÖBB). Thirty shift workers (28 male; mean age=24±45.90, age range 24-56 years) answered the same survey before and six months after the seminar (baseline and follow-up) containing items of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), their chronotype, personality factors, and burnout risk factors. The baseline findings in this group were compared with those of non-completers (who did not take the follow-up survey) (N=154) to see if the two groups differed significantly enough to create a bias among completers (who took the follow-up survey as well). Groups differed significantly in burnout levels as well as sleep duration, but not in the distribution of critical PSQI and ESS values. The two-day sleep coaching seminar resulted in a significant improvement in total PSQI score and subjective sleep quality and in a significant reduction in diurnal fatigue, sleep latency, and daytime sleepiness. Nevertheless, more research with a larger sample and a longitudinal design is needed to establish the long-term effects of sleep coaching.

Meta-analysis: Exercise intervention for sleep problems in cancer patients.

Sleep problems cause physical and mental distress and may influence the survival of cancer patients. This study aimed to explore the efficacy of exercise intervention to improve sleep in cancer patients. Published papers from 1980 to 2018 were searched. The major findings included (a) exercise intervention had small positive effects on enhancing total subjective sleep quality (TSSQ; g=0.38, 95% CI=0.21-0.54) and objective sleep onset latency (g=0.21, 95% CI=0.01-0.41). (b) The characteristics in subgroups in regarding the small to large effects of an exercise programme on sleep were identified. First, the groups of a home-based exercise and a supervised exercise combined with a home-based exercise had a medium effect on TSSQ than the usual group. Second, interventions with aerobic exercise, especially the 4- to 8-week programmes and those with weekly volume of 80-149min per week for cancer patients with ongoing or completed treatment also had a medium to large positive effect on TSSQ. Finally, patients with breast cancer and haematologic malignancies contributed a small effect in this meta-analysis. Maintaining regular aerobic exercises, even of different durations and weekly volumes, benefits patient sleep quality.

Study on the influence and intervention strategy of nursing staff rushing to plateau on sleep quality

Objective To understand the changing characteristics of sleep quality of acute plateau nursing staff during the period of assistance to Tibet, formulate comprehensive intervention measures, improve the support ability of nursing staff, and provide the basis for effectively completing the work of plateau assistance to Tibet. Methods From November to December 2017, 12 nurses who participated in the assistance work for Tibet in Lhasa region with an altitude of 3,650 m were selected as the emergency group, and 12 nurses from a hospital in Tibet were selected as the plateau group. Pittsburgh sleep quality index (PSQI) was used to investigate the sleep quality of the acute group before and after Tibet entry and the plateau group respectively. A sleep quality survey scale was designed to investigate the sleep quality of nursing staff in the emergency group and the plateau group at 5 different shifts on the same night after admission to Tibet. Results The scores of total sleep score, sleep quality, sleep time, sleep time, sleep efficiency and daytime dysfunction in the acute group were 3.77±1.79, 0.89±0.47, 0.78±0.36, 0.76±0.41, 0.19±0.05, 0.54±0.07, and 5.37±1.23, 1.57±0.36, 1.53±0.43, 1.21±0.38, 0.72±0.10, 0.99±0.91 respectively. The differences before and after Tibet were statistically significant (t=2.327-4.399, P <0.05).The scores of sleep time, sleep time, sleep efficiency and sleep disorder in the acute group were 1.53±0.43, 1.21±0.38, 0.72±0.19, 1.16±0.21, and 1.04±0.21, 0.86±0.32, 0.39±0.31 and 0.76±0.33 respectively. The differences between the two groups were statistically significant (t=2.441-3.547, P<0.05 or 0.01).Radical groups after Tibet plateau and nursing staff sleep quality scale scores compare, radical group day shift, middle shift, night after night under three different shifts the total score of sleep quality, respectively 11.76±0.12, 11.98±0.23, 12.43±0.52, higher than that of plateau group 11.18±0.04 11.23±0.57, 11.98±0.54, the difference between two groups was statistically significant (t=15.554, 4.227, 2.07, P<0.01 or 0.05). The sleep quality score (11.38±0.36) in the night of the rest class was lower than that of the plateau group (11.92±0.38), and the difference was statistically significant (t=-3.574, P=0.002). The score of sleep quality and sleep delay of the acute group were 1.87±0.57, 1.93±0.61, and 1.39±0.39, 1.25±0.42 respectively. The difference between the two groups was statistically significant (t=2.408, 3.181, P< 0.05 or 0.01). Conclusions It is a common sleep problem for medical and nursing personnel in Tibet who rush into the plateau. Comprehensive intervention measures should be taken in advance, scientific popularization, education and health technical guidance should be carried out in the early stage, mental health conditions should be improved, and drug prevention should be taken when necessary to help medical and nursing personnel in Tibet sleep quality. Key words: Into the plateau; Nursing staff; Quality of sleep; Intervention strategy

Relationship between sleep quality and postural balance in community-dwelling older persons: studio transversal.

To determine the relationship between sleep quality and postural balance in older adults living in the community. An analytical cross-sectional study was used. We recruited 53 subjects who fulfilled the inclusion criteria. The Pittsburgh Sleep Quality Index (PSQI) was administered, and a static balance test was performed through a computerized posturography to evaluate the postural balance. Fifty-three subjects 60 to 80 years old (M = 70.13; standard deviation = 6.06) were evaluated; 69.8% were women and 30.2% were men. The correlation test found a statistically significant and positive relationship, but moderate (p = 0.002; r = 0.417) between total displacement and sleep quality in the Romberg open eyes test. The same happened with the total displacement in the Romberg close eyes test (p = 0.002, r = 0.445). Displacements were always greater in the anteroposterior plane, where a statistically significant and positive correlation with sleep quality was also found in all posturological tests. The correlation was moderate in all cases. There is a relationship between the quality of sleep measured and postural balance. However, this relationship is low to moderate, and the size of the effect must be considered before accepting the hypothesis.