Sleep Health最新文献

Objectives: Few studies have examined sleep health among African adolescents. We aimed to understand sleep health among Ugandan secondary school students.

Methods: We collected quantitative data in two schools through a survey with items on sleep health and insomnia (using the Cleveland Adolescent Sleepiness Questionnaire, Munich Chronotype Questionnaire and Insomnia Severity Index [ISI]) and mental health with the UNICEF Measuring Mental Health Among Adolescents and Young People at the Population Level (MMAPP) tool. We used regression models to assess characteristics associated with ISI score, and of sleep health with depression and anxiety. We conducted focus group discussions and in-depth interviews with students, parents, teachers, and officials. Quantitative and qualitative analyses were guided by the social ecological model of sleep health.

Results: The 358 participants generally reported poor sleep health (assessed by satisfaction, alertness, timing, efficiency and duration), especially among boarding students. The median sleep duration was 5.1 hours (interquartile range 4.2-6.2). Overall, 36 (10.1%) participants screened positive for moderate/severe insomnia (ISI ≥15), with higher prevalence among females than males (12.7% vs. 6.2%; p = .05). Qualitative interviews highlighted that individual (knowledge and attitudes), social-cultural (religious beliefs, family dynamics, academic demands, peer pressure), environmental (school and home conditions, technological influences), and societal factors (national school schedule guidelines) influenced sleep patterns. Depression and anxiety were associated with multiple dimensions of poor sleep health.

Conclusions: Ugandan adolescents face substantial sleep challenges, which are associated with poor mental health. Evidence-based interventions should be adapted for specific social-ecological contexts to improve sleep and mental health in this population.

Objectives: Daily temperature variability is projected to increase in some world regions up to 100% by 2100. This study investigated associations between night-to-night temperature variability with sleep duration timing and regularity.

Methods: Data were collected from global users of the Withings Sleep Analyzer (n = 125,295) and ScanWatch (n = 238,550) between January 2020-September 2023. Sleep regularity was assessed using intra-monthly variation in sleep duration and timing (onset, midpoint and offset). Ambient temperature data were extracted from established climate models to calculate night-to-night temperature variability. Fixed-effects models were used to assess the association between night-to-night temperature variability and sleep regularity (duration and timing).

Results: Participants (n = 313,822) were middle-aged (50 ± 15 years), 70% male, with an average 17 months of data. During months with high vs. low night-to-night temperature variability (99th percentile: 4.3°C vs. 50th percentile: 1.9°C), sleep onset variability was higher in southern (mean [95%CI]; 17.9 [16.1, 19.6]min), central (6.5°C vs. 1.0°C; 32.2 [29.8, 34.6]min) and northern locations (5.5°C vs. 2.1°C; 11.4 [11.2, 11.7]min). There was greater variability in sleep midpoint and offset with higher night-to-night temperature variability, with similar effect sizes. High night-to-night temperature variability was associated with <10 minutes difference in sleep duration irregularity.

Conclusions: Our findings highlight that high night-to-night temperature variability is associated with a 20%-50% increase in sleep timing irregularity, with central and southern regions being more affected. Given that sleep irregularity is associated with adverse health outcomes, targeted interventions to mitigate the impact of temperature variability on sleep health is an important public health priority.

Introduction: We previously developed a brief, behavioral intervention (Sleep Promotion Program, SPP) that demonstrated feasibility, acceptability, and increased self-reported sleep. Here, we tested the effects of SPP on the trial's secondary outcomes: sleep duration, regularity, and timing as measured by actigraphy and conducted a secondary analysis of SPP's effects on rest-activity rhythms.

Methods: Forty participants (ages 13-15) with insufficient and irregular sleep randomized to SPP-continuation (n = 22), or to sleep monitoring-SPP (n = 18), had analyzable actigraphy data. SPP included sleep psychoeducation and one individual clinician session. Participants wore an actigraph for 1-2 weeks during baseline, Period 1, and Period 2. We hypothesized SPP would lead to longer and more regular sleep from baseline to Period 1 compared to sleep monitoring that would be sustained at Period 2. We used multilevel models with a treatment by time interaction to test whether SPP improved sleep relative to sleep monitoring. We also compared sleep changes from Period 1 to Period 2 among participants randomized to SPP-continuation.

Results: Participants receiving SPP decreased the difference in weekend-weekday sleep onset by 54-minute (β = 1.1; p = .03) from baseline to Period 1 (i.e., increased regularity). Increased regularity was maintained at Period 2. Total sleep time did not change significantly.

Conclusion: SPP regularized weekend-weekday sleep onset timing in adolescents with insufficient and irregular sleep but did not change actigraphic sleep duration, which differed from increases in self-reported sleep duration previously reported. Regularizing sleep may be an attainable first step to improving adolescent sleep. Future work is needed to test whether sleep regularity predicts adolescent health outcomes.

Clinical trials: Targeted Intervention for Insufficient Sleep among Typically-Developing Adolescents (TAPAS); https://clinicaltrials.gov/ct2/show/NCT04163003; NCT04163003.

Objectives: This longitudinal study investigated bidirectional links between objective and self-reported sleep and symptoms of depression and anxiety in both parents from pregnancy to 12 months postpartum. Using Random Intercept Cross-Lagged Panel Models (RI-CLPM), we examined whether sleep disturbances predict later depressive and anxiety symptoms and vice versa.

Methods: A total of 232 couples were recruited during pregnancy. Data were collected in the third trimester and at 4, 8, and 12 months postpartum. Sleep was assessed over seven nights using actigraphy and diaries. Parents completed the Insomnia Severity Index (ISI), the Edinburgh Postnatal Depression Scale (EPDS), and the trait subscale of the State-Trait Anxiety Inventory (STAI).

Results: Correlational analyses demonstrated that lower self-reported sleep quality (diary, ISI) was significantly associated with higher depressive and anxiety symptoms in both parents, whereas actigraphy-based measures showed no such associations. RI-CLPM revealed within-person concurrent associations between poorer sleep quality and higher depressive-anxiety symptoms (combined score), especially in late postpartum. Prospectively, higher depressive-anxiety symptoms at 8 months predicted poorer reported sleep quality at 12 months in both parents. Only in fathers, did poorer sleep quality at 4 months predict increased depressive-anxiety symptoms at 8 months.

Conclusion: Parental depressive-anxiety symptoms may increasingly contribute to ongoing sleep disturbances over time. This link may be shaped by unique postpartum processes, rather than reflecting only general adult sleep-mental health associations. Clinically, addressing parental distress symptoms could contribute to improvements in perceived sleep quality, though further research is needed to confirm this.

Objectives: (1) Develop and iteratively refine an infographic designed to promote obstructive sleep apnea activation in parents of symptomatic children; and (2) describe parental response to the infographic as implemented in clinical practice.

Methods: An infographic designed to activate parents to speak with their child's primary care provider about obstructive sleep apnea symptoms was developed using qualitative themes from parent interviews. To promote stakeholder acceptability of the infographic, we conducted 12 focus groups with parents (n = 24), primary care providers (n = 9), and sleep medicine physicians (n = 4) across three testing phases. For each iterative version, participants provided ratings on the infographic's clarity, activation, relevance, acceptability, feasibility, and accuracy. The infographic was then implemented in clinical practice across eight pediatric primary care clinics. A sample of parents whose child screened positive for obstructive sleep apnea (n = 148) viewed the infographic on a patient portal and were asked whether they planned to speak to their child's primary care provider about obstructive sleep apnea.

Results: Stakeholder feedback yielded to revisions of the language, images, and text. Parents highly rated the infographic's final iteration for clarity (scale 1-5, M = 4.8, SD = 0.2), activation (M = 4.6, SD = 0.2), and relevance (M = 4.9, SD = 0.1). Primary care providers rated the infographic as highly acceptable (M = 4.7, SD = 0.5) and sleep medicine physicians highly rated the infographic as highly accurate (M = 5, SD = 0). When implemented in clinical care, almost half of parents who viewed the infographic (45.9%) reported intent to speak with their child's primary care provider about obstructive sleep apnea, with 36.5% reporting uncertainty and 17.6% indicating they did not plan to speak to their child's primary care provider.

Conclusions: We developed an infographic that can be applied across settings and may activate parents to speak with their child's provider about obstructive sleep apnea. The use of infographics and other parent-directed strategies can play an important role in obstructive sleep apnea detection.

Objectives: This study aimed to examine the longitudinal associations between parental supervision of bedtime screen use and children's sleep health across multiple dimensions (timing, duration, efficiency, alertness, satisfaction, and regularity) and to investigate whether these associations were mediated by reduced bedtime screen use.

Methods: This longitudinal study included 1618 children aged 9-11 years from 4 primary schools in Beijing, China. Data were collected at baseline from April to June 2024 and at a 6-month follow-up in January 2025. Parents reported their supervision of children's bedtime screen use, and children reported their bedtime screen use and sleep outcomes.

Results: Overall, 49.1% of children received consistent supervision of bedtime screen use. After adjusting for covariates, children with parental supervision had a significantly lower risk of adverse sleep outcomes, including late bedtimes (weekday: relative risks = 0.71, 95% confidence interval: 0.58-0.88; weekend: relative risks = 0.70, 95% confidence interval: 0.63-0.79), prolonged sleep onset latency (relative risks = 0.74, 95% confidence interval: 0.64-0.84), daytime sleepiness (relative risks = 0.81, 95% confidence interval: 0.68-0.95) and an irregular sleep schedule (relative risks = 0.83, 95% confidence interval: 0.74-0.94). Mediation analysis indicated that reduced bedtime screen use partially mediated these associations.

Conclusions: Parental supervision of bedtime screen use was associated with improved sleep health in school-aged children. These benefits were partly explained by reduced bedtime screen use. Therefore, encouraging parental supervision may be an effective strategy to improve children's sleep health.

Objectives: We sought to move beyond typical therapeutic interventions to improve insomnia symptoms by exploring food aid as a means to decrease insomnia symptoms in contexts with high food insecurity.

Methods: We recruited participants from food aid distribution centers in Pakistan. Participants were randomly assigned to a treatment condition in which they received food aid (weighted to be 60% of participants) or were in the waitlist control condition (weighted to be 40% of participants), followed by an outcome survey. 186 participants completed the study.

Results: Participants in the food aid condition reported significantly lower anxiety (M = 2.71, SD = 0.81) than participants in the waitlist control condition (M = 3.83, SD = 0.55), p < .001, cohen's d = -1.57. Participants in the food aid condition reported significantly lower insomnia symptoms (M = 2.66, SD = 1.12) than participants in the waitlist control condition (M = 3.28, SD = 1.01), p < .001, cohen's d = -0.57. The indirect effect of food aid on insomnia symptoms via anxiety was significant (Est = -0.45, 95% CI [-0.23, -0.69]), consistent with anxiety as a mediator.

Conclusions: In our exploratory study of a context characterized by high food insecurity, the provision of food aid lowered anxiety and insomnia symptoms. Food aid provision may be an effective means to address insomnia in contexts in which traditional therapeutic approaches may be impractical to sufficiently scale.

Purpose: This study assesses the role of personal, family-related, and school-related factors in adolescence in the perception of the presence of difficulties in falling asleep.

Methods: The study used data from the Italian 2022 Health Behavior in School-Aged Children (HBSC) study, focusing on 3201 participants (99.7% of response) from the Italian HBSC sample in Tuscany. Descriptive and hierarchical multivariable logistic regression models including personal, family- and school-related factors were used to assess perceived difficulties in falling asleep as reported by 11-, 13-, 15-, and 17-year-old adolescents.

Results: Around 49.7% of the sample was female. Nearly a quarter of the adolescents reported sleep difficulty daily or more than once a week. Females reported significantly higher risk of sleep difficulty (odds ratio (OR) of 1.38, 95% CI 1.1-1.7), as did those with higher levels of perceived school pressure (OR 1.47, 95% CI 1.3-1.6) and lack of student support (OR 1.14, 95% CI 1.0-1.3). Those in the middle level of the Family Affluence and older adolescents reported lower risk of sleep difficulty falling asleep (OR 0.74, 95% CI 0.6-0.9 and 0.46, 95% CI 0.3-0.6, respectively).

Conclusion: Since concurrent factors in different settings have shown to influence the expression of sleep problems, integrated intervention strategies should be applied to promote healthy sleep habits among adolescents. Therefore, it is necessary for invest in multidimensional intervention approaches, taking into account all the key stakeholders such as the individual, the family and the school into a more integrated perspective design.

Objectives: Few studies have examined daily effects of sleep on cognition. This analysis examined both between-person and within-person associations of actigraphic sleep with daily cognitive performance ascertained via ecological momentary assessments.

Methods: Data are from community-residing, dementia-free older adults in the Einstein Aging Study (mean age 77.2 ± 4.7, 67.3% female, 47% non-Hispanic White, and 40% non-Hispanic Black) who were free of dementia. Over 16 days, participants wore wrist actigraphs and completed cognitive assessments six times daily using study-provided smartphones and completed overnight pulse oximetry. Brief cognitive tasks assessed four domains of cognitive function. Multilevel linear mixed-effect models assessed associations of sleep characteristics with cognitive performance. Data were aligned such that models addressed the relationship between a day's sleep parameters and the next day's cognitive performance, adjusted for demographics, depression, cardiovascular comorbidity, and sleep-disordered breathing.

Results: In adjusted models, between-person associations showed that higher average wake after sleep onset (WASO) was associated with slower average processing speed, worse working memory, and worse visual memory binding. Within-person effects showed that an individual's processing speed was slower than usual on days following a night with greater-than-usual WASO. Sleep duration, timing, or naps were not associated with any of the cognitive tests.

Conclusions: Using ambulatory assessments in real-world environments, the results demonstrate short-term effects of sleep fragmentation (WASO) on processing speed the next day in dementia-free older adults. Better understanding short-term effects might identify individuals who may benefit from early interventions to prevent long-term cognitive decline.