Behavioral Sleep Medicine最新文献

Objective: To explore the attitudes and experiences of people with chronic low back pain (LBP) on sleep, health care, and digital health.

Method: Participants completed a survey about LBP, sleep, health care, and digital health. All data collected was self-reported by participants. Survey completers were invited for semi-structured interviews comprising open-ended questions exploring LBP and sleep interplay, health care experiences, and digital health preferences. Interviews were analyzed using a thematic framework approach.

Results: Six-hundred and sixty-nine participants completed the survey. n = 501 female, mean age = 56.7 ± 14.4 years. Most participants (90%) reported LBP-related sleep disturbance. More than half (61%) were not satisfied with their current LBP-related health care Sixty-one percent of participants were willing to use a sleep-specific digital health intervention (DHI) if recommended by a health care professional. Interviews (n = 26) revealed three themes: (i) living with LBP and poor sleep, (ii) health-seeking behaviors, and (iii) implementing sleep and back pain DHIs. Participants were concerned with the legitimacy of non-health professional advice and preferred evidence-based DHIs.

Conclusions: Sleep disturbance and health care dissatisfaction was highly prevalentin individuals with chronic LBP. Participants were willing to use evidence-based self-directed DHIs for LBP and sleep disturbance management but wanted clinical authority. These findings reveal opportunities for clinical implementation and intervention studies for individuals with chronic LBP and sleep disturbance.

Objective: Research on the prevalence of bedtime procrastination (BtP) is currently focused on the breadth of BtP presentations, with limited insights into the severity of BtP in terms of its frequency, duration, and dysfunctional impacts. This study aimed to explore the BtP severity and its prevalence among Chinese college students. Moreover, correlates and outcomes of BtP were also examined.

Methods: A total of 20704 college students participated in a cross-sectional survey. BtP was measured by combining the bedtime procrastination scale with items related to BtP frequency, duration per episode, and dysfunctional impacts. Sociodemographics, lifestyles, trait- and state-like factors, and indicators of sleep and mental health were also evaluated.

Results: The prevalence of severe BtP was 10.5%. Poor family socioeconomic status, physical inactivity, alcohol use, pre-sleep media use, and perceived stress were identified as risk factors for severe BtP, while older age, self-control, and an earlier chronotype were protective factors. Moreover, severe BtP was associated with shorter sleep duration, greater social jetlag, and increased risks of daytime sleepiness and depressive symptoms.

Conclusions: The findings provided valuable insights for BtP screening. The associations between BtP and adverse outcomes underscore the importance of screening for severe BtP and offering appropriate interventions.

Objectives: This study investigated cross-country differences in infant and maternal sleep across Korea, the U.S.A. and Australia.

Methods: Participants were 2,005 mother-infant dyads (infant M_age = 13.82 months, SD_age = 6.23 months) from Australia (n = 73), Korea (n = 222), and the U.S.A. (n = 1710). Mothers completed the Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), and Brief Infant Sleep Questionnaire (BISQ) and were grouped (6, 12, and 24 months) dependent on infant age. Data were analyzed using multiple regressions.

Results: Korean mothers had higher insomnia symptoms compared to Australian and U.S.A. mothers at all timepoints (p's < .002). Mean DBAS scores were higher for Korean compared to U.S.A. and Australian mothers (p's < .007). Compared to U.S.A. infants at all timepoints and to Australian infants at 12- and 24 months, Korean infants had shorter nighttime TST (p's < .040) and longer SOL (p's < .003). Bedsharing was associated with lower insomnia symptoms in Korean mothers at 24 months (p = .043). Co-sleeping was not significantly associated with insomnia and DBAS scores (p's > .164).

Conclusions: Korean mothers had higher insomnia and DBAS scores, which did not differ by co-sleeping status; Korean infants had shorter nighttime TST, and longer SOL. Bedsharing in Korea was protective against insomnia symptoms at 24 months. Further exploration into the mechanisms of sleep changes is required to tailor future interventions for diverse backgrounds.

Objectives: Insomnia is common for women with breast cancer, and related to fatigue, depression, and pain. Research exploring these symptoms among breast cancer patients in medically underserved areas is lacking. This study aimed to characterize symptom severity, and examine how fatigue, depression, and pain vary based on categories of insomnia severity.

Methods: Women (N = 127) with Stage 0-IV breast cancer receiving care at clinics in mostly rural, medically underserved areas completed self-report measures of insomnia (Insomnia Severity Index), fatigue (PROMIS-Fatigue), depression (Center for Epidemiological Studies Depression Scale), and pain (Brief Pain Inventory). ANOVA or Kruskal-Wallis tests compared differences in fatigue, depression, and pain across insomnia severity categories. Post-hoc tests determined pairwise significant differences. Analyses were conducted using SAS software.

Results: Median [IQR] insomnia symptom severity fell within the Subthreshold/Mild range (12.00 [6.00, 16.00]). Thirty-four percent of women endorsed insomnia symptoms in the Moderate range or higher. Median fatigue was moderate (60.80 [55.60, 64.85]), and median depressive symptoms (17.00 [10.50, 23.50]) indicated risk for clinical depression. Mean pain severity (4.59 [1.85]) and median pain interference (4.29 [2.57, 6.46]) were moderate. Women endorsing Subthreshold/Mild and Moderate/Severe insomnia symptoms exhibited significantly worse fatigue, depressive symptoms, and pain.

Conclusions: Results highlight a multi-symptom burden for women with breast cancer receiving care at clinics in medically underserved areas with a largely rural population. Behavioral symptom management is critically needed. Intervening on insomnia may, in turn, improve fatigue, depression, and pain. Behavioral interventions targeting insomnia and related symptoms should be adapted for, and tested, in this population.

Objectives: This study aimed to determine the extent to which Cognitive Behavioral Therapy for Insomnia (CBT-I) influences participant willingness to seek treatment for behavioral health conditions. We hypothesized that, relative to sleep hygiene control, CBT-I would be associated with increased willingness to seek treatment for alcohol use, depression, anxiety, PTSD, and chronic pain. Since all participants had insomnia, we also tested CBT-I effects on willingness to seek treatment for residual or future episodes of insomnia.

Method: Data were derived from a randomized controlled trial comparing the efficacy of CBT-I to sleep hygiene control among heavy-drinking Veterans with insomnia (N = 70; 57 men, 13 women; age M = 37.6, SD = 9.4). Willingness to seek treatment was measured on a scale from 0 (strongly disagree) to 4 (strongly agree).

Results: At the end of treatment, across both groups, participants reported most willingness to seek treatment for insomnia (M = 3.08, SD = 1.04), followed by chronic pain (M = 2.82, SD = 1.21), anxiety (M = 2.76, SD = 1.24), depression (M = 2.75, SD = 1.29), PTSD (M = 2.61, SD = 1.27), and alcohol use (M = 2.51, SD = 1.19). Relative to those in sleep hygiene, CBT-I participants reported increased willingness to seek treatment for insomnia [F(1,48) = 10.25, p = .002, d = 0.86] and chronic pain [F(1,48) = 5.76, p = .02, d = 0.60]. No other group-by-time interactions were significant.

Conclusions: CBT-I does increase willingness for future treatment, but only targeting insomnia and chronic pain. Continued research on how to engage Veterans in evidence-based treatment for common mental health concerns (e.g. alcohol use, depression, anxiety, and PTSD) is needed.

Purpose: Poor sleep among adolescents is a significant public health concern. Delivering Cognitive Behavioral Therapy for insomnia (CBT-I) in schools may be an effective way to reach adolescents with poor sleep. This systematic review and meta-analysis examined the effectiveness of school-based CBT-I for improving sleep quality and/or duration among adolescents with insomnia symptoms or disorder.

Methods: A systematic search of studies between 2003 and 2025 was conducted in March 2025. Inclusion criteria were adolescents aged 10-19 years (population) with insomnia symptoms, school-based interventions using evidence-based CBT-I principles (intervention), randomized or non-randomized trials (comparator), and reported sleep quality and/or duration (outcome).

Results: Eight studies (n = 323; M age = 15.3 years; 62.57% female) from four countries were included. Meta-analysis of within sleep intervention condition groups (n = 8) found significant subjective improvements post-intervention: total sleep time (TST) increased by 23.87 minutes (p < .001), sleep onset latency (SOL) decreased by 8.34 minutes (p < .01), and sleep quality improved g = 0.376 (p = .001). Objective measures of TST increased by 20.91 minutes (p = 0.100), SOL decreased by 1.35 minutes (p = 0.202), and sleep efficiency rose by 0.50% (p = .792). Anxiety improved significantly g = 0.373 (p < .01), but depression did not g = 0.806 (p = .196).

Discussion: While sleep improvements were only observed for subjective sleep outcomes, this review suggests that school-based CBT-I may be an effective avenue to address adolescent insomnia. Given the limited evidence, we identify key methodological and implementation considerations to guide practice.

Background: Insomnia and its association with mental health problems are prevalent in young populations. While person-centered statistical methods have identified insomnia phenotypes using a wide range of variables, the potential of common screening tools like the Insomnia Severity Index (ISI) for subtyping insomnia is underexplored. This study aimed to investigate insomnia subtypes in university students using ISI items.

Methods: In a cross-sectional online survey, 1,234 Italian university students (mean age: 23.3 ± 2.4 years) completed the ISI, the Pittsburgh Sleep Quality Index, the Depression Anxiety Stress Scale, and the Short Form-12 health survey. Latent class analysis (LCA) was performed using ISI items as indicators, and class differences in sleep quality, psychological distress, and health-related quality of life were assessed.

Results: A four-class solution was identified: "no insomnia" (NI; 31.4%) with no significant sleep complaints; "high insomnia risk" (HI; 17.7%) showing severe nighttime and daytime symptoms; "subthreshold insomnia" (SI; 37.0%) characterized by moderate nighttime symptoms and sleep dissatisfaction; and "predominant daytime symptoms" (DS; 13.9%) featuring pronounced daytime dysfunction without major nighttime issues. The HI group exhibited the worst sleep quality and highest psychological distress. NI had the best overall outcomes, with SI and DS in intermediate positions. DS had worse mental well-being, higher daytime dysfunction, and more psychological distress compared to SI.

Conclusion: LCA identified four insomnia subtypes based on ISI scores, delineating a continuum from no insomnia to high risk, with one subtype marked primarily by daytime impairments. These findings could guide tailored interventions for different clinical presentations.

Objectives: This study examined whether the interaction between chronotype and sleep duration moderates the relationship between smartphone usage time and problematic smartphone use (PSU) among early adolescents.

Methods: A cross-sectional secondary analysis was conducted using nationally representative data from the 2018 Korean Children and Youth Panel Survey (N = 3,919; 4th and 7th graders). Chronotype, sleep duration, smartphone use, and PSU were assessed. Moderation and moderated moderation analyses were conducted using PROCESS Macro models, controlling for personal, familial, school, and community covariates.

Results: This study demonstrated that chronotype and sleep duration interacted to moderate the association between smartphone use and problematic smartphone use (PSU) in early adolescents. Short sleep duration strengthened the positive association between smartphone use and PSU in both advanced and delayed chronotypes. By contrast, with longer sleep duration, this association shifted to a negative correlation, particularly in advanced chronotypes.

Conclusions: These findings suggest that both sleep duration and chronotype may play important roles in the association between smartphone use and PSU in early adolescence. Parental and school-based programs that encourage healthy sleep and smartphone use habits could be promising avenues for intervention. Longitudinal research is needed to further investigate the directionality and mechanisms of these associations.

Objective: The cultural and historical experiences of African American family caregivers increase their risk for poor sleep health. Limited research representation hinders the development of effective sleep interventions for their unique needs. The purpose of this study is to explore the barriers and facilitators to sleep health in African American family caregivers and describe participants' preferences and recommendations for sleep health interventions.

Method: Using a qualitative descriptive approach, African American family caregivers of community-dwelling adults with chronic or disabling conditions were recruited via community-based methods. Twenty-four caregivers participated in semi-structured in-person, telephone, or videoconference interviews. Transcribed interviews were analyzed using conventional content analysis.

Results: Participants were on average 58 years old, mostly female (87.5%), and caring for a parent (79.2%). Caregivers reported significant sleep health barriers due to caregiving responsibilities, various sources of stress, and personal health problems such as anxiety or sleep apnea. Caregiving responsibilities disrupted sleep due to irregular sleep timing, night time interruptions from care recipients' needs, and hypervigilance to ensure care recipient safety. Sleep facilitators included accessing caregiving resources such as self-initiated proactive strategies to address care recipient needs and caregiving support from other family members. Caregivers also described how daytime activities, relaxation strategies, and natural or prescribed sleep aids helped improve their sleep. Lastly, caregivers suggested topics for intervention sessions and shared their preferences for intervention delivery.

Conclusion: Our findings inform the cultural adaptation of sleep health interventions for African American family caregivers to address stress reduction, caregiving support, and sleep apnea risk and treatment.