Chronotype, Time of Day, and Children's Cognitive Performance in Remote Neuropsychological Assessment.

Research on the influence of chronotype and time of day (TOD) on cognitive performance, especially in children, is limited. We explored potential interactive effects, hypothesizing that performance differs when comparing preferred vs. non-preferred TOD. In total, 76 morning-type (MT = 37) or evening-type (ET = 39) children from the third and fourth grades (48.7% girls; M age = 8.05; SD age = 0.51), identified through the Children Chronotype Questionnaire, completed two 30-min neuropsychological assessment sessions via videoconference on the first (9:00) or last hour (16:00) of the school day. The protocol included neuropsychological tests targeting memory, language, and attention/executive domains. The results revealed an interactive effect of medium size between chronotype and TOD on a Rapid Alternating Stimulus (Naming) Task. MT and ET performed faster in asynchrony conditions (morning for ET; afternoon for MT). Additionally, ET outperformed MT in a Backward Digit Span Task, irrespective of TOD. TOD also influenced performance on an Alternating Verbal Fluency Task, with both MT and ET children performing better in the morning. These results underscore the importance of chronotype and TOD in children's cognitive performance, particularly in working memory and verbal fluency. Children assessed during non-preferred TOD exhibited better performance on some cognitive tasks, challenging the assumption that optimal times always yield superior results.

The Dysfunctional Beliefs and Attitudes about Sleep scale: Dimensions of the European Portuguese DBAS-30 and development of a new short version (DBAS-SF-16).

OBJECTIVES: The Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) is the most widely validated instrument for assessing sleep-related cognitions. This study aimed to examine the reliability of the DBAS-30 European Portuguese version, explore its dimensionality, and develop a new short version suitable for differentiating the presence/absence of insomnia. METHODS: From 824 participants aged 18-85 years, the Insomnia Group (IG, n = 355, 261 females and 94 males) and Normal Sleepers Group (NSG, n = 292, 237 females, 54 males and 1 with no response) were constituted. Thirty-one patients with Obstructive Sleep Apnea Syndrome were also recruited. For the DBAS 16-items version, the ability to differentiate dysfunctional beliefs between people with and without insomnia was used as the main criterion for item retention. RESULTS: DBAS-30 PT demonstrated good internal consistency and significantly discriminated IG from NSG. Based on a robust EFA (RDWLS), a three-dimensional structure was determined for IG (Ageing and Hopelessness, Sleep Expectations, and Consequences and Helplessness). DBAS-SF-16 presented as an internally-consistent measure with a reliable two-factor structure (Consequences and Helplessness, Medication and Hopelessness) and showed construct and known groups validity. ROC analysis demonstrated DBAS-SF-16's relevant clinical accuracy, and 4.3 provides the best cut-off score in detecting the level of dysfunctional beliefs associated with clinical insomnia. CONCLUSIONS: A new and meaningful dimensionality of the DBAS-30 was found. DBAS-SF-16 showed to be a reliable, valid, and robust tool for evaluating dysfunctional beliefs about insomnia in clinical and non-clinical populations.

European Portuguese Version of the Multidimensional Fatigue Symptom Inventory-Short Form: Validation Study.

INTRODUCTION: Appropriate management of fatigue relies upon comprehensive assessment instruments and timely delivery of targeted interventions. The aims of this study were to translate a commonly used English-language measure of fatigue in cancer patients (the Multidimensional Fatigue Symptom Inventory-Short-Form, or MFSI-SF) into European Portuguese and to evaluate the psychometric properties (internal consistency reliability, factorial structure, and discriminant, convergent and criterion concurrent validity) of the translated measure for use with Portuguese patients. MATERIAL AND METHODS: After translation and adaptation of the MFSI-SF to European Portuguese, 389 participants (68.38% women), with a mean age of 59.14 years, completed the study protocol. This sample included 148 patients in active cancer treatment from a cancer center and a community sample composed of 55 cancer survivors, 75 patients with other chronic diseases, and 111 healthy controls. RESULTS: The European Portuguese version of the Multidimensional Fatigue Symptom Inventory-Short Form (IMSF-FR) showed strong internal consistency (Cronbach's alpha = 0.97, McDonald's omega = 0.95). An exploratory factor analysis indicated that the items loaded in a 5-factor model in subscales were similar to the original version. Strong correlations between the IMSF-FR and other measures of fatigue and vitality confirmed convergent validity. Discriminant validity was supported by weak-to-moderate correlations between the IMSF-FR and measures of sleepiness, propensity to sleep, and lapses of attention and memory. The IMSF-FR accurately distinguished cancer patients from healthy controls and was able to differentiate clinician rated levels of performance among cancer patients. CONCLUSION: The IMFS-FR is a reliable and valid tool to assess cancer-related fatigue. By providing integrated comprehensive characterization of fatigue, this instrument may assist clinicians implementing targeted interventions.

Sleep-wake patterns and disturbances in Portuguese primary school children: a comparison between 1995 and 2016.

Purpose: It is often assumed sleep duration has decreased and sleep schedules have delayed over the last decades, as society modernized. We aimed to investigate changes in the sleep patterns of school-age children over time. Methods: We compared the sleep timings, durations, and disturbances of primary school-age children in 1995 and roughly two decades later, in 2016. Data from 666 children attending the 3rd and 4th grades of basic education were combined from two different cross-sectional school-based studies conducted within the same educational region of mainland Portugal using the same parent-report questionnaire (Children's Sleep-wake Patterns Questionnaire). Results: Mean sleep duration did not differ significantly between the two time points (schooldays: t = .118, p = .906; free days: t = 1.310, p = .191), albeit the percentage of children sleeping the recommended number of hours decreased significantly in 2016 when compared to 1995 (schooldays: χ2 = 4.406, p = .036; free days: χ2 = 16.859, p < .001). Wake-times advanced on free days in 2016. Difficulties on settling to sleep alone and returning to sleep were more prevalent in 2016, as well as fearing the dark and needing lights on or parent's presence to fall asleep. Conclusions: Sleep onset-related disturbances appear to have increased from 1995 to 2016. One possible explanation for this increase might be the change in parental practices preventing children from learning to fall asleep autonomously.

The European Portuguese version of the insomnia severity index.

Insomnia is the most prevalent sleep complaint, but remains largely an unidentified public health issue. The Insomnia Severity Index (ISI) is a brief self-report questionnaire to assess insomnia, long-established both in clinical and research settings. The present study aimed to analyse the reliability, validity, and accuracy of the ISI European Portuguese version. After the translation protocol, 1,274 participants (65.54% female), with a mean (SD, range) age of 37.52 (16.82, 18-95) years, completed the ISI. This sample included 250 patients with insomnia from a Sleep Medicine Centre, presenting a diagnosis of insomnia disorder (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; International Classification of Sleep Disorders, Third Edition), and 1,024 individuals from the community. A group of 30 patients with obstructive sleep apnea (OSA) was also recruited. Cronbach's α was 0.88 (internal consistency), and corrected item-total correlations ranged from 0.56 to 0.83. An exploratory factor analysis (oblique rotation) revealed a two-factor solution for both clinical and community samples. The ISI total score significantly differentiated insomnia disorder, no insomnia, and OSA subgroups with a large effect size (η 2  = 0.42). The correlation between ISI and Pittsburgh Sleep Quality Index supported concurrent validity (0.82), and discriminant validity was confirmed by a moderate correlation between ISI and Beck Depression Inventory Second Edition (0.32). The area under the curve was 0.88, and the optimal cut-off to detect clinical insomnia was 14 (82.1% sensitivity, 79.5% specificity). In conclusion, the Portuguese version of the ISI is a reliable and valid measure of insomnia in clinical and non-clinical populations. Our present study also contributes to relevant data for the international literature regarding the cut-off score of the scale for the detection of clinical insomnia.

An epidemiological study of sleep-wake timings in school children from 4 to 11 years old: insights on the sleep phase shift and implications for the school starting times' debate.

OBJECTIVE: It has been assumed that during adolescence there is a strong shift toward eveningness chronotype, whereas children's sleep is relatively stable. Several studies have focused on the conflict between school start times and adolescents' circadian rhythms; however, fewer studies have been conducted in younger children. The aim of this study was to examine sleep durations, schedules, and sleep phase shift in preschool- and school-aged children. METHODS: Data for sleep patterns on school days and free days (ie, days when children's sleep-wake patterns were free from any influence of individual or family activities) was obtained by means of questionnaires (Children ChronoType Questionnaire) for 3155 Portuguese children 4-11 years of age. RESULTS: As children grew older and school grade level increases, we found later bedtimes and sleep onsets on both school days and free days; and later wake times only on free days. By contrast, wake times were progressively earlier, imposed by school start times. There was a progressive reduction in the amount of sleep on school nights as grade level increased. Greater social jetlag, later midpoint of sleep, and higher restriction-extension patterns were found across age groups. CONCLUSION: The displacement of bed and wake times for later hours on free days starts at an early age. Changing early school start times could adjust social demands to the biological rhythm of children.

Mindfulness and self-compassion along the chronotype: a cross-sectional study.

It is well established in the literature that morning-type individuals present better health indicators than evening-types. Mindfulness is considered an adaptive self-regulation skill associated with well-being and physical and mental health. However, there is scarce studies that relate chronotype and mindfulness. Thus, in this research, our aim was to study the relationship between chronotype and mindfulness-related variables. For this purpose, a sample composed of 483 participants from the community was recruited through an online survey and invited to fill out the Five Facet Mindfulness Questionnaire, the Self-Compassion Scale, and the Composite Morningness Scale. Regarding mindfulness measure, the results indicated that morning-types presented higher levels of "acting with awareness" than intermediate and evening-types. Additionally, as to self-compassion measure, morning-types presented higher levels of "mindfulness" and "overall self-compassion" than intermediate and evening-types. The remaining associations examined were not statistically significant. In sum, the morning-types showed higher scores in some of the mindfulness and self-compassion scales which seem to suggest that this morningness tendency may function as protective factor concerning eventual disorders´ development. Nonetheless, more systematic studies are needed to better understand this association and subsequently foster changes for psychological intervention.

Pre-Sleep Arousal Scale (PSAS): psychometric study of a European Portuguese version.

OBJECTIVE/BACKGROUND: Pre-sleep arousal constitutes one of the major features of insomnia. As such, it is imperative to have adequate instruments to measure this construct in both clinical and research settings. The Pre-Sleep Arousal Scale (PSAS) is the most well-known measure to evaluate pre-sleep arousal. The current study aimed to examine some of the psychometric properties of a European Portuguese version of the scale. PARTICIPANTS/METHODS: For this purpose, data from 691 undergraduate students from a medical school were analyzed. Internal consistency indices and factor analysis were performed. In addition, the association between the PSAS and its subscales with other measures was also examined. Finally, PSAS scores of self-reported insomniacs were compared with those of self-reported non-insomniacs. RESULTS: The results indicated that the PSAS comprises a cognitive scale and a somatic scale, both with adequate internal consistency indices (α = 0.82 and 0.79, respectively). However, a three-factor solution also seemed plausible, suggesting that the original somatic arousal subscale might be divided into two subscales. Significant associations between the PSAS total score and its subscales were found with other concurrent measures such as sleep reactivity to stress, arousability and neuroticism. Self-defined insomniacs presented higher levels of cognitive and somatic arousal than healthy individuals. CONCLUSIONS: Further investigations of the PSAS are needed to refine its psychometric properties and explore its research and clinical utility in other populations.

Assessing Stress-Induced Sleep Reactivity in College Students: The European Portuguese Version of the Ford Insomnia Response to Stress Test (FIRST).

OBJECTIVE AND BACKGROUND: Over the past few years, the comprehensive models of insomnia have exhibited impressive developments. However, there is scarce knowledge on predisposing or vulnerability factors for insomnia. One of the most promising constructs to aid in filling this gap is stress-induced sleep reactivity assessed through self-report. Our aim was to study the psychometric properties of the European Portuguese version of the Ford Insomnia Response to Stress Test (FIRST). PARTICIPANTS: We recruited a large sample of students attending medical school (N = 699). METHODS: Several analyses were carried out such as internal consistency, construct validity, and discriminant groups' analysis. RESULTS: It was observed that FIRST-PT shows good internal consistency (Cronbach´s alpha = .81) and validity indicators. Interestingly, and contrary to what was observed in the previously published studies on psychometric properties of the FIRST, it was observed that a two-factor solution (Factor I = rumination, Factor II = worry) was the most adequate one to explain the correlation matrix, accounting for approximately 44% of the total variance. CONCLUSIONS: The FIRST-PT proved to be a useful and reliable tool to measure stress-induced sleep reactivity. However, these results should be replicated in other groups, particularly clinical samples, in order to verify the stability of its factorial dimension.

European Portuguese Adaptation of Glasgow Content of Thoughts Inventory (GCTI): Psychometric Characterization in Higher Education Students.

Persistent cognitive activity is an important factor in disturbing sleep-onset both during bedtime and when attempting to get back to sleep after nocturnal awakenings. One of the most specific self-report measures designed to assess this feature is the Glasgow Content of Thoughts Inventory (GCTI). In this study, we investigated the preliminary psychometric properties of GCTI in a large sample of higher education European Portuguese students (N = 2995). Our results suggest that there is evidence of good internal consistency (α = 0.93) and validity indicators. Moreover, we found an interpretable factorial structure comprising 5 correlated factors that needs to be confirmed in future studies. The European Portuguese version of the GCTI appears to be a reliable and valid instrument for measurement of sleep-onset disturbing cognitions.

Psychometric properties of Glasgow Sleep Effort Scale in Portuguese language.

Sleep effort is generally defined as the attempt to force and induce sleep in a voluntary manner. This study aimed to document the psychometric properties of a brief measure of sleep effort--the Glasgow Sleep Effort Scale--in its European (Portuguese) version using a large sample (N = 2,995). The results supported the good internal consistency of the overall scale scores (α = .79). Potential construct validity was evaluated with various methods, including criterion validity. There was also a convergent validity indicator. Principal components analysis revealed a 1-dimensional structure that accounted for 45% of the total variance. This preliminary study suggests that this Portuguese version of the Glasgow Sleep Effort Scale is a measure of sleep behavior suitable for research and clinical purposes. However, more studies are needed, particularly with clinical groups.

Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS): reliability, initial validity and normative scores in higher education students.

Based on successive samples totaling more than 5000 higher education students, we scrutinized the reliability, structure, initial validity and normative scores of a brief self-report seven-item scale to screen for the continuum of nighttime insomnia complaints/perceived sleep quality, used by our team for more than a decade, henceforth labeled the Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS). In study/sample 1 (n = 1654), the items were developed based on part of a larger survey on higher education sleep-wake patterns. The test-retest study was conducted in an independent small group (n = 33) with a 2-8 week gap. In study/sample 2 (n = 360), focused mainly on validity, the BaSIQS was completed together with the Pittsburgh Sleep Quality Index (PSQI). In study 3, a large recent sample of students from universities all over the country (n = 2995) answered the BaSIQS items, based on which normative scores were determined, and an additional question on perceived sleep problems in order to further analyze the scale's validity. Regarding reliability, Cronbach alpha coefficients were systematically higher than 0.7, and the test-retest correlation coefficient was greater than 0.8. Structure analyses revealed consistently satisfactory two-factor and single-factor solutions. Concerning validity analyses, BaSIQS scores were significantly correlated with PSQI component scores and overall score (r = 0.652 corresponding to a large association); mean scores were significantly higher in those students classifying themselves as having sleep problems (p < 0.0001, d = 0.99 corresponding to a large effect size). In conclusion, the BaSIQS is very easy to administer, and appears to be a reliable and valid scale in higher education students. It might be a convenient short tool in research and applied settings to rapidly assess sleep quality or screen for insomnia complaints, and it may be easily used in other populations with minor adaptations.

[Sleep-wake patterns in Portuguese undergraduates]. / Padrões de sono em estudantes universitários Portugueses.

INTRODUCTION: Sleep habits of Portuguese undergraduates are almost unknown, and very few international published articles have addressed whether demographic and academic variables such as residence, university year and academic field, might be associated to the sleep-wake patterns of university students. The aims of the present work were thus to characterize perceived sleep habits, behaviours and problems of Portuguese undergraduates, and to examine them by gender, residence status, university year and academic field. POPULATION AND METHODS: The selected participants were 1654 undergraduates (55% female) of a public Portuguese university, aged 17-25 years (M = 19.98, SD = 1.65), at the 1st, 2nd a 3rd university years, studying Engineering, Management, Sciences, Languages and Education, in its majority living outside their parents/family home (<> students). Participants answered to a self-response questionnaire about sleep-wake patterns, developed for the main research. RESULTS: Compared to men, women showed more regular and earlier sleep-wake schedules, fewer sleeplessness nights, and less napping, but more troubles initiating/maintaining sleep and use of pills to fall asleep. <> students had the latest sleep-wake schedules on week nights, and felt more disturbed by noise; <> men reported more sleeplessness nights to complete academic tasks and greater changes of sleep habits since high school. Across university years (1st-3rd), there was a rising of perceived change of sleep habits, a delay of bedtime on school nights, and a decrease, in men, of week-weekend irregularity of rise time and of sleeplessness nights. Engineering students had the fewest difficulties initiating/maintaining sleep and the lowest use of sleeping promoting pills but, together with Sciences and Management, later sleep-wake schedules, than Languages and Education students. DISCUSSION AND CONCLUSION: Differences on sleep-wake patterns were found between men and women, in accordance to the sleep literature. On addition to gender, the present study highlights that university year and, most importantly, residence circumstances, are also important variables to be considered for a better understanding of sleep habits and behaviours in undergraduates. Thus, we hope our findings constitute a contribution for the improvement of health prevention and intervention strategies directed to university students.