Physical Activity, Sedentary Behaviour, Sleep and Mental Wellbeing in Family Caregivers of Adults With Intellectual and/or Developmental Disabilities.

BACKGROUND: Canadian 24-h movement guidelines recommend that adults achieve 150 min per week of moderate-to-vigorous physical activity (MVPA), 7-9 h of sleep per night and spend no more than 8-h per day sedentary to optimise health and wellbeing. METHOD: Using a cross-sectional survey of 131 family caregivers of adults with intellectual and developmental disabilities, we aimed to (a) determine whether adherence to these guidelines predicts mental wellbeing in family caregivers and (b) explore the relationship between movement behaviours of family caregivers and their loved ones. RESULTS: While MVPA was found to weakly predict wellbeing, sleep and sedentary behaviour did not. The movement behaviours of the family caregivers were not closely related to that of their loved ones. CONCLUSIONS: Fostering physical activity is important to promote the wellbeing of adults with intellectual and developmental disabilities, as well as their family caregivers. Opportunities to be active together may be even more beneficial.

Cortical high-frequency oscillations (≈ 110 Hz) in cats are state-dependent and enhanced by a subanesthetic dose of ketamine.

Ketamine is an NMDA receptor antagonist that has antidepressant and anesthetic properties. At subanesthetic doses, ketamine induces transient psychosis in humans, and is used to model psychosis in experimental animals. In rodents, subanesthetic doses of ketamine increase the power of high-frequency oscillations (HFO, > 100 Hz) in the electroencephalogram (EEG), a frequency band linked to cognitive functions. However, to date, the effects of ketamine in carnivores and primates have been poorly investigated. Here, we examined in the cat, cortical HFO during wakefulness, sleep, and after administering a sub-anesthetic dose of ketamine. Four cats were prepared with cortical electrodes for chronic polysomnographic recordings in head-restrained conditions. The cortical HFO power, connectivity, direction of the information flow using Granger Causality (GC) analysis, their relationships with respiratory activity, and the effect of auditory stimulation were analyzed. During wakefulness, but not during sleep, we found that HFO were coupled with the inspiratory phase of the respiration. After ketamine administration, HFO power was enhanced and remained associated with the inspiratory phase. GC analysis suggests that ketamine-enhanced HFO originate from the olfactory bulb (OB) and stream towards the prefrontal cortex (Pf). Accordingly, occluding the nostrils significantly reduced the power of the ketamine-enhanced HFO in both the OB and Pf. Finally, auditory stimulation did not affect HFO. In conclusion, the HFO are associated with respiration during wakefulness, but not during sleep. The enhancement of this rhythm by ketamine may disrupt cortical information processing, which could contribute to some of the neuropsychiatric effects associated with ketamine.

Association of physical activity, screen time and sleep with substance use in children and adolescents: a large sample cross-sectional study.

Background: 24-h movement guidelines (24-HMG) play an important role in various demographics such as early years, children, youth, and the older adult. Nevertheless, most existing research exploring the links between socioeconomic factors, dietary intake, and substance use with sleep patterns, physical activity (PA), and sedentary behavior (SB) has been conducted in high-income Western countries. Purpose: Hence, this study seeks to investigate the relationship between adherence to the 24-HMG and smoking and alcohol use behaviors among children and adolescents in China. Methods: A comprehensive survey, in collaboration with the Municipal Education Commission, was carried out across primary and middle schools in Shenzhen, China. Sleep duration was gauged using the Pittsburgh Sleep Quality Index (PSQI), screen time was assessed with items adapted from the Health Behavior of School-aged Children (HBSC) survey, and PA was measured using a single item adapted from the HBSC survey. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), considering p-values below 0.05 as statistically significant. Results: Among the sample, 51.9% were boys and 48% were girls. Those who did not meet any guidelines had a higher probability of smoking (OR = 1.62 [95% CI: 1.03, 2.56], p = 0.037) among children and adolescents. Conversely, meeting one (OR = 0.94 [95% CI: 0.61, 1.52], p = 0.874) or two guidelines (OR = 0.84 [95% CI: 0.52, 1.34], p = 0.459) showed no significant impact. The data displayed an inverse correlation between the number of guidelines adhered to and the likelihood of alcohol use among children and adolescents: none (OR = 2.07, p < 0.001), one guideline (OR = 1.40, p = 0.006), and two guidelines (OR = 1.22, p = 0.106). Conclusion: Not meeting guidelines elevates smoking and alcohol use risks in children and adolescents, whereas following more guidelines lowers these risks, highlighting the importance of guideline adherence in reducing substance use.

Unexplained Infant Deaths Without Unsafe Sleep Factors: 2011 to 2020.

OBJECTIVES: To describe sudden unexpected infant deaths (SUIDs) occurring in safe sleep environments and explore differences in selected characteristics. METHODS: We examined SUID from 22 jurisdictions from 2011 to 2020 and classified them as unexplained, no unsafe sleep factors (U-NUSF). Data were derived from the Sudden Unexpected Infant Death and Sudden Death in the Young Case Registry, a population-based Centers for Disease Control and Prevention surveillance system built on the National Center for Fatality Review and Prevention's child death review program. SUID classified as U-NUSF included infants who were (1) awake, under supervision, and witnessed to become unresponsive or (2) found unresponsive in a safe sleep environment after sleep (unwitnessed). We calculated frequencies and percentages for demographics, birth and environmental characteristics, medical history, and death investigation findings. RESULTS: Most of the 117 U-NUSF SUID occurred before 4 months of age. Witnessed deaths most commonly occurred at <1 month of age (28%), whereas unwitnessed deaths most commonly occurred at ages 2 to 3 months (44%) Among all U-NUSF, 69% occurred in the infant's home (62% witnessed, 77% unwitnessed). All unwitnessed deaths occurred in a crib; most witnessed deaths occurred while being held (54%) or in a car seat traveling (18%). Most infants (84%) had no history of abuse or neglect. Abnormal autopsy findings were reported in 46% of deaths (49% witnessed, 42% unwitnessed). CONCLUSIONS: Characterizing these deaths is key to advancing our knowledge of SUID etiology. Our study revealed a heterogeneous group of infants, suggesting physiologic, genetic, or environmental etiologies.

Using Sudden Unexpected Infant Death-Case Registry Data to Drive Prevention.

Sudden unexpected infant death (SUID) is a major contributor to infant death and a persistent public health issue. After an initial decline after the 1994 "Back to Sleep" campaign, SUID numbers plateaued. Currently, ∼10 infants die suddenly and unexpectedly each day in the United States. In 2019, we established a surveillance system for SUID in Cook County, Illinois, partnering our academic medical center, the Cook County Medical Examiner's Office, and child death review to create the Cook County SUID Case Registry. Our data show that, in Cook County, including the city of Chicago, ∼1 infant dies unexpectedly during sleep every week. Of these SUID, ∼25% were because of suffocation/possible suffocation. SUID peaks at 30 to 60 days old. SUID rates are 15 times higher in non-Hispanic Black infants and 3 times higher in Hispanic infants, compared with white infants. Nearly all involved 1 or more unsafe sleep factors. SUID are concentrated in community areas experiencing high hardship. Through our Community Partnership Approaches for Safe Sleep-Chicago team, we have developed collaborative prevention approaches in affected communities, allowing for conversations with families and those who support them to better understand barriers to safe sleep that they experience. These partnerships and our data allow for tailoring of informed prevention approaches to address upstream factors driving disproportionate infant mortality in historically disinvested communities, as well as optimizing the immediate risks posed by the infant sleep environment. Data from our system show the number of SUID declining modestly since our prevention work began.

Improving Consistency in Classifying Child Maltreatment for Sudden Unexpected Infant Deaths.

OBJECTIVE: Develop guidelines for child death review teams that will improve the consistency in classifying child maltreatment (CM) and distinguish between classification of exposure to hazards and neglect for sleep-related sudden unexpected infant deaths (SUID). METHODS: Sleep-related SUID (n = 25 797) were identified from the National Fatality Review-Case Reporting System between 2004 and 2018. Key variables considered when classifying CM among sleep-related SUID were identified. Logistic regression was used to assess the strength of associations and identify factors that distinguished between exposure to hazards and neglect. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Guidelines were developed based on these findings. RESULTS: Among the 13 034 sleep-related SUID with CM identified, hazards in the infant sleep environment were strongly associated with classification of both exposure to hazards and neglect, as were supervisor impairment and child welfare substantiation of the death. Comparing neglect to exposure to hazards, there was no association with sleep environment hazards with ORs ranging from 0.8 to 1.3 (95% CI 0.4-3.0), but sleep-related SUID were approximately twice as likely to be classified as neglect when the supervisor was impaired (OR 2.3, 95% CI 2.0-2.7) or child welfare action was taken (OR 1.8, 95% CI 1.5-2.0). The guidelines recommend classification of exposure to hazards for sleep environment hazards with elevation to neglect if the supervisor was impaired or child welfare substantiated the death. CONCLUSIONS: Among sleep-related SUID, classification of exposure to hazards is based on presence of sleep environment hazards, whereas neglect is based on supervisor impairment and child welfare action.

The association between sleep duration trajectories and successful aging: a population-based cohort study.

BACKGROUND: Insufficient or excessive sleep duration are associated with increased risk of individual adverse outcomes. However, it remains largely unknown whether sleep duration trajectories are associated with overall health among older adults. This study aimed to examine the association between sleep duration trajectories and successful aging. METHODS: In the China Health and Retirement Longitudinal Study (CHARLS), 3,306 participants without major chronic diseases at baseline and survived to aged 60 years and older at the end of follow-up were potentially eligible participants. Total sleep duration was assessed in 2011, 2013, and 2015, and successful aging was evaluated in 2020 and was defined as being free of major chronic diseases, no physical impairment, high cognitive function, good mental health, and active engagement with life. Latent class mixed model (LCMM) was used to identify sleep duration trajectories and logistic regression was performed to explore the association between these trajectories and successful aging. RESULTS: During the 9-year follow-up, 455 individuals (13.8%) met the criteria for successful aging. Five sleep duration trajectories were identified: normal stable, long stable, decreasing, increasing, and short stable. Compared with the normal stable trajectory, the adjusted ORs (95% CI) for achieving successful aging for participants with long stable, decreasing, increasing, and short stable trajectories were 1.00 (0.77, 1.30), 0.64 (0.40, 1.03), 0.64 (0.45, 0.92), and 0.48 (0.35, 0.66), respectively. The stratified and sensitivity analyses were generally consistent with the main results. CONCLUSIONS: Increasing and short stable trajectories of sleep duration are associated with lower odds of successful aging relative to participants in the normal stable trajectory. The findings underscore the critical importance of monitoring dynamic changes in sleep duration in middle-aged and older Chinese adults.

Association Between Serum Vitamin D Levels and Periodontal Conditions According to Sleep Duration Using Data from Korea National Health and Nutrition Examination Survey.

PURPOSE: This study aimed to investigate the association between vitamin D levels and periodontitis according to sleep duration in a representative sample of Korean adults. MATERIALS AND METHODS: A total of 3535 subjects who participated in the sixth (2013-2014) Korea National Health and Nutrition Examination Survey were examined. Vitamin D deficiency was defined as a 25-hydroxyvitamin D serum concentration of 20 ng/ml. Periodontal status was assessed with the community periodontal index (CPI). A high CPI was defined as a score ≥ 3. Multivariable logistic regression analyses were adjusted for sociodemographic variables, oral and general health behaviors, and systemic health status. All analyses used a complex sampling design, and a subgroup analysis was performed to determine estimates following stratification for sleep duration (≤ 5, 6, 7-8, and ≥ 9 h per day). RESULTS: Multivariable regression analysis indicated that among participants who slept for ≥ 9 h per day, those with vitamin D deficiency were 5.51 times (95% confidence interval = 2.04-14.89) more likely to have periodontitis than those with sufficient vitamin D levels. This association was not statistically significant in the other sleep duration groups. CONCLUSION: The findings of this study indicate that people with vitamin D deficiency who sleep 9 h or longer may also be statistically significantly more likely to have periodontitis.

Auditory circuits: Watchmen of the sleeping brain.

A new study shows that glutamatergic neurons of the pontine central gray (PCG) play a key role in mediating rapid sound-induced awakenings from sleep by relaying short-latency auditory information to multiple arousal centers in the brain.

Who Should Talk to Patients and How About Whether They Have Access to Sufficient, Quality Sleep?

Primary care clinicians are well-equipped to screen for sleep concerns, help some patients, and refer patients whose sleep troubles are more complex to specialists. Poor sleep affects nearly every organ system and influences many morbidity and mortality causes, so screening for sleep sufficiency and quality should be prioritized in primary care settings. This commentary on a case suggests strategies for more fully supporting primary care clinicians' compensation and capacity for conducting effective conversations with patients experiencing sleep trouble.

Sleep Is a Human Right, and Its Deprivation Is Torture.

Sleep is integral to human health and well-being; it is recognized as a fundamental right by international bodies. Nevertheless, deliberate sleep deprivation is frequently employed as a form of torture, violating the right to health. Legal cases such as LeMaire v Maass, Ireland v UK, and Huertas v Secretary Pennsylvania Dept of Corrections illustrate the varying interpretations of sleep deprivation as torture or cruel and unusual punishment. Ambiguity in domestic and international legal definitions underscores the need for collaboration between health and legal professionals. Clinicians can offer expertise about physiological and psychological consequences of sleep deprivation, which informs what legally counts as torture. This commentary explores the intersection of sleep deprivation, human rights, and the role of medical professionals in addressing, identifying, and preventing sleep deprivation as a means of coercion and abuse.

What Should a Public Health Approach to Sleep Look Like?

Sleep is essential for a healthy, productive life, but access to sufficient and quality sleep is not universal. Sleep equity is influenced by both pathological and nonpathological sources. This article considers nonpathological determinants of adequate sleep, defines 3 features of sleep insecurity, and suggests how to promote sleep literacy to remove some barriers to adequate sleep, promote sleep equity, and improve individual and community health and well-being.

Why Does the History of Circadian Rhythms Matter for Sleep Today?

A paradigm shift in circadian science is underway, exposing ethical tensions from a legacy of pervasive neglect of circadian disorders. This article canvasses ethical questions about stigma, justice, and accommodation that should be formally recognized to reconceive circadian care. Responding to these questions first requires confronting medicine's long-standing history of ableism in how circadian disorders are understood. This article also examines historical origins of the clinical and ethical need to expand diagnostic and therapeutic care access for patients with circadian disorders. Finally, this article recommends how to create space within the disabilities movement for persons with circadian disorders.

Neuroscience at the Core of a Sound Sleep Health Curriculum.

Neuroscience should be at the core of a sound sleep health curriculum, especially in early classroom-based medical education. This article canvasses ways in which sleep medicine has been rapidly transformed by tele-sleep tools and by research on neurobiological mechanisms underlying sleep disorders and on comorbidities associated with sleep disorders, including stroke, traumatic brain injury, and movement or neurocognitive disorders.

We're All Healthier Under a Starry Sky.

A star-filled sky has long been a source of awe and inspiration, and its loss adversely affects human, nonhuman, and environmental health. In one generation, this majestic nighttime overstory has been lost due to national and international overuse of light-emitting diodes lighting. This article canvasses ill health effects of excessive light at night. Blue wavelengths of light are damaging to many forms of life, and glare from unshielded light compromises road safety and infiltrates bedrooms, suppressing melatonin production, undermining sleep quality and duration, and exacerbating susceptibility to many kinds of illness.

Psychological distress and trajectories of sleep duration among Australian adolescents: a prospective cohort study.

OBJECTIVES: This study investigated the association between indicators of psychological distress and well-being and trajectories of sleep duration among a cohort of Australian adolescents. DESIGN: A prospective cohort of adolescents was followed over 27 weeks (8 November 2019-14 May 2020). Data on sleep duration and psychological distress were collected via smartphones, based on ecological momentary assessments. SETTING: Sydney population catchment, Australia. PARTICIPANTS: Young people aged 13-19 years were recruited via social media (Instagram or Facebook). PRIMARY OUTCOME MEASURE: Self-reported sleep duration in the past 24 hours. Sleep duration was dichotomised into 'less than 8 hours' and 'at least 8 hours', to represent those participants not meeting the recommended minimum amount of daily sleep. RESULTS: Participants with high psychological distress had higher odds of sleeping less than 8 hours (OR 1.51 (95% CI 1.17 to 1.96)), compared with those with low psychological distress. Social media use (OR 1.34 (95% CI 1.01 to 1.79)) and longer periods spent on homework (OR 1.37, (95% CI 1.07 to 1.75)) were also associated with a sleep duration of less than 8 hours. Also, decreasing sleep trajectories were associated with increased psychological distress (ß=0.069, (95% CI -0.010 to 0.149)) and increased homework hours (ß=0.078 (95% CI 0.036 to 0.120)). CONCLUSION: Findings highlight the adverse impact of psychological distress and high levels of social media use on sleep duration among adolescents. Longitudinal studies with longer follow-up periods are warranted to further explore the temporal associations between sleep duration and different health outcomes among varying populations.

Biological rhythms in premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.

BACKGROUND: Women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) typically experience a range of psychological and physiological symptoms that negatively affect their quality of life. Disruption in biological rhythms, including alterations of the sleep-wake cycle, have been implicated in PMS/PMDD, though literature is still growing to substantiate these findings. The objective of this study is to systematically review the available literature on biological rhythms disruption in PMS/PMDD. METHODS: A literature search was conducted on four databases (Pubmed, Embase, Medline, and Web of Science) on December 3rd, 2021. This search yielded a total of 575 articles that assessed the relationship between biological rhythms and PMS/PMDD/premenstrual symptoms. RESULTS: After the exclusion of irrelevant articles and hand-searching references, 25 articles were included in this systematic review. Some studies showed that women with PMS/PMDD present lower melatonin levels, elevated nighttime core body temperature, and worse subjective perception of sleep quality when compared to women without PMS/PMDD. Other biological rhythms parameters showed either no differences between groups (wrist actimetry) or conflicting results (objective sleep parameters, cortisol, prolactin, and thyroid stimulating hormone). CONCLUSION: Current research demonstrates that women with PMS/PMDD experience lower melatonin levels, higher body temperature, and worse subjective perception of sleep quality. This review outlines some possible mechanisms behind these findings and proposes recommendations for future research. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020149921.

Validity and Reliability of the Korean Version of Reduced Morningness-Eveningness Questionnaire: Results From a General Population-Based Sample.

BACKGROUND: Chronotype refers to individual variations in diurnal preferences that manifest as everyday behaviors, including sleep patterns. Traditionally, the Horne & Östberg Morningness-Eveningness Questionnaire (MEQ), which comprises of 19 items, has been the standard for determining chronotype. However, its length makes it cumbersome for widespread application. To address this issue, the reduced MEQ (rMEQ), a concise version containing only five items from the MEQ, was developed for a more practical approach to chronotype assessment. This study aimed to evaluate the validity and reliability of Korean version of rMEQ in a sample from the general Korean population. METHODS: The Korean version of the rMEQ comprises of items 1, 7, 10, 18, and 19 of the original MEQ. The validity of the rMEQ was assessed by correlating its scores with those of the MEQ and Munich Chronotype Questionnaire (MCTQ). Its reliability was determined by calculating internal consistency. RESULTS: A total of 3,030 individuals participated in the study, yielding an average rMEQ score of 14.0 ± 3.4. There was a substantial positive correlation between the rMEQ and MEQ scores (r = 0.859, P < 0.001). Furthermore, the rMEQ scores were significantly negatively correlated with the midpoint of sleep on free days corrected for sleep debt as measured by the MCTQ (r = -0.388, P < 0.001), indicating a robust association with chronotype. The internal consistency of rMEQ, measured using Cronbach's alpha, was 0.609. CONCLUSION: This study finds the Korean version of the rMEQ to be a valid and reliable instrument for assessing chronotype in the general population.

Longitudinal single-subject neuroimaging study reveals effects of daily environmental, physiological, and lifestyle factors on functional brain connectivity.

Our behavior and mental states are constantly shaped by our environment and experiences. However, little is known about the response of brain functional connectivity to environmental, physiological, and behavioral changes on different timescales, from days to months. This gives rise to an urgent need for longitudinal studies that collect high-frequency data. To this end, for a single subject, we collected 133 days of behavioral data with smartphones and wearables and performed 30 functional magnetic resonance imaging (fMRI) scans measuring attention, memory, resting state, and the effects of naturalistic stimuli. We find traces of past behavior and physiology in brain connectivity that extend up as far as 15 days. While sleep and physical activity relate to brain connectivity during cognitively demanding tasks, heart rate variability and respiration rate are more relevant for resting-state connectivity and movie-watching. This unique data set is openly accessible, offering an exceptional opportunity for further discoveries. Our results demonstrate that we should not study brain connectivity in isolation, but rather acknowledge its interdependence with the dynamics of the environment, changes in lifestyle, and short-term fluctuations such as transient illnesses or restless sleep. These results reflect a prolonged and sustained relationship between external factors and neural processes. Overall, precision mapping designs such as the one employed here can help to better understand intraindividual variability, which may explain some of the observed heterogeneity in fMRI findings. The integration of brain connectivity, physiology data and environmental cues will propel future environmental neuroscience research and support precision healthcare.

Effects of oral pregabalin on postoperative sleep of patients after video-assisted thoracoscopic surgery: a randomized double-blind controlled trial.

BACKGROUND: The aim of this study was to explore the effect of oral pregabalin at varying concentrations on postoperative sleep of patients undergoing video-assisted thoracic surgery (VATS), and to identify the optimal dosage. METHODS: A total of 120 VATS-treated patients admitted from June 2023 to October 2023 were randomly assigned to be orally administered with 75 mg pregabalin, 150 mg pregabalin and starch capsules (control group) at a 1:1:1 ratio. One capsule of pregabalin (75 mg) and one capsule of placebo with the same shape and odor, two capsules of pregabalin (150 mg), and two capsules of placebo with the same shape and odor were administered orally to patients in the three groups on the night of surgery, and in the morning and evening of postoperative days 2 and 3. The primary outcome was the incidence of postoperative sleep disturbance (PSD) on postoperative day 1 (POD1). The secondary outcomes included the St.Mary's Hospital Sleep Questionnaire (SMH), the Pittsburg Sleep Quality Index (PSQI) and pain intensity measured with a Numerical Rating Scale (NRS). Multivariate logistic regression analysis was performed to identify risk factors for PSD in VATS-treated patients. RESULTS: The incidence of PSD on POD1 in the 75 mg pregabalin group and 150 mg pregabalin group was significantly lower than that of the control group (45.0% vs. 42.5% vs. 72.5%; P<0.0167 for two-by-two comparisons of groups A and B with group C, respectively). The SMH scores at night on POD1-3 were significantly higher in the 75 mg pregabalin group and 150 mg pregabalin group than those of the control group (P<0.05). Since there was definitive lower incidence of pain in the experimental groups,the median NRS scores of the incisional pain on POD2-3 were significantly lower in the 75 mg pregabalin group and 150 mg pregabalin group (P<0.05). The incidence of dizziness in the 150 mg pregabalin group was significantly higher than that of the 75 mg pregabalin group and control group (55.0% vs. 25.0% vs. 32.5%; P<0.0167 for two-by-two comparisons of groups A and C with group B, respectively). NRS score on POD1, preoperative PSQI and Self-Rating Depression Scale scores were risk factors for PSD in VATS-treated patients. CONCLUSIONS: Oral administration of 75 mg or 150mg pregabalin for consecutive three days after VATS effectively reduces the incidence of PSD and improves the quality of sleep.