Pregnancy as a window of opportunity for dementia prevention: a narrative review.

Dementia is a debilitating condition with a disproportionate impact on women. While sex differences in longevity contribute to the disparity, the role of the female sex as a biological variable in disease progression is not yet fully elucidated. Metabolic dysfunctions are drivers of dementia etiology, and cardiometabolic diseases are among the most influential modifiable risk factors. Pregnancy is a time of enhanced vulnerability for metabolic disorders. Many dementia risk factors, such as hypertension or blood glucose dysregulation, often emerge for the first time in pregnancy. While such cardiometabolic complications in pregnancy pose a risk to the health trajectory of a woman, increasing her odds of developing type 2 diabetes or chronic hypertension, it is not fully understood how this relates to her risk for dementia. Furthermore, structural and functional changes in the maternal brain have been reported during pregnancy suggesting it is a time of neuroplasticity for the mother. Therefore, pregnancy may be a window of opportunity to optimize metabolic health and support the maternal brain. Healthy dietary patterns are known to reduce the risk of cardiometabolic diseases and have been linked to dementia prevention, yet interventions targeting cognitive function in late life have largely been unsuccessful. Earlier interventions are needed to address the underlying metabolic dysfunctions and potentially reduce the risk of dementia, and pregnancy offers an ideal opportunity to intervene. This review discusses current evidence regarding maternal brain health and the potential window of opportunity in pregnancy to use diet to address neurological health disparities for women.

Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study.

OBJECTIVE: Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, but there is limited evidence on the treatment effect of CBT-I in individuals after a concussion. Therefore, the main purpose of this study was to evaluate the treatment effect of CBT-I on sleep outcomes and postconcussion symptoms. SETTING: This study was conducted at an academic institution. The CBT-I sessions were conducted using a teleconferencing system (Zoom). PARTICIPANTS: Participants were eligible to participate if they were at least 4 weeks post- concussion, aged 18 to 64 years, and scored 10 or more on the Insomnia Severity Index. A total of 40 people were enrolled; 32 participants were included in analyses. DESIGN: This was a randomized controlled wait-list study. Participants were randomized into starting the CBT-I intervention immediately after the baseline assessment or into the wait-list group for 6 weeks before starting CBT-I. Assessments were performed at baseline, 6, 12, and 18 weeks. MAIN MEASURES: The primary outcome was the Insomnia Severity Index. Secondary measures included the Pittsburg Sleep Quality Index, Post-Concussion Symptom Scale, and Beck Depression and Anxiety Inventories. Statistical analyses included a repeated-measures analysis of variance, t tests, and mixed linear regression modeling. RESULTS: There was a group-by-time interaction for the sleep outcomes but not for the concussion or mood outcomes. Differences were seen between groups on sleep outcomes, symptom severity, and depression. The treatment effect was maintained following CBT-I for all outcomes. Improvement in sleep outcomes was predictive of improvement in postconcussion symptom severity and number of symptoms. CONCLUSIONS: CBT-I reduces insomnia in individuals with concussions, and improved sleep was associated with lower postconcussion and mood symptoms. These effects were maintained 6 to 12 weeks following the intervention.

Toward sleep health as a focus of physical therapy practice: one lecture can positively impact sleep knowledge and beliefs in entry-level students.

BACKGROUND: Challenges to integrating health promotion including sleep health into entry-level physical therapist curricula include lack of faculty expertise, time, and support. A lecture provided by a content expert may mitigate such challenges. The purpose of this study was to determine if a sleep education session impacts Doctor of Physical Therapy students' knowledge and beliefs about sleep. METHODS: Faculty shared the opportunity to participate in the study 1-3 days prior to the remotely-provided lecture including sleep health assessment and interventions. The survey included demographics, a sleep health knowledge question, 11 questions on "What I think about sleep as a professional", and the 20-item Sleep Beliefs Scale. McNemar's and paired sample t-tests determined change in knowledge and beliefs. RESULTS: 209 individuals (70% female, 86% Caucasian, 25.5 ± 3.4 years old) completed the pre-lecture survey, and 137 individuals completed the post-lecture survey. There was an increase in knowledge about sleep health (p < .001) and change in Sleep Beliefs Scales score (p < .001). CONCLUSIONS: A single remotely provided sleep education session increased DPT students' knowledge and changed their beliefs about sleep. Future studies should determine if these positive beliefs about sleep translate into clinical practice and enhance patient outcomes.

Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity.

BACKGROUND: Obesity is a risk factor for developing multiple sclerosis (MS) and MS-related disability. The efficacy of behavioral weight loss interventions among people with MS (pwMS) remains largely unknown. OBJECTIVE: Examine whether a group-based telehealth weight loss intervention produces clinically significant weight loss in pwMS and obesity. METHODS: Seventy-one pwMS were randomized to the weight loss intervention or treatment-as-usual (TAU). The 6-month program promoted established guidelines for calorie reduction and increased physical activity. Anthropometric measurements, mobility tasks, self-report questionnaires, and accelerometry were used to assess changes at follow-up. RESULTS: Mean percent weight loss in the treatment group was 8.6% compared to 0.7% in the TAU group (p < .001). Sixty-five percent of participants in the intervention achieved clinically meaningful weight loss (⩾ 5%). Participants in the treatment group engaged in 46.2 minutes/week more moderate-to-vigorous physical activity than TAU participants (p = .017) and showed improvements in quality of life (p = .012). Weight loss was associated with improved mobility (p = .003) and reduced fatiguability (p = .008). CONCLUSION: Findings demonstrate the efficacy of a behavioral intervention for pwMS and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life.

Physical activity for obstructive sleep apnea after stroke? A pilot study assessing the contribution of body fluids.

PURPOSE: Obstructive sleep apnea (OSA) and physical inactivity are common after stroke. Physical inactivity can lead to/or exacerbate edema following stroke, and the resultant overnight fluid shift may increase the risk of OSA. We aimed to investigate the effect of physical activity on nocturnal rostral fluid shift, sleep pattern, and edematous state of hemiparetic patients. METHODS: Neck circumference (tape measured) and arms, legs, and trunk fluid volume (bioelectrical impedance spectrum analyzer) were measured before and after 2 polysomnography (PSG) examinations. In the lab, a whole night PSG was performed after the intervention. The intervention consisted of inactivity (lying down and sitting) or activity (standing, performing calf muscle contractions while standing, walking, and climbing stairs) between 13 and 21 h, after the randomization of the participants. With a 7-day interval, participants crossed over to the other group. RESULTS: From 126 eligible participants, 8 with hemiparetic post-first-ever ischemic stroke at the subacute phase were recruited (age: 53.2 ± 16.2; 6 women). Physical activity reduced AHI from 19 to 13 n°/h and wake after sleep onset from 76.5 to 60.3 min and increased fluid volume of paretic and non-paretic arms and trunk before sleep compared to inactivity. CONCLUSION: An acute bout of physical activity reduced OSA classification based on AHI (from moderate to mild) and sleep fragmentation. Our results provide preliminary evidence of a possible link between physical activity in patients after stroke as an intervention to counteract OSA severity and improve sleep.

Eliminating Sleep Health Disparities and Achieving Health Equity: Seven Areas for Action in the Behavioral Sleep Medicine Community.

Racial and ethnically minoritized and under-resourced populations do not reap the same benefits of sufficient sleep as their white counterparts resulting in insufficient sleep and sleep health disparities. Research exploring these disparities have documented a plethora of factors including social determinants of health, community violence, and structural issues - all of which are associated with adverse sleep. There are robust evidence base behavioral intervention that can be leveraged to improve sleep health among racial and ethnic groups. However, EBIs are not well leveraged. In 2021, with participation from members of the society of behavioral sleep medicine, we conducted this report to bring together the field of behavioral sleep medicine including researchers, clinicians and trainees to discuss gaps and opportunities at the intersection of the COVID-19 pandemic, systemic racism, and sleep health. The goals were anchored around seven recommendations toward reducing disparities in the near-term and longer-term approaches to eliminating disparities. Furthermore, we acknowledge that reducing and eliminating disparities in sleep health requires a multifaceted approach that includes a focus on individual, community, health care and societal levels of influence with participation from diverse partners including federal, state and local.

Sleep disturbance in cancer survivors with lymphedema: a scoping review.

PURPOSE: The purpose of this study is to identify the amount and scope of knowledge on sleep disturbance in cancer survivors who have lymphedema. The research question investigated was "what are the known sleep disturbances in cancer survivors with lymphedema?" METHODS: A literature search was performed on February 15 to March 27, 2021, in four databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and structure recommended by Arksey and O'Malley. An iterative process of study selection was performed by two reviewers for abstract and full-text review. The Joanna Briggs Institute's critical appraisal tools were used to analyze study quality. RESULTS: One hundred twenty-one unique references were reviewed, and seven met the inclusion criteria. One article had the primary aim of assessing sleep and noted that the presence of lymphedema did increase the risk for sleep disturbance. Four cross-sectional studies compared sleep quality between cancer survivors with lymphedema and cancer survivors without lymphedema. These studies found that lymphedema is a significant predictor of insomnia and is a risk factor for insomnia. Two randomized control trials compared sleep among breast cancer survivors with lymphedema after an intervention. Sleep improved with a yoga intervention and was unchanged after adding a night-time compression garment. CONCLUSION: In this scoping review, breast and gynecological cancer survivors with lymphedema report increased sleep disturbance compared to survivors without lymphedema. Further research is needed to characterize the specific sleep disturbances in cancer survivors with lymphedema for improved screening and treatment.

How Occupational Therapists Assess and Address the Occupational Domain of Sleep: A Survey Study.

IMPORTANCE: Sleep is a foundational occupation in the Occupational Therapy Practice Framework: Domain and Process (2nd ed.), yet little is known about how occupational therapists assess and address sleep in practice. OBJECTIVE: To survey practicing occupational therapists' comfort with their level of knowledge about sleep, how they are assessing and addressing sleep in clinical practice, and the amount of sleep-related education they have received. DESIGN: Cross-sectional survey study. SETTING: Electronic survey. PARTICIPANTS: Practicing occupational therapists were invited to participate in November 2020. Survey invitations were sent via email targeting occupational therapists serving as clinical instructors. OUTCOMES AND MEASURES: The survey consisted of 41 items assessing comfort with sleep knowledge, occupation of sleep, and sleep education received. This survey was modified from a previous survey and tailored to the occupational therapy profession. RESULTS: A total of 169 occupational therapists completed the survey. Most (87%) agreed that sleep was an occupation, but only 44% evaluated their clients' sleep, and 30% established treatment goals pertaining to sleep. In addition, 66% reported not receiving education about sleep in their entry-level occupational therapy program, and 78% reported receiving no continuing education about sleep in the past 2 yr. Most (92%) reported that occupational therapists should be better prepared to evaluate and treat sleep after graduation. CONCLUSIONS AND RELEVANCE: Most occupational therapists identified sleep as an area of occupation but had limited knowledge of how to assess and address sleep in practice. Entry-level occupational therapy education programs must enhance sleep-related curricula, and continuing education programs tailored to sleep issues within occupational therapists' practice are needed. What This Article Adds: The results of this study indicate gaps in occupational therapists' knowledge regarding how best to assess and treat sleep problems. We offer next steps to improve the profession's capacity to address the occupation of sleep.

Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom.

OBJECTIVE/BACKGROUND: The primary aim of this study was to examine the effect of Cognitive Behavioral Therapy for Insomnia (CBT-I) on the severity of insomnia in people with Type 2 diabetes (T2D) compared to a health education (HE) control group. The secondary aim was to explore the effect of CBT-I on other sleep outcomes and concomitant symptoms. PARTICIPANTS: Twenty-eight participants with T2D were randomly assigned to CBT-I (n = 14) or HE (n = 14). METHODS: Validated assessments were used at baseline and post intervention to assess sleep outcomes and concomitant symptoms. In addition, actigraph and sleep diaries were used to measure sleep parameters. Independent sample t tests and Mann-Whitney U tests were utilized to measure between-group differences in the mean change scores. RESULTS: Participants in the CBT-I group showed higher improvements in the following mean change scores compared to the HE group: insomnia symptoms (d = 1.78; p < .001), sleep quality (d = 1.53; p =.001), sleep self-efficacy (d = 1.67; p < .001). Both actigraph and sleep diary showed improvements in sleep latency and sleep efficiency in the CBT-I group as compared to the HE group. In addition, participants in the CBT-I group showed greater improvement in the mean change scores of depression symptoms (d = 1.49; p = .002) and anxiety symptoms (d = 0.88; p = .04) compared to the HE group. CONCLUSION: This study identified a clinically meaningful effect of CBT-I on sleep outcomes and concomitant symptoms in people with T2D and insomnia symptoms. Further work is needed to investigate the long-term effects of CBT-I in people with T2D and insomnia symptoms.

The effects of cognitive behavioral therapy for insomnia in people with type 2 diabetes mellitus, pilot RCT part II: diabetes health outcomes.

BACKGROUND: Previous studies have shown the negative impact of sleep disturbances, specifically insomnia symptoms, on glucose metabolism for people with type 2 diabetes (T2D). People with insomnia symptoms are at risk of poor glycemic control and suboptimal diabetes self-care behavior (DSCB). Investigating the impact of a safe and effective intervention for individuals with T2D and insomnia symptoms on diabetes' health outcomes is needed. Therefore, the aim of this exploratory study is to examine the effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on glycemic control, DSCB, and fatigue. METHODS: Twenty-eight participants with T2D and insomnia symptoms, after passing an eligibility criteria at a medical research center, were randomly assigned to CBT-I (n = 14) or Health Education (HE; n = 14). The CBT-I and HE groups received 6 weekly one-hour sessions. This Randomized Controlled Trial (RCT) used a non-inferiority framework to test the effectiveness of CBT-I. Validated assessments were administered at baseline and post-intervention to assess glycemic control, DSCB, and fatigue. A Wilcoxon signed-rank test was utilized to compare within-group changes from baseline to post-intervention. A Mann-Whitney test was utilized to measure the between-group differences. Linear regression was used to assess the association between the blood glucose level and the number of days in the CBT-I group. RESULTS: The recruitment duration was from October 2018 to May 2019. A total of 13 participants completed the interventions in each group and are included in the final analysis. No adverse events, because of being a part of this RCT, were reported. CBT-I participants showed significantly greater improvement in glycemic control, DSCB, and fatigue. There was a significant association between the number of days in the CBT-I intervention with the blood glucose level before bedtime (B = -0.56, p = .009) and after awakening in the morning (B = -0.57, p = .007). CONCLUSIONS: This study demonstrated a clinically meaningful effect of CBT-I on glycemic control in people with T2D and insomnia symptoms. Also, CBT-I positively impacted daytime functioning, including DSCB and fatigue. Future research is needed to investigate the long-term effects of CBT-I on laboratory tests of glycemic control and to understand the underlying mechanisms of any improvements. TRIAL REGISTRATION: Clinical Trials Registry ( NCT03713996 ). Retrospectively registered on 22 October 2018.

Does cognitive-behavioural therapy improve sleep outcomes in individuals with traumatic brain injury: a scoping review.

BACKGROUND: Insomnia symptoms are common after a traumatic brain injury (TBI). Cognitive-behavioural therapy (CBT) to treat sleep disturbances and insomnia (CBT-I) has been used to improve sleep outcomes. It is unclear if CBT/CBT-I is efficacious in individuals with a TBI. This review was performed to evaluate the use of CBT/CBT-I in individuals with a TBI who also endorse insomnia and concomitant symptoms. METHODS: Literature searches were conducted in June 2019. A total of 861 articles were found. The full text of 14 articles was reviewed for inclusion/exclusion criteria. Quality appraisal was conducted to assess the risk of bias. RESULTS: Five articles met the criteria. Two articles were pilot-randomized control trials and three were case studies. The review indicates that individuals participating in CBT/CBT-I reported increased sleep efficiency, sleep quality, and reduced insomnia symptoms and concomitant symptoms. The major source of bias is a limited number of participants across all studies. CONCLUSION: This review provides evidence that CBT/CBT-I following a TBI can improve sleep outcomes and reduce concomitant symptoms. More robust studies are needed due to limited number of randomized control trials to determine if CBT/CBT-I is an effective treatment in individuals with TBI.

The Relationship Between Apolipoprotein ε4 Carrier Status and Sleep Characteristics in Cognitively Normal Older Adults.

The apolipoprotein (APOE) ε4 allele, a well-described genetic risk factor for late-onset Alzheimer disease (AD), is associated with sleep disturbances even in cognitively normal older adults, although it is not clear whether this association is independent of sleep apnea. We sought to extend previous studies by examining whether cognitively normal older adults without self-reported sleep apnea who carry the APOE ε4 allele have altered sleep characteristics compared to noncarriers. Data from N = 36 (APOE ε4 carriers [n = 9], noncarriers [n = 27]) cognitively normal older adults (Clinical Dementia Rating [CDR] scale = 0) without self-reported sleep apnea were used for these analyses. Participants wore an actigraph for 7 days to determine sleep characteristics. The Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to assess sleep quality and daytime sleepiness, respectively. The APOE ε4 carriers had a higher number of awakenings compared to the noncarriers ( P = .02). There was no significant difference in the PSQI global score and the ESS; however, the PSQI subcomponent of daily disturbances was significantly higher in APOE ε4 carriers ( P = .03), indicating increased daytime dysfunction is related to disrupted sleep. This study provides evidence that individuals who are cognitively normal and genetically at risk of AD may have disrupted sleep. These findings are consistent with prior studies and suggest that sleep disruption may be present in the presymptomatic stages of AD.

Executive Function Is Associated With Off-Line Motor Learning in People With Chronic Stroke.

BACKGROUND AND PURPOSE: Sleep has been shown to promote off-line motor learning in individuals following stroke. Executive function ability has been shown to be a predictor of participation in rehabilitation and motor recovery following stroke. The purpose of this study was to explore the association between executive function and off-line motor learning in individuals with chronic stroke compared with healthy control participants. METHODS: Seventeen individuals with chronic stroke (>6 months poststroke) and 9 healthy adults were included in the study. Participants underwent 3 consecutive nights of polysomnography, practiced a continuous tracking task the morning of the third day, and underwent a retention test the morning after the third night. Participants underwent testing on 4 executive function tests after the continuous tracking task retention test. RESULTS: Participants with stroke showed a significant positive correlation between the off-line motor learning score and performance on the Trail-Making Test from Delis-Kaplan Executive Function System (r = 0.652; P = 0.005), while the healthy control participants did not. Regression analysis showed that the Trail-Making Test-Delis-Kaplan Executive Function System is a significant predictor of off-line motor learning (P = 0.008). DISCUSSION AND CONCLUSIONS: This is the first study to demonstrate that better performance on an executive function test of attention and set-shifting predicts a higher magnitude of off-line motor learning in individuals with chronic stroke. This emphasizes the need to consider attention and set-shifting abilities of individuals following stroke as these abilities are associated with motor learning. This in turn could affect learning of activities of daily living and impact functional recovery following stroke.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A166).

Performance on a functional motor task is enhanced by sleep in middle-aged and older adults.

BACKGROUND AND PURPOSE: Although sleep has been shown to enhance motor skill learning, it remains unclear whether sleep enhances learning of a functional motor task in middle-aged and older individuals. The purpose of this study was to examine whether sleep enhances motor learning of a functional motor task in middle-aged and older adults. METHODS: Twenty middle-aged and 20 older individuals were randomly assigned to either the sleep condition or the no-sleep condition. Participants in the sleep condition practiced a novel walking task in the evening, and returned the following morning for retesting. Participants in the no-sleep condition practiced the walking task in the morning and returned the same day in the evening for a retest. Outcome measures included time around the walking path and spatiotemporal gait parameters. RESULTS: Only the middle-aged and older adults in the sleep condition demonstrated significant off-line improvement in performance, measured as a decline in time to walk around the novel path and improvement in spatiotemporal gait parameters. The middle-aged and older adults in the no-sleep condition failed to demonstrate off-line improvements in performance of this functional task. CONCLUSIONS: This is the first study to provide evidence that sleep facilitates learning a clinically relevant functional motor task in middle-aged and older adults. Because many neurologic conditions occur in the middle-aged and older adults and sleep issues are very prevalent in many neurologic conditions, it is imperative that physical therapists consider sleep as a factor that may impact motor learning and recovery in these individuals. VIDEO ABSTRACT AVAILABLE: (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A73) for more insights from the authors.

Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis.

PURPOSE: The purpose of this convergent mixed methods study was to assess the perceptions and characteristics of sleep in breast cancer survivors (BCSs) and elucidate perceptions of sleep among BCS with lymphedema. METHODS: Participants were BCS with and without lymphedema. Both groups completed the Pittsburgh Sleep Quality Index (PSQI), PROMIS® Sleep Disturbance (8a short form), and wore an actigraph on their wrist to capture sleep/wake cycles for 7 days/nights while logging their sleep using a sleep diary. The coefficient of variation of sleep efficiency was calculated from the sleep diary to assess intraindividual variability. In addition, a subsample of BCS with lymphedema participated in a semi-structured qualitative interview. The qualitative data was analyzed separately, and the themes were applied to provide a more nuanced explanation of the quantitative outcomes. RESULTS: The BCS with lymphedema (n=23) had a significant difference in PSQI (p=0.002), PROMIS® Sleep Disturbance (p=0.084), and sleep efficiency coefficient of variation (p=0.014) compared to BCS without lymphedema (n=23). There were no statistically significant differences between groups in the actigraphy results. BCS with lymphedema perceived that lymphedema management contributed to their sleep disturbance, further exacerbating their mind/body fatigue. CONCLUSION: This study provides the foundation for future research to investigate the integration of sleep interventions with lymphedema management for holistic survivorship care for BCS with lymphedema. IMPLICATIONS FOR CANCER SURVIVORS: An innovative sleep health intervention designed to consider the unique factors contributing to sleep disturbance in BCS with lymphedema will fill a gap in their post-cancer treatment quality of life.

Sex Differences in the Role of Sleep on Cognition in Older Adults.

Study Objectives: The study aimed to investigate sex differences in the relationship between sleep quality (self-report and objective) and cognitive function across three domains (executive function, verbal memory, and attention) in older adults. Methods: We analyzed cross-sectional data from 207 participants with normal cognition or mild cognitive impairment (89 males and 118 females) aged over 60. The relationship between sleep quality and cognitive performance was estimated using generalized additive models. Objective sleep was measured with the GT9X Link Actigraph, and self-reported sleep was measured with the Pittsburgh Sleep Quality Index. Results: We found that females exhibited stable performance of executive function with up to about 400 minutes of total sleep time, with significant declines in performance (p = 0.02) when total sleep time was longer. Additionally, a longer total sleep time contributed to lower verbal memory in a slightly non-linear manner (p = 0.03). Higher self-reported sleep complaints were associated with poorer executive function in females with normal cognition (p = 0.02). In males, a positive linear relationship emerged between sleep efficiency and executive function (p = 0.04), while self-reported sleep was not associated with cognitive performance in males with normal cognition. Conclusions: Our findings suggest that the relationships between sleep quality and cognition differ between older males and females, with executive function being the most influenced by objective and self-reported sleep. Interventions targeting sleep quality to mitigate cognitive decline in older adults may need to be tailored according to sex, with distinct approaches for males and females.

Behavioral Interventions to Improve Sleep Outcomes in Individuals With Multiple Sclerosis: A Systematic Review.

BACKGROUND: Sleep disturbances are common in individuals with multiple sclerosis. The objective of this systematic review was to determine effective behavioral interventions to improve their sleep. METHODS: Literature searches were performed in December 2021 in Ovid MEDLINE, Elsevier Embase, and Web of Science, along with hand searching for grey literature and cited references. Four reviewers independently reviewed titles and abstracts (2 reviewers for each article; n = 830) and the full-text articles (n = 81). Consensus for inclusion was achieved by a fifth reviewer. Thirty-seven articles were eligible for inclusion. Four reviewers extracted relevant data from each study (2 reviewers for each article) using a standard data extraction table. Consensus was achieved for completeness and accuracy of the data extraction table by a fifth reviewer. The same 4 reviewers conducted a quality appraisal of each article to assess the risk of bias and quality of the articles, and consensus was achieved by a fifth reviewer as needed. Descriptive data were used for types of interventions, sleep outcomes, results, and key components across interventions. RESULTS: Overall, the cognitive behavioral therapy for insomnia, cognitive behavioral therapy/psychotherapy, and education/self-management support interventions reported positive improvements in sleep outcomes. Quality appraisal scores ranged from low to high, indicating potential for bias. CONCLUSIONS: Variability in the intervention type, intervention dose, outcomes used, training/expertise of interventionist, specific sample, and study quality made it difficult to compare and synthesize results. Further research is necessary to demonstrate the efficacy of most of the interventions.

The Impact of Sleep on the Lives of Women Who Have Breast Cancer-Related Lymphedema: A Qualitative Exploration.

Background: Breast cancer survivors (BCSs) have many lifelong symptoms of anxiety, depression, lymphedema, and fatigue that can be exacerbated by sleep disturbance. However, little is known about unique factors contributing to sleep disturbance among BCSs with lymphedema; this requires further investigation to offer appropriate support and treatment to these individuals. Therefore, the objective of this study was to capture perceptions and experiences of lymphedema and sleep among BCSs with lymphedema. Methods and Results: Qualitative description guided data collection and analysis as part of a mixed-methods investigation to characterize sleep disturbance among BCSs with and without lymphedema. The participants were interviewed one-on-one using a semistructured interview guide. Inductive content analysis was completed using an iterative coding approach, condensing, and categorizing to develop four themes. Seven BCSs with lymphedema participated. From their narratives, four themes were developed: (1) mind and body fatigue are exacerbated by sleep disturbance; (2) fatigue impacted fragile coping and support systems; (3) fatigue influenced self-identity and roles in society; and (4) self-management strategies were used for sleep health. Conclusion: The participants' perceptions of sleep disturbances' impact on their lives endorse further investigation into optimal interventions to improve sleep quality and modify these impactful findings to create a higher quality of life for survivorship.

Quality-of-life among women with breast cancer: application of the international classification of functioning, disability and health model.

Background: This study aimed to identify the factors that influence Breast Cancer (BC) women's quality of life (QoL) based on the International Classification of Functioning, Disability and Health (ICF) framework. Method: A cross-sectional study was conducted among 188 women with BC. The dependent variable, QoL, was measured using the Quality of Life Index (QLI-c). The independent variables were measured using the following Arabic-validated questionnaires: Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ). Results: There was a significant positive correlation between monthly income (r = 0.17, p = 0.016) and QoL, and significant negative correlation between the stage of disease (r = -0.221, p = 0.002) and duration of first diagnosis (r = -0.280, p = 0.004) with QoL. Poor sleep quality, sexual dysfunction, fatigue, depression, and anxiety had significant negative correlations with QoL (p < 0.01). Multiple regression analysis revealed that among the various factors that might affect QoL, sexual dysfunction, poor sleep quality, depression, and anxiety were significant predictors of QoL (p ≤ 0.05). Conclusion: The ICF provided an excellent framework to explore the factors influencing QoL among women with BC. This study has given evidence for the relationship of demographic, clinical, and body functional factors with QoL among women with BC. Interestingly, sexual dysfunction, poor sleep quality, depression, and anxiety factors are predictors of QoL. Awareness of these factors that predict QoL will guide healthcare professionals to improve the health and QoL of BC women.