Adapting Research to a Global Pandemic: A Fully Remote Actigraphy and Ecological Momentary Assessment Study.

BACKGROUND: Mandated social distancing practices and quarantines in response to COVID-19 have resulted in challenges for research on healthcare workers, such as hospital nurses. It remains unknown whether nursing studies utilizing complex methodology like sleep actigraphy and ecological momentary assessment (EMA) can be conducted remotely without compromising data quality. OBJECTIVES: We aimed to (a) disseminate our remote study protocol for sleep actigraphy and EMA data from hospital nurses during COVID-19, (b) assess feasibility and acceptability of this approach for studies on hospital nurses, and (c) examine the reliability and ecological validity of sleep characteristics measured across 14 days. METHODS: Using an online platform, we provided 86 outpatient nurses from a cancer hospital with detailed video/text instructions regarding the study and facilitated virtual study onboarding meetings. Feasibility was assessed by comparing adherence rates to a similar in-person study of nurses from the same hospital; acceptability was evaluated through content analysis of qualitative study feedback. Multilevel modeling was conducted to assess changes in sleep characteristics as a function of study day and daily stressful experiences. RESULTS: Adherence to EMA (91.8%) and actigraphy (97.9%) was high. EMA adherence was higher than the in-person study of inpatient day-shift nurses from the same hospital. Content analyses revealed primarily positive feedback, with 51.2% reporting "easy, clear, simple onboarding" and 16.3% reporting the website was "helpful." Six participants provided only negative feedback. Sleep characteristics did not change as a function of study day except for self-reported quality, which increased slightly during Week 1 and regressed toward baseline after that. A higher incidence of stressor days or higher stressor severity followed nights with shorter-than-usual time in bed or poorer-than-usual sleep quality, supporting the ecological validity for these methods of assessing sleep in nurses. DISCUSSION: Findings suggest that a fully remote study protocol for EMA and actigraphy studies in nursing yields robust feasibility, acceptability, reliability, and validity. Given the busy schedules of nurses, the convenience of this approach may be preferable to traditional in-person data collection. Lessons learned from COVID-19 may apply to improving nursing research postpandemic.

Subjective social status moderates back pain and mental health in older men.

OBJECTIVES: Back pain and poor mental health are interrelated issues in older men. Evidence suggests that socioeconomic status moderates this relationship, but less is known about the role of subjective social status (SSS). This study examined if the association between back pain and mental health is moderated by SSS. METHOD: We used a sample of community-dwelling older men (≥65 years) from the Osteoporotic Fractures in Men Study (N = 5994). Participants self-reported their back pain severity and frequency over the past 12 months. SSS was assessed with the MacArthur Scale of SSS. Mental health was assessed with the SF-12 Mental Component Summary (MCS). RESULTS: Severe back pain was associated with lower SF-12 MCS scores (p = .03). Back pain frequency was not associated with SF-12 MCS scores. SSS moderated the back pain and mental health relationship. Among men with higher national or community SSS, the association between back pain severity and SF-12 MCS scores was not significant. However, among men with lower national or community SSS, more severe back pain was associated with lower SF-12 MCS scores (p's < .001). Among those with lower national or community SSS, greater back pain frequency was also associated with lower SF-12 MCS scores (p's < .05). CONCLUSION: Where one ranks oneself within their nation or community matters for the back pain and mental health relationship. Higher SSS may be a psychosocial resource that buffers the negative associations of severe and frequent back pain on mental health in older men.

Subjective cognitive abilities correlate with poor sleep among day-shift and night-shift nurses.

Experimental studies have shown that sleep deprivation may lead to worse performance on cognitive tests. However, few studies have considered how sleep is associated with perceived cognitive performance in the daily lives of hospital nurses who require high cognitive abilities to deliver high-quality patient care. The current study examined the relationship between sleep and subjective cognition in nurses, and whether the relationship differed by work shift and workdays. Sixty in patient nurses working full-time (M = 35 years; 39 day-shift nurses, 21 night-shift nurses) reported their sleep characteristics and daily subjective cognition using ecological momentary assessment for 14 days. Concurrently, objective sleep characteristics were measured with a sleep actigraphy device for 14 days. Using multilevel modelling, results indicated that at the within-person and between-person level, better sleep quality and higher sleep sufficiency were associated with better subjective cognition at the daily-level and on average. Moderation analyses indicated at the within-person level, better sleep quality and longer time in bed were associated with better next-day cognition; these associations were stronger for night-shift nurses compared with day-shift nurses. At the between-person level, better sleep quality and higher sleep sufficiency were also associated with better subjective cognition overall; these associations were significant for day-shift nurses, but not for night-shift nurses. The sleep-subjective cognition relationships were more apparent on workdays versus non-workdays. Findings suggest that sufficient sleep recovery is important for nurses' reports of daily and overall cognitive functioning. Night-shift nurses' subjective cognitive abilities may be more protected on days following better sleepquality and more sufficient sleep.

From the Workroom to the Bedroom: Work-to-Home Spillover as a Mechanism Linking Work Characteristics to Sleep Health.

Work may influence the home domain and subsequently impact employee sleep. Past work found that negative spillover mediated the relationship between perceived unfairness about work and insomnia symptoms across 20 years. As an extension of past work, this study investigated whether negative spillover and positive spillover mediate the relationship between job demands (perceived unfairness, job discrimination) and job resources (coworker and supervisor support) on multidimensional sleep health. Two waves of survey data from a subset of full-time workers were obtained from the Midlife in the United States Study approximately 10 years apart. A sleep health composite captured irregularity, dissatisfaction, nap frequency, inefficiency, and suboptimal sleep duration (higher=more sleep health problems). PROCESS Macro evaluated cross-sectional (T1) and sequential (T1 exposureàT1 mediatoràT2 outcome) mediation pathways, adjusting for sociodemographic characteristics, physical health, neuroticism, and work hours. Both cross-sectionally and prospectively, higher negative spillover mediated the association of higher unfairness with more sleep health problems, and the association between higher discrimination and more sleep health problems. There was no support for positive spillover as a mediator between job resources and sleep health cross-sectionally or prospectively. Findings suggest that organizations should reduce the amount of negative spillover by limiting instances of unfairness and discrimination at work to promote specific aspects of employee sleep health such as sleep irregularity, dissatisfaction, efficiency, and nap frequency.

Be present now, sleep well later: Mindfulness promotes sleep health via emotion regulation.

OBJECTIVE: Despite the popularity of mindfulness in research and interventions, information is missing about how and why mindfulness may benefit employee sleep health. Drawing from emotion regulation theory, we evaluate affective rumination, negative affect, and positive affect as potential mechanisms. We also explore differential effects of trait and state attentional mindfulness on both subjective (e.g., quality and sufficiency) and actigraphy-measured aspects (e.g., duration and wake after sleep onset) of sleep health. METHOD: Ecological momentary assessment and sleep actigraphy data were collected across two independent samples of health care workers (N1 = 60, N2 = 84). Ecological momentary assessment was also used to collect daily information on state mindfulness, affect, and rumination. RESULTS: Our results support rumination and, to a less consistent extent, negative affect as mediators of the association between mindfulness and sleep health but not positive affect. Trait and state mindfulness demonstrate comparable benefits for employee sleep health, but these benefits largely emerge for subjective sleep dimensions than actigraphy-measured. CONCLUSIONS: These findings support emotion regulation as a sound theoretical framework for sleep and mindfulness research and may support more informed workplace mindfulness interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Multidimensional Sleep Health Problems Across Middle and Older Adulthood Predict Early Mortality.

BACKGROUND: Having multiple sleep problems is common in adulthood. Yet, most studies have assessed single sleep variables at one timepoint, potentially misinterpreting health consequences of co-occurring sleep problems that may change over time. We investigated the relationship between multidimensional sleep health across adulthood and mortality. METHODS: Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (MIDUS-2; M2) and in 2013-2014 (MIDUS-3; M3). We calculated a composite score of sleep health problems across 5 dimensions: Regularity, Satisfaction, Alertness, Efficiency, and Duration (higher = more problems). Two separate models for baseline sleep health (n = 5 140; median follow-up time = 15.3 years) and change in sleep health (n = 2 991; median follow-up time = 6.4 years) to mortality were conducted. Cox regression models controlled for sociodemographics and key health risk factors (body mass index, smoking, depressive symptoms, diabetes, and hypertension). RESULTS: On average, 88% of the sample reported having one or more sleep health problems at M2. Each additional sleep health problem at M2 was associated with 12% greater risk of all-cause mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI] = 1.04-1.21), but not heart disease-related mortality (HR = 1.14, 95% CI = 0.99-1.31). An increase in sleep health problems from M2 to M3 was associated with 27% greater risk of all-cause mortality (HR = 1.27, 95% CI = 1.005-1.59), and 153% greater risk of heart disease mortality (HR = 2.53, 95% CI = 1.37-4.68). CONCLUSIONS: More sleep health problems may increase the risk of early mortality. Sleep health in middle and older adulthood is a vital sign that can be assessed at medical checkups to identify those at greater risk.

The role of caregiving in cognitive function and change: The REGARDS study.

Chronic stress is associated with negative health outcomes, including poorer cognition. Some studies found stress from caregiving associated with worse cognitive functioning; however, findings are mixed. The present study examined the relationship between caregiving, caregiving strain, and cognitive functioning. We identified participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were family caregivers at baseline assessment and used propensity matching on 14 sociodemographic and health variables to identify matched noncaregivers for comparison. Data included up to 14 years of repeated assessments of global cognitive functioning, learning and memory, and executive functioning. Our results showed that when compared to noncaregivers, caregivers had better baseline scores on global cognitive functioning and word list learning (WLL). Among caregivers, a lot of strain was associated with better WLL and delayed word recall in the unadjusted model only. Caregivers with a lot of strain had higher depressive symptoms but not significantly higher high-sensitivity c-reactive protein (hsCRP) at baseline compared to caregivers with no or some strain after covariate adjustment. Although caregiving can be highly stressful, we found caregiving status and caregiving strain were not associated with cognitive decline. More methodologically rigorous studies are needed, and conclusions that caregiving has negative effects on cognition should be viewed with caution. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The moderating role of trait and state mindfulness between daily sleep and physical pain symptoms: an ecological momentary assessment and actigraphy study.

Objective: Poorer sleep quality and insufficient sleep increase the risk of physical pain. The current study examined the daily associations between sleep and physical pain symptoms and tested the moderating role of trait and state mindfulness in this relationship. Methods: Sixty hospital nurses (Mage=35.4 ± 11.8 years) completed 14-day ecological momentary assessment (EMA) and sleep actigraphy. EMA measured physical pain frequency and interference (1×/day) and state mindfulness (3×/day). Multilevel modelling was used to examine the associations at the between-person and within-person levels. Results: After nights with poorer sleep quality, lower sleep sufficiency, and more insomnia symptoms, the frequency of physical pain symptoms and pain interference were greater than usual. Overall, those with poorer sleep quality, lower sleep sufficiency, and more insomnia symptoms reported more physical pain symptoms and greater pain interference. Higher state mindfulness buffered the negative within-person association between sleep efficiency and physical pain frequency. There was evidence that the joint moderating effects of trait and state mindfulness yielded more protective benefits in the relationship between sleep quality and physical pain than trait or state mindfulness alone. Conclusion: Even without mindfulness training, one's mindfulness may be protective against the adverse effects of poor sleep quality on physical pain.

Effects of music interventions on sleep in people with dementia: A systematic review.

Poor sleep health is a risk factor for and a common symptom of dementia. Music has been shown to improve sleep across a wide range of clinical and community populations. However, it is unclear whether and to what extent music interventions may also help alleviate sleep problems in people with dementia. This systematic review is the first review examining the effects of music on sleep outcomes among people with dementia. In accordance with PRISMA guidelines, we extracted 187 articles from nine databases (Academic Search Premier, Ageline, APA PsycArticles, PsycINFO, CINAHL, Embase, PubMed, Scopus, and Web of Science). Eight studies were eligible for this systematic review (Range sample sizes: 1-59 people with dementia). Results revealed that assessments of sleep in the current literature were limited and mainly focused on sleep duration, subjective sleep quality, or nighttime sleep disturbances. Intervention delivery, music selection, and findings varied. Positive effects of music on sleep outcomes were observed in six out of the eight studies (75%), specifically there were decreases in nighttime sleep disturbances, increases in daytime alertness, and improvements in sleep quality. The remaining two studies found no statistically significant change in sleep outcomes (i.e., daytime sleepiness and quality). Study limitations included small sample sizes and the use of proxy reporters (e.g., caregiver, researcher, blinded clinician) which may reduce the accuracy of the sleep measures. Future research may want to incorporate objectively measured sleep to better understand the role of sleep in dementia care. More research is needed to determine whether music interventions are effective in improving sleep in people with dementia and whether improvements in sleep can slow the progression of dementia.

Sleep health composites are associated with the risk of heart disease across sex and race.

We examined whether subjectively and objectively measured sleep health composites have a relationship with heart disease. 6,820 adults (Mage = 53.4 years) from the Midlife in the United States study provided self-reported sleep characteristics and heart disease history. A smaller sample (n = 663) provided actigraphy sleep data. We tested two sleep health composites, based on self-report only and both self-report and actigraphy, across multiple sleep dimensions. We used a weighted sum approach, where higher scores indicated more sleep health problems. Modified Poisson regressions adjusted for sociodemographics and known risk factors. Having more sleep health problems was associated with a higher risk of heart disease using the self-report sleep health composite (aRR = 54%, P < .001) and the actigraphy/self-report composite (aRR = 141%, P < .001). Individual sleep dimensions of satisfaction, alertness, and efficiency (from the self-report composite) and regularity, satisfaction, and timing (from the actigraphy/self-report composite) were associated with the risk of heart disease. The effect size of each sleep health composite was larger than the individual sleep dimensions. Race moderated the association between the actigraphy/self-report sleep health composite and heart disease. There was no significant moderation by sex. Findings suggest poorer sleep health across multiple dimensions may contribute to heart disease risk among middle-aged adults.

Sleep health is associated with next-day mindful attention in healthcare workers.

OBJECTIVES: Previous studies have focused on the role of mindfulness in improving sleep health. Sleep health may also increase daily mindfulness; however, this potential directionality is understudied, with a lack of research on healthcare workers who need high-quality sleep and mindful attention for patient care. This study examined whether sleep health predicts next-day mindful attention, and vice versa, in nurses. DESIGN: Smartphone-based ecological momentary assessment. SETTING: U.S. hospitals. PARTICIPANTS: Sixty-one full-time nurses. MEASUREMENTS: For 2 consecutive weeks, participants provided actigraphy-measured and self-reported daily sleep characteristics. We examined 8 sleep variables across 5 key dimensions: satisfaction (self-report of sleep sufficiency, quality, and insomnia symptoms), alertness (self-report of daytime sleepiness), timing (actigraphy bed- and wake- times), efficiency (actigraphy percentage of time spent asleep during time in bed), and duration (actigraphy sleep duration). Participants reported state mindfulness specific to attention and awareness. Covariates included previous night's sleep, sociodemographics, work shift, workday (vs. nonworkday), and weekend (vs. weekday). RESULTS: Multilevel modeling revealed that, at the within-person level, after nights with greater sleep sufficiency, better sleep quality, lower efficiency, and longer sleep duration, daily mindful attention was greater than usual. Daily mindful attention was inversely associated with sleepiness, but not predictive of other sleep characteristics. At the between-person level, participants with greater sleep sufficiency, higher sleep quality, and fewer insomnia symptoms reported greater mindful attention overall. CONCLUSION: Findings show that optimal sleep health is an antecedent of daily mindful attention in nurses. Improving sleep may provide important benefits to their well-being and to the quality of patient care.