Alcohol Use Predicts Longer But More Fragmented Sleep: A Daily Diary Study of Alcohol, Sleep, and PTSD in Nurses.

BACKGROUND: Due to the demanding nature of their profession, nurses are at risk of experiencing irregular sleep patterns, substance use, and fatigue. Evidence supports a reciprocal relationship between alcohol use and sleep disturbances; however, no research has examined such a link in a sample of nurses. One factor that may further impact the dynamic between alcohol and sleep patterns is posttraumatic stress disorder (PTSD) symptoms. We investigated the daily bidirectional associations between alcohol use and several sleep domains (i.e., self-report and actigraphy-determined sleep), and moderation by baseline PTSD symptom severity. METHOD: Over a 14-day period, 392 nurses (92% female; 78% White) completed sleep diaries and actigraphy to assess alcohol use and sleep patterns. Within-person bidirectional associations between alcohol and sleep were examined using multilevel models, with symptoms of PTSD as a cross-level moderator. RESULTS: Daily alcohol use (i.e., ≥ 1 alcoholic beverage; 25.76%) was associated with shorter self-reported sleep onset latency (b = -4.21, p = .003) but longer self-reported wake after sleep onset (b = 2.36, p = .009). Additionally, days with any alcohol use were associated with longer self-reported sleep duration (b = 15.60, p = .006) and actigraphy-determined sleep duration (b = 10.06, p = .037). No sleep variables were associated with next-day alcohol use. Bidirectional associations between alcohol consumption and sleep were similar regardless of baseline PTSD symptoms. CONCLUSION: Our results suggested that on days when nurses drank alcohol, they experienced longer but also more fragmented sleep.

Psychometric Evaluation of the Insomnia Severity Index in Nurses.

OBJECTIVES: Examine psychometric properties of the Insomnia Severity Index (ISI) in a sample of nurses. METHOD: In a sample of day shift nurses (N = 289), a confirmatory factor analysis (CFA), convergent and discriminant validity analyses, and a test-retest reliability analysis were performed. RESULTS: CFA showed that a two-factor model provided the best fit. The ISI had moderate to poor convergent validity with sleep diary parameters, and moderate convergent validity with the Sleep Condition Indicator (r = -.66), Pittsburgh Sleep Quality Index (r = .66), and PROMIS Sleep-Related Impairment measure (r = .67). The ISI demonstrated good discriminant validity with the measures Composite Scale of Morningness (r = -.27), Nightmares Disorder Index (r = .25), PTSD Checklist for DSM-5 (sleep items removed; r = .32), and Perceived Stress Scale (r = .43). The ISI had weaker discriminant validity with the PHQ-9 (r = .69) and Generalized Anxiety Disorder Screener (r = .51). The ISI demonstrated a good test-retest reliability (ICCs = .74-.88). CONCLUSIONS: The ISI is a psychometrically strong measure for the assessment of insomnia severity in day shift nurses. Overlap with psychological symptoms, primarily anxiety and depression, suggests caution while interpreting these constructs.

Integration of Sensor-Based and Self-Reported Metrics in a Sleep Diary: A Pilot Exploration.

OBJECTIVES: Discrepancies between sleep diaries and sensor-based sleep parameters are widely recognized. This study examined the effect of showing sensor-based sleep parameters while completing a daily diary. The provision of sensor-based data was expected to reduce variance but not change the mean of self-reported sleep parameters, which would in turn align better with sensor-based data compared to a control diary. METHOD: In a crossover study, 24 volunteers completed week-long periods of control diary (digital sleep diary without sensor-based data feedback) or integrated diary (diary with device feedback), washout, and then the other diary condition. RESULTS: The integrated diary reduced self-reported total sleep time (TST) by <10 minutes and reduced variance in TST. The integrated diary did not impact mean sleep onset latency (SOL) and, unexpectedly, the variance in SOL increased. The integrated diary improved both bias and limits of agreement for SOL and TST. CONCLUSIONS: Integration of wearable, sensor-based device data in a sleep diary has little impact on means, mixed evidence for less variance, and better agreement with sensor-based data than a traditional diary. How the diary impacts reporting and sensor-based sleep measurements should be explored.

Using a frequentist and Bayesian approach to examine video game usage, substance use, and sleep among college students.

Video games are a popular form of entertainment. However, there is mixed evidence for the association between video game usage and poor sleep quality, short sleep duration, or delayed sleep timing. The current study examined associations between daily sleep behaviours and video game usage via a Bayesian and frequentist statistical approach. Caffeine and alcohol consumption were also assessed as moderators, as these behaviours may co-occur with video game usage and poor sleep. 1032 (72% female) undergraduate students were recruited between 2006-2007. Participants completed questionnaires examining video game and substance use, as well as sleep diaries for 1 week. Frequentist analyses revealed that video game usage was related to increased variability in the total sleep time, and a later average sleep midpoint, but not sleep efficiency. Alcohol use moderated the relationships between video game usage and both average and variability in total sleep time. Caffeine use was related to shorter average total sleep time and more variability in sleep efficiency. Alcohol consumption was related to more variability in the total sleep time and sleep midpoint, and a later average sleep midpoint. Bayesian models suggested strong evidence that video game playing was associated with later average sleep midpoint. Like the frequentist approach, alcohol consumption moderated the relationship between video game usage and both average and variability in total sleep time, but the evidence was weak. The effect sizes for both approaches tended to be small. Using a rigorous statistical approach and a large sample, this study provides robust evidence that video game usage may not be strongly associated with poor sleep among undergraduate students.

Treatment of comorbid sleep disorders and posttraumatic stress disorder in U.S. active duty military personnel: A pilot randomized clinical trial.

Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT-I&N) and cognitive processing therapy (CPT) for PTSD are first-line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N = 93) to one of three conditions: CBT-I&N delivered before CPT, CBT-I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT-I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms, d = -0.36; insomnia, d = -0.77; sleep efficiency, d = 0.62; and nightmares, d = -.53. Compared to participants who received CBT-I&N delivered before CPT, those who received CBT-I&N delivered after CPT demonstrated larger improvements in PTSD symptoms, d = 0.48, and sleep efficiency, d = -0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone.

Implicit and Explicit Stigma of Chronotype in Emerging Adults.

BACKGROUND: Individuals with poor sleep (e.g., insomnia) and mental health (e.g., depression) experience negative stigma but no studies have examined the relationship between stigma and evening chronotype. The present mixed methods study aimed to assess and describe explicit and implicit attitudes about evening and morning chronotypes in a sample of emerging adults. PARTICIPANTS: 49 undergraduates (Mage = 19.9 [SD = 1.5], 83.7% female). METHODS: Participants completed self-reports of demographics and chronotype. Attitudes about "night owls" and "early birds" were measured with self-report questionnaires (explicit attitudes) and an Implicit Association Task (implicit attitudes). Participants described associations with evening and morning chronotypes in free-text responses, which were qualitatively coded. RESULTS: We found evidence of implicit bias against night owls and for early birds. The positive mean implicit d score was 0.57 (SD = 0.47), indicating a moderate implicit bias for pairing "bad" with "night owl" and "good" with "early bird." No baseline characteristics, including chronotype, were significantly associated with implicit bias. Analyses of explicit bias revealed participants perceived night owls as significantly more lazy, unhealthy, undisciplined, immature, creative, and young. Analysis of free-text responses provided further evidence of these associations. CONCLUSIONS: Consistent with hypothesis, undergraduates demonstrated predominantly negative implicit and explicit stigma toward evening chronotypes compared to morning types. As stigma can lead to adverse consequences, future studies should assess the impact of negative societal and self-stigma on evening types. Consideration of societal stigma within clinical intervention contexts could have the potential to reduce shame or other emotions that interfere with sleep.

Primary Care Engagement Among Individuals with Experiences of Homelessness and Serious Mental Illness: an Evidence Map.

BACKGROUND: Experiences of homelessness and serious mental illness (SMI) negatively impact health and receipt of healthcare. Interventions that promote the use of primary care services for people with both SMI and homelessness may improve health outcomes, but this literature has not been evaluated systematically. This evidence map examines the breadth of literature to describe what intervention strategies have been studied for this population, elements of primary care integration with other services used, and the level of intervention complexity to highlight gaps for future intervention research and program development. METHODS: We followed an a priori protocol developed in collaboration with clinical stakeholders. We systematically searched the published literature to identify interventions for adults with homelessness who also had SMI. We excluded case reports, editorials, letters, and conference abstracts. Data abstraction methods followed standard practice. Data were categorized into intervention strategies and primary care integration strategies. Then we applied the Complexity Assessment Tool for Systematic Reviews (iCAT_SR) to characterize intervention complexity. RESULTS: Twenty-two articles met our inclusion criteria evaluating 15 unique interventions to promote engagement in primary care for adults with experiences of homelessness and SMI. Study designs varied widely from randomized controlled trials and cohort studies to single-site program evaluations. Intervention strategies varied across studies but primarily targeted patients directly (e.g., health education, evidence-based interactions such as motivational interviewing) with fewer strategies employed at the clinic (e.g., employee training, multidisciplinary teams) or system levels (e.g., data sharing). We identified elements of primary care integration, including referral strategies, co-location, and interdisciplinary care planning. Interventions displayed notable complexity around the number of intervention components, interaction between intervention components, and extent to which interventions were tailored to specific patient populations. DISCUSSION: We identified and categorized elements used in various combinations to address the primary care needs of individuals with experiences of homeless and SMI.

How much does sleep vary from night-to-night? A quantitative summary of intraindividual variability in sleep by age, gender, and racial/ethnic identity across eight-pooled datasets.

Habitual sleep duration and efficiency vary widely by age, gender, and racial/ethnic identity. Despite growing research on the importance of night-to-night, intraindividual variability (IIV) in sleep, few studies have examined demographic differences in sleep IIV. The present study describes typical sleep IIV overall and by demographics among healthy sleepers. Eight datasets of healthy sleepers (N = 2,404; 26,121 total days of sleep data) were synthesised to examine age, gender, and racial/ethnic identity differences in sleep IIV measured via diaries, actigraphy, and electroencephalography (EEG). Sleep IIV estimates included the intraindividual standard deviation (iSD), root mean square of successive differences (RMSSD), coefficient of variation (CV), and a validated Bayesian Variability Model (BVM). There was substantial IIV in sleep across measurement types (diary, actigraphy, EEG) for both sleep duration (iSD: 85.80 [diary], 77.41 [actigraphy], 67.04 [EEG] minutes; RMSSD: 118.91, 108.89, 91.93 minutes; CV: 19.19%, 19.11%, 18.57%; BVM: 60.60, 58.20, 48.60 minutes) and sleep efficiency (iSD: 5.18% [diary], 5.22% [actigraphy], 6.46% [EEG]; RMSSD: 7.01%, 7.08%, 8.44%; CV: 5.80%, 6.27%, 8.14%; BVM: 3.40%, 3.58%, 4.16%). Younger adults had more diary and actigraphy sleep duration IIV. Gender differences were inconsistent. White and non-Hispanic/Latinx adults had less IIV in sleep duration and efficiency compared to racial/ethnic minority groups. Even among healthy sleepers, sleep varies widely from night-to-night. Like mean sleep, there also may be disparities in IIV in sleep by demographic characteristics. Study results help characterise normative values of sleep IIV in healthy sleepers.

Daily stress and sleep associations vary by work schedule: A between- and within-person analysis in nurses.

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work is common among nurses and may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by recent shift worker status and daily work schedule among nurses. Participants were 392 nurses (92% female; 78% White, mean age = 39.54, SD = 11.15) who completed 14 days of electronic sleep diaries and actigraphy. They simultaneously completed assessments of daily stress and work schedule upon awakening (day shift vs. night shift [work between 9 p.m.-6 a.m.] vs. off work). Participants were classified as recent night shift workers if they worked at least one night shift during the past 14 days (n = 101; 26%). In the entire sample, greater daily stress predicted shorter self-reported total sleep time and lower self-reported sleep efficiency that night. Shorter self-reported and actigraphy total sleep time and lower self-reported sleep efficiency predicted higher next-day stress. Compared with recent night shift workers, day workers reported higher stress after nights with shorter total sleep time. Stress-sleep associations mostly did not vary by nurses' daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime targets for tailored interventions among nurses. Night shift workers may be less susceptible to the effects of short sleep on next-day stress. Research is needed to understand the short- and long-term effects of shift work and address the unique sleep challenges nurses face.

Racial/ethnic variations in inflammatory markers: exploring the role of sleep duration and sleep efficiency.

Individuals from minoritized racial/ethnic groups have higher levels of circulating inflammatory markers. However, the mechanisms underlying these differences remain understudied. The objective of this study was to examine racial/ethnic variations in multiple markers of inflammation and whether impaired sleep contributes to these racial/ethnic differences. Nurses from two regional hospitals in Texas (n = 377; 71.62% White; 6.90% Black; 11.14% Hispanic, 10.34% Asian; mean age = 39.46; 91.78% female) completed seven days of sleep diaries and actigraphy to assess mean and variability in total sleep time (TST) and sleep efficiency (SE). On day 7, blood was drawn to assess 4 inflammatory markers: C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-1 beta (IL-1ß), and tumor necrosis factor-alpha (TNF-α). Results from regression models showed differences in inflammatory markers by race/ethnicity, adjusting for age and gender. The associations between sleep parameters and inflammatory markers also varied by race/ethnicity. Among White nurses, lower mean and greater variability in actigraphy-determined TST and greater variability in diary-determined TST were associated with higher levels of IL-6. Among Black nurses, lower mean diary-determined SE was associated with higher levels of IL-6 and IL-1ß. Among Hispanic nurses, greater diary-determined mean TST was associated with higher CRP. Among Asian nurses, greater intraindividual variability in actigraphy-determined SE was associated with lower CRP. Among nurses, we did not find racial/ethnic disparities in levels of inflammation. However, analyses revealed differential relationships between sleep and inflammatory markers by race/ethnicity. Results highlight the importance of using a within-group approach to understand predictors of inflammatory markers.

Characterizing Patterns of Nurses' Daily Sleep Health: a Latent Profile Analysis.

BACKGROUND: Nursing is a demanding occupation characterized by dramatic sleep disruptions. Yet most studies on nurses' sleep treat sleep disturbances as a homogenous construct and do not use daily measures to address recall biases. Using person-centered analyses, we examined heterogeneity in nurses' daily sleep patterns in relation to psychological and physical health. METHODS: Nurses (N = 392; 92% female, mean age = 39.54 years) completed 14 daily sleep diaries to assess sleep duration, efficiency, quality, and nightmare severity, as well as measures of psychological functioning and a blood draw to assess inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP). Using recommended fit indices and a 3-step approach, latent profile analysis was used to identify the best-fitting class solution. RESULTS: The best-fitting solution suggested three classes: (1) "Poor Overall Sleep" (11.2%), (2) "Nightmares Only" (8.4%), (3) "Good Overall Sleep" (80.4%). Compared to nurses in the Good Overall Sleep class, nurses in the Poor Overall Sleep or Nightmares Only classes were more likely to be shift workers and had greater stress, PTSD symptoms, depression, anxiety, and insomnia severity. In multivariate models, every one-unit increase in insomnia severity and IL-6 was associated with a 33% and a 21% increase in the odds of being in the Poor Overall Sleep compared to the Good Overall Sleep class, respectively. CONCLUSION: Nurses with more severe and diverse sleep disturbances experience worse health and may be in greatest need of sleep-related and other clinical interventions.

Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review.

BACKGROUND: Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. OBJECTIVE: We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? METHODS: We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ≥2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. RESULTS: We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. CONCLUSIONS: This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases.

Web-based provider training of cognitive behavioral therapy of insomnia: engagement rates, knowledge acquisition, and provider acceptability.

Insomnia is common but severely underreported and undertreated. One possible reason for this problem is the lack of providers in cognitive behavioral therapy for insomnia (CBT-I). To address this we created CBTIweb.org, an online training platform for providers to learn the basics of sleep, assessing insomnia, and CBT-I. The present study assessed the reach of CBTIweb by examining engagement, knowledge acquisition, and perceived acceptability. Participants who registered for CBTIweb self-reported their practice setting and personal characteristics (i.e. degree, profession, licensure status). Knowledge acquisition was assessed with pre- and post-tests, and provider acceptability was assessed via a survey. In the first three months after launching CBTIweb, 2586 providers registered and 624 of these completed the training within three months of registering. Chi-square tests of independence revealed no differences in completion rates by education or profession, though trainees were more likely to initiate and complete treatment than licensed providers. Paired t tests revealed significant knowledge acquisition, and most providers positively rated the website navigation, content, aesthetics, and understanding of core CBT-I skills. This study demonstrated CBTIweb is an effective platform for training health professionals to be minimally proficient in the gold standard treatment for insomnia disorder.

The Cycle of Daily Stress and Sleep: Sleep Measurement Matters.

BACKGROUND: Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress. PURPOSE: We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG). METHODS: Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]). RESULTS: Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (ß = -0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (ß = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity. CONCLUSIONS: Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary-not redundant-sleep measurement approaches.

Nightmares and Insomnia in the US National Guard: Mental and Physical Health Correlates.

BACKGROUND: Nightmares and insomnia are significant concerns that commonly co-occur with each other and with other health disorders. Limited research has examined the unique and shared aspects of insomnia and nightmares, and little is known about sleep in US National Guard personnel. This study sought to determine the prevalence and psychosocial correlates of nightmares with and without insomnia in US National Guard personnel. METHOD: National Guard personnel (N = 841) completed an online survey and were classified as having nightmares only, insomnia only, both, or neither, using a minimum nightmare frequency of "less than once a week" and an Insomnia Severity Index cutoff of ≥ 15. Analyses examined differences in demographics, physical health, and psychosocial variables and in the prevalence of nightmares and insomnia in personnel with physical and mental health problems. RESULTS: In this sample, 32% reported nightmares only, 4% reported insomnia only, and 12% reported both. Those in the youngest age group (18-21) were more likely to have no nightmares or insomnia. Those with both nightmares and insomnia had more deployments. Nightmares and insomnia were associated with poorer physical and mental health and greater prevalence of comorbid physical and mental health conditions. Personnel with both insomnia and nightmares reported the greatest severity of comorbid conditions. CONCLUSION: US National Guard personnel with nightmares and/or insomnia reported worse mental and physical health impairment than those without these conditions. Personnel may benefit from screening for nightmares and insomnia and referrals for evidence-based treatment.

The Development of a Brief Version of the Insomnia Severity Index (ISI-3) in Older Adult Veterans with Posttraumatic Stress Disorder.

Objective/Background: The Insomnia Severity Index (ISI) is an insomnia self-report measure used to identify individuals at risk for insomnia disorder. Although the full ISI is only seven questions, a briefer version would allow more efficient and pragmatic administration in routine practice settings. Reliable and valid brief measures can support measurement-based care. The present study was a proof-of-concept study that developed a brief version of the ISI, the ISI-3, in a sample of older adult veterans with posttraumatic stress disorder (PTSD), a group which is at increased risk for insomnia.Patients/Methods: Participants included 86 older veterans with combat- or military-related PTSD. Veterans completed a clinician-administered PTSD diagnostic interview, self-report measures of insomnia and other psychosocial questionnaires, and two neuropsychological assessments. The factor structure of the ISI was examined to reduce the measure into a brief version. The reliability and validity of the ISI-3 were examined.Results: Principal axis factoring yielded a one-factor solution, which reproduced 59% of the item variance. Item reduction procedures resulted in three items, which best represented this factor ("Insomnia Impact;" ISI-3). For the ISI-3, internal consistency was good (α =.89). Convergent validity was demonstrated via moderate to high positive correlations between the ISI-3 and other measures of sleep disturbance. Divergent validity was demonstrated via non-significant correlations between the ISI-3 and unrelated measures and moderate correlations with self-reported depression.Conclusions: The ISI-3 is a psychometrically valid brief version of the ISI. Clinicians can administer the ISI-3 to screen for insomnia and monitor changes in insomnia during treatment.

Insomnia, Psychosocial Well-Being, and Weight Control Behaviors Among Healthy-Weight Adolescent Females: Brief Report.

BACKGROUND: Weight control behaviors (WCBs) typically involve appearance- or health-driven behaviors that may be influenced by physiological, psychological, or social factors. Sleep disturbances like insomnia are an important area of research for adolescent populations, as early intervention may result in improvements in other physical and mental health domains. The purpose of this study was to investigate the relationship of insomnia, psychosocial well-being, and current WCBs in healthy-weight female adolescents. METHOD: Female adolescents (N = 323; Mage = 12.33 ± .04) who had healthy body mass index (BMI) levels completed self-report items on insomnia, depression, self-esteem, and physical self-concept. Multivariate analysis of covariance (MANCOVA), controlling for age, was conducted to further examine differences in insomnia and psychosocial variables among the WCB groups. RESULTS: Compared to those who were trying to stay the same weight or not trying to do anything about their weight, the girls who were trying to lose weight had significantly greater insomnia and depression symptoms, and lower self-esteem, with small to medium effect sizes. CONCLUSIONS: Clinicians working with adolescent girls should include assessments of WCBs in addition to measures of insomnia symptoms, even for adolescent girls within a normal BMI range, as these are common and frequently co-occurring phenomena. Additional research is needed to further disentangle these complicated relationships.

Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review.

BACKGROUND: The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE: To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function. DATA SOURCES: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020. STUDY SELECTION: Randomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure. DATA EXTRACTION: Data were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools. DATA SYNTHESIS: Of 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83 291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n = 118 844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease. LIMITATIONS: Study heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment. CONCLUSION: Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).

Intraindividual Variability in Sleep and Levels of Systemic Inflammation in Nurses.

OBJECTIVE: Disturbed sleep is common among nurses and is associated with morbidity and mortality. Inflammation may be one mechanism linking sleep and disease. However, most studies rely on retrospective questionnaires to assess sleep, which fail to account for night-to-night fluctuations in sleep across time (i.e., intraindividual variability [IIV]). We examined prospective associations between mean and IIV in sleep with inflammation markers in nurses. METHODS: Participants were 392 nurses (mean age = 39.54 years, 92% female, 23% night-shift working) who completed 7 days of sleep diaries and actigraphy to assess mean and IIV in total sleep time and sleep efficiency. Blood was drawn on day 7 to assess inflammation markers C-reactive protein, interleukin (IL)-6, tumor necrosis factor α, and IL-1ß. RESULTS: Greater IIV in total sleep time-measured via both actigraphy and sleep diary-was associated with higher IL-6 (actigraphy: b = 0.05, p = .046, sr = 0.01; diary: b = 0.04, p = .030, sr = 0.01) and IL-1ß (actigraphy: b = 0.12, p = .008, sr = 0.02; diary: b = 0.09, p = .025, sr = 0.01), but not C-reactive protein or tumor necrosis factor α. IIV in actigraphy- and sleep diary-determined sleep efficiency was not associated with inflammation biomarkers, nor were any mean sleep variables. Shift work did not moderate any associations. CONCLUSIONS: Nurses with more variable sleep durations had elevated levels of inflammation, which may increase risk for development of inflammatory-related diseases. Research should investigate how sleep regularization may change levels of inflammation and improve health.

Validity of Actigraphy in Young Adults With Insomnia.

Objective/Background: Actigraphy is an inexpensive and objective wrist-worn activity sensor that has been validated for the measurement of sleep onset latency (SOL), number of awakenings (NWAK), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) in both middle-aged and older adults with insomnia. However, actigraphy has not been evaluated in young adults. In addition, most previous studies compared actigraphy to in-lab polysomnography (PSG), but none have compared actigraphy to more ecologically valid ambulatory polysomnography.Participants: 21 young adults (mean age = 19.90 ± 2.19 years; n = 13 women) determined to have chronic primary insomnia through structured clinical interviews.Methods: Sleep diaries, actigraphy, and ambulatory PSG data were obtained over a single night to obtain measures of SOL, NWAK, WASO, time spent in bed after final awakening in the morning (TWAK), TST, and SE.Results: Actigraphy was a valid estimate of SOL, WASO, TST, and SE, based on significant correlations (r = 0.45 to 0.87), nonsignificant mean differences between actigraphy and PSG, and inspection of actigraphy bias from Bland Altman plots (SOL α = 1.52, WASO α = 7.95, TST α = -8.60, SE α = -1.38).Conclusions: Actigraphy was a valid objective measure of SOL, WASO, TST, and SE in a young adult insomnia sample, as compared to ambulatory PSG. Actigraphy may be a valid alternative for assessing sleep in young adults with insomnia when more costly PSG measures are not feasible.