The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement.

OBJECTIVE: To achieve consensus on whether screen-based digital media (1) in general, (2) via prebedtime content, and (3) via prebedtime light impairs sleep health in (a) childhood, (b) adolescence, and (c) adulthood. Furthermore, to address whether employing behavioral strategies and interventions may reduce the potential negative effects of screens on sleep health. METHODS: The National Sleep Foundation convened a 16-person multidisciplinary expert panel ("Panel"). Panelists met virtually 5 times throughout 2023, during which they followed a modified Delphi RAND/UCLA Appropriateness Method to reach consensus. RESULTS: The Panel conducted a literature review starting with 2209 articles, narrowed down to 522 relevant empirical articles and 52 relevant review articles. The search was refined to include 35 experimental/intervention studies that examined whether there was a causal link between screen-based digital media and sleep. In addition, panelists reviewed 5 recent relevant systematic review articles. After reviewing the summarized current literature, panelists voted on 10 candidate statements about whether screen use impairs sleep health. The Panel met virtually to discuss the results of the first round of votes, which was then followed by a second round of voting, ultimately achieving consensus on 5 out of the 10 statements. CONCLUSIONS: The Panel achieved consensus that (1) in general, screen use impairs sleep health among children and adolescents, (2) the content of screen use before sleep impairs sleep health of children and adolescents, and (3) behavioral strategies and interventions may attenuate the negative effects of screen use on sleep health.

Design and methods of the mobile assessment of cognition, environment, and sleep (MACES) feasibility study in newly diagnosed breast cancer patients.

Endocrine therapy (ET) for breast cancer treatment is associated with cognitive complaints, but their etiology is poorly understood. To address this, we developed and implemented an ambulatory assessment protocol consisting of wearable activity monitors, brief surveys of affect, context, and perceived impairments, and ultra-brief performance-based measures of cognition. Newly diagnosed, ER/PR+, stage 0-III, female breast cancer patients, were recruited. Ambulatory assessments were conducted on smart phones and wearable activity monitors were used to monitor sleep and physical activity. Participants were asked to complete five 7-day measurement bursts (one before starting ET and one each month for 4 consecutive months while on ET). We observed a consent rate of 36%, 27 women completed the study. Of the women that withdrew, 91% dropped prior to the midpoint of follow up. There were no significant differences in demographics, clinical breast cancer characteristics, sleep or physical activity patterns, or measures of cognition between women who completed versus withdrew. Women who did not complete the study provided fewer valid days of baseline data. In conclusion, while some women may be overwhelmed with their cancer diagnosis, we did not identify any predictive characteristics of women whom did not complete the study. This novel method enables the prospective study of psychological changes associated with cancer treatment, capturing a wide array of information about behavior, experience, and cognition, thus providing a picture of the lived experiences of cancer patients before and during exposure to ET.

Actigraphic sleep dimensions and associations with academic functioning among adolescents.

STUDY OBJECTIVES: There is mixed evidence regarding associations of sleep duration with academic functioning in adolescents and a lack of research on other sleep dimensions, particularly using objective sleep measures. We examined associations of multiple actigraphic sleep dimensions with academic functioning among adolescents. METHODS: Data were from the sleep sub-study of the age 15 wave of the Future of Families and Child Wellbeing Study (n = 774-782; 52% female), a national, diverse sample of teens. Adolescents wore wrist-actigraphs for ~1 week and completed a survey reporting academic performance and school-related behavioral problems. Regression models assessed whether average sleep duration, timing, maintenance efficiency, and SD-variability were associated with self-reported academic functioning in cross-sectional analyses adjusted for demographic characteristics, depressive symptoms, and anxious symptoms. RESULTS: Later sleep timing (hours) and greater sleep variability (SD-hours) were associated with poorer academic outcomes, including sleep onset variability with higher odds of receiving a D or lower (OR = 1.29), sleep onset (ß = -.07), sleep offset (ß = -.08), and sleep duration variability (ß = -.08) with fewer A grades, sleep offset with lower GPA (ß = -.07), sleep offset (OR = 1.11), sleep duration variability (OR = 1.31), and sleep onset variability (OR = 1.42) with higher odds of being suspended or expelled in the past 2 years, and sleep duration variability with greater trouble at school (ß = .13). Sleep duration, sleep maintenance efficiency, and sleep regularity index were not associated with academic functioning. CONCLUSIONS: Later sleep timing and greater sleep variability are risk factors for certain academic problems among adolescents. Promoting sufficient, regular sleep timing across the week may improve adolescent academic functioning.

Sleep-independent circadian rhythm of aldosterone secretion in healthy young adults.

OBJECTIVE: A diurnal variation in urine output has been described in humans, whereby it is lowest at night. Fluid balance hormones such as vasopressin and aldosterone as well as urine output have a diurnal variation. Although the diurnal variation of vasopressin results in part from a circadian rhythm, the variation in aldosterone has until recently been reported to be due to the sleep/wake cycle. The present study used a specialized protocol to explore whether aldosterone has an underlying circadian rhythm. METHODS: Ten healthy participants (average age 23.1) were enrolled in the 57.3-hour protocol that included an 8-hour baseline sleep episode, 40 hours in constant routine conditions (wakefulness, food and fluid intake, posture, and dim light), and a 9.3-hour recovery sleep. Blood samples for aldosterone were taken every 4 hours. Cosinor analysis was performed on the constant routine data to test the effect of the sleep/wake cycle on overall aldosterone secretion. RESULTS: There was a significant circadian rhythm during the 40-hour constant routine, independent of sleep, with aldosterone higher at the end of the biological night and lower at the end of the biological day. When analyzing data from the entire 57.3-hour protocol and controlling for this circadian rhythm, aldosterone concentration was significantly higher during the recovery night following the 40-hour sleep deprivation compared to the night spent awake. CONCLUSION: We found a significant endogenous circadian rhythm in the secretion of aldosterone, independent of sleep. In addition, as shown previously, there was a significant effect of the sleep/wake cycle on aldosterone secretion.

Effects of a 1-hour per night week-long sleep extension in college students on cardiometabolic parameters, hydration status, and physical activity: A pilot study.

OBJECTIVES: Short sleep duration is associated with poor physical health in college students. Few studies examine the effects of sleep extension on physical health in this population, who are susceptible to sleep loss. We examined health effects of a 1-week, 1-hour nightly sleep extension in college students. METHODS: Twelve healthy undergraduate college students (83% female; age 20.2 ± 1.5years) completed a study consisting of sleeping typically for 1week ("Habitual"), then extending sleep by ≥1 hour/night during the second week ("Extension"). Sleep and physical activity actigraphy were collected throughout. Following each week, participants completed cardiometabolic assessments including a meal response and provided a urine sample for markers of hydration. RESULTS: In Extension compared to Habitual, average sleep duration increased (mean change±SEM, +42.6 ± 15.1 minutes; p = .005), while subjective sleepiness (-1.8 ± 0.8 units; p = .040), systolic blood pressure (-6.6 ± 2.8 mmHg; p = .037), postprandial glucose area under the curve (-26.5 ± 10.2 mg/dL × h; p = .025) and time to baseline (-83.0 ± 46.4 minutes; p = .031) after the meal response, sedentary time (-44.3 ± 15.7 minutes; p = .018), and percentage of wake in moderate-to-vigorous activity (-0.89% ± 0.35%; p = .030) decreased. Participants who increased average sleep duration by ≥20 minutes (n = 9) were better hydrated according to urine osmolality (-187.0 ± 68.4 mOsm/kg; p = .026) and specific gravity (-0.01 ± 0.002 g/mL; p = .012) and had reduced odds of dehydration according to urine osmolality (≥800 mOsm/kg; -67%; OR=0.03; p = .035). CONCLUSIONS: This pilot study's findings suggest that sleep extension may improve cardiometabolic functioning and hydration, and alter sedentary behavior and physical activity, in college students. Sleep extension may be employed to improve multiple aspects of health in this sleep-deprived population.

Entrainment to gradual vs. immediate 8-hour phase advance shifts with and without short-wavelength enriched polychromatic green light.

OBJECTIVES: For optimal health and well-being the sleep episode and the circadian timing system should be properly aligned. We evaluated the effectiveness of different dynamic light and sleep/wake shift schedules for rapid circadian entrainment following an 8-hour advance of sleep. METHODS: Forty-three healthy participants completed an 8-day inpatient protocol in which the 8-hour sleep episode was advanced by 8 hours. Participants were assigned to one of five conditions: (1) dim ambient WHITE light and GRADUAL shift in which the sleep episode was incrementally advanced over 5days; (2) dim GREEN, short-wavelength (∼504 nm) polychromatic light and GRADUAL shift; (3) dim WHITE light and SLAM shift, including an abrupt 8-hour advance on day 3 following an extended 32-hour wake episode; (4) GREEN light and SLAM shift; or (5) COMBINED (higher illuminance WHITE plus GREEN) light and modified SLAM shift with 2 short naps scheduled on the day prior to the abrupt advance. Phase shifts of the plasma dim light melatonin onset and sleep measures were compared to examine effects of protocol condition. RESULTS: After 5days, the COMBINED light/modified SLAM shift condition showed larger phase advances of dim light melatonin onset (4.02 ± 1.13 hours) compared to the other 4 conditions (range 1.50 ± 0.96-2.83 ± 2.23 hours; p < .05) and resulted in increased REM sleep duration and fewer sleep disruptions. CONCLUSIONS: Consideration of the type of shift and the illuminance and wavelength of light may assist in designing lighting countermeasures to sleep and circadian disruption, which has implications for jetlag, shiftwork, and circadian rhythm sleep disorders.

Interactive Screen-Based Activities Predict Worse Actigraphic Sleep Health That Night Among Adolescents.

PURPOSE: To determine the micro-longitudinal effects of duration and timing of screen-based activities on sleep within and between adolescents. METHODS: Daily survey and actigraphy data from the age 15 wave of the Future of Families and Child Wellbeing Study were analyzed using multilevel modeling. Four hundred seventy five adolescents provided three or more days of valid daily survey and nighttime sleep data. RESULTS: Within-person results showed that on days when adolescents played video games more than their daytime average ± SE (1.3 ± 1.2 hours), sleep onset (6 ± 2 minutes, p < .01) and midpoint (4 ± 2 minutes, p < .02) were delayed for each additional hour of gaming. Between-person results showed that for each hour adolescents used screens to communicate with friends across the day, sleep onset was later (11 ± 3 minutes, p < .01), sleep midpoint was later (8 ± 3 minutes, p < .01), and sleep duration was shorter (-5 ± 2 minutes, p < .03). Adolescents who used screens to communicate with friends or play video games in the hour before bed had later sleep onset (30 ± 14 minutes, p < .03) and midpoint (25 ± 13 minutes, p < .05). DISCUSSION: Among adolescents, passive screen usage such as browsing the Internet or watching videos may not affect sleep timing or duration, but limiting interactive screen-based activities could protect adolescent sleep health and well-being.

Longitudinal relations of sleep quality with depressive symptoms, diabetes distress and self-efficacy in young people with type 1 diabetes.

PURPOSE: To examine the longitudinal, bidirectional associations of sleep quality with depressive symptoms, diabetes-specific distress and diabetes management self-efficacy among adolescents and young adults with type 1 diabetes. METHODS: Cross-lagged analyses used baseline, three-, six- and nine-month data from a randomized trial among 60 young people. Self-report measures included the Pittsburgh Sleep Quality Index, Center for Epidemiological Studies - Depressed Mood scale, Problem Areas in Diabetes Teen version, and Diabetes Management Self-efficacy Scale. RESULTS: Lower sleep quality at baseline was associated with higher three-month depressive symptoms (b = 0.21, p = 0.005) and lower diabetes self-efficacy (b = -0.18, p = 0.014), but not diabetes distress (b = 0.06, p = 0.403). Similar patterns were found at six and nine months. Three-month psychological functioning was not associated with six-month sleep quality. CONCLUSIONS: Among adolescents and young adults with type 1 diabetes, lower sleep quality predicted subsequent depressive symptoms and lower diabetes self-efficacy rather than vice versa. Sleep deserves a central place in diabetes care.

Performance of an open machine learning model to classify sleep/wake from actigraphy across ∼24-hour intervals without knowledge of rest timing.

GOAL AND AIMS: Commonly used actigraphy algorithms are designed to operate within a known in-bed interval. However, in free-living scenarios this interval is often unknown. We trained and evaluated a sleep/wake classifier that operates on actigraphy over ∼24-hour intervals, without knowledge of in-bed timing. FOCUS TECHNOLOGY: Actigraphy counts from ActiWatch Spectrum devices. REFERENCE TECHNOLOGY: Sleep staging derived from polysomnography, supplemented by observation of wakefulness outside of the staged interval. Classifications from the Oakley actigraphy algorithm were additionally used as performance reference. SAMPLE: Adults, sleeping in either a home or laboratory environment. DESIGN: Machine learning was used to train and evaluate a sleep/wake classifier in a supervised learning paradigm. The classifier is a temporal convolutional network, a form of deep neural network. CORE ANALYTICS: Performance was evaluated across ∼24 hours, and additionally restricted to only in-bed intervals, both in terms of epoch-by-epoch performance, and the discrepancy of summary statistics within the intervals. ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES: Performance of the trained model applied to the Multi-Ethnic Study of Atherosclerosis dataset. CORE OUTCOMES: Over ∼24 hours, the temporal convolutional network classifier produced the same or better performance as the Oakley classifier on all measures tested. When restricting analysis to the in-bed interval, the temporal convolutional network remained favorable on several metrics. IMPORTANT SUPPLEMENTAL OUTCOMES: Performance decreased on the Multi-Ethnic Study of Atherosclerosis dataset, especially when restricting analysis to the in-bed interval. CORE CONCLUSION: A classifier using data labeled over ∼24-hour intervals allows for the continuous classification of sleep/wake without knowledge of in-bed intervals. Further development should focus on improving generalization performance.

Actigraphic Sleep Variability is Associated With Lower Positive Mood in Adolescents.

PURPOSE: Poor sleep health is associated with lower positive mood in adolescents, and more variable sleep is associated with more negative mood. There is a lack of research on the associations between sleep variability and positive mood in adolescents. We investigated whether several types of sleep variability, measured with actigraphy, were associated with positive mood reported on a daily diary in adolescents. METHODS: Data were collected from a substudy of the Year 15 wave of the Future of Families and Child Wellbeing Study (n = 580; 53% female, mean age ± standard deviation [SD] = 15.4 ± 0.5 years, range 14.7-17.7). Adolescents wore an actigraphy device (M ± SD = 5.6 ± 1.4 nights per adolescent, range: 3-10) and completed daily diaries (M ± SD = 5.5 ± 1.4 days per adolescent, range: 3-9) for ∼1 week, where they rated their levels of happiness and excitement during that day from 0 (not at all) to 4 (extremely). Happiness and excitement were averaged into "positive mood." Separate linear regression models assessed whether actigraphy-measured variability of sleep duration, onset, and offset (residual individual standard deviation, riSD), sleep regularity index, social jetlag, and free night catch-up sleep were associated with average positive mood per person. Analyses adjusted for age, birth sex, race/ethnicity, household income, and the primary caregiver's education level. RESULTS: Greater variability in sleep duration (p = .011, ß = -0.11) and lower sleep regularity index (p = .034, ß = 0.09) were associated with lower ratings of positive mood. There were no other significant associations (p ≥ .10). DISCUSSION: Variable and irregular sleep are associated with lower levels of positive mood in adolescence, which may increase the risk of poor emotional health in adulthood.

Recovery Sleep After Sleep Restriction Is Insufficient to Return Elevated Daytime Heart Rate and Systolic Blood Pressure to Baseline Levels.

OBJECTIVE: Sleep restriction alters daytime cardiac activity, including elevating heart rate (HR) and blood pressure (BP). There is minimal research on the cumulative effects of sleep loss and the response after subsequent recovery sleep on HR and BP. This study examined patterns of HR and BP across baseline, sleep restriction, and recovery conditions using multiple daytime cardiac measurements. METHODS: Participants (15 healthy men, mean [standard deviation] = 22.3 [2.8] years) completed an 11-day inpatient protocol with three nights of 10 hours/night baseline sleep opportunity, five sleep restriction nights (5-hour/night sleep opportunity), and two recovery nights (10-hour/night sleep opportunity). Resting HR and BP were measured every 2 hours during wake. Multilevel models with random effects for individuals examined daytime HR and BP across study conditions and days into the study. RESULTS: Mean daytime HR was 1.2 (0.5) beats/min lower during sleep restriction compared with baseline ( p < .001). During recovery, HR was 5.5 (1.0) beats/min higher ( p < .001), and systolic BP (SBP) was 2.9 (1.1) mm Hg higher ( p = .009). When accounting for days into the study (irrespective of condition) and measurement timing across the day, HR increased by 7.6 beats/min and SBP increased by 3.4 mm Hg across the study period ( p < .001). CONCLUSIONS: Our findings suggest that daytime HR and SBP increase after successive nights of sleep restriction, even after accounting for measurement time of day. HR and SBP did not recover to baseline levels after two recovery nights of sleep, suggesting that longer recovery sleep may be necessary to recover from multiple, consecutive nights of moderate sleep restriction.

Why so slangry (sleepy and angry)? Shorter sleep duration and lower sleep efficiency predict worse next-day mood in adolescents.

PURPOSE: The goal of this study was to evaluate the relationships of actigraphic nighttime sleep duration and quality with next-day mood among urban adolescents using a micro-longitudinal design. METHODS: A subsample (N = 525) of participants from the Fragile Families & Child Wellbeing Study (mean age: 15.4 years; 53% female; 42% Black non-Hispanic, 24% Hispanic/Latino, 19% White non-Hispanic) in the United States between 2014 and 2016 concurrently wore a wrist actigraphic sleep monitor and rated their daily mood in electronic diaries for about 1 week. Multilevel models tested the within-person temporal associations of nightly sleep duration and sleep maintenance efficiency with next-day reports of happiness, anger, and loneliness. The models also tested the between-person associations of sleep variables and mood. Models adjusted for sociodemographic and household characteristics, weekend, and school year. RESULTS: After nights when adolescents obtained longer sleep duration than their usual, they reported lower ratings of anger (B = -.03, p < .01) the next day. After nights when adolescents had higher sleep maintenance efficiency than their usual, they reported higher ratings of happiness (B = .02, p < .01) the next day. Adolescents who had longer average sleep duration reported lower ratings of anger (B = -.08, p < .01) and loneliness (B = -.08, p < .01) compared to others. There was no within-person association of sleep duration or efficiency with loneliness. Sleep duration was not associated with happiness between adolescents, and sleep maintenance efficiency was not associated with any mood measure between adolescents. CONCLUSIONS: Improvements to nightly sleep may help increase happiness and decrease anger the following day in adolescents. Promoting sleep health is recommended to improve mood.

Sleep restriction impairs visually and memory-guided force control.

Sleep loss is a common phenomenon with consequences to physical and mental health. While the effects of sleep restriction on working memory are well documented, it is unknown how sleep restriction affects continuous force control. The purpose of this study was to determine the effects of sleep restriction on visually and memory-guided force production magnitude and variability. We hypothesized that both visually and memory-guided force production would be impaired after sleep restriction. Fourteen men participated in an eleven-day inpatient sleep study and completed a grip force task after two nights of ten hours' time in bed (baseline); four nights of five hours' time in bed (sleep restriction); and one night of ten hours' time in bed (recovery). The force task entailed four 20-second trials of isometric force production with the thumb and index finger targeting 25% of the participant's maximum voluntary contraction. During visually guided trials, participants had continuous visual feedback of their force production. During memory-guided trials, visual feedback was removed for the last 12 seconds of each trial. During both conditions, participants were told to maintain the target force production. After sleep restriction, participants decreased the magnitude of visually guided, but not memory-guided, force production, suggesting that visual attention tasks are more affected by sleep loss than memory-guided tasks. Participants who reported feeling more alert after sleep restriction and recovery sleep produced higher force during memory-guided, but not visually guided, force production, suggesting that the perception of decreased alertness may lead to more attention to the task during memory-guided visual tasks.

Worse sleep health predicts less frequent breakfast consumption among adolescents in a micro-longitudinal analysis.

BACKGROUND: Poor self-reported sleep health has been linked to not consuming breakfast in adolescents, but it is unknown whether poor sleep measured objectively predicts next-day breakfast consumption within adolescents. We investigated within- and between-person associations of objectively measured sleep dimensions and subjective sleep quality with adolescent breakfast consumption. METHODS: Data were collected from a micro-longitudinal substudy of the Year 15 wave of the Fragile Families and Child Wellbeing Study (n = 590). Adolescents wore an actigraphy device and completed daily diaries for ~ 1 week (M ± SD = 5.6 ± 1.4 nights per adolescent, range: 3-9), where they rated their sleep quality and reported whether they had eaten breakfast that day, with no specific definition of breakfast provided (M ± SD = 5.5 ± 1.4 days per adolescent, range: 3-9). Separate mixed models assessed whether actigraphy-measured sleep duration (linear and quadratic, sleep duration x sleep duration), timing, maintenance efficiency, and subjective quality predicted odds of breakfast consumption both within and between adolescents. Variability of sleep duration and timing (standard deviation per person), sleep regularity index (SRI), and social jetlag were tested as additional between-person predictors. Analyses with predictors other than sleep duration were adjusted for sleep duration. RESULTS: Following nights when adolescents had shorter or longer sleep duration (p = .005; curvilinear association), later sleep onset, or later sleep midpoint (both p = .025) than their own usual, they had lower odds of consuming breakfast the next day (within-person associations). Adolescents who on average had later sleep onset (p = .013) or midpoint (p = .013) or who reported lower sleep quality (p = .011) had lower average odds of consuming breakfast (between-person associations). Adolescents with greater variability of sleep duration (p = .005), midpoint (p = .004), or offset (p < .001) had lower average odds of consuming breakfast (between-person associations). Sleep maintenance efficiency (within or between adolescents), SRI, and social jetlag were not associated with breakfast consumption (all p > .10). CONCLUSIONS: Multiple dimensions of sleep health are associated with breakfast consumption, both within and between adolescents. Poor sleep and dietary behaviors in adolescence may negatively impact future metabolic health.

Interindividual differences in attentional vulnerability moderate cognitive performance during sleep restriction and subsequent recovery in healthy young men.

We investigated whether interindividual attentional vulnerability moderates performance on domain-specific cognitive tasks during sleep restriction (SR) and subsequent recovery sleep. Fifteen healthy men (M ± SD, 22.3 ± 2.8 years) were exposed to three nights of baseline, five nights of 5-h time in bed SR, and two nights of recovery sleep. Participants completed tasks assessing working memory, visuospatial processing, and processing speed approximately every two hours during wake. Analyses examined performance across SR and recovery (linear predictor day or quadratic predictor day2) moderated by attentional vulnerability per participant (difference between mean psychomotor vigilance task lapses after the fifth SR night versus the last baseline night). For significant interactions between day/day2 and vulnerability, we investigated the effect of day/day2 at 1 SD below (less vulnerable level) and above (more vulnerable level) the mean of attentional vulnerability (N = 15 in all analyses). Working memory accuracy and speed on the Fractal 2-Back and visuospatial processing speed and efficiency on the Line Orientation Task improved across the entire study at the less vulnerable level (mean - 1SD) but not the more vulnerable level (mean + 1SD). Therefore, vulnerability to attentional lapses after SR is a marker of susceptibility to working memory and visuospatial processing impairment during SR and subsequent recovery.

Changes in Subjective Motivation and Effort During Sleep Restriction Moderate Interindividual Differences in Attentional Performance in Healthy Young Men.

PURPOSE: The effects of sleep restriction on subjective alertness, motivation, and effort vary among individuals and may explain interindividual differences in attention during sleep restriction. We investigated whether individuals with a greater decrease in subjective alertness or motivation, or a greater increase in subjective effort (versus other participants), demonstrated poorer attention when sleep restricted. PARTICIPANTS AND METHODS: Fifteen healthy men (M±SD, 22.3±2.8 years) completed a study with three nights of 10-hour time in bed (baseline), five nights of 5-hour time in bed (sleep restriction), and two nights of 10-hour time in bed (recovery). Participants completed a 10-minute psychomotor vigilance task (PVT) of sustained attention and rated alertness, motivation, and effort every two hours during wake (range: 3-9 administrations on a given day). Analyses examined performance across the study (first two days excluded) moderated by per-participant change in subjective alertness, motivation, or effort from baseline to sleep restriction. For significant interactions, we investigated the effect of study day2 (day*day) on the outcome at low (mean-1 SD) and high (mean+1 SD) levels of the moderator (N = 15, all analyses). RESULTS: False starts increased across sleep restriction in participants who reported lower (mean-1 SD) but not preserved (mean+1 SD) motivation during sleep restriction. Lapses increased across sleep restriction regardless of change in subjective motivation, with a more pronounced increase in participants who reported lower versus preserved motivation. Lapses increased across sleep restriction in participants who reported higher (mean+1 SD) but not preserved (mean-1 SD) effort during sleep restriction. Change in subjective alertness did not moderate the effects of sleep restriction on attention. CONCLUSION: Vigilance declines during sleep restriction regardless of change in subjective alertness or motivation, but individuals with reduced motivation exhibit poorer inhibition. Individuals with preserved subjective alertness still perform poorly during sleep restriction, while those reporting additional effort demonstrate impaired vigilance.

Secondhand smoke exposure is longitudinally associated with shorter parent-reported sleep duration during childhood.

BACKGROUND: Secondhand smoke exposure has been cross-sectionally associated with worse sleep health outcomes in children and shorter sleep duration in adolescents. OBJECTIVES: We assessed longitudinal and cross-sectional associations between secondhand smoke (SHS) exposure and shorter sleep duration in children from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort. We additionally examined whether associations would persist after controlling for potential confounders. PARTICIPANTS: Mothers (n = 4898) were recruited using a stratified random sample of large United States cities and oversampling for nonmarital births. MEASUREMENTS: Mothers were asked about whether they smoked during pregnancy, whether their child spent time with someone who is smoking, and their child's weekday sleep duration. Sociodemographic factors, asthma diagnosis, and bedtime routines were assessed as potential confounders. Data collected at ages 3, 5, and 9 years were analyzed using multivariable regression models (N = 1912; 51.6% boys). RESULTS: SHS exposure at age 3 predicted 15.0 fewer minutes at age 5 (P = .001) and 12.3 fewer minutes at age 9 (P = .003). SHS exposure at age 9 was cross-sectionally associated with 14.4 fewer minutes of sleep duration at age 9 (P = .002). Findings persisted after controlling for potential confounders. CONCLUSION: These results provide associational support for the hypothesis that SHS exposure may have long-term consequences for childhood sleep duration. Future studies should investigate the relationship between SHS exposure and shorter sleep duration using objective measurements of serum cotinine and sleep actigraphy and by exploring potential mechanisms.

Strategies adopted to manage physical and psychosocial challenges after returning home among people with stroke: A qualitative study.

ABSTRACT: Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors' performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one's own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors' recovery outcomes.