Increased Risk for Clinically Significant Sleep Disturbances in Mild Traumatic Brain Injury: An Approach to Leveraging the Federal Interagency Traumatic Brain Injury Research Database.

STUDY OBJECTIVES: The Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System contains individual-patient-level traumatic brain injury (TBI) data, which when combined, allows for the examination of rates and outcomes for key subpopulations at risk for developing sleep disturbance. METHODS: This proof-of-concept study creates a model system for harmonizing data (i.e., combining and standardizing data) across FITBIR studies for participants with and without a history of TBI to estimate rates of sleep disturbance and identify risk factors. RESULTS: Three studies were eligible for harmonization (N = 1753). Sleep disturbance was common among those with a history of mild TBI (63%). Individuals with mild TBI were two to four times more likely to have sleep disturbance compared to those with no history of TBI. CONCLUSIONS: This study established methods, harmonization code, and meta-databases that are publicly available on the FITBIR website. We demonstrated how the harmonization of FITBIR studies can answer TBI research questions, showing that associations between TBI and sleep disturbance may be influenced by demographic factors.

Integrative Treatment Approaches with Mind-Body Therapies in the Management of Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathophysiology characterized by intense pruritus, often associated with psychological stress and atopic and non-atopic comorbidities that significantly reduce quality of life. The psychological aspects of AD and the interaction between the mind and body via the skin-brain axis have led to an interest in mind-body therapies (MBT). The aim of this article is, therefore, to reinforce the importance of psychodermatological care in AD. We performed a focused literature review on holistic practices or integrative MBT in AD, including education, cognitive behavioral therapy, habit reversal, meditation, mindfulness, hypnotherapy, eye movement desensitization and reprocessing, biofeedback, progressive muscle relaxation, autonomous sensory meridian response, music therapy, massage, and touch therapy. A multidisciplinary holistic approach with MBT, in addition to conventional pharmacologic antipruritic therapies, to break the itch-scratch cycle may improve AD outcomes and psychological well-being. Although there is a paucity of rigorously designed trials, evidence shows the potential benefits of an integrative approach on pruritus, pain, psychological stress, anxiety, depressive symptoms, and sleep quality. Relaxation and various behavioral interventions, such as habit reversal therapy for replacing harmful scratching with massaging with emollient 'plus', may reduce the urge to scratch, while education may improve adherence to conventional therapies.

Workplace Violence and Burnout among Health Workers Two Years after the COVID-19 Outbreak in Wuhan, China: The Chain Mediation Effect of Sleep Disturbance and Work Ability.

BACKGROUND: Health workers (HWs) faced considerable psychosocial hazards during the COVID-19 pandemic, which profoundly affected their occupational health and job performance. The potential indirect relationship between workplace violence (WPV) and burnout among HWs needs to be further explored. The purpose of this study is to examine the chain mediating effects of sleep disturbance and work ability in the relationship between WPV and burnout among HWs. METHODS: A cross-sectional study was conducted in a secondary hospital two years after the COVID-19 outbreak in Wuhan, China. A sample of 571 HWs was recruited using a cluster sampling method, achieving a response rate of 80.06%. Participants completed self-report questionnaires that included demographic information and measures of WPV, burnout, sleep disturbance, and work ability. RESULTS: The prevalence rates of burnout and WPV among HWs two years after the COVID-19 outbreak were 37.30% and 31.52%, respectively. WPV was significantly associated with burnout (ß = 0.446, p < 0.001). Sleep disturbance was identified as a mediator in the relationship between WPV and burnout (ß = 0.063, 95% CI: 0.027-0.105), accounting for 14.13% of the total effect. Similarly, work ability also played a mediating role in this relationship (ß = 0.142, 95% CI: 0.065-0.225), accounting for 31.84%. Additionally, both sleep disturbance and work ability exhibited a chain mediation effect on the association between WPV and burnout (ß = 0.020, 95% CI: 0.008-0.036), and the total indirect effect accounted for 50.67%. CONCLUSIONS: Among Chinese HWs, WPV exerts significant direct and indirect effects on burnout symptoms, mediated by sleep disturbance and work ability. This finding provides valuable empirical insights for designing interventions to mitigate the adverse effects of psychosocial factors such as WPV and burnout among HWs. After exposure to WPV, measures focused on reducing sleep disturbance and enhancing work ability may prove effective in alleviating burnout in subsequent interventions.

Hair cortisol and psychiatric symptomatology in children; outcomes of group CBT.

The associations between hair cortisol concentration (HCC), a biomarker of chronic stress, and behavior and sleep disturbance symptoms have not been studied in children with psychiatric disorders. While cognitive behavioral therapy (CBT) has proven effective in treating psychiatric symptoms in children, its potential biological implications as determined by HCC have not been investigated. We explored associations between HCC, behavior and sleep disturbance symptoms, and different diagnostic groupings (depression/anxiety, ADHD, or other types of psychiatric disorders) in clinician-diagnosed 6-12-year-old children (n = 100) with mixed psychiatric disorders and comorbidities. In addition, we examined whether group CBT led to changes in HCC, behavior symptoms, and sleep disturbance symptoms and whether any fluctuations in HCC levels were associated with potential symptom change. We collected data on HCC, internalizing and externalizing symptoms (The Spence Children's Anxiety Self-Report, Child Behavior Checklist, and Teacher Report Form), and sleep disturbance symptoms (The Sleep Disturbance Scale for Children) at three time points (baseline, post-treatment, and seven-month follow-up). Baseline HCC was not associated with behavior or sleep disturbance symptoms, whereas behavior and sleep disturbance symptoms were mutually correlated. No changes in HCC levels were observed with group CBT. Moreover, potential variations in HCC levels over the course of the study did not appear to be associated with behavior symptom relief after group CBT. Our findings suggest that HCC may not be a methodologically relevant biomarker of behavior or sleep disturbance symptoms in children with diverse psychiatric disorders.

Sleep disturbance and other co-occurring conditions in autistic children: A network approach to understanding their inter-relationships.

Autistic children frequently have one or more co-occurring psychological, behavioral, or medical conditions. We examined relationships between child behaviors, sleep, adaptive behavior, autistic traits, mental health conditions, and health in autistic children using network analysis. Network analysis is hypothesis generating and can inform our understanding of relationships between multiple conditions and behaviors, directing the development of transdiagnostic treatments for co-occurring conditions. Participants were two child cohorts from the Autism Treatment Network registry: ages 2-5 years (n = 2372) and 6-17 years (n = 1553). Least absolute-shrinkage and selection operator (LASSO) regularized partial correlation network analysis was performed in the 2-5 years cohort (35 items) and the 6-17 years cohort (36 items). The Spinglass algorithm determined communities within each network. Two-step expected influence (EI2) determined the importance of network variables. The most influential network items were sleep difficulties (2 items) and aggressive behaviors for young children and aggressive behaviors, social problems, and anxious/depressed behavior for older children. Five communities were found for younger children and seven for older children. Of the top three most important bridge variables, night-waking/parasomnias and anxious/depressed behavior were in both age-groups, and somatic complaints and sleep initiation/duration were in younger and older cohorts respectively. Despite cohort differences, sleep disturbances were prominent in all networks, indicating they are a transdiagnostic feature across many clinical conditions, and thus a target for intervention and monitoring. Aggressive behavior was influential in the partial correlation networks, indicating a potential red flag for clinical monitoring. Other items of strong network importance may also be intervention targets or screening flags.

Impact of sleep disturbance on longitudinal cognitive performance in patients with transient ischemic attack or mild stroke.

INTRODUCTION: Sleep disturbances including obstructive sleep apnea (OSA) and poor sleep quality are common after stroke, while its association with cognitive changes following transient ischemic attack (TIA) or mild stroke remains unclear. We aim to determine whether sleep duration, OSA parameters, or nocturnal hypoxemia is associated with a greater cognitive decline after stroke. METHODS: We prospectively followed-up patients with acute TIA/mild stroke [National Institute Health Stroke Scale (NIHSS) < 7] who underwent baseline sleep questionnaire [Pittsburgh Sleep Quality Index (PSQI)], and serial cognitive assessments [Montreal Cognitive Assessment (MoCA) 5-min, Stroop Test] at baseline and one-year. We also evaluated apnea-hypopnea index (AHI) and nocturnal hypoxemia by Home Sleep Apnea Test (HSAT) at one-year. Primary outcome was one-year change in MoCA 5-min score. RESULTS: One hundred and five patients with TIA/mild stroke (mean age 63 years, 65 % male) were included. Baseline short sleep (< 6 hour/night) and AHI ≥ 20/hour at one-year were independently associated with a decline in the MoCA 5-min total score after covariates adjustment [short sleep: ß = -2.36 95 % confidence interval (CI) (-4.13, -0.59), p = 0.009; AHI ≥ 20/hour: ß = -1.79 (-3.26, -0.32), p = 0.017; remained significant after multiple comparisons correction]. A lower mean MinSpO2 was associated with a decline in executive function [Stroop interference index: ß = 0.29 (0.04, 0.53), p = 0.021], but not with MoCA 5-min score at one-year. Moderation analysis indicated AHI ≥ 20/hour was associated with a pronounced decline in executive function only in men. CONCLUSIONS: Short sleep after stroke onset, AHI ≥ 20/hour and nocturnal hypoxemia at one-year contributed to an impaired cognitive trajectory at one-year following stroke in patients with TIA/mild stroke.

Integrating lived experience to develop a tailored sleep intervention for people living with dementia and carepartners.

OBJECTIVES: Sleep disturbances are highly prevalent and have adverse health consequences for both people living with dementia and their carepartners. Despite this, they are under-addressed caregiving settings. This study aimed to explore these sleep disturbances and co-design a multimodal sleep intervention for people living with dementia and their carepartners. METHODS: We conducted two focus groups and five semi-structured interviews (n = 4 people living with dementia, n = 6 carepartners). Active involvement of community advisors was sought throughout the design, development, and facilitation phases. Reflexive thematic analysis was used to explore sleep-related experiences and receive feedback to shape intervention development. FINDINGS: People living with dementia reported disruptions to sleep and circadian rhythms, including sleep disturbances and confusion between day and night. Multiple sleep challenges were encountered by carepartners including insomnia, hypervigilance, and daytime impairment. The proposed sleep intervention was received positively, with significant insights emphasising the need for a multimodal toolkit approach, adaptation of the intervention across different dementia stages, and a focus on tailoring the program to carepartners. CONCLUSION: Sleep interventions for caregivers and care-recipients should target both sleep and daytime functioning to ensure holistic support. Participants were receptive towards time-friendly, online, multimodal sleep interventions that combine cognitive behaviour therapies, light therapy, mindfulness, and exercise elements.

The association between epilepsy and sleep disturbance in US adults: the mediating effect of depression.

BACKGROUND: People with epilepsy (PWE) frequently experience sleep disturbances that can severely affect their quality of life. Depression is also a common symptom in the PWE population and can aggravate sleep problems. However, the interplay between epilepsy, depression, and sleep disturbances is not yet fully understood. Our study was designed to investigate the association between epilepsy and sleep disturbances in US adults and to determine whether depressive symptoms play a mediating role in this relationship. METHODS: We examined data from the National Health and Nutrition Examination Survey (NHANES) spanning January 1, 2015, to March 2020, before the pandemic.A total of 10,093 participants aged ≥ 20 years with complete data on epilepsy and sleep disturbance were included. Weighted multiple logistic regression and mediation analysis were used to explore the associations among depression, epilepsy, and sleep disturbance. Interaction effects of epilepsy with various covariates were also investigated. RESULTS: Epilepsy was associated with depression and sleep disturbances. Weighted logistic regression analysis revealed a significant association between epilepsy and sleep disturbances (OR = 3.67, 95% CI = 1.68-8.04). Depression partially mediated this relationship, demonstrating a mediation effect of 23.0% (indirect effect = 0.037, P < 0.001). Subgroup analyses revealed variations in the relationship between epilepsy and sleep disturbances among different groups. Furthermore, interaction analyses revealed significant interactions between epilepsy and age (P = 0.049) and hypertension (P = 0.045). CONCLUSIONS: Our study utilizing NHANES data confirmed that depression partially mediated the association between epilepsy and sleep disturbance. Additionally, we observed differences in this association across demographic groups. Addressing depressive symptoms in PWE may improve their sleep quality, but further research is needed to explore the underlying mechanisms.

Characteristics of sleep disturbance across two waves of the COVID-19 pandemic among nursing staffs.

Objectives: COVID-19 has impacted human lifestyles, including sleep quality. For nursing staff, sleep disorders not only impact their health and daily lives but also have implications for patient safety. The objective of this study is to explore the impact of the COVID-19 pandemic on the psychological and social aspects of nursing staff and the factors influencing their sleep quality through a two-wave survey. Methods: Nursing staff from a psychiatric hospital in southern Taiwan were recruited in two waves during the COVID-19 epidemic. The level of sleep disturbance and related variables, such as Lo's Healthy and Happy Lifestyle Scale (LHHLS) and Societal Influences Survey Questionnaire (SISQ), were collected through self-report questionnaires. Factors related to the level of sleep disturbance were examined using univariate linear regression and multilevel linear regression. Results: 508 nursing staff members were included in the study, with 254 members in each wave. A significant difference was found between the two waves in the positive thinking of LHHLS and all subscales of SISQ. During the second wave, sleep disturbances were mainly related to self-efficacy, positive thinking, social anxiety, and social desirability. At the fourth wave, sleep disturbances were mainly related to self-efficacy, positive thinking, and social anxiety. However, these effects change when the trend of the epidemic shifts, and other factors are taken into account. Conclusions: This study analyzed the factors related to the sleep quality of nursing staff during the COVID-19 pandemic. We preliminarily explored the impact of the COVID-19 pandemic on the sleep quality of nursing staff. However, determining whether the end of the epidemic has reduced the impact on nursing staff requires further research.

Prevalence and characterization of sleep quality and insomnia in security guards working on the day and night shift in Delhi-NCR.

BACKGROUND: In today's modern world, shift working has become an important part of society and industrial work; prolonged wakefulness is a widespread phenomenon due to which the sleep patterns of individuals are getting disturbed, and many sleep disorders are arising. PURPOSE: This study compared the sleep quality and insomnia of the security guards working the day and night shifts. METHODS: This observational study comprised 100 security guards from Delhi and the NCR region. Self-administered questionnaires, i.e., the Pittsburgh sleep quality index (PSQI) and the Athens Insomnia Scale (AIS), were used to assess sleep quality and insomnia. Fifty questionnaires were filled out by the day shift security guards, and the night shift security guards filled out 50. The data underwent analysis, and a comparison was conducted between security workers on night and day shifts using a Mann-Whitney U test, with a significance level set at p < 0.05. RESULTS: The result revealed a significant difference (95% CI; p < 0.05) for the variables, sleep quality and insomnia when compared between night and day shift working security guards. Among night shift workers, 74% reported issues with sleep quality and 48% experienced insomnia. In comparison, among day shift workers, 58% reported concerns about sleep quality, while 32% reported experiencing insomnia. CONCLUSION: The study concluded that night-shift working security guards had poorer sleep quality and a higher prevalence of insomnia compared to their day-shift counterparts. These differences are highly significant, highlighting the potential adverse effects of night shift work on sleep health, urging the need for interventions to improve sleep quality and manage insomnia among night shift workers.

Sleep disturbances based on patient reported outcomes in patients with breast cancer.

PURPOSE: Sleep disturbances are common in patients with breast cancer, but comprehensive evaluations with patient-reported outcomes (PRO) and sleep evaluation with polysomnography (PSG) are lacking. This study describes sleep disruption using PROs and PSG to identify underlying sleep disorders. METHODS: A retrospective review of patients with breast cancer undergoing formal sleep evaluation from 4/1/2009 to 7/31/2014 was performed. Clinical characteristics, PROs using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and PSG data were reviewed. RESULTS: 404 patients were identified with 43% early, 30% locally advanced and 17% metastatic disease. PSQI revealed poor sleep in 75%, and ESS demonstrated daytime sleepiness in 55%. Sleep aid use was reported by 39%, and pain medication use in 22%. Most patients (50.2%) had multiple sleep disorders. Insomnia (54.5%) was the most frequent sleep disorder, followed closely by obstructive sleep apnea (OSA) (53.7%). PSG was performed in 74%. Multivariate analysis linked poor sleep to use of sleep aids [OR 7.7, 95% CI 3.9 to 15.2], anxiety disorder [OR 4.8, 95% CI 1.7 to 14.0], and metastatic disease [OR 2.8, 95% CI 1.1 to 6.6]. Daytime sleepiness correlated with known diagnosis of OSA [OR 1.9, 95% CI 1.0 to 3.3] and sleep aid use [OR 0.6, 95% CI 0.4 to 0.9]. CONCLUSIONS: Poor sleep was associated with sleep aid use, anxiety disorder and metastatic disease. Insomnia was the most common sleep disorder, followed by OSA (mostly mild). Education about sleep health and proactive screening for sleep symptoms would be beneficial in patients with breast cancer.

Factors affecting sleep quality in hospitalised patients.

INTRODUCTION: Hospitalised patients are at increased risk of poor sleep quality which can negatively impact on recovery and quality of life. This study aimed to assess sleep quality in hospitalised patients and explore the factors associated with poor sleep. METHODS: Prospective data were collected from 84 respiratory ward inpatients at time of discharge using a Likert scale questionnaire on contributing factors to sleep quality. Differences between groups reporting good and poor quality sleep were recorded. RESULTS: Most participants (77%) described inpatient sleep quality to be worse or much worse compared to their home environment. Noise (39%), checking of vital signs (33%) and light (24%) were most frequently identified as factors disrupting sleep. Binary logistic regression analysis demonstrated that men (OR 2.8, CI 1.1-7.4, p = 0.037) and those in shared rooms (OR 3.9, CI 1.4-10.9, p = 0.009) were more likely to be affected by noise. Younger patients (OR 0.92, CI 0.88-0.96, p < 0.001) and those in shared rooms (OR 8.5 CI 1.9-37.9, p < 0.001) were more likely to be affected by light. CONCLUSION: In conclusion, a high proportion of hospitalised respiratory patients on a medical ward reported poorer sleep quality compared to home due to operational interruptions and noise. Age, gender and room type further modified the sleep disruption. Future research should focus on whether strategies to reduce interruptions and noise will improve sleep quality and clinical outcomes.

Exacerbation of symptoms, nocturnal acid reflux, and impaired autonomic function are associated with sleep disturbance in gastroesophageal reflux disease patients.

Background and aim: Gastroesophageal reflux disease (GERD) patients often report sleep disturbance (SD); however, the relationship between GERD and SD is unknown. This study investigated whether SD affects symptoms, acid reflux, and autonomic function in GERD patients. Methods: A total of 257 subjects (126 patients with SD and 99 patients without SD) participated in this survey from January 2020 to August 2022. Participants were required to complete questionnaires including the GERD impact scale (GIS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD). Esophageal mucosal injury, acid exposure, peristaltic function, and autonomic function were assessed by upper endoscopy, high-resolution esophageal manometry (HRAM), 24-h multichannel intraluminal impedance with pH (24 h-MII-pH), and electrocardiography (ECG). Results: Gastroesophageal reflux disease patients with SD experienced a higher frequency of prolonged reflux (p < 0.001), longest reflux event (p < 0.001), acid exposure time (p < 0.001) during the recumbent period, and a higher incidence of erosive esophagitis (EE) (59.5 vs. 45.5%, p = 0.036) than those without SD. Pearson's correlation analysis showed that SD was positively correlated with GIS (r = 0.725, p < 0.001), HAMA (r = 0.680, p < 0.001), and HAMD (r = 0.323, p < 0.001) scores, and negatively correlated with parasympathetic or vagal nerve activity (r = -0.770, p < 0.001). Conclusion: Gastroesophageal reflux disease patients with SD experience more severe reflux symptoms and nocturnal acid reflux, which may be related to autonomic dysfunction.

Evolution and characteristics of nocturnal knee pain after knee arthroplasty.

INTRODUCTION: Nocturnal knee pain and sleep disorders are two common but poorly studied issues contributing to dissatisfaction following knee arthroplasty. This study aims to evaluate the prevalence and associated factors of nocturnal pain and sleep disturbance in a population undergoing knee arthroplasty. METHODS: We included in this prospective observational study 111 patients undergoing knee athroplasty (79 TKA and 32 UKA). Sleep quality, nocturnal knee pain (preoperatively, at day 3, at 3 and 6 weeks, at 3 months and one year after surgery), pain during mobilization and neuropathic pain were evaluated by scores. Painkillers and sleeping pills intake were recorded. Potentially predictive factors for postoperative nocturnal pain evolution were studied. RESULTS: Poor sleeping quality rate was 54% for the pre-operative patients and was still 53% at one year after surgery. The prevalence of nocturnal knee pain was 38,74% before surgery and 2,9% at one year after arthroplasty. This study has been performed at the University Hospital Saint Luc Brussels. Evolution and Characteristics of nocturnal knee pain after knee arthroplasty. Nocturnal pain after knee surgery was significantly associated with higher pain scores at rest during activity and at night. Nocturnal pain was significantly associated with a higher PSQI and DN4 scores and a higher consumption of painkillers or sleeping pills at W6. The multiple variable regression showed a statistically significant correlation between preoperative and postoperative nocturnal pain at D3 and W3. Compared to TKA, UKA patients reported significantly less nocturnal pain at W3 and W6. CONCLUSIONS: Bad sleeping quality is present in 54% of knee arthroplasty patients before and after surgery. Nocturnal pain is present in 39% of knee arthroplasty patients before surgery and this drops to 3% after one year. Nocturnal pain is associated with higher pain intensity, neuropathic symptoms, increased medication consumption and poor sleeping quality. Night pain disappeared faster after UKA than TKA, with a tipping point around 6 weeks postoperatively.

Does tinnitus amplify the effects of healthy eating patterns and physical activity on the sleep disturbance or sleep insufficiency, based on the case study of NHANES survey in the United States.

Objective: Exploring whether the presence of tinnitus amplifies the effects of an individual's dietary patterns and physical activity on sleep disturbance or sleep insufficiency. Study design: This study extracted data from the five National Health and Nutrition Examination Surveys (NHANES) between 2009 and 2018, including individuals who had undergone complete questionnaires on tinnitus, dietary habits, physical activity, and sleep. Multivariate logistic regression, restricted cubic spline (RCS) and subgroup analyses were conducted to explore the associations of dietary habits, physical activity, and tinnitus with sleep disturbance and sleep insufficiency. Results: A total of 7,440 participants were enrolled in this study, of whom 1,795 participants were evaluated as sleep disturbance (24.13%), and 2,281 were sleep insufficiency (30.66%). With adjusting confounding factors of demographic and socioeconomic variables, among overall population, participants with tinnitus showed a significantly increased risk of sleep disturbance [adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.83-2.36), and sleep insufficiency (aOR = 1.31, 95% CI: 1.15-1.49). Poor dietary habits also increased the risk of sleep disturbance (aOR = 1.08, 95% CI: 1.04-1.12), as does lack of physical activity (aOR = 1.14, 95% CI: 1.03-1.27); but neither exposure factors significantly increased the risk of sleep insufficiency. The non-linear trend analyses of RCS found that the influence of exposure factors on sleep disturbance experiencing a steady or small decline trend after rising. In addition, the results of the subgroup analysis showed that in tinnitus patients, poor dietary habits and lack of physical activity both significantly increased the risk of sleep disturbance, and poor dietary habits also increased the risk of sleep insufficiency remarkable, but lack of physical activity did not. In healthy participants, poor dietary habits were only significantly associated the sleep disturbance, while lack of physical inactivity even had a protective effect against sleep insufficiency. Conclusion: Compared to the general population, tinnitus significantly amplified the effects of poor dietary patterns and physical inactivity on sleep disturbance and sleep insufficiency. For tinnitus patients, adjusting a healthy diet and increasing exercise could more effectively promote their sleep health.

Concussion history is associated with poor sleep quality in adolescent athletes: a cross-sectional study.

STUDY OBJECTIVES: While previous research has primarily focused on the immediate effects of concussion within the first year post-injury, this study examines the persistent effects of concussion on subsequent sleep quality in adolescent soccer players. METHODS: This study utilized a cross-sectional design, recruiting a convenience sample of adolescent athletes from US Youth Soccer camps. Participants completed a self-reported questionnaire including the Pittsburgh Sleep Quality Index (PSQI) to assess their sleep quality. Athletes were also asked to report sport participation information, any past occurrence of concussion or knee injury, and any sport-related injury in the past 12 months. Independent Samples t-tests were performed to identify significant differences in PSQI scores between injured and non-injured participants. RESULTS: A total of 177 participants (103 male, 14.61±1.88 years) were included in the analysis. The concussion injury group exhibited later bedtimes (difference: 0.32±0.05 hours; p=0.047), fewer hours of sleep (difference: 0.56±0.11 hours, p=0.015), and more frequent sleep disturbances (p=0.012). Furthermore, these athletes reported lengthened sleep latency (difference: 2.55±3.36 minutes, p=0.016) and higher levels of daytime dysfunction (p=0.041) following their concussion injuries. Moreover, athletes in the concussion injury group displayed worse sleep quality scores (difference: 0.42±0.06, p<0.001) and higher total PSQI scores (difference: 1.91±0.41, p<0.001). No significant differences were found based on past knee injury or sport-related injury in the past 12 months. CONCLUSIONS: These findings suggest the need for targeted interventions aimed at improving sleep quality in adolescent athletes with a history of concussion.

Influences of Social Disengagement and Depressive Symptoms on Sleep Disturbance in Dementia Caregiving Dyads: A Nationally Representative Study.

OBJECTIVES: To examine the influence of social disengagement and depressive symptoms on sleep disturbance among dementia caregiving dyads and the actor-partner interdependence nature of these influences. DESIGN: Actor-partner interdependence model through structural equation modeling for dyadic analyses. SETTING AND PARTICIPANTS: A total of 310 dyads of older adults with dementia and their care partners from 2 national representative studies in the United States, the National Health and Aging Trends Study (NHATS) and its companion study, the National Study of Caregiving (NSOC). METHODS: Data from the NHATS Round 11 and NSOC IV were analyzed using descriptive statistics, Pearson correlation analysis, and the actor-partner interdependence model. Structural equation modeling was used to assess the mediation effects of depressive symptoms within the actor-partner interdependence models. RESULTS: In the model of caregivers, social disengagement had a direct impact on sleep disturbance (ß = 0.49, P < .001) and an indirect impact through depressive symptoms (ß = 0.25, P < .001). In the model of older adults with dementia, social disengagement only had an indirect effect on sleep disturbance through depressive symptoms. In models examining partner effects, caregivers' social disengagement directly influenced their care partners' depressive symptoms (ß = 0.20, P = .019), which subsequently affected caregivers' sleep disturbance (ß = 0.17, P < .001). Social disengagement (ß = 0.17, P = .001) and depressive symptoms (ß = 0.17, P < .001) in older adults with dementia directly impacted their caregivers' sleep disturbance. Depressive symptoms of older adults with dementia served as multiple mediators linking one member's social disengagement to both their own and partner's sleep. CONCLUSIONS AND IMPLICATIONS: This study represents one of the first attempts to investigate the influencing mechanism of sleep disturbances among older adults with dementia and their informal caregivers through a dyadic perspective. The sleep disturbance of caregivers may be directly influenced by the social disengagement and depressive symptoms exhibited by both members of the dyad, whereas the sleep disturbance experienced by older adults with dementia can only be indirectly influenced by the dyad's social disengagement via their own depressive symptoms. Dyadic social activities targeting depressive symptoms could be designed to address sleep disturbances in dementia caregiving dyads.

Gender differences in relations between social comparison, social support, and sleep disturbance among midlife and older adults.

Objective: To examine associations between sleep disturbance, social support, and social comparison among midlife and older adults, including the moderating role of gender. Methods: Adults ages ≥40 years (N = 557, MAge = 57, 53% men) completed a cross-sectional survey including validated measures of sleep disturbance, perceptions of social support, and social comparison orientation. Results: Sleep disturbance was negatively associated with social support (rs = -0.42 to - 0.33, ps = 0.001) and associations were stronger for men than women - particularly perceived support from friends (η 2 = 0.01). Sleep disturbance was also associated with upward comparison orientation (r = 0.12, p = 0.003), more strongly for women than men (η 2 = 0.01). Discussion: Findings indicate that perceived support from friends (for men) and upward comparison (for women) may have particular influence on sleep among midlife and older adults. Additional work is needed to clarify the nature of these associations and their mechanism(s) of action, to inform potential treatment adaptations for this population.

The role of arousal in maintaining the relationship between insomnia and gastrointestinal conditions.

The relationship between gastrointestinal (GI) conditions and sleep disturbance has been well established. With a higher-than-average prevalence of sleep disturbance in individuals with GI conditions, it is imperative to better understand the maintaining factors driving this comorbidity. Although there are separate, ongoing investigations into both the biological mechanisms and interventions for the sleep and GI relationship, there is a considerable need to further specify common and mutually influential pathways. In our review, we highlight arousal as both a unifying feature of insomnia and various GI conditions as well as a possible mechanism for action for the bidirectional relationship. This review aims to summarize the relationship between arousal, insomnia, and GI conditions, specifically examining sources of arousal across four broad domains: psychosocial factors, physical health factors, daily living factors, and sociocultural factors. Online databases, including PubMed, PsychInfo, and Google Scholar, were searched for full-text English language articles focused on patients with insomnia and/or GI conditions and involving mental health, physical comorbidities, and social factors. Understanding the nature of this bidirectional relationship between sleep and GI through the lens of arousal as a common mechanism will lend itself to using a multidisciplinary approach to treatment and care.

Self-reported sleep duration and quality and cardiovascular diseases among middle-aged and older Chinese: A 7-year longitudinal cohort study.

Cardiovascular disease (CVD) is a leading cause of death worldwide, and several studies have attempted to identify its risk factors. This study aimed to investigate the association between sleep duration and sleep quality, and the 7-year incidence of CVD among middle-aged and older Chinese individuals. A total of 6682 participants aged 45-90 years from the China Health and Retirement Longitudinal Study database were included in this study. The authors estimated sleep duration and quality based on self-reported data of night sleep hours and disturbance symptoms, and examined the associations between them and the composite outcome of CVD using logistic regression models. A total of 1692 participants (25.32%) reported new CVD events during follow-up. Short sleep duration (< 6 h/night) was significantly associated with a higher risk of CVD in all three models (p < .05). However, this was not observed for long sleep duration (> 8 h/night). Additionally, participants with mild sleep disturbance in all three models, and severe sleep disturbance in Models 2 and 3 had a significantly higher risk of CVD (p < .05). After stratification by age and daytime napping, we still found a significant association between short sleep duration and CVD in individuals aged 45-59 years, and between sleep disturbance and CVD in non-nappers (p < .05). However, these associations were not significant in individuals aged ≥60 years or in nappers (p > .05). In conclusion, short sleep duration and sleep disturbance are both associated with an increased risk of CVD in middle-aged and older Chinese individuals.