The interaction between stress and sleep disorders among foreign medical students in Georgia.

OBJECTIVES: This study aimed to: a. Investigate daytime sleepiness, stress, and pre-sleep arousal prevalence among foreign medical students in Georgia. b. Explore gender-based associations between sleep and stress parameters. METHODS: Mental health was assessed in 207 foreign medical students in Georgia using the Epworth Sleepiness Scale (ESS), Pre-Sleep Arousal Scale (PSAS), and Student-Life Stress Inventory (SLSI). RESULTS: Most participants reported elevated stress levels and excessive daytime sleepiness (EDS). EDS affected 25.1% of students, with slightly higher prevalence in males. PSAS was prevalent in 97.1% of students. Stress was widely reported, with 78% experiencing it, with a higher prevalence in females. Significant correlations were observed between sleepiness and arousal, including somatic (r = 0.41) and total scores (r = 0.28). Sleepiness was also linked to stressors like pressure, changes, self-imposed stress, and overall self-evaluation stress (r = 0.45). Strong correlations existed between ESS, Total PSAS, and overall self-evaluation SLSI scores for both genders. Gender differences were observed in the associations with Cohen's d within the small to moderate size. Men showed significant associations between ESS and stressors: conflict, pressure, chances, all stress reaction categories, and total SLSI scores (p < 0.001). In women, ESS correlated significantly only with overall self-evaluation (p < 0.001). Excessive daytime sleepiness, especially with somatic and total PSAS, predicted total SLSI scores for the entire sample and both genders, with stronger predictive values for total PSAS. CONCLUSION: The study reveals a high prevalence of clinical sleepiness and its significant correlation with pre-sleep arousal and stress among foreign medical students, with females experiencing more difficulties than males.

Age-Based Differences in Sleep Quality, Pre-Sleep Arousal, and Psychosocial Factors during the Second Wave Lockdown of the COVID-19 Pandemic in Georgia-A Higher Vulnerability of Younger People.

The COVID-19 pandemic has deeply disrupted sleep and mental health of people around the world. We aimed to investigate age-based differences in the prevalence of and relationship between sleep quality, pre-sleep arousal, and psychosocial factors during the second wave lockdown of the COVID-19 pandemic in Georgia. Data were collected through an online survey (n = 1117). Participants were categorized into four age groups: 18-29, 30-41, 42-53, and 54-70 years. The youngest participants reported the most prevalent disruption of sleep behavior. Overall, 58.3% of respondents were poor sleepers. The Pittsburgh Sleep Quality Index (PSQI) global score was highest in the youngest age group but the difference was not significant. There was a significant difference in the PSQI component scores for subjective sleep quality, sleep latency, and daytime dysfunction, all being worse in young respondents. We also observed a significantly higher prevalence rate of worse sleep quality in the youngest age group, relative to the pre-pandemic period. On the other hand, the oldest respondents showed significantly greater use of sleeping medications. Significantly higher levels of somatic and cognitive pre-sleep arousal, perceived stress, feeling depressed, anxious, and socially isolated were reported by the youngest age group. Study findings indicate a higher vulnerability of younger people to the impact of the COVID-19 pandemic. Assessment of pre-sleep arousal and implementation of specific, age-based interventions may prove beneficial to improve possible consequences of the pandemic on sleep and mental health.

Sleep electroencephalogram evidence of delayed brain maturation in attention deficit hyperactivity disorder: a longitudinal study.

STUDY OBJECTIVES: This study investigates whether longitudinally measured changes in adolescent brain electrophysiology corroborate the maturational lag associated with attention deficit hyperactivity disorder (ADHD) reported in magnetic resonance imaging (MRI) studies and cross-sectional sleep electroencephalogram (EEG) data. METHODS: Semiannually nine adolescents diagnosed with ADHD (combined presentation, DSM-V criteria, mean age 12.39 ±â€…0.61 years at first time-point, two females) and nine typically developing controls (12.08 ±â€…0.35 years, four females) underwent all-night laboratory polysomnography, yielding four recordings. RESULTS: Sleep macrostructure was similar between groups. A quadratic model of the age change in non-rapid eye movement (NREM) delta (1.07-4 Hz) power, with sex effects accounted for, found that delta power peaked 0.92 ±â€…0.37 years later in the ADHD group. A Gompertz function fit to the same data showed that the age of most rapid delta power decline occurred 0.93 ±â€…0.41 years later in the ADHD group (p = 0.037), but this group difference was not significant (p = 0.38) with sex effects accounted for. For very low frequency (0.29-1.07 Hz) EEG, the ADHD lag (1.07 ±â€…0.42 years later, p = 0.019) was significant for a Gompertz model with sex effects accounted for (p = 0.044). Theta (4-7.91 Hz) showed a trend (p = 0.064) toward higher power in the ADHD group. Analysis of the EEG decline across the night found that standardized delta and theta power in NREMP1 were significantly (p < 0.05 for both) lower in adolescents with ADHD. CONCLUSIONS: This is the first longitudinal study to reveal electrophysiological evidence of a maturational lag associated with ADHD. In addition, our findings revealed basically unaltered sleep macrostructure but altered sleep homeostasis associated with ADHD.

Longitudinal assessment of NREM sleep EEG in typically developing and medication-free ADHD adolescents: first year results.

OBJECTIVE: Clinical observation and structural MRI studies suggest that delayed brain maturation is a major cause of attention deficit hyperactivity disorder (ADHD). Sleep electroencephalogram (EEG) which exhibits major changes across adolescence provides an opportunity to investigate brain electrophysiology evidence for maturational delay. We present data from an ongoing longitudinal study of sleep EEG in medication-free ADHD and typically developing adolescents to investigate brain electrophysiological evidence for this maturational delay. METHODS: Nine adolescents diagnosed with ADHD (combined presentation, DSM-V criteria, mean age 12.39 ± 0.61 years, 2 females), and nine typically developing controls (12.08 ± 0.35 years, 4 females) were recruited. Subjects underwent an adaptation night and all night polysomnography twice yearly at the Laboratory. RESULTS: Basic sleep structure did not differ between the ADHD and control groups. In addition, we found no group differences on delta power (p = 0.77), but found a possible trend toward higher theta power (p = 0.057) for the ADHD group. The decline of standardized delta power across the 4 non-rapid eye movement (NREM) periods differed by group (p < 0.05) with the percent delta power in the first NREM period being lower in the ADHD group. CONCLUSIONS: Our data support the preponderant evidence that basic sleep structure is unaltered with ADHD. Our data do suggest altered sleep homeostatic recuperative processes in ADHD. The theta findings from the first two recordings are suggestive of a maturational delay associated with ADHD, but follow-up data-points are needed.

Insomnia, Pre-Sleep Arousal, Psychosocial Factors and Changes in Sleep Pattern during the Second Wave Lockdown of the COVID-19 Pandemic in Georgia.

Studies performed across the COVID-19 pandemic waves point to the persistent impact of the pandemic on sleep and mental health. We expand these data by examining insomnia, pre-sleep arousal, psychosocial factors, and retrospective changes in sleep pattern during the COVID-19 second wave lockdown period in Georgia. Data were collected through an online survey (n = 1117). The prevalence rate of probable insomnia disorder was 24.2%. Clinically relevant somatic and cognitive pre-sleep arousal was present in 49.8% and 58.0% of participants, and high levels of anxiety, depression and social isolation were found in 47.0%, 37.3%, 47.2% of respondents, respectively. We observed high prevalence rates of worse sleep quality, delayed bedtimes and risetimes, longer sleep latencies, higher awakenings and shorter sleep durations, relative to the pre-pandemic period. COVID-19-infected participants showed more severe sleep and mental problems. Specific predictors differentially affected insomnia, somatic and cognitive pre-sleep arousal. Depression and COVID-19 infection emerged as vulnerability factors for pre-sleep arousal, which, in turn, was associated with a higher predisposition to insomnia disorder. We confirm the strong deteriorating impact of the COVID-19 pandemic on sleep and psychosocial well-being during the second wave lockdown period. The specific association between pre-sleep arousal, insomnia, and psychosocial factors is of clinical relevance for the prevention of severity and persistence of sleep and mental problems across the repeated lockdown/reopening waves. Modulation of pre-sleep arousal may prove beneficial to implement targeted interventions.

Sleep disturbances and stress among foreign medical students at European University, Georgia.

This article was migrated. The article was marked as recommended. Introduction: The present study is the first attempt to assess the stressors associated with students' life, daytime sleepiness, and pre-sleep arousal and to study the relationship between stress and sleep disturbance among foreign medical students in Georgia. Methodology: Forty-four foreign volunteer students from the European University, Tbilisi, Georgia participated in this study in November 2018. Participants completed Epworth the Sleepiness Scale (ESS), Pre-Sleep Arousal Scale (PSAS), and Student-Life Stress Inventory (SLSI), and the data were statistically analysed. Results: ESS scores were slightly higher than the normal value in the general population (7.25 ± 3.00). Students revealed high somatic (13.55 ± 4.39) and cognitive PSAS scores (18.05 ± 6.13) and high overall self-rating (1.95 ± 0.57) and total SLSI scores (143.86 ± 40.33). ESS scores were slightly higher in females (7.86 ± 3.00 vs 6.64 ± 2.94). Females showed higher somatic (13.73 ± 3.71 vs 13.36 ± 5.07) and cognitive PSAS scores (18.36 ± 5.34 vs 17.73 ± 6.94). Overall, self-rating and total SLSI scores were slightly higher among males (2.00 ± 0.69 vs 1.91 ± 0.43 and 146.55 ± 42.48 vs 141.18 ± 38.86, respectively). The differences were not statistically significant. In females, only the cognitive pre-sleep arousal was significantly correlated with ESS (p<0.05), overall self-rating (p<0.05), and total SLSI scores (p<0.05). In males, ESS showed significant correlation with both somatic and cognitive PSAS scores (p<0.05). ESS showed significant association with overall self-rating (p<0.01), which in turn was significantly associated with somatic and cognitive arousal (p<0.05). Both somatic and cognitive arousal were strongly correlated with total SLSI scores (p<0.01). Conclusion: Medical students are at high risk of developing sleep disturbance and psycho-behavioural difficulties. Additional studies are needed to assess the specific relationship among sleep patterns, stress, and academic performance of foreign medical students.

Sleep and psycho-behavioral problems in internally displaced children in Georgia.

OBJECTIVE: The aim of this study was to examine sleep and psycho-behavioral variables in Georgian Internally Displaced (ID) Children and their population-based controls. METHODS: One hundred and sixty one children (10.85 ± 0.9) from ID families escaped from Shida Kartli, Georgia, and 161 non-ID children (10.94 ± 0.9) were studied after seven years of displacement. Children completed the Pre-Sleep Arousal Scale, Buss-Perry Aggression Questionnaire (BPAQ), Children's Depression Inventory (CDI), and the Child Trauma Screening Questionnaire (CTSQ). In addition, we assessed the children's appraisal of the family environment. Moreover, parents reported socio-demographic information, their children's academic excellence, and completed the Sleep Disturbance Scale for Children (SDSC), Beck Depression Inventory II (BDI), and Perceived Stress Scale (PSS). RESULTS: Compared with the control group, ID children had a lower level of academic excellence and family environment (p < 0.01) as well as higher scores in all SDSC dimensions with the significant difference for breathing (p < 0.001), hyperhidrosis and SDSC total scores (p < 0.05). Cognitive pre-sleep arousal was significantly higher in non-IDs (p < 0.01), while there was no difference between groups in somatic pre-sleep arousal level. All BPAQ component and total scores were higher in IDs than in non-IDs but the difference was significant only in Physical Aggression (p < 0.01). Mean scores for BDI and PSS were significantly higher in ID than non-ID parents (p < 0.001). Both cognitive and somatic pre-sleep arousal predicted SDSC total score in non-IDs (p < 0.01) while cognitive but not somatic arousal was significant predictor in IDs (p < 0.01). CONCLUSION: Sleep and psycho-behavioral problems are noticeable even in those ID children who were very young at the time of displacement. Psycho-social environment in which children are growing up warrants major consideration in ID population.

Relationship between Sleep Disorders and Health Related Quality of Life-Results from the Georgia SOMNUS Study.

The extent to which sleep disorders are associated with impairment of health-related quality of life (HRQoL) is poorly described in the developing world. We investigated the prevalence and severity of various sleep disorders and their associations with HRQoL in an urban Georgian population. 395 volunteers (20⁻60 years) completed Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, STOP-Bang questionnaire, Insomnia Severity Index, Beck Depression Inventory-Short Form, and Short Form Health Survey (SF-12). Socio-demographic data and body mass index (BMI) were obtained. The prevalence of sleep disorders and their association with HRQoL was considerable. All SF-12 components and physical and mental component summaries (PCS, MCS) were significantly lower in poor sleepers, subjects with daytime sleepiness, apnea risk, or insomnia. Insomnia and apnea severity were also associated with lower scores on most SF-12 dimensions. The effect of insomnia severity was more pronounced on MCS, while apnea severity-on PCS. Hierarchical analyses showed that after controlling for potential confounding factors (demographics, depression, BMI), sleep quality significantly increased model's predictive power with an R² change (ΔR²) by 3.5% for PCS (adjusted R² = 0.27) and by 2.9% for MCS (adjusted R² = 0.48); for the other SF-12 components ΔR² ranged between 1.4% and 4.6%. ESS, STOP-Bang, ISI scores, all exerted clear effects on PCS and MCS in an individual regression models. Our results confirm and extend the findings of studies from Western societies and strongly support the importance of sleep for HRQoL. Elaboration of intervention programs designed to strengthen sleep-related health care and thereof HRQoL is especially important in the developing world.

Sleep-wake patterns and sleep quality in urban Georgia.

OBJECTIVES: Sleep problems represent a worldwide health concern but their prevalence and impacts are unknown in most non-European/North American countries. This study aimed to evaluate sleep-wake patterns, sleep quality and potential correlates of poor sleep in a sample of the urban Georgian population. METHODS: Analyses are based on 395 volunteers (267 females, 128 males, aged 20-60 years) of the Georgia Somnus Study. Subjects completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory-Short Form. Sociodemographic information and self-reported height and weight were collected. RESULTS: 43% of subjects had poor sleep quality (PSQI > 5). Further, 41% had low sleep efficiency, 27.6% slept 6 hours or less, 32.4% went to bed after midnight, 27.6% snored, 10.6% were taking sleep medication, and 26.8% had sleep maintenance problems as occurring three or more times a week. The latest bedtime, rise time, and gender effect on these variables were found in the age group 20-29 years. PSQI global score showed a significant age but not gender difference. The economic status and the depression score were two significant predictors of sleep quality. CONCLUSIONS: Poor sleep quality has a high prevalence and is strongly linked to the economic status. Study findings call for a global assessment of sleep problems in countries where sleep disturbances represent an insufficiently recognized public health issue.

Sleep quality among internally displaced Georgian adolescents and population-based controls.

Sleep problems in children and adolescents are a significant public health concern and may be linked to a variety of psychoemotional difficulties. This study aimed to evaluate sleep quality and associated factors in conflict-affected Georgian adolescents after 9 months of forced displacement. Thirty-three internally displaced adolescents (mean age 11.4 years) and 33 adolescents (mean age 10.8 years) from the general population completed the Epworth Sleepiness Scale and the Children's Depression Inventory (CDI). Parents completed the Children's Sleep-Wake Scale and provided information on their socioeconomic status (SES) and the adolescents' sleep behavior, academic performance, and peer social relationships. The groups differed significantly in sleep quality, peer relationships, SES, and CDI scores. In the internally displaced group, the only significant predictor of sleep quality was SES, which increased the predictive capacity of the model (demographic and psychosocial variables) by 20% in the hierarchical analyses. The most significant predictor in the non-internally displaced group was CDI. This research indicates that displacement may affect sleep quality and psychosocial functioning. The importance of family SES as a contributing factor to displaced adolescents' poor sleep quality is highlighted. An integrated approach designed to improve the psychosocial environment of internally displaced adolescents is needed for their protection.