"The worst thing is lying in bed thinking 'I want a cigarette'" a qualitative exploration of smoker's and ex-smoker's perceptions of sleep during a quit attempt and the use of cognitive behavioural therapy for insomnia to aid cessation.

Smokers report poorer sleep quality than non-smokers and sleep quality deteriorates further during cessation, increasing risk of smoking relapse. Despite the use of cognitive behavioural therapy for insomnia (CBT-I) to aid quit attempts emerging in the area, little is known about smokers and ex smoker's experiences of sleep during a quit attempt or their perceptions of CBT-I. This study addresses this gap by exploring smoker's and ex-smoker's experiences of the link between smoking and sleep and how this may change as a function of smoking/smoking abstinence. It also explores views of traditional CBT-I components (i.e., perceived feasibility, effectiveness, barriers of use). We conducted semi-structured interviews with current and recently quit smokers (n = 17) between January and September 2022. The framework method was used for analysis. Four themes addressing research questions were described. These included: 1) A viscous cycle; poor sleep quality and negative psychological state during cessation; 2) Perceived engagement and effectiveness; the importance of feasibility, experience, value, identity and psychological state in assessing CBT-I as a cessation tool; 3) Striking a balance; tailoring CBT-I to reduce psychological overload in a time of lifestyle transition; and 4) Personalisation and digital delivery helping overcome psychological barriers during cessation. The analysis suggested during quit attempts smokers experienced a range of sleep problems that could increase risk of relapse due to a negative impact on psychological state. It also revealed participants thought that CBT-I is something they would use during a quit attempt but suggested changes and additions that would improve engagement and be better tailored to quitting smokers. Key additions included the integration of smoking-based cognitive restructuring, starting the intervention prior to a quit attempt, and the need for personalisation and tailoring.

Caring for patients in the Covid era: Are the quality of life the same for doctors and nursing staff?

BACKGROUND: The Covid-19 pandemic has represented one of the most stressful events of recent times and has placed enormous psychological pressure on doctors and nurses. AIMS: The objective of this work is to evaluate the psychological impact of the Covid-19 outbreak on Spanish nurses and doctors, and to identify factors related to their mental health. METHODS: The study is a descriptive study and examined 812 doctors and 768 nurses. The dependent variables were health-related quality of life, anxiety, depression, perceived stress and insomnia. Participants completed the Health-related Quality of Life-Questionnaire, the Generalized Anxiety Disorder 7-item-Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, and the Insomnia Severity Index. Sociodemographic and Covid-related data were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were used. RESULTS: A greater proportion of nurses than doctors suffered clinical anxiety, depression and insomnia (56.84 % vs 45.81 p-value<0.0001, 64.67 % vs 53.39 p-value<0.0001, and 23.04 % vs 18.02 p-value 0.01, respectively). Although in our study nurses were more likely to suffer clinical anxiety, stress and insomnia than doctors, our results nevertheless showed that there were no differences in terms of quality of life. Different factors related to mental health were identified for doctors and nurses. Nurses working in care homes or geriatric services (OR = 4.13, IC95% 1.71-9.99, p-value 0.002), and in services with greatest contact with Covid-19 patients (OR = 1.71,IC95% 1.10-2.68, p-value 0.02) were more likely to suffer depression. CONCLUSIONS: Our study confirms that doctors and nurses are at high risk of clinical anxiety, depression, stress or insomnia during the Covid-19 pandemic.

Association between self-perception of the neighborhood environment and sleep problems in older Brazilian adults: findings from ELSI-Brazil.

This study aimed to investigate associations between neighborhood perception and sleep problems in older Brazilian adults. A cross-sectional study was conducted with 5,719 community-dwelling older adults (≥ 60 years) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021). The outcomes were self-reported sleep problems: poor sleep quality, daytime sleepiness, primary insomnia complaints, difficulty staying asleep, and waking up at dawn. The exposure variables were questions about the perception of participants about the physical and social environment of the neighborhood. Logistic regression was used in data analysis. Garbage, rubbish, or tall grass on the streets and the desire to move were associated with higher odds of poor sleep quality. Concern about falling due to damaged sidewalks, concern about having difficulties taking transportation, and concern about having difficulties crossing the street were associated with higher odds of all sleep problems. Sound/noise of buses and cars was associated with higher odds of some sleep problems. Perceiving the neighborhood as a good place to live was associated with lower odds of daytime sleepiness and primary insomnia complaints. Trusting most people in the neighborhood and perceiving that kids and younger people treat adults with respect were associated with lower odds of daytime sleepiness, primary insomnia complaints, and waking up at dawn. Being a good place for kids to play and raise teenagers was associated with lower odds of daytime sleepiness. These results can assist public administrators in creating urban planning policies aimed at improving neighborhood environments as a means of health promotion.

Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study.

BACKGROUND: The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy. METHODS: This was a prospective pilot cohort of pregnant people between 23 to 36 weeks' gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters. RESULTS: Among the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: ß 6.1, p = 0.01, MAP: ß 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: ß 9.6, p = 0.01, DBP: ß 8.1, p < 0.001, and MAP: ß 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP. CONCLUSIONS: When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1-9.6 mmHg higher SBP, 6.1-8.1 mmHg higher DBP, and 6.2-8.8 mmHg higher MAP than people without anxiety.

[Correlation of insomnia with perceived stress in college students].

OBJECTIVE: To investigate the prevalence of insomnia in college students and analyze the correlation between insomnia and perceived stress. METHODS: A cluster sampling method was used to investigate the prevalence of insomnia and stress levels in 3702 college students using Insomnia Severity Index (ISI) and Perceived Stress Scale-10 (PSS-10). RESULTS: Insomnia was detected in 31.4% of the college students, and the symptoms were more severe in male students (t=2.047, P=0.041) and in those with poorer family economic conditions (F=20.423, P<0.001). Insomnia was positively correlated with perceived stress, perceived distress, and perceived coping ability, with correlation coefficients of 0.42, 0.38, and 0.31, respectively (P<0.001). The students with higher levels of perceived stress had higher insomnia scores (F=203.03, P<0.001) and higher detection rate of insomnia (χ2=359.784, P<0.001), and those with moderate or severe insomnia also had higher levels of perceived stress (F=293.569, P<0.001). The types of perceived stress among college students included incontrollable (15.3%), nervous (8.3%), vulnerable (23.0%) and the relaxed types (53.5%). The incontrollable type was associated with the highest insomnia scores, followed by the nervous type and susceptible type, and the relaxed type had the lowest insomnia scores (F= 185.969, P<0.001). The prevalence rates of insomnia in students with the 4 types of perceived stress were 57.3%, 43.3%, 39.3%, and 18.7%, respectively (χ2=368.876, P<0.001). CONCLUSION: There is a close correlation between perceived stress and insomnia, and identification of the high-risk population for insomnia from the perspectives of perceived stress level and perceived stress type can facilitate the management and prevention of insomnia.

The mediation effects of nightmares and depression between insomnia and suicidal ideation in young adults.

Suicide is prevalent among young adults, and epidemiological studies indicate that insomnia, nightmares, and depression are significantly associated with a high incidence of suicidal ideation (SI). However, the causal relationship between these factors and SI remains unclear. Therefore, the purpose of this study was to examine the association between nightmares and depression and insomnia and SI in young adults, as well as to develop a mediation model to investigate the causal relationship between insomnia, nightmare, depression, and SI. We assessed insomnia, nightmares, depression, and SI in 546 young adults using the Insomnia Severity Scale (ISI), Disturbing Dream and Nightmare Severity Scale (DDNSI), Depression Study Scale (CESD-20), and Columbia-Suicide Severity Rating Scale (C-SSRS). Using the Bootstrap method, the mediation effects of nightmares and depression between insomnia and SI were calculated. The results demonstrated that nightmares and depression fully mediated the relationship between insomnia and SI, including the chain-mediation of insomnia and SI between nightmare and depression with an effect value of 0.02, 95% CI 0.01-0.04, and depression as a mediator between insomnia and SI with an effect value of 0.22, 95% CI 0.15-0.29. This study found that depression and nightmares may be risk and predictive factors between insomnia and SI, which implies that the assessment and treatment of depression and the simple or linked effect of nightmares play crucial roles in preventing SI in young adults.

Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis.

BACKGROUND: Firefighters are an at-risk population for multiple psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), and insomnia. These disorders are likely to co-occur; however, patterns of comorbidity have scarcely been investigated in firefighters. We aimed to identify subgroups of comorbidity of PTSD, depression, AUDs, and insomnia in a nationwide population of firefighters in South Korea. METHODS: A total of 54,054 firefighters responded to an online survey. Latent classes of comorbidity were categorized using latent profile analysis (LPA) based on the symptom scores of PTSD, depression, AUDs, and insomnia. Analysis of variance was performed to compare the characteristics of the identified classes, and multinomial logistic regression was conducted to examine whether anger reactions, resilience, and number of traumatic events predicted class membership. RESULTS: The LPA identified four subgroups: minimal symptoms (n = 42,948, 79.5 %), predominant PTSD (n = 2858, 5.3 %), subthreshold symptoms and comorbidity (n = 7003, 13.0 %), and high symptoms and comorbidity (n = 1245, 2.3 %). Three comorbidity classes were defined based on severity and one class showed predominant PTSD symptoms. Number of traumatic exposures predicted predominant PTSD, while resilience and anger reactions predicted severity of comorbidities. LIMITATIONS: The cross-sectional design and usage of self-reported questionnaires are limitations of this study. CONCLUSIONS: The severity of PTSD, depression, AUDs and insomnia tend to correlate and co-occur in firefighters. Our findings highlight the need to assess comorbid symptoms in firefighters and need to reduce anger reactions and enhance resilience in those with multiple comorbidities.

Depression, anxiety, and insomnia symptoms among Chinese college students: A network analysis across pandemic stages.

BACKGROUND: As the stages of the COVID-19 pandemic evolved, the symptoms of depression, anxiety, and insomnia have increasingly manifested among Chinese college students. The aim of this study is to investigate the relationships between these symptoms through network analysis among Chinese college students during COVID-19. METHOD: A three-wave cross-sectional survey was conducted at 22 colleges in Guangdong Province, involving 381,152 students during three specific time intervals: T1 (baseline, February 3 to 10, 2020), T2 (19 months after baseline, June 10 to 18, 2021), and T3 (37 months after baseline, March 15 to April 22, 2023). Depression (PHQ-9), anxiety (GAD-7), and insomnia (YSIS) were used separately. We analyzed two key network indices: "Expected influence" and "Bridge expected influence". Network stability was assessed through a case-dropping bootstrap program. RESULT: The effective sample sizes for the three periods were as follows: T1 - 164,101 (103,645 females, 63.2 %), T2 - 86,767 (52,146 females, 60.1 %), and T3 - 130,284 (76,720 females, 58.9 %). Across these three periods, the key central symptoms were "Fatigue" (PHQ4), "Restlessness" (GAD5), "Uncontrollable worrying" (GAD2), "Worry too much" (GAD3) and "Sleep insufficiency" (YSIS6). Notably, "Fatigue" (PHQ4), "Restlessness" (GAD5) and "Irritability" (GAD6) consistently served as bridge symptoms. In the T1 and T2 period, "Motor" (PHQ8) acted as a bridge symptom but weakened in T3. CONCLUSION: Throughout the three periods, the mental health issues among Chinese college students displayed characteristics of somatization within the depression-anxiety-insomnia comorbidity network. Over time, anxiety symptoms appeared to become more prominent. Consequently, this study highlights the importance of accurately identifying and promptly intervening in these core symptoms of mental health among college students, as these symptoms may evolve across different stages of a pandemic.

Associations of evening-type and insomnia symptoms with depressive symptoms among youths.

BACKGROUND: Evening-type and insomnia symptoms are significantly related to each other and independently associated with depressive symptoms, yet few studies have examined the potential interaction between these two conditions. Therefore, we aimed to examine the associations of evening-type and insomnia symptoms with depressive symptoms among Chinese youths, with a specific focus on the joint effects of the two conditions on depressive symptoms. METHODS: Participants aged between 12 and 25 were invited to participate in an online survey from December 15, 2022, to May 26, 2023. Multivariate logistic regression models and additive interaction models were used to examine the independent and joint effects of chronotypes and insomnia symptoms on depressive symptoms, respectively. RESULTS: Of the 6145 eligible youths, the prevalence of evening-type and insomnia symptoms were 24.9 % and 29.6 %, respectively. Both evening-type (adjusted OR, [AdjOR]: 3.21, 95 % CI: 2.80-3.67) and insomnia symptoms (AdjOR: 10.53, 95 % CI: 9.14-12.12) were associated with an increased risk of depressive symptoms. In addition, the additive interaction models showed that there is an enhanced risk of depression related to interaction between evening-type and insomnia symptoms (relative excess risk due to interaction, [RERI]: 11.66, 95 % CI: 7.21-16.11). CONCLUSIONS: The present study provided additional evidence demonstrating the presence of interaction between evening-type and insomnia symptoms, which can lead to a higher risk of depressive symptoms. Our findings argue the need for addressing both sleep and circadian factors in the management of depressive symptoms in young people.

Explaining how childhood physical abuse and physical neglect influence adult depression: An analysis with multiple sequential mediators.

BACKGROUND: Substantial evidence indicates that experiencing physical abuse and neglect during childhood significantly elevates the likelihood of developing depression in adulthood. Nevertheless, there remains a dearth of understanding regarding the mechanisms underpinning this correlation. OBJECTIVE: In this study, we aimed to examine the associations of childhood physical abuse and physical neglect with depression using follow-up data from UK Biobank and quantified the contribution of smoking, insomnia, and BMI in these associations. PARTICIPANTS AND SETTINGS: This study included 144,704 participants (64,168 men and 80,536 women) from UK Biobank, most of whom were white (97 %). METHODS: Physical abuse and physical neglect were measured using two items of Childhood Trauma Screener (CTS). Data on the incidence of depression were obtained from primary care, hospital inpatient records, self-reported medical conditions, and death registries. We used a sequential mediation analysis based on the "g-formula" approach to explore the individual and joint effects of potential mediators. RESULTS: The depression incidence rate was 1.85 per 1000 person-years for men and 2.83 per 1000 person-years for women, respectively. Results of Cox proportional risk regression showed that physical abuse (HRs: 1.39-1.53, P < 0.001) and physical neglect (HRs: 1.43-1.60, P < 0.001) are associated with depression. Smoking, insomnia, and BMI together mediated 3 %-26 % of the associations. CONCLUSIONS: These findings contribute to our understanding of how physical abuse and physical neglect influence depression. Furthermore, a more effective reduction in the burden of depression can be achieved by managing modifiable mediators.

Predisposing, Precipitating, and Perpetuating Factors of Insomnia in Cancer Survivors.

OBJECTIVES: To explore and characterize predisposing, precipitating, and perpetuating factors of subthreshold, moderate, and severe insomnia in cancer survivors. SAMPLE & SETTING: 135 cancer survivors who self-reported symptom severity on the Insomnia Severity Index during the baseline phase of a randomized clinical trial on insomnia treatment. METHODS & VARIABLES: Participants completed measures assessing predisposing factors (age, sex, race and ethnicity, body mass index), precipitating factors (number of years since cancer diagnosis, depression and anxiety symptoms, health-related quality of life), and perpetuating factors (frequency of consuming alcoholic and caffeinated beverages, napping behavior, dysfunctional beliefs about sleep). RESULTS: In the multivariate model, being female was protective against insomnia, and being a person of color, having higher anxiety, having more depression symptoms, and having stronger dysfunctional beliefs about sleep were significantly associated with greater insomnia severity. IMPLICATIONS FOR NURSING: By fostering interprofessional collaboration and implementing evidence-based interventions, nurses can contribute to the well-being of cancer survivors and address their sleep-related challenges. This study underscores the importance of regular insomnia screenings for cancer survivors, with nurses as essential facilitators.

Inter-relationships of depression and insomnia symptoms with life satisfaction in stroke and stroke-free older adults: Findings from the Health and Retirement Study based on network analysis and propensity score matching.

BACKGROUND: Depression and insomnia are common co-occurring psychiatric problems among older adults who have had strokes. Nevertheless, symptom-level relationships between these disorders remain unclear. OBJECTIVES: In this study, we compared inter-relationships of depression and insomnia symptoms with life satisfaction among older stroke patients and stroke-free peers in the United States. METHODS: The study included 1026 older adults with a history of stroke and 3074 matched controls. Data were derived from the US Health and Retirement Study. Depression, insomnia and life satisfaction were assessed. Propensity score matching was employed to identify demographically-similar groups of stroke patients and controls. Central and bridge symptoms were assessed using Expected influence (EI) and bridge EI, respectively. RESULTS: The prevalence of depression in the stroke group (25.0 %) was higher than that of controls (14.3 %, P < 0.001). In stroke group, "Feeling depressed" (CESD1; EI: 5.80), "Feeling sad" (CESD7; EI: 4.67) and "Not enjoying life" (CESD6; EI: 4.51) were the most central symptoms, while "Feeling tired in the morning" (JSS4; BEI: 1.60), "Everything was an effort" (CESD2; BEI: 1.21) and "Waking up during the night" (JSS2; BEI: 0.98) were key bridge symptoms. In controls, the most central symptoms were "Lack of happiness" (CESD4; EI: 6.45), "Feeling depressed" (CESD1; EI: 6.17), and "Feeling sad" (CESD7; EI: 6.12). Furthermore, "Feeling tired in the morning" (JSS4; BEI: 1.93), "Everything was an effort" (CESD2; BEI: 1.30), and "Waking up too early" (JSS3; BEI: 1.12) were key bridge symptoms. Life satisfaction had the most direct associations with "Not enjoying life" (CESD6) and "Feeling lonely" (CESD5) in the two groups, respectively. CONCLUSION: Older adults with stroke exhibited more severe depression and insomnia symptoms. Interventions targeting central and bridge symptoms may help to mitigate the co-occurrence of these symptoms.

Testing the reciprocal relationship between depressive symptoms and insomnia.

BACKGROUND: Although the importance of sleep difficulties in emotional disorders has long been acknowledged, the nature of the potential reciprocal relationship between sleep and depressive symptoms is not yet well understood. The coronavirus disease 19 pandemic provided a unique opportunity to study the interrelation of these symptoms over a period marked by increases in sleep and psychological difficulties. METHODS: Using online data collection, we followed 1200 adults (59% male) through 1 year of the pandemic. Measures of sleep disturbance and depressive symptoms were assessed at eight time points. Factor analysis of the items from these two measures suggested separate insomnia and depressive symptom factors. A random intercept cross-lagged panel model was used to assess within-person relationships between factor analysis-informed subscales of insomnia and depressive symptoms. RESULTS: Depressive symptoms predicted subsequent changes in insomnia symptoms; however, insomnia did not predict changes in depressive symptoms. CONCLUSIONS: Our findings suggest the impact of depressive symptoms on insomnia is evident, but the reverse is not. Implications of this finding along with the need for research addressing depressive symptoms and insomnia as treatment targets are discussed.

Mental health consequences among Sudanese due to the armed conflicts and civil unrest of 2023: a cross-sectional study.

AIM: To investigate depression, anxiety, PTSD, and insomnia levels among Sudanese citizens during the 2023 Armed Forces conflict in Sudan. METHODS: An online survey was distributed. It is composed of five parts, covering the following areas: (a) sociodemographic data; (b) depression assessment; (c) generalized anxiety disorder assessment; (d) post-traumatic stress disorder assessment; and (e) insomnia assessment.Statistical Package for Social Sciences version 27 was used for data analysis; frequency and percentage were used to describe the qualitative variables. The Pearson correlation coefficient and Chi-square test were used for correlation and association analysis; a p-value equal to or less than .05 was considered statistically significant. RESULTS: The study included 221 participants, whose ages were 35.02 ± 11.83 years. Among the participants, 57.5% were female. The length of stay in the war zone was 39.29 ± 31.71 days. The sound of gunfire, bombs, or explosions was the most frequent war violence personally experienced by participants or their family members, friends, or acquaintances, in 203 (91.8%) and 221 (100%), respectively. Moderate-severe and severe depression were present in 25.3% and 62.0%, respectively. Moderate and severe anxiety were present in 36.2% and 52.9%, respectively. 58.8% had PTSD. Sub-threshold insomnia was present in 57.5%. There was a negative correlation between sex (female) and depression (correlation coefficient = -.183, p-value = .006), which indicates that depression is more likely to be in females. For PTSD, there was a negative correlation between age and PTSD (correlation coefficient = -.150, p-value = 0.026), which indicates that younger age groups were more likely to experience PTSD. Additionally, there was a negative correlation between marital status (married) and PTSD (correlation coefficient = -.175, p-value = .009), which indicates that married participants were more likely to experience PTSD. CONCLUSIONS: Exposure to war-related trauma can also lead to mental health issues. These findings emphasize the urgent need for proper mental health support and interventions in war-affected areas to address the prevalent mental disorders.

Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective.

STUDY OBJECTIVES: Various models of insomnia stress the role of cognitive components, such as dysfunctional sleep-related beliefs, in maintenance and exacerbation of insomnia. This study aimed to use network analysis to identify the particular beliefs that are central and have strong associations with insomnia severity. In addition, we aimed to use a relative importance network to map out predictive pathways between types of dysfunctional beliefs and insomnia severity. METHODS: This study was a retrospective study, with data collected from 219 patients with insomnia. Patients' responses to the Dysfunctional Beliefs about Sleep Scale-16 (DBAS-16) and Insomnia Severity Index (ISI) were collected. All network analyses were performed using R Studio to produce 3 networks: (1) DBAS-16 network, (2) DBAS-16 and ISI network, and (3) relative importance network containing DBAS-16 subscales and ISI. RESULTS: Beliefs reflecting overestimation of negative consequences of sleep (eg, "insomnia is ruining life"), loss of ability (eg, "worry about losing abilities to sleep"), and unpredictability (eg, "can't predict sleep quality") were identified as most central and strongly associated with insomnia severity. Worry/helplessness about insomnia had the largest predictive value on insomnia severity, and also acted as a mediator between other subscales and insomnia severity. CONCLUSIONS: The results of our study suggest that overestimation of negative consequences, loss of ability, and unpredictability are key beliefs that exacerbate and maintain insomnia, thus supporting existing cognitive models of insomnia. CITATION: Cha EJ, Hong S, Kim S, Chung S, Jeon HJ. Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective. J Clin Sleep Med. 2024;20(5):743-751.

The mediating role of attention deficit in relationship between insomnia and social cognition tasks among nurses in Saudi Arabia: A cross-sectional study.

Purpose: Insomnia-related affective functional disorder may negatively affect social cognition such as empathy, altruism, and attitude toward providing care. No previous studies have ever investigated the mediating role of attention deficit in the relationship between insomnia and social cognition. Methods: A cross-sectional survey was carried out among 664 nurses (Mage = 33.03 years; SD ± 6.93 years) from December 2020 to September 2021. They completed the Scale of Attitude towards the Patient (SAtP), the Athens Insomnia Scale (AIS), a single-item numeric rating scale assessing the increasing severity of attention complaints, and questions relating to socio-demographic information. The analysis was carried out by examining the mediating role of attention deficit in the relationship between insomnia and social cognition. Results: The prevalence of insomnia symptoms was high (52% insomnia using the AIS). Insomnia was significantly correlated with attention problems (b = 0.18, standard error (SE) = 0.02, p < 0.001). Attention problems were significantly negatively correlated with nurses' attitudes towards patients (b = -0.56, SE = 0.08, p < 0.001), respect for autonomy (b = -0.18, SE = 0.03, p < 0.001), holism (b = -0.14, SE = 0.03, p < 0.001), empathy (b = -0.15, SE = 0.03, p < 0.001), and altruism (b = -0.10, SE = 0.02, p < 0.001). Attention problems indirectly mediated the effect of insomnia on attitudes toward patients (99% CI = -0.10 [-0.16 to -0.05]), respect for autonomy (99% CI = -0.03 [-0.05 to -0.02]), holism (99% CI = -0.02 [-0.04 to -0.01]) empathy (99% CI = -0.03 [-0.04 to -0.01]), and altruism (99% CI = -0.02 [-0.03 to -0.01]). Conclusion: Nurses with insomnia-related attention problems are likely to have poor explicit social cognition such as attitude toward patients, altruism, empathy, respect for autonomy, and holism.

Depression, anxiety and insomnia in Chinese older adults and their family caregivers during the COVID-19 pandemic: an actor-partner interdependence model approach.

Aims: This study aimed to explore the dyadic effects of depression and anxiety on insomnia symptoms in Chinese older adults and their caregivers living in a community setting. Methods: Data were collected from 1,507 pairs of older adults and their caregivers who were in the Guangdong Mental Health Survey in China. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder module 7 (GAD-7), and Insomnia Severity Index (ISI) were used to measure depression, anxiety, and insomnia symptoms. Actor-Partner Interdependence Models (APIM) were used to determine whether anxiety or depression symptoms predicted individual or dyadic insomnia. Results: Older adults' and caregivers' depression and anxiety had significant positive correlations with their own and their caregivers' insomnia symptoms (all P < 0.001). Actor effects were found between depression and insomnia symptoms in both older adults and caregivers (B = 0.695, P < 0.001; B = 0.547, P < 0.001, respectively), with one significant partner effects (B = 0.080, P = 0.007). Actor effects were also found between anxiety and insomnia symptoms in both older adults and caregivers (B = 0.825, P < 0.001; B = 0.751, P < 0.001, respectively), with one significant partner effects (B = 0.097, P = 0.004). However, the caregivers' depression and anxiety were not associated with older adults' insomnia symptoms in the APIM analyses. Conclusions: Older adults and their caregivers had an interrelationship between psychological distress and insomnia. Consequently, healthcare providers might consider involving dyads when designing programs to reduce insomnia and improve psychological distress for family caregivers.

The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: Visual impairment could worsen sleep/wake disorders and cognitive decline. OBJECTIVE: To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site. METHOD: HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations. RESULT: Sleepiness (ß= 0.04; p < 0.01) and insomnia (ß= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (ß= -0.16; p < 0.001) and on average 7-years later (ß= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (ß= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations. CONCLUSION: Self-reported visual impairment was independently associated with worse cognitive function and decline.

El tratamiento psicológico del insomnio durante la infancia: Una revisión paraguas / The psychological treatment of insomnia during childhood: An umbrella review

El insomnio es un problema muy frecuente en niños y adolescentes y está relacionado con numerosos resultados negativos. La evidencia sobre lasintervenciones psicológicas efectivas en el tratamiento del insomnio infantil ha ido en aumento, pero carece de una síntesis exhaustiva de los hallazgos. Por ello, realizamos una revisión sistemática de revisiones sistemáticas y meta-análisis sobre la efectividad de las intervenciones psicológicasen el tratamiento del insomnio infantil. Se realizaron búsquedas en la base de datos PsycINFO, hasta julio de 2022, mediante una combinaciónde palabras clave. Los datos fueron extraídos de forma independiente por las dos autoras y se presentó una síntesis de los resultados. La calidadmetodológica fue evaluada de forma independiente por las dos autoras, utilizando AMSTAR-2. Se incluyeron cuatro artículos que informaron, engeneral, sobre la efectividad de las intervenciones psicológicas para disminuir los síntomas de insomnio durante la infancia y adolescencia, tanto acorto como a largo plazo. Las revisiones incluidas fueron calificadas con una calidad metodológica baja, lo que debilita la evidencia de los resultados reportados. Se encontró que actualmente la Terapia Cognitivo Conductual es la intervención psicológica más basada en la evidencia y la másefectiva, independientemente del formato de tratamiento. Se necesitan realizar más ensayos clínicos aleatorios de alta calidad. (AU)

Insomnia is a very common problem in children and adolescents andis associated with numerous negative outcomes. Evidence for effective psychological interventions in the treatment of childhood insomnia has beenincreasing, but lacks a comprehensive synthesis of findings. Therefore, we conducted a systematic review of systematic reviews and meta-analyseson the effectiveness of psychological interventions in the treatment of childhood insomnia. We searched the PsycINFO database, until July 2022, using a combination of keywords. Data were extracted independently by the two authors and a synthesis of the results was presented. Methodologicalquality was assessed independently by the two authors using AMSTAR-2. Four articles were included that reported, in general, on the effectivenessof psychological interventions to decrease insomnia symptoms during childhood and adolescence, both in the short and long term. The includedreviews were rated with low methodological quality, which weakens the evidence for the reported results. CBT was currently found to be the mostevidence-based and effective psychological intervention, regardless of treatment format. More high-quality randomized clinical trials are needed. (AU)

Efficacy of cognitive behavioural therapy for insomnia or sleep disturbance in pregnant women: A systematic review ad meta-analysis.

During pregnancy many women may experience negative emotions and sleep disturbances. This systematic review and meta-analysis was conducted to assess the efficacy of cognitive behavioural therapy for insomnia (CBT-I) or sleep disturbance in pregnant women. From the earliest available publications to 15 April 2022, seven electronic literature databases were searched: PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database for Chinese Science and Technology Journal. Randomised controlled trials of CBT-I in pregnant women with insomnia or sleep disorders were included. The methodological bias of the included studies was assessed using the Cochrane risk of bias tool. The meta-analysis was performed using RevMan 5.4 software. Stata Statistical Software: Release 15 was used for sensitivity analysis and publication bias. We included eight randomised controlled trials involving 743 pregnant women. Meta-analysis showed that, compared with the control group, CBT-I significantly improved the Insomnia Severity Index (mean difference [MD] = -4.25, 95% confidence interval [CI, -6.32, -2.19], p < 0.001), The Pittsburgh Sleep Quality Index (MD = -3.30, 95% CI [-4.81, -1.79], p < 0.001), sleep onset latency (standardised mean difference [SMD] = -1.25, 95% CI [-2.01, -0.50], p = 0.001), anxiety (SMD = -0.99, 95% CI [-1.32, -0.67], p < 0.001), and depression (SMD = -0.40, 95% CI [-0.72, -0.07], p = 0.02). No significant differences were found in total sleep time (SMD = 0.31, 95% CI [-0.54, 1.17], p = 0.47) and sleep efficiency (SMD = 0.80, 95% CI [-0.53, 2.13], p = 0.24). CBT-I significantly improved pregnant women's sleep quality, insomnia severity, depression, and anxiety. This meta-analysis provides evidence that CBT-I is valid for insomnia or sleep disturbances during pregnancy.