Profiles of sleep changes during the COVID-19 pandemic: Demographic, behavioural and psychological factors.

This study aimed to evaluate changes in sleep during the COVID-19 outbreak, and used data-driven approaches to identify distinct profiles of changes in sleep-related behaviours. Demographic, behavioural and psychological factors associated with sleep changes were also investigated. An online population survey assessing sleep and mental health was distributed between 3 April and 24 June 2020. Retrospective questions were used to estimate temporal changes from before to during the outbreak. In 5,525 Canadian respondents (67.1% females, 16-95 years old: Mean ± SD = 55.6 ± 16.3 years), wake-up times were significantly delayed relative to pre-outbreak estimates (p < .001, ηp2  = 0.04). Occurrences of clinically meaningful sleep difficulties significantly increased from 36.0% before the outbreak to 50.5% during the outbreak (all p < .001, g ≥ 0.27). Three subgroups with distinct profiles of changes in sleep behaviours were identified: "Reduced Time in Bed", "Delayed Sleep" and "Extended Time in Bed". The "Reduced Time in Bed" and "Delayed Sleep" subgroups had more adverse sleep outcomes and psychological changes during the outbreak. The emergence of new sleep difficulties was independently associated with female sex, chronic illnesses, being employed, family responsibilities, earlier wake-up times, higher stress levels, as well as heavier alcohol use and television exposure. The heterogeneity of sleep changes in response to the pandemic highlights the need for tailored interventions to address sleep problems.

The associations of self-stigma, social constraints, and sleep among Chinese American breast cancer survivors.

PURPOSE: The aim of the current study was to examine the incidence of poor sleep quality, medication use, and dysfunction and the association of self-stigma and perceived social constraints (i.e., ambivalence over emotional expression; AEE) on sleep among a sample of Chinese American breast cancer survivors. METHODS: The data were based on self-report baseline data (n = 136) from an expressive writing intervention study for Chinese American breast cancer survivors (MTime since diagnosis = 27.17 months; SD = 19.31). Participants completed self-report questionnaires related to psychological and physical health and health behaviors. Using linear regression and path modeling, our hypotheses were tested using models where (1) self-stigma predicted sleep characteristics (i.e., quality, medication use, and dysfunction) with (2) AEE mediating the relationship between self-stigma and sleep. RESULTS: Participants frequently reported poor sleep quality (44.9%), use of sleep aids (37.5%), and difficulty staying awake during the day (37.5%). Greater self-stigma was related to greater AEE (b = .48, SE = .09, p < .05), which was related to worse sleep quality (b = - .19, SE = .08, p < .05), greater use of sleep aids (b = .25, SE = .11, p < .05), and greater difficulty staying awake during the day (b = .30, SE = .09, p < .05). Further, the indirect effect of self-stigma on sleep quality (ab = - .09, 95% CI - .19, - .03), use of sleep aids (ab = .12, 95% CI .03, .25), and difficulty staying awake during the day (ab = .15, 95% CI .06, .18) through AEE was significant. CONCLUSION: The results of this study highlight significant sleep-related problems among Chinese American breast cancer survivors and the importance of considering cultural beliefs of cancer in counseling. IMPLICATION FOR CANCER SURVIVORS: Chinese American breast cancer survivors are at risk for sleep-related difficulties due, in part, to perceived self-stigma and emotional constraints. Greater education and community outreach to Chinese communities may help destigmatize breast cancer and encourage emotional expression around cancer-related topics.

Practical management of behavioral problems in mucopolysaccharidoses disorders.

The mucopolysaccharidosis (MPS) disorders are caused by deficiencies of specific lysosomal enzymes, resulting in progressive glycosaminoglycan (GAG) accumulation in cells and tissues throughout the body. Excessive GAG storage can lead to a variety of somatic manifestations as well as primary and secondary neurological symptoms. Behavioral problems (like hyperactivity, attention difficulties, and severe frustration) and sleeping problems are typical primary neurological symptoms of MPS caused by GAG accumulation in neurons, and are frequently observed in patients with MPS I, II, III, and VII. As these problems often place a significant burden on the family, proper management is important. This review summarizes current insights into behavioral and sleeping problems in MPS disorders and the most optimal management approaches, as presented and discussed during a meeting of an international group of experts with extensive experience in managing and treating MPS.

Co-sleeping in school-aged children with a motor disability: a comparative population-based study.

AIM: To determine the prevalence and determinants of co-sleeping in school-aged children with a motor disability compared with the school-aged general population. METHOD: A questionnaire on demographic characteristics and co-sleeping habits, along with the Sleep Disturbance Scale for Children (SDSC), was sent to parents of children aged between 4 years and 18 years followed in our tertiary paediatric neurorehabilitation clinic, and to school-aged children in a representative sample of state schools. RESULT: We analysed responses for 245 children with motor disability (142 males, 103 females; mean age 10y 6mo, standard deviation [SD] 3y 10mo, range 4-18y) and 2891 of the general population (1484 males, 1497 females; mean age [SD] 9y 6mo [3y 5mo], range 4-18y) (response rates 37% and 26% respectively). Cerebral palsy was the most common diagnosis among children with motor disability. Weekly co-sleeping was significantly more common in children with motor disability than in the general population (11.8% vs 7.9% respectively, p=0.032). Special care of the child with motor disability at night, mainly addressing epilepsy, was reported as a cause of co-sleeping by two-thirds of parents. Factors associated with co-sleeping in the motor disability group were age, housing crowding, severe visual impairment, and pathological sleep according to the SDSC. INTERPRETATION: Co-sleeping is common among children with motor disability. It is influenced by personal and medical factors, as well as the requirements for special care at night. Therefore, health professionals should explore sleeping arrangements in families of children with motor disability.

Psychosocial factors at work and sleep problems: a longitudinal study of the general working population in Norway.

PURPOSE: A growing number of longitudinal studies report associations between adverse psychosocial factors at work and sleep problems. However, the evidence regarding the direction of these associations and the effects of changes in exposure across time is limited. This study examined the plausibility of normal, reverse, and reciprocal associations between ten psychosocial factors at work and sleep problems. In addition, we analyzed if reduced exposure across time had the anticipated result of reducing the risk of sleep problems. METHODS: Randomly drawn from the general working-age population, the cohort comprised respondents with an active employee relationship in 2009 and 2013 (N = 5760). Exposures and outcome were measured on two occasions separated by 4 years. We computed several sex-stratified logistic regression models with adjustments for various plausible confounders. RESULTS: We found support for the commonly hypothesized unidirectional forward associations between psychosocial factors at work and sleep problems among women only. Among men, psychosocial stressors at work and sleep problems were reciprocally and reversely related. Nevertheless, reduced exposure levels across time pertaining to effort-reward imbalance (OR = 0.36; 95% CI = 0.19-0.69) and lack of social support (OR = 0.55; 95% CI = 0.32-0.93) among men, and work-family imbalance (OR = 0.26; 95% CI = 0.15-0.46) among women were associated with a robust significant lower risk of sleep problems compared to those in the stable high exposure groups. CONCLUSIONS: The study results suggest that preventive measures targeting effort-reward imbalance and lack of social support among men, and work-family imbalance among women, might contribute to reduce the risk of troubled sleep among employees.

Long-term exposure to residential traffic noise and changes in body weight and waist circumference: A cohort study.

BACKGROUND: Traffic noise can act as a stressor and disturb sleep, and has been associated with cardiovascular disease. Recent studies suggest a possible association to metabolic outcomes and adiposity through biological mechanisms related to physiological stress and sleep disturbance. OBJECTIVES: We aimed to investigate the association between long-term residential traffic noise and changes in adiposity. MATERIALS AND METHODS: The study was based on 39,720 middle-aged Danish men and women from a cohort, with information on weight and waist circumference at two points in time. Residential exposure to traffic noise was calculated for all participants' present and historical addresses using the Nordic prediction method. The associations between traffic noise and changes in adiposity measures after a mean follow-up of 5.3 years were analyzed by linear and logistic regression with adjustments for age, sex, socioeconomic position and lifestyle factors in three models with increasing adjustment. RESULTS: In linear models adjusted for sex, age, socioeconomic position and competing noise sources we found road traffic noise to be significantly associated with small gains in both weight and waist circumference. For example, time-weighted mean exposure 5-years preceding follow-up was associated with a yearly weight gain of 15.4 g (95% confidence interval (CI): 2.14; 28.7) and a yearly increase in waist circumference of 0.22 mm (95% CI: 0.018; 0.43) per 10dB. Similarly, in Poisson regression models we found an 10% increased risk for gaining more than 5 kg body weight during follow-up (95% CI: 1.04; 1.15) per 10 dB higher 5 years exposure preceding follow-up. Exposure to railway noise above 55 dB was associated with weight gain (39.9 g/year (95% CI: 10.2; 69.6)), but not with a significant change in waist circumference. We found baseline BMI (p<0.001) and waist circumference (p=0.001) to be significant effect modifiers for the association between road traffic noise and waist circumference, with gain in waist circumference only among the obese (BMI≥30) participants (1.20 mm/year (95% CI: 0.68; 1.72)) and participants with a large waist circumference (0.83 mm/year (95% CI: 0.42; 1.23)). CONCLUSION: The findings supports previous studies suggesting that traffic noise may be associated with development of adiposity. However, the potential effects are small and suggest an effect mainly among obese participants.

Mood and objective and subjective measures of sleep during late pregnancy and the postpartum period.

This study examined the association between measures of objective sleep (OS) and subjective sleep (SS) to postpartum mood in healthy women from the third trimester of pregnancy to 10 to 12 weeks postpartum. Twenty-nine pregnant women completed self-report measures of mood and SS, and wore actigraphs for 7 continuous days during the third trimester (Time 1), within 15 days (Time 2), and 10 to 12 weeks postpartum (Time 3). The subjective perception of marked daytime dysfunction was associated with low mood during Time 1 and Time 3. Poor nighttime SS was related to low mood only at Time 2, whereas poor nighttime OS influenced stress during the same assessment time. These data indicate a stronger association between postpartum mood and the subjective perception of sleep than with OS quality and duration in healthy, non-depressed women, and highlight the awareness of poor daytime functioning as a significant contributor to new mothers' emotional wellbeing.

Kind attention and non-judgment in mindfulness-based cognitive therapy applied to the treatment of insomnia: state of knowledge.

Psychophysiological insomnia is characterized by acquired sleep difficulties and/or a state of hypervigilance when going to bed. This mental and physiological condition prevents sleep onset regardless of the presence of anxious or depressive disorders. Despite the fact that cognitive behavioural therapies have been shown to be effective for this disorder, some people are not responding to this treatment. It is therefore important to explore new ways of increasing the effectiveness of current treatments. Approaches based on mindfulness, which promote a non-judgemental acceptance of the living experience, are increasingly reported in the literature to be effective in the treatment of various physical and psychological health conditions, being particularly efficient in reducing the stress and discomfort associated with these problems. This article focuses on some cognitive factors associated with maintaining insomnia and suggests that approaches based on mindfulness, through certain action mechanisms, may help to improve sleep. A review of recent studies on the application of mindfulness-based approaches to treat insomnia is hereby presented. Avenues for future research to improve insomnia treatment protocols based on mindfulness are suggested.

Psychometric evaluation of the sleep hygiene index: a sample of patients with chronic pain.

BACKGROUND: Sleep Hygiene Index (SHI) was designed to assess sleep hygiene. Although the SHI has shown adequate psychometric properties in a nonclinical sample, it has not been validated in a sample with chronic pain. Also, its factor structure, measurement error, and incremental validity over and above other factors affecting sleep quality have not been investigated in a nonclinical sample. Thus, this present study aimed to extend prior psychometric investigation of the SHI. Specifically, we evaluated the factor structure, measurement error, and incremental validity as well as the reliabilities and concurrent validity of the SHI in a sample with chronic pain. METHODS: A total of 161 patients seeking treatment in a tertiary pain center located in Seoul, Korea participated. To explore the factor structure of the SHI, we performed an exploratory factor analysis using principal component with varimax. Cronbach's alphas and intraclass correlation coefficients were computed to investigate internal consistency and 2-week test-retest stability of the SHI, respectively. Measurement error was estimated using standard error of measurement and minimum detectable change (MDC) of the SHI. For concurrent validity, Pearson correlations were calculated to examine the relations between the SHI and outcome measures including background variables. Also for incremental validity, a hierarchical multiple regression was performed in relation to sleep quality. RESULTS: Results indicated that two-factor solution is most appropriate; sleep disturbing behavior and environment (B/E) and irregular sleep-wake schedule. Results also showed that the internal consistencies and test-retest stability estimates of the SHI were deemed acceptable. At the 95% confidence level, the MDCs were 5.75 for 'sleep disturbing B/E,' 3.65 for 'irregular sleep-wake schedule,' and 7.49 points for total. The SHI was significantly correlated with age, depression, pain-related anxiety, and sleep quality. Also, sleep quality was significantly predicted by the irregular sleep-wake schedule subscale of the SHI, over and above background variables, pain intensity, depression, pain-related anxiety. CONCLUSIONS: The SHI has the reliability, measurement error, and concurrent and incremental validity support for assessing sleep hygiene in a sample with chronic pain.

Does ethnic-racial socialization matter? A within-person analysis of racial discrimination and sleep health among Black and Latinx emerging adults.

OBJECTIVES: Emerging work suggests that racism-related stressors may contribute to adverse sleep health, yet little is known about how culturally relevant resources may influence the relationship between racism-related stressors and adverse sleep health. The aim of this study was to examine associations between weekly reports of racial hassles and young adults' sleep health (i.e., sleep onset latency, total sleep time, sleep quality) and to determine whether various forms of parental ethnic-racial socialization would moderate these associations. METHODS: Participants were 141 college students (Mage = 20.7 years, standard deviation (SD) = 1.22, 70% female) who identified as either Black (n = 88; 62.4%) or Latinx (n = 53; 37.6%). Participants completed an initial 1.5-hour assessment in the laboratory and 4 weekly sleep diary surveys (assessed sleep health and depressive symptoms). RESULTS: Weekly racial hassles are related to greater sleep onset latency, decreased total sleep time, and poorer sleep quality. The promotion of mistrust and cultural socialization significantly moderated associations between weekly racial hassles and sleep onset latency and total sleep time, respectively. CONCLUSIONS: These results provide supportive evidence that parental ethnic-racial socialization practices, a preemptive cultural resource, may be an understudied mechanism in sleep health research. Future research is needed to clarify the role of parental ethnic-racial socialization in promoting sleep health equity among youth and young adults.

Rectal cancer patients' quality of life with a temporary stoma: shifting perspectives.

BACKGROUND: Patients with rectal cancer who have a temporary ostomy report good quality of life despite identifying a number of stoma-related difficulties. OBJECTIVE: This study aimed to qualitatively explore the experiences of patients with rectal cancer who have a temporary ileostomy to better understand the discordant findings of previous quantitative quality-of-life studies. DESIGN/SETTING: We conducted in-depth qualitative interviews with patients with stage I to III rectal cancer who underwent sphincter-preserving surgery that resulted in a temporary ileostomy. PATIENTS: Twenty-six patients (54% male, median age 54) participated. Sixty-five percent had stage III disease, and 88% received neoadjuvant therapy. MAIN OUTCOME MEASURES: Interviews examined preoperative expectations, overall experience, and stoma impact on quality of life. With the use of grounded theory, 2 investigators independently performed line-by-line content analysis to identify key themes. Analysis continued until data saturation. RESULTS: Two major themes were identified: stoma-related difficulties and perceived response shift. Patients reported difficulty in exercise, sleep, social activities, sexuality, and clothing. Patients' perception of quality of life with a temporary stoma appears to have undergone a response shift through recalibration of their standards for measuring quality of life (internal measurement scale altered by side effects of neoadjuvant/adjuvant treatment, temporary nature of stoma, and accommodation to stoma) and reconceptualization of what "good quality of life" is (stoma difficulties were felt to be less important in comparison with cancer-related mortality). LIMITATIONS: Although qualitative research is, by design, not generalizable, these data support our previous quantitative work. This convergence of findings suggests that our data may be representative. CONCLUSIONS: A temporary ileostomy represents significant difficulties for patients with rectal cancer. However, because of response shift, these difficulties may not be perceived as important to overall quality of life when considered within the context of the cancer experience. Our results can inform preoperative consultations with patients who have rectal cancer to assist in aligning patient expectations of what life with a temporary ileostomy may be like.

Behavioral sleep problems in children and adolescents.

Sleep problems in children and adolescents are common, and they impact multiple domains of child and family functioning. Psychologists have a critical role in the assessment and treatment of sleep problems and are integral to interdisciplinary sleep teams. Certain sleep problems may be related to co-morbid psychological or developmental conditions, and others are considered to be primarily medical, yet behavioral approaches may be applicable. There are also sleep problems considered to be behavioral in etiology (e.g. inadequate sleep hygiene, behavioral insomnia of childhood, nightmares/bad dreams/nighttime fears, delayed sleep phase syndrome, and psychophysiological insomnia). In this article, the assessment of behavioral sleep problems, as well as specific behavioral sleep disorders, and their treatments will be discussed.

Sleep Dysfunction is an Independent Predictor of Productivity Losses in Patients with Chronic Rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is known to have a significant impact on economic productivity. Sleep dysfunction is associated with staggering productivity losses and is highly prevalent in patients with CRS. The effect of sleep dysfunction on productivity in CRS has not been elucidated. The objective of this study was to determine the relationship between sleep dysfunction and lost productivity in patients with CRS. METHODS: Eighty-two adult patients with CRS were prospectively enrolled into a cross-sectional cohort study. Patients with obstructive sleep apnea were excluded. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Presenteeism (reduced work efficiency), absenteeism (missed work days), and lost work, household, and overall productivity were analyzed. The primary aim was assessing the correlation between PSQI and productivity. Regression analyses were performed to account for disease severity, pain, and depression. RESULTS: Sleep dysfunction is significantly correlated with overall lost productivity (R2 = 0.397, P < .05). Presenteeism is the most strongly affected by sleep dysfunction (R2 = -0.441, P < .001). Higher PSQI scores were significantly associated with productivity losses, whereas lower scores were not. Sleep remained an independent predictor of productivity when regression analysis accounted for disease severity, depression, and pain. CONCLUSION: Sleep dysfunction has a significant association with lost productivity in patients with CRS, particularly with worsening PSQI scores. More clearly defining those components of CRS that most impact a patient's daily function will allow clinicians to more optimally manage and counsel patients with CRS.

Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study.

OBJECTIVES: Young people are sleeping less. Short sleep duration has a range of negative consequences including a hypothesized link with psychological distress, which has yet to be studied DESIGN: Prospective cohort study SETTING: Community-based sample from Australia PARTICIPANTS: Twenty thousand (20,822) young adults (aged 17-24) identified through the state vehicle licensing authority. A random sample (n = 5000) was approached for follow-up 12-18 months later, with 2837 providing full data. MAIN OUTCOME MEASURE: Psychological distress, determined by a Kessler 10 score > 21, at baseline; and as both onset and persistence of distress at follow-up. RESULTS: Shorter sleep duration was linearly associated with prevalent psychological distress: relative risk (RR) 1.14 (95% CI 1.12 to 1.15). Only the very short (< 5 h) sleepers among those not distressed at baseline had an increased risk for onset of psychological distress (RR 3.25 [95% CI 1.84, 5.75]). Of 945 cohort participants reporting psychological distress at baseline, 419 (44%) were distressed at follow-up. Each hour less of sleep increased the risk of psychological distress persisting after adjustment for potential confounding variables: RR 1.05 (95% CI 1.01 to 1.10). Long sleep duration showed no association with distress at any time point. CONCLUSIONS: Self-reported shorter sleep duration is linearly associated with prevalent and persistent psychological distress in young adults. In contrast, only the very short sleepers had a raised risk of new onset of distress. Different approaches to sleep duration measurement yield different results and should guide any interventions to improve subjective sleep duration in young adults.

Sleep complaints in middle-aged women and men: the contribution of working conditions and work-family conflicts.

This study aimed to examine how physical working conditions, psychosocial working conditions and work-family conflicts are associated with sleep complaints, and whether health behaviours explain these associations. We used pooled postal questionnaire surveys collected in 2001-2002 among 40-60-year-old employees of the City of Helsinki (n = 5819, response rate 66%). Participants were classified as having sleep complaints if they reported sleep complaints at least once a week on average (24% of women and 20% of men). Independent variables included environmental work exposures, physical workload, computer work, Karasek's job strain and work-family conflicts. Age, marital status, occupational class, work arrangements, health behaviours and obesity were adjusted for. Most working conditions were associated strongly with sleep complaints after adjustment for age only. After adjustment for work-family conflicts, the associations somewhat attenuated. Work-family conflicts were also associated strongly with women's [odds ratio (OR) 5.90; confidence interval (CI) 4.16-8.38] and men's sleep (OR 2.56; CI 1.34-4.87). The associations remained robust even after controlling for unhealthy behaviours, obesity, health status, depression and medications. Physically strenuous working conditions, psychosocial job strain and work-family conflicts may increase sleep complaints. Efforts to support employees to cope with psychosocial stress and reach a better balance between paid work and family life might reduce sleep complaints. Sleep complaints need to be taken into account in worksite health promotion and occupational health care in order to reduce the burden of poor sleep.

Predictors of sleep quality in hemodialysis patients.

PURPOSE: Poor sleep quality (SQ) is common in hemodialysis (HD) patients. Factors associated with poor SQ are not well understood. The objectives of the present study were to determine the prevalence of poor SQ in HD patients in our region and to examine the association between SQ and health-related quality of life (HRQoL), depression, and certain clinical and laboratory parameters. METHODS: A total of 233 HD patients at 5 centers in the city center of Konya, Turkey were included in this study. Their demographic data and biochemical parameters were analyzed. All patients were instructed to complete Turkish versions of three questionnaires, namely, a modified post-sleep inventory (PSI), Beck Depression Inventory (BDI) and a Short Form of Medical Outcomes Study (SF-36). RESULTS: The mean age of the patients was 52.8 +/- 15.3 years and the male to female ratio was 1.33:1. The prevalence of poor sleepers, defined as those having a total sleep score (PSI-4 score) > or = 4, was 60.9%. Compared with good sleepers, poor sleepers had higher BDI scores and as well as lower PCS and MCS domains of HRQoL. In addition, poor sleepers were older and more likely to be unemployed. There was a significant inverse correlation of PSI-4 score with PCS and MCS, and significant positive correlation of PSI-4 score with BDI and age (p < 0.001). The significant independent predictors of PSI-4 score were BDI score, MCS score and employment status. CONCLUSIONS: Depression, MCS score and employment status were the most important predictors of sleep quality in HD patients.

Sleep disturbance due to noise: current issues and future research.

There is growing interest in carrying out further research to understand and reduce the impact of aircraft noise on airport neighborhood in anticipation of the projected substantial increase in global aviation. Soundscapes provide new analytical methods and a broader, more comprehensive appreciation of the aural environment, which may have a useful role in understanding noise-induced sleep disturbance and annoyance. Current noise metrics like Leq do not provide a common language to report noise environment to residents, which is a key obstacle to effective noise management and acceptance. Non-auditory effects complicate the production of consistent dose-response functions for aircraft noise affecting sleep and annoyance. There are various end-points that can be chosen to assess the degree of sleep disturbance, which has detracted from the clarity of results that has been communicated to wider audiences. The World Health Organization (WHO-Europe) has produced Night Noise Guidelines for Europe, which act as a clear guide for airports and planners to work towards. Methodological inadequacies and the need for simpler techniques to record sleep will be considered with the exciting potential to greatly increase cost-effective field data acquisition, which is needed for large scale epidemiological studies.

Analysis of Psychological and Sleep Status and Exercise Rehabilitation of Front-Line Clinical Staff in the Fight Against COVID-19 in China.

BACKGROUND The aim of this study was to understand the changes in psychological factors and sleep status of front-line medical staff in the fight against COVID-19 and provide evidence of exercise interventions to relieve psychological stress and improve sleep status for medical staff. MATERIAL AND METHODS A survey study was conducted among 120 front-line medical staff in the fight against COVID-19, of which 60 medical staff worked at the designated hospital (experimental group) and 60 medical staff worked at the non-designated hospital (control group). The Symptom Checklist 90 (SCL-90), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and PTSD Checklist-Civilian Version (PCL-C) were used to assess mental status. Sleep status was assessed using the Pittsburgh Sleep Quality Index (PSQI). RESULTS SCL-90 scores of somatization, depression, anxiety, and terror were higher than normal in front-line medical staff at the designated hospital. The SAS (45.89±1.117), SDS (50.13±1.813), and PCL-C (50.13±1.813) scores in the experimental group were higher than the normal control group, and were significantly different from those in the control group on SDS and PCL-C scales (P<0.05). The total average PSQI of the experimental group was 16.07±3.761, indicating that the sleep quality was poor. Among them, participants with moderate insomnia reached 61.67%, and participants with severe insomnia reached 26.67%. CONCLUSIONS There are psychological symptoms and sleep symptoms in front-line medical staff who participate in the fight against COVID-19, and they affect each other. Hospitals should improve emergency management measures, strengthen psychological counseling for clinical front-line medical staff, strengthen exercise intervention, and improve their sleep quality and mental health.

Association of restless legs syndrome with nocturnal eating: a case-control study.

We investigated the prevalence of nocturnal eating (sleep-related eating disorder-SRED or night-eating syndrome-NES) in patients with restless legs syndrome (RLS). One hundred RLS patients living in Emilia-Romagna (Northern Italy) and 100 matched controls randomly selected from the general population received two telephone interviews, and were investigated for socio-demographic characteristics, general health status, and presence of nocturnal eating. Additionally, subjects underwent interviews for psychopathological traits [by means of the Eating Disorder Inventory-2 (EDI-2), the Maudsley Obsessive-Compulsive Inventory (MOCI), the Beck Depression Inventory (BDI)], excessive daytime sleepiness (EDS), and subjective sleep quality. Compared with controls, RLS patients had more frequently pathological MOCI scores (24% versus 10%, P = 0.03), used significantly more drugs for concomitant diseases and had more nocturnal sleep impairment and EDS. SRED was more prevalent in RLS patients than controls (SRED: 33% versus 1%, P < 0.001). Medication use and pathological MOCI scores were more prevalent in RLS patients with SRED than among RLS patients without SRED. Use of dopaminergic or hypnotic drugs for RLS was not correlated with the presence of SRED. We demonstrate an association between RLS and SRED. Prospective studies are needed to establish the mechanisms underlying such association and whether it is causal.