- "A ruffled mind makes a restless pillow": Reducing depression incidence and severity with dCBT-I. Sleep 2020
Age-dependent associations among insomnia, depression, and inflammation in nurses.
Psychology & health
OBJECTIVE: Insomnia and depression have been inconsistently associated with inflammation. Age may be one important moderator of these associations. This study examined associations between insomnia and depression with inflammatory biomarkers in nurses and how these associations varied by age. Design: Participants were 392 nurses ages 18-65 (M age = 39.54years ± 11.15, 92% female) recruited from two hospitals. Main outcome measures: Participants completed surveys to assess insomnia and depression symptoms. Serum samples were obtained and analysed for inflammatory biomarkers interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-1 beta (IL-1beta), and tumour necrosis factor alpha (TNF-alpha). Results: Neither insomnia nor depression symptoms were associated with inflammatory biomarkers. Older age was associated with higher IL-1beta, and age moderated the effects of depression symptoms on CRP and TNF-alpha: Greater depression symptoms were associated with higher CRP (b = .14, p = .017) and TNF-alpha (b = .008, p = .165) among older nurses only. Conclusion: Results suggest older nurses with higher depression symptoms may be at increased risk for elevated inflammation. Interventions should consider the role of age-related processes in modifying health and well-being. Given relatively low levels of depression in the current sample, future studies should replicate results in clinical and non-nurse samples.
View details for DOI 10.1080/08870446.2020.1805450
View details for PubMedID 32795158
The Cycle of Daily Stress and Sleep: Sleep Measurement Matters.
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
BACKGROUND: Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress.PURPOSE: We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG).METHODS: Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]).RESULTS: Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (beta = -0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (beta = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity.CONCLUSIONS: Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary-not redundant-sleep measurement approaches.
View details for DOI 10.1093/abm/kaaa053
View details for PubMedID 32756869
Intraindividual variability in sleep and levels of systemic inflammation in nurses.
OBJECTIVE: Disturbed sleep is common among nurses and is associated with morbidity and mortality. Inflammation may be one mechanism linking sleep and disease. Yet most studies have relied on retrospective questionnaires to assess sleep, which fail to account for night-to-night fluctuations in sleep across time (i.e., intraindividual variability (IIV]). We examined prospective associations between mean and IIV in sleep with inflammation markers in nurses.METHODS: Participants were 392 nurses (Mage = 39.54, 92% female; 23% night-shift working) who completed 7 days of sleep diaries and actigraphy to assess mean and IIV in total sleep time (TST) and sleep efficiency (SE). Blood was drawn on day 7 to assess inflammation markers C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 beta (IL-1beta).RESULTS: Greater intraindividual variability in TST - measured via both actigraphy and sleep diary - was associated with higher IL-6 (actigraphy beta = 0.05, p = .046, sr = .01; diary beta = 0.04, p = .030, sr = .01) and IL-1beta (actigraphy beta = 0.12, p = .008, sr = .02; diary beta = 0.09, p = .025, sr = .01), but not CRP or TNF- alpha. IIV in actigraphy- and sleep diary-determined SE was not associated with inflammation biomarkers, nor were any mean sleep variables. Shift work did not moderate any associations.CONCLUSIONS: Nurses with more variable sleep durations had elevated levels of inflammation, which may increase risk for development of inflammatory-related diseases. Research should investigate how sleep regularization may change levels of inflammation and improve health.
View details for DOI 10.1097/PSY.0000000000000843
View details for PubMedID 32697443
BIDIRECTIONAL ASSOCIATIONS BETWEEN DAILY STRESS TRAJECTORIES AND SLEEP IN A COMMUNITY SAMPLE
LIPPINCOTT WILLIAMS & WILKINS. 2020: A103?A104
View details for Web of Science ID 000549961200289
Beyond the mean: Personality, social jetlag, and night-to-night variability in sleep
LIPPINCOTT WILLIAMS & WILKINS. 2020: A141
View details for Web of Science ID 000549961200395
Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review.
Annals of internal medicine
BACKGROUND: The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear.PURPOSE: To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function.DATA SOURCES: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020.STUDY SELECTION: Randomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure.DATA EXTRACTION: Data were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools.DATA SYNTHESIS: Of 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n= 118844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease.LIMITATIONS: Study heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment.CONCLUSION: Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations.PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).
View details for DOI 10.7326/M20-0299
View details for PubMedID 32568573
Nightmares and Insomnia in the US National Guard: Mental and Physical Health Correlates.
International journal of behavioral medicine
BACKGROUND: Nightmares and insomnia are significant concerns that commonly co-occur with each other and with other health disorders. Limited research has examined the unique and shared aspects of insomnia and nightmares, and little is known about sleep in US National Guard personnel. This study sought to determine the prevalence and psychosocial correlates of nightmares with and without insomnia in US National Guard personnel.METHOD: National Guard personnel (N=841) completed an online survey and were classified as having nightmares only, insomnia only, both, or neither, using a minimum nightmare frequency of "less than once a week" and an Insomnia Severity Index cutoff of ?15. Analyses examined differences in demographics, physical health, and psychosocial variables and in the prevalence of nightmares and insomnia in personnel with physical and mental health problems.RESULTS: In this sample, 32% reported nightmares only, 4% reported insomnia only, and 12% reported both. Those in the youngest age group (18-21) were more likely to have no nightmares or insomnia. Those with both nightmares and insomnia had more deployments. Nightmares and insomnia were associated with poorer physical and mental health and greater prevalence of comorbid physical and mental health conditions. Personnel with both insomnia and nightmares reported the greatest severity of comorbid conditions.CONCLUSION: US National Guard personnel with nightmares and/or insomnia reported worse mental and physical health impairment than those without these conditions. Personnel may benefit from screening for nightmares and insomnia and referrals for evidence-based treatment.
View details for DOI 10.1007/s12529-020-09889-2
View details for PubMedID 32495239
The Development of a Brief Version of the Insomnia Severity Index (ISI-3) in Older Adult Veterans with Posttraumatic Stress Disorder.
Behavioral sleep medicine
OBJECTIVE/BACKGROUND: The Insomnia Severity Index (ISI) is an insomnia self-report measure used to identify individuals at risk for insomnia disorder. Although the full ISI is only seven questions, a briefer version would allow more efficient and pragmatic administration in routine practice settings. Reliable and valid brief measures can support measurement-based care. The present study was a proof-of-concept study that developed a brief version of the ISI, the ISI-3, in a sample of older adult veterans with posttraumatic stress disorder (PTSD), a group which is at increased risk for insomnia.PATIENTS/METHODS: Participants included 86 older veterans with combat- or military-related PTSD. Veterans completed a clinician-administered PTSD diagnostic interview, self-report measures of insomnia and other psychosocial questionnaires, and two neuropsychological assessments. The factor structure of the ISI was examined to reduce the measure into a brief version. The reliability and validity of the ISI-3 were examined.RESULTS: Principal axis factoring yielded a one-factor solution, which reproduced 59% of the item variance. Item reduction procedures resulted in three items, which best represented this factor ("Insomnia Impact;" ISI-3). For the ISI-3, internal consistency was good (alpha=.89). Convergent validity was demonstrated via moderate to high positive correlations between the ISI-3 and other measures of sleep disturbance. Divergent validity was demonstrated via non-significant correlations between the ISI-3 and unrelated measures and moderate correlations with self-reported depression.CONCLUSIONS: The ISI-3 is a psychometrically valid brief version of the ISI. Clinicians can administer the ISI-3 to screen for insomnia and monitor changes in insomnia during treatment.
View details for DOI 10.1080/15402002.2020.1760278
View details for PubMedID 32475177
INSOMNIA IDENTITY AND PSYCHOSOCIAL HEALTH IN NURSES
OXFORD UNIV PRESS INC. 2020: S376
View details for Web of Science ID 000546262400779
DEVELOPING AND TESTING A WEB-BASED PROVIDER TRAINING FOR COGNITIVE BEHAVIORAL THERAPY OF INSOMNIA
OXFORD UNIV PRESS INC. 2020: S111
View details for Web of Science ID 000546262400228
Validity of Actigraphy in Young Adults With Insomnia
BEHAVIORAL SLEEP MEDICINE
2020; 18 (1): 91?106
Actigraphy is an inexpensive and objective wrist-worn activity sensor that has been validated for the measurement of sleep onset latency (SOL), number of awakenings (NWAK), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) in both middle-aged and older adults with insomnia. However, actigraphy has not been evaluated in young adults. In addition, most previous studies compared actigraphy to in-lab polysomnography (PSG), but none have compared actigraphy to more ecologically valid ambulatory polysomnography.21 young adults (mean age = 19.90 ± 2.19 years; n = 13 women) determined to have chronic primary insomnia through structured clinical interviews.Sleep diaries, actigraphy, and ambulatory PSG data were obtained over a single night to obtain measures of SOL, NWAK, WASO, time spent in bed after final awakening in the morning (TWAK), TST, and SE.Actigraphy was a valid estimate of SOL, WASO, TST, and SE, based on significant correlations (r = 0.45 to 0.87), nonsignificant mean differences between actigraphy and PSG, and inspection of actigraphy bias from Bland Altman plots (SOL ? = 1.52, WASO ? = 7.95, TST ? = -8.60, SE ? = -1.38).Actigraphy was a valid objective measure of SOL, WASO, TST, and SE in a young adult insomnia sample, as compared to ambulatory PSG. Actigraphy may be a valid alternative for assessing sleep in young adults with insomnia when more costly PSG measures are not feasible.
View details for DOI 10.1080/15402002.2018.1545653
View details for Web of Science ID 000501298700008
View details for PubMedID 30472879
Perspective: Cognitive Behavioral Therapy for Insomnia Is a Promising Intervention for Mild Traumatic Brain Injury.
Frontiers in neurology
2020; 11: 530273
Mild traumatic brain injury (mTBI) is a significant public health problem. Insomnia is one of the most common symptoms of TBI, occurring in 30-50% of patients with TBI, and is more frequently reported in patients with mild as opposed to moderate or severe TBI. Although insomnia may be precipitated by mTBI, it is unlikely to subside on its own without specific treatment even after symptoms of mTBI reduce or remit. Insomnia is a novel, highly modifiable treatment target in mTBI, treatment of which has the potential to make broad positive impacts on the symptoms and recovery following brain injury. Cognitive-behavioral therapy for insomnia (CBT-I) is the front-line intervention for insomnia and has demonstrated effectiveness across clinical trials; between 70 and 80% of patients with insomnia experience enduring benefit from CBT-I and about 50% experience clinical remission. Examining an existing model of the development of insomnia in the context of mTBI suggests CBT-I may be effective for insomnia initiated or exacerbated by sustaining a mTBI, but this hypothesis has yet to be tested via clinical trial. Thus, more research supporting the use of CBT-I in special populations such as mTBI is warranted. The current paper provides a background on existing evidence for using CBT-I in the context of TBI, raises key challenges, and suggests considerations for future directions including need for increased screening and assessment of sleep disorders in the context of TBI, examining efficacy of CBT-I in TBI, and exploring factors that impact dissemination and delivery of CBT-I in TBI.
View details for DOI 10.3389/fneur.2020.530273
View details for PubMedID 33117253
Insomnia, Psychosocial Well-Being, and Weight Control Behaviors Among Healthy-Weight Adolescent Females: Brief Report.
International journal of behavioral medicine
Weight control behaviors (WCBs) typically involve appearance- or health-driven behaviors that may be influenced by physiological, psychological, or social factors. Sleep disturbances like insomnia are an important area of research for adolescent populations, as early intervention may result in improvements in other physical and mental health domains. The purpose of this study was to investigate the relationship of insomnia, psychosocial well-being, and current WCBs in healthy-weight female adolescents.Female adolescents (N?=?323; Mage?=?12.33?±?.04) who had healthy body mass index (BMI) levels completed self-report items on insomnia, depression, self-esteem, and physical self-concept. Multivariate analysis of covariance (MANCOVA), controlling for age, was conducted to further examine differences in insomnia and psychosocial variables among the WCB groups.Compared to those who were trying to stay the same weight or not trying to do anything about their weight, the girls who were trying to lose weight had significantly greater insomnia and depression symptoms, and lower self-esteem, with small to medium effect sizes.Clinicians working with adolescent girls should include assessments of WCBs in addition to measures of insomnia symptoms, even for adolescent girls within a normal BMI range, as these are common and frequently co-occurring phenomena. Additional research is needed to further disentangle these complicated relationships.
View details for DOI 10.1007/s12529-020-09872-x
View details for PubMedID 32140933
Treatment of comorbid sleep disorders and posttraumatic stress disorder in active duty military: Design and methodology of a randomized clinical trial.
Contemporary clinical trials
Many individuals with posttraumatic stress disorder (PTSD) also suffer from insomnia and nightmares, which may be symptoms of PTSD or constitute partially independent comorbid disorders. Sleep disturbances are resistant to current treatments for PTSD, and those suffering from PTSD, insomnia, and nightmares have worse PTSD treatment outcomes. In addition, insomnia and nightmares are risk factors for depression, substance abuse, anxiety, and suicide. Cognitive-Behavioral Therapy for Insomnia and Nightmares (CBT-I&N) and Cognitive Processing Therapy (CPT) for PTSD are first line treatments of these conditions. CPT does not typically address insomnia or nightmares, and CBT-I&N does not typically address other symptoms of PTSD. There are limited scientific data on how best to provide these therapies to individuals suffering with all three disorders. This project aims to inform the most effective way to treat individuals suffering from PTSD, insomnia, and nightmares, potentially changing the standard of care. U.S. military personnel and recently discharged Veterans who served in support of combat operations following 9/11 aged 18-65 with PTSD, insomnia, and nightmares (N?=?222) will be randomly assigned to one of the following 18-session individual treatment conditions delivered over 12-weeks: (1) 6 sessions of CBT-I&N followed by 12 sessions of CPT; (2) 12 sessions of CPT followed by 6 sessions of CBT-I&N; or (3) 12 sessions of CPT followed by an additional 6 sessions of CPT. All participants will be assessed at baseline, during treatment, and at 1-week, 1-month, 3-months, and 6-months posttreatment. The primary outcome will be PTSD symptom severity.
View details for DOI 10.1016/j.cct.2020.106186
View details for PubMedID 33091589
The Nightmare Disorder Index: Development and Initial Validation in a Sample of Nurses.
Nurses are a group at high risk for nightmares, yet little is known about the rate of nightmare disorder and associated psychosocial factors in this group in part attributable to the lack of a self-report questionnaire to assess DSM-5 criteria for nightmare disorder. Aims of the current study were to 1) report on development and initial validity of a self-report measure of DSM-5 nightmare disorder, and 2) examine the rate and associated factors of nightmare disorder among nurses.Nurses (N = 460) completed baseline measures online including Nightmare Disorder Index (NDI), psychosocial and demographic questionnaires. A subset (n = 400) completed 14 days of sleep diaries and actigraphy.NDI demonstrated satisfactory psychometric characteristics as indicated by good internal consistency (? = .80), medium inter-item correlations (r = 0.50), medium to large item-total (r = 0.55 - 0.85) and convergent correlations (0.32 - 0.45), and small to medium discriminant correlations (-0.12 - 0.33). Per NDI, 48.7% of nurses reported no nightmares in the past month, 43.9% met partial/subthreshold criteria and 7.4% met full criteria for probable nightmare disorder. Nurses with nightmare disorder demonstrated significantly poorer psychosocial functioning (i.e., posttraumatic stress, depression, anxiety, stress) than those with subthreshold nightmare symptoms, who had poorer functioning than those with no nightmares.NDI is an efficient and valid self-report assessment of nightmare disorder. Nurses have high rates of nightmares and nightmare disorder which are associated with poorer psychosocial functioning. We recommend increased nightmare screening particularly for high-risk populations such as healthcare workers.
View details for DOI 10.1093/sleep/zsaa254
View details for PubMedID 33245781
Intraindividual variability in sleep and perceived stress in young adults
2019; 5 (6): 572?79
Research suggests strong associations between habitual sleep parameters (eg, mean duration, timing, efficiency), perceived stress, and insomnia symptoms. The associations between intraindividual variability (IIV; night-to-night within-person variation) in sleep, perceived stress, and insomnia have not been explored. This study examined associations between IIV in subjectively and objectively determined sleep parameters and to perceived stress in young adults with and without insomnia.Prospective longitudinal.Participants were 149 college students (mean age?=?20.2 [SD?=?2.4], 59% female) either with insomnia (n?=?81; 54%) or without insomnia (n?=?68; 46%).Participants completed 1 week of daily sleep diaries and actigraphy (to assess total sleep time [TST], sleep efficiency [SE], and circadian midpoint [CM]), the Perceived Stress Scale, and a diagnostic interview for determination of insomnia as part of a parent study.Greater IIV in actigraphy-determined TST (but not SE or CM) was independently associated with greater perceived stress, regardless of insomnia status. Greater IIV in sleep diary-determined TST, SE, or CM was not associated with perceived stress. Insomnia status was the most robust predictor of elevated perceived stress. There was a significant interaction between IIV in sleep diary-determined TST and insomnia status on perceived stress: Only in those without insomnia was greater IIV in sleep diary-determined TST associated with higher perceived stress.Maintaining a more consistent sleep duration may be associated with lower stress in college students. Future research is needed to clarify the directionality and implications of this association for treatment.
View details for DOI 10.1016/j.sleh.2019.07.009
View details for Web of Science ID 000502998900007
View details for PubMedID 31575485
View details for PubMedCentralID PMC6917884
Posttraumatic Stress Disorder Symptoms and Sleep in the Daily Lives of World Trade Center Responders
JOURNAL OF OCCUPATIONAL HEALTH PSYCHOLOGY
2019; 24 (6): 689?702
Sleep disturbances are common in posttraumatic stress disorder (PTSD) and can have major impacts on workplace performance and functioning. Although effects between PTSD and sleep broadly have been documented, little work has tested their day-to-day temporal relationship particularly in those exposed to occupational trauma. The present study examined daily, bidirectional associations between PTSD symptoms and self-reported sleep duration and quality in World Trade Center (WTC) responders oversampled for PTSD. WTC responders (N = 202; 19.3% with current PTSD diagnosis) were recruited from the Long Island site of the WTC health program. Participants were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; SCID; First, Spitzer, Gibbon, & Williams, 1997) and completed daily assessments of PTSD symptoms, sleep duration and sleep quality for 7 days. PTSD symptoms on a given day were prospectively associated with shorter sleep duration (? = -.13) and worse sleep quality (? = -.18) later that night. Reverse effects were also significant but smaller, with reduced sleep duration (not quality) predicting increased PTSD the next day (? = -.04). Effects of PTSD on sleep duration and quality were driven by numbing symptoms, whereas effects of sleep duration on PTSD were largely based on intrusion symptoms. PTSD symptoms and sleep have bidirectional associations that occur on a daily basis, representing potential targets to disrupt maintenance of each. Improving PTSD numbing symptoms may improve sleep, and increasing sleep duration may improve intrusion symptoms in individuals with exposure to work-related traumatic events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
View details for DOI 10.1037/ocp0000158
View details for Web of Science ID 000498807800004
View details for PubMedID 31204820
Validity of two retrospective questionnaire versions of the Consensus Sleep Diary: the whole week and split week Self-Assessment of Sleep Surveys
2019; 63: 127?36
Prospective, daily sleep diaries are the gold standard for assessing subjective sleep but are not always feasible for cross-sectional or epidemiological studies. The current study examined psychometric properties of two retrospective questionnaire versions of the Consensus Sleep Diary.College students (N = 131, mean age = 19.39 ± 1.65; 73% female) completed seven days of prospective sleep diaries then were randomly assigned to complete either the Self-Assessment of Sleep Survey (SASS), which assessed past week sleep (n = 70), or the SASS-Split (SASS-Y), which assessed weekday/weekend sleep separately (n = 61). Participants also completed psychosocial/sleep questionnaires including the Pittsburgh Sleep Quality Index (PSQI). Sleep parameters derived from SASS, SASS-Y, PSQI, and sleep diaries were assessed via Bland Altman plots, limits of agreement, mean differences, and correlations.SASS-Y demonstrated stronger correlations with prospective sleep diaries and slightly less biased estimates (r = 0.51 to 0.85, ? = -0.43 to 1.70) compared to SASS (r = 0.29 to 0.84, ? = -1.63 to 2.33) for terminal wakefulness (TWAK), sleep onset latency (SOL), sleep efficiency (SE), and quality (QUAL). SASS resulted in slightly less bias for total sleep time (TST) and wake after sleep onset (WASO) (? = -0.65 and 0.93, respectively) compared to SASS-Y (? = 14.90 and 1.05, respectively). SASS and SASS-Y demonstrated greater convergence with sleep diary than PSQI.Results demonstrated good psychometric properties for the SASS and SASS-Y. When prospective sleep diaries are not feasible, the SASS and SASS-Y are acceptable substitutes to retrospectively estimate sleep parameters. Retrospective estimation of sleep parameters separately for weekdays/weekends may offer advantages compared to whole week estimation.
View details for DOI 10.1016/j.sleep.2019.05.015
View details for Web of Science ID 000496765000021
View details for PubMedID 31622954
- The enigma of objective and subjective measurement of response to cognitive behavioral therapy for insomnia: Call to action SLEEP MEDICINE REVIEWS 2019; 47: 119?21
Associations Between Objective Sleep and Ambulatory Blood Pressure in a Community Sample
2019; 81 (6): 545?56
Epidemiologic data increasingly supports sleep as a determinant of cardiovascular disease risk. Fewer studies have investigated the mechanisms underlying this relationship using objective sleep assessment approaches. Therefore, the aim of this study was to examine associations between daily blood pressure and both objectively assessed sleep duration and efficiency.A diverse community sample of 300 men and women ages 21-70, enrolled in the North Texas Heart Study, participated in the study. Actigraphy assessed sleep was monitored over 2 consecutive nights with ambulatory blood pressure sampled randomly within 45-min blocks on the first and second day as well as the second night.Overall, sleep duration results paralleled those of sleep efficiency. Individuals with lower sleep efficiency had higher daytime systolic (B=-0.35, SE=0.11, p=.0018, R=0.26) but not diastolic BP (B=-0.043, SE=0.068, p=.52, R=0.17) and higher nighttime BP (systolic: B=-0.37, SE=0.10, p<.001, R=.15; diastolic: B=-0.20, SE=0.059, p<.001, R=.14). Moreover, lower sleep efficiency on one night was associated with higher systolic (B=-0.51, SE=0.11, p<.001, R=0.23) and diastolic BP (B=-0.17, SE=0.065, p=.012, R =.16) the following day. When both sleep duration and efficiency were assessed together, sleep efficiency was associated with daytime systolic BP, while sleep duration was associated with nighttime BP.Lower sleep duration and efficiency are associated with higher daytime systolic BP and higher nighttime BP when assessed separately. When assessed together, sleep duration and efficiency diverge in their associations with BP at different times of day. These results warrant further investigation of these possible pathways to disease.
View details for DOI 10.1097/PSY.0000000000000711
View details for Web of Science ID 000475406800008
View details for PubMedID 31083055
EXAMINING THE ASSOCIATIONS BETWEEN OBJECTIVE SLEEP AND AMBULATORY BLOOD PRESSURE IN A COMMUNITY SAMPLE OVER TIME
LIPPINCOTT WILLIAMS & WILKINS. 2019: A113
View details for Web of Science ID 000467560700324
VALIDITY OF SURVEY MEASURES OF SLEEP DURATION, EFFICIENCY, AND TIMING
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071001103
ASSOCIATIONS BETWEEN PAIN, DEPRESSION, STRESS, AND SUBSTANCE USE IN NURSES WITH AND WITHOUT INSOMNIA
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071001195
EFFECTS OF CHRONOTYPE, INSOMNIA, DEPRESSION, AND AGE ON MARKERS OF SYSTEMIC INFLAMMATION IN NURSES
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071000042
INSOMNIA SEVERITY IS ASSOCIATED WITH POSITIVE AND NEGATIVE AFFECT: NHST AND BAYESIAN MULTILEVEL APPROACHES
OXFORD UNIV PRESS INC. 2019
View details for Web of Science ID 000471071000163
Position statement: start middle and high schools at 8:30 AM or later to promote student health and learning
TRANSLATIONAL BEHAVIORAL MEDICINE
2019; 9 (1): 167?69
The Society of Behavioral Medicine recommends school officials start middle and high school classes at 8:30 am or later. Such a schedule promotes students' sleep health, resulting in improvements in physical health, psychological well-being, attention and concentration, academic performance, and driving safety. In this position statement, we propose a four-tiered approach to promote later school start times for middle and high schools.
View details for DOI 10.1093/tbm/iby0200
View details for Web of Science ID 000492961800018
View details for PubMedID 29546285
The role of sleep dysfunction in the relationship between trauma, neglect and depression in methamphetamine using men.
Neurology, psychiatry, and brain research
2018; 30: 30?34
Background: Childhood abuse and neglect, or childhood trauma (CT), has been associated with methamphetamine use, HIV, and depression. This study explored the potential for sleep dysfunction to influence the relationship between CT and depression in methamphetamine using men.Methods: A total of N = 347 men were enrolled: 1) HIV-uninfected, non-methamphetamine (MA) using heterosexual and homosexual men (HIV- MA-; n = 148), 2) MA-using MSM living with HIV (HIV + MA +; n = 147) and 3) HIV-uninfected, MA using MSM (HIV- MA +; n = 52). Participants completed measures of demographic characteristics, sleep dysfunction, childhood trauma, and depression.Results: Participants were on average 37 years old (SD = 9.65). Half of participants were Hispanic, and 48.1% had a monthly personal income of less than USD$500. Controlling for sleep dysfunction and control variables, the impact of CT on depression decreased significantly, b = 0.203, p < 0.001, and the indirect effect of CT on depression was significant according to a 95% bCI, b = 0.091, bCI (95% CI 0.057, 0.130). That is, sleep dysfunction partially explained the relationship between CT on depression.Limitations: Important limitations included the cross-sectional design of the study, and the self-reported measure of sleep.Conclusions: Results highlight the use of sleep interventions to prevent and treat depression, and the utility of assessing sleep disturbances in clinical care.
View details for DOI 10.1016/j.npbr.2018.05.002
View details for PubMedID 30643354
- Special Considerations in the Adaptation of Cognitive Behavioral Therapy for Insomnia With Active-Duty US Army Personnel COGNITIVE AND BEHAVIORAL PRACTICE 2018; 25 (4): 515?30
- Integration of Cognitive Behavioral Therapy for Insomnia JOURNAL OF PSYCHOTHERAPY INTEGRATION 2018; 28 (3): 269?74
Computer-Guided Problem-Solving Treatment for Depression, PTSD, and Insomnia Symptoms in Student Veterans: A Pilot Randomized Controlled Trial
2018; 49 (5): 756?67
Depression is a highly prevalent psychological disorder experienced disproportionately by college student military veterans with many deleterious effects including risk for suicide. Treatment can help, but the debilitating nature of depression often makes seeking in-person treatment difficult and many are deterred by stigma, inconvenience, concerns about privacy, or a preference to manage problems themselves. The current study examines the efficacy of a computer-guided Problem-Solving Treatment (ePST®) for reducing symptoms of depression, posttraumatic stress disorder (PTSD), and insomnia in student military veterans. Twenty-four student veterans (Meanage = 32.7) with symptoms of depression were randomly assigned either to a treatment group receiving six weekly sessions of ePST or to a minimal contact control group (MCC). Participants completed the Patient Health Questionnaire-9 (PHQ-9) depression scale at baseline and then weekly through post-ePST or post-MCC. PTSD and insomnia questionnaires were also completed at baseline and posttreatment. A linear mixed model regression showed a statistically significant Group (ePST vs. MCC) × Time (pretreatment through posttreatment) interaction for depression, with the ePST showing substantial improvements in depressive symptoms over the 6-week period. Significant improvements were also seen in PTSD and insomnia symptoms. Results suggest that ePST can effectively treat depression, PTSD, and insomnia symptoms in student military veterans and may be a viable alternative for those who are not able to access live therapy. Future work should examine the durability of treatment effects and utility for more severe depression and suicide prevention.
View details for DOI 10.1016/j.beth.2017.11.010
View details for Web of Science ID 000445300700010
View details for PubMedID 30146142
TRAIT ANXIETY AND RESTRICTIVE EATING AS PREDICTORS OF SLEEP ONSET LATENCY AND SLEEP QUALITY
OXFORD UNIV PRESS INC. 2018: S64
View details for Web of Science ID 000431185200142
Gender and racial/ethnic differences in sleep duration in the North Texas heart study
2017; 3 (5): 324?27
Short sleep duration has been linked with a wide array of poor mental and physical health outcomes. Such risks, however, may be moderated by demographic factors such as gender and race/ethnicity. In a diverse community sample, the current study examined the relationship between gender, race/ethnicity and objectively measured sleep duration, controlling for select potential confounds.Participants were 300 community adults (50% female), aged 21 to 70 years, and included 60% non-Hispanic Whites, 15% non-Hispanic Blacks, 19% Hispanic/Latino, and 6% other. As part of a larger study, participants wore an actigraphy device over two nights to assess sleep duration (averaged across both nights). Gender and race/ethnicity were used as grouping variables in a two-way analysis of covariance (ANCOVA) predicting objectively assessed total sleep time, with age, income, and employment status as covariates.On average, males slept 34 min less than females (P=.002). After controlling for socioeconomic factors, there was a gender by race/ethnicity interaction (P=.030). Within males, Hispanics slept 45 min less than non-Hispanic Whites (P=.002) and 57 min less than non-Hispanic others (P=.008). Males also slept significantly less than females within the non-Hispanic White (difference=-22.9; P=.016) and the Hispanic (difference=-77.1; P<.001) groups.Extending previous research, the current study provides additional evidence for differences in objective sleep duration based on gender and race/ethnicity in daily life. These data suggest that risk associated with sleep duration is patterned in important ways across gender and race/ethnicity; such information can be used to tailor prevention efforts.
View details for DOI 10.1016/j.sleh.2017.07.002
View details for Web of Science ID 000425612500004
View details for PubMedID 28923187
View details for PubMedCentralID PMC5679291
Psychometric Evaluation of the PSQI in US College Students
JOURNAL OF CLINICAL SLEEP MEDICINE
2016; 12 (8): 1121?29
Examine the psychometric properties of the PSQI in two U.S. college samples.Study I assessed convergent and divergent validity in 866 undergraduates who completed a sleep diary, PSQI, and other sleep and psychosocial measures. Study II assessed PSQI insomnia diagnostic accuracy in a separate sample of 147 healthy undergraduates with and without insomnia.The PSQI global score had only moderate convergent validity with sleep diary sleep efficiency (prospective global measure of sleep continuity; r = 0.53), the Insomnia Severity Index (r = 0.63), and fatigue (r = 0.44). The PSQI global score demonstrated good divergent validity with measures of excessive daytime sleepiness (r = 0.18), circadian preference (r = -0.08), alcohol (r = 0.08) and marijuana (r = 0.05) abuse scales, and poor divergent validity with depression (r = 0.48), anxiety (r = 0.40), and perceived stress (r = 0.33). Examination of other analogous PSQI and sleep diary components showed low to moderate convergent validity: sleep latency (r = 0.70), wake after sleep onset (r = 0.37), sleep duration (r = 0.51), and sleep efficiency (r = -0.32). Diagnostic accuracy of the PSQI to detect insomnia was very high (area under the curve = 0.999). Sensitivity and specificity were maximized at a cutoff of 6.The PSQI demonstrated moderate convergent validity compared to measures of insomnia and fatigue and good divergent validity with measures of daytime sleepiness, circadian phase preference, and alcohol and marijuana use. The PSQI demonstrated considerable overlap with depression, anxiety, and perceived stress. Therefore, caution should be used with interpretation.
View details for DOI 10.5664/jcsm.6050
View details for Web of Science ID 000389989600009
View details for PubMedID 27166299
View details for PubMedCentralID PMC4957190
Adolescent sleep disparities: sex and racial/ethnic differences
2015; 1 (1): 36?39
During adolescence, significant changes occur in sleep (eg, decreased sleep duration and increased sleep problems). To date, few studies have examined whether self-reported sleep duration differences exist between races/ethnicities in early adolescence (ages 11-14 years).This study compared sexes and race/ethnicity groups on self-reported sleep duration in a large (n = 1543; 48.9% boys) racially/ethnically diverse (62.7% White, 23.7% Hispanic/Latino, 10.4% African American, and 3.2% Asian) sample of young adolescents (mean age, 12.31) drawn from local middle schools.A 2-way analysis of variance revealed that there was a trend for a significant sex effect (P = .067, partial ?2 = .002), with boys reporting more sleep than girls and significant race/ethnicity effects (P < .001, partial ?2 = .012), with Hispanic and African American students reporting shorter sleep duration than White and Asian students. The interaction between sex × race/ethnicity was significant (P = .014, partial ?2 = .002), with post hoc tests revealing that Hispanic males demonstrated significantly shorter sleep duration than White and Asian males and African American females demonstrating significantly shorter sleep duration than White females.Given the literature showing short sleep duration is related to various negative health outcomes and all-cause mortality, more research is needed to determine the factors involved in these disparities. Adolescent sleep disparities: sex and racial/ethnic differences.
View details for DOI 10.1016/j.sleh.2014.12.003
View details for Web of Science ID 000437195100009
View details for PubMedID 29073411