Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk.

Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange.

The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39).

Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed.

ClinicalTrials.gov Identifier: NCT02458690

Sleep disturbance and impulsivity are key components of mood vulnerability in bipolar disorder (BD), but few studies have assessed the association between these two symptoms among patients with BD.

Forty-seven euthymic patients with bipolar I disorder (BDI) or bipolar II disorder (BDII) and 58 age- and sex-matched healthy controls were enrolled in this cross-sectional study. Trait impulsivity was measured using the Barratt Impulsiveness Scale Version 11 (BIS-11), which yielded 3 second-order factors: attention, motor, and non-planning. Subjective sleep quality was assessed using the self-reported Pittsburgh Sleep Quality Index (PSQI). General linear models (GLMs) were used to assess the associations between subjective poor sleep and trait impulsivity with multiple testing corrections.

Patients with BD scored higher in BIS-11 and PSQI than healthy controls. PSQI total scores positively correlated with BIS-11 total scores, while sleep disturbance and daytime dysfunction were associated with attentional impulsiveness after controlling for covariates. Participants with higher PSQI total scores (>10) had higher scores in BIS-11 total, attention, and non-planning than those with low PSQI scores (≤5).

These findings support the hypothesis that poor sleep quality might lead to impulsivity and add to the growing evidence that improving sleep quality may be a therapeutic target for patients with BD.

In Malaysia, a nationwide movement control order (MCO), implemented to curb the COVID-19 spread, impacted on the lives of the working population which could impair sleep quality.

This study aims to find the sleep quality status and its association with the socioeconomic, employment and lifestyle factors of working adults during the MCO period.

A cross-sectional study was conducted among 500 eligible working adults. Data were collected using a structured questionnaire consisting of the Pittsburg Sleep Quality Index.

The proportion of poor sleep quality is found to be 59.4%. Analysis shows that the use of electronic devices before sleep (OR = 2.33, 95% CI = 1.02–5.35, p-value = 0.046), increased amount of workload (OR = 0.45, p-value = 0.005), decreased in amount of workload (OR = 0.48, p-value = 0.003) and distracted while working (OR = 0.57, p-value = 0.014) are the factors significantly associated with and are predictors of poor sleep quality.

During crisis, there is a need for public health interventions for the working population to adopt a healthy lifestyle. Employers are recommended to support employees’ well-being and to provide a healthy workplace during challenging times. Policy recommendations are also made to implement flexible working arrangements, workload management, workplace mental health support and legal protections on reasonable working hours, rest breaks and time off during crises.

This study aimed to investigate changes in sleep parameters and self-perceived sleep quality in unilateral vestibular hypofunction participants after vestibular rehabilitation.

Forty-six unilateral vestibular hypofunction participants (before and after vestibular rehabilitation) along with a control group of 60 healthy patients underwent otoneurological examination, a one-week actigraphy sleep analysis and a series of self-report and performance measures.

After vestibular rehabilitation, unilateral vestibular hypofunction participants showed a significant score decrease in the Pittsburgh Sleep Quality Index, a self-rated reliable questionnaire depicting sleep quality during the last month, as well as a reduction in sleep onset latency and an increase in total sleep time, indicating an objective improvement in sleep quality as measured by actigraphy analysis. However, after vestibular rehabilitation, unilateral vestibular hypofunction participants still showed statistically significant differences with respect to the control group in both self-rated and objective measurements of sleep quality.

Vestibular rehabilitation may impact on sleep performance and chronotype behaviour, possibly by opposing long-term structural changes along neural pathways entangled in sleep activity because of the deafferentation of the vestibular nuclei.

The COVID-19 (Coronavirus Disease 2019) pandemic is associated with several stressful factors that can negatively affect peoples’ sleep quality and mental health.

The aim of the current study was to prospectively identify decreased sleep quality and associated risk factors in general population during COVID-19 pandemic.

We conducted a prospective, observational online study on a Romanian sample of 667 respondents aged >18 years. Sleep quality and quantity was evaluated with Athens Insomnia scale (AIS) and the main concerns associated with the pandemic context were evaluated through a multiple-choice question.

The data collected identified important evidence regarding the prevalence and intensity of insomnia. The average score for AIS was 6.13 (cut-off point for was set at 8). However, it is worth noting that 179 respondents (26.8%) meet the criteria for insomnia. Of the 8 self-assessment items, daytime sleepiness was the criterion evaluated with the highest average score (1.01), all other items getting subunit values. A low quality of sleep was linearly related with fear of illness/death (p=0.053), fear of illness/death of close people (p=0.032), social isolation (p<0.001), economic impact (p=0.003), losing the job (p<0.001) and social stigma associated with COVID-19 infection (p=0.009).

More than a qurter of respondes scored above the threshold of 8 at the insomnia scale, while losing the job, social stigma associated with COVID-19 infection and social isolation are the main risk factors for a low quality and quantity of sleep.

No significant relationships.

Fruit and vegetable intake may improve sleep.

To assess the relationship between fruit and vegetable intake and sleep quality in a longitudinal study.

We analysed longitudinal data from two consecutive population surveys of adults in Agincourt, South Africa (2014–2015 and 2018–2019).

In total, 331 of 2975 participants without poor sleep quality in Wave 1 (11.1%) had incident poor sleep quality in Wave 2, and 270 of 3546 participants who had poor sleep quality in Wave 1 (7.6%) had poor sleep quality in both Waves 1 and 2 (persistent poor sleep quality). The prevalence of poor sleep quality at baseline was 17.2%. In the fully adjusted model for people without poor sleep quality at baseline, higher fruit and vegetable consumption (≥5 servings/day) was positively associated with incident poor sleep quality among men (AOR = 1.43, 95% CI 1.51–2.01) but not among women (AOR = 1.09, 95% CI 0.78–1.46). Two or more servings of fruits were positively associated with incident poor sleep quality among men (AOR = 3.35, 95% CI 1.96–5.72) and among women (AOR = 1.84, 95% CI 1.15–2.94). No models among men and women showed a significant association between vegetable intake and incident poor sleep quality or between fruit and vegetable intake, vegetable intake and persistent poor sleep quality. Fruit intake (one serving) was positively associated with persistent poor sleep quality among men (AOR = 1.76, 95% CI 1.00–3.08) but not among women (AOR = 1.42, 95% CI 0.93–2.18).

Higher fruit and vegetable intake was independently associated with poorer sleep quality among men but not women, and higher fruit but not vegetable intake was associated with poorer sleep quality among both men and women.

To characterize 1) the relationship between laxative use and objective sleep metrics, and 2) the relationship between laxative use and self-reported insomnia symptoms in a convenience sample of middle-aged/elderly patients who completed in-laboratory polysomnography.

We cross-sectionally analyzed first-night diagnostic in-laboratory polysomnography data for 2946 patients over the age of 40 (mean age 60.5 years; 48.3% male). Laxative use and medical comorbidities were obtained through self-reported questionnaires. Patient insomnia symptoms were based on self-report. Associations between laxative use and objective sleep continuity were analyzed using multivariable linear regression models. Associations between laxative use and insomnia were assessed using multivariable logistic regression models.

After adjusting for age, sex, body mass index, total recording time, and relevant comorbidities, laxative users had a 7.1% lower sleep efficiency (p < 0.001), 25.5-minute higher wake after sleep onset (p < 0.001), and a 29.4-minute lower total sleep time (p < 0.001) than patients not using laxatives. Laxative users were found to be at greater odds of reporting insomnia symptoms (OR = 1.7, p = 0.024) than patients not using laxatives.

Laxative use is associated with impairments in objective sleep continuity. Patients using laxatives were also at greater odds of reporting insomnia symptoms.

This study aimed to explore the effects of eye masks on the sleep quality and pain of school-age children with CHD after surgery.

Forty school-age children with CHD who underwent open-heart surgery in the Cardiac Surgery Department of a provincial hospital in China from January 2020 to December 2020 were selected. The children were randomly divided into the experimental group (n = 20) and the control group (n = 20). Children in the control group were given routine sleep care, and the children in the experimental group were given a sleep intervention with eye masks for three nights following the removal of tracheal intubation. The Pittsburgh Sleep Quality Index was used to evaluate the sleep quality of the children. The Children’s Pain Behaviour Scale was used to evaluate the pain of the children.

After three nights of receiving the eye masks intervention, the sleep quality scores of the children in the experimental group were significantly lower than those of the control group, the difference was statistically significant (p < 0.05) and the sleep quality of the children in the experimental group was higher. The pain scores of the children in the experimental group were significantly lower than those of the children in the control group, the difference was statistically significant (p < 0.05), and the children in the experimental group suffered less post-operative pain.

Eye masks are a simple, safe and economical intervention, that is beneficial for improving the post-operative sleep quality and relieving post-operative pain in school-age children with congenital heart disease.

Understanding factors associated with post-discharge sleep quality among COVID-19 survivors is important for intervention development.

This study investigated sleep quality and its correlates among COVID-19 patients 6 months after their most recent hospital discharge.

Healthcare providers at hospitals located in five different Chinese cities contacted adult COVID-19 patients discharged between 1 February and 30 March 2020. A total of 199 eligible patients provided verbal informed consent and completed the interview. Using score on the single-item Sleep Quality Scale as the dependent variable, multiple linear regression models were fitted.

Among all participants, 10.1% reported terrible or poor sleep quality, and 26.6% reported fair sleep quality, 26.1% reported worse sleep quality when comparing their current status with the time before COVID-19, and 33.7% were bothered by a sleeping disorder in the past 2 weeks. After adjusting for significant background characteristics, factors associated with sleep quality included witnessing the suffering (adjusted B = −1.15, 95% CI = −1.70, −0.33) or death (adjusted B = −1.55, 95% CI = −2.62, −0.49) of other COVID-19 patients during hospital stay, depressive symptoms (adjusted B = −0.26, 95% CI = −0.31, −0.20), anxiety symptoms (adjusted B = −0.25, 95% CI = −0.33, −0.17), post-traumatic stress disorders (adjusted B = −0.16, 95% CI = −0.22, −0.10) and social support (adjusted B = 0.07, 95% CI = 0.04, 0.10).

COVID-19 survivors reported poor sleep quality. Interventions and support services to improve sleep quality should be provided to COVID-19 survivors during their hospital stay and after hospital discharge.

To examine the feasibility and possible effect of an 8-week exercise program on sleep quality, insomnia and psychological distress in individuals with multiple sclerosis (MS).

Twenty-four individuals with MS were recruited into a controlled pre-post feasibility study and divided into 2 groups: exercise (n = 13; Expanded Disability Status Scale (EDSS): 1.0–7.5) and a related control group with no exercise (n = 11; EDSS: 1.0–7.0). The exercise group performed combined upper limb, lower limb and breathing exercises in a controlled group (2d/week, 60 min/session) for 8 weeks. Participants were administered measures to evaluate sleep quality (Pittsburgh Sleep Quality Index, PSQI), insomnia severity (Insomnia Severity Index, ISI), psychological distress (Clinical Outcomes in Routine Evaluation–Outcome Measure, CORE-OM) and additionally impact of fatigue (Modified Fatigue Impact Scale, MFIS) after 8-weeks.

Insomnia severity measured with ISI (F(1;22)=5.95, p = 0.023, ηp2 = 0.213, 90% CI = 0.02–0.42) and psychological distress measured with the CORE-OM (F(1;22)=4.82, p = 0.039, ηp2 = 0.179, 90% CI = 0.01–0.40) showed statistically significant group-by-time interaction. Sleep quality measured with the PSQI showed statistically significant group-by-time interaction only in an aspect of daytime sleep dysfunction (F(1;22)=5.33, p = 0.031, ηp2 = 0.195, 90% CI = 0.01–0.40). The fatigue impact measured with the MFIS showed statistically significant group-by-time interaction in physical (F(1;22)=6.80, p = 0.016, ηp2 = 0.236, 90% CI = 0.02–0.44) and cognitive aspects (F(1;22)=9.12, p = 0.006, ηp2 = 0.293, 90% CI = 0.05–0.49), and total score (F(1;22)=11.29, p = 0.003, ηp2 = 0.339, 90% CI = 0.08–0.52).

Our 8-week program reduced insomnia severity, psychological distress and some aspects of fatigue (physical; cognitive; total), and improved sleep quality in an aspect of daytime sleep dysfunction in a small group of individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work.

Sleep represents an important process in the stable behavioural and emotional functioning of the individual and is an important health indicator. Personality is related with academic and occupational achievement, quality of interpersonal relationships, but also with sleep. Concerning personality, individuals with lower emotional stability have greater sensitivity to stress and maladaptive sleep-related behaviour.

The main goal of this study is to analyze the relation between sleep quality and personality in college students.

This study employed a correlational design. A sample of 220 Portuguese students (84.9% females), with mean age of 19.5 years (sd=3.4), from different health courses, filled in the Pittsburgh Sleep Quality Questionnaire and HEXACO-60, during a single individual session. A descriptive statistical analysis, a Pearson correlation analyses and the t Student test, for independent samples, were performed.

The results showed a predominance of poor sleep quality among students (96.3%). The more prevalent HEXACO dimensions are: Conscientiousness (X=32.6; sd=4.2) and Emotionality (X=31.2; sd=5.2). When exploring personality differences between sleep groups (GSG=Good Sleep Group; PSG=Poor Sleep Group) a significant difference was found in mean scores of the dimension Emotionality. It was observed that the PSG revealed higher levels of Emotionality than the GSG (PSG=31.5; sd=5.1; PSG=26.3; sd=4.0; p<.05).

College students self-report a poor sleep and the prevalent personality dimensions are Conscientiousness and Emotionality. Students with higher levels of Emotionality (fearfulness, anxiety, dependence and sentimentality) presented a poor sleep. To conclude, mediation studies are needed in order to better understanding the link between personality and sleep.

Sleep disorders are a substantial public health issue with serious consequences on patients’ quality of life. Cannabis has been recently suggested as a potential treatment for patients with sleep disorders; however, research on the relationship between cannabis and sleep is still in its infancy.

The aim of this investigation was to assess whether cannabis use was associated with improved sleep quality.

Our study comprised 173 participants, 42 cannabis users and 131 non-cannabis users, who completed the Pittsburgh Sleep Quality Index (PSQI), the most common self-reported measure of sleep quality. The scale provides a global PSQI score and seven component domain scores, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime functions.

Cannabis users self-reported statistically significantly healthier scores than non-cannabis users in the global PSQI as well as the specific domains of subjective sleep quality, sleep latency, as well as sleep disturbances.

This preliminary evidence points to the possibility that cannabis could provide effective treatment for patients with sleep disorders. Research into the constituents of cannabis that may have a differential impact on sleep and sleep disorders is warranted.

Sleep disturbances can occur as a result of major stressful events. Additionally, research evidence suggests that COVID-19 pandemic may have negatively impacted the quality of sleep among various populations. However, individuals respond differently to the stress, uncertainty and social isolation related with COVID-19 pandemic.

This study aimed to explore the changes in sleep quality and pattern among voluntary psychiatric patients visiting our clinic in Romania during COVID-19 pandemic.

We implemented a cross-sectional study over a period of 3 months, utilizing a Romanian-translated version of the Pittsburgh Sleep Quality Index (PSQI) which was administered through Google Forms web application. Participants lacking digital skills were provided with guidance for completing the questionnaire. Informed consent was obtained prior to participating in this study and data anonymity and confidentiality were ensured.

Among a total of 98 responders, 63% reported a global PSQI score greater than 5, indicating poor sleep. Approximately 25% of participants subjectively marked their sleep as either fairly bad or very bad. When analysing the 7 components of PSQI, our participants struggled most with long sleep latency. About a third of participants reported using sleep medication (both prescription and over-the-counter) three or more times a week within the past month.

Considering the fact that the current situation is likely to evolve for an unknown period of time, there is a dire need to assess the effect of prolonged adjustments in daily routine and their impact on the sleep and the quality of life of our patients.

Although sleep hygiene is a well-studied factor of good sleep (Irish et al., 2015, McNail et al., 2016), less is known about its role in the complaints on anxiety and depression (wither direct or through sleep quality).

The aim was to reveal direct and indirect effects of sleep behavior on subjective sleep quality, anxiety and depression.

174 people aged 17-57 without diagnosed sleep disorders filled the Scale of Behavioral Factors of Sleep Disturbances (Rasskazova, Leonov, 2020), Insomnia Severity Index (Morin, 1993), Hospital Scale of Anxiety and Depression (Zingmond, Snaith, 1983), Beck’s Anxiety and Depression Inventories (Beck, Steer, 1993, Beck et al., 1996).

Taking medications and non-medications before sleep, alcohol, tonic drinks and using gadgets in the evening, delaying bedtime, self-limitations after poor nights, poor adherence to the regimen and postponement of the morning rise were characterized by an indirect effect on anxiety and depressiveness through poor sleep (|β|=0,03-0,24). Self-limiting behavior and delaying the morning rise are associated with higher levels of anxiety and depression, even in the absence of sleep-related complaints (β=0,23-0,34, p<0,01).

Based on the data we suggest that the dysfunctional role of behavior on anxiety and depression is predominantly indirect (through the perpetuation of complaints), but it can also be direct (regardless of complaints of sleep disorders). Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00740.

Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00740.

Poor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults.

We conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50–80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO).

Intention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = −1.27, 95% confidence interval (CI) −1.61 to −0.89; SHEEP: d = −0.69, 95% CI −0.96 to −0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = −1.19; SHEEP: d = −1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = −0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = −0.25; SHEEP: d = −0.09), and WASOPSG (MBTI: d = −0.26; SHEEP (d = −0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects.

MBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

To examine associations between serum micronutrients and neurobehavioural function and the mediating role of sleep quality in early adolescents.

In this cross-sectional study, peripheral blood samples were analysed for Fe and Zn levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to assess sleep quality and neurobehavioural function, respectively. The logistic/linear regressions and generalised structural equation modelling were performed to estimate the associations.

Jintan, China

In total, 226 adolescents (106 females) from the Jintan Child Cohort study.

Adolescents with low Fe (<75 μg/dl) (OR = 1·29, P = 0·04) and low Zn (<70 μg/dl) (OR = 1·58, P < 0·001) were associated with increased odds for poor sleep quality. Adolescents with low Fe and Zn were associated with fast (Fe: β = –1353·71, P = 0·002, Zn: β = –2262·01, P = 0·02) but less-accurate (Fe: β = –0·97, P = 0·04; Zn: β = –1·76, P = 0·04) performance on non-verbal reasoning task and poor sleep quality partially mediated the associations between low Fe/Zn and non-verbal reasoning (P < 0·05). Additionally, low Fe was associated with a slower reaction on spatial processing task (β = 276·94, P = 0·04), and low Zn was associated with fast (β = –1781·83, P = 0·03), but error-prone performance (β = –1·79, P = 0·04) on spatial processing ability and slower reaction speed (β = 12·82, P = 0·03) on the attention task. We observed similar trends using a cut-off point of 75 μg/dl for low serum Zn, except for the association with attention task speed (P > 0·05).

Fe and Zn deficiencies may possibly be associated with poor sleep and neurobehavioural function among early adolescents. Poor sleep may partially mediate the relationship between micronutrients and neurobehavioural function.