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Objectives To describe changes in sleep patterns during the coronavirus disease 2019 (COVID-19) pandemic, develop profiles according to these patterns, and assess sociodemographic, economic, COVID-19 related, and sleep and mental health factors associated with these profiles. Design, setting, and participants A 25-minute online survey was distributed worldwide through social media from 5/21/2020 to 7/1/2020. Measurements Participants reported sociodemographic/economic information, the impact of the pandemic on major life domains, insomnia and depressive symptoms, and changes in sleep midpoint, time-in-bed, total sleep time (TST), sleep efficiency (SE), and nightmare and nap frequency from prior to during the pandemic. Sleep pattern changes were subjected to latent profile analysis. The identified profiles were compared to one another on all aforementioned factors using probit regression analyses. Results The sample of 991 participants (ages: 18-80 years; 72.5% women; 60.3% residing outside of the United States) reported significantly delayed sleep midpoint, reductions in TST and SE, and increases in nightmares and naps. Over half reported significant insomnia symptoms, and almost two-thirds reported significant depressive symptoms. Latent profile analysis revealed 4 sleep pattern change profiles that were significantly differentiated by pre-pandemic sleep patterns, gender, and various COVID-19-related impacts on daily living such as severity of change in routines, and family stress and discord. Conclusions In an international online sample, poor sleep and depressive symptoms were widespread, and negative shifts in sleep patterns from pre-pandemic patterns were common. Differences in sleep pattern response to the COVID-19 crisis suggest potential and early targets for behavioral sleep health interventions.

Background Sedentary time is associated with chronic disease and premature mortality. We tested a multilevel workplace intervention with and without sit-stand workstations to reduce sedentary time and lower cardiometabolic risk. Methods Stand and Move at Work was a group (cluster) randomized trial conducted between January 2016 and December 2017 among full-time employees; ≥18 years; and in academic, industry/healthcare, and government worksites in Phoenix, Arizona and Minneapolis/St. Paul, Minnesota, USA. Eligible worksites were randomized to (a) MOVE+, a multilevel intervention targeting reduction in sedentary time and increases in light physical activity (LPA); or (b) STAND+, the MOVE+ intervention along with sit-stand workstations to allow employees to sit or stand while working. The primary endpoints were objectively-measured workplace sitting and LPA at 12 months. The secondary endpoint was a clustered cardiometabolic risk score (blood pressure, glucose, insulin, triglycerides, and HDL-cholesterol) at 12 months. Results Worksites (N = 24; academic [n = 8], industry/healthcare [n = 8], and government [n = 8] sectors) and employees (N = 630; 27 ± 8 per worksite; 45 ± 11 years of age, 74% female) were enrolled. All worksites were retained and 487 participants completed the intervention and provided data for the primary endpoint. The adjusted between arm difference in sitting at 12 months was − 59.2 (CI: − 74.6,-43.8) min per 8 h workday, favoring STAND+, and in LPA at 12 months was + 2.2 (− 0.9,5.4) min per 8 h workday. Change in the clustered metabolic risk score was small and not statistically significant, but favored STAND+. In an exploratory subgroup of 95 participants with prediabetes or diabetes, the effect sizes were larger and clinically meaningful, all favoring STAND+, including blood glucose, triglycerides, systolic blood pressure, glycated hemoglobin, LDL-cholesterol, body weight, and body fat. Conclusions Multilevel workplace interventions that include the use of sit-stand workstations are effective for large reductions in sitting time over 12 months. Among those with prediabetes or diabetes, clinical improvements in cardiometabolic risk factors and body weight may be realized. Trial registration ClinicalTrials.gov Identifier: NCT02566317. Registered 2 October 2015, first participant enrolled 11 January 2016.

Multicomponent interventions that use sit-stand workstations (SSW) to reduce workplace sitting time have been largely successful. However, the long-term maintenance (i.e., >12 months) of this behavior change is relatively unknown. We aimed to evaluate the 24-month maintenance of reductions in workplace sitting time, along with the effects of introducing the SSW after 12 months of multicomponent intervention only. We used data from Stand and Move at Work, a two-arm multi-site group randomized trial of 24 worksites (12 worksites per arm; N=630, 74% female, 45±11 years of age). Worksites in the STAND+ arm received 12 months of a multilevel (i.e., worksite policy, environmental, and individual-level strategies) intervention to increase light-intensity physical activity, along with a SSW, to increase standing time. Worksites in the MOVE+ arm (i.e., comparator) received the same multilevel intervention but were not provided with the SSW until after the intervention ended at 12 months. Sitting time was assessed for 7 consecutive days using the activPAL3c micro accelerometer at baseline, 12, and 24 months. Results are presented below in table form. In STAND+ , sitting time at 24 months, relative to baseline, was significantly reduced and similar in magnitude of change to what was observed at 12 months. In MOVE+ , sitting time at 24 months (a year after the SSW was introduced), relative to baseline, was significantly reduced but markedly smaller in magnitude of change than observed during the STAND+ active intervention period (i.e., 0 to 12 months). These results support the use of SSW coupled with a multicomponent intervention for optimal and long-term maintenance of reductions in workplace sitting time. Hierarchical regression models were adjusted for worksite clustering, age, sex, and baseline BMI.

Long-term effects of workplace sedentary behavior interventions on cardiometabolic risk are poorly understood. Stand and Move at Work was a multi-site group randomized trial in 24 worksites (N=630, 74% female, 45±11 years of age) of office-based employees in Phoenix, AZ and Minneapolis/St. Paul, MN. Worksites in the STAND+ study arm received 12 months of a multilevel (i.e., worksite policy, environmental, and individual-level strategies) intervention to increase light-intensity physical activity along with a sit-stand workstation (SSW) to increase standing time. Worksites in the MOVE+ study arm received the same multilevel intervention but were not provided the SSW until after the intervention ended at 12 months. The STAND+ arm, but not the MOVE+ arm, had significant reductions in sedentary time over the 12-month intervention. However, 12-month improvements in cardiometabolic risk factors were only observed among a subgroup with dysglycemia (prediabetes or diabetes). Here we report the long-term follow-up of these changes, 12 months after the end of the trial (24 months). Results are shown in the Table. The effects at 12 months were largely sustained at 24 months. Although limited by the small sample size in this subgroup, long-term meaningful and sustained improvement in blood glucose, triglycerides, systolic blood pressure, and weight may be observed from a multilevel workplace sedentary behavior intervention that includes sit-stand workstations.

Background Positive airway pressure (PAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), a chronic disorder that affects 6–13% of the adult population. However, adherence to PAP therapy is challenging, and current approaches to improve adherence have limited efficacy and scalability. Methods/design To promote PAP adherence, we developed SleepWell24, a multicomponent, evidence-based smartphone application that delivers objective biofeedback concerning PAP use and sleep/physical activity patterns via cloud-based PAP machine and wearable sensor data, and behavior change strategies and troubleshooting of PAP therapy interface use. This randomized controlled trial will evaluate the feasibility, acceptability, and initial efficacy of SleepWell24 compared to a usual care control condition during the first 60 days of PAP therapy among patients newly diagnosed with OSA. Discussion SleepWell24 is an innovative, multi-component behavior change intervention, designed as a self-management approach to addressing the psychosocial determinants of adherence to PAP therapy among new users. The results will guide lengthier future trials that assess numerous patient-centered and clinical outcomes.