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Background: Medical students are frequently affected by poor sleep quality. Since poor sleep quality has negative physiological and psychological consequences such as on executive function, there is an opportunity to improve sleep quality and executive functions using non-pharmacological intervention such as cognitive behavioural therapy., Objective: The aim of this study therefore is to determine if improving sleep quality could improve executive functions in medical students with poor sleep quality by comparing cognitive behavioural therapy for insomnia (CBT-I) with sleep hygiene education (SHE) in a randomized controlled trial (RCT)., Methods: A parallel group, RCT with a target sample of 120 medical students recruited from government-based medical universities in Malaysia. Eligible participants will be randomized to internet group CBT-I or internet group SHE in a 1:1 ratio. Assessments will be performed at baseline, post-intervention, 1 month, 3-months, and 6-months. The primary outcome is between-group differences in sleep quality and executive function post-baseline. The secondary outcomes include pre-sleep worry, attitude about sleep, sleep hygiene and sleep parameters., Results: This study received approval from the Research Ethics Committee in Universiti Putra Malaysia (JKEUPM-2023-1446) and Universiti Kebangsaan Malaysia (JEP-2024-669). The clinical trial was also registered in Australian New Zealand Clinical Trial Registry (ACTRN1264000243516). As of June 2024, the recruitment process is ongoing and a total of 48 and 49 students have been enrolled from the universities into the CBT-I and ISHE groups, respectively. All the participants provided signed and informed consent to participate in the study. Data collection has been completed for the baseline (pre-treatment assessment), and follow-up assessments for T1 and T2 for all the participants in both groups, while T3 and T4 assessments will be completed by July 2025. Data analysis will be performed by August 2025 and the research will be completed by December 2025., Conclusions: This study is the first attempt to design a CBT intervention to ameliorate poor sleep quality and its related negative effects among medical students. This research is also the first large-scale exploring the relationship between health status and CBT-mediated sleep improvement among medical students., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12624000243516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=387030., International Registered Report Identifier (irrid): PRR1-10.2196/59288., (©Vijandran Mariappan, Firdaus Mukhtar. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.12.2024.)

Purpose: Poor sleep quality is a global health problem for adolescent. The aim of this study was to examine how sleep education, with or without social media reminders, affects sleep quality in adolescents aged 14 to 18., Methods: The study was a three-center, parallel-arm, randomized controlled study, recruiting participants from September 9, 2019, to January 6, 2020. Adolescents with poor sleep quality and sleepiness, using smartphones apps and internet browser, without chronic diseases, and obesity, and without mental problems were included in the study. Primary outcomes were sleep quality, sleepiness, sleep hygiene, and sleep parameters at week 5 as measured by subjective report scales and actigraphy. Sleep quality was measured by the Pittsburgh Sleep Quality Index (Poor sleep quality = PSQI > 5), sleepiness by the Cleveland Adolescent Sleepiness Questionnaire (CASQ > 16), and sleep hygiene developed by the researchers in the literature of Adolescent Sleep Habits Form., Results: A total of 55 participants (mean [SD] age, 15.64 [1.22] years) participated. PSQI and CASQ scores of adolescents in sleep education that were not supported by social media reminders decreased compared to the baseline (p = 0.01, p = 0.02). Adolescent PSQI score in sleep education supported by social media reminders decreased from baseline, their sleep hygiene score increased (p = 0.02). There were no significant differences between the groups in terms of sleep parameters (total sleep duration, deep and light sleep levels, nighttime sleeping, and morning wake-up times) (p > 0.05)., Conclusion: This study suggests that sleep education, supported by reminders via social media, can be used to improve the quality of sleep of adolescents., Trial Registration: ClinicalTrials.gov Identifier: NCT05071989., Competing Interests: Declarations Conflict of interest None. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional permissions regarding the appropriateness of working in schools were obtained from the Provincial Directorate of National Education and the Governor’s Office. Informed consent Informed consent was obtained from all individual participants included in the study. Written informed consent was sent to the parents through the students before the study was conducted. and the intervention was made after taking both parent and student permission., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: To explore the influence of sleep conditions and sleep hygiene behaviors in early pregnancy on gestational diabetes mellitus (GDM) development., Methods: This 1:1 propensity-score matched study included 1,216 pregnant women divided into GDM and control groups based on diagnosis via the oral glucose tolerance test at 24-28 gestational weeks. Sleep conditions and hygiene behaviors were evaluated using structural questionnaires, including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Sleep Hygiene Practice Scale. Univariate and multivariate logistic regression analyses and Spearman's correlation were conducted to identify the associations., Results: After adjusting for baseline clinical characteristics, women with GDM were more likely to have poor sleep quality (adjusted odds ratio [AOR] = 1.585, 95% confidence interval [CI]: 1.261-1.992) and higher scores for subjective sleep quality, latency, duration, efficiency, and sleep disturbances (all P < 0.01). Mild sleepiness (AOR = 1.311, 95% CI: 1.012-1.699) and worrying about not being able to fall asleep (AOR = 1.123, 95% CI: 1.005-1.255) were more likely to occur in the GDM group. Sleep quality and hygiene behaviors such as sleep-irrelevant activities, staying in bed after waking up, weekend catch-up sleep, and overeating before bedtime were significantly correlated with gestational diabetes variables., Conclusion: Poor sleep conditions and specific sleep hygiene behaviors in early pregnancy may be independent risk factors for GDM. This suggests that sleep assessment and behavior education can be used as new approaches for the early implementation of surveillance and prevention of GDM., Competing Interests: Declarations Ethical approval All procedures performed in this study involving human participants were reviewed and approved by the Ethics Committee of the International Peace Maternity and Child Health Hospital (GKLW 2019-58). The procedures used in this study adhere to the 1964 Helsinki declaration and its later amendments. Informed consent Informed consent was obtained from all individual participants included in the study. Conflict of interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (© 2024. The Author(s).)

The current study focused on investigating the relationship between level and timing of physical activity and sleep quality and hygiene in healthy individuals. This cross-sectional study design recruited 175 participants (male: 98, 56%, female: 77, 44%, and BMI: 23.87 ± 3.92) aged between 18 and 65, 157 of whom were physically active and 18 of whom were physically inactive. The study recruited healthy participants from various sports facilities, fitness centers, and walking parks to ensure a diverse sample of physically active individuals in a metropolitan city. The study excluded people with sleep disorders, rheumatoid arthritis, heart or neurological problems, and those who had shift work. The study employed the Demographic Information Form, International Physical Activity Questionnaire (Short Form), Pittsburgh Sleep Quality Scale, and Sleep Hygiene Questionnaire. A one-way MANOVA was employed to compare sleep quality and hygiene in different physical activity levels. A second MANOVA compared sleep quality and hygiene in different physical activity timing, including only the minimally active and very active participants. One-way MANOVA showed a significant difference F (4, 171) = 7.532, Pillai's trace = 0.161, partial eta squared = 0.081 between sleep quality and hygiene scores among inactive, minimally active, and very active participants. A post hoc analysis showed sleep quality was significantly better in minimal active (6.42 ± 2.55, p = 0.002, Cohen's d = 0.867) and very active participants (5.99 ± 2.29, p < 0.001, Cohen's d = 1.092) than inactive (8.61 ± 2.50) participants. Also, sleep hygiene was significantly better in minimal active (28.50 ± 6.74, p = 0.001, Cohen's d = 0.867) and very active participants (29.52 ± 6.56, p < 0.001, Cohen's d = 0.992) than inactive (36.05 ± 8.39) participants. The one-way MANOVA revealed no statistically significant differences in sleep quality and hygiene scores based on physical activity time. Our study showed that physically active individuals had significantly better sleep quality and hygiene scores, while there was no difference based on the timing of physical activity. Healthy individuals may be encouraged to participate in physical activity in the morning, afternoon, or evening to improve sleep parameters., Competing Interests: Declarations. Ethics approval and consent to participate: The Non-Invasive Ethical Committee of Uskudar University obtained ethical approval of the research. The ethical approval’s serial number is 61351342/HAZIRAN 2021-65. All participants provided a signed informed consent form before enrolled the study. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Gestational diabetes mellitus (GDM) is the most common complication of pregnancy, affecting an estimated 16.7% of live births worldwide, which translates to approximately 21 million cases annually. Although poor sleep quality is a prevalent concern in this population, most existing studies predominantly focus on the impact of sleep disorders on GDM, rather than directly assessing sleep quality in women diagnosed with GDM. This study aimed to investigate sleep quality and its associated factors specifically among women with GDM., Methods: We originally aimed to include 287 women with GDM; ultimately, 618 were invited, of whom 393 participated in the survey through a convenience sampling method at the obstetric clinics of four general tertiary hospitals in Chongqing, China, from June to August 2022. Data were collected utilizing sociodemographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), the Sleep Hygiene Scale, and the Pregnancy-related Anxiety Scale (PrAS). We employed linear regression analysis to identify factors associated with sleep quality., Results: The PSQI score of participants was (5.83 ± 3.41). Notably, 43.77% of participants reported an actual sleep duration of less than 8 h per night, whereas 45.55% experienced poor sleep quality. Worrying during the day about your inability to fall asleep (β = 0.204, P < 0.01), body image concern (β = 0.159, P < 0.01), going to bed thirsty (β = 0.160, P < 0.01), educational attainment (β=-0.150, P < 0.01), avoidance (β = 0.124, P < 0.01), sleep disturbed by bed partner's sleep (β = 0.126, P < 0.01), and worrying as you prepare for bed about your inability to fall asleep (β = 0.137, P < 0.05) significantly affected the sleep quality of participants., Conclusions: The study revealed a high prevalence of insufficient sleep duration and poor sleep quality among women with GDM, which was significantly influenced by inadequate sleep hygiene habits and pregnancy-related anxiety. These findings enhance our understanding of the factors affecting sleep quality in this population and underscore the necessity for healthcare professionals to timely identify sleep disorders. Implementing appropriate interventions, such as the development of educational programs focused on sleep hygiene and body image acceptance through cognitive behavioral therapy, could enhance the quality of care for women with GDM., Competing Interests: Declarations. Ethics approval and consent to participate: The study followed the guidelines established in the 1995 Helsinki Declaration (as revised in Edinburgh 2000). Ethical Approval was obtained from the Ethics Committee of Chongqing Medical University (No.2022174). Additionally, we secured permission from the hospitals to access participants electronic medical records. Prior to data collection, participants were provided with informed consent through an online survey tool. To safeguard participants’ information throughout the study, we implemented data privacy measures, including the anonymization of all collected data to protect participant identities. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Sleep disorders are widespread and constitute a major public health risk. The present study thus aims to investigate the effect of a facial cosmetic self-massage daily routine on women's sleep and well-being., Methods: The present pilot study was conducted on 62 middle-aged women declaring daily tiredness and sleep troubles. We examined the effect of a regular facial cosmetic self-massage routine on sleep patterns, daytime sleepiness, and well-being over the course of 2 months., Results: After 1 and 2 months, our results show improved sleep quality (Pittsburgh Sleep Quality Index, PSQI - -20.2% after 2 months), reduced daytime sleepiness (Epworth Sleepiness Scale, ESS, -31.2% after 2 months), and increased well-being measures. The number of participants with abnormal sleep (PSQI >5) decreased over the course of the experiment as well, from 71.9% to 49.2% at the end of the 2 months [odds ratio 95% CI for decrease: 0.38 (0.18-0.81)]. Similarly, the number of participants with excessive daytime sleepiness (>10 on the ESS) decreased over the course of the study from 44.3% to 21% after 1 month [95% CI: 0.33 (0.15-0.73)] and to 16.1% after 2 months [95% CI: 0.24 (0.10-0.56)]., Conclusions: These results suggest that a facial cosmetic self-massage routine may improve sleep patterns and is likely to be a useful addition to a standard sleep hygiene routine., (© 2024 Chanel Parfums Beauté. International Journal of Cosmetic Science published by John Wiley & Sons Ltd on behalf of Society of Cosmetic Scientists and Societe Francaise de Cosmetologie.)

Background: The study aimed to ascertain the effect of sleep hygiene training on nursing students' sleep quality., Methods: The research study group consisted of 80 nursing students studying in the nursing department. A quasi-experimental model with a pretest-posttest control group was used. Sleep hygiene training was given to nursing students in the experimental group. The sociodemographic data form for nurse students and the Pittsburg Sleep Quality Index (PSQI) were used to collect data. The t-test for independent groups was used to compare the PSQI pre-test and post-test scores of the experimental and control groups, and the dependent group t-test was used to compare the PSQI pre-test and post-test scores within groups., Results: There was a difference in the sleep-related data of the nursing students in the experimental and control groups and between the PSQI pretest and posttest score averages according to the groups. No significant difference between the pre-test and post-test mean scores was observed in the control group for subjective sleep quality, sleep duration, sleep disturbance, and daytime dysfunction., Conclusions: Sleep hygiene education helps nursing students develop regular sleep behaviors.

Abstract: Sleep is critical to a person's physiological and psychological functioning. Approximately 30% to 40% of the general population experiences insomnia, and among patients with mental health conditions, the prevalence of insomnia and other sleep disturbances rises to about 70%. Insomnia is associated with many adverse health issues, including lower immunity, weight gain, elevated BP, and increased mortality, and it is often undiagnosed and either untreated or self-treated. Providers can work together with patients to enact measures-such as implementation of enhanced sleep hygiene, engagement in cognitive behavioral therapy, and treatment of any underlying causes-that can markedly improve patient sleep quality. This article provides an overview of evidence-based best practices and whole-person strategies that NPs can adopt to address poor sleep quality in adult patients, and it serves as a primer for primary care NPs on common presentations of several sleep disorders., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Sleep is critical to a person's physiological and psychological functioning. Approximately 30% to 40% of the general population experiences insomnia, and among patients with mental health conditions, the prevalence of insomnia and other sleep disturbances rises to about 70%. Insomnia is associated with many adverse health issues, including lower immunity, weight gain, elevated BP, and increased mortality, and it is often undiagnosed and either untreated or self-treated. Providers can work together with patients to enact measures-such as implementation of enhanced sleep hygiene, engagement in cognitive behavioral therapy, and treatment of any underlying causes-that can markedly improve patient sleep quality. This article provides an overview of evidence-based best practices and whole-person strategies that NPs can adopt to address poor sleep quality in adult patients, and it serves as a primer for primary care NPs on common presentations of several sleep disorders., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The prevalence of locomotive syndrome naturally increases with age, but approximately half of nonelderly individuals also meet the criteria for locomotive syndrome, suggesting that even younger people need to pay attention to their own health status. Sleep is important for physical, cognitive, and psychological health. Some individuals with poor sleep quality may be at risk of developing negative health status. Although the effects of sleep hygiene strategies for elderly individuals have been well investigated, optimal nonpharmacological sleep hygiene strategies for improving sleep quality in nonelderly individuals has not been identified. We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials aimed to elucidate the effects of various nonpharmacological interventions on sleep quality in nonelderly individuals and to identify the optimal intervention. Cochrane Central Register of Controlled Trials, Medline, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Scopus were comprehensively searched. We identified 27 studies focusing on the effects of various nonpharmacological sleep hygiene strategies in nonelderly individuals, and 24 studies were applied into NMA. The present results showed that resistance training was the most effective intervention for improving sleep quality in nonelderly individuals. In addition, this study revealed the effects of nonpharmacological interventions, such as physical activity, nutritional intervention, as well as exercise interventions. This is the first report that utilized NMA to compare the effects of various nonpharmacological interventions on sleep quality in nonelderly individuals., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hirohama et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Although prior research demonstrates the interdependence of sleep quality within couples (i.e., the sleep of one partner affects the sleep of the other), little is known about the degree to which couples' sleep hygiene behaviours are concordant or discordant, and if one's own sleep hygiene or their report of their partners' sleep hygiene is related to worse relational, psychological, and sleep outcomes. In a sample of 143 mixed-gender, bed-sharing couples, each partner completed an online questionnaire consisting of the Sleep Hygiene Index (for themselves and their partner), PROMIS sleep disturbance scale, conflict frequency, PHQ-4 for anxiety and depressive symptoms, and the Perceived Stress Scale. Paired samples t-tests between partners were conducted using total and individual-item Sleep Hygiene Index scores to examine similarities and differences. Intraclass correlation coefficient (ICC) scores of dyadic reports were conducted to examine the level of agreement between each partner's sleep hygiene. Finally, we examined associations between one's own sleep hygiene and their report of their partner's sleep hygiene with both partner's sleep quality, emotional distress, and conflict frequency in a dyadic structural equation model with important covariates and alternative model tests. The results revealed a significant difference between men's (M = 14.45, SD = 7.41) and women's total score self-report sleep hygiene ([M = 17.67, SD = 8.27]; t(142) = -5.06, p < 0.001) and partners only had similar sleep hygiene for 5 out of the 13 items. Examining dyadic reports of sleep hygiene revealed that partners had moderate agreement on their partners' sleep hygiene (0.69-0.856). The results from the dyadic structural equation model revealed that poorer sleep hygiene was associated with one's own poor sleep quality, higher emotional distress, and more frequent relational conflict. For both men and women a poorer report of a partner's sleep hygiene was associated with one's own report of higher relationship conflict. Finally, men's poorer report of a partner's sleep hygiene was related better to their own sleep quality but was related to poorer sleep quality for their partners. These results have implications for sleep promotion and intervention efforts as well as for couple relationship functioning., (© 2023 European Sleep Research Society.)

Aims: To assess the sleep strategies that nurses working irregular night shifts use to improve their sleep quality, and to compare the strategies of good and poor sleepers to determine whether the differences between the two groups could provide insights into possible effective strategies., Design: A qualitative descriptive study., Methods: The study was conducted from September 2019 to January 2020. Thirty-four nurses working irregular night shifts participated; 17 were classified as good sleepers and 17 as poor sleepers based on the Sleep-Wake Experience List, a validated self-report instrument that measures one's sleep quality. Interviews were conducted using open questions to explore strategies around the night-shift set. The interviews were analysed using thematic analysis., Findings: Both groups described similar and different strategies that help them work and sleep well during and after night shifts. However, good sleepers mentioned a greater number of strategies and seemed to have thought about them more than poor sleepers. The most common strategies were having a clear structure, being organized-especially regarding sleeping time-maintaining a daily routine and adjusting their sleep environment., Conclusion: Healthcare institutions should consider offering education and training programs aimed at empowering nurses who work irregular night shifts. These programs should provide nurses with various sleep strategies to enhance their sleep quality and overall well-being., Implications for the Profession: Nurses working irregular night shifts can possibly enhance their sleep quality by making personalized plans, for example, including a clear day structure, or an optimized sleep environment., Impact: The study focused on how nurses working night shifts could possibly enhance their sleep quality. The findings highlight the importance of providing nurses with diverse sleep strategies to improve sleep quality, helping them to identify what works best for them and consistently apply these strategies., Reporting Method: The Consolidated Criteria for Reporting Qualitative Research guidelines were followed., Patient or Public Contribution: Nurses working irregular night shifts at Maastricht University Medical Center in Maastricht, the Netherlands, who agreed to participate in the study, engaged in a discussion to assess the relevance of sleep quality to their work. They were also encouraged to share their perspectives during the interviews., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: The aim of this study was to evaluate the association of perceived stress and poor sleep quality with periodontitis in a university-based cohort of individuals., Methods: A total of 235 individuals were included in this cross-sectional study. Perceived stress and sleep quality were evaluated through validated questionnaires, while periodontitis was identified with a full-mouth periodontal examination protocol using both European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) and Centers for Disease Control and Prevention (CDC)/AAP case definitions. Simple and multiple linear and ordinal logistic regression analyses were performed to evaluate the association between perceived stress and sleep quality with periodontitis prevalence and severity., Results: Stage III/IV periodontitis resulted associated with both moderate/high perceived stress (odds ratio [OR] = 5.4; 95% confidence interval [CI]: 2.2-13.5; p < 0.001) and poor sleep quality (OR = 3.0; 95% CI: 1.2-7.4; p < 0.05). The interaction between moderate/high perceived stress and poor sleep quality presented a multiplicative association with stage III/IV periodontitis (EFP/AAP; OR = 5.8; 95% CI: 1.6-21.3; p < 0.001). Multiple linear regression analyses indicated a similar trend of association also with linear periodontal parameters, that is, mean clinical attachment level (CAL) and mean probing pocket depth (PPD)., Conclusions: The findings from the present study suggest that stress and poor sleep quality may exert a multiplicative effect on periodontitis prevalence and severity., (© 2023 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

To optimise the relationship between exercise and sleep quality, the intensity of exercise and its proximity to sleep are key factors to manage. Although low-to-moderate exercises promote sleep quality, late-evening vigorous exercise instead of morning should still be avoided. It potentially impacts the objective and subjective markers of sleep quality. In the present study, we investigated the effects of vigorous morning and evening exercise on objective and subjective sleep features in an ecological context. A total of 13 recreational runners (mean [SD] age 27.7 [7.2] years, four females) performed a 45-60 min run (70% maximal aerobic velocity) either in the MORNING (30 min to 2 h after waking-up) or in the EVENING (2 h to 30 min before sleep). The two exercise conditions were separated by a REST day. After each condition, sleep was objectively assessed using an electroencephalographic headband and subjectively using the Spiegel Sleep Inventory. Compared with REST, both MORNING and EVENING exercise increased the time spent in non-rapid eye movement (NREM, +24.9 min and +22.7 min; p = 0.01, η 2  = 0.11, respectively). Longer NREM duration was mainly due to sleep stage 2 extension after both MORNING (+20.8 min) and EVENING (+22.8 min) exercise relative to REST (p = 0.02, η 2  = 0.12). No other effect of exercise on either objective or subjective sleep could be observed. Exercise, independently of the time at which it takes place, leads to extended NREM sleep without other effects on sleep quality. Considering the crucial role of exercise in achieving good health, sleep hygiene guidelines should be updated to promote exercise at any time of the day., (© 2023 European Sleep Research Society.)

Purpose: The relationships between sleep quality and sleep hygiene awareness in the Chinese population were unclear. We aimed to investigate the associations and related factors between sleep quality and sleep hygiene awareness in adults and to identify the most central domain for sleep quality using network analysis., Methods: A cross-sectional survey was conducted from April 22 to May 5, 2020. Adults (18 years old or above) who had access to smartphones were invited to participate in this survey. The Pittsburg Sleep Quality Index (PSQI) and the Sleep Hygiene Awareness and Practice Scale (SHAPS) were used to evaluate the sleep quality and sleep hygiene awareness of the participants. Propensity score matching (PSM) was used as sensitivity analysis to reduce the confounding effects. Multiple logistic regression was performed to evaluate the associations. The R packages "bootnet" and "qgraph" were used to estimate the connection and calculate the network centrality indices between good and poor sleepers., Results: In total, 939 respondents were included in the analysis. Of them, 48.8% (95% CI: 45.6-52.0%) were identified as poor sleepers. Participants with nervous system diseases, psychiatric diseases, and psychological problems were more likely to have poor sleep quality. The notion that using sleep medication regularly was beneficial to sleep was associated with poor sleep quality. Similarly, the notion that waking up at the same time each day disrupted sleep was also associated with poor sleep quality. The findings were consistent before and after PSM. Subjective sleep quality was the most central domain for sleep quality in good and poor sleepers., Conclusion: Poor sleep quality was positively associated with certain sleep hygiene notions in Chinese adults. Effective measures such as self-relief, sleep hygiene education, and cognitive behavioral treatment may have been needed to improve sleep quality, especially during the COVID-19 outbreak., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: College students report disturbed sleep patterns that can negatively impact their wellbeing and academic performance., Objectives: This study examined the effect of a 4-week sleep hygiene program that included sleep education and actigraph sleep trackers (FITBITs) on improving sleep quality and reducing psychological worry without control group., Design Settings and Participants: A pilot quasi-experimental design, participants were randomly selected medical and health sciences from a university students in the United-Arab-Emirates., Methods: Students were asked to wear FITBITs and log their daily sleep data and completed the Pittsburgh Sleep Quality Index (PSQI) and Penn State Worry Questionnaire (PSWQ). Extensive sleep hygiene education was delivered via lectures, a WhatsApp group, and the Blackboard platform. In total, 50 students completed pre-and post-assessments and returned FITBIT data., Results: There was a significant difference in the prevalence of good sleep postintervention compared with pre-intervention (46% vs. 28%; p = 0.0126). The mean PSQI score was significantly lower post-intervention compared with pre-intervention (6.17 ± 3.16 vs. 7.12.87; p = 0.04, Cohen's d 0.33). After the intervention, subjective sleep quality, sleep latency, and daytime dysfunction were significantly improved compared with pre-intervention ( p < 0.05). In addition, FITBIT data showed total sleep time and the number of restless episodes per night were significantly improved postintervention compared with pre-intervention ( p = 0.013). The mean PSWQ score significantly decreased from pre-intervention to p = 0.049, Cohen' d = 0.25. The correlation between PSQI and PSWQ scores was significant post-intervention (β = 0.40, p = 0.02)., Conclusion: Our results may inform university educational policy and curricular reform to incorporate sleep hygiene awareness programs to empower students and improve their sleep habits., Competing Interests: ArA-S was employed by Glaxosmithkline. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bani Issa, Hijazi, Radwan, Saqan, Al-Sharman, Samsudin, Fakhry, Al-Yateem, Rossiter, Ibrahim, Moustafa, Naja, Alameddine, Abbas, Abdelrahim, Al-Shujairi and Awad.)

Background: There is a worldwide struggle to quit smoking and prevent relapsing. Aerobic exercises are frequently utilized to aid in smoking cessation and prevent relapse., Aims: This study aimed to investigate the effects of aerobic exercises of different intensity on the level of anxiety, smoking addiction, and quality of sleep and life in former smokers., Methods: The study included 60 people aged 18 to 45 who had quit smoking within the previous month. Individuals were randomly assigned to control (CON), mild-intensity aerobic activity (MIA), and moderate-intensity aerobic activity (MoIA) groups. The MIA group did submaximal aerobic exercises at 40% of maximum heart rate (MHR), while the MoIA group did them at 60% of MHR for 8 weeks/3 days. Participants' anxiety levels were assessed using the Beck Anxiety Scale (BAS), smoking addiction was assessed using the Fagerström Test for Nicotine Dependence and Substance Craving Scale (SCS), sleep quality was assessed using the Pittsburgh Sleep Quality Index, and quality of life was assessed using the SF-36 Short Form Scale (SF-36)., Results: The SCS score of the MoIA group declined more than the MIA and CON groups, and the MIA group had a lower sleep disturbance score than other groups when the influence of exercise training was assessed over time (p < 0.05). Aerobic exercise had no influence on SF-36 or BAS scores (p > 0.05)., Conclusions: The benefits of mild and moderate aerobic exercise on quality of life and anxiety are similar. However, mild-intensity aerobic exercises may be suitable for sleep difficulties while moderate-intensity aerobic exercises may be preferred for reducing smoking addiction., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Introduction: Improved sleep hygiene is postulated to be protective against burnout. Previous studies assessing a potential association between poor sleep quality and burnout showed incongruent results., Objective: To investigate the relationship between sleep quality and burnout., Design: Setting and Participants: A survey was conducted in a large health care cluster in Singapore and included health care staff from different professions (N = 4777). The Maslach Burnout Inventory - Human Services Survey was used to measure burnout across 3 sub-scales: Emotional Exhaustion, Depersonalization and Personal Accomplishment, while the Pittsburgh Sleep Quality Index (PSQI) was used to gauge the participants' sleep quality. Multi-variable general linear model ANOVA was used for correlation analysis., Results: There is a strong correlation between sleep quality and all 3 burnout sub-scales. PSQI is associated with Emotional Exhaustion (F value = 90.65, P-value <.0001), Depersonalization (F value = 49.46, P-value <.0001) and Personal Accomplishment (F value = 12.29, P-value <.0001). PSQI shows a significant linear upward trend with Emotional Exhaustion (linear contrast = 957.06, P-value <.0001) and with Depersonalization (linear contrast = 521.92, P-value <.0001). With Personal Accomplishment, PSQI shows a significant linear downward trend (linear contrast = 123.61, P-value <.0001)., Conclusion: Poor sleep quality is progressively and linearly associated with burnout and its 3 sub-scales. Future studies that evaluate interventions which improve sleep quality among health care workers may be useful in reducing burnout and improving patient care., Competing Interests: Declaration of competing interest No conflict of interest declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Poor sleep quality affects university students' life and increases their risk of long-term health consequences. This study aimed to describe the quality of sleep among Jordanian university students, examine differences in sleep quality according to selected variables, and identify predictors of sleep quality. A cross-sectional correlational design and a multi-strategic sampling technique were used to select a sample of 1,308 university students. The Pittsburgh Sleep Quality Index, the Perceived Stress Scale, and the Sleep Hygiene Instrument were administered to the subjects. T - test, ANOVA, and multiple regressions were used to analyze the data. The results showed that most students were classified as poor sleepers (87.1%), and only (12.8%) reported having a good sleep quality. Among the components of sleep quality, subjective sleep quality (m = 1.90, SD = 0.89) and daytime dysfunction (m = 1.72, SD = 0.67) had the highest mean scores, while sleep efficiency (m = 0.50, SD = 0.91) and the use of sleep medications (m = 0.23, SD = 0.73) had the lowest mean scores. There were statistically significant differences in sleep quality in relation to residency, academic level, academic achievement, and family income. Significant predictors of sleep quality were gender, marital status, employment status, sleep hygiene, and stress.

Objectives: Pain can have a negative impact on sleep and emotional well-being. This study investigated whether this may be partly explained by maladaptive sleep-related cognitive and behavioural responses to pain, including heightened anxiety about sleep and suboptimal sleep hygiene., Methods: This cross-sectional study used data from an online survey that collected information about pain (Brief Pain Inventory), sleep (Pittsburgh Sleep Quality Index; Sleep Hygiene Index; Anxiety and Preoccupation about Sleep Questionnaire) and emotional distress (PROMIS measures; Perceived Stress Scale). Structural equation modelling examined the tenability of a framework linking these factors., Results: Of 468 survey respondents (mean age 39 years, 60% female), 29% reported pain (mean severity 1.12), most commonly in the spine or low back (28%). Pain severity correlated with poor sleep quality, poor sleep hygiene, anxiety about sleep and emotional distress. In the first structural equation model, indirect effects were identified between pain severity and sleep quality through anxiety about sleep (β = .08, p < .001) and sleep hygiene (β = .12, p < .001). In the second model, an indirect effect was identified between pain severity and emotional distress through sleep quality (β = .19, p < .01). Combining these models, indirect effects were identified between pain severity and emotional distress through anxiety about sleep, sleep hygiene and sleep quality., Conclusions: This study provides data to support the tenability of a theoretically guided framework linking pain, sleep and emotional distress. If upheld by experimental and/or longitudinal study, this framework holds the potential to inform public health initiatives and more comprehensive pain assessment., Competing Interests: AR, DW and NKYT have no conflicts of interest to declare.

Aim: To clarify the meaning of the concept sleep quality., Background: Sleep loss and sleep quality are global health concerns. Poor sleep quality has significant adverse health outcomes. A clarification of the term is necessary to inform patients and healthcare providers, promote consistent theoretical and operational definitions in research, and develop prevention and treatment strategies., Design: Concept analysis., Data Sources: Scientific literature from electronic databases (CINAHL, PsycINFO, PubMED, Web of Science, and JSTOR) and definitions from online dictionaries., Review Methods: Rodgers' Evolutionary method was applied to guide the concept analysis to identify and determine the attributes, antecedents, and consequences., Results: Sleep quality is defined as an individual's self-satisfaction with all aspects of the sleep experience. Sleep quality has four attributes: sleep efficiency, sleep latency, sleep duration, and wake after sleep onset. Antecedents include physiological (e.g., age, circadian rhythm, body mass index, NREM, REM), psychological (e.g., stress, anxiety, depression), and environmental factors (e.g., room temperature, television/device use), and family/social commitments. Good sleep quality has positive effects such as feeling rested, normal reflexes, and positive relationships. Poor sleep quality consequences include fatigue, irritability, daytime dysfunction, slowed responses, and increased caffeine/alcohol intake., Conclusions: Sleep quality is essential, and poor sleep quality contributes to disease and poor health outcomes. Given the extensive consequences of poor sleep quality, nurses and clinicians are vital in instructing the importance of good sleep., (© 2021 Wiley Periodicals LLC.)

Purpose: Tuberculosis (TB) can affect sleep and can predispose patients to chronic diseases like diabetes mellitus. On the other hand, sleep deprivation and diabetes mellitus can worsen tuberculosis. The aim of this study was to assess sleep quality, to estimate the prevalence of poor sleepers and those at risk for restless legs syndrome (RLS) and to evaluate the knowledge and practices regarding sleep hygiene among patients diagnosed with TB., Methods: In a cross-sectional study, a semi-structured questionnaire was administered to patients diagnosed with TB in Bengaluru, India. The questionnaire was comprised of sections including demography, knowledge and practice regarding sleep hygiene, the international restless leg study group consensus diagnostic criteria to diagnose RLS, the Pittsburgh sleep quality index, the Epworth sleepiness scale, and history of adverse drug reactions (ADRs)., Results: Of 206 participants enrolled, 125 men (61%), mean (SD) age was 41.0 (16.2) years, and 121 (59%) had pulmonary TB while the remaining 85 (41%) had extrapulmonary TB. The prevalence (95% confidence intervals) of poor quality sleepers was 17% (12, 23%), those with poor knowledge of sleep hygiene (< 6 marks) 33% (27, 40%), those at risk for RLS 32% (26, 39%), and those with excessive daytime sleepiness (EDS) 12% (8, 17%)., Conclusion: Prevalence of poor quality sleepers and those at risk for RLS are higher than normal population, thus making sleep quality assessment important in patients diagnosed with TB. Prevalence of those at risk for EDS was comparable to normal population., (© 2020. Springer Nature Switzerland AG.)

There has been a significant increase in mental health concerns among student-athletes in recent years. Several factors can contribute to this issue, such as inadequate sleep, social pressures, and the impact of social media. Among student-athletes, social media has become an integral part of their daily routine, particularly for those who aspire to pursue careers in sports after graduation. Self-promotion can be a great way for student-athletes to build their personal brand and connect with fans, but it can also increase the pressure and stress that student-athletes feel to maintain a positive image online. This study included 191 student athletes from various sports at one DII school in the US in one school semester. It emphasizes the importance of balancing self-promotion and social media use while being aware of potential negative effects and practicing proper sleep hygiene and time management. This study also touches on various other factors that positively or negatively impact the mental health of student-athletes, and the strongest significant negative relationships between self-promotion and mental health. [ABSTRACT FROM AUTHOR]

Purpose: To examine nocturnal sleep patterns, napping behaviors, and subjective wellness responses of elite water polo players within an in-season week and to identify whether sleeping patterns differ between men and women. Methods: Sleep characteristics of 10 male and 17 female professional water polo players were objectively assessed during 1 week of the in-season period, including 5 training days, 1 match day, and 1 day of rest. Internal load (rating of perceived exertion × duration of training or match) was assessed 30 minutes posttraining or postmatch, and the total quality of recovery was recorded every morning. A series of multilevel models were used to analyze the data. Results: Time in bed and wake-up time were earlier on both training (P <.001) and rest days (P <.001) than on the day of the match. Internal workload did not predict any of the players' sleeping patterns. Midday naps predicted less time in bed (P =.03) and likely less sleep time (P =.08). The total quality of recovery was predicted only by the total sleep time (P <.01). Women exhibited higher sleep efficiency (P <.001), less waking after sleep onset (P =.01), and a lower number of awakenings (P =.02) than men. Conclusions: The current results indicate that the nocturnal sleep patterns of elite water polo players are not associated with internal load and that women display better nocturnal sleep quality compared with men. As long naps interfere with nocturnal sleep, and total nocturnal sleep time predicts total quality of recovery, we suggest that athletes follow hygiene sleep strategies to facilitate adequate nocturnal sleep and next-day recovery. [ABSTRACT FROM AUTHOR]

Purpose: Few data are available on sleep characteristics of elite track-and-field athletes. Our study aimed to assess (1) differences in sleep between sexes and among different track-and-field disciplines, (2) the effect of individualized sleep-hygiene strategies on athletes' sleep parameters, and (3) daytime nap characteristics in track-and-field athletes. Methods: Sleep characteristics of 16 elite Olympic-level track-and-field athletes (male: n = 8; female: n = 8) were assessed during the preseason period, at baseline (T0), and during the in-season period, after the adoption of individualized sleep-hygiene strategies (T1). Sleep parameters were objectively monitored by actigraphy for a minimum of 10 days, for each athlete, at both T0 and T1. A total of 702 nights were analyzed (T0 = 425; T1 = 277). Results: Female athletes displayed better sleep efficiency (88.69 [87.69–89.68] vs 91.72 [90.99–92.45]; P =.003, effect size [ES]: 0.44), lower sleep latency (18.99 [15.97–22.00] vs 6.99 [5.65–8.32]; P <.001, ES: 0.65), higher total sleep time (07:03 [06:56–07:11] vs 07:18 [07:10–07:26]; P =.030, ES: 0.26), earlier bedtime (00:24 [00:16–00:32] vs 00:13 [00:04–00:22]; P =.027, ES: 0.18), and lower nap frequency (P <.001) than male athletes. Long-distance runners had earlier bedtime (00:10 [00:03–00:38] vs 00:36 [00:26–00:46]; P <.001, ES: 0.41) and wake-up time (07:41 [07:36–07:46] vs 08:18 [08:07–08:30]; P <.001, ES: 0.61), higher nap frequency, but lower sleep efficiency (88.79 [87.80–89.77] vs 91.67 [90.95–92.38]; P =.013, ES: 0.44), and longer sleep latency (18.89 [15.94–21.84] vs 6.69 [5.33–8.06]; P <.001, ES: 0.67) than athletes of short-term disciplines. Furthermore, sleep-hygiene strategies had a positive impact on athletes' total sleep time (429.2 [423.5–434.8] vs 451.4 [444.2–458.6]; P <.001, ES: 0.37) and sleep latency (14.33 [12.34–16.32] vs 10.67 [8.66–12.68]; P =.017, ES: 0.19). Conclusions: Sleep quality and quantity were suboptimal at baseline in Olympic-level track-and-field athletes. Large differences were observed in sleep characteristics between sexes and among different track-and-field disciplines. Given the positive effect of individualized sleep-hygiene strategies on athlete's sleep, coaches should implement sleep education sessions in the daily routine of top-level athletes. [ABSTRACT FROM AUTHOR]

Purpose: Short sleep duration and poor sleep quality are common in swimmers. Sleep-hygiene strategies demonstrated beneficial effects on several sleep parameters. The present study assessed the impact of a multisession sleep-hygiene training course on sleep in elite swimmers. Methods: Twenty-eight elite swimmers (17 [2] y) participated. The sleep-hygiene strategy consisted of 3 interventions. Sleep was measured by actigraphy for 7 days before the beginning of the intervention (baseline), after the first collective intervention (postintervention), after the second collective intervention (postintervention 2), and, finally, after the individual intervention (postintervention 3). The Epworth Sleepiness Scale (ESS) was completed concurrently. Swimmers were classified into 2 groups: nonsomnolent (baseline ESS score ≤ 10, n = 13) and somnolent (baseline ESS score ≥ 11, n = 15). Results: All swimmers had a total sleep time of <8 hours per night. Sixty percent of swimmers were moderately morning type. Later bedtime, less time in bed, and total sleep time were observed in the somnolent group compared with the nonsomnolent group at baseline. An interaction between training course and group factors was observed for bedtime, with a significant advance in bedtime between baseline, postintervention 2, and postintervention 3 for the somnolent group. Conclusions: The present study confirms the importance of implementing sleep-hygiene strategies, particularly in athletes with an ESS score ≥11. A conjunction of individual and collective measures (eg, earlier bedtime, napping, and delaying morning training session) could favor the total sleep time achieved. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effects of a sleep hygiene strategy on parameters of sleep quality and quantity in youth elite rugby union players. Method: Eleven male players (age: 19.0 [1.4] y) undertook a sleep hygiene strategy composed of 2 theoretical sessions and 3 practical sessions over a 4-week period. Sleeping time, time in bed, total sleep time, sleep latency (SL), sleep efficiency (SE), wake after sleep onset, and wake bouts were recorded with an actigraphic device during the 4-week sleep hygiene strategy (baseline) and during 4 weeks after the last intervention (postintervention). Results: At baseline, the overall group reported poor sleep quantity (total sleep time = 6:27 [0:30] min), but sleep quality was considered acceptable (SL = 0:18 [0:08] min and SE = 77.8% [5.8%]). Postintervention, the overall group showed a small improvement in SL (d = −0.23 [−0.42 to −0.04], P =.003) and SE (d = 0.30 [0.03 to 0.57], P =.0004). For individual responses, sleeping time, time in bed, and total sleep time were positively influenced in only 4, 3, and 5 players, respectively. For parameters of sleep quality, SL and SE were positively influenced in a majority of players (n = 7 and 8, respectively). The magnitude of difference between baseline and postintervention was strongly associated with baseline values in SE (r = −.86; P =.0005) and wake after sleep onset (r = −.87; P =.0007). Conclusion: A sleep hygiene strategy is efficient to improve sleep quality but not sleep quantity in young rugby union players. The strategy was more efficient in players with lower initial sleep quality and should be implemented prior to a high cumulative fatigue period. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to investigate if major dietary patterns (DPs) interact with psychological disorders (PDs) in association with sleep quality and quantity among a large sample of Iranian adults living in Yazd, Iran. Methods: This cross-sectional investigation was conducted on the baseline data of a population-based Iranian cohort study (Yazd Health Study-Taghzieh Mardom-e-YaZd: YaHS-TAMYZ). All data regarding dietary intakes, PDs, and sleep status were collected via validated questionnaires. The interaction between major DPs and PDs in relation to sleep parameters was determined using multivariable adjusted binary logistic regression. Results: A total of 6048 adults participated in this study. Compared to subjects with the lowest adherence to each DP and without any severe PDs: a) individuals with the highest adherence to the "western" DP and with severe anxiety had higher risk of "short sleep duration" (P = 0.030) and "insufficient sleep" (P = 0.020); b) subjects in the "western" DP's top tertile and with severe depression had lower chance of having "short sleep duration" (P = 0.029) and "insufficient sleep" (P = 0.029); c) those with the highest adherence to the "high animal protein" DP and with severe anxiety had significantly greater odds of "long sleep duration" (P = 0.044); d) a lower chance of "low sleep quality" was observed in participants in the "high animal protein" DP's top tertile and with severe stress (P = 0.05). Conclusions: The "western" and "high animal protein" DPs might interact with PDs in association with the quality and duration of sleep. Further investigations are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Summary: Many patients with depression report insomnia symptoms that profoundly affect their health and well‐being. Non‐pharmacological treatments of insomnia may be preferable for some patients. In this randomised crossover trial, we investigated the efficacy of the Protac Ball Blanket® on insomnia among patients with depression. Included patients (n = 45) were diagnosed with unipolar depression, and with subjective insomnia and poor sleep quality (Pittsburgh Sleep Quality Index Score > 5). Each patient slept 2 weeks with a Protac Ball Blanket® and 2 weeks with a control duvet. Randomisation defined the order of the 2‐week sleep periods. Patients served as their own control in this design. The primary outcome was changes in total night‐time sleep. Secondary outcomes were sleep‐onset latency, number of awakenings, wake after sleep onset, daily use of pro necessitate sedatives and hypnotics, subjective sleep quality (Pittsburgh Sleep Quality Index), insomnia severity (Insomnia Severity Index), symptoms of depression (Hamilton Depression Rating Scale, Major Depression Inventory), symptoms of anxiety (Beck Anxiety Index), and patient‐reported outcomes concerning interpersonal sensitivity, neurasthenia, anxiety and depression (Self‐Reported Symptom State Scale). Paired two‐sided t‐tests were used to compare the means of the differences of the outcomes. Protac Ball Blanket® increased total night‐time sleep by 12.9 min (95% confidence interval: 1.21–24.63, p = 0.031). Among the secondary outcomes, Protac Ball Blanket® decreased Hamilton Depression Rating Scale by 2.78 (95% confidence interval: −5.44; −0.11, p = 0.042) and Insomnia Severity Index by 2.98 (95% confidence interval: −5.45; −0.50, p = 0.020). No changes were observed in sleep‐onset latency, number of awakenings, wake after sleep onset, Pittsburgh Sleep Quality Index, Major Depression Inventory, Beck Anxiety Index, Self‐Reported Symptom State Scale, and medication use. The results suggest that some patients may benefit from Protac Ball Blanket® as an add‐on non‐pharmacological treatment to improve sleep in depression. [ABSTRACT FROM AUTHOR]

Summary: This cross‐sectional study investigated the effect of maternal sleep quality in late pregnancy on prenatal, birth and early postnatal outcomes. The research was conducted in three parts with women at 28 or more weeks of gestation. In the first part, pregnant women admitted for delivery were evaluated in terms of eligibility criteria. Pregnant women in the latent phase of labour completed the Prenatal Questionnaire. In the second part, labour follow‐up was performed. The researchers completed the Birth Follow‐up Questionnaire based on observations and hospital birth records. In the third part, mothers were interviewed between the 12th and 24th hour of postnatal. Participants filled out the Postnatal Questionnaire, the Childbirth Experience Questionnaire, and the Pittsburgh Sleep Quality Index (n = 385). The data were analysed using the chi‐square independence test, Fisher test, independent samples t‐test, effect sizes, and binary logistic regression analysis. Participants had a mean maternal sleep quality score of 4.00 ± 1.38. They slept for 7.53 ± 0.92 hr on average. One‐third of the participants were poor sleepers (32.2%). Employed participants were 71.6% less likely to have poor maternal sleep quality than their non‐employed counterparts (odds ratio = 0.29, 95% confidence interval: 0.13–0.62; p = 0.002). The odds of poor maternal sleep quality increased by 13.7% when maternal weight gain during pregnancy increased by 1 kg (odds ratio = 1.14, 95% confidence interval: 1.03–1.26; p = 0.014). Increased maternal sleep quality positively affected the birth process (p < 0.05). Healthcare professionals should routinely screen the maternal sleep quality of pregnant women and increase their sleep hygiene. [ABSTRACT FROM AUTHOR]

Summary: Sleep is fundamental to health. The aim of this study was to analyse and determine factors predicting sleep quality during and after national lockdowns due to severe acute respiratory syndrome coronavirus 2 (COVID‐19) in the UK. A longitudinal online survey‐based study (SleepQuest) involving UK adults was administered in Spring 2020, Winter 2020, and Winter 2022 including questionnaires probing sleep quality, depression, anxiety, beliefs about sleep, demographics, COVID‐19 status, and exercise. The primary outcome was sleep quality (Pittsburgh Sleep Quality Index). A linear mixed‐effects model evaluated factors associated with baseline and longitudinal sleep quality. Complete data were provided by 3306 participants in Spring 2020, 2196 participants in Winter 2020, and 1193 in Winter 2022. Participants were mostly female (73.8%), white (97.4%), and aged over 50 years (81.0%). On average, participants reported poor sleep quality in Spring 2020 (mean [SD] Pittsburgh Sleep Quality Index score = 6.59 [3.6]) and Winter 2020 (mean [SD] Pittsburgh Sleep Quality Index score = 6.44 [3.6]), with improved but still poor sleep quality in Winter 2022 (mean [SD] Pittsburgh Sleep Quality Index score = 6.17 [3.5]). Improved sleep quality was driven by better subjective sleep and reduced daytime dysfunction and sleep latency. Being female, older, having caring responsibilities, working nightshifts, and reporting higher levels of depression, anxiety, and unhelpful beliefs about sleep were associated with worse baseline PSQI scores. Better sleep quality was associated with more days exercising per week at baseline. Interventions focusing on improving mental health, exercise, and attitudes towards sleep, particularly in at‐risk groups, may improve sleep‐related outcomes in future pandemics. [ABSTRACT FROM AUTHOR]

Background: Recurrent episodes of upper airway collapse during sleep cause obstructive sleep apnoea (OSA). Patients with OSA, a serious clinical condition, frequently halt or reduce their breathing while they are asleep. This results in non-restful, fragmented sleep, which exacerbates symptoms such as morning headaches and drowsiness during the day. Aims and objectives: This review article focuses only on the current medical treatment of OSA. It will also catalyse further study and better awareness of the current medical treatment of OSA. Materials and methods: A search was conducted for recent research articles on current medical treatment for OSA. We searched the PubMed, Scopus, Medline and Google Scholar online databases. Results: Heart arrhythmias, depression, hypertension and coronary artery disease are among the medical disorders linked to OSA. Clinical symptoms that are predictive include obesity, enlarged neck circumferences, gasping when sleeping and loud snoring. Those who are obese, hypertensive, frequent snorers and hyper-somnolent should be suspected of having OSA. An essential test for accurately diagnosing OSA is overnight polysomnography. Conclusion: As OSA is a chronic illness, a long-term, interdisciplinary strategy is required. The first step in managing OSA is patient education. For treatment of OSA, lifestyle changes including losing weight, switching to a different sleeping position, abstaining from alcohol and using certain drugs are crucial. When treating OSA, positive airway pressure is a crucial choice. Since OSA affects both the person and society as a whole, further investigation is needed to find novel treatment approaches for this morbid clinical condition. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular joint dysfunction (TMD) is a multifactorial and complex problem. The underlying causes of the symptoms and related factors of TMD should be specifically identified. This study aimed to examine factors in the relationship between TMD severity and compare cases regarding TMD severity in university students. Methods: The participants were evaluated with the Visual Analog Scale (VAS) for jaw and neck pain severity. TMD severity was assessed with the Fonseca Anamnestic Index (FAI), sleep quality with the Pittsburgh Sleep Quality Index (PSQI), oral habits with the Oral Behavior Checklist (OBC), and depression and anxiety status with the Hospital Anxiety and Depression Scale (HADS). In addition, mandibular movements were also evaluated. Results: A total of 51 individuals (39 female, 12 male; mean age: 21.9 ± 3.8) were included in the study. There was a positive moderate correlation between FAI and OBC (r = 0.560, p < 0.01). PSQI (r = 0,373), VAS-jaw pain (r = 0,374, p < 0.05), VAS-neck pain (r = 0,437, p < 0.05) and HADS-D (r = 0,392, p < 0.05) were moderately associated with FAI. There was also a low correlation between FAI and HADS-A (r = 0.346, p < 0.05). A statistically significant predictive correlation was found between VAS-Neck pain and OBC with FAI (p < 0.05). Conclusions: This study's results show that jaw and neck pain, sleep habits, oral habits, and anxiety-depression levels are associated with TMD severity. This association highlights the need to consider these factors in assessing and treating TMD. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Due to the unclear etiology of recurrent aphthous stomatitis (RAS), a painful and distressing condition with a high prevalence, the researchers have hypothesized a connection between sleep quality and RAS.The cross‐sectional study enrolled 10,138 Fasa Cohort Study participants aged 35–70 years. Various sleep quality factors were calculated and categorized based on the Pittsburgh Sleep Questionnaire.Among 9030 subjects finally included with RAS prevalence of 20.2%, adjusted logistic regression showed significant odds ratios (ORs) in subjects who sleep < 5 h (OR = 1.44, 95%CI 1.25, 1.66), have sleep latencies of more than 60 min (OR = 1.37, 95%CI 1.11, 1.69), have sleep efficiencies of 65%–75% (OR = 1.55, 95%CI 1.21, 1.98), or regularly go to bed after 11 p.m. (OR = 1.23, 95%CI 1.11, 1.37). Subgroup analyses indicated no significant associations between RAS and various sleep factors in individuals who worked night shifts, and stronger associations were observed in men than women.The study found a significant positive association between RAS and sleep quality factors such as shorter duration, lower efficiency, longer latency, later bedtime, and regular sleeping pill use. Establishing early and sufficient sleep and addressing sleep onset disturbances by adhering to sleep hygiene principles should be prioritized in individuals with RAS. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to validate the Korean version of the sleep hygiene practice scale (SHPS-K) and determine its effectiveness in screening poor sleepers with insomnia. Methods: Online survey was conducted using translated SHPS in Korean, the Korean versions of the Pittsburgh Sleep Quality Index (PSQI-K), Insomnia Severity Index (ISI-K), and Epworth Sleepiness Scale (KESS) in a non-clinical population. The internal consistency and test-retest reliability of the SHPS-K were assessed using Cronbach's alpha and intraclass correlation coefficients (ICC), respectively. Construct validity was evaluated using correlation analyses with other questionnaires and confirmatory factor analysis. We determined the cutoff values that could identify poor sleepers with insomnia symptoms (PSQI-K > 5 and ISI-K ≥ 15) using receiver operating characteristic analysis. Results: A total of 484 participants (242 women, mean age of 43.8 years) were enrolled. The average SHPS-K score was 71.2, with no significant sex differences. Women had poorer sleep scheduling and timing behaviors, and men had poorer eating and drinking behaviors. Good internal consistency (Cronbach's alpha = 0.88) and test-retest reliability (ICC = 0.80) were observed. The SHPS-K was positively correlated with the PSQI-K (r = 0.55), ISI-K (r = 0.54), and KESS (r = 0.42). A cutoff value of 73 identified poor sleepers with insomnia (area under the curve = 0.828). Conclusions: The SHPS-K is a reliable instrument for evaluating sleep hygiene in non-clinical Korean populations. [ABSTRACT FROM AUTHOR]

Background: Adolescent overweight and obesity are a public health problem with an epidemic trend. There is growing evidence that sleep quality correlates to body weight. The aim of this study was to investigate, sleep quality in adolescents with obesity/overweight. Methods: A total of 100 adolescents with overweight/obesity aged 12–18 years were enrolled. Anthropometric parameters were recorded and a laboratory investigation in the fasting state [glucose, insulin, cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides, uric acid and glycated hemoglobin (HbA1c)] was performed. Insulin resistance was calculated by the Homeostasis Model Assessment of Insulin Resistance index (HOMA-IR). Sleep quality was assessed with the Adolescent Sleep Hygiene Scale (ASHS) questionnaire. Results: According to ASHS, 93% of the participants were classified as "Good Sleepers" (GSs) (score > 3.8) and 7% as "Poor Sleepers" (PSs) (score < 3.8). PSs had a statistically higher body mass index (BMI) compared to GSs (p = 0.026). Increased body mass index (BMI) (r = −0.306, p = 0.002), fast insulin (r = −0.224, p = 0.027), and HOMA-IR (r = −0.260, p = 0.010) exerted a negative effect on sleep quality. Controlling for lipids and uric acid, only TC levels appeared to have a statistically significant and specifically positive correlation with the ASHS score (r = 0.202, p = 0.045). HbA1c values and waist circumference tended to be negatively correlated, but not significant to adolescent sleep quality [(r = −0.101, p = 0.330), (r = −0.095, p = 0.359), respectively]. The influence of central obesity on the ASHS score was also explored, but no correlation was found (p = 0.566). Conclusions: Sleep quality, as reflected by the ASHS score, was associated negatively with BMI, fasting insulin levels, and insulin resistance. Furthermore, a gender difference was observed, as adolescent males were found to achieve a higher overall ASHS score compared to females. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers often encounter inadequate sleep conditions. However, limited research has examined the underlying sleep patterns among healthcare workers. This study aimed to identify sleep patterns in healthcare workers, explore predictors associated with various sleep patterns, and investigate the relationship between sleep patterns and psychiatric symptoms. Methods: This cross-sectional study was conducted in Shenzhen, China, from April 2023 to June 2023. In total, data from 1,292 participants were included using a convenience sampling method. A latent profile analysis was conducted to identify sleep patterns based on the seven dimensions of the Pittsburgh Sleep Quality Index. Multinomial logistic regression analysis was conducted to investigate the influence of socio-demographic variables on each profile. A one-way ANOVA test was employed to examine the relationships between sleep patterns and psychiatric symptoms. Results: Three distinct profiles were identified: good sleepers (63.9%), inefficient sleepers (30.3%), and poor sleepers (5.7%). Multinomial logistic regression analysis indicated that gender and marital status were predictors of various sleep patterns. The ANOVA revealed significant differences in psychiatric symptoms scores among the three sleep patterns; poor sleepers exhibited the highest levels of mental distress. Conclusion: This study identified three distinct sleep patterns in healthcare workers and their significant associations with psychiatric symptoms. These findings contribute to the development of targeted intervention strategies aimed at improving sleep and reducing psychiatric symptoms among healthcare workers. [ABSTRACT FROM AUTHOR]

Background: Emotional eating is a prevalent maladaptive coping mechanism among college students, which is associated with mental health and sleep concerns. Though previous studies have established a link between sleep quality, depression and emotional eating, most of these have been in Western populations. In addition, few existing studies have taken physical activities into account, and the underlying mechanisms between these four variables remain to be further studied. Therefore, our study investigated the mediating role of depression and the moderating role of physical activity levels in the relationship between sleep quality and emotional eating among Chinese college students. Our study can help to understand the characteristics of this population and provide guidance on the intervention pathways for emotional eating. Methods: A convenience sampling method was employed to select eligible participants for investigation. The General Information Questionnaire, the Pittsburgh Sleep Quality Index Scale, the Patient Health Questionnaire, the Dutch Eating Behavior Scale, and the International Physical Activity Questionnaire were employed to measure the general condition, sleep quality, depression, emotional eating, and physical activity. A total of 813 college students (Mage = 19.14, SD = 1.12, range = 17 ~ 25 years old, 71.1% females) completed the survey. The moderated mediation analysis was carried out using the SPSS PROCESS macro. Results: After controlling for sex, age, and body mass index (BMI), sleep quality positively predicted emotional eating. Depression primarily mediated the association between them. Besides, physical activity levels moderated the relationship between sleep quality and emotional eating via depression. Depression significantly predicted emotional eating among students with low levels of physical activity; however, it was not significant among students with moderate or high levels of physical activity. Conclusions: The role of depression mediates the link between sleep quality and emotional eating. Regular exercise can ease the symptoms of emotional eating through depression. This implies the importance of offering more sleep hygiene education and physical activity in university settings. Plain English summary: College students often experience poor sleep quality and negative emotions due to different kinds of pressure, which can lead to emotional eating. But the mediating or moderating mechanism is not fully understood between them. Our research looked at how depression might explain this connection and whether physical activity can help. We surveyed 813 college students about their sleep quality, depression, emotional eating, and physical activity levels. The results showed that students with poor sleep were more likely to eat emotionally, which was totally mediated by depression. However, students who were physically active were less affected by this pattern. This means that regular exercise can weaken the impact of poor sleep and depression on emotional eating. Our findings suggest that encouraging good sleep habits and physical activity in colleges can help prevent emotional eating. [ABSTRACT FROM AUTHOR]

Background: The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a plant-based and anti-inflammatory diet that has the ability to protect and manage cardiovascular and nervous system diseases. Regarding that insomnia and cardiovascular problems are x'common in type 2 diabetes mellitus (T2DM), the present study will assess the effectiveness of the MIND dietary pattern on sleep quality, cardiometabolic indicators, and other psychological indicators. Methods: Forty-four overweight/obese T2DM women with insomnia, aged 30–65 years, will voluntarily participate in this randomized controlled trial and will be randomized to receive either a MIND low-calorie diet (MLCD) or a low-calorie diet (LCD) over a 3-month period. Before and after the study, sleep quality, some biochemical and cardiometabolic indices, cortisol, brain-derived neurotrophic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP), and oxidative stress indicators will be assessed. Discussion: The use of dietary interventions in the management of T2DM complications is practical and safe. This research seeks to investigate the capacity of the MIND diet in the management of insomnia and cardiovascular problems of DM. It is expected that the results of this research will provide new perspectives on using an ideal dietary regimen to treat these health conditions. Trial registration: IRCT20181111041611N8. Registered on August 7, 2023. https://www.irct.ir/trial/71772 [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Insomnia affects both quality of life and productivity at work, and it raises the risk of other diseases, such as depression, that coexist with insomnia. Nowadays, it is highly advised to treat insomnia with behavioral and psychological therapeutic methods to ensure the quality of your sleep. Aim: This study aimed to find the efficacy of sleep hygiene techniques in improving sleep quality and mental ability among insomnia clients. Methods: Self-structured questionnaires used to evaluate sleep quality and the McQuaig Mental Ability Test to test mental ability were used to collect data during the study's six-week duration, which involved the recruitment of 50 participants using a purposive sample technique. A paired sample t -test and Pearson correlation were used for the statistical analysis. Results: Data analysis shows that sleep quality (t = 33.35) (P = 0.0000) and mental ability (t = 35.33) (P = 0.0001) are both highly significant at P =0.0001. Correlation regression data of sleep hygiene elements such as schedule, avoiding caffeine and beverages, relaxation routine, and sleep-stimulating environment shows that there is a positive correlation with the quality of sleep at r = 0.9, 0.89, 0.75, and 0.68, whereas P = 0.000, 0.01, and 0.023, respectively. Similar to this, there is a positive association between mental ability and good sleep habits such as a relaxing routine, a sleep-promoting environment, and a schedule with r = 0.91, 0.88, and 0.92, respectively, with P values of 0.0001, 0.001, and 0.001. Conclusion: The results of the study provide compelling evidence that good sleep hygiene can help enhance insomniacs' mental ability and sleep quality. Furthermore, those with moderate levels of sleep quality, those between the ages of 18 and 38, and those with higher education benefited more than others. [ABSTRACT FROM AUTHOR]

Insomnia is commonplace in the general population. Poor sleep quality leads to various health dysfunctions and compromises the well-being of the affected individuals. Non-pharmacologic approaches should be considered the first-line treatment as suggested by various guidelines. Among others (e.g., sleep hygiene, cognitive-behavioral therapy, light therapy), appropriate physical activity seems to be promising in treating and preventing sleep disturbance development. We found that improvement in a particular objective and subjective sleep quality parameters may be attributed to appropriate physical activity. When further analyzing the activity, lightintensity aerobic exercises and resistance training reduced insomnia symptoms. High-intensity interval training also showed a positive effect on the improvement in depressive symptoms. Regarding mind-body practices, current evidence is insufficient to conclude. However, it was documented that stress, depression, and anxiety reduction, can improve well-being. [ABSTRACT FROM AUTHOR]

Summary: This review examines the temporal association between nocturnal gastro‐oesophageal reflux and sleep‐arousal cycles. Most nocturnal gastro‐oesophageal reflux events occur during the awake cycle, and arousals precede most nocturnal gastro‐oesophageal reflux events, indicating that arousal from sleep predisposes to nocturnal gastro‐oesophageal reflux. This sheds light on the complex relationship between nocturnal gastro‐oesophageal reflux and sleep, and has implications for managing nocturnal gastro‐oesophageal reflux symptoms. The appearance of symptoms and the pathophysiology of nocturnal gastro‐oesophageal reflux are influenced by sleep hygiene, sleep disturbances and the misalignment of circadian rhythms. Nocturnal gastro‐oesophageal reflux and its related sleep disorders are prevalent and negatively impact the quality of life. There is conflicting evidence on whether nocturnal gastro‐oesophageal reflux and sleep disturbances are causally linked, and whether sleep disturbances drive nocturnal gastro‐oesophageal reflux. Poor sleep quality increases oesophageal hypersensitivity and overall acid exposure. The nocturnal gastro‐oesophageal reflux is linked to the more severe forms of gastro‐oesophageal reflux disease, especially with atypical/extra‐oesophageal manifestations and complications of mucosal damage such as oesophagitis and stricture, Barret's oesophagus, and oesophageal adenocarcinoma. This review highlights the role of sleep problems in presenting nocturnal gastro‐oesophageal reflux, and the potential benefits of treating sleep disturbances in enhancing patient care and quality of life. [ABSTRACT FROM AUTHOR]

Aims: To consolidate adolescents' perspectives regarding various aspects of sleep and offer insights to promote healthier sleep habits during their critical developmental years. Methods/Data Sources: Six electronic databases (PubMed, CINAHL, Embase, Scopus, PsycINFO and Web of Science) were searched from their inception dates to June 2023. Data were extracted and meta‐summarised using Sandelowski and Barroso's approach and synthesised using Thomas and Harden's thematic analysis framework. Results: Meta‐synthesis from 11 peer‐reviewed published studies identified four main themes: (1) Awareness and understanding of sleep's significance, (2) The shadows and radiance of slumber, (3) Traversing the sleepscape: trouble bubbles and (4) Illuminating the path: Guiding lights to enhanced sleep. Conclusion/Implications: Our review findings suggest a lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Identified barriers to adequate sleep encompass various factors, including overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. Strategies to improve adolescents' sleep health involve multiple sleep strategies, including sleep education, workshops/seminars, parental involvement, incorporating digital well‐being practices, the promotion of relaxation techniques and the provision of essential resources. Prioritising sleep health and implementing targeted interventions are key steps to empower adolescents, create supportive environments and shape a healthier future generation. Future research endeavours should focus on evaluating the effectiveness of interventions and exploring the influence of cultural factors. Impact: There exists a notable lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents.Barriers to achieving adequate sleep among adolescents include overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities.The collaboration between healthcare institutions, professionals and educational institutions is crucial to facilitate (1) the implementation of sleep education workshops/seminars targeting adolescents, (2) increased parental involvement and role‐modelling to instil good sleep practices among adolescents and (3) enhanced integration of digital well‐being practices, the promotion of relaxation techniques and accessibility to essential sleep hygiene resources. Reporting Method: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Patient or Public Contribution: No patient or public contribution. Trial and Protocol Registration: This review was registered on the Prospective Register of Systematic Reviews (CRD42023403775). [ABSTRACT FROM AUTHOR]

Sleep is a vital but overlooked and undervalued part of our overall health and well-being. Striving to optimize productivity and meet numerous daily demands often means that sleep is not prioritized. As sleep stewardship's importance gains wider recognition, clinical and ethical management of sleep resources and practices will likely be key features of health professionalism. This article considers how sleep stewardship should be advanced as a clinical, ethical, and cultural priority. [ABSTRACT FROM AUTHOR]

Primary care clinicians are well-equipped to screen for sleep concerns, help some patients, and refer patients whose sleep troubles are more complex to specialists. Poor sleep affects nearly every organ system and influences many morbidity and mortality causes, so screening for sleep sufficiency and quality should be prioritized in primary care settings. This commentary on a case suggests strategies for more fully supporting primary care clinicians' compensation and capacity for conducting effective conversations with patients experiencing sleep trouble. [ABSTRACT FROM AUTHOR]

Background: Sleep hygiene behaviours are a suggested set of behaviours people can engage in to improve sleep. However, there are numerous issues relating to the measurement of sleep hygiene, primarily, the lack of consensus as to which behaviours impact sleep and should therefore be included in scales. Method: Cross-sectional correlational methods were used to assess the association between sleep quality, a highly inclusive range of sleep hygiene behaviours, and individual perceptions of those behaviours in a non-clinical sample of 300 participants. Results: Of the 35 sleep hygiene behaviours assessed, 18 were independently associated with sleep quality. Post-hoc factor analysis revealed that behaviours clustered together across four factors. A 'routine' factor included behaviours such as going to bed and waking up at the same time each night, and were important predictors of sleep quality, as were behaviours belonging to the 'perseverative cognition' and 'negative emotionality' factor. Other behaviours related to physiological processes like exposure to sunlight during the day and going to bed hungry were also significantly associated with sleep. Negative perceptions moderated the relationship between daytime exposure to sunlight and sleep. Conclusions: Although certain behaviours were significantly related to sleep, almost half were not, supporting the need to examine the association between sleep and behaviours used for sleep hygiene recommendations more critically. Reframing sleep hygiene recommendations into a condensed set of shared underlying mechanisms may be of benefit for the development of sleep hygiene scales and interventions in non-clinical populations. [ABSTRACT FROM AUTHOR]

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Excessive daytime sleepiness (EDS) and insomnia (IN) complaints represent the most common sleep/wake disorders. Currently, the specific needs of these patients and their relatives, as well as the overall socio-economic burden of IN and EDS remains widely unexplored. This pilot study to be carried out in Switzerland is a retro- and prospective, national, one-center cohort observational study for the systematic evaluation of the burden of EDS and IN and its evolution 12 months after the first assessment. Patient recruitment will be organized through 7–8 primary care providers (primary/general care practitioners and pharmacies). Primary outcomes are the prevalence of EDS/IN in the primary care setting and the association between EDS/IN with health-related quality of life (QOL) as assessed with the established instruments. Secondary outcomes are the association between EDS/IN with the presence of comorbidities, number of injuries/accidents, and number of sick/leave days for the subgroup of working subjects. Calculation of direct per-patient costs will be undertaken to analyze the economic implications of sleep/wake disorders, providing valuable insights into the financial burden experienced by affected individuals within the healthcare system. This research will provide information on the feasibility of such a study and inform on aspects of the QOL most associated with EDS/IN. Based on this pilot project, a European multicenter study on the burden of sleep/wake disorders will be conducted by the European Academy of Neurology. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has left behind mental health issues like anxiety, depression, and sleep disorders among survivors. This study assessed the efficacy of spa therapy in enhancing psychological well-being and sleep quality in individuals with chronic arthro-rheumatic, respiratory, and otorhinolaryngological diseases, including COVID-19 recoverees. Our prospective observational study included 144 Caucasian subjects from three Italian spas who underwent a 2-week spa therapy cycle, involving balneotherapy and/or inhalation treatments. Symptoms were assessed with the Visual Analogue Scale (VAS), psychological well-being with Depression Anxiety Stress Scales-21 items (DASS-21), and sleep quality with the Insomnia Severity Index (ISI). Significant reductions in VAS scores for arthro-rheumatic, respiratory, and otorhinolaryngological symptoms were observed after spa therapy, as well as for DASS-21 and ISI scores for sleep quality, transitioning to less severe insomnia categories. Females had more pronounced improvements in DASS-21 scores and sleep quality. Subjects with and without prior SARS-CoV-2 infection experienced significant reductions in anxiety, depression, and stress, with more pronounced improvements in those without prior infection. COVID-19 survivors also showed significant ISI score improvements. Spa therapy is a promising complementary treatment for improving mental health and sleep quality in chronic disease patients, including COVID-19 survivors. [ABSTRACT FROM AUTHOR]