Journal articles: 'Sleep outcomes'

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Chasens, Eileen R., Susan M. Sereika, and Lora E. Burke. "Daytime Sleepiness and Functional Outcomes in Older Adults With Diabetes." Diabetes Educator 35, no. 3 (April 14, 2009): 455–64. http://dx.doi.org/10.1177/0145721709333857.

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Purpose This secondary analysis examined the effect of excessive sleepiness on daytime function in older adults with diabetes from the National Sleep Foundation's Sleep and Aging poll. Methods Respondents were older adults (N = 1506; age range, 55-84 years) evaluated by telephone survey on their sleep duration, sleep disturbances, daytime functional outcomes, and self-reported height, weight, and comorbidities. Results Approximately 16% (n = 244) of the sample acknowledged a diagnosis of diabetes; they were older, had more comorbidities, had a higher body mass index (BMI), and were more likely to be sleepy during the daytime than nondiabetic respondents (all P < .05). Respondents with diabetes who reported frequent daytime sleepiness (n = 50; 20%) had significantly (P < .05) higher BMI, lower self-rated health, and more sleep disturbances than those who were not sleepy (n = 194). Sleepy respondents with diabetes also reported more frequent feelings of depression, decreased pleasure in life, naps, feeling drowsy, or dozing off while driving (all P < .05). Excessive sleepiness was significantly associated (P < .001) with an increased risk for depressive symptoms while controlling for BMI, age, and number of comorbidities. Conclusions These results indicate that sleep disturbances affect not only sleep quality but also daytime function in older adults with diabetes.

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Wanderer, Jonathan P., and Naveen Nathan. "Poor Sleep, Worse Outcomes." Anesthesia & Analgesia 127, no. 4 (October 2018): 804. http://dx.doi.org/10.1213/ane.0000000000003745.

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Fleming, Melanie K., Tom Smejka, David Henderson Slater, Veerle van Gils, Emma Garratt, Ece Yilmaz Kara, and Heidi Johansen-Berg. "Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery." Neurorehabilitation and Neural Repair 34, no. 7 (June 7, 2020): 661–71. http://dx.doi.org/10.1177/1545968320929669.

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Background. Sleep is important for consolidation of motor learning, but brain injury may affect sleep continuity and therefore rehabilitation outcomes. Objective. This study aims to assess the relationship between sleep quality and motor recovery in brain injury patients receiving inpatient rehabilitation. Methods. Fifty-nine patients with brain injury were recruited from 2 specialist inpatient rehabilitation units. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included Action Research Arm test (upper limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead Mobility Index. The Functional Independence Measure (FIM) was assessed at admission and discharge by the clinical team. Fifty-five age- and gender-matched healthy controls completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality ( P < .001) and more fragmented sleep ( P < .001) than controls. For inpatients, sleep fragmentation explained significant additional variance in motor outcomes, over and above that explained by admission FIM score ( P < .017), such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM ( R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions. Inpatients with brain injury demonstrate impaired sleep quality, and this is associated with poorer motor outcomes and slower functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.

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Dubik, M. "Obstructive Sleep Apnea: Adenotonsillectomy Outcomes." AAP Grand Rounds 24, no. 2 (August 1, 2010): 25. http://dx.doi.org/10.1542/gr.24-2-25.

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Ruggiero, Aria R., Hannah D. Peach, and Jane F. Gaultney. "0276 Sleep Attitudes Predicting Sleep Outcomes: An Intersectionality Perspective." Sleep 42, Supplement_1 (April 2019): A112—A113. http://dx.doi.org/10.1093/sleep/zsz067.275.

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Aljassim, Abrar, Kenny P. Pang, and Brian W. Rotenberg. "Does Drug‐Induced Sleep Endoscopy Improve Sleep Surgery Outcomes?" Laryngoscope 130, no. 11 (April 18, 2020): 2518–19. http://dx.doi.org/10.1002/lary.28668.

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Pirner, Maddison, Scott Doyle, Janna Mantua, Alexxa Bessey, Jacob Naylor, Bradley Ritland, Walter Sowden, Tina Burke, and Ashlee Mckeon. "307 Sleep and occupational wellbeing in active duty U.S Army Soldiers." Sleep 44, Supplement_2 (May 1, 2021): A122—A123. http://dx.doi.org/10.1093/sleep/zsab072.306.

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Abstract Introduction Insufficient sleep is ubiquitous among active duty service members in operational settings. Although insufficient sleep has been linked to poor cognitive, psychological, and physiological outcomes in military populations, little research has investigated the impact of insufficient sleep on Soldier occupational wellbeing. This study examined the longitudinal association between sleep quality and occupational functioning in a population of active duty U.S. Army Soldiers. Methods Sixty male Soldiers (age 25.41±3.74 years) participated. Sleep quality and occupational outcomes were assessed four weeks apart (before and after an annual training mission). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Occupational outcome measures included the Emotional Exhaustion Scale, Walter Reed Functional Impairment Short Scale, Role Overload Scale, and Perceived Stress Scale. Linear regressions assessed the prediction of PSQI Global Score on occupational outcome scores. Student’s t-tests compared occupational outcomes between “good” and “poor” sleepers (PSQI Global Score > 5 = poor sleeper). Results Poorer sleep quality at baseline broadly predicted poor occupational outcomes post-training. Specifically, higher PSQI Global Scores predicted higher emotional exhaustion (B = 1.6, p < 0.001, R2 = 0.25), functional impairment (B = 0.29, p < 0.03, R2 = 0.14), role overload (B = 28, p < 0.008, R2 = 0.12), and perceived stress (B = 0.34, p < 0.004, R2 = 0.2). Furthermore, occupational outcome scores were significantly higher in poor sleepers than good sleepers: emotional exhaustion: (t(58) = -4.18, p < .001); functional impairment: (t(59) = -3.68, p = .001); role overload (t(58) = -3.20, p = .002); and perceived stress (t(58) = -2.43, p = .02). Conclusion This study identified a longitudinal relationship between sleep quality and occupational outcomes, suggesting that service members with poor sleep may be at risk for experiencing poor workplace wellbeing. Given the association between service member wellbeing and likelihood to re-enlist, insufficient sleep may negatively impact Soldier attrition. Future studies should aim to augment sleep quality and track occupational outcomes in this population. Support (if any) This work was funded by the Military Operational Medicine Research Program of the United States Army Medical Research and Development Command.

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Neuendorf, Rachel, Helané Wahbeh, Irina Chamine, Jun Yu, Kimberly Hutchison, and Barry S. Oken. "The Effects of Mind-Body Interventions on Sleep Quality: A Systematic Review." Evidence-Based Complementary and Alternative Medicine 2015 (2015): 1–17. http://dx.doi.org/10.1155/2015/902708.

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Study Objectives. To evaluate the effect of mind-body interventions (MBI) on sleep.Methods. We reviewed randomized controlled MBI trials on adults (through 2013) with at least one sleep outcome measure. We searched eleven electronic databases and excluded studies on interventions not considering mind-body medicine. Studies were categorized by type of MBI, whether sleep was primary or secondary outcome measure and outcome type.Results. 1323 abstracts were screened, and 112 papers were included. Overall, 67 (60%) of studies reported a beneficial effect on at least one sleep outcome measure. Of the most common interventions, 13/23 studies using meditation, 21/30 using movement MBI, and 14/25 using relaxation reported at least some improvements in sleep. There were clear risks of bias for many studies reviewed, especially when sleep was not the main focus.Conclusions. MBI should be considered as a treatment option for patients with sleep disturbance. The benefit of MBI needs to be better documented with objective outcomes as well as the mechanism of benefit elucidated. There is some evidence that MBI have a positive benefit on sleep quality. Since sleep has a direct impact on many other health outcomes, future MBI trials should consider including sleep outcome measurements.

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McDaid, Catriona, Adwoa Parker, Arabella Scantlebury, Caroline Fairhurst, Vicky Dawson, Heather Elphick, Catherine Hewitt, Gemma Spiers, Megan Thomas, and Bryony Beresford. "Outcome domains and outcome measures used in studies assessing the effectiveness of interventions to manage non-respiratory sleep disturbances in children with neurodisabilities: a systematic review." BMJ Open 9, no. 6 (June 2019): e027205. http://dx.doi.org/10.1136/bmjopen-2018-027205.

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ObjectivesTo assess whether a core outcome set is required for studies evaluating the effectiveness of interventions for non-respiratory sleep disturbances in children with neurodisabilities.DesignSurvey of outcome measures used in primary studies identified by a systematic review.Data sourcesASSIA, CENTRAL, Cochrane Database of Systematic Reviews, Conference Proceedings Citation Index, CINAHL, DARE, Embase, HMIC, MEDLINE, MEDLINE In-Process, PsycINFO, Science Citation Index, Social Care Online, Social Policy & Practice, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform and the UK Clinical Trials Gateway were searched up to February 2017.Eligibility criteriaStudies evaluating pharmacological or non-pharmacological interventions for children (≤18 years old) with a neurodisability and experiencing non-respiratory sleep disturbance.Data extraction and synthesisOutcome measures were listed from each study and categorised into domains.ResultsThirty-nine studies assessed five core outcome areas: child sleep, other child outcomes, parent outcomes, adverse events and process measures. There were 54 different measures of child sleep across five domains: global measures; sleep initiation; maintenance; scheduling; and other outcomes. Fifteen non-pharmacological (58%) and four pharmacological studies (31%) reported child outcomes other than sleep using 29 different measures.One pharmacological and 14 non-pharmacological (54%) studies reported parent outcomes (17 different measures). Eleven melatonin studies (85%) recorded adverse events, with variation in how data were collected and reported. One non-pharmacological study reported an explicit method of collecting on adverse events. Several process measures were reported, related to adherence, feasibility of delivery, acceptability and experiences of receiving the intervention.ConclusionsThere is a lack of consistency between studies in the outcome measures used to assess the effectiveness of interventions for non-respiratory sleep disturbances in children with neurodisabilities. A minimum core outcome set, with international consensus, should be developed in consultation with parents, children and young people, and those involved in supporting families.PROSPERO registration numberCRD42016034067

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Chaput, Jean-Philippe, Caroline Dutil, Ryan Featherstone, Robert Ross, Lora Giangregorio, Travis J. Saunders, Ian Janssen, et al. "Sleep timing, sleep consistency, and health in adults: a systematic review." Applied Physiology, Nutrition, and Metabolism 45, no. 10 (Suppl. 2) (October 2020): S232—S247. http://dx.doi.org/10.1139/apnm-2020-0032.

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The objective of this systematic review was to examine the associations between sleep timing (e.g., bedtime/wake-up time, midpoint of sleep), sleep consistency/regularity (e.g., intra-individual variability in sleep duration, social jetlag, catch-up sleep), and health outcomes in adults aged 18 years and older. Four electronic databases were searched in December 2018 for articles published in the previous 10 years. Fourteen health outcomes were examined. A total of 41 articles, including 92 340 unique participants from 14 countries, met inclusion criteria. Sleep was assessed objectively in 37% of studies and subjectively in 63% of studies. Findings suggest that later sleep timing and greater sleep variability were generally associated with adverse health outcomes. However, because most studies reported linear associations, it was not possible to identify thresholds for “late sleep timing” or “large sleep variability”. In addition, social jetlag was associated with adverse health outcomes, while weekend catch-up sleep was associated with better health outcomes. The quality of evidence ranged from “very low” to “moderate” across study designs and health outcomes using GRADE. In conclusion, the available evidence supports that earlier sleep timing and regularity in sleep patterns with consistent bedtimes and wake-up times are favourably associated with health. (PROSPERO registration no.: CRD42019119534.) Novelty This is the first systematic review to examine the influence of sleep timing and sleep consistency on health outcomes. Later sleep timing and greater variability in sleep are both associated with adverse health outcomes in adults. Regularity in sleep patterns with consistent bedtimes and wake-up times should be encouraged.

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Brown, Devin L., Valerie Durkalski, Jeffrey S. Durmer, Joseph P. Broderick, Darin B. Zahuranec, Deborah A. Levine, Craig S. Anderson, et al. "Sleep for Stroke Management and Recovery Trial (Sleep SMART): Rationale and methods." International Journal of Stroke 15, no. 8 (February 4, 2020): 923–29. http://dx.doi.org/10.1177/1747493020903979.

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Rationale Obstructive sleep apnea is common among patients with acute ischemic stroke and is associated with reduced functional recovery and an increased risk for recurrent vascular events. Aims and/or hypothesis The Sleep for Stroke Management and Recovery Trial (Sleep SMART) aims to determine whether automatically adjusting continuous positive airway pressure (aCPAP) treatment for obstructive sleep apnea improves clinical outcomes after acute ischemic stroke or high-risk transient ischemic attack. Sample size estimate A total of 3062 randomized subjects for the prevention of recurrent serious vascular events, and among these, 1362 stroke survivors for the recovery outcome. Methods and design Sleep SMART is a phase III, multicenter, prospective randomized, open, blinded outcome event assessed controlled trial. Adults with recent acute ischemic stroke/transient ischemic attack and no contraindication to aCPAP are screened for obstructive sleep apnea with a portable sleep apnea test. Subjects with confirmed obstructive sleep apnea but without predominant central sleep apnea proceed to a run-in night of aCPAP. Subjects with use (≥4 h) of aCPAP and without development of significant central apneas are randomized to aCPAP plus usual care or care-as-usual for six months. Telemedicine is used to monitor and facilitate aCPAP adherence remotely. Study outcomes Two separate primary outcomes: (1) the composite of recurrent acute ischemic stroke, acute coronary syndrome, and all-cause mortality (prevention) and (2) the modified Rankin scale scores (recovery) at six- and three-month post-randomization, respectively. Discussion Sleep SMART represents the first large trial to test whether aCPAP for obstructive sleep apnea after stroke/transient ischemic attack reduces recurrent vascular events or death, and improves functional recovery.

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Burnham, Alisa, Olena Kucheruk, Emily Brown, and Jodi Mindell. "596 Sleep Outcomes and Sleep-Related Behaviors in NICU Graduates." Sleep 44, Supplement_2 (May 1, 2021): A235. http://dx.doi.org/10.1093/sleep/zsab072.594.

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Abstract Introduction Previous studies of sleep patterns and problems in preterm infants and toddlers have yielded inconsistent results, with some studies noting differences on salient sleep parameters and others indicating similarities. Furthermore, little is known about any differences about sleep-related behaviors. Thus, the current aims of this study were to assess sleep patterns, problems, and sleep-related behaviors in young children born prematurely who were NICU graduates. Methods Caregivers of 262 children (53.4% boys; 35.9% Black, 40.5% White, 23.6% Other) being followed in a neonatal follow-up clinic at their corrected age one-year (10–16 months) or two-year (22–28 month) visit completed the Brief Infant Sleep Questionnaire-Revised SF (BISQ-R SF). Results At approximately one year of age, infants were going to bed at 8:36, taking 33 minutes to fall asleep, and waking .63 times per night for 19 minutes, for a total nighttime sleep duration of 8’01”. Similarly, at approximately two years of age, infants were going to bed at 8:16, taking 26.7 minutes to fall asleep, and waking .94 times per night for 16.3 minutes, for a total nighttime sleep duration of 8’26”. Sleep problems were reported by 18.1% and 19.6% of caregivers, respectively, with the majority indicating that their child slept well (78.5% and 76.5%) and minimal bedtime difficulties (13.6% and 14.6%). The majority of infants slept in their own crib (81%), with infants more likely to room share at 1-year compared to 2-year (49% vs 35%), and almost half falling asleep independently (43% and 46%). Conclusion Overall, sleep patterns and parent-perceived sleep problems (18–20%) in these NICU graduates were better than expected, and similar to normative data of similar age children (Sadeh et al., 2008). However, these infants/toddlers obtained less nighttime (8–8.5 hrs vs 10 hrs). Sleep education of parents of NICU graduates should not only focus on sleep behaviors, but also on ensuring sufficient sleep. Support (if any):

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PICCIRILLO, JAY F., GEORGE A. GATES, DONNA L. WHITE, and KENNETH B. SCHECTMAN. "Clinical Epidemiology/Outcomes Research." Otolaryngology–Head and Neck Surgery 118, no. 6 (June 1998): 833–44. http://dx.doi.org/10.1016/s0194-5998(98)70277-3.

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Approximately 40 million Americans have chronic sleep disorders, the most serious of which is obstructive sleep apnea. The goals of this research were to serve as a demonstration project for a multicenter treatment outcomes research project for patients with obstructive sleep apnea. A clinical-severity staging system was created to control for important differences in the severity of sleep apnea among the enrolled patients. A disease-specific quality-of-life measure was used in this project to measure, from the patient's perspective, important pretreatment and posttreatment physical, functional, and emotional aspects of obstructive sleep apnea. Adults with apnea indexes greater than 5 who had not previously undergone uvulopalatoplasty were eligible. In total 142 patients were enrolled from eight otolaryngology practices. The mean age was 48 years, 112 were men, and 114 were white. The mean pretreatment apnea index was 40.0, and the mean respiratory distress index was 60.5. Seventy-one patients received continuous positive airway pressure, and 48 patients received surgery. Outcomes were assessed from scores on patient-based general and disease-specific health status measures 4 months after enrollment. The short duration of follow-up and limited number of patients undergoing posttreatment polysomnograms prohibit any analysis of treatment effectiveness. Nevertheless, this research represents a step forward for the support of future outcomes research projects by organized otolaryngology. (Otolaryngol Head Neck Surg 1998;118:833–44.)

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Plekhanova, Tatiana, Alex V. Rowlands, Tom Yates, Andrew Hall, Emer M. Brady, Melanie Davies, Kamlesh Khunti, and Charlotte L. Edwardson. "Equivalency of Sleep Estimates: Comparison of Three Research-Grade Accelerometers." Journal for the Measurement of Physical Behaviour 3, no. 4 (December 1, 2020): 294–303. http://dx.doi.org/10.1123/jmpb.2019-0047.

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Introduction: This study examined the equivalency of sleep estimates from Axivity, GENEActiv, and ActiGraph accelerometers worn on the nondominant and dominant wrists and with and without using a sleep log to guide the algorithm. Methods: 47 young adults wore an Axivity, GENEActiv, and ActiGraph accelerometer continuously on both wrists for 4–7 days. Sleep time, sleep window, sleep efficiency, sleep onset, and wake time were produced using the open-source software (GGIR). For each outcome, agreement between accelerometer brands, dominant and nondominant wrists, and with and without use of a sleep log, was examined using pairwise 95% equivalence tests (±10% equivalence zone) and intraclass correlation coefficients (ICCs), with 95% confidence intervals and limits of agreement. Results: All sleep outcomes were within a 10% equivalence zone irrespective of brand, wrist, or use of a sleep log. ICCs were poor to good for sleep time (ICCs ≥ .66) and sleep window (ICCs ≥ .56). Most ICCs were good to excellent for sleep efficiency (ICCs ≥ .73), sleep onset (ICCs ≥ .88), and wake time (ICCs ≥ .87). There were low levels of mean bias; however, there were wide 95% limits of agreement for sleep time, sleep window, sleep onset, and wake time outcomes. Sleep time (up to 25 min) and sleep window (up to 29 min) outcomes were higher when use of the sleep log was not used. Conclusion: The present findings suggest that sleep outcomes from the Axivity, GENEActiv, and ActiGraph, when analyzed identically, are comparable across studies with different accelerometer brands and wear protocols at a group level. However, caution is advised when comparing studies that differ on sleep log availability.

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Mindell, Jodi A., Erin S. Leichman, and Russel M. Walters. "Sleep location and parent-perceived sleep outcomes in older infants." Sleep Medicine 39 (November 2017): 1–7. http://dx.doi.org/10.1016/j.sleep.2017.08.003.

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Puzino, Kristina, Amanda Pearl, Susan Calhoun, Jamal Essayli, Danielle Alexander, Michael Murray, and Julio Fernandez-Mendoza. "692 Longitudinal Stability of Sleep and Health Correlates in Adults with Autism Spectrum Disorder." Sleep 44, Supplement_2 (May 1, 2021): A270—A271. http://dx.doi.org/10.1093/sleep/zsab072.690.

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Abstract Introduction Individuals with Autism Spectrum Disorder (ASD) experience sleep disturbances to a greater degree than the general population. The majority of research investigating sleep disturbances in ASD has focused on children and adolescents. The aim of the current study was to determine the stability and health correlates of self-reported sleep disturbances in adults with ASD. Methods Participants included 55 adults with ASD recruited from state-funded Pennsylvania programs (31.2±7.6 years old, 80% male, 10.9% minority). Patient-Reported Outcomes Measurement Information System (PROMIS) measures assessing Sleep Disturbances, Sleep-Related Impairment, Fatigue, Anxiety, Depression, Anger, and Physical Health, were completed at baseline and every 90 ± 14 days over a 2-year period. Intraclass correlation coefficients (ICC) were calculated for each sleep outcome, and interpreted as 0.00–0.20=“poor stability,” 0.21–0.40=“slight stability,” 0.41–0.60=“moderate stability,” 0.61–0.80=“substantial stability,” and 0.81–1.00=“almost perfect stability” across the first three time-points. Linear mixed models examined the independent association of sleep disturbances, sleep-related impairment, and fatigue on anxiety, depression, anger, and physical health over the two-year period. Results Sleep-related impairment (ICC=0.73) and fatigue (ICC=0.64) were substantially stable, while sleep disturbances were moderately stable (ICC=0.58). All three sleep-related outcomes were independently associated with anxiety (sleep-related impairment p=0.012; sleep disturbance p<0.001; fatigue p=<0.001) and anger (sleep-related impairment p=<0.001; sleep disturbance p=0.001; fatigue p<0.001) across the two-year period. Sleep disturbance (p=<0.001) and fatigue (p<0.001), but not sleep-related impairment (p=0.267), were associated with depression across the two-year period. In contrast, none of the sleep-related outcomes (sleep-related impairment p=0.285; sleep disturbance p=0.250; fatigue p=0.709) were associated with physical health over time. Conclusion Measures of sleep-related impairment, fatigue, and sleep disturbance remained stable over time, suggesting that they can provide clinicians and researchers with a brief, accurate, and reliable way to assess patient-reported sleep outcomes in adults with ASD. Furthermore, given the stability of these sleep measures and their independent association with elevated mental health outcomes, there is a need for evidence-based treatments targeting sleep difficulties and associated symptomology in adults with ASD, a particularly underserved population. Support (if any) Pennsylvania State Bureau of Autism Services through the Autism Services, Education, Resources, and Training (ASERT) grant

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Niu, Xinran, Shijing Zhou, and Melynda Casement. "091 The Feasibility of At-home Sleep Extension in Adolescents and Young adults: A Meta-Analysis and Systematic Review." Sleep 44, Supplement_2 (May 1, 2021): A38. http://dx.doi.org/10.1093/sleep/zsab072.090.

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Abstract Introduction Insufficient sleep duration has negative consequences for health and performance and is alarmingly common in adolescents and young adults. The primary aim of the meta-analysis and systematic review was to assess whether at-home sleep extension is a feasible means to improve sleep duration and daytime sleepiness without negative consequences for sleep quality or efficiency in adolescents and young adults. An additional aim of the review was to provide a qualitative summary of the health and performance outcomes associated with at-home sleep extension. Methods Peer-reviewed journal articles and doctoral dissertations available in English were searched and screened. Eligible studies had at least five consecutive days of at-home sleep extension, measurement of sleep duration during baseline/habitual sleep and extension of sleep opportunity, and participants 13–30 years of age. Information on primary sleep outcome (i.e., sleep duration), available secondary sleep outcomes (i.e., sleep opportunity, sleep efficiency, sleep quality, daytime sleepiness), and health and performance outcomes were extracted for quantitative synthesis and qualitative review. Results Of the 2254 articles assessed for eligibility, 17 studies (seven in adolescents and ten in young adults) met the eligibility criteria for this review. The average number of days of sleep manipulation was 14.29 (range: 5 to 49 nights). At-home extension of sleep opportunity reliably increased objective (ES = 0.97) and subjective sleep duration (ES = 2.19) and sleep quality (ES = 0.24), and decreased daytime sleepiness (ES = -0.39), when compared to unmanipulated sleep opportunity. Sleep extension was also found to have additional health (e.g., lower psychological stress) and performance benefits (e.g., better athletic performance) across ages and populations. A potential upward publication bias was found based on the distribution of within-subject effect sizes of actigraphic sleep duration. Conclusion The review indicates that at-home sleep extension is feasible in adolescents and young adults to improve sleep duration and daytime sleepiness, and maintain or improve sleep quality. However, the degree of improvement in sleep duration, sleep quality, and daytime sleepiness varied by study population and sleep extension method. Future research should investigate how variations in population and methods of sleep extension impact health and performance outcomes. Support (if any):

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Bonnet, Michael H., and Donna L. Arand. "Situational Insomnia: Consistency, Predictors, and Outcomes." Sleep 26, no. 8 (December 2003): 1029–36. http://dx.doi.org/10.1093/sleep/26.8.1029.

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Rogers, Michelle, Alison M. Coates, and Siobhan Banks. "Meal timing, sleep, and cardiometabolic outcomes." Current Opinion in Endocrine and Metabolic Research 18 (June 2021): 128–32. http://dx.doi.org/10.1016/j.coemr.2021.03.006.

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De Beritto, Theodore V. "Newborn Sleep: Patterns, Interventions, and Outcomes." Pediatric Annals 49, no. 2 (February 1, 2020): e82-e87. http://dx.doi.org/10.3928/19382359-20200122-01.

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Deflandre, Eric P., and Jean-Francois H. Brichant. "Obstructive Sleep Apnea and Perioperative Outcomes." Anesthesia & Analgesia 129, no. 3 (September 2019): e106-e107. http://dx.doi.org/10.1213/ane.0000000000004281.

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Hunt, Carl E. "Neurocognitive outcomes in sleep-disordered breathing." Journal of Pediatrics 145, no. 4 (October 2004): 430–32. http://dx.doi.org/10.1016/j.jpeds.2004.07.026.

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Piccirillo, Jay F. "Outcomes Research and Obstructive Sleep Apnea." Laryngoscope 110, S94 (March 2000): 16–20. http://dx.doi.org/10.1097/00005537-200003002-00005.

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MACNEIL, JANE SALODOF. "Sleep Disorders May Affect Pregnancy Outcomes." Clinical Psychiatry News 35, no. 3 (March 2007): 39. http://dx.doi.org/10.1016/s0270-6644(07)70185-6.

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Corso, Ruggero M., Paolo Pelosi, Giuseppe Insalaco, Alberto Braghiroli, and Cesare Gregoretti. "Sleep-Disordered Breathing and Postoperative Outcomes." Chest 144, no. 4 (October 2013): 1421–22. http://dx.doi.org/10.1378/chest.13-1342.

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Wardrop, Pell Ann, Ofer Jacobowitz, Edward M. Weaver, and Jonathan R. Skirko. "Sleep Surgery Treatment Outcomes and Policy." Otolaryngology–Head and Neck Surgery 147, no. 2_suppl (August 2012): P35. http://dx.doi.org/10.1177/0194599812449008a90.

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Lisabeth, Lynda D., Brisa N. Sánchez, David Lim, Ronald D. Chervin, Erin Case, Lewis B. Morgenstern, Susan Tower, and Devin L. Brown. "Sleep‐disordered breathing and poststroke outcomes." Annals of Neurology 86, no. 2 (June 19, 2019): 241–50. http://dx.doi.org/10.1002/ana.25515.

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Giordani, Bruno. "Sleep-Disordered Breathing and Neurobehavioral Outcomes." JAMA 299, no. 17 (May 7, 2008): 2078. http://dx.doi.org/10.1001/jama.299.17.2078.

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Chindamporn, P., J. Bena, L. Wang, A. Zajichek, A. Milinovich, R. Kaw, S. Kashyap, et al. "0583 Obesity-Associated Sleep Hypoventilation Syndrome and Adverse Post-Operative Bariatric Surgery Outcomes." Sleep 43, Supplement_1 (April 2020): A223—A224. http://dx.doi.org/10.1093/sleep/zsaa056.580.

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Abstract Introduction Although obesity hypoventilation syndrome (OHS) is associated with right ventricular dysfunction and increased mortality, its contribution to post-bariatric surgery risk remains unclear due to non-systematic OHS assessments. We hypothesize that patients with obesity-associated sleep hypoventilation (OASH) have increased adverse post-bariatric surgery outcomes than those without. Methods Patients undergoing polysomnography (PSG) prior to bariatric surgery at the Cleveland Clinic from 2011-2018 were retrospectively examined. OASH was defined by body mass index (BMI) ≥30kg/m2 and either PSG-based end-tidal CO2 ≥45mmHg or serum bicarbonate ≥27mEq/L. The following were considered individually and as a composite outcome: ICU stay, re-intubation, tracheostomy, discharge disposition or 30-day readmission. All-cause mortality was also examined. Outcomes were compared using two-sample t-test or Wilcoxon rank sum test and Chi-square or Fisher exact test. A multivariable logistic regression model included age, sex, BMI, apnea hypopnea index(AHI) and diabetes to examine OAHS and the composite outcome. All-cause mortality was compared using Kaplan-Meier estimation and hazard ratios from Cox proportional hazards models. SAS software (version 9.4) was used with overall significance level of 0.05. Results The sample comprised 1665 patients: age 45.2±12 years, 20.4% male, BMI=48.7±9 kg/m2, and 63.6% Caucasian. OASH prevalence was 68.5%. OAHS patients were older and more likely to be male with higher BMI, AHI and HbA1c. Although some individual outcomes were higher in OASH vs. non-OASH, findings were not statistically significant: re-intubation (1.5%vs.1.3%, p=0.81) and 30-day readmission (13.8% vs.11.3%, p=0.16). The composite outcome remained significantly associated with OAHS in the multivariable model: OR=1.36, 95%CI:1.005,1.845. Mortality was 2% in OASH and not significantly higher than non-OAHS (HR=1.39, 95%CI:0.56,3.42). Conclusion In this largest sample to date of systematically phenotyped OASH in patients undergoing bariatric surgery, we identify increased post-operative morbidity in those with OASH. Further study is needed to identify whether peri-operative treatment of OASH improves surgical outcomes. Support

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Kim, Jinseok, Jin-Won Noh, Ahraemi Kim, and Young Dae Kwon. "Relationships between Sleep Patterns, Health Risk Behaviors, and Health Outcomes among School-Based Population of Adolescents: A Panel Analysis of the Korean Children and Youth Panel Survey." International Journal of Environmental Research and Public Health 16, no. 13 (June 27, 2019): 2278. http://dx.doi.org/10.3390/ijerph16132278.

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Sleep patterns among adolescents are related to health outcomes and health risk behaviors. This study aimed to describe sleep patterns of Korean adolescents and to find the association between sleep patterns and health risk behaviors and health outcomes. Using the junior high school students’ panel data (n = 2351, 12–15 years old) from the Korean Children and Youth Panel Survey, this study described the sleep patterns operationalized as rising time, bedtime, and sleep duration both on weekdays and weekends. The relationships of sleep patterns with health outcomes and/or health risk behaviors were tested using mixed effect linear regression for continuous health variables and using mixed effect logit regression for binary health variables. Obesity status, the number of chronic symptoms, self-rated health status, smoking, and alcohol consumption were associated with rising time on weekdays after controlling for gender, living area, and housing type. The same set of variables except for the number of chronic symptoms were associated with bedtime during the weekdays. Sleep duration during the weekdays was associated with obesity status, smoking, and alcohol consumption. Similar patterns of association between sleep pattern variables during the weekends and health-related outcome variables were found, but were less obvious than those for weekdays. Significant relationships between sleep patterns and various health-related variables were found among adolescents in Korea. The results from this study indicate that helping adolescents change their sleeping times as necessary to ensure adequate sleep should be considered important in diminishing health risk behaviors and promoting positive health outcomes.

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Reilly, Erin Dawna, Stephanie A. Robinson, Beth Ann Petrakis, Melissa M. Gardner, Renda Soylemez Wiener, Carmen Castaneda-Sceppa, and Karen S. Quigley. "Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial." JMIR Formative Research 5, no. 12 (December 9, 2021): e29573. http://dx.doi.org/10.2196/29573.

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Background Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354

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Alshehri, Mohammed M., Aqeel M. Alenazi, Jeffrey C. Hoover, Shaima A. Alothman, Milind A. Phadnis, Jason L. Rucker, Christie A. Befort, John M. Miles, Patricia M. Kluding, and Catherine F. Siengsukon. "Effect of Cognitive Behavioral Therapy for Insomnia on Insomnia Symptoms for Individuals With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial." JMIR Research Protocols 8, no. 12 (December 19, 2019): e14647. http://dx.doi.org/10.2196/14647.

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Background Insomnia symptoms are a common form of sleep difficulty among people with type 2 diabetes (T2D) affecting sleep quality and health outcomes. Several interventional approaches have been used to improve sleep outcomes in people with T2D. Nonpharmacological approaches, such as cognitive behavioral therapy for insomnia (CBT-I), show promising results regarding safety and sustainability of improvements, although CBT-I has not been examined in people with T2D. Promoting sleep for people with insomnia and T2D could improve insomnia severity and diabetes outcomes. Objective The objective of this study is to establish a protocol for a pilot randomized controlled trial (RCT) to examine the effect of 6 sessions of CBT-I on insomnia severity (primary outcome), sleep variability, and other health-related outcomes in individuals with T2D and insomnia symptoms. Methods This RCT will use random mixed block size randomization with stratification to assign 28 participants with T2D and insomnia symptoms to either a CBT-I group or a health education group. Outcomes including insomnia severity; sleep variability; diabetes self-care behavior (DSCB); glycemic control (A1c); glucose level; sleep quality; daytime sleepiness; and symptoms of depression, anxiety, and pain will be gathered before and after the 6-week intervention. Chi-square and independent t tests will be used to test for between-group differences at baseline. Independent t tests will be used to examine the effect of the CBT-I intervention on change score means for insomnia severity, sleep variability, DSCB, A1c, fatigue, sleep quality, daytime sleepiness, and severity of depression, anxiety, and pain. For all analyses, alpha level will be set at .05. Results This study recruitment began in February 2019 and was completed in September 2019. Conclusions The intervention, including 6 sessions of CBT-I, will provide insight about its effect in improving insomnia symptoms, sleep variability, fatigue, and diabetes-related health outcomes in people with T2D and those with insomnia symptoms when compared with control. Trial Registration ClinicalTrials.gov NCT03713996; https://clinicaltrials.gov/ct2/show/NCT03713996 International Registered Report Identifier (IRRID) DERR1-10.2196/14647

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Zhao, Di, Yanru Li, Yue Qu, Junbo Zhang, Xin Cao, and Jingying Ye. "The Role of Genioglossus Activity in Predicting Uvulopalatopharyngoplasty Outcomes." Otolaryngology–Head and Neck Surgery 162, no. 2 (November 26, 2019): 255–60. http://dx.doi.org/10.1177/0194599819889346.

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Objective The aim of this study was to evaluate the association between genioglossus activity during sleep onset and the outcome of uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea. Study Design Case series with planned data collection. Setting Sleep medical center. Subjects and Methods Forty-four patients with obstructive sleep apnea underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) with intraoral electrodes. In addition, all patients underwent revised UPPP with uvula preservation and were followed up with polysomnography at least 3 months after surgery. Results Twenty-five patients (56.8%) were responders. Multiple regression analysis revealed that increasing tonsil size (odds ratio [OR], 0.086; P = .038) and higher sleep-onset GGEMG (OR, 0.664; P = .04) were significant predictors for surgical success. The area under the receiver operating characteristic curve was 0.942 (OR, 0.040; P < .001) for those predictors, 0.884 for GGEMG, and 0.848 for tonsil size. Moreover, all patients were divided into 4 groups according to tonsil size and sleep-onset GGEMG. The success rate of patients with tonsil size III or IV and sleep-onset GGEMG >11.20% (maximal GGEMG) was optimal (92.9%, 13 of 14), while the success rate of patients with tonsil size I or II and sleep-onset GGEMG ≤11.20% was 0% (0 of 10). Conclusions Sleep-onset GGEMG and tonsil size are both important in deciding outcomes of UPPP. Patients with tonsil size III or IV and higher sleep onset may be more suitable candidates for UPPP because of the higher probability of surgical success.

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Mineyko, Aleksandra, Wei Qi, Helen L. Carlson, Luis Bello-Espinosa, Brian L. Brooks, and Adam Kirton. "Neuropsychological Outcome in Perinatal Stroke Associated With Epileptiform Discharges in Sleep." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 4 (March 8, 2017): 358–65. http://dx.doi.org/10.1017/cjn.2017.29.

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AbstractBackground: Patients with arterial perinatal stroke often suffer long-term motor sequelae, difficulties in language, social development, and behaviour as well as epilepsy. Despite homogeneous lesions, long-term behavioural and cognitive outcomes are variable and unpredictable. Sleep-related epileptic encephalopathies can occur after early brain injury and are associated with global developmental delays. We hypothesized that sleep-potentiated epileptiform abnormalities are associated with worse developmental outcomes after perinatal stroke. Methods: Participants were identified from a population-based cohort (Alberta Perinatal Stroke Project). Inclusion criteria were magnetic resonance imaging–confirmed arterial perinatal stroke, age 4 to 18 years, electroencephalogram (EEG) including sleep, and comprehensive neuropsychological evaluation. Sleep-related EEG abnormalities were categorized by an epileptologist blinded to the cognitive outcome. Associations between EEG classification and neuropsychological outcomes were explored (t tests, Bonferroni correction for multiple comparisons). Results:Of 128 potentially eligible participants, 34 (53% female) had complete EEG (mean age, 8.1 years; range, 0.2-16.4) and neuropsychology testing (mean age, 9.8 years; range 4.4-16.7). Twelve (35%) were classified as having electrical status epilepticus in sleep. Patients with abnormal EEGs were more likely to have statistically worse scores when corrected for multiple comparisons, in receptive language (median, 1st percentile; IQR 1-7th percentile; p<0.05), and externalizing behaviours (median, 82nd percentile; IQR, 79-97th percentile; p<0.05). Conclusions: Developmental outcome in language and behaviour in children with arterial perinatal stroke is associated with electrical status epilepticus in sleep. Increased screening with sleep EEG is suggested, whereas further studies are necessary to determine if treatment of EEG abnormalities can improve outcome.

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Johnson, Brian P., Andrea G. Shipper, and Kelly P. Westlake. "Systematic Review Investigating the Effects of Nonpharmacological Interventions During Sleep to Enhance Physical Rehabilitation Outcomes in People With Neurological Diagnoses." Neurorehabilitation and Neural Repair 33, no. 5 (April 2, 2019): 345–54. http://dx.doi.org/10.1177/1545968319840288.

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Objective. Conduct a systematic review of nonpharmacological interventions applied during sleep to enhance physical rehabilitation outcomes of individuals with a neurological diagnosis. Data Sources. Three online databases were searched for original research. Study Selection. Intervention studies were included that used outcome measures of impairment, activity, and/or participation. Data Extraction. Two reviewers independently screened 2287 titles and abstracts, reviewed 101 full texts, extracted data, and assessed study quality and risk of bias for 9 included studies. Data Synthesis. All included studies were randomized controlled trials involving continuous positive airway pressure (CPAP) with inpatient individuals with stroke and sleep apnea. Several studies also included long-term outpatient follow-ups. Results in terms of outcomes based on impairment, activity, and participation were mixed. However, several studies found that the use of CPAP following stroke and sleep apnea during early stroke recovery had benefits relative to no CPAP. Conclusions. The only nonpharmacological intervention to be administered during sleep in a neurological population to improve physical rehabilitation outcomes was found to be CPAP. This review was complicated by the variety of outcome measures used, lack of physical rehabilitation description, and CPAP compliance. In general, participants who had acceptable to good CPAP compliance saw the largest improvements in physical rehabilitation outcomes. Several other promising methods of brain stimulation during sleep are discussed.

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Pierce, Mackenzie, Sunny A. Linnebur, Scott M. Pearson, and Danielle R. Fixen. "Optimal Melatonin Dose in Older Adults: A Clinical Review of the Literature." Senior Care Pharmacist 34, no. 7 (July 1, 2019): 419–31. http://dx.doi.org/10.4140/tcp.n.2019.419.

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OBJECTIVE: To review clinical studies evaluating melatonin doses and their effects on sleep in adults 65 years of age and older. DATA SOURCES: The MEDLINE databases were searched (1946 to October 10, 2018) using the following Medical Subject Heading terms: melatonin and: sleep initiation and maintenance disorders, dyssomnia, sleep wake disorders, insomnia, sleep disorders intrinsic, and sleep disorders circadian rhythm. Sources were limited to English and human data. STUDY SELECTION/DATA EXTRACTION: An initial search resulted in 144 publications, with 25 included in this review. Studies were selected for full review based on design, mean age of participants, use of exogenous melatonin, and reports on any sleep-related outcome. DATA SYNTHESIS: Because of the side effect profiles of most prescription and nonprescription sleep aids, safe and effective alternative therapies are necessary. Based on the current literature, no dose-related response to sleep improvement has been identified for melatonin in older adults. Variations in melatonin formulation and dosages, as well as available tools to measure sleep outcomes, make it challenging to compare studies. CONCLUSIONS: This review evaluated a variety of melatonin doses, 0.5 mg to 10 mg, and their effects on sleep in older adults. The results varied, with some studies finding no difference in sleep outcomes when compared with placebo, while other studies found statistically significant improvements in sleep outcomes. Doses of melatonin between 1 mg and 6 mg appear to be effective for improving sleep in older adults; however, further studies are needed to find the optimal minimum effective dose.

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Meltzer, L. J., S. Jump, K. D. Flewelling, D. Sundstrom, M. White, and M. J. Strand. "0851 Sleep Duration and Asthma Outcomes in Adolescents." Sleep 41, suppl_1 (April 2018): A315—A316. http://dx.doi.org/10.1093/sleep/zsy061.850.

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Mellor, A., E. Kavaliotis, and S. Drummond. "P093 A Systematic Review of Adherence to Cognitive Behavioural Therapy for Insomnia (CBT-I) - Key Findings." SLEEP Advances 2, Supplement_1 (October 1, 2021): A51. http://dx.doi.org/10.1093/sleepadvances/zpab014.137.

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Abstract Introduction Research into factors influencing adherence to CBT-I and how adherence impacts treatment outcomes remains scarce. Through a systematic review, we aimed to determine how adherence is assessed; which factors predict adherence; and which treatment outcomes are predicted by adherence. Methods Included publications met the following criteria: adults with insomnia; an intervention of CBT-I, including sleep restriction (SRT) and/or stimulus control (SCT); a reported measure of adherence; and written in English. Results Final n=103 papers. Measures assessed either global adherence or adherence to specific components of CBT-I via questionnaires, sleep diaries, interviews, or actigraphy. Most common measures were sleep diary-derived CBT-I components for therapist-led studies, and module completion for digital studies. Twenty-eight papers (27.2% of total) examined predictors of adherence. Depression, pre- and post-session sleep, psychosocial support, and dysfunctional beliefs about sleep predicted adherence. Demographic variables, other psychological comorbidities, insomnia severity, and sleep questionnaires did not predict adherence. Twenty-eight papers (27.2%) examined whether adherence predicted treatment outcomes. Neither global adherence nor adherence to any specific component of therapist-led CBT-I reliably predicted sleep outcomes. For digital CBT-I, completion of treatment modules was linked to improvements in ISI, however there were only five studies. Conclusion There was a high degree of heterogeneity in how adherence was measured, and in predictors and outcome variables assessed. This heterogeneity likely explains why adherence does not appear to predict treatment outcome. The field needs to develop a standardised method for assessing each specific adherence construct to fully understand the role of adherence in CBT-I.

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Chaput, Jean-Philippe, Caroline Dutil, Ryan Featherstone, Robert Ross, Lora Giangregorio, Travis J. Saunders, Ian Janssen, et al. "Sleep duration and health in adults: an overview of systematic reviews." Applied Physiology, Nutrition, and Metabolism 45, no. 10 (Suppl. 2) (October 2020): S218—S231. http://dx.doi.org/10.1139/apnm-2020-0034.

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The objective of this overview of systematic reviews was to examine the associations between sleep duration and health outcomes in adults. Four electronic databases were searched in December 2018 for systematic reviews published in the previous 10 years. Included reviews met the a priori determined population (community-dwelling adults aged 18 years and older), intervention/exposure/comparator (various levels of sleep duration), and outcome criteria (14 outcomes examined). To avoid overlap in primary studies, we used a priority list to choose a single review per outcome; reviews that examined the effect of age and those that looked at dose–response were prioritized. A total of 36 systematic reviews were eligible and 11 were included. Reviews included comprised 4 437 101 unique participants from 30 countries. Sleep duration was assessed subjectively in 96% of studies and 78% of studies in the reviews were prospective cohort studies. The dose–response curves showed that the sleep duration that was most favourably associated with health was 7–8 h per day. Modification of the effect by age was not apparent. The quality of the evidence ranged from low to high across health outcomes. In conclusion, the available evidence suggests that a sleep duration of 7–8 h per day is the one most favourably associated with health among adults and older adults. (PROSPERO registration no.: CRD42019119529.) Novelty This is the first overview of reviews that examines the influence of sleep duration on a wide range of health outcomes in adults. Seven to 8 h of sleep per day was most favourably associated with health. Effect modification by age was not evident.

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Sofer, Tamar, Matthew O. Goodman, Suzanne M. Bertisch, and Susan Redline. "Longer sleep improves cardiovascular outcomes: time to make sleep a priority." European Heart Journal 42, no. 34 (May 16, 2021): 3358–60. http://dx.doi.org/10.1093/eurheartj/ehab248.

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Berger, A. M., S. Agrawal, J. Chamberlain, L. Farr, B. Kuhn, J. Lynch, and S. Von Essen. "Sleep intervention during breast cancer chemotherapy: Fatigue and sleep disturbances outcomes." Journal of Clinical Oncology 26, no. 15_suppl (May 20, 2008): 9580. http://dx.doi.org/10.1200/jco.2008.26.15_suppl.9580.

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Elkins, T. "Pediatric sleep apnea: can sleep studies predict adverse outcomes after adenotonsillectomy?" Otolaryngology - Head and Neck Surgery 129, no. 2 (August 2003): P212. http://dx.doi.org/10.1016/s0194-5998(03)00735-6.

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Driscoll, Colin LW, B. Tucker Woodson, Edward M. Weaver, B. Tucker Woodson, David L. Witsell, Michael G. Stewart, Timothy L. Smith, Bevan Yueh, and Maureen T. Hannley. "10:06: UPPP and Subjective Sleep Apnea Outcomes: The SLEEP Study." Otolaryngology–Head and Neck Surgery 137, no. 2_suppl (August 2007): P67. http://dx.doi.org/10.1016/j.otohns.2007.06.121.

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Gogou, Maria, Katerina Haidopoulou, and Evangelos Pavlou. "Sleep and prematurity: sleep outcomes in preterm children and influencing factors." World Journal of Pediatrics 15, no. 3 (March 4, 2019): 209–18. http://dx.doi.org/10.1007/s12519-019-00240-8.

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Altman, Nicole G., Bilgay Izci-Balserak, Elizabeth Schopfer, Nicholas Jackson, Pinyo Rattanaumpawan, Philip R. Gehrman, Nirav P. Patel, and Michael A. Grandner. "Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes." Sleep Medicine 13, no. 10 (December 2012): 1261–70. http://dx.doi.org/10.1016/j.sleep.2012.08.005.

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Arroyo, Amber Carmen, and Matthew J. Zawadzki. "The Implementation of Behavior Change Techniques in mHealth Apps for Sleep: Systematic Review." JMIR mHealth and uHealth 10, no. 4 (April 4, 2022): e33527. http://dx.doi.org/10.2196/33527.

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Background Mobile health (mHealth) apps targeting health behaviors using behavior change techniques (BCTs) have been successful in promoting healthy behaviors; however, their efficacy with sleep is unclear. Some work has shown success in promoting sleep through mHealth, whereas there have been reports that sleep apps can be adverse and lead to unhealthy obsessions with achieving perfect sleep. Objective This study aims to report and describe the use of BCTs in mHealth apps for sleep with the following research questions: How many BCTs are used on average in sleep apps, and does this relate to their effectiveness on sleep outcomes? Are there specific BCTs used more or less often in sleep apps, and does this relate to their effectiveness on sleep outcomes? Does the effect of mHealth app interventions on sleep change when distinguishing between dimension and measurement of sleep? Methods We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review articles on mHealth app interventions for sleep published between 2010 and 2020. Results A total of 12 studies met the eligibility criteria. Most studies reported positive sleep outcomes, and there were no negative effects reported. Sleep quality was the most common dimension of sleep targeted. Subjective measures of sleep were used across all apps, whereas objective measures were often assessed but rarely reported as part of results. The average number of BCTs used was 7.67 (SD 2.32; range 3-11) of 16. Of the 12 studies, the most commonly used BCTs were feedback and monitoring (n=11, 92%), shaping knowledge (n=11, 92%), goals and planning (n=10, 83%), and antecedents (n=10, 83%), whereas the least common were scheduled consequences (n=0, 0%), self-belief (n=0, 0%), and covert learning (n=0, 0%). Most apps used a similar set of BCTs that unfortunately did not allow us to distinguish which BCTs were present when studies reported more positive outcomes. Conclusions Our study describes the peer-reviewed literature on sleep apps and provides a foundation for further examination and optimization of BCTs used in mHealth apps for sleep. We found strong evidence that mHealth apps are effective in improving sleep, and the potential reasons for the lack of adverse sleep outcome reporting are discussed. We found evidence that the type of BCTs used in mHealth apps for sleep differed from other health outcomes, although more research is needed to understand how BCTs can be implemented effectively to improve sleep using mHealth and the mechanisms of action through which they are effective (eg, self-efficacy, social norms, and attitudes).

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Moore, Jesse, Peng Jin, Anthony Briggs, Diana Grisby, Azizi Seixas, and Girardin Jean-Louis. "0617 Association Between Green, Blue, and Open Spaces and Sleep Health in a Black Population: An Analysis of the MetSO Dataset." Sleep 45, Supplement_1 (May 25, 2022): A270—A271. http://dx.doi.org/10.1093/sleep/zsac079.614.

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Abstract Introduction Blacks have a high burden of poor sleep health outcomes. Environmental determinants, such as green space or open environments, represent an underexplored contributor to sleep burden among Blacks. The extent these environmental factors affect sleep health outcomes within this population has not been adequately explored. To fill this gap in the literature, we investigated associations between environmental factors and sleep outcomes among Blacks in a large urban city. Objectives included (1) examine if zip-code derived open spaces (defined as proportion of open space in residential area,) green spaces (defined as open tree coverage of the ground) and blue spaces (proportion of water space) sleep apnea risk, and insomnia symptoms; (2) Examine if open, blue, and green spaces predict sleep outcomes independent of sex, age, and education level. Methods Our study used data from the Metabolic Syndrome Cohort Study (2009-2014), a studythat examined behavioral intervention methods to improve sleep apnea outcomes among Blacks. Sleep Apnea was assessed with the ARES (apnea risk) scale and insomnia status was collected through self-report (“Do you have difficulty staying/falling asleep or waking up?”) in a subset of 344 participants. Logistic regression analyses were performed to predict the effect green, blue, and open spaces had on sleep outcomes. To account for within zip-code correlation, mixed effects models (unadjusted and adjusted) account for sex, age, and education were considered. Results We found that none of the green, blue, or open space variables predicted sleep outcomes in the unadjusted model. In adjusted models, green space predicted sleep apnea risk scores, (OR=1.03, P<.05), but not insomnia. Conclusion Our study examined the extent which green, blue, and open spaces predicted insomnia and sleep apnea in urban blacks. We found that only green spaces were associated with sleep apnea, and none of our environmental variables predicted insomnia. Given the large amount of literature detailing a complex and multifactorial process on how environment affects sleep outcomes, our findings suggest that the link between urban environments, green spaces, and sleep outcomes may not be as definitive as they seem. Further research should explore the differential effect environment has on diverse populations’ sleep outcomes. Support (If Any) NIH R01HL142066, R01HL095799, RO1MD004113, R01HL152453

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Wells, S., D. Inman, and H. Huang. "P136 Sleep Quality and Obesity: an investigation into the relationship between obesity and poor sleep quality as measured by polysomnography." SLEEP Advances 3, Supplement_1 (October 1, 2022): A73. http://dx.doi.org/10.1093/sleepadvances/zpac029.204.

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Abstract Background Studies have demonstrated a link between obesity and poor sleep quality. However, definitions of sleep quality vary, and are often subjective. Furthermore, these studies do not explore whether this link is independent of comorbidities associated with obesity. We aim to establish whether an independent link exists between poor sleep and obesity, with sleep quality measured objectively through polysomnography. Methods A retrospective observational study of patients undergoing level 1 or 2 diagnostic polysomnography over one year. We recorded demographics, body mass index (BMI), comorbidities; and polysomnography data including apnoea-hypopnoea index, total sleep time (TST), percentage slow-wave sleep (%SWS) and percentage rapid eye movement (%REM) sleep. Primary outcome was %SWS, with secondary outcomes TST, %REM sleep and O2 nadir. Linear regression analysis was used to investigate correlations between variables and the outcomes proposed. Progress to Date 297 patients were included. The average BMI was 37.9 (17.8-79.5). BMI was not significantly correlated with %SWS. Howevere, a significant negative correlation was found between BMI and %REM (β = -0.196, p = 0.013), BMI and TST (β = -0.199, p = 0.018) as well as BMI and O2 nadir (β = -0.140, p = 0.054). Statistical analysis is ongoing, and additional interesting correlations are being explored. Intended Outcome and Impact To investigate if an independent correlation between obesity and abnormal sleep architecture exists. To explore if commonly associated obesity comorbidities are significantly correlated with polysomnographic indices of sleep quality, to help target interventions aimed at both investigating and improving sleep quality.

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Bors, Roxana Georgiana, Vlad Dima, Mihaela Plotogea, and Valentin Varlas. "Changes in maternal sleep during pregnancy and pregnancy outcomes." Romanian Journal of Pediatrics 71, S2 (November 30, 2022): 102–8. http://dx.doi.org/10.37897/rjp.2022.s2.20.

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Sleep disorders in pregnancy are incompletely studied, as they are significant health problems with maternal-fetal implications. These are quite common due to the hormonal, anatomical, and functional changes that occur in the mother’s body. Sleep deprivation influences the mother’s health, with important repercussions on the fetus. Polysomnography shows that the changes regarding sleep architecture begin in the first trimester, and disturbances are also observed after birth. Obstetrical implications (way of birth, duration of labor, analgesia, anesthesia at birth, early onset of labor) and maternal conditions (hypertension induced by pregnancy, gestational diabetes, mental disorders) can change sleep quality. Early identification of sleep disorders, as well as prompt prenatal management, especially through non-pharmacological means, is essential to avoid negative consequences.

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Mayne, S., K. Morales, A. A. Williamson, S. F. Grant, A. G. Fiks, D. F. Dinges, B. Zemel, and J. A. Mitchell. "0390 Associations of the Neighborhood Built Environment with Adolescent Sleep Outcomes." Sleep 43, Supplement_1 (April 2020): A149—A150. http://dx.doi.org/10.1093/sleep/zsaa056.387.

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Abstract Introduction Over 75% of U.S. high school students obtain insufficient amounts of sleep. Identification of modifiable environmental determinants of adolescent sleep is needed to inform interventions and public health strategies, yet little is known about the influence of the built environment on adolescent sleep. We examined associations of the built environment with objectively-measured adolescent sleep outcomes. Methods In this longitudinal, prospective study, we used actigraphy to assess sleep outcomes for 14 days each in 8th grade and 9th grade: duration (hours/night), onset (hours from 00:00), offset (hours from 00:00), and sleeping >8 hours. Home addresses were linked to built environment exposures based on half-mile Euclidian buffers (overall/human-made sound levels, percent tree canopy cover, street density, intersection density) and census block group (population density, housing density). Mixed-effects linear (sleep duration, onset, offset) and logistic (>8 hours) regression estimated associations of each built environment measure with sleep outcomes, adjusting for sex, race, parent education, household income, grade and weeknight status (school or non-school night). Results Among 108 adolescents - 53% female and 25% Black - providing 2,388 nights of sleep data across 8th and 9th grades, a 1-standard deviation increase in neighborhood sound (overall and human-made) associated with 11 minutes later sleep onset (β=0.19; 95% CI: 0.01, 0.38) and 20% lower odds of sleeping for >8 hours (OR=0.80, 95% CI: 0.62, 1.02). A 1-standard deviation increase in neighborhood tree canopy cover associated with 11 minutes earlier sleep onset (β= -0.19, 95% CI: -0.35, -0.03) and 7 minutes earlier sleep offset (β= -0.12, 95% CI: -0.23, -0.02). No associations were observed for “density based” exposures. Conclusion Higher tree canopy cover associated with more favorable sleep timing while higher neighborhood sound level associated with later timing of sleep onset. These modifiable neighborhood built environment factors should be considered when intervening to support healthier sleep among adolescents. Support NIH/NHLBI K01HL123612 (JM) and Sleep Research Society Foundation and K23HD094905 (AAW)

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Journal articles on the topic 'Sleep outcomes'

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