Making errors at work due to sleepiness or sleep problems is not confined to non-standard work hours: results of the 2016 Sleep Health Foundation national survey

Almost one-third of Australians report having made errors at work that are related to sleep issues. While there is significant literature investigating the role of sleep in workplace health and safety in shiftworking and nightwork operations, long working hours, work-family conflict, and commute times getting longer also impact day workers’ sleep behaviors and opportunities. The aim of this study was to examine the relationship between sleep duration and disorders, sleep health and hygiene factors, work-related factors and errors at work in Australian workers. From a sample of 1011 Australian adults, age-adjusted binary logistic regression analyses were conducted in 512 workers who provided responses to the question “Thinking about the past three months, how many days did you make errors at work because you were too sleepy or you had a sleep problem?” A number of sleep behaviors and poor sleep hygiene factors were linked with work errors related to sleepiness or sleep problems, with age-adjusted odds of errors (confidence intervals) up to 11.6 times higher (5.4–25.1, p < 0.001) in those that snored, 7.7 (4.6–12.9) times higher in those reporting more than three sleep issues (p < 0.001), 7.0 times higher (3.4–14.8) in short (≤5 hours/night) sleepers (p < 0.021), 6.1 times higher (2.9–12.7) in those staying up later than planned most nights of the week (p< 0.001) and 2.4 times higher (1.6–3.7) in those drinking alcohol ≥3 nights/week before bed (p < 0.001). More than 40% of participants working non-standard hours reported making errors at work, and they were more likely to be young (compared to the main sample of workers) and more likely to engage in work activities in the hour before bed. Sleep factors (other than clinical sleep disorders) were associated with an increased likelihood of sleep-related work errors. Both day workers and those working non-standard hours engage in work, sleep and health behaviors that do not support good sleep health, which may be impacting safety and productivity in the workplace through increased sleepiness-related errors.     

Insomnia and Relationship with Anxiety in University Students: A Cross-Sectional Designed Study

Purpose

Sleep disorders (SDs) are now recognized as a public health concern with considerable psychiatric and societal consequences specifically on the academic life of students. The aims of this study were to assess SDs in a group of university students in Lebanon and to examine the relationship between SDs and anxiety.

Methods

An observational cross-sectional study was conducted at Saint-Joseph University, Lebanon, during the academic year 2013–2014. Four questionnaires were face-to-face administered to 462 students after obtaining their written consent: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Generalized Anxiety Disorder 7-item scale (GAD-7).

Results

The prevalence of clinically significant insomnia was 10.6% (95% CI: 7.8–13.4%), more frequent in first year students. ISI mean score was 10.06 (SD = 3.76). 37.1% of the participants were poor sleepers. Excessive daytime sleepiness (EDS) and poor sleep were significantly more frequent among participants with clinical insomnia (p = 0.031 and 0.001 respectively). Clinically significant anxiety was more frequent in students suffering from clinical insomnia (p = 0.006) and in poor sleepers (p = 0.003). 50.8% of the participants with clinically significant anxiety presented EDS versus 30.9% of those with no clinically significant anxiety (p<0.0001).

Conclusions

The magnitude of SDs in this sample of Lebanese university students demonstrate the importance of examining sleep health in this population. Moreover, the link between SD and anxiety reminds us of the importance of treating anxiety as soon as detected and not simply targeting the reduction of sleep problems.     

Poor Sleep in Patients with Multiple Sclerosis

Background

Poor sleep is a frequent symptom in patients with multiple sclerosis (MS). Sleep may be influenced by MS-related symptoms and adverse effects from immunotherapy and symptomatic medications. We aimed to study the prevalence of poor sleep and the influence of socio-demographic and clinical factors on sleep quality in MS- patients.

Methods

A total of 90 MS patients and 108 sex-and age- matched controls were included in a questionnaire survey. Sleep complaints were evaluated by Pittsburgh Sleep Quality Index (PSQI) and a global PSQI score was used to separate good sleepers (≤5) from poor sleepers (>5). Excessive daytime sleepiness, the use of immunotherapy and antidepressant drugs, symptoms of pain, depression, fatigue and MS-specific health related quality of life were registered. Results were compared between patients and controls and between good and poor sleepers among MS patients.

Results

MS patients reported a higher mean global PSQI score than controls (8.6 vs. 6.3, p = 0.001), and 67.1% of the MS patients compared to 43.9% of the controls (p = 0.002) were poor sleepers. Pain (p = 0.02), fatigue (p = 0.001), depression (p = 0.01) and female gender (p = 0.04) were associated with sleep disturbance. Multivariate analyses showed that female gender (p = 0.02), use of immunotherapy (p = 005) and a high psychological burden of MS (p = 0.001) were associated with poor sleep among MS patients.

Conclusions

Poor sleep is common in patients with MS. Early identification and treatment of modifiable risk factors may improve sleep and quality of life in MS.     

Comparison of dream anxiety and subjective sleep quality between chronotypes

Morning and evening-type individuals differ on a number of psychological and biological variables. In this study, we aimed to investigate the relationship between sleep quality, dream anxiety, and chronotypes. A sample of 264 university students, aged between 17 and 26 years, completed the Morningness-Eveningness Questionnaire, the Pittsburgh Sleep Quality Index, and the Van Dream Anxiety Scale for assessing nightmare frequency and the dream anxiety caused by frightening dreams. Main findings indicated that evening-type individuals were significantly more likely to suffer from poor sleep quality, daytime dysfunction, nightmares, and nightmare-related disturbances as compared to either intermediate- or morning-type individuals. Previous studies have pointed out the possible connections of irregular sleep-wake habits and circadian dysregulation with a tendency to reveal eveningness chronotypical characteristics. Current findings suggest that evening-type individuals are more prone to experience psychologically deteriorating nightmares and sleep-related anxiety. Poor sleep quality is also a significant antecedent of dream anxiety after controlling for age and gender.

     

The Association between Self-Reported Sleep Quality and Metabolic Syndrome

Objectives

Short and long sleep duration are associated with metabolic syndrome. However, there is limited research on the association between sleep quality and metabolic syndrome, and thus the aim of this study is to investigate this relationship.

Materials and Methods

The cross-sectional baseline data were collected from the decoded database of the Prevention Health Center of National Cheng Kung University Hospital from 2002 to 2006. The diagnosis of metabolic syndrome was according to the statement of the American Heart Association/National Heart, Lung, and Blood Institute. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates poorer sleep quality, and a global PSQI score greater than five differentiates poor from good sleepers.

Results

Of the 3,435 subjects recruited, 899 (26.2%) had metabolic syndrome. Subjects with metabolic syndrome had higher PSQI and prevalence of poor sleepers than those without metabolic syndrome. The multivariate lineal regression analysis showed that female gender, metabolic syndrome, sleep duration, snoring, alcohol drinking, and habitual exercise were independent predictors of PSQI. When substituting metabolic syndrome with the five components, hyperglycemia and low high-density lipoprotein cholesterol (HDL-C) were positively associated with PSQI. The multivariate logistic regression analyses showed that female gender, metabolic syndrome, sleep duration, and snoring were independently associated with being poor sleepers. Of the five components, only low HDL-C was an independent predictor of being poor sleepers.

Conclusions

Subjects with metabolic syndrome have higher global PSQI scores and a higher risk of being poor sleepers. Of the five components of metabolic syndrome, hyperglycemia and low HDL-C are independently associated with the global PSQI scores, while low HDL-C is an independent predictor of being poor sleepers.     

Relation of chronotype to sleep complaints in the general Finnish population

Individuals show variation in their preference for the daily timing of activities. In this study the authors analyzed whether chronotypes associate with sleep duration and sleep-related complaints. The authors used the National FINRISK Study 2007 Survey data on 3696 women and 3162 men, representative of the Finnish population aged 25 yrs and older, for the assessment of chronotype and self-reported sleep. Evening types experienced insomnia symptoms, had nightmares, and had used recently hypnotics significantly more often than other chronotypes among both men and women. In a multinominal logistic regression model predicting insufficient sleep, the association of eveningness with insufficient sleep was not abolished after adjustment for sex, age, and sleep duration. The prevalence of short sleepers was significantly higher in evening types among men than among women, whereas that of long sleepers was significantly higher in evening types among both men and women, as compared with the other chronotypes. These results indicate that eveningness predisposes individuals to a range of sleep complaints.     

Evening chronotype and sleepiness predict impairment in executive abilities and academic performance of adolescents

The study aim was to better understand sleep and sleep-related factors affecting everyday executive capacities and academic performance among healthy adolescents. A cross-sectional survey on sleep, phase preference, academic performance and executive functions of high-school students was conducted. Female gender, grade status, sleepiness and evening chronotype accounted for approximately 25–30% of the variance in daily executive ability. Sleep duration was a weak predictor of executive skills. Lower school grades were associated with increased sleepiness, evening preference and poorer executive skills. These findings support the need for health education on ways to attenuate sleepiness and delayed phase in this population.     

Sleep and Multisystem Biological Risk: A Population-Based Study

BackgroundShort sleep and poor sleep quality are associated with risk of cardiovascular disease, diabetes, cancer, and mortality. This study examines the contribution of sleep duration and sleep quality on a multisystem biological risk index that is known to be associated with morbidity and mortality.MethodsAnalyses include a population-based sample from the Midlife Development in the United States survey recruited to the Biomarker substudy. A total of 1,023 participants aged 54.5 years (SD = 11.8), 56% female and 77.6% white, were included in the analyses. A multisystem biological risk index was derived from 22 biomarkers capturing cardiovascular, immune, lipid-metabolic, glucose-metabolic, sympathetic, parasympathetic, and hypothalamic-pituitary-adrenal systems. Self-reported average sleep duration was categorized as short (<5 hrs), below normal (5 to <6.5 hrs), normal (6.5 to <8.5 hrs), and long sleepers (8.5+ hrs). Sleep quality was determined using the Pittsburgh Sleep Quality Index categorized as normal (≤5) and poor quality (>5) sleep.FindingsLinear mixed effect models adjusting for age, gender, race, education, income, BMI, and health status were performed. As compared to normal sleepers, multisystem biological risk in both short (B(SE) = .38(.15), p<.01) and long sleepers (B(SE) = .28(.11), p<.01) were elevated. Poor quality sleep alone was associated with elevated multisystem biological risk (B(SE) = .15(.06), p = .01), but was not significant after adjustment for health status. All short sleepers reported poor sleep quality. However in the long sleepers, only those who reported poor sleep quality exhibited elevated multisystem biological risk (B(SE) = .93(.3), p = .002).ConclusionsSelf-reported poor sleep quality with either short or long sleep duration is associated with dysregulation in physiological set points across regulatory systems, leading to elevated multisystem biological risk. Physicians should inquire about sleep health in the assessment of lifestyle factors related to disease risk, with evidence that healthy sleep is associated with lower multisystem biological risk.     

Awake EEG Disregulation in Good Compared to Poor Sleepers

This study was designed to test a disregulation model of sleep deprivation by assessing the ability of good sleepers compared to poor sleepers to shift daytime EEG patterning to changing environmental demands. Ten good and ten poor sleepers were identified from a sample of 110 college students who completed the Pittsburgh Sleep Quality Inventory (PSQI). EEG and SCR were recorded during a five task assessment session, including: (1) pre-baseline, (2) eyes open at rest, (3) eyes closed at rest, (4) sensory attentiveness (listening to an audio book clip), and (5) cognitive effort (a higher level cognitive flexibility task). A significant Group × Task interaction, F (3, 16) = 4.81, p = . 01 was attained on the theta data. Specifically, for good sleepers, theta decreased from the “eyes open at rest” to the “sensory attentiveness” tasks, while poor sleepers showed the opposite pattern. This pattern of theta suppression was found in 70% of the good sleepers and only 20% of the poor sleepers. No between group differences were noted in the SCR data, supporting a brain disregulation model, rather than a general psychophysiological stress model. Partial funding for this research was provided by the office of Research, Grants, and Contracts at the University of Tennessee at Martin.     

Selected Neurophysiological,Psychological, and Behavioral Influences on Subjective Sleep Quality in Nurses: A Structure Equation Model

Few studies have examined relationships among neurophysiological, psychological, and behavioral factors with regard to their effects on sleep quality. We used a structure equation model to investigate behavioral and psychological factors that influence neurophysiological regulation of sleep in shift workers. Using a cross-sectional study design, we tested the model with a sample of 338 female nurses working rotating shifts at an urban regional hospital. The Morningness-Eveningness Questionnaire (MEQ) and short-form Menstrual Distress Questionnaire (MDQ) were used to measure neurophysiological factors involved in morningness-eveningness and menstrual distress. The Sleep Hygiene Awareness and Practice Scale (SHAPS) and Profile of Mood States Short Form (POMS-SF) were completed to measure behavioral factors of sleep hygiene practices and psychological factors of mood states. In addition, the Pittsburgh Sleep Quality Index (PSQI) measured participant''s self-reported sleep quality. The results revealed that sleep hygiene practices and mood states mediated the effects of morningness-eveningness and menstrual distress on sleep quality. Our findings provide support for developing interventions to enhance sleep hygiene and maintain positive mood states to reduce the influence of neurophysiological factors on sleep quality among shift workers.     

Chronotype: implications for sleep quality in medical students

ABSTRACT

Medical students who suffer from poor sleep quality may be afflicted by distress. While the change of chronotype may improve sleep quality, few studies have focused on this association. The objective of this study is to analyze the effects of chronotype on sleep quality in medical students while controlling for confounding covariate factors. A cross-sectional survey on sleep quality was conducted among 5497 medical students. Sleep quality, chronotype, and lifestyle were measured according to the Pittsburgh Sleep Quality Index, Morningness-eveningness Questionnaire and Health-promoting Lifestyle Profile. Hierarchical logistic regression was conducted to analyze the influence of various factors, especially chronotype effect on sleep quality. Our results showed that the total score of sleep quality in evening-types was 5.43 ± 2.66, which was significantly higher than that in morning-types (3.88 ± 2.20, P < .001). Morning-type students (OR = 0.40, 95%CI = 0.29–0.55) and intermediate-type students (OR = 0.53, 95%CI = 0.41–0.69) had a lower risk of poor sleep quality compared to evening-types. The strongest predictor of sleep quality was chronotype while controlling for covariates (grade, gender, father’s educational level, mother’s educational level, internet addiction, mood state, midnight snack frequency, and health-promoting lifestyle profile). Based on the results, we believe that sleep quality among evening-type students may be improved by shifting to keep early hours.     

Psychometric properties and accuracy of the European Portuguese version of the Pittsburgh Sleep Quality Index in clinical and non-clinical samples

To assess the reliability and validity concerning the formal European Portuguese version of the Pittsburgh Sleep Quality Index [PSQI (EP)], its accuracy, and optimal cut-off point. N = 564 volunteers (18–80 years old) recruited in several settings (e.g., university campuses; work place; home; sleep consultations), agreed to complete the PSQI (EP). Subgroups completed additional measures: Insomnia Severity Index (ISI), STOP-Bang, Glasgow Sleep Effort Scale, or responded to a supplementary question about perceived sleep problems. As to internal consistency, Cronbach’s α = 0.75. Principal component analysis revealed a unidimensional structure. Six PSQI (EP) components and total scores were able to discriminate individuals who did versus did not describe having any sleep problem; all PSQI (EP) scores were significantly higher (denoting poorer quality) in participants suffering from a sleep disorder. Most Cohen’s d values showed large magnitude associations. PSQI (EP) and ISI scores were highly correlated, but no significant correlations were found considering STOP-Bang. ROC analysis confirmed an optimal cut-off point > 5 of the PSQI (EP) to detect self-reported poor/good sleepers in non-clinical settings. To discriminate non-clinical from clinical sleep patients, the optimal cutoff was > 7, and AUC = 0.94. The European Portuguese version of the PSQI performs as a reliable, valid, and accurate measure of overall sleep quality in Portuguese participants. Furthermore, results suggest that PSQI (EP) can discriminate poor sleepers in non-clinical settings, in addition to demonstrating high clinical accuracy in signaling potential sleep-disorder cases. In conclusion, the PSQI (EP) is a suitable tool to assess general sleep quality in Portuguese participants, both for clinical or non-clinical applications.

     

Comparison of sleep and chronotype between senior and undergraduate university students

ABSTRACT

The university programs for seniors provide a third age perspective in lifelong learning with classes and recreational facilities, and enable students to share their experiences and knowledge. A good sleep quality promotes better cognitive functioning and serves to protect against age-related cognitive declines. Central nervous system reorganization takes place during sleep, and although the influence of sleep quality on memory is not clear, circadian rhythm disorders affect alertness and individual performance. Physiological change during aging need to be clarified to better understand how university might help students. The aim of the present study was to evaluate for the first time the chronotype, the sleep quality and their relationship in senior university students and to compare them with those of undergraduate students. The Morningness–Eveningness Questionnaire (MEQ) and the Pittsburgh Sleep Quality Index (PSQI) were used. The results indicated that approximately 50% of the participants were good sleepers. This percentage was equal in the senior and undergraduate students. The results showed that undergraduate students tended toward eveningness while senior students tended toward morningness. Among the undergraduate students, evening type chronotypes had a tendency toward higher PSQI scores and this affected their daytime function scores, while it did not in the senior students, in whom worsening sleep quality was associated with disturbances such as going to the bathroom and nocturnal awakening. This information would be useful for designing environmental interventions to optimize sleep/work cycles for decreasing age-associated changes in memory in senior students and for improving the academic achievements of undergraduate students.     

Determinants of insomnia in relatively healthy elderly. A literature review

A review is presented based on the findings resulting from interview and questionnaire research concerning factors that determine insomnia in relatively healthy elderly. The investigated factors include modes of living, sleep wishes and personality aspects. During the period 1988-1997 18 published reports were found. Based on the findings it is difficult to claim that elderly persons with insomnia are characterized by inappropriate modes of living. There were, however, some (inconsistent) indications that tea consumption, smoking and lack of exercise predicted insomnia. There were also scarce indications for less realistic sleep expectations in bad than in good sleepers. More bad sleepers perceived their sleep as uncontrollable and unpredictable than than good sleepers. Bad sleepers had significantly higher scores for anxiety, neuroticism and depression than good sleepers. Anxiety as well as depression correlated positively with insomnia and negatively with sleep duration. Depression, anxiety or neuroticism often were better predictors of insomnia than health indicators such as perceived health and number of prescribed drugs. The findings suggest that insomnia in relatively healthy elderly is more tightly associated with psychological factors than with modes of living or health indicators. This has some consequences for therapy. In addition to advice concerning modes of living and sleep hygiene, one has to be alert for the possible presence of depression or anxiety. In that case depression or anxiety has to be treated, pharmacologically or nonpharmacologically.     

Sleep habits of Iranian pre-school children in an urban area: Late sleeping and sleep debt in children

Using BEARS (Bedtime problems, Excessive sleepiness, Awakenings during the night, Regularity of sleep, Snoring), and CSHQ (Children’s Sleep Habits Questionnaires) screening tools with 224 participants revealed that Iranian children have shorter night sleep duration than expected (9.54 vs 12 h) for their age group. Earlier sleepers had longer night sleep duration (10:36 ± 1:12; 9:12 ± 1:06 h, P > 0.001), and total daily sleep time (11:36 ± 1:42; 10:36 ± 1:30 h, P = 0.005) than late sleepers. A majority (85%) of naptakers had sleep bedtime of 22:00 or later. The poor sleep quality of Iranian preschool children is probably due to cultural characteristics, climate differences, or harmful sleep habits.

     

The association between self‐reported sleep quality and overweight in a Chinese population

Objective:

Sleep quality and obesity are associated with type 2 diabetes, hypertension, and metabolic syndrome. However, there is limited research on the association between sleep quality and obesity, and thus the aim of this study is to investigate this relationship in a Chinese population.

Design and Methods:

Subjects were recruited from the Prevention Health Center of National Cheng Kung University Hospital. Anthropometric data and metabolic parameters were measured. Being overweight or obese was defined according to the recommendations of the Department of Health in Taiwan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).

Results:

Of the total 2,803 subjects, 1,059 were classified as normal weight, 1,127 were overweight, and 617 were obese. The global PSQI score were 6.30 ± 2.56, 6.61 ± 2.96, and 7.02 ± 2.95 in subjects who were normal weight, overweight, and obese, respectively (test for trend, P < 0.001). Of the variables tested in the multivariate linear regression model, female gender, being overweight, obesity, sleep duration, and alcohol drinking were significantly associated with global PSQI scores, and in the multivariate logistic regression model, female gender, being overweight, obesity, and sleep duration were independent predictors of poor sleepers after controlling for age, gender, BMI or different weight statuses, sleep duration, alcohol drinking, smoking, habitual exercise, hypertension, newly diagnosed diabetes, total cholesterol, high‐density lipoprotein, triglyceride, estimated glomerular filtration rate, and alanine aminotransferase.

Conclusions:

In conclusion, female gender, being overweight, obesity, and sleep duration were associated with poor sleep quality independent of cardiometabolic risk factors. In clinical practice, subjects who are obese, or even only overweight, should be evaluated for the presence of sleep disturbance.     

Relation of Chronotype to Sleep Complaints in the General Finnish Population

Individuals show variation in their preference for the daily timing of activities. In this study the authors analyzed whether chronotypes associate with sleep duration and sleep-related complaints. The authors used the National FINRISK Study 2007 Survey data on 3696 women and 3162 men, representative of the Finnish population aged 25 yrs and older, for the assessment of chronotype and self-reported sleep. Evening types experienced insomnia symptoms, had nightmares, and had used recently hypnotics significantly more often than other chronotypes among both men and women. In a multinominal logistic regression model predicting insufficient sleep, the association of eveningness with insufficient sleep was not abolished after adjustment for sex, age, and sleep duration. The prevalence of short sleepers was significantly higher in evening types among men than among women, whereas that of long sleepers was significantly higher in evening types among both men and women, as compared with the other chronotypes. These results indicate that eveningness predisposes individuals to a range of sleep complaints. (Author correspondence: ilona.merikanto@helsinki.fi)     

Shift work and sleep disorder comorbidity tend to go hand in hand

Taking into consideration that shift work has a wide-ranging impact on circadian and sleep functioning, it seems likely that shift work increases the risk of a general sleep disturbance, spread out over a multitude of comorbid sleep disorders. The aim of the present study is to analyze and present the sleep disorder data of 250 shift workers and 971 permanent day workers, taken from a nationally representative sample. Additional data concerning duration, timing, and quality of sleep, daytime functioning and social/family variables were added to the analyses. The results showed that the shift workers experienced significantly more difficulties with the variability of their sleep times, reported more napping and considered themselves more as poor sleepers than the day workers. Most importantly, shift work, in comparison with day work, appeared associated with a significantly higher prevalence of the clinical, International Classification of Sleep Disorders’ defined symptoms of nearly all main sleep disorders (including shift work disorder). For shift workers, the prevalence of a general sleep disturbance was 39.0% (95%CI 33.2 – 45.2), significantly higher than for day workers (24.6%, 95%CI 22.0 – 27.4). Moreover, shift workers were characterized by high levels of sleep disorder comorbidity. In addition, exclusively for shift workers, the prevalence of disordered sleep systematically decreased across decades of life and was considerably higher for single versus partnered shift workers. This study adds to the insight into the interacting factors that determine shift work coping and may play a role in occupational health interventions aimed at reducing sleep problems and thus improving the resilience and tolerance of the shift worker.