Racial/ethnic disparities in sleep duration and sleep disturbances among pregnant and non‐pregnant women in the United States

Sleep disturbances among pregnant women are increasingly linked to suboptimal maternal/birth outcomes. Few studies in the USA investigating sleep by pregnancy status have included racially/ethnically diverse populations, despite worsening disparities in adverse birth outcomes. Using a nationally representative sample of 71,644 (2,349 pregnant) women from the National Health Interview Survey (2004–2017), we investigated relationships between self‐reported pregnancy and six sleep characteristics stratified by race/ethnicity. We also examined associations between race/ethnicity and sleep stratified by pregnancy status. We used average marginal predictions from fitted logistic regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep dimension, adjusting for sociodemographic and health characteristics. Pregnant women were less likely than non‐pregnant women to report short sleep (PR_Overall = 0.75; 95% CI, 0.68–0.82) and more likely to report long sleep (PR_Overall = 2.06; 95% CI, 1.74–2.43) and trouble staying asleep (PR_Overall = 1.34; 95% CI, 1.25–1.44). The association between pregnancy and sleep duration was less pronounced among women aged 35–49 years compared to those <35 years. Among white women, sleep medication use was less prevalent among pregnant compared to non‐pregnant women (PR_White = 0.45; 95% CI, 0.31–0.64), but this association was not observed among black women (PR_Black = 0.98; 95% CI, 0.46–2.09) and was less pronounced among Hispanic/Latina women (PR_{Hispanic/Latina} = 0.82; 95% CI, 0.38–1.77). Compared to pregnant white women, pregnant black women had a higher short sleep prevalence (PR_Black = 1.35; 95% CI, 1.08–1.67). Given disparities in maternal/birth outcomes and sleep, expectant mothers (particularly racial/ethnic minorities) may need screening followed by treatment for sleep disturbances. Our findings should be interpreted in the historical and sociocultural context of the USA.     

Relationships of sleep duration with sociodemographic and health‐related factors,psychiatric disorders and sleep disturbances in a community sample of Korean adults

The aim of this study is to examine relationships of sleep duration with sociodemographic and health‐related factors, psychiatric disorders and sleep disturbances in a nationwide sample in Korea. A total of 6510 subjects aged 18–64 years participated in this study. Logistic regression was used to calculate the odd ratios and 95% confidence intervals of the covariates, psychiatric disorders and sleep disturbances across the following sleep duration categories: 5 h or less, 6, 7, 8 and 9 h or more per day. Low levels of education, unemployment and physical illness were associated with sleeping for 5 h or less and 9 h or more. Being older and widowed/divorced/separated, high levels of physical activity, pain/discomfort, obesity and high scores on the General Health Questionnaires were associated with sleeping for 5 h or less. Female, being younger and underweight were associated with sleeping for 9 h or more. Alcohol dependence, anxiety disorder and social phobia were associated significantly with sleeping for 5 h or less and 9 h or more. Other psychiatric disorders were more common in subjects who slept for 5 h or less (e.g. alcohol use disorder, mood disorder, major depressive disorder, dysthymic disorder, obsessive‐compulsive disorder and specific phobia) or 9 h or more (e.g. post‐traumatic stress disorder). In addition, subjects who slept for 5 h or less reported more sleep disturbances than did subjects who slept for 7 h. Short or long sleep is associated with psychiatric disorders and/or sleep disturbance, therefore attention to the mental health of short or long sleepers is needed.     

Predictors of sleep quality in women in the menopausal transition

STUDY OBJECTIVES: To determine associations between menopausal status, reproductive hormone levels, menopausal symptoms, and poor sleep quality. DESIGN: The present study examines subjective sleep quality over an 8-year period in participants in an ongoing longitudinal study of ovarian aging in a randomly identified cohort of African American and Caucasian women. PARTICIPANTS: The Penn Ovarian Aging Study, a population-based cohort of 436 women from Philadelphia County who were 35 to 47 years of age and had regular menstrual cycles at enrollment. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The primary outcome measure was the Sleep Quality factor score, derived from the St. Mary's Hospital Sleep Questionnaire, which was adapted for this population and collected at each assessment period over the 8-year follow-up. Associations between menopausal status, reproductive hormone levels, menopausal symptoms, sleep quality, age, and race were examined in multivariable linear mixed regression models for repeated measures. Menopausal status was not significantly associated with sleep quality (P = 0.12). In the adjusted model, independent predictors of sleep quality were hot flashes (P < 0.0001), Center for Epidemiological Studies Depression Scale scores (P < 0.0001) and levels of the reproductive hormone inhibin B (P = 0.05). CONCLUSIONS: Sleep quality was predicted by hormone levels and symptoms that occur in the menopausal transition but did not worsen with advancing menopausal status alone. Lower inhibin B levels, hot flashes, and symptoms of depression were all strong and independent predictors of difficulty sleeping. Race was not a significant contributor to sleep quality. Together, the findings demonstrate that women who experience other perimenopausal symptoms are likely to experience sleep problems during the menopausal transition.     

Determinants of sleep quality in middle-aged women with fibromyalgia syndrome

The objectives of this study were: (i) to compare the sleep quality at home of patients with fibromyalgia with that of healthy controls; and (ii) to examine the factors associated with sleep quality in patients with fibromyalgia. In addition to anthropometric measures, 75 women with fibromyalgia and 48 healthy controls completed standardized questionnaires that assessed sleep quality, functional impairment (Fibromyalgia Impact Questionnaire), depression, anxiety and physical activity level. Comparisons between groups, correlation coefficients and a series of hierarchical multiple regressions were performed. The global Pittsburgh Sleep Quality Index scores were worse in patients with fibromyalgia than in the controls. This result was partly explained by the Fibromyalgia Impact Questionnaire score. For the patients with fibromyalgia, the results of the first model that tested the importance of demographic factors were not statistically significant. In the disease-related model, the duration of symptoms and symptom severity contributed to poor sleep quality. A measurement of physical activity participation and the sum of the skinfold thickness were added to the demographic factors. In the psychological model, the level of anxiety contributed to poor sleep quality. When all variables were entered simultaneously, the level of physical activity, duration of symptoms and symptom severity remained significant determinants of sleep quality. In conclusion, our results showed that the symptoms associated with fibromyalgia contributed to poor overall sleep quality in patients compared with healthy subjects. The findings also suggest that the duration of symptoms, symptom severity and especially a sedentary lifestyle contributed to decreased sleep quality in patients with fibromyalgia.     

Association of hostility with sleep duration and sleep disturbances in an employee population

Background: Sleep disturbances are common among the general population, and hostile persons have been proposed to be at greater risk of several serious health problems and diseases. Purpose: This study examined the relationships between hostility, sleep disturbances, and sleep duration in a large non-clinical sample of 5,433 employees working in 12 Finnish hospitals. Method: Data were collected by questionnaire surveys in 1998 and 2000. Results: Higher hostility was cross-sectionally associated with increased sleep disturbances but not with sleep duration after adjustment for gender, age, marital status, education, shift work, smoking, alcohol consumption, physical activity, body mass index, psychiatric morbidity, and somatic disease. A stratified analysis distinguishing individuals with stable hostility across the two measurements and those with transient hostility (>0.5 SD difference between measurements) replicated the association with increased sleep disturbance in both groups, but among those with transient hostility, there additionally was a cross-sectional association between higher hostility and shorter sleep duration. Conclusion: Our evidence suggests that hostility is an independent risk factor for sleep disturbances and that transient hostility may also predispose shorter sleep duration. However, the effect sizes for all these associations were small, suggesting limited clinical significance for our findings.     

Actigraphic sleep fragmentation,efficiency and duration associate with dietary intake in the Rotterdam Study

Short self‐reported sleep duration is associated with dietary intake and this association may partly mediate the link between short sleep and metabolic abnormalities. Subjective sleep measures, however, may be inaccurate and biased. The objective of this study was to evaluate the associations between actigraphic measures of sleep fragmentation, efficiency and duration and energy and macronutrient intakes. We used data from a subgroup of 439 participants of the population‐based cohort, Rotterdam Study. Sleep was assessed using 7‐day actigraphy and sleep diaries, and dietary data with a validated food frequency questionnaire. We assessed the associations of actigraphic sleep parameters with dietary intake using multivariable linear regression models. Higher sleep fragmentation was associated with 4.19 g lower carbohydrate intake per standard deviation of fragmentation {β [95% confidence interval (CI) = ?4.19 (?8.0, ?0.3)]; P = 0.03}. Each additional percentage increase in sleep efficiency was associated with 11.1 kcal lower energy intake [β (95% CI) = ?11.1 (?20.6, ?1.7); P = 0.02]. Furthermore, very short sleep duration (<5.5 h) was associated with 218.1 kcal higher energy intake [β (95% CI = 218.06 (33.3, 402.8), P = 0.02], relative to the reference group (≥6.5 to <7.5 h). We observed associations between higher sleep fragmentation with lower carbohydrate intake, and both lower sleep efficiency and very short sleep duration (<5 h) with higher energy intake. The association between sleep and higher energy intake could mediate, in part, the link between short sleep or sleep fragmentation index and metabolic abnormalities.     

The role of slow-wave sleep on the duration of quiet sleep in infants

The duration of quiet sleep (QS) phases has been shown to increase during the first year of life. Slow-wave sleep (SWS) appears in about half of the QS phases beyond 20 weeks. In order to evaluate the role of SWS in the lengthening of QS phase duration during the first year of life, we looked at 48 normal full-term infants (aged between 1 and 54 weeks), recorded for a whole-night period. Records included electro-encephalogram (EEG) and other polygraphic parameters. Infants were separated into two groups: (1) those who did not show SWS episodes at all, and (2) those who show both QS phases with (QS SWS+) and without (QS SWS-) SWS episodes. In group 2 the duration of QS SWS+ was longer than that of QS SWS, as well as longer than that of QS of group 1. Group 1 had a duration of QS phases similar to that of QS SWS-. The duration of QS SWS+ depended both on the SWS latency and SWS duration. The lengthening of QS phases with age is accounted for by those phases containing SWS episodes, reflecting a maturational restructuring of QS.     

Mother‐reported sleep,accelerometer‐estimated sleep and weight status in Mexican American children: sleep duration is associated with increased adiposity and risk for overweight/obese status

We know of no studies comparing parent‐reported sleep with accelerometer‐estimated sleep in their relation to paediatric adiposity. We examined: (i) the reliability of mother‐reported sleep compared with accelerometer‐estimated sleep; and (ii) the relationship between both sleep measures and child adiposity. The current cross‐sectional study included 303 Mexican American mother–child pairs recruited from Kaiser Permanente Northern California. We measured sleep duration using maternal report and accelerometry and child anthropometrics. Concordance between sleep measures was evaluated using the Bland–Altman method. We conducted zero‐ordered correlations between mother‐reported sleep, accelerometer‐estimated sleep and child BMI z‐scores (BMIz). Using linear regression, we examined three models to assess child BMIz with mother‐reported sleep (model 1), accelerometer‐estimated sleep (model 2) and both sleep measures (model 3). Children had an average age of 8.86 years (SD = 0.82). Mothers reported that their child slept 9.81 ± 0.74 h [95% confidence interval (CI): 9.72, 9.89], compared to 9.58 ± 0.71 h (95% CI: 9.50, 9.66) based on accelerometry. Mother‐reported sleep and accelerometer‐estimated sleep were correlated (r = 0.33, P < 0.001). BMIz outcomes were associated negatively with mother‐reported sleep duration (model 1: β = ?0.13; P = 0.02) and accelerometer‐estimated sleep duration (model 2: β = ?0.17; P < 0.01). Accounting for both sleep measures, only accelerometer‐measured sleep was related to BMIz (model 3: β = ?0.14, P = 0.02). Each sleep measure was related significantly to adiposity, independent of covariates. Accelerometry appeared to be a more reliable measure of children's sleep than maternal report, yet maternal report may be sufficient to examine the sleep–adiposity relationship when resources are limited.     

Self-reported sleep duration in Finnish general population

Self-reported short or long sleep duration has been repeatedly found to be associated with increased mortality and health risks. However, there is still an insufficient amount of detailed knowledge available to characterize the short and long sleep duration groups in general population. Consequently, the underlying mechanisms potentially explaining the health risks associated with short and long sleep duration are unclear. In the present study, the self-reported sleep duration in a sample of Finnish general population was studied, and its possible associations with such factors as self-perceived health, sociodemographic characteristics, lifestyle, sleep difficulties and daytime concomitants were analyzed. In particular, an effort was made to define mutually statistically-independent determinants of sleep duration. In the Finnish Health 2000 Survey, a representative sample of 8,028 subjects of 30 years of age or older and a sample of 1,894 subjects of 18-29 years of age were invited to take part in the health interview and health examination. The participation rate of the study was over 80%. The most important and statistically-independent determinants of short and long sleep duration were gender, physical tiredness, sleep problems, marital status, main occupation and physical activity. However, in the multivariable model they only accounted for approximately 16% of the variance in sleep duration in short and long sleepers, suggesting multiple sources of variance. The present study also suggests a dose-response like relationship between the sleep duration and many of its determinants within both short and long sleepers. A more detailed analysis of the clinical status of the short and long sleep duration groups is needed to evaluate the possible importance of these findings for health risks associated with sleep duration.     

Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review

OBJECTIVE: This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Disorder (DSPD), Free-Running Disorder (FRD) and Irregular Sleep-Wake Rhythm ISWR). METHODS: A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. RESULTS: A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of CRSDs. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications. CONCLUSION: Circadian rhythm science has also pointed the way to rational interventions for CRSDs and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.     

The duration of REM sleep epic, odes in normal sleep

SUMMARY  The distributions of the durations of the first 3 REM sleep episodes have been analysed using a total of 134 overnight sleep recordings from 10 subjects. From investigation of the length of uninterrupted episodes of stage REM, it is shown that arousals to stage 0/1 could play an important part in the process of REM exit, and that by the middle of the sleep period, these arousals probably occur according to a Poisson process. During the first and second REM episodes a more complex process appears to be at work, which could reflect increased pressure for slow wave sleep. These findings suggest that the duration of a REM episode is determined by a process that has a large stochastic element, which is not necessarily tied to REM entry.     

Effects of different sleep duration on delta sleep in recovery nights

The study assessed the effects of different amounts of sleep restriction on slow wave sleep (SWS) in the ensuing recovery nights. After one adaptation night and an 8-hr baseline night, six healthy men were individually studied during and following five nights in which sleep was reduced to 5, 4, 3, 2, and 1 hr with a 1-week interval between conditions. Bach sleep reduction was followed by an 8-hr recovery night. Finally, a second 8-hr baseline night was recorded. A trend analysis revealed that SWS amount in recovery nights increases with decreasing previous sleep duration. Regression analyses showed that, within each participant, the rebound of SWS after a sleep reduction is predicted better by the total duration of sleep than by the specific amount of SWS lost.     

Trajectories of reported sleep duration associate with early childhood cognitive development

Study ObjectivesExamine how different trajectories of reported sleep duration associate with early childhood cognition.MethodsCaregiver-reported sleep duration data (n = 330) were collected using the Brief Infant Sleep Questionnaire at 3, 6, 9, 12, 18, and 24 months and Children’s Sleep Habits Questionnaire at 54 months. Multiple group-based day-, night-, and/or total sleep trajectories were derived—each differing in duration and variability. Bayley Scales of Infant and Toddler Development-III (Bayley-III) and the Kaufman Brief Intelligence Test- 2 (KBIT-2) were used to assess cognition at 24 and 54 months, respectively.ResultsCompared to short variable night sleep trajectory, long consistent night sleep trajectory was associated with higher scores on Bayley-III (cognition and language), while moderate/long consistent night sleep trajectories were associated with higher KBIT-2 (verbal and composite) scores. Children with a long consistent total sleep trajectory had higher Bayley-III (cognition and expressive language) and KBIT-2 (verbal and composite) scores compared to children with a short variable total sleep trajectory. Moderate consistent total sleep trajectory was associated with higher Bayley-III language and KBIT-2 verbal scores relative to the short variable total trajectory. Children with a long variable day sleep had lower Bayley-III (cognition and fine motor) and KBIT-2 (verbal and composite) scores compared to children with a short consistent day sleep trajectory.ConclusionsLonger and more consistent night- and total sleep trajectories, and a short day sleep trajectory in early childhood were associated with better cognition at 2 and 4.5 years.     

学龄儿童不同睡眠状况下的学业成绩表现

目的:分析学龄儿童不同睡眠状况下的学业成绩表现特点。方法:采用分层整群抽样方法,抽取上海市10所小学的五年级学生2249名。使用自编学业成绩表现教师评估问卷(各维度得分用学业成绩指数表示,学业成绩指数越低,学业表现越好)和中文版儿童睡眠习惯问卷(CSHQ)(CSHQ总评分>41分为睡眠质量不良)对学业成绩和睡眠状况进行调查,分析不同睡眠时间、睡眠质量的儿童学业成绩表现特点。结果:女生的学业成绩各项指数均低于男生。儿童睡眠习惯问卷中由家长汇报的睡眠时间<9h的学龄儿童的各学业成绩指数均高于睡眠时间9～10h、>10h者(P<0.05),CSHQ总评分≤41分的学龄儿童的各学业成绩指数均低于儿童睡眠习惯问卷总评分>41分者。结论:睡眠时间短以及睡眠质量差的学龄儿童在学业表现上差于睡眠时间长、睡眠质量好者;家长及教师应更加关注儿童的睡眠健康。     

Mammography adherence and beliefs in a sample of low-income African American women

The purpose of this article is to describe the relation of perceptions of perceived breast cancer risks and perceived benefits and barriers to mammography and stage of mammography adherence in a convenience sample of low-income African American women. The theoretical framework of the Health Belief Model and the Transtheoretical Model were used to identify concepts and stage of mammography adherence. Data were obtained in waiting rooms of multipurpose centers. Scores for susceptibility and benefits were lowest for those who were in (a) precontemplation (had not thought about having a mammogram); as compared to (b) contemplation (had thought about having a mammogram, but not yet acted); (c) action (had a mammogram as recommended by the American Cancer Society); and (d) relapse (had a mammogram in the past, but overdue). Barriers scores were highest for those who had not had a mammogram (precontemplators and contemplators). In addition, individual bamers were significantly lower for women in action. Results have implications for interventions to increase screening in low-income African American women.     

Self-reported seasonality is associated with complaints of sleep problems and deficient sleep duration: the Hordaland Health Study

Change in sleep duration dependent on time of year is a central characteristic of seasonal affective disorder (SAD). In a community health survey, we analysed associations between seasonality, subjective sleep problems and sleep duration. Totally, 8860 subjects (3531 men and 5329 women) aged between 40 and 44 years were included in the study. Seasonal changes in mood and behaviour were measured by the Global Seasonality Score (GSS) questionnaire, and subjects were grouped in high (GSS > or = 11), moderate (GSS 8-10) or low (GSS < 8) seasonality groups. Sleep symptomatology was assessed using a modified version of the Karolinska Sleep Questionnaire. Significant sleep duration deficiency was defined as the difference between subjective sleep need and sleep duration of at least 1 h. Sleep problems suggesting insomnia as well as increased daytime sleepiness were more prevalent in the high/moderate seasonality groups compared with the low seasonality group. Seasonality was furthermore associated with shorter sleep duration and increased subjective sleep need. Significant sleep duration deficiency was more prevalent in subjects reporting high (men 20% and women 21%) and moderate (men 13% and women 19%) seasonality than subjects reporting low (men 10% and women 14%) seasonality. In conclusion, we found seasonal changes in mood and behaviour to be associated with several sleep-related complaints. Sleep duration deficiency increased with increasing seasonality, mainly due to increasing subjective sleep need.     

Association of active and passive smoking with sleep disturbances and short sleep duration among Japanese working population

Background: The relationship between passive smoking and sleep is uncertain. Purpose: To examine the association of passive/active smoking with sleep disturbances. Method: 732 women and 1,896 men, working in a suburb of Tokyo, were surveyed using a self-administered questionnaire. Information on smoking, passive smoking exposure, and sleep was elicited. Exposure levels to passive smoking were assessed separately at work and at home as no, occasional, or regular exposure. Risk of sleep disturbances according to smoking status was estimated using logistic regression with odds ratios (OR) and 95% confidence intervals (CIs) as measures of association. Results: Compared to never smokers, odds of difficulty awakening in the morning (DAM) in current smokers were significantly higher for women (OR 1.95) and men (OR 1.50), while increased difficulty initiating sleep (OR 1.88) and decreased early morning awakening (OR 0.31) were found only in women. Never smoking men occasionally exposed to passive smoking at work but not at home had increased odds (OR 1.81) of short sleep duration (SSD, <6 h) than unexposed counterparts. Conclusions: The analyses suggest that exposure to passive smoking at work is associated with SSD in men, while current smoking relates to various subtypes of sleep disturbances in both sexes.     

Circadian period and the timing of melatonin onset in men and women: predictors of sleep during the weekend and in the laboratory

Sleep complaints and irregular sleep patterns, such as curtailed sleep during workdays and longer and later sleep during weekends, are common. It is often implied that differences in circadian period and in entrained phase contribute to these patterns, but few data are available. We assessed parameters of the circadian rhythm of melatonin at baseline and in a forced desynchrony protocol in 35 participants (18 women) with no sleep disorders. Circadian period varied between 23 h 50 min and 24 h 31 min, and correlated positively (n = 31, r_s = 0.43, P = 0.017) with the timing of the melatonin rhythm relative to habitual bedtime. The phase of the melatonin rhythm correlated with the Insomnia Severity Index (n = 35, r_s = 0.47, P = 0.004). Self‐reported time in bed during free days also correlated with the timing of the melatonin rhythm (n = 35, r_s = 0.43, P = 0.01) as well as with the circadian period (n = 31, r_s = 0.47, P = 0.007), such that individuals with a more delayed melatonin rhythm or a longer circadian period reported longer sleep during the weekend. The increase in time in bed during the free days correlated positively with circadian period (n = 31, r_s = 0.54, P = 0.002). Polysomnographically assessed latency to persistent sleep (n = 34, r_s = 0.48, P = 0.004) correlated with the timing of the melatonin rhythm when participants were sleeping at their habitual bedtimes in the laboratory. This correlation was significantly stronger in women than in men (Z = 2.38, P = 0.017). The findings show that individual differences in circadian period and phase of the melatonin rhythm associate with differences in sleep, and suggest that individuals with a long circadian period may be at risk of developing sleep problems.