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Concept: Sleep hygiene

194

Traditional screen time (e.g. TV and videogaming) has been linked to sleep problems and poorer developmental outcomes in children. With the advent of portable touchscreen devices, this association may be extending down in age to disrupt the sleep of infants and toddlers, an age when sleep is essential for cognitive development. However, this association has not been demonstrated empirically. This study aims to examine whether frequency of touchscreen use is associated with sleep in infants and toddlers between 6 and 36 months of age. An online survey was administered to 715 parents reporting on child media use (daily exposure to TV and use of touchscreens), sleep patterns (night-time and daytime sleep duration, sleep onset - time to fall asleep, and frequencies of night awakenings). Structural equation models controlling for age, sex, TV exposure and maternal education indicated a significant association between touchscreen use and night-time sleep, daytime sleep and sleep onset. No significant effect was observed for the number of night awakenings. To our knowledge, this is the first report linking the use of touchscreen with sleep problems in infants and toddlers. Future longitudinal studies are needed to clarify the direction of effects and the mechanisms underlying these associations using detailed sleep tracking.

Concepts: Infant, Sleep, Sleep disorder, Circadian rhythm, Narcolepsy, Structural equation modeling, Sleep hygiene

28

The purpose of this study was to evaluate the impact on sleep quality of a nursing-driven sleep hygiene protocol (SHP) instituted in a single burn-trauma intensive care unit. Criteria for eligibility were adult patients admitted to the Burn Service who were not delirious, able to respond verbally, and had not received general anesthesia in the prior 24 hours. Patients were surveyed using the validated Richards-Campbell Sleep Questionnaire prior to implementation (“PRE”; May to December 2010) and following implementation (“POST”; January to August 2011) of a SHP that sought to minimize environmental stimuli and limit disruptions during the night. This analysis includes only initial survey responses from each patient. A total of 130 patients were surveyed, 81 PRE and 49 POST; 60% were burn admissions. There was no significant difference in responses to the questionnaire between burn and nonburn patients. All patients in the POST group were significantly older and more frequently endorsed taking sleep medication at home. Although not significant, POST patients reported falling asleep somewhat more quickly, but no other differences were identified between the two groups. Among patients who reported having sleep difficulties prior to admission, POST patients not only reported a significantly higher pain score than PRE patients, but also reported significant improvement in falling asleep and being able to go back to sleep. Frequency of complaints of sleep disruption was unchanged between PRE and POST patients. POST patients did complain significantly less than PRE patients about sleep disruptions by clinicians. Implementation of the SHP permitted acutely injured or ill patients in our intensive care unit to fall asleep more quickly and to experience fewer sleep disruptions. A sleep protocol may be helpful in improving sleep and overall well-being of burn center patients.

Concepts: Sleep, Sleep disorder, Illness, Anesthesia, Complaint, Sleep hygiene

23

The etiological role of sleep disturbance in sexual difficulties has been largely overlooked. Research suggests that short sleep duration and poor sleep quality lead to poor female sexual response. However, prior research consists of cross-sectional studies, and the influence of sleep on sexual functioning and behavior has not been prospectively examined.

Concepts: Cross-sectional study, Sleep, Cultural studies, Cross-sectional analysis, Sleep hygiene

10

Sleep disorders have become increasingly prevalent affecting health and working ability. Restorative sleep may be considered important for athletes' successful recovery and performance. However, some athletes seem to experience major problems in sleeping. Thus far, there is limited scientific information about their sleep. This study aimed to evaluate the quality of sleep and the prevalence of sleep disorders as well as the impact of a structured sleep counselling protocol in professional athletes. A total of 107 professional ice hockey players participated in the study. The exploratory observational 1-year follow-up study consisted of questionnaire-based sleep assessment followed by general sleep counselling and, when needed, polysomnography and an individual treatment plan. One in every four players was found to have a significant problem in sleeping. All athletes considered sleep essential for their health and three in every four players considered that counselling would improve their performance. Counselling and individual treatment were found to improve significantly the quality of sleep with the mean alteration of 0.6 (95% CI 0.2-1.0, P = 0.004) in a scale from 0 to 10. Our results support that sleep problems are common in professional athletes. However, systematic examination, counselling and individual treatment planning can improve the quality of their sleep.

Concepts: Sleep, Sleep disorder, Sleep apnea, Polysomnography, Sleep medicine, Circadian rhythm, Narcolepsy, Sleep hygiene

10

Abstract Purpose . The purpose of this study was to examine the relationship between sleep patterns and adiposity in young adult women. Design . Cross-sectional. Setting . The study took place at two Mountain West region universities and surrounding communities. Subjects . Subjects were 330 young adult women (20.2 ± 1.5 years). Measures . Sleep and physical activity were monitored for 7 consecutive days and nights using actigraphy. Height and weight were measured directly. Adiposity was assessed using the BOD POD. Analysis . Regression analysis, between subjects analysis of variance, and structural equation modeling were used. Results . Bivariate regression analysis demonstrated that sleep efficiency was negatively related to adiposity and that the 7-day standard deviations of bedtime, wake time, and sleep duration were positively related to adiposity (p < .05). Controlling for objectively measured physical activity strengthened the relationship between sleep duration and adiposity by 84% but had a statistically negligible impact on all other relationships that were analyzed. However, multivariate structural equation modeling indicated that a model including sleep efficiency, sleep pattern inconsistency (latent variable consisting of the 7-day standard deviations of bedtime, wake time, and sleep duration), and physical activity was the best for predicting percent body fat. Conclusion . Inconsistent sleep patterns and poor sleep efficiency are related to adiposity. Consistent sleep patterns that include sufficient sleep may be important in modifying risk of excess body fat in young adult women.

Concepts: Statistics, Variance, Econometrics, Sleep, Adipose tissue, Standard deviation, Analysis of variance, Sleep hygiene

8

Sleeping difficulty has been associated with type 2 diabetes in some prior studies. Whether the observed associations are independent of health behaviours, other cardiovascular risk factors or other sleep disorders is unclear.

Concepts: Diabetes mellitus type 2, The Canon of Medicine, Sleep, Sleep disorder, Polysomnography, Circadian rhythm, Narcolepsy, Sleep hygiene

6

Adolescence is a time of increasing vulnerability for poor mental health, including depression. Sleep disturbance is an important risk factor for the development of depression during adolescence. Excessive electronic media use at night is a risk factor for both adolescents' sleep disturbance and depression. To better understand the interplay between sleep, depressive symptoms, and electronic media use at night, this study examined changes in adolescents' electronic media use at night and sleep associated with smartphone ownership. Also examined was whether sleep disturbance mediated the relationship between electronic media use at night and depressive symptoms. 362 adolescents (12-17 year olds, M = 14.8, SD = 1.3; 44.8 % female) were included and completed questionnaires assessing sleep disturbance (short sleep duration and sleep difficulties) and depressive symptoms. Further, participants reported on their electronic media use in bed before sleep such as frequency of watching TV or movies, playing video games, talking or text messaging on the mobile phone, and spending time online. Smartphone ownership was related to more electronic media use in bed before sleep, particularly calling/sending messages and spending time online compared to adolescents with a conventional mobile phone. Smartphone ownership was also related to later bedtimes while it was unrelated to sleep disturbance and symptoms of depression. Sleep disturbance partially mediated the relationship between electronic media use in bed before sleep and symptoms of depression. Electronic media use was negatively related with sleep duration and positively with sleep difficulties, which in turn were related to depressive symptoms. Sleep difficulties were the more important mediator than sleep duration. The results of this study suggest that adolescents might benefit from education regarding sleep hygiene and the risks of electronic media use at night.

Concepts: Risk, Sleep, Sleep disorder, Bipolar disorder, Mobile phone, Radio, Text messaging, Sleep hygiene

5

To determine whether subjective poor sleep prospectively increases functional limitations and incident disability in a national sample of adults living in the United States.

Concepts: United States, Sleep, Poverty in the United States, U.S. state, Maize, Latin America, Oregon, Sleep hygiene

5

In any sport, successful performance requires a planned approach to training and recovery. While sleep is recognized as an essential component of this approach, the amount and quality of sleep routinely obtained by elite athletes has not been systematically evaluated. Data were collected from 70 nationally ranked athletes from seven different sports. Athletes wore wrist activity monitors and completed self-report sleep/training diaries for 2 weeks during normal training. The athletes also recorded their fatigue level prior to each training session using a 7-point scale. On average, the athletes spent 08:18 ± 01:12 h in bed, fell asleep at 23:06 ± 01:12 h, woke at 6:48 ± 01:30 h and obtained 06:30 ± 01:24 h of sleep per night. There was a marked difference in the athletes' sleep/wake behaviour on training days and rest days. Linear mixed model analyses revealed that on nights prior to training days, time spent in bed was significantly shorter (p = 0.001), sleep onset and offset times were significantly earlier (p < 0.001) and the amount of sleep obtained was significantly less (p = 0.001), than on nights prior to rest days. Moreover, there was a significant effect of sleep duration on pre-training fatigue levels (p ≤ 0.01). Specifically, shorter sleep durations were associated with higher levels of pre-training fatigue. Taken together, these findings suggest that the amount of sleep an elite athlete obtains is dictated by their training schedule. In particular, early morning starts reduce sleep duration and increase pre-training fatigue levels. When designing schedules, coaches should be aware of the implications of the timing of training sessions for sleep and fatigue. In cases where early morning starts are unavoidable, countermeasures for minimizing sleep loss - such as strategic napping during the day and correct sleep hygiene practices at night - should be considered.

Concepts: Sleep, Sleep deprivation, Somnolence, Common cold, Duration, Sleep hygiene, Bed

3

Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

Concepts: Sleep, Sleep disorder, Sleep apnea, Polysomnography, Sleep medicine, Mental disorder, Narcolepsy, Sleep hygiene