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Sleep Medicine Reviews Dec 2021The goal of this study was to examine the effects of behavioral sleep extension interventions on sleep duration outcomes in children and adults ≥ age 12. We... (Meta-Analysis)
Meta-Analysis Review
The goal of this study was to examine the effects of behavioral sleep extension interventions on sleep duration outcomes in children and adults ≥ age 12. We conducted a systematic literature review, article extraction and meta-analysis. Our search yielded 42 studies from 14 countries. The majority of studies (n = 19) enrolled adults, 10 studies enrolled college students, 13 enrolled children (high school or middle school aged). Results from the meta-analysis demonstrated behavioral sleep extension resulted in a significantly higher sleep duration as compared to control group or baseline, with pooled standardized mean difference (SMD) that was similar for both two-arm 0.80 (95 % CI 0.28 to 1.31; p < 0.01; I = 99.2%) and one-arm studies 0.75 (95% CI 0.39 to 1.11; p < 0.01; I = 86%), and there was significant heterogeneity among both study types. Subgroup analyses revealed that studies with direct interventions on sleep duration (i.e., specified the sleep schedule) had larger effects compared to indirect methods (coaching, educational approaches) and a greater number of curriculum components was associated with smaller effects. Results of this review demonstrate that sleep extension studies are effective at extending sleep in a variety of populations but improving the description of intervention methods and use of more rigorous study designs will improve the quality and reproducibility of this area of research.
Topics: Adult; Child; Cognitive Behavioral Therapy; Humans; Motivation; Reproducibility of Results; Sleep; Sleep Wake Disorders
PubMed: 34507028
DOI: 10.1016/j.smrv.2021.101532 -
American Journal of Health Promotion :... Sep 2019Workplace-based employee health promotion programs often target weight loss or physical activity, yet there is growing attention to sleep as it affects employee health...
OBJECTIVE
Workplace-based employee health promotion programs often target weight loss or physical activity, yet there is growing attention to sleep as it affects employee health and performance. The goal of this review is to systematically examine workplace-based employee health interventions that measure sleep duration as an outcome.
DATA SOURCE
We conducted systematic searches in PubMed, Web of Knowledge, EMBASE, Scopus, and PsycINFO (n = 6177 records).
STUDY INCLUSION AND EXCLUSION CRITERIA
To be included in this systematic review, studies must include (1) individuals aged >18 years, (2) a worker health-related intervention, (3) an employee population, and (4) sleep duration as a primary or secondary outcome.
RESULTS
Twenty studies met criteria. Mean health promotion program duration was 2.0 months (standard deviation [SD] = 1.3), and mean follow-up was 5.6 months (SD = 6.5). The mean sample size of 395 employees (SD = 700.8) had a mean age of 41.5 years (SD = 5.2). Measures of sleep duration included self-report from a general questionnaire (n = 12, 66.6%), self-report based on Pittsburgh Sleep Quality Index (n = 4, 22.2%), and self-report and actigraphy combined (n = 5, 27.7%). Studies most commonly included sleep hygiene (35.0%), yoga (25.0%), physical activity (10.0%), and cognitive-behavioral therapy for insomnia (10.0%) interventions. Across the interventions, 9 different behavior change techniques (BCTs) were utilized; the majority of interventions used 3 or fewer BCTs, while 1 intervention utilized 4 BCTs. Study quality, on average, was 68.9% (SD = 11.1). Half of the studies found workplace-based health promotion program exposure was associated with a desired increase in mean nightly sleep duration (n = 10, 50.0%).
CONCLUSIONS
Our study findings suggest health promotion programs may be helpful for increasing employee sleep duration and subsequent daytime performance.
Topics: Clinical Trials as Topic; Exercise; Health Behavior; Health Promotion; Humans; Occupational Health; Self Report; Sleep; Workplace
PubMed: 30957509
DOI: 10.1177/0890117119841407 -
The International Journal of Behavioral... Apr 2023Promoting physical activity (PA) in different populations experiencing sleep disturbance may increase population PA levels and improve sleep. This scoping review aimed...
BACKGROUND
Promoting physical activity (PA) in different populations experiencing sleep disturbance may increase population PA levels and improve sleep. This scoping review aimed to examine the effect of various PA intervention strategies on sleep across different populations, identify key sleep outcomes, and analyze knowledge gaps by mapping the relevant literature.
METHODS
For this study, we systematically searched articles published till March 2022 from PubMed, Web of Science, Cochrane Library, and Embase databases for randomized clinical trials (RCTs) regarding the effect of physical activity on sleep. Two authors extracted key data and descriptively analyzed the data. Thematic analysis was used to categorize the results into themes by all authors. Arksey and O'Malley's scoping review framework was used to present the findings.
RESULTS
Twenty-one randomized controlled trials out of 3052 studies were finally included with 3677 participants (2852 females (78%)). Five trials were conducted in healthy working-age adults with sleep disturbance but without the diagnosis of insomnia, five in healthy older adults, two in perinatal women, four in patients with cancer, three in mental illness related subjects, and another two in other disease-related areas. PA interventions were diverse, including walking, resistance training, aerobic exercise, housework, water exercise, basketball, smartphone/tablet "apps", web, online videos or wearable actigraphy, and self-determined exercise. Three major themes were identified: (1) Sleep environment may be important to address prior to instituting PA interventions, (2) All types of PA were effective for improving sleep in all populations studied, (3) Self-tolerated PA is safe for improving sleep in the elderly and in co-morbid or perinatal populations.
CONCLUSIONS
PA is effective and safe for improving sleep in both healthy and co-morbid populations with sleep disturbance by increasing daily activity levels using a variety of strategies, even low intensity, such as housekeeping, sit-to-stand repetitions, along with encouraging PA through web pages, videos, and self-goal setting apps. In addition, this scoping review identifies the need for further therapeutic research and future exploration in populations with sleep initiation or sleep maintenance disturbance.
Topics: Aged; Female; Humans; Exercise; Neoplasms; Randomized Controlled Trials as Topic; Sleep; Walking
PubMed: 37069626
DOI: 10.1186/s12966-023-01449-7 -
Canadian Journal of Psychiatry. Revue... Jun 2020In 2016, the global number of individuals living with dementia was 43.8 million, representing a 117% increase from 1990-mainly due to increases in aging and population... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In 2016, the global number of individuals living with dementia was 43.8 million, representing a 117% increase from 1990-mainly due to increases in aging and population growth. Up to 90% of individuals with dementia experience neuropsychiatric symptoms (NPS). However, the limitations of current treatments for NPS have drivent he search for safer pharmacotherapies-including cannabinoids.
AIM
To assess the efficacy and acceptability of cannabinoids for the treatment of NPS in individuals with dementia.
DESIGN
Systematic review and meta-analysis of clinical trials.
SETTING AND PARTICIPANTS
Of 6,902 papers, 9 were eligible ( = 205, 44% female, 78 ± 7 years, 85% Alzheimer disease). Trials were in North America and Europe and explored tetrahydrocannabinol ( = 3), dronabinol ( = 5), or nabilone ( = 1).
MEASUREMENT
Titles/abstracts were independently screened by one reviewer and reviewed by a second. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on the standardized mean difference (SMD) for several NPS instruments, trial completion, and adverse events. Data were pooled using random-effects models.
FINDINGS
Cannabinoids led to significant improvements across NPS instruments, including the Cohen Mansfield Agitation Inventory (SMD = -0.80; 95% confidence interval [CI], -1.45 to -0.16), the Neuropsychiatric Inventory (SMD = -0.61; CI, -1.07 to -0.15), and nocturnal actigraphy (SMD = -1.05; CI, -1.56 to -0.54h). Cannabinoids were well-tolerated, with an overall trial completion rate of 93% (193/205) and no serious treatment-related adverse events. Treatment efficacy was associated with baseline dementia severity and dose, but not dementia subtype, age, or sex. The overall study quality was rated as low.
CONCLUSIONS
There is preliminary evidence for the efficacy and tolerability of cannabinoids as treatments for NPS. Population-based studies are needed to characterize their real-world effectiveness and acceptability.
Topics: Alzheimer Disease; Cannabinoids; Female; Humans; Male; North America; Treatment Outcome
PubMed: 31835954
DOI: 10.1177/0706743719892717 -
Health Psychology Review Dec 2020Associations have been found between perseverative cognition (PC: worry and rumination) and somatic markers of ill-health. Further studies have reported associations... (Meta-Analysis)
Meta-Analysis
Associations have been found between perseverative cognition (PC: worry and rumination) and somatic markers of ill-health. Further studies have reported associations between sleep and both PC and poorer health. As such, sleep disturbance may represent a pathway between PC and ill-health. Therefore, studies assessing the relationship between PC and sleep in non-clinical populations were synthesised. Meta-analyses (= 55) revealed small- to medium-sized associations between higher PC and poorer sleep quality (SQ, = -0.28), shorter total sleep time (TST, = -0.15) and longer sleep onset latency (SOL, = -0.16). Variations included associations between SQ and rumination ( = -.33) and worry ( = -.23). Associations were stronger in studies measuring SQ via self-report rather than actigraphy, and where SOL and TST outcomes were cross-sectional. Associations with SOL were stronger when outcomes were from non-diary studies and when trait, rather than state PC, was measured, but weaker where studies incorporated more measures of PC. Effect sizes were generally larger where studies were higher quality and being female may act as a protective factor between PC and longer SOL. Therefore, there is a consistent association between PC and sleep which may partially explain the link between PC and ill-health.
Topics: Anxiety; Humans; Rumination, Cognitive; Sleep; Sleep Wake Disorders; Stress, Psychological
PubMed: 31910749
DOI: 10.1080/17437199.2019.1700819 -
Journal of Intensive Care Medicine Nov 2020In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions...
OBJECTIVE
In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, a measure of activity involving a wristwatch-like accelerometer, as a method to inform these efforts. Therefore, we performed a systematic review of studies that used actigraphy to measure patient activity in the ICU setting.
DATA SOURCES
We searched PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest from inception until December 2016.
STUDY SELECTION
Two reviewers independently screened studies for inclusion. A study was eligible for inclusion if it was published in a peer-reviewed journal and used actigraphy to measure activity in ≥5 ICU patients.
DATA EXTRACTION
Two reviewers independently performed data abstraction and risk of bias assessment. Abstracted actigraphy-based activity data included total activity time and activity counts.
RESULTS
Of 16 studies (607 ICU patients) identified, 14 (88%) were observational, 2 (12%) were randomized control trials, and 5 (31%) were published after 2009. Mean patient activity levels per 15 to 60 second epoch ranged from 25 to 37 daytime and 2 to 19 nighttime movements. Actigraphy was evaluated in the context of ICU and post-ICU outcomes in 11 (69%) and 5 (31%) studies, respectively, and demonstrated potential associations between actigraphy-based activity levels and delirium, sedation, pain, anxiety, time to extubation, and length of stay.
CONCLUSION
Actigraphy has demonstrated that patients are profoundly inactive in the ICU with actigraphy-based activity levels potentially associated with important measures, such as delirium, sedation, and length of stay. Larger and more rigorous studies are needed to further evaluate these associations and the overall utility of actigraphy in the ICU setting.
Topics: Actigraphy; Airway Extubation; Critical Care; Exercise; Humans; Intensive Care Units; Length of Stay; Randomized Controlled Trials as Topic
PubMed: 31331220
DOI: 10.1177/0885066619863654 -
Frontiers in Neurology 2020Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the...
Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice. CINAHAL, PubMed/Medline, and Cochrane Library were searched from January 1, 2000 to February 1, 2020 to identify studies that evaluated sleep quality in critically ill patients. Sixty-two studies using polysomnography (PSG) and other electroencephalogram-based methods, actigraphy, clinician observation, or patient perception using questionnaires were identified and evaluated. Key recommendations are: standard criteria are needed for scoring PSG in ICU patients who often have atypical brain waves; studies are too few, samples sizes too small, and study duration too short for recommendations on electroencephalogram-based measures and actigraphy; use the Sleep Observation Tool for clinician observation of sleep; and use the Richards Campbell Sleep Questionnaire to measure patient perception of sleep. Measuring the impact of interventions to prevent sleep deprivation requires reliable and valid sleep measures, and investigators have made good progress developing, testing, and applying these measures in the ICU. We recommend future large, multi-site intervention studies that measure multiple dimensions of sleep, and provide additional evidence on instrument reliability, validity, feasibility and responsiveness. We also encourage testing new technologies to augment existing measures to improve their feasibility and accuracy.
PubMed: 33240191
DOI: 10.3389/fneur.2020.542529 -
Schizophrenia Bulletin Sep 2020Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterized. We aimed to describe and compare the magnitude and heterogeneity of...
BACKGROUND
Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterized. We aimed to describe and compare the magnitude and heterogeneity of sleep-circadian alterations in remitted schizophrenia and compare them with those in interepisode bipolar disorder.
METHODS
EMBASE, Medline, and PsycINFO were searched for case-control studies reporting actigraphic parameters in remitted schizophrenia or bipolar disorder. Standardized and absolute mean differences between patients and controls were quantified using Hedges' g, and patient-control differences in variability were quantified using the mean-scaled coefficient of variation ratio (CVR). A wald-type test compared effect sizes between disorders.
RESULTS
Thirty studies reporting on 967 patients and 803 controls were included. Compared with controls, both schizophrenia and bipolar groups had significantly longer total sleep time (mean difference [minutes] [95% confidence interval {CI}] = 99.9 [66.8, 133.1] and 31.1 [19.3, 42.9], respectively), time in bed (mean difference = 77.8 [13.7, 142.0] and 50.3 [20.3, 80.3]), but also greater sleep latency (16.5 [6.1, 27.0] and 2.6 [0.5, 4.6]) and reduced motor activity (standardized mean difference [95% CI] = -0.86 [-1.22, -0.51] and -0.75 [-1.20, -0.29]). Effect sizes were significantly greater in schizophrenia compared with the bipolar disorder group for total sleep time, sleep latency, and wake after sleep onset. CVR was significantly elevated in both diagnoses for total sleep time, time in bed, and relative amplitude.
CONCLUSIONS
In both disorders, longer overall sleep duration, but also disturbed initiation, continuity, and reduced motor activity were found. Common, modifiable factors may be associated with these sleep-circadian phenotypes and advocate for further development of transdiagnostic interventions that target them.
PubMed: 32154882
DOI: 10.1093/schbul/sbaa024 -
Journal of Affective Disorders Aug 2020Emerging literature suggests that the arousal and regulatory systems as measured by sleep-wakefulness, heart rate (HR) and heart rate variability (HRV) may be powerful... (Review)
Review
BACKGROUND
Emerging literature suggests that the arousal and regulatory systems as measured by sleep-wakefulness, heart rate (HR) and heart rate variability (HRV) may be powerful objective warning signs of suicidality. However, there is no systematic literature review examining the association between objective measurements of these variables with suicide and suicidal behavior.
METHODS
A web-based, systematic literature search using PubMed and EMBASE was conducted for articles that measured sleep-wakefulness and HR/HRV quantitatively in association with suicide. Search results were limited to human subjects and articles published in peer-reviewed journals in English. There were no restrictions for age, sex, settings and durations of measurements, types of mental illnesses, or comorbidity.
RESULTS
Twenty-three studies were included in the current systematic review. Across the studies, consistent patterns of disturbed sleep-wakefulness such as greater sleep onset latency and lower sleep efficiency were related to suicide. In addition, higher HR and lower variance of R-R intervals was an indicator of risk of suicide.
LIMITATIONS
Studies that used different equipment for sleep studies (i.e., polysomnography, electroencephalogram, actigraphy) were combined, and potential differences in their findings due to the different equipment were not considered.
CONCLUSIONS
Findings provide initial evidence for consistent patterns of sleep-wakefulness and HR/HRV possibly associated with suicidality; however, more studies are needed in order to identify the precise objective variables (e.g., sleep onset latency, high-frequency HRV), as well as time-varying patterns in these variables, that are related to acute suicide risk.
Topics: Exercise; Heart Rate; Humans; Sleep; Suicide; Wakefulness
PubMed: 32421619
DOI: 10.1016/j.jad.2020.03.096 -
What are the sleep characteristics of elite female athletes? A systematic review with meta-analysis.Biology of Sport Sep 2022With the recent growth in female sport, practitioners need to be able to provide specific support to female athletes to ensure their sleep, health and athletic... (Review)
Review
With the recent growth in female sport, practitioners need to be able to provide specific support to female athletes to ensure their sleep, health and athletic performance are optimised. Examine the patterns, duration and quality of sleep among elite female athletes, and consider the impact of situational challenges and their effects on the sleep of elite female athletes. Data was located through a search of SPORTDiscus, MEDLINE and Scopus from inception up to May 2021. Studies needed to be peer-reviewed research reporting quantitative sleep outcomes for female athletes ≥ 18 years of age and competing at a predefined elite level. A meta-analysis was performed on habitual sleep outcomes (e.g. total sleep time [TST] and sleep efficiency [SE]) measured with actigraphy. A total of 38 studies were included. Meta-analysis showed habitual TST (n = 14) was 7.8 h [7.4, 8.2] (mean [95% CI]), and SE was 86.7% [84.7, 88.6], with high variability among studies (I = 97.8-98.2%). Subjective sleep complaints are common before a competition, as do post-training sleep disturbances (63% studies report TST decrease), and post-competition sleep disturbances (75% studies report TST decrease). Female athletes achieve satisfactory objective sleep quantity and quality during habitual periods, but experience sleep disturbances pre- and post-situational challenges. There is high variability of objective sleep outcomes, demonstrating the individual nature of habitual female athlete sleep. Overall, future research must focus on optimising the sleep appraisal methods and creating high-quality study designs in a broader number of sports.
PubMed: 35959341
DOI: 10.5114/biolsport.2022.108705