BACKGROUND: The association between the length of sleep and atherosclerosis has been reported in many observational studies. However, little is known about its significance as a risk factor for atherosclerosis or as a negative consequence of atherosclerosis.
OBJECTIVE: This study aimed to assess the causal association between sleep duration and the risk of atherosclerosis using publicly available genome-wide association studies (GWAS) summary statistics.
METHODS: We employed a two-sample Mendelian randomization (MR) method with 2 cohorts from MRC-IEU (n=460,099) and UK Biobank (n=361,194) to investigate the causal association between sleep duration and the risk of atherosclerosis. Three methods including the inverse-variance weighted (IVW) technique, Robust adjusted profile score (RAPS), and simple-and weighted-median approach were used to obtain reliable results, and an odds ratio with a 95% confidence interval (CI) was calculated. P<0.05 was considered as a statistical difference. In addition, MR-Egger regression, Radial MR, MR-PRESSO, and leave-one-out analyses were used to assess the possible pleiotropy effects.
RESULTS: No causal association of sleep duration with atherosclerosis was found [OR (95%CI): 0.90 (0.98-1.00), p = 0.186]. Leave-one-out, MR-Egger, and MR-PRESSO analyses failed to detect horizontal pleiotropy.
CONCLUSIONS: This MR analysis indicated no causal association between genetically predicted sleep duration and atherosclerosis across European populations.
OBJECTIVE: A associação entre a duração do sono e a aterosclerose foi relatada em muitos estudos observacionais. No entanto, pouco se sabe sobre a sua importância como fator de risco para aterosclerose ou como consequência negativa da aterosclerose.
OBJECTIVE: Este estudo teve como objetivo avaliar a associação causal entre a duração do sono e o risco de aterosclerose usando estatísticas resumidas de estudos de associação genômica ampla (GWAS) disponíveis publicamente.
UNASSIGNED: Empregamos um método de randomização mendeliana (RM) de duas amostras com 2 coortes do MRC-IEU (n = 460.099) e do UK Biobank (n = 361.194) para investigar a associação causal entre a duração do sono e o risco de aterosclerose. Três métodos, incluindo a técnica de variância inversa ponderada (IVW), escore de perfil ajustado robusto (RAPS) e abordagem de mediana simples e ponderada, foram usados para obter resultados confiáveis, e uma razão de chances com intervalo de confiança (IC) de 95% foi calculada. P<0,05 foi considerado diferença estatística. Além disso, foram utilizadas análises de regressão: MR-Egger regression, Radial MR, MR-PRESSO e leave-one-out para avaliar os possíveis efeitos de pleiotropia.
RESULTS: Não foi encontrada associação causal entre duração do sono e aterosclerose [OR (IC95%): 0,90 (0,98-1,00), p = 0,186]. As análises Leave-one-out, MR-Egger, e MR-PRESSO não conseguiram detectar pleiotropia horizontal.
UNASSIGNED: Esta análise de RM não indicou nenhuma associação causal entre a duração do sono geneticamente prevista e a aterosclerose nas populações europeias.

BACKGROUND: Previous intervention studies among night workers mainly focused on single interventions and found inconclusive evidence for effectiveness. A comprehensive intervention approach that includes individual and environmental components has been argued as important. Gaining insight into contributing factors for the implementation of interventions for night workers and effectiveness is important to distinguish between theory and programme failure.
OBJECTIVE: To evaluate the effects and implementation of the PerfectFit@Night intervention to improve sleep, fatigue and recovery of night workers in healthcare, using the RE-AIM framework, which assesses reach, effectiveness, adoption, implementation and maintenance of interventions.
METHODS: A prospective pre-post study design, with two measurements before and three and six months after the intervention.
METHODS: Twelve different departments of a university hospital in the Netherlands.
METHODS: Healthcare workers working night shifts (n = 210).
METHODS: PerfectFit@Night consisted of environmental (provision of a powernap bed and healthy food, and workshop healthy rostering) and individual elements (e-learning and sleep coaching) and was implemented for three months in a phased manner. Questionnaires, logbooks and interview data were used. Effects of the intervention on sleep, fatigue and recovery were evaluated with mixed-effects models, and implementation factors of reach, adoption, implementation and maintenance were evaluated.
RESULTS: Night shift-related insomnia (-11 %-points, 95 % CI: -19 %, -4 % at three months), need for recovery (β: -2.45, 95 % CI: -4.86, -0.03 at six months) and fatigue (OR: 0.46, 95 % CI: 0.25, 0.86 at six months) decreased significantly after the intervention. No changes were found for subjective sleep quality and sleep duration. Barriers and facilitators for implementation were identified for each intervention element at individual (e.g., dietary preferences), organisational (e.g., responsibilities at work) and workplace levels (e.g., location of power nap bed), and for the intervention itself (e.g., useful information in e-learning). Although satisfaction was high and continuation was preferred, embedding of the intervention in the daily routine was limited. Facilitators for future implementation include a positive attitude towards the intervention, clear guidelines regarding intervention elements, appointment of night workers as ambassadors, and suitable conditions in terms of work demands and for the intervention elements.
CONCLUSIONS: The multi-faceted PerfectFit@Night intervention reduced insomnia, fatigue and need for recovery in night workers in healthcare. The most important facilitators to improve the implementation of PerfectFit@Night exist at the organisational level (e.g., positive attitude within the culture and suitable work demands). Combining effect and implementation evaluation is crucial to identify barriers and facilitators that hamper or enhance intervention effects.
BACKGROUND: The study was registered in the Netherlands Trial Register on 17 January 2021 (trial number NL9224).

BACKGROUND: The increased trends in psychological distress and mental illness have been of great significance in public health concerns. The study aimed to investigate the proportion and correlates of meeting 24-h movement guidelines (including moderate to vigorous physical activity, screen time and sleep duration) and the associations between 24-h movement guidelines met and mental well-being and psychological distress in a large sample of Chinese students.
METHODS: All participants received a physical examination and filled out questionnaires in this study. Chi-square tests were used to analyse the proportion of reaching 24-h guidelines by gender and logistic regression was used to analyse correlates of meeting 24-h guidelines. Two binary logistic regression models were used to analyse the association between meeting 24-h guidelines and mental well-being and psychological distress. The back-propagation artificial neural network was used to describe the importance of the independent variables.
RESULTS: The findings revealed a generally low rate of meeting the 24-h movement guidelines, particularly concerning moderate to vigorous physical activity (16.5%). Meeting all three guidelines was related to better mental health in both boys and girls. Particularly, meeting screen time guideline and meeting sleep duration guideline appeared to be more important on mental outcomes, compared to meeting moderate to vigorous physical activity guideline. Compared with boys, girls were more susceptible to the influences of 24-h movement guidelines on mental health.
CONCLUSIONS: Meeting all three components of the 24-h movement guidelines was associated with the most favourable mental health outcomes for both boys and girls. Thus, maintaining a daily balance of sufficient physical activity, limited screen time, and adequate sleep is crucial for enhancing the mental health status of students.

OBJECTIVE: Sleep is a multi-dimensional human function that is associated with cancer outcomes. Previous work on sleep and cancer mortality have not investigated how this relationship varies by sex and cancer site. We investigated the association of sleep duration and perceived insomnia with site-specific and overall cancer mortality among participants in the Cancer Prevention Study-II.
METHODS: Sleep was collected at baseline in 1982 among 1.2 million cancer-free US adults. Cancer-specific mortality was determined through 2018. We used multivariable Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for overall and site-specific cancer mortality, stratified by sex.
RESULTS: Among 983,105 participants (56% female) followed for a median of 27.9 person-years, there were 146,911 primary cancer deaths. Results from the adjusted model showed short (6 h/night) and long (8 h/night and 9-14 h/night) sleep duration, compared to 7 h/night, were associated with a modest 2%, 2%, and 5% higher risk of overall cancer mortality, respectively, and there was a significant non-linear trend (p-trend < 0.01). This non-linear trend was statistically significant among male (p-trend < 0.001) but not female (p-trend 0.71) participants. For male participants, short and long sleep were associated with higher risk of lung cancer mortality and long sleep was associated with higher risk of colorectal cancer mortality. Perceived insomnia was associated with a 3-7% lower risk of overall cancer mortality.
CONCLUSIONS: Sleep is important to consider in relation to sex- and site-specific cancer mortality. Future research should investigate other components of sleep in relation to cancer mortality.

UNASSIGNED: There is a strong association between obstructive sleep apnea and hypertension, but the effects of obstructive sleep apnea symptoms on the risk of incident hypertension are not well documented. The aim of this prospective study was to examine whether snoring and sleepiness are associated with incident hypertension.
UNASSIGNED: Data from the French population-based CONSTANCES cohort were analyzed. Normotensive participants, aged 18 to 69 years, were included between 2012 and 2016 and screened for snoring, morning fatigue, and daytime sleepiness in 2017 using items of the Berlin Questionnaire. We used Cox models, adjusted for multiple potential confounders, including body mass index, baseline blood pressure, sleep duration, and depressive symptoms, to compute hazards ratios of incidentally treated hypertension.
UNASSIGNED: Among 34 727 subjects, the prevalence of self-reported habitual snoring, morning fatigue, and excessive daytime sleepiness (≥3× a week for each) was 23.6%, 16.6%, and 19.1%, respectively. During a median follow-up of 3.1 years (interquartile range, 3.0-3.5), the incidence of treated hypertension was 4.1%. The risk of de novo treated hypertension was higher in participants who reported habitual snoring (adjusted hazard ratio, 1.17 [95% CI, 1.03-1.32]) and excessive daytime sleepiness (adjusted hazard ratio, 1.42 [95% CI, 1.24-1.62]), and increased with the weekly frequency of symptoms, with a dose-dependent relationship (Ptrend≤0.02 for all symptoms).
UNASSIGNED: Self-reported snoring and excessive daytime sleepiness are associated with an increased risk of developing hypertension. Identification of snoring and daytime sleepiness may be a useful public health screening tool in primary care for hypertension prevention.

BACKGROUND: Depression poses a significant challenge globally, including in safety-critical industries such as aviation. In Saudi Arabia, where the aviation sector is rapidly expanding, pilots encounter unique stressors inherent to their profession. However, research on pilot mental health, particularly within the Saudi context, remains limited despite its critical role in flight safety.
METHODS: This cross-sectional survey was designed to estimate the self-reported prevalence of depression in a convenience sample of airline pilots in Saudi Arabia. Participants were recruited from various commercial airlines in Saudi Arabia. Recruitment efforts utilized targeted outreach on social media platforms, focusing on pilot forums and groups. The survey was administered online for accessibility and convenience. The structured questionnaire, developed through a literature review and expert consultation, comprises sections on demographic and professional characteristics, occupational information, health habits, and depression assessment via the Patient Health Questionnaire-9 (PHQ-9).
RESULTS: This study enrolled 310 participants, with the largest cohort (34.8%, n = 108) falling within the 30-39 years age group, closely followed by individuals under 30 years (30.0%, n = 93). Males dominated the sex distribution (99.0%, n = 307). The mean PHQ-9 score was 8.2 ± 5.4. Notably, 40.6% (n = 126) of the participants had a score of 10 or higher, indicating the potential for moderate, moderate-severe, or severe depression. Multivariable binary logistic regression analysis revealed that pilots with 11-15 years of experience had greater odds of experiencing depression than did those with 0-10 years of experience did (odds ratio [OR]: 3.0, 95% confidence interval [CI]: [1.1-8.4], p = 0.04). Pilots with rest times exceeding 24 h had lower odds of depression than did those with rest times less than 1 h (OR: 0.3, 95% CI: [0.1-0.8], p = 0.02). Engaging in regular exercise was associated with reduced odds of depression (OR: 0.3, 95% CI: [0.2-0.5], p < 0.01), as was longer sleep duration (> 8 h) (OR: 0.2, 95% CI: [0.1-1.0], p = 0.04).
CONCLUSIONS: Our study estimates the prevalence and severity of self-reported depressive symptoms among airline pilots in Saudi Arabia, surpassing global estimates. The identified factors, including lack of regular exercise, short sleep duration, and insufficient rest between flights, underscore the complex mental health challenges faced by pilots in this region. Addressing these issues is crucial not only for pilot well-being but also for flight safety.

OBJECTIVE: This study aims to investigate the relationship between midday nap time, nighttime sleep duration, and mild cognitive impairment (MCI) in Chinese older adults and determine the recommended sleep duration to provide a scientific basis for preventing and managing MCI in this population.
METHODS: Utilizing the 2020 China Health and Retirement Longitudinal Study database, the demographic data, health status, and lifestyle information of the study participants were collected. A total of 5,314 valid samples were included in the analysis. Logistic regression and restricted cubic spline plots were employed to explore the relationship between sleep patterns and MCI.
RESULTS: In the cross-sectional analysis, a linear relationship was observed between midday nap duration and MCI among Chinese elderly. The probability of MCI was lowest among those who napped for less than 30 min at noon. Compared with individuals who napped for30-90 min, those who did not nap were more likely to have MCI (OR = 1.30, 95% CI: 1.05-1.60). Older adults with napping duration < 30 min (OR = 0.73, 95% CI:0.56-0.95) also exhibited lower probability of MCI when compared those without napping habit, Nighttime sleep duration exhibited a U-shaped relationship with MCI. Individuals with less than approximately 6 h of nighttime sleep showed a gradual decrease in the probability of MCI with increasing sleep duration, whereas those with more than 7.5 h demonstrated an increase in the probability of MCI with longer sleep duration. Older adults who slept less than 6 h at night (OR = 1.22, 95% CI: 1.01 ~ 1.46) or more than 8 h (OR = 1.78, 95% CI: 1.35-2.33) were more likely to develop MCI compared with those who slept 6 to 8 h.
CONCLUSIONS: After controlling for potential confounding variables, both nighttime sleep duration and midday nap duration exhibited a nonlinear \"U\"-shaped relationship with MCI among the elderly. The probability of depression was lower with a nap duration of approximately 60 min, and the optimal nighttime sleep duration was 6-8 h, with around 7 h providing the greatest cognitive benefits.

BACKGROUND: The associations of sleep duration and depressive status on cognitive function among the elderly remain controversial. This study aimed to investigate the associative effects and mediating mechanisms between sleep duration and depressive status on cognitive function in elderly adults.
METHODS: Participants were recruited from cross-sectional and cohort surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We identified thresholds for sleep duration and depression and used logistic regression to explore their independent and joint effects on cognitive impairment. Further, we analyze the mediating effects of depressive status on the association between sleep duration and cognitive function.
RESULTS: Of 13840 elderly (median age: 84 years, female: 54.6 %), 2835 (20.5 %) had cognitive impairment. Compared with those who slept 6-8 h, the ORs (95%CIs) for those who slept < 6 h and > 8 h were 0.98 (0.85, 1.12) and 1.48 (1.32, 1.66). Compared with non-depressed, the OR (95%CI) for the depressed participants was 1.74 (1.53, 1.98). Compared with those with sleep 6-8 h and none-depression, those with sleep > 8 h and depression had the highest odds of cognitive impairment (OR = 2.40, 95%CI: 1.88-3.07). Additionally, Compared with those who slept 6-8 h, the associations between depression-mediated short and long sleep and cognitive impairment were 51.1 % and 6.5 %, respectively.
CONCLUSIONS: Cross-sectional studies require caution in the interpretation of causal associations.
CONCLUSIONS: Long sleep and depression were independently and jointly associated with higher odds of cognitive impairment among the Chinese elderly, and short sleep increased the risk of cognitive impairment by promoting the prevalence of depression.

OBJECTIVE: This study aimed to investigate the association between social jetlag (SJL) and obesity-related outcomes among adolescents from Valle de Ricote (Region of Murcia, Spain). We explored the relationship between SJL and body mass index (BMI) z-score, waist circumference, and body fat percentage, as well as the odds of having excess weight, obesity, and abdominal obesity in a sample of Spanish adolescents.
METHODS: A cross-sectional study was conducted using data from the Eating Healthy and Daily Life Activities (EHDLA) project, which included 847 Spanish adolescents aged 12-17 years. SJL was assessed based on the differences in sleep patterns between weekdays and weekends. Obesity-related indicators such as BMI z-score, waist circumference, body fat percentage, excess weight, obesity, and abdominal obesity were measured. Generalized linear models with a Gaussian or binomial distribution were used to analyze the associations between SJL and obesity-related outcomes, adjusting for potential confounders.
RESULTS: The analysis revealed significant associations between SJL and BMI z-score (unstandardized beta coefficient [B] = 0.15, 95% CI: 0.05 to 0.25, p = 0.003), waist circumference (B = 1.03, 95% CI: 0.39 to 1.67, p = 0.002), and body fat percentage (B = 0.83, 95% CI: 0.31 to 1.43, p = 0.008). Additionally, the odds ratios (ORs) for excess weight (OR = 1.35, 95% CI: 1.16 to 1.57; p < 0.001), obesity (OR = 1.59, 95% CI: 1.26 to 2.00; p < 0.001), and abdominal obesity (OR = 1.46, 95% CI: 1.23 to 1.72; p < 0.001) increased significantly with each 60 min increment in SJL.
CONCLUSIONS: This study pointed out that the misalignment of sleeping times during weekdays and weekends (SJL) is significantly associated with higher BMI z-scores, waist circumference, body fat percentage, and higher odds of excess weight, obesity, and abdominal obesity among adolescents, being more significant in boys than in girls. These findings highlight the importance of addressing circadian misalignment in the prevention and management of obesity and its related metabolic disorders in this population.

BACKGROUND: Studies have explored the connections between tobacco use, sleep and cardiovascular disease (CVD) risks in adults, but no study has examined the link between tobacco use and sleep among adults with CVDs. This study explores the association between tobacco use (cigarette only, e-cigarette only, and dual use) and poor sleep duration among adults with CVDs.
METHODS: A sample of 47,180 US adults with CVDs (myocardial infarction, coronary heart disease, or stroke) was drawn from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional survey. Poor/inadequate sleep (< 7 h/24-hour) was defined based on National Sleep Foundation recommendations. Logistic regression models assessed tobacco use status across seven categories (i.e., non-use [reference], current [past-month use] cigarette only, current e-cigarettes only, current dual use, former cigarette only, former e-cigarette only, and former dual use) with inadequate sleep, adjusting for demographics and health conditions.
RESULTS: Overall, 40% of US adults with a history of CVD reported inadequate sleep. Current cigarette, e-cigarette, and dual use were associated with a relatively higher proportion of inadequate sleep duration. Unweighted findings revealed a significant association between current cigarette use (OR = 1.35, 95%CI: 1.26-1.44), e-cigarette use (1.40 [1.19-1.63]) and dual use (1.50 [1.27-1.77]) and increased odds of reporting inadequate sleep among adults with CVDs. Weighted analysis showed only a significant link between current cigarette use and inadequate sleep (1.34 [1.17-1.54]).
CONCLUSIONS: Current cigarette use is associated with poor sleep in adults with CVDs. Unweighted findings suggested a similar association for e-cigarettes. Interventions targeting smoking cessation may offer promising avenues for improving sleep health and reducing the burden on adults with CVDs.