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  • 1.
    Andreasson, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden; Macquarie University, Australia.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    Bosch, Jos A.
    Balter, Leonie J. T.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    Poor sleep quality is associated with worse self-rated health in long sleep duration but not short sleep duration2021In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 88, p. 262-266Article in journal (Refereed)
    Abstract [en]

    Unhealthy sleep duration, either short or long, is associated with worse health and central subjective dimensions of sleep and health such as fatigue. It has been argued that the link between sleep duration and health may depend on the quality of the slept hours, and on its functional impact (ie, fatigue). The present study therefore assessed whether the relationship between last night's sleep duration and general self-rated health (SRH) differs as a function of sleep quality, and secondly, whether current fatigue and sleep quality are factors linking sleep duration and SRH. The present cross-sectional dataset involved 1304 individuals (57% female, M age = 28.8, range 18-79). Participants completed surveys for general SRH, previous night's sleep duration and sleep quality, and current fatigue. Results showed the expected inverted U-shaped (ie, quadratic) relation between last night's sleep duration and SRH and a linear relation between last night's sleep quality and SRH. However, long sleep duration was only associated with poorer SRH in individuals who also reported poor sleep quality. Further, the quadratic relationship between sleep duration and SRH was partially mediated by fatigue and sleep quality. The results of this multi-study analysis suggest that SRH is particularly poor in those who slept both long and with poor quality the night before, while good sleep quality may protect those with a long sleep duration from poor SRH. Thus, last night's long sleep does not seem to be associated with poor subjective health unless it is coupled with poor sleep quality. Furthermore, fatigue and sleep quality are potential pathways linking short and long sleep duration with SRH. Different dimensions of sleep interact in their association with health, and future research will benefit from an integrative approach. 

  • 2. Dahlgren, A.
    et al.
    Epstein, M.
    Söderström, M.
    Tucker, Philip
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Swansea University, United Kingdom.
    Nurses' strategies for managing sleep when starting shift work – implications for interventions targeting sleep behaviours in a shift work population2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Suppl. 1, article id e73Article in journal (Refereed)
    Abstract [en]

    Introduction: Shift work is related to short and disturbed sleep. Various aspects of a shift schedule will produce different opportunities and conditions for sleep depending on how they interact with circadian rhythms and the homeostatic drive for sleep. A third factor influencing sleep between shifts is the activation of the stress system. The aim of the current study was to examine sleep behaviours and strategies that nurses used when starting shift work and determine which sleep behaviours should be promoted when developing a programme for sleep interventions for newly graduated nurses.

    Material and methods: 11 (mean age 29.1±8) newly graduated nurses (3–12 months work experience) from different hospitals in Sweden were recruited for a semi-structured interview (approx. 45 min). Deductive content analysis was used to examine sleep strategies related to the homeostatic and circadian regulation of sleep, and to managing stress.

    Results: In relation to morning shifts (starting 6:45 h) most nurses perceived sleep as somewhat disturbed. Some had a strategy of undertaking activities that helped them unwind before bedtime, such as having a shower, watching TV, surfing the Internet or using relaxation techniques. One nurse had a strategy of getting up early in the morning before a morning shift in order to facilitate sleep in the evening, thereby enhancing the homeostatic drive for sleep. One nurse tried to keep her bed times constant despite irregular work hours in order to maintain a stable circadian rhythm.

    In relation to evening shifts, few experienced problems with sleep. Most had a lie-in before starting an evening shift and were being quite inactive before the shift started.

    Most nurses reported sleep problems when an evening shift was followed by a morning shift, i.e. a quick return, with many having problems unwinding and stopping thinking about work before bedtime. A few nurses described experiencing stress from knowing that their sleep would be short. Many had a strategy of undertaking other activities to unwind (see examples from morning shifts) before going to bed. A few went to bed straight away but described experiencing difficulties falling asleep. A few who reported no problems with sleep during quick returns said that they undertook activities that made them detach from work, with one regularly using a relaxation technique. The five nurses who worked night shifts had strategies of either sleeping in the evening before the nightshift, or staying up as long as possible the night before, thereby reducing the homeostatic drive for sleep during the shift.

    Conclusions: Newly graduated nurses would probably benefit from a sleep programme based on cognitive behavioural therapy techniques that are modified to fit shift workers. Behaviours and strategies that should be targeted are: routines and techniques for unwinding before bed time; sleep behaviours that promote building up enough homeostatic pressure for initiating sleep (e.g. not having long lie-ins before evening shifts that are followed by morning shifts); and sleep behaviours that promote a stable circadian rhythm.

  • 3.
    Gerhardsson, Andreas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Emotional working memory in older adults after total sleep deprivation2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Suppl. 1, p. e110-e110Article in journal (Refereed)
    Abstract [en]

    Introduction: Even though the occurrence of sleep problems increases with age, few studies have focused on the cognitive effects of acute sleep deprivation in elderly. Most previous research indicate that, compared to young, older adults show less impairment in e.g. attention after sleep deprivation. However, little is known of whether the same pattern holds for higher cognitive functions. In addition, while old age is usually related to a general decrease in working memory abilities, performance on working memory tasks may differ depending on the emotional valence of the stimuli, where positive stimuli seem to be beneficial for working memory performance in older adults. The aim of the present study was to investigate the effect of sleep deprivation on emotional working memory in older adults using two levels of working memory load.

    Materials and methods: A healthy sample of 48 old adults (MAge=66.69 years, SDAge=3.44 years) was randomized into a total sleep deprivation group (TSD; n=24) or a sleep control group (SC; n=24). They performed a working memory task (n-back) containing positive, negative and neutral pictures in a low (1-back) and a high (3-back) working memory load condition. Performance was measured as Accuracy (d'), Omissions and Reaction Time (RT).

    Results: For the d' and Omissions we performed two separate 2x2x3 (sleep, working memory load, valence) repeated measures analyses of variance (rmANOVA). For the RTs, we applied a mixed-effects model. For both d' and RT we found no effect of sleep deprivation (Ps > .05). For valence, we found main effects on both d' (F1,46 = 5.56, P=.005) and RT (F1,95.7 = 4.84, P=.01). d' did not differ for positive and neutral pictures, but was in both cases significantly better than for negative pictures. RTs were significantly faster for positive pictures. However, a working memory loadvalence interaction (F1,95.7 = 4.50, P=.01) further revealed an effect of valence in the low, but not in the high load condition. In the low load condition, RTs were faster for positive than for neutral pictures and faster for neutral than for negative pictures. There was no significant effect of Omissions.

    Conclusions: Our results showed that emotional working memory performance was not significantly affected by one night of sleep deprivation in older adults, which contrast what we found in a sample of young adults from the same project. In line with previous research, our results indicate a beneficial effect of positive stimuli on working memory in older adults. This effect was present in both groups and most pronounced for reaction times in the condition with a lower cognitive demand. We can conclude that, among older adults, the working memory performance is not impaired by sleep deprivation and that the benefits of positive stimuli on working memory seem intact. These findings contribute to a better understanding of older adults' cognitive functioning after sleep deprivation.

  • 4. Hedström, Anna Karin
    et al.
    Bellocco, Rino
    Hössjer, Ola
    Stockholm University, Faculty of Science, Department of Mathematics.
    Ye, Weimin
    Trolle Lagerros, Ylva
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    The relationship between nightmares, depression and suicide2021In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 77, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Objective: Previous studies investigating the association between nightmares and suicide have yielded different results. We aimed to investigate whether nightmares, directly or indirectly, influence the incidence of suicide.

    Methods: We used a prospective cohort study, based on 40,902 participants with a mean follow-up duration of 19.0 years. Cox proportional hazards models with attained age as time-scale were fitted to estimate hazard ratios (HR) of suicide with 95% confidence intervals (CI) as a function of the presence or absence of depression and nightmares. Mediation analysis was used to asses to what extent the relationship between nightmares and the incidence rate of suicide could be mediated by depression.

    Results: No association was observed between nightmares and the incidence of suicide among participants without depression. Compared with non-depressed participants without nightmares, the incidence of suicide among participants with a diagnosis of depression was similar among those with and without nightmares (HR 12.3, 95% CI 5.55-27.2 versus HR 13.2, 95% CI 7.25-24.1). The mediation analysis revealed no significant effects of nightmares on suicide incidence. However, the incidence of depression during follow-up was higher among those who suffered from nightmares than among those who did not (p < 0.001).

    Conclusions: Our findings indicate that nightmares have no influence on the incidence rate of suicide, but may reflect pre-existing depression. This is supported by a recent discovery of a strong genetic correlation of nightmares with depressive disorders, with no evidence that nightmares would predispose to psychiatric illness or psychological problems. Interventions targeting both depression and nightmares, when these conditions co-occur, may provide additional therapeutic benefit.

  • 5.
    Nordin, Maria
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Umeå University, Sweden.
    Nordin, Steven
    Sleep and sleepiness in environmental intolerances: a population based study2016In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 24, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: About one fourth of the general population report environmental intolerance (El) to odorous/pungent chemicals, certain buildings, electromagnetic fields (EMFs), and/or sounds. EI sufferers show various clinical features, of which sleep disturbance is one. Sleep disturbance is common also in the general population, but it is not known whether the disturbance is more prominent in EI sufferers than in individuals who do not experience EI. Therefore, El was compared on various sleep aspects with referents without El.

    Methods: A population-based sample of 3406 individuals, aged 18-79 years, was recruited from Northern Sweden. Sleep quality, non-restorative sleep, daytime sleepiness, obstructive breathing, and nocturnal insomnia were assessed with the Karolinska Sleep Questionnaire. Single questions assessed time slept, amount of hours of needed sleep, and extent of enough time slept.

    Results: All four EI groups, compared to the referents, reported significantly poorer sleep quality, more non-restorative sleep, more daytime sleepiness, more obstructive breathing and higher prevalence of nocturnal insomnia than the referents. Nocturnal insomnia was an important factor for El groups attributing their most prevalent symptoms to chemicals and sounds, irrespective of distress and certain syndromes. None of the EI groups differed significantly from the referents on time slept, but reported needing more sleep time (the EMF-intolerance group showing only a tendency), and all four groups reported to perceive enough sleep to a significantly lesser extent.

    Conclusion: Sleep disturbance and daytime sleepiness are more common in individuals reporting El compared to normal referents. Moreover, nocturnal insomnia is an important symptom in its own right in various types of EI. This evokes the question of whether or not sleep therapy may attenuate the severity of the El.

  • 6.
    Schwarz, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gerhardsson, Andreas
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Age-dependent effects of sleep deprivation on task performance and mind wandering2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Suppl. 1, article id e297Article in journal (Refereed)
    Abstract [en]

    Introduction: Mind wandering, the drift of attention from the current task at hand to self-generated thought is commonly associated with poorer performance, and could be a potential pathway through which sleep deprivation affects performance. Little is known about this, however. Therefore, the aim of the present study was to address the effect of sleep deprivation on mind wandering and performance in a sustained attention task. In addition, we studied age as moderating factor, since older individuals are generally less prone to mind wandering.

    Materials and methods: Healthy young (18-30years) and older (60-72years) subjects participated in either a normal night sleep (NSD) or a total sleep deprivation (SD) condition, i.e. 4 conditions: NSD (n=31), SD (n=30), NSDold (n = 24), SDold (n= 24). Performance was measured using the Sustained Attention to Response Task, during which 10 thought probes were included that prompted the subjects to answer a question on what they were you just thinking about, using predefined answer alternatives. Mind wandering was quantified as occurrence of task-unrelated thoughts.

    Results: Applying a 2 (age) X 2 (sleep deprivation) ANOVA, significant main effects for sleep deprivation and age were observed for omissions, indicating worse performance after sleep deprivation and in young participants (p's < .05). These main effects were dominated by an age*sleep deprivation interaction (p = .04), which was due to sleep deprivation causing significantly more omission errors in young subjects (Mean ±SEM; NSD: 2.3 ±0.9; SD: 13.1 ±4.1) but not in older subjects (NSDold: 1.9 ±0.4; SDold: 2.8 ±0.9).

    Likewise, main and interaction effects for age and sleep deprivation were significant for task-unrelated thoughts (p's < 0.01). Task unrelated thoughts were significantly more frequent after sleep loss in young (NSD: 1.5 ±0.2; SD: 4.3 ±0.6), but not older subjects (NSDold: 0.3 ±0.2; SDold: 0.5 ±0.2) (interaction age*sleep deprivation p < .01). Young subjects had significantly more task-unrelated thoughts than older, regardless of sleep condition.

    Task-unrelated thoughts correlated with errors of omission (r = 0.65, p < .001). Also, including task unrelated thoughts as covariate in the age * sleep deprivation ANOVA, main and interactions effect of age and sleep deprivation were no longer significant.

    Reaction time was significantly slower in older adults, but no main or interaction effect of sleep deprivation occurred. Errors of commission were not affected by condition.

    Conclusions: The results show that sleep deprivation caused both mind wandering and poorer task performance in young but not older participants. In addition, mind wandering rates correlated with errors of omission, which may indicate that a diminished ability to shut down off-task thoughts after sleep deprivation could be an important pathway to performance decrements after sleep loss. In line with previous research, mind wandering appears to occur less frequently in older individuals compared with younger. This lower occurrence of mind wandering in older subjects may potentially enable them to better maintain performance after sleep deprivation and partially explain the higher resilience of older adults to sleep deprivation.

  • 7.
    Sindi, Shireen
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; Imperial College London, United Kingdom.
    Johansson, Lena
    Skoog, Johan
    Mattsson, Alexander Darin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Sjöberg, Linnea
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; Stockholm Gerontology Research Center, Sweden.
    Kulmala, Jenni
    Soininen, Hilkka
    Solomon, Alina
    Johansson, Boo
    Skoog, Ingmar
    Kivipelto, Miia
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Sleep disturbances and later cognitive status: a multi-centre study2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 52, p. 26-33Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the associations between sleep disturbances in mid-life and late-life and late-life cognitive status. Methods: In four population-based studies (three Swedish studies: H70 study, Kungsholmen Project (KP) and The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD); and one Finnish study: Cardiovascular Risk Factors, Aging and Dementia (CAIDE)), participants provided self-reports on insomnia, nightmares and general sleep problems. Late-life cognitive status was measured by the Mini Mental State Exam (MMSE). The associations between late-life sleep disturbances and cognition 3-11 years later were investigated across all studies (n = 3210). Mean baseline ages were 70 (CAIDE, H70 and SWEOLD), and 84 years (KP). Additional analyses examined the association between midlife sleep and late-life cognition using CAIDE (21 and 31 years follow-up, n = 1306, mean age 50 years), and SWEOLD (20-24 years follow-up, n = 2068, mean age 58 years). Ordered logistic regressions, adjusted for potential baseline confounders, were used in the analyses. Results: Late-life sleep disturbances were associated with poorer cognition after 3-11 years (fully adjusted beta = -0.12, 95% CI = -0.24 to -0.01). Midlife nightmares and insomnia were also associated with lower MMSE scores (fully adjusted beta = -0.28, 95% CI = -0.49 to -0.07 and beta = -0.20, 95% CI = -0.39 to -0.01), although the latter association was attenuated after adjusting for lifestyle/health-related confounders. Midlife general sleep problems were not associated with late-life MMSE performance. Conclusions: Sleep disturbances and midlife nightmares were associated with lower MMSE scores, which suggests that sleep disturbances in earlier life stages can be associated with worse late-life cognition.

  • 8. Teixeira, Liliane
    et al.
    Lowden, Arne
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    da Luz, Andréa Aparecida
    Turte, Samantha Lemos
    Moreno, Claudia Roberta
    Valente, Daniel
    Nagai-Manelli, Roberta
    Louzada, Fernando Mazzilli
    Fischer, Frida Marina
    Exposure to bright light during evening class hours increases alertness among working college students2013In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 14, no 1, p. 91-97Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of exposure to bright light on sleepiness during evening hours among college students. METHODS: Twenty-seven healthy college students, all males, with ages ranging from 21 to 24years, working during the day and studying in the evening, participated in this study. During the 3week study, the students wore actigraphs and recorded levels of sleepiness. In a crossover design, on the second and third weeks, the students were exposed to bright light (BL) at either 19:00 or 21:00h. Salivary melatonin samples were collected before and after BL exposure. ANOVA test for repeated measurements were performed. RESULTS: After BL exposure, sleepiness levels were reduced at 20:30 and 22:00h (F=2.2; p<0.05). ANOVA showed statistical differences between time (F=4.84; p=0.04) and between day and time of BL exposure (F=4.24; p=0.05). The results showed effects of melatonin onset at 20:00 and 21:30h and sleepiness levels (F=7.67; p=0.02) and perception of sleepiness and intervention time (F=6.52; p=0.01). CONCLUSION: Controlled exposure to BL during evening hours increased alertness among college students. The effects of BL on sleepiness varied according to the time of melatonin onset.

  • 9.
    Tucker, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Swansea University, United Kingdom.
    Härmä, M.
    Ojajärvi, A.
    Kivimäki, M.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, J:
    Shiftwork and the use of prescription medication for sleep, anxiety and depression: a prospective cohort study2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Suppl. 1, article id e330Article in journal (Refereed)
    Abstract [en]

    Introduction: There is only limited evidence to date linking shiftwork with clinical levels of sleep disturbance and mental health problems. Few studies have examined redeemed drug prescriptions using register data, which is the focus of this study.

    Materials and methods: Data were obtained from three waves of the Finnish Public Sector Study (2000, 2004, 2008. 66-68% response rate). Participants were from two cohorts; local government employees in 10 towns–a mixture of healthcare workers and employees from other occupational sectors ('10 Towns Cohort'); and employees of 21 hospitals ('Hospitals Cohort'). The overall sample was N=53,275 (mean age 43.6 (SD=9.8), range 18-69), with approximately 73% coming from the 10 Towns Cohort. Women made up 82% of the entire sample. Responses to surveys were linked to records on redeemed prescriptions (until December 2011).

    Data from the two cohorts were analysed separately to examine the associations between work schedule and drug purchase. Cox regressions were used to predict time to first incident use of:

    1. Hypnotics & Sedatives; and

    2. Anxiolytics & Antidepressants. We separately compared 2- and 3-shift workers (i.e. rotating shifts either without, or with, nights) with dayworkers, matched for occupational group.

    Each analysis was stratified by age (< = 39 years, 40-49 years and >= 50 years). HRs were calculated with adjustments for age, sex, socioeconomic status and marital status (Model 1); and with additional adjustments for alcohol consumption (Model 2). Participants were excluded if they had any recorded purchase of the drug in question prior to follow-up, or if they reported previous diagnosis of depression or other mental disease.

    Results: There were fewer significant associations in the Hospitals Cohort than in the 10 Towns Cohort. The 10 Towns Cohort showed significant positive associations between 3-shift work and the use of both categories of medication; with the exception of Anxiolytic & Antidepressant use among the middle-age group. Among the 2-shift workers, the only significant associations were with the use of Anxiolytics & Antidepressants in the lower- and upper-age groups. In the Hospitals Cohort, the majority of associations were either non-significant or negative (i.e. indicative of a protective effect). The main exception was positive associations between 3-shift work and use of Hypnotics & Sedatives among the upper-age group.

    Conclusions: The finding of greater use of hypnotics and sedatives by rotating nightshift workers adds to the limited evidence to date linking night with clinical levels of sleep disturbance. The finding of greater use of anxiolytics and antidepressants by some groups of shiftworkers provides limited evidence of a link between shiftwork and mental health problems.

    Sensitivity analyses indicated that the disparity between cohorts was neither due to the presence of non-healthcare workers in the 10 Towns Cohort, nor to the presence of former shiftworkers in the control sample of the Hospital Cohort. Other possible explanations are that: the cohorts differ with respect to type of shift schedule e.g. the intensity of nightwork; shiftworkers in the Hospital Cohort may be more selected as it may be easier for them to transfer to daywork.

  • 10. Westerlund, Anna
    et al.
    Bottai, Matteo
    Adami, Hans-Olov
    Bellocco, Rino
    Nyrén, Olof
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Lagerros, Ylva Trolle
    Habitual sleep patterns and the distribution of body mass index: cross-sectional findings among Swedish men and women.2014In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 15, no 10, p. 1196-1203Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare distributions of body mass index (BMI) between individuals with different habitual sleep patterns.

    METHODS: We performed cross-sectional analyses of 40,197 Swedish adults (64% women), who reported sleep duration and quality, weight, height, and possible confounding factors in 1997. Using quantile regression, we estimated associations between sleep patterns and selected percentiles of the distribution of BMI.

    RESULTS: While the medians were similar, larger adjusted values of BMI were estimated in the upper part of the distribution among men and women with short sleep (≤5 h) compared with medium-length sleep (6-8 h). For example, in men, the 90th percentile of BMI was 0.80 kg/m(2) (95% confidence interval: 0.17-1.43 kg/m(2)) higher among short sleepers. In women, long sleepers (≥9 h) also showed larger values in the upper part of the BMI distribution; the 90th percentile was 1.23 kg/m(2) (0.42-2.04 kg/m(2)) higher than in medium-length sleepers. In male long sleepers, smaller values were estimated in the lower part of the BMI distribution; the 10th percentile was 0.84 kg/m(2) lower (0.35-1.32 kg/m(2)) than in medium-length sleepers. The 90th percentile of BMI in women with poor-quality compared with good-quality sleep was larger by 0.82 kg/m(2) (0.47-1.16 kg/m(2)); the 10th percentile was smaller by 0.17 kg/m(2) (0.02-0.32 kg/m(2)).

    CONCLUSIONS: Short, long or poor-quality sleepers showed larger, or smaller, values at the tails of the BMI distribution, but similar medians. Hence, unfavorable sleep patterns and BMI were associated only in a subset of this study population.

  • 11.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    Narusyte, Jurgita
    Svedberg, Pia
    Sleep duration and mortality - Influence of age and occupational group in retired individuals2021In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 80, p. 199-203Article in journal (Refereed)
    Abstract [en]

    The importance of sleep duration for health or mortality attracts much public attention. Prior work indicates that both long and short sleep duration predicts mortality, with optimal sleep duration (lowest risk) at 7 h. However, we believe this may differ between subgroups. This may be the case with, for example, age groups (due to aging), or blue-collar and white-collar worker (due to work exposure). It is also likely that retirement, which permits extension of the time in bed, may confound analyses. The purpose of the present study was to investigate how occupational group (blue-collar/white-collar worker) and age influence the pattern of association between sleep duration and mortality in retired individuals. Retired individuals were selected since it was hypothesized that effects of occupation may accumulate over years and since the transition into retirement may be a confounder. We used a sample of 14 000 individuals from the Swedish Twin Registry, which had provided data on sleep duration and a number of covariates. Cox proportional hazards analysis was applied to data. The results show that occupational group did not influence the association, but showed significant hazard ratios (HR) for long (>= 9.5 h) and short (<6.5 h) sleep in both groups (HR > 1.35), with optimal sleep duration (lowest HR) with a wide span (6.5-9.5 h). Age groups in tertiles also showed significant U-shapes, with a wide span (6.5-9.5 h) for the younger 2/3 (54-74 years), but a weaker pattern for the oldest third (>= 75 years), for which optimal sleep fell in the 6.5-7.5 h interval. It was concluded that occupational group does not influence the association between sleep duration and mortality in retired individuals, but that age does.

  • 12.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Nordin, Maria
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Umeå University, Sweden.
    Alfredsson, Lars
    Westerholm, Peter
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Predicting changes in sleep complaints from baseline values and changes in work demands, work control, and work preoccupation - The WOLF-project2012In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 13, no 1, p. 73-80Article in journal (Refereed)
    Abstract [en]

    Study objective: Stress as a cause of disturbed sleep is often taken for granted, but the longitudinal evidence is limited. The aim of this study was to evaluate new cases of poor sleep as a function of changes in reported work demands, work control, and work preoccupation. Methods: Longitudinal study of change with measures occurring twice within a 5-year interval during a period when the prevalence of impaired sleep was increasing in Sweden. The sample of companies was taken from northern Sweden (Norrland) and included 3637 individuals from the "WOLF Norrland" longitudinal cohort, collected through company health services. Measurement and results: During the measurement period, 16% of those studied developed new cases of impaired sleep. Logistic regressions adjusted for demographics, work environment factors, and disturbed sleep at T1 period one showed a significant increase in new cases for high work demands and high work preoccupation (OR = 1.37; Ci = 1.09-1.72 and OR = 1.80; CI = 1.42-2.28, respectively). The analysis of change in the predictors showed effects of a change from low to high work demands (OR = 1.39; Ci = 1.00-1.95) on new cases of impaired sleep. Consistent high work demands (high at both points) showed a similar increase (OR = 1.49; Ci = 1.06-2.11) but no effect was seen for reduced demands. Change in work preoccupation yielded stronger effects with OR = 2.47 (1.78-2.47) for increased work preoccupation and OR = 3.79 (2.70-5.31) for consistent high work preoccupation. Also, a reduction in work preoccupation was associated with a reduction in new cases of disturbed sleep. Control at work was not related to sleep. Stratification with respect to gender mainly led to fewer significant results (particularly for women) due to larger confidence intervals. Conclusions: It was concluded that self-reported work preoccupation predicts subsequent impairment of sleep and that increased preoccupation is associated with new cases of impaired sleep. Similar, but weaker, results were obtained for work demands.

  • 13.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Orsini, Nicola
    Petersen, Helena
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Axelsson, John
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Predicting sleep quality from stress and prior sleep - a study of day-to-day covariation across six weeks2012In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 13, no 6, p. 674-679Article in journal (Refereed)
    Abstract [en]

    Background/objectives: The connection between stress and sleep is well established in cross-sectional questionnaire studies and in a few prospective studies. Here, the intention was to study the link between stress and sleep on a day-to-day basis across 42 days.

    Methods: Fifty participants kept a sleep/wake diary across 42 days and responded to daily questions on sleep and stress. The results were analyzed with a mixed model approach using stress during the prior day to predict morning ratings of sleep quality.

    Results: The results showed that bedtime stress and worries were the main predictors of sleep quality, but that, also, late awakening, short prior sleep, high quality of prior sleep, and good health the prior day predicted higher sleep quality.

    Conclusions: Stress during the day predicts subsequent sleep quality on a day-to-day basis across 42 days. The observed range of variation in stress/worries was modest, which is why it is suggested that the present data underestimates the impact of stress on subsequent sleep quality.

  • 14.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institute, Sweden.
    Schwarz, Johanna F. A.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institute, Sweden.
    Theorell-Haglöw, Jenny
    Lindberg, Eva
    What do women mean by poor sleep?: A large population-based sample with polysomnographical indicators, inflammation, fatigue, depression, and anxiety2023In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 109, p. 219-225Article in journal (Refereed)
    Abstract [en]

    Survey studies indicate that reports of disturbed sleep are prevalent and may be prospectively linked to several major diseases. However, it is not clear what self-reported disturbed sleep represents, since the link with objective sleep measures (polysomnography; PSG) seems very weak. The purpose of the present study was to try to investigate what combination of variables (PSG, inflammation, fatigue, anxiety, depression) that would characterize those who complain of disturbed sleep. This has never been done before. Participants were 319 women in a population-based sample, who gave ratings of sleep quality, fatigue, depression, and anxiety, then had their sleep recorded at home, and had blood drawn the following morning for analysis of immune parameters. Correlations and hierarchical multivariable regression analyses were applied to the data. For ratings of difficulties initiating sleep, the associations in the final step were ß = .22, (p < .001) for fatigue, ß = 0.22 (p < .001) for anxiety, and ß = 0.17 (p < .01) for sleep latency, with R2 = 0.14. The rating of repeated awakenings was associated with fatigue (ß = 0.35, p < .001) and C-reactive protein (CRP) (ß = 0.12, p < .05), with R2 = 0.19. The rating of early morning awakenings was associated with fatigue (ß = 0.31, p < .001), total sleep time (TST) (ß = −0.20, p < .01), and CRP (ß = 0.15, p < .05), with R2 = 0.17. Interleukin-6 and Tumour Necrosis Factor were not associated with ratings of sleep problems. The results indicate that subjective fatigue, rather than objective sleep variables, is central in the perception of poor sleep, together with CRP.

  • 15.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Gruber, Georg
    Theorell-Haglöw, Jenny
    Lindberg, Eva
    Women with both sleep problems and snoring show objective impairment of sleep2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 51, p. 80-84Article in journal (Refereed)
    Abstract [en]

    Objective: Combined insomnia and obstructive sleep apnea has been the focus of considerable research with respect to its health effects. A related issue is whether sleep disturbances in combination with snoring might exert effects on objective sleep variables in the non-clinical general population. The purpose of the present study was to investigate the polysomnographical characteristics of individuals who had sought medical help for both disturbed sleep and for snoring. No previous work of this type has been carried out. Method: For this study we used a representative set of data of 384 women with one night of in-home PSG. We identified those individuals who had sought medical help for sleep problems (SL), individuals that had sought help for snoring (SN), as well as those that had sought help for either both (Combined), or for neither (Control). Results: Our results yielded an N of 46, 16, 21, and 301 individuals, respectively. A one-factor analysis of variance showed significant main effects on N1% (F = 10.2, p < 0.001), N3% (F = 2.7, p < 0.05), AHI/h (F = 5.5, p < 0.001), and a delta power measure (F = 3.8, p < 0.05). The combined group showed significantly higher levels than the other groups for N1% (29% vs < 21%), AHI/h (19/h vs < 10/h) and lower levels for N3%, and a measure of delta power. Reported sleep quality measures did not show the same pattern, since the highest/lowest value were found for either the group presenting snoring alone or sleep problems alone. Conclusion: We concluded that individuals who had sought help for both insomnia and snoring showed impaired sleep in terms of PSG and that this was not reflected in ratings of sleep or health. This suggests that simultaneous sleep disturbances and snoring may potentiate each other to cause impaired sleep, yet the mechanism still needs to be elucidated.

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