OBJECTIVES Parental mental health is linked to infant sleep, but research has focused mainly on mothers and on single distress dimensions. This study examined whether parental anxiety, depression, and sleep quality are associated with infant sleep across the first year, and whether mothers and fathers contribute differently. METHOD Two independent cohorts of Taiwanese families (42 and 80 infants; 107 and 270 observations) were followed across the first year, assessed at 1-6 months (Cohort 1) and 1-12 months (Cohort 2). At each assessment, both parents completed the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index, and infant sleep was assessed by a sleep diary and the Brief Infant Sleep Questionnaire. Linear mixed-effects models with standardized predictors treated one cohort as discovery and the second as replication. RESULTS Poorer maternal sleep quality was associated with more parent-perceived night awakenings in both cohorts (b = 0.28 and 0.48), the only association that replicated. In the larger cohort, poorer maternal sleep quality was also associated with shorter nighttime sleep. Parental anxiety, depression, and paternal sleep quality showed no consistent associations. CONCLUSIONS Maternal sleep quality was the most robust parental correlate of infant sleep, most evident for perceived night awakenings. Extending a literature that has centered on maternal mood, these findings point to maternal sleep quality as a distinct correlate; in perinatal care, brief screening of maternal sleep quality may help flag families who could benefit from sleep-focused guidance or referral.
STUDY OBJECTIVES:This study explored the preliminary effects of the quarter-of-an-hour-rule (QHR), a single instructional element of stimulus control therapy (SCT) for insomnia. METHODS:A total of 44 adults (n = 30, 68% female; mean age 47.4 ± 13.3 years), recruited in primary care and meeting diagnostic criteria for chronic insomnia, were randomized to QHR implemented either out of bed [QHR(Out)], in bed [QHR(In)], or to a self-monitoring control group (SMC). Intervention was delivered by a single in-person session, with telephone support (total time c.60 minutes). Sleep pattern was assessed throughout the study by sleep diary and 2 nights of home-based polysomnography (PSG) at pre- and post-treatment. Sleep quality was appraised using the Pittsburgh Sleep Quality Index (PSQI). Treatment adherence (self-reported and actigraphy-estimated) and treatment credibility data were collected. RESULTS:Significant group-time interaction effects confirmed that QHR(Out) and QHR(In) were associated with reductions in self-reported sleep-onset latency (SOL) and wake-time after sleep-onset (WASO), and improvements in sleep efficiency (SE), relative to no change in SMC. PSG-defined sleep outcomes did not improve. However, subjective-objective sleep discrepancy (SOSD) in the index measure, SE, reduced following both interventions. The interventions were regarded as credible, and overall, SE improvement was c.14% following treatment. Subjective adherence was higher than objectively estimated, although the differential was smaller in the QHR(In) group. CONCLUSIONS:The QHR, a simple and brief derivative of SCT, appears efficacious for insomnia on pre-post analysis. Longer-term clinical effectiveness studies on the QHR(Out) and QHR(In) protocols appear warranted. Experimental investigation of how the QHR addresses the fundamentals of sleep-related stimulus control would be valuable. TRIAL REGISTRATION:NCT00170391, https://clinicaltrials.gov/study/NCT00170391.
OBJECTIVES:African Americans experience health disparities and notably report poorer sleep than their non-Hispanic White counterparts. This study aimed to identify behavioral and physiological contributors of self-reported poor sleep among African Americans. METHOD:Eighty African Americans (50.1 ± 16.1 years [mean ± SD], 69 women) who reported poor sleep (<7 hr sleep/night, difficulty falling asleep or staying asleep, unrefreshing sleep, etc.) were enrolled. Sleep patterns were determined by 7-day accelerometry. Pittsburgh Sleep Quality Index (PSQI), Sleep Hygiene Index, Epworth Sleepiness Scale, and the Insomnia Severity Index (ISI) assessed sleep habits and disorders. Multidimensional Fatigue Inventory, Perceived Stress Scale, and Beck's Depression Inventory were also administered. RESULTS:Participants self-reported poor sleep quality (PSQI, 9.63 ± 3.89) and insomnia symptoms (ISI, 14.4 ± 5.9); 45% of participants had clinically significant insomnia symptoms (ISI score > 15). Short sleep duration was common, with 72.5% of participants sleeping less than 6.5 hours/night. Sleep continuity was lacking (wake after sleep onset: 54.1 ± 30.4 minutes; sleep fragmentation index 29.0 ± 9.9%). High ISI scores were correlated with larger body mass index and worse scores for sleep quality, sleep hygiene, stress, daytime sleepiness, fatigue, and depression (r range: 0.25-0.60). CONCLUSIONS:Insomnia symptoms were common among our cohort of African Americans. Considering the relationships observed with ISI, treatment of insomnia may be targeted to reduce health disparities.
