[This corrects the article DOI: 10.1016/j.bbih.2026.101169.].

OBJECTIVE:Poor self-reported sleep is common in rheumatoid arthritis (RA), but studies using objective sleep measures are rare. We report the prevalence of objectively measured sleep characteristics in individuals with RA and their association with clinical measures of RA disease activity. METHODS:Data were from a longitudinal study with four measurement periods at 6-month intervals. Sleep data were collected by actigraphy over 7 days at each period. Primary actigraphy sleep variables were sleep efficiency (SE; time asleep/time in bed), time awake after sleep onset (WASO), and total sleep time. At baseline, WatchPAT devices were also used for two nights to assess presence of sleep-disordered breathing (SDB; primarily obstructive sleep apnea (OSA) indicated by the apnea-hypopnea index [AHI]). Disease activity measures (Clinical Disease Activity Index [CDAI], Disease Activity Score [DAS] 28 joints, DAS C-reactive protein [CRP], and DAS erythrocyte sedimentation rate) were completed by rheumatologists before each sleep-monitoring period. Prevalence of sleep problems was estimated, and associations of sleep characteristics with RA disease activity were analyzed with regression models. RESULTS:Of 133 individuals enrolled, 116 had sufficient actigraph wear time for scoring at baseline, and 63 completed WatchPAT monitoring. More than 40% of the cohort had poor SE (<85%) at all measurement periods completed. More than half with WatchPAT assessments had moderate to severe OSA (AHI ≥ 15). Lower SE and higher WASO were associated with greater disease activity across all measures. AHI was associated with CDAI and DAS-CRP. CONCLUSION:Objectively measured sleep problems were frequent and associated with RA disease activity. Given high rates of sleep disorders and their significant negative health effects, greater attention to sleep disorders among individuals with RA is warranted.

OBJECTIVE:Racial sleep disparities may lead to long-term cognitive health consequences, with a specific impact on memory formation and maintenance. Few studies have examined the physiological sleep features, including non-rapid eye movement (NREM) Stage 2 and 3 sleep and the corresponding electroencephalographic activity indicative of these stages (i.e., delta oscillations 0.5-4Hz), that are sensitive to racial stress and result in memory vulnerability, which is the goal of this investigation. METHODS:We assessed self-report and polysomnographic indices of sleep, psychosocial outcomes, and memory performance in a sample of young, Black (n=63) and White (n=77) adults living in the U.S. RESULTS:Black participants self-reported more experiences of discrimination, lower incomes, perceived social status, and educational attainment, as well as worse subjective sleep quality. Racial group membership was associated with differential pre-sleep memory profiles for both neutral and negatively-valenced word pairs; however, memory disparities were attenuated after accounting for sociodemographic and psychosocial factors. Overnight sleep architectural differences emerged, with Black participants spending more time in Stage 2 sleep, less time in Stage 3 sleep, and having reduced NREM delta power when compared to White participants. NREM delta activity was a significant mediator of racial group membership and post-sleep memory performance, especially for negative valenced word pairs. CONCLUSION:These findings suggest that known racial sleep disparities likely lead to daily, measurable deficits in memory for Black Americans and that NREM delta activity may be a uniquely sensitive biopsychosocial factor that can support cognitive resilience for those experiencing racialized contexts.

Sleep gets worse with age and is correlated with risk for disease and mortality. The possibility that poor sleep causes aging to accelerate has prompted interest in improving sleep to slow aging and prevent disease. However, the existing evidence on the link between poor sleep and accelerated aging is unclear. Here, we tested for correlation and causation between poor sleep and accelerated aging using five independent datasets of adults (total N > 64,000). We found strong evidence for a correlation between poor sleep and fast aging that is consistent across young, middle, and late adulthood and across aging biomarkers derived from different tissues and modalities. We found that this correlation is robust to the influence of chronic disease burden, but not to the influence of shared genetic and early environmental factors among twins. Finally, we found mixed evidence for a causal influence of poor sleep on accelerated aging using Mendelian randomization. Our findings indicate that the correlation between poor sleep and accelerated aging is highly robust; however, the claim that poor sleep causes aging to accelerate is not consistently supported.

The purpose of this exploratory analysis is to identify pathways common to both DNA methylation and gene expression linked to high perceived stress and evaluate protein-protein interactions of the genes in these pathways. To do this, we selected a sample of premenopausal healthy women stratified for being high (n=31) and low stress (n=32) from a large study who had available biospecimens. We used two meta-analysis approaches (strict and inclusive) to identify the pathways supported across the molecular data types, both methylation and gene expression. To delineate potential interactions among the pathways and functional roles of genes linked to the high stress group through epigenomic and transcriptomic analyses, we assessed protein-protein interaction (PPI) network connectivity utilizing the Search Tool for the Retrieval of Interacting Genes (STRING). We identified 17 KEGG pathways that were significant (p-value < 0.05) and are implicated in immune response and inflammation, cellular transduction and structure, neurotransmission, and disease. The PPI network exhibits significant interconnectedness among genes, with many gene members of multiple pathways, indicating direct interactions among these pathways. Our findings help target novel stress-related biological pathways for monitoring - for timely intervention, prevention, and tailored treatment approaches. Further replicative studies in wider, diverse populations are necessary to validate the observed functional network pathways and to quantify the specificity of these pathways for duration or magnitude of perceived psychological stress.

Abstract Emerging evidence suggests that adults with a history of early life adversity (ELA), while more susceptible to psychopathology, may also be particularly sensitive to the benefits of contemplative practices. In the present study, we examined whether ELA was associated with greater mental health benefits following a contemplative-based social resilience training program, administered as a university elective course across all ten campuses of the University of California ( n = 321; median age = 21 years; 74% female). While significant improvements in mental health were observed for all participants, those with higher ELA exhibited greater reductions in mental distress (3.5-fold larger, p = .007) and greater increases in well-being (2.5-fold larger, p = .010) relative to those with lower ELA. Replication in future studies and further research on the mechanisms underlying this enhanced benefit may improve our understanding of how adults with a history of ELA recover and may ultimately thrive.

Poor sleep and pain are common in rheumatoid arthritis (RA). This study sought to understand the temporal relationships between multidimensional sleep and pain in daily life among individuals with RA. Participants with RA completed up to four waves of 7-day daily diary and sleep actigraphy spanning two years (n=117, Mean age=58.05 years, 87% female). A sleep health composite captured regularity, satisfaction, alertness, timing, efficiency, and duration. Both individual sleep dimensions and the composite were examined. Average daily pain severity, night pain, morning pain, and morning joint stiffness were assessed. Adjusted models controlled for sociodemographic characteristics, depression, anxiety, fatigue, and frequency of pain medication use in linear mixed-effects models. After adjusting for multiple comparisons, at the between-person level, the sleep health composite was not associated with pain or joint stiffness outcomes. Participants with shorter nap duration reported less night pain, and participants with higher sleep efficiency reported less daily pain, night pain, morning pain, and joint stiffness. At the daily level, better sleep health the previous night was associated with less night pain and less morning pain the following day. Nights with better sleep quality, higher sleep efficiency, and longer sleep duration were associated with less pain and joint stiffness the next day. Conversely, less night pain was associated with better sleep health the following night. In sum, night pain shares a bidirectional relationship with the sleep health composite, and notably, sleep quality and efficiency influence pain in daily life. PERSPECTIVE: Among adults with RA, there is bidirectionality between better sleep health and less night pain in daily life. Notably, sleep quality, nap duration, efficiency, and duration are associated with pain in adults with rheumatoid arthritis.

Loneliness is a psychologically aversive experience with links to well-being and health; yet its role in shaping neutralizing antibody responses, reported side effects, and affective experiences (e.g., stress, negative and positive mood) following COVID-19 vaccination remains unclear. In this preregistered study (n = 514; 9,226 daily observations), we examined whether loneliness predicted antibody response, side effects, and negative affective reactions post-vaccination. Participants completed baseline assessments of loneliness, demographics, and health factors. After each vaccine dose, they reported daily side effects and affect for five days. Blood samples were collected one and six months after the final vaccine dose to assess SARS-CoV-2 neutralizing antibody (nAB) responses. Neither baseline nor daily mean loneliness levels were associated with the nAB response. Daily loneliness consistently predicted more adverse subjective experiences (e.g., elevated stress and negative mood, and lower positive mood) and more reported side effects following vaccination, with baseline loneliness held constant. These findings underscore how loneliness may shape post-vaccination experiences, highlighting the importance of perceived social disconnection in health-related outcomes.

OBJECTIVE:Observing a loved one undergo a stressful experience can be a stressor in and of itself. However, the extent to which an observer can experience or "catch" another person's stress may depend on the observer's available resources. Here, we test how personal resources shape empathic stress by examining the impact of sleep deprivation on people's biopsychosocial responses while observing a romantic partner undergo a stressful experience. METHODS:In the lab (Nfinal=136 individuals, 68 couples), one partner underwent the Trier Social Stress Test (TSST) while the other partner observed. Prior to the lab visit, half of observers were randomly assigned to undergo partial sleep deprivation for two nights. During the TSST, we assessed observers' and speakers' subjective stress, non-verbal behavior, and physiological reactivity (cortisol and autonomic nervous system reactivity). We then examined the extent to which observers showed stress reactivity during their partner's TSST (i.e., vicarious stress) and the extent to which observers' stress reactivity covaried with speakers' stress reactivity (i.e., stress contagion). RESULTS:Observers showed a vicarious stress response across self-report and physiological measures, but there was little evidence of stress contagion. That is, although watching one's partner undergo a stressor was associated with increased affective and physiological reactivity, those responses did not consistently align with their partners' responses. Sleep deprivation did not affect empathic stress. CONCLUSIONS:Overall, these results show robust, multi-measure evidence of a vicarious stress response for observers that was unaffected by two nights of partial sleep deprivation.

Sleep disturbance is highly common in Long COVID (LC), and is known to worsen infection outcomes and hinder full recovery from infections. We here investigated whether sleep disturbance prior to SARS-CoV-2 infection compromised inflammatory responses in LC. Blood of 74 participants from the National Institute of Health RECOVER Adult clinical cohort were analyzed at the 6-month time point following the infection. Participants were categorized into groups of Likely, Possible, and No LC based on the Long COVID Research Index. Findings show that Likely LC did not differ from Possible or No LC with respect to interferon-gamma expression in CD4 and CD8 T cells stimulated with omicron spike-peptide variants, the expression of inflammatory mediators by monocytes (IL-6, TNF, COX-2), the ability of glucocorticoids (GC) to suppress inflammatory expression in monocytes, or levels of inflammatory pro-resolving mediators (SPMs). 53% of the Likely LC group reported pre-existing sleep disturbance, compared to 30 and 23% of Possible and No LC groups, respectively. In the Likely LC group, reduced ability of GCs to suppress inflammation was associated pre-existing sleep disturbance, suggesting compromised anti-inflammatory control. Research on the type of sleep disturbance (insomnia, hypersomnia) driving altered GC sensitivity will help to identify LC subtype-specific intervention targets.

Background Cognitive behavioral therapy (CBT) is recommended as the first-line treatment for insomnia; however, few patients have access to it. A new class of Food and Drug Administration (FDA)–regulated digital CBT treatments has the potential to address this unmet need. These treatments are ordered or prescribed by health care providers and are fully automated, delivering CBT directly to patients without human coaches. This trial builds upon promising earlier digital cognitive behavioral therapy for insomnia (CBT-I) research by using a decentralized design to recruit a sample with greater representation of the US general population, including individuals from lower socioeconomic status groups who often face greater barriers to care. Objective This decentralized trial evaluated the effectiveness of a fully automated digital CBT-I program (SleepioRx) for treating insomnia disorder compared with online sleep hygiene education (SHE) in a sample of participants recruited from across the United States. Methods A decentralized, parallel-group randomized controlled trial was conducted between November 2022 and August 2023. Participants were recruited nationally from across the United States, and a total of 336 adults aged 22 and older, diagnosed with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) insomnia disorder via structured clinical interview, were allocated 1:1 to either digital CBT-I (SleepioRx) or online SHE. The primary end points were insomnia severity, assessed using the Insomnia Severity Index (ISI), and sleep diary measures of sleep onset latency (SOL) and wake after sleep onset (WASO) at 10 weeks, with follow-up assessments at 16 and 24 weeks postrandomization. Results Compared with SHE, SleepioRx showed statistically and clinically significant improvements on the ISI at posttreatment (10 weeks; Cohen d=0.60, P<.001), with effects sustained at follow-up (16 weeks; d=0.65, P<.001; and 24 weeks, d=0.77, P<.001). SleepioRx led to significant reductions in WASO at all time points (10 weeks, P=.003; 16 and 24 weeks, P<.001); however, effects on SOL were not statistically significant at an adjusted α (10 weeks, P=.01; 16 weeks, P=.07; 24 weeks, P=.27). SleepioRx participants had 2.5 times (odds ratio 2.52; P<.001, 99% CI 1.33-4.75) and 5.8 times (odds ratio 5.78; P<.001, 99% CI 2.11-15.84) greater odds of response and remission at week 10, respectively, with statistically and clinically significant differences in rates sustained at follow-up assessments (P<.001). SleepioRx also demonstrated sustained improvements in secondary sleep and broader mental health outcomes. Conclusions The results of this trial demonstrate the effectiveness of digital CBT-I (SleepioRx) for treating insomnia, with gains sustained at 6 months, and support the FDA authorization of SleepioRx for the treatment of insomnia disorder. These findings underscore the potential of a new class of FDA-authorized, fully automated digital treatments to provide first-line, guideline-recommended CBT at scale. Efforts should now focus on expanding access to these evidence-based treatments. Trial Registration ClinicalTrials.gov NCT05541055; https://clinicaltrials.gov/ct2/show/NCT05541055

Importance Mindfulness meditation may improve well-being among employees; however, effects of digital meditation programs are poorly understood. Objective To evaluate the effects of digital meditation vs a waiting list condition on general and work-specific stress and whether greater engagement in the intervention moderates these effects. Design, Setting, and Participants This randomized clinical trial included a volunteer sample of adults (aged >= 18 years) employed at a large academic medical center who reported mild to moderate stress, had regular access to a web-connected device, and were fluent in English. Exclusion criteria included being a regular meditator. Participants were recruited from May 16, 2018, through September 28, 2019, and completed baseline, 8-week, and 4-month measures assessing stress, job strain, burnout, work engagement, mindfulness, depression, and anxiety. Data were analyzed from March 2023 to October 2024. Intervention Participants were randomized 1:1 to a digital meditation program or the waiting list control condition. Participants in the intervention group were instructed to complete 10 minutes of meditation per day for 8 weeks. The control group was instructed to continue their normal activities and not add any meditation during the study period. Main Outcomes and Measures The primary outcome measure was change in Perceived Stress Scale (PSS) score at 8 weeks. Secondary outcome measures included changes in job strain, measured as work effort-reward imbalance. Results A total of 1458 participants (mean [SD] age, 35.54 [10.30] years; 1178 [80.80%] female) were included. Those randomized to meditation (n = 728) vs waiting list (n = 730) showed improvements in PSS (Cohen d, 0.85; 95% CI, 0.73-0.96) and in all secondary outcome measures (eg, job strain: Cohen d, 0.34; 95% CI, 0.23-0.46) at 8 weeks. These improvements were maintained at 4 months after randomization (PSS: Cohen d, 0.71; 95% CI, 0.59-0.84; job strain: Cohen d, 0.37; 95% CI, 0.25-0.50). Those using the app from 5 to 9.9 min/d vs less than 5 min/d showed greater reduction in stress (mean PSS score difference, -6.58; 95% CI, -7.44 to -5.73). Conclusions and Relevance The findings suggest that a brief, digital mindfulness-based program is an easily accessible and scalable method for reducing perceptions of stress. Future work should seek to clarify mechanisms by which such interventions contribute to improvements in work-specific well-being.

Objective: Eating in response to stress can become habitual and have long-term consequences for weight gain, but little research has explored what may help break stress-eating cycles. We examined daily social resources as potential protective factors against daily stress eating and eventual weight gain. Method: In Study 1 (N = 1,264), we assessed stress-eating tendencies, body mass index (BMI) and waist-to-hip ratio (WHR) at baseline, receipt of emotional support over 8 days (9,649 reports), and tracked BMI/WHR after about 10 years. We examined the average likelihood of receiving emotional support as a moderator of the link between stress eating and BMI/WHR at the follow-up. In Study 2 (N = 536; 10,288 reports), we assessed stress-eating status and BMI at baseline, social responsiveness (feeling that others are caring), and stress-eating behavior over 24 days and tracked BMI a year later. We examined if social responsiveness moderates stress-eaters' daily stress-eating behaviors and changes in BMI. Results: In Study 1, stress eating predicted increases in BMI and WHR at the 10-year follow-up but not among individuals who were more (vs. less) likely to receive emotional support in daily life. In Study 2, stress eaters tended to report more daily stress-eating behaviors compared to nonstress eaters, but such tendency was attenuated on days they perceived high (vs. low) levels of social responsiveness. Stress eating did not predict BMI at the 1-year follow-up. Conclusions: These observational findings suggest that social resources in daily lives may have long-term benefits for stress eaters, potentially by reducing their everyday stress eating. Objetivo: Comer en respuesta al estr & eacute;s puede volverse habitual y tener consecuencias a largo plazo en el aumento de peso, pero poca investigaci & oacute;n ha explorado qu & eacute; puede ayudar a romper los ciclos de alimentaci & oacute;n por estr & eacute;s. Examinamos los recursos sociales diarios como posibles factores protectores contra la alimentaci & oacute;n diaria por estr & eacute;s y el eventual aumento de peso. M & eacute;todos: En el estudio 1 (N = 1,264), evaluamos las tendencias a comer por estr & eacute;s, el & iacute;ndice de masa corporal (BMI, por sus siglas en ingl & eacute;s) y la relaci & oacute;n cintura-cadera (WHR, por sus siglas en ingl & eacute;s) al inicio del estudio, la recepci & oacute;n de apoyo emocional durante ocho d & iacute;as (9,649 informes) y realizamos un seguimiento de BMI/WHR despu & eacute;s de unos diez a & ntilde;os. Examinamos la probabilidad promedio de recibir apoyo emocional como moderador del v & iacute;nculo entre comer por estr & eacute;s y el BMI/WHR en el seguimiento. En el Estudio 2 (N = 536; 10,288 informes), evaluamos el estado de alimentaci & oacute;n por estr & eacute;s y el BMI al inicio del estudio, la capacidad de respuesta social (sentir que los dem & aacute;s se preocupan) y el comportamiento de alimentaci & oacute;n por estr & eacute;s durante 24 d & iacute;as y realizamos un seguimiento del BMI un a & ntilde;o despu & eacute;s. Examinamos si la capacidad de respuesta social modera las conductas diarias de alimentaci & oacute;n estresada de los consumidores y los cambios en el BMI. Resultados: En el Estudio 1, comer por estr & eacute;s predijo aumentos en el BMI y el WHR en el seguimiento de 10 a & ntilde;os, pero no entre las personas que ten & iacute;an m & aacute;s (frente a menos) probabilidades de recibir apoyo emocional en la vida diaria. En el Estudio 2, los consumidores que com & iacute;an por estr & eacute;s tend & iacute;an a informar m & aacute;s conductas diarias de alimentaci & oacute;n estresada en comparaci & oacute;n con los que no com & iacute;an por estr & eacute;s, pero esa tendencia se atenuaba en los d & iacute;as en que percib & iacute;an niveles altos (frente a bajos) de capacidad de respuesta social. Comer bajo estr & eacute;s no predijo el BMI al a & ntilde;o de seguimiento. Conclusiones: Estos hallazgos observacionales sugieren que los recursos sociales en la vida diaria pueden tener beneficios a largo plazo para quienes comen por estr & eacute;s, potencialmente al reducir su alimentaci & oacute;n diaria por estr & eacute;s.

The interaction between sleep, circadian rhythms and cardiovascular resilience is a crucial yet underexplored research area with important public health implications. Disruptions in sleep and circadian rhythms exacerbate hypertension, diabetes mellitus and obesity, conditions that are increasingly prevalent globally and increase the risk of cardiovascular disease. A National Heart, Lung, and Blood Institute workshop examined these connections, as well as the emerging concept of cardiovascular resilience as a dynamic and multifaceted concept spanning molecular, cellular and systemic levels across an individual’s lifespan. The workshop emphasized the need to expand the focus from solely understanding whether and how sleep and circadian rhythm disturbances contribute to disease, to also exploring how healthy sleep and aligned circadian rhythms can increase cardiovascular resilience. To develop a Roadmap towards this goal, workshop participants identified key knowledge gaps and research opportunities, including the need to integrate biological, behavioural, environmental and societal factors in sleep and circadian health with cardiovascular research to identify therapeutic targets. Proposed interventions encompass behavioural therapies, chronotherapy, lifestyle changes, organizational policies and public health initiatives aimed at improving sleep and circadian health for better cardiovascular outcomes. Future cross-disciplinary research and translation of discoveries into public health strategies and clinical practices could improve cardiovascular resilience across the lifespan in all populations. In this Roadmap, Aggarwal and colleagues summarize current research and knowledge gaps on the relationship between sleep, circadian rhythms and cardiovascular resilience; highlight potential therapeutic targets and interventions for optimizing sleep and circadian rhythms to improve cardiovascular function and prevent disease; and outline research directions and opportunities, emphasizing the need for multidisciplinary collaboration.

ImportanceMindfulness meditation may improve well-being among employees; however, effects of digital meditation programs are poorly understood.ObjectiveTo evaluate the effects of digital meditation vs a waiting list condition on general and work-specific stress and whether greater engagement in the intervention moderates these effects.Design, Setting, and ParticipantsThis randomized clinical trial included a volunteer sample of adults (aged ≥18 years) employed at a large academic medical center who reported mild to moderate stress, had regular access to a web-connected device, and were fluent in English. Exclusion criteria included being a regular meditator. Participants were recruited from May 16, 2018, through September 28, 2019, and completed baseline, 8-week, and 4-month measures assessing stress, job strain, burnout, work engagement, mindfulness, depression, and anxiety. Data were analyzed from March 2023 to October 2024.InterventionParticipants were randomized 1:1 to a digital meditation program or the waiting list control condition. Participants in the intervention group were instructed to complete 10 minutes of meditation per day for 8 weeks. The control group was instructed to continue their normal activities and not add any meditation during the study period.Main Outcomes and MeasuresThe primary outcome measure was change in Perceived Stress Scale (PSS) score at 8 weeks. Secondary outcome measures included changes in job strain, measured as work effort-reward imbalance.ResultsA total of 1458 participants (mean [SD] age, 35.54 [10.30] years; 1178 [80.80%] female) were included. Those randomized to meditation (n = 728) vs waiting list (n = 730) showed improvements in PSS (Cohen d, 0.85; 95% CI, 0.73-0.96) and in all secondary outcome measures (eg, job strain: Cohen d, 0.34; 95% CI, 0.23-0.46) at 8 weeks. These improvements were maintained at 4 months after randomization (PSS: Cohen d, 0.71; 95% CI, 0.59-0.84; job strain: Cohen d, 0.37; 95% CI, 0.25-0.50). Those using the app from 5 to 9.9 min/d vs less than 5 min/d showed greater reduction in stress (mean PSS score difference, −6.58; 95% CI, −7.44 to −5.73).Conclusions and RelevanceThe findings suggest that a brief, digital mindfulness-based program is an easily accessible and scalable method for reducing perceptions of stress. Future work should seek to clarify mechanisms by which such interventions contribute to improvements in work-specific well-being.Trial RegistrationClinicalTrials.gov Identifier: NCT03527303

Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by joint pain. Self-reported poor sleep is common in RA. This study examined the potential reciprocal relationship between sleep health and pain in RA. Participants completed four waves of data collection with approximately 6 months between visits. 118 participants completed at least one wave of data collection with 7-day daily diary collecting multidimensional information on sleep (e.g., timing, perceived sufficiency) and pain severity (e.g., night, morning). A linear mixed-effects model was used to examine the associations between sleep (the primary predictor) and the next-day pain (outcome). Fully adjusted models controlled for age, sex, race, education, marital status, health covariates (e.g., depression), and medication use. Statistical significance was defined as p-value<.05. The sample mean age was 57.9 years and 87.3% were female. Overall, those with more severe average pain for the day, night pain, morning pain, and joint stiffness had longer sleep onset latency, more nighttime awakenings, and lower perceived sleep sufficiency (feeling rested). This between-person effect remained significant when examining the inverse of the relationship, such that those with longer sleep onset latency, nighttime awakenings, and lower sleep sufficiency had more average pain for the day, night pain, morning pain, and joint stiffness. Turning to the daily associations, experiencing night pain, morning pain, and joint stiffness were associated with longer sleep onset latency, more nighttime awakenings, and lower sleep sufficiency the following night’s sleep. Average pain for the day was associated with lower sleep sufficiency and this association was reciprocal. Inversely, earlier bedtime and later waketime were associated with more night pain and joint stiffness the following day. Findings highlight the daily and temporal relationship between sleep and pain. Average pain for the day and sleep sufficiency were found to have a reciprocal relationship, yet this relationship was not observed for sleep timing, sleep onset latency, and nighttime awakenings. This research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Award No. R01-AR072040).

OBJECTIVE:Previous studies have demonstrated that stress and sleep are bidirectional and perseverative cognition (ie, worry and rumination) is a key cognitive mechanism in this relationship. The goal of our study was to examine the relationships between stress and sleep, and test whether physical activity moderates the stress-sleep link. METHODS:Participants aged 18 and above were recruited from May 2020 to November 2021 and completed questionnaires and 7 days of twice daily text-based surveys, morning and evening. Morning text-based surveys assessed evening/overnight perseverative cognition and sleep, and evening surveys assessed daily stress ratings. Habitual physical activity was measured by the International Physical Activity Questionnaire. Analyses were conducted using bivariate multilevel autoregressive modeling (ML-VAR), a discrete-time structural equation model (SEM), to test relationships between repeated daily measures of sleep (duration/efficiency), stress, and preservative cognition, which were adjusted for age, sex, and race/ethnicity. RESULTS:We obtained data from 155 participants (age M =42, SD=15, 82 f) over 1009 days. In the models, 95% credibility intervals for both stress (95% CI=-0.7, -0.1) and perseverative cognition (95% CI=-13.3, -6) showed they predicted shorter sleep duration during the corresponding night. Perseverative cognition had a stronger relationship with sleep duration than stress, but did not mediate its relationship. Participants with higher habitual MVPA had a weaker relationship between stress and sleep duration (95% CI=<0.001, 0.015). Perseverative cognition also predicted lower sleep efficiency that night (95% CI=-0.024, -0.006). There were no significant mediators or moderators in models of sleep efficiency. CONCLUSIONS:Results demonstrated that stress and perseverative cognition had a stronger impact on sleep at night than the opposite direction. In addition, results highlight the importance of physical activity in mitigating the deleterious effects of stress.

BACKGROUND:To cope with chronic stress, which can contribute to depression, humans often pursue arousal-reducing activities. Yet, hormetic stressors (intermittent, acute stressors) might also reduce chronic stress. PURPOSE:We compared the effects of arousal-reducing and arousal-enhancing interventions on depressive symptoms and perceived stress. METHODS:Female adults (N = 141; predominantly White, 63%, and Asian, 34%) reporting high perceived stress were randomized to 1 of 4 three-week stress resilience interventions in 2019-2020. Low arousal conditions included mindfulness meditation or slow breathing with warm showers (Control). Hormetic stress conditions included fast paced breathing with cold showers (the Wim Hof Method; WHM) or high-intensity interval training. We assessed depressive symptoms and perceived stress at baseline, postintervention, and 3 months later, and cortisol reactivity to a lab stressor. RESULTS:At postintervention, all 4 groups had decreases in depressive symptoms (15.93% reduction, r = .76, P < .001) and perceived stress (9.70% reduction, r = .48, P < .001), with no group differences. "As treated" analysis showed the WHM group had better maintenance of reduced depression 3 months later (r = .17, P < .01). The WHM group had greater increases in daily positive affect across days (r = .16, P ≤ .05) and at postintervention (r = .17, P < .015) compared to the control group. Groups were similar in cortisol reactivity pre- and postintervention. CONCLUSIONS:All groups experienced reduced stress and depressive symptoms and did not differ from each other after 3 weeks. After 3 months, a post hoc analysis of adherent subjects showed the WHM group had more sustained improvements in depression and positive affect, a finding that needs replication with larger and more diverse samples.