Sleep Promotion in a Busy Inner City High Dependency Unit

Introduction: Critical care patients commonly have disrupted sleep patterns, with reduction of REM sleep, duration of sleep, increased fragmentation and loss of circadian rhythm.1 Causes include the patients' pathophysiology, medications administered and the busy critical care environment. Data collection showed that our patients were sleeping, on average, for a single block of sleep of 3.5 hours. Delirium rates and its known deleterious effects are highly associated with poor sleep, as well as an impairment of psychomotor performance and neurocognitive dysfunction. Sleep deprivation in the healthy population impairs lymphocyte action, cytokine production and pro-inflammatory balance, as well as a reduction in respiratory function and prolongation of respiratory support.2 Objectives: To firstly measure the sleep quality and explore the reasons behind poor sleep from the patients themselves and to gauge the MDT knowledge and interest in sleep, as a fundamental component of patient management. Then using the results we aimed to improve the duration and quality of the patients sleep on high dependency unit. Method(s): The Adapted Richard Campbell Sleep Questionnaire was given to all patients in the HDU over a 4 week period. Results were analysed, then stored for post intervention comparison. The duration of sleep was documented for all patients and a staff questionnaire was done to assess knowledge and concern of staff. Interventions included a staff sleep awareness week with education and prompts attached to the charting tables promoting sleep. Face masks and ear plugs were freely available to be distributed at the evening ward round. The critical care pharmacist identified medications that could alter the patients ability to achieve REM sleep - e.g. evening administered PPIs, and melatonin was commenced early when sleep was troublesome. Estates fixed soft close doors and soft closed bins supplied for clinical areas. After interventions, there was a further 4 week study period where the above factors were repeated. The need for natural light was highlighted and thus this was optimized in the ward environment and those physiologically able were offered trips outdoors to facilitate normal day night wake cycle. With the COVID pandemic ongoing we also endeavored to limit movement overnight of venerable patients. Result(s): The original data collection was of 45 patients with multiple data points, and the second of 27 patients with multiple data points. Results from the Adapted Richard Campbell Sleep Questionnaire were compared using a one tailed students t test. There were significant increases in the subjective quality of sleep (p=0.046) and quantity of sleep (p=0.00018). Reasons given as to improvement of sleep were reduction in discomfort from monitoring and the bed (p=0.026), reduced ambient light (p=0.031) and reduced impact from the presence of other patients (p=0.002). Conclusion(s): There was marked improvement in the awareness of the importance of sleep within the critical care team after education promoting a change in attitude and culture towards sleep. We are planning a second iteration targeting sedation, noise from monitors and staff and overnight interventions. Although this has been done with level 2 patients, extension to level 3 areas would be beneficial.

Effects of Covid-19 Vaccines on Mental Health of an Individual A Cross-Sectional Clinical Study

Objective: The mains and objectives of the study was to evaluate the impact of Covid'19 vaccination on mental health status. Study Design: A Cross-Sectional Clinical Study. Place and Duration: It is a cross-sectional study which was conducted by the house officers and the faculty of Dow International Dental College from june2022 to January 2023. Methodology: This study was conducted by distributing the questionnaire among the patients coming to the Outpatient Department at Dow International Dental College. A total of 280 Questionnaires were filled among the Vaccinated Patients coming to the OPD. Questions were inquired related to demographics, dosage, history, last dose, and benefit of vaccine, depression, sleep deprivation, feeling low, trouble concentrating and suicidal thoughts. The consent to fill this questionnaire by the patient was taken by 'Implied Consent'. It was in English language but was translated in Urdu by the house officers whenever it was needed to ensure the comprehension of the questions to the patients. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of which 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. Practical Implications: The results of this cross-sectional clinical study have practical implications for the wider community. Encouraging Covid-19 vaccination can have a positive impact on both physical and mental health, and promoting vaccine uptake may lead to improved mental health outcomes for individuals. Such benefits can reduce the overall burden of mental health issues during the pandemic, which is beneficial to the community. Thus, public health campaigns should focus on the potential positive effects of Covid-19 vaccines on mental health to improve community well-being and promote vaccine acceptance. Result(s): Approximately 48% women and 52% male have anxiety, depression or either disorder, respectively. Adults with anxiety and depression were more likely to have low educational attainment, low household income, lack of health insurance and either lack or delay medical care. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of whom 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. There was a common mental impact that was noticed and brought about people's mental health at stake. Conclusion(s): Forceful vaccination has a potential to affect mental health of an individual. Further studies are required to extrapolate the findings of the present study.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Impact of Covid-19 on Mental Health among Medical Students

Background: The COVID-19 pandemic is a major health crisis affecting several nations. Such widespread outbreaks are associated with adverse mental health consequences. Objective(s): To conduct a survey-based assessment of mental health among medical students during the COVID-19 pandemic. Aimed at identifying severity levels of depression and anxiety, stressors related to the pandemic, and barriers students experienced in handling the pandemic-related stress. Method(s): An analytical cross-sectional study was chosen as the study design for this research to study the association between demographic social and mental health among medical students during the pandemic COVID-19. Result(s): The results of this study were collected by respondents through questionnaires as the respondents were needed to answer about 16 questions and the main question was asked mostly about their mental health condition during the pandemic COVID-19. 101 respondents participated in the study. Discussion(s): the impact of COVID-19 on mental health among medical students has been studied. Due to the long-lasting pandemic situation and numerous measures such as lockdown and stay-at-home orders, COVID-19 brings negative impacts on higher education of medical students, self and social isolation, disconnection from friends and teachers resulting in more medical students than ever experiencing feelings of helplessness, isolation, grief, anxiety and depression. The issue of mental health is not only relevant but crucial. Demand for health support services has increased exponentially as a result. Conclusion(s): In this study, severity levels of depression and anxiety, stressors related to the pandemic, and barriers students experienced in handling the pandemic-related stress have increased due to many factors such as social isolation, own health and the health of loved ones, financial difficulties, suicidal thoughts, depressive thoughts, class workload, changes in living environment, eating patterns and sleeping habits.Copyright © RJPT. All right reserved.

The link between fear about COVID-19 and insomnia: mediated by economic concerns and psychological distress, moderated by mindfulness

This paper adds to extant research by examining the relationship between employees' fear of coronavirus disease 2019 and their suffering from insomnia. It specifically proposes mediating roles of employees' economic concerns and psychological distress and a moderating role of mindfulness in this process. The research hypotheses are tested with survey data collected through two studies among Pakistani-based professionals: 316 in study 1 and 421 in study 2. The results pinpoint a salient risk for employees who experience fear during a pandemic crisis, in that the associated economic and psychological hardships make the situation worse by undermining their sleep quality, which eventually could diminish the quality of their lives even further. It also reveals how organizations can mitigate this risk if employees can leverage pertinent personal resources, such as mindfulness.

Features of life activity and the incidence rate of anxiety and depressive disorders among medical students studying remotely during the epidemic of a new coronavirus infection (Covid 19)

Aims. The aim is to study the features of life and the incidence rate of anxiety and depressive disorders among medical faculty students studying remotely during the epidemic of a new coronavirus infection (Covid 19) at the Kabardino-Balkarian State University named after H.M. Berbekov. Materials and methods. We examined 335 students (34% males, 66% females) at the Faculty of Medicine in November- December 2020. The average age of the students examined was 20.3+/-2.3 years. The study included an anonymous mail survey to examine educational conditions, lifestyle, levels of anxiety and depression. Results. 43.8% of the students had insufficient sleep duration, 58.5% had low physical activity, in 24.8% of them we recorded high levels of situational anxiety and in 82.1% of them personal anxiety, in 7.1% of the students we recorded clinically expressed anxiety and 1.8% had clinically expressed depression. During the transition to remote learning, students increased the time use to prepare for classes (51.2%) and the duration of sleep (61.5%), while their physical activity decreased (76.5%). Statistically significant linear correlations were identified between the level of anxiety and depression and the duration of sleep, low physical activity, preparation time for classes, academic performance, and academic debt. Conclusions. The results obtained by us can be used to optimize the educational process, as well as to preserve the mental health of students during the transition to distance learning.Copyright © 2020 Novyi Russkii Universitet. All rights reserved.

Selected Bibliography of Recent Research in Sleep (2020–2021)

The American Journal of Respiratory and Critical Care Medicine· AmakATS and the American Journal of Respiratory Cell and Molecular Biology· as well as non-American Thoracic Society journals JAMA, lite Lancet Respiratory tledicine, and Cltest are reviewed in this article as outstanding studies in the field of sleep medicine that were published in 2020 and 2021. We notably highlight the influence of the coronavirus disease (COVID-19) pandemic on the provision of sleep care, significant advancements in machine learning, and the phenotyping of obstructive sleep apnea (OSA). precision health, new epidemiologic insights on the causes, effects, and treatment response of OSA, as well as improvements in our knowledge of obesity and respiratory pathophysiology in sleep.

COVID-19 and preventive strategy

In December 2019, an unprecedented outbreak of the novel coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began to spread internationally, now impacting more than 293,750,692 patients with 5,454,131 deaths globally as of January 5, 2022. COVID-19 is highly pathogenic and contagious which has caused a large-scale epidemic impacting more deaths than the severe acute respiratory syndrome (SARS) epidemic in 2002-2003 or the Middle East respiratory syndrome (MERS) epidemic in 2012-2013. Although COVID-19 symptoms are mild in most people, in those with pre-existing comorbidities there is an increased risk of progression to severe disease and death. In an attempt to mitigate this pandemic, urgent public health measures including quarantining exposed individuals and social distancing have been implemented in most states, while some states have even started the process of re-opening after considering both the economic and public health consequences of social distancing measures. While prevention is crucial, both novel agents and medications already in use with other indications are being investigated in clinical trials for patients with COVID-19. The collaboration between healthcare providers, health systems, patients, private sectors, and local and national governments is needed to protect both healthcare providers and patients to ultimately overcome this pandemic. The purpose of this review is to summarize the peer-reviewed and preprint literature on the epidemiology, transmission, clinical presentation, and available therapies as well as to propose a preventive strategy to overcome the present global pandemic.

The impact of social isolation on health and behavior in Drosophila melanogaster and beyond

Many organisms, including humans, have evolved dynamic social behaviors to promote survival. Public health studies show that isolation from social groups is a major risk factor for adverse health outcomes in humans, but these studies lack mechanistic understanding. Animal models can provide insight into the molecular and neural mechanisms underlying how social isolation impacts health through investigations using genetic, genomic, molecular, and neuroscience methods. In this review, we discuss Drosophila melanogaster as a robust genetic model for studying the effects of social isolation and for developing a mechanistic understanding of the perception of social isolation and how it impacts health.

NASEM on long‐term effects of COVID‐19 on children and families

Probably the most devastating loss to a child is the death of a parent. This happened to more than 265,000 children in the United States due to COVID‐19. But there are other losses too, which have also been devastating – when a parent loses a job, which happened often during the pandemic, and in fact, that is still occurring. And there are many other long‐term effects of COVID‐19, some of which were alleviated by extra money from the federal government. That is now drying up as the federal emergency ends.

Night shift work and sleep deprivation in relation to vaccine induced SARS-CoV-2 antibody responses in a general population cohort (COVICAT study)

IntroductionNight shift work and sleep deprivation have been associated with lower antibody responses induced by vaccination against seasonal influenza, meningitis-C and hepatitis A. We examined the association of exposure to night shift work and sleep deprivation with antibody levels induced by COVID-19 vaccines.Materials and MethodsThis study was nested in an ongoing population-based cohort in Catalonia, Spain. Blood samples were collected in 2021 from a random subsample of 1,090 participants. We measured 3 immunoglobulins (Ig)M, IgG, and IgA antibodies against 5 SARS-CoV-2 antigens, including RBD (receptor-binding domain), S (spike-protein), and S2 (subunit 2 from spike-protein). We collected data on night shift work (current night work, frequency, duration) and sleep metrics (sleep duration, sleep problems, changes in sleep duration since the beginning of the pandemic). We adjusted linear regression estimates (% change) for individual- and area-level covariates, time since vaccination, vaccine doses and type. Analyses were restricted to participants without previous COVID-19 infection (N=639). Infection status was defined using questionnaires, SARS-CoV-2 test registry and serology information (seropositivity to N-antigen).ResultsParticipants' mean age was 57.6 years, 57% were female, 73% received 2 vaccine doses (42% Pfizer, 44% AstraZeneca),5.8% were current night workers and 36.5% of the sample reported sleep problems. No overall association pattern was observed between current? night work and vaccine-induced antibody responses. IgG levels tended to be lower (differences in the range of 3.6–53.7%) among night workers, compared to day workers but differences were not statistically significant. Participants with short sleep (<=6 hours) had significantly lower IgM antibody levels compared to those that reported 7 hours of sleep. No clear pattern was observed with sleep quality.ConclusionsFurther research in larger studies is needed to evaluate the influence of night shift work and impaired sleep on vaccine induced immune responses and risk of breakthrough infections.

Healthy sleep and nursing

The COVID-ig pandemic has increased and highlighted the day-to-day demands of nursing and effects on sleep.1 During the pandemic, the prevalence of sleep disturbances among healthcare workers and nursing students was 31% and 27% (respectively), compared to 18% of the general population.2,3 Given that sleep is important for cognitive, emotional and physical wellbeing,4,5 sleep may be especially important for nurses - a demanding profession that often requires shift work - a known risk factor for poor sleep.1,6 Studies support the importance of sleep for nurses.7"9 Poor sleep has been associated with reduced quality of life, weight gain, hypertension, and diabetes among nurses.7,8,10"12 In addition to personal health concerns, poor sleep has also been associated with medical errors,13 reduced job productivity9 and burnout.14"16 Perhaps most concerning, studies suggest that although objective performance continues to decline with chronic partial sleep deprivation, subjective ratings of alertness level-off.17 This means that an individual who is sleep deprived becomes less aware of how their performance has been impaired, in much the same way that a person who is intoxicated does not realise many of their cognitive and physical abilities are compromised.18 Fortunately, wellness programs that recognise the importance of sleep are being developed to support nurses. There are thoughts that strategies to promote wellbeing and resilience should be developed early in a nurse's career.1 However, many of these initiatives fail to identify the importance of sleep despite growing concerns of poor sleep during the graduate nurse year.1 In a recent study of 88 newly graduated nurses working in a tertiary hospital in South Korea, Kim and Lee found a significant decline in subjective sleep quality over the first four months of undertaking shift work as a nurse, which was associated with a decline in quality of life.23 Similarly Donovan and colleagues reported emotional, physical and mental exhaustion was often attributed to sleep deprivation during the graduate year of nursing and midwifery24 Epstein and colleagues also explored sleep during the graduate year and found graduate nurses had limited and potentially counterproductive strategies to cope with fatigue.25 Whether poor sleep continues, worsens, or improves during the nursing career remains unclear. Prevalence of mental health problems and sleep disturbances in nursing students during the COVID-19 pandemic: a systematic review and meta-analysis. Sampson M, Melnyk B, Hoying J. The MINDBODYSTRONG intervention for new nurse residents: 6-Month effects on mental health outcomes, healthy lifestyle behaviors, and job satisfaction.

The impact of sleeplessness on work productivity

IntroductionPeople in Asia are reported to have the shortest sleep duration worldwide. In particular, Indians slept an average of 6 hours and 46 minutes compared to the 7 hours recommended by the National Sleep Foundation. In addition, COVID-19 pandemic may have exacerbated sleep woes with 2 in 3 people have reported that their ability to sleep well has been affected by the pandemic. Stress and increase in phone use before bedtime are common reasons for poor sleep. Poor sleep is well documented to make us error prone with up to 3 times attention lapses and 2 times odds of making place keeping errors.Material and MethodsIn this investigation, we surveyed more 2236 adults of working age of 25 to 55 years old in 7 major India cities to understand their sleeping patterns, duration, prevalence of sleep difficulties and daytime consequences. The Stanford Presenteeism Scale was used to analyse the impact of reported sleep problems on work performance. We compared workers' ability to handle job stress, complete work tasks, achieve goals, maintain focus and energy during work.Results and ConclusionOnly 15% respondents reported that they have good sleep (7 or more hours of sleep, takes less than 30 minutes to fall asleep and acknowledgment of no sleeping problems). About 40% of respondents shared that they slept less than 7 hours on work days. Among the 1225 employed individuals, IT Professionals (30%) topped the list of profession in facing sleep problems. Using the Stanford Presenteeism Scale, more than 75% of the employed individuals agreed that lack of sleep has major impact on their work performance. However, more than 30% reported to do nothing about it and assumed sleep will get better with time. In conclusion, a majority of Indians reported lack of good sleep during working day and lack of sleep decreases work performance. With many are not taking action, there is a need to raise awareness of impact of insufficient sleep on work and daily life.

Sleep Disturbance and Immunological Consequences of COVID-19.

The overarching importance of sleep was further emphasized during the pandemic of COVID-19. The subjects infected by COVID-19 frequently experience sleep disturbances; some are long-lasting problems and decrease the quality of life. Insomnia is the most studied sleep disorder associated with COVID-19. Insomnia affects patients who have experienced an infection and the general population. Good sleep is important in maintaining mental and physical health, including immune system functions. The interconnections between insomnia, the immune system, and COVID-19 are complex. Insomnia triggers numerous immune system dysregulations and makes individuals more vulnerable to respiratory infections. This narrative review overviews the influence of the COVID-19 pandemic on the immune system through sleep disorders.

Sleeping in a bubble: factors affecting sleep during New Zealand's COVID-19 lockdown.

New Zealand (NZ) enforced a rigorous lockdown in response to the outbreak of COVID-19 in 2020. Infection rates remained remarkably low, yet social and personal routines were affected. Factors associated with reporting worsening sleep were explored using an anonymous online survey launched during New Zealand's 2020 lockdown. Participants were 723 adults aged 20-85 years (median: 45 years, 82% women). Bed and wake times occurred significantly later compared to pre-lockdown estimates and resulted in shorter social jetlag (15 min). During lockdown, 54.5% were identified as "poor sleepers" [i.e. score > 5 on the Pittsburgh Sleep Quality Index (PSQI)]. Overall, 45% rated their sleep quality to worsen compared to pre-lockdown, 22% reported an improvement. Reports of worsening sleep were significantly related to increased sleep latency, reduced sleep efficiency, and heightened PSQI scores compared to those with better sleep or no change. Subjectively worse sleep was significantly associated with less time engaging in physical activity, less exposure to daylight, and social interactions compared to pre-lockdown estimates (p < .05). Logistic regression models identified significant relationships between having more vivid dreams and worsening sleep. Worse sleepers also had increased likelihoods of reporting poorer mood and they also scored higher for anxiety compared to those with no change or improved sleep during lockdown (p < .05). Pandemic-related restrictions contributed to poorer self-reported sleep which was linked to deterioration of mood. Negative affect was comparatively lower than reported elsewhere. These findings provide unique insights to the psychosocial impact of the initial COVID-19 lockdown in New Zealand, where the disease outbreak remained low.

Impact of SARS-CoV-2 pandemic on Sleep Quality

The coronavirus disease 2019 (COVID-19) pandemic has led to considerable stress and anxiety, adversely affecting the quality of the sleep. A study was conducted to evaluate if the COVID-19 pandemic had any effects(s) on the sleeping pattern and on overall sleep quality. Study was conducted as a cross sectional, questionnaire-based survey in Indian population on an online platform utilising Pittsburgh Sleep Quality Index (PSQI) to assess pattern and quality of sleep before and during the pandemic. The survey questionnaire was conducted during pandemic;hence the data collected for "before pandemic” duration was retrospective. A total of 1615 participants' responses were received of which there were 756 female and 859 male participants. The mean PSQI score (global) before the pandemic was 4.68 ± 2.98 while that during the pandemic is 6.02 ± 3.62 indicating a significant change in the sleep quality. The proportion of poor sleepers also increased dramatically from 26.1% pre-covid to 49.3% during covid. Both sleep deprivation and poor-quality of sleep are well-known to produce significant mood disturbances and to lower the immunity. Thus, it can be extrapolated that those individuals who developed significant sleep disturbances during COVID-19 are likely to be at a greater risk for negative health consequences even if they did not develop active COVID-19 infection. As sleep is vital for both mental and physical health of the human body, adequate measures should be taken at an individual level as well as at the community level to maintain quality of the sleep during pandemic or other disasters like war that trigger considerable stress.

The effects of low-grade inflammation and sleep loss on model-based and model-free control: Results of an experimental double hit model

Methods: In an ongoing study, we recruited 46 individuals who complete three sessions: sleep loss (2 nights of 4h in bed), normal sleep (2 nights of 9h in bed) (within-subjects), and a low-grade inflammation condition (COVID-19 vaccination) preceded by either sleep loss or normal sleep (between subjects). Blood samples were taken (not analyzed), sickness symptoms were assessed (SicknessQ with 10-point scale), and model-based and model-free control was quantified (a sequential decision task). Result(s): Sickness symptoms were highest after vaccination with sleep loss (M = 34.6), followed by vaccination with normal sleep (M = 24.3) and sleep loss (M = 23.8), and normal sleep only (M = 15.3). Model-free control increased in the vaccine as compared to the non-vaccine condition (b = 0.23, 95% CI 0.10, 0.37, p <.001), most clearly in the normal sleep condition. Model-based control decreased after sleep loss versus normal sleep (reward + common: b = -0.47, 95% CI -0.67, -0.28, p <.001, non-reward + rare: b = -0.43, 95% CI -0.63, -0.18, p <.001), which was not modulated by vaccination. Conclusion(s): These results suggest that low-grade inflammation and sleep loss independently attenuate behavioral control towards a cognitively less expensive but inflexible decision style. The potential role of sleep-immune pathways in model-based and model-free control will be discussed. Copyright © 2022

COVID-19 Pandemic and Its Impact on Sleep Health: A Rapid Review

This rapid review aims to elucidate the impact of coronavirus 2 (SARS-CoV-2) (COVID) disease-both in the acute phase and the "long-hauler" syndrome-on sleep health. Literature regarding the direct physiologic impact of COVID disease on sleep is sparse but has illuminated a toxic synergy between the immune response to COVID disease and the proinflammatory state brought on by obstructive sleep apnea (OSA). Primary care physicians and sleep medicine specialists should aggressively screen for OSA in COVID patients.

Effect of sleep disorders on post-vaccination antibody response - A systematic review and meta-analysis

Objectives/Introduction: Sleep deprivation and sleep disorders have been related to a reduced or delayed antibody response following vaccination. However, studies in this field have provided inconsistent results, with some failing to show significant effects on antibody titers in these conditions. The possible reasons for the discrepancies on the results rely on methodological variability, including different sleeprelated conditions, diseases and time from vaccination to antibody assessment. This study intended to perform a systematic review and meta-analysis on the effects of sleep deprivation and sleep disorders on antibody response after vaccination. Method(s): Literature searches were performed at PubMed, Scopus and Web of Science, comprising two search domains, one related to sleep and other to vaccination. The records were screened in a twostep process (title and s, follow by full text analysis), by two independent reviewers. Eligibility criteria included individuals with previous diagnosis of a sleep disease or subjected to an experimental sleep deprivation schedule, which have undergone vaccination for a specific disease. The main outcome was the post-vaccinal antibody titers. The effects size for each article was calculated using standardized mean differences and the meta-analyses used the DerSimonian and Laird random effects model. Result(s): Out of 9009 identified records, six were included in the final sample. Among these, four were related to H1N1/influenza, one to hepatitis and one to COVID-19. Three studies evaluated the effects of sleep deprivation, two were related to obstructive sleep apnea and one was related to insomnia. The date since vaccination to antibody measurement varied from five days to one month. The results demonstrated a non-significant reduction in antibody titers due to sleep disorders (SDM: -0.206;CI95%: -0.783 to 0.071;p = 0.144). Conclusion(s): The results demonstrate that sleep disorders and sleep deprivation altogether do not lead into a significant reduction in the antibody titers after vaccination. However, the studies included are subjected to substantial methodological heterogeneity, and it is possible that significant effects would appear in more specific conditions (such as for specific sleep disorders, diseases and time points after vaccination).