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Background Insomnia is a common and increasing illness among general population all over the world. With insomnia, patients would more likely to have physical, social dysfunction and mood disorders, and even have increased risk of accidents. Therefore, identifying the harm of insomnia and improving the quality of life of patients are very important. Objectives The objective of this systematic review is to evaluate quality of life in patients affected with insomnia. Particularly focuses on the following two question: 1) How insomnia impact quality of life in patients with insomnia. 2) What factors affect quality of life among people with insomnia, such as demographic factors, physical and psychological factors. Methods Systematic reviewing the articles from 1990 to 2013 in PubMed and Medline, which evaluated the quality of life in patients affected with insomnia, using the keywords “insomnia” AND “quality of life”. Results and Discussion There were 9 articles have been included in this review. The year were ranged from 1998 to 2012,8 out of 9 papers had the average age ranged from 42-57 year old. Insomnia significantly related to all of the eight domains and PCS,MCS of QOL negatively, and both of the severity of insomnia and the number of sleep problems have negative impact on QOL. Moreover, regarding the factors which affect QOL of patients, older, female, not married, smoking, drinking, psychiatric disorders and without treatment were associated with lower QOL. Furthermore, regarding the future directions, in Hong Kong the application of the results in this review is appropriate but still need more studies which evaluating the associated factors of insomniacs’ QOL with validated Chinese version QOL measures. Conclusion There was a negative relationship between insomnia and quality of life, and the severity of insomnia and the number of sleep problems had negative impact on quality of life. Particularly, older, female, single statuse, smoking, drinking, psychiatric disorders had negative influence on patients’s QOL. Regarding the control strategies, using appropriate medical treatment under physician guidance, consultation of mental disorders, increasing the public awareness of the harm of insomnia play a pivotal role in reduce the impairment of insomnia. / published_or_final_version / Public Health / Master / Master of Public Health

University of Macau / Faculty of Social Sciences and Humanities / Department of Psychology

Sleep has been recognized as a major determinant of physical and mental health. Emerging studies suggested that social and built environments should be considered as important determinants of sleep health, however causal mechanisms between neighborhood factors and sleep health still remain unclear. The proposed dissertation is a connected set of papers including a systematic review and longitudinal studies investigating associations between neighborhood stressors and sleep health as well as potential causal mechanisms via psychological distress and physical activity. The longitudinal studies employed comprehensive measures of neighborhood characteristics and sleep health along with g-estimation and mediation analysis techniques. Neighborhood social and built environments may contribute to poor sleep health, particularly in low-income and racial/ethnic minority neighborhoods, and psychological distress can be a salient pathway linking these neighborhood characteristics and sleep health. Based on our findings, interventions to improve sleep should target modifiable factors and enhance neighborhood environments. These sorts of strategies have the potential to improve not only sleep health but also other health outcomes.

Many studies have shown that short sleep duration and/or poor sleep quality is associated with increasing rates of cardiovascular (CVD) mortality and morbidity. One hypothesized explanation for this association has been that sleep loss is a type of chronic stress that induces dysregulation of biological systems that ultimately increase the risk of CVD. One biological system that has been thought to link sleep loss and CVD is the hypothalamus-pituitary-adrenal (HPA) axis. A number of studies using small or convenience samples have addressed the effects of sleep deprivation on cortisol. Only a few studies have examined the association of habitual short sleep duration and/or poor sleep quality with changes in the diurnal cortisol in population based-samples; those studies vary in their methodology and in findings. Another biological system that has been thought to link sleep loss and CVD is the autonomic nervous system (ANS), through overactivation of the sympathetic nervous system (SNS) and/or probably a withdrawal of the parasympathetic nervous system. Experimental studies have shown an association between the sleep stages and markers of the sympathetic system. However, very few studies of habitual sleep duration/sleep quality and ANS markers have been conducted. Even fewer studies have examined the association of habitual sleep duration and/or sleep quality and ANS responses to a stress challenge in a population-based sample. The findings again have been inconsistent probably due to the use of different methodology and different samples. This dissertation used measures of salivary diurnal cortisol as well as cortisol responses to a stress challenge protocol to assess the relationship of habitual sleep duration and/or sleep quality with diurnal cortisol profile in natural conditions and in response to a stress challenge protocol in a laboratory setting. Diurnal cortisol was assessed from up to 16 samples of salivary cortisol for two days. Cortisol responses to a stress challenge were assessed from four salivary samples taken during the stress challenge that was performed in a different day than the diurnal cortisol collection. To examine the relationship of habitual sleep duration and/or sleep quality and markers of the ANS, this dissertation used continuous cardiovascular measures (heart rate and heart rate variability) and four salivary amylase samples obtained during the stress challenge. The stress challenge included mental stress and orthostatic stress. Sleep duration and sleep efficiency (an objective measure of sleep quality) were assessed from 7-day actigraphy and sleep diaries. Insomnia symptoms (a subjective measure of sleep quality) were also assessed using a questionnaire that included the Women’s Health Initiative Insomnia rating scale (WHIIRS). We used mixed models so as to account for the repeated measures of diurnal salivary cortisol levels as well as the responses (reactivity and recovery) to the stress challenge tests. Chapter 1 presents an introduction to this dissertation discussing the relationship between short sleep duration and/or poor sleep quality and CVD morbidity and mortality. Chapter 2 presents a systematic literature review of studies of the association between habitual sleep duration and/or sleep efficiency and markers of neuro-endocrine systems: HPA and ANS. These are plausible mechanisms that link short and/or poor sleep to CVD morbidity and mortality. Chapter 3 presents our analyses of the relationship between short sleep duration and/or poor sleep quality and features of the diurnal cortisol. We hypothesized that those participants whose slept < 6 hours per night or whose sleep efficiency was < 85% would have higher cortisol levels on awakening, flatter cortisol awakening responses (CAR), and higher evening cortisol levels than participants who slept longer or slept better. We found that short sleepers had higher evening cortisol than the longer sleepers and that this association persisted after the adjustment for several known confounders. In chapter 4, we examined how the same groups of participants responded in terms of hormones (cortisol and amylase) and cardiovascular indices (heart rate (HR) and HR variability (HRV)) to a stress challenge test. We hypothesized that those participants who slept for a shorter time or whose sleep was of poorer quality would have more exaggerated responses to and less recovery from a stress challenge test than participants who slept longer or slept better. We found that participants with insomnia had exaggerated high frequency-HRV (HF-HRV) orthostatic reactivity. In an extended analysis, we found that participants who slept less than 7 hours/night had exaggerated heart rate reactivity to a mental stress test compared to participants who slept 7 or more hours/night, but this association was attenuated after adjustment for naps. Paradoxically, we also found that participants who slept less than 7 hours had higher HF-HRV recovery from mental stress compared to longer sleepers (≥7 hours). Short sleep duration or low sleep efficiency was not associated with cortisol or amylase responses to the stress challenge protocol. These findings suggest that sustained high evening cortisol levels and cardiovascular responses to a stress challenge may be among the mechanisms linking short/poor sleep and CV disease.

University attendance includes various activities and experiences that can have a unique impact on psychosocial development and adult health behaviors, and can influence life course outcomes such as short- and long-term health and quality of life. College attendance and health are cyclical and reinforcing factors. Healthier students do better while at college, which allows them to effectively progress through university. College graduation is closely associated with improved health status in later life. In addition, students' personal development as part of their transition to adulthood during college, which includes psychosocial and interpersonal growth, is associated with greater gains in health and personal success in later life. Identifying the factors associated with enhanced health status while in college would ensure that a greater number of the overall population has access to the potential health benefits of progressing through and graduating from an institution of higher education. Because health behaviors can have a significant impact on how well a student progresses through college, as well as future quality of life, colleges and universities should recognize the role health is playing in the student experience. This study explored the connection of how factors such as student sub-group participation, health behaviors, and particular negative experiences affect the health status of college students attending a large, urban, top-tier university. It investigated which students were at an increased risk for negative mental health symptoms and overall lower general health and how students' participation in various groups (student athletes, students who are members of sororities and fraternities, and students who volunteer) is associated with health behavior (alcohol and other drug use, sexual behavior, and sleep), negative experiences (bias/discrimination and interpersonal violence), and health outcomes. In addition, the study analyzed how personal development at college mediates those relationships. This study is based on non-experimental cross-sectional survey data from the National College Health Assessment that was collected in collaboration with the American College Health Association at Columbia University (CU). All enrolled undergraduate students at CU in Columbia College or the School of Engineering and Applied Sciences in the spring semester of 2009 (n=5708) were invited to participate in the survey, and 31.8% of the sample responded. This research used the Baron and Kenny model to examine the mediation effects of personal development on general health and mental health via a series of bivariate and regression analyses. While the overall general and mental health of respondents was good, particular groups were less likely to report overall excellent or very good general health and more likely to report mental health symptoms. Negative experiences and health behaviors varied significantly between student sub-groups. Health behaviors and negative experiences were predictive of overall general health and mental health symptoms. Sleep, drug use, and experiences of bias/discrimination and interpersonal violence (IPV) were most predictive of health. Personal development was found to partially mediate the relationship between IPV, sleep and overall general health. In addition, personal development was found to partially mediate the relationship between IPV, drug use other than or in addition to marijuana, and sleep and mental health symptoms. The findings from this study suggest that college and university administrators should consider directing resources into targeting particular groups of students for focused health promotion interventions related to specific topics as a method for improving overall general health and reducing mental health symptoms of students. College and university administrators are encouraged to consider the role of personal development as a unique factor in improving student health.

This study investigated the associations between sleep patterns and singing voice quality in 231 adult singers of various skill levels across the United States. The four-part survey using a general questionnaire on demographics, musical background, vocal health, and three established survey instruments: the Pittsburgh Sleep Quality Index (PSQI), the Singing Voice Handicap Index-10 (SVHI-10), and the Epworth Sleepiness Scale (ESS) found that while scores were worse than normative values for the PSQI and the SVHI-10, a Pearson correlation between the two showed a moderate association. A linear regression also yielded that 8.9% of the variance in SVHI-10 scores could be predicted from PSQI scores. While further research is needed in this area, this study suggests that the amount of sleep needed for an optimal singing voice may be different from the amount needed to feel well-rested for some singers. Moreover, singers may overestimate the influence of sleep on their singing voices.