Evaluating the effectiveness of the fatigue and shift working risk management strategy for UK home office police forces: a pilot study

PurposeTo evaluate the effectiveness of a fatigue-management training and sleep health promotion intervention in a sample of officers from UK Home Office Police Forces.Design/methodology/approachUsing a pre- and post-design we exposed 50 officers from selected UK police forces to a fatigue-management training intervention. Pre- and post-intervention data collection included wrist actigraphy, a physiological and objective measure of sleep quantity and quality, as well as surveys including the Pittsburg Sleep Quality Index (PSQI), the World Health Organization Quality of Life (WHOQOL) instrument, the Epworth Sleepiness Scale (ESS), the Perceived Stress Scale (PSS) and the PTSD Checklist (PCL-5).FindingsWe found the training significantly increased sleep quantity by 25 min per 24-h period, from 6.9 h to 7.3 h (f = 9.2; df = 519; p = 0.003), and improved sleep quality scores from 84% before the intervention, to 87% after the training (f = 10.6; df = 519; p = 0.001).Research limitations/implicationsContinued research is necessary to guide nationwide implementation of fatigue-management and sleep health promotion programs.Practical implicationsOur findings show that a fatigue-management training resulted in a significant and meaningful increase in sleep among police officers.Originality/valueThis is the first piece of research to emerge from a full population survey (response rate 16.6%) of the UK police service exploring issues of sleep and fatigue.

Sleep in Habitual Adult Video Gamers: A Systematic Review

Video gaming is a popular, globally recognized phenomenon, played recreationally or competitively as esports. Gaming is a typically sedentary nighttime activity; therefore, the potential to impact sleep and health is high. Furthermore, there are limited studies on adult gamers, who represent the majority demographic in esports. This review examines evidence describing sleep in habitual adult gamers to understand the associated risk for cardiometabolic disease or the benefits to gaming performance. Three electronic databases (PubMed, Scopus, ISI Web of Science) were searched for peer-reviewed articles published between January 2000 – April 2020. Twelve studies reporting on sleep in habitual adult gamers were included. A narrative synthesis was employed to report results, owing to high levels of heterogeneity across the included studies. Gamers with higher gaming addiction scores were more likely to have shorter, poorer quality sleep and greater daytime sleepiness and insomnia scores than gamers with lower gaming addiction scores and non-gamers. In addition, high-volume gamers were more likely to have worsened sleep quantity and quality, with delayed sleep timing and increased prevalence of insomnia. Despite limitations in the design of the included studies, excessive gaming is broadly associated with worsened sleep parameters. Noteworthy is the lack of studies investigating cardiometabolic health in gamers. Future work should explore the relative contribution and associated risk that various games, genres, and timing of gaming activities have on sleep, physical and mental health, particularly in vulnerable gaming cohorts engaged with contemporary forms of gaming and esports.

The quality of rest and its relationship with physical activity practice during the COVID-19 lockdown in Spain (Calidad del descanso durante el confinamiento por la COVID-19 en España. Su relación con la práctica de actividad física)

The Spanish state of alarm, for the COVID-19 outbreak, resulted in mobility restrictions, changes of habits and sleep disorders. We are investigating whether these disorders can be reduced with the practice of physical activity (PA). A questionnaire was administered to 1,046 people (48.57% men and 51.43% women), with an average age of 40 years (SD: ±13.35). A descriptive quantitative methodology based on a non-purposive sample was used and the data were subjected to non-parametric tests. Regarding rest (quantity of hours of sleep) increased in general, going from 7.13 hours to 7.65 (p=.000), whereas sleep quality worsened, the score decreased from 3.67 to 3.24, p=.000. For the age ranges (18 to 24 years, 25 to 64 and 65 or older), there was significant data (quality and quantity) for the first two ranges (p=.000), and none for the third. The relationship between PA practice and hours/quality of sleep, there were no significant correlations in the entire sample (p=.191, p=.113). The main finding was no significant correlation for any age ranges (sleep quantity & sleep quality), except for the group of 18-24 years. This result contradicts the findings of previous studies. Resumen. El estado de alarma en España, por el brote de COVID-19, se tradujo en restricciones de movilidad, cambios de hábitos y trastornos del sueño. Se investiga si dichos trastornos pueden reducirse con la práctica de actividad física (AF). Se administra cuestionario a 1.046 personas (48,57% hombres y 51,43% mujeres), con una edad media de 40 años (DE: ±13,35). Se emplea metodología cuantitativa de corte descriptivo basado en muestra no intencional y los datos se someten a pruebas no paramétricas. En cuanto al descanso (cantidad de horas de sueño) aumentó en general, pasando de 7,13 horas a 7,65 (p=.000), mientras que la calidad del sueño empeoró, la puntuación disminuyó de 3,67 a 3,24, p=.000. Para los rangos de edad (18 a 24 años, 25 a 64 y 65 o más), hubo datos significativos (calidad y cantidad) para los dos primeros rangos (p=.000), y ninguno para el tercero. La relación entre la práctica de AF y las horas/calidad de sueño, no hubo correlaciones significativas en toda la muestra (p=.191, p=.113). El principal hallazgo fue que no hubo correlación significativa para ningún rango de edad (cantidad y calidad del sueño), excepto para el grupo de 18-24 años. Este resultado contradice conclusiones de estudios anteriores.

Feasibility and Preliminary Efficacy of an Internet-Delivered Intervention for Insomnia in Individuals with Mild Cognitive Impairment

Background: Approximately 50%of older adults with cognitive impairment suffer from insomnia. When untreated, pre-existing cognitive problems may be exacerbated and potentially contribute to further cognitive decline. One promising approach to maintain cognitive health is to improve sleep quantity and quality. Objective: To determine feasibility, acceptability, and preliminary efficacy of Sleep Health Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness (SHUTi OASIS), an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program in older adults with mild cognitive impairment (MCI). Methods: Older adults with MCI and insomnia were recruited from hospital-based memory and sleep disorders clinics and enrolled in a single-arm pilot study. Participants completed the six cores of SHUTi OASIS, over nine weeks with two-week baseline and post-assessments using self-reported sleep diaries. Feasibility and acceptability were informed by usage statistics and qualitative interviews; preliminary efficacy was informed by patient-generated sleep data. Results: Twelve participants enrolled and, on average, were 75.8 years of age. Ten participants completed the study and logged in most days. Most participants reported a positive overall experience, and interviews revealed successful and independent program management and completion. There were significant changes on all baseline to post-assessment sleep measures, including clinically meaningful improvements on the Insomnia Severity Index (13.5 to 8.3, p < 0.01), sleep efficiency, wake after sleep onset, and sleep onset latency (ps < 0.02). There was no statistically significant change in cognitive measures (p > 0.05). Conclusion: This study supports that older adults with cognitive impairment can independently complete CBT-I via the Internet and achieve clinical sleep improvements.

P091 The impact of cognitive fitness and gender on sleep quantity and timing and mental health of competitive athletes

Introduction Mental fitness is increasingly considered key to an athlete’s competitive arsenal. Its active ingredients include cognitive fitness factors, such as impulse control, and recovery factors, such as sleep, which may differ between male and female athletes. Our study investigated: 1) gender differences in cognitive fitness; and 2) the associations of gender and cognitive fitness with sleep and mental health in competitive athletes during the COVID-19 lockdown. Methods 84 athletes competing at levels from regional/state to international (42F, mean age=23.2) completed a questionnaire battery containing validated measures of: a) depression, anxiety, and stress; b) sleep (Total Sleep Time, Sleep Latency, mid-sleep time on training- and competition-free days); and c) self-control, intolerance of uncertainty, and impulsivity (representing cognitive fitness constructs). Results Female athletes reported significantly higher depression, anxiety, and stress, a later mid-sleep time on free days, lower self-control, higher intolerance of uncertainty, and higher positive urgency impulsivity compared with male athletes. Self-control was negatively associated, and intolerance of uncertainty was positively associated, with depression, anxiety, and mid-sleep time on free days. Discussion Female athletes in our sample reported poorer mental health and cognitive fitness, and later sleeping times on free days. Greater cognitive fitness was associated with better mental health, independent of gender. Overall, these findings are consistent with prior work in community samples. Future work should examine the source(s) of these gender differences. If replicated, our findings would suggest a need to develop interventions aimed at improving athlete well-being, potentially with a particular focus on female athletes.

P103 Impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic

Introduction This study aimed to assess the impact of the COVID-19 pandemic on the sleep of adult patients of a multidisciplinary sleep clinic. Methods Patients were invited to complete online surveys: Survey 1 in October 2020 (increased COVID-19 restrictions) followed by Survey 2 in February 2021 (after easing of restrictions for a COVIDSafe summer). Results Of the 746 patients invited to participate, 73 completed and 8 partially returned Survey 1 (mean age 50.1 years, range 21–83 years, 58% female). Subsequently, 46 completed and 5 partially answered Survey 2. In Survey 1, 22/74 (29.7%) reported reduced sleep quantity and 31/75 (41.3%) indicated worse sleep quality compared with prior to the pandemic. In Survey 2, 33/46 (71.7%) described unchanged sleep quantity whilst 5/46 (10.9%) reported increased sleep quantity since easing COVID-19 restrictions. 36/46 (78.3%) indicated unchanged sleep quality whereas 5/46 (10.9%) described improved sleep quality since easing restrictions. However, 9/46 (19.6%) reported that their sleep remained worse compared with pre-pandemic. For patients who completed both surveys, there was no significant change in Insomnia Severity Index scores (Survey 1 mean 13.6, Survey 2 mean 12.9, mean difference -0.67 [95%CI -2.02, 0.68], p=0.32) or PROMIS Sleep-Related Impairment 8a T-scores (Survey 1 mean 59.0, Survey 2 mean 59.5, mean difference 0.44 [95%CI -1.55, 2.42], p=0.66). Discussion The COVID-19 pandemic has negatively affected the sleep of 44% of patients. Following easing of restrictions, symptoms of insomnia and sleep-related impairment did not change significantly, and 19.6% reported that their sleep was not back to their pre-pandemic baseline.

Impact of Body Mass Index, Socioeconomic Status, and Bedtime Technology Use on Sleep Duration in Adolescents

Factors related to adolescents and sleep are understudied. We evaluate the relationship between bedtime technology use (TU), TV in bedroom, weight, and socioeconomic status in seventh graders (N = 3956) enrolled in a school-based wellness intervention. Sleep quantity was dichotomized to insufficient (<8 hours) or sufficient (≥8 hours); high TU before sleep was defined by use “a few nights each week” or “every, or almost every night.” Insufficient sleep (38.7%), having TV in bedroom (72.9%), and high TU (83.1%) were commonly reported. The likelihood of sufficient sleep was lower for those with high TU (odds ratio [OR] = 0.529 [0.463-0.605]), obese students (OR = 0.815 [0.700-0.949]), and those with a TV in the bedroom (OR = 0.817 [0.703-0.950]). Also, attending a school with higher percent low socioeconomic status students was also associated with insufficient sleep ( P = .026). Interventions to reduce TU may be important for improving sleep quantity, especially for some vulnerable populations.

Sleep Patterns of Resident Physicians and the Effect of Heartfulness Meditation

Background: Medical residents are vulnerable to poor sleep quality due to intense work shifts and academic load. Studies objectively quantified with sleep quantity and quality among resident physicians are limited. Meditation techniques have been shown to improve sleep but are rarely studied in this population. The aim of the present study is to evaluate sleep patterns of internal medicine residents and the effect of a structured Heartfulness meditation program to improve sleep quality. Methods: A total of 36 residents participated in a pre–post cohort study from January 2019 through April 2019. Sleep was monitored during a one-week outpatient rotation with two validated assessment tools, namely consensus sleep diary and actigraphy. After four intervening weeks, when the residents returned to the same rotation, Heartfulness meditation was practiced and the same parameters were measured. At the end of the study period, an anonymous qualitative feedback survey was collected to assess the feasibility of the intervention. Results: All 36 residents participated in the study (mean age 31.09 years, SD 4.87); 34 residents (94.4%) had complete pre–post data. Consensus sleep diary data showed decreased sleep onset time from 21.03 to 14.84 min ( P = .01); sleep quality and restfulness scores increased from 3.32 to 3.89 and 3.08 to 3.54, respectively ( P < .001 for both). Actigraphy showed a change in sleep onset time from 20.9 min to 14.5 min ( P = .003). Sleep efficiency improved from 83.5% to 85.6% ( P = .019). Wakefulness after initial sleep onset changed from 38.8 to 39.9 min ( P = .682). Sleep fragmentation index and the number of awakenings decreased from 6.16 to 5.46 ( P = .004) and 41.71 to 36.37 ( P = .013), respectively. Conclusions: Residents obtained nearly 7 h of sleep during outpatient rotation. Findings suggest a structured Heartfulness meditation practice to be a feasible program to improve subjective sleep onset time and several objective measures among resident physicians.

Exploring the Effect of Nightly Infusion Pump Alarms on Sleep in the Hospital

Purpose Optimal sleep helps parents and children cope with life-threatening disease. However, hospital-surroundings are noisy, negatively affecting sleep quality and quantity. We aimed to determine sleep quantity; sleep satisfaction; their relation to infusionpump alarms in pediatric cancer patients and parents; and sleep quality and daytime impairment in parents. Methods Patients (2–18 years), admitted for scheduled anti-cancer therapy were eligible, as were inrooming parents. Frequency and duration of nightly infusion pump alarms were recorded. Patients and parents wore an accelerometer to assess sleep quantity (sleep efficiency, wake after sleep onset, night awakenings), additionally daily sleep satisfaction was assessed. Parents filled out questionnaires on sleep quality (PROMIS Sleep Disturbance, Insomnia Severity Index) and daytime impairment (PROMIS Sleep-Related Impairment, PROMIS Fatigue). Sleep quality scores were compared to norms. In children and parents the relation between alarms and sleep was assessed using multilevel analyses. Results Nineteen children (age 8.8 ± 4.9 years, 40 nights) and 30 parents (age 41.1 ± 6.3, 46 nights) participated (response 78%). Nightly alarms sounded median 3 times / 6 minutes in parents and 5 times / 10 minutes in children. Parents scored worse than the norm on sleep disturbances (P .01), but not on daytime impairment, 16% experienced clinical insomnia. There was no relation between alarms and sleep quantity or satisfaction for children and parents. Conclusions This explorative study showed that alarms sound frequently at night and parents sleep poorly during admissions. However, sleep of children and parents and alarms were not significantly related here. Future research should identify and improve (other) disrupting factors in the hospital.