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We examined whether subjectively and objectively measured sleep health composites have a relationship with heart disease. 6,820 adults (Mage = 53.4 years) from the Midlife in the United States study provided self-reported sleep characteristics and heart disease history. A smaller sample (n = 663) provided actigraphy sleep data. We tested two sleep health composites, based on self-report only and both self-report and actigraphy, across multiple sleep dimensions. We used a weighted sum approach, where higher scores indicated more sleep health problems. Modified Poisson regressions adjusted for sociodemographics and known risk factors. Having more sleep health problems was associated with a higher risk of heart disease using the self-report sleep health composite (aRR = 54%, P < .001) and the actigraphy/self-report composite (aRR = 141%, P < .001). Individual sleep dimensions of satisfaction, alertness, and efficiency (from the self-report composite) and regularity, satisfaction, and timing (from the actigraphy/self-report composite) were associated with the risk of heart disease. The effect size of each sleep health composite was larger than the individual sleep dimensions. Race moderated the association between the actigraphy/self-report sleep health composite and heart disease. There was no significant moderation by sex. Findings suggest poorer sleep health across multiple dimensions may contribute to heart disease risk among middle-aged adults.

Nurses make up the largest subset of healthcare professionals (Jacob et al., 2015). Due to unconventional work shifts and long workdays, nurses often report sleep problems (Sun et al., 2019). Poor sleep is associated with worse cognitive functioning (Lee et al., 2019), lower ratings of patient care, and may even compromise patient safety (Stimpfel et al., 2020). Little is known in regard to how daily sleep is related to subjective cognition and how work characteristics moderate this relationship (Costa & Fardell, 2019). Previous research indicates on days following nights with shorter sleep duration or poorer sleep quality, workers report

BackgroundMandated social distancing practices and quarantines in response to COVID-19 have resulted in challenges for research on healthcare workers, such as hospital nurses. It remains unknown whether nursing studies utilizing complex methodology like sleep actigraphy and ecological momentary assessment (EMA) can be conducted remotely without compromising data quality.ObjectivesWe aimed to (a) disseminate our remote study protocol for sleep actigraphy and EMA data from hospital nurses during COVID-19, (b) assess feasibility and acceptability of this approach for studies on hospital nurses, and (c) examine the reliability and ecological validity of sleep characteristics measured across 14 days.MethodsUsing an online platform, we provided 86 outpatient nurses from a cancer hospital with detailed video/text instructions regarding the study and facilitated virtual study onboarding meetings. Feasibility was assessed by comparing adherence rates to a similar in-person study of nurses from the same hospital; acceptability was evaluated through content analysis of qualitative study feedback. Multilevel modeling was conducted to assess changes in sleep characteristics as a function of study day and daily stressful experiences.ResultsAdherence to EMA (91.8%) and actigraphy (97.9%) was high. EMA adherence was higher than the in-person study of inpatient day-shift nurses from the same hospital. Content analyses revealed primarily positive feedback, with 51.2% reporting “easy, clear, simple onboarding” and 16.3% reporting the website was “helpful.” Six participants provided only negative feedback. Sleep characteristics did not change as a function of study day except for self-reported quality, which increased slightly during Week 1 and regressed toward baseline after that. A higher incidence of stressor days or higher stressor severity followed nights with shorter-than-usual time in bed or poorer-than-usual sleep quality, supporting the ecological validity for these methods of assessing sleep in nurses.DiscussionFindings suggest that a fully remote study protocol for EMA and actigraphy studies in nursing yields robust feasibility, acceptability, reliability, and validity. Given the busy schedules of nurses, the convenience of this approach may be preferable to traditional in-person data collection. Lessons learned from COVID-19 may apply to improving nursing research postpandemic.

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Previous research indicates poor sleep and cognitive functioning are associated. Studies have yet to consider the role of work shift on this relationship. The current study examined the sleep and subjective cognition relationship in nurses, and if this relationship differed for day- and night- shift nurses. Sixty-one nurses (M=35.39, SD=11.73; 39 day-, 22 night-shift) reported their nightly sleep characteristics and next-day subjective cognition (i.e., processing speed, memory, and mental focus) using ecological momentary assessments for 2 weeks. Multilevel models controlled for sociodemographic characteristics and decomposed the variance attributed by between- and within-person levels. At the within-person level, better sleep the previous night was associated with better subjective cognition the following day. This relationship was more apparent in night-shift nurses than in day-shift nurses, such that (a) longer sleep duration predicted better mental focus (B=1.62, p&lt;.05) and (b) higher sleep quality predicted better memory (B=8.67, p&lt;.001). At the between-person level, better sleep overall was associated with better subjective cognition across days. This association was more apparent in day-shift nurses than in night-shift nurses, such that (a) better sleep quality and sufficiency predicted faster processing speed (B=34.33; B=26.28; p&lt;.001) and (b) better sleep quality and greater sleep sufficiency predicted better memory (B=30.94; B=23.09; p&lt;.001). Findings suggest that sleep characteristics are associated with subjective cognition in nurses day-to-day and on average. Specific sleep characteristics associated with subjective cognition differ between day- and night-shift nurses, presumably due to differences in their sleep issues and perceived cognitive abilities.

Introduction Sleep and pain have a bidirectional relationship in clinical populations; however, we know less about the daily association in non-clinical but potentially vulnerable populations. Nurses are prone to poor sleep and pain symptoms due to work schedules and occupational stress. Implications from mindfulness-based interventions suggest that mindfulness may play a role in improving sleep and subsequently, reducing pain. The current study examined the within-person relationship between sleep and pain in nurses, and whether trait mindfulness moderates the relationship. Methods Participants were 60 nurses employed at a cancer hospital (Mage=35.35±11.83, 32% reported pain). For 14 consecutive days, ecological momentary assessment collected participants’ sleep characteristics, pain symptoms (i.e., chest pain, headaches, upset stomach, and other pain), and pain interference with daily activities. Trait mindfulness was measured using the 15-item Mindful Attention Awareness Scale. Multilevel modeling decomposed variances at the between- and within-person levels. Results At the between-person level, after controlling for sociodemographic covariates, more frequent insomnia symptoms (β=0.35) or lower sleep sufficiency (β=-0.19) were associated with more pain symptoms (ps&lt;.05). Inversely, individuals with more pain symptoms reported lower sleep sufficiency (β=-0.41, p&lt;.05). At the within-person level, after nights with poorer sleep quality (β=-0.08, p&lt;.01), lower sleep sufficiency (β=-0.08, p&lt;.01), or shorter sleep duration (β =-0.03, p&lt;.05), participants reported more pain symptoms the following day. There were significant interactions of mindfulness with (a) sleep sufficiency predicting pain interference and (b) sleep duration predicting number of pain symptoms, such that the adverse associations of less sufficient and shorter sleep with more pain were more apparent in those with lower mindfulness than those with higher mindfulness. Conclusion Although there was a bidirectional association between sleep and pain at the between-person level, sleep was more likely to be the predictor of pain at the within-person level in oncology nurses. The significant moderation by mindfulness suggest that promoting mindfulness among nurses, prone to having poor sleep and pain, may reduce the adverse impact of poor sleep on daily pain. Support This work was supported, in part, by the University of South Florida College of Behavioral & Community Sciences Internal Grant Program (PI: Lee, Grant No. 0134930).