Aim
The aim of this study was to develop and validate a Japanese version of the Athens Insomnia Scale (AIS‐J).
Methods
The AIS‐J was created using a back‐translation design. A total of 477 ...outpatients with chronic insomnia and 163 individuals from the general community were recruited. Participants were asked to complete the AIS‐J along with two other insomnia scales – Japanese versions of the Pittsburgh Sleep Quality Index and the Insomnia Severity Index.
Results
The AIS‐J consisted of a two‐factor structure: ‘nocturnal sleep problem’ (items 1–5) and ‘daytime dysfunction’ (items 6–8). Internal consistencycoefficients ranged from 0.78 to 0.88. Correlations between the AIS‐J and the aforementioned authorized scales were 0.81 and 0.85, respectively. Scores on the AIS‐J were significantly higher for the insomnia group than for the control group. The AIS‐J cut‐off value for identifying pathological insomnia was estimated at 6 points or more, and the AIS‐J‐nocturnal cut‐off value was estimated at 4 points or more.
Conclusions
The AIS‐J has sufficient validity and diagnostic utility.
Previous meta-analyses have shown the effectiveness of cognitive behavioral therapy for insomnia (CBT-I). However, conclusive information about therapeutic effects (especially during follow-up), ...effect sizes of objective sleep parameters and self-rating scales, and the problem of publication bias has not been obtained. We conducted a meta-analysis focusing on these issues. We identified 14 randomized controlled studies published between 1990 and 2009 that fulfilled our selection criteria. Intra-group comparison of CBT-I and comparison between CBT-I and control groups were performed on these studies. The intra-group comparison revealed that the effect sizes of CBT-I for subjective sleep variables from sleep diaries were medium to large at the end point of treatment, and these effect sizes were favorably maintained on follow-up. A between-group comparison revealed that CBT-I was more effective than the control for subjective sleep variables at the end of treatment and that its effectiveness was also recognized on follow-up. With regard to self-rating scales, as compared to the control group, the effect sizes in the CBT-I group were medium to large both at the end of treatment and on follow-up. However, there were problems of publication bias in some of the subjective or objective sleep variables. The abovementioned results support the effectiveness of CBT-I for the treatment and prevention of relapse of primary insomnia despite the existence of a certain publication bias.
Several studies have assessed the effects of milk and dairy product intake on sleep quality and duration. Such investigations have varied in terms of their geographic locations, amounts of milk and ...dairy products, study participants (age, sex, race), and study designs. The present study aimed to summarize this literature and provide a unified view on whether the intake of milk and dairy products affects sleep quality. This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The following keywords were chosen as electronic database search items from MeSH (medical subject headings) terms and descriptors in health sciences (DeHS) lists: milk, yogurt, dairy product, cheese, sleep, human, observational study, and interventional study. As a result, a total of 14 studies published between 1972 and 2019 were included in this review, including eight randomized controlled trials, two experimental studies with cross-over designs, one longitudinal study, and three cross-sectional studies. Four studies targeted older adults, three included toddlers, two targeted children, and six enrolled adults inclusive of university students. Overall, these studies indicated that a well-balanced diet that includes milk and dairy products is effective in improving sleep quality, despite mixed results across studies attributable to differences in study populations and methods.
Sleep debt is associated with presenteeism and mental health; however, the association of sleep debt with presenteeism and well-being in the context of work-related social factors (commuting time, ...workdays, and working hours) has not been fully elucidated. This study aimed to examine whether work-related social factors are associated with presenteeism and well-being via sleep debt. The participant group comprised 872 full-time and 526 part-time workers (mean age: 44.65 ± 12.37 and 48.47 ± 12.93 years, respectively). For both the full-time and part-time workers, increased sleep debt was significantly associated with presenteeism (β = -0.171; β = -0.160) and low well-being (β = -0.135; β = -0.153). Notably, commuting time was significantly associated with increased sleep debt in full-time workers (β = 0.09). In contrast, the number of workdays was significantly associated with increased sleep debt in part-time workers (β = -0.102). Working hours were not significantly associated with sleep debt for both full- and part-time workers. These results reveal that sleep debt might lead to various risks among workers, elucidating the work-related social factors related to sleep debt. They also highlight the importance of considering work-related social factors when addressing sleep debt.
Misalignment between an individual’s circadian phase and his/her environment due to social imposition is called social jetlag (SJL). SJL has emerged as a public health concern, as it contributes to ...an unhealthy lifestyle and adverse health outcomes. This study aimed to elucidate the percentage of SJL in a large Japanese population using the Japanese version of the Munich ChronoType Questionnaire (MCTQ). A total of 10,000 participants responded to a web-based cross-sectional survey, and the final sample comprised 3708 participants (60.1% male; average age 45.1 SD 13.4 years). SJL was measured by subtracting each participant’s midpoint of sleep on workdays from their midpoint of sleep on free days. The average SD absolute SJL (SJLabs) value was 0.91 0.89 hours, and the percentage of participants with SLJabs of more than 1 h was 40.1%. Our data also showed that SJLabs becomes progressively smaller with advancing age. A considerable number of participants of our Japanese population showed differences in sleep behavior between workdays and free days. Young people in particular commonly oversleep on free days to compensate for the sleep debt accumulated over the workweek because of their late chronotype.
Although cognitive behavioral therapy (CBT-I) has been recommended for the treatment of insomnia comorbid with psychiatric disorders and medical diseases, the effectiveness of CBT-I in such cases ...remains to be established. To fill this gap in the literature, we conducted a meta-analysis on the efficacy of CBT-I in the remediation of insomnia severity, important disease-related symptoms, and quality of life (QoL) in comorbid insomnia. A comprehensive literature search identified 30 randomized controlled trials (RCT) that were eligible for inclusion in the final analyses. Effect sizes were computed with Hedges’
g
, and study quality was evaluated using the Jadad scale. Analysis revealed that the effect sizes of the treatment were medium to large for important disease-related symptoms (
g
= 0.60), insomnia severity (
g
= 0.94), subjective and objective sleep onset latency (
g
= 0.65 and
g
= 0.51, respectively), subjective waking after sleep onset (
g
= 0.61), subjective and objective sleep efficiency (
g
= 0.83 and g = 0.48, respectively), and sleep quality (
g
= 0.80), but was small for health-related QoL (
g
= 0.34) compared with a control group. At follow-up, the effect sizes of CBT-I were large for all outcome variables, but several large and significant heterogeneities were confirmed. CBT-I is an effective treatment for reducing the severity of insomnia and important disease-related symptoms of comorbid insomnia.
Background
COVID-19-related anxiety, sleep problems, and loneliness may be risk factors for school refusal in children and adolescents. However, few studies have examined the mechanisms by which ...these risk factors cause school refusal. This study examined the process by which COVID-19-related anxiety, sleep problems, and loneliness cause school refusal, using structural equation modeling.
Methods
In this cross-sectional questionnaire-based study, 256 (109 male, 147 female, mean age: 15.37 ± 0.48 years) senior high school students were asked to complete the Stress and Anxiety associated with Viral Epidemics-6 questionnaire to assess COVID-19-related anxiety, the Athens Insomnia Scale (AIS), Sleep Debt Index (SDI), and chronotype (MSFsc) to assess sleep problems, the Three-Item Loneliness Scale (TILS) to assess loneliness, and Feelings of School-Avoidance Scale (FSAS) to assess school refusal.
Results
Structural equation modeling showed that sleep problems affected loneliness (β = 0.52) and feelings of school refusal (β = 0.37), and that loneliness affected feelings of school refusal (β = 0.47). There was no significant pathway of COVID-19-related anxiety on sleep problems, loneliness, or feelings of school refusal. The indirect effect of sleep problems on feelings of school refusal through loneliness was significant. The results of hierarchical multiple regression analysis showed that AIS (β = 0.30) and SDI (β = 0.13) scores were associated with TILS, and AIS (β = 0.26) and MSFsc (β = −0.14) scores were associated with FSAS scores.
Conclusion
The findings of this study showed that sleep problems affected feelings of school refusal
via
both direct and indirect pathways through the exacerbation of loneliness. To prevent school refusal in adolescents, addressing the indirect pathway
via
loneliness could be effective in improving insomnia and sleep debt, while addressing the direct pathway could be effective in improving insomnia and chronotype.
The present study examined to examine whether improvement of insomnia is mediated by a reduction in sleep-related dysfunctional beliefs through cognitive behavioral therapy for insomnia. In total, 64 ...patients with chronic insomnia received cognitive behavioral therapy for insomnia consisting of 6 biweekly individual treatment sessions of 50 minutes in length. Participants were asked to complete the Athens Insomnia Scale and the Dysfunctional Beliefs and Attitudes about Sleep scale both at the baseline and at the end of treatment. The results showed that although cognitive behavioral therapy for insomnia greatly reduced individuals' scores on both scales, the decrease in dysfunctional beliefs and attitudes about sleep with treatment did not seem to mediate improvement in insomnia. The findings suggest that sleep-related dysfunctional beliefs endorsed by patients with chronic insomnia may be attenuated by cognitive behavioral therapy for insomnia, but changes in such beliefs are not likely to play a crucial role in reducing the severity of insomnia.
The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) might be applicable for assessing delayed sleep-wake phase disorder (DSWPD). We aimed to investigate the reliability and ...validity of the Japanese version of the BRIAN self-report (J-BRIAN-SR) in DSWPD patients and determine a cutoff score to identify the presence of the disorder.
We enrolled 60 newly diagnosed DSWPD outpatients and 64 age-matched healthy controls. We used Cronbach's alpha for internal reliability to evaluate J-BRIAN-SR. We confirmed the reliability of the A test and re-test using Pearson's correlation coefficient in the controls. We used confirmatory factor analysis to evaluate the factor structure of J-BRIAN-SR and referenced the Morningness-Eveningness Questionnaire (MEQ) to check concurrent validity. We analyzed the receiver operating characteristic curve (ROC) to determine the J-BRIAN-SR cutoff point for the presence of DSWPD.
The 18-component scores of the J-BRIAN-SR had an overall reliability coefficient (Cronbach's alpha) of 0.82. We confirmed a high test-retest reliability using an intraclass correlation coefficient (r = 0.84). The correlation between J-BRIAN-SR and MEQ was 0.38 (p = 0.003). The J-BRIAN-SR that we extracted by exploratory factor analysis consisted of three factors. A score of 40 points provided a sensitivity of 80.0% and a specificity of 75.6% for the positivity of DSWPD.
The results of the present study revealed that J-BRIAN-SR is a valid and reliable instrument for screening and evaluating the severity of DSWPD. Our findings will be useful to physicians and patients in Japan and those in clinical settings.
•We aimed to develop the Japanese version of the BRIAN in DSWPD patients.•We tested our version's reliability and stability on 60 patients and 64 controls.•Our version had adequate reliability and fair stability.•A cutoff score of 40 on our J-BRIAN-SR indicated DSWPD.
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