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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 93095

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Dr. Giuseppe Barbato

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Department of Psychology, Università degli Studi della Campania, Luigi Vanvitelli, Viale Ellittico 31, 81100 Caserta, Italy
Interests: sleep; sleep disorders and sleep medicine; circadian rhythms; REM sleep polysomnography; sleep and mood disorders; depression; seasonal affective disorder; EEG signal processing; clinical neurophysiology
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Dear Colleagues,

A “good night’s sleep” is traditionally considered a night with a sufficient sleep duration (seven–eight hours for most individuals) that has provided enough time for the homeostatic restorative process. Although sleep duration is the gold standard to define our sleep need, sleep quality is also an important aspect to be considered, and “sleep efficiency”, the relation between total sleep duration and time spent in bed, an indirect parameter used to judge sleep quality. Recently, the National Sleep Foundation has suggested that individuals should focus on their own sleep quality, highlighting the importance of sleep stability during the night.
Since the main sleep function is to allow a good wake functioning, a measure of sleep quality can also refer to the ability to stay fully awake and adequately perform during the day. It should be considered that sleep quality can not only influence day functioning but also significantly affect mood, resulting in a critical factor to guarantee mental health.
Sleep quality being the result of regular sleep–wake processes, it can also express disturbances of the various systems that allow restfulness and can be significantly altered in several medical illnesses that might disturb such systems. Currently, widespread availability of portable light-emitting devices has been shown to seriously affect circadian timing and disturb sleep quality, adding to the factors that in our 24/7-rhythm society disrupt sleep–wake functions.
Considering the impact that a “good night’s sleep” can have on individual physical and mental health, it now seems appropriate to further focus on sleep quality, addressing all those aspects that can alter normal sleep behavior and its effects on wakefulness. It is also important to highlight the role of sleep quality on cognitive functioning in young subjects who are massively exposed to new devices that profoundly disturb sleep functions. Sleep quality is obviously more difficult to measure than sleep duration, and thus, research should currently also move toward methodologies to assess sleep quality. The improvement of our knowledge on indicators and consequences of a “good night’s sleep” appears today as a hot topic, considering the 24/7 revolution and the consequent shrinkage of the dark period that has reduced the time for restfulness and sleep. Papers addressing these topics are invited for this Special Issue.

Dr. Giuseppe Barbato
Guest Editor

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Keywords

Sleep quality
Sleep homeostasis
Sleep–wake
Wakefulness
Circadian rhythm
Light–dark period
Mood
Light-emitting devices
Sleep disorders
Cognitive performance
Attention
Memory
Circadian misalignment
24/7 schedule

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Related Special Issue

Sleep Quality: A Focus on Sleep Structure in International Journal of Environmental Research and Public Health (2 articles)

Published Papers (11 papers)

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Research

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15 pages, 1970 KiB

Open AccessArticle

Psychological Wellbeing, Worry, and Resilience-Based Coping during COVID-19 in Relation to Sleep Quality

by Olivia H. Tousignant, Sarah W. Hopkins, Abigail M. Stark and Gary D. Fireman

Int. J. Environ. Res. Public Health 2022, 19(1), 50; https://doi.org/10.3390/ijerph19010050 - 21 Dec 2021

Cited by 9 | Viewed by 3298

Abstract

The current study evaluated the impact of psychological wellbeing on sleep quality during the onset of the COVID-19 pandemic. A novel empirical model tested variables that mediate and moderate this impact. First, a relationship was established between psychological wellbeing during the COVID-19 pandemic and sleep quality. Second, resilience-based coping associated with the COVID-19 pandemic was tested as a mediator of the impact of psychological wellbeing on sleep quality. Third, dispositional rumination, mindfulness, and worry were compared as moderators of the impact of psychological wellbeing on sleep quality. Fourth, a moderated mediated model was tested for each moderator. Online survey data was collected from 153 adults in the United States. Results demonstrated that coping with the COVID-19 pandemic partially mediated the impact of psychological wellbeing on sleep quality. Worry, but not rumination or mindfulness, moderated the impact. A moderated mediation model failed to demonstrate significance, indicating that the data are best represented by distinct mediation and moderation models. Thus, interventions aimed at improving sleep quality should prioritize concurrent reduction in worry and increase in resilience-based coping strategies. This study provides practical and theoretical contribution to the literature by demonstrating relationships between key variables and contextualizing how the model can be used for assessments and interventions during widespread crises. Full article

(This article belongs to the Special Issue Sleep Quality Research)

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16 pages, 1122 KiB

Open AccessArticle

Learning Monologues at Bedtime Improves Sleep Quality in Actors and Non-Actors

by Francesca Conte, Oreste De Rosa, Benedetta Albinni, Daniele Mango, Alessia Coppola, Serena Malloggi, Davide Giangrande, Fiorenza Giganti, Giuseppe Barbato and Gianluca Ficca

Int. J. Environ. Res. Public Health 2022, 19(1), 11; https://doi.org/10.3390/ijerph19010011 - 21 Dec 2021

Cited by 1 | Viewed by 2194

Abstract

Several studies show that pre-sleep learning determines changes in subsequent sleep, including improvements of sleep quality. Our aims were to confirm this finding using a more ecological task (learning a theatrical monologue) and to investigate whether the effect is modulated by expertise. Using a mixed design, we compared polysomnographic recordings of baseline sleep (BL, 9-h TIB) to those of post-training sleep (TR, with the same TIB but preceded by the training session), in one group of actors (N = 11) and one of non-actors (N = 11). In both groups, TR appears reorganized and re-compacted by the learning session, as shown, among others, by a significant decrease of WASO%, awakenings, arousals, and state transitions and by a trend towards an increased number of complete cycles and total cycle time. Concerning memory performance, the number of synonyms produced was significantly higher in the morning relative to immediate recall. No between-groups differences emerged either for sleep or memory variables. Our data confirm pre-sleep learning’s beneficial effect on sleep quality in an ecological context. While expertise appears not to influence memory-related sleep mechanisms, results on morning recall support the recent view that sleep’s role in memory processes consists in trace “transformation” for adaptive purposes, rather than rote consolidation. Full article

(This article belongs to the Special Issue Sleep Quality Research)

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15 pages, 370 KiB

Open AccessArticle

Anxiety, Insomnia, and Napping Predict Poorer Sleep Quality in an Autistic Adult Population

by Emma C. Sullivan, Elizabeth J. Halstead, Jason G. Ellis and Dagmara Dimitriou

Int. J. Environ. Res. Public Health 2021, 18(18), 9883; https://doi.org/10.3390/ijerph18189883 - 19 Sep 2021

Cited by 2 | Viewed by 3132

Abstract

Autistic adults have a high prevalence of sleep problems and psychiatric conditions. In the general population sleep problems have been associated with a range of demographic and lifestyle factors. Whether the same factors contribute to different types of disturbed sleep experienced by autistic adults is unknown and served as the main aim of this study. An online survey was conducted with 493 autistic adults. Demographic information (e.g., age, gender), about lifestyle (e.g., napping), and information about comorbid conditions was collected. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the Epworth Sleepiness Scale (ESS) was used to assess daytime somnolence. Stepwise multiple regression analyses were used to examine predictors of each subscale score on the PSQI, as well as PSQI and ESS total scores. Results indicated that individuals who reported having a diagnosis of anxiety and insomnia were more likely to have poorer sleep quality outcomes overall. Furthermore, individuals who reported habitually napping had higher daytime dysfunction, increased sleep disturbances, and increased daytime sleepiness. These results provide novel insights into the demographic and lifestyle factors that influence sleep quality and daytime somnolence in autistic adults and can be used for targeted sleep interventions. Full article

(This article belongs to the Special Issue Sleep Quality Research)

17 pages, 438 KiB

Open AccessArticle

Sleep and Awakening Quality during COVID-19 Confinement: Complexity and Relevance for Health and Behavior

by Teresa Paiva, Cátia Reis, Amélia Feliciano, Hugo Canas-Simião, Maria Augusta Machado, Tânia Gaspar, Gina Tomé, Cátia Branquinho, Maria Raquel Silva, Lúcia Ramiro, Susana Gaspar, Carla Bentes, Francisco Sampaio, Lara Pinho, Conceição Pereira, Alexandra Carreiro, Susana Moreira, Isabel Luzeiro, Joana Pimentel, Gabriela Videira, Júlio Fonseca, Ana Bernarda, Joana Vaz Castro, Sofia Rebocho, Katie Almondes, Helena Canhão and Margarida Gaspar Matos Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(7), 3506; https://doi.org/10.3390/ijerph18073506 - 28 Mar 2021

Cited by 18 | Viewed by 5613

Abstract

Objective: The aim of this study was to evaluate sleep and awakening quality (SQ and AQ) during COVID-19 in a large and diversified population in order to identify significant associations and risks in terms of demography, health and health-related behaviors, sleep variables, mental health, and attitudes. Methods/Results:Online surveys were used for data collection, received from 5479 individuals from the general population, sleep disorder patients, and COVID-involved (medical doctors (MDs) and nurses) and COVID-affected professionals (teachers, psychologists, and dentists). SQ and AQ were worse in adults, females, and high-education subjects. Feeling worse, having economic problems, depression, anxiety, irritability, and a high Calamity Experience Check List (CECL) score during COVID were significantly associated with poor SQ and AQ. Shorter sleep duration, increased latency, poor nutrition, low physical activity, increased mobile and social network use, more negative and less positive attitudes and behaviors were associated with poor AQ. Conclusions: The SQ logistic regression showed gender, morbidities, CECL, and awakenings as relevant, whereas, for AQ, relevant variables further included age and physical activity. Aiming to have a high stress compliance, each individual should sleep well, have important control of their mood, practice positive behaviors while dismissing negative behaviors and attitudes, practice exercise, have adequate nutrition, and beware of technologies and dependences. Full article

(This article belongs to the Special Issue Sleep Quality Research)

16 pages, 3458 KiB

Open AccessArticle

The Effects of Sleep Quality on Dream and Waking Emotions

by Francesca Conte, Nicola Cellini, Oreste De Rosa, Marissa Lynn Rescott, Serena Malloggi, Fiorenza Giganti and Gianluca Ficca

Int. J. Environ. Res. Public Health 2021, 18(2), 431; https://doi.org/10.3390/ijerph18020431 - 7 Jan 2021

Cited by 10 | Viewed by 8223

Abstract

Despite the increasing interest in sleep and dream-related processes of emotion regulation, their reflection into waking and dream emotional experience remains unclear. We have previously described a discontinuity between wakefulness and dreaming, with a prevalence of positive emotions in wakefulness and negative emotions during sleep. Here we aim to investigate whether this profile may be affected by poor sleep quality. Twenty-three ‘Good Sleepers’ (GS) and 27 ‘Poor Sleepers’ (PS), identified through the Pittsburgh Sleep Quality Index (PSQI) cut-off score, completed three forms of the modified Differential Emotions Scale, assessing, respectively, the frequency of 22 emotions over the past 2 weeks, their intensity during dreaming and during the previous day. The ANOVA revealed a different pattern of emotionality between groups: GS showed high positive emotionality in wakefulness (both past 2 weeks and 24 h) with a significant shift to negative emotionality in dreams, while PS showed evenly distributed emotional valence across all three conditions. No significant regression model emerged between waking and dream affect. In the frame of recent hypotheses on the role of dreaming in emotion regulation, our findings suggest that the different day/night expression of emotions between groups depends on a relative impairment of sleep-related processes of affect regulation in poor sleepers. Moreover, these results highlight the importance of including sleep quality assessments in future dream studies. Full article

(This article belongs to the Special Issue Sleep Quality Research)

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15 pages, 893 KiB

Open AccessArticle

Prevalence and Determinants of Bad Sleep Perception among Italian Children and Adolescents

by Serena Malloggi, Francesca Conte, Giorgio Gronchi, Gianluca Ficca and Fiorenza Giganti

Int. J. Environ. Res. Public Health 2020, 17(24), 9363; https://doi.org/10.3390/ijerph17249363 - 14 Dec 2020

Cited by 5 | Viewed by 2538

Abstract

Although sleep problems at young ages are well investigated, the prevalence of bad sleepers and the determinants of sleep quality perception remain unexplored in these populations. For this purpose, we addressed these issues in a sample of children (n = 307), preadolescents (n = 717), and adolescents (n = 406) who completed the School Sleep Habits Survey, addressing sleep quality perception, sleep habits, sleep features, daytime behavior and sleep disturbances, circadian preference, and dreaming. The sample was split in “good sleepers” and “bad sleepers”, based on the answer to the question item assessing overall subjective sleep quality. Being a bad sleeper was reported by 11.7% of the sample, with significant between-groups differences (children: 8.3%; preadolescents: 11.3%; adolescents: 15.3%; p = 0.01). At all ages, relative to good sleepers, bad sleepers showed higher eveningness, sleepiness, and depression, longer sleep latency, more frequent insufficient sleep, nocturnal awakenings, sleep–wake behavioral problems, and unpleasant dreams (all p’s ≤ 0.01). Sleep quality perception was predicted: in children, by depressed mood, eveningness, and unpleasant dreams (all p’s ≤ 0.01); in preadolescents, by sleep latency, awakening frequency, depressed mood, sufficiency of sleep, and unpleasant dreams (all p’s < 0.01); in adolescents, by awakening frequency, depressed mood, and sufficiency of sleep (all p’s < 0.001). In children, bad subjective sleep quality appears to be mainly determined by daytime psychological features, for example, depressed mood, whereas at later ages, sleep characteristics, such as frequent awakenings, add to the former determinants. This could depend on (a) the appearance, with increasing age, of objective sleep modifications and (b) a greater attention paid by adolescents to their sleep characteristics. Full article

(This article belongs to the Special Issue Sleep Quality Research)

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18 pages, 421 KiB

Open AccessArticle

The Role of Sleep Quality, Trait Anxiety and Hypothalamic-Pituitary-Adrenal Axis Measures in Cognitive Abilities of Healthy Individuals

by Javier Labad, Neus Salvat-Pujol, Antonio Armario, Ángel Cabezas, Aida de Arriba-Arnau, Roser Nadal, Lourdes Martorell, Mikel Urretavizcaya, José Antonio Monreal, José Manuel Crespo, Elisabet Vilella, Diego José Palao, José Manuel Menchón and Virginia Soria

Int. J. Environ. Res. Public Health 2020, 17(20), 7600; https://doi.org/10.3390/ijerph17207600 - 19 Oct 2020

Cited by 18 | Viewed by 4513

Abstract

Sleep plays a crucial role in cognitive processes. Sleep and wake memory consolidation seem to be regulated by glucocorticoids, pointing out the potential role of the hypothalamic-pituitary-adrenal (HPA) axis in the relationship between sleep quality and cognitive abilities. Trait anxiety is another factor that is likely to moderate the relationship between sleep and cognition, because poorer sleep quality and subtle HPA axis abnormalities have been reported in people with high trait anxiety. The current study aimed to explore whether HPA axis activity or trait anxiety moderate the relationship between sleep quality and cognitive abilities in healthy individuals. We studied 203 healthy individuals. We measured verbal and visual memory, working memory, processing speed, attention and executive function. Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Trait anxiety was assessed with the State-Trait Anxiety Inventory. HPA axis measures included the cortisol awakening response (CAR), diurnal cortisol slope and cortisol levels during the day. Multiple linear regression analyses explored the relationship between sleep quality and cognition and tested potential moderating effects by HPA axis measures and trait anxiety. Poor sleep quality was associated with poorer performance in memory, processing speed and executive function tasks. In people with poorer sleep quality, a blunted CAR was associated with poorer verbal and visual memory and executive functions, and higher cortisol levels during the day were associated with poorer processing speed. Trait anxiety was a moderator of visual memory and executive functioning. These results suggest that subtle abnormalities in the HPA axis and higher trait anxiety contribute to the relationship between lower sleep quality and poorer cognitive functioning in healthy individuals. Full article

(This article belongs to the Special Issue Sleep Quality Research)

Review

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12 pages, 366 KiB

Open AccessReview

REM Sleep: An Unknown Indicator of Sleep Quality

by Giuseppe Barbato

Int. J. Environ. Res. Public Health 2021, 18(24), 12976; https://doi.org/10.3390/ijerph182412976 - 9 Dec 2021

Cited by 27 | Viewed by 13319

Abstract

Standard polysomnographic analysis of sleep has not provided evidence of an objective measure of sleep quality; however, factors such as sleep duration and sleep efficiency are those more consistently associated with the subjective perception of sleep quality. Sleep reduction as currently occurs in our 24/7 society has had a profound impact on sleep quality; the habitual sleep period should fit within what is a limited nighttime window and may not be sufficient to satisfy the whole sleep process; moreover, the use of artificial light during the evening and early night hours can delay and disturb the circadian rhythms, especially affecting REM sleep. The correct phase relationship of the sleep period with the circadian pacemaker is an important factor to guarantee adequate restorative sleep duration and sleep continuity, thus providing the necessary background for a good night’s sleep. Due to the fact that REM sleep is controlled by the circadian clock, it can provide a window-like mechanism that defines the termination of the sleep period when there is still the necessity to complete the sleep process (not only wake-related homeostasis) and to meet the circadian end of sleep timing. An adequate amount of REM sleep appears necessary to guarantee sleep continuity, while periodically activating the brain and preparing it for the return to consciousness. Full article

(This article belongs to the Special Issue Sleep Quality Research)

50 pages, 1398 KiB

Open AccessReview

Measuring Subjective Sleep Quality: A Review

by Marco Fabbri, Alessia Beracci, Monica Martoni, Debora Meneo, Lorenzo Tonetti and Vincenzo Natale

Int. J. Environ. Res. Public Health 2021, 18(3), 1082; https://doi.org/10.3390/ijerph18031082 - 26 Jan 2021

Cited by 250 | Viewed by 38153

Abstract

Sleep quality is an important clinical construct since it is increasingly common for people to complain about poor sleep quality and its impact on daytime functioning. Moreover, poor sleep quality can be an important symptom of many sleep and medical disorders. However, objective measures of sleep quality, such as polysomnography, are not readily available to most clinicians in their daily routine, and are expensive, time-consuming, and impractical for epidemiological and research studies., Several self-report questionnaires have, however, been developed. The present review aims to address their psychometric properties, construct validity, and factorial structure while presenting, comparing, and discussing the measurement properties of these sleep quality questionnaires. A systematic literature search, from 2008 to 2020, was performed using the electronic databases PubMed and Scopus, with predefined search terms. In total, 49 articles were analyzed from the 5734 articles found. The psychometric properties and factor structure of the following are reported: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Mini-Sleep Questionnaire (MSQ), Jenkins Sleep Scale (JSS), Leeds Sleep Evaluation Questionnaire (LSEQ), SLEEP-50 Questionnaire, and Epworth Sleepiness Scale (ESS). As the most frequently used subjective measurement of sleep quality, the PSQI reported good internal reliability and validity; however, different factorial structures were found in a variety of samples, casting doubt on the usefulness of total score in detecting poor and good sleepers. The sleep disorder scales (AIS, ISI, MSQ, JSS, LSEQ and SLEEP-50) reported good psychometric properties; nevertheless, AIS and ISI reported a variety of factorial models whereas LSEQ and SLEEP-50 appeared to be less useful for epidemiological and research settings due to the length of the questionnaires and their scoring. The MSQ and JSS seemed to be inexpensive and easy to administer, complete, and score, but further validation studies are needed. Finally, the ESS had good internal consistency and construct validity, while the main challenges were in its factorial structure, known-group difference and estimation of reliable cut-offs. Overall, the self-report questionnaires assessing sleep quality from different perspectives have good psychometric properties, with high internal consistency and test-retest reliability, as well as convergent/divergent validity with sleep, psychological, and socio-demographic variables. However, a clear definition of the factor model underlying the tools is recommended and reliable cut-off values should be indicated in order for clinicians to discriminate poor and good sleepers. Full article

(This article belongs to the Special Issue Sleep Quality Research)

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27 pages, 762 KiB

Open AccessReview

Good Places to Live and Sleep Well: A Literature Review about the Role of Architecture in Determining Non-Visual Effects of Light

by Laura Bellia and Francesca Fragliasso

Int. J. Environ. Res. Public Health 2021, 18(3), 1002; https://doi.org/10.3390/ijerph18031002 - 23 Jan 2021

Cited by 22 | Viewed by 4842

Abstract

Light plays a crucial role in affecting the melatonin secretion process, and consequently the sleep–wake cycle. Research has demonstrated that the main characteristics of lighting affecting the so-called circadian rhythms are spectrum, light levels, spatial pattern and temporal pattern (i.e., duration of exposure, timing and previous exposure history). Considering that today people spend most of their time in indoor environments, the light dose they receive strictly depends on the characteristics of the spaces where they live: location and orientation of the building, dimensions of the windows, presence of external obstructions, geometric characteristics of the space, optical properties of walls and furniture. Understanding the interaction mechanism between light and architecture is fundamental to design non-visually comfortable spaces. The goal of the paper is to deepen this complex issue. It is divided into two parts: a brief historical excursus about the relationship between lighting practice and architecture throughout the centuries and a review of the available research works about the topic. The analysis demonstrates that despite the efforts of the research, numerous open questions still remain, and they are mostly due to the lack of a shared and clear method to evaluate the effects of lighting on circadian rhythm regulation. Full article

(This article belongs to the Special Issue Sleep Quality Research)

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26 pages, 464 KiB

Open AccessReview

Patient Reported Outcome Measures of Sleep Quality in Fibromyalgia: A COSMIN Systematic Review

by Carolina Climent-Sanz, Anna Marco-Mitjavila, Roland Pastells-Peiró, Fran Valenzuela-Pascual, Joan Blanco-Blanco and Montserrat Gea-Sánchez

Int. J. Environ. Res. Public Health 2020, 17(9), 2992; https://doi.org/10.3390/ijerph17092992 - 26 Apr 2020

Cited by 20 | Viewed by 5469

Abstract

Poor sleep quality is a common concern and a troublesome symptom among patients suffering from fibromyalgia. The purpose of this review was to identify and describe the available patient reported outcome measures (PROMs) of sleep quality validated in adult people diagnosed with fibromyalgia. The COSMIN and PRISMA recommendations were followed. An electronic systematized search in the electronic databases PubMed, Scopus, CINAHL Plus, PsycINFO, and ISI Web of Science was carried out. Validation studies of PROMs of sleep quality in fibromyalgia published in English or Spanish were included. The selection of the studies was developed through a peer review process through the online software “COVIDENCE”. The quality of the studies was assessed using the COSMIN Risk of Bias checklist. A total of 5 PROMs were found validated in patients with fibromyalgia: (1) Pittsburgh Sleep Quality Index (PSQI), (2) Jenkins Sleep Scale (JSS), (3) Sleep Quality Numeric Rating Scale (SQ-NRS), (4) Medical Outcomes Study-Sleep Scale (MOS-SS), and (5) Fibromyalgia Sleep Diary (FSD). The quality of the evidence was very good and the quality of the results ranged from moderate to high. All the included PROMs, except for the FSD, showed adequate psychometric properties and, therefore, are valid and reliable tools for assessing sleep quality in the context of FM. However, none of the studies analyzed all the psychometric properties of the included PROMs as established in the COSMIN guidelines, highlighting that this is a potential field of research for future investigations. Full article

(This article belongs to the Special Issue Sleep Quality Research)

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