Improving university students’ mental health using multi-component and single-component sleep interventions: A systematic review and meta-analysis

University is a time of significant transitions during a young adult's life, with delayed and shortened sleep and poor mental health a common occurrence. This systematic review and meta-analysis examined the effect of both multi-component and single-component sleep interventions on improving university students' sleep and mental health. Five databases (MEDLINE, PsycINFO, Embase, CINAHL and Cochrane Library) were searched for relevant literature published until April 2022. Treatment studies including university students aged 18–24 years, participating in a sleep intervention (multi-component, e.g., CBT-I, or single-component, e.g., sleep hygiene) were eligible. Comparator groups were either active, i.e., alternative intervention, or passive, i.e., waitlist control or treatment-as-usual, with study outcomes to include measures of sleep and mental health. Of 3435 references screened, 11 studies involving 5267 participants, with and without insomnia symptoms, were included for a narrative synthesis on intervention designs and methodology. Six studies eligible for meta-analyses showed a moderate effect of sleep interventions in reducing sleep disturbance (SMD = −0.548 [CI: −0.837, −0.258]) at post-treatment, alongside a small effect in improving anxiety (SMD = −0.226 [CI: −0.421, −0.031]) and depression (SMD = −0.295 [CI: −0.513, −0.077]). Meta-regression examining study and intervention characteristics identified subpopulation (experiencing insomnia or not) as a significant moderator for effects on sleep (p = 0.0003) and depression (p = 0.0063), with larger effects in studies with participants experiencing insomnia. Comparison group type (active or passive) was also a significant moderator (p = 0.0474), with larger effects on sleep in studies using passive comparison groups. Study type, delivery format, and intervention duration were not identified as significant moderators. At follow-ups, small but significant effects were sustained for anxiety and depression. Protecting and promoting sleep amongst university students may help safeguard and advance mental health

Bidirectional association between disturbed sleep and neuropathic pain symptoms: a prospective cohort study in post-total joint replacement participants

Disturbed sleep is strongly correlated with chronic pain. The aim of this study was to examine the association between sleep disturbance and incident joint pain focusing on neuropathic pain-like symptoms. 423 individuals who had undergone total joint replacement (TJR) for osteoarthritis (OA) were assessed 3.6 years post-surgery, using the Medical Outcomes Survey sleep subscale, the WOMAC and PainDETECT instruments, and again 5.9 years post-TJR. Cox hazards ratios (HR) and 95% confidence intervals (CIs) were computed adjusting for age, BMI, sex, use of hypnotic and analgesic medication. The presence of neuropathic pain symptoms predicted incidence of disturbed sleep after adjustment for covariates and pain severity (aHR 2.01, 95% CI: 1.00-4.10 p<0.05). There was no association between joint pain and incidence of disturbed sleep when individuals with neuropathic pain symptoms at baseline visit were excluded (aHR 1.11, 95% CI: 0.47-2.67). Disturbed sleep at baseline predicted incident neuropathic joint pain symptoms (aHR 2.75, 95% CI: 1.21-6.26; p<0.016) but had no effect on incidence of joint pain when all types of pain were considered together (aHR 0.63, 95%CI: 0.30-1.39). These data suggest a causal bidirectional link between sleep disturbance and joint pain with neuropathic features, but not with other types of joint pain

Impact of musculoskeletal pain on insomnia onset: a prospective cohort study

Objective. pain, the most common manifestation of rheumatological conditions, is highly prevalent among older adults, with worse health outcomes found in those with co-morbid insomnia. Proactive prevention of insomnia may reduce the overall disease burden of pain and rheumatological conditions. To inform such development, this study examined the role of pain, physical limitation and reduced social participation in predicting and mediating insomnia onset.Methods. a prospective cohort study was conducted involving 6676 individuals ≥50 years of age who completed questionnaires at baseline and a 3-year follow-up. Participants were classified into none, some and widespread pain according to the ACR criteria. Logistic regression was used to examine the relationship between baseline pain and insomnia onset at 3 years. Path analysis was used to test for the mediating role of physical limitation and social participation restriction.Results. some [adjusted odds ratio (AOR) 1.57 (95% CI 1.15, 2.13)] and widespread [2.13 (1.66, 3.20)] pain increased the risk of insomnia onset at 3 years, after adjusting for age, gender, socio-economic class, education, anxiety, depression, sleep and co-morbidity at baseline. The combination of physical limitation and reduced social participation explained up to 68% of the effect of some pain on insomnia onset and 66% of the effect of widespread pain on insomnia onset.Conclusion. there was a dose–response association between the extent of pain at baseline and insomnia onset at 3 years that was substantially mediated by physical limitation and reduced social participation. Targeting physical limitation and social participation in older people with pain may buffer co-morbid insomnia, reducing the overall disease burden