Taylor F. D. Vigoureux

Summary: Previous research shows that adults with children have poorer sleep overall than adults without children. Poorer sleep is associated with experiencing more frequent and severe stressors. The daily link between sleep and stressors may differ by parenting status; yet this potential difference has not been addressed, especially in nurses who provide care both at work and home. This study examined whether the sleep–stress relationship is stronger for nurses with children than those without. During 14 days of ecological momentary assessment, 60 hospital nurses (24 parents) reported their previous night's sleep characteristics upon waking. Three times daily, they also reported whether they encountered any stressors and how severe those stressors were. Associations were assessed at the within‐ and between‐person levels with parenting status as a between‐person moderator. After controlling for covariates, previous night's poorer sleep quality, lower sleep sufficiency, and shorter time in bed were associated with perceiving more frequent or severe stressors the following day. Some of these daily associations were moderated by parenting status, such that the sleep–stressor link was only significant for parents, with the magnitude of association being stronger for those with 2+ children relative to 1 child. These findings suggest that nurses with children are at greater risk for a stronger linkage between poorer sleep and greater stressor frequency and severity. A stronger sleep–stressor relationship could have compounding effects on health. Improving sleep in this group may be critical to reduce their stress and improve the quality of care across work and home.

Background: Mandated 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. Objectives: We 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. Methods: Using 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. Results: Adherence 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. Discussion: Findings 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.

Sleep and stress are predictors of daily physical and emotional well-being, but few studies assess both simultaneously. This study examined individual and joint associations of daily sleep and stress with daily well-being (DWB) in hospital nurses. Nurses (n = 60) participated in a 14-day ecological momentary assessment and actigraphy study. Multilevel modeling revealed associations of stressor severity and poor sleep health with DWB, independent of and coupled with each other, at within- and between-person levels. Greater stressor severity or poorer sleep health, independent of each other, were associated with more physical symptoms, less positive affect (PA), and more negative affect (NA). Joint associations of stress and sleep with DWB were observed: PA was lowest when higher stressor severity was coupled with poorer sleep health; NA was lowest when lower stressor severity was coupled with better sleep health. Findings suggest the importance of considering both sleep and stress for DWB in hospital nurses.

Objectives: We examined associations between job strain and cognitive aging in a sample of older Puerto Ricans. Methods: Members of the Puerto Rican Elderly: Health Conditions study, aged 60–100 years at baseline, participated. Job strain indicators were quantified from O*NET (n = 1632) and a matrix of Job Content Questionnaire scores (JCQ; n = 1467). Global cognition was assessed twice across 4 years. Results: Controlling for age, sex, depressive symptoms, financial problems, hypertension, diabetes, childhood economic hardship, low job control and high job strain were consistently associated with greater cognitive decline. Adding education attenuated these associations. High education strengthened the JCQ job control-cognitive change link. Discussion: Low job control and high job strain may accelerate cognitive aging in this population. However, it may be more difficult to disentangle the intersecting roles of education and job strain in cognitive aging among older Puerto Ricans relative to older adults from contiguous United States or Europe.

Chronic stress at work, represented by job strain, has been associated with adverse late-life cognitive outcomes in the United States and Western Europe. We examined the relationship between job strain and change in cognition in a less affluent, Hispanic sample of adults aged 60-100 from mainland Puerto Rico. Job strain indicators (i.e., job demands/job control/job strain) were quantified from (a) standardized occupation-based job strain scores from Karasek’s Job Content Questionnaire (JCQ; n=1102), and (b) O*Net variables forming factors of job demands and job control (n=1639). Occupation information, covariates, and cognition came from the Puerto Rican Elderly Health Conditions (PREHCO) Study conducted in 2002-2003, with cognition follow-up in 2006-2007. All analyses controlled for age, sex, baseline depressive symptoms, baseline financial problems, and childhood economic hardship. Across both operationalizations of job strain indicators, higher job control was associated with less decline in late-life cognition (JCQ: b=.18, p<.05; O*Net: b=.31, p<.001) until controlling for education (JCQ: b=.09, p=.248; O*Net: b=.12, p=.097). Job strain was associated with more decline in cognition (JCQ: b=-.75, p<.05; O*Net: b=-.87, p<.05) until controlling for education (JCQ: b=-.49, p=.098; O*Net: b=-.46, p=.262). For Karasek’s measure, the relationships were driven by more educated participants. Job control was related to less cognitive decline whereas strain related to more decline among older Puerto Ricans over four years, whether assessed with JCQ-based or O*Net-based scores. However, education emerged as more important for change in late-life cognition than job strain indicators overall, suggesting results that diverge from countries with higher average socioeconomic status.

Summary: There is evidence that insufficient sleep and more stressors are individually associated with poor metabolic health outcomes. Examining sleep and stressors jointly may account for greater variability in health outcomes; however, we know little about the combined effect of both insufficient sleep and more stressors on metabolic health. This study examined whether experiencing more stressors in response to insufficient sleep (“stressor reactivity to insufficient sleep”) was associated with body mass index in middle‐aged workers. One‐hundred and twenty‐seven participants (M_age = 45.24 ± 6.22 years) reported nightly sleep characteristics and daily stressors on 8 consecutive days. We collected height and weight measurements to calculate body mass index (kg m−²). On average, workers reported more stressors following nights with shorter‐than‐usual sleep duration or poorer‐than‐usual sleep quality (negative slope means higher stressor reactivity to insufficient sleep). When examining stressor reactivity to insufficient sleep with insufficient sleep represented by shorter‐than‐usual sleep duration, compared with those with average stressor reactivity to insufficient sleep (within ±½ SD; reference), workers with high stressor reactivity to insufficient sleep (≤−½ SD) had higher body mass index (B = 3.24, p < .05). The body mass index of these workers fell in the obese range. There was no difference in body mass index between workers with low stressor reactivity to insufficient sleep (≥+½ SD) and the reference group. When examining stressor reactivity to insufficient sleep with insufficient sleep represented by poorer‐than‐usual sleep quality, stressor reactivity to insufficient sleep was not significantly associated with body mass index. Results suggest that middle‐aged workers with higher stressor reactivity to insufficient sleep duration may be at greater risk for obesity. Results may inform future studies on interventions for improving sleep and reducing stress in middle‐aged workers.