title: Does loneliness mediate the stress-sleep quality relation? The Hordaland Health Study.
abstract: BACKGROUND
  Sleep problems are common in the general population. A strong association between stress due to inadequate social relationships or loneliness and sleep problems has been found. This paper aims to investigate stress in close social relationships in relation to disrupted sleep patterns in middle-aged and older adults. In addition, in exploring the underlying processes involved in poor social interactions, loneliness is assumed to be a mediator in the stress-sleep quality relation.
  
  
  METHODS
  Data from a community sample of 7074 Norwegian middle-aged and older adults in the Hordaland Health Study (HUSK) were used to examine the mediating role of loneliness.
  
  
  RESULTS
  A significant association between interpersonal stress and both nocturnal sleep problems and daytime sleepiness was found in both age groups. This relation was mediated by loneliness (indirect path) as well as effected by a direct path (RMSEA = 0.051; CFI = 0.93). The size of the indirect effect varied with age. Nocturnal sleep problems were fully mediated by loneliness in the older group, while 74% of the total effect was mediated through loneliness in the middle-aged group. For daytime sleepiness, a partial mediation of 36% and 40% was observed for the two groups respectively.
  
  
  CONCLUSIONS
  The mediation effects found in this study indicate that the wider social aspects of an individual's life should be taken into account when planning interventions for improving sleep quality in the elderly.
authors.affiliation: Faculty of Psychology, University of Bergen, Bergen, Norway.
authors.forename: Mette M
authors.initials: MM
authors.lastname: Aanes
authors.forename: Jørn
authors.initials: J
authors.lastname: Hetland
authors.forename: Ståle
authors.initials: S
authors.lastname: Pallesen
authors.forename: Maurice B
authors.initials: MB
authors.lastname: Mittelmark
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008132:Loneliness / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012890:Sleep; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D012934:Social Isolation / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D014851:Wakefulness