{
  "abstract": "BackgroundBidirectional next-day associations between sleep disturbances and affective symptoms have been shown in previous research, yet the consecutive day effects between these factors remains poorly understood.\n\nMethodsWe analysed longitudinal ecological momentary assessment (EMA) data obtained from a subsample of young persons in the Brazilian High-Risk Cohort (BHRC) study collected in 2020-2021. Participants reported sleep quality each morning and rated affective symptoms relating to mood, anxiety, and energy four times daily for 28 days. We selected 88 individuals (17.83{+/-}1.74 years, 56 [63.6%] female gender) with at least one instance where individuals were observed three-days in a row. Within-person bidirectional next-day effects between sleep quality and affective symptoms were estimated using mixed-effects regression analysis adjusting. We then applied g-estimation approaches to estimate the effect that lagged sleep quality and consecutive improvements in sleep quality had on affective symptoms.\n\nResultsSleep quality and affective symptoms had bidirectional next-day effects, with sleep quality tending to have greater influence on affective symptoms than the reverse. Improved lagged sleep quality had positive effects on affective symptoms incrementally above the prior nights sleep quality. Also, improvement of sleep quality across consecutive days had incremental and approximately equal effects on affective symptoms.\n\nConclusionsSleep quality and affective symptoms exhibit a feedback loop, whereby poor sleep quality influences affective symptoms over consecutive days. Breaking these feedback loops, by improving sleep quality across several consecutive nights should improve affective symptoms. This supports interventions that target sustained improvement in sleep and possibly circadian regulation to improve affective symptoms.",
  "abstract_shown": true,
  "affiliations": [
    "Brain and Mind Centre, The University of Sydney"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "M. R. Varidel"
    },
    {
      "name": "L. Borgnolo"
    },
    {
      "name": "V. An"
    },
    {
      "name": "J. S. Carpenter"
    },
    {
      "name": "I. B. Hickie"
    },
    {
      "name": "P. M. Pan"
    },
    {
      "name": "F. da Silva"
    },
    {
      "name": "J. J. Crouse"
    },
    {
      "name": "E. C. Miguel"
    },
    {
      "name": "L. A. Rohde"
    },
    {
      "name": "G. A. Salum"
    },
    {
      "name": "F. Iorfino"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7ansjyjddqz47.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.07.14.26358099",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.07.14.26358099v2.full",
  "id": "7ansjyjddqz47",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.07.14.26358099v2",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "psychiatry and clinical psychology"
    ],
    [
      "openalex",
      "3205|Sleep and related disorders"
    ]
  ],
  "openalex": "W7168919858",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.07.14.26358099v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-14",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7ansjyjddqz47.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:42Z",
      "native_id": "10.64898/2026.07.14.26358099",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.07.14.26358099v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:psychiatry and clinical psychology",
      "subfield": "psychiatry"
    }
  ],
  "title": "Consecutive day effects between sleep quality and affective symptoms among youth in the Brazilian High-Risk Cohort study",
  "title_text": "Consecutive day effects between sleep quality and affective symptoms among youth in the Brazilian High-Risk Cohort study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:42Z",
  "url": "https://research.draconitic.com/paper/7ansjyjddqz47",
  "venue": "medRxiv",
  "versions": []
}