Journal of Sleep Research最新文献

Mandibular advancement devices are an effective treatment option for obstructive sleep apnea. While their efficacy depends on the degree of mandibular protrusion, other contributing factors influencing the optimal outcome are not fully understood. This magnetic resonance imaging-based pilot study aimed at investigating whether there are promising planimetric parameters that may be related to the optimal therapeutic position. A second aim was to assess possible sex-specific differences. Planimetric data from magnetic resonance imaging taken in the habitual position and four protrusion grades were collected from 11 female and 14 male patients with obstructive sleep apnea (age 45 ± 13.3 years; body mass index 27.6 ± 4.5 kg m^-2). Data were correlated with outcome as substantiated by polygraphic data obtained at the habitual position and at each of two protrusion positions considered to reveal the highest treatment effect. Protrusion degree and lateral widening of the retropalatal region correlated most strongly (R = 0.56, p < 0.001). Relationships between planimetric data and treatment success were most pronounced at the level of the smallest cross-section, expressed, for example, by a correlation between oxygen desaturation index and lateral diameter (R = -0.4, p = 0.012). Female participants appeared to show improved polygraphic values at a lower protrusion degree than males. Data from magnetic resonance imaging allow for a comprehensive analysis combining insights from planimetric velopharyngeal measurements at different individual protrusion grades and correlation with outcome. The results of this pilot work encourage further evaluation in large-scale studies. These should focus on the velopharyngeal region and investigate the influence of sex more closely.

This study compared the effects of sleeping in the supine position and rapid eye movement sleep on the severity of obstructive sleep apnea, and investigated the effect of sleep stage on position-dependent obstructive sleep apnea, and of sleep position on rapid eye movement-dependent obstructive sleep apnea. We analysed epoch-labelled polysomnographic readouts of 3843 patients, and calculated the apnea-hypopnea index for each sleep position and sleep stage. Subgroup analyses were performed to evaluate whether the proportion of position-dependent obstructive sleep apnea patients changed during rapid eye movement and non-rapid eye movement sleep, and whether that of rapid eye movement-dependent obstructive sleep apnea patients changed during supine/lateral sleep. The apnea-hypopnea index was highest in the rapid eye movement-supine position (50.7 ± 22.6 events per hr), followed by non-rapid eye movement-supine, rapid eye movement-lateral and non-rapid eye movement-lateral (39.2 ± 25.3, 22.9 ± 24.4, 15.9 ± 21.9 events per hr, respectively; p < 0.001). Patients with position-dependent obstructive sleep apnea had a higher ratio of rapid eye movement sleep, and those with rapid eye movement-dependent obstructive sleep apnea had a higher ratio of sleep time in the supine position (p < 0.001). During rapid eye movement sleep, position-dependent obstructive sleep apnea was not observed in 21.1% of patients who otherwise had position-dependent obstructive sleep apnea. In the lateral position, 36.9% of patients with rapid eye movement-dependent obstructive sleep apnea did not retain rapid eye movement dependency. Although sleeping in the supine position and rapid eye movement sleep were both associated with more frequent respiratory events, this was the first study to demonstrate that the former had a stronger correlation with obstructive sleep apnea severity. Position dependency in patients with obstructive sleep apnea decreased during rapid eye movement sleep, and worsening of rapid eye movement dependency was alleviated in the lateral position, suggesting potential for personalized obstructive sleep apnea management.

Prior studies evaluating sleep quality have found that women often have better polysomnography-defined sleep quality than men, but women subjectively report a greater frequency of sleep disturbances. Although these studies can be partially attributed to study design, it is currently unclear what may be causing these discrepancies. In this study, we aim to identify potential differences in objectively assessed sleep quality between men and women with further emphasis on subgroup analysis based on age. We hypothesize that women's sleep worsens after menopause. Sleep quality was assessed by comparing the Sleep Quality Index, Arousal Index, sleep efficiency and apnea-hypopnea index, as provided by the SleepImage Ring@ 2.3.0, between men and women, with a sub-group analysis performed by age (18-40 years, 41-50 years, 51-60 years, 61-70 years, and > 70 years), run separately for women and men. In total, 1444 subjects (704 women and 740 men) with a mean age of 53.6 ± 14.71 years were enrolled in this analysis. In women, a significant drop in Sleep Quality Index was noted after age 51 years. Regression analysis demonstrated that age, Arousal Index, sleep efficiency and apnea-hypopnea index correlated significantly with Sleep Quality Index - with age, Arousal Index and apnea-hypopnea index negatively correlated, and sleep efficiency positively correlated. The highest correlation coefficient was obtained for Arousal Index in both women and men. In women, age older than 50 years was associated with a more rapid decrease of sleep quality than men, as defined by an increase in Arousal Index and apnea-hypopnea index with a concurrent decrease in Sleep Quality Index.

Dual orexin receptor antagonists (DORAs) are indicated for the treatment of insomnia disorder. However, DORAs may change sleep parameters, thus having adverse effects on patients with obstructive sleep apnea (OSA). This meta-analysis clarified the impact of DORAs in OSA treatment on sleep architecture and respiratory parameters. We systematically searched PubMed, Embase, and Cochrane Central databases for randomised control trials published up to May 2024. The search focussed on studies discussing the effects of DORAs on sleep architecture in patients with OSA. Nonrandomised studies were excluded. A meta-analysis using a random-effects model was performed. The patients were categorised into subgroups based on the treatment protocol (single or multiple dosages). The Cochrane risk of bias tool for randomised trials assessed the risk of bias. Our meta-analysis included four randomised placebo-controlled trials, encompassing 126 patients with a mean age of 49.1 years. The effects of DORAs on sleep architecture and respiratory parameters were examined. The main findings were as follows: DORAs significantly increased the total sleep time and improved sleep efficiency. However, they did not affect rapid eye movement sleep. DORAs also showed a trend towards decreased wake after sleep onset and did not increase the apnea-hypopnea index. DORAs did not increase the percentage of total sleep time with oxygen saturation lower than 90% and 85% compared with placebo, respectively. Furthermore, DORAs were not associated with significantly higher adverse effects compared with placebo. This meta-analysis demonstrated that DORAs improve sleep and do not impair nighttime respiratory function in patients with OSA.

This is the first study to provide valuable insights into the effects of the Israeli Navy's 20-h rotating watch schedule on submariners' alertness, mood states, risk-taking behaviours, and sleep. Specifically, we assessed the impact of the non-circadian-aligned schedule on cognitive performance, mood, and behavioural outcomes in a highly controlled submarine environment. A total of 20 male submariners participated in an at-sea mission, where their cognitive performance, mood states, risk-taking propensity, and caffeine consumption were measured. A psychomotor vigilance task (PVT) assessed alertness, the propensity for risky behaviour (Evaluation of Risks Scale) measured risk-taking behaviours, and the Profile of Mood States evaluated mood disturbances. Actigraphy was used to monitor sleep times. Data were analysed according to seven watch schedule segments. Submariners slept a mean (standard error of the mean [SEM]) of 8.3 (0.2) h/24 h, fragmented into 3.7 (0.8) h epochs. Caffeine consumption decreased at sea (mean [SEM] 149.3 [6.0] mg) compared to land (mean [SEM] 205.5 [7.2] mg; p = 0.027). In the PVT, premature responses significantly increased during Watch VI (5:00-8:00 p.m.) and Watch VII (8:00 p.m.-12:00 a.m.; p = 0.014). In the mood subscales, tension was significantly higher during Watch II (4:00-8:00 a.m.; p = 0.002), indicating greater stress. Risk-taking propensity significantly increased during afternoon shifts (p = 0.050). The 20-h watch schedule led to fragmented sleep, reduced alertness in the evening, worsened mood states in the early morning, and increased risk-taking propensity in the afternoon. These findings suggest the need for the Israeli Navy to establish evidence-based caffeine guidelines and optimise the watch schedule to improve submariners' sleep, performance, and overall well-being.

Sleep difficulties are presumably a transdiagnostic factor in the complex aetiology of psychiatric disorders in youth. This study assessed the prevalence of sleep difficulties in children and adolescents seeking specialized psychiatric care, examined the relationships of internalizing and externalizing problems, and considered the moderating role of sex and age on these relationships. Parent-reported data on difficulties initiating sleep, difficulties maintaining sleep, early morning awakenings and daytime fatigue from a large sample of children and adolescents referred for specialized psychiatric care (n = 4638; < 18 years) were used to estimate prevalence rates. To examine associations between these sleep difficulties and internalizing/externalizing problems, multiple linear regression analyses were conducted on available data (n = 3768) stratified in three age groups (1.5-5 years; 6-11 years; 12-18 years). Overall prevalence, i.e. at least one sleep difficulty was reported to be often or always present, was 65%. Difficulties initiating sleep occurred the most, closely followed by daytime fatigue. In all age groups, sleep difficulties were positively related to internalizing and externalizing problems. In young children and school-age children, age moderated the interaction between sleep difficulties and internalizing problems. To conclude, prevalence rates of sleep difficulties in children with mental illness appear higher than it has been reported in the general youth population, especially difficulties initiating sleep and daytime fatigue. We observed that the associations between internalizing problems and sleep difficulties in young children and school-age children seemed to be amplified with age, suggesting a negative, bidirectional, spiral in development.

Digital cognitive behavioural therapy for insomnia has been developed to increase capacity and scalability for patients with insomnia, but implementation in primary care remains limited. The aim of the trial was to evaluate the implementation of digital insomnia therapy into primary care practice for patients with insomnia. We conducted a single-arm feasibility trial of digital behavioural therapy for insomnia (SleepFix) providing sleep restriction therapy with insomnia patients in primary care. Healthcare professionals (comprising General Practitioners, community pharmacists and nurses) were enrolled into the trial and, when deemed clinically appropriate, prescribed SleepFix to patients with insomnia. The primary outcome was uptake assessed by the number of downloads of SleepFix. Interviews with primary care healthcare professionals explored their attitudes towards implementing/using insomnia digital therapeutics in clinical practice, and patients about their experiences with SleepFix. Insomnia symptoms, mood and sleep quality were measured before and after the trial. This trial was prospectively registered (ACTRN12620000055909). Thirty healthcare professionals and 105 patients were enrolled into the trial. Fourteen healthcare professionals administered at least one insomnia digital therapeutic prescription between November 2021 and March 2022. Fifty patients downloaded and used SleepFix (47.6% uptake). In post-trial interviews, healthcare professionals felt they could incorporate digital sleep health into clinical practice and patients found SleepFix acceptable. There were significant improvements in insomnia symptoms, mood and sleep quality at week 6 (all p < 0.05). This trial shows a real-world implementation of a digital insomnia therapy into primary care that could provide a framework for prescribing digital sleep interventions.

Differential diagnosis of narcolepsy type 2 and idiopathic hypersomnia relies on the frequency of sleep-onset rapid eye movement periods observed on the Multiple Sleep Latency Test. This study investigated whether variations in sleep schedules, particularly delayed sleep-wake patterns, contribute to the diagnostic distinction between narcolepsy type 2 and idiopathic hypersomnia. The study included 871 patients aged 18-39 years (316 with narcolepsy type 2, 555 with idiopathic hypersomnia). These patients were diagnosed based on MSLT results following polysomnography from November 2013 to November 2017. Patients' sleep habits, including bedtime and wake-up times on weekdays and weekends during the 2 weeks preceding the polysomnography/Multiple Sleep Latency Test, were assessed using self-reported sleep logs. A multivariate logistic regression analysis was conducted to identify factors associated with narcolepsy type 2 diagnosis. The analysis revealed that being male (p < 0.001), younger age (p < 0.001), shorter weekday sleep duration (p < 0.05), and a delayed weekday sleep midpoint time (p < 0.01) were significantly associated with a diagnosis of narcolepsy type 2. The study suggests that the conventionally fixed schedule of polysomnography and Multiple Sleep Latency Test administration may have contributed to the increased occurrence of sleep-onset rapid eye movement periods particularly in individuals with a delayed sleep-wake schedule.

Both rapid eye movement and non-rapid eye movement sleep are important for cognitive function and well-being, yet few studies have examined whether human sleep architecture is affected by long-duration spaceflight. We recorded 256 nights of sleep from five crew members before (n = 112 nights), during (n = 83 nights) and after (n = 61 nights) ~6-month missions aboard the Mir space station, using the Nightcap sleep monitor. We compared sleep outcomes (including total sleep time, efficiency, latency, rapid eye movement and non-rapid eye movement) during spaceflight with those on Earth. We also evaluated longitudinal changes over time in space. We found that wakefulness increased by 1 hr in space compared with on Earth. Over time in space, rapid eye movement was initially reduced and then recovered to near preflight levels at the expense of non-rapid eye movement sleep. Upon return to Earth, sleep architecture returned to preflight distribution. Our findings suggest that spaceflight may alter sleep architecture and should be explored further.