Journal of Sleep Research最新文献

Catathrenia is an uncommon sleep disorder. Having been originally classified as a parasomnia it is now considered a sleep related breathing disorder. Polysomnography (PSG) is the gold standard for diagnosing catathrenia which demonstrates a classic pattern of a deep inhalation followed by a protracted exhalation, accompanied by groaning sounds. Home polygraphy sleep studies are widely used to assess for sleep disordered breathing and have previously been demonstrated to yield sufficient evidence to warrant a suspicion of catathrenia, later confirmed by PSG. We present sleep studies from five patients presenting with fragmented sleep and daytime somnolence. Two were clinically suspicious for a diagnosis of catathrenia with the remaining patients suspected as having obstructive sleep apnea. Analysis of their sleep studies identified changes in flow and effort consistent with those found on PSG in catathrenia. Analysis of concomitant sound recordings revealed groaning and moaning sounds different to any recorded snoring. Our findings demonstrate that polygraphy sleep studies demonstrating an initial positive inflection in flow, immediately followed by a fall in flow and a slow attenuation in both thoracic and abdominal effort signals are suggestive of a catathrenia diagnosis. Careful analysis of traces is required to prevent misdiagnosis of central events.

Insomnia is common in adolescents with associated negative health consequences. This systematic review and meta-analysis assessed the effect of cognitive behavioural therapy for insomnia interventions on insomnia symptoms and subjective sleep quality in adolescents aged 10-19 years. Key electronic databases, including CINAHL, Embase, MEDLINE, PsycINFO and Scopus, were systematically searched from inception to October 2024, and five randomised controlled trials met inclusion criteria for qualitative synthesis. Four randomised controlled trials, examining a total of 527 participants, were included in the meta-analysis. One randomised controlled trial employing a hybrid cluster design was excluded in quantitative analyses due to the number of clusters and sizes not reported. Cognitive behavioural therapy for insomnia delivered to adolescents with insomnia improved subjective sleep quality and insomnia symptoms, with effect sizes (Hedge's g) of 0.4 and 1.04, respectively. Our findings provide support for the efficacy of cognitive behavioural therapy for insomnia in the treatment of adolescents with insomnia regardless of delivery modality. Further high-quality randomised controlled trials are required to strengthen our findings and understand how best to deliver cognitive behavioural therapy for insomnia to adolescents.

Obstructive sleep apnea (OSA) is a common sleep disorder that is associated with a wide variety of health conditions, including cardiovascular, cerebrovascular, metabolic, neoplastic, and neurocognitive manifestations. OSA, as a chronic condition, is mainly characterised by repeated upper airway obstructions during sleep that cause episodes of intermittent hypoxia (IH), resulting in tissue hypoxia-reoxygenation cycles. Decreased arterial oxygen pressure (PaO₂) and haemoglobin saturation (SatO₂) stimulate reflex responses to overcome the obstruction. The prevalence of OSA is significant worldwide, and an underrated problem when focussing on women during pregnancy. The physiological changes associated with pregnancy, especially during its latest stages, are related to a higher prevalence of OSA events in pregnant mothers, and associated with an increased risk of hypertension, pre-eclampsia and diabetes, among other deleterious consequences. Furthermore, OSA during pregnancy can interfere with normal fetal development and is associated with growth retardation, preterm birth, or low birth weight. Carotid body overstimulation and hypoxia-reoxygenation episodes contribute to cardiovascular disease and oxidative stress, which can harm both mother and fetus and have long-lasting effects that can reach into adulthood. Because IH is the hallmark of OSA, this review examines the literature available about the impact of gestational intermittent hypoxia (GIH) on the respiratory system at maternal, fetal, and offspring levels. Offering the latest scientific data about OSA during pregnancy, we may help to tackle this condition with lifestyle changes and therapeutic approaches, that could influence the mothers, but also impact adult health problems, mostly unknown, inherited from these hypoxic episodes in the uterus.

Many adults suffer from insomnia. Cognitive-behavioural therapy for insomnia is the recommended treatment option, but access to it is not readily available. Digital interventions have the potential to close the treatment gap by offering scalable and cost-efficient options. The present randomised controlled trial aimed at investigating the effectiveness and safety of somnovia, an interactive internet-based intervention for patients with insomnia. A total of 290 participants with chronic insomnia were randomised to intervention (n = 149) or the control (n = 141) condition. Participants of the intervention group received access to somnovia for 6 months in addition to treatment as usual, whereas participants in the control group only had access to treatment as usual for the time of the study. Online questionnaires were filled in before randomisation and after 3 and 6 months. The primary endpoint was the Insomnia Severity Index, with the Patient Health Questionnaire-9, the Generalised Anxiety Disorder Assessment-7, and the Work and Social Adjustment Scale as secondary endpoints. After 3 months, the intervention group showed lower insomnia (Cohen's d = 0.71, CI = [0.44, 0.98]), depressive (Cohen's d = 0.66, CI = [0.41, 0.90]), and anxiety (Cohen's d = 0.56, CI = [0.32, 0.81]) symptoms, as well as improved overall functioning (Cohen's d = 0.50, CI = [0.24, 0.76]) compared with participants in the control group. The effects stayed stable after 6 months. The results indicate that next to a therapeutic effect on insomnia symptoms, somnovia might potentially help to prevent the onset of other psychiatric disorders such as depression and anxiety.

When self-regulatory resources are depleted, people tend to act more on "autopilot", with minimal forethought. It follows that when sleepy, people should be more likely to act habitually, based on learned cue-behaviour associations that trigger behaviour automatically when the cue is encountered. This ecological momentary assessment study investigated whether, over the course of a week, between-person differences and momentary within-person variation in daytime sleepiness were associated with the reported habit strength of behaviours. Participants (N = 105, 71% female, M age = 35 years) completed a baseline assessment of sleep quality and, six times daily over 7 days, momentary assessments in which they reported the habit strength of the behaviour they were doing when prompted and their momentary sleepiness. Multilevel modelling revealed that people who were more sleepy than others were not more or less likely to act habitually, but on occasions when people were more sleepy than was typical for them, the behaviour they were engaging in tended to be more habitual (Pseudo-R² = 2%). Our results suggest that sleepiness causes people to rely on non-reflective processes such as habit to regulate their behaviour. Interventions should promote habit formation for desirable behaviours so that when people are sleepy, they can rely on the efficiency of habits to ensure they continue to enact wanted behaviours. Conversely, interventions promoting behaviours that require deliberative thought might encourage performance during times of day when people are more alert.

Numerous hormones and genes exhibit diurnal 24-hr rhythms that can also be affected by sleep deprivation. Here we studied diurnal rhythms in DNA methylation under a 24-hr sleep/wake cycle and a subsequent 29 hr of continual wakefulness (1 night of sleep deprivation). Fifteen healthy men (19-35 years) spent 3 days/nights in a sleep laboratory: (1) adaptation; (2) baseline; (3) total sleep deprivation day/night. DNA methylation was analysed from peripheral blood leukocytes, collected every 3 hr for 45 hr (starting at 15:00 hours) during the baseline period and the total sleep deprivation period. Epigenome-wide DNA methylation variation was assessed with the Infinium MethylationEPIC v2.0 Beadchip kit. Rhythm analysis was performed separately for the baseline and the total sleep deprivation time-series data. Pairwise analysis between diurnal samples and sleep deprivation samples at the same timepoint was also carried out to detect differentially methylated positions related to sleep deprivation. Of all DNA methylation sites, 14% exhibited a diurnal rhythm in methylation on the baseline day/night that was altered by sleep deprivation. During sleep deprivation, the number of differentially methylated positions increased towards the end of the sleep deprivation period, with a dominating pattern of hypomethylation. Among differentially methylated positions, an enrichment of genes related to the FAS immune response pathway was detected. In conclusion, DNA methylation exhibits diurnal rhythmicity, and this time-of-day variation needs to be considered when studying DNA methylation as a biomarker in biomedical studies. In addition, the observed DNA methylation changes under wakefulness might serve as a mediator of sleep deprivation-related immune response alterations.

This study explored the prospective associations between sleep patterns, mental health and registry-based school grades among older adolescents. In the spring of 2019, 1st year high-school students in Western Norway were invited to a survey assessing habitual sleep duration, insomnia, depression and anxiety. Sleep patterns, depression and anxiety were assessed using the Munich ChronoType Questionnaire, the Bergen Insomnia Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7. Students consenting to data linkage with the county school authorities were re-invited 2 years later. Registry-based grade point averages for each of the included school years were accessed through the school authorities. The final longitudinal sample included 1092 students (65.1% girls; initial mean age 16.4 years). Data were analysed using linear mixed models. Longer school night sleep duration and less severe symptoms of insomnia, depression and anxiety were all associated with higher grade point averages at baseline in crude analyses. Shorter school night sleep duration, as well as more severe symptoms of insomnia and depression at baseline, all predicted better grade point averages at 2-year follow-up when controlled for baseline grade point averages. By contrast, anxiety symptomatology at baseline was unrelated to changes in grade point averages over time. The longitudinal associations between school night sleep duration and insomnia symptoms on grade point averages were significant also when adjusted for sex and baseline symptoms of depression and anxiety. These findings indicate that shorter school night sleep duration and more severe insomnia symptoms predict lower grade point averages development over time, irrespective of co-existing symptoms of depression and anxiety.

The gestational period is a sensitive time marked by significant changes that can affect women's sleep and dreaming processes, with an augmented frequency and recall of dreams suggesting that dreaming represents an adaptive mechanism of emotional regulation. This study investigates the relationship between pregnancy-related variables, alexithymia, and depressive symptoms in influencing dream characteristics in women during the first trimester of pregnancy. A total of 118 pregnant women were recruited at the Obstetric Outpatient Service of an Italian University Hospital and completed the Mannheim Dream Questionnaire, the Toronto Alexithymia Scale-20, and the Edinburgh Postnatal Depression Scale. Regression analysis, t-test, and moderation analysis were conducted through Jamovi. Dream recall frequency was predicted by age, parity, and depressive symptoms. Nightmare frequency and lucid dream frequency were significantly predicted by depressive symptoms, while nightmare distress was predicted by an unplanned pregnancy. Alexithymia was linked to higher nightmare frequency and nightmare distress. Moderation analysis revealed that the presence of depressive symptoms predicted increased nightmare frequency only in women with higher levels of alexithymia. These findings highlight the role of emotional regulation in dreaming during pregnancy, particularly among women exhibiting alexithymic traits and depressive symptoms. Nightmare frequency may serve as an indicator of impaired emotional regulation, emphasising the need for targeted interventions to enhance emotional coping strategies in this population. Future research should examine the content of nightmares to further understand their implications for maternal mental health.

Obstructive sleep apnea (OSA) predominantly affects patients who are obese and causes systemic organ damage. Little is known about the relationship between fat distribution and bone impairment in these patients. We aimed to evaluate the impact of the visceral adipose tissue (VAT) on the bone quality of patients with OSA. In our prospective study, 49 untreated patients with mild-to-severe OSA underwent dual-energy X-ray absorptiometry. Polygraphy data were also collected. According to the recent reference values for European adults, patients were divided by the sex-related threshold of the VAT index into two categories: VAT index within limits (normal VAT [nVAT]) and increased VAT (iVAT). In all, 63% of the patients were in the iVAT category. Compared to patients with nVAT, those with iVAT had a higher prevalence of arterial hypertension (52% versus 22%) and diabetes (32% versus 6%), and higher values of mean nocturnal desaturation. Patients with iVAT had, in comparison to those with nVAT, lower values of the lumbar spine trabecular bone score (TBS; mean 1.24 versus 1.39; p < 0.001), TBS T-score (mean -1.82 versus -0.52; p < 0.001) and TBS Z-score (mean -0.35 versus 0.75; p = 0.002). Moreover, a close association was present between the VAT index and TBS lumbar spine L1-L4 (r² linear 0.573; p < 0.001), and altered values of the TBS Z-score were associated with the severity of vertebral fractures. Finally, in a linear regression-adjusted model, the VAT index predicted TBS lumbar spine L1-L4 (β -0.323; p < 0.001). In patients with OSA VAT impacts bone quality. In these patients, the role of VAT as a metabolically active tissue should be considered.

Shift work can cause circadian misalignment, which often results in sleeping problems and has been associated with immune dysfunction. To better understand the impact of shift work on a primary immune response to vaccination, we compared severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-specific humoral and cellular immune responses after one injection of the messenger RNA (mRNA)-1273 vaccine between day workers (n = 24) and night shift workers (n = 21). In addition, duration and quality of sleep were assessed for a period of 7 days around the time of vaccination using actigraphy and daily sleep diaries, and their relationship with immunogenicity of mRNA-1273 vaccination was studied. We found that median total sleep time on the 2 days immediately after vaccination, which coincided with the days that night shift workers worked night shifts, was significantly lower in night shift workers (342 and 318 min) than day workers (431 and 415 min) (both p < 0.001). There was no difference in sleep quality between day workers and night shift workers. Furthermore, no difference in the antibody response between the two groups was observed, yet night shift workers had a significantly higher virus-specific T-cell response than day workers 28 days after immunisation (p = 0.013). Multivariate regression analysis showed no association between sleep duration, sleep quality and SARS-CoV-2-specific humoral or cellular immune responses. Collectively, these findings indicate that shift work-induced sleep loss and night shift work have little to no effect on the primary immune response to mRNA-based COVID-19 vaccination.