Journal of Sleep Research最新文献

Exposure to bullying behaviours has been associated with a variety of negative health outcomes, such as sleep complaints. However, the current state of the knowledge is limited regarding the association with objective sleep. The present study investigated the short-term effects of workplace bullying on objective sleep patterns using an actigraphy diary approach. Participants (N = 55) wore actigraphy devices for 10 days to measure sleep parameters such as duration, wake-after-sleep onset (WASO), and the number of awakenings. Multilevel analyses showed that exposure to workplace bullying was directly associated with the three parameters of sleep disturbances, with higher levels of bullying linked to poorer sleep outcomes. Anxiety was also found to mediate this relationship. Specifically, anxiety mediated the association between bullying and WASO and sleep duration. The study contributes valuable insights into the detrimental impact of workplace bullying on objective sleep quality, highlighting the importance of addressing psychosocial stressors in the workplace to promote healthy sleep patterns.

Previous studies have linked sleep-disordered breathing during rapid eye movement (REM) sleep to hypertension. However, no standardised definition of REM-related obstructive sleep apnea (REM-OSA) exists. This study aimed to evaluate whether the ratio of the apnea-hypopnea index (AHI) in REM to that in non-REM (NREM) (REM-AHI/NREM-AHI) accurately identifies patients with OSA comorbid with hypertension. We screened 1439 participants and included 790 patients with OSA. REM-OSA was defined as AHI ≥5 events/h, REM-AHI/NREM-AHI ≥2, and REM stage ≥30 min. Differences between REM-OSA and NREM-OSA groups, and among quartiles of REM-AHI/NREM-AHI, were assessed. The impact of REM-AHI/NREM-AHI on hypertension was assessed by logistic regression and restricted cubic spline analysis. Overall, patients with REM-OSA, as traditionally defined, had a lower hypertension prevalence, lower blood pressure, and milder OSA. Patients with REM-AHI/NREM-AHI <2 but a higher total AHI had a higher prevalence of hypertension. The highest REM-AHI/NREM-AHI quartile had the mildest OSA and the lowest hypertension prevalence. In subgroups restricted by total AHI or NREM-AHI, a similar trend existed, suggesting that total AHI appeared more influential on hypertension than the predominance of REM-AHI. Restricted cubic spline analysis certified a non-linear relationship between REM-AHI/NREM-AHI and total AHI, blood pressure and hypertension prevalence. Our research showed that patients with REM-OSA defined by REM-AHI/NREM-AHI ≥2 are not the subgroup with the highest hypertension prevalence within the entire OSA population. It is important to avoid focusing solely on the REM-AHI/NREM-AHI ratio and overlooking the overall severity of OSA, which could lead to missing groups that also have a high prevalence of hypertension.

Sleep-disordered breathing is common in stroke and may negatively affect its outcome. Screening for sleep-disordered breathing in this setting is of interest but poorly studied. We aimed to evaluate the performance of eight obstructive sleep apnea screening questionnaires to predict sleep-disordered breathing in acute stroke or transient ischaemic attack patients, and to assess the impact of stroke/transient ischaemic attack-specific factors on sleep-disordered breathing prediction. We analysed acute stroke/transient ischaemic attack patients (N = 195) from a prospective cohort ("Sleep Deficiency and Stroke Outcome study"). Assessments included anthropometrics, stroke-specific parameters, sleep history, an in-hospital respiratory polygraphy within the first week after stroke, and obstructive sleep apnea screening questionnaires (Berlin Questionnaire, Epworth Sleepiness Scale, STOP-BANG, NoSAS, Sleep Apnea Clinical Score, No-Apnea, Sleep Obstructive apnea score optimized for Stroke, SLEEP-IN). In a binary classification task for respiratory event index ≥ 15 per hr, we evaluated the performance of the above-mentioned questionnaires. We used logistic regression to identify predictors for sleep-disordered breathing in this cohort. The areas under the curve for respiratory event index ≥ 15 per hr were: Berlin Questionnaire 0.60; STOP-BANG 0.72; NoSAS 0.69; No-Apnea 0.69; Sleep Apnea Clinical Score 0.75; Epworth Sleepiness Scale 0.50; Sleep Obstructive apnea score optimized for Stroke 0.58; and SLEEP-IN 0.67. The No-Apnea had the lowest false omission rate (0.13), a sensitivity of 0.97 and a specificity of 0.12. In multiple logistic regression analysis (respiratory event index ≥ 15 per hr), age, neck circumference, National Institutes of Health Stroke Scale at admission, prior stroke, cardioembolic stroke aetiology and observed apneas were associated with sleep-disordered breathing. The logistic regression model performed similar (area under the curve 0.80) to Sleep Apnea Clinical Score (p = 0.402) and STOP-BANG (p = 0.127), but outperformed the other questionnaires. Neither existing questionnaires nor our statistical model are sufficient to accurately diagnose sleep-disordered breathing after stroke, thus requiring sleep study evaluation. The No-Apnea questionnaire may help to identify patients amenable to sleep testing.

We collected measures of sleep architecture and nightmares from participants (N = 61) wearing the DREEM 3 headband across 2 weeks of data collection to test the hypothesis that there are bidirectional links between insomnia (measured as sleep disturbance) and nightmare events. Nightmares were predicted by increased sleep disturbance the night before the nightmare, but not on the same night or 2 nights before. We also found that nightmare occurrences did not predict increased sleep disturbance on the same night or the following 2 nights, rather nightmares predicted increased sleep disturbance at the between-subjects level only. We suggest that nightmares are associated with an N3 sleep rebound on the night of the nightmare following a night of sleep disturbance.

The aim of the study was to examine associations between moderate-to-vigorous physical activity and sedentary time with sleep quality and quantity among preschool girls and boys using objective methods. Children (5-6 years old) attending kindergarten were recruited (n = 676). Measures included accelerometer-derived 24-hr activity and sleep for seven consecutive days. Longer time spent in moderate-to-vigorous physical activity was associated with higher sleep efficiency both in boys (p < 0.0001) and girls (p = 0447), and with lower Sleep Fragmentation Index in boys (p = 0.0042) and girls (p = 0.0494). Moreover, among boys, moderate-to-vigorous physical activity was inversely associated with wakefulness after sleep onset (p = 0.0006), number of awakenings (p = 0.0081) and Fragmentation Index (p = 0.0041), while in girls with sleep duration (p = 0.0405), Movement Index (p = 0.0128) and Sleep Fragmentation Index (p = 0.0494). Longer time spent sedentary was associated with lower sleep efficiency, and higher wakefulness after sleep onset, number of awakenings, Movement Index and Sleep Fragmentation Index-all with p < 0.0001. Furthermore, sedentary time was inversely associated with sleep duration both in boys (p < 0.0001) and girls (p = 0.0006), and directly associated with Fragmentation Index but only in boys (p = 0.0069). Meeting the recommended level of moderate-to-vigorous physical activity was associated with better sleep efficiency, lower wakefulness after sleep onset and number of awakenings among boys. All sleep-related variables showed significant differences between quartile groups according to sedentary time (p < 0.05) in both the total group and the boys. The sedentary time had the strongest, negative effect on sleep-related parameters in preschool children, therefore sedentary time reduction may contribute more to improving sleep quality than increasing moderate-to-vigorous physical activity.

The decrease in sleep quality leads to an increased risk of cardiovascular disease and is closely related to the prognosis of various diseases. However, the relationship between preoperative sleep quality and postoperative clinical outcomes in patients with acute aortic dissection is still unclear. We aimed to assess the relationship between sleep quality and the clinical outcomes of acute aortic dissection. We assessed participants' sleep quality and the clinical outcomes of acute aortic dissection, which included prolonged mechanical ventilation, postoperative delirium, in-hospital death, continuous renal replacement therapy, intensive care unit stay time, and length of stay. Patients were divided into good sleep quality group (n = 103) and poor sleep quality group (n = 113). Postoperative delirium, in-hospital death, prolonged mechanical ventilation and intensive care unit stay time were significantly increased in the poor sleep quality group when compared with the good sleep quality group (p < 0.05). Multivariate regression analysis showed that the poorer sleep quality, the greater the risk of in-hospital death (odds ratio = 3.451, 95% confidence interval 1.19-10.004) and prolonged mechanical ventilation (odds ratio = 6.302, 95% confidence interval 3.105-12.791), and the longer intensive care unit stay time (β = 62.37, 95% confidence interval 22.411-102.329). In addition, the higher the incidence of smoking history (odds ratio = 7.417, 95% confidence interval 2.425-22.684), poor sleep quality (odds ratio = 11.59, 95% confidence interval 3.844-34.942) and postoperative delirium (odds ratio = 5.1, 95% confidence interval 1.793-14.504), the greater the risk of prolonged mechanical ventilation. Our findings revealed that poor sleep quality may be a risk factor for adverse clinical outcomes of acute aortic dissection. Rapid assessment of self-reported sleep quality may be a simple and effective way to identify patients with acute aortic dissection who are at high risk for prolonged mechanical ventilation.

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.