Nature and Science of Sleep最新文献

Purpose: Depression patients frequently report sleep disorder. Aerobic exercise is believed to improve sleep quality, but its effect on the overall sleep of depressed patients remains uncertain. This study systematically evaluates the effects of aerobic exercises at different intensities on subjective and objective sleep quality in participants diagnosed with depression or at high risk of depression, from studies covering various depression subtypes (including but not limited to geriatric depression, prenatal depression, and poststroke depression), and examines changes in depression, anxiety, and quality of life following aerobic exercise.

Methods: Systematic searches for randomized controlled trials on aerobic exercise, depression, and sleep quality were conducted using PubMed, Web of Science, Embase, and the Cochrane Library up to December 31, 2024. Meta-analysis was performed using Review Manager 5.4.1 and stata 17.0.

Results: In total, 13 trials (n = 994) were included. Aerobic exercise significantly improved subjective sleep quality [SMD = -0.52, 95% CI = (-0.66, -0.38)] but had no significant effect on objectively measured sleep efficiency [SMD = -0.14, 95% CI = (-0.46, 0.75)], total sleep time [SMD = 0.30, 95% CI = (-0.03, 0.62)], or sleep latency [SMD = -0.11, 95% CI = (-0.76, 0.54)]. Additionally, aerobic exercise significantly alleviated depression [SMD = -0.70, 95% CI = (-0.93, -0.47)] and anxiety [SMD = -0.47, 95% CI = (-0.74, -0.19)], and enhanced quality of life [SMD = 0.64, 95% CI = (0.36, 0.92)]. Subgroup analyses revealed no significant differences among the different intensities.

Conclusion: Aerobic exercise significantly improves subjective sleep quality, alleviates depressive and anxiety symptoms, and enhances quality of life in depression patients. Light-, moderate-, and vigorous-intensities aerobic exercises have equal positive effects on these indicators. Given the bidirectional relationship between sleep disturbances and depression progression, this study highlights the potential of exercise therapy to disrupt the vicious cycle.

Systematic review registration: www.crd.york.ac.uk/PROSPERO/, identifier, CRD42023455212.

Background: Recent research has increasingly underscored a significant correlation between gut microbiota and obstructive sleep apnea (OSA). Probiotics have emerged as promising adjunctive interventions for OSA. Metabolites and their related biochemical pathways have emerged as important contributors to the development of OSA. This study aimed to estimate the causal association between gut microbiota and OSA and to quantify the mediating effects of metabolites.

Methods: We employed two-step, two-sample Mendelian randomization techniques, utilizing single nucleotide polymorphisms as genetic instruments for exposures and mediators. Summary statistics were obtained from genome-wide association studies of gut microbiota (the Dutch Microbiome Project, n=7,738), plasma metabolites (the Canadian Longitudinal Study on Aging cohort, n=8,299), and OSA (FinnGen database, n=410,385). To ensure the robustness of our findings, sensitivity analyses and heterogeneity tests were systematically conducted.

Results: In the Dutch Microbiome Project, species Parabacteroides merdae, genus Faecalibacterium, species Faecalibacterium prausnitzii and species Bifidobacterium longum demonstrated a potential protective association with OSA. We included the top 10 metabolites with potential biological significance as candidate mediators. Among them, only 2-hydroxypalmitate was associated with a reduced risk of OSA. 2-hydroxypalmitate partially mediated the association between species Parabacteroides merdae and OSA, with a mediation proportion of 20.53%.

Conclusion: The study highlighted the protective effect of species Parabacteroides merdae against OSA. It also revealed the mediating role of 2-hydroxypalmitate in the relationship between species Parabacteroides merdae and OSA.

Background: Sleep and frailty are established influencing factors for cardiometabolic diseases (CMDs). However, their joint effects on cardiometabolic multimorbidity (CMM) in older adults remain poorly understood. This study aimed to assess the joint effect of sleep health and frailty on CMD prevalence and severity, with an emphasis on subgroup-specific health risk profiles.

Methods: This study analyzed 8944 adults aged ≥60 years from the National Health and Nutrition Examination Survey (NHANES, 2007-2018). Weighted Logistic and quasi-Poisson regression models were used to assess the associations between sleep health, frailty, and CMD/CMM burden. Mediation analyses were used to examine the indirect effects of frailty index (FI) on the associations between sleep and CMM. Further cross-stratification of the population was conducted to evaluate the differences in characteristic indicators of health risks and biological aging.

Results: Poor sleep and frailty exhibited dose-dependent joint effects on CMD risk. After full adjustment, poor sleep combined with frailty had an incidence rate ratio (IRR) of 2.01 (95% CI: 1.78, 2.27) for existing cumulative number of CMDs (p for interaction = 0.006). The indirect effect of the FI explained 57.80% of the relationship between sleep health and the cumulative number of CMDs. Frailty was mainly manifested as differences in individual inflammation and aging indicators (eg, Systemic inflammation response index, Phenoage acceleration), while poor sleep was more reflected in changes in metabolic indicators (eg, Metabolic score for insulin resistance).

Conclusion: Poor sleep and frailty jointly amplified associations with CMM in older US adults. The relationship between sleep and CMM could be partially explained by FI. Elderly individuals with poor sleep should focus on changes on metabolic indicators, while those combined with frailty need to pay extra attention to aging and inflammation indicators.

Objective: This study aimed to identify distinct REM sleep characteristics that differentiate type 1 narcolepsy (NT1) from type 2 narcolepsy (NT2) using polysomnography (PSG), while acknowledging the need for future validation against other hypersomnia disorders.

Methods: A retrospective review included 31 patients with NT1, 21 patients with NT2, and 24 healthy participants. Each participant underwent overnight PSG and a subsequent multiple sleep latency test (MSLT) to assess REM sleep parameters including average REM density, neck myoclonus index, and leg movement index. Cerebrospinal fluid (CSF) samples were collected to measure orexin-A and catecholamine levels.

Results: 1. NT1 patients demonstrated significantly higher average REM density versus NT2 (P<0.05); 2. Elevated REM sleep characteristics in NT1: neck myoclonus index (0.82 vs 0.25 n/hr), leg movement index (18 vs 7 n/hr), and REM sleep without atonia (RSWA) incidence (71% vs 24%) (all P<0.05); 3. Biochemical correlations: REM density negatively correlated with orexin-A (r=-0.42) and positively with norepinephrine (r=0.38) (both P<0.05).

Conclusion: While REM density, leg movement index and RSWA show promise for NT1/NT2 differentiation, these findings require validation in cohorts including idiopathic hypersomnia and other central hypersomnolence disorders. The observed electrophysiological patterns may reflect orexin-mediated dysregulation of REM motor control, but their diagnostic specificity remains to be established.

Objective: To investigate the prevalence of dry eye disease (DED) among children and adolescents aged 9 to 19 years in Fengyang County, and to explore the associations of sleep duration and social jetlag with DED, with the aim of providing scientific evidence for sleep-based interventions to prevent DED in this population.

Methods: Between November and December 2023, 14 primary and secondary schools were randomly selected in Fengyang County, Chuzhou City, Anhui Province, China. Students from Grade 4 to Grade 12 (aged 9-19 years) were invited to participate. A trained professional conducted clinical assessments to evaluate DED, and participants completed self-administered questionnaires to report their sleep behaviors. Sleep quality was assessed by an item from Pittsburgh Sleep Quality Index. Chi-square tests and independent-samples t-tests were used to compare sociodemographic characteristics between DED and non-DED groups. Logistic regression models were applied to examine the associations of sleep duration, social jetlag, and their interaction with DED after adjusting for potential confounders.

Results: The overall prevalence of DED among children and adolescents in Fengyang County was 51%. After adjusting for confounders, binary logistic regression analysis showed that students who slept less than 9 hours per night had a significantly higher likelihood of DED (OR = 1.37, 95% CI: 1.21-1.68), and those with social jetlag ≥1 hour also had an elevated risk of DED (OR = 1.28, 95% CI: 1.07-1.54). Notably, the group with sleep duration ≥ 9 h combined with social jet lag ≥ 1 h showed a significant positive association with DED after adjusting for sleep quality (OR = 1.77, 95% CI: 1.35-2.33).

Conclusion: Both insufficient sleep duration and significant social jetlag are associated with an increased risk of DED in children and adolescents. These findings suggest the need for targeted sleep education programs in schools that emphasize not only sufficient sleep duration but also consistent sleep-wake schedules between weekdays and weekends to promote ocular health among youth.

Aim: Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse during sleep, resulting in frequent cortical arousals. However, currently used frequency-based arousal metrics do not sufficiently capture the heterogeneity and clinical significance of arousal responses. The odds ratio product (ORP) is a novel electroencephalographic marker that provides a continuous assessment of sleep depth and has the potential to serve as an objective measure of arousal intensity.

Purpose: This study aimed to quantify the intensity of arousals in untreated OSA patients using the ORP, and to explore the relationships between arousal intensity, respiratory event features, and subjective sleepiness.

Patients and methods: We retrospectively analysed data from 1057 adults with untreated OSA enrolled in the APPLES cohort. EEG spectral power was mapped to ORP values, and arousal intensity for each event was objectively calculated based on deviations in ORP from baseline. A total of 258,121 arousal events were included. Mixed-effects modelling was used to assess the impact of event type, duration, latency, sleep stage, position, and inter-individual variability on arousal intensity. Stepwise multiple regression explored associations between individual arousal intensity and subjective sleepiness.

Results: Arousal intensity increased significantly with the duration of preceding respiratory events, and was markedly higher than that of spontaneous arousals. The association between respiratory events and arousal intensity was stronger for apneas than for hypopneas, while deep sleep stage and lateral posture significantly reduced arousal response. Inter-individual variability was pronounced. Higher baseline arousal intensity was independently associated with increased subjective daytime sleepiness, after adjusting for known confounders.

Conclusion: ORP-derived arousal intensity provides a quantitative biomarker of cortical arousal. Arousal intensity is shaped by respiratory event characteristics, sleep architecture, and intrinsic individual traits. Although slight, arousal intensity is independently associated with subjective daytime sleepiness.

Purpose: To assess the effects of magnesium bisglycinate supplementation on insomnia symptoms in healthy adults reporting poor sleep quality.

Patients and methods: This randomized, double-blind, placebo-controlled trial enrolled 155 adults aged 18-65 years with self-reported poor sleep quality. Participants were randomly assigned to either magnesium bisglycinate supplementation (250 mg elemental magnesium, daily) or placebo capsules. Sleep quality was assessed using the Insomnia Severity Index (ISI) and additional psychological questionnaires at baseline and multiple time points throughout the study. Generalized linear mixed models (GLMM) adjusted for baseline ISI scores, age, sex, body mass index, and occupation were applied.

Results: The magnesium bisglycinate group showed a significantly greater reduction in ISI scores compared to the placebo group from baseline to Week 4 (-3.9 [95% CI: -5.8 to -2.0] vs -2.3 [95% CI: -4.1 to -0.4], respectively; p = 0.049). The effect size was small (Cohen's d = 0.2), indicating a modest benefit. Exploratory analyses suggested notably greater improvements among participants reporting lower baseline dietary magnesium intake, potentially indicating a subgroup of high responders. No significant differences were observed in other psychological outcomes.

Conclusion: Magnesium bisglycinate supplementation modestly improved insomnia severity in adults reporting poor sleep quality. Future research should include objective sleep assessments, longer intervention periods, and better characterization of potential high responders by systematically assessing baseline dietary magnesium intake and status.

Clinical trial registration name: Effect of magnesium bisglycinate supplementation on sleep and fatigue parameters in healthy adults reporting poor sleep quality; https://drks.de/search/en/trial/DRKS00031494 DRKS-ID: DRKS00031494.

Introduction: Type 2 diabetes (T2D) shows bidirectional relationships with polysomnographic measures. However, no studies have searched systematically for novel polysomnographic biomarkers of T2D. We therefore investigated if state-of-the-art explainable machine learning (ML) models could identify new polysomnographic biomarkers predictive of incident T2D.

Methods: We applied explainable ML models to longitudinal cohort study data from 536 males who were free of T2D at baseline and identified 52 cases of T2D at follow-up (mean 8.3, range 3.5-10.5 years). Beyond ranking biomarker importance, we explored how the explainable ML model approach can identify novel relationships, assist in hypothesis testing, and provide insights into risk factors.

Results: The top five most predictive biomarkers included waist circumference, glucose, and three novel sleep biomarkers: the number of 3% desaturations in non-supine sleep, mean heart rate in supine sleep, and mean hypopnea duration. Explainable machine learning identified a significant association between the number of non-supine desaturation events (threshold of 19 events) and incident T2D (Odds ratio = 2.4 [95% CI 1.2-4.8], P = 0.013). No significant associations were found using continuous or quartiled versions of non-supine desaturation. Additionally, the model provided an individualized risk factor breakdown, supporting a more personalized approach to precision sleep medicine.

Conclusion: Explainable ML supports the role of established biomarkers and reveals novel biomarkers of T2D likely to help guide further hypothesis testing and validation of more robust and clinically useful biomarkers. Although further validation is needed, these proof-of-concept data support the benefits of explainable ML in prospective data analysis.

Purpose: To compare the efficacy differences between acupuncture and sham acupuncture in adult primary insomnia through Bayesian network meta-analysis, analyze the impact of different types of sham acupuncture on efficacy, and explore the basis for the control setting.

Methods: A literature search of seven databases, including PubMed and Embase, until April 23, 2025, included randomized controlled trials (RCTs) comparing AT with noninvasive sham acupuncture (NISA), superficial acupuncture (SA), and non-acupuncture therapy (NAT) for treating PI in adults. The statistical analyses were conducted using R (version 4.4.1) and Stata (version 15.1). The protocol was registered with the International Prospective Register of Systematic Reviews (CRD420251012912).

Results: This meta-analysis incorporated 33 RCTs encompassing 3004 participants, with most studies originating from China. The results showed that at the treatment endpoint and after 4 weeks, AT significantly improved subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) compared to SA and NISA, exceeding the minimum clinically important difference (MCID: 2.5 points). Specifically, at the endpoint, AT vs SA (MD: -3.66; 95% CI: -4.48 to -2.84) and AT vs NISA (MD: -4.35; 95% CI: -5.67 to -3) were significant, while differences among SA, NISA, and NAT were not. Based on the surface under the cumulative rank curve (SUCRA), AT ranked first (99.9%), followed by SA (47.8%), NAT (31.9%), and NISA (20.4%). No significant differences were found between AT, NISA, and SA regarding objective sleep parameters.

Conclusion: AT significantly improved subjective sleep quality in patients with PI, though its impact on objective sleep measures was limited. When designing RCTs of acupuncture for PI, NISA is recommended as the sham acupuncture control. However, due to geographical limitations, the study results may be difficult to generalize. Future research should focus on monitoring objective sleep parameters and conducting international, multicenter RCTs involving diverse cultural populations.

Objective: A low arousal threshold (AT) appears to contribute to obstructive sleep apnea (OSA) pathogenesis. However, the role of low AT in OSA and overlap syndrome (OVS) is still unclear. This study is aimed to investigate the value of the AT score, a new method for qualifying AT, for examining the relationship between OSA and OVS, including chronic obstructive pulmonary disease (COPD) and asthma.

Methods: In this retrospective study, a total of 3400 adults diagnosed with OSA at a sleep medicine center were finally included. All patients were stratified into low-, high- and very high-AT score groups according to the previous logistic regression for qualifying AT. Multivariate logistic regression was conducted to evaluate the association between AT score and OVS prevalence. We compared this association with that of the apnea hypopnea index (AHI).

Results: 40.3%, 42.9% and 16.8% of OSA patients had low-, high- and very high AT score, respectively. Compared with the very high AT score, the low AT score was independently associated with the prevalence of COPD (OR = 2.17, 95% CI = 1.09-4.32) and asthma (OR = 4.54, 95% CI = 2.52-8.17). With decreasing AT score, the adjusted ORs of the comorbidities increased stepwise, particularly in some subgroups based on sex, age and BMI. Conversely, the classification of AHI did not show similar values.

Conclusion: In individuals with OSA, low AT is a common pathophysiological feature associated with COPD and asthma. The AT score is a new and effective indicator for evaluating the relationship between OSA and OVS.