Nature and Science of Sleep最新文献

Purpose: In China, stringent and long-lasting infection control measures, which were called "dynamic zero-COVID policy", have significantly affected the mental health of college students, particularly concerning depressive and insomnia symptoms. This study aims to investigate how depressive and insomnia symptoms evolved among Chinese college students throughout the pandemic, including the beginning and end of the dynamic zero-COVID policy period.

Patients and methods: We conducted a 2-years longitudinal survey involving 1102 college students, collecting data at three key time points. Depressive symptoms were assessed using the Patient Health Questionnaire-9, and insomnia symptoms were measured with the Youth Self-rating Insomnia Scale-8. Three contemporaneous symptom networks and two cross-lagged panel networks were constructed.

Results: In the current sample, the prevalence of clinically significant depressive symptoms was 6.1%, 8.9%, and 7.7% during the first, second, and third waves, respectively. The prevalence of clinically significant insomnia symptoms was 8.1%, 13.0%, and 14.1%. Over time, the severity of depressive and insomnia symptoms and network density increased, persisting at least one year after the pandemic and control measures ended. "Difficulty initiating sleep" bridged the two disorders, while "anhedonia" played a pivotal role in triggering and sustaining other symptoms.

Conclusion: This study underscores the lasting impact of the evolving zero-COVID policy on depressive and insomnia symptoms among college students, elucidating the underlying interaction mechanisms. There is a pressing need for a more comprehensive evaluation of the implementation of restrictive public policies, taking into account their potential long-term consequences.

Purpose: There is a lack of national studies examining the relationship between insufficient sleep and depression among Chinese adolescents, and previous research has not comprehensively considered related factors. This study aimed to investigate the prevalence of depressive symptoms in adolescents with insufficient sleep and explore the role of associated factors using a nationally representative sample in China.

Patients and methods: A pen-and-paper survey was conducted among 24147 Chinese adolescents from November 2019 to January 2020. Data on depressive symptoms, maltreatment experiences, psychological resilience, demographic information, parent-child relationships, parental marital status, and sleep duration were collected.

Results: A total of 22231 valid questionnaires were analyzed. Among the respondents, 67.7% reported insufficient sleep, while 32.3% had sufficient sleep. The prevalence of depressive symptoms was 25.3% in adolescents with insufficient sleep, compared to 8.2% in those with sufficient sleep. Insufficient sleep was identified as an independent risk factor for depressive symptoms (OR = 3.058, 95% CI: 2.753-3.396, P < 0.001). In adolescents with sufficient sleep, being female, emotional abuse, physical abuse, sexual abuse, and physical neglect were significant risk factors for depressive symptoms (P < 0.05), while higher resilience scores and a good parent-child relationship were protective factors (P < 0.05). Among adolescents with insufficient sleep, additional risk factors included higher body mass index (BMI), older age, parental divorce, and living with a single parent (P < 0.05).

Conclusion: Insufficient sleep is significantly associated with depressive symptoms in Chinese adolescents. The adolescents with insufficient sleep, particularly those who are older, have a higher BMI, or come from divorced or single-parent households, require increased attention.

Purpose: The effect of metabolic factors on cardiovascular risk in obstructive sleep apnea (OSA) is unclear. This study aimed to investigate the effect of metabolic factors on the left ventricular diastolic function in patients with OSA.

Patients and methods: This cross-sectional study included a total of 478 patients with OSA from September 2018 to September 2023. After propensity score matching, wherein 193 patients with OSA with metabolic syndrome (MS) were 1:1 matched to patients with OSA without MS by sex and age, data from 386 patients were ultimately analyzed. Furthermore, all patients were divided into mild, moderate, and severe OSA groups according to their sleep apnea-hypopnea index (AHI). Measurements included nocturnal polysomnography, biochemical testing, and transthoracic echocardiography data.

Results: The AHI in the MS group was higher (30.24±21.69 vs 23.19±17.65, p<0.001) and the lowest oxygen saturation at night was lower (77.67±9.23 vs 80.59±9.26, p<0.001) than those in the non-MS group. Additionally, the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), end-diastolic ventricular septal thickness (IVST), left ventricular end-diastolic posterior wall thickness (LVPWT), left atrial internal diameter (LAD), and E peak to A peak velocity ratio (E/A) in the MS group were higher than those in the non-MS group (P<0.05). The E peak to e' peak velocity ratio (E/e') in the MS group was higher than that in the non-MS group (12.02±3.68 vs 11.13±3.12, P=0.011) and was positively correlated with the diagnosis of MS and metabolic factors (r=0.115, p=0.024; r=0.131, p=0.010, respectively). Patients with five metabolic factors had a significantly higher risk of E/e' elevation than patients in the non-MS group (odds ratio=4.238, p=0.007).

Conclusion: MS may be related to OSA severity and left ventricular diastolic dysfunction. An increase in metabolic factors may increase the risk of diastolic dysfunction. Among metabolic factors, blood pressure may be the most important.

Purpose: We designed a study investigating the cardioprotective role of sleep apnea (SA) in patients with acute myocardial infarction (AMI), focusing on its association with infarct size and coronary collateral circulation.

Methods: We recruited adults with AMI, who underwent Level-III SA testing during hospitalization. Delayed-enhancement cardiac magnetic resonance (CMR) imaging was performed to quantify AMI size (percent-infarcted myocardium). Rentrop Score quantified coronary collateralization (scores 0-3, higher scores indicating augmented collaterals). Group differences in Rentrop grade and infarct size were compared using the Wilcoxon Rank-Sum test and Fisher's Exact test as appropriate, with a significance threshold set at p <0.05.

Results: Among 33 adults, mean age was 54.4±11.5 and mean BMI was 28.4±5.9. 8 patients (24%) had no SA, and 25 (76%) had SA (mild n=10, moderate n=8, severe n=7). 66% (n=22) underwent CMR, and all patients had Rentrop scores. Median infarct size in the no-SA group was 22% versus 28% in the SA group (p=0.79). While we did not find statistically significant differences, moderate SA had a trend toward a smaller infarct size (median 15.5%; IQR 9.23) compared to the other groups (no SA [22.0%; 16.8,31.8], mild SA [27%; 23.8,32.5], and severe SA [34%; 31.53], p=0.12). A higher proportion of moderate SA patients had a Rentrop grade >0, with a trend toward significance (moderate SA versus other groups: 62.5% versus 28%, p=0.08).

Conclusion: Our study did not find statistically significant differences in cardiac infarct size and the presence of coronary collaterals by sleep apnea severity among patients with AMI. However, our results are hypothesis-generating, and suggest that moderate SA may potentially offer cardioprotective benefits through enhanced coronary collaterals. These insights call for future research to explore the heterogeneity in ischemic preconditioning by SA severity and hypoxic burden to guide tailored clinical strategies for SA management in patients with AMI.

Purpose: The aim of this study was to investigate the effect of general anesthesia combined with transversus abdominis plane block on postoperative sleep disorders in elderly patients undergoing gastrointestinal tumor surgery.

Methods: For elderly patients with gastrointestinal malignant tumors, we recruited 94 patients, aged 65-80, who were scheduled for radical laparoscopic surgery. Using the random number table method, the patients were randomly divided into two groups, the general anesthesia group (group GA) and the general anesthesia combined with transversus abdominis plane block group (group GT). The group GA received the sedation-aspiration complex general anesthesia regimen, while the group GT underwent bilateral transversus abdominis plane blocks (TAPB) after the same induction of anesthesia. Group GA was injected bilaterally with equal amounts of saline in the same way. Sleep was monitored using wearable devices on the first day before surgery (P1) and the first and third day after surgery (D1 and D3). The Pittsburgh Sleep Quality Index(PSQI) scale was used to assess sleepiness and the occurrence of postoperative sleep disorders (POSD) on P1, D1 and D3 nights, respectively.

Results: Compared to the group GA, the group GT showed a significant decrease in remifentanil use during surgery (P<0.05). At D1, the group GT showed an increase in the ratio of deep sleep to rapid eye movement sleep (REM), along with a significant decrease in the number of wakefulness (P<0.05). At D3, the proportion of REM continued to increase and PSQI scores were significantly lower at both D1 and D3 (P<0.05). In addition, the incidence of POSD and the visual analog scores (VAS) at 0.5h and 6h postoperative activity in D1 showed a decreasing trend (P<0.05). However, no significant differences were observed between the two groups in general condition, intraoperative condition, remedial analgesia and number of analgesic pump presses (P>0.05).

Conclusion: General anesthesia combined with transversus abdominis plane block reduces the dosage of opioids in abdominal surgery, especially gastrointestinal surgery, alleviates postoperative pain in elderly gastrointestinal oncology patients, improves sleep quality, and reduces the incidence of sleep disorders.

Purpose: To develop a deep learning (DL) model for obstructive sleep apnea (OSA) detection and severity assessment and provide a new approach for convenient, economical, and accurate disease detection.

Methods: Considering medical reliability and acquisition simplicity, we used electrocardiogram (ECG) and oxygen saturation (SpO₂) signals to develop a multimodal signal fusion multiscale Transformer model for OSA detection and severity assessment. The proposed model comprises signal preprocessing, feature extraction, cross-modal interaction, and classification modules. A total of 510 patients who underwent polysomnography were included in the hospital dataset. The model was tested on hospital and public datasets. The hospital dataset was utilized to demonstrate the applicability and generalizability of the model. Two public datasets, Apnea-ECG dataset (consisting of 8 recordings) and UCD dataset (consisting of 21 recordings), were used to compare the results with those of previous studies.

Results: In the hospital dataset, the accuracy (Acc) values of per-segment and per-recording detection were 91.38 and 96.08%, respectively. The Acc values for mild, moderate, and severe OSA were 90.20, 88.24, and 92.16%, respectively. The Bland‒Altman plots revealed the consistency of the true apnea-hypopnea index (AHI) and the predicted AHI. In the public datasets, the per-segment detection Acc values of the Apnea-ECG and UCD datasets were 95.04 and 90.56%, respectively.

Conclusion: The experiments on hospital and public datasets have demonstrated that the proposed model is more advanced, accurate, and applicable in OSA detection and severity assessment than previous models.

Study objectives: This study aimed to evaluate the test-retest reliability of the Epworth Sleepiness Scale (ESS) in patients with untreated obstructive sleep apnea (OSA) and investigate the effects of different follow-up techniques and various factors on ESS score discrepancies.

Methods: This study prospectively enrolled participants diagnosed with OSA at West China Hospital of Sichuan University from October 2022 to May 2023. Each participant completed a polysomnography (PSG) and the Chinese version of the ESS. Initial ESS evaluations were performed before the PSG and were reassessed either face-to-face or on telephone within a week. Analysis involved Bland-Altman plots, the intraclass correlation coefficient (ICC), and calculation of mean differences.

Results: We included 382 patients with untreated OSA, averaging 43.52 years old, with a mean body mass index (BMI) of 26.54 kg/m² and an average apnea-hypopnea index (AHI) of 47.93 events/hour. The ICC was recorded at 0.820. The signed difference in ESS scores from baseline to follow-up was 1.68 ± 2.93 overall. In OSA patients with a BMI > 28, the difference was 2.39 ± 3.46, while in those with an AHI ≥ 30, it was 1.77 ± 3.27.

Conclusion: This study underscores the significance of repeated ESS testing to improve the reliability of sleepiness evaluations in patients with OSA. Further studies should aim to confirm these findings in a broader demographic and develop refined methods for more precise sleepiness assessments among different OSA groups.

Purpose: This study assesses sleep quality amongst hemodialysis (HD) patients and identifies contributing factors, which include demographic and clinical factors and significant symptoms associated with HD (ie, fatigue and pruritus).

Patients and methods: In this cross-sectional design, 116 participants were recruited from HD units of two hospitals in Saudi Arabia. Three measures were used to identify predictors of sleep quality among HD patients, including the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), and the 5-D itch scale. Demographic and clinical profiles were also obtained. Univariate and multiple regression analyses were used to determine significant factors associated with sleep quality during HD.

Results: The mean global PSQI score was 6.77±3.23, with 56.9% of participants scoring 5 or more, indicating poor sleep. Sleep latency achieved the highest mean PSQI score (1.70 ±0.94), and 'use of sleep medication components' the lowest (0.36 ±0.83). Increased age, lower educational status, higher fatigue, and pruritus were associated with poorer sleep. Controlling for status and age suggested that fatigue and pruritus independently influenced HD patients' sleep quality (F (4, 111) = 10.89, P = <0.001). There were positive relationships between increased levels of fatigue and pruritus and poor quality of sleep.

Conclusion: This is the first study to examine fatigue, pruritus, and sleep quality in HD patients. Findings will assist dialysis clinicians to develop appropriate management strategies to mitigate factors causing poor sleep for such patients. Intervention programs targeting self-management of fatigue and pruritus symptoms could potentially improve patients' sleep quality.

Background: Poor sleep is associated with longer recovery following adolescent concussion, making the longitudinal assessment of sleep important for monitoring recovery and identifying sleep disruptions. An important consideration for successful monitoring of sleep following concussion is the feasibility and adherence of a given sleep monitoring tool when used in an at-home environment. Understanding the usability of different sleep monitoring tools is essential for determining their applicability for longitudinal assessment in an ecologically valid environment.

Purpose: The purpose of this study was to: (1) report on the adherence and feasibility of at-home sleep monitoring in adolescents following concussion, and (2) compare outcomes of subjective and wearable measures of sleep between adolescents with and without a concussion.

Patients and methods: Participants included adolescents within 21 days of a concussion and uninjured controls that participated in four separate, prospective and longitudinal investigations of sleep following concussion. Sleep data was measured with: (1) Dreem Headband; (2) Philips Actiwatch; (3) Fitbit; and (4) subjective sleep diary. Sleep data was collected nightly, and adherence was defined as percentage of nights the participant used the sleep-monitoring tool over the study duration. Independent t-tests and effect sizes were calculated for the following sleep data outcomes as measured by each of the monitoring tools: duration, efficiency, latency, wake after sleep onset.

Results: Sleep data for a total of 183 adolescents (104 with concussion, 79 uninjured controls) was assessed. Adherence rates across all devices ranged from 53% to 98%, with the subjective sleep diary showing the highest adherence rate for both groups (concussion: 91%, control: 94%). Across the four different monitoring tools, adolescents with a concussion demonstrated longer duration, latency, wake after sleep onset, and lower (worse) efficiency, with medium to large effect sizes.

Conclusion: The results indicate that at-home sleep monitoring is a feasible approach for tracking sleep in adolescents following concussion.

Objective: There is a connection between obstructive sleep apnea (OSA) and coronary microvascular dysfunction (CMD), but the underlying mechanisms remain unclear. This study aims to evaluate the correlation between OSA-related nocturnal hypoxemia parameters and CMD.

Methods: This is an observational, single-center study that included patients who underwent polysomnography and coronary angiography during hospitalization. The presence of CMD was determined by angio-based index of microcirculatory resistance (AccuIMR). Categorical variables were compared using chi-square test or Fisher exact test. The t-test and Mann-Whitney U-test were used to compare normally and non-normally distributed continuous variables, respectively. Univariate and multivariable logistic regression analyses were performed to evaluate the relationship between nocturnal hypoxemia parameters and CMD.

Results: A total of 133 patients were included in this study, of whom 72 (54.14%) had evidence of CMD. Patients with CMD exhibited a higher prevalence of OSA and experienced more severe nocturnal hypoxia. After adjusting for potential confounding factors, minimum oxygen saturation (minSpO₂) ≤90% (OR 5.89; 95% CI 1.73-19.99; P=0.004) and the percentage of time spent with oxygen saturation below 90% (T90) ≥5% (OR 3.13; 95% CI 1.05-9.38; P=0.041) were independently associated with CMD. However, no significant association was observed between apnea-hypopnea index (AHI) and CMD.

Conclusion: Parameters of nocturnal hypoxemia are associated with CMD. Hypoxemia parameters may more sensitively reflect the correlation between OSA and CMD than AHI.