Nature and Science of Sleep最新文献

Purpose: Aggression is a significant issue in schizophrenia, with insomnia identified as a modifiable risk factor. However, research often treats insomnia as a single construct, neglecting potential differences among its symptoms: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA). This study examined these distinct associations in a large sample of Chinese patients with chronic schizophrenia.

Patients and methods: A total of 702 inpatients with chronic schizophrenia was approached and screened. Among them, 31 were excluded due to missing data, resulting in a final sample size of 671. Aggression was assessed with the Modified Overt Aggression Scale, insomnia symptoms with the Insomnia Severity Index, and psychopathology with the Positive and Negative Syndrome Scale (PANSS). Logistic regression models examined associations between insomnia symptoms and aggression, controlling for theory-driven set of demographic and clinical variables identified from the literature as potential confounders (age, gender, illness duration, PANSS factor scores, antipsychotic dosage, clozapine use, polypharmacy, and sleep medication usage).

Results: The prevalence of aggression, DIS, DMS, and EMA were as follows: 14.6% (n=98), 14.2% (n=95), 11.3% (n=76), and 9.6% (n=64). One-fifth of the patients used sleep medication. Unadjusted analyses linked all three insomnia symptoms to increased aggression risk, with DIS showing the strongest association (Crude odds ratio =4.18, 95% CI=2.55-6.86, p<0.001). After full adjustment, only DIS remained independently associated (Adjusted odds ratio=3.81, 95% CI=1.77-8.21, p<0.001). Further analysis revealed DIS rather than DMS or EMA was uniquely linked to all aggression domains: verbal, property, auto-, and physical aggression.

Conclusion: DIS, rather than other insomnia symptoms, shows a consistent and independent association with multiple forms of aggression, highlighting its clinical significance in managing chronic schizophrenia. Clinical assessment should therefore differentiate between insomnia symptoms, and longitudinal and interventional studies are needed to confirm this association and explore its therapeutic implications.

Disruption of circadian rhythms is a recognized hallmark of age-related neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), and Huntington's disease (HD). Emerging evidence suggests these disruptions are not merely symptoms but potential causal factors that, in some cases, manifest prior to clinical onset. This points to a bidirectional relationship in which neurodegenerative processes and circadian dysfunction mutually exacerbate each other. Core clock genes, including BMAL1, PER, and CRY, regulate critical processes such as redox balance, mitochondrial function, and neuroinflammation, which are commonly disrupted in neurodegenerative conditions. Although molecular pathways involving altered protein homeostasis, immune dysregulation, and inflammatory processes are proposed, the precise mechanisms linking circadian rhythm disruptions to neurodegeneration remain unclear. This review provides an integrated overview of shared circadian rhythm disruptions observed in major neurodegenerative diseases and evidence on the underlying molecular mechanisms including oxidative stress and clock gene perturbation, and evaluates the temporal dynamics of circadian disruption relative to disease onset and progression. Furthermore, we discuss the translational potential of circadian-oriented interventions and highlight the limitations of current evidence. Understanding these interactions may help identify novel therapeutic strategies for stabilizing circadian rhythm to mitigate disease progression in neurodegenerative diseases.

Objective: Although growth hormone was shown to be specifically released during slow wave sleep (SWS), no population-based evidence has demonstrated the association between sleep quality and childhood height. To address this gap, our study aims to investigate the relationship between SWS and height of children.

Methods: We analyzed polysomnography data and z-scores for height in 2527 suspected obstructive sleep apnea (OSA) children (537 non-OSA children and 1990 OSA children) collected over the past 16 years. Different grades of z-scores for height and SWS were classified by the quartile method, and the lowest z-scores for height quartile defined short stature as the main outcome. Logistic regression models were used to assess the relationship between SWS and short stature.

Results: 1990 OSA children and 537 non-OSA children were included in analyses. The mean value of z-score for height from high to low were 0.80, 0.34, 0.23 and -0.19 in non-OSA children, and 0.47, 0.10, 0.14 and 0.05 in OSA children. Fully adjusted logistic regression models showed that, compared to the highest SWS quartile, the lowest quartile had 4.85-fold higher odds (95% CI, 2.4-9.4) of short stature in non-OSA children and 2.15-fold higher odds (95% CI, 1.5-3.0) in OSA children. Subgroup analyses demonstrated that in both non-OSA and OSA children, the reduction of SWS was significantly related to short stature in prepubertal children. Linear regression models confirmed positive correlations between SWS and z-score for height.

Conclusion: Our findings emphasize the crucial role of adequate sleep quality in childhood growth and development, supporting the inclusion of sleep assessments and improvements in pediatric growth monitoring programs.

Background: Hypertension carries a substantial public health burden, and obesity and sleep disturbances are bidirectionally linked; however, their combined impact remains underexamined among hypertensive adults in Turkey. We aimed to estimate the prevalence of obesity in a primary care sample of Turkish adults with hypertension and to evaluate associations between multiple anthropometric indicators (BMI, waist circumference, neck circumference, and waist-to-height ratio [WHtR]) and sleep quality.

Methods: The sample of this cross-sectional, descriptive, analytical study consisted of 124 individuals who applied to Giresun Training and Research Hospital Family Medicine Polyclinics between November 2024 and February 2025 and were diagnosed with hypertension. Research data were collected face-to-face using a sociodemographic survey and the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

Results: The mean age of participants (63.7% female) was 52.8 ± 8.06 years. The mean time since hypertension diagnosis was 9.27 ± 6.25 years; the prevalence of obesity was 51.6%, and 42.7% had poor sleep quality. In univariate analyses, higher BMI was associated with poor sleep quality (OR = 1.081; p = 0.025); however, this association was not retained in the multivariable model (p = 0.122). Other anthropometric parameters (eg, waist circumference, WHtR, neck circumference) and blood pressure values were not significantly associated with sleep quality.

Conclusion: Among hypertensive individuals managed in primary care, obesity and poor sleep quality are prevalent and should be addressed together. The waist-to-height ratio (WHtR) is a practical secondary indicator, and regular physical activity along with healthy sleep habits may support hypertension control.

Introduction: Metabolic syndrome (MS) is a common disease associated with multiple cardiovascular risk factors. Sleep-disordered breathing (SDB) and insomnia are associated with several metabolic components, such as hypertension, diabetes, dyslipidemia, and obesity. Although studies have shown an association between these sleep disorders and MS, the longitudinal relationship in the US Hispanic/Latino population is still unknown. This study aimed to examine the longitudinal associations of SDB and insomnia, individually and jointly, with incident MS risk over a 6-year follow-up period in a Hispanic/Latino cohort.

Methods: We conducted Cox regression analysis in 4625 participants (mean age 44.5±13.4 years, 60.3% women) who did not have MS at baseline, from the main Hispanic Community Health Study/Study of Latinos study, adjusting for potential covariates, such as age, sex, BMI, and smoking status. MS was defined by the NCEP ATP-III standard, and SDB (apnea-hypopnea index ≥5) and insomnia (Women's Health Initiative Insomnia Rating Scale score ≥9) were assessed during baseline.

Results: The prevalence of incident MS with an average 6-year interval was found to be 23.6%. In the fully adjusted model, SDB showed a significant association with incident MS (HR 1.31, 95% CI 1.10-1.56), and the comorbidity of SDB and insomnia (COMISA) was associated with an even higher risk of incident MS (HR 1.40, 95% CI 1.14-1.72), while insomnia alone showed no significant association.

Conclusion: SDB and COMISA were associated with incident MS in the Hispanic/Latino population, and COMISA had a stronger association with MS. These findings underscore the importance of addressing sleep disorders as modifiable risk factors in the prevention and management of MS among the Hispanic/Latino population in the USA.

Objective: To investigate the prevalence, characteristics, risk factors, and clinical outcomes of positional obstructive sleep apnea (POSA) in Chinese children.

Methods: This was a retrospective analysis of children aged 4-17 years with OSA from local referrals for sleep-disordered breathing. Children who underwent diagnostic polysomnography (PSG) with at least 30 minutes of total sleep time in both supine and non-supine sleep were included. Standardized sleep questionnaires, Sleepiness Scales, Child Behavior Checklist and 24-hour ambulatory blood pressure monitoring were completed. OSA was defined as obstructive apnea-hypopnea index (OAHI) ≥1/h. POSA was defined as OAHI in the supine position ≥ two times the OAHI in the non-supine position.

Results: 314 children (mean age: 10.88±3.22 years; male: 70%) with OSA were analyzed, of whom 147 (46.8%) had moderate/severe OSA (OAHI≥5). Prevalence of POSA was 58% within our cohort and 51% among those with moderate/severe OSA. Children with POSA were older (10.8±3.3 years vs 9.1±2.6 years; p<0.001), had milder disease [OAHI 4.12 (2.14-8.62) events/h vs 6.16 events/h); p=0.026] and had smaller tonsillar size (55% vs 72%; p=0.011). By logistic regression, POSA was associated with older age (OR 1.20; 95% confidence interval (CI) 1.09-1.32; p<0.001) and lower OAHI (B-0.036; SE 0.011; OR 0.964; 95% CI 0.943-0.986; p=0.001).

Conclusion: POSA is a prevalent phenotype seen in children, demonstrating strong associations with older age, more mature pubertal development, smaller tonsillar size and milder disease severity. Future studies should also delineate the natural history and longitudinal stability of this subtype over time.

Objective: Social media has been implicated in curtailing the quality and quantity of sleep. This study applied a network analysis approach to explore associations between social media addiction (SMA) and sleep quality among prospective university students, to identify central and bridge symptoms and compare networks by gender.

Methods: A cross-sectional survey was conducted among 1139 Bangladeshi university entrance examinees in February 2025 using a convenience sampling technique. Participants completed the Bergen Social Media Addiction Scale and the Pittsburgh Sleep Quality Index. A Gaussian Graphical Model was estimated using the Extended Bayesian Information Criterion Graphical Lasso (EBICglasso). Network centrality, bridge centrality, stability, and accuracy were evaluated. Network comparison tests (NCT) were performed across genders. All analyses were conducted using R (version 4.4.1) and SPSS (version 27).

Results: Strong intra-domain connections emerged within both SMA (Conflict-Relapse; Tolerance-Withdrawal) and sleep (Sleep Quality-Latency; Disturbance-Medication Use). Cross-domain associations included Relapse-Daytime Dysfunction and Mood Modification-Sleep Efficiency. Bridge centrality identified Daytime dysfunction, Mood modification, and sleep latency as prominent connectors. Males reported higher SMA scores, whereas females exhibited poorer sleep quality. The NCT indicated significant gender-based structural differences (M = 0.203, p = 0.013), though global strength remained similar.

Conclusion: Findings highlight symptom-level associations between SMA and sleep quality and suggest gender-sensitive targets for behavioral intervention among adolescents and young adults.

Acupuncture and acupressure are widely used for managing self-reported impaired sleep quality and duration. However, outside East Asia, access is often limited due to a shortage of trained acupuncturists and minimal reimbursement under national health insurance systems, leading to treatment discontinuation or inaccessibility driven by "Financial Toxicity." This prompts a critical yet underexplored inquiry: can advanced practice nurses serve as alternative providers to deliver acupuncture/acupressure for managing these common sleep complaints, thereby improving accessibility, expanding treatment coverage, and lowering consultation costs? This comprehensive mini-review synthesizes current evidence to assess the feasibility of this promising and innovative acupuncturist-nurse task-shifting paradigm and outlines key preparatory steps for its pilot implementation.

Purpose: To investigate the association between change in sleep quality over a 3-month period and the overall perceived effect of treatment, pain intensity, and health-related quality of life up to 12-month follow-up.

Patients and methods: This longitudinal study included 997 individuals (mean age 49.7 years, 72.1% women) with musculoskeletal pain who sought care from a physiotherapist in primary health care in Norway. Postoperative patients were excluded. We used a Generalized Estimating Equation (GEE) model to calculate adjusted risk ratios (RRs) for the probability of a positive treatment outcome at 6 and 12 months, associated with categories of good and poor sleep reported at first encounter and after three months.

Results: Compared with those who reported poor sleep quality over the first three months, those who reported improved sleep quality had a greater probability for a positive perceived effect of treatment (relative risk 1.66; 95% confidence interval [CI]:1.37-2.00), low pain intensity (RR:1.71; 95% CI:1.34-2.19), and high health-related quality of life (RR:2.06; 95% CI:1.55-2.75) at 12 months. Those who reported good sleep quality over the 3-month period had similar probabilities of positive treatment outcomes as those who reported improved sleep quality.

Conclusion: Individuals who reported improved sleep quality during the first three months after the first consultation with a physiotherapist in primary care had a substantially higher probability of positive treatment outcomes up to 12 months, compared with those who had poor sleep.

Purpose: Although polysomnography (PSG) is the gold standard for sleep evaluation, its use in children and adolescents is limited by poor compliance and the time-consuming setup required. For the first time in a paediatric population, this study tested the Sleep Profiler (SP), a self-applied ambulatory PSG device previously validated in adults.

Patients and methods: Simultaneous standard PSG and SP recordings were acquired from hospitalized patients (n=14), aged 11 to 15 years, and independently scored by two certified sleep medicine experts, blinded to patient identity. Epoch-by-epoch agreement between manually scored PSG, manually scored SP and automatically scored SP records was assessed using confusion matrices and Cohen's kappa coefficient (κ), with PSG as the reference. Sleep macrostructure measures were compared using Bland-Altman analysis.

Results: Manual scoring of SP data (SP1) showed substantial agreement with standard PSG across all stages, particularly for REM (κ=0.83), wake (κ=0.83), and N3 (κ=0.82). By contrast, automatic scoring algorithms (AA1 and AA2) provided by the device performed markedly worse (κ always below 0.70). SP1 resulted particularly strong in stage discrimination (specificity over 96% for wake, N1, N3, REM, and 88% in N2), with a sensitivity above 84% in all stages, except N1, which was lower at 55%. Moreover, Bland-Altman plots showed minimal bias and good agreement for sleep macrostructure parameters. These findings were further supported by a robust interrater reliability between scorers (κ=0.82).

Conclusion: The SP represents a reliable tool for sleep monitoring even in contexts where low compliance and time-consuming setups may compromise the quality or feasibility of standard recordings, such as in paediatric populations. While automatic scoring requires further refinement, and relatively small sample size should be considered when interpreting the generalizability of the findings, its robust detection especially of REM and N3 sleep make it suitable for both clinical and research applications.