Nature and Science of Sleep最新文献

Purpose: Non-benzodiazepine hypnotics, commonly known as Z-drugs, are widely prescribed for conditions such as insomnia, anxiety, and epilepsy. Emerging evidence suggests that these agents may influence auditory function and may be associated with tinnitus, potentially through their modulation of GABAA receptors. However, existing research findings on this association remain inconsistent. The objective of this study was to examine the potential association between the use of Z-drugs and the subsequent risk of incident tinnitus.

Patients and methods: This study was conducted using the Taiwan Longitudinal Health Insurance Database. The exposure cohort was composed of all beneficiaries who were prescribed a Z-drug during the study period. The comparison cohort was selected from beneficiaries without any prescription history for Z-drugs during the same timeframe. The primary outcome was the risk of tinnitus within a 5-year follow-up period. To minimize potential confounding, propensity score matching was applied, followed by Cox proportional hazards regression analyses to calculate hazard ratios (HRs) comparing Z-drug users with nonusers.

Results: 16,225 patients were identified as Z-drug users, while 1,370,776 were classified as nonusers. Over the 5-year period, Cox proportional hazards regression analysis revealed that Z-drug users had a higher risk of developing tinnitus compared to nonusers (adjusted HR: 1.501; 95% CI: 1.423-1.583). After propensity score matching, this association remained significant (adjusted HR: 1.496; 95% CI: 1.377-1.624). Furthermore, a consistent association between Z-drug use and tinnitus was observed across most subgroups.

Conclusion: The study suggests that the use of Z-drugs, the most prescribed psychoactive drugs globally, may be associated with an increased risk of developing tinnitus. Limitations include the potential for residual confounding and misclassification inherent to claims-based data. Clinicians should consider this potential association when prescribing Z-drugs.

Aim: Obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) are two common yet frequently co-occurring conditions that significantly impact sleep quality and overall health. While a growing body of evidence suggests a potential link between these disorders, the nature and strength of their relationship remain unclear. This systematic review and meta-analysis aims to comprehensively evaluate the association between OSA and RD, focusing on the incidence of RD in OSA patients and the potential impact of RD on sleep parameters, including sleep stages and apnea severity.

Methods: We systematically searched PubMed, Embase, the Cochrane Library, and Scopus databases to identify relevant studies for this review. Eligible studies had to investigate the association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) in adult populations. The primary outcomes assessed were the incidence of RD in OSA patients, as well as the impact of RD on sleep parameters, including sleep stages, apnea severity, and the Epworth Sleepiness Scale (ESS).

Results: Totally 49 studies were included in this analysis. A modest association between obstructive sleep apnea (OSA) and the increased incidence of gastroesophageal reflux disease (RD), with a pooled relative risk of 1.23 (95% CI: 1.00, 1.52), although this did not reach statistical significance (p = 0.056). A trend towards increased reflux symptoms in severe OSA patients compared to mild OSA was noted (p=0.036). Patients with RD exhibited significantly lower sleep efficiency (p=0.003) and reduced oxygen saturation (p<0.001). Heterogeneity analysis indicated moderate variability across studies, primarily due to differences in patient characteristics and OSA severity.

Conclusion: A certain association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (RD) was observed, but this association did not reach statistical significance. RD was significantly associated with reduced sleep efficiency, but no significant relationship was found between RD and OSA severity levels. While RD may influence early sleep stages (eg, N1), this effect remains inconclusive due to limited and variable supporting data. These findings highlight the need for further research to clarify the nature and direction of the OSA-RD relationship.

Purpose: To examine the orofacial myofunctional profile and its determinants in adults with obstructive sleep apnea (OSA).

Patients and methods: A sample of 229 patients with OSA who underwent polysomnographic monitoring from June 1 to July 31, 2023, were enrolled in the study. All participants completed questionnaires, scales, and physical measurements to obtain information on general demographics, orofacial myofunction, degree of snoring, neck circumference, waist circumference, BMI, and OSA characteristics.

Results: The proportions of participants with normal weight, overweight, and obesity were 24.5%, 44.1%, and 31.4%, respectively. Mild, moderate, and severe OSA patients accounted for 16.6%, 21.4%, and 62%, respectively. The median total orofacial myofunction score was 90. Larger neck circumference (r=-0.18, P=0.007), higher BMI (r=-0.216, P=0.001), and more severe OSA (r=-0.191, P=0.004) were associated with poorer orofacial myofunction. Age, obesity, diabetes, and RDI were significant predictors of total orofacial myofunction.

Conclusion: All OSA patients have varying degrees of orofacial myofunction insufficiency in this study, which is more pronounced in overweight and obese individuals. The evaluation and intervention of orofacial myofunction should be emphasized in patients with OSA who are older, overweight or obese, who have comorbidities of other metabolic disorders, and who have poor PSG indicators.

Purpose: The purpose of this study was to investigate the relationship between glymphatic function and sleep quality in adolescents with Major Depressive Disorder (MDD). Previous research has linked glymphatic dysfunction to MDD in adults, often associated with sleep disturbances, but the relationship between these factors in adolescents remains unclear.

Patients and methods: This study utilized Diffusion Tensor Imaging analysis along the perivascular space (DTI-ALPS) to assess glymphatic system function and the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality in adolescents. A total of 138 participants were included: 80 first-episode and medication-naive patients with MDD (total 80: 9 with mild MDD, 28 with moderate MDD, 43 with severe MDD), and 58 healthy controls. Pearson correlation analysis was performed to examine the relationship between sleep quality and glymphatic function.

Results: The results showed adolescents with MDD demonstrated poor sleep quality, whereas healthy controls exhibited normal sleep quality. However, no significant impairment in glymphatic function was observed. Furthermore, no clear correlation was found between sleep quality and glymphatic function in the adolescent MDD group.

Conclusion: This study provides novel insights into the neurobiological mechanisms of adolescent MDD, suggesting that the glymphatic system may not contribute to its pathogenesis in the same way as in adults. However, this cross-sectional study, with its small sample size and single-center design, limits the generalizability of the findings. Future research should adopt longitudinal, multicenter, and larger-scale designs to further investigate these relationships in more depth.

Purpose: The variants of restless legs syndrome (RLS) remain poorly recognized, complicating differential diagnosis and treatment in clinical practice. We aimed to explore the clinical features and potential diagnostic indicators of variant RLS through clinical cases and literature review.

Patients and methods: Patients with variants of RLS were collected from the sleep medicine center of West China Hospital and followed up till February 2024. Demographic and clinical information were collected, and questionnaires were used to assess RLS symptom severity, sleep disturbances, and daytime dysfunction. Polysomnography and blood tests (eg, iron metabolism) were performed in a subset of cases. A systematic review of literature cases was performed, and comparable data were analyzed.

Results: A total of eight cases (57.0 ± 15.7 years, five females) were enrolled, with half classified as early‑onset. Six cases reported isolated abnormal sensations, most commonly in the abdomen, and two had scattered paresthesias involving the legs. Questionnaire rated severe symptoms of variant RLS, night sleep disturbance, and anxiety symptoms in most cases. Dopaminergic agents were effective treatment in seven cases. A literature review of 62 eligible studies (430 cases) confirmed female predominance with the arms most affected. Then, we extracted 70 literature cases, revealed divergent symptoms and early-onset feature in variant RLS. Noteworthily, the periodic limb movement index (PLMI) was abnormal in two-thirds of the cases, but the value in leg-free cases was lower than those which involved legs.

Conclusion: The clinical features and dopaminergic responsiveness of variant RLS closely resembled those of typical RLS, suggesting that existing diagnostic criteria and treatment strategies for typical RLS is applicable to variant phenotypes. Additionally, the PLMI may indicate the potential for variant RLS symptoms progressing to involvement of the legs.

Purpose: Insomnia is a prevalent sleep-wake disturbance that significantly impairs the quality of life and adversely affects physical and mental health. This study aimed to evaluate the clinical efficacy of ultrasound-guided stellate ganglion block (SGB) combined with acupuncture at cervicotemporal myofascial trigger points (MTrPs) in patients with insomnia accompanied by anxiety and depression.

Patients and methods: This retrospective study included 42 patients diagnosed with insomnia and comorbid anxiety and depression who were treated at the Anesthesia and Sleep Clinic of the Shandong Second Provincial General Hospital between November 2024 and April 2025. All patients received ultrasound-guided SGB combined with acupuncture at cervicotemporal MTrPs. Treatment efficacy was assessed by comparing Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) scores before treatment initiation and four weeks after completion of the intervention.

Results: Compared with baseline, post-treatment PSQI scores (5.00 ± 2.84 versus 17.10 ± 2.61; mean difference, -12.10; 95% Cl, -12.91 to -11.28; P < 0.001), HAMA scores (5.05 ± 2.80 versus 19.00 ± 4.23; mean difference, -13.95; 95% Cl, -15.0912.82 to -12.82; P < 0.001), and HAMD scores (3.41 ± 2.68 versus 15.76 ± 4.43; mean difference, -12.36; 95% Cl, -13.56 to -11.15; P < 0.001) were all significantly reduced after four weeks of therapy.

Conclusion: The preliminary study suggests that ultrasound-guided SGB combined with acupuncture at the cervicotemporal MTrPs is an effective, comprehensive intervention for insomnia with comorbid anxiety and depression. The benefits may result from synergistic mechanisms involving autonomic balance regulation, suppression of excessive sympathetic activity, reduction of myofascial tension, and modulation of the sleep-wake cycle. These findings warrant further clinical application and investigation.

Background: Insomnia is a common symptom of depression, and their complex, bidirectional relationship poses significant challenges for treatment. Dexmedetomidine (Dex), an α₂-adrenergic receptor agonist, shows unique advantages in inducing sleep closely resembling physiological sleep and is gaining interest as a potential therapy for insomnia.

Objective: This study aimed to determine the average effective Dex dose for inducing stage N2 sleep in patients with depression-related insomnia via polysomnography (PSG), and to identify factors affecting dose variability.

Methods: From April to August 2023, 91 patients with depression-related insomnia were recruited from the Center for Pain and Sleep Medicine at the Affiliated Hospital of Shandong Second Medical University. All patients received intravenous Dex infusion (diluted to 4 μg/mL and administered at 60 mL/h) under continuous PSG monitoring. The cumulative Dex dose required to induce stage N2 sleep was recorded. Clinical data were collected, and univariate and multiple linear regression analyses were performed to identify factors influencing Dex dose.

Results: A total of 82 patients were included in the final analysis. The mean effective dose of Dex required to induce stage N2 sleep was 49.0 ± 16.4 μg. Multivariate regression analysis identified age (P < 0.001) and body weight (P = 0.022) as independent predictors of Dex dose, with age exerting a stronger predictive effect. Simple linear regression further demonstrated a positive association between age and Dex dose (R² = 0.181). During titration, patients' vital signs remained stable, with heart rate significantly decreasing (68.2 ± 10.0 vs 57.0 ± 13.3 bpm, P < 0.05), whereas mean arterial pressure and oxygen saturation showed no significant changes (P > 0.05).

Conclusion: Dex could effectively induces stage N2 sleep in patients with depression-related insomnia and has a favorable safety profile, with the required dose increasing with age.

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.