Pub Date : 2025-02-01DOI: 10.1016/j.sleep.2024.12.024
Nicole Rheinheimer, Carolina de Weerth
Our aims are 1) to assess whether sleeping problems persist from early childhood until adolescence, and 2) to investigate whether infant colic is associated with more sleeping problems throughout childhood and adolescence. Furthermore, we explore a moderation by parent-infant room sharing of potential associations between infant colic and sleeping problems. Data originate from a prospective longitudinal study in a healthy community sample (N = 185). Infant colic data were collected using cry diaries, filled in by the mothers for four days at age six weeks. The number of weeks of parent-infant room sharing from zero to six months of age were recorded using daily maternal diaries. Sleeping problems were assessed through maternal report at ages 2.5, 6 and 10 years, and child report at ages 12.5, 14 and 16.5 years. We used a score of Total Sleeping Problems, as well as subscales on Night Waking and Sleep Duration. Correlations were found between sleeping problems measured from 2.5 through 16.5 years for the Total Sleeping Problems, as well as for Night Waking and Sleep Duration. Compared to participants without infant colic, those with colic showed higher scores of Total Sleeping Problems between ages 12.5 and 16.5 years. We found no differences in sleeping problems between 2.5 and 10 years, nor evidence of a moderation by room sharing. Current findings suggest that sleeping problems developing in early and middle childhood persist throughout adolescence, and that children with infant colic may be prone to developing sleeping problems during adolescence.
{"title":"Infant colic and sleeping problems from early childhood through adolescence","authors":"Nicole Rheinheimer, Carolina de Weerth","doi":"10.1016/j.sleep.2024.12.024","DOIUrl":"10.1016/j.sleep.2024.12.024","url":null,"abstract":"<div><div>Our aims are 1) to assess whether sleeping problems persist from early childhood until adolescence, and 2) to investigate whether infant colic is associated with more sleeping problems throughout childhood and adolescence. Furthermore, we explore a moderation by parent-infant room sharing of potential associations between infant colic and sleeping problems. Data originate from a prospective longitudinal study in a healthy community sample (N = 185). Infant colic data were collected using cry diaries, filled in by the mothers for four days at age six weeks. The number of weeks of parent-infant room sharing from zero to six months of age were recorded using daily maternal diaries. Sleeping problems were assessed through maternal report at ages 2.5, 6 and 10 years, and child report at ages 12.5, 14 and 16.5 years. We used a score of Total Sleeping Problems, as well as subscales on Night Waking and Sleep Duration. Correlations were found between sleeping problems measured from 2.5 through 16.5 years for the Total Sleeping Problems, as well as for Night Waking and Sleep Duration. Compared to participants without infant colic, those with colic showed higher scores of Total Sleeping Problems between ages 12.5 and 16.5 years. We found no differences in sleeping problems between 2.5 and 10 years, nor evidence of a moderation by room sharing. Current findings suggest that sleeping problems developing in early and middle childhood persist throughout adolescence, and that children with infant colic may be prone to developing sleeping problems during adolescence.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 267-274"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.sleep.2024.12.019
Zhihua Huang , Qing Zhao , Zhihui Zhao , Robert Joseph Thomas , Anqi Duan , Xin Li , Sicheng Zhang , Luyang Gao , Chenhong An , Yijia Wang , Sicong Li , Qi Wang , Qin Luo , Zhihong Liu , Consensus Group , the National Cardiovascular Disease Expert Committee, the Sleep Medicine Professional Committee Cardiovascular Group of the Chinese Medical Doctor Association, the Elderly Sleep Disorders and Cardiopulmonary Vascular Group of the Chinese Society of Gerontology and Geriatrics
As cardiovascular disease (CVD) incidence and mortality rates continue to rise in China, the importance of identifying and managing CVD risk factors grows. Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder, affecting an estimated 936 million individuals aged 30–69 worldwide, with China leading globally with about 176 million affected. Increasing research indicates a close association between OSA and the onset and progression of various CVD, significantly affecting outcomes. However, OSA has long been underrecognized and undertreated in CVD clinical practice. To address this gap, a multidisciplinary expert panel developed evidence-based recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology and the Delphi process. This consensus provides 17 recommendations on core clinical issues such as screening, diagnosis, treatment, and follow-up of CVD patients with OSA, aiming to standardize care and improve patient outcomes. The recommendations were informed by current evidence-based research and extensive expert consensus discussions. This approach seeks to support clinical decision-making, improve the quality of care, and address the unique challenges of managing OSA in Chinese CVD patients.
{"title":"Chinese consensus report on the assessment and management of obstructive sleep apnea in patients with cardiovascular disease: 2024 edition","authors":"Zhihua Huang , Qing Zhao , Zhihui Zhao , Robert Joseph Thomas , Anqi Duan , Xin Li , Sicheng Zhang , Luyang Gao , Chenhong An , Yijia Wang , Sicong Li , Qi Wang , Qin Luo , Zhihong Liu , Consensus Group , the National Cardiovascular Disease Expert Committee, the Sleep Medicine Professional Committee Cardiovascular Group of the Chinese Medical Doctor Association, the Elderly Sleep Disorders and Cardiopulmonary Vascular Group of the Chinese Society of Gerontology and Geriatrics","doi":"10.1016/j.sleep.2024.12.019","DOIUrl":"10.1016/j.sleep.2024.12.019","url":null,"abstract":"<div><div>As cardiovascular disease (CVD) incidence and mortality rates continue to rise in China, the importance of identifying and managing CVD risk factors grows. Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder, affecting an estimated 936 million individuals aged 30–69 worldwide, with China leading globally with about 176 million affected. Increasing research indicates a close association between OSA and the onset and progression of various CVD, significantly affecting outcomes. However, OSA has long been underrecognized and undertreated in CVD clinical practice. To address this gap, a multidisciplinary expert panel developed evidence-based recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology and the Delphi process. This consensus provides 17 recommendations on core clinical issues such as screening, diagnosis, treatment, and follow-up of CVD patients with OSA, aiming to standardize care and improve patient outcomes. The recommendations were informed by current evidence-based research and extensive expert consensus discussions. This approach seeks to support clinical decision-making, improve the quality of care, and address the unique challenges of managing OSA in Chinese CVD patients.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 248-259"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.sleep.2024.12.029
Seong-Uk Baek , Yu-Min Lee , Jong-Uk Won , Jin-Ha Yoon
Objectives
Social jetlag (SJL), which arises from the misalignment of biological and social rhythms, is associated with adverse health outcomes. We explored the association between SJL and anxiety symptoms in Korean workers.
Methods
This cross-sectional study included a nationally representative sample, consisting of 2731 adult workers. SJL was calculated as the absolute difference in the midpoint between sleep onset and offset times on workdays and free days. The Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms. Logistic regressions were used to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs).
Results
Among the sample, 66.5 % individuals had 0–59 min of SJL, 22.6 % had 60–119 min of SJL, and 10.9 % had ≥120 min of SJL. The prevalence of anxiety symptoms was 3.4 % for those with 0–59 min of SJL, 3.2 % for those with 60–119 min of SJL, and 7.7 % for those with ≥120 min of SJL. Workers with ≥120 min of SJL, compared with those with 0–59 min of SJL, were associated with an increase in the odds of having anxiety symptoms (OR:2.04, 95 % CI:1.10–3.78). A 1-h increase in SJL is associated with a 1.35-fold increase in the odds of anxiety symptoms (95 % CI:1.04–1.75). This positive association remained robust after adjusting for the effect of sleep deprivation using a sleep-corrected formula.
Conclusion
≥2 h of SJL is associated with anxiety symptoms in Korean workers. Policy measures are required to mitigate excess SJL and monitor the mental health of workers with high SJL levels.
{"title":"Association between social jetlag and anxiety symptoms: Findings from a nationally representative sample of the Korean working population","authors":"Seong-Uk Baek , Yu-Min Lee , Jong-Uk Won , Jin-Ha Yoon","doi":"10.1016/j.sleep.2024.12.029","DOIUrl":"10.1016/j.sleep.2024.12.029","url":null,"abstract":"<div><h3>Objectives</h3><div>Social jetlag (SJL), which arises from the misalignment of biological and social rhythms, is associated with adverse health outcomes. We explored the association between SJL and anxiety symptoms in Korean workers.</div></div><div><h3>Methods</h3><div>This cross-sectional study included a nationally representative sample, consisting of 2731 adult workers. SJL was calculated as the absolute difference in the midpoint between sleep onset and offset times on workdays and free days. The Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms. Logistic regressions were used to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Among the sample, 66.5 % individuals had 0–59 min of SJL, 22.6 % had 60–119 min of SJL, and 10.9 % had ≥120 min of SJL. The prevalence of anxiety symptoms was 3.4 % for those with 0–59 min of SJL, 3.2 % for those with 60–119 min of SJL, and 7.7 % for those with ≥120 min of SJL. Workers with ≥120 min of SJL, compared with those with 0–59 min of SJL, were associated with an increase in the odds of having anxiety symptoms (OR:2.04, 95 % CI:1.10–3.78). A 1-h increase in SJL is associated with a 1.35-fold increase in the odds of anxiety symptoms (95 % CI:1.04–1.75). This positive association remained robust after adjusting for the effect of sleep deprivation using a sleep-corrected formula.</div></div><div><h3>Conclusion</h3><div>≥2 h of SJL is associated with anxiety symptoms in Korean workers. Policy measures are required to mitigate excess SJL and monitor the mental health of workers with high SJL levels.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 300-306"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.sleep.2024.12.004
Mehmet Göktuğ Kılınçarslan , Özgül Ocak , Erkan Melih Şahin
Objective
In patients with Restless Legs Syndrome (RLS), neuropsychiatric comorbidities like anxiety, depression, and somatization are common, yet the precise connection between somatization and RLS severity remains unclear. This study aims to elucidate the influence of neuropsychiatric comorbidities on RLS severity, focusing particularly on the role of somatization.
Methods
This cross-sectional analytical study was conducted at a tertiary hospital. All 113 RLS patients who followed in neurology clinic for at least a year were invited, and 87 participated. Data collection included sociodemographic details, the International Restless Legs Syndrome Study Group rating scale (IRLS), the Beck Depression Inventory, Beck Anxiety Scale, and Somatization Scale. Elastic-net regularized path analysis was used as the statistical method.
Results
Among the 87 participants (70.1 % female, mean age 52.5 ± 13.2 years), the mean duration of RLS diagnosis was 4.95 ± 4.53 years. Univariate statistics revealed positive correlations among RLS severity, anxiety, depression, and somatization. Path analysis showed that somatization was associated with RLS severity (p = 0.014). Anxiety had no direct effect on RLS severity but influenced it indirectly through its positive association with somatization (p < 0.001). Depression was found to have no effect on RLS severity, either directly or through somatization.
Conclusions
The relationship between anxiety and RLS severity is mediated by somatization. Furthermore, the association between RLS severity and somatization appears to be more significant than previously recognized, highlighting the importance of considering somatization in addressing the neuropsychiatric burden of RLS patients.
{"title":"The impact of neuropsychiatric burden on Restless Legs Syndrome (RLS) disease severity","authors":"Mehmet Göktuğ Kılınçarslan , Özgül Ocak , Erkan Melih Şahin","doi":"10.1016/j.sleep.2024.12.004","DOIUrl":"10.1016/j.sleep.2024.12.004","url":null,"abstract":"<div><h3>Objective</h3><div>In patients with Restless Legs Syndrome (RLS), neuropsychiatric comorbidities like anxiety, depression, and somatization are common, yet the precise connection between somatization and RLS severity remains unclear. This study aims to elucidate the influence of neuropsychiatric comorbidities on RLS severity, focusing particularly on the role of somatization.</div></div><div><h3>Methods</h3><div>This cross-sectional analytical study was conducted at a tertiary hospital. All 113 RLS patients who followed in neurology clinic for at least a year were invited, and 87 participated. Data collection included sociodemographic details, the International Restless Legs Syndrome Study Group rating scale (IRLS), the Beck Depression Inventory, Beck Anxiety Scale, and Somatization Scale. Elastic-net regularized path analysis was used as the statistical method.</div></div><div><h3>Results</h3><div>Among the 87 participants (70.1 % female, mean age 52.5 ± 13.2 years), the mean duration of RLS diagnosis was 4.95 ± 4.53 years. Univariate statistics revealed positive correlations among RLS severity, anxiety, depression, and somatization. Path analysis showed that somatization was associated with RLS severity (p = 0.014). Anxiety had no direct effect on RLS severity but influenced it indirectly through its positive association with somatization (p < 0.001). Depression was found to have no effect on RLS severity, either directly or through somatization.</div></div><div><h3>Conclusions</h3><div>The relationship between anxiety and RLS severity is mediated by somatization. Furthermore, the association between RLS severity and somatization appears to be more significant than previously recognized, highlighting the importance of considering somatization in addressing the neuropsychiatric burden of RLS patients.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 82-87"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.sleep.2024.12.013
Lifeng Li , Liming Song , Yuting Liu , Muhammad Ayoub , Yucheng Song , Yongqiang Shu , Xiang Liu , Yingke Deng , Yumeng Liu , Yunyan Xia , Haijun Li , Dechang Peng
Background and purpose
Patients with obstructive sleep apnea (OSA) experience chronic intermittent hypoxia and sleep fragmentation, leading to brain ischemia and neurological dysfunction. Therefore, it is important to identify features that can differentiate patients with OSA from healthy controls (HC) and provide insights into the underlying brain alterations associated with OSA. This study aimed to distinguish patients with OSA from healthy individuals and predict clinical symptom alterations using cerebellum-whole-brain static and dynamic functional connectivity (sFC and dFC, respectively), with the cerebellum as the seed region.
Methods
Sixty male patients with OSA and 60 male HC matched for age, education level, and sex were included. Using 27 cerebellar seeds, sliding-window analysis was performed to calculate sFC and dFC between the cerebellum and the whole brain. The sFC and dFC values were then combined and used in multiple machine-learning models to distinguish patients with OSA from HC and predict the clinical symptoms of patients with OSA.
Results
Patients with OSA showed increased dFC between cerebellar subregions and the superior and middle temporal gyri and decreased dFC with the middle frontal gyrus. Conversely, increased sFC was observed between cerebellar subregions and the cerebellar lobule VI, cingulate gyrus, middle frontal gyrus, inferior parietal lobules, insula, and superior temporal gyrus. Combined dynamic-static FC features demonstrated superior classification performance with a support vector machine in discriminating OSA from HC. In clinical symptom prediction, FC alterations contributed up to 30.11 % to cognitive impairment, 55.96 % to excessive sleepiness, and 27.94 % to anxiety and depression.
Conclusions
Combining cerebrocerebellar sFC and dFC analyses enables high-precision classification and prediction of OSA. Aberrant FC patterns reflect compensatory brain reorganization and disrupted cognitive network integration, highlighting potential neuroimaging markers for OSA.
背景和目的：阻塞性睡眠呼吸暂停（OSA）患者会经历慢性间歇性缺氧和睡眠片段化，从而导致大脑缺血和神经功能障碍。因此，确定可将 OSA 患者与健康对照组（HC）区分开来的特征并深入了解与 OSA 相关的潜在脑部改变非常重要。本研究旨在以小脑为种子区域，利用小脑-全脑静态和动态功能连接（分别为sFC和dFC）来区分OSA患者和健康人，并预测临床症状的改变：方法：研究对象包括60名男性OSA患者和60名年龄、教育程度和性别匹配的男性HC患者。使用 27 个小脑种子区进行滑动窗口分析，计算小脑和全脑之间的 sFC 和 dFC。然后将sFC和dFC值合并并用于多个机器学习模型，以区分OSA患者和HC患者，并预测OSA患者的临床症状：结果：OSA患者的小脑亚区与颞上回和颞中回之间的dFC增加，而与额中回之间的dFC减少。相反，小脑亚区与小脑第六小叶、扣带回、额中回、顶叶下叶、岛叶和颞上回之间的sFC增加。结合动态和静态FC特征的支持向量机在区分OSA和HC方面表现出了卓越的分类性能。在临床症状预测方面，FC改变对认知障碍的影响高达30.11%，对过度嗜睡的影响高达55.96%，对焦虑和抑郁的影响高达27.94%：结论：结合小脑sFC和dFC分析可对OSA进行高精度分类和预测。异常的FC模式反映了大脑的代偿性重组和认知网络整合的中断，突显了OSA的潜在神经影像标记。
{"title":"Combining static and dynamic functional connectivity analyses to identify male patients with obstructive sleep apnea and predict clinical symptoms","authors":"Lifeng Li , Liming Song , Yuting Liu , Muhammad Ayoub , Yucheng Song , Yongqiang Shu , Xiang Liu , Yingke Deng , Yumeng Liu , Yunyan Xia , Haijun Li , Dechang Peng","doi":"10.1016/j.sleep.2024.12.013","DOIUrl":"10.1016/j.sleep.2024.12.013","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Patients with obstructive sleep apnea (OSA) experience chronic intermittent hypoxia and sleep fragmentation, leading to brain ischemia and neurological dysfunction. Therefore, it is important to identify features that can differentiate patients with OSA from healthy controls (HC) and provide insights into the underlying brain alterations associated with OSA. This study aimed to distinguish patients with OSA from healthy individuals and predict clinical symptom alterations using cerebellum-whole-brain static and dynamic functional connectivity (sFC and dFC, respectively), with the cerebellum as the seed region.</div></div><div><h3>Methods</h3><div>Sixty male patients with OSA and 60 male HC matched for age, education level, and sex were included. Using 27 cerebellar seeds, sliding-window analysis was performed to calculate sFC and dFC between the cerebellum and the whole brain. The sFC and dFC values were then combined and used in multiple machine-learning models to distinguish patients with OSA from HC and predict the clinical symptoms of patients with OSA.</div></div><div><h3>Results</h3><div>Patients with OSA showed increased dFC between cerebellar subregions and the superior and middle temporal gyri and decreased dFC with the middle frontal gyrus. Conversely, increased sFC was observed between cerebellar subregions and the cerebellar lobule VI, cingulate gyrus, middle frontal gyrus, inferior parietal lobules, insula, and superior temporal gyrus. Combined dynamic-static FC features demonstrated superior classification performance with a support vector machine in discriminating OSA from HC. In clinical symptom prediction, FC alterations contributed up to 30.11 % to cognitive impairment, 55.96 % to excessive sleepiness, and 27.94 % to anxiety and depression.</div></div><div><h3>Conclusions</h3><div>Combining cerebrocerebellar sFC and dFC analyses enables high-precision classification and prediction of OSA. Aberrant FC patterns reflect compensatory brain reorganization and disrupted cognitive network integration, highlighting potential neuroimaging markers for OSA.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 136-147"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To prospectively assess, using polysomnography (PSG), the evolution in obstructive sleep apnea (OSA) in infants with Robin Sequence (RS) during their first year of life and to evaluate the role of PSG in OSA treatment.
Methods
Prospective and longitudinal study conducted in 2 tertiary hospitals (2018–2021). Data from 2 PSG (PSG1 0–3 months of life, PSG2 6–10 months of life) performed in RS infants in different sleep positions/conditions (without treatment: supine [SP]; with treatment: lateral [LP], prone [PP], respiratory support) were analyzed. OSA treatment type were compared before and after both PSG.
Results
Among the 45 RS infants included (median [IQR] age 2[1-2] months at PSG1 and 8[6-8] months at PSG2), 27 had available data from both PSG1/PSG2. Sleep efficacy without treatment (SP) tended to be lower at PSG1 than PSG2 (77%[66-84] versus 88%[78-96], p=0.0048). At PSG1 without treatment, 77% of infants had a severe OSA; OAHI significantly decreased between PSG1 and PSG2 (17/h[10-36 versus 5/h[3-7], p<0.0001). At PSG1 under treatment, despite an improvement in OAHI, OSA remained severe for 81% of infants in LP, 47% in PP, and 85% with respiratory support (16/h[11-21],10/h[6-17],18/h[11-20], respectively). PSG1 led to a change in treatment for 40% of infants (de-escalation 18%; escalation 22%).
Conclusion
Sleep and OSA improved spontaneously during the first months of life in RS infants, approaching near-normal at 8 months of age. Early PSG led to a change in management strategy in nearly half the RS infants, highlighting that PSG represents a precious tool to optimize OSA treatment.
Clinical trial registration
Not applicable.
目的：采用多导睡眠图（PSG）前瞻性评估罗宾序列（RS）婴儿1岁时阻塞性睡眠呼吸暂停（OSA）的演变，并评价PSG在OSA治疗中的作用。方法：2018-2021年在2家三级医院进行前瞻性和纵向研究。RS婴儿在不同睡姿/条件下(未经治疗：仰卧[SP]；治疗方式：侧卧[LP]，俯卧[PP]，呼吸支持)分析。比较两组PSG前后OSA治疗类型。结果：在纳入的45例RS婴儿中（PSG1时的中位[IQR]年龄为2[1-2]个月，PSG2时的中位[IQR]年龄为8[6-8]个月），27例具有PSG1/PSG2的可用数据。无治疗睡眠效率（SP）在PSG1期往往低于PSG2期（77%[66-84]对88%[78-96]，p=0.0048）。在未治疗的PSG1期，77%的婴儿有严重的OSA；OAHI在PSG1和PSG2组显著降低（17/h[10-36] vs . 5/h[3-7]）。结论：RS婴儿在出生后的头几个月睡眠和OSA自发改善，在8月龄时接近正常。早期PSG导致近一半RS婴儿管理策略的改变，强调PSG是优化OSA治疗的宝贵工具。临床试验注册：不适用。
{"title":"Role of polysomnography in the management of obstructive sleep apnea during the first year of life in robin sequence: A prospective and longitudinal study","authors":"Laurianne Coutier , Romane Gyapay , Aurore Guyon , Marine Thieux , Robin Pouyau , Sébastien Blanc , Sonia Ayari , Lucie Griffon , Agnès Giuseppi , Pauline Adnot , Adrien Aubin , Brigitte Fauroux , Véronique Abadie , Patricia Franco","doi":"10.1016/j.sleep.2024.11.041","DOIUrl":"10.1016/j.sleep.2024.11.041","url":null,"abstract":"<div><h3>Objectives</h3><div>To prospectively assess, using polysomnography (PSG), the evolution in obstructive sleep apnea (OSA) in infants with Robin Sequence (RS) during their first year of life and to evaluate the role of PSG in OSA treatment.</div></div><div><h3>Methods</h3><div>Prospective and longitudinal study conducted in 2 tertiary hospitals (2018–2021). Data from 2 PSG (PSG1 0–3 months of life, PSG2 6–10 months of life) performed in RS infants in different sleep positions/conditions (without treatment: supine [SP]; with treatment: lateral [LP], prone [PP], respiratory support) were analyzed. OSA treatment type were compared before and after both PSG.</div></div><div><h3>Results</h3><div>Among the 45 RS infants included (median [IQR] age 2[1-2] months at PSG1 and 8[6-8] months at PSG2), 27 had available data from both PSG1/PSG2. Sleep efficacy without treatment (SP) tended to be lower at PSG1 than PSG2 (77%[66-84] versus 88%[78-96], p=0.0048). At PSG1 without treatment, 77% of infants had a severe OSA; OAHI significantly decreased between PSG1 and PSG2 (17/h[10-36 <em>versus</em> 5/h[3-7], p<0.0001). At PSG1 under treatment, despite an improvement in OAHI, OSA remained severe for 81% of infants in LP, 47% in PP, and 85% with respiratory support (16/h[11-21],10/h[6-17],18/h[11-20], respectively). PSG1 led to a change in treatment for 40% of infants (de-escalation 18%; escalation 22%).</div></div><div><h3>Conclusion</h3><div>Sleep and OSA improved spontaneously during the first months of life in RS infants, approaching near-normal at 8 months of age. Early PSG led to a change in management strategy in nearly half the RS infants, highlighting that PSG represents a precious tool to optimize OSA treatment.</div></div><div><h3>Clinical trial registration</h3><div>Not applicable.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 73-81"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Actigraphy is increasingly being used to assess sleep in patients with neurodegenerative diseases. However, information on its accuracy relative to polysomnography (PSG) in this clinical population remains scarce. This study investigates the performance of actigraphy compared to PSG in patients with behavioral variant frontotemporal dementia (bvFTD), which is the leading form of early-onset dementia.
Methods
Eighteen patients with bvFTD (10 males, mean age 70.50 ± 8.48 years) underwent overnight, in-home PSG while concurrently wearing an actigraph on their non-dominant wrist. Actigraphy performance was assessed through discrepancy analysis, Bland-Altman plots, and epoch-by-epoch analysis (EBE). Analyses were conducted separately for the Cole-Kripke and UCSD scoring algorithms.
Results
Discrepancy analysis highlighted that the Cole-Kripke and UCSD algorithms overestimate total sleep time (by 43 and 60 min, respectively) and sleep efficiency (by 7.13 % and 10.33 %, respectively). The Cole-Kripke algorithm also overestimates sleep onset latency (by 7.75 min). Wake after sleep onset (WASO) showed a negative proportional bias for both algorithms, indicating that actigraphy underestimates WASO for subjects with longer PSG-measured WASO. In the EBE analysis, the Cole-Kripke algorithm shows an accuracy of 84 % (sensitivity 93 %, specificity 62 %) and the UCSD algorithm an accuracy of 85 % (sensitivity 96 %, specificity 57 %).
Conclusions
In patients with bvFTD, actigraphy significantly overestimates total sleep time, sleep latency, and sleep efficiency, while underestimating WASO. Clinicians and researchers using actigraphy to study sleep in bvFTD must carefully consider these measurement biases and correct for them based on the results of previous comparison studies.
{"title":"Actigraphy validation in behavioral variant frontotemporal dementia","authors":"Ludovica Tamburrino , Benedetta Tafuri , Valentina Gnoni , Salvatore Nigro , Alessia Giugno , Daniele Urso , Stefano Zoccolella , Marco Filardi , Giancarlo Logroscino","doi":"10.1016/j.sleep.2024.12.009","DOIUrl":"10.1016/j.sleep.2024.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Actigraphy is increasingly being used to assess sleep in patients with neurodegenerative diseases. However, information on its accuracy relative to polysomnography (PSG) in this clinical population remains scarce. This study investigates the performance of actigraphy compared to PSG in patients with behavioral variant frontotemporal dementia (bvFTD), which is the leading form of early-onset dementia.</div></div><div><h3>Methods</h3><div>Eighteen patients with bvFTD (10 males, mean age 70.50 ± 8.48 years) underwent overnight, in-home PSG while concurrently wearing an actigraph on their non-dominant wrist. Actigraphy performance was assessed through discrepancy analysis, Bland-Altman plots, and epoch-by-epoch analysis (EBE). Analyses were conducted separately for the Cole-Kripke and UCSD scoring algorithms.</div></div><div><h3>Results</h3><div>Discrepancy analysis highlighted that the Cole-Kripke and UCSD algorithms overestimate total sleep time (by 43 and 60 min, respectively) and sleep efficiency (by 7.13 % and 10.33 %, respectively). The Cole-Kripke algorithm also overestimates sleep onset latency (by 7.75 min). Wake after sleep onset (WASO) showed a negative proportional bias for both algorithms, indicating that actigraphy underestimates WASO for subjects with longer PSG-measured WASO. In the EBE analysis, the Cole-Kripke algorithm shows an accuracy of 84 % (sensitivity 93 %, specificity 62 %) and the UCSD algorithm an accuracy of 85 % (sensitivity 96 %, specificity 57 %).</div></div><div><h3>Conclusions</h3><div>In patients with bvFTD, actigraphy significantly overestimates total sleep time, sleep latency, and sleep efficiency, while underestimating WASO. Clinicians and researchers using actigraphy to study sleep in bvFTD must carefully consider these measurement biases and correct for them based on the results of previous comparison studies.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 178-184"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Parkinson's disease (PD), rapid eye movement (REM) sleep behaviour disorder (RBD) signifies a poorer prognosis, yet its impact on white matter (WM) degeneration remains unclear. The study examined the effect of RBD on WM alterations in PD progression.
Methods
The study included 45 PD patients with possible RBD (PD-pRBD), 38 PD patients without possible RBD (PD-npRBD), and 79 healthy controls (HC). All patients underwent clinical assessments and diffusion MRI scans at least once a year for up to 4 visits. 79 HC underwent the same protocol at baseline. WM metrics, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), were calculated using tract-based spatial statistics. Linear mixed-effects models were conducted to examine the changes in clinical features and WM fibers.
Results
At baseline, PD-npRBD showed increased RD in several regions, predominantly in bilateral uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF), compared to HC (PFDR<0.05). During follow-up, PD-npRBD had further FA decrease in left UF and ILF (PFDR<0.05). PD-pRBD showed reduced FA in several regions relative to HC at baseline (PFDR<0.05), and faster FA decline in left UF and ILF than PD-npRBD during follow-up, with more extensive FA decrease in other regions such as anterior thalamic radiation and inferior fronto-occipital fasciculus (PFDR<0.05). Moreover, increased RD in the left corticospinal tract correlated with motor symptoms (p = 0.045) in PD-pRBD.
Conclusions
PD patients with pRBD demonstrated more extensive WM degeneration and accelerated degeneration in the left ILF and UF during the disease course. However, due to the lack of PSG verification, these results should be interpreted cautiously while directly relating to RBD. These findings provide new insights into the neural structural basis associated with the potential impact of RBD on PD progression.
{"title":"Wider and faster degeneration of white matter in Parkinson's disease with possible REM sleep behaviour disorder","authors":"Sijia Tan , Jiaqi Wen , Jianmei Qin , Xiaojie Duanmu , Chenqing Wu , Weijin Yuan , Qianshi Zheng , Tao Guo , Cheng Zhou , Haoting Wu , Jingwen Chen , Jingjing Wu , Hui Hong , Bingting Zhu , Yuelin Fang , Yaping Yan , Baorong Zhang , Minming Zhang , Xiaojun Guan , Xiaojun Xu","doi":"10.1016/j.sleep.2024.12.001","DOIUrl":"10.1016/j.sleep.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>In Parkinson's disease (PD), rapid eye movement (REM) sleep behaviour disorder (RBD) signifies a poorer prognosis, yet its impact on white matter (WM) degeneration remains unclear. The study examined the effect of RBD on WM alterations in PD progression.</div></div><div><h3>Methods</h3><div>The study included 45 PD patients with possible RBD (PD-pRBD), 38 PD patients without possible RBD (PD-npRBD), and 79 healthy controls (HC). All patients underwent clinical assessments and diffusion MRI scans at least once a year for up to 4 visits. 79 HC underwent the same protocol at baseline. WM metrics, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), were calculated using tract-based spatial statistics. Linear mixed-effects models were conducted to examine the changes in clinical features and WM fibers.</div></div><div><h3>Results</h3><div>At baseline, PD-npRBD showed increased RD in several regions, predominantly in bilateral uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF), compared to HC (<em>P</em><sub>FDR</sub><0.05). During follow-up, PD-npRBD had further FA decrease in left UF and ILF (<em>P</em><sub>FDR</sub><0.05). PD-pRBD showed reduced FA in several regions relative to HC at baseline (<em>P</em><sub>FDR</sub><0.05), and faster FA decline in left UF and ILF than PD-npRBD during follow-up, with more extensive FA decrease in other regions such as anterior thalamic radiation and inferior fronto-occipital fasciculus (<em>P</em><sub>FDR</sub><0.05). Moreover, increased RD in the left corticospinal tract correlated with motor symptoms <em>(p</em> = 0.045) in PD-pRBD.</div></div><div><h3>Conclusions</h3><div>PD patients with pRBD demonstrated more extensive WM degeneration and accelerated degeneration in the left ILF and UF during the disease course. However, due to the lack of PSG verification, these results should be interpreted cautiously while directly relating to RBD. These findings provide new insights into the neural structural basis associated with the potential impact of RBD on PD progression.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 97-106"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.sleep.2024.11.038
Shrijan Bariya , Yun Tao , Ruiqing Zhang , Ming Zhang
<div><h3>Background</h3><div>Infertility affects millions of individuals worldwide, imposing significant personal and societal burdens. Assisted reproductive technologies (ART), such as IVF and ICSI, provide hope for many, yet clinical pregnancy rate per embryo transfer remains around 35 %. Modifiable lifestyle factors, including sleep, may influence ART outcomes. However, the relationship between specific sleep characteristics and IVF/ICSI success is unclear. This study aims to explore the associations between sleep characteristics and various IVF/ICSI outcomes. Additionally, we investigated if perceived stress mediates these relationships.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled 174 women undergoing IVF/ICSI at Zhongnan Hospital of Wuhan University from December 2021 to December 2023. Prior to initial ART treatment, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10). IVF/ICSI outcomes such as the number of retrieved oocytes, matured oocytes, number of fertilized oocytes, fertilization rate, good-quality embryos, blastocyst formation rate and early pregnancy outcome (implantation and clinical pregnancy) were obtained from medical records. We employed multivariate generalized linear models to assess the associations between sleep characteristics and IVF/ICSI outcomes. Dose-response relationships between napping duration and maturation rate were analyzed using generalized additive models. Mediation analysis was used to assess the role of stress in the relationship between sleep characteristics and IVF/ICSI outcomes.</div></div><div><h3>Results</h3><div>Women reporting poor sleep quality had significantly fewer retrieved oocytes (−22.89 %, 95%CI: 37.82 %, −4.00 %) and matured oocytes (−22.01 %, 95%CI: 37.54 %, −2.62 %). Those sleeping ≥10 h per night had fewer retrieved oocytes (−30.68 %, 95%CI: 48.88 %, −6.00 %), matured oocytes (−27.17 %, 95%CI: 46.57 %, −0.73 %), and good-quality embryos (−45.64 %, 95%CI: 65.43 %, −14.51 %). Women experiencing difficulty falling asleep more than three times a week had a significant reduction in blastocyst rates (−64.40 %, 95 % CI: 85.55 %, −12.30 %). Those reporting difficulty falling asleep less than once a week had fewer retrieved oocytes (−28.89 %, 95%CI: 47.34 %, −3.98 %), and matured oocytes (−27.77 %, 95%CI: 46.90 %, −1.73 %). Napping exceeding 1 h daily was associated with a significantly lower oocyte maturation rate (−73.8 %, 95%CI: 88.91 %, −38.06 %). A significant non-linear dose-response relationship was observed between napping duration and maturation rate (<em>p</em> < 0.001), with maturation rates initially increasing slightly with short naps but declining significantly with longer naps, particularly beyond 1 h. This relationship was significant among women with good sleep quality (PSQI ≤5) (<em>p</em> < 0.001) and those with normal BMI (<em>p</em> = 0.0005). Perceived stress did not significantly mediat
{"title":"Impact of sleep characteristics on IVF/ICSI outcomes: A prospective cohort study","authors":"Shrijan Bariya , Yun Tao , Ruiqing Zhang , Ming Zhang","doi":"10.1016/j.sleep.2024.11.038","DOIUrl":"10.1016/j.sleep.2024.11.038","url":null,"abstract":"<div><h3>Background</h3><div>Infertility affects millions of individuals worldwide, imposing significant personal and societal burdens. Assisted reproductive technologies (ART), such as IVF and ICSI, provide hope for many, yet clinical pregnancy rate per embryo transfer remains around 35 %. Modifiable lifestyle factors, including sleep, may influence ART outcomes. However, the relationship between specific sleep characteristics and IVF/ICSI success is unclear. This study aims to explore the associations between sleep characteristics and various IVF/ICSI outcomes. Additionally, we investigated if perceived stress mediates these relationships.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled 174 women undergoing IVF/ICSI at Zhongnan Hospital of Wuhan University from December 2021 to December 2023. Prior to initial ART treatment, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10). IVF/ICSI outcomes such as the number of retrieved oocytes, matured oocytes, number of fertilized oocytes, fertilization rate, good-quality embryos, blastocyst formation rate and early pregnancy outcome (implantation and clinical pregnancy) were obtained from medical records. We employed multivariate generalized linear models to assess the associations between sleep characteristics and IVF/ICSI outcomes. Dose-response relationships between napping duration and maturation rate were analyzed using generalized additive models. Mediation analysis was used to assess the role of stress in the relationship between sleep characteristics and IVF/ICSI outcomes.</div></div><div><h3>Results</h3><div>Women reporting poor sleep quality had significantly fewer retrieved oocytes (−22.89 %, 95%CI: 37.82 %, −4.00 %) and matured oocytes (−22.01 %, 95%CI: 37.54 %, −2.62 %). Those sleeping ≥10 h per night had fewer retrieved oocytes (−30.68 %, 95%CI: 48.88 %, −6.00 %), matured oocytes (−27.17 %, 95%CI: 46.57 %, −0.73 %), and good-quality embryos (−45.64 %, 95%CI: 65.43 %, −14.51 %). Women experiencing difficulty falling asleep more than three times a week had a significant reduction in blastocyst rates (−64.40 %, 95 % CI: 85.55 %, −12.30 %). Those reporting difficulty falling asleep less than once a week had fewer retrieved oocytes (−28.89 %, 95%CI: 47.34 %, −3.98 %), and matured oocytes (−27.77 %, 95%CI: 46.90 %, −1.73 %). Napping exceeding 1 h daily was associated with a significantly lower oocyte maturation rate (−73.8 %, 95%CI: 88.91 %, −38.06 %). A significant non-linear dose-response relationship was observed between napping duration and maturation rate (<em>p</em> < 0.001), with maturation rates initially increasing slightly with short naps but declining significantly with longer naps, particularly beyond 1 h. This relationship was significant among women with good sleep quality (PSQI ≤5) (<em>p</em> < 0.001) and those with normal BMI (<em>p</em> = 0.0005). Perceived stress did not significantly mediat","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 122-135"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence on the potential effects of midday napping on risk of stroke in Chinese populations remains limited.
Objectives
We aimed to prospectively investigate the association between midday napping and risk of subsequent stroke and stroke subtypes in the Kailuan study.
Methods
Midday napping duration was obtained from a self-reported questionnaire. Incident stroke cases from baseline (2014) to December 31, 2020 were confirmed by review of medical records. The association of midday napping duration with risk of incident stroke and subtypes was examined using a Cox regression model, adjusting for potential confounders. We further investigated the joint effects of nocturnal sleep duration and midday napping on the risk of stroke.
Results
A total of 96,899 individuals (21.0 % women; 51.9 ± 14.0 years) were included. During an average follow-up of 5.62 ± 0.69 years, 2539 incident stroke cases were documented. After adjusting for potential confounders, we found that participants with a midday napping duration of >60 min/day had higher risk of incident stroke (adjusted HR: 1.23; 95 % CI: 1.07, 1.42), compared with those without midday napping. Furthermore, significant joint effects were found in both nocturnal sleep duration (P-interaction=0.04) and snoring status (P-interaction= 0.005) on the association between midday napping duration and the risk of incident stroke, especially for participants who napped >60 min/day and slept ≤7 h/night compared with those who slept 7–8 h/night and did not take a nap, or those who napped >60 min/day and snored compared with those who did not take a nap and snore.
Conclusions
We found that prolonged midday napping (>60 min/day) was associated with higher risk of stroke and the association was stronger among those with shorter nocturnal sleep duration or those who snored.
{"title":"Midday napping duration and risk of stroke: A prospective study in China","authors":"Jiani Huang , Yuntao Wu , Liang Sun , Yesong Liu , Shouling Wu , Sheng Zhuang , Shuohua Chen , Xiang Gao","doi":"10.1016/j.sleep.2024.12.012","DOIUrl":"10.1016/j.sleep.2024.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Evidence on the potential effects of midday napping on risk of stroke in Chinese populations remains limited.</div></div><div><h3>Objectives</h3><div>We aimed to prospectively investigate the association between midday napping and risk of subsequent stroke and stroke subtypes in the Kailuan study.</div></div><div><h3>Methods</h3><div>Midday napping duration was obtained from a self-reported questionnaire. Incident stroke cases from baseline (2014) to December 31, 2020 were confirmed by review of medical records. The association of midday napping duration with risk of incident stroke and subtypes was examined using a Cox regression model, adjusting for potential confounders. We further investigated the joint effects of nocturnal sleep duration and midday napping on the risk of stroke.</div></div><div><h3>Results</h3><div>A total of 96,899 individuals (21.0 % women; 51.9 ± 14.0 years) were included. During an average follow-up of 5.62 ± 0.69 years, 2539 incident stroke cases were documented. After adjusting for potential confounders, we found that participants with a midday napping duration of >60 min/day had higher risk of incident stroke (adjusted HR: 1.23; 95 % CI: 1.07, 1.42), compared with those without midday napping. Furthermore, significant joint effects were found in both nocturnal sleep duration (<em>P</em>-interaction<em>=</em>0.04) and snoring status (<em>P</em>-interaction<em>=</em> 0.005) on the association between midday napping duration and the risk of incident stroke, especially for participants who napped >60 min/day and slept ≤7 h/night compared with those who slept 7–8 h/night and did not take a nap, or those who napped >60 min/day and snored compared with those who did not take a nap and snore.</div></div><div><h3>Conclusions</h3><div>We found that prolonged midday napping (>60 min/day) was associated with higher risk of stroke and the association was stronger among those with shorter nocturnal sleep duration or those who snored.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"126 ","pages":"Pages 205-210"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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