Sleep medicine最新文献_第8页

Association between obstructive sleep apnea and metabolic profiles across sleep stages in pediatrics 阻塞性睡眠呼吸暂停与儿科睡眠阶段代谢谱之间的关系。

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-02 DOI: 10.1016/j.sleep.2026.108763

Yiling Wan , Xiaoyi Wang , Xianshan Hu , Xiaojun Zhan , Yaru Kong , Tianxu Liu , Wen Hu , Jun Tai

Objective

To evaluate the association between metabolic profiles and obstructive sleep apnea (OSA) during rapid eye movement (REM) and non-REM (NREM) sleep in children.

Methods

A total of 514 children underwent overnight polysomnography (PSG) and biochemical testing. Obstructive apnea hypopnea indices (OAHI) and oxygen desaturation indices (ODI) were recorded for total sleep time (TST), REM, and NREM. A multivariate analysis of covariance model assessed the associations of OAHI_TST, OAHI_NREM, and OAHI_REM with overall metabolic parameters, adjusting for body mass index (BMI) z-score and other covariates. Then, multivariable linear regression models were used to quantify the independent effects of sleep variables on metabolic profiles during REM and NREM sleep.

Results

When stratified by OAHI-defined severity of OSA, TP, TCH, TG, HDL-C, LDL-C, LDL-C/HDL-C, TyG, and ALT levels were significantly different during TST and NREM (all P < 0.05). In fully adjusted multivariable linear regression models, both OAHI_TST, OAHI_NREM and OAHI_REM were independently associated with these metabolic parameters. When stratified by ODI-defined severity of OSA, HDL-C, LDL-C, LDL-C/HDL-C, and TyG levels differed significantly during NREM (all P < 0.05) and were independently related to ODI_NREM. ODI_REM was independently associated with TP, TCH, TG, HDL-C, LDL-C, LDL-C/HDL-C, and TyG levels. And in fully adjusted multivariable linear regression models, associations between ODI and TG, LDL-C, and TCH were evident during REM sleep but not during NREM sleep.

Conclusions

In pediatric OSA, OAHI was associated with metabolic alterations throughout sleep stages. ODI showed more pronounced metabolic effects during REM sleep, where the associations of TG, LDL-C, and TCH varied across ODI severity categories.

目的：探讨儿童快速眼动（REM）和非快速眼动（NREM）睡眠期间代谢谱与阻塞性睡眠呼吸暂停（OSA）的关系。方法：对514例患儿进行夜间多导睡眠图（PSG）和生化检查。记录总睡眠时间（TST）、快速眼动（REM）和非快速眼动（NREM）的阻塞性呼吸暂停低通气指数（OAHI）和氧去饱和指数（ODI）。协方差模型的多变量分析评估了OAHITST、OAHINREM和OAHIREM与总体代谢参数的关系，调整了身体质量指数（BMI） z分数和其他协变量。然后，使用多变量线性回归模型量化睡眠变量对快速眼动和非快速眼动睡眠期间代谢谱的独立影响。结果：根据oahi定义的OSA严重程度分层，TP、TCH、TG、HDL-C、LDL-C、LDL-C/HDL-C、TyG和ALT水平在TST和NREM期间存在显著差异（所有P、TST、OAHINREM和OAHIREM均与这些代谢参数独立相关）。当按odi定义的OSA严重程度分层时，HDL-C、LDL-C、LDL-C/HDL-C和TyG水平在NREM期间差异显著（均为P NREM）。ODIREM与TP、TCH、TG、HDL-C、LDL-C、LDL-C/HDL-C和TyG水平独立相关。在完全调整的多变量线性回归模型中，ODI与TG、LDL-C和TCH在快速眼动睡眠期间存在显著相关性，而在非快速眼动睡眠期间不存在相关性。结论：在儿童OSA中，OAHI与整个睡眠阶段的代谢改变有关。ODI在快速眼动睡眠期间表现出更明显的代谢影响，其中TG， LDL-C和TCH的相关性在ODI严重程度类别中有所不同。

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引用次数: 0

Drivers of suboptimal sleep education and insomnia in children: A Cognitive and Emotional Model of Young Children's Insomnia (CEMYCI) 次优睡眠教育和儿童失眠的驱动因素：幼儿失眠的认知和情感模型（CEMYCI）。

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-24 DOI: 10.1016/j.sleep.2025.108737

Florian Lecuelle , Royce Anders , Marie-Paule Gustin , Marie-Josèphe Challamel , Marc Weissbluth , Patricia Franco , Benjamin Putois

Aims

This study involved empirical data modelling with the aim of developing a Cognitive and Emotional Model of Young Children's Insomnia (CEMYCI). This theoretical framework newly integrates influential cognitive and emotional dimensions, or drivers, and parent-child dynamics, into the classically-described behavioral framework of insomnia. It more comprehensively accounts for the mechanisms leading to or reinforcing childhood insomnia, thereby offering important clinical angles to consider for successfully managing behavioral insomnia.

Methods

A large array of sleep, health, cognitive, behavioral, and emotional variables were measured in children and parents, including for example nighttime parent interventions, screen exposure, and perceived guilt. 2291 mothers of children aged from 6 months to 6 years old participated in the study. Psychometrically-validated questionnaires were used for measurement. Correlation, regression, factor analyses, and structural equation modelling were performed.

Results

The resultant CEMYCI model successfully explained R² = 91 % of the variance in childhood insomnia compared to R² = 78 % from the multiple regression analysis. The CEMYCI model specifies paths between key psychological and behavioral constructs such as nighttime toddler crying, parent interpretations of crying, judgmental emotions, daytime parenting challenges, drivers of overinvolvement and maladaptive parenting interventions that exacerbate child insomnia, in-turn leading to parent distress symptoms.

Conclusion

This new theoretical framework highlights the importance of integrating psychoeducational strategies and cognitive restructuring into the treatment of childhood sleep disorders. By enhancing our understanding of the complex dynamics between parents and children, this model offers innovative perspectives for therapeutic interventions, aiming to reduce the impact of insomnia on children and their families.

目的：本研究采用实证数据建模，旨在建立幼儿失眠的认知和情绪模型（CEMYCI）。这一理论框架将有影响的认知和情感维度，或驱动因素，以及亲子动态整合到经典的失眠症行为框架中。它更全面地解释了导致或加强儿童失眠的机制，从而为成功管理行为性失眠提供了重要的临床角度。方法：对儿童和父母的睡眠、健康、认知、行为和情绪变量进行了大量测量，包括夜间父母干预、屏幕暴露和感知内疚感。2291名6个月至6岁儿童的母亲参与了这项研究。采用心理测量验证问卷进行测量。进行相关分析、回归分析、因子分析和结构方程建模。结果：由此产生的CEMYCI模型成功地解释了R2 = 91%的儿童失眠方差，而多元回归分析的R2 = 78%。CEMYCI模型指定了关键心理和行为结构之间的路径，如夜间幼儿哭泣，父母对哭泣的解释，判断情绪，白天育儿挑战，过度参与的驱动因素和不适应的育儿干预加剧了儿童失眠，进而导致父母的痛苦症状。结论：这一新的理论框架强调了将心理教育策略和认知重构整合到儿童睡眠障碍治疗中的重要性。通过加强我们对父母和孩子之间复杂动态的理解，该模型为治疗干预提供了创新的视角，旨在减少失眠对儿童及其家庭的影响。

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引用次数: 0

Association of estimated cardiorespiratory fitness with circadian syndrome: A cross-national analysis of two large aging cohorts 估计的心肺健康与昼夜节律综合征的关联：两个大型老龄化队列的跨国分析。

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-19 DOI: 10.1016/j.sleep.2025.108736

Mingjie Liu , Chendong Wang , Bohan Xiang , Rundong Liu , Yingjia Hu , Haili Ma

Background

Promoting healthy aging requires identifying modifiable factors that can preserve physiological regulation. Cardiorespiratory fitness (CRF), a key pillar of healthspan, and Circadian Syndrome (CircS), an emerging marker of systemic dysregulation, are both strongly linked to health outcomes, yet their direct relationship is unknown. This study aimed to investigate the cross-sectional and longitudinal associations between estimated CRF (eCRF) and CircS in two large, distinct aging populations.

Methods

This population-based study utilized data from the China Health and Retirement Longitudinal Study (CHARLS; n = 3116) and the English Longitudinal Study of Ageing (ELSA; n = 7039). Associations were evaluated using logistic regression for prevalent CircS and Cox proportional hazards models for incident CircS. Covariate selection for these models was guided by a Directed Acyclic Graph (DAG). Restricted cubic splines were used to model non-linear associations, and stratified analyses were conducted to identify potential effect modifiers.

Results

A total of 10,155 participants were included. Cross-sectionally, higher eCRF was robustly associated with lower odds of prevalent CircS in both CHARLS (OR for high vs. low: 0.12, 95 %CI 0.10–0.15) and ELSA (OR: 0.16, 95 %CI 0.14–0.18), with a linear dose-response in CHARLS but a non-linear one in ELSA. Longitudinally, higher baseline eCRF was associated with a lower risk of incident CircS in both the CHARLS (HR: 0.38, 95 %CI 0.25–0.56) and the ELSA cohorts (HR: 0.45, 95 %CI 0.36–0.56). The association in ELSA was significantly modified by sex (P-interaction<0.001), being stronger in females; this interaction was observed in both cross-sectional and longitudinal analyses.

Conclusion

Higher eCRF is associated with both a lower prevalence and reduced long-term incidence of CircS in both Chinese and English older adults. However, the characteristics of this association, including dose-response patterns and modification by sex, appear to be population-dependent.

背景：促进健康老龄化需要确定可以保持生理调节的可改变因素。心肺适能（CRF）是健康的关键支柱，昼夜节律综合征（CircS）是系统失调的新兴标志，两者都与健康结果密切相关，但它们之间的直接关系尚不清楚。本研究旨在调查两个大型、不同的老龄化人群中估计的CRF （eCRF）和CircS之间的横断面和纵向关联。方法：这项基于人群的研究使用了中国健康与退休纵向研究（CHARLS, n = 3116）和英国老龄化纵向研究（ELSA, n = 7039）的数据。使用流行CircS的逻辑回归和事件CircS的Cox比例风险模型来评估相关性。这些模型的协变量选择由有向无环图（DAG）指导。限制三次样条用于模拟非线性关联，并进行分层分析以确定潜在的影响修饰因子。结果：共纳入10155名受试者。横断面上，较高的eCRF与CHARLS（高/低OR: 0.12, 95% CI 0.10-0.15）和ELSA （OR: 0.16, 95% CI 0.14-0.18）中较低的流行CircS几率显著相关，CHARLS呈线性剂量效应，而ELSA呈非线性剂量效应。纵向上，在CHARLS组（HR: 0.38, 95% CI 0.25-0.56）和ELSA组（HR: 0.45, 95% CI 0.36-0.56）中，较高的基线eCRF与较低的CircS发生风险相关。结论：在中国和英国的老年人中，较高的eCRF与较低的CircS患病率和较低的长期发病率相关。然而，这种关联的特征，包括剂量-反应模式和性别变化，似乎依赖于人群。

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引用次数: 0

Remote assessments of sleep and cognition in cognitively normal older adults at risk for Alzheimer disease 阿尔茨海默病风险中认知正常老年人睡眠和认知的远程评估

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-19 DOI: 10.1016/j.sleep.2025.108734

Hannah M. Wilks , Matthew S. Welhaf , Andrew J. Aschenbrenner , Brian D. Carpenter , Brian A. Gordon , Suzanne E. Schindler , Brendan P. Lucey , John C. Morris , Jason Hassenstab

Study objectives

Sleep is a marker of brain function that could potentially identify patients for early intervention by detecting cognitive change during the early asymptomatic stages of Alzheimer disease (AD). We examined the relationship between sleep and cognition in cognitively unimpaired older adults and evaluated whether the relationship was altered by AD risk factors.

Methods

Cognitively unimpaired older adults (N = 319, age 54–97 years) were administered a sleep diary (1x/day) and brief cognitive assessments (4x/day) for seven consecutive days via a smartphone application. We evaluated if a previous night's sleep predicts next-day cognition and if sleep averaged over a week predicts cognitive performance averaged over a week. Additional analyses included the effects of carrying an apolipoprotein (APOE) ε4 allele and cerebrospinal fluid biomarkers of AD pathology.

Results

At the between-person level, no associations were observed between sleep and cognition. Within-person analyses revealed that deviations (both higher and lower scores) from an individual's usual sleep pattern were associated poorer next day cognitive performance. Carriage of the APOE ε4 allele and AD biomarkers did not interact with sleep-cognition relationships.

Conclusions

Remote, multi-day assessments of cognition and sleep revealed subtle non-linear associations between nightly sleep and next-day cognition in cognitively unimpaired older adults. Furthermore, the individualized nature of sleep-cognition relationships underscores the importance of maintaining consistent person-centered sleep health metrics to support cognitive function. Capturing latent AD-related changes in sleep and cognition among asymptomatic older adults may require repeated assessments across extended timeframes.

研究目的：睡眠是一种脑功能的标志物，可以通过检测阿尔茨海默病（AD）早期无症状阶段的认知变化来识别患者并进行早期干预。我们研究了认知功能未受损的老年人睡眠与认知之间的关系，并评估了这种关系是否会因AD危险因素而改变。方法通过智能手机应用程序连续7天对认知功能未受损的老年人（N = 319，年龄54-97岁）进行睡眠日记（1次/天）和简短认知评估（4次/天）。我们评估了前一晚的睡眠是否能预测第二天的认知，以及一周的平均睡眠是否能预测一周的平均认知表现。其他分析包括携带载脂蛋白(APOE) ε4等位基因和AD病理脑脊液生物标志物的影响。结果在人与人之间，睡眠和认知之间没有关联。对个人的分析显示，与个人通常睡眠模式的偏差（无论是得分较高还是较低）与第二天较差的认知表现有关。携带APOE ε4等位基因和AD生物标志物与睡眠认知关系没有相互作用。结论：认知和睡眠的远程、多日评估显示，在认知功能未受损的老年人中，夜间睡眠和第二天认知之间存在微妙的非线性关联。此外，睡眠-认知关系的个体化本质强调了保持一致的以人为中心的睡眠健康指标以支持认知功能的重要性。在无症状的老年人中捕捉潜在的ad相关的睡眠和认知变化可能需要在较长的时间框架内反复评估。

{"title":"Remote assessments of sleep and cognition in cognitively normal older adults at risk for Alzheimer disease","authors":"Hannah M. Wilks , Matthew S. Welhaf , Andrew J. Aschenbrenner , Brian D. Carpenter , Brian A. Gordon , Suzanne E. Schindler , Brendan P. Lucey , John C. Morris , Jason Hassenstab","doi":"10.1016/j.sleep.2025.108734","DOIUrl":"10.1016/j.sleep.2025.108734","url":null,"abstract":"<div><h3>Study objectives</h3><div>Sleep is a marker of brain function that could potentially identify patients for early intervention by detecting cognitive change during the early asymptomatic stages of Alzheimer disease (AD). We examined the relationship between sleep and cognition in cognitively unimpaired older adults and evaluated whether the relationship was altered by AD risk factors.</div></div><div><h3>Methods</h3><div>Cognitively unimpaired older adults (N = 319, age 54–97 years) were administered a sleep diary (1x/day) and brief cognitive assessments (4x/day) for seven consecutive days via a smartphone application. We evaluated if a previous night's sleep predicts next-day cognition and if sleep averaged over a week predicts cognitive performance averaged over a week. Additional analyses included the effects of carrying an apolipoprotein <em>(APOE)</em> ε4 allele and cerebrospinal fluid biomarkers of AD pathology.</div></div><div><h3>Results</h3><div>At the between-person level, no associations were observed between sleep and cognition. Within-person analyses revealed that deviations (both higher and lower scores) from an individual's usual sleep pattern were associated poorer next day cognitive performance. Carriage of the <em>APOE</em> ε4 allele and AD biomarkers did not interact with sleep-cognition relationships.</div></div><div><h3>Conclusions</h3><div>Remote, multi-day assessments of cognition and sleep revealed subtle non-linear associations between nightly sleep and next-day cognition in cognitively unimpaired older adults. Furthermore, the individualized nature of sleep-cognition relationships underscores the importance of maintaining consistent person-centered sleep health metrics to support cognitive function. Capturing latent AD-related changes in sleep and cognition among asymptomatic older adults may require repeated assessments across extended timeframes.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"139 ","pages":"Article 108734"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841759","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}

引用次数: 0

Co-classification network analysis reveals nodal dysfunction and dimension-specific alterations in obstructive sleep apnea-hypopnea syndrome 共分类网络分析揭示了阻塞性睡眠呼吸暂停低通气综合征的淋巴结功能障碍和维度特异性改变。

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2026-01-04 DOI: 10.1016/j.sleep.2026.108764

Zhiyuan Yang , Maoyuan Jiang , Jialiu Jiang , Ruozhu Xiong , Chenglu Mao , Shuang Fang , Lili Huang , Zhihong Ke , Zheqi Hu , Yuting Mo , Yun Xu

Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a prevalent sleep disorder linked to brain alterations, but its brain network patterns and convenient screening methods remain unclear. This study aimed to characterize OSAHS functional brain networks via co-classification network analysis and assess their diagnostic utility.

Methods

174 participants were stratified by the apnea-hypopnea index (AHI) into none or mild (nm-OSAHS) and moderate or severe (ms-OSAHS) groups, and by the lowest oxygen saturation (SpO₂ nadir) into none or mild (nm-hypoxemia) and moderate or severe (ms-hypoxemia) groups. (Registered number: MR-32-25-040098). They underwent out-of-center sleep testing, neuropsychological tests, and MRI. Co-classification networks (via consensus modularity analysis) and traditional functional networks (via graph theory) were analyzed, with random forest model for diagnostic accuracy.

Results

Ms-OSAHS and ms-hypoxemia groups showed worse sleep respiratory parameters. Co-classification network analysis revealed significant alterations in intra-module z score, participation coefficient (PC), and diversity coefficient (SD) in the visual, dorsal attention, salience/ventral attention, and executive control networks in ms-OSAHS patients. PC in the left temporo-occipital junction and right parietal operculum was positively correlated with AHI, while PC in limbic regions was negatively correlated with lowest SpO₂. The random forest model using co-classification metrics demonstrates good diagnostic performance for OSAHS, with dorsal attention, control, and salience networks mostly contributing to classification.

Conclusions

OSAHS induced widespread nodal dysfunction in brain networks, with distinct changes driven by hypoxemia and apnea frequency. Co-classification network analysis outperforms traditional methods in detecting network abnormalities, and machine learning models based on nodal parameters show high diagnostic accuracy, suggesting potential for OSAHS screening.

背景：阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种与大脑改变有关的普遍睡眠障碍，但其大脑网络模式和方便的筛查方法尚不清楚。本研究旨在通过共分类网络分析来表征OSAHS的功能脑网络，并评估其诊断效用。方法：174例受试者按呼吸暂停低通气指数（AHI）分为无或轻度（nm-OSAHS）组和中度或重度（ms-OSAHS）组，按最低血氧饱和度（SpO2最低点）分为无或轻度（nm-低氧血症）组和中度或重度（ms-低氧血症）组。（注册号：MR-32-25-040098）他们接受了中心外睡眠测试、神经心理测试和核磁共振成像。对共分类网络（通过共识模块化分析）和传统功能网络（通过图论）进行了分析，采用随机森林模型提高诊断准确率。结果：Ms-OSAHS组和ms-低氧血症组睡眠呼吸参数较差。共分类网络分析显示，ms-OSAHS患者的视觉、背侧注意、显著性/腹侧注意和执行控制网络的模块内z评分、参与系数（PC）和多样性系数（SD）均有显著变化。左侧颞枕交界处和右侧顶盖的PC与AHI呈正相关，而边缘区PC与最低SpO2呈负相关。使用协同分类指标的随机森林模型对OSAHS具有良好的诊断性能，其中背侧注意网络、控制网络和显著性网络主要用于分类。结论：OSAHS引起广泛的脑网络节点功能障碍，低氧血症和呼吸暂停频率驱动的变化明显。共分类网络分析在检测网络异常方面优于传统方法，基于节点参数的机器学习模型具有较高的诊断准确率，提示OSAHS筛查的潜力。

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引用次数: 0

Sex-specific changes and age-specific trends in sleep quality and sleep apnea: Analysis of one-million nights of sleep 睡眠质量和睡眠呼吸暂停的性别特异性变化和年龄特异性趋势：对一百万晚睡眠的分析。

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI: 10.1016/j.sleep.2025.108728

Hugi Hilmisson , Solveig Magnusdottir , Robert J. Thomas

Introduction

Sleep quality and breathing changes with aging. Women report worse subjective sleep-quality while having better objective polysomnographic (PSG) sleep quality, than men. Electroencephalogram (EEG) slow-wave sleep shows marked reductions with age, but non-EEG based sleep quality is relatively well preserved.

Methods

The CPC-based SleepImage® System was used to estimate a sleep quality index (SQI), sleep fragmentation and sleep apnea. Included in the analysis are 1 million nights of clinical home recordings including ≥6-h of duration and ≥4-h of estimated total-sleep time, with good signal quality (≥80%) from individuals ≥18-years (45.5%-women, average 2-nights).

Results

Age groups in years (n = 1 million, 45.4 % women) were defined as 18-30-years (n = 97,192, 46.0%-women), 31-40-years (n = 170,879, 41.6%-women), 41-50-years (n = 211,795, 42.7%-women), 51-60-years (n = 224,795, 46.8%-women), 61-70-years (188,798, 48.8%-women) and ≥71-years (107,065, 47.1%-women). Paralleling known N3 patterns, women have significantly higher SQI in all age-groups. However, sleep efficiency is significantly lower in women in all age-groups and starts to decline in both sexes ≥71-years of age. The SQI gradually declines in both sexes until ≥61-years and then stabilizes, unlike the EEG based N3. AHI₃_% is significantly lower in women in all age-groups. AHI₃_% gradually increases with age, most prominently in men from 31 to 51 years and women after 51 years AHI₃_% has stronger negative correlation with SQI in men, then declines ≥61 years.

Conclusion

The sleep quality decline with age in a non-PSG EEG based assessment is less evident than the reported steep decline in N3 sleep. The CPC-SQI is higher in women in all age-groups, but sleep efficiency is lower, which may help explain lower subjective sleep quality in women.

睡眠质量和呼吸随着年龄的增长而变化。与男性相比，女性主观睡眠质量较差，而客观多导睡眠图（PSG）睡眠质量较好。脑电图（EEG）慢波睡眠随着年龄的增长而明显减少，但非脑电图睡眠质量相对较好。方法：采用基于cpc的SleepImage®系统评估睡眠质量指数（SQI）、睡眠碎片化和睡眠呼吸暂停。分析纳入了100万晚的临床家庭记录，包括≥6小时的持续时间和≥4小时的估计总睡眠时间，信号质量良好（≥80%），来自≥18岁的个体（45.5%-女性，平均2晚）。结果：年龄组（n = 100万，45.4%女性）定义为18-30岁（n = 97192, 46.0%女性）、31-40岁（n = 170879, 41.6%女性）、41-50岁（n = 211795, 42.7%女性）、51-60岁（n = 224795, 46.8%女性）、61-70岁（188798,48.8%女性）和≥71岁（107065,47.1%女性）。与已知的N3模式相似，在所有年龄组中，女性的SQI明显更高。然而，睡眠效率在所有年龄组的女性中都明显较低，并且在年龄≥71岁的男女中都开始下降。与基于脑电图的N3不同，男女SQI在≥61岁时逐渐下降，然后趋于稳定。在所有年龄组的妇女中，AHI3%明显较低。AHI3%随着年龄的增长而逐渐升高，男性在31 ~ 51岁之间最为显著，女性在51岁之后AHI3%与SQI呈较强的负相关，然后在≥61岁时下降。结论：基于非psg脑电图的评估中，睡眠质量随年龄的下降不如N3睡眠的急剧下降明显。各年龄组女性的CPC-SQI都较高，但睡眠效率较低，这可能有助于解释女性主观睡眠质量较低的原因。

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引用次数: 0

Sleep problems in relation to emotion dysregulation in children with ADHD 睡眠问题与多动症儿童情绪失调的关系。

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.sleep.2025.108738

Lin Sørensen , Camille Hjo , Stephen P. Becker

Sleep disturbances are highly prevalent in children with attention-deficit/hyperactivity disorder (ADHD). Although situation-inappropriate emotion regulation is a well-established characteristic of ADHD, and sleep problems have been linked to such emotion dysregulation (EDR) in children more broadly, the nature of this relationship in ADHD remains insufficiently understood. EDR in ADHD is typically characterized by emotion lability, most prominently through heightened negative emotions. However, increasing evidence suggests that children with ADHD also struggle with lability in regulating positive affect. In this study, we applied a four-factor model of EDR—negative emotion lability, positive emotion lability, socially inappropriate affect, and socially incongruent affect—to examine associations between sleep disturbances and EDR in a sample of children with ADHD. Caregivers of 139 children aged 8–12 years completed the Children's Sleep Habits Questionnaire and the Emotion Regulation Checklist. Based on prior evidence, we hypothesized that sleep disturbances would be more strongly related to emotion lability than to socially inappropriate or socially incongruent affect. Multiple linear regression analyses supported this hypothesis: sleep disturbances were primarily associated with emotion lability, particularly fluctuations in positive affect. These findings provide clinically relevant insights into the interplay between sleep and EDR in ADHD and extend the focus beyond the traditional emphasis on negative emotion lability.

睡眠障碍在患有注意力缺陷/多动障碍（ADHD）的儿童中非常普遍。尽管情境不恰当的情绪调节是ADHD的一个公认的特征，并且睡眠问题与儿童的这种情绪调节障碍（EDR）有更广泛的联系，但这种关系在ADHD中的本质仍然没有得到充分的理解。ADHD患者的EDR通常以情绪不稳定为特征，最显著的是负面情绪的加剧。然而，越来越多的证据表明，患有多动症的儿童在调节积极情绪方面也很不稳定。在这项研究中，我们应用了消极情绪不稳定、积极情绪不稳定、社会不适当情绪和社会不一致情绪的四因素模型来检验ADHD儿童样本中睡眠障碍和EDR之间的关系。139名8 ~ 12岁儿童的照顾者填写了儿童睡眠习惯问卷和情绪调节检查表。基于先前的证据，我们假设睡眠障碍与情绪不稳定性的关系比与社会不适当或社会不一致的影响的关系更强。多元线性回归分析支持这一假设：睡眠障碍主要与情绪不稳定有关，尤其是积极情绪的波动。这些发现为ADHD患者睡眠和EDR之间的相互作用提供了临床相关的见解，并扩展了对负面情绪不稳定性的传统强调。

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引用次数: 0

Pharmacological management of insomnia with a focus on GABAA receptor positive allosteric modulators and orexin receptor antagonists 失眠的药理学管理，重点是GABAA受体阳性变构调节剂和食欲素受体拮抗剂

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-26 DOI: 10.1016/j.sleep.2025.108743

Chelsea Unger, Kristi A. Kohlmeier

The scientific literature regarding the effectiveness of two insomnia treatments: GABA_A receptor positive allosteric modulators, and orexin receptor antagonists is reviewed. In this review, we define insomnia, present epidemiological statistics on insomnia, and provide a rationale for use of medications targeting GABA_A and orexin receptors for management of insomnia. Following this, we present results of a PRISM guideline-based literature search spanning multiple databases, including PubMed, Google Scholar, ScienceDirect as well as curated searches through Baker Library at Harvard Business School covering publications evaluating insomnia therapies based on targeting GABA_A and orexin receptors available as of March 2025. We conclude that orexin receptor antagonists, notably lemborexant, were found to be more effective, safer, and improve quality of life greater when compared to GABA_A receptor positive allosteric modulators for short and long-term treatment of insomnia. While GABA_A receptor positive allosteric modulators are effective for short-term use, which typically spans two to four weeks, they present a greater number of contraindications than orexin receptor antagonists, and orexin receptor antagonists are superior at preserving the natural sleep architecture. Adverse events are particularly exacerbated when GABA_A receptor positive allosteric modulators are used for longer treatment durations spanning months, whereas orexin receptor antagonists tend to show a more favorable profile over similar long-term use. Nevertheless, there is an observed dose-response relationship with orexin receptor antagonists that may increase the risk of abuse at higher dosages. Approval for use of orexin receptor antagonists for management of insomnia is more restrictive in European countries than that seen in other regions around the globe. Taken together, the findings advocate for increased accessibility of orexin receptor antagonists in Europe for management of primary insomnia.

本文综述了GABAA受体阳性变构调节剂和食欲素受体拮抗剂两种治疗失眠的科学文献。在这篇综述中，我们定义了失眠症，介绍了失眠症的流行病学统计数据，并为使用靶向GABAA和食欲素受体的药物治疗失眠症提供了依据。在此之后，我们展示了基于PRISM指南的文献检索结果，该检索跨越多个数据库，包括PubMed， b谷歌Scholar， ScienceDirect以及哈佛商学院Baker图书馆的精选检索，涵盖截至2025年3月基于靶向GABAA和食欲素受体评估失眠治疗的出版物。我们的结论是，与GABAA受体阳性变构调节剂相比，食欲素受体拮抗剂，特别是lemborexant，在短期和长期治疗失眠方面更有效，更安全，更能改善生活质量。虽然GABAA受体阳性变构调节剂对短期使用有效，通常持续两到四周，但它们比食欲素受体拮抗剂有更多的禁忌症，而食欲素受体拮抗剂在保持自然睡眠结构方面更优越。当使用GABAA受体阳性变构调节剂的治疗持续时间较长（跨越数月）时，不良事件尤其加剧，而在类似的长期使用中，食欲素受体拮抗剂往往表现出更有利的情况。然而，观察到与食欲素受体拮抗剂存在剂量-反应关系，这可能会增加高剂量滥用的风险。与全球其他地区相比，欧洲国家对使用食欲素受体拮抗剂治疗失眠的批准更为严格。综上所述，这些发现提倡在欧洲增加食欲素受体拮抗剂用于治疗原发性失眠的可及性。

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引用次数: 0

Clinical and socioeconomic burden among people with narcolepsy or idiopathic hypersomnia: A retrospective cohort analysis of the Danish National Patient Registry 发作性睡病或特发性嗜睡症患者的临床和社会经济负担：丹麦国家患者登记的回顾性队列分析

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-02 DOI: 10.1016/j.sleep.2025.108690

Poul Jørgen Jennum , Michael Ibsen , Sam Mettam , Sarah C. Markt , Douglas S. Fuller , Jessica K. Alexander , Rikke Ibsen , Jakob Kjellberg , Caroleen Drachenberg

Objective/background

To assess the clinical and socioeconomic burden of narcolepsy and idiopathic hypersomnia (IH) in Denmark.

Patients/methods

This retrospective cohort study using Danish National Patient Registry data included individuals diagnosed with narcolepsy or IH (1/1/2005–12/31/2017). Individuals with narcolepsy were matched 1:4 with controls without narcolepsy; matching was repeated for individuals with IH. Comorbidities, employment, income, and healthcare costs were assessed in the 3 years before and after diagnosis using logistic regression and generalized linear models.

Results

1183 individuals with narcolepsy (4728 controls) and 1801 individuals with IH (7204 controls) were assessed. Before diagnosis, individuals with narcolepsy had higher odds (odds ratio [OR]; 95 % confidence interval [CI]) of having nervous system (7.92 [6.46, 9.71]) or circulatory system diseases (2.45 [1.95, 3.07]) than controls, in addition to higher unemployment (2.30 [1.79, 2.96]). Individuals with narcolepsy had lower mean income before (€22,076 vs €26,538) and after (€21,786 vs €27,090) diagnosis and higher mean healthcare costs before (€4547 vs €1909) and after (€7411 vs €2178) diagnosis. Before diagnosis, individuals with IH had higher odds (OR [95 % CI]) of having nervous system (9.37 [7.93, 11.08]) or circulatory system diseases (1.80 [1.49, 2.16]) than controls, in addition to higher unemployment (1.73 [1.42, 2.10]). Individuals with IH had lower mean income before (€31,947 vs €34,503) and after (€30,262 vs €35,139) diagnosis and higher mean healthcare costs before (€4050 vs €1840) and after (€5124 vs €2106) diagnosis.

Conclusions

Danish individuals with narcolepsy or IH had a greater clinical and socioeconomic burden than controls.

目的/背景：评估丹麦发作性睡病和特发性嗜睡症（IH）的临床和社会经济负担。患者/方法：本回顾性队列研究使用丹麦国家患者登记处的数据，包括诊断为发作性睡病或IH的个体（2005年1月1日至2017年12月31日）。发作性睡病患者与非发作性睡病患者按1:4配对；对IH患者重复匹配。使用logistic回归和广义线性模型评估诊断前后3年的合并症、就业、收入和医疗费用。结果：共评估了1183例发作性睡症患者（对照4728例）和1801例IH患者（对照7204例）。在诊断前，发作性睡病患者患神经系统疾病（7.92[6.46,9.71]）或循环系统疾病（2.45[1.95,3.07]）的几率高于对照组（95%可信区间[OR]），失业率也高于对照组（2.30[1.79,2.96]）。发作性睡病患者在诊断前（22,076欧元对26,538欧元）和诊断后（21,786欧元对27,090欧元）的平均收入较低，诊断前（4547欧元对1909欧元）和诊断后（7411欧元对2178欧元）的平均医疗费用较高。诊断前，IH患者患神经系统疾病（9.37[7.93,11.08]）或循环系统疾病（1.80[1.49,2.16]）的几率（OR [95% CI]）高于对照组，失业率也较高（1.73[1.42,2.10]）。患有IH的个体在诊断前（31,947欧元对34,503欧元）和诊断后（30,262欧元对35,139欧元）的平均收入较低，诊断前（4050欧元对1840欧元）和诊断后（5124欧元对2106欧元）的平均医疗费用较高。结论：丹麦发作性睡病或IH患者的临床和社会经济负担大于对照组。

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引用次数: 0

The impact of exercise training on the obstructive sleep apnea endotypes 运动训练对阻塞性睡眠呼吸暂停内窥镜的影响。

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine

Pub Date : 2026-03-01 Epub Date: 2025-12-22 DOI: 10.1016/j.sleep.2025.108740

Caroline J. Beatty , Shane A. Landry , Dwayne L. Mann , Simon A. Joosten , Jinny Collet , Rosyvaldo Ferreira-Silva , Linda M. Ueno-Pardi , Pedro R. Genta , Garun S. Hamilton , Bradley A. Edwards

Rationale

Weight-loss interventions such as exercise are often recommended to manage obstructive sleep apnea (OSA). Interestingly, exercise can modestly improve OSA severity even without significant changes in body weight. However, the mechanisms underlying the improvements in OSA severity, separate from those observed with weight loss, are currently unknown. We aimed to assess how exercise affects the OSA endotypes (upper-airway collapsibility, loop gain, arousal threshold and upper-airway muscle compensation) and identify individuals most likely to benefit.

Methods

We retrospectively analyzed data from participants with OSA (mean age = 52.8 ± 7.0 years) who underwent a 6-month exercise intervention (n = 22). OSA endotypes were calculated from routine polysomnographic recordings before and following the intervention. Paired t-tests were used to compare the OSA endotypes before and after the exercise intervention. Regression analysis was used to assess whether the baseline OSA endotype(s) predict change in OSA severity.

Results

Following exercise training, there was an improvement in the apnea-hypopnea index (AHI; 37.2[17.1, 57.4] to 27.9[15.9, 48.8] events/hr, p = 0.046) but no significant change in body weight. Overall, there was no change in OSA endotypes; however, improvements in AHI were associated with improvements in muscle compensation (r² = 0.332, p = 0.006) and reductions in the arousal threshold (r² = 0.256, p = 0.023). Furthermore, poor muscle compensation (r² = 0.462, p = 0.001) and a high arousal threshold (r² = 0.397, p = 0.004) at baseline predicted greater reductions in OSA severity.

Conclusion

Exercise may improve OSA by strengthening the upper airway muscles. As such, regular exercise may be helpful to improve OSA in those with poor upper airway muscle function (and a high arousal threshold).

理由：减肥干预措施，如运动，经常被推荐用于治疗阻塞性睡眠呼吸暂停（OSA）。有趣的是，即使体重没有明显变化，运动也能适度改善呼吸暂停的严重程度。然而，与减肥所观察到的不同，OSA严重程度改善的机制目前尚不清楚。我们旨在评估运动如何影响OSA内型（上气道可折叠性、循环增益、唤醒阈值和上气道肌肉代偿），并确定最有可能受益的个体。方法：我们回顾性分析了接受6个月运动干预的OSA患者（平均年龄52.8±7.0岁）的资料（n = 22）。通过干预前后的常规多导睡眠图记录计算OSA内型。采用配对t检验比较运动干预前后OSA内型的差异。采用回归分析评估基线OSA内型是否能预测OSA严重程度的变化。结果：运动训练后，呼吸暂停低通气指数（AHI; 37.2[17.1, 57.4]至27.9[15.9,48.8]事件/小时，p = 0.046）有所改善，但体重无显著变化。总体而言，OSA内型没有变化；然而，AHI的改善与肌肉代偿的改善（r2 = 0.332, p = 0.006）和觉醒阈值的降低（r2 = 0.256, p = 0.023）相关。此外，基线时较差的肌肉代偿（r2 = 0.462, p = 0.001）和较高的唤醒阈值（r2 = 0.397, p = 0.004）预示着OSA严重程度的更大降低。结论：运动可通过加强上呼吸道肌肉来改善阻塞性睡眠呼吸暂停。因此，有规律的运动可能有助于改善上气道肌肉功能差（觉醒阈值高）的OSA患者。

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引用次数: 0