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Healthcare Burden and Productivity Loss Due to Narcolepsy in Sweden.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-19 DOI: 10.3390/clockssleep7010008
Anna Giertz, Johan Mesterton, Tanja Jakobsson, Stephen Crawford, Somraj Ghosh, Anne-Marie Landtblom

Background: Narcolepsy impacts both patients and society, yet there is limited data on its socioeconomic consequences.

Methods: This retrospective longitudinal cohort study used pseudonymized patient-level data from Swedish registers and included narcolepsy patients from January 2015-December 2019 and age-sex matched controls. All patients received an index date corresponding to their first narcolepsy diagnosis.

Results: This study included 466 incident narcolepsy patients and 2330 matched controls. During the years studied, healthcare resource utilization was 2-5 times higher for incident narcolepsy patients compared to matched controls (p < 0.0001). Modafinil, stimulants, and antidepressants were prescribed more often to incident narcolepsy patients (p < 0.0001). Work productivity was significantly impacted, as incident narcolepsy patients took 7.0-10.5 more sick leave days than their matched controls (p < 0.0001) and had an average of 14.8 net days of disability leave (associated with indirect costs of EUR 1630) versus only 5.8 days among matched controls (EUR 638) during the year of the index (p = 0.027). After controlling for age, sex, and the Charlson comorbidity index, the odds of disability leave were 3.3 times higher in incident narcolepsy patients.

Conclusions: This study provides evidence of the magnitude of the substantial societal economic burden due to narcolepsy in Sweden, evidenced by higher healthcare resource utilization and indirect costs.

背景:嗜睡症对患者和社会都有影响:嗜睡症对患者和社会都有影响,但有关其社会经济后果的数据却很有限:这项回顾性纵向队列研究使用了来自瑞典登记册的化名患者级数据,纳入了2015年1月至2019年12月的嗜睡症患者和年龄性别匹配的对照组。所有患者都获得了与其首次嗜睡症诊断相对应的索引日期:这项研究纳入了 466 名嗜睡症患者和 2330 名匹配对照者。在研究期间,嗜睡症患者的医疗资源利用率是匹配对照组的 2-5 倍(p < 0.0001)。嗜睡症患者更常服用莫达非尼、兴奋剂和抗抑郁药(p < 0.0001)。嗜睡症事件患者的工作效率受到严重影响,因为他们的病假天数比匹配的对照组多 7.0-10.5 天(p < 0.0001),在指数年期间,他们平均有 14.8 天的净残疾假(与 1630 欧元的间接成本相关),而匹配的对照组只有 5.8 天(638 欧元)(p = 0.027)。在对年龄、性别和夏尔森合并症指数进行控制后,嗜睡症患者发生残疾假的几率是对照组的 3.3 倍:本研究提供了瑞典嗜睡症造成的巨大社会经济负担的证据,其表现为较高的医疗资源利用率和间接成本。
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引用次数: 0
Circadian Rhythms, Regular Exercise, and Cognitive Performance in Morning-Trained Dancers.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-18 DOI: 10.3390/clockssleep7010007
Mariana Marchesano, Alejandra Carboni, Bettina Tassino, Ana Silva

Time-of-day and individual circadian variability influence cognitive performance, with later chronotypes being most compromised earlier in the day. On the other hand, moderate-intensity exercise has been shown to enhance cognitive function. We sought to evaluate the interplay among circadian rhythms, exercise, and cognitive performance in 22 students from the Uruguayan National Dance School, a population previously characterized as late chronotypes, attending a demanding morning schedule. We assessed sleep habits and physical activity patterns using self-report questionnaires and actigraphy. Before and after morning training, participants completed a psychomotor vigilance task (PVT) and a visual Stroop task (congruent and incongruent). The reaction speeds were lower early in the morning than at noon for all these tasks. We also found (1) a positive correlation between weekend sleep duration and PVT performance before training but not after; (2) a negative correlation between individual circadian phase and Stroop performance for both congruent and incongruent conditions after training but not before; and (3) a better Stroop performance after training for both congruent and incongruent conditions in dancers who engaged longer moderate-intensity exercise during training. Our findings suggest that regular morning training might help mitigate cognitive impairments experienced by dancers with later chronotypes in challenging morning scenarios.

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引用次数: 0
Sleep Alterations in the Population of the Metropolitan Area of Mexico and Their Association with Lifestyle Changes During COVID-19 Confinement.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-17 DOI: 10.3390/clockssleep7010006
María Del Rosario Ayala-Moreno, Paola Andrea Martínez-Serrano, Montserrat Alheli Melgarejo-Gutiérrez, Alma Rosa Hernández-Mondragón, Azucena Martínez-Basila, Araceli Martínez-Coronado, María José Losana-Valencia, Esther Vargas-Medina, Eloisa Colín-Ramírez, Adriana Benítez-Rico

Home confinement due to Coronavirus Disease 2019 (COVID-19) led to lifestyle changes that increased sleep disturbances, particularly in areas with higher infection and mortality rates. This study is a retrospective study based on data collected through an online survey conducted during the COVID-19 confinement. It aims to analyze changes in sleep quantity and quality and their association with lifestyle changes in the metropolitan area of Mexico City. A total of 899 adults from this area completed an online questionnaire between June 2020 and February 2021. This study assessed sleep quantity, sleep quality, insomnia symptoms, and lifestyle changes during the confinement period. Results showed that sleep quantity increased (7.10 ± 1.37 vs. 7.43 ± 1.42 h, p < 0.0001), with more participants, especially young adults and women, reporting later bed and wake-up times. The Pittsburgh Sleep Quality Index increased by 1.4 units, with poor sleep quality associated with lifestyle during confinement. Insomnia symptoms, sleep latency, and poor sleep quality also increased, particularly in women. Males and those without chronic comorbidities were less likely to experience poor sleep quality, while tobacco use and later bedtimes increased this risk. This study concludes that, while sleep quantity increased, sleep quality declined, particularly among young adults, women, and those with unhealthy lifestyles. These findings could guide sleep health initiatives tailored to specific lifestyle changes in different population groups.

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引用次数: 0
Association Between Alcohol Use Patterns and Insomnia Symptoms or Poor Sleep Quality Among Adult Women: An Internet Cross-Sectional Survey in Japan.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2025-02-13 DOI: 10.3390/clockssleep7010005
Suguru Nakajima, Yuichiro Otsuka, Yoshitaka Kaneita, Osamu Itani, Yuki Kuwabara, Aya Kinjo, Ruriko Minobe, Hitoshi Maesato, Susumu Higuchi, Hideyuki Kanda, Hisashi Yoshimoto, Maki Jike, Hideaki Kasuga, Teruna Ito, Yoneatsu Osaki

It is unclear whether patterns of alcohol consumption are associated with sleep disturbance. We aimed to investigate the relationship between comprehensive alcohol-related factors and insomnia symptoms, as well as sleep quality, among adult women in Japan. Responses to an online cross-sectional survey were gathered from 12,000 women. The survey items included demographic characteristics, alcohol consumption (Alcohol Use Disorders Identification Test, nightcaps, years of drinking), sleep-related factors (sleep duration, insomnia symptoms, sleep quality), lifestyle-related factors, and mental health. Binary logistic regression was used to investigate the relationship between alcohol consumption and both insomnia symptoms and sleep quality. A total of 10,233 women were included in the final analysis. The results revealed that several alcohol-related behaviors, including the consumption of nightcaps and years of drinking, were significantly associated with insomnia symptoms and poor sleep quality. Specifically, nightcaps were significantly associated with all types of insomnia symptoms and poor sleep quality, with a higher odds ratio than other alcohol-related items. Our findings suggest that specific alcohol-related behaviors, particularly the consumption of nightcaps, are associated with insomnia symptoms and poor sleep quality among women. Intervention programs for alcohol consumption should be provided to prevent sleep problems among women.

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引用次数: 0
Feasibility of an At-Home Experimental Circadian Misalignment Induction for Adolescents.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-28 DOI: 10.3390/clockssleep7010004
Dean W Beebe, Andrea L Fidler, Laura McLaughlin, Sabrina Grove, Stephanie J Crowley

Despite extensive research on the effects of sleep restriction on adolescent health, the field lacks experimental methods to study the health effects of mistimed sleep, which is also common among adolescents. This paper describes a novel 3-week experimental protocol that was designed to compare sleep restriction, like what many adolescents experience on school nights, against sleep that meets the recommended duration but is timed to be relatively aligned or misaligned with their circadian phase. Healthy 14-18-year-olds, classified as early ("Lark") and late ("Owl") chronotypes, entered a six-night chronotype-aligned stabilization condition, followed by five nights of sleep restriction, a return to the stabilization schedule, and five nights of healthy sleep duration (HS). During HS, participants were randomly assigned to early-to-bed versus late-to-rise arms, intended to align with or misalign with their circadian phase. Actigraphy monitored sleep, and weekly dim-light melatonin onset (DLMO) assessed circadian phase. Analyses confirmed that the protocol met five key validation metrics related to differential attrition, sleep timing, circadian phase, and experimental induction of HS that is timed to be relatively aligned vs. misaligned with circadian phase. This protocol appears useful for future research into how misaligned sleep patterns, which occur regularly for many adolescents, may impact health.

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引用次数: 0
Wearable Neurotechnology for the Treatment of Insomnia: The Study Protocol of a Prospective, Placebo-Controlled, Double-Blind, Crossover Clinical Trial of a Transcranial Electrical Stimulation Device.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-26 DOI: 10.3390/clockssleep7010003
Keenan Caswell, Grace Roe, Emamoke Odafe, Subodh Arora, Caddie Motoni, John Kent Werner

Sleep disruption and deprivation are epidemic problems in the United States, even among those without a clinically diagnosed sleep disorder. Military service members demonstrate an increased risk of insomnia, which doubles after deployment. This study will investigate the ability of a translational device, Teledyne PeakSleep™ (Teledyne Scientific & Imaging, Durham, NC, USA), to reduce sleep onset latency and the time spent awake after sleep onset, with improvement in the subjective benefits of sleep for patients with insomnia by enhancing the brain rhythms within the frontal lobe implicated in slow wave generation. During this crossover trial, patients will use the wearable neurotechnology prototype headband, which delivers < 14 min of frontal short duration repetitive-transcranial electrical stimulation over a 30 min period immediately before trying to fall asleep. Using active stimulation versus a sham paradigm, we will compare actigraphy data, physiological data, and subjective sleep measures against a pre-treatment baseline in the same patient over the course of the 8-week study. If successful, PeakSleep™ could address the final common pathway in insomnia, namely the onset and maintenance of slow-wave sleep (SWS), and accordingly has the potential to enhance sleep onset in a wide range of individuals, most importantly warfighters in whom efficient sleep onset may be critical for operational success.

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引用次数: 0
Impact of Varying Sleep Pressure on Daytime Sleep Propensity in Healthy Young and Older Adults.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2025-01-02 DOI: 10.3390/clockssleep7010002
Stella de Haan, Marine Dourte, Michele Deantoni, Mathilde Reyt, Marion Baillet, Christian Berthomier, Vincenzo Muto, Gregory Hammad, Christian Cajochen, Carolin F Reichert, Micheline Maire, Christina Schmidt, Svetlana Postnova

Fixed sleep schedules with an 8 h time in bed (TIB) are used to ensure participants are well-rested before laboratory studies. However, such schedules may lead to cumulative excess wakefulness in young individuals. Effects on older individuals are unknown. We combine modelling and experimental data to quantify the effects of sleep debt on sleep propensity in healthy younger and older participants. A model of arousal dynamics was fitted to sleep data from 22 young (20-31 y.o.) and 26 older (61-82 y.o.) individuals (25 male) undertaking 10 short sleep-wake cycles during a 40 h napping protocol, following >1 week of fixed 8 h TIB schedules. Homeostatic sleep drive at the study start was varied systematically to identify best fits between observed and predicted sleep profiles for individuals and group averages. Daytime sleep duration was the same on the two days of the protocol within the groups but different between the groups (young: 3.14 ± 0.98 h vs. 3.06 ± 0.75 h, older: 2.60 ± 0.98 h vs. 2.37 ± 0.64 h). The model predicted an initial homeostatic drive of 11.2 ± 3.5% (young) and 10.1 ± 3.5% (older) above well-rested. Individual variability in first-day, but not second-day, sleep patterns was explained by the differences in the initial homeostatic drive for both age groups. Our study suggests that both younger and older participants arrive at the laboratory with cumulative sleep debt, despite 8 h TiB schedules, which dissipates after the first four sleep opportunities on the protocol. This has implications for protocol design and the interpretation of laboratory studies.

{"title":"Impact of Varying Sleep Pressure on Daytime Sleep Propensity in Healthy Young and Older Adults.","authors":"Stella de Haan, Marine Dourte, Michele Deantoni, Mathilde Reyt, Marion Baillet, Christian Berthomier, Vincenzo Muto, Gregory Hammad, Christian Cajochen, Carolin F Reichert, Micheline Maire, Christina Schmidt, Svetlana Postnova","doi":"10.3390/clockssleep7010002","DOIUrl":"10.3390/clockssleep7010002","url":null,"abstract":"<p><p>Fixed sleep schedules with an 8 h time in bed (TIB) are used to ensure participants are well-rested before laboratory studies. However, such schedules may lead to cumulative excess wakefulness in young individuals. Effects on older individuals are unknown. We combine modelling and experimental data to quantify the effects of sleep debt on sleep propensity in healthy younger and older participants. A model of arousal dynamics was fitted to sleep data from 22 young (20-31 y.o.) and 26 older (61-82 y.o.) individuals (25 male) undertaking 10 short sleep-wake cycles during a 40 h napping protocol, following >1 week of fixed 8 h TIB schedules. Homeostatic sleep drive at the study start was varied systematically to identify best fits between observed and predicted sleep profiles for individuals and group averages. Daytime sleep duration was the same on the two days of the protocol within the groups but different between the groups (young: 3.14 ± 0.98 h vs. 3.06 ± 0.75 h, older: 2.60 ± 0.98 h vs. 2.37 ± 0.64 h). The model predicted an initial homeostatic drive of 11.2 ± 3.5% (young) and 10.1 ± 3.5% (older) above well-rested. Individual variability in first-day, but not second-day, sleep patterns was explained by the differences in the initial homeostatic drive for both age groups. Our study suggests that both younger and older participants arrive at the laboratory with cumulative sleep debt, despite 8 h TiB schedules, which dissipates after the first four sleep opportunities on the protocol. This has implications for protocol design and the interpretation of laboratory studies.</p>","PeriodicalId":33568,"journal":{"name":"Clocks & Sleep","volume":"7 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in the Spatial Structure of Synchronization Connections in EEG During Nocturnal Sleep Apnea.
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2024-12-31 DOI: 10.3390/clockssleep7010001
Maxim Zhuravlev, Anton Kiselev, Anna Orlova, Evgeniy Egorov, Oxana Drapkina, Margarita Simonyan, Evgenia Drozhdeva, Thomas Penzel, Anastasiya Runnova

This study involved 72 volunteers divided into two groups according to the apnea-hypopnea index (AHI): AHI>15 episodes per hour (ep/h) (main group, n=39, including 28 men, median AHI 44.15, median age 47), 0≤AHI≤15ep/h (control group, n=33, including 12 men, median AHI 2, median age 28). Each participant underwent polysomnography with a recording of 19 EEG channels. Based on wavelet bicoherence (WB), the magnitude of connectivity between all pairs of EEG channels in six bands was estimated: Df1 0.25;1, Df2 1;4, Df3 4;8, Df4 8;12, Df5 12;20, Df6 20;30 Hz. In all six bands considered, we noted a significant decrease in symmetrical interhemispheric connections in OSA patients. Also, in the main group for slow oscillatory activity Df1 and Df2, we observe a decrease in connection values in the EEG channels associated with the central interhemispheric sulcus. In addition, patients with AHI>15 show an increase in intrahemispheric connectivity, in particular, forming a left hemisphere high-degree synchronization node (connections PzT3, PzF3, PzFp1) in the Df2 band. When considering high-frequency EEG oscillations, connectivity in OSA patients again shows a significant increase within the cerebral hemispheres. The revealed differences in functional connectivity in patients with different levels of AHI are quite stable, remaining when averaging the full nocturnal EEG recording, including both the entire sleep duration and night awakenings. The increase in the number of hypoxia episodes correlates with the violation of the symmetry of interhemispheric functional connections. Maximum absolute values of correlation between the apnea-hypopnea index, AHI, and the WB synchronization strength are observed for the Df2 band in symmetrical EEG channels C3C4 (-0.81) and P3P4 (-0.77). The conducted studies demonstrate the possibility of developing diagnostic systems for obstructive sleep apnea syndrome without using signals from the cardiovascular system and respiratory activity.

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引用次数: 0
Impact of CPAP Therapy on Cognition and Fatigue in Patients with Moderate to Severe Sleep Apnea: A Longitudinal Observational Study. CPAP治疗对中重度睡眠呼吸暂停患者认知和疲劳的影响:一项纵向观察研究。
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2024-12-23 DOI: 10.3390/clockssleep6040051
Oumaïma Benkirane, Olivier Mairesse, Philippe Peigneux

Continued solicitation of cognitive resources eventually leads to cognitive fatigue (CF), i.e., a decrease in cognitive efficiency that develops during sustained cognitive demands in conditions of constrained processing time, independently of sleepiness. The expression of CF and its impact on cognition are partly contingent upon prior sleep quality and its restorative effects. Sleep in obstructive sleep apnea (OSA) may be largely restored through the use of continuous positive airway pressure (CPAP) treatment, contributing to a gradual improvement in sleep quality. In this longitudinal observational study, we investigated immediate and longer-term behavioral effects of CPAP treatment on cognitive functioning, evaluating outcomes after the initiation of treatment, and at three and six months, in compliant CPAP-treated OSA patients. Results indicate that CPAP therapy significantly enhances subjective sleep quality and cognitive functions, including episodic memory, inhibition, sustained attention, working memory, and executive control. Noticeable performance improvements were observed in CF-inducing tasks, particularly after six months of CPAP use. Participants also reported substantial gains in quality of life, reduced daytime sleepiness, and improved mood. These results confirm that CPAP therapy not only alleviates immediate physiological disturbances associated with OSA, but also supports cognitive recovery and enhanced overall daily functioning.

持续的认知资源请求最终导致认知疲劳(CF),也就是说,在有限的处理时间条件下,持续的认知需求会导致认知效率的下降,而与嗜睡无关。CF的表达及其对认知的影响部分取决于先前的睡眠质量及其恢复作用。阻塞性睡眠呼吸暂停(OSA)患者的睡眠可以通过持续气道正压通气(CPAP)治疗得到很大程度的恢复,有助于睡眠质量的逐步改善。在这项纵向观察研究中,我们调查了CPAP治疗对认知功能的即时和长期行为影响,评估了依从性CPAP治疗的OSA患者在治疗开始后、3个月和6个月时的结果。结果表明,CPAP治疗显著提高主观睡眠质量和认知功能,包括情景记忆、抑制、持续注意、工作记忆和执行控制。在cf诱导任务中观察到明显的性能改善,特别是在使用CPAP六个月后。参与者还报告说,他们的生活质量大幅提高,白天困倦减少,情绪也有所改善。这些结果证实,CPAP治疗不仅可以缓解与OSA相关的即时生理障碍,还可以支持认知恢复和增强整体日常功能。
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引用次数: 0
Multi-Night Home Assessment of Total Sleep Time Misperception in Obstructive Sleep Apnea with and Without Insomnia Symptoms. 伴有和不伴有失眠症状的阻塞性睡眠呼吸暂停患者总睡眠时间错觉的多夜家庭评估。
IF 2.1 Q3 CLINICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.3390/clockssleep6040050
Jasmin Kuhn, Laura R B Schiphorst, Bernice M Wulterkens, Jerryll Asin, Nanny Duis, Sebastiaan Overeem, Merel M van Gilst, Pedro Fonseca

Total sleep time (TST) misperception has been reported in obstructive sleep apnea (OSA). However, previous findings on predictors were inconsistent and predominantly relied on single-night polysomnography, which may alter patients' sleep perception. We leveraged advances in wearable sleep staging to investigate predictors of TST misperception in OSA over multiple nights in the home environment. The study included 141 patients with OSA, 75 without insomnia symptoms (OSA group), and 66 with insomnia symptoms (OSA-I group). Objective TST was measured using a previously validated wrist-worn photoplethysmography and accelerometry device. Self-reported TST was assessed using a digital sleep diary. TST misperception was quantified with the misperception index (MI), calculated as (objective - self-reported TST)/objective TST. MI values differed significantly between the OSA (median = -0.02, IQR = [-0.06, 0.02]) and the OSA-I group (0.05, [-0.02, 0.13], p < 0.001). Multilevel modeling revealed that the presence of insomnia symptoms (β = 0.070, p < 0.001) and lower daily reported sleep quality (β = -0.229, p < 0.001) were predictive of higher MI (TST underestimation), while a higher apnea-hypopnea index (AHI) was predictive of lower MI (TST overestimation; β = -0.001, p = 0.006). Thus, insomnia symptoms and AHI are associated with TST misperception in OSA patients, but in opposite directions. This association extends over multiple nights in the home environment.

据报道,阻塞性睡眠呼吸暂停(OSA)患者会对总睡眠时间(TST)产生误解。然而,之前关于预测因素的研究结果并不一致,而且主要依赖于单夜多导睡眠图,这可能会改变患者的睡眠感知。我们利用可穿戴睡眠分期技术的进步,研究了 OSA 患者在家庭环境中多夜 TST 错误感知的预测因素。这项研究包括 141 名 OSA 患者,其中 75 人无失眠症状(OSA 组),66 人有失眠症状(OSA-I 组)。客观 TST 使用之前经过验证的腕戴式光电血压计和加速度计测量。自我报告的 TST 采用数字睡眠日记进行评估。TST误感用误感指数(MI)进行量化,计算公式为(客观 TST - 自我报告 TST)/客观 TST。MI 值在 OSA 组(中位数 = -0.02,IQR = [-0.06,0.02])和 OSA-I 组(0.05,[-0.02,0.13],P <0.001)之间存在明显差异。多层次模型显示,存在失眠症状(β = 0.070,p < 0.001)和较低的每日报告睡眠质量(β = -0.229,p < 0.001)可预测较高的心肌缺血率(TST低估),而较高的呼吸暂停-低通气指数(AHI)可预测较低的心肌缺血率(TST高估;β = -0.001,p = 0.006)。因此,失眠症状和 AHI 与 OSA 患者的 TST 误测有关,但方向相反。这种关联在家庭环境中的多个夜晚都存在。
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引用次数: 0
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