Clocks & Sleep最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.