Sleep Medicine Reviews最新文献

Obstructive sleep apnea (OSA) and insomnia could accelerate biological aging through pathways including oxidative stress and systemic inflammation. This systematic review aimed to determine the association of sleep disorders with circulating markers of biological aging. We searched MEDLINE, Embase, CINAHL, Cochrane, PsycINFO from inception to October 2024. Eligibility criteria included full manuscript English studies on adult humans examining OSA or insomnia and circulating markers of aging. Of the 1839 deduplicated records screened, 49 full-text studies were eligible for inclusion. Included studies ranged from poor to good quality and assessed telomere length (TL), DNA methylation clocks (epigenetics), mitochondrial alterations, sirtuin levels and activity, autophagy protein levels, and klotho gene expression. Telomeres were the most extensively studied marker, with our findings showing a significant association between TL and OSA, based on both unadjusted and adjusted values (SMD = -0.451, 95% CI: 0.688 to -0.215, p = 0.0026 and SMD = -3.01, 95% CI: 4.98 to -1.04, p = 0.033, respectively). Most studies linked insomnia and poor sleep quality to shorter TL. Although evidence for other aging biomarkers was more limited, the published literature supports the role of OSA and insomnia in accelerating biological aging, especially for telomere length.

Early childhood insomnia (ECI) affects 20-30 % of children aged 6-36 months, making it the most common sleep disturbance in this age group. Current interventions often focus on independent sleep through extinction-based behavioral methods, with less emphasis on broader socioecological influences such as caregiving quality and feeding practices. This paper introduces a conceptual model to reframe ECI interventions using the World Health Organization endorsed Nurturing care framework (NCF), which includes five components: good health, adequate nutrition, safety and security, responsive caregiving and opportunities for learning. Sleep is essential for health, and early childhood represent a critical window for shaping lifelong sleep patterns. Breastfeeding helps integration of all five components while responsive caregiving, supports the other four components. Sensory-motor nourishment fosters a sense of safety and early learning opportunities promote self-regulation. The model outlines actionable strategies under each NCF components, offering guidance for researchers and supporting adaptation across diverse settings, viewing sleep health as part of a broader caregiver ecosystem rather than isolated behavioral problem.

Background: This systematic review and Bayesian meta-analysis examined determinants of exercise effects on subjective sleep quality.

Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus and CINAHL from inception to August 2025 for randomised controlled trials in adults (≥18 years) comparing exercise with non-exercise controls. Two reviewers independently assessed risk of bias (RoB 2). Bayesian multilevel models, MetaForest and structural equation modelling estimated pooled effects and moderators, expressed as standardised mean differences (Hedges' g).

Results: Two hundred trials (n = 23,523) were included. Compared with active controls, qigong, walking and high-intensity interval training showed the largest benefits. In 20 trials reporting objective sleep efficiency, exercise produced a small but significant improvement, consistent with subjective outcomes. Baseline sleep quality (assessed with Pittsburgh Sleep Quality Index) and population type were the main determinants of response. Populations with poorer baseline sleep quality were much more likely to achieve a clinically important improvement than good sleepers. Intervention duration showed a U-shaped association with benefit, peaking at 25 weeks. Certainty of evidence was very low.

Conclusion: Exercise improves subjective sleep quality in a benefit-on-demand pattern, supporting prioritisation of approximately 25-week programmes for adults with moderate-to-severe sleep problems while acknowledging very low certainty.