Journal of Clinical Sleep Medicine最新文献

Study objectives: Sleep disturbances in "long COVID" are common, but the associations between the severity of sleep problems and the severity of COVID infection are unclear. We evaluated the prevalence, persistence, comorbidities, and clinical effects of insomnia following recovery from acute COVID-19 infection in a COVID-specific clinic.

Methods: Inpatients discharged after COVID infection and outpatients referred for persistent post-COVID symptoms were surveyed on insomnia severity (Insomnia Severity Index), other neuropsychological symptoms, cardiopulmonary symptoms and physiological functions (6-minute walk distance and others), and functional outcome and quality of life. Multivariable regression models evaluated the severity of Insomnia Severity Index against independent variables.

Results: A total of 280 patients met criteria at the initial visit. The prevalence of significant insomnia at the initial visit was 50% and 42% at the subsequent visit (obtained in 78 of the 280 patients). Lower age, female sex, non-White race, and non-Hispanic ethnicity were significantly associated with worse initial Insomnia Severity Index scores. More severe symptoms of anxiety and depression were strong correlates with worse Insomnia Severity Index scores. Interval improvements in insomnia severity correlated with improvements in anxiety and posttraumatic stress disorder scores. Physiological sequelae of infection did not correlate with insomnia at any stage.

Conclusions: Initial and persistent insomnia is common in long COVID. Treatment for insomnia with the use of evidence-based approaches (such as cognitive behavioral therapy for insomnia) may best suit this particular post-COVID symptom.

Citation: Kadl A, Davis EM, Oliver SF, et al. Prevalence and associations of insomnia after COVID-19 infection. J Clin Sleep Med. 2025;21(2):383-391.

The botulinum toxin (BT) is United States Food and Drug Administration-approved for therapeutic applications in different medical conditions. However, BT is not considered an obstructive sleep apnea therapy. Obstructive sleep apnea is characterized by recurrent airway collapse during sleep, leading to intermittent hypoxia, hypercapnia, and arousal. The application of BT in pharyngeal and masticatory musculature can reduce its constrictive activity, attenuating the obstructions. We present the first case report of a 38-year-old man with severe obstructive sleep apnea syndrome who underwent a BT infiltration in palatoglossal, stylohyoid, and masseter muscles bilaterally to treat obstructive sleep apnea itself. He had significant clinical and polysomnographic improvement during the muscle afferent block by intramuscular injection of BT, without adverse effects.

Citation: Ottoline ACX, da Cunha Viana A, Migueis DP. The effect of botulinum toxin in the masticatory and constrictor musculature of the pharynx as an option in the treatment of obstructive sleep apnea: a case report. J Clin Sleep Med. 2025;21(2):431-434.

Study objectives: Examine sleep patterns in children with sleep-disordered breathing (SDB) who habitually bedshare.

Methods: We evaluated associations of bedsharing with parent-reported (n = 457) and actigraphy-based (n = 258) sleep patterns in a diverse child sample (mean age 6.6 ± 2.3 years, range 3.0-12.9) with mild SDB using baseline data from the Pediatric Adenotonsillectomy Trial for Snoring. Multivariable linear regressions examined associations between sleep patterns and bedsharing, adjusting for sociodemographic, child, and parent/environmental factors. Moderation effects were investigated using interaction terms. Analyses were stratified by age, categorizing children as younger (< 6) and older (≥ 6) years.

Results: Bedsharing rates were 38%, with higher rates in younger (48%) vs older (30%) children (P < .001). In adjusted models, bedsharing was associated with about 30 minutes shorter actigraphy-derived nocturnal sleep duration (P = .005) and parent-reported later sleep midpoint (P < .005) in younger children. In older children, associations of bedsharing with shorter parent-reported sleep duration were more pronounced in children with greater SDB symptom burden (P = .02), and in children with higher ratings of anxiety (P = .048) and depressive symptoms (P = .02).

Conclusions: In children with mild SDB, bedsharing is associated with shorter sleep duration and later sleep timing in younger children. In older children, these relationships were modified by child factors, including SDB symptom burden and internalizing symptoms. These findings suggest that whereas age and parenting factors may play a greater role in the younger group, SDB and internalizing symptoms may play more of a role in older children who bedshare, suggesting the need to address co-occurring medical and emotional problems in children with SDB.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Pediatric Adenotonsillectomy for Snoring (PATS); URL: https://clinicaltrials.gov/study/NCT02562040; Identifier: NCT02562040.

Citation: Ibrahim S, Ievers-Landis CE, Taylor HG, et al. Bedsharing sleep characteristics in children with mild sleep-disordered breathing. J Clin Sleep Med. 2025;21(2):237-247.

Study objectives: Obstructive sleep apnea (OSA) is a common chronic medical condition that results in impaired daytime functioning. While the link between OSA and cardiovascular disease is important, there has been increasing recognition of the impact of OSA on daytime functioning and experience. Better insight into illness perceptions can help better understand how to initiate and maintain treatment.

Methods: Data from 2 OSA clinical trials were examined. The baseline respiratory event index was obtained from diagnostic sleep testing. The Brief Illness Perception Questionnaire assesses the cognitive and emotional representation of illness and was administered at baseline along with the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index.

Results: A total of 523 patients diagnosed with OSA were studied. The sample had a mean age of 51.1 ± 16.6, mean respiratory event index of 28.6 ± 17.9 events/h, and mean body mass index of 32.8 ± 15.5 kg/m². The mean Brief Illness Perception Questionnaire total score at baseline was 43.3 ± 11.3. Brief Illness Perception Questionnaire scores were significantly correlated with sleepiness and sleep quality but not with respiratory event index. Relative to other common chronic conditions with major comorbidities, Brief Illness Perception Questionnaire scores for patients with OSA were higher on consequences, identity, concern, and emotional representation dimensions.

Conclusions: The study shows that veterans with OSA report elevated illness perceptions across several dimensions at levels as high, or higher, than other common chronic conditions. Implications for clinical practice are that it is important to ask patients about their understanding of illness across several dimensions to appreciate better patient needs and preferences.

Citation: Zamora T, Nokes B, Malhotra A, Stepnowsky C. Obstructive sleep apnea illness perception relative to other common chronic conditions. J Clin Sleep Med. 2025;21(2):229-235.

Study objectives: Insomnia, poor sleep quality, and extremes of sleep duration are associated with COVID-19 infection. This study assessed whether these factors are related to post-acute sequelae of SARS-CoV-2 infection (PASC).

Methods: Cross-sectional survey of a general population of 24,803 United States adults to determine the association of insomnia, poor sleep quality, and sleep duration with PASC. Three definitions of PASC were used based on post COVID-19 clinical features: COVID-19 Outbreak Public Evaluation Initiative (COPE) (≥ 3), National Institute for Health and Care Excellence (NICE) (≥ 1), and Researching COVID to Enhance Recovery (RECOVER) (scoring algorithm).

Results: Prevalence rates of PASC were 21.9%, 38.9%, and 15.5% for COPE, NICE, and RECOVER PASC definitions, respectively. PASC was associated with insomnia in all 3 models after full adjustment with odds ratios and 95% confidence intervals (CIs) ranging from 1.30 (95% CI: 1.11-1.52, P ≤ .05, RECOVER PASC score) to 1.52 (95% CI: 1.34-1.71, P ≤ .001, NICE). Poor sleep quality was related to PASC in all models with adjusted odds ratios ranging from 1.77 (95% CI: 1.60-1.97, P ≤ .001, NICE) to 2.00 (95% CI: 1.77-2.26, P ≤ .001, COPE). Sleep < 6 hours was associated with PASC with adjusted odds ratios between 1.59 (95% CI: 1.40-1.80, P ≤ .001, RECOVER PASC score) and 1.70 (95% CI: 1.53-1.89, P ≤ .001, COPE). Sleep ≥ 9 hours was not associated with PASC in any model. Although vaccination with COVID-19 booster decreased the likelihood of developing PASC, it did not attenuate associations between insomnia, poor sleep quality, and short sleep duration with PASC in any of the models.

Conclusions: Insomnia, poor sleep quality, and short sleep duration are cross-sectionally associated with PASC and may be potential risk factors. Further longitudinal studies should be conducted.

Citation: Quan SF, Weaver MD, Czeisler MÉ, et al. Sleep and long COVID: preexisting sleep issues and the risk of post-acute sequelae of SARS-CoV-2 infection in a large general population using 3 different model definitions. J Clin Sleep Med. 2025;21(2):249-259.

Health campaigns hold promise for promoting general awareness about obstructive sleep apnea. In 2023, the American Academy of Sleep Medicine developed a series of messages as part of their "Count on Sleep" campaign. Three distinct messaging strategies were employed in posts disseminated on Facebook: (1) positive outcome (benefits of obstructive sleep apnea treatment); (2) negative outcome (consequences of untreated obstructive sleep apnea); and (3) partner-focused. We evaluated Facebook analytics to explore which of the 3 strategies was most impactful. The impressions were highest for the positive outcome message (n = 120,062), followed by the negative outcome (n = 12,286) and partner-focused (n = 10,259) messages. Female users were more likely to engage with positive (39% vs 28%) and negative (34% vs 25%) message than males, but sexes were quite balanced in engagement with the partner-focused message (36% vs 36%). There was more engagement from older adults (65 years and older) than from younger adults across all message types.

Citation: Robbins R, Morkous SSW, Honaker S, Darby CV, DelRosso LM. Evaluating the impact of different message strategies about OSA employed in the American Academy of Sleep Medicine Count on Sleep campaign. J Clin Sleep Med. 2025;21(2):417-419.

Study objectives: Disrupted nighttime sleep and sleep instability are common in children and adolescents with narcolepsy type 1, but optimal objective sleep measures have not been determined. We compared self-reported and objective sleep measures between young people with narcolepsy type 1 and healthy controls and test the hypotheses that the wake/non-rapid eye movement sleep stage 1 (N1) index is the best objective measure of perceived nocturnal wakings vs other disrupted nighttime sleep measures reported in the literature and is associated with daytime functional problems.

Methods: n = 26 healthy controls and n = 27 narcolepsy type 1 participants ages 8-21 years completed a 15-item habitual sleep quality survey and an in-lab polysomnogram. We compared group survey responses and performed stepwise regression of sleep quality and instability measures with a survey question ("During the night, I wake more than once"). Last, we used logistic regression to identify associations between the wake/N1 index with daytime functional concerns across groups.

Results: Compared to healthy controls, narcolepsy type 1 participants reported more frequent restless sleep, nighttime moaning/groaning/talking, tossing and turning, and nocturnal wakings (all P values < .01), but no greater difficulties in falling asleep or returning back to sleep. Across groups, self-reported waking from sleep was associated with increased wake/N1 index and selective serotonin reuptake inhibitor/selective norepinephrine re-uptake inhibitor use. The wake/N1 index was associated with daytime fatigue but no other behavioral or cognitive concerns.

Conclusions: Disrupted nighttime sleep is a multifactorial complaint that differs from insomnia. We believe the wake/N1 index is a useful sleep instability measure that should be helpful in research and as a treatment target in clinical practice, especially for fatigue concerns.

Citation: Heckler G, Worhach J, Wang G, et al. Characterizing disrupted nighttime sleep and associated functional outcomes in youth with narcolepsy type 1. J Clin Sleep Med. 2025;21(2):355-363.

Study objectives: Insomnia and sleep problems are common in pregnancy and have potentially negative impacts on both parental and infant health. This study examined the Sleeping for Two adaptation of cognitive behavioral therapy for insomnia (CBT-I) in pregnancy.

Methods: A parallel (1:1) randomized controlled trial evaluated CBT-I (n = 32) compared to a treatment as usual waitlist (n = 32) among pregnant individuals from Alberta, Canada experiencing insomnia. Five weekly individual sessions of CBT-I pivoted from in-person delivery to telehealth due to the COVID-19 pandemic physical distancing regulations. Insomnia symptom severity (primary outcome), insomnia diagnosis by structured interview, self-reported sleep problems, as well as sleep parameters measured by diary and actigraphy were assessed pretreatment at 12-28 weeks gestation, 1-week posttreatment, and 6 months postpartum. Birth information (secondary outcomes) were collected via delivery record and parent report of infant sleep (exploratory outcome) was taken at 6 months postpartum.

Results: Multilevel modeling using an intention-to-treat approach showed that CBT-I was associated with a decrease in insomnia symptoms and improved sleep quality across time compared to treatment as usual. The CBT-I group had fewer diagnoses of insomnia posttreatment, but the difference did not reach statistical significance until 6 months postpartum. Participants with worse sleep quality at baseline benefitted substantially more from CBT-I vs treatment as usual waitlist.

Conclusions: CBT-I delivered in pregnancy can reduce symptoms of insomnia and improve sleep quality, which could in turn minimize risk of negative consequences for birthing parent and infant health.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Sleeping for Two: RCT of CBT-Insomnia in Pregnancy; URL: https://www.clinicaltrials.gov/study/NCT03301727; Identifier: NCT03918057.

Citation: MacKinnon AL, Silang K, Watts D, et al. Sleeping for Two: a randomized controlled trial of cognitive behavioral therapy for insomnia in pregnancy. J Clin Sleep Med. 2025;21(2):365-376.