Journal of Clinical Sleep Medicine最新文献

Restless sleep is a common complaint among children, yet its quantification and clinical significance remain poorly defined. Polysomnography, the standard diagnostic tool for sleep disorders, often fails to fully explain restlessness, even when other conditions are excluded. Measuring body movement indices, proposed as an objective marker of sleep restlessness but lacking a standardized methodology, currently has limited clinical application. Recent efforts by the International Restless Legs Syndrome Study Group have led to consensus diagnostic criteria for restless sleep disorder that incorporate both self-reported and objective measures. We review various methodologies used to quantify body movements during sleep, including polysomnography with video recordings, actigraphy, and a less-invasive "contactless" device. Key discrepancies in measurement techniques and normative data reporting are identified. To advance the inclusion of this disorder into the clinical setting, we collated and compared studies providing normative values for sleep movements across different populations and explore their relevance to other disorders. Providing a historical perspective on how the measurements of sleep movement have evolved shows how technological advancements have influenced current approaches. In this context, the consequences of restless sleep and its potential impact on neurocognitive and behavioral outcomes are discussed. We conclude by highlighting key knowledge gaps and proposing future research directions.

Citation: Lu M, Fitzgerald DA, Norman MB, Sullivan CE, Waters KA. Pediatric sleep movements: a review of methodologies, normative data, disease associations, and research gaps. J Clin Sleep Med. 2025;21(10):1773-1785.

Elevated environmental carbon dioxide (CO₂) levels can have important health impacts, including increased anxiety, impaired high-level cognitive performance, reduced sleep quality, and decreased next-day alertness, especially in children. Bedrooms, where people spend a third of their lives, are often poorly ventilated, further exacerbating CO₂ exposure during sleep. These symptoms may be of particular concern for individuals with obstructive sleep apnea treated with continuous positive pressure as a result of CO₂ trapping within the mask, which is dependent on environmental levels, and circuit CO₂ rebreathing_. Additionally, lower inhaled oxygen concentrations may be encountered when exhaled gases are rebreathed from the circuit. Low expiratory positive airway pressure, high ventilation levels (eg, in large individuals or at altitude), and small exhaust valves increase rebreathing risk, which can self-propagate due to patient attempts to compensate by increasing tidal volume. Elevated environmental CO₂ may further exacerbate the clinical consequences of rebreathing, including reduced continuous positive pressure adherence. Although strategies including higher expiratory positive airway pressure or larger exhaust valves help mitigate CO₂ buildup, they can also lead to increased noise, which may potentially affect adherence. With this work, we review the available evidence on the thresholds and effects of classroom, office, bedroom, and rebreathed CO₂ levels in healthy individuals and those with obstructive sleep apnea, both adults and children. Importantly, we provide the often-overlooked link between environmental CO₂ concentrations and circuit rebreathing for patients with obstructive sleep apnea, underscoring the need to optimize current indoor ventilation standards and thresholds for mask-based CO₂ inhalation, as well as continuous positive pressure technology to maximize adherence, abate CO₂/hypoxic exposure, and improve health outcomes.

Citation: Noah WH, White DP, Hete B, Messineo L. Rebreathing during CPAP therapy and its implications in obstructive sleep apnea. J Clin Sleep Med. 2025;21(10):1759-1771.

Study objectives: Sleep and mental illnesses, particularly mood disorders, share complex bidirectional relationships. Emerging evidence suggests sleep may also play an important role in the course of borderline personality disorder (BPD). This study was designed to examine associations between sleep disturbance and maladaptive sleep-related cognitions with recovery from BPD in a longitudinal sample.

Methods: The Pittsburgh Sleep Quality Index and brief Dysfunctional Beliefs and Attitudes about Sleep-16 scales were completed by 223 participants in the McLean Study of Adult Development at the 16-year follow-up wave and over 4 additional consecutive biannual follow-up waves. Generalized estimating equations were used to assess relationships between sleep-related outcomes and recovery vs nonrecovery among participants with BPD over time.

Results: After controlling for clinical and demographic covariates, nonrecovered BPD participants had poorer sleep quality as assessed by the Pittsburgh Sleep Quality Index, lower self-reported sleep quality, greater sleep disturbance, higher use of sleep medication, and greater daytime dysfunction compared to recovered BPD (all P < .002). Additionally, in adjusted analyses, nonrecovered BPD participants had greater maladaptive sleep-related cognitions measured by the overall Dysfunctional Beliefs and Attitudes about Sleep-16 and its related subscales (all P < .006).

Conclusions: These findings demonstrate relationships between sleep disturbance and maladaptive sleep-related cognitions with recovery from BPD over a decade of longitudinal evaluation. Further research to determine whether interventions that target sleep improve core symptoms, functional impairment, and recovery in BPD is indicated.

Citation: Plante DT, Glass IV, Zanarini MC. Sleep disturbance and maladaptive sleep-related cognitions in borderline personality disorder in the longitudinal McLean Study of Adult Development. J Clin Sleep Med. 2025;21(10):1733-1741.

Study objectives: In addition to sleep duration, sleep timing is another important but significantly understudied sleep characteristic that may be closely associated with cardiovascular disease (CVD) mortality. To investigate optimal sleep timing, we assessed the associations of sleep timing with all-cause and CVD mortality in a large sample of older adults.

Methods: This prospective cohort study included 18,129 adults (median age = 65 years) from Guangzhou Biobank Cohort Study, recruited during 2008-2012 and followed up until July 2022. Participants' sleep timing (early, intermediate, and late) was defined by the midpoint between bedtime and wake time. Four CVD susceptibility single-nucleotide polymorphisms were used to calculate the genetic risk score.

Results: During a median follow-up of 12.4 years with 213,534 person-years, 2,997 deaths occurred. Compared with the intermediate group, both early and late midpoint groups were associated with a higher risk of all-cause mortality (adjusted hazard ratio = 1.18, 95% confidence interval = 1.07-1.30; and adjusted hazard ratio = 1.13, confidence interval = 1.01-1.26, respectively). Restricted cubic spline curves indicated U-shaped associations of sleep at midpoint, bedtime, and wake time with all-cause and CVD mortality (all P for nonlinearity < .05), with the lowest risk observed at approximately 2:30 am, 11:00 pm, and 6:00 am, respectively. The associations of early and late sleep timing with risk of all-cause mortality were more pronounced in males, older people, and those with a high CVD genetic risk score.

Conclusions: For the first time, we identified U-shaped associations of sleep timing with all-cause and CVD mortality by identifying the specific sleep timing points associated with the lowest mortality risk, explicitly from 11:00 pm to 6:00 am.

Citation: Wang J, Li YR, Jiang CQ, et al. Optimal sleep timing revealed: a new perspective on reducing all-cause mortality and cardiovascular disease-cause mortality in older adults. J Clin Sleep Med. 2025;21(10):1709-1722.

In this case report we present a rare cause of central sleep apnea secondary to severe cervical stenosis in a young male after excluding all the possible causes of central sleep apnea.

Citation: Rashed AN, Bedaiwi N. Spinal stenosis as a rare cause of central sleep apnea: a case report. J Clin Sleep Med. 2025;21(9):1643-1647.

In the management of obstructive sleep apnea, the integrative concept of care is gathering momentum. This is an encouraging development to prevent deficiencies or errors due to a lack of professional collaboration since risks, benefits and alternatives of various techniques can be discussed candidly. However, while the deployment of a multidisciplinary team is encouraged, a scientific, evidence-based approach needs to be rigorously engendered to encompass the phenotypic heterogeneity of obstructive sleep apnea, including neurologic, metabolic, craniofacial, and myopathic endotypes. This classification helps identify diverse techniques for screening, diagnostics, treatment, and long-term follow-up, while recognizing underlying principles of management, such as the critical airway collapsing pressure, arousal threshold, loop gain, and muscle tone classification. For example, in the craniofacial endotype, recognizing developmental compensation, postural compensation, and decompensation will aid in case selection and indicate the most appropriate treatment protocol to help with clinical, interdisciplinary decision-making and management of obstructive sleep apnea. In fact, emerging techniques indicated to achieve future directions and goals of an integrated approach include the use of novel algorithms, artificial intelligence, and pharmaceuticals for data-driven predictive modeling.

Citation: Singh GD, Battle J. Integrative treatment of obstructive sleep apnea: principles and practice. J Clin Sleep Med. 2025;21(9):1591-1596.