Journal of Clinical Sleep Medicine最新文献

Study objectives: Temporomandibular disorders (TMDs) were linked to poor sleep on the Pittsburgh Sleep Quality Index (PSQI), whereas polysomnography revealed no major sleep disturbances, implying sleep state misperception. This study investigates sleep state misperception in TMD and control participants; correlates sleep state misperception with objective short sleep duration (SSD), depression symptoms, daytime sleepiness, and orofacial pain; and compares objective SSD between the groups.

Methods: General linear models were used to compare second-night polysomnography total sleep time, sleep latency, sleep efficiency (SE), and wake after sleep onset with homologous PSQI-derived variables in 124 women with myofascial TMD and 46 age and body mass index matched controls. PSQI variables were regressed onto objective SSD, depression symptoms, daytime sleepiness, and pain. Lastly, objective SSD was related to TMD presence.

Results: Compared to controls, TMD cases misperceived SE (P = .02); depression symptoms explained PSQI-derived SE (P = .002) and mediated the effect of pain (P < .001). PSQI variables were unrelated to respective polysomnography measures or objective SSD, except a significant self-reported-objective correlation in SE among controls only (P = .002). Objective SSD was more frequent in TMD cases (P = .02, odds ratio = 2.95), but it was unrelated to depression symptoms, daytime sleepiness, or prepolysomnography pain.

Conclusions: The study demonstrates misperception of SE among TMD cases, which was accounted for by depression symptoms. Objective SSD nearly tripled in TMD cases; however, it was unrelated to PSQI variables, depression, daytime sleepiness, or pain, suggesting that sleep state misperception and objective SSD are 2 independent sleep features in TMD.

Citation: Chan C, Dubrovsky B, Bouchard M, Tartter VC, Raphael KG. Sleep misperception in women with myofascial temporomandibular disorder. J Clin Sleep Med. 2025;21(1):55-64.

Study objectives: Sleep-disordered breathing and diabetes mellitus (DM) are often concomitant; however, data on the impact of sleep-disordered breathing on mortality in the population with diabetes remain scarce.

Methods: The population from the Sleep Heart Health Study, a multicenter prospective observational study representing 5,780 patients with polysomnography and mortality data, including 453 patients with DM, was analyzed to assess the impact of sleep-disordered breathing variables and the presence of DM on all-cause, cardiovascular disease, and noncardiovascular disease associated mortality. Survival analysis and proportional hazard regression models were used to calculate the adjusted hazard ratios (aHRs) for mortality.

Results: Patients with DM and the average oxygen saturation > 91.4% had significantly lower all-cause (aHR 0.52, confidence interval [CI] 0.34-0.80) and cardiovascular disease mortality risk (aHR 0.44, CI 0.22-0.87) as compared with patients with oxygen saturation below this value. Apnea-hypopnea index > 31 (aHR 1.58, CI 1.10-2.28) and oxygen desaturation index > 13.3 (aHR 1.58, CI 1.10-2.25) were associated with increased all-cause mortality in participants with DM on treatment. Sleep efficiency and proportion of rapid eye movement sleep did not have any impact on mortality in patients with DM and thus differed significantly from individuals without DM, where increased all-cause mortality was observed in those with sleep efficiency < 81.4% (aHR 0.77, CI 0.68-0.87) or rapid eye movement sleep < 14.9% (aHR 0.78, CI 0.68-0.89).

Conclusions: Patients with diabetes on treatment and moderate to severe sleep-disordered breathing experience increased all-cause mortality. Reduced average oxygen saturation predicted both all-cause and cardiovascular death in the population with diabetes.

Citation: Vichova T, Petras M, Waldauf P, Westlake K, Vimmerova-Lattova Z, Polak J. Sleep-disordered breathing increases mortality in patients with diabetes. J Clin Sleep Med. 2025;21(1):89-99.

Study objectives: Narcolepsy type 1 (NT1) is an autoimmune disease caused by the selective immune attack against orexin-producing neurons. However, the pathophysiology of narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) remains controversial. The neutrophil-to-lymphocyte ratio (NLR) is an easily calculated parameter from the white blood cell count, which has already been extensively used as an inflammatory marker in immunological disorders. In this study, we examined the white blood cell count of patients with NT1, NT2, and IH compared to healthy controls (HC) and evaluated the NLR to test the possibility of identifying an easy biofluid marker for detecting inflammation and distinguishing patients from HC.

Methods: White blood cell count and NLR were compared between 28 patients with NT1, 17 with NT2, 11 with IH, and 21 sex/age-matched HC. These parameters were correlated with cerebrospinal fluid levels of orexin-A, the cerebrospinal fluid/serum albumin ratio (as a marker of blood-brain barrier integrity), and polysomnographic parameters.

Results: Patients with NT1 (NLR 2.01 ± 0.44) showed significantly higher NLR than those with NT2 (NLR 1.59 ± 0.53) or IH (NLR 1.48 ± 0.37) and HC (NLR 1.48 ± 0.43). Correlation analysis did not document significant associations between NLR and the other biological markers in each group of patients. The receiver operating characteristic curve analysis detected an optimal cutoff value to discriminate patients with NT1 from those with NT2, IH, and HC for values of NLR ≥ 1.60, 1.62, and 1.59, respectively.

Conclusions: Patients with NT1 showed a higher NLR than those with NT2, IH, and HC, possibly reflecting lymphocyte migration within the central nervous system, supporting the hypothesis of a neuroinflammatory attack of lymphocytes against orexin-producing neurons. Considering its sensitivity, this easily obtainable biofluid marker could help to screen patients with NT1.

Citation: Conti M, Cirillo F, Maio S, et al. Increased neutrophil-to-lymphocyte ratio as a possible marker to detect neuroinflammation in patients with narcolepsy type 1. J Clin Sleep Med. 2025;21(1):101-107.

Study objectives: The COVID-19 pandemic has created unprecedented levels of stress and anxiety, which has a profound effect on sleep quality. However, limited data are available on the sleep quality of medical residents who work directly with patients infected with SARS-CoV-2. As sleep is a crucial brain state, our goal is to know the sleep quality of these medical residents.

Methods: This study evaluated sleep quality among medical residents caring for patients with COVID-19 at Hospital São Paulo, São Paulo, Brazil. It used a validated questionnaire and assessed sleep habits and sociodemographic variables. The study focused on sleep latency, bedtime changes, early awakening, and discouragement.

Results: A total of 150 resident physicians participated, 93 females and 57 males. We observed poor sleep quality in 72.7%, discouragement complaints in 91.33%, what was moderate or intense in 52.0%. Discouragement was associated with sleep fragmentation and awakening early in the morning; sleeping pill users had a greater sleep latency (P < .00001). Poor sleep quality was linked to changes in bedtime and use of sleeping medications during social isolation in 2020 (P = .037 and P < .001, respectively).

Conclusions: During the COVID-19 pandemic, more than two-thirds of resident physicians experienced poor sleep quality. They changed their bedtime, increased sleep latency, the use of hypnotics, feelings of discouragement, fragmented sleep, and early awakening in the morning. These findings should serve as a wake-up call for everyone, especially those in administrative roles. They are a matter of concern for medical residents, chief residents, supervising physicians, medical directors, and faculties. Maximās grātiās vōbīs agimus.

Citation: dos Santos FTAR, Bizari Fernandes do Prado L, Bizari Coin de Carvalho L, do Prado GF. The impact of the COVID-19 pandemic on the quality of sleep of medical residents in a tertiary care hospital. J Clin Sleep Med. 2025;21(1):17-22.

Study objectives: Whereas previous research has primarily focused on the immediate effects of concussion within the first year postinjury, this study examines the persistent effects of concussion on subsequent sleep quality in adolescent soccer players.

Methods: This study used a cross-sectional design, recruiting a convenience sample of adolescent athletes from US Youth Soccer camps. Participants completed a self-reported questionnaire including the Pittsburgh Sleep Quality Index to assess their sleep quality. Athletes were also asked to report sport participation information, any past occurrence of concussion or knee injury, and any sport-related injury in the past 12 months. Independent samples t tests were performed to identify significant differences in Pittsburgh Sleep Quality Index scores between injured and noninjured participants.

Results: A total of 177 participants (103 male, 14.61 ± 1.88 years of age) were included in the analysis. The concussion injury group exhibited later bedtimes (difference: 0.32 ± 0.05 hours, P = .047), fewer hours of sleep (difference: 0.56 ± 0.11 hours, P = .015), and more frequent sleep disturbances (P = .012). Furthermore, these athletes reported lengthened sleep latency (difference: 2.55 ± 3.36 minutes, P = .016) and higher levels of daytime dysfunction (P = .041) following their concussion injuries. Moreover, athletes in the concussion injury group displayed worse sleep quality scores (difference: 0.42 ± 0.06, P < .001) and higher total Pittsburgh Sleep Quality Index scores (difference: 1.91 ± 0.41, P < .001). No significant differences were found based on past knee injury or sport-related injury in the past 12 months.

Conclusions: These findings suggest the need for targeted interventions aimed at improving sleep quality in adolescent athletes with a history of concussion.

Citation: Sahin S, Erdman AL, Loewen A, et al. Concussion history is associated with poor sleep quality in adolescent athletes: a cross-sectional study. J Clin Sleep Med. 2025;21(1):129-135.

Study objectives: To evaluate the performance of a novel three-dimensional-printed customized nasal mask on patient satisfaction and adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea.

Methods: Patients prescribed CPAP therapy with suboptimal CPAP adherence using a conventional CPAP mask (< 70% of nights with ≥ 4 hours per night over 4 weeks) were recruited from the sleep investigation unit of a tertiary hospital. Patients underwent a three-dimensional facial mapping procedure to have a novel three-dimensional-printed customized nasal mask fabricated which was trialed for four weeks. CPAP adherence data download of the same period was conducted with their pre-existing conventional mask and customized mask. Questionnaires assessing symptoms of obstructive sleep apnea and mask-related side-effects were administered before and after the trial of the customized mask.

Results: Thirty patients (22 males and 8 females, age 63.3 ± 12.5 years, body mass index 31.7 ± 5.2 kg/m², apnea-hypopnea index 37.3 ± 21.9 events/h [mean ± standard deviation]) were studied. CPAP was used in a greater proportion of nights with the customized mask (85.7 [66.1, 98.2]% vs 63.2 [13.1, 96.8]%, P = .009) compared to the conventional mask. Hourly CPAP usage was higher with the customized mask (3.8 [2.7, 5.8] hours vs 2.4 [0.3, 5.0] hours, P = .016) compared to a conventional mask. Patients preferred the customized mask (P = .008) and reported less mask-related side effects.

Conclusions: The novel three-dimensional-printed customized mask improved CPAP usage in patients with suboptimal CPAP adherence. Customized CPAP masks may be a suitable option for patients experiencing poor CPAP adherence from mask-related side effects.

Clinical trial registration: Registry: ANZCTR; Name: Conventional vs custom made nasal Continuous Positive Airway Pressure (CPAP) mask for treatment of Obstructive Sleep Apnoea: Pilot study A; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382142; Identifier: ACTRN12621001301853.

Citation: Tong BK, Cistulli PA, Ledger S, Chan ASL. A novel three-dimensional-printed customized nasal mask for improving CPAP adherence and satisfaction for the treatment of obstructive sleep apnea. J Clin Sleep Med. 2025;21(1):9-16.

Study objectives: Cannabidiol (CBD) is increasingly used as a health supplement, though few clinical studies have demonstrated benefits. The primary objective of this study was to evaluate the effects of an oral CBD-terpene formulation on sleep physiology in individuals with insomnia.

Methods: In this double-blind, placebo-controlled, randomized clinical trial, 125 individuals with insomnia received an oral administration of CBD (300 mg) and terpenes (1 mg each of linalool, myrcene, phytol, limonene, α-terpinene, α-terpineol, α-pinene, and β-caryophyllene) for ≥ 4 days/wk over 4 weeks using a crossover design. The study medication was devoid of Δ⁹-tetrahydrocannabinol. The primary outcome measure was the percentage of time participants spent in the combination of slow-wave sleep (SWS) and rapid eye movement (REM) sleep stages, as measured by a wrist-worn sleep-tracking device.

Results: This CBD-terpene regimen marginally increased the mean nightly percentage of time participants spent in SWS + REM sleep compared to the placebo (mean [standard error], 1.3% [0.60%]; 95% confidence interval, 0.1-2.5%; P = .03). More robust increases were observed in participants with low baseline SWS + REM sleep, as well as in day sleepers. For select participants, the increase in SWS + REM sleep averaged as much as 48 minutes/night over a 4-week treatment period. This treatment had no effect on total sleep time, resting heart rate, or heart rate variability, and no adverse events were reported.

Conclusions: Select CBD-terpene ratios may increase SWS + REM sleep in some individuals with insomnia and may have the potential to provide a safe and efficacious alternative to over-the-counter sleep aids and commonly prescribed sleep medications.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Evaluation of an Oral Cannabidiol (CBD)-Terpene Formulation on Sleep Physiology in Participants With Insomnia; URL: https://clinicaltrials.gov/study/NCT05233761; Identifier: NCT05233761.

Citation: Wang M, Faust M, Abbott S, et al. Effects of a cannabidiol/terpene formulation on sleep in individuals with insomnia: a double-blind, placebo-controlled, randomized, crossover study. J Clin Sleep Med. 2025;21(1):69-80.

Sleep-disordered breathing, with both central and obstructive sleep apneas, has been reported in association with Chiari malformation type 1. Chiari malformation type 1 is a congenital or acquired herniation of the cerebellar tonsils through the foramen magnum. In this case, a 5-year-old girl with a history of Chiari malformation type 1 and syringomyelia experienced worsening intracranial pressure secondary to sleep-disordered breathing. This case highlights the importance of early recognition of sleep-related respiratory disorders in patients with Chiari malformation and its association with increased intracranial pressure.

Citation: Machin Y, Morales DS, Garagozlo K, Graw-Panzer K. A case of sleep-disordered breathing presenting with increased intracranial pressure in a child with type 1 Chiari malformation. J Clin Sleep Med. 2025;21(1):215-217.

Study objectives: The Belun ring is a new home sleep apnea testing device using a pulse oximeter sensor and a neural network algorithm, but its data in children are limited. This study aims to evaluate the correlation and agreement of the Belun ring, compared with polysomnography (PSG) and determine the diagnostic accuracy of the Belun ring for moderate-to-severe obstructive sleep apnea (OSA).

Methods: This is a cross-sectional observational study in children aged 5-18 years with suspected OSA between June 2023 and February 2024. The Belun ring and PSG were undertaken on eligible participants to assess apnea-hypopnea index (AHI) in the same sleep test session.

Results: Of 75 children enrolled, OSA was diagnosed in 74 children by PSG. The Belun AHI (B-AHI) was moderately correlated with the PSG AHI (P-AHI) (r = .63, P < .001) with mean difference (standard deviation) -7.8 (13.91) events/h. The area under the receiver operating characteristic curve of the B-AHI to identify moderate-to-severe OSA (P-AHI > 5 events/h) was 0.66, and the B-AHI cut-off of 3 events/h yielded 74.1% sensitivity and 52.4% specificity. The B-AHI cut-off of 2 events/h yielded 92.6% sensitivity, and 7 events/h yielded 95.2% specificity.

Conclusions: Despite the correlation, the difference in AHI between the Belun ring and PSG in children was noted. Either single or multiple B-AHI cut-offs to diagnose, include or exclude moderate-to-severe OSA may be valuable, but their implementation must be approached with caution.

Clinical trial registration: Registry: Thai Clinical Trials Registry; Name: Diagnostic Accuracy of the Belun Ring in Children at Risk of Obstructive Sleep Apnea; URL: https://www.thaiclinicaltrials.org/show/TCTR20240604003; Identifier: TCTR20240604003.

Citation: Panichapat N, Niyomkarn W, Boonjindasup W, Thiamrakij P, Sritippayawan S, Deerojanawong J. Diagnostic accuracy of the Belun ring in children at risk of obstructive sleep apnea. J Clin Sleep Med. 2025;21(1):123-128.

Study objectives: Physicians-in-training (residents, fellows) and Advanced Practice Providers (APPs) receive limited education on sleep disorders, including obstructive sleep apnea (OSA). They often assess patients first. We aimed to understand their views on OSA and screening for OSA in the perioperative period.

Methods: Electronic-mail surveys were sent to physicians-in-training and APPs, in five categories of practice (Anesthesiology, Internal Medicine, Family Medicine, Obstetrics/Gynecology/Gynecologic Oncology, and Surgery) at nine major institutions. Cochran-Mantel-Haenszel (CMH) tests evaluated associations between participant characteristics (clinical role, physician years of training, APP years of practice, categories of practice) and survey responses (perception of OSA, perioperative risk factor, screening/managing of perioperative OSA) stratified by institution. False discovery rate (FDR) adjustment accounted for multiple comparisons (FDR-adjusted-p-values) of associations between multiple characteristics and a given response. Breslow-Day tests evaluated the homogeneity of odds ratios from CMH tests.

Results: We received 2236/6724 (33.3%) responses. Almost all (97%) agreed OSA represents a risk factor for perioperative complications. Many (37.9%) were unaware which screening tool was used at their institution, with differences by clinical role (FDR-adjusted-p<0.001), with APPs reporting not knowing more than residents and fellows, and across category of practice (FDR-adjusted-p<0.001). While 66.5% routinely asked perioperative patients about signs/symptoms of OSA, 33.5% did not. There were differences by clinical role (FDR-adjusted-p<0.001), as APPs reported asking about OSA more frequently than residents/fellows; and, by category of practice (FDR-adjusted-p<0.001) as Anesthesia and medical specialties reported asking about OSA more than surgical services. Importantly, approximately half of the respondents in Surgery (48%) and OB/GYN (46%) reported not routinely asking. Differences also existed by physician PGY clinical training (FDR-adjusted-p=0.005) with those with higher PGY reporting they asked about OSA more often.

Conclusions: Significant differences exist in screening by clinical roles and categories of care. This highlights the importance of improving provider education on the role of OSA in perioperative risk assessment and patient care.