Journal of Clinical Sleep Medicine最新文献

Study objectives: A proportion of the population sleeps longer on the weekends. We investigated a possible association between weekend catch-up sleep (WCUS) and a known index of later development of atherosclerotic cardiovascular disease (ASCVD). We tested for an association of WCUS and ASCVD risk scores in 2 existing datasets.

Methods: We analyzed national data from the 2019-2021 Korean National Health and Nutrition Examination Survey (n = 11,502) and the 2017-2020 US National Health and Nutrition Examination Survey (n = 2,135). WCUS duration from self-reported questionnaires was categorized as ≤ 0 hours, > 0-1 hour, 1-2 hours, and > 2 hours. The ASCVD risk score estimating a 10-year risk of ASCVD events was categorized into low (< 7.5%), intermediate (7.5-20%), and high (≥ 20%) groups.

Results: WCUS (> 2 hours) was inversely associated with the high ASCVD risk group in the Korean National Health and Nutrition Examination Survey (adjusted odds ratio = 0.19, 95% confidence interval: 0.08-0.45) but not in the US National Health and Nutrition Examination Survey. The inverse association of WCUS (> 2 hours) with the high ASCVD risk group was shown only in the Korean National Health and Nutrition Examination Survey, independent of weekday sleep duration (adjusted odds ratio = 0.20, 95% confidence interval: 0.07-0.51 for < 6 hours; adjusted odds ratio = 0.17, 95% confidence interval: 0.07-0.39 for ≥ 6-8 hours; adjusted odds ratio = 0.13, 95% confidence interval: 0.03-0.63 for ≥ 8 hours). However, WCUS (> 2 hours) showed no significant association with the high ASCVD risk group in weekday sleep duration subgroups.

Conclusions: The apparent association between WCUS and ASCVD in an existing dataset underscores the need to investigate WCUS in prospective studies.

Citation: Shin M-K, Chang Y, Song T-J. Association of weekend catch-up sleep with the atherosclerotic cardiovascular disease risk score: a hypothesis-generating study from US and Korean National Health and Nutrition Examination Surveys. J Clin Sleep Med. 2025;21(11):1871-1881.

The Veterans Affairs (VA) seeks to improve the quality of life and long-term health outcomes for veterans facing unique sleep challenges related to their military service. The prevalence and burden of sleep disorders among military service members and veterans are alarmingly high, often worsened by inadequate sleep environments, insufficient sleep, shift work, and exposure to trauma. VA's National Sleep Medicine Program Office has outlined key priorities for enhancing sleep medicine research and quality improvement. These recommendations reflect the consensus within the Sleep Research and Quality Improvement Subcommittee of the Field Advisory Board for the Sleep Medicine Program Office. These priorities include advancing sleep science at basic, clinical, and population levels; promoting sleep health through personalized treatment strategies tailored to veterans; increasing funding for sleep research; establishing a network of VA sleep research centers to conduct high-quality, multicenter, collaborative studies; developing a veteran-specific portfolio of sleep research and innovations; and optimizing the dissemination of diagnostic tools and therapies through quality improvement initiatives. VA aims to achieve these goals through a series of strategic objectives and milestones that consider importance, timeline, effort, and cost. Specific topics of interest are highlighted and investigators are encouraged to address knowledge gaps in these areas. This white paper seeks to strengthen sleep research within VA by developing a comprehensive pipeline of researchers and systematically evaluating strategies to improve sleep health care for veterans. The ultimate goal is to generate actionable insights that could potentially influence broader sleep-related clinical guidelines and policies within and beyond the VA health care system.

Citation: Shamim-Uzzaman QA, Zeidler MR, Boudreau EA, et al. Sleep research, quality and implementation priorities in the Veterans Health Administration: a white paper. J Clin Sleep Med. 2025;21(10):1787-1797.

Study objectives: To determine the relative effectiveness and predictors of cognitive therapy (CT), behavioral therapy (BT), and cognitive behavioral therapy (CBT) for insomnia in older adults.

Methods: In a registered clinical trial (NCT02117388), 128 older adults with insomnia disorder were randomly assigned to receive CBT, BT, or CT. Insomnia Severity Index (ISI) score was the primary outcome. Sleep diaries, fatigue, beliefs about sleep, cognitive arousal, and stress were secondary outcomes. Split-plot linear mixed models assessed within- and between-subject changes in outcomes among the treatments. As a secondary analysis, we used linear regression to test predictors of insomnia symptoms improvement, including sleep diary measures, cognitive arousal, stress, beliefs about sleep, baseline ISI score, and age. Benjamini-Hochberg correction was applied.

Results: All groups exhibited insomnia symptom reduction at posttreatment (CT: d = -2.53, P < .001; BT: d = -2.39, P < .001; CBT: d = -2.90, P < .001) and at the 6-month follow-up (CT: d = -2.68, P < .001; BT: d = -2.85, P < .001; CBT: d = -3.14, P < .001). There were no group differences in the magnitude of ISI improvement (P_adj = .63), response (P_adj > .63), or remission (ISI < 8; P_adj > .27). All groups exhibited significant improvements in secondary outcomes at posttreatment (P_adj < .05) and at the 6-month follow-up (P_adj < .05). At posttreatment, the CT and CBT groups showed greater reductions in beliefs about sleep than the BT group (F_Interaction(2,185) = 5.99, P_adj = .03), and the CBT group showed a greater time in bed reduction than the CT group (F_Interaction(2,185) = 7.05, P_adj = .01). Baseline ISI was the only treatment predictor (b = 1.95, P_adj < .001).

Conclusions: CBT for insomnia and its components each independently result in significant improvements in self-reported insomnia symptoms, beliefs about sleep, worry, and fatigue in older adults.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Treatments for Insomnia: Mediators, Moderators and Quality of Life; URL: https://clinicaltrials.gov/study/NCT02117388; Identifier: NCT02117388.

Citation: O'Hora KP, Morehouse AB, Freidman L, et al. Comparative effectiveness and predictors of cognitive behavioral therapy for insomnia and its components in older adults: main outcomes of a randomized dismantling trial. J Clin Sleep Med. 2025;21(10):1679-1695.

Study objectives: Sleep education programs are emerging in university settings, but educating students about sleep health does not always change nighttime behaviors. A potential solution for bridging this knowledge-behavior gap is to incorporate behavioral change techniques into sleep education programs. This study's objective was to test the implementation intention technique in students completing an academically-demanding gateway course for medical career paths.

Methods: Participants were undergraduate students enrolled in organic chemistry courses (n = 101, 64.4% females, 51.5% nonwhite). After completing baseline questionnaires and actigraphy monitoring, participants took the Sleep 101 educational program. They were randomly assigned to an Education-Only condition or to also form an implementation intention (combining sleep education with an implementation intention strategy [Education+II]). Education+II individuals formed specific plans to go to bed earlier for the next 5 school nights. Participants repeated questionnaires at midsemester (mean = 50.33 days) and next-semester (mean = 248.51 days) follow-ups. Academic performance records were extracted prior to the study, during the study semester, and during the following semester.

Results: Following the educational program, both groups reported improvements in sleep quality, but only Education+II participants showed actigraphy-measured improvements in bedtimes and sleep duration. Some effects in the Education+II condition persisted at midsemester and next-semester follow-ups. Adjusting for prior academic performance, the Education+II condition showed worse academic outcomes initially (but not long term) than the Education-Only condition, particularly among students with evening circadian preferences.

Conclusions: Incorporating behavioral change strategies into sleep education programs can improve sleep outcomes. The relationship between sleep and academic performance is complex in demanding academic programs.

Citation: Barley BK, Scullin MK. Reinforcing sleep education with behavioral change strategies: intervention effects on sleep timing, sleep duration, and academic performance. J Clin Sleep Med. 2025;21(10):1697-1707.

Study objectives: This study aimed to assess the effectiveness of metabolic and bariatric surgery in patients with obesity comorbid with obesity hypoventilation syndrome (OHS) at 1-year follow-up.

Methods: This retrospective study was conducted between January 2020 and June 2023 at a metabolic and bariatric surgery center in a university-affiliated tertiary hospital in China. Clinical data, including body mass index, arterial blood gas values, portable sleep study results, and anthropometric parameters, were recorded pre- and postoperatively. Correlations between variables and risk factors for OHS resolution were analyzed.

Results: Among 1,134 candidates for metabolic and bariatric surgery, 187 (16.5%) had comorbid OHS; 151 patients with OHS met inclusion criteria and completed the 1-year follow-up visit (body mass index 39.1 ± 6.8 kg/m² with partial pressure of carbon dioxide in arterial blood [PaCO₂] 48.6 ± 3.0 mmHg). At 1-year follow-up, body mass index decreased to 29.0 ± 6.0 kg/m² (P < .001) and PaCO₂ dropped to 43.8 ± 5.5 mmHg (P < .001). Resolution of OHS, defined as awake PaCO₂ < 45 mmHg with discontinuation of positive airway pressure therapy for a minimum of 6 months before obtaining the arterial blood gas at the 12-month visit, was achieved in 105 (69.5%) of the patients. Nonlinear analysis indicated that PaCO₂ did not significantly decrease until the percentage of total weight loss exceeded approximately 20%. A larger reduction in waist circumference was associated with a greater reduction in PaCO₂, particularly when waist circumference reached less than 25 cm. Beyond this point, ΔPaCO₂ reached a plateau. In multivariate analysis, a larger preoperative waist circumference (odds ratio: 1.046, 95% confidence interval: 1.031-1.118, P = .025) and arterial blood gas pH < 7.35 (odds ratio: 3.921, 95% confidence interval: 2.305-9.140, P < .001) were associated with lack of resolution of OHS, and a larger percentage of total weight loss after bariatric surgery (odds ratio: 0.917, 95% confidence interval: 0.846-0.965, P = .001) was independently associated with OHS resolution.

Conclusions: Metabolic and bariatric surgery is an effective treatment for OHS. Achieving a sufficient percentage of total weight loss is critical for the resolution of OHS.

Citation: Ma S, Yu W, Yang C, et al. Impact of bariatric surgery on the resolution of obesity hypoventilation syndrome at 1-year follow-up: a retrospective study. J Clin Sleep Med. 2025;21(10):1665-1678.

Study objectives: This review describes the legal and regulatory landscape surrounding controlled substance prescribing in sleep medicine, focusing on the Controlled Substances Act, Drug Enforcement Agency, and best practices. It explores abuse and dependence risks associated with these medications and addresses telemedicine and e-prescribing considerations.

Methods: We synthesized information from the Controlled Substances Act, Drug Enforcement Agency, Centers for Disease Control and Prevention, Federation of State Medical Boards, peer-reviewed medical literature, and professional organizational position statements regarding controlled substances in sleep medicine.

Results: Managing controlled substances in sleep medicine necessitates careful consideration of Drug Enforcement Agency scheduling, regulatory requirements, and potential risks. Opioids pose a risk of dependence or abuse, but the lower doses used in sleep medicine may mitigate this risk. There is less evidence available regarding the abuse potential of stimulants. Hypnotics and benzodiazepines require cautious prescribing due to the potential for long-term use by patients and possibility of dose escalation. Oxybates are subject to strict risk evaluation and mitigation strategy programs. Best practices include comprehensive patient evaluations, thorough risk assessments, prescription drug monitoring program checks, and transparent patient communication. Telemedicine prescribing is governed by strict regulatory statutes, with temporary exceptions currently in place.

Conclusions: Controlled substances are vital for managing various sleep disorders. Balancing patient access to effective medications while minimizing abuse and diversion is crucial. Further research is needed to refine risk assessment tools and develop standardized protocols, particularly for nonopioids. The evolving role of telemedicine and e-prescriptions requires ongoing evaluation and adaptation of practices to ensure patient safety and regulatory adherence.

Citation: Kolla BP, Silber MH, Rushlow DR, Ramar K, Mansukhani MP. Prescribing controlled substances in sleep medicine clinics: an overview of legal issues and best safety practices. J Clin Sleep Med. 2025;21(10):1799-1807.

Study objectives: To develop and validate a publicly available, patient-reported outcome (PRO) tool specific to obstructive sleep apnea (OSA) in adults, designed for clinical use to monitor treatment response and longitudinal symptom progression.

Methods: The PRO tool was developed in accordance with Food and Drug Administration guidance for PRO measures, utilizing a multiphase, mixed-methods approach. Part 1 involved concept elicitation and cognitive interviews with patients to identify key symptoms and impacts. Part 2 consisted of pilot testing the draft tool in 10 American Academy of Sleep Medicine-accredited sleep centers. Part 3 included psychometric validation using longitudinal online surveys in 560 adults with OSA and 40 controls. Analyses included exploratory factor analysis, Rasch modeling, test-retest reliability, internal consistency, construct validity, responsiveness to change, and determination of clinically important difference thresholds.

Results: The final 11-item Patient-reported Longitudinal Assessment Tool for OSA has a 7-day recall period and assesses both daytime and nighttime OSA symptoms. It demonstrated strong internal consistency (α = 0.94), test-retest reliability (intraclass correlation coefficients = 0.91-0.97), and construct validity through moderate to strong correlations with established measures. The 11-item Patient-reported Longitudinal Assessment Tool for OSA scores discriminated between OSA severity and body mass index groups and were responsive to symptom improvement. The mean completion time was under 4 minutes. The tool can be used in both paper and electronic formats and has been translated into Spanish.

Conclusions: The 11-item Patient-reported Longitudinal Assessment Tool for OSA is a valid, reliable, and feasible PRO instrument for assessing OSA-related symptoms in clinical practice. It enables efficient monitoring of PROs across treatment stages.

Citation: Kirsch D, Abbasi-Feinberg F, Davies C, et al. The Patient-reported Longitudinal Assessment Tool for OSA (PLATO): development and validation of a new clinical tool to assess response to obstructive sleep apnea treatment in adults. J Clin Sleep Med. 2025;21(10):1743-1758.