Behavioral Sleep Medicine最新文献

Background: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder associated with cardiovascular, metabolic, and psychological complications. Data on its prevalence in Arab countries remain scarce. This study aimed to estimate the pooled prevalence of OSA in Egypt, Jordan, Oman, and Iraq, and to explore sources of heterogeneity.

Methods: A systematic search of major scientific databases was conducted to identify studies up to 2025. Pooled prevalence was calculated using a random-effects model and Heterogeneity was assessed. Subgroup analyses were performed by country and diagnostic tool, and meta-regression examined temporal trends. Publication bias was evaluated with Egger's and Begg's tests, and adjusted using the trim-and-fill method.

Results: Fifty studies with 58 prevalence estimates involving 881,184 participants were included. The pooled prevalence of OSA was 33.0% (95% CI: 28.3%-37.8%), with marked heterogeneity (I² = 99.8%). Subgroup analysis showed higher prevalence in Egypt (39%) compared with Jordan (28%) and other Arab countries (24%). No significant differences were observed between diagnostic tools, and heterogeneity persisted across subgroups. Meta-regression revealed no significant change in prevalence over time. Evidence of small-study effects was found; after trim-and-fill adjustment, the pooled prevalence rose to 37.1%.

Conclusion: OSA prevalence in Arab countries is higher than in many Western populations, representing a significant public health concern. The persistent heterogeneity and stable prevalence suggest that risk factors such as obesity, sedentary lifestyle, and genetic predisposition remain unchanged. These findings underscore the need for targeted prevention, systematic screening, and improved diagnostic standards to reduce the disease burden.

Objectives: Insomnia often involves physiological hyperarousal, particularly autonomic dysregulation. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) is effective, some patients do not achieve complete remission. This preliminary study evaluated whether combining CBT-I with heart rate variability (HRV) biofeedback could enhance treatment effects by improving autonomic regulation.

Methods: Forty-four adults with insomnia were randomized to either a CBT-I group or a combined group that received HRV biofeedback (HRV-BF) and CBT-I (CBT-I+BF group). Both groups received seven weekly CBT-I sessions, with HRV-BF introduced in session four in the CBT-I+BF group. The primary outcome measure was the Insomnia Severity Index (ISI). Other outcome measures included the Pre-Sleep Arousal Scale (PSAS), sleep diaries, and HRV metrics. Assessments were conducted at baseline, post-treatment, and six-month follow-up. ISI and PSAS were also assessed at week 4 before the introduction of HRV-BF.

Results: Both groups significantly improved in insomnia severity, pre-sleep arousal, and some sleep diary variables.The CBT-I+BF group showed unique and significant improvement in subjective total sleep time. While overall autonomic balance only showed a trend-level improvement in the CBT-I+BF group, sensitivity analyses on participants with more severe objective sleep disturbance suggested greater autonomic balance improvement for the CBT-I+BF group.

Conclusions: Incorporating HRV-BF into CBT-I did not significantly enhance the benefits of CBT-I alone in this study. However, it offers additional advantages for individuals with more objective sleep disturbance, particularly in improving autonomic balance. Future research should identify optimal treatment intensity and explore the utility of HRV-BF in various insomnia sub-populations.

Objectives: This study assessed public knowledge about insomnia treatments, particularly Cognitive Behavioral Therapy for Insomnia (CBT-I), and examined whether familiarity varied by gender or race. The primary aim was to quantify what proportion of adults in the United States are familiar with and use CBT-I.

Methods: A nationally representative sample of 3080 U.S. adults (M_age = 39.5 years, SD_age = 12.9) was surveyed. Approximately 48.3% identified as women. Participants reported their familiarity with various insomnia treatments, including pharmacological and behavioral options, and whether they had used prescription medications, over-the-counter sleep aids, or CBT-I within the past year or at any point in their lifetime.

Results: Participants were substantially more familiar with pharmacological treatments than behavioral therapies, with notably low recognition of CBT-I. Treatment utilization patterns supported that people tend to have a greater reliance on pharmacological interventions, particularly over-the-counter options, than CBT-I. Demographic differences emerged, with women and White participants reporting greater awareness of insomnia treatments than men and individuals from other racial groups. Age related differences were also observed, though, these varied by treatment approach.

Conclusions: This study identified major gaps in public awareness of CBT-I and highlighted disparities in treatment knowledge. Addressing these gaps is critical for improving treatment access and promoting CBT-I as a first-line, evidence-based treatment for insomnia.

Introduction: Women are less adherent to continuous positive airway pressure (CPAP) treatment than men, but the reasons remain unclear. This study explored women's unique challenges, experiences, and support needs during CPAP initiation and adherence.

Methods: Semi-structured interviews were conducted with 27 women who initiated CPAP for obstructive sleep apnea (OSA). Questions elicited detailed accounts of their challenges and perceptions of support. Responses were thematically analyzed by two independent reviewers to identify key conceptual categories.

Results: Participants initiated CPAP a median of 2 years prior. Mean age was 51 ± 15 years; 29% were Black, 71% White. OSA severity included 40% mild, 21% moderate, 25% severe, and 14% unknown. Three themes emerged: women desired more practical and social support, social and personal factors acted as barriers and facilitators, and persistence and self-advocacy were key to success. Support from durable medical equipment companies, healthcare providers, friends, family, and social media was inconsistent. Women who faced frustration or significant barriers were less successful, while persistence and self-advocacy were critical for those who succeeded.

Conclusion: Tailored support addressing women's personal circumstances and motivations may help overcome challenges during CPAP therapy initiation.

Objectives: Sleep and depression are known to be related in patients with fibromyalgia but the strength of this association is not well defined. Hence, this study aimed to investigate the association between subjective and objective sleep parameters with depression and to quantitatively summarize the results.

Methods: Five English databases (PubMed, Web of Science, Scopus, Science Direct, Google Scholar) were systematically searched for studies published between January 2000 and March 2025. Statistical analyses were performed using MedCalc software.

Results: 28 studies matched the inclusion criteria, with a total sample size of 3,027 patients. Of these, 14 studies were included in the meta-analysis evaluating the association between PSQI and depression, which revealed a weakly positive association [pooled correlation coefficient r = 0.353 (95% CI: 0.264 to 0.435)]. In the meta-analysis of two PSG studies, TST showed a weak, non-significant inverse relationship with depression (r = -0.09). Other parameters WASO, sleep latency, sleep efficiency and % REM sleep also showed no significant associations. These PSG related findings remain non-conclusive and warrant further investigation.

Conclusion: This meta-analysis highlights that there is a weak to moderate level of positive association between subjective sleep quality and depression in patients with fibromyalgia. High-quality PSG studies are needed to clarify the relationship of PSG parameters with depression.

Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment over medication. However, its use among Veterans in the Polytrauma/Traumatic Brain Injury System of Care (PSC) - a high-riskgroup for insomnia and medication complications - remains unclear. We describe CBT-I utilization in the PSC and identify predictors of receiving CBT-I.

Method: We analyzed medical records of Veterans who initiated PSC services after 10/1/2019 and received either first-line CBT-I or sleep medications within one year. We modeled the likelihood of receiving first-line CBT-I vs. medications based on sociodemographic, clinical, spatial access (e.g. drive time), and facility-level factors (e.g. patient-reported access).

Results: Veterans who received insomnia treatment after initiating PSC services (N = 18,293) were 85% male, 61% White, 21% Black or African American,14% Hispanic, and 8% age 65 or older. Only 11% received first-line CBT-I. Older Veterans; Native Hawaiian/Pacific Islander and Hispanic Veterans; those with bipolar disorder, depression, and alcohol use or other substance use disorders; and those with extended drive times were less likely to receive CBT-I. Findings were consistent in the sensitivity analysis.

Conclusions: Veterans were approximately eight times more likely to receive medications than CBT-I. Implementation strategies that overcome barriers toguideline-concordant care in the PSC are needed.

Objective: This study aimed to develop a short form of the Korean version of the Sleep-Related Behaviors Questionnaire (SRBQ) and assess its validity and psychometric properties.

Method: We collected 300 responses from the EMBRAIN survey system and conducted exploratory and confirmatory factor analyses to group SRBQ items based on response similarity. The most representative item from each group was selected using eXtreme Gradient Boosting (XGBoost). The psychometric properties of the final 10 items were assessed using the Rasch model of item response theory (IRT).

Results: Based on the selected 10 key items, we developed the SRBQ-10-a data-driven shortened version of the SRBQ, which demonstrated excellent performance (0.96) in predicting the SRBQ score, despite having only 10 items, which is one-third of the items in the original SRBQ-32. In addition to its reliability, the photometric properties of the SRBQ-10 were in the theoretically expected order, with no overlap or reversal of scale order, confirming the validity of the item scale.

Conclusion: The SRBQ-10, a concise version of SRBQ, enables efficient screening of sleep-related behaviors in clinical settings. Our study framework combining classical test theory, XGBoost, and IRT can be applied to develop and validate shorter versions of other questionnaires.

Objective: This study assessed the effects of cognitive therapy (CT) for depression on insomnia in women with metastatic breast cancer.

Methods: Thirty-four women with metastatic breast cancer and depressive symptoms were randomly assigned to CT for depression or a waitlist control group (WLC). Insomnia was measured using the Insomnia Severity Index (ISI) at pre-treatment (PRE) and posttreatment (POST), as well as 3 (FU3) and 6 (FU6) months later.

Results: In the CT group, the proportion of women obtaining a clinically significant level of insomnia (ISI ≥8) decreased significantly from pre- to posttreatment (PRE = 80.0%; POST = 26.7%; p = .013). The mean ISI score differed significantly between groups at posttreatment/waiting (intervention = 5.5; control = 12.7; p = .048) and the ISI score decreased significantly from pre- to posttreatment (PRE = 11.5; POST = 5.5; p = .001). Additional analyses were performed pooling both groups together after WLC patients received CT. The proportion of patients with a clinical level of insomnia (PRE = 77.5%; POST = 28.3%; FU3 = 46.3%; FU6 = 21.0%; p < .0001), and the mean ISI score significantly decreased over time(PRE = 12.1; POST = 5.0; FU3 = 8.0; FU6 = 5.5; p < .0001).

Conclusions: Although insomnia improved over time, 21.0% to 46.3% of women reported residual insomnia symptoms following CT for depression. Therefore, a concomitant treatment that directly targets insomnia should be provided to women with cooccurring depression and insomnia.

Objectives: We developed and evaluated the psychometric properties of the Sleep Acceptance Scale (SAS), a tool designed to measure sleep acceptance via cognitive and emotional responses to sleep problems.

Method: We designed a six-item scale, rated on a 7-point Likert scale, to capture the nuances of sleep acceptance. Data were collected from 1,350 participants, both with and without sleep problems. We employed an Exploratory Graph Analysis (EGA) and a Confirmatory Factor Analysis (CFA) to assess internal consistency, convergent validity, and measurement invariance over time and between groups.

Results: The EGA revealed a unidimensional structure for the SAS, which the CFA also confirmed. However, the root mean square error of approximation was marginally above the ideal threshold. The scale demonstrated high internal consistency (${\omega }_{\mathrm{tot}}$ = 0.91) and strong correlations with measures of insomnia severity, anxiety, depression, and willingness, supporting its convergent validity. Although the SAS maintained temporal stability over 14 days, it lacked configural invariance between good and bad sleepers, suggesting potential differences in how sleep acceptance manifested across these groups.

Conclusions: The SAS effectively measures sleep acceptance, capturing important cognitive and emotional dimensions. It can be used to monitor progress in acceptance and commitment therapy and mindfulness-based interventions.