Behavioral Sleep Medicine最新文献

Objectives: Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia. However, patients with objective short sleep duration may show a reduced response to CBT-I and require alternative or additional treatment.This study investigated the effect of objective and subjective short sleep duration before treatment on response to CBT-I in patients with chronic insomnia.

Methods: We analyzed chart-review data from 446 patients with chronic insomnia (66.6% female, age M = 51.6 ± 15.6 years) treated with a 5-6 session CBT-I program in a sleep clinic. Short sleep duration was assessed from single-night polysomnography ( < 6 h:n = 254; ≥6 h:n = 178) and oneweek of sleep diaries ( < 6 h:n = 229; ≥6 h:n = 124). Mixed models tested for differences between sleep duration groups on changes in sleepdiary outcomes and daytime functioning questionnaires at post-treatment and three-month follow-up.

Results: Short objective sleep duration predicted reduced improvements in daytime functioning (p = .019) and depression (p = .04), but no other outcomes. Short subjective sleep duration predicted greater improvement in all sleep diary outcomes (all p < .001). Results were consistent across sensitivity analyses.

Conclusions: Objective and subjective sleep duration predicted some, mostly small, differences in treatment response to CBT-I in patients with chronic insomnia. That said, patients with short or normal sleep durations benefitted from CBT-I.

Background: Sleep-disordered breathing (SDB) is common in ischemic stroke patients and may influence recovery and long-term outcomes. This systematic review and meta-analysis aims to evaluate the impact of SDB on clinical outcomes of ischemic stroke including complications, cognitive impairment, hospitalization, recurrent stroke, and mortality.

Methods: A systematic search of PubMed, Embase, and Scopus databases was conducted to identify observational studies examining the relationship between SDB and outcomes in ischemic stroke patients. Random-effect models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic.

Results: A total of 30 observational studies were included. SDB was associated with significantly higher odds of hospitalization (OR: 6.14, 95% CI: 1.35-27.97) and mortality (OR: 3.39, 95% CI: 1.15-9.98). Moderate-to-severe SDB (AHI > 15) was linked to a higher incidence of adverse outcomes (OR: 1.03, 95% CI: 1.01-1.05). However, no significant associations were found for cognitive impairment (OR: 1.05, 95% CI: 0.73-1.51), complications (OR: 1.14, 95% CI: 0.84-1.55), or recurrent stroke (OR: 1.02, 95% CI: 0.19-5.47).

Conclusions: SDB significantly increases the risk of hospitalization and mortality in ischemic stroke patients. Early identification and management of SDB could improve clinical outcomes, though further research is needed to explore causal relationships and optimize interventions.Prospero Registration Number: CRD42024612023.

Methods: In Study 1, 349 Turkish-speaking adults (57% female; M = 24.05 years, range = 18-68) completed the translated Vamping Scale with related sleep and procrastination measures. CFA, item-total correlations, and IRT assessed factor structure and item properties, while reliability was evaluated with α, ω, and λ6. In Study 2, 342 adults (56% female; M = 26.65 years, range = 18-56) completed the Vamping Scale with mental health and well-being measures. Pearson correlations and SEM tested whether psychological distress mediated the relationship between vamping and well-being.

Results: A revised 10-item, two-factor model showed acceptable fit (CFI = .901; SRMR = .0562) and high internal consistency (α = .890). Vamping was positively related to bedtime procrastination, sleep effort, and psychological distress, and negatively to life satisfaction and well-being. SEM confirmed psychological distress mediated the link between vamping and well-being.

Conclusion: The Turkish Vamping Scale is a psychometrically sound instrument for assessing late-night technology use behaviors in adult populations. The findings underscore the detrimental associations between vamping, sleep-related difficulties, and psychological distress, supporting the need for targeted interventions. Future research should incorporate longitudinal designs and objective sleep measures to clarify causal pathways.

Narcolepsy and Idiopathic Hypersomnia (IH) are chronic sleep disorders that negatively impact the Health-Related Quality of Life (HRQoL) of those who are diagnosed with the disorders. As such, Narcolepsy and IH may also impact the HRQoL of those close to the patient (e.g. partners, parents).

Aim: This project explored the experiences of partners of people with Narcolepsy or IH, and examined how living with someone with the diagnosis had impacted their own HRQoL.

Methods: In this in-depth qualitative study, semi-structured interviews were used to collect data from eight people (4 males and 4 females, aged between 21 and 53 years old) whose partners had Narcolepsy T1, T2, or IH. The data was analyzed using Reflexive Thematic Analysis (RTA) to find common themes emerging from the participants' narratives. Self-reports for psychological distress (K10) and sleep quality (PSQI) were used.

Results: Five themes (and two sub-themes) were identified: 1) changes in dyadic identity; 2) negative impact on intimacy; 3) loneliness; 4) sacrifices to maintain the relationship, and 5) dissatisfaction at the lack of knowledge and information.

Conclusions: Partners of patients with Narcolepsy or IH reported being affected by some of the symptoms of their partners' sleep disorder. Partners' social and emotional HRQoL were the features most strongly impacted by the disorders. Future research should focus on developing collaborative care models that involve patients' partners in treatment.

Objectives: To examine the relationship between insomnia symptoms and self-injurious behaviors (SIB) among adolescents and young adults, with a focus on the mediation effects of depression and anxiety on this association.

Methods: An online survey among adolescents and young adults was conducted in Xiamen City, Fujian Province, from December 2022 to May 2023. SIB was assessed using two items from Health-Related Risky Behavior Inventory. Insomnia, depressive, and anxiety symptoms were evaluated by Insomnia Severity Index, Patient Health Questionnaire, and Generalized Anxiety Disorder Scale, respectively. A structural equation model was employed to explore the mediating role of depressive and anxiety symptoms in the relationship between insomnia and SIB.

Results: A total of 3436 participants (M_age = 18.12 years; 58.4% female) were included in final analysis, with 707 (20.6%) reporting SIB within the past 12 months. Participants with SIB exhibited higher levels of insomnia, depressive, and anxiety symptoms compared to those without SIB. Insomnia symptoms were significantly associated with SIB (β = 0.343, p < .001). Additionally, depressive (β = 0.093, p < .001) and anxiety (β = 0.026, p = .001) symptoms mediated the relationship between insomnia symptoms and SIB. Total indirect effects accounted for 79.33% of the total effects (insomnia → SIB). However, sex did not moderate the mediation effect. Sensitivity analyses yielded similar results.

Conclusion: Depressive and anxiety symptoms mediate the relationship between insomnia and SIB in adolescents and young adults, suggesting that insomnia may act as a transdiagnostic factor contributing to emotional dysregulation and SIB.

Objectives: This study investigated cross-country differences in infant and maternal sleep across Korea, the U.S.A. and Australia.

Methods: Participants were 2,005 mother-infant dyads (infant M_age = 13.82 months, SD_age = 6.23 months) from Australia (n = 73), Korea (n = 222), and the U.S.A. (n = 1710). Mothers completed the Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), and Brief Infant Sleep Questionnaire (BISQ) and were grouped (6, 12, and 24 months) dependent on infant age. Data were analyzed using multiple regressions.

Results: Korean mothers had higher insomnia symptoms compared to Australian and U.S.A. mothers at all timepoints (p's < .002). Mean DBAS scores were higher for Korean compared to U.S.A. and Australian mothers (p's < .007). Compared to U.S.A. infants at all timepoints and to Australian infants at 12- and 24 months, Korean infants had shorter nighttime TST (p's < .040) and longer SOL (p's < .003). Bedsharing was associated with lower insomnia symptoms in Korean mothers at 24 months (p = .043). Co-sleeping was not significantly associated with insomnia and DBAS scores (p's > .164).

Conclusions: Korean mothers had higher insomnia and DBAS scores, which did not differ by co-sleeping status; Korean infants had shorter nighttime TST, and longer SOL. Bedsharing in Korea was protective against insomnia symptoms at 24 months. Further exploration into the mechanisms of sleep changes is required to tailor future interventions for diverse backgrounds.

Objectives: Insomnia is common for women with breast cancer, and related to fatigue, depression, and pain. Research exploring these symptoms among breast cancer patients in medically underserved areas is lacking. This study aimed to characterize symptom severity, and examine how fatigue, depression, and pain vary based on categories of insomnia severity.

Methods: Women (N = 127) with Stage 0-IV breast cancer receiving care at clinics in mostly rural, medically underserved areas completed self-report measures of insomnia (Insomnia Severity Index), fatigue (PROMIS-Fatigue), depression (Center for Epidemiological Studies Depression Scale), and pain (Brief Pain Inventory). ANOVA or Kruskal-Wallis tests compared differences in fatigue, depression, and pain across insomnia severity categories. Post-hoc tests determined pairwise significant differences. Analyses were conducted using SAS software.

Results: Median [IQR] insomnia symptom severity fell within the Subthreshold/Mild range (12.00 [6.00, 16.00]). Thirty-four percent of women endorsed insomnia symptoms in the Moderate range or higher. Median fatigue was moderate (60.80 [55.60, 64.85]), and median depressive symptoms (17.00 [10.50, 23.50]) indicated risk for clinical depression. Mean pain severity (4.59 [1.85]) and median pain interference (4.29 [2.57, 6.46]) were moderate. Women endorsing Subthreshold/Mild and Moderate/Severe insomnia symptoms exhibited significantly worse fatigue, depressive symptoms, and pain.

Conclusions: Results highlight a multi-symptom burden for women with breast cancer receiving care at clinics in medically underserved areas with a largely rural population. Behavioral symptom management is critically needed. Intervening on insomnia may, in turn, improve fatigue, depression, and pain. Behavioral interventions targeting insomnia and related symptoms should be adapted for, and tested, in this population.

Objectives: This study aimed to determine the extent to which Cognitive Behavioral Therapy for Insomnia (CBT-I) influences participant willingness to seek treatment for behavioral health conditions. We hypothesized that, relative to sleep hygiene control, CBT-I would be associated with increased willingness to seek treatment for alcohol use, depression, anxiety, PTSD, and chronic pain. Since all participants had insomnia, we also tested CBT-I effects on willingness to seek treatment for residual or future episodes of insomnia.

Method: Data were derived from a randomized controlled trial comparing the efficacy of CBT-I to sleep hygiene control among heavy-drinking Veterans with insomnia (N = 70; 57 men, 13 women; age M = 37.6, SD = 9.4). Willingness to seek treatment was measured on a scale from 0 (strongly disagree) to 4 (strongly agree).

Results: At the end of treatment, across both groups, participants reported most willingness to seek treatment for insomnia (M = 3.08, SD = 1.04), followed by chronic pain (M = 2.82, SD = 1.21), anxiety (M = 2.76, SD = 1.24), depression (M = 2.75, SD = 1.29), PTSD (M = 2.61, SD = 1.27), and alcohol use (M = 2.51, SD = 1.19). Relative to those in sleep hygiene, CBT-I participants reported increased willingness to seek treatment for insomnia [F(1,48) = 10.25, p = .002, d = 0.86] and chronic pain [F(1,48) = 5.76, p = .02, d = 0.60]. No other group-by-time interactions were significant.

Conclusions: CBT-I does increase willingness for future treatment, but only targeting insomnia and chronic pain. Continued research on how to engage Veterans in evidence-based treatment for common mental health concerns (e.g. alcohol use, depression, anxiety, and PTSD) is needed.

Purpose: Poor sleep among adolescents is a significant public health concern. Delivering Cognitive Behavioral Therapy for insomnia (CBT-I) in schools may be an effective way to reach adolescents with poor sleep. This systematic review and meta-analysis examined the effectiveness of school-based CBT-I for improving sleep quality and/or duration among adolescents with insomnia symptoms or disorder.

Methods: A systematic search of studies between 2003 and 2025 was conducted in March 2025. Inclusion criteria were adolescents aged 10-19 years (population) with insomnia symptoms, school-based interventions using evidence-based CBT-I principles (intervention), randomized or non-randomized trials (comparator), and reported sleep quality and/or duration (outcome).

Results: Eight studies (n = 323; M age = 15.3 years; 62.57% female) from four countries were included. Meta-analysis of within sleep intervention condition groups (n = 8) found significant subjective improvements post-intervention: total sleep time (TST) increased by 23.87 minutes (p < .001), sleep onset latency (SOL) decreased by 8.34 minutes (p < .01), and sleep quality improved g = 0.376 (p = .001). Objective measures of TST increased by 20.91 minutes (p = 0.100), SOL decreased by 1.35 minutes (p = 0.202), and sleep efficiency rose by 0.50% (p = .792). Anxiety improved significantly g = 0.373 (p < .01), but depression did not g = 0.806 (p = .196).

Discussion: While sleep improvements were only observed for subjective sleep outcomes, this review suggests that school-based CBT-I may be an effective avenue to address adolescent insomnia. Given the limited evidence, we identify key methodological and implementation considerations to guide practice.