Frontiers in sleep最新文献

Background: Mast cell-mediated inflammation has been proposed as a potential contributor to neuroinflammatory insomnia and dysautonomia, but objective clinical documentation remains limited. Histamine and related immune mediators can disrupt circadian rhythm, arousal systems, and autonomic stability. Conventional pharmacological therapies for sleep restoration often fail to address these inflammatory mechanisms.

Case presentation: A previously healthy and active 74-year-old male presented with post-viral dysautonomia and severe, treatment-refractory insomnia accompanied by persistent sneezing and ocular irritation suggestive of histamine reactivity. Despite optimal CPAP use and multiple pharmacological trials for sleep disturbance (zolpidem, trazodone, gabapentin, diazepam, lemborexant), Oura Ring data demonstrated persistently low sleep scores, often in the 30-40 range, and minimal REM and deep sleep. Routine laboratory studies (CBC, CMP, thyroid, cortisol, testosterone) were normal except for mildly low DHEA-S, consistent with chronic inflammatory stress. Following evaluation by a tertiary sleep specialist who suggested daytime stimulant therapy (declined by the patient), a targeted supportive regimen was initiated to promote physiologic recovery and restore sleep architecture. This included phosphatidylcholine, alpha-GPC, coenzyme Q10, cyproheptadine (2-4 mg at qHS) and removal of scented household products. Sleep metrics improved within 24 h, with Oura sleep scores increasing to 75+ from a 10-month period characterized by nightly scores often in the 30-40 range and remained stable thereafter. At 4-week follow-up, lingering daytime fatigue and patient-reported cognitive fog prompted additional dietary modification to a low-histamine pattern and the addition of loratadine (10 mg AM) and famotidine (20 mg BID).

Outcome: Within several days, the patient reported marked improvement in energy, cognition, and overall functional capacity, following nearly a year of functional incapacitation.

Conclusion: This case demonstrates a reversible form of inflammatory insomnia and fatigue, likely mediated by mast cell-driven histamine activity. A multi-component intervention targeting histamine pathways, including antihistamine therapy, environmental modification, and dietary adjustment, was associated with rapid and sustained normalization of objective sleep metrics in this patient. These findings highlight the importance of evaluating immune and inflammatory contributors in patients with refractory insomnia and support further investigation of mast cell-related pathways in translational sleep medicine.

Introduction: Sleep plays a critical role in maintaining physical and cognitive health in older adults, yet sleep problems are highly prevalent in this population. Conventional management strategies often rely on pharmacological interventions, which may cause adverse side effects, evidencing the need for safe, low-cost alternatives. Sleep hygiene education offers a promising approach, and this study evaluates the efficacy of a strategy combining a one-time educational video and daily automated text messages in improving sleep quality, daytime sleepiness, and overall sleep hygiene practices among older adults.

Methods: Participants completed an electronic survey that collected demographic information and included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Sleep Hygiene Index (SHI), Perceived Stress Scale, and Numeric Pain Rating Scale. Each participant wore a Fitbit sleep tracker for 2 weeks to establish baseline data on total sleep time, time awake, time in rapid eye movement (REM)/light/deep sleep, and sleep efficiency. Participants were then randomly assigned to a control group, a video-only group, or a video-plus-text group. Sleep tracking continued for 4 additional weeks, and all assessments were repeated at the end of the study.

Results: A total of 119 participants (mean age 66.5 ± 7.2 years; 77 females) completed the study. Paired t-tests compared pre- and post-intervention scores. Both the video-only and video-plus-text groups showed significant improvements on the PSQI, ESS, and SHI compared to the control. No significant changes were found in measured objective sleep parameters.

Discussion: Findings indicate that video-based sleep hygiene education, with or without supplemental text messaging, was associated with improvements in subjective sleep quality, daytime sleepiness, and sleep hygiene behaviors. However, these improvements were not reflected in objective sleep measures, highlighting a discrepancy commonly reported in sleep research.

Conclusion: Brief, low-cost sleep hygiene education interventions, delivered through video or a combination of video and text messaging, may improve perceived sleep quality and sleep-related behaviors in older adults.

Objectives: Different aspects of sleep quality are known to decline with age, and these changes have been shown to impact performance across multiple cognitive domains. However, despite a growing body of literature, the impact of changes to quality of sleep on episodic memory remains elusive, with some studies finding effects and others failing to find a relation.

Methods: In this study, participants [N = 173, mean age = 65.30, range = [45-88]], completed the Pittsburgh Sleep Quality Index as well as three episodic memory tests (verbal and visual episodic memory and pattern separation).

Results: We found that worse sleep efficiency was associated with worse overall episodic memory. Further, medication use had a positive effect on verbal, pattern separation, and overall episodic memory. Findings occurred in an age-dependent manner.

Conclusions: These results underscore the complexity of sleep-memory interactions and suggest that certain aspects of episodic memory may be more sensitive to specific components of sleep quality than others, particularly as individuals age.

Introduction: Recurrent nightmares often severely impair the quality of life, school functioning, and daily functioning of trauma-exposed children and adolescents. However, research to date is limited for treatments focused on reducing the impact of posttraumatic nightmares among youth in conflict zones. This study aimed to investigate the outcome of the Better Learning Program 3 (BLP) as it was implemented in over 100 schools in Gaza (2012-2017).

Methods: Treatment outcome was investigated in an open trial among war- and conflict-exposed students (6-17 years of age) in Gaza (N = 1093). All participants sought help with nightmares and sleep disturbance and reported recurrent traumatic nightmares on average 4.86 nights per week. The intervention was inspired by imagery rehearsal therapy and trauma-focused cognitive behavioral therapy.

Results: Students experienced significant week-to-week reductions in reported nightmares throughout the 8-week intervention. Approximately half of the participants reported no nightmares post-treatment, and a further 47% reported a reduction in nightmare frequency. In a 10-month follow-up, 42% of a smaller sample (n = 215) maintained treatment gains and remained free of nightmares, whereas 42% maintained a reduction of nightmares to one or two per week. Students with relapse responded effectively to booster sessions offered after follow-up.

Discussion: The current study demonstrates the apparent success of this school-based treatment, showing that it is both feasible to intervene directly with students' nightmare disturbance and to significantly reduce their nightmare frequency.

Background: A consistent bedtime routine (≥5 nights per week) is an empirically supported intervention associated with better sleep outcomes. However, few studies have examined the impacts of a bedtime routine on outcomes beyond sleep, and among families of lower educational attainment.

Objective: This pilot randomized controlled trial (RCT) examined initial outcomes (sleep, development, caregiver stress), feasibility, and acceptability of a primary care-based bedtime routine intervention for toddlers, and explored variation in outcomes by caregiver educational attainment.

Method: Caregivers of 86 toddlers (M _age = 12.89 months, 67.4% Black/African American, 23.3% Hispanic/Latine; United States) were randomly assigned to a bedtime routine intervention or usual care at their 12-month well-child visit (age-based preventative care). At their 15- and 24-month well visits, child sleep (Brief Infant Sleep Questionnaire-R SF), social-emotional development (Brief Infant-Toddler Social and Emotional Assessment), caregiver stress (Parenting Stress Inventory-SF), and intervention acceptability were assessed.

Results: There were no differences in outcomes between the groups, however, the intervention positively impacted sleep consolidation, social-emotional outcomes, and caregiver stress, primarily at 24 months of age, for toddlers of caregivers with lower educational attainment. Additionally, families in the intervention were more likely to include reading in their bedtime routine at 15 months. Caregivers assigned to the intervention also reported strong acceptability and 85% completed both sessions.

Conclusions: This pilot study suggests that bedtime routine intervention for toddlers is acceptable, feasible, and results in increased integration of reading at 15 months of age. Caregivers of lower educational attainment in the intervention condition reported improvements in aspects of child sleep health, social-emotional concerns, and caregiver stress, highlighting the potential for this intervention to reduce sleep health disparities. Future research should continue to examine potential bedtime routine benefits beyond sleep in larger-scale RCTs.

Pediatric obesity has emerged as a significant global health issue with multifaceted consequences, including its impact on sleep health. Obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) are among the serious sleep-related comorbidities in obese children, contributing to impaired quality of life, cognitive deficits, and cardiovascular risks. These conditions frequently coexist with other obesity-related complications such as insulin resistance, type 2 diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD). This review explores the importance of multidisciplinary care in addressing pediatric obesity, emphasizing early diagnosis, nutritional counseling, physical activity interventions, psychological support, and pharmacologic therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists. The role of global trends, academic performance, and wellbeing clinics are also discussed. Although promising, the use of GLP-1s and surgical interventions in pediatrics remains constrained by limited data, particularly concerning their impact on sleep disorders. Further research is essential to clarify the long-term effects of GLP-1 receptor agonists and bariatric surgery not only on obesity and sleep-related comorbidities such as OSA and OHS, but also on cognitive function, psychosocial wellbeing, and overall health outcomes-thereby informing evidence-based, multidisciplinary approaches to pediatric obesity management.

Background: Quality sleep is crucial for the growth and development of children. Sleep training is an effective method to improve the sleep quality of young children. This study aims to identify the knowledge and practices of mothers regarding sleep training for young children in Indonesia.

Methods: This cross-sectional study included 417 mothers of children aged 3-36 months recruited purposively from three healthcare facilities in Indonesia, two urban and one rural, between March and June 2024. Data on sociodemographic characteristics, maternal knowledge, and maternal sleep-training behaviors were collected using validated, structured questionnaires. Item reliability and content validity were assessed through expert review and pilot testing. Descriptive, bivariate, and multiple linear regression analyses were performed using continuous knowledge and behavior scores, with co-sleeping variables included in sensitivity analyses. Mixed-effects linear models with random intercepts by site were applied to account for facility-level clustering and to assess model robustness.

Results: Higher maternal education, formal employment, and higher socioeconomic status were significantly associated with greater knowledge and behavior scores. Mothers residing in urban areas demonstrated significantly better sleep-training practices, whereas knowledge scores did not differ between urban and rural participants. Multiple regression analyses confirmed that education level, employment type, and socioeconomic status independently predicted knowledge scores, while employment type, socioeconomic status, and urban residence independently predicted behavior scores. Mixed-effects modeling indicated that site-level clustering accounted for approximately 47% of variance in knowledge and 35% in behavior scores, with model comparisons (AIC/BIC) confirming robustness across specifications. Sensitivity analyses adjusting for co-sleeping and household crowding yielded consistent findings, indicating that the main associations were not affected by these contextual variables.

Conclusion: Mothers with higher education, formal employment, and greater socioeconomic status demonstrated better knowledge and sleep-training behaviors; however, knowledge was not directly associated with practice. These findings highlight that improving maternal understanding alone may be insufficient to change behavior without addressing sociocultural norms-particularly widespread co-sleeping and household constraints-that influence sleep practices. Tailored, context-sensitive educational interventions are needed to promote consistent and developmentally appropriate sleep routines for young children in Indonesia.

Background: Poor sleep health in childhood has significant implications for life-long physical, cognitive, and behavioral outcomes, but sleep problems and potential developmentally-driven sex differences in early childhood are poorly understood.

Objective: To objectively assess sleep health and investigate sex-specific differences in sleep in early childhood.

Methods: Three hundred thirty-six children enrolled in the PRogramming of Intergenerational Stress Mechanisms (PRISM) pregnancy cohort in Boston and New York City underwent actigraphy for 7 days. A subset (n = 117) completed home unattended Type II polysomnography (PSG). Sleep parameters from actigraphy and PSG were examined using standard descriptive analyses, and non-parametric tests of comparison of means, specifically two-sample Wilcoxon Rank Sum tests, were used to assess differences between boys and girls.

Results: Children were median (IQR) age of 6.9 (4.9, 8.9) years, half were male, and most were Black (46.2%) and/or Hispanic (33.9%). On actigraphy, average sleep duration and sleep efficiency were low compared to published normative data, with median (IQR) time spent asleep of 7.8 (7.4, 8.3) hours and sleep efficiency of 79.1% (74.7, 82.6). Wake duration after sleep onset (WASO) assessed by actigraphy was elevated (median (IQR) of 1.8 (1.4, 2.2) hours), and significantly worse among boys compared to girls (p = 0.0007). Overall, boys had significantly more restless and fragmented sleep as measured by both actigraphy and PSG. Sleep disordered breathing events were infrequent, with median (IQR) Apnea-Hypopnea Index of 0.7 (0.3, 1.3) events per hour.

Conclusion: Clinically significant and objectively assessed sleep disturbance was common in this pediatric cohort, and worse in boys compared to girls. These findings emphasize early sex-based sleep disparities warranting intervention to intercept lifelong consequences of poor sleep in early childhood.

Sleep health is essential for overall wellbeing; however, millions of people worldwide experience poor sleep quality due to insomnia, stress, or lifestyle-related disturbances. Pharmacological and behavioral treatments, while effective, remain limited by side effects, accessibility barriers, or patient adherence. In contrast, music is an accessible, low-cost, and non-invasive intervention that is increasingly used by individuals to improve sleep. This narrative review synthesizes findings from randomized controlled trials and meta-analyses to identify the musical elements and delivery methods that are most effective in enhancing sleep quality. Across studies, listening to music consistently reduced sleep-onset latency, improved sleep efficiency, and increased total sleep time. Music that was slow in tempo (60-80 bpm), soft and smooth in melodies, instrumental, and simple in structure, often classical or new age, was most effective. Cultural familiarity, nature sounds, and religious music also demonstrated benefits in specific contexts. Innovative approaches, such as brain-wave music and binaural beats, show promise but require further validation. Optimal dosing included 30-45 min of daily listening before bedtime at comfortable volume levels. Despite strong evidence of short-term benefits, gaps remain in our understanding of the long-term effects, mechanisms of action, and impacts on youth populations. Future research should explore how personalized music interventions and artificial intelligence-generated compositions may advance sleep health. Overall, this review highlights the elements at work that make music a safe, scalable, and culturally adaptable adjunct to traditional sleep therapies.