Frontiers in sleep最新文献

Introduction: Sleep is crucial for health and wellbeing, but different dimensions of sleep may affect health differently. This cross-sectional study explores the associations of self-reported sleep sufficiency and accelerometer-measured sleep duration with mental health, physical health, and life satisfaction.

Materials and methods: Data from 1,022 individuals (age ≥16 years) from the Danish Health and Morbidity Survey in 2023 were used. Mental and physical health were assessed using the SF-12 questionnaire, and life satisfaction with the Cantril Ladder scale. Multiple adjusted linear regression models were used to examine associations separately and in four combined categories: (1) low sufficiency, <7/>9 h (n = 106), (2) low sufficiency, 7-9 h (n = 89), (3) high sufficiency, <7/>9 h (n = 271), and (4) high sufficiency, 7-9 h (n = 556).

Results: Deviations from recommended sleep durations (<7 or >9 h) and low sleep sufficiency were associated with poorer mental health, physical health and life satisfaction, most strongly for mental health and life satisfaction. Specifically, individuals sleeping 7-9 h with low perceived sleep sufficiency had mental health scores of 10.9 points (95% CI: -13.2; -8.6) lower than those sleeping 7-9 h and reporting high sleep sufficiency. Similarly, those sleeping <7/>9 h and reporting low sleep sufficiency had mental health scores 8.5 points (95% CI: -10.8; -6.3) lower.

Conclusion: Regardless of sleep duration, low sleep sufficiency was consistently associated with poorer health outcomes, suggesting that self-reported sleep sufficiency may be more correlated to health than accelerometer-measured sleep duration alone. These findings underscore the need to integrate multiple sleep dimensions and measurement strategies into public health surveillance.

Obstructive sleep apnea (OSA) represents a significant and increasingly prevalent health burden, impacting individual patients through diminished quality of life, increased morbidity and mortality, as well as society at large, via reduced productivity and escalating healthcare and welfare expenditures. As a multifactorial and heterogeneous disorder, OSA encompasses diverse endotypes and phenotypes, necessitating personalized approaches to diagnosis and management in order to achieve optimal clinical outcomes. Modern telemedicine encompasses a broad spectrum of digital tools designed to enhance the efficiency and precision of care delivery for complex conditions. Recent years have witnessed the rapid integration of advanced telehealth technologies, including consumer-grade devices, into clinical practice. Simultaneously, artificial intelligence (AI) has emerged as a transformative force in healthcare, enabling the automation of routine tasks, advanced data analytics, and the generation of novel clinical hypotheses. Within this domain, large language models, a subclass of AI specializing in natural language processing, offer new opportunities for augmenting patient-provider interactions, including streamlining communication and triaging patient-reported data. Despite these technological advancements, the full potential of telemedicine in the management of OSA remains underexplored. However, its implementation is expanding, particularly in longitudinal care models involving large patient cohorts. This Perspective aims to synthesize current state-of-the-art developments and proposes a comprehensive, integrated framework that leverages telemedicine, AI, and a multidimensional understanding of comorbidities and treatable traits throughout the continuum of OSA care, from screening and diagnosis to adherence monitoring and treatment optimization.

Background: Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is an immune-mediated disorder marked by abrupt onset of obsessive-compulsive symptoms and a spectrum of neuropsychiatric and somatic features, including sleep disturbances. Although polysomnographic studies increasingly document REM Sleep Without Atonia (RSWA) in children with PANS, persistence of RSWA into adulthood remains unreported and poorly understood.

Case presentation: We report a 20-year-old woman with a 5-year history of relapsing-remitting neuropsychiatric symptoms consistent with PANS, including obsessive-compulsive features, complex tics, anxiety, and sleep disruption. The onset was temporally associated with a viral illness and followed by recurrent exacerbations triggered by infections and psychosocial stressors. Polysomnography, conducted during an inter-episode baseline, revealed RSWA with reduced REM atonia and fragmented sleep architecture, despite the absence of REM sleep behavior disorder (RBD). At onset, clinical findings included motor incoordination and sensorimotor hypersensitivities. Past serological workup supported a post-infectious inflammatory phenotype.

Discussion: This case expands current understanding of PANS by documenting persistent RSWA in an adult patient, suggesting chronic disruption of REM-regulating neurocircuits. Mechanistically, we explore how basal ganglia autoimmunity, dopaminergic dysregulation, and hypothalamic orexin imbalance may converge to impair REM atonia. Emerging literature is consistent with RSWA as a state or trait marker of central neuroinflammation in neuroimmune conditions such as PANS. These findings underscore the diagnostic and pathophysiological relevance of sleep phenotyping in neuroinflammatory syndromes and call for longitudinal evaluation of sleep physiology across the disease course.

Conclusion: RSWA may represent an under-recognized manifestation of chronic neuroimmune dysfunction in PANS. Its persistence into adulthood suggests long-term dysregulation of REM sleep circuitry and invites further investigation into the role of orexin and basal ganglia-mediated inhibition in neuroimmune disorders.

Persistent severe obstructive sleep apnea (OSA) after adenotonsillectomy (AT) is not uncommon in children with genetic syndromes and/or obesity. Although continuous positive airway pressure (CPAP) is the standard treatment, adherence in pediatric patients is often low, limiting its effectiveness. We report three cases of children with persistent OSA and failure to continue CPAP therapy, in whom an alternative pharmacological approach was explored. In agreement with their families, a 4-week trial of combined atomoxetine and oxybutynin was initiated. Of note, the first patient was concurrently treated with lisdexamfetamine for attention deficit hyperactivity disorder, while the second had morbid obesity under treatment with liraglutide. Both patients demonstrated a great improvement in their apnea-hypopnea index (AHI), with reductions >50% measured by polysomnography. The combination therapy was well tolerated, with no significant adverse effects or interactions with ongoing medications. The third patient did not adhere to the drug therapy, and the effect of a single night of treatment before the follow-up polysomnography was evaluated, showing no change in AHI. These cases suggest a potential role for atomoxetine and oxybutynin as alternative therapeutic options for pediatric OSA in complex scenarios where severe OSA persists despite AT and failed CPAP therapy, warranting further evaluation in large pediatric clinical trials. Nevertheless, the final case underscores that even pharmacological treatments, although seemingly straightforward to administer, may encounter adherence challenges.

Background and objectives: Sleep apnea-related autonomic responses may increase cardiac arrhythmias. Ablation, cardioversion, and pharmacologic therapies for paroxysmal atrial fibrillation (AF) could benefit from adjunctive oral appliance therapy with a mouth shield (OAT+) compared to auto-adjusting positive airway pressure (APAP).

Methods: A 67-year-old male with moderate obstructive sleep apnea (OSA), AF history, three ablations, and on Carvedilol (10 mg daily) underwent home sleep recordings with APAP and with OAT+ after 4 weeks. Randomly selected premature atrial contractions (PACs; n=20) and time-linked plethysmography waves from each intervention were compared.

Results: OAT+ reduced the PAC index (-61.9%), cardiac conduction intervals (nR-R, p = 0.025; pre-PAC R-R, p = 0.003; R-PAC-R, p = 0.051; PAC R-post systolic pause-R, p < 0.001) except for a P-R interval increase (p = 0.032). PAC-associated plethysmography wave amplitudes increased with OAT+ (pre-PAC wave-1, p < 0.001; PAC wave-2, p = 0.023; post-PAC wave-3, p < 0.001).

Conclusions: OAT+ shows promise as an adjunct AF therapy in OSA patients, improving cardiac conduction and vascular function over APAP.

Introduction: Some studies have indicated a possible association between obstructive sleep apnea (OSA) and restless legs syndrome (RLS). Our aim was to explore this association in a large sample of patients referred to a hospital for suspected OSA.

Methods: The sample included 8,852 patients referred to Haukeland University Hospital with suspicion of OSA between 2011 and 2022. OSA was diagnosed and categorized using standard respiratory polygraphy. Prior to the sleep study the patients completed an extensive questionnaire, including questions to determine if they had RLS. Pearson chi-square tests were used to examine RLS in relation to the presence and severity of OSA. Two separate logistic regression analyses were conducted. The first with moderate-severe OSA as the dependent variable and RLS as predictor, the second with RLS as the dependent variable and OSA severity as predictor. Both were adjusted for sex, age, marital status, alcohol consumption, daily smoking, caffeine after 17:00, and body mass index ≥30.

Results: In total, 24.0% fulfilled the criteria for RLS, whereas moderate-severe OSA (apnea-hypopnea-index ≥15) occurred in 38.1% of the patients. The proportion of patients with RLS did not differ depending on OSA severity. Furthermore, there was no association between RLS and OSA in either chi-square or logistic regression analyses.

Conclusion: The present study did not show increased prevalence of RLS in patients with OSA compared to patients without OSA. Furthermore, we found no increase in prevalence of RLS with increasing OSA severity. This suggests that these two sleep disorders are independent of each other.

Introduction: This study aimed to extend the knowledge about orthosomnia, that is, excessive preoccupation with sleep, by developing a scale for its assessment.

Methods: In Study 1, an initial item pool was presented to 34 sleep experts for assessment using the Delphi method. In Study 2, relevant items were administered to 994 survey respondents (mean age = 42 years, SD = 13.2) for exploratory and confirmatory factor analysis. Two factors were retained, reflecting "interference" and "rigidity," each comprising six items. In Study 3, the scale was validated against multiple validated instruments reflecting sleep-related behaviors and perceptions, the five-factor personality traits, the dark triad personality traits, measures of obsessive-compulsive disorder (OCD) and health anxiety, as well as demographic variables, in a new sample (n = 473, mean age = 41 years, SD = 12.8).

Results: The two-factor model demonstrated acceptable fit (root mean square of approximation = 0.07, comparative fit index = 0.96, Tucker-Lewis Index = 0.95) with Cronbach's alphas of 0.87 and 0.88, and 3-week test-retest reliability of 0.74 and 0.82, respectively. Both orthosomnia factors correlated positively with sleep effort, dysfunctional beliefs and attitudes about sleep, narcissism, perfectionism, OCD, and health anxiety. The interference factor correlated positively with insomnia, neuroticism, psychopathy, and Machiavellianism and negatively with conscientiousness. The rigidity factor correlated positively with conscientiousness.

Conclusion: The new scale for assessing orthosomnia possesses good psychometric properties and provides clinicians and researchers with an instrument for further investigating this new sleep construct.

Background: Sleep is essential for physical health and psychological wellbeing, and insomnia is strongly associated with mental health difficulties, including depression, anxiety, and fatigue. Among first responders, the prevalence of insomnia is particularly high due to chronic exposure to stress, trauma, and irregular work hours.

Aim: As part of a broader study focusing on the mental health of first responders in South Africa, the current study examined the psychometric properties of the Insomnia Severity Index from three different psychometric perspectives: classical test theory, Rasch analysis and Mokken scale analysis.

Methods: Participants were first responders (n = 429) in the Western Cape province of South Africa and they included police officers (n = 309) and paramedics (n = 120). They completed the Insomnia Severity Index (ISI), the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Chalder Fatigue Questionnaire.

Results: The three psychometric paradigms converged to confirm that the ISI measures a unidimensional scale. Furthermore, all three paradigms provided evidence for the construct validity of the ISI. In addition, classical test theory indices provided evidence for convergent and discriminant validity. Lastly, the correlations between insomnia as measured by the ISI and depression, anxiety, and fatigue provided evidence for concurrent validity.

Conclusion: These findings affirm that the ISI is a stable and sound tool for assessing insomnia severity within the first responder population. The absence of measurement bias across gender and professional roles also enhances the practical utility of the ISI, as it ensures equitable assessment across subgroups within the first responder workforce. The ISI emerges from this study as a valuable resource for clinicians, researchers, and occupational health professionals working with South African first responders.

With millions suffering from sleep disorders in today's society, a better understanding of sleep disruption related to cognitive outcomes is urgently needed. To that end, a preclinical investigation into the effects of paradoxical sleep deprivation (PSD) on neurobehavioral outcomes and associated hippocampal neuroinflammation was conducted in male and female rats. Due to epidemiological identification of sex differences in many aspects of sleep disorders, sex and estrous-cycle stage factors were investigated. Sprague-Dawley rats underwent 120 h of PSD using a modified multiple-platform "flowerpot" method. At 96 h of PSD, animals were trained on neurobehavioral Novel Object Recognition (NOR) and Passive Avoidance Task (PAT) paradigms. Before NOR/PAT testing, at 120 h PSD, the Elevated Zero Maze (EZM) was used to assess anxiolytic-like behavior. PSD-impaired PAT performance among males and females. In males after PSD, anxiolytic-like and locomotor behavior was increased, and NOR performance was impaired. Based on estrous cycle stages determined by cytological analysis of daily wet smears, females were found to exhibit estrous-specific differences across all neurobehavioral paradigms, with increased anxiolytic-like behavior and impaired PAT performance only among PSD females in estrus. Immunohistochemical analysis of the hippocampus after 120 h of PSD found microgliosis, but not astrogliosis, in the CA1/2 of males and females in estrus. This study contributes to a better understanding of the sex- and estrous-specific differences in sleep disruption-induced neurobehavioral outcomes and associated hippocampal inflammation. Further research is needed to investigate the molecular mechanisms underlying the interaction between estrous cycle, hippocampal microgliosis, and sleep-disrupted cognitive outcomes.