Sleep advances : a journal of the Sleep Research Society最新文献

In 1978, as a young pediatrician, I became interested in the developing field of clinical sleep medicine and set out on a journey into uncharted waters, namely into the previously non-existent field of pediatric sleep medicine. I describe my early training (in a specialty where no formal training programs existed), my excellent mentors, my early struggles to work with equipment that was both primitive by today's standards and not designed to work with children and infants, and various other obstacles I initially faced. I also share some of early findings in pediatric insomnia, sleepiness, parasomnias, and rhythm disorders, and I outline some of our efforts to develop new treatment approaches and techniques where scientifically based ones previously did not exist. Finally, I try to describe translating what I was learning about children and their sleep problems into a wide-ranging book to help parents, especially those who were sleep-deprived themselves.

Study objectives: Airline transport pilot sleep during layover is an important factor for alertness on subsequent flights. Assessing pilots' sleep on layover is an important first step in helping them obtain the most recuperative sleep possible on layover. Here, we investigate the quantity and timing of sleep during layovers and determine predictors for layover sleep.

Methods: Sleep was assessed in 256 pilots flying a total of 473 long-range (LR; flight time 12-16 hours) or ultra-long-range (ULR; flight time > 16 hours) trips. Sleep was assessed using actigraphy. We employed linear mixed-effects models with layover sleep characteristics as the outcomes. The predictor variables included operational factors and sleep history.

Results: Overall, pilots averaged 7.2 hours of sleep per 24 hours of layover, which was significantly less than their daily sleep before or after the trip. Layover start time (relative to home base time) was the most salient predictor of sleep timing and quantity during both shorter (∼24-hour) and the first 24 hours of longer (∼48-hour) layovers. During the last 24 hours of longer layovers, crew type predicted sleep quantity.

Conclusions: Although average sleep quantity during layovers was within the margins of recommended sleep duration, it was still less than pre- and post-trip sleep duration, suggesting modest sleep loss on layovers. Layover start timing was the strongest predictor of layover sleep quantity and timing and, thus, may be a modifiable factor to protect circadian-aligned sleep opportunities during layover.

Study objectives: We investigated how a dimension of early life adversity (ELA), capturing threat in the home, relates to later epigenetic age acceleration in adolescence through sleep (duration, efficiency, and timing) to empirically test theoretical models suggesting the importance of sleep as a key mechanism linking ELA with poor health outcomes and to expand the limited literature on sleep and epigenetic aging among youth.

Methods: We utilized data from 861 participants in the Future of Families and Child Wellbeing Study who participated in the actigraphy substudy at age 15. Sleep variables used were average total sleep time (TST), sleep efficiency (SE), and sleep onset timing. Home threat was determined at ages 3, 5, and 9 from parent reports on the Child Conflict Tactics Scale, and epigenetic aging was measured through DNA methylation analyses of saliva samples collected at age 15.

Results: Higher levels of childhood home threat exposure were associated with less adolescent TST, lower SE, and later sleep onset timing. Adolescent SE and timing were associated with a faster pace of aging and epigenetic age acceleration. SE and timing mediated the link between childhood home threat exposure and adolescent epigenetic aging.

Conclusions: Epigenetic embedding of childhood threat exposure in the home may occur through adversity-related sleep disturbances in adolescence. Findings warrant greater attention to pediatric sleep health in theoretical models of biological embedding of adversity and point to sleep health improvement as a potential way to prevent adversity-related epigenetic age acceleration. This paper is part of the Genetic and other Molecular Underpinnings of Sleep, Sleep Disorders, and Circadian Rhythms Including Translational Approaches collection.

[This corrects the article DOI: 10.1093/sleepadvances/zpae070.153.].

Study objectives: Trauma nightmares are a core feature of PTSD, with potentially devastating implications for mental health outcomes. Treatments remain unsatisfactory and nightmares are poorly understood, both biologically and phenomenologically; measurement methods are limited. The aims of the current analyses were to (1) characterize distressing dreams in trauma survivors, (2) examine the relationships of dream features to next-day symptoms and to suicidal ideation, and (3) validate sleep diary mobile app items for the measurement of clinically relevant dream characteristics.

Methods: Adult male and female veterans and nonveterans with a history of PTSD criterion trauma and at least 1 nightmare weekly were enrolled. Participants completed 3 weeks of sleep diary, including bedtime and morning surveys and weekly assessments. They also completed a Clinician-Administered PTSD Scale (CAPS)-5 PTSD assessment. Multivariable mixed models with repeated measures and standard regression were utilized to examine relationships between dream features and next-day symptoms and suicidal ideation.

Results: Dream features and dream distress independently predict clinically relevant outcomes; no single feature was sufficient for predicting all outcomes of interest. In particular, the replicative quality of trauma nightmares stood out in terms of associations with next-day symptoms, CAPS severity, and suicidal ideation. Subjective dream duration, extent of postdream arousal, and subjective distress severity also independently predicted daytime symptoms.

Conclusions: Results underscore the importance of examining dream characteristics to understand nightmare effects and associations with suicidal ideation. These findings also underscore the utility of mobile app technology for obtaining informative data with high temporal resolution in an appealing and user-friendly manner.

Study objectives: To estimate the prevalence and incidence and evaluate the treatment patterns of patients diagnosed with narcolepsy in specialist care in Sweden.

Methods: This non-interventional retrospective longitudinal study used Swedish register data from 2010 to 2020 and included patients diagnosed with narcolepsy (either type 1 or type 2), recorded in specialist outpatient and inpatient care from January 2015 to December 2019. All patients received an index date corresponding to the date of the first narcolepsy diagnosis.

Results: The prevalence and incidence of narcolepsy were 14.7/100 000 and 0.9/100 000 individuals, respectively, with a greater proportion of females than males. The study included 1846 prevalent narcolepsy patients of either type, of which 466 were incident. The majority of prevalent patients (87.9%) were prescribed narcolepsy-related treatment at index with stimulants being the most common treatment. Both in the years before and after index, the most used medication by prevalent patients was stimulants (42.4% and 54.8%, respectively). Among incident patients, stimulants were the most common drug in the year after index (57.0%). Treatment switching following index was frequent and a large share of incident patients who started on modafinil were switched to stimulants.

Conclusions: The prevalence of narcolepsy was lower than previously reported and was higher in females than in males; incidence was comparable throughout the study period. At index, not all patients used narcolepsy-related medications, potentially indicating a hesitance towards treatment and/or a need for faster initiation of treatment following index. Many patients were switched from the treatment they first initiated after diagnosis, which might be due to a lack of efficacy and/or unacceptable side effects.

Carefully timed light exposure is a promising countermeasure to overcome the negative sleep and circadian implications of shift work. However, many lighting interventions are static and applied at the group level (e.g. light banks, changes to ambient lighting), which is not appropriate for all populations or settings. This study investigates whether individualized lighting exposure, via personal light treatment devices (PLTDs), can improve sleep, sustain projected performance, and entrain circadian rhythms with the work schedules of US Navy submariners. Submarines are a unique testbed for PLTD intervention because they provide a self-contained environment with little influence from outside schedules or lighting. Forty-two submariners were pseudo-randomly assigned to either the PLTD or Control group. PLTD group participants wore blue-light exposure glasses for ~40 minutes upon waking and blue-blocking glasses for ~2 hours before sleep; Control group participants did not use PLTDs. Both groups completed questionnaires assessing subjective sleep and mood before and after the 12-day intervention, and wore wrist actigraphy devices to objectively assess sleep, projected performance, and predicted circadian phase outcomes. Compared with the Control group, several objective and subjective sleep outcomes and projected performance scores were improved in the PLTD group. The PLTD group's predicted circadian phase (modeled from actigraphy-derived accelerometer data) more rapidly shifted to align with scheduled work periods. Compliance with PLTD use was high, with no major disruptions to operational duties reported. These data provide initial support for the use of PLTDs as a flexible and customizable countermeasure for fatigue, sleep loss, and circadian misalignment in an operational environment.

Robert Stickgold's research was among the earliest to rigorously quantify the effect of learning on dream content. As a result, we learned that dreaming is influenced by the activation of newly formed memory traces in the sleeping brain. Exactly how this happens is an ongoing area of investigation. Here, we test the hypothesis that participants are especially likely to dream of recent experiences, which overlap with well-established semantic networks. We created an artificial situation in which participants encountered new information about a person with which they have extensive past experience-a favorite celebrity. We tracked the effect of novel information about a favorite celebrity on participants' dream content across 3 consecutive nights and queried participants about other recent and remote memory sources of their dreams. While the celebrity manipulation failed to affect dream content, this dataset provides rich descriptive information about how recent and remote memory fragments are incorporated into dreams, and how multiple memory sources combine to create bizarre, imaginative scenarios. We discuss these observations in light of the proposed "memory updating" function of sleep-dependent memory consolidation, as well as Stickgold and Zadra's NEXTUP (Network Exploration to Understand Possibilities) model of dreaming. This paper is part of the Festschrift in honor of Dr Robert Stickgold.