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

Study objectives: Sleep as a construct in the postpartum period and its perceived importance to postpartum patients remain largely under explored. The aim of this concept elicitation study was to develop a conceptual framework for postpartum sleep based on the key themes (domains and subdomains) identified. Secondary aims were to determine the frequency of discussion of individual domains/subdomains among participants and provide exemplar patient quotes for the most frequently discussed subdomains.

Methods: This study received Institutional Review Board approval from Stanford Lucile Packard Children's Hospital and the University of Arkansas for Medical Sciences. Semi-structured interviews were conducted with patients, partners and multidisciplinary experts until thematic saturation was achieved. All interviews were audio recorded and professionally transcribed and de-identified. Thematic codes (domains and subdomains of postpartum sleep) were derived from review of interview transcripts. Iterative thematic analysis of transcripts with constant comparison across cases was conducted systematically by ≥2 analysts. All transcripts were coded in Nvivo software and qualitatively analyzed to report frequency of domain/subdomain discussion and to identify exemplar patient quotes for individual subdomains.

Results: Interviews were conducted with 42 patients, 13 multidisciplinary experts, and 6 partners over a total of 20 h. Median interval between delivery and interview for the recruited postpartum women was 8 weeks (interquartile range 6-10 weeks, range 3-52 weeks). Analysis of all 61 participant interviews resulted in derivation of 10 domains (psychological, pharmacological, non-pharmacological, sleep interference, medical factors, feeding of neonate, sleep disruption, social factors, societal and cultural factors, and infant related factors) and 85 subdomains related to the construct of postpartum sleep. The three most frequently discussed domains were sleep disruption, non-pharmacological interventions to improve sleep, and medical factors related to sleep. The top 10 most frequently discussed subdomains were breast feeding/feeding, maternal awakenings, social support, childbirth experience, infant sleep routine, day time sleep, infant care (bottles, milk, diapers), sleep arrangements, chronotype, and nighttime sleep.

Conclusions: This study provides a conceptual framework based on 10 domains and 85 subdomains, which can be used to comprehensively describe and study the complex construct of postpartum sleep. These findings can be used to counsel patients regarding postpartum sleep experiences, facilitate patient discussion in the postnatal period when assessing postpartum sleep experiences, guide development of new measures, and assess content validity of existing sleep measures.

Insomnia is a prevalent and debilitating sleep-wake disorder, with growing evidence indicating that it is an independent risk factor for suicidal ideation and behaviors. Cognitive behavioral therapy for insomnia is the recommended first-line treatment for chronic insomnia. However, its effect on suicidal ideation and behaviors in those with insomnia has not been well-characterized. Thus, the aim of the planned meta-analysis is to quantify the effects of cognitive behavioral therapy for insomnia on suicidal ideation, suicidal behaviors, and suicide deaths in adults with insomnia with and without comorbidities. This study will include randomized controlled trials comparing cognitive behavioral therapy for insomnia with a control condition with no presumed strong effect on insomnia in individuals with insomnia according to standardized diagnostic criteria or a clinically relevant screening score. Both published and unpublished randomized controlled trials will be retrieved through a systematic search in major databases and trial registries. The primary outcomes include suicidal ideation, suicidal behaviors, and suicide deaths, assessed post-treatment and at follow-ups. We will only consider randomized controlled trials reporting suicide-related outcomes and/or enrolling participants with suicidal ideation or behaviors. For continuous data, a random-effects meta-analysis will be conducted to estimate (standardized) mean differences. In the case of categorical data, a random-effects logistic regression meta-analysis model will be used. The risk of bias of the primary outcomes will be evaluated using the Cochrane Risk of Bias 2 tool. The certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. Systematic review registration: PROSPERO-ID CRD420250628820.

Functional neuroimaging conducted at regular intervals throughout sleep deprivation reveals key thalamocortical connectivity changes that characterize the transition from a well-rested to a sleep-deprived state. Decreased thalamic connectivity is distributed across sensorimotor, visual, and limbic networks, including subcortical structures such as the parahippocampal gyrus and hippocampus. Associated changes in globally efficiency closely track group-level deficits in psychomotor vigilance, suggesting that thalamic-cortical interactions play a role in wake maintenance during sleep deprivation. These patterns of connectivity disruptions may reflect transient, sleep-like states arising from unstable wakefulness. Causal modeling indicates impaired self-inhibition within the thalamus is a dominant feature of sleep deprivation, which likely contributes to wake-state instability and attentional lapses.

Study objectives: Melatonin regulates daily rhythms and is important for maintaining a healthy pregnancy. Certain socioeconomic factors may affect melatonin release. This study evaluates whether the increase in melatonin with advancing gestation is associated with social disadvantage.

Methods: Data were prospectively collected from a socioeconomically diverse cohort of participants with singleton pregnancies (n = 921) at a Midwest academic center. Participants self-collected saliva every four hours over a 24-hour period once per trimester. Diurnal melatonin concentration was measured, and for each trimester, the maximum and mean diurnal melatonin concentration values were obtained. Cosinor-fitting was performed to obtain peak, mesor, and amplitude values, and melatonin profiles were also analyzed by calculating area under the curve. Participants were dichotomized by high and low social disadvantage score (SDS), and diurnal melatonin parameters were compared between participants with high and low SDS.

Results: Mean diurnal melatonin concentration increased at an average rate of 0.19 pg/mL/week, and amplitude increased by 0.04 pg/mL/week. Participants with high SDS had significantly lower diurnal melatonin concentration amplitudes, means, mesors, and peaks than those with low SDS. Participants with high SDS had a 2.19 [95%CI = 1.94, 2.47] adjusted relative risk for low diurnal amplitude melatonin and had a smaller increase in diurnal melatonin amplitude over weeks of pregnancy than those with low SDS (-0.04 vs. 0.11 pg/mL/week, p<.001).

Conclusions: Average salivary diurnal melatonin concentration increases across pregnancy, but the degree of increase varies among pregnant participants and is associated with social disadvantage.

This study proposes a method to automatically identify dream experience (DE) and no experience (NE) during the sleep stage N2 of nonrapid eye movement (NREM). We investigated the use of machine learning (ML) to automatically identify when a subject is having a dream during NREM from electroencephalography (EEG) signals. We use permutation-based channel selection to identify the most informative EEG channels for the classification of DE and NE and to select a set of channels that allow focus on the most important areas of the brain at the scalp level. The results show that when the ML models are trained on a balanced dataset containing both DE and NE reports, along with high-density EEG, they can achieve a classification performance of up to 0.94 in accuracy, F1 score, precision and recall, an Area Under the Receiver Operating Characteristic of 0.97, and a kappa of 0.88. Performance decreases while we reduce the number of channels, but it remains like using up to 30-40 EEG channels. We show that ML models trained on high-density EEG to classify NE and DE can identify whether a subject was dreaming, achieving an accuracy of 0.7 on a separate set of dream reports where subjects reported a dream experience without recall, and channel selection methods have shown that performance could increase by 0.02 when EEG channels are removed from the occipital area. Our results show a high classification performance for automatic dream detection and the need to reduce the number of EEG channels needed to create the ML models, thus obtaining low-cost portable devices that can be used in real-life scenarios.

Obstructive Sleep Apnea (OSA) is a highly prevalent, yet significantly under-recognized disorder in First Nations Australians. Responding to strong community demand for local capacity building for sleep health equity, this paper outlines the Let's Yarn About Sleep-OSA (LYAS-OSA) program protocol. The LYAS-OSA program will involve the co-design, implementation, and evaluation of a place-based, culturally responsive, nurse-led, and Aboriginal Health Worker-supported model for OSA diagnosis and management for First Nations peoples. This program will partner with health services and organizations across 12 communities in Queensland, Australia. The program will be conducted from 2023 to 2027. During the set up and development stage, an advanced data analytics study of secondary data will examine OSA phenotypes and symptomatology in First Nations Queensland communities. In addition, consumers and healthcare professionals will be engaged in co-design workshops to inform the development of a service delivery model framework. In stage two, local capacity building activities for Aboriginal Health Workers and nurses will be undertaken, with training on OSA diagnosis and management. This work will culminate in delivering and evaluating the co-designed service model. This community-led approach to co-designing, implementing, and evaluating the LYAS-OSA service delivery model will advance knowledge to deliver culturally responsive, context-responsive, OSA diagnosis, and management care for First Nations communities. The LYAS-OSA program outputs will significantly contribute to the evidence base and service delivery provision for OSA care, thereby improving sleep health equity for First Nations Australians.

Age-related sleep disruption is common in older adults. Not only does the total amount of time spent in sleep decline, but also the number of arousals during sleep increases with age. As sleep is important for both memory consolidation and to prevent neurodegenerative pathology, this decline in sleep and/or sleep consolidation may underlie age-related cognitive decline and dementias. Furthermore, treatment of sleep disruption can improve quality of life. However, few interventions have successfully reversed age-related sleep decline. Extracts from the plant Centella asiatica have demonstrated neuroprotective effects in human, rodent, and fly models of aging and neurodegenerative diseases and is a promising intervention for dementias, yet little is known about how these extracts affect sleep patterns. Here, we administered chow containing Centella asiatica water extract (CAW) or control chow to male and female C57BL6/J mice aged 18 months. Effects on sleep composition were determined using electrodes that recorded electroencephalogram (EEG) and electromyogram (EMG) signals. We found that chow containing CAW (1000 mg/kg/day) increased the duration of rapid eye movement (REM) sleep and theta power during REM sleep in aged male mice as well as decreased the number of arousals during sleep observed in aged females, compared to age- and sex-matched controls. We conclude that CAW administered in food has a moderate, sex-dependent effect on sleep quantity and quality.

Individuals with mild cognitive impairment (MCI) demonstrate cognitive decline without major functional impairment and are at increased risk for developing Alzheimer's disease and related dementias (ADRD). Sleep and biobehavioral rhythm disturbances (disruptions in 24-h oscillations in physiology and behavior, including rest-activity patterns and mealtimes) are more than twice as common among patients with MCI than cognitively intact older adults. Importantly, the consequences of sleep and biobehavioral rhythm disruption in MCI extend beyond the patient, also profoundly affecting the spouse/partner. However, scant research has investigated sleep and biobehavioral rhythms that may contribute to the health and cognitive functioning of individuals with MCI and their partners. The current paper presents the rationale and methods for the Couples Healthy Aging and Rhythms (CHARMS) study, a longitudinal cohort study of sleep and biobehavioral rhythms among older couples in which one partner evidences cognitive decline but is independent in daily functioning. The targeted enrollment goal will consist of 185 couples who meet study eligibility criteria including that one partner shows evidence of cognitive decline but reports being independent in daily activities. This is a longitudinal observational study that includes a baseline assessment, a seven-day at-home naturalistic study protocol, and a two-year follow-up to examine change over time. Findings from this study will advance the understanding of the daily and longitudinal relationships between the individual and couple-level processes in sleep and biobehavioral rhythms that influence the progression of cognitive decline in a population at increased risk for developing ADRD.

Study objectives: Sleep health is essential for wellbeing, yet few studies examine sociodemographic differences among young adults using objective sleep measures. We examined sociodemographic differences in actigraphic sleep health among a national, diverse sample of several hundred young adults.

Methods: Data from the Young Adult Sleep Sub-Study were collected during year 22 (mean age = 22.1 ± 0.3 years; range 21.6-24.4) of the Future of Families and Child Wellbeing Study (n = 442), a national, diverse sample of US-based young adults. Participants wore wrist-actigraphs for ~2 weeks. Multivariable linear regression models assessed whether sex, race, Hispanic/Latino ethnicity, education level, and employment status (simultaneously adjusted) were associated with dimensions of actigraphic sleep health.

Results: In adjusted models, women had longer total sleep time (TST), earlier sleep onset, and less weekend night catchup sleep than men. Black young adults had shorter TST, later sleep onset, more variability in nighttime TST, in sleep onset, and in sleep maintenance efficiency, and lower sleep regularity index (SRI) than White young adults. Young adults with a lower education level had greater variability in nighttime TST and in sleep timing and lower SRI than those with a higher education level. Young adults who were unemployed had later sleep timing, lower SRI, and less weekend night catchup sleep than those employed full-time.

Conclusions: Male sex, Black race, lower education level, and unemployment are associated with poorer actigraphic sleep health among this sample of young adults. Strategies to improve young adult sleep health should specifically prioritize men, marginalized populations, and those of lower socioeconomic status.