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Understanding Latine disparities in nocturnal wakefulness as a suicide risk factor 了解拉丁人夜间清醒的差异作为自杀风险因素
Pub Date : 2025-09-24 DOI: 10.1016/j.sleepe.2025.100117
Fabian-Xosé Fernandez , Andrew S. Tubbs , Michael L. Perlis , Michael A. Grandner
Individuals who remain awake during hours typically reserved for sleep exhibit a significantly elevated risk (1.2 to 7.2-fold) of suicidal ideation, behaviours, or death, varying according to the specific hour of nocturnal wakefulness. This association has been robustly replicated across diverse populations and within individual assessments. Notably, Hispanic/Latine adults demonstrate a 26–45% stronger relationship between nighttime wakefulness and suicide risk compared to other groups, resulting in a disproportionately higher occurrence of nighttime suicides, despite lower overall suicide rates. We previously proposed the "Mind after Midnight" (MaM) hypothesis, suggesting that the interplay between accumulating sleep pressure and circadian modulation impairs decision-making and emotional regulation during nighttime, thus heightening vulnerability to maladaptive behaviours, including suicide. In this manuscript, we summarize evidence supporting the MaM hypothesis and propose two mechanisms potentially underpinning the heightened nocturnal suicide risk among Latine adults. First, cultural values emphasizing social connectedness may amplify vulnerability to social isolation during nighttime wakefulness. Second, existing social disadvantages may increase nocturnal wakefulness and exacerbate the psychological impact of daily stressors experienced during these periods. Given that Hispanic/Latine individuals represent one of the largest and fastest-growing minority populations in the United States—and considering Mexican Americans, a significant subgroup, report the greatest reductions in sleep duration among racial/ethnic groups—our findings underscore the critical need to verify whether nocturnal wakefulness disproportionately increases suicidal ideation and behaviours in this demographic. Confirmation of these relationships could inform culturally tailored interventions aimed at reducing suicide risk within the broader Latine community.
在典型的睡眠时间保持清醒的个体,其自杀意念、行为或死亡的风险显著增加(1.2至7.2倍),这取决于夜间清醒的具体时间。这种关联在不同人群和个人评估中得到了有力的证实。值得注意的是,与其他群体相比,西班牙裔/拉丁裔成年人夜间清醒与自杀风险之间的关系比其他群体强26-45%,导致夜间自杀的发生率不成比例地高,尽管总体自杀率较低。我们之前提出了“午夜后的思维”(MaM)假说,认为积累的睡眠压力和昼夜节律调节之间的相互作用削弱了夜间的决策和情绪调节,从而增加了对包括自杀在内的适应不良行为的脆弱性。在这篇论文中,我们总结了支持MaM假说的证据,并提出了拉丁裔成年人夜间自杀风险增加的两种潜在机制。首先,强调社会联系的文化价值观可能会在夜间清醒时放大对社会孤立的脆弱性。其次,现有的社会劣势可能会增加夜间觉醒,并加剧在这些时期经历的日常压力源的心理影响。考虑到西班牙裔/拉丁裔个体是美国最大和增长最快的少数民族人口之一,考虑到墨西哥裔美国人是一个重要的亚群体,在种族/民族群体中睡眠时间减少最多,我们的研究结果强调了验证夜间清醒是否不成比例地增加了这一人口统计中的自杀意念和行为的迫切需要。确认这些关系可以为在更广泛的拉丁社区内减少自杀风险的文化量身定制的干预措施提供信息。
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引用次数: 0
The relationship between ambient neighborhood noise exposure and sleep parameters among Black adults living in the Miami metropolitan area 居住在迈阿密都市圈的黑人成人环境噪音暴露与睡眠参数之间的关系
Pub Date : 2025-09-16 DOI: 10.1016/j.sleepe.2025.100116
Matthew Coppello , Carolina Scaramutti , Clarence E. Locklear , Bruno Oliveira , Michelle G. Thompson , Sadeaqua S. Scott , Joon Chung , Gabrielle Belony , Aisha Severe , Debbie Chung , Girardin Jean-Louis , Azizi Seixas

Objective

Black individuals in the US are burdened by sleep health disparities compared to non-Hispanic White individuals. Neighborhood factors could contribute and provide insights into these disparities. This investigation examined associations between environmental noise and sleep parameters among Black adults to deepen the understanding of sleep disparities.

Methods

Participant sleep parameters were recorded at-home for seven nights using cardiopulmonary coupling-based SleepImage Ring. Soundscores™ derived from HowLoud were used as a proxy for neighborhood noise. Score are noise estimates based on traffic models and local factors. Participants on average lived in slightly noisy neighborhoods (soundscore M = 70.8). Linear regressions were conducted to assess the relationship between noise and sleep parameters.

Results

Analysis of 261 Black adults (aged 18–85 years; 66.7 % female) from South Florida showed quieter environments (higher soundscores) were associated with increased deep sleep and improved sleep quality. When stratified by age and sex, lower noise was associated with decreased nocturnal awakening duration in males aged 18–54 years (β [95 % CI] = -110.76 [-203.18, -18.34]; p = .02; r2 = .20) and increased time slept in females aged 55–85 years (β [95 % CI] = 379.48 [5.92, 753.04]; p = .04; r2 = .09).

Conclusions

To the authors’ knowledge, this investigation is among the first to investigate associations between noise and sleep in Black adults using objective measures. Results showed sleep parameters were associated with noise, with unique demographic variations. Future investigations are necessary to address the effects of neighborhood features on sleep among Black adults.
目的:与非西班牙裔白人相比,美国黑人的睡眠健康状况存在差异。邻里因素可能会对这些差异有所贡献,并提供一些见解。本研究考察了环境噪音与黑人成年人睡眠参数之间的关系,以加深对睡眠差异的理解。方法使用基于心肺耦合的睡眠图像环记录参与者的睡眠参数,为期7晚。来自HowLoud的声音评分™被用作邻里噪音的代理。分数是基于交通模型和当地因素的噪音估计。参与者平均居住在稍微嘈杂的社区(声音评分M = 70.8)。采用线性回归来评估噪音与睡眠参数之间的关系。结果对来自南佛罗里达的261名黑人成年人(年龄在18-85岁之间,其中66.7%为女性)的分析显示,更安静的环境(更高的声音评分)与深度睡眠的增加和睡眠质量的改善有关。当按年龄和性别分层时,低噪音与18-54岁男性夜间觉醒时间减少相关(β [95% CI] = -110.76 [-203.18, -18.34]; p = 0.02; r2 = .20),与55-85岁女性睡眠时间增加相关(β [95% CI] = 379.48 [5.92, 753.04]; p = 0.04; r2 = .09)。据作者所知,这项调查是第一次用客观的方法调查黑人成年人的噪音和睡眠之间的关系。结果显示,睡眠参数与噪音有关,具有独特的人口统计学差异。未来的调查有必要解决邻里特征对黑人成年人睡眠的影响。
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引用次数: 0
Sleep, fatigue, and altered cognition in healthcare professionals: Evidence from Portugal using the fatigue and altered cognition scale 医疗保健专业人员的睡眠、疲劳和认知改变:来自葡萄牙的证据,使用疲劳和认知改变量表
Pub Date : 2025-09-16 DOI: 10.1016/j.sleepe.2025.100115
Amanda Alencar , Fábio Abreu , Carina Fernandes
While the detrimental impact of poor sleep on mental health and cognitive performance is well established, few studies have explored these relationships using sensitive, population-specific tools. This study offers a novel contribution by examining the associations between sleep quality, fatigue, altered cognition, and symptoms of anxiety and depression among Portuguese healthcare professionals, incorporating the Fatigue and Altered Cognition Scale (FACs), a newly validated instrument for the Portuguese context. A total of 80 healthcare professionals completed standardized measures assessing sleep (Pittsburgh Sleep Quality Index - PSQI and Sleep Health Scale - SHS), emotional well-being (Hospital Anxiety and Depression Scale - HADS), and psychocognitive exhaustion (FACs). The relationships between these variables were statistically analyzed through correlations and comparisons between groups. The results revealed that poorer sleep quality was significantly associated with higher levels of fatigue, perceived cognitive alterations, and symptoms of anxiety and depression. Marital status, physical exercise, and caffeine consumption showed no statistically significant associations, but age was positively correlated with sleep quality. No significant differences were found between professional categories. However, professionals working in shifts reported significantly poorer sleep quality compared to those with regular schedules. The FACs provided a measure of cognitive and fatigue-related difficulties, allowing for a clearer characterization of how poor sleep affects both mental performance and fatigue symptoms. These findings highlight the value of integrating contextually adapted tools in occupational health research and reinforce the need for institutional strategies targeting sleep hygiene and cognitive well-being in healthcare settings.
虽然睡眠不足对心理健康和认知表现的有害影响是众所周知的,但很少有研究使用敏感的、针对特定人群的工具来探索这些关系。本研究通过检查葡萄牙医疗保健专业人员的睡眠质量,疲劳,认知改变以及焦虑和抑郁症状之间的关联,结合疲劳和认知改变量表(FACs),这是一种针对葡萄牙上下文的新验证工具,提供了新的贡献。共有80名医疗保健专业人员完成了评估睡眠(匹兹堡睡眠质量指数- PSQI和睡眠健康量表- SHS)、情绪健康(医院焦虑和抑郁量表- HADS)和心理认知衰竭(FACs)的标准化测量。通过组间相关和比较,统计分析这些变量之间的关系。研究结果显示,较差的睡眠质量与较高程度的疲劳、感知到的认知改变以及焦虑和抑郁症状显著相关。婚姻状况、体育锻炼和咖啡因摄入没有统计学上的显著关联,但年龄与睡眠质量呈正相关。在专业类别之间没有发现显著差异。然而,与定期工作的人相比,轮班工作的专业人士的睡眠质量明显较差。FACs提供了一种认知和疲劳相关困难的测量方法,可以更清楚地描述睡眠不良如何影响精神表现和疲劳症状。这些发现强调了在职业健康研究中整合情境适应工具的价值,并强调了在医疗保健环境中针对睡眠卫生和认知健康的机构战略的必要性。
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引用次数: 0
High burden of moderate-to-severe obstructive sleep apnea: comparative accuracy of screening tools against polysomnography 中度至重度阻塞性睡眠呼吸暂停的高负担:多导睡眠图筛选工具的相对准确性
Pub Date : 2025-09-10 DOI: 10.1016/j.sleepe.2025.100114
Asmaa Ali , Liang Wu , Seham Ezzat Fathy Elfeky , Mohammad H. Alhassoon , Dhuha S. Aldrees , Eman M. Moazen , Abdulaziz Alghulayqah , Mai M. Saleh

Background and objectives

Timely diagnosis of obstructive sleep apnea (OSA) is essential, but polysomnography (PSG) is resource intensive. Simple screening tools may aid triage, yet their comparative accuracy in high-risk populations remains unclear. This study aimed to assess OSA burden and evaluate the diagnostic performance of three tools (STOP-BANG, Epworth Sleepiness Scale (ESS), and NoSAS) against PSG, along with a Combined Screening Model (CSM) integrating these tools.

Methods

In this cross-sectional study, 140 patients referred for overnight PSG were screened using STOP-BANG, ESS, and NoSAS. Sensitivity, specificity, predictive values, and area under the receiver operating characteristic curve (AUC) were calculated using an apnea–hypopnea index (AHI) ≥5 events/h and oxygen desaturation index (ODI) ≥5 events/h as diagnostic thresholds. A CSM was developed to assess the combined predictive value.

Results

OSA was confirmed in 91% of patients, with 74% having moderate-to-severe disease. NoSAS had the highest AUC (0.70), followed by STOP-BANG (0.67), CSM (0.65), and ESS (0.61), with no significant differences. CSM showed the greatest sensitivity (71%), while NoSAS had the highest specificity (64%).

Conclusion

OSA was highly prevalent and often severe in this referral population. NoSAS performed slightly better individually, and combined models showed potential for supporting early triage. However, PSG remains essential for definitive diagnosis and management.
背景和客观诊断阻塞性睡眠呼吸暂停(OSA)是必要的,但多导睡眠图(PSG)是资源密集的。简单的筛查工具可能有助于分诊,但它们在高危人群中的相对准确性尚不清楚。本研究旨在评估OSA负担,并评估三种工具(STOP-BANG, Epworth嗜睡量表(ESS)和NoSAS)对PSG的诊断性能,以及整合这些工具的联合筛选模型(CSM)。方法在这项横断面研究中,使用STOP-BANG、ESS和NoSAS对140例接受过夜PSG的患者进行筛选。以呼吸暂停低通气指数(AHI)≥5个事件/小时和氧去饱和指数(ODI)≥5个事件/小时作为诊断阈值,计算敏感性、特异性、预测值和受试者工作特征曲线下面积(AUC)。开发了CSM来评估联合预测值。结果91%的患者确诊为sosa,其中74%为中重度疾病。NoSAS的AUC最高(0.70),其次是STOP-BANG(0.67)、CSM(0.65)和ESS(0.61),差异无统计学意义。CSM的敏感性最高(71%),NoSAS的特异性最高(64%)。结论osa在该转诊人群中发病率高,且病情严重。NoSAS单独表现稍好,联合模型显示支持早期分诊的潜力。然而,PSG对于明确诊断和治疗仍然至关重要。
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引用次数: 0
Data driven phenotyping and longitudinal feature modeling of sleep apnea subtypes using interpretable machine learning 使用可解释机器学习的睡眠呼吸暂停亚型的数据驱动表型和纵向特征建模
Pub Date : 2025-09-09 DOI: 10.1016/j.sleepe.2025.100113
Shireen Fathima, Maaz Ahmed
Sleep apnea is a heterogeneous disorder with distinct physiological mechanisms such as obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed forms, yet many subjects exhibit diagnostically ambiguous events that do not fit these categories. We define such cases as a novel Borderline (BL) Apnea phenotype, which our longitudinal analysis revealed to often behave as a transitional stage between normal breathing and pathological subtypes. Most machine learning (ML) studies adopt binary classification frameworks, overlooking phenotypic diversity, risk stratification, and longitudinal patterns. This study proposes a comprehensive framework integrating rule-based phenotyping, observational and statistical profiling, multiclass ML, and interpretable modeling to classify subjects from the Sleep Heart Health Study (SHHS) cohort into Normal, OSA, CSA, Both (mixed), or BL Apnea types using apnea–hypopnea index (AHI) thresholds: total (AHIA), obstructive (AHIO), and central (AHIC). The BL group captures individuals with elevated total AHI but subthreshold OSA and CSA components, representing a diagnostically ambiguous, underexplored phenotype. Demographic, anthropometric, and lifestyle traits were compared across subtypes to enable risk stratification . Dimensionality reduction (PCA, t-SNE) revealed substantial overlap, justifying non-linear modeling. Among nine classifiers, Gradient Boosting and LightGBM performed best (macro AUC >0.83, accuracy >84%, specificity >88%). SHAP interpretation consistently identified neck circumference, minimum O2 saturation, Epworth Sleepiness Score, and arousal index as top predictors. Longitudinal analysis using SHHS Visit 2 showed heterogeneous outcomes for BL Apnea: 44% reverted to Normal and 22% progressed to ’Both’ type, highlighting its transitional nature and potential clinical utility for risk stratification, disease monitoring, and personalized management.
睡眠呼吸暂停是一种异质性疾病,具有不同的生理机制,如阻塞性睡眠呼吸暂停(OSA)、中枢性睡眠呼吸暂停(CSA)和混合形式,但许多受试者表现出诊断上模棱两可的事件,不符合这些类别。我们将这些病例定义为一种新的边缘性(BL)呼吸暂停表型,我们的纵向分析显示,这种表型通常表现为正常呼吸和病理亚型之间的过渡阶段。大多数机器学习(ML)研究采用二元分类框架,忽略了表型多样性、风险分层和纵向模式。本研究提出了一个综合的框架,将基于规则的表型、观察和统计分析、多类别ML和可解释模型整合在一起,使用呼吸暂停-低通气指数(AHI)阈值将睡眠心脏健康研究(SHHS)队列中的受试者分为正常、OSA、CSA、两者(混合)或BL呼吸暂停类型:total (AHIA)、obstructive (AHIO)和central (AHIC)。BL组捕获总AHI升高但阈下OSA和CSA成分的个体,代表诊断模糊,未充分探索的表型。对不同亚型的人口统计学、人体测量学和生活方式特征进行比较,以便进行风险分层。降维(PCA, t-SNE)显示了大量的重叠,证明了非线性建模的合理性。在9个分类器中,Gradient Boosting和LightGBM表现最好(宏观AUC >;0.83,准确率>;84%,特异性>;88%)。SHAP解释一致认为颈围、最低氧饱和度、Epworth嗜睡评分和觉醒指数是最重要的预测因素。使用SHHS Visit 2进行的纵向分析显示,BL呼吸暂停的结果存在异质性:44%恢复为正常,22%进展为“两种”类型,突出了其过渡性和潜在的临床应用,包括风险分层、疾病监测和个性化管理。
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引用次数: 0
Association between sleep problems and depressive symptoms among small-scale miners in Ghana 加纳小型矿工睡眠问题与抑郁症状之间的关系
Pub Date : 2025-08-09 DOI: 10.1016/j.sleepe.2025.100112
Emmanuel Nyaaba , Emma AO. Sefa , Vanessa F. Epis , Lawrence Guodaar , Razak M. Gyasi

Objective

Sleep problems (SP) are increasingly linked to poor mental health outcomes, yet limited research has explored this association among high-risk occupational groups in low- and middle-income countries (LMICs). We investigate the association between SP and depressive symptoms among small-scale miners in Ghana and explores whether emotional distress and anxiety explain this association.

Methods

We recruited 664 miners (mean age = 28.8, SD = 8.2 years; males = 84.3 %) in this study. SP was assessed using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), while depressive symptoms were measured using the PHQ-9. Emotional distress and anxiety were assessed using the MOS SF-36 scale and the GAD-7 scale, respectively. Multiple linear regressions and bootstrapping techniques evaluated the hypothesized direct and indirect associations.

Results

SP was significantly associated with higher levels of depressive symptoms (B = 0.171, p < 0.001), after adjustment. Crucially, emotional distress (53.06 %; B = 0.2447, 95 % CI [0.1739, 0.3221]), and anxiety (25.0 %; B = 0.1153, 95 % CI [0.0592, 0.1745]) partially accounted for the association between SP and depressive symptoms.

Conclusions

Poor sleep quality may be a clinical marker for depressive symptoms among small-scale miners, with emotional distress and anxiety as key psychological pathways. Integrated sleep-related screening and intervention strategies is needed in poor occupational health settings. Nevertheless, given the non-probability sampling approach used, some degree of selection bias cannot be ruled out, and findings should be interpreted with caution regarding their generalizability beyond the study communities.
睡眠问题(SP)越来越多地与不良的心理健康结果联系在一起,然而,在低收入和中等收入国家(LMICs)的高风险职业群体中,探索这种关联的研究有限。我们调查了SP与加纳小型矿工抑郁症状之间的联系,并探讨了情绪困扰和焦虑是否解释了这种联系。方法招募664名矿工,平均年龄28.8岁,SD = 8.2岁;男性= 84.3%)。SP采用世卫组织残疾评估表2.0 (WHODAS 2.0)进行评估,抑郁症状采用PHQ-9进行测量。情绪困扰和焦虑分别采用MOS SF-36量表和GAD-7量表进行评估。多元线性回归和自举技术评估了假设的直接和间接关联。结果ssp与较高程度的抑郁症状显著相关(B = 0.171, p <;0.001),调整后。最关键的是情绪困扰(53.06%);B = 0.2447, 95% CI[0.1739, 0.3221]),焦虑(25.0%;B = 0.1153, 95% CI[0.0592, 0.1745])部分解释了SP与抑郁症状之间的关联。结论睡眠质量差可能是小型矿工抑郁症状的临床标志,情绪困扰和焦虑是关键的心理通路。在较差的职业卫生环境中,需要综合睡眠相关筛查和干预策略。然而,考虑到所使用的非概率抽样方法,不能排除一定程度的选择偏差,并且应该谨慎地解释研究结果,以确保其在研究群体之外的普遍性。
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引用次数: 0
Sleep quality, daytime sleepiness, and obstructive sleep apnea risk among iranian commercial airline pilots 伊朗商业航空公司飞行员的睡眠质量、白天嗜睡和阻塞性睡眠呼吸暂停风险
Pub Date : 2025-08-09 DOI: 10.1016/j.sleepe.2025.100111
Asghar Akhavan , Mahdieh Hasanalifard , Reyhaneh Abolghasemi , Abolfazl Khamaki , Shokofeh Radfar , Taleb Badri

Introduction

Sufficient sleep is one of the most important factors in maintaining focus and attention in pilots. In this matched cross-sectional comparative study, the sleep status and related factors in commercial airline flight pilots were evaluated.

Methods

All pilots and the healthy sex- and age-matched controls who met the inclusion criteria and signed informed consent were included in the study. Information about sleep quality was collected using the Pittsburgh sleep quality index. The Epworth sleepiness scale assessed the subjective daytime sleepiness. The Stop-Bang sleep apnea questionnaire was a tool for the risk of obstructive sleep apnea screening.

Results

One hundred and seven airline pilots and 100 healthy control people were included in this study. The results showed that the risk of obstructive sleep apnea was significantly equal in pilot and control groups. The sleep quality and daytime sleepiness were significantly worse in the pilot group. In the pilot group, the marital status, sleep duration of 24 hours, education level, physical activity, and exercise correlated to sleep quality. The sleep apnea state was correlated to age, Body Mass Index, marital status, and morning headache. The flight hours and distances were correlated with at least one of the sleep questionnaires results. The regression model analysis showed that none of the independent variables had a significant effect on the probability of the Stop-Bang questionnaire and PSQI scores. But nine independent variables had a significant effect on the Epworth sleepiness scale.

Discussion

Among the Iranian commercial airline pilots, the risk of sleep apnea is not higher than those in the control group. Even though they are at higher risk of reducing sleep quality and increasing daytime sleepiness. Appropriate intervention on demographic factors and blood parameters improves pilots' sleep status.
充足的睡眠是保持飞行员注意力集中的最重要因素之一。本研究对商业航空公司飞行飞行员的睡眠状况及相关因素进行了对比研究。方法所有符合纳入标准并签署知情同意书的飞行员和性别、年龄匹配的健康对照者纳入研究。使用匹兹堡睡眠质量指数收集有关睡眠质量的信息。爱普沃斯睡意量表评估的是白天的主观睡意。Stop-Bang睡眠呼吸暂停问卷是筛查阻塞性睡眠呼吸暂停风险的工具。结果117名航空公司飞行员和100名健康对照者参与了本研究。结果显示,飞行员和对照组患阻塞性睡眠呼吸暂停的风险显著相等。飞行员组的睡眠质量和白天嗜睡明显更差。在试验组中,婚姻状况、24小时睡眠时间、受教育程度、身体活动、运动与睡眠质量相关。睡眠呼吸暂停状态与年龄、体重指数、婚姻状况和早晨头痛有关。飞行时间和距离与至少一项睡眠问卷结果相关。回归模型分析显示,自变量均未对Stop-Bang问卷的概率和PSQI得分产生显著影响。但有9个独立变量对爱普沃斯嗜睡量表有显著影响。在伊朗商业航空公司飞行员中,睡眠呼吸暂停的风险并不高于对照组。即使他们有降低睡眠质量和增加白天困倦的风险。适当的人口因素和血液参数干预可以改善飞行员的睡眠状况。
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引用次数: 0
Validation of algorithms identifying diagnosed obstructive sleep apnoea and narcolepsy in coded primary care and linked hospital activity data in England 英格兰编码初级保健和相关医院活动数据中识别诊断为阻塞性睡眠呼吸暂停和发作性睡病的算法的验证
Pub Date : 2025-07-20 DOI: 10.1016/j.sleepe.2025.100110
Helen Strongman , Sofia H. Eriksson , Kwabena Asare , Michelle A. Miller , Martina Sýkorová , Hema Mistry , Kristin Veighey , Charlotte Warren-Gash , Krishnan Bhaskaran

Purpose

To assist sleep epidemiology research, we created and tested the accuracy of five algorithms identifying diagnosed Obstructive Sleep Apnoea (OSA) and narcolepsy in routinely collected data from England (01/01/1998–29/03/2021).

Methods

The primary algorithm identified the first coded record in Clinical Practice Research Datalink (CPRD) primary care or linked hospital admissions data as an incident diagnosis of OSA (n = 92,222) or narcolepsy (n = 1072). Alternative algorithms required codes in CPRD, both datasets, or an additional proximate possible-sleep-related outpatient visit or excessive daytime sleepiness drug prescription (narcolepsy only). Staff in 73/1574 CPRD practices completed online questionnaires for a convenience sample of 144 OSA and 101 narcolepsy cases. We estimated Positive Predictive Values (PPVs) describing the proportion of cases confirmed by a gold standard hospital specialist diagnosis, the percentage of gold standard cases from the primary algorithm retained with alternative algorithms, and time between specialist and recorded diagnosis dates.

Results

Using the primary algorithm, the PPV (95 % CI) was 75.3 % (69.2–81.3) and 65.2 % (57.0–73.4) for OSA and narcolepsy, respectively: 80.6 % and 62.7 % of confirmed cases were recorded within 6 months of the specialist diagnosis. The CPRD-only algorithm increased the PPV to 85.3 (77.3–91.4, OSA) and 71.0 (58.8–81.3, narcolepsy) and retained high proportions of gold standard cases. Requiring additional outpatient or prescribing data increased PPVs, and for OSA improved diagnostic date accuracy, but omitted a high proportion of gold standard cases.

Conclusion

Highly accurate OSA diagnoses can be identified in routinely collected data. Recorded cases of narcolepsy are moderately accurate, but diagnosis dates are not.
为了协助睡眠流行病学研究,我们在英国(1998年1月1日- 2021年3月29日)的常规数据中创建并测试了五种识别诊断为阻塞性睡眠呼吸暂停(OSA)和发作性睡病的算法的准确性。方法主要算法将临床实践研究数据链(CPRD)初级保健或相关住院数据中的第一条编码记录识别为OSA (n = 92222)或发作性睡病(n = 1072)的偶发诊断。替代算法需要CPRD中的代码,两个数据集,或额外的可能与睡眠相关的门诊就诊或白天过量的嗜睡药物处方(仅限嗜睡症)。73/1574 CPRD诊所的工作人员完成了144例OSA和101例嗜睡症患者的在线问卷调查。我们估计了阳性预测值(Positive Predictive Values, ppv),该值描述了由金标准医院专家诊断确诊的病例比例、由替代算法保留的主要算法的金标准病例百分比,以及专家诊断日期与记录诊断日期之间的时间。结果采用主要算法,OSA和发作性睡病的PPV (95% CI)分别为75.3%(69.2 ~ 81.3)和65.2%(57.0 ~ 73.4),确诊病例在专科诊断后6个月内分别为80.6%和62.7%。仅cprd算法将PPV提高到85.3 (77.3-91.4,OSA)和71.0(58.8-81.3,发作性睡病),并保留了高比例的金标准病例。需要额外的门诊或处方数据增加了ppv,对于OSA提高了诊断日期的准确性,但遗漏了很大比例的金标准病例。结论通过常规采集的资料,可以对OSA进行高度准确的诊断。记录的发作性睡病病例是中等准确的,但诊断日期不是。
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引用次数: 0
A patient-centric benefit-risk assessment of daridorexant for the treatment of insomnia disorder using patient preference data collected in two phase 3 clinical trials 利用两项3期临床试验收集的患者偏好数据,对daridorexant治疗失眠障碍进行以患者为中心的获益-风险评估
Pub Date : 2025-04-23 DOI: 10.1016/j.sleepe.2025.100108
Sebastian Heidenreich , Melissa Ross , Bruno Flamion , Andrea Phillips-Beyer

Study objectives

To conduct a patient-centric benefit-risk assessment of daridorexant vs. placebo for insomnia disorder treatment.

Methods

A quantitative benefit-risk assessment (qBRA) combined patient preference information and clinical data collected in two multicenter placebo-controlled phase 3 trials. The qBRA weighted efficacy and adverse event data collected in the daridorexant and placebo trial arms based on the acceptable benefit-risk trade-offs patients would be willing to make in a discrete choice experiment. The preference-weighted trial arms were used to test the total net benefits of daridorexant 50 mg and daridorexant 25 mg vs. placebo. Sensitivity analyses accounted for uncertainty in both clinical trial and patient preference data.

Results

Preferences of 602 trial participants (68.1 % female, mean age 58.6 years) were used in the qBRA analysis. Both daridorexant 25 mg (net benefit [standard error {SE}] = 0.097 [0.022]) and daridorexant 50 mg (net benefit [SE] = 0.197 [0.025]) had a significantly higher net benefit than placebo (both p < 0.001). Time to fall asleep, daytime functioning, and total time asleep provided added value for daridorexant over placebo and outweighed potential side effects. The sensitivity analyses accounting for differences in both clinical trial and patient preference data indicated that both doses of daridorexant would still be preferred over placebo.

Conclusion

Even when accounting for uncertainty in clinical data and patients’ preferences, both daridorexant 25 mg and 50 mg were likely to have a positive benefit-risk balance from the patient’s perspective.
研究目的:以患者为中心,对达利多耐药与安慰剂治疗失眠症的获益-风险进行评估。方法采用定量获益-风险评估(qBRA),结合患者偏好信息和两项多中心安慰剂对照3期试验的临床数据。qBRA加权的疗效和不良事件数据收集于daridorexant和安慰剂试验组,基于患者在离散选择实验中愿意做出的可接受的收益-风险权衡。偏好加权试验组用于测试daridorexant 50mg和daridorexant 25mg相对于安慰剂的总净收益。敏感性分析解释了临床试验和患者偏好数据的不确定性。结果采用602名受试者(女性68.1%,平均年龄58.6岁)的参考文献进行qBRA分析。daridorexant 25 mg(净收益[标准误差{SE}] = 0.097[0.022])和daridorexant 50 mg(净收益[SE] = 0.197[0.025])的净收益均显著高于安慰剂(p和lt;0.001)。与安慰剂相比,入睡时间、白天功能和总睡眠时间为daridorexant提供了附加价值,并超过了潜在的副作用。考虑到临床试验和患者偏好数据差异的敏感性分析表明,两种剂量的daridorexant仍然比安慰剂更受欢迎。结论:即使考虑到临床数据的不确定性和患者的偏好,从患者的角度来看,25mg和50mg的daridorexant都可能具有积极的利益-风险平衡。
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引用次数: 0
Sleep quality and its correlates among medical undergraduates in Anhui Province: A cross-sectional study on academic stress, mental health, and lifestyle factors 安徽省医学本科生睡眠质量及其相关因素:学业压力、心理健康和生活方式因素的横断面研究
Pub Date : 2025-04-22 DOI: 10.1016/j.sleepe.2025.100109
Miao Li , Xiao-Ying Jin , Han Li , Meng-Dan Chu , Zeng-Feng Su
This study investigates the relationship between sleep quality, study stress, and mental health among medical undergraduates in Anhui Province. Utilizing the Pittsburgh Sleep Quality Index (PSQI) and Depression-Anxiety-Stress Scale-21 (DASS-21), data from 550 students were analyzed. Findings reveal that heavy academic burdens, including high weekly course loads and examination stress, significantly impact sleep quality and mental health. Students attending 45–50 classes/week had a significantly higher PSQI score (5.41 ± 3.25) compared to those with lighter loads (e.g., 30–35 classes: 4.61 ± 2.75, p = 0.050; Table 8). Although no significant association was found between caffeine and alcohol consumption and mental health, lifestyle factors such as exercise frequency and interpersonal relationships showed notable effects. These results underline the need for targeted interventions, including stress management programs and healthy lifestyle promotion, to enhance student well-being.
本研究旨在探讨安徽省医学本科生睡眠质量、学习压力与心理健康的关系。利用匹兹堡睡眠质量指数(PSQI)和抑郁-焦虑-压力量表-21 (DASS-21),分析了550名学生的数据。研究结果显示,沉重的学业负担,包括每周高课程负担和考试压力,会显著影响睡眠质量和心理健康。每周上45-50节课的学生PSQI得分(5.41±3.25)显著高于负荷较轻的学生(例如,30-35节课:4.61±2.75,p = 0.050;表8)。虽然咖啡因和酒精摄入与心理健康之间没有明显的联系,但生活方式因素,如运动频率和人际关系,却有显著的影响。这些结果强调需要有针对性的干预措施,包括压力管理方案和促进健康的生活方式,以提高学生的福祉。
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引用次数: 0
期刊
Sleep epidemiology
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