Sleep, Health, and Society

25 years of Drosophila "Sleep genes"

The field of Drosophila sleep research, which began 25 years ago, has identified more than 200 genes influencing sleep. In this review, I summarize the foundation of the field and the growing list of genes implicated in sleep regulation. I compare the genetic methods used to identify genes governing sleep and circadian rhythms and the distinct outcomes of screens for genes regulating these two highly related processes. Finally, I discuss the ~ 200 sleep-regulating genes of Drosophila in the context of recent developments in the field and voice reasons for scepticism regarding the relevance of these genes to the homoeostatic regulation of sleep. Finally, I speculate on the future promise of the fly model system for revealing conserved molecular mechanisms of sleep homoeostasis.

Consensus Recommendations for Sustainable and Equitable Neonatology Staffing: A Delphi Approach

BACKGROUND AND OBJECTIVE

The specialty of neonatology faces significant and growing challenges related to patient safety, physician well-being, and workforce sustainability that highlight the necessity for innovative work models. Our objective was to develop consensus recommendations to improve neonatologist staffing practices in the United States.

METHODS

We used a modified Delphi process with 32 diverse subject-matter expert stakeholders to reach consensus. We derived 60 initial potential recommendations for improved staffing from the literature and our 2 previous studies of physician leaders. We defined consensus as 80% or higher agreement and strong consensus as 90% or higher agreement. We ultimately eliminated statements that achieved less than 80% consensus from the recommendations.

RESULTS

Fifty-one individual statements reached consensus and were grouped into 24 final recommendations to improve neonatology staffing. Topics of focus included clinical allocations (eg, clinic work is counted in hours/year), shift characteristics (eg, clinical work after 24 hours is minimized), allocation of nonclinical work (eg, nonclinical work is accounted for in full-time equivalent), and staffing flexibility (eg, options to restructure clinical work are provided for specific circumstances such as aging and pregnancy). Significant discussion on many statements focused on ensuring that recommendations were both feasible and not overly prescriptive for individual institutions.

CONCLUSIONS

We reached consensus on a set of neonatologist staffing recommendations that emphasize the critical issues related to patient safety and physician well-being. Future work will focus on advocating for widespread implementation of these recommendations and evaluating their effect on patient safety, physician well-being, and sustainability of the neonatal workforce.

Dietary Protocols to Promote and Improve Restful Sleep: A Narrative Review

Humans spend approximately one third of their life asleep but, as counterintuitive as it may sound, sleep is far from being a quiet state of inactivity. Sleep provides the opportunity to perform numerous biological and physiological functions that are essential to health and wellbeing, including memory consolidation, physical recovery, immunoregulation, and emotional processing. Yet, sleep deprivation, chronic sleep restriction, and various types of sleep disorders are all too common in modern society. Failure to meet the recommended 7-9 hours of restful sleep per night is known to increase the risk of several health conditions, reason why regular and adequate sleep should be seen as a priority instead of an unnecessary commodity easily traded as required by the commitments of our busy lives. While both the quantity and the quality of sleep can be largely improved with relatively straightforward practices dictated by good sleep hygiene, emerging research suggests that dietary and supplementation protocols focused on certain foods, nutrients, and biochemical compounds with sleep-promoting properties can act as subsidiary sleep aids in complementing these behavioral changes. The scope of this narrative review is to summarize the available evidence on the potential benefits of selected nutraceuticals in the context of circadian rhythm and sleep disturbances, namely melatonin, magnesium, omega-3 fatty acids, tart cherry juice, kiwifruit, apigenin, valerian root, L-theanine, glycine, ashwagandha, myoinositol, Rhodiola rosea, and phosphatidylserine. A comprehensive recapitulation of the relevant literature is provided, alongside corresponding evidence-based nutritional protocols to promote and improve restful sleep.

The Role of Sleep and the Effects of Sleep Loss on Cognitive, Affective, and Behavioral Processes

Sleep is essential for various cognitive, affective, and behavioral processes, including attention, memory, executive function, emotional regulation, and interpersonal interactions. Sleep disruptions undermine these functions, resulting in measurable impairments in daily activities, occupational performance, and public safety. Adequate sleep supports sustained vigilance and concentration, whereas sleep deprivation is associated with attentional lapses, diminished cognitive control, and impaired sensory processing. Memory consolidation, which depends on both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, is particularly susceptible to disruption by sleep loss. Executive functions, such as working memory, impulse control, and decision-making, are notably impaired due to the prefrontal cortex's heightened sensitivity to insufficient sleep. Sleep deprivation increases amygdala reactivity, weakens prefrontal-amygdala connectivity, and contributes to emotional dysregulation, impulsivity, and risk-taking behaviors. Chronic sleep deprivation exacerbates cognitive deficits, emotional instability, and motor performance decline, leading to higher error rates and reduced workplace productivity. Given its widespread consequences, chronic sleep deprivation constitutes a significant public health concern. This narrative review synthesizes contemporary research on the effects of sleep and sleep loss on waking behavior, with a focus on attention, memory, executive function, emotional regulation, and daytime performance.

Sleep and the Mediterranean diet: A systematic review and meta-analysis

We conducted the current systematic review and meta-analysis to critically review and synthesize available evidence regarding the association between sleep duration, sleep quality, and chronotype with the Mediterranean diet (MedDiet) among the general population using observational studies. Online databases, including PubMed, Scopus, and ISI Web of Science, were searched from the earliest available date until December 2024. We enrolled 62 studies with a total sample size of 328,493. The mean age and BMI of the participants in the enrolled studies ranged from 6.1 to 74.7 years and 18.1-32.1 kg/m2. Individuals with sufficient sleep duration (OR: 1.39; 95 % CI, 1.04, 1.85; P = 0.030; I2 = 97.89 %, PQ-test < 0.001), good-quality sleep (OR: 1.38; 95 % CI, 1.10, 1.73; P < 0.001; I2 = 93.83 %, PQ-test < 0.001), and earlier chronotype (OR: 1.74; 95 % CI, 1.21, 2.50; P = 0.002; I2 = 89.72 %, PQ-test < 0.001) had significantly increased odds of high MedDiet scores, compared to those with insufficient sleep duration, poor-quality sleep, and later chronotype, respectively. Our study revealed that sleep duration, sleep quality, and chronotype are lifestyle-related factors linked to MedDiet. However, more longitudinal studies and clinical trials are needed to investigate causality, mediating factors, and underlying mechanisms.

Relationship between the presence of meaning in life and sleep quality: A moderated chain-mediation model

Sleep is a vital component of health; however, sleep issues are particularly prominent among college students. Identifying protective factors for sleep among college students is of paramount importance. To investigate the mechanisms behind the association between the presence of meaning in life (PML) and sleep quality, we conducted two questionnaire surveys (separated by an interval of 6 months) with 5660 college students to collect longitudinal data. The results show that PML predicted sleep quality and that this relationship was influenced by the mediating effect of depression and the chain mediating effect of coping style and depression; further, the search for meaning in life played a moderating role in the chain mediation model. This study offers new theoretical perspectives on the protective factors of sleep quality and provides empirical insights useful for improving sleep health among college students.

Decades of Night-Shift Work Induce Diurnal Disruption and Corneal Adaptations: Evidence from Pentacam Analysis

We aimed to determine the effects of night-shift work on corneal parameters in thirty-five healthy individuals (24-59 years) in a retrospective cohort study. Among them, 12 hospital nurses regularly worked two shifts, spending a third of their nights awake, whereas 23 age-matched controls never worked shifts and slept regularly. Measurements were performed at least five times within 12 h. We analyzed the keratometric parameters of the corneal front (F) and back (B) surfaces, including the refractive power in the flattest and steepest axes (K1, K2), astigmatism (Astig); and corneal pachymetry (Pachy) at the thinnest corneal point and pupil center, volume relative to the 10 mm corneal diagonal (Vol D10); and surface variance index (ISV). A multilevel mixed-effects linear regression adjusted for age was applied to 905 measurements. All parameters exhibited significant periodic fluctuations (p ≤ 0.005). The two groups also showed significantly different periodic fluctuations (p ≤ 0.008), except in K1B and AstigB. K1/K2 (F and B), AstigF, Pachy, and ISV differed significantly (p < 0.0001). Surprisingly, prolonged night shift work did not increase the ISV, and no evidence of age-related corneal thinning was observed. Long-term night-shift exposures change various corneal parameters, reflecting both concomitant and adaptive effects. This study highlights the impact of consistent sleep deprivation on corneal properties, warranting further research into understanding the long-term effects of night-shift work.

Use of the biopsychosocial model of functioning in physiotherapeutic evaluation of patients with obstructive sleep apnea: a survey-based study

PURPOSE

Our study aimed to analyze the use of the biopsychosocial model of functioning in the physiotherapeutic evaluation of patients with obstructive sleep apnea in Brazil.

METHODS

Physiotherapists working with sleep-related breathing disorders were included. They completed an electronic questionnaire with items related to physiotherapeutic evaluations and sociodemographic characteristics. Data were reported in descriptive statistics, and the Wilcoxon test compared the codes of the International Classification of Functioning, Disability, and Health (ICF) included in the evaluation and therapeutic objectives.

RESULTS

The sample (n = 72) had a mean age of 41.4 ± 8.3 years, and most (n = 40) worked in the Southeast region. About 43.1% of the physiotherapists held sleep therapy certifications, 87.5% worked in clinical care, and most (62.5%) only with sleep disorders. Regarding the evaluation of sleep functions, 98.6% of the physiotherapists evaluated excessive sleepiness, and sleep quality was investigated using subjective questioning (80.3%). The components considered very relevant for evaluation were activity (73.6%), followed by body functions (72.2%), environmental factors (70.8%), body structure (65.3%), and participation (63.9%). Some components were evaluated but were not often included among the therapeutic objectives, such as recreational activity (p = 0.016) and intimate relationships (p = 0.035).

CONCLUSIONS

Physiotherapists reported collecting information on all functioning components; most were activity and body function components. However, standardized evaluation tools for investigating functioning are not often applied.

Lifestyle and Job-Related Factors Associated with Sleep Quality: Gender-Specific Insights from Taiwanese Hospital Physicians

Background

Poor sleep in physicians is a major concern, affecting their physical and psychological well-being and increasing the risk of medical errors. In this cross-sectional study, we explored gender-specific differences in factors associated with sleep quality in physicians.

Participants and Methods

Self-report questionnaires were distributed to 401 hospital physicians in Taiwan. Statistical analyses-Student's t test, Pearson's correlation test, and multivariate linear regression-were conducted to identify factors associated with sleep quality. Subgroup analyses were also conducted to analyze gender-specific differences in sleep quality and its related factors.

Results

Of a total of 189 physicians, approximately 40% reported poor sleep quality, with no significant gender-specific differences. Multivariate analysis revealed that unhealthy dietary habits (β = 0.39, p = 0.02) and a lack of regular exercise (β = -0.52, p = 0.04) were significantly associated with poor sleep quality in the female physicians. By contrast, higher job demands were significantly associated with poorer sleep quality in the male physicians (β = 0.16, p = 0.03).

Conclusion

In physicians, sleep quality is influenced by gender-specific factors. To enhance sleep quality, male physicians should focus on reducing their workload, and female physicians should prioritize improving their dietary and exercise habits. To achieve these goals, we recommend implementing gender-sensitive strategies involving flexible scheduling and workload management to reduce job demands for male physicians. We also recommend providing on-site healthy meal options and establishing exercise facilities to promote healthier lifestyle habits for female physicians. In addition, we recommend developing sleep hygiene education and mentorship programs to support work-life balance and aid stress management tailored to gender-specific needs. These strategies could help enhance the sleep quality of physicians, potentially improving their well-being and patient care quality.

A U-shaped relationship between sleep duration and tinnitus incidence: analysis of 13,871 participants from NHANES

Sleep duration is associated to various health impairments, while its comprehensive association with tinnitus is rarely investigated. The current study aimed to explore the relationship between sleep duration and tinnitus incidence, and to determine the optimal sleep duration relating to the lowest tinnitus risk. Data of participants from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2012 and 2015 to 2018 were retrieved. A total of 13,871 participants were eligible and included in the analysis. Generally, sleep duration was lower in participants with tinnitus compared to those without (7.15±1.76 vs 7.30±1.51 h, P<0.001). After adjustment by demographics, lifestyle, and chronic diseases, a U-shaped relationship between sleep duration and tinnitus incidence was observed, with the inflection point at 8.5 h. Interestingly, in participants with sleep duration <8.5 h, sleep duration exhibited an independent negative correlation with tinnitus risk [OR=0.88 (95%CI: 0.84-0.93), P<0.001], while in participants with sleep duration ≥8.5 h, sleep duration had an independent positive association with tinnitus risk [OR=1.16 (95%CI: 1.04-1.28), P=0.006]. In conclusion, a U-shaped relationship was found between sleep duration and tinnitus incidence, with a sleep duration of about 8.5 h being associated with the lowest tinnitus risk.

Sleep Across the Lifespan: A Neurobehavioral Perspective

Purpose of Review

Sleep is dynamic across the lifespan, influenced by brain maturation, neurophysiology, hormones, and cognitive processes. Sleep behaviors influenced by physiological and external factors can also impact sleep health. As sleep plays a mechanistic role in health across the lifespan, understanding when and how to intervene to benefit health is essential.

Recent Findings

Recent research has advanced our understanding of sleep across three domains: patterns, neurophysiology, and behaviors. Highlights include (1) Early childhood nap cessation is thought to relate to medial temporal lobe network maturation and underlie long-term hippocampal-dependent memory development. (2) Chronotype misalignment is a key factor in sleep deficits and social jetlag. (3) Older adult daytime sleep has complex effects on health, at times beneficial while others, potentially maladaptive. (4) Longitudinal sleep oscillation trajectories are starting to be investigated and indicate neurophysiology could be interpreted as indicative of brain maturation in development. (5) In adults, sleep quality and macrostructure trajectories show high variability, emphasizing distinctive traits in shaping sleep and its lifespan trajectories. (6) Neighborhood and socioeconomic factors influence sleep health across all ages. (7) In older adults, associations between loneliness and poor sleep are being unpacked.

Summary

This recent research, while comprehensively describing our current understanding of sleep trajectories across the lifespan, emphasizes the need to expand current approaches to longitudinal measurement studies that cross age-spans. Expanding will enhance our ability to mechanistically determine the temporal and causal relations between the multiple dimensions of sleep (i.e., patterns, behaviors, and physiology) and outcomes in sleep health.

Melatonin Pattern: A New Method for Machine Learning-Based Classification of Sleep Deprivation

Background: Pattern recognition and machine learning-based classification approaches are frequently used, especially in the health field. In this research, a new feature extraction model inspired by the melatonin hormone (sleep hormone) and named MelPat (melatonin pattern) has been developed. The developed model has been tested on an open access dataset. Materials and Methods: An open access sleep deprivation electroencephalography (EEG) dataset was tested to evaluate the MelPat method. There are two classes in the dataset. These are (a) sleep deprivation (SD) and (b) healthy control (HC) groups, respectively. In this study, EEG signals were divided into 15 s segments, thus obtaining 1377 SD and 1378 HC samples. In the next phase of the research, a new feature extraction model was proposed, and this model was named MelPat as it was inspired by the melatonin hormone. Additionally, the feature vector was expanded using the statistical moment approach. In the signal decomposition phase of the model, the Tunable Q-Wavelet Transform (TQWT) method was used. Thus, the signal was decomposed into sub-bands, and feature extraction was applied to each band. Neighborhood Component Analysis (NCA) and Chi2 methods were used together to reduce the dimension of the feature vector and select the most significant features. In this phase, the most significant features from both feature selection algorithms were combined, and the final feature vector was obtained. In the classification phase of the model, the Support Vector Machine (SVM) algorithm, which is a shallow classifier, was used. The dataset used in the research has 61 channels. Therefore, after obtaining channel-based results, the iterative majority voting (IMV) algorithm was applied to achieve higher classification performance and generalize the results, and the most accurate results were automatically selected. Results: With the proposed MelPat algorithm, a high classification success of 97.71% was achieved on the open access sleep deprivation dataset. Conclusions: The obtained results show that the MelPat-based new classification approach is highly effective on the dataset collected for SD detection. Moreover, the fact that the proposed method is inspired by the melatonin chemical, which is the sleep hormone, makes the method attractive and ironic.

Personality and Sleep Psychopathology: Associations Between the DSM-5 Maladaptive Trait Domains and Multiple Sleep Problems in an Adult Population

Given the lack of sufficient studies exploring the nature of sleep problems from the perspective of the alternative model of personality disorders (AMPD) proposed by the DSM-5, the present study is aimed at determining the associations between five trait domains such as negative affectivity and sleep problems (insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorder, restless legs syndrome, and sleep-disordered breathing) in an adult population. Adults aged 18-65 from western Iran were invited to the study via virtual platforms (N = 928; 62% female) and responded online to the Brief Form of Personality Inventory for DSM-5 and the Holland Sleep Disorder Questionnaire to assess sleep problems. The regression analyses indicated that the AMPD trait domains could significantly predict both specific sleep problems (R2 ranges from 0.13 to 0.17; all p ≤ 0.001) and total score of sleep problems (R2 = 0.23; p < 0.001). Psychoticism (β ranges from 0.26 to 0.39; all p < 0.001) and negative affectivity (β ranges from 0.14 to 0.29; all p ≤ 0.002) were the strongest specific domains associated with all sleep problems. The findings highlighted links between maladaptive domains of the AMPD and multiple sleep problems. The unique profiles of each sleep problem are useful in selecting treatments tailored to specific sleep problems in adults.

Functional Connectivity Alterations Associated with COVID-19-Related Sleep Problems: A Longitudinal Resting-State fMRI Study

Background

COVID-19 has led to reports of fatigue and sleep problems. Brain function changes underlying sleep problems (SP) post-COVID-19 are unclear.

Purpose

This study investigated SP-related brain functional connectivity (FC) alterations.

Patients and methods

Fifty-five COVID-19 survivors with SP (COVID_SP) and 33 without SP (COVID_NSP), matched for demographics, completed PSQI and underwent rs-fMRI at baseline and 2-month follow-up. Correlations between FC and clinical data were analyzed by Pearson correlation analysis with Gaussian random field (GRF) correction. The repeated-measures analysis of variance (R-M ANOVA) was completed to explore the interaction with time.

Results

At baseline, COVID_SP exhibited elevated FC: right precentral gyrus (PrG) with left lateral occipital cortex (LOcC)/right PrG, left inferior parietal lobule (IPL) with right superior frontal gyrus (SFG), left hippocampus with right inferior frontal gyrus (IFG). Higher FC between left hippocampus and right SFG correlated with PSQI scores. At 2-month follow-up, decreased FC implicated in emotion regulation, executive function, and memory; increased FC in semantics, attention, and auditory-visual processing. The changes in these regions are correlated with the scores of PSQI, GAD, and PHQ. The Repeated-Measures Analysis of Variance (R-M ANOVA) revealed a significant time interaction effect between sleep and various emotion scales. Moreover, the analysis of the functional connectivity between the right PrG and the right PrG as well as that between the left IPL and the right SFG also discovered a significant time interaction effect.

Conclusion

This study provides insight into the changes in brain function associated with SP after COVID-19. These changes may partially explain the development of SP, and they also changed over time.

Characteristics of sleep disturbance across two waves of the COVID-19 pandemic among nursing staffs

Objectives

COVID-19 has impacted human lifestyles, including sleep quality. For nursing staff, sleep disorders not only impact their health and daily lives but also have implications for patient safety. The objective of this study is to explore the impact of the COVID-19 pandemic on the psychological and social aspects of nursing staff and the factors influencing their sleep quality through a two-wave survey.

Methods

Nursing staff from a psychiatric hospital in southern Taiwan were recruited in two waves during the COVID-19 epidemic. The level of sleep disturbance and related variables, such as Lo's Healthy and Happy Lifestyle Scale (LHHLS) and Societal Influences Survey Questionnaire (SISQ), were collected through self-report questionnaires. Factors related to the level of sleep disturbance were examined using univariate linear regression and multilevel linear regression.

Results

508 nursing staff members were included in the study, with 254 members in each wave. A significant difference was found between the two waves in the positive thinking of LHHLS and all subscales of SISQ. During the second wave, sleep disturbances were mainly related to self-efficacy, positive thinking, social anxiety, and social desirability. At the fourth wave, sleep disturbances were mainly related to self-efficacy, positive thinking, and social anxiety. However, these effects change when the trend of the epidemic shifts, and other factors are taken into account.

Conclusions

This study analyzed the factors related to the sleep quality of nursing staff during the COVID-19 pandemic. We preliminarily explored the impact of the COVID-19 pandemic on the sleep quality of nursing staff. However, determining whether the end of the epidemic has reduced the impact on nursing staff requires further research.

Association of the Korean Healthy Eating Index and sleep duration with prediabetes in middle-aged adults

BACKGROUND/OBJECTIVES

Sleep duration and diet quality are reportedly associated with the risk of diabetes. This study aimed to examine the risk of diabetes according to sleep duration and diet quality in middle-aged Koreans.

SUBJECTS/METHODS

Using the Korea National Health and Nutrition Examination Survey 2019-2020, raw data from 2,934 participants aged 40-64 yrs (1,090 men and 1,844 women) who were not diagnosed with type 2 diabetes were analyzed. With a sleep duration of 7-7.9 h per night as the referent category, diet quality was assessed using the Korean Healthy Eating Index (KHEI), which comprises adequacy, moderation, and energy balance.

RESULTS

The study results showed that individuals with a short sleep duration had significantly higher blood glucose (P = 0.034) and HbA1c levels (P < 0.001) than those had by individuals with a sleep duration of 7-7.9 h. Within the group with a sleep duration of 7-7.9 h, the lowest quintile of the KHEI score had a significantly higher risk of prediabetes than that had by the highest quintile of the KHEI score (Model 1: odds ratio [OR], 1.775; 95% confidence interval [CI], 1.072-2.939; P < 0.05 and Model 2: OR, 1.731; 95% CI, 1.040-2.882; P < 0.05).

CONCLUSION

Our findings suggest that achieving the sleep duration of 7-7.9 h and eating good diet are associated with the lowest risk of prediabetes. We recommend that the results of this study be used to educate adults aged 40-64 yrs on diet and lifestyle habits to prevent diabetes.

Sleep quality assessment of adults in care settings using non-wearable sleep trackers: Scoping review

AIMS

This review aimed to explore and map the literature on sleep quality assessments of adults in care settings using non-wearable sleep trackers.

BACKGROUND

Sleep-monitoring technology is advancing, and sleep quality assessments using non-wearable sleep trackers can provide objective evidence for quality care.

DESIGN

This was a scoping review.

DATA SOURCES

Four electronic databases (PubMed, CINAHL, PsycInfo and Embase) were searched on 23 September 2022.

REVIEW METHODS

This review followed the Joanna Briggs Institute's methodology and used the PRISMA-ScR checklist.

RESULTS

Thirty studies met our inclusion criteria. Sleep quality was assessed at home and in acute, non-acute and long-term care facilities. Physiological (heart rate and respiratory rate) and sleep parameters were assessed alone or in combination during patient care using non-wearable sleep trackers. Sleep parameters representing sleep quality varied across studies. Real-time monitoring with non-wearable sleep-tracking devices effectively shortened the length of hospital stay. However, studies investigating caregivers and nursing outcomes are lacking in the literature.

CONCLUSION

Sleep quality assessments using non-wearable sleep trackers may facilitate the provision of quality care in home-based and clinical care settings. Future studies should focus on caregivers and care outcomes that could contribute to evidence-based nursing practice for sleep care in adults.

OSA diagnosis goes wearable: are the latest devices ready to shine?

STUDY OBJECTIVES

From 2019-2023, the United States Food and Drug Administration has cleared 9 novel obstructive sleep apnea-detecting wearables for home sleep apnea testing, with many now commercially available for sleep clinicians to integrate into their clinical practices. To help clinicians comprehend these devices and their functionalities, we meticulously reviewed their operating mechanisms, sensors, algorithms, data output, and related performance evaluation literature.

METHODS

We collected information from PubMed, United States Food and Drug Administration clearance documents, ClinicalTrials.gov, and web sources, with direct industry input whenever feasible.

RESULTS

In this "device-centered" review, we broadly categorized these wearables into 2 main groups: those that primarily harness photoplethysmography data and those that do not. The former include the peripheral arterial tonometry-based devices. The latter was further broken down into 2 key subgroups: acoustic-based and respiratory effort-based devices. We provided a performance evaluation literature review and objectively compared device-derived metrics and specifications pertinent to sleep clinicians. Detailed demographics of study populations, exclusion criteria, and pivotal statistical analyses of the key validation studies are summarized.

CONCLUSIONS

In the foreseeable future, these novel obstructive sleep apnea-detecting wearables may emerge as primary diagnostic tools for patients at risk for moderate-to-severe obstructive sleep apnea without significant comorbidities. While more devices are anticipated to join this category, there remains a critical need for cross-device comparison studies as well as independent performance evaluation and outcome research in diverse populations. Now is the moment for sleep clinicians to immerse themselves in understanding these emerging tools to ensure our patient-centered care is improved through the appropriate implementation and utilization of these novel sleep technologies.

CITATION

Chiang AA, Jerkins E, Holfinger S, et al. OSA diagnosis goes wearable: are the latest devices ready to shine? J Clin Sleep Med. 2024;20(11):1823-1838.

Assessing the relationship between mental workload and work fatigue among oil and gas workers in PT X, Jambi Province, Indonesia: PLS-SEM analysis

Occupational fatigue among oil and gas workers can have perilous consequences related to safety, health, economy, and wellbeing. This makes it necessary to discover major factors related to fatigue and implement appropriate prevention programs and education. Therefore, this study aimed to investigate the relationship between mental workload, sleep quality, and occupational fatigue in oil and gas office workers in Jambi Province, Indonesia. Mental workload, sleep quality, and occupational fatigue were measured using the NASA-TLX, PSQI, and the Indonesian Questionnaire Measuring Feelings of Work Fatigue (KAUPK2), respectively. A PLS-SEM approach was used to determine the association between mental workload, sleep quality, and occupational fatigue. Out of the 116 oil and gas workers in Jambi Province who participated in this study, 58.6% were male, 54.3% had Senior High School or less, 85.3% were not smoking, and 88.8% were married, working experience from 0.17 to 34 years. The mean of body height, weight, and mass index were 165.35 cm, 64.65 kg, and 23.64 respectively. The PLS-SEM model illustrated that the direct effect of mental workload on occupational fatigue was not significant. Meanwhile, the mental workload had a significant effect on sleep quality, which significantly affected fatigue. This indicated that the effect of workload on fatigue was fully mediated by sleep quality. The impact of good sleep on an employee's ability to recover from increased mental workload was substantial. According to this study, introducing mental workload coping methods, routine measurement, and sleep hygiene programs among oil and gas workers can reduce occupational fatigue.

Influence of race and age in sleep duration and mortality relationship among adults in the United States: results from the 2004 NHIS-NDI record linkage study

Limited information exists on age and racial disparities in sleep duration and mortality in the United States (US) population. This study compared the association between mortality and sleep duration within distinct races and age groups in the US. This study used data on 26,915 US citizens (≥ 18 years) from the 2004 wave of the National Health Interview Survey, linked to the National Death Index prospective mortality through 2019. Cox proportional hazard models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality by sleep duration, race (Whites, Black/African Americans, and Others (AIAN, Asian, and Native Hawaiian or other Pacific Islander)), and age (< 40, 40-60, and ≥ 60 years), while controlling for covariates such as sex, education, smoking status, disease history, and other vital factors. Race and age significantly modified the sleep duration-mortality relationship. Compared to other races, White participants exhibited higher mortality risks at all hours except at 5-6 h [HR: 0.993, 95% CI: 0.923-1.069]. Likewise, sleep duration associated mortality risks varied by age. Those at greater risk included < 40 years sleeping for 1-4 h [HR: 2.461, 95% CI: 1.446-4.187], 40-< 60 years sleeping for less than 7 h and more than 8 h, and ≥ 60 years sleeping for 9 h [HR: 1.309, 95% CI: 1.162-1.475] and ≥ 10 h [HR: 1.662, 95% CI: 1.486-1.858]. Age and race were significant effect modifiers in the sleep duration-mortality relationship. Thus, it is important to consider these factors when evaluating mortality risks associated with sleep patterns.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-024-00536-x.

Erectile dysfunction and sleep related bruxism: An exploratory review of an improbable association

The World Health Organization recognizes sexual health as not merely the absence of disease, but a state of physical, mental, and social well-being in relation to one's sexuality. Achieving sexual satisfaction is pivotal for many individuals, as it significantly contributes to their quality of life. Among various sexual disorders, erectile dysfunction (ED) is notably prevalent, affecting an estimated 10-20 million men in the United States alone. This condition impacts not just the person experiencing it but also significantly influences their intimate connections with partners. Although the causes of ED are multifactorial, recent research highlights a compelling association between sleep disorders, such as sleep deprivation, obstructive sleep apnea (OSA), and insomnia, and the incidence of ED. Furthermore, engaging in night work has been observed to exacerbate the risk of developing ED. One common sleep disorder, sleep related bruxism (SRB), despite its prevalence, has not generally been associated with ED. However, there is some interesting evidence hinting at a potential relationship, including a few studies reporting a high prevalence of ED in individuals with SRB. This review delves into the epidemiological, etiological, and mechanistic links between ED and SRB, aiming to uncover potential intersections between these two conditions. These insights could pave the way for innovative research avenues, possibly exploring treatments like vasodilation medication, that might concurrently address both ED and SRB.

Prevalence and risk factors of sleep disorders in inflammatory bowel disease: a cross-sectional study

BACKGROUND

Sleep disorders are one of the major public health problems, which can potentially induce inflammation and exacerbate disease activity, resulting in compromised sleep quality. This study aimed to investigate the prevalence and risk factors associated with sleep disorders among patients with inflammatory bowel disease (IBD).

METHODS

Between March 2023 and February 2024, the Pittsburgh Sleep Quality Index was employed to assess sleep quality in both IBD patients and healthy control subjects. Univariate and multivariate analysis were performed to identify the risk factors associated with SD in IBD patients.

RESULTS

Overall, 208 IBD patients [150 Crohn's disease (CD) and 58 ulcerative colitis (UC)] and 199 healthy individuals were included. Sleep disorders were observed in 59.6% of patients with IBD, with a higher prevalence among females (63.5%) compared to males (56.9%) (P = 0.476). The prevalence of sleep disorders in IBD patients was significantly higher than that found in healthy controls (37.7%) (all P < 0.01). The prevalence of sleep disorders  among CD and UC patients was 58% and 63.8%, respectively (P = 0.291). The multivariate analysis revealed that older age (OR, 1.070; 95% CI: 1.035-1.105, P = 0.000), smoking (OR, 2.698; 95% CI: 1.089-6.685, P = 0.032), and depression (OR, 4.779; 95% CI: 1.915-11.928, P = 0.001) were risk factors for sleep disorders in IBD patients. However, higher body mass index (OR, 0.879; 95% CI: 0.790-0.977, P = 0.017) was identified as a protective factor.

CONCLUSION

Sleep disorders are common among IBD patients regardless of activity levels. Smoking and depression are the major risk factors.

The effects of time-restricted eating on sleep in adults: a systematic review of randomized controlled trials

Introduction

Time-restricted eating (TRE), a dietary pattern reducing the duration of daily food consumption, has recently gained popularity. Existing studies show the potential benefits of TRE for cardiometabolic health. Uncertainty remains about whether these benefits are solely from altered meal timing or influences on other health behaviors, including sleep. Despite growing scientific interest in the effects of TRE on sleep parameters, the topic has not been systematically explored.

Methods

This review examined the effects of TRE interventions (daily fasting duration ≥14 h) lasting at least 8 weeks on objective and subjective sleep parameters. Six randomized control trials were identified through Pubmed, Embase, Google Scholar, and Scopus through September 2023.

Results

Of the included studies, three employed objective sleep measures using wearables and five studies assessed sleep subjectively through self-report questionnaires. Only one study reported significant improvements in subjective sleep quality following a TRE intervention. Additionally, one study found significant decreases in sleep duration, two studies found significant decreases in sleep efficiency, and one found significant increases in sleep onset latency.

Discussion

Current evidence indicates that short to mid-term TRE does not typically worsen sleep parameters. However, some populations may experience reduced sleep disturbances, while others may experience reductions in sleep efficiency. Longer duration studies with objective sleep assessments are needed to better understand the effects of TRE on sleep parameters.

Revitalizing your sleep: the impact of daytime physical activity and balneotherapy during a spa stay

Background

In modern society, achieving high-quality sleep is increasingly challenging. We conducted a study to explore the potential benefits of daytime physical activity and balneotherapy, including mud application and thermal-water bathing, on sleep quality.

Methods

To assess daytime physical activity and sleep parameters, we actigraphically monitored 127 healthy participants (34.6% male, average age 64.61 ± 0.89 years) during a one-week stay at a spa resort, where they received mud application and thermal-water bathings.

Results

Participants were divided into three groups based on the timing of mud application. Those receiving mud application before 8:30 a.m. tended to have shorter sleep durations compared to those with later application, especially if it occurred before 7:45 a.m. However, mud application did not significantly affect sleep quality. Three-way ANCOVA revealed a significant effect of daytime physical activity on delta Sleep Efficiency, but post-hoc tests were insignificant. Furthermore, analyzing the duration of daily thermal-water bathings, individuals bathing for over 75 min per day experienced a noteworthy improvement in sleep quality, particularly in terms of delta Sleep Efficiency (2.15 ± 0.9% vs. -0.34 ± 0.31%, p = 0.007).

Conclusion

Our findings suggest that extended thermal-water bathing may enhance objective aspects of sleep quality. Since balneotherapy is mainly prescribed for individuals with musculoskeletal pathologies or psychological disorders, these findings may encourage doctors to recommend bathing in thermal water also to healthy subjects. Future researchers need to investigate the role of daytime physical activity in depth.

Determinants of Perceived Comfort: Multi-Dimensional Thinking in Smart Bedding Design

Sleep quality is an important issue of public concern. This study, combined with sensor application, aims to explore the determinants of perceived comfort when using smart bedding to provide empirical evidence for improving sleep quality. This study was conducted in a standard sleep laboratory in Quanzhou, China, from March to April of 2023. Perceived comfort was evaluated using the Subjective Lying Comfort Evaluation on a seven-point rating scale, and body pressure distribution was measured using a pressure sensor. Correlation analysis was employed to analyze the relationship between perceived comfort and body pressure, and multiple linear regression was used to identify the factors of perceived comfort. The results showed that body pressure was partially correlated with perceived comfort, and sleep posture significantly influenced perceived comfort. In addition, height, weight, and body mass index are common factors that influence comfort. The findings highlight the importance of optimizing the angular range of boards based on their comfort performance to adjust sleeping posture and equalize pressure distribution. Future research should consider aspects related to the special needs of different populations (such as height and weight), as well as whether users are elderly and whether they have particular diseases. The design optimization of the bed board division and mattress softness, based on traditional smart bedding, can improve comfort and its effectiveness in reducing health risks and enhancing health status.

Sleep deprivation induces corneal endothelial dysfunction by downregulating Bmal1

BACKGROUND

Sleep deprivation (SD) is a common public health problem that contributes to various physiological disorders and increases the risk of ocular diseases. However, whether sleep loss can damage corneal endothelial function remains unclear. This study aimed to determine the effect and possible mechanism of SD on the corneal endothelium.

METHODS

Male C57BL/6J mice were subjected to establish SD models. After 10 days, quantitative RT-PCR (qRT-PCR) and western blot or immunostaining for the expression levels of zonula occludens-1 (ZO-1), ATPase Na+/K + transporting subunit alpha 1 (Atp1a1), and core clock genes in the corneal endothelium were evaluated. Reactive oxygen species staining and mitochondrial abundance characterized the mitochondrial function. The regulatory role of Bmal1 was confirmed by specifically knocking down or overexpressing basic helix-loop-helix ARNT like 1 protein (Bmal1) in vivo. In vitro, a mitochondrial stress test was conducted on cultured human corneal endothelial cells upon Bmal1 knockdown.

RESULTS

SD damaged the barrier and pump functions of mouse corneal endothelium, accompanied by mitochondrial dysfunction. Interestingly, SD dramatically downregulated the core clock gene Bmal1 expression level. Bmal1 knockdown disrupted corneal endothelial function, while overexpression of Bmal1 ameliorated the dysfunction induced by SD. Mitochondrial bioenergetic deficiency mediated by Bmal1 was an underlying mechanism for SD induced corneal endothelial dysfunction.

CONCLUSION

The downregulation of Bmal1 expression caused by SD led to corneal endothelial dysfunction via impairing mitochondrial bioenergetics. Our findings offered insight into how SD impairs the physiological function of the corneal endothelium and expanded the understanding of sleep loss leading to ocular diseases.

Tracked and self-reported nighttime smartphone use, general health, and healthcare utilization: results from the SmartSleep Study

STUDY OBJECTIVES

Nighttime smartphone use is an increasing public health concern. We investigated whether nighttime smartphone use is associated with general health and primary healthcare utilization.

METHODS

Four thousand five hundred and twenty individuals (age 35.6 ± 9.7 years, 35% male) provided self-reported information on smartphone use frequency, symptoms of depression, and general health (one-item perceived health and cross-symptom composite score). A subset of the study sample (n = 3221) tracked their nighttime smartphone use. Primary healthcare utilization, i.e. the number of weeks in which at least one service from the patient's general practitioner (GP) was billed in 2020, was extracted from Danish population registries. Statistical analysis comprised logistic and multiple linear regression, controlling for sociodemographics.

RESULTS

Three hundred and nineteen individuals (7%) reported using their smartphone almost every night or more. More frequent self-reported nighttime smartphone use was associated with poor general health across all measures. Using the smartphone almost every night or more was associated with 2.8 [95% CI: 1.9, 4.1] fold higher odds of reporting poor health and with an average of 1.4 [95% CI: 0.7, 2.1] additional GP utilizations per year compared to no use. Associations were also found for the cross-symptom composite score across all symptoms. Further adjustment for symptoms of depression attenuated some associations. Smartphone use towards the end of the sleep period (sleep-offset use) was associated with poorer self-reported general health, but not with healthcare utilization.

CONCLUSIONS

Nighttime smartphone use frequency is associated with poor general health and healthcare utilization. Further studies should investigate the underlying causal structure and nighttime smartphone use as a transdiagnostic intervention target.

The Impact of Sleep: From Ancient Rituals to Modern Challenges

Although sleep is crucial for mental and physical health, insufficient sleep is a growing problem in our modern society. In general, adults need approximately eight hours of sleep per night, but this is often unfeasible nowadays. This sleep restriction has been observed, and it has worsened, throughout the past two centuries; therefore, it is more attributed to socioeconomic changes than to biological adaptations. The most important factors to contribute to this sleep restriction were the popularization of artificial light and industrialization. The present manuscript briefly overviews, from a socioanthropological perspective, the reasons why sleep has been impacted, disclosing its effects on individuals and on society.

Examining sleep characteristics in Canada through a diversity and equity lens

OBJECTIVE

To examine specific sleep characteristics of adults living in Canada according to sex, gender, ethnoracial background, socioeconomic status, immigration status, sexual orientation, and language spoken at home.

METHODS

This cross-sectional and nationally representative study used self-reported data from the 2021 Canadian Community Health Survey (n = 39,346 adults aged 18 years and older). Sleep characteristics (sleep duration, nighttime insomnia symptoms, unrefreshing sleep, and difficulty staying awake) were assessed and compared across groups.

RESULTS

Females were more likely than males to report nighttime insomnia symptoms (23.1% vs. 14.8%) and unrefreshing sleep (17.2% vs. 13.5%). The same was also observed for gender identity. Although White respondents were more likely to meet sleep duration recommendations (58.3%), they had the highest prevalence of nighttime insomnia symptoms (20.9%) compared to respondents with other ethnoracial backgrounds. Respondents coming from lower socioeconomic backgrounds were more likely to report poorer sleep compared to those coming from higher socioeconomic backgrounds. Insomnia symptoms were lower among immigrants (13.9%) compared to nonimmigrants (21.1%). Respondents with a sexual orientation not classified as heterosexual, gay, or lesbian reported poorer sleep. Finally, for language spoken at home, those who responded "French only" were more likely to meet sleep duration recommendations (64.1%) and were less likely to report unrefreshing sleep (8.8%). Nighttime insomnia symptoms were the lowest among those who reported speaking a language other than French or English at home (9.5%).

CONCLUSION

This study highlights important sleep disparities among Canadians. Future intervention strategies should aim to reduce sleep health disparities.

Objective sleep quality predicts subjective sleep ratings

In both clinical and observational studies, sleep quality is usually assessed by subjective self-report. The literature is mixed about how accurately these self-reports track objectively (e.g. via polysomnography) assessed sleep quality, with frequent reports of little to no association. However, previous research on this question focused on between-subject designs, which may be confounded by trait-level variables. In the current study, we used the novel Budapest Sleep, Experiences and Traits Study (BSETS) dataset to investigate if within-subject differences in subjectively reported sleep quality are related to sleep macrostructure and quantitative EEG variables assessed using a mobile EEG headband. We found clear evidence that self-reported sleep quality in the morning is influenced by within-subject variations in sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency. These effects were replicated if detailed sleep composition metrics (percentage and latency of specific vigilance states) or two alternative measures of subjective sleep quality were used instead. We found no effect of the number of awakenings or relative EEG delta and sigma power. Between-subject effects (relationships between individual mean values of sleep metrics and subjective sleep quality) were also found, highlighting that analyses focusing only on these may be erroneous. Our findings show that while previous investigations of this issue may have been confounded by between-subject effects, objective sleep quality is indeed reflected in subjective sleep ratings.

Urolithin A Prevents Sleep-deprivation-induced Neuroinflammation and Mitochondrial Dysfunction in Young and Aged Mice

Sleep deprivation (SD) has reached epidemic proportions worldwide and negatively affects people of all ages. Cognitive impairment induced by SD involves neuroinflammation and mitochondrial dysfunction, but the underlying mechanisms are largely unknown. Urolithin A (UA) is a natural compound that can reduce neuroinflammation and improve mitochondrial health, but its therapeutic effects in a SD model have not yet been studied. Young (3-months old) and aged (12-months old) mice were sleep deprived for 24 h, and UA (2.5 mg/kg or 10 mg/kg) was injected intraperitoneally for 7 consecutive days before the SD period. Immunofluorescent staining, western blotting, and RT-PCR were employed to evaluate levels of proteins involved in neuroinflammation and mitochondrial function. Transmission electron microscope and Golgi-Cox staining were used to evaluate mitochondrial and neuronal morphology, respectively. Finally, contextual fear conditioning and the Morris water maze test were conducted to assess hippocampal learning and memory. In the hippocampus of young (3 months-old) and aged (12 months-old) mice subjected to 24 h SD, pretreatment with UA prevented the activation of microglia and astrocytes, NF-κB-NLRP3 signaling and IL-1β, IL6, TNF-α cytokine production, thus ameliorating neuroinflammation. Furthermore, UA also attenuated SD-induced mitochondrial dysfunction, normalized autophagy and mitophagy and protected hippocampal neuronal morphology. Finally, UA prevented SD-induced hippocampal memory impairment. Cumulatively, the results show that UA imparts cognitive protection by reducing neuroinflammation and enhancing mitochondrial function in SD mice. This suggests that UA shows promise as a therapeutic for the treatment of SD-induced neurological disorders.

Better characterizing sleep beliefs for personalized sleep health promotion: the French sleep beliefs scale validation study

Background

The Sleep Beliefs Scale (SBS) is a well-known tool to design and monitor personalized sleep health promotion at an individual and population level. The lack of an established French version limits the development of effective interventions targeting these populations. Thus, the aim of this study was to validate the French version of the SBS in a representative sample of the general population.

Methods

Quota sampling was used to recruit 1,004 participants (18-65 years, mean age: 43 years, 54% of female) who underwent an online survey to complete the SBS, and to assess sleep schedules, sleep quality and disorders, and mental health. Cronbach's α coefficient, confirmatory factor analysis, item-internal consistency (IIC), and item discriminant validity (IDV) of the SBS were computed to assess internal validity while bivariate associations with sleep schedules, sleep quality and disorders, and mental health were used to assess external convergent and discriminant validity.

Results

The mean score on the SBS was 12.3 ± 4.9. Item 19 ("Quiet & Dark") showed the highest rate of correct answers (n = 801, 79.8%), while item 20 ("Recovering sleep") showed the lowest rate of correct answers (n = 246, 24.5%). Overall, the SBS showed satisfactory internal consistency (α = 0.87) and confirmed the three-factor structure proposed by the original study. All items were found consistent (IIC > 0.4) and discriminant (IIC > IDV) except for item 20 ("recovering lost sleep by sleeping for a long time"). Females, older participants, and subjects with short time-in-bed, poor sleep quality, insomnia, and circadian rhythm disorder had higher SBS scores while participants with depressive symptoms had lower SBS scores.

Conclusion

We successfully translated and validated the French version of the SBS in a representative sample, making it a reliable instrument for researchers and clinicians to assess and target sleep beliefs. Correct answers vary from 25 to 80% which underlines the importance of continuing sleep health promotion campaigns by targeting poorly understood behaviors. Our findings also shed light on the fickleness of beliefs that are prone to vary within individuals across time, in step with societal changes. Several associated factors were identified, thus contributing to our understanding of sleep beliefs and offering insights for personalized approaches to enhance sleep health and overall well-being.

Fatigue and fallibility: the perils of prolonged shifts for neonatologists

Sleep deprivation is a major challenge for neonatologists, who face increasing demands in the complex healthcare system. Current neonatal intensive care unit (NICU) schedule models often include extended shifts and overnight call, which can lead to sleep deprivation. This lack of sufficient sleep poses adverse health risks to neonatologists and can impair cognitive function, which increases the risk of medical errors and compromises patient safety. This paper proposes reducing shift durations and implementing policies and interventions to reduce fatigue among neonatologists and improve patient safety. The paper also offers policymakers, healthcare leaders, and NICU physicians valuable insights on potential ways to promote the health of the neonatologist workforce and safety in the NICU.

The Role of Perceived Sleep Quality in Cardiovascular Health Factors and Behaviors Among Young Adults With Type 1 Diabetes

PURPOSE

The purpose of this study was to determine the associations between perceived sleep quality and individual cardiovascular health (CVH) factors (A1C and body mass index [BMI]) and CVH behaviors (physical activity and dietary diabetes self-management) in young adults ages 18 to 25 years with type 1 diabetes (T1D).

METHODS

Associations among perceived sleep quality and CVH factors and behaviors were examined using multivariable linear regression in 69 participants ages 18 to 25 years (mean age 21.4 ± 2.0, mean T1D duration 9.7 ± 5.6 years).

RESULTS

Lower perceived sleep quality was associated with multiple lower CVH factors and behaviors (higher A1C and BMI, lower physical activity, poorer diet) even after adjusting for covariates (age, T1D duration, sex assigned at birth).

CONCLUSION

Experimental studies are needed to better understand the impact of modifying sleep habits on both short- and long-term CVH in adults with T1D.

The prevalence and associated factors of sleep deprivation among healthy college students in China: a cross-sectional survey

Background

The prevalence of sleep deprivation among college students is increasing and has a few associated factors.

Methods

The present study analyzed 2,142 college students from 28 provinces in China. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. Binary logistic regression was conducted to explore the sleep deprivation related factors. Age and gender were controlled as covariates.

Results

Among the 2,142 college students (27.7% male, 72.3% female), 1,620 (75.6%) reported the average sleep duration was below 7 h per day for one month, 49.3% (1,055/2,142) slept 6∼7 h (contains 6 h), 21.0% (449/2,142) slept 5∼6 h (contains 5 h), and 5.4% (116/2,142) slept <5 h. Age increased the risk of sleep deprivation, the adjusted odds ratio = 1.05 (95% CI [1.01∼1.10]). The adjusted odds ratio (A-OR) for sleep deprivation was higher for students of more than 60 min nap duration per day (A-OR = 2.35, 95% CI [1.45∼3.80]), and age growth (A-OR = 1.05, 95% CI [1.01∼1.10]). In contrast, A-ORs were lower among sleeping inconsistency between work and rest days (A-OR = 0.61, 95% CI [0.49∼0.75]), accustomed to staying up late (A-OR = 0.45, 95% CI [0.36∼0.57]), staying up late to work or study (A-OR = 0.62, 95% CI [0.49∼0.78]), stress (A-OR = 0.75, 95% CI [0.58∼0.98]), and repeated thoughts in bed had (A-OR = 0.79, 95% CI [0.62∼0.99]).

Conclusions

Sleep deprivation is extremely common among healthy college students in China. It is necessary to perform methods maintaining enough sleep due to the current high incidence of sleep deprivation. Controlling the nap duration and getting enough sleep on rest days to replace missing hours of sleep on workdays might improve college students' sleep.

Physical activity and morningness: A helpful combination in improving the sleep quality of active Italian university students

University students are commonly described as having worsened sleep quality, especially when inactive and Evening-type (E-type) subjects. This study aimed to examine the interactions between physical activity and chronotype on sleep quality among a sample of active Sports Science university students. In November 2019, 433 participants (mean age: 19.7 ± 1.56 years; 70% males) completed the Pittsburgh Sleep Quality Index, the Godin-Shepard Leisure-Time Physical Activity Questionnaire (tertiles categorisation), and the Morningness-Eveningness Questionnaire. Females and E-type slept significantly worse than males and Neither-(N-types) and Morning-types (M-types), respectively. However, there were no significant differences in sleep quality based on physical activity levels. The three-way ANOVA revealed that sleep quality in N- and E-types appeared to be independent of physical activity, whereas M-types showed an improvement in sleep classification with increased physical activity. Moderation analysis indicated that physical activity significantly moderated the relationship between chronotypes and sleep quality. Specifically, M-types demonstrated a more pronounced improvement in sleep quality with increasing physical activity compared to the other chronotypes. In conclusion, M-type university students derived the greatest benefits from physical activity in improving sleep quality. Conversely, physical activity seemed to have a limited impact on sleep quality among active E-type university students.

FABP7: a glial integrator of sleep, circadian rhythms, plasticity, and metabolic function

Sleep and circadian rhythms are observed broadly throughout animal phyla and influence neural plasticity and cognitive function. However, the few phylogenetically conserved cellular and molecular pathways that are implicated in these processes are largely focused on neuronal cells. Research on these topics has traditionally segregated sleep homeostatic behavior from circadian rest-activity rhythms. Here we posit an alternative perspective, whereby mechanisms underlying the integration of sleep and circadian rhythms that affect behavioral state, plasticity, and cognition reside within glial cells. The brain-type fatty acid binding protein, FABP7, is part of a larger family of lipid chaperone proteins that regulate the subcellular trafficking of fatty acids for a wide range of cellular functions, including gene expression, growth, survival, inflammation, and metabolism. FABP7 is enriched in glial cells of the central nervous system and has been shown to be a clock-controlled gene implicated in sleep/wake regulation and cognitive processing. FABP7 is known to affect gene transcription, cellular outgrowth, and its subcellular localization in the fine perisynaptic astrocytic processes (PAPs) varies based on time-of-day. Future studies determining the effects of FABP7 on behavioral state- and circadian-dependent plasticity and cognitive processes, in addition to functional consequences on cellular and molecular mechanisms related to neural-glial interactions, lipid storage, and blood brain barrier integrity will be important for our knowledge of basic sleep function. Given the comorbidity of sleep disturbance with neurological disorders, these studies will also be important for our understanding of the etiology and pathophysiology of how these diseases affect or are affected by sleep.

Sleep disturbance and decrements in morning energy contribute to a higher symptom burden in oncology patients

OBJECTIVE/BACKGROUND

An emerging area of research is the relationship between sleep disturbance and decrements in energy. Given the paucity of research on the co-occurrence of these two symptoms, study purposes were to identify subgroups of oncology patients with distinct joint sleep disturbance AND morning energy profiles and evaluate for differences among the subgroups in demographic, clinical, and sleep disturbance characteristics, as well as the severity of other common symptoms and QOL outcomes.

PATIENTS/METHODS

Patients (n = 1336) completed measures of sleep disturbance and energy 6 times over two cycles of chemotherapy. All of the other measures were completed at enrollment. Latent profile analysis was used to identify the distinct joint sleep disturbance and morning energy profiles.

RESULTS

Three distinct profiles were identified (i.e., Low Sleep Disturbance and High Morning Energy (Normal, 20.6%), Moderate Sleep Disturbance and Low Morning Energy (Moderately Severe, 52.1%), Very High Sleep Disturbance and Very Low Morning Energy (Very Severe, 27.3%). Compared to Normal class, other two classes were more likely to be female, less likely to be employed, and had higher comorbidity burden and poorer functional status. Symptom scores and QOL outcomes exhibited a dose response effect (i.e., as the profile worsened, symptom scores increased and QOL scores decreased).

CONCLUSIONS

Given the associations between sleep disturbance and decrements in energy and a higher symptom burden, poorer QOL outcomes, and increased mortality, assessment of these two symptoms needs to be a high priority for clinicians and appropriate interventions initiated.

Problems in the Development of the Sleep-Wake Rhythm Influence Neurodevelopmental Disorders in Children

Development of the sleep-wake rhythm has a significant effect on the physical and mental development of children. The sleep-wake rhythm is controlled by aminergic neurons in the brainstem's ascending reticular activating system, which is associated with synaptogenesis and the promotion of brain development. The sleep-wake rhythm develops rapidly within the first year after birth. At 3-4 months of age, the framework of the circadian rhythm is established. The objective of the present review is to assess a hypothesis concerning problems in the development of the sleep-wake rhythm and their effect on neurodevelopmental disorders. Autism spectrum disorder is characterised by a delay in the development of sleep rhythms at 3-4 months of age and also insomnia and night-time awakenings, as supported by several reports. Melatonin may shorten the sleep latency in ASD. Rett syndrome sufferers kept awake during the daytime were analysed by the Sleep-wake Rhythm Investigation Support System (SWRISS) (IAC, Inc., (Tokyo, Japan)), and the cause was found to be the dysfunction of aminergic neurons. Children and adolescents with attention deficit hyperactivity disorder show sleep problems such as resistance to bedtime, difficulty falling asleep, sleep apnoea, and restless legs syndrome. Sleep deprivation syndrome in schoolchildren is deeply influenced by Internet use, games, and smartphones, and this syndrome affects emotion, learning, concentration, and executive functioning. Sleep disorders in adults are strongly considered to affect not only the physiological/autonomic nervous system but also neurocognitive/psychiatric symptoms. Even adults cannot avoid serious problems, much less children, and the impact of sleep problems is considerably greater in adults. Paediatricians and nurses should be aware of the significance, from birth, of sleep development and sleep hygiene education for carers and parents. This research was reviewed and approved by the ethical committee of the Segawa Memorial Neurological Clinic for Children (No. SMNCC23-02).

Recent Progress in Long-Term Sleep Monitoring Technology

Sleep is an essential physiological activity, accounting for about one-third of our lives, which significantly impacts our memory, mood, health, and children's growth. Especially after the COVID-19 epidemic, sleep health issues have attracted more attention. In recent years, with the development of wearable electronic devices, there have been more and more studies, products, or solutions related to sleep monitoring. Many mature technologies, such as polysomnography, have been applied to clinical practice. However, it is urgent to develop wearable or non-contacting electronic devices suitable for household continuous sleep monitoring. This paper first introduces the basic knowledge of sleep and the significance of sleep monitoring. Then, according to the types of physiological signals monitored, this paper describes the research progress of bioelectrical signals, biomechanical signals, and biochemical signals used for sleep monitoring. However, it is not ideal to monitor the sleep quality for the whole night based on only one signal. Therefore, this paper reviews the research on multi-signal monitoring and introduces systematic sleep monitoring schemes. Finally, a conclusion and discussion of sleep monitoring are presented to propose potential future directions and prospects for sleep monitoring.

Sleep Quality Before and After Bariatric Surgery

PURPOSE

Sleep deprivation is associated with growth hormone deficiency and an elevated cortisol level, both of which have been linked to obesity. However, assessing sleep quality is often not established in the multidisciplinary peribariatric evaluation program. This study aimed to determine sleep quality in patients who are seeking or underwent bariatric surgery by using Pittsburgh Sleep Quality Index (PSQI) measurements.

MATERIALS AND METHODS

In this observational study, patients who underwent or were seeking bariatric surgery between April and November 2021 were included. Self-reported patients' demographics, operative techniques, and sleep quality measured by PSQI were collected. Baseline characteristics were compared between the preoperative group (PRE), patients who underwent surgery < 1.5 years ago (EARLY), and > 1.5 years ago (LATE). A multivariate linear regression model was built.

RESULTS

In total, 270 patients filled out the questionnaire of which 100 (37.1%) were preoperative, 87 (32.2%) early, and 83 (30.7%) late postoperative. The PSQI significantly improved in the EARLY group compared to PRE (4.8 vs 6.1). This effect disappeared in the LATE group (6.1) even though their body mass index was less. Linear regression revealed that age (p = 0.004) and body mass index (p = 0.003) predicted worse sleep quality.

CONCLUSION

Sleep quality improves early after bariatric surgery; however, this benefit does not seem to last in the long term. Other factors than weight regain should be considered for this finding, future studies with longer follow-up periods are recommended, including other variables associated with sleep quality such as health conditions and socioeconomic status.