Sleep disturbance and psychiatric disorders

The role of objective sleep duration, continuity, and architecture for subjective sleep perception: Findings from an intensive longitudinal study using heart-rate variability to infer objective sleep indicators

This study investigates the relationship between objective sleep indicators derived from heart rate variability (HRV) and sleep perception in young adults using an intensive longitudinal design over 14 consecutive nights. The sample included 178 participants aged 18-29 years from two separate studies, who provided data via daily sleep diaries. Using a multi-resolution convolutional neural network model, heart rate variability measured via ambulatory electrocardiography was used for sleep stage classification. Within-subject analyses revealed that longer total sleep time, higher sleep efficiency, more slow-wave sleep, and more rapid-eye-movement sleep were associated with better sleep perception, while longer wake after sleep onset was linked to poorer sleep perception. Notably, no significant associations were found on the between-subject level. The objective sleep indicators explained nearly five times as much variance in sleep perception at the within-subject level than at the between-subject level. Additionally, gender, as well as depressive symptoms and insomnia symptoms measured at baseline did not moderate the within-subject associations between objective sleep indicators and sleep perception. These findings underscore the importance of sufficient sleep duration, quality of sleep architecture, and sleep continuity for individuals' perceptions of their sleep on a nightly basis. The study's use of HRV-derived sleep staging over multiple nights represents a methodological strength, providing detailed and less intrusive assessment compared to traditional polysomnography. Furthermore, these results are particularly important for clinical applications, as they can be basis for individualized interventions to improve sleep perception.

Are sleep disturbances a risk factor for suicidal behavior in the first episode of psychosis? Evidence from a systematic review

Sleep disturbances are common in individuals with first-episode psychosis (FEP) and have been identified as potential contributors to an increased risk of suicidal behavior. This systematic review aims to synthesize the existing evidence on the association between sleep disturbances and suicidal behavior in individuals experiencing FEP, a critical period for early intervention. In accordance with the guidelines established by PRISMA, this systematic review was duly registered in PROSPERO (CRD42024598203) prior to its initiation. A comprehensive search was conducted across databases including PubMed, Web of Science, EMBASE, and PsycINFO, encompassing studies from their inception through February 2025. The review specifically included observational studies that investigated the association between sleep disturbances and suicidal behaviors, which include suicidal ideation, attempts, or completed suicides, among individuals with FEP. The inclusion criteria required that all studies featured adult participants aged 18 years and older, employed validated measures for both sleep disturbances and suicidality, and concentrated on populations with FEP. Reviews, case reports, and studies not published in English were systematically excluded. The selection of studies, extraction of data, and assessment of quality were conducted independently by two reviewers. Seven studies met the inclusion criteria, with sample sizes ranging from 118 to 688 participants. The findings indicate that sleep disturbances, especially insomnia, are significantly linked to an increased risk of suicidal ideation and behavior in individuals with FEP. The strength of these associations varied among the studies, with some reporting moderate to strong effect sizes. However, there was noted methodological heterogeneity, including variations in sleep assessment tools. This systematic review highlights sleep disturbances as a key modifiable risk factor for suicidal behavior in individuals with FEP. Future research should prioritize longitudinal designs and standardized sleep assessments to better characterize this relationship and guide targeted interventions.

Associations of objectively measured physical activity and sedentary behavior with sleep quality in college students

BACKGROUND

Sleep disorders are prevalent in college students and are often exacerbated by academic pressures. Accumulating evidence indicates that physical activity and sedentary behaviors exert divergent effects on sleep quality. This study aimed to investigate the associations of objectively measured physical activity and sedentary behavior with sleep quality in college students. The potential effects of substituting sedentary behavior with physical activity on sleep quality were also examined.

METHODS

This cross-sectional study included 349 college students (age range: 17-25 years; 57.6 % female) recruited from Shanghai, China. Light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and sedentary behavior were objectively measured using wrist-worn accelerometers for 7 days. Sleep quality was assessed using the Pittsburgh Sleep Quality Index. A single-factor model was used to examine independent associations, whereas an isotemporal substitution model (ISM) was used to estimate the effects of replacing sedentary behavior with physical activity on sleep quality.

RESULTS

Higher levels of LPA (B = -0.007, 95 % CI = -0.013 to -0.001, p < 0.05) and MVPA (B = -0.013, 95 % CI = -0.022 to -0.003, p < 0.05) were associated with better sleep quality. Conversely, sedentary time was negatively associated with sleep quality (B = 0.007, 95 % CI = 0.002 to 0.012, p < 0.05). In the ISM, replacing 30 min of sedentary behavior with an equivalent duration of MVPA was associated with improved sleep quality (B = -0.322, 95 % CI = -0.624 to -0.021, p < 0.05).

CONCLUSIONS

The findings indicated that physical activity was positively associated with sleep quality, whereas sedentary time was negatively associated with sleep quality in college students. Replacing sedentary behavior with an equivalent duration of MVPA positively affected sleep quality.

Multivariate deep phenotyping reveals behavioral correlates of non-restorative sleep in 22q11.2 deletion syndrome

Converging evidence suggests that sleep disturbances can directly contribute to a transdiagnostic combination of behavior and neurocognitive difficulties characterizing most forms of psychopathology. However, it remains unclear how the growing comprehension of sleep neurophysiology should best inform sleep quality assessment in mental health patients. To address this fundamental question, we performed deep multimodal sleep and behavioral phenotyping in 37 individuals at high genetic risk for psychopathology due to 22q11.2 Deletion Syndrome (Mean age:19±8.17, M/F = 22/15) and 34 Healthy Controls (Mean age:17.06±6.87, M/F = 12/22). We implemented a multivariate analysis pipeline informed by the current neurobiological understanding of the behavioral consequences of sleep disruption. We detected multivariate patterns of disrupted sleep architecture consistently influenced by age and diagnosis across recordings and experimental settings. With high-density EEG polysomnography we detected atypical trajectories of Slow-Wave-Activity (SWA) reduction, influenced by age and sleep duration which, according to the Synaptic-Homeostasis-Hypothesis, could reflect combined alterations in neurodevelopmental and synaptic homeostasis mechanisms in 22q11DS. Blunted SWA reduction was linked with EEG markers of residual sleep pressure in morning-vs-evening EEG and with questionnaires estimating subjective somnolence in everyday life, potentially representing a clinically relevant signature of non-restorative sleep. Moreover, blunted SWA decline was linked to a transdiagnostic combination of behavioral difficulties, including negative psychotic symptoms, ADHD symptoms, and neurocognitive impairments in processing speed and inhibitory-control. These findings suggest that systematic screening and management of sleep disturbances could directly improve behavioral outcomes in 22q11DS. They highlight the potential of precision/multivariate phenotyping approaches for characterizing the role of sleep disturbances in developmental psychopathology.

Epidemiology of sleep disturbances among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Background

Sleep disturbances and their associated health issues are common among medical students. Despite this, the epidemiology of sleep disturbances among medical students in the Middle East and North Africa (MENA) region remains inadequately understood. Our objective was to synthesise the prevalence of sleep disturbances, including poor sleep quality, insufficient sleep duration, and excessive daytime sleepiness (EDS), and their variation in relation to academic performance and stress levels.

Methods

We performed a systematic review and meta-analysis. Two independent reviewers searched PubMed, Web of Science, Google Scholar, and the reference lists of relevant studies and reviews up to May 2024. We assessed the quality of the included studies using a risk of bias tool. We performed meta-analyses using random-effects models and used Cochran's Q between-subgroups statistic to test for differences across subgroups. We used the I2 statistic to assess the statistical heterogeneity. Further, we assessed the publication bias using Doi plots.

Results

We included 150 studies conducted in 16 MENA countries. We found that 59.1% of medical students suffer from poor sleep quality (Pittsburgh Sleep Quality Index mean (x̄) = 8.5; 95% confidence interval (CI) = 7.0-10.1), 59.8% have insufficient sleep duration (<7 hours per night) averaging 6.1 hours per night (95% CI = 5.4-6.9), and 38.4% experience EDS (Epworth Sleepiness Scale x̄ = 8.6; 95% CI = 8.0-9.1). Our results indicate a significantly higher prevalence of poor sleep quality among students with moderate or high stress levels during the preclinical training period and in low-income MENA countries. A significantly higher prevalence of insufficient sleep duration was found among students during preclinical academic years. A significantly higher prevalence of EDS was found among students in public medical schools and those in low-income MENA countries. We observed no differences in poor sleep quality and EDS between students with poor and good academic performance.

Conclusions

Our findings highlight the substantial prevalence of sleep disturbances among MENA medical students. Medical schools must address this critical issue with targeted, locally informed, and culturally appropriate interventions. Further research is needed to assess the association between sleep disturbances and identify factors for tailored interventions that mitigate the adverse consequences on medical students' health and well-being.

Registration

Open Science Framework BF2A6.

Distinct Convergent Brain Alterations in Sleep Disorders and Sleep Deprivation: A Meta-Analysis

Importance

Sleep disorders have different etiologies yet share some nocturnal and daytime symptoms, suggesting common neurobiological substrates; healthy individuals undergoing experimental sleep deprivation also report analogous daytime symptoms. However, brain similarities and differences between long-term sleep disorders and short-term sleep deprivation are unclear.

Objective

To investigate the shared and specific neural correlates across sleep disorders and sleep deprivation.

Data Sources

PubMed, Web of Science, Embase, Scopus, and BrainMap were searched up to January 2024 to identify relevant structural and functional neuroimaging articles.

Study Selection

Whole-brain neuroimaging articles reporting voxel-based group differences between patients with different sleep disorders and healthy control participants or between total or partial sleep-deprived and well-rested individuals were included.

Data Extraction and Synthesis

Significant coordinates of group comparisons, their contrast direction (eg, patients < controls), and imaging modality were extracted. For each article, 2 raters independently evaluated eligibility and extracted data. Subsequently, several meta-analyses were performed with the revised activation likelihood estimation algorithm using P < .05 cluster-level familywise error correction.

Main Outcomes and Measures

Transdiagnostic regional brain alterations were identified across sleep disorders and among articles reporting sleep deprivation. Their associated behavioral functions and task-based or task-free connectivity patterns were explored using 2 independent datasets (BrainMap and the enhanced Nathan Kline Institute-Rockland Sample).

Results

A total of 231 articles (140 unique experiments, 3380 unique participants) were retrieved. The analysis across sleep disorders (n = 95 experiments) identified the subgenual anterior cingulate cortex (176 voxels, z score = 4.86), associated with reward, reasoning, and gustation, and the amygdala and hippocampus (130 voxels, z score = 4.00), associated with negative emotion processing, memory, and olfaction. Both clusters had positive functional connectivity with the default mode network. The right thalamus (153 voxels, z score = 5.21) emerged as a consistent regional alteration following sleep deprivation (n = 45 experiments). This cluster was associated with thermoregulation, action, and pain perception and showed positive functional connectivity with subcortical and (pre)motor regions. Subanalyses regarding the direction of alterations demonstrated that the subgenual anterior cingulate cortex exhibited decreased activation, connectivity, and/or volume, while the amygdala and hippocampus cluster and the thalamus cluster demonstrated increased activation, connectivity, and/or volume.

Conclusions and Relevance

Distinct convergent brain abnormalities were observed between long-term sleep disorders (probably reflecting shared symptoms) and short-term sleep deprivation.

Integration of sleep and emotion treatment: a randomized trial of transdiagnostic CBT for comorbid insomnia

BACKGROUND

Insomnia frequently co-occurs with emotional disorders, yet integrated treatment approaches remain understudied. This study examined the efficacy of Transdiagnostic Cognitive Behavior Therapy (TCBT) for treating comorbid insomnia in patients with emotional disorders.

METHODS

In this double-blind randomized controlled trial, 32 university students with comorbid insomnia and emotional disorders were randomly assigned to either TCBT (n = 16) or waitlist control (n = 16). The TCBT group received 20 one-hour sessions of treatment. Insomnia severity was assessed using the Insomnia Severity Index (ISI) at baseline, post-treatment, and three-month follow-up.

RESULTS

Mixed-model ANOVA revealed significant main effects for time (F = 52.18, p < .001, Eta-Squared = 0.635) and group (F = 45.55, p < .001, Eta-Squared = 0.603), and a significant time × group interaction (F = 61.66, p < .001, Eta-Squared = 0.673). The TCBT group showed large effect sizes for insomnia reduction from pre- to post-treatment (Hedges' g = 3.75) and pre-treatment to follow-up (g = 3.07), with benefits maintained at three months. The waitlist group showed no significant changes.

CONCLUSIONS

TCBT demonstrated robust efficacy in treating comorbid insomnia among university students with emotional disorders, with effects maintained at follow-up. These findings suggest TCBT as a promising integrated treatment approach for this population.

TRIAL REGISTRATION

This randomized clinical trial comprised an intervention and a waitlist that was registered in the Iranian Registry of Clinical Trials (IRCT Id: IRCT20200112046097N1). (Registration Date: 26/07/2020).

Psychophysiological stress response, emotion dysregulation and sleep parameters as predictors of psychopathology in adolescents and young adults

BACKGROUND

Increased emotional reactivity to stress, emotional dysregulation and sleep disturbances are interdependent trans-diagnostic processes that are present in internalising disorders such as depression and anxiety disorders. This study investigated which objective and subjective parameters of stress reactivity, sleep and emotional processing would predict symptoms of anxiety and depression in adolescents and young adults.

METHODS

Participants were adolescents and young adults between the ages of 14 to 21 (N = 106, 25[24 %] male, M age = 17.93). Heart rate, heart rate variability, and subjective stress levels were measured before, during and after a stress induction using the Trier Social Stress Test (TSST). Questionnaires on internalising symptoms, emotion dysregulation, and sleep quality were used. For seven consecutive nights, objective sleep parameters were measured with a wearable device.

RESULTS

Heart rate and heart rate variability after (but not during) the stress induction and emotion dysregulation predicted depressive and anxiety symptoms. Lower subjective sleep quality (but not the objective sleep parameters) was associated with depressive and anxiety symptoms. Emotion dysregulation mediated the relationship between sleep quality and depressive symptoms.

LIMITATIONS

A cross-sectional design, no measurement of daily activity or naps, and only self-report measures of depressive and anxiety symptoms as well as emotion dysregulation.

CONCLUSION

The findings of elevated cardiovascular activation after - but not during - the stress induction and emotion dysregulation underlines problems in regulating and recovering from stress as predictors of youth internalising psychopathology. Differences between subjective and objective measures of sleep and stress reactivity suggests a role of cognitive biases in these domains.

Sleep and schizophrenia polygenic scores in non-affective and affective psychotic disorders

BACKGROUND

Sleep problems are common in psychotic disorders and are associated with worse quality of life and disease prognosis. Genome-wide association studies (GWAS) have revealed genetic influences for schizophrenia and sleep, but polygenic scores (PGSs) for sleep traits have not been evaluated systematically in patients with psychotic disorders.

METHODS

This study investigated the associations between PGSs for sleep traits (insomnia, PGSINS; sleep duration, PGSSD; short sleep duration, PGSSS; long sleep duration; PGSLS), diurnal preference (eveningness, PGSME), and schizophrenia (PGSSZ) with clinical features of psychotic disorders in the Finnish SUPER study comprising 8,232 patients with psychotic disorders. The measures included self-reported sleep and well-being, cognitive assessments, clozapine use, and functional outcomes. Using FinnGen data of 356,077 individuals, we analyzed the distributions of PGSs in psychotic and bipolar disorders and the general population.

RESULTS

PGSINS associated with more sleep problems and worse well-being (e.g. worse health-related quality of life [β = -0.07, CI = -0.09, -0.05, p < .001]). High PGSSZ is associated with better sleep quality, worse clinical outcomes, and performance in cognitive tests (e.g. more errors in paired-associated learning [β = 0.07, CI = 0.04, 0.09, p < .001]). PGSINS was higher in affective psychotic and bipolar disorders, while PGSSD and PGSME were higher in schizophrenia as compared with individuals with no psychiatric disorders.

CONCLUSION

Genetic risks for sleep and diurnal preference vary between non-affective psychosis, affective psychosis, and the general population. The findings in this study emphasize the heterogeneity in genetic etiology of the objective features of disease severity and the more subjective measures related to well-being and self-reported measures of sleep.

Short-term prospective and reciprocal relations between social anxiety symptoms and sleep quality among community-recruited adolescents

OBJECTIVE

Research conducted with socially anxious youth suggests that there is an increased risk for poor sleep quality; however, this link is not consistent across the few studies and there is evidence to suggest that poor sleep quality may increase the risk for elevated social anxiety symptoms. The present study investigates both prospective and reciprocal associations between levels of self-reported social anxiety and global sleep quality while also distinguishing between within-person and between-person variations in these associations.

METHOD AND MEASURES

Community-recruited adolescents from the United States (N = 71; Mage=16.04, SD = 1.08; 64.8% girls; 80.3% White) completed a battery of questionnaires across three time-points within a six-month period; each wave occurred three months apart. A random-intercepts cross-lagged panel model was used for the analysis.

RESULTS

Findings indicated a positive relation between social anxiety and poor sleep quality at both within- and between-person levels. Higher levels of social anxiety were associated with poorer sleep quality three months later, but the reverse relation was not observed.

CONCLUSIONS

These findings provide evidence supporting the link between elevated social anxiety symptoms and future sleep problems among adolescents and lay groundwork for investigation of mechanisms driving this link. Findings suggests a need to screen for and treat sleep problems in socially anxious youth.

Novel digital markers of sleep dynamics: causal inference approach revealing age and gender phenotypes in obstructive sleep apnea

Despite evidence that sleep-disorders alter sleep-stage dynamics, only a limited amount of these parameters are included and interpreted in clinical practice, mainly due to unintuitive methodologies or lacking normative values. Leveraging the matrix of sleep-stage transition proportions, we propose (i) a general framework to quantify sleep-dynamics, (ii) several novel markers of their alterations, and (iii) demonstrate our approach using obstructive sleep apnea (OSA), one of the most prevalent sleep-disorder and a significant risk factor. Using causal inference techniques, we address confounding in an observational clinical database and estimate markers personalized by age, gender, and OSA-severity. Importantly, our approach adjusts for five categories of sleep-wake-related comorbidities, a factor overlooked in existing research but present in 48.6% of OSA-subjects in our high-quality dataset. Key markers, such as NREM-REM-oscillations and sleep-stage-specific fragmentations, were increased across all OSA-severities and demographic groups. Additionally, we identified distinct gender-phenotypes, suggesting that females may be more vulnerable to awakenings and REM-sleep-disruptions. External validation of the transition markers on the SHHS database confirmed their robustness in detecting sleep-disordered-breathing (average AUROC = 66.4%). With advancements in automated sleep-scoring and wearable devices, our approach holds promise for developing low-cost screening tools for sleep-, neurodegenerative-, and psychiatric-disorders exhibiting altered sleep patterns.

Acupuncture effects on emotional reactivity of youth with self-reported depressive symptoms

Background

Emotional symptomatology is a hallmark of depression. Antidepressant often fail to effectively target emotional blunting, while acupuncture, by contrast, has emerged as a promising alternative. However, the exact electrophysiologic mechanisms remain unclear. This study aimed to investigate how acupuncture influences emotional reactivity in youth with self-reported depressive symptoms.

Methods

A modified oddball paradigm incorporating a negative emotional valence deviant, combined with event-related potential analysis, was used to measure emotional reactivity before and after intervention. Seventy individuals exhibiting depressive symptoms in the previous 2 weeks, were randomly assigned to either a verum or sham acupuncture group. Electroencephalogram data from 59 participants were analyzed following preprocessing and quality assessment. Occipital P1, N170, frontal N1, N2, and parietal P3 components were extracted. The Positive and Negative Affect Schedule (PANAS) was completed after each oddball session. The Massachusetts General Hospital Acupuncture Sensation Scale (MASS) was completed after each intervention session.

Results

The MASS Index was significantly higher in the verum group. However, significant increases in occipital P1, N170, frontal N1, N2, and parietal P3 amplitudes for high-negative, mild-negative, and neutral pictures were observed after the intervention in both the verum and sham groups, with no significant difference between the groups. Additionally, both groups induced PANAS changes, and positive effect changes were significantly correlated with N170 and P1 (in response to high-negative pictures) changes in the sham group.

Conclusion

Acupuncture altered emotional reactivity in youth with depressive symptoms, highlighting its potential role, albeit possibly non-specific, in depression prevention and treatment.

Pre-and post-migration factors associated with sleep health among Latin American immigrants in the United States: A systematic review

Immigrants face unique challenges and stressors before leaving their country of origin and upon arrival to their host country, all of which may impair their sleep health. We synthesized the literature on pre-and-post migration factors predicting sleep outcomes among foreign-born Latin American immigrants to the United States. Following PRISMA guidelines, we searched three electronic databases: PubMed, PsycINFO, and Web of Science. We supplemented our search using Google Scholar and by manually reviewing reference lists from all included studies and four reviews on similar topics. Out of 2581 references screened, 12 peer-reviewed studies met our inclusion criteria. All studies but one were quantitative. Most were cross-sectional, consisted of adults, relied on self-reported measures of sleep, and had a low risk of bias. Acculturation stress, perceived discrimination and racism, working multiple jobs, as well as poor physical and mental health were the most consistent predictors of poorer sleep health in this population. Being born in Mexico and greater biculturalism were predictors of better sleep health. We discuss gaps in the literature, highlight opportunities for future research, and argue for a more comprehensive examination of how pre-migration experiences impact post-migration sleep health.

The prevalence of common mental disorders, stress, and sleep disturbance among international migrant workers: A meta-analysis with subgroup analysis

International migrant workers face an elevated risk of common mental disorders (CMDs), stress, and sleep disturbances due to various individual, psychosocial, and occupational factors. This meta-analysis systematically evaluated the prevalence of CMDs, stress, and sleep disturbance among international migrant workers. Two independent reviewers systematically searched the literature on five electronic databases from inception to June 2022. Random effects meta-analyses were performed to estimate the pooled prevalence of depressive symptoms, anxiety symptoms, stress, and sleep disturbance among international migrant workers. Additionally, subgroup analyses were conducted to examine potential modifiers for the prevalence rates. Of 8461 records, 57 studies (n = 29,481) were included in this meta-analysis. The pooled prevalence rates of depressive symptoms, anxiety symptoms, stress, and sleep disturbance were 20.3 %, 17.8 %, 17.3 %, and 25.3 %, respectively. Subgroup analyses revealed that the prevalence of CMDs and stress was statistically significantly modified by country of destination and type of work, stress by gender and country of origin, and anxiety by migration type. Potential publication bias was observed only in the meta-analysis of stress. Most of the studies included were of moderate to high methodological quality. However, given that the included studies were predominantly cross-sectional and used non-probability sampling, the results should be interpreted with caution. This meta-analysis highlights that CMDs, stress, and sleep disturbances are prevalent among international migrant workers, posing a significant public health concern for host countries. These findings underscore the urgent need for tailored mental health interventions for specific subgroups within this population.

Antepartum insomnia symptoms and its association with postpartum depression symptoms in women with and without psychiatric vulnerability: A prospective cohort study

BACKGROUND

Postpartum depression is common and may be linked to antepartum insomnia, a potentially modifiable risk factor. We examine the association between insomnia- and postpartum depression symptoms, considering whether psychiatric vulnerability moderates this link.

METHOD

Participants completed the Insomnia Severity Index during trimester two and three and the Hospital Anxiety and Depression questionnaire postpartum. Linear regression analyses were used to investigate the associations between antepartum insomnia- and postpartum depression symptoms. We used stratified regression models and a test for multiplicative interaction to understand if psychiatric vulnerability moderates this association.

RESULTS

A total of 217 women participated (median age 37, IQR 5). Women with clinically significant insomnia symptoms in trimester two and three reported higher postpartum depression symptoms (p = .008 and p = .002 respectively). Linear regression analyses showed effect sizes that were almost equal for both trimesters (two: β = 0.19, 95 % CI -0.20., 0.40, p = .069 and three: β = 0.23, 95 % CI 0.09., 0.36, p ≤ .001), but only statistically significant for trimester three. When antepartum depression was taken into account, neither the second nor third trimester was significantly associated with postpartum depressive symptoms. Psychiatric vulnerability did not moderate the relationship (p = .163).

CONCLUSION

Insomnia symptoms in the second and third trimesters are not associated with postpartum depression when antepartum depression is taken into account in both women with and without psychiatric vulnerability. Hence it is important to screen for both insomnia and depression during pregnancy to prevent postpartum depression in all pregnant women.

Therapeutic Effect of Yu Melody Relaxation Training Combined with Jianpi Jieyu Decoction in Insomnia Patients: A Randomized Controlled Trial

OBJECTIVE

To evaluate the therapeutic effect of Yu Melody relaxation training (YMRT) combined with Jianpi Jieyu Decoction (JJD) in treating patients with insomnia disorders (ID).

METHODS

In this randomized controlled study, 94 ID patients were included from Xiyuan Hospital, China Academy of Chinese Medical Sciences from September 2022 to January 2024. They were randomly assigned to the YMRT group (47 cases, YMRT plus JJD) and the control group (47 cases, oral JJD) using a random number table. Both treatment administrations lasted for 4 weeks, with a 2-week follow-up. The primary outcome was change in Insomnia Severity Index (ISI) scores from baseline to 4 weeks of intervention. Secondary outcomes included ISI response at week 4, as well as ISI, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7) scores at baseline and weeks 1, 2, 3, 4, and 6. Additionally, Pittsburgh Sleep Quality Index (PSQI) scores were evaluated at baseline and weeks 4 and 6. Adverse events (AEs) were recorded and compared between groups.

RESULTS

Five patients in each group did not complete the protocol requirements. The overall dropout rate was 10.64%. The full analysis set included all 47 cases in each group. The ISI score decreased significantly at week 4 from baseline in the YMRT group compared with the control group, with a between-group difference of -3.2 points [95% confidence interval (CI): -5.08 to -1.34; P<0.05]. The ISI response at week 4 in the YMRT group was significantly higher than that in the control group (85.11% vs. 51.06%), with a between-group difference of 34.05% (95% CI: 13.77% to 50.97%; P<0.05). At week 6, the YMRT group demonstrated greater reductions from baseline than the control group, with between-group differences of -2.1 points (-95% CI: -3.49 to -0.64; P<0.05) for PHQ-9 scores, -3.5 points (95% CI: -5.21 to -1.85; P<0.05) for PSQI scores, and -1.9 points (95% CI: -3.47 to -0.28; P<0.05) for GAD-7 scores. Moreover, at weeks 4 and 6, the ISI and PSQI scores in the YMRT group were significantly lower than those in the control group (P<0.05); and at week 6, the PHQ-9 score in the YMRT group was significantly lower (P<0.05). There was no significant difference in the incidence rates of AEs between the two groups (8.51% vs. 4.26%, P>0.05).

CONCLUSIONS

YMRT combined with oral JJD could improve sleep quality and alleviate depressive and anxiety symptoms in patients with ID. This combined therapy was effective and safe, and its effect was superior to oral JJD alone. (Registration No. ChiCTR2200063884).

The association between lifestyle risk score and mental health in Iranian overweight and obese women: a cross-sectional study

Background

Since evidence on the relationship between a combination of lifestyle factors and mental health in the Iranian population is limited, this study employed a cross-sectional design which is a quick and low-cost method to provide more information on the potential association between lifestyle and mental health. This study addresses this gap by focusing on Iranian overweight and obese women.

Methods

This cross-sectional study analyzed 278 Iranian overweight and obese women. A multistage random sampling method was used to recruit the participants. The lifestyle risk score (LRS) was created based on diet, physical activity (PA), sleep, obesity, and sociodemographic characteristics. Multinomial logistic regression analysis was used to evaluate the association between LRS and the odds of depression, anxiety, and stress. Participants were assigned a score of 0 for each healthy behavior and a score of 1 for each unhealthy behavior. A higher LRS indicates an unhealthier lifestyle. A binary logistic regression analysis was used to examine LRS and the stress and depression anxiety stress scale (DASS).

Results

Significant positive associations between high LRS and moderate and severe depression were found (p < 0.05). Furthermore, there were significant positive associations between higher LRS and mild and extremely severe stress (p < 0.05).

Conclusion

This is the first study that examined associations between LRS and total DASS-21 and demonstrated that participants with lower LRS had lower levels of depression and stress. This study highlights the crucial role of healthy lifestyle choices in psychological wellbeing. These findings inform the design of interventions to address mental health disorders in Iran. Further prospective studies, including a larger sample size of both genders, are needed to expand our understanding of lifestyle scores' associations with mental health.

Mediating Effects of Sleep Problems and Emotional Symptoms in the Relationship Between Chronotype and Self-Harm Among Adolescents Aged 11-19 Years

Purpose

Self-harm is linked to numerous adverse health and social outcomes, including repetitive self-harm and an increased risk of suicide. This study aims to explore the influence of chronotype on self-harm among adolescents and further investigate the mediating role of sleep problems and emotional symptoms.

Participants and Methods

The study was conducted between April and June 2022, involving 13 junior and senior high schools in Tianjin. The participants were asked to complete online questionnaires assessing chronotype, sleep problems, depression, anxiety, and self-harm. The data were analyzed and processed using Spearman correlation and mediation effect analysis. Two mediation pathways were tested: Model 1 with sleep problems and depression as the mediators, and Model 2 with sleep problems and anxiety as the mediators.

Results

Participants comprised 13,374 Chinese middle school adolescents (6745 boys) aged 11-19 years. In Model 1, the independent mediation effects of sleep problems and depression were -0.216 (95% CI = [-0.263, -0.172]) and -0.101 (95% CI = [-0.121, -0.083]), accounting for 33.33% and 15.59% of the total effect, respectively. The chain mediation effect was -0.170 (95% CI = [-0.196, -0.146]), accounting for 26.23% of the total effect. In Model 2, the independent mediation effects of sleep problems and anxiety were -0.232 (95% CI = [-0.279, -0.189]) and -0.075 (95% CI = [-0.091, -0.059]), respectively accounting for 35.63% and 11.52% of the total effect. The chain mediation effect was -0.151 (95% CI = [-0.176, -0.128]), accounting for 23.20% of the total effect.

Conclusion

Chronotype is a significant predictor of self-harm, with a later chronotype associated with a higher risk. Both sleep problems and emotional symptoms independently and serially mediate the relationship between chronotype and self-harm. These findings highlight the complex pathways through which chronotype influences self-harm behavior and suggest potential targets for intervention.

Improving access to help with poor sleep across youth mental health services: Interim implementation and clinical outcomes

OBJECTIVES

There is a high, unmet sleep need in young people with mental health difficulties. We took a whole-system approach to improving access to sleep support across a youth mental health system (14-25 years).

METHODS

We used the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to develop an implementation programme (The Better Sleep Programme) incorporating two levels of training: (i) therapeutic practitioners received training and supervision in CBT for insomnia (CBTi) adapted for young people with mental health difficulties, (ii) non-therapeutic practitioners received knowledge and skills workshops. Implementation and clinical outcome measures were collected.

DESIGN

Implementation outcomes of acceptability, adoption, appropriateness, accessibility and fidelity were considered for the programme and CBTi intervention within it. Clinical outcomes for the CBTi intervention covered sleep, wellbeing and personal goals and were evaluated using a pre-post comparison within-subject design.

RESULTS

High levels of attendance and uptake were seen for CBTi training (210 therapeutic practitioners from 18 services) and workshops (270 attendees from 29 services). Five of the six core service areas trained were routinely offering the CBTi intervention. Significant improvements were seen across all clinical outcome measures (n = 83, p ≤ 0.001 to p ≤ 0.05) with moderate to large effect sizes observed across measures of sleep (d = 0.61-1.35), mental health (d = 0.57-1.26) and personal goals (d = 1.77).

CONCLUSIONS

This centrally-funded, system-wide implementation programme shows significant promise as a means of improving sleep in young people with mental health difficulties. High uptake with encouraging clinical outcomes was seen across services. Further evaluation is required to establish sustainability and generalizability.

In Situ Mass Spectrometry Imaging to Elucidate the Effects of an Adenosine A2A Receptor Agonist and Alprazolam on Sleep Regulation

Alprazolam (Alp), a commonly used sleep medication in clinical practice, has several potential limitations, including a narrow therapeutic dosage range and a delayed sleep onset. CGS21680 (CGS), a selective agonist of the adenosine A2A receptor, exhibits neuroinhibitory properties. This study aimed to evaluate the effects of CGS on the sleep properties of Alp. The sleep-inducing effects of Alp were assessed through the righting reflex, while the sedative effects of CGS were evaluated by spontaneous activity detection. The synergistic effect of CGS on Alp was evaluated by using electroencephalography and electromyography. The results indicate that we optimized and selected ED5 dose of Alp and ED50 dose of CGS for coadministration. CGS reduced the sleep latency induced by Alp and extended the sleep duration. The distribution of Alp in the brain was assessed through mass spectrometry imaging (MSI). The blood-brain barrier (BBB) model was established to evaluate the impact of CGS on the transmittance of Alp. The results indicated that CGS influenced the distribution of Alp across various brain regions and increased Alp's transmittance across the BBB. The metabolic pathways of GABA, glutamate, and glutamine were assessed through MSI and enzyme activity verification. The coadministration of Alp and CGS resulted in the regulation of GABA, glutamate, and glutamine during the sleep latency and sleep maintenance periods, respectively. In conclusion, the potentiating effect of CGS on the sleep-inducing properties of Alp is attributed to its ability to modulate the distribution of Alp in the brain by enhancing BBB permeability and its influence on Alp-induced neurotransmitter release.

Treatment of Insomnia in Forensic Psychiatric Patients: A Randomized Controlled Trial

Background: Insomnia is common in forensic psychiatric patients. Not only does insomnia severely impair general mental health, but it has specifically been associated with poor emotion regulation and self-control, potentially leading to problems in impulsivity, hostility, and even aggression. Cognitive behavioral therapy for insomnia (CBT-I) could therefore be beneficial in this patient group. Methods: We conducted a 14-week randomized controlled trial of the effects of cognitive behavioral therapy for insomnia (CBT-I) on sleep, general psychopathology, hostility, impulsivity, and aggression in 31 male forensic psychiatric patients. Results: The CBT-I group (n = 11) showed a stronger reduction in self-reported insomnia symptoms and hostility than the waitlist group (n = 11). No differences were found in post-treatment self-reported general psychopathology, impulsivity, or aggression, nor on actigraphy-measured sleep efficiency. Conclusions: This study demonstrates the effectiveness of CBT-I in forensic psychiatric patients and indicates the importance of insomnia treatment in this population, especially considering the effect on hostility.

Prediction of mental health risk in adolescents

Prospective prediction of mental health risk in adolescence can facilitate early preventive interventions. Here, using psychosocial questionnaires and neuroimaging measures from over 11,000 children in the Adolescent Brain and Cognitive Development Study, we trained neural network models to stratify general psychopathology risk. The model trained on current symptoms accurately predicted which participants would convert into the highest psychiatric illness risk group in the following year (area under the receiver operating characteristic curve = 0.84). The model trained solely on potential etiologies or disease mechanisms achieved an area under the receiver operating characteristic curve of 0.75 without relying on the child's current symptom burden. Sleep disturbances emerged as the most influential predictor of high-risk status, surpassing adverse childhood experiences and family mental health history. Including neuroimaging measures did not enhance predictive performance. These findings suggest that artificial intelligence models trained on readily available psychosocial questionnaires can effectively predict future psychiatric risk while highlighting potential targets for intervention. This is a promising step toward artificial intelligence-based mental health screening for clinical decision support systems.

Phase angle between dim light melatonin onset and sleep timing during residential treatment prospectively predicts obsessive-compulsive symptoms

The relation between obsessive-compulsive disorder (OCD) and circadian rhythm disturbance has been increasingly acknowledged in recent years. While prior clinical studies have utilized patients' self-reported sleep behaviors, there is a need to also explore the measurable, biological aspects of circadian rhythms. The current study has two aims: first, to describe the biological circadian rhythms of individuals with OCD seeking intensive residential treatment, including their relationship with self-reported measures of sleep and OCD symptoms; and second, to examine longitudinal associations between biological circadian rhythms and OCD symptom severity during the course of residential treatment. Adults receiving residential treatment for OCD (n = 23) completed a procedure to measure their dim-light melatonin onset (DLMO) at admission, week two, week four, and discharge from treatment along with a battery of self-report assessments of OCD symptom severity and depression severity. Phase angle between DLMO and the midpoint of self-reported sleep was also calculated as a measure of the alignment between behavioral sleep-wake patterns and biological circadian rhythms at each time point. Cross-sectional correlations between these constructs were assessed and then cross-lagged panel models (CLPM) were fit to these data in order to examine the relation between 1) DLMO and OCD symptom severity across treatment and 2) phase angle of DLMO and midpoint of sleep and OCD symptom severity across treatment. Descriptive statistics indicate that sleep duration and timing were shifting closer toward general population averages across this period of treatment, perhaps due to newly supported bed and wake times in the treatment milieu. There were no significant cross-lagged paths between DLMO and OCD symptom severity during the first weeks of residential treatment. There was a significant cross-lagged path between DLMO phase angle from self-reported sleep midpoint and OCD symptom severity during the first weeks of residential treatment. Specifically, relatively shorter phase angle at admission was associated with less severe OCD symptoms at the second week of treatment; and relatively shorter phase angle at the second week of treatment was associated with more severe OCD symptoms at the fourth week of treatment. This study demonstrated the feasibility of measuring biological circadian rhythms in a residential treatment context and provided initial data demonstrating a longitudinal and dynamic relation between sleep, circadian rhythms, and OCD symptoms. Further study with larger samples is warranted. The non-linear pattern of relations across the course of this study also indicate that consideration of treatment processes and other factors not measured herein will strengthen future studies. Follow-up studies with residential treatment settings that continue salivary melatonin collection after treatment ends and patients return to their daily lives are also possible with this self-administered data collection procedure.

Systematic review: REM sleep, dysphoric dreams and nightmares as transdiagnostic features of psychiatric disorders with emotion dysregulation - Clinical implications

BACKGROUND

Fragmented rapid eye movement (REM) sleep disrupts the overnight resolution of emotional distress, a process crucial for emotion regulation. Emotion dysregulation, which is common across psychiatric disorders, is often associated with sleep disturbances. This systematic review explores how REM sleep and nightmares affect emotion processing and regulation in individuals with psychiatric disorders where emotion dysregulation is a key concern, suggesting novel sleep-related treatment pathways.

METHODS

We performed a PRISMA-compliant systematic search of the PUBMED, Web of Science, and EBSCO databases from January 1994-February 2023. This systematic review targeted studies on REM sleep, nightmares, and emotion regulation in a postpubescent clinical population with affective dysregulation. The quality of the studies was assessed via the Newcastle‒Ottawa Scale (NOS), adapted for cross-sectional studies.

RESULTS

From the 714 screened records, 28 articles met the inclusion criteria and focused on REM sleep, dreams, or nightmares in individuals with mood disorders (k = 8), anxiety disorders (k = 1), posttraumatic stress disorder (PTSD) (k = 16), non-suicidal self-injury (NSSI), personality disorders (k = 2), and autism (k = 1). Fifteen studies used objective sleep measures, seventeen used self-reported assessments, six included treatment components, eight investigated nightmares, and three examined dreams. NOS scores ranged from moderate to high.

CONCLUSIONS

REM sleep disturbances represent a transdiagnostic feature across psychiatric disorders and are crucial for emotion regulation. Nightmares are associated with suicidal behaviour and emotion dysregulation. Targeted sleep interventions may improve emotion regulation and mental health outcomes. Future research should explore the role of REM sleep in disorder prognosis to develop tailored interventions.

I "Gut" Rhythm: the microbiota as a modulator of the stress response and circadian rhythms

Modern habits are becoming more and more disruptive to health. As our days are often filled with circadian disruption and stress exposures, we need to understand how our responses to these external stimuli are shaped and how their mediators can be targeted to promote health. A growing body of research demonstrates the role of the gut microbiota in influencing brain function and behavior. The stress response and circadian rhythms, which are essential to maintaining appropriate responses to the environment, are known to be impacted by the gut microbiota. Gut microbes have been shown to alter the host's response to stress and modulate circadian rhythmicity. Although studies demonstrated strong links between the gut microbiota, circadian rhythms and the stress response, such studies were conducted in an independent manner not conducive to understanding the interface between these factors. Due to the interconnected nature of the stress response and circadian rhythms, in this review we explore how the gut microbiota may play a role in regulating the integration of stress and circadian signals in mammals and the consequences for brain health and disease.

Indirect Interventions: Lifestyle Options to Treat Mental Disorders

Mental disorders are highly prevalent worldwide. Unfortunately, most people with these disorders do not receive any treatment. This is due in part to a large set of barriers (e.g., no access to therapists or clinics, lack of insurance, stigma) that impede seeking and obtaining mental health services. Many lifestyle interventions that are not part of traditional mental health services have indirect effects on reducing symptoms of mental disorders. These are interventions that target a direct focus (e.g., physical health, socialization, general well-being) but also have indirect and significant impact on reducing mental disorders. This article discusses indirect interventions as an additional way of reaching people in need of help with mental health problems. Interventions such as physical activity and exercise, diet, addressing sleep problems, yoga, tai chi, qigong, and volunteering have indirect beneficial effects. This article highlights the scope of mental illness as a background, introduces indirect interventions, and details three illustrations with evidence that targeting one focus with indirect effects on improving mental disorders. The interventions point to a category of interventions are not systematically used in the care of mental health problems. Among their many advantages is the prospect of their use at the levels of individuals and populations. Indirect interventions do not replace any of the current advances in treatment but add to ways of reaching people in need.

The subcortical correlates of self-reported sleep quality

Study objectives

To assess the association between self-reported measures of sleep quality and cortical and subcortical local morphometry.

Methods

Sleep quality, operationalized with the Pittsburgh Sleep Quality Index (PSQI), and neuroanatomical data from the full release of the young adult Human Connectome Project dataset were analyzed (N=1,112; 46% female; mean age: 28.8 years old). Local cortical and subcortical morphometry was measured with subject-specific segmentations resulting in voxelwise gray matter difference (i.e., voxel based morephometry) measurements for cortex and local shape measurements for subcortical regions. Associations between the total score of PSQI, two statistical groupings of its subcomponents (obtained with a principal component analysis), and their interaction with demographic (i.e., sex, age, handedness, years of education) and biometric (i.e., BMI) variables were assessed using a general linear model and a nonparametric permutation approach.

Results

Sleep quality-related variance was significantly associated with subcortical morphometry, particularly in the bilateral caudate, putamen, and left pallidum, where smaller shape measures correlated with worse sleep quality. Notably, these associations were independent of demographic and biometric factors. In contrast, cortical morphometry, along with additional subcortical sites, showed no direct associations with sleep quality but demonstrated interactions with demographic and biometric variables.

Conclusions

This study reveals a specific link between self-reported sleep quality and subcortical morphometry, particularly within the striatum and pallidum, reinforcing the role of these regions in sleep regulation. These findings underscore the importance of considering subcortical morphology in sleep research and highlight potential neuromodulatory targets for sleep-related interventions.

Explainable Artificial Intelligence Models for Predicting Depression Based on Polysomnographic Phenotypes

Depression is a common mental health disorder and a leading contributor to mortality and morbidity. Despite several advancements, the current screening methods have limitations in enabling the robust and automated detection of depression, thereby hindering early diagnosis and timely intervention. This study aimed to develop explainable artificial intelligence (AI) models to predict depression using polysomnographic phenotype data, ensuring high predictive performance while providing clear insights into the importance of features influencing the risk of depression. Advanced machine learning algorithms such as random forest, extreme gradient boosting, categorical boosting, and light gradient boosting machines were employed to train and validate the predictive AI models. Phenotype data from subjective health questionnaires, clinical assessments, and demographic factors were analyzed. The explainable AI models identified the important features, and their performance was evaluated using cross-validation. The study population, comprising 114 control participants and 39 individuals with depression, was stratified based on validated depression-scoring methods. The proposed explainable AI models achieved an F1-score of 85%, verifying their high reliability in predicting depression. Key features influencing the risk of depression, such as anxiety disorders, sleep efficiency, and demographic factors, offer actionable insights for clinical practice, highlighting the transparency of these models. This study proposed and developed explainable AI models based on polysomnographic phenotype data for the automated detection of depression and verified that these models help improve mental health diagnostics, enabling timely interventions.

The Influence of Heat on Pediatric and Perinatal Health: Risks, Evidence, and Future Directions

Children, particularly infants and those with chronic conditions, are highly vulnerable to heat-induced health risks, similarly to the elderly. This narrative review synthesizes current evidence on the impact of heat exposure on pediatric and perinatal health. A systematic literature search was conducted using PubMed/MEDLINE and manual reference checks, focusing on studies from 2000 to 2024. Findings indicate that maternal heat exposure is associated with adverse pregnancy outcomes, including pre-eclampsia, gestational diabetes, hypertension, and increased hospital admissions. Additionally, prenatal heat stress correlates with preterm birth, low birth weight, birth defects, and stillbirth. In childhood, heat-related health consequences range from heatstroke and dehydration to renal impairment, respiratory diseases, and gastrointestinal infections. Psychosocial effects, including cognitive impairment, sleep disturbances, and mental health issues, have also been reported in school-age children and adolescents. Despite strong epidemiological evidence, critical knowledge gaps remain, including the exact temperature thresholds that increase disease risk and how these thresholds vary by age and underlying health conditions. Urgent public health measures are required to mitigate these risks, while further research is needed to define exposure-response relationships and effective interventions. Addressing the rising burden of heat-related pediatric illness is essential in the context of climate change and increasing global temperatures.

Digital sleep phenotype and wrist actigraphy in individuals at clinical high risk for psychosis and people with schizophrenia spectrum disorders: a systematic review and meta-analysis

AIM

To identify sleep abnormalities in individuals at clinical high risk for psychosis (CHR-P) or with schizophrenia spectrum disorders (SSDs) compared with healthy controls (HCs) using wrist actigraphy, and to assess potential differences in the direction of effect with self-reported assessments of sleep.

METHODS

We conducted a systematic review of observational studies, with the search last updated on 29 April 2024. Primary outcome was total sleep time (TST), with secondary outcomes including time in bed (TIB), sleep latency, sleep efficiency, wake after sleep onset, nighttime awakenings and self-reported sleep quality. Random-effects pairwise meta-analyses were used to summarise the effects of each outcome.

RESULTS

Nineteen studies were included, with 18 contributing to the meta-analyses (202 CHR-P, 584 SSD, 582 HC). TST results were inconclusive for CHR-P (MD -4.88 min (95% CI -20.57 to 10.81)), while SSD participants showed an increase in TST compared with HC (MD 106.13 min (86.02 to 124.24)). Factors such as antipsychotic medications (pseudo-R²=88.14%), age (38.89%) and gender (26.29%) partially explained the heterogeneity between subgroups. Additionally, CHR-P individuals exhibited reduced sleep efficiency (MD -2.04% (-3.55 to 0.53)), whereas SSD participants had increased TIB (MD 121.58 min (88.16 to 155.00)) and sleep latency (MD 13.05 min (2.11 to 24.00)). The risk-of-bias assessment ranged from some concerns to high risk.

CONCLUSIONS

Our analyses identified sleep abnormalities in CHR-P and SSD compared with placebo. However, observed heterogeneity and potential biases across studies may limit the interpretability of findings. These limitations underscore the need for standardised guidelines and more precise participant stratification.

Mapping the exposome of mental health: exposome-wide association study of mental health outcomes among UK Biobank participants

BACKGROUND

Dissecting the exposome linked to mental health outcomes can help identify potentially modifiable targets to improve mental well-being. However, the multiplicity of exposures and the complexity of mental health phenotypes pose a challenge that requires data-driven approaches.

METHODS

Guided by our previous systematic approach, we conducted hypothesis-free exposome-wide analyses to identify factors associated with 7 psychiatric diagnostic domains and 19 symptom dimensions in 157,298 participants from the UK Biobank Mental Health Survey. After quality control, 294 environmental, lifestyle, behavioral, and economic variables were included. An Exposome-Wide Association Study was conducted per outcome in two equally split datasets. Variables associated with each outcome were then tested in a multivariable model.

RESULTS

Across all diagnostic domains and symptom dimensions, the top three exposures were childhood adversities and traumatic events. Cannabis use was associated with common psychiatric disorders (depressive, anxiety, psychotic, and bipolar manic disorders), with ORs ranging from 1.10 to 1.79 in the multivariable models. Additionally, differential associations were identified between specific outcomes-such as neurodevelopmental disorders, eating disorders, and self-harm behaviors-and exposures, including early life experiences (being adopted), lifestyle (time spent using computers), and dietary habits (vegetarian diet).

CONCLUSIONS

This comprehensive mapping of the exposome revealed that several factors, particularly in the domains of those previously well-studied were shared across mental health phenotypes, providing further support for transdiagnostic pathoetiology. Our findings also showed that distinct relations might exist. Continued exposome research through multimodal mechanistic studies guided by the transdiagnostic mental health framework is required to better inform public health policies.

Sleep duration in adolescence buffers the impact of childhood trauma on anxiety and depressive symptoms

BACKGROUND

Childhood trauma is a pervasive issue contributing to adverse mental health outcomes. Obtaining optimal sleep supports healthy development and protects against mood-related disorders. Whether sleep serves as a potential buffer between trauma and adverse mental health outcomes holds promise for informing targeted interventions and prevention for adolescents.

METHODS

Data were drawn from the baseline assessment of a randomised controlled trial of a mental health prevention program. A total sample of 752 adolescents completed an online, self-report survey in 2023. Participants were students (Mage=13.8 years), attending independent schools in Australia and comprised of 37% girls and 60% boys. Australian sleep guidelines were used to dichotomise nightly sleep duration into whether adolescents met, or did not meet, the sleep guidelines for their age. Mixed-effects linear regression was used to examine whether sleep moderated the association between trauma and symptoms of anxiety, depression, and mental wellbeing.

RESULTS

The majority of participants (82%) reported exposure to at least one traumatic event. The mean number of traumatic events was 1.8. Trauma was independently associated with higher depressive and anxiety symptoms and lower mental wellbeing scores. Those reporting exposure to one or more traumatic events were more likely to report difficulties falling asleep and less likely to report meeting nightly sleep duration guidelines. We found a significant interaction between meeting nightly sleep duration guidelines and any trauma exposure on depressive and anxiety scores, such that depression and anxiety symptoms were lower in trauma-exposed adolescents who met sleep duration guidelines compared to those who did not meet sleep guidelines.

CONCLUSIONS

Obtaining optimal amounts of sleep each night may help mitigate anxiety and depressive symptoms for non-clinical adolescents exposed to trauma, however, longitudinal research is needed to confirm the directionality of the relationships between trauma, sleep, and mental health symptoms. Future research should examine the effectiveness of public health interventions targeting sleep behaviours in adolescents to promote mental wellbeing.

Influence of sleep duration and quality on depression symptoms among nurses during the Omicron outbreak: a cross-sectional survey

BACKGROUND

Nurses who work during the global pandemic are known to experience physical and psychological exhaustion, as well as severe anxiety and depression symptoms. This study aimed to explore the relationships between sleep duration, sleep quality, and depression symptoms among nurses during the outbreak of the Omicron variant.

METHODS

A cross-sectional study was conducted between August 2022 and September 2022. Participants (N = 2140) were evaluated for depression symptoms via the Hospital Anxiety and Depression Scale (HADS), and sleep was evaluated via the Pittsburgh Sleep Quality Index (PSQI), and "short sleep duration" was defined as ≤ 5 h per day. Demographic information was also collected. Binary and multivariate logistic regression was performed to assess the relationships between sleep duration, sleep quality, and depression symptoms.

RESULTS

In total, 2140 nurses were included in this study; 1481 (69.2%) had poor sleep quality, while 866 (40.4%) had depression symptom scores > 7 according to the HADS criteria. Both duration and quality of sleep were significantly correlated with depression symptoms among nurses (P < 0.001). In multivariable analyses adjusted for potential confounders, short sleep duration (≤ 5 h) was associated with an odds ratio (OR) of 2.26 (95% confidence interval [CI] 1.25-4.07), whereas poorer sleep quality was associated with an OR of 1.97 (95% CI 1.32-2.94) for experiencing depression symptoms.

CONCLUSIONS

Following the COVID-19 pandemic, there was a strong association between the sleep quality, sleep duration and depression symptoms among nurses. We recommend the development of targeted interventions to increase sleep duration, enhance sleep quality and alleviate depression symptoms.

Sleep and physical activity patterns in relation to daily-life symptoms in psychosis: An actigraphy and experience sampling study

Sleep disturbances and reduced physical activity (PA) are important risk factors for poor physical and mental health outcomes in people with psychosis. However, the precise interrelations between sleep, PA and psychopathology remain unclear. This study combined experience sampling (ESM) and actigraphy in thirty-two patients with a schizophrenia spectrum disorder to investigate interrelations of day-to-day variations in actigraphic estimates of PA and sleep and psychotic and affective symptoms. Multilevel mixed-models show that subjects reported more positive affect on more physically active days. Unexpectedly, participants reported worse next-day negative affect and/or psychotic symptoms after nights with higher sleep continuity, as consistently indicated by sleep efficiency and the mean duration of bouts of wake and sleep. Lastly, PA was higher after nights with higher sleep continuity and shorter total sleep duration. These results highlight that modifiable lifestyle factors such as PA and sleep have an intricate, but clinically relevant relationship with psychotic and affective symptoms. Future studies are needed to further examine the complex effects of these behaviors in order to develop effective, targeted treatment strategies to improve clinical outcome in psychosis.

The role of hyperarousal for understanding the associations between sleep problems and emotional symptoms in family caregivers of people with dementia. A network analysis approach

Caregiving for a family member with dementia is a stressful situation that has been associated with symptoms of depression, anxiety, and insomnia. Several models have highlighted the role of hyperarousal for understanding sleep disorders; however, there is little evidence about how insomnia, depression, and anxiety are linked together. Network analysis could help to explore the mechanisms underlying the associations between these disorders. A total of 368 community-dwelling family caregivers of a person with dementia took part in the study. The depression-anxiety-sleep symptoms network was composed of 26 items using the R package qgraph to estimate and visualise the network. The results showed that the strongest symptoms in the network were shakiness, tension, restlessness, nervousness, and restless sleep. Tension was the symptom with the most predictive power, restless sleep was the most important shortcut node in the connection between other symptoms. The central stability coefficient showed adequate indices. The strength of hyperarousal symptoms suggested a prominent role of this variable. Our results invite the hypothesis that sleep problems may trigger symptoms specific to depression via fatigue or energy loss. This study is the first to examine the network structure of the associations between the symptoms of depression, anxiety, and insomnia in a sample of informal caregivers, and to explore the role of hyperarousal in this network.

Sleep as a possible mediator in the association of mental health parameters with cardiovascular health indices in women: exploratory analyses from the Heart SCORE Study

OBJECTIVE

This exploratory study aimed to determine the possible role of sleep in the relationships of depression and anxiety, with early surrogate markers of subclinical atherosclerosis, such as brachial artery (BA) diameter and carotid intima media thickness (CIMT) in women.

METHODS

We included 1,075 self-reported postmenopausal women, 45 to 75 years from the Heart Strategies Concentrating on Risk Evaluation Study. Exposure variables were depression and anxiety assessed using the Center for Epidemiologic Studies Depression Scale and the State-Trait Anxiety Inventory, respectively. Outcome variables were BA diameter and CIMT measured using ultrasonography. The mediator, sleep, was assessed with the Pittsburgh Sleep Symptom Questionnaire-Insomnia. Ordinary least squares regression was used for mediation analyses.

RESULTS

Of the 1,075 participants, 56.3% were White and 43.7% were Black. Our analyses revealed significant associations of depression and anxiety with sleep ( P < 0.001 for all). After adjusting for confounders, depression was associated with max CIMT (R 2 = 0.15, P = 0.004), but not BA diameter (R 2 = 0.09, P = 0.083). Although the mediating role of sleep in the association between anxiety and BA diameter was not statistically significant [proportion mediated (CI); 0.41 (-2.77, 4.06); P = 0.219], we observed differential results within each racial group. Sleep appeared to partially mediate the association of anxiety with BA diameter in White [0.21 (0.54, 0.80); P = 0.044] women only.

CONCLUSIONS

We found preliminary indications that sleep might mediate the association of anxiety with BA diameter in White women but does not appear to serve as a mediator in all the other relationships we examined.

Subjective sleep quality, but not objective sleep measures, mediates the relationship between pre-sleep worrying and affective wellbeing

Pre-sleep worrying is associated with sleep disturbance, which in turn is associated with impaired affective wellbeing. However, studies examining the fine-grained temporal order of these variables are still lacking. In particular, within-person mediation of the association between pre-sleep worrying and the following day's affective wellbeing by subjective and objective indicators of sleep has not been tested yet. This study investigates the extent to which pre-sleep worrying predicts positive/negative affect the following day, and whether subjective/objective sleep disturbances are possible mediators for this relationship. Data from two experience sampling studies were pooled for the analyses, resulting in a total sample of 220 participants aged between 18 and 30 years (M = 23.2 years, SD = 2.8). The hypotheses were tested at both the between- and within-subject level using causal mediation analysis. The within-subject analyses revealed partial mediation of the relationship between pre-sleep worrying and positive as well as negative affect the next day by subjective sleep quality. By contrast, sleep as measured by actigraphy appears not to be relevant for the link between pre-sleep worrying and affective wellbeing the following day. Baseline levels of depressive symptoms and sleep disturbances did not moderate the associations between pre-sleep worrying, sleep indices and affective states the following day. Improving perceived sleep quality by addressing pre-sleep worrying could be a potential avenue to enhance affective wellbeing and promote better mental health in young adults.

A sensor-based study on the environmental determinants of sleep in older adults

INTRODUCTION

The residential environment is hypothesized to influence sleep quality within urban settings. Factors associated with the residential environment include air and noise pollution, area socioeconomic status, green and blue spaces, and other neighborhood features. This study seeks to quantify the association of selected environmental factors with sleep quality in the daily lives of 211 older adults residing in the Paris metropolitan area with sensor-based methods.

METHODS

Participants' sleep and physical activity were monitored over a 7-day period using 2 accelerometers. Ecological momentary assessment (EMA) surveys were administered 4 times a day to assess depressive and anxiety symptoms. Environmental factors surrounding participants residential addresses, including noise and air pollution, walkability, green and blue space availability, median income, and population density, were computed using geoprocessing methods. Hierarchical mixed models with a random intercept at the individual level were fitted to estimate the adjusted association between residential environmental factors and sleep outcomes [total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO)]. Potential effect modification of or mediation by physical activity and depression and anxiety levels were explored in the analyses.

RESULTS

We observed an effect size of 1.4 more minutes of sleep for each increase of one thousand euro in neighborhood median income (Confidence Intervals: 0.35, 2.45). The average adjusted difference in total sleep time between the 10th and 90th percentiles of neighborhood median income was 23.6 minutes of sleep. Other environmental factors and depression and anxiety levels did not exhibit correlations with sleep outcomes.

CONCLUSIONS

The results reveal a positive association between median income at the residential level and TST, while no associations were identified for SE and WASO. In conclusion, these findings underscore the impact of neighborhood socioeconomic status on total sleep time within the context of urban living, highlighting the need for further research.

Latent profile analysis of transdiagnostic emotional distress, suicidality, and resilience in first responders

BACKGROUND

First responders (i.e., law enforcement officers, firefighters, and emergency medical technicians/paramedics), experience significantly higher occupational trauma exposure than U.S. adult workers outside these fields, leading to increased risks of comorbid mental health disorders. Repeated and intense trauma exposure may combine with personal factors to place them at higher risk for suicide. Conversely, first responders may show higher levels of psychological resilience in the face of occupational trauma experiences. Some research exists on resilience, though little is known about suicide resilience in first responder populations.

METHODS

We used latent profile analysis (LPA) on a treatment-seeking sample of first responders (N = 340) with measures of posttraumatic stress disorder (PTSD), generalized anxiety, depression, suicidality, and resilience.

RESULTS

We determined the best fit was a five-class solution, including the following emotional distress categories: minimal (19 %), mild (33 %), moderate (8 %), moderately severe (27 %), and severe (13 %) emotional distress. In this study, all multivariate analyses of variance (MANOVAs) were statistically significant and had large effect sizes ranging from the lowest (resilience) to the largest (depression).

LIMITATIONS

We used self-report assessments and not a clinical interview. Also, we did not have data on measures of substance use, emotional dysregulation (e.g., attachment), or trauma exposure.

CONCLUSIONS

This study underscores the critical need for developing and implementing transdiagnostic interventions that not only address the spectrum of emotional distress and suicidality but also actively enhance resilience among treatment-seeking first responders.

Do patients with severe acne vulgaris prefer the evening chronotype more? A case-control study

This study aimed to investigate sleep quality, chronotype preferences, anxiety, and depression levels in patients diagnosed with acne vulgaris and compare them with healthy controls. This cross-sectional case-control study included 92 patients with acne vulgaris and 59 age- and sex-matched healthy controls. Acne severity was assessed using the Global Acne Grading System (GAGS); sleep quality using the Pittsburgh Sleep Quality Index (PSQI); chronotype preferences using the Morningness-Eveningness Questionnaire (MEQ); and anxiety and depression levels using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). There were no significant differences in the MEQ, BDI, or BAI scores between the two groups. The PSQI score was significantly higher in the patient group than that in the control group. Acne severity was negatively correlated with the MEQ scores and positively correlated with the PSQI scores. When the patient group was divided into three subgroups according to acne severity (mild, moderate, and severe), significant differences in MEQ and BAI scores were observed between the groups. According to the post-hoc analysis, the severe acne group had higher BAI scores, while the mild acne group had higher MEQ scores. It would be more appropriate to be aware of the potential psychiatric comorbidities of acne vulgaris and adopt a multidisciplinary approach to the treatment and management process.

The Role of Essential Oils on Sleep Quality and Other Sleep-related Issues: Evidence from Clinical Trials

Essential oils (EOs) are a volatile mixture of bioactive compounds extracted from aromatic plants. The composition of EOs varies, which majorly depends on the extraction methods and plant parts. Aromatherapy using EOs has been reported for its several beneficial effects in humans. Aromatherapy is considered a complementary and/ or adjuvant therapeutic approach for treating several illnesses, especially to improve mental health and well-being. The incidence of sleep disorders, specifically insomnia, is nowadays increased, possibly due to urbanization and lifestyle. The studies showed that EOs-based treatments using lavender EO, bergamot EO, cinnamon EO, and rosemary EO (alone or in combinations) could improve sleep quality, duration, and deprivation in healthy subjects and patients, those who suffer from sleep-related issues. The current manuscript details the outcomes of EO-based treatments on the sleep quality of humans and the possible mechanisms associated with the health-promoting properties of EOs. Also, the toxicity and adverse effects of EOs have been discussed. The study indicated that EOs are potent adjuvant therapeutic candidates to manage mood-associated complications in humans. Moreover, the aromatherapeutic field requires detailed studies on toxicity and dose determination, which could provide safe and effective therapeutic results.

Assessing the reliability and validity of sleep assessments in patients seeking metabolic and bariatric surgery

BACKGROUND

More than 80% of patients seeking metabolic and bariatric surgery (MBS) report disturbance in sleep function. No studies have assessed the psychometric properties of sleep measures in MBS samples.

OBJECTIVES

This study assessed the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) in a large sample of patients seeking MBS.

SETTING

Two academic medical centers.

METHODS

Measures of sleep (PSQI and ISI) and psychological functioning, including the Quick Inventory of Depressive Symptomatology (QIDS), were administered presurgically. Internal consistency was assessed with mean inter-item correlations and item-total correlations. Construct validity was assessed using confirmatory factor analyses (CFAs) based on models identified in the literature and by measuring convergent and discriminant validity.

RESULTS

Participants (N = 939) were primarily female (83.4%) with a mean age of 41.7 (SD = 11.5) years and mean body mass index (BMI) of 47.5 kg/m2 (SD = 8.5). CFAs indicated excellent fit for 2-factor solutions for the PSQI and ISI. Internal consistency for the PSQI and ISI were acceptable. Convergent validity was demonstrated by large correlations between the PSQI and ISI (r = .80, p < .001), and moderate correlation between the PSQI, ISI, and QIDS (rs > .50, ps < .001). The PSQI and ISI were moderately correlated with QIDS items assessing sleep function (P < .001), but correlations with items assessing appetite change were small (r < .10), demonstrating good discriminant validity.

CONCLUSIONS

Results support the reliability and validity of the PSQI and ISI for patients undergoing MBS.

Sleep and circadian rhythms modeling: From hypothalamic regulatory networks to cortical dynamics and behavior

Sleep and circadian rhythms are regulated by dynamic physiologic processes that operate across multiple spatial and temporal scales. These include, but are not limited to, genetic oscillators, clearance of waste products from the brain, dynamic interplay among brain regions, and propagation of local dynamics across the cortex. The combination of these processes, modulated by environmental cues, such as light-dark cycles and work schedules, represents a complex multiscale system that regulates sleep-wake cycles and brain dynamics. Physiology-based mathematical models have successfully explained the mechanisms underpinning dynamics at specific scales and are a useful tool to investigate interactions across multiple scales. They can help answer questions such as how do electroencephalographic (EEG) features relate to subthalamic neuron activity? Or how are local cortical dynamics regulated by the homeostatic and circadian mechanisms? In this chapter, we review two types of models that are well-positioned to consider such interactions. Part I of the chapter focuses on the subthalamic sleep regulatory networks and a model of arousal dynamics capable of predicting sleep, circadian rhythms, and cognitive outputs. Part II presents a model of corticothalamic circuits, capable of predicting spatial and temporal EEG features. We then discuss existing approaches and unsolved challenges in developing unified multiscale models.

Assessing Sleep Disorders in an Inpatient Child and Adolescent Psychiatric Unit

Sleep and mental health have a strong relationship. There is a lack of training in Sleep Medicine for Psychiatrists. Sleep problems often accompany mental health issues, especially in children and adolescents on inpatient psychiatry units. Recognizing common sleep disorders is important in these settings. It is also important to involve pediatric sleep specialists when needed. This article addresses common sleep disorders observed in inpatient child and adolescent psychiatry units and outlines optimal management strategies.

Sleep quality and disruptive nocturnal behaviors as short-term predictors of suicidal intent: An ecological momentary assessment study

BACKGROUND

Emerging research suggests that poor sleep quality and some disruptive nocturnal behaviors (DNBs) may be advance markers of short-term worsening in suicidal intent. However, relationships between many types of DNBs and suicide risk have not been examined, and whether DNBs provide useful information apart from sleep quality in predicting suicidal intent is unknown. This study addressed these critical knowledge gaps by examining associations between sleep quality, DNBs, and next-day suicidal intent in a community sample of adults.

METHODS

A sample of 237 adults with severe suicidal ideation provided daily indices of sleep quality and DNBs, and suicidal intent 6 times per day for 2 weeks via ecological momentary assessment. Linear mixed models and general linear models were conducted to examine relationships between sleep quality and DNBs with measures of average severity of suicidal intent and fluctuations in intent over time.

RESULTS

Poor sleep quality and specific DNBs (sleep disruptions due to general nervousness, trauma-related memories and/or nightmares interrupting sleep, and non-trauma-related anxiety or panic) predicted more severe suicidal intent in multivariate models. Only poor sleep quality predicted within-day variability in suicidal intent.

CONCLUSIONS

These findings suggest that monitoring sleep quality and specific DNBs may be a useful indicator of short-term risk for worsening in suicidal intent.

Knockout of AMPA receptor binding protein Neuron-specific gene 2 (NSG2) enhances associative learning and cognitive flexibility

The vast majority of gene mutations and/or gene knockouts result in either no observable changes, or significant deficits in molecular, cellular, or organismal function. However, in a small number of cases, mutant animal models display enhancements in specific behaviors such as learning and memory. To date, most gene deletions shown to enhance cognitive ability generally affect a limited number of pathways such as NMDA receptor- and translation-dependent plasticity, or GABA receptor- and potassium channel-mediated inhibition. While endolysosomal trafficking of AMPA receptors is a critical mediator of synaptic plasticity, mutations in genes that affect AMPAR trafficking either have no effect or are deleterious for synaptic plasticity, learning and memory. NSG2 is one of the three-member family of Neuron-specific genes (NSG1-3), which have been shown to regulate endolysosomal trafficking of a number of proteins critical for neuronal function, including AMPAR subunits (GluA1-2). Based on these findings and the largely universal expression throughout mammalian brain, we predicted that genetic knockout of NSG2 would result in significant impairments across multiple behavioral modalities including motor, affective, and learning/memory paradigms. However, in the current study we show that loss of NSG2 had highly selective effects on associative learning and memory, leaving motor and affective behaviors intact. For instance, NSG2 KO animals performed equivalent to wild-type C57Bl/6n mice on rotarod and Catwalk motor tasks, and did not display alterations in anxiety-like behavior on open field and elevated zero maze tasks. However, NSG2 KO animals demonstrated enhanced recall in the Morris water maze, accelerated reversal learning in a touch-screen task, and accelerated acquisition and enhanced recall on a Trace Fear Conditioning task. Together, these data point to a specific involvement of NSG2 on multiple types of associative learning, and expand the repertoire of pathways that can be targeted for cognitive enhancement.

Understanding immune system dysfunction and its context in mood disorders: psychoneuroimmunoendocrinology and clinical interventions

Mood disorders include a set of psychiatric manifestations of increasing prevalence in our society, being mainly represented by major depressive disorder (MDD) and bipolar disorder (BD). The etiopathogenesis of mood disorders is extremely complex, with a wide spectrum of biological, psychological, and sociocultural factors being responsible for their appearance and development. In this sense, immune system dysfunction represents a key mechanism in the onset and pathophysiology of mood disorders, worsening mainly the central nervous system (neuroinflammation) and the periphery of the body (systemic inflammation). However, these alterations cannot be understood separately, but as part of a complex picture in which different factors and systems interact with each other. Psychoneuroimmunoendocrinology (PNIE) is the area responsible for studying the relationship between these elements and the impact of mind-body integration, placing the immune system as part of a whole. Thus, the dysfunction of the immune system is capable of influencing and activating different mechanisms that promote disruption of the psyche, damage to the nervous system, alterations to the endocrine and metabolic systems, and disruption of the microbiota and intestinal ecosystem, as well as of other organs and, in turn, all these mechanisms are responsible for inducing and enhancing the immune dysfunction. Similarly, the clinical approach to these patients is usually multidisciplinary, and the therapeutic arsenal includes different pharmacological (for example, antidepressants, antipsychotics, and lithium) and non-pharmacological (i.e., psychotherapy, lifestyle, and electroconvulsive therapy) treatments. These interventions also modulate the immune system and other elements of the PNIE in these patients, which may be interesting to understand the therapeutic success or failure of these approaches. In this sense, this review aims to delve into the relationship between immune dysfunction and mood disorders and their integration in the complex context of PNIE. Likewise, an attempt will be made to explore the effects on the immune system of different strategies available in the clinical approach to these patients, in order to identify the mechanisms described and their possible uses as biomarkers.