Hyperarousal and sleep reactivity in insomnia: current insights

Child maltreatment and insomnia symptoms among Chinese university students: the buffering role of self-efficacy

Insomnia symptoms represent a significant public health concern, as it engenders substantial long-term health consequences. Considerable research has established the detrimental impacts of child maltreatment on sleep problems among university students. However, the role of self-efficacy in the association between childhood maltreatment and insomnia remains unclear. This study aimed to examine the associations between child maltreatment and insomnia symptoms among university students, and to investigate whether self-efficacy moderated the effects of child maltreatment on insomnia symptoms. A total of 2014 participants with random cluster sampling method were recruited from Jinan University in Guangzhou, China, from October 2022 to November 2022. Adjusting for covariates, the results of multiple logistic regression indicated that the participants with the experience of any type of child maltreatment (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.63-3.07), childhood emotional abuse (OR 2.58, 95% CI 1.95-3.41), childhood emotional neglect (OR 1.16, 95% CI 0.87-1.54), childhood physical abuse (OR 2.15, 95% CI 1.60-2.8), childhood physical neglect (OR 2.19, 95% CI 1.64-2.92), childhood sexual abuse (OR 1.98, 95% CI 1.46-2.68) were more likely to report insomnia symptoms than those without. Individuals reporting one-two types and three-five types of child maltreatment were 1.81 times (95% CI 1.30-2.52) and 3.77 times (95% CI 2.58-5.50) more likely to report insomnia symptoms than those reporting zero types of child maltreatment, respectively. Furthermore, robust linear regression analysis revealed that self-efficacy moderated the associations between child maltreatment and insomnia symptoms (β = 0.007, 95% CI 0.004-0.010). These findings underscore the need for integrated mental health education, support services, and faculty training to address the impact of child maltreatment on insomnia symptoms among university students. Policy recommendations include advocating for comprehensive mental health services, incorporating self-efficacy initiatives, and fostering community engagement for a holistic approach to student well-being.

Neural Mechanisms in Cardiovascular Health and Disease

Although the neurocardiac axis is central to cardiovascular homeostasis, its dysregulation drives heart failure and cardiometabolic diseases. This review examines the bidirectional interplay between the autonomic nervous system and the heart, highlighting the role of this interplay in disease progression and its therapeutic potential. The autonomic nervous system modulates cardiac function and vascular tone through its sympathetic and parasympathetic branches. However, in heart failure, chronic sympathetic overdrive and parasympathetic withdrawal exacerbate myocardial remodeling and metabolic dysfunction, both of which are exacerbated by cardiometabolic conditions such as obesity and diabetes. These conditions are increasingly recognized to impair neurocardiac regulation, thereby promoting inflammation and adverse outcomes. An important emerging area concerns neuroimmune control, in which the brain orchestrates systemic inflammation through circuits involving the bone marrow, spleen, and other organs, thereby amplifying cardiovascular damage. This neuroimmune axis integrates peripheral signals to influence immune responses that contribute to disease progression. Lifestyle factors, such as stress, sleep, exercise, and diet, affect autonomic and immune balance and, thus, cardiovascular disease. Therapeutically, targeting neurocardiac and neuroimmune pathways pharmacologically or via neuromodulation (eg, vagal or splenic nerve stimulation) offers promise although the clinical translation of the latter remains challenging. In this review, we synthesize preclinical and clinical data to highlight the neurocardiac axis as a critical nexus in heart failure and cardiometabolic disease. Harnessing neuroimmune and neurocardiac interactions may inform precision approaches to reduce the burden of these conditions.

Cognitive behavioural therapy for sleep problems in psychosis: systematic review of effectiveness and acceptability

BACKGROUND

Sleep problems are common among people with psychosis. Research suggests poor sleep is causally related to psychosis, anxiety and depression.

AIMS

This review investigates the effectiveness and acceptability of cognitive-behavioural therapy (CBT) in targeting sleep problems in people with and at risk of psychosis.

METHOD

Four databases were searched in line with PRISMA guidelines. Eligible studies either evaluated (a) CBT targeting sleep problems in people with or at risk of psychosis, or (b) subjective experiences of this treatment. Articles not published in peer-review journals were excluded. Treatment effectiveness was investigated for sleep, psychosis and other clinical outcomes. Acceptability was evaluated using qualitative data, drop-out rates, adverse events and relevant questionnaires. Adaptations to standard treatment protocols were described. Research quality was appraised using Cochrane Risk of Bias tools for randomised and non-randomised trials, and a checklist was developed for qualitative papers.

RESULTS

Of the 975 records identified, 14 were eligible. The most common CBT target was insomnia. Treatment protocols were typically adapted by omitting sleep restriction. Large effect sizes were reported for sleep outcomes; however, effects for other clinical outcomes were less clear. Qualitative data and acceptability outcomes suggest that treatment was received positively by participants.

CONCLUSIONS

CBT is an effective and acceptable treatment for sleep problems in people with and at risk of psychosis. However, our conclusions are limited by few good-quality studies and small samples. Further gold-standard research is required to inform evidence-based guidelines.

Perceived Stress and Clinical Insomnia in Primary Care: Associations with Lifestyle and Medication Use

Purpose

Insomnia and perceived stress are among the most prevalent health concerns in primary care, yet their complex relationship remains underexplored. This study examines the association between perceived stress and insomnia severity, while considering the potential moderating or mediating effects of lifestyle factors and medication use.

Methods

A cross-sectional study was conducted with 300 consecutive primary care patients who completed validated questionnaires assessing insomnia severity (Insomnia Severity Index, ISI) and perceived stress (Perceived Stress Scale, PSS). Logistic regression models were employed to identify predictors of clinical insomnia and explore key relationships.

Results

A moderate but statistically significant correlation (r = 0.460, p < 0.001) was observed between perceived stress and insomnia severity. In logistic regression analysis, higher perceived stress scores (OR = 1.134, p < 0.001) and hypnotic medication use (OR = 3.220, p < 0.001) were significant predictors of clinical insomnia. Interestingly, alcohol consumption was unexpectedly associated with insomnia (OR = 0.551, p = 0.048), warranting further exploration. No significant associations were found for caffeine intake, tobacco use, or demographic variables. The model explained 33% of the variance in insomnia (Nagelkerke R² = 0.328).

Conclusion

These findings highlight the significant role of perceived stress in insomnia severity and underscore the complex interplay between pharmacological interventions and sleep disturbances. While hypnotic medications are commonly used, their long-term impact and potential dependence require careful consideration. Integrating stress-reduction strategies into primary care may improve insomnia management while reducing reliance on pharmacological treatments. Future research should employ longitudinal designs to clarify causality and further explore additional factors influencing sleep disturbances.

The Psychopathology of Problematic Smartphone Use (PSU): A Narrative Review of Burden, Mediating Factors, and Prevention

Background & Aims

Problematic smartphone use (PSU) has emerged as a growing public health concern, with increasing evidence linking it to mental health issues such as anxiety, depression, and sleep disturbances. While smartphones offer numerous benefits, excessive use can contribute to cognitive overload, emotional distress, and behavioral addiction. This review aims to explore the burden of PSU, its psychological and neurobiological mediating factors, and potential prevention and intervention strategies.

Methods

A narrative literature review was conducted using relevant studies from PubMed, Scopus, and Google Scholar. Articles were selected based on their relevance to PSU and its associations with mental health conditions, including depression, anxiety, and insomnia. Both theoretical and empirical studies were included to provide a broad perspective on the topic.

Results

Findings indicate that PSU is associated with increased stress, anxiety, depression, and sleep disruptions. The mechanisms underlying these associations include dopaminergic dysregulation, social comparison, Fear of Missing Out, cognitive overload, and poor sleep hygiene. Various interventions, such as cognitive-behavioral therapy, digital detox programs, and smartphone usage tracking applications, have been proposed to mitigate the negative impact of PSU.

Conclusion

PSU is a significant risk factor for mental health disturbances, particularly among adolescents and young adults. Addressing PSU requires a multi-faceted approach involving behavioral interventions, public awareness initiatives, and policy regulations. Further research is needed to assess the long-term effectiveness of existing interventions and to develop tailored strategies for reducing smartphone overuse and its psychological consequences.

Effect of high-intensity interval training exercise on sleep quality in women with probable post-traumatic stress disorder: A pilot randomized controlled trial

Poor sleep quality is a major problem for women with post-traumatic stress disorder (PTSD). Potential causes of poor sleep quality include elevated symptoms of anxiety, hyperarousal, and decreased high frequency-heart rate variability (HF-HRV). Exercise training both decreases anxiety symptoms and increases HF-HRV among samples without PTSD. The effect of exercise training on sleep quality, HF-HRV and PTSD-related symptoms has not been tested in a sample of women exposed to trauma. This study aimed to evaluate the impact of High-Intensity Interval Training (HIIT) on sleep quality in a sample of women with probable PTSD and test if reductions in anxiety or hyperarousal symptoms and/or increased HF-HRV mediate improved sleep quality. Thirty women with poor sleep quality and a Post-Traumatic Diagnostic Scale (PDS-5) score indicative of PTSD (≥ 28) were randomly assigned to either six-weeks of HIIT or a waitlist control (WL). Sleep quality, PTSD and anxiety symptoms were assessed at baseline (BL), weeks 2, 4, 6, and post-intervention (POST). HF-HRV was measured at BL and POST. A mixed model ANOVA 2 group × 5 time interaction for sleep quality was significant (p < 0.001; HIIT BL: 11.27 ± 2.55; POST: 5.60 ± 2.03 versus WL BL: 9.47 ± 2.83; POST: 8.23 ± 2.39; Hedges' d = -1.57). Anxiety and hyperarousal symptom reductions significantly mediated sleep quality changes. HF-HRV mediation models were non-significant. HIIT-based cycle exercise training in a sample of women with probable PTSD improves sleep quality, and reductions in trait anxiety and hyperarousal symptoms mediated these improvements. CLINICAL TRIAL REGISTRATION: (Clinical Trials. gov) Identifier: NCT05097352.

Evaluation of alpha neurofeedback training to enhance sleep in remitted depression and anxiety sufferers with persistent insomnia

This study evaluates whether neurofeedback training (NFT) to boost alpha wave activity in the central brain may effectively mitigate persistent insomnia in patients with remitted depression and anxiety. Thirty-two participants in clinical remission from depression or anxiety were enrolled and evaluated for insomnia severity. Individuals were randomly assigned in a single-blinded manner to either NFT or the sham treatment. The effectiveness of the intervention was measured using recognized scales for depression, anxiety and sleep quality. While subjective sleep quality, measured by the PSQI, showed significant improvements in the active group compared to the sham group at post training, 1-month, 3-month, and 6-month follow-up, objective measures of sleep quality largely remained within the normal range, with few significant changes observed. Specifically, the active group exhibited notable improvements in alpha amplitude and duration during NFT sessions, which were not seen in the sham group. This highlights the potential of NFT as a complementary approach for improving sleep perception in this population, but further research is needed to confirm its effects on actual sleep architecture and long-term outcomes.

Migraine and sleep apnea, insomnia, and sleep patterns in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

OBJECTIVE

To quantify the prevalence of migraine and examine its association with sleep disorders, patterns, and symptoms in adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We hypothesized that migraine would be associated with insomnia but not sleep apnea.

BACKGROUND

Sparse research has examined migraine prevalence and sleep comorbidities in underrepresented racial and ethnic groups in the United States. Hispanic/Latino adults in the United States may be at risk for worse health outcomes due to disparities in health-care access and socioeconomic stressors.

METHODS

We analyzed data collected during the baseline examination (March 2008-June 2011) from the HCHS/SOL, a community-based cohort study of self-identified Hispanic/Latino adults in the United States. The exposure was self-reported medical diagnosis of migraine, and primary outcomes were obstructive sleep apnea (apnea-hypopnea index ≥ 15 events/h from at-home sleep testing) and insomnia (≥ 9 on the Women's Health Initiative Insomnia Rating Scale). Exploratory outcomes included self-reported sleep duration, timing, sleeping pill use, and naps. We compared weighted differences in outcomes by migraine status, adjusting for age and sex in all reported models.

RESULTS

Our analytical sample included HCHS/SOL participants who completed questionnaires on sleep and migraine (16,325). The mean age (standard deviation) was 41.1 (31.7) years, 52.2% identified as female, and 39.5% had a body mass index ≥ 30 kg/m2. Lifetime prevalence of migraine was 15.9% (95% confidence interval [CI]: 15.0, 16.8; 23.6% [95% CI: 22.2, 25.0] of females and 7.5% [95% CI:6.6, 8.5] of males). Those with migraine were more likely to be unemployed (50.8% vs. 36.2%) and to have a household yearly income of < $20,000 (50.9% vs. 45.5%). There was no association between migraine and obstructive sleep apnea (odds ratio [OR] 0.98 [95% CI: 0.76, 1.26]) or napping (OR 0.92 [95% CI: 0.81, 1.06]). Compared to individuals without migraine, those with migraine were more likely to have insomnia (OR = 1.87; 95% CI: 1.62, 2.15) and to use sleeping pills (OR = 2.16; 95% CI: 1.80, 2.60) in sex- and age-adjusted models. Individuals with migraine also had shorter mean sleep duration (7.88 ± 2.5 h vs. 8.00 ± 2.1 h, β = -0.20; 95% CI: -0.30, -0.09) and later bedtimes (11:28 p.m. ± 5.1 h vs. 11:17 p.m. ± 4.2 h, β = 16.85; 95% CI: 3.58, 30.13; weekdays) in sex- and age-adjusted models.

CONCLUSION

Self-reported medical diagnosis of migraine is common in Hispanic/Latino adults, especially females. Migraine is not associated with obstructive sleep apnea. Consistent with non-Hispanic/Latino populations, migraine is associated with insomnia in the HCHS/SOL.

Financial stress and sleep duration in immune and neuroendocrine patterning. An analytical triangulation in ELSA

BACKGROUND

Proinflammatory and neuroendocrine mediators are implicated in disease aetiopathogenesis. Stress increases concentrations of immune-neuroendocrine biomarkers through a complex network of brain-body signalling pathways. Suboptimal sleep further modulates these processes by altering major effector systems that sensitise the brain to stress. Given the ubiquitous, impactful nature of material deprivation, we tested for a synergistic association of financial stress and suboptimal sleep with these molecular processes.

METHODS

With data drawn from the English Longitudinal Study of Ageing (ELSA), associations were tested on 4,940 participants (∼66 ± 9.4 years) across four-years (2008-2012). Through analytical triangulation, we tested whether financial stress (>60% insufficient resources) and suboptimal sleep (≤5 / ≥9  h) were independently and interactively associated with immune-neuroendocrine profiles, derived from a latent profile analysis (LPA) of C-reactive protein, fibrinogen, white blood cell counts, hair cortisol, and insulin-like growth factor-1.

RESULTS

A three-class LPA model offered the greatest parsimony. After adjustment for genetic predisposition, sociodemographics, lifestyle, and health, financial stress was associated with short-sleep cross-sectionally (RRR = 1.45; 95% CI = 1.18-1.79; p < 0.001) and longitudinally (RRR = 1.31; 95% CI = 1.02-1.68; p = 0.035), and it increased risk of belonging to the high-risk inflammatory profile by 42% (95% CI = 1.12-1.80; p = 0.004). Suboptimal sleep was not related to future risk of high-risk profile membership, nor did it moderate financial stress-biomarker profile associations.

DISCUSSION

Results advance psychoneuroimmunological knowledge by revealing how inflammation and neuroendocrine markers cluster in older cohorts and respond to financial stress over time. Financial stress associations with short-sleep are supported. The null role of suboptimal sleep, as exposure and mediator, in profile membership, provides valuable insight into the dynamic role of sleep in immune-neuroendocrine processes.

Associations Between Sleep Disorders and Treatment Response in Service Members With Post-traumatic Stress Symptoms: A Secondary Outcome Analysis

INTRODUCTION

Compared with the civilian population, a higher rate of reported sleep apnea exists among military service members resulting in inadequate sleep. Those who experience chronic sleep deprivation may suffer from debilitating problems that may compromise military mission readiness and unit safety. The purpose of the study on which this secondary outcome analysis was based was to evaluate the effect of manual standardized stress acupuncture as an adjunct therapy to an abbreviated form of cognitive behavioral therapy for insomnia for sleep disturbances in post-deployment service members. The aim of this secondary outcome analysis was 2-fold: (1) to assess the relationship between sleep disorder symptoms and post-traumatic stress symptoms (PSS) and (2) to determine if the presence of sleep disorder symptoms influenced the effects of acupuncture and cognitive behavioral therapy as compared to cognitive behavior therapy only on PSS) in post-deployment military service members.

MATERIALS AND METHODS

The study was a 2-arm, single-center, randomized controlled trial approved by the Naval Medical Center San Diego and the Vanderbilt University Institutional Review Board. It was conducted at the U.S. Naval Hospital in Okinawa, Japan. Participants were active duty service members from all military branches who were stationed in Okinawa. Two measures were used to analyze the data: the Global Sleep Assessment Questionnaire (GSAQ) and the Post-traumatic Stress Disorder Checklist. A Pearson correlation coefficient was calculated to determine the relationship between sleep disorder symptoms (i.e., 11 pre-intervention GSAQ symptoms) and PSS treatment outcomes (i.e., PCL and PTSD clusters).

RESULTS

Results indicated associations between the GSAQ components and PCL total and PTSD cluster scores. Findings showed that the presence of sleep disorder symptoms influenced PSS treatment response in post-deployment military service members.

CONCLUSIONS

Results from this secondary outcome analysis showed associations between GSAQ components (i.e., excessive daytime sleepiness, working conditions causing inadequate sleep, involuntary movements in sleep, and sadness or anxiousness) and PCL total and PTSD cluster scores (i.e., avoidance, negative cognition and mood, avoidance, and hyperarousal). Furthermore, sleep disorder symptoms such as having stressful working conditions (e.g., shift work), probable obstructive sleep apnea, insomnia, anxiety, and depression influenced PSS treatment responses. This study provided information on the major contribution of sleep disorder symptoms in the treatment of PSS through self-report. Future researchers should consider the use of physiologic measures to further understand the mechanisms of how sleep disorder symptoms affect treatment responses in service members with PSS. Implications for this study may assist clinicians in determining effective PSS treatments for those with OSA and insomnia.

Pharmacological and psychological approaches to insomnia treatment in cardiac patients: a narrative literature review

Sleep disorders are highly prevalent in the general population and are considered a major public health issue. Insomnia constitutes the most frequent sleep disorder in healthy individuals and has been shown to be even more frequent in patients with physical illnesses including cardiovascular diseases. Inadequate sleep quality and short sleep duration, independent of underlying causes, have been linked to the development and progression of cardiometabolic disorders. Additionally, insomnia has been found to be associated with adverse outcome measures, including daytime sleepiness, fatigue, decreased self-reported physical functioning, lower exercise capacity, poor health related quality of life, depressive symptoms, higher rates of hospitalization and increased mortality in patients with cardiovascular diseases. Against this background, comparatively little information is available in the literature regarding the treatment of chronic insomnia in cardiac patient populations. While guidelines for the general population suggest cognitive behavioral therapy for insomnia as a first-line treatment option and preliminary evidence suggests this treatment to be beneficial in cardiac patients with insomnia symptoms, it is often limited by availability and possibly the clinician's poor understanding of sleep issues in cardiac patients. Therefore, pharmacologic treatment remains an important option indicated by the high number of hypnotic drug prescriptions in the general population and in patients with cardiovascular disorders. In this narrative review of the literature, we summarize treatment options for chronic insomnia based on clinical guidelines for the general population and highlight necessary considerations for the treatment of patients with cardiovascular diseases.

The Role of Mature Brain-Derived Neurotrophic Factor and Its Precursor in Predicting Early-Onset Insomnia in Stroke Patients Experiencing Early Neurological Deterioration

Background

The investigation and management of early-onset insomnia (EOI) in patients undergoing early neurological deterioration (END) appear to be insufficiently prioritized in clinical practice. Brain-derived neurotrophic factor (mBDNF) and its precursor, proBDNF, play essential roles in neuroplasticity and may be involved in the pathophysiological mechanisms underlying EOI. This study aimed to investigate the associations of serum mBDNF, proBDNF, and the mBDNF/proBDNF ratio with EOI in stroke patients experiencing END.

Methods

In a prospective cohort study from October 2021 to December 2023, 232 stroke patients with END and 56 healthy controls (HCs) were enrolled. Serum levels of mBDNF and proBDNF were quantified using enzyme-linked immunosorbent assays. EOI was diagnosed according to the International Classification of Sleep Disorders, Third Edition (ICSD-3). Patients with END were categorized into subgroups based on the presence or absence EOI.

Results

Serum levels of mBDNF, proBDNF, and the mBDNF/proBDNF ratio were significantly lower in END patients compared to those in HCs (all p < 0.05). Among the 232 END patients, 82 (35.3%) developed EOI. Those with EOI had significantly lower levels of mBDNF and the mBDNF/proBDNF ratio compared to those without EOI (all p < 0.001). Multivariate logistic regression analysis revealed that male gender (p = 0.026), Hamilton Depression Rating Scale (HAMD) scores (p < 0.001), mBDNF (p = 0.009), and the mBDNF/proBDNF ratio (p < 0.001) were independent predictors of EOI in END patients. The areas under the curve (AUC) for mBDNF and the mBDNF/proBDNF ratio were 0.686 and 0.778, respectively.

Conclusion

Our study identified a correlation between reduced mBDNF levels and a decreased mBDNF/proBDNF ratio with the development of EOI in END patients. In addition, the mBDNF/proBDNF ratio may provide greater insight as a promising biomarker for EOI than mBDNF or proBDNF alone.

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.

Daily Associations Between Sleep Parameters and Depressive Symptoms in Individuals with Insomnia: Investigating Emotional Reactivity and Regulation as Mediators

OBJECTIVES

Previous research suggests that insomnia and depressive symptoms might be causally related. Emotional reactivity and regulation have been proposed to explain the potential causal relationship between insomnia and depression. However, longitudinal evaluations of their mediating effects are limited. Hence, the current study aimed to examine the mediating effects of emotional reactivity and regulation on the longitudinal associations between daily sleep parameters and depressive symptoms over 14 days in individuals with insomnia.

METHODS

Participants were sixty adults aged 18-65 who had clinically significant insomnia. They filled out a survey each morning and evening and wore actigraphy watches for 14 consecutive days. The five sleep parameters were measured by sleep diary in the morning survey (subjective total sleep time, subjective sleep efficiency, and sleep quality) and actigraphy watches (objective total sleep time and objective sleep efficiency). Emotional reactivity and emotion regulation strategy use during the day were assessed in the evening survey using the International Positive and Negative Affect Schedule Short Form, Emotion Regulation Questionnaire, and Cognitive Emotion Regulation Questionnaire. Depressive symptoms of the day were evaluated in the evening survey with the Center for Epidemiologic Studies Depression Scale.

RESULTS

Results showed that sleep quality and depressive symptoms, as well as actigraphy-measured sleep efficiency and depressive symptoms, predicted each other in individuals with insomnia, mediated by negative reactivity but not emotion regulation.

CONCLUSIONS

The present findings support the mediating role of negative emotional reactivity in the bidirectional, daily relationship between sleep parameters and depression in individuals with insomnia.

Association Between Sleep Reactivity, Pre-Sleep Arousal State, and Neuroendocrine Hormones in Patients with Chronic Insomnia Disorder

Purpose

The purpose of this study was to look into the relationship between pre-sleep arousal state, sleep reactivity, and serum levels of neuroendocrine hormones (cortisol, copeptin, and corticotropin-releasing hormone) in patients with chronic insomnia disorders (CID), and whether the effects of sleep reactivity and pre-sleep arousal on insomnia are related to the levels of these neuroendocrine hormones.

Patients and Methods

This study included 61 CID patients and 27 healthy controls (HC) whose base data were matched to those of the CID patients. The Pittsburgh Sleep Quality Index(PSQI), Pre-Sleep Arousal Scale (PSAS), and the Ford Insomnia Response to Stress Test (FIRST) were used to evaluate the participants' sleep, stress, and neuropsychological function. We measured the participants' serum concentration levels of cortisol, copeptin, and corticotropin-releasing hormone (CRH), using quantitative sandwich enzyme-linked immunosorbent assays.

Results

The CID group had significantly greater serum levels of copeptin, CRH, and cortisol, as well as higher FIRST and PSAS scores than the HC group. The partial correlation analysis revealed a substantial and positive association among cortisol, CRH, copeptin PSQI, PSAS, and FIRST after adjusting for sex, age, depression, and cognition. Principal component analysis showed that PSQI, FIRST, and PSAS, as well as cortisol, CRH, and copeptin, were all loaded on factor 1.

Conclusion

Patients with CID showed increased sleep reactivity and pre-sleep arousal, which correlated with serum levels of cortisol, copeptin, and CRH. Changes in neuroendocrine hormone levels may influence how pre-sleep arousal and sleep reactivity affect the development of insomnia.

Effect of combined Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults: A randomized controlled trial

BACKGROUND AND AIMS

Novel approaches to improve sleep disturbance in older adults are needed. Our study comprises a pioneering attempt to test the efficacy of Tai Chi (TC) combined with repetitive transcranial magnetic stimulation (rTMS) in improving sleep disturbance in older adults. The influence of baseline depressive symptoms was tested in a subset of the sample.

METHOD

In the randomized controlled trial, 152 participants were each allocated to one of the following groups: (1) TC plus active rTMS (n = 38), (2) TC plus sham rTMS (n = 38), (3) TC alone (n = 38), and (4) low-intensity physical exercise (PE) control group (n = 38). Four-week interventions were conducted for each group. The outcomes included insomnia severity, actigraphy-assessed and self-reported sleep parameters, mood states, and quality of life. Assessments were carried out at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).

RESULTS

Of the 152 randomized participants, the mean (SD) age was 67.68 (4.98) years, with 112 female (73.68%). The findings revealed that TC plus active rTMS induced a significant reduction in actigraphy-assessed sleep onset latency compared to TC plus sham rTMS at T1 and T2. In the subsample without depressive symptoms, the combination treatment exhibited a greater benefit in actigraphy-assessed sleep efficiency and wake time after sleep onset compared to both variables in the PE group and in the sham comparator group at T1, respectively. The other subsample with depressive symptoms showed the improvements with TC plus active rTMS, TC plus sham rTMS, and TC alone differed significantly from PE at T1 and T2.

CONCLUSIONS

This study has demonstrated the positive effect of TC combined with rTMS on sleep disturbance in older adults. Specific sample characteristics should be considered when applying TC, either alone or combined with rTMS.

Profiles of community support and challenges associated with insomnia symptoms: Findings from the pilot Bhutanese Community of Central Ohio Health Study

STUDY OBJECTIVES

We investigated profiles of community support and challenges in relation to insomnia symptoms among the Bhutanese living in the United States.

METHODS

Using data from the pilot Bhutanese Community of Central Ohio Health Study (N = 495; 51.5% men, 69.8% aged 18-44years), we used latent class analysis to identify distinct profiles of neighborhood social cohesion, social support, and community challenges (e.g., limited access to healthcare services and transportation, crime and safety issues, substance use, intimate partner violence) and their associations with insomnia symptoms. Insomnia symptoms were self-reported as difficulty falling and staying asleep and dichotomized as "not at all" vs. "some to always." Identified classes/profiles were further differentiated by self-reported sociodemographic, socioeconomic, health, acculturative, and discrimination factors.

RESULTS

Latent class analysis revealed four distinct classes/profiles. The High Cohesion (class 1) profile (30.1% of sample) had the lowest likelihood of insomnia symptoms at 6.5%, followed by class 2 or High Support (23.6%) with a 15.3% likelihood. Class 3 or High Challenges profile (11.5%) had a moderate likelihood of insomnia symptoms at 49%. Class 4 or the Low Cohesion/Support profile (34.7%) had a 100% likelihood of reporting insomnia symptoms. Class 4 when compared to class 1 was more likely to report cardiometabolic conditions, experiences of everyday discrimination, limited English linguistic proficiency, and not using telehealth.

CONCLUSION

Community social cohesion and support may play an important role in mitigating insomnia symptoms among Bhutanese refugees. Further investigations are warranted.

Influence of sleep on physiological systems in atherosclerosis

Sleep is a fundamental requirement of life and is integral to health. Deviation from optimal sleep associates with numerous diseases including those of the cardiovascular system. Studies, spanning animal models to humans, show that insufficient, disrupted or inconsistent sleep contribute to poor cardiovascular health by disrupting body systems. Fundamental experiments have begun to uncover the molecular and cellular links between sleep and heart health while large-scale human studies have associated sleep with cardiovascular outcomes in diverse populations. Here, we review preclinical and clinical findings that demonstrate how sleep influences the autonomic nervous, metabolic and immune systems to affect atherosclerotic cardiovascular disease.

Sleep health, its intraindividuality, and perceived stress in college students during the COVID-19 pandemic

Objective: To describe the changes in sleep health domains and examine the associations between the repeated measures and intraindividual variability (IIV) of these domains and perceived stress. Participants: A diverse racial and ethnic group of first-year college students (N = 23, 78.3% female, aged 17-18) attending in-person classes during the COVID-19 pandemic. Methods: Sleep health domains were determined using 7-day wrist actigraph and daily sleep diaries, and perceived stress scale was completed at 1-month intervals across 3 months. Results: Sleep timing, regularity, and alertness during daytime demonstrated statistically significant changes between three timepoints. Greater stress was associated with more irregularity (B = 2.25 [.87-3.62], p < .001), more dissatisfaction in sleep (B = .04 [.02-.19], p < .01), alertness during daytime (B = .18 [.05-.31], p < .001), and greater IIV (ie, fluctuations) in sleep satisfaction (B = .083 [.02, .15], p < .01). Conclusion: These findings offer insights for future researchers to facilitate intervention development to promote mental and sleep health among college students.

Hyperarousal dynamics reveal an overnight increase boosted by insomnia

Hyperarousal is a key symptom of anxiety, stress-related disorders, and insomnia. However, it has been conceptualized in many different ways, ranging from various physiological markers (e.g. cortisol levels, high-frequency EEG activity) to personality traits, or state assessments of subjective anxiety and tension. This approach resulted in partly inconsistent evidence, complicating unified interpretations. Crucially, no previous studies addressed the likely variability of hyperarousal within and across days, nor the relationship of such variability in hyperarousal with the night-by-night variability in sleep quality characteristic of insomnia. Here, we present a novel data-driven approach to understanding dynamics of state hyperarousal in insomnia. Using ecological momentary assessment, we tracked fluctuations in a wide range of emotions across 9 days in 169 people with insomnia disorders and 38 controls without sleep problems. Exploratory factor analysis identified a hyperarousal factor, comprised of items describing tension and distress. People with insomnia scored significantly higher on this factor than controls at all timepoints. In both groups, the hyperarousal factor score peaked in the morning and waned throughout the day, pointing to a potential contributing role of sleep or other circadian processes. Importantly, the overnight increase in hyperarousal was stronger in people with in insomnia than in controls. Subsequent adaptive LASSO regression analysis revealed a stronger overnight increase in hyperarousal across nights of worse subjective sleep quality. These findings demonstrate the relationship between subjective sleep quality and overnight modulations of hyperarousal. Disorders in which hyperarousal is a predominant complaint might therefore benefit from interventions focused on improving sleep quality.

The Night Divide: Gender-Specific Trajectories of Sleep Disturbances Among Multiple Cohorts of Aging Populations

OBJECTIVES

Sleep disturbances in later life are prevalent and can profoundly impact health and well-being. However, whether and how trajectories of sleep disturbances vary as people age by gender and across age cohorts remains unexplored. This study applies an integrated theoretical framework to understand gender-specific trajectories of sleep disturbances over time and how they vary by cohort.

METHODS

Accelerated longitudinal data from the Health and Retirement Study (N = 20,947; M = 8,562, F = 12,385) was analyzed to investigate gender-specific trajectories of sleep disturbances and potential cohort variations. Weighted growth curve model was applied with sociodemographic and health-related variables. Men and women were analyzed separately.

RESULTS

Results showed that sleep disturbances increased with age in men, but not in women. Also, younger cohorts of men increased sleep disturbances over time at a slower rate than older cohorts. Among men, health profiles accounted for the association between age and sleep disturbances. Among men and women, younger cohorts started with higher levels of sleep disturbances around midlife. When examining specific types of sleep disturbance separately, having trouble falling asleep was the type that drove the observed patterns in men. For women, there was no association between age and any individual type of sleep disturbance.

DISCUSSION

This study shows that men, rather than women, tend to experience increasing sleep disturbances with age, with some variations across cohorts. These findings imply that different strategies for men and women and targeted timing over the life course would be most effective at promoting sleep health in American men and women.

Mechanism of cognitive processing for acupuncture action on generalized anxiety with naturally occurring consecutive partial sleep deprivation in early adulthood: a randomized controlled study and evaluation of event-related potentials

Introduction

Generalized anxiety disorder (GAD) is a common mental disorder that often begins in adolescence or early adulthood and is characterized by widespread and persistent anxiety. Partial sleep deprivation (PSD) is an important risk factor for GAD development and a common comorbidity. Adolescence is a period of rapid brain and nervous system development, and during this time, the occurrence of GAD can lead to neurocognitive deficits, such as impaired attention, cognitive control, and attention bias, that significantly affect cognitive function. However, relatively little research has been conducted on GAD comorbid with PSD in early adulthood compared with other psychiatric disorders. Clinical studies have demonstrated the effectiveness of acupuncture in treating GAD and sleep disorders, but the mechanism of how acupuncture modulates neurocognitive processing in patients with GAD comorbid with PSD has not been clarified.

Methods/design

In this randomized clinical trial, a total of 56 participants diagnosed with GAD comorbid with naturally occurring PSD and 28 healthy controls (HCs) will be recruited. The participants diagnosed with GAD comorbid with PSD will be randomly assigned to either the acupuncture group or the sham acupuncture group at a 1:1 ratio. The primary outcome measure is the Hamilton Anxiety Rating Scale (HAMA). Secondary outcome measures are the Sleep Deprivation Index (SDI), the Self-Assessment Scale for Anxiety (SAS), the Epworth Sleepiness Scale (ESS), and the State-Trait Anxiety Inventory (STAI). Additionally, three psychological paradigms (the attentional network test, psychomotor vigilance test, and emotional face Go/No-go) and event-related potential (ERP) data. Healthy volunteers will not undergo acupuncture but will instead participate in baseline assessments for the scales, mental paradigms, and ERP data. Acupuncture and sham acupuncture interventions will be conducted for 30 min, three times a week, over a 2-week period. Evaluations will be performed at zero weeks (baseline), 1 week, and 2 weeks, with the data enumerator, outcome assessor, and participant blinded to the treatment assignment.

Discussion

This study contributes to the exploration of the effects of acupuncture on improving anxiety symptoms and cognitive functions in individuals with comorbid GAD and PSD.

Trial registration

ClinicalTrials.gov, ChiCTR2400082221. Registered March 25, 2024.

Resilience, Anger, and Insomnia in Nurses after the End of the Pandemic Crisis

INTRODUCTION

Nurses seem to be persistently experiencing intense psychological repercussions, even after the official conclusion of the COVID-19 pandemic. In this cross-sectional study conducted after the end of the pandemic crisis, from 1 June 2023 to 30 June 2023, we evaluated the levels and explored the associations between anger, insomnia, and resilience among Greek nurses.

METHODS

A total of 441 nurses participated in an online survey and were invited to state their work experience, gender, and age and to complete the self-report measures of the Dimensions of Anger Reactions-5 (DAR-5), the Athens Insomnia Scale (AIS), and the Brief Resilience Scale (BRS).

RESULTS

Overall, 62.1% of the participants presented with positive scores on the AIS, and 41.5% displayed positive values on the DAR-5 scale, whereas 24.9% demonstrated scores indicative of low resilience on the BRS. A regression analysis revealed that 23.5% of the variance in the AIS scores can be attributed to the DAR-5 scores and 3% to the BRS scores. A mediation analysis confirmed the protective role of resilience, contributing as a negative mediator in the DAR-5 and AIS relationship.

CONCLUSIONS

Screening for insomnia symptoms and anger issues among nurses after the end of the pandemic and implementing appropriate interventions is considered imperative to avoid long-term health consequences.

Basic education teachers post-COVID-19 pandemic: prevalence of disease symptoms and association with health habits and behaviors

Introduction

COVID-19 is an infectious disease, caused by the SARS-CoV-2 virus, which may be associated with health problems arising after recovery from disease-specific symptoms; these are understood as sequelae.

Objectives

To analyze health problems arising from COVID-19 and their associated factors among basic education teachers in the state of Minas Gerais, Brazil.

Methods

Epidemiological, cross-sectional, analytical study, using an online survey design, carried out with teachers working in basic education in the public school system. Data collection took place between October and December 2021 using an online form. The dependent variable was health problems resulting from COVID-19, categorized as no vs. yes. Descriptive bivariate and multiple analyzes were carried out using Poisson regression.

Results

A total of 1,907 teachers participated in the study, 77.2% of whom were female, 94.4% were under 60 years old, 21.4% were part of at least one high-risk group for COVID-19, and 99.5% had been vaccinated against COVID-19. Of the total number of teachers, 19.7% were diagnosed with COVID-19; among these, 41.9% reported some health problem resulting from COVID-19. There was a higher prevalence of health problems resulting from COVID-19 among teachers who reported poor sleep quality (prevalence ratio = 1.79), who were depressed (prevalence ratio = 1.39), and who were part of at least one high-risk group for COVID-19 (prevalence ratio = 1.46).

Conclusions

Among teachers who contracted COVID-19, a substantial prevalence of health problems resulting from this infection was observed, as well as major health outcomes associated with these problems.

Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial

BACKGROUND

The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances.

METHODS

Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).

RESULTS

Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity.

CONCLUSION

The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.

Heart rate variability during sleep onset in patients with insomnia with or without comorbid sleep apnea

OBJECTIVES

Pre-sleep stress or hyperarousal is a known key etiological component in insomnia disorder. Despite this, physiological alterations during the sleep onset are not well-understood. In particular, insomnia and obstructive sleep apnea (OSA) are highly prevalent co-morbid conditions, where autonomic regulation may be altered. We aimed to characterize heart rate variability (HRV) during sleep onset as a potential measure of pre-sleep hyperarousal.

METHODS

We described the profile of pre-sleep HRV measures and explore autonomic differences in participants with self-reported insomnia disorder (with no OSA, n = 69; with mild OSA, n = 70; with moderate or severe OSA, n = 66), compared to normal sleep controls (n = 123). Heart rate data during the sleep onset process were extracted for HRV analyses.

RESULTS

During the sleep onset process, compared to normal sleep controls, participants with insomnia had altered HRV, indicated by higher heart rate (p = 0.004), lower SDNN (p = 0.003), reduced pNN20 (p < 0.001) and pNN50 (p = 0.010) and lower powers (p < 0.001). Participants with insomnia and moderate/severe OSA may have further deteriorated HRV outcomes compared to no/mild OSA patients with insomnia but differences were not significant. Insomnia itself was associated with significantly higher heart rate, lower pNN20, and lower high frequency power even after adjustment for age, gender, BMI and OSA severity.

CONCLUSIONS

Participants with insomnia had lower vagal activity during the sleep onset period, which may be compounded by OSA, reflected in higher heart rates and lower HRV. These altered heart rate dynamics may serve as a physiological biomarker for insomnia during bedtime wakefulness, or as a potential tool to evaluate the efficacy of behavioral interventions which target bedtime stress.

2024 Guidelines of the Taiwan Society of Cardiology on the Primary Prevention of Atherosclerotic Cardiovascular Disease --- Part I

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide and in Taiwan. It is highly prevalent and has a tremendous impact on global health. Therefore, the Taiwan Society of Cardiology developed these best-evidence preventive guidelines for decision-making in clinical practice involving aspects of primordial prevention including national policies, promotion of health education, primary prevention of clinical risk factors, and management and control of clinical risk factors. These guidelines cover the full spectrum of ASCVD, including chronic coronary syndrome, acute coronary syndrome, cerebrovascular disease, peripheral artery disease, and aortic aneurysm. In order to enhance medical education and health promotion not only for physicians but also for the general public, we propose a slogan (2H2L) for the primary prevention of ASCVD on the basis of the essential role of healthy dietary pattern and lifestyles: "Healthy Diet and Healthy Lifestyles to Help Your Life and Save Your Lives". We also propose an acronym of the modifiable risk factors/enhancers and relevant strategies to facilitate memory: " ABC2D2EFG-I'M2 ACE": Adiposity, Blood pressure, Cholesterol and Cigarette smoking, Diabetes mellitus and Dietary pattern, Exercise, Frailty, Gout/hyperuricemia, Inflammation/infection, Metabolic syndrome and Metabolic dysfunction-associated fatty liver disease, Atmosphere (environment), Chronic kidney disease, and Easy life (sleep well and no stress). Some imaging studies can be risk enhancers. Some risk factors/clinical conditions are deemed to be preventable, and healthy dietary pattern, physical activity, and body weight control remain the cornerstone of the preventive strategy.

Predicting response to stepped-care cognitive behavioral therapy for insomnia using pre-treatment heart rate variability in cancer patients

OBJECTIVE

This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework.

METHODS

177 participants (86.3 % female; Mage = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up.

RESULTS

Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses.

CONCLUSION

Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients.

Fading Focus: Addressing the Association Between Challenge Stressors, Role Blurring, Insomnia, Fatigue, and Workplace Cognitive Failure

The primary goal of the present study is to inspect the plausible job-related (i.e., challenge stressors and role blurring) and individual factors (i.e., fatigue and insomnia) that potentially lead to work-related cognitive failures among healthcare staff. Through the judgmental sampling technique, data was collected from healthcare personnel in Iran. The results revealed that challenge stressors in the form of time pressure, job responsibility, and work overload are significantly related to role blurring. Moreover, role blurring increases fatigue and insomnia among medical staff, and both insomnia and fatigue cause workplace cognitive failure. The results also confirm the mediation effect of role blurring in the association between challenge stressors, insomnia, and fatigue. According to the results, insomnia and fatigue similarly mediate the role blurring on workplace cognitive failure association. Theoretical implications, useful suggestions for practitioners, and prospective research avenues are debated in the study.

Sleep disorders and hyperarousal among patients with endometriosis: A case-control survey study

BACKGROUND

Endometriosis has been associated with sleep disorders, and hyperarousal appears to be involved in their pathogenesis; however, the presence of hyperarousal in the endometriosis population was never investigated.

METHODS

We conducted a case-control survey study by sending a questionnaire to all endometriosis patients followed up at our Centers. Controls were recruited among the general population. The questionnaire included demographic information, symptoms and history of endometriosis, the Hyperarousal Scale (H-Scale), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI).

RESULTS

A total of 847 women completed the questionnaires: 430 (50.8 %) had endometriosis, and 417 (49.2 %) were controls. Endometriosis was associated with higher H-scale score (OR 2.9, 95 % CI 2.4-3.8, p = 0.000), higher PSQI score (OR 4.3, 95 % CI 3.2-5.7, p = 0.000), and higher ISI score (OR 4.6, 95 % CI 3.5-6.1, p = 0.000) in multivariable ordinal logistic regressions analysis. With path analysis, hyperarousal (H-Scale) reported a partial mediating role in the association between endometriosis and sleep disorders. The mediation effect represented 22.3-27.8 % of the entire association between endometriosis and sleep disturbances.

CONCLUSION

Endometriosis patients complaining sleep disorders may benefit by investigating the presence of hyperarousal given cognitive behavioral therapy was reported effective in improving hyperarousal and associated sleep disorders.

Acupuncture modulates emotional network resting-state functional connectivity in patients with insomnia disorder: a randomized controlled trial and fMRI study

BACKGROUND

Insomnia disorder (ID) is one of the most common sleep problems, usually accompanied by anxiety and depression symptoms. Functional magnetic resonance imaging (fMRI) study suggests that both poor sleep quality and negative emotion are linked to the dysregulation of brain network related to emotion processing in ID patients. Acupuncture therapy has been proven effective in improving sleep quality and mood of ID patients, but the involved neurobiological mechanism remains unclear. We aimed to investigate the modulation effect of acupuncture on resting-state functional connectivity (rsFC) of the emotional network (EN) in patients experiencing insomnia.

METHODS

A total of 30 healthy controls (HCs) and 60 ID patients were enrolled in this study. Sixty ID patients were randomly assigned to real and sham acupuncture groups and attended resting-state fMRI scans before and after 4 weeks of acupuncture treatment. HCs completed an MRI/fMRI scan at baseline. The rsFC values within EN were calculated, and Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), Hyperarousal Scale (HAS), and actigraphy data were collected for clinical efficacy evaluation.

RESULTS

Resting-state FC analysis showed abnormalities in rsFC centered on the thalamus and dorsolateral prefrontal cortex within EN of ID patients compared to HCs. After real acupuncture treatment, rsFC of the anterior cingulate cortex, hippocampus, and amygdala were increased compared with the sham acupuncture group (p < 0.05, FDR corrected). In real acupuncture group, the rsFC value was decreased between left amygdala and left thalamus after 4 weeks of treatment compared with baseline. A trend of correlation was found that the increased rsFC value between the right amygdala and left hippocampus was positively correlated with the decreased HAMA scores across all ID patients, and the decreased left amygdala rsFC value with the left thalamus was negatively correlated with the increased sleep efficiency in the real acupuncture group.

CONCLUSION

Our findings showed that real acupuncture could produce a positive effect on modulating rsFC within network related to emotion processing in ID patients, which may illustrate the central mechanism underlying acupuncture for insomnia in improving sleep quality and emotion regulation.

TRIAL REGISTRATION

http://www.chictr.org.cn ., ChiCTR1800015282, 20/03/2018.

Waking qEEG in older adults with insomnia and its associations with sleep reactivity and dysfunctional beliefs about sleep

Sleep quality often deteriorates with age, and insomnia among the elderly increases the risks of both physical and psychiatric disorders. To elucidate the mechanisms and identify useful diagnostic biomarkers for insomnia in the elderly, the current study investigated the associations of waking brain activity patterns with susceptibility to stress-induced insomnia (sleep reactivity) and dysfunctional beliefs about sleep, major factors precipitating and maintaining insomnia, respectively. Forty-five participants aged 60 years or older with insomnia completed self-reported measures assessing depression, anxiety, sleep quality, dysfunctional beliefs about sleep, and sleep reactivity. Participants were then examined by quantitative electroencephalography (qEEG) during wakefulness, and spectral analysis was conducted to examine associations of regional frequency band power with these insomnia-precipitating and -maintaining factors. Dysfunctional beliefs about sleep were significantly correlated with higher beta/high-beta frequency band powers, while sleep reactivity was correlated with higher theta and delta frequency band powers. These findings suggest that sleep reactivity of older adults is associated with widespread cortical deactivation leading to poor stress coping, while their dysfunctional beliefs about sleep are associated with hyperactivation which is related to cognitive processes. These associations suggest that cognitive inflexibility and maladaptive stress-coping contribute to insomnia among the elderly.

Stress and Sleep Duration in Immune and Neuroendocrine Patterning. An Analytical Triangulation in ELSA

Background

Proinflammatory and neuroendocrine mediators are implicated in disease aetiopathogenesis. Stress increases concentrations of immune-neuroendocrine biomarkers through a complex network of brain-body signalling pathways. Suboptimal sleep further modulates these processes by altering major effector systems that sensitise the brain to stress. Given the ubiquitous, impactful nature of material deprivation, we tested for a synergistic association of financial stress and suboptimal sleep with these molecular processes.

Methods

With data drawn from the English Longitudinal Study of Ageing (ELSA), associations were tested on 4,940 participants (~66±9.4 years) across four-years (2008-2012). Through analytical triangulation, we tested whether financial stress (>60% insufficient resources) and suboptimal sleep (≤5/≥9 hours) were independently and interactively associated with immune-neuroendocrine profiles, derived from a latent profile analysis (LPA) of C-reactive protein, fibrinogen, white blood cell counts, hair cortisol, and insulin-like growth factor-1.

Results

A three-class LPA model offered the greatest parsimony. After adjustment for genetic predisposition, sociodemographics, lifestyle, and health, financial stress was associated with short-sleep cross-sectionally (RRR=1.45; 95%CI=1.18-1.79; p<0.001) and longitudinally (RRR=1.31; 95%CI=1.02-1.68; p=0.035), and it increased risk of belonging to the high-risk biomarker profile by 42% (95%CI=1.12-1.80; p=0.004). Suboptimal sleep was not related to future risk of high-risk profile membership, nor did it moderate financial stress-biomarker profile associations.

Discussion

Results advance psychoneuroimmunological knowledge by revealing how immune-neuroendocrine markers cluster in older cohorts and respond to financial stress over time. Financial stress associations with short-sleep are supported. The null role of suboptimal sleep, as exposure and mediator, in profile membership, provides valuable insight into the dynamic role of sleep in immune-neuroendocrine processes.

Exploring the Interplay between Sleep Quality, Stress, and Somatization among Teachers in the Post-COVID-19 Era

(1) Background. The post-COVID-19 era has imposed unique challenges on educators, significantly impacting their psychological and physical well-being. This study examines the interrelationships among psychological stress, sleep quality, and somatization in a sample of teachers, elucidating the impact of these factors during the ongoing recovery from the pandemic. (2) Methods. Using validated instruments such as the Pittsburgh Sleep Quality Index (PSQI) and the Mesure du Stress Psychologique (MSP), this research investigates how stress and sleep disturbances correlate with somatization among teachers. The study also considers the influence of demographic factors such as age, gender, and years of experience. (3) Results. The results indicated that sleep quality significantly correlates with both psychological stress and somatic pain, emphasizing the crucial role of sleep in managing stress-induced physical symptoms. Additionally, the fear of COVID-19 significantly exacerbates these effects, illustrating the complex interplay of psychological and physical health factors during the pandemic. Contrary to initial hypotheses, demographic factors such as gender, age, and years of experience did not significantly influence these primary relationships. (4) Conclusions. The findings emphasize the necessity of addressing both psychological stress and sleep quality to mitigate their combined effects on somatization. Educational institutions and policymakers are urged to develop targeted interventions that address these issues to support teachers' health and well-being in a post-pandemic landscape.

Sleep Difficulties in Swiss Elite Athletes

For athletes, sleep is essential for recovery and performance. Yet, up to two-thirds of athletes report poor sleep quality. Comprehensive data across all sports disciplines on the underlying causes of sleep problems are missing. We reanalyzed a data set of N = 1004 Swiss top athletes across an extensive array of 88 sports to gain knowledge on the specific deficits in sleep health with respect to gender, sport classes, sport-related factors, and well-being. We found that 18% of athletes were affected by at least two out of five high-risk sleep factors: 9% of athletes slept less than 6 h per day, 30% were dissatisfied with their sleep, 17% showed problems falling asleep within 30 min, 18% of athletes reported difficulty maintaining sleep more than three times a week, and 6% of athletes used sleeping pills more than once a week. We found sleep health strongly linked to overall well-being and mental health (22% showed at least moderate symptoms of either depression or anxiety). Therefore, screening and treating sleep disorders might effectively improve mental health and general well-being as well as performance among athletes around the globe.

Activity-Based Prospective Memory in Insomniacs

OBJECTIVE

To investigate the activity-based prospective memory performance in patients with insomnia, divided, on the basis of actigraphic evaluation, into sleep onset, maintenance, mixed and negative misperception insomnia.

METHODS

A total of 153 patients with insomnia (I, 83 females, mean age + SD = 41.37 + 16.19 years) and 121 healthy controls (HC, 78 females, mean age + SD = 36.99 + 14.91 years) wore an actigraph for one week. Insomnia was classified into sleep onset insomnia (SOI), maintenance insomnia (MaI), mixed insomnia (MixI) and negative misperception insomnia (NMI). To study their activity-based prospective memory performance, all the participants were required to push the actigraph event marker button twice, at bedtime (task 1) and at get-up time (task 2).

RESULTS

Only patients with maintenance and mixed insomnia had a significantly lower accuracy in the activity-based prospective memory task at get-up time compared with the healthy controls.

CONCLUSION

The results show that maintenance and mixed insomnia involve an impaired activity-based prospective memory performance, while sleep onset and negative misperception insomnia do not seem to be affected. This pattern of results suggests that the fragmentation of sleep may play a role in activity-based prospective memory efficiency at wake-up in the morning.

The Role of Insomnia and Exercise in COVID-19 Worries for Psychological Distress in Hong Kong Chinese: A Moderated Mediation Model

OBJECTIVE

To examine the role of insomnia as a mediator between worrying and mental health and whether the association between worrying and insomnia is moderated by the levels of exercise frequency.

METHODS

A cross-sectional online survey was conducted during the fourth wave of the COVID-19 outbreak in Hong Kong (n = 988). Participants' insomnia, psychological distress, and exercise frequency were evaluated. A mediation analysis was performed to examine the direct effect of COVID-19 worries and their indirect effect through insomnia on psychological distress.

RESULTS

A significant indirect effect of COVID-19 worries through insomnia was found on psychological distress (beta = 0.18, SE = 0.02, 95% CI = 0.14-0.22, p < .001). The significant index of moderated mediation supported the moderating effect of exercise frequency on the indirect effect of COVID-19 worries on psychological distress (IMM = 0.06, SE = 0.02, 95% CI = 0.02-0.10, p = .006). The conditional indirect effects of insomnia on psychological distress were significant in individuals with mean and higher exercise frequency but not in those with lower exercise frequency.

CONCLUSION

COVID-19 worries increased psychological distress through the worsening of sleep, and such an array of COVID-19 worries on insomnia was moderated by exercise frequency. Engaging more frequent exercise could reduce insomnia in people with less COVID-19 worries.

Precision Assessment of Real-World Associations Between Stress and Sleep Duration Using Actigraphy Data Collected Continuously for an Academic Year: Individual-Level Modeling Study

BACKGROUND

Heightened stress and insufficient sleep are common in the transition to college, often co-occur, and have both been linked to negative health outcomes. A challenge concerns disentangling whether perceived stress precedes or succeeds changes in sleep. These day-to-day associations may vary across individuals, but short study periods and group-level analyses in prior research may have obscured person-specific phenotypes.

OBJECTIVE

This study aims to obtain stable estimates of lead-lag associations between perceived stress and objective sleep duration in the individual, unbiased by the group, by developing an individual-level linear model that can leverage intensive longitudinal data while remaining parsimonious.

METHODS

In total, 55 college students (n=6, 11% second-year students and n=49, 89% first-year students) volunteered to provide daily self-reports of perceived stress via a smartphone app and wore an actigraphy wristband for the estimation of daily sleep duration continuously throughout the academic year (median usable daily observations per participant: 178, IQR 65.5). The individual-level linear model, developed in a Bayesian framework, included the predictor and outcome of interest and a covariate for the day of the week to account for weekly patterns. We validated the model on the cohort of second-year students (n=6, used as a pilot sample) by applying it to variables expected to correlate positively within individuals: objective sleep duration and self-reported sleep quality. The model was then applied to the fully independent target sample of first-year students (n=49) for the examination of bidirectional associations between daily stress levels and sleep duration.

RESULTS

Proof-of-concept analyses captured expected associations between objective sleep duration and subjective sleep quality in every pilot participant. Target analyses revealed negative associations between sleep duration and perceived stress in most of the participants (45/49, 92%), but their temporal association varied. Of the 49 participants, 19 (39%) showed a significant association (probability of direction>0.975): 8 (16%) showed elevated stress in the day associated with shorter sleep later that night, 5 (10%) showed shorter sleep associated with elevated stress the next day, and 6 (12%) showed both directions of association. Of note, when analyzed using a group-based multilevel model, individual estimates were systematically attenuated, and some even reversed sign.

CONCLUSIONS

The dynamic interplay of stress and sleep in daily life is likely person specific. Paired with intensive longitudinal data, our individual-level linear model provides a precision framework for the estimation of stable real-world behavioral and psychological dynamics and may support the personalized prioritization of intervention targets for health and well-being.

Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation

BACKGROUND AND HYPOTHESIS

Trauma is a robust risk factor for delusional ideation. However, the specificity and processes underlying this relationship are unclear. Qualitatively, interpersonal traumas (i.e., trauma caused by another person) appear to have a specific relationship with delusional ideation, particularly paranoia, given the commonality of social threat. However, this has not been empirically tested and the processes by which interpersonal trauma contributes to delusional ideation remain poorly understood. Given the role of impaired sleep in both trauma and delusional ideation, it may be a critical mediator between these variables. We hypothesized that interpersonal trauma, but not non-interpersonal trauma, would be positively related to subtypes of delusional ideation, especially paranoia, and that impaired sleep would mediate these relationships.

STUDY DESIGN

In a large, transdiagnostic community sample (N = 478), an exploratory factor analysis of the Peter's Delusion Inventory identified three subtypes of delusional ideation, namely magical thinking, grandiosity, and paranoia. Three path models, one for each subtype of delusional ideation, tested whether interpersonal trauma and non-interpersonal trauma were related to subtypes of delusional ideation, and impaired sleep as a mediating variable of interpersonal trauma.

STUDY RESULTS

Paranoia and grandiosity were positively related to interpersonal trauma and unrelated to non-interpersonal trauma. Furthermore, these relationships were significantly mediated by impaired sleep, which appeared strongest for paranoia. In contrast, magical thinking was unrelated to traumatic experiences.

CONCLUSIONS

These findings support a specific relationship between interpersonal trauma and paranoia as well as grandiosity, with impaired sleep appearing as an important process by which interpersonal trauma contributes to both.

Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms

STUDY OBJECTIVES

The study aimed to characterize insomnia symptom trajectories over 12 months during a time of stress and uncertainty, the coronavirus disease 2019 (COVID-19) pandemic. It also aimed to investigate sleep and psychological predictors of persistent insomnia symptoms.

METHODS

This longitudinal cohort study comprised 2069 participants with and without insomnia symptoms during the first year of the pandemic. Participants completed online surveys investigating sleep, insomnia, and mental health at four timepoints over 12 months (April 2020-May 2021). Additional trait-level cognitive/psychological questionnaires were administered at 3 months only.

RESULTS

Six distinct classes of insomnia symptoms emerged: (1) severe persistent insomnia symptoms (21.65%), (2) moderate persistent insomnia symptoms (32.62%), (3) persistent good sleep (32.82%), (4) severe insomnia symptoms at baseline but remitting over time (2.27%), (5) moderate insomnia symptoms at baseline but remitting over time (7.78%), and (6) good sleep at baseline but deteriorating into insomnia symptoms over time (2.85%). Persistent insomnia trajectories were predicted by high levels of sleep reactivity, sleep effort, pre-sleep cognitive arousal, and depressive symptoms at baseline. A combination of high sleep reactivity and sleep effort reduced the odds of insomnia remitting. Higher sleep reactivity also predicted the deterioration of good sleep into insomnia symptoms over 12 months. Lastly, intolerance of uncertainty emerged as the only trait-level cognitive/psychological predictor of insomnia trajectory classes.

CONCLUSIONS

Insomnia was more likely to persist than remit over the first year of the COVID-19 pandemic. Addressing sleep reactivity and sleep effort appears critical for reducing insomnia persistence rates after times of stress and uncertainty.

Dysphoric mood may explain the relation between sleep reactivity and binge eating but not purging

Objective: This study investigated whether sleep reactivity (i.e., a propensity to experience sleep disturbances when stressed) relates to eating disorder behavioral symptoms indirectly through dysphoric mood in a sample of college students. Participants: One hundred and ninety-eight college students (51.5% female). Methods: Participants completed self-report measures of dysphoric mood, eating disorder behavioral symptoms, and sleep reactivity. Results: Higher sleep reactivity was associated with greater binge-eating symptoms indirectly through higher dysphoric mood. Higher sleep reactivity was associated with greater purging symptoms; however, this association was not explained by dysphoric mood. Conclusions: Findings support the relevance of sleep reactivity to binge eating and purging and suggest that sleep reactivity relates to binge-eating symptoms indirectly through dysphoric mood. If replicated in prospective data, targeting stress-induced sleep and mood disturbances in college students may reduce risk for binge eating.

Mid-to-Late-Life Anxiety and Sleep during Initial Phase of COVID-19: Age- and Sex-Specific Insights to Inform Future Pandemic Healthcare

This study examined associations between COVID-19-related anxiety and sleep in middle-aged and older adults and tested whether these varied by age or sex. In June/July 2020, middle-aged/older adults aged 50+ (n = 277, 45% women, Mage = 64.68 ± 7.83) in the United States completed measures of sleep and COVID-19-related anxiety. Multiple regressions examined whether anxiety was independently associated with or interacted with age or sex in its associations with sleep health, controlling for age, education, medical conditions, sleep/pain medication use, and COVID-19 status. Greater COVID-19 anxiety was associated with worse sleep quality and daytime dysfunction. COVID-19-related anxiety interacted with age (not sex) in associations with total sleep time and sleep efficiency. Greater anxiety was associated with shorter total sleep time and lower sleep efficiency in oldest-older adults (~73 years old) and youngest-older adults (~65 years old) but not middle-aged adults (~57 years old). In mid to late life, older adults may be most vulnerable to the impact of COVID-19-related anxiety on sleep health. Social and behavioral (e.g., knowledge on age-related vulnerability to COVID-19 risk/morbidity/mortality, uncertainty, and changes to daily routines) and physiological factors (sleep disruption and age-related autonomic dysfunction) may underlie these associations. Interventions that mitigate negative pandemic-related psychological and sleep outcomes may be particularly relevant for older adults.

The effect of anxiety on sleep disorders in medical students: a moderated mediation model

The relationship between anxiety and sleep disorders is a key research topic in the academic community. However, evidence on the mechanism through which anxiety influences sleep disorders remains limited. The purpose of this study was to investigate the roles of flourishing and neuroticism in the mechanism through which anxiety influences sleep disorders in medical students. We constructed a moderated mediation model and tested the mediating role of flourishing and the moderating role of neuroticism in medical college students. The results showed that: (1) anxiety was significantly and positively related to sleep disorders and significantly and negatively related to flourishing; flourishing was significantly and negatively related to sleep disorders; neuroticism was significantly and positively related to sleep disorders; (2) flourishing had a mediation effect on the relationship between anxiety and sleep disorders; (3) neuroticism moderated the process through which flourishing mediated the effect of anxiety on sleep disorders. Our research expands the literature on the mechanism underlying the effects of anxiety on sleep disorders and provides insights into the potential prevention and intervention of sleep and emotional problems in medical students.

Cross-sectional analyses of factors associated with the presence and aggravation of chronic insomnia by symptom subtypes

Aim

The aim of this study was to investigate the association of psychological and chronobiological factors with the presence and severity of chronic insomnia by symptom subtypes and their impacts on daytime dysfunctions.

Methods

Participants of the present web-based epidemiological study were classified as follows: difficulty initiating sleep (DIS) (n = 91); difficulty maintaining sleep (DMS) (n = 13); early morning awakening (EMA) (n = 48); DIS + DMS (n = 67); DIS + EMA (n = 23); DMS + EMA (n = 24); triplet of DIS, DMS, and EMA symptoms (TRP) (n = 69); and normal sleepers (n = 4590). The Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), Munich Chronotype Questionnaire (MCTQ), insomnia-related psychological measures (including the Ford Insomnia Response to Stress Test [FIRST] and the Dysfunctional Beliefs and Attitudes about Sleep Scale [DBAS]), and the cognitive and somatic domains of the Pre-Sleep Arousal Scale (PSAS) were evaluated.

Results

The presence of DIS and DIS + DMS were significantly associated with an evening preference, and EMA and EMA + DMS with a morning preference, while TRP showed no significant association with either chronotype. The increase in DBAS scores was associated with higher ISI scores in all subtypes. Meanwhile, the associations of each psychological measure varied among insomnia subtypes, with the association of PSAS cognitive arousal to DIS and PSAS somatic arousal to both DMS + EMA and TRP. Pathological HADS score was associated with all subtypes.

Conclusion

Chronotypes may be associated with the presence of some insomnia subtypes; however, only psychological factors were speculated to contribute to the aggravation of all subtypes. All insomnia subtypes possibly contribute to the formation of depression.

Pediatric Insomnia

Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.

Brain structural correlates of subjective sleepiness and insomnia symptoms in shift workers

Background

Studies on the brain structures of shift workers are limited; thus, this cross-sectional study aimed to compare the brain structures and the brain structural correlates of subjective sleepiness and insomnia symptoms between shift workers and non-shift workers.

Methods

Shift workers (n = 63) and non-shift workers (n = 58) completed questionnaires assessing subjective sleepiness and insomnia symptoms. Cortical thickness, cortical surface area, and subcortical volumes were measured by magnetic resonance imaging. The brain morphometric measures were compared between the groups, and interaction analyses using the brain morphometric measures as the dependent variable were performed to test the interactions between the study group and measures of sleep disturbance (i.e., subjective sleepiness and insomnia symptoms).

Results

No differences in cortical thickness, cortical surface area, or subcortical volumes were detected between shift workers and non-shift workers. A single cluster in the left motor cortex showed a significant interaction between the study group and subjective sleepiness in the cortical surface area. The correlation between the left motor cortex surface area and the subjective sleepiness level was negative in shift workers and positive in non-shift workers. Significant interaction between the study group and insomnia symptoms was present for the left/right putamen volumes. The correlation between the left/right putamen volumes and insomnia symptom levels was positive in shift workers and negative in non-shift workers.

Conclusion

Left motor cortex surface area and bilateral putamen volumes were unique structural correlates of subjective sleepiness and insomnia symptoms in shift workers, respectively.

The mediating effect of sleep disturbance on the association between hypertension and depression: a national data analysis

BACKGROUND

Sleep disturbance is a common among people with hypertension. However, the mediating role of sleep disturbance in the association between hypertension and depression remains unclear. This study aims to investigate the mediating role of sleep disturbance in the association between hypertension and depression.

MATERIALS AND METHODS

This was cross-sectional study. The data were derived from the Indonesian Family Life Survey Fifth Wave (2014-2015). We include a total of 19,138 adults' participants with age range from 18 to 65 years old who completed response on the variable of hypertension, sleep disturbance, and depression. The mediating model analysis was processed using the PROCESS macro ins SPSS from Hayes model.

RESULTS

Depression was reported by 22% of total respondents. The group with hypertension showed a substantially higher prevalence of depression than non-hypertension group (P < 0.001). Hypertension had a significant overall effect on depression (β = 0.682; 95%CI 0.489 to 0.875, P < 0.001). The direct effect of hypertension on depression was significant (β = 0.418; 95%CI 0.244 to 0.592, P < 0.001) and the indirect effect that mediated by sleep disturbance was also significant (β = 0.264, 95%CI 0.174 to 0.356, P < 0.001). It is worth noting that sleep disturbance partially mediated the association between hypertension and depression.

CONCLUSION

The findings of this study indicated that sleep disturbance contributed to the etiology of depression and hypertension in adult populations. Nurses should be involved in managing sleep disturbances, such as using behavioral therapy, as it may serve as both a treatment and primary prevention measure for depression and hypertension.

Sleep disturbance mediates the link between both self-compassion and self-criticism and psychological distress during prolonged periods of stress

Poor sleep and subsequent decline in mental health often occur during times of prolonged stress, such as a pandemic. Self-compassion is linked with improved sleep and better mental health, while self-criticism is linked with poorer sleep and psychological distress. Given there is little evidence of the interrelationships of these constructs, we examined whether higher self-compassion or lower levels of self-criticism can reduce psychological distress directly and indirectly via sleep during times of prolonged stress. Structural equation modelling was used to analyse two samples (N = 722, Study 1, and N = 622, Replication Study) of university students during different stages of the pandemic. An aggregate psychological distress construct was calculated using depression, anxiety and stress measures. We created models that showed insomnia symptoms mediated the relationship between self-compassion/self-criticism and psychological distress. Sleep partially mediated both relationships, and this was the strongest effect in both samples. This suggests that improving self-compassion and reducing self-criticism will improve sleep, leading to reduced psychological distress. As our findings are robust and held at two time points, future research should investigate broader demographics and differing stress responses.

Transcranial Magnetic Stimulation of the Default Mode Network to Improve Sleep in Individuals With Insomnia Symptoms: Protocol for a Double-Blind Randomized Controlled Trial

BACKGROUND

Cortical hyperarousal and ruminative thinking are common aspects of insomnia that have been linked with greater connectivity in the default mode network (DMN). Therefore, disrupting network activity within the DMN may reduce cortical and cognitive hyperarousal and facilitate better sleep.

OBJECTIVE

This trial aims to establish a novel, noninvasive method for treating insomnia through disruption of the DMN with repetitive transcranial magnetic stimulation, specifically with continuous theta burst stimulation (cTBS). This double-blind, pilot randomized controlled trial will assess the efficacy of repetitive transcranial magnetic stimulation as a novel, nonpharmacological approach to improve sleep through disruption of the DMN prior to sleep onset for individuals with insomnia. Primary outcome measures will include assessing changes in DMN functional connectivity before and after stimulation.

METHODS

A total of 20 participants between the ages of 18 to 50 years with reported sleep disturbances will be recruited as a part of the study. Participants will then conduct an in-person screening and follow-on enrollment visit. Eligible participants then conduct at-home actigraphic collection until their first in-residence overnight study visit. In a double-blind, counterbalanced, crossover study design, participants will receive a 40-second stimulation to the left inferior parietal lobule of the DMN during 2 separate overnight in-residence visits. Participants are randomized to the order in which they receive the active stimulation and sham stimulation. Study participants will undergo a prestimulation functional magnetic resonance imaging scan and a poststimulation functional magnetic resonance imaging scan prior to sleep for each overnight study visit. Sleep outcomes will be measured using clinical polysomnography. After their first in-residence study visit, participants conduct another at-home actigraphic collection before returning for their second in-residence overnight study visit.

RESULTS

Our study was funded in September 2020 by the Department of Defense (W81XWH2010173). We completed the enrollment of our target study population in the October 2022 and are currently working on neuroimaging processing and analysis. We aim to publish the results of our study by 2024. Primary neuroimaging outcome measures will be tested using independent components analysis, seed-to-voxel analyses, and region of interest to region of interest analyses. A repeated measures analysis of covariance (ANCOVA) will be used to assess the effects of active and sham stimulation on sleep variables. Additionally, we will correlate changes in functional connectivity to polysomnography-graded sleep.

CONCLUSIONS

The presently proposed cTBS protocol is aimed at establishing the initial research outcomes of the effects of a single burst of cTBS on disrupting the network connectivity of the DMN to improve sleep. If effective, future work could determine the most effective stimulation sites and administration schedules to optimize this potential intervention for sleep problems.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04953559; https://clinicaltrials.gov/ct2/show/NCT04953559.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51212.

The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans

Introduction

Gulf War Illness is a type of chronic multisymptom illness, that affects about 30% of veterans deployed to the 1990-91 Persian Gulf War. Veterans deployed to Iraq/Afghanistan after 2000 are reported to have a similar prevalence of chronic multisymptom illness. More than 30 years after the Persian Gulf War, Gulf War Illness still has an unexplained symptom complex, unknown etiology and lacks definitive diagnostic criteria and effective treatments. Our recent studies have found that substantially smaller brainstem volumes and lower fiber integrity are associated with increased sleep difficulty and pain intensity in 1990-91 Persian Gulf War veterans. This study was conducted to investigate whether veterans deployed to Iraq/Afghanistan present similar brainstem damage, and whether such brainstem structural differences are associated with major symptoms as in Gulf War Illness.

Methods

Here, we used structural magnetic resonance imaging and diffusion tensor imaging to measure the volumes of subcortices, brainstem subregions and white matter integrity of brainstem fiber tracts in 188 veterans including 98 Persian Gulf War veterans and 90 Iraq/Afghanistan veterans.

Results

We found that compared to healthy controls, veterans of both campaigns presented with substantially smaller volumes in brainstem subregions, accompanied by greater periaqueductal gray matter volumes. We also found that all veterans had reduced integrity in the brainstem-spinal cord tracts and the brainstem-subcortical tracts. In veterans deployed during the 1990-91 Persian Gulf War, we found that brainstem structural deficits significantly correlated with increased sleep difficulties and pain intensities, but in veterans deployed to Iraq/Afghanistan, no such effect was observed.

Discussion

These structural differences in the brainstem neurons and tracts may reflect autonomic dysregulation corresponding to the symptom constellation, which is characteristic of Gulf War Illness. Understanding these neuroimaging and neuropathological relationships in Gulf War and Iraq/Afghanistan veterans may improve clinical management and treatment strategies for modern war related chronic multisymptom illness.