Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation

Sleep schedules and MSLT-based diagnosis of narcolepsy type 2 and idiopathic hypersomnia: Exploring potential associations in a large clinical sample

Differential diagnosis of narcolepsy type 2 and idiopathic hypersomnia relies on the frequency of sleep-onset rapid eye movement periods observed on the Multiple Sleep Latency Test. This study investigated whether variations in sleep schedules, particularly delayed sleep-wake patterns, contribute to the diagnostic distinction between narcolepsy type 2 and idiopathic hypersomnia. The study included 871 patients aged 18-39 years (316 with narcolepsy type 2, 555 with idiopathic hypersomnia). These patients were diagnosed based on MSLT results following polysomnography from November 2013 to November 2017. Patients' sleep habits, including bedtime and wake-up times on weekdays and weekends during the 2 weeks preceding the polysomnography/Multiple Sleep Latency Test, were assessed using self-reported sleep logs. A multivariate logistic regression analysis was conducted to identify factors associated with narcolepsy type 2 diagnosis. The analysis revealed that being male (p < 0.001), younger age (p < 0.001), shorter weekday sleep duration (p < 0.05), and a delayed weekday sleep midpoint time (p < 0.01) were significantly associated with a diagnosis of narcolepsy type 2. The study suggests that the conventionally fixed schedule of polysomnography and Multiple Sleep Latency Test administration may have contributed to the increased occurrence of sleep-onset rapid eye movement periods particularly in individuals with a delayed sleep-wake schedule.

Melatonin use in managing insomnia in typically developing (TD) children: A technical report

Although melatonin is widely used globally for the management of insomnia in children and adolescents, there are few clinical guidelines available for healthcare practitioners, particularly in typically developing (TD) children. Because existing data are either sparse or inconclusive, a task force comprised of pediatric sleep researchers and clinicians was established by the International Pediatric Sleep Association (IPSA) to first examine the available literature and to develop a set of evidence-based (when possible) and consensus-based recommendations to guide practitioners in decision-making regarding melatonin use in pediatric insomnia. A summary of the evidence pertaining to melatonin's use in pediatric clinical settings, and efficacy and safety in TD children is presented below as a companion to an accompanying list of specific recommendations.

Acceptance of Illness, Quality of Sleep and Emotional State of Adolescents with Lymphatic Malignancy During the First Cycle of Anticancer Treatment-A Preliminary Report

Background: Medical care provided to adolescents with lymphatic system cancer and leukemia should take into consideration psychological aspects, due to the increased risk of anxiety disorders, depression, irritability and sleep disorders, which may determine acceptance of the disease. Methods: The study included 50 patients of both sexes, aged 14-17. The following questionnaires were used: The Hospital Anxiety and Depression Scale (HADS-M), Athens Insomnia Scale (AIS), Acceptance of Illness Scale (AIS) and Numeric Rating Scale (NRS). Results: A significant group of patients did not accept their disease. Male gender turned out to be a predictor of higher acceptance of the disease. The dominant emotion among young people was anxiety, especially among girls (p = 0.012). The level of depression of most respondents was low or moderate (p = 0.143), and irritability was high (p = 0.074), regardless of gender. Sleep disorders were more common in girls (p < 0.001) and were associated with high levels of anxiety and depression. Regardless of gender, most adolescents experienced pain (≥3 NRS). Conclusions: Recognizing the predictors of disease acceptance, especially in the initial stage of treatment, may be of key importance for current and further therapeutic effects in adolescents; therefore, it should be included in the standards of care for this group of patients.

The relationship between night eating behavior, gastrointestinal symptoms, and psychological well-being: insights from a cross-sectional study in Türkiye

BACKGROUND

This cross-sectional study aimed to address the gap in understanding how night eating behavior impacts gastrointestinal health and psychological well-being in adult populations.

METHOD

This descriptive and cross-sectional study was conducted with 1372 adults aged 19-65 between September 2023 and November 2023. The research data were collected with the help of a web-based survey form (Google form) created by the researchers using the snowball sampling method. The demographic characteristics (sex, age, education level, marital status, income status), eating behaviors (number of main meals and snacks), and anthropometric measurements (body weight and height). Gastrointestinal symptoms observed in individuals were evaluated with the Gastrointestinal Symptom Rating Scale. The Night Eating Questionnaire (NEQ) was used to quantify the severity of night eating syndrome, and The Psychological Well-Being Scale was used to measure psychological well-being. All analyses were performed using the Statistical Package for the Social Sciences (version 27.0) software.

RESULTS

A statistically significant negative correlation was found between the Psychological Well-Being Scale total score and Gastrointestinal Symptom Rating Scale subdimensions (r=-0.067, r=-0.067, r=-0.109, r=-0.068, r=-0.129, respectively). Also, a statistically significant negative correlation was found between the Psychological Well-Being Scale total score and the Night Eating Questionnaire total score (r=-0.287) (p < 0.05).

CONCLUSION

This study found a relationship between night eating syndrome, psychological well-being, and gastrointestinal symptoms. Nutritional strategies for night eating syndrome, an eating disorder, may have important consequences on the psychological well-being of individuals with night eating. Our study highlights the significant relationships between night eating behavior, gastrointestinal symptoms, and psychological well-being, suggesting that night eating may contribute to both physical and mental health challenges.

Accelerometry-assessed sleep clusters and obesity in adolescents and young adults: a longitudinal analysis in GINIplus/LISA birth cohorts

BACKGROUND

Some studies have revealed various sleep patterns in adolescents and adults using multidimensional objective sleep parameters. However, it remains unknown whether these patterns are consistent from adolescence to young adulthood and how they relate to long-term obesity.

METHODS

Seven-day accelerometry was conducted in German Infant Study on the influence of Nutrition Intervention PLUS environmental and genetic influences on allergy development (GINIplus) and Influence of Lifestyle factors on the development of the Immune System and Allergies in East and West Germany (LISA) birth cohorts during the 15-year and 20-year follow-ups, respectively. Five sleep clusters were identified by k-means cluster analysis using 12 sleep characteristics at each follow-up. Adjusted linear and logistic regression models using generalized estimating equations were examined. Further, the interaction effects with time of follow-ups and polygenic risk scores (PRS) for body mass index (BMI) were tested.

RESULTS

Five sleep clusters were classified consistently in both adolescence (n = 1347, aged 14.3-16.4 years) and young adulthood (n = 1262, aged 19.5-22.4 years). Adolescents in the "good sleep", "delayed sleep phase", and "fragmented sleep" clusters displayed greater stability transitioning into young adulthood, while those in the "sleep irregularity and variability", and "prolonged sleep latency" clusters showed lower stability (n = 636). Compared to the "good sleep" cluster, the "prolonged sleep latency" cluster exhibited associations with higher BMI [β = 0.56, 95% confidence interval (CI) = (0.06, 1.05)] and increased odds of overweight/obesity [Odds ratio = 1.55, 95% CI = (1.02, 2.34)]. No significant PRS-sleep cluster interaction was found for BMI or overweight/obesity. Among males only, the "delayed sleep phase", "sleep irregularity and variability" and "fragmented sleep" clusters showed stronger associations with overweight/obesity as age increased.

CONCLUSION

Adolescents and young adults shared five consistent sleep patterns, with the "prolonged sleep latency" pattern linked to higher BMI and overweight/obesity.

Nocturnal sentry duty and cardiometabolic characteristics in armed forces personnel

BACKGROUND

Sleep deprivation can lead to increased body weight and blood pressure (BP), but the latent effects of partial sleep deprivation related to required night sentry duties within a short-term period on cardiometabolic characteristic changes in military personnel are unclear.

AIM

To investigate the association between night sentry duty frequency in the past 3 months and cardiometabolic characteristics in armed forces personnel.

METHODS

A total of 867 armed forces personnel who were aged 18-39 years and did not take any antihypertensive medications in Taiwan in 2020 were included. The frequency of night sentry duty was self-reported via a questionnaire (average number of night sentry shifts per month for the past 3 months). Hemodynamic status was assessed via the resting BP and pulse rate (PR). Cardiometabolic risk factors were defined according to the International Diabetes Federation criteria. Multivariable linear regression analyses of the associations between night sentry duties and PR, BP, and other metabolic syndrome (MetS) marker levels were performed, with adjustments for age, sex, substance use, body mass index and aerobic fitness. Multiple logistic regression analysis was carried out to determine the associations between night sentry duties and the prevalence of each MetS feature.

RESULTS

There was an association between night sentry duties and PR [standardized β (standard error) = 0.505 (0.223), P =0.02], whereas there was no association with systolic and diastolic BP. In addition, there was an inverse association between night sentry duties and high-density lipoprotein cholesterol (HDL-C) levels [standardized β = -0.490 (0.213), P = 0.02], whereas there was no association with the other metabolic marker levels. Compared with personnel without night sentry duties, those with ≥ 1 night sentry shift/month had a greater risk of impaired fasting glucose (≥ 100 mg/dL) [odds ratio: 1.415 (confidence interval: 1.016-1.969)], whereas no associations with other MetS features were found.

CONCLUSION

Among military personnel, the burden of night sentry duty was positively associated with the resting PR but inversely associated with HDL-C levels. In addition, personnel with partial sleep deprivation may have a greater risk of impaired fasting glucose than those without partial sleep deprivation.

Optimizing Chronotherapy in Psychiatric Care: The Impact of Circadian Rhythms on Medication Timing and Efficacy

In many medical settings, medications are typically administered in the morning or evening, aligning with patients' daily routines. This practice does not stem from chronotherapy, which involves scheduling drug administration to enhance its effectiveness, but rather from the way clinical operations are structured. The timing of drug administration can significantly affect a medication's effectiveness and side effects, with the impact varying by up to ten times based on circadian rhythms. Disorders such as major depression, bipolar disorder, and schizophrenia are linked to disruptions in these rhythms. Recent studies have found that circadian dysfunctions, including genetic and neurohumoral changes, underlie many psychiatric conditions. Issues such as an altered glucocorticoid rhythm due to impaired HPA axis function, disturbed melatonin balance, and sleep disturbances have been noted in psychotic disorders. Furthermore, mood disorders have been associated with changes in the expression of circadian rhythm genes such as Clock, Bmal1, and Per. Considering that the absorption, biodistribution, effects on target organs, half-life, metabolism, and elimination of drugs are all influenced by the body's circadian rhythms, this narrative review explores the optimal timing of medication administration to maximize efficacy and minimize side effects in the treatment of psychiatric disorders. By closely monitoring circadian variations in cortisol, melatonin, and key clock genes, as well as by deepening our understanding of the metabolisms and pharmacokinetics of antipsychotic medications, we propose a chronotherapy approach for psychiatric patients that could significantly enhance patient care.

Screen Use at Bedtime and Sleep Duration and Quality Among Youths

Importance

Although questionnaire-based cross-sectional research suggests that screen time before bed correlates with poor sleep, self-reported data seem unlikely to capture the complexity of modern screen use, requiring objective night-by-night measures to advance this field.

Objective

To examine whether evening screen time is associated with sleep duration and quality that night in youths.

Design, Setting, and Participants

This repeated-measures cohort study was performed from March to December 2021 in participant homes in Dunedin, New Zealand. Participants included healthy youths aged 11 to 14.9 years. Data were analyzed from October to November 2023.

Exposure

Objectively measured screen time, captured using wearable or stationary video cameras from 2 hours before bedtime until the first time the youth attempted sleep (shut-eye time) over 4 nonconsecutive nights. Video data were coded using a reliable protocol (κ = 0.92) to quantify device (8 options [eg, smartphone]) and activity (10 options [eg, social media]) type.

Main Outcomes and Measures

Sleep duration and quality were measured objectively via wrist-worn accelerometers. The association of screen use with sleep measures was analyzed on a night-by-night basis using mixed-effects regression models including participant as a random effect and adjusted for weekends.

Results

Of the 79 participants (47 [59.5%] male; mean [SD] age, 12.9 [1.1] years), all but 1 had screen time before bed. Screen use in the 2 hours before bed had no association with most measures of sleep health that night (eg, mean difference in total sleep time, 0 minutes [95% CI, -3 to 20 minutes] for every 10 minutes more total screen time). All types of screen time were associated with delayed sleep onset but particularly interactive screen use (mean difference, 10 minutes; 95% CI, 4 to 16 minutes for every additional 10 minutes of interactive screen time). Every 10 minutes of additional screen time in bed was associated with shorter total sleep time (mean difference, -3 minutes; 95% CI, -6 to -1 minute). The mean difference in total sleep time was -9 minutes (95% CI, -16 to -2 minutes) for every 10 minutes of interactive screen use and -4 minutes (95% CI, -7 to 0 minutes) for passive screen use. In particular, gaming (mean difference, -17 minutes; 95% CI, -28 to -7 minutes for every 10 minutes of gaming) and multitasking (mean difference, -35 minutes; 95% CI, -67 to -4 minutes on nights with vs without multitasking) were associated with less total sleep time.

Conclusions and Relevance

In this repeated-measures cohort study, use of an objective method showed that screen time once in bed was associated with impairment of sleep, especially when screen time was interactive or involved multitasking. These findings suggest that current sleep hygiene recommendations to restrict all screen time before bed seem neither achievable nor appropriate.

Sleep duration and perceptions of sleep quality in British Army recruits during basic training - an observational analysis

Introduction

Sleep is critical to the health, wellbeing and performance of military personnel during basic training. This two-part study evaluated sleep-wake patterns and sleep disturbances in junior soldiers (JS) and infantry recruits in Autumn 2021 (study 1), and non-infantry recruits in spring 2022 (study 2).

Methods

During studies 1 and 2, validated wearable technology combined with a sleep diary was used to quantify sleep-wake indices, sleep disturbances and perceptions of sleep quality. Sleep diary data was analysed descriptively. A series of repeated-measures ANOVAs examined differences in objective sleep-wake indices. Correlation analysis determined associations between time in bed (TIB) and total sleep time (TST).

Results

Significant (p < 0.05) differences in most sleep-wake indices were observed between weeks of basic training for all cohorts. Strong positive correlations between TIB and TST were observed for each cohort across basic training (r = 0.681 - 0.970, p < 0.001), with longer TST associated with greater TIB. The mean±SD sleep duration (hours and mins [hm]) for JS (06:22 ± 00:27hm), non-infantry (05:41 ± 00:47hm) and infantry (05:46 ± 00:34hm) recruits across basic training was consistently below national recommendations. The mean±SD bed and wake times for JS (bedtime: 23:01 ± 00:32hm; awake: 05:34 ± 00:10hm), non-infantry (bedtime: 23:38 ± 01:09hm; awake: 04:47 ± 00:58hm), and infantry (bedtime: 23:13 ± 00:29hm; awake: 05:38 ± 00:26hm) recruits varied across weeks of basic training, with over 80% reporting "fairly bad" or "very bad" sleep quality and frequent periods of "dozing off" during daytime activity. The most commonly reported sleep disturbing factors identified during basic training involved: late-night military admin (e.g., ironing, boot cleaning, kit set up etc), early morning wake times, extraneous noise, light and hot room temperatures within the primary sleeping environment, bed/mattress discomfort, muscle soreness and feelings of stress and anxiety.

Discussion/Conclusion

Our findings contribute to the existing evidence that long-term sleep loss is pervasive during initial military training programmes. The average sleep durations indicate chronic and unrecoverable sleep loss which would be expected to significantly impair physical and cognitive military performance, and increase the risk of injury, illness and attrition rates during basic training. Changes in the design and scheduling of basic training programmes to enable, at the least, minimum sleep recommendations to be met, and to improve sleep hygiene in the primary sleeping environment are warranted.

The optimal dose of Ramelteon for the better treatment adherence of delayed sleep-wake phase disorder: a dropout rate study

Background

Evidence regarding the effectiveness of melatonin receptor agonists in treating delayed sleep-wake phase disorder (DSWPD) remains limited. This study aimed to determine the optimal dose of ramelteon, a melatonin receptor agonist, for the better treatment adherence of DSWPD.

Methods

The patients who were diagnosed definitely as having DSWPD by board-certified physicians specialized in sleep medicine and started to receive strategically timed ramelteon medications after the diagnosis were included. Data on the initial ramelteon dose and follow-up duration (up to 24 months) were collected retrospectively. Patients with treatment discontinuation, changes in ramelteon dose, or the addition of other sleep-related medications were considered dropouts. Kaplan-Meier estimates, log-rank tests, and Cox regression analyses were performed.

Results

Overall, 373 patients were analyzed. The findings revealed that the 2 mg dose of ramelteon was associated with a lower dropout rate compared to the other doses (8 mg, 4 mg, and 1 mg). The dropout rate for the 2 mg group was estimated to have a hazard ratio (HR) of 0.5762 when compared with the 8 mg dose group. Sex did not reveal a significant HR, whereas older age exhibited a small but significant HR (0.9858).

Conclusion

For achieving better adherence, a dosing regimen of strategically timed 2 mg ramelteon may be the best for the treatment of DSWPD. The therapeutic dose window for better adherence seems to center approximately 2 mg of ramelteon. Furthermore, caution should be exercised when treating younger patients to prevent dropouts.