When and what: A longitudinal study on the role of screen time and activities in adolescent sleep

OBJECTIVES

Previous research has highlighted a link between electronic media use and sleep outcomes, but the nuanced impacts of screen use at different time of day and activities on adolescent sleep are underexplored.

METHODS

831 participants underwent online assessment three times with interval of three months regarding their screen time and activities at specific times of the day, daytime sleepiness was assessed with the Epworth Sleepiness Scale, and sleep outcomes were assessed with the Pittsburgh Sleep Quality Index and Insomnia Severity Index. The associations between time spent on various screen activities, and sleep outcomes were examined respectively after controlling for inter-individual differences using the Random Intercept Cross-Lagged Panel Model models and LMMs.

RESULTS

The RI_CLPM model revealed that both electronic screen time during daytime and after lights off in the evening in Wave1 negatively predicted the sleep quality in Wave2; the nighttime screen time before lights off in Wave1 significantly negatively predicted the seventy of insomnia in Wave2. Whereas no cross-lag and predictive effects of sleep outcomes on screen time were revealed. Moreover, daytime screen exposure, including T.V. watching and social media use, and nighttime music listening were negatively associated with sleep quality. Conversely, nighttime screen time of shopping and working/studying positively influenced sleep quality. Additionally, daytime screen time of T.V. viewing was positively associated with increased insomnia severity, whereas nighttime work/study-related screen time negatively affected insomnia severity. Nighttime screen time of music listening negatively predicted daytime sleepiness.

CONCLUSIONS

The current findings contributed to the existing literature suggesting that the effects of electronic screen time on sleep depended on both the time of day and type of screen activities.

Restless legs syndrome in patients with obstructive sleep apnea: Association between apnea severity and symptoms of depression, insomnia, and daytime sleepiness

OBJECTIVE

To determine if the prevalence and severity of restless legs syndrome (RLS) varies with apnea severity and analyze differences between the sexes in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness in patients with obstructive sleep apnea (OSA).

METHODS

Symptoms of depression, insomnia, and daytime sleepiness were defined as Patient Health Questionnaire-9 score ≥10, Insomnia Severity Index score ≥15, and Epworth Sleepiness Scale score ≥11. Multivariate logistic and linear regression analyses were conducted.

RESULTS

In 707 adults with OSA (85.1% males), 16.1% (n = 114) had comorbid RLS. The prevalence of RLS was markedly lower in those with moderate and severe OSA than in those with mild OSA. Similarly, the odds of RLS significantly decreased with increasing apnea-hypopnea index. After controlling for age and sex, in patients with comorbid RLS, the International RLS Study Group Rating Scale scores were negatively correlated with apnea-hypopnea index and a nadir peripheral oxygen saturation during sleep. The presence of RLS was more likely to be associated with symptoms of depression, insomnia, and daytime sleepiness after controlling for confounding variables, but only in men.

CONCLUSIONS

RLS is frequently noted in combination with OSA, with a female preponderance. The severities of OSA and RLS may be negatively associated. In patients with OSA, sex-related differences in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness warrant further investigations.

Sex difference in the association between excessive daytime sleepiness and health-related quality of life in community-dwelling older adults: The Yilan study, Taiwan

OBJECTIVES

The association between excessive daytime sleepiness and health-related quality of life among older adults and at-risk individuals remains unclear. This study examined relationships between excessive daytime sleepiness and unfavorable health-related quality of life and explored the moderating effect of sex.

STUDY DESIGN

This was a community-based study of adults aged 65 years or more. Excessive daytime sleepiness was defined as a score exceeding 10 on the Epworth Sleepiness Scale. Multiple logistic regression analyses were used to examine the relationships between excessive daytime sleepiness and health-related quality of life. The moderating effect of sex was examined by testing interaction terms.

MAIN OUTCOME MEASURES

Health-related quality of life was measured using the Short Form 12 Health Survey, which includes a physical component summary and a mental component summary. Unfavorable health-related quality of life was defined as the lowest tertile of the scores for both components.

RESULTS

In total, 3788 individuals participated. After controlling for covariates, older adults with excessive daytime sleepiness did not have an unfavorable physical component summary but were more likely to have an unfavorable mental component summary (odds ratio 1.96; 95 % confidence interval 1.47-2.61). When stratified by sex, excessive daytime sleepiness was associated with a poor physical component summary in men (odds ratio 1.77, 95 % confidence interval 1.00-3.13) but not in women.

CONCLUSIONS

Excessive daytime sleepiness was associated with a poor mental component summary in both sexes; however, the association with a poor physical component summary was specific to men.

Bidirectional associations between sleep problems and suicidal thought/attempt in adolescents: A 3-wave data path analysis

PURPOSE

This longitudinal data analysis examined the bidirectional relationships between sleep problems and suicidal thought (ST)/attempt (SA) in a large sample of Chinese adolescents.

METHODS

A total of 6995 adolescents (mean age = 14.86 years and 51.4% males) participated in a 3-wave longitudinal study of behavior and health in Shandong, China. A self-administered questionnaire and standardized scales were used to assess ST, SA, sleep duration, insomnia, daytime sleepiness, and behavioral/emotional problems in 2015 (T1), 1 year later (T2), and 2 years later (T3). Path analyses were performed without and with adjustment for covariates, including gender, grade level, chronic diseases, cigarette smoking, alcohol use, anxiety/depressive symptoms, paternal education, and family economic status.

RESULTS

The prevalence rates of short sleep (<7 h/night), insomnia symptoms, and daytime sleepiness were 46.9-58.8%, 16.0-19.4%, and 25.1-25.3% at T1, T2, and T3, respectively. The rates of past-year ST and SA were 9.1-12.4% and 1.6-2.4% at T1, T2, and T3, respectively. Path analyses showed that short sleep, insomnia, and daytime sleepiness predicted subsequent ST, and vice versa. Daytime sleepiness and SA predicted each other 1 year later. Sleep problems and ST/SA in the previous year significantly predicted themselves in the follow-up year.

STUDY LIMITATION

All data were based on self-report.

CONCLUSION

Short sleep, insomnia, and daytime sleepiness all had bidirectional relationships with ST. Daytime sleepiness and SA were bidirectionally linked. Our findings suggest that interventions should be taken for both night sleep disturbances and daytime sleepiness to prevent suicide. Adverse sleep outcomes in suicidal adolescents should be assessed, which can in turn increase suicide risk.

Poor sleep quality and its associated neurocognitive function in children with obesity with or without obstructive sleep apnea

OBJECTIVE

To evaluate the associations of OSA severity, snoring symptoms, subjective sleep quality, and daytime sleepiness with executive functioning and behaviors in children with obesity.

METHODS

This was a cross-sectional study of children aged 8-18 years with obesity and symptoms suggestive of OSA. All participants underwent an overnight polysomnography and completed a set of questionnaires to assess their sleep-related breathing disordered (SRBD) symptoms [Pediatric Sleep Questionnaire (SRBD-PSQ)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], executive function [Behavior Rating Inventory of Executive Function (BRIEF)], and inattention and hyperactivity symptoms (Conners-3 Parent Short Form).

RESULTS

A total of 85 children (62% male, mean age: 13.9 ± 3.0 years) were included in this analysis, of whom 36, 16, and 33 were categorized into the non-OSA (obstructive apnea hypopnea index, OAHI < 1.5/h), mild OSA (OAHI 1.5-5/h), and moderate-severe OSA (OAHI ≥ 5/h) groups, respectively. Of 85 participants, 27 (32%) were classified with poor sleep quality (PSQI composite score ≥ 8). From multiple linear regression analyses, poor sleep quality and sleepiness were both independently associated with higher BRIEF behavioral regulation T-score, metacognition T-score, and global executive composite T-score in the fully adjusted model. In addition, poor sleep quality was also independently associated with higher Conners-3 inattention and executive functioning T-scores, while greater sleepiness was also associated with a higher learning problem T-score. The presence of OSA and snoring were not associated with any cognitive outcomes.

CONCLUSIONS

Subjective sleep quality and daytime sleepiness, but not OSA severity and snoring symptoms, were independently associated with executive functioning and behavioral problems in children with obesity.

Comparison of sleep characteristics between Parkinson's disease with and without freezing of gait: A systematic review

Parkinson's disease (PD) is a neurodegenerative disorder characterized by a range of motor and non-motor symptoms. Among the motor complaints, freezing of gait (FOG) is a common and disabling phenomenon that episodically hinders patients' ability to produce efficient steps. Concurrently, sleep disorders are prevalent in PD and significantly impact the quality of life of affected individuals. Numerous studies have suggested a bidirectional relationship between FOG and sleep disorders. Therefore, our objective was to systematically review the literature and compare sleep outcomes in PD patients with FOG (PD + FOG) and those without FOG (PD-FOG). By conducting a comprehensive search of the PubMed and Web of Science databases, we identified 20 eligible studies for inclusion in our analysis. Our review revealed that compared to PD-FOG, PD + FOG patients exhibited more severe symptoms of rapid eye movement sleep behavior disorder in nine studies, increased daytime sleepiness in eight studies, decreased sleep quality in four studies, and more frequent and severe sleep disturbances in four studies. These findings indicate that PD + FOG patients generally experience worse sleep quality, higher levels of daytime sleepiness, and more disruptive sleep disturbances compared to those without FOG (PD-FOG). The association between sleep disturbances and FOG highlights the importance of evaluating and monitoring these symptoms in PD patients and open the possibility for future studies to assess the impact of managing sleep disturbances on the severity and occurrence of FOG, and vice versa.

Assessment of cognitive function and sleep-wake rhythms in community-dwelling older adults

Disruption of the circadian rhythm and sleep-wake cycles is a consequence of aging and is associated with the cognitive decline and many neurodegenerative conditions. We investigated the bedtime, wake-up time, sleep timing (midpoint between bedtime and wake-up time), and sleep timing standard deviation (SD) using the actigraphy among 80 consecutive volunteers aged ≥ 60 years. Global cognitive function and executive function of detailed cognitive domains were evaluated using the mini-mental state examination (MMSE) and Wisconsin card sorting test (WCST) and subjective daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). The category achievement (CA), total errors (TE), perseverative errors of Nelson (PEN), non-perseverative errors (NPE), and difficulties in maintaining set (DMS) on the WCST were significantly correlated with sleep timing SD (CA: r = - 0.276, p = 0.013, TE: r = 0.311, p = 0.005, PEN: r = 0.241, p = 0.032, NPE: r = 0.250, p = 0.025, DMS: r = 0.235, p = 0.036), but not with the MMSE score. Multiple regression analyses with the stepwise forward selection method including age, ESS score, bedtime, sleep timing, and sleep timing SD, revealed that the ESS score, and sleep timing SD were significant factors related to CA on the WCST (ESS score: β = - 0.322, p = 0.004; sleep timing SD: β = - 0.250, p = 0.022). Assessment of sleep-wake rhythms, daytime sleepiness, and cognitive function using the MMSE and WCST is valuable for the prediction of cognitive decline in the geriatric population.

Different dimensions of daytime sleepiness predicted mortality in older adults: Sex and muscle power-specific risk in Yilan Study, Taiwan

OBJECTIVES

This study aimed to investigate the relationship between daytime sleepiness and mortality risk among older adults. The moderating effects of sex and physical function were examined.

METHODS

This 9-year follow-up study was conducted with community-dwelling individuals aged ≥65 years. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). Exploratory factor analysis (EFA) was used to examine the ESS factors. Handgrip strength was measured to assess physical function, and the highest quartile was defined as good muscle power. Cox regression analysis was used to estimate the 9-year all-cause mortality risk. The interaction terms were examined to evaluate their moderating effect.

RESULTS

In total, 2588 individuals participated in the study. The EFA explored two factors: the passive factor (PF) and the active factor (AF). After controlling for various covariates, the cutoff-defined daytime sleepiness (ESS≥11), total raw scores, and factor scores of the ESS all failed to predict mortality risk. The 3-way interaction terms showed statistical significance in terms of [sex × PF × muscle power (p = 0.03)] but not for [sex × AF × muscle power (p = 0.11)]. Specifically, PF predicted mortality risk in women with good muscle power (hazard ratio (HR): 1.48; 95 % confidence interval (CI): 1.04-2.10), which is female-specific. In contrast, AF predicted mortality risk only in men with good muscle power (HR: 1.35; 95 % CI: 1.02-1.78).

CONCLUSIONS

The ESS-measured daytime sleepiness in older adults is multidimensional. The mortality risk for each dimension was determined based on sex and physical function.

[Combined therapy of severe obstructive sleep apnea]

Obstructive sleep apnea is the most common breathing-related sleep disorder. The spectrum of therapy is wide ranging. The symptom of persistent daytime sleepiness can be an important indicator for reviewing the existing treatment. If polygraphic monitoring shows inadequate treatment under ongoing therapy, a combination of therapies should be considered.

Dysmenorrhea and Sleep: A Review

This review encompasses the clinical features and relevance to investigate sleep in women with dysmenorrhea. Dysmenorrhea is a prevalent gynecologic dysfunction that affects the social and professional lives of women. It can occur at every menstrual cycle, depending on the cause and psychologic factors. Studies have reported poor sleep and insomnia symptoms in dysmenorrhea condition, which may intensify the dysmenorrhea manifestation and interfere negatively to its treatment. There is an urgent need to identify the main cause of this dysfunction and provide efficient treatments to minimize the detrimental effects of dysmenorrhea in quality of life of these women.

Effect of second-generation antihistamines on nighttime sleep and daytime sleepiness in patients with allergic rhinitis

BACKGROUND

The daytime tiredness experienced by the vast majority of allergic rhinitis (AR) sufferers is directly related to the fact that they experience disrupted sleep at night. This study compared the effects of recently marketed second-generation H1 antihistamines (SGAs) on nighttime sleep and daytime sleepiness in patients with AR, with patients grouped into those taking non-brain-penetrating antihistamines (NBP group) and those taking brain-penetrating antihistamines (BP group).

METHODS

Patients with AR completed self-administered questionnaire-based surveys to determine Pittsburgh Sleep Quality Index (PSQI) before and after taking SGAs. Statistical analysis was performed on each evaluation item.

RESULTS

Of 53 Japanese patients with AR between 6 and 78 years old, median (SD) age was 37.0 (22.4) years old and 21 were men (40%). Of the 53 patients, 34 were the NBP group and 19 were the BP group. In the NBP group, mean (SD) subjective sleep quality score after medication was 0.76 (0.50), which was significantly lower (better) than the score of 0.97 (0.52) before medication (p = 0.020). In the BP group, mean (SD) subjective sleep quality score after medication was 0.79 (0.54), which was not significantly different from the score of 0.74 (0.56) before medication (p = 0.564). In the NBP group, mean (SD) global PSQI score was 3.47 (1.71) after medication, which was significantly lower (better) than the score of 4.35 (1.92) before medication (p = 0.011). In the BP group, mean (SD) global PSQI score was 2.47 (2.39) after medication, which was not significantly different from the score of 3.00 (2.71) before medication (p = 0.125).

CONCLUSION

Subjective sleep quality and global PSQI score were improved only in the group taking non-brain-penetrating SGAs.

Concurrence of Insomnia and Daytime Sleepiness Predicted 9-Year Mortality Risk in Community-Dwelling Older Adults: The Yilan Study, Taiwan

BACKGROUND

Co-occurring insomnia and daytime sleepiness has an undetermined clinical significance in older adults. We aimed to investigate the relationship between various combinations of insomnia and daytime sleepiness with mortality risk in community-dwelling older adults. The moderation effect of sex was also assessed.

METHODS

We conducted this follow-up study including community-dwelling adults aged ≥65 in Yilan City, Taiwan. Daytime sleepiness was defined as scoring ≥11 on the Epworth Sleepiness Scale. Insomnia was defined as scores ≥5 on the Athens Insomnia Scale-5. Four phenotypes were defined based on the presence of insomnia or daytime sleepiness. The 9-year mortality risks for various phenotypic combinations were estimated using Cox regression analysis. Sex-specific risks were examined using an interaction term.

RESULTS

In total, 2 702 older adults participated in the study, and 59.1% were women. The total 9-year mortality rate was 27.5%. After adjusting for all covariates, compared with those without insomnia or daytime sleepiness, the phenotype of co-occurring insomnia with daytime sleepiness predicted higher mortality risk (hazard ratio [HR]: 1.76, confidence interval [CI]: 1.20-2.58). In contrast, insomnia and daytime sleepiness alone did not correlate with higher mortality. The interaction between sex with co-occurring insomnia and daytime sleepiness was significant (p = .01). When stratifying by sex, the association between co-occurring insomnia and daytime sleepiness with higher mortality risk was male-specific (HR: 3.07, CI: 1.87-5.04).

CONCLUSIONS

Concurrence of insomnia and daytime sleepiness indicates a toxic phenotypic combination in older adults, particularly in men. Precise public health and preventive medicine can be implemented through geriatric sleep medicine.

Analysis of the relationship between sleep-related disorder and systemic immune-inflammation index in the US population

BACKGROUND

The association between sleep-related disorders and inflammation has been demonstrated in previous studies. The systemic immune-inflammation index (SII) is a novel inflammatory index based on leukocytes, but its relationship with sleep-related disorder is unclear. We aimed to investigate the relationship between sleep-related disorder and SII in a nationally representative nonhospitalized sample.

METHODS

Data were obtained from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Exposure variables included self-reported sleep-related disorders, such as sleep duration, sleep problems, high risk of OSA, and daytime sleepiness. SII and other traditional markers of inflammation were considered as outcome variables, including platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). Multiple linear regression models were employed to examine the correlation between sleep-related disorders and inflammatory markers. Subgroup interactions were analyzed using likelihood ratio tests, and nonlinear relationships were explored by fitting restricted cubic splines.

RESULTS

A total of 8,505 participants were enrolled in this study. Overall, sleep-related disorders were found to have a stronger association with SII compared to the PLR and NLR. The results of multiple linear regression analysis revealed that participants who experienced sleep problems (β: 21.421; 95% CI 1.484, 41.358), had symptoms of OSA (β: 23.088; 95% CI 0.441, 45.735), and reported daytime sleepiness (β: 30.320; 95% CI 5.851, 54.789) exhibited a positive association with higher SII. For the analysis of other inflammatory markers, we only found that daytime sleepiness was associated with increased NLR levels (β: 0.081; 95% CI 0.002, 0.159).

CONCLUSION

Sleep problems, symptoms of OSA, and daytime sleepiness were found to have a positive association with the SII in US adults. However, further prospective studies are necessary to establish whether there is a causal relationship between these factors.

The interaction between stress and sleep disorders among foreign medical students in Georgia

OBJECTIVES

This study aimed to: a. Investigate daytime sleepiness, stress, and pre-sleep arousal prevalence among foreign medical students in Georgia. b. Explore gender-based associations between sleep and stress parameters.

METHODS

Mental health was assessed in 207 foreign medical students in Georgia using the Epworth Sleepiness Scale (ESS), Pre-Sleep Arousal Scale (PSAS), and Student-Life Stress Inventory (SLSI).

RESULTS

Most participants reported elevated stress levels and excessive daytime sleepiness (EDS). EDS affected 25.1% of students, with slightly higher prevalence in males. PSAS was prevalent in 97.1% of students. Stress was widely reported, with 78% experiencing it, with a higher prevalence in females. Significant correlations were observed between sleepiness and arousal, including somatic (r = 0.41) and total scores (r = 0.28). Sleepiness was also linked to stressors like pressure, changes, self-imposed stress, and overall self-evaluation stress (r = 0.45). Strong correlations existed between ESS, Total PSAS, and overall self-evaluation SLSI scores for both genders. Gender differences were observed in the associations with Cohen's d within the small to moderate size. Men showed significant associations between ESS and stressors: conflict, pressure, chances, all stress reaction categories, and total SLSI scores (p < 0.001). In women, ESS correlated significantly only with overall self-evaluation (p < 0.001). Excessive daytime sleepiness, especially with somatic and total PSAS, predicted total SLSI scores for the entire sample and both genders, with stronger predictive values for total PSAS.

CONCLUSION

The study reveals a high prevalence of clinical sleepiness and its significant correlation with pre-sleep arousal and stress among foreign medical students, with females experiencing more difficulties than males.

Insomnia during coronavirus disease 2019 pandemic in Korea: a National sleep survey

Coronavirus disease 2019 (COVID-19) pandemic has caused widespread increase in stress and affected sleep quality and quantity, with up to 30% prevalence of sleep disorders being reported after the declaration of the pandemic. This study aimed to assess perceived changes due to the pandemic in the prevalence of insomnia and excessive daytime sleepiness (EDS) in Korea, and identify the associated factors. An online survey was conducted among 4000 participants (2035 men and 1965 women) aged 20-69 years enrolled using stratified multistage random sampling according to age, sex, and residential area, between January, 2021 and February, 2022. The questionnaire included various items, such as socio-demographics, Insomnia Severity Index, and Epworth Sleepiness Scale (ESS). Insomnia was defined as difficulty falling asleep and difficulty maintaining sleep more than twice a week. EDS was classified as an ESS score ≥ 11. Insomnia was reported by 32.9% (n = 1316) of the participants (37.3% among women and 28.6% among men). Multivariate logistic regression revealed that insomnia was associated with female sex [odds ratio (OR) = 1.526, 95% confidence interval (CI) = 1.297-1.796], night workers (OR 1.561, 95% CI 1.160-2.101), and being unmarried (OR 1.256, 95% CI 1.007-1.566). EDS was reported by 12.8% (n = 510) of the participants (14.7% among men and 10.7% among women). EDS was associated with male sex (OR 1.333, 95% CI 1.062-1.674), and being employed (OR 1.292, 95% CI 1.017-1.641). During the COVID-19 pandemic, the prevalence of insomnia increased in Korea, while there was no significant change in EDS compared with pre-pandemic evidence.

Nighttime sleep quality & daytime sleepiness across inpatient psychiatric treatment is associated with clinical outcomes

Prior research has demonstrated the strong link between sleep disturbance and mental health outcomes, including the importance of examining nighttime sleep quality and daytime sleepiness as separate constructs in relation to mental health outcomes. As such, the current study examined patients' self-reported nighttime sleep quality and daytime sleepiness trajectories over the course of inpatient treatment and how these trajectories related to treatment outcomes. Participants were 1,500 adults who voluntarily admitted to an inpatient psychiatric hospital. Mental health outcomes measured were emotion regulation problems, anxiety severity, depression severity, nightmare severity, and suicide risk. Group-based trajectory modeling was used to determine nighttime sleep quality and daytime sleepiness trajectory groups. Multivariate analyses of covariance (MANCOVA) were used to determine between group differences on mental health outcomes. Patients fit into distinct groups based on their trajectories of nighttime sleep quality and daytime sleepiness across inpatient psychiatric treatment: Low, Moderate, and High. Individuals with greater nighttime sleep disturbance and greater daytime sleepiness throughout treatment (High group) demonstrated significantly increased suicide risk, higher nightmare severity, more anxiety, more depression, and more emotion regulation difficulties at discharge. Results suggest an important connection exists between nighttime sleep quality and excessive daytime sleepiness and mental health outcomes for inpatient psychiatry.

Associations of sleep characteristics in late midlife with late-life hearing loss in the Atherosclerosis Risk in Communities-Sleep Heart Health Study (ARIC-SHHS)

OBJECTIVES

This study investigated associations of late midlife sleep characteristics with late-life hearing, which adds to the existing cross-sectional evidence and is novel in examining polysomnographic sleep measures and central auditory processing.

METHODS

A subset of Atherosclerosis Risk in Communities Study participants underwent sleep assessment in the Sleep Heart Health Study in 1996-1998 and hearing assessment in 2016-2017. Peripheral hearing thresholds (0.5-4kHz) assessed by pure-tone audiometry were averaged to calculate speech-frequency pure-tone average in better-hearing ear (higher pure-tone average=worse hearing). Central auditory processing was measured by the Quick Speech-in-Noise Test (lower score=worse performance). Sleep was measured using polysomnography (time spent in stage 1, stage 2, stage 3/4, rapid eye movement sleep; sleep-disordered breathing [apnea-hypopnea index ≥5]) and self-report (habitual sleep duration; excessive daytime sleepiness [Epworth Sleepiness Scale 10]). Linear regression models adjusted for demographic and lifestyle factors with additional adjustment for cardiovascular factors.

RESULTS

Among 719 Atherosclerosis Risk in Communities-Sleep Heart Health Study participants (61 ± 5years, 54% female, 100% White), worse speech-frequency pure-tone average was found with sleep-disordered breathing (2.51dB, 95% confidence interval: 0.27, 4.75) and excessive daytime sleepiness (3.35 dB, 95% confidence interval: 0.81, 5.90). Every additional hour of sleep when sleeping >8 hours was associated with worse Quick Speech-in-Noise score (1.61 points, 95% confidence interval: 0.03, 3.19). Every 10-minute increase in rapid eye movement sleep was associated with 0.14-point better Quick Speech-in-Noise score (95% confidence interval: 0.02, 0.25).

CONCLUSIONS

Sleep abnormalities might be risk factors for late-life hearing loss. Future longitudinal studies are needed to confirm these novel findings and clarify the mechanisms.

Disease-modifying therapies do not affect sleep quality or daytime sleepiness in a large Australian MS cohort

BACKGROUND

Poor sleep is common in multiple sclerosis (MS) and may impact daily functioning. The extent to which disease-modifying therapies (DMTs) contribute to sleep outcomes is under-examined.

OBJECTIVE

To compare the effects of DMTs on sleep outcomes in an Australian cohort of people with MS and investigate associations between DMT use and beliefs about sleep problems and daily functioning (social functioning and activity engagement).

METHODS

Sleep outcomes were assessed using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. DMT use and functioning were self-reported.

RESULTS

Of 1,715 participants, 64% used a DMT. No differences in sleep outcomes were detected between participants who did and did not use DMTs, the type of DMT used (lower vs higher efficacy, interferon-β vs other DMTs), the timing of administration, or adherence to standard administration recommendations. Beliefs that DMT use worsened sleep were associated with poorer sleep quality and perceptions that sleep problems interfered with daily functioning.

CONCLUSION

The use of a DMT does not appear to affect self-reported sleep outcomes in people with MS. However, beliefs that DMT use makes sleep worse were associated with poorer sleep quality and increased interference in daily functioning, suggesting a need for education to diminish negative perceptions of DMT use.

Impact of Taiwan's 2021 COVID-19 lockdown on the symptom severity and quality of life of patients with narcolepsy

COVID-19 lockdowns can influence the sleep quality and daytime condition of patients with narcolepsy. Using data from our cohort study, we investigated changes in the quality of life and the symptom severity of patients with narcolepsy during Taiwan's 2021 lockdown and investigated differences by narcolepsy subtype, sex, and age. Patients with type 1 and type 2 narcolepsy (NT1 and NT2, respectively) aged 6-40 years were retrospectively recruited from our narcolepsy cohort study. These patients were regularly evaluated using the Short Form 36 Health Survey questionnaire (SF-36), the Epworth Sleepiness Scale (ESS), the visual analog scale (VAS) for hypersomnolence, the VAS for cataplexy and sleep diary. We compared the differences between the lockdown and the prelockdown periods by narcolepsy subtype, sex, and age. We used a paired t test analysis to compare differences in the SF-36, ESS, VAS scores and data of sleep diary between the prelockdown and lockdown periods (p1), and an independent t test analysis was used to compare the changes in different subgroups between the prelockdown and lockdown periods (p2). A total of 120 patients with narcolepsy were recruited (mean age 24.22 ± 6.87 years; 58% male); 80 of the patients had NT1 (mean age 25.25 ± 6.79 years; 60% male) and 40 had NT2 (mean age 22.16 ± 6.64, 53% male). During the lockdown period, the ESS score of total patients was decreased (p = 0.039) and body mass index was increased (p = 0.02). The NT1 group decreased significantly (p1 = 0.017), especially in men (p1 = 0.016) and adults (p1 = 0.04); scores for the VT domain of the SF-36 increased significantly in male and adult patients with NT2 (p1 = 0.048 and 0.012). Additionally, male patients with NT2 exhibited significantly decreased scores in the physical and emotional role functioning domains (p1 = 0.028, 0.024). The children and adolescents with NT1 had significantly decreased scores in the general health domain of the SF-36, but no significant change was noted in that of adults (p1 = 0.027, p2 = 0.012). We observed both negative and positive impacts of Taiwan's 2021 lockdown on patients with narcolepsy. A more flexible but structured daily routine with adequate sleep time should be considered for this population during lockdown and nonlockdown periods.

Daytime sleepiness in Chinese professional, semi professional and students soccer players in the Shanghai lockdown

PURPOSE

April-May 2021 Shanghai city was under strict lockdown. Soccer players suffered from the restrictions, being unable to train and have a social life. The aim of this study was to compare differences in daytime sleepiness between genders and qualification levels in a cohort university Chinese soccer player under 0 Covid policy restrictions in the urban area of Shanghai.

METHODS

491 questionnaires of Epworth Sleepiness Scales (ESS) were compiled online by male and female Soccer Students (SS), Semi-Professional players (SP) and Professional Players (PP) during the ongoing restriction measures post Shanghai lockdown. ANOVA was performed for players levels and gender.

RESULTS

Significant differences were found between the 3 levels and between males and females. PP showed a very low score in the ESS (5,97) well below the threshold of 8 for daytime sleepiness, while SS and SP showed an ESS score above the threshold. Female showed higher scores in comparison to males. Differences between males and females reflect the confinement conditions in the ESS items, showing more difference in the item of ESS which are related with indoor situations.

CONCLUSIONS

This study shows the first data on sleepiness in Chinese soccer players of different level of qualification immediately post lockdown condition. Professional male's players sleepiness was lower, than females, SS and SP after the exceptional lockdown measures. The reasons can reside in the more ordered lifestyle of PP in comparison to SS and SP, which mitigated the effects of the lockdown. Our results suggest that measures to improve sleep in females' soccer player should be adopted if these exceptional conditions will happen again.

Sleep Disturbance in Chronic Rhinitis: Evaluation of Nasal Symptoms, Sleep Disorder Questionnaires, and Sleep Architecture in Allergic and Non-allergic Rhinitis in Dr. Cipto Mangunkusumo Hospital

Chronic rhinitis is often associated with sleep disturbance and daytime sleepiness. Disturbance in sleep impairs numerous metabolic processes and brain function. However, there is a paucity of data regarding the evaluation of nasal symptoms and sleep disturbance in chronic rhinitis, either allergic or non-allergic group. To evaluate the characteristic of sleep disturbance in allergic and non-allergic rhinitis in Dr. Cipto Mangunkusumo Hospital Jakarta, a cross sectional analytic descriptive study was performed. All recruited subjects were evaluated for total nasal symptom scores (TNSS) and nasal obstruction symptoms evaluation scores (NOSE). Sleep disorder was assessed using Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Index (PSQI) questionnaires, and polysomnography (PSG). A total of 22 chronic rhinitis patients, with 11 allergic and 11 non-allergic rhinitis were evaluated. Most subjects with allergic rhinitis experienced daytime sleepiness and poor quality of sleep as well as non-allergic rhinitis, without significant differences in TNSS, NOSE, ESS, and PSQI scores. There was impairment in sleep architecture from PSG parameters in both groups, but the difference was not significant. However, RDI-REM (17.7 ± 14.5 vs. 14.7 ± 18.5) and RERA (2.2 ± 2.1 vs. 1.6 ± 1.7) parameters have a tendency to be higher in the allergic rhinitis compared to non-allergic rhinitis group. Sleep disturbance existed in chronic rhinitis, presented by excessive daytime sleepiness and impairment in sleep architecture, yet no significant difference shown in the severity of TNSS, NOSE, ESS, PSQI scores, and sleep architecture parameters between the allergic and non-allergic rhinitis.

Normal multiple sleep latency test values in adults: A systematic review and meta-analysis

Sleep latency is a measure of time it takes to enter sleep. Very short sleep latencies are indicative of excessive daytime sleepiness and pathological sleep conditions such as narcolepsy. The normal range of mean sleep latency calculated from the multiple sleep latency test in healthy adults is not well-established. We provide a review of normative mean sleep latency values on the multiple sleep latency test by synthesizing data from 110 healthy adult cohorts. We also examine the impact of demographic variables such as age, sex, body mass index, sleep architecture and sleep-disordered breathing as well as methodological variables such as sleep onset definitions and multiple sleep latency test protocols. The average mean sleep latency was 11.7 min (95% CI: 10.8-12.6; 95% PI: 5.2-18.2) for cohorts evaluated using the earlier definition of sleep onset and 11.8 min (95% CI: 10.7-12.8; 95% PI: 7.2-16.3) for those evaluated using the later definition. There were no significant associations between mean sleep latency and demographic or methodological variables. A negative association of -0.29 per one unit increase (95% CI: -0.55 to -0.04) was found between mean sleep latency and apnea-hypopnea index on prior night polysomnography. Establishing updated ranges for mean sleep latency among healthy adults may guide clinical decision-making surrounding sleep pathologies and inform future research into the associations between patient variables, daytime sleepiness, and sleep pathologies.

Whole-food plant-based diet reduces daytime sleepiness in patients with OSA

Consumption of a diet high in saturated fat has been associated with daytime sleepiness. A whole-food plant-based (WFPB) dietary pattern, which is low in saturated fat, has been shown to be beneficial in a variety of health conditions. We assessed the effect of a short-term (21 days) WFPB diet intervention on daytime sleepiness in 14 patients with obstructive sleep apnea (OSA). We found a mean decrease of 3.8 points (SD = 3.3, p = 0.003) on the Epworth Sleepiness Scale (ESS) after switching from a standard Western diet to a WFPB diet. Our results suggest that a WFPB diet could be a viable dietary intervention to reduce symptom of daytime sleepiness.

Sleep quality and sleep deprivation: relationship with academic performance in university students during examination period

The beginning of the university brings together maturational, psychosocial and academic changes that make university students more prone to suffer from insufficient or poor quality sleep, which can negatively influence their academic performance. The period of taking exams is a key part of the academic year. However, there are few studies that analyze sleep during this period of time. Our aim is to study the association of sleep quality and sleep deprivation with academic performance during the examination period. A descriptive, cross-sectional and correlational study was carried out with the participation of 640 subjects in the first three years of five faculties belonging to the Universidad Autónoma de Madrid. The instrument used consisted of a questionnaire that included sociodemographic and academic data, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and information about the academic performance. During the examination period, a positive association was found between sleep quality and academic performance. University students slept less than desired, both on weekdays and weekends, and the sleep debt during the week was associated with a worse students' perception of their academic performance. In total, 61.3% of the students believed that their performance would improve by getting more sleep. In addition, low drowsiness and napping were also found. In conclusion, during periods of greater academic demand, an insufficient sleep and poor quality is commonly observed, affecting negatively to their academic performance. Actually, about 2/3 of our subjects believed that their performance would improve by getting more sleep.

Changes in cognitive function and daytime sleepiness in patients with chronic heart failure and Cheyne-Stokes respiration with adaptive servo ventilation treatment

STUDY OBJECTIVES

Cheyne - Stokes respiration (CSR) is prevalent in patients with chronic heart failure (CHF). Adaptive Servo Ventilation (ASV) alleviates CSR and improves objective sleep quality. We investigated the effects of ASV on neurocognitive function in the symptomatic phenotype of patients with CSR and CHF.

METHODS

This case series included patients diagnosed with stable CHF (NYHA ≥ II) and CSR (N = 8). Sleep and neurocognitive function were assessed at baseline and after 1- and 6-months following initiation of ASV treatment.

RESULTS

In CHF patients (n = 8, median age 78.0[64.5-80.8] years and BMI 30.0[27.0-31.5] kg/m2, median ejection fraction 30[24-45]%, Epworth Sleepiness Scale (ESS) score 11.5[9.0-15.0]), ASV markedly improved respiration during sleep (Apnea-Hypopnea Index (AHI) 44.1[39.0-51.5]n/h at baseline, 6.3[2.4-9.7]n/h at 6 months treatment, respectively, p < 0.01). The 6-min-walk test distance increased by treatment from (295.0[178.8-385.0] m to 356.0[203.8-495.0] m (p = 0.05)). Sleep structure was modified, and Stage 3 increased markedly from 6.4[1.7-20.1] % to 20.8[14.2-25.3] %, p < 0.02). Sleep latency in the Maintenance of Wakefulness Test increased from 12.0[6.0-30.0] min to 26.3[12.0-30.0] min, (p = 0.04). In the Attention Network Test, evaluating neurocognition, the number of lapses decreased from 6.0[1.0-44.0] to 2.0[0.3-8.0], (p = 0.05) and the overall number of responses to a preset stimulus increased after treatment (p = 0.04).

CONCLUSIONS

ASV treatment in CHF patients with CSR may improve sleep quality, neurocognition and daytime performance.

Nighttime sleep and daytime sleepiness patterns among left ventricular assist device patients

Despite the high prevalence of sleep disturbance in the heart failure population, information about its consequence on daytime function in patients with left-ventricular assist devices (LVADs) is limited. This study examined the nighttime and daytime sleep patterns and changes from pre-implant to 6 months post-implant. This study included 32 LVAD patients. Demographics, nighttime and daytime sleep variables were collected pre-implant and at 1, 3, and 6 months post-implant. Wrist actigraphy and self-report questionnaires measured objective and subjective sleep, respectively. Objective nighttime sleep data were sleep efficiency (SE), sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), and sleep fragmentation (SF). Objective daytime sleep data were nap times. Self-reported Subjective Sleep Quality Scale (SSQS) and Stanford Sleepiness Scale (SSS) were subjective measures. Increased SF and WASO scores and decreased TST and SE scores were found pre-LVAD implant, indicative of poor sleep quality. TST, SE, naptime and SSQS scores were higher at 3 and 6 months post-implant compared to baseline. Decreases in TST and SF scores were observed at 3 and 6 months post-implant along with increases in SSS scores. Increasing SSS scores and decreasing overall scores from pre- and up to 6 months post-implant suggest improvement in daytime function. This study provides information on sleep-daytime function in the LVAD patient population. Improvements in daytime sleepiness do not imply "good" sleep quality, consistent with the extant knowledge in LVAD literature. Future investigations should elucidate the mechanism by which sleep-daytime function influences quality of life.

Menstrual pain mediated the association between daytime sleepiness and suicidal risk: A prospective study

BACKGROUND

Adolescents with daytime sleepiness have been demonstrated to have a higher level of suicidal risk than those without. Currently, few studies had examined the pathway from daytime sleepiness to suicidal risk among female adolescents. This study aimed to explore the association among menstrual pain, daytime sleepiness, and suicidal risk among female adolescents in China.

METHODS

Of 7072 adolescents who participated in the follow-up survey of Shandong Adolescents Behavior & Health Cohort (SABHC), 3001 were female adolescents who had begun to menstruate and included for the analysis. A structured self-administrated questionnaire was used to measure menstrual pain, daytime sleepiness, suicidal risk and demographic characteristics. Participants were first surveyed in November-December 2015 and resurveyed 1 year later.

RESULTS

Of 3001 participants, 11.43 % had suicidal risk, 79.8 % experienced menstrual pain. Cross-lagged analysis showed that there was cause-and-effect relationship between menstrual pain and daytime sleepiness. Moderate (OR = 1.79, 95%CI: 1.22-2.63) and severe (OR = 2.73, 95%CI: 1.80-4.12) menstrual pain (follow-up) were associated with suicidal risk (follow-up). Daytime sleepiness (baseline: OR = 1.04, 95%CI: 1.02-1.06, follow-up: OR = 1.07, 95%CI: 1.05-1.09) had effects on suicidal risk (follow-up). Mediation analysis showed that menstrual pain played a partially mediating role between daytime sleepiness and suicidal risk, with the indirect effect being 0.002 (95%CI: 0.001-0.004).

LIMITATIONS

All data were self-reported.

CONCLUSIONS

Menstrual pain and daytime sleepiness had effects on each other, and they both were the risk factors of suicidal risk. Among female adolescents, the association between daytime sleepiness and suicidal risk could be partially mediated by menstrual pain. Releasing the menstrual pain of female adolescents with daytime sleepiness could reduce their suicidal risk.

High- and low-intensity expiratory muscle strength training in patients with severe obstructive sleep apnea syndrome using non-invasive mechanical ventilation: A double-blinded, randomized controlled trial

BACKGROUND

The effects of expiratory muscle strength training (EMST) with different intensity on stages of sleep were not examined in patients with obstructive sleep apnea syndrome (OSAS).

OBJECTIVES

The aim of this study was to compare the effects of high- and low-intensity EMST (H-EMST and L-EMST) on disease severity, sleep stages, disease-related symptoms, daytime sleepiness, fatigue severity, and sleep quality in adult patients with severe OSAS using non-invasive mechanical ventilation (NIMV).

METHODS

Thirty-one clinically stable patients with severe OSAS were included in this prospective, randomized controlled, double-blinded study. These were randomly divided into two groups. The H-EMST group underwent training at 60% of maximum expiratory pressure (MEP) and the L-EMST group at 30% of MEP, seven days a week for eight weeks. Apnea hypopnea index (AHI), sleep stages, and respiratory sleep parameters were recorded using polysomnographic sleep analysis.

RESULTS

AHI decreased by 34.57% and 20.20% in the H-EMST and L-EMST groups, respectively. A statistically significant improvement in disease severity classifications distributions was observed in the H-EMST group after training (p = 0.016). A greater number of symptoms improved in the H-EMST. The effects of training on respiratory muscle strength, daytime sleepiness, fatigue perception, and sleep quality levels were comparable between the two groups (p>0.05).

CONCLUSIONS

H-EMST training is more effective in reducing disease severity and disease-related symptoms than L-EMST. Further studies are warranted for evaluating the long-term effects of EMST with larger sample sizes in OSAS.

The relationship between obstructive sleep apnea and asthma severity and vice versa: a systematic review and meta-analysis

BACKGROUND

There is a great association between the prevalence of obstructive sleep apnea (OSA) and asthma. Nonetheless, whether OSA impacts lung function, symptoms, and control in asthma and whether asthma increases the respiratory events in OSA are unknown. This meta-analysis aimed to examine the relationship between obstructive sleep apnea and asthma severity and vice versa.

METHODS

We carried out a systematic search of PubMed, EMBASE, and Scopus from inception to September 2022. Primary outcomes were lung function, parameters of polysomnography, the risk of OSA in more severe or difficult-to-control asthmatic patients, and the risk of asthma in patients with more severe OSA. Heterogeneity was examined with the Q test and I² statistics. We also performed subgroup analysis, Meta-regression, and Egger's test for bias analysis.

RESULTS

34 studies with 27,912 subjects were totally included. The results showed that the comorbidity of OSA aggravated lung function in asthmatic patients with a consequent decreased forced expiratory volume in one second %predicted (%FEV1) and the effect was particularly evident in children. %FEV1 tended to decrease in adult asthma patients complicated with OSA, but did not reach statistical significance. Interestingly, the risk of asthma seemed to be slightly lower in patients with more severe OSA (OR = 0.87, 95%CI 0.763-0.998). Asthma had no significant effect on polysomnography, but increased daytime sleepiness assessed by the Epworth Sleepiness Scale in OSA patients (WMD = 0.60, 95%CI 0.16-1.04). More severe asthma or difficult-to-control asthma was independently associated with OSA (odds ratio (OR) = 4.36, 95%CI 2.49-7.64).

CONCLUSION

OSA was associated with more severe or difficult-to-control asthma with decreased %FEV₁ in children. The effect of OSA on lung function in adult patients should be further confirmed. Asthma increased daytime sleepiness in OSA patients. More studies are warranted to investigate the effect of asthma on OSA severity and the impact of different OSA severity on the prevalence of asthma. It is strongly recommended that people with moderate-to-severe or difficult-to-control asthma screen for OSA and get the appropriate treatment.

Seasonal variation and sleep patterns in a hot climate Arab Region

PURPOSE

To describe the effect of seasonal variations on sleep patterns in a hot climate Arab region.

METHODS

This is a cross-sectional study that included healthy Omani subjects of both genders between ages 18 and 59 years. Data for sleep pattern identification in summer and winter were collected from participants using an actigraphy wristband.

RESULTS

Among 321 participants, in summer seasons, a polyphasic sleep pattern (40%) prevailed over other sleep patterns (P < 0.001). While in the winter season, monophasic sleep (31%) was the dominant pattern (P < 0.001). Subjects slept longer during the winter seasons with total hours of sleep during the day 48 min longer than in the summer, though the difference was not statistically significant (P > 0.05), while siesta duration in the summer was significantly longer (13 min, P < 0.01). In summer, the sleep quality was good (PSQI ≤ 5); however, it was poor (PSQI > 5) in winter (P < 0.05). Night sleep duration, daytime sleepiness, and sleep latency were not statistically different between the summer and winter seasons.

CONCLUSION

Sleep patterns may be influenced by seasonal changes. A polyphasic sleep pattern prevailed in summer while a monophasic pattern was the predominant sleep pattern in winter. In summer, the sleep quality was good and the siesta duration was longer compared to the winter.

The association between sleep architecture, quality of life, and hypertension in patients with obstructive sleep apnea

OBJECTIVE

The aim of this study was to investigate the association between hypertension and overnight polysomnography measures of sleep duration, sleep architecture, and quality of life (QoL) in patients with obstructive sleep apnea (OSA).

METHODS

Participants were patients suspected of having OSA with or without hypertension. All patients underwent overnight polysomnography and completed the Epworth Sleepiness Scale (ESS), Self-Rating Anxiety Scale, Self-Rating Depression Scale, and 12-item Short-Form Health Survey.

RESULTS

Of 128 patients (mean age 46.2 ± 12.5 years), 53% had hypertension. The average total sleep duration was 344 min (standard deviation 90) or 5.7 h and sleep efficiency was < 70%. There was no significant difference between patients with OSA with/without hypertension in total sleep duration, sleep architecture, anxiety, depression, ESS scores, or QoL. In patients with OSA, nocturnal minimum oxygen saturation was significantly negatively correlated with bodily pain and physical component summary (PCS) scores; mean nocturnal saturation was negatively correlated with bodily pain and social function; anxiety showed a significant negative correlation with role emotional; and depression was significantly negatively correlated with physical function, role physical, general health, role emotional, PCS, and mental component summary (MCS) scores. In the group with OSA and hypertension, N3 duration was negatively correlated with social function, mental health, and MCS scores. Anxiety was significantly negatively correlated with physical function, role physical, vitality, mental health, role emotional, PCS, and MCS scores. Depression was significantly negatively correlated with physical function, role physical, vitality, mental health, role emotional, PCS, and MCS scores. In patients with mild, moderate, and severe OSA, QoL was associated with depression. In mild OSA, PCS was correlated with ESS and anxiety. In moderate OSA, MCS was correlated with apnea-hypopnea index scores. In severe OSA, MCS and PCS were correlated with anxiety.

CONCLUSIONS

There were no significant associations between the presence of hypertension and total sleep duration, sleep architecture, or QoL in patients with OSA. However, hypertension may affect the influencing factors of QoL in patients with OSA. Further cohort studies are needed to confirm these findings.

Parkinsonian daytime sleep-wake classification using deep brain stimulation lead recordings

Excessive daytime sleepiness is a recognized non-motor symptom that adversely impacts the quality of life of people with Parkinson's disease (PD), yet effective treatment options remain limited. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for PD motor signs. Reliable daytime sleep-wake classification using local field potentials (LFPs) recorded from DBS leads implanted in STN can inform the development of closed-loop DBS approaches for prompt detection and disruption of sleep-related neural oscillations. We performed STN DBS lead recordings in three nonhuman primates rendered parkinsonian by administrating neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Reference sleep-wake states were determined on a second-by-second basis by video monitoring of eyes (eyes-open, wake and eyes-closed, sleep). The spectral power in delta (1-4 Hz), theta (4-8 Hz), low-beta (8-20 Hz), high-beta (20-35 Hz), gamma (35-90 Hz), and high-frequency (200-400 Hz) bands were extracted from each wake and sleep epochs for training (70% data) and testing (30% data) a support vector machines classifier for each subject independently. The spectral features yielded reasonable daytime sleep-wake classification (sensitivity: 90.68 ± 1.28; specificity: 88.16 ± 1.08; accuracy: 89.42 ± 0.68; positive predictive value; 88.70 ± 0.89, n = 3). Our findings support the plausibility of monitoring daytime sleep-wake states using DBS lead recordings. These results could have future clinical implications in informing the development of closed-loop DBS approaches for automatic detection and disruption of sleep-related neural oscillations in people with PD to promote wakefulness.

Sleep-disordered breathing symptoms and their association with structural and functional pulmonary changes in children born extremely preterm

This study aimed to evaluate symptoms of sleep-disordered breathing (SDB) among children born extremely preterm, with and without a history of bronchopulmonary dysplasia (BPD), including associations between sleep and respiratory symptoms, physical activity, pulmonary function, and pulmonary magnetic resonance imaging (MRI). This multi-center cross-sectional study enrolled children aged 7-9 years born extremely preterm with and without BPD. Participants completed the Pediatric Sleep Questionnaire (PSQ), the modified Epworth sleepiness scale, a respiratory symptom questionnaire, pedometer measurements, pulmonary function testing, and pulmonary MRI. Spearman's correlations and univariate and multivariable linear regression modelling were performed. Twenty-eight of 45 children included had a history of moderate-to-severe BPD. The prevalence of sleep-related symptoms was low, with the exception of hyperactivity and inattention. There were no differences in mean (SD) scores on sleep questionnaires in children with and without BPD (PSQ: 0.21 (0.13) vs 0.16 (0.14), p = 0.3; modified Epworth: 2.4 (2.4) vs 1.8 (2.8), p = 0.4). Multiple regression analyses examining difference in sleep scores between groups, adjusting for gestational age and intraventricular hemorrhage, found no statistical difference (p > 0.05). Greater daytime sleepiness was moderately correlated with FEV1%-predicted (r =  - 0.52); no other moderate-strong associations were identified.  Conclusions: There was no evidence of clinically important differences in sleep symptoms between children with and without BPD, suggesting that sleep symptoms may be related to prematurity-related factors other than a BPD diagnosis, including airflow limitation. Further research is necessary to explore the relationship between sleep symptoms, airway obstruction, and neurobehavioral symptoms among premature-born children.  Trial registration: NCT02921308. Date of registration: October 3, 2016. What is Known: • Presence of bronchopulmonary dysplasia (BPD) may further contribute to the development of SDB, though its impact is not well-studied. • Premature-born children have a greater risk of lung structural and functional differences, including sleep-disordered breathing (SDB). What is New: • There was no difference in sleep symptoms between children with and without BPD, suggesting that sleep symptoms are related to other prematurity-related factors, such as airflow limitation. • Greater daytime sleepiness was correlated with lower FEV1 in our population, which reflects greater airflow limitation.

Genetic associations between sleep traits and cognitive ageing outcomes in the Hispanic Community Health Study/Study of Latinos

BACKGROUND

Sleep phenotypes have been reported to be associated with cognitive ageing outcomes. However, there is limited research using genetic variants as proxies for sleep traits to study their associations. We estimated associations between Polygenic Risk Scores (PRSs) for sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnoea (OSA) and measures of cogntive ageing in Hispanic/Latino adults.

METHODS

We used summary statistics from published genome-wide association studies to construct PRSs representing the genetic basis of each sleep trait, then we studied the association of the PRSs of the sleep phenotypes with cognitive outcomes in the Hispanic Community Healthy Study/Study of Latinos. The primary model adjusted for age, sex, study centre, and measures of genetic ancestry. Associations are highlighted if their p-value <0.05.

FINDINGS

Higher PRS for insomnia was associated with lower global cognitive function and higher risk of mild cognitive impairment (MCI) (OR = 1.20, 95% CI [1.06, 1.36]). Higher PRS for daytime sleepiness was also associated with increased MCI risk (OR = 1.14, 95% CI [1.02, 1.28]). Sleep duration PRS was associated with reduced MCI risk among short and normal sleepers, while among long sleepers it was associated with reduced global cognitive function and with increased MCI risk (OR = 1.40, 95% CI [1.10, 1.78]). Furthermore, adjustment of analyses for the measured sleep phenotypes and APOE-ε4 allele had minor effects on the PRS associations with the cognitive outcomes.

INTERPRETATION

Genetic measures underlying insomnia, daytime sleepiness, and sleep duration are associated with MCI risk. Genetic and self-reported sleep duration interact in their effect on MCI.

FUNDING

Described in Acknowledgments.

What's "app"-ning to adolescent sleep? Links between device, app use, and sleep outcomes

This study investigated the associations between adolescent evening use of technology devices and apps, night time sleep, and daytime sleepiness. Participants were 711 adolescents aged 12-18 years old (46% Female, M_age = 15.1, SD = 1.2). Time spent using technology devices and apps in the hour before bed, and in bed before sleep onset, was self-reported. Participants additionally completed a questionnaire about their sleep on school nights and next day sleepiness. In the hour before bed, 30 min of phone use was associated with a 9-min delay in bedtimes. Thirty minutes spent using laptops, gaming consoles, and watching YouTube was associated with later lights out times of 9 min, ∼16 min and ∼11 min respectively, while watching TV was associated with a 9 min earlier lights out times. Using gaming consoles and watching YouTube were associated with greater odds of receiving insufficient sleep (≤7 h TST). In bed before sleep onset, 30 min spent using laptops, phones, iPad/tablets, and watching YouTube were linked with later lights out times of ∼7 min for phones and laptops, 9 min for iPad/tablets, and ∼13 min for YouTube. Watching Netflix was associated with greater daytime sleepiness. YouTube at this time point was associated with increased odds of sleeping ≤7 h on school nights. Adolescents are engaging with a wide range of technology devices and apps in the evenings. However, certain devices and apps (e.g., phones, laptops, gaming and YouTube) might lead to more negative sleep outcomes for adolescents on school nights compared to others.

The impact of sleep-corrected social jetlag on mental health, behavioral problems, and daytime sleepiness in adolescents

STUDY OBJECTIVES

This study aimed to examine the effect of sleep-corrected social jetlag (SJLsc) on mental health, behavioral problems, and daytime sleepiness in adolescents.

METHODS

This was a cross-sectional study which included 4787 adolescents (Mean age: 14.83±1.6y, 56.0% girls) recruited from 15 secondary schools in Hong Kong. SJLsc was defined as the absolute difference between sleep-corrected midsleep on weekdays and weekends, at which the sleep debt has been considered. It was classified into three groups: low-level ("LSJLsc", <1h), mid-level ("MSJLsc", ≥1h and <2h), and high-level of SJLsc ("HSJLsc", ≥2h). Adolescents' mental health, behavioral problems and daytime sleepiness were measured by the General Health Questionnaire (GHQ-12), the Strengths and Difficulties Questionnaire (SDQ) and the Pediatric Daytime Sleepiness Scale (PDSS). Logistic regression analysis and restricted cubic spline regression (RCS) analysis were applied with consideration of confounders including age, gender, puberty and sleep problems.

RESULTS

Nearly half (46.9%) of adolescents had SJLsc for at least 1 h. Greater SJLsc was associated with more behavioral difficulties (MSJLsc: OR: 1.20, p = 0.03; HSJLsc: OR: 1.34, p = 0.02) when controlling for age, sex, puberty, chronotype, insomnia, and time in bed. There was a dose-response relationship in which higher SJLsc had an increased risk of conduct problems and hyperactivity, while only high-level SJLsc was associated with a peer relationship problem. In RCS analysis, SJLsc was associated with a higher likelihood of behavioral difficulties (p = 0.03) but not poor mental health or daytime sleepiness.

CONCLUSIONS

Sleep-corrected social jetlag was a unique risk factor for behavioral problems in adolescents. Our findings highlighted the need for interventions to promote healthy sleep-wake patterns in school adolescents.

Sleep and Exercise among Young Doctors in a Tertiary Care Hospital in India: A Pilot Cross-Sectional Study

Background

Limited information is available on the sleep and propensity for daytime sleepiness in young medical doctors of India.

Methods

The 2-week self-reported data surrounding sleep and exercise habits, and the Epworth sleepiness scale (ESS) score obtained from volunteering doctors of a tertiary care hospital in India, were summarized as median (Q1-Q3). Comparisons with Mann-Whitney U test and correlations with Spearman's rank correlation were done.

Results

Forty-seven doctors (28 [26-33] years, 16 males) reported a total sleep duration (TSD) of 6.3 (6-6.7) hours, sleep latency of 9 (5.1-15.8) minutes, and ESS score of 8 (5-10). The number of days (out of 14) when the subjective feeling of 'refreshed', 'somewhat refreshed', and 'fatigued' was experienced was respectively 6 (2-9), 5 (3-8), and 1 (0-4). Junior-level doctors experienced more days of 'fatigue' than senior-level doctors (3 [0-4.3], 0 [0-0]; p = 0.002). Doctors who did not exercise reported greater days of fatigue than those who exercised (2 [0-4.8], 0 [0-2]; p = 0.047).

Conclusions

The young doctors of our study slept less than the recommended amount of 7 hours by the American Academy of Sleep Medicine. Their short sleep latency and normal propensity for daytime sleepiness, though encouraging, may be an effect of insufficient sleep and mentally alerting daytime schedule respectively. Notably, we found a positive association between exercise habits and subjective restoration following sleep in our study population. The sleep requirements and sleep structure among Indians are yet to be established. Our findings add to the data on sleep in the Indian context.

Non-motor symptoms burden in motor-fluctuating patients with Parkinson's disease may be alleviated by safinamide: the VALE-SAFI study

Parkinson’s disease (PD) is characterized by motor symptoms often experienced in concomitance with non-motor symptoms (NMS), such as depression, apathy, pain, sleep disorders, and urinary dysfunction. The present study aimed to explore the effect of safinamide treatment on NMS and quality of life in motor-fluctuating PD patients. VALE-SAFI is an observational single-centre study performed in fluctuating PD patients starting safinamide treatment and followed for 6 months. The effects of safinamide on NMS, sleep, fatigue, depression and pain were assessed through validated sales. Changes in the scales from baseline to the 6-month follow-up visit were analysed. 60 PD patients (66.67% males) were enrolled at baseline, and 45 patients completed the 6-month follow-up. PD patients improved motor symptoms at follow-up, with the significant reduction of motor fluctuations. The global score of the NMS Scale significantly decreased between baseline and the follow-up. Regarding pain domains, patients reported a significant improvement in discolouration and oedema/swelling. Further, a significant improvement was observed from baseline to follow-up in sleep quality measured through the Pittsburgh Sleep Quality Index, while no changes were documented in daytime sleepiness. No differences were found in depression and fatigue between baseline and follow-up. Finally, the patient’s perception of the impact of PD on functioning and well-being decreased from baseline to follow-up. The present findings confirmed the beneficial effect of safinamide on both motor and non-motor symptoms, also improving the quality of life of PD patients. Furthermore, these data support the positive effects of safinamide on pain and mood, as well as on sleep quality and continuity.

Chronic Opioid Use and Sleep Disorders

Opioid medications are considered a significant component in the multidisciplinary management of chronic pain. In the past two decades, the use of opioid medications has dramatically risen in part because of an increased awareness by health care providers to treat chronic pain more effectively. In addition, patients are encouraged to seek treatment. The release of a sentinel joint statement in 1997 by the American Academy of Pain Medicine and the American Pain Society in a national effort to increase awareness and support the treatment of chronic pain has undoubtedly contributed to the opioid crisis.

Continuous positive airway pressure improved daytime sleepiness and memory function in patients with obstructive sleep apnea

Objectives

Obstructive sleep apnea (OSA) is a sleep disorder which results in daytime sleepiness and impaired memory function. The aim of this study was to investigate the effect of continuous positive airway pressure (CPAP) on daytime sleepiness and memory function in OSA patients. We also investigated whether CPAP compliance impacted the effect of this treatment.

Materials and Methods

The nonrandomized, nonblinded clinical trial enrolled 66 patients with moderate-to-severe OSA subjects. All subjects completed a polysomnographic study, daytime sleepiness questionnaires (the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index), and four memory function tests (working memory; processing speed [PS]; logical memory [LM]; face memory [FM]).

Results

Before CPAP treatment, no significant differences (P < 0.05) were noted in the demographic data, daytime sleepiness, or memory function between two groups (with/without CPAP). However, OSA patients treated with CPAP for 2 months showed significant improvements in daytime sleepiness, PS, mostly of LM, and FM comparing to 2 months ago. As compared to those who did not receive CPAP treatment, CPAP can improve only parts of LM (delayed LM [DLM] and LM percentage [LMP]). In addition, compared to control group, a significant improvement of daytime sleepiness and LM (LM learning, DLM, and LMP) in good compliance with CPAP treatment group and of DLM and LMP in the low compliance with CPAP treatment group was found.

Conclusion

CPAP treatment for 2 months could improve some of LM in OSA patients, especially in patients exhibiting good CPAP compliance.

Adolescent mobile phone addiction during the COVID-19 pandemic predicts subsequent suicide risk: a two-wave longitudinal study

Both the rate of mobile phone addiction and suicidality among adolescents have increased during the pandemic lockdown. However, the relationship between mobile phone addiction and suicide risk and the underlying psychological mechanisms remains unknown. This study examined the associations between mobile phone addiction in adolescents during the first month of lockdown and the suicide risk in the subsequent five months. A two-wave short-term longitudinal web-based survey was conducted on 1609 senior high school students (mean age = 16.53 years, SD = 0.97 years; 63.5% female). At Time 1 (T1), the severity of mobile phone addiction and basic demographic information was collected from Feb 24 to 28, 2020 in Sichuan Province, China (at the pandemic’s peak). Five months later, between July 11 and July 23 (Time 2, T2), mobile phone addiction, daytime sleepiness, depression, and suicidality were measured within the past five months. The regression analysis revealed that mobile phone addiction during quarantine directly predicted suicidality within the next five months, even after controlling for the effect of depression and daytime sleepiness. Meanwhile, mobile phone addiction at T1 also indirectly predicted suicidality at T2, with depression and daytime sleepiness mediating this association. Programs targeting improvement of daytime sleepiness and depressive symptoms may be particularly effective in reducing suicide risk among adolescents with mobile phone addiction.

Paradoxical association between chronotype and academic achievement: eveningness reduces academic achievement through sleep disturbance and daytime sleepiness

There are conflicting reports about the association between chronotype and academic achievement. Eveningness persons tend to have lower academic achievement, but have higher cognitive abilities. We hypothesized that sleep disturbance and daytime sleepiness, which are known to affect academic achievement, will interact with this association. To investigate the association, a sleep survey and covariance structure analysis was performed on high-school students. Among a total of 344 first-year high-school students, 294 students validly completed the questionnaire. The association between the recent change in their academic achievement, chronotype, daytime sleepiness, and sleep disturbance were analyzed. A simple comparison demonstrated that not chronotype but sleep disturbance and excessive daytime sleepiness were significant associated factors. Chronotype affects academic achievement through sleep disturbance and daytime sleepiness. Chronotype did not have a significant total effect on the reduction in academic achievement, whereas morningness had a significant direct effect and a significant indirect inverse effect through better sleep and less daytime sleepiness. This model accounted for 13.0% of the variance of the reduction in academic achievement. When discussing the association between chronotype and academic achievement, the effect of sleep disturbance and daytime sleepiness should be considered. Reducing sleep disturbance and daytime sleepiness with consideration to the chronotype of each person would be beneficial for the improvement of academic achievement.

Sleep Deficiency in Adolescents: The School Start Time Debate

Adolescence is commonly accepted as a challenging time for sleep, with multiple factors contributing to sleep deficiency in adolescents. These include physiologic changes with shifts in their circadian rhythm; medical sleep disorders; and social, cultural, and environmental factors. Early school start times negatively affect sleep in adolescents as well, with poorer outcomes in their overall health, wellbeing, and performance. This article highlights the different contributing factors for sleep deficiency in adolescents and the consequences of sleep deficiency. In addition, the authors discuss the impact of delayed school start times in improving adolescents' sleep and overall function.

Gut microbiome and daytime function in Chinese patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is underscored by daytime dysfunction-associated features, including mood disturbances, impaired cognition, fatigue, and daytime sleepiness. Importantly, the gut-brain axis may represent a potential mechanistic link between MDD and daytime dysfunction. Therefore, this study aimed to explore the gut microbiome composition and daytime dysfunction in Chinese patients with MDD.

METHODS

We enrolled 36 patients with MDD and 45 healthy controls (HCs) matched by age, sex, and body mass index (BMI). Daytime function including emotion, fatigue, and sleepiness were assessed using the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD). 16S rRNA sequencing was employed to characterize the gut microbiota in stool samples.

RESULTS

The operational taxonomic units (OTUs) OTU255, OUT363 were positively correlated with HAMD and HAMA. OTU244, OTU542 and OTU221 were positively correlated with ESS, HAMD and HAMA. OTU725 and OTU80 were positively correlated with FSS, ESS, HAMD and HAMA, while OTU423 and OTU502 were negatively correlated with all above. Flavonifractor positively correlated with fatigue in patients with MDD and all individuals simultaneously. The correlation between gut microbiome and daytime function was different in MDD and HCs.

CONCLUSIONS

We identified several OTUs associated with the severity of fatigue, depression, daytime sleepiness and anxiety in all individuals. Our results revealed the differences in microbiome found between patients with MDD and HCs. These findings provide insights into the potential microbiota changes that occur in MDD, and will enable the development of specific therapeutic strategies for targeting the various symptoms of depression.

Memantine for the patients with mild cognitive impairment in Parkinson's disease: a pharmacological fMRI study

BACKGROUND

Mild cognitive impairment in Parkinson's disease (PD-MCI) is associated with an increased risk of cognitive decline. PD-MCI is characterized by impairments in executive function and visuospatial recognition. The visuospatial n-back test is useful for assessing both domains. The 0-back test reflects visuospatial recognition, while the 1-back and 2-back tests reflect working memory. Cholinesterase inhibitors are effective in the treatment of PD-MCI and dementia in PD (PDD). Although some studies have reported the efficacy of memantine for PDD, the therapeutic efficacy of memantine in patients with PD-MCI remains uncertain.

METHODS

This study aimed to investigate the effects of memantine on brain function in patients with PD-MCI, using a randomized double-blinded crossover protocol and functional MRI (fMRI). Ten patients who completed 16 weeks of follow-up were included. They were randomly assigned to either the memantine or placebo. Patients in the memantine group received 5 mg/day of memantine in the first week. The memantine dose was increased by 5 mg/day per week, until a final dose of 20 mg/day. Patients in the placebo group received the placebo following the same regimen as memantine. After the intervention, they underwent a 4 weeks washout period. Following the crossover protocol, a second intervention was conducted after the washout period. In each intervention, fMRI and neuropsychological tests were performed at the maximum dose period. Comparing the memantine and placebo groups, we investigated difference in the brain regions using the visuospatial n-back test.

RESULTS

There were no significant regions enhanced by memantine comparing with placebo at any load of n-back tests. In contrast, exploring regions reduced by memantine, we found significant reduction of activations within right lingual gyrus and left superior frontal gyrus in comparison between 2-back and 0-back test. A number of correct answers of the 2-back test and time to complete Trail Making Test-A were worse during memantine intervention.

CONCLUSIONS

Memantine did not improve visuospatial working memory of the patients with PD-MCI. Treatment for PD should be planned carefully considering the impact on cognitive function. Further study is needed to establish new therapeutic strategy.

TRIAL REGISTRATION

UMIN000046104. Retrospectively registered. First registration date: 28 Sept 2017.

Adherence to the MIND dietary pattern and sleep quality, sleep related outcomes and mental health in male adults: a cross-sectional study

BACKGROUND

A large number of studies have investigated the association of the Mediterranean and DASH diets with psychological health as well as sleep related outcomes. However, only a few number of studies have examined the association of their newly proposed hybrid, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) dietary pattern, with sleep quality and sleep related outcomes.

METHODS

This cross-sectional study was conducted on 400 male health professions (mean age 38.67 years). Dietary information was collected using a validated 168-item semi-quantitative food frequency questionnaire. The MIND score was computed based on major dietary components emphasized or minimized in this pattern. The higher the MIND score of a subject, the greater his adherence to the MIND pattern. Mental health was evaluated using the 21-item depression, anxiety, and stress scale (DASS-21). Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Sleep-related outcomes (day-time sleepiness and insomnia) were also evaluated using standard questionnaires RESULTS: No significant associations were found between adherence to the MIND diet score and odds of stress, anxiety and depression either in the crude or multivariable-adjusted models (P > 0.05). Nevertheless, participants with the greatest adherence to the MIND diet had lower odds of poor sleep quality (OR for T3 vs. T1: 0.56 (95% CI: 0.34, 0.92), P-trend = 0.023). The results remained significant after full adjustment for confounding variables (P-trend = 0.042). Participants in the highest tertile of MIND diet had a 42% lower odds of daytime sleepiness in the crude and multivariable-adjusted model (P-trend < 0.05). Although no significant association was observed between adherence to the MIND diet and severity of insomnia in the crude model (P-trend = 0.055), the multivariable-adjusted model showed that the highest adherence to the MIND diet was associated with lower odds of insomnia (OR for T3 vs. T1: 0.54 (95% CI: 0.31, 0.93), P-trend = 0.031).

CONCLUSION

While no significant associations were found between adherence to the MIND diet and stress, anxiety and depression, greater adherence to the MIND diet were associated with lower odds of poor sleep quality and sleep-related outcomes.

Factors associated with different levels of daytime sleepiness among Korean construction drivers: a cross-sectional study

Background

Commercial vehicle accidents are the leading cause of occupational fatalities and an increased risk of traffic accidents is associated with excessive fatigue, other health problems as well as poor sleep during work. This study explores individual and occupational factors associated with different levels of daytime sleepiness and identifies their association with driving risk among occupational drivers working at construction sites.

Methods

This cross-sectional and correlational study adopted a self-reported questionnaire of Korean construction drivers (N = 492). The data were collected from October 2018 to February 2019 using a battery of six validated instruments about participants’ sociodemographic, health-related, and occupational characteristics. One-way ANOVA and multinomial logistic regression were conducted using IBM SPSS WIN/VER 25.0, with a two-tailed alpha of .05.

Results

Based on the Epworth Sleepiness Scale, “moderate” (31.7%) and “severe” (10.2%) daytime sleepiness groups were identified. There were significant differences in break time, driving fatigue, depressive symptom, subjective sleep quality, physical and mental health, and driving risk among the three groups (all p-values < .001). Driving fatigue (Adjusted Odds Ratio [aOR] = 1.08, 1.17), depressive symptoms (aOR = 0.91, 0.98), subjective sleep quality (aOR = 1.18 in moderate only), and driving over the speed limit (aOR = 1.43, 2.25) were significant factors for determining “moderate” and “severe” daytime sleepiness groups, respectively.

Conclusion

A significant number of construction drivers experience excessive daytime sleepiness; thus it is important to reduce the negative impact of driving fatigue and other factors on daytime sleepiness. Our study findings suggest that occupational health care providers should pay attention to development and implementation of health management interventions to reduce driving fatigue that incorporate the drivers’ physical, mental, and occupational factors. Professional organizations need to establish internal regulations and public policies to promote health and safety among occupational drivers who specifically work at construction sites.

Heart rate change and clinical characteristics in patients with neck myoclonus: An observational study

•

Heart rates increased with neck myoclonus events.

•

The rate of increase was higher for neck myoclonus with cortical arousal than for those without.

•

Neck myoclonus may be associated with excessive daytime sleepiness or abnormal behaviors during REM sleep.

Objective

This study was conducted to evaluate heart rate (HR) change and clinical characteristics in patients with neck myoclonus (NM), a physiological motor phenomenon occurring during sleep.

Methods

For 18 consecutive patients in whom NM was confirmed from video-polysomnography, we analyzed 576 NMs. Change rate of HR at each 1 sec point towards the averaged HR in prior 5 sec period was calculated before and after all NM events.

Results

Findings show NM events as more prevalent during REM sleep than during NREM sleep (83.9% vs. 16.1%). For NM without cortical arousal in REM and NREM sleep, the respective HR increased 20 s before NM (p < 0.05); the change rate was up to 13%. For NM with cortical arousal in REM sleep, the HR increased 50 s before NM (p < 0.05); the change rate reached 18%. Three NM subjects showed abnormal vocalization or shouting during REM. Six NM subjects had excessive daytime sleepiness without sleep disorder.

Conclusion

HR increased before NM events, which may be associated with pathophysiology of NM. NM may possibly be associated with excessive daytime sleepiness or abnormal behaviors during REM sleep.

Significance

HR increase is associated with pathophysiology of NM and clinical symptoms.

[(Daytime-)Sleepiness at the Wheel: Conceptual Basics for the Evaluation of the Fitness to Drive]

(Daytime-)Sleepiness at the Wheel: Conceptual Basics for the Evaluation of the Fitness to Drive Abstract. The number of accidents that are caused because the driver fell asleep is most likely underestimated. Clear signs of sleepiness are either misinterpreted or ignored. Independent of whether sleepiness is caused by behavior or a medical condition, the short-term and maybe even long-term fitness-to-drive is not given. Despite clear criteria for sleepiness from guidelines, medical reports and practice use a number of paraphrasing and thus misleading terms. To improve clarity in reports and to prepare future research projects, we present our understanding of such terms and suggest a more selective overall use.

Daytime sleepiness and risk of stroke: A Mendelian randomization analysis

OBJECTIVE

Daytime sleepiness is known to be related to stroke, but whether daytime sleepiness is a risk factor for stroke remains unclear. We conducted a two-sample Mendelian randomization study to assess the relationship between daytime sleepiness and stroke, ischemic stroke (IS) and IS subtypes.

METHODS

Thirty-six single-nucleotide polymorphisms (SNPs) associated with daytime sleepiness were selected as instrumental variables, which were identified from a recent genome-wide association study(N = 452,071). Summary statistics of the SNPs on stroke, IS and IS subtypes were derived from the MEGASTROKE consortium with 40,585 stroke cases and 406,111 controls.

RESULTS

We found that daytime sleepiness was associated with large artery stroke (OR, 6.75; 95%CI, 1.49-30.57; p = 0.013), but not with all stroke (OR, 1.29; 95%CI, 0.81-2.05; p = 0.282), all ischemic stroke(OR, 1.46; 95%CI, 0.90-2.39; p = 0.136), cardioembolic stroke(OR, 1.0; 95%CI, 0.39-2.64; p = 0.984), or small artery stroke(OR, 1.52; 95%CI, 0.46-5.05; p = 0.485).

CONCLUSION

Our findings indicated that daytime sleepiness is causally associated with an increased risk of large artery stroke. Further studies are necessary to verify our results and explain the physiological mechanisms.