Abstract The non-rapid-eye movement (NREM) sleep power spectrum is composed of rhythmic and arrhythmic components, respectively associated with brain rhythms and scale-free dynamics. Both components are hypothesized to represent distinct processes underlying sleep-dependent memory consolidation as well as other brain complex processes. Recent advancements in spectral parametrization techniques and the use of multifractal models have enabled new insights into these components and their connection to brain networks. Aging impacts NREM sleep oscillations, but no animal studies considered the impact of age on rhythmic and arrhythmic components. In this study, we assessed the effects of age on the power spectrum and its two components using local field potential (LFP) recordings in mice. We recorded across the cerebral cortex and within the hippocampus—a central brain hub involved in NREM sleep-dependent cognitive processing. Ten younger (7.6 months) and eleven older (15.7 months) C57BL/6 J male and female mice were continuously recorded over a 24-hour period. We extracted the NREM sleep standard and rhythmic spectra, controlled for scale-free activity, and estimated multifractal arrhythmic properties during NREM sleep using the Wavelet Leader and Bootstrap based MultiFractal analysis (WLBMF) toolbox. Older mice showed specific alterations in both components compared to younger animals: reduced rhythmic gamma power in the anterior cortex, greater regional differentiation of scaling exponents, and higher multifractal dispersion of the arrhythmic component in the hippocampus. These findings demonstrate that aging alters rhythmic and arrhythmic properties of NREM sleep in distinct brain regions, suggesting that both contribute to age-related changes in sleep-dependent cognition.

ABSTRACT Study Objectives National prevalence estimates for idiopathic hypersomnia (IH) are difficult to obtain. This study estimated the diagnosed IH prevalence among US adults. Methods Symphony Integrated Dataverse® claims (01/2015–12/2023) were analyzed. Eligible patients were aged ≥18 years with at least one medical/prescription claim in the year of interest (2019–2023) and prior year. IH was defined by ≥1 medical claim with an IH diagnosis code. Prevalence was estimated among all eligible patients in two ways: annual (IH diagnoses during year of interest) and all-time (IH diagnoses looking back all-time in the database from 2015 through year of interest). Age- and sex-adjusted prevalence estimates were also calculated using the US Census Bureau. Results Over 179, 182, 193, 205, and 198 million adults were assessed for diagnosed IH prevalence in each respective year 2019–2023. Unweighted annual prevalence of diagnosed IH from 2019–2023 was 12.1, 11.1, 11.0, 10.5, and 11.1 per 100,000 persons, respectively. Unweighted all-time lookback prevalence of diagnosed IH from 2019–2023 was 32.7, 37.3, 40.6, 43.3, and 49.0 per 100,000 persons, respectively. From 2019–2023, estimated standardized numbers of US adults diagnosed with IH were 30,563, 27,975, 27,859, 26,624, and 28,754 based on annual prevalence, and 82,027, 93,768, 101,766, 107,763, and 124,905 based on all-time prevalence. Conclusions Annual prevalence estimates (ie, proportions of individuals with diagnosed idiopathic hypersomnia during each year of interest) remained consistent across the follow-up period, ranging from 10.5–12.1 per 100,000 persons, signifying the rarity of the diagnosis.

Abstract Study Objectives Sleep monitoring outside of clinics could enhance care for insomnia and other sleep disorders but requires home systems that are easily operable and provide consistent data quality over multiple nights. We assessed the Waveband for usability by participants and feasibility of obtaining multi-night sleep data in the home setting. Methods 15 subjects with insomnia wore the Waveband EEG headband and an FDA-cleared wearable home sleep testing device, WatchPAT ONE (“WP1”) for 3 nights. Usability was assessed via the System Usability Scale (SUS). Feasibility of participants to collect data was evaluated by examining stability of measured total sleep time in relation to measurements from the reference device (WP1) and data quality as evaluated by 3 human experts. Results Average SUS score was 69.7, meeting the 68-point threshold for good usability. Total sleep time recorded by the Waveband and WP1 devices showed a correlation of 87.3%. All the recordings had an average of over 7 scorable hours of data per night. Conclusions Waveband demonstrated good usability by patients, was operable by patients, and generated interpretable data that provided stable sleep estimates across nights, comparable to an established home sleep testing device. The device has potential to advance patient care, sleep research, and clinical trials by enabling longitudinal ambulatory sleep assessment.

Abstract Introduction Bedtime routines are recommended for young children’s sleep. Most supporting evidence is, however, subjective, and the effects of constituent activities are rarely examined. This study explored pre-bedtime activity and sleep associations using objective measures. Methods In this repeated-measures observational study, 70 healthy 3–4-year-old children wore AX3 actigraphs for seven nights with chest-worn GoPros videoing activities for 2h before bed for five of those nights. Nutrition, self-care, screen, story, and other connection activity data were extracted using a reliable coding scheme developed for this study (κ ≥ 0.8). Exploratory analyses using Bayesian mixed effects linear and Poisson regression investigated associations between activities in the hour before bedtime and that night’s actigraphy-derived sleep measurements. Results Total sleep time (TST) was greater when the pre-bedtime period included connection activities like cuddling (16 min [Bayesian 95% credible interval (CrI) -11, 43]; 88% chance of a positive association) or bath/shower (15 min [95%CrI -9, 38]; 89% chance of a positive association). Screen exposure showed the least evidence of a relationship (TST <1 min shorter per 10 mins of exposure [95%CrI -6, 5]). Credible intervals were wide for audiobook use, which was uncommon, although directionality suggested less TST (-42 min [95%CrI -97, 15]; 93% chance of a negative association). Adjusting for sociodemographic factors did not substantially change results. Discussion Findings are consistent with connection activities involving caregivers supporting young children’s sleep, but that screen exposure is not a meaningful predictor when measured objectively. Further research on audiobook use is needed, including for reverse causation.

Abstract Objectives This study investigated cross-country differences in infant and maternal sleep across Korea, the U.S.A., and Australia. Methods Participants were 2005 mother-infant dyads (infant Mage = 13.82 months, SDage = 6.23 months) from Australia (n = 73), Korea (n = 222), and the U.S.A. (n = 1710). Mothers completed the Insomnia Severity Index, Dysfunctional Beliefs and Attitudes About Sleep, and the Brief Infant Sleep Questionnaire – Revised postpartum and were grouped (6, 12, and 24 months) dependent on infant age. Data were analysed using multiple regressions. Results Korean mothers had higher insomnia symptoms compared to Australian and U.S.A. mothers at all timepoints (p’s < .002). Mean DBAS scores were higher for Korean compared to U.S.A. and Australian mothers (p’s < .007). Compared to U.S.A. infants at all timepoints and to Australian infants at 12- and 24 months, Korean infants had shorter nighttime TST (p’s < .040) and longer SOL (p’s < .003). Bedsharing was associated with lower insomnia symptoms in Korean mothers at 24 months (p=.043). Co-sleeping was not significantly associated with insomnia and DBAS scores (p’s > .164). Conclusions Korean mothers had higher insomnia and DBAS scores, which did not differ by co-sleeping status; Korean infants had shorter nighttime TST, and longer SOL. Bedsharing in Korea was protective against insomnia symptoms at 24 months. Further exploration into the mechanisms of sleep changes is required to tailor future interventions for diverse backgrounds.

Abstract Introduction Competitive video gaming (esports) often involves cognitively demanding and irregular late-night routines that may compromise sleep health and daytime functioning. This two-part study aimed to identify behavioural and sleep-based predictors of perceived sleep quality in esports players using both subjective and objective measures. Methods Study 1 used a cross-sectional online questionnaire (n = 243; 81% male; mean age = 21.3 ± 4.0 years) to assess self-reported sleep behaviour and esports activity. Study 2 employed wrist-worn actigraphy and sleep diaries collected over approximately seven consecutive nights in a subsample of male esports players (n = 23; mean age = 21.3 ± 3.5 years). Results In Study 1, participants reported an average of 7.2 hours of sleep per night, with 45% experiencing poor sleep quality. Regression analyses identified younger age, evening chronotype, and greater daytime sleepiness as significant predictors. Longer weekday gameplay duration predicted poorer sleep quality among casual players (independent-ranked) but not among competitive players (team-based) participating in organised leagues, suggesting that structured routines may mitigate gameplay-related sleep disruption. In Study 2, participants averaged 6.7 hours of sleep per night with moderate daily intraindividual variability in sleep timing (IIV = 1.2 ± 0.4 hours). Multilevel modelling indicated that increased nightly total sleep, improved sleep hygiene, later habitual bedtimes, and earlier wake times each significantly predicted better sleep quality. Discussion These cumulative findings highlight the restorative value of regular and continuous sleep, combined with effective sleep hygiene practices, which may help optimise performance and recovery in competitive environments such as esports.

Abstract Introduction This analysis evaluated the efficacy and safety of lemborexant (LEM), a competitive dual-orexin-receptor-antagonist, in Asian participants with insomnia disorder. Methods E2006-G000-303 (Study 303; NCT02952820; 12-month; global, only Asian participants included here) and E2006-J086-311 (Study 311; NCT04549168; 1-month; China) were randomised, placebo (PBO)-controlled (Study 303: first 6 months), double-blind, parallel-group, phase 3 studies in adults with insomnia disorder. Outcomes were calculated using sleep diary data across the first month of treatment (LEM 10mg [LEM10] and PBO; first 7/last 7 nights [7N]). Safety data were collected. Results Baseline median (quartile [Q]1], Q3) subjective sleep onset latency (sSOL) values (min) for LEM10 and PBO, respectively, were 60.00 (35.00, 90.00) and 49.00 (34.29, 72.86) for Study 303 (n = 116) and 80.71 (50.00, 102.43) and 74.86 (58.29, 113.43) for Study 311 (n = 193). In Study 303, decreases (improvements) from baseline in sSOL were larger with LEM10 versus PBO and reached statistical significance for the first 7N (median [Q1, Q3]: LEM10: −11.73 [−30.00, −1.43]; PBO: −4.29 [−20.00, 3.57]; p=.0087). Decreases (improvements) reached significance at both timepoints in Study 311 (first 7N: LEM10: −17.00 [−42.86, −2.14]; PBO: −11.86 [−25.00, 5.17]; p=.0010; last 7N: LEM10: −29.29 [−57.14, −10.00]; PBO: −20.46 [−38.71, −3.43]; p=.0063). Larger decreases (improvements) from baseline in subjective wake after sleep onset with LEM10 versus PBO were observed in both studies, reaching statistical significance in Study 311 (first 7N). LEM10 was well-tolerated. Discussion LEM treatment improved subjective sleep parameters and was well-tolerated in Asian participants with insomnia disorder in these 2 studies with limited sample sizes.

Abstract Introduction Sleep is a fundamental biological process, but environmental and social factors influence individuals’ opportunities to obtain sufficient, high-quality sleep. These factors contribute to and explain sleep health disparities. The aim of this project was to conduct a Delphi study to conceptualise “Sleep Security”. Sleep Security places the opportunity for sufficient and high-quality sleep within a rights-based framework, drawing together a conceptualisation that highlights socio-environmental influences on sleep health. Methods An in-person workshop was held in 2024 to develop a preliminary conceptual model of Sleep Security. A 2-round online Delphi study was then conducted (2024-2025) to further refine and revise the conceptual model, definition and primary dimensions. Participants were Australian/New Zealand experts with clinical/academic experience in sleep, who rated their agreement on a 5-point Likert scale and provided qualitative feedback. Consensus was set apriori at ≥75% of participants indicating they “agree” or “strongly agree”, with qualitative data used to further refine if needed. Results Thirty-one experts participated in round 1, and 18 participated in round 2. Informed by qualitative feedback, changes were put forward for rating in round 2 for the definition of Sleep Security and three of the five domains. Consensus was reached on the definition and for five primary domains: “Safety and Security”, “Conducive Environment”, “Policy and Practice”, “Opportunities and Demands”, and “Autonomy”. Conclusions This new expert-driven conceptualisation of “Sleep Security” may be used in research and advocacy efforts to understand and promote sleep as a human right and a fundamental pillar for human health and well-being.

Abstract Background Joubert Syndrome (JS) is a rare autosomal recessive neurodevelopmental disorder, characterised by hypotonia, developmental delay, and a “molar tooth sign” on MRI brain. Sleep disordered breathing (SDB) is common, although referral for polysomnography (PSG) is variable. The aim of this study was to collate overnight PSG results from a series of patients with JS, and monitor the pattern of SDB over time. Methods A retrospective analysis of children with JS in a tertiary paediatric hospital from 2010-2025. Progess to date Twenty-one children (16 males) with confirmed JS were identified during the study period. Fourteen had PSGs, at a median age of 4 years (1mo – 10 years), while 11 had repeat PSGs at a median age of 5 years. Genetic sequencing has been performed in 18. Initial and repeat PSGs have been analysed. The mean initial AHI was 9.4 events/hr, compared to 7.2 events/hr in the repeat. The mean OAHI in initial studies was 5.4 events/hr compared to 2.2 events/hr in repeat studies. Six children received treatment between studies, including adenotonsillectomy, non-invasive ventilation, or a combination of both. Objective improvement was seen in 7 children, while 3 had stable but persisting SDB. SDB worsened in 1 child. Intended outcome and impact Children with JS show a range of SDB, ranging from normal PSGs, to those showing severe OSA requiring varying levels of intervention. Patients with JS would benefit from serial PSGs during childhood, although not all are referred for sleep assessment. More awareness is required to ensure these children get adequate monitoring.

Abstract Aim Sleep problems often co-exist with hip osteoarthritis (OA) can be improved with exercise. Our aim was to investigate whether improvements in sleep quality and duration were associated with improvements in pain and function in people with hip OA following exercise. Methods Data from 185 participants with hip OA, randomized to an exercise intervention were pooled and analyzed. The dependent variable was 3-month change in sleep quality and duration using the Pittsburgh Sleep Quality Index (PSQI; range 0–21, higher scores = poorer sleep). The independent variables were 3-month change in hip pain severity (11-point scale; range 0-10, with higher scores indicating worse pain; minimum clinical important difference 1.8) and function (Western Ontario and McMaster Universities Osteoarthritis Index; range 0-68, with higher scores indicating more dysfunction; minimum clinical important difference 6). Associations between change in PSQI scores and change in pain and function were examined using linear regression models, adjusted for baseline values and covariates. Results Each one-point improvement in the PSQI was associated with a 0.2-point reduction in pain (95% CI: 0.1 to 0.3; adjusted R2 = 0.14) and a 1.1-point improvement in function (95% CI: 0.6 to 1.6; R2 = 0.28). Each one hour increase in sleep duration was associated with a 0.33-point reduction in pain (95% 0.02 to 0.63; R2 = 0.09) and a 2.6-unit improvement in function (95% 1.1 to 4.1; R2 = 0.24). Conclusion Improvements in sleep quality and duration are associated with small improvements in pain and function post-exercise.