Morning Awakening Research Articles

Relationship of Nocturnal Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation.

In patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected postsurgical outcomes. Observational. Multicenter registry. We included patients from the Adherence and Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea International Registry (ADHERE) with a baseline ISI from 2020 to 2023. Regression analysis examined the association of ISI question scores for SOI, SMI, and EMA and outcomes: Apnea-Hypopnea Index (AHI) reduction, device usage, changes in the Epworth Sleepiness Scale (ESS) and overall ISI score, final visit (FV) completion, and satisfaction. No relationship was noted between insomnia subtypes and AHI reduction or FV completion. In the subgroup of patients with baseline moderate/severe insomnia, patients with major impairment for SOI used their device 64 min/day longer than those with minimal impairment. Amongall patients, those with baseline major impairment for SOI had a 2.3 points greater improvement in ISI from baseline to FV compared to patients with minimal impairment, while patients with baseline major impairment for SMI had a 2.0 and 3.5 points greater improvement in the ESS and ISI than those with minimal impairment. Patients with EMA and moderate/severe baseline insomnia had decreased odds of being satisfied after surgery. In ADHERE, nocturnal symptoms of insomnia did not limit HGNS efficacy or therapy use. Conversely, those with worse insomnia subtype impairments at baseline had improved outcomes related to adherence, sleepiness, and insomnia at the FV.

Principal component analysis on the effect of early morning awakening in major depressive disorder

Sleep disturbance is one of the most prevalent symptoms associated with Major Depressive Disorder (MDD). A recent article (Wu et al., 2022, Journal of Multiscale Neuroscience 1, 133-139) explored the significant relationship between early morning awakening (EMA), a type of sleep disturbance, and recovery in MDD patients. In the paper, the authors examined the relationship between EMA and the treatment of MDD with twelve neuropsychological parameters. The authors employed two univariate statistical techniques, students’ t-test and ANOVA, to analyze their data. While their analysis derived a meaningful conclusion that EMA may result in a statistically and clinically significant delay in recovery, we found that a multivariate statistical technique, principal component analysis (PCA), extracted additional quantitative information from their study. In this paper, we present quantitative features in the interaction between EMA and the treatment of MDD obtained from PCA.

Longer sleep duration and neuroinflammation in at-risk elderly with a parental history of Alzheimer's disease.

Although short sleep could promote neurodegeneration, long sleep may be a marker of ongoing neurodegeneration, potentially as a result of neuroinflammation. The objective was to evaluate sleep patterns with age of expected Alzheimer's disease (AD) onset and neuroinflammation. We tested 203 dementia-free participants (68.5 ± 5.4 years old, 78M). The PREVENT-AD cohort includes older persons with a parental history of AD whose age was nearing their expected AD onset. We estimated expected years to AD onset by subtracting the participants' age from their parent's at AD dementia onset. We extracted actigraphy sleep variables of interest (times of sleep onset and morning awakening, time in bed, sleep efficiency, and sleep duration) and general profiles (sleep fragmentation, phase delay, and hypersomnia). Cerebrospinal fluid (CSF) inflammatory biomarkers were assessed with OLINK multiplex technology. Proximity to, or exceeding, expected age of onset was associated with a sleep profile suggestive of hypersomnia (longer sleep and later morning awakening time). This hypersomnia sleep profile was associated with higher CSF neuroinflammatory biomarkers (IL-6, MCP-1, and global score). Interaction analyses revealed that some of these sleep-neuroinflammation associations were present mostly in those closer/exceeding the age of expected AD onset, APOE4 carriers, and those with better memory performance. Proximity to, or exceeding, parental AD dementia onset was associated with a longer sleep pattern, which was related to elevated proinflammatory CSF biomarkers. We speculate that longer sleep may serve a compensatory purpose potentially triggered by neuroinflammation as individuals are approaching AD onset. Further studies should investigate whether neuroinflammatory-triggered long sleep duration could mitigate cognitive deficits.

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

The aim of this study was to investigate the association of psychological and chronobiological factors with the presence and severity of chronic insomnia by symptom subtypes and their impacts on daytime dysfunctions. Participants of the present web-based epidemiological study were classified as follows: difficulty initiating sleep (DIS) (n = 91); difficulty maintaining sleep (DMS) (n = 13); early morning awakening (EMA) (n = 48); DIS + DMS (n = 67); DIS + EMA (n = 23); DMS + EMA (n = 24); triplet of DIS, DMS, and EMA symptoms (TRP) (n = 69); and normal sleepers (n = 4590). The Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), Munich Chronotype Questionnaire (MCTQ), insomnia-related psychological measures (including the Ford Insomnia Response to Stress Test [FIRST] and the Dysfunctional Beliefs and Attitudes about Sleep Scale [DBAS]), and the cognitive and somatic domains of the Pre-Sleep Arousal Scale (PSAS) were evaluated. The presence of DIS and DIS + DMS were significantly associated with an evening preference, and EMA and EMA + DMS with a morning preference, while TRP showed no significant association with either chronotype. The increase in DBAS scores was associated with higher ISI scores in all subtypes. Meanwhile, the associations of each psychological measure varied among insomnia subtypes, with the association of PSAS cognitive arousal to DIS and PSAS somatic arousal to both DMS + EMA and TRP. Pathological HADS score was associated with all subtypes. Chronotypes may be associated with the presence of some insomnia subtypes; however, only psychological factors were speculated to contribute to the aggravation of all subtypes. All insomnia subtypes possibly contribute to the formation of depression.

The Lighter Touch: Less-Restriction in Sequentially Implemented Behavioral Sleep Interventions for Children with Rare Genetic Neurodevelopmental Conditions.

The prevalence of sleep difficulties among children with rare genetic neurodevelopmental conditions (RGNC) is high. Behavioral interventions are commonly used in the treatment of sleep difficulties in children with neurodevelopmental conditions such as autism, however, research is scarce in children with RGNC. The range of co-occurring complexities within this population, means there is a need for research to not only determine the effectiveness of behavioral sleep interventions, but also which components might be the least restrictive (i.e., intensive/aversive) and minimally sufficient. This study used a single-case multiple baseline design to investigate the effectiveness and acceptability of behavioral sleep interventions, indicated within a Functional Behavior formulation in eight children with RGNC (M = 7.3years). Intervention components were sequentially administered across up to three phases, based on the principle of less restriction (from least to relatively more intensive) to determine what might be minimally sufficient. Results showed an improvement in sleep onset latency, night wakings, early morning waking and unwanted bed-sharing for 7/7, 6/7, 3/3 and 3/3 children respectively. Improvement was observed for most participants following the less restrictive phases of intervention (circadian modifications, antecedent modifications and positive reinforcement), however, more restrictive, albeit modified, extinction procedures were still implemented for five participants. Improvements were maintained at follow-up and interventions were deemed acceptable to parents. Less restrictive function-based behavioral strategies are an effective, and in some cases sufficient, contribution to a sequence of interventions for a range of sleep difficulties. They should be implemented first, before more restrictive strategies.

Insomnia with objective but not subjective short sleep duration is associated with incident cardiovascular and/or cerebrovascular disease.

Insomnia with objective short sleep duration (ISSD) has been associated with cardiometabolic outcomes (ie, hypertension or diabetes). We examined whether ISSD, based on objective or subjective sleep measures, is associated with more serious health problems, such as incident cardiovascular and/or cerebrovascular disease (CBVD). 1,258 men and women from the Penn State Adult Cohort (56.9% women, aged 48.3 ± 12.95 years) without CBVD at baseline were followed up for 9.21 ± 4.08 years. The presence of CBVD was defined as a history of diagnosis or treatment of heart disease and/or stroke. Insomnia was defined as a complaint of insomnia with a duration ≥ 1 year. Poor sleep was defined as a complaint of difficulty falling asleep, staying asleep, nonrestorative sleep, or early morning awakening. Objective short sleep duration was defined as < 6 hours' sleep based on polysomnography. Subjective short sleep duration was based on the median self-reported percentage of sleep time (ie, < 7 hours). Compared with normal sleepers with normal sleep duration, the highest risk of incident CBVD was in the ISSD group (odds ratio = 2.46, 95% confidence interval = 1.04-5.79), and the second highest was in normal sleepers with short sleep duration (odds ratio = 1.68, 95% confidence interval = 1.11-2.54). The risk of incident CBVD was not significantly increased in poor sleepers or those with insomnia with normal sleep duration. Finally, insomnia with subjective short sleep duration was not associated with increased incident CBVD. These data add to the cumulative evidence that ISSD, based on objective but not subjective measures, is the more severe biological phenotype of the disorder associated with incident CBVD. Pejovic S, Vgontzas AN, Fernandez-Mendoza J, etal. Insomnia with objective but not subjective short sleep duration is associated with incident cardiovascular and/or cerebrovascular disease. J Clin Sleep Med. 2024;20(7):1049-1057.

Mindfulness-based cognitive therapy improves insomnia symptoms in individuals with recurrent depression: secondary analyses from a randomized controlled trial.

Embedded within a randomized efficacy trial, the present study aimed to investigate whether mindfulness-based cognitive therapy (MBCT) for recurrent depression improved symptoms of insomnia. Sixty-eight remitted participants with at least three prior episodes of depression were randomized to 8 weeks of MBCT (n = 33) or a waitlist control condition (n = 35). The Bergen Insomnia Scale was used to screen for insomnia symptoms before and after the intervention. The analyses were conducted using one-way between-groups analyses of covariance. Twenty-five MBCT participants and 30 waitlist controls completed the study (74.5% females; mean age 40.7 ± 12.9 years). At baseline, 83.6% screened positive for the insomnia diagnosis. Following the intervention and after controlling for corresponding insomnia parameters at baseline, MBCT completers reported significantly less severe insomnia symptoms (p = 0.017), as well as less problems with prolonged sleep onset (p = 0.047) and nocturnal awakenings (p = 0.023), relative to controls. No group differences were found on early morning awakening, daytime impairment, or dissatisfaction with sleep. The results suggest that MBCT improves certain insomnia symptoms. However, additional sleep-specific interventions may be needed to further improve this population's sleep.Clinical Trial Registration: ISRCTN, ISRCTN18001392, registered 22/11/2018. URL: 10.1186/ISRCTN18001392.

Central sensitization and comorbid disorders in patients with coronary heart disease

Study of central sensitization (CS), insomnia and meteosensitivity in patients with coronary heart disease (CHD) admitted for a routine examination. 67 patients (29 men and 38 women), aged 50-87 years, average age 73 [67; 85] years, with chronic forms of coronary heart disease were examined. The examination included the Russian version of the central sensitization inventory (CSI); assessment of meteosensitivity using a visual analogue scale (VAS); questionnaire for semi-quantitative assessment of subjective sleep characteristics (ASHS). Patients with the presence of CS were prescribed Anvifen 250 mg 3 times a day; in addition, patients could take the drug during the day if necessary, as well as during night or early morning awakening (without exceeding the maximum daily dose of 1500 mg). The duration of drug administration and observation of patients was 30 days. The severity of CS (before and after treatment): subclinical - in 14 and 20, mild - in 15 and 37, moderate - in 17 and 10, severe - in 14 and 0, critical - in 7 and 0 patients, respectively. The average CSI score was 40.5[30; 50] and 32.5[25; 37.3] (p=0.00001). The severity of meteosensitivity according to VAS before and after treatment was 70 [60; 80] and 25 [20; 30] points (p=0.00002). The average ASHS score for subjective sleep characteristics before and after treatment was 13 [12; 15] and 26 [25; 28] points (p=0.00001). Central nervous system, insomnia and meteosensitivity are common clinical conditions in patients with coronary artery disease. Inattention to them leads to insufficient effectiveness of specific therapy and worsening of the course of cardiovascular diseases. The GABAergic drug Anvifen effectively reduces CS, meteosensitivity and improves sleep. The CSI is a simple and informative tool for assessing cerebral dysfunction in patients with coronary artery disease and can be recommended for daily routine practice in order to optimize personalized medical care.

CANNABINOIDS AS A TREATMENT APPROACH FOR ASD: A LITERATURE REVIEW

Given the increasing incidence and high economic and social costs associated with ASD, along with the need for effective pharmacotherapies for its core symptoms, alternative treatment options have become widely researched. The present study is a literature review that explored the DeCS/MeSH descriptors 'cannabinoid,' 'treatment,' and 'autism.' It is estimated that up to 80% of children with ASD experience sleep disturbances, such as prolonged latency for sleep onset, along with nocturnal and early morning awakenings, which are widely associated with alterations in the sleep-wake circadian cycle. In this context, it is known that the endocannabinoid system (eCB) is one of the main regulators of the sleep-wake cycle. However, the effect of phytocannabinoids on the sleep quality of children with ASD still lacks further clarification. Furthermore, these cannabinoids exhibit anti-inflammatory properties, reducing levels of pro-inflammatory cytokines and contributing to a neuroprotective microglial phenotype. In ASD, cannabinoid derivatives have demonstrated efficacy in controlling behavior and irritability. However, as of now, there is no FDA-approved product for regular use.

Sleep experiences of post-stroke patients: A qualitative study

Objective: To explore the sleep experience of post-stroke patients. Methodology: This descriptive study was conducted with purposive sampling technique in a class A central general hospital from February to July 2024. Data were collected from 17 stroke patients using in-depth interviews with open-ended question using guidelines and field note. Data were analyzed using thematic analysis. Results: All informants reported experiencing disturbances to their sleep patterns, which were attributed to a number of different factors; irritating thoughts, discomfort and physical constraints were identified as the primary causes of disrupted sleep. There were difficulties in initiating sleep, the occurrence of early morning awakenings and alterations in the fragmentation of sleep. Individuals had attempted to address these sleep issues through various means, including seeking comfort, maintaining calmness, and acquiring knowledge from social media, family members, friends, and healthcare professionals. Conclusion: Sleep disorders are prevalent among individuals who have experienced a stroke. Despite their best efforts, they are often unable to convey the extent of their sleep difficulties to health professionals. It is therefore recommended that health workers assess and provide appropriate information regarding sleep disorder interventions, particularly in stroke patients who are at risk.

Yoga Nidra, a Nonpharmacological Technique in Management of Insomnia and Overall Health in Postmenopausal Women.

Yoga Nidra is a promising technique through which body is consciously simulated into a profound relaxation state similar to attained during naturally occurring deep sleep. It is aimed to attain complete emotional, physical, and mental relaxation of body and mind. In postmenopausal phase of life, regular practice of Yoga Nidra at home preferably in morning, can help in reduction in anxiety and pain associated with early morning awakenings. This nonpharmacological technique has a therapeutic potential to improve sleep quality and quantity, and overall well-being.

Sleeping Difficulties, Sleep Duration, and Risk of Hypertension in Women.

Rates of poor sleep and hypertension are alarming worldwide. In this study, we investigate the association between sleeping difficulties and sleep duration with hypertension risk in women. Sixty-six thousand one hundred twenty-two participants of the NHS2 (Nurses' Health Study 2), who were free of hypertension at baseline (2001), were followed prospectively for 16 years and incident hypertension assessed every 2 years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for hypertension incidence associated with sleeping difficulties and sleep duration. During follow-up, we documented 25 987 incident cases of hypertension. After controlling for demographic and lifestyle risk factors, compared with women who slept 7 to 8 hours, women with shorter sleep duration had a significantly higher risk of hypertension (≤5 hours: HR, 1.10 [95% CI, 1.05-1.16]; 6 hours: HR, 1.07 [95% CI, 1.03-1.10]), whereas the risk for women with longer sleep duration was not statistically significant (9 hours: HR, 1.03 [95% CI, 0.97-1.10]; >9 hours: HR, 1.08 [95% CI, 0.94-1.23]). Compared with women rarely having difficulty falling or staying asleep, women sometimes or usually having these sleep difficulties had significantly higher risk of developing hypertension (HR, 1.14 [95% CI, 1.11-1.17] and 1.28 [95% CI, 1.22-1.35]; Ptrend<0.001). Early morning awakening was not associated with hypertension risk (Ptrend=0.722). There was no effect modification by night work or chronotype. Difficulty falling or staying asleep and short sleep duration were associated with higher risk of hypertension among women in our study. Screening for poor sleep could be useful in identifying people at higher risk for hypertension.

Inhalation of smoke from cooking activities in Katanga, a health burden among women users of charcoal and firewood

This study focused on the Inhalation of smoke from culinary activities in Katanga. It was carried out over a period of approximately 4 years. The study population consisted of women whose average age was 37.8 (16) years. On the one hand, 119 rural women (permanent users of coal in the Futuka village and 121 urban women (FU) in the Vallée urban district of the city of Lubumbashi were approached and selected. The fundamental question was whether prolonged or sporadic exposure to smoke from cooking activities could be an exposure factor to the risk of respiratory infections. Following the investigations made and the multiple functional explorations, we arrived at the confirmation of this hypothesis . In view of the results obtained, we found that the frequency of use of these biomasses oscillated respectively between 63.6% in town and 75% in rural areas. In the two female categories considered, the rates of cough and morning and usual sputum were, in almost all cases, higher among women from Futuka than among those from the Vallée district. Concerning the crisis of breathlessness and difficulty breathing, we noticed that for the three parameters observed (morning awakening with difficulty breathing, shortness of breath at rest during the day and shortness of breath after intense effort), the women users of the Vallée district were the more affected. For the values, apart from the Tiffnaud ratio (FEV1/FVC%), the functional exploration using the spirometer showed overall that almost all the spirometric parameters led to statistically significant differences between urban women (FU ) of the Vallée district and rural (FR) of the Futuka village. These are the forced vital capacity (FVC% pred with a p=0.034), the peak expiratory flow (PEF with a p value of 0.000) and the expiratory volume at the first second (FEV1% pred with a p value of 0.000).

The association between polluted fuel use and self-reported insomnia symptoms among middle-aged and elderly Indian adults: a cross-sectional study based on LASI, wave 1

BackgroundInsomnia predisposes the aging population to reduced quality of life and poor mental and physical health. Evidence of the association between polluted fuel use and insomnia symptoms is limited and is non-existent for the Indian population. Our study aimed to explore the link between polluted fuel use and insomnia symptoms in middle-aged and older (≥ 45 years) Indian populations.MethodsWe utilized data from nationally representative Longitudinal Aging Study in India (LASI) Wave 1. Participants with complete information on fuel use, insomnia symptoms, and covariates were included. Insomnia symptoms were indicated by the presence of at least one of three symptoms: difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), or early morning awakening (EMA), ≥ 5 times/week. Survey-weighted multivariable logistic regression analyses were conducted to evaluate the association between polluted fuel use and insomnia symptoms. We also assessed the interaction of association in subgroups of age, gender, BMI, drinking, and smoking status.ResultsSixty thousand five hundred fifteen participants met the eligibility criteria. Twenty-eight thousand two hundred thirty-six (weighted percentage 48.04%) used polluted fuel and 5461 (weighted percentage 9.90%) reported insomnia symptoms. After full adjustment, polluted fuel use was associated with insomnia symptoms (OR 1.16; 95%CI 1.08–1.24) and was linked with DIS, DMS, and EMA (OR 1.14; 95%CI 1.05–1.24, OR 1.12; 95%CI 1.03–1.22, and OR 1.15; 95%CI 1.06–1.25, respectively). No significant interactions for polluted fuel use and insomnia symptoms were observed for analyses stratified by age, sex, BMI, drinking, or smoking.ConclusionsPolluted fuel use was positively related to insomnia symptoms among middle-aged and older Indians. Suggestions are offered within this article for further studies to confirm our results, to explore underlying mechanisms, and to inform intervention strategies.

Unlocking the Secret to a Restful Night's Sleep: Understanding Insomnia (Anidra) and Overcoming it with Ayurveda

Sleep is a naturally occurring state of both mind and body. The challenge of insomnia disorder arise when an individual subjectively perceives or subpar sleep quality. This can manifest in various ways, including difficulty initiating sleep, frequent nighttime awakenings with subsequent struggles to return to slumber, premature morning awakenings. Insomnia is intimately linked to various medical and psychiatric conditions and can have profound repercussions on an individual's overall quality of life and emotional well-being. Regrettably, in our contemporary world, a growing number of individuals have become reliant on sleep-inducing medications, forming habitual dependencies on them. Within the framework of holistic well-being, three essential pillars support a healthy life: Aahar (nutrition), Nidra (sleep), and Brahmcharya (celibacy or responsible sexual conduct). Nidra, plays a crucial role in nourishing the living body. Anidra, the absence of sound sleep, has been meticulously described by ancient scholars in various contexts, such as its connection to Vata Nanatmaja Vikara and Vataja Jwara. Traditional Ayurvedic therapies, known as Panchkarma, offer effective approaches to address Anidra. These therapies include Shirodhara (a continuous stream of warm oil on the forehead), Shirobasti (retaining oil on the head), Shiroabhyang (head massage), Shiropicchu (warm oil application in the ear canal), and Padaabhyang (foot massage). These techniques have proven to be valuable in the treatment of insomnia. In light of recent research findings, it is our aim to delve into the underlying causes, consequences, and potential management strategies for insomnia, all through the unique lens of Ayurvedic wisdom.

Coronasomnia: A Concept Analysis

COVID-19 has been a global pandemic for three years. Symptoms experienced by patients with this disease include fever, cough, fatigue, muscle pain, and diarrhea as well as mental health issues. The terms "coronasomnia" and "COVID-somnia" emerged in 2021 to describe sleep disorders attributable to stress associated with the COVID-19 pandemic. In this study, the concept analysis method proposed by Walker & Avant (2019) was utilized to define the concept of coronasomnia (Walker & Avant, 2019), with three key attributes identified, including COVID-related anxiety or depression; insomnia that emerges after the pandemic; and experiencing difficulty falling asleep, interrupted sleep, or early morning awakenings accompanied by difficulty returning to sleep. Furthermore, the concept was elucidated in this study using typical, borderline, opposite, and relative cases. Lastly, evidence-based tools for validating the antecedents and consequences of coronasomnia were introduced. We hope the results of this concept analysis enhance nurses' understanding of coronasomnia and facilitate the implementation of clinical care and research in this area.

The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients – Trial protocol of a randomised controlled trial

AimsThis study will assess the efficacy of digital CBT for insomnia (dCBT-I) compared to sleep hygiene education (SHE) for the management of insomnia in women with cancer. Background30% of patients with cancer meet insomnia diagnostic criteria and this can be detrimental to health outcomes. Insomnia disorder comprises a dissatisfaction with sleep quantity or quality characterized by difficulty initiating sleep, frequent awakenings, or early morning wakening without the ability to return to sleep, at least 3 nights per week, for at least 3 months, causing significant impairment or distress in areas of functioning. MethodsWe will recruit 308 women with a current or prior cancer diagnosis who are currently experiencing insomnia; defined as a score of 16 or less on the Sleep Condition Indicator (SCI). Participants will be randomised to dCBT-I or SHE. dCBT-I will be delivered online via 6 sessions. SHE will be provided in an online format. Assessments of sleep and other related parameters, through validated questionnaires, will be taken at 12 and 24 weeks following intervention. Once 24 week assessments are completed, participants will crossover to the alternate arm (either SHE or dCBT-I) and undergo a final assessment at week 36. OutcomesThe primary outcome will be the mean continuous change in SCI score in the intervention arm compared to the control arm at 24 weeks. Additionally, the proportion of women with an SCI > 16 at 24 weeks will be assessed. Secondary outcomes include fatigue, sleep related quality of life, depression, anxiety, and hot flush interference. RegistrationThis study is registered on ClinicalTrials.gov with number NCT05816460

Redefining Comorbid Insomnia and Sleep Apnea: The Association of Sleep Breathing Impairment and Insomnia with Incident Diabetes.

Rationale: Obstructive sleep apnea (OSA) is a prevalent sleep disorder that is frequently comorbid with insomnia and often accompanied by metabolic diseases such as type 2 diabetes. Although the apnea-hypopnea index (AHI) is currently the diagnostic criterion for gauging the severity of OSA, the AHI has not consistently predicted incident diabetes. Objectives: To test whether a combined insomnia-OSA (COMISA) phenotype based on comorbid insomnia and sleep breathing impairment index (COMISA-SBII) predicts incident diabetes and to compare the association with an AHI definition of COMISA (COMISA-AHI) in the MrOS (Osteoporotic Fractures in Men) study. Methods: The study samples came from participants in the MrOS sleep study without diabetes at their baseline examination. The SBII was derived as the product of the duration of each respiratory event (apnea and hypopnea) and the accompanying desaturation area from baseline unattended polysomnography. A subgroup of individuals classified as having comorbid insomnia (difficulties falling asleep, waking up in the middle of the night and/or early morning awakenings >15 times per month, and daytime impairments) and sleep breathing impairment (greater than 50th percentile of SBII) were identified at baseline. The primary outcome was incident diabetes during the follow-up visits. Cox proportional models were built to assess the adjusted hazard ratios of COMISA-AHI and COMISA-SBII. Prediction model performances of incident diabetes were compared across different models. Results: A total of 2,365 men (mean age, 76 yr) without diabetes at baseline were included. During a median follow-up of 10.0 years, diabetes developed in 181. After adjusting for demographic characteristics, comorbidities, and behavioral risk factors, participants with COMISA-SBII had a higher risk of incident diabetes (hazard ratio, 1.82; 95% confidence interval, 1.15-2.89) than those without sleep disorders (those with an SBII ⩽13.17 and no insomnia). The result remained significant in the risk competing model. Compared with COMISA-AHI, the addition of COMISA-SBII to a crude model with established risk factors significantly improved the predictive value of incident diabetes. Conclusions: COMISA-SBII, but not COMISA-AHI, predicted incident diabetes after accounting for multiple covariates in a cohort of older men. A comorbid insomnia phenotype based on SBII plus insomnia symptoms may be an important clinical subtype.

Interactive association between insomnia symptoms and sleep duration for the risk of dementia-a prospective study in the Swedish National March Cohort.

Given the importance of sleep in maintaining neurocognitive health, both sleep duration and quality might be component causes of dementia. However, the possible role of insomnia symptoms as risk factors for dementia remain uncertain. We prospectively studied 22,078 participants in the Swedish National March Cohort who were free from dementia and stroke at baseline. Occurrence of dementia was documented by national registers during a median follow-up period of 19.2years. Insomnia symptoms and sleep duration were ascertained by Karolinska Sleep Questionnaire. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Compared to participants without insomnia at baseline, those who reported any insomnia symptom experienced a greater incidence of dementia during follow-up (HR 1.08, 95% CI: 1.03, 1.35). Difficulty initiating sleep versus non-insomnia (HR 1.24, 95% CI: 1.02, 1.52), but not difficulty maintaining sleep or early morning awakening was associated with an increased risk of dementia. Short sleep duration was associated with increased risk of dementia (6h vs. 8h, HR 1.29, 95% CI: 1.11-1.51; 5h vs. 8h, HR 1.26, 95% CI: 1.00-1.57). Stratified analyses suggested that insomnia symptoms increased the risk of dementia only amongst participants with ≥7h sleep (vs. non-insomnia HR 1.24, 95% CI: 1.00-1.54, P = 0.05), but not amongst short sleepers (<7h). Short sleep duration also did not further inflate the risk of dementia amongst insomniacs. Insomnia and short sleep duration increase the risk of dementia amongst middle-aged to older adults.

The effect of nonrestorative sleep on incident hypertension 1–2 years later among middle-aged Hispanics/Latinos

BackgroundInsomnia is known to be a major risk factor for incident hypertension. Nonrestorative sleep (NRS), which refers to insufficiently rested sleep, has reported to associate with various diseases. This study aimed to investigate the longitudinal association between insomnia-related symptoms including NRS and incident hypertension 1–2 years later by age group (young, 18–39 years and middle-age, 40–64 years) using existing cohort data involving Hispanics/Latinos.MethodsThis study included 1100 subjects who had participated in both the Hispanic Community Health Study/Study of Latinos and its follow-up study, the Sueño Ancillary Study, and met additional eligibility criteria. Incident hypertension was assessed by self-reported history and/or the use of antihypertensives. The Women’s Health Initiative Insomnia Rating Scale (WHIIRS) was used to evaluate insomnia-related symptoms (difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, difficulty returning to sleep, and NRS). Logistic regression analyses were conducted to assess the degree to which insomnia-related symptoms at baseline predicted incident hypertension.ResultsAmong the participants (64% middle-aged, 36% young adults), 140 (12.7%) developed hypertension during the follow-up period. Among the sleep-related symptoms, only NRS predicted incident hypertension after adjusting for sociodemographic factors and physical condition (odds ratio: 1.88, 95% confidence interval: 1.10–3.21, p = 0.022) in middle-aged adults. None of the insomnia-related symptoms were associated with incident hypertension in the young adults. No association was found between WHIIRS-defined insomnia (total score ≥ 9) and incident hypertension in middle-aged adults or young adults.ConclusionThe present findings suggest the importance of focusing on NRS to help prevent the development of hypertension in middle-aged adults.