Objective Short Sleep Duration Research Articles

Obstructive sleep apnea comorbid with insomnia symptoms and objective short sleep duration is associated with clinical and preclinical cardiometabolic risk factors: Clinical implications

BackgroundInsomnia with objective short sleep duration (ISSD) but not insomnia with normal sleep duration (INSD) is associated with cardiometabolic morbidity. It has been reported that sleep apnea comorbid with insomnia (COMISA) confers higher cardiovascular risk than each condition alone. We hypothesize that the association of COMISA with clinical (hypertension) and preclinical (inflammatory and metabolic) biomarkers is driven by the ISSD phenotype. MethodsA clinical sample of 101 adults with mild-to-moderate OSA (mmOSA) (5 ≤ AHI <30) and insomnia symptoms underwent polysomnography or home sleep apnea testing, blood pressure measures (BP), fasting blood glucose, insulin, CRP and IL-6 plasma levels. Insomnia was based on PSQI. Objective short sleep duration was based on the median total sleep time of the sample. Participants were classified into 2 groups based on objective sleep duration: mmOSA with ISSD vs. mmOSA with INSD. Analysis of covariance and logistic regression analysis were conducted controlling for confounders. ResultsSystolic and diastolic BP were elevated in the ISSD group compared to INSD group (p = 0.039 and p = 0.004, respectively). Also, the risk of hypertension was significantly higher in the ISSD (OR = 3.88, 95%CI = 1.26–11.95, p < 0.05) compared to INSD group. Plasma IL-6 concentrations and insulin resistance as indexed by glucose/insulin ratio were significantly higher in the ISSD group compared to INSD group (both p < 0.05). CRP levels were not different between the two groups. ConclusionIt appears that the additive adverse effects of COMISA on cardiometabolic risks are driven by the ISSD phenotype, a finding with potential implications for further phenotyping COMISA.

Sleep misperception in women with myofascial temporomandibular disorder.

Temporomandibular disorders (TMD) were linked to poor sleep on the Pittsburgh Sleep Quality Index (PSQI), whereas polysomnography (PSG) revealed no major sleep disturbances, implying sleep state misperception (SSM). This study investigates SSM in TMD and control participants; correlates SSM with objective short sleep duration (SSD), depression symptoms, daytime sleepiness, and orofacial pain; and compares objective SSD between the groups. General linear models were used to compare second-night PSG total sleep time (TST), sleep latency (SL), sleep efficiency (SE) and wake after sleep onset (WASO) with homologous PSQI-derived variables in 124 women with myofascial TMD and 46 age and BMI matched controls. PSQI variables were regressed onto objective SSD, depression symptoms, daytime sleepiness, and pain. Lastly, objective SSD was related to TMD presence. Compared to controls, TMD cases misperceived SE (p = 0.02); depression symptoms explained PSQI-derived SE (p = 0.002) and mediated the effect of pain (p <.001). PSQI variables were unrelated to respective PSG measures or objective SSD, except a significant subjective-objective correlation in SE among controls only (p = 0.002). Objective SSD was more frequent in TMD cases (p = 0.02, OR = 2.95), but it was unrelated to depression symptoms, daytime sleepiness or pre-PSG pain. The study demonstrates misperception of SE among TMD cases, which was accounted for by depression symptoms. Objective SSD nearly tripled in TMD cases; however, it was unrelated to PSQI variables, depression, daytime sleepiness, or pain, suggesting that SSM and objective SSD are two independent sleep features in TMD.

Functional MRI-based biomarkers of insomnia with objective short sleep duration phenotype

BackgroundInsomnia disorder with objective short sleep duration (ISS) phenotype is a more serious biological subtype than insomnia with objective normal sleep duration (INS) phenotype, and the neuroimaging data is helpful to understand the pathophysiology of the ISS phenotype. This study was to compare the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) between the ISS phenotype and the INS phenotype. MethodsIn this cross-sectional study, 55 patients with insomnia disorder were recruited, and 22 of them were defined as the ISS phenotype by the objective cardiopulmonary coupling (CPC) technique. The blood oxygen level-dependent (BOLD) sequences of all participants were obtained using the 3.0 T magnetic resonance imaging system. We analyzed and compared the ALFF, ReHo, and FC between the ISS phenotype and the INS phenotype. We also conducted Pearson's correlation analysis between significant neuroimaging biomarkers and the CPC parameters. ResultsThe differences were not significant in ALFF (PFWE-corr＞0.05) or ReHo (PFWE-corr＞0.05) between the ISS phenotype and the INS phenotype. For the FC analysis, the ISS phenotype had a Hub-node of the left inferior occipital gyrus (IOG.L), with significantly decreased connections (p＜0.001) in the bilateral occipital, parietal, and temporal regions. The significant FCs were closely related to sleep parameters. ConclusionThe left inferior occipital gyrus (IOG.L), as a Hub-node with decreased functional connections, may be a potential fMRI-based biomarker of the ISS phenotype.

Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study

BackgroundThe potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.MethodsThis was a prospective pilot cohort of pregnant people between 23 to 36 weeks’ gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.ResultsAmong the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.ConclusionsWhen including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1–9.6 mmHg higher SBP, 6.1–8.1 mmHg higher DBP, and 6.2–8.8 mmHg higher MAP than people without anxiety.

0757 Association of Insomnia with Objective Short Sleep Duration and Other Phenotypes with Mortality in Older Persons

0757 Association of Insomnia with Objective Short Sleep Duration and Other Phenotypes with Mortality in Older Persons

Lemborexant Treatment Effects on Polysomnographic Sleep Measures in a Subgroup of Elderly Subjects with Insomnia and Objective Short-Sleep Duration from a Phase 3 Trial

Lemborexant Treatment Effects on Polysomnographic Sleep Measures in a Subgroup of Elderly Subjects with Insomnia and Objective Short-Sleep Duration from a Phase 3 Trial

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.

Association of Objective and Subjective Sleep Duration and Diurnal Cortisol Rhythm among Community‐Dwelling People Living with Dementia

AbstractBackgroundEvidence has shown that both short and long sleep duration have adverse effects on cognitive health in older adults. Although changes in sleep duration have been linked with alterations in the hypothalamic‐pituitary‐adrenal axis, research on the association between sleep duration and various components of diurnal cortisol rhythm is inconsistent. In addition, limited research has examined this association in community‐dwelling people living with dementia. The aim of this study is to examine the association of objective and subjective sleep duration and cortisol rhythm indicators in a community‐dwelling population living with dementia.MethodParticipants in the Healthy Patterns Sleep Study (NCT03682185) provided three saliva samples at wakening, 30 minutes after waking, and bedtime on two consecutive days. Diurnal cortisol rhythm indicators included waking cortisol, cortisol awaking response, diurnal cortisol slope, and bedtime cortisol. Objective sleep duration was measured by averaging actigraphy over three days, and subjective sleep duration was assessed by a single item from the Pittsburgh Sleep Quality Index. The average daily total sleep duration was grouped into three categories: ≤5 (short), ≥9 (long), and &gt;5 &amp; &lt;9 (normal). 195 participants with valid cortisol and sleep data were used for analysis.ResultApproximately 60% (objective) or 45% (subjective) of the participants maintained seven to eight hours of sleep. Normal and long objective and subjective sleep duration preserved an intact diurnal cortisol rhythm. Short objective sleep duration, however, was associated with higher waking cortisol (p = 0.016) and diminished cortisol awaking response (p = 0.049), compared to normal sleep. No significance was found using subjective short sleep duration.ConclusionThis cross‐sectional study showed that objective short sleep duration was associated with disrupted cortisol rhythm. The findings suggest that neuroendocrine disturbance could be one mechanism linking sleep and dementia risk. Future studies are needed to confirm these findings using more sampling points in the morning. Additionally future research needs to consider the confounding sociodemographic and clinical characteristics such as race and dementia severity in a larger sample.

0829 Insomnia with Objective Short Sleep Duration is Associated with Hypertension

Abstract Introduction Insomnia with objective short sleep duration (ISSD) has been proposed as the most biologically severe phenotype of the disorder associated with cardiometabolic morbidity in population-based samples. Methods In this study, we investigated the association between ISSD and hypertension in a large clinical sample. We studied 348 patients diagnosed with chronic insomnia disorder (CID) based on International Classification of Sleep Disorders (ICSD-3) criteria and 150 normal sleepers. Objective short sleep duration was defined by the median total sleep time (TST) of the sample (&amp;lt; 7 hours) measured with 1-night polysomnography. Hypertension was defined based on blood pressure (BP) levels, antihypertensive medication use and/or a physician diagnosis. Results After adjusting for potential confounders, patients with CID who slept &amp;lt; 7 hours were associated with 2.8-fold increased odds of hypertension compared to normal sleepers who slept ≥7 hours (odds ratio [OR]=2.81, 95% confidence interval [95%CI]=1.068–7.411) or &amp;lt; 7 hours (OR=2.75, 95%CI=1.005-7.542), whereas patients with CID who slept ≥ 7 hours (OR=1.52, 95%CI=0.537-4.285) or normal sleepers who slept &amp;lt; 7 hours (OR=1.07, 95%CI=0.294-3.904) were not significantly associated with increased odds of hypertension compared to normal sleepers who slept ≥ 7 hours. Linear regression analyses showed that, for every hour decrease in TST, systolic and diastolic blood pressure increased by 1.014 mmHg (p=0.045) and 0.923 mmHg (p=0.015), respectively, in patients with CID but not in normal sleepers. Conclusion Our findings further support that ISSD is a risk factor for hypertension and objective short sleep duration may be a useful marker of the biological severity of CID in clinical practice. Support (if any) This study was supported by the National Natural Science Foundation of China (81970087), Guangdong Province Science and Technology Special Fund Project (200115165870512), and the 2020 Li Ka Shing Foundation Cross-Disciplinary Research Grant (2020LKSFG05B). The authors report no conflict of interest.

0409 Is insomnia with objective short sleep duration related to insufficient sleep drive or physiological hyperarousal?

Abstract Introduction IInsomnia with objective short sleep duration (OSSD) was found to be associated with higher risks of cardiometabolic disorders, and was therefore proposed to be a phenotype associated with higher physiological hyperarousal. Previous studies further reported that insomnia with OSSD had higher autonomic arousal as measured by heart rate variability (HRV) during sleep. Since sleep duration could be determined by the interplay of arousal and sleep drive and HRV during sleep could be influenced by sleep staging and quality, the present study examined the level of arousal and sleep drive prior to sleep with EEG power and HRV to further understand the phenotyping of insomnia. Methods Ninety-four insomnia patients participated in the study and went through one night of 8-hour PSG recording. They were divided, with a cut-off of PSG total sleep time of 6 hours, into two groups: an OSSD group (N=26; mean age=37.0 ±10.3; M:F=7:19; TST=286.21±87.21 min) and an objective normal sleep duration (ONSD) group (N=68, mean age=32.95 ±10.05, M:F=12: 56, TST=414.4±28.9 min). Resting-state EEG and EKG were recorded for a 6-min period, 3-min eye-opened (EO) with fixation focus and 3 mins eye-closed (EC), prior to bedtime. Results T-tests showed no significant difference in HRV measures (SDNN, RMSD, LF, HF, LF/HF) between the two groups, but shorter R-R interval for OSSD group than ONSD group. Mann-Whitney tests for EEG power showed significantly lower theta power at F3, F4, C3, C4, and O2, and higher sigma power at F3, C3, C4, O1, and O2 during EC, as well as lower theta power at C3 and higher sigma power at O2 during EO for OSSD group in comparison to ONSD group. Conclusion The results partially support that insomnia with OSSD is associated with physiological hyperarousal as indicated by faster heart rate and higher high frequency EEG power prior to sleep. However, the lower EEG theta power prior to sleep suggest that lower homeostatic sleep drive may also play a role for the insomnia with short objective sleep duration. Support (if any) Supported by Taiwan National Science and Technology Council

0852 Insomnia with Objective, but not Subjective, Short Sleep Duration is Associated with Increased Risk of Incident Hypertension

Abstract Introduction Insomnia with objective short sleep duration (ISSD) has been associated with higher risk of cardiometabolic morbidity. In this study, we examined the association between ISSD, also based on subjective sleep duration, with incident hypertension in the Sleep Heart Health Study (SHHS). Methods We analyzed data from 1413 participants free of hypertension or sleep apnea at baseline from the SHHS with a median follow-up duration of 5.1 years. Insomnia symptoms were defined based on difficulty falling asleep, difficulty returning to sleep, early morning awakening, or sleeping pill use more than half days in a month. Objective short sleep duration was defined as polysomnography-measured total sleep time &amp;lt; 6 hours. Incident hypertension was defined based on blood pressure measures and/or use of antihypertensive medications at follow-up. Results Insomnia subjects who slept objectively &amp;lt; 6 hours had significantly higher odds of incident hypertension compared to normal sleeping subjects who slept ≥6 hours (OR=2.00, 95% CI=1.09-3.65) or &amp;lt; 6 hours (OR=2.00, 95%CI=1.06-3.79) or insomnia subjects who slept ≥6 hours (OR=2.79, 95%CI= 1.24-6.30). Insomnia subjects who slept ≥6 hours or normal sleepers who slept &amp;lt; 6 hours were not associated with increased risk of incident hypertension compared to normal sleepers who slept ≥6 hours. Finally, insomnia subjects who self-reported sleeping &amp;lt; 6 hours were not associated with significantly increased odds of incident hypertension. Conclusion These data further support that the ISSD phenotype based on objective, but not subjective measures is, similar to sleep apnea. Support (if any) The Sleep Heart Health Study (SHHS) was supported by National Heart, Lung, and Blood Institute cooperative agreements U01HL53916 (University of California, Davis), U01HL53931 (New York University), U01HL53934 (University of Minnesota), U01HL53937 and U01HL64360 (Johns Hopkins University), U01HL53938 (University of Arizona), U01HL53940 (University of Washington), U01HL53941 (Boston University), and U01HL63463 (Case Western Reserve University). The National Sleep Research Resource was supported by the National Heart, Lung, and Blood Institute (R24 HL114473, 75N92019R002).

0334 INSOMNIA WITH OBJECTIVE SHORT SLEEP DURATION IS ASSOCIATED WITH METABOLIC SYNDROME

Abstract Introduction Several studies have shown that the insomnia with objective short sleep duration (ISSD) phenotype is associated with stage 2 hypertension and type 2 diabetes. We aimed to determine if there is an association between ISSD and metabolic syndrome (MetS). Methods We studied 1,741 adults from the Penn State Adult Cohort (age 20-88 years, 52.3% female, 12.4% racial/ethnic minority) who underwent a 1-night polysomnographic (PSG) evaluation, clinical history, and physical examination. Insomnia was defined as a complaint of insomnia with a duration ≥ 1 year, while 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 &amp;lt; 6-hours. MetS was defined by the presence of 3 or more of: BMI≥30 kg/m2, elevated total cholesterol (≥200 mg/dL), triglycerides (≥150 mg/dL), fasting glucose (≥100 mg/dL), or treatment, and blood pressure (≥130/85 mm Hg) or treatment. Logistic regression models examined the odds of developing MetS, while simultaneously adjusting for sex, race, age, alcohol, smoking, sleep-disordered breathing, mental and physical problems, and sampling weight. Results Compared to normal sleepers with normal sleep duration, ISSD was associated with a significantly increased risk of MetS (OR=2.04, 95%CI=1.13-3.70), while insomnia with normal sleep duration (INSD) was not (OR=1.03, 95%CI=0.53-1.99). Neither normal sleepers with short sleep duration nor poor sleeper with normal or short sleep duration were associated with increased risk of MetS. Further analysis of the clustering of the cardiometabolic risk factors revealed that in the ISSD group who had MetS, 94% had elevated blood pressure, 78% had elevated cholesterol, 72% had insulin resistance, 53% had elevated triglycerides, and 53% had BMI≥30 kg/m2. Conclusion These data indicate that hypercholesterolemia, but not hypertriglyceridemia or obesity, contributes to the association of ISSD with MetS. These data suggest that in addition to the previously-identified elevated blood pressure and insulin resistance, treatment of hypercholesterolemia in patients with ISSD may prevent the development of cardiovascular and cerebrovascular disease. Support (if any)

Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes.

Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.

Insomnia with objective, but not subjective, short sleep duration is associated with increased risk of incident hypertension: the Sleep Heart Health Study.

Insomnia with objective short sleep duration has been associated with higher risk of cardiometabolic morbidity. In this study, we examined the association between insomnia with objective short sleep duration, also based on subjective sleep duration, with incident hypertension in the Sleep Heart Health Study. We analyzed data from 1,413 participants free of hypertension or sleep apnea at baseline from the Sleep Heart Health Study, with a median follow-up duration of 5.1 years. Insomnia symptoms were defined based on difficulty falling asleep, difficulty returning to sleep, early morning awakening, or sleeping pill use more than half the days in a month. Objective short sleep duration was defined as polysomnography-measured total sleep time < 6 hours. Incident hypertension was defined based on blood pressure measures and/or use of antihypertensive medications at follow-up. Individuals with insomnia who slept objectively < 6 hours had significantly higher odds of incident hypertension compared to normal sleepers who slept ≥ 6 hours (odds ratio = 2.00, 95% confidence interval = 1.09-3.65) or < 6 hours (odds ratio = 2.00, 95% confidence interval = 1.06-3.79) or individuals with insomnia who slept ≥ 6 hours (odds ratio = 2.79, 95% confidence interval = 1.24-6.30). Individuals with insomnia who slept ≥ 6 hours or normal sleepers who slept < 6 hours were not associated with increased risk of incident hypertension compared to normal sleepers who slept ≥ 6 hours. Finally, individuals with insomnia who self-reported sleeping < 6 hours were not associated with significantly increased odds of incident hypertension. These data further support that the insomnia with objective short sleep duration phenotype based on objective, but not subjective measures, is associated with increased risk of developing hypertension in adults. Dai Y, Chen B, Chen L, etal. Insomnia with objective, but not subjective, short sleep duration is associated with increased risk of incident hypertension: the Sleep Heart Health Study. J Clin Sleep Med. 2023;19(8):1421-1428.

Insomnia disorder with objective short sleep duration (ISS) phenotype and cognitive performance: a systematic review and meta-analysis.

Insomnia disorder with objective short sleep duration (ISS) has been considered as a biologically severe subtype. The aim of this meta-analysis was to reveal the association of the ISS phenotype and cognitive performance. We searched PubMed, EMBASE, and the Cochrane Library for studies that observed an association of cognitive performance and insomnia with objective short sleep duration (ISS) phenotype. The "metafor" and "MAd" packages in R software (version 4.2.0) were used to calculate the unbiased standardized mean difference (Hedge's g), which was adjusted so that a negative value indicated worse cognitive performance. The pooled analysis with 1339 participants revealed that the ISS phenotype was associated with overall cognitive impairments (Hedges' g = - 0.56 [- 0.89, - 0.23]), as well as specific cognitive domains including attention (Hedges' g = - 0.86 [- 1.25, - 0.47]), memory (Hedges' g = - 0.47 [- 0.82, - 0.12]), and executive function (Hedges' g = - 0.39 [- 0.76, - 0.02]). However, cognitive performance was not significantly different between insomnia disorder with objective normal sleep duration (INS) and good sleepers (p > .05). Insomnia disorder with the ISS phenotype, but not the INS phenotype, was associated with cognitive impairments, suggesting the possible utility of treating the ISS phenotype to improve cognitive performance.

Insomnia with objective short sleep duration is associated with hypertension.

Insomnia with objective short sleep duration has been proposed as the most biologically severe phenotype of the disorder associated with cardiometabolic morbidity in population-based samples. In this study, we investigated the association between insomnia with objective short sleep duration and hypertension in a large clinical sample. We studied 348 patients diagnosed with chronic insomnia disorder based on International Classification of Sleep Disorders Third Edition criteria and 150 normal sleepers. Objective short sleep duration was defined by the median total sleep time of the sample (< 7hr) measured with 1-night polysomnography. Hypertension was defined based on blood pressure levels, antihypertensive medication use and/or a physician diagnosis. After adjusting for potential confounders, patients with chronic insomnia disorder who slept < 7hr were associated with 2.8-fold increased odds of hypertension compared with normal sleepers who slept ≥ 7hr (odds ratio=2.81, 95% confidence interval=1.068-7.411) or < 7hr (odds ratio=2.75, 95% confidence interval=1.005-7.542), whereas patients with chronic insomnia disorder who slept ≥ 7hr (odds ratio=1.52, 95% confidence interval=0.537-4.285) or normal sleepers who slept < 7hr (odds ratio=1.07, 95% confidence interval=0.294-3.904) were not significantly associated with increased odds of hypertension compared with normal sleepers who slept ≥ 7hr. Linear regression analyses showed that, for every hour decrease in total sleep time, systolic and diastolic blood pressure increased by 1.014 mmHg (p=0.045) and 0.923 mmHg (p=0.015), respectively, in patients with chronic insomnia disorder but not in normal sleepers. Our findings further support that insomnia with objective short sleep duration is a risk factor for hypertension, and objective short sleep duration may be a useful marker of the biological severity of chronic insomnia disorder in clinical practice.

Effects of electrostatic therapy on nighttime sleep and daytime symptoms in patients with chronic insomnia: Evidences from an open label study.

Transcranial electric stimulation (TES) is a neuromodulation approach that applies low-intensity electrical current to the brain and has been proposed as a treatment for insomnia. Electrostatic therapy is a kind of TES and people do not have a feeling of electrical stimuli when the voltage of static electricity is lower than 2,000 volts. However, no studies have examined the effects of electrostatic therapy on objective sleep and daytime symptoms in patients with insomnia. Thirty chronic insomnia patients were included. All patients received a 6 week electrostatic therapy and three comprehensive assessments including two consecutive polysomnography (PSG) and daytime symptoms assessments, at pre-treatment, 3 week and 6 week of treatment. Insomnia Severity Index (ISI) was used to assess the severity of insomnia. Multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS), and Flinders Fatigue Scale (FFS) were used to assess objective and self-reported daytime sleepiness and fatigue, respectively. Attention network test (ANT) was used to assess attention levels. Total ISI scores decreased significantly at 3 weeks (p < 0.001) and 6 weeks (p < 0.001) after initiation of treatment. Furthermore, objective total sleep time (TST, p = 0.020) and sleep efficiency (SE, p = 0.009) increased and wake time after sleep onset (p = 0.012) decreased significantly after 6 weeks electrostatic therapy. Regarding daytime symptoms, ESS and FFS scores decreased significantly at 3 weeks (ESS, p = 0.047; FFS, p = 0.017) and 6 weeks (ESS, p = 0.008; FFS, p = 0.003) after initiation of treatment. Moreover, executive control improved significantly from pre-treatment to 3 weeks (p = 0.006) and 6 weeks (p = 0.013) and altering network improved significantly at 6 weeks (p = 0.003) after initiation of treatment. Secondary analyses showed that TST and SE improved significantly after electrostatic therapy in insomnia patients who slept < 390 min (all p-value < 0.05). However, no significant changes regarding TST and SE were observed in insomnia patients who slept ≥ 390 min. Electrostatic therapy improves both nighttime sleep and daytime symptoms in patients with chronic insomnia. The effect on objective sleep appears to be stronger in patient with objective short sleep duration. Electrostatic therapy might be a therapeutic choice for insomnia patients with difficulty maintaining sleep and not responding to behavioral treatments. [www.clinicaltrials.gov], identifier [ChiCTR2100051590].

Insomnia with objective short sleep duration in community-living older persons: A multifactorial geriatric health condition.

Insomnia or poor sleep quality with objective short sleep duration (hereafter referred to as ISSD) has been identified as a high-risk phenotype among middle-aged persons. We evaluated the prevalence and clinical correlates of ISSD among community-living older persons. In 3053 men from the Osteoporotic Fractures in Men Sleep Study (MrOS; average age 76.4 ± 5.5 years) and 3044 women from the Study of Osteoporotic Fractures (SOF; average age 83.6 ± 3.8 years), we evaluated the prevalence of ISSD (trouble getting to sleep within 30 minutes, waking up in the middle of the night or early morning, and/or taking a medication to help with sleep ≥3 times per week and actigraphy-estimated sleep duration <6 h). Using separate logistic regression models in men and women, we evaluated the cross-sectional associations between predisposing, precipitating, and perpetuating factors for ISSD, as compared with normal sleep (no insomnia and actigraphy-estimated sleep duration of 6-9 h). Overall, 20.6% of older men and 12.8% of older women had insomnia with short sleep duration. Multiple predisposing, precipitating, and perpetuating factors were cross-sectionally associated with ISSD in both men and women. In multivariable models that adjusted for predisposing factors (demographics, multimorbidity, obesity), precipitating (depression, anxiety, central nervous system-active medication use, restless legs syndrome) and perpetuating (napping, falls) factors were significantly associated with ISSD in men and women (adjusted odds ratios ranging 1.63-4.57). In this cross-sectional study of community-living older men and women, ISSD was common and associated with multiple predisposing, precipitating, and perpetuating factors, akin to a multifactorial geriatric health condition. Future work should examine causal pathways and determine whether the identified correlates represent modifiable risk factors.

The effect and relative importance of sleep disorders for all-cause mortality in middle-aged and older asthmatics

BackgroundPrevious studies observed that sleep disorders potentially increased the risk of asthma and asthmatic exacerbation. We aimed to examine whether excessive daytime sleepiness (EDS), probable insomnia, objective short sleep duration (OSSD), and obstructive sleep apnea (OSA) affect all-cause mortality (ACM) in individuals with or without asthma.MethodsWe extracted relevant data from the Sleep Heart Health Study established in 1995–1998 with an 11.4-year follow-up. Multivariate Cox regression analysis with a proportional hazards model was used to estimate the associations between ACM and four sleep disorders among asthmatic patients and individuals without asthma. Dose-response analysis and machine learning (random survival forest and CoxBoost) further evaluated the impact of sleep disorders on ACM in asthmatic patients.ResultsA total of 4538 individuals with 990 deaths were included in our study, including 357 asthmatic patients with 64 deaths. Three multivariate Cox regression analyses suggested that OSSD (adjusted HR = 2.67, 95% CI: 1.23–5.77) but not probable insomnia, EDS or OSA significantly increased the risk of ACM in asthmatic patients. Three dose-response analyses also indicated that the extension of objective sleep duration was associated with a reduction in ACM in asthmatic patients compared to very OSSD patients. Severe EDS potentially augmented the risk of ACM compared with asthmatics without EDS (adjusted HR = 3.08, 95% CI: 1.11–8.56). Machine learning demonstrated that OSSD of four sleep disorders had the largest relative importance for ACM in asthmatics, followed by EDS, OSA and probable insomnia.ConclusionsThis study observed that OSSD and severe EDS were positively associated with an increase in ACM in asthmatic patients. Periodic screening and effective intervention of sleep disorders are necessary for the management of asthma.

Mediating effect of sympathetic activation on the association between objective short sleep duration and increased blood pressure in patients with chronic insomnia

Mediating effect of sympathetic activation on the association between objective short sleep duration and increased blood pressure in patients with chronic insomnia