Sleep Maintenance Research Articles

Dimdazenil for the treatment of insomnia: a systematic review and narrative synthesis.

Insomnia is a common sleep disorder affecting approximately 10-20% of adults worldwide. Despite various available treatment modalities, significant gaps remain in improving sleep maintenance and reducing functional impairments. To systematically review and synthesize studies on the efficacy and safety of Dimdazenil for the treatment of insomnia. A comprehensive search of multiple databases and websites was conducted to identify published and unpublished trials from inception to July 19, 2024. Due to the limited number of studies available, quantitative data were synthesized narratively. This synthesis included four randomized controlled trials. The primary efficacy endpoints of these studies met the predetermined criteria for superiority. Dimdazenil significantly improved certain objective and subjective sleep measures in patients with insomnia, including reduced sleep latency and longer total sleep duration. Importantly, these outcomes were achieved without causing significant excessive daytime drowsiness or impairing daytime functionality. Furthermore, Dimdazenil demonstrated a generally acceptable safety profile and was well tolerated. Most evaluation indicators related to withdrawal symptoms, drug residues, and rebound effects did not show significant statistical differences. The number of included studies and sample sizes were small, and there is a lack of data on the long-term efficacy and safety of Dimdazenil. Dimdazenil offers significant benefits in improving sleep onset and maintenance in patients with insomnia. It presents a favorable safety and tolerability profile while preserving daytime functioning. Future studies should extend the duration and scale to assess the long-term efficacy and safety of Dimdazenil across diverse populations.

Motor learning promotes regionally-specific spindle-slow wave coupled cerebral memory reactivation.

Sleep is essential for the optimal consolidation of newly acquired memories. This study examines the neurophysiological processes underlying memory consolidation during sleep, via reactivation. Here, we investigated the impact of slow wave - spindle (SW-SP) coupling on regionally-task-specific brain reactivations following motor sequence learning. Utilizing simultaneous EEG-fMRI during sleep, our findings revealed that memory reactivation occured time-locked to coupled SW-SP complexes, and specifically in areas critical for motor sequence learning. Notably, these reactivations were confined to the hemisphere actively involved in learning the task. This regional specificity highlights a precise and targeted neural mechanism, underscoring the crucial role of SW-SP coupling. In addition, we observed double-dissociation whereby primary sensory areas were recruited time-locked to uncoupled spindles; suggesting a role for uncoupled spindles in sleep maintenance. These findings advance our understanding the functional significance of SW-SP coupling for enhancing memory in a regionally-specific manner, that is functionally dissociable from uncoupled spindles.

The Impact of Sleep Onset and Efficiency on Body Mass Index among College Students: A Factor Analysis Approach

Sleep is crucial for overall health and well-being, and college students often face sleep issues due to various factors. Inadequate sleep, which affects metabolism and behavior, increases the risk of obesity. Prior studies typically examine individual sleep factors or compare them, neglecting potential interactions and the multidimensional role of sleep in health outcomes. Hence, this study surveyed the seven sleep components using the Pittsburgh Sleep Quality Index (PSQI) to identify factors affecting sleep quality and evaluate its effect on the body mass index of GE-Science, Technology, and Society (GE-STS) students in a private university in Cebu. Three factors were determined through factor analysis: Sleep Health, Sleep Onset and Maintenance Efficiency, and Sleep Disruption Intervention. Moreover, regression analysis supported the significant relationship (p = 0.023) between the sleep onset and maintenance efficiency factor and Body Mass Index (BMI), emphasizing its importance in designing sleep interventions for college students.

Association between skin temperature and actigraphic sleep metrics in patients with Parkinson's disease: The PHASE study

Introduction Sleep initiation and maintenance are linked to thermoregulation. In Parkinson's disease (PD), thermoregulatory dysfunction potentially worsens sleep disorders. However, the association between thermoregulation and sleep quality in patients with PD remains unclear. We aimed to examine the association between skin temperature, a measure of heat dissipation, and actigraphic sleep metrics in PD.Methods In this cross-sectional study with 186 outpatients with PD and 580 non-PD controls, we measured wrist skin temperature (WST) and actigraphic sleep quality for seven days in PD and two days in controls in real-life settings. Linear mixed-effect models were used to examine the association between nighttime WST and sleep quality.Results Nighttime WST in PD was significantly lower than that in controls (adjusted difference 0.39 [95 % confidence interval, 0.23–0.54] °C, P < 0.001). In patients with PD, changes in sleep efficiency, wake after sleep onset, total sleep time, and log-transformed fragmentation index per 1 °C increase in nighttime WST were 3.2 (95 % CI, 2.4–3.9) %, −10.3 (95 % CI, −13.6, −7.1) minutes, 13.4 (95 % CI, 9.1–17.8) minutes, and −0.09 (95 % CI: −0.12, −0.06), respectively, independent of potential confounders. Significant interactions were observed between nighttime WST and the presence of PD for sleep efficiency, wake after sleep onset, and total sleep time.Conclusions: Within-individual changes in nighttime WST were significantly associated with changes in actigraphic sleep measures in PD. Interventional studies are necessary that address the limitations and potential biases of this study to elucidate whether cutaneous temperature modulation can enhance the quality of sleep in PD.

THE ROLE OF PHYSICAL ACTIVITY IN IMPROVING THE QUALITY OF SLEEP OF PATIENTS WITH VARIOUS SLEEP DISORDERS

Sleep is an important human behavior and difficulties with sleep are closely related to health, potentially leading to the development of diseases and a reduced quality of life. Sleep disorders cover a wide range of problems associated with mental health disorders, such as anxiety and depression, and contribute to an increased tendency to become overweight or obese. In addition, sleep difficulties can lead to more serious sleep disorders, such as problems with sleep maintenance, poor sleep efficiency, and reduced daytime attention. The purpose of the study is to highlight the role of physical activity in improving the quality of sleep in patients with various sleep disorders. Materials and methods. To better understand the impact of physical activity on sleep quality and its positive effect on sleep onset and duration, a search of scientific literature was conducted between 2019 and 2024 in the PubMed, Scopus, Web of Science, and Google Scholar databases using the terms “exercise,” “sleep,” “quality of life,” “insomnia,” and “activity.” The search resulted in the selection of publications that examined the relationship between daily sleep and physical activity and will be discussed in this review. Results. The study identified potential biological pathways that explain the possible interactions between sleep and physical activity in the short and long term. Acute or repetitive physical activity increases total sleep time by reducing insulin resistance and the concentration of inflammatory markers, better regulation of circadian rhythm, and the release of brain-derived neurotrophic factor. In turn, sleep deprivation can alter physical performance or contribute to fatigue during physical activity by increasing cortisol concentrations, decreasing growth hormone and prolactin concentrations, and stimulating inflammatory markers. Scientific studies have established the beneficial effects of physical activity in alleviating sleep problems. Numerous studies show that moderate to vigorous physical activity has a positive effect on sleep quality. Physical activity has pluripotential beneficial effects on bodily functions. These benefits include a reduction in the incidence of cardiovascular disease, coronary heart disease, hypertension, type 2 diabetes, and death. In addition to these effects, physical activity has a significant beneficial effect on the onset, duration, and quality of sleep, which complements its beneficial effects. In contrast, lack of sleep is associated with an increased incidence of cardiovascular complications and death. In this regard, physical activity serves as a non-pharmacological means of improving sleep, especially in older people who often have difficulty falling asleep. Regarding the time of exercise and its effect on sleep, there was no difference between morning and evening exercise in terms of sleep onset and quality. In addition, the multifaceted benefits of physical activity go beyond improving sleep to contribute to overall well-being and longevity, offering a comprehensive health solution that is comparatively better than alternative treatments. Conclusions. Based on the research presented here, it can be concluded that the scientific literature has identified an improvement in sleep quality after physical activity, and empirical evidence confirms its positive impact, regardless of type or intensity. Increased physical activity was found to be associated with improved total sleep duration, reduced sleep latency, and improved sleep efficiency. Exercise can improve sleep by reducing sleep latency and increasing slow wave sleep.

Exploring the Factors Associated with Sleep Concerns and Perceived Need for Treatment among Patients with Sleep Disorders

ABSTRACT Objectives This study aimed to investigate the factors affecting patient perceptions of sleep concerns and the need for treatment to understand and enable effective management. Methods This cross-sectional study analyzed data collected between November 2018 and October 2022 at the sleep clinic of a tertiary hospital. Adults aged > 19 years who completed sleep questionnaires and polysomnography (PSG) were included. Logistic regression models were used to assess the associations between demographic, clinical, and social factors, sleep questionnaire responses, and PSG data with self-reported sleep concerns (n = 3,457) and perceived need for treatment(n = 3,135). Results Insomnia-related symptoms affect both sleep concerns and need for treatment, and sleep maintenance is the most influential factor in both sleep concerns (odds ratio[OR] = 19.74, 95% confidence interval[CI] 6.17–63.20) and need for treatment (OR = 3.84, 95% CI 2.19–6.73). Young age (OR = 2.66, 95% CI 1.38–5.12), employment status, and daily life dysfunction were determinants of treatment readiness. None of the PSG parameters showed an independent association with sleep concerns or need for treatment. Conclusions Sleep maintenance problems had the most profound effect on sleep concerns and the need for treatment. Social needs are key factors in seeking treatment. A discrepancy has been noted between the effects of subjective and objective factors on sleep concerns and the need for treatment; therefore, patient management should pay attention to subjective sleep complaints.

Association of Sleep Duration and BMI with Periodontitis in Nurses Working in Day and Night Shifts and Its Impact on Co-morbidities

Background: Gender imbalances persist in high-ranking leadership roles, particularly in Aim: To evaluate the association between duration of Sleep and Body-Mass Index (BMI) as potential risk factors with Periodontitis and other co morbidities in duty nurses. Methodology: An observational study was carried out on 42 duty nurses working in hospital. Two Questionnaires (PSQI) Pittsburgh Sleep Quality Index and (ESS) Epworth-Sleepiness Scale were subjectively filled. Study was conducted in 2 phases in the same duty nurses. Phase 1 Duty nurses in morning shift underwent evaluation for periodontal health, BMI and Waist -Hip ratio was recorded. Blood Samples were drawn for analysis of C-Reactive protein, lipid profile and Fasting Blood Sugar. Participants were asked to maintain sleep diary for 6 months. Phase 2: Same Duty Nurses working in Night Shift after 6 months of sleep diary maintenance underwent evaluation of same parameters as phase 1. All-the data were tabulated and sent for statistical-analysis. Results: The result showed that, the association of duration of sleep to Periodontitis was statistically significant in the morning-shift and night-shift (p=0.001), although association of Body Mass Index to periodontitis was statistically significant in the night shift with p value=0.001 than in the morning-shift. The association of Plaque Index and Gingival-Index with duration of sleep and BMI was statistically significant. The parameters taken to study the co-morbidities showed statistical significant difference between the two shifts except WHR ratio, LDL, HDL, Triglyceride, Plaque index. Conclusion: There is an association of Duration of Sleep and Body Mass Index as a potential risk factor for periodontitis and other co-morbidities (Cardiovascular disease and Diabetes) in duty nurses, however the association is much stronger in duty nurses working in night shift than morning shift.

Insomnia in ambulatory care: A clinical review.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. One-third to one-half of ambulatory care patients report insomnia. The objective of this clinical review is to detail the many causes and evidence-based treatment options for insomnia in outpatients and to recommend screening and summarize evidence for the place in therapy of prescription and nonprescription treatments. This work provides an overview of the literature on insomnia regarding causes, patient assessment, and nonpharmacological and pharmacological treatments. Patients who present with insomnia should be assessed for sleep apnea, restless legs syndrome, narcolepsy, and all contributing medications as well as medical, psychiatric, and substance use disorder diagnoses. The type of insomnia, namely difficulty falling asleep, difficulty maintaining sleep, and early morning awakening with resulting functional impairment, should be documented in addition to whether insomnia is short term or persistent. Cognitive behavioral therapy for insomnia (CBT-I) or digital CBT-I is first-line treatment for all patients with insomnia irrespective of the cause or type. Nonprescription treatments such as antihistamines or melatonin are for select populations. Prescription hypnotics are best utilized on an as-needed basis or for nightly use for less than 6 weeks. Z-hypnotics are safe and effective for insomnia in persons with depression or an anxiety disorder but should be avoided in older individuals or if there is respiratory or cognitive impairment. Orexin receptor antagonists are effective for sleep initiation and maintenance in healthy persons or if there is mild cognitive impairment, but they require further study in individuals with psychiatric and medical diagnoses. Trazodone is the most prescribed off-label treatment due to its efficacy for sleep initiation and maintenance and its lack of abuse potential. Insomnia treatment should be guided by patient age, diagnoses, and type of insomnia. Pharmacological treatments should be used at the lowest effective dose for the shortest duration of time.

Insomnia symptoms as long-term predictors of anxiety symptoms in middle-aged and older adults from the English Longitudinal Study of Ageing (ELSA), and the role of systemic inflammation

Insomnia, i.e., difficulties in sleep onset and sleep maintenance, may increase the risk of anxiety symptoms, although long-term follow-up studies are rarely reported. Here, we examined whether insomnia symptoms may predict anxiety symptoms in a 9-year follow-up, and whether inflammation may play a mediating role. Data from 1355 participants (63.44 ± 7.47 years, 55.1 % females) from the English Longitudinal Study of Ageing (ELSA) were analysed. Insomnia symptoms were assessed in 2012/13. High-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, was measured in 2016/17. Anxiety symptoms were assessed in 2020/21. After adjusting for confounders and baseline levels, structural equation modelling (SEM) revealed that insomnia symptoms significantly predicted anxiety symptoms (β = 0.357, p < .001) but not hs-CRP (β = −0.016, p = .634). Similarly, hs-CRP was not related to anxiety symptoms (β = −0.024, p = .453). The hs-CRP mediation hypothesis was therefore rejected (β = 0.0004; 95 % BCI -0.001 to 0.005), and multi-group SEM showed that sex did not moderate these paths. However, baseline diagnoses of anxiety disorders prospectively predicted higher hs-CRP (B = 0.083, p = .030). Results of the current study suggest that individuals with baseline anxiety disorders may be at higher risk of developing low-grade chronic inflammation. Several alternative psychophysiological mechanisms linking insomnia and anxiety symptoms should be explored, including autonomic and cortical pre-sleep arousal, cortisol reactivity, and pro-inflammatory cytokines. Finally, insomnia symptoms may be a treatment target to lower the risk of anxiety symptoms in elderly.

Discovery, synthesis and SAR of 2-acyl-1-biarylmethyl pyrazolidines, dual orexin receptor antagonists designed as fast and short-acting sleeping drugs

Dual orexin receptor antagonists (DORAs) are approved for the treatment of sleep onset and/or sleep maintenance insomnia. In the present disclosure, we report the discovery of a new class of DORAs designed to treat sleep disorders requiring a fast onset and a short duration of action (<4 h). We used early human pharmacokinetic-pharmacodynamic (PK-PD) predictions and in vivo experiments to identify DORAs eliciting this specific hypnotic profile. A high-throughput screening campaign revealed hits based on a rarely precedented tricyclic pyrazolidine scaffold. After unsuccessful structure–activity-relationship (SAR) studies on this hit series, a scaffold hopping exercise, aimed at reducing the molecular complexity of the tricyclic scaffold, resulted in the discovery of the 2-acyl-1-biarylmethylpyrazolidine series. SAR studies on this achiral series gave rise to the lead compound DORA 42. In vitro and in vivo parameters of DORA 42, and its PK-PD simulation for human use are detailed.

Sleep Disturbances and Co-sleeping in Italian Children and Adolescents with Autism Spectrum Disorder.

The current study aimed (1) to provide an analysis of the frequency and prevalence of sleep disturbances in a large Italian sample of children and adolescents with ASD, detecting specific predictors of the presence/absence of sleep disorders, (2) to examine the phenomenon of co-sleeping within a subgroup of participants with ASD. A total of 242 children and adolescents with ASD (194 males, mean age 5.03 ± 3.15years) were included. After the diagnostic procedure, caregivers were requested to complete the Sleep Disturbance Scale for Children (SDSC) to assess sleep disorders among participants. The presence of co-sleeping was investigated in a subgroup of 146 children and adolescents with ASD. An elevated or clinically relevant global score for sleep disorders (≥ 60) was found in 33% of participants. The most prevalent sleep disorder in our group was related to difficulties with sleep onset and sleep maintenance (~ 41% of cases). Sleep disturbances were predicted by higher intelligence quotient (IQ)/developmental quotient (DQ), increased internalizing problems, and elevated parental stress. The subgroup of participants engaged in co-sleeping (N = 87) were younger and had lower IQ/DQ scores, reduced adaptive functioning, and diminished psychological wellbeing than the non-co-sleeping group. Our findings are consistent with the current literature highlighting that insomnia is the most widespread sleep problem associated with ASD. The relationship between IQ/DQ and sleep alterations is a crucial topic that deserves additional research. Future studies should assess sleep by objective measures such as EEG topography to better understand the mechanisms underlying sleep alterations in this neurodevelopmental disorder.

A Deep Learning–Derived Transdiagnostic Signature Indexing Hypoarousal and Impulse Control: Implications for Treatment Prediction in Psychiatric Disorders

BackgroundPsychiatric disorders are traditionally classified within diagnostic categories, but this approach has limitations. The Research Domain Criteria (RDoC) constitute a research classification system for psychiatric disorders based on dimensions within domains that cut across these psychiatric diagnoses. The overall aim of RDoC is to better understand mental illness in terms of dysfunction in fundamental neurobiological and behavioral systems, leading to better diagnosis, prevention, and treatment. MethodsA unique electroencephalographic feature, referred to as spindling excessive beta, has been studied in relation to impulse control and sleep as part of the arousal/regulatory system RDoC domain. Here, we studied electroencephalographic frontal beta activity as a potential transdiagnostic biomarker capable of diagnosing and predicting impulse control and sleep problems. ResultsWe showed in the first dataset (n = 3279) that the probability of having spindling excessive beta, classified by a deep learning algorithm, was associated with poor sleep maintenance and low daytime impulse control. Furthermore, in 2 additional, independent datasets (iSPOT-A [International Study to Predict Optimized Treatment in ADHD], n = 336; iSPOT-D [International Study to Predict Optimized Treatment in Depression], n = 1008), we revealed that conventional frontocentral beta power and/or spindling excessive beta probability, referred to as Brainmarker-III, is associated with a diagnosis of attention-deficit/hyperactivity disorder, with remission to methylphenidate in children with attention-deficit/hyperactivity disorder in a sex-specific manner, and with remission to antidepressant medication in adults with major depressive disorder in a drug-specific manner. ConclusionOur results demonstrate the value of the RDoC approach in psychiatry research for the discovery of biomarkers with diagnostic and treatment prediction capacities.

Sleep in Myasthenia Gravis: A Questionnaire-Based Study.

Disturbed sleep and its impact on quality of life (QoL) are underrecognized in myasthenia gravis (MG). To evaluate the quality of sleep in MG using standard sleep questionnaires and assess factors that determine sleep. Prospective, cross-sectional, hospital-based study. Fifty patients on stable drug therapy for at least 1 month and age- and gender-matched controls were assessed using standard sleep questionnaires [Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and NIMHANS Comprehensive Sleep Disorders Questionnaire (NCSDQ)]. Myasthenia Gravis Foundation of America (MGFA) grade was I, IIA, IIB, IIIA, IIIB, and IVA in 11, 19, 3, 10, 6, and 1 respectively. The mean PSQI and ESS scores were similar in patients and controls. Patients with abnormal ESS (>10) were older and had greater neck circumference (P = 0.018 and <0.001). Body mass index was greater in patients with PSQI > 5 (P < 0.05). Age, gender, and clinical severity did not affect PSQI. Compared with ESS and PSQI, NCSDQ showed higher frequency of disturbed sleep, snoring, early morning headache, difficulty in initiation, and maintenance of sleep in MG, although the differences between patients and controls were not significant. No correlation was found between QoL and ESS or PSQI. Patients of MG with stable clinical course with adequate treatment have sleep quality comparable with healthy controls. Longitudinal assessment of sleep quality at multiple time points throughout the disease course and correlating with cross-sectional disease severity may further delineate the impact of disease on sleep and QoL.

Treatment strategies for insomnia in Japanese primary care physicians’ practice: A Web-based questionnaire survey

BackgroundIt is unclear how primary care physicians manage insomnia after the introduction of novel hypnotics such as orexin receptor antagonists and melatonin receptor agonists. This Web-based questionnaire survey aimed to examine treatment strategies for insomnia in Japanese primary care practice.MethodsOne-hundred-and-seventeen primary care physicians were surveyed on the familiarity of each management option for insomnia on a binary response scale (0 = “unfamiliar”; 1 = “familiar”) and how they managed insomnia using a nine-point Likert scale (1 = “I never prescribe/perform it”; 9 = “I often prescribe/perform it”). Physicians who were unfamiliar with a management option were deemed to have never prescribed or performed it.ResultsRegarding medication, most physicians were familiar with novel hypnotics. Suvorexant was the most used hypnotic, followed by lemborexant and ramelteon. These novel hypnotics averaged 4.8–5.4 points and 4.0–4.7 points for sleep onset and sleep maintenance insomnia, respectively. By contrast, most benzodiazepines were seldom used below two points. Regarding psychotherapy, only approximately 40% of the physicians were familiar with cognitive behavioral therapy for insomnia (CBT-I) and they rarely implemented it, at an average of 1.5–1.6 points. More physicians were familiar with single-component psychotherapies (i.e., relaxation, sleep restriction therapy, and stimulus control) compared to CBT-I, and 48–74% of them implemented it slightly more often, with scores ranging from 2.6 to 3.4 points.ConclusionThis study suggests that Japanese primary care physicians seldom use CBT-I to treat insomnia. In addition, they use novel sleep medications more frequently than benzodiazepines in terms of pharmacotherapy. The use and availability of CBT-I in Japanese primary care might be facilitated by: educating primary care physicians, implementing brief or digital CBT-I, and/or developing collaborations between primary care physicians and CBT-I specialists.

Exploring the Clinical and Genetic Landscape of Angelman Syndrome: Patient-Reported Insights from an Italian Registry.

Background: The Angelman Syndrome Registry (RISA) was developed as a retrospective study with the following objectives: to evaluate the clinical history of individuals with Angelman Syndrome (AS) in Italy and compare it with the existing literature; to investigate the feasibility of gathering data by directly involving participants in the data collection process; and to explore the relationship between different symptoms and genotypes. Methods: Established in 2018, RISA enrolled a total of 82 participants, with 62 (75.6%) providing complete data. Demographic, clinical, and genetic information was collected using electronic case report forms. Descriptive statistics characterized the sample, while associations between genotype and clinical characteristics were examined. Results: Descriptive analysis revealed a median participant age of 8.0 years, with males comprising 48.8% of the sample. Deletion (58.1%) was the most common genotype. The majority (82.2%) experienced epilepsy, with seizures typically onset before 3 years of age. Most patients (86.2%) required multiple anti-epileptic drugs for control, with generalized tonic-clonic seizures and atypical absence seizures being most prevalent. The deletion group exhibited more severe developmental delays and a trend towards higher seizure severity. Sleep problems affected 69.4% of participants, characterized by difficulties in sleep onset and maintenance. Conclusions: This study offers valuable insights into the clinical history and genetic characteristics of AS in Italy, consistent with the prior literature. Additionally, it underscores the efficacy of patient registries in capturing comprehensive data on rare diseases such as AS, highlighting their potential to advance research and enhance patient care.

Activity-Based Prospective Memory in Insomniacs.

To investigate the activity-based prospective memory performance in patients with insomnia, divided, on the basis of actigraphic evaluation, into sleep onset, maintenance, mixed and negative misperception insomnia. A total of 153 patients with insomnia (I, 83 females, mean age + SD = 41.37 + 16.19 years) and 121 healthy controls (HC, 78 females, mean age + SD = 36.99 + 14.91 years) wore an actigraph for one week. Insomnia was classified into sleep onset insomnia (SOI), maintenance insomnia (MaI), mixed insomnia (MixI) and negative misperception insomnia (NMI). To study their activity-based prospective memory performance, all the participants were required to push the actigraph event marker button twice, at bedtime (task 1) and at get-up time (task 2). Only patients with maintenance and mixed insomnia had a significantly lower accuracy in the activity-based prospective memory task at get-up time compared with the healthy controls. The results show that maintenance and mixed insomnia involve an impaired activity-based prospective memory performance, while sleep onset and negative misperception insomnia do not seem to be affected. This pattern of results suggests that the fragmentation of sleep may play a role in activity-based prospective memory efficiency at wake-up in the morning.

Associations between residential daytime indoor temperature and self-reported sleep disturbances in UK adults: A cross-sectional study

BackgroundIn the past few decades, research on the association between indoor temperature and sleep has primarily used laboratory rather than field data collected in epidemiological cohorts. MethodsSecondary data on 2493 individuals aged 43 years was obtained from the National Survey of Health and Development (NSHD). Logistic regression models were used to investigate the associations between temperatures (indoor at home, spot measurement when the nurses visited during the day; and outdoor, monthly average) and self-reported sleep disturbances, adjusting for socio-demographics, health variables, housing variables, and temperature-related variables. ResultsAssociations were found between daytime indoor temperature with difficulty initiating (OR: 0.95, 95%CI: 0.91–0.98) and maintaining sleep (OR: 0.96, 95%CI: 0.93–0.99). Compared with neutral indoor temperatures (17–28 °C), low indoor temperature (≤17 °C) was associated with difficulty initiating sleep (OR: 1.79, 95%CI: 1.21–2.65). Stratified analysis results across tertiles showed that associations with difficulty initiating (OR: 0.87, 95%CI: 0.77–0.99) and maintaining sleep (OR: 0.88, 95%CI: 0.79–0.98) were observed respectively in the lowest (≤20 °C) and highest tertile (≥23 °C) of indoor temperature. There was no association between outdoor temperature and self-reported sleep disturbances in this study. ConclusionIn this first UK-based epidemiology study investigating temperature and sleep, self-reported sleep disturbances were associated with residential daytime indoor temperatures. Low indoor temperature had significantly higher odds ratio for difficulty initiating sleep compared with the neutral indoor temperature. A warmer indoor environment might be more suitable for sleep maintenance than sleep initiation. Indoor temperature in this study was a superior indicator of sleep disturbances than outdoor temperature. Although these findings are based on a UK sample, they may be relevant to other high-income settings with similar housing stock and climatic conditions.

Efficacy of Lemborexant in Adults ≥ 65 Years of Age with Insomnia Disorder.

Pharmacologic treatments are available to treat insomnia, a common and burdensome sleep disorder, but may be contraindicated in older adults who are prone to side effects from sleep-promoting drugs. These analyses of sleep diary data from Study E2006-G000-303 (Study 303) investigated the benefits of lemborexant 5mg (LEM5) and 10mg (LEM10) in the subgroup age ≥ 65years with insomnia. Study 303, a 12-month, double-blind study of LEM5 and LEM10 in adults (age ≥ 18years) with insomnia disorder (sleep onset and/or maintenance difficulties) assessed subject-reported (subjective) sleep-onset latency (sSOL), sleep efficiency (sSE), wake after sleep onset (sWASO), and total sleep time (sTST). Morning sleepiness/alertness, insomnia severity (Insomnia Severity Index [ISI]), fatigue (Fatigue Severity Scale [FSS]), perceptions of sleep-related medication effects (Patient Global Impression-Insomnia [PGI-I] questionnaire), and safety were also evaluated. In this subgroup of older adults (≥ 65years; n = 262), there were significantly larger changes from baseline for sSOL, sSE, sTST, and sWASO with LEM5 and LEM10 versus placebo through month 6 (except sWASO month 1), indicating improvement; these improvements were sustained through month 12. Subject-reported increases in morning alertness were significantly greater with one or both LEM doses versus placebo through month 6 and sustained through month 12. There were significantly larger ISI total and daytime functioning score decreases (improvement) from baseline with LEM versus placebo at months 1, 3, and 6 (total score: both doses; daytime functioning: LEM5 month 1 and both doses months 3 and 6) and decreases from baseline FSS at months 1 and 3 (LEM5) and month 6 (both doses), sustained to month 12. Compared with placebo, more subjects reported that LEM (both doses) positively impacted ability to sleep, time to fall asleep, and TST through month 6, sustained to month 12, with no rebound after drug withdrawal. LEM was well tolerated to month 12; mild somnolence was the most common treatment-emergent adverse event. Improvements in subject-reported efficacy in LEM-treated adults age ≥ 65years with insomnia were observed as early as the first week of treatment and sustained through end of month 12. LEM was well tolerated. ClinicalTrials.gov identifier NCT02952820: E2006-G000-303; Study 303; SUNRISE-2 (First posted: October 2016); EudraCT 2015-001463-39 (First posted: November 2016).

Polysomnographic parameters associated with cognitive function in patients with major depression and insomnia.

To examine whether objective sleep parameters are associated with cognitive function (CF) in patients with major depressive disorder (MDD) with chronic insomnia (CI) and whether the severity of these disorders is related to CF. Thirty patients with MDD with CI attending a tertiary care institution underwent two consecutive nights of polysomnographic (PSG) recording and a battery of neuropsychological tests, which included episodic memory, sustained attention, working memory, and executive function. The severity of MDD and CI was assessed by clinical scales. We examined the relationship between PSG parameters and CF, as well as whether the severity of the disorders is related to CF. Linear regression analysis revealed that total sleep time (TST) was positively associated with higher learning and recall of episodic memory, as well as better attention. Slow-wave sleep (SWS) showed a positive association with better working memory. Furthermore, wake after sleep onset (WASO) was negatively associated with episodic memory and lower attention. No significant relationships were found between the severity of MDD or CI with CF. Both sleep duration and depth are positively associated with several aspects of CF in patients with MDD with CI. Conversely, a lack of sleep maintenance is negatively related to CF in these patients. These findings could help identify modifiable therapeutic targets to reduce CF impairment.

Assessment of Effects of Carbon Dioxide Exposure on Sleep Stability in Insomnia Using the Envelope Analysis

Objectives: Insomnia is a common sleep disorder, and various strategies have been explored for its treatment. One of the methods involves the administration of carbon dioxide (CO&lt;sub&gt;2&lt;/sub&gt;) at bedtime, as the CO&lt;sub&gt;2&lt;/sub&gt; increment exerts a sedative effect on the central nervous system. We aimed to assess the effect of CO&lt;sub&gt;2&lt;/sub&gt; on sleep quality in patients with insomnia using the coefficient of variation of the envelope (CVE) analysis, a novel analytical method. Methods: In this randomized, double-blind, sham-controlled crossover trial, 24 adults with sleeping difficulties underwent level 1 polysomnography. Two interventions involved exposure to either 2% low-concentration CO&lt;sub&gt;2&lt;/sub&gt; gas or room air. CVE analysis was performed to assess the stability of the delta band. Morphological variations in delta waves can be quantitatively monitored using the envelope analysis, which assesses the effect of manipulations on sleep that may otherwise elude detection. Results: Exposure to CO&lt;sub&gt;2&lt;/sub&gt; improved the total sleep time (TST) (&lt;i&gt;p&lt;/i&gt;=0.010) and total arousal index (TAI) (&lt;i&gt;p&lt;/i&gt;=0.011). The CVE analysis showed a distinct distribution between the experimental and sham-controlled groups. Moreover, correlations between the TST and CVE (r=0.41) and those between the TAI and CVE (r=0.40) were observed. Conclusions: This study is the first to evaluate the effects of CO&lt;sub&gt;2&lt;/sub&gt; exposure on sleep stability in patients with insomnia. The CVE analysis implies the possibility of sleep stabilization by CO&lt;sub&gt;2&lt;/sub&gt; administration and suggests a link between enhanced sleep maintenance and sleep stability.