Sleep-related Behaviors Research Articles

Cognitive-behavioral factors in tinnitus-related insomnia.

A significant proportion of individuals with distressing tinnitus also report insomnia. Limited, but emerging, evidence suggests that tinnitus-related insomnia cannot be explained only by the presence of tinnitus and that sleep-related cognitive-behavioral processes may play a key role in exacerbating tinnitus-related insomnia. This study aimed to assess whether sleep-related cognitions and behaviors believed to maintain insomnia disorder are present in individuals with tinnitus-related insomnia. This between-groups study recruited 180 participants online for four groups: tinnitus-related insomnia (N = 49), insomnia disorder without tinnitus (N = 34), tinnitus sufferers who are good sleepers (N = 38), and controls (N = 59). They completed questionnaires assessing insomnia severity, sleep-related cognitions and behaviors, sleep quality, anxiety, and depression. People with tinnitus completed a measure of tinnitus severity and rated the loudness of their tinnitus on a subjective measure. Linear regression demonstrated that group significantly predicted sleep related thoughts and behaviors, and sleep quality. Pairwise comparisons showed that the tinnitus-related insomnia group had significantly greater insomnia-related thoughts and behaviors and significantly worse sleep quality than tinnitus-good sleepers. No differences were seen between the tinnitus-related insomnia and the insomnia groups. The tinnitus-related insomnia group had significantly higher depression, anxiety, and tinnitus distress than tinnitus-good sleepers. Findings suggest that tinnitus-related insomnia may be maintained by cognitive-behavioral processes similar to those found in insomnia disorder. Such processes are more important than tinnitus severity when understanding sleep disturbance. People with tinnitus-related insomnia may benefit from treatments such as cognitive-behavioral therapy for insomnia.

What daily factors affect the sleep habits of Japanese toddlers?

Good sleep, especially during early childhood, is important for development. In Japan, the mean nocturnal sleep duration of toddlers is < 10 hours, and even if toddlers slept for > 11 hours/day, as recommended by the National Sleep Foundation, some of them showed late bedtime and late wake-up time or took long naps. Therefore, we provisionally assumed the minimal sleep conditions for Japanese toddlers, named Nenne-criteria, such as bedtime before 10:00 pm, nocturnal sleep duration of ≥ 9 hours, and < 1 average time of awakening after sleep onset, and investigated the important factors for good sleep. We analyzed cross-sectional data from online surveys describing the sleep-related behaviors of 2,124 toddlers and their caregivers. We compared the daily schedules that affect sleep between the Nenne-criteria-meet group and the not-meet group. The Nenne-criteria-meet group showed better daytime behaviors than the not-meet group. Structural equation modeling on daily schedules revealed that, to increase sleep pressure at the appropriate time, it is important to restrict media viewing, play outdoors in the morning, have an early nap ending time, avoid hyperarousal-inducing behaviors before bedtime, maintain daily schedules regularly, and decrease social jetlag. The Nenne-criteria are useful for screening Japanese toddlers who require intervention for sleep hygiene. To improve toddlers' sleep, it is important not only to guide the ideal bedtime but also to provide tips for improving daily schedules and to avoid suboptimal sleep-related behaviors. Murata E, Yoshizaki A, Fujisawa TX, Tachibana M, Taniike M, Mohri I. What daily factors affect the sleep habits of Japanese toddlers? J Clin Sleep Med. 2023;19(6):1089-1101.

Maternal Differentiation of Self and Toddlers' Sleep: The Mediating Role of Nighttime Involvement.

Good sleep is essential for optimal development and adaptive functioning. Hence, identifying the factors that shape sleep quality is important. Based on the transactional model of sleep development and drawing on Bowen's concept of differentiation of self (DoS), the present study examined the interrelations between sleep-related parental behavior, child's sleep quality, and mothers' DoS. A community sample of 130 mothers of 24- to 36-month-old children completed the DoS instrument and sleep questionnaires. Lower maternal DoS levels were associated with higher parental sleep-related involvement, both at bedtime and through the course of the night. Using structural equation modeling (SEM), a path analysis model indicates that maternal sleep-related involvement functions as a mediator through which the differentiation of self is related to the sleep characteristics of toddlers. As the links between parenting practices and child sleep reflect bi-directional associations, the conclusion that can be drawn from the present data is that relational aspects, such as those defined and measured by the construct of DoS, contribute to sleep-wake regulation beyond infancy. The data suggest that this construct should be considered in intervention research.

Sleep Bruxism in Puerperal Women: Data from a Population-Based Survey.

To evaluate the self-reported SB prevalence and explore associated risk factors in puerperal women who had given birth in Rio Grande, Southern Brazil. A single, standardized questionnaire was given within the 48h postpartum period. Self-reported SB was the main outcome investigated. Chi-square test was used to compare proportions, and Poisson regression with robust variance adjustment was used in the multivariate analysis. A total of 2225 women were included. Only 79 (3.6%) of these reported clenching or grinding their teeth during sleep. Adjusted analysis showed that the higher education level of the mothers (PR = 3.07; 95% CI 1.49-6.28; P = 0.006); living with three or more persons in the household (PR = 0.54; 95% CI 0.34-0.84; P = 0.007); medication intake during pregnancy (PR = 1.68; 95% CI 1.09-2.58; P = 0.017); smoking (PR = 1.93; 1.16-3.23; P = 0.024), or ever smoked (PR = 1.82; 95% CI 0.85-3.90; P = 0.024); severe anxiety (PR = 1.36; 95% CI 0.61-3.02; P = 0.005); and headache upon waking (PR = 4.19; 95% CI 1.95-9.00; P < 0.001) were significantly associated with self-reported SB. Our data pointed towards new factors in a specific group of women that may be relevant for preventing sleep-related behaviors in the pregnancy-puerperal cycle. The higher levels of education, medication intake, smoking or even smoked, severe anxiety, the higher the probability of puerperal woman to self-report SB. The nighttime tooth clenching strongly increased headache upon waking.

Polysomnographic Assessment of Effects of Tobacco Smoking and Alcohol Consumption on Sleep Bruxism Intensity.

Background: Sleep bruxism (SB) is a common sleep-related movement behavior with a complex etiology. A recent hypothesis suggests psychoactive substance usage, tobacco smoking, and alcohol intake are risk factors for SB. This study aimed to evaluate SB intensity in tobacco smokers and alcohol drinkers. Methods: A total of 133 adults underwent full-night audio- and video-polysomnography, and the polysomnograms were evaluated using the American Academy of Sleep Medicine guidelines. The study group was divided into smoker and nonsmoker groups as well as drinker and non-drinker groups. Results: The results of the polysomnographic analysis confirmed that tobacco smoking has a significant effects on SB. Tobacco smokers showed increased bruxism intensity (5.50 ± 4.71 vs. 3.83 ± 3.26, p < 0.05), especially the mixed phenotype (0.93 ± 1.00 vs. 0.59 ± 0.59, p < 0.05), in the N1 sleep stage (22.84 ± 20.45 vs. 15.66 ± 13.60, p < 0.05) and the nonsupine position (4.93 ± 5.56 vs. 2.50 ± 2.31, p < 0.05). They also showed a higher number of bruxism episodes with arousal compared with nonsmokers (2.91 ± 2.83 vs. 1.61 ± 1.49, p < 0.05), indicating increased sleep fragmentation. However, no significant effect of alcohol on SB intensity was observed, and the bruxism episode index was similar in alcohol drinkers and nondrinkers. In addition, electrolyte disturbances and lipid disorders were evaluated. Compared with nonsmokers, tobacco smokers showed a higher concentration of plasma triglycerides (177.67 ± 106.9 vs. 129.18 ± 65.61) and lower levels of iron and magnesium (96.68 ± 43.58 vs. 123.83 ± 52.36 and 1.85 ± 0.22 vs. 1.96 ± 0.21, respectively). Conclusions: In summary, this study showed that tobacco smoking, but not alcohol consumption, is related to bruxism intensity and lipid and electrolyte disturbances in individuals with sleep disorders.

Sleep-related factors and orofacial pain symptoms associated with rhythmic masticatory muscle activity frequency scored by polysomnography recordings: A case-control study

ObjectiveThis study aimed to evaluate the influence of the frequency of rhythmic masticatory muscle activity per hour (RMMA/h) scored by polysomnography (PSG) recordings on sleep-related factors and orofacial pain symptoms. MethodsAccording to RMMA/h frequency, participants were assigned either to the control group (i.e., CRMMA, n = 40); or the case group according to high (i.e., HRMMA, n = 12) or low (LRMMA, n = 28) RMMA/h frequency. Fisher's exact (nominal variables), One-way Analysis of Variance followed by post-hoc Tukey (continuous variables) and Poisson Regression tests were used to calculate orofacial pain symptoms and sleep-related breathing, behavior, and architecture differences between controls versus cases at a significance level of 5%. ResultsThe CRMMA differed from HRMMA and LRMMA subgroups considering orofacial pain, self-reported tooth clenching or grinding, obstructive sleep apnea (OSA), snoring, and most variables considering sleep architecture (P ≤ 0.05). Multivariate adjusted Poisson regression analysis revealed that bruxers, regardless of RMMA/h frequency, presented a significantly higher prevalence rate (PR) related to orofacial pain (PR 1.68; P = 0.025) and self-reported behavior (PR 1.71; P = 0.012). ConclusionSignificant differences in N1, N2 and N3 stages, arousals, arousal per hour, and sleep onset latency variables were found comparing bruxer with high or low RMMA/h frequency. Compared to controls, bruxers presented higher PR related to headache and self-reported tooth clenching or grinding.

Adolescent sleep myths: Identifying false beliefs that impact adolescent sleep and well-being

ObjectiveCommonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents. MethodWe identified myths with a panel of adolescent sleep health experts (n = 12) using the Delphi method in three sequential steps: (1) focus groups; (2) online discussion; and (3) closed-ended questionnaires with which the experts rated myths on: (1) falseness and (2) public health significance using 5-point Likert scales ranging from 1 (not at all false/important for public health) to 5 (extremely false/important for public health). Next, we explored the prevalence of the myths among a demographically diverse sample of parents/caregivers of adolescents in the United States. Finally, we report the counterevidence to refute each myth. ResultsTen myths about adolescent sleep were identified by the experts using the Delphi method. The most prevalent myths were the beliefs that (1) “Going to bed and waking up late on the weekends is no big deal for adolescents, as long as they get enough sleep during that time,” reported by 74% of parents/caregivers; (2) “If school starts later, adolescents will stay up that much later,” reported by 69% of parents/caregivers; and (3) “Melatonin supplements are safe for adolescents because they are natural,” reported by 66% of parents/caregivers. ConclusionParents/caregivers have the potential to serve as sleep health advocates for their adolescent and support their adolescent's sleep health behaviors. Our study found that many parents/caregivers endorse myths about adolescent sleep that may hinder their ability to support their adolescent's sleep health. Future research may explore methods for promoting evidence-based beliefs about adolescent sleep among parents/caregivers.

Chinese translation and validation of the adolescent sleep wake scale

BackgroundInadequate sleep is a problem for teens world-wide. Identifying the biological and cultural factors that underlie this phenomenon is dependent on tools that can accurately query sleep-related behaviors. While there are many sleep-related questionnaires available in English, there are a paucity of validated Chinese language versions. As such, it was the purpose of this study to translate the Adolescent Sleep Wake Scale into Chinese and to provide a preliminary validation of this questionnaire.MethodsWe used a dual forward translation-back translation approach to translate the Adolescent Sleep Wake Scale into Chinese. We then tested the sensitivity, specificity, and internal consistency of the translated questionnaire using 517 adolescents from Taiwan. Preliminary criterion validity was examined through comparison with a measure of chronotype, with the a priori assumption that evening chronotypes would have worse sleep-related behavior.ResultsInternal consistency for both the overall scale (α = .86) and five subscales (α’s > .81) were good. These five subscales explained 62.6% of the total variance. Confirmatory Factory Analysis indicated a good fit of the data. The overall scale and each of the subscales also showed the expected relationship with chronotype, with worse sleep-related behavior in evening-types.ConclusionOur Chinese translation of the Adolescent Sleep Wake Scale is valid and has preliminary criterion validity. This can be a useful tool to explore sleep quality among Chinese-speaking adolescents as well as cross-cultural aspects of sleep behavior between Chinese- and English-speaking adolescents.

Sleep health and its related influencing factors in primary and middle school students in Fuzhou: A large multi-center cross-sectional study

BackgroundThis current study set out to investigate the status of sleep health in 7–20-year-old students in Fuzhou and explore the related influencing factors of sleep health.MethodsA total of 38,467 children and adolescents in Fuzhou were included in the study through a random stratified cluster sampling. Data were collected from May to June 2019, in 18 primary schools and 18 middle schools from nine districts, Fuzhou. Children's parents and adolescents of sampled classes were invited to fill out a series of questionnaires about the performance of the last 6 months (sociodemographic characteristics, sleep-related lifestyle behaviors, and electronic-products usage). Multiple linear regression was carried out to analyze data.ResultsOf the total 40,888 questionnaires we released, 38,467 were valid and effective with the response rate was 94.08%. The age of the surveyed participants was 11.85 ± 3.1, including 20,013 boys and 18,454 girls. The multiple linear regression analysis identified factors associated with sleep health (p < 0.05): Boy (coef = 0.073, 95% CI: 0.030–0.115), age (coef = 1.797, 95% CI: 0.224–0.243), key school (coef = 2.069, 95% CI: 0.105–0.193), urban (coef = 0.096, 95% CI: 0.054–0.139), excessive daytime sleepiness (coef = 0.535, 95% CI: 0.432–0.639), unhealthy sleep habits (coef = 0.363, 95% CI: 0.307–0.419), eating before sleep (coef = 0.578, 95% CI: 0.527–0.630), using electronic products in bedroom (coef = 0.074, 95% CI: 0.028–0.121), screen time per day during school (coef = 0.260, 95% CI: 0.235–0.284), frequency of using electronics 30 min before bedtime (coef = 0.150, 95% CI: 0.134–0.166), strained relationship with parents (coef = 0.361, 95% CI: 0.270–0.452), strained relationship with peers (coef = 0.267, 95% CI: 0.171–0.363), excessive homework or learning (coef = 0.189, 95% CI: 0.141–0.237), time for doing homework (coef = 0.266, 95% CI: 0.245–0.287), and mood swings frequently (coef = 1.174, 95% CI: 1.127–1.221) negatively impact sleep health. Sleep alone (coef = −0.204, 95% CI: −0.262–0.147) were the risk factors for sleep health. Furthermore, frequent mood swings was considered the most influential factor on overall variables.ConclusionsSleep health is associated with factors covered sociodemographic characteristics, family sleep habits, and routine activities before bedtime. Multiple measures should be taken to improve sleep quality in a targeted manner.

A Case Report of a Patient with Probable-REM Sleep Behavior Disorder Treated by &lt;italic&gt;Ukgan-san&lt;/italic&gt; with Western Medicine

Objectives: This study examined the case of a 69-year-old man with a history of stroke and Alzheimer’s disease who had been diagnosed with probable-rapid eye movement sleep behavior disorder (probable-RBD).Methods: The patient was treated with herbal medicine (&lt;i&gt;Ukgan-san, Ukgansangayonggolmoryeo-tang&lt;/i&gt;, and powdered &lt;i&gt;Gamisoyo-san&lt;/i&gt; extract), Western medicine (clonazepam, antiplatelet, psychotropic agents, antihypertensive drugs, and others), and acupuncture. Their effects were evaluated by the frequency and severity of sleep-related behavioral symptoms.Results: After treatment, the observed frequency and severity of sleep-related behavior decreased.Conclusion: The results suggest that using traditional Korean medicine with clonazepam can be effective in the treatment of patients with probable-RBD.

The development of a scale to assess children's and adolescents' sleep environments.

To develop a measure of children's sleep environments and to assess its initial reliability and validity. This cross-sectional study consisted of an online survey for parents of children ages 5-18 years across the United States. A total of 840 parents/caregivers (Mage = 40.6 years, standard deviation = 8.6; 72.0% female) completed surveys regarding a target child (Mage = 10.4 years, standard deviation = 3.8). The items on the scale that was developed were evaluated with exploratory and confirmatory factor analyses in separate random sample halves of the dataset. Cronbach's alpha coefficients were calculated to assess internal consistency across multiple demographic groups. We explored convergent and discriminant validity by examining associations with measures from the nomological net of constructs surrounding the children's sleep environment. Finally, we examined incremental/unique predictive validity of the full scale and its subscales through regression analyses. The Children's and Adolescents' Sleep Environment Scale (13 items) produced 3 factors: general environmental hazards (7 items), availability of bedding materials (2 items), and presence of electronics (4 items). The full scale and its subscales showed strong discriminant validity, and analyses suggested that the Children's and Adolescents' Sleep Environment Scale and its subscales were generalizable across diverse demographic groups. Finally, after controlling for children's sleep hygiene, sleep disturbances, behavioral problems, and family functioning, the full-scale Children's and Adolescents' Sleep Environment Scale significantly predicted children's sleepiness, as did the general environmental hazards and presence of electronics subscales in a separate regression analysis. The Children's and Adolescents' Sleep Environment Scale shows strong psychometric properties and has emerged as both a reliable and valid indicator of children's and adolescents' sleep environments and their potential impact on children's sleep and sleep-related behavior. Peltz JS, Rogge RD, Elmore-Staton L, Spilsbury J, Buckhalt JA. The development of a scale to assess children's and adolescents' sleep environments. J Clin Sleep Med. 2022;18(10):2353-2365.

Cross-cultural adaptation, validation, and the reliability of the Sleep-Related Behaviors Questionnaire in patients with multiple sclerosis.

Examining sleep-related behavioral disorder strategies in detail for MS patients provides an essential assessment to address specific disease findings. The aim of the study was to demonstrate the reliability and validity of the Turkish Sleep-Related Behaviors Questionnaire in patients with multiple sclerosis (MS). A total of 100 MS patients were filled Sleep-Related Behaviors Questionnaire (SRBQ), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). One week later, 30 randomly selected patients were refilled the SRBQ. The test-retest reliability, internal consistency, and contruct validity were determined. The mean age of the individuals included in the study was 38.9 ± 11.0years. The ICC value of the reproducibility of SRBQ was calculated as 0.877 (CI: 0.74-0.94). The test-retest reliability of the SRBQ was excellent (ICC > 0.80). Cronbach's alpha value of the SRBQ was 0.877, which indicates excellent consistency. The SRBQ had correlation coefficients of 0.573, 0.509, and 0.523 with ISI, PSQI, and BDI, respectively. The SRBQ had high validity (r > 0.50, p < 0.01). The Turkish SRBQ was found to be valid and reliable in patients with MS. Owing to the long but comprehensive nature of the SRBQ, a low-cost detailed measurement could be obtained in clinical practice.

0843 Sexsomnia in a female patient with nightmares and obstructive sleep apnea: a case report

Abstract Introduction Sexsomnia has been described as various sleep-related abnormal sexual behaviors primarily associated with confusional arousals and more rarely linked to rapid eye movement (REM) sleep behavior disorder (RBD). Clinical descriptions are based on case reports and review series, which leads to diagnostic ambiguity, challenges with appropriate classification, and forensic and legal ramifications Report of Cases: We report a 34 year old female with a past medical history of polycystic ovarian syndrome and childhood post-traumatic stress disorder. Family history significant for parent with lifelong parasomnias. The patient was referred to Sleep Medicine with concern for snoring, sleepiness, and sleep behaviors. The patient reports sleep talking since childhood which predate trauma, traumatic themed nightmares, and ex-husband and current spouse reporting sleep-related masturbation, sexual advances described as coital-like pelvic movements which often lead to intercourse and subsequent amnesia. In addition, spouse describes bruxism and ongoing night terrors. Physical examination notable for body mass index 44 kg/m2, high arched palate, Mallampati class III, and 18 inch neck circumference. The patient underwent a polysomnagram which demonstrated fragmented sleep architecture, total arousal index up to 20.3/hr, and totalsleep time in stage N3 20%, Four awakenings fromN3, and findings of N3 partial arousal. The patient was observed in v-PSG to have periods of nocturnal lagophthalmos, finger movements, and vocalizations during NREM sleep. However, many of these observations were in the setting of respiratory events. The apnea-hypopnea index was 16.9/hr and a minimum oxygen saturation of 81% and mean saturation of 95%. A total of 3.1 minutes were spent less than or equal to 90%. TCO2 was without concern for hypoventilation. The patient was started on Auto CPAP 5-15cmH2O with resolution of snoring and some improvement to sleepiness. However, spouse reports ongoing sexsomnia in the same frequency despite treatment of obstructive sleep apnea. Conclusion This case reports a female adult with persistent sexsomnia despite early treatment of obstructive sleep apnea which highlights the possibility of co-occurring sleep disorder. The case does support current limited literature around sexsomnias having features of partial arousals from NREM sleep given the co-occuring history of night terrors, elevated N3 awakenings, and evidence of cortico-cortical dissociation. Support (If Any) None

Associations of sleep-related behaviors and the sleep environment at infant age one month with sleep patterns in infants five months later

ObjectiveTo characterize family and environmental correlates of sleep patterns that may contribute to differences in infant sleep. MethodsWe studied 313 infants in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort. Our main exposures were the parent-reported sleep environment, feeding method and sleep parenting strategies at infant age one month. The main outcomes were nighttime sleep duration, longest nighttime sleep and number of awakenings measured by actigraphy at age six months. We used multivariable linear regression models to examine associations, and secondarily also explored the role of sleep-related environmental exposures in mediating previously observed associations of racial/ethnicity and parental education with infant sleep characteristics. ResultsIn adjusted models, a non-dark sleep environment (versus an always dark sleep location) and taking the baby to parent's bed when awake at night (versus no co-sleeping) were associated with 28 (95% CI, −45, −11) and 18 (95% CI, −33, −4) minutes less sleep at night, respectively. Bottle feeding at bedtime was associated with 62 (95% CI, 21, 103) minutes additional longest nighttime sleep period. Exploratory mediation analyses suggested a modest mediating role of a non-dark sleep environment on racial/ethnic and educational differences in sleep duration. ConclusionsInfant sleep duration was positively associated with a dark sleep environment and a focal feed at bedtime while taking the baby to the parent's bed was associated with reduced infant sleep. Modifying the sleep environment and practices may improve infant sleep and reduce sleep health disparities.

Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home.

Hospitalised older persons with dementia are commonly discharged with intensified sleep disturbances. These disturbances can impede the recovery process. Nurses are well-positioned to assist persons with dementia and their family caregivers in managing sleep disturbances during the transition from hospital to home. To describe the development of a multi-component intervention to promote sleep. We applied three stages of the intervention mapping method to develop a non-pharmacological, multi-component sleep intervention. The first stage involved a review of the literature to generate an understanding of the determinants of sleep disturbances experienced by persons with dementia in hospital and home settings. The second stage consisted of a literature review to identify therapies for managing commonly reported determinants of sleep disturbances. The third stage entailed delineation of the intervention components. The most common determinants of sleep disturbances experienced by persons with dementia in hospital and home settings were: physiological changes associated with ageing, sleep environments non-conducive to sleep, limited exposure to light and engagement in physical activity, stress and sleep-related beliefs and behaviours. Therapies found effective included: light therapy, physical activity therapy, sleep hygiene, and stimulus control therapy. These therapies were integrated into a multi-component sleep intervention to be provided using the teach-back technique, during and following hospitalisation. Consistent with the principles of patient engagement, the multi-component sleep intervention will be evaluated for its acceptability and feasibility. The intervention has potentials to improve sleep during the transition from hospital to home.

Clinical characterization of insomnia in adolescents – an integrated approach to psychopathology

Objectives/BackgroundInsomnia in adolescence is common and debilitating yet it remains poorly understood. Here, we examine the complexity of clinical, behavioral, and psychosocial factors characterizing insomnia in adolescents. MethodsNinety-five adolescents (16–19 years) with (N = 47, 31 female) and without (N = 48, 28 female) insomnia symptoms participated. In the insomnia group, 26 (20 female) met full DSM-5 criteria for insomnia disorder, while 21 (11 female) met partial criteria. Participants completed a clinical interview and assessments of clinical, behavioral, and psychosocial dimensions associated with insomnia. GLMs and network analyses were used to evaluate group and sex differences in severity and inter-relationships between symptoms. ResultsAdolescents with insomnia symptomatology had lower sleep hygiene and thought control, more depressive symptoms and dysfunctional sleep-related cognitions, and more substance use as a coping behavior than healthy controls. They also indicated higher neuroticism, stress levels, and sleep stress reactivity (p < 0.05), but no difference in adverse childhood experiences, than controls. Girls compared to boys with insomnia reported lower sleep quality, and more pre-sleep cognitive activity and sleep stress reactivity (p < 0.05). Compared to healthy girls, girls in the insomnia group reported lower sleep hygiene and higher agreeableness. Network analyses confirmed profound group differences in network topology, with the insomnia group having different levels of centrality and relationships between clinical characteristics compared with controls. ConclusionsFindings highlight clinical and sex-specific characteristics of adolescent insomnia, with network analyses revealing a complex interplay between clinical, behavioral, and psychosocial domains. Adolescents with insomnia symptoms, particularly girls, may benefit from interventions to improve negative cognition, mood, and stress, and behavioral strategies to counteract sleep-related maladaptive behaviors.

Differential effects of COVID-related lockdown on sleep-wake rhythms in adults with autism spectrum disorder compared to the general population.

COVID‐related lockdown led to a radical modification of daily activities and routines which are known to affect sleep. Compared to the general population, participants with autism may be particularly vulnerable to the repercussions of lockdown on sleep, given their intrinsic inflexible adherence to routines and the high overall prevalence of sleep disturbances in this population. The study is a French nation‐wide online survey assessing sleep–wake rhythms and behaviors known to affect sleep (daily screen time, daylight exposure, and physical activity), before and during COVID‐related lockdown. Respondents were 207 adults with autism (56% female) and 1652 adults of the general population (77% female), with a mean age 35.3 years (SD 11.3). Before lockdown, the adults with autism displayed on average later bedtime and waking hours, lower sleep quality, more evening screen time, less exposure to daylight, and less exercise (all p < 0.01). Lockdown affected all studied measures of sleep and related exposures in a similar way in both groups: poorer self‐rated sleep quality as well as a less regular and delayed sleep–wake rhythm, longer screen time in the evening and less exposure to daylight (all p < 0.001). Adults with autism displayed significantly higher levels of sleep and circadian rhythm disturbances and less favorable daily routines known to regulate sleep. While the effect of confinement on sleep and sleep related behaviors was similar in both groups, the results highlight that the pre‐existing shift in circadian rhythms and lifestyles in adults with ASD further deteriorated during lockdown.Lay abstractCOVID‐related lockdown led to a radical modification of daily activities and routines known to affect sleep. In a sample of 1800 adults, we observed that, before lockdown, participants with autism displayed significantly higher levels of sleep disturbances and less favorable daily routines known to regulate sleep, compared to the general population. While the deleterious effect of lockdown on sleep was similar in both groups, pre‐existing difficulties in adults with autism reached worrying levels during lockdown.

Maternal sleep behaviours preceding fetal heart rate events on cardiotocography.

In Australia, a significant proportion of stillbirths remain unexplained. Recent research has highlighted nocturnal maternal behaviours as potentially modifiable contributors. This study determined whether sleep-related behaviours including sleep position and sleep-disordered breathing adversely affect fetuses overnight, in both uncomplicated pregnancies and those at increased risk due to hypertensive disorders or fetal growth restriction (FGR). All participants underwent polysomnography with time-synchronized fetal heart rate (FHR) monitoring (cardiotocography - CTG) in late pregnancy. CTGs were analysed for abnormal FHR events, including decelerations and reduced variability, by two blinded observers and exported into the sleep study to temporally align FHR events with sleep behaviours. For each FHR event, 10 control epochs with normal FHR were randomly selected for the same participant. Conditional logistic regression assessed the relationships between FHR events and sleep behaviours. From 116 participants, 52 had a total of 129 FHR events overnight; namely prolonged decelerations and prolonged periods of reduced variability. Significantly more FHR events were observed in women with FGR and/or a hypertensive disorder compared with uncomplicated pregnancies (P=0.006). FHR events were twice as likely to be preceded by a change in body position within the previous 5min, compared with control epochs (P=0.007), particularly in hypertensive pregnancies both with and without FGR. Overall, FHR events were not temporally related to supine body position, respiratory events or snoring. Our results indicate that most fetuses tolerate sleep-related stressors, but further research is needed to identify the interplay of maternal and fetal conditions putting the fetus at risk overnight. KEY POINTS: Maternal sleep behaviours including supine position and sleep-disordered breathing are potential contributors to stillbirth but much of this work is based on self-reported data. Using time-synchronized polysomnography and cardiotocography, we found that nocturnal fetal heart rate decelerations were more likely to be preceded by a change in body position compared with epochs containing normal fetal heart rate, particularly in hypertensive pregnancies with or without fetal growth restriction. There was no temporal relationship between maternal sleeping position, snoring or apnoeic events and an abnormal fetal heart rate overnight. We conclude that most fetuses can tolerate sleep-related stressors with no evidence of fetal heart rate changes indicating compromised wellbeing. Further work needs to identify how sleep behaviours contribute to stillbirth risk and how these intersect with underlying maternal and fetal conditions.

Phentermine\u2013topiramate extended release for the dual treatment of obesity and sleep-related eating disorder: a case report

BackgroundObesity and eating disorders can present together, and pose diagnostic and therapeutic challenges to the clinician. Generally, lifestyle interventions alone for the treatment of obesity have modest long-term effectiveness. Phentermine–topiramate extended release is a relatively new medication approved for weight reduction. Sleep-related eating disorder is a rare condition that is often underdiagnosed. Both conditions are chronic and require long-term management. There is no definitive treatment for sleep-related eating disorder, and therapeutic options are based on case reports.Case presentationA 35-year-old Caucasian male with a body mass index of 41.7 kg/m2 presented for obesity treatment. History revealed nocturnal episodes of hyperphagia associated with amnesia of overeating and other features of sleep-related eating disorder. Treatment was initiated with phentermine–topiramate extended release. Five months later he lost 5% of his body weight and demonstrated resolution of sleep-related eating disorder behaviors. He reported no adverse side effects. Upon self-discontinuation of the medication, his eating disorder recurred.ConclusionsClinicians intending to help patients reduce body weight should screen for nocturnal eating and other eating disorders. Sleep-related eating disorder can be associated with significant morbidity and excess weight. Patients report adverse effects on quality of life as a result. Phentermine–topiramate extended release may be a good therapeutic option for patients presenting with comorbid obesity and sleep-related eating disorder. More research is needed to explore the efficacy and safety in this patient population.

Lateral hypothalamic neuronal ensembles regulate pre-sleep nest-building behavior

The transition from wakefulness to sleep requires striking alterations in brain activity, physiology, and behavior, yet the precise neuronal circuit elements facilitating this transition remain unclear. Prior to sleep onset, many animal species display characteristic behaviors, including finding a safe location, performing hygiene-related behaviors, and preparing a space for sleep. It has been proposed that the pre-sleep period is a transitional phase in which engaging in a specific behavioral repertoire de-arouses the brain and facilitates the wake-to-sleep transition, yet both causal evidence for this premise and an understanding of the neuronal circuit elements involved are lacking. Here, we combine detailed behavioral observations, EEG-EMG recordings, selective targeting, and activity modulation of pre-sleep-active neurons to reveal the behaviors preceding sleep initiation and their underlying neurobiological mechanisms. We show that mice engage in temporally structured behaviors with stereotypic EEG signatures prior to sleep and that nest-building and grooming become significantly more prevalent with sleep proximity. We next demonstrate that the ability to build a nest promotes the initiation and consolidation of sleep and that the lack of nesting material chronically fragments sleep. Lastly, we identify broadly projecting and predominantly glutamatergic neuronal ensembles in the lateral hypothalamus that regulate the motivation to engage in pre-sleep nest-building behavior and gate sleep initiation and intensity. Our study provides causal evidence for the facilitatory role of pre-sleep behaviors in sleep initiation and consolidation and a functional characterization of the neuronal underpinnings regulating a sleep-related and goal-directed complex behavior.