Sleep-related Factors Research Articles

Senegenin regulates the mechanism of insomnia through the Keap1/Nrf2/PINK1/Parkin pathway mediated by GAD67.

GAD67 impacts insomnia as a key enzyme catalysing the conversion of glutamate (Glu) to gamma-aminobutyric acid (GABA). Senegenin enhances neuroprotection and is used widely to treat insomnia and other neurological diseases. This study aimed to investigate how senegenin regulates insomnia through a GAD67-mediated signalling pathway. We measured GAD67 expression levels in insomnia patients and evaluated the expression levels of GAD67 and Keap1/Nrf2/Parkin/PINK1-related cytokines following GAD67 lentiviral transfection in PC12 cells and in rat models. We also assessed cellular reactive oxygen species (ROS) and mitochondrial membrane potential levels. Additionally, EEG/EMG was used to analyse the sleep phases of rats and to assess memory and exploration functions. Pathological changes and the expression of GAD67 and sleep-related proteins in the hippocampus were examined. The results showed that GAD67 expression was increased in insomnia patients, ROS levels were elevated, and the mitochondrial membrane potential was decreased in the GAD67-KD group. Insomnia rats exhibited changes in sleep rhythm, learning, and exploration dysfunction, pathological changes in the CA1 region of the hippocampus, and differential expression of GAD67 and sleep-related factors. Inhibitory neurofactor expression levels were decreased in insomnia rats, showing a positive correlation in the GAD67-KD group and a negative correlation in the GAD67-OE group. Conversely, excitatory factor expression levels were increased in insomnia rats, showing a positive correlation in the GAD67-KD group and a negative correlation in the GAD67-OE group. Senegenin intervention modulated cytokine expression levels. In conclusion, GAD67 negatively regulates insomnia, and senegenin can regulate insomnia by mediating the expression of cytokines in the GAD67-regulated Keap1/Nrf2/Parkin/PINK1 pathway.

Association between commuting and mental health among Japanese adolescents.

Mental health issues in adolescence contribute to various disease burdens later in life and are associated with violence, crime, and suicide. Activities such as sleep, diet, exercise, and time spent using electronic devices are related to declining mental health. However, few studies have examined the association between commuting times to school and mental health. This study tested the hypothesis that high school students' long commuting times are associated with poor mental health. A cross-sectional study was conducted between October and December 2022 among 2067 students at two private high schools. Survey items included participant information (sex, grade, school), commuting time, mental health status (Patient Health Questionnaire 9 [PHQ-9]: depressive symptoms, and Generalized Anxiety Disorder 7 [GAD-7]: anxiety symptoms), lifestyle factors, and sleep-related factors. Data from 1899 high school students were analyzed. The prevalence of depressive and anxiety symptoms was 17.3% and 19.0%, respectively. A commuting time of ≥1 h was significantly associated with depressive symptoms (adjusted odds ratio: 1.60 [95% confidence interval]: 1.14-2.24) and anxiety symptoms (adjusted odds ratio: 1.51 [95% confidence interval]: 1.09-2.10). Sex, grade, use of ≥8 h/day of electronic devices, and chronotype were significantly associated with depressive symptoms, while sex, grade, use of ≥8 h/day of electronic devices, and insomnia were significantly associated with anxiety symptoms. It is suggested that long commuting times are associated with poor mental health in high school students. Parents and schools should consider commuting time when advising students on school selection to maintain their mental health.

Development and Validation of Machine Learning Models to Predict Postoperative Delirium Using Clinical Features and Polysomnography Variables.

Background: Delirium affects up to 50% of patients following high-risk surgeries and is associated with poor long-term prognosis. This study employed machine learning to predict delirium using polysomnography (PSG) and sleep-disorder questionnaire data, and aimed to identify key sleep-related factors for improved interventions and patient outcomes. Methods: We studied 912 adults who underwent surgery under general anesthesia at a tertiary hospital (2013-2024) and had PSG within 5 years of surgery. Delirium was assessed via clinical diagnoses, antipsychotic prescriptions, and psychiatric consultations within 14 days postoperatively. Sleep-related data were collected using PSG and questionnaires. Machine learning predictions were performed to identify postoperative delirium, focusing on model accuracy and feature importance. Results: This study divided the 912 patients into an internal training set (700) and an external test set (212). Univariate analysis identified significant delirium risk factors: midazolam use, prolonged surgery duration, and hypoalbuminemia. Sleep-related variables such as fewer rapid eye movement (REM) episodes and higher daytime sleepiness were also linked to delirium. An extreme gradient-boosting-based classification task achieved an AUC of 0.81 with clinical variables, 0.60 with PSG data alone, and 0.84 with both, demonstrating the added value of PSG data. Analysis of Shapley additive explanations values highlighted important predictors: surgery duration, age, midazolam use, PSG-derived oxygen saturation nadir, periodic limb movement index, and REM episodes, demonstrating the relationship between sleep patterns and the risk of delirium. Conclusions: The artificial intelligence model integrates clinical and sleep variables and reliably identifies postoperative delirium, demonstrating that sleep-related factors contribute to its identification. Predicting patients at high risk of developing postoperative delirium and closely monitoring them could reduce the costs and complications associated with delirium.

Determinants of Engagement in Leisure-Time Physical Activity and Club Sports among University Students: A Large-Scale Study.

Various socio-demographic, environmental, and lifestyle-related factors have been reported to be associated with physical activity (PA) habits. However, there exist insufficient data comparing different forms of engagement in PA, sports, and exercise. This study aimed to investigate potential factors associated with the engagement in leisure-time PA (LPA) and club sports (CSs) in a large sample of college/university students. This Austria-wide study followed a cross-sectional design with a final sample of 4508 participants (mean age: 24.9 years; 65.9% female) from 52 Austrian colleges/universities. A standardized survey was used to collect data on demographics, anthropometric characteristics, and a wide range of health-related lifestyle factors, including patterns of PA and underlying motivations for PA engagement as well as details of dietary habits, sleep routines, smoking, and alcohol consumption. Descriptive statistics, chi-squared, logistic regression, and MANCOVA were used for data analysis. Across the entire sample, 85.7% of participants reported regular participation in LPA, including 22.5% who were active members of sports clubs. Of the 36 potential motives listed in the questionnaire, "maintaining physical health", "feeling good", and "refreshing the mind" were the most commonly reported factors motivating students to engage in either LPA or CSs. Ten socio-demographic, dietary, or lifestyle factors were identified as predictors of CSs participation (p < 0.01), whereas only two variables (specifically sleep-related factors) were identified as predictors of LPA participation (p < 0.001). These findings emphasize the importance of considering the type of PA and sport participation and the associated determinants when designing tailored strategies to promote an active lifestyle.

Exploring the nexus between sleep, chronotype, and non-cognitive predictors in university students: Implications for academic success

ABSTRACT While the association between sleep-related variables and academic achievement is widely acknowledged, limited attention has been directed towards exploring non-cognitive predictors of academic achievement such as conscientiousness and self-regulation. In this study, we investigated the relationships between various sleep-related factors (circadian preference, chronotype, sleep duration, quality, and irregularity) and non-cognitive predictors (conscientiousness, self-regulation, self-efficacy, and achievement motivation) in 637 university students. Bivariate analyses revealed moderate to strong correlations among several sleep-related measures. Notably, distinctness, representing the subjective perception of daily changes, and daytime sleepiness exhibited negative associations with self-regulation, while high sleep quality was positively linked to robust self-regulation. These findings emphasize the importance of exploring various measures, particularly distinctness within circadian typology. Furthermore, we discuss the potential integration of sleep intervention programs with strategies aimed at enhancing self-regulation.

Sleep duration irregularity and risk for incident cardiovascular disease in the UK Biobank.

Emerging evidence supports a link between circadian disruption as measured by higher night-to-night variation in sleep duration and increased risk of cardiovascular disease (CVD). It remains unclear whether this association varies by CVD types or may be modified by average sleep duration and genetic risk for CVD. Our prospective analysis included 86,219 UK Biobank participants who were free from CVD when completing 7 days of accelerometer measurement in 2013-2016. Sleep irregularity was evaluated by the standard deviation (SD) of accelerometer-measured sleep duration over 7 days. Incident major CVD events, defined as fatal or nonfatal myocardial infarction (MI) and stroke, were identified through linkage to Hospital Episode Statistics data until May 31, 2022. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs for associations of sleep duration SD with risk for major CVD events overall and for MI and stroke separately. We documented 2,310 incident cases of major CVD events (MI: 1,183, stroke: 1,175) over 636,258 person-years of follow-up. After adjusting for sociodemographic factors and family history of CVD, the HR (95% CI) associated with a 1-hour increase in sleep duration SD was 1.19 (1.10, 1.27) for CVD (p-trend<0.0001), 1.23 (1.11, 1.35) for MI (p-trend<0.0001), and 1.17 (1.05, 1.29) for stroke (p-trend=0.003). Additional adjustment for lifestyle factors, co-morbidities and sleep-related factors modestly attenuated these associations. Higher sleep irregularity was associated with higher CVD risk irrespective of genetic risk (p-interaction=0.43), but this association was stronger among individuals with longer average sleep duration >8 hours (p-interaction=0.006). Higher night-to-night variation in accelerometer-measured sleep duration was associated with consistently higher risks for major CVD events. The association did not seem to be modified by genetic risk for CVD and was more pronounced in long sleepers.

Investigating The Relationship Between Sleep Quality, Adherence to Proper Sleep Hygiene Practices, And Academic Performance Among Students.

In this correlational study, the relationship between sleep quality, sleep hygiene, and academic performance among individuals aged 17- 24 years was investigated (200) utilizing correlation. Descriptive statistics showed normal distributions for Academic Performance, Sleep Quality, and Sleep Hygiene scores. Spearman’s rho correlation analyses showed a weak negative correlation between Academic Performance and Sleep Quality (ρ = -0.184, p = 0.009), proposing that higher Sleep Quality is related to slightly lower Academic Performance. Contrarily, no significant correlation was discovered between Academic Performance and Sleep Hygiene (ρ = -0.060, p = 0.393), suggesting that sleep hygiene practices alone do not affect academic outcomes. A moderate positive correlation was seen between Sleep Quality and Sleep Hygiene (ρ = 0.484, p &lt; 0.001), underscoring that good sleep hygiene led to higher Sleep Quality. These results emphasize the complex nature of the relation between sleep-related factors and academic performance, proposing the influence of multifaceted variables beyond sleep on academic outcomes. The study suggests comprehensive approaches combine various factors to optimize both academic performance and overall well-being. Future research should explore additional variables and employ longitudinal designs to elucidate causality and refine interventions aimed at advancement of sleep and academic performance.

The training times of athletes could play a role in clinical sleep problems due to their associations with sleep difficulty scores

ObjectivesSleep is a key component of athletic recovery, yet training times could influence the sleep of athletes. The aim of the current study was to compare sleep difficulties in athletes across different training time groups (early morning, daytime, late evening, early morning plus late evening) and to investigate whether training time can predict sleep difficulties. MethodsAthletes from various sports who performed at a national-level (n = 273) answered the Athlete Sleep Screening Questionnaire (ASSQ) along with several other questionnaires related to demographics, exercise training, and mental health. From the ASSQ, a Sleep Difficulty Score (SDS) was calculated. Transformed SDS (tSDS) was compared across different training time categories using multiple one-way ANOVAs. A stepwise regression was then used to predict tSDS from various sleep-related factors. ResultsSDSs ranged from none (31%), mild (38%), moderate (22%), and severe (9%). However, the one-way ANOVAs revealed training earlier or later vs. training daytime shifted the tSDS in a negative direction, a trend toward increased sleep difficulty. In particular, athletes training in the late evening (>20:00 or >21:00) had a significantly higher tSDS when compared to daytime training (p = .03 and p < .01, respectively). The regression model (p < .001) explained 27% of variance in the tSDS using depression score, age, training time, and chronotype score. ConclusionAmong a heterogeneous sample of national-level athletes, 31% displayed moderate to severe SDSs regardless of their training time. However, when athletes trained outside daytime hours there was a tendency for the prevalence of sleep difficulties to increase.

A machine learning model to predict the risk of perinatal depression: Psychosocial and sleep-related factors in the Life-ON study cohort

Perinatal depression (PND) is a common complication of pregnancy associated with serious health consequences for both mothers and their babies. Identifying risk factors for PND is key to early detect women at increased risk of developing this condition. We applied a machine learning (ML) approach to data from a multicenter cohort study on sleep and mood changes during the perinatal period (“Life-ON”) to derive models for PND risk prediction in a cross-validation setting. A wide range of sociodemographic variables, blood-based biomarkers, sleep, medical, and psychological data collected from 439 pregnant women, as well as polysomnographic parameters recorded from 353 women, were considered for model building. These covariates were correlated with the risk of future depression, as assessed by regularly administering the Edinburgh Postnatal Depression Scale across the perinatal period. The ML model indicated the mood status of pregnant women in the first trimester, previous depressive episodes and marital status, as the most important predictors of PND. Sleep quality, insomnia symptoms, age, previous miscarriages, and stressful life events also added to the model performance. Besides other predictors, sleep changes during early pregnancy should therefore assessed to identify women at higher risk of PND and support them with appropriate therapeutic strategies.

The importance of parental education and cultural humility when addressing co‐sleeping with infants

Last October, an Indiana woman was charged with two felonies for her infant's death related to co‐sleeping, after she had lost another infant to the same cause in 2020. The rationale for her indictment was that she should have been cognizant of the risk. This was also the case with an Ohio woman early this year for the same set of tragedies, and a FL woman in January as well, also two infants. A quick search yields a concerning number of these cases, and indeed the American Association of Pediatrics (AAP) notes that approximately 3500 infants die annually of sleep related factors (Moon et al, 2022).

SLEEP QUALITY AND RELATED FACTORS IN INDIVIDUALS AGED 20 AND OVER APPLYING TO PRIMARY HEALTH CARE CENTERS IN MANISA

ABSTRACT&#x0D; Objective: This cross-sectional study aimed to evaluate the prevalence of poor sleep quality and to identify related factors among adults. Methods: This study was among adults aged ≥20 years registered at Primary Health Care Center in August-September 2022. Primary outcome was sleep quality, which was assessed by Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were sociodemographic, lifestyle, health characteristics, sleep-related factors, anxiety-depression. Chi-square test for categorical variables was used in univariate analysis, logistic regression models in multivariate analysis was used. SPSS version 23.0 was used for analysis, type-1 error accepted as 0.05. Results: Participant’s average age was 40.98±13.68 years. 34.6% of participants had poor sleep quality. 12.7% of them had abnormal level anxiety while 8.5% had abnormal level depression. Between total PSQI score and anxiety-depression, there was a moderate positive correlation (r=.375,p

Sleep patterns and quality among Nigerian medical students: A cross-sectional study.

Adequate sleep is crucial for individuals' well-being and cognitive functioning. However, medical students face unique challenges that disrupt their sleep patterns, such as a rigorous curriculum, long study hours, and high-stress levels. Understanding the sleep patterns and quality among medical students in Nigeria is important to develop targeted interventions and support their overall well-being. This study involved 802 medical students from 3 medical schools in Southwest Nigeria. Participants completed an online questionnaire that collected data on their demographic characteristics, sleep patterns and self-reported sleep quality. Descriptive statistics and correlation analysis were used to analyze the data and identify patterns and associations. Most participants were female (56.9%), with the highest representation from the UNILORIN (65.5%). The average reported sleep duration was 5.74 hours per night, indicating insufficient sleep. Irregular bedtimes and wake-up times were commonly reported. A significant proportion of students consumed coffee late at night (27.1%) and used medication to induce sleep (24.3%). Sleep patterns and behaviors, such as snoring (36.1%) and nocturnal eating (57.6%), were reported. Overall, participants reported satisfactory (28.3%) or poor (29.7%) sleep quality. Correlation analysis revealed significant associations between sleep patterns, sleep quality, academic performance, and other sleep-related factors. The study identified insufficient sleep duration, irregular bedtimes, late-night coffee consumption, and poor sleep quality. These findings emphasize the need for interventions and strategies to promote healthy sleep habits among medical students, which can positively impact their overall health and academic performance.

Effectiveness of manual lymphatic drainage in women with fibromyalgia: A pilot study

BackgroundCurrently there is no treatment capable of significantly alleviating all the symptoms of fibromyalgia (FM), even though it is a complex syndrome with a high prevalence in the population. DesignExperimental study using a single-blind, randomised, clinical trial. ObjectiveTo analyse the efficacy of manual lymphatic drainage (MLD) as an alternative to traditional treatment of fibromyalgia (FM) in women. MethodsThis was an experimental study using a single-blind, randomised, clinical trial of 20 women between 30 and 55 years old with FM. Patients were divided into an experimental group (n = 10) and a control group (n = 10). During the study, 3 measurements of pain (visual analogue scale and algometry), FM impact (Fibromyalgia Impact Questionnaire), sleep quality (Index Pittsburgh), anxiety and depression (Hospital Anxiety and Depression Scale) were recorded. Treatment of the experimental group consisted of 2 weekly MLD sessions for 6 weeks. ResultsThe effect of the interaction of MLD showed statistically significant results in Right intercostal space (F2,36 = 3.54; p = 0.04; n2p = 0.16). The sleep quality was significantly better favour of the treatment (F2,36 = 4.16; p = 0.01; n2p = 0.20). ConclusionsMLD therapy demonstrated effects in the experimental group in contrast to the control group across the intervention period concerning the right intercostal space and sleep-related factors. However, MLD did not result in observable alterations in pain perception.

Secular trends in sleep and circadian problems among adolescents in Hong Kong: From 2011-2012 to 2017-2019

ObjectiveThe study aimed to investigate secular trends in sleep and circadian problems in Hong Kong Chinese adolescents. MethodsThis study analyzed cross-sectional data from two large-scale school-based sleep surveys conducted in 2011-2012 and 2017-2019. Sleep and circadian problems, including sleep-wake pattern, insomnia, chronotype, social jetlag, daytime sleepiness, and other sleep-related factors, were compared between two survey years. ResultsA total of 8082 adolescents (5639 students in 2011-2012 [Mean age: 14.4 years, 50.9% boys] and 2443 students in 2017-2019 [Mean age: 14.7 years, 54.0% boys]) were included in this 7-year study. The average time in bed of Hong Kong adolescents decreased from 8.38 hours to 8.08 hours from 2011-2012 to 2017-2019. There was a 0.28-hour delay in weekday bedtime, 0.54-hour advance in weekend wake-up time, and a 0.36-hour decline in average time in bed, resulting in increased trends of sleep loss (Time in bed <8h: OR = 2.06, 95%CI: 1.44–2.93, p < 0.01; Time in bed <7h: OR = 2.73, 95%CI: 1.92–3.89, p < 0.01), daytime sleepiness (OR = 1.70, 95%CI: 1.34–2.16, p < 0.01), and evening chronotype (OR = 1.26, 95%CI: 1.08–1.48, p < 0.01). The increased trend in insomnia disorder, however, was insignificant when covariates were adjusted. ConclusionA secular trend of reduced time in bed, delay in weekday bedtime, advance in weekend wake-up time, increase in evening chronotype and daytime sleepiness from 2011-2012 to 2017-2019 were observed. There is a timely need for systematic intervention to promote sleep health in adolescents.

Cardiorespiratory effects of indoor ozone exposure during sleep and the influencing factors: A prospective study among adults in China

Ambient ozone (O3) is recognized as a significant air pollutant with implications for cardiorespiratory health, yet the effects of indoor O3 exposure have received less consideration. Furthermore, while sleep occupies one-third of life, research on the health consequences of O3 exposure during this crucial period is scarce. This study aimed to investigate associations of indoor O3 during sleep with cardiorespiratory function and potential predisposing factors. A prospective study among 81 adults was conducted in Beijing, China. Repeated measurements of cardiorespiratory indices reflecting lung function, airway inflammation, cardiac autonomic function, blood pressure, systemic inflammation, platelet and glucose were performed on each subject. Real-time concentrations of indoor O3 during sleep were monitored. Associations of O3 with cardiorespiratory indices were evaluated using linear mixed-effect model. Effect modification by baseline lifestyles (diet, physical activity, sleep-related factors) and psychological status (stress and depression) were investigated through interaction analysis. The average indoor O3 concentration during sleep was 20.3 μg/m3, which was well below current Chinese indoor air quality standard of 160 μg/m3. O3 was associated with most respiratory indicators of decreased airway function except airway inflammation; whereas the cardiovascular effects were only manifested in autonomic dysfunction and not in others. An interquartile range increases in O3 at 6-h average was associated with changes of −3.60 % (95 % CI: −6.19 %, −0.93 %) and −9.60 % (95 % CI: −14.53 %, −4.39 %) in FVC and FEF25–75, respectively. Further, stronger effects were noted among participants with specific dietary patterns, poorer sleep and higher level of depression. This study provides the first general population-based evidence that low-level exposure to indoor O3 during sleep has greater effects on the respiratory system than on the cardiovascular system. Our findings identify the respiratory system as an important target for indoor O3 exposure, and particularly highlight the need for greater awareness of indoor air quality, especially during sleep.

Comparative Analysis of Sleep Hygiene and Patterns among Adolescents in Two Russian Arctic Regions: A Pilot Study.

The circumpolar habitat stands as one of the most vulnerable environments for human activity and health. The primary study objective was to compare sleep-related factors, light exposure, social cues, and potential confounding variables among schoolchildren residing in the European Arctic region from two settlements situated below and above the Polar Circle using validated self-reported questionnaires. We recruited 94 children aged 13-15 years (40.4% males), matched by sex and age, from public educational institutions in two circumpolar settlements located below (Kem', Republic of Karelia; 64.6 NL) and above the Polar Circle (Apatity, Murmansk Region; 67.3 NL). Participants completed several surveys, including the Pediatric Daytime Sleepiness Scale, the Insomnia Severity Index, the Adolescent Sleep Hygiene Scale, and the Munich ChronoType Questionnaire, to evaluate sleep parameters and chronotype. The χ2 test was used to test for differences between proportions. Linear regression and multiple regression models with co-factors were applied to assess the relationship between studied indicators. A noteworthy increase in physical activity was observed in children residing in Kem' compared to those in Apatity. Children from Apatity showed higher alcohol consumption than their counterparts from Kem'. The overall rate of excessive daytime sleepiness in the sample was 17.1%. Moderate insomnia symptoms were reported in 18.4% of adolescents living in Kem' and in 25% of respondents living in Apatity, respectively. Notably, participants from Kem' attained higher academic scores and had longer exposure to sunlight on schooldays. On the other hand, children from Apatity tended to have later bedtimes and sleep-onset times on schooldays. According to the Munich ChronoType Questionnaire data, a reliance on alarm clocks on schooldays, and a higher Sleep Stability Factor based on the Adolescent Sleep Hygiene Scale. Our study indicating that higher physical activity and longer sunlight exposure among Kem' children on schooldays are associated with earlier wake-up times during schooldays, earlier bedtime whole week, reduced dependence on alarm clocks, and higher academic achievements. The results of older schoolchildren differ from many works published previously in the USA, Argentina, and Japan, which could be explained by the season when the study was performed. Here, we observed a negative impact on school performance and sleep parameters in children living in high latitudes, namely in circumpolar regions. Our study points out that adolescents living above the Polar Circle tend to have sleep problems, e.g., late sleep-onset times, higher excessive daytime sleepiness, and insomnia-related symptoms, because of experiencing reduced exposure to natural light. Future research encompassing assessments across all four seasons will provide a more comprehensive understanding.

The relationship between positive airway pressure tolerance and adherence: defining a new metric.

Positive airway pressure (PAP) therapy adherence rates range from 30% to 60%, yet adherent patients may still express dissatisfaction with treatment. The identification of factors affecting PAP tolerance could provide insight into its impact on adherence. Patients with obstructive sleep apnea presenting for first follow-up visit after newly initiating PAP therapy were given a 10-question PAP tolerance survey encompassing domains of psychosocial perception, practical issues, and side effects, utilizing 10-point visual analog scales. Relationships between adherence data, tolerance scores, and patient variables (demographics, sleep-related factors, comorbidities, usage data) were explored via 2-tailed t tests, multivariable regression analysis, and recursive partitioning regression trees with a significance level of P ≤ .05. For 105 patients, tolerance scores were higher in patients considered adherent to therapy (P = .033), as were scores for individual survey questions addressing the ability to fall asleep (P = .013) and sleep through the night (P = .020). Depression positively (P = .006) and insomnia medication use negatively (P = .010) predicted tolerance score. Data-driven tolerance score cutoffs were identified to correlate with PAP adherence, with higher tolerance scores correlating with greater adherence rates. PAP tolerance may play an important role in therapy adherence. Tolerance can be statistically defined and categorized based on prior adherence data. Its utility as a predictive tool in assessing future adherence is warranted. Tekumalla S, Plawecki A, Kaffenberger T, etal. The relationship between positive airway pressure tolerance and adherence: defining a new metric. J Clin Sleep Med. 2024;20(7):1033-1038.

CORRELATES OF SLEEP HEALTH AMONG OLDER PEOPLE WITH AND WITHOUT HIV IN UGANDA

Abstract The proportion of older people in Uganda is expected to grow rapidly. Sleep issues disproportionately affect older people and people with HIV (PWH). Identifying determinants of sleep health is essential in the development of interventions. Thus, we assessed sleep-related factors in older Ugandans (aged ≥50 years) using cross-sectional data from the Quality of Life and Aging with HIV in Rural Uganda study. Sleep outcomes were measured by the Pittsburgh Sleep Quality Index (quality, duration, efficiency). The associations between sleep outcomes and potential determinants (loneliness, urban/rural setting, depression, anxiety, alcohol use, physical activity) were evaluated using multivariable linear regressions. Of 556 participants, 271 were PWH and 285 were people without HIV (PWoH). The two groups were similar in age, sex, and education. Depression screening via the 13-item Hopkins Symptoms Checklist was positive in 131 participants (PWH: 28.2%; PWoH: 21.6%; p=.05). There were no differences in sleep outcomes by HIV serostatus. Mean sleep quality was 0.89 (SD=0.78; range=0-3, 0=very good to 3=very bad), mean sleep duration was 6.5 hours (SD=1.7), and mean sleep efficiency was 74% (SD=19.5%; &amp;gt;85% is optimal). Depressive symptoms were associated with worse sleep quality (b=0.58; p&amp;lt;.001), reduced sleep duration (b=-0.94; p&amp;lt;.001), and worse sleep efficiency (b=-0.12; p&amp;lt;.001) regardless of HIV serostatus. Interestingly, older age was related to increased sleep duration (B=0.04, p=.001). Interventions targeting depression among older Ugandans may help with sleep. Longitudinal studies are needed to determine the bi-directionality of this relationship and further elicit potential pathways to support sleep health among older Ugandans.

Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians.

To update and examine available literature germane to the recognition, assessment and treatment of comorbid autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption, with a predominant focus on children, adolescents and emerging adults. Considerable overlaps exist among ASD, ADHD and sleep disruption. Literature and guidance for clinicians, administrators, policy makers and families have been limited, as such deliberations were rarely considered until 2013. This narrative review of the literature addressing sleep disruption issues among those with ASD, ADHD and comorbid ASD and ADHD involved searching multiple databases and use of reverse citations up to the end of September 2022. Emphasis is placed on secondary sources and relevant data for clinical practice. Complex clinical presentations of ASD/ADHD/sleep disruption are frequently encountered in clinical practice. Prior to 2013, prevalence, clinical presentation, pathophysiology, prognosis, other sleep-related factors and interventions were determined separately for each disorder, often with overlapping objective and subjective methods employed in the process. High percentages of ADHD and ASD patients have both disorders and sleep disruption. Here, the extant literature is integrated to provide a multidimensional understanding of the relevant issues and insights, allowing enhanced awareness and better care of this complex clinical population. Database limitations are considered. Assessment of ASD symptomatology in youth with ADHD, and the reverse, in cases with disrupted sleep is critical to address the special challenges for case formulation and treatment. Evidence-based approaches to treatment planning and multi-treatment modalities should consider combining psychosocial and biological interventions to address the complexities of each case.

Association of sleep-related factors with nocturia

Purpose:Sleep-related factors, such as snoring or sleep duration may be causes for or consequence of nocturia. The purpose of this study was to evaluate the associations between sleep-related factors and nocturia in the absence of sleep disorders. Materials and Methods:Using the National Health and Nutrition Examination Survey (NHANES) database from 2005/06 to 2017/18, we analyzed respondents who completed the kidney conditions and sleep disorders questionnaires. Respondents who reported a physician-diagnosed sleep disorder, did not provide an answer to this sleep disorder question, or had other conditions impacting nocturia were excluded. After sample weighing, the prevalence of nocturia for responses to sleep-related factors (hours of sleep, work schedule, snoring, snorting or stopping breathing, and sleepiness) was analyzed using chi-square analysis and the association of sleep-related factors to nocturia, accounting for age, gender, race, and BMI, was determined using univariate and multivariate regression. Results:From the 2005/06–2017/18 NHANES database, 23,895 respondents (11,672 males and 12,223 females; mean age, SD = 45.2, 20.1 years) were included. For sleep-related factors, greatest nocturia prevalence was seen in those sleeping <6 h (38.4%) or >8 h (38.0%), snoring ≥5 nights per week (33.4%), snorting or stopping breathing ≥5 nights per week (38.7%), and feeling sleepy 16–30 times per month (44.7%). Work schedule differences (morning, evening/night, rotating) showed no differences in nocturia prevalence (21.1–22.5%) or significant odds of nocturia. On univariate analysis, nocturia was associated with age (OR = 1.035, p < 0.001), BMI (OR = 1.038, p < 0.001), sleeping <6 h (OR = 1.603, p < 0.001) or >8 h (OR = 1.673, p < 0.001), snoring ≥5 nights per week (OR = 1.192, p = 0.004), snorting or stopping breathing 3–4 nights (OR = 1.425, p < 0.001) to ≥5 nights per week (OR = 1.528, p < 0.001), and feeling sleepy 5–15 times (OR = 1.579, p < 0.001) to 16–30 times per month (OR = 1.970, p < 0.001). On multivariate analysis, only age (OR = 1.035, p < 0.001), BMI (OR = 1.032, p < 0.001), and sleepiness (OR = 1.169, p < 0.001) showed an association with nocturia. Conclusion:While most sleep-related factors showed increasing prevalence of nocturia at their extremes, only sleepiness showed an association to nocturia on multivariate analysis. Further examination of sleep issues related to nocturia elucidating causality are warranted.