Sleep Time Research Articles

How sleep duration impacts cognitive status among Indian population aged ≥45 years: Evidence from Longitudinal Aging Study India (LASI).

An aging population is associated with an increased risk of cognitive decline. Sleep duration, both excess and deficiency, is a risk factor for cognitive impairment. Therefore, this study was conducted to assess the relationship between sleep duration and cognition in the Indian population. This study was a secondary analysis of the first wave of the Longitudinal Aging Study in India (LASI) conducted across India in all 34 states and union territories. Sleep duration was calculated using sleep and wake times, whereas cognition was measured as a composite cognitive index. Both univariable and multivariable linear regressions were performed on the composite cognitive score. Subgroup analyses were conducted based on sex and age groups (45-59 years and ≥60 years). The median (IQR) cognition score was 25 (20-30). A sleep duration of ≤4 hours was associated with a decrease in cognition status of 1.15 points (1.57-0.72), and a sleep duration of ≥9 hours was associated with a decrease of 0.93 points (1.25-0.60). Subgroup analysis revealed that this relationship remained consistent across both genders and both age groups. Both long and short durations of sleep were seen to be associated with a decrease in cognition scores among Indian adults, in both sexes and both age groups. Thus, proper sleep duration can help in the prevention of declining cognition as one ages and the development of dementia.

Capsaicin alleviates the hepatic clock gene disruption and gut microbiota dysbiosis in circadian rhythm disorder mouse model

Capsaicin alleviates the hepatic clock gene disruption and gut microbiota dysbiosis in circadian rhythm disorder mouse model

Sleep and quality of life in adults with atopic dermatitis: cross sectional study.

Background.Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that causes sleep disturbances and worsens quality of life.However, few studies have been conducted on sleep in adults with atopic dermatitis. This study aimed to evaluate sleep and quality of life in adults with AD. Methods. A cross-sectional study was conducted with 36 adults diagnosed with AD and 21 healthy volunteers (controls), who completed questionnaires on sleep, itching, and quality of life. Disease severity was estimated using SCORing Atopic Dermatitis (SCORAD). All participants wore actigraphy watches for one week to objectively assess sleep quality. Results. Adults with AD slept worse than controls as measured by self-report (Global Pittsburgh Sleep Quality Index, mean ± SD, 9.33 ± 3.59 vs 5.00 ± 2.30, p < 0.001) and by actigraphy (sleep efficiency, SE), mean ± SD, 74.48 ± 11.63 vs 85.6 ± 6.53, p < 0.001). Actigraphy showed that adults with AD slept, on average, almost one hour less (p = 0.010), stayed awake during sleep for almost 44 minutes more (p < 0.001), and woke up 25% more than the controls (p = 0.047). In the AD group, SE and total sleep time were significantly inversely correlated with SCORAD (rs = -0.601, p < 0.001 and rs = -0.604, p < 0.001, respectively), but no significant correlation was found between itch and SE. A decreased quality of life was observed in adults with AD (DLQI, mean ± SD, 8.75 ± 6.7). Conclusions. Adults with AD slept worse than the controls and had a diminished quality of life. Actigraphy is a useful tool to objectively measure sleep quality in adults with AD especially those with moderate to severe disease.

Associations of Intermittent Hypoxia Burden with Gut Microbiota Dysbiosis in Adult Patients with Obstructive Sleep Apnea.

Clinical studies focusing on the association between the gut microbiota and obstructive sleep apnea (OSA) are limited. This study aimed to explore the relationship between intermittent hypoxia and the composition of gut microbiota in adults by analyzing the differences in the characteristics and functional distribution of gut microbiota between patients with different severities of OSA and healthy individuals. A cohort of 113 individuals from the First Affiliated Hospital of Sun Yat-sen University underwent overnight polysomnography from July 2019 to August 2021. The individuals included 16 healthy controls and 97 patients with OSA, categorized by the apnea-hypopnea index into mild, moderate, and severe groups. Fecal samples were analyzed using high-throughput sequencing of the 16S rRNA V3-V4 region to assess gut microbiota composition and function. Correlation analysis was used to evaluate the association between clinical indicators and microbiota markers. In patients with OSA, the gut microbiota diversity and the abundance of specific microbes that produce short-chain fatty acids decreased (P<0.05). The phyla Verrucomicrobia and Candidatus Saccharibacteria, genera Gemmiger and Faecalibacterium, and the species Gemmiger formicilis exhibited decreasing abundance with increasing OSA severity. Correlation analysis revealed a robust association between the proportion of total sleep time, characterized by nighttime blood oxygen saturation below 90%, and the alterations in the gut microbiota, demonstrating that elevated levels of desaturation are correlated with pronounced microbiota dysbiosis (P<0.05). Compared to the control group, the intermittent hypoxia exhibited by patients with OSA may be related to alterations in the composition and structure of the gut microbiota. Our results demonstrate the importance of monitoring hypoxia indicators in future clinical practice.

Performance of Wrist-Worn Pulse Oximeter for the Screening of Obstructive Sleep Apnea.

A sleep apnea monitor (BM2000A) is a wrist-worn device that measures oxygen saturation and pulse rate during sleep. This study aimed to evaluate the efficacy of the watch-like BM2000A for screening obstructive sleep apnea (OSA). 102 patients complaining of sleep breathing disorders were included; 81% were men and 19% were women. All participants underwent overnight simultaneous polysomnography (PSG) and BM2000A sleep monitoring. The number of apneas and hypopneas, apnea-hypopnea index (AHI), percentage of time spent with oxygen saturation under 90%, average oxygen saturation, lowest oxygen saturation, and duration of sleep were computed by the BM2000A and PSG. Then, these parameters were compared to validate the BM2000A. All parameters, measured with BM2000A, had a good correlation (r ≥ 0.6, p < 0.0001) with PSG-derived indexes, except for sleep time (r = 0.19, p = 0.061) and hypopnea index (r = 0.4, p < 0.0001). AHI had the strongest correlation (r = 0.87, p < 0.0001). The mean difference between AHI values calculated with PSG and wrist-worn pulse oximeter (WPO) was -17.66 events/h (95% CI: -50.39 to 15.06). In AHI ≥ 5, BM2000A had 90.7% sensitivity, 100% specificity, 91.2% accuracy, and 0.994 area under the curve. Using AHI ≥ 5, ≥ 15, and ≥30 as the screening criteria, optimal WPO-AHI cutoffs to improve the screening accuracy were 3.10, 8.92, and 13.05. BM2000A-derived results properly correlate with PSG and can provide OSA screening with good sensitivity and specificity.

Insomnia and the effect of zolpidem-extended-release on the sleep items of the Hamilton Rating Scale for Depression in outpatients with depression, insomnia, and suicidal ideation: Relationship to patient age.

There are limited data regarding gamma-aminobutyric acid (GABA) allosteric modulator sleep-aid medications in persons with depression, insomnia, and suicidal ideation (SI). This secondary analysis examined the relationship of age to insomnia and the impact of age on the treatment of insomnia with zolpidem extended-release (zolpidem-ER) in depressed suicidal patients. A prior report found that the addition of zolpidem-ER promoted significantly superior reductions in global severity of insomnia in depressed outpatients with insomnia and SI over 8 weeks, but here we report the differences among early, middle, and late insomnia. This secondary analysis examined the three early, middle, and late insomnia items of the Hamilton Rating Scale for Depression (HRSD) and their relationship to age and responsiveness to treatment with zolpidem-ER. One hundred and three patients with major depression, SI, and insomnia received open-label serotonin reuptake inhibitors and were randomly allocated 1:1 to receive zolpidem-ER or placebo at bedtime. Results: Older age at baseline was associated with worse middle and late insomnia, but not with early insomnia. Subsequent treatment with zolpidem-ER produced superior improvement in early and middle insomnia, but not late insomnia. These findings are consistent with the known age-related advancement of sleep timing in the general population and depressed outpatients and with the expected effects of a short half-life GABA allosteric modulator sleep aid. By implication, prescribers of pharmacologic treatment of insomnia in depressed patients should consider an alternative to zolpidem-ER when late insomnia is a concern.Trial registration number: ClinicalTrials.gov Identifier: NCT01689909.

O58 CONTINUOUS MEASUREMENT OF BLOOD PRESSURE DURING NIGHT - INSIGHTS INTO THE GENESIS OF THE NOCTURNAL BLOOD PRESSURE FLUCTUATIONS

Background and Objective: Nighttime blood pressure (BP) is a strongly predictive marker for overall cardiovascular risk. Traditional cuff-based BP measurements methods provide only discrete BP data. Short-term BP fluctuations are not detectable with such methods. Therefore, we applied two independent and continuously measuring methods with the aim to characterize systolic nocturnal blood pressure fluctuations (NBPF) related to sleep apnoea or periodic leg movements (PLM). Methods: BP fluctuations were analysed in patients with suspected sleep disturbances. The Portapres™ device (Penaz method) and a system based on the measurement of the pulse transit time (SOMNOscreen®) were used to measure the BP in addition to a polysomnography performed under the conditions of a clinical sleep laboratory. The calculation of the BP by the SOMNOscreen® was performed using a BP-pulse wave velocity (PWV) transfer function. Results: We saw BP fluctuations which occurred in connection with obstructive apnoeic events as well as in connection with PLM. Both methods recorded the same apnoea related NBPF. The amplitudes of these NBPF accounted for 24.7 mmHg and 22.8 mmHg (Portapres™ and SOMNOscreen®, respectively, 11 patients, number of events: n=695). PLM related PB fluctuations (in 5 of 11 patients, n=317) amounted to 18.4 mmHg (Portapres™ and 16.9 mmHg (SOMNOscreen®). Most of the patients did not show BP dipping when comparing awake with sleep time periods and they had a moderate to severe apnoea/hypopnoea index. Conclusions: The study demonstrates a strong relation between apnoeic events/PLM and NPBF. The NBPF were similarly detected by two different BP measuring methods suggesting that the more indirect method of BP determination using the PWV provides a reliable measurement of NBPF. The results suggest that OSA and PLM related NBPF strongly contribute to non- or reverse dipping of patients with these sleep disorders.

Matcha Does Not Affect Electroencephalography during Sleep but May Enhance Mental Well-Being: A Randomized Placebo-Controlled Clinical Trial.

Although theanine in matcha improves sleep quality and cognitive function, the caffeine in green tea is thought to worsen sleep quality. Therefore, this study investigated the factors behind the observed improvements in subjective sleep quality in matcha. A placebo-controlled randomized double-blind parallel-group study was conducted on healthy Japanese men and women aged 27-64 years. After 4 weeks of consuming 2.7 g of matcha daily (containing 50.3 mg theanine, 301.4 mg catechins, and 71.5 mg caffeine), no significant differences were observed between the control and matcha groups on total sleep time, sleep latency, wake after sleep onset, or sleep efficiency measured by electroencephalography (EEG). However, the sleep questionnaire Oguri-Shirakawa-Azumi Sleep Inventory, the Middle-age and Aged version (OSA-MA), administered immediately after waking showed a trend toward increased satisfaction with sleep time (p < 0.1), and EEG measurements indicated significantly shortened wake-up times after waking with matcha intake (p < 0.05). The Beck Depression Inventory-II scores also tended to decrease (p < 0.1). The continuous intake of matcha may offer improved subjective sleep quality and emotional stability despite not offering significant changes in objective sleep parameters.

Sleep and circadian disruption in bipolar disorders: From psychopathology to digital phenotyping in clinical practice.

Sleep and biological rhythms are integral to mood regulation across the lifespan, particularly in bipolar disorder (BD), where alterations in sleep phase, structure, and duration occur in all mood states. These disruptions are linked to poorer quality of life, heightened suicide risk, impaired cognitive function, and increased relapse rates. This review highlights the pathophysiology of sleep disturbances in BD and aims to consolidate understanding and clinical applications of these phenomena. It also summarizes the evolution of sleep and biological rhythms assessment methods, including ecological momentary assessment (EMA) and digital phenotyping. It underscores the importance of recognizing circadian rhythm involvement in mood regulation, suggesting potential therapeutic targets. Future research directions include elucidating circadian clock gene mechanisms, understanding environmental impacts on circadian rhythms, and investigating the bidirectional relationship between sleep disturbances and mood regulation in BD. Standardizing assessment methods and addressing privacy concerns related to EMA technology and digital phenotyping are essential for advancing research. Collaborative efforts are crucial for enhancing clinical applicability and understanding the broader implications of biological rhythms in BD diagnosis and treatment. Overall, recognizing the significance of sleep and biological rhythms in BD offers promise for improved outcomes through targeted interventions and a deeper understanding of the disorder's underlying mechanisms.

Exploring the Congruence of actigraphy and the Pediatric Autism Insomnia rating Scale

Objective/BackgroundInsomnia is common in children with autism spectrum disorder (ASD). We recently developed and validated the 21-item Pediatric Autism Insomnia Rating Scale (PAIRS). This report explores the associations and agreements between actigraphy and PAIRS. Participants MethodsChildren with ASD, with and without sleep problems, were assessed with a battery of parent-rated and clinician measures (N = 134). In a subset (n = 70), a wrist-worn actigraph measured sleep for five consecutive nights. Parents completed logs for scoring sleep intervals. Spearman correlations evaluated associations with the PAIRS and actigraphy indices (sleep onset latency = SOL, wake after sleep onset = WASO, total sleep time = TST, sleep efficiency = SE%). Agreements on “poor sleepers” based on PAIRS total score (≥33) and conventional thresholds for TST and SE% were evaluated with Cohen's Kappa and McNemar's test. ResultsActigraphy data were averaged over 4.64 ± 0.68 nights in 70 children (mean age = 7.3 ± 2.9, 74.3 % male). There were no significant correlations between PAIRS and any actigraphy indices. On TST, 48.6 % (n = 34) and on SE% 52.9 % (n = 37) were classified as “poor sleepers” compared to 32.9 % (n = 23) on PAIRS (kappa = 0.11 for TST and 0.27 for SE%). P-values on McNemar's Chi square test for PAIRS with TST and with SE% were 0.072 and 0.011, respectfully. ConclusionsThese results suggest that actigraphy and PAIRS do not agree. Actigraphy TST captures movement and an estimate of specific sleep parameters. PAIRS is a broader measure that incorporates sleep disturbance and sleep-related impairment.

Clinical efficacy study of position-responding mandibular advancement device in patients with obstructive sleep apnea.

Although mandibular advancement device (MAD) treatment is effective in patients with obstructive sleep apnea (OSA), there are still some concerns about its potential therapeutic and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. Therefore, we conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Fourteen patients with OSA were enrolled in this study. Polysomnography (PSG) was conducted at the start of the clinical trial, and PSG with AMAD in situ was performed after three months of treatment. The mean Epworth Sleepiness Scale (ESS) and STOP-Bang scores were 8.21 ± 4.21 and 5.00 ± 1.00, respectively. After 3 months of treating AMAD, STOP-Bang scores improved to 3.75 ± 1.06; however, there was no significant change in ESS scores. Additionally, we found statistically significant improvements in several respiratory parameters in the PSG data after AMAD treatment. The AHI (32.85 ± 21.71 to 12.93 ± 10.70), supine AHI (45.91 ± 23.58 to 15.59 ± 12.76), lateral AHI (13.94 ± 10.95 to .49 ± 7.40), lowest O2 saturation (79.71 ± 6.22 to 84.00 ± 5.71), total arousal number (191.14 ± 112.07 to 86.57 ± 48.80), and arousal index (33.76 ± 21.00 to 15.05 ± 8.42) were recorded. However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, we did not observe any major side effects during treatment, specifically related to tooth or jaw pain. Our clinical trial revealed that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.

Subjective and objective sleep quality assessment in adolescent patients with inflammatory bowel disease

ObjectivesThere is a link between inflammatory bowel disease (IBD) and poor sleep quality that is presumed to be multifactorial. The purpose of this study was to identify factors that impact sleep quality in this group including clinical disease activity, depression, anxiety, quality of life, and disordered social media use through questionnaires. MethodsThis prospective study analyzed sleep quality in adolescent patients ages 13 to 18 with a diagnosis of IBD using objective data from wrist actigraphy and subjective report from the Pittsburgh Sleep Quality Index (PSQI). Additional screeners including the Short Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index, Pediatric Quality of Life Inventory Gastrointestinal Symptoms Module, Generalized Anxiety Disorder 7-item screener, Patient Health Questionnaire depression screener, and Social Media Disorder scale were also collected. ResultsTwenty-three subjects enrolled and 16 completed questionnaires. 62.5 % of participants were in clinical remission and the remaining 37.5 % had mild to severe clinical IBD activity. Poor subjective sleep quality was associated with a shorter duration of sleep time and an increased clinical disease activity score. Patients in clinical remission slept for a longer duration than those with mild IBD activity. ConclusionsThis study did not identify a significant relationship between sleep quality and psychosocial factors in the adolescent population with IBD, though their influence cannot be discounted. There was a connection between the presence of disease activity and shorter sleep duration. Similarly, PSQI scores correlated with sleep time but not sleep quality.

The influence of lighting and thermal environments on sleep and cognitive function in older adults

Recent research has demonstrated the significant influence of lighting and thermal conditions on cognitive performance and sleep quality. However, a notable gap exists in understanding how these factors impact older adults within their living environments. This study examined the relationship between daily lighting and thermal exposures with cognitive performance and sleep quality in older adults. Eighteen older adults, with a mean age of 75 (SD = 7.7, female = 13), participated in a three-day study. Throughout the protocol, their indoor lighting and thermal conditions were monitored using environmental sensors. Participants were instructed to complete a series of cognitive tasks twice a day. Additionally, they wore a smartwatch-type actigraph and a wearable light tracker to monitor their sleep/wake patterns and daily light exposure. The findings showed that appropriate nighttime lighting correlated with improved evening cognitive performance. Higher nighttime indoor lighting intensity positively correlated with cognitive measures, while nighttime correlated color temperature (CCT) exposure had negative correlations. Daytime melanopic equivalent daylight illuminance (MEDI) exposure significantly predicted total sleep time, with increased circadian-effective light exposure reducing sleep fragmentation. Conversely, higher nighttime lighting intensity was linked to decreased sleep efficiency. Higher bedroom temperatures were associated with improved sleep efficiency and reduced fragmentation. These findings highlight the importance of optimizing lighting conditions and maintaining comfortable temperatures in residential environments to promote cognitive performance and sleep quality among older adults.

Effects of global postural re-education on stress and sleep quality in health sciences female students: a randomized controlled trial pilot study.

The purpose of this study was to determine, for the first time, whether the application of a self-management program with global postural re-education (GPR) influences stress and sleep quality in female health science students. In this randomized controlled trial pilot study, forty-one female health science students were randomized into a control group (n=21) and an intervention group (n=20). Participants underwent 8 weeks of self-management with and without GPR, after familiarization and therapy training. Outcomes included the State-Trait Anxiety Inventory (STAI) questionnaire and cortisol levels in saliva measured with the "CORTISOL Saliva ELISA SA E-6000" kit. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a Sleep Diary; total sleep time (TST), sleep onset latency (SOL), wakefulness after sleep onset (WASO), sleep efficiency (SE), and perceived sleep quality or satisfaction were assessed using the Likert scale. After self-treatment with GPR, participants in the intervention group showed lower cortisol levels compared to the control group (p = 0.041). Additionally, the intervention group demonstrated statistically significant improvements in sleep quality according to their PSQI (p = 0.010), STAI (p=0.043), SOL (p = 0.049), and SE (p = 0.002). This study shows that self-management through GPR helps reduce stress and improve sleep quality in female health science students. https://clinicaltrials.gov/, identifier NCT05488015.

The effects of bedroom microclimate regulation behaviors on sleep quality: A field study on the Qinghai-Tibetan Plateau

The environmental regulatory behaviors of humans have a myriad of effects on the microclimate of bedrooms and the quality of sleep. Due to the special geographical climate, proposing non-invasive optimal strategies for environmental regulation is of considerable significance to improve sleep quality among high-altitude residents. However, there is no report on the environmental regulatory behaviors of residents at high-altitudes. Conducted in the Qinghai-Tibet Plateau at an altitude of 3255m, this study investigated the environmental regulatory behaviors, bedroom microclimate, and sleep quality of 355 local residents over the course of one week, and analyzed the influence of the behaviors on the bedroom environment and sleep quality. Results from 1462 nights of monitoring revealed that residents of the Qinghai-Tibet Plateau prefer to sleep with doors or windows open in both winter and summer. Leaving the doors or windows open during summer led to a reduction in sleep time, rapid eye movement sleep and awakening time, which is the most prominent sleep issue at high-altitude, while in winter the percentage of deep sleep decreased with open doors or windows. The habit of humidification displayed a noticeable seasonal bias, with plateau residents being more inclined to adopt humidification measures in winter. Based on the results, this study recommends sleeping with doors or windows open without humidification in summer, while in the winter, humidification is necessary.

Are Adolescent Athletes Sleeping Enough? An Observational Study of Sleep Parameters during Schooldays and Holidays.

Background: Inconsistent sleep schedules, frequent awakening after sleep onset (WASO), and decreased sleep efficiency (SE) are common issues among adolescent team sports athletes. Moreover, research indicates that sleep problems are enhanced across schooldays. The aim of the present study was to assess sleep patterns of adolescent athletes and compare sleep parameters between schooldays and holidays. Methods: The chronotype and sleep quality of twelve adolescent basketball players (mean age: 15.58 ± 0.67 years) were assessed. Objective sleep parameters were then analyzed using actigraphy over a 12-day period, which included six days during the school period and six days during holidays. Results: Data showed that total sleep time (TST), SE, and WASO (382.48 min, 81.81%, and 66.70 min, respectively) did not meet international recommendations for sleep quantity and quality. During school weekdays, time in bed (TIB), TST, and SE significantly decreased compared to weekends (p < 0.001, d = -1.49; p < 0.001, d = -1.64; and p = 0.01, d = -0.89, respectively). On weekdays, TIB, TST, and WASO were significantly lower on schooldays compared to holidays (p < 0.001, d = -1.83; p < 0.01, d = -1.01; and p = 0.02, d = -0.77, respectively). While no significant difference was observed in social jetlag, the mid-point of sleep was significantly later on holiday weekdays compared to school weekdays (p < 0.05, d = 0.65). Conclusions: Adolescent athletes experience insufficient sleep, especially on school weekdays, which is partially improved during weekends and holidays. Although sleep duration was longer during holidays, our results suggest that adolescent athletes' sleep was more fragmented. Consequently, it remains crucial to implement strategies to enhance their sleep health (e.g., napping).

Altered circadian expression of clock genes and clock-regulatory epigenetic modifiers in saliva of children with fetal alcohol spectrum disorders

Prenatal alcohol-exposed (AE) infants and children often demonstrate disrupted sleep patterns, including more frequent awakenings, reduced total sleep time, and more night-to-night sleep variability. Despite the strong connection between sleep patterns and circadian rhythmicity, relatively little is known about circadian rhythm disruptions in individuals with AE. Recently, several reports demonstrated that evaluating the expression patterns of human clock genes in biological fluids could reveal an individual’s circadian phenotype. Human saliva offers an emerging and easily available physiological sample that can be collected non-invasively for core-clock gene transcript analyses. We compared the expression patterns of core-clock genes and their regulatory genes in salivary samples of children aged 6–10 years-old with and without AE during the light cycle between ZT0-ZT11. We isolated the RNA from the samples and measured the expression patterns of core clock genes and clock regulating genes using the human specific primers with quantitative real-time PCR. Analysis of core clock genes expression levels in saliva samples from AE children indicates significantly altered levels in expression of core-clock BMAL1, CLOCK, PER1-3 and CRY1,2, as compared to those in age-matched control children. We did not find any sex difference in levels of clock genes in AE and control groups. Cosinor analysis was used to evaluate the rhythmic pattern of these clock genes, which identified circadian patterns in the levels of core clock genes in the control group but absent in the AE group. The gene expression profile of a salivary circadian biomarker ARRB1 was rhythmic in saliva of control children but was arhythmic in AE children. Altered expression patterns were also observed in clock regulatory genes: NPAS2, NFL3, NR1D1, DEC1, DEC2, and DBP, as well as chromatin modifiers: MLL1, P300, SIRT1, EZH2, HDAC3, and ZR1D1, known to maintain rhythmic expression of core-clock genes. Overall, these findings provide the first evidence that AE disturbs the circadian patten expression of core clock genes and clock-regulatory chromatin modifiers in saliva.

Efficacy study comparing a CBT-I developed for shift workers (CBT-I-S) to standard CBT-I (cognitive behavioural therapy for insomnia) on sleep onset latency, total sleep time, subjective sleep quality, and daytime sleepiness: study protocol for a parallel group randomised controlled trial with online therapy groups of seven sessions each

BackgroundShift workers are at an increased risk of developing sleep disorders. The standard therapy recommended for sleep disorders is cognitive behavioural therapy for insomnia (CBT-I). Many of its interventions are based on a regular sleep and wake rhythm, which is difficult to apply for shift workers. We have therefore developed a new therapy manual specifically for shift workers (CBT-I-S), which should be more applicable to their needs. In particular, all interventions that require regularity have been removed, and instead, interventions that address factors that proved to be relevant to sleep in our preliminary study have been integrated. We now want to test this manual for its effectiveness.MethodsA randomised controlled trial with N = 142 will be conducted to compare two conditions: the newly developed therapy manual will be carried out in the experimental group, while cognitive behavioural therapy for insomnia will be employed in the standard group. Both treatments will be conducted online via MS Teams in a group setting with seven sessions each. Data will be collected at three measurement points (pre, post, 6-month follow-up) and analysed using linear mixed models. The study will investigate whether the two treatments have led to significant improvements in total sleep time, sleep onset latency, subjective sleep quality and daytime sleepiness in shift workers. It will also examine whether the new therapy manual is superior to standard therapy in shift workers and whether these effects are stable.DiscussionWe assume that interventions designed to address depressive mood, anxiety, worry, rumination, dysfunctional thought patterns and attitudes towards sleep will also improve sleep. If this is indeed the case, these interventions could replace previous ones that require regularity. This could significantly improve the treatment of insomnia in shift workers.Trial registrationGerman Clinical Trials Registry DRKS DRKS00032086. Registered on August 16, 2023.

Initial treatment choices for long-term remission of chronic insomnia disorder in adults: a systematic review and network meta-analysis.

We aimed to evaluate the comparative efficacy and acceptability of cognitive behavioral therapy for insomnia (CBT-I), pharmacotherapy, and their combination in the long and short terms among adults with chronic insomnia disorder. We searched multiple databases to December 27, 2023. We included trials in hypnotic-free adults with chronic insomnia comparing at least two of CBT-I, pharmacotherapy, or their combination. We assessed the confidence in evidence using CINeMA. The primary outcome was long-term remission. Secondary outcomes included all-cause dropout and self-reported sleep continuity measures in the long term, and the same outcomes in the short term. We performed frequentist random-effects network meta-analyses (CRD42024505519). We identified 13 trials including 823 randomized participants (mean age, 47.8 years; 60% women). CBT-I was more beneficial than pharmacotherapy in the long term (median duration, 24 weeks [range, 12 to 48 weeks]; remission odds ratio, 1.82 [95% confidence interval (CI), 1.15-2.87]; [certainty of evidence: high]), while there was weaker evidence of benefit of combination against pharmacotherapy (1.71 [95% CI, 0.88-3.30: moderate]) and no clear difference of CBT-I against combination (1.07 [95% CI, 0.63-1.80: moderate]). CBT-I was associated with fewer dropouts than pharmacotherapy. Short-term outcomes favored CBT-I over pharmacotherapy except total sleep time. Given the average long-term remission rate in the pharmacotherapy-initiating arms of 28%, CBT-I resulted in a long-term remission rate of 41% (95% CI, 31%-53%) and combination 40% (95% CI, 25%-56%). The current study found that starting with CBT-I for chronic insomnia leads to better outcomes than pharmacotherapy. Combination may be better than pharmacotherapy alone, but unlikely to be worth the additional burden over CBT-I alone.

Chronotype Differences and Symptom Network Dynamics of Post-Pandemic Sleep in Adolescents and Young Adults.

Background: Social restrictions during the COVID-19 pandemic resulted in altered sleep patterns and mental health challenges, particularly among adolescents and young adults. Our objective was to examine the potential difference in insomnia prevalence and sleep patterns in this population between the first COVID-19 lockdown and the post-lockdown period, with a focus on chronotype. Additionally, we explored the network of sleep-related differences between these two periods. Methods: A total of 946 respondents participated in our online questionnaire. We performed mixed ANOVA, Ising network and Directed Acyclic Graph (DAG) analyses. Results: Respondents reported going to bed earlier, waking up earlier, sleeping less, and feeling less mentally tired than during the lockdown. The severity of insomnia symptoms did not change. The lethargic chronotype reported more insomnia symptoms, depressive feelings, and agitation than others. Mental fatigue was the central symptom in the Ising network and served as the parent node in the DAG. Conclusions: Post-lockdown, adolescents and young adults have shifted to earlier sleep and wake times with reduced overall sleep, and they experience fewer depressive feelings and less agitation, though insomnia symptoms remain unchanged. Participants who reported increased irritability or poorer sleep quality during confinement also reported similar or diminished attentional capacities compared to their usual levels.