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Sleep
Journal Prestige (SJR): 2.37  Citation Impact (citeScore): 5 Number of Followers: 29  Subscription journalISSN (Print) 0161-8105 - ISSN (Online) 1550-9109 Published by Sleep Research Society  [1 journal]
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- Correction to: Cannabis dosing and administration for sleep: a systematic
review-
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Abstract: This is a correction to: Rob Velzeboer, Adeeb Malas, Pierre Boerkoel, Katie Cullen, Michelle Hawkins, Jordanna Roesler, Wayne Wei-Ku Lai, Cannabis dosing and administration for sleep: a systematic review, Sleep, Volume 45, Issue 11, November 2022, zsac218, https://doi.org/10.1093/sleep/zsac218
PubDate: Sat, 28 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsad008
Issue No: Vol. 46, No. 3 (2023)
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- Correction to: Do your troubles today seem further away than
yesterday' On sleep’s role in mitigating the blushing response to a
reactivated embarrassing episode-
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Abstract: European Research Council10.13039/501100000781743163ZonMw Open Competition09120011910032
PubDate: Mon, 23 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsad006
Issue No: Vol. 46, No. 3 (2023)
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- It is time to understand daylight saving time
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Abstract: Dear Editor,
PubDate: Wed, 11 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsac309
Issue No: Vol. 46, No. 3 (2023)
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- What triggered narcolepsy: H1N1 vaccination, virus, or both' Important
lessons learned from China-
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Abstract: The influenza A virus subtype H1N1 pandemic surfaced in the first month of 2009. Subsequently, a rigorous vaccination campaign began. With this came the first reports of a clearly increased incidence of narcolepsy in Scandinavian children [1]. The H1N1 vaccine named Pandemrix was suggested to be the culprit. Not long after, however, research groups from countries with a low vaccination grade (e.g. China, the United States, Taiwan, and several other European countries) reported a more modest increase in narcolepsy incidence [2–5]. A possible role for the H1N1 virus itself was thus emphasized. Increased incidences were mainly reported in children, and to a lesser extent in adults.
PubDate: Wed, 11 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsad005
Issue No: Vol. 46, No. 3 (2023)
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- Author’s response to “It is Time to Understand Daylight Saving
Time”-
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Abstract: Dear Editor,
PubDate: Fri, 06 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsac323
Issue No: Vol. 46, No. 3 (2023)
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- Cortical thinning and hippocampal hypertrophy: two risk factors for
adolescents and children with obstructive sleep apnea-
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Abstract: Beijing Hospitals Authority’s Ascent PlanNational Natural Science Foundation of China10.13039/50110000180912171330
PubDate: Fri, 06 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsad002
Issue No: Vol. 46, No. 3 (2023)
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- Obstructive sleep apnea during REM sleep and hypertension: new findings
from a clinical cohort-
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Abstract: Obstructive sleep apnea (OSA) affects nearly 1 billion people worldwide and is associated with significant cardiovascular, metabolic, and neurocognitive disturbances [1]. OSA severity is categorized by the overall apnea-hypopnea index (AHI), however, this “one size fits all approach” underappreciates the heterogeneity and complexity of OSA and likely distorts the estimation of cardiovascular outcome risk and effects of treatment [2]. There is interest in defining phenotypes and endotypes of OSA to better characterize health risks and personalize treatment options. One such phenotype is OSA that occurs predominately during rapid eye movement (REM) sleep (REM-predominant OSA or REM OSA) [3]. REM sleep composes 20%–25% of total sleep time and is more concentrated during the second half of the sleep period. OSA severity often worsens in REM sleep due to a perfect storm of physiological changes. First, cholinergic-mediated inhibition leads to reduced muscle tone, particularly affecting genioglossus activity, and leading to increased collapsibility of the upper airway [4]. In addition, increased sympathetic activity [5] and lower hypoxic/hypercapnic ventilatory drive compared with non-REM (NREM) sleep worsens the severity of obstructive respiratory events during REM [6].
PubDate: Thu, 05 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsad003
Issue No: Vol. 46, No. 3 (2023)
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- Changed epidemiology of narcolepsy before, during, and after the 2009 H1N1
pandemic: a nationwide narcolepsy surveillance network study in mainland
China, 1990–2017-
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Abstract: AbstractStudy ObjectivesIncreased incidence of narcolepsy was reported in children during the 2009 H1N1 pandemic following Pandemrix, a H1N1 flu vaccine. A link with A(H1N1) pdm09 infections remains controversial. Using nationwide surveillance data from China (1990 to 2017), the epidemiology of narcolepsy was analyzed.MethodsIndividual records of narcolepsy patients were collected from 15 of 42 hospitals across China known to diagnose cases. Incidence was estimated assuming the representativeness of these hospitals. Age-specific incidence, epidemiological and clinical characteristics of patients were evaluated before, during, and after the 2009 H1N1 pandemic. Sensitivity analyses were conducted by including NT1 cases only and excluding the effect of the 2009 H1N1 vaccination.ResultsAverage annual incidence was 0.79 per 100 000 person-years (PY) from 1990 to 2017 and 1.08 per 100 000 PY from 2003 to 2017. Incidence increased 4.17 (95% CI 4.12, 4.22) and 1.42 (95% CI 1.41, 1.44) fold during and after the 2009 H1N1 pandemic when compared to baseline. These results were robust in sensitivity analyses. Patients with the onset of narcolepsy during the pandemic period were younger (notably in 5–9-year-old strata), and the age shift toward younger children reversed to baseline following the pandemic.ConclusionsIncreased incidence of narcolepsy was observed during the 2009 H1N1 pandemic period. This is likely to be associated with the circulation of the wild type A(H1N1)pdm09 virus. This observation should be considered for future influenza pandemic preparedness plans.
PubDate: Tue, 03 Jan 2023 00:00:00 GMT
DOI: 10.1093/sleep/zsac325
Issue No: Vol. 46, No. 3 (2023)
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- Using machine learning to extract cognitive status from the sleep EEG in
progressing stages of dementia: defining interpretable and age-related
features-
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Abstract: Itamar Medical Ltd
PubDate: Sat, 31 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac324
Issue No: Vol. 46, No. 3 (2022)
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- Increased muscle activity during sleep and more RBD symptoms in
H1N1-(Pandemrix)-vaccinated narcolepsy type 1 patients compared with their
non-narcoleptic siblings-
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Abstract: AbstractStudy ObjectivesNarcolepsy type 1 (NT1) is characterized by unstable sleep-wake and muscle tonus regulation during sleep. We characterized dream enactment and muscle activity during sleep in a cohort of post-H1N1 NT1 patients and their siblings, and analyzed whether clinical phenotypic characteristics and major risk factors are associated with increased muscle activity.MethodsRBD symptoms and polysomnography m. tibialis anterior electromyographical signals [long (0.5–15 s); short (0.1–0.49 s)] were compared between 114 post-H1N1 NT1 patients and 89 non-narcoleptic siblings. Association sub-analyses with RBD symptoms, narcoleptic symptoms, CSF hypocretin-1 levels, and major risk factors [H1N1-(Pandemrix)-vaccination, HLA-DQB1*06:02-positivity] were performed.ResultsRBD symptoms, REM and NREM long muscle activity indices and REM short muscle activity index were significantly higher in NT1 patients than siblings (all p < 0.001). Patients with undetectable CSF hypocretin-1 levels (<40 pg/ml) had significantly more NREM periodic long muscle activity than patients with low but detectable levels (40–150 pg/ml) (p = 0.047). In siblings, REM and NREM sleep muscle activity indices were not associated with RBD symptoms, other narcolepsy symptoms, or HLA-DQB1*06:02-positivity. H1N1-(Pandemrix)-vaccination status did not predict muscle activity indices in patients or siblings.ConclusionIncreased REM and NREM muscle activity and more RBD symptoms is characteristic of NT1, and muscle activity severity is predicted by hypocretin deficiency severity but not by H1N1-(Pandemrix)-vaccination status. In the patients’ non-narcoleptic siblings, neither RBD symptoms, core narcoleptic symptoms, nor the major NT1 risk factors is associated with muscle activity during sleep, hence not indicative of a phenotypic continuum.
PubDate: Fri, 23 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac316
Issue No: Vol. 46, No. 3 (2022)
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- Contribution of post-trauma insomnia to depression and posttraumatic
stress disorder in women service members: findings from the Millennium
Cohort Study-
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Abstract: AbstractStudy ObjectivesWe examined whether women service members and veterans who reported recent combat and/or sexual trauma experiences had a greater risk of insomnia compared with women who did not report these recent experiences, and whether insomnia would be associated with a greater risk of mental health outcomes.MethodsWe analyzed two waves of survey data (2011–2013, Time 1 [T1] and 2014–2016, Time 2 [T2]) from 26 443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas in the past 3 years, and probable insomnia at T1 and probable post-traumatic stress disorder (PTSD) and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia.ResultsWomen who had experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI = 1.24–2.10), sexual harassment (OR = 1.22; 95% CI = 1.05–1.41), and combat (OR = 1.34; 95% CI = 1.20–1.49) at T1 had a greater risk of probable insomnia at T1 compared with women who had not recently experienced these events. Probable insomnia at T1, in turn, was associated with probable depression (OR = 2.66; 95% CI = 2.31–3.06) and PTSD (OR = 2.57; 95% CI = 2.27–2.90) at T2. Recent combat experience did not moderate the associations of recent sexual trauma with insomnia or mental health outcomes.ConclusionsInsomnia contributes to the risk of subsequent mental health conditions following trauma. The diagnosis and treatment of post-trauma insomnia should be prioritized to mitigate the development of posttraumatic mental health conditions.
PubDate: Wed, 21 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac313
Issue No: Vol. 46, No. 3 (2022)
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- The sleep homeostatic response to sleep deprivation in humans is heritable
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Abstract: AbstractStudy ObjectivesFollowing sleep deprivation, increases in delta power have historically been used to index increases in sleep pressure. Research in mice has demonstrated that the homeostatic delta power response to sleep deprivation is heritable. Whether this is true in humans is unknown. In the present study, we used delta power and ORP, a novel measure of sleep depth, to investigate the effects of acute sleep deprivation on sleep depth and to assess the heritability of sleep homeostasis in humans.MethodsORP and delta power were examined during baseline and recovery sleep following 38 h of sleep deprivation in 57 monozygotic and 38 dizygotic same-sex twin pairs. Two complementary methods were used to estimate the trait heritability of sleep homeostasis.ResultsDuring recovery sleep, ORP was lower and delta power was higher than at baseline, indicating deeper sleep. However, at the end of the recovery night, delta power reached baseline levels but ORP demonstrated incomplete recovery. Both ORP and delta power showed a broad sense heritability of sleep homeostasis following sleep deprivation. The classical approach demonstrated an h2 estimate of 0.43 for ORP and 0.73 for delta power. Mixed-effect multilevel models showed that the proportion of variance attributable to additive genetic transmission was 0.499 (95% CI = 0.316–0.682; p < .0001) for ORP and 0.565 (95% CI = 0.403–0.726; p < .0001 for delta power.ConclusionsThese results demonstrate that the homeostatic response to sleep deprivation is a heritable trait in humans and confirm ORP as a robust measure of sleep depth.
PubDate: Wed, 21 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac314
Issue No: Vol. 46, No. 3 (2022)
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- Discovery of genomic loci associated with sleep apnea risk through
multi-trait GWAS analysis with snoring-
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Abstract: AbstractStudy ObjectivesDespite its association with severe health conditions, the etiology of sleep apnea (SA) remains understudied. This study sought to identify genetic variants robustly associated with SA risk.MethodsWe performed a genome-wide association study (GWAS) meta-analysis of SA across five cohorts (NTotal = 523 366), followed by a multi-trait analysis of GWAS (multi-trait analysis of genome-wide association summary statistics [MTAG]) to boost power, leveraging the high genetic correlation between SA and snoring. We then adjusted our results for the genetic effects of body mass index (BMI) using multi-trait-based conditional and joint analysis (mtCOJO) and sought replication of lead hits in a large cohort of participants from 23andMe, Inc (NTotal = 1 477 352; Ncases = 175 522). We also explored genetic correlations with other complex traits and performed a phenome-wide screen for causally associated phenotypes using the latent causal variable method.ResultsOur SA meta-analysis identified five independent variants with evidence of association beyond genome-wide significance. After adjustment for BMI, only one genome-wide significant variant was identified. MTAG analyses uncovered 49 significant independent loci associated with SA risk. Twenty-nine variants were replicated in the 23andMe GWAS adjusting for BMI. We observed genetic correlations with several complex traits, including multisite chronic pain, diabetes, eye disorders, high blood pressure, osteoarthritis, chronic obstructive pulmonary disease, and BMI-associated conditions.ConclusionOur study uncovered multiple genetic loci associated with SA risk, thus increasing our understanding of the etiology of this condition and its relationship with other complex traits.
PubDate: Fri, 16 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac308
Issue No: Vol. 46, No. 3 (2022)
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- Overcoming the underdiagnosis of obstructive sleep apnea to empower
genetic association analyses-
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Abstract: National Heart, Lung, and Blood Institute10.13039/100000050R01HL61012
PubDate: Thu, 15 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac312
Issue No: Vol. 46, No. 3 (2022)
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- Wearing an eye mask during overnight sleep improves episodic learning and
alertness-
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Abstract: AbstractAmbient light can influence sleep structure and timing. We explored how wearing an eye mask to block light during overnight sleep impacts memory and alertness, changes that could benefit everyday tasks like studying or driving. In Experiment 1, ninety-four 18–35-year-olds wore an eye mask while they slept every night for a week and underwent a control condition in which light was not blocked for another week. Five habituation nights were followed by a cognitive battery on the sixth and seventh days. This revealed superior episodic encoding and an improvement on alertness when using the mask. In Experiment 2, thirty-five 18–35-year-olds used a wearable device to monitor sleep with and without the mask. This replicated the encoding benefit and showed that it was predicted by time spent in slow-wave sleep. Our findings suggest that wearing an eye mask during overnight sleep can improve episodic encoding and alertness the next day.
PubDate: Thu, 15 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac305
Issue No: Vol. 46, No. 3 (2022)
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- Genome-wide gene by environment study of time spent in daylight and
chronotype identifies emerging genetic architecture underlying light
sensitivity-
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Abstract: AbstractStudy ObjectivesLight is the primary stimulus for synchronizing the circadian clock in humans. There are very large interindividual differences in the sensitivity of the circadian clock to light. Little is currently known about the genetic basis for these interindividual differences.MethodsWe performed a genome-wide gene-by-environment interaction study (GWIS) in 280 897 individuals from the UK Biobank cohort to identify genetic variants that moderate the effect of daytime light exposure on chronotype (individual time of day preference), acting as “light sensitivity” variants for the impact of daylight on the circadian system.ResultsWe identified a genome-wide significant SNP mapped to the ARL14EP gene (rs3847634; p < 5 × 10−8), where additional minor alleles were found to enhance the morningness effect of daytime light exposure (βGxE = −.03, SE = 0.005) and were associated with increased gene ARL14EP expression in brain and retinal tissues. Gene-property analysis showed light sensitivity loci were enriched for genes in the G protein-coupled glutamate receptor signaling pathway and genes expressed in Per2+ hypothalamic neurons. Linkage disequilibrium score regression identified Bonferroni significant genetic correlations of greater light sensitivity GWIS with later chronotype and shorter sleep duration. Greater light sensitivity was nominally genetically correlated with insomnia symptoms and risk for post-traumatic stress disorder (PTSD).ConclusionsThis study is the first to assess light as an important exposure in the genomics of chronotype and is a critical first step in uncovering the genetic architecture of human circadian light sensitivity and its links to sleep and mental health.
PubDate: Thu, 15 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac287
Issue No: Vol. 46, No. 3 (2022)
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- Phenotypic divergence in sleep and circadian cycles linked by affective
state and environmental risk related to psychosis-
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Abstract: AbstractStudy ObjectivesEnvironmental cues influence circadian rhythm timing and neurochemicals involved in the regulation of affective behavior. How this interplay makes them a probable nonspecific risk factor for psychosis is unclear. We aimed to identify the relationship between environmental risk for psychosis and circadian timing phenotypes sampled from the general population.MethodsUsing an online survey, we devised a cumulative risk exposure score for each of the 1898 survey respondents based on 23 empirically verified transdiagnostic risks for psychosis, three dimensions of affect severity, psychotic-like experiences, and help-seeking behavior. Quantitative phenotyping of sleep and circadian rhythms was undertaken using at-home polysomnography, melatonin and cortisol profiles, and 3-week rest–activity behavior in individuals with a high-risk exposure load (top 15% of survey respondents, n = 22) and low-risk exposure load (bottom 15% of respondents, n = 22).ResultsPsychiatric symptoms were present in 100% of the high-load participants and 14% of the low-load participants. Compared to those with a low-load, high-load participants showed a later melatonin phase which was reflected by a greater degree of dispersion in circadian timing. Phase relationships between later circadian melatonin phase and later actigraphic sleep onsets were maintained and these were strongly correlated with self-reported sleep mid-points. No differences were identified from polysomnography during sleep between groups.ConclusionDistinguishing circadian timing from other sleep phenotypes will allow adaptation for dosage of time-directed intervention, useful in stabilizing circadian timekeeping physiology and potentially reducing the multisystemic disruption in mental health disorders.
PubDate: Wed, 14 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac311
Issue No: Vol. 46, No. 3 (2022)
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- Activity of GABA neurons in the zona incerta and ventral lateral
periaqueductal grey is biased towards sleep-
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Abstract: AbstractStudy ObjectivesAs in various brain regions the activity of gamma-aminobutyric acid (GABA) neurons is largely unknown, we measured in vivo changes in calcium fluorescence in GABA neurons in the zona incerta (ZI) and the ventral lateral periaqueductal grey (vlPAG), two areas that have been implicated in regulating sleep.MethodsvGAT-Cre mice were implanted with sleep electrodes, microinjected with rAAV-DIO-GCaMP6 into the ZI (n = 6) or vlPAG (n = 5) (isoflurane anesthesia) and a GRIN (Gradient-Index) lens inserted atop the injection site. Twenty-one days later, fluorescence in individual vGAT neurons was recorded over multiple REM cycles. Regions of interest corresponding to individual vGAT somata were automatically extracted with PCA–ICA analysis.ResultsIn the ZI, 372 neurons were identified. Previously, we had recorded the activity of 310 vGAT neurons in the ZI and we combined the published dataset with the new dataset to create a comprehensive dataset of ZI vGAT neurons (total neurons = 682; mice = 11). In the vlPAG, 169 neurons (mice = 5) were identified. In both regions, most neurons were maximally active in REM sleep (R-Max; ZI = 51.0%, vlPAG = 60.9%). The second most abundant group was W-Max (ZI = 23.9%, vlPAG = 25.4%). In the ZI, but not in vlPAG, there were neurons that were NREMS-Max (11.7%). vlPAG had REMS-Off neurons (8.3%). In both areas, there were two minor classes: wake/REMS-Max and state indifferent. In the ZI, the NREMS-Max neurons fluoresced 30 s ahead of sleep onset.ConclusionsThese descriptive data show that the activity of GABA neurons is biased in favor of sleep in two brain regions implicated in sleep.
PubDate: Wed, 14 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac306
Issue No: Vol. 46, No. 3 (2022)
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- Atypical hypnotic compound ML297 restores sleep architecture immediately
following emotionally valenced learning, to promote memory consolidation
and hippocampal network activation during recall-
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Abstract: AbstractSleep plays a critical role in consolidating many forms of hippocampus-dependent memory. While various classes of hypnotic drugs have been developed in recent years, it remains unknown whether, or how, some of them affect sleep-dependent memory consolidation mechanisms. We find that ML297, a recently developed candidate hypnotic agent targeting a new mechanism (activating GIRK1/2-subunit containing G-protein coupled inwardly rectifying potassium [GIRK] channels), alters sleep architecture in mice over the first 6 hr following a single-trial learning event. Following contextual fear conditioning (CFC), ML297 reversed post-CFC reductions in NREM sleep spindle power and REM sleep amounts and architecture, renormalizing sleep features to what was observed at baseline, prior to CFC. Renormalization of post-CFC REM sleep latency, REM sleep amounts, and NREM spindle power were all associated with improved contextual fear memory (CFM) consolidation. We find that improvements in CFM consolidation due to ML297 are sleep-dependent, and are associated with increased numbers of highly activated dentate gyrus (DG), CA1, and CA3 neurons during CFM recall. Together our findings suggest that GIRK1/2 channel activation restores normal sleep architecture— including REM sleep, which is normally suppressed following CFC—and increases the number of hippocampal neurons incorporated into the CFM engram during memory consolidation.
PubDate: Tue, 13 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac301
Issue No: Vol. 46, No. 3 (2022)
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- Causal associations of obstructive sleep apnea with cardiovascular
disease: a Mendelian randomization study-
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Abstract: AbstractStudy ObjectivesObstructive sleep apnea (OSA) had been associated with various cardiovascular diseases (CVDs) in observational studies, but causal inferences have not been confirmed. We used the Mendelian randomization (MR) study to explore the potential causal association between OSA with CVDs in the general population.MethodsWe performed a two-sample MR analysis using five gene-wide significant single-nucleotide polymorphisms associated with OSA at genome-wide significance from the FinnGen study (N = 217 955) and 12 cardiovascular diseases from the UK Biobank and the genetic consortia. The inverse-variance weight was chosen as the primary analysis and was complemented by various sensitivity analyses. The study design applied univariable MR, multivariable MR, and mediation analysis.ResultsMR analyses provide evidence of genetically predicted OSA on the risk of heart failure (odds ratio [OR],1.26; 95% confidence interval [CI],1.08 to 1.47), hypertension (OR,1.24; 95%CI, 1.11 to 1.39) and atrial fibrillation (OR,1.21; 95%CI,1.12 to 1.31). Multivariable MR indicated the adverse effect of OSA on heart failure persisted after adjusting BMI, smoking, drinking, and education (IVW OR,1.13; 95%CI, 1.01 to 1.27). However, the significance of hypertension and atrial fibrillation was dampened. Mediation analyses suggest that the causal association between OSA and heart failure is mediated in part by Apolipoprotein B, with a mediated portion of 9%.ConclusionsThis study suggested that genetically predicted OSA is a potential causal risk factor for heart failure based on a large-scale population. Nevertheless, further studies regarding ancestral diversity are needed to confirm the causal association between OSA and CVDs.
PubDate: Thu, 08 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac298
Issue No: Vol. 46, No. 3 (2022)
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- Increased connectivity of the anterior cingulate cortex is associated with
the tendency to awakening during N2 sleep in patients with insomnia
disorder-
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Abstract: AbstractStudy ObjectivesTo investigate the relationship between sleep transition dynamics and stage-specific functional connectivity (FC) of the anterior cingulate cortex (ACC) in patients with insomnia disorder (ID).MethodsSimultaneous electroencephalography–functional magnetic resonance imaging (EEG–fMRI) data from 37 patients with ID and 30 well-matched healthy controls (HCs) were recorded during wakefulness and different sleep stages and subsequently analyzed. A Markov chain model was used to estimate the transition probability between each stage. The FC between the ACC (set as the seed) and voxels across the whole brain was calculated. A linear mixed effect model was used to determine the group-by-stage interaction of the seed-based connectivity. The correlation between the sleep-stage transition probability and the ACC-based connectivity was explored.ResultsPatients with ID exhibited a higher likelihood of transitioning from N2 to wakefulness than HCs. A significant group-by-stage interaction of connectivity with the bilateral ACC was observed in the cerebellar, subcortical, and cortical regions. Moreover, a significant positive correlation was found in patients with ID between the transition probability from N2 to wakefulness and the FC of the ACC with the anterior cerebellum in N2 (r = 0.48).ConclusionsThis exploratory analysis indicates that enhanced FC between the ACC and cerebellum represents a potential neural pathway underlying the greater likelihood of patients with ID waking during N2 sleep. These findings contribute to an emerging framework that reveals the link between sleep maintenance difficulty and ACC function, further highlighting the possibility that N2 sleep is a therapeutic target for meaningfully reducing sleep disruption.
PubDate: Sat, 03 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac290
Issue No: Vol. 46, No. 3 (2022)
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- Craniofacial phenotyping by photogrammetry in Chinese prepubertal children
with obstructive sleep apnea-
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Abstract: AbstractStudy ObjectivesThis study aimed to examine the craniofacial phenotype of Chinese prepubertal children with and without obstructive sleep apnea (OSA) using a quantitative photographic analysis technique and to develop a prediction model for OSA diagnosis based on the photogrammetric data. Potential ethnic differences in the association between OSA and photogrammetric data between Chinese and Caucasian children were also examined.MethodsThis was a cross-sectional study. Chinese children aged 5–12 years old, suspected to have OSA were recruited from our sleep clinic. Frontal and side photos were taken for craniofacial phenotyping by photogrammetry. Polysomnography was performed and participants were divided into three groups: non-OSA (obstructive apnea hypopnea index (OAHI) < 1/h), mild OSA (OAHI between 1/h and 5/h), and moderate-to-severe (MS) OSA (OAHI ≥ 5/h). Prediction models were built from 70% of training data using logistic regression and evaluated on the remaining 30% of test data for receiver operating characteristic (ROC) curve construction.ResultsThis study included 90 participants (mean age: 8.2 ± 1.6 years, 67 males). Non-OSA, mild OSA, and MS OSA groups included 32, 31, and 27 participants, respectively. There were significant trends for an increasing maxillary-mandibular relationship angle (p = .002) and a decreasing anterior mandibular height to whole face length ratio (p < .001) with increasing OSA severity. A prediction model built with clinical measurements and the two photogrammetric features yielded an area under the ROC curve (AUC) of 0.81 (95% C.I.: 0.64–0.96).ConclusionsCraniofacial features obtained by photogrammetry are significantly different between OSA groups in prepubertal children. Increased maxillary-mandibular relationship angle is an OSA feature found in both Asian and Caucasian children.
PubDate: Sat, 03 Dec 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac289
Issue No: Vol. 46, No. 3 (2022)
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- Dementia detection from brain activity during sleep
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Abstract: AbstractStudy ObjectivesDementia is a growing cause of disability and loss of independence in the elderly, yet remains largely underdiagnosed. Early detection and classification of dementia can help close this diagnostic gap and improve management of disease progression. Altered oscillations in brain activity during sleep are an early feature of neurodegenerative diseases and be used to identify those on the verge of cognitive decline.MethodsOur observational cross-sectional study used a clinical dataset of 10 784 polysomnography from 8044 participants. Sleep macro- and micro-structural features were extracted from the electroencephalogram (EEG). Microstructural features were engineered from spectral band powers, EEG coherence, spindle, and slow oscillations. Participants were classified as dementia (DEM), mild cognitive impairment (MCI), or cognitively normal (CN) based on clinical diagnosis, Montreal Cognitive Assessment, Mini-Mental State Exam scores, clinical dementia rating, and prescribed medications. We trained logistic regression, support vector machine, and random forest models to classify patients into DEM, MCI, and CN groups.ResultsFor discriminating DEM versus CN, the best model achieved an area under receiver operating characteristic curve (AUROC) of 0.78 and area under precision-recall curve (AUPRC) of 0.22. For discriminating MCI versus CN, the best model achieved an AUROC of 0.73 and AUPRC of 0.18. For discriminating DEM or MCI versus CN, the best model achieved an AUROC of 0.76 and AUPRC of 0.32.ConclusionsOur dementia classification algorithms show promise for incorporating dementia screening techniques using routine sleep EEG. The findings strengthen the concept of sleep as a window into neurodegenerative diseases.
PubDate: Wed, 30 Nov 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac286
Issue No: Vol. 46, No. 3 (2022)
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- Sleep architecture is associated with core symptom severity in autism
spectrum disorder-
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Abstract: AbstractStudy ObjectivesWhile caregiver-reported sleep disturbances are common in children and adolescents with autism spectrum disorder ([‘), few studies have measured objective sleep in ASD compared to controls, and their findings are mixed. We investigated (1) differences in sleep architecture, specifically slow-wave sleep (SWS) and rapid eye movement (REM) sleep, between ASD and typically developing controls (TD); and (2) if any observed differences in sleep were associated with core ASD symptoms.MethodsWe used ambulatory polysomnography (PSG) in 53 participants with ASD (ages 4–18) and 66 age-matched TD in their home sleeping environment. The primary outcome measures were SWS and REM sleep. Core behavioral ASD symptoms were assessed using the Autism Diagnostic Interview-Revised (ADI-R). Spectral power bands during sleep, and additional behavioral measures, were examined in exploratory analyses.ResultsCompared to TD, participants with ASD exhibited a higher SWS ratio and lower REM sleep ratio. Within the ASD group, higher SWS was associated with more severe symptoms on the Restricted, Repetitive, and Stereotyped Behaviors subscale of the ADI-R. No association was observed between REM sleep ratio and any ASD symptom.ConclusionsIncreased SWS and reduced REM sleep ratio differentiated ASD from TD. However, only increased SWS was associated with more severe core ASD symptoms. Increased SWS may reflect neuronal immaturity specific to ASD in this age group. These findings may inform the underlying mechanisms of clinical symptoms observed in children and adolescents with ASD.
PubDate: Thu, 17 Nov 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac273
Issue No: Vol. 46, No. 3 (2022)
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- Effect of smartphone-based cognitive behavioral therapy app on insomnia: a
randomized, double-blind study-
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Abstract: AbstractStudy ObjectivesThis study assessed the effects and safety of the smartphone-based cognitive behavioral therapy for insomnia (CBT-I) app compared with the sham app.MethodsIn this multicenter, double-blind, and parallel-group study, 175 patients with insomnia were randomized to a smartphone-based CBT-I app (Active, n = 87) or a sham app (Sham, n = 88) group. The primary endpoint was the change in Athens Insomnia Score (AIS) from baseline after 8 weeks of treatment.ResultsThe change in AIS (mean ± standard deviation) from baseline, assessed using a modified-intent-to-treat analysis, was −6.7 ± 4.4 in the Active group and −3.3 ± 4.0 in the Sham group. The difference in the mean change between the groups was −3.4 (p < .001), indicating a greater change in the Active group. The change in CGI-I from the baseline was 1.3 ± 0.8 in the Active group and 0.7 ± 0.8 in the Sham group (p < .001). The proportion of patients with an AIS less than 6 was 37.9% in the Active group and 10.2% in the Sham group (p < .001). As for the safety assessment, no adverse reactions or device failures were detected in the Active group.ConclusionsThis study demonstrated the effectiveness of a smartphone-based CBT-I system for treating insomnia.Clinical Trial RegistrationID: jRCT2032210071; trial name: Sham (software)-controlled, multicenter, dynamic allocation, double-blinded study of non-medication therapy with a software Yukumi in patients with insomnia disorders (verification study); URL: https://jrct.niph.go.jp/en-latest-detail/jRCT2032210071
PubDate: Thu, 10 Nov 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac270
Issue No: Vol. 46, No. 3 (2022)
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- Mental and physical health pathways linking insomnia symptoms to cognitive
performance 14 years later-
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Abstract: AbstractStudy ObjectivesInsomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia–cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender.MethodsParticipants included 2595 adults ages 51–88 at baseline (Mage=64.00 ± 6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, night time awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographic and global cognition.ResultsFrequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (−0.06 ≤ β ≤ −0.04; equivalent to 2.2–3.4 years of aging). Depressive symptoms explained 12.3%–19.5% of these associations and vascular disease explained 6.3%–14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender.ConclusionsDifficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.
PubDate: Sun, 30 Oct 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac262
Issue No: Vol. 46, No. 3 (2022)
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- Obstructive sleep apnea during REM sleep: effects on morning and evening
blood pressure-
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Abstract: AbstractStudy ObjectivesObstructive sleep apnea (OSA) is linked to the emergence and progression of cardiovascular complications including hypertension, stroke, arrhythmias, coronary artery disease, and heart failure. Epidemiological studies have reported that hypertension is associated with respiratory events during REM sleep. We examined the relationship between respiratory events during REM and morning and evening hypertensive blood pressure (BP) levels in a clinical sleep population.MethodsThis study included data from in-laboratory diagnostic polysomnographic studies (n = 797) from adults attending for investigation of OSA. Hypertensive BP levels were defined using BP measurements taken in the evening before and morning after polysomnography, and the use of antihypertensive medication. Regression modeling was undertaken to examine the probability of evening and morning hypertensive BP levels according to REM apnea-hypopnea index (AHI), NREM AHI, gender, age, body mass index (BMI), alcohol use, total sleep time (TST), sleep time SpO2 <90%, and smoking status.ResultsThe probability of morning hypertensive BP levels was significantly independently associated with age (p < .001), BMI (p < .001), and REM AHI (p < .001). No significant effect was found for the male gender, NREM AHI, alcohol use, TST, sleep time SpO2 <90%, or smoking (p > .05 for all). The probability of evening hypertensive BP levels was only significantly associated with age (p < .001), male gender (p = .012), BMI (p < .001), and TST (p = .032).ConclusionsRespiratory events during REM sleep are significantly associated with morning hypertensive BP levels. Future research is needed to determine whether treatment of these events can prevent or reverse morning hypertensive BP levels.
PubDate: Sat, 29 Oct 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac259
Issue No: Vol. 46, No. 3 (2022)
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- Cortical thickness and hippocampal volume in adolescent children with
obstructive sleep apnea-
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Abstract: AbstractStudy ObjectivesIntermittent hypoxia and sleep fragmentation due to obstructive sleep apnea (OSA) may contribute to oxidative tissue damage and apoptotic neuronal cell death, inflammation, and intracellular edema in the brain. We examined whether OSA in overweight and obese adolescent children is associated with cortical thickness and hippocampal structure compared to overweight and obese controls and whether OSA severity is associated with measures of brain integrity.MethodsWe calculated cortical thickness and hippocampal subfield volumes from T1-weighted images of 45 controls (age 15.43 ± 1.73 years, 21 male) and 53 adolescent children with OSA (age 15.26 ± 1.63 years, 32 male) to investigate the association of childhood OSA with the alteration of cortical structure and hippocampal subfield structural changes. In addition, we investigated the correlation between OSA severity and cortical thickness or hippocampal subfield volume using Pearson’s correlation analysis.ResultsWe found cortical thinning in the right superior parietal area of adolescent children with OSA (cluster size 32.29 mm2, cluster-wise corrected p-value = .030) that was negatively correlated with apnea-hypopnea index (AHI) (R=−0.27, p-value = .009) and arousal index (R=−0.25, p-value = .014). In addition, the volume of the right subiculum-head area of the hippocampus of adolescent children with OSA was larger than controls (0.19 ± 0.02 ml vs. 0.18 ± 0.02 ml, β = 13.79, false discovery rate corrected p-value = .044), and it was positively correlated with AHI (R = 0.23, p-value = .026) and arousal index (R = 0.31, p-value = .002).ConclusionsOur findings provide evidence for OSA-associated brain structure alterations in adolescent children prior to the onset of treatment that likely have important implications for timely intervention and continued monitoring of health outcomes.
PubDate: Thu, 25 Aug 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac201
Issue No: Vol. 46, No. 3 (2022)
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- Don’t leave a light on for me: commentary on Kim et al. “Light at
night in older age is associated with obesity, diabetes, and
hypertension”-
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Abstract: National Institutes of Health10.13039/100000002R01 DK127254R01 AG044416
PubDate: Tue, 26 Jul 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac173
Issue No: Vol. 46, No. 3 (2022)
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- Light at night in older age is associated with obesity, diabetes, and
hypertension-
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Abstract: AbstractLight at night (LAN) has been associated with negative health consequences and metabolic risk factors. Little is known about the prevalence of LAN in older adults in the United States and its association with CVD risk factors. We tested the hypothesis that LAN in older age is associated with higher prevalence of individual CVD risk factors. Five hundred and fifty-two community-dwelling adults aged 63−84 years underwent an examination of CVD risk factor profiles and 7-day actigraphy recording for activity and light measures. Associations between actigraphy-measured LAN, defined as no light vs. light within the 5-hour nadir (L5), and CVD risk factors, including obesity, diabetes, hypertension, and hypercholesterolemia, were examined, after adjusting for age, sex, race, season of recording, and sleep variables. LAN exposure was associated with a higher prevalence of obesity (multivariable-adjusted odds ratio [OR] 1.82 [95% CI 1.26−2.65]), diabetes (OR 2.00 [1.19−3.43]), and hypertension (OR 1.74 [1.21−2.52]) but not with hypercholesterolemia. LAN was also associated with (1) later timing of lowest light exposure (L5-light) and lowest activity (L5-activity), (2) lower inter-daily stability and amplitude of light exposure and activity, and (3) higher wake after sleep onset. Habitual LAN in older age is associated with concurrent obesity, diabetes, and hypertension. Further research is needed to understand long-term effects of LAN on cardiometabolic risks.
PubDate: Wed, 22 Jun 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac130
Issue No: Vol. 46, No. 3 (2022)
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- Central sleep apnea: pathophysiologic classification
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Abstract: AbstractCentral sleep apnea is not a single disorder; it can present as an isolated disorder or as a part of other clinical syndromes. In some conditions, such as heart failure, central apneic events are due to transient inhibition of ventilatory motor output during sleep, owing to the overlapping influences of sleep and hypocapnia. Specifically, the sleep state is associated with removal of wakefulness drive to breathe; thus, rendering ventilatory motor output dependent on the metabolic ventilatory control system, principally PaCO2. Accordingly, central apnea occurs when PaCO2 is reduced below the “apneic threshold”. Our understanding of the pathophysiology of central sleep apnea has evolved appreciably over the past decade; accordingly, in disorders such as heart failure, central apnea is viewed as a form of breathing instability, manifesting as recurrent cycles of apnea/hypopnea, alternating with hyperpnea. In other words, ventilatory control operates as a negative—feedback closed-loop system to maintain homeostasis of blood gas tensions within a relatively narrow physiologic range, principally PaCO2. Therefore, many authors have adopted the engineering concept of “loop gain” (LG) as a measure of ventilatory instability and susceptibility to central apnea. Increased LG promotes breathing instabilities in a number of medical disorders. In some other conditions, such as with use of opioids, central apnea occurs due to inhibition of rhythm generation within the brainstem. This review will address the pathogenesis, pathophysiologic classification, and the multitude of clinical conditions that are associated with central apnea, and highlight areas of uncertainty.
PubDate: Wed, 11 May 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsac113
Issue No: Vol. 46, No. 3 (2022)
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- Automatic analysis of muscular activity in the flexor digitorum
superficialis muscles: a fast screening method for rapid eye movement
sleep without atonia-
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Abstract: AbstractStudy objectivesTo identify a fast and reliable method for rapid eye movement (REM) sleep without atonia (RWA) quantification.MethodsWe analyzed 36 video-polysomnographies (v-PSGs) of isolated REM sleep behavior disorder (iRBD) patients and 35 controls’ v-PSGs. Patients diagnosed with RBD had: i) RWA, quantified with a reference method, i.e. automatic and artifact-corrected 3-s Sleep Innsbruck Barcelona (SINBAR) index in REM sleep periods (RSPs, i.e. manually selected portions of REM sleep); and ii) v-PSG-documented RBD behaviors. We quantified RWA with other (semi)-automated methods requiring less human intervention than the reference one: the indices proposed by the SINBAR group (the 3-s and 30-s phasic flexor digitorum superficialis (FDS), phasic/”any”/tonic mentalis), and the REM atonia, short and long muscle activity indices (in mentalis/submentalis/FDS muscles). They were calculated in whole REM sleep (i.e. REM sleep scored following international guidelines), in RSPs, with and without manual artifact correction. Area under curves (AUC) discriminating iRBD from controls were computed. Using published cut-offs, the indices’ sensitivity and specificity for iRBD identification were calculated. Apnea-hypopnea index in REM sleep (AHIREM) was considered in the analyses.ResultsRWA indices from FDS muscles alone had the highest AUCs and all of them had 100% sensitivity. Without manual RSP selection and artifact correction, the “30-s phasic FDS” and the “FDS long muscle activity” had the highest specificity (85%) with AHIREM < 15/h. RWA indices were less reliable when AHIREM≥15/h.ConclusionsIf AHIREM<15/h, FDS muscular activity in whole REM sleep and without artifact correction is fast and reliable to rule out RWA.
PubDate: Tue, 04 Jan 2022 00:00:00 GMT
DOI: 10.1093/sleep/zsab299
Issue No: Vol. 46, No. 3 (2022)
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