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Summary: The association between nightmare frequency (NMF) and suicidal ideation (SI) is well known, yet the impact of the COVID‐19 pandemic on this relation is inconsistent. This study aimed to investigate changes in NMF, SI, and their association during the COVID‐19 pandemic. Data were collected in 16 countries using a harmonised questionnaire. The sample included 9328 individuals (4848 women; age M[SD] = 46.85 [17.75] years), and 17.60% reported previous COVID‐19. Overall, SI was significantly 2% lower during the pandemic vs. before, and this was consistent across genders and ages. Most countries/regions demonstrated decreases in SI during this pandemic, with Austria (−9.57%), Sweden (−6.18%), and Bulgaria (−5.14%) exhibiting significant declines in SI, but Italy (1.45%) and Portugal (2.45%) demonstrated non‐significant increases. Suicidal ideation was more common in participants with long‐COVID (21.10%) vs. short‐COVID (12.40%), though SI did not vary by COVID‐19 history. Nightmare frequency increased by 4.50% during the pandemic and was significantly higher in those with previous COVID‐19 (14.50% vs. 10.70%), during infection (23.00% vs. 8.10%), and in those with long‐COVID (18.00% vs. 8.50%). The relation between NMF and SI was not significantly stronger during the pandemic than prior (rs = 0.18 vs. 0.14; z = 2.80). Frequent nightmares during the pandemic increased the likelihood of reporting SI (OR = 1.57, 95% CI 1.20–2.05), while frequent dream recall during the pandemic served a protective effect (OR = 0.74, 95% CI 0.59–0.94). These findings have important implications for identifying those at risk of suicide and may offer a potential pathway for suicide prevention. [ABSTRACT FROM AUTHOR]

Summary: Recent investigations show that many people affected by SARS‐CoV2 (COVID‐19) report persistent symptoms 2–3 months from the onset of the infection. Here, we report the Italian findings from the second International COVID‐19 Sleep Study survey, aiming to investigate sleep and dream alterations in participants with post‐acute symptoms, and identify the best determinants of these alterations among patients with long‐COVID. Data from 383 participants who have had COVID‐19 were collected through a web‐survey (May–November 2021). Descriptive analyses were performed to outline the sociodemographic characteristics of long‐COVID (N = 270, with at least two long‐lasting symptoms) and short‐COVID (N = 113, with none or one long‐lasting symptom) participants. They were then compared concerning sleep and dream measures. We performed multiple linear regressions considering as dependent variables sleep and dream parameters discriminating the long‐COVID group. Age, gender, work status, financial burden, COVID‐19 severity and the level of care were significantly different between long‐COVID and short‐COVID subjects. The long‐COVID group showed greater sleep alterations (sleep quality, daytime sleepiness, sleep inertia, naps, insomnia, sleep apnea, nightmares) compared with the short‐COVID group. We also found that the number of long‐COVID symptoms, psychological factors and age were the best explanatory variables of sleep and oneiric alterations. Our findings highlight that sleep alterations are part of the clinical presentation of the long‐COVID syndrome. Moreover, psychological status and the number of post‐acute symptoms should be considered as state‐like variables modulating the sleep problems in long‐COVID individuals. Finally, according to previous investigations, oneiric alterations are confirmed as a reliable mental health index. [ABSTRACT FROM AUTHOR]

Summary: The present study estimated the frequency of using methods or tricks to fall asleep in the general Norwegian population. Further, people with chronic insomnia were compared with people without chronic insomnia. A representative sample of 1028 participants aged 18 years or older completed a web‐based survey. The response rate was 33.5%. Insomnia symptoms were assessed with the validated Bergen Insomnia Scale, and chronic insomnia based on ICSD‐3/DSM‐5 criteria. Data were analysed with chi‐square tests and logistic regression with adjustment for sex, age, education, and circadian preference. The results showed that 34.3% reported using a method or a trick to fall asleep, with relaxation exercises/breathing exercises being the most common. More females (39.5%) compared with males (29.1%) reported the use of a method/trick to fall asleep with an adjusted odds ratio (aOR) of 1.44. Chronic insomnia was reported by 24.9%, and clearly associated with higher use of such methods/tricks (53.7%; aOR = 3.49). Among the participants without chronic insomnia, 28.1% reported using methods/tricks to fall asleep. In conclusion, most people do not use methods or tricks to fall asleep, but chronic insomnia was associated with a higher frequency of such use. Still, since methods/tricks were also used by some participants without chronic insomnia, this may suggest that, for some people, this strategy may be effective or at least does not seem to disrupt the sleep onset process. [ABSTRACT FROM AUTHOR]

Summary: Many people report suffering from post‐acute sequelae of COVID‐19 or "long‐COVID", but there are still open questions on what actually constitutes long‐COVID and how prevalent it is. The current definition of post‐acute sequelae of COVID‐19 is based on voting using the Delphi‐method by the WHO post‐COVID‐19 working group. It emphasizes long‐lasting fatigue, shortness of breath and cognitive dysfunction as the core symptoms of post‐acute sequelae of COVID‐19. In this international survey study consisting of 13,628 subjects aged 18–99 years from 16 countries of Asia, Europe, North America and South America (May–Dec 2021), we show that post‐acute sequelae of COVID‐19 symptoms were more prevalent amongst the more severe COVID‐19 cases, i.e. those requiring hospitalisation for COVID‐19. We also found that long‐lasting sleep symptoms are at the core of post‐acute sequelae of COVID‐19 and associate with the COVID‐19 severity when COVID‐19 cases are compared with COVID‐negative cases. Specifically, fatigue (61.3%), insomnia symptoms (49.6%) and excessive daytime sleepiness (35.8%) were highly prevalent amongst respondents reporting long‐lasting symptoms after hospitalisation for COVID‐19. Understanding the importance of sleep‐related symptoms in post‐acute sequelae of COVID‐19 has a clinical relevance when diagnosing and treating long‐COVID. [ABSTRACT FROM AUTHOR]

Summary: There has been increasing concern about the long‐term impact of coronavirus disease 2019 (COVID‐19) as evidenced by anecdotal case reports of acute‐onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream‐enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α‐synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID‐19 diagnosis and symptoms. We assessed dream‐enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single‐Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream‐enactment behaviours was 19.4% and 3.1% and were found to be 1.8‐ and 2.9‐times higher in COVID‐19‐positive cases, respectively. Both lifetime and weekly dream‐enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID‐19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post‐traumatic stress disorder features. Among COVID‐19‐positive cases, weekly dream‐enactment behaviours were positively associated with the severity of COVID‐19. Dream‐enactment behaviours are common among the general population during the COVID‐19 pandemic and further increase among patients with COVID‐19. Further studies are needed to investigate the potential neurodegenerative effect of COVID‐19. [ABSTRACT FROM AUTHOR]

Summary: This protocol paper describes the second survey produced by the International Covid Sleep Study (ICOSS) group with the aim to examine the associations between SARS‐CoV‐2 infection and sleep, sleepiness, and circadian problems as potential predisposing factors for more severe COVID‐19 disease profile and for development of Long‐COVID in the general population. The survey consists of 47 questions on sleep, daytime sleepiness, circadian rhythm, health, mental wellbeing, life habits, and socioeconomic situation before and during the pandemic, and conditional questions to those reporting having had coronavirus infection, being vaccinated, or suffering from particular sleep symptoms or sleep disorders. Surveys will be administered online between May and November 2021 in Austria, Brazil, Bulgaria, Canada, China, Croatia, Finland, France, Germany, Israel, Italy, Japan, Norway, Portugal, Sweden and USA. Data collected by the survey will give valuable information on the open questions regarding COVID‐19 disease risk factors, symptomatology and evolution of Long‐COVID, and on other long‐term consequences related to the pandemic. [ABSTRACT FROM AUTHOR]

Summary: There has been great concern about the impact of coronavirus disease 2019 (COVID‐19)‐related school lockdown on adolescent health. The aim of the present study was to compare sleep patterns before and during COVID‐19‐related school lockdown, in a large sample of high school students. The present study is based a prospective, longitudinal survey on adolescent sleep health. Phase 1 was conducted in 2019, whereas phase 2 was conducted in 2020 (response rate 60.2%), during the last 10 days of a 60‐day long school lockdown. Main outcomes comprised sleep parameters from the Munich ChronoType Questionnaire (MCTQ). A total of 2,022 students provided valid responses to MCTQ in both survey phases. Results showed later sleep timing on schooldays in 2020 compared to 2019 (36 min later bedtimes, Cohen's d = 0.56; 1:35 hr later rise times, Cohen's d = 1.44). Time spent in bed on schooldays increased from 8:20 to 9:19 hr (Cohen's d = 0.78), and sleep duration increased by 45 min (Cohen's d = 0.49). The proportion of adolescents obtaining the recommended ≥8 hr of sleep on schooldays increased from 13.4% (2019) to 37.5% during the lockdown. Social jetlag was reduced from 2:37 hr (2019) to 1:53 hr (2020, Cohen's d = 0.59). Results points to a potential advantageous effect of school lockdown in terms of increased school day sleep duration and reduced social jetlag. As sleep is important for mental and somatic health, it is conceivable that increased sleep duration offered some protection against harmful aspects of the COVID‐19 pandemic and associated social restrictions. Future studies should address possible associations between sleep changes and health during COVID‐19‐related school lockdown. [ABSTRACT FROM AUTHOR]

Summary: The aims of the present prospective clinical study were to determine objective, sensor‐measured adherence to a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify partner‐specific adherence‐related factors. A total of 77 eligible participants with mild, moderate, or severe OSA and who were non‐adherent to continuous positive airway pressure (mean age 56.2 years) participated in the study (32.5% women). The mean (range) observation time between MAD delivery and final follow‐up was 8.3 (3.4–16.5) months. The mean apnea–hypopnea index (AHI) was 26.6 events/hr at baseline and 12.5 events/hr at the 8‐month follow‐up (both p < 0.001). The mean sensor‐measured adherence at the 8‐month follow‐up was 60.1% for ≥4 hr/night of appliance use for ≥5 days/week. Average usage was 6.4 hr/night, when worn. The mean reduction in the AHI was significantly greater in the "good adherence" (Δ 17.4) than the "poor adherence" group (Δ11.0; p < 0.05). From the partner's perspective, the appliance had a positive effect on sharing a bedroom in the good‐ (55%) compared to the poor‐adherence group (25%; p < 0.05) and on their relationship (51.7% versus 17.9%, respectively; p < 0.05). Regression analyses identified the partner's snoring and apneas to be the most significant factor predicting good adherence to MAD (odds ratio 4.4, 95% confidence interval 1.4–14.0). In conclusion, social factors, like partner perceptions, were positively associated with adherence, which indicate that partner's attitudes and support may be a resource that can be utilised to improve adherence in oral appliance treatment of OSA. [ABSTRACT FROM AUTHOR]

The aim of the present study was to describe sleep patterns in a large and representative sample of Norwegian adolescents. The sample included 4,010 first‐year high school students, aged 16–17 years (54% female), who completed a web‐based survey on sleep patterns. The process of going to sleep was addressed as a two‐step sequence of (a) shuteye latency (interval from bedtime to shuteye time) and (b) sleep onset latency (interval from shuteye time to sleep onset). Results showed that 84.8% of the adolescents failed to obtain the recommended amount of sleep (8+ h) on schooldays, and 49.4% obtained less than 7 h. Mean bedtime on schooldays was 10:33 PM, with rise time 8:19 h later (time in bed). The adolescents reported long school‐day shuteye latency (43 min), limiting sleep opportunity to 7:36 h. Sleep onset latency was 32 min and mean school‐day sleep duration was only 6:43 h. On free days, 26.3% of the adolescents obtained less than 8 h of sleep, and 11.7% obtained less than 7 h. Mean bedtime was 00:33 AM, time in bed was 10:35 h, shuteye latency was 39 min and sleep onset latency was 24 min. Mean free‐day sleep duration was 8:38 h. There were sex differences in several sleep parameters, including shuteye latency. The results indicate that the majority of Norwegian adolescents fail to obtain the recommended amount of sleep (8+ h) on schooldays. Long shuteye latency appears to be a main driver for short school‐day sleep duration in adolescents. [ABSTRACT FROM AUTHOR]

This protocol paper describes the development of an international collaboration to survey several thousand adults from different countries around the world about their sleep during the coronavirus disease 2019 (COVID‐19) pandemic. It is based on the development of a harmonised survey with 50 questions (106 different items) on sleep habits and sleep symptoms that permit comparability of information. The harmonised questionnaire may be used in anonymous cross‐sectional surveys, and the instruments within the questionnaire may also be used in prospective studies and clinical studies. The aim was to develop a questionnaire to sample a variety of sleep–wake disorders and other symptoms likely to be caused by prolonged social confinement or by having had COVID‐19. The questionnaire was designed to be: (a) simple and, (b) free to use, for research purposes, (c) multilingual, and (d) comprehensive. It can be completed in <30 min. By the end of June 2020, the survey questionnaire had been administered in Austria, Canada, China, Finland, France, Germany, Hong Kong, Italy, Japan, Norway, Poland, Sweden, UK and USA. Research questions to be addressed by the pooled data derived from the participating sites focus on describing the nature and rates of various sleep and circadian rhythms symptoms, as well as their psychological and medical correlates, that arise at various points during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT‐I) should be the first‐line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT‐I Academy that would enable a Europe‐wide system of standardized CBT‐I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT‐I, preconditions for health professionals to teach CBT‐I, the way in which CBT‐I should be taught, who should be taught CBT‐I and to whom CBT‐I should be administered. Furthermore, diverse aspects of CBT‐I care and delivery were discussed and incorporated into a stepped‐care model for insomnia. [ABSTRACT FROM AUTHOR]

Several studies have indicated a high degree of overlap between insomnia and obstructive sleep apnoea, but little is known regarding how the overlap may affect adverse outcomes associated with each of the disorders. The aim of the current study was to examine the separate and combined effects of symptoms of insomnia and obstructive sleep apnoea on long-term sick leave. We used an historical cohort design with 4 years follow-up. Information on sick leave was obtained from Norwegian official registry data, and merged with health information from the Hordaland Health Study in western Norway, 1997-99. A total of 6892 participants aged 40-45 years were assessed for self-reported symptoms of insomnia and obstructive sleep apnoea (snoring and breathing cessations), as well as confounding factors. The level of overlap between insomnia and obstructive sleep apnoea was low (7-12%). Both insomnia and obstructive sleep apnoea alone were significant risk factors for subsequent sick leave after adjusting for confounding factors (odds ratios ranging from 1.4 to 2.3). Having comorbid insomnia and obstructive sleep apnoea increased the risk significantly. There was an additive interaction effect between the two conditions in the unadjusted analyses, but this was reduced to a non-significant level when adjusting for confounders. This study is the first to report the separate and combined effects of insomnia and obstructive sleep apnoea on any adverse outcome. Having both insomnia and obstructive sleep apnoea increased the risk of later sick leave, but there was no evidence of an independent synergy effect of the two conditions. [ABSTRACT FROM AUTHOR]

Summary The hypothesis of whether day length (photoperiod) is an important zeitgeber (time-giver) for keeping the circadian rhythm entrained to a 24-hour cycle was examined, as was its association with sleep patterns and mood problems. Data were collected prospectively from a site with very large differences in daylight duration across seasons (Tromsø in Norway, 69°39′N) and a site with very small seasonal differences in daylight duration (Ghana in Accra, 5°32′N). Two hundred subjects were recruited from both sites in January. At the follow-up in August, 180 and 150 subjects in Ghana and Norway participated, respectively. Use of a weekly sleep diary indicated low to moderately strong seasonal changes in rise- and bedtime, sleep efficiency and sleep onset latency only in the northern latitude. No seasonal changes in sleep duration or night awakenings were observed. The self-report measures indicated moderate to strong seasonal differences in insomnia and fatigue, and weaker differences in depressed mood in Norway, but small to non-existing seasonal differences in Ghana. Lack of daylight was related to phase-delayed rise- and bedtimes, increased problems falling asleep, daytime fatigue and depressive mood. However, total sleep duration and sleep quality appeared unaffected. [ABSTRACT FROM AUTHOR]

Difficult early morning awakening is one of the defining symptoms of delayed sleep–wake phase disorder. It is accompanied by low cognitive arousal and drowsiness resulting in difficulty concentrating and focusing attention upon awakening. We designed the current study to quantitate cognitive performance (i.e. omissions, commissions, reaction time [average and variability]) and cognitive domains (i.e. focused attention, sustained attention, impulsivity and vigilance) with Conners' Continuous Performance Test II during both habitual and conventional (00:00–07:00 hr) sleep–wake schedule in young adult patients with delayed sleep–wake phase disorder (n = 20, mean age = 24.8 years, SD = 3.0) and controls (n = 16, mean age = 24.4 years, SD = 3.4). Conners' Continuous Performance Test II was administered after awakening and in the afternoon during both habitual and conventional conditions. In‐laboratory polysomnography was performed for 2 nights. We assessed sleep, tiredness, chronotype and depression using questionnaires. Saliva was sampled for dim light melatonin onset measurements. Repeated‐measures ANOVAs were applied for the Conners' Continuous Performance Test II measures with group (patient/control), time (afternoon/morning) and condition (habitual/conventional schedule) as fixed factors. Patients with delayed sleep–wake phase disorder had reduced reaction times, especially in the morning, greater response speed variability, and made more omission and commission errors compared with controls. Patients with delayed sleep–wake phase disorder also had reduced focused attention, especially upon forced early awakening. The short total sleep time of patients with delayed sleep–wake phase disorder could not statistically explain this outcome. In conclusion, we observed a state‐dependent reduced ability to focus attention upon early morning awakening in patients with delayed sleep–wake phase disorder. Patients also had more omissions, longer reaction time and increased RT variability after habitual sleep, suggesting a possible small cognitive trait dysfunction in delayed sleep–wake phase disorder. [ABSTRACT FROM AUTHOR]

Summary: The objective was to investigate symptoms of depression and anxiety in relation to the presence and severity of obstructive sleep apnea (OSA) among patients referred with suspicion of OSA. The sample comprised 3770 consecutive patients with a mean age of 49.1 years; 69.7% were male. OSA was diagnosed and categorized based on a standard respiratory polygraphic sleep study using a type 3 portable monitor. Patients completed the validated Hospital Anxiety and Depression Scale (HADS) prior to the sleep study. In addition, they answered questions about whether they were currently in treatment for mental disorders and whether they had been diagnosed previously with depression. We adjusted for sex, age, smoking, alcohol consumption and obesity in the logistic regression analyses. In total, 35.1% had apnea–hypopnea index (AHI) < 5 (no OSA), 31.9% had AHI: 5–14.9 (mild OSA), 17.3% had AHI: 15–29.9 (moderate OSA) and 15.7% had AHI ≥ 30 (severe OSA). The prevalence of anxiety and depressive symptoms were significantly lower with increased OSA severity, and also when adjusting for sex, age, smoking, alcohol consumption and obesity (AHI ≥ 15 as dependent variable). Similarly, currently being in treatment for mental disorders and being diagnosed previously with depression were both associated negatively with OSA severity, with only the latter remaining significant in the fully adjusted model. Furthermore, multiple linear regressions showed that HADS anxiety and depression total scores were associated negatively with AHI. In conclusion, symptoms of anxiety and depression were associated negatively with OSA severity in these referred patients. The findings remained significant also after adjusting for several relevant confounders. [ABSTRACT FROM AUTHOR]