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Background: Sleep macro and microstructural features have a relevant role for cognition. Although alterations in sleep macrostructure have been reported in persons with neurodegenerative disorders, including Parkinson's disease (PD), it is unknown whether there is a relationship between alterations in microstructure (sleep spindles) and global cognitive deficits in this disease., Objective: To explore the association between the macro and microstructure of sleep (sleep spindles) and the general cognitive state in persons with PD., Methods: Thirty-three patients with idiopathic PD underwent a one-night polysomnography (PSG) and a global cognitive assessment using the Montreal Cognitive Assessment (MoCA) test. PSG-based macrostructural sleep values and quantification and spectral estimation of sleep spindles were obtained., Results: We found increases in total sleep time, latency to rapid eye movement (REM) sleep, and percentage of N1 stage, as well as a decrease in percentage of REM sleep and sleep efficiency compared to values reported in healthy adults. Compared to expected values, a decrease in the number of sleep spindles was found at frontal regions. Participants with cognitive impairment showed an even lower count of sleep spindles, as well as an increase in the amplitude of underlying sigma (12-16 Hz) waves (fast spindles). When exploring MoCA subdomains, we found a consistent relationship between the number and amplitude of sleep spindles and attention capacity., Conclusions: Decreased number and increased amplitude of sleep spindles are linked to cognitive impairment in persons with PD, especially in attention capacity. Therefore, sleep spindles characteristics could serve as prognostic indicators of cognitive deterioration in PD., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To examine whether objective sleep parameters are associated with cognitive function (CF) in patients with major depressive disorder (MDD) with chronic insomnia (CI) and whether the severity of these disorders is related to CF., Method: Thirty patients with MDD with CI attending a tertiary care institution underwent two consecutive nights of polysomnographic (PSG) recording and a battery of neuropsychological tests, which included episodic memory, sustained attention, working memory, and executive function. The severity of MDD and CI was assessed by clinical scales. We examined the relationship between PSG parameters and CF, as well as whether the severity of the disorders is related to CF., Results: Linear regression analysis revealed that total sleep time (TST) was positively associated with higher learning and recall of episodic memory, as well as better attention. Slow-wave sleep (SWS) showed a positive association with better working memory. Furthermore, wake after sleep onset (WASO) was negatively associated with episodic memory and lower attention. No significant relationships were found between the severity of MDD or CI with CF., Conclusion: Both sleep duration and depth are positively associated with several aspects of CF in patients with MDD with CI. Conversely, a lack of sleep maintenance is negatively related to CF in these patients. These findings could help identify modifiable therapeutic targets to reduce CF impairment.

Background: Since disturbances of appetite and sleep are closely related and both affect metabolic disorders, it would be expected that a renal specific oral nutritional supplement (RS-ONS) that covers the energy the patient does not consume on the HD day, could contribute to improve the nutritional status and body composition, as well as sleep quality. There is still scarce information related to this topic., Aim: To evaluate the effect of the use of intra-dialytic RS-ONS vs. RS-ONS at home on sleep quality, nutritional status, and body composition in patients on HD., Methods: Adult patients < 65 years, with ≥3 months on HD were invited to participate in an open randomized pilot study (ISRCTN 33897). Patients were randomized to a dialysis-specific high-protein supplement provided during the HD session (Intradialytic oral nutrition [ION]) or at home (control), during non-HD days (thrice weekly, for both) 12 weeks. The primary outcome was sleep quality defined by the Pittsburgh Sleep Quality Index (PSQI) score. Nutritional assessment included Malnutrition Inflammation Score (MIS), bioelectrical impedance analysis, anthropometry, 3-day food records, and routine blood chemistries., Results: A total of 23 patients completed the study. Age was median 35 (range 24-48 years), 42% were women. At baseline, the PSQI score was median 4 (range 2-7), and MIS showed a median of 6 (range 5-8); there were no baseline differences between groups. After intervention, both groups improved their MIS scores and similarly when we analyzed the whole cohort (pre- vs. post-intervention P < 0.01). Patients in the ION group improved the overall PSQI score to median 3 (2-5), and assessment of sleep duration and sleep disturbances (pre- vs. post-intervention P < 0.05), with a trend toward an effect difference compared to patients consuming the supplement at home (P for treatment-effect across arms 0.07 for PSQI score and 0.05 for sleep latency)., Conclusion: Oral supplementation improved nutritional status in the whole cohort, but only ION improved the PSQI score. More studies are needed to explore the nutritional strategies that influence the relationship between sleep and nutritional status in HD patients., Competing Interests: JJC reports grant funding from AstraZeneca, ViforPharma and Astellas, consulting for Baxter and AstraZeneca, speaker fees for Abbott, Nutricia, AstraZeneca, and ViforPharma all outside the submitted work. ÁE-C acknowledges speaker honoraria from Abbott Laboratories and AbbVie. AG-O acknowledges being speaker for Abbott Laboratories. RC-R reports grant funding from AstraZeneca, Novonordisk, and Glaxo. Consulting fees for Boheringer Ingelheim, AstraZeneca, Chinook, and all unrelated to the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 González-Ortiz, Ramos-Acevedo, Santiago-Ayala, Gaytan, Valencia-Flores, Correa-Rotter, Carrero, Xu and Espinosa-Cuevas.)

Problem: Sleep disturbance is a characteristic symptom of depression, but it is also a problem in itself related to the severity of this illness. Hence, the objective of this study was to examine sleep habits and sleep problems associated with increased depressive symptoms in children., Methods: The sample included 524 children equally distributed by gender (51.1% female), with an average age of 10.29 (SD = 1.34) years. The administered instruments were the Children's Depression Inventory (CDI; Cronbach α = 0.82) and a Sleep Habits and Sleep Problems Questionnaire (α = 0.91)., Findings: The mean score for the CDI was 12.51 (SD = 6.74) and 20% presented symptoms of depression. The linear regression model showed that sleep habits associated with the increase in symptoms of depression were: little sleep, hours of sleep during the week, and wake-up time on weekdays. In the same model, the associated sleep problems were: nocturnal awakenings, nightmares, and difficulty waking up. The presence of these sleep habits and sleep problems increased the score from 2.07 to 13.50 points on the CDI scale., Conclusions: Depressive symptoms increase with the presence of sleep habits related to sleep deprivation and sleep problems related to parasomnias in school-age children., (© 2021 Wiley Periodicals LLC.)

Introduction: Background: the restriction of nocturnal sleep has immediate effects, including the presence of excessive daytime sleepiness, general fatigue, or impaired concentration. In the long term, it increases the risk of death from cardiac, respiratory, and metabolic disorders, and the prevalence of obesity in healthy populations. However, despite the existence of a large number of studies on this topic, results have been controversial. Objective: to discuss and analyze the evidence on the effects of nocturnal sleep restriction versus habitual sleep on dietary energy intake, including specific meals, as well as the relationship between ghrelin and leptin levels in a healthy population. Methods: a systematic search of the literature was conducted in October 2016 and February 2019 using the PubMed, Scopus, Lilacs, and Embase databases. Terms used were "sleep," "feeding behavior," "dietary energy intake," "energy intake," "meal," "ghrelin," and "leptin." Results: the bibliographic search identified 384 potential articles. Of a total of eight articles accepted in the review, six contain information available for the analysis of total energy intake. The overall result shows a significant difference in energy intake between study groups (149.86 (95 % CI: 10.09-289.63); p = 0.04), and a higher intake of all macronutrients. Conclusions: the present systematic review and meta-analysis demonstrated that partial sleep deprivation increases total energy intake, as well as all macronutrients, when compared to habitual sleep.

Purpose: Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America., Methods: Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12-18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey., Results: Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m 2 ) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001)., Conclusions: Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy.

Background: Although obstructive sleep apnea (OSA) has long been associated with daytime sleepiness, far less is known about its association with the ability to remain awake. The aim of this study was to examine the relative importance of inter-correlated measures of OSA severity (eg, various indices of oxygen saturation and sleep fragmentation) in the ability to stay alert as measured objectively by the Maintenance of Wakefulness Test (MWT), defined by a mean sleep latency of ≥12 min., Methods: Seventy-eight obese women and men of similar age and body mass index living at altitude (Mexico City) underwent standard polysomnography, MWT, and completed validated sleep-related questionnaires., Results: Men had more severe sleep apnea than women (p = 0.002) and were also less alert on MWT (p = 0.022). Logistic regression models indicated that measures of desaturation consistently predicted MWT-defined alertness, whereas varied measures of sleep fragmentation did not. Nearly a third of the variance (r(2) = 0.304) in MWT-defined alertness was accounted for by the number of desaturations per hour of sleep (p = 0.003), which is considerably higher than other studies have reported in different populations., Conclusion: The ability to remain awake in obese patients is best accounted for by hypoxemia rather than sleep fragmentation. Whether the size of this effect reflects differences in the population under study (eg, extent of obesity, racial background, residence at moderate altitude) and/or is a function of the measurement of alertness with the MWT remains uncertain., (Copyright © 2016 Elsevier B.V. All rights reserved.)