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Quetiapine is an antipsychotic medication indicated for schizophrenia and bipolar disorder. However, quetiapine also has hypnotic properties and as such is increasingly being prescribed at low doses 'off-label' in people with insomnia symptoms. Pharmacologically, in addition to its dopaminergic properties, quetiapine also modulates multiple other transmitter systems involved in sleep/wake modulation and potentially breathing. However, very little is known about the impact of quetiapine on obstructive sleep apnoea (OSA), OSA endotypes including chemosensitivity, and control of breathing. Given that many people with insomnia also have undiagnosed OSA, it is important to understand the effects of quetiapine on OSA and its mechanisms. Accordingly, this concise review covers the existing knowledge on the effects of quetiapine on sleep and breathing. Further, we highlight the pharmacodynamics of quetiapine and its potential to alter key OSA endotypes to provide potential mechanistic insight. Finally, an agenda for future research priorities is proposed to fill the current key knowledge gaps., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale-15 items (GSS-15). Data were derived from a population-based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut-off scores and test associations with sleep, daytime functioning, health, and quality-of-life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ 2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS-15 global scores and outcomes, including 'a good night's sleep' (r = 0.7), 'feeling un-refreshed' (r = -0.59), and 'experienced sleepiness' (r = -0.51), p < 0.001. Cut-off scores were derived to categorise individuals likely to be a good sleeper (GSS-15 score ≥40) and those very likely to be a good sleeper (GSS-15 score ≥45). The GSS-15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples., (© 2022 European Sleep Research Society.)

Background Poor sleep quality is associated with increased incident hypertension. However, few studies have investigated the impact of objective sleep structure parameters on hypertension. This study investigated the association between sleep macrostructural and microstructural parameters and incident hypertension in a middle- to older-aged sample. Methods and Results Participants from the HypnoLaus population-based cohort without hypertension at baseline were included. Participants had at-home polysomnography at baseline, allowing assessment of sleep macrostructure (nonrapid eye movement sleep stages 1, 2, and 3; rapid eye movement sleep stages; and total sleep time) and microstructure including power spectral density of electroencephalogram in nonrapid eye movement sleep and spindles characteristics (density, duration, frequency, amplitude) in nonrapid eye movement sleep stage 2. Associations between sleep macrostructure and microstructure parameters at baseline and incident clinical hypertension over a mean follow-up of 5.2 years were assessed with multiple-adjusted logistic regression. A total of 1172 participants (42% men; age 55±10 years) were included. Of these, 198 (17%) developed hypertension. After adjustment for confounders, no sleep macrostructure features were associated with incident hypertension. However, low absolute delta and sigma power were significantly associated with incident hypertension where participants in the lowest quartile of delta and sigma had a 1.69-fold (95% CI, 1.00-2.89) and 1.72-fold (95% CI, 1.05-2.82) increased risk of incident hypertension, respectively, versus those in the highest quartile. Lower spindle density (odds ratio, 0.87; 95% CI, 0.76-0.99) and amplitude (odds ratio, 0.98; 95% CI, 0.95-1.00) were also associated with higher incident hypertension. Conclusions Sleep microstructure is associated with incident hypertension. Slow-wave activity and sleep spindles, 2 hallmarks of objective sleep continuity and quality, were inversely and consistently associated with incident hypertension. This supports the protective role of sleep continuity in the development of hypertension.

Study Objectives: Sleep microarchitecture parameters determined by quantitative power spectral analysis of electroencephalograms have been proposed as potential brain-specific markers of cognitive dysfunction. However, data from community samples remain limited. This study examined cross-sectional associations between sleep microarchitecture and cognitive dysfunction in community-dwelling men., Methods: Florey Adelaide Male Ageing Study participants (n = 477) underwent home-based polysomnography (2010-2011). All-night electroencephalogram recordings were processed using quantitative power spectral analysis following artifact exclusion. Cognitive testing (2007-2010) included the inspection time task, Trail-Making Tests A and B, and Fuld object memory evaluation. Complete case cognition, polysomnography, and covariate data were available in 366 men. Multivariable linear regression models controlling for demographic, biomedical, and behavioral confounders determined cross-sectional associations between sleep microarchitecture and cognitive dysfunction overall and by age-stratified subgroups., Results: In the overall sample, worse Trail-Making Test A performance was associated with higher rapid eye movement (REM) theta and alpha and non-REM theta but lower delta power (all P  < .05). In men ≥ 65 years, worse Trail-Making Test A performance was associated with lower non-REM delta but higher non-REM and REM theta and alpha power (all P  < .05). Furthermore, in men ≥ 65 years, worse Trail-Making Test B performance was associated with lower REM delta but higher theta and alpha power (all P  < .05)., Conclusions: Sleep microarchitecture parameters may represent important brain-specific markers of cognitive dysfunction, particularly in older community-dwelling men. Therefore, this study extends the emerging community-based cohort literature on a potentially important link between sleep microarchitecture and cognitive dysfunction. The utility of sleep microarchitecture for predicting prospective cognitive dysfunction and decline warrants further investigation., Citation: Parker JL, Appleton SL, Melaku YA, et al. The association between sleep microarchitecture and cognitive function in middle-aged and older men: a community-based cohort study. J Clin Sleep Med . 2022;18(6):1593-1608., (© 2022 American Academy of Sleep Medicine.)

Rationale: Conventional markers of sleep disturbance, based on manual electroencephalography scoring, may not adequately capture important features of more fundamental electroencephalography-related sleep disturbance. Objectives: This study aimed to determine if more comprehensive power-spectral measures of delta wave activity during sleep are stronger independent predictors of mortality than conventional sleep quality and disturbance metrics. Methods: Power spectral analysis of the delta frequency band and spectral entropy-based markers to quantify disruption of electroencephalography delta power during sleep were performed to examine potential associations with mortality risk in the Sleep Heart Health Study cohort ( N  = 5,804). Adjusted Cox proportional hazard models were used to determine the association between disrupted delta wave activity at baseline and all-cause mortality over an approximately 11-year follow-up period. Results: Disrupted delta electroencephalography power during sleep was associated with a 32% increased risk of all-cause mortality compared with no fragmentation (hazard ratio, 1.32 [95% confidence interval, 1.14-1.50]), after adjusting for total sleep time and other clinical and lifestyle-related covariates, including sleep apnea. The association was of similar magnitude to a reduction in total sleep time from 6.5 hours to 4.25 hours. Conventional measures of sleep quality, including wake after sleep onset and arousal index, were not predictive of all-cause mortality. Conclusions: Delta wave activity disruption during sleep is strongly associated with all-cause mortality risk, independent of traditional potential confounders. Future investigation into the potential role of delta sleep disruption on other specific adverse health consequences such as cardiometabolic, mental health, and safety outcomes has considerable potential to provide unique neurophysiological insight.

Background and Objective: Atomoxetine combined with oxybutynin (Ato-Oxy) has recently been shown to reduce obstructive sleep apnoea (OSA) severity by >60%. However, Ato-Oxy also modestly reduced the respiratory arousal threshold, which may decrease sleep quality/efficiency. We sought to investigate the additional effect of zolpidem with Ato-Oxy on sleep efficiency (primary outcome), the arousal threshold, OSA severity, other standard polysomnography (PSG) parameters, next-day sleepiness and alertness (secondary outcomes)., Methods: Twelve participants with OSA received 10 mg zolpidem plus Ato-Oxy (80-5 mg, respectively) or Ato-Oxy plus placebo prior to overnight in-laboratory PSG according to a double-blind, randomized, crossover design (1-week washout). Participants were fitted with an epiglottic catheter, a nasal mask and pneumotachograph to quantify arousal threshold and airflow. Next-day sleepiness and alertness were assessed via the Karolinska Sleepiness Scale and a driving simulation task., Results: The addition of zolpidem increased sleep efficiency by 9% ± 13% (80.9% ± 16.9% vs. 88.2% ± 8.2%, p = 0.037) and the respiratory arousal threshold by 17% ± 18% (-26.6 ± 14.5 vs. -33.8 ± 20.3 cm H 2 O, p = 0.004) versus Ato-Oxy + placebo. Zolpidem did not systematically change OSA severity. Combination therapy was well tolerated, and zolpidem did not worsen next-day sleepiness. However, median steering deviation during the driving simulator task increased following the zolpidem combination., Conclusion: Zolpidem improves sleep efficiency via an increase in the respiratory arousal threshold to counteract potential wake-promoting properties of atomoxetine in OSA. These changes occur without altering the rate of respiratory events or overnight hypoxaemia. However, while the addition of zolpidem does not increase next-day perceived sleepiness, caution is warranted given the potential impact on next-morning objective alertness., (© 2021 Asian Pacific Society of Respirology.)

Background: Mental health disorders are prevalent and costly to workplaces and individuals in Australia. Work-life interference is thought to contribute negatively. The interplay between work-life interference, depressive symptoms and sleep has not been explored to date in population data. The aims of this study were to establish whether sleep duration moderates the relationship between work-life interference and depressive symptoms, and whether this is expressed differentially in male and female respondents., Methods: Data were drawn from the North West Adelaide Health Study (NWAHS) longitudinal, representative population-based cohort study. Working members of the cohort were invited to participate in a telephone survey about their work conditions, with an 86.7% response rate achieved. Data from 823 respondents were analysed after employing purposeful selection of covariates, using multivariable regression analysis., Results: Sleep duration was found to moderate the relationship between work-life interference and depressive symptoms (F 7,815  = 26.60, p < 0.001), and accounted for 19% of the variance observed in depressive symptoms. The strongest effect of work-life interference on depressive symptoms was observed in habitual short sleepers, with the effect weakening as sleep duration increased. The relationship was observed in male and female respondents, but was stronger in females., Conclusions: Supporting and educating workers about the benefits of sleep for managing the relationship between work-life interference and depressive symptoms may offer a novel strategy for improving worker well-being, particularly when negative facets of work-life interference are not easily remedied or 'reduced'. There is a need for education and support strategies around sleep in Australian workplaces.

Epidemiological evidence on the association between macronutrient intake and excessive daytime sleepiness (EDS) is scarce. Using data from the North West Adelaide Health Study, we aimed to determine the association between iso-caloric substitution of macronutrients and EDS. Data from 1997 adults aged ≥ 24 years were analyzed. Daytime sleepiness was measured using the Epworth Sleepiness Scale, a score ≥ 11 was considered EDS. Dietary intake data were collected using a food frequency questionnaire. We determined absolute and relative energy intake based on consumption of saturated and unsaturated fats, protein, and carbohydrate. Odds ratios (ORs) were used to determine the associations using log-binomial logistic regression with and without iso-caloric substitution methods, and models were adjusted for confounders. The prevalence of EDS in the sample was 10.6%. After adjusting for potential confounders, substituting 5% energy intake from protein with an equal amount of saturated fat (OR = 1.57; 95% CI: 1.00-2.45) and carbohydrate (OR = 1.23; 95% CI: 0.92-1.65) increased the odds of EDS. When carbohydrate was substituted with saturated fat (OR = 1.27; 95% CI: 0.93-1.59), the odds of EDS were increased. The odds of EDS were lower when saturated fat was substituted with unsaturated fat (OR = 0.74; 95% CI: 0.51-1.06), protein (OR = 0.63; 95% CI: 0.41-0.99) or carbohydrate (OR = 0.79; 95% CI: 0.57-1.08). While these results were consistent over different iso-caloric substitution methods, inconsistent results were found with standard regression. While substitution of fat and carbohydrate with protein was inversely associated with EDS, substitution of protein with fat and carbohydrate was positively associated with EDS. Randomized trials are needed to confirm if dietary interventions can be used to improve daytime alertness in those with EDS., Competing Interests: The authors declare no conflict of interest.

Study Objectives: Quantitative electroencephalography (EEG) measures of sleep may identify vulnerability to obstructive sleep apnea (OSA) sequelae, however, small clinical studies of sleep microarchitecture in OSA show inconsistent alterations. We examined relationships between quantitative EEG measures during rapid eye movement (REM) and non-REM (NREM) sleep and OSA severity among a large population-based sample of men while accounting for insomnia., Methods: All-night EEG (F4-M1) recordings from full in-home polysomnography (Embletta X100) in 664 men with no prior OSA diagnosis (age ≥ 40) were processed following exclusion of artifacts. Power spectral analysis included non-REM and REM sleep computed absolute EEG power for delta, theta, alpha, sigma, and beta frequency ranges, total power (0.5-32 Hz) and EEG slowing ratio., Results: Apnea-hypopnea index (AHI) ≥10/h was present in 51.2% (severe OSA [AHI ≥ 30/h] 11.6%). In mixed effects regressions, AHI was positively associated with EEG slowing ratio and EEG power across all frequency bands in REM sleep (all p < 0.05); and with beta power during NREM sleep (p = 0.06). Similar associations were observed with oxygen desaturation index (3%). Percentage total sleep time with oxygen saturation <90% was only significantly associated with increased delta, theta, and alpha EEG power in REM sleep. No associations with subjective sleepiness were observed., Conclusions: In a large sample of community-dwelling men, OSA was significantly associated with increased EEG power and EEG slowing predominantly in REM sleep, independent of insomnia. Further study is required to assess if REM EEG slowing related to nocturnal hypoxemia is more sensitive than standard PSG indices or sleepiness in predicting cognitive decline., (© Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Almost one-third of Australians report having made errors at work that are related to sleep issues. While there is significant literature investigating the role of sleep in workplace health and safety in shiftworking and nightwork operations, long working hours, work-family conflict, and commute times getting longer also impact day workers' sleep behaviors and opportunities. The aim of this study was to examine the relationship between sleep duration and disorders, sleep health and hygiene factors, work-related factors and errors at work in Australian workers. From a sample of 1011 Australian adults, age-adjusted binary logistic regression analyses were conducted in 512 workers who provided responses to the question "Thinking about the past three months, how many days did you make errors at work because you were too sleepy or you had a sleep problem?" A number of sleep behaviors and poor sleep hygiene factors were linked with work errors related to sleepiness or sleep problems, with age-adjusted odds of errors (confidence intervals) up to 11.6 times higher (5.4-25.1, p < 0.001) in those that snored, 7.7 (4.6-12.9) times higher in those reporting more than three sleep issues (p < 0.001), 7.0 times higher (3.4-14.8) in short (≤5 hours/night) sleepers (p < 0.021), 6.1 times higher (2.9-12.7) in those staying up later than planned most nights of the week (p< 0.001) and 2.4 times higher (1.6-3.7) in those drinking alcohol ≥3 nights/week before bed (p < 0.001). More than 40% of participants working non-standard hours reported making errors at work, and they were more likely to be young (compared to the main sample of workers) and more likely to engage in work activities in the hour before bed. Sleep factors (other than clinical sleep disorders) were associated with an increased likelihood of sleep-related work errors. Both day workers and those working non-standard hours engage in work, sleep and health behaviors that do not support good sleep health, which may be impacting safety and productivity in the workplace through increased sleepiness-related errors.

Introduction: Sleep disorders are associated with sickness absenteeism (SA), at significant economic cost. Correlates of absenteeism are less well described in nonclinical samples., Participants and Methods: We determined the relationship between markers of inadequate sleep and SA in a sample of 551 working adults aged ≥18 years across Australia. We considered diagnosed obstructive sleep apnea (OSA) and insomnia symptoms, daytime symptoms, and sleepiness with respect to sickness absenteeism (missing ≥1 day of work in the past 28 days because of problems with physical or mental health)., Results: Sickness absenteeism was reported by 27.0% of participants and was more frequent in younger participants, university graduates, and those experiencing financial stress. Sickness absenteeism was independently associated with insomnia (odds ratio [OR]=2.5, confidence interval [CI]=1.5-4.0], OSA (OR=9.8, CI=4.7-20.7), sleep aid use (OR=3.0, CI=1.9-4.7), and daytime symptoms (OR=3.0, CI=2.0-4.6) and inversely associated with perception of getting adequate sleep (OR=0.6, CI=0.4-0.9). Associations persisted in the population free of insomnia and/or OSA., Conclusions: In adults without clinical sleep disorders, sleep behaviors are contributing to sickness absenteeism. An increased focus at an organizational level on improvement of sleep hygiene is important to reduce lost work performance., (Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Soy isoflavone is beneficial for menopausal/postmenopausal symptoms, including sleep complaints. However, little is known about its longitudinal association with sleep in the general population., Objective: Our aim was to investigate the association between soy isoflavone intake and sleep duration and daytime falling asleep among Chinese adults., Design: A longitudinal analysis was performed. Soy isoflavone intake was assessed by food frequency questionnaire. Sleep duration was self-reported at two time points. Occurrence of daytime falling asleep was determined at follow-up. Short and long sleep were defined as sleep <7 h/day or ≥9 h/day, respectively., Participants/setting: Adults aged 20 years and older from the Jiangsu Nutrition Study (2002-2007) with complete isoflavone intake and sleep duration data at both time points (n=1,474) were analyzed (follow-up, n=1,492)., Main Outcome Measures: We measured sleep duration in 2002 and 2007 and daytime falling asleep occurrence in 2007., Statistical Analyses Performed: Mixed-effects logistic regression was performed for repeated measures between isoflavone intake and sleep duration. Logistic regression was performed for daytime falling asleep at follow-up. Demographic, anthropometric, and social factors were adjusted in the analyses., Results: The prevalence of long sleep duration was 18.9% in 2002 and 12.6% in 2007, and the prevalence of daytime falling asleep was 5.3%. Compared with the lowest quartile of isoflavone intake, the highest quartile was associated with a lower risk of long sleep duration (odds ratio=0.66; 95% CI 0.48 to 0.90; P for trend=0.018) over 5 years. Compared with persistent low intake of isoflavone (less than median intake of isoflavone at two time points), persistent high intake was associated with a reduced risk of daytime falling asleep in women (odds ratio=0.20; 95% CI 0.06 to 0.68), but not men. No consistent association between soy isoflavone intake and short sleep duration was found., Conclusions: Soy isoflavone intake was associated with a low risk of long sleep duration in both sexes and a low risk of daytime falling asleep in women but not men., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Emerging evidence suggests potential effects of nutrients/foods on sleep parameters. However, no studies have addressed the complex interactions among nutrients/foods and relate them to sleep outcomes. To investigate the associations between dietary patterns and sleep parameters (polysomnography (PSG) measured and self-reported sleep symptoms) in a large sample of community dwelling men in South Australia., Methods and Study Design: Cross-sectional analysis was conducted of participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort enrolled in a sleep sub-study (n=784, age 35-80 years). Dietary intake was measured by a validated food frequency questionnaire. Dietary patterns were identified by factor analysis. Sleep was assessed by an overnight home PSG and self-reported questionnaires., Results: Two factors were obtained by factor analysis: Factor 1 was characterised by high intakes of vegetables, fruits, and legumes and factor 2 was characterised by processed meat, snacks, red meat and take-away foods. Three categories of the dietary patterns were defined (prudent, mixed and western) through classification of the sample according to the actual consumption higher or lower of each factor. The prudent (factor 1 dominant) and mixed dietary patterns were inversely associated with sleep onset, compared with the western dietary pattern (factor 2 dominant) (β=-6.34 (95% CI-1.11, -11.57), β=-4.34 (95% CI-8.34, -0.34) respectively)). The association was only significant with the prudent dietary pattern after multiple comparison adjustment. No associations were found with between dietary patterns and other sleep outcomes., Conclusions: The prudent dietary pattern was associated with a faster sleep onset, which may provide a solution for sleep management.

Objectives: Cross-sectional studies have indicated an association between fat intake and short sleep. However, whether the association differs by meal occasions, and remains in the long term, is unknown. This study aimed to determine the association between meal specific macronutrients intake (by eating occasions) and persistent short sleep over 5 y., Methods: Data from 1474 Chinese subjects from the Jiangsu Nutrition Study were analyzed. Two time points were examined (i.e., baseline in 2002 and follow-up in 2007). Meal specific food and macronutrients intake was assessed using three-day weighed food records. Sleep duration and sleep related symptoms (daytime sleepiness and falling asleep) were self-reported using a sleep questionnaire. Persistent short sleep was defined as <7 h/d in 2002 and ≤7 h/d in 2007., Results: Overall, 7.4% of the participants reported persistent short sleep. Fluctuation of sleep duration over 5 y was observed with an increase in short-duration sleepers (<7 h) and a decrease in long-duration sleepers (9 h). The highest quartile of fat intake from dinner at baseline was associated with persistent short sleep over 5 y (odds ratio 3.30, 95% confidence interval 1.40-7.79, P for trend 0.003). The highest quartile of fat intake from breakfast at baseline was associated with less falling asleep during the day at follow up (odds ratio 0.36, 95% confidence interval 0.14-0.94, P for trend 0.006). Dinner fat intake at baseline was not associated with short sleep (<7 h) at follow up., Conclusion: The association between fat intake and sleep varies according to how late or how early in the day a meal is eaten by meal occasions. While a high-fat breakfast may prevent daytime falling asleep, a high-fat dinner is-in the case of the Chinese adults of our study-associated with persistent short sleep in Chinese adults., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: There is limited information on sleep duration and obesity among Australian children. The objective of the study is to cross-sectionally examine the relationship between sleep duration and obesity in Australian children aged 5 to 15 years., Methods: Data were collected using the South Australian Monitoring and Surveillance System between January 2004 and December 2008. Each month a representative random sample of South Australians are selected from the Electronic White Pages with interviews conducted using Computer Assisted Telephone Interviewing (CATI). Within each household, the person who was last to have a birthday was selected for interview. Parents reported the number of hours their children slept each day. Obesity was defined according to the International Obesity Task Force (IOTF) definition based on BMI calculated from reported body weight and height., Results: Overall, parents of 3495 children aged 5-15 years (mean 10.7 years, 50.3% boys) were interviewed. The prevalence of obesity was 7.7% (8.9% in boys, 6.6% in girls). In multivariate analysis after adjusting for sociodemographic variables, intake of fruit and vegetables, physical activity and inactivity, the odds ratio (OR) for obesity comparing sleeping <9 hours with ≥10 hours was 2.23 (95% CI 1.04-4.76) among boys, 1.70(0.78-3.73) among girls, and 1.97(1.15-3.38) in both genders. The association between short sleep (<9 hours) and obesity was stronger in the younger age group. No significant association between short sleep and obesity was found among children aged 13-15. There was also an additive interaction between short sleep and low level of physical activity., Conclusion: Short sleep duration is associated with increased obesity in children especially among younger age groups and boys.

Introduction: The aim of this investigation was to determine which factors were associated with symptoms of sleep and mental health disorders in former athletes. Methods: Former athletes (N = 173, 50% women) who retired from any competition level within the last 20 years participated in an online survey. The survey consisted of the Athlete Sleep Screening Questionnaire (ASSQ), Personal Wellbeing Index-Adult (PWI-A), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and Generalised Anxiety Disorder Assessment (GAD-7). Results: Binary logistic regressions revealed that both age (OR = 0.95 [95% CI:0.92, 0.99], p = 0.007) and gender (OR = 2.28 [95% CI:1.09, 4.79], p = 0.029) were associated with anxiety, with women and younger ex-athletes presenting greater risk of anxiety symptoms. Higher body mass was associated with an increased risk for sleep difficulty (OR = 1.13 [95% CI:1.03, 1.23], p = 0.008), sleep disordered breathing (OR = 1.20 [95% CI:1.10, 1.30], p < 0.001), and compromised wellbeing (OR = 0.89 [95% CI:0.83, 0.96], p = 0.001). Athletes who subjectively placed a lower priority on sport while competing presented greater risk of sleep disordered breathing (OR = 2.00[95% CI:1.05, 3.80], p = 0.035). No associations between recency retirement and any outcome measures were observed. Discussion: Findings suggest potential predictive factors for difficulty transitioning out of sport. Future longitudinal research should consider the interplay between sport re-engagement and the incidence and chronicity of sleep and mental health disorders. [ABSTRACT FROM AUTHOR]

Aim: To determine whether a digital nudge soon after dinner reduces after‐dinner snacking events as measured objectively by continuous glucose monitoring (CGM) in patients with type 2 diabetes (T2D). Methods: This is a single‐site micro‐randomized trial (MRT). People with T2D, aged 18‐75 years, managed with diet or a stable dose of oral antidiabetic medications for at least 3 months, and who habitual snack after dinner at least 3 nights per week, will be recruited. Picto‐graphic nudges were designed by mixed research methods. After a 2‐week lead‐in phase to determine eligibility and snacking behaviours by a CGM detection algorithm developed by the investigators, participants will be micro‐randomized daily (1:1) to a second 2‐week period to either a picto‐graphic nudge delivered‐in‐time (Intui Research) or no nudge. During lead‐in and MRT phases, 24‐hour glucose will be measured by CGM, sleep will be tracked by an under‐mattress sleep sensor, and dinner timing will be captured daily by photographing the evening meal. Results: The primary outcome is the difference in the incremental area under the CGM curve between nudging and non‐nudging days during the period from 90 minutes after dinner until 04:00 AM. Secondary outcomes include the effect of baseline characteristics on treatment, and comparisons of glucose peaks and time‐in‐range between nudging and non‐nudging days. The feasibility of 'just‐in‐time' messaging and nudge acceptability will be evaluated, along with the analysis of sleep quality measures and their night‐to‐night variability. Conclusions: This study will provide preliminary evidence of the impact of appropriately timed digital nudges on 24 ‐hour intertitial glucose levels resulting from altered after‐dinner snacking in people with T2D. An exploratory sleep substudy will provide evidence of a bidirectional relationship between after‐dinner snacking behaviour, glycaemia and sleep. Ultimately, this study will allow for the design of a future confirmatory study of the potential for digital nudging to improve health related behaviours and health outcomes. [ABSTRACT FROM AUTHOR]

Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help seeking behaviours for sleep in shift workers is limited. The primary aim of this study was to examine the help seeking behaviours of Australian workers who meet criteria for SWD. Of the 448 (46% of sample, n = 964 total) Australian workers reporting non-standard work hours, 10.5% (n = 41) met the criteria for probable shift work disorder (pSWD). Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD. Of the small proportion of workers with pSWD who sought help, general practitioners were the most common healthcare professionals for sleep problems. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of 'accept it and keep going' as a sleepiness management strategy, highlighting a potential barrier to help seeking behaviour in workers with pSWD. These findings provide novel insight into the help seeking behaviours of those with pSWD. There is a need for further research to understand why individuals at risk for SWD are not actively seeking help, and to develop health promotion and intervention strategies to improve help seeking when needed. [ABSTRACT FROM AUTHOR]

Summary: The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well‐being in Australian adults. A cross‐sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18–90 years. Composite scores of self‐reported healthy sleep were based on Ru‐SATED (R‐SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 (<1 hr). Mental well‐being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ‐5D‐5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well‐being with sleep dimensions, and total R‐SATED (range 0–11) and SATED scores (0–10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well‐being. A 1 unit increase in the total SATED score (mean [SD] 6.6 [2.1]) was associated with less problems on the EQ‐5D‐5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08–1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17–1.23). These estimates did not differ when the total R‐SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well‐being. [ABSTRACT FROM AUTHOR]

Rationale: Recent studies suggest that obstructive sleep apnea (OSA) severity can vary markedly from night to night, which may have important implications for diagnosis and management. Objectives: This study aimed to assess OSA prevalence from multinight in-home recordings and the impact of night-to-night variability in OSA severity on diagnostic classification in a large, global, nonrandomly selected community sample from a consumer database of people that purchased a novel, validated, under-mattress sleep analyzer. Methods: A total of 67,278 individuals aged between 18 and 90 years underwent in-home nightly monitoring over an average of approximately 170 nights per participant between July 2020 and March 2021. OSA was defined as a nightly mean apnea-hypopnea index (AHI) of more than 15 events/h. Outcomes were multinight global prevalence and likelihood of OSA misclassification from a single night's AHI value. Measurements and Main Results: More than 11.6 million nights of data were collected and analyzed. OSA global prevalence was 22.6% (95% confidence interval, 20.9-24.3%). The likelihood of misdiagnosis in people with OSA based on a single night ranged between approximately 20% and 50%. Misdiagnosis error rates decreased with increased monitoring nights (e.g., 1-night F1-score = 0.77 vs. 0.94 for 14 nights) and remained stable after 14 nights of monitoring. Conclusions: Multinight in-home monitoring using novel, noninvasive under-mattress sensor technology indicates a global prevalence of moderate to severe OSA of approximately 20%, and that approximately 20% of people diagnosed with a single-night study may be misclassified. These findings highlight the need to consider night-to-night variation in OSA diagnosis and management. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Withings Sleep Analyzer (WSA) monitoring body movement, breathing pattern, and cardiac activity using the analysis of pressure variations time-series. Topics include chest displacement resulting in variation in pressure detected by the under-the-mattress sensors being used for infering breathing pattern; and participants undertaking simultaneous measures of gold-standard polysomnography and WSA at the Adelaide Institute for Sleep Health.

Background: Obstructive sleep apnoea (OSA) is a significant public health problem affecting a large proportion of the population and is associated with adverse health consequences and a substantial economic burden. Despite the existence of effective treatment, undiagnosed OSA remains a challenge. The gold standard diagnostic tool is polysomnography (PSG), yet the test is expensive, labour intensive and time-consuming. Home-based, limited channel sleep study testing (levels 3 and 4) can advance and widen access to diagnostic services. This systematic review aims to summarise available evidence regarding the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA. Methods: Eligible studies will be identified using a comprehensive strategy across the following databases from inception onwards: MEDLINE, PsychINFO, SCOPUS, CINAHL, Cochrane Library, Emcare and Web of Science Core Collection and ProQuest databases. The search will include a full economic evaluation (i.e. cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) that assesses limited channel tests and PSG. Two reviewers will screen, extract data for included studies and critically appraise the articles for bias and quality. Meta-analyses will be conducted if aggregation of outcomes can be performed. Qualitative synthesis using a dominance ranking matrix will be performed for heterogeneous data. Discussion: This systematic review protocol uses a rigorous, reproducible and transparent methodology and eligibility criteria to provide the current evidence relating to the clinical and economic impact of limited channel and full PSG OSA diagnostic tests. Evidence will be examined using standardised tools specific for economic evaluation studies. Trial registration: PROSPERO (CRD42020150130): [ABSTRACT FROM AUTHOR]

Research related to the paramedic workforce is increasing, particularly given the associations with physical and mental health outcomes. However, it is clear that the evidence base to support future paramedic workforce initiatives lacks longitudinal data in cohorts of paramedics. We identify gaps in the epidemiological evidence base for this workforce, and provide insight into the role that prospective cohorts can, and should, play in future research in the paramedic workforce in order to identify health and safety changes over time, and the associations with job requirements, particularly shift work. [ABSTRACT FROM AUTHOR]

Sleep and circadian rhythm disturbances are prevalent in older populations. Numerous factors can affect sleep, including medications, living environment and physical, mental and psychosocial factors (e.g. loneliness and stress). Sleep architecture changes with aging, with less deep sleep (slow wave sleep) and an increased frequency of awakenings after sleep onset. Benzodiazepines, Z‐drugs and low doses of the tricyclic antidepressant doxepin have modest positive benefits for sleep complaints, but side effects are a concern in older people because they include an increased risk of falls, fractures and cognitive impairment. Somnolence can be prolonged in older adults. Melatonin has very modest effects on sleep initiation in older adults, although appears safe. Overall, the effects of pharmacological treatments are modest and there are concerns about the efficacy and safety of their ongoing use. There is strong evidence for non‐pharmacological interventions, including cognitive and behavioural strategies, to improve sleep. These have at least comparable efficacy to pharmacological interventions, fewer adverse effects and are more likely to have longer‐term, sustained benefits. Sleep complaints in older adults need to be approached on a patient‐by‐patient basis, and medication should be reviewed frequently, with preference to limit pharmacological intervention as far as practicable. [ABSTRACT FROM AUTHOR]

Objective: To assess the suitability for use within economic evaluation of a widely used sleep-related instrument (the Epworth Sleepiness Scale [ESS]) by examining its convergent and discriminant validity with two widely used generic preference-based instruments (Short-Form 36 [SF-36] and the Assessment of Quality of Life 4 dimensions [AQoL-4D]). Methods: Data from a cross-section of 2,236 community-dwelling Australian men were analyzed. Convergent validity was investigated using Spearman’s correlation, intraclass correlation, and modified Bland-Altman plots, while discriminant validity was examined using Kruskal Wallis tests. Results: All instruments showed good discriminant validity. The ESS was weakly correlated to the Short Form 6 dimension, or SF-6D (derived from the SF-36) and AQoL-4D utilities (r = 0.20 and r = 0.19, respectively). Correlations between ESS and SF-36/AQoL-4D dimensions measuring the same construct were all in the hypothesized directions but also weak (range of absolute r = 0.00 to 0.18). The level of agreement between the ESS and AQoL-4D was the weakest, followed by that between the ESS and SF-6D. Moderate convergent validity was seen between the utilities. Conclusions: The lack of convergent validity between the ESS and the preference-based instruments shows that sleep-related constructs are not captured by the latter. The ESS has, however, demonstrated good discriminant validity comparable to that of the AQoL-4D and the SF-36/SF-6D and would therefore be equally useful for measuring subgroup differences within economic evaluation. We therefore recommend using the ESS within cost-effectiveness analysis as a complement to preference-based instruments in order to capture sleep-specific constructs not measured by the latter. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of musculoskeletal pain with objectively determined obstructive sleep apnea (OSA) and subjective sleep measures in a population-based sample.Methods: Participants were community-dwelling men (n = 360) age ≥35 years from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study. Shoulder, back, hip, knee, hand, and foot pain were assessed by computer-assisted telephone interview or self-completed questionnaire. OSA was determined with full in-home unattended polysomnography (Embletta X100) scored by 2007 American Academy of Sleep Medicine alternative criteria. The Epworth Sleepiness Scale assessed daytime sleepiness and the Pittsburgh Sleep Quality Index assessed sleep quality.Results: OSA was not associated with the presence of any joint pain (adjusted odds ratio [OR] 1.03 [95% confidence interval (95% CI) 0.61-1.76]). There was no association between OSA and pain in any specific joint (shoulder, back, hip, knee, hand, or foot), nor was the number of joints in pain associated with OSA. There was, similarly, no association between pain variables and excessive daytime sleepiness, except for hand pain (OR 3.10 [95% CI 1.50-6.39]). However, pain was associated with poor sleep quality: any pain (OR 2.19 [95% CI 1.25-3.82]), shoulder pain (OR 2.16 [95% CI 1.25-3.75]), back pain (OR 2.24 [95% CI 1.41-3.55]), and foot pain (OR 2.47 [95% CI 1.43-4.26]). The number of painful joints was also associated with poor sleep quality (5-6 joints versus no joints OR 7.34 [95% CI 2.30-23.42]).Conclusion: No association between OSA and pain or between daytime sleepiness and pain was found. Consistent with previous reports, poor sleep quality was associated with musculoskeletal pain in this population sample. The etiologic differences between OSA-related sleep disruption and poor subjective sleep quality require further investigation. [ABSTRACT FROM AUTHOR]

Background Diet and sleep are strongly and bidirectionally linked. This study aims to assess the association between dietary inflammatory index (DII) and sleep duration using the National Health and Nutrition Survey (NHANS) of the United States. Methods A total of 27,999 (median age 47 years, 48.6% male) participants were included. Dietary data were collected using 24-hour recall method and DII was calculated using 27 nutrients. Quantiles of DII were constructed (quantile 1, least inflammatory; quantile 5, most inflammatory). Self-reported habitual sleep duration was categorized as ≤ 6 hr (short sleep), ≥7 hr (normal/long sleep). We used log-binomial and multinomial logistic regression, adjusted for potential confounders, to examine the association between DII and short sleep duration. Sensitivity analysis was performed by excluding common chronic diseases. The analyses were adjusted using NHANES sampling weights. Results In the fully adjusted model, higher DII score was associated with shorter sleep duration [odds ratio (OR)quartile2vs1=1.04; 95% confidence interval (CI): 0.84-1.29; ORquartile3vs1=1.27; 95% CI: 1.06, 1.52; ORquartile4vs1=95% CI: 1.47; 95 CI: 1.25, 1.74; ORquartile5vs1=1.62; 95% CI: 1.33, 1.97; P for trend<0.0001]. A similar trend of association was observed with long sleep duration and in both male and female participants. Participants in the fifth quantile, compared to those in the first, on average had 6 minutes (95% CI: 1, 11) less sleep. Conclusions Pro-inflammatory diet was positively associated with increased odds of short sleep duration. Key messages Patients with short sleep duration may benefit from avoiding pro-inflammatory foods. The association between DII and sleep duration could be bidirectional. [ABSTRACT FROM AUTHOR]

Sleep disturbances are commonly reported by patients with autoimmune disease, and are negatively related to both disease activity and quality of life. Despite the potential for sleep disturbance to exacerbate inflammatory pathways, acute management of sleep disturbance with pharmacological aids is not well understood in this patient group. The objective of this review was to determine the efficacy of pharmacological treatments for sleep disturbance to improve sleep outcomes in adult patients with diagnosed autoimmune disease. Four databases and grey literature were searched for randomized controlled trials which used a pharmacological treatment specifically to treat sleep disturbance in patients with diagnosed autoimmune disease, both in hospitalized and non-hospitalized settings. A sleep outcome was required to be the primary endpoint of the study. Of the 409 studies identified, a total of six were included in the systematic review. Risk of bias across the studies was largely unclear, making an assessment challenging; meta-analysis was not undertaken due to clinical and methodological heterogeneity between studies. While there appeared to be perceived improvement in self-reported sleep quantity and quality in existing studies with pharmacological treatment, there was also evidence of placebo effect on some measures. Relatively small numbers of patients have undergone gold-standard polysomnographic (PSG) recording of sleep which limits our knowledge of objectively determined sleep quantity and quality in patients with autoimmune disease receiving pharmacological treatment for sleep disturbance. Presently there is insufficient evidence to determine whether pharmacological treatment of sleep disturbance is beneficial for improving sleep quantity and quality in this patient group beyond rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

The article reflects on several studies related to the obstructive sleep apnoea (OSA) that were published within the periodical in 2016. Topics discussed include linkage between the brain disorder schizophrenia and OSA, treatment of previously undiagnosed OSA expected to lead to improvements in the main drivers of morbidity and mortality; and OSA expected to increase oxidative stress and sympathetic activation.

Objective: Investigate associations of objective and subjective indicators of sleep impairment and disorders with low muscle strength (LMS) in different age groups and genders using data from a population-based cohort study.Methods: Polysomnographic and subjective sleep data from participants (aged 40-80 years) of the HypnoLaus study (Lausanne, Switzerland) were cross-sectionally analyzed. Indicators of sleep impairment and disorders were based on pre-defined cutoffs. LMS was defined according to the diagnosis of sarcopenia (grip strength <27 kg for men and <16 kg for women). Results obtained by multivariate logistic regression were controlled for confounders.Results: 1902 participants (mean [SD] age, 57.4 [10.5] years; 968 [50.9 %] female) were enrolled. Objective short (<6.2 h) and long sleep durations (>8.5 h) were associated with LMS (OR = 1.74, 95 % CI = 1.07-2.82; OR = 6.66, 95 % CI = 3.45-12.87, respectively). Increased nighttime wakefulness >90 min and severe obstructive apnea (OSA) (AHI > 30) were associated with LMS (OR = 1.60, 95 % CI = 1.01-2.56; OR = 2.36, 95 % CI = 1.29-4.31, respectively). In adults aged over 60 years, these associations persisted, and reduced sleep efficiency was associated with LMS (aOR = 1.81, 95 % CI 1.05-3.13). Objective long sleep duration was associated with LMS in both genders and severe OSA predicted LMS among women (aOR = 2.64, 95 % CI 1.11-6.24).Conclusions: Markers of early sarcopenia are affected by long sleep duration from middle age onwards in both genders. Older adults are more susceptible to the effects of other indicators of inappropriate sleep duration and quality. The findings support a potential role of sarcopenia in age-related OSA. The intricate relationships between sleep and muscle health are potential targets of public health interventions and clinical research on preventive and therapeutic strategies against the increasing morbimortality observed with ageing. [ABSTRACT FROM AUTHOR]

Background and Objectives: Emerging evidence suggests potential effects of nutrients/foods on sleep parameters. However, no studies have addressed the complex interactions among nutrients/foods and relate them to sleep outcomes. To investigate the associations between dietary patterns and sleep parameters (polysomnography (PSG) measured and self-reported sleep symptoms) in a large sample of community dwelling men in South Australia.Methods and Study Design: Cross-sectional analysis was conducted of participants in the Men Androgen Inflammation Lifestyle Environment and Stress cohort enrolled in a sleep sub-study (n=784, age 35-80 years). Dietary intake was measured by a validated food frequency questionnaire. Dietary patterns were identified by factor analysis. Sleep was assessed by an overnight home PSG and self-reported questionnaires.Results: Two factors were obtained by factor analysis: Factor 1 was characterised by high intakes of vegetables, fruits, and legumes and factor 2 was characterised by processed meat, snacks, red meat and take-away foods. Three categories of the dietary patterns were defined (prudent, mixed and western) through classification of the sample according to the actual consumption higher or lower of each factor. The prudent (factor 1 dominant) and mixed dietary patterns were inversely associated with sleep onset, compared with the western dietary pattern (factor 2 dominant) (β=-6.34 (95% CI-1.11, -11.57), β=-4.34 (95% CI-8.34, -0.34) respectively)). The association was only significant with the prudent dietary pattern after multiple comparison adjustment. No associations were found with between dietary patterns and other sleep outcomes.Conclusions: The prudent dietary pattern was associated with a faster sleep onset, which may provide a solution for sleep management. [ABSTRACT FROM AUTHOR]

Objective: To assess whether monosodium glutamate (MSG) intake is associated with sleepdisordered breathing (SDB). Methods: Data from 1227 Chinese subjects who participated in the Jiangsu Nutrition Study were analyzed. All the participants were examined at two time points (baseline in 2002 and follow-up in 2007). The MSG intake was assessed quantitatively in 2002 and a sleep questionnaire was used to assess snoring and to construct an SDB probability score in 2007. Those within the fifth quintile of the score (highest) were defined as having a high probability of SDB. Results: The MSG intake was positively associated with snoring and a high probability of SDB in participants who had a normal body weight but in those who were overweight. A comparison of the extreme quartiles of MSG intake in subjects with a body mass index lower than 23 kg/m² showed an odds ratio of 2.02 (95% confidence interval 1.02-4.00) for snoring and an odds ratio of 3.11 (95% confidence interval 1.10-8.84) for a high probability of SDB. There was a joint effect between MSG and overweight in relation to SDB. Conclusion: The intake of MSG may increase the risk of SDB in Chinese adults with a normal body weight. [ABSTRACT FROM AUTHOR]