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The hypnagogic state refers to a transitional stage between wakefulness and sleep, in which sensory perceptions can be experienced. In this review, we compile and discuss the recent scientific literature on hypnagogia research regarding the future directions proposed by Schacter (1976; Psychological Bulletin, 83, 452). After a short introduction discussing the terminology used in hypnagogia research and the differentiation of hypnagogic states with other related phenomena, we review the reported prevalence of hypnagogic states. Then, we evaluate the six future directions suggested by Schacter and we propose three further future directions. First, a better understanding of the emotional quality of hypnagogic states is needed. Second, a better understanding of why hypnagogic states occur so frequently in the visual and kinaesthetic modalities is needed. Lastly, a better understanding of the purpose of hypnagogic states is needed. In conclusion, research has made great progress in recent years, and we are one step closer to demystifying the hypnagogic state., (© 2022 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

This article examines the question of sleeping (or not) during the course of ethnographic fieldwork. It is argued that the concept of what is termed here 'sleepwork' has yet to be fully addressed or adequately problematised in the fields of sociology and social anthropology, in particular. The first part of the article highlights the relative silence about sleeping and fieldwork in the literature on qualitative research methods, and reflects upon why this subject is largely absent from the ethnographic corpus. I then make a number of propositions about some potential methodological strategies for incorporating 'sleepwork' into fieldwork. The second part of the article suggests that data analysis should not be seen as an activity that only occurs in states of wakefulness, but rather as a 24/7 activity that is undertaken with varying intensity. [ABSTRACT FROM AUTHOR]

Sleep dysfunction is prevalent among patients with schizophrenia. Although sex differences have been identified in schizophrenia, sex differences in sleep patterns among patients with schizophrenia are not established. Therefore, the current study examined sex differences in subjective sleep quality patterns in people with schizophrenia utilizing a standardized inventory. Study sample consisted of 75 patients with schizophrenia and 82 healthy controls (HC). Participants completed the Pittsburgh Sleep Quality Index (PSQI). Compared to HC, patients with schizophrenia were more likely to report being poor sleepers (PSQI global score > 5), longer sleep duration, more sleep disturbances, longer sleep onset latency, increased daytime dysfunction due to poor sleep, and more frequent use of sleep medications. Regarding sex differences, female patients were more likely to report being poor sleepers and endorsed more sleep disturbances than female HC, while male patients reported longer sleep duration, more daytime dysfunction, and poorer overall sleep quality relative to male HC. Additionally, higher level of sleep dysfunction was linked to higher symptom severity in male patients only. Patients with schizophrenia endorsed a range of sleep difficulties, and male and female patients with schizophrenia differ compared to their HC counterparts. Implications for treatment of sleep complaints among patients with schizophrenia are discussed. [ABSTRACT FROM AUTHOR]

A growing body of work supports linear associations between sleep and socioemotional adjustment in adolescence. However, associations between sleep and adjustment are not necessarily linear and investigations of nonlinear effects are scarce. This study examined linear and nonlinear relations between several sleep-wake parameters and externalizing behavior and internalizing symptoms in adolescence, and assessed the role of adolescent sex as a moderator of effects. Participants were high school students (N = 180; M age = 17.49, SD =.62; 59% female; 68% White/European American, 32% Black/African American) from a wide range of socio-economic backgrounds living in semirural communities and small towns in Alabama. Sleep-wake parameters were indexed by actigraphy-derived sleep minutes and adolescents' reports on morningness-eveningness (circadian preference), sleep-wake problems (sleep quality), and sleepiness. Adolescents completed questionnaires on externalizing behaviors and internalizing symptoms. Controlling for sleep duration, a higher preference for eveningness and poor sleep quality were associated in a linear fashion with increased externalizing and internalizing symptoms. Nonlinear relations between sleepiness and internalizing symptoms emerged with pronounced sex-related effects, including somewhat delayed accelerating relations for males and rapidly accelerating associations that tended to plateau for females. Results illustrate the importance of examining multiple sleep-wake and adjustment variables as well as linear and nonlinear associations. [ABSTRACT FROM AUTHOR]

Sleep duration and sleep quality are often linked to increased risk of mortality and morbidity. However, national representative data on both sleep duration and sleep quality and their relationship with chronic health problems are rarely available from the same source. This current study aimed to examine the independent and combined associations of sleep duration and sleep quality with physical and mental disorders, using data from the Singapore Mental Health Study 2016. 6,126 residents aged ≥18years participated in this epidemiological, cross-sectional survey. Sleep measures were assessed using the Pittsburg Sleep Quality Index while lifetime or 12-month medical and psychiatric diagnoses were established using the Composite International Diagnostic Interview 3.0. Both short sleep (<6hrs compared to 7-8hrs) and poor sleep were found to be independently associated with chronic pain, obsessive compulsive disorder and any mental disorder while poor sleep was additionally associated with major depressive disorder, bipolar disorder, generalized anxiety disorder and any physical disorder, when adjusted for confounders. Poor sleep combined with short sleep (≤6hrs/day vs 7-8hrs/day) was associated with the highest number of comorbidities among other sleep combinations. Sleep duration and sleep quality, when adjusted for each other, remained independently associated with both physical and mental disorders. Affective disorders may be more closely related to poor sleep quality compared to abnormal sleep duration. Our findings suggest sleep quality to be a more important indicator for psychological and overall health compared to sleep duration. [ABSTRACT FROM AUTHOR]

Rationale: The nuclear receptor retinoid X receptor (RXR) belongs to a nuclear receptor superfamily that modulates diverse functions via homodimerization with itself or several other nuclear receptors, including PPARα. While the activation of PPARα by natural or synthetic agonists regulates the sleep-wake cycle, the role of RXR in the sleep modulation is unknown. Objectives: We investigated the effects of bexarotene (Bexa, a RXR agonist) or UVI 3003 (UVI, a RXR antagonist) on sleep, sleep homeostasis, levels of neurochemical related to sleep modulation, and c-Fos and NeuN expression. Methods: The sleep-wake cycle and sleep homeostasis were analyzed after application of Bexa or UVI. Moreover, we also evaluated whether Bexa or UVI could induce effects on dopamine, serotonin, norepinephrine epinephrine, adenosine, and acetylcholine contents, collected from either the nucleus accumbens or basal forebrain. In addition, c-Fos and NeuN expression in the hypothalamus was determined after Bexa or UVI treatments. Results: Systemic application of Bexa (1 mM, i.p.) attenuated slow-wave sleep and rapid eye movement sleep. In addition, Bexa increased the levels of dopamine, serotonin, norepinephrine epinephrine, adenosine, and acetylcholine sampled from either the nucleus accumbens or basal forebrain. Moreover, Bexa blocked the sleep rebound period after total sleep deprivation, increased in the hypothalamus the expression of c-Fos, and decreased NeuN activity. Remarkably, UVI 3003 (1 mM, i.p.) induced opposite effects in sleep, sleep homeostasis, neurochemicals levels, and c-Fos and NeuN activity. Conclusions: The administration of RXR agonist or antagonist significantly impaired the sleep-wake cycle and exerted effects on the levels of neurochemicals related to sleep modulation. Moreover, Bexa or UVI administration significantly affected c-Fos and NeuN expression in the hypothalamus. Our findings highlight the neurobiological role of RXR on sleep modulation. [ABSTRACT FROM AUTHOR]

Objective: To assess the independent and combined effects of night sleep duration and sleep quality on depressive symptoms.Methods: A total of 28,202 participants (11,236 males and 16,966 females) aged 18-79 years from the Henan Rural Cohort were included in this study. Night sleep duration and sleep quality were defined by the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and restricted cubic splines were applied to evaluate the association of night sleep duration and sleep quality with depressive symptoms.Results: A U-shaped dose-response relationship between night sleep duration and depressive symptoms along with a J-shaped relationship between sleep quality and depressive symptoms were observed. Compared with reference group (7-<8 h), shorter sleep duration (<6 h) and longer sleep duration (≥10 h) were associated with increased risk of depressive symptoms in males (short sleep: Odds Ratio (OR) = 1.84, 95% confidence interval (CI), 1.34-2.52; long sleep: OR = 1.56, 95% CI, 1.01-2.42) and females (short sleep: OR = 2.19, 95% CI, 1.77-2.70; long sleep: OR = 1.51, 95% CI, 1.10-2.10). Compared with good sleepers, poor sleepers had 4.23-fold (95% CI:3.54-5.06) and 3.87-fold (95% CI: 3.41-4.40) increased odds of depressive symptoms in males and females. Furthermore, participants with longer night sleep duration (≥10 h) and poorer sleep quality had the strongest effect on depressive symptoms (males: OR = 6.64, 95% CI, 3.21-13.74; females: OR = 7.76, 95% CI, 5.00-12.02).Conclusions: Extreme night sleep duration and poor sleep quality were independently and combinedly related to elevated depressive symptoms, suggesting that keeping optimal night sleep duration and good sleep quality maybe benefit for maintaining mental health.Trial Registration: Chinese Clinical Trial Register. Registration number: ChiCTR-OOC-15006699. [ABSTRACT FROM AUTHOR]

Circadian rhythms refer to biological rhythms that have an endogenous period length of approximately 24 hr. However, not much is known about the variance in the development of the sleep–wake rhythm. The study objectives were (a) to describe the normative variation in the development of a sleep–wake rhythm in infancy, (b) to assess whether slower development is related to sleep quality and (c) to evaluate factors that are related to the slower development of a sleep–wake rhythm. The study is based on a representative birth cohort. Questionnaires at the ages of 3 (n = 1,427) and 8 months (n = 1,302) and actigraph measurement at 8 months (n = 372) were available. Infants with significant developmental delays (n = 11) were excluded. The results are based on statistical testing and multivariate modelling. We found that the average percentage of daytime sleep was 36.3% (standard deviation [SD], 8.5%) at 3 months and 25.6% (SD, 6.6%) at 8 months. At both time‐points, infants with slower sleep–wake rhythm development slept more hours per day, had a later sleep–wake rhythm, more difficulties in settling to sleep and longer sleep‐onset latency; they also spent a longer time awake during the night. According to actigraph registrations, we found that the infants with slow development of a sleep–wake rhythm slept less and had a later start and end to night‐time sleep than the other infants. Infants' sleep–wake rhythm development is highly variable and is related to parent‐reported and objectively measured sleep quality and quantity. Interventions to improve the sleep–wake rhythm might improve sleep quality in these infants. [ABSTRACT FROM AUTHOR]

Background: Sleep and physical activity are modifiable behaviors that play an important role in preventing overweight, obesity, and metabolic health problems. Studies of the association between concurrent objective measures of sleep, physical activity, and metabolic risk factors among adolescents are limited. Objective: The aim of the study was to examine the association between metabolic risk factors and objectively measured school day physical activity and sleep duration, quality, onset, and variability in adolescents. Materials and methods: We measured one school week of free-living sleep and physical activity with wrist actigraphy in 252 adolescents (146 girls), aged 15.8±0.3 years. Metabolic risk factors included body mass index, waist circumference, total body and trunk fat percentage, resting blood pressure, and fasting glucose and insulin levels. Multiple linear regression adjusted for sex, parental education, and day length was used to assess associations between metabolic risk factors and sleep and activity parameters. Results: On average, participants went to bed at 00:22±0.88 hours and slept 6.2±0.7 hours/night, with 0.83±0.36 hours of awakenings/night. However, night-to-night variability in sleep duration was considerable (mean ± interquartile range) 0.75±0.55 hours) and bedtime (0.64±0.53 hours) respectively. Neither average sleep duration nor mean bedtime was associated with any metabolic risk factors. However, greater night-to-night variability in sleep duration and bedtime was associated with higher total body and trunk fat percentage, and less physical activity was associated with higher trunk fat percentage and insulin levels. Conclusion: Greater nightly variation in sleep duration and in bedtime and less physical activity were associated with a less favorable metabolic profile in adolescents. These findings support the idea that, along with an adequate amount of physical activity, a regular sleep schedule is important for the metabolic health of adolescents. [ABSTRACT FROM AUTHOR]

Study Objectives: To analyze the association between sleep-related symptoms and sleep length in parents and their children in relation to other risk factors in both generations.Method: The participants were parents (n = 5,855, age 54.3 ± 6.5 years, 45.2% men) who participated in the community-based Respiratory Health in Northern Europe (RHINE) study and one random member of their adult offspring (n = 5,855, age 30.2 ± 7.7 years, 41.5% men) who participated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS.Results: All sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and parents' total number of children, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI: 1.52, 1.20-1.93), DMS (1.34, 1.15-1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15-2.37), insomnia (1.39, 1.13-1.73), short sleep time (<6 h/night) (2.51, 1.72-3.68) and EDS (1.48, 1.26,1.72). There were no independent relationships between symptoms in parents and offspring for EMA, nocturnal sweating or long sleep time (>9 h/night).Conclusion: The familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems. [ABSTRACT FROM AUTHOR]

Summary: Sleep disruption is common among intensive care unit patients, with potentially detrimental consequences. Environmental factors are thought to play a central role in ICU sleep disruption, and so it is unclear why environmental interventions have shown limited improvements in objectively assessed sleep. In critically ill patients, it is difficult to isolate the influence of environmental factors from the varying contributions of non‐environmental factors. We thus investigated the effects of the ICU environment on self‐reported and objective sleep quality in 10 healthy nurses and doctors with no history of sleep pathology or current or past ICU employment participated. Their sleep at home, in an unfamiliar environment ('Control'), and in an active ICU ('ICU') was evaluated using polysomnography and the Richard‐Campbell Sleep Questionnaire. Environmental sound, light and temperature exposure were measured continuously. We found that the control and ICU environment were noisier and warmer, but not darker than the home environment. Sleep on the ICU was perceived as qualitatively worse than in the home and control environment, despite relatively modest effects on polysomnography parameters compared with home sleep: mean total sleep times were reduced by 48 min, mean rapid eye movement sleep latency increased by 45 min, and the arousal index increased by 9. Arousability to an awake state by sound was similar. Our results suggest that the ICU environment plays a significant but partial role in objectively assessed ICU sleep impairment in patients, which may explain the limited improvement of objectively assessed sleep after environmental interventions. [ABSTRACT FROM AUTHOR]

Focusing on lucid dreaming, this paper examined relationships between dissociated experiences related to rapid eye movement (REM) sleep (lucid dreaming, nightmares, and sleep paralysis), reality testing, and paranormal experiences/beliefs. The study comprised a UK-based online sample of 455 respondents (110 males, 345 females, Mean age = 34.46 years, SD = 15.70), who had all previously experienced lucid dreaming. Respondents completed established self-report measures assessing control within lucid dreaming, experience and frequency of nightmares, incidence of sleep paralysis, proneness to reality testing deficits (Inventory of Personality Organization subscale, IPO-RT), subjective experience of receptive psi and life after death (paranormal experience), and paranormal belief. Analysis comprised tests of correlational and predictive relationships between sleep-related outcomes, IPO-RT scores, and paranormal measures. Significant positive correlations between sleep and paranormal measures were weak. Paranormal measures related differentially to sleep indices. Paranormal experience correlated with lucid dreaming, nightmares, and sleep paralysis, whereas paranormal belief related only to nightmares and sleep paralysis. IPO-RT correlated positively with all paranormal and sleep-related measures. Within the IPO-RT, the Auditory and Visual Hallucinations sub-factor demonstrated the strongest positive associations with sleep measures. Structural equation modeling indicated that Auditory and Visual Hallucinations significantly positively predicted dissociated experiences related to REM sleep, while paranormal experience did not. However, paranormal experience was a significant predictor when analysis controlled for Auditory and Visual Hallucinations. The moderate positive association between these variables explained this effect. Findings indicated that self-generated, productive cognitive-processes (as encompassed by Auditory and Visual Hallucinations) played a significant role in conscious control and awareness of lucid dreaming, and related dissociative sleep states (sleep paralysis and nightmares). [ABSTRACT FROM AUTHOR]

Objective: To elucidate the sleep quality characteristics and factors related to either good or poor sleep quality in acromegaly patients before surgery and to explore sleep quality changes after transsphenoidal surgery and the factors related to these changes.Methods: We prospectively enrolled 39 acromegaly patients and 78 patients with nonfunctioning pituitary adenomas. Scales for anxiety, depression, disease stigma and nasal condition were evaluated. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered before surgery as well as one month and three months after surgery.Results: A higher percentage of acromegaly patients had poor sleep quality compared to controls (35.9% vs. 5.1%, p < 0.001). In addition, acromegaly patients experienced worse subjective sleep quality, extended sleep latency, increased sleep disturbance and decreased daytime functioning. Higher scores for anxiety, disease stigma and sinonasal outcomes were correlated with worse sleep quality in acromegaly patients. At one month after transsphenoidal surgery, we found worse subjective sleep quality, extended sleep latency, shortened sleep duration, impaired sleep efficiency and increased sleep disturbance in acromegaly patients. At three months postoperatively, most impaired PSQI domains in acromegaly patients recovered to preoperative levels. The use of soluble gauze was related to decreased sleep quality at one month after surgery and severe anxiety and depression were related to improved sleep quality at three months after surgery.Conclusions: Sleep quality was reduced in acromegaly patients. Moreover, sleep quality initially worsened after surgery but later recovered. Emotional problems and the use of soluble gauze were related factors.Clinical Trial Registration: None. [ABSTRACT FROM AUTHOR]

Objective: In forensic psychiatric patients, sleep problems as well as impulsivity and aggression are highly prevalent, yet studies on their association over time are lacking. This study investigates the association between sleep quality and changes in impulsivity and aggression in forensic psychiatric patients over one year.Methods: Data were drawn from an ongoing prospective observational study in adult forensic psychiatric patients admitted to a forensic treatment facility between October 2006 and January 2018. Validated self-reports and observational instruments were used to assess sleep quality, impulsivity and aggression upon admission to the hospital and after one year. Linear regression analyses were performed to examine the association between sleep quality, impulsivity and aggression. All models were adjusted for baseline values of outcome measures, demographic features and general psychopathology.Results: Data from 83 men (age 37.7 ± 11.7 years) with completed consecutive measurements were analyzed. Poor sleep quality was associated with increased self-reported aggression (β = 1.08; 95% CI, 0.38-1.78). This association was positively confounded by general psychopathology, indicating that sleep quality is specifically related to self-reported aggression instead of being part of general psychopathology (adjusted β = 1.18; 95% CI, 0.39-1.97). Poor sleep quality was not associated with changes in self-reported impulsivity, clinician-rated impulsivity or clinician-rated hostility in this population.Conclusion: Poor sleep quality was associated with an increase in self-reported aggression over one year in male forensic psychiatric patients. Early evaluation and treatment of sleep problems in (forensic) psychiatric patients may play an important role in reducing the risk of aggressive behavior. [ABSTRACT FROM AUTHOR]

Study Objectives: Sleep disorders are significant problems in patients with rheumatoid arthritis (RA) and are associated with poor quality of life. Irisin is myokine which may have anti-inflammatory and energy regulatory roles. This study assessed the association of serum irisin levels with the quality of sleep and disease activity in RA patients.Methods: In sum, 58 RA patients and 30 matched healthy controls were included. Disease activity score in 28 joints (DAS28-ESR) and the patients' global score were calculated. RA patients were grouped according to the Pittsburgh Sleep Quality Index score (PSQI) into good-sleepers (group 1) defined as a PQSI score≤5 and poor sleepers (group 2) with a PSQI > 5. Serum irisin levels were measured for both patients and controls by commercially available enzyme-linked immunosorbent assay kits.Results: Poor sleep quality was found in 26 (45%) of the RA patients. Irisin levels were significantly lower in RA patients with poor sleep compared to those with good sleep and healthy controls (p < 0.001). Serum irisin levels correlated inversely with disease duration, morning stiffness duration, DAS28-ESR, global score, and total PSQI score (r = -0.722 to -0.263 & p values≤0.001-0.04) indicating a possible anti-inflammatory role of irisin in RA patients. The analysis employed Student's t-test, ANOVA, and Pearson correlation.Conclusions: Irisin levels were decreased in RA patients with poor sleep quality compared to RA patients with good sleep quality and healthy controls, indicating a possible association of decreased serum irisin with sleep impairment in RA patients. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the neural mechanisms of brain-wave music on sleep quality. Background: Sleep disorders are a common health problem in our society and may result in fatigue, depression, and problems in daytime functioning. Previous studies have shown that brain-wave music generated from electroencephalography (EEG) signals could emotionally affect our nervous system and have positive effects on sleep. However, the neural mechanisms of brain-wave music on the quality of sleep need to be clarified. Methods: A total of 33 young participants were recruited and randomly divided into three groups. The participants listened to rapid eye movement (REM) brain-wave music (Group 1: 13 subjects), slow-wave sleep (SWS) brain-wave music (Group 2: 11 subjects), or white noise (WN) (Control Group: 9 subjects) for 20 min before bedtime for 6 days. EEG and other physiological signals were recorded by polysomnography. Results: We found that the sleep efficiency increased in the SWS group but decreased in REM and WN groups. The sleep efficiency in the SWS group was ameliorated [ t (10) = −1.943, p = 0.076]. In the EEG power spectral density analysis, the delta power spectral density in the REM group and in the control group increased, while that in the SWS group decreased [ F (2,31) = 7.909, p = 0.005]. In the network analysis, the functional connectivity (FC), assessed with Pearson correlation coefficients, showed that the connectivity strength decreased [ t (10) = 1.969, p = 0.073] between the left frontal lobe (F3) and left parietal lobe (C3) in the SWS group. In addition, there was a negative correlation between the FC of the left frontal lobe and the left parietal lobe and sleep latency in the SWS group (r = −0.527, p = 0.064). Conclusion: Slow-wave sleep brain-wave music may have a positive effect on sleep quality, while REM brain-wave music or WN may not have a positive effect. Furthermore, better sleep quality might be caused by a decrease in the power spectral density of the delta band of EEG and an increase in the FC between the left frontal lobe and the left parietal lobe. SWS brain-wave music could be a safe and inexpensive method for clinical use if confirmed by more data. [ABSTRACT FROM AUTHOR]

Objective: Driving during young adulthood is a time of increased crash risk. Many factors (e.g., driving experience, aggression) contribute to the increased risk, but factors associated with daytime sleepiness and sleep health may also contribute. The current study examined the relationships between experiences of sleepiness, sleep timing and stability, sleep-impaired emotional regulation, and sleep-impaired cognition among younger persons engaging in 2 risky sleepy driving behaviors: Continuing to drive while sleepy and having experienced a sleep-related close call.Method: The study was advertised in the Queensland University of Technology's online environment and 137 young adults (58.39% women) aged 18 to 25 years completed an anonymous online questionnaire assessing aspects related to daytime sleepiness, sleep timing and stability, sleep-impaired emotional regulation, and sleep-impaired cognition.Results: In total, 15.38% of the participants reported that they had experienced a sleep-related close call. The main outcomes were that both age and the sleep-impaired emotional regulation variable were associated with the outcome variables. The study variables accounted for 18.94% of the variance in continuing to drive while sleepy, and the same variables accounted for 42.69% of the variance (Nagelkerke's R2 statistic) in having had a sleep-related close call. Shorter sleep durations and greater levels of sleep-impaired cognition were significantly associated with having a sleep-related close call.Conclusion: Different variables were associated with the 2 risky driving behaviors, suggesting different underlying factors. Sleep-impaired emotional regulation and/or sleep-impaired cognition could be used to signal drivers that they are impaired by sleepiness. [ABSTRACT FROM AUTHOR]

Eveningness and sleep disturbances are considered as markers of Bipolar Disorder (BD) and influence mood and emotional or behavioral states. This study investigates the associations between circadian markers and sleep quality on residual depressive symptoms and inhibition/activation dimensions during the euthymic phase. A sample of 89 euthymic adult individuals with BD was assessed for circadian preference and typology using the Composite Scale of Morningness (CSM) and the Circadian Type Inventory (CTI) and for sleep quality using the Pittsburgh Sleep Quality Index (PSQI). The Montgomery and Asberg Depression Rating Scale (MADRS) and the Multidimensional Assessment of Thymic States (MAThyS) were used to measure residual depressive symptoms and the inhibition/activation dimensions. We examined any associations between these parameters using correlations and path analyses. We identified significant associations between eveningness and poorer sleep quality that correlated to higher depressive residual symptoms and a global inhibition. The use of path analyses led us to conclude that poor sleep quality mediated the relationship between eveningness and either residual mood symptoms or behavioral inhibition (motivation, sensory perception, interpersonal interaction, and cognition). These factors should be considered in the clinical evaluation of individuals with BD, with a specific attention during the euthymic phase, in order to achieve the best functional outcome possible. [ABSTRACT FROM AUTHOR]

Background/objective: Sleep problems are commonly reported by individuals with Autism Spectrum Disorder (ASD). However, to date, no quantitative evidence synthesis of available studies has been performed to quantify sleep alterations in adults with ASD. We performed a systematic review and meta-analysis of objective (ie, based on actigraphy or polysomnography [PSG]) and subjective (ie, based on sleep diaries/questionnaires) studies comparing sleep parameters in adults with ASD and in a typically developing (TD) control group.Methods: PubMed, OVID databases and Web of Knowledge were systematically searched up to February 2019 with no language restrictions. Original studies including adults with a diagnosis of ASD according to DSM, ICD, or based on standard diagnostic tools (eg, ADOS), and a TD control group were included. Random-effects models were used. Study quality was evaluated with the Newcastle Ottawa Scale (NOS). Analyses were conducted using Comprehensive Meta-Analysis.Results: From initial pool of 1948 references, 14 publications including 8 datasets, (194 ASD and 277 controls) met the inclusion criteria. Compared to controls, individuals with ASD were significantly more impaired in six out of 11 subjective parameters, including lower sleep efficiency (SE, SMD = -0.87, CI = -1.14 - 0.60) and in 10 out of 17 objective outcomes, including longer sleep onset latency (PSG) (SMD = 0.86, CI = 0.29-1.07) and wake after sleep onset (WASO, actigraphy) (SMD = 0.57, CI = 0.28-0.87). The mean NOS score was 4.88/6.Conclusions: Individuals with ASD demonstrated impaired sleep compared to controls in most subjective and objective measures. [ABSTRACT FROM AUTHOR]

Background: Sleep is related to various kinds of health outcomes. Many studies traditionally collect data on sleep using questionnaires or sleep diaries. An increasing popular alternative is a wrist-worn device. The accuracy of these devices is uncertain, and assessment of this accuracy is important. Introduction: The purpose of this study is to compare consensus sleep diary (CSD) and an actigraphy-based wrist-worn device (Fitbit Alta™ [Fitbit, San Francisco, CA]) measurements of total sleep time (TST), sleep onset latency, wake time after sleep onset, number of awakenings, and sleep efficiency. Materials and Methods: Ten healthy young adults (50% female, 100% Asian) in the age range between 20 to 24 years old wore a Fitbit Alta around their nondominated hand during seven consecutive nights. The participants also filled in a CSD every day. Results: On average, the wrist-worn device (Fitbit Alta) recorded a TST per night of 437.15 min, which is 5.46 min shorter on average than the CSD recorded (442.61 min). Bland–Altman plots indicate that there is large variance in the sleep recorded between Fitbit™ (Fitbit, San Francisco, CA) and CSD. For example, Fitbit recorded 2.15 more awakenings per night than CSD, which is equal to 13.09 min on average longer wake time after sleep onset. Conclusion: Fitbit and CSD show significant differences in recording sleep. We find that for most sleep metrics, the level of disagreement is small enough for the devices to be interchangeably used except for recording wakes during the night. [ABSTRACT FROM AUTHOR]

Background: The usage of smart-devices has increased considerably both globally and specifically in Middle Eastern countries. Recently, it has been shown that 65% of United Arab Emirates (UAE) residents lack proper sleep. Several health aspects of the relationship between over usage of smart-devices and poor sleep quality have not been thoroughly investigated. This study aims to determine the correlation between smart-device overuse and sleep quality among UAE residents.Methods: This is a cross-sectional, self-administered questionnaire-based study. Our sample comprised 494 participants, from the three major cities in the UAE. Statistical and regression analyses were conducted using SPSS.Results: Overall, 47.5% of the population were considered heavy users of smart-devices, of which 81% were poor sleepers. Furthermore, the physical proximity of the smart-device at night affected sleep quality; as the distance decreased, the sleep quality worsened, reaching a value of 86.8%. It was also found that 74.5% of the participants used their smart-device at bedtime.Conclusion: Poor sleep is strongly correlated with smart-device overuse. Specifically, poor sleepers were five times more likely to be overusers. The intensity and duration of smart-device usage during the whole day impacted sleep quality more drastically than just before bedtime usage. With the increasing dependence and inappropriate use of smart-devices, future studies are needed to further understand the short and long term impact of this trend on the health and wellbeing of younger individuals as well as the whole community. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to establish the determinants of perceived sleep quality over a longer period of time, taking into account the separate contributions of actigraphy-based sleep measures and self-reported sleep indices. Methods: Fifty participants (52 ± 6.6 years; 27 females) completed two consecutive weeks of home monitoring, during which they kept a sleep–wake diary while their sleep was monitored using a wrist-worn actigraph. The diary included questions on perceived sleep quality, sleep–wake information, and additional factors such as well-being and stress. The data were analyzed using multilevel models to compare a model that included only actigraphy-based sleep measures (model Acti) to a model that included only self-reported sleep measures to explain perceived sleep quality (model Self). In addition, a model based on the self-reported sleep measures and extended with nonsleep-related factors was analyzed to find the most significant determinants of perceived sleep quality (model Extended). Results: Self-reported sleep measures (model Self) explained 61% of the total variance, while actigraphy-based sleep measures (model Acti) only accounted for 41% of the perceived sleep quality. The main predictors in the self-reported model were number of awakenings during the night, sleep onset latency, and wake time after sleep onset. In the extended model, the number of awakenings during the night and total sleep time of the previous night were the strongest determinants of perceived sleep quality, with 64% of the variance explained. Conclusion: In our cohort, perceived sleep quality was mainly determined by self-reported sleep measures and less by actigraphy-based sleep indices. These data further stress the importance of taking multiple nights into account when trying to understand perceived sleep quality. [ABSTRACT FROM AUTHOR]

Background: Sleep-disordered breathing may precipitate angina pectoris (AP) in rapid eye movement (REM) sleep. The purpose of this study was to investigate whether REM sleep is associated with the incidence of AP in different categories of apnea-hypopnea index (AHI).Methods: A total of 2710 participants from Sleep Heart Health Study (59.3% women; mean age 61.7 years), who had 6-8 h of sleep; experienced an almost 11-year follow-up period. Complete polysomnography data and medical records were available for all participants. Percentage of REM sleep time (REM%) was classified into grade 1 (<20%), grade 2 (20-25%) and grade 3 (>25%). Logistic regression analysis was used to characterize the independent association between REM sleep and prevalent AP in this multi-center community-based cohort study.Results: Patients with REM% of grade 3 had a higher incidence of AP than those with grade 1 and grade 2 (50.3% vs 42.4% vs 42.1%, respectively; p = 0.003). After adjusting for age, gender, race, AHI, marital status, education level, body mass index, sleep duration, arousal index, diabetes, hypertension and smoking status, multivariate logistic regression analysis revealed that REM% >25% was independently associated with the occurrence of AP (odds ratio = 1.500; 95% confidence interval = 1.188-1.894; p = 0.001).Conclusions: The percentage of REM sleep time may affect the incidence of AP irrespective of AHI level. Therefore, the relationship between sleep structure and cardiovascular disease merits further exploration. [ABSTRACT FROM AUTHOR]

Objective: Isolated sleep paralysis (ISP) is a relatively common parasomnia often accompanied by fear and distress. However, little is known about the range and relative severities of typical ISP symptoms and accompanying hallucinations. Furthermore, there have been inconsistent findings with regard to demographic differences in ISP.Patients/method: In sum, 185 individuals with ISP (and 322 controls) were assessed for 27 symptoms and hallucinations using a clinical interview and trained diagnosticians. Insomnia symptoms were also assessed.Results: Rates of ISP did not differ according to gender or ethnic minority status, but higher levels of insomnia were associated with episodes. The participants with ISP reported a mean of 7.73 symptoms beyond atonia. Hallucinations of the presence of others were relatively common. Specifically, 57.84% of the sample sensed a presence in the room with them during ISP, and the majority believed it to be a non-human presence. In addition, 21.62% of the sample experienced visual hallucinations of others, with the majority perceiving strangers as opposed to known individuals. A panoply of supernatural/paranormal entities were reported by the 24.32% of participants who hallucinated non-human beings. A minority of individuals with ISP experienced clinically-significant distress (10.27%) and/or impairment (7.57%) as a result of episodes.Conclusion: ISP episodes were complex and often multisensorial experiences, and the majority of assessed symptoms were associated with clinically-significant levels of fear/distress. Vivid hallucinations of other people and entities were common as well, and it is recommended that ISP be assessed when patients report seemingly anomalous experiences. [ABSTRACT FROM AUTHOR]

Background: In healthy populations, irregular sleep patterns are associated with delayed sleep and poor functional/mood outcomes. Currently, it is unknown whether irregular sleep contributes to poor functional/mood outcomes in individuals with Delayed Sleep-Wake Phase Disorder (DSWPD).Methods: In 170 patients with DSWPD, we collected sleep-wake patterns, dim light melatonin onset (DLMO), and functional/mood outcomes. The Sleep Regularity Index (SRI) and other sleep timing metrics were computed. Correlations of SRI were computed with phase angle (difference between DLMO and desired bedtime), sleep timing and quality variables, daytime function, sleep-related daytime impairment, mood, and insomnia symptom severity. Path analyses assessed whether SRI or total sleep time mediated the associations between sleep onset time and phase angle with daytime functioning, sleep-related impairment, and mood outcomes.Results: Higher SRI was associated with earlier sleep and longer total sleep time, but did not relate to sleep quality, daytime function, or mood outcomes. Path analysis showed that phase angle was directly associated with all outcome variables, whereas sleep onset time was not directly associated with any. SRI mediated the effects of sleep onset time and phase angle on daytime function. Total sleep time mediated the effects of sleep onset time and phase angle on sleep-related impairment.Conclusion: Individuals with DSWPD who have more delayed sleep and a greater phase angle also have more irregular sleep. This suggests that it is not delayed sleep timing per se that drives poor functional outcomes in DSWPD, but rather the timing of sleep relative to circadian phase and resultant irregular sleep patterns. [ABSTRACT FROM AUTHOR]

Shift work is associated with vitamin D level, sleep quality, and depressive symptoms. Vitamin D and sleep quality are also associated with depressive symptoms. The purpose of this study was to compare vitamin D level, sleep quality, and depressive symptoms between shift workers and daytime workers and analyze the mediating effect of vitamin D and sleep quality between shift work and depressive symptoms. Among those who participated in the Kangbuk Samsung Health Study in 2012 and 2014, 82,078 cases of full-time workers were analyzed. We evaluated their shift work, vitamin D level, sleep quality, and depressive symptoms with blood samples and questionnaires. Chi-square tests, t-tests, and path statistical analysis were performed. More depressive symptoms, lower vitamin D levels, and poorer sleep quality were associated with shift work. According to a path analysis, shift work had both a direct effect and an indirect effect on depressive symptoms, each mediated by sleep quality and vitamin D level. When a multigroup analysis was conducted for each sex, paths containing sleep quality were more significant in female shift workers than male shift workers; paths involving vitamin D did not differ between sexes. To assess depression risk in shift workers, evaluating vitamin D level and sleep quality is essential. Also, sleep problems are more prevalent in female compared to male shift workers with respect depression prevalence. [ABSTRACT FROM AUTHOR]

Aim: To test the association between cardiometabolic risk factors and subjective sleep quality assessed by the Pittsburgh sleep quality index (PSQI), independent of obstructive sleep apnea (OSA) and sleep duration.Methods: A total of 573 participants from the Baependi Heart Study, a rural cohort from Brazil, completed sleep questionnaires and underwent polygraphy for OSA evaluation. Multivariable linear regression analysis tested the association between cardiovascular risk factors (outcome variables) and sleep quality measured by PSQI, adjusting for OSA and other potential confounders (age, sex, race, salary/wage, education, marital status, alcohol intake, obesity, smoking, hypertension, and sleep duration).Results: The sample mean age was 43 ± 16 years, 66% were female, and mean body mass index (BMI) was 26 ± 5 kg/m2. Only 20% were classified as obese (BMI ≥30). Overall, 50% of participants reported poor sleep quality as defined by a PSQI score ≥5. A high PSQI score was significantly associated with higher very-low-density lipoprotein (VLDL) cholesterol levels (beta = 0.392, p = 0.012) and higher triglyceride levels (beta = 0.017, p = 0.006), even after adjustments, including the apnea-hypopnea index. Further adjustments accounting for marital status, alcohol intake, and medication use did not change these findings. No significant association was observed between PSQI scores and glucose or blood pressure. According to PSQI components, sleep disturbances (beta = 1.976, p = 0.027), sleep medication use (beta = 1.121, p = 0.019), and daytime dysfunction (beta = 1.290, p = 0.024) were significantly associated with higher VLDL serum levels. Only the daytime dysfunction domain of the PSQI components was significantly associated with higher triglyceride levels (beta = 0.066, p = 0.004).Conclusion: Poorer lipid profile was independently associated with poor sleep quality, assessed by the PSQI questionnaire, regardless of a normal sleep duration and accounting for OSA and socio-economic status. [ABSTRACT FROM AUTHOR]

Objective: The present cross-sectional study investigated the relationship between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and the presence of poor sleep quality in a community-based Japanese adult population.Methods: Poor sleep quality, defined as poor subjective sleep quality and/or use of sleep medications, was assessed using a self-administered questionnaire. The prevalence of poor sleep quality was compared among 512 Japanese participants aged 35-79 years, based on serum 25(OH)D3 levels, which were determined using tandem mass spectrometry. A logistic regression model was used to calculate the odds ratios (ORs) for the presence of poor sleep quality in each group with the highest quartile of 25(OH)D3 serving as the reference group.Results: Poor sleep quality was reported by 33.2% of the total study population. The prevalence of poor sleep quality was higher in the first quartile group (25[OH]D3: 2.08-18.13 ng/mL) than in the second, third and fourth quartile groups (18.14-23.07 ng/mL, 23.08-28.32 ng/mL, and 28.33-78.83 ng/mL, respectively). The ORs for poor sleep quality were 1.86 (95% confidence interval, 1.08-3.20) for the first quartile group, 0.73 (0.41-1.29) for the second quartile group, and 0.73 (0.42-1.27) for the third quartile group after adjusting for age, sex, and sociodemographic, lifestyle, physical and environmental factors, while the ORs were 1.68 (0.96-2.95), 0.69 (0.39-1.24), and 0.65 (0.37-1.15) after further adjustment for overall health status and depression status.Conclusions: The first quartile group of serum 25(OH)D3 was associated with the presence of poor sleep quality. [ABSTRACT FROM AUTHOR]

Background: The hemodialysis regimen is an inevitable and mandatory treatment for patients with end-stage renal disease (ESRD). During the dialysis journey, patients may experience maladaptation in terms of sleep disturbances, depressive symptoms, and reduced health-related quality of life (HRQOL). Psychosocial resources such as social support may have beneficial influences on health outcomes, but studies have rarely analyzed the integrated relationships among risk factors which include pain, sleep disturbances, duration since diagnosis and various health outcomes in Taiwan. This study aimed to bridge this gap by investigating the relationships among related risk factors, social support, sleep disturbances, depressive symptoms, and HRQOL, which is composed of physical quality of life (PQOL) and mental quality of life (MQOL), in ESRD patients. Method: A correlational design was used, and 178 patients aged 20 years or older were recruited via convenience sample. The relationships among the risk factors, the mediators, depressive symptoms, PQOL, and MQOL were analyzed using structural equation modeling. Results: The findings showed that more than 70% of the participants reported poor sleep quality, and 32% reported depressive symptoms. When participants had greater pain and more sleep disorders, they were more likely to be depressed. When participants had more appraisal support; they had better PQOL and fewer depressive symptoms. Overall, the structural equation model explained 31.8% of the variance in self-reported depressive symptoms, 29.4% of the variance in PQOL, and 5.7% of the variance in MQOL. Moreover, appraisal support enhanced PQOL and reduced depressive symptoms by exerting its two mediating effects on sleep disturbances. Conclusion: Our findings indicate that patients with ESRD who have more social support have better PQOL and MQOL and fewer depressive symptoms than those with less social support. [ABSTRACT FROM AUTHOR]

Objective: Maternal depressive symptoms during pregnancy have been associated with poor offspring sleep. Yet, it remains unknown whether depressive symptoms throughout pregnancy are more harmful to the child than depressive symptoms only during certain time periods in pregnancy, whether associations are specific to pregnancy stage, whether maternal symptomatology after pregnancy mediates or adds to the prenatal effects, and whether any effects are specific to some child sleep characteristics.Methods: A total of 2321 mothers from the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study completed the Center for Epidemiological Studies Depression Scale biweekly between gestational weeks + days 12 + 0/13 + 6 and 38 + 0/39 + 6. At child's mean age of 3.5 (standard deviation = 0.7) years, mothers completed the Beck Depression Inventory-II and answered questions on child sleep quantity and quality using the Brief Infant Sleep Questionnaire (BISQ) and sleep disorders using the Sleep Disturbance Scale for Children.Results: Maternal depressive symptoms showed high stability throughout pregnancy. Children of mothers with clinically significant symptomatology throughout pregnancy had shorter mother-rated sleep duration, longer sleep latency, higher odds for waking up two or more times during the night and for total and several specific sleep disorders. These associations were robust to covariates. However, maternal depressive symptoms at the child follow-up fully mediated the associations with sleep duration and awakenings, partially mediated those with sleep latency and disorders, and added to the effects on sleep disorders.Conclusion: Maternal depressive symptoms throughout pregnancy are associated with mother-rated child sleep quantity, quality, and disorders. Maternal depressive symptoms at child follow-up mediate and add to the prenatal adverse effects on child sleep characteristics. [ABSTRACT FROM AUTHOR]

Research has shown that greater stress responses predict worse sleep and that the quality of one's current romantic relationship predicts one's sleep. Despite these established links, research has not examined connections between ongoing patterns of interpersonal experiences and competencies (relationship effectiveness) and stress exposure on sleep. Participants in the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) completed measures assessing relationship effectiveness and stress exposure at ages 23 and 32 years, as well as sleep quality/duration at age 37 years. Analyses demonstrate that relationship effectiveness at age 23 years positively predicts sleep quality—but not sleep duration—at age 37 years via reduced stress exposure at age 32 years. These findings highlight the effects of relationship effectiveness and stress exposure across early to middle adulthood on sleep. [ABSTRACT FROM AUTHOR]

Dysregulation of sleep and feeding has widespread health consequences. Despite extensive epidemiological evidence for interactions between sleep and metabolic function, little is known about the neural or molecular basis underlying the integration of these processes. D. melanogaster potently suppress sleep in response to starvation, and powerful genetic tools allow for mechanistic investigation of sleep–metabolism interactions. We have previously identified neurons expressing the neuropeptide leucokinin (Lk) as being required for starvation-mediated changes in sleep. Here, we demonstrate an essential role for Lk neuropeptide in metabolic regulation of sleep. The activity of Lk neurons is modulated by feeding, with reduced activity in response to glucose and increased activity under starvation conditions. Both genetic silencing and laser-mediated microablation localize Lk-dependent sleep regulation to a single pair of Lk neurons within the Lateral Horn (LHLK neurons). A targeted screen identified a role for 5′ adenosine monophosphate-activated protein kinase (AMPK) in starvation-modulated changes in sleep. Knockdown of AMPK in Lk neurons suppresses sleep and increases LHLK neuron activity in fed flies, phenocopying the starvation state. Further, we find a requirement for the Lk receptor in the insulin-producing cells (IPCs), suggesting LHLK–IPC connectivity is critical for sleep regulation under starved conditions. Taken together, these findings localize feeding-state–dependent regulation of sleep to a single pair of neurons within the fruit fly brain and provide a system for investigating the cellular basis of sleep–metabolism interactions. [ABSTRACT FROM AUTHOR]

Background and purpose: Cluster headache (CH) is characterized by severe, unilateral attacks of pain and a high nocturnal attack burden. It remains unknown whether perturbations of sleep are solely present during the CH bout. Therefore, we aimed to investigate differences in sleep between the bout and remission period in patients with episodic CH and, secondly, to compare patients in the two phases with controls. Methods: Patients with episodic CH (aged 18–65 years), diagnosed according to the International Classification of Headache Disorders 2nd edition, were admitted for polysomnography at the Danish Center for Sleep Medicine in bout and in remission. The macrostructure of sleep, including arousals, breathing parameters, limb movements and periodic limb movements, was compared with 25 age‐, sex‐ and body mass index‐matched healthy controls. Results: There were no differences in any of the sleep parameters for patients in bout (n = 32) compared with patients in remission (n = 23). Attacks were unrelated to sleep stages, presence of apnea episodes, periodic limb movements, limb movements and arousals. In bout, patients had longer sleep latency (18.8 vs. 11.7 min, P < 0.05) and rapid eye movement sleep latency (1.7 vs. 1.2 h, P < 0.05) than controls and sleep efficiency was lower (82.5% vs. 86.5%, P < 0.05). Patients in remission only had a longer sleep latency compared with controls (17.5 vs. 11.7 min, P < 0.01). Conclusions: The results support the presence of a continuing or slowly recovering disturbance of sleep outside the bout rather than a disturbance occurring secondary to attacks. Further, we confirm that there is no relation between CH attacks and specific sleep stages or between CH and breathing parameters. [ABSTRACT FROM AUTHOR]

Highlights • Alternating Leg Muscle Activation, Hypnagogic Foot Tremor, High Frequency Leg Movements are minor motor activities in sleep. • HFT, ALMA and the more recently described HFLM have overlapping features. • Restless Legs Syndrome should be excluded carefully in patients with an accidental finding of HFLM pattern. [ABSTRACT FROM AUTHOR]

Background/aim: The aims of this study were to primarily investigate fatigue and sleep and to secondarily examine possible relationships between disease activity, pain, and functional ability in children and adolescents with juvenile idiopathic arthritis (JIA). Materials and methods: Ninety-six patients were enrolled in the study. Disease activity, functional ability, fatigue symptoms, fatigue severity, and sleep quality were assessed with the Juvenile Arthritis Disease Activity Score (JADAS), Childhood Health Assessment Questionnaire (CHAQ), Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale (PedsQL-F), visual analog scale (VAS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Results: Fatigue severity was moderate to high in 75% of patients with JIA and sleep quality was poor in 40% of them. VAS-fatigue was correlated with VAS-pain, VAS-wellbeing, PSQI, and sleep duration (P < 0.001). Significant relationships were found between the PedsQL-F and all other parameters except JADAS (P < 0.05). VAS-fatigue, CHAQ, and PSQI were identified as significant predictors of PedsQL-F (P < 0.05). Sleep quality, pain, and sleep duration were also significant predictors of fatigue severity (P < 0.05). Conclusion: This study suggests that fatigue and sleep problems are common problems in JIA. If underlying factors of fatigue and sleep are understood, strategies for improving sleep/fatigue paradox may develop in JIA. [ABSTRACT FROM AUTHOR]

Highlights • We tested the effects of sleep deprivation on an active avoidance task in zebrafish. • Sleep plays an important role in memory and learning processes. • Partial sleep deprivation did not impair stimulus perception and learning. • Total sleep deprivation impaired the fish's ability to respond to the task. • Ethanol exposure improved learning following sleep deprivation. Abstract The zebrafish (Danio rerio) has become a valuable model organism for behavioral studies examining learning and memory. Its diurnal circadian rhythm and characterized sleep-like state make it comparable to mammals, features that have contributed to establishing this small vertebrate as a translational model for sleep research. Despite sleep being an evolutionarily conserved behavior, its mechanisms and functions are still debated. Sleep deprivation is commonly associated with decreased attention, reduced responsiveness to external stimuli, altered locomotor activity and impaired performance on cognitive tasks. In the current study, we examined the effects of partial and total sleep deprivation on zebrafish learning performance in an active avoidance conditioning paradigm. In addition, we examined the effects of two drugs known to alter sleep (alcohol and melatonin) on learning performance in sleep deprived animals. Our results suggest that although partial sleep deprivation did not alter learning performance, total sleep deprivation was found to significantly impair behavioral responses to the electric shock as well as avoidance learning. However, when sleep deprived fish were treated with alcohol the night before the learning task, learning performance was similar to the control group. In contrast, melatonin treatment did not alter learning performance in sleep deprived animals. We conclude that the zebrafish is a sensitive tool for investigating the effects of sleep deprivation on cognitive performance and may be a useful model for dissecting the mechanisms underlying learning and memory. [ABSTRACT FROM AUTHOR]

Objective: Clearance of the pharynx by deglutition, which removes matter that could be aspirated, is important in protecting the airways and lungs against aspiration. The deglutition and respiratory phase patterns during sleep in the aged with obstructive sleep apnea syndrome (OSAS) were investigated. Study Design: Retrospective study with case groups. Methods: Ten aged adults with severe OSAS (average age 75, average apnea‐hypopnea index 43.8) were examined via time‐matched digital recordings of polysomnography and surface electromyography of the muscles (thyrohyoid and suprahyoid) related to swallowing and compared with aged adults without OSAS previously reported on. Results: During sleep, swallowing was infrequent and absent for long periods. The median number of swallows per hour during total sleep time was 4.1 and the median longest deglutition‐free period was 70.5 minutes. Three‐fourths of deglutition occurred in association with respiratory electroencephalographic arousal. Deglutition was related to the sleep stage. The deeper the sleep stage, the lower the mean deglutition frequency. The median number of swallows per hour was 5.7 during stage N1 sleep and 2.8 during stage N2 sleep. There was no deglutition during stage N3 (deep) sleep. The median number of swallows per hour was 0.6 during REM sleep. Approximately 40% of swallows occurred after inspiration and approximately 42% were followed by inspiration. Conclusion: Deglutition was infrequent and respiratory phase patterns were unique during sleep in the aged with OSAS. Sleep‐related deglutition and respiratory phase patterns may adversely influence aspiration‐related diseases (aspiration pneumonia, etc) in the aged with sleep‐related breathing disorders. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Keywords: sleep; hd-EEG; MEG; fMRI-EEG; K-complex; slow wave; spindle; connectivity D'Ambrosio et al. summarize the neurophysiological bases of local sleep and compare it to other forms of intrusions of sleep into wakefulness, such as microsleep episodes. In line with this, Christensen et al. demonstrate that insomnia patients are characterized by a stronger expression of sleep patterns characteristic of light sleep or wakefulness, even during the deepest stages of sleep, indicating a deep sleep fragility. [Extracted from the article]

Objectives: In sleep laboratory studies, the new environment is generally considered to disturb sleep during the first night. However, older women have rarely been studied. Although menopause and hormone therapy affect sleep, their impact on the first-night effect is virtually unknown. Participants: Four groups of women with no sleep laboratory experience: young on hormonal contraceptives (n = 11, 23.1 [0.5] years), perimenopausal (n = 15, 48.0 [0.4] years), postmenopausal without hormone therapy (HT; off-HT, n = 22, 63.4 [0.8] years) and postmenopausal with HT (n = 16, 63.1 [0.9] years). Procedure: A cross-sectional study. Methods: Polysomnography was performed over two consecutive nights and the first-night effect and group differences were evaluated. Questionnaire-based insomnia and sleepiness scores were correlated to sleep variables and their between-night changes. Results: Although sleep in young women was deeper and less fragmented than in the other groups, first-night effect was similar in all study groups. Total sleep time, sleep efficiency, and S1 and S2 sleep increased, and wake after sleep onset, awakenings per hour of sleep, S2 and REM latencies, and percentage of SWS decreased from the first to the second night. Perimenopausal women had more insomnia complaints than other women. Insomnia complaints were associated with more disturbed sleep but not with the first-night effect. Conclusions: A first night in a sleep laboratory elicits a marked interference of sleep architecture in women of all ages, with a carryover effect of lighter sleep on the second study night. Menopausal state, HT use, or insomnia complaints do not modify this effect. [ABSTRACT FROM AUTHOR]

This study examined the extent to which individual differences in time perspective, i.e., habitual way of relating to the personal past, present, and future, are associated with sleep quality and daytime sleepiness in a sample of older adults. The participants (N = 437, 60–90 years) completed the Karolinska Sleep Questionnaire (KSQ), a the Swedish version of the Zimbardo Time Perspective Inventory (S-ZTPI), and two ratings of subjective well-being (SWB) (life satisfaction, happiness). Based on established relationships between dimension of time perspective and other variables (e.g., depression) and relations between negative retrospection (rumination) and negative prospection (worry) in prior studies, we expected higher scores on Past Negative and Future Negative to be linked to poor sleep quality and (indirectly) increased daytime sleepiness. Moreover, we examined the possibility that variations in perceived sleep and sleepiness during the day mediates the expected association between an aggregate measure of deviations from a so called balanced time perspective (DBTP) and SWB. In regression analyses controlling for demographic factors (age, sex, and work status), higher scores on Past Negative and Future Negative predicted poorer sleep quality and higher levels of daytime sleepiness. Additionally, most of the association between time perspective and daytime sleepiness was accounted for by individual differences in sleep quality. Finally, structural equation modeling yielded results consistent with the hypothesis that variations in sleep mediate part of the negative relationship between DBTP and SWB. Given that good sleep is essential to multiple aspects of health, future studies evaluating relationships between time perspective and adverse health outcomes should consider sleep quality as a potentially contributing factor. [ABSTRACT FROM AUTHOR]

There are many ways in which women experience sleep differently from men. Women contending with distinct sleep challenges respond differently to sleep disorders, as well as sleep deprivation and deficiency, and face particular health outcomes as a result of poor sleep. Idiosyncrasies, including changes that occur with the biological life cycles of menstruation, pregnancy, and menopause, make the understanding of sleep in women an important topic to study. Each phase of a woman's life, from childhood to menopause, increases the risk of sleep disturbance in unique ways that may require distinct management. Indeed, new research is unraveling novel aspects of sleep pathology in women and the fundamental role that sex hormones play in influencing sleep regulation and arousals and possibly outcomes of sleep conditions. Moreover, studies indicate that during times of hormonal change, women are at an increased risk for sleep disturbances such as poor sleep quality and sleep deprivation, as well as sleep disorders such as OSA, restless legs syndrome, and insomnia. This article reviews sleep changes in female subjects from neonatal life to menopause. [ABSTRACT FROM AUTHOR]

Introduction: Shift work schedules are biological standpoint worse because compel the body to anticipate periods of wakefulness and sleep and thus eventually cause a disruption of biological rhythms. Objective: The objective of this study is to evaluate the sleep pattern and decision-making in physicians working in mobile units of emergency attention undergoing day shift and rotating shift. Methods: The study included 26 physicians. The instruments utilized were a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index, the Sleep Habits Questionnaire, the Epworth Sleepiness Scale and Chronotype Identification Questionnaire of Horne-Ostberg, the Iowa Gambling Task (IGT) and hypothetical scenarios of decision-making created according to the Policy-Capturing Technique. For inclusion and exclusion criteria, the participants answered the Chalder Fatigue Scale, the Beck Anxiety Inventory, the Beck Depression Inventory and the Inventory of Stress Symptoms for adults of Lipp. Results: It was found good sleep quality for physicians on day shift schedule and bad sleep quality for physicians on rotating shift schedule. The IGT measure showed no impairment in decision-making, but the hypothetical scenarios revealed impairment decision-making during the shift for both schedules. Good sleep quality was related to a better performance in decision-making. Conclusion: Good sleep quality seems to influence a better performance in decision-making. [ABSTRACT FROM AUTHOR]

Sleep disruption is a prevalent clinical feature in many neurodegenerative disorders, including human prion diseases where it can be the defining dysfunction, as in the case of the "eponymous" fatal familial insomnia, or an early-stage symptom as in certain types of Creutzfeldt-Jakob disease. It is important to establish the role of the cellular prion protein (PrPC), the key molecule involved in prion pathogenesis, within the sleep-wake system in order to understand fully the mechanisms underlying its contribution to both healthy circadian rhythmicity and sleep dysfunction during disease. Although severe disruption to the circadian rhythm and melatonin release is evident during the pathogenic phases of some prion diseases, untangling whether PrPC plays a role in circadian rhythmicity, as suggested in mice deficient for PrPC expression, is challenging given the lack of basic experimental research. We provide a short review of the small amount of direct literature focused on the role of PrPC in melatonin and circadian rhythm regulation, as well as suggesting mechanisms by which PrPC might exert influence upon noradrenergic and dopaminergic signaling and melatonin synthesis. Future research in this area should focus upon isolating the points of dysfunction within the retino-pineal pathway and further investigate PrPC mediation of pinealocyte GPCR activity. [ABSTRACT FROM AUTHOR]

Hcrt gene inactivation in mice leads to behavioral state instability, abnormal transitions to paradoxical sleep, and cataplexy, hallmarks of narcolepsy. Sleep homeostasis is, however, considered unimpaired in patients and narcoleptic mice. We find that whereas Hcrtko/ko mice respond to 6-h sleep deprivation (SD) with a slowwave sleep (SWS) EEG δ (1.0 to 4.0 Hz) power rebound like WT littermates, spontaneous waking fails to induce a δ power reflecting prior waking duration. This correlates with impaired θ (6.0 to 9.5 Hz) and fast-γ (55 to 80 Hz) activity in prior waking. We algorithmically identify a theta-dominated wakefulness (TDW) substate underlying motivated behaviors and typically preceding cataplexy in Hcrtko/ko mice. Hcrtko/ko mice fully implement TDW when waking is enforced, but spontaneous TDW episode duration is greatly reduced. A reformulation of the classic sleep homeostasis model, where homeostatic pressure rises exclusively in TDW rather than all waking, predicts δ power dynamics both in Hcrtko/ko and WT mouse baseline and recovery SWS. The low homeostatic impact of Hcrtko/ko mouse spontaneous waking correlates with decreased cortical expression of neuronal activityrelated genes (notably Bdnf, Egr1/Zif268, and Per2). Thus, spontaneous TDW stability relies on Hcrt to sustain θ/fast-γ network activity and associated plasticity, whereas other arousal circuits sustain TDW during SD. We propose that TDW identifies a discrete global brain activity mode that is regulated by contextdependent neuromodulators and acts as a major driver of sleep homeostasis. Hcrt loss in Hcrtko/ko mice causes impaired TDW maintenance in baseline wake and blunted δ power in SWS, reproducing, respectively, narcolepsy excessive daytime sleepiness and poor sleep quality. [ABSTRACT FROM AUTHOR]

This study examined mothers' and fathers' beliefs about responding to infant night wakings across the first year of life, changes in those beliefs, and how individual maternal and paternal beliefs and interparental discrepancy in beliefs about responding to infant night wakings related to parents' perceptions of coparenting quality. Participants were 167 mothers and 155 fathers who reported on their own beliefs about responding to infant night wakings and perceptions of coparenting quality when infants were 1, 3, 6, 9, and 12 months old. As predicted, mothers endorsed stronger beliefs about responding more immediately to infant night wakings than fathers, but for both parents these beliefs declined over the first year. Troubled beliefs about responding to infant night wakings predicted worse coparenting quality. In addition, the discrepancy between mothers' and fathers' beliefs predicted coparenting quality such that a larger discrepancy in parents' beliefs about responding to infant night wakings significantly predicted poorer perceptions of coparenting, particularly in the early months, but only when mothers endorsed stronger beliefs than fathers. Results emphasize the importance of communication and concordance in nighttime parenting practices for aspects of parents' coparenting relationship. Future research should consider the importance of examining domain-specific parenting practices and cognitions as well as interparental discrepancies when assessing coparenting quality. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

The combination of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is associated with substantial morbidity and mortality. We hypothesized that predictors of OSA among patients with COPD may be distinct from OSA in the general population. Therefore, we investigated associations between traditional OSA risk factors (e.g. age), and sleep questionnaires [e.g. Epworth Sleepiness Scale] in 44 patients with advanced COPD. As a second aim we proposed a pilot, simplified screening test for OSA in patients with COPD. In a prospective, observational study of patients enrolled in the UCSD Pulmonary Rehabilitation Program we collected baseline characteristics, cardiovascular events (e.g. atrial fibrillation), and sleep questionnaires [e.g. Pittsburgh Sleep Quality Index (PSQI)]. For the pilot questionnaire, a BMI ≥25 kg/m2 and the presence of cardiovascular disease were used to construct the pilot screening test. Male: 59%; OSA 66%. FEV1 (mean ± SD) = 41.0±18.2% pred., FEV1/FVC = 41.5±12.7%]. Male gender, older age, and large neck circumference were not associated with OSA. Also, Epworth Sleepiness Scale and the STOP-Bang questionnaire were not associated with OSA in univariate logistic regression. In contrast, BMI ≥25 kg/m2 (OR = 3.94, p = 0.04) and diagnosis of cardiovascular disease (OR = 5.06, p = 0.03) were significantly associated with OSA [area under curve (AUC) = 0.74]. The pilot COPD-OSA test (OR = 5.28, p = 0.05) and STOP-Bang questionnaire (OR = 5.13, p = 0.03) were both associated with OSA in Receiver Operating Characteristics (ROC) analysis. The COPD-OSA test had the best AUC (0.74), sensitivity (92%), and specificity (83%). A ten-fold cross-validation validated our results. We found that traditional OSA predictors (e.g. gender, Epworth score) did not perform well in patients with more advanced COPD. Our pilot test may be an easy to implement instrument to screen for OSA. However, a larger validation study is necessary before further clinical implementation is warranted. [ABSTRACT FROM AUTHOR]

Objective: This study examined the effects of total and partial sleep deprivation on subjective symptoms and objective neurocognitive performance, as measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in a sample of healthy adults. Method: One-hundred and two, right-handed, healthy participants (between ages 18 and 30 years old) completed three consecutive nights in the sleep laboratory with concurrent continuous polysomnography monitoring. Night 1 served as a baseline night. Prior to Night 2, they were randomly assigned to one of three sleep conditions: undisrupted normal sleep (N = 34), sleep restriction (50% of habitual sleep, N = 37), or total sleep deprivation (N = 31). Participants slept undisturbed on Night 3. ImPACT was administered on three separate occasions. Results: Sleep loss was associated with increased severity of subjectively reported affective, cognitive, physical, and sleep symptoms. Although objective neurocognitive task scores derived from the ImPACT battery did not corroborate subjective complaints, sleep loss was associated with significant differences on tasks of visual memory, reaction time, and visual motor speed over time. Conclusions: While self-report measures suggested marked impairments following sleep loss, deficits in neurocognitive performance were observed only on three domains measured with ImPACT. ImPACT may capture subtle changes in neurocognitive performance following sleep loss; however, independent and larger validation studies are needed to determine its sensitivity to acute sleep loss and recovery sleep. Neurocognitive screening batteries may be useful for detecting the effects of more severe or chronic sleep loss under high-stress conditions that mimic high-risk occupations. [ABSTRACT FROM AUTHOR]

The anatomical and functional mapping of lateral hypothalamic circuits has been limited by the numerous cell types and complex, yet unclear, connectivity. Recent advances in functional dissection of input-output neurons in the lateral hypothalamus have identified subset of inhibitory cells as crucial modulators of both sleep-wake states and metabolism. Here, we summarize these recent studies and discuss the multi-tasking functions of hypothalamic circuitries in integrating sleep and metabolism in the mammalian brain. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) has been associated with increased risk of cardiovascular morbidity and mortality. Although inflammatory markers may mediate this association, it is unknown the influence of gender in this mechanism. Thus, we aimed to evaluate the interaction effects between OSA and gender on metabolic and inflammatory profile in a population sample. This study is part of EPISONO cohort, in which 1042 participants underwent polysomnography, answered questionnaires, and had their blood collected for analysis of fasting glucose, total cholesterol and fractions, leptin, ghrelin, liver transaminases, tumor necrosis factor (TNF)-α, interleukin (IL)-6, and C-reactive protein. The results showed that men with OSA had higher leptin levels, shorter sleep latency and lower N3 sleep stage compared to men control (CTRL). They also presented higher apnea index and number of central apneas compared to both CTRL men and OSA women. In women, OSA was related to longer REM sleep latency, higher apnea-hypopnea index (AHI) during REM sleep and increased TNF-α levels compared to CTRL women. A multivariate model showed that male gender, ghrelin and total cholesterol were negatively associated with TNF-α, while IL-6, triglycerides and hypopnea index were positively associated (R 2 = 0.21). Additionally, gender (men), body mass index, ghrelin, apnea index and smoking were positive predictors of leptin levels (R 2 = 0.55). Of note, postmenopause was associated with changes observed in both TNF-α and AHI during REM sleep in women with OSA. Taken together, our study suggests that OSA consequences may differ between genders and this could indicate a need for different OSA management in women according to their reproductive life’s stage. [ABSTRACT FROM AUTHOR]