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Objectives. We studied the association between insomnia symptoms and late-life functioning, including physical capacity, limitations in household activities, and participation in valued activities. Methods. Participants were 6,050 adults independent in self-care activities from a representative sample of older Medicare beneficiaries. They completed objective measures of physical capacity and self-report measures of insomnia symptoms, help and difficulty with household activities, and participation in valued activities. Results. After adjustment, insomnia symptoms were associated with a greater odds of receiving help or having difficulty with selected household activities (laundry, shopping), greater odds of help or difficulty with ≥1 household activity [1 symptom vs. 0, odds ratio (OR)=1.27, p < .05; 2 symptoms vs. 0, OR = 1.35, p < .01), and of restricted participation in specific valued activities (attending religious services, going out for enjoyment) and in ≥1 valued activity (1 symptom vs. 0, OR = 1.29, p < .05; 2 symptoms vs. 0, OR = 1.50, p < .01). There was no independent association between insomnia symptoms and physical capacity. Discussion. Among older adults, insomnia symptoms are associated with a greater odds of limitation in household activities and of restricted participation in valued activities. Insomnia interventions may improve functioning and quality of life among elders. [ABSTRACT FROM AUTHOR]

The link between sleepiness and the risk of motor vehicle accidents is well known, but little is understood regarding the risk of home, work and car accidents of subjects with insomnia. An international cross-sectional survey was conducted across 10 countries in a population of subjects with sleep disturbances. Primary care physicians administered a questionnaire that included assessment of sociodemographic characteristics, sleep disturbance and accidents (motor vehicle, work and home) related to sleep problems to each subject. Insomnia was defined using the International Classification of Sleep Disorders ( ICSD-10) criteria. A total of 5293 subjects were included in the study, of whom 20.9% reported having had at least one home accident within the past 12 months, 10.1% at least one work accident, 9% reported having fallen asleep while driving at least once and 4.1% reported having had at least one car accident related to their sleepiness. All types of accident were reported more commonly by subjects living in urban compared to other residential areas. Car accidents were reported more commonly by employed subjects, whereas home injuries were reported more frequently by the unemployed. Car accidents were reported more frequently by males than by females, whereas home accidents were reported more commonly by females. Patients with insomnia have high rates of home accidents, car accidents and work accidents related to sleep disturbances independently of any adverse effects of hypnotic treatments. Reduced total sleep time may be one factor explaining the high risk of accidents in individuals who complain of insomnia. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study aims to examine the association between the chronotype (morningness/eveningness) and specific mental disorders. Methods: Cross-sectional epidemiological study conducted in three in-patient clinical settings. A total of 1468 consecutive in-patients who gave their written consent were enrolled. On the admission day, patients filled sleep questionnaires and a nurse filled a Clinical Global Impressions scale. Hospitalization reports and ICD-10 diagnoses were collected. Results: Sleep/wake schedule was similar between the psychiatric diagnoses. On the other hand, morning type patients had an earlier bedtime, earlier wakeup time and shorter sleep duration than the other chronotype regardless of the diagnosis. In multivariate models, patients with a depressive disorder or a psychosis were more likely to be morning type. Patients with an anxiety disorder, addiction disorder or personality disorder were more likely to be evening type. Conclusions: Age and sleep/wake schedule are contributing factors for the chronotype but mental disorders too appeared to modulate chronotype preferences. [Copyright &y& Elsevier]

Abstract: Sleep disorders and various common acute and chronic medical conditions directly or indirectly affect the quality and quantity of one''s sleep or otherwise cause excessive daytime fatigue. This article reviews the potential contribution of several prevalent medical conditions – allergic rhinitis, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis/osteoarthritis – and chronic fatigue syndrome and clinical sleep disorders – insomnia, obstructive sleep apnea, narcolepsy, periodic limb movement of sleep, and restless legs syndrome – to the risk for drowsy-driving road crashes. It also explores the literature on the cost-benefit of preventive interventions, using obstructive sleep apnea as an example. Although numerous investigations have addressed the impact of sleep and medical disorders on quality of life, few have specifically addressed their potential deleterious effect on driving performance and road incidents. Moreover, since past studies have focused on the survivors of driver crashes, they may be biased. Representative population-based prospective multidisciplinary studies are urgently required to clarify the role of the fatigue associated with common ailments and medications on traffic crash risk of both commercial and non-commercial drivers and to comprehensively assess the cost-effectiveness of intervention strategies. [Copyright &y& Elsevier]

Summary: The outbreak of the novel coronavirus disease 2019 (COVID‐19) changed lifestyles worldwide and subsequently induced individuals' sleep problems. Sleep problems have been demonstrated by scattered evidence among the current literature on COVID‐19; however, little is known regarding the synthesised prevalence of sleep problems (i.e. insomnia symptoms and poor sleep quality) for males and females separately. The present systematic review and meta‐analysis aimed to answer the important question regarding prevalence of sleep problems during the COVID‐19 outbreak period between genders. Using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline and Newcastle–Ottawa Scale checklist, relevant studies with satisfactory methodological quality searched for in five academic databases (Scopus, PubMed Central, ProQuest, Web of Science , and EMBASE) were included and analysed. The protocol of the project was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identification code CRD42020181644). A total of 54 papers (N = 67,722) in the female subgroup and 45 papers (N = 45,718) in the male subgroup were pooled in the meta‐analysis. The corrected pooled estimated prevalence of sleep problems was 24% (95% confidence interval [CI] 19%–29%) for female participants and 27% (95% CI 24%–30%) for male participants. Although in both gender subgroups, patients with COVID‐19, health professionals and general population showed the highest prevalence of sleep problems, it did not reach statistical significance. Based on multivariable meta‐regression, both gender groups had higher prevalence of sleep problems during the lockdown period. Therefore, healthcare providers should pay attention to the sleep problems and take appropriate preventive action. [ABSTRACT FROM AUTHOR]

Abstract: This article reviews the literature pertaining to the association between demographic variables (e.g., age, sex, race, socio-economic status) with fatigue, and when feasible, accident risk. It also explores their potential influence and interaction with some working arrangements, commute time, personality characteristics, and circadian chronotype. Fatigue has been implicated in a range of impairments that can have detrimental effects on individuals, and it is differentially associated with conventional demographic variables. However, several major methodological limitations prevent clear conclusions. First, there is absence of a shared definition both within and across disciplines. Second, although fatigue has been investigated using a variety of diverse designs, they have either been too weak to substantiate causality or lacked ecological validity. Third, while both subjective and objective measures have been used as dependent variables, fatigue has been more often found to be more strongly linked with the former. Fourth, with the exception of age and sex, the influence of other demographic variables is unknown, since they have not yet been concomitantly assessed. In instances when they have been assessed and included in statistical analyses, they are considered as covariates or confounders; thus, their contribution to the outcome variable is controlled for, rather than being a planned aspect of investigation. Because the interaction of demographic factors with fatigue is largely a neglected area of study, we recommend greater interdisciplinary collaborations, incorporation of multiple demographic variables as independent factors, and use of within-participant analyses. These recommendations would provide meaningful results that may be used to inform public policy and preventive strategies. [ABSTRACT FROM AUTHOR]

• Alexithymia, a difficulty identifying and expressing emotions, may result in lowered sleep quality. • The association between alexithymia and poor sleep quality exists across healthy and patient populations across countries. • In patient populations, the serious effect on sleep quality indicates the importance of addressing alexithymia. Alexithymia, a difficulty identifying and expressing emotions experienced by oneself or others, measurably harms quality of sleep. Research has observed the association between alexithymia and sleep problems; however, the cumulative effect of this association is still unknown. Therefore, this systematic review and meta-analysis was conducted to present scientific evidence regarding the relationship between alexithymia and sleep quality. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and using relevant keywords, we searched six databases: Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, EMBASE, and Science Direct. We selected observational studies on the association between alexithymia and sleep. We conducted meta-analysis using a random-effect model to calculate the effect size (ES) with Fisher's z transformation. Eligible studies (N = 26) in 24 papers included 7546 participants from 12 countries. The entire ES for the association between alexithymia and sleep was 0.44 (95 % CI: 0.31, 0.56). Additionally, patient populations had a larger ES (ES = 0.55; 95 % CI: 0.30, 0.79) than healthy populations (ES = 0.30; 95 % CI: 0.20, 0.41). The results of the present systematic review and meta-analysis revealed a significant association between alexithymia and sleep problems, especially among people with any medical condition. [ABSTRACT FROM AUTHOR]

Abstract: This prospective study aimed to assess symptomatic evolution of patients diagnosed with Upper Airway Resistance Syndrome (UARS) four and half years after the initial UARS diagnosis. For this purpose, 138 UARS patients were contacted by mail between 43 and 69 months after the initial evaluation; 105 responded to the letter and 94 patients accepted to undergo new clinical and polysomnographic evaluations. Initial and follow-up polysomnographic recordings were scored using the same criteria. Results: Of the 94 patients who completed the follow-up examination, none of them were using nasal CPAP. It was related to refusal by insurance providers to provide equipment based on initial apnea–hypopnea index (AHI) in 90/94 subjects. Percentage of patients with sleep related-complaints significantly increased over the four and half year period: daytime fatigue, insomnia and depressive mood increased by 12 to 20 times. Reports of sleep maintenance sleep onset insomnia and depressive mood was significantly increased. Hypnotic, antidepressant and stimulant prescription increased from initial to follow-up visit (from 11.7% to 61.7%; from 3.2% to 25.5% and from 0% to 9.6%, respectively) with antidepressant given as much for sleep disturbance as mood disorder. The polysomnography results at follow-up showed that 5 subjects had AHI compatible with Obstructive Sleep Apnea Syndrome (OSAS) but overall, respiratory disturbance index had no significant change. Total sleep time was significantly reduced compared to initial visit. Conclusions: Many UARS patients remained untreated following initial evaluation. Worsening of symptoms of insomnia, fatigue and depressive mood were seen with absence of treatment of UARS. [Copyright &y& Elsevier]

Long-duration spaceflight beyond Earth's magnetosphere poses serious health risks, including muscle atrophy, bone loss, liver and kidney damage, and the Spaceflight-Associated Neuro-ocular Syndrome (SANS). RNA-seq of mice aboard the International Space Station (ISS) for 37 days revealed extraordinary hypermutation in tissue-specific genes, with guanine base conversion predominating, potentially contributing to spaceflight-associated health risks. Our results suggest that the genome-wide accelerated mutation that we measured, seemingly independent of radiation dose, was induced by oxidative damage from higher atmospheric carbon dioxide (CO 2 ) levels and increased reactive oxygen species (ROS) on the ISS. This accelerated mutation, faster via RNA transcription than replication and more numerous than by radiation alone, unveils novel hotspots in the mammalian proteome. Notably, these hotspots correlate with commonly mutated genes across various human cancers, highlighting the ISS as a crucial platform for studying accelerated mutation, genome instability, and the induction of disease-causing mutations in model organisms. Our results suggest that metabolic processes can contribute to somatic mutation, and thus may play a role in the development of cancer. A metabolic link to genetic instability potentially has far-reaching implications for various diseases, with implications for human health on Earth and in space., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In the REST-ON clinical trial (NCT02720744), mean sleep latency on the Maintenance of Wakefulness Test (MWT) was significantly improved with extended-release once-nightly sodium oxybate (ON-SXB) vs placebo ( P  < 0.001) in participants with narcolepsy. This post hoc analysis assessed response to treatment and improvement in excessive daytime sleepiness., Methods: Participants with narcolepsy aged ≥16 years were randomized 1:1 to receive ON-SXB (4.5 g, week 1; 6 g, weeks 2-3; 7.5 g, weeks 3-8; and 9 g, weeks 9-13) or placebo. Mean sleep latency on the MWT was measured across 5 trials of ≤30 min each. Post hoc assessments included percentage of participants whose sleep latency improved ≥5, ≥10, ≥15, and ≥20 min and with a mean sleep latency of 30 min., Results: Significantly more participants receiving ON-SXB vs placebo experienced increased mean sleep latency ≥5 min (all doses P  < 0.001), ≥10 min (all doses P  < 0.001), ≥15 min (6 and 7.5 g, P  < 0.001; 9 g, P  < 0.01), and ≥20 min (6 g, P  < 0.01; 7.5 g, P  < 0.001; 9 g, P  < 0.05). More participants receiving ON-SXB had mean sleep latency of 30 min vs placebo (6 g, 5.7 % vs 0 %, respectively [ P  < 0.05]; 7.5 g, 10.5 % vs 1.3 % [ P  < 0.05]; 9 g, 13.2 % vs 5.1 % [ P  = 0.143])., Conclusions: Significantly more participants who received ON-SXB experienced increased mean sleep latency ≥5 to ≥20 min; at the 2 highest doses, >10 % remained awake for the entirety of the MWT. ON-SXB offers a once-at-bedtime treatment option for adults with narcolepsy., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michael J. Thorpy reports a relationship with Axsome Therapeutics that includes: consulting or advisory. Michael J. Thorpy reports a relationship with Balance Therapeutics that includes: consulting or advisory. Michael J. Thorpy reports a relationship with Eisai that includes: consulting or advisory. Michael J. Thorpy reports a relationship with Avadel Pharmaceuticals that includes: consulting or advisory. Michael J. Thorpy reports a relationship with Harmony BioSciences that includes: consulting or advisory. Michael J. Thorpy reports a relationship with 10.13039/100011096Jazz Pharmaceuticals that includes: consulting or advisory. Michael J. Thorpy reports a relationship with NLS Pharmaceuticals that includes: consulting or advisory. Michael J. Thorpy reports a relationship with Suven Life Sciences Ltd. that includes: consulting or advisory. Michael J. Thorpy reports a relationship with 10.13039/100008373Takeda Pharmaceutical Co that includes: consulting or advisory. Clete A. Kushida reports a relationship with Avadel Pharmaceutical that includes: consulting. Clete A. Kushida reports a relationship with XW Pharma that includes: consulting. Richard Bogan reports a relationship with WaterMark Medical and Health Humming LLC that includes: equity or stocks. Richard Bogan reports a relationship with WaterMark Medical that includes: board membership. Richard Bogan reports a relationship with 10.13039/100011096Jazz Pharmaceuticals that includes: consulting or advisory, funding grants, and speaking and lecture fees. Richard Bogan reports a relationship with Harmony BioSciences that includes: consulting or advisory and speaking and lecture fees. Richard Bogan reports a relationship with 10.13039/100008373Takeda Pharmaceutical Co. that includes: consulting or advisory and funding grants. Richard Bogan reports a relationship with Avadel Pharmaceuticals that includes: consulting or advisory and funding grants. Richard Bogan reports a relationship with Oventus that includes: consulting or advisory. Richard Bogan reports a relationship with BresoTec that includes: funding grants. Richard Bogan reports a relationship with 10.13039/100004326Bayer that includes: funding grants. Richard Bogan reports a relationship with 10.13039/501100016198Idorsia that includes: funding grants. Richard Bogan reports a relationship with Suven Life Sciences Ltd. that includes: funding grants. Richard Bogan reports a relationship with Balance Therapeutics that includes: funding grants. Richard Bogan reports a relationship with 10.13039/100010902Vanda that includes: funding grants. Richard Bogan reports a relationship with 10.13039/100004334Merck that includes: funding grants. Richard Bogan reports a relationship with 10.13039/501100003769Eisai that includes: funding grants and speaking and lecture fees. Richard Bogan reports a relationship with Fresca that includes: funding grants. Richard Bogan reports a relationship with 10.13039/100013410LivaNova that includes: funding grants. Richard Bogan reports a relationship with 10.13039/100004337Roche that includes: funding grants. Richard Bogan reports a relationship with Sommetrics that includes: funding grants. John Winkelman reports a relationship with Avadel Pharmaceuticals that includes: consulting or advisory. John Winkelman reports a relationship with Emalex Biosciences that includes: consulting or advisory. John Winkelman reports a relationship with Noctrix Health that includes: consulting or advisory. John Winkelman reports a relationship with Disc Medicine that includes: consulting or advisory. John Winkelman reports a relationship with 10.13039/501100016198Idorsia Pharmaceuticals that includes: consulting or advisory. John Winkelman reports a relationship with 10.13039/100004334Merck & Co. that includes: funding grants. John Winkelman reports a relationship with 10.13039/100016473American Regent that includes: funding grants. John Winkelman reports a relationship with 10.13039/100000026NIDA that includes: funding grants. John Winkelman reports a relationship with 10.13039/100004087RLS Foundation that includes: funding grants. John Winkelman reports a relationship with Baszucki Brain Research Fund that includes: funding grants. Maurice M. Ohayon reports a relationship with Avadel Pharmaceuticals that includes: consulting or advisory. Maurice M. Ohayon reports a relationship with 10.13039/100008373Takeda Pharmaceutical Co. that includes: consulting or advisory. Maurice M. Ohayon reports a relationship with Jazz Pharmaceuticals that includes: consulting or advisory. Colin M. Shapiro reports a relationship with Avadel Pharmaceuticals that includes: consulting or advisory and speaking and lecture fees. Colin M. Shapiro reports a relationship with 10.13039/100011096Jazz Pharmaceuticals that includes: consulting or advisory and speaking and lecture fees. Jennifer Gudeman reports a relationship with Avadel Pharmaceuticals that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Competing Interests: M. M. Ohayon déclare avoir participé à des interventions ponctuelles pour Jazz Pharmaceuticals, Takeda, Tris Pharma.

Objective: The objectives of this study are to evaluate the prevalence and incidence of Narcolepsy type 1 and type 2 and to determine the prevalence of narcolepsy diagnosis criteria in the US general population., Methods: This longitudinal study was conducted in the adult US general population in two occasions. The initial interviews included 15 states (Arizona, California, Colorado, Florida, Idaho, Missouri, New York, North Carolina, North Dakota, Oregon, Pennsylvania, South Dakota, Texas, Washington, and Wyoming). The follow-up interviews, was done three years later in eight of these states. Of the 19,136 contacted individuals, 15,929 completed the initial interview and 10,931 completed the follow-up. Participants were interviewed using the Sleep-EVAL system, an artificial intelligence tool. Narcolepsy Type 1 (with cataplexy) and Narcolepsy Type 2 (without cataplexy) were defined according to the ICSD-3 classification. Symptoms of narcolepsy were assessed by frequency per week and duration. Medical visits and diagnoses were also collected., Results: Participants were aged between 18 and 102 years of age (mean 45.8 ± 17.9 years), 51.3 % were women. The prevalence of narcolepsy with cataplexy was 12.6 per 100,000 individuals (95 % C.I., 0 to 30) and narcolepsy without cataplexy was 25.1 per 100,000. The incidence per year was 2.6 per 100,000 individuals (95 % C.I., 0 to 11)., Conclusions: Narcolepsy is a rare condition affecting 37.7/100,000 individuals (126,191 individuals in the current US population). Our US general population prevalence is in line with rates found in community-based studies but lower than what is reported in claim database studies., Competing Interests: SD and JG are current employees of Tris Pharma. MMO is consultant for Tris Pharma and Takeda Pharmaceuticals. MMO has received grant from 10.13039/100004336Novartis. MLC has received grants from Jazz Pharmaceuticals, Takeda Pharmaceuticals and 10.13039/100004336Novartis., (© 2023 The Authors.)

Background: Major depressive disorder (MDD) is largely managed in primary care, but physicians vary widely in their understanding of symptoms and treatments. This study aims to better understand the evolution of depression from initial diagnosis over a 3-year period., Methods: This was a noninterventional, retrospective, longitudinal study, with 2 waves of participant interviews approximately 3 years apart. Phone interviews were conducted using the hybrid artificial intelligence (AI) Sleep-EVAL system, an AI-driven diagnostic deep learning tool. Participants were noninstitutionalized adults representative of the general population in 8 US states. Diagnosis was confirmed according to the DSM-5 using the Sleep-EVAL System., Results: 10,931 participants completed Wave 1 and 2 (W1, W2) interviews. The prevalence of MDD, including partial and complete remission, was 13.4 % and 19.6 % in W1 and W2, respectively. About 42 % of MDD participants at W1 continued to report depressive symptoms at W2. Approximately half of antidepressant (AD) users in W1 were moderately to completely dissatisfied with their treatment; 29.6 % changed their AD for a different one, with 16.4 % switching from one SSRI to another between W1 and W2. Primary care physicians were the top AD prescribers, both in W1 (45.7 %) and W2 (59%), respectively., Limitations: Data collected relied on self-reporting by participants. As such, the interpretation of the data may be limited., Conclusions: Depression affects a sizeable portion of the US population. Dissatisfaction with treatment, frequent switching of ADs, and changing care providers are associated with low rates of remission. Residual symptoms remain a challenge that future research must address., Competing Interests: Conflict of interest Maggie McCue, Lambros Chrones, and Debra Lawrence are employees of Takeda Pharmaceuticals U.S.A., Inc. Maggie McCue receives annual stock options from Takeda. Debra Lawrence has stock in Takeda. Katherine J. Selzler is an employee of Lundbeck LLC. Maurice M. Ohayon received support from Takeda and Lundbeck for secondary study analyses, an educational grant from Novartis, and consulting fees from Takeda. Andrew Krystal received grants or contracts from Janssen Pharmaceuticals, Axsome Pharmaceutics, Reveal Biosensors, The Ray and Dagmar Dolby Family Fund, and the National Institutes of Health; consulting fees from Adare, Angelini, Axsome Therapeutics, Big Health, Eisai, Evecxia, Ferring Pharmaceuticals, Galderma, Harmony Biosciences, Idorsia, Janssen Pharmaceuticals, Jazz Pharmaceuticals, Millennium Pharmaceuticals, Merck, Neurocrine Biosciences, Neurawell, Pernix, Otsuka Pharmaceuticals, Sage, and Takeda; honoraria from Eisai; and stock or stock options from Big Health Options. Andrew Krystal participated on a data safety monitoring board or advisory board for Neurocrine and Idorsia and is the Sleep Research Society president. Marie-Lise Côté received support from Takeda and Lundbeck for secondary study analyses and grants or research contracts from Novartis, Takeda, and Jazz., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The effects of cognitive behavioral therapy for insomnia (CBT-I) have consistently been shown to improve insomnia symptoms and other health-related outcomes, but the effects on QoL have been inconsistent. Many factors including the type CBT-I delivery and type of instrument used to assess QoL make the topic complex. The present systematic review and meta-analysis synthesized the evidence of CBT-I efficacy on QoL outcomes across different populations, delivery modes, and methodological aspects. Following the guidelines on preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a literature search was conducted through PubMed, Web of Science, Scopus, and PsycINFO using keywords from relevant MeSH terms based on PICOS (Participants, Intervention, Comparison, Outcome and Study) criteria. Clinical trials investigating the effect of CBT-I as an intervention on QoL with any kind of control group were eligible if they reported mean scores and variation of QoL. Meta-analysis using a random-effect model was conducted to calculate the standardized mean differences (SMDs) in a set including all identified studies, as well as in three sub-sets: face-to-face CBT-I using randomized controlled trials (RCTs), online CBT-I using RCTs, and one-group pre- and post-treatment design. A total of 24 studies comprising 1977 participants (808 in an intervention group) from 12 countries were eligible for meta-analysis. The overall pooled estimate of SMD of QoL when all 24 studies were included was 0.47 (95% CI: 0.22; 0.72; I 2  = 84.5%; tau 2  = 0.31; p < 0.001). The overall pooled estimate of SMD of QoL was 0.46 (95% CI: 0.01-0.90; I 2  = 87.5%; tau 2  = 0.48, p < 0.001) for intervention groups with face-to-face CBT-I compared to controls; 0.47 (95% CI: 0.02-0.92; I 2  = 88.3%; tau 2  = 0.36; p = 0.04) for intervention groups with digital CBT-I compared to controls, and 0.46 (95% CI: 0.12-0.80; I 2  = 52.9%; tau 2  = 0.07; p = 0.08) for one-group pre- and post-comparison using CBT-I intervention compared to baseline. Moreover, effects of CBT-I on QoL were different across populations (pooled SMD = 0.59 for patients with insomnia; 0.29 for patients with insomnia comorbid with another major disorder; and 0.48 for other conditions) and types of QoL instruments (pooled SMD = 0.36 for disease-specific QoL instrument not on insomnia, 0.43 for generic QoL instrument, and 0.67 for a single-QoL-item instrument). The probability of publication bias was ruled out in overall and design specific sub-group analysis based on funnel plot and Egger's test. In conclusion, this meta-analysis confirmed a moderate, overall effect of CBT-I in improving QoL. However, due to small power and heterogeneity, future studies are needed to better explore the impact of moderating factors such as mode of delivery and type of QoL measure for assessment used., Competing Interests: Conflicts of interest The authors do not have any conflicts of interest to disclose., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aging is accompanied by changes in the quantity and quality of sleep. Obstructive sleep apnea (OSA) is also more prevalent in the older population. Although severe OSA has been linked to a higher risk of cardiovascular disease regardless of adult age, clinical consequences of mild-to-moderate OSA in the older adults are still uncertain., Objectives: To investigate the relationships between severity and metabolic, cognitive, and functional characteristics in community-dwelling older adults from a representative sample of the city of São Paulo., Methods: In total, 199 participants of the first follow-up of the São Paulo Epidemiologic Sleep Study (EPISONO, São Paulo, Brazil) >60 years were cross-sectionally assessed through questionnaires, physical evaluations, laboratory tests, and full in-lab polysomnography (PSG). Three groups according to the OSA severity were compared according to sociodemographic characteristics, anthropometric measures, PSG parameters, the frequency of comorbidities, and the use of medications., Results: Participants' age ranged from 60 to 87 years with a mean of 70.02 ± 7.31, 59.8% female. In the univariate analysis, body mass index (BMI, kg/m 2 ) ( p = 0.049) and waist circumference ( p = 0.005) were significantly higher in the participants with moderate OSA, but not among those with severe OSA. Participants with severe OSA had a higher arousal index ( p = 0.007). Multivariate analysis showed that severe OSA was significantly associated with hypertension ( p = 0.005), heart diseases ( p = 0.025), and the use of two or more medications ( p = 0.035)., Conclusion: In a population-based study, severe, but not mild-to-moderate, OSA in older adults was associated with hypertension and the use of more medications. As age advances, anthropometric indicators of obesity may not increase the risk of severe OSA., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Silva, Poyares, Silva, Souza, Andersen, Ohayon, Tufik and Piovezan.)

Background: The severity of COVID-19 remains high worldwide. Therefore, millions of individuals are likely to suffer from fear of COVID-19 and related mental health factors., Aims: The present systematic review and meta-analysis aimed to synthesize empirical evidence to understand fear of COVID-19 and its associations with mental health-related problems during this pandemic period., Method: Relevant studies were searched for on five databases (Scopus, ProQuest, EMBASE, PubMed Central, and ISI Web of Knowledge), using relevant terms (COVID-19-related fear, anxiety, depression, mental health-related factors, mental well-being and sleep problems). All studies were included for analyses irrespective of their methodological quality, and the impact of quality on pooled effect size was examined by subgroup analysis., Results: The meta-analysis pooled data from 91 studies comprising 88 320 participants (mean age 38.88 years; 60.66% females) from 36 countries. The pooled estimated mean of fear of COVID-19 was 13.11 (out of 35), using the Fear of COVID-19 Scale. The associations between fear of COVID-19 and mental health-related factors were mostly moderate (Fisher's z = 0.56 for mental health-related factors; 0.54 for anxiety; 0.42 for stress; 0.40 for depression; 0.29 for sleep problems and -0.24 for mental well-being). Methodological quality did not affect these associations., Conclusions: Fear of COVID-19 has associations with various mental health-related factors. Therefore, programmes for reducing fear of COVID-19 and improving mental health are needed.

Objective/background: The real-world experience of people with narcolepsy is not well understood., Patients/methods: The Nexus Narcolepsy Registry (NCT02769780) is a longitudinal, web-based patient registry of self-reported data from adults with physician-diagnosed narcolepsy. Surveys were electronically distributed every 6 months; the current analysis reports registry population demographics, narcolepsy diagnosis journey, and predictors of diagnostic delays., Results: The registry population included in this analysis (N = 1024) was predominantly female (85%) and White (92%), with a mean age of 37.7 years. Most participants had education/training beyond high school (93%). Mean (median) reported ages at narcolepsy symptom onset, first consultation for symptoms, and narcolepsy diagnosis were 18.1 (16), 26.4 (24), and 30.1 (28) years, respectively. A majority (59%) of participants reported ≥1 misdiagnosis, and 29% reported consulting ≥5 physicians before narcolepsy diagnosis. More than half (56%) of participants' first consultations for narcolepsy symptoms were with a general practitioner, whereas the diagnosing clinician was usually a sleep specialist (64%) or neurologist (27%). Pediatric symptom onset was associated with a longer mean interval to first consultation than adult symptom onset (10.7 and 4.6 years, respectively; P < 0.001) and a longer mean interval between first consultation and diagnosis (4.5 and 2.2 years, respectively; P < 0.001). Overall, mean (95% CI) time from symptom onset to diagnosis was 11.8 (11.1-12.5) years., Conclusions: The Nexus Narcolepsy Registry data indicate that onset of narcolepsy symptoms frequently occurs in childhood or adolescence. In many individuals, the diagnostic process is long and involves multiple physicians and frequent misdiagnosis., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The aim of this study was to evaluate the impact of different therapy regimens, including sodium oxybate (SXB)-containing regimens, on patient-reported outcomes (PROs) in people with narcolepsy., Methods: Online surveys were used to collect information from persons with narcolepsy in the Nexus Narcolepsy Registry. Surveys contained questionnaires assessing self-reported sleep quality (SQ; via single question), daytime sleepiness and function (Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire), health-related quality of life (HRQoL; 36-Item Short Form Health Survey [SF-36]), work productivity and impairment (Work Productivity and Activity Impairment: Specific Health Problem), and history of injuries or motor vehicle accidents. Treatment with SXB (including monotherapy or combination therapy; SXB group) was compared with non-SXB therapy (No SXB group). The P values presented are nominal, as there are no adjustments for multiplicity., Results: From June 2015 through December 2017, 983 participants completed 1760 surveys. SQ and daytime functioning scores were better in the SXB group compared with the No SXB group (all P < 0.001). HRQoL scores were better for the SXB group compared with the No SXB group for the SF-36 Physical Component (P = 0.016), Mental Component (P < 0.001), and all 8 subscales. Additionally, PROs were better for the SXB group for presenteeism, overall work and activity impairment, and risk of motor vehicle accidents (all P ≤ 0.001)., Conclusion: Based on participants' self-assessments, treatment regimens with SXB were associated with better outcomes than regimens not containing SXB across many PROs, including SQ, HRQoL, work and activities, and risk of traffic accidents. CLINICALTRIALS., Gov Identifier: NCT02769780., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress., Methods: Five academic databases ( Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase ) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644., Findings: 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p -values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively., Interpretation: Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced., Funding: The present study received no funding., Competing Interests: Chung-Ying Lin was supported in part by a research grant from the Ministry of Science and Technology, Taiwan (MOST109-2327-B-006-005). All other authors have nothing to declare., (© 2021 The Author(s).)

Background: Sleep hygiene is important for maintaining good sleep and reducing insomnia., Objective: This study examined the long-term efficacy of a theory-based app (including cognitive behavioral therapy [CBT], theory of planned behavior [TPB], health action process approach [HAPA], and control theory [CT]) on sleep hygiene among insomnia patients., Methods: The study was a 2-arm single-blind parallel-group randomized controlled trial (RCT). Insomnia patients were randomly assigned to a treatment group that used an app for 6 weeks (ie, CBT for insomnia [CBT-I], n=156) or a control group that received only patient education (PE, n=156) through the app. Outcomes were assessed at baseline and 1 month, 3 months, and 6 months postintervention. Primary outcomes were sleep hygiene, insomnia, and sleep quality. Secondary outcomes included attitudes toward sleep hygiene behavior, perceived behavioral control, behavioral intention, action and coping planning, self-monitoring, behavioral automaticity, and anxiety and depression. Linear mixed models were used to evaluate the magnitude of changes in outcomes between the two groups and across time., Results: Sleep hygiene was improved in the CBT-I group compared with the PE group (P=.02 at 1 month, P=.04 at 3 months, and P=.02 at 6 months) as were sleep quality and severity of insomnia. Mediation analyses suggested that perceived behavioral control on sleep hygiene as specified by TPB along with self-regulatory processes from HAPA and CT mediated the effect of the intervention on outcomes., Conclusions: Health care providers might consider using a CBT-I app to improve sleep among insomnia patients., Trial Registration: ClinicalTrials.gov NCT03605732; https://clinicaltrials.gov/ct2/show/NCT03605732., (©Nilofar Rajabi Majd, Anders Broström, Martin Ulander, Chung-Ying Lin, Mark D Griffiths, Vida Imani, Daniel Kwasi Ahorsu, Maurice M Ohayon, Amir H Pakpour. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.04.2020.)

The pathological use of the internet - conceptualized as 'internet addiction' - might be crucial in initiating and increasing sleep disturbances in the community. While inconsistent evidence is reported regarding the association of internet addiction and sleep disturbances, the severity of this association remains unclear. This systematic review and meta-analysis were conducted to increase our understanding of the relationship between internet addiction and sleep disturbances. A systematic review was conducted through Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and EMBASE using keywords related to internet addiction and sleep problems. Observational studies (cohort, case-control or cross-sectional studies) focusing on association between internet addiction and sleep disturbances including sleep problems and sleep duration were selected. A meta-analysis using random-effect model was conducted to calculate the odds ratio (OR) for experiencing sleep problems and standardized mean differences (SMDs) for sleep duration. Eligible studies (N = 23) included 35,684 participants. The overall pooled OR of having sleep problems if addicted to the internet was 2.20 (95% CI: 1.77-2.74). Additionally, the overall pooled SMDs for sleep duration for the IA group compared to normal internet users was -0.24 (95% CI: -0.38, -0.10). Results of the meta-analysis revealed a significant OR for sleep problems and a significant reduced sleep duration among individuals addicted to the internet., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

An ever-growing number of electromagnetic (EM) emission sources elicits health concerns, particularly stemming from the ubiquitous low to extremely low frequency fields from power lines and appliances, and the radiofrequency fields emitted from telecommunication devices. In this article we review the state of knowledge regarding possible impacts of electromagnetic fields on melatonin secretion and on sleep structure and the electroencephalogram of humans. Most of the studies on the effects of melatonin on humans have been conducted in the presence of EM fields, focusing on the effects of occupational or residential exposures. While some of the earlier studies indicated that EM fields may have a suppressive effect on melatonin, the results cannot be generalized because of the large variability in exposure conditions and other factors that may influence melatonin. For instance, exposure to radiofrequency EM fields on sleep architecture show little or no effect. However, a number of studies show that pulsating radiofrequency electromagnetic fields, such as those emitted from cellular phones, can alter brain physiology, increasing the electroencephalogram power in selective bands when administered immediately prior to or during sleep. Additional research is necessary that would include older populations and evaluate the interactions of EM fields in different frequency ranges to examine their effects on sleep in humans., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The National Sleep Foundation (NSF) sought to test, refine, and add statistical rigor to its previously described provisional Sleep Satisfaction Tool (SST). The tool assesses the general population's sleep satisfaction., Design: In 2017, NSF created a provisional tool through systematic literature review and an expert consensus panel process. This tool was expanded, refined, and tested through an open-ended survey, 2 rounds of cognitive testing, and a national survey of a random sample of Internet users (aged 18-90). Factor analysis and final consensus panel voting produced the robust SST., Results: The exploratory, open-ended surveying for identifying additional factors important to the public led to question formulation around mind relaxation. Cognitive testing yielded significant refinement to question and response option formatting. Factor analysis of questions from field testing indicated loading on one construct identified as "sleep satisfaction." The final 9-item SST demonstrated strong reliability and internal validity with overall SST scores of 56/100 (higher scores indicating greater sleep satisfaction). Individual SST item mean scores ranged from 39 to 66, and overall SST scores varied substantially across demographic groups., Conclusions: NSF used a series of development and validation tests on its provisional SST, producing a novel and reliable research tool that measures the general population's sleep satisfaction. The SST is a short, reliable, nonclinical assessment that expands the set of tools available to researchers that implements the individual, social, and environmental factors related to sleep satisfaction. Further research will explore refined scoring methods along with factor weighting and use within different populations., (Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the evolution of narcolepsy symptoms in first-, second, and third-degree relatives and to compare multiplex and simplex families., Methods: A total of 4045 family members and 362 narcoleptic individuals were entered in the study; with 3255 family members interviewed twice, five to seven years apart. A control group (n = 178) composed of spouses or housemates was also interviewed twice. Family members were divided according to their blood relationship with the probands and further divided into multiplex (ie, more than one narcolepsy cases) and simplex (only one narcolepsy case) families. Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy probands were evaluated and diagnosed by a Sleep Specialist in a Sleep Clinic Center., Results: A total of 1123 family members from 72 families were identified as members of multiplex families while the rest of the sample were a part of simplex families (n = 2132). Multiplex families had higher incidence and chronicity of hypersomnolence than the simplex family members and the control group. For cataplexy-like symptoms, only prevalence at the time of the first assessment distinguished multiplex (5.5%) and simplex (2.9%) families. Prevalence of sleep paralysis was higher among the first- and second-degree relatives coming from multiplex families, while incidence was the highest among second- and third-degree relatives. Hypnagogic hallucinations had similar prevalence between multiplex and simplex families but the incidence and chronicity were significantly higher among multiplex families. For each symptom, predictive factors were also determined in simplex and multiplex families., Conclusions: Our results show that individuals coming from multiplex families are at greater risks of a broad range of narcolepsy symptoms compared to simplex families., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: The goal of this project was to provisionally identify the basic elements of sleep satisfaction within the general population., Methods: The National Sleep Foundation conducted a systematic literature review and identified 495 published articles evaluating potential indicators of sleep satisfaction. The National Sleep Foundation then convened an expert panel ("Panel"), provided full-text articles and summaries, and used a modified RAND appropriateness method with three total rounds of voting to determine the appropriateness of indicators for sleep satisfaction., Results: The literature review revealed no tools or measures of sleep satisfaction (not dissatisfaction) applied to the general population and directly associated with good health. Nonetheless, a variety of sleep factors were extracted from the extant sleep research literature. Panel members voted on these indicators: sleep environmental factors; and sleep initiation and maintenance parameters. Using these indicators, the Panel constructed provisional questions for measuring sleep satisfaction., Conclusions: The Panel determined that appropriate sleep satisfaction elements include how an individual feels (a) about their sleep, (b) immediately after their sleep, and (c) during the subsequent day. Additionally, appropriate environmental elements include (a) bedding comfort, (b) bedroom temperature, and (c) noise and light in the bedroom. How one feels with (a) the time it takes to fall asleep, (b) the ease with which one falls back to sleep after awakening during a sleep period, (c) the amount of sleep on weekdays and weekends, as well as how undisturbed one's sleep is also were determined to be appropriate contributors to sleep satisfaction. Finally, the Panel agreed that whether an individual desired to change anything about their sleep, is a relevant question., (Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment., Methods: The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus., Results: A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours., Conclusions: There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed., (Copyright © 2016. Published by Elsevier Inc.)

Excessive sleepiness or hypersomnolence is currently defined by two main symptoms: 1) the excessive amount of sleep, defined as a prolonged period of main sleep or the presence of naps; and 2) poor quality of awakening. Excessive sleepiness was reported by 27.8%. The presence of recurrent periods of irresistible sleep in the same day was found in 13.2%, recurrent naps in the same day in 1.9%, non-restorative sleep despite a nighttime sleep of more than 9 hours (0.7%), as well as a sleep drunkenness (4.4%). Adding criteria for duration and frequency (minimum of 3 times per week and duration of at least 3 months), having social or professional impairment and psychological distress, and after excluding significant associated comorbidities, the prevalence fall to 1.5%. These very important prevalence hypersomnolence figures constitute an excellent argument to educate doctors and health authorities on the need to identify and support the excessive sleepiness disorders.

Objective: In this study, we used a strict definition of hypersomnia and tested if the association between overeating-hypersomnia remained positive and significant. Hypersomnia was present if the total sleep time was close to 10h per day or was at least 2h longer than in normothymic periods., Methods: Cross-sectional study using the adult general population of California and New York. The sample was composed of 6694 individuals aged between 18 and 96years. Participants were interviewed by telephone using the Sleep-EVAL system. The interviews included various sleep and health topics and the assessment of DSM-IV sleep and psychiatric disorders., Results: The one-month prevalence of major depressive episode was 6.1%, including a one-month prevalence of atypical depression of 1.6%, in this sample. Atypical depression subjects had a greater number of depressive symptoms and a longer duration of the current depressive episode than the other depressive subjects. Depressive subjects with hypersomnia slept longer (8h, 29min) than the other depressive subjects (6h, 36min) and longer than the subjects "getting too much sleep" (6h, 48min). Furthermore, hypersomnia was not associated with overeating while "getting too much sleep" showed a positive association with overeating., Conclusions: Hypersomnia needs to be evaluated using a strict definition. Otherwise, it leads to an overestimation of this symptom in major depressive episode subjects and to a false association with overeating., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To assess the prevalence of insomnia symptoms in Chronic Obstructive Pulmonary Disease (COPD) participants, their association with psychiatric disorders and their impact on health care utilization and quality of life., Method: It is a cross-sectional telephone study using a representative sample consisting of 10,854 non-institutionalized individuals aged 15 or over living in Germany, Spain and the United Kingdom. Interviews were managed by the Sleep-EVAL expert system. The questionnaire included questions on sleeping habits, life habits, health, DSM-IV mental disorders, DSM-IV and ICSD sleep disorders. COPD was defined as chronic bronchitis or emphysema (treated or not) diagnosed by a physician., Results: A total of 2.5% [2.1%-2.8%] of the sample reported having been diagnosed with COPD. As many as 48.1% of COPD had insomnia symptoms, which was twice higher than the rate observed in non-COPD (OR: 2.4). Only 11.8% of COPD addressed their sleep difficulties to their physician. Mental disorders were higher in COPD compared to non-COPD participants: Major Depressive disorder (AOR: 2.8); Generalized Anxiety Disorder (AOR: 11.0); Panic Disorder (AOR: 7.1) and Specific Phobia (AOR: 3.7). As many as 84.4% of COPD with depression and 59.7% of those with an Anxiety Disorder had associated insomnia symptoms. The co-occurrence of both conditions increased by five times the likelihood of hospitalizations in the previous year among COPD. Both conditions were associated with a diminished Quality of Life in COPD., Conclusions: COPD is a debilitating disease accompanied with psychiatric disorders and sleep disturbances in the overwhelming majority of cases. This high comorbidity is associated with greater health care utilization and great deterioration of the quality of life., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: To examine how occupational activities (work, school), separation from parents, environmental conditions, stressors ad social insertion affect on the prevalence of Major Depressive Disorder (MDD) and mental health care-seeking among young adults., Methods: Cross-sectional study conducted in two samples: 1) 19,136 subjective representative of the US non-institutionalized general population including 2082 18-26 y.o. subjects. 2) 2196 subjects representative of the students' population living on an university campus. Telephone interviews were realized using the Sleep-EVAL system to assess sleeping habits, general health, organic, sleep and mental disorders., Results: One-month prevalence of depressed mood was similar between community and campus student groups (21.7% and 23.4%), and less common than for working (23.6%) and non-working (28.2%) young adults in the community. One-month MDD was found in 12.0% of non-working young people, compared with 6.6% of young workers, 3.2% of on-campus students and 4.1% of students in the general population (p < 0.01). Correlates for depressive mood and MDD such as female gender, dissatisfaction with social life, obesity, living with pain and other factors were identified across groups. A minority of on-campus (10.8%) and general population students (10.3%) had sought mental health services in the prior year. Individuals with MDD had higher rates of care-seeking than other young people (p < 0.001), high rates of psychotropic medication use (p < 0.001)., Conclusions: Being a student appears to have a protective effect with respect to having depressive symptoms or MDD and seeking needed mental health care. Stress and social isolation were important determinants for depression among young adults., (Copyright © 2013. Published by Elsevier Ltd.)

Objective: Using population-based data, we document the comorbidities (medical, neurologic, and psychiatric) and consequences for daily functioning of excessive quantity of sleep (EQS), defined as a main sleep period or 24-hour sleep duration ≥ 9 hours accompanied by complaints of impaired functioning or distress due to excessive sleep, and its links to excessive sleepiness., Methods: A cross-sectional telephone study using a representative sample of 19,136 noninstitutionalized individuals living in the United States, aged ≥ 18 years (participation rate = 83.2%). The Sleep-EVAL expert system administered questions on life and sleeping habits; health; and sleep, mental, and organic disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision; International Classification of Sleep Disorders: Diagnostic and Coding Manual II, International Classification of Diseases and Related Health Problems, 10th edition)., Results: Sleeping at least 9 hours per 24-hour period was reported by 8.4% (95% confidence interval = 8.0-8.8%) of participants; EQS (prolonged sleep episode with distress/impairment) was observed in 1.6% (1.4-1.8%) of the sample. The likelihood of EQS was 3 to 12× higher among individuals with a mood disorder. EQS individuals were 2 to 4× more likely to report poor quality of life than non-EQS individuals as well as interference with socioprofessional activities and relationships. Although between 33 and 66% of individuals with prolonged sleep perceived it as a major problem, only 6.3 to 27.5% of them reported having sought medical attention., Interpretation: EQS is widespread in the general population, co-occurring with a broad spectrum of sleep, medical, neurologic, and psychiatric disorders. Therefore, physicians must recognize EQS as a mixed clinical entity indicating careful assessment and specific treatment planning., (© 2013 American Neurological Association.)

Background: Individuals affected with narcolepsy represent a vulnerable segment of the population. However, we only have a partial understanding of this vulnerability. Our study aims to examine psychiatric disorders and medical conditions associated with narcolepsy., Methods: A total of 320 narcoleptic participants were interviewed regarding sleeping habits, health, medication consumption, medical conditions (International Statistical Classification of Diseases and Related Health Problems, 10th edition), sleep disorders (International Classification of Sleep Disorders, second edition [ICSD-2]) and mental disorders (Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision [DSM-IV-TR]) using Sleep-EVAL. A general population comparison sample (N=1464) matched for age, sex, and body mass index (BMI) and interviewed with the same instrument was used to estimate odds ratios (OR)., Results: Five diseases were more frequently observed among narcoleptic participants, including hypercholesterolemia (OR, 1.51), diseases of the digestive system (OR, 3.27), heart diseases (OR, 2.07), upper respiratory tract diseases (OR, 2.52), and hypertension (OR, 1.32). Most frequent psychiatric disorders among the narcolepsy group were major depressive disorder (MDD) (OR, 2.67) and social anxiety disorder (OR, 2.43), both affecting nearly 20% of narcoleptic individuals. However, most mood and anxiety disorders were more prevalent among the narcoleptic group. Alcohol abuse or alcohol dependence was comparable between groups., Conclusions: Narcolepsy is associated with a high comorbidity of both medical conditions and psychiatric disorders that need to be addressed when developing a treatment plan., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Growing evidence supports the hypothesis that narcolepsy with cataplexy is an autoimmune disease. We here report genome-wide association analyses for narcolepsy with replication and fine mapping across three ethnic groups (3,406 individuals of European ancestry, 2,414 Asians and 302 African Americans). We identify a SNP in the 3' untranslated region of P2RY11, the purinergic receptor subtype P2Y₁₁ gene, which is associated with narcolepsy (rs2305795, combined P = 6.1 × 10⁻¹⁰, odds ratio = 1.28, 95% CI 1.19-1.39, n = 5689). The disease-associated allele is correlated with reduced expression of P2RY11 in CD8(+) T lymphocytes (339% reduced, P = 0.003) and natural killer (NK) cells (P = 0.031), but not in other peripheral blood mononuclear cell types. The low expression variant is also associated with reduced P2RY11-mediated resistance to ATP-induced cell death in T lymphocytes (P = 0.0007) and natural killer cells (P = 0.001). These results identify P2RY11 as an important regulator of immune-cell survival, with possible implications in narcolepsy and other autoimmune diseases.

Sleep disorders can be expressed in different ways. The International Classification of Sleep Disorders lists more than 80 different sleep disorder diagnoses. In general population, although the insomnia complaint is reported by nearly the third of the population, it is translated into a diagnosis of insomnia for only 6% to 15% of the population. Sleep apnea syndrome, often associated with insomnia or daytime sleepiness, is found in approximately 2% to 4% of the general population. Restless legs syndrome is present for approximately 6% of the general population with a higher prevalence in the elderly subject. Narcolepsy is rare with a prevalence of 0.04%. Parasomnias are less studied in the general population; prevalences of several of parasomnias remain unknown. Among those more extensively studied, sleep paralysis is found for approximately 6% of the general population. Nocturnal terrors, the confusional arousals and nightmares have been observed with prevalences ranging from 2.2% to 5%. Despite their high frequency, sleep disorders remain poorly identified; less than 20% of individuals with sleep disorders are correctly diagnosed and treated.

Objective: To evaluate how the presence of a chronic painful physical condition (CPPC) lasting 6 months or more influences the frequency and severity of depressive symptoms in subjects with major depressive disorder (MDD)., Method: Random samples of 18,980 subjects aged between 15 and 100 years who were representative of the general population of 5 European countries (the United Kingdom, Germany, Italy, Portugal, and Spain) were interviewed by telephone between 1994 and 1999. Subjects answered a series of questions that allowed positive and differential diagnosis of DSM-IV mental disorders. The questionnaire also included a series of questions about painful physical conditions, medical treatment, consultations, and hospitalizations for medical conditions and a list of diseases., Results: A total of 4% (95% CI = 3.7% to 4.3%) of the sample had MDD at the time of the interview. Nearly half of subjects with MDD (43.4%) also reported having a CPPC. Compared with MDD subjects without chronic pain, MDD subjects with a CPPC had a longer duration of depressive symptoms (7 months longer) and were more likely to report severe fatigue (OR = 5.4), insomnia nearly every night (OR = 3.3), severe psychomotor retardation (OR = 3.3), weight gain (OR = 2.3), severe difficulty concentrating (OR = 1.7), and severe feelings of sadness or depressed mood (OR = 1.8)., Conclusion: A CPPC was present in nearly half of subjects with MDD. CPPCs increased the severity of physical symptoms of depression (fatigue, insomnia, psychomotor retardation, weight gain). Moreover, CPPCs affected the duration of depressive episodes and their recurrence. Physicians should consider CPPCs as a major factor in the expression and evolution of MDD. They must remember that MDD patients tend to amplify physical symptoms, to the detriment of their depressive symptomatology.