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Cheng-Jie Mao,1,* Hao Peng,2,* Sheng Zhuang,1,* Ying-Chun Zhang,3 Wei-Ye Xie,1 Jia-Hui Yan,1 Hui-Hui Liu,1 Jing Chen,1 Jun-Yi Liu,4 Jianan Zhang,5 Hai Jiang,5 Yonghong Zhang,2 Mingzhi Zhang,2 Chun-Feng Liu1,6 1Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 2Department of Epidemiology, School of Public Health, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China; 3Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 4Department of Neurology, The Fourth Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 5Department of Chronic Disease, Taicang Center of Disease Prevention and Control, Suzhou, People’s Republic of China; 6Institute of Neuroscience, Soochow University, Suzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chun-Feng Liu, Department of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, People’s Republic of China, Email liuchunfeng@suda.edu.cn Mingzhi Zhang, Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park, Suzhou, 215123, People’s Republic of China, Email zhangmingzhi@suda.edu.cnBackground: Sleep is critical in health problems including Parkinson’s disease (PD). This study examined the association between sleep characteristics and the likelihood of prodromal PD.Methods: At baseline examination of the Heart and Brain Investigation in Taicang (HABIT) study, potential PD biomarkers were obtained for 8777 participants aged over 50 years, and the probability of prodromal PD was assessed based on the Chinese expert consensus and Movement Disorder Society (MDS) criteria. General and component sleep characteristics were evaluated by the Pittsburgh Sleep Quality Index (PSQI). Median regression was applied to examine the association between sleep and the probability of prodromal PD, adjusting for age, sex, education level, physical activity, obesity, fast plasma glucose, lipids, and hypertension.Results: Based on China criteria, a higher level of PSQI score was significantly associated with a higher probability of prodromal PD (β = 0.02, 95% CI: 0.01– 0.03) and a higher risk of having an increased probability of prodromal PD (OR = 1.04, 95% CI: 1.02– 1.05). Compared to participants with good quality sleep, those with poor quality sleep had a 0.07% increased probability of prodromal PD (95% CI: 0.01– 0.13) and a 19% increased risk of having a high prodromal PD probability (95% CI: 1.04– 1.20). Similar associations between sleep quality and the probability of prodromal PD were also observed using the MDS criteria. Subjective sleep quality, sleep latency, habitual sleep efficiency, daytime dysfunction, and use of sleep medications were also associated with the probability of prodromal PD.Conclusion: Poor sleep quality was associated with a high probability of prodromal PD. Sleep may be helpful for understanding and intervention of prodromal PD.Keywords: prodromal Parkinson’s disease, sleep, Parkinson’s disease

T Muhammad,1 Milan Das,2 Arup Jana,2 Soomi Lee1 1Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA; 2Department of Population & Development, International Institute for Population Sciences, Mumbai, Maharashtra, IndiaCorrespondence: Arup Jana; T Muhammad, Email arupjana0000@gmail.com; mkt5742@psu.eduBackground: Sleep problems are a critical issue in the aging population, affecting quality of life, cognitive efficiency, and contributing to adverse health outcomes. The coexistence of multiple diseases is common among older adults, particularly women. This study examines the associations between specific chronic diseases, multimorbidity, and insomnia symptoms among older Indian men and women, with a focus on the interaction of sex in these associations.Methods: Data were drawn from 31,464 individuals aged 60 and older in the Longitudinal Ageing Study in India, Wave-1 (2017– 18). Insomnia symptoms were assessed using four questions adapted from the Jenkins Sleep Scale (JSS-4), covering difficulty falling asleep, waking up, waking too early, and feeling unrested during the day. Multivariable logistic regression models, stratified by sex, were used to analyze the associations between chronic diseases and insomnia symptoms.Results: Older women had a higher prevalence of insomnia symptoms than men (44.73% vs 37.15%). Hypertension was associated with higher odds of insomnia in both men (AOR: 1.20) and women (AOR: 1.36). Women with diabetes had lower odds of insomnia (AOR: 0.80), while this association was not significant in men. Neurological or psychiatric disorders, stroke, and bone and joint diseases were linked to higher odds of insomnia in both sexes. Chronic lung disease was associated with insomnia in men (AOR: 1.65), but not in women. Additionally, having three or more chronic diseases significantly increased the odds of insomnia in both men (AOR: 2.43) and women (AOR: 2.01).Conclusion: Hypertension, bone and joint diseases, lung diseases, stroke, neurological or psychiatric disorders, and multimorbidity are linked to insomnia symptoms in older Indian adults. Disease-specific management and routine insomnia screening are crucial for promoting healthy aging in this vulnerable population.Keywords: chronic conditions, India, insomnia symptoms, multimorbidity

Abstract Face reshaping aims to adjust the shape of a face in a portrait image to make the face aesthetically beautiful, which has many potential applications. Existing methods 1) operate on the pre-defined facial landmarks, leading to artifacts and distortions due to the limited number of landmarks, 2) synthesize new faces based on segmentation masks or sketches, causing generated faces to look dissatisfied due to the losses of skin details and difficulties in dealing with hair and background blurring, and 3) project the positions of the deformed feature points from the 3D face model to the 2D image, making the results unrealistic because of the misalignment between feature points. In this paper, we propose a novel method named face shape transfer (FST) via semantic warping, which can transfer both the overall face and individual components (e.g., eyes, nose, and mouth) of a reference image to the source image. To achieve controllability at the component level, we introduce five encoding networks, which are designed to learn feature embedding specific to different face components. To effectively exploit the features obtained from semantic parsing maps at different scales, we employ a straightforward method of directly connecting all layers within the global dense network. This direct connection facilitates maximum information flow between layers, efficiently utilizing diverse scale semantic parsing information. To avoid deformation artifacts, we introduce a spatial transformer network, allowing the network to handle different types of semantic warping effectively. To facilitate extensive evaluation, we construct a large-scale high-resolution face dataset, which contains 14,000 images with a resolution of 1024 × 1024. Superior performance of our method is demonstrated by qualitative and quantitative experiments on the benchmark dataset.

João Guerreiro,1 Laura Schulze,1 Albert Garcia i Tormo,1 Amanda J Henwood,1 Luc Schneider,1,2 Elise Krob,1 Sarah Salvilla,3 Kelly MY Chan,3 Sarah Deedat,3 Aleksandar Matic1 1R&D, Koa Health, Barcelona, Spain; 2Department of Management, LSE, London, UK; 3FWD Group, FWD Group, Hong Kong, People’s Republic of ChinaCorrespondence: João Guerreiro, R&D, Koa Health, Carrer de la Ciutat de Granada 121, Barcelona, 08018, Spain, Email joao.leitaoguerreiro@koahealth.comAbstract: Sleep, an intrinsic aspect of human life, is experienced by individuals differently which may be influenced by personality traits and characteristics. Exploring how these traits influence behaviors and sleep routines could be used to inform more personalized and effective interventions to promote better sleep. Our objective was to summarize the existing literature on the relationship between personality traits and sleep patterns through a systematic review. An abstract and keyword search was conducted in PsycINFO, Cochrane and PubMed, collecting relevant literature, published between January 1980 and June 2024. A total of 1713 records were found, of which 18 studies were analyzed in the descriptive synthesis. Relevant studies covered populations in 11 different countries, Australia, China, Estonia, Finland, Germany, Italy, Japan, Poland, Turkey, the United Kingdom, and the United States, comprising a total of 58,812 subjects. All studies reported an association between a sleep pattern with at least one of the Big Five personality traits (agreeableness, conscientiousness, extraversion, neuroticism, openness to experience). Ten studies found associations between personality and sleep quality, all of which reported a link between neuroticism and sleep quality (effect sizes 0.183-0.40). Five studies found an association between conscientiousness and morningness (effect sizes 0.16-0.35). Other sleep patterns linked to personality traits included sleep duration, nightmare frequency and distress, sleep deficiency, sleep continuity, insomnia severity and sleep problems, sleep hygiene, sleep latency and daytime sleepiness. This novel systematic review confirms that sleep and personality traits are related, suggesting that those traits should be considered when trying to understand or change one’s sleep behavior.Keywords: personality traits, sleep patterns, big five, sleep quality, chronotype

Amjaad Muhammad Ar Reshaid,1 Yasser Abdulathim Alshawakir,2 Mohammed A Almuayrifi,2 Omar Salem Al-Attas,1 Ahmed S BaHammam,3,4 Reem Abdullah Al Khalifah4– 6 1Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia; 2Experimental Surgery and Animal Lab, College of Medicine, King Saud University, Riyadh, 11451, Saudi Arabia; 3The University Sleep Disorders Centre, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4King Saud University Medical City, Riyadh, Saudi Arabia; 5Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 6University Diabetes Centre, King Saud University Medical City, Riyadh, Saudi ArabiaCorrespondence: Reem Abdullah Al Khalifah, Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, P.O Box 2925, Riyadh, 11461, Saudi Arabia, Tel +0118066750, Email reem_ah@yahoo.comObjective: We aimed to evaluate the effect of light–dark cycle alteration and soft drink consumption on the acceleration of type 1 diabetes mellitus (T1DM) development among non-obese diabetic (NOD) mice model.Methods: We exposed female NOD and C57BL/6 mice from the age of 5 weeks to either adlib soft drink consumption and/or T20 light–dark cycle alteration until the development of diabetes, or the mice reached the age of 30 weeks. Each group consisted of 7– 15 mice. We monitored weight, length, blood glucose level, and insulin autoantibody (IAA) levels weekly.Results: Out of 75 NOD and 22 C57BL/6 mice, 41 NOD mice developed diabetes, and 6 mice died between 7 and 8 weeks of age. The mean time to development of T1DM among NOD control mice was 20 weeks. The time to development of T1DM was accelerated by two weeks in the NOD mice exposed to light–dark cycle alteration, hazard ratio of 2.65,95th CI (0.70, 10.04) p = 0.15). The other groups developed T1DM, similar to the control group.Conclusion: There was a trend toward earlier development of T1DM among NOD mice exposed to light–dark cycle alteration, but this difference was not statistically significant. Further studies are needed to confirm our findings using larger sample sizes and different animal species.Keywords: type 1 diabetes mellitus, soft drink, sugar, light-dark cycle alteration, NOD/ShiLtJ

Zhaorong Gao,1– 3 Zhen Guo,1– 3 Yongbo Song,1– 3 Xiujing Shi,1– 3 Yingzuo Zhao,1– 3 Conghui Liu1– 3 1Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, Qingdao, People’s Republic of China; 2State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of China; 3School of Ophthalmology, Shandong First Medical University, Qingdao, People’s Republic of ChinaCorrespondence: Zhen Guo, Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong, 266071, People’s Republic of China, Fax +86532 8761 0087, Email guoz@sdfmu.edu.cnPurpose: With girls typically exhibiting higher rates of myopia than boys, however, the mechanisms behind this gender difference remain unclear. This study aims to investigate the gender disparities in the relationship between myopia, sleep duration, physical activity, and BMI.Patients and Methods: A total of 3138 primary and secondary school students were included. Mplus 8.3 was used to perform the multiple mediation analysis.Results: Sleep duration was indicated to directly affect myopia (β=0.273, 95% CI=0.184− 0.356) and through physical activity, BMI, physical activity and BMI three significantly mediation pathways, respectively. In terms of gender, the mediating direct effect of sleep duration on myopia of boys was 66.96%, which is much higher than that of girls’ 50.91%. And the mediating indirect effect of sleep duration on myopia through physical activity and BMI are 32.65% and 12.10% respectively among girls, both of which are significantly higher than that of boys.Conclusion: The study found that there are significant differences in the impact of sleep duration on myopia in children and adolescents of different genders. In this regard, while paying attention to the sleep duration of children and adolescents, special attention should also be paid to the indirect impact of girls’ physical activity and BMI on myopia, and targeted measures should be formulated according to children of different genders to effectively protect the eye health of children and adolescents.Keywords: myopia, children and adolescents, sleep duration, physical activity, BMI, gender difference

Li-Ming Zheng, Yan Li Department of Psychology and Sleep Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People’s Republic of ChinaCorrespondence: Li-Ming Zheng, Department of Psychology and Sleep Medicine, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, 510120, People’s Republic of China, Tel +8620-81887233-30409, Email 897898215@qq.comIntroduction: Sleep deprivation(SD) has numerous negative effects on mental health. A growing body of research has confirmed the implication of gut microbiota in mental disorders. However, the specific modifications in mammalian gut microbiota following SD exhibit variations across different studies.Methods: Male specific-pathogen-free Wistar rats were given a modified multiple-platform exposure for 7 days of SD. Fecal samples were obtained from the control and SD groups both at baseline and after 7 days of SD. We utilized 16S rDNA gene sequencing to investigate the gut microbial composition and functional pathways in rats.Results: Analysis of the microbiota composition revealed a significant change in gut microbial composition after chronic SD, especially at the phylum level. The relative abundances of p_Firmicutes, g_Romboutsia, and g_Enterococcus increased, whereas those of p_Bacteroidetes, p_Verrucomicrobia, p_Fusobacteria, g_Akkermansia, and g_Cetobacterium decreased in animals after chronic SD compared with controls or animals before SD. The ratio of Firmicutes to Bacteroidetes exhibited an increase following SD. The relative abundance of gut microbiota related to the functional pathways of GABAergic and glutamatergic synapses was observed to be diminished in rats following SD compared to pre-SD.Conclusion: Collectively, these findings suggest that chronic SD causes significant alterations in both the structural composition and functional pathways of the gut microbiome. Further researches are necessary to investigate the chronological and causal connections among SD, the gut microbiota and mental disorders.Keywords: gut microbiota, rats, sleep deprivation, mental disorders

Abstract Background Since its debut in 1949, lithium (Li) has been regarded as a gold standard therapy for mood stabilization. Neuroprotective effects of Li have been replicated across many different paradigms ranging from tissue cultures to human studies. This has generated interest in potentially repurposing this drug. However, the optimal dosage required for neuroprotective effects remains unclear and may be different than the doses needed for treatment of bipolar disorders. Recent studies on trace-Li levels in the water suggest that Li, could slow cognitive decline and prevent dementia with long-term use even at very low doses. The current review aims to synthesize the data on the topic and challenge the conventional high-dose paradigm. Results We systematically reviewed five available studies, which reported associations between trace-Li in water and incidence or mortality from dementia. Association between trace-Li levels and a lower risk or mortality from dementia were observed at concentrations of Li in drinking water as low as 0.002 mg/L and 0.056 mg/L. Meanwhile, levels below 0.002 mg/L did not elicit this effect. Although three of the five studies found dementia protective properties of Li in both sexes, a single study including lower Li levels (0.002 mg/l) found such association only in women. Conclusion The reviewed evidence shows that trace-Li levels in the water are sufficient to lower the incidence or mortality from dementia. Considering the lack of options for the prevention or treatment of dementia, we should not ignore these findings. Future trials of Li should focus on long term use of low or even micro doses of Li in the prevention or treatment of dementia.

Abstract Background Using event-related potentials (ERPs), we aimed to investigate audiovisual integration neural mechanisms during a letter identification task in the left and right sides. Unimodal (A,V) and bimodal (AV) stimuli were presented on either side, with ERPs from unimodal (A,V) stimuli on the same side being compared to those from simultaneous bimodal stimuli (AV). Non-zero results of the AV-(A + V) difference waveforms indicated audiovisual integration on the left/right side. Results When spatially coherent AV stimuli were presented on the right side, two significant ERP components in the integrated differential wave were noted. The N134 and N262, present in the first 300 ms of the AV-(A + V) integration difference wave, indicated significant audiovisual integration effects. However, when these stimuli were presented on the left side, there were no significant integration components. This audiovisual integration difference may stem from left/right asymmetry of cerebral hemisphere language processing. Conclusions Audiovisual letter information presented on the right side was easier to integrate, process, and represent. Additionally, only one significant integrative component peaked at 140 ms in the parietal cortex for spatially non-coherent AV stimuli and provided audiovisual multisensory integration, which could be attributed to some integrative neural processes that depend on the spatial congruity of the auditory and visual stimuli.

Abstract The trail making test (TMT) is a commonly used tool for evaluating executive functions, and the activation of cerebral oxygenation in the prefrontal cortex (PFC) during the test can reflect the participation of executive function. This study aimed to compare the differences in cerebral oxygenation in the PFC between the computer- and paper-based versions of the TMT and provide a theoretical basis for the optimization and clinical application of the computer-based version. A total of 32 healthy adult participants completed the computer- and paper-based TMT Types A and B. Cerebral oxygenation changes in the PFC were monitored during the experiment using near-infrared spectroscopy. Moreover, average changes in oxyhemoglobin (Δoxy-Hb) levels at the baseline and during activation periods in different types of testing were compared and analyzed. The number of correct connections in the computer-based version Type B was less than that in the paper-based version Type B (p

Abstract Rapid mapping is a transcranial magnetic stimulation (TMS) mapping method which can significantly reduce data collection time compared to traditional approaches. However, its validity and reliability has only been established for upper-limb muscles during resting-state activity. Here, we determined the validity and reliability of rapid mapping for non-upper limb muscles that require active contraction during TMS: the masseter and quadriceps muscles. Eleven healthy participants attended two sessions, spaced two hours apart, each involving rapid and ‘traditional’ mapping of the masseter muscle and three quadriceps muscles (rectus femoris, vastus medialis, vastus lateralis). Map parameters included map volume, map area and centre of gravity (CoG) in the medial-lateral and anterior-posterior directions. Low to moderate measurement errors (%SEMeas = 10–32) were observed across muscles. Relative reliability varied from good-to-excellent (ICC = 0.63–0.99) for map volume, poor-to-excellent (ICC = 0.11–0.86) for map area, and fair-to-excellent for CoG (ICC = 0.25–0.8) across muscles. There was Bayesian evidence of equivalence (BF’s > 3) in most map outcomes between rapid and traditional maps across all muscles, supporting the validity of the rapid mapping method. Overall, rapid TMS mapping produced similar estimates of map parameters to the traditional method, however the reliability results were mixed. As mapping of non-upper limb muscles is relatively challenging, rapid mapping is a promising substitute for traditional mapping, however further work is required to refine this method.

Abstract The scientific relationship between neuroscience and artificial intelligence is generally acknowledged, and the role that their long history of collaboration has played in advancing both fields is often emphasized. Beyond the important scientific insights provided by their collaborative development, both neuroscience and AI raise a number of ethical issues that are generally explored by neuroethics and AI ethics. Neuroethics and AI ethics have been gaining prominence in the last few decades, and they are typically carried out by different research communities. However, considering the evolving landscape of AI-assisted neurotechnologies and the various conceptual and practical intersections between AI and neuroscience—such as the increasing application of AI in neuroscientific research, the healthcare of neurological and mental diseases, and the use of neuroscientific knowledge as inspiration for AI—some scholars are now calling for a collaborative relationship between these two domains. This article seeks to explore how a collaborative relationship between neuroethics and AI ethics can stimulate theoretical and, ideally, governance efforts. First, we offer some reasons for calling for the collaboration of the ethical reflection on neuroscientific innovations and AI. Next, we explore some dimensions that we think could be enhanced by the cross-fertilization between these two subfields of ethics. We believe that considering the pace and increasing fusion of neuroscience and AI in the development of innovations, broad and underspecified calls for responsibility that do not consider insights from different ethics subfields will only be partially successful in promoting meaningful changes in both research and applications.

Abstract Genetic and environmental factors have been linked with neurodegeneration, especially in the elderly. Yet, efforts to impede neurodegenerative processes have at best addressed symptoms instead of underlying pathologies. The gap in the understanding of neuro-behavioral plasticity is consistent from insects to mammals, and cockroaches have been proven to be effective models for studying the toxicity mechanisms of various chemicals. We therefore used head injection of 74 and 740 nmol STZ in Nauphoeta cinerea to elucidate the mechanisms of chemical-induced neurotoxicity, as STZ is known to cross the blood-brain barrier. Neurolocomotor assessment was carried out in a new environment, while head homogenate was used to estimate metabolic, neurotransmitter and redox activities, followed by RT-qPCR validation of relevant cellular signaling. STZ treatment reduced the distance and maximum speed travelled by cockroaches, and increased glucose levels while reducing triglyceride levels in neural tissues. The activity of neurotransmitter regulators – AChE and MAO was exacerbated, with concurrent upregulation of glucose sensing and signaling, and increased mRNA levels of redox regulators and inflammation-related genes. Consequently, STZ neurotoxicity is conserved in insects, with possible implications for using N. cinerea to target the multi-faceted mechanisms of neurodegeneration and test potential anti-neurodegenerative agents.

Yingying Jiang,1,* Siqi Ge,2,* Chunyang Wang,1 Chen Jin,1 Yumei Zhao,1 Qingying Liu3 1Department of Neuropharmacology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People’s Republic of China; 2Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People’s Republic of China; 3Department of Pain Medicine, the First Affiliated Hospital of Zhengzhou University, Henan, 450052, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qingying Liu, Email liuqy1679@163.comBackground: Sleep played an important part in human health, and COVID-19 led to a continuous deterioration of sleep. However, the causal relationship between micronutrient and sleep disorder was not yet fully understood.Methods: In this research, the genetic causal relationship between micronutrient and sleep disorder was analyzed utilizing a two-sample Mendelian randomization (MR). Single nucleotide polymorphisms (SNPs) were used as instrumental variables. The analyses were conducted using the MR-Egger, inverse variance weighted, weighted mode, weighted median, simple mode, Cochran’s Q test and leave-one-out.Results: Our results suggested that 8 genetically predicted micronutrients participated in sleep disorders, including liver iron (L-iron) and iron in sleeping too much, spleen iron (S-iron) in sleeplessness/insomnia, trouble falling or staying asleep, sleep duration (undersleepers) and nonorganic sleeping disorders, iron metabolism disorder (IMD) and vitamin B12 deficiency anaemia (VB12DA) in narcolepsy, urine sodium (uNa) in narcolepsy, sleep apnea syndrome and sleep disorder, vitamin D (VD) in sleep duration (oversleepers), 25-Hydroxyvitamin D (25(OH)D) in trouble falling or staying asleep.Conclusion: Our study used Mendelian randomization methods at the SNP level to explore the potential causal relationship among L-iron, iron, S-iron, IMD, uNa, 25(OH)D, VD, VB12DA with certain sleep disorder subtypes. Our results uncovered a micronutrient-based strategy for alleviating sleep disorder symptoms.Keywords: Mendelian randomization, micronutrient, sleep disorder, causality, vitamin

Shauna Stevenson,1 Haresh Suppiah,1 Joshua Ruddy,2 Sean Murphy,2 Matthew Driller1 1Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, Australia; 2Essendon Football Club, Melbourne, AustraliaCorrespondence: Shauna Stevenson, School of Allied Health, La Trobe University, Plenty Road, Bundoora, Melbourne, VIC, 3086, Australia, Tel +61 450 782 680, Email s.stevenson@latrobe.edu.auObjective: Light exposure techniques have been recommended to combat sleep issues caused by disruption to circadian regularity in the athletic population, although studies are lacking.Methods: A total of 17 professional male Australian Football athletes (age ± SD: 22 ± 3 years) wore a wrist actigraph to measure sleep parameters, and a wearable light sensor to measure melanopic equivalent daylight illuminance (mEDI, in lux) for 14 days. Participants completed three sleep questionnaires at the end of the data collection period and completed well-being surveys 6 times. The Sleep Regularity Index (SRI) for each player was also calculated from actigraphy data. Light exposure data were organised into three different timeframes: morning (wake time + 2 hours), daytime (end of morning to 6 pm), and evening (2 hours leading up to bedtime) for analysis. Repeated measures correlation was conducted for objective sleep measures and mEDI values per timeframe. Pearson’s correlation was conducted on subjective sleep measures and well-being measures against mEDI values per timeframe.Results: Higher morning light was associated with significantly (p < 0.001) greater total sleep time (r = 0.31). Higher daytime light exposure was associated with higher subjective sleep quality (r = 0.48, p < 0.05). Higher evening light exposure was associated with higher Athlete Sleep Screening Questionnaire (ASSQ) global scores (r = 0.52, p < 0.05). There were no other significant correlations between light exposure and sleep or well-being measures (p > 0.05).Conclusion: Higher morning and daylight exposure levels were associated with various positive objective and subjective sleep measures in professional team sport athletes, supporting the need for education on optimising light exposure to improve circadian function, sleep, and health.Keywords: mEDI, actigraphy, wearable light sensors, lux, circadian rhythms

Abstract Background Alongside affective episodes, cognitive dysfunction is a core symptom of bipolar disorder. The intracellular parasite T. gondii has been positively associated with both, the diagnosis of bipolar disorder and poorer cognitive performance, across diagnostic boundaries. This study aims to investigate the association between T. gondii seropositivity, serointensity, and cognitive function in an euthymic sample of bipolar disorder. Methods A total of 76 participants with bipolar disorder in remission were tested for T. gondii-specific IgG and IgM antibodies and for cognitive performance using neuropsychological test battery. Cognitive parameters were categorized into three cognitive domains (attention and processing speed, verbal memory, and executive function). Statistical analysis of associations between continuous indicators of cognitive function as dependent variables in relationship to T. gondii, included multivariate analyses of co-variance for seropositivity, and partial correlations with IgG serointensity in IgG seropositives. All analyses were controlled for age and premorbid IQ. Results In seropositives (n = 27), verbal memory showed significant inverse partial correlations with IgG antibody levels (short delay free recall (r=–0.539, p = 0.005), long delay free recall (r=–0.423, p = 0.035), and immediate recall sum trial 1–5 (r=–0.399, p = 0.048)). Cognitive function did not differ between IgG seropositive and seronegative individuals in any of the cognitive domains (F (3,70) = 0.327, p = 0.806, n = 76). IgM positives (n = 7) were too few to be analyzed. Conclusions This investigation is the first to show an association between T. gondii IgG serointensity and memory function in a well-diagnosed bipolar disorder sample. It adds to the existing literature on associations between latent T. gondii infection and cognition in bipolar disorder, while further research is needed to confirm and expand our findings, eliminate potential sources of bias, and establish cause-effect relationships.

Abstract Background Current treatments for bipolar depression have limited effectiveness, tolerability and acceptability. Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation method that has demonstrated treatment efficacy for major depressive episodes. tDCS is portable, safe, and individuals like having sessions at home. We developed a home-based protocol with real-time remote supervision. In the present study, we have examined the clinical outcomes, acceptability and feasibility of home-based tDCS treatment in bipolar depression. Results Participants were 44 individuals with bipolar disorder (31 women), mean age 47.27 ± 12.89 years, in current depressive episode of at least moderate severity (mean Montgomery Asberg Depression Rating Scale (MADRS) score 24.59 ± 2.64). tDCS was provided in bilateral frontal montage, F3 anode, F4 cathode, 2 mA, for 30 min, in a 6-week trial, for total 21 sessions, a follow up visit was conducted 5 months from baseline. Participants maintained their current treatment (psychotherapy, antidepressant or mood stabilising medication) or maintained being medication-free. A research team member was present by video conference at each session. 93.2% participants (n = 41) completed the 6-week treatment and 72.7% of participants (n = 32) completed the 5 month follow up. There was a significant improvement in depressive symptoms following treatment (mean MADRS 8.77 ± 5.37) which was maintained at the 5 month follow up (mean MADRS 10.86 ± 6.90), rate of clinical response was 77.3% (MADRS improvement of 50% or greater from baseline), and rate of clinical remission was 47.7% (MADRS rating of 9 or less). Acceptability was endorsed as “very acceptable” or “quite acceptable” by all participants. No participants developed mania or hypomania. Conclusions In summary, home-based tDCS with real-time supervision was associated with significant clinical improvements and high acceptability in bipolar depression. Due to the open-label design, efficacy findings are preliminary. Trial registration ClinicalTrials.gov number NCT05436613 registered on 23 June 2022 https//www.clinicaltrials.gov/study/NCT05436613.

Abstract Visual perception of X-radiation is a well-documented, but poorly understood phenomenon. Scotopic rod cells and rhodopsin have been implicated in visual responses to X-rays, however, some evidence suggests that X-rays excite the retina via a different mechanism than visible light. While rhodopsin’s role in X-ray perception is unclear, the possibility that it could function as an X-ray receptor has led to speculation that it could act as a transgenically expressed X-ray receptor. If so, it could be used to transduce transcranial X-ray signals and control the activity of genetically targeted populations of neurons in a less invasive version of optogenetics, X-genetics. Here we investigate whether human rhodopsin (hRho) is capable of transducing X-ray signals when expressed outside of the retinal environment. We use a live-cell cAMP GloSensor luminescence assay to measure cAMP decreases in hRho-expressing HEK293 cells in response to visible light and X-ray stimulation. We show that cAMP GloSensor luminescence decreases are not observed in hRho-expressing HEK293 cells in response to X-ray stimulation, despite the presence of robust responses to visible light. Additionally, irradiation had no significant effect on cAMP GloSensor responses to subsequent visible light stimulation. These results suggest that ectopically expressed rhodopsin does not function as an X-ray receptor and is not capable of transducing transcranial X-ray signals into neural activity for X-ray mediated, genetically targeted neuromodulation.

Abstract Background Adipose and muscle tissue wasting outlines the cachectic process during tumor progression. The sympathetic nervous system (SNS) is known to promote tumor progression and research suggests that it might also contribute to cancer-associated cachexia (CAC) energetic expenditure through fat wasting. Methods We sympathectomized L5178Y-R tumor-bearing male BALB/c mice by intraperitoneally administering 6-hydroxydopamine to evaluate morphometric, inflammatory, and molecular indicators of CAC and tumor progression. Results Tumor burden was associated with cachexia indicators, including a 10.5% body mass index (BMI) decrease, 40.19% interscapular, 54% inguinal, and 37.17% visceral adipose tissue loss, a 12% food intake decrease, and significant (p = 0.038 and p = 0.0037) increases in the plasmatic inflammatory cytokines IL-6 and IFN-γ respectively. Sympathectomy of tumor-bearing mice was associated with attenuated BMI and visceral adipose tissue loss, decreased interscapular Ucp-1 gene expression to basal levels, and 2.6-fold reduction in Mmp-9 relative gene expression, as compared with the unsympathectomized mice control group. Conclusion The SNS contributes to CAC-associated morphometric and adipose tissue alterations and promotes tumor progression in a murine model.

Benedikt Holm,1 Michal Borsky,1 Erna S Arnardottir,2,3 Marta Serwatko,2 Jacky Mallett,1 Anna Sigridur Islind,1 María Óskarsdóttir1 1Reykjavik University, School of Technology, Department of Computer Science, Reykjavik, Iceland; 2Reykjavik University, School of Technology, Sleep Institute, Reykjavik, Iceland; 3Landspitali, The National University Hospital of Iceland, Reykjavik, IcelandCorrespondence: Benedikt Holm, Email benedikthth@ru.isIntroduction: The field of automatic respiratory analysis focuses mainly on breath detection on signals such as audio recordings, or nasal flow measurement, which suffer from issues with background noise and other disturbances. Here we introduce a novel algorithm designed to isolate individual respiratory cycles on a thoracic respiratory inductance plethysmography signal using the non-invasive signal of the respiratory inductance plethysmography belts.Purpose: The algorithm locates breaths using signal processing and statistical methods on the thoracic respiratory inductance plethysmography belt and enables the analysis of sleep data on an individual breath level.Patients and Methods: The algorithm was evaluated against a cohort of 31 participants, both healthy and diagnosed with obstructive sleep apnea. The dataset consisted of 13 female and 18 male participants between the ages of 20 and 69. The algorithm was evaluated on 7.3 hours of hand-annotated data from the cohort, or 8782 individual breaths in total. The algorithm was specifically evaluated on a dataset containing many sleep-disordered breathing events to confirm that it did not suffer in terms of accuracy when detecting breaths in the presence of sleep-disordered breathing. The algorithm was also evaluated across many participants, and we found that its accuracy was consistent across people. Source code for the algorithm was made public via an open-source Python library.Results: The proposed algorithm achieved an estimated 94% accuracy when detecting breaths in respiratory signals while producing false positives that amount to only 5% of the total number of detections. The accuracy was not affected by the presence of respiratory related events, such as obstructive apneas or snoring.Conclusion: This work presents an automatic respiratory cycle algorithm suitable for use as an analytical tool for research based on individual breaths in sleep recordings that include respiratory inductance plethysmography.Keywords: respiratory analysis, breath detection algorithm, sleep analysis, breath segmentation, respiratory cycle isolation

Jiaqin Yu,1,&ast; Ting Shen,2,&ast; Zongshan Li,3 Tian Lv,4 Lisan Zhang3 1School of Medicine, Shaoxing University, Shaoxing, Zhejiang, People’s Republic of China; 2Department of Neurology, Zhuji People’s Hospital of Zhejiang Province, Zhuji, People’s Republic of China; 3Department of Neurology and Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; 4Department of Neurology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lisan Zhang, Department of Neurology and Center for Sleep Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China, Email zls09@zju.edu.cnAbstract: Narcolepsy type 1 (NT1) is a unique central sleepiness disorder that affects individuals with excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, and hypnagogic hallucinations. The etiology and pathogenesis of NT1 remains unclear, although some viral infections are thought to be related to NT1. This paper reports an unusual case of late-onset NT1 with human immunodeficiency virus (HIV) infection and antiretroviral therapy for five years. The relationship between HIV infection, immune, Immune reconstitution inflammatory syndrome (IRIS) and NT1 should be further investigated, as excessive daytime sleepiness is more common in HIV-infected patients than in the general population.Keywords: narcolepsy, excessive daytime sleepiness, HIV, immune, Immune reconstitution inflammatory syndrome

Firoj Al-Mamun,1– 3 Mohammed A Mamun,1– 3 Md Emran Hasan,1,4 Moneerah Mohammad ALmerab,5 David Gozal6 1CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh; 2Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh; 3Department of Public Health, University of South Asia, Dhaka, Bangladesh; 4Software College, Northeastern University, Shenyang, 110169, People’s Republic of China; 5Department of Psychology, College of Education and Human Development, Princess Nourah Bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 6Department of Pediatrics and Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25701, USACorrespondence: Mohammed A Mamun, CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh, Email mamunphi46@gmail.com David Gozal, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25701, USA, Email gozal@marshall.eduBackground: Sleep disruptions among prospective university students are increasingly recognized for their potential ramifications on academic achievement and psychological well-being. But, information regarding sleep issues among students preparing for university entrance exams is unknown. Thus, this study aimed to investigate the prevalence and factors associated with sleep duration and insomnia among university entrance test-takers in Bangladesh, utilizing both traditional statistical analyses and advanced geographic information system and machine learning techniques for enhanced predictive capability.Methods: A cross-sectional study was conducted in June 2023 among 1496 entrance test-takers at Jahangirnagar University, Dhaka. Structured questionnaires collected data on demographics, academic information, and mental health assessments. Statistical analyses, including chi-square tests and logistic regression, were performed using SPSS, while machine learning models were applied using Python and Google Colab.Results: Approximately 62.9% of participants reported abnormal sleep duration (< 7 hours/night or > 9 hours/night), with 25.5% experiencing insomnia. Females and those dissatisfied with mock tests were more likely to report abnormal sleep duration, while repeat test-takers, those with unsatisfactory mock test results, or anxiety symptoms had a higher risk of insomnia. Machine learning identified satisfaction with previous mock tests as the most significant predictor of sleep disturbances, while higher secondary school certificate GPA had the least influence. The CatBoost model achieved maximum accuracy rates of 61.27% and 73.46%, respectively, for predicting sleep duration and insomnia, with low log loss values indicating robust predictive performance. Geographic analysis revealed regional variations in sleep disturbances, with higher insomnia prevalence in some southern districts and abnormal sleep duration in northern and eastern districts.Conclusion: Sleep disturbances are prevalent among prospective university students and are associated with various factors including gender, test-taking status, mock test satisfaction, and anxiety. Targeted interventions, including sleep education and psychological support, hold promise in ameliorating sleep health and overall well-being among students, potentially enhancing entrance test performance.Keywords: sleep disturbances, abnormal sleep duration, insomnia, university entrance exams, mental health

Xuliang Shi,1,&ast; Miaomiao Hou,1,&ast; Xiaoyan Chen,2 Ya Zhu3 1College of Education, Hebei University, Baoding, Hebei Province, 071002, People’s Republic of China; 2Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong; 3Center for Mental Health Education and Counseling, Guangdong University of Science and Technology, Dongguan, Guangdong Province, 523083, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xuliang Shi, Associate professor at the College of Education, Hebei University, Baoding, 071002, People’s Republic of China, Email shixl163@163.comObjective: This longitudinal study examined the reciprocal relationship between sleep disturbances with non-suicidal self-injury and whether self-compassion mediates these associations.Methods: A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students at the baseline. This study spanned six waves with a six-month interval between each wave. Data from the last four waves were used because self-compassion or non-suicidal self-injury was not measured in the first two waves. The cross-lagged panel models were used to examine the longitudinal dynamic relationships between sleep disturbances, self-compassion, and non-suicidal self-injury.Results: The results showed that all the auto-regressive paths were significant. For the cross-lagged paths, there was a reciprocal relation between sleep disturbances and self-compassion. Importantly, self-compassion played a longitudinal mediating role in the prediction from sleep disturbances to non-suicidal self-injury (indirect effect = 0.007 to 0.009, all p values < 0.001).Conclusion: Psychological interventions targeting improved sleep quality and self-compassion may hold great promise for reducing the incidence of non-suicidal self-injury.Keywords: sleep disturbances, self-compassion, NSSI, longitudinal design

Abstract Mask face recognition has recently gained increasing attention in the current context. Face mask occlusion seriously affects the performance of face recognition systems, because more than 75% of the face area remains unexposed and the mask directly causes an increase in intra-class differences and a decrease in inter-class separability in the feature space. To improve the performance of face recognition model against mask occlusion, we propose a fast and efficient method for mask generation in this paper, which can avoid the need for large-scale collection of real-world mask face training sets. This approach can be embedded in the training process of any mask face model as a module and is very flexible. Experiments on the MLFW, MFR2 and RMFD datasets show the effectiveness and flexibility of our approach that outperform the state-of-the-art methods.

Abstract Background The 33-item Hypomania Checklist (HCL-33) has been shown to distinguish between adolescent bipolar disorder (BD) and unipolar depression. To investigate the utility of the HCL-33 as a screening tool in routine diagnostics, the frequency and psychopathological characteristics of detected individuals in a mixed psychiatric sample necessitate more examination. Methods The HCL-33, Children’s Depression Inventory, Beck’s Anxiety Inventory, and Strengths and Difficulties Questionnaire were completed by 285 children and adolescents (12–18 years) in a mixed psychiatric sample. Applying the proposed HCL-33 cut-off score of ≥ 18, individuals with depressive symptoms were divided into at-risk or not at-risk for BD groups. The factorial structure, sum and factor score correlations with psychopathology, and impact on daily functioning were assessed. Results 20.6% of the sample met at-risk criteria for BD. These individuals (n = 55) were older, more anxious, and showed more conduct problems vs the not at-risk group (n = 107). A two- and a three-factor model were pursued with the same Factor 1 (“active-elated”). Factor 2 (“risk-taking/irritable”) was separated into 2a (“irritable-erratic”) and 2b (“outgoing-disinhibited”) in the three-factor model. Whereas higher Factor 2 and 2a scores correlated with a broad range of more severe symptomatology (i.e., depression, anxiety, hyperactivity), higher Factor 1 and 2b scores correlated with more emotional and conduct problems, respectively. 51.7% of the sample reported a negative impact from hypomanic symptoms on daily functioning. Limitations Cross-sectional design and data collection in a single mental health service. Conclusions The HCL-33 may be a useful tool to improve diagnostics, especially in adolescents with depressive symptoms additionally presenting with anxious symptoms and conduct problems.

Abstract Background There have been case reports of renal dysfunction with lithium toxicity among severely ill COVID-19 patients. Lithium levels may be affected by comorbid conditions and the presence of infective disease states like the SARS-CoV-2 which clearly adds systemic health burden. This study aimed to review the effect SARS-CoV-2 has on serum Li levels and the possible mechanism underlying it. Methods Retrospective data from all clinical service encounters within the University of Michigan health system between September 2019 and September 2023 were reviewed. The study cohort included 98 patients with an average age of 45 years (62% female) who were diagnosed with any subtype of bipolar disorder, actively taking Li, and infected with SARS-CoV-2 during the study timeframe. Results There was no overarching effect of a SARS-CoV-2 infection on Li chemistry in the overall sample. Higher serum Li levels were not significantly associated with SARS-CoV-2 infection nor total comorbidity index. However, higher Li levels were observed in males while infected with SARS-CoV-2 when compared with no infection. eGFR remained unassociated with serum Li level. Receiving COVID vaccination was associated with lower serum Li levels (Coeff. = − 0.88, p = 0.048). Conclusions Patients with a diagnosis of BD, treated with Li, and infected with SARS-CoV-2 were not likely to present with elevated Li levels unless they are male or unvaccinated. Elevated serum Li level was not associated with significant renal dysfunction in this cohort. The case reports of severe renal complications and Li toxicity may be among cases of greater overall clinical severity of COVID-19. These findings are reassuring that Li may be used in the context of a COVID-19 illness but emphasize the ongoing need for clinical vigilance.

Abstract Background Status epilepticus is a common and potentially life-threatening neurological emergency with a high risk for cognitive and neurobiological impairment. Our aim was to evaluate the neuroprotective effects of centrally administered irisin and acute exhausting exercise against oxidative brain injury and memory dysfunction due to a pentylenetetrazole (PTZ)-induced single seizure. Male Sprague Dawley rats with intracerebroventricular (icv) cannulas were randomly divided into intraperitoneally (ip) saline-injected control and PTZ-injected (45 mg/kg) seizure groups. Both the control and PTZ groups were then treated with irisin (7.5 µg/kg, 2 µl, icv), saline (2 µl, icv) or were forced to an acute bout of strenuous exercise before the ip injection of saline (control) or PTZ. Seizures were evaluated using the Racine score. To evaluate memory performance, a passive avoidance test was performed before and after PTZ injection. Following euthanasia at the 24th hour of seizure induction, brain tissues were removed for histopathological examination and for evaluating oxidative damage, antioxidant capacity, and neurotransmitter levels. Results Glutamate/GABA imbalance observed in PTZ rats was corrected by irisin administration (p

Abstract Conversation is an essential component of virtual avatar activities in the metaverse. With the development of natural language processing, significant breakthroughs have been made in text and voice conversation generation. However, face-to-face conversations account for the vast majority of daily conversations, while most existing methods focused on single-person talking head generation. In this work, we take a step further and consider generating realistic face-to-face conversation videos. Conversation generation is more challenging than single-person talking head generation, because it requires not only the generation of photo-realistic individual talking heads, but also the listener’s response to the speaker. In this paper, we propose a novel unified framework based on the neural radiance field (NeRF) to address these challenges. Specifically, we model both the speaker and the listener with a NeRF framework under different conditions to control individual expressions. The speaker is driven by the audio signal, while the response of the listener depends on both visual and acoustic information. In this way, face-to-face conversation videos are generated between human avatars, with all the interlocutors modeled within the same network. Moreover, to facilitate future research on this task, we also collected a new human conversation dataset containing 34 video clips. Quantitative and qualitative experiments evaluate our method in different aspects, e.g., image quality, pose sequence trend, and natural rendering of the scene in the generated videos. Experimental results demonstrate that the avatars in the resulting videos are able to carry on a realistic conversation, and maintain individual styles.

Jianghao Xiao, Dengkai Chen, Suihuai Yu, Hui Wang, Yiwei Sun, Hanyu Wang, Zhiming Gou, Jingping Wang Key Laboratory of Industrial Design and Ergonomics, Ministry of Industry and Information Technology, Northwestern Polytechnical University, Xi’an, 710072, People’s Republic of ChinaCorrespondence: Jianghao Xiao, Key Laboratory of Industrial Design and Ergonomics, Ministry of Industry and Information Technology, Northwestern Polytechnical University, 127 Youyi West Road, Xi’an, 710072, People’s Republic of China, Tel +86 15528076860, Email xiaojianghao@mail.nwpu.edu.cnPurpose: Exposure to artificial light influences human performance, which is essential for maintaining healthy work and sleep. However, existing research has not explored the intrinsic links between sleep performance and human states over time under prebedtime light exposure interventions (LEIs).Methods: To investigate the time-dependent effects of altered prebedtime light exposure, four LEI groupings (&num;L1 - &num;L4) and a Time factor (D8, D9, and D10) were chosen for sleep experiments in enclosed spaces. Forty-eight young adults recruited were available for data analysis. Subjective alertness (SA), negative affect (NA), subjective sleep, and objective sleep were measured via the Karolinska Sleepiness Scale, Positive and Negative Affect Schedule, Next-day Self-assessment Sleep Quality, and joint assessment of wrist actigraphy and sleep diaries, respectively. Statistical analysis was used for the effects of light exposure on the human states (corresponding to the SA and NA) and sleep performance, while the process model helped construct the associations between the two.Results: The statistical effects revealed that the Time had a significant main effect on subjective sleep and changes in prebedtime alertness; the LEI had a significant main effect only on sleep onset latency (SOL). After undergoing altered prebedtime light exposure, the mean SA increased at prebedtime of D9 (p = 0.022) and D10 (p = 0.044); No significant effect on the NA was observed; Mean subjective sleep had a significant increase from D8 to D10. Moreover, five actigraphy-estimated sleep parameters were interrelated. In light of this, a chained pathway relationship was identified. The SOL played a mediating predictor between prebedtime state and objective sleep, which was linked to the awakening state through subjective sleep.Conclusion: Our study suggests that time-dependent effects of altered prebedtime light exposure on sleep performance are associated with human states at prebedtime and awakening, with implications for its prediction of sleep health.Keywords: prebedtime light exposure, sleep performance, non-visual effects, alertness, negative affect, sleep onset latency

Yuxin Wang,1,&ast; Xiaona Wang,1,2,&ast; Jinmei Luo,1 Bintao Qiu,3 Rong Huang,1 Yi Xiao1 1Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Central Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinmei Luo, Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People’s Republic of China, Email palmljm@126.comPurpose: There are currently no ideal indicators for predicting the cardiovascular risk of obstructive sleep apnea (OSA). This study aimed to employ urinary metabolomics to detect early cardiovascular risk in patients with moderate-to-severe OSA.Patients and Methods: Male participants who underwent polysomnography from November 2020 to May 2021 were screened. Clinical data, polysomnography data and urine samples were collected. Untargeted metabolomics analyses of urine were performed. Multivariate analyses and receiver operating characteristic (ROC) curve analyses were subsequently performed to identify potential biomarkers. Associations between metabolites and clinical indicators and cardiovascular risk were examined through linear regression analyses with interaction and mediation analyses.Results: Thirty-six male participants were included in the study, comprising 22 males with moderate-to-severe OSA and 14 age-matched controls, with an average age of 39.6 ± 9.2 years. We identified 65 metabolites in the study, involving pathways including pyrimidine, androgen, estrogen, vitamin B6 and sulfate/sulfite metabolism. Among them, epinephrine sulfate was the most significantly altered metabolite. ROC analyses highlighted that epinephrine sulfate had the highest area under the curve (AUC=0.883) for detecting moderate-to-severe OSA. Epinephrine sulfate was statistically correlated with OSA severity, hypoxia-related indicators (apnea-hypopnea index: r=0.685; oxygen desaturation index: r=0.743, p< 0.0001), arterial stiffness (arterial augmentation index: r=0.361, p=0.031) and long-term cardiovascular risk (Framingham cardiovascular risk: r=0.375, p=0.024). Linear regression analysis revealed that epinephrine sulfate was significantly associated with an increased in the Framingham risk (β = 0.004, 95% CI = 0.000– 0.009, p = 0.049), with the effect partly mediated by systolic blood pressure (27.6%) and not moderated by other factors. Additionally, it also significantly associated with the increased in the arterial augmentation index (β = 0.019, 95% CI = 0.000– 0.037, p = 0.046), with the effect fully mediated by blood pressure and not moderated by other indices statistically.Conclusion: There are significant metabolic pathway alterations in moderate-to-severe OSA patients. Urinary epinephrine sulfate markedly predicts early cardiovascular risk in OSA patients.Keywords: metabolomics, Framingham cardiovascular risk score, epinephrine sulfate, obstructive sleep apnea

Lili Huang,1,&ast; Yesong Liu,2,&ast; Tingting Geng,1,&ast; Nannan Zhang,2 Liang Sun,1 Shouling Wu,3 Xiang Gao1 1Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, People’s Republic of China; 2Department of Neurology, Kailuan General Hospital, Tangshan, People’s Republic of China; 3Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiang Gao, Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, 130 Dongan Road, Shanghai, 200032, People’s Republic of China, Email xiang_gao@fudan.edu.cn Shouling Wu, Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Road, Tangshan, 063000, People’s Republic of China, Tel +86 315 3025655, Fax +86 315 3725312, Email drwusl@163.comBackground: Sleep complaints were reported to be associated with stroke, however, the evidence on the association between healthy sleep pattern and stroke risk in Chinese is limited.Objective: The aim of this study was to investigate the association between healthy sleep pattern and stroke in Chinese, and the influence of metabolic diseases on the association.Methods: A total of 11,851 participants from the Kailuan study in China without stroke at baseline were included. We calculated a healthy sleep score according to four sleep factors, and defined the low-risk groups as follows: no insomnia, no excessive daytime sleepiness, no frequent snoring, and sleep 7– 8h/d. Each low-risk sleep factor was assigned a score of 1. Cox proportional hazard models were used to assess the association between healthy sleep score and stroke. Mediation analysis was used to estimate the role of metabolic diseases (obesity, diabetes, and hypertension) in the healthy sleep score-stroke association.Results: During a mean follow-up period of 7.7 years, 504 cases of stroke were identified. A higher healthy sleep score was associated with a lower risk of stroke in a dose-response manner (P-trend=0.03). The adjusted hazard ratio (HR) for participants with a healthy sleep score of 4 versus ≤ 2 was 0.75 (95% confidence interval [CI]: 0.56, 0.96). In addition, obesity, diabetes, and hypertension collectively explained 21.9% (95% CI: 17.2, 26.5) of the association between healthy sleep score and stroke.Conclusion: Adherence to healthy sleep pattern was associated with a lower risk of stroke, and the favorable association was partially mediated by metabolic diseases.Keywords: healthy sleep pattern, metabolic disease, stroke, mediation

Zijuan Ma,1,&ast; Yunge Fan,1,&ast; Zhijun Yu,1 Wenxuan Wu,1 Xiangting Zhang,1 Huolian Li,1 Shaochen Zhao,2 Yang Li,3 Yuanyuan Li,4 Dongfang Wang,1 Fang Fan1 1Center for Studies of Psychological Application, School of Psychology, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, People’s Republic of China; 2Research Center for Guangdong-Hong Kong-Macao Policing Model Innovation, China People’s Police University, Guangzhou, People’s Republic of China; 3Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 4Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dongfang Wang; Fang Fan, School of Psychology, South China Normal University, Shipai Road, Guangzhou, 510631, People’s Republic of China, Email wdfpsyc@126.com; fangfan@scnu.edu.cnPurpose: Although experimental psychopathology using PET, EEG, and fMRI is at the forefront of understanding the underlying mechanisms of sleep inertia, many questions concerning causality remain unanswerable due to ethical constraints and the use of small and heterogeneous samples in experimental methods. There is a pressing need for a novel perspective in a large and relatively homogeneous population to fully capture and elucidate longitudinal processes and dynamic causality that culminate in episodes of sleep inertia over time. Therefore, this study aimed to reveal the causal relationships between symptoms of sleep inertia across its distinct patterns.Patients and Methods: A total of 1636 intern nurses participated in the first survey (94.1% validity rate), then 1277 intern nurses were followed up (82.9% tracing rate). Symptoms of sleep inertia were self-reported using the Sleep Inertia Questionnaire. The cross-lagged panel network models were used to examine unique longitudinal relationships between symptoms of sleep inertia across distinct trajectories.Results: Four distinct trajectories of sleep inertia were established. Additionally, we found differences in those symptoms with the highest influence on other symptoms at the subsequent point across the networks of four trajectories, particularly, “Difficulty in concentrating” in the persistent-high group and “Feeling tense” in the deteriorating groups.Conclusion: The current study highlights changes in sleep inertia based on the long-term course over time. Notably, symptoms of “Difficulty in concentrating” and “Feeling tense” are imperative to address these specific symptoms within subpopulations.Keywords: sleep inertia, change patterns, network structures, intern nurse, shift work

Qianqian Li,1,&ast; Yujie Liu,2,&ast; Zulun Zhang,1 Sheng Zhang,1 Xiao Ding,2 Faming Zhang1,3 1Department of Microbiota Medicine & Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, People’s Republic of China; 2Department of Medicine & Therapeutics, the Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 3National Clinical Research Center for Digestive Diseases, Xi’an, 710032, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Faming Zhang, Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan, Nanjing, 210011, People’s Republic of China, Email fzhang@njmu.edu.cnPurpose: There is scarce evidence to support the effectiveness of faecal microbiota transplantation (FMT) in improving sleep among individuals with inflammatory bowel disease (IBD). Our study aimed to evaluate the effect of washed microbiota transplantation (WMT) (the new method of FMT) on the sleep of patients with IBD in short term.Patients and Methods: This prospective study was conducted as part of two interventional clinical trials (starting on February 2013 and expected to end on December 2025) and placed significant emphasis on evaluating sleep quality in patients with IBD. To measure subjective sleep, we used the Pittsburgh sleep quality index (PSQI). The primary endpoint was the PSQI score one month after WMT.Results: This stage study included 52 eligible patients evaluated by PSQI questionnaire who underwent WMT from January 2020 to March 2021 and 47 patients were enrolled for analysis. The age of the patients ranged from 13 to 60 years, with a mean of 33.4 years, and 57.4% (25/47) of the patients were male. The PSQI scores for all 47 patients one month after undergoing WMT were significantly lower (Cohen d = 0.59, p < 0.001) compared to the baseline. Moreover, baseline PSQI score was correlated with the difference value of the PSQI score before and after WMT (post-PSQI minus pre-PSQI) (r = 0.61, p < 0.05).Conclusion: The study suggests that WMT might be a helpful intervention for improving the sleep quality of patients with IBD, encouraging clinicians to consider its use in clinical practice for addressing poor sleep in IBD patients.Clinical Trial Registration: ClinicalTrials.gov; ID: NCT01793831, NCT01790061.Keywords: faecal microbiota transplantation, transendoscopic enteral tubing, sleep disorder, Crohn’s disease, ulcerative colitis, inflammatory bowel disease

Jan Vagedes,1,2 Mohsen Sobh,2 Mohammad Oli Al Islam,2 Christian F Poets1 1Department of Neonatology, Children’s Hospital, University of Tübingen, Tübingen, Germany; 2ARCIM-Institute, Research Department, Filderklinik, Filderstadt, GermanyCorrespondence: Jan Vagedes, ARCIM Institute, Im Haberschlai 7, Filderstadt, 70794, Germany, Tel +49 711 7703-1687, Email J.Vagedes@arcim-institute.dePurpose: Clinical management decisions often rely on a patient’s SpO2 level and desaturation rate. Limitations include that measurements depend on the averaging time (AVT) used, which is particularly relevant to sleep medicine, but has yet received little attention.Methods: Cross-sectional review of studies reporting pulse oximeter saturation (SpO2) measurements published in 5 leading sleep medicine journals. All papers published between 2017 and 2023 reporting SpO2 measurements were screened regarding the AVT used.Results: Of 193 papers identified, 151 were included; of these, only 9 studies mentioned the AVT, 4 of these were published in one journal. The AVT ranged from zero (beat-to-beat-mode) to 10s, with 3s being used most often (33.3%), followed by 2s (22.2%).Conclusion: The AVT is only rarely mentioned in sleep medicine papers, despite its influence on sleep study results. Reported AVTs were heterogenous. Further research is warranted to set up guidelines for using or reporting the AVT.Keywords: pulse oximetry, averaging time, oxygen saturation, desaturation, SpO2, sleep medicine

Abstract Background There are currently no effective prediction methods for evaluating the occurrence of cognitive impairment in patients with cerebral small vessel disease (CSVD). Aims To investigate the risk factors for cognitive dysfunction in patients with CSVD and to construct a risk prediction model. Methods A retrospective study was conducted on 227 patients with CSVD. All patients were assessed by brain magnetic resonance imaging (MRI), and the Montreal Cognitive Assessment (MoCA) was used to assess cognitive status. In addition, the patient’s medical records were also recorded. The clinical data were divided into a normal cognitive function group and a cognitive impairment group. A MoCA score

Jinxi Li,1,&ast; Yiduo Lu,2,&ast; Xuyun Zhang,1 Gang Liu3 1International Medical College, Chongqing Medical University, Chongqing, People’s Republic of China; 2College of Basic Medical Sciences, Naval Medical University, Shanghai, People’s Republic of China; 3Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Gang Liu, Email 203745@hospital.cqmu.edu.cnIntroduction: The burden of cardiometabolic diseases (CMDs), defined as stroke, coronary artery disease, and diabetes mellitus, continues to pose a global challenge. Sleep duration has been linked to cardiovascular health. However, there is a lack of focused investigations on CMDs in underdeveloped areas of China.Purpose: This study aimed to examine the relationship between sleep duration and CMDs among residents from southwest China.Patients and Methods: This large cross-sectional study screened data from the National Key Research and Development Program (2018YFC1311400). Based on sleep duration reported through a standardized questionnaire, encompassing the sleep patterns of the past five years, participants were classified into three groups: < 6, 6– 8, > 8 hours. Baseline characteristics were compared, and Poisson regression models were used to assess the relationship between sleep duration and CMDs. Subgroup analysis was conducted based on age and gender.Results: This study included 28,908 participants with an average age of 65.6 ± 10.0 years, of whom 57.6% were female. The overall prevalence of CMDs was 22.6%. After multivariate adjustments, the prevalence ratios (PR) (95% CI) for CMDs across the three groups (6– 8h, < 6h and > 8h) were: reference, 1.140 (1.068– 1.218), 1.060 (0.961– 1.169) (P for trend =0.003), respectively. The subgroup analysis revealed that among older females, a longer sleep duration (> 8h) was also associated with an increased prevalence risk of CMDs, with PR 1.169 (1.001– 1.365) (p=0.049).Conclusion: A shorter sleep duration (< 6 hours) was associated with an increased risk of CMDs in the general population, while a longer sleep duration (> 8 hours) also raised the prevalence risk among older females.Keywords: cardiometabolic disease, sleep duration, Southwest China

Sitong Feng,1,2,&ast; Ziyao Wu,1,2,&ast; Sisi Zheng,1,2 Linrui Dong,1,2 Hongxiao Jia,1,2 Yanzhe Ning1,2 1Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanzhe Ning; Hongxiao Jia, Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China, Email ningzy0923@mail.ccmu.edu.cn; jhxlj@ccmu.edu.cnObjective: The thalamus plays a critical role in attentional maintenance. Previous studies have revealed the dysfunction of the thalamus in attention decline after acute sleep deprivation (SD). However, the functional connectivity (FC) between the thalamus subregions and cortical regions underlying attentional impairment after acute SD remains unclear. Here, we aimed to probe the relationship between attentional function and the altered thalamocortical FC after acute SD.Methods: In this study, 25 healthy participants with regular sleep conducted an attentional network test and received a resting-state fMRI scan before and after 24 hours of SD. Then, we analyzed the FC between the thalamus and cerebrum and relationships with attentional function in the enrolled subjects.Results: Our results showed that the participants showed a significantly lower alerting effect, a higher executive effect, and lower accuracy after acute SD. Compared to the rested wakefulness state, we observed decreased FCs between the “somatosensory” thalamic seed and left frontal pole, right frontal pole, left middle temporal gyrus (posterior division), and right middle temporal gyrus (posterior division). Furthermore, the reduced FC between the right middle temporal gyrus and “somatosensory” thalamic seed was negatively associated with the change in orienting effect of the participants.Conclusion: Our findings reveal that the disrupted FC between thalamus subregions and cortical regions may contribute to impaired attention after SD.Keywords: sleep deprivation, fMRI, attention, thalamus, functional connectivity

Jing Ye,1,2 Yunhui Lv,2 Hui Xie,3 Kun Lian,4 Xiufeng Xu1 1Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China; 2Sleep Medicine Center, The First People’s Hospital of Yunnan, Kunming, Yunnan, People’s Republic of China; 3Department of Traumatology, The First People’s Hospital of Yunnan, Kunming, Yunnan, People’s Republic of China; 4Department of Neurosurgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of ChinaCorrespondence: Xiufeng Xu, Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, No. 295 of Xichang Road, Kunming City, Yunnan Province, People’s Republic of China, Email xfxu2004@sina.comBackground: Obstructive sleep apnea (OSA) patients commonly experience high rates of depression. This study aims to examine the oral microbiota characteristics of OSA and those with comorbid major depressive disorder (OSA+MDD) patients.Methods: Participants were enrolled from Aug 2022 to Apr 2023. Polysomnography, psychiatrist interviews, and scales were used to diagnose OSA and MDD. Oral samples were collected from participants by rubbing swabs on buccal mucosa, palate, and gums. Oral microbiota was analyzed via whole-genome metagenomics and bioinformatic analysis followed sequencing. Venous blood was drawn to detect plasma inflammatory factor levels.Results: The study enrolled 33 OSA patients, 28 OSA+MDD patients, and 28 healthy controls. Significant differences were found in 8 phyla, 229 genera, and 700 species of oral microbiota among the three groups. Prevotellaceae abundance in the OSA and OSA+MDD groups was significantly lower than that in healthy controls. Linear discriminant analysis effect size (LEfSe) analysis showed that Streptococcaceae and Actinobacteria were the characteristic oral microbiota of the OSA and OSA+MDD groups, respectively. KEGG analysis indicates 30 pathways were changed in the OSA and OSA+MDD groups compared with healthy controls, and 23 pathways were changed in the OSA group compared with the OSA+MDD group. Levels of IL-6 in the OSA+MDD group were significantly higher than in the healthy group, correlating positively with the abundance of Schaalia, Campylobacter, Fusobacterium, Alloprevotella, and Candidatus Nanosynbacter in the oral, as well as with Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores.Conclusion: Significant differences in oral microbiota populations and gene function were observed among the three groups. OSA patients were characterized by a decreased abundance of Prevotellaceae and an increased abundance of Streptococcaceae. OSA+MDD patients had an increased abundance of Actinobacteria. IL-6 might regulate the relationship between depression and the oral microbiota in OSA+MDD patients.Keywords: obstructive sleep apnea, major depressive disorder, oral microbiota, whole-genome metagenomic analysis, inflammatory factors

Abstract Background The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents’ social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring. Methods During offspring’s middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later. Results Parents’ social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents’ social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents’ coping style were found. Conclusions Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents’ social support may thus have a protective function for children in these high-risk families.

Abstract The regulation of circadian rhythms and the sleep–wake states involves in multiple neural circuits. The suprachiasmatic nucleus (SCN) is a circadian pacemaker that controls the rhythmic oscillation of mammalian behaviors. The basal forebrain (BF) is a critical brain region of sleep–wake regulation, which is the downstream of the SCN. Retrograde tracing of cholera toxin subunit B showed a direct projection from the SCN to the horizontal limbs of diagonal band (HDB), a subregion of the BF. However, the underlying function of the SCN–HDB pathway remains poorly understood. Herein, activation of this pathway significantly increased non–rapid eye movement (NREM) sleep during the dark phase by using optogenetic recordings. Moreover, activation of this pathway significantly induced NREM sleep during the dark phase for first 4 h by using chemogenetic methods. Taken together, these findings reveal that the SCN–HDB pathway participates in NREM sleep regulation and provides direct evidence of a novel SCN-related pathway involved in sleep–wake states regulation.

Dominic Jaworski,1,2 Edward J Park1,2 1Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, V3T 0A3, Canada; 2WearTech Labs, Simon Fraser University, Surrey, BC, V3V 0C6, CanadaCorrespondence: Edward J Park; Dominic Jaworski, Surrey Centre 2 Building, 9639 - 137A Street, Unit 206, Surrey, BC, V3V 0C6, Canada, Email ed_park@sfu.ca; djaworsk@sfu.caPurpose: Wearable or non-contact, non-intrusive devices present a practical alternative to traditional polysomnography (PSG) for daily assessment of sleep quality. Physiological signals have been known to be nonlinear and nonstationary as the body adapts to states of rest or activity. By integrating more sophisticated nonlinear methodologies, the accuracy of sleep stage identification using such devices can be improved. This advancement enables individuals to monitor and adjust their sleep patterns more effectively without visiting sleep clinics.Patients and Methods: Six participants slept for three cycles of at least three hours each, wearing PSG as a reference, along with an Apple Watch, an actigraphy device, and a ballistocardiography (BCG) bed sensor. The physiological signals were processed with nonlinear methods and trained with a long short-term memory (LSTM) model to classify sleep stages. Nonlinear methods, such as return maps with advanced techniques to analyze the shape and asymmetry in physiological signals, were used to relate these signals to the autonomic nervous system (ANS). The changing dynamics of cardiac signals in restful or active states, regulated by the ANS, were associated with sleep stages and quality, which were measurable.Results: Approximately 73% agreement was obtained by comparing the combination of the BCG and Apple Watch signals against a PSG reference system to classify rapid eye movement (REM) and non-REM sleep stages.Conclusion: Utilizing nonlinear methods to evaluate cardiac dynamics showed an improved sleep quality detection with the non-intrusive devices in this study. A system of non-intrusive devices can provide a comprehensive outlook on health by regularly measuring sleeping patterns and quality over time, offering a relatively accessible method for participants. Additionally, a non-intrusive system can be integrated into a user’s or clinic’s bedroom environment to measure and evaluate sleep quality without negatively impacting sleep. Devices placed around the bedroom could measure user vitals over longer periods with minimal interaction from the user, representing their natural sleeping trends for more accurate health and sleep disorder diagnosis.Keywords: ballistocardiogram, wearable, heart rate variability, nonstationary signals

Xiuqi Qiao,1,2 Xiaoxia Wang,1 Lixin Guo,1,2 Qi Pan1,2 1Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China; 2Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of ChinaCorrespondence: Lixin Guo; Qi Pan, Email glx1218@163.com; panqi621@126.comBackground: Prior research based on observations has furnished evidence that supports a connection between daytime napping and the prevalence of non-alcoholic fatty liver disease (NAFLD). Nevertheless, the question of whether this correlation is indicative of a causal link has not been definitively answered.Methods: We used meta-analysis and Mendelian randomization (MR) to synthesize genetic and observational data. A two-sample MR analysis was conducted, leveraging 105 single-nucleotide polymorphisms (SNPs) known to be associated with daytime napping patterns. Additionally, summary-level data pertaining to NAFLD outcomes were acquired from the comprehensive UK Biobank study. Network meta-analyses were employed to investigate the relationship between excessive daytime napping and NAFLD, while subgroup was also performed.Results: Significant associations were observed between daytime napping and NAFLD. The systematic review/meta-analysis uncovered a heightened risk of NAFLD development among individuals who engaged in daytime naps exceeding 30 minutes, when compared to those who did not nap(odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.05 to 1.66). Furthermore, MR analysis indicated that a genetic propensity towards longer daytime napping was significantly linked to an increased likelihood of NAFLD (OR = 2.26, 95% CI: 1.38 to 3.73).Conclusion: Daytime napping has been found to be causally related to a higher risk of NAFLD. Furthermore, across all participants, napping for an average duration over 30 minutes was linked to an elevated likelihood of NAFLD.Keywords: daytime napping, non-alcoholic fatty liver disease, genetic variants, Mendelian randomization, network meta-analysis

Jaimee K Miller, Simon L Evans School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UKCorrespondence: Jaimee K Miller, Email jaimeekmiller@outlook.comObjective: Poor sleep among young adults is prevalent, yet the mediating variables are largely understudied, and there is limited relevant work utilizing objective sleep measures. The present study investigated the mediating effects of perceived stress and rumination in the relationship between trait mindfulness and subjective and objective sleep quality in young adults.Methods: A total of 170 healthy adults (aged 18– 37, M = 20.8, SD = 2.9) self-reported on trait mindfulness, perceived stress, and rumination. The primary (N = 140) and secondary (N = 30) samples both completed the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality. The secondary sample (N = 30) additionally provided sleep diaries, as well as wrist-worn actigraphy data for assessing objective sleep quality. A mediation analysis was conducted to assess the effect of trait mindfulness on sleep quality with perceived stress and rumination as mediators.Results: Trait mindfulness was positively associated with better subjective sleep quality; this was fully mediated by perceived stress, b = − 0.08, 95% CI [− .12, − 0.06]. Rumination was negatively associated with subjective sleep quality but did not mediate the relationship between trait mindfulness and sleep quality, b = − 0.01, 95% CI [− .03, 0.02]. Only trait mindfulness was correlated with diary-based sleep ratings, and none of the measures were associated with actigraphy-based sleep quality.Conclusion: This study indicates that perceived stress is an important mediator in the relationship between trait mindfulness and subjective sleep quality among young adults, rather than rumination. These findings have implications for mindfulness-based therapeutic approaches to address the high prevalence of sleep disorders among young adults, adding mechanistic detail to the literature.Keywords: mindfulness, perceived stress, rumination, sleep

Marcus McMahon,1 Jeremy Goldin,2 Elizabeth Susan Kealy,3 Darrel Joseph Wicks,4 Eugene Zilberg,5 Warwick Freeman,5 Behzad Aliahmad5 1Department of Respiratory and Sleep Medicine, Epworth Hospital, Richmond, Victoria, Australia and Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; 2Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkvile, Victoria, Australia; 3Sleepmetrics Pty Ltd, Heidelberg, Victoria, Australia; 4Sleep Disorders Unit, Epworth Hospital, Richmond, Victoria, Australia; 5Medical Innovations, Compumedics Limited, Abbotsford, Victoria, AustraliaCorrespondence: Eugene Zilberg, Compumedics Limited, 30-40 Flockhart Street, Abbotsford, Victoria, 3067, Australia, Tel +61 412225842, Fax +61 3 84207399, Email ezilberg@compumedics.com.auPurpose: To investigate accuracy of the sleep staging algorithm in a new miniaturized home sleep monitoring device – Compumedics® Somfit. Somfit is attached to patient’s forehead and combines channels specified for a pulse arterial tonometry (PAT)-based home sleep apnea testing (HSAT) device with the neurological signals. Somfit sleep staging deep learning algorithm is based on convolutional neural network architecture.Patients and Methods: One hundred and ten participants referred for sleep investigation with suspected or preexisting obstructive sleep apnea (OSA) in need of a review were enrolled into the study involving simultaneous recording of full overnight polysomnography (PSG) and Somfit data. The recordings were conducted at three centers in Australia. The reported statistics include standard measures of agreement between Somfit automatic hypnogram and consensus PSG hypnogram.Results: Overall percent agreement across five sleep stages (N1, N2, N3, REM, and wake) between Somfit automatic and consensus PSG hypnograms was 76.14 (SE: 0.79). The percent agreements between different pairs of sleep technologists’ PSG hypnograms varied from 74.36 (1.93) to 85.50 (0.64), with interscorer agreement being greater for scorers from the same sleep laboratory. The estimate of kappa between Somfit and consensus PSG was 0.672 (0.002). Percent agreement for sleep/wake discrimination was 89.30 (0.37). The accuracy of Somfit sleep staging algorithm varied with increasing OSA severity – percent agreement was 79.67 (1.87) for the normal subjects, 77.38 (1.06) for mild OSA, 74.83 (1.79) for moderate OSA and 72.93 (1.68) for severe OSA.Conclusion: Agreement between Somfit and PSG hypnograms was non-inferior to PSG interscorer agreement for a number of scorers, thus confirming acceptability of electrode placement at the center of the forehead. The directions for algorithm improvement include additional arousal detection, integration of motion and oximetry signals and separate inference models for individual sleep stages.Keywords: home sleep apnea testing, polysomnography, forehead electroencephalography, deep learning, interscorer agreement

Yu-Pei Wang,1,&ast; Hui-Xia Wei,2,&ast; Yuan-Yuan Hu,3 Yu-Ming Niu3,4 1Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, People’s Republic of China; 2Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, People’s Republic of China; 3Department of Stomatology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, People’s Republic of China; 4Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei Provincial Clinical Research Center for Umbilical Cord Blood Hematopoietic Stem Cells, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yu-Ming Niu, Department of Stomatology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, People’s Republic of China, Tel: +86 13581370999, Email niuyuming@yeah.netObjective: This study was conducted to investigate the bidirectional causal relationship between obstructive sleep apnea (OSA) and temporomandibular disorders (TMD).Methods: Using an online pooled dataset of genome-wide association studies (GWAS), a two-sample bi-directional Mendelian randomization (MR) method was implemented. Inverse variance weighting was used as the primary analyses approach, and other methods of MR Egger, weighted median method, MR-Egger, Simple mode, and Weighted mode analysis were conducted as supplements to evaluate the causal relationship between OSA and TMD with odds ratios (OR) and 95% confidence interval (CI). Furthermore, the Cochran Q, MR-Egger, and MR-PRESSO approaches were used to perform the heterogeneity test and multiple validity.Results: The general results of the forward MR analysis indicated that OSA had a significant causal influence on TMD (OR=1.241, 95% CI: 1.009– 1.526, P=0.041), but no significant correlation was observed in the reverse MR analysis (IVW: OR=0.975, 95% CI=0.918– 1.036, P=0.411).Conclusion: In summary, our research demonstrated a hereditary causative relationship between OSA and TMD, indicating that appropriate intervention is required for both prevention and treatment of TMD.Keywords: Mendelian randomization analysis, obstructive sleep apnea, temporomandibular disorders

Ruijie Zhang,1,&ast; Xinran Dong,2,&ast; Lu Zhang,1,&ast; Xinao Lin,1 Xuefeng Wang,1 Yan Xu,3 Chuyan Wu,4 Feng Jiang,1 Jimei Wang1 1Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People’s Republic of China; 2Center for Molecular Medicine, Children’s Hospital of Fudan University, Shanghai, People’s Republic of China; 3Department of Neurology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, People’s Republic of China; 4Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jimei Wang; Feng Jiang, Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, People’s Republic of China, Email wjm821920@163.com; dxyjiang@163.comBackground: Neonatal sleep is pivotal for their growth and development, yet manual interpretation of raw images is time-consuming and labor-intensive. Quantitative Electroencephalography (QEEG) presents significant advantages in terms of objectivity and convenience for investigating neonatal sleep patterns. However, research on the sleep patterns of healthy neonates remains scarce. This study aims to identify QEEG markers that distinguish between different neonatal sleep cycles and analyze QEEG alterations across various sleep stages in relation to postmenstrual age.Methods: From September 2023 to February 2024, full-term neonates admitted to the neonatology department at the Obstetrics and Gynecology Hospital of Fudan University were enrolled in this study. Electroencephalographic (EEG) recordings were obtained from neonates aged 37– 42 weeks, within 1– 7 days post-birth. The ROC curve was employed to evaluate QEEG features related to amplitude, range EEG (rEEG), spectral density, and connectivity across different sleep stages. Furthermore, regression analyses were performed to investigate the association between these QEEG characteristics and postmenstrual age.Results: The alpha frequency band’s spectral_diff_F3 emerged as the most potent discriminator between active sleep (AS) and quiet sleep (QS). In distinguishing AS from wakefulness (W), the theta frequency’s spectral_diff_C4 was the most effective, whereas the delta frequency’s spectral_diff_P4 excelled in differentiating QS from W. During AS and QS phases, there was a notable increase in entropy within the delta frequency band across all monitored brain regions and in the spectral relative power within the theta frequency band, correlating with postmenstrual age (PMA).Conclusion: Spectral difference showcases the highest discriminative capability across awake and various sleep states. The observed patterns of neonatal QEEG alterations in relation to PMA are consistent with the maturation of neonatal sleep, offering insights into the prediction and evaluation of brain development outcomes.Keywords: quantitative EEG, neonates, sleep, postmenstrual age

Qiming Gan,1,&ast; Quanzhen Liu,1,2,&ast; Yanjuan Wu,1,&ast; Xiaofeng Zhu,1,2 Jingcun Wang,1 Xiaofen Su,1 Dongxing Zhao,1 Nuofu Zhang,1 Kang Wu1 1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Disease, Department of Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510160, People’s Republic of China; 2Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong, 511436, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Kang Wu; Nuofu Zhang, Department of Pulmonary and Critical Care Medicine, Sleep Medicine Center, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28 Qiaozhong Mid Road, Guangzhou, Guangdong, 510160, People’s Republic of China, Email d102_wk@126.com; nfzhanggird@163.comPurpose: Obstructive sleep apnea (OSA) had been associated with asthma in observational studies, but the effect of OSA on the onset of asthma in childhood or adulthood remains unclear, and the causal inferences have not been confirmed. This study aims to investigate the potential causal association between OSA with asthma, including different age-of-onset subtypes, providing reliable basis for the clinical treatment of OSA and asthma.Patients and Methods: Causality between OSA and asthma was assessed using a two-sample bi-directional Mendelian randomization (MR) analysis. OSA data were obtained from the FinnGen consortium R9, while asthma and its subtypes (adult-onset asthma, child-onset asthma, and moderate-to-severe asthma) were sourced from the IEU OpenGWAS project. The inverse-variance weighted (IVW) method was chosen as the primary analysis and was complemented by various sensitivity analyses. The MR-PRESSO outlier test was employed to systematically identify and remove outlier variants, mitigating heterogeneity and potential effects of horizontal pleiotropy.Results: The MR analyses provided evidence of genetically predicted OSA having a promoting effect on child-onset asthma (OR,1.49; 95% CI, 1.05– 2.11; P=0.025) and moderate-to-severe asthma (OR,1.03; 95% CI, 1.00– 1.06; P=0.046). However, no causal association between OSA with asthma and adult-onset asthma was observed.Conclusion: Our study revealed a causal association between OSA and child asthma, but not in adults. Moderate-to-severe asthma may have a potential promoting effect on OSA. These findings underscore the importance of age-specific considerations in managing asthma and suggests the need for personalized approaches in clinical practice.Keywords: asthma, obstructive sleep apnea, Mendelian randomization, genetic

Qiying Zeng,1,&ast; Wenjun Xue,2,&ast; Zhicheng Wei,1 Hangdong Shen,1 Huajun Xu,1 Huaming Zhu,1 Jian Guan,1 Hongliang Yi,1 Yunhai Feng,2 Xinyi Li,1 Haibo Ye1 1Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Sleep Disordered Breathing, Otorhinolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, People’s Republic of China; 2Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Eighth People’s Hospital Affiliated to Jiangsu University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xinyi Li; Haibo Ye, Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Sleep Disordered Breathing, Otorhinolaryngology Institute of Shanghai JiaoTong University, Shanghai, 200233, People’s Republic of China, Tel/Fax +86-2164834143, Email lixinyilixinyi123@163.com; yehaibo_2012@163.comBackground: Sleep-disordered breathing is more prevalent in individuals with allergic rhinitis (AR) than in those without AR. In addition to increased risk for sleep-disordered breathing, AR is associated with greater severity of obstructive sleep apnea (OSA) symptoms. The aim of this research study was to evaluate the association of multiple single nucleotide polymorphism (SNP) variations in AR with sleep- and breathing-related parameters in men with OSA.Methods: Men who had complained of snoring were consecutively enrolled in the Shanghai Sleep Health Study of Shanghai Sixth People’s Hospital from 2007 to 2018. After rigorous screening, 5322 men were included in the analysis. Anthropometric, fasting biochemical, and polysomnographic parameters, along with 27 AR-associated SNPs were analyzed. The associations between AR-related genetic polymorphisms and OSA were determined via linear, binary, and multinomial logistic regression analyses.Results: Rs12509403 had significantly positive associations with most sleep-breathing parameters. While the risk for OSA was increased by rs12509403, it was decreased by rs7717955 [odds ratio (OR) = 1.341, 95% confidence interval [CI] = 1.039– 1.732, P = 0.024; OR = 0.829, 95% CI = 0.715– 0.961, P = 0.013, respectively]. A graded increase in the risk of being in the highest quartile (Q4) vs the reference category (Q1) for sleep breathing indicators, especially REM-AHI and NREM-AHI, was identified by rs12509403 (OR = 1.496, 95% CI = 1.175– 1.904, P = 0.001; OR = 1.471, 95% CI = 1.151– 1.879, P < 0.001, respectively).Conclusion: The association of multiple AR SNPs with OSA-related hypoxia and sleep indices provides a genetic explanation for the higher AR susceptibility of OSA patients. Understanding the AR-related genetic underpinnings of OSA may lead to more personalized treatment approaches.Keywords: allergic rhinitis, obstructive sleep apnea, single nucleotide polymorphism, polysomnography

Yuan-Kai Fu,1 Chi-chin Sun,2,3 Kuan-Jen Chen,1,3 Yu-Jr Lin,4 Chee-Jen Chang,4– 6 Shu-Chen Chang,4 Ming-Hui Sun1,3 1Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 2Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 3College of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan; 5Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; 6Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, TaiwanCorrespondence: Ming-Hui Sun, Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan, 333, Taiwan, Tel +886-3-3281200 ext 8666, Fax +886-3-3287798, Email minghui0215@gmail.comStudy Objectives: To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED.Methods: This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer’s test, lacking tear break-up time values, or with a history of refractive surgery, Sjögren’s syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared.Results: In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 ± 23.4, patients without DED: 17.9 ± 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47– 10.49, P = 0.006).Conclusion: OSA severity is associated with DED and might be attributed to the use of CPAP.Keywords: dry eye disease, obstructive sleep apnea, continuous positive airway pressure

Junwen Wang, Yuyang Ye, Xuefeng Chen, Xinru Hu, Yong Peng Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of ChinaCorrespondence: Yong Peng, Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, People’s Republic of China, Email pengyong@scu.edu.cnBackground: Identifying risk factors for cardiovascular disease (CVD) is critical for effective prevention and management. While classic CVD risk factors have been extensively studied, there is a scarcity of research on the association between snoring and CVD risk, particularly in the context of sex differences.Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020. Participants were initially categorized based on the severity of snoring or the presence of snoring.Within the snoring group, they were further classified by sex. Analysis was carried out using multivariate logistic regression.Results: Our study included 12,681 participants aged 18 years or older. When compared to the non-snoring group, individuals in the moderate snoring group had a higher odds ratio (OR) of 1.418 (95% CI 1.083 to 1.857, p = 0.011), while those in the severe snoring group had a higher OR of 1.882 (95% CI 1.468 to 2.409, p < 0.001). In the snoring group, individuals were further categorized by gender: 4527 males and 4131 females. Importantly, male patients showed a higher OR for atrial fibrillation (4.945, 95% CI 1.187 to 20.598, p = 0.028) compared to females. Additionally, male patients had a higher OR for coronary heart disease (2.002, 95% CI 1.152 to 3.479, p = 0.014) compared to females.Conclusion: Sex plays a significant role in the relationship between snoring and CVD risk. Males with snoring have a higher risk of developing CVD compared to females. In particular, male snorers are nearly five times more likely to develop atrial fibrillation and about twice as likely to experience coronary artery disease in comparison to female snorers. It is recommended that healthcare providers and public health officials prioritize cardiovascular risk assessments for male individuals who exhibit symptoms of snoring.Keywords: gender differences, snoring, cardiovascular risk, atrial fibrillation, coronary artery disease