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Purpose: To examine nocturnal sleep patterns, napping behaviors, and subjective wellness responses of elite water polo players within an in-season week and to identify whether sleeping patterns differ between men and women. Methods: Sleep characteristics of 10 male and 17 female professional water polo players were objectively assessed during 1 week of the in-season period, including 5 training days, 1 match day, and 1 day of rest. Internal load (rating of perceived exertion × duration of training or match) was assessed 30 minutes posttraining or postmatch, and the total quality of recovery was recorded every morning. A series of multilevel models were used to analyze the data. Results: Time in bed and wake-up time were earlier on both training (P <.001) and rest days (P <.001) than on the day of the match. Internal workload did not predict any of the players' sleeping patterns. Midday naps predicted less time in bed (P =.03) and likely less sleep time (P =.08). The total quality of recovery was predicted only by the total sleep time (P <.01). Women exhibited higher sleep efficiency (P <.001), less waking after sleep onset (P =.01), and a lower number of awakenings (P =.02) than men. Conclusions: The current results indicate that the nocturnal sleep patterns of elite water polo players are not associated with internal load and that women display better nocturnal sleep quality compared with men. As long naps interfere with nocturnal sleep, and total nocturnal sleep time predicts total quality of recovery, we suggest that athletes follow hygiene sleep strategies to facilitate adequate nocturnal sleep and next-day recovery. [ABSTRACT FROM AUTHOR]

Summary Differential diagnosis of narcolepsy type 2 and idiopathic hypersomnia relies on the frequency of sleep‐onset rapid eye movement periods observed on the Multiple Sleep Latency Test. This study investigated whether variations in sleep schedules, particularly delayed sleep–wake patterns, contribute to the diagnostic distinction between narcolepsy type 2 and idiopathic hypersomnia. The study included 871 patients aged 18–39 years (316 with narcolepsy type 2, 555 with idiopathic hypersomnia). These patients were diagnosed based on MSLT results following polysomnography from November 2013 to November 2017. Patients' sleep habits, including bedtime and wake‐up times on weekdays and weekends during the 2 weeks preceding the polysomnography/Multiple Sleep Latency Test, were assessed using self‐reported sleep logs. A multivariate logistic regression analysis was conducted to identify factors associated with narcolepsy type 2 diagnosis. The analysis revealed that being male (p < 0.001), younger age (p < 0.001), shorter weekday sleep duration (p < 0.05), and a delayed weekday sleep midpoint time (p < 0.01) were significantly associated with a diagnosis of narcolepsy type 2. The study suggests that the conventionally fixed schedule of polysomnography and Multiple Sleep Latency Test administration may have contributed to the increased occurrence of sleep‐onset rapid eye movement periods particularly in individuals with a delayed sleep–wake schedule. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation We established a prospective cohort study to investigate the differences in motor and non‐motor symptoms between idiopathic Parkinson's disease (IPD) and Parkinson's disease in carriers of leucine‐rich repeat kinase 2 (LRRK2) gene risk variants (LRRK2‐PD).The study included 1407 individuals with IPD and 649 individuals with LRRK2‐PD (comprising 304 with LRRK2‐G2385R, 220 with LRRK2‐R1628P, and 105 with LRRK2‐A419V). Differences in symptoms between LRRK2‐PD and IPD were analyzed using LCMM modeling and Cox regression analysis.The LRRK2‐G2385R variant showed slower progression in tremor symptoms and excessive daytime sleepiness compared with IPD. In contrast, symptoms associated with LRRK2‐R1628P and LRRK2‐A419V were more similar to those of IPD. Survival analysis revealed that LRRK2‐PD does not affect life expectancy compared with IPD.Our extended longitudinal follow‐up of LRRK2‐PD in the Chinese population provided valuable insights, further confirming the clinical characteristics of the three LRRK2 variants. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionWe investigated the relationship between irregular sleep-wake patterns and other aspects of sleep and mental health among adolescents.Community-based sample of adolescents (n = 200, mean age 16.8; 61.7% female) completed baseline assessment (i.e. sleep quality, daytime sleepiness, depressive symptoms, social anhedonia, problematic alcohol use), and 7–8 consecutive days of wearing wrist actigraphy. Irregular sleep-wake patterns were assessed via two methods, both based on actigraphy, to capture day-to-day irregularity (intraindividual variability, IIV) and weekly irregularity (social jet lag, SJL). The Bayesian variability method was performed to calculate IIV in total sleep time (TST), sleep onset, and offset time. SJL was quantified as the actual difference in the sleep midpoint on school days versus non-school days.Greater IIV in TST was associated with poorer sleep quality (B = 1.66, 95% CI, 0.14, 3.31, p < .05), and greater depressive symptoms (B = 0.72, 95% CI, 0.17, 1.35, p < .05), while greater IIV in sleep offset time was associated greater depressive symptoms (B = 0.63, 95% CI, 0.03, 1.28, p < .05), and greater problematic alcohol use (B = 0.70, 95% CI, 0.12, 1.35, p < .05), all after adjusting for age, sex, family SES, alcohol drinks, and SJL. No significant association was found with sleep onset time. Greater SJL was associated with poorer sleep quality (B = 0.40, 95% CI, 0.27, 0.54, p < .001) and fewer problematic alcohol uses (B = −0.05, 95% CI, −0.09, −0.00, p < .05), when adjusting for age, sex, family SES, and alcohol drinks.Our findings add to a growing body of research on irregularity in sleep-wake patterns and clinical implications. [ABSTRACT FROM AUTHOR]

Patients with central hypersomnia (HCO) often show symptoms of depression. Despite of many studies conducted in this field, the link between these two disorders remains unclear. In order to contribute data to this research, we examined the question of which depressive symptoms characterize these patients. Furthermore, we investigated the differences between HCO who were more or less depressed regarding insomnia, sleep quality and daytime tiredness. The retrospective analysis assesses the presence and kind of depressive symptoms as measured by the Beck Depression Inventory (BDI) in 168 HCO including narcolepsy type I (NAR1), narcolepsy type II (NAR2) and idiopathic hypersomnia (HYP). Sleep parameters from one night of polysomnography, scores of questionnaires for insomnia and for daytime sleepiness, and data from sustained attention tests were compared between HCO with and without depression, as determined by BDI scores (cut off >12). According to BDI scores 52% exhibited no depression. The BDI items pertaining to tiredness and work inhibition exhibited elevated scores, whereas those pertaining to suicidality showed low scores. No difference was found between depressed and non-depressed HCO with regard to daytime vigilance performance or daytime sleepiness. However, depression was associated with older age, higher insomnia scores, and a shorter sleep time on polysomnography. A potential interpretation of our findings is that depressive symptoms in HCO may be a consequence of restricted life quality due to hypersomnia. Thus, therapeutical effort should focus more intensely on coping strategies. [ABSTRACT FROM AUTHOR]

Background and Objective: Although there are several treatments for narcolepsy type 2 and idiopathic hypersomnia, studies that assess amphetamines, symptoms beyond sleepiness, and comparative effectiveness are needed. We performed a randomized, fully blinded, noninferiority trial of modafinil versus amphetamine–dextroamphetamine in these disorders. Methods: Forty-four adults were randomized to modafinil or amphetamine–dextroamphetamine, individually titrated to a maximum of modafinil 200 mg twice daily or amphetamine–dextroamphetamine 20 mg twice daily, for 12 weeks. Primary outcome was change in Epworth from baseline to week 12, with a noninferiority threshold of 2 points. Secondary outcomes were (1) patient global impression of change measures of disease severity, sleepiness, sleep inertia, and cognition; (2) change from baseline in Hypersomnia Severity Index; and (3) change from baseline in Sleep Inertia Questionnaire. Adverse events were compared between groups. Results: Epworth improved 5.0 [± standard deviation (SD) 2.7] points with modafinil and 4.4 (± SD 4.7) with amphetamine–dextroamphetamine; noninferiority of amphetamine–dextroamphetamine was not demonstrated (P = 0.11). Noninferiority of amphetamine-dextroamphetamine was demonstrated for change scores of severity, sleepiness, sleep inertia, Hypersomnia Severity Index, and Sleep Inertia Questionnaire. Dropouts due to adverse events were 31.8% for modafinil (including two severe events) and 9.1% for amphetamine–dextroamphetamine, P = 0.13. Anxiety was more common with modafinil and appetite suppression with amphetamine-dextroamphetamine. Conclusion: Noninferiority of amphetamine–dextroamphetamine to modafinil was not demonstrated for the primary outcome. However, amphetamine–dextroamphetamine was noninferior on multiple secondary measures of disease severity and symptomatology. These data may inform shared decision-making regarding treatment for idiopathic hypersomnia and narcolepsy type 2. Registration: Clinicaltrials.gov Registration (NCT03772314) 12/10/18.. [ABSTRACT FROM AUTHOR]

COVID-19 infection has resulted in a high prevalence of a post-infectious syndrome, known as post-acute sequelae of SARS-CoV-2 (PASC) or "Long COVID". PASC is a heterogeneous disease with a high prevalence of sleep disturbances, varying from an insomnia disorder to excessive daytime sleepiness. Patients seen in the Covid Survivorship Program at the Beth Israel Deaconess Medical Center Boston, USA, were screened for sleep disorders as part of a comprehensive multi-system evaluation. Those who screened positive were referred for a comprehensive sleep evaluation in a dedicated COVID-19-Sleep clinic, followed by diagnostic sleep testing and treatment. This report summarizes patients who completed an American Academy of Sleep Medicine (AASM) accredited facility-based diagnostic evaluation. International Classification of Sleep Disorders 3rd Edition-Revised criteria were met for all diagnoses. In 42 patients with PASC, five categories of sleep disorder syndromes were observed following a sleep clinic evaluation, including obstructive sleep apnea, chronic insomnia disorder, primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay. Seven patients met criteria for idiopathic hypersomnia, and two had narcolepsy type 2. RBD patients were infected in three different waves; circadian disturbance patients were all infected in the winter wave of 2020/21, and the primary hypersomnolence group occurred during all waves, predominantly the initial wave of 2020. A peculiar form of insomnia was a persistent loss of sleep regularity. Specific sleep symptoms/syndromes are reported in this select group of patients with PASC/Long Covid. As new onset sleep complaints are prevalent in PASC, we recommend a complete clinical and investigative sleep evaluation for persistent severe sleep symptoms following COVID-19 infection. • Sleep complaints in PASC are frequent, varying from insomnia to excessive daytime sleepiness. • Noted syndromes: sleep apnea, insomnia, primary hypersomnia, REM behavior disorder, and circadian phase delay. • All circadian disturbances patients were infected in the Winter 20/21 wave. • The response to therapy for hypersomnia and narcolepsy has so far been unremarkable. • Vaccination could have influenced the incidence of PACS patients and their sleep syndromes. [ABSTRACT FROM AUTHOR]

The apnea-hypopnea index (AHI) is the current diagnostic parameter for diagnosing and estimating the severity of obstructive sleep apnea (OSA). It is, however, poorly associated with the main clinical symptom of OSA, excessive daytime sleepiness, and with the often-seen cognitive decline among OSA patients. To better evaluate OSA severity, novel hypoxic load parameters have been introduced that consider the duration and depth of oxygen saturation drops associated with apneas or hypopneas. The aim of this paper was to compare novel hypoxic load parameters and traditional OSA parameters to verbal memory and executive function in OSA patients. A total of 207 adults completed a one-night polysomnography at sleep laboratory and two neuropsychological assessments, the Rey Auditory Verbal Learning Test and Stroop test. Results : Simple linear regression analyses were used to evaluate independent associations between each OSA parameter and cognitive performance. Associations were found between immediate recall and arousal index, hypoxia <90 %, average SpO 2 during sleep, and DesSev100+RevSev100. Total recall was associated with all OSA parameters, and no associations were found with the Stroop test. Subsequently, sex, age, and education were included as covariates in multiple linear regression analyses for each OSA parameter and cognitive performance. The main findings of the study were that average SpO 2 during sleep was a significant predictor of total recall (p <.007, β = −.188) with the regression model explaining 21.2 % of performance variation. Average SpO 2 during sleep was also a significant predictor of immediate recall (p <.022, β = −.171) with the regression model explaining 11.4 % of performance variation. Neither traditional OSA parameters nor novel hypoxic load parameters predicted cognitive performance after adjustment for sex, age, and education. The findings validate that the AHI is not an effective indicator of cognitive performance in OSA and suggest that average oxygen saturation during sleep may be the strongest PSG predictor of cognitive decline seen in OSA. The results also underline the importance of considering age when choosing neurocognitive tests, the importance of including more than one test for each cognitive domain as most tests are not pure measures of a single cognitive factor, and the importance of including tests that cover all cognitive domains as OSA is likely to have diffuse cognitive effects. • The currently used diagnostic tool for obstructive sleep apnea, the apnea-hypopnea index, is not associated with verbal memory and executive function. • Novel hypoxic load parameters are not associated with verbal memory or executive function in obstructive sleep apnea. • Average oxygen saturation during sleep is the strongest predictor of verbal memory in obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient clinic. Methods: We included data of 3,691 adult patients diagnosed with ADHD, who had filled out a screener for sleep disorders (Holland Sleep Disorders Questionnaire (HSDQ)) as part of routine diagnostic assessment. The HSDQ screens for the sleep disorders insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorders (CRSD), restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), and sleep-related breathing disorders (SBD). As delayed sleep phase syndrome (DSPS) is very frequent in ADHD, we additionally screened for DSPS. Psychiatric comorbidities were diagnosed through clinical assessment and the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus, which assesses 26 psychiatric disorders following the classification of the DSM-5. All data were retrieved from the electronic patient files. Results: Mean age was 35.4 and 49.4% of the patients were female. About 60% of the adults with ADHD screened positive for any sleep disorder. Highest prevalences were found for symptoms of DSPS (36%), insomnia (30%), and RLS/PLMD (29%). Sleep problems in adults with ADHD were associated with comorbid depression, anxiety, substance use disorder, personality disorder, and post-traumatic stress disorder. Conclusion: Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems. [ABSTRACT FROM AUTHOR]

Summary The aim of the present study was to examine gender and age‐specific effects on subjective daytime sleepiness (as measured by the Epworth Sleepiness Scale), body weight and eating behaviour in patients with central disorders of hypersomnolence. Based on the European Narcolepsy Network database, we compared 1035 patients with narcolepsy type I and 505 patients with other central disorders of hypersomnolence (“narcoleptic borderland”), including narcolepsy type II (N = 308) and idiopathic hypersomnia (N = 174), using logistic regression and general linear models. In the entire study population, the Epworth Sleepiness Scale was higher in women (N = 735, mean age = 30 years, mean Epworth Sleepiness Scale = 16.6 ± SD 3.9) than in men (N = 805, mean age = 32 years, mean Epworth Sleepiness Scale = 15.8 ± SD 4.4). In women with narcolepsy type I (N = 475), both Epworth Sleepiness Scale and body mass index increased in parallel with age. In women of the narcoleptic borderland (N = 260), the Epworth Sleepiness Scale markedly peaked in their early 30s, while body mass index only started to rise at that age. This rise in body mass index following the Epworth Sleepiness Scale peak cannot be explained by sleepiness‐induced uncontrolled eating, as self‐reported uncontrolled eating was negatively associated with the Epworth Sleepiness Scale in this group. We propose that the narcoleptic borderland harbours a unique cluster of women in their fertile years with an unexplored aetiology requiring further investigation towards tailored interventions. [ABSTRACT FROM AUTHOR]

The article "The repressed life of adult female patients with mild ADHD" published in Frontiers in Psychiatry discusses the overlooked characteristics of adult females with mild ADHD, focusing on their daily struggles and psychopathological phenotypes. It highlights the challenges faced by these individuals in the workplace, their tendency to camouflage their symptoms, and the prevalence of comorbidities such as anxiety disorders. The article also addresses the cultural differences in symptom manifestation and the impact of ADHD on social activities. The authors emphasize the need for a better understanding of these individuals to prevent underdiagnosis or misdiagnosis. [Extracted from the article]

Summary Presence of psychiatric comorbidities is well documented in narcolepsy type‐1 (NT1) but there are limited data on patients with ‘other central disorders of hypersomnolence’ (OCH). This study aimed to investigate frequency of psychiatric comorbidities in patients with NT1 and OCH, and to evaluate their impact on quality of life and sleep as an additive factor in combination with hypersomnolence‐related symptoms. This study was conducted within the scope of the international Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (iSPHYNCS), which aims to find new biomarkers in central disorders of hypersomnolence (CDH). Study participants underwent Mini International Neuropsychiatric Interview and completed questionnaires related to quality of life and sleep. Comparative analysis was conducted to investigate group differences, and multivariable regression models were used to reveal the impact of psychiatric comorbidities. Among a total of 90 patients, 26 were diagnosed with NT1 and 64 with OCH. In all, 38 patients showed at least one psychiatric disorder, 27% of NT1 and 48% of OCH, with female dominance (50% in females versus 23% in males, p < 0.02). Major depressive episodes (n = 29) were most common, followed by suicidality (n = 13). Patients with a psychiatric diagnosis were more fatigued (β = 0.70, p < 0.05), apathic (β = −5.41, p < 0.002), had more disturbed sleep (β = 0.55, p < 0.02), worse sleep (β = 1.89, p < 0.001) and general health (β = −12.55, p < 0.02) quality. Comorbid psychiatric disorders are frequent in patients with CDH and worsen the impact of hypersomnolence‐related symptoms on daily activities regardless of the type of CDH. Psychiatric comorbidities may create a vicious circle with fatigue and avoidance of physical activities, which aggravates hypersomnolence‐related symptoms. [ABSTRACT FROM AUTHOR]

Background/Objectives: Uvulopalatopharyngoplasty (UPPP), palatal plus nasal surgery (PNS), and continuous positive airway pressure (CPAP) are widely implemented treatments for obstructive sleep apnea (OSA). This study aims to explore the long-term effects on objective sleep parameters and patient-reported outcomes (PROs) following different therapeutic interventions for OSA. Methods: Data from patients with moderate-to-severe OSA were retrospectively collected from a medical center and a regional hospital, spanning from December 2011 to August 2018. Objective evaluations included the Apnea–Hypopnea Index (AHI), minimum O2 saturation, and sleep efficiency. The PROs consisted of the Snore Outcomes Survey and Epworth Sleepiness Scale. Using mixed-effects models, we evaluated longitudinal changes in sleep parameters and PROs, accounting for repeated measures and variations within individuals over time. Results: Among 448 patients with moderate-to-severe OSA, follow-up data were collected for 42 patients undergoing UPPP surgery, 171 undergoing PNS, 127 using CPAP, and 108 in the non-treated group. The mean follow-up was 16.7 months (SD = 11.9, range: 1.6–77.3). Significant improvements were observed in AHI, minimum O2 saturation, and hypersomnia immediately following interventions with UPPP, PNS, and CPAP therapy (p < 0.05). Moreover, the analysis revealed no significant rate of change in these parameters over time, suggesting that the benefits of these treatments were sustained in the long term. Furthermore, all interventions exhibited a significant short-term effect on self-reported snoring when compared to the control group, with a p-value of less than 0.001. However, the magnitude of this improvement gradually decreased over time. The snore scores seemed to return to pre-treatment levels among the UPPP, PNS, and CPAP groups after averages of 46.4, 63.5, and 74.4 months, respectively (all p < 0.05). Conclusions: Surgical interventions and CPAP therapy showed potential long-term effectiveness in managing OSA. Snoring symptoms reappeared about 3.9–5.3 years after surgical treatments, which seemed earlier than the average of 6.2 years in patients receiving CPAP and should be considered in patient-participatory decision-making processes. [ABSTRACT FROM AUTHOR]

A paradigm shift in circadian science is underway, exposing ethical tensions from a legacy of pervasive neglect of circadian disorders. This article canvasses ethical questions about stigma, justice, and accommodation that should be formally recognized to reconceive circadian care. Responding to these questions first requires confronting medicine's long-standing history of ableism in how circadian disorders are understood. This article also examines historical origins of the clinical and ethical need to expand diagnostic and therapeutic care access for patients with circadian disorders. Finally, this article recommends how to create space within the disabilities movement for persons with circadian disorders. [ABSTRACT FROM AUTHOR]

Sleep disorders are highly prevalent in chronic kidney disease (CKD) but are often under-recognized. Restless legs syndrome, which is common in CKD owing to issues with dopamine metabolism and is exacerbated by iron deficiency and uraemia, can lead to poor sleep quality and increased daytime fatigue. Insomnia is also prevalent in CKD, particularly in patients requiring dialysis, with increased sleep latency and sleep fragmentation being reported. The cause of insomnia in CKD is multifactorial — poor sleep habits and frequent napping during dialysis, uraemia, medications and mood disorders have all been suggested as potential contributing factors. Sleep apnoea and CKD are also now recognized as having a bi-directional relationship. Sleep apnoea is a risk factor for accelerated progression of CKD, and fluid overload, which is associated with kidney failure, can lead to both obstructive and central sleep apnoea. The presence of obstructive sleep apnoea in CKD can exacerbate the already heightened cardiovascular morbidity and mortality in these patients, as well as leading to daytime fatigue and reduced quality of life. Increased awareness, timely diagnosis and appropriate therapeutic interventions are essential to reduce the negative impact of sleep disorders in patients with kidney disease. In this Review, Owen Lyons discusses the diagnosis, epidemiology and pathophysiology of three sleep disorders that commonly affect patients with chronic kidney disease — restless legs syndrome, insomnia and sleep apnoea — and their impact on patient morbidity and mortality. Key points: Sleep disorders, such as sleep apnoea, restless legs syndrome and insomnia, are very common in patients with chronic kidney disease (CKD), and their presence can have a substantial impact on symptom burden (including poor sleep quality, daytime fatigue and sleepiness), morbidity and mortality. Various treatment options for restless legs syndrome in CKD, including cool dialysate, iron supplementation and gabapentin, can be effective in improving sleep quality and reducing daytime fatigue. Evidence to support the use of sedatives or sleeping medications in CKD is lacking, but cognitive behavioural therapy for insomnia can be effective to improve sleep quality and daytime functioning. Sleep apnoea and kidney disease have a bi-directional relationship; obstructive sleep apnoea is associated with an accelerated decline in estimated glomerular filtration rate, whereas hypervolaemia in kidney failure can lead to obstructive and central sleep apnoea. Intensification of kidney replacement therapy or fluid removal by ultrafiltration attenuates the severity of sleep apnoea in patients with kidney failure. [ABSTRACT FROM AUTHOR]

There is growing enthusiasm towards the role of smartphone app-based interventions in the management of insomnia and related sleep problems. A considerable number of apps designed to address insomnia have been developed in recent years, and randomized controlled trials (RCTs) have begun to explore their efficacy. We conducted a meta-analysis investigating the effectiveness of apps for insomnia and sleep disturbances. From 19 RCTs, we identified significant pooled effect sizes for the primary outcomes of self-reported insomnia (g = 0.60; 05 % CI = 0.44, 0.76; NNT = 4.8) and sleep disturbances (g = 0.70; 95 % CI = 0.58, 0.83; NNT = 4.1) in favour of apps over control conditions. These effects remained robust when restricting the analyses to trials that delivered a placebo control, received a lower risk of bias rating, and had a larger sample size. Significant pooled effects in favour of apps were also observed for secondary outcomes of night time awakenings (g = 0.56), total sleep time (g = 0.33), and sleep onset latency (g = 0.32), but non-significant effects emerged for daytime sleepiness, dysfunctional beliefs about sleep, sleep efficiency, sleep hygiene, and wake after sleep onset. The pooled dropout rate from app conditions was 13.1 % (95 % CI = 8.3, 20.0), which was significantly higher than control conditions (OR = 1.78, 95 % CI = 1.39, 2.28). Findings suggest that stand-alone app-based interventions can effectively address insomnia and sleep disturbances, and may play an important role in the management of these symptoms. • Conducted a meta-analysis of 19 randomized trials of app-based interventions for insomnia. • Apps produced medium-large effects over controls on insomnia and sleep disturbances. • Apps may play an important role in the management of sleep disturbances. [ABSTRACT FROM AUTHOR]

To examine the relationships between Ramadan fasting observance (RFO) and sleep-wake patterns, daytime sleepiness, and insomnia levels in student-athletes. Sleep was measured using wrist-actigraphy in 25 semi-professional student-athletes (mean ± SD; age = 22 ± 2 years, height = 182.0 ± 5.8 cm, body mass = 81.3 ± 15.2 kg) during seven nights before RFO (academic study period), during the first half of RFO (14 nights, holiday period), and the second half of RFO (14 nights, academic study period). Additionally, participants completed the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires seven days before RFO and on the last day of RFO. Actigraphy results indicated RFO was associated with significant decreases in sleep duration during the second half of RFO vs. before and during the first half of RFO (p < 0.001). However, the first half of RFO was associated with a delay of ⁓ 2.5 h in sleep onset compared to before RFO; this delay persisted during the second half of RFO (p < 0.001). The total PSQI score before RFO (6.6 ± 2.3 AU) and during RFO (8.2 ± 2.3 AU) suggested poor overall sleep quality. ISI and ESS scores were greater during than before RFO (p = 0.002 and p = 0.041, respectively). The second half of RFO was associated with decreases in objectively assessed sleep duration among student-athletes. RFO was also associated with impaired sleep quality, excessive daytime sleepiness, and increased insomnia symptoms. Personalized interventions to address sleep-related issues in student-athletes during RFO are warranted. • The second half of Ramadan was linked with reduced sleep duration in student-athletes. • Ramadan fasting was associated with decreased perceived sleep quality. • Ramadan fasting was linked with excessive sleepiness and increased insomnia symptoms. • Interventional studies on sleep optimization during Ramadan are warranted. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe fatigue, health-related quality of life (HRQOL) and brain tumor-associated symptoms after surgical resection and during proton radiotherapy, using latent class analysis (LCA), and to determine if there is class membership change among pediatric patients with craniopharyngioma. Methods: For all patients (n = 92), demographic and disease-related/clinical variables were attained, and patient reported outcomes were collected prior to proton therapy, at week three, and at the completion of proton therapy. The mean scores for fatigue, HRQOL, and brain tumor symptoms were compared over time and profiles were identified. Factors that influenced profile status and transition probability were examined. Results: Fatigue, HRQOL, and brain tumor symptoms improved over time during proton therapy; however, a subset remained in the lower profile, profile 1, associated with increased internalizing behaviors, compared to profile 2. Conclusions: Future study should explore the bidirectional relationship of sleep, worry and anxiety in the context of ongoing radiotherapy. [ABSTRACT FROM AUTHOR]

Disrupted sleep and rest-activity pattern are common clinical features in depressed individuals. This meta-analysis compared sleep and circadian rest-activity rhythms in people with major depressive disorder (MDD) or depressive symptoms and healthy controls. Eligible studies were identified in five databases up to December 2023. The search yielded 53 studies with a total of 11,115 participants, including 4000 depressed participants and 7115 healthy controls. Pooled meta-analyses demonstrated that depressed individuals have significantly longer sleep latency (SMD = 0.23, 95 % CI: 0.12 to 0.33) and wake time after sleep onset (SMD = 0.37, 95 % CI: 0.22 to 0.52), lower sleep efficiency (SMD = −0.41, 95 % CI: −0.56 to −0.25), more nocturnal awakenings (SMD = 0.58, 95 % CI: 0.29 to 0.88), lower MESOR (SMD = −0.54, 95 % CI: −0.81 to −0.28), amplitude (SMD = −0.33, 95 % CI: −0.57 to −0.09), and interdaily stability (SMD = −0.17, 95 % CI: −0.28 to −0.05), less daytime (SMD = −0.79, 95 % CI: −1.08 to −0.49) and total activities (SMD = −0.89, 95 % CI: −1.28 to −0.50) when compared with healthy controls. Most of the included studies reported separate sleep and activity parameters instead of 24-hour rest-activity rhythms. The variabilities among actigraphy devices and the types of participants recruited also impede precise comparisons. The findings emerging from this study offered a better understanding of sleep and rest-activity rhythm in individuals with MDD or depressive symptoms. Future studies could advocate for deriving objective, distinctive 24-hour rest-activity profiles contributing to the risk of depression. CRD42021259780. • The review included 53 new studies up to December 2023. • Depressed individuals reported significantly poorer sleep than healthy controls. • Depressed individuals had disrupted circadian rest-activity rhythms. • Actigraphy has wide reaching and cost-effective public mental health implication. • Future studies can identify objective, distinctive 24-h rest-activity profiles in depression. [ABSTRACT FROM AUTHOR]

Introduction: Kleine-Levin syndrome (KLS) is a rare disorder characterized by recurrent periodic hypersomnia, cognitive disturbances, hyperphagia, and hypersexuality. Although many factors have been associated with its occurrence, little is known about treatment. Herein, we present a case of symptoms similar to KLS thought to be related to vascular occlusion disease. Case description: An 81-year-old woman was admitted to the hospital due to recurring episodes of disturbance of consciousness, cognitive disorder, and hyperphagia for 18 years. She was diagnosed with KLS and basilar artery occlusion. Endovascular and antithrombotic therapy was initiated, and her symptoms fully resolved within 2 weeks of treatment initiation. Conclusion: KLS has diverse clinical presentations and demonstrates variable therapeutic responses. Vascular disease or blood flow disorder may be one possible factor for this disease. This case underscores the need for further research into the etiology and pathogenesis of KLS to promote evidence-based approaches for its diagnosis and treatment. [ABSTRACT FROM AUTHOR]

This document contains abstracts, symposia, research studies, and presentations related to bipolar disorder (BD) and its various aspects. The topics covered include the role of cytomegalovirus infection, environmental factors, childhood trauma, and past infection exposures in BD. The document also explores the diagnosis, treatment, and management of mixed features in BD, as well as the impact of cardiometabolic disease risk factors, obesity, brain structure, and generative artificial intelligence on individuals with BD. Additionally, the document discusses suicide risk, neurobiological and genetic factors, and potential treatment targets in BD. Other studies focus on antipsychotics, glucose metabolism, insulin resistance, metformin, mitochondrial DNA, DNA repair mechanisms, oxidative DNA damage, nucleotide excision repair, cognitive dysfunction, cognitive remediation therapy, and virtual reality-based cognitive assessment tools. The document also highlights the feasibility and acceptability of cognitive behavioral therapy, the Canadian Biomarker Integration Network in Depression, precision psychiatry, patient engagement, and the use of psilocybin for mood disorders. Lastly, the document covers the effects of stopping and restarting lithium treatment on kidney function, serious adverse drug events, group psychotherapy, and the potential therapeutic targets of the 5HT7 and 5HT4 receptor systems in mood disorders. These studies and presentations contribute to our understanding of BD and offer potential avenues for treatment and support. [Extracted from the article]

This is the first investigation of psychological, medical, and neurodevelopmental problems in children with versus without cognitive disengagement syndrome (CDS) (formerly sluggish cognitive tempo) in autism, ADHD-Combined, ADHD-Inattentive, and general population samples. Mothers rated 987 children with autism, 700 with ADHD-Combined, and 303 with ADHD-Inattentive (5–17 years) and 665 elementary school children (6–12 years) on the Pediatric Behavior Scale. Comorbid problems that were significantly more prevalent in children with versus without CDS in all or most of the four diagnostic groups in order of significance were cognitive problems (comprehension problems, illogical thinking, forgetful, and thinks and works slowly), gross motor incoordination, depression, somatic complaints (stomachaches, headaches, other body aches, and feels sick), excessive sleep, anxiety, inattention, insomnia, academic impairment, bully victimization, autism, dysgraphia, and overweight. Comorbidities not differing between children with and without CDS in all or most diagnostic groups were hyperactivity, impulsivity, oppositional behavior, irritability/temper outbursts, aggression, bullying, suicide ideation and attempts, incontinence, underweight, seizures, speech problems, and low IQ. Given CDS's association with multiple problems and functional impairment, its general population prevalence similar to that of other childhood disorders, and its high frequency in clinical children, it is important to evaluate CDS symptoms and comorbidity in referred children and intervene when symptoms are present. [ABSTRACT FROM AUTHOR]

Narcolepsy type-1 is a rare chronic sleep disorder that has negative effects on quality of life if left untreated. Symptoms such as excessive daytime sleepiness, cataplexy, sleep paralysis, disrupted night sleep, vivid dreams, psychosomatic complaints, and decreased sexual desire are also observed. Diagnosis will be made according to the criteria in the international classification of sleep disorders 3rd edition 2023 revision (ICSD-3-TR-2023). In our case, there was excessive daytime sleepiness, disrupted night sleep, cataplexy, overeating, and increased sexual desire. As a result of clinical data, polysomnography, and multiple sleep latency tests, she was diagnosed with narcolepsy type-1 according to the ICSD-3-TR-2023 guidelines. In the differential diagnosis of excessive sexual desire, it was planned to distinguish "persistent genital arousal", "restless genital syndrome", "sexomnia", and "hypersexuality" diseases. According to the diagnostic and statistical manual of mental disorders fifth edition criteria, "hypersexuality" accompanying narcolepsy type-1 was diagnosed in the patient. To date, no increase in sexual desire has been reported in the literature regarding the diagnosis of narcolepsy type-1. In this case, it is aimed to discuss a case of hypersexuality that has not been observed to date, together with a diagnosis of narcolepsy type-1, in the light of the literature. [ABSTRACT FROM AUTHOR]

Valbenazine is commonly used to treat tardive dyskinesia, and we conducted a pharmacovigilance analysis using the Food and Drug Administration Adverse Event Reporting System (FAERS) to evaluate neurological safety signals associated with valbenazine. Data was collected in FAERS from the second quarter of 2017 to the fourth quarter of 2023 for data cleaning. Neurological adverse event (AE) signals of valbenazine were mined by calculating reporting odds ratios (ROR), information component (IC) and empirical Bayesian geometric mean (EBGM). The serious and non-serious cases and signals were prioritized using a rating scale. The number of neurological AE reports where the primary suspect (PS) drug was 8981 for valbenazine. Significant AE signals were identified by the preferred term (PT) analysis for valbenazine, including somnolence (ROR 19.69), tremor (ROR 15.17), and tardive dyskinesia (ROR 236.91), among which 18 AEs were identified as new signals. Patient age (p < 0.009) and sex (p = 0.197) might be associated with an increased risk of neurological AE severity. Notably, the association between valbenazine and neurological disorders remained when stratified by sex, age, and reporter type. AE timing analysis was performed for the drug and four moderate clinical priority signals [i.e., somnolence, balance disorder, parkinsonism, and akathisia (priorities 7)], showing the same early failure type profiles. The increase in neurological safety signals is identified in the post-marketing research of valbenazine. Clinicians need to pay attention to not only common AEs but also be alert to new neurological AE signals when using valbenazine. • This study provides the latest valbenazine-related neurological safety profiles, and eighteen AEs were identified as new signals. • Neurological AEs most commonly identified for valbenazine were somnolence, tremor, dizziness, drooling, dyskinesia, and balance disorder. • Our findings could potentially prompt improved awareness of valbenazine-related toxicities and help healthcare professionals mitigate the risk of neurological events. [ABSTRACT FROM AUTHOR]

Optimal measurement tools for problematic sleep inertia, common in some central disorders of hypersomnolence (CDH), have not yet been determined. We evaluated the performance of the Sleep Inertia Questionnaire (SIQ) in CDH, and how well it distinguished hypersomnolent groups from controls, and IH (idiopathic hypersomnia) from narcolepsy type 1 (NT1). This prospective, bi-centric study included 63 control, 84 IH, 16 NT1, 18 narcolepsy type 2 (NT2), and 88 subjective excessive daytime sleepiness (sEDS) participants, using ICSD-3 criteria. 126 (47.2 %) participants were on any medication at the time of SIQ completion. We assessed construct validity of SIQ scores, and sleep inertia duration (SID), and compared them across diagnoses, controlling for age and center. We derived cutpoints to distinguish hypersomnolent patients from controls and IH from NT1. Sensitivity analyses for depression, chronotype, and medication were performed. The SIQ sum and composite score were significantly lower in controls than in other groups (p < 0.0001), demonstrating outstanding ability to distinguish patients from controls (AUCs 0.92), without differences among hypersomnolent groups. SID (AUC 0.76) was significantly shorter in controls than in all hypersomnolent groups except NT1, and was shorter in NT1 than in IH or sEDS. Optimal SIQ sum cutpoint was 42 (J = 0.71) for patients versus controls. Optimal SID cutpoint in distinguishing IH from NT1 was 25 min (J = 0.39). The SIQ has excellent ability to distinguish hypersomnolent patients from healthy controls, after controlling for depression, eveningness, and medication. SID is best at distinguishing IH from NT1. • Sleep inertia can be disabling in some central disorders of hypersomnolence. • Optimal tools to measure sleep inertia severity have not yet been determined. • The Sleep Inertia Questionnaire (SIQ) distinguishes sleepy patients from controls. • Optimal SIQ sum cutpoint to distinguish patients from controls was 42 (J = 0.71). • Sleep inertia duration distinguishes Idiopathic Hypersomnia from Narcolepsy Type 1. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to investigate the potential correlation between physical performance and health metrics in patients with obstructive sleep apnea syndrome (OSA), while also comparing variations in health metrics (such as obesity, hypoxia, quality of life, etc.) and physical performance across different severities of OSA. Material and Methods: Eighty-four participants undergoing polysomnography with the suspected presence of OSAS were included. Participants completed the Epworth Sleepiness Scale (ESS), 36-ltem Short Form (SF-36), Hospital Anxiety-Depression Scale (HADS) questionnaires. Physical performance was assessed using the 30-Second Sit-to-Stand Test (30CST). Participants were categorized into two groups to compare health metrics based on the severity of OSA. Results: Body mass index, neck circumference, ESS scores, hypoxia levels, emotional well-being, and energy levels of SF-36, differed statistically according to the severity of OSA. While there was no correlation between 30CST scores and social functioning (r=.125, p=.29O), all other SF-36 subheadings and 30CST were significantly correlated (p<.05). 30CST variance is predicted significantly by SF-36 (p<.001), HADS (p<.001), ESS (p<.001), obesity (p=.001), and hypoxia (p=.011). Conclusion: These results indicate that the physical performance of patients with OSA is correlated with health metrics, including quality of life, daytime sleepiness, anxiety-depression, hypoxia, and obesity, irrespective of the severity of apnea-hypopnea. [ABSTRACT FROM AUTHOR]

Daytime dysfunction, including symptoms like sleepiness, poor memory, and reduced responsiveness, is not well researched. It is crucial to develop animal models and study the biological mechanisms involved. We simulated sleep disorders through sleep deprivation, and stressful stimuli were used to establish daytime functional animal models. We used tests like the sodium pentobarbital sleep synergy test and the DSI telemetry system to measure sleep duration and structure. We also used tests like the Morris water maze, open field test, grip test, and baton twirling test to assess mental and physical fatigue. To assess the intrinsic biological mechanisms, we measured sleep–wake-related neurotransmitters and related receptor proteins, circadian rhythm-related proteins and cognition-related proteins in hypothalamus tissue, and oxidative stress, inflammatory factors, S100β, and HPA axis-related indexes in serum. Multi-factor sleep deprivation resulted in the disruption of sleep–wakefulness structure, memory–cognitive function degradation, decreased grip coordination, and other manifestations of decreased energetic and physical strength. The intrinsic biological mechanisms were related to the disturbed expression of sleep–wake, circadian rhythm, memory–cognition-related proteins, as well as the significant elevation of inflammatory factors, oxidative stress, the HPA axis, and other related indicators. Intrinsically related biological mechanisms and reduced sirt1 expression can lead to disruption of circadian rhythms; resulting in disruption of their sleep–wake-related neurotransmitter content and receptor expression. Meanwhile, the reduced expression of sirt1 also resulted in reduced expression of synapse-associated proteins. This study prepared an animal model of daytime dysfunction by means of multi-factor sleep deprivation. With sirt1 as a core target, the relevant biological mechanisms of neurological disorders were modulated. [ABSTRACT FROM AUTHOR]

Introduction: Adverse sleep is common in multiple sclerosis (MS). Population-based studies including adequate control groups are lacking. We hypothesized that the prevalence of sleep disorders and other sleep disturbances would be higher in persons with MS than in controls. Methods: We conducted a population-based study linking individual-level data from the Danish MS Registry (n = 21,943 persons with MS) and the Danish Population Registry (n = 109,715 matched controls) with information on sleep disorders from the Danish National Patient Registry and other sleep disturbances assessed by dispensed prescription drugs from the Danish National Prescription Registry. Results: Prevalence of diagnosed sleep disorders in terms of central hypersomnia (0.15% vs. 0.06%), sleep disturbances (1.05% vs. 0.70%), and sleep movements (0.22% vs. 0.13%) and other sleep disturbances identified by dispensed central acting (10.73% vs. 1.10%) and hypnotic use (30.65% vs. 20.13%) medication was statistically significantly higher among persons with MS when compared to controls. We found no statistically significant difference in the prevalence of sleep apnea and parasomnia between groups. Stratified by sex and age at MS diagnosis, results for differences between persons with MS and controls were similar. Conclusion: In this registry-based study, we found that the prevalence of several diagnosed sleep disorders was higher in persons with MS than in controls, that is, those reflecting insomnia and daytime symptoms including hypersomnia. Other sleep disturbances identified by dispensed prescription medication were markedly higher in persons with MS than in controls. [ABSTRACT FROM AUTHOR]

Narcolepsy is a chronic central disorder of hypersomnolence most frequently arising during childhood/adolescence. This review article examined the literature concerning the etiology, prevalence, clinical course, and treatment of children with type 1 narcolepsy (NT1). Core symptoms of pediatric NT1 include excessive daytime sleepiness (EDS) and cataplexy, together with disrupted night sleep, sleep paralysis, and hypnagogic and hypnopompic hallucinations that can also occur. This disease frequently presents several comorbidities, such as obesity and precocious puberty, conditions ranging from psychological distress to psychiatric disorders, and cognitive aspects that further worsen the clinical picture. NT1 impairs the quality of life of children, thus calling for an early diagnosis and adequate treatment. To date, pharmacological treatments have been registered for childhood NT1 and can improve symptoms. Non-pharmacological approaches are also essential to improve patients' well-being, ranging from behavioral treatments (e.g., planned napping) to psychosocial interventions (e.g., school programs). Multidisciplinary treatment management and early diagnosis are key factors in order to allow for adequate quality of life and development in children with NT1. [ABSTRACT FROM AUTHOR]

This review aims to systematically examine the relationship between sleep quality and its impact on physical and mental health, and to assess the effectiveness of psychotherapeutic interventions for the treatment of sleep disorders. A comprehensive literature search was conducted using major databases including PubMed, MEDLINE, and Google Scholar, focusing on articles published between 2001 and 2023. The review synthesized information from 52 studies using methods of analysis, synthesis, comparison, and generalization to assess indicators of sleep quality, their impact on health, and the effectiveness of different psychotherapeutic treatments. The review found that optimal sleep quality, characterized by adequate duration, continuity, and depth, is crucial for maintaining both physical and mental health. Poor sleep quality was found to contribute significantly to the development and exacerbation of many health problems, including metabolic disorders, cardiovascular disease, depression, and anxiety. Cognitive behavioral therapy was identified as an effective psychotherapeutic approach for improving sleep quality and managing sleep disorders, while hypnotherapy is not recommended. The findings highlight the critical role of sleep in maintaining health and the potential of targeted psychotherapeutic interventions to improve sleep quality. Given the reciprocal relationship between sleep and health, healthcare providers should prioritize the assessment and treatment of sleep disorders. Further research should focus on long-term clinical trials to establish causal relationships and the sustainability of treatment effects, promoting wider application of these findings in clinical practice.

Sex differences in sleep disturbances during major depressive episodes (MDE) have been suggested. This study compares the prevalence, sociodemographic characteristics, and psychiatric comorbidity associated with sleep complaints specific to each sex among adults with MDE. These findings are crucial for precise diagnosis, personalized treatment, and improved clinical outcomes. In a large nationally representative prospective survey, we used multi-adjusted logistic regression models including sociodemographic characteristics, psychiatric comorbidity, and depression severity to examine whether associations differ between men and women. Among women, 93.3 % reported at least one type of sleep complaints (i.e., trouble falling asleep, early morning awakening or hypersomnia) while 91.0 % of men did, with respectively 78.3 % and 77.2 % of insomnia complaints, and 46.2 % and 41.3 % of hypersomnia complaints. Women with sleep complaints were more likely to be black, with lower individual incomes, have histrionic personality disorder or a specific phobia. Conversely, men with sleep complaints were more likely to have a lifetime diagnosis of mania spectrum disorder, generalized anxiety disorder, drug use disorder, as well as dependent and schizotypal personality disorders. Surprisingly, being "never married" has emerged as a protective factor against sleep complaints in women, while posing as a risk factor in men compared to other marital statuses. Differences and specificities were also noted concerning subtypes of insomnia and hypersomnia complaints. The cross-sectional design means the associations found do not imply causality. These findings provide insights into the complex relationship between sleep and depression in men and women, highlighting the need for personalized interventions. • 93.3 % of women and 91.0 % of men reported sleep complaints during depression. • Men with sleep issues often had mania, anxiety, personality or drug use disorders. • Women more likely black, low-income, with personality disorder or specific phobias. • "Never married" women had fewer sleep complaints; opposite for men. • Findings highlight gender-specific links between sleep complaints and depression. [ABSTRACT FROM AUTHOR]

Background: Kidney failure at any age has a significant impact on quality of life (QoL) but the overall symptom burden for children and young people (CYP) is poorly described. Kidney failure has no cure and whilst transplantation is the preferred management option, it is not always possible, with patients requiring supportive care at the end of their lives. Aim: To use the literature to understand the symptom burden for CYP with kidney failure who are approaching end-of-life. Methods: Using three databases, a systematic literature review was performed to identify eligible studies to extract data on symptoms experienced in CYP aged < 21 years with kidney failure. Data extraction was completed by two authors using a pre-designed proforma. Study quality assessment was undertaken using the BMJ AXIS tool. Results: A total of 20,003 titles were screened to yielding 35 eligible studies including 2,862 CYP with chronic kidney disease (CKD), of whom 1,624 (57%) had CKD stage 5. The studies included a median of 30 (range 7–241) patients. Symptoms were subcategorised into eight groups: sleep, mental health, gastrointestinal, dermatology, ear, nose and throat (ENT), neurology, multiple symptoms, and ophthalmology. The prevalences of the most commonly reported symptoms were: restless leg syndrome 16.7–45%, sleep disordered breathing 20–46%, hypersomnia 14.3–60%, depression 12.5–67%, anxiety 5.3–34%, overall gastrointestinal symptoms 43–82.6%, nausea and vomiting 15.8–68.4%, abdominal pain 10.5–67.4%, altered appetite or anorexia 19–90%, xerosis 53.5–100%, pruritis 18.6–69%, headache 24–76.2% and ophthalmological symptoms 26%. Within each subgroup, the symptom definitions used were heterogeneous, the methods of assessment were varied and some symptoms, such as pain and constipation, were poorly represented. Conclusions: There is a marked lack of evidence relating to the symptom burden for CYP with CKD. This study highlights the high symptom prevalence, particularly in relation to sleep, mental health, headache, dermatological and gastrointestinal symptoms. There is a need for consensus recommendations on the evaluation and management of symptoms for CYP with CKD approaching end-of-life. PROSPERO ID: CRD42022346120. [ABSTRACT FROM AUTHOR]

Background and purpose: Accompanying sleep disorders such as insomnia, delayed sleep, and wakefulness, as well as anxiety and depression with obsessive-compulsive disorder, are common in patients with OCD. However, not much research has been done on the relationship between sleep disorders and the severity of symptoms in patients with OCD. This article examines the frequency and relationship between sleep disorders, depression, anxiety, and the severity of obsessive-compulsive symptoms in patients with OCD. Materials and methods: Convenience sampling was used in this cross-sectional research. The participants in the study were those who were referred to the clinic of a psychiatric hospital and the central clinic complex in Sari. Obsessive-compulsive disorder diagnosis of the participants was confirmed by a psychiatrist based on DSM-5 diagnostic criteria. Eighty-eight patients participated in the study after obtaining informed consent. Demographic questionnaires, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), morning-evening questionnaire (MEQ), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), WHO-5 well-being (Depression) Index, and Generalized Anxiety Disorder-7 (GAD-7). Data analysis was done with SPSS version 20 software. Results: Out of 88 patients, 65 (73.86%) were women 23 (26.14%) were men, 71.59% were married, 57.95% had under diploma degree, and 94.22% had no history of drug use. The average age of the patients was 44.48 ± 11.51 years. The duration of OCD was 11.28±14.60 years In terms of the severity of OCD symptoms, 1.1% was very mild, 19.32% was relatively mild, 42.45% was moderate, and 37.50% was severe. In the type of sleep schedule, 17.03% were inclined to evening or relative evening type. Four patients (4.62%) had daytime sleepiness. Also, 52 patients (61.90%) had some degree of insomnia. In terms of the severity of insomnia, 23.86% were mild, 28.40% were moderate and 6.81% were severe. The frequency of depression was 68% and anxiety was 79%. No statistically significant relationship was found between the severity of obsessive-compulsive disorder and hypersomnia, evening chronotype, anxiety, and depression. But insomnia (P= 0.046) and duration of illness (P= 0.004) were related to it. The Pearson correlation coefficient between age, duration of obsessive-compulsive disorder, and severity of obsessive-compulsive symptoms was 0.169 (P= 0.116) and 0.377 (P=0.001), respectively. Spearman's correlation coefficient between the severity of obsessive-compulsive symptoms with depression and anxiety was 0.090 (P=0.403) and 0.044 (P=0.685), respectively. The average severity of obsessive-compulsive symptoms was 23.48±7.87 in women and 20.04±5.88 in men, and no significant difference was seen in both sexes (P=0.060). In linear regression, the two factors affecting the severity of obsessive-compulsive symptoms were the duration of the illness and the severity of insomnia. Conclusion: Considering the higher frequency of insomnia in patients with obsessive-compulsive disorder compared to the normal population and its role in the severity of obsessive-compulsive disorder symptoms, it is necessary to examine patients with obsessive-compulsive disorder in terms of insomnia. Also, older OCD patients should be examined more carefully in terms of the severity of obsessive-compulsive symptoms.

Hypersomnia, a disorder of sleep characterized by excessive quantity of sleep and excessive daytime sleepiness (EDS), could adversely affect health outcomes in childhood. To highlight diagnostic challenges and the impact of childhood hypersomnia in a resource limited setting, a 14 year old Nigerian who presented with a seven year history of hypersomnia was studied. Screening for sleep disorder using BEARS sleep algorithm and assessment for EDS using the Epworth Sleepiness Scale were both positive for EDS. The assessment of sleep hygiene using the Adolescent Sleep Hygiene Scale was normal and the use of Raven’s Progressive Matrices to assess intelligence was also normal. There was no contributory past medical history or demonstrable etiology. Magnetic Resonance Imaging (MRI) of the brain, Electro Encephalogram (EEG), assay of serum electrolytes were all normal while screening test for trypanosomiasis was negative. Poor level of awareness, high cost of evaluation and limited facilities for diagnosis of sleep disorder were the major diagnostic challenges. Depression, poor academic performance, suicidal ideation and stigmatization were all associated with hypersomnia in the patient.

Kleine Levin syndrome (KLS) is a rare entity. It presents with subacute onset episodic hypersomnia, cognitive decline, altered perception, and occasional hyperphagia and hypersexuality with full recovery during the interepisodic period. Five cases presented with episodic hypersomnia and met the diagnostic criteria of KLS. The majority of the cases were females (3/5) in whom KLS is even rarer. The initial presentation was in the age range of 10–25 years. Cognitive dysfunction (5/5), derealization (4/5), viral prodrome (3/5), hyperphagia (3/5), and hypersexuality (2/5) were other clinical presentations. A differential diagnosis of atypical depression is the major challenge, and thorough history taking would help in differentiation. Treatment with stimulants (modafinil) and mood stabilizers (lithium) proved effective. A high degree of suspicion should be kept for cases of episodic hypersomnolence for early diagnosis and management of KLS.

Background and purpose: Accompanying sleep disorders such as insomnia, delayed sleep, and wakefulness, as well as anxiety and depression with obsessive-compulsive disorder, are common in patients with OCD. However, not much research has been done on the relationship between sleep disorders and the severity of symptoms in patients with OCD. This article examines the frequency and relationship between sleep disorders, depression, anxiety, and the severity of obsessive-compulsive symptoms in patients with OCD. Materials and methods: Convenience sampling was used in this cross-sectional research. The participants in the study were those who were referred to the clinic of a psychiatric hospital and the central clinic complex in Sari. Obsessive-compulsive disorder diagnosis of the participants was confirmed by a psychiatrist based on DSM-5 diagnostic criteria. Eighty-eight patients participated in the study after obtaining informed consent. Demographic questionnaires, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), morning-evening questionnaire (MEQ), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), WHO-5 well-being (Depression) Index, and Generalized Anxiety Disorder-7 (GAD-7). Data analysis was done with SPSS version 20 software. Results: Out of 88 patients, 65 (73.86%) were women 23 (26.14%) were men, 71.59% were married, 57.95% had under diploma degree, and 94.22% had no history of drug use. The average age of the patients was 44.48 ± 11.51 years. The duration of OCD was 11.28±14.60 years In terms of the severity of OCD symptoms, 1.1% was very mild, 19.32% was relatively mild, 42.45% was moderate, and 37.50% was severe. In the type of sleep schedule, 17.03% were inclined to evening or relative evening type. Four patients (4.62%) had daytime sleepiness. Also, 52 patients (61.90%) had some degree of insomnia. In terms of the severity of insomnia, 23.86% were mild, 28.40% were moderate and 6.81% were severe. The frequency of depression was 68% and anxiety was 79%. No statistically significant relationship was found between the severity of obsessive- compulsive disorder and hypersomnia, evening chronotype, anxiety, and depression. But insomnia (P= 0.046) and duration of illness (P= 0.004) were related to it. The Pearson correlation coefficient between age, duration of obsessive-compulsive disorder, and severity of obsessive-compulsive symptoms was 0.169 (P= 0.116) and 0.377 (P=0.001), respectively. Spearman's correlation coefficient between the severity of obsessive-compulsive symptoms with depression and anxiety was 0.090 (P=0.403) and 0.044 (P=0.685), respectively. The average severity of obsessive-compulsive symptoms was 23.48±7.87 in women and 20.04±5.88 in men, and no significant difference was seen in both sexes (P=0.060). In linear regression, the two factors affecting the severity of obsessive-compulsive symptoms were the duration of the illness and the severity of insomnia. Conclusion: Considering the higher frequency of insomnia in patients with obsessive-compulsive disorder compared to the normal population and its role in the severity of obsessive-compulsive disorder symptoms, it is necessary to examine patients with obsessive-compulsive disorder in terms of insomnia. Also, older OCD patients should be examined more carefully in terms of the severity of obsessive-compulsive symptoms. [ABSTRACT FROM AUTHOR]

Sleep–wake disturbances (SWDs) are one of the most common complaints following traumatic brain injury (TBI). The high prevalence and socioeconomic burden of SWDs post-TBI have only been recognized in the past decade. Common SWDs induced by TBI include excessive daytime sleepiness (EDS), hypersomnia, insomnia, obstructive sleep apnea (OSA), and circadian rhythm sleep disorders. Sleep disturbances can significantly compromise quality of life, strain interpersonal relationships, diminish work productivity, exacerbate other clinical conditions, and impede the rehabilitation process of TBI patients. Consequently, the prompt regulation and enhancement of sleep homeostasis in TBI patients is of paramount importance. Although studies have shown that abnormal neural network function, neuroendocrine changes, disturbance of sleep–wake regulators, and immune inflammatory responses related to brain structural damage induced by TBI are involved in the development of SWDs, the exact neuropathological mechanisms are still poorly understood. Therefore, we systematically review the current clinical and experimental studies on the characteristics and possible neural mechanisms of post-TBI SWDs. Elucidating the neural underpinnings of post-TBI SWDs holds the potential to diversify and enhance therapeutic approaches for these conditions. Such advancements could hasten the recuperation of TBI patients and ameliorate their overall quality of life. It is our aspiration that departments specializing in neurosurgery, rehabilitation, and neuropsychiatry will be able to recognize and address these conditions promptly, thereby facilitating the healing journey of affected individuals. [ABSTRACT FROM AUTHOR]

Sleep health is known to be multidimensional, and there is increasing clinical interest in composite sleep health scores that capture the number of adverse sleep characteristics. We investigated whether a composite sleep health score was associated with depressive symptoms in patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Participants were OSA patients using CPAP (n = 1768, (92.1 % men, age 52.7 ± 10.7 years) attending sleep clinics in Japan. A cross-sectional survey conducted in 2020 assessed self-reported sleep and depressive symptoms. Sleep health was categorized as "good' or "poor' on five dimensions: satisfaction, daytime sleepiness, mid-sleep time, efficiency, and duration. A composite sleep health score was calculated by summing the "poor' dimensions. Depressive symptoms were assessed using two items from the Patient Health Questionnaire (PHQ-2). Associations between sleep health and depressive symptoms were assessed using multivariable logistic regression analysis. Individual sleep health symptoms of poor satisfaction and efficiency were significantly associated with depressed mood; poor satisfaction, daytime sleepiness, and duration were significantly associated with loss of interest; and poor satisfaction, efficiency, and duration were significantly associated with depressive symptoms. Composite sleep health scores were associated with greater odds of depressive symptoms in a graded manner. Individual and composite sleep health scores were associated with depressive symptoms. Measures of multidimensional sleep health may provide a better understanding of the association between poor sleep and depressive symptoms among patients with OSA using CPAP, accounting for CPAP adherence, leading to improved intervention strategies. • Sleep health is multidimensional and needs a composite measure of sleep health. • We studied sleep health and depressive symptoms in OSA patients using CPAP. • Both individual and composite sleep health were associated with depressive symptoms. • Multidimensional sleep health enhances understanding of depressive symptoms of OSA. [ABSTRACT FROM AUTHOR]

Background: Pharmacologic treatments are available to treat insomnia, a common and burdensome sleep disorder, but may be contraindicated in older adults who are prone to side effects from sleep-promoting drugs. These analyses of sleep diary data from Study E2006-G000-303 (Study 303) investigated the benefits of lemborexant 5 mg (LEM5) and 10 mg (LEM10) in the subgroup age ≥ 65 years with insomnia. Method: Study 303, a 12-month, double-blind study of LEM5 and LEM10 in adults (age ≥ 18 years) with insomnia disorder (sleep onset and/or maintenance difficulties) assessed subject-reported (subjective) sleep-onset latency (sSOL), sleep efficiency (sSE), wake after sleep onset (sWASO), and total sleep time (sTST). Morning sleepiness/alertness, insomnia severity (Insomnia Severity Index [ISI]), fatigue (Fatigue Severity Scale [FSS]), perceptions of sleep-related medication effects (Patient Global Impression–Insomnia [PGI-I] questionnaire), and safety were also evaluated. Results: In this subgroup of older adults (≥ 65 years; n = 262), there were significantly larger changes from baseline for sSOL, sSE, sTST, and sWASO with LEM5 and LEM10 versus placebo through month 6 (except sWASO month 1), indicating improvement; these improvements were sustained through month 12. Subject-reported increases in morning alertness were significantly greater with one or both LEM doses versus placebo through month 6 and sustained through month 12. There were significantly larger ISI total and daytime functioning score decreases (improvement) from baseline with LEM versus placebo at months 1, 3, and 6 (total score: both doses; daytime functioning: LEM5 month 1 and both doses months 3 and 6) and decreases from baseline FSS at months 1 and 3 (LEM5) and month 6 (both doses), sustained to month 12. Compared with placebo, more subjects reported that LEM (both doses) positively impacted ability to sleep, time to fall asleep, and TST through month 6, sustained to month 12, with no rebound after drug withdrawal. LEM was well tolerated to month 12; mild somnolence was the most common treatment-emergent adverse event. Conclusions: Improvements in subject-reported efficacy in LEM-treated adults age ≥ 65 years with insomnia were observed as early as the first week of treatment and sustained through end of month 12. LEM was well tolerated. Clinical trials registration: ClinicalTrials.gov identifier NCT02952820: E2006-G000-303; Study 303; SUNRISE-2 (First posted: October 2016); EudraCT 2015-001463-39 (First posted: November 2016). Plain Language Summary: Insomnia is a common sleep disorder associated with significant difficulties, particularly in older adults. Although there are many drug treatments available, some are associated with the important risk of side effects and may not adequately treat sleep maintenance (ability to stay asleep), which is a frequent sleep complaint in older people. Lemborexant has been approved in multiple countries for the treatment of adults with insomnia based on studies that show lemborexant improved adults' ability to fall asleep and stay asleep and is well tolerated. To examine the long-term benefit of lemborexant, we investigated subject-reported benefits and safety of lemborexant in older (≥ 65 years) adults who participated in a 1-year study. The results showed that within the first few days of taking lemborexant, and lasting through 12 months of treatment, nightly lemborexant improved nighttime sleep (that is, it reduced the time it took to fall asleep, reduced the time awake during the night, and increased total sleep time) more than placebo. Morning alertness improved more in older adults who took lemborexant compared with placebo. In addition, those who took lemborexant also reported that their insomnia symptoms were less severe and they had less fatigue compared with placebo. Lemborexant was well tolerated in older adults. These results suggest that lemborexant may be a good option for older adults with insomnia disorder. [ABSTRACT FROM AUTHOR]

The duration and quality of sleep are believed to significantly influence the onset of metabolic syndrome (MetS), but existing data lack consistency. The meta-analysis aims to evaluate the prevalence of the MetS in association with sleep duration. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines. A comprehensive search of PubMed, Google Scholar, and Research Gate databases was performed to identify cohort and cross-sectional studies published in English between 2013 and 2023. We included studies that examined the association between sleep duration/quality and MetS, and two independent reviewers assessed study quality and bias using the Newcastle–Ottawa scale. The systematic review included 11 studies with a total of 343,669 participants, including 4 cohort studies and 7 cross-sectional studies. Sample sizes varied widely, ranging from 293 to 162,121 individuals. The studies had different follow-up periods, participant ages ranging from 10 to 80 years, and predominantly male populations. The prevalence of MetS was higher in average sleepers [52%, 95% confidence interval (CI): 40%–64%] compared with short sleepers (13%, 95% CI: 8%–18%) and long sleepers (15%, 95% CI: 9%–24%). Globally, North American countries exhibit the highest prevalence of MetS across short- (25.3%, 95% CI: 4.2%–72.4%) and long-sleeper (22.4%, 95% CI: 2.8%–74.1%) categories, whereas Asian countries experience the highest prevalence among the average sleeper category (58.7%, 95% CI: 44.1%–71.9%). Our meta-analysis indicates an elevated prevalence of MetS in average sleepers. Future research endeavors address delve into the underlying mechanisms and incorporate objective measures to understand the multifaceted connection between sleep patterns and MetS, guiding more effective preventive and management strategies. [ABSTRACT FROM AUTHOR]

Summary Hypersomnia spectrum disorders are underdiagnosed and poorly treated due to their heterogeneity and absence of biomarkers. The electroretinography has been proposed as a proxy of central dysfunction and has proved to be valuable to differentiate certain psychiatric disorders. Hypersomnolence is a shared core feature in central hypersomnia and psychiatric disorders. We therefore aimed to identify biomarkers by studying the electroretinography profile in patients with narcolepsy type 1, idiopathic hypersomnia and in controls. Cone, rod and retinal ganglion cells electrical activity were recorded with flash‐electroretinography in non‐dilated eye of 31 patients with idiopathic hypersomnia (women 84%, 26.6 ± 5.9 years), 19 patients with narcolepsy type 1 (women 63%, 36.6 ± 12.7 years) and 43 controls (women 58%, 30.6 ± 9.3 years). Reduced cone a‐wave amplitude (p = 0.039) and prolonged cone (p = 0.022) and rod b‐wave (p = 0.009) latencies were observed in patients with narcolepsy type 1 as compared with controls, while prolonged photopic negative response‐wave latency (retinal ganglion cells activity) was observed in patients with idiopathic hypersomnia as compared with controls (p = 0.033). The rod and cone b‐wave latency clearly distinguished narcolepsy type 1 from idiopathic hypersomnia and controls (area under the curve > 0.70), and the photopic negative response‐wave latency distinguished idiopathic hypersomnia and narcolepsy type 1 from controls with an area under the curve > 0.68. This first original study shows electroretinography anomalies observed in patients with hypersomnia. Narcolepsy type 1 is associated with impaired cone and rod responses, whereas idiopathic hypersomnia is associated with impaired retinal ganglion cells response, suggesting different phototransduction alterations in both hypersomnias. Although these results need to be confirmed with a larger sample size, the electroretinography may be a promising tool for clinicians to differentiate hypersomnia subtypes. [ABSTRACT FROM AUTHOR]

Introduction: Sleep disorders are common in children with autism spectrum disorder (ASD). Transcranial magnetic stimulation (TMS) can influence the excitability of neuronal cells in stimulated areas, leading to improvements in sleep and other autistic symptoms. However, studies on clinical mechanisms of TMS in treating sleep disorders associated with ASD are limited. Therefore, we aimed to explore the effects of TMS on sleep structure and quality in children with ASD. Methods: Between January 2020 and December 2021, recruitment was advertised through child and adolescent outpatient clinics and online platforms by the Hangzhou Seventh People's Hospital and Lishui Second People's Hospital. Sixty children with ASD who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were selected and randomly divided into the active TMS and sham TMS treatment groups. Thirty healthy children of the same age were recruited as controls. The active TMS group received bilateral low-frequency (0.5 Hz) TMS targeting the dorsolateral prefrontal cortex on both sides in children with ASD, whereas the sham TMS group received sham stimulation with the same stimulation time and location as the experimental group. Both groups were treated for 6 weeks, and the participants were assessed using the Sleep Disturbance Scale for Children (SDSC) before treatment, at 3 weeks, and at 6 weeks of intervention. Independent sample t-tests and difference t-tests were used for statistical analysis of the data. Results: No significant differences were observed in general demographic variables, such as age and sex, between the ASD and control groups (P>0.05). Independent sample t-test analysis showed that the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis scores were significantly higher in the ASD group than in the control group (P<0.05). Before treatment, no significant differences were observed in the factor or total SDSC scores between the sham TMS group and the active TMS group (P>0.05). After 15 and 30 treatment sessions, the total SDSC score, difficulty falling asleep, sleep maintenance, sleep-wake transition disorders, and excessive daytime sleepiness scores were significantly higher in the sham TMS group than in the active TMS group (P<0.05). The difference t-test analysis showed that after 30 treatment sessions, the reduction rates of the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis dimensions were significantly higher in the active TMS group than in the sham TMS group (P<0.05). Conclusion: Low-frequency TMS targeting the dorsolateral prefrontal cortex in children with ASD can effectively improve their sleep status, and significant improvement can be achieved after 6 weeks (30 sessions) of treatment. [ABSTRACT FROM AUTHOR]

Summary Since the first description of narcolepsy at the end of the 19th Century, great progress has been made. The disease is nowadays distinguished as narcolepsy type 1 and type 2. In the 1960s, the discovery of rapid eye movement sleep at sleep onset led to improved understanding of core sleep‐related disease symptoms of the disease (excessive daytime sleepiness with early occurrence of rapid eye movement sleep, sleep‐related hallucinations, sleep paralysis, rapid eye movement parasomnia), as possible dysregulation of rapid eye movement sleep, and cataplexy resembling an intrusion of rapid eye movement atonia during wake. The relevance of non‐sleep‐related symptoms, such as obesity, precocious puberty, psychiatric and cardiovascular morbidities, has subsequently been recognized. The diagnostic tools have been improved, but sleep‐onset rapid eye movement periods on polysomnography and Multiple Sleep Latency Test remain key criteria. The pathogenic mechanisms of narcolepsy type 1 have been partly elucidated after the discovery of strong HLA class II association and orexin/hypocretin deficiency, a neurotransmitter that is involved in altered rapid eye movement sleep regulation. Conversely, the causes of narcolepsy type 2, where cataplexy and orexin deficiency are absent, remain unknown. Symptomatic medications to treat patients with narcolepsy have been developed, and management has been codified with guidelines, until the recent promising orexin‐receptor agonists. The present review retraces the steps of the research on narcolepsy that linked the features of the disease with rapid eye movement sleep abnormality, and those that do not appear associated with rapid eye movement sleep. [ABSTRACT FROM AUTHOR]

Background: Insomnia is common in adolescents. This study evaluated feasibility and preliminary efficacy of a six-week internet-delivered cognitive-behavioral therapy for insomnia (ICBT-I) in adolescents. Methods: In this uncontrolled pilot study, participants (n = 27, 78% female) completed assessments pre- and post intervention. Data on recruitment, adherence to treatment, treatment activity, satisfaction and credibility was collected to assess feasibility. Self-reported insomnia symptoms, sleep parameters as well as depression, anxiety and daytime function were also assessed. Results: Participants showed good adherence to treatment and found the intervention overall credible and satisfactory. From pre- to post-assessment, statistically significant improvements were found for insomnia symptoms (p <.001; d = 1.02), sleep onset latency (p <.001; d =.39), wake after sleep onset (p =.001; d =.34), sleep efficiency (p <.001; d =.5) and depression (p =.01, d =.37). Changes in scores of total sleep time, generalized anxiety, daytime sleepiness and functional disability were not significant. Conclusions: The present study indicates that ICBT-I is well accepted by adolescents, that insomnia symptoms and sleep parameters can improve following the intervention, and that co-morbid symptoms of depression can be reduced. Due to the limited sample size and the uncontrolled design, the suggested results need to be replicated in well-powered controlled clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: Obstructive sleep apnea (OSA) is a common sleep breathing disorder and is associated with increased cardiovascular risk and daytime sleepiness. Continuous positive airway pressure (CPAP) is a treatment for OSA, which splints the airway open. The introduction of telemedicine in CPAP devices offers clinical staff an alternative method of reviewing patients, monitoring treatment, and reducing clinical time. Materials and Methods: A randomized control trial was conducted with patients randomized to one of three arms: Arm 1 (standard care), Arm 2 (modem and a virtual appointment), and Arm 3 (modem, smart device application DreamMapper™, and a virtual appointment). Ninety participants requiring treatment with CPAP following a diagnosis of OSA were recruited and data collected at baseline, 14 days, and 180 days. Additional contacts or appointments were also recorded. Results: Ninety participants (n = 90) were recruited (68% males and 32% females) with an average age of 52.0 ± 13.13 years and apnea/hypopnea index (AHI) 43.5 ± 21.92 (events/h). There was a statistically significant difference between the three arms in the average clinical time taken for the first follow-up appointment (p = 0.001). There was a statistically significant difference between the three arms in the number of additional appointments or contacts required (p = 0.03). Discussion and Conclusion: Telemedicine reduced clinical time at first follow-up, and in patients who received standard care or a smart device application to monitor their own CPAP treatment, there were significantly less additional appointments required when compared with telemedicine support in the form of a modem alone. [ABSTRACT FROM AUTHOR]

The present study investigated the roles birthplace and acculturation play in sleep estimates among Hispanic/Latino population at the US–Mexico border. Data were collected in 2016, from N = 100 adults of Mexican descent from the city of Nogales, AZ, at the US–Mexico border. Sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index categorized as none, mild, moderate, and severe, and Multivariable Apnea Prediction Index (MAP) categorized as never, infrequently, and frequently. Acculturation was measured with the Acculturation Rating Scale for Mexican-Americans II (ARSMA-II). The sample consisted of majority Mexican-born (66%, vs. born in the USA 38.2%). Being born in the USA was associated with 55 fewer minutes of nighttime sleep (p =.011), and 1.65 greater PSQI score (p =.031). Compared to no symptoms, being born in the USA was associated with greater likelihood of severe difficulty falling asleep (OR = 8.3, p =.030) and severe difficulty staying asleep (OR = 11.2, p =.050), as well as decreased likelihood of breathing pauses during sleep (OR = 0.18, P =.020). These relationships remained significant after Mexican acculturation was entered in these models. However, greater Anglo acculturation appears to mediate one fewer hour of sleep per night, poorer sleep quality, and reporting of severe difficulty falling asleep and staying asleep. Among individuals of Mexican descent, being born in the USA (vs Mexico) is associated with about 1 hour less sleep per night, worse sleep quality, more insomnia symptoms, and less mild sleep apnea symptoms. These relationships are influenced by acculturation, primarily the degree of Anglo rather than the degree of Mexican acculturation. [ABSTRACT FROM AUTHOR]