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Background: Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes. Objectives: To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA. Design: A pilot randomized, double-blind, placebo-controlled trial. Setting: A tertiary university hospital in Beijing, China. Patients: One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28  mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022. Intervention: After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02  μg/kg/h) or placebo. We monitored polysomnogram from 9:00  pm to 6:00  am during the first night. Main outcome measures: Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0–100 score range, higher score better). Results: All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p  =  0.029); it also decreased the percentage of stage N1 sleep (median difference, −10%; 95% CI, −20% to −1%; p  =  0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p  =  0.060). Adverse events were similar between groups. Conclusion: Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events. [ABSTRACT FROM AUTHOR]

Summary: The present study examined the relationship between subjective sleep onset latency (SOL), sleep structure, changes in skin and body temperature, and subjective evaluation of sleep in healthy young adults to elucidate the pathophysiological mechanisms of insomnia. A total of 28 participants (age 21.54 [0.50] years) with no sleep problems participated in a 1‐h polysomnographic recording that obtained objective sleep parameters during the daytime while skin and body temperatures were recorded. The distal–proximal skin temperature gradient (DPG) was calculated. Subjective parameters, such as subjective SOL, sleep time, and restorative sleepiness, were evaluated before and after sleep. Most participants estimated their sleep latency as being longer than their actual SOL (13.7 versus 7.6 min). Objective SOL was significantly correlated with each sleep stage parameter whereas subjective SOL was negatively correlated with Stage N2 sleep duration (Rho = −0.454, p = 0.020), slow‐wave activity and delta power (Rho = −0.500, p = 0.011 and Rho = −0.432, p = 0.031, respectively), and ΔDPG (the degree of reduction of heat loss before and after lights‐off). Stepwise regression analysis showed that ΔDPG was the strongest predictive factor in explaining the length of subjective SOL. The degree of heat dissipation before and after lights‐off contributed most to the sensation of falling asleep in healthy young adults. This finding may be helpful for elucidating the physiological mechanisms of insomnia and its treatment. [ABSTRACT FROM AUTHOR]

Purpose: To continuously and dynamically monitor the sleep status of patients in the acute phase of cerebral infarction, and to investigate the characteristics of acute cerebral infarction(ACI)associated with sleep-disordered breathing (SDB), variations in sleep structure, and changes in sleep circadian rhythms. Methods: Patients with ACI within 48 h of onset who were admitted to the Department of Neurology at Kailuan General Hospital from November 2020 to December 2022 were selected. Detailed baseline information such as age, gender, smoking history, drinking history, were recorded for the selected participants. From the beginning of their hospitalization, the selected participants were monitored for their sleep status continuously for 5 days using the Intelligent Mattress-based Sleep Monitoring Platform System(IMSMPS). Based on the heart rate data obtained from the monitoring, the interdaily stability (IS) and intradaily variability (IV) of the sleep circadian rhythm were calculated. Results: 1,367 patients with ACI were selected. Monitoring results over 5 days indicated 147 cases (10.75%) without SDB, and 1,220 cases (89.25%) with SDB. Among the group with SDB, there were 248 cases (18.14%) with continuous mild SDB, 395 cases (28.90%) with moderate SDB, 295 cases (21.58%) with severe SDB, and 282 cases (20.63%) that fluctuated between different severity levels. Within this fluctuating group, 152 cases (53.90%) fluctuated between two severity levels, 120 cases (42.55%) between three levels, and 10 cases (3.55%) among all four levels. There were statistically significant differences (P < 0.05) in the sleep latency, sleep efficiency, non-rapid eye movement stages 1–2, rapid eye movement, proportion of non-rapid eye movement, proportion of rapid eye movement, wake after sleep onset, time out of bed, number of awakenings, respiratory variability index, and heart rate variability index among patients with ACI monitored from day 1 to 5. However, other monitored sleep structure parameters did not show statistically significant differences (P > 0.05). The coefficient of variation for all sleep monitoring parameters ranged between 14.54 and 36.57%. The IV in the SDB group was higher than in the group without SDB (P < 0.05), and the IS was lower than in the group without SDB (P < 0.05). Conclusion: Patients in the acute phase of cerebral infarction have a high probability of accompanying SDB. The sleep structure of these patients shows significant variability based on the onset time of the stroke, and some patients experience fluctuations among different severity levels of SDB. ACI accompanied by SDB can further reduce the IS of a patient's sleep circadian rhythm and increase its IV. [ABSTRACT FROM AUTHOR]

Jieyang Yu,1,2 Yanan Zhang,1 Lijia Cai,1 Qingqing Sun,1 Wanru Li,1 Junfang Zhou,1 Jianmin Liang,2 Zan Wang1 1Sleep Centre, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China; 2Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of ChinaCorrespondence: Jianmin Liang, Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, People’s Republic of China, Email liangjm@jlu.edu.cn Zan Wang, Sleep Centre, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, People’s Republic of China, Email wangzan@jlu.edu.cn; wangzanprof@163.comPurpose: This study aimed to evaluate nocturnal sleep structure and anxiety, depression, and fatigue in patients with narcolepsy type 1 (NT1).Methods: Thirty NT1 patients and thirty-five healthy controls were enrolled and evaluated using the Epworth sleepiness scale (ESS), Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Fatigue Severity Scale (FSS), polysomnography, multiple sleep latency test, and brain function state monitoring. Statistical analyses were performed using SPSS Statistics for Windows, version 23.0. Benjamini-Hochberg correction was performed to control the false discovery rate.Results: Apart from typical clinical manifestations, patients with NT1 are prone to comorbidities such as nocturnal sleep disorders, anxiety, depression, and fatigue. Compared with the control group, patients with NT1 exhibited abnormal sleep structure, including increased total sleep time (Padj=0.007), decreased sleep efficiency (Padj=0.002), shortening of sleep onset latency (Padj< 0.001), elevated wake after sleep onset (Padj=0.002), increased N1% (Padj=0.006), and reduced N2%, N3%, and REM% (Padj=0.007, Padj< 0.001, Padj=0.013). Thirty-seven percent of patients had moderate to severe obstructive sleep apnea-hypopnea syndrome. And sixty percent of patients were complicated with REM sleep without atonia. Patients with NT1 displayed increased anxiety propensity (Padj< 0.001), and increased brain fatigue (Padj=0.020) in brain function state monitoring. FSS scores were positively correlated with brain fatigue (Padj< 0.001) and mean sleep latency was inversely correlated with FSS scores and brain fatigue (Padj=0.013, Padj=0.029). Additionally, ESS scores and brain fatigue decreased after 3 months of therapy (P=0.012, P=0.030).Conclusion: NT1 patients had abnormal nocturnal sleep structures, who showed increased anxiety, depression, and fatigue. Excessive daytime sleepiness and fatigue improved after 3 months of treatment with methylphenidate hydrochloride prolonged-release tablets in combination with venlafaxine.Keywords: narcolepsy, sleep structure, excessive daytime sleepiness, anxiety, depression, fatigue

Objective To investigate the relationship between cognitive impairment and sleep parameters in acute ischemic stroke patients with obstructive sleep apnea (OSA). Methods A total of 343 patients with acute ischemic stroke and OSA were selected. The cognitive function was assessed using the simple mental state examination scale (MMSE). Patients were divided into the stroke with OSA and cognitive impairment group (MMSE＜27 points, n=119) and the stroke with OSA without cognitive impairment group (MMSE≥27 points, n=224). General data, TOAST etiological classification and distribution of cerebral infarction lesions were collected. The intelligent sleep monitoring system was used to calculate apnea hypopnea index (AHI) and evaluate OSA. Objective sleep monitoring parameters were collected at night. Sleep monitoring was conducted within 24 h of admission and continuous monitoring for≥3 nights. Continuous monitoring duration ≥7 h every night to obtain night sleep structure parameters. Multifactor Logistics regression was used to analyze the relationship between cognitive impairment and sleep parameters in stroke patients with OSA. Results Compared with the stroke with OSA without cognitive impairment group, the proportion of age, diabetes history and HHcy history, the proportion of patients with infarct lesions located in frontal, temporal, parietal, occipital, thalamus, basal ganglia, brainstem and hemioval center increased in the stroke with OSA and cognitive impairment group, and the number of years of education decreased, the number of waking times, the proportion of light sleep and AHI increased, the nighttime sleep efficiency and deep sleep period decreased (P＜0.05). Logistics regression analysis showed that after controlling for years of education, age and other interference factors, nighttime sleep efficiency and AHI were strongly associated with cognitive impairment in acute ischemic stroke patients with OSA (P＜0.05). The increased nighttime sleep efficiency was protective factor for cognitive impairment, and increased AHI was risk factor for cognitive impairment. Conclusion Cognitive impairment in acute ischemic stroke patients with OSA is closely related to sleep parameters, in which the increased sleep efficiency at night is a protective factor for cognitive impairment, and the increased AHI is a risk factor. [ABSTRACT FROM AUTHOR]

We performed a matched-pair analysis of the content of GDF11 and GDF15 proteins in the plasma of patients (56 middle-aged men) with obstructive sleep apnea syndrome (OSAS) and healthy volunteers (27 men with no complaints of sleep disorders). The groups were comparable in terms of age and presence of chronic diseases. No statistically significant differences in GDF11 content in the studied groups were revealed, while the content of GDF15 in the OSAS group was 1.3 times higher. These results require further research from the viewpoint of geriatric somnology and molecular biology [ABSTRACT FROM AUTHOR]

BACKGROUND: Identifying children with sleep-disordered breathing (SDB) and treating them early is essential. This study was conducted to determine the structure of sleep in children with obstructive sleep apnea (OSA). METHODS: This cross-sectional, retrospective-descriptive study was performed in the sleep center of Qods Hospital, Qazvin City, Iran, from April 2017 to June 2021. Using simple random sampling, 46 children and adolescents aged 2-12 years, who underwent polysomnography, were selected. Electroencephalography (EEG), chin and limbs electrooculography (EOG) and electromyography (EMG), and electrocardiogram (ECG) electrodes were implanted. The information recorded using polysomnography were interpreted manually according to the standards of the American Academy of Sleep Medicine (AASM). Due to the quality of the data, frequency distribution tables were used to analyze the data. RESULTS: Among the 33 patients with OSA included in the study, 24 (72.72%) patients had severe OSA and 9 (27.3%) patients had moderate OSA. The mean of respiratory disorders in each patient included: 6.73% central apnea, 58.92% obstructive apnea, 3.87% mixed apnea, and 30.45% hypopnea. The average total sleep time (TST) was 6 hours and 47 minutes. Furthermore, the mean hypopnea apnea index (AHI) was 30.86 per hour. Sleep structure consisted of 9.03% stage N1, 51.33% stage N2, 23.18% stage N3, and 14.39% rapid eye movement sleep (REM). Sleep efficiency was estimated to be 79.57% CONCLUSION: Sleep apnea-disordered breathing including severe OSA, moderate apnea, central apnea, obstructive apnea, and mixed apnea-hypopnea were observed in the studied children.

Objective To evaluate the consistency of multiple parameters between the Micro-Motion-Sensitive Mattress Sleep Monitoring System (MSMSMS) and polysomnography (PSG) in the diagnosis of obstructive sleep apnea (OSA) and sleep assessment. Methods Sixty-seven subjects suspected of having OSA underwent PSG and MSMSMS simultaneously to record multiple sleep parameters. The consistency between PSG and MSMSMS in the diagnosis and grading of OSA, as well as the consistency in respiratory events, blood oxygen events, sleep basic information, and sleep structure parameters, was compared. Paired t-test, Bland-Altman analysis, and intraclass correlation coefficient (ICC) were used for continuous data, and weighted kappa analysis was used for categorical data. Results Compared with PSG, the areas under the curve for diagnosing mild, moderate, and severe OSA were 1,0. 999,and 0. 967, respectively (P ＜0. 001); the weighted kappa coefficient for the two diagnostic results was 0. 841 (95% CI: 0. 766-0. 928,P ＜ 0. 001). The intraclass correlation coefficients of the apnea-hypopnea index (AHI), apnea index (AI), and blood oxygen indexes were 0. 967 (0. 943,0. 980), 0. 937 (0. 900,0. 961), and 0. 900 (0. 837,0. 939), respectively, and 0. 936 (0. 891,0. 962). Except for the hypopnea index (HI) [0. 181（-0. 032,0. 387), P = 0. 036], there was high consistency in the interpretation of other respiratory events and blood oxygen indexes (P ＜ 0. 001). There was a moderate level of consistency between the two methods in the interpretation of sleep structure, including the proportion and time of light sleep and the time of deep sleep. Conclusion MSMSMS has high sensitivity and specificity in the diagnosis and grading of OSA compared with PSG. In addition to strong consistency in respiratory events and blood oxygen indexes, MSMSMS also has certain significance in evaluating the sleep structure of OSA patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to evaluate the quantitative relationship between Oxygen Desaturation Index (ODI) and sleep structure of obstructive sleep apnea (OSA) and cardiac remodeling. Methods: In this study, patients were enrolled from January 2015 to October 2022, and were divided into 3 groups according to AHI: patients with AHI < 15, patients with 15 ≤ AHI < 30, and 260 patients with AHI ≥ 30. Stratified linear regression was used to analyze independent risk factors for cardiac remodeling in OSA. Results: A total of 479 patients were enrolled. We found that compared with AHI < 15 group (n = 120), the group with AHI > 30 (n = 260) had increased left atrial anteroposterior diameter, left ventricular end-diastolic internal diameter, left ventricular posterior wall thickness, right ventricular anteroposterior diameter, and interventricular septal thickness (P < 0.05). The group with 15 ≤ AHI ≤ 30 (n = 99) had increased left atrial anteroposterior diameter (P < 0.05). Multivariate linear regression revealed that N2 sleep was an independent risk factor for left ventricular posterior wall thickness, with positive correlation (p < 0.05). N3 sleep was an independent risk factor for transverse right atrial diameter and right ventricular anteroposterior diameter, with negative correlation (P < 0.05). ODI was an independent risk factor for interventricular septal thickness, with positive correlation (P < 0.05). The arousal index was an independent risk factor for increased left atrial anteroposterior diameter, with positive correlation (P < 0.05). Conclusions: Increased ODI is an independent risk factor for interventricular septal thickness, while decreased slow wave sleep is an independent risk factor for right heart remodeling in OSA. [ABSTRACT FROM AUTHOR]

Abstract Background Many patients treated for breast cancer (BC) complain about cognitive difficulties affecting their daily lives. Recently, sleep disturbances and circadian rhythm disruptions have been brought to the fore as potential contributors to cognitive difficulties in patients with BC. Yet, studies on these factors as well as their neural correlates are scarce. The purpose of the ICANSLEEP-1 (Impact of SLEEP disturbances in CANcer) study is to characterize sleep using polysomnography and its relationship with the evolution of cognitive functioning at both the behavioral and the neuroanatomical levels across treatment in BC patients treated or not with adjuvant chemotherapy. Methods ICANSLEEP-1 is a longitudinal study including BC patients treated with adjuvant chemotherapy (n = 25) or not treated with adjuvant chemotherapy (n = 25) and healthy controls with no history of BC (n = 25) matched for age (45–65 years old) and education level. The evaluations will take place within 6 weeks after inclusion, before the initiation of chemotherapy (for BC patients who are candidates for chemotherapy) or before the first fraction of radiotherapy (for BC patients with no indication for chemotherapy) and 6 months later (corresponding to 2 weeks after the end of chemotherapy). Episodic memory, executive functions, psychological factors, and quality of life will be assessed with validated neuropsychological tests and self-questionnaires. Sleep quantity and quality will be assessed with polysomnography and circadian rhythms with both actigraphy and saliva cortisol. Grey and white matter volumes, as well as white matter microstructural integrity, will be compared across time between patients and controls and will serve to further investigate the relationship between sleep disturbances and cognitive decline. Discussion Our results will help patients and clinicians to better understand sleep disturbances in BC and their relationship with cognitive functioning across treatment. This will aid the identification of more appropriate sleep therapeutic approaches adapted to BC patients. Improving sleep in BC would eventually help limit cognitive deficits and thus improve quality of life during and after treatments. Trial registration NCT05414357, registered June 10, 2022. Protocol version Version 1.2 dated March 23, 2022.

A meta-analysis was used to explore the characteristic changes in objective sleep structure of patients with mild cognitive impairment (MCI) compared with cognitively healthy older adults. PubMed, EMBAS, Cochrane Library, Scopus, and Web of Science were searched until November 2023. A literature quality evaluation was performed according to the Newcastle-Ottawa Scale, and a meta-analysis was performed by RevMan 5.3 software. Fifteen studies with 771 participants were finally included. Compared with normal control groups, patients with MCI had a decreased total sleep time by 34.44 min, reduction in sleep efficiency by 7.96 %, increased waking after sleep onset by 19.61 min, and increased sleep latency by 6.97 min. Ten included studies showed that the patients with MCI had increased N1 sleep by 2.72 % and decreased N3 sleep by 0.78 %; however, there was no significant difference between the MCI and control groups in percentage of N2 sleep. Moreover, Twelve included studies reported the MCI groups had shorter REM sleep of 2.69 %. Our results provide evidence of abnormal sleep architecture in patients with MCI. As a "plastic state," abnormal sleep architecture may be a promising therapeutic target for slowing cognitive decline and dementia prevention. • A meta-analysis was conducted to compare sleep structure between MCI and the cognitively healthy older adults. • Our results provide evidence of abnormal sleep architecture in patients with MCI. • As a "plastic state", abnormal sleep architecture may be a promising therapeutic target for slowing cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Many patients treated for breast cancer (BC) complain about cognitive difficulties affecting their daily lives. Recently, sleep disturbances and circadian rhythm disruptions have been brought to the fore as potential contributors to cognitive difficulties in patients with BC. Yet, studies on these factors as well as their neural correlates are scarce. The purpose of the ICANSLEEP-1 (Impact of SLEEP disturbances in CANcer) study is to characterize sleep using polysomnography and its relationship with the evolution of cognitive functioning at both the behavioral and the neuroanatomical levels across treatment in BC patients treated or not with adjuvant chemotherapy. Methods: ICANSLEEP-1 is a longitudinal study including BC patients treated with adjuvant chemotherapy (n = 25) or not treated with adjuvant chemotherapy (n = 25) and healthy controls with no history of BC (n = 25) matched for age (45–65 years old) and education level. The evaluations will take place within 6 weeks after inclusion, before the initiation of chemotherapy (for BC patients who are candidates for chemotherapy) or before the first fraction of radiotherapy (for BC patients with no indication for chemotherapy) and 6 months later (corresponding to 2 weeks after the end of chemotherapy). Episodic memory, executive functions, psychological factors, and quality of life will be assessed with validated neuropsychological tests and self-questionnaires. Sleep quantity and quality will be assessed with polysomnography and circadian rhythms with both actigraphy and saliva cortisol. Grey and white matter volumes, as well as white matter microstructural integrity, will be compared across time between patients and controls and will serve to further investigate the relationship between sleep disturbances and cognitive decline. Discussion: Our results will help patients and clinicians to better understand sleep disturbances in BC and their relationship with cognitive functioning across treatment. This will aid the identification of more appropriate sleep therapeutic approaches adapted to BC patients. Improving sleep in BC would eventually help limit cognitive deficits and thus improve quality of life during and after treatments. Trial registration: NCT05414357, registered June 10, 2022. Protocol version: Version 1.2 dated March 23, 2022. [ABSTRACT FROM AUTHOR]

Objective　To explore the effects of paroxetine and sulpiride in the treatment of social phobia in young women and the effects on neurotransmitters and sleep structure. Methods　102 young female patients with social phobia in our hospital from February 2021 to February 2023 were selected and divided into 2 groups with 51 cases in each group by random number table method. The control group was treated with Paxil，and the study group was treated with Paxil + sulpiride for 3 months. Treatment effect，neurotransmitters [5-hydroxytryptamine（5-HT）， dopamine（ DA） ， gamma-aminobutyric acid（ GABA） ， myeloperoxidase（ MPO） ]， sleep structure， social anxiety（LASA），social fear（SPS） and social Results　The research group's overall effective rate of treatment is 88.24%，which is higher than the control group's 70.59%（P<0.05）. 1 month and 3 months after treatment，the research group's serum levels of DA and MPO are lower than those of the control group，while the levels of 5-HT and GABA are higher than those of the control group（P<0.05）. 1 month and 3 months after treatment，the research group's sleep transition frequency and the proportion of stage I + stage II are lower than those of the control group， while the proportion of stage III + stage IV and REM stage are higher than those of the control group（P<0.05）. 1 month and 3 months after treatment，the research group's LASA，SPS，and SAFE scores are lower than those of the control group（P<0.05）; The incidence of adverse events in the research group is 13.73% compared to 9.80% in the control group，with no statistically significant difference（P>0.05）. Conclusion　Paroxetine and sulpiride combined can improve the sleep structure of young women with social phobia， regulate serum neurotransmitter levels， alleviate social anxiety symptoms，improve social adaptability，and have a certain level of safety. [ABSTRACT FROM AUTHOR]

Objective To summarize the characteristics of cognitive function and sleep structure in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and to explore the correlation between them. Methods Total 73 patients with iRBD who visited Fujian Medical University Union Hospital from August 2018 to August 2021 were included, all of whom underwent neuropsychological tests and polysomnography monitoring. Pearson and partial correlation analyses were used to explore correlation between cognitive function and sleep structure parameters. Results 1) Neuropsychological tests: iRBD patients had lower Mini ⁃ Mental State Examination (MMSE; t = ⁃ 3.703, P = 0.000), Montreal Cognitive Assessment (MoCA; t = ⁃ 4.811, P = 0.000), Verbal Fluency Test (VFT)⁃number of correct words (t = ⁃ 2.171, P = 0.032) than control group. Trail Making Test (TMT)⁃A (t = 2.500, P = 0.014), TMT⁃B (t = 2.430, P = 0.016) and Stroop Color Word Test (SCWT)⁃A (t = 2.507, P = 0.013), SCWT⁃B (t = 15.042, P = 0.000), SCWT⁃ C (t = 27.228, P = 0.000) completion times were longer than control group. 2) Polysomnography monitoring: total sleep time (t = 2.699, P = 0.008), sleep efficiency (Z = ⁃ 2.103, P = 0.035), number of sleep stage transitions (t = 3.965, P = 0.000), proportion of non⁃rapid eye movement sleep stage 1 (N1 stage) to total sleep time (t = 2.887, P = 0.005), periodic limb movement of sleep index (PLMSI; t = ⁃ 2.917, P = 0.004), periodic limb movement⁃related arousal index (Z = ⁃ 2.291, P = 0.022), and total arousal index (Z = ⁃ 2.609, P = 0.009) were higher than those in control group, and the time of wakefulness after sleep was less than those in control group (t = ⁃ 2.230, P = 0.027). 3) Correlation between cognitive function and sleep structure parameters: MoCA score was negatively correlated with the percentage of N1 stage (r = ⁃ 0.184, P = 0.035), and positively correlated with the percentage of N2 stage (r = 0.173, P = 0.049); SCWT⁃B completion time was negatively correlated with the number of awakenings (r = ⁃ 0.186, P = 0.033); SCWT⁃C completion time was positively correlated with the number of sleep phase transitions (r = 0.212, P = 0.015) and the percentage of N1 stage (r = 0.181, P = 0.039); VFT⁃number of correct words was negatively correlated with the periodic limb movement of wake index (PLMWI; r = ⁃ 0.216, P = 0.018); the number of correct China⁃Rey Auditory Verbal Learning Test (C⁃RAVLT) immediate recall was positively correlated with the rapid eye movement (REM) sleep latency (r = 0.183, P = 0.045); the number of correct C⁃RAVLT delay recall was negatively correlated with the PLMWI (r = ⁃ 0.196, P = 0.032) and PLMSI (r = ⁃ 0.180, P = 0.049); the Clock Drawing Test was positively correlated with sleep latency (r = 0.192, P = 0.035) and REM sleep latency (r = 0.199, P = 0.029), and negatively correlated with the percentage of REM sleep (r = ⁃ 0.189, P = 0.038). The Beck Depression Inventory (BDI) score was positively correlated with total sleep time (r = 0.347, P = 0.000), sleep efficiency (r = 0.319, P = 0.000) and the percentage of REM sleep (r = 0.204, P = 0.026), and negatively correlated with the time of wakefulness after sleep (r = ⁃ 0.280, P = 0.002) and the percentage of N1 stage (r = ⁃ 0.299, P = 0.001). Conclusions Patients with iRBD have cognitive dysfunction mainly manifested by decreased attention, executive function and language function, and sleep structural disorders may affect the cognitive function of such patients.

Abstract Objective Sleep impairment is one of the most common comorbidities affecting people with epilepsy (PWE). The bidirectional relation between epilepsy and sleep has been widely established. Several studies investigated subjective sleep quality and daytime vigilance in PWE, highlighting frequent complaints of sleep fragmentation, difficulties in falling asleep, and daytime sleepiness. The present study aimed to evaluate sleep structure in drug‐naive PWE, distributed on the basis of epilepsy type, and compared with controls. Methods This observational study included adult patients newly diagnosed with epilepsy and drug‐naive as well as a control group of healthy subjects. All PWE and controls underwent a dynamic 24‐h EEG with signals for sleep recording to evaluate sleep architecture, structure, continuity, and fragmentation. Results Twenty‐four PWE were included and distributed in two groups based on epilepsy type. Eleven patients were included in the generalized epilepsy group (63.6% male; 34.91 ± 9.80 years) and 13 patients in the focal epilepsy group (53.8% male; 38.69 ± 12.74 years). The control group included 16 subjects (56.3% male; 32.75 ± 12.19 years). Patients with generalized or focal epilepsy had a significantly lower sleep efficiency than controls. Moreover, both patient groups presented the alteration of markers of sleep fragmentation and loss of continuity, with higher indices of sleep stage transitions and arousal. Finally, the two patient groups presented less REM sleep than controls. Significance This study highlighted the alteration of sleep quality, continuity, and stability in both patients with focal or generalized epilepsy compared with controls, also in the absence of ictal events. This sleep impairment resulted in the reduction of REM sleep. Therefore, these findings may be explained by the increase in awakenings and sleep stage shifts, which may be attributed to both sleep networks impairment and neurotransmission dysfunction in PWE, and also possibly triggered by paroxysmal interictal abnormalities.

Background: Sleep disturbance is a common non-motor symptom of Parkinson's disease (PD). Most polysomnography (PSG) studies are conducted when patients are in their "on medication" state. Our study aimed to investigate changes in the sleep structure in drug-naive PD patients with poor subjective sleep quality based on polysomnography (PSG) and to explore potential correlations between sleep structure and clinical features of the disease. Methods: A total of 44 drug-naive PD patients were included. All patients completed a standardized questionnaire to obtain demographic and clinical characteristics and underwent whole-night PSG recording. Patients with PSQI scores >5.5 were considered poor sleepers, and patients with PSQI scores <5.5 were considered to be good sleepers. Results: There were 24 (54.5%) PD patients in the good sleeper group and 20 (24.5%) PD patients in the poor sleeper group. We observed that poor sleepers had severe non-motor symptoms (NMS) and worse life quality. The PSG displayed that they had a longer wake-up time after sleep onset (WASO) and lower sleep efficiency (SE). Correlation analysis revealed that the micro-arousal index was positively associated with UPDRS-III, and the N1 sleep percentage was negatively associated with the NMS score in good sleepers. For poor sleepers, rapid eye movement (REM) sleep percentage was negatively related to the Hoehn-Yahr (H-Y) stage, WASO increased with UPDRS-III, periodic limb movement index (PLMI) increased with the NMS score, and N2 sleep percentage was negatively related to the score of life quality. Conclusion: Night awakening is the main manifestation of decreased sleep quality in drug-naive PD patients. Poor sleepers have severe non-motor symptoms and poor life quality. Additionally, the increase in nocturnal arousal events may predict the progression of motor dysfunction. [ABSTRACT FROM AUTHOR]

Background Sleep disorder is a common complication of stroke with various clinical manifestations. Among them, periodic limb movements in sleep (PLMS) are characterized by repetitive and stereotyped limb movements during sleep. Due to limited clinical date, the pathogenesis of PLMS and their impact on prognosis of stroke are still in the exploratory stage. Studies about the effect of PLMS on sleep in stroke patients are few in worldwide. Objective To explore the sleep structure of stroke patients with PLMS. Methods From December 2020 to February 2022, a total of 81 stroke patients with sleep disorders were selected from the Second Affiliated Hospital of Zhengzhou University, in which polysomnography (PSG) was performed. The clinical information and PSG sleep monitoring data of patients were collected. According to the Periodic Limb Movement Index (PLMI) , the patients were divided into non-PLMS patients (control group, PLMI0.05) . The results of Spearman rank correlation analysis showed that PLMS was positively correlated with awake PLMI, proportion of stage N2 sleep in total sleep time, sleep latency, arousal index, and PLMAI (rs values were 0.619, 0.250, 0.271, 0.312, 0.828, respectively; P values were

Objective: To analyze the characteristics of sleep structure and its correlation with cognitive impairment in early Alzheimer’s disease(AD) patients by assessing cognitive function and polysomnography. Methods: Eighty-eight elderly patients who underwent polysomnography were retrospectively analyzed and enrolled. According to the presence or absence of cognitive impairment, 39 patients were in the control group with a total score of montreal cognitive assessment (MoCA) score more than or equal to 26, 49 patients were in the AD group, with a total MoCA score less than 26 and a clinical dementia rating scale (CDR) score=0.5. Pearson correlation analysis and Spearman rank correlation analysis were used to explore the sleep structure characteristics of the early AD patients and its correlation with cognitive impairment. Results: Compared with the control group, the early AD group had statistically significant differences in MoCA, CDR, Hamilton Depression Scale (HAMD), micro perception index, non-rapid eye movement(NREM)/total sleep time (TST)%, N4 stage (N4)/TST% and REM /TST% (P

Objective: Polysomnographic findings in neurodevelopmental disorders have been reported, but previous studies have had several limitations. The purpose of this study was to characterize sleep structure in untreated adults diagnosed with ADHD, excluding ADHD-related sleep disorders as determined by polysomnography and multiple sleep latency testing. Methods: This study included 55 patients aged 18 years or older who visited the Kurume University Hospital Sleep Clinic between April 2015 and March 2020. The diagnosis of ADHD was determined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (ADHD group, n = 28; non-ADHD, n = 27). Results: The ADHD group had significantly longer slow wave sleep (SWS) duration than the non-ADHD group (ADHD: 68.3 ± 31.0 minutes vs. non-ADHD: 43.4 ± 36.6 minutes; p =.0127). Conclusions: The increased SWS volume observed in drug-naïve adult patients with ADHD may be related to the pathogenesis of this disorder. [ABSTRACT FROM AUTHOR]

Objective: Sleep impairment is one of the most common comorbidities affecting people with epilepsy (PWE). The bidirectional relation between epilepsy and sleep has been widely established. Several studies investigated subjective sleep quality and daytime vigilance in PWE, highlighting frequent complaints of sleep fragmentation, difficulties in falling asleep, and daytime sleepiness. The present study aimed to evaluate sleep structure in drug‐naive PWE, distributed on the basis of epilepsy type, and compared with controls. Methods: This observational study included adult patients newly diagnosed with epilepsy and drug‐naive as well as a control group of healthy subjects. All PWE and controls underwent a dynamic 24‐h EEG with signals for sleep recording to evaluate sleep architecture, structure, continuity, and fragmentation. Results: Twenty‐four PWE were included and distributed in two groups based on epilepsy type. Eleven patients were included in the generalized epilepsy group (63.6% male; 34.91 ± 9.80 years) and 13 patients in the focal epilepsy group (53.8% male; 38.69 ± 12.74 years). The control group included 16 subjects (56.3% male; 32.75 ± 12.19 years). Patients with generalized or focal epilepsy had a significantly lower sleep efficiency than controls. Moreover, both patient groups presented the alteration of markers of sleep fragmentation and loss of continuity, with higher indices of sleep stage transitions and arousal. Finally, the two patient groups presented less REM sleep than controls. Significance: This study highlighted the alteration of sleep quality, continuity, and stability in both patients with focal or generalized epilepsy compared with controls, also in the absence of ictal events. This sleep impairment resulted in the reduction of REM sleep. Therefore, these findings may be explained by the increase in awakenings and sleep stage shifts, which may be attributed to both sleep networks impairment and neurotransmission dysfunction in PWE, and also possibly triggered by paroxysmal interictal abnormalities. [ABSTRACT FROM AUTHOR]

Background: Sleep quality disturbances are frequent in adults with type 1 diabetes. However, the possible influence of sleep problems on glycemic variability has yet to be studied in depth. This study aims to assess the influence of sleep quality on glycemic control. Materials and methods: An observational study of 25 adults with type 1 diabetes, with simultaneous recording, for 14 days, of continuous glucose monitoring (Abbott FreeStyle Libre system) and a sleep study by wrist actigraphy (Fitbit Ionic device). The study analyzes, using artificial intelligence techniques, the relationship between the quality and structure of sleep with time in normo-, hypo-, and hyperglycemia ranges and with glycemic variability. The patients were also studied as a group, comparing patients with good and poor sleep quality. Results: A total of 243 days/nights were analyzed, of which 77% (n = 189) were categorized as poor quality and 33% (n = 54) as good quality. Linear regression methods were used to find a correlation (r =0.8) between the variability of sleep efficiency and the variability of mean blood glucose. With clustering techniques, patients were grouped according to their sleep structure (characterizing this structure by the number of transitions between the different sleep phases). These clusters showed a relationship between time in range and sleep structure. Conclusions: This study suggests that poor sleep quality is associated with lower time in range and greater glycemic variability, so improving sleep quality in patients with type 1 diabetes could improve their glycemic control. [ABSTRACT FROM AUTHOR]

The ellipsoid body (EB) is a major structure of the central complex of the Drosophila melanogaster brain. Twenty-two subtypes of EB ring neurons have been identified based on anatomic and morphologic characteristics by light-level microscopy and EM connectomics. A few studies have associated ring neurons with the regulation of sleep homeostasis and structure. However, cell type-specific and population interactions in the regulation of sleep remain unclear. Using an unbiased thermogenetic screen of EB drivers using female flies, we found the following: (1) multiple ring neurons are involved in the modulation of amount of sleep and structure in a synergistic manner; (2) analysis of data for DP(doze)/DP(wake) using a mixed Gaussian model detected 5 clusters of GAL4 drivers which had similar effects on sleep pressure and/or depth: lines driving arousal contained R4m neurons, whereas lines that increased sleep pressure had R3m cells; (3) a GLM analysis correlating ring cell subtype and activity-dependent changes in sleep parameters across all lines identified several cell types significantly associated with specific sleep effects: R3p was daytime sleep-promoting, and R4m was nighttime wake-promoting; and (4) R3d cells present in 5HT7-GAL4 and in GAL4 lines, which exclusively affect sleep structure, were found to contribute to fragmentation of sleep during both day and night. Thus, multiple subtypes of ring neurons distinctively control sleep amount and/or structure. The unique highly interconnected structure of the EB suggests a local-network model worth future investigation; understanding EB subtype interactions may provide insight how sleep circuits in general are structured. [ABSTRACT FROM AUTHOR]

Objective: To investigate the differences of serum neuropeptide Y (NPY), heat shock protein 70 (HSP-70) and γ-aminobutyric acid (GABA) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) with different conditions, and to analyze their correlation with sleep structure parameters and the risk factors of cognitive dysfunction in patients with OSAHS. Methods: 122 patients with OSAHS who were admitted to Nanjing Jiangbei Hospital Affiliated to Nantong University and Jiangsu Provincial People's Hospital from March 2019 to March 2022 were selected. According to the sleep apnea hypopnea index (AHI) and the lowest oxygen saturation (SPO2) at night, patients with OSAHS were divided into mild group with 32 cases, moderate group with 54 cases and severe group with 36 cases. According to the Montreal Cognitive Assessment Scale (MoCA), they were divided into cognitive dysfunction group (less than 26 scores, 71 cases) and normal cognitive function group (greater than or equal to 26 scores, 51 cases). The serum NPY, HSP-70, GABA levels were detected. Pearson correlation analysis was performed to analyze the correlation between serum NPY, HSP-70, GABA and sleep structure parameters in patients with OSAHS. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of cognitive dysfunction in OSAHS. Results: The serum NPY, HSP-70 levels, times of fast wave sleep, times of awakening after falling asleep and percentage of fast wave sleep in the severe group were higher than those in the moderate group and mild group (P＜0.05), while the serum GABA level, times of slow wave sleep and percentage of slow wave sleep were lower than those in the moderate group and mild group (P＜0.05). The serum NPY and HSP-70 levels in patients with OSAHS were positively correlated with the times of fast wave sleep, the times of awakening after falling asleep and the percentage of fast wave sleep (P＜0.05), and negatively correlated with the times of slow wave sleep and the percentage of slow wave sleep (P＜0.05). The serum GABA level was negatively correlated with the times of fast wave sleep, the times of awakening after falling asleep and the percentage of fast wave sleep (P＜0.05), and positively correlated with the times of slow wave sleep and the percentage of slow wave sleep (P＜0.05). Severe OSAHS, increased times of awakening after falling asleep, NPY (increased) and HSP-70 (increased) were risk factors for cognitive dysfunction in patients with OSAHS (P＜0.05), while GABA (increased) was a protective factor (P＜0.05). Conclusion: The increased serum NPY and HSP-70 levels and the decreased GABA level are associated with sleep structure disorder and cognitive dysfunction in patients with OSAHS. The detection of serum NPY, HSP-70 and GABA can assist in evaluating sleep and cognitive function of patients. [ABSTRACT FROM AUTHOR]

Automatic algorithms are a proposed alternative to manual assessment of polysomnography data for analyzing sleep structure; however, none are acceptably accurate for clinical use. We investigated the feasibility of an automated sleep stage scoring system called Sleep Scope, which is intended for use with portable 1-channel electroencephalograph, and compared it with the traditional polysomnography scoring method. Twenty-six outpatients and fourteen healthy volunteers underwent Sleep Scope and polysomnography assessments simultaneously. Polysomnography records were manually scored by three sleep experts. Sleep Scope records were scored using a dedicated auto-staging algorithm. Sleep parameters, including total sleep time, sleep latency, wake after sleep onset, and sleep efficiency, were calculated. The epoch-by-epoch pairwise concordance based on the classification of sleep into five stages (i.e., wake, rapid eye movement, N1, N2, and N3) was also evaluated after validating homogeneity and bias between Sleep Scope and polysomnography. Compared with polysomnography, Sleep Scope seemed to overestimate sleep latency by approximately 3 min, but there was no consistent tendency in bias in other sleep parameters. The Κ values ranged from 0.66 to 0.75 for experts' inter-rater polysomnography scores and from 0.62 to 0.67 for Sleep Scope versus polysomnography scores, which indicated sufficient agreement in the determination of sleep stages based on the Landis and Koch criteria. We observed sufficient concordance between Sleep Scope and polysomnography despite lower concordance in sleep disorder patients. Thus, this auto-staging system might serve as a novel clinical tool for reducing the time and expenses required of medical staff and patients. [ABSTRACT FROM AUTHOR]

The restorative function of sleep is shaped by its duration, timing, continuity, subjective quality, and efficiency. Current sleep recommendations specify only nocturnal duration and have been largely derived from sleep self-reports that can be imprecise and miss relevant details. Sleep duration, preferred timing, and ability to withstand sleep deprivation are heritable traits whose expression may change with age and affect the optimal sleep prescription for an individual. Prevailing societal norms and circumstances related to work and relationships interact to influence sleep opportunity and quality. The value of allocating time for sleep is revealed by the impact of its restriction on behavior, functional brain imaging, sleep macrostructure, and late-life cognition. Augmentation of sleep slow oscillations and spindles have been proposed for enhancing sleep quality, but they inconsistently achieve their goal. Crafting bespoke sleep recommendations could benefit from large-scale, longitudinal collection of objective sleep data integrated with behavioral and self-reported data. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the effects of modified Chaihu Shugan powder combined with acupoint application on sleep and emotions in patients with sleep disorder of liver-depression and qi-stagnation. METHODS: A total of 100 patients with sleep disorder of liver-depression and qi-stagnation admitted into Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from Jun. 2020 to Jun. 2021 were selected and randomly divided into control group (dexzopiclone tablets) and observation group (modified Chaihu Shugan powder combined with acupoint application), with 50 cases in each group and observed for 3 months. Scores of Self Rating Scale of Sleep (SRSS), Pittsburgh Sleep Quality Index (PSQI), polysomnogram, Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were compared between two groups, and the correlation were analyzed. RESULTS: The total effective rate of the observation group was 90. 0% (45/50), which was significantly higher than that of the control group (74. 0%, 37/50), with statistically significant difference (P<0. 05). The PSQI score of the observation group after 2 weeks of treatment were significantly lower than that of the control group (P<0. 01), the SRSS score of the observation group after 4 weeks of treatment were significantly lower than that of the control group (P<0. 05), with statistically significant differences. Compared with the control group, the total sleep time, REM sleep latency, N2 and N3 stage sleep times of the observation group were significantly prolonged, the proportion and efficiency of N3 stage sleep were significantly increased; the sleep latency and wake time of the observation group were significantly shortened, the proportions of N1 and N2 stage sleep were significantly decreased, with statistically significant differences (P<0. 05). The HAMD and HAMA scores were significantly negatively correlated with the total sleep time and N3 stage sleep, and significantly positively correlated with PSQI score. CONCLUSIONS: The combination of modified Chaihu Shugan powder with acupoint application has better overall improvement on subjective sleep quality, objective sleep structure and sleep process in patients with sleep disorder of liver-depression and qi-stagnation, and can alleviate patients’ anxiety and depression, improve their sleep quality. Sleep disorders are correlated with patients’ anxiety and depression status. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is often accompanied by sleep disturbances, impacting patients' quality of life. While repetitive transcranial magnetic stimulation (rTMS) shows promise in improving self-reported sleep quality, its effects on objective sleep architecture in PD remain understudied. Sleep disturbances, including rapid eye movement (REM) and slow-wave sleep disturbances, correlate with cognitive decline and motor symptoms. This study investigated the effect of low-frequency rTMS targeting the right dorsolateral prefrontal cortex (DLPFC) modifying objective sleep architecture and explored symptom improvement mechanisms in PD patients. In this randomized, double-blind, sham-controlled trial, 67 PD patients received 10 consecutive days of 1-Hz rTMS over the right DLPFC. Polysomnography assessed sleep microstructure, while electroencephalogram recordings evaluated power spectral density and sleep spindle activity. Clinical scales measured sleep quality, motor symptoms, and cognition at baseline, post-treatment, and 3 months post-rTMS. The rTMS group exhibited improvements in sleep quality, motor symptoms, and cognition post-treatment, persisting at the 3-month follow-up. There was a notable increase in the REM sleep proportion post-rTMS. The rTMS group exhibited elevated low-frequency (0.5–2 Hz) slow-wave electroencephalogram spectral density during non-REM sleep. Cognitive enhancement correlated with increased lower delta power, while motor symptom progression correlated with spindle frequency and slow-wave sleep percentage changes. Low-frequency rTMS targeting the right DLPFC holds promise for improving clinical symptoms and modulating sleep architecture in PD. These findings suggest a link between symptom improvement and sleep structure enhancement, highlighting the need for further investigation into the therapeutic potential of rTMS in PD management. • Low frequency repetitive transcranial magnetic stimulation over the right dorsolateral prefrontal cortex can improve sleep quality, and adjust sleep structure reflected on the change of rapid eye movement sleep and low-frequency slow wave during non-rapid eye movement sleep. • The increase of lower delta power during non-rapid eye movement sleep was found to correlate with the improvement of cognition in the active group. • The progress of motor symptoms was significantly correlated with the increase in spindle frequency and percentage of slow-wave sleep. [ABSTRACT FROM AUTHOR]

BackgroundSleep quality disturbances are frequent in adults with type 1 diabetes. However, the possible influence of sleep problems on glycemic variability has yet to be studied in depth. This study aims to assess the influence of sleep quality on glycemic control.Materials and methodsAn observational study of 25 adults with type 1 diabetes, with simultaneous recording, for 14 days, of continuous glucose monitoring (Abbott FreeStyle Libre system) and a sleep study by wrist actigraphy (Fitbit Ionic device). The study analyzes, using artificial intelligence techniques, the relationship between the quality and structure of sleep with time in normo-, hypo-, and hyperglycemia ranges and with glycemic variability. The patients were also studied as a group, comparing patients with good and poor sleep quality.ResultsA total of 243 days/nights were analyzed, of which 77% (n = 189) were categorized as poor quality and 33% (n = 54) as good quality. Linear regression methods were used to find a correlation (r =0.8) between the variability of sleep efficiency and the variability of mean blood glucose. With clustering techniques, patients were grouped according to their sleep structure (characterizing this structure by the number of transitions between the different sleep phases). These clusters showed a relationship between time in range and sleep structure.ConclusionsThis study suggests that poor sleep quality is associated with lower time in range and greater glycemic variability, so improving sleep quality in patients with type 1 diabetes could improve their glycemic control.

Objective: Changes in sleep architecture following ischemic stroke have been poorly investigated. Our objective was to explore changes of sleep structure in patients with ischemic stroke or transient ischemic attack in order to verify a possible predictive value of sleep with respect to clinical outcome.Methods: Patients recruited in the prospective SAS-CARE study received two polysomnographies (PSG) in the acute and chronic phases after stroke/TIA. Sleep parameters were compared between the two time-points and matched with a non-stroke population randomly selected from the HypnoLaus cohort.Results: Of the 169 patients investigated with PSG in the acute phase, 104 were again studied 3 months after stroke symptom onset and compared with 162 controls. The acute phase of stroke/TIA was associated with sleep disruption, which significantly improved in the chronic phase, but remained worse than controls (total sleep time improve from 318.8 ± 90.8 to 348.4 ± 81.5 min, compared to 388.2 ± 71.3 in controls, sleep latency from 49.9 ± 58.4 to 27.9 min, compared to 20.2 ± 22 in controls, sleep efficiency from 58.2 ± 18.1% to 27.9 ± 36.4 min, compared to 83.4 ± 10.3% in controls, wakefulness after sleep onset percentage from 36.5 ± 17.3 to 29.3 ± 15.6, compared to 13.2 ± 9.2 in controls). The percentage of REM sleep was negatively associated with stroke severity, whereas stroke topography did not correlate with sleep parameters.Conclusions: This study confirmed a severe sleep disruption in the acute phase of stroke. Although a significant improvement of sleep quality was observed during the three months after stroke, sleep architecture did not normalize. In particular, sleep efficiency and REM sleep seem to be particularly affected by stroke in the acute phase, with a relative preservation of NREM sleep. We suggest that these sleep architecture changes represent a persistent marker of brain damage due to stroke. Further studies are needed to assess the relationship with stroke topographic and outcome. [ABSTRACT FROM AUTHOR]

We report the polysomnography findings of a 2‐year‐old girl who was previously diagnosed with CCHS and treated with bilevel positive airway pressure (BiPAP) and O2 supplementation for a year. The girl had convulsions 2 times in the last 10 days. After we replaced her nasal cannula with a nasal mask and adjusted the parameters of the BiPAP, her sleep and ventilation were improved. The polysomnographies measured under spontaneous breathing without oxygen supplementation showed that her sleep structure, heart rate, and oxygen saturation during sleep were improved 1 month and 1 year after effective BiPAP treatment. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of electroacupuncture (EA) on sleep quality, sleep structure, and cognitive function in patients with insomnia related to cerebral infarction, and to explore the brain effect mechanism of EA on insomnia related to cerebral infarction., Methods: Thirty-six patients with insomnia related to cerebral infarction were randomly divided into an EA group (18 cases, 1 case was eliminated and 1 case dropped out) and a sham acupuncture group (18 cases, 1 case was eliminated and 2 cases dropped out). Both groups received conventional treatment for cerebral infarction. The EA group received EA at Sishencong (EX-HN 1) with continuous waves at a frequency of 2 Hz, at an intensity tolerable to the patient. The sham acupuncture group received sham acupuncture at non-acupoints with the same EA parameters but electrical stimulation was interrupted after 30 s. Both groups were treated for 20 min each session, once daily, 5 days per week, for a total of 4 weeks. Pittsburgh sleep quality index (PSQI), Montreal cognitive assessment-basic (MoCA-B) scores, and short-term memory (STM) encoding test accuracy and average reaction time were observed before and after treatment in the two groups. Polysomnography (PSG) was used to evaluate sleep structure, and electroencephalogram (EEG) data were collected to observe the standardized power value of the Theta frequency band before and after treatment., Results: Compared with before treatment, PSQI score was decreased and MoCA-B score was increased in the EA group after treatment ( P <0.001); the EA group had lower PSQI score and higher MoCA-B score than those in the sham acupuncture group ( P <0.001, P <0.01). Compared with before treatment, STM encoding test accuracy was increased and average reaction time was shortened in the EA group after treatment ( P <0.01, P <0.001); sleep efficiency (SE) was increased ( P <0.01), total sleep time (TST), REM, and N3 stages were prolonged ( P <0.01, P <0.05), and sleep latency (SL) was shortened ( P <0.01). The standardized power value of the Theta frequency band in EEG channels F3, C3, C4, O1 and O2 was decreased ( P <0.05). After treatment, the EA group had higher STM encoding test accuracy, shorter average reaction time ( P <0.05), higher SE ( P <0.01), longer TST, REM and N3 stages ( P <0.01), and shorter SL ( P <0.01) than those in the sham acupuncture group. There was no statistically significant difference in the standardized power value of the Theta frequency band between the two groups ( P >0.05)., Conclusion: EA could regulate sleep quality and structure in patients with insomnia related to cerebral infarction, and improve cognitive function, possibly related to the reduction of slow-wave activity in EEG.

Background: Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes., Objectives: To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA., Design: A pilot randomized, double-blind, placebo-controlled trial., Setting: A tertiary university hospital in Beijing, China., Patients: One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28 mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022., Intervention: After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02 μg/kg/h) or placebo. We monitored polysomnogram from 9:00 pm to 6:00 am during the first night., Main Outcome Measures: Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0-100 score range, higher score better)., Results: All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p  = 0.029); it also decreased the percentage of stage N1 sleep (median difference, -10%; 95% CI, -20% to -1%; p  = 0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p  = 0.060). Adverse events were similar between groups., Conclusion: Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events., Clinical Trial Registration: Clinicaltrials.gov, identifier NCT04608331., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sun, Liang, Chen, Ma, Zhang, Shen, Zhu and Wang.)

Abstract We report the polysomnography findings of a 2‐year‐old girl who was previously diagnosed with CCHS and treated with bilevel positive airway pressure (BiPAP) and O2 supplementation for a year. The girl had convulsions 2 times in the last 10 days. After we replaced her nasal cannula with a nasal mask and adjusted the parameters of the BiPAP, her sleep and ventilation were improved. The polysomnographies measured under spontaneous breathing without oxygen supplementation showed that her sleep structure, heart rate, and oxygen saturation during sleep were improved 1 month and 1 year after effective BiPAP treatment.

The purpose of this paper is to review the research progress on the effects of obstructive sleep apnea （OSA） on memory consolidation， and to speculate on possible mechanisms underlying these effects， so as to inform the exploration of effective therapeutic measures for impaired memory consolidation. Previous studies have shown that mild OSA may impair different types of memory consolidation， and the impairments are closely related to certain indices of polysomnography （such as sleep microstructure， apnea hypopnea index， arousal index， etc）. Therefore， it is hypothesized that disruption of sleep architecture and damage to brain regions and neural pathways associated with sleep-dependent memory consolidation due to intermittent hypoxia may trigger a decline in memory consolidation. Meantime， long-term continuous positive airway pressure can alleviate the impairment of memory consolidation induced by OSA， but whether other interventions can mitigate the damage remains unclear.

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

The sleep quality of lowlanders in hypoxic environments has become increasingly important with an increase in highland and alpine activities. This study aimed to identify the effects of acute exposure to hypoxia on the sleep structure of lowlanders and to analyze the changes in sleep indicators at varying levels of hypoxia. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-three studies were screened and included in the quantitative analysis. The results showed that acute exposure to hypoxia reduced sleep quality in lowlanders. Post-sleep arousal events and the percentage of N1 were significantly increased, whereas total sleep time, sleep efficiency, and the percentage of N3 and rapid eye movement sleep were significantly decreased in hypoxic environments. Acute exposure to hypoxia had the greatest negative impact on wakefulness after sleep onset (WASO). In addition, a larger decrease in sleep efficiency and higher increase in the percentages of N1 and WASO were observed when lowlanders were exposed to higher levels of hypoxia. This study clarifies the quantitative effects of acute hypoxic exposure on sleep in lowlanders based on original studies and explains the sleep disorders faced by lowlanders in hypoxic environments. [ABSTRACT FROM AUTHOR]

Our study aimed to assess functional, structural changes of the right ventricular using strain parameters and sleep structure using polysomnography in patients with obstructive sleep apnea (OSA). Our study group consisted of 43 patients, 29 men, 14 women. The mean age was 56.36 ± 14.77. All patients underwent full night polysomnography and transthoracic echocardiography. The right ventricular global longitudinal strain was measured by 2D speckle-tracking echocardiography. The prevalence of OSA (AHI ≥ 5) was 76.7% in the studied group. We observed a significant positive correlation between OAH and average free wall strain (r = 0.37), snore and mid-free wall strain (r = 0.34), average HR, and basal free wall strain (r = 0.34). Moreover, CSB was positively correlated with basal septal strain and mid septal strain (r = 0.36 and 0.42). In summary, among patients with sleep disorders, functional disorders of the right ventricle, assessed using the strain method, are partly observed. [ABSTRACT FROM AUTHOR]

Close links between epilepsy and sleep is doubtless; however, the available literature does not allow for its unequivocal interpretation from the common pathophysiological mechanisms' perspective. GABAergic neuronal deficiency is believed to be the neurochemical background of the intimate mechanisms of sleep and epileptogenesis. Sleep impacts the epileptiform activity, with an increase in epileptiform discharge during NREM and a decrease during REM phases. Sleep deprivation may complicate the course of epilepsy, while epileptic attacks may change the sleep structure and quality. Anti-epileptic agents exert diverse effects on the sleep architectonics; they can induce sedation or increase alertness. Our potential to correct the results of the pathological interplay between sleep mechanisms and epilepsy are rather limited and are frequently overestimated by clinicians. Investigation of the interrelationship between epileptic seizures and sleep and the use of polysomnography can substantially add to the diagnosis of the epileptic syndrome and define the subsequent outcomes.

Objectives: Existing data suggest that smoking may be associated with sleep disturbances. This study aimed to determine the association between smoking and both subjective and objective sleep quality.Methods: Cross-sectional analysis of sleep characteristics in 3233 participants from the population-based CoLaus-HypnoLaus cohort (52.2% women, mean age 56.6 ± 10.2 years) who completed questionnaires on sleep quality, of whom 1489 (46%) had a full polysomnography. Smoking data were self-reported; participants were classified by smoking status as current, former or never smokers. Primary outcomes were subjective sleep quality assessed by sleep questionnaires, and objective sleep quality based on polysomnography (sleep macrostructure), including power spectral analysis of the electroencephalogram on C4 electrode (sleep microstructure), quantifying the relative amount of delta power (1-4 Hz), a marker of sleep depth, and arousal-associated alpha power (8-12 Hz).Results: Current smokers had a shift toward faster sleep electroencephalogram activity with lower delta power in non-REM sleep compared with former and never smokers (-2.8 ± 0.4% and -2.4 ± 0.4%, respectively; both p < 0.001) and higher alpha power (+0.8 ± 0.2%; p < 0.001) compared with never smokers. There was a dose-dependent negative association between electroencephalogram delta power and smoking intensity (r2 = -1.2 [-1.9, -0.5]; p = 0.001). Additionally, mean nocturnal oxygen saturation was lower in current smokers.Conclusions: Current smokers had decreased objective sleep quality, with a dose-dependent association between smoking intensity and decrease in electroencephalogram delta power during non-REM sleep, in addition to an increase in alpha power. Considering the importance of sleep quality for wellbeing and health, these results provide further data to support smoking cessation. [ABSTRACT FROM AUTHOR]

The aim of our study was to define the structure of sleep in Caucasian and Asian peri- and postmenopausal women with sleep apnea. Materials and Methods: Two hundred and forty-seven menopausal women between 45 and 60 years of age participated in this study. The participants were divided into 2 ethnic groups, taking into account the genealogy (the representatives having in two generations of parents of one ethnic group) and self-identification, taking into account phenotype elements. Caucasians were represented by the Russian ethnic group (n=115) and Asians by the Buryat ethnic group (n=132). The study included the collection of anamnestic data, physical examinations, clinical (Berlin questionnaire, general medical examination, gynecological examination, polysomnographic monitoring according to American Academy of Sleep Medicine recommendations), and biochemical laboratory methods. Results: Sleep complaints, such as difficulty falling asleep, frequent night awakenings (more than 2 times), difficulties of morning awakening or problems waking up too early, were increased in perimenopausal Caucasian women. We found ethnic differences in a greater frequency of complaints in Caucasian women, but Asian women also showed a tendency to increased complaints about poor sleep. Polysomnographic monitoring revealed that OSA was more common in Asian postmenopausal women than in Caucasians. However, in structure of sleep we have not seen distinctions. Conclusion: For improving the quality of life, it is necessary not only to pay attention to menopausal problems, but also to solve the sleep problems associated with various strategies, both age management and lifestyle.

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Objectives: To observe the efficacy of acupuncture for reducing the south to reinforce the north on executive function, sleep structure and sleep quality in patients with chronic insomnia disorder of heart-kidney disharmony., Methods: A total of 100 patients with chronic insomnia disorder of heart-kidney disharmony were randomized into an acupuncture group (50 cases, 1 case dropped out) and a western medication group (50 cases, 2 cases dropped out). Acupuncture for reducing the south to reinforce the north was applied at Baihui (GV 20) and bilateral Shenmen (HT 7), Sanyinjiao (SP 6), Shenmai (BL 62), Zhaohai (KI 6), Xinshu (BL 15), Shenshu (BL 23) in the acupuncture group, once a day, 5 days a week. Lorazepam tablet was given orally in the western medication group, 0.5-1 mg a time, once a day. Both groups were treated for 4 weeks. The Stroop color-word test (SCWT) indexes (the time consuming and the correct number of card A, B, C and the Stroop interference effect [SIE]), sleep structure indexes (total sleep time [TST], sleep latency [SL], wake after sleep onset [WASO], sleep efficiency [SE], non-rapid eye movement period 1 [N1], non-rapid eye movement period 2 [N2], non-rapid eye movement period 3 [N3], rapid eye movement period [REM]) and Pittsburgh sleep quality index (PSQI) score were observed before and after treatment in the two groups., Results: After treatment, the time consuming of card B and C, the time consuming and the correct number of SIE, SL, WASO, N1, N2, as well as the sub-item scores and total score of PSQI were decreased ( P <0.05, P <0.01), the correct number of card A, B and C, TST, SE, N3 and REM were increased ( P <0.01) compared with those before treatment in the acupuncture group; the time consuming of card C and SIE, the correct number of card A and SIE, TST, SE, REM were increased ( P <0.05, P <0.01), SL, WASO, N1, as well as the sub-item scores of sleep quality, sleep latency, sleep duration, sleep efficiency, daytime function and total score of PSQI were decreased ( P <0.01) compared with those before treatment in the western medication group. After treatment, in the acupuncture group, the time consuming of card C, the time consuming and the correct number of SIE, N1, N2, as well as the sub-item scores of sleep quality, sleep dysfunction, daytime function and total score of PSQI were lower than those in the western medication group ( P <0.01), the correct number of card B and C, N3, REM were higher than those in the western medication group ( P <0.01)., Conclusions: Acupuncture for reducing the south to reinforce the north can improve the executive function of patients with chronic insomnia disorder of heart-kidney disharmony, adjust the sleep structure, and improve the night sleep quality and daytime body function.

Study Objectives: Hypnograms contain a wealth of information and play an important role in sleep medicine. However, interpretation of the hypnogram is a difficult task and requires domain knowledge and "clinical intuition." This study aimed to uncover which features of the hypnogram drive interpretation by physicians. In other words, make explicit which features physicians implicitly look for in hypnograms., Methods: Three sleep experts evaluated up to 612 hypnograms, indicating normal or abnormal sleep structure and suspicion of disorders. ElasticNet and convolutional neural network classification models were trained to predict the collected expert evaluations using hypnogram features and stages as input. The models were evaluated using several measures, including accuracy, Cohen's kappa, Matthew's correlation coefficient, and confusion matrices. Finally, model coefficients and visual analytics techniques were used to interpret the models to associate hypnogram features with expert evaluation., Results: Agreement between models and experts (Kappa between 0.47 and 0.52) is similar to agreement between experts (Kappa between 0.38 and 0.50). Sleep fragmentation, measured by transitions between sleep stages per hour, and sleep stage distribution were identified as important predictors for expert interpretation., Conclusions: By comparing hypnograms not solely on an epoch-by-epoch basis, but also on these more specific features that are relevant for the evaluation of experts, performance assessment of (automatic) sleep-staging and surrogate sleep trackers may be improved. In particular, sleep fragmentation is a feature that deserves more attention as it is often not included in the PSG report, and existing (wearable) sleep trackers have shown relatively poor performance in this aspect., (© The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The aim of the study was to assess sleep structure, phenotypes related to bruxism activity and basic respiratory parameters among a large group of participants with sleep bruxism and without obstructive sleep apnea. Adult participants with clinical suspicion of sleep bruxism and with no other significant medical history were recruited. Video‐polysomnography was performed to detect masseter muscles activity. Polysomnographic scoring was performed according to the American Academy of Sleep Medicine Criteria. Finally, 146 participants were included. The participants were divided into three subgroups: severe, mild and no sleep bruxism. There were no differences in total sleep time, sleep latency, sleep efficiency, wake duration after sleep onset, rapid eye movement, and measured respiratory parameters. The severity of sleep bruxism contributed to the increased intensity of all sleep bruxism phenotypes in almost all sleep stages, apart from tonic and mixed activity in non‐rapid eye movement stage 3 sleep (slow‐wave sleep). Those with bruxism spent more time in rapid eye movement sleep compared to controls; there were no differences in non‐rapid eye movement sleep stages. The results confirmed that sleep bruxism does not significantly affect sleep duration, efficiency and continuity (in terms of sleep–wake cycles). Sleep bruxism contributes to a higher percentage of rapid eye movement sleep in the total sleep time. Those with bruxism present more frequent episodes during all stages of sleep; however, in the case of slow‐wave sleep, tonic and mixed activity observed in participants with sleep bruxism are comparable to those of healthy people. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to explore the differences of sleep structure between patients with amnestic mild cognitive impairment (aMCI) and elderly people with normal cognition, which will help to provide evidence for the relationship between sleep disturbances and cognitive impairment.Methods: A systematic review and meta-analysis were conducted on the literature on sleep parameters obtained by polysomnography or actigraphy in patients with aMCI. The PubMed and EMBASE databases were searched up to April 2020. Inclusion and exclusion criteria were established according to evidence-based medicine methods, and data of all eligible studies were meta-analyzed using the Review Manager 5.3 software.Results: Among the 1,171 literature articles on sleep structure of patients with MCI, eight case-control studies met the inclusion criteria and were included in this meta-analysis. A total of 278 subjects were included, of which 103 were patients with aMCI and 175 were elderly people with normal cognition. The results showed that sleep efficiency (SE) and slow wave sleep (SWS) of patients with aMCI were significantly lower than those of healthy elderly people. Compared with the control group, the percentage of stage 1 of non-rapid eye movement (N1%) in the aMCI patients group increased, and the percentage of stage 2 of non-rapid eye movement (N2%) decreased.Conclusions: Patients with aMCI may experience more severe sleep disturbances than normal cognitive elderly people. There were specific changes, especially in SE and SWS, in the sleep structure of patients with aMCI when compared to those with normal cognition.

Depression and its related mood disorders are a major global health issue that disproportionately affects young adults. A number of factors that influence depressive symptoms are particularly relevant to the young adult developmental stage, including sleep loss, poor sleep quality, and the tendency toward eveningness in circadian preferences. However, relatively few studies have examined the relationship between sleep and circadian phenotypes, and their respective influences on mood, or considered potential molecular mechanisms driving these associations. Here, we use a multi-year, cross-sectional study of 806 primarily undergraduates to examine the relationships between sleep-wake chronotype, sleep disturbance, depression and genotypes associated with the PER3 variable number of tandom repeats (VNTR) polymorphism—circadian gene variants associated with both chronotype and sleep homeostatic drive. In addition, we use objective, Fitbit-generated sleep structure data on a subset of these participants (n = 67) to examine the relationships between chronotype, depression scores, actual measures of sleep duration, social jetlag, and the percent of deep and rapid eye movement (REM) sleep per night. In this population, chronotype is weakly associated with depressive symptoms and moderately correlated with self-reported sleep disturbance. Sleep disturbance is significantly associated with depression scores, but objective sleep parameters are not directly correlated with Beck Depression Inventory (BDI-II) scores, with the exceptions of a moderate correlation between social jetlag and depression scores in females and a marginal correlation between sleep duration and depression scores. Multiple regression and path analyses reveal that chronotype effects on depressive symptoms in this population are mediated largely by sleep disturbance. The PER3 VNTR genotype significantly predicts depressive symptoms in a model with objective sleep parameters, but it does not significantly predict depressive symptoms in a model with chronotype or subjective sleep disturbance. Interestingly, PER35,5 genotypes, in males only, are independently related to chronotype and depression scores. Our results support hypotheses linking subjective sleep quality and chronotype and provide a first step in understanding how objective sleep structure may be linked to chronotype and depressive symptoms. Our results also suggest that circadian gene variants may show sex-specific effects linking sleep duration and sleep structure to depression.

Our study aimed to assess functional, structural changes of the right ventricular using strain parameters and sleep structure using polysomnography in patients with obstructive sleep apnea (OSA). Our study group consisted of 43 patients, 29 men, 14 women. The mean age was 56.36 ± 14.77. All patients underwent full night polysomnography and transthoracic echocardiography. The right ventricular global longitudinal strain was measured by 2D speckle-tracking echocardiography. The prevalence of OSA (AHI ≥ 5) was 76.7% in the studied group. We observed a significant positive correlation between OAH and average free wall strain (r = 0.37), snore and mid-free wall strain (r = 0.34), average HR, and basal free wall strain (r = 0.34). Moreover, CSB was positively correlated with basal septal strain and mid septal strain (r = 0.36 and 0.42). In summary, among patients with sleep disorders, functional disorders of the right ventricle, assessed using the strain method, are partly observed.