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Elsevier Science
Sleep medicine

Elsevier Science

1389-9457

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    Creating an optimal observational sleep stage classification system for very and extremely preterm infants

    de Groot E.R.Bik A.Sam C.Wang X....
    9页
    查看更多>>摘要：? 2022 The Author(s)Background: Sleep plays a major role in neuronal survival and guiding the fetal brain's development. Preterm infants in the neonatal intensive care unit are exposed to numerous external stimuli that can severely disrupt their sleep/wake patterns. Currently, almost no behavioral classification scales are validated for preterm infants. This study aims to develop a new, easy-to-use, validated visual sleep stage classification system for preterm infants with a gestational age between 25 and 37 weeks. Methods: The Behavioral Sleep stage classification for Preterm Infants (BeSSPI) consists of four sleep-wake stages; active sleep (AS), quiet sleep (QS), intermediate sleep (IS) and wake (W), which are classified using seven items. Items include eye movements, body movements, facial movements, vocalizations, heart rate, respiratory pattern and activity level. Results: 69 preterm infants were observed (24 + 6–36 + 0 weeks GA at birth; 25 + 2–36 + 6 weeks PMA at observation; 57.3% male). Across all 69 infants, the BeSSPI was based on 10,922 min of observed behavior, with 4264 min AS (38.83%), 2873 min QS (26.16%), 2887 min IS (26.29%), and 957 min W (8.72%). For the final BeSSPI, an interrater agreement of κ = 0.80 was reached. Additionally, construct, content, face validity, and expert validity were carefully assessed and deemed satisfactory. Conclusions: We developed a method to evaluate sleep-wake stages that is simple for all neonatal healthcare providers to learn and use. The BeSSPI is of high reliability and validity. Furthermore, it can be used in all preterm age-groups. Therefore, this novel instrument may improve rigor and reproducibility for future preterm sleep research.
      原文链接:
    • NSTL
    • Elsevier

    Biology vs. ecology: a longitudinal examination of sleep, development, and a change in school start times

    Meltzer L.J.Plog A.E.Wahlstrom K.L.Strand M.J....
    9页
    查看更多>>摘要：? 2022 The AuthorsBackground: Secondary school start times are associated with student sleep and daytime functioning; however, no study examining this association has included linked longitudinal data for both primary and secondary students. To understand the interplay between biology (ie, normal developmental changes in sleep) and ecology (ie, school start times), this study examined sleep and daytime functioning in elementary/primary and secondary school students over a three-year period that included changes to school start times. Methods: Students (grades 3–10, n = 6168) and parents (for student grades Kindergarten-2, n = 2772) completed annual surveys before (pre-change) and for two-years after (post-change, follow-up) implementation of new school start times (elementary/primary: 60 min earlier, secondary: 50–80 min later). Participants were 48.9% female, 65.5% White, and 16.2% qualified for free/reduced lunch. Results: With new school start times, significant changes were found for weekday wake times and sleep duration; elementary/primary students woke earlier (23 min) and obtained less sleep (14 min), while secondary students woke later (44 min) and obtained more sleep (31 min). Small changes in weekend sleep duration (<7 min) were found across levels. Secondary school students had significant improvements in daytime functioning post-change, due in part to changes in sleep duration. Minimal changes in elementary/primary students’ daytime functioning was found, despite shorter sleep duration. Conclusions: School start times are a significant factor in weekday wake times for students across grade levels, while later bedtimes are more a factor of normal development. Later start times positively affected secondary students’ daytime functioning, with non-significant findings for earlier elementary/primary start times.
      原文链接:
    • NSTL
    • Elsevier

    Association between cognitive dysfunction and nocturnal peaks of blood pressure estimated from pulse transit time in obstructive sleep apnoea

    Alomri R.M.A.Kennedy G.A.Wali S.Alhejaili F....
    7页
    查看更多>>摘要：? 2022 Elsevier B.V.Background: Obstructive sleep apnoea (OSA) is characterised by recurrent episodes of partial or complete cessation of breathing during sleep and an increased effort to breathe. Patients with untreated OSA exhibit cognitive impairment that is only partly accounted for by hypoxia and sleep disruption, suggesting that other factors remain to be identified. OSA can involve repeated spikes of nocturnal blood pressure because of increased activity of the sympathetic nervous system during sleep. While high resting blood pressure is associated with cognitive dysfunction, it is not yet known whether peaks in nocturnal blood pressure are associated with cognitive impairment in OSA. Methods: A cohort of patients participated in overnight polysomnographic studies at a major sleep laboratory to investigate whether nocturnal elevations in blood pressure are associated with cognitive dysfunction in OSA. Nocturnal pulse transit time was measured as a surrogate for arterial blood pressure during sleep. Results: Of the 75 patients, 12 had no obstructive sleep apnoea, 26 had mild OSA, 18 moderate, and 19 severe OSA. The results revealed that systolic blood pressure peaks were associated with OSA severity, while diastolic blood pressure peaks were not. Peaks of nocturnal systolic blood pressure were independently associated with poorer performance on a test of visuospatial function, but not with impairments on tests of sustained attention, reaction time or autobiographical memory. Conclusion: The present findings indicate nocturnal peaks of systolic blood pressure that are substantially higher than normal daytime values may contribute to visuospatial dysfunction in OSA.
      原文链接:
    • NSTL
    • Elsevier

    Short-wavelength light exposure at night and sleep disturbances accompanied by decreased melatonin secretion in real-life settings: a cross-sectional study of the HEIJO-KYO cohort

    Mitsui K.Saeki K.Tone N.Suzuki S....
    7页
    查看更多>>摘要：? 2022 Elsevier B.V.Objectives: To determine the association between short-wavelength light exposure at night (LAN) power and sleep quality or melatonin levels in real-life settings. Methods: In this cross-sectional study of 580 older adults (mean age, 71.0 years), we measured short-wavelength LAN power at cornea level using an originally developed light loggers over two nights. Sleep quality and physiological melatonin levels were measured using the Pittsburgh sleep quality index (PSQI) questionnaire and overnight urinary 6-sulfatoxymelatonin excretion (UME), respectively. Results: The first and second tertile short-wavelength LAN power values obtained were 0.77 × 10?2 μW/cm2 and 7.0 × 10?2 μW/cm2, respectively, and the overall prevalence of sleep disturbances was 34.7%. The mean UME was 1.88 ± 0.70 log μg. The mean global PSQI score and the prevalence of sleep disturbances significantly increased (P = 0.004 and 0.006, respectively) with increasing tertile groups of short-wavelength LAN power. In multivariable analysis adjusted for potential confounders, the odds ratio (OR) for sleep disturbances was significantly higher in the highest tertile group of short-wavelength LAN power compared with that in the lowest tertile group (adjusted OR, 1.90; 95% confidence interval [CI]: 1.20, 3.00; P = 0.006). In addition, UME was significantly lower in the highest tertile group of short-wavelength LAN power than that in the lowest tertile group (adjusted mean difference, ?0.14 log μg; 95% CI: ?0.28, ?0.007; P = 0.039). Conclusions: Although short-wavelength LAN power measured at cornea level in real-life settings seemed to be significantly low, our findings suggest that short-wavelength LAN power is significantly associated with both melatonin levels and sleep disturbance.
      原文链接:
    • NSTL
    • Elsevier

    Associations between burnout symptoms and sleep among workers during the COVID-19 pandemic

    Sorengaard T.A.Saksvik-Lehouillier I.
    5页
    查看更多>>摘要：? 2022 The Author(s)Background: The aim of this study was to investigate the relations between underlying dimensions of burnout (ie exhaustion, mental distance, cognitive impairment and emotional impairment) and sleep reactivity in occupations that maintain critical societal functions during the COVID-19 pandemic. Sleep reactivity refers to the vulnerability of experiencing sleep disturbances during stressful and challenging situations, and manifests as difficulties with falling and staying asleep. Previous research has highlighted the importance investigating psychological factors that may influence or trigger vulnerability to stress induced sleep problems, including factors at work. Methods: Longitudinal self-report data was collected using an online survey administered to Norwegian workers employed in health care, education, social services, emergency services and other sectors with critical tasks during the COVID-19 pandemic at two different time points three months apart. The sample in the present study (N = 1331) consisted of 76% females and 24% males with a mean age of 44 years. Results: The results showed that work-related exhaustion measured at baseline was the strongest symptom of burnout associated with higher sleep reactivity three months later, followed by emotional impairment. Mental distance and cognitive impairment at work were not associated with sleep reactivity, indicating that these burnout dimensions have less of an impact on sleep than exhaustion and emotional impairment. Conclusion: Work-related exhaustion and emotional impairment can lower the individual's tolerance to perceiving events as stressful as well as reinforce the stress response, and contribute to difficulties with initiating and/or maintaining sleep. Workers employed in occupations with critical tasks during the pandemic may be more susceptible to exhaustion, emotional strain and poorer sleep due to increased and prolonged work pressure. Organizational and individual measures that can decrease stress and increase coping should be offered to employees working in high-stress conditions.
      原文链接:
    • NSTL
    • Elsevier

    Racial disparity in sleep apnea-related mortality in the United States

    Lee Y.-C.Chang K.-Y.Mador M.J.
    10页
    查看更多>>摘要：? 2022 Elsevier B.V.Background: Sleep apnea is one of the most common sleep disorders in the United States (US). Although the prevalence, risk factors, and clinical presentations of sleep apnea vary by racial groups, the racial disparity in sleep apnea-related mortality remains unclear. Methods: Sleep apnea-related mortality for 1999–2019 was obtained from the National Center for Health Statistics provided by the Centers for Disease Control and Prevention. We examined the mortality trends for sleep apnea using Joinpoint regression analysis and compared the associated outcomes and multiple causes of death between Blacks and Whites. Results: For 1999–2019, sleep apnea was documented as the underlying cause of death in 17,053 decedents, with 2593 Blacks and 14,127 Whites. The overall age-adjusted mortality rates in all population, Blacks, and Whites were 2.5, 3.5, and 2.4 per 1,000,000 population, respectively (P < 0.001). Both Blacks and Whites had the highest mortality rates in the Midwest and the lowest in the Northeast. Despite the flattened mortality trend in the last decade overall, Black males had a continuous mortality increase over the study period (Annual Percentage Change 2.7%, 95% CI: 1.2–4.2). For both genders of sleep apnea decedents, Blacks were more likely to have multiple cause of death of Cardiac Arrest, Hypertension, Obesity, and Chronic Renal Failure, but Arrhythmia was more common in Whites (P < 0.05). Conclusions: There is a significant racial disparity in sleep apnea-related mortality in the US. The uptrend in mortality in Black males and associated outcomes related to cardiovascular disease should raise concerns specifically in Blacks with sleep apnea.
      原文链接:
    • NSTL
    • Elsevier

    Decision making under uncertainty in Parkinson's disease with Rem sleep behavior disorder

    Marques A.Pereira B.Figorilli M.Vidal T....
    8页
    查看更多>>摘要：? 2022 Elsevier B.V.Background: REM sleep behavior disorder (RBD) is associated with an increased risk to develop Impulse control disorders (ICDs) in Parkinson's disease (PD), however the mechanisms underlying this putative association are still poorly understood. Decision-making impairment, one major neuro-psychological dimension that may lead to ICDs, has been reported in idiopathic RBD, but has never been assessed in RBD associated with PD. Objective: We aimed to assess decision-making abilities under ambiguous situations associated with the presence of RBD in PD patients. Methods: In this cross-sectional study, 60 non-demented PD patients with (PD-RBD, n = 40) and without (PD-nRBD, n = 20) video polysomnography-confirmed RBD, and 20 healthy controls matched for gender and age were included. All subjects underwent neurological and neuropsychological examination, including Iowa Gambling task designed to asses decision-making under uncertainty. Results: IGT total score did not differ between groups (p = 0.851), however PD-RBD presented, more disadvantageous choices for the last blocks of IGT compared to PD-nRBD (p = 0.001) and to HC (p = 0.012). Progression of scores did not differ between HC and PD-nRBD. Multivariate analyses taking into account the value of scores at baseline, as well as the duration of PD, the duration of treatment, the presence of ICDs and MMSE confirmed those results. Conclusion: Decision making under uncertainty is impaired in PD-RBD compared to PD-nRBD and healthy controls, regardless to the duration of disease, treatment, cognitive status and the presence of ICDs. This could reflect an inability to learn from punishment or reward in PD-RBD, and could explain the increased risk to develop ICDs reported in those patients.
      原文链接:
    • NSTL
    • Elsevier

    A certified child life specialist influences the emotional response during polysomnography setup

    Baughn J.M.Lechner H.G.Herold D.L.Brown V.A....
    8页
    查看更多>>摘要：? 2022 Elsevier B.V.Objectives: To examine if the presence of a certified child life specialist (CCLS) had a positive impact on patient emotion at the time of polysomnography setup and to determine the optimal timing of CCLS intervention prior to polysomnography (PSG) in our sleep center. Methods: We implemented a study which measured the impact of a CCLS on the emotional manifestation score (EMS) of pediatric patients (4 months–17 years, median 7 years) during PSG setup. CCLS intervention was either at the time of sleep medicine consultation (daytime) or during PSG setup (evening). We used Emotional Manifestations Scores (EMS) as well as patient/caregiver satisfaction data to measure the impact of a CCLS and inform decision-making regarding ongoing employment of a CCLS in our sleep lab. Results: High EMS scores were noted during PSG setup in all groups indicating the emotional distress of children undergoing PSG. The EMS improved more when CCLS was present at the time of PSG setup. Statistically significant improvements occurred in level of cooperation, pain/discomfort, and child coping. Based on the results of the study, we hired a CCLS to work in our sleep center at the time of PSG setup 2 evenings per week. Conclusions: PSG is emotionally stressful for pediatric patients as seen on EMS. A CCLS present in the evening at our sleep lab led to an improvement in EMS in children being prepared for PSG set-up. After implementation of a CCLS two nights per week in our sleep lab, parents/caregiver satisfaction scores were higher on nights a CCLS was present at setup.
      原文链接:
    • NSTL
    • Elsevier

    Evidence of a maturational disruption in non-rapid eye movement sleep slow wave activity in youth with attention-deficit/hyperactivity, learning and internalizing disorders

    Ricci A.He F.Calhoun S.L.Fang J....
    8页
    查看更多>>摘要：? 2022 Elsevier B.V.Background: Sleep slow wave activity (SWA) peaks during childhood and declines in the transition to adolescence during typical development (TD). It remains unknown whether this trajectory differs in youth with neuropsychiatric disorders. Methods: We analyzed sleep EEGs of 664 subjects 6 to 21 y (449 TD, 123 unmedicated, 92 medicated) and 114 subjects 7-12 y (median 10.5 y) followed-up at 18-22 y (median 19 y). SWA (0.4–4 Hz) power was calculated during non-rapid eye movement sleep. Results: TD and unmedicated youth showed cubic central and frontal SWA trajectories from 6 to 21 y (p-cubic<0.05), with TD youth showing peaks in central SWA at 6.8 y and frontal at 8.2 y. Unmedicated attention-deficit/hyperactivity (ADHD) and/or learning disorders (LD) showed peak central SWA 2 y later (at 9.6 y, coinciding with peak frontal SWA) than TD, followed by a 67% steeper slope by 19 y. Frontal SWA peak and slope in unmedicated ADHD/LD, and that of central and frontal in internalizing disorders (ID), were similar to TD. Unmedicated ADHD/LD did not differ in the longitudinal SWA percent change by 18–22 y; unmedicated ID showed a lower longitudinal change in frontal SWA than TD. Medicated youth showed a linear decline in central and frontal SWA from 6 to 21 y (p-linear<0.05). Conclusions: ADHD/LD youth show a maturational delay and potential topographical disruption in SWA during childhood and steeper decline throughout adolescence, suggesting faster synaptic pruning. Youth with ID experience less changes in frontal SWA by late adolescence. Psychotropic medications may impact the maturational trajectory of SWA, but not the magnitude of developmental decline by late adolescence.
      原文链接:
    • NSTL
    • Elsevier

    Stroke-related restless legs syndrome: epidemiology, clinical characteristics, and pathophysiology

    Wang X.-X.Feng Y.Tan E.-K.Ondo W.G....
    11页
    查看更多>>摘要：? 2022 Elsevier B.V.Stroke-related restless legs syndrome (RLS) is one of stroke-related sleep disorders, which may be due to de novo RLS after stroke onset or an exacerbation of RLS symptoms after incident stroke. To date, the diagnostic rate of stroke-related RLS is low but it has a significant effect on patients' daily life and functional outcome. This review provides an overview of the epidemiology, clinical characteristics, pathophysiology, and impact on functional outcome of stroke-related RLS.
      原文链接:
    • NSTL
    • Elsevier