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Sleep medicine
Elsevier Science
Sleep medicine

Elsevier Science

1389-9457

Sleep medicine/Journal Sleep medicineSCIISTPBSCIAHCI
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    Efficacy and safety of Wuling capsule for insomnia disorder: a systematic review and meta-analysis of randomized controlled trials

    Zhou, HufangZhao, YingPeng, WenhuaHan, Wenbo...
    14页
    查看更多>>摘要：Objectives: Wuling capsule has been used in treatment of insomnia disorder in China for decades, but the reported treatment efficacy of different studies was not consistent. This study intended to evaluate the efficacy and safety of Wuling capsule for insomnia disorder, so as to provide evidence for clinical application. Methods: Eight databases (MEDLINE, EMBASE, Ovid, Cochrane Library, Chinese National Knowledge Infrastructure, VIP information database, Chinese Biomedical Database and Wanfang) were searched from inception to September 14, 2021. Randomized controlled trials (RCTs) comparing Wuling capsule with controls in adults with insomnia disorder were eligible. The primary outcome was sleep quality assessed by Pittsburgh Sleep Quality Index (PSQI), and the secondary outcomes were severity of insomnia disorder measured by Sleep Dysfunction Rating Scale (SDRS) and adverse events. This study was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. Results: Nineteen RCTs with a total of 1850 participants were included. In terms of sleep quality assessed by PSQI, Wuling capsule significantly lowered PSQI score (MD:-1.92, 95% CI: [-2.34,-1.50], P < 0.00001, I-2 = 95%) compared to controls, and the effect of Wuling capsule was significantly better than control no matter when Wuling capsule as monotherapy (MD:-1.71, 95% CI: [-2.33,-1.09], P < 0.00001, I-2 = 97%) or as adjunctive therapy (MD:-2.10, 95% CI: [-2.66,-1.55], P < 0.00001, I-2 = 90%). Wuling capsule was more effective for the treatment duration lasted 8 weeks (MD:-2.57, 95% CI: [-3.52,-1.62], P < 0.00001, I-2 = 93%) than 4 weeks (MD:-1.68, 95% CI: [-2.13,-1.22], P < 0.00001, I-2 = 95%). In terms of severity of insomnia disorder measured by SDRS, Wuling capsule significantly reduced SDRS score (MD:-4.21, 95% CI: [-4.95,-3.46], P < 0.00001, I-2 = 0%) compared to benzodiazepines. Wuling capsule significantly reduced adverse events compared to controls (RR: 0.47, 95% CI: [0.34, 0.65], P < 0.00001, I-2 = 43%). Conclusion: Wuling capsule can safely and effectively improve sleep quality in patients with insomnia disorder. However, these findings require careful recommendation due to the high heterogeneity and high risk of bias in the included trials. Clinical trials with higher quality designs are needed. (c) 2022 The Authors. Published by Elsevier B.V.
      原文链接:
    • NSTL
    • Elsevier

    Bright light alone or combined with caffeine improves sleepiness in chronically sleep-restricted young drivers

    Soleimanloo, Shamsi ShekariGarcia-Hansen, VeronicaWhite, Melanie J.Huda, M. Mamun...
    11页
    查看更多>>摘要：Background: Young drivers are over-involved in sleepiness-related crashes. The alerting effects of bright light offer a potential countermeasure for driver sleepiness, either replacing or in conjunction with current countermeasures such as the use of caffeine. Methods: Thirty young (18-25) chronically sleep-restricted drivers drove in a simulator under randomized conditions of continuous bright light ('Light,' 500 nm, 230 mu w/cm(2)), caffeine ('Caffeine,' 100 mg caffeinated gum), or light and caffeine together ('Light + Caffeine'), after driving under a placebo condition ('Placebo,' decaffeinated gum, 555 nm light, 0.3 mu W/cm(2)) on three consecutive days. Using mixed effects linear models, the associations between these conditions and physiological outcomes (EEG alpha and theta power, heart rate, and beat-to-beat intervals), driving performance (lateral lane and steering related outcomes and lateral acceleration), and subjective sleepiness was assessed. Results: Relative to Placebo, all conditions improved driving performance outcomes (P < 0.0001), with effects of Light + Caffeine equal to Light but greater than Caffeine. Light + Caffeine reduced EEG alpha power more than Light or Caffeine (P < 0.0006), but ECG outcomes were generally worse under all conditions relative to Placebo. Subjective sleepiness improved under the Light + Caffeine condition only (P < 0.0001). Conclusions: Combining bright light and caffeine enhances their alerting effects on lateral lane variability and subjective sleepiness. A bright light could be a practical alternative to caffeine for sleepy drivers who avoid caffeine. The alerting effects of bright light could alleviate chronic community-level mild sleep restriction and provide on-road benefits to reduce severe injuries and fatal sleepiness-related crashes. Crown Copyright (C) 2022 Published by Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Clinical characterization of insomnia in adolescents-an integrated approach to psychopathology

    Yuksel, DilaraKiss, OrsolyaProuty, Devin E.Baker, Fiona C....
    13页
    查看更多>>摘要：Objectives/Background: Insomnia in adolescence is common and debilitating yet it remains poorly understood. Here, we examine the complexity of clinical, behavioral, and psychosocial factors characterizing insomnia in adolescents.Methods: Ninety-five adolescents (16-19 years) with (N = 47, 31 female) and without (N = 48, 28 female) insomnia symptoms participated. In the insomnia group, 26 (20 female) met full DSM-5 criteria for insomnia disorder, while 21 (11 female) met partial criteria. Participants completed a clinical interview and assessments of clinical, behavioral, and psychosocial dimensions associated with insomnia. GLMs and network analyses were used to evaluate group and sex differences in severity and inter-relationships between symptoms.Results: Adolescents with insomnia symptomatology had lower sleep hygiene and thought control, more depressive symptoms and dysfunctional sleep-related cognitions, and more substance use as a coping behavior than healthy controls. They also indicated higher neuroticism, stress levels, and sleep stress reactivity (p < 0.05), but no difference in adverse childhood experiences, than controls. Girls compared to boys with insomnia reported lower sleep quality, and more pre-sleep cognitive activity and sleep stress reactivity (p < 0.05). Compared to healthy girls, girls in the insomnia group reported lower sleep hygiene and higher agreeableness. Network analyses confirmed profound group differences in network topology, with the insomnia group having different levels of centrality and relationships between clinical characteristics compared with controls. Conclusions: Findings highlight clinical and sex-specific characteristics of adolescent insomnia, with network analyses revealing a complex interplay between clinical, behavioral, and psychosocial domains. Adolescents with insomnia symptoms, particularly girls, may benefit from interventions to improve negative cognition, mood, and stress, and behavioral strategies to counteract sleep-related maladaptive behaviors.(c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Comparative effectiveness of multiple acupuncture therapies for primary insomnia: a systematic review and network meta-analysis of randomized trial

    Lu, YaoZhu, HongfeiWang, QiTian, Chen...
    10页
    查看更多>>摘要：Background: Acupuncture has been widely practiced for primary insomnia (PI). However, the relative benefit and harm among acupuncture therapies remain uncertain.Objectives: To compare and evaluate the effect differences of multiple acupuncture therapies for patients with PI.Methods: Systematic literature search for randomized controlled trials (RCTs). Pairs of reviewers independently conducted literature screening, data extraction, and risk of bias assessment. Meta-analysis was conducted using R and Stata software. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to assess certainty of evidence and interpret results.Results: Fifty-seven RCTs with 4678 patients were included. Compared with usual treatment, multiple acupuncture therapies showed a better effect for Pittsburgh sleep quality index score. And acupoints catgut embedding (ACE) was proved to be the most effective with a moderate certainty of evidence; auricular acupressure or auricular acupuncture plus manual acupuncture (AP + MA), electroacupuncture plus acupoint application (EA + APA), and intradermal needle (IN) might be also the most effective with low certainty of evidence. ACE, ACE + MA, AP + MA, EA, EA + APA, HPN, MA and PBN + MA showed significantly improvement in effective rate when compared with usual treatment. Insufficient evidence reported on Epworth Sleepiness Scale, Athens Insomnia Scale, and recurrence rate. The most common slight adverse events mainly included hematoma, pain, headache, and bleeding.Conclusions: With moderate to low certainty of evidence, multiple acupuncture therapies showed impressive insomnia improvement, especially ACE, AP + MA, and EA + APA. Differences between therapies were small or insignificant and based-on low or very low certainty of evidence.(c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    The mediating effects of working hours, sleep duration, and depressive mood on the association between shift work and the risk of suicidal ideation in Korean workers

    Kim, Sun-YoungLee, Mi YeonKim, Soo InLim, Weon-Jeong...
    7页
    查看更多>>摘要：Objectives: This study aimed to investigate the mediating effects of working hours, sleep duration, and depressive mood on the association between shift work and the risk of suicidal ideation in Korean workers.Methods: Data from 33,047 workers were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys conducted in 2007-2018. Healthy workers without depressive disorders and chronic medical illnesses were included in the current study. Shift work patterns, sleep duration, working hours, depressive mood, and suicidal ideation were assessed using self-reported questionnaires. Multivariate logistic regressions were used to examine the association between shift work and the risk of suicidal ideation. Additionally, mediating studies were conducted to identify the roles of working hours and sleep durations on the association.Results: Compared with daytime workers, shift workers had 1.33 times greater risk of suicidal ideation (OR = 1.33, 95% Cl = 1.17-1.52, p < 0.001). Specifically, among shift work patterns, fixed-night shift, 24h rotating shift and irregular rotating shift were associated with the risk of suicidal ideation when compared with daytime workers (irregular rotating shift: OR = 1.92, 95% Cl = 1.29-2.86, p = 0.001; fixed-night shift: OR = 1.75, 95% Cl = 1.32-2.31, p < 0.001; 24-h rotating shift: OR = 1.58, 95% Cl = 1.06-2.36, p = 0.024). In the mediating study, working hours, sleep duration and depressive mood signifi-cantly mediated the relationship between shift work and suicidal ideation (direct effect: f3 = 0.019, p = 0.001; indirect effect: f3 = 0.004, p = 0.031; total effect: f3 = 0.023, p < 0.001).Conclusion: This study revealed that shift workers had a greater risk of suicidal ideation. The patterns significantly associated with suicidal ideation were irregular rotating, fixed-night, and 24-h rotating shifts. The pathway analysis revealed serial mediating effects of working hours, sleep duration, and depressive mood on the association between shift work and suicidal ideation.(c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Distribution of leptin receptors in the brain stem: possible route in the pathophysiology of neuromuscular control of airway resistance during sleep

    Martins, Maira GarciaMagliarelli Filho, Pedro AugustoNagahashi Marie, Suely KazueSennes, Luiz Ubirajara...
    7页
    查看更多>>摘要：Introduction: Leptin, a hormone related to satiety, has been studied because of its association with obesity and sleep apnea. The distribution of leptin receptors in the brain stem, and in the hypoglossal nucleus, has not yet been described. The stimulation of these muscles has been studied in the treatment of sleep apnea. Objective: to detail the presence of leptin receptors in the nuclei of these nerves to enable studies of stimulation of this region through leptin. Methods: the brains of five cadavers, removed during necropsy, collected at the Death Verification Service were included. An informed consent was signed by a family member (wife, mother or son/daughter) who answered specific questionnaire concerning comorbities. Anthropometric measurements were recorded. The medulla oblongata and pons fragments were identified. Immunohistochemical staining analysis was performed to identify the location of the leptin receptors. Results: In the immunohistochemical analysis an intense staining signal of the brownish coloration of neurons was evidenced in the hypoglossal nerve nucleus, moderate in the olivary nucleus and mild in the dorsal nucleus of the vagus and trigeminal nucleus. In motor neurons, more intense brown pigmentation can be observed in the nucleus and cytoplasm when compared to sensory neurons. Conclusion: The immunoexpression of leptin receptor was demonstrated in the motor neurons of the human hypoglossal nucleus. These results may contribute to unravel details of the pathophysiology of neuromuscular control of airway collapse during sleep and to the development of new drugs capable of improving the neuromuscular tone of upper airway in apneic individuals. (c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    A network analysis of self-reported sleep bruxism in the Netherlands sleep registry: its associations with insomnia and several demographic, psychological, and life-style factors

    Chattrattrai, ThipraweeBlanken, Tessa F.Lobbezoo, FrankSu, Naichuan...
    8页
    查看更多>>摘要：Objectives: To investigate the association between self-reported sleep bruxism and insomnia and their potential risk factors (eg, depression and anxiety), and to construct a network model with all these factors.Methods: We recruited 2251 participants from the Netherlands Sleep Registry. All participants completed questionnaires on self-reported sleep bruxism, insomnia, depression, anxiety, smoking frequency, and alcohol and caffeine consumption. The associations between self-reported sleep bruxism and other variables were analyzed by univariate analysis, multivariate logistic regression, and network analysis.Results: Although univariate analysis showed that there was a positive association between sleep bruxism and insomnia (P < 0.001), this association disappeared in the multivariate logistic regression model (P = 0.258). However, multivariate logistic regression did show an association between self reported sleep bruxism and anxiety (OR = 1.087, 95% CI 1.041-1.134). The network model showed that there was no direct link between self-reported sleep bruxism and insomnia. However, there was an indirect link between self-reported sleep bruxism and insomnia via anxiety. Conclusions: Although self-reported sleep bruxism has no direct association with insomnia, anxiety is a bridging factor between these variables.(c) 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
      原文链接:
    • NSTL
    • Elsevier

    Circadian misalignment is associated with Covid-19 infection

    Coelho, JulienMicoulaud-Franchi, Jean-ArthurWiet, Anne-SophieNguyen, Duc...
    4页
    查看更多>>摘要：Background: Circadian system contributes to the regulation of inflammatory processes, but the role of circadian misalignment as a risk factor for contracting Covid-19 has up to now been poorly studied. The aim of this study was to explore the relationship between circadian misalignment (chronic disturbance of the circadian system) and the risk of Covid-19 infection in a population of subjects suspected of contact or infection with SARS-CoV-2.Methods: Cross-sectional single-center study conducted during a period without lockdown in winter 2021. Recruitment took place in a Covid-19 outpatient testing center. Subjects between 18 and 45 years old were included whether they were symptomatic or not, healthcare workers or not, in contact with a Covid-19 case or not. To determine social jetlag, a proxy of circadian misalignment, they were asked about their usual sleep-wake behaviors. Usual sleep duration and sleep-wake timing were explored on workdays and free days. Social jetlag was defined as at least 2 h shift of circadian alignment (defined as the difference between mid-sleep on workdays and mid-sleep on free days, mid-sleep as the median between bedtime and rise time).Results: One thousand fourteen subjects were included (sampling rate: 10.8%, 39% men, mean age 28 +/- 8) with 56 subjects positive for Covid-19 (positivity rate: 5.5%). Usual mean sleep duration was equivalent in both groups (7h47 versus 7h49, p = 0.733). Social jetlag greater than 2 h comprised 33.3% of subjects in the Covid-19 group versus 20.6% in the control group (p = 0.026). After adjustment on age, gender, BMI and work schedules, subjects presenting with social jetlag greater than 2 h had a 2.07-fold higher likelihood to test positive than subjects who had identical sleep-wake timing on workdays and free days (OR = 2.07, 95%CI = [1.12-3.80], p = 0.024).Conclusion: Circadian misalignment not only is present in subjects infected by Covid-19 but could also be responsible for a higher likelihood of being infected. The chronobiological impact on the immune system or a higher likelihood of being exposed to social contacts during nocturnal activities could explain our findings, which need to be confirmed in a future large cohort study. Regular sleep-wake timing could ultimately become a target for preventing Covid-19 infection. (c) 2022 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Increased serum levels of cyclophilin a and matrix metalloproteinase-9 are associated with cognitive impairment in patients with obstructive sleep apnea

    Li, MengfanSun, HairongShen, TengqunXue, Song...
    9页
    查看更多>>摘要：Objectives: To investigate the relationship between serum cyclophilin A (CyPA) and matrix metalloproteinase-9 (MMP-9) levels and mild cognitive impairment (MCI) in patients with obstructive sleep apnea (OSA). Methods: Study subjects underwent whole-night in-laboratory polysomnography (PSG), and all partici-pants were scored using a neuropsychological scale and peripheral blood samples were collected the next morning. The presence and severity of OSA were assessed with the apnea hypopnea index (AHI), and OSA was defined as AHI >5 events/hour. MCI was defined as the MoCA <25, and met the revised Mayo Clinic criteria. Serum CyPA and MMP-9 levels were measured with enzyme-linked immunosorbent assays (ELI-SAs). A univariate analysis and a logistic model were used to assess risk factors for MCI in patients with OSA. A correlation analysis was performed to estimate whether a linear relationship existed between serum CyPA and MMP-9 levels and the severity of cerebral small vessel disease (CSVD) and white matter hyperintensities (WMHs). A linear regression analysis was used to clarify the relationship between serum CyPA and MMP-9 levels and the degree of cognitive impairment in patients with OSA.Results: The 186 patients who met the criteria for inclusion and exclusion comprised 71 patients with OSA presenting with MCI (OSA + MCI), 73 patients with OSA without MCI (OSA-MCI), and 42 controls. Patients with OSA + MCI presented higher serum CyPA and MMP-9 levels than patients in the OSA-MCI (11.56 +/- 4.52 ng/ml vs 9.95 +/- 3.63 ng/ml, p = 0.020; 597.71 +/- 204.41 ng/ml vs 523.05 +/- 205.47 ng/ml, p = 0.030) and control groups (11.56 +/- 4.52 ng/ml vs 8.80 +/- 3.71 ng/m, p = 0.001; 597.71 +/- 204.41 ng/ml vs 490.39 +/- 155.07 ng/ml, p = 0.002). The logistic regression analysis revealed that both CyPA (OR: 1.111, 95% CIs: 1.012-1.219, p = 0.027) and MMP-9 levels (OR: 1.003, 95% CIs: 1.000-1.004, p = 0.011) contributed significantly to MCI in patients with OSA. In the OSA + MCI group, positive correlations were observed between serum CyPA and MMP-9 levels with Scheltens scores (r = 0.437, p = 0.000; r = 0.613, p = 0.000, respectively) and total CSVD burden scores (r = 0.318, p = 0.003; r = 0.487, p = 0.000, respectively). Serum CyPA and MMP-9 levels were linearly negatively correlated with mean oxygen saturation during sleep (mean SaO2) (r =-0.595, p = 0.000; r =-0.570, p = 0.000). There was linear correlation between mean SaO2 and MoCA scores by Pearson's correlation coefficient (r = 0.403, p = 0.000). The linear regression analysis revealed negative correlations between serum CyPA and MMP-9 levels and the Montreal Cognitive Assessment (MoCA) scores (r =-0.528, p = 0.000; r =-0.459, p = 0.000, respectively), and serum CyPA levels were negatively correlated with score of cognitive subdomainss, including visuo-executive function, attention and delayed recall. However, serum MMP-9 levels were negatively correlated with score of cognitive subdomains, including visuo-executive function and delayed recall.Conclusions: Increased serum levels of CyPA and MMP-9 are associated with MCI in OSA patients and directly related to the severity of CSVD and WMHs. The results suggest that damage to the blood-brain barrier (BBB) may be involved in the early stages of cognitive impairment in patients with OSA.(c) 2021 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    The association of saccadic abnormalities with rem sleep in patients with Huntington's disease

    Annapureddy, JagadishRay, SomdattaaKamble, NitishKumar, Gulshan...
    6页
    查看更多>>摘要：Background: Huntington's disease (HD) is a progressive neurodegenerative disorder characterised by chorea, cognitive impairment, psychiatric and behavioral disturbances. Sleep disturbances including reduced REM sleep have been observed in HD. Objectives: The aim of the study was to study the polysomnography findings in HD and to assess whether oculomotor abnormalities are associated with poor REM sleep. Methods: Twenty-nine genetically confirmed HD patients underwent clinical evaluation including extraocular movement and OKN examination. Twenty-six patients and 15 controls underwent overnight video polysomnography (VPSG). Results: VPSG of 23 HD patients and 13 controls were considered for analysis. Compared to controls, HD patients had higher median wake period and higher WASO percentage (p = 0.005). REM sleep percentage was reduced significantly in HD in comparison to controls (p < 0.001). Out of 23 patients, only two patients had REM sleep above 20% while 14 patients had REM sleep percentage less than 15%. Poor horizontal OKN (grades 2 and 3) was associated with the presence of low REM sleep percentage (REM sleep less than 15%) (p = 0.02). Low REM sleep was also associated with severe illness (UHDRS) (p = 0.038). Conclusion: An association between decreased REM sleep and OKN abnormalities indicate that EOM abnormalities seen in HD could lead to errors in scoring REM sleep. To understand the actual degree of decreased REM sleep percentage will require additional parameters in AASM guidelines to score REM sleep in patients with EOM abnormalities like that seen in HD.(c) 2021 Elsevier B.V. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier