查看更多>>摘要：Study objectives: Our study examined the association between insomnia, and cognitive as well as functional outcomes in a cohort of ischemic stroke patients. We evaluated which stroke features were associated with the development of post-stroke insomnia and how it might affect stroke prognosis. Methods: 157 ischemic stroke patients were retrospectively evaluated during their hospitalization in a Portuguese Stroke Unit and re-assessed two years afterwards, at a follow up appointment. We collected data including clinical variables, vascular risk factors, insomnia developed after stroke, use of psychotropic drugs, further sleep studies, specific measures of cognitive function, severity of stroke, and functional performance. Results: Mean age of study participants was 69.54 +/- 12.71 years and 48.4% were male. Post stroke insomnia was diagnosed in 45/157 (28.6%) of patients. Compared to those subjects with no evidence of insomnia, insomnia was associated with worse neurological severity, lower functional independence and higher disability scores at admission and follow up. Male gender (p = 0.006) and previous minor vascular events (p = 0.013) were significantly associated with the development of insomnia after ischemic stroke. There were no significant differences between development of insomnia in patients suffering from anterior circulation stroke when compared with those of the posterior circulation. Conclusion: Insomnia may have a negative influence on neurological recovery from ischemic stroke, and it seems to associate with worse functional and cognitive outcome of these patients. Screening and appropriate management of post-stroke insomnia should become part of the therapeutic strategy to optimize outcomes of this potentially devastating disease. (C) 2022 Elsevier B.V. All rights reserved.
查看更多>>摘要：Importance and study objective: Emotion plays an important role in sleep quality, meanwhile, poor sleep quality is usually correlated with high negative emotions (NES). However, less is known about the neural basis for NES and the underlying mechanism for how NES affect individuals' sleep quality in the health brain. The present study combined voxel-based morphometry and resting-state functional connectivity analysis to identify the relationship between brain regions and NES, and then explored how NES-related brain structures are related to sleep quality in a large sample of normal young adults. Design and participants: The present study used a fMRI procedure. Participants were 339 normal young adults. The NES was represented by the principal components of four measures: the Self-rating Anxiety Scale, Self-rating Depression Scale, Negative Affect Schedule, and Psychosomatic Tension Relaxation Inventory. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Results: Results showed that higher NES scores were associated with larger regional gray matter volume (rGMV) in the left parahippocampal gyrus, right superior temporal gyrus, and right postcentral gyrus. Further functional connectivity analysis demonstrated that the connectivity between these three brain regions and a specific set of emotion-related regions was also significantly associated with NES scores. Moreover, NES acted as a mediator of the relationship between the rGMV of the left parahippocampal gyms, right superior temporal gyrus, and right postcentral gyrus and sleep quality. NES also mediated the relationship between the connectivity between the right superior temporal-supplementary motor area and the right superior temporal-right precentral gyrus and sleep quality. Conclusion: The present study provides the further evidence for neural substrates of NES and reveals a potential mechanism that NES mediates the effect of spontaneous brain activity on sleep quality. Meanwhile, these findings indicate that negative emotions share a common brain structure and function based on sleep quality. (C) 2022 Elsevier B.V. All rights reserved.
Akyildiz, Utku OganTezer, F. IrselKoc, GurayIsmailogullari, Sevda...
9页
查看更多>>摘要：Introduction: Narcolepsy type 1 (NT1) is caused by hypocretin deficiency, the pathophysiology of narcolepsy type 2 (NT2) has not been delineated. Except for the hypocretin deficiency and cataplexy, all clinical and laboratory features used in the diagnosis of NT2 are identical to those used for NT1. The aim of this study was to assess the rapid eye movement (REM) sleep-related characteristics in the patients with narcolepsy; the characteristics of REM sleep in polysomnography (PSG) and multiple sleep latency test (MSLT) recordings, the quantification of REM sleep without atonia (RSWA) and atonia index, and the analysis of rapid eye movements (REMs) during REM sleep. Materials and methods: This study was planned by the Sleep Medicine Study Group of the Turkish Neurology Society, and conducted in 11 centers in eight cities in Turkey. The analysis of RSWA was analyzed by reviewing all REM sleep periods on nocturnal PSG and MSLT recordings per standard criteria. The total duration of the increased muscle tone during REM sleep in the chin and bilateral leg electromyography (EMG) recordings was calculated as RSWA index. The REMs index was also investigated the relation to the RSWA. Results: A total of 274 patients were involved; 147 patients (53.6%) were males and 127 patients (46.4%) were females; the mean age was 29.1 +/- 12.0 years. The diagnosis of NT1 was made in 166 patients (60.6%), and 108 patients (39.4%) were diagnosed as having NT2. The mean Epworth sleepiness scale score was significantly higher in patients with NT1 than the patients with NT2 (P = 0.001). The diagnosis of REM sleep behavior disorder (RBD) was made in 19.3% of the patients with NT1 versus in 2.8% of the patients with NT2 (P < 0.001). The percentage of SOREMP in PSG recordings was significantly higher in patients with NT1 (37.1%) than those with NT2 (18.9%, P = 0.001). MSLT showed that the mean sleep latency was shorter in patients with NT1 compared to those with NT2 (P < 0.001). The total duration of REMs on electrooculography recordings was also significantly higher in patients with RSWA in comparison with the patients without RSWA (P = 0.002). Total duration of REMs was significantly and positively correlated with the duration of RSWA on chin-EMG and leg-EMG recordings (P = 0.001). ROC analyses showed an RSWA index of >= 2% for the RSWA on chin-EMG with a sensitivity of 86.7% and a specificity of 71.3% (P < 0.001). The REMs index >= 20% was associated with the presence of RSWA with a sensitivity of 70.0% and a specificity of 57.1% (P = 0.008). Conclusions: In this nation-wide study, we identified for the first time that the increase in REMs density during REM sleep may be a major correlate of the RSWA. Significant positive correlations were demonstrated between the total duration of REMs on electrooculography recordings and the mean durations of RSWA in both chin and leg EMG recordings. A REMs index of >20% was demonstrated to have a moderate sensitivity and specificity in the diagnosis of RSWA. As observed in chin RSWA index, REMs index also showed a significantly high association with RBD, in comparison to RSWA per standard criteria. (C) 2022 Elsevier B.V. All rights reserved.
查看更多>>摘要：Restless legs syndrome (RLS) is a common sleep-related movement disorder in populations of European descent and disease risk is strongly influenced by genetic factors. Common variants have been assessed extensively in several genome-wide association studies, but the contribution of rarer genetic variation has not been investigated at this scale. We therefore genotyped a case-control set of 9246 individuals for mainly rare and low frequency exonic variants using the Illumina ExomeChip. However, standard single variant and gene-level association tests were negative. This does not preclude a role of rare variants in RLS, but is likely due to the small sample size and the limited selection of rare genetic variation captured on the array. Therefore, exome or whole genome sequencing should be performed rather than increasing the sample size of ExomeChip studies in order to identify rare risk variants for RLS. (C) 2022 Elsevier B.V. All rights reserved.
查看更多>>摘要：Objective: To characterize family and environmental correlates of sleep patterns that may contribute to differences in infant sleep. Methods: We studied 313 infants in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort. Our main exposures were the parent-reported sleep environment, feeding method and sleep parenting strategies at infant age one month. The main outcomes were nighttime sleep duration, longest nighttime sleep and number of awakenings measured by actigraphy at age six months. We used multivariable linear regression models to examine associations, and secondarily also explored the role of sleep-related environmental exposures in mediating previously observed associations of racial/ethnicity and parental education with infant sleep characteristics. Results: In adjusted models, a non-dark sleep environment (versus an always dark sleep location) and taking the baby to parent's bed when awake at night (versus no co-sleeping) were associated with 28 (95% CI, -45, -11) and 18 (95% CI, -33, -4) minutes less sleep at night, respectively. Bottle feeding at bedtime was associated with 62 (95% CI, 21, 103) minutes additional longest nighttime sleep period. Exploratory mediation analyses suggested a modest mediating role of a non-dark sleep environment on racial/ethnic and educational differences in sleep duration. Conclusions: Infant sleep duration was positively associated with a dark sleep environment and a focal feed at bedtime while taking the baby to the parent's bed was associated with reduced infant sleep. Modifying the sleep environment and practices may improve infant sleep and reduce sleep health disparities. (C) 2022 Elsevier B.V. All rights reserved.
查看更多>>摘要：Objective/background: To examine the impact of prostate cancer (PCa) on sleep health for patients and caregivers. We hypothesized that sleep disturbances and poor sleep quality would be prevalent among patients with PCa and their caregivers. Patients/methods: A systematic literature search was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis guidelines. To be eligible for this systematic review, studies had to include: (1) patients diagnosed with PCa and/or their caregivers; and (2) objective or subjective data on sleep. 2431 articles were identified from the search. After duplicates were removed, 1577 abstracts were screened for eligibility, and 315 underwent full-text review. Results and conclusions: Overall, 83 articles met inclusion criteria and were included in the qualitative synthesis. The majority of papers included patients with PCa (98%), who varied widely in their treatment stage. Only 3 studies reported on sleep among caregivers of patients with PCa. Most studies were designed to address a different issue and examined sleep as a secondary endpoint. Commonly used instruments included the Insomnia Severity Index and European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaires (EORTC-QLQ). Overall, patients with PCa reported a variety of sleep issues, including insomnia and general sleep difficulties. Both physical and psychological barriers to sleep are reported in this population. There was common use of hypnotic medications, yet few studies of behavioral interventions to improve sleep for patients with PCa or their caregivers. Many different sleep issues are reported by patients with PCa and caregivers with diverse sleep measurement methods and surveys. Future research may develop consensus on validated sleep assessment tools for use in PCa clinical care and research to promote facilitate comparison of sleep across PCa treatment stages. Also, future research is needed on behavioral interventions to improve sleep among this population. (C) 2022 Elsevier B.V. All rights reserved.
查看更多>>摘要：Study objective: To compare sleep behavior before and during pregnancy. Methods: In this prospective cohort study, healthy women were followed from pre-pregnancy until delivery. At pre-pregnancy and each trimester, participants completed validated questionnaires of chronotype and sleep quality and timing, including the Munich ChronoType Questionnaire, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index. The primary outcomes were sleep period start and end times, sleep duration, sleep midpoint, and social jetlag, compared between pre-pregnancy and each trimester. Wrist actigraphy was used to measure the same outcomes in a subset of participants. Results: Eighty-six women were included in analysis of questionnaires. Of these, 37 provided complete actigraphy data. Questionnaire and actigraphy data indicate that participants had less social jetlag during pregnancy than before pregnancy. Sleep period start times were earlier on both work and free days in the first and second trimesters than pre-pregnancy, and returned to pre-pregnancy times by the third trimester. Actigraphy data revealed that, compared to pre-pregnancy, participants had longer sleep periods in all trimesters on work days and in the first trimester on free days. Sleep surveys revealed that participants had poorer sleep quality in the first and third trimesters and more sleepiness in the first trimester than pre-pregnancy. Conclusion: The first trimester of pregnancy is characterized by earlier sleep period start time, longer sleep duration, and poorer sleep quality than pre-pregnancy. Sleep quality temporarily improves in the second trimester, and sleep period start time returns to pre-pregnancy time by the third trimester. Study rationale: Multiple parameters of sleep have been studied in the context of pregnancy and pregnancy outcomes, but rarely in comparison to pre-pregnancy or longitudinally through pregnancy. Study impact: Actigraphy and questionnaire data reveal sleep timing and quality change throughout pregnancy. These data on sleep changes in healthy pregnancy can be used as a baseline to identify sleeprelated risk factors throughout pregnancy. (C) 2022 Elsevier B.V. All rights reserved.
Maier, Lars S.Arzt, MichaelBuchner, StefanWester, Michael...
7页
查看更多>>摘要：Background: Left ventricular diastolic dysfunction is a predictor of adverse outcome after acute myocardial infarction (AMI). We aimed to test if sleep-disordered breathing (SDB) contributes to the development of diastolic dysfunction in patients with preserved left ventricular ejection fraction after AMI. Method: Patients with AMI, percutaneous coronary intervention and an ejection fraction >= 50% were included in this sub-analysis of a prospective observational study. Patients with AMI (n = 41) underwent cardiovascular magnetic resonance imaging (volume-time curve analysis) to define diastolic function by means of the normalised peak filling rate [nPFR; (end diastolic volume/second)]. In patients with AMI, the nPFR was assessed within <5 days and three months after AMI. Patients with AMI were stratified in patients with (apnoea-hypopnoea index, AHI >= 15/h) and without (AHI <15/h) SDB as assessed by polysomnography. Results: At the time of AMI, the nPFR was similar between patients with and without SDB (2.90 +/- 0.54 vs. 3.03 +/- 1.20, p = 0.662). Within three months after AMI, diastolic function was significantly lower in patients with SDB than in patients without SDB (AnPFR: -0.83 +/- 0.14 vs. 0.03 +/- 0.14; p < 0.001; ANCOVA, adjusted for baseline nPFR). In contrast to central AHI, obstructive AHI was associated with a lower nPFR three months after AMI, after accounting for established risk factors for diastolic dysfunction [multiple linear regression analysis, B (95%CI): -0.036 (-0.063 to -0.009), p = 0.011]. Conclusion: Our data indicate that obstructive sleep apnoea impairs diastolic function early after myocardial infarction. (C) 2022 The Authors. Published by Elsevier B.V.
Reffi, Anthony N.Kalmbach, David A.Cheng, PhilipJovanovic, Tanja...
6页
查看更多>>摘要：Background: Survivors of childhood abuse are prone to adult insomnia, but the mechanisms for this development are poorly understood. Abuse that occurs during sensitive developmental periods might affect risk for insomnia by impacting emerging stress regulatory processes. Sleep reactivity refers to the sensitivity of the sleep system to stress and is a robust risk factor for insomnia. Recent evidence shows stress exposure itself worsens sleep reactivity, thereby increasing insomnia vulnerability. In this preliminary study, we hypothesized the association between childhood abuse experiences and adult insomnia would be mediated through greater sleep reactivity. Methods: Community adults were recruited from the United States during the COVID-19 pandemic between June 2020 and June 2021 (N = 241, 88% female, M-age = 39, SD = 13.40). Participants completed a cross-sectional survey that included the Childhood Trauma Questionnaire, Ford Insomnia Response to Stress Test, Insomnia Severity Index, and a measure of general COVID-19 stress. Results: Reporting more frequent childhood emotional, physical, or sexual abuse was associated with more severe insomnia during the COVID-19 pandemic. Only childhood emotional and physical (but not sexual) abuse histories were associated with greater sleep reactivity, which exerted an indirect effect on the relationships between these two abuse types and insomnia symptoms. These findings were robust to the effects of gender, age, and stress about the COVID-19 pandemic. Conclusions: This preliminary study suggests recurrent emotional and physical abuse in childhood might promote later insomnia through heightened sleep reactivity. Stress management interventions could be important to prevent insomnia for abuse survivors by bolstering resilience of the sleep system. (C) 2022 Elsevier B.V. All rights reserved.
查看更多>>摘要：Objective: The purpose of our study was to investigate the correlation between neural-derived plasma exosomal amyloid-beta (A beta)42, total tau (T-tau) and tau phosphorylated at threonine 181 (P-T181-tau) protein levels and cognitive impairment in patients with obstructive sleep apnea (OSA). Methods: There were 122 subjects without dementia included in the study: 27 patients with OSA and mild cognitive impairment (MCI), 52 OSA patients without MCI, and 43 subjects diagnosed with simple snoring but not MCI as the control group. Neuronal-derived exosomal proteins were measured by ELISA kits for A beta 42, T-tau and P-T181-tau. The cognitive function was evaluated by a Chinese version of the Montreal Cognitive Assessment (MoCA) questionnaire, and a normal cognitive score was >= 26. Results: The exosomal A beta 42, T-tau and P-T181-tau levels in the OSA with MCI group were higher than those in the OSA group. The A beta 42, T-tau, and P-T181-tau levels in the plasma neuronal-derived exosomes were associated with an increased risk of cognitive impairment in OSA patients after additional adjustment for age, gender, education, vascular risk factors, apnea-hypopnea index (AHI) or oxygen reduction index (ODI). Furthermore, there were also significant associations between A beta 42, T-tau, and PT181-tau in neural-derived plasma exosomes and Epworth Sleepiness Scale, AHI, and ODI in OSA patients. After 1 year of continuous positive airway pressure (CPAP) intervention, the neuronal-derived exosome levels of A beta 42, T-tau, and P-T181-tau were significantly lower than those at baseline (P = 0.001, P = 0.012, and P = 0.034). Conclusions: These findings indicate that peripheral blood levels of neuronal-derived exosomal A beta and tau proteins were increased in OSA patients with cognitive impairment. CPAP interventions could possibly improve cognitive function and be associated with decreased levels of exosomal A beta and tau proteins. (C) 2022 Elsevier B.V. All rights reserved.
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