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

Investigate whether aiding sleep by online cognitive behavioral therapy for insomnia (CBT-I) can improve glycemic and metabolic control, mood, quality of life (QoL) and insomnia symptoms in people with type 2 diabetes and assess the mediating role of lifestyle factors. Adults with type 2 diabetes and insomnia symptoms were randomly assigned to CBT-I or care as usual. At baseline, three and six months we assessed HbA1c as primary outcome and glycemic control, metabolic outcomes, sleep, mood and QoL as secondary outcomes. Mixed models were used to determine within-person and between-persons differences in outcomes and mediation analysis for lifestyle factors. We randomized 29 participants to CBT-I and 28 to care as usual. Intention-to-treat analysis showed no significant differences in glycemic control, metabolic outcomes, anger, distress or QoL, but showed a significantly larger decrease in insomnia (−1.37(2.65: 0.09)) and depressive symptoms (−0.92(-1.77: 0.06)) and increase in BMI (0.29 kg/m2(0.00:0.57)) in the intervention compared to the control group. Only half of the intervention participants completed the CBT-I. Per protocol analysis showed a not statistically significant decrease in HbA1c (−2.10 mmol/l(-4.83:0.63)) and glucose (−0.39 mmol/l(-1.19:0.42)), metabolic outcomes and increase in QoL. Furthermore, the intervention group showed a significant decrease in insomnia (−2.22(-3.65: 0.78)) and depressive symptoms (−1.18(-2.17: 0.19)) compared to the control group. Lifestyle factors partially mediated the effect of the intervention. CBT-I might improve insomnia symptoms and mood, and perhaps improves glycemic control, albeit not significant, in people with type 2 diabetes and insomnia symptoms, compared to care as usual. • Insomnia symptoms are highly prevalent in people with type 2 diabetes. • Can we improve glycemic status by improving sleep through CBT-I? • CBT-I improves insomnia symptoms and mood, and might improve glycemic control and QoL. • Lifestyle factors partially mediated the effect of CBT-I. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to examine the prevalence and correlates of social jetlag (SJL) in Chinese adolescents, as well as to test the relationships between SJL and mental health problems. A total of 106979 students (M age = 13.0 ± 1.8 years; N male = 58296 [54.5 %]) from Shenzhen, China completed an online survey from May 24th to June 5th, 2022. Information on sociodemographics, lifestyles, sleep characteristics, anxiety symptoms, and depressive symptoms was collected by a self-administered questionnaire. Multivariate and binary logistic regression were adopted for data analysis. 17.8 % of participants experienced SJL ≥ 2 h. To adjust the accumulated sleep debt, sleep-corrected SJL (SJLsc) was calculated and 8.3 % of individuals self-reported SJLsc ≥ 2 h. Both SJL and SJLsc show an increasing trend with age. Risk factors of SJL included females, poor parental marital status, being overweight, physically inactive, smoking, drinking, and having a late chronotype. Moreover, males, having siblings, boarding at school, short sleep duration, experiencing insomnia, and frequent nightmares were significantly associated with an increased risk of SJLsc. After adjusting for all covariates, adolescents with SJLsc ≥ 2 h were more likely to have anxiety symptoms (OR: 1.35, 95 % CI: 1.24–1.48) and depressive symptoms (OR: 1.35, 95 % CI: 1.25–1.46) than those with SJLsc < 1 h. SJL is common among Chinese school-age adolescents. This study is valuable for the development of prevention and intervention strategies for SJL in adolescents at the population level. Additionally, the strong links between SJLsc and emotional problems underscore the critical significance of addressing SJL as a key aspect of adolescent well-being. • SJL is common among Chinese adolescents and increases with age (10–18 years). • Adolescents with SJLsc ≥ 2 h have an increased risk of anxiety and depression. • Interventions for SJL can be considered a strategy for adolescent mental health. [ABSTRACT FROM AUTHOR]

Idiopathic hypersomnia typically is a chronic and potentially debilitating neurologic sleep disorder, and is characterized by excessive daytime sleepiness. In addition to excessive daytime sleepiness, idiopathic hypersomnia symptoms can include severe sleep inertia; long, unrefreshing naps; long sleep time; and cognitive dysfunction. Patients with idiopathic hypersomnia may experience a significant impact on their quality of life, work or school performance, earnings, employment, and overall health. Given the complex range of symptoms associated with idiopathic hypersomnia and the array of treatments available, there is a need to provide guidance on the treatment of idiopathic hypersomnia and the clinically relevant recommendations that enhance effective disease management. Identifying appropriate treatment options for idiopathic hypersomnia requires timely and accurate diagnosis, consideration of individual patient factors, and frequent reassessment of symptom severity. In 2021, low-sodium oxybate was the first treatment to receive approval by the US Food and Drug Administration for the treatment of idiopathic hypersomnia in adults. However, many off-label treatments continue to be used. Adjunct nonpharmacologic therapies, including good sleep hygiene, patient education and counseling, and use of support groups, should be recognized and recommended when appropriate. This narrative review describes optimal treatment strategies that take into account patient-specific factors, as well as the unique characteristics of each medication and the evolution of a patient's response to treatment. Perspectives on appropriate symptom measurement and management, and potential future therapies, are also offered. [Display omitted] • Treatment options and strategies considering patient-specific factors are reviewed. • Low-sodium oxybate is the only FDA-approved medication for idiopathic hypersomnia. • Clinical experience in and perspectives on proper symptom management are discussed. • Interactions between medications used to treat idiopathic hypersomnia are summarized. [ABSTRACT FROM AUTHOR]

To prospectively investigate the associations of longitudinal changes in sleep score and LTPA and their combination with all-cause mortality. Among 12,543 participants (mean age: 66.1 years) from the Dongfeng-Tongji cohort, we calculated sleep score (range, 0–4, integrating bedtime, sleep duration, sleep quality, and midday napping, higher score indicating healthier sleep) and LTPA at baseline (2008–2010) and the first follow-up (2013) surveys and their 5-year changes (defining stable sleep score as no change and stable LTPA as change within 150 min/week). We prospectively documented deaths from the first follow-up survey (2013) through December 31, 2018. During a mean 5.5-year follow-up, 792 deaths occurred. The 5-year changes in sleep score and LTPA were inversely associated with all-cause mortality risk, regardless of their initial values. When assessing 5-year changes in sleep score and LTPA jointly, compared with the stable sleep score-stable LTPA group, the decreased sleep score-decreased LTPA group had a 40 % (5–85 %) higher all-cause mortality risk, whereas the increased sleep score-increased LTPA group had a 34 % (9–52 %) lower risk. The direction of the joint association was mainly driven by sleep score change. Participants maintaining sleep scores ≥ 3 and LTPA ≥ 150 min/week over 5 years had a 44 % (28–56 %) lower all-cause mortality risk. Promoting sleep hygiene and LTPA together may benefit efforts in reducing mortality risk, with particular attention to monitoring long-term sleep health. • The 5-year changes in sleep score and LTPA were inversely associated with all-cause mortality risk. • Decreased sleep scores combined with decreased LTPA were associated with a higher all-cause mortality risk. • Increased sleep scores combined with increased LTPA were associated with a lower all-cause mortality risk. • The joint association of changes in sleep score and LTPA with all-cause mortality was driven by the sleep score change. • Maintaining healthy sleep habits and sufficient LTPA together over time may benefit reducing mortality risk. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the effect of the circadian timing program (SİZAP) developed for evening-chronotype individuals with obesity on obesity management and sleep quality. This single-site, randomized controlled trial with an experimental research design was registered in ClinicalTrials.gov. It was reported in accordance with the "Consolidated Standards of Reporting Trials" (CONSORT) randomized controlled trial guidelines. The study sample consisted of 38 evening-chronotype individuals with first-degree obesity, with 19 individuals in each study group. The intervention group's sleep hygiene training was conducted and their lifestyle changes were ensured through SİZAP. The control group followed their normal daily lifestyle. No intervention was made in terms of the dietary practices of both groups. Study data were collected using the personal information form, the anthropometric measurement form, the Horne and Ostberg Morning and Evening Questionnaire (MEQ), the Impact of weight on quality of life–lite (IWQOL-lite), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the sleep diary, and the data tracked via the website and smart bracelets. It was determined that the participants in the SİZAP group had a statistically significant decrease in the anthropometric measurements and daytime sleepiness (p < 0.05). The sleep quality scores and the scores of the bodily functions sub-dimension of the quality of life scale were significantly better in the intervention group than in the control group (p < 0.05). It was found that SİZAP is effective in obesity management in evening-chronotype individuals and increases weight loss success and sleep quality. • Circadian misalignment and late timing of food intake reduce weight loss success. • Evening-chronotype individuals with obesity are less successful in adapting to weight loss treatments. • Circadian timing program according to chronotypes can be applied in obesity management. • Circadian timing program support weight loss in evening-chronotype individuals with obesity. • Circadian timing program contribute to improvement of sleep quality in evening-chronotype individuals with obesity. [ABSTRACT FROM AUTHOR]

To investigate the relationship between both self-reported and objective sleep variables and low-grade inflammation in children and adolescents with major depressive disorder (MDD) of moderate to severe symptom severity. In this cross-sectional study, we examined twenty-nine children and adolescents diagnosed with MDD and twenty-nine healthy controls (HC). Following a one-week actigraphy assessment, comprehensive sleep evaluations were conducted, including a one-night sleep EEG measurement and self-reported sleep data. Plasma high-sensitivity C-reactive protein (hsCRP) was employed as a marker to assess low-grade inflammation. No significant difference in hsCRP levels was observed between participants with MDD and HC. Furthermore, after adjusting for sleep difficulties, hsCRP exhibited no correlation with the severity of depressive symptoms. In HC, levels of hsCRP were not linked to self-reported and objective sleep variables. In contrast, depressed participants showed a significant correlation between hsCRP levels and increased subjective insomnia severity (Insomnia Severity Index; r = 0.41, p < 0.05), increased time spent in the N2 sleep stage (r = 0.47, p < 0.01), and decreased time spent in slow-wave sleep (r = − 0.61, p < 0.001). Upon additional adjustments for body mass index, tobacco use and depression severity, only the inverse association between hsCRP and time spent in slow-wave sleep retained statistical significance. Moderation analysis indicated that group status (MDD vs. HC) significantly moderates the association between slow-wave sleep and hsCRP. Our findings suggest that alterations in the architecture of slow-wave sleep may have a significant influence on modulating low-grade inflammatory processes in children and adolescents with MDD. • Evidence for a relationship between sleep and inflammation in adolescents with MDD. • Inverse association between C-reactive protein and slow-wave sleep in MDD patients. • In healthy controls, low-grade inflammation is not linked to self-reported and objective sleep. [ABSTRACT FROM AUTHOR]

Within the context of sleep, attachment is hypothesized to play a central role in regulating bedtime affect and arousal. While previous studies have suggested a link between attachment and sleep quality, a meta-analysis specifically examining this association in adults has been lacking. To address this gap, we conducted a series of multilevel meta-analyses of 28 studies on this topic. Our results indicated a correlation between attachment anxiety and an individual's own sleep quality (r = −0.16, p < 0.001), as well as their partner's sleep quality (r = −0.10, p < 0.05). There was also a negative correlation between attachment avoidance and an individual's sleep quality (r = −0.15, p < 0.001) as well as their partner's sleep quality (r = −0.16, p < 0.01). Additionally, the relationships were moderated by several variables, including age, sleep measurement, and gender. Further analysis indicated that attachment anxiety was associated with poorer subjective sleep quality (PSQI) (r = −0.23, p < 0.001), longer sleep latency (r = −0.10, p < 0.05), increased wakefulness after sleep onset (r = −0.09, p < 0.05), and greater daytime sleepiness (r = −0.20, p < 0.01). Attachment avoidance was associated with poorer self-reported sleep quality (PSQI) (r = −0.16, p < 0.001), longer time to fall asleep (r = −0.15, p < 0.05), and increased daytime sleepiness (r = −0.15, p < 0.05). In summary, the findings of the current study supported the association between attachment insecurity and poorer sleep quality in both individuals and their partners. These findings hold important implications for future interventions aimed at improving sleep quality by addressing attachment-related concerns. • Meta-Analysis reveals attachment's impact on adult sleep quality. • Attachment anxiety correlates negatively with personal and partner sleep. • Attachment avoidance linked to poorer self and partner sleep quality. • Modulating factors include age and sleep measurement method. • Results inform future sleep interventions addressing attachment issues. [ABSTRACT FROM AUTHOR]

The effect of sleep apnea treatment on reducing cardiovascular disease risk remains inconclusive. This study aims to assess if the effective apnea hypopnea index (eAHI), a measure of residual sleep apnea burden post-treatment, is a factor in determining blood pressure (BP) response to continuous positive airway pressure therapy. The eAHI integrates time on therapy, residual apnea, and % of sleep time untreated. A secondary analysis of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a randomized, controlled, parallel group assessment of continuous positive airway pressure (CPAP), oxygen and sleep hygiene. The Delta-AHI (▲AHI) was defined as the difference between baseline AHI and effective AHI at 12 weeks. Logistic and linear regression models estimated the predictors for nocturnal systolic BP change following sleep apnea therapy. One hundred and sixty-nine subjects with a mean age of 62.82 ± 6.99 years were included in the final analysis. Fifty subjects had ▲AHI ≤8/hour of sleep and 119 subjects were higher. After adjustment, baseline mean nighttime systolic blood pressure (OR 1.036, 95% CI 1.015–1.058, p: 0.001) and ▲AHI ≥8/hour (OR 2.406 , 95% CI 1.116–5.185 , p :0.025) were independent predictors for mean nighttime systolic blood pressure change >3 mm Hg. The higher effective AHI was negatively related with BNP (β: −2.564 , SE: 1.167 , p: 0.029) and positively related with troponin change (β: 0.703 , SE: 0.256 , p: 0.007). The ▲AHI was an independent predictor of the blood pressure response to sleep apnea treatment. NCT01086800. • Effective AHI is a composite metric evaluating the residual sleep apnea burden on therapy. • Gap between effective and baseline AHI predicts the blood pressure response to treatment. • Baseline severity, efficacy and duration of treatment should be focused during follow up. [ABSTRACT FROM AUTHOR]

Sleep problems often accompany ADHD and negatively affect ADHD symptoms, however, there are not enough intervention studies on sleep interventions in children with ADHD. The present study investigated the effects of sleep hygiene training (SH) and progressive muscle relaxation exercises (PMR) in children with ADHD. Method: 57 children aged 6–12 years with ADHD were randomly assigned to the SH and SH + PMR groups and completed the intervention consisting of group training and eight weeks of telephone interviews. The effects of both intervenitons were evaluated via parent, child and clinician report scales and neuropsychological tests. Results: Both interventions resulted in significant positive changes in child sleep, ADHD symptoms, functioning, neuropsychological tests and parental sleep quality. Significant differences were found between the interventions in selective attention, peer problems and anxiety scores in favor of the SH + PMR group. Conclusion: SH may have positive effects on various clinical parameters as well as sleep problems in children with ADHD. Addition of PMR to SH may lead to further improvements in anxiety, peer problems and selective attention. SH and PMR may be a useful tool in the clinical management of children with ADHD with sleep problems. • Sleep trainings are a useful in the management of ADHD with sleep problems. • Sleep trainings can improve sleep quality of not only for children but also parents. • Sleep trainings provides an increase in the quality of life and functionality level. • Sleep trainings can have a significant impact on the processing speed of ADHD. • Adding relaxation may improve anxiety, peer problems and selective attention. [ABSTRACT FROM AUTHOR]

Child developmental rate holds predictive value for early-stage developmental trajectories, yet few studies explored how sleep problems during different infancy stages impact this rate. This study aims to investigate the correlation between sleep problems and child developmental trajectories. This study utilized a prospective national cohort of 5006 children in Taiwan. The developmental inventories covering motor, cognitive, language, and socioemotional domains were collected through questionnaire-based in-person home interviews conducted at 3, 12, 24, and 36 months. Sleep problems data, encompassing bedtime regularity, sleep duration, and sleep quality, were collected at 3 and 12 months. Child developmental rate was assessed by analyzing the slope of developmental ability estimates over a period of time. Bedtime regularity and high-quality sleep at 3 and 12 months were found to be significantly associated with intercepts across all domains (estimate = −0.196∼0.233, p < 0.033). Children with high-quality sleep at 3 months showed enhanced developmental slopes in socioemotional domains (estimate = 0.032, p < 0.001). Atypical sleep duration at 3 and 12 months had differential detrimental association with child development in various domains (estimate = −0.108∼-0.016, p < 0.048). The relationship between sleep problems and child development exhibited variability based on the timing of exposure to these issues. Early exposure to low-quality sleep was significantly related to developmental functions and socioemotional developmental rate, potentially leading to increased developmental disparities as children age. Inadequate sleep duration in late infancy and excessive sleep duration in early infancy were both negatively associated with child development trajectories. Policymakers can use these findings to design targeted sleep programs for optimal child development. • The study revealed that sleep problems in different infancy stages can lead to diverse effects on child development. • Notably, exposing infants to low-quality sleep during early infancy could exacerbate developmental gaps in socioemotional domain. • Atypical sleep duration, especially insufficient sleep during late infancy and excessive sleep during early infancy, was negatively associated with child development. • Irregular bedtime and low-quality sleep during infancy were both linked to adverse child developmental functions. • The findings emphasize the importance of addressing sleep problems early on to mitigate potential developmental disparities. [ABSTRACT FROM AUTHOR]

Discrepancies between sleep diaries and actigraphy occur among individuals with insomnia. Cognitive behavioural therapy for insomnia (CBT-I) improves insomnia but the impact on discrepancy is unclear. This study examined CBT-I's effects on actigraphy-diary discrepancy and explored sleep-related beliefs and attitudes as a mediator. Participants were 108 (age M ± SD = 47.23 ± 12.42, 67.60 % female) adults with insomnia and major depressive disorder from the Treatment of Insomnia and Depression study. They were randomized to 7 sessions of CBT-I or sham Quasi-Desensitization Therapy for Insomnia (DTI), plus 16 weeks of antidepressants. Two weeks of actigraphy and sleep diary were collected at baseline, mid-treatment, end-treatment. Differences between sleep diary and actigraphy total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated. Participants completed Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) at baseline and mid-treatment. At baseline, diary (versus actigraphy) TST was shorter (1.1 ± 1.41h), whilst SOL (21.64 ± 41.25min) and WASO (17.45 ± 61.99min) were longer. Mixed effects models using daily data showed that after adjusting for age and sex, participants in the CBT-I group (versus DTI) showed greater reduction in all actigraphy-diary discrepancy domains (all p-values <.01), reductions evident from mid-treatment. Group differences on actigraphy-diary discrepancy reductions in TST, SOL, and SE (not WASO) were mediated by changes in DBAS from baseline to mid-treatment (all p-values <.05). Changes in discrepancy did not mediate insomnia symptom changes (p-values >.39). CBT-I reduced actigraphy-diary discrepancy in individuals with comorbid insomnia and depression; this reduction was associated with improved sleep-related attitudes, a therapeutic target of CBT-I. TRIAD (Treatment of Insomnia and Depression): Improving Depression Outcome by Adding Insomnia Therapy to Antidepressants. Prospectively registered with Clinical Trials (NCT00767624). MH078924, MH078961, MH079256. • Individuals with insomnia and depression reported shorter and worse sleep compared to actigraphy measures. • CBT-I reduced actigraphy-diary discrepancy in these individuals. • Discrepancy reduction was associated with improved sleep-related attitudes and beliefs. [ABSTRACT FROM AUTHOR]

To characterize sleep duration and investigate its association with quality of life among Parkinson's Disease (PD) patients. In this multicenter cross-sectional study, 970 PD patients were divided into five groups based on self-reported sleep duration: <5, ≥5 to <6, ≥6 to <7, ≥7 to ≤8, and >8 h. The quality of life was evaluated using the 39-Item Parkinson's Disease Questionnaire (PDQ-39). Multivariable linear regression analysis, subgroup analysis, and mediation analysis were conducted to examine the association between sleep duration and quality of life. In multivariable linear regression model, patients with sleep duration (<5 h) had significantly higher PDQ-39 scores (β = 8.132, 95 % CI: 3.99 to 12.266), especially in mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort (p < 0.05). The association between sleep duration (<5 h) and worse quality of life was more pronounced in patients with higher HY stage, longer disease duration, and sleep disorders. Moreover, a significant indirect effect of sleep duration (<5 h) on quality of life was observed, with UPDRS I, UPDRS II, and UPDRS IV scores acting as mediators. Short sleep duration (<5 h) is associated with worse quality of life among PD patients. This association was stronger among patients with advanced PD and sleep disorders, while non-motor symptoms and motor complications were identified as significant mediators in this association. These findings highlight the significance of adequate sleep duration and suitable interventions for sleep may help improve quality of life. • There is a high prevalence of short sleep duration among PD patients. • There is a significant association between short sleep duration (<5 h) and a decline in quality of life. • Non-motor symptoms and motor complications were identified as significant mediators in this association. [ABSTRACT FROM AUTHOR]

Insomnia represents a significant public health burden, with a 10% prevalence in the general population. Reduced sleep affects social and working functioning, productivity, and patient's quality of life, leading to a total of $100 billion per year in direct and indirect healthcare costs. Primary insomnia is unrelated to any other mental or medical illness; secondary insomnia co-occurs with other underlying medical, iatrogenic, or mental conditions. Epidemiological studies found a 40-50% comorbidity prevalence between insomnia and psychiatric disorders, suggesting a high relevance of mental health in insomniacs. Sleep disturbances also worsen the outcomes of several psychiatric disorders, leading to more severe psychopathology and incomplete remission, plausibly contributing to treatment-resistant conditions. Insomnia and psychiatric disorder coexistence can lead to polypharmacy, namely, the concurrent use of two or more medications in the same patient, regardless of their purpose or rationale. Polypharmacy increases the risk of using unnecessary drugs, the likelihood of drug interactions and adverse events, and reduces the patient's compliance due to regimen complexity. The workup of insomnia must consider the patient's sleep habits and inquire about any medical and mental concurrent conditions that must be handled to allow insomnia to be remitted adequately. Monotherapy or limited polypharmacy should be preferred, especially in case of multiple comorbidities, promoting multipurpose molecules with sedative properties and with bedtime administration. Also, non-pharmacological interventions for insomnia, such as sleep hygiene, relaxation training and Cognitive Behavioral Therapy may be useful in secondary insomnia to confront behaviors and thoughts contributing to insomnia and help optimizing the pharmacotherapy. However, insomnia therapy should always be patient-tailored, considering drug indications, contraindications, and pharmacokinetics, besides insomnia phenotype, clinical picture, patient preferences, and side effect profile. • Insomnia is a significant public health burden, affecting 10% of the adults. • There is a 40-50% comorbidity prevalence between insomnia and psychiatric disorders. • Psychiatric polypharmacy is a rising issue and comorbid insomnia can aggravate it. • Multipurpose drugs could be employed to treat both the mental disorder and insomnia. • Non-pharmacological interventions can be helpful in optimizing the pharmacotherapy. [ABSTRACT FROM AUTHOR]

Patients with multiple sclerosis (MS) frequently report sleep complaints. The ketogenic diet (KD) is safe and tolerable in MS patients. Our aim was: 1) to investigate the effects of KD on sleep complaints in patients affected by relapsing-remitting MS and 2) to verify if sleep changes can positively impact on psychological status and quality of life (QoL) in these patients. From January 2020 to November 2022, we consecutively enrolled 21 non-disabled or minimally disabled MS patients. We collected information regarding: 1) anthropometric measures; 2) psychological status by the Depression Anxiety Stress Scale-21; 3) QoL by the Multiple Sclerosis Quality of Life-54 (MSQOL-54); 4) subjective sleep complaints, i.e. sleep quality, by the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness (EDS), by the Epworth Sleepiness Scale (ESS). After 6 months of KD therapy, anthropometric measures considerably changed, psychological status significantly improved, and almost all the MSQOL-54 subscales ameliorated. Regarding sleep, we observed that the global PSQI (T0: 7.7 ± 3.1 versus T1: 4.4 ± 3.1, p = 0.002) and the ESS (T0: 7.5 ± 3.9 versus T1: 4.9 ± 3.2, p = 0.001) scores significantly decreased after KD therapy. At T1, only the global PSQI score was an independent predictor of anxiety, stress, and mental health. For the first time, we demonstrated that KD may improve sleep complaints in MS patients. In addition, KD seems to have a positive impact on psychological status and QoL of MS patients, mainly through improving sleep quality. Further controlled studies with larger sample sizes are needed to confirm these preliminary results. • Patients with multiple sclerosis frequently report sleep complaints. • Although ketogenic diet is safe and tolerable in patients with multiple sclerosis, data on its effects on sleep are lacking. • After ketogenic diet, patients reported lower prevalence of poor sleep quality and daytime somnolence. • Ketogenic diet improved psychological status and quality of life as well. • Ketogenic diet positively impacted on psychological status and QoL of MS patients, mainly through improving sleep quality. [ABSTRACT FROM AUTHOR]

Growing evidence suggests concordance between parent and youth sleep. However, no known study has simultaneously examined concordance among siblings' sleep patterns. This study investigated daily and average concordance in (1) parent-youth and (2) sibling actigraphy-measured sleep, as well as the degree to which sibling concordance varied by sleeping arrangements. 516 twin siblings (M age = 10.74, 51% female; 30% monozygotic (MZ) twin pairs, 37% same-sex dizygotic pairs (DZ-ss), 33% opposite-sex DZ pairs (DZ-os)) and their primary caregivers (M age = 40.59, 95% female) wore wrist-based accelerometers for 7 consecutive nights to measure sleep duration, efficiency, midpoint time, and latency. Primary caregivers also reported on demographics, youth pubertal status, and room-sharing. Two-level multilevel models were estimated to examine daily and average concordance in parent-youth and sibling sleep. Daily concordance was observed between parent and youth sleep duration and midpoint; average concordance was found for sleep duration, midpoint, and latency. Within sibling dyads, daily and average concordance was evident across all sleep parameters (duration, efficiency, midpoint, latency), with generally stronger concordance patterns for MZ than DZ twin pairs, and for twins who shared a room with their co-twin. This is the first known study to document concordance among parent-youth and siblings' actigraphy-measured sleep within the same study (i.e., triad). Our findings can help inform the development of family-level interventions targeting daily and overall sleep hygiene. • Parent-child and sibling sleep behaviors were similar at the daily and average level. • Sleep duration and midpoint time were more consistently related within families. • Sibling concordance was stronger among monozygotic twins and twins who shared rooms. • Family-level interventions targeting sleep hygiene may improve adolescent sleep. [ABSTRACT FROM AUTHOR]

Non-rapid eye movement (NREM) parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted to summarize the range of behavioral and psychological interventions and their efficacy. We conducted a systematic search of the literature to identify all reports of behavioral and psychological treatments for NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). This review was conducted in line with PRISMA guidelines. The protocol was registered with PROSPERO (CRD42021230360). The search was conducted in the following databases (initially on March 10, 2021 and updated February 24, 2023): Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), PsycINFO (EBSCO), and Web of Science (Clarivate). Given a lack of standardized quantitative outcome measures, a narrative synthesis approach was used. Risk of bias assessment used tools from Joanna Briggs Institute. A total of 72 publications in four languages were included, most of which were case reports (68%) or case series (21%). Children were included in 32 publications and adults in 44. The most common treatment was hypnosis (33 publications) followed by various types of psychotherapy (31), sleep hygiene (19), education/reassurance (15), relaxation (10), scheduled awakenings (9), sleep extension/scheduled naps (9), and mindfulness (5). Study designs and inconsistent outcome measures limited the evidence for specific treatments, but some evidence supports multicomponent CBT , sleep hygiene, scheduled awakenings, and hypnosis. This review highlights the wide breadth of behavioral and psychological interventions for managing NREM parasomnias. Evidence for the efficacy of these treatments is limited by the retrospective and uncontrolled nature of most research as well as the infrequent use of validated quantitative outcome measures. Behavioral and psychological treatments have been studied alone and in various combinations, and recent publications suggest a trend toward preference for multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias. [Display omitted] • 72 publications reported behavioral and psychological treatments for NREM parasomnias (1909–2023). • Most have been case reports (68%) or case series (21%). • Hypnosis and psychotherapies were the most common treatments reported. • Evidence for specific treatments is limited by study designs and measurement methods. • Multicomponent cognitive behavioral therapy is emerging as a favored approach. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of sleep disturbances (SDs), their related comorbidities, interventions and the impact on the family for individuals with current SDs and those who had SDs in the past. Members of the Italian national association of parents of persons with autism (ANGSA) completed an anonymous online survey collecting demographic data, the presence of comorbidities and specific information on sleep arrangement and sleep disorders using a modified version of the of the Sleep Disturbance Scale for Children (SDSC). The final sample consisted of 143 participants, 90 patients presented current SDs (C_SDs) and 53 reported previous SDs (P_SDs). In the C_SDs group, the most prevalent sleep disorders were related to insomnia and, especially, difficulty falling asleep; a high number of individuals presented with restless sleep. Also, the parents in the P_SDs group retrospectively reported a high prevalence of insomnia with difficulty falling asleep, night awakenings and restless sleep. Parents reported that sleep hygiene practice were effective in less than one third of cases in both groups and the most used compound was immediate-release melatonin, followed by antihistamines and then benzodiazepines, antipsychotics, and antidepressants, with approximately 60–70% reported efficacy. Parents of both groups reported that insomnia negatively affected their children behavior and caused stress, mood changes or physical fatigue in their daily life. Our study shows that insomnia is most prevalent in individuals with autism with several consequences on children and family behavior and quality of life. As reported by parents, melatonin might be helpful for sleep disturbances in these children and the causes of restless sleep need further investigations. • We studied two groups of autistic subjects with current sleep disturbances (SDs) and previous SDs. • In both groups, the most prevalent sleep disorders were insomnia and restless sleep. • Sleep hygiene practice were effective in less than one third of cases in both groups. • Most used drugs were melatonin, antihistamines, benzodiazepines, antipsychotics, and antidepressants. • Insomnia negatively affected child behavior and stress, mood changes and fatigue in parents. [ABSTRACT FROM AUTHOR]

Various digital sleep interventions have been implemented to address sleep and psychological complications during the coronavirus disease 2019 (COVID-19) pandemic. However, the characteristics and effectiveness of digital sleep interventions on sleep and psychological outcomes for people with sleep problems during the COVID-19 pandemic are unknown. The protocol of this systematic review and meta-analysis was registered on PROSPERO (ID: CRD42022325662), seven databases were searched from December 2019 to June 2023. Reference lists from digital sleep reviews were also identified and selected. Two reviewers independently screened eligible articles and extracted data. Quality appraisal was undertaken by two independent reviewers using the Cochrane Risk-of-Bias Tools. Data synthesis was conducted using fixed- or random-effects model based on the results of the heterogeneity test. A total of 20 studies were identified, including nine randomised controlled trials (RCTs) and 11 non-RCTs, involving 3860 participants. Meta-analyses showed that digital sleep interventions significantly improve sleep quality, insomnia, and depression during the COVID-19 pandemic. Subgroup analysis showed that interventions of more than four weeks, healthcare workers as participants, and relaxation therapies may have the advantage of improving sleep quality. Most non-RCTs supported the efficacy of digital sleep interventions on sleep and psychological health. Digital sleep interventions during the COVID-19 pandemic had significant effectiveness in improving sleep and psychological outcomes for people with sleep problems. More structured and personalised digital sleep interventions should be designed, and other diverse digital technologies could be used to improve sleep and psychological disorders. • The COVID-19 pandemic has caused a higher risk of sleep disorders and increased psychological problems. • Digital sleep interventions significantly improve sleep quality, insomnia, and depression during the COVID-19 pandemic. • Longer intervention duration, healthcare providers as participants, and relaxation therapy may have more benefits on sleep. • Future research could further explore the role of digital technologies in sleep assessment, management, and resources sharing. [ABSTRACT FROM AUTHOR]

Digital cognitive behavioral therapy for insomnia (dCBT-I) improves several sleep and health outcomes in individuals with insomnia. This study investigates whether changes in Dysfunctional Beliefs and Attitudes about Sleep (DBAS) during dCBT-I mediate changes in psychological distress, fatigue, and insomnia severity. The study presents a secondary planned analysis of data from 1073 participants in a randomized control trial (Total sample = 1721) of dCBT-I compared with patient education (PE). Self-ratings with the Dysfunctional Beliefs and Attitudes about Sleep (DBAS), the Hospital Anxiety Depression Scale (HADS), the Chalder Fatigue Scale (CFQ), and the Insomnia Severity Index (ISI) were obtained at baseline and 9-week follow-up. Hayes PROCESS mediation analyses were conducted to test for mediation. sDBAS scores were significantly reduced at 9-week follow-up for those randomized to dCBT-I (n = 566) compared with PE (n = 507). The estimated mean difference was −1.49 (95% CI -1.66 to −1.31, p <.001, Cohen's d. = 0.93). DBAS mediated all the effect of dCBT-I on the HADS and the CFQ, and 64% of the change on the ISI (Estimated indirect effect −3.14, 95% CI -3.60 to −2.68) at 9-week follow-up compared with PE. Changes in the DBAS fully mediated the effects of dCBT-I on psychological distress and fatigue, and the DBAS partially mediated the effects on insomnia severity. These findings may have implications for understanding how dCBT-I works and highlights the role of changing cognitions in dCBT-I. • Need to identify mechanisms of action of Digital cognitive behavioral therapy for insomnia (dCBT-I). • Dysfunctional Beliefs and Attitudes about sleep (DBAS) mediated all the observed changes on the HADS and the CFQ. • DBAS partly mediated the change in the ISI (64%) after dCBT-I. • Changing cognitions is essential for the effectiveness of dCBT-I. [ABSTRACT FROM AUTHOR]

This paper summarizes the position statement of the World Sleep Society (WSS) International Guidelines Committee regarding the Clinical Practice Guidelines on the Behavioral and Psychological Treatments for Chronic Insomnia Disorder in Adults prepared by a task force of the American Academy of Sleep Medicine (AASM). The practice guidelines were reviewed for their relevance and applicability to the practice of sleep medicine around the world. The WSS Work Group endorsed the AASM strong recommendation for Multicomponent Cognitive Behavioral Therapy as the treatment of choice for Insomnia Disorder and conditional endorsement for its single-therapy components (sleep restriction, stimulus control, relaxation); use of sleep hygiene education as single therapy was not endorsed due to lack of evidence for its efficacy. The strong recommendation for multicomponent CBT-I applied to patients with chronic insomnia disorder with or without comorbid psychiatric and medical conditions. Main caveats with regard to CBT-I remains the lack of adequately trained therapists and variability in terms of training available in different parts of the world. Unanswered questions about the applicability, availability, accessibility and potential sociodemographic (age, sex, ethnicity, regions) moderators of treatment outcomes were discussed. Despite growing evidence documenting the benefits of digital CBT-I, individual, in-person CBT-I delivered by a trained professional (mental health) provider is regarded as the optimal method to deliver CBT-I. • Insomnia is a highly prevalent condition with long-term adverse health outcomes. Insomnia is often a persistent condition. • CBT-I was recognized as first-line therapy in an AASM Clinical Practice Guidelines, a recommendation endorsed by the World Sleep Society. [ABSTRACT FROM AUTHOR]

Sleep difficulty is an unmet public health concern affecting a vast proportion of the world's population. Poor sleep duration (short or long sleep length) and quality affect more than half of older people. Sleep difficulty is associated with negative health outcomes such as obesity and reduced longevity. We aimed to assess whether poor sleep duration and quality are significant risk factors for obesity in adults aged 15 and over in Australia by examining a nationally representative panel data. We used three waves (waves 13, 17, and 21) of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey data. The study applied generalized estimating equations (GEE) logistic regression model to assess the relationship between sleep duration and quality with obesity. The study found that the odds of being obese was significantly higher amongst the study participants with poor sleep duration (adjusted odds ratio [aOR]: 1.24, 95% confidence interval [CI]: 1.16–1.32) and poor sleep quality (aOR: 1.29, 95% CI: 1.02–1.38) compared with their counterparts who had good sleep duration and quality, respectively. Having short or long sleep at night and poor sleep quality are associated with an increased risk of obesity. Obesity poses a significant threat to the health of Australian adults. Enacting policies that raise public awareness of the significance of good sleep hygiene and encouraging healthy sleeping habits should be considered to address the alarming rise in the obesity rate. • Having short or long sleep at night is associated with an increased risk of obesity. • Poor sleep quality is also associated with a greater risk of being obese. • Interventions that improve sleep hygiene and promote healthy sleeping patterns may be an effective obesity prevention strategy. [ABSTRACT FROM AUTHOR]

To examine social class discrimination as a mediator of socioeconomic disparities in sleep outcomes in an adolescent sample. Sleep was assessed from established actigraphy (efficiency, long wake episodes, duration) and self-report (sleep/wake problems, daytime sleepiness) measures among 272 high school students in the Southeastern region of the United States (35% low income; 59% White, 41% Black, 49% female, Mean age = 17.3, SD = 0.8). Social class discrimination was assessed using a new measure, the Social Class Discrimination Scale (SCDS; 22-items), and an established measure, the Experiences of Discrimination Scale (EODS; 7-items). Socioeconomic disadvantage (SED) was measured as an aggregate of six indicators. The SCDS was associated with sleep efficiency, long wake episodes, sleep/wake problems and daytime sleepiness (but not sleep duration), and significantly mediated the socioeconomic gradient in each sleep outcome. Black males experienced higher levels of social class discrimination than Black females, White males, or White females. A race by gender moderation effect was evident for two of the five sleep outcomes (sleep efficiency and long wake episodes) suggesting a stronger association between social class discrimination and sleep problems for Black females than White females but no clear race differences among males. The EODS was not associated with objective sleep outcomes or SED but was associated with self-reported sleep and showed a similar pattern of moderation effects. Findings suggest that social class discrimination may contribute to socioeconomic disparities in sleep problems, with some variability across measures and demographic groups. Results are discussed in light of evolving trends in socioeconomic health disparities. • Socioeconomically disadvantaged adolescents had poorer sleep. • Social class discrimination was linked to worse actigraphy-assessed sleep quality. • Social class discrimination predicted more self-reported sleep problems. • Social class discrimination partially explained socioeconomic disparities in sleep. [ABSTRACT FROM AUTHOR]

Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, without external reasons. This study is a randomized controlled trial aiming to establish efficacy of a behavioral intervention to decrease BP in a non-clinical sample. This was an open-label trial that was conducted in sixty participants (mean age 21.33 ± 2.35 years, 86.7% females) without insomnia or psychopathology who endorsed frequent BP. They were randomized to either the treatment group (n = 32) or wait-list control group (n = 28). Participants completed the Bedtime Procrastination Scale (BPS), the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), Center for Epidemiologic Studies Depression Scale (CES-D), Morningness-Eveningness Questionnaire (MEQ), and a weekly sleep diary. Functional analysis was conducted to investigate the function of BP. Linear mixed models were used for analyses. The treatment group showed significant improvement on the BPS (35.56% decrease, d = 2.19, bedtime procrastination duration based on the sleep diary (−46.29 min, d = 1.22), and sleep efficiency (5.70% increase, d = 1.25) compared to the wait-list control group following the intervention. There were also significant reductions in time spent from bedtime to lights out, and wake time to time out of bed, in addition to improvements in ISI and ESS scores in the treatment group compared to the control group. Functional analysis results indicated emotional regulation (31.3%), compensation (26.5%), and social interaction and belongingness (18.1%) as the most frequent functions of bedtime procrastination. This study shows promising results for a behavioral intervention targeting BP and sleep. In addition, this study demonstrated various functions of BP as a sleep-interfering behavior. We expect that these findings could be used in future studies and clinical settings to decrease BP. • This study tested the efficacy of a behavioral intervention for reducing bedtime procrastination (BP). • BP improved (35.56% reduction in questionnaire scores, −46.29 min average/daily) in the intervention group. • The main function of BP was emotion regulation.. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has drastically increased the exposure to electronic devices in children, influencing their lifestyle and their sleep. This study was conducted to explore the relationship between the augmented screen exposure and sleep habits in children during and after the pandemic. Using the "Google Forms" tool, we created an online questionnaire addressed to parents of children and adolescents aged 2–18 years. We explored the use of screens before and during/after the lockdown and assessed the presence of sleep disturbances through the Sleep Disturbance Scale for Children (SDSC), referring to the period before and during/after COVID-19 pandemic. We collected 1084 valid questionnaires (median age 8.5 ± 4.1 years). We observed a significant increase in screens exposure for school (72%) and for leisure (49.7%) during the pandemic. We reported an increased sleep disturbances prevalence from 22.1% before the pandemic to 33.9% during the outbreak (p < 0.001). Even before the pandemic, the highest risks for sleep disorders were related to daily screen time for school reasons (OR 1.65, p < 0.001) and total screen time after 6 p.m. (OR 1.59, p < 0.001). The augmented exposure to screens for any reasons during the pandemic was significantly related to an increase of sleep disorders, especially regarding the increased exposure after 6 p.m. (OR 1.67, p < 0.001). The augmented use of electronic devices was recognized to be a significant predisposing factor in increasing the rate of sleep disorders during and after the pandemic, thus sleep hygiene recommendations should be highlighted to improve sleep habits. • COVID-19 pandemic modified children's lifestyle with a possible impact on mental health. • Restrictions favoured deskbound activities and use of electronic devices. • Sleep disorders considerably increased during lockdown. • There is a strong relation between augmented screens exposure and sleep disturbances. • Correct hygiene recommendations are needed to cope with sleep disorders in children. [ABSTRACT FROM AUTHOR]

Improved sleep hygiene is postulated to be protective against burnout. Previous studies assessing a potential association between poor sleep quality and burnout showed incongruent results. To investigate the relationship between sleep quality and burnout. Setting and Participants: A survey was conducted in a large health care cluster in Singapore and included health care staff from different professions (N = 4777). The Maslach Burnout Inventory – Human Services Survey was used to measure burnout across 3 sub-scales: Emotional Exhaustion, Depersonalization and Personal Accomplishment, while the Pittsburgh Sleep Quality Index (PSQI) was used to gauge the participants' sleep quality. Multi-variable general linear model ANOVA was used for correlation analysis. There is a strong correlation between sleep quality and all 3 burnout sub-scales. PSQI is associated with Emotional Exhaustion (F value = 90.65, P-value <.0001), Depersonalization (F value = 49.46, P-value <.0001) and Personal Accomplishment (F value = 12.29, P-value <.0001). PSQI shows a significant linear upward trend with Emotional Exhaustion (linear contrast = 957.06, P-value <.0001) and with Depersonalization (linear contrast = 521.92, P-value <.0001). With Personal Accomplishment, PSQI shows a significant linear downward trend (linear contrast = 123.61, P-value <.0001). Poor sleep quality is progressively and linearly associated with burnout and its 3 sub-scales. Future studies that evaluate interventions which improve sleep quality among health care workers may be useful in reducing burnout and improving patient care. • This is the largest survey on sleep quality and burnout in Southeast Asia, thus far on health care workers. • Burnout has 3 sub-scales: Emotional Exhaustion, Depersonalization and Personal Accomplishment. • Poor sleep quality is progressively and linearly associated with all 3 burnout sub-scales. • Future studies on interventions to improve sleep quality and burnout among health care workers may help decrease burnout. [ABSTRACT FROM AUTHOR]

We used baseline polysomnography (PSG) data obtained during the clinical program development for suvorexant to compare the PSG profiles of people with Alzheimer's disease and insomnia (ADI) versus age-matched elderly individuals with insomnia (EI). Sleep laboratory baseline PSG data from participants age 55–80 years from 2 trials in people with insomnia and a trial in people with ADI were included. ADI participants had dementia of mild-to-moderate severity. Diagnostic criteria for insomnia, exclusion for other sleep problems, PSG recording procedures, and endpoint derivations were similar across the trials. All participants underwent a night of in-laboratory PSG prior to the baseline night to allow for screening/adaptation. Participants in the EI and ADI groups were compared with regard to sleep architecture, sleep micro-structure, and quantitative EEG power spectral endpoints. The analysis was performed on a post hoc basis using propensity score matching to compare sleep parameters separately in women and men while accounting for age group and total sleep time. A total of 837 EI and 239 ADI participants were included, with the majority in each population (∼65%) being women. Compared to EI, those with ADI had a lower percentage of time spent in slow wave sleep (and a corresponding higher percentage of time spent in the lighter N1 sleep), a lower number of spindles per minute of N2 sleep, and lower absolute EEG power during NREM sleep, particularly in the lower-frequency bands. Trends for lower REM sleep percentage in ADI did not reach statistical significance. Our findings in this large data set, in which the influence of sleep problems was effectively subtracted out (since both groups had insomnia), provide strong confirmatory support of results from previous smaller studies in indicating that AD of mild-to-moderate severity is associated with less slow wave sleep, spindles, and lower-frequency EEG power. ClinicalTrials.gov, numbers NCT01097616, NCT01097629, NCT02750306 • We compared PSG in people with AD and insomnia versus non-demented people with insomnia. • Baseline PSG data for 1076 people from clinical drug development trials were analyzed. • Mild-to-moderate AD is associated with less SWS, spindles, and lower-frequency EEG power. [ABSTRACT FROM AUTHOR]

Objective: To examine how changes in sleep patterns and sleep problems occurring between the pre-pandemic and the Covid-19 lockdown period influenced mood-behavioral functioning of children with Attention Deficit Hyperactivity Disorder (ADHD).Methods: Parents of 992 children with ADHD (85.4% boys, mean age: 11.52 years, SD = 3.17), recruited from the Italian ADHD family association, completed a modified version of the Sleep Disturbance Scale for Children and filled out 11 emotional behavioral items selected from the Child Behavior Checklist (CBCL) 6-18 questionnaire. Subgroups identified based on sleep duration changes ("maintained", "increased", "reduced") and of sleep problems during lockdown ("onset", "remission", "maintained", "no sleep problem") were analyzed to evaluate the association with internalizing and externalizing scores.Results: Sleep duration showed no or low influence on internalizing and externalizing behaviors after control for age, sex, and socioeconomic status. Patients with ADHD with "no sleep problem" showed significant lower scores in internalizing and externalizing behaviors than those who "maintained" or had "onset" of different sleep problems. The effect sizes were higher for internalizing than externalizing behaviors. Lower internalizing scores were found in those who remitted difficulty in falling asleep, daytime sleepiness, nightmares, vs. the "maintained" or "onset" groups and those who remitted hypnic jerks vs. the "onset" group. Children with ADHD who "maintained" sleep terrors reported higher internalizing and mainly externalizing scores than the other groups.Conclusion: Sleep problems negatively influence daytime functioning of patients with ADHD. but mood and behavioral domains show different susceptibility to the changes of sleep problems, and different vulnerability to specific sleep problems. [ABSTRACT FROM AUTHOR]

Pro-inflammatory cytokines are involved in sleep-wake regulation and are associated with caffeine consumption. This is a cross-sectional study in 1023 active French workers investigating associations between self-reported sleep complaints (>3months) and total sleep time (TST) with nine single-nucleotide-polymorphisms (SNPs) including pro-inflammatory cytokines, according to caffeine consumption. Participants were characterized as low, moderate and high (0-50, 51-300, and >300 mg/day) caffeine consumers. After adjusting the odd ratios (OR) for age, gender, and smoking, the risk of sleep complaints was higher in subjects with genetic mutations in tumor necrosis factor alpha (TNF-α, rs 1800629) (ORa [95%CI] = 1.43 [1.07-1.92] for both G/A and A/A aggregate genotypes) or interleukin-1 beta (IL-1β, rs1143627) (ORa = 1.61 [1.08-2.44] for homozygous A/A genotype), and the risk was higher when subjects carry the mutations in TNF-α plus IL-1β regardless of caffeine consumption. When stratified with caffeine consumption, the risk of sleep complaints was higher in TNF-α A allele carriers in high caffeine consumers, and in homozygous A/A genotype of IL-1β in moderate and high consumers. None of the nine SNPs influence TST, with the exception of the mutation on CYP1A2 and only when stratified with caffeine consumption. Our results also indicated more caffeine side-effects when carrying mutation on IL1β. This study showed that polymorphisms in TNF-α and/or IL-1β influenced sleep complaints but did not influence total sleep time. This suggests that management of sleep complaints, which can be addressed by clinical interventions, should consider the influence of the genetic profile of pro-inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of the COVID-19 pandemic on the sleep-wake patterns of preschool children.Methods: A cohort of preschoolers established before the COVID-19 pandemic was invited to participate in this study. Data including children's demographics, their own and parental sleep-wake patterns, physical activities, and screen time were collected through an online questionnaire from August to September 2020. A comparison was made on the collected data from the same cohort of children before and during the pandemic.Results: The cohort which was established before the pandemic consisted of 3720 preschoolers. For this current study, 642 (17%) participated, and 497 (13%) children who fulfilled the eligibility criteria were included in the final analysis. They showed a delay in their bedtime and wake time on both weekdays and weekends with a 15-30 min increase in nocturnal sleep duration. However, with a reduction in nap time, the average daily sleep duration was shortened by 16.3 ± 64.3 min (p < 0.001) and 27.5 ± 72.9 min (p < 0.001) during weekdays and weekends, respectively. Screen time was increased while outdoor activity duration was decreased. Parental sleep/wake times were also delayed with an increase in sleep duration. Children's sleep habits were associated with screen time and parental sleep/wake patterns.Conclusion: Despite school suspension during the COVID-19 pandemic, preschoolers were not sleeping longer. Screen time and parental sleep/wake patterns were the major factors driving the preschoolers' sleep habits. Health education is required to control screen time in children and to promote sleep hygiene among all family members. [ABSTRACT FROM AUTHOR]

Objective: In the absence of systematic and longitudinal data, this study prospectively assessed both frequency and evolution of sleep-wake disturbances (SWD) after stroke.Methods: In 437 consecutively recruited patients with ischemic stroke or transient ischemic attack (TIA), stroke characteristics and outcome were assessed within the 1st week and 3.2 ± 0.3 years (M±SD) after the acute event. SWD were assessed by interview and questionnaires at 1 and 3 months as well as 1 and 2 years after the acute event. Sleep disordered breathing (SDB) was assessed by respirography in the acute phase and repeated in one fifth of the participants 3 months and 1 year later.Results: Patients (63.8% male, 87% ischemic stroke and mean age 65.1 ± 13.0 years) presented with mean NIHSS-score of 3.5 ± 4.5 at admission. In the acute phase, respiratory event index was >15/h in 34% and >30/h in 15% of patients. Over the entire observation period, the frequencies of excessive daytime sleepiness (EDS), fatigue and insomnia varied between 10-14%, 22-28% and 20-28%, respectively. Mean insomnia and EDS scores decreased from acute to chronic stroke, whereas restless legs syndrome (RLS) percentages (6-9%) and mean fatigue scores remained similar. Mean self-reported sleep duration was enhanced at acute stroke (month 1: 07:54 ± 01:27h) and decreased at chronic stage (year 2: 07:43 ± 01:20h).Conclusions: This study documents a high frequency of SDB, insomnia, fatigue and a prolonged sleep duration after stroke/TIA, which can persist for years. Considering the negative effects of SWD on physical, brain and mental health these data suggest the need for a systematic assessment and management of post-stroke SWD. [ABSTRACT FROM AUTHOR]

Introduction: There have been no previous meta-analytic studies that have looked at the prevalence of insomnia symptoms in different COVID-19 groups using a single assessment instrument to evaluate insomnia symptoms while maintaining data homogeneity. The current review's associated goal is to undertake an individual participant data (IPD) analysis to further investigate past meta-analyses, a method that has been shown to be more robust than standard meta-analyses.Meethods: Only studies that used the Insomnia Severity Index (ISI) to assess insomnia are used in this analysis. The IPDMA was performed and registered in PROSPERO in compliance with the PRISMA IPD Statement (CRD42021275817). From November 2019 to August 2021, researchers explored seventeen databases and six preprint services for relevant studies.Results: The pooled estimate of insomnia symptoms (subthreshold and clinically significant) was 52.57%. An estimated 16.66% of the population suffered from clinically significant insomnia, of which 13.75% suffered from moderate insomnia, and 2.50% suffered from severe insomnia. The different populations' grouping had no statistically significant differences in the prevalence of insomnia symptoms. Insomnia symptoms did not appear to be associated with age or sex.Conclusion: Our findings imply that the COVID-19 pandemic is linked to a significant rise in subthreshold insomnia symptoms, but not to moderate or severe insomnia. Educating people from all walks of life about the importance of sleep and the risk of acquiring insomnia symptoms during this or future pandemics should be a top concern. [ABSTRACT FROM AUTHOR]

Background: Oculomotor abnormalities are one of the cardinal clinical features of progressive supranuclear palsy (PSP). Vertical saccadic slowing is an early sign of PSP. The association between oculomotor abnormalities and sleep architecture has not been studied so far.Objectives: To study the association of oculomotor abnormalities of PSP with the sleep stages by using video polysomnography (vPSG).Methods: This was a cross-sectional single-center study. Twenty-two patients with PSP and 15 age and gender-matched controls were recruited. Saccades, vestibulo-ocular reflex, and optokinetic nystagmus were assessed and graded clinically in all patients and one overnight vPSG was done in all cases.Results: Vertical saccades, upward more than downwards, were affected in all cases. While horizontal saccades were normal only in 41% of cases. Vertical optokinetic nystagmus (OKN) was affected in all cases. Horizontal OKN was normal in 36% of patients. The vertical upward saccades had a negative correlation with N1% and duration (r = -0.418; p = 0.05, r = -0.457; p = 0.03), N3% and duration (r = -0.486; p = 0.02, r = -0.510; p = 0.01), REM% (r = -0.449; p = 0.04), total sleep time (r = -0.487; p = 0.02) and sleep efficiency (r = -0.444; p = 0.04). There was a positive correlation between horizontal OKN and sleep onset latency (r = 0.432; p = 0.05).Conclusions: Vertical saccadic restriction in PSP has significant negative correlation with total sleep time and sleep efficiency. The oculomotor and sleep abnormalities in PSP are probably interlinked and their assessment is useful in determining the characteristics of the disease. [ABSTRACT FROM AUTHOR]

Background: Although sleep disorder is thought as a risk factor for functional bowel disorders, its impact role in adolescents remains unknown and the contribution of different sleep dimensions may deserve further attention. This study aimed to evaluate the relationship between multiple sleep dimensions and functional bowel disorders among Chinese college freshmen.Methods: A cross-sectional survey was conducted in college freshmen from Huazhong University of Science and Technology in Wuhan, China in September 2019 with random cluster sampling method. All participants completed questionnaires about living habits, sleep and digestive symptoms. Diagnosis of irritable bowel syndrome and functional constipation were based on the Rome IV criteria. Univariate and multivariate logistic regression models were applied to assess the association of sleep dimensions with irritable bowel syndrome or functional constipation.Results: Based on the 3335 individuals who completed the questionnaire, the overall prevalence of irritable bowel syndrome and functional constipation in college freshmen were 2.5% and 1.7%, respectively. Multivariate analysis revealed that compared with individuals reporting good sleep quality, those reporting poor (OR = 7.269, 95%CI: 2.876-18.370) were associated with increased risk of irritable bowel syndrome. Similarly, those reporting fair (OR = 2.068, 95%CI: 1.010-4.236) and poor (OR = 5.664, 95%CI: 1.864-17.205) were associated with increased risk of functional constipation. There was no statistically significant association between other sleep dimensions (sleep duration, sleep timing, or sleep latency) and irritable bowel syndrome or functional constipation.Conclusion: Self-reported poor sleep quality was a stronger independent predictor of functional bowel disorders than other sleep dimensions among Chinese college freshmen. Future intervention studies should consider the role of sleep quality for the prevention of FBDs in adolescents. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Recent studies have reported inconclusive results regarding the potential effects of Rosa damascena on sleep quality. Therefore, this review aimed to summarize the findings of parallel-group and cross-over randomized controlled trials (RCTs) on the effects of aromatherapy and oral intake of Rosa damascena on adults' sleep quality.Methods: The electronic data sources of PubMed, Scopus, Web of Science Core Collection, Embase, CENTRAL, ProQuest, CINAHL, SID, and MagIran were searched from inception to June 30, 2021. Out of 1341 publications found in the initial search, 10 RCTs were considered eligible for this review. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Sufficient data were statistically pooled by a random-effects model using Stata software (version 11.2); otherwise, a narrative summary was presented.Results: Based on the systematic review, the inhalation and oral intake of Rosa damascena could improve some sleep-related outcomes. The pooled analysis of seven effect sizes revealed that inhalation aromatherapy with Rosa damascena significantly improved sleep quality (standardized mean difference: 2.24; 95% confidence interval: 1.01-3.48; P < 0.001). Most RCTs had fair methodological quality, and two RCTs reported the adverse effects of treatment, including headache, nausea, vomiting, and frequent sneezing.Conclusions: The administration of Rosa damascena seems to be a promising approach in complementary and alternative medicine for the improvement of adults' sleep quality. However, considering the fair methodological quality of most RCTs and reported adverse effects, it is required to perform further high-quality RCTs to draw an evidence-based conclusion on the use of Rosa damascena for the improvement of adults' sleep quality.Prospero No: CRD42020211778. [ABSTRACT FROM AUTHOR]

Background: Long before being described as a disorder, sleepwalking was considered as a mysterious phenomenon inspiring artwork. From the early beginning of cinema, sleepwalkers were shown to populations, playing a crucial role in storytelling and collective knowledge.Objective: We characterized how sleepwalking has been portrayed in a large number of movies from the origins of cinema to recent years.Methods: Movies containing the words "sleepwalking" or "somnambulism" were searched for in International Movie Databases. Types of movies, sleepwalking characters, postures and behaviors during episodes, triggers, and suggested treatments were collected.Results: Production of 87 movies and 22 cartoons portraying sleepwalkers was clustered around two peaks, in the 1910s and 2010s. Comedies predominated before 1960, and thriller/horror movies as a dominant genre after 1960. In contrast with real-life sleepwalking epidemiology, sleepwalkers are more often portrayed as women than men (and often wearing a transparent white nightgown), as adults more than children on-screen, and 23% suffered psychiatric comorbidities. The unrealistic posture of outstretched arms and eyes closed was found in 20% of movies and 79% of cartoons. Night terrors, sexsomnias (kissing, having sex, initiated pregnancy), sleep-related eating and sleep driving were also featured. Homicides and falls while sleepwalking were recurrent fear-inducing topics. The first sleep EEG was featured in a sleepwalking movie in 1985, and a sleep specialist gave his first advice in 1997.Discussion: The representation of sleepwalking on the screen seems to have evolved from popular, unrealistic stereotypes of somnambulism towards a medical condition, paralleling the development of sleep medicine. [ABSTRACT FROM AUTHOR]

Objective/background: Poor sleep hygiene is considered an exacerbating and perpetuating factor of sleep disturbances and is also associated with poor mental health. The Sleep Hygiene Index (SHI) is a self-report measure assessing adherence to sleep hygiene practices. The aim of this study was to estimate the psychometric properties of the SHI in an Italian representative sample of the general population, following a formative measurement approach.Patients/methods: Participants (n = 6276; M = 33.62, SD = 13.45) completed the SHI alongside measures of sleep disturbance, depression, anxiety, and stress. To consider the item formative nature, sets of item-composites weighted by means of canonical correlation analysis was created and a confirmatory factor analysis (CFA) was implemented. Factorial invariance tests were computed considering both presence of sleep problems and presence of emotional distress symptoms as grouping variables.Results and Conclusions: CFA confirmed the unidimensional structure of SHI. Internal consistency was acceptable (ω = 0.752). Test-retest reliability at 8-10 months presented an ICC of 0.666. SHI significantly correlated with sleep, depression, anxiety and stress symptoms (r range from 0.358 to 0.500). Configural and metric invariance were reached for both grouping variables. Partial scalar invariance was obtained only across emotional distress groups. People with emotional symptoms reported higher latent means on the sleep hygiene dimension. Findings support the validity and reliability of the Italian version of the SHI. Importantly, the SHI showed robust psychometric properties both in healthy individuals and in individual reporting mental health symptoms. Thus, it is advisable to use this version of the SHI in both research and clinical practice. [ABSTRACT FROM AUTHOR]

Objectives/background: Sleep is critical to recovery, but inpatient sleep is often disrupted. During the COVID-19 pandemic, social distancing efforts to minimize spread may have improved hospitalized children's sleep by decreasing unnecessary overnight disruptions. This study aimed to describe the impact of these efforts on pediatric inpatient sleep using objective and subjective metrics.Methods: Sleep disruptions for pediatric inpatients admitted prior to and during the COVID-19 pandemic were compared. Hand hygiene sensors tracking room entries were utilized to measure objective overnight disruptions for 69 nights pre-pandemic and 154 pandemic nights. Caregiver surveys of overnight disruptions, sleep quantity, and caregiver mood were adopted from validated tools: the Karolinska Sleep Log, Potential Hospital Sleep Disruptions and Noises Questionnaire, and Visual Analog Mood Scale.Results: Nighttime room entries initially decreased 36% (95% CI: 30%, 42%, p < 0.001), then returned towards baseline, mirroring the COVID-19 hospital census. However, surveyed caregivers (n_pre = 293, n_post = 154) reported more disrupted sleep (p < 0.001) due to tests (21% vs. 38%), anxiety (23% vs. 41%), and pain (23% vs. 48%). Caregivers also reported children slept 61 fewer minutes (95% CI: -12 min, -110 min, p < 0.001). Caregivers self-reported feeling more sad, weary, and worse overall (p < 0.001 for all).Conclusions: Despite a decrease in objective room entries during the pandemic, caregivers reported their children were disrupted more and slept less. Caregivers also self-reported worse mood. This highlights the effects of the COVID-19 pandemic on subjective experiences of hospitalized children and their caregivers. Future work targeting stress and anxiety could improve pediatric inpatient sleep. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study had two stages. One was to examine the psychometric quality of the Sleep Hygiene Index (SHI) in Chinese version and its predicted function for the prevalence of insomnia. The other was to describe the prevalence of poor sleep hygiene habits and associated factors of sleep hygiene habits in Chinese nursing students.Method: According to Brislin translation model, the English version of SHI was translated into Chinese. And a pilot-survey was carried out to measure psychometric quality of the Chinese version of SHI with 260 nursing students by convenient sampling. Then a cross-sectional survey was conducted. 659 undergraduates were recruited by simple random sampling in a medical university in China. Data collection instruments consisted of a demographic questionnaire, the Sleep Hygiene Index (SHI), the Insomnia Severity Index (ISI) and the Brief Insomnia Questionnaire (BIQ). Data were analyzed by SPSS 24.0 and Amos 24.0 with P = 0.05 as the significant test value.Results: The internal consistency reliability of SHI in Chinese version was more than 0.60 (α = 0.62, ω = 0.63). The concurrent validity presented significantly (r = 0.25, P < 0.001). Exploratory factor analysis found that a six component model explained 63.06% of total variance and confirmatory factor analysis showed good fitness (χ2/df=2.14, RMSEA = 0.04). ROC analysis showed that the cut-off value predicting for insomnia was 5.50 (52.90% sensitivity and 75.80% specificity). The area under the ROC curve was 0.66 (95% confidence interval = 0.61-0.71). 199 (30.20%) participant had poor sleep hygiene habits, especially in the aspects of staying too longer in bed (65.25%) and irregular sleep schedule. Multiple linear regression analysis showed health condition, academic difficulties and gender were more common associated factors of sleep hygiene.Conclusions: The Chinese version of the Sleep Hygiene Index demonstrates satisfactory psychometric qualities and has higher sensitivity and specificity to predict for insomnia. So SHI could be used in Chinese nursing students and detect high levels of insomnia. The status of sleep hygiene of nursing students in China should be concerned. Sleep hygiene education should be carried out in nursing students with different gender, health condition, and academic performance. [ABSTRACT FROM AUTHOR]

Objective: School-based sleep education programs help to promote sleep health information to many children and adolescents. The aim of this systematic review was to identify and describe school-based sleep education programs, to update previous reviews and identify recent advances and improvements in this field worldwide.Methods: Four electronic databases were searched. Eligibility criteria included children aged 5-18 years, sleep education intervention conducted in a school setting, and at least one pre-post-measure of a sleep variable.Results: A total of 32 articles met eligibility criteria with Australian sleep researchers constituting ∼ one quarter of these studies. Studies dated from 2007 to 2020 with sample sizes ranging from 9 to 3713 students. The majority of participants were high school students and predominantly female. Education programs generally took 4-6 weeks and content was consistent across studies. Overall, exposure to sleep education increased sleep knowledge, however changes in sleep behaviour variables and secondary outcome variables (eg, mental health; cognitive function; sleep hygiene practices) presented varied results. Studies conducted since 2015 were more likely to be randomised controlled trials and to include more interactive, online designs utilising innovative content such as mindfulness.Conclusions: An exponential growth in school sleep education programs was identified since 2016. Future studies should consider utilising objective sleep measures, longer-term follow-ups, innovative delivery methods, and stronger attempts at implementing a knowledge-to-action approach for more sustainable programs. [ABSTRACT FROM AUTHOR]

This study sought to validate the Japanese version of the Sleep Hygiene Practices Scale (SHPS-J). A cross-sectional questionnaire-based study was conducted via the internet. In total, 854 participants (435 men, 419 women; mean age, 42.91 ± 11.54 years) were asked to complete all scales, and 283 of them were asked to complete the same scales two weeks later. The survey consisted of the SHPS-J, the Japanese version of the Insomnia Severity Index (ISI-J), and the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). The SHPS-J was developed according to the International Society for Pharmacoeconomics and Outcomes Research Task Force for Translation and Cultural Adaption. For the analysis, participants were divided into three groups: insomnia syndrome, insomnia symptoms, and good sleep groups. The SHPS-J had good test-retest reliability (ICC: 0.55–0.76) and adequate internal consistency (α = 0.54–0.74), except with regard to eating/drinking behaviors. The factorial validity of the four-factor structure was confirmed through a confirmatory factor analysis; however, one item related to eating/drinking behaviors had no significant factor loading. The construct validity was confirmed through a correlation analysis between each domain of the SHPS-J and ISI-J (r = 0.19–0.60, p < 0.01). The results of clinical validation confirmed that all domains of the SHPS-J were significantly higher for individuals with insomnia than for good sleepers. This study confirmed both the reliability and validity of the SHPS-J. • The Japanese version of Sleep Hygiene Practice Scale (SHPS-J) was validated. • Sleep hygiene was classified into four domains. • The SHPS-J improved the efficiency of sleep hygiene education. [ABSTRACT FROM AUTHOR]

Aims: To analyse the quality of sleep of the Spanish population during the lockdown due to COVID-19.Design: Cross-sectional descriptive study using a web based survey design.Methods: Pittsburgh Sleep Quality Index questionnaire and sociodemographic, occupational, health and sleep quality variables were used to collect data during the first month of the lockdown period due to COVID-19 (March-April 2020). A snowball sampling was carried out, where participants were asked to disseminate and distribute the questionnaire among their own profiles in social networks.Results: A representative sample of 5220 participants aged ≥18 years old took part in the study. The global PSQI score was 8.17 points (SD 4.43). A statistical association was found between the global PSQI score and several of the variables collected. Findings show that the quality of sleep was worse among women (p < 0.001), single participants (p 0.02), those working in rotating shifts (p < 0.001), on-site workers (p < 0.001), and people diagnosed with COVID-19 or who had someone in their environment diagnosed with the virus (p < 0.001).Conclusion: Findings show that the Spanish population has experienced poor quality of sleep during the lockdown period. Being a woman, working in rotating shifts, having suffered from COVID-19 or having someone close suffering from COVID-19, being unemployed or being affected by a Temporary Redundancy Scheme, as well as spending long hours in bed were associated with poorer sleep quality. On the contrary, being older and sleeping longer hours were associated with a better sleep quality. [ABSTRACT FROM AUTHOR]

Aim: this study aims to assess the reliability and validity of an Arabic version of the Sleep Hygiene Index (SHI).Methods: A methodological study was carried out in four stages: initial translation by 2 professional translators, evaluation and synthesis of the initial translation by project managers, back-translation and validation. The Arabic (SHI-AR) and English (SHI-ENG) versions of the SHI were administered across Lebanon as an anonymous online survey in April 2020. Internal consistency of the SHI-AR and inter-rater reliability were assessed by calculating Cronbach alpha (α) and Intraclass Correlation Coefficient (ICC) respectively. Inter-rater agreement for each item of the SHI was measured using Cohen's Kappa coefficient. Construct validity was investigated by exploratory factor analysis (EFA).Results: 363 participants were enrolled in the study (129 men, 234 women, mean age 30 ± 11 years). There was no statistically significant difference between mean overall scores on the 2 versions of the SHI with mean scores of 19.16 ± 7.4 and 19.25 ± 7.6 on SHI-AR and SHI-ENG respectively (p = 0.265). Internal consistency was satisfactory (α = 0.749), and the inter-rater agreement for the total scores of the 2 versions of the SHI was excellent (ICC = 0.980). All items of the SHI showed substantial to high level of agreement between the 2 versions. EFA established four factors underlying the questionnaire.Conclusion: The Arabic version of the SHI is a valid tool to assess sleep hygiene in Arabic speaking populations. [ABSTRACT FROM AUTHOR]

Introduction: CoVID-19 pandemic and the subsequent lockdown have impacted the sleep quality and the overall wellbeing of mankind. The present epidemiological study measured various aspects of sleep disturbance such as sleep quality, daytime impairments, negative emotionality, sleep hygiene, and well-being associated with CoVID-19 pandemic among the Indian population.Methods: This cross-sectional voluntary online survey (using Google form) was communicated across the country from 4th June to 3rd July 2020 through mail and social media applications. The responses received (N = 450) were categorized and validated using the latent class analysis and logistic regression tests respectively, and the classes and subclasses derived were profiled. These techniques are used for the first time in a CoVID-19 sleep study.Results: Out of the three classes derived from the LCA, people with severe dyssomnia belonging to class 1 (33.3%) showed high daytime impairments, negative emotionality and high vulnerability towards CoVID-19 pandemic measures. In addition, the two subclasses derived from the severe dyssomnia group; one with negative emotionality predominance and the other with excessive daytime sleepiness, were similarly affected by CoVID-19 measures. People with moderate dyssomnia (class 2, 28.5%) showed frequent arousals with daytime impairments and the majority (38.2%) which fell in to class 3, the 'no dyssomnia' category, were not impacted by CoVID-19 pandemic.Conclusion: People with existing sleep problems or those who were vulnerable to the same were the ones affected by CoVID-19 pandemic. Those with inadequate emotional coping styles have showed heightened vulnerability. Proper medical and cognitive interventions are highly recommended for this population. No or moderate dyssomnia categories (class 3 and 2 respectively) were less impacted by CoVID-19. [ABSTRACT FROM AUTHOR]

Objective: This study reviewed systematically the effects of sleep extension on sports performance.Design: Systematic review.Method: The systematic review was conducted in November 2020. Articles published in English were searched in PubMed, Virtual Health Library, SPORTDiscus, and Web of Science and Scopus databases. The search terms used were "sleep extension" AND athlete. The measures of interest were sports performance. Studies were included if they were a) original articles, b) published in English and peer-reviewed article, c) had only athletes as participants, d) experimental protocol whose objective was to investigate the effects of sleep extension on sports performance, including randomized (RCT) and non-randomized controlled trial (nRCT), and e) at least a sports performance measure as a dependent variable.Results: The primary search revealed that a total of 5 out of 74 articles were considered eligible and 2 studies were subsequently included. The studies used different strategies to extend time in bed or total sleep time (extending 26-106 min). From fifteen sports measures, six presented a large effect size, and the others ranged from trivial to medium. Overall, the risk of bias was high to RCT and low to nRCT and the quality of evidence ranged from very low quality to moderate quality in ten outcomes.Conclusions: The limited evidence suggests that sleep extension interventions may be beneficial to improve sports performance in athletes where the magnitude is dependent on the variable assessed, although such conclusions are tentative because of the quality of the evidence and risk of bias. [ABSTRACT FROM AUTHOR]

Background: An outbreak of the 2019 novel coronavirus (COVID-19) has been ongoing in China since January 2020. The threat of infection affects the work and life of most of the population and may also damage sleep. This study aims to examine the subjective sleep status and mental health of the population during the peak of the COVID-19 epidemic.Method: The data were collected through an online questionnaire with a sample of 5461 individuals in China from February 5, 2020, to February 23, 2020. Participants were divided into four groups based on their degree of threat from COVID-19: Group 1 was most closely associated with COVID-19, including inpatients diagnosed with COVID-19, first-line hospital workers and first-line management staff; Group 2 included outpatients diagnosed with COVID-19 and patients who developed a fever and visited the hospital; Group 3 included people related to Group 1 or 2, such as their colleagues, relatives, friends and rescuers; and Group 4 was the farthest removed from contact with COVID-19, covering the general public affected by COVID-19 prevention strategies. The Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Acute Stress Disorder Scale (ASDS) were used.Results: Threat degree of COVID-19 (groups) had significant correlations with insomnia, depression, anxiety, and stress (p < 0.05, p < 0.01). Age, gender, and area (Hubei province or other provinces) had significant correlations with insomnia (p < 0.01). A total of 1380 (24.46%) participants were suspected of having major depression based on the PHQ-9. Additionally, 1042 (18.47%) participants were suspected of having generalized anxiety disorder based on the GAD-7. A total of 892 (15.8%) of the participants had Acute Stress Disorder (ASD) according to the ASDS. The prevalence of clinical insomnia during the outbreak was 20.05% (1131) according to the ISI. The factors of satisfaction with the current sleep pattern and how perceptible the symptoms of the current sleep pattern are to other people (p < 0.05) and the middle (difficulty staying asleep) and terminal (waking up too early) (p < 0.01) factors of the ISI were significantly different across groups. A total of 1129 (20.01%) participants spent more than one hour awake in bed.Conclusion: The results indicated that insomnia is more severe in people who are female, young, living in the epicenter and experiencing a high degree of threat from COVID-19. As prevention and treatment efforts continue with regard to COVID-19, the general public has developed poor sleep hygiene habits, which deserve attention. [ABSTRACT FROM AUTHOR]

Background: Lockdown has been one of the major worldwide strategies to control the spread of coronavirus disease 2019 (COVID-19). Its consequences on the well-being of individuals needs to be better understood. The objective of this work was to evaluate the impact of lockdown on the well-being of a general population and the factors associated with this potential impairment of well-being in a population that has been only lightly affected by COVID-19 such as in Reunion island, an overseas French department.Methods: An online survey was proposed to the population of Reunion Island between the 35th and 54th days of lockdown relative to pre- and per-lockdown periods. Well-being was measured by the 5-item World Health Organization Well-Being Index, with some questions about sleep habits (Pittsburgh questionnaire), weekly physical activity (IPAQ), health, and lifestyle.Results: Four hundred volunteers answered the survey. They reported a 15.7% decrease in well-being (p < 0.001), accompanied by increased anxiety (p < 0.001), decreased weekly physical activity (p < 0.001), delayed and poorer quality sleep (p < 0.001). Multivariate logistical analysis showed that impairment in well-being during lockdown was independently associated with an increase in anxiety (odds ratio (OR): 4.77 (3.26-6.98), p < 0.001), decrease in weekly physical activity (OR: 0.58 (0.43-0.79), p < 0.001), and poor-quality sleep (OR: 0.29 (0.19-0.43), p < 0.001).Conclusions: This study suggested an impairment in well-being during lockdown, associated with anxiety, lack of physical activity and sleep disruptions. Public policies must consider these factors as levers for improving the well-being of the population in order to effectively combat the spread of COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate the effects of cognitive behavioral therapy for insomnia (CBTI) in patients with Restless Legs Syndrome (RLS).Methods: This is a randomized controlled study. The patients were sequentially selected and randomly assigned to either a CBTI group or a non-CBTI group. A total of 25 RLS patients with comorbid insomnia were recruited from a tertiary university hospital sleep center. Twelve were assigned to the CBTI group, and 13 were assigned to the non-CBTI group. The CBTI group received 4 sessions of behavioral therapy, while the non-CBTI group received one informative session on sleep hygiene. All patients completed sleep and psychiatric-related questionnaires. In addition, each individual completed a one-week sleep log for collecting subjective sleep data and actigraphy for objective sleep data.Results: After conducting the CBTI, there were significant improvements in severity of insomnia symptoms, subjective sleep efficiency, total sleep time, latency to sleep onset, wake after sleep onset, objective latency to sleep onset, and anxiety in the CBTI group as compared to the non-CBTI group. The effect of CBTI on sleep-related data was maintained for up to three months.Conclusions: CBTI was effective in RLS patients by improving sleep quality and anxiety symptoms. CBTI may be considered in clinical practice for RLS patients with comorbid insomnia. [ABSTRACT FROM AUTHOR]

Background: Adequate sleep is crucial for normal functioning. However, most people, including middle-aged adults of reproductive age, show a marked reduction in their sleep duration. Thus, sleep is a major issue that should be addressed in health management. We investigated the effects of short-term sleep restriction on subjective parameters (sleepiness, stress, fatigue) and physiological parameters (cortisol, thyrotropin [TSH], thyroxine [T4], triiodothyronine [T3], C-reactive protein [CRP]) in middle-aged adults, the recovery of these parameters after rest, and the associations between parameters.Methods: A total of 118 healthy adults (59 men, 59 women), aged 35-44 years, and without sleep problems, were enrolled. Participants underwent a 4-h sleep restriction per day for 3 day at a hospital, and then returned to their daily lives to take four days of rest. A questionnaire and blood test were administered before and after sleep restriction, and after the recovery period, to assess subjective and physiological parameters.Results: After sleep restriction, sleepiness, fatigue, and stress significantly increased compared to baseline. Cortisol and TSH were elevated after sleep restriction, while T4, T3, and CRP were reduced compared to baseline. After the recovery phase, all parameters were restored to levels similar to baseline levels. Changes in each parameter were mutually associated; fatigue and sleepiness had the strongest association.Conclusion: Our results suggest that even a short period of sleep restriction can have an adverse impact on psychological and physiological stress parameters in middle-aged adults, and that adequate rest and sleep are needed to restore them to normal levels. [ABSTRACT FROM AUTHOR]