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Aims Nocturnal polyuria (NP) is defined by the International Continence Society (ICS) as "excessive production of urine during the main sleep period" and is one of the main causes of nocturia. The ICS recognized that "excessive" is not clearly defined and that this needs to be highlighted in both clinical and research settings. The aim of this study was to identify different definitions of NP and apply them to a population of women attending the Urogynaecology clinic. Methods This was a retrospective study of complete bladder diaries collected from women attending a tertiary Urogynaecology Unit. Six different definitions were identified and were divided into "absolute," "relative," and "functional definitions." Prevalence data were calculated and values generated for sensitivity, specificity, positive and negative predictive values when related to women voiding ≥ 2 times per night. Results Complete bladder diaries were obtained from 1398 women, over 6 years, with a mean age of 57 years. Prevalence varied across the definitions from 21.5% (absolute definition) to 77% (relative definition). Sensitivity ranged from 43% (absolute) to 87% (relative). The definitions that showed the highest combined sensitivity and specificity were the functional definitions. Conclusion From this study it is clear that more work needs to be done to arrive at a consensus for defining NP to enable accurate diagnosis and development of treatment pathways. We propose that a relative definition may provide a more clinically relevant method of defining NP.

Aims Nocturnal polyuria (NP) and global polyuria (GP) are not mutually exclusive. However, by rate, the common criteria for GP (40 mL/kg/24 hours [117 mL/kg/hour in a 70-kg individual] or 3000 mL/24 hours [125 mL/h]) are more stringent than those for NP (90 mL/hour during the sleep period or NP index [NPi; nocturnal volume/24-hour volume] > 0.33 [no minimum rate]). It remains unclear whether total nocturnal urine volume (NUV) may reliably delineate between NP patients with and without comorbid GP. Methods A clinical database of men with lower urinary tract symptoms was searched for voiding diaries completed by patients reporting greater than or equal to 1 nocturnal void(s). Four separate analyses were performed using all combinations of the two NP and two GP criteria listed above. For each analysis, patients were included if they met the criteria for NP, and then stratified by presence or absence of GP (ie, NP + GP vs isolated NP). Results Median NUV was greater among patients with NP + GP for all criteria combinations. Sensitivities greater than or equal to 80%/90%/100% for NP + GP were observed at 1275/1230/1085 mL for {NPi > 0.33 + 24-hour volume > 3000 mL}; 1075/1035/1035 mL for {NPi > 0.33 + 24-hour volume > 40 mL/kg}; 900/745/630 mL for {NUP > 90 mL/hour + 24-hour volume > 3000 mL}; and 1074/1035/990 mL for {NUP > 90 mL/hour + 24-hour volume > 40 mL/kg}. Conclusions An inordinate NUV among men with NP is fairly sensitive for comorbid GP. In the appropriate clinical setting, nocturnal-only diaries may suffice in the evaluation and follow-up of patients with NP, so long as outlying nocturnal volumes prompt a 24-hour diary/urine collection.

The around-the-clock smartphone use and its relation to disturbed sleep is a public health concern. The present study aimed to quantify the effects of different dimensions of smartphone behaviours (frequency of daytime use, problematic use, use before sleep and use during the sleep period) on disturbed sleep (sleep quality and sleep quantity) and to disentangle their inter-relationship in a large population-based sample of 24,856 Danish adults aged ≥16 years. Data come from the SmartSleep Experiment, which is a web-based survey carried out using a citizen science approach. Tested items were used to evaluate smartphone use and disturbed sleep was evaluated with the Karolinska Sleep Questionnaire (KSQ). Linear and multinomial logistic regression was employed to evaluate the relationship between smartphone use and disturbed sleep. While several of the smartphone measures were associated with disturbed sleep when assessed individually, smartphone use during the sleep period was the only dimension consistently associated with disturbed sleep when assessed independently of other smartphone behaviours. Weekly smartphone use during the sleep period versus no use was associated on average with a 0.96 point higher score (95% confidence interval [CI] 0.90-1.02) on the 5-point KSQ scale, and a higher risk of both short (odds ratio [OR] 1.32, 95% CI 1.08-1.62) and long (OR 1.94, 95% CI 1.63-2.32) sleep duration. Smartphone use during the sleep period is the factor strongest associated to disturbed sleep relative to other dimensions of smartphone use. Recommendations around smartphone use during the sleep period are warranted in order to protect the fundamentally important biological and mental processes of sleep.

International audience; The objective of the present study was to confirm the link between spontaneous smiling and active sleep in newborns, and to identify the role of the cortex in the generation of spontaneous smiles. A total of 12 healthy newborns born at term and three infants with major congenital abnormalities (two with hydranencephaly and one with a left hemispherectomy) were evaluated by video and polysomnography during a 3-hr sleep period. Smiles were graded and their association with isolated rapid eye movements and grouped rapid eye movements was analysed. In all, 383 smiles were recorded of which 377 occurred during active sleep. Smiles were shown to be significantly associated with active sleep (p

Summary Background Gastro-oesophageal reflux disease (GERD) adversely impacts on sleep, but the mechanism remains unclear. Aim To review the literature concerning gastro-oesophageal reflux during the sleep period, with particular reference to the sleep/awake state at reflux onset. Methods Studies identified by systematic literature searches were assessed. Results Overall patterns of reflux during the sleep period show consistently that oesophageal acid clearance is slower, and reflux frequency and oesophageal acid exposure are higher in patients with GERD than in healthy individuals. Of the 17 mechanistic studies identified by the searches, 15 reported that a minority of reflux episodes occurred during stable sleep, but the prevailing sleep state at the onset of reflux in these studies remains unclear owing to insufficient temporal resolution of recording or analysis methods. Two studies, in healthy individuals and patients with GERD, analysed sleep and pH with adequate resolution for temporal alignment of sleep state and the onset of reflux: all 232 sleep period reflux episodes evaluated occurred during arousals from sleep lasting less than 15 s or during longer duration awakenings. Six mechanistic studies found that transient lower oesophageal sphincter relaxations were the most common mechanism of sleep period reflux. Conclusions Contrary to the prevailing view, subjective impairment of sleep in GERD is unlikely to be due to the occurrence of reflux during stable sleep, but could result from slow clearance of acid reflux that occurs during arousals or awakenings from sleep. Definitive studies are needed on the sleep/awake state at reflux onset across the full GERD spectrum.

Aims To explore the durability of efficacy and gender differences during chronic administration of desmopressin in nocturia. Methods This pooled analysis of three short-term efficacy studies, with extensions, of desmopressin administered as orally disintegrating tablet (ODT) or solid tablet in nocturia treatment, comprised 351 patients completing 40–56 weeks' treatment. Efficacy endpoints of change in number of nocturnal voids and duration of initial undisturbed sleep period from baseline were analyzed to determine response durability and gender differences. Results The mean decrease in number of nocturnal voids during short-term treatment was maintained and further reduced during the long term. At 52 weeks, the mean decrease in number of nocturnal voids from baseline reached 1.4–2.1 voids for desmopressin ODT 25–100 µg. Following 40-week tablet treatment, the decrease in number of nocturnal voids was 0.8–1.5 for desmopressin 100–400 µg. The mean decrease in nocturnal voids (25–50 µg ODT) was greater for females than males. For females, the improvement in initial period of undisturbed sleep was 2.5–3 hr for desmopressin ODT 25–100 µg, compared with 1.3–2.6 hr for males. No gender difference in efficacy was seen in the tablet studies. Conclusions The decrease in nocturnal voids and improvement in sleep with short-term desmopressin treatment were maintained throughout long-term treatment. A durable gender difference in efficacy in favor of females was observed with desmopressin ODT 25 µg. Further, large-scale long-term trials are needed to confirm the durability of efficacy with gender-specific doses of desmopressin. Neurourol. Urodynam. 32: 363–370, 2013. © 2012 Wiley Periodicals, Inc.

Aim: The aim of this study was to assess the relationship between breastfeeding and sleep patterns in infants from Asia-Pacific region. Methods: Parents of 10 321 infants (0–11 months) from Australia, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand and Vietnam completed an expanded version of the Brief Infant Sleep Questionnaire. Results: Overall, 4714 (45.72%) were currently being breastfed; 61.3% of those between 0 and 5 months and 36.6% of those between 6 and 11 months. Currently breastfed infants, when compared with not currently breastfed infants, had a significant increase in the number and duration of night-time wakings and less consolidated sleep. Interestingly, currently breastfed infants less than 6 months also showed longer duration of daytime sleep and obtained more sleep overall. Of note, of those who were currently breastfed, those infants who were nursed back to sleep during night, woke up more often at night (2.41 vs. 1.67 times) and had shorter continuous night-time sleep period (5.58 vs. 6.88 h; P < 0.001). There was no significant difference between breastfeeding and non-breastfeeding infants in the number of night wakings, when the nursing to sleep variable was controlled for in the analysis of variance. Conclusion: Breastfeeding is associated with reduced sleep consolidation in infants. This relationship, however, may be moderated by parenting practices of nursing to sleep and back to sleep during the night. Thus, parents of infants with night waking problems should be encouraged to limit the association between nursing and falling to sleep, to improve sleep while maintaining breastfeeding.

Infancy and early childhood sleep–wake behaviours from current and retrospective parental reports were used to explore the relationship between sleeping arrangements and parent–child nighttime interactions at both time points. Children (N=45) from educated, middle-class families, mostly breastfed in infancy, composed a convenience sample that was recruited from a university preschool in the Northeast US. Parents responded to the Sleep Habits Inventory, a 19-item Likert-style inventory measuring sleep-related behaviours during the last week, and the Sleeping Arrangements Questionnaire, a 30-question, open-ended, short-answer-style instrument which queries both retrospective infancy and current sleep location, bedtime routine, night waking and parent–child interactions during the sleep period. Co-sleeping in early childhood was associated with sleep location in infancy (i.e. proximity to the mother's bed) during wake–sleep transitions and night feedings. Security object use during infancy was inversely related to early childhood co-sleeping (calling for the parents, night waking, poor bedtime routine and fear of the dark). Results showed that early childhood co-sleeping in this sample was reactive, i.e. associated with current parent-seeking, night waking and social contact during wake–sleep transitions. These findings suggest that co-sleeping in early childhood is related to social experiences during infancy, particularly the amount of parent social contact and security object use. Copyright © 2007 John Wiley & Sons, Ltd.

This paper is a systematic review on the reference values and changes in infant sleep–wake behaviour during the first 12 months of life. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Seventyfour papers were included, and the reference values and changes in sleep–wake behaviour during the first 12 months of life were identified. Sleep duration during the 24-h period, and day and sleep periods during the night decreased over the first 12 months of life. Night wakings and bedtime/sleep-onset time decreased, while the longest sleep period increased at night during the first 6 months. High discrepancy was noted between studies in the reference values of sleep–wake behaviour, while more congruence was noted regarding changes, especially those occurring in the first 6 months of life. Several methodological differences were identified between studies and may partially explain inconsistencies in the results, including the assessment of different sleep–wake behaviours, the focus on specific ages or age ranges, the use of selfreport, observational or direct measures, the recruitment of small or large representative samples, and the countries where the research was conducted. These aspects should be considered in future research and caution should be taken when generalizing results from studies with diverse methodological characteristics. Nonetheless, this review identifies normative reference values and the changes occurring in infant sleep–wake behaviour, and could inform both practitioners and researchers, helping them identify infants with sleep delays or problems., This research was supported by FEDER Funds through the Programa Operacional Factores de Competitividade - COMPETE and by National Funds through FCT - Fundacao para a Ciencia e a Tecnologia under the project: PTDC/SAU/SAP/116738/2010 and PhD grant SFRH/BD/113005/2015. This study was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Education and Science through national funds, and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653)., info:eu-repo/semantics/publishedVersion

The stage from which the spontaneous ending of sleep occurred was investigated in 138 sleep episodes obtained from 14 younger (19-28 years) and 11 older (60-82 years) individuals. The possible influences of circadian phase and quality of the preceding sleep period, as well as the impact of aging on characteristics of sleep termination were examined. Under experimental conditions in which subjects were isolated from time cues, and behavioral options to sleep were limited, no age-associated differences in the duration of sleep periods, or in the number or duration of REM episodes were observed. Despite similar percentages of NREM (stages 2-4) and REM sleep across age groups, younger subjects awakened preferentially from REM while older subjects did not. Of the sleep episodes obtained from older subjects, those with sleep efficiencies higher than the median were more likely to terminate from REM than those with lower sleep efficiencies. For all subjects, the REM episodes from which sleep termination occurred were truncated relative to those that did not end the sleep period. In addition, nonterminating REM episodes that were interrupted by a stage shift were most often interrupted by brief arousals to stage 0. Such arousals within nonterminating REM episodes occurred, on average, after a similar duration as the terminating point of sleep-ending REM episodes. The results from this study demonstrate that there are age-related differences in the sleep stage from which spontaneous awakenings occur, and that these differences may be due in part to the quality of the sleep period preceding termination. Findings regarding the characteristics of both terminating and nonterminating REM episodes are consistent with the notion that the neural and biochemical context of REM sleep may facilitate a smooth transition to wakefulness. It is speculated that age-associated changes in sleep continuity may render unnecessary the putative role of REM sleep in providing a 'gate' to wakefulness.

The sleep of 52 healthy paid subjects (23 male) divided into three age-bands (20-34, 35-49 and 50-70 y) were recorded at night in their homes for a total of 190 subject-nights while following their normal daily activities and habitual sleep-wake schedule. There was a shortening in both nocturnal total sleep period and total sleep time (TST) with age, the oldest group sleeping 46 min less than the youngest. Also, the mid-point of sleep occurred 32 min earlier in the oldest group compared with the youngest group. The reduction in TST with age was due, in part, to increased wake periods within sleep. The youngest subjects showed more Movement Time which progressively decreased with age while the amount of stage 1 increased with age. The amount of slow-wave sleep (SWS, stages 3+4) was reduced, stage 4 was more than halved, while REM was slightly reduced with age. There were far fewer significant gender differences in the sleep variables: males, particularly in the middle and oldest age bands, had more stage 1 than females, while females had more SWS, particularly stage 3, than males. In general, despite relatively limited subject selection criteria, there was good agreement with previous laboratory-based normative sleep values for the effect of age and gender.

SUMMARY Evidence for circasemidian sleep/wake regulation is briefly reviewed with respect to protocols used to quantify sleep propensity. Existing models of sleep/wake regulation are examined in view of their ability to accommodate data which demonstrate an afternoon sleep period. Finally, a modelling approach is briefly outlined which emphasizes the maintenance of the phase and amplitude characteristics of the circadian rhythm of body (and brain) temperature and predicts the circasemidian phenomena.

SUMMARY The distributions of the durations of the first 3 REM sleep episodes have been analysed using a total of 134 overnight sleep recordings from 10 subjects. From investigation of the length of uninterrupted episodes of stage REM, it is shown that arousals to stage 0/1 could play an important part in the process of REM exit, and that by the middle of the sleep period, these arousals probably occur according to a Poisson process. During the first and second REM episodes a more complex process appears to be at work, which could reflect increased pressure for slow wave sleep. These findings suggest that the duration of a REM episode is determined by a process that has a large stochastic element, which is not necessarily tied to REM entry.

The effects of light conditions during night sleep on sleep habits and morning-evening preference were studied in Japanese students (18-28 years old). Students who usually used fluorescent or non-fluorescent light on the room ceiling, wall or desk preferred to have a daytime nap significantly later (Mean: 14:50 h) than those who used no light (13:34 h). Students who used no curtain or a half-transparent lace-curtain showed shorter sleep latency (duration from going-to-bed to sleep-onset) than those who used a curtain which shuts off lights from outside. Light conditions during the middle of night and early in the morning may affect the timing of sleep in Japanese students based on the circadian system.

This experiment was designed to test the effects on subsequent sleep of a restriction in sleep length on the previous night. Eight male subjects were studied. After baseline recordings were made, sleep was restricted to either a period between 4-8 am or to a period between 6–8 am. On the night following the restriction of sleep the subjects retired at 11 pm and they were permitted to sleep ad lib in the morning. The restricted sleep periods resulted in differential sleep deprivation. Stages REM and 2 were markedly reduced whereas stages 3 and 4 showed little or no reduction in amount. There were significant reductions in sleep latencies and in the amount of lime spent in stages 0 and 1. The first 8 hrs of ad lib sleep following the 2 restricted sleep periods did not differ in any significant way from the 8 hrs of baseline sleep. When sleep was permitted to continue until the subjects awakened spontaneously, the sleep after the restriction of sleep to‘i hrs was significantly longer and displayed significantly more of stages REM and 2 when compared with the baseline ad lib sleep condition. The ad lib sleep period following the 4 hr condition showed similar changes although the differences were not statistically significant. The significant reductions in stages KEM and 2 during the restricted sleep periods were attributed to the effects of reduced steep length per se. The increases in sleep length and specifically the increases in stages REM and 2 during the ad lib sleep periods were attributed to a differential sleep “debt” accruing from restricted sleep length.

Stage 4 typically occurs dominantly in the first third of a normal night of sleep and REM sleep occurs dominantly in the last third of the night. In this experiment conditions were imposed to prevent these stages from occurring at their usual peak periods. Stage 4 sleep was permitted to occur only during the last two hours of sleep and REM was permitted to occur only during the first two hours of sleep. The results show that each stage can be partially displaced to the peak period of the other, but that stage 4 sleep is elicited more readily late in the sleep period than is REM early during the night.

Summary A review and analysis of the sleep and wakefulness patterns of one boy from birth to 35 weeks of age has been presented. This boy's total sleeping time decreased gradually from 17.8 hours in the first week t o 14.3 hours a t 35 weeks. The most remarkable changes were in the increase in the duration of the sleep and waking periods. The average longest sleep period for the first week was 4.4 hours and for the 29th week 11.7 hours. The frequency of wakeful periods dropped from an average of 7.5 in the first week to 4.2 in the 35th week. A diurnal sleep pattern is apparent in the Behavior Day Charts from the sixth week on and very definite after the 12th week. The sleep pattern noted in this case are essentially the same as reported in the literature cited. Essentially, all have noted predominantly a lenghthening of single sleep and wakeful periods with maturation in the first year, rather than a marked reduction in the total amount of sleeping time. Possible neurophysiological explanations for the changes in sleep patterns are discussed.

Human beings have a diurnal variation in their intraocular pressure and this variation is related to the sleep-wake cycle. Patients with chronic open angle glaucoma have a similar fluctuation in intraocular pressure and, even without medication, may achieve a "normal" intraocular pressure several hours into their sleep period. Two patients with chronic open angle glaucoma, maintained on their usual miotic therapy, also maintained a normal diurnal fluctuation in intraocular pressure as did one patient with a unilaterally transected optic nerve and another with a surgically divided trigeminal nerve.