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Abstract Background Sleep distrurbances involves daytime preoccupation about sleep, which plays a critical role in perpetuating sleep disturbances. Recent cognitive models highlight the importance of daytime processes, like processing sleep-related information and interpretations during waking hours, in influencing sleep quality and quantity. The Sleep Preoccupation Scale (SPS) quantifies this daytime cognitive activity related to sleep. This study aimed to translate and validate an Arabic version of the SPS for assessing sleep preoccupation among Arabic speakers. Methods 523 Arabic speakers (mean age 23.6 years, 75% female) from four countries completed the Arabic SPS alongside the Athens Insomnia Scale, Generalized Anxiety Disorder-7 Scale, and the Anxiety and Preoccupation about Sleep Questionnaire (APSQ). The sample repeated the SPS after two weeks for test-retest reliability. Confirmatory factor analysis evaluated the SPS’s two-factor structure. Internal consistency, item response theory, and convergent validity with the other scales were examined. Results Confirmatory factor analysis supported the two-factor model’s fit. Measurement invariance results suggest that the SPS exhibits a similar basic factor structure across both insomnia and non-insomnia groups. The Arabic SPS demonstrated good internal consistency (Cronbach’s α = 0.92, McDonald’s ω = 0.92) and two-way mixed effects, consistency, single rater/measurement intraclass correlation coefficient (ICC) test-retest reliability (ICC = 0.95). Most items exhibited satisfactory item response theory fit statistics and discrimination. The SPS total score showed strong positive correlations with insomnia severity (r = 0.48, p

Abstract Background Self-medication practices involve the use of medications without healthcare professional requests. The threat of coronavirus disease 2019 (COVID-19) caused the practice of a fittest to survive action, with the assumption that something is better than nothing. Moreover, owing to the lack of effective treatment for COVID-19, the general public has shifted toward self-medication and symptomatic treatment, with approximately 80% of people stockpiling medication for use during the pandemic. Thus, this study aimed to assess the factors associated with self-medication practices during the COVID-19 pandemic crisis in southwestern Ethiopia. Methods A community-based cross-sectional study design was employed at selected drug retail outlets in southwestern Ethiopia for 415 community pharmacy clients from July 1, 2021, to September 1, 2021. Purposive sampling techniques were employed to select five drug retail outlets on the basis of high patient flows, and we took the study participants until the required quota allotted to each selected drug retail outlet had been filled. Bivariable and multivariable logistic regression analyses were employed to identify factors associated with self-medication. AORs with 95% CIs were used to report associations, and the level of significance was set at P

Achieving synchronization between the central and peripheral body clocks is essential for ensuring optimal metabolic function. Meal timing is an emerging field of research that investigates the influence of eating patterns on our circadian rhythm, metabolism, and overall health. This narrative review examines the relationship between meal timing, circadian rhythm, clock genes, circadian hormones, and metabolic function. It analyzes the existing literature and experimental data to explore the connection between mealtime, circadian rhythms, and metabolic processes. The available evidence highlights the importance of aligning mealtime with the body’s natural rhythms to promote metabolic health and prevent metabolic disorders. Specifically, studies show that consuming meals later in the day is associated with an elevated prevalence of metabolic disorders, while early time-restricted eating, such as having an early breakfast and an earlier dinner, improves levels of glucose in the blood and substrate oxidation. Circadian hormones, including cortisol and melatonin, interact with mealtimes and play vital roles in regulating metabolic processes. Cortisol, aligned with dawn in diurnal mammals, activates energy reserves, stimulates appetite, influences clock gene expression, and synchronizes peripheral clocks. Consuming meals during periods of elevated melatonin levels, specifically during the circadian night, has been correlated with potential implications for glucose tolerance. Understanding the mechanisms of central and peripheral clock synchronization, including genetics, interactions with chronotype, sleep duration, and hormonal changes, provides valuable insights for optimizing dietary strategies and timing. This knowledge contributes to improved overall health and well-being by aligning mealtime with the body’s natural circadian rhythm.

الملخص: أهداف البحث: تتطور ممارسة طب النوم بشكل متسارع على مستوى العالم، مما يتطلب أطباء طب نوم مؤهلين جيدا لتلبية هذه الخدمة الإكلينيكية. على الرغم من اعتماد طب النوم كتخصص مستقل في المملكة العربية السعودية في عام 2012، تشير البيانات الوطنية إلى أن عدد المتخصصين المدربين والمعتمدين في طب النوم لا يزال منخفضا نسبيا. تم إنشاء برنامج زمالة منظم في طب النوم في المملكة العربية السعودية في عام 2009، من قبل جامعات وبدون وجود برنامج تدريب وطني تحت رعاية الهيئة السعودية للتخصصات الصحية. لذلك، كانت هناك خطط لبناء برنامج تدريب وطني متعدد التخصصات لطب النوم لخدمة البلد بأكمله. طرق البحث: في عام 2020، كلفت الهيئة السعودية للتخصصات الصحية لجنة تطوير المناهج التخصصية لبرنامج الزمالة في طب النوم لتطوير برنامج تدريب وطني لطب النوم للبالغين. النتائج: طورت اللجنة منهج ومتطلبات برنامج الزمالة في طب النوم للبالغين والتي تضمن أن يصبح المتدربين مؤهلين في تقييم وتشخيص وإدارة اضطرابات النوم المختلفة. تمت الموافقة على المنهج من قبل رئيس هيئة تحرير المناهج في الهيئة السعودية للتخصصات الصحية. الاستنتاجات: تعرض هذه الورقة المنهج المطور، ومتطلبات القبول لبرنامج الزمالة السعودي في طب النوم. Abstract: Objectives: Given the rapid global development of sleep medicine, well-qualified sleep medicine physicians are necessary to meet the demand. Although sleep medicine was accredited as an independent specialty in KSA in 2012, national data suggest that the number of trained and accredited sleep medicine specialists remains comparatively low. A structured sleep medicine fellowship programme was established in KSA in 2009. However, universities issued training and certification without a national training programme under the auspices of the Saudi Commission for Health Specialties (SCFHS). Therefore, plans have been made to establish a national interdisciplinary sleep medicine training programme to serve the whole country. Methods: In 2020, the SCFHS mandated the Specialty Curriculum Development Committee of the Sleep Medicine Fellowship Program to develop the National an adult sleep medicine national program. Results: The committee developed an adult sleep medicine fellowship programme curriculum and requirements to ensure that trainees become competent at assessing, diagnosing, and managing various sleep disorders. The curriculum was approved by the head of the Curricula Editorial Board of the SCFHS. Conclusions: This paper presents the curriculum and admission requirements for the newly developed Saudi Sleep Medicine Fellowship Program.

We examined the immediate impact of a social media outage on nomophobia and associated symptoms using a longitudinal cohort design. Data were collected at two timepoints, baseline (T1) and during the social media outage of 4 October 2021 (T2). T1 was collected in August–September 2021 as part of the baseline of an ongoing study. The nomophobia questionnaire (NMP-Q), Generalized Anxiety Disorder-7 scale (GAD-7), and Athens insomnia scale (AIS) were administered to 2706 healthy participants from the general Bahraini population (56% females, mean age 33.57 ± 11.65 years). Approximately one month later, during the social media outage, 306 of the study participants were opportunistically assessed using the NMP-Q. At baseline, we found that nomophobia levels strongly correlated positively with both insomnia (p = 0.001) and anxiety symptoms (p = 0.001). This is the first report to examine the impact of a social media outage on nomophobia. Our findings indicate that symptoms of nomophobia increased significantly during a social media outage. Baseline insomnia scores predicted a surge in the global scores of nomophobia symptoms during a social media outage.

ObjectivesThis study assessed the prevalence of restless leg syndrome (RLS) among patients with multiple sclerosis (pwMS) and the association between RLS and MS disease duration, sleep disturbance, and daytime fatigue.MethodsIn this cross-sectional study, we interviewed 123 patients via phone calls using preset questionnaires containing the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria, Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS) diagnostic criteria validated in both Arabic and English. The prevalence of RLS in MS was compared to a group of healthy controls.ResultsThe prevalence of RLS in pwMS, defined by meeting all four requirements included in the IRLSSG diagnostic criteria, was 30.3% compared to 8.3% in the control group. About 27.3% had mild RLS, 36.4% presented with moderate, and the remaining had severe or very severe symptoms. Patients with MS who experience RLS had a 2.8 times higher risk of fatigue compared to pwMS without RLS. pwMS with RLS had worse sleep quality, with a mean difference of 0.64 in the global PSQI score. Sleep disturbance and latency had the most significant impact on sleep quality.ConclusionThe prevalence of RLS among MS patients was significantly higher compared to the control group. We recommend educating neurologists and general physicians to increase their awareness of the increasing prevalence of RLS and its association with fatigue and sleep disturbance in patients with MS.

Background: Understanding post-stroke fatigue (PSF) and its associated factors is crucial for effective therapy and rehabilitation. This study aimed to assess the mediating role of the excessive daytime sleepiness-related functional status (SFS) on the relationship between sleep and the severity of fatigue in subacute stroke survivors. Methods: Subacute stroke survivors (n = 50; male = 38; female = 12), completed a cross-sectional study involving the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the insomnia severity index (ISI), the functional outcome of the sleep questionnaire (FOSQ), and the fatigue severity scale (FSS). Results: The SFS mediated the association between the severity of fatigue and sleep problems. The PSQI and FOSQ (b = −0.37, p < 0.001), and the FOSQ and FSS were correlated (b = −0.18, p < 0.05), with a significant indirect effect of the PSQI on the FSS. The ISI correlated with the FOSQ (b = −0.20, p < 0.001), with significant direct (b = 0.15, p < 0.001), as well as indirect, effects of the ISI on the FSS. The ESS correlated with the FOSQ (b = −0.23, p < 0.001), with a significant indirect effect of the ESS on the FSS. Conclusions: In subacute stroke survivors, fatigue and sleep are linked. Increased understanding of sleep-PSF may help in exploring new targets for supplement therapy.

الملخص: أهداف البحث: تهدف الدراسة لتقييم مخاطر انقطاع النفس الانسدادي اثناء النوم لدى مرضى السكري من النوع الثاني في جنوب المملكة العربية السعودية وعوامل الخطر المرتبطة به. طرق البحث: هذه الدراسة عبارة عن دراسة مقطعية أجريت في مستشفى القوات المسلحة بجازان. تم تقييم انتشار انقطاع النفس الانسدادي أثناء النوم من خلال ترجمة عربية مصدقة لاستبانة فحص (ستوب-بانج). تم إجراء عمليات الجدولة المتقاطعة وفقا لمستويات مخاطر انقطاع النفس الانسدادي أثناء النوم المقدرة وتبعها تحليل الانحدار لتقدير احتمالات ارتفاع مخاطر الاصابة وفقا للمتغيرات السريرية والديموغرافية المقاسة. النتائج: بلغ العدد الإجمالي للمشاركين 306 حيث كان 70٪ فوق سن الخمسين، و 81٪ متزوجين، و 53٪ من الإناث. كانت الدرجة المتوسطة الإجمالية لمستوى مخاطر توقف النفس الانسدادي اثناء النوم التي تم تقييمها بواسطة عناصر استبانة (ستوب-بانج) هي 3 على مقياس من صفر إلى 8 حيث تم تصنيف 63.1٪ من المشاركين في العينة على أنهم معرضون لخطر كبير لحدوث المرض. تم تحديد العديد من الارتباطات ذات الدلالة الإحصائية حيث تم اكتشاف نسب الأرجحية ذات مستوى خطر أعلى من المرض وفقا للعمر والجنس والحالة الاجتماعية ومحيط الخصر والرقبة ومستويات السكري التراكمي ومؤشر كتلة الجسم ومدة مرض السكري والاعتلال المشترك مع ارتفاع ضغط الدم. الاستنتاجات: يمكن أن يكون الخطر الأكبر للإصابة بانقطاع النفس الانسدادي أثناء النوم الذي تم تحديده في العينات من مرضى السكري مرتبطا بانتشار السمنة، ومحيط العنق، وارتفاع ضغط الدم، وعوامل أخرى مرتبطة بمدة مرض السكري وعلاجه. بالإضافة إلى ذلك، فإن الارتباط بين محيط الخصر، والسكري التراكمي، والمدة منذ تشخيص مرض السكري يشير إلى وجود تأثير تداخلى يتطلب مزيدا من البحث. Abstract: Objective: To assess the risk of obstructive sleep apnoea (OSA) and its associated risk factors among patients with type 2 diabetes in southern KSA. Methods: This was a cross-sectional study conducted at the Armed Forces Hospital in Jazan. The prevalence of OSA was assessed using a validated Arabic translation of the STOP-BANG screening questionnaire. The odds of a higher OSA risk were calculated via regression analysis, according to the measured clinical and demographic variables. Results: The total number of participants was 306, of which 213 (69.6%) were over the age of 50, 247 (80.7%) were married, and 161 (52.6%) were female. The overall median score of the OSA risk level assessed by the STOP-BANG items was three on a scale of 0–8, of which 193 (63.1%) of the participants in the sample were classified as being at high risk of developing OSA. Several statistically significant associations were identified, where odds ratios (ORs) with a higher OSA risk level were detected according to age, sex, marital status, waist and neck circumference, haemoglobin A1c (HbA1c) and body mass index levels, duration of diabetes, and comorbidity with hypertension (p < 0.05). Conclusion: The higher risk of OSA identified in our sample of diabetic patients can be related to a high prevalence of obesity, larger neck circumferences, hypertension, and other factors linked to the duration and treatment of diabetes. Additionally, the association between waist circumference, HbA1c, and duration since the diagnosis of diabetes suggests an interaction effect that requires further investigation.

BackgroundOf around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors.MethodsThis cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters.ResultsIn total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7–9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters.ConclusionIncreasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

الملخص: أهداف البحث: يحتك الأطباء المقيمين مع مرضى فيروس كورونا المستجد بشكل مباشر مما يجعلهم عُرضة للاضطرابات النفسية. تهدف الدراسة لاستنتاج نسبة انتشار الاكتئاب والقلق بين الأطباء المقيمين في المملكة العربية السعودية وعلاقتهما بجائحة فيروس كورونا المستجد. طرق البحث: أُجريت هذه الدراسة خلال الفترة من يناير 2021 إلى مارس 2021. تم استخدام استبانة صحة المرضى لفحص الاكتئاب وكذلك مقياس اضطراب القلق العام لفحص القلق. النتائج: شارك 533 طبيب مقيم في هذه الدراسة ‏وقد بلغ متوسط أعمارهم 28.47±2.90 ‏ ‏وكان غالبيتهم سعوديي الجنسية ومثل الذكور 52% من العدد الكلي والعزاب 58%. معظم الأطباء المقيمين تعرضوا لاحتكاك مباشر مع مريض أو أكثر مصاب بفيروس كورونا المستجد. بلغت نسبة انتشار الاكتئاب 65.8% وأما القلق 58.3%. كشفت الدراسة أن أعلى عوامل الخطورة في الإصابة بفيروس كورونا المستجد هي عند الأطباء المقيمين الذكور وكذلك غير المدخنين. هناك ارتباط معتبر بين القلق وكل من الأطباء المقيمين النساء والأطباء المقيمين في المستوى الخامس من التدريب. أيضا هناك ارتباط معتبر بين الاكتئاب وكل من الأطباء المقيمين النساء والتخصصات (تخصص طب الأسرة). الاستنتاجات: وجد أن هناك نسبة عالية من الاكتئاب والقلق بين الأطباء المقيمين في المملكة العربية السعودية. وكانت النسبة أعلى بشكل معتبر عند الأطباء المقيمين النساء. Abstract: Objectives: Medical residents’ direct contact with patients with COVID-19 places them at high risk of psychological disturbance. This study aimed to estimate the prevalence of depression and anxiety symptoms, and their relationship with the COVID-19 pandemic among medical residents in KSA. Methods: A cross-sectional study was conducted between January and March of 2021. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) were used to screen for depressive disorders and generalized anxiety disorder, respectively. Results: A total of 533 medical residents participated in the study; 52% were men, and 58% were single. Most residents had direct contact with one or more patients with COVID-19. The prevalence of depression and anxiety symptoms was 65.8% and 58.3%, respectively. The study revealed that gender was a risk factor for diagnosis with COVID-19 among residents: male residents were diagnosed with COVID-19 to a greater extent than female residents. In addition, being a nonsmoker rather than a smoker was associated with a higher risk of COVID-19 diagnosis. A multivariate regression analysis revealed that gender (female) and residency level (R5) were independently associated with anxiety symptoms. Similarly, the independent correlates of depression symptoms were gender (female) and specialty (family medicine). Conclusion: A high prevalence of depression and anxiety symptoms was found among medical residents trained in KSA. The rates were significantly higher among female than male residents.

Scoring polysomnography for obstructive sleep apnea diagnosis is a laborious, long, and costly process. Machine learning approaches, such as deep neural networks, can reduce scoring time and costs. However, most methods require prior filtering and preprocessing of the raw signal. Our work presents a novel method for diagnosing obstructive sleep apnea using a transformer neural network with learnable positional encoding, which outperforms existing state-of-the-art solutions. This approach has the potential to improve the diagnostic performance of oximetry for obstructive sleep apnea and reduce the time and costs associated with traditional polysomnography. Contrary to existing approaches, our approach performs annotations at one-second granularity. Allowing physicians to interpret the model’s outcome. In addition, we tested different positional encoding designs as the first layer of the model, and the best results were achieved using a learnable positional encoding based on an autoencoder with structural novelty. In addition, we tried different temporal resolutions with various granularity levels from 1 to 360 s. All experiments were carried out on an independent test set from the public OSASUD dataset and showed that our approach outperforms current state-of-the-art solutions with a satisfactory AUC of 0.89, accuracy of 0.80, and F1-score of 0.79.

This study investigates the possible effect of exogenous melatonin on appetite control by investigating plasma leptin and subjective appetite parameters. Nine healthy male participants [26 ± 1.3 years, body mass index (BMI) 24.8 ± 0.8 kg/m2] (mean ± SD) were recruited. The study was designed as a randomized three-way cross-over design; light (>500 lux) (LS), dark (500 lux) + exogenous melatonin (LSC), with an interval of at least 7 days between each session. Each session started at 18:00 h and ended at 06:00 h the following day. Participants were awake and in a semi-recumbent position during each clinical session. The meal times were individualized according to melatonin onset from 48 h sequential urine collection, whereas melatonin intake was given 90 min before the evening meal. Subjective appetite parameters were collected at 30 min intervals during each session. Plasma leptin was collected at specific time points to analyze pre-prandial and postprandial leptin. Subjective hunger and desire to eat were reported higher in LS than DSC and LSC (P = 0.03, and P = 0.001). Plasma leptin showed a significant increase in LSC and DSC (p = 0.007). This study suggested a positive impact of exogenous melatonin on subjective appetite and plasma leptin.

الملخص: أهداف البحث: تعد نماذج الإبلاغ عن الوفاة وإصدار الشهادات جزءا أساسيا من سياسات الرعاية الصحية للبلد. هناك العديد من التحديات المتعلقة بالإبلاغ عن الوفيات وإصدار الشهادات في المملكة العربية السعودية. طرق البحث: صممت الأمانة العامة للمجلس الصحي السعودي في عام ٢٠١٩، مشروع بحث نوعي يهدف إلى تقديم توصيات لتوحيد إخطارات الوفاة. شكل المجلس فريق عمل من الأطباء ومسؤولي الرعاية الصحية لتصميم وتطبيق بحث نوعي لمراجعة سياسات المجلس الصحي السعودي المتعلقة بشهادة الوفاة وللتحقق من الوسائل المختلفة لتحسينها. كما أجرى فريق العمل مراجعة شاملة للأدبيات والممارسات الحالية في المملكة العربية السعودية. النتائج: اقترح فريق العمل مجموعة من التوصيات القوية لتصحيح المشكلات التي تؤثر على الأنظمة الحالية للإبلاغ عن الوفيات وشهادات الوفاة. الاستنتاجات: يعرض هذا التقرير منهجية العمل وتوصيات فريق العمل. Abstract: Objectives: Death reporting and certification forms are essential elements of a country's healthcare policies. KSA faces several challenges regarding death reporting and certification. This study aims to provide recommendations to unify death notifications in Saudi Arabia. Methods: In 2019, the General Secretariat of the Saudi Health Council designed a qualitative research project that aimed to provide recommendations to unify death notifications. The council convened a task force of physicians and healthcare administrators to design and conduct qualitative research to review the Saudi Health Council's policies related to death certification and investigate potential methods of improvement. In addition, the task force performed an extensive review of the literature and current practices in KSA. Results: The task force proposed a set of robust recommendations to correct the issues affecting the current systems of death reporting and certification. Conclusions: This report presents the working methodology and recommendations of the task force.

BackgroundNotable lifestyle changes can occur in Ramadan due to the sudden shift in eating routine with fasting during daylight hours. This study aimed to examine the changes in dietary intakes, chronotype, sleep pattern, and physical activity level before and during Ramadan in healthy adults.MethodsThis study was conducted in Jeddah city, Saudi Arabia, and convenience sampling was used. To compare dietary, chronotype and sleep pattern changes before and during Ramadan, data were collected in two separate periods: the first period was 2 months before Ramadan, and the second period was during the last 3 weeks of Ramadan. Dietary intake was assessed using 24-h food recall and chronotype using Morningness-Eveningness Questionnaire. Daytime sleepiness and sleep duration were assessed using the Epworth sleepiness scale and a sleep diary for seven consecutive days, respectively. Anthropometric measurements were also taken across the study periods.ResultsA total of 115 adults (96 females and 19 males) were included in the study. Significant increases in daily calorie and carbohydrate intakes during Ramadan than before Ramadan were noted (calorie intake: 1,482.9 ± 536.4 kcal/day before Ramdan vs. 1,635.5 ± 635.1 kcal/day during Ramadan; carbohydrate intake: 180.8 ± 72.1 g/day before Ramadan vs. 202.6 ± 88.7 g/day during Ramadan; p < 0.05). Chronotypes and daytime sleepiness were also associated significantly with Ramadan fasting. A significant slight reduction in body weight during Ramadan was observed (66.4 ± 18.1 kg before Ramdan vs. 66.1 ± 17.8 kg before Ramadan and during Ramadan, respectively; p < 0.05).ConclusionThis study indicates that Ramadan diurnal fasting was associated with greater calorie and carbohydrate intake, changes in chronotype, and daytime sleepiness. The study also suggests that Ramadan diurnal fasting model may be a promising weight loss strategy.

The magnitude of post-COVID-19 syndrome was not thoroughly investigated. This study evaluated the quality of life and persistence of fatigue and physical symptoms of individuals post-COVID-19 compared with noninfected controls. The study included 965 participants; 400 had previous COVID-19 disease and 565 controls without COVID-19. The questionnaire collected data on comorbidities, COVID-19 vaccination, general health questions, and physical symptoms, in addition to validated measures of quality of life (SF-36 scale), fatigue (fatigue severity scale, FSS), and dyspnea grade. COVID-19 participants complained more frequently of weakness, muscle pain, respiratory symptoms, voice disorders, imbalance, taste and smell loss, and menstrual problems compared to the controls. Joint symptoms, tingling, numbness, hypo/hypertension, sexual dysfunction, headache, bowel, urinary, cardiac, and visual symptoms did not differ between groups. Dyspnea grade II–IV did not differ significantly between groups (p = 0.116). COVID-19 patients scored lower on the SF-36 domains of role physical (p = 0.045), vitality (p < 0.001), reported health changes (p < 0.001), and mental-components summary (p = 0.014). FSS scores were significantly higher in COVID-19 participants (3 (1.8–4.3) vs. 2.6 (1.4–4); p < 0.001). COVID-19 effects could persist beyond the acute infection phase. These effects include changes in quality of life, fatigue, and persistence of physical symptoms.

الملخص: أهداف البحث: تحديد مدى انتشار أعراض وخطر انقطاع النفس الانسدادي النومي، وتحديد العوامل المرتبطة بانقطاع النفس الانسدادي النومي بين كبار السن السعوديين. طرق البحث: استخدمت الدراسة المسح الوطني السعودي لصحة المسنين، وهو مسح يشمل عينة وطنية لكبار السن بين عامي ٢٠٠٦ و٢٠٠٧ في المملكة العربية السعودية. وتم تحديد أعراض انقطاع النفس الانسدادي النومي والمخاطر من خلال استبانة برلين. كما تم استخدام تحليل الانحدار اللوجستي متعدد المتغيرات لتحديد العوامل الرئيسة المرتبطة بخطر انقطاع النفس الانسدادي النومي. النتائج: من بين ٢٩٤٦ من كبار السن، كان ١٥٤٤ (٥٢.٤٪) معرضين لخطر الإصابة بانقطاع النفس الانسدادي النومي مع تعرض النساء لخطر أعلى من الرجال (٦٠.٨٪ مقابل ٤٤.٢٪ على التوالي، القيمة الاحتمالية

Abstract A limited number of papers have addressed the association between non-dipping-blood pressure (BP) obstructive sleep apnea (OSA), and no study has assessed BP-dipping during rapid eye movement (REM) and non-REM sleep in OSA patients. This study sought to noninvasively assess BP-dipping during REM and non-REM (NREM)-sleep using a beat-by-beat measurement method (pulse-transit-time (PTT)). Thirty consecutive OSA patients (men = 50%) who had not been treated for OSA before and who had > 20-min of REM-sleep were included. During sleep, BP was indirectly determined via PTT. Patients were divided into dippers and non-dippers based on the average systolic-BP during REM and NREM-sleep. The studied group had a a median age of 50 (42–58.5) years and a body mass index of 33.8 (27.6–37.5) kg/m2. The median AHI of the study group was 32.6 (20.1–58.1) events/h (range: 7–124), and 89% of them had moderate-to-severe OSA. The prevalence of non-dippers during REM-sleep was 93.3%, and during NREM-sleep was 80%. During NREM sleep, non-dippers had a higher waist circumference and waist-hip-ratio, higher severity of OSA, longer-time spent with oxygen saturation

PurposePoor sleep and cognitive deficits are often associated with increased drug use. However, no study has addressed the relationship between poor sleep, substance dependence, and metacognitive deficit in polysubstance users.MethodsThis was a cross-sectional study with a simple random sampling involving community-dwelling polysubstance users (n = 326, age = 18–43 years) in Mizan, Ethiopia. Participants completed a brief sleep questionnaire, severity of dependence on khat (SDS-Khat), a brief meta-cognition questionnaire, and a socio-demographic survey.ResultsMajority (56.4%) of the polysubstance users had sleep disturbance. Chronic health conditions [adjusted odds ratio (AOR) = 2.52, 95% confidence interval (CI) 1.31–4.85], chronic conditions in the family (AOR = 2.69, 95% CI 1.40–5.20), illiterate-primary level of educational status (AOR = 2.40, 95% CI 1.30–4.04), higher SDS-Khat score (AOR = 1.39, 95% CI 1.13–1.72), and lower meta-cognition score (AOR = 0.90, 95% CI 0.84–0.97) predicted poor sleep in the polysubstance users. Moreover, low metacognition score and high SDS score also predicted additional sleep disturbances like chronic sleep insufficiency, lethargy and restlessness after nighttime sleep, socio-occupational dysfunctions, and daytime disturbances in polysubstance users.ConclusionPoor sleep, severe khat dependence, and metacognitive deficits are common in community polysubstance users. Moreover, poor sleep is associated with higher khat dependence, lower metacognitive ability, lower educational status, and the presence of chronic conditions in polysubstance users or their families.

Abstract Background Psychometric investigations of tools used in the screening of migraine including the migraine screen questionnaire (MS-Q), using an adequate statistical approach is needed. We assessed the psychometric properties of the migraine screen questionnaire (MS-Q) using categorical data methods. Material and methods A total of 343 students at Mizan-Tepi University, Ethiopia, age range = 18–35 years were selected by a simple random sampling method to participate in a cross-sectional study. The respondents completed the MS-Q, a semi-structured socio-demographic questionnaire, and a visual analog scale for attention (VAS-A). Results The cumulative variance rule (> 40%), the Kaiser’s criteria (Eigenvalue> 1), the Scree test and, the parallel analysis (minimum rank) identified a 1-factor model for the MS-Q with the factor loadings in the range of 0.78 to 0.84. Fit indices favored a 1-factor model of the MS-Q as indicated by comparative fit index (0.993), weighted root mean square residual (0.048), root mean square error of approximation (0.067), the goodness of fit index (1.00), and non-normed fit index (0.987). The values of the Factor Determinacy Index (0.953), marginal reliability (0.909), H-latent (0.909), H-observed (0.727), explained common variance (0.906) and the mean item residual absolute loadings (0.225) further complimented finding of the 1-Factor model. McDonald’s Omega (0.903) suggested adequate internal consistency. Discriminative validity was supported by significantly higher scores for the total and all the MS-Q items except one among those with complaints of attention. Conclusion The categorical methods support the psychometric validity of the MS-Q in the study population.

Abstract Rapid eye movement-predominant obstructive sleep apnea has been shown to be independently associated with hypertension. This study aimed to non-invasively measure blood pressure during the rapid eye movement (REM) and non-rapid eye movement (NREM) obstructive events and the post-obstructive event period. Thirty-two consecutive continuous positive airway pressure-naïve obstructive sleep apnea patients (men, 50%) aged 50.2 ± 12 years underwent overnight polysomnography. Blood pressure was assessed indirectly using a validated method based on the pulse transit time and pulse wave velocity during the NREM and REM obstructive events (both apneas and hypopneas) and the post-obstructive event period. Among the recruited patients, 10 (31.3%) had hypertension. Mean apnea-hypopnea index was 40.1 ± 27.6 events/hr. Apnea-hypopnea indexes were 38.3 ± 30.6 and 51.9 ± 28.3 events/hr for NREM and REM sleep, respectively. No differences were detected in obstructive respiratory event duration or degree of desaturation between REM and NREM sleep. Additionally, no difference in blood pressure (systolic and diastolic) was detected between REM and NREM sleep during obstructive events and post-obstructive event period. Simple linear regression identified history of hypertension as a predictor of increased systolic blood pressure during obstructive events and post-obstructive event period in both rapid eye movement and non-rapid eye movement sleep. Oxygen desaturation index was also a predictor of increased systolic blood pressure during obstructive events and post-obstructive event period in REM sleep. When obstructive event duration and the degree of desaturation were comparable, no difference in blood pressure was found between REM and NREM sleep during obstructive events and post-obstructive event period.

BackgroundWe aimed to examine the effect of the COVID-19 pandemic and associated mitigation measures on sleep quality and psychological distress in Saudi Arabia.MethodsSubjective sleep quality over the preceding 30 days was measured using the Pittsburgh Sleep Quality Index (PSQI). In addition, Kessler Psychological Distress Scale (K10) was used to assess the psychological distress.ResultsThe study included 836 participants. The median age was 28 years, 624 (74.64%) were females, and 158 (18.90%) were healthcare workers. Factors associated with poor sleep were recent changes in the sleep habits p = 0.004), anxiety or fear because of coronavirus news on social media p = 0.02), fear because there was no approved drug to treat COVID-19 p = 0.03), and unaware of the presence of chronic diseases p = 0.03). Female gender p = 0.02), fear or anxiety because of coronavirus news on social media p = 0.04), recent change in sleep habits (OR: 1.97 (1.15–3.39); p = 0.01), fear because there is no approved drug to treat COVID-19 p = 0.001), monthly income

Narcolepsy is a known auto-immune disease that presents mainly in the teenage years with irresistible sleep attacks. Patients with narcolepsy, especially NT1, have been found to have a high prevalence of obesity and other metabolic derangements. This narrative review aimed to address the relationship between narcolepsy and changes in weight and metabolic rate, and discuss potential mechanisms for weight gain and metabolic changes and future research agendas on this topic. This article will provide a balanced, up-to-date critical review of the current literature, and delineate areas for future research, in order to understand the pathophysiological metabolic changes in narcolepsy. Articles using predefined keywords were searched for in PubMed and Google Scholar databases, with predefined inclusion and exclusion criteria. Compared to controls, patients with narcolepsy are more likely to be obese and have higher BMIs and waist circumferences. According to recent research, weight gain in narcolepsy patients may be higher during the disease’s outset. The precise mechanisms causing this weight gain remains unknown. The available information, albeit limited, does not support differences in basal or resting metabolic rates between patients with narcolepsy and controls, other than during the time of disease onset. The evidence supporting the role of orexin in weight gain in humans with narcolepsy is still controversial, in the literature. Furthermore, the available data did not show any appreciable alterations in the levels of CSF melanin-concentrating hormone, plasma and CSF leptin, or serum growth hormone, in relation to weight gain. Other mechanisms have been proposed, including a reduction in sympathetic tone, hormonal changes, changes in eating behavior and physical activity, and genetic predisposition. The association between increased body mass index and narcolepsy is well-recognized; however, the relationship between narcolepsy and other metabolic measures, such as body fat/muscle distribution and metabolic rate independent of BMI, is not well documented, and the available evidence is inconsistent. Future longitudinal studies with larger sample sizes are needed to assess BMR in patients with narcolepsy under a standard protocol at the outset of narcolepsy, with regular follow-up.

Background: Anxiety symptoms, stress, poor sleep, and inadequate sleep hygiene are common in university students and these affect their learning and increase attrition. However, limited knowledge exists about the inter-relationship between these factors among university students in low-middle income countries. Therefore, this study aimed to investigate the prevalence of anxiety symptoms and their relationship with sleep quality, sleep hygiene practices, and psychological stress.Materials and Methods: A cross-sectional study was conducted with a randomly selected sample of students in Mizan-Aman, Ethiopia. Participants completed a self-administered questionnaire, which included questions about socio-demographics, socio-economic factors, the Leeds Sleep Evaluation Questionnaire-Mizan, Sleep hygiene index, Perceived stress scale-10 (PSS-10), and Generalized anxiety disorder-7 scale (GAD-7).Results: The prevalence of anxiety symptoms was about 22%. Multivariate regression analysis showed that both anxiety status χ2[(13, N = 480) = 82.68, p < 0.001], and increasing levels of anxiety (model adjusted R2 = 0.204, p < 0.001) were associated with greater psychological stress, inadequate sleep hygiene practices, and poor sleep quality scores after adjusting for age, gender, attendance, substance use, years of university education, time spent in athletic activity every day, and frequency of tea/coffee consumption.Conclusion: There was a high prevalence of anxiety symptoms in this study population, and this condition was associated with psychological stress, poor sleep, and inadequate sleep hygiene parameters. These results suggest a need to address the various aspects of mental health and its diverse sleep correlates in university students.

Abstract Background Stress is a common psychological condition usually associated with many psycho-physical disorders. Stress and its risk factors are frequently seen in Ethiopians including university students. In such circumstances, a valid measure to screen for stress in Ethiopians is necessary. Therefore, we assessed the psychometric properties of the Perceived Stress Scale (PSS) in Ethiopian university students. Methods A cross-sectional study with a simple random sampling method was performed on students of Mizan-Tepi University, Mizan-Aman, Ethiopia. The study presents a psychometric investigation on a sample of 387 students (age = 21.8 ± 3.8 years, and body mass index = 20.8 ± 3.2 kg/m2) who completed PSS, Generalized anxiety disorder-7 scale (GAD-7), and a socio-demographics tool. McDonald’s Omega (internal consistency), factor validity for ordinal data and convergent validity (Spearman’s correlation) were assessed. Results No ceiling/floor effect was seen for the total or factor scores of the PSS-10 and PSS-4. Two factor model of the PSS-10 was favored by fit indices with Comparative Fit Index> 0.95, Weighted root mean square residual

The purpose of the study was to measure changes in sleep quality and perceived stress and their interrelationships in a sample of healthcare workers two years post the COVID-19 pandemic. Using a cohort design, data were collected from frontline healthcare workers (FLHCW, n = 70) and non-frontline healthcare workers (NFLHCW, n = 74) in April 2020 (T1) and in February 2022 (T2). The Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10) were administered at both time points. There were no differences in sleep quality or perceived stress between FLHCW and NFLHCW at either timepoint. For the entire sample, the PSQI scores at T2 were significantly higher than at T1 (7.56 ± 3.26 and 7.25 ± 3.29, respectively) (p = 0.03, Cohen’s d = 0.18). PSS-10 scores at T2 were significantly lower than at T1 (19.85 ± 7.73 and 21.13 ± 7.41, respectively) (p = 0.001, Cohen’s d = 0.78). Baseline sleep quality PSQI (T1) was a significant predictor for changes in sleep quality. During the initial months of the outbreak of the COVID-19 pandemic, poor sleep quality and perceived stress were common for healthcare workers. Two years into the pandemic, the perceived stress was reduced, but sleep quality worsened.

Ramadan is the 9th month of the lunar calendar during which Muslims abstain from food and drink between dawn and sunset for 30 consecutive days. Ramadan fasting is observed by all healthy Muslim adults, as well many Muslims with type 2 diabetes (T2DM). Hypoglycemic events (HE) are a serious complication associated with diabetes management and are associated with increased cardiovascular disease risk. Conflicting results have been reported concerning the incidence of HE among people with T2DM observing Ramadan fasting. This review summarizes available scientific evidence on the occurrence of HE and the effects of different moderators on the incidence of HE among patients with T2DM during Ramadan. We conducted a systematic review of available observational studies and randomized controlled trials (RCTs) for patients with T2DM who fasted during Ramadan, with HE as the primary outcome. Ten databases were searched for relevant studies from inception until October 31, 2020. In total, 68 studies (35 RCTs and 33 observational studies) met the inclusion criteria. Non-sulfonylureas hypoglycemic medications showed superior effects in lowering the incidence of HE over sulfonylureas hypoglycemic medications. Variable moderators were associated with experiencing HE during Ramadan in both observational studies and RCTs, including sex, geographical location, body anthropometric indicators, season, dietary behaviors, fasting duration, time since diagnosis, and pre-fasting education. This comprehensive systematic review covered the largest number of observational and clinical studies investigating the impact of Ramadan on HE among patients with T2DM. The study highlights the significance of different moderators that influence the effect of Ramadan fasting on HE, including dietary behaviors, fasting time duration, sex, season, country, pre-fasting education, age, and time since diagnosis. The study also highlighted the impact of different hypoglycemic medications on HE and noted the superiority of non-sulfonylureas over sulfonylureas hypoglycemic medications in lowering the risk for hypoglycemia in people with T2DM during Ramadan fasting.

Recent research indicates that Photoplethysmography (PPG) signals carry more information than oxygen saturation level (SpO2) and can be utilized for affordable, fast, and noninvasive healthcare applications. All these encourage the researchers to estimate its feasibility as an alternative to many expansive, time-wasting, and invasive methods. This systematic review discusses the current literature on diagnostic features of PPG signal and their applications that might present a potential venue to be adapted into many health and fitness aspects of human life. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. To this aim, papers from 1981 to date are reviewed and categorized in terms of the healthcare application domain. Along with consolidated research areas, recent topics that are growing in popularity are also discovered. We also highlight the potential impact of using PPG signals on an individual’s quality of life and public health. The state-of-the-art studies suggest that in the years to come PPG wearables will become pervasive in many fields of medical practices, and the main domains include cardiology, respiratory, neurology, and fitness. Main operation challenges, including performance and robustness obstacles, are identified.

In this article, we reviewed recent data that examined the relationship of circadian rhythm, mealtime, and intermittent fasting with the risk of cardiometabolic dysfunction. We also examined the effect of their interactions on cardiometabolic risks. Furthermore, since major differences exists between Ramadan diurnal intermittent fasting compared to other forms of experimental intermittent fasting, in this article, we further restricted the discussion to Ramadan diurnal intermittent fasting. PubMed and Google Scholar databases were searched using “intermittent fasting,” “time-restricted feeding,” “fasting,” “mealtime,” “circadian rhythm,” and “cardiometabolic risk,” focusing on human studies published after 2013. Recent evidence indicates that meal timing may influence circadian rhythm, as a result, it may also directly or indirectly impact cardiometabolic risk. In humans, several studies suggested that late mealtime is related to an increased risk of poor cardiometabolic health. Nevertheless, large clinical interventional studies are required to assess causality between late mealtime and cardiometabolic morbidity. Currently, evidence indicates that Ramadan diurnal intermittent fasting has several beneficial effects that may reduce the risk of cardiometabolic disorders, such as weight reduction, improvement in lipid profile and glycemic control, reduction in proinflammatory markers, and oxidative stress. Nevertheless, several changes in daily lifestyle routine, happening during the Ramadan month, may affect the all measured markers of cardiometabolic diseases. Summarily, no definitive conclusion about the impact of Ramadan intermittent fasting on oxidative stress can be formulated. Therefore, large, well-designed studies, which control for various confounding factors are required to assess the influence of Ramadan diurnal intermittent fasting on markers of cardiometabolic risk and disorders.

Abstract Background The Pittsburgh Sleep Quality Index (PSQI) dimensionality is much debated, with the greatest number of reported factor structures. Therefore, this review appraised the methodologies of studies investigating the factor structure of the PSQI. Material and methods MEDLINE, PsycInfo, AJOL, BASE, Cochrane Library, Directory of Open Access Journals (Lund University), CINAHL, and Embase were searched systematically to include articles published till 23rd March, 2018. The articles with the objective of factor analysis of the PSQI (20 articles) or with a major section on the same subject (25 articles) were included. There was no limitation about participant characteristics. Descriptive analysis of articles for measures of the suitability of the data for factor analysis, details of the exploratory factor analysis (EFA) and details of the confirmatory factor analysis (CFA) was performed. Results The analysis used by the majority did not employ the simplest scheme for interpreting the observed data: the parsimony principle. Other shortcomings included under- or non-reporting of sample adequacy measures (11 out of 45 articles), non-use of EFA (20 out of 45 articles), use of EFA without relevant details, non-use of CFA (11 out of 45 articles), and use of CFA without relevant details. Overall, 31 out of 45 articles did not use either EFA or CFA. Conclusion We conclude that the various PSQI factor structures for standard sleep assessment in research and clinical settings may need further validation. Trial registration Not applicable because this was a review of existing literature.

Abstract Background Current evidence supports the applicability of the Leeds Sleep Evaluation Questionnaire (LSEQ) in screening for insomnia. The psychometric properties of the LSEQ have never been investigated in an African population. Therefore, this study aimed to validate the adapted version of the LSEQ-Mizan (LSEQ-M) in Ethiopian university students. Methods Of a preliminary sample of 750 (random sampling), 424 students (age = 21.87 ± 4.13 years and body mass index = 20.84 ± 3.18 kg/m2) from Mizan-Tepi University, Mizan-Aman, South-west Ethiopia completed the LSEQ-M, the General Anxiety Disorder Scale-7 and a semi-structured questionnaire for socio-demographics. Insomnia was screened in accordance with the International Classification of Sleep Disorders as a measure of concurrent validity. Results Although, individual items showed ceiling and floor effect, the LSEQ-M as a scale did not have these effects. Good internal consistency (Cronbach’s alpha of 0.84) and strong internal homogeneity as measured by the correlation coefficient between items scores and the LSEQ-M global score was found. The LSEQ-M showed excellent screening applicability for insomnia with optimal cut-off scores of 52.6 (sensitivity 94%, specificity 80%), and the area under the curve, 0.95 (p

Background: Ramadan fasting (RF) is a form of intermittent fasting that generally improves body composition and related metabolic profiles. Whether RF exacerbates depressive symptomatology in individuals diagnosed with major depressive disorder (MDD) is undetermined. Methods: 100 men, who lived in Bahrain and were between the ages of 18 and 64 years with an established diagnosis of MDD, participated in this 4-week study. Based on preference, participants were assigned to a fasting group (FG, n = 50) and a non-fasting group (NFG, n = 50). The FG engaged in fasting from 03:40 to 18:10 (dawn and dusk timings). Changes in depressive symptoms, body mass, body composition, and components of metabolic syndrome were measured. Results: There were no significant changes in depressive symptoms within the FG vs. NFG after controlling for baseline covariates: mean difference 0.49 (SE = 0.63), p = 0.43. No adverse effects were reported in either group. The FG experienced significant reductions in body mass, 1.87 kg, p = 0.001; body mass index, 0.69 kg/m2, p = 0.001; body fat, 0.87%, p = 0.001; body surface area, 0.03 m2, p = 0.001; and lean mass, 0.77 kg, p = 0.001. Conclusions: RF did not negatively affect depressive symptoms and improved body composition, suggesting short-term intermittent fasting may be a safe dietary practice for adult males with MDD.

Abstract Background The applicability of the Pittsburgh Sleep Quality Index (PSQI) in screening of insomnia is demonstrated in various populations. But, the tool has not been validated in a sample of Ethiopians. Therefore, this study aimed to assess its psychometric properties in community dwelling Ethiopian adults. Material and methods Participants (n = 311, age = 25.5 ± 6.0 years and body mass index = 22.1 ± 2.3 kg/m2) from Mizan-Aman town, Southwest Ethiopia completed the PSQI and a semi-structured questionnaire for socio-demographics. Clinical interview for screening of insomnia according to the International Classification of Sleep Disorders was carried out as a concurrent validation measure. Results Overall, the PSQI scale did not have floor effect and ceiling effects. Moderate internal consistency (Cronbach’s alpha was 0.59) and sufficient internal homogeneity as indicated by correlation coefficient between component scores and the global PSQI score was found. The PSQI was of good value for screening insomnia with optimal cut-off scores of 5.5 (sensitivity 82%, specificity 56.2%) and the area under the curve, 0.78 (p

Obstructive sleep apnea (OSA) can present with or provoke various psychological symptoms. In this article, we critically review studies that have examined dreams, dream recall, and dream content in patients with OSA. Obstructive events induce recurrent sleep fragmentation and intermittent desaturations in patients with OSA, which may trigger different parasomnias, including nightmares. Contradictory results have been reported concerning dreams in patients with OSA; while some investigators have reported less dreams in OSA patients, others have described that patients with OSA have increased dreams with emotional content, mainly violent and hostile content. Although there are reports of respiratory-related dream content in patients with OSA, most studies that have assessed the dream content of patients with OSA revealed that respiratory-related dream content was unusual. A clear association between post-traumatic stress disorders, comorbid OSA, and nightmares has been reported in several studies. Furthermore, an improvement in nightmare frequency with continuous positive airway pressure (CPAP) treatment has been shown. An inverse relationship between the severity of OSA reflected by the apnea-hypopnea index and dream recall has been demonstrated in several studies. Future studies should differentiate between patients with non-stage specific OSA and patients with rapid eye movement (REM) predominant OSA.

Objectives: Despite the demonstrated utility of the Pittsburgh Sleep Quality Index (PSQI) in various demographic groups, it has never been validated in a sample of Indian subjects. To extend and confirm the PSQI’s applicability for South Asian subjects, this preliminary study aimed to assess its psychometric and diagnostic validity in a sample of university students. Methods: Forty-seven male students were recruited from Jamia Millia Islamia, a public central university in New Delhi, India. The mean age of the students was 23.4±3.9 years, and they had a mean body mass index (BMI) of 23.3±3.3kg/m2. The PSQI was administered to all subjects and overnight polysomnographic testing was carried out as a concurrent validation measure. Results: Cronbach’s alpha for the questionnaire was found to be 0.736. Internal homogeneity was high, with the majority of correlations between questionnaire component scores and the summed global score being significant (p6 and was generated using receiver operating characteristic curve analysis. The area under the curve, sensitivity, specificity, positive and negative likelihood ratios at the cut-off score were 0.838 (p

Over the last three to four decades, it has been observed that the average total number of hours of sleep obtained per night by normal individuals have decreased. Concomitantly, global figures indicate that insufficient sleep is associated with serious adverse health and social outcomes. Moreover, insufficient sleep has been linked to seven of the fifteen leading causes of death. Additionally, current evidence suggests that sleep plays a significant role in determining cognitive performance and workplace productivity. There is a great need for a systematic analysis of the economic impact of insufficient sleep, particularly given current evidence that this phenomenon, as well as the poor sleep hygiene practices which produce it, is increasing worldwide. This paper takes the view that health authorities around the world need to raise the general awareness of benefits of sleep. There is considerable scope for research into both the public health impact as well as the macroeconomic consequences of insufficient sleep syndrome (ISS). Additionally, various models which estimate the undiagnosed burden of ISS on the GDP (gross domestic product) are needed to prioritize health issues and to highlight the national policies that are necessary to combat this medical problem. Sleep insufficiency has been declared to be a ‘public health epidemic’; therefore, we propose ISS as a potential noncommunicable disease. This review elaborates on this topic further, exploring the causes and consequences of insufficient sleep, and thus providing a perspective on the policies that are needed as well as the research that will be required to support and justify these policies.