Although many studies have indicated a significant association between migraine and restless legs syndrome (RLS), few long-term longitudinal studies have examined RLS in patients with migraine. We conducted a single-center, 12-year, longitudinal study of migraine patients and assessed whether RLS was present in 2010, 2017, or 2022 to evaluate its associations with clinical factors. Headache-related disability was assessed using the Migraine Disability Assessment (MIDAS). Sleep quality, daytime sleepiness, and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Beck Depression Inventory-II (BDI-II), respectively. Of the 262 patients included at baseline (2010), 101 were available after 7 years (2017), and 74 were available after 12 years (2022). The RLS incidence rates were 13.7%, 20.8%, and 24.3% in 2010, 2017, and 2022, respectively. The RLS severity score did not significantly differ among the three time points. The persistent RLS group, defined as those who were positive for RLS at the last evaluation in addition to the first and/or second evaluations, had significantly higher MIDAS, BDI-II, PSQI and ESS scores than did the never RLS group, defined as those who did not exhibit RLS at any of the three time points. Our 12-year longitudinal study revealed significant impacts of RLS on the burden of patients with migraine.

Epidemiologic research has demonstrated a connection between the duration of sleep and the risk of overall mortality. This research investigates the correlation between sleep duration (SD) and the likelihood of all-cause and cancer-specific mortality among cancer patients, exploring the association between SD and mortality risk. The study used the National Health Interview Survey (NHIS) data from 2004, a U.S.-based survey linked to a mortality database up to December 31, 2019. A total of 26,976 participants based on cancer responses, including 2082 cancer patients and 24,894 non-cancer patients, were included in this study. Participants self-reported SD (categorized as ≤ 5, 6, 7, 8, 9, or ≥ 10 h/day) was used. The Cox proportional hazards model for mortality risk was performed with demographic adjustments. Mortality risk was higher in adults with and without cancer and extremes (insufficient or more than sufficient) of SD. A J-shaped association was found between SD and all-cause and cancer-specific mortality risk among cancer and non-cancer patients. Among the cancer patients, compared with the reference group (7 h/day), both shorter and longer SDs were associated with increased risk of all-cause and cancer-specific mortality (≤ 5 h/day, HR 1.48 CI [1.77, 1.88]; 8 h/day, HR 1.45 CI [1.23, 1.72]; 9 h/day, HR 1.53 CI [1.18,1.99], ≥ 10 h/day, HR 2.15 CI [1.66, 2.78]); except the SD 6 h/day, HR 1.14 CI [0.93, 1.40]. The analysis included 349,936 person-years of observation. This study suggests that sleeping too long and too short is associated with increased risk among patients with all-cause and cancer-specific mortality.

In this paper, we investigated the relationship between different levels of sleep and the risk of suicide among depressive patients. The sample consisted of 301 adults with depression who were recruited from a hospital in Ningxia, China. The Pittsburgh Sleep Quality Index (PSQI) and the Self-Rating Depression Scale (SDS) were applied to evaluate the quality of sleep and the degree of depression. The Suicidal Risk Factor Assessment Form evaluated suicide risk. A Latent Class Analysis (LCA) has been performed with MPLUS 7.0 to investigate the most probable category of the PSQI sub-scales. Multivariate Logistic Regression was applied to analyse the relation between Sleep Quality and Suicide Hazard in Adult Depressive Patients. Classes identified were "Global sleep impairment", "Poor sleep quality", "Short sleep duration" and "Good sleep quality." Patients with poor overall sleep quality and clear daytime dysfunction had a higher risk of suicide than those with good sleep quality. The results are helpful in understanding the relationship between the variability of sleep patterns and the risk of suicide among depressed people, and it is suggested that some sleep variables may have a higher predictive value than others. The results will provide guidance on how to improve and implement therapy for depressive disorders in adults, and to lower suicidal rates.

This study aimed to investigate the prevalence of daytime sleepiness (DS) and its impact on quality of life (QOL) in outpatients with schizophrenia in the maintenance phase, as well as to identify the factors associated with DS. A total of 191 outpatients with schizophrenia completed a self-administered questionnaire including questions on lifestyle, sleep habits, DS, QOL, and sleep disorders. Insomnia, DS, and QOL were evaluated by the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), and the MOS 8-Item Short-Form Health Survey (SF-8), respectively. The prevalence of DS was assessed with two cut-off points, ESS ≥ 11 (ESS11-DS) and ESS ≥ 8 (ESS8-DS). Psychiatric symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Logistic regression analyses were used to identify factors associated with DS. The prevalence of ESS11-DS and ESS8-DS was 7.3% and 21.5%, respectively. Seven of eight QOL domains were reduced in the ESS11-DS group, and four of eight QOL domains were reduced in the ESS8-DS group. In both groups, the Mental Component Summary Score of the SF-8 was decreased. On logistic regression analyses, severity of insomnia was associated with both ESS11-DS and ESS8-DS. Moreover, negative symptoms were associated with ESS11-DS. Psychotropic medications were not associated with either ESS11-DS or ESS8-DS. The present findings suggest that focusing on improving insomnia, rather than reducing medication dosage, may be more important in ameliorating DS and, consequently, QOL in patients with schizophrenia in the maintenance phase.

Restless legs syndrome (RLS) is characterized by an uncomfortable urge to move the legs, worsened in the evening, occurring at rest, and relieved temporarily by movement. Although its pathophysiology remains incompletely understood, oxidative stress has been suggested. Uric acid (UA) is a marker associated with oxidative stress, and its reduced levels pose a risk for certain neurodegenerative diseases. In this study, we aimed to assess serum UA concentrations in RLS patients to gain insights into its role in the etiopathogenesis of the condition.: This study involved 200 individuals. Serum UA levels were compared with clinical parameters. Disease severity was assessed, categorizing patients into "mild," "moderate," "severe," and "very severe" subgroups. Comparative analysis of UA levels was conducted between these subgroups and the control group. Patients exhibited a statistically significant reduction in UA levels compared to controls ( = 0.001;  < 0.01). No significant disparities in UA levels were observed among patients based on RLS scores ( > 0.05). The generalized linear model in which UA serves as the dependent variable revealed statistically significant associations with the "moderate" and "severe" stages of RLS, as well as age ( < 0.05). Additionally, a ROC curve analysis was executed to evaluate the potential of UA as a biomarker. The ROC analysis, focusing on the patient-control classification, revealed a statistically significant area under the curve ( = 0.848,  < 0.001). Our study supports the hypothesis implicating serum UA levels in RLS pathogenesis. Further understanding of UA and its physiological effects will clarify on its role in RLS pathophysiology.

Sleep-disordered breathing is common among patients with heart failure with preserved ejection fraction (HFpEF), and might impact their quality of life due to nighttime hypoxemia and awakenings. However, the factors contributing to deterioration in quality of life remain unclear. This study investigated the factors associated with quality of life deterioration in patients with HFpEF and sleep-disordered breathing. This prospective cross-sectional study included inpatients with HFpEF (left ventricular ejection fraction of ≥ 50%). Sleep-disordered breathing and quality of life were evaluated using polysomnography and the Short Form-8 Health Survey, respectively. The patients were grouped based on thei median physical and mental component summary Short Form-8 Health Survey scores. Among the 31 patients with HFpEF (aged 73.7 ± 10.9 years; 67.7% women; left ventricular ejection fraction, 65.3% ± 8.1%), the median apnea-hypopnea index was 11.5 per hour. Although no differences in parameters related to sleep-disordered breathing were found among the physical component summary-stratified groups, the low mental component summary group exhibited significantly lower nadir oxygen saturation than those exhibited by the high mental component summary group (84.3 ± 5.7% vs. 88.5 ± 3.9%; p = 0.02); this difference remained significant even when adjusted for potential confounders (β = 0.43; p = 0.02). Nocturnal hypoxemia may be a contributing factor to the decline in the mental health aspect of quality of life in patients with HFpEF. Thus, clinicians should consider hypoxemia when managing HFpEF and sleep-disordered breathing.

[This corrects the article DOI: 10.1007/s41105-022-00389-2.].

The purpose of this study was to evaluate how the first oral administration of suvorexant affects PSG results in patients with severe obstructive sleep apnea (OSA). Single-center, prospective study conducted in a nonrandomized, uncontrolled, unblinded fashion. Undiagnosed 64 patients with suspected OSA underwent first-night PSG, and 30 patients with severe OSA (Apnea Hypopnea Index [AHI] ≥ 30 events/h) underwent second-night PSG testing after administration of 15 mg suvorexant. The change in AHI between the first and second nights was not significant, although the upper limit of the 95% confidence interval for the mean difference in AHI was high at 5.987.The mean duration of apnea on the second night was significantly prolonged compared to that on the first night, but there were no significant differences n 3% oxygen desaturation index, saturation of percutaneous oxygen<90% time. On the second night, total sleep time was significantly prolonged, mid-night awakenings decreased, REM sleep percentage increased, and REM latency was shorter. Because the environment for PSG testing is very different from the patient's home and many patients have difficulty sleeping, there are clinical cases in which PSG is performed with sleep medication. In this study, PSG after oral administration of 15 mg of suvorexant on the second night showed no significant difference or clear trend in AHI. However, the upper limit of the 95% confidence interval for the mean difference in AHI was greater than 5, suggesting that suvorexant may exacerbate AHI, even with the first administration.

The ovarian steroid hormones, estrogen and progesterone, the levels of which fluctuate dynamically with the estrous cycle, alter circadian behavioral rhythms in mammals. However, it remains unclear whether the sleep-wake rhythm fluctuates with the menstrual cycle in humans. To ascertain the relationship between the menstrual cycle and sleep-wake rhythms, we evaluated the objective and long-term sleep-wake rhythms of ten healthy women using a recently developed wearable device. The results showed a strong negative correlation between the sleep midpoint and the quasi-peak value (an indicator of rhythm robustness), and a positive correlation between the length of the menstrual cycle (days) and social jetlag (hours). These results suggest that healthy women with late sleeping habits have a disturbed sleep-wake rhythm and that irregular habits prolong the menstrual cycle. The sleep midpoint and quasi-peak values showed variations during the menstrual cycle. The quasi-peak values in the follicular phase were significantly higher than those in the menstrual and luteal phases. In rodents, the phase of locomotor activity rhythm advances, and activity increases at night during proestrus. The increase in quasi-peak values during the follicular phase, when estrogen is relatively high, may be due to the increased activity caused by estrogen. These results suggest that ovarian steroid hormones influence sleep-wake rhythms in women. Verifying the results of this study under various conditions is necessary; however, accurately predicting the day of ovulation using only the acquisition of sleep-wake rhythms with wearable devices will be possible.

To examine whether the effects of low sleep quality, sleep deprivation, and chronotype on daytime cognitive function varied by age group. All data were collected online. We obtained the data from 366 employed people in their 20s, 40s, or 60s. The participants were required to fill out a questionnaire comprising of the Pittsburgh Sleep Quality Index, an Ultra-Short Version of the Munich ChronoType Questionnaire, and Karolinska Sleepiness Scale, and perform the online Stroop task through the web browser on their own PC. The results of analyses of variance showed that people in their 20s had more of an evening chronotype, while those in their 20s and 40s experienced more sleep loss than those in their 60s. Stroop interference, reflecting decline in selective attention, was greater in people in their 60s. The results of structural equation modeling showed that sleep loss tended to relate to lower Stroop interference in people in their 20s. Additionally, people in their 60s exhibited a significant relationship between lower sleep quality and lower Stroop interference in the reaction time. At least in this study, interindividual differences in sleep loss, chronotype, and sleep quality did not have a strong effect on cognitive function measured using the online Stroop task in the 40s age group. However, people in their 20s with sleep loss and those in their 60s with lower sleep quality showed higher selective attention, the mechanism of which requires further research.

A bout of leisure-time physical activity improves sleep on the subsequent night. However, whether breaking up sedentary time during the workday improves sleep is unknown. The purpose of this study was to examine whether breaking up prolonged sitting by standing during the workday leads to better sleep the following night. 25 inactive adults (16 males, 42.4 ± 11.8 years, body mass index: 31.9 ± 5.0 kg/m) participated in a randomized crossover trial consisting of two simulated 8-h workdays involving prolonged sitting (SIT) or alternating sitting and standing every 30 min (SIT-STAND). Sleep was assessed on the night following each workday. Participants completed a diary and wore a wrist accelerometer (Actiwatch Spectrum) to assess multiple dimensions of sleep (e.g., timing, duration, wakefulness, quality). Paired -tests and Hedges' effect sizes evaluated differences in sleep across conditions. Self-reported wakefulness after sleep onset (WASO) was significantly lower following SIT-STAND compared to SIT (13.9 ± 30.1 min vs. 23.2 ± 38.6 min;  = 0.03,  = - 0.51), mirrored by a small-sized nonsignificant reduction in accelerometer-assessed WASO following SIT-STAND compared to SIT (32.7 ± 13.6 min vs. 40.8 ± 25.8 min;  = 0.06,  = - 0.38). Mean accelerometer-based activity levels during sleep were also lower following SIT-STAND compared to SIT (10.8 ± 14.5 vs. 14.7 ± 10.4 counts/min;  = 0.03,  = - 0.47). Other sleep outcomes (e.g., bed- and wake-time, total sleep time, sleep onset latency) were not different between conditions. Alternating sitting and standing rather than prolonged sitting during a simulated workday modestly reduces night-time wakefulness. Whether similar benefits occur with long-term reduction in workplace sedentary behavior deserves further exploration.

Intermittent hypoxia in sleep apnea syndrome (SAS) patients increases the oxidative stress and can cause serious cardiovascular diseases such as hypertension or atherosclerotic diseases through endothelial dysfunction. The evaluation of risk caused by oxidative stress, however, is not easy in a clinical setting. Thus, we intended to evaluate the changes in oxidative stress by SAS treatment using a simple method that can be easily used in the clinical testing. We enrolled 42 consecutive newly diagnosed severe SAS patients (30 men). Reactive oxygen species metabolites (d-ROMs) for oxidative stress and biological antioxidant (BAP) in blood samples were estimated using FREE Carrio Duo before and 3 months after continuous positive airway pressure (CPAP) treatment. SAS parameters were obtained by polysomnography before CPAP and endothelial function was measured twice as well. The body mass index and apnea hypopnea index (AHI) were 29.1 ± 5.3 and 57.9 ± 19.7/h. The d-ROMs and BAP were 317.4 ± 71.8 CARR U and 2121.2 ± 299.6 μmol/L. Although no significant correlation was found between hypoxia parameters and d-ROMs or BAP before CPAP treatment, we found a significant negative correlation between basal AHI or basal oxygen desaturation index representing intermittent hypoxia and the change in d-ROMs ( = - 0.31,  = 0.046/ = - 0.33,  = 0.03) and between the change in SpO < 90% duration (min) representing continuous hypoxia and the change in BAP ( = - 0.35,  = 0.03) after CPAP treatment. The changes in d-ROM and BAP might reflect the different kind of reduction of oxidative stress by CPAP treatment and, thus, can be used as handy indicators of the treatment effect.

This study aimed to examine the effects of "adaptive" bedtime routines on a child's well-being, either directly or indirectly through sleep health. A web-based survey was conducted on 700 adults (321 male, 379 female, mean age = 39.98 years, SD = 6.33 years) responsible for preschool children aged 4-6 years old. Results of the mediation analysis showed that the bedtime routines index (BTR-Index[S]) could not confirm any significant regression coefficient with the total disturbance score of the Strengths and Difficulties Questionnaire (SDQ_TDS) (β = -0.063, p = 0.094) and the total sleep disturbance of Children's Sleep Habits Questionnaire (CSHQ_TSD) (β = -0.013, p = 0.736) in a single regression analysis. Sobel's test did not confirm any significant indirect effect (Z = -0.337, p = 0.736). As exploratory examination of the relationships between each of the items of BTR-Index(S) with SDQ_TDS and CSHQ_TSD, multiple regression analysis showed a significant positive partial regression coefficient for "Reading/sharing a story before bed" (β = 0.228, p = 0.006) and a significant negative partial regression coefficient for"Avoiding the use of electronic devices before bed" (β = -0.222, p = 0.011) towards CSHQ_TSD, with no significant partial regression coefficient identified for SDQ_TDS in any of the items. These findings suggest that bedtime routines do not directly either indirectly, through their sleep health, affect a child's well-being. However, caregivers' deliberate attempt to avoid stimuli that increases children's wakefulness before bedtime may serve as protection for the child's sleep health.

This mini-meta-analysis evaluated the internal consistency of the Anxiety and Preoccupation about Sleep Questionnaire (APSQ) across existing studies to assess its potential as an orthosomnia (an obsessive preoccupation with achieving perfect sleep) screening tool. A systematic literature search identified four studies with 2,506 participants using English, Swedish, Turkish, and Arabic versions. Cronbach's alpha ranged from 0.91 to 0.95 across studies. The APSQ demonstrated high overall internal consistency reliability (pooled Cronbach's alpha of the entire ASPQ = 0.93, 95% CI 0.91-0.94), suggesting utility for screening orthosomnia symptoms. The pooled Cronbach's alpha of the first and second factors of the ASPQ were: 0.91 (95% CI 0.89-0.93) and 0.87 (95% CI 0.84-0.89), respectively. APSQ demonstrated high overall internal consistency reliability; however, limited linguistic/cultural representation and significant heterogeneity across studies impact generalizability.

Limited information exists on age and racial disparities in sleep duration and mortality in the United States (US) population. This study compared the association between mortality and sleep duration within distinct races and age groups in the US. This study used data on 26,915 US citizens (≥ 18 years) from the 2004 wave of the National Health Interview Survey, linked to the National Death Index prospective mortality through 2019. Cox proportional hazard models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality by sleep duration, race (Whites, Black/African Americans, and Others (AIAN, Asian, and Native Hawaiian or other Pacific Islander)), and age (< 40, 40-60, and ≥ 60 years), while controlling for covariates such as sex, education, smoking status, disease history, and other vital factors. Race and age significantly modified the sleep duration-mortality relationship. Compared to other races, White participants exhibited higher mortality risks at all hours except at 5-6 h [HR: 0.993, 95% CI: 0.923-1.069]. Likewise, sleep duration associated mortality risks varied by age. Those at greater risk included < 40 years sleeping for 1-4 h [HR: 2.461, 95% CI: 1.446-4.187], 40-< 60 years sleeping for less than 7 h and more than 8 h, and ≥ 60 years sleeping for 9 h [HR: 1.309, 95% CI: 1.162-1.475] and ≥ 10 h [HR: 1.662, 95% CI: 1.486-1.858]. Age and race were significant effect modifiers in the sleep duration-mortality relationship. Thus, it is important to consider these factors when evaluating mortality risks associated with sleep patterns.

Sleep is integral to cognitive functioning, and disturbances in sleep patterns can impair cognition. This study investigated the relationships between executive functions, sleep problems, and negative pre-sleep cognitions, proposing a model for their interaction. We assessed 107 adults using the Bedtime Counterfactual Processing Questionnaire and the Glasgow Content of Thoughts Inventory for negative pre-sleep cognitions, the Insomnia Severity Index and the Pittsburgh Sleep Quality Index for sleep problems, and the Free Research Executive Evaluation test battery for executive functions. Regression and mediation analyses were conducted to examine both direct and indirect relationships between these variables. Higher executive functions were associated with fewer negative pre-sleep cognitions, which in turn predicted fewer sleep problems. However, the anticipated direct effect of sleep problems on executive functioning was not supported, indicating a more complex interplay. Notably, pre-sleep cognition mediated the relationship between executive functions and sleep problems, indirectly affecting sleep problems through its connection with executive functions. While the findings support the mediation model of executive functions, negative pre-sleep cognitions, and sleep problems, the proposed cyclical model was not fully substantiated. This suggests that additional factors may influence the dynamics of this relationship, offering potential avenues for future research and interventions targeting sleep disorders and cognitive well-being enhancement.

Objectives: Social jetlag (SJL), the discrepancy between an individual's inherent circadian rhythm and external social schedule, is associated with obesity. This study aimed to investigate whether SJL also influences body weight and body fat loss during dieting. Methods: This was an observational study from 2015 to 2018 with participants who had joined an exercise and nutrition program at a private personal training gym. Data from 11,829 individuals provided by the gym along with their sleep logs were analyzed. Differences in change in body mass index (BMI) and body fat percentage (%body fat) were compared by the degree of SJL. Regression was conducted for the change in BMI and %body fat on SJL, adjusted for gender, age, engagement duration in the program, initial BMI, initial %body fat, chronotype, and dietary intakes. Results: The subjects comprised 3,696 men and 8,133 women with a mean age of 40.4 years. Greater SJL was associated with a lower efficacy of BMI and %body fat reduction. The change in BMI (+ 0.56 / hour: SJL) and %body fat (+ 1.40 / hour: SJL) was associated with SJL after adjusting for each variable including dietary intake. Conclusion: SJL was associated with the effect of exercise and nutrition instruction on BMI and body fat reduction, even after adjustment for covariates related to dietary intake. Maintaining consistent sleep-wake rhythms may be crucial for enhancing the efficacy of weight loss programs.

The aim of this study is to examine the psychometric properties of the Turkish adaptation of the Morningness/Eveningness Scale (M/E Scale-Parent Report Form) family evaluation form for preschool children. The study sample consisted of 276 parents with children aged 4-6 years. The study calculated Cronbach's alpha internal consistency coefficient and corrected item-total correlations of the scale. It also determined the scale's distinctiveness, stability analyses, and convergent validity. The Turkish version of the M/E Scale (Parent Report Form), consisting of 10 items, is unidimensional. The Cronbach's alpha internal consistency coefficient of the scale was 0.80 and the corrected item-total correlation values varied between 0.51 and 0.76. There was a positive correlation at the level of 0.75 between the applications of the scale with two-week intervals and at the level of 0.63 between the single-item chronotype scale within the scope of convergent validity and the M/E Scale (Parent Report Form). This study determined a low correlation between the child's chronotype and the father's chronotype, and a moderate correlation with the mother's chronotype. The Turkish M/E Scale (Parent Report Form) was found to be valid and reliable. This scale is a short and easy-to-use measurement tool for determining the chronotypes of 4-6-year-old children.

Substance use disorders (SUDs) are associated with profound sleep disturbances, including insomnia, sleep fragmentation, and circadian rhythm dysfunction resulting in serious mental and physical consequences. This minireview presents an overview of the neurocircuitry underlying sleep disturbances in SUDs and elaborates on treatment options with emphasis on alcohol use disorder (AUD) and opioid use disorder (OUD). A PubMed, Embase, CINAHL Plus, Cochrane, and Scopus search were conducted using sleep- and AUD/OUD related keywords from January 1st, 2000, to January 31st, 2023, with preferences for recent publications and randomized-controlled trials. A bidirectional relationship exists between insomnia and addiction with the status of each condition impacting the other in dictating clinical outcome. Existing evidence points to a resurgence of insomnia during detoxification, and unless treated satisfactorily, insomnia may lead to relapse. The discussion summarizes the strengths and limitations of cognitive behavioral therapy and pharmacological treatment for insomnia in SUDs covering evidence from both animal and clinical studies. The assumption of reestablishing normal sleep patterns by attaining and maintaining sobriety is misguided. Comorbid insomnia in patients with SUDs should be approached as an independent condition that requires its own treatment. Future clinical trials are needed with the aim of providing a resource for guiding clinical management of the many patients with insomnia and SUD.