Sleep Medicine

Objectiveto evaluate the effectiveness of a sleep education program among young athletes in enhancing sleep quality and duration, as well as mood and academic performance. Design: prospective cohort study. MethodsWe included 639 players (11% female; mean age of 13.89{+/-}3.8 years) of 5 sports disciplines in a professional club were evaluated before and after a sport season, through 4 specific instruments: 1) sleep diaries to estimate nocturnal sleep duration, 2) the Childrens Sleep Disorder Score Scale (SDSC) to assess sleep quality, 3) the Sleep Vitality Scale (SVS) to examine mood, and 4) school records of academic performance. The sleep education program included staff, family and individual sessions. It focused on the promotion of healthy sleep habits. ResultsThe 16t-25 years-old (y-o) group exhibited an increase in nocturnal sleep duration (p=0.002), while the 12-15 y-o group showed a decrease (p=0.01). In contrast, the 7-11y-o group exhibited no change. For sleep quality, the 12-15y-o (p < 0.001) and 16-25y-o (p<0.001) groups, while the 7-11y-o group exhibited inferior sleep quality (p 0.001). Regarding mood, the 7-11y-o group showed a significant deterioration (p=0.008), while no changes were observed in the 12-15y-o and 16-25y-o groups. Academic performance exhibited a significant improvement in the 7-11y-o (p=0.001), 12-15y-o (p<0.001), and 16-25y-o (p=0.008) groups. ConclusionsAmong athletes aged 12-25y-o, participation in a sleep education program led to improvements in sleep quality and duration, accompanied by enhanced academic performance. However, this intervention did not yield positive effects for athletes between the ages of 7 and 11 years.

ObjectivesDrug induced sleep endoscopy (DISE) is a standardly used investigation for surgical planning in obstructive sleep apnoea management once conservative treatments have proven inadequate. There are a variety of anaesthetic agents used to obtain sedation necessary for DISE. These agents may have different effect on the upper airway and other parameters important in the diagnosis of the site of collapse during sleep. We aimed to review the commonly agents and evaluate the significance of their impact on the the diagnosis. MethodsA search was conducted through PubMed looking for studies on commonly used anaesthetic agents and their effect on the upper airway and cardiopulmonary parameters. Results: Of the 109 studies yielded by the search, 19 were deemed relevant to the review and met all inclusion criteria. The agents reviewed were: propofol, dexmedetomidine, remifentanil, isoflurane, sevoflurane, midazolam and topical lidocaine. A meta-analysis was not conducted due to the limited number of relevant studies and the heterogeneity of outcomes measured. All agents examined gave some element of airway collapse and impact on cardiopulmonary measures. Most of these effects were shown to be dose-dependent. Of the agents considered dexmedetomidine and propofol gave the most consistently reliable and physiologically safe representations of upper airway collapse seen in OSA patients. ConclusionThere is limited information and no industry standard for the sedative regimen used for DISE. Of the agents reviewed those that caused least cardiopulmonary instability, respiratory depression and exaggerated upper airway collapse were deemed the most appropriate for DISE. The agent that best meet these criteria is dexmedetomidine followed by propofol.

BackgroundGood quality sleep is essential for good health and well-being. Medical students are at no exception to this and are prone to greater risk for sleep deprivation. The major reason being challenges to maintain a high level of academic achievement and constant thirst to acquire new learning skills and knowledge. However, in this process they are circumstanced to various levels of stress that might cause potential damage to their cognitive functioning and mental exhaustion to a certain extent. ObjectivesThus, our study objectives were to evaluate the sleep pattern in first- and second-year medical students. To understand how the stress levels and academic performance are related to sleep pattern and to explore the copying strategies of stress in our study participants. MethodologyThis cross-sectional study was conducted using a self-reported, web-based, questionnaire that included questions on sleep quality and deprivation through Pittsburgh sleep quality index. All the eligible students of first and second year who were part of a premiere teaching hospital during February and March 2021 were included. Data was analysed using IBM SPSS version 24. ResultsOut of 180 participants, 91(50.55%) had their initiation of sleeping time from 12-2 am and also, majority of students 112 (62.22%) had a sleep duration of six to eight hours. However, 119 (66.1%) students had self-reported change in sleeping pattern which was found to be significantly associated with relatively greater number of academic factors as compared to social factors. Most of the students scored between 50-60% score in their four assessments amongst which their first assessment was significantly associated with change in sleep pattern (P 0.040). Also, these individual assessment score was found to significantly affect their duration of sleep. The common coping strategies adopted by students under study were talking to family members/ friends, music/ book reading (hobby). ConclusionMajority of students in our study had reported change in sleeping pattern. Also, association between stress factors and change in sleeping pattern were observed with academic stress factors proving to be more significantly associated than social stress factors. The academic performance of students was also found to be associated with change in sleeping pattern and duration of sleep.

Background and purposeA new version of the Sleep Hygiene Index (SHI-10) has recently been introduced, and the psychometric performance in other populations is unknown. This study aimed to determine the dimensionality, internal consistency, and nomological validity of the SHI-10 among medical students at a Colombian university. MethodsA psychometric study was designed to determine indicators of validity (construct and nomological) and reliability (internal consistency) in which 309 medical students between 18 and 39 years (M=20.83, SD=2.68), and 54.69% were female. Construct validity (dimensionality) was tested through confirmatory factor analysis, internal consistency with Cronbachs alpha and McDonalds omega coefficients, and nomological validity through correlations with the Athens Insomnia Scale, Epworth Somnolence Scale, Generalized Anxiety Disorder (GAD)-7) and Patient Health Questionnaire (PHQ-9). ResultsThe four-dimensional structure of the SHI-10 showed adequate indicators of goodness of fit (Satorra-Bentlers chi-square of 43.30 [df of 29, p=.04], chi-square/df of 1.49, RMSEA of .04 [90%CI .01-.06], CFI of .97, TLI of .96 and SRMR .04). The four dimensions of the SHI-10 showed values less than .70 and limited nomological validity (most Pearson correlations were less than .30). ConclusionsThe SHI-10 shows a four-dimensional structure of SHI-10; however, the four dimensions of the SHI-10 present low internal consistency and limited nomological validity. More studies are needed to show the psychometric performance of the SHI-10.

Study objectiveTo evaluate the association between obstructive sleep apnea (OSA) and cognitive impairment by comparing individuals with continuous positive airway pressure (CPAP)-treated OSA, untreated OSA, and those without OSA. MethodsIn this cross-sectional study, participants were divided into 3 groups based on overnight sleep study and CPAP use: (1) OSA-CPAP group, (2) OSA-no treatment group, and (3)non-OSA group. The primary outcome was the prevalence of cognitive impairment among 3 groups measured by Montreal Cognitive Assessment (MoCA) and the secondary outcome was ambulatory blood pressure monitoring (ABPM). ResultsA total of 113 participants (male 69.9%, median age: 57.0 years) are enrolled, comprising 50 participants in the OSA-CPAP group, 50 participants in the OSA-no treatment group, and 13 participants in the non-OSA group. The cognitive impairment prevalence was 46.0% in the OSA-CPAP group, 70.0% in the OSA-no treatment group, and 46.0% in the non-OSA groups (p=0.038). Subdomain analysis showed significantly higher scores in memory and visuospatial abilities in the OSA-CPAP and the non-OSA group (p=0.039 and p=0.005). Post-hoc analysis revealed significantly higher MoCA scores and lower prevalence of cognitive impairment in the OSA-CPAP group compared to OSA-no treatment group (p=0.002 and p=0.015). No significant differences in ABPM parameters were observed. ConclusionCPAP therapy in patients with OSA is associated with better cognitive performance and lower prevalence of cognitive impairment. These findings suggest a potential role for OSA treatment preserving cognitive function, however further longitudinal studies are needed. BRIEF SUMMARYThe relationship between obstructive sleep apnea (OSA) and cognitive impairment remains controversial. Most prior studies relied on retrospective analyses or selected participants using strict inclusion and exclusion criteria, limiting their real-world applicability. In this study, we analyzed data from unselected patients attending a sleep clinic. We found that patients with treated OSA had a similar prevalence of cognitive impairment as those without OSA, and both groups had a lower prevalence than patients with untreated OSA.

PurposeIntermittent hypoxia and transient arousals in obstructive sleep apnea (OSA) can lead to poor sleep quality and acute stress. Rising levels of obesity and increased incidence of OSA in young adults predisposes them to acute stress. We propose a mediation model to assess if risk of OSA is associated with acute stress and if the relationship between risk for OSA and acute stress is mediated by sleep quality. Methods493 healthy individuals (F=237, M=256) from 18-25 years of age (mean age=20.3{+/-}1.53 years) were screened for OSA, sleep quality and acute stress using STOP-BANG questionnaire, Pittsburg Sleep Quality Index and American Psychiatry Associations National Stressful Events Survey Acute Stress Disorder Short Scale (NSESS-S) respectively. Binary and logistic regression were used establish the relationships between the variables. Sobel test for mediation analysis was conducted. Results73 participants (17.3%) were found at an intermediate and high risk of OSA by STOP BANG questionnaire. 79 (16%) participants reported level of stress as None. Mild, moderate and severe stress was present in 248 (50.3%), 109 (22.1%), 51 (10.3%) and 16 (3.2%) participants respectively. The odds of having severe and extreme stress among those at risk of sleep apnea is 2.18 times higher than that among those not at risk of sleep apnea (OR: 2.18, 95% Confidence Interval: 1.37-3.51). Sobel test established that the relationship between OSA and acute stress is mediated by sleep quality. ConclusionSleep quality mediates the relationship between risk for sleep apnea and acute stress. This highlights the importance of screening for OSA in young adults, particularly young men with high BMI, presenting with high stress levels.

IntroductionUnilateral hypoglossal nerve stimulation (HGNS) is an approved surgical therapy for obstructive sleep apnea (OSA), but its efficacy is limited by obesity and unfavorable (laterally directed) pharyngeal collapse patterns. This study tested whether the effect of body mass index (BMI) on HGNS efficacy differs by pharyngeal collapse pattern, specifically comparing laterally directed and anteroposterior (AP) collapse. MethodsWe pooled data from two independent HGNS cohorts (n=760) to evaluate the interaction between BMI and pharyngeal collapse pattern on HGNS efficacy. Collapse sites were identified via drug-induced sleep endoscopy (DISE) and grouped as laterally directed or AP directed. Multivariable mixed model regression evaluated the association between HGNS efficacy, largely based on optimal setting AHI during titration polysomnogram (primary: percent reduction in apnea-hypopnea index [AHI]; secondary: success defined as [&ge;]50% AHI reduction to <15 events/h) and the interaction between collapse pattern and BMI, adjusting for baseline AHI, partial collapse, surgical center, type of follow-up sleep study, and prior or concomitant pharyngeal surgery. ResultsGreater BMI was associated with a larger reduction in HGNS efficacy in those with lateral collapse (-19.7% [95% CI: -33.2, -6.2] per 5 kg/m{superscript 2}) than in those with AP collapse (-3.8% [-8.0, 0.36]; p-interaction=0.027). In lateral collapse, greater BMI reduced the odds of treatment success (odds ratio [95% CI]: 4.4 [1.4, 14.3] per 5 kg/m{superscript 2}), with no significant effect in AP collapse (1.1 [0.75, 1.5]; p-interaction=0.023). ConclusionThe impact of BMI on HGNS efficacy varies by collapse pattern. Tailoring BMI criteria to collapse pattern may improve HGNS candidate selection.

PurposeObstructive sleep apnea (OSA) is a highly prevalent disease, and positional OSA (pOSA) is a subgroup whose OSA severity is highly affected by sleeping position. This study investigated differences in demographic and sleep characteristics between patients with and without pOSA and developed a simple discrimination model. MethodsWe reviewed polysomnography records of patients admitted to the Sleep Center at Shuang-Ho Hospital between March 2015 and March 2019. They were categorized into pOSA and non-pOSA groups, and their demographic and sleep characteristics were compared. The receiver operating characteristic (ROC) curve was used to estimate the feasibility of discrimination model. ResultsOf the patients, 33% received diagnoses of pOSA; they had smaller neck circumference and waistline and lower weight, body mass index (BMI), OSA severity, heart rate, and snoring and respiratory-related limb movement indexes but higher sleep efficiency and mean oxygen saturation compared with patients without pOSA. Sleep stage analysis revealed that as severity increased, the proportion of sleep time spent in N2, N3, and rapid eye movement stages decreased, but the proportion of time spent in the N1 stage increased in both populations. Sleep position analysis revealed a higher proportion of sleep time in a supine position among patients with pOSA after adjustment for severity. The corresponding area under the ROC curve of our discrimination model was 0.924. ConclusionsDemographic and sleep characteristics differed significantly between patients with and without pOSA. Our model uses readily available measurements such as BMI and waistline and can aid physicians in the timely identification of patients with pOSA. Trial registration numberTMU-JIRB No.: N201911007 Date of registration2019/11/12

An ever-increasing burden of non-communicable diseases, especially in the post pandemic times and an association of sleep problems with them highlighted a felt need to estimate the sleep problem in India. A meta-analysis of the studies conducted on Indian data was planned adhering to PRISMA guidelines. An electronic search of available literature was performed on databases including PubMed, Google Scholar, PsycNet, and Epistemonikos. 100 eligible articles were analysed. To assess the methodological quality 10-points Joanna Briggs Institute (JBI) checklist for prevalence studies was used. The pooled estimates for prevalence of Insomnia found were 25.7%, OSA 37.4%, and RLS 10.6%. An increased prevalence was seen in patients of diabetes, heart disease patients and in otherwise healthy population. Subgroup analysis showed a higher prevalence in patient population and in the otherwise healthy population too,; e.g. Insomnia 32.3% (95% CI: 18.6% to 49.9%, I2=99.4%) and 15.1% (95% CI: 8.0% to 26.6%, I2=99.1%); OSA 48.1% (95% CI: 36.1% to 60.3%, I2=97.4%) and 14.6% (95% CI: 9.2% to 22.5%, I2=97.4%) and RLS 13.1% (95% CI: 8.7% to 19.3%, I2=91.9%) and 6.6% (95% CI: 2.4% to 16.4%, I2=99.1%) respectively. Excessive daytime sleepiness remained prevalent (19.6%) (95 % CI: 8.4% to 39.1%, I2=99.8%) in the healthy, which was alarming. A multipronged approach for sleep management, evaluation and research is the need of the hour for managing non communicable disorders and for promoting sleep health in the healthy population.

The COVID-19 lockdown brought disruptions to daily life and social schedules which influenced sleep and stress. Young adults, already vulnerable to irregular sleep patterns and heightened psychological stress, may have experienced notable shifts in sleep quality, duration, and circadian alignment during this period. Seventy-nine urban young adults (18-25 years) provided matched pre-lockdown and during-lockdown data via an online survey. Measures included the Pittsburgh Sleep Quality Index (PSQI), Berlin Questionnaire for OSA risk, the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESS-S), and self-reported height and weight for BMI. Social jet lag was derived from sleep timing. Within-participant changes were tested using Wilcoxon signed-rank tests; univariate and multivariate logistic regressions identified predictors of OSA risk. No significant changes were observed in PSQI scores, subjective sleep quality, sleep latency, acute stress, or social jet lag during lockdown. Sleep duration increased slightly, and BMI and social jet lag showed small numerical rises without statistical significance. OSA risk was positively associated with acute stress (p < 0.001), higher BMI (p < 0.05), and poor sleep quality (p < 0.001). In multivariate models, poor sleep quality was the strongest independent predictor of OSA risk, followed by acute stress and BMI. Lifestyle factors, including physical activity, screen time, and ambient noise, showed no significant associations. Flexible schedules during lockdown may have offset expected negative impacts on sleep and stress in this demographic. The strong links between OSA risk, poor sleep quality, and acute stress highlight the need for integrated behavioural and physiological approaches to sleep health in young adults.

IntroductionThe purpose of the present study was to determine whether mild traumatic brain injury (mTBI+) results in latent changes in microRNA expression profiles across an episode of total sleep deprivation (TSD). MethodsSeven previously concussed (mTBI+) adults (24.5 {+/-} 5.3 y.o.) and 6 non-concussed control adults (mTBI-; 24.8 {+/-} 1.6 y.o.) underwent 24 h TSD (T2) preceded by 8 h baseline sleep (T1; BSL) and followed by 8 h recovery (T3; REC) sleep. Salivary microRNA expression was assessed across the entire study. ResultsSubjects (mTBI+ and mTBI-) had differential expression of salivary microRNA targets across TSD. mTBI+ subjects had greater change to microRNA expression profiles compared to mTBI- subjects between T1 and T3. DiscussionAlthough there is some evidence that TSD may unmask latent changes in gene expression in mTBI+ subjects, a definitive conclusion was precluded by differences in baseline sleep in mTBI+ (vs. mTBI-) subjects measured through polysomnography (not shown). However, this study is unique in that the mTBI+ subjects were exposed to a sleep deprivation challenge very shortly after medical clearance from mTBI demonstrating lingering neurobiological impacts of mTBI.

RationaleObstructive sleep apnea (OSA) is a common, treatable chronic disease with significant health and societal consequences. Many patients face barriers to care due to systemic inequality, poverty, and other contributors to social vulnerability, leading to delayed diagnosis and more severe disease at presentation. Several studies have examined the impacts of social vulnerability on OSA severity using individual-level factors. However, there is comparatively limited work examining how neighbourhood-level indicators may influence OSA severity. This study aimed to determine whether social vulnerability, measured using a neighbourhood-level multidimensional index, is associated with OSA severity at referral to a tertiary sleep centre. MethodsWe conducted a retrospective observational study of adult patients referred to an academic hospital in Calgary, Canada for evaluation of OSA between November 2016 and November 2019. Patient data were linked using residential postal codes to the Canadian Index of Multiple Deprivation (CIMD), a census-based tool designed to reflect dimensions of social vulnerability in Canadian populations. CIMD divides social vulnerability into four dimensions including residential instability, ethnocultural composition, economic dependency, and situational vulnerability. We employed both linear and logistic mixed-effects models to assess the impact of neighbourhood-level social vulnerability on sleep apnea severity, using postal code as the grouping variable. OSA severity was based on home sleep apnea test (HSAT) derived oxygen desaturation index (ODI). Secondary outcomes included severe OSA (ODI [&ge;] 30), sleepiness based on Epworth Sleepiness Scale (ESS), and severe sleepiness (ESS > 15). ResultsThe study included 2,232 patients, 80% of whom had at least mild OSA. ODI was positively associated with situational vulnerability (p < 0.01) and inversely associated with ethnocultural composition (p < 0.01), though both associations lost significance after adjusting for BMI. ESS was independently associated with situational vulnerability (p < 0.01) and inversely with ethnocultural composition (p = 0.01), independent of BMI and ODI. Severe sleepiness was associated with situational vulnerability (p < 0.01) and residential instability (p = 0.02). ConclusionLiving in a socially deprived area was associated with OSA severity at time of referral, though this relationship appeared to be mediated by BMI. Deprivation dimensions were independently associated with sleepiness, highlighting the broader impact of social-related factors on sleepiness. These findings demonstrate the complex interplay between social vulnerability and sleep disorders and suggest that composite indices like the CIMD can enhance our understanding of these relationships.

Study ObjectivesExcessive daytime sleepiness (EDS) is common in participants with sleep disorders, particularly obstructive sleep apnea (OSA), and can be assessed using the Epworth Sleepiness Scale (ESS) and the Psychomotor Vigilance Test (PVT). However, the relationship between these measures of sleepiness/attention, and their relationships to OSA severity and treatment, remains understudied. This study examined these associations in a sleep center population. MethodsA total of 167 participants, primarily diagnosed or suspected of OSA (n=128 [76.6%]), completed the ESS and PVT during their clinical visit. Associations among ESS, PVT, OSA severity and CPAP adherence were examined using Pearsons correlations, unadjusted and controlling for age, sex and body mass index. ResultsResults showed no significant correlations between ESS and PVT measures of attention/vigilance. While higher ESS scores correlated with more severe apnea-hypopnea index (AHI) in participants with OSA, no association was found with PVT measures. Among participants using continuous positive airway pressure (CPAP), greater hours/night of usage was associated with lower ESS scores, but not with better PVT performance. ConclusionsOur data indicate that ESS scores track more closely than PVT to OSA severity and treatment. The findings suggest that the tendency to fall asleep as measured by the ESS and attention deficits on PVT may capture different aspects of "sleepiness". While the ESS is commonly used in sleep clinics, further research is needed to determine if PVT should also be used routinely in clinical practice. Brief summaryExcessive daytime sleepiness (EDS) is a prevalent symptom among individuals with obstructive sleep apnea (OSA), but the relationship between a subjective measure (Epworth Sleepiness Scale) and an objective measure (Psychomotor Vigilance Test) of sleepiness or attention, as well as how each relates to OSA severity and treatment, is not well understood. This study found no association between the ESS and measures from a 3-minute PVT, suggesting that these assessments are not evaluating the same aspects of "sleepiness" reported by participants. Higher ESS scores, but not worse PVT performance, was related to more severe OSA and less adherence to CPAP, indicating that the ESS tracks more closely than the PVT to OSA severity and treatment use.

Background and ObjectiveAccurate measurements of peripheral blood oxygen saturation (SpO2) are important in evaluating sleep patients with frequent desaturations due to pathological breathing events. This project compared synchronised SpO2 measurements at the finger, forehead and toe of patients undergoing Type 1 polysomnography (PSG) to evaluate potential SpO2 variability across the sites. MethodsPulse oximetry SpO2 measurements were simultaneously and continuously recorded for 41 sleep patients at the finger, forehead and toe, and synchronised with PSG data. Recordings were scored for desaturations of [&le;] 3% (peak to trough, lasting [&le;]10 seconds), signal dropouts, and artefact occurrences. Forehead and toe SpO2 measurements were compared against the finger as the standard PSG oximetry site. ResultsDifferences between anatomical sites for mean SpO2, mean number of SpO2 desaturations per hour, and time spent below an SpO2 level of 95% during total sleep time were significant (P < 0.01). The forehead pulse oximeter had the highest mean SpO2, least number of SpO2 desaturations per hour, and experienced the least number of artefact occurrences. Dropouts were lowest for the forehead and toe pulse oximeters. ConclusionDifferences between SpO2 measurements, dropouts and artefact occurrences at the finger, forehead and toe may have diagnostic and prognostic implications for sleep patients. The differences in SpO2 measurements may be attributed to variability in perfusion of the extremities and core during sudden oscillating blood pressure changes associated with breathing events. Further research is required to determine which anatomical site correlates closest to arterial oxygenation for pulse oximetry in sleep patients. BRIEF SUMMARYO_ST_ABSStudy rationaleC_ST_ABSAn absence of research investigating anatomical site location for pulse oximetry during overnight polysomnography exists. Our study was performed to fill this gap, as accurate pulse oximetry measurements are key for the diagnosis, treatment and monitoring of sleep patients; a patient cohort where SpO2 desaturations are recurrent. Study impactOur findings demonstrate there are significant differences between finger, forehead and toe pulse oximetry measurements, particularly SpO2 desaturations per hour, which may have diagnostic and clinical implications. This research is applicable and important to not only sleep physicians and scientists, but also other disciplines where continuous SpO2 monitoring is required.

BackgroundInsomnia disorder is a common sleep disturbance characterized by adverse daytime cognitive and emotional impairments, such as repetitive negative thinking and increased psychological distress. Memory control, a key self-regulatory ability to control or inhibit unwanted thoughts and memories, plays an essential role in supporting cognitive functions and emotional well-being. Here, we delineate the neurocognitive mechanisms underlying memory control among individuals with insomnia. Methods41 participants meeting DSM-5 criteria for insomnia disorder and 40 healthy sleepers completed an emotional Think/No-Think task, during which participants either retrieved (Think) or suppressed the retrieval (No-Think) of aversive memories in response to memory cues while electroencephalograms were recorded. ResultsLinear mixed model analyses with age and depression scores as covariates showed that participants with insomnia exhibited impaired memory control abilities, as evidenced by reduced suppression-induced forgetting in memory recall when compared to healthy sleepers. Electrophysiologically, healthy sleepers showed enhanced right prefrontal theta power in retrieval suppression than in retrieval, indicating elevated needs of inhibitory control during memory control. In sharp contrast, this difference was absent among those with insomnia. Notably, the greater the severity of insomnia symptoms, the smaller the retrieval vs. retrieval suppression theta power differences across participants, linking inefficient top-down control of unwanted memories with low sleep qualities. ConclusionIndividuals with insomnia showed impaired memory control of aversive memories and aberrant electrophysiological activities during retrieval suppression. Future research shall investigate the causal relationship between memory control abilities and insomnia symptoms.

BackgroundPoor sleep quality in children can lead to physical and psychosocial problems. The FIFA World Cup has been shown to impact adult behaviors, but its effect on childrens sleep patterns is less understood. The study aimed to evaluate the impact of the FIFA World Cup 2022 (FWC-2022) on childrens sleep patterns. MethodsA cross-sectional survey was conducted between 27 November and 25 December 2022, targeting parents in Saudi Arabia (Arabia standard time) and countries with a +6-hour time difference. Participants completed the validated Childrens Sleep Habits Questionnaire (CSHQ), alongside demographics, time spent watching matches, and parental perceptions on sleep. ResultsA total of 848 parents participated, with 60.6% being mothers. The study found that children averaged 9.10 hours of sleep; 64.2% of parents observed no change, while 10.4% reported substantial changes. Parents aged [&ge;]45 and those noticing shifts in sleep habits reported higher problematic sleep scores. Larger families reported fewer sleep issues, with a negative correlation between family size and sleep problems. Childrens CSHQ scores indicate mild to moderate sleep difficulties across domains. No significant differences were observed between Saudi Arabia and countries with +6-hour time difference. However, one-third of children experienced delays in sleep onset exceeding one hour on weekdays during the World Cup. ConclusionSociodemographic factors, family dynamics, and major events like the FWC-2022 influence parental perceptions of child sleep issues. Older parents and smaller families reported more challenges, while higher socioeconomic status was linked to fewer bedtime difficulties. Our findings may be particularly relevant for FIFA 2026, where transcontinental hosting across North America will expose children globally to matches at even more variable times. Subtle impacts of prolonged event schedules highlight the need for interventions supporting healthy routines during such events, potentially through engaging, sleep-friendly technologies.

PurposeThis study aimed to examine the association between age-specific sleep sufficiency and autism spectrum disorders (ASD) among U.S. children aged 6-17 years. MethodsData were gathered from the 2022-2023 National Survey of Childrens Health (NSCH), including 63,866 children. Sleep sufficiency was defined based on age-specific guidelines from the American Academy of Sleep Medicine. Descriptive statistics, incidence risk ratios (IRRs), and adjusted logistic regression models were used to assess associations between ASD and key predictors. Stratified models by sex and BMI were conducted to explore effect modification. Additionally, a machine learning model was developed to predict the adjusted probability of ASD risk. ResultsChildren with insufficient sleep had a significantly higher incidence of ASD (5.16%) compared to those with sufficient sleep (4.05%) (p < 0.001). In adjusted models, sufficient sleep was associated with lower odds of ASD (OR = 0.78; 95% CI: 0.72-0.85; p < 0.001). Stratified analyses showed a protective effect in both males (OR = 0.78; 95% CI: 0.71-0.86) and females (OR = 0.80; 95% CI: 0.68-0.93), more pronounced in males. Machine learning analysis revealed that females with sufficient sleep and age below 14 years exhibited the lowest probability of ASD, whereas males aged 8 to 14 years with insufficient sleep demonstrated the highest likelihood of ASD risk. ConclusionThese results suggest that sufficient age-specific sleep is significantly associated with reduced odds of ASD, particularly in male children. Findings highlight the importance of sleep as a potentially modifiable factor in ASD risk and support targeted public health interventions.

RationaleExcessive daytime sleepiness, an important symptom of obstructive sleep apnea (OSA), is commonly quantified using the Epworth Sleepiness Scale score (ESS). Baseline OSA severity measures (ventilatory burden, flow limitation, and hypoxemia) provide insights into OSA pathophysiology and could predict changes in sleepiness (i.e. change-in-ESS) following continuous positive airway pressure (CPAP) treatment. ObjectivesWe hypothesized that change-in-ESS following CPAP treatment can be predicted from baseline polysomnography. MethodsAssociations between OSA severity measures and ESS were evaluated in 2332 participants, adjusting for age, sex, BMI, and total sleep time. Change-in-ESS prediction was evaluated using 213 CPAP treatment studies (HomePAP, BestAIR, and ABC) in three steps: severity measures were compared (adjusted regression, n=64), a prediction model was developed using baseline ventilatory burden and baseline ESS (n=139), and then evaluated in holdout participants (n=74). Measurements and Main ResultsIn cross-sectional analysis, ESS was associated with ventilatory burden (0.45 points/SD; 95% CI 0.23-0.67), hypoxic burden (0.39; 0.17-0.62), the apnea-hypopnea index (AHI) (0.36; 0.14-0.59), and flow limitation severity (0.22; 0.01-0.43). Comparison analysis revealed that change-in-ESS was most strongly associated with baseline ventilatory burden (-1.08 points/SD; -2.13 to -0.05) and baseline ESS (-2.75; -3.83 to -1.69); the AHI association was weaker (-0.97; -2.01-0.05). Predicted change-in-ESS and actual change-in-ESS were correlated in holdout participants (adjusted R{superscript 2}=0.313); median [IQR] actual change-in-ESS of predicted responders ([&ge;]2-point ESS improvement, n=54, 73.0%) was -5.0 [-10.0 to -2.0] and non-responders was 0.0 [-1.0-1.0] (P<0.001). ConclusionsBaseline ventilatory burden and baseline ESS were independently associated with change-in-ESS and could be used together to inform clinicians whether CPAP treatment will likely improve a patients sleepiness.

BackgroundThe COVID-19 pandemic has spread worldwide, affecting millions of people and exposing them to home quarantine, isolation, and social distancing. While recent reports showed increased distress and depressive/anxiety state related to COVID-19 crisis, we investigated how home quarantine affected sleep parameters in healthy individuals. Methods160 healthy individuals who were in home quarantine in April 2020 for at least one month participated in this study. Participants rated and compared their quantitative sleep parameters (time to go to bed, sleep duration, getting-up time) and sleep quality factors, pre-and during home quarantine due to the COVID-19 pandemic. Furthermore, participants chronotype was determined to see if sleep parameters are differentially affected in different chronotypes. ResultsThe time to fall asleep and get-up in the morning were significantly delayed in all participants, indicating a significant circadian misalignment. Sleep quality was reported to be significantly poorer in all participants and chronotypes, and included more daily disturbances (more sleep disturbances, higher daily dysfunctions due to low quality of sleep) and less perceived sleep quality (lower subjective sleep quality, longer time taken to fall asleep at night, more use of sleep medication for improving sleep quality) during home quarantine. ConclusionsHome quarantine due to COVID-19 pandemic has a detrimental impact on sleep quality. Online interventions including self-help sleep programs, stress management, relaxation practices, stimulus control, sleep hygiene, and mindfulness training are available interventions in the current situation.

Study ObjectivesHigh-frequency EEG activity during sleep (cortical hyperarousal), is a transdiagnostic feature across psychiatric disorders, including nightmare disorder. It is discussed as a target of intervention; however, specific treatment options are yet unavailable. We tested whether exposure to relaxation-associated odor cues during sleep would reduce cortical hyperarousal, i.e. beta (16.25 - 31 Hz), gamma (31.25 - 45 Hz), spindle activity and nightmare occurrence in participants with frequent nightmares. MethodsTwenty-five (21 female, mean age (SD) = 24.94(5.01)) participants, recruited from undergraduate students at University of Luebeck, with [&ge;]1 nightmare / week received a deep breathing relaxation intervention for one week coupled with an odor. On two subsequent nights in the sleep laboratory, the associated odor (A), or control odor (B) were presented in randomized order in a crossover design with randomization at baseline; participants were blinded to intervention. ResultsN = 11 participants were allocated to AB and n = 14 to BA sequence. Exposure to relaxation-associated odor cues during sleep did not affect beta or gamma activity while spindle count and density were significantly reduced. Reduction in spindle count during reactivation nights correlated with reduced subjective wake-after-sleep-onset. There was no additional impact on nightmare symptoms. There were no adverse events or side effects. ConclusionsThe reactivation of relaxation-associated states with odor cues during sleep may be associated with changes in spectral activity, specifically spindle activity. Future studies should implement multiple nights of reactivation and include different patient groups with cortical hyperarousal to test the transdiagnostic potential of this new intervention.