Sleep, as a behavioural lifestyle factor, has so far received limited attention in medical risk assessment. Nonetheless, behavioural lifestyle factors can offer valuable insights into the health status of applicants. Health trackers enable the continuous recording of lifestyle factors such as physical activity and sleep patterns. Currently, there is a dearth of experience in incorporating such data when calculating premiums, as well as in understanding the correlation between continuously recorded lifestyle factors and mortality/morbidity. Hence, the literature was reviewed to examine the association between sleep duration and all-cause mortality to derive dose-response rates. Relative risks were calculated by pooling data from 10 selected studies comprising over 3 million study participants. The findings suggest that both short (<6 hours) and long sleep duration (>9 hours) are associated with an increased risk of all-cause mortality.

We examined the associations between sleep characteristics and cardiovascular biomarkers among middle-aged and older adults from the general population and explored interactions by age and sex. Cross-sectional data from wave 6 (2013-2017) of the Doetinchem Cohort Study were used, including 3,437 adults aged 46-85 years. Sleep characteristics were measured with the Medical Outcomes Study Sleep Scale (MOS-SS). Sleep duration was categorized into short/moderate/long; sleep quality was expressed on a scale between 0 and 100 with higher scores reflecting poorer sleep quality (sleep disturbance, shortness of breath or headache, sleep adequacy, somnolence, snoring). Multivariable linear regression analyses were performed to assess the association between sleep characteristics with cardiovascular biomarkers (Body Mass Index (BMI), mean arterial pressure, cholesterol ratio). Effect-modification by sex and age was examined. Associations were adjusted for age, sex, educational level, cigarette smoking, alcohol consumption, physical activity and the other biomarkers. Almost all unhealthy sleep characteristics were associated with higher BMI, e.g. somnolence (β = 0.023, 95%CI: 0.014-0.031) and short sleep duration (β = 0.723, 95%CI: 0.154-1.291). The association of snoring with BMI was stronger for women (β = 0.044, 95%CI: 0.035-0.053). A higher cholesterol ratio was associated with somnolence and snoring (in particular age group 65-85 years). For hypertension no associations were found with one exception: somnolence was associated with lower mean arterial pressure. Unhealthy sleep characteristics seem predominantly associated with a higher BMI. More research is needed into the mechanisms underlying the associations between sleep characteristics and cardiovascular biomarkers.

Sleep is recognized as a foundational pillar of health, essential for maintaining nearly all vital processes, and a crucial component of cardiovascular function. In recent years, there has been a paradigm shift to conceptualize sleep health as a combination of multiple domains, including duration, timing, quality, variability/regularity, habits/behaviors, and disordered sleep. This review provides a comprehensive overview of the current evidence linking the multifaceted elements that contribute to healthy sleep with cardiovascular and blood pressure-related outcomes. The reviewed literature indicates a strong relationship between sleep and cardiovascular health. However, the specific pathophysiological mechanisms that bridge the various dimensions of sleep with cardiovascular outcomes remain elusive. Given the global burden of cardiovascular disease, understanding the interplay between sleep and cardiovascular health has important implications for both individual and population health. Sustained efforts to move beyond a focus on discrete domains of sleep are essential to fully understand this complex and potentially bidirectional relationship. Promoting healthy sleep patterns and optimizing the management and treatment of sleep disorders are key steps toward developing more comprehensive strategies for reducing cardiovascular risk. Integrating sleep health into routine clinical care is identified as a critical opportunity to enhance cardiovascular disease prevention and management, particularly among vulnerable and high-risk populations.

Short sleep duration (<7 h/day) affects one-third of the population, is implicated in morbidity and mortality from coronary heart disease (CHD), and is driven by an interplay of individual, social, and societal factors.

To review observational and experimental studies that have tested interventions to address short sleep in various clinical presentations (sleep disorders, behaviorally induced short sleep, lack of sleep opportunity) and describe considerations needed for CHD populations.

Few existing interventions have a primary aim to increase sleep duration in individuals with insufficient sleep, and none specifically target individuals with established CHD. Short sleep duration may be modifiable via treatment of insomnia, behavioral sleep extension, and system-level changes to healthcare settings, workplace policies, and communities. With further research on interventions that address diverse phenotypes of short sleep-while assessing long-term cardiometabolic outcomes, patient preferences, and mechanisms-of-action-sleep health could become an important component of CHD secondary prevention.

Sleep fragmentation (SF) and intermittent hypoxia (IH), hallmark features of obstructive sleep apnea (OSA), disrupt restorative processes by inducing sympathetic activation and endothelial dysfunction, contributing to cardiovascular risk. While IH has been extensively studied, the independent effects of SF remain underexplored. This study investigated the cardiovascular impact of chronic SF in a murine model mimicking moderate-to-severe OSA. Male C57BL/6J mice were exposed to chronic SF or control conditions for 12 weeks. Mean blood pressure (MBP), cardiac function, pulse wave velocity (PWV), and coronary flow velocity reserve (CFVR) were assessed. Endothelium-dependent relaxation in aortic and coronary vessels was examined ex vivo, and aortic histological analysis evaluated intima-to-media thickness and collagen content. SF significantly elevated MBP (107 ± 8 mmHg vs. 89 ± 5 mmHg; p = 0.0001) and PWV (4.3 ± 0.6 m/s vs. 3.1 ± 0.2 m/s; p = 0.0001), indicating hypertension and arterial stiffness. Endothelium-dependent relaxation was impaired in coronary (67 ± 9 % vs. 86 ± 5 %; p = 0.0004) and aortic (73 ± 12 % vs. 87 ± 7 %; p = 0.045) vessels. Histology revealed increased intima-to-media thickness (128 ± 9 μm vs. 102 ± 14 μm; p = 0.008) and collagen deposition (56 ± 10 μm vs. 41 ± 7 μm; p = 0.027). Cardiac function and CFVR were unaffected. Chronic SF independently drives cardiovascular dysfunction through hypertension, arterial stiffness, endothelial impairment, and vascular remodeling. These findings emphasize SF as a distinct pathological factor in OSA, necessitating adjunctive interventions to mitigate cardiovascular risks.

This study investigates the relationship between objective sleep indicators derived from heart rate variability (HRV) and sleep perception in young adults using an intensive longitudinal design over 14 consecutive nights. The sample included 178 participants aged 18-29 years from two separate studies, who provided data via daily sleep diaries. Using a multi-resolution convolutional neural network model, heart rate variability measured via ambulatory electrocardiography was used for sleep stage classification. Within-subject analyses revealed that longer total sleep time, higher sleep efficiency, more slow-wave sleep, and more rapid-eye-movement sleep were associated with better sleep perception, while longer wake after sleep onset was linked to poorer sleep perception. Notably, no significant associations were found on the between-subject level. The objective sleep indicators explained nearly five times as much variance in sleep perception at the within-subject level than at the between-subject level. Additionally, gender, as well as depressive symptoms and insomnia symptoms measured at baseline did not moderate the within-subject associations between objective sleep indicators and sleep perception. These findings underscore the importance of sufficient sleep duration, quality of sleep architecture, and sleep continuity for individuals' perceptions of their sleep on a nightly basis. The study's use of HRV-derived sleep staging over multiple nights represents a methodological strength, providing detailed and less intrusive assessment compared to traditional polysomnography. Furthermore, these results are particularly important for clinical applications, as they can be basis for individualized interventions to improve sleep perception.

Hyperbaric oxygen (HBO) has been proposed to be effective for treating chronic insomnia at high altitudes.

Patients suffering from chronic insomnia at high altitude were randomly assigned at a 1:1 ratio to either the hyperbaric oxygen (HBO) treatment group or the control group for a 10-day procedure. The primary outcome was insomnia status, which was assessed via the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). The secondary outcomes included stratified comparisons of changes in the PSQI score and ISI score, Fatigue Severity Scale (FSS) score and Hospital Anxiety and Depression Scale (HADS) score. Analyses were performed for multiple comparisons for the primary outcomes at 2-sided 0.05 significance levels with Bonferroni corrections.

A total of 80 patients were randomized in this study, and the median age was 25.0 years (IQR, 21.25-29.75). For the primary outcome of sleep quality, the PSQI score after treatment was significantly lower in the HBO group than in the control group (4.6 ± 3.15 vs. 9.1 ± 4.02; adjusted mean difference [aMD] -3.96 [-5.26 to -2.66], p < 0.0001). The ISI was also significantly lower in the HBO group than in the control group (5.0 ± 4.09 vs. 9.8 ± 6.47; aMD -4.10 [95 % CI, -5.68 to -2.51], p < 0.0001). For the secondary outcomes, the HBO group showed improvements in terms of fatigue, anxiety, and depression. No serious adverse events were reported in either group.

HBO is an efficacious and safe treatment for chronic insomnia at high altitude.

ChiCTR2100046917.

Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life's Essential 8. Although chronic sleep duration is the sole metric used in Life's Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.

The objective of this systematic review was to investigate the association between sleep quality with awake bruxism or sleep bruxism in adult individuals. Inclusion criteria comprised observational studies conducted in adults related to the research question, assessing bruxism by instrumental or non-instrumental approaches, and sleep quality by subjective or objective measures, or sleep duration. Sleep disorders, syndromes, neurological and psychiatric disorders, or psychotropic medications were excluded. PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were searched until August 2024. Risk of bias was assessed by the JBI Critical Appraisal Checklist tool for cross-sectional studies, and the Newcastle-Ottawa scale for case-control studies. Independent meta-analyses comparing awake or sleep bruxism individuals with control individuals were performed when there were at least two studies for each sleep outcome. Thirty-two studies assessing a total of 4706 individuals were included. Meta-analyses showed no differences between sleep bruxism and control individuals regarding polysomnography parameters (sleep efficiency, sleep latency, awakenings, wake after sleep onset, and sleep duration). Pittsburgh Sleep Quality Index showed higher scores for sleep bruxism individuals compared to control individuals (MD = 1.98; 95 % CI = 0.96-3.00) and for awake bruxism individuals compared to control individuals (MD = 1.99; 95 % CI = 0.42-3.57). In total, 12 studies were rated as low risk of bias, 15 as moderate risk of bias, and 5 as high risk of bias. The certainty of evidence was rated as very low. Objective sleep quality was not associated with sleep bruxism, while subjective sleep quality was associated with both sleep and awake bruxism.

The relationship between sleep duration and frailty remains unclear, particularly regarding their bidirectional nature and temporal dynamics in the Chinese population. This study aimed to investigate the cross-sectional association, developmental trajectories, and interactions between sleep duration and frailty in Chinese middle-aged and older adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which included 12,942 participants for cross-sectional analysis and 11,192 participants for the longitudinal trajectory study. Latent growth models and cross-lagged panel models were utilized to explore the temporal effects of sleep duration on frailty and vice versa. Participants' mean age was 59.29 ± 9.48 years, comprising 47.73% men and 52.27% women. Cross-sectional analysis revealed that, compared with participants with normal sleep duration (6-8 h), both Q1 (≤ 5 h, OR = 1.99, 95% CI 1.64-2.41, P < 0.001) and Q4 (> 8 h, OR = 1.50, 95% CI 1.12-2.02, P = 0.01) showed increased risks of frailty. The parallel latent growth model demonstrated that the initial level of sleep duration significantly negatively predicted the initial level of frailty (β = - 0.34, P < 0.001), while the rate of change in sleep duration negatively predicted the rate of change in frailty (β = - 0.61, P < 0.001). Conversely, the initial level of frailty significantly negatively predicted the initial level of sleep duration (β = - 0.36, P < 0.001), and the rate of change in frailty negatively predicted the rate of change in sleep duration (β = - 0.71, P < 0.001). Cross-lagged analysis indicated a bidirectional causal association between sleep duration and frailty, with the negative predictive effect of frailty on sleep duration being relatively stable, while sleep duration had a short-term effect on frailty. Our study revealed a U-shaped correlation between sleep duration and frailty risk in cross-sectional analysis and established a bidirectional relationship through longitudinal investigation. These findings underscore the importance of balanced sleep patterns and early screening for both conditions in middle-aged and older adults.

Physical activity, sedentary behavior (SB), and sleep duration are associated with brain health. Effects of those on developing Parkinson's disease (PD) are poorly investigated. This study aimed to examine the independent and joint associations of physical activity, SB, sleep with PD risk.

We analyzed data on 401,697 participants from the UK Biobank cohort, which was enrolled in 2006-2010. Physical activities were measured based on a questionnaire. Sleep and SB time were defined through self-reported total number of hours. Models fitted with restricted cubic spline were conducted to test for linear and non-linear shapes of each association. Cox proportional hazards regression models were used to estimate the association of three modifiable behaviors.

Our analytic sample included 401,697 participants with 3030 identified cases of PD (mean age, 63 years; 62.9% male). PD risk was 18% lower in the high total physical activity group (95% CI, 0.75-0.90), 22% lower in the high leisure-time physical activity (LTPA) group (95% CI, 0.71-0.86) compared with the low level and 14% higher in the high sleep duration group (95% CI, 1.05-1.24) compared to moderate group. Total SB time was irrelevant with PD risk, while high TV viewing showed a 12% increase of PD risk compared to the low group (95% CI, 1.02-1.22). Low computer use (0 h/day) was associated with a 14% higher risk compared to 1 h/day use (95% CI, 1.04-1.26). Those associations were independent. A combination of 7 h/day sleep, moderate-to-high computer use, and moderate-to-vigorous intensity of LTPA showed lowest PD risk (HR, 0.70; 95% CI, 0.57-0.85).

Physical activity, SB, and sleep were associated with PD risks separately. Our findings emphasize the possibility for changing these three daily activities concurrently to lower the risk of PD. These findings may promote an active lifestyle for PD prevention.

Sleep disturbances are known to have adverse effects on health, but knowledge on the effect of sleep disturbances on epigenetic ageing is limited. We investigated (1) whether symptoms of insomnia, obstructive sleep apnoea, sleep deprivation, and circadian rhythm lateness are associated with epigenetic ageing, and (2) whether years spent in shift work moderates these associations.

We used the population-based Young Finns data (n = 1618). Epigenetic clocks such as AgeDevHannum, AgeDevHorvath, AgeDevPheno, AgeDevGrim, and DunedinPACE were utilized to measure epigenetic ageing. Sleep was evaluated using various validated self-report questionnaires. Covariates included sex, array type, smoking status, health behaviours, socioeconomic factors, and cardiovascular health factors.

Among the various sleep measures, obstructive sleep apnoea symptoms were most consistently linked to accelerated epigenetic ageing, as measured by AgeDevGrim and DunedinPACE. Insomnia, sleep deprivation, and years spent in shift work were not associated with epigenetic ageing after adjusting for health-related or socioeconomic covariates. Additionally, we found interactions between years spent in shift work and sleep disturbances when accounting for epigenetic ageing. Among those with little to no history of shift work, both insomnia and sleep deprivation were associated with more accelerated epigenetic ageing in AgeDevGrim when compared to long-term shift workers. However, the pace of epigenetic ageing (measured with DunedinPACE) appears to be higher in those with both sleep deprivation and longer history of shift work.

Among various sleep measures, symptoms of obstructive sleep apnoea appear to be most consistently associated with accelerated epigenetic ageing even after adjusting for various health-related and socioeconomic factors. Shift work seems to have a crucial role in the relationship between sleep disturbances and epigenetic ageing in working-age adults.

Background/Objectives: Sleep is a fundamental physiological function that plays a crucial role in maintaining health and well-being. The aim of this study was to assess dietary and lifestyle factors associated with adequate sleep duration in children and adolescents living in five Mediterranean countries. Methods: Parents of children and adolescents taking part in an initial survey for the DELICIOUS project were examined to assess their children's dietary and eating habits (i.e., meal routines), as well as other lifestyle behaviors (i.e., physical activity levels, screen time, etc.) potentially associated with adequate sleep duration (defined as 8-10 h according to the National Sleep Foundation). The youth healthy eating index (Y-HEI) was used to assess the diet quality of children and adolescents. Multivariate logistic regression analyses were performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs), indicating the level of association between variables. Results: A total of 2011 individuals participated in the survey. The adolescents and children of younger parents reported being more likely to have inadequate sleep duration. Among eating behaviors, having breakfast (OR = 2.23, 95% CI: 1.62, 3.08) and eating at school (OR = 1.33, 95% CI: 1.01, 1.74) were associated with adequate sleep duration. In contrast, children eating alone, screen time, and eating outside of the home were less likely to have adequate sleep duration, although these findings were only significant in the unadjusted model. After adjusting for covariates, a better diet quality (OR = 1.63, 95% CI: 1.24, 2.16), including higher intake of fruits, meat, fish, and whole grains, was associated with adequate sleep duration. Conclusions: Adequate sleep duration seems to be highly influenced by factors related to individual lifestyles, family and school eating behaviors, as well as diet quality.

Few studies have investigated the impact of sleep duration at night and daytime napping on mortality from aortic disease. In this study, we examined the associations of sleep duration at night with daytime napping and mortality from aortic disease.

We followed 67,269 participants (26,826 men and 40,443 women, aged 40-79 years) who were not night shift workers and had no history of stroke, heart disease, or cancer. The baseline survey was conducted in 1988-1990, and follow-up continued until the end of 2009. Sleep duration at night was classified into three categories: ≤ 6, 7, and ≥ 8 hours/day. We also asked the presence or absence of daytime napping. Hazard ratios (HRs) for mortality from aortic disease with 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model.

During an average 16.3-year follow-up period, we observed 87 deaths from aortic dissection and 82 from aortic aneurysms. There was no association between sleep duration at night and mortality from aortic disease, but daytime napping was associated with an increased risk of mortality from total aortic disease; the multivariable-adjusted HRs were 1.48 [95% CIs: 1.08-2.02]. Furthermore, the stratified analysis revealed a stronger association with medium sleep duration (7 hours at night) compared to the other shorter and longer sleep duration: the multivariable-adjusted HR for aortic disease, 2.02 [1.16-3.52].

Daytime napping but not sleep duration at night was associated with an increased risk of mortality from aortic disease.

This study examined the relationship between head injuries due to intimate partner violence (IPV) and sleep quality among women survivors of IPV.

Women were recruited from Kentucky courts after receiving protective orders against intimate partners, including women survivors of IPV with no head injury (n = 260; M = 31.8 years-old, SD = 9.7; 77.3% White) and women survivors with IPV-related head injuries (n = 244; M = 33.7 years-old, SD = 8.9; 88.1% White). Women completed in-person interviews, querying IPV severity, posttraumatic stress disorder (PTSD), pain severity, and sleep quality.

Women with IPV-related head injuries reported significantly worse sleep quality (p < .001, d = .63) than women survivors without head injuries. Analyses of components of sleep quality indicated that women with IPV-related head injuries had worse subjective sleep quality, longer sleep latency, shorter sleep duration, more sleep disturbances, greater sleep medication use, and more daytime dysfunction (all p-values<.001). The relationship between IPV-related head injury and sleep remained significant (p = .017, η p 2 =.01) after controlling for sociodemographics, IPV severity, PTSD, and pain.

Compared to women survivors without head injuries, women with IPV-related head injuries, on average, had 10-minute longer sleep latency, slept 24 minutes less per night, had trouble falling asleep six more times per month, and used sleep medications more often. Further study of sleep quality among women with IPV-related head injuries and interventions to address poor sleep warrant future investigation.

To investigate the association between symptoms of long-term effects of coronavirus disease 2019 (long COVID) and sleep problems in a sample population from southern Brazil. This cross-sectional study used data from the SULcovid-19 survey, developed in the municipality of Rio Grande, RS, Brazil. The outcome, long COVID, was investigated through the presence of 18 symptoms, and the exposure variable was sleep problems. Poisson regression with robust adjustment for variance was used to estimate crude and adjusted prevalence ratios for the outcome-exposure relationship. Odds ratio was calculated through multinomial regression of the relationship between the number of symptoms of long COVID and sleep problems. Analyses were adjusted for sex, age, marital status, income, body mass index, smoking status, comorbidities, and hospital admission. A total of 2919 adults and older adults were interviewed. The prevalence of long COVID was 48.3% (95% confidence interval [CI] 46.5-50.1%) and sleep problems were reported by 41.2% of the sample (95% CI 39.4-43.0%). Individuals with sleep problems were more likely to exhibit altered sensitivity (prevalence ratio [PR] 3.27; 95% CI 1.96-5.45), nasal congestion (PR 2.75; 95% CI 1.53-4.94), musculoskeletal symptoms (PR 1.75; 95% CI 1.48-2.06), respiratory issues (PR 1.58; 95% CI 1.24-2.01), and one or more symptom of long COVID (PR 1.27; 95% CI 1.15-1.39). Approximately one-half of the population analysed had long COVID, and four of 10 reported experiencing sleep problems. In addition, the sample tended to have experienced a greater number of symptoms compared with those who reported to sleep well.

Sleep is implicated in circulating aldosterone, whereas effects of overall sleep quality are not characterized. Therefore, we explored relationship of sleep quality with plasma aldosterone concentration (PAC) in general population. We evaluated sleep quality using Pittsburgh sleep quality index (PSQI) and measured PAC in adults cross-sectionally. We divided participants into very good, fairly good, fairly bad and very bad sleepers, compared PAC and log-PAC, and applied linear regression to examine association of PSQI score with log-PAC, in total, gender- and age-stratified (young, middle-aged and old) participants. Sensitivity analysis were performed by excluding hypertension, sleep disordered breathing (SDB), or both. Among 29,499 participants, PAC showed significant increase from very good to very bad sleepers in total (14.3 vs. 14.4 vs. 14.7 vs. 15.8ng/dL), and in male participants (13.1 vs. 13.6 vs. 14.1 vs. 14.9ng/dL), consistent in the young and the middle-aged (P for all < 0.001) and in log PAC of total, in male and in different age groups (P for trend < 0.001). PSQI score showed significant positive association with log-PAC in total (B, 95%CI: 0.007, 0.003-0.010, P < 0.001) in male participants (0.013, 0.008-0.018, P < 0.001), consistent in the young and the middle-aged and in adjusted models. In female, PSQI score showed significant positive association with log-PAC in the old-aged. Sensitivity analysis yielded consistent observation with main analysis. Poor sleep quality is associated with elevated PAC, in young and middle-aged male and in elder female, independent of SDB and hypertension, indicating potential involvement of sleep quality on regulation of circulating aldosterone.

The influence of extreme sleep duration on coronary heart disease (CHD) risk across genders remains a debated topic.

This analysis gathers observational studies that explore association between varying sleep durations and CHD risks. Trend estimation employs generalized least squares, converting specific category risk estimates into relative risks (RR) per hour of sleep increase. A two-stage hierarchical regression model evaluates potential linear dose-response relationships. Data analysis utilizes random-effects restricted cubic spline models with four knots.

Involving 17 studies and 906,908 participants, this meta-analysis identifies a pronounced U-shaped nonlinear relationship between sleep duration and CHD risk applicable to both genders (P < 0.01). Notably, shorter sleep durations are linked to higher CHD risks in women, whereas longer durations are more consequential for men. The optimal sleep duration for minimizing CHD risk is between 7.0-8.0 h daily for men and 7.5-8.5 h for women.

The influence of sleep duration on CHD risk differs significantly between genders.

https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier (CRD42023478235).

Objectives: This study examines the relationship between nutrition, lifestyle habits, and perceived sleep quality in a cross-sectional analysis of 22,181 Spanish adults. Methods: Data were collected between August 2020 and November 2021 using the Nutritional and Social Healthy Habits (NutSo-HH) questionnaire, which assessed variables such as sleep duration, self-perceived restfulness, dietary patterns, and physical activity. Results: Findings indicate that 48.9% of participants sleep 7-8 h per night, while 8.6% sleep less than 6 h. Approximately 50% report frequently feeling rested, whereas 45.4% seldom or sometimes feel rested. Non-parametric Mann-Whitney and Kruskal-Wallis tests with Dwass-Steel-Critchlow-Fligner (DSCF) correction revealed that perceived sleep quality had an average score of 3.39 on a 0-5 scale, with significant differences based on socio-demographic and lifestyle factors (p < 0.001 for sex, age, education, income, and living in a family). Participants with sufficient sleep reported a lower BMI, a higher nutritional index, and more weekly physical activity. A network analysis demonstrated strong clustering between sleep variables and eating behaviors. Although causality cannot be established in this observational study, the results suggest that better sleep is associated with the lower consumption of sugary drinks and ultra-processed foods, as well as improved body image and mental health. Conclusions: These findings highlight the interconnectedness of sleep, nutrition, and lifestyle habits, suggesting that targeted interventions in any of these areas could positively influence the others, ultimately improving overall health outcomes.

Sleep duration is a crucial factor influencing health outcomes, yet its relationship with mortality remains debated. In this meta-analysis, we aimed to investigate the association between short and long sleep duration and all-cause mortality in adults, including sex-specific differences. A systematic search was performed in multiple databases, including PubMed, Cochrane Central, and Web of Science, up to October 2024. Retrospective and prospective cohort studies involving adults with at least 1 year of follow-up and data on sleep duration and all-cause mortality were included. Hazard ratios were pooled using a random-effects model, with subgroup analyses performed based on sex and sleep duration categories. A total of 79 cohort studies were included, with data stratified by sex and categorized into short and long sleep durations. Short sleep duration (< 7 h per night) was associated with a 14% increase in mortality risk compared to the reference of 7-8 h, with a pooled hazard ratio of 1.14 (95% CI 1.10 to 1.18). Conversely, long sleep duration (≥ 9 h per night) was associated with a 34% higher risk of mortality, with a hazard ratio of 1.34 (95% CI 1.26 to 1.42). Sex-specific analyses indicated that both short and long sleep durations significantly elevated mortality risk in men and women, although the effect was more pronounced for long sleep duration in women. Both short and long sleep durations are associated with increased all-cause mortality, though the degree of risk varies by sex. These findings underscore the importance of considering optimal sleep duration in public health strategies aimed at enhancing longevity and highlight the need for sex-specific approaches in sleep health research.

Sleep, a vital pillar of health, impacts daily functioning and overall quality of life. Despite extensive research on sleep disturbances within specific therapeutic areas (TAs), there's limited understanding of how these disturbances affect patients across multiple TAs. This systematic literature review adopts a patient-centered approach to explore the meaningful aspects of health and concepts of interest relating to sleep and sleep disturbances across a variety of TAs, utilizing qualitative research to bridge the gap between patient experiences and clinical measures.

A systematic search was conducted in Embase and PubMed for qualitative studies on sleep within selected TAs, using a pre-registered strategy. Initial screenings based on titles and abstracts were followed by full-text reviews and quality appraisal using the CASP checklist.

From 4331 unique publications, 52 full-text articles were analyzed across 11 TAs. Thematic analysis highlighted issues within the sleep window, and proximal and distal impacts of sleep disturbances. Using thematic analysis a conceptual model was developed, illustrating a multitude of sleep disturbances from a patient-first perspective, which emphasized sleep quality's role in daily functionality.

This review emphasizes the importance of incorporating patient perspectives into sleep research and clinical practice. By presenting a holistic conceptual model, it provides a foundation for developing outcome measures that reflect meaningful aspects of patients' sleep experiences. This patient-centered approach highlights the need for novel methodologies in sleep research, beyond traditional clinical outcome assessments, to capture the full spectrum of sleep disturbances' impacts on patients' lives across various TAs.

Cardiology and sleep societies recommend 7-9 h sleep/night for adults (7-8 h for seniors) and more for youngsters; nonetheless, short sleep duration (SSD) of <7 h/night is epidemic. We searched PubMed for representative investigations, including those cited by meta-analyses, that reported association between SSD and long sleep duration (LSD) of >9 h/night and blood pressure (BP) levels to assess shortcomings of their methods. Studies indicate both SSD and LSD negatively impact BP despite major deficiencies, such as (i) reliance mainly on cross-sectional rather than longitudinal protocols, (ii) inclusion of participants diagnosed with hypertension (HTN) and/or taking antihypertension medications, (iii) assessment of BP and diagnosis of HTN performed by single wake-time office measurement rather than multiple measurements performed by 24 h ambulatory BP monitoring (ABPM), and (iv) determination of SD by subjective recall, single-night polysomnography, or diary recordings rather than objective wrist actigraphy of sufficient duration. The limited number of ABPM-based studies, despite evidencing major shortcomings, particularly (i) assessment for 24 h rather than preferred ≥48 h and (ii) inclusion of subjects diagnosed with HTN and/or taking antihypertension medications, also report association between abnormal SD and elevated 24 h 'daytime'/wake-time diastolic and systolic (SBP) means plus 'nighttime'/sleep-time SBP mean and dipping-the latter two indices, in combination, the strongest predictors of major adverse cardiovascular events.

This multicenter study aimed to elucidate the association between sleep duration and various lifestyle-related disorders in healthy adults in Japan. A total of 62,056 healthy participants (age: 49.4 ±  10.9 years) who received medical checkups from 2010 to 2020 were analyzed cross-sectionally and longitudinally. The mean sleep duration was 6.2 ±  1.0 h in men and 6.1 ±  1.0 h in women. The distribution of sleep duration showed that older people tended to sleep longer, which was clearly observed in men but not in women. Univariate analyses showed that older age, lower body mass index (BMI), habitual drinking, and habitual exercise were significantly associated with longer sleep duration. Multivariate analyses in men showed that sleep duration was positively associated with age, habitual exercise, serum triglyceride (TG), systolic blood pressure (SBP), and habitual drinking and negatively associated with BMI and hemoglobin A1c (HbA1c). Alternatively, in women, sleep duration was positively associated with habitual exercise and TG and negatively associated with BMI, high-density lipoprotein-cholesterol, HbA1c, and current smoking. During the follow-up period, 3,360 of 31,004 individuals (10.8%) developed obesity. The Cox proportional hazards model showed that shorter sleep duration was a significantly higher risk of obesity, and longer sleep duration might be a lower risk of obesity. On the other hand, 1,732 of 39,048 participants (4.4%) developed impaired glucose tolerance, and 6,405 of 33,537 participants (19.1%) developed hypertriglyceridemia. However, the Cox proportional hazards model did not show significant association between sleep duration and impaired glucose tolerance or hypertriglyceridemia. In conclusion, our large-scale cross-sectional study showed that sleep duration was positively associated with habitual exercise and TG and negatively associated with BMI and HbA1c, regardless of sex. Longitudinal analysis revealed that shorter sleep duration is a significant risk factor for obesity.

The burden of obesity-related, non-communicable diseases in South Africa is persistent, with poor and black South African women particularly vulnerable. The purpose of the present study was to determine relationships between obesity, physical activity, sleep patterns and beverage consumption among black South African women in a rural village in the Limpopo province.

A cross-sectional study was conducted among 200 rural-dwelling African women. Data were collected on beverage consumption, sociodemographic information, sleep patterns and anthropometry using self-reported questionnaires.

The mean body mass index (BMI) was 28.5±7.3 kg/m2, with 40% being classified as obese (BMI ≥30 kg/m2) and the mean sleep score was 4.68±2.51. Participants with very bad habitual sleeping patterns consumed significantly more sugar-sweetened beverages and alcohol than those with very good sleeping patterns. We also observed that when total coffee with sugar, fruit juice, total sugar-sweetened beverages and weight decreased the number of hours participants slept increased.

The study identified significant associations between body weight, sleep duration and sugar-sweetened beverage consumption among rural black South African women. This underscores a need to address unhealthy lifestyle behaviours to lower incidences of non-communicable diseases in rural-dwelling women.

Insomnia is a sleep disorder that affects significant portion of the population. It can result in adverse health outcomes and increased healthcare utilization. The purpose of this review was to identify existing research on the association between insomnia and healthcare utilization. A five-stage scoping review process was conducted guided by the Joanna Briggs Institute process. Data sources searched through 2022 were PubMed, HINARI, Google Scholar and Cochrane, with additional studies identified through hand searching. Descriptive and exploratory analyses were conducted from the findings of the selected studies. After reviewing 124 references, 23 studies were selected. A strong and positive association between insomnia and healthcare utilization and healthcare costs was identified. We also found that insomnia was associated with absenteeism from work, lower work performance ratings, disability, difficulties in daily activities, and life dissatisfaction. An unexpected theme that emerged from the included studies is that there is a large population with persistent insomnia who do not seek help that could benefit from improved management. Findings suggest that identifying and managing insomnia could result in a decrease in healthcare utilization and costs. Further research is needed to determine the most effective methods of identifying and managing insomnia.

Sleep disturbances are a major public health concern in the United States, leading to adverse health outcomes. In the working population, job strain has been identified as an important risk factor for sleep disturbances, but evidence from the United States remained limited. This study aimed to examine longitudinal associations between job strain and sleep disturbances in the United States, with a focus on the alternative formulations of job strain.

A total of 1721 participants were drawn from two waves of the Midlife in the United States (MIDUS) study, with an average 9-year follow-up period. Job strain was measured using Karasek's Job-Demand-Control model and operationalized in six formulations: standard quadrant, simplified quadrant, linear, quotient, logarithm quotient, and quartile based on quotient. Generalized Estimating Equations were used to estimate longitudinal associations of alternative formulations of job strain at baseline with sleep disturbances across follow-up. Corrected Quasi-likelihood Information Criterion (QICu) was used to assess the goodness of fit.

All approaches showed that higher job strain at baseline was significantly associated with an increase in sleep disturbances across follow-up. QICu scores indicated that continuous Demand-Control formulations (linear, quotient, logarithm quotient) had better model performance of 4602.66, 4604.28, and 4601.99, respectively. The logarithm quotient showed the best fit.

Our findings imply the importance of early workplace interventions in reducing job strain to improve sleep hygiene. They further show that the continuous formulations quantifying job strain were more consistent and robust, which provides suggestions for future workplace health research in the United States.

The inflammation score is currently regarded as a reliable composite index for comprehensive assessment of inflammatory status. However, the relationship between inflammation score and cardiovascular disease (CVD) is unclear. Thus, we aimed to explore the association of inflammatory score with CVD, as well as to evaluate whether adhering to a healthy lifestyle could alleviate this association.

We analyzed 6,164 participants aged ≥45 years who entered a prospective cohort study of the China Longitudinal Study of Health and Retirement (CHARLS) between 2011 and 2012 and were followed up for CVD incidence untill 2018. The inflammatory score was measured by summing of the Z-scores for C-reactive protein and white blood cell count at baseline. The healthy lifestyle score was calculated by four factors, smoking status, alcohol consumption, body mass index, and sleep duration. Cox proportional hazard models were utilized to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of CVD.

During the 7-year follow-up period, there were 761 incident cases of CVD. Compared with the lowest tertiles, the highest inflammatory score was associated with an elevated risk of CVD (HR = 1.25, 95% CI = 1.04-1.49). Compared to the unhealthy lifestyle, participants adhered to a healthy lifestyle was inversely associated with CVD risk (HR = 0.74, 95% CI = 0.60-0.93). Of note, when participants adhered to a healthy lifestyle, the higher inflammatory score was no longer significantly correlated with CVD risk (HR = 1.00, 95% CI = 0.76-1.34). Additionally, a multiplicative interaction was detected between inflammatory score and healthy lifestyle score for CVD risk (p interaction <0.05).

The inflammation score was associated with higher risk of CVD incidence, but adherence to a healthy lifestyle may mitigate the adverse association of inflammation score and CVD among the middle-aged and older participants.

Home confinement due to Coronavirus Disease 2019 (COVID-19) led to lifestyle changes that increased sleep disturbances, particularly in areas with higher infection and mortality rates. This study is a retrospective study based on data collected through an online survey conducted during the COVID-19 confinement. It aims to analyze changes in sleep quantity and quality and their association with lifestyle changes in the metropolitan area of Mexico City. A total of 899 adults from this area completed an online questionnaire between June 2020 and February 2021. This study assessed sleep quantity, sleep quality, insomnia symptoms, and lifestyle changes during the confinement period. Results showed that sleep quantity increased (7.10 ± 1.37 vs. 7.43 ± 1.42 h, p < 0.0001), with more participants, especially young adults and women, reporting later bed and wake-up times. The Pittsburgh Sleep Quality Index increased by 1.4 units, with poor sleep quality associated with lifestyle during confinement. Insomnia symptoms, sleep latency, and poor sleep quality also increased, particularly in women. Males and those without chronic comorbidities were less likely to experience poor sleep quality, while tobacco use and later bedtimes increased this risk. This study concludes that, while sleep quantity increased, sleep quality declined, particularly among young adults, women, and those with unhealthy lifestyles. These findings could guide sleep health initiatives tailored to specific lifestyle changes in different population groups.

Insufficient sleep costs the US economy over $411 billion per year. However, most studies investigating the economic costs of sleep rely on one-time measures of sleep, which may be prone to recall bias and cannot capture variability in sleep. To address these gaps, we examined how sleep metrics captured from daily sleep diaries predicted medical expenditures.

Participants were 391 World Trade Center (WTC) responders enrolled in the WTC Health Program (mean age = 54.97 years, 89% men). At baseline, participants completed 14 days of self-reported sleep and stress measures. Mean sleep, variability in sleep, and a novel measure of sleep reactivity (i.e. how much people's sleep changes in response to daily stress) were used to predict the subsequent year's medical expenditures, covarying for age, race/ethnicity, sex, medical diagnoses, and body mass index.

Mean sleep efficiency did not predict mental healthcare utilization. However, greater sleep efficiency reactivity to stress (b = $191.75, p = .027), sleep duration reactivity to stress (b = $206.33, p = .040), variability in sleep efficiency (b = $339.33, p = .002), variability in sleep duration (b = $260.87, p = .004), and quadratic mean sleep duration (b = $182.37, p = .001) all predicted greater mental healthcare expenditures. Together, these sleep variables explained 12% of the unique variance in mental healthcare expenditures. No sleep variables were significantly associated with physical healthcare expenditures.

People with more irregular sleep, more sleep reactivity, and either short or long sleep engage in more mental healthcare utilization. It may be important to address these individuals' sleep problems to improve mental health and reduce healthcare costs.

The present study aimed to analyze the effects of the use of a digital wellness device on improving sleep through reducing environmental noise.

Fifty-five self-reported light or moderate sleepers with difficulty falling or staying asleep due to environmental noise participated in the study. Objective sleep architecture data were collected via a wireless electroencephalogram (EEG) sleep monitor and subjective data were obtained through analysis of daily sleep diaries and responses to study-specific user experience surveys. Four primary outcomes specified a priori were analyzed for statistical significance: objectively measured sleep onset latency (SOL), wake after sleep onset (WASO), number of awakenings, and perceived SOL. Exploratory analysis through descriptive statistics was conducted for an additional 36 secondary outcomes.

Use of the digital wellness device was associated with reduced SOL both objectively and subjectively. Perceived SOL was 32.5% reduced (p < 0.001, difference in means 7.5 min, 95% CI 22.3%-41.4% faster), and objectively measured SOL was 13.3% reduced (p = 0.030, difference in means 2.7 min, 95% CI = 1.4%-23.8% faster). No statistically significant differences were found for other primary outcomes. Among the subjective secondary outcomes, 100% of participants felt the device blocked environmental noise, 86% reported falling asleep more easily, 76% felt they stayed asleep longer, and 82% felt overall sleep quality was improved. No differences were observed among objectively measured secondary outcomes.

Participants fell asleep faster when using the wearable wellness device. Participants also perceived sleep quality improvements with the intervention, although no objective differences were measured. These findings show promise for using noise-masking digital wellness devices in noisy environments to improve sleep quality.

There exists an intricate relationship between burnout and sleep disturbances, especially among firefighters. Network analysis offers novel perspectives for understanding the interactions of psychopathological variables. This study aims to elucidate the relationship between burnout and sleep disturbances among firefighters through network analysis.

A total of 1,486 Chinese firefighters were included in this study. The Maslach Burnout Inventory-General Survey (MBI-GS) (Chinese version) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess burnout and sleep disturbances among firefighters, respectively. Two network construction methodologies, the regularized partial correlation network (RPCN) and the directed acyclic graph (DAG), were employed to perform network analysis.

Within the RPCN, "Subjective sleep quality" emerged as the central domain of firefighters' burnout and sleep disturbances, as well as "Emotional exhaustion" and "Daytime dysfunction" were influential bridge domains connecting the two. From the results pertaining to the DAG, "Subjective sleep quality" was the activation domain that triggered other burnout and sleep disturbance domains, with sleep disturbances serving as the potential cause of burnout.

Our findings offer some enlightenment into further understanding the relationship between burnout and sleep disturbances in firefighters. Furthermore, the aforementioned central, bridge, and activation domains may be potential targets for prevention and intervention.

The 2D:4D digit ratio (DR), representing the relative length of the index finger to the ring finger, is an anthropometric marker that shows sexual dimorphism, with males typically having a lower ratio than females. This parameter is linked to prenatal androgen exposure (PAE), which influences sexual differentiation of the brain and behavior. This study aimed to investigate the correlation between PAE and sleep among young adults.

Anthropometric measurements were used to assess PAE, while sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), actigraphy, and polysomnography (PSG). Data was collected from 720 participants via surveys, with 290 completing all questionnaires. Of these, 138 underwent anthropometric measurements, and 38 were further recruited for actigraphy, PSG.

Men exhibited a lower 2D:4D ratio than women, indicating higher PAE. The average PSQI score was 6.94 ± 2.98, and the MEQ score was 35.43 ± 19.59, with no significant gender differences in sleep quality or chronotype. Low PAE was associated with better sleep efficiency and a morning chronotype, but worse sleep quality in males. Actigraphy results showed no significant differences based on PAE. PSG data revealed that males with longer 2nd fingers and higher 2D:4D ratios were more likely to suffer from mild sleep apnea, a pattern not observed in women. PAE did not significantly impact other sleep architecture parameters.

PAE, indicated by the 2D:4D ratio, is linked to sleep efficiency and chronotype, with significant gender differences. Men with lower PAE exhibited poorer sleep quality, and those with certain finger length patterns were more prone to mild sleep apnea. These findings underscore the potential long-term impacts of PAE on sleep health and emphasize the need for further research into gender-specific sleep regulation mechanisms.

The association between the recently updated cardiovascular health (CVH) assessment algorithm, the Life's Essential 8 (LE8), and all-cause mortality among adults with depression remains unknown. From the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018, a cohort of 2,935 individuals diagnosed with depression was identified. Their CVH was evaluated through the LE8 score system. The investigation of mortality status utilized connections with the National Death Index up to December 31, 2019. To assess the impact of CVH on mortality risk, Kaplan-Meier survival analysis and Cox proportional hazards models, adjusting for variables related to demographics and socioeconomic status, were applied. Among 2,935 participants, those with higher CVH levels had significantly lower all-cause mortality compared to those with lower CVH levels. Cox regression analyses demonstrated that each 1-point increase in CVH score was associated with a lower risk of all-cause mortality [HR = 0.97, 95%CI:0.96-0.98]. The inverse association between CVH and mortality persisted across different demographic and socioeconomic subgroups. Higher CVH levels were associated with a significantly lower risk of all-cause mortality in individuals with depression. These findings underscore the importance of comprehensive CVH management as part of healthcare strategies for people with depression, suggesting that improving CVH may contribute to longer life expectancy in this vulnerable population.

As the population ages, understanding the association between sleep patterns and physical frailty in older adults is crucial for formulating effective health interventions. This study aimed to explore the relationship among nap time, nighttime sleep duration, and physical frailty in older Chinese individuals; establish recommended sleep times; and provide a scientific and reasonable basis for the prevention and management of frailty in older adults.

On the basis of the 2020 China Health and Retirement Longitudinal Study database, demographic information, health data, and lifestyle information of the research subjects were obtained. A total of 5,761 survey participants were included, and logistic regression and restricted cubic splines were used to explore the association between sleep duration and frailty.

In our cross-sectional analysis, the duration of napping in older adults did not show a significant correlation with frailty. The optimal nighttime sleep interval for older adults was 7-8 h, and the maximum health benefit was achieved when nighttime sleep reached 7.5 h. Compared with older adults in China who slept 6-8 h at night, those with a sleep duration of <6 h (OR = 1.58, 95% CI: 1.36-1.82) were more likely to be frail. After adjusting for all covariates such as smoking, multimorbidity, self-rated health, social events, education level, and frequency of physical activity, we found no interaction between gender and age concerning sleep duration.

The potential correlation between nighttime sleep duration and frailty in older adults is basically U-shaped. Older Chinese adults with a moderate nighttime sleep duration of 7-8 h exhibited the lowest likelihood of frailty than their counterparts. The duration of napping is not related to the likelihood of frailty in older people. Thus, the importance of sufficient nighttime sleep for the health of older adults must be emphasized.

The 2-fold objective of this research is to investigate machine learning's (ML) predictive value for the incidence of depression among China's older adult population and to determine the noteworthy aspects resulting in depression.

This research selected 7,880 older adult people by utilizing data from the 2020 China Health and Retirement Longitudinal Study. Thereafter, the dataset was classified into training and testing sets at a 6:4 ratio. Six ML algorithms, namely, logistic regression, k-nearest neighbors, support vector machine, decision tree, LightGBM, and random forest, were used in constructing a predictive model for depression among the older adult. To compare the differences in the ROC curves of the different models, the Delong test was conducted. Meanwhile, to evaluate the models' performance, this research performed decision curve analysis (DCA). Thereafter, the Shapely Additive exPlanations values were utilized for model interpretation on the bases of the prediction results' substantial contributions.

The range of the area under the curve (AUC) of each model's ROC curves was 0.648-0.738, with significant differences (P < 0.01). The DCA results indicate that within various probability thresholds, LightGBM's net benefit was the highest. Self-rated health, nighttime sleep, gender, age, and cognitive function are the five most important characteristics of all models in terms of predicting the occurrence of depression.

The occurrence of depression among China's older adult population and the critical factors leading to depression can be predicted and identified, respectively, by ML algorithms.

Although sleep disparities contribute to racial health disparities, little is known about factors affecting sleep among African Americans. One such factor may be positive affect, which could impact sleep directly (direct effect hypothesis) or indirectly by buffering the effects of stress (stress buffering hypothesis).

We tested the direct effect and stress buffering effects of positive affect on sleep at three levels (day, week, trait) in a sample of 210 older African American adults, ranging in age from 50 to 89 years old.

Daily positive affect, perceived stress, sleep quality, and sleep duration were collected for five consecutive days. Multilevel modeling was used to test the direct and stress buffering hypotheses both within-person (day level) and between-persons (week level). Trait positive affect, past five-year stress severity, and global sleep quality were assessed cross-sectionally. Regression was used to test the direct and stress buffering hypotheses at the trait level.

In line with the direct effect hypothesis, higher week-level positive affect predicted better sleep quality and sleep duration. Day-level positive affect was not significantly associated with daily sleep quality or daily sleep duration. Higher trait positive affect predicted better global sleep quality. However, neither day-level perceived stress nor past five-year stress severity significantly interacted with positive affect measures for any sleep outcome; no interaction effect was observed on week-level sleep duration. Positive affect and perceived stress interacted at the week level to predict sleep quality, but not in the hypothesized direction.

We found support for the direct effect hypothesis at the week- and trait-levels, but not at the day level. In contrast, we found no support for the stress buffering hypothesis.

Severe chronic insomnia is a common sleep disorder that is mostly persistent and needs to be treated. Pharmacologic treatment options and guidelines are sparse, particularly for long-term treatment. Our study aimed to investigate a graduated therapy scheme for moderate-to-severe chronic insomnia in practice, considering the effects on self-reported sleep quality and quality of life.

Patients with moderate-to-severe chronic insomnia were given appropriate medication according to a graduated therapy scheme, ranging from l-tryptophan (as the first choice, least potent) to Z-drugs and combination therapies (as the last option, most potent). Each step of the graduated therapy scheme was tested for at least 4 weeks. Data related to sleep and quality of life were collected in questionnaire form (Insomnia Severity Index, Pittsburgh Sleep Quality Index, Beck Depression Inventory, second edition, and Short Form 36 Health Survey) at baseline and during the course of the treatment after 1, 3, 6, 9, and 12 months.

Of 86 eligible patients, 60.5% started treatment with l-tryptophan and 8.1% with melatonin. After 3 months, 12.5% were still taking l-tryptophan and 12.5% were taking melatonin. There was a significant decrease in mean Insomnia Severity Index, Pittsburgh Sleep Quality Index, Beck Depression Inventory, second edition, and Short Form 36 Health Survey scores after 3 months of treatment for all patients in the study (n = 64). After 6 months, 22.2% were still taking l-tryptophan, melatonin, or agomelatine, and the remainder had switched to more potent drugs such as antidepressants, hypnotics, daridorexant, or combination therapies.

A significant number of patients already responded favorably to mild sleep medications, whereas others demonstrated a need for more potent treatments. Ongoing monitoring will evaluate the long-term effectiveness of both approaches.

Registry: German Clinical Trials Register; Name: Schlafqualität und Lebensqualität mit einer medikamentösen Langzeittherapie bei moderater bis schwerer Insomnie; URL: https://drks.de/search/de/trial/DRKS00033175; Identifier: DRKS00033175.

Boer J, Toncar T, Stange A, Rosenblum L, Fietze I. Effect of graduated drug therapy for moderate-to-severe chronic insomnia on the severity of disease: an observational study in Germany. J Clin Sleep Med. 2025;21(1):33-45.

In this review paper, we explore the complex relationship between sleep duration and stroke risk, outlining the association of both insufficient sleep and excessive sleep with an increased risk of cerebrovascular diseases. We explore a U-shaped relationship between sleep duration and cardiovascular outcomes, including stroke. Our review explores findings from cohort studies, meta-analyses, and Mendelian randomization studies, highlighting the nuanced findings and identifying gaps in the current literature. We discussed the direct and indirect effects of sleep duration on stroke risk, considering factors such as atherosclerosis, atrial fibrillation, hypertension, and hyperlipidemia. We also discuss the methodological challenges inherent in current studies, such as the reliance on self-reported sleep measures and the need for more objective and comprehensive assessments. The paper emphasizes the importance of recognizing individual variations in optimal sleep duration and the potential confounding effects of sleep quality and other sleep-related disorders on stroke risk. Furthermore, we explore the potential mechanisms by which sleep duration may influence endothelial function, oxidative stress, and vascular compliance, suggesting areas for future investigation. The paper makes a compelling case for the inclusion of sleep duration as a key factor in stroke prevention strategies, recommending that healthcare professionals proactively assess and manage sleep patterns to mitigate stroke risk.

To investigate the interplay between individual nighttime and midday sleep duration and the number of new-onset chronic diseases and determine the optimal sleep duration associated with lowest number of new-onset chronic diseases.

We used data from the China Health and Retirement Longitudinal Study (CHARLS) covering a decade and involving 10,828 participants. A random intercept cross-lagged model was used to explore the interplay between nighttime/midday sleep durations and new-onset chronic diseases at both the within-individual and between-individual levels, followed by a dose-response analysis at the between-individual level to determine the optimal sleep duration. New-onset chronic diseases include 14 types of self-reported diseases diagnosed by doctors.

Within-individual analysis revealed that increased nighttime/midday sleep duration led to a higher number of new-onset chronic diseases, and an increased number of new-onset chronic diseases resulted in decreased nighttime sleep duration. Between nighttime and midday sleep, one type of sleep duration increase was likely to lead to an increase in another type. Between-individual analysis found a nonlinear relationship between the number of new-onset chronic diseases and nighttime sleep duration, identifying the optimal nighttime sleep duration as 7.46 h.

These findings elucidate the interplay between sleep duration and number of new-onset chronic diseases and underscore the need for public awareness and comprehensive interventions. Future studies should focus on refining sleep monitoring and exploring the sleep-chronic diseases nexus in greater depth.

This study aimed to explore the predictive value of machine learning (ML) in mild cognitive impairment (MCI) among older adults in China and to identify important factors causing MCI.

In this study, 6434 older adults were selected based on the data of the China Health and Elderly Care Longitudinal Survey (CHARLS) in 2020, and the dataset was subsequently divided into the training set and the test set, with a ratio of 6:4. To construct a prediction model for MCI in older adults, six ML algorithms were used, including logistic regression, KNN, SVM, decision tree (DT), LightGBM, and random forest (RF). The Delong test was used to compare the differences of ROC curves of different models, while decision curve analysis (DCA) was used to evaluate the model performance. The important contributions of the prediction results were then used to explain the model by the SHAP value.The Matthews correlation coefficient (MCC) was calculated to evaluate the performance of the models on imbalanced datasets. Additionally, causal analysis and counterfactual analysis were conducted to understand the feature importance and variable effects.

The area under the ROC curve of each model range from 0.71 to 0.77, indicating significant difference (P < 0.01). The DCA results show that the net benefits of LightGBM is the largest within various probability thresholds. Among all the models, the LightGBM model demonstrated the highest performance and stability. The five most important characteristics for predicting MCI were educational level, social events, gender, relationship with children, and age. Causal analysis revealed that these variables had a significant impact on MCI, with an average treatment effect of -0.144. Counterfactual analysis further validated these findings by simulating different scenarios, such as improving educational level, increasing age, and increasing social events.

The ML algorithm can effectively predict the MCI of older adults in China and identify the important factors causing MCI.