Lumin Liu,1,* Zhicheng Guo,1,* Shihan Jiang,1,* Ming Yang,2 Yue Zhang,1 Yingying Hu,1 Chengmei Yuan,3 Ping Yin1 1Sleep Medicine Center, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Clinical Research Center, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 3Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ping Yin, Sleep Medicine Center, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China, Email bingxue616@163.com; Chengmei Yuan, Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China, Email yuanchengmei@yeah.netBackground: The prevalence of chronic insomnia disorder (CID) is relatively high and increases with age. The use of sedatives, along with the incidence of their adverse effects, is also rising, which can easily lead to health risks and negative outcomes. This study aims to evaluate the clinical efficacy and safety of acupuncture-assisted zolpidem tartrate tapering and discontinuation in patients with CID whose insomnia symptoms are clinically stable while taking zolpidem.Methods: This study is designed as a single-center, single-blind, randomized controlled trial.Ninety participants will be randomly assigned in a 1:1 ratio to either the acupuncture group or the sham acupuncture group. Each participant will undergo 24 sessions of either acupuncture or sham acupuncture, in conjunction with zolpidem tartrate tapering therapy, over a duration of 8 weeks, followed by a 4-week follow-up observation period. The primary outcome is the discontinuation rate of zolpidem tartrate at week 8. Secondary outcomes include the reduction rate of zolpidem tartrate, the discontinuation rates at weeks 10 and 12, frequency of zolpidem tartrate use (nights/week), average daily dose (mg/day), total weekly dose (mg/week), Insomnia Severity Index (ISI), Generalized Anxiety Disorder − 7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Short Form Health Survey-12 (SF-12), sleep diary-related indicators, Dysfunctional Beliefs and Attitudes about Sleep Scale − 16 (DBAS-16), Epworth Sleepiness Scale (ESS) and emergency medication usage. Adverse events will also be monitored throughout the study. Efficacy analyses will be conducted on the intention-to-treat population.Discussion: The findings of the study may provide preliminary evidence for standardized protocols for reducing and ceasing zolpidem tartrate use through acupuncture assistance. Additionally, this research may offer useful references for patients with CID seeking to safely and effectively reduce or discontinue zolpidem tartrate. These findings may inform future clinical research and larger multicenter confirmatory studies.Clinical Trial Registration: ITMCTR2026000497 (Registered on 10 Mar 2026) https://itmctr.ccebtcm.org.cn/mgt/project/view/2031287058080858112.Keywords: chronic insomnia disorder, acupuncture, zolpidem tartrate, intervention, protocol, randomized controlled trial
Shuyao Wu,1,* Yongming Wang,1,* Wenqi Lyu,1 Shuancheng Ren,2 Xiangdong Tang,1 Ye Zhang,1 Rong Ren1 1Sleep Medicine Center, Mental Health Center, National Center for Mental Disorders, Sleep Research Laboratory, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Department of Physiology, Collaborative Innovation Center for Brain Science, Third Military Medical University, Chongqing, 400038, People’s Republic of China*These authors contributed equally to this workCorrespondence: Rong Ren, Sleep Medicine Center, Mental Health Center, National Center for Mental Disorders, Sleep Research Laboratory, West China Hospital, Sichuan University, Chengdu, People’s Republic of China, Email 498880651@qq.com; Ye Zhang, Sleep Medicine Center, Mental Health Center, National Center for Mental Disorders, Sleep Research Laboratory, West China Hospital, Sichuan University, Chengdu, People’s Republic of China, Email 569389672@qq.comPurpose: We aimed to explore whether insomnia modifies the relationship between insulin resistance (IR) and incident hypertension (HTN) over a 6-year longitudinal period.Methods: To explore the longitudinal relationship between IR, insomnia, and HTN, we included data from 3300 participants over a 6-year follow-up period in a large Hispanic/Latino cohort. IR was defined using the Youden index to select the optimal homeostasis model assessment of insulin resistance cut‑point based on ROC curve analysis, while insomnia was assessed using the Women’s Health Initiative Insomnia Rating Scale. Cox regression analysis was performed to assess the relationship between IR, insomnia and incident HTN.Results: We found neither IR nor insomnia alone was associated with incident HTN, whereas IR combined with insomnia increased the risk of HTN by 39% (HR, 1.39; 95% CI, 1.05– 1.85) after adjustment for potential confounders. Meanwhile, a significant interaction between IR and insomnia was observed (P = 0.045). Post-estimation linear combination analyses showed that IR was associated with a 60% higher risk of incident HTN among participants with insomnia (HR, 1.60; 95% CI, 1.16– 2.21), but not among those without insomnia. Moreover, this synergistic association was significantly associated with incident HTN among men and participants younger than 42 years.Conclusion: This large, longitudinal study identified a significant longitudinal relationship that IR was associated with a higher HTN risk only among participants with insomnia, suggesting that coexisting insomnia may identify a subgroup particularly susceptible to hypertension.Plain Language Summary: Insulin resistance occurs when the body does not respond effectively to insulin and may increase the likelihood of developing high blood pressure. Insomnia has also been linked to cardiovascular and metabolic problems, but it remains unclear whether insomnia makes people with insulin resistance more susceptible to hypertension. We analyzed data from 3,300 Hispanic and Latino adults who were followed for approximately 6 years. Insulin resistance alone was not associated with a significantly higher risk of hypertension. However, among participants with insomnia, insulin resistance was associated with a 60% higher risk of developing hypertension. These findings suggest that people with both insulin resistance and insomnia may represent a subgroup at increased risk of hypertension. Further studies are needed to confirm these findings and determine whether improving sleep can help reduce this risk.Keywords: insulin resistance, insomnia, hypertension, hispanic/latino
Objective: To examine the associations of readily available clinical indicators and the neutrophil-to-lymphocyte ratio (NLR) with moderate-to-severe obstructive sleep apnea (OSA) in patients with acute ischemic stroke and to explore the discriminatory performance of BMI, NLR, and a combination of BMI, snoring, and NLR. Methods: This single-center retrospective study included 220 patients with acute ischemic stroke who completed overnight polysomnography during hospitalization between October 2024 and April 2026. Moderate-to-severe OSA was defined as an apneahypopnea index >= 15 events/h. Clinical characteristics, laboratory indicators, and polysomnographic parameters were compared between groups. Multivariable logistic regression was used to evaluate factors associated with moderate-to-severe OSA, and receiver operating characteristic analysis assessed discriminatory performance. Spearman correlation and NLR tertile analyses explored the relationships between NLR and sleep-disordered breathing and nocturnal hypoxia. Results: Moderate-to-severe OSA was present in 109 of 220 patients (49.5%). After multivariable adjustment for prespecified clinical covariates, higher BMI (aOR 1.204, 95% CI 1.088-1.332), snoring (aOR 2.910, 95% CI 1.485-5.705), and higher NLR (aOR 2.291, 95% CI 1.449-3.622) remained associated with moderate-to-severe OSA. Modified Poisson sensitivity analyses yielded consistent associations for BMI, snoring, and NLR. The combined model had an AUC of 0.798 (95% CI, 0.736-0.851), indicating moderate discriminatory ability. Higher NLR was also associated with greater sleep-disordered breathing and nocturnal hypoxia burden. Conclusion: BMI, snoring, and NLR were associated with moderate-to-severe OSA in this single-center acute ischemic stroke cohort. Their combined discriminatory performance was moderate. These observational findings are hypothesis-generating and require prospective multicenter validation before clinical application.
