Occupational burnout and poor subjective sleep quality are each linked to adverse cardiovascular outcomes, yet their combined effects on arterial stiffness remain unclear. This study examined whether poor sleep is associated with arterial stiffness, measured by aortic pulse wave velocity, in physicians with burnout. Sixty male physicians (30 with clinical burnout, 30 without) completed the Pittsburgh Sleep Quality Index and underwent aortic pulse wave velocity assessment using the Arteriograph. Multivariable regression tested independent and interactive associations of burnout and sleep quality, adjusting for heart rate, systolic blood pressure, age, body mass index, and physical activity. Poor sleepers were more frequent in burnout (40%) than controls (10%). Although neither burnout nor sleep quality predicted aortic pulse wave velocity, a significant interaction indicated that poorer, particularly shorter, sleep was associated with greater arterial stiffness only in burnout. Findings highlight the potential value of sleep-focused interventions to improve cardiovascular health in occupational stress.
Background and Objective Circadian rhythms play a crucial role in human health, with disruptions linked to various mental health issues. The COVID-19 pandemic has amplified these concerns, particularly among university students who faced significant changes in their daily routines due to lockdowns and remote learning. This study aims to investigate the impact of the pandemic on chronotype and mental health among Indonesian university students. Methods A comparative analysis was conducted involving two student populations: those affected by COVID-19 (n=257) from 2021 and a pre-pandemic comparison group (n=325) from 2019. Participants completed the Indonesian version of the Munich Chronotype Questionnaire and the Depression, Anxiety, and Stress Scale. Statistical analyses were performed using SPSS version 20.0, employing chi-square tests, Mann-Whitney U-tests, and Spearman’s rank correlation tests. Results We observed significant increases in depression, anxiety, and stress levels during the pandemic compared to pre-pandemic conditions for both sexes (all p<0.01). Average sleep duration increased significantly during the pandemic for both males (6:40 to 7:13 hours) and females (6:46 to 7:13 hours), while mid-sleep times shifted later across all groups. Interestingly, traditional measures of chronotype using mid-sleep time on free days corrected for sleep debt did not reflect significant changes during this period. Conclusions This current study highlights profound impacts on mental health and sleep patterns among university students due to COVID-19-related disruptions. Under extreme conditions such as a pandemic, it is necessary to adapt assessment tools like questionnaires to accurately capture shifts in chronotype and associated mental health outcomes.
Sleep disorders impact human health and their well-being which thereby necessitate an accurate and efficient diagnosing approach. Although traditionally, these disorders are diagnosed using clinical interviews, polysomnography test, etc., but they are time-consuming and costly. This paper focuses on the role of multiple machine-learning models in classifying different types of sleep disorders such as insomnia and sleep apnea. A comprehensive methodology is employed like data preprocessing, class balancing using SMOTE on the dataset containing clinical and behavioral attributes. which includes physical activity level, sleep duration, body mass index, stress level, blood pressure, and heart rate. Multiple models are examined, such as Logistic Regression, Decision Tree, Random Forest, Support Vector Machine, K-Nearest Neighbors, and Näive Bayes, alongside advanced ensemble methods like Voting Classifier, CatBoost, XGBoost, and HistGradient Boosting. Among all models, ensemble techniques, particularly the Voting Classifier and HistGradient Boosting, determined superior performance by obtaining an accuracy of 93.94%. The highest observed values of recall, precision, as well as F1-score are 0.94, computed by Voting and HistGradient Boosting, indicating strong model reliability across multiple classes. These results emphasize the importance of ensemble machine learning methods in building effective tools for automated sleep disorder diagnosis, contributing to more timely and accurate clinical assessments.
Background and Objective Adolescent sleep deprivation, increasingly driven by digital media, poses a significant threat to cardiovascular health by promoting risks like obesity and hypertension. To address these modifiable factors, this study measures daily screen time duration and sleep patterns among adolescents to identify behavioural precursors to early heart disease. Methods In this cross-sectional study, 483 adolescents aged 12–17 were participated. Pittsburgh Sleep Quality Index and an Electronic Media Use Questionnaire were applied to assess sleep and screen pattern. Chi-square tests and regression analysis were employed to evaluate associations between screen exposure and sleep quality, with significance set at p<0.05. Results Of the 483 participants, 49.7% exhibited poor sleep quality. Poor sleepers reported significantly higher daily media duration and social media frequency compared to good sleepers. Logistic regression identified device usage before sleep (odds ratio [OR]=1.64, p=0.008), obsessive urge to use devices (OR=1.81, p=0.002), and next-morning tiredness (OR=1.73, p=0.006) as significant predictors of poor sleep quality. Conclusions Excessive and compulsive electronic media use, particularly before bedtime, significantly degrades adolescent sleep quality. Given the established link between sleep deprivation as an early cardiometabolic risk factor, the study founds limiting evening screen exposure creates a vital preventive cardiology strategy to mitigate the future burden of cardiovascular disease.
Background and Objective Delayed Sleep-Wake Phase Disorder (DSWPD) is a sleep disorder that causes difficulty falling asleep, leading to functional impairment in daily activities. This review study analyzes the effectiveness of exogenous melatonin through the optimal timing of melatonin administration and standard dosage on improving sleep quality and shifting the sleep chronobiology of DSWPD patients. Methods Based on the guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020, literature review searches were conducted using databases such as PubMed, Scopus, Web of Science, and Proquest. Methodological quality assessment was performed using Cochrane Risk of Bias 2.0 and the overall analysis was conducted using R 5.4.2 to process the data. Results Overall analysis of actigraphy shows that exogenous melatonin improves sleep quality, such as wakefulness after sleep onset and sleep onset latency (SOL) (z=-4.94, p<0.0001), total sleep time (TST) and time in bed (TIB) (z=3.72, p=0.0002), and shifts sleep timing (z=-8.80, p<0.0001) such as dim light melatonin onset (DLMO), sleep onset time, sleep offset time, and wake-up time. Subgroup analysis indicated that high-dose exogenous melatonin (≥3 mg) reduced SOL parameters (z=-4.11, p<0.0001), while low-dose exogenous melatonin (<3 mg) significantly increased TST parameters (z=6.52, p<0.0001). Meta-regression on melatonin administration 3–5 hours before DLMO was found to be effective (SOL parameter result β=74.6, p=0.005, and TST parameter result β=-49.60, p=0.042). Conclusions As a chronobiotic substance, exogenous melatonin can improve sleep quality and shift the sleep time of DSWPD patients by considering the dosage and timing of administration.
Background and Objective Dexamethasone is a corticosteroid commonly used in patients with brain tumors to manage vasogenic edema and intracranial pressure. However, it is often associated with sleep disturbances that can impair patients’ quality of life. This study aimed to evaluate the relationship between dexamethasone therapy and sleep disorders using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and serum melatonin levels in patients with brain tumors. Methods A cross-sectional study was conducted involving 66 patients with brain tumors at Saiful Anwar General Hospital, Malang. Subjects were divided into two groups: dexamethasone users and non-users. Sleep quality was assessed using PSQI and ISI, while melatonin levels were analyzed from blood samples drawn during daytime (11:00–12:00 am). Results The dexamethasone group had significantly higher PSQI (p=0.006) and ISI (p<0.001) scores, indicating worse sleep quality and greater insomnia severity compared to non-users. However, there was no significant association between melatonin levels and dexamethasone use (p=0.131). Conclusions Dexamethasone therapy is associated with impaired sleep quality and increased insomnia severity in brain tumor patients. However, no significant correlation was found between melatonin levels and sleep disturbances. The daytime sampling of melatonin may have limited the hormonal assessment. Further studies with nocturnal sampling are recommended.
Background and Objective Obstructive sleep apnea (OSA) and stroke share a bidirectional relationship, where OSA increases stroke risk, and stroke predisposes patients to OSA. Continuous positive airway pressure (CPAP) is the gold standard therapy for OSA. This systematic review and meta-analysis aims to determine the effect of CPAP therapy on clinical outcomes in stroke patients with OSA. Methods Literature was searched in PubMed, ScienceDirect, and Taylor & Francis using the keywords “Sleep Apnea, Obstructive,” “Stroke,” and “Continuous Positive Airway Pressure.” Primary outcomes were CPAP adherence, dropout rate, functional status, and neurological function; secondary outcomes included cognitive function, balance, depression, cardiovascular events and mortality, apnea-hypopnea index (AHI), and sleepiness. Results Six randomized controlled trials involving 349 patients (180 CPAP, 169 control) were included. Mean nightly CPAP use was 4.35 hours (95% confidence interval [CI]: 3.41 to 5.29), with a higher dropout rate in the CPAP group (risk ratio=5.41; 95% CI: 2.19 to 13.39; p=0.0003). CPAP did not significantly improve functional status (standardized mean difference [SMD]=0.46; 95% CI: -0.08 to 1.00; p=0.10) or neurological function (SMD=1.18; 95% CI: -0.35 to 2.70; p=0.13), both with high heterogeneity. However, CPAP significantly reduced AHI (mean difference=-21.31; 95% CI: -33.14 to -9.47; p=0.0004) and sleepiness (SMD=-1.43; 95% CI: -2.76 to -0.10; p=0.04). Conclusions Current evidence shows that CPAP improves OSA-specific parameters but remains insufficient to demonstrate benefits in stroke-related clinical outcomes. Larger, long-term studies with earlier CPAP initiation and evaluation of alternative treatments are needed.
Background and Objective This study aimed to evaluate the validity and reliability of the Turkish version of the Sleeping Pills Receptivity and Involuntariness Scale-6 (SPRIS-6) for assessing acceptance of hypnotic use. Methods A methodological-descriptive-correlational study was conducted with 350 individuals aged 18 years and older from August 15, 2025 to October 10, 2025. Data were collected using a socio-demographic form, the SPRIS-6 to measure acceptance of hypnotics, and the Troy Sleep Scale. Statistical analyses were performed using SPSS 27.0 and AMOS 24.0, including exploratory and confirmatory factor analysis, Cronbach’s alpha, McDonald’s omega coefficients, and correlation analysis. Results The correlation coefficient, applied as a test-retest reliability method, revealed moderate to high positive and significant correlations between scores from the first and second administrations (0.74). Criterion validity results showed a moderately positive and significant correlation between overall scores from the SPRIS-6 and acceptance of hypnotic medications (p<0.01, n=50). Conclusions The analyses and evaluations conducted in this study demonstrated that the SPRIS-6 is a valid and reliable measurement tool for the Turkish population.
Background and Objective Depression and attentional difficulties are prevalent in narcolepsy. Although depression has been noted in first-degree relatives, the impact of sleep disturbances on these self-reported symptoms remains unclear. We investigated depressive symptoms and attention-deficit/hyperactivity disorder (ADHD)-related traits in patients and their relatives, while controlling for sleep quality and sleepiness. Methods A cross-sectional study included 613 participants: narcolepsy patients (n=253), first-degree relatives (n=156), and healthy controls (n=204). We measured symptoms using the Beck Depression Inventory-II (BDI-II), Adult ADHD Self-Report Scale (ASRS), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). We analyzed group differences using ANCOVA, adjusting for age, sex, body mass index, PSQI, and ESS. Results Patients exhibited significantly high unadjusted scores for depression (mean, 27.51) and attentional symptoms (mean, 11.47). After controlling for covariates, group status remained significantly associated with BDI-II total scores (F=25.03, p<0.001), with both patients and relatives reporting higher levels of depression than controls. Notably, affective-cognitive items on the BDI-II remained elevated. However, the group effect on the ASRS was no longer significant after adjustment (F=1.45, p=0.236). Conclusions Depressive symptoms were consistently elevated in both patients and first-degree relatives, even after accounting for sleep quality and daytime sleepiness, indicating a potential shared familial vulnerability. In contrast, ADHD-like symptoms appeared to be largely influenced by sleep quality and excessive daytime sleepiness, indicating they may be state-dependent.
Background and Objective This study aimed to examine the association between digital health literacy and subjective health and to investigate whether sleep adequacy mediates this relationship among Korean adults. Methods The analysis draws on microdata obtained from the 2021 Digital Health Access and Individual Competence Factors Survey carried out by the Korea Institute for Health and Social Affairs. Mediation analysis was conducted using PROCESS macro Model 4 with 5,000 bootstrap resamples. Digital health literacy was specified as the independent variable, sleep adequacy as the mediator, and subjective health as the dependent variable. Sociodemographic and health-related variables were included as covariates. Results Digital health literacy was positively associated with sleep adequacy (B=0.0282, p<0.001) and subjective health (B=0.0326, p<0.001). Sleep adequacy was also positively associated with subjective health (B=0.1914, p<0.001). The indirect effect of digital health literacy on subjective health through sleep adequacy was statistically significant (B=0.0054), and the 95% bootstrap confidence interval did not include zero (95% confidence interval: 0.0030–0.0084), indicating partial mediation. Conclusions Adequate sleep emerged as a contributing pathway linking digital health literacy to individuals’ overall health perceptions. The results imply that when people are better equipped to navigate digital health information, their self-rated health can improve directly and also through healthier sleep patterns. To fully leverage these benefits, public health strategies that seek to raise digital health literacy should also include components that encourage and educate about maintaining sufficient sleep.
Background and Objective Sleep disturbances are common in survivors of sexual violence and may significantly hinder recovery. Identifying predictors of insomnia can provide insights into trauma response and clinical intervention. This study examined the prevalence of sleep disorders during the initial response phase and analyzed the influence of personal and situational trauma factors on insomnia severity. Methods This study included 365 women who survived rape and were registered at Sunflower Centers between 2015 and 2022, with a mean age of 27.64 years. Data were collected on participants’ demographic characteristics, incident-related variables, insomnia severity, and posttraumatic stress symptoms. Descriptive statistics, independent-samples t-tests, one-way analyses of variance, and multiple regression analyses were performed. Results The mean insomnia score among the participants was 15.51, approximately 50% experiencing clinically significant symptoms. The severity of insomnia was significantly associated with age, subjective health status, past psychiatric visits, physical violence, and loss of consciousness. Regarding the relative influence on insomnia severity, trauma symptoms emerged as the strongest predictor (β=0.568, p<0.001), followed by subjective health status reported as “very poor” (β=0.249, p=0.010), whereas survivors who experienced partial loss of consciousness during the incident reported lower insomnia scores than those who remained fully conscious (β=−0.101, p<0.030). Conclusions Insomnia severity after sexual violence was more strongly associated with subjective factors—such as trauma response and perceived health—than by objective characteristics of the assault. These findings highlight importance of early assessment of psychological responses in post-assault care.
Background and Objective Orexin receptor antagonists (ORAs) are increasingly used as hypnotic sedatives. Compared to γ-aminobutyric acid receptor agonists, ORAs lack muscle-relaxant properties and are associated with a lower risk of falls. However, falls do occur in small numbers. We aimed to determine factors correlated with fall risk in patients administered ORAs. Methods Data of hospitalized patients administered suvorexant or lemborexant between January 1, 2022 and December 31, 2023 were retrospectively analyzed. Patients already taking medications upon hospitalization and those with unknown height or weight were excluded. Falls were identified through incident reports. Propensity-score matching was conducted based on demographics and clinical background, followed by statistical analysis. Logistic regression was applied to factors with p<0.2. Results Of 2,348 patients, 1,324 were eligible for analysis. After propensity-score matching, 66 patients were in the falls group and 132 in the non-falls group. Antidepressant use was significantly more common in the falls group (p=0.017) than in the non-falls group. Antidepressant use was associated with increased fall risk (odds ratio [OR], 14.40; p=0.016), whereas comorbid depression was protective (OR, 0.04; p=0.022). No significant associations were found for lemborexant use, benzodiazepine use, heart failure, or schizophrenia. Conclusions Antidepressants increase fall risk in ORA users, whereas comorbid depression may prevent falls.
Drug-induced sleep endoscopy (DISE) is an essential diagnostic tool for assessing upper airway obstruction in patients with obstructive sleep apnea (OSA). However, traditional single-channel DISE (SDS) often fails to capture important external maneuvers, vital signs, and dynamic changes in the airway. To address these limitations, we developed and implemented a multichannel DISE (MDS) protocol, which has been routinely used since 2018 at Chonnam National University Hospital for OSA patients undergoing polysomnography. This system integrates up to six synchronized video channels, including endoscopic views, vital sign monitoring, patient positioning, continuous positive airway pressure (CPAP) status, external maneuvers, and acoustic signals. The procedure consists of three phases: awake evaluation, sedation, and CPAP titration to determine the optimal therapeutic pressure. The MDS system allows for a comprehensive assessment of both anatomical and functional factors contributing to obstruction. Real-time visualization and maneuver testing enhance procedural safety, enabling trained residents to perform the examination under supervision, with no complications reported to date. Additionally, the ability to review recorded videos aids in clinical interpretation and facilitates patient education and treatment compliance. In conclusion, MDS offers a practical and scalable improvement over conventional DISE. It enables detailed evaluation of upper airway dynamics and supports individualized therapeutic decision-making, demonstrating strong potential for both clinical practice and research in OSA management.
Background and Objective Chronotype, sleep, and diet are interconnected. Social demands, such as work or school, often hinder alignment with biological rhythms, potentially harming dietary habits and health. This study investigated the association between chronotype and social jetlag in undergraduate students and their impact on diet. Methods Sixty-three young adults (40 females), who studied at night and worked during the week, participated. Chronotype, social jetlag, sleep quality, and daytime sleepiness were assessed through validated questionnaires. A 1-week sleep and food diary evaluated sleep and dietary intake. Results Most students were classified as good sleepers, despite excessive daytime sleepiness. The majority had an intermediate chronotype and social jetlag exceeding 1 hour (median: 1.57 h; range: 0.05–4.02 h). On free days, participants woke later, slept longer, and had later sleep midpoints compared to workdays (p<0.001). Social jetlag was negatively correlated with chronotype (p=0.009), but not with sleep quality, efficiency, or daytime sleepiness. Negative correlations were observed between protein, lipid, and energy intake and sleep latency on day 1. On day 4, higher carbohydrate, lipid, and energy intake were associated with later bedtimes, and lipid and energy intake were negatively correlated with sleep latency. Social jetlag was also negatively correlated with weekly average intake of carbohydrates (p=0.05), protein (p=0.03), and energy (p=0.03). Conclusions Social demands affected biological rhythms, leading to social jetlag exceeding one hour in most participants, especially in evening chronotypes. While no clear links were found with sleep quality, observed diet–sleep correlations suggest dietary intake may influence sleep timing and latency.
Background and Objective Chronic insomnia disorder is characterized by physiologic hyperarousal, yet evidence regarding elevated basal metabolic rate (BMR) is inconsistent. Whether predicted BMR—an accessible, anthropometry-derived metabolic estimate—relates to objective sleep continuity is unclear. This study examined 1) whether predicted BMR differs between individuals with chronic insomnia and matched controls and 2) whether predicted BMR is associated with polysomnography (PSG) markers of sleep continuity. Methods Among 7,338 adults who underwent overnight PSG and bioelectrical impedance analysis from 2017–2024, 225 individuals with chronic insomnia disorder were identified using International Classification of Sleep Disorders, Third Edition criteria and age- and sex-matched to 225 controls. Predicted BMR was calculated using the Harris–Benedict equations. Group comparisons and correlation and partial correlation analyses assessed associations between predicted BMR and PSG-derived sleep variables. Results A total of 450 participants (mean age, 36.4±13.1 years; 57% female) were included. Predicted BMR did not differ between insomnia and control groups (1,409.5±257.3 vs. 1,426.0± 272.0 kcal/day, p=0.60). No significant associations were observed between predicted BMR and PSG metrics in controls. In the insomnia group, higher predicted BMR correlated with longer total sleep time (r=0.203), higher sleep efficiency (r=0.248), shorter sleep latency (r=−0.196), and reduced wake after sleep onset (r=−0.195), with all p≤0.003; associations partially persisted after adjustment for age and BMI. Conclusions Predicted BMR does not differentiate insomnia from matched controls but is selectively coupled with objective sleep continuity within the insomnia phenotype. Predicted BMR may reflect metabolic heterogeneity and physiologic correlates of sleep stability in chronic insomnia.
Obstructive sleep apnea (OSA) is prevalent among patients with end-stage renal disease (ESRD), but documented improvements following kidney transplantation are rare. We present a case of a 51-year-old male with ESRD on peritoneal dialysis who suffered from severe OSA that was resistant to multiple positive airway pressure (PAP) therapies. Sixteen months after his OSA diagnosis, he underwent kidney transplantation, which led to a marked and sustained resolution of his OSA symptoms. Follow-up polysomnography indicated a reduction in OSA severity from severe to mild. This case supports the hypothesis that renal dysfunction plays a direct role in the development of OSA and suggests that restoring renal function can lead to remission. It also highlights the limitations of PAP therapy in ESRD patients and underscores the influence of systemic factors on sleep-disordered breathing.
Background and Objective This cross-sectional study was conducted to investigate subjective sleep quality and the relationship between sleep quality and quality life adolescent aged 16–18 years. Methods A descriptive study was conducted from February 1 to April 30, 2024 with adolescents aged 16–18 years who voluntarily participated in the study with the consent of their parents. Data was collected from a total of 350 adolescents aged 16–18 years. The sample of the study was selected from adolescents between the ages of 16 and 18 years living in Turkey using the convenience sampling method, a non-probability sampling method. The data were collected using the following tools: sociodemographic data form, Pittsburgh Sleep Quality Index (PSQI), and Quality Life Scale Short Form-36. SPSS 26.0 program was used with correlation analysis in the statistical analysis of the data. Results Among adolescents aged 16–18 years, 56.3% were girls and 43.7% were boys. According to education groups, 29.4% were high school 1, 28.9% were high school 2, and 25.4% were students. A total PSQI score of <5 was considered good sleep quality. In the study, the mean PSQI score was 8.92±4.92, according to which low sleep quality was observed in 78% of the adolescents (p<0.05). Adolescents with sleep disorders experience sleep problems and their quality of life decreases. Conclusions Sleep quality should be evaluated and considered as a factor affecting the quality of life of adolescents. It is recommended on the relationship between sleep and quality of life in a detailed biological, psychological, and social way.
