Sleep quality and stress levels can impact university professors’ physical and mental health. Indeed, high academic demands, multiple responsibilities, and strict deadlines contribute to the increase in perceived stress, which can affect sleep quality and cause excessive daytime sleepiness. This study investigated the relationship between sleep quality, daytime sleepiness, and perceived stress in a sample of university professors (n = 59) using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Perceived Stress Scale (PSS-10). The results revealed that 74.58
Deprivation of sleep and prolonged insomnia are now acknowledged not only as lifestyle concerns but also as key biological determinants of neuroinflammation and neurocognitive decline. Sleep disruption provokes imbalance of the central nervous, endocrine, and immune systems through disrupted circadian rhythms, increased sympathetic nervous system activity, and systemic pro-inflammatory cytokine production. Sleep deprivation interferes with higher-order function, long-term memory formation, and emotional regulation by decreasing the prefrontal cortex activity while increasing the activity of the amygdala. At the cellular level, low levels of cyclic adenosine monophosphate diminish synaptic plasticity and long-term memory formation. Moreover, sleep loss disrupts the glymphatic clearance pathway, leading to the buildup of neurotoxic proteins—such as beta-amyloid, tau, and alpha-synuclein—commonly associated in conditions like Alzheimer’s and Parkinson’s diseases. Sleep quality examination should be coordinated as an established practice aspect of mental health preservation. Preventive, sleep-specific therapeutic approaches offer a beneficial target for reducing neuroinflammation and the long-term risk of neurodegenerative diseases.
To systematically evaluate and quantitatively synthesize the effects of non-pharmacological interventions on depression, quality of life (QoL), and sleep quality in adults with hypothyroidism. This systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251148807). PubMed, Scopus, Web of Science and the Cochrane Library were searched for randomized controlled trials (2010–October 2025). Eligible studies included adults with clinically diagnosed hypothyroidism receiving non-pharmacological interventions such as aerobic exercise, resistance training, combined exercise, Pilates, yoga, cognitive behavioral therapy (CBT), or relaxation training. Methodological quality was assessed using the PEDro scale, risk of bias using Cochrane RoB 2.0, and certainty of evidence using GRADE. A random-effects meta-analysis was performed for QoL outcomes. Eight RCTs involving 558 participants met the inclusion criteria. Interventions ranged from 4 to 24 weeks. Most studies demonstrated significant improvements in depression scores, sleep quality indices, and QoL domains following exercise-based, yoga, or CBT interventions. Only four studies were included in the meta-analysis as they are provided sufficiently comparable quantitative data. Meta-analysis of four trials showed a large but statistically non-significant pooled effect for QoL under the random-effects model (SMD = 1.561; 95
Neurodegeneration with brain iron accumulation (NBIA) comprises rare genetic neurological disorders typified by pathological iron deposition in basal ganglia. Sleep disturbances remain under-recognized despite involvement of sleep regulating brain areas in NBIA. This multicentre case-control study compares sleep disturbances in genetically-confirmed NBIA patients with age- and gender-matched healthy controls (HC). Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI), International Restless Legs Syndrome (RLS) study group criteria, Rapid Eye Movement (REM) Sleep Behaviour Disorder Single-Question Screen (RBD1Q), Berlin’s questionnaire were used to assess the risk for poor quality of sleep, excessive daytime sleepiness (EDS), insomnia, RLS, dream-enactment behaviour, and obstructive sleep apnea (OSA), respectively. Four genetically-confirmed NBIA patients (Pantothenase Kinasse-Associated Neurodegeneration = 1, Phospholipase A2-associated neurodegeneration = 2, Mitochondrial membrane protein-associated neurodgeneration = 1) and 24 HCs were included. The median age at presentation was 26.5 years, and median illness duration was 78 months. Dystonia (100
Orofacial myofunctional therapy (OMT) is an emerging adjunctive treatment for obstructive sleep apnea (OSA), but real-world evidence in moderate-to-severe disease remains limited. This study evaluated the effectiveness of a home-based, telemonitored OMT program on daytime sleepiness, quality of life, and medication burden, with particular focus on independence from positive airway pressure (PAP) therapy and adherence-dependent effects. This retrospective cohort study included 197 adults with polysomnography-confirmed moderate-to-severe OSA (AHI ≥ 15 events/h) who participated in a structured OMT program (daily 15–20-min sessions for ≥ 120 days). The program was delivered via printed materials with weekly telephone reminders; adherence was tracked using weekly Google Forms. No structured dietary counseling or physical activity program was delivered as part of the OMT protocol. Concomitant PAP use was recorded for 114 participants (57.9
Sedative-hypnotics for insomnia carry risks of adverse effects and dependence. We reviewed how lemborexant, a dual orexin receptor antagonist (DORA), compares with sedative-hypnotics (benzodiazepines and z-drugs) in adults with insomnia across sleep, adverse events, dependence, and switching. We conducted a PRISMA-guided systematic narrative review (not a meta-analysis; not prospectively registered), searching PubMed, Google Scholar, Embase, Cochrane CENTRAL, and PsycINFO from January 2000 (last searched 10 June 2026). Two reviewers independently screened and extracted data; risk of bias was assessed with Cochrane RoB 2 and ROBINS-I and certainty with GRADE, and synthesis followed SWiM. Sixteen reports (12 unique studies) were included. The only head-to-head efficacy comparator was zolpidem; no trial has compared lemborexant with a benzodiazepine or a non-zolpidem agent for insomnia efficacy. Against zolpidem, lemborexant improved objective polysomnographic sleep onset, maintenance, and efficiency (moderate certainty), although subjective sleep maintenance was mixed (zolpidem was superior on diary-reported wake after sleep onset at one month). At therapeutic doses it caused less next-day postural instability (moderate certainty), psychomotor/cognitive separation was clearest versus supratherapeutic zolpidem (low certainty). Falls and switching signals were of very low certainty, and abuse potential did not differ significantly from zolpidem (not lower). Lemborexant is a promising alternative to zolpidem, with a favourable objective-sleep and next-day-safety profile (in older adults), but evidence against the broader sedative-hypnotic class is absent and most safety and switching signals are of low certainty; broader, long-term, head-to-head trials against benzodiazepines and other agents are needed.
To systematically review observational evidence on the association between CRD and urolithiasis risk. This review was registered in PROSPERO (CRD420251127344) and conducted per PRISMA 2020 guidelines. PubMed and EBSCOhost were searched to August 2025 using Medical Subject Headings and free-text terms for circadian rhythm, sleep, shift work, and kidney stones. Eligible studies included observational designs in adults, assessing CRD exposure and reporting prevalence or incidence of kidney stones. Two reviewers independently screened records via Rayyan.AI, extracted data, and appraised quality using the Newcastle–Ottawa Scale (NOS). Of 210 records, three studies met inclusion: two cross-sectional (n = 4603; n = 9797) and one prospective cohort (n = 154,990 across two U.S. nurse cohorts). CRD definitions included circadian syndrome, poor sleep quality, and current rotating night-shift work. Across studies, CRD was associated with increased kidney stone risk (OR 1.178–1.42; HR 1.13), with stronger associations in younger individuals, women, and certain racial/ethnic subgroups. NOS scores were uniformly high, but GRADE certainty ranged from low to moderate. CRD appears to modestly but consistently increase urolithiasis risk, potentially through melatonin suppression, altered urinary calcium/oxalate handling, metabolic disturbances, and dehydration in night-shift workers. Large, diverse, prospective studies using objective CRD measures are needed to confirm causality and guide prevention strategies integrating circadian health.
What is the purpose of sleep? This ubiquitous biological phenomenon has retained a frustratingly opaque primordial function, despite decades of neurocentric research. There are multiple competing hypotheses but no unifying framework, partly because the field has sought answers in the brain that may be much deeper. In this perspective, we argue that sleep did not evolve as a neural phenomenon but as a conserved cellular state based on an ancient metabolic enzyme network. We mapped orthologs of sleep genes across the tree of life (ToL), from the Last Universal Common Ancestor (LUCA) to bacteria, archaea, protists, fungi, plants, and animals, and identified a core set of universally conserved enzymes involved in amino acid metabolism, protein synthesis, detoxification, and response to oxidative stress. Sleep-like processes exist in some lineages that do not have nervous systems, so some form of sleep probably existed before multicellularity. We suggest that sleep was originally a primordial cellular strategy for metabolic homeostasis and repair, which was later co-opted and elaborated by complex physiological systems. This phylogenomic perspective redefines sleep as a key feature of biological existence, offering new perspectives on the understanding of sleep disorders, metabolism, and evolutionary medicine.
Attentional lapses are often attributed to fatigue and poor sleep. The present study examined whether boredom proneness contributes to attention-related cognitive errors among university students and whether sleep quality mediates this relationship. Data were gathered through a cross-sectional survey involving 843 university students in the 18–25 age range. Participants completed the Boredom Proneness Scale (BPS), Pittsburgh Sleep Quality Index (PSQI) and Attention-Related Cognitive Errors Scale (ARCES). Data were analysed using IBM SPSS (version 26). Mediation was tested through the PROCESS macro (Model 4). Boredom proneness showed a strong positive association with attention-related cognitive errors (r = 0.749, p < 0.001) and a moderate relationship with poorer sleep quality (r = 0.381, p < .001). Poorer sleep quality was also positively related to cognitive errors (r = 0.376, p < 0.001). Mediation analysis indicated that sleep quality significantly mediated the relationship between boredom proneness and cognitive errors. However, the indirect effect accounted for only 5.42
Cancer remains one of the leading causes of mortality among children worldwide, and its effect extends beyond physical health. A rising body of research shows that poor sleep quality in children with cancer is associated with heightened sensitivity of pain, fatigue, and adverse psychological outcomes, including anxiety and depression. Increasingly, these sleep disturbances are now recognised as part of a wider psychosocial and family context, where familial well-being and functioning are closely interconnected with child outcomes. As a result, there is growing recognition of the need to prioritise sleep assessment and intervention within paediatric oncology settings. This study presents a scientometric analysis of the evolving body of literature on sleep and psychological well-being in paediatric cancer populations, spanning the period from 1995 to 2025. The primary aim is to identify and map research trends, recognise influential publications and authors, and analyse the emerging thematic areas within the Paediatric cancer and sleep field. Using Document Co-Citation Analysis (DCA) as the main methodological approach, the study examined 706 publications retrieved from Scopus as well as their 42,593 cited references. The findings highlight an increasing emphasis on child-centred care, the pivotal role of nursing in holistic treatment approaches, and the integration of psychosocial and behavioural dimensions into long-term survivorship planning. Additionally, the results highlight the pressing need for more standardised and age-appropriate strategies for symptom management throughout paediatric cancer care.
This study aims to evaluate the acceptability and feasibility of a telehealth-delivered Cognitive Behavioural Therapy for Insomnia (CBT-I) intervention delivered for undergraduate students in Saudi Arabia, and to explore its potential effects on sleep and mental health outcomes. A single-arm design study was conducted. Fifteen participants were enrolled in the study, and nine of them completed baseline, post-intervention and one-month follow-up measures. Outcome measures included actigraphy monitoring, sleep-related questionnaires, and mental health variables, including depression, anxiety, stress, and resilience. The findings indicated that recruitment and retention rates were high, and participants reported high levels of satisfaction with the intervention. Moreover, participants demonstrated good compliance with the sleep intervention by following healthy sleep routines and applying the sleep toolbox, as well as cognitive and relaxation techniques. In addition, this study also investigated the possible association between improvements in sleep, mental health related to depression, anxiety, stress and resilience scores at baseline, post-intervention and follow-up. Given the high prevalence of sleep disturbances among undergraduate students in Saudi Arabia, this study contributes to the emerging evidence that telehealth cognitive behavioural sleep interventions may be both feasible and acceptable in this population.
Insomnia disorder, with its high prevalence and profound impact on physical health, mental well-being, and overall quality of life, presents an ongoing challenge in diagnosis and management, both in India and globally. This expert opinion paper aims to provide an updated and comprehensive overview of current strategies for diagnosing and managing insomnia disorder in the Indian clinical context, with emphasis on integrating emerging evidence into practice. This paper synthesizes expert perspectives and current clinical guidelines relevant to insomnia disorder diagnosis and treatment in India. It discusses key diagnostic approaches, including assessment of sleep patterns, identification of comorbid conditions, and differentiation between short-term and chronic insomnia disorder. Management strategies covered include both non-pharmacological approaches, such as cognitive-behavioural therapy for Insomnia disorder (CBT-I), and pharmacological options. Non-pharmacological interventions, particularly CBT-I and sleep hygiene education, are emphasized as first-line treatments. Pharmacotherapy remains relevant, especially in chronic cases or where behavioural interventions are inaccessible. Newer pharmacologic agents such as Dual orexin receptor antagonists (DORAs) are highlighted for their favorable efficacy and safety profiles compared to traditional sedative-hypnotics, particularly in the Indian treatment landscape. Accurate diagnosis and individualized treatment planning are critical to improving insomnia disorder outcomes. Clinicians are encouraged to tailor interventions based on patient age, comorbidities, and risk of adverse effects. The integration of newer therapeutic options like DORAs can enhance clinical outcomes and improve quality of life for individuals suffering from insomnia disorder in India.
Delirium-associated sleep disorder is often linked to circadian rhythm dysregulation, in which the melatonin 1 (MT1) receptor plays a central role. The purpose of this study was to investigate the agonistic potential of Avena sativa derived phytocompounds against the MT1 receptor and to identify promising natural candidates for managing delirium-related sleep disturbances using in silico approaches. Phytocompounds derived from A. sativa were initially screened using the IMMPAT 2.0 server. Selected compounds, namely luteolin, apigenin, tricin, isovitexin, and vitexin, were docked against the MT1 receptor using PyRx 0.8. Pharmacokinetic and toxicity profiling were performed using Deep-PK and ProTox-III to assess ADME/T properties. Drug-likeness was evaluated based on Lipinski’s rule of five, and blood–brain barrier permeability was assessed using the MolSoft server. Molecular interactions were visualised and analysed using Discovery Studio. Molecular dynamics (MD) simulations were conducted to evaluate the stability of ligand-MT1 receptor complexes in comparison with the reference drug ramelteon. All five phytocompounds exhibited favourable docking scores ranging from − 7.9 to − 9.6 kcal/mol. Tricin showed unfavourable drug-likeness properties, while isovitexin and vitexin failed to meet acceptable toxicity criteria. Apigenin and luteolin demonstrated strong binding affinity, favourable pharmacokinetic profiles, acceptable toxicity and stable interactions with key MT1 receptor residues. MD simulation results revealed that both apigenin and luteolin formed stable complexes with the MT1 receptor, which were comparable to ramelteon. Luteolin exhibited slightly enhanced compactness, while apigenin showed stability closely resembling the standard ligand. The findings suggest that apigenin and luteolin are promising modulators of the MT1 receptor with potential therapeutic relevance for delirium-associated sleep disorders. However, further in vitro and in vivo studies are required to validate their efficacy and safety.
Hypoxemia-driven conditions such as chronic lung disease and highaltitude exposure are recognized causes of erythrocytosis. Obstructive sleep apnea (OSA) produces recurrent nocturnal hypoxemia and could theoretically induce polycythemia; however, prior studies using older hemoglobin thresholds reported very low prevalence. Following the 2016 WHO revision lowering diagnostic cut-offs, the true burden of polycythemia in OSA requires reassessment. To determine the prevalence of polycythemia in treatment-naïve OSA using WHO-2016 criteria and evaluate its association with polysomnographic severity markers. We conducted a retrospective study of consecutive patients diagnosed with OSA diagnosed using AASM 2012 criteria. OSA was defined as AHI > 5/h. Severity indices included AHI, lowest oxygen saturation, and percentage of total sleep time with SpO2 ≤ 90
This narrative review integrates available evidence with expert opinion to explore the challenges and unmet needs in insomnia care for older adults and the role of lemborexant in this milieu. A panel of nine clinicians with extensive experience in managing sleep disorders met in February 2025 and discussed the challenges and barriers they face when managing insomnia in older adults, and their experience with lemborexant in this population. The assessment and diagnosis of insomnia in older adults is complicated by age-related sleep changes, comorbidities, polypharmacy, and cognitive decline, and requires a systematic approach that considers comprehensive sleep history alongside medical, cognitive, pharmacological, and psychosocial contributors to sleep disturbances. Sedative-hypnotic agents are associated with risks in older adults, including falls, cognitive impairment, residual sedation, and poor motor coordination; prolonged use may lead to tolerance, dependence, and rebound insomnia upon discontinuation. Lemborexant, a dual orexin receptor antagonist approved for the treatment of insomnia in adults, shows sustained efficacy in older adults by improving sleep onset and maintenance through 12 months with a favorable safety profile and low risk of next-morning sedation, dependency, or withdrawal. Long-term real-world studies will confirm the safety and effectiveness of lemborexant in older adults with insomnia. Insomnia in older adults is underdiagnosed and undertreated, with available treatments constrained by risks including dependency, falls, residual sedation and cognitive impairment. Lemborexant, with demonstrated efficacy in improving sleep onset and maintenance, a favorable safety profile, and low dependency and withdrawal risks, may be a valuable alternative to sedative-hypnotics.
Patient-reported outcome surveys are important instruments in sleep disorder research and routine clinical management. While web-based surveys offer logistical advantages, they often suffer from lower response rates, and their comparability to paper-based surveys remains uncertain. This single center study examines response rates and data completeness between both formats in patients with sleep disorders. A total of 324 patients from the Sleep center at the University Hospital Dresden (2020–2023) completed baseline surveys and were assigned to a paper-based or web-based follow-up survey. Response rates and data completeness were analyzed. In this single center cohort, the paper-based survey had a significantly higher response rate than the web-based survey (58.7
This study explored the molecular basis of insomnia and sleep deprivation through comprehensive genomic and network analyses. We retrieved microarray expression data from 26 Homo sapiens datasets in the Gene Expression Omnibus (GEO). Differential gene expression analysis in R identified 14,275 DEGs in insomnia (12,960 upregulated, 1,490 downregulated) and 8,096 DEGs in sleep deprivation (3,577 upregulated, 4,851 downregulated). Venny analysis found 20 common DEGs, with 7,806 unique to each condition. Using ShinyGO for functional enrichment, we analysed these DEGs across Gene Ontology categories (BP, CC, MF) and KEGG pathways, pinpointing top-enriched terms. PPI networks were constructed using STRING, and hub genes were identified in Cytoscape using cytoHubba, employing EPC, Degree, MNC, and MCC algorithms. This led to the discovery of 18 core hub genes, including IL6, IL1B, CD8A, IL10, CCL2, HIF1A, MAPK3, CASP3, HSP90AA1, PTEN, GSK3B, and CREB1, highlighting their key roles in sleep disorder mechanisms. For the identification of a molecular signature, LASSO regression was used, where HIF1A was identified as the key signature gene. Further validation across the brain dataset using ROC analysis suggested HIF1A as a potential biomarker and therapeutic target for sleep issues. This integrated study offers valuable insights into the molecular complexity of insomnia and sleep deprivation.
