Although the association between stress and quality of life (QoL) is well established, less is known about the psychological mechanisms underlying this relationship, particularly sex-specific sequential pathways involving depressive symptoms and sleep problems. Using a large population-based sample, this study investigated sex-specific pathways linking stress to QoL. Data from a nationally representative sample of adults (N = 230,407) drawn from the Korea Community Health Survey (KCHS) were analyzed using multigroup path analysis to examine pathways linking stress to QoL through depressive symptoms and sleep problems. Stress was treated as an ordered variable in the analyses. The proposed model demonstrated good fit (CFI = 0.976, TLI = 0.962, SRMR = 0.015). Higher stress levels were associated with greater depressive symptoms, which in turn predicted more sleep problems and poorer QoL in both sexes. Significant sequential mediation effects were observed. Notably, the association between depressive symptoms and sleep problems was significantly stronger in women than in men (p < .001). Stress was associated with poorer quality of life through sequential associations involving depressive symptoms and sleep problems. These sex differences suggest that mood-related pathways linking stress to sleep disruption may be more pronounced in women, highlighting the value of sex-sensitive stress interventions.
Obstructive sleep apnea (OSA) is frequently associated with psychiatric symptoms such as depression, insomnia, and disordered eating behaviors. Night eating syndrome (NES) has gained increasing attention in this context; however, the relative contributions of depressive symptoms, insomnia, and chronotype to night eating severity in patients with OSA remain insufficiently understood. This study aimed to investigate these relationships in patients with OSA compared with healthy controls. A total of 62 patients with polysomnography-confirmed OSA and 60 healthy controls completed the Insomnia Severity Index (ISI), Night Eating Questionnaire (NEQ), Eating Attitudes Test-26 (EAT-26), Morningness–Eveningness Questionnaire (MEQ), Epworth Sleepiness Scale (ESS), and Beck Depression Inventory (BDI). Patients with OSA had significantly higher scores on the NEQ, ISI, EAT-26, ESS, and BDI compared with controls. Clinically relevant night eating symptoms were observed in 8.1
This study aimed to examine the association between fear of hypoglycemia and sleep quality and to evaluate the contribution of sociodemographic and clinical variables to this relationship in individuals with type 2 diabetes using insulin. This descriptive and correlational was conducted between February and August 2024 in the inpatient internal medicine clinics of a state hospital. The sample consisted of 264 hospitalized individuals diagnosed with type 2 diabetes and receiving insulin. Data were collected using a Patient Information Form, the Hypoglycemia Fear Scale (HFS), and the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, Pearson correlation analysis, and Structural Equation Modeling (SEM) were used for data analysis. The mean PSQI score was 6.26 ± 3.89, and 43.6
Comorbid insomnia and obstructive sleep apnea (COMISA) is a common and clinically important phenotype associated with impaired sleep quality and adverse clinical outcomes. Rapid eye movement (REM) sleep is particularly vulnerable to obstructive respiratory events; however, whether clinically significant insomnia independently contributes to REM-specific respiratory burden remains unclear. This study investigated REM sleep–specific respiratory events in patients with obstructive sleep apnea (OSA), focusing on the independent contributions of clinically significant insomnia and obesity. We retrospectively analyzed consecutive adults who underwent overnight polysomnography between June 2025 and January 2026. Moderate-to-severe OSA was defined as an apnea–hypopnea index (AHI) ≥ 15 events/h, and clinically significant insomnia as an Insomnia Severity Index (ISI) score ≥ 15. Patients were classified into four phenotypes: controls, insomnia alone, OSA alone, and COMISA. Demographic, clinical, and polysomnographic characteristics were compared across groups. Multivariable linear regression was performed to identify independent predictors of REM-AHI after adjustment for age, sex, body mass index (BMI), and NREM-AHI. Ninety-four patients were included (25 controls, 15 insomnia alone, 31 OSA alone, and 23 COMISA). Compared with patients with OSA alone, those with COMISA had significantly higher Epworth Sleepiness Scale scores (p = 0.011), total AHI (p = 0.023), NREM-AHI (p = 0.020), and non-supine AHI (p = 0.026), whereas REM-AHI did not differ significantly between groups (p = 0.481). In multivariable analysis, BMI (β = 1.14, 95
Circadian rhythm disturbances are widely reported in schizophrenia and bipolar disorder and have been proposed as transdiagnostic vulnerability mechanisms. Whether such alterations are detectable in unaffected first-degree relatives remains unclear. This study examined sleep quality, chronotype, and biological rhythm functioning in relatives of individuals with these disorders. In this cross-sectional study, 146 participants were included: 44 relatives of individuals with schizophrenia (SCZr), 47 relatives of individuals with bipolar disorder (BDr), and 55 healthy controls. Sleep quality and habitual bedtime and wake-up time were assessed using the Pittsburgh Sleep Quality Index (PSQI), chronotype using the Morningness–Eveningness Questionnaire (MEQ), and biological rhythms using the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN). Group differences were analyzed using ANOVA and ANCOVA adjusting for age, gender, and comorbid medical conditions. No significant differences were observed in overall sleep quality, chronotype, or biological rhythm measures. Differences in specific sleep components were observed, particularly for sleep duration (p=.025), while sleep latency showed a trend-level effect (p=.068); however, these effects were small and not consistently indicative of greater disturbance among relatives. Moreover, relatives reported significantly later habitual bedtimes (p=.009) and wake-up times (p=.005). Correlation analyses demonstrated robust associations between sleep quality, chronotype, and biological rhythm regulation (p < .001). These findings suggest that self-reported circadian characteristics appeared largely preserved at the time of assessment in individuals with familial risk. Although modest differences in habitual sleep timing and selected sleep characteristics were observed, longitudinal studies using larger samples and objective circadian assessments will be important to clarify whether such alterations precede the onset of major psychiatric disorders.
To evaluate whether patients with RLS have increased odds of ED compared with non-RLS controls. We conducted a systematic review and meta-analysis analyzing the odds of ED in patients with RLS. We included studies that: (i) evaluated adults with a diagnosis of RLS established by the pre-established criteria; (ii) included a control group without RLS; and (iii) evaluated outcomes related to the odds of ED in patients with RLS. We followed the PRISMA 2020 protocol. This systematic review included a total sample of 33,740 participants. Patients with RLS had 70
Social determinants of health (SDoH) influence sleep duration, but their independent and combined effects on short and long sleep are not well understood. We analyzed 31,223 adults from NHANES 2005–2018. Sleep duration was categorized as short (< 7 h), recommended (7–9 h), and long (> 9 h). Eight SDoH indicators were included, representing economic stability (employment status, family poverty income ratio, food security), education (educational attainment), healthcare access (healthcare access, insurance coverage), housing stability, and social context (marital status). Survey-weighted logistic regression assessed associations, adjusting sequentially for other SDoH, demographic, lifestyle, and clinical factors. Weighted quantile sum (WQS) regression evaluated cumulative SDoH effects and relative contributions. Lower education, marital disruption, and low food security were associated with short sleep. In contrast, low income, never married or widowed, lower education, unemployment, very low food security, and government insurance were associated with long sleep. WQS analysis demonstrated a cumulative association between SDoH burden and sleep duration, with each quartile increase in the SDoH index associated with higher odds of short sleep (OR = 1.93, 95
Sleep patterns, including nighttime sleep, daytime napping, and their relationship with the risk of cardiovascular disease (CVD) remain unclear, particularly when psychological factors are considered. This study aims to investigate the influence of depressive symptoms on the association between sleep patterns and the incidence of CVD risk. A longitudinal analysis using CHARLS data included 4,912 participants, with a mean age of 68.13 (SD = 8.91). Sleep patterns and CVD were assessed by self-reported data. Multivariable logistic regression models were used to examine the associations. Stratified analyses based on depressive symptoms were conducted to assess potential effect modification. Mediation analyses were performed to explore potential pathways linking sleep patterns to incident CVD. In all participants of fully adjusted model (Model 3), short nighttime sleep (< 7 h) was significantly associated with higher CVD risk (OR = 1.53, 95
Standardized and non-standardized Japanese translations of the Athens Insomnia Scale (AIS) have been used interchangeably. This study examined whether the non-standardized Japanese translation is equivalent to the standardized translation. A total of 1642 city government employees participated in this study. They completed both the standardized and non-standardized Japanese translations of the AIS. Item scores (weighted kappa coefficients = 0.614–0.819), total scores (intraclass correlation coefficient = 0.883), and insomnia severity classifications (weighted kappa coefficient = 0.798) were statistically consistent between the translations. Our findings suggest that non-standardized translation can be used to assess insomnia symptoms.
The purpose of our study is to clarify the relationship between sleep duration, self-reported trouble sleeping, sleep disorders, and poor sleep patterns and all-cause mortality in participants with hypertension. We analyzed data from 11,359 hypertensive adults with complete follow-up. Sleep patterns were characterized based on sleep duration, self-reported trouble sleeping, and the presence of physician-diagnosed sleep disorders. Hazard ratios (HRs) and 95
The aim of this study was to investigate whether having children and engaging in caregiving responsibilities influence the regularity of sleep–wake rhythms in men, particularly in terms of reducing the phenomenon of social jet lag—the misalignment between biological and social time. This cross-sectional study was based on self-reported data collected online in the fall of 2023. Social jet lag was calculated as the difference between sleep timing on workdays and non-workdays. Statistical analyses included the Shapiro–Wilk test, Student’s t-test, Mann–Whitney U test, chi-square test, and binary logistic regression. Group comparisons between four categories (fathers and childless men, with and without social jet lag) were performed using the Kruskal–Wallis test. The study sample consisted of 238 adult men (mean age = 28 years; SD = 9.05). The questionnaire included questions about the number and age of children, relationship status, sleep habits, alcohol use, and sleep medication intake. Individuals with irregular circadian patterns or shift work were excluded. Social jet lag was significantly less prevalent among fathers compared to childless men. Having children was associated with a 70
Sleep is a key component of biological rhythms, and autonomic regulation across the 24-hour cycle reflects circadian influences on cardiovascular control. Although reduced heart rate variability (HRV) is associated with adverse cardiovascular outcomes, the relationship between habitual sleep duration and parasympathetic function in patients with hypertension remains unclear. This study examined the association between sleep duration and autonomic activity, focusing on the high-frequency (HF) component of HRV as an indicator of parasympathetic regulation. Seventy-four patients with hypertension were classified into a short sleep (S) group (< 7 h, n = 28) and a recommended sleep (R) group (7–9 h, n = 46). Twenty-four-hour HRV was assessed using Holter electrocardiography, and the HF component was analyzed as an index of parasympathetic activity. Habitual physical activity was measured for one month using a waist-worn monitor, from which physical activity–related energy expenditure (PAEE), moderate-to-vigorous physical activity, and light physical activity were calculated. The 24-hour HF component was significantly greater in the R group than in the S group (p = 0.039), even after adjustment for age, sex, dyslipidemia, β-blocker use, and PAEE. Similar but nonsignificant trends were observed during awake and sleep periods (p = 0.078 and 0.074, respectively). Achieving the recommended sleep duration was associated with greater parasympathetic activity, independent of habitual physical activity. These findings suggest that adequate sleep is an important behavioral factor for autonomic regulation and may be a relevant target for lifestyle guidance in patients with hypertension.
