Sleep

STUDY OBJECTIVES:To explore neurophysiological and neurocognitive characteristics of OSA patients with residual excessive sleepiness (RES) using EEG spectral analysis and multidimensional cognitive assessments. METHODS:This case-control study included 76 participants (38 RES, 38 Non-RES) from our RES cohort. Polysomnography (PSG) and multiple sleep latency tests (MSLTs) were recorded and used to obtain relative EEG spectral power. A series of standard neurocognitive assessments were conducted during the first MSLT interval (approximately 09:00-11:00 AM). RESULTS:In PSG and MSLTs, RES patients showed increased delta and theta power and decreased alpha and beta power (all FDR-adjusted q<0.05). RES patients demonstrated multidimensional cognitive impairments, including longer WCST reaction time (mean difference [MD] = -642.71 ms, 95% CI: -1045.70 to -239.72, p = 0.002, partial η2 = 0.130), longer SCWT color-word reaction time (MD = -16.02 s, 95% CI: -25.32 to -6.71, p = 0.001, partial η2 = 0.148), and more PVT lapses (MD = -3.65, 95% CI: -5.28 to -2.03, p < 0.001, partial η2 = 0.228). The EEG spectral patterns of increased delta-theta power and decreased alpha-beta power were significantly associated with impairments in executive function, processing speed, working memory and selective attention, while the decreased alpha-beta power was more related to impairment of vigilance and sustained attention. CONCLUSIONS:RES patients exhibit a characteristic EEG power spectrum marked by increased delta-theta and decreased alpha-beta power values, indicating sleep-wake dysregulation. RES patients also demonstrate multidimensional cognitive impairments, including deficits in processing speed, working memory, attention, and executive function, with distinct neurophysiological correlates.

STUDY OBJECTIVES:Sleep is regulated by conserved kinase signaling pathways, yet how specific molecular variants encode sleep need, sleep intensity, and circadian timing remains unclear. We investigated the functional specialization of SIK3 isoforms and protein kinase A (PKA)-phosphorylation sites in mouse sleep/wake and circadian regulation. METHODS:We first generated isoform-selective Sik3 knock-in mice expressing either the 150 kDa or 70 kDa SIK3 isoform. To determine the isoform-specific effects of the Sleepy (Slp) mutation, which causes exon 13 skipping and deletes a region containing S551, we introduced the mutation separately into the 150 kDa-specific or 70 kDa-specific allele. In addition, we generated knock-in mice carrying alanine substitutions at the PKA-phosphorylation sites T469, S551, or S674. Sleep/wake states were quantified by EEG/EMG recording, and circadian behavior was assessed by wheel-running under light-dark and constant-dark conditions. RESULTS:The mouse brain expressed two major SIK3 isoforms: a 150 kDa isoform and a 70 kDa isoform generated by intron 14 retention. Isoform-selective knock-in analyses showed that the 150 kDa isoform was required for normal wakefulness at dark onset and circadian period regulation, whereas the 70 kDa isoform contributed predominantly to NREM sleep EEG delta power. Introducing the Sleepy mutation into either isoform increased NREM sleep time and delta power. Alanine substitution of T469 or S551, but not S674, produced a Sleepy-like hypersomnia phenotype. CONCLUSION:Partially separable molecular features of SIK3, including its isoforms and phosphorylation sites, contribute to sleep and circadian regulation.

STUDY OBJECTIVES:The heart rate (HR) of patients with obstructive sleep apnea (OSA) exhibits cyclical variation during sleep-disordered breathing (SDB), decreasing during apnoeas/hypopnoeas and increasing abruptly when air exchange resumes. It is not yet known whether this variation exceeds spontaneous HR variation during periods without SDB (noSDB), thereby giving rise to measurable chronotropic effects. This study aimed to address this knowledge gap by comparing the distribution of HR during SDB and noSDB. METHODS:Instantaneous HR was derived from the ECG signal recorded during standard polysomnography in 135 patients with moderate-to-severe OSA. HR distributions during noSDB and SDB were characterized using a set of relevant percentiles and probabilities for each state. Four dominant chronotropic effects were defined based on changes in these descriptors from noSDB to SDB: bradycardic (B), tachycardic (T), bradycardic and tachycardic (B-T), and neither (noB-T). RESULTS:15.5%, 48.9%, 32.6%, and 3.0% of the patients were classified into groups B, T, noB-T and B-T (excluded due to negligible sample size). The frequency of troughs below spontaneous HR variation was higher in group B than in groups T and noB-T (p<0.0001). Furthermore, patients in group B had a higher apnoea/hypopnoea index (p<0.01), oxygen desaturation index (p<0.01) and hypoxic burden (p<0.05). There was no significant difference in age, sex, or BMI between the groups. CONCLUSIONS:Patients with OSA exhibit clear heterogeneity in the overall chronotropic effects elicited by respiratory events. These different responses are associated with different degrees of OSA severity and hypoxic burden, although anthropometric and clinical characteristics remain consistent.

STUDY OBJECTIVES:Obstructive sleep apnea (OSA) is associated with structural, microstructural, functional, vascular, and metabolic brain alterations. Continuous positive airway pressure (CPAP) is the first-line treatment for OSA, but whether OSA-related abnormalities on brain magnetic resonance imaging (MRI) improve after treatment remains uncertain. This systematic review synthesized longitudinal MRI evidence on brain changes following CPAP therapy in adults with OSA. METHODS:PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception to December 2025. Eligible studies included adults with OSA who underwent brain MRI before and after CPAP therapy or were compared with untreated, sham-treated, best-supportive-care, or healthy control groups. MRI outcomes included structural, diffusion, functional, perfusion, cerebrovascular reactivity, magnetic resonance spectroscopy, susceptibility-related, and perivascular-space measures. Risk of bias was assessed using an adapted Newcastle-Ottawa Scale. Findings were synthesized qualitatively because of substantial heterogeneity. RESULTS:Thirty studies were included. Reported post-CPAP MRI changes were heterogeneous and included gray matter or cortical alterations, white matter microstructural changes, modified functional connectivity and regional activity, perfusion or cerebrovascular reactivity changes, and preliminary metabolic, susceptibility-related, and perivascular-space findings. Results varied across MRI techniques, anatomical targets, CPAP duration, adherence definitions, comparator groups, and analytical methods. CONCLUSIONS:The available longitudinal MRI literature suggests possible domain-specific brain changes after CPAP, but the evidence is largely exploratory because most studies were small and nonrandomized and used heterogeneous imaging and analytical approaches. The findings do not establish reproducible MRI treatment effects or support routine MRI monitoring of individual response. Larger, prospectively specified, harmonized longitudinal studies are needed.

Sleep has undergone a remarkable shift in scientific and public perception, moving from a relatively overlooked biological process to a widely recognized component of health. This growing recognition reflects substantial advances in sleep science, but it has also created a translational challenge: while contemporary research increasingly recognizes sleep as a multidimensional and context-dependent construct, these nuances can be attenuated as findings are communicated to clinicians, policymakers, commercial stakeholders, and the public. This Perspective examines how sleep can be promoted as an important component of health without overstating its effects or presenting it as a universal solution to complex health problems. It argues for communication approaches that preserve evidentiary nuance, acknowledge relevant uncertainty, and situate sleep within the broader behavioral, biological, social, and environmental contexts that shape its relationship with health. Such communication can help ensure that the growing prominence of sleep evolves into a mature and appropriately contextualized component of health, rather than simply becoming the latest target of health optimization and overstatement.

STUDY OBJECTIVES:Sleep disturbance is closely linked to affective symptoms and suicidal ideation (SI). These symptoms fluctuate across the menstrual cycle; however, menstrual cycle-related sleep variability remains poorly characterized in psychiatric populations. This study examined how subjective and objective sleep fluctuate across the menstrual cycle in a psychiatric sample, considering individual differences and associations with negative affective and SI symptom trajectories. MATERIALS AND METHODS:A transdiagnostic psychiatric sample recruited for recent suicidality provided intensive daily subjective sleep and symptom ratings (N = 142,M = 26.59,years SD = 5.34) alongside wearable-derived (Oura) objective sleep measures (N = 39) across 1-3 menstrual cycles. Cycle timing was aligned to ovulation and menses using Phase-Aligned Cycle Time Scaling. Generalized additive mixed models quantified average cyclical effects and interindividual heterogeneity. Exploratory smooth mixture modeling (SMM) identified latent subgroups with shared temporal sleep trajectories which were compared to trait-level demographic and clinical characteristics as well as affective, SI, and pain cyclical symptom trajectory subgroups. RESULTS:Most sleep outcomes showed substantial within-person cyclical variability. SMM identified distinct subgroups for Oura-derived sleep efficiency, and for subjective ratings of fatigue, insomnia, sleep quality, and hypersomnia, with patterns including perimenstrual or luteal worsening, as well as no cycle-related variability. Sleep subgroups, especially for subjective ratings, frequently significantly aligned with parallel affective, pain, and SI trajectories, suggesting temporally-coupled vulnerability. CONCLUSIONS:Sleep trajectories across the menstrual cycle are heterogeneous and meaningfully coupled with psychiatric symptom patterns. These findings support cycle-aware sleep monitoring and suggest that cyclical sleep disruption may help identify windows of heightened psychiatric risk, motivating replication and personalized intervention approaches.

STUDY OBJECTIVES:To predict the improvement in sleepiness following continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) using baseline characteristics. METHODS:Data from five polysomnography cohorts (HomePAP, BestAIR, ABC, STAGES, and MESA; total n=2332) were analyzed. Associations between polysomnographic metrics and Epworth Sleepiness Scale (ESS) were assessed using multivariable linear regression. Cross-validated LASSO regression was used to select predictor variables. Prediction of ESS improvement was evaluated in CPAP-treated participants (n=213) using linear regression models trained on 139 participants and tested in a holdout group (n=74). RESULTS:Cross-sectional analysis revealed significant associations between baseline ESS and ventilatory burden (0.56 points/SD; 95% CI 0.34-0.78), hypoxic burden (0.51; 0.28-0.74), the apnea-hypopnea index (AHI, 0.45; 0.23-0.68), time below 90% oxygen saturation (0.36; 0.15-0.57), and flow limitation severity (0.31; 0.10-0.53). Baseline ESS and baseline ventilatory burden were the most frequently selected predictors of ESS improvement. Using these two variables in a regression model, predicted and actual ESS improvement were correlated in the holdout group (adjusted R2=0.313). The model classified CPAP responders (≥2 points ESS improvement) more accurately than current clinical guidelines (78.1% [3.5% SD] versus 68.4% [3.7%]). Substituting the AHI for ventilatory burden slightly reduced accuracy (77.3% [3.4%]). Charts were developed to assist in predicting ESS improvement from baseline metrics. CONCLUSIONS:Models incorporating baseline ESS and either ventilatory burden or AHI predict ESS improvement and may help identify patients with OSA likely to benefit from CPAP. The ventilatory burden model demonstrated modestly better performance, while the AHI-based model offers greater clinical applicability.

STUDY OBJECTIVES:While growing evidence suggests neighborhood safety and physical disorder may impact adolescent sleep, prior research has not accounted for mobility outside the home neighborhood. This study examined associations of crime and physical disorder surrounding adolescents' homes, schools, and in their daily activity spaces with sleep patterns. METHODS:Adolescents aged 15-18 years (n=142) were followed for 14 days using smartphone GPS tracking and actigraphy. GPS locations recorded during adolescents' waking hours were spatially linked to local data on crime and vacant lots to derive exposures surrounding adolescents' homes, schools, and daily activity spaces. Mixed-effects linear and modified Poisson models estimated associations of crime and vacant lots with sleep duration, timing, efficiency, insufficient (<8 hours) and very short sleep (<6 hours). Fixed-effects models estimated associations of within-person differences in activity-space crime and vacant lot exposures with sleep patterns. RESULTS:Higher crime exposure surrounding adolescents' homes and schools was associated with shorter sleep duration, higher risk of insufficient and very short sleep, earlier offset timing (home only) and later onset timing (school only). Higher activity-space exposure to vacant lots was associated with shorter sleep duration, later onset, and higher risk of insufficient sleep. On days when adolescents' exposure to vacant lots was higher relative to their own average, they had shorter sleep duration, earlier offset timing, and higher risk of insufficient and very short sleep, while such associations were not seen for neighborhood crime. CONCLUSIONS:Associations of crime and vacant lot exposures with actigraphy-assessed adolescent sleep patterns varied by setting.

STUDY OBJECTIVES:Prior studies on siesta and obesity are inconsistent, and the role of siesta timing remains unclear. We examined cross-sectional associations between objectively estimated siesta characteristics and body composition in two populations across two continents. METHODS:Actigraphy-derived siesta timing (clock time and relative to wake/bedtime), duration, and frequency from 90 adults in the Spanish ONTIME Study (NCT02829619) and 69 adults in the US SHIFT Study (NCT02997319) were analyzed. Outcomes included BMI, waist circumference, body fat percentage, and muscle mass percentage. Associations were assessed using adjusted linear and logistic models. RESULTS:In the ONTIME Study (52±10 years, 91% women), each 1-hour later siesta start time was associated with lower BMI (β(SE)=-0.044(0.012) log(kg/m2), p=0.0003), body fat (β(SE)=-0.031(0.011)log(%), p=0.014), waist circumference (β(SE)=-0.026(0.012)log(cm), p=0.009), and higher muscle mass in women (β(SE)=0.019(0.006)log(%), p=0.005). Participants with late siestas (16:12-17:42 h) had ~3.94 kg/m2 lower BMI vs. early siestas (ANCOVA P=0.017). Longer siesta duration was associated with 3.98 higher odds of overweight/obesity (95% CI:1.12-14.18, p=0.033), while higher siesta frequency (days/week) trended toward lower body fat and higher muscle mass (p<0.1). Analyses in the independent SHIFT Study (31±9 years, 62.5% women) were directionally consistent but not statistically significant. Fixed-effect meta-analysis combining both cohorts (n = 159) identified significant associations between later siesta start time and lower BMI, lower body fat percentage, lower waist circumference and higher muscle mass percentage (all p<0.05). CONCLUSIONS:Later siesta timing is associated with lower obesity traits and higher muscle mass. Objective multidimensional assessment of siesta may help identify behavioral patterns associated with body composition and inform future intervention studies on weight management.

STUDY OBJECTIVES:Poor sleep is linked to adverse health outcomes. Animal studies suggest the gut microbiome may influence sleep, but human findings remain inconsistent. We examined associations of self-reported insomnia symptoms, daytime sleepiness, and actigraphy-measured sleep with gut microbiome diversity and composition in older adults. METHODS:We studied 869 Baltimore Longitudinal Study of Aging participants with self-reported sleep and shotgun metagenomic sequencing; 332 also had actigraphy. We tested associations of sleep with alpha diversity, beta diversity, and species composition using regression, PERMANOVA, and ANCOM-BC2, adjusting for age, sex, BMI, physical activity, education, and depressive symptoms. RESULTS:Participants had mean age 70.7 years; 54.8% were female and 66.9% White. Trouble falling asleep ≥5 times/week was associated with higher Shannon diversity (β=0.41 SD; 95% CI: 0.09, 0.73) and Pielou's evenness, but not richness metrics. No actigraphy-measured sleep variables were associated with alpha or beta diversity. Beta diversity analyses suggested excessive sleepiness (1-2 o 3-4 times/week) was associated with different microbial composition, though variance explained was small. In species-level analyses, frequent insomnia symptoms or excessive sleepiness were associated with depleted or undetected Eubacterium sp. CAG:251. In exploratory actigraphy models, each doubling of sleep efficiency was associated with higher Eubacterium sp. CAG:251 prevalence (PR=2.15; 95% CI: 1.47, 3.14), while each 30-minute increase in wake after sleep onset was associated with lower prevalence (PR=0.49; 95% CI: 0.29, 0.81). CONCLUSIONS:Global diversity findings were limited and inconsistent, whereas subjective and objective sleep disturbances converged on Eubacterium sp. CAG:251. Findings are exploratory and require longitudinal replication.

STUDY OBJECTIVES:Insomnia with objective short sleep duration has been reported to be associated with cardiometabolic comorbidities. We aimed to investigate the association between insomnia symptoms with objective or self-reported sleep duration and mortality in a general population sample. METHODS:From the Wisconsin Sleep Cohort, 373 participants with insomnia symptoms and 394 participants without insomnia symptoms with a median follow-up duration of 8 years were included. Insomnia symptoms were defined as the presence of difficulty in falling sleep, maintaining sleep or early awakening for more than 5 times/month. Objective short sleep duration was defined as total sleep time < 6 hours based on polysomnography. Self-reported short sleep duration was defined as < 7 hours. RESULTS:Insomnia symptoms with objective short sleep duration were associated with a 2.6-fold higher risk of all-cause mortality (hazard ratio [HR]=2.57, 95% confidence interval [95%CI]=1.12-5.89) compared to participants without insomnia symptoms and normal sleep duration (>6 hours) after controlling for confounders. Furthermore, participants with insomnia symptoms and normal sleep duration or with objective short sleep duration but without insomnia symptoms were not associated with increased risk of all-cause mortality. Finally, insomnia symptoms with self-reported short sleep duration were not associated with risk of all-cause mortality. CONCLUSIONS:Our findings support that insomnia with objective short sleep duration is the more severe insomnia phenotype. Objective short sleep duration appears to be a valid marker of the biological severity of insomnia.

STUDY OBJECTIVES:Sleep research has been limited by the lack of large, diverse polysomnography (PSG) datasets. Existing resources are often single-center, age-specific, or epidemiological in nature, restricting generalizability and large-scale clinical research. The objective of this study was to create a large, multi-center clinical PSG dataset to support scalable and broadly representative research in sleep medicine and clinical neuroscience. METHODS:The Human Sleep Project (HSP) dataset comprises 119,234 overnight sleep recordings from more than 90,000 unique patients collected across five major U.S. institutions: Stanford University, Massachusetts General Brigham (MGB), Emory University, Beth Israel Deaconess Medical Center (BIDMC), and Boston Children's Hospital (BCH). Each study includes at least a standard attended PSG montage, along with clinical annotations and standardized automated sleep annotations. Data were harmonized using the Brain Imaging Data Structure (BIDS) framework and linked to de-identified demographic and electronic health record (EHR) data. RESULTS:The HSP spans the full human lifespan, from infancy to individuals over 90 years old, and includes diagnoses across 22 ICD-10 clinical categories. Analysis of the aggregated data demonstrates expected age-related trends in sleep architecture, including reduced total sleep time and N3 sleep and increased sleep fragmentation with advancing age. Standardization procedures successfully addressed technical and scoring variability across sites, creating a consistent and high-quality resource for large-scale analyses. CONCLUSIONS:The Human Sleep Project provides harmonized physiological signals, manual and automated annotations, and quality metadata for 119,234 sleep studies, including 115,129 PSGs and 4,105 home sleep apnea tests, enabling reproducible sleep research at an unprecedented scale.

Abstract Introduction Obstructive sleep apnea (OSA) and short sleep duration each contribute to hypertension risk, yet their combined influence on 24-hour blood pressure patterns is not well characterized. This study evaluated associations between apnea–hypopnea index (AHI), objective sleep duration, and ambulatory blood pressure (ABP), and tested whether sleep duration modifies relationships between AHI and nocturnal dipping among adults with elevated in-office blood pressure. Methods This cross-sectional analysis used baseline data from a behavioral sleep extension trial. Adults aged 18–65 years were eligible if they reported habitual sleep < 7 hours and had elevated in-office blood pressure (systolic 120–140 mmHg or diastolic 80–90 mmHg). Objective sleep was measured for seven days with a wrist-worn actigraphy device. OSA severity was assessed using a single-night home sleep apnea test generating AHI values. Participants completed 24-hour ABP monitoring, with daytime and nighttime windows aligned to actigraphy-defined rest periods. Linear regression models tested associations between AHI and mean systolic and diastolic blood pressure. Logistic models examined associations between AHI and systolic and diastolic non-dipping (< 10% nocturnal reduction). Moderation by total sleep time was evaluated with interaction terms. Adjusted models included age, sex, race, and body mass index. Results A total of 195 participants had valid actigraphy, AHI data, and ambulatory blood pressure data with a mean age of 42 ± 11 years. AHI was not associated with mean systolic blood pressure in unadjusted or adjusted models. Higher AHI was associated with higher mean diastolic blood pressure in unadjusted (p=0.013) and adjusted (p=0.045) models. AHI predicted systolic non-dipping in unadjusted analyses (p=0.049), with a marginal effect after adjustment (p=0.090). AHI was not associated with diastolic non-dipping. Sleep duration did not moderate AHI associations with mean blood pressure but longer sleep significantly attenuated the AHI–systolic non-dipping relationship (p=0.045). Conclusion Among adults with elevated in-office blood pressure and short sleep duration, greater OSA severity predicted higher mean diastolic blood pressure and increased systolic non-dipping, with longer sleep time weakening the influence of AHI on nocturnal systolic dipping. Support (if any) NIH award number R01HL141811 (PI: Baron).

Abstract Introduction AD109, an investigational oral anti-apneic neuromuscular modulator, combines in one tablet the novel antimuscarinic aroxybutynin (2.5 mg) with the selective norepinephrine reuptake inhibitor atomoxetine (75 mg). In two phase 3 clinical trials for obstructive sleep apnea (OSA), AD109 significantly improved airway obstruction and oxygenation vs placebo. This study evaluated the pharmacokinetics (PK), efficacy, tolerability and safety of AD109 when co-administered with glucagon-like peptide-1 receptor agonists (GLP-1 RA) in participants with OSA and obesity. Methods This was an open-label, parallel-arm, 6-week phase 2 study of AD109 in participants with mild-to-severe OSA and obesity, administered either alone or while remaining on a stable maintenance dose of a GLP-1 RA (tirzepatide, semaglutide, or liraglutide). The study consisted of a screening period, 2-day single dose PK period, followed by a 6-week AD109 dosing period. Plasma PK for aroxybutynin and atomoxetine, including maximum plasma concentration (Cmax) and exposures (AUClast and AUCinf), were derived by noncompartmental analysis and evaluated using a mixed-effects model. Results Forty participants were enrolled and received AD109 (n=22) or AD109+GLP-1 RA (n=18). Geometric mean ratios (GMR; AD109+GLP-1 RA/AD109 alone [90% CI]) of aroxybutynin for Cmax, AUClast, and AUCinf were 100.6 (68.0–148.8), 142.0 (102.1–197.5), and 152.7 (111.0–210.1), respectively. GMR of atomoxetine for Cmax, AUClast, and AUCinf were 67.0 (51.0–88.1), 81.9 (57.0–117.7), and 78.2 (51.3–119.1), respectively. The proportion of participants achieving ≥50% reduction in respiratory event index based on 4% hypopnea desaturation assessed with home sleep apnea test at Week 5 in the AD109 and AD109+GLP-1 RA arms were similar (33.3% vs 29.4%, respectively). Treatment-emergent adverse events (TEAEs) were reported by 85% of participants with the majority being mild-to-moderate severity. TEAEs of dry mouth, decreased appetite, nausea, and constipation were reported with higher incidence in the AD109 alone arm. No clinically meaningful trends were detected in mean changes from baseline in lab values, physical examination variables, or vital signs. No deaths or serious TEAEs occurred. Conclusion AD109 was generally safe and well-tolerated in both treatment arms of this phase 2 trial, without large differences in PK when co-administered with GLP-1 RA. Support (if any) This study was supported by Apnimed, Inc.

Abstract Introduction Major political events can serve as naturalistic stress tests, disrupting sleep and heightening emotional affect. The 2020 United States presidential election was rather unusual as the outcome was not projected for several days, prolonging uncertainty beyond election night. Emotional responses to such events are likely to depend on whether the apparent or eventual outcome aligns with individuals’ political preferences and on the strength of their ideological commitment. Sleep is a modifiable behavior that may further shape these trajectories. The study examines how election-night sleep, political ideology, and outcome congruence jointly relate to changes in emotional affect. Methods A non-representative, primarily liberal-leaning (69.6%) convenience sample of US (n=437) and non-US-residing (n=106) participants was recruited. Participants completed daily online surveys assessing sleep duration and quality, affect, alcohol use, and related health measures during a baseline period (October 1–13, 2020) and the days surrounding the 2020 election (October 30–November 12, 2020). Linear mixed-effects models will estimate within-person changes in emotional affect across the election window as a function of election-night total sleep time and sleep efficiency, ideology strength, and outcome congruence. Results Planned analyses are anticipated to show higher negative affect during the election window than on baseline mornings. Misaligned outcomes (preferred candidate not winning) and stronger ideological positions are expected to be associated with larger and more persistent elevations in negative affect. Longer and more efficient election-night sleep is expected to attenuate these elevations and to be associated with steeper declines in negative affect over subsequent days, particularly among participants with misaligned outcomes and strong ideological commitment. Conclusion These anticipated patterns would suggest that misalignment between political preferences and election outcomes, especially among strongly ideological individuals, is associated with heightened and prolonged negative affect and that better sleep may partially buffer these responses. Interpretation will need to consider that ideological self-report does not fully capture satisfaction with specific candidates and that the delayed projection of the 2020 outcome means much of the election window reflects prolonged uncertainty rather than a single post-result day. Support (if any)