This study examined the association between social jetlag and inhibitory control in healthy young adults. Two hundred and eleven participants (aged 18 to 24 years) completed the self-report assessments and a remote Stop-Signal Task (SST). Response inhibition was measured using the horse-race model and analyzed using four SST-derived metrics: reaction time (RT) on Go trials, RT on unsuccessful stop trials, the SST Race Model (RT stop-fail minus RT Go), and the Stop-Signal Reaction Time (SSRT). These outcomes served as dependent variables in generalized linear models, with absolute social jetlag (assessed by the Munich Chronotype Questionnaire) as the main predictor and covariates including age, sex, education, sleep insufficiency, and minor psychiatric symptoms. Results showed that higher social jetlag significantly predicted longer SSRTs (β = 23.13, p = .014) and greater SST Race Model values (β = 18.31, p = .015), indicating delayed inhibition processes. No significant associations were observed for raw RTs, highlighting the importance of computational modeling in detecting subtle cognitive effects of circadian misalignment. The findings support the idea that circadian misalignment, which is common in student populations, may disrupt executive functioning.
BACKGROUND:Sleep disorders are increasingly recognized in individuals with Cri-du-Chat (CdC) syndrome, yet most available data focus on pediatric populations. The present study investigated the prevalence, characteristics, and potential determinants of sleep disturbances in adults with CdC syndrome using standardized and validated scales and questionnaires. Findings were also compared with previously published pediatric data to explore developmental trajectories and persistence of sleep problems into adulthood. METHODS:Adults (≥18 years) with genetically confirmed CdC syndrome were recruited through the Italian Associazione Bambini Cri du Chat ONLUS (A.B.C.). Between September and October 2025, caregivers completed a structured questionnaire comprising general demographic and clinical data, and four standardized sleep assessment instruments: the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and the Sleep Questionnaire for Children with Severe Psychomotor Impairment (SNAKE). RESULTS:Seventy adults (median age 31 years) were included. Poor sleep quality and insomnia symptoms were detected by using PSQI and ISI in 49% and 35.7% of participants, respectively. According to SNAKE results, disturbances in sleep maintenance were the most frequent (47.1%), followed by sleep-onset difficulties (25.7%) and daytime sleepiness (22.9%). A large proportion of participants with SNAKE scores suggestive of a clinically relevant sleep problem had never undergone a formal diagnostic evaluation for a sleep problem, highlighting a potential gap in clinical recognition. After adjustment for age, sex, and degree of intellectual disability, older age was independently associated with poorer overall sleep quality, greater insomnia severity, and increased daytime sleepiness, while epilepsy was independently associated with greater daytime sleepiness, and severe intellectual disability was associated with more pronounced daytime behavioural disturbances. CONCLUSIONS:Sleep problems are common yet underdiagnosed in adults with CdC syndrome, often persisting from childhood into adulthood. These findings emphasize the need for systematic sleep screening and multidisciplinary management in this population, integrating behavioural, neurological, and environmental factors.
OBJECTIVES:Continuous positive airway pressure (CPAP) can partially reverse brain abnormalities associated with obstructive sleep apnea (OSA), but the biological substrates underlying this recovery remain unclear. We investigated whether diffusion MRI could identify tissue-compartment changes associated with brain recovery following CPAP. METHODS:Thirteen adults with OSA underwent paired brain MRI before and after 3 months of CPAP treatment. Diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) were analyzed using tract-based spatial statistics (TBSS; n = 13) and gray matter-based spatial statistics (GBSS; n = 10). Exploratory region-of-interest (ROI) analyses were performed across 102 Gy matter regions. Voxel-wise analyses used permutation-based inference with threshold-free cluster enhancement and family-wise error (FWE) correction. RESULTS:CPAP produced three coordinated white matter changes that survived FWE correction: FA increased in 7 of 10 examined tracts, restricted to the left hemisphere; AD increased bilaterally across all 10 tracts; and ODI decreased bilaterally across all 10 tracts. No significant changes were detected in RD, MD, NDI, or FWF within white matter. In gray matter, FWE-corrected analysis identified increased FA in the right cerebellar Crus II and decreased FWF in the left medial orbitofrontal cortex. Exploratory ROI analysis suggested widespread cortical microstructural changes and distinct diffusivity patterns in subcortical regions, with changes concentrated within default mode and salience networks. AHI was significantly reduced following CPAP, and HAMD scores improved. CONCLUSIONS:CPAP-induced brain recovery was characterized by coordinated, tissue-specific diffusion changes after 3 months of treatment. The combination of DTI and NODDI identified orientation-dispersion changes that are not captured by conventional DTI, while the absence of RD and NDI changes suggests that early recovery may precede detectable remyelination or neurite-density changes. These findings support NODDI-based tissue-compartment imaging as a promising approach for investigating the biological basis of brain recovery following CPAP in OSA.
This letter evaluates the prognostic significance of patent foramen ovale (PFO) in adults with central sleep apnea (CSA) using a retrospective TriNetX cohort (2010-2024) with 1:1 propensity score matching. In matched analyses (908 CSA with PFO vs 908 CSA without PFO), PFO was associated with higher rates of major adverse cardiac events (HR 1.30), acute heart failure events (HR 1.34), and ischemic stroke (HR 1.31), without significant differences in all-cause mortality or hospitalization. These findings suggest that coexisting PFO identifies a higher-risk CSA phenotype and warrant prospective validation.
PURPOSE:Autistic children are at high risk for sleep problems, which have significant detrimental effects on overall functioning. Behavioral treatment is effective for pediatric insomnia in the general population; however, current evidence on behavioral sleep interventions for autistic children has not been synthesized. This study addressed this gap by systematically reviewing available evidence on the effects of behavioral sleep interventions on sleep and daytime functioning in autistic children. METHODS AND RESULTS:A systematic search of five databases (PubMed, PsycInfo, Web of Science, Embase, CINAHL) was conducted in accordance with PRISMA guidelines. Studies were eligible if they were published in English in a peer-reviewed journal, included autistic children under 18 years of age, evaluated a behavioral sleep intervention, measured sleep outcomes, and used a quantitative study design. Thirty-nine studies were included, published between 2002 and 2025. Most studies (92%) included multi-component behavioral interventions, and studies tested a range of treatment delivery modalities (in-person, virtual, online, and hybrid). Most studies (95%) found that behavioral interventions were effective for at least some sleep outcomes. Most studies (51%) were rated as "weak" quality overall, with 26% rated as "moderate," and only 23% rated as "strong" in overall quality. CONCLUSIONS:Existing quantitative research provides consistent evidence supporting the overall effectiveness of behavioral sleep interventions for autistic children. However, the evidence base remains limited, as most studies employ research designs with notable methodological weaknesses. Future research is needed with larger, more representative samples, and with more rigorous study designs.
BACKGROUND:The cyclic alternating pattern (CAP) is a key marker of NREM sleep microstructure, reflecting the balance between sleep-protective (A1) and arousal-promoting (A2/A3) processes. However, normative spectral and topographic data for CAP subtypes during development are limited, and high-density EEG (HD-EEG) mapping in children is lacking. This study aimed to characterize the scalp topography and spectral properties of CAP A subtypes in typically developing children and to assess their overnight dynamics. METHODS:Nineteen typically developing children (mean age 10.2 years, range 8-13.7; 10 females) underwent overnight video-polysomnography with 256-channel HD-EEG. Power spectral density was estimated using Welch's method for CAP A1 (0.5-2.5 Hz), A2-low (0.5-2.5 Hz), A2-high (11-14 Hz), and A3 (11-14 Hz). Topographic distributions were computed across the night and compared between early and late NREM sleep using linear mixed-effects models with permutation-based TFCE correction. RESULTS:A1 and A2-low activity showed maximal power over fronto-central and centro-parietal midline regions and was significantly higher during early compared to late night. In contrast, A2-high and A3 activity displayed a predominantly frontal distribution and increased during the late night. High-frequency components of A2 and A3 peaked within the 11-14 Hz range, differing from the alpha-band activity typically reported in adults. CONCLUSIONS:This exploratory study characterises the scalp topography and spectral properties of CAP A subtypes in typically developing children using HD-EEG. Slow-frequency CAP activity declined across the night, consistent with homeostatic processes, whereas faster components showed a frontal predominance and a late-night increase. These findings highlight developmental differences in CAP organization and provide preliminary reference data for paediatric sleep research, which require confirmation in larger, multicentre cohorts.
INTRODUCTION:Augmentation is a major complication of dopamine agonist (DA) therapy for restless legs syndrome (RLS) and its management continues to be a major clinical challenge. We sought to evaluate the feasibility and efficacy of a structured protocol designed to achieve complete DA withdrawal within one month. METHODS:In this prospective observational cohort at a specialized sleep center, consecutive adults with RLS and clinically significant augmentation treated with DA therapy underwent a structured withdrawal protocol that included rapid DA tapering, iron optimization, and alpha-2-delta ligand initiation or increase, with the dopamine partial agonist, aripiprazole, considered as an adjunctive option in patients with significant worsening. RESULTS:Of 31 patients, 24 (77%) achieved complete DA withdrawal at one month. Mean International RLS score improved from 27.1 to 15.1 and Clinical Global Impressions Severity from 5.2 to 3.5 (both p < 0.001), while gabapentin-equivalent dose increased from 417 to 1288 mg/day. Longer augmentation duration was associated with failure to withdraw (11.4 vs. 3.5 years; p = 0.003). Aripiprazole use during tapering was associated with successful withdrawal. CONCLUSIONS:A structured protocol achieved complete DA withdrawal in the majority of patients within one month, with short-term clinical improvement. Early management of augmentation improves the likelihood of successful withdrawal.
BACKGROUND:Sleep is essential for maintaining health, yet patients hospitalized in intensive care units (ICUs) face an environment highly unconducive to quality sleep due to multiple disruptive factors. Understanding sleep architecture in the ICU is essential for comprehensive patient care. OBJECTIVE:This scoping review aims to synthesize current knowledge on sleep architecture in adult ICU settings while identifying knowledge gaps and proposing areas for future research. METHODS:A systematic search was conducted across PubMed/MEDLINE and Cochrane Library databases from 1987 to 2024 using specific keywords to identify publications on sleep in adult ICU patients that included electroencephalographic (EEG) data. The search was supplemented by reviewing bibliographies of included articles and conducting a complementary Google Scholar search. Data extraction followed PRISMA-ScR guidelines. RESULTS:Of 961 studies identified from databases and 709 from other sources, 150 publications were included comprising 69 reviews, 55 observational studies, and 24 randomized trials. The majority were single-center studies (87.6%) with small sample sizes (58% with n < 25). Measurement methodologies were highly heterogeneous regarding recording duration (2-57 h), timing during ICU stay, patient populations (ventilated vs. non-ventilated, medical vs. surgical), and scoring methods. Only 3 studies (3%) examined sleep longitudinally. Among 74 observational studies and trials from the 2000s onwards, only 21 (26%) considered atypical sleep in their scoring methodology. CONCLUSIONS:Current knowledge of ICU sleep is based predominantly on single time-point assessments with significant methodological heterogeneity. The critical gap is understanding sleep evolution over time. Simplified, validated monitoring tools are needed to enable prolonged sleep assessment in critically ill patients and inform evidence-based interventions.
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. Many people with OSA use a continuous positive airway pressure (CPAP) device as part of their treatment, although treatment tolerance and adherence may be affected by adverse events. We performed a systematic review of randomized controlled trials (RCTs) published from 2009 through 2023 evaluating the reporting of harms and adverse events (AEs) associated with CPAP therapy. This review was undertaken following concerns regarding polyurethane foam degradation in certain CPAP devices, which highlighted uncertainties surrounding the characterization and reporting of CPAP-related harms in the existing literature. We sought to evaluate how AEs associated with CPAP therapy were defined, characterized, and reported in RCTs, including the types and severity of reported AEs. We included 28 manuscripts reporting AEs, representing 8232 participants. Study populations, protocols and harms reported were highly heterogeneous, limiting reliable comparison and synthesis of AE frequencies across studies and precluding quantitative meta-analysis. Reporting of the AE followed four patterns: (i) explicit reporting of no AEs (3 studies N = 293); (ii) reporting of study-specific events unrelated to CPAP therapy (6 studies, N = 873); (iii) reporting of common CPAP-related AEs as occurring more frequently with CPAP use (4 studies, N = 480); (iv) comprehensive AE reporting (2 studies, N = 3942) and (v) study specific AE (17 studies, N = 3124). Respiratory and device-related harms were not reported by 20 studies and indirectly reported by 2 others. Overall, adverse event reporting in CPAP randomized controlled trials lacked standardization and completeness, limiting interpretation of the safety profile of CPAP therapy and reducing the ability of clinicians and patients to anticipate, contextualize, and mitigate potential harms.
OBJECTIVE:Sleep disturbances and pain commonly co-occur, though the prospective relationship between diagnosable insomnia disorder and pain conditions remains unclear. Insomnia disorder is distinct from broader sleep disturbances; diagnostic criteria require longer symptom persistence and the presence of functional impairment, which may confer greater pain risk. The present study characterized directionality between incident insomnia disorder and incident pain conditions in a community sample. MATERIALS AND METHODS:This study assessed a large cohort (N = 2174) of US adults with no lifetime history of insomnia disorder, depression, or pain condition. Outcomes were assessed annually across two years. Insomnia disorder was classified using DSM-IV-TR criteria. Incident pain was defined as a newly reported diagnosis of back pain and/or chronic pain. Logistic regression models examined whether incident insomnia predicted incident pain conditions a year later and whether incident pain predicted incident insomnia disorder a year later. For descriptive purposes, post-hoc analyses explored pain severity and interference among pain patients by insomnia disorder status, and examined mediation analyses of depressive symptoms. RESULTS:Insomnia disorder predicted an incident pain condition one year later, odds ratio [OR] = 2.44, p = .02. Indeed, 10.8% of those with incident insomnia developed a pain condition one year later, compared to only 2.3% of those without insomnia. Pain patients with insomnia reported greater pain severity and greater pain interference than pain patients without insomnia, d = 0.67-1.07. Change in depressive symptoms significantly mediated the association between incident insomnia and later pain, indirect effect = 0.087, 95% CI [0.002,0.216]. Contrary to hypotheses, pain conditions did not predict future insomnia disorder, OR = 0.59, p = .61. CONCLUSION:Insomnia disorder is a robust risk factor for developing chronic pain and may represent a clinical target for pain prevention or early intervention. As pain patients with insomnia present with greater morbidity, addressing insomnia in pain interventions may enhance pain-related outcomes.
INTRODUCTION:To determine whether pediatric patients with narcolepsy type 1 (NT1) who develop psychotic symptoms exhibit a distinct clinical and sleep-related phenotype compared with those with NT1 without psychosis. METHODS:We report on clinical and polysomnographic features of nine consecutive pediatric patients observed at our center between 2014 and 2025, who developed psychotic symptoms either at NT1 onset or within one year from NT1 diagnosis, and on a control group of 96 consecutive NT1 patients without evidence of psychotic symptoms. RESULTS:Final psychiatric diagnoses included very-early-onset schizophrenia, psychosis not otherwise specified, psychotic depression, obsessive-compulsive disorders, or autism spectrum disorder with psychotic features. Compared to control NT1 patients, NT1cases with psychosis showed much higher rates of psychiatric family history (OR = 36, 55.6% vs. 2.2%, p < 0.01), lower cerebrospinal fluid hypocretin-1 levels (4.9 ± 9.0 pg/mL vs. 18.9 ± 24.2 pg/mL, p = 0.02) and the following polysomnographic features: shorter nocturnal total sleep time (430.8 ± 86.5min vs. 503.7 ± 76.8min, p = 0.03), lower nocturnal sleep efficiency (75.6 ± 15.6% vs. 89.5 ± 7.6%, p = 0.02), and higher rate of daytime naps (3.7 ± 1.8 vs 2.6 ± 1.7, p = 0.04). Sleep-wake transition metrics indicated increased nocturnal sleep fragmentation, namely higher transition indices between wakefulness and sleep and between wakefulness NREM and REM sleep, respectively. CONCLUSIONS:Our findings suggest the presence of a pediatric NT1-psychotic phenotype characterized by more severe hypocretin deficiency and pronounced daytime and nighttime sleep disruption, suggesting that these features may reflect the interaction between hypocretin deficiency and broader neuro-developmental vulnerabilities. Early recognition of this phenotype may guide toward tailored treatment strategies and inform about prognosis in this complex disorder.
INTRODUCTION:Sleep disturbances are common in patients with interstitial lung diseases (ILD) and are often compounded by comorbid obstructive sleep apnea (OSA). Conventional polysomnographic indices may not fully capture disease-specific neurophysiological alterations. METHODOLOGY:We aimed to characterize EEG-derived sleep microarchitecture in ILD with comorbid OSA (ILD-OSA) and compare it with ILD without OSA and apnea hypopnea index matched non-ILD OSA (n = 20 in each group). Quantitative EEG analysis was performed using standardized preprocessing and data extraction protocols. Spectral power, slow wave and spindle metrics, and a novel measure of micro-continuity (Neuroloop gain), reflecting the brain's propensity to generate and sustain sleep spindles and slow oscillations, were computed and compared across the groups. RESULTS:Sleep macro and microarchitecture were similar between ILD with and without OSA. However, compared with non-ILD OSA, patients with ILD-OSA exhibited higher spindle amplitude and power, with preserved slow-wave characteristics. Notably, spindle neuroloop gain was significantly reduced in ILD-OSA. CONCLUSIONS:Patients with ILD-OSA demonstrate differences in EEG-derived sleep microarchitecture compared with non-ILD OSA patients, particularly in spindle dynamics. These findings suggest that quantitative EEG may provide additional insights into sleep neurophysiology in ILD that warrant confirmation in larger prospective studies.
OBJECTIVES:This study aimed to quantify the prevalence of poor sleep quality and its associated factors among the general population in Lebanon, a middle-eastern country witnessing economic-political instability and a rise in the prevalence of mental health disorders. METHODS:An online cross-sectional survey study targeting Lebanese residents 18 to 80 years old. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), depression the Patient Health Questionnaire (PHQ-9), and anxiety the Generalized Anxiety Disorder Scale (GAD-7). PSQI as an outcome variable compared poor to good sleep quality. RESULTS:Data was collected from 582 participants with a mean age of 34.5 ± 14.9 years, and 63.8% females. According to the PSQI, the prevalence of poor sleep quality was estimated to be 63.6%. Binary logistic regression analysis indicated that moderate (OR = 4.69, CI = 2.33-9.41) to severe anxiety (OR = 8.75, CI = 3.44-22.26), moderate (OR = 3.56, CI = 1.60-7.97) to severe depression (OR = 3.13, CI = 1.26-7.76), diabetes (OR = 3.18, CI = 1.14-8.91) and sleep apnea (OR = 3.13, CI = 1.07-9.18) were significantly associated with a higher odds of poor sleep quality. Sociodemographic, lifestyle factors and other co-morbidities were no more significantly associated with poor sleep after adjustment in the multivariate regression analysis. CONCLUSIONS:There is a high prevalence of poor sleep quality among our sampled population in Lebanon, and a strong correlation with poor mental health, namely symptoms of anxiety and depression. These findings may warrant strategic interventions for patient care, such as routine sleep quality screening for individuals suffering from mental health disorders as well as chronic diseases namely diabetes, in high-stress communities.
BACKGROUND AND OBJECTIVE:Restless legs syndrome (RLS) is a sleep-related sensorimotor disorder characterized by a prominent circadian rhythm that severely impairs patients' quality of life and sleep. Although previous studies indicate that sleep disturbances can disrupt glymphatic function, alterations in glymphatic system-related MRI markers in patients with primary RLS remain to be fully clarified. This study aims to systematically evaluate alterations in multimodal glymphatic system-related MRI markers in patients with primary RLS and to explore their clinical relationships with disease severity. METHODS:This prospective study enrolled 42 patients with primary RLS and 42 healthy controls (HC) with comparable age and sex distributions. All participants underwent multi-sequence brain MRI and clinical sleep quality questionnaire assessments. Glymphatic system-related MRI parameters, including the choroid plexus volume fraction (CPVF), perivascular space volume fraction (PVSVF), diffusion tensor imaging along the perivascular space (DTI-ALPS) index, and free water in white matter (FW-WM) volume fraction, were quantified. Partial correlation analysis was performed to evaluate relationships between these MRI parameters and clinical characteristics of RLS. RESULTS:Compared with HC, the RLS group demonstrated a significantly decreased DTI-ALPS index (1.440 ± 0.078 vs. 1.629 ± 0.086, PFDR-corrected < 0.001), along with significantly increased FW-WM (0.211 ± 0.029 vs. 0.189 ± 0.017, PFDR-corrected < 0.001) and CPVF (0.925 ± 0.277 vs. 0.747 ± 0.253, PFDR-corrected = 0.007). No statistically significant difference was observed in PVSVF (PFDR-corrected = 0.367). Partial correlation analysis revealed that the FW-WM in patients with RLS was significantly positively correlated with International Restless Legs Syndrome Study Group Rating Scale (IRLS) scores (r = 0.491, PFDR-corrected = 0.009); no other clinical or imaging parameters demonstrated significant correlations (all PFDR-corrected > 0.05). CONCLUSION:Patients with primary RLS exhibit alterations in glymphatic system-related MRI markers, with FW-WM correlated with disease severity. These findings suggest that these MRI parameters represent candidate surrogate markers for RLS. However, longitudinal studies are required to establish whether these alterations are causes, consequences, or correlates of RLS severity.
OBJECTIVE:This study aimed to explore the independent and joint associations of fine particulate matter (PM2.5) constituent exposure with total sleep time, the sum of nocturnal sleep and daytime napping duration, among middle-aged and older Chinese adults. METHODS:We explored how intermediate- (6-mth) and long-term (2-yr) PM2.5 and its five key chemical constituents-black carbon (BC), organic matter (OM), sulfate (SO42-), nitrate (NO3-), and ammonium (NH4+)-relate to total sleep time, with additional analyses for nocturnal sleep duration. Data were obtained from 19,505 middle-aged and older adults (≥45 years) in the CHARLS cohort during 2011-2018. Ambient PM2.5 constituent exposures were estimated using the Tracking Air Pollution in China dataset, while sleep metrics were collected via standardized questionnaires. We utilized linear mixed-effects models and quantile g-computation to assess single-constituent associations as well as combined impacts of the PM2.5 mixture. RESULTS:In intermediate- and long-term exposure, NO3-, SO42-, and NH4+ showed the most consistent and pronounced positive associations with total sleep time. Specifically, the results of fully adjusted models demonstrated that compared with the reference quartile, the highest quartile of intermediate-term exposure to PM2.5, BC, OM, SO42-, NO3-, and NH4+ increased total sleep time by 0.16 (95% Confidence Interval [CI]: 0.09-0.22), 0.08 (95% CI: 0.02-0.15), 0.08 (95% CI: 0.01-0.14), 0.17 (95% CI: 0.10-0.23), 0.14 (95% CI: 0.08-0.20), and 0.13 (95% CI: 0.08-0.19) h, respectively. The weight coefficient of SO42-, NO3-, and NH4+ was relatively larger compared with other PM2.5 constituents in the qgcomp models. Vulnerable subgroups included female, older participants, rural residents and individuals with pension. CONCLUSION:Intermediate- and long-term exposure to PM2.5 constituents correlated inversely with nocturnal sleep duration and positively with total sleep time. Moving beyond overall PM2.5 mass, this work emphasizes the divergent health impacts induced by different chemical constituents.
Background Multidimensional sleep health has been linked to mortality, but most evidence is based on conventional association models and provides limited information on population-level risk under hypothetical sleep-health improvement. Methods We included 4382 adults from the Sleep Heart Health Study with baseline polysomnography, questionnaire-based sleep assessments, covariates, and mortality follow-up. Six sleep-health domains were assessed: duration, continuity, timing, sleepiness/alertness, architecture, and sleep disorders. A composite sleep health score ranging from 0 to 6 was calculated, with higher scores indicating better sleep health. Cox model-based g-computation estimated 1-, 5-, and 10-year population standardized mortality risks. Pragmatic scenarios increased each participant’s observed score by up to 1 or 2 points, capped at 6; component-specific analyses set individual domains to the healthy level while other domains remained observed. Results During a median follow-up of 4327 days, 926 deaths occurred. Each 1-point higher score was associated with lower all-cause mortality (HR, 0.924; 95% CI, 0.875-0.977). The standardized 10-year risk under observed scores was 16.78%. Increasing scores by up to 1 and 2 points yielded risks of 15.82% (RD, -0.96 percentage points; 95% CI, -1.63 to -0.34) and 15.06% (RD, -1.72 percentage points; 95% CI, -2.92 to -0.61), respectively. Flexible modeling indicated modest nonlinearity and attenuated incremental estimates. Continuity and timing had the largest isolated component-specific risk differences, but neither remained significant after Holm correction. Conclusions Better multidimensional sleep health was associated with lower mortality. Pragmatic hypothetical improvements were associated with modest reductions in standardized 10-year mortality risk.
OBJECTIVE:There is mixed evidence as to whether lipid-lowering agents impact sleep, with some patients reporting significant sleep disruption after starting these medications. Our objective was to determine the relationship between use of lipid-lowering agents and objective measures of sleep quality recorded via in-laboratory polysomnography. METHODS:In this cross-sectional retrospective study, we examined data from patients who underwent diagnostic in-laboratory polysomnography at Sunnybrook Sleep Laboratory, an academic tertiary care sleep center. Self-reported questionnaires were used to ascertain use of any lipid-lowering agent and medical comorbidities. Multivariable linear regression models were utilized to analyze the association between use of lipid-lowering agents, including specific classes, with objective polysomnography-derived measures of sleep (i.e. sleep efficiency, total sleep time, REM latency, sleep onset latency, and wake time after sleep onset). RESULTS:We included 3754 patients (mean age±SD = 54.7 ± 16.4 years; 47.5% male; mean BMI±SD = 29.0 ± 6.64 kg/m2). Overall, 1055 patients were found to be using lipid-lowering agents with atorvastatin being the most common, followed by rosuvastatin, cholesterol absorption inhibitors, simvastatin, pravastatin, fibrates, and bile acid sequestrants. After adjusting for age, sex, body mass index, relevant comorbidities, obstructive sleep apnea and its severity, habits that worsen sleep, and other medication classes that impact sleep, the use of atorvastatin was found to significantly decrease sleep efficiency (β = -1.95; 95% CI = -3.71 to -0.19; p = 0.030). The use of other lipid-lowering agents, regardless of medication class, did not significantly impact sleep. CONCLUSION AND RELEVANCE:The use of atorvastatin may be associated with negative impacts to patients' sleep, though the magnitude of change is small. Clinicians should be aware of these effects and counsel patients accordingly.
BACKGROUND:Socioeconomic precarity is a well-established determinant of academic difficulties in higher education, yet the mechanisms underlying this association remain insufficiently understood. Sleep disturbances and mental health vulnerabilities may represent key intermediate processes. The present study examined a serial mediation model linking precarity to academic performance through insomnia and psychotic-like experiences in undergraduate students. METHODS:A total of 346 students completed self-report measures of precarity, insomnia symptoms, and psychotic-like experiences. Academic performance was assessed using first-semester grade point average. Path analysis within a structural equation modelling framework was conducted to test direct and indirect associations. RESULTS:The model showed good fit to the data. Higher precarity was significantly associated with higher insomnia symptoms, which in turn was associated with higher levels of psychotic-like experiences. Higher insomnia was associated with lower academic performance, whereas psychotic-like experiences were negatively associated with grades. Importantly, the indirect effect of precarity on academic performance through insomnia symptoms was significant, as was the serial indirect pathway through insomnia and psychotic-like experiences. CONCLUSIONS:Overall, the findings are consistent with previous evidence linking socioeconomic vulnerability, insomnia symptoms, psychotic-like experiences, and academic functioning in university students. Importantly, the originality of the present study lies in the integration of these associations within a single sequential framework. Although causal inferences cannot be drawn due to the cross-sectional design, the results highlight insomnia as a promising and modifiable target for interventions aimed at improving both psychological functioning and academic success in vulnerable student populations.
