The association of sleep quality and night sleep duration with coronary heart disease in a large-scale rural population

ObjectiveThe purposes of the present study were to explore independent and interactive associations between night sleep duration, night sleep quality and coronary heart disease (CHD) based on a rural population in China.MethodsA total of 27,935 participants (11,177 men and 16,758 women) were investigated from the Henan Rural Cohort. Information about sleep was assessed by using the Pittsburgh Sleep Quality Index (PSQI). Restricted cubic splines and logistic regression were used to estimate the relationship between night sleep duration and quality with CHD.ResultAmong the 27,935 participants, 1506 participants with CHD were identified. Compared with participants with scores lower than 3, the odds ratios (ORs) and 95% confidence intervals (95% CIs) of participants with score of 3–5, 6–8, ≥9 were respectively 1.42 (1.24–1.63), 1.99 (1.70–2.33), and 2.56 (2.13–3.08) with full adjustment of covariates. Compared with night sleep duration of 7 h, men and women who slept less than 5 h were 1.55 (1.11–2.17), 1.12 (0.59–2.12) and 1.80 (1.20–2.68), after being adjusted ORs (95% CIs) of the total. Moreover, the ORs and 95% CIs of CHD increased with the shortening of sleep duration at PSQI score above the highlighted levels.ConclusionPoor sleep quality and short night sleep duration were all associated with CHD in Chinese rural areas. Moreover, the association was more obvious in women. In addition, the strongest prevalence of CHD was found in short sleepers with poor sleep quality.     

The relationship between sleep disturbance,symptoms and daytime functioning in psoriasis: a prospective study integrating actigraphy and experience sampling methodology

Objective/backgroundSleep disturbance is common in individuals with psoriasis and appears to be related to both physical and psychological factors. We sought to examine whether psoriasis symptoms, night-time arousal and low mood predicted subsequent objective and self-reported sleep; and whether objective and self-reported sleep predicted next-day psoriasis symptoms and day-time functioning.Participants/MethodsA total of 19 individuals (Female: 11 [57.9%], median age: 39 years) with chronic plaque psoriasis and poor sleep quality (mean Pittsburgh Sleep Quality Index, PSQI = 9.11) participated. Momentary assessments of psoriasis symptoms, mood and daytime functioning were completed at five pseudo-random intervals each day for 15 days using time-stamped digital diary entry. Objective sleep was estimated using wrist-worn actigraphy. Self-reported sleep and night-time arousal were assessed each morning using validated measures.Results and conclusionsTwo-level random intercept models showed that increased night-time arousal was associated with poorer diary-reported sleep. Neither self-reported nor objective sleep parameters were associated with daytime psoriasis symptoms in bi-directional analyses. Diary-reported sleep predicted next-day functioning, specifically sleepiness, concentration, and fatigue. Actigraphy-defined total sleep time predicted next-day fatigue. Night-time arousal is associated with poorer self-reported sleep in people with psoriasis, and sleep predicts next-day functioning. Contrary to our hypothesis, sleep disturbance does not appear to be associated with momentary assessments of psoriasis symptoms.     

Expanding the clinical and EEG spectrum of CNKSR2-related encephalopathy with status epilepticus during slow sleep (ESES)

ObjectiveTo investigate the clinical and EEG features of Encephalopathy with Status Epilepticus during slow Sleep (ESES) related to CNKSR2 pathogenic variants.MethodsDetailed clinical history, repeated wakefulness/overnight sleep EEGs, brain MRI were collected in five patients, including one female, with CNKSR2-related ESES.ResultsNeurodevelopment in infancy was normal in two patients, delayed in three. Epilepsy onset (age range: 2–6 years) was associated with appearance or aggravation of cognitive impairment, language regression and/or behavioral disorders. Worsening of epilepsy and of cognitive/behavioral disturbances paralleled by enhancement of non-rapid eye movement (NREM) sleep-related, frontally predominant, EEG epileptic discharges [spike-wave-index (SWI): range 60–96%] was consistent with ESES. In three patients, episodes of absence status epilepticus or aggravation of atypical absences occurred, in this latter case associated with striking increment of awake SWI. Speech/oro-motor dyspraxia was diagnosed in four patients. In two patients, long-term follow-up showed epilepsy remission and persistence of mild/moderate cognitive disorders and behavioral disturbances into adulthood.ConclusionsNovel findings of our study are occurrence also in females, normal neurodevelopment before epilepsy onset, epilepsy aggravation associated with enhanced awake SWI, mild/moderate evolution in adulthood and language disorder due to speech/oro-motor dyspraxia.SignificanceOur findings expand the phenotypic spectrum of CNKSR2-related ESES.     

Sleep modulates effective connectivity: A study using intracranial stimulation and recording

ObjectiveSleep is an active process with an important role in memory. Epilepsy patients often display a disturbed sleep architecture, with consequences on cognition. We aimed to investigate the effect of sleep on cortical networks’ organization.MethodsWe analyzed cortico-cortical evoked responses elicited by single pulse electrical stimulation (SPES) using intracranial depth electrodes in 25 patients with drug-resistant focal epilepsy explored using stereo-EEG. We applied the SPES protocol during wakefulness and NREM – N2 sleep. We analyzed 31,710 significant responses elicited by 799 stimulations covering most brain structures, epileptogenic or non-epileptogenic. We analyzed effective connectivity between structures using a graph-theory approach.ResultsSleep increases excitability in the brain, regardless of epileptogenicity. Local and distant connections are differently modulated by sleep, depending on the tissue epileptogenicity.In non-epileptogenic areas, frontal lobe connectivity is enhanced during sleep. There is increased connectivity between the hippocampus and temporal neocortex, while perisylvian structures are disconnected from the temporal lobe. In epileptogenic areas, we found a clear interhemispheric difference, with decreased connectivity in the right hemisphere during sleep.ConclusionsSleep modulates brain excitability and reconfigures functional brain networks, depending on tissue epileptogenicity.SignificanceWe found specific patterns of information flow during sleep in physiologic and pathologic structures, with possible implications for cognition.     

Association between loneliness,sleep behavior and quality: a propensity-score-matched case–control study

ObjectiveTo explore the influence of loneliness on sleep behavior and sleep quality based on propensity score-matched samples in Southwest China.MethodsIndividual-level data were obtained from a Southwest China cohort study. Participants who felt lonely were matched with those who did not with propensity scores on the basis of age, gender, socioeconomic factors, physical exercise and social connection level. Sleep behavior (onset and offset timing), sleep quality (sleep latency, nocturnal awakenings and subjective sleep quality), and daytime function (daytime sleepiness and fatigue) were assessed with the Pittsburgh Sleep Index Scale (PSQI) and compared between the two groups. The data were collected between May 2019 and December 2019, and data analyses were completed in April 2021.ResultsA total of 11,696 participants were included, and 824 out of 839 participants who felt loneliness were statistically matched with 824 participants who did not. Analyses of the matched samples showed that sleep onset and offset timing were similar between those who felt lonely and those who did not (p = 0.110 and p = 0.751, respectively). Sleep latency was longer in those who felt lonely (26.84 [0.9] vs. 35.52 [1.2] min, p < 0.001) than in those who did not. Furthermore, participants who felt lonely tended to have poor subjective sleep, a higher frequency of nocturnal awakenings, daytime sleepiness and fatigue (all p < 0.001).ConclusionsLoneliness was associated with extended sleep latency, increased nocturnal awakenings, and reduced subjective sleep quality and daytime function but was not associated with sleep behavior, including sleep onset and offset timings.     

The Arousal Disorders Questionnaire: a new and effective screening tool for confusional arousals,Sleepwalking and Sleep Terrors in epilepsy and sleep disorders units

BackgroundArousal Disorders (DoA) include Confusional Arousals, Sleepwalking and Sleep Terrors. DoA diagnosis is mainly clinical but no validated questionnaires exist for DoA screening according to the criteria of the International Classification of Sleep Disorders, Third Edition. Recently our group proposed the Arousal Disorders Questionnaire (ADQ) as a new diagnostic tool for DoA diagnosis. The objective of this study was to evaluate the diagnostic accuracy of the ADQ in a sleep and epilepsy center.MethodsOne interviewer blinded to clinical and video-polysomnographic (VPSG) data administered the ADQ to 150 patients consecutively admitted to our Sleep and Epilepsy Centers for a follow-up visit. The final diagnosis, according to VPSG recordings of at least one major episode, classified patients either with DoA (DoA group) or with other sleep-related motor behaviors confounding for DoA (nDoA group).Results47 patients (31%) composed the DoA group; 56 patients with REM sleep behavior disorder, 39 with sleep-hypermotor epilepsy, six with night eating syndrome, and two with drug-induced DoA composed the nDoA group. The ADQ had a sensitivity of 72% (95% CI: 60–82) and a specificity of 96% (95% CI: 89–98) for DoA diagnosis; excluding the items regarding consciousness and episode recall, sensitivity was 83% (95% CI: 71–90) and specificity 93% (95% CI: 86–97).ConclusionsThe ADQ showed good accuracy in screening patients with DoA in a sleep and epilepsy center setting. Diagnostic criteria related to cognition and episode recall reduced ADQ sensitivity, therefore a better definition of these criteria is required, especially in adults.     

Sleep spindles in children with restless sleep disorder,restless legs syndrome and normal controls

ObjectiveTo analyze and identify differences in sleep spindles in children with restless sleep disorder (RSD), restless legs syndrome (RLS) and normal controls.MethodsPSG (polysomnography) from children with RSD, RLS and normal controls were analyzed. Sleep spindle activity was detected on one frontal and one central electrode, for each epoch of N2 and N3 sleep. Sleep spindle density, duration and intensity (density × duration) were then obtained and used for analysis.ResultsThirty-eight children with RSD, twenty-three children with RLS and twenty-nine controls were included. The duration of frontal spindles in sleep stage N2 was longer in children with RSD than in controls. Frontal spindle density and intensity tended to be increased in RSD children. No significant differences were found for central spindles.ConclusionChildren with RSD had longer frontal spindles. This finding may contribute to explain the occurrence of excessive movement activity during sleep and the presence of daytime symptoms.SignificanceRecent research has demonstrated that children with RSD have increased NREM instability and sympathetic activation during sleep. Analyzing sleep spindles in children with RSD in comparison with children with RLS and controls adds to our understanding of the pathophysiology or RSD and its effects on daytime impairment.     

Female and male sleep duration in association with the probability of conception in two representative populations of reproductive age in US and China

ObjectiveSleep duration has been found to affect some reproductive phenotypes but fecundability has been rarely researched. We aim to evaluate the association between female/male sleep duration and the probability of conception in two representative populations.MethodsThe present study uses two datasets, namely, a cross-sectional dataset of 9137 reproductive-age females in the US (National Health Interview Survey, NHIS) and a longitudinal dataset of 2687 reproductive-age females and their male mates in China (China Health and Nutrition Survey, CHNS). Logistic regression or mixed model was used to analyze the association between sleep duration and the probability of conception in the females of both populations and in CHNS males with adjustments for demographic, socioeconomic, behavioral, sleep health and reproductive factors.ResultsAn inverse association was observed between male sleep duration (≥8 h/day) and their mates' conception probability in the CHNS population (P = 0.012). Sleep of 9 h/day and ≥10 h/day in men was associated with 0.65 (0.41–1.02) fold and 0.53 (0.31–0.90) fold of conception probability when compared to 8 h/day sleep. On the other hand, a U-shaped association between female sleep duration and conception probability was observed in both populations. Each hour/day departure (longer or shorter) from 7 h/day sleep was associated with 1.26 (1.12–1.42, P < 0.001) and 1.21 (1.03–1.41, P = 0.019) fold conception probability in the NHIS and CHNS populations, respectively. An adjustment for potential confounders, including spouse characteristics did not substantially attenuate these associations.ConclusionsFemale and male sleep duration may be independent predictors of conception, suggesting there is an intervention target for reproductive health.     

A meta-analysis of the relationship between subjective sleep and depressive symptoms in adolescence

BackgroundAdolescence is a risk period for the development of mental illness, as well as a time for pronounced change in sleep behaviour. While prior studies, including several meta-analyses show a relationship between sleep and depressive symptoms, there were many inconsistences found in the literature.ObjectiveTo investigate the relationship between subjective sleep and depressive symptoms.MethodsFollowing PRISMA guidelines, we conducted a literature search that yielded forty-nine recent studies (2014–2020) with adolescent samples aged 9 to 25-year-olds, and more than double the sample size of previous meta-analyses (N = 318,256).ResultsIn a series of meta-analyses, we show that while several common categories of subjective sleep are associated with depressive symptoms in adolescents, the strength of this relationship varies. Measures of sleep perception: poor sleep quality (r = 0.41), insomnia (r = 0.37), sleep disturbances (r = 0.36), wake after sleep onset (r = 0.31), and daytime sleepiness (r = 0.30) correlated more strongly with depressive symptoms, than measures of sleep behaviour: sleep latency (r = 0.22), and sleep duration (r = −0.19).ConclusionsThese findings suggest that in studies of depressive symptoms it may be important to assess an adolescent's perception about their sleep, in addition to their sleep/wake behaviours.     

A randomized,double blind,placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults

ObjectiveNon-restorative sleep (NRS) affects 10% people worldwide, leading to poor sleep quality, as well as physical and cognitive fatigue. This is the first human study in which an extract of ashwagandha (Withania somnifera Dunal L.) was evaluated for effects in improving overall sleep quality in subjects with NRS.MethodsIn this randomized, double-blind, placebo-controlled trial, 150 healthy subjects scoring high on non-restorative sleep measures were given 120 mg of standardized ashwagandha extract (Shoden®) once daily for six weeks. Subjects were evaluated using the Restorative Sleep Questionnaire-weekly version and World Health Organization Quality of Life-Bref (WHOQOL) scale. Sleep actigraphy was used to measure the onset of sleep latency, sleep efficiency, total sleep time and wake after sleep onset. Safety of the treatment was determined by testing of vitals, hematology, biochemistry and urinalysis.ResultsA total of 144 subjects completed the study, with no dropouts due to adverse events. A 72% increase in self-reported sleep quality was found for the treatment group, compared with 29% in the placebo group (p < 0.001). Based on activity monitoring data, the treatment group showed significant improvement in sleep efficiency (SE) (p < 0.01), total sleep time (p < 0.001) and sleep latency (p < 0.01) and wake after sleep onset (WASO) (p < 0.05) versus placebo after six weeks. In the ashwagandha group quality of life (QOL) scores showed significant improvement in physical (p < 0.001), psychological (p < 0.001), and environment domains (p < 0.01).ConclusionsSupplementation with the standardized ashwagandha extract for six weeks improved the overall quality of sleep by significantly improving the NRS condition in healthy subjects. No treatment related adverse events were reported in the study.Trial registrationClinical Trials Registry-India (www.ctri.nic.in). Registration number: CTRI/2017/02/007801.     

Sleep quality in acromegaly and changes after transsphenoidal surgery: a prospective longitudinal study

ObjectiveTo elucidate the sleep quality characteristics and factors related to either good or poor sleep quality in acromegaly patients before surgery and to explore sleep quality changes after transsphenoidal surgery and the factors related to these changes.MethodsWe prospectively enrolled 39 acromegaly patients and 78 patients with nonfunctioning pituitary adenomas. Scales for anxiety, depression, disease stigma and nasal condition were evaluated. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered before surgery as well as one month and three months after surgery.ResultsA higher percentage of acromegaly patients had poor sleep quality compared to controls (35.9% vs. 5.1%, p < 0.001). In addition, acromegaly patients experienced worse subjective sleep quality, extended sleep latency, increased sleep disturbance and decreased daytime functioning. Higher scores for anxiety, disease stigma and sinonasal outcomes were correlated with worse sleep quality in acromegaly patients. At one month after transsphenoidal surgery, we found worse subjective sleep quality, extended sleep latency, shortened sleep duration, impaired sleep efficiency and increased sleep disturbance in acromegaly patients. At three months postoperatively, most impaired PSQI domains in acromegaly patients recovered to preoperative levels. The use of soluble gauze was related to decreased sleep quality at one month after surgery and severe anxiety and depression were related to improved sleep quality at three months after surgery.ConclusionsSleep quality was reduced in acromegaly patients. Moreover, sleep quality initially worsened after surgery but later recovered. Emotional problems and the use of soluble gauze were related factors.Clinical trial registrationNone.     

Exploring the bi-directional relationship between sleep and resilience in adolescence

ObjectiveThe study examined whether overall sleep quality and the sleep components comprising the Pittsburgh Sleep Quality Index (PSQI) have a bi-directional relationship with resilience among adolescents, after adjusting for sex, age, depression, and socioeconomic status, and investigated which sleep components have a stronger effect on resilience.MethodsA total of 1299 students (58% females; mean age, 15.79 years) participated at baseline, with 840 finishing all four study waves over the course of 24 months. Data were collected through questionnaires, including socio-demographics, the Pittsburgh Sleep Quality Index, Patient Health Questionnaire 9-item, and the Connor-Davidson Resilience Scale. Cross-lagged models were used to analyze the relationships between sleep and resilience.ResultsBoth daytime dysfunction and sleep disturbance had an independent bi-directional relationship with resilience. Higher resilience scores predicted overall better sleep quality and shorter sleep latency, but not vice versa. Sleep disturbance and daytime dysfunction had stronger effects on resilience.ConclusionsThese findings highlight the importance of future school interventions for sleep to improve students' resilience.     

It twitches without kicking – An association between fragmentary myoclonus and arousal?

ObjectiveFragmentary myoclonus (FM) is a polysomnographic motor phenomenon of unknown clinical relevance. This study investigates FM prevalence, gender differences, sleep stage distribution and association with clinical factors using recently introduced advanced FM scoring criteria.MethodsWe analyzed polysomnographic recordings of 178 patients of a mixed sleep-disorder patient cohort. FM indices (FMI) of newly introduced 25 μV (FMI25) and standard 50 μV (FMI50) amplitude cut-offs were calculated.ResultsFMI25 and FMI50 were higher in men compared to women. FMI were higher during wakefulness and lower during S3 compared to all other sleep stages, with stronger effects in men compared to women. FMI25 was correlated with higher age, lower mean oxygen saturation, lower sleep efficiency, higher periodic limb movement (PLM) index, shorter sleep period time and higher arousal index. Linear regression showed that age predicted higher FMI25 in both males and females. Additionally, higher arousal index predicted higher FMI25 in women only. FMI were not associated with the presence of sleep-related breathing disorders.ConclusionsWe suggest FM represents a ubiquitous motor phenomenon occurring spontaneously during relaxed wakefulness and sleep, primarily in men and with advanced age.SignificanceIn women, particularly FMI25 may be a surrogate marker for more frequent arousals and sleep fragmentation.     

Grandparental care and sleep disturbances in preschool children: a population-based prospective cohort study

ObjectivesSleep disturbances are common in preschoolers, and profoundly affected by parenting. Grandparents are increasingly involved in childcare and have attracted worldwide attention for their potential impacts on child well-being. However, no studies have explored child sleep health within the context of grandparental care. We aimed to explore the association between grandparents as primary caregivers and children's sleep disturbances.MethodsParticipants included 20,324 preschoolers from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) in Shanghai, China. They were initially assessed in November 2016 and were reassessed in April 2018 and April 2019. Children's primary caregivers were collected at each survey. Sleep disturbances were assessed by the Children's Sleep Habits Questionnaire (CSHQ).ResultsAt baseline, 84.4% of children had global sleep disturbances (CSHQ total score >41). Compared with parents, random-effects model indicated that grandparents as primary caregivers increased the adjusted odds ratio (OR) for children's global sleep disturbances by 30% (OR [95%CI]: 1.30 [1.21, 1.40]). To the specific domains of CSHQ, two-way repeated-measures ANOVA showed significant “caregiver transition” group × wave interaction in the behavioral sleep disturbances, such as “Bedtime Resistance” (p < 0.001). At each survey, children with grandparents as primary caregivers demonstrated significant higher behavioral sleep disturbances than their counterparts with parental care.ConclusionsGrandparental care is associated with increased sleep disturbances, particularly behavioral sleep disturbances, in preschoolers. Future studies should explore the underlying mechanisms and whether sleep programs targeting grandparents can decrease children's sleep disturbances.     

Sleep time and sleep-related symptoms across two generations – results of the community-based RHINE and RHINESSA studies

Study objectivesTo analyze the association between sleep-related symptoms and sleep length in parents and their children in relation to other risk factors in both generations.MethodThe participants were parents (n = 5,855, age 54.3 ± 6.5 years, 45.2% men) who participated in the community-based Respiratory Health in Northern Europe (RHINE) study and one random member of their adult offspring (n = 5,855, age 30.2 ± 7.7 years, 41.5% men) who participated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS.ResultsAll sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and parents' total number of children, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI: 1.52, 1.20–1.93), DMS (1.34, 1.15–1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15–2.37), insomnia (1.39, 1.13–1.73), short sleep time (<6 h/night) (2.51, 1.72–3.68) and EDS (1.48, 1.26,1.72). There were no independent relationships between symptoms in parents and offspring for EMA, nocturnal sweating or long sleep time (>9 h/night).ConclusionThe familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems.     

Poor sleep quality is associated with new-onset hypertension in a diverse young and middle-aged population

BackgroundSleep disorders have been proposed as the potential risk factors for hypertension, thus we aimed to investigate the association of sleep quality with new-onset hypertension.MethodsWe evaluated sleep quality using Pittsburgh Sleep Quality Index (PSQI) and it's seven components in normotensive population aged 18 years old and over in Emin Xinjiang, China in 2016 and followed up till 2019 using annual health checkup data. Poor sleep quality was defined as a PSQI score>5, and good sleep quality was defined as a PSQI score⩽5.ResultsAmong 9344 analytic sample 57.29% were female. A total of 2958 (31.66%) subjects developed hypertension during 22,960 person-years of follow-up. Poor sleep quality (HR 1.131, 95% CI 1.045, 1.224) showed had higher risk of development hypertension in total population in adjusted Cox models. Fairly bad subjective sleep quality (HR 1.148, 95% CI 1.015, 1.298), habitual sleep efficiency of <65%–75% group (HR 1.174, 95% CI 1.026, 1.344), and mild (HR 1.194, 95% CI 1.098, 1.299) and moderate (HR 1.264, 95% CI 1.080, 1.479) sleep disturbance increased the risk of developing hypertension compared to their counterparts. In age stratification, poor sleep quality (HR 1.100, 95% CI 1.007, 1.202) had higher risk of developing hypertension in the young and middle-aged population after adjusted all covariates.ConclusionsPoor sleep quality is associated with higher risk of new-onset hypertension in young and middle-aged population.     

Associations of sleep duration,sedentary behaviours and energy expenditure with maternal glycemia in pregnancy

BackgroundWomen with high levels of physical activity (PA) are less likely to develop gestational diabetes mellitus (GDM), but the relations with sleep and sedentary behaviours (SB) are more controversial. We aimed to investigate all three components (sleep, PA, and SB) and their association with maternal glucose in pregnancy.MethodsWe included 766 pregnant women recruited at first trimester and that we followed at second trimester. We collected blood samples, anthropometry and standardized questionnaires about lifestyle including PA, SB, and sleep duration at both visits. Women completed a 50 g glucose challenge test at first trimester and 75-g oral glucose tolerance test (OGTT) at second trimester. We conducted regression analyses to test cross-sectional associations between sleep, PA, and SB with maternal glucose levels while taking into account potential confounders (maternal age, pre-pregnancy body mass index (BMI), gravidity, and smoking). We considered linear and quadratic relationships.ResultsAt first trimester, we observed a linear relationship between shorter sleep duration and higher glucose levels, which was attenuated after adjustments for confounders. At second trimester, we found a quadratic relationship between sleep and glucose showing lowest levels at fasting and 1 h-post OGTT for women who slept 6–10 h/night. This association remained significant after adjusting for confounders and taking into account PA and/or SB. Greater amount of SB was associated with higher 1 h-glucose after adjustment for confounders (β = 0.132; SE = 0.047; P = 0.005).ConclusionsSleep duration is associated with glucose regulation in pregnancy, independently of PA and SB, and this association varies according to the period of gestation.     

Association between eveningness preference,socio-behavioral factors,and insomnia symptoms in Korean adolescents

Objective/BackgroundStudies focusing on insomnia in adolescents are relatively scarce compared to those on excessive daytime sleepiness. We aimed to investigate the prevalence of insomnia symptoms and associated factors in Korean high school students.Patients/methodsA total of 8565 students (girls: 4104) were investigated nationwide, across 15 South Korean districts using an online self-report questionnaire. Insomnia symptoms were evaluated using the Global Sleep Assessment Questionnaire. The participants’ mean age was 16.77 ± 0.85 years.ResultsThe prevalence of insomnia symptoms was 39.43% (n = 3377). Logistic regression was used to estimate the odds ratio (OR) of insomnia symptoms associated with sleep characteristics and social behaviors after adjusting for the relevant covariates. Evening preference (OR, 2.51, 95% CI, 2.20–2.86), perception of insufficient sleep (OR, 3.55, 95% CI, 3.11–4.06), snoring usually/always (OR, 1.25; 95% CI, 1.00–1.55), witnessed sleep apnea usually/always (OR, 1.70; 95% CI, 1.17–2.46), increased internet addiction (OR, 1.02; 95% CI, 1.02–1.03), bad sleep environment (OR, 1.77; 95% CI, 1.50–2.10), ≥3 private extra classes (OR, 1.23; 95% CI, 1.01–1.49), often coffee consumption (OR, 1.31; 95% CI, 1.10–1.56), and often nocturnal eating (OR, 1.24; 95% CI, 1.06–1.45) were associated with insomnia symptoms. Evening preference (OR, 3.48; 95% CI, 2.52–4.82) was also associated with insomnia symptoms in the perceived sufficient sleep subgroup.ConclusionInsomnia symptoms were common in Korean high school students. Evening preference was the major factor associated with insomnia symptoms. Various socio-behavioral factors were also associated with insomnia symptoms.     

The prevalence of sleep problems among children in mainland China: a meta-analysis and systemic-analysis

BackgroundWe conducted a meta-analysis and systematic review to identify a reliable estimate of sleep problems prevalence among children in mainland China and to describe its epidemiological characteristics.MethodsRelevant studies were searched thoroughly via electronic databases included China National Knowledge Infrastructure, Wanfang, Weipu, PubMed, Embase and Medline databases from inception until December 2020. Prevalence estimates were calculated by random-effects models. The sources of heterogeneity were explored using subgroup analyses and Meta-regression analysis, and publication bias was estimated by funnel plots and Egger's Test.ResultsOverall, 66 studies were included in this meta-analysis, which revealed that the pooled prevalence of sleep problems was 37.6% (95%CI: 34.3–40.9%) with high heterogeneity (I² = 99.6%,P < 0.001). The incidence of snoring was 7.7%, choking or gasping was 0.9%, apnea was 1.5%, restless sleep was 11.3%, mouth breathing was 4.7%, hyperhidrosis was 17.2%, leg movements was 2.7%, bruxism was 9.6%, sleep talking was 0.7%, sleep-walking was 0.8%, nightmare was 5.1%, enuresis was 3.4%, night awakening was 6.7% and trouble falling asleep was 11.1%. The prevalence rate of sleep problems among males was higher than females (OR:1.01,95%CI:1.05–1.13). In all age groups, the prevalence rates of sleep problems increased with age, including infancy or early childhood group (33.3%), pre-school group (38.9%), school-age group (43.7%). The prevalence rate in South China (30.4%, 95%CI: 23.9–36.8%) was the lowest, and the highest prevalence rate was in West China (47.4%,95%CI:35.9–58.9%), which than any other region in China. The point estimate for sleep disorders prevalence obtained using the CSHQ criterion was higher than other criteria. Meta-regression indicated that age group could influence prevalence estimation (P = 0.011).ConclusionsOver the past two decades, the prevalence rate of sleep problems among children in mainland China has increased, significantly affecting two-fifth of the school-age children. The incidence of hyperhidrosis, restless sleep and trouble falling asleep were significantly higher than other sleep prombles. The prevalence rate of sleep problems in west China was significantly higher than in any other area. There is still a lack of guidelines on children's sleep problems in mainland China, so future research should pay special attention to the sleep problems of school-age children and children in economically backward areas.