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Sleep Disorders: Advances in the Diagnosis and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 14167

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Special Issue Editor

Dr. Ivan Vargas

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Guest Editor

Department of Psychological Science, University of Arkansas, 310 Memorial Hall, Fayetteville, AR 72701, USA
Interests: sleep disorders; treatment; sleep health; insomnia

Special Issue Information

Dear Colleagues,

In the area of sleep disorders, prior studies consistently support two notions: (1) comorbid sleep disorders are highly prevalent among clinical populations, and (2) a history of sleep disturbance can increase the risk of developing a clinical disorder. It is therefore critical that we continue to investigate the role of sleep disorders in overall patient health. This Special Issue aims to collate state-of-the-art research on the diagnosis and treatment of sleep disorders. In general, we encourage basic, translational, and clinical research that has the potential to inform advances in the diagnosis and treatment of sleep disorders, and more specifically, those studies that may have implications for better understanding the impact of sleep on physical health. Original articles, reviews, and communications are welcome. We look forward to receiving your contributions. You may contact the Guest Editor, Dr. Ivan Vargas, if you are interested in submitting to this Special Issue or have any questions.

Dr. Ivan Vargas
Guest Editor

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Keywords

sleep disorders
treatment
sleep health
insomnia

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Published Papers (9 papers)

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8 pages, 213 KiB

Open AccessArticle

The Effects of Cognitive Behavioral Therapy for Insomnia on Physical Activity Before and After Time in Bed Among Shift Workers

by Marcin Sochal, Bernd Feige, Kai Spiegelhalder and Johanna Ell

J. Clin. Med. 2025, 14(9), 3206; https://doi.org/10.3390/jcm14093206 - 6 May 2025

Viewed by 239

Abstract

Background: Sleep and physical activity (PA) are bidirectionally related, with PA having a positive effect on sleep, and sleep quality influencing PA the following day. However, little is known about the effects of clinical interventions for sleep disorders on PA. Therefore, the aim of this secondary analysis is to evaluate the impact of cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia, on PA. Methods: Thirty-eight nurses with shift work disorder and insomnia were randomly assigned to either CBT-I or a waitlist control group. PA was measured for one week before (T0) and after the intervention/waiting period (T1) using actigraphy and sleep diary items. The impact of CBT-I on the PA parameters was analyzed using linear mixed models. In addition, correlations of pre-to-post-treatment changes in PA and pre-to-post-treatment changes in the clinical outcomes (insomnia severity, sleep efficiency, depression) were explored in the CBT-I group. Results: CBT-I increased actigraphy-derived PA during the two hours (β = 26.17, SE = 9.41, p = 0.009) and one hour (β = 13.24, SE = 4.57, p = 0.006) after time in bed, and resulted in a higher percentage of self-reported days with PA (β = 19.11, SE = 9.36, p = 0.049) compared to the waitlist control group. No significant correlations were found between the changes in PA and clinical outcomes, except for a moderate positive correlation between changes in self-reported sleep efficiency and changes in PA one hour before time in bed (r = 0.56, p = 0.013). Conclusions: This is the first study to investigate the impact of CBT-I on PA, providing preliminary evidence of the potential positive effects. Further studies with larger sample sizes and randomized controlled designs with continuous PA monitoring are needed to confirm these preliminary results. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

11 pages, 761 KiB

Open AccessArticle

The Impact of Comorbid Sleep-Disordered Breathing on Hospitalization Risk Related to Diabetes and Atherosclerotic Disease: A Retrospective Cohort Analysis

by Hlynur Davíð Hlynsson, Jason C. Ong, Joseph Day, Thomas Kauss, Kristófer Montazeri, Jeffrey Hertzberg, Emerson Wickwire, Rebecca M. Hankla, Eysteinn Finnsson, Jón Skírnir Ágústsson and Heidi Riney

J. Clin. Med. 2024, 13(24), 7715; https://doi.org/10.3390/jcm13247715 - 18 Dec 2024

Viewed by 1164

Abstract

Objective: To determine the relationship between comorbid sleep-disordered breathing (SDB) and hospitalization rates related to diabetes mellitus (DM) and atherosclerotic disease (AD). Methods: This study used a retrospective cohort design from a large medical claims database with 5 years of data between 2018 and 2022. The presences of SDB, DM, and AD were identified using International Classification of Diseases (ICD-10) and relevant Current Procedural Terminology (CPT) codes. Hospitalizations related to DM and AD were identified primarily using Place of Service (POS) code 21. Propensity-score matching was first used on data from the entire 5-year period to select matched controls (unadjusted n = 883,910, adjusted n = 888,619) compared to those diagnosed with SDB (n = 519,818) on hospitalization rates during the concurrent 5-year period. A second analysis used propensity-score matching on data from year 1 only to select matched controls (unadjusted n = 248,848, adjusted n = 260,298) compared to those diagnosed with SDB in year 1 (n = 193,671) on hospitalization outcomes in the subsequent 4-year period. Results: Odds ratios (ORs) revealed a significant association between SDB diagnosis and hospitalizations related to DM (OR 1.23–1.71), AD (OR: 1.08–1.34), and either condition (OR 1.17–1.49) in both analyses. Post hoc analysis revealed sex differences in the relationship between SDB and future hospitalizations, with females showing a pattern of significantly elevated risk across all future hospitalization outcomes (OR: 1.25–1.44), whereas males were found to have a significant relationship between SDB diagnosis and future DM hospitalization only (OR 1.10). Conclusions: These findings provide real-world evidence that comorbid SDB increases the risk for hospitalizations related to chronic cardiometabolic conditions. Sex is a potential moderator of this relationship and should be further explored. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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9 pages, 1101 KiB

Open AccessArticle

The Self-Reported Quality of Sleep and Its Relationship with the Development of Arterial Hypertension: Perspectives from the Tlalpan 2020 Cohort

by Luis M. Amezcua-Guerra, Kelly P. Velázquez-Espinosa, Lizbeth A. Piña-Soto, Guadalupe O. Gutiérrez-Esparza, Mireya Martínez-García and Malinalli Brianza-Padilla

J. Clin. Med. 2024, 13(20), 6089; https://doi.org/10.3390/jcm13206089 - 12 Oct 2024

Viewed by 1164

Abstract

Background/Objectives: A well-established association exists between the development of hypertension and sleep quality. The connection between self-reported sleep quality and the onset of hypertension is particularly significant in populations with metabolic deterioration, such as in Mexico. Methods: The Tlalpan 2020 Cohort was analyzed to explore this association. Clinical and anthropometric characteristics, along with the Medical Outcomes Study Sleep Scale (MOS-SS), were compared between participants who developed hypertension and those who did not over a follow-up period of 30.8 months. The potential role of poor sleep quality in the development of hypertension was assessed. Results: Among 1520 participants, 12% developed hypertension. These individuals had higher anthropometric and laboratory values and reported poorer sleep quality. An elevated sleep problems index was associated with a 50% higher relative risk of developing hypertension (OR: 1.5; 95% CI: 1.087 to 2.069). Additionally, self-reported snoring was associated with hypertension onset (36.3 vs. 43.3; p = 0.019). Conclusions: Poor sleep quality and respiratory disturbances during sleep increase the risk of developing hypertension. Furthermore, hypertension was associated with snoring, highlighting the importance of early interventions to improve sleep quality. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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16 pages, 475 KiB

Open AccessArticle

The Association between Suicidal Ideation and Subtypes of Comorbid Insomnia Disorder in Apneic Individuals

by Matthieu Hein, Benjamin Wacquier, Matteo Conenna, Jean-Pol Lanquart and Camille Point

J. Clin. Med. 2024, 13(19), 5907; https://doi.org/10.3390/jcm13195907 - 3 Oct 2024

Cited by 1 | Viewed by 1067

Abstract

Background/Objectives: Given the existence of higher suicidality in apneic individuals, this study aimed to determine the potential role played by subtypes of the comorbid insomnia disorder (CID) in the occurrence of suicidal ideation for this specific subpopulation. Methods: To perform our analyses, 1488 apneic individuals were retrospectively extracted from the Sleep Laboratory hospitalization register. Only apneic individuals with suicidal ideation highlighted during the psychiatric interview and/or with a score ≥1 on item G of the Beck Depression Inventory confirmed during the clinical interview were included in the group with suicidal ideation. The likelihood of suicidal ideation associated with CID subtypes was investigated using logistic regression analyses. Results: The prevalence of suicidal ideation was 9.3% in our sample of apneic individuals. After hierarchically introducing the significant confounders for adjustment, multivariate logistic regression analyses demonstrated that unlike short sleep duration alone and CID without short sleep duration, the likelihood of suicidal ideation was only higher for CID with short sleep duration in apneic individuals. Conclusions: Thus, we highlighted in this study that CID with short sleep duration could play a major role in higher suicidality for apneic individuals, which seems to require systematic screening and appropriate treatment of this comorbid sleep disorder to enable better management of suicidal risk in this specific subpopulation. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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12 pages, 716 KiB

Open AccessArticle

Prevalence of Diamine Oxidase Enzyme (DAO) Deficiency in Subjects with Insomnia-Related Symptoms

by Raquel López García, Júlia Ferrer-Garcia, Anna Sansalvador and Maria-Antonia Quera-Salva

J. Clin. Med. 2024, 13(16), 4583; https://doi.org/10.3390/jcm13164583 - 6 Aug 2024

Cited by 1 | Viewed by 2591

Abstract

Background: To assess the prevalence of diamine oxidase (DAO) enzyme deficiency caused by single nucleotide polymorphisms (SNPs) of the AOC1 gene in a sample of patients with symptoms of insomnia. Methods: A total of 167 adult patients (>18 years of age) with symptoms of insomnia attended a specialized institute for healthy sleep, in Barcelona (Spain), between May and November 2023, and underwent genotyping analysis of the four most relevant SNP variants, including c.691G>7 (rs2052129), c.47C>T (rs10156191), c.995C>T (rs1049742), and c.1990C>G (rs1049793). Results: Genetic DAO deficiency was present in 138 patients, with a prevalence rate of 82.6% (95% CI 76–88.1%). Difficulties in staying asleep were the most common complaints in 88% of patients followed by trouble falling asleep in 60.5%. More than half of patients suffered from insomnia symptoms every day. Also, 99.4% reported daytime consequences of insomnia, with fatigue (79.6%), mood changes (72.5%), and impaired concentration in 70.1%. When patients were grouped by DAO-score, which reflected the number of heterozygous and homozygous SNPs variants, the group with a DAO-score ≥ 4 vs. 1 showed higher percentages of insomnia-related symptoms, in particular, trouble staying asleep and early morning awakening. These two symptoms were also more common in the presence of the c.1990C>G (rs1049793) variant. Conclusions: This preliminary real-world study presents novel evidence of a potential link between a DAO enzyme deficiency of a genetic origin and clinical symptoms of insomnia, which may suggest the potential benefit of DAO supplementation to improve the quality of sleep in these subjects. The study was registered at ClinicalTrials.gov (NCT06488027). Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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11 pages, 600 KiB

Open AccessArticle

Acute Effect of Positive Airway Pressure on Heart Rate Variability in Obstructive Sleep Apnea

by Ji Hye Shin, Min Ji Song and Ji Hyun Kim

J. Clin. Med. 2023, 12(24), 7606; https://doi.org/10.3390/jcm12247606 - 10 Dec 2023

Cited by 2 | Viewed by 2187

Abstract

Autonomic dysregulation is associated with cardiovascular consequences in obstructive sleep apnea (OSA). This study aimed to investigate the effect of acute continuous positive airway pressure (CPAP) treatment on autonomic activity and to identify factors contributing to heart rate variability (HRV) changes in OSA. Frequency domain HRV parameters were calculated and compared between the baseline polysomnography and during the CPAP titration in 402 patients with moderate to severe OSA. There were significant reductions in total power, very low-frequency band power, low-frequency band power, and high-frequency band power during the CPAP titration as compared to the baseline polysomnography. This tendency was pronounced in male patients with severe OSA. Multivariate analysis found that changes in the apnea-hypopnea index and oxygen saturation were significantly associated with changes in sympathetic and parasympathetic activity, respectively. This study demonstrated that HRV parameters significantly changed during the CPAP titration, indicating a beneficial effect of CPAP in the restoration of sympathetic and parasympathetic hyperactivity in OSA. Prospective longitudinal studies should determine whether long-term CPAP treatment aids in maintaining the long-lasting improvement of the autonomic functions, thereby contributing to the prevention of cardiovascular and cerebrovascular diseases in patients with OSA. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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20 pages, 1236 KiB

Open AccessArticle

A Pilot Nurse-Administered CBT Intervention for Insomnia in Patients with Schizophrenic Disorder: A Randomized Clinical Effectiveness Trial

by David Batalla-Martin, Maria-Antonia Martorell-Poveda, Angel Belzunegui-Eraso, Alejandro Marieges Gordo, Helena Batlle Lleal, Raquel Pasqual Melendez, Raquel Querol Girona and Marina López-Ruiz

J. Clin. Med. 2023, 12(19), 6147; https://doi.org/10.3390/jcm12196147 - 23 Sep 2023

Cited by 1 | Viewed by 1851

Abstract

Insomnia is a highly prevalent disorder among the population with schizophrenia and has a significant impact on their quality of life. Cognitive behavioural therapies (CBT) have shown effectiveness in the treatment of insomnia in the general population. The aim of this this pilot study was to evaluate the effectiveness of a group intervention led by nurses in an outpatient mental health centre. The group work combined cognitive behavioural and psychoeducational therapeutic interventions to improve insomnia in patients with schizophrenic disorder and their health-related quality of life. This randomized clinical trial included intervention and control groups with follow-up assessments at 6 and 9 months, using the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and EuroQol-5D (EQ-5D) scales. The inclusion criteria were as follows: over 18 years of age, diagnosis of schizophrenia, and a score of >7 on the ISI scale. The total sample was 40 participants. The ISI scale showed a mean difference of 3.63 (CI 95%: 2.02–5.23) (p = 0.000) and 4.10 (CI 95%: 2.45–5.75) (p = 0.000) and a large effect size (F: 28.36; p = 0.000; ηp2: 0.427). Regarding the PSQI scale, the mean difference was 3.00 (CI 95%: 1.53–4.49) (p = 0.000) and 2.30 (CI 95%: 0.85–3.75) (p = 0.000), with a medium effect size (F: 18.31; p = 0.000 ηp2: 0.325). The EQ-VAS scale showed a difference in mean scores between the groups of 10.48 (CI 95%: −19.66–−1.29) (p = 0.027). CBT adapted for populations with mental disorders, carried out by nurses, is effective in improving insomnia and health-related quality of life. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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9 pages, 418 KiB

Open AccessArticle

The Assessment of Post-COVID Fatigue and Its Relationship to the Severity and Duration of Acute COVID Illness

by Alexandria Muench, Elizabeth W. Lampe, Julia T. Boyle, Mark Seewald, Michelle G. Thompson, Michael L. Perlis and Ivan Vargas

J. Clin. Med. 2023, 12(18), 5910; https://doi.org/10.3390/jcm12185910 - 12 Sep 2023

Cited by 1 | Viewed by 1379

Abstract

Emerging data suggests that COVID-19 is associated with fatigue well beyond the acute illness period. The present analysis aimed to: (1) characterize the prevalence and incidence of high fatigue at baseline and follow-up; (2) examine the impact of COVID-19 diagnosis on fatigue level following acute illness; and (3) examine the impact of acute COVID-19 symptom severity and duration on fatigue at follow-up. Subjects (n = 1417; 81.0% female; 83.3% White;

\bar{X}

_age = 43.6 years) completed the PROMIS-Fatigue during the initial wave of the pandemic at baseline (April–June 2020) and 9-month follow-up (January–March 2021). A generalized linear model (binomial distribution) was used to examine whether COVID-19 positivity, severity, and duration were associated with higher fatigue level at follow-up. Prevalence of high fatigue at baseline was 21.88% and 22.16% at follow-up, with 8.12% new cases at follow-up. Testing positive for COVID-19 was significantly associated with higher fatigue at follow-up. COVID-19 symptom duration and severity were significantly associated with increased fatigue at follow-up. COVID-19 symptom duration and severity during acute illness may precipitate longer-term fatigue, which could have implications for treatment planning and future research. Future studies should further evaluate the relationship between symptom severity, duration, and fatigue. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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13 pages, 584 KiB

Open AccessFeature PaperReview

Harnessing the Power of Integrated Behavioral Health to Enhance Insomnia Intervention in Primary Care

by Rebecca L. Campbell and Ana J. Bridges

J. Clin. Med. 2024, 13(18), 5629; https://doi.org/10.3390/jcm13185629 - 23 Sep 2024

Viewed by 1356

Abstract

Insomnia is prevalent in primary care and associated with co-morbid physical and mental health conditions and poor health outcomes. While there are effective treatments for insomnia in specialty mental health care, many patients have difficulty accessing these interventions. To begin, patients do not always report their sleep challenges to physicians; meanwhile, primary care providers often do not screen for insomnia symptoms. Furthermore, patients may experience several barriers to accessing specialty care for insomnia treatment, such as a limited number of available providers, financial burden, lack of transportation, and low perceptions of treatment effectiveness. Primary care behavioral health (PCBH) is well-equipped to address the challenges of accessing evidence-based care for insomnia through (1) identifying sleep issues, (2) providing psychoeducation on the possible treatments for insomnia, (3) intervening with poor sleep habits and acute insomnia early to prevent chronic insomnia, and (4) delivering appropriate evidence-based interventions for chronic insomnia. Primary care clinics should leverage behavioral health providers to increase screening and embed interventions into routine care for the benefit of improved outcomes for patients with insomnia and other sleep challenges. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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