Search Results (350)

Background/Objectives: Microvascular dysfunction is an early manifestation of vascular impairment in type 1 diabetes (T1D). Although physical activity may improve vascular health, the relationship between integrated 24 h physical behavior patterns and microvascular function remain unclear. This study evaluated the association between 24 h physical behavior patterns and cutaneous microvascular reactivity in adults living with T1D, and examined their relationship with endothelium-dependent microvascular function. Methods: This cross-sectional study included 92 adults with T1D. Physical activity and sedentary behavior were assessed through accelerometry and combined with self-reported sleep duration. Participants were classified into three clusters using partitioning around medoids. Cutaneous microvascular reactivity was assessed through laser speckle contrast imaging, with post-occlusive reactive hyperemia (PORH) peak and amplitude of cutaneous vascular conductance (CVC) as primary outcomes. Acetylcholine (ACh)-induced responses were evaluated as exploratory outcomes. Generalized linear models with progressive adjustment were used to examine the associations. Results: Three distinct behavioral patterns were identified. In the fully adjusted model, compared with Cluster 3, the estimates for PORH peak CVC were β = −0.02 (95% CI: −0.16 to 0.11) for Cluster 1 and β = 0.01 (95% CI: −0.13 to 0.16) for Cluster 2. Similar null findings were observed for PORH amplitude CVC and ACh-derived outcomes. Sensitivity analyses including microvascular burden did not alter the findings. Conclusions: In adults living with T1D, 24 h physical behavior patterns were not associated with microvascular reactivity or endothelium-dependent function. These findings suggest that daily behavior distribution may not be strongly related to microvascular responses, although subtle effects cannot be excluded. Longitudinal studies using fully device-based 24 h assessments are warranted. Full article

Background: Smith–Magenis syndrome (SMS) is a rare neurodevelopmental disorder characterized by severe sleep disturbances, circadian rhythm dysregulation, and prominent behavioral difficulties. Objective: To examine associations between subjective and objective sleep and circadian characteristics and behavioral difficulties in children with SMS in real life. Methods: Children aged 5–13 years with genetically confirmed SMS were included in a prospective single-center cohort study. Sleep and circadian rhythms were assessed using parent-reported questionnaires (Sleep Disturbance Scale for Children (SDSC), Horne and Östberg Morningness–Eveningness Questionnaire (H&O)) and 15-day home-based wrist actigraphy. Behavioral difficulties were evaluated using the Aberrant Behavior Checklist-Community (ABC-C). Associations between subjective and objective sleep and circadian measures with behavioral difficulties were studied using Spearman correlations for each ABC-C subscale. Results: Among the 20 children included (55% female, mean age 10 ± 2.5 years), 75% were carriers of a 17p11.2 microdeletion and 25% had an RAI1 mutation. Overall, 95% of children were treated with melatonin, 55% with psychostimulants and 20% with beta-blockers. According to the SDSC results, pathological sleep disturbances were present in 14/20 (70%) children and concerned mainly complaints of insomnia (10/20, 50%) and excessive daytime sleepiness (8/20, 40%). The H&O chronotypes confirmed the morning type in 70% of patients. Sleep and circadian measures obtained by actigraphy showed reduced total sleep time in 71% of the children, reduced sleep efficiency in 88%, long wake after sleep onset (WASO > 60 min) in 59%, as well as an early L5 onset (5 h period with the least movements < 23:38) and M10 onset (10 h period with the highest activity levels < 09:12) in 92% and 62% of children, respectively. The behavioral domains of the ABC-C with the highest scores were hyperactivity (mean 52.1, range 2.1–97.9) and irritability, agitation, and crying (mean 46.9, range 17.8–82.2). In the analysis of the relationship between behavior and sleep, a positive correlation was found between sleep disorders and stereotyped behaviors (r = 0.472, p = 0.048), insomnia and irritability, social withdrawal and stereotyped behaviors (r = 0.472, p = 0.048; r = 0.701, p = 0.001; and r = 0.648, p = 0.004, respectively), and non-restorative sleep and inappropriate speech (r = 0.476, p = 0.046). No significant association was found between objective sleep measures and behaviors. While subjective assessments suggested that a stronger morning chronotype was associated with lower irritability (r = −0.565, p = 0.015), actigraphy-derived circadian rhythm analyses revealed that an earlier L5 onset was associated with greater social withdrawal and hyperactivity (r = −0.556, p = 0.048 and r = −0.560, p = 0.049, respectively). Conclusions: The present cohort study of children with SMS studied in real-life conditions, using both objective and subjective measures, shows that patients continued to experience sleep and behavioral disturbances despite treatment. Exploratory analyses identified distinct associations between subjective sleep disturbances, circadian rhythm characteristics, and specific behavioral domains. While subjective sleep disturbances were associated with irritability, stereotypic behavior, and inappropriate speech, circadian rhythm parameters are specifically associated with hyperactivity. Both were also associated with social withdrawal. As these findings arise from an exploratory observational secondary analysis, they should be considered hypothesis-generating and require confirmation in larger prospective studies. If confirmed, they may help identify sleep and circadian rhythm characteristics as potential targets for future interventions in children with SMS. Full article

Background/Objectives: Sleep disturbances are increasingly implicated in age-related cognitive decline and may contribute to heterogeneity in cognitive and social–cognitive functioning in Mild Cognitive Impairment (MCI). Nevertheless, it remains unclear whether longitudinal actigraphy-derived sleep parameters predict social cognition, including theory of mind (ToM), across amnestic (aMCI) and non-amnestic (naMCI) MCI subtypes. This study examined longitudinal trajectories of cognitive control and ToM in individuals with aMCI and naMCI and healthy older adults, and investigated whether actigraphy-derived sleep indices prospectively predict subsequent cognitive control and higher-order social cognition across these groups. Methods: A total of 179 participants (46 healthy controls, 75 aMCI, 58 naMCI) were assessed across three waves over approximately 16–20 months. Actigraphy-derived sleep indices were obtained using wrist actigraphy. Cognitive control was assessed with Delis–Kaplan Executive Function System subtests, whereas ToM was evaluated through tasks involving non-literal language comprehension, metaphor and proverb interpretation, higher-order mentalizing, and emotion recognition. Longitudinal trajectories were examined using mixed-design ANOVAs, and prospective sleep effects were tested using longitudinal path models. Results: Both cognitive control and ToM declined over time in the MCI groups, whereas healthy controls showed relative stability. Subtype differences in cognitive control emerged primarily in higher-order planning and rule-monitoring processes, with naMCI showing greater impairment. ToM revealed a clearer and more consistent gradient (healthy controls > aMCI > naMCI), particularly in higher-order inferential tasks. Among the actigraphy-derived sleep indices, only TST prospectively predicted later ToM performance, whereas prospective associations with cognitive control were limited and inconsistent. Conclusions: Reduced sleep duration was prospectively associated with poorer subsequent performance in higher-order social cognition, independently of the executive-control measures examined. These findings highlight phenotypic heterogeneity across MCI subtypes and suggest that objectively measured sleep duration may serve as a clinically relevant longitudinal marker of social–cognitive vulnerability. Future studies are needed to determine whether interventions targeting sleep duration are associated with improved social–cognitive outcomes. Full article

Background: This study applies Buysse’s sleep health framework to examine sleep in children and adolescents with neurofibromatosis type 1 (NF1). By examining sleep timing, daytime sleepiness, sleep quality, sleep behavior, sleep duration, and sleep efficiency together, this framework captures the multidimensional nature of sleep and its relationship with biopsychosocial factors and health-related quality of life (HR-QoL) in NF1. Methods: This multi-site, prospective, cross-sectional study included 131 children and adolescents with NF1 and 71 typically developing (TD) controls aged 6 to 16 years. A sleep health composite was derived from carer rating scales and 7 days of actigraphy. A biopsychosocial framework was used to examine factors associated with sleep health in NF1, including sociodemographic, cognitive, psychopathology, and biological variables. Independent predictors of QoL were examined to assess the unique contributions of sleep quality, sleep duration, and previously established predictors of HR-QoL in NF1. Results: Poorer sleep health was evident in children with NF1. Compared with TD controls, children with NF1 were five times as likely to have poor sleep quality, with almost 78% demonstrating impaired sleep efficiency and nearly half not obtaining sufficient sleep at night. The strongest risk factors were being male, elevated pain, and having greater levels of ADHD and autism spectrum disorder traits. Conclusions: Findings suggest sleep health in NF1 is interconnected with multiple biopsychosocial factors. A better understanding of these relationships will help identify early risk markers, improve prediction of clinical trajectories, and guide the development of targeted multimodal interventions for sleep disruption in NF1. Full article

Sleep disturbances are highly prevalent across psychiatric disorders and represent both a clinical feature and a potential transdiagnostic therapeutic target. Growing evidence suggests that the gut microbiota may contribute to sleep regulation through immune, metabolic, circadian, and neuroendocrine pathways. Prebiotics, defined as selectively utilized substrates that confer health benefits through modulation of host microorganisms, have received increasing attention as nutritional strategies capable of influencing the gut–brain axis. This narrative review summarizes preclinical and human evidence on prebiotic interventions in relation to sleep-related outcomes and psychiatric symptomatology, with particular attention to short-chain fatty acids, circadian regulation, inflammatory pathways, stress-related hypothalamic–pituitary–adrenal axis activity, and microbial metabolite signaling. Preclinical studies suggest that selected prebiotics may influence sleep architecture, stress resilience, neuroinflammation, and behavioral phenotypes, particularly under conditions of stress or sleep disruption, but translation to human populations remains preliminary. Available clinical studies are limited by small sample sizes, heterogeneous prebiotic formulations, variable doses and intervention durations, inconsistent microbiome methodologies, and frequent reliance on subjective sleep measures rather than polysomnography or actigraphy. Therefore, current evidence supports prebiotics as biologically plausible and generally well-tolerated adjunctive strategies, but not as established treatments for insomnia or psychiatric symptoms. Sleep may provide a clinically meaningful transdiagnostic framework for future nutritional psychiatry research, provided that adequately powered randomized controlled trials integrate objective sleep assessment, standardized microbiome and metabolomic profiling, and clinically relevant psychiatric outcomes. Full article

This study aimed to examine plasma melatonin levels, seasonal variation, and their association with sleep quality in adults aged 25–65 years using both the Pittsburgh Sleep Quality Index and actigraphy. A cross-sectional study was conducted in a stratified random sample of 500 adults from Salamanca and Ávila (Spain). Plasma melatonin was quantified by HPLC-DAD-MS/MS, and sleep quality was assessed using the Pittsburgh Sleep Quality Index and a 5-day wrist actigraphy protocol (ActiGraph GT3X+). Participants were stratified by age and sex, and seasonal variation was evaluated. Multivariable analyses were adjusted for relevant confounders. A total of 334 participants with valid melatonin measurements were included (mean age 43 years). Mean plasma melatonin concentration was 14.5 ± 15.9 pg/mL, with higher levels observed in men than women and a decreasing trend with age. A trend toward higher melatonin levels during winter was observed, although the differences were not statistically significant. No significant association was found between plasma melatonin levels and Pittsburgh Sleep Quality Index scores. However, higher melatonin levels were associated with slightly greater sleep efficiency measured by actigraphy. Participants reporting melatonin supplement use showed higher Pittsburgh Sleep Quality Index scores and lower total sleep time compared with non-users. Overall, plasma melatonin levels varied by sex, age, and season but showed no association with subjective sleep quality, while a modest relationship was observed with objective sleep efficiency, suggesting that melatonin alone is not a strong determinant of perceived sleep quality and highlighting the multifactorial nature of sleep regulation in adults. Full article

Sleep is essential for infants’ physical and cognitive development. Unlike older children or adolescents, infants sleep longer durations, including multiple daytime naps. While nighttime sleep is easier to detect due to its extended periods, identifying daytime sleep is more challenging due to its short, fragmented nature and its similarity to idle wakefulness. Moreover, parent-reported sleep estimations are prone to error as continuous monitoring is often impractical. To address these limitations, we developed a Multi-Stage Sleep–Wake (MSW) classification approach using triaxial accelerometer data collected from wearable devices placed on infants’ ankles and waists over multiple days. This method systematically refines and classifies sleep and wake states through a series of analytical steps. This systematic process generates refined proxy sleep–wake labels that account for behavioral overlaps and correct mislabeled idle periods. We trained and validated multiple machine learning models using these labels and compared the results to parent annotated labels. Models trained using MSW-derived labels achieved 96.6% accuracy using Random Forest classifier compared to 72% using parent-reported labels. These findings demonstrate that the MSW framework produces a more consistent set of proxy sleep–wake annotations for model development, although the derived labels were not validated against an independent reference standard. Furthermore, the proposed MSW framework may serve as a practical label-refinement methodology for improving noisy caregiver-reported sleep annotations in future wearable-based infant sleep studies where independent sleep labels are unavailable. Full article

Background/Objectives: Juvenile myoclonic epilepsy (JME) is characterized by seizures clustering in the early morning hours, reflecting circadian modulation of cortical excitability. To the best of our knowledge, circadian rest–activity rhythms have not previously been objectively characterized in adolescents with JME, a gap that may be relevant to understanding seizure timing in this population. This study aimed to characterize circadian rest–activity rhythms and sleep parameters in adolescents with JME compared to healthy controls (HCs) and to explore whether chronotype relates to the strength of circadian rhythm. Methods: This pilot case–control study analyzed data from 11 adolescents with JME and 10 age- and sex-matched HCs who underwent 14-day continuous wrist actigraphy. Non-parametric circadian rhythm analysis (NPCRA) and cosinor analysis were conducted, and conventional sleep–wake parameters and night-to-night variability were derived. Subjective data from the Morningness–Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index, a modified Epworth Sleepiness Scale, and the Pediatric Sleep Questionnaire were included. Between-group comparisons used the Mann–Whitney U test with an effect size of r. Results: Patients showed significantly lower interdaily stability (p = 0.002, r = 0.692), higher intradaily variability (p = 0.022, r = 0.500), reduced peak daytime activity (p = 0.002, r = 0.672), and attenuated cosinor (p = 0.013, r = 0.544) and mesor (p = 0.001, r = 0.754) amplitude, all with large effect sizes. Night-to-night variability was significantly greater for sleep efficiency (p = 0.010, r = 0.561), the fragmentation index (p = 0.003, r = 0.653), and mean sleep-bout duration (p = 0.020, r = 0.509). The MEQ score correlated positively with cosinor amplitude (rho = 0.679, p = 0.022) and peak daytime activity (rho = 0.615, p = 0.044). No significant group differences were found in conventional sleep–wake parameters. Given the exploratory nature of this pilot study, no correction for multiple comparisons was applied, and these findings should be considered hypothesis-generating. Conclusions: This pilot study provides preliminary evidence of circadian rest–activity rhythm disruption in a small and clinically heterogeneous adolescent cohort, with large effect sizes in JME, despite preserved conventional sleep parameters, underscoring the potential value of NPCRA-based actigraphy monitoring in this population and the need for replication in larger cohorts. Full article

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

Introduction: Sleep disturbances are common as we age and have been linked to poor cognition and increased cognitive decline. Objective: We aimed to examine cross-sectional and longitudinal associations between objective sleep measures and cognition in middle-aged and older adults, including cognitively healthy (CH) individuals and those with mild cognitive impairment (MCI). Methods: Participants from the Aiginition Longitudinal Biomarker Investigation Of Neurodegeneration (ALBION) study (age > 40) underwent 7-day wrist actigraphy (Actiwatch 2). Sleep exposures included sleep duration, sleep efficiency, sleep variability, sleep onset latency, wake after sleep onset (WASO), and number of awakenings. A neuropsychological battery was administered examining memory, executive function, visuospatial ability, language, attention speed, and a global composite score. Cross-sectional associations were tested using generalized linear models (adjusted for age, sex, education). Longitudinal associations with cognitive trajectories were examined with linear mixed-effect models. Results: In total (N = 184; 65% women; mean age 65 years), average sleep duration was 7.2 h and mean sleep efficiency was at 80%. Cross-sectionally, more nightly awakenings were associated with poor memory and attention speed. In a 1.5-year follow-up, (n = 93), higher baseline sleep efficiency was associated with better memory and language performance, while longer WASO, more awakenings, and longer sleep onset latency showed nominal associations with less favorable cognitive trajectories, although these associations did not remain statistically significant after FDR correction. Time-varying analyses indicated that sleep variability showed robust non-linear associations with poorer memory trajectories over follow-up and remained significant after FDR adjustment; significant mean change in awakenings and variability appeared to intensify in later follow-up phases. The association between sleep characteristics and cognitive decline varied across follow-up time, with stronger adverse changes observed during later follow-up phases. Discussion: Objective indicators of sleep continuity, especially sleep variability, were most consistently related to domain-specific cognitive outcomes, with strongest evidence for memory over time. Sleep fragmentation and irregular sleep patterns may represent potentially modifiable targets for future strategies aimed at preserving cognitive health during aging. Full article

Background/Objectives: Diet and sleep are both important modifiable factors in healthy aging, yet little is known about whether attention to healthy eating behaviors is associated with objectively measured sleep. This study examined the association between self-reported attention to fruit and vegetable intake and actigraphy-measured sleep efficiency among women aged 45 years and older. Methods: This cross-sectional study included 143 women aged 45 years and older recruited from community centers. Participants wore a wrist-worn actigraphy device continuously for 7 days and completed daily sleep logs. Attention to fruit and vegetable intake was assessed using a single-item, four-category self-report measure. Hierarchical multiple linear regression was used to examine its independent association with sleep efficiency after adjustment for sociodemographic, health-related, and psychological covariates. Results: The mean age of the participants was 56.34 ± 7.67 years, and the mean sleep efficiency was 82.69 ± 8.60%. In the fully adjusted model, participants who reported “often” paying attention to fruit and vegetable intake had significantly higher sleep efficiency than those who reported doing so “almost every day” (β = 0.24, p = 0.013). Older age was independently associated with lower sleep efficiency (β = −0.31, p = 0.001). Conclusions: In this exploratory cross-sectional study, a single-item measure of self-reported attentiveness to fruit and vegetable intake showed a category-specific association with actigraphy-measured sleep efficiency. Longitudinal studies using more detailed dietary and behavioral measures are needed to clarify the direction and meaning of this association. Full article

Background/Objectives: Sleep disturbance is common in older adults and is associated with impaired daily functioning and poorer health-related outcomes. This study examined whether a 12-week Health Qigong program could improve subjective and objective sleep quality in older adults with self-reported sleep disturbance. Methods: Sixty adults aged 55 years or older who reported poor sleep and had Pittsburgh Sleep Quality Index total scores above 5 were randomly allocated to an intervention group or a control group (30 participants per group; 10 men and 20 women in each group). Both groups received health education and lifestyle guidance, and the intervention group completed supervised Health Qigong sessions twice weekly. Sleep quality was assessed before and after the intervention using the Pittsburgh Sleep Quality Index and wrist actigraphy. Results: Baseline characteristics were comparable between groups. In adjusted post-intervention comparisons, the intervention group showed lower Pittsburgh Sleep Quality Index scores, higher sleep efficiency, less wake after sleep onset, fewer awakenings, shorter average awake time, and longer total sleep time than the control group. The adjusted group difference for sleep onset latency was not significant. Conclusions: These preliminary findings suggest that Health Qigong may be a feasible community-based practice for improving sleep quality in older adults with self-reported sleep disturbance. The overall pattern was more consistent with improvement in sleep continuity than in sleep onset latency, although this interpretation should remain cautious because no direct contrast between sleep maintenance and sleep initiation was tested. Full article

Sleep deprivation (DS) is a reduction in sleep duration due to voluntary or external factors. The mechanisms underlying the psychological and cognitive consequences of DS are complex and incompletely understood; one proposed pathway involves alterations in the serotonin (5-HT) and melatonin (MLT) systems. This study aimed to assess the effects of a single night of DS on the tryptophan (TP)-5-HT-MLT system and to examine their associations with mood and cognitive performance. Eighty healthy adults underwent polysomnography (PSG) and actigraphy-monitored DS. Blood samples, mood assessments, and cognitive tests (BEHCT, TMT, Stroop) were performed before and after PSG and DS. Levels of serotonin transporter (SERT) mRNA, TP, 5-HT, and MLT were measured. Participants were classified as Responders (RE) or Non-Responders (NR) based on post-DS mood change. DS significantly decreased TP and MLT overall. In NR, 5-HT increased and MLT decreased, unlike in RE. ΔBEHCT correlated positively with ΔTP (RE), Δ5-HT (overall), and ΔMLT (overall and RE), and negatively with ΔSERT mRNA (NR). In RE, ΔSERT mRNA negatively correlated with ΔStroop performance and positively with ΔTMT. Acute DS disrupts the TP–5-HT–MLT axis, with effects differing by mood response. These changes may influence cognitive outcomes after sleep loss. Full article

Background: Highly effective CFTR modulation with Elexacaftor/Tezacaftor/Ivacaftor (ETI) markedly improves clinical outcomes in people with cystic fibrosis (CF). Data on its effects on physical activity, sleep, sinonasal symptoms, and parent-perceived outcomes in preschool-aged children are limited. Methods: In this prospective, observational, single-center cohort study, ten children with cystic fibrosis (aged 2–6 years) and at least one CFTR variant eligible for ETI were included. Data were collected using wrist-worn Garmin vívofit Junior 2 activity trackers and standardized questionnaires one month before ETI initiation and at 1, 3, 6, and 12 months after start of ETI. Outcomes included step count, minutes of moderate-to-vigorous physical activity, sleep parameters, sinonasal symptoms, and parental perceptions. Results: ETI was well tolerated. Sweat chloride levels decreased significantly. Physical activity improved at 3 and 6 months (step count and active minutes/day; p < 0.05) but declined to near-baseline levels at 12 months. Parental assessments of physical and sporting performance showed sustained improvement. Sleep duration remained stable, with no changes in deep or light sleep phases or nighttime awakenings. Sinonasal symptoms remained low. Discussion & Conclusions: Preliminary findings of this exploratory pilot study show that improvement in physical activity after three and six months of ETI therapy might be attributable to seasonality, as therapy was started in winter months. No changes in sleep duration or sleep patterns are reassuring in this small cohort of young children with CF. ETI therapy was safe and well tolerated. Parental appraisal of their children’s physical performance improved after start of ETI. Longitudinal, controlled studies involving larger cohorts are required to validate these findings and to account for potential confounding factors, such as age-dependent changes and individual and environmental factors such as seasonal variation. Full article

Background/Objectives: Circadian misalignment, including mistimed sleep or eating, is associated with altered glucose metabolism. The importance of eating window timing for time-restricted eating (TRE) is increasingly recognized. This secondary analysis examined associations between meal to sleep timing intervals and glycemic parameters in individuals with obesity across three dietary interventions [TRE, CR: caloric restriction, and UE: unrestricted eating]. Methods: Participants aged 18–65 years with obesity were randomized to a 12-week intervention: TRE (8 h eating window), CR (15% reduction in daily caloric intake), or UE (usual eating habits). CGM and actigraphy were assessed over two weeks at baseline and end-intervention. Mixed effects models examined associations between continuous glucose monitoring (CGM) outcomes and two intervals: last meal to sleep onset (PM meal-Sleep) and awakening to first meal (Awake-AM meal). Results: Each hour increase in the Awake-AM meal interval was associated with lower overnight (1 AM–5 AM) average glucose, lower glycemic variability, lower %time > 180 mg/dL, and greater %time < 70 mg/dL. Each hour increase in the PM meal-Sleep interval was associated with lower overnight (1 AM–5 AM) average glucose. Both associations persisted after adjustment for baseline sleep duration, HbA1c, and randomization assignment. Conclusions: In individuals with obesity, morning (Awake-AM meal interval) and evening (PM meal-Sleep interval) fasting relative to sleep were differentially associated with glycemic control. These findings highlight the relevance of eating and sleep timing to glycemic parameters and may inform eating window selection for individuals practicing TRE. Full article