Search Results (494)

Sleep disorders and stroke are intricately linked through a complex, bidirectional relationship. Sleep disturbances such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) not only increase the risk of stroke but also frequently emerge as consequences of cerebrovascular events. OSA, in particular, is associated with a two- to three-fold increased risk of incident stroke, primarily through mechanisms involving intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation. Conversely, stroke can disrupt sleep architecture and trigger or exacerbate sleep disorders, including insomnia, hypersomnia, circadian rhythm disturbances, and breathing-related sleep disorders. These post-stroke sleep disturbances are common and significantly impair rehabilitation, cognitive recovery, and quality of life, yet they remain underdiagnosed and undertreated. Early identification and management of sleep disorders in stroke patients are essential to optimize recovery and reduce the risk of recurrence. Therapeutic strategies include lifestyle modifications, pharmacological treatments, medical devices such as continuous positive airway pressure (CPAP), and emerging alternatives for CPAP-intolerant individuals. Despite growing awareness, significant knowledge gaps persist, particularly regarding non-OSA sleep disorders and their impact on stroke outcomes. Improved diagnostic tools, broader screening protocols, and greater integration of sleep assessments into stroke care are urgently needed. This narrative review synthesizes current evidence on the interplay between sleep and stroke, emphasizing the importance of personalized, multidisciplinary approaches to diagnosis and treatment. Advancing research in this field holds promise for reducing the global burden of stroke and improving long-term outcomes through targeted sleep interventions. Full article

This pilot, randomized, double-blind, placebo-controlled trial investigated the effects of branched-chain amino acids (BCAAs)—provided in a 2:1:1 ratio of leucine:isoleucine:valine—combined with exercise on fatigue, physical performance, and quality of life in older adults. Twenty participants (63% female; BMI: 35 ± 2 kg/m²; age: 70.5 ± 1.2 years) were randomized to 8 weeks of either exercise + BCAAs (100 mg/kg body weight/d) or exercise + placebo. The program included moderate aerobic and resistance training three times weekly. Physical function was assessed using handgrip strength, chair stands, gait speed, VO₂ max, and a 400 m walk. Psychological health was evaluated using the CES-D, Fatigue Assessment Scale (FAS), Insomnia Severity Index (ISI), and global pain, fatigue, and quality of life using a visual analog scale (VAS). Significant group x time interactions were found for handgrip strength (p = 0.03), chair stands (p < 0.01), and 400 m walk time (p < 0.01). Compared to exercise + placebo, exercise + BCAAs showed greater improvements in strength, mobility, and endurance, along with reductions in fatigue (−45% vs. +92%) and depressive symptoms (−29% vs. +5%). Time effects were also observed for ISI (−30%), FAS (−21%), and VAS quality of life (16%) following exercise + BCAA supplementation. These preliminary results suggest that BCAAs combined with exercise may be an effective way to improve physical performance and reduce fatigue and depressive symptoms in older adults. Full article

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From September to November 2024, 95 students (grades 4–6) living near a coal-fired power plant in midwestern South Korea were assigned to either an intervention group (n = 44) or a control group (n = 51). The intervention group completed a three-session CBT-based education program; the control group received stress management education. Assessments were conducted at weeks 1, 2, 4, and 8 using standardized mental health and behavior scales (PHQ: Patient Health Questionnaire, GAD: Generalized Anxiety Disorder Assessment, PSS: Perceived Stress Scale, ISI: Insomnia Severity Index). Results: A chi-square test was conducted to compare pre- and post-test changes in knowledge and behavior related to PM2.5. The intervention group showed significant improvements in seven fine dust-related knowledge and behavior items (e.g., PM2.5 awareness rose from 33.3% to 75.0%; p < 0.05). The control group showed limited gains. Regarding mental health, based on a mixed-design ANCOVA, anxiety scores significantly declined over time in the intervention group, with group and interaction effects also significant (p < 0.05). Depression scores showed time effects, but group and interaction effects were not significant. No significant changes were observed for stress, sleep, or group × PM2.5 interactions. Conclusions: The CBT-based education program effectively enhanced fine dust knowledge, health behaviors, and reduced anxiety among students. It presents a promising, evidence-based strategy to promote environmental and mental health in school-aged children. Full article

The mental and physical health of college students, especially in urban environments like Shanghai, is crucial given the high academic and urban stressors, which were intensified by the COVID-19 lockdown. Prior research has shown gender differences in health impacts during public health crises, with females often more vulnerable to mental health issues. Objective: This study aimed to comprehensively assess the physical and psychological health of Chinese college students post-lockdown, focusing on the relationship between stress, anxiety, depression, sleep patterns, and physical health, with a particular emphasis on gender differences. Methods: We conducted a cross-sectional study involving 116 students in Shanghai, utilizing psychological scales (HAMA, IPAQ, PSQI, SDS, FS 14, PSS, SF-36) and physical fitness tests (resting heart rate, blood pressure, hand grip, forced vital capacity, standing long jump, sit-and-reach, one-minute sit-up test and the one-minute squat test, single-leg stand test with eyes closed), to analyze health and behavior during the pandemic lockdown. All students have undergone the same life habits during the pandemic. Results: The HAMA scores indicated no significant levels of physical or mental anxiety. The PSS results (42.45 ± 8.93) reflected a high overall stress level. Furthermore, the PSQI scores (5.4 ± 2.91) suggested that the participants experienced mild insomnia. The IPAQ scores indicated higher levels of job-related activity (1261.49 ± 2144.58), transportation activity (1253.65 ± 987.57), walking intensity (1580.78 ± 1412.20), and moderate-intensity activity (1353.03 ± 1675.27) among college students following the lockdown. Hand grip strength (right) (p = 0.001), sit-and-reach test (p = 0.001), standing long jump (p = 0.001), and HAMA total score (p = 0.033) showed significant differences between males and females. Three principal components were identified in males: HAMA, FS14, and PSQI, explaining a total variance of 70.473%. Similarly, three principal components were extracted in females: HAMA, PSQI, and FS14, explaining a total variance of 69.100%. Conclusions: Our study underscores the complex interplay between physical activity (PA), mental health, and quality of life, emphasizing the need for gender-specific interventions. The persistent high stress, poor sleep quality, and reduced PA levels call for a reorganized teaching schedule to enhance student well-being without increasing academic pressure. Full article

Background: Insomnia and excessive sleepiness are significant health problems with a complex etiology, increasingly affecting young people, especially students. This study aimed to assess the prevalence of sleep disturbances and patterns of psychoactive drug use among female Polish students. We also explored the potential impact of the COVID-19 pandemic on sleep behaviors. We hypothesized that sleep disorders are common in this group, that medical students are more likely to experience insomnia and excessive sleepiness, and that the pandemic has exacerbated both sleep disturbances and substance use. Methods: This cross-sectional study utilized a custom survey designed using standardized questionnaires—the Athens Insomnia Scale and Epworth Sleepiness Scale—that was distributed online using the Computer-Assisted Web Interviewing method. A total of 11,988 responses were collected from 31 January 2016 to 1 January 2021. Inclusion criteria were being female, having a college student status, and giving informed consent. Results: Among the 11,988 participants, alcohol use declined after the pandemic began (p = 0.001), while sedative use increased (p < 0.001). Insomnia (AIS) was associated with study year, university profile, and field of study (p < 0.001), with the highest rates in first-year and non-medical students. It was more common among users of sedatives, psychostimulants, and multiple substances. No significant change in insomnia was found before and after the pandemic. Excessive sleepiness (ESS) peaked in first-year and medical students. It decreased during the pandemic (p < 0.001) and was linked to the use of alcohol, psychostimulants, cannabinoids, and multiple substances. Conclusions: These findings highlight that female students are particularly vulnerable to sleep disorders. The influence of the COVID-19 pandemic on sleep disturbances remains inconclusive. Given the varied results in the existing literature, further research is needed. Full article

Shift work can have an adverse impact on sleep and wellbeing, as well as negative consequences for workplace safety and productivity. SleepShifters is a co-developed sleep management programme that aims to equip shift workers and employers with the skills needed to manage sleep from the onset of employment, thus preventing sleep problems and their associated consequences from arising. This paper describes the co-development process and resulting programme protocol of SleepShifters, designed in line with the Medical Research Council’s framework for the development and evaluation of complex interventions. Programme components were co-produced in partnership with stakeholders from four organisations across the United Kingdom, following an iterative, four-stage process based on focus groups and interviews. As well as a handbook containing guidance on shift scheduling, workplace lighting, and controlled rest periods, SleepShifters consists of five key components: (1) an annual sleep awareness event; (2) a digital sleep training induction module for new starters; (3) a monthly-themed sleep awareness campaign; (4) a website, hosting a digital Cognitive Behavioural Therapy for insomnia platform and supportive video case studies from shift-working peers; (5) a sleep scheduling app for employees. Future work will implement and assess the effectiveness of delivering SleepShifters in organisational settings. Full article

Background/Objectives: Research regarding the relationship between insomnia symptoms and self-regulated eating behaviors in Hispanic populations is limited, particularly that pertaining to emerging adulthood (18–25 years old) and the potential role of cultural factors. The present study explored the association between insomnia symptoms and self-regulated eating behaviors in a Hispanic emerging adult sample, as well as the role of acculturative stress. Methods: Participants who identified as Hispanic between the ages of 18–25 years old and were English-speaking completed an online survey assessing insomnia symptoms, self-regulated eating behavior, and acculturative stress. Results: In a multiple regression analysis, insomnia symptoms emerged as a significant predictor of self-regulated eating behavior such that Hispanic individuals with increased insomnia symptoms were more likely to report low self-regulated eating behavior. Furthermore, it was found that acculturative stress partially mediated the association between insomnia symptoms and self-regulated eating behavior. Conclusions: Insomnia symptoms are a risk for problematic eating behaviors in Hispanic emerging adults. Identifying other early risk factors, including culturally unique risks like acculturative stress, may be important for the development of tailored early intervention efforts to reduce problematic eating patterns. Full article

Background: Longitudinal studies on cognitive disengagement syndrome (CDS) are scarce, and only one study has investigated the trajectory of CDS from childhood to early adulthood. Given this, the aims of the present study were to explore, with a quasi-longitudinal design, (1) whether scores for childhood CDS were associated with scores for CDS during early adulthood; (2) whether childhood CDS scores were associated with childhood and adult scores for depression, anxiety, stress, and insomnia; (3) whether childhood CDS, depression, anxiety, stress, and insomnia and adult depression, anxiety, stress, and insomnia were independently associated with adult scores for CDS, and (4) whether childhood CDS scores were directly and indirectly associated with adult CDS scores via adult depression and stress in two conditional effect models. Methods: A total of 246 young adult students (mean age = 22.62; 56.3% females) participated in a cross-sectional and quasi-longitudinal study. The participants completed questionnaires assessing CDS (Adult Concentration Inventory; ACI), depression, anxiety, stress, and insomnia for the following two developmental periods: for the present time point as young adults and for a past time point, when they were about eight years old. To enable retrospective past recall, the participants undertook a standardized imagination exercise. Results: Childhood scores for CDS, depression, anxiety, stress, and insomnia were highly associated with adult scores for CDS, depression, anxiety, stress, and insomnia. In the regression model, higher childhood scores for CDS, depression, and anxiety and higher adult scores for depression, stress, and insomnia, but not adult anxiety, were strongly and independently associated with adult scores for CDS. In the two conditional effects models, childhood CDS was associated with adult CDS directly and indirectly via adult depression and adult stress. Conclusions: In this quasi-longitudinal study, childhood scores for CDS were associated with adult scores for CDS, suggesting a potentially stable trajectory of CDS from childhood to early adulthood. Further, the two conditional effects models suggested that childhood and adult CDS were both directly and indirectly associated via adult depression and stress. As such, symptoms of depression, anxiety, stress, and insomnia should be considered in conceptualizations of adult CDS. Next, given that standardized psychotherapeutic interventions for depression, stress, and insomnia are available, such interventions might also favorably impact CDS symptoms. These findings further underscore the importance of prospective longitudinal and intervention studies on adult CDS. Full article

Poor sleep quality and insomnia are increasingly linked to chronic inflammation and obesity-related metabolic dysfunction. Aerobic exercise is a promising non-pharmacological approach for enhancing sleep quality and reducing systemic inflammation; Therefore, we aim to systematically evaluate and quantify the effects of aerobic exercise interventions on subjective sleep quality, insomnia severity, and circulating markers (IL-6 and TNF-α) in adults. A systematic search was conducted in institutional databases (UNAM, UACJ) and PubMed to identify randomized controlled trials (RCTs) examining the effects of exercise on sleep and inflammation. Risk of bias was assessed using the Cochrane RoB2 tool. Meta-analyses were performed using RevMan 5.4 with random-effects models to estimate pooled mean differences (MD) and standardized mean differences (SMD), with 95% confidence intervals. Anaerobic protocols were excluded from the meta-analysis due to the insufficient availability of data. : Eleven RCTs met the inclusion criteria. Aerobic exercise showed a significant pooled effect on sleep outcomes (MD = −2.51; 95% CI: −4.80 to −0.23; p = 0.03). However, subgroup analyses for Pittsburgh Sleep Quality Index (PSQI) (MD = −2.27; p = 0.15) and Insomnia Severity Index (ISI) (MD = −2.98; p = 0.16) were not statistically significant. Two studies on IL-6 reported a non-significant reduction (SMD = −0.17; p = 0.66), with moderate heterogeneity. TNF-α results were also non-significant (SMD = 0.60; p = 0.29) with substantial variability. Our results showed that aerobic exercise may modestly improve sleep outcomes; however, current evidence does not support its effectiveness in reducing levels of IL-6 or TNF-α. Further well-controlled trials are needed to clarify its immunometabolic effects, particularly in populations with obesity or metabolic disorders. Full article

Background: Insomnia, as one of the most common sleep disorders, is a significant health problem, especially among patients suffering from drug-resistant depression. Problems related to the quality of sleep in that population can significantly affect the effectiveness of treatment and quality of life, which is why it is necessary to search for effective therapeutic interventions in this area. Objective: The aim of this study was to compare the effectiveness of esketamine and other standard antidepressants in improving sleep quality in patients with drug-resistant depression. The main research question is whether and to what extent esketamine improves sleep parameters compared with other antidepressants. Methods: This study involves the analysis of data collected from 50 patients divided into two groups: those using esketamine in combination with other antidepressants and those using other antidepressants. The analysis of the results focuses on the assessment of differences in AIS scores between the groups assessed using the Athens Insomnia Scale (AIS). Results: Insomnia occurs much less frequently among people using esketamine than among people not using this drug. With the increase in the time of using esketamine and with the increase in the dose, the level of insomnia decreases. Conclusions: Esketamine brings about a rapid improvement in sleep quality, which is a significant advance in the treatment of drug-resistant depression. The obtained results not only confirm the effectiveness of esketamine but also show its advantage over traditional treatment methods in improving sleep quality. Full article

Background/Objectives: Passiflora (passionflower), traditionally used for anxiety and insomnia, is primarily known for GABAergic modulation. However, evidence suggests broader neuropharmacological actions. This review aimed to systematically explore non-GABAergic mechanisms of Passiflora. Methods: We performed a systematic review following PRISMA Guidelines (PROSPERO: CRD420251028681). PubMed/Medline, PsycINFO, Embase, Web of Science, and Scopus were searched for original research on non-GABA neurobiological mechanisms of Passiflora species (P. incarnata, P. edulis, P. caerulea, P. actinia, P. foetida). Studies were screened and assessed for eligibility, and data on design, Passiflora preparation, mechanisms, and main findings were extracted. Results: Thirteen studies revealed diverse non-GABAergic actions. Passiflora modulates opioidergic and nicotinic cholinergic systems (relevant to analgesia), monoaminergic pathways (affecting dopamine, norepinephrine, serotonin), and the glutamatergic system (offering neuroprotection via NMDA receptor inhibition). It also exhibits significant anti-inflammatory and antioxidant effects (reducing cytokines, activating Nrf2) and modulates the HPA axis (reducing stress hormones). Other mechanisms include gut microbiota modulation and metabolic effects. Conclusions: Passiflora’s therapeutic potential extends beyond GABA, involving multiple neurotransmitter systems and neuroprotective, anti-inflammatory, antioxidant, and HPA axis-regulating activities. This multi-target profile likely contributes to its clinical efficacy in conditions like anxiety, pain, and stress, potentially with a favorable side-effect profile. Further research, including mechanistic studies and clinical trials with relevant biomarkers, is needed to fully elucidate its complex pharmacology. Full article

Background/Objectives: Epilepsy and sleep disturbances frequently co-occur, yet the causal nature of this relationship remains uncertain, particularly in relation to epilepsy subtypes and status epilepticus. We investigated potential bidirectional causal associations between sleep-related traits and epilepsy, including subtypes and status epilepticus, using Mendelian randomization (MR). Methods: We conducted two-sample MR using genome-wide association study (GWAS) summary statistics from European ancestry cohorts. Epilepsy, its subtypes, and status epilepticus were analyzed using data from the International League Against Epilepsy Consortium on Complex Epilepsies (ILAE) and the FinnGen study. Nine self-reported sleep-related traits were derived from the UK Biobank-based GWAS. Causal estimates were primarily obtained using inverse variance weighted models with additional MR analysis methods. Pleiotropy and heterogeneity were assessed to enhance the robustness of the finding. Results: Several subtype-specific associations were identified, with direction and statistical significance varying across cohorts and subtypes. After correction for multiple testing and filtering for tests with ≥10 instrumental variables to ensure robust and reliable MR estimates, several consistent and potentially mutually reinforcing associations emerged. In the ILAE cohort, focal epilepsy with hippocampal sclerosis was associated with an increased risk of insomnia, and juvenile myoclonic epilepsy with reduced sleep duration. In the FinnGen cohort, overall epilepsy was associated with increased risk of both insomnia and daytime sleepiness. In reverse MR, daytime sleepiness and napping were associated with increased risk of epilepsy, while daytime napping and frequent insomnia symptoms were linked to elevated risk of status epilepticus. Conclusions: Our findings reveal subtype-specific and bidirectional causal links between epilepsy and sleep-related traits. These results highlight the biological interplay between epileptic networks and sleep regulation and underscore the need for further clinical and mechanistic studies. Full article

Background: Cachexia worsens prognosis, quality of life and chemotherapy treatment compliance of patients with lung cancer. Chemotherapy-induced cachexia has also been implicated in lowered mortality. This study aimed to evaluate the frequency of cachexia-related measures and symptoms as outcomes in lung cancer chemotherapy trial protocols and to examine how key trial characteristics influence them. Method: We conducted a cross-sectional data analysis of randomised controlled chemotherapy trials of lung cancer registered in four public trial registries between 2012 and 2023. Trial outcome measures included overall survival, treatment toxicity/side effects and cachexia-related indicators such as physical activity, weight/body mass index (BMI), dietary limitations, caloric intake and lean muscle mass. Symptom-related outcomes, including appetite loss, diarrhoea, pain, fatigue/insomnia, constipation, nausea, vomiting, dysphagia, dyspnoea and oral mucositis, were also extracted. Additionally, the number and type of performance status and assessment tool were recorded. Data were summarised descriptively. Chi-square tests were used to examine associations between trial outcomes and characteristics including cancer type, trial location, lead investigator/funding source, assessment tools and trial commencement year. A p < 0.05 was considered statistically significance. Results: Of the 335 trial protocols (non-small cell (87.2%) and small cell (12.8%)), most were from Europe (50.4%). The trial lead investigator was from industry (56.7%) followed by academia (25.1%). Allied health professional involvement was minimal (0.6%). Trial protocols mostly recorded overall survival (96.4%) and toxicity (83.9%). However, physical activity, weight/BMI, dysphagia, dyspnoea and oral mucositis were recorded in <30%, with dietary limitations, caloric intake and lean muscle mass recorded in <3% of the trials. Measures and symptoms were not associated with cancer type. Trial location was associated with the measures toxicity, physical activity and caloric intake and all symptoms. Lead investigator was associated with the measures toxicity and weight/BMI and all symptoms except for dyspnoea. Performance status and assessment tools were mentioned in 93.4% and 41.8% of the trials, respectively, with significant associations between assessment tools and outcomes, except for weight/BMI, dietary limitations, lean muscle mass, dysphagia and oral mucositis. There was a significant trend with trial commencement year for the measures physical activity (p = 0.002) and weight/BMI (p = 0.000) and all symptoms, except for appetite loss (p = 0.115) and pain (p = 0.433). Conclusions: While the reporting of measures and outcomes was generally higher compared to gastrointestinal chemotherapy cancer trials, it still faced significant under-reporting. Assessment tools should include cachexia-specific symptoms to accurately assess the quality of life in patients with lung cancer undergoing chemotherapy clinical trials. Full article

Bidirectionality between insomnia and depression is well documented in general and clinical populations but remains under-researched in family caregivers of people with dementia. This study aimed to explore this relationship using a longitudinal design with 155 family caregivers assessed annually over three years. Data collected included sociodemographic information, health behaviors, medical data, caregiving stressors, and depressive and insomnia symptoms. Two linear mixed models were tested: Model 1 considered insomnia symptoms as the independent variable and depressive symptoms as the outcome; Model 2 considered depressive symptoms as the independent variable and insomnia symptoms as the outcome. The results showed that caregivers with more insomnia symptoms over time had significantly higher depressive symptoms, even after adjusting for covariates. Insomnia accounted for an additional 7.47% of the variance, with a total explained variance of 57.93%. Conversely, higher depressive symptoms over time were associated with increased insomnia. Depressive symptoms explained an additional 7.28% of the variance, with a total explained variance of 25.74%. These results were consistent with previous studies on non-caregiving populations, adding empirical evidence to the notion that both insomnia and depression may operate as a risk factor for the other disorder. Caregiver support interventions could improve their psychological well-being if they incorporate sleep-focused strategies. Full article

Background and Objectives: During exam sessions, many students experience high levels of stress caused by the large volume of material to study, tight deadlines, and pressure to achieve top grades. This study aimed to examine the relationship between academic stress, sleep disturbances, and eating behaviors by using validated questionnaires administered to a student sample. As stress levels increased, the data revealed a higher frequency of insomnia symptoms and disordered eating, including behaviors such as compulsive eating and irregular meal patterns. Materials and Methods: This cross-sectional, correlational study was conducted on a convenience sample of 317 university students from various academic centers across Romania. Participants were recruited via online distribution of a self-administered questionnaire during a four-month period, including exam sessions. The survey included the Perceived Stress Scale (PSS), the Insomnia Severity Index (ISI), and the Eating Disorder Examination Questionnaire (EDE-Q), alongside additional items assessing perceived links between stress, sleep, and eating behaviors, and the use of medication. Data were analyzed using SPSS with Spearman correlations, t-tests, and linear regression. Results: Statistical analyses revealed significant and positive associations between perceived stress levels and insomnia, as indicated by Spearman’s correlation (p < 0.01). A similar significant correlation was identified between perceived stress and disordered eating behaviors among students. Specifically, the feeling of being overwhelmed by academic workload showed a strong positive correlation with a lack of control over eating behaviors (r = 0.568). Furthermore, linear regression analysis confirmed a significant predictive relationship between feeling overwhelmed and the tendency to eat excessively beyond initial intentions, with a standardized regression coefficient B = 0.581 (p < 0.001). A separate regression analysis focusing on exam-related stress and episodes of compulsive eating behavior demonstrated a comparable result (B = 0.573, p < 0.001), indicating a robust positive association. Additionally, independent samples t-tests demonstrated that students experiencing high levels of stress during the exam period reported significantly greater difficulties with sleep initiation and higher levels of disordered eating compared to their peers with lower stress levels. The difference in insomnia scores was highly significant (t = 11.516, p < 0.001), as was the difference in eating behavior scores (t = 10.931, p < 0.001). Conclusions: These findings underscore the need for emotional support services and effective stress management strategies, enabling students to navigate academic demands without compromising their mental or physical well-being. Full article