Search Results (105)

Background: Behavioural heterogeneity in obesity is increasingly recognised, but how specific dietary patterns, food preferences and physical activity vary between obesity classes remains poorly characterised. Methods: We analysed behavioural, dietary, and lifestyle data from 1366 adults attending a tertiary obesity clinic in Italy. Participants were stratified into five obesity classes defined by BMI. Age-adjusted regression models and chi-square tests with Bonferroni correction were used to examine associations between obesity severity and key behavioural outcomes, including food preferences, eating behaviours, physical activity, and self-reported sleep quality. Results: The prevalence of uncontrolled eating, skipping meals, and fast eating significantly increased with obesity severity after adjusting for age (all p < 0.05). Preference for yoghurt and legumes declined with increasing BMI, whereas preferences for meat and dairy remained stable. Age-adjusted sport participation decreased progressively, with significantly lower odds in Obesity I, II, and IIIA compared to the Overweight group. Sleep quality was highest among overweight participants and declined with obesity severity; night-time awakenings were most frequent in Obesity IIIB. Conclusions: Distinct behavioural and lifestyle traits, including lower sport participation, reduced preference for fibre-rich foods, and greater frequency of uncontrolled, fast, and irregular eating, showed overall trends across obesity classes. While these findings suggest the presence of behavioural phenotypes, their interpretation is limited by the cross-sectional design and the use of self-reported, non-validated measures. Future studies should incorporate objective assessments to inform targeted obesity interventions. Full article

Background/Objectives: The glymphatic system plays a crucial role in clearing brain metabolic waste, and its dysfunction has been correlated to various neurological disorders. The Diffusion Tensor Imaging Analysis Along the Perivascular Space (DTI-ALPS) index has been proposed as a non-invasive marker of glymphatic function by measuring diffusivity along perivascular spaces; however, its sensitivity to sleep-related changes in glymphatic activity has not yet been validated. This study aimed to evaluate the feasibility of using the DTI-ALPS index as a quantitative marker of dynamic glymphatic activity during sleep. Methods: Diffusion tensor imaging (DTI) data were obtained from 12 healthy male participants (age = 24.44 ± 2.5 years; Pittsburgh Sleep Quality Index (PSQI) < 5), once while awake and 16 times during sleep, following 24 h sleep deprivation and administration of 10 mg zolpidem. Simultaneous MR-compatible electroencephalography was used to determine whether the subject was asleep or awake. DTI preprocessing included eddy current correction and tensor fitting. The DTI-ALPS index was calculated from nine regions of interest in projection and association areas aligned to standard space. The final analysis included nine participants (age = 24.56 ± 2.74 years; PSQI < 5) who maintained a continuous sleep state for 1 h without awakening. Results: Among nine ROI pairs, three showed significant increases in the DTI-ALPS index during sleep compared to wakefulness (Friedman test; p = 0.027, 0.029, 0.034). These ROIs showed changes at 14, 19, and 25 min after sleep induction, with FDR-corrected p-values of 0.024, 0.018, and 0.018, respectively. Conclusions: This study demonstrated a statistically significant increase in the DTI-ALPS index within 30 min after sleep induction through time-series DTI analysis during wakefulness and sleep, supporting its potential as a biomarker reflecting glymphatic activity. Full article

Background: Sleep is a fundamental component of health, and deprivation has been linked to numerous adverse outcomes, including reduced academic and occupational performance, greater risk of accidents, and increased susceptibility to chronic diseases and premature mortality. Dietary and lifestyle behaviors are increasingly recognized as key determinants of sleep quality. Women are particularly susceptible to sleep disturbances due to hormonal fluctuations and psychosocial factors. However, women remain underrepresented in sleep research. This study aims to examine the associations between sleep quality, nutrition, and lifestyle in a large cohort of Spanish women. Methods: A cross-sectional study was conducted with 785 women aged 18–64. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the NutSo-HH questionnaire on dietary and lifestyle behaviors. Descriptive analyses, correlation matrices, Gaussian Graphical Models, and Principal Component Analyses were used to assess relationships between variables. Results: More than half of the participants rated their sleep quality as good or very good, although over 30% experienced frequent nighttime awakenings. Poor sleep quality was significantly associated with higher alcohol consumption, lower vegetable and white fish intake, and lower levels of physical activity. Diets rich in ultra-processed foods correlated moderately with subjective poor sleep and daytime dysfunction. However, no strong associations were found between stimulant consumption, late meals, or dietary patterns (e.g., Mediterranean diet) and sleep. Self-perceived health emerged as a protective factor, while nocturnal lifestyles were linked to longer sleep latency and fragmented sleep. Conclusions: In adult women, better sleep quality is linked to healthy dietary choices, regular physical activity, and a positive perception of general health. In contrast, alcohol use and irregular lifestyles are associated with poor sleep. Individual variability and cultural adaptation may moderate the impact of some traditionally harmful behaviors. Personalized, multidimensional interventions are recommended for promoting sleep health in women. Full article

Background/Objectives: The vestibulo-respiratory reflex regulates the tension of the respiratory muscles, which prevents apneas and awakenings during sleep. This study aimed to determine whether functional deficits in the inner ear disturb sleep quality. Methods: We compared sleep parameters in patients with their first episode of acute inner ear deficit (Group A: sudden idiopathic vertigo attack, sudden sensorineural hearing loss), chronic functional inner ear impairment (Group B: chronic peripheral vertigo, permanent hearing loss), and in healthy individuals (Group C). Polygraphy recordings were performed twice, in Group A at the onset of acute otoneurological symptoms and the second time after their withdrawal with an interval of 1 to 13 days, in Group B after 1 to 6 days, and in Group C after 1 to 8 days. Results: In Group A during the symptomatic night, overall and central apnea-hypopnea indices were significantly higher and snoring time was longer. Group A also had higher central apnea-hypopnea index on the first night compared to healthy individuals. In chronic disorders, sleep recordings showed lower autonomic arousal index than in controls or symptomatic nights in Group A. Conclusions: These findings highlight the severity of sleep apnea indicators in Group A. Our results suggest that acute dysfunction of the inner ear substantially impacts central neuronal signaling responsible for regulating normal sleep-related breathing and leads to a deterioration in sleep quality in contrast to individuals with chronic inner ear impairments. It can also be assumed that people with chronic vertigo or hearing loss experience less interrupted sleep than healthy individuals. Full article

Currently, approximately 40% of patients with dementia develop some form of sleep disorder. Benzodiazepines are widely prescribed but pose the risk of tolerance and cognitive decline; however, Z-drugs may offer safer alternatives. Therefore, this systematic review aimed to analyze the effect of benzodiazepines and Z-drugs on sleep disorders in patients with dementia. Two authors conducted a systematic search in PubMed, Scopus, Web of Science, Espistemonikos, and ACCESSSS for studies published between 2019 and 2024 using the MeSH terms “dementia”, “sleep disorders”, and “pharmacotherapy”. Randomized clinical trials comparing benzodiazepines, Z-drugs, or innovative medications with placebo or other drugs were included. Sleep and cognitive outcomes were assessed using validated instruments; the ROB-2 tool evaluated the risk of bias. The protocol was registered in “PROSPERO”. Three randomized clinical trials involving a total of 192 patients were included in the review. Zopiclone increased the main duration of nighttime sleep by 81 min, Zolpidem reduced nighttime awakenings by 21 min, and Eszopiclone improved sleep quality, benefited the progression of sleep architecture, and reduced mental symptoms such as fear and anxiety. Z-drugs show superior efficacy and safety over benzodiazepines, improving sleep and cognitive symptoms in dementia. Personalized treatment and further research across dementia subtypes are needed to optimize long-term outcomes. Full article

As globalization deepens, concerns over global fragmentation have intensified, accompanied by rising expectations that the Global South will emerge as a key driver of innovation, competitiveness, advanced markets, and high-quality employment. The widespread diffusion of the Internet and smartphones across developing countries suggests the possibility of leapfrog growth, highlighting the informal economy as a potential source of innovation. Recent developments in generative artificial intelligence (GAI) have further underscored the opportunity for collaborative engagement between developed and developing countries to awaken and harness sleeping innovation resources. This study investigates the dynamism of such international collaboration, focusing on digitalization-related challenges and its contributions to leapfrog growth. The interconnections among Internet usage, smartphone penetration, and economic development are examined, revealing the formation of a self-propagating cycle facilitated by GAI. A mathematical model is constructed to demonstrate the dependency of growth on sleeping resources inherent in the informal economy, which is empirically validated through data from nine African countries. Using the coevolutionary dynamics of Amazon and AWS as a conceptual reference, a novel framework is proposed for international collaborative utilization of sleeping innovation resources, offering new insights into GAI-driven innovation rooted in the informal economy. Full article

Background/Objectives: Alcohol consumption is known to influence cardiovascular regulation and sleep quality; however, real-world data on its acute effects—particularly during nocturnal rest—are limited. This study aimed to investigate the impact of moderate alcohol intake on nocturnal resting heart rate (HR) and sleep parameters using continuous smartwatch-based monitoring in healthy individuals. Methods: In this prospective observational study, 40 healthy adults (63% female, mean age of 30.5 years) underwent a structured 9-day smartwatch monitoring period. The protocol included three alcohol-free baseline days, three consecutive evenings with moderate alcohol consumption (40 g/day for women, 60 g/day for men), and three post-exposure days. Continuous data on HR, sleep stages, nocturnal awakenings, and physical activity were recorded. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline. The primary endpoint was the change in the average nocturnal resting HR. Secondary outcomes included sleep parameters and activity levels. Results: Alcohol consumption led to a statistically significant increase in nocturnal resting HR from 63.6 ± 9.2 bpm at baseline to 66.6 ± 9.0 bpm during exposure (p < 0.001), with rapid normalization during the post-exposure phase (64.9 ± 9.3 bpm). No significant changes were observed in objective sleep architecture or daytime activity. Despite stable sleep structure, participants reported reduced subjective sleep quality under alcohol exposure, suggesting a potential link to the elevated HR. Conclusions: Even moderate alcohol intake transiently elevates nocturnal resting HR without affecting sleep architecture, likely impairing physiological recovery. These findings underscore the underestimated cardiovascular impact of alcohol and warrant further research in larger and more diverse populations. Full article

Trail running has seen a surge in participants, including individuals with disabilities, particularly in ultratrail running (UTRs). Sleep–wake patterns are crucial for optimal performances in UTRs, which present unique physiological and behavioral challenges. This case study evaluated the sleep–wake cycle of a blind trail ultramarathoner (BTR) and his guide (GTR) before, during, and after an 80 km UTR. Two male participants (BTR: 54 years, BMI: 26.1 kg/m²; GTR: 48 years, BMI: 24.2 kg/m²) were assessed using validated questionnaires (MEQ, ESS, ISI, and PSQI) and actigraphy over 35 days. The BTR exhibited a morning chronotype (MEQ = 63), mild insomnia (ISI = 11), poor sleep quality (PSQI = 5), and prolonged sleep latency (>60 min), while the GTR showed an indifferent chronotype (MEQ = 52), good sleep quality (PSQI = 3), and shorter latency (10 min). Post-competition, both athletes experienced an increased total sleep time (TST): the BTR by 17.8% (05:32:00 vs. 04:25:00) and the GTR by 5.5% (07:01:00 vs. 06:39:00). The BTR demonstrated a greater Wakefulness after sleep onset (WASO 01:00:00 vs. 00:49:00) and awakenings (15.4 vs. 6.1). A time series analysis revealed greater variability in the BTR’s post-competition sleep efficiency and TST, while the GTR exhibited a greater stability of the circadian phase. These findings highlight the intricate sleep challenges faced by blind athletes, informing strategies to optimize recovery and performance. Full article

Introduction: Sleep is a fundamental biological function critical for physical and mental health. Chronic sleep disturbances can significantly impair cognitive, emotional, and social functioning, leading to deficits in attention, alertness, and executive function, alongside increased irritability, anxiety, and depression. For pediatric patients, such disturbances pose additional concerns, potentially disrupting developmental processes and quality of life for both children and their families. Objectives: Emerging evidence suggests a correlation between neurofibromatosis type 1 (NF1) and an increased prevalence of sleep disorders in children. NF1, a genetic condition affecting multiple body systems, including the nervous system, may predispose children to sleep disturbances due to its neurodevelopmental and behavioral impacts. This observational case–control study aimed to explore the association between NF1 and sleep disorders in pediatric patients, comparing the prevalence and patterns of sleep disturbances between NF1 patients and healthy controls. Patients and Methods: The study included 100 children aged 2–12 years, divided into two groups: 50 with NF1 (case group) and 50 children belonging to the control group. NF1 patients were recruited from the Unit of Rare Diseases of the Nervous System in Childhood at the Policlinico “G. Rodolico—San Marco” University Hospital in Catania. Data were collected using a questionnaire completed by parents, assessing parasomnias, breathing-related sleep disorders, and other behavioral and physiological disturbances; these data were compared to a sleep assessment performed using an Apple Watch Ultra. Results: NF1 patients exhibited a significantly higher prevalence of sleep disorders than controls. Notable differences included increased nocturnal hyperhidrosis (48% vs. 10%), bruxism (48% vs. 28%), restless legs syndrome (22% vs. 4%), frequent nighttime awakenings (22% vs. 8%), and sleep paralysis (12% vs. 0%). A finding of poorer sleep quality also emerged from the results of sleep analysis using an Apple Watch Ultra. Conclusions: These findings confirm an elevated risk of sleep disorders in children with NF1, emphasizing the importance of early identification and management to improve quality of life and mitigate cognitive and behavioral impacts. Further research is essential to understand the mechanisms underlying these associations and develop targeted interventions for this population. Full article

Background: Many athletes experience sleep difficulties, and prior research within this cohort suggests that acute supplementation of alpha-lactalbumin (ALAC), a whey protein rich in the amino acid tryptophan, may improve sleep and performance. Therefore, this study investigated whether sub-chronic ALAC supplementation in the evening would improve sleep and physical performance within a poor-sleeping athletic population. Methods: In total, 24 athletically trained participants with sleep difficulties (Athlete Sleep Screening Questionnaire: 8.6 ± 2.2; Pittsburgh Sleep Quality Index: 10.0 ± 3.0) completed this double-blinded, randomised controlled, crossover trial. The participants were supplemented with 40 g of ALAC or control 2 h pre-sleep for seven consecutive nights within habitual settings, with sleep measured via actigraphy. Performance was assessed following the 1-week supplementation period, with the 30 s countermovement jump test, Yo-Yo Intermittent Recovery Test Level 1, and reaction time testing performed in a standardised sequence under controlled conditions. Results: During the ALAC condition, the objective number of awakenings increased (CON: 10.25 ± 5.28, ALAC: 11.01 ± 5.79; p = 0.031), the average jump height reduced (CON: 28.58 ± 5.53 cm, ALAC: 27.68 ± 5.14 cm; p = 0.037), the subjective physical and mental performance capabilities declined in the evening (p < 0.001), and evening negative emotional states (p = 0.001) were reduced. Conclusions: Seven days of ALAC supplementation may not improve the sleep and physical performance of an athletically trained population with mild–moderate sleep difficulties. Future research should recruit populations with more severe sleep difficulties and measure sleep architecture over an extended period to fully ascertain the effects, and potential benefits, of ALAC supplementation for athletes. Full article

Background/Objectives: Active gamification, which incorporates game elements with physical interaction, is presented as an innovative strategy to address anxiety problems and sleep quality in children. This study aimed to evaluate the impact of an active gamification program on the aforementioned variables in children in primary education. Methods: This study utilized a randomized, controlled trial with 120 children between 8 and 11 years of age, divided into an experimental group, which participated in a 12-week gamified program, and a control group, which continued with traditional physical education classes. Results: The main findings indicate that the intervention had a significant impact on reducing anxiety, with improvements in most of the subscales evaluated except for the obsessive-compulsive disorder subscale. Significant improvements were also found in sleep quality, with reductions in bedtime resistance, nighttime awakenings, parasomnias, and sleep-disordered breathing, although no significant changes were noted in sleep-onset delay, sleep duration, sleep anxiety, and daytime sleepiness. Conclusions: The gamification intervention in physical exercise showed positive effects in reducing anxiety and improving sleep quality in primary school children, highlighting its potential as an intervention strategy in primary education classrooms. Full article

Introduction: Sleep disturbance (SD) in the second half of the night due to inflammatory pain was included in the 2009 ASAS classification criteria of Spondyloarthritis (SpA), even though its definition is uncertain. Aim: We aimed to investigate SD in early-SpA (e-SpA) patients at T1 (2010–2013), comparing them to long-term SpA (l-SpA) patients at T2 (2023–2024) after at least 10 years of follow-up. Methods: At T1, in e-SpA and l-SpA cases, SD, classified as “difficulty in initiating sleep” (DIS), “difficulty in maintaining sleep” (DMS) and “early awakening” (EA), was compared to clinical parameters (ASDAS-CRP, BASDAI, m-HAQ-S, BASMI, MASES, 68/66 joint count, tenderness of sacroiliac joints, fatigue [FACIT] and HADS for anxiety [A] and depression [D]). At T2, e-SpA patients were re-evaluated using the Pittsburgh Sleep Quality Index (PSQI). Results: At T1, 45% of 166 SpA patients had SD; in e-SpA patients (60), SD correlated with sacroiliac pain (DMS) BASDAI, FACIT and HADS-D (EA); in l-SpA patients (106), it correlated with HADS-A (DIS), BASDAI and FACIT (DMS). At T2, e-SpA patients showed a high PSQI in 51.5% of cases, correlated with T2-ASDAS-CRP and T2-BASDAI. Moreover, T1-ASDAS-CRP was predictive of T2-PSQI. Conclusions: SD is more specific for inflammatory pain in e-SpA and might be influenced by disease activity also in long-term disease. Full article

Background/Objectives: Ageing is associated with several cognitive, physical, and emotional changes, including a decrease in sleep quality and mental health issues. This study studies NESA (Spanish acronym for Neuromodulación Superficial Aplicada) non-invasive neuromodulation using microcurrents as something that may provide a potential improvement in the quality of sleep and general health of older adults and residents in a healthcare institution. Methods: This observational study recruited 24 people who were residents at a long-term care facility. Participants were divided into two groups: one intervention group, who underwent NESA therapy twice a week for a total of 20 sessions, and a control group, who did not receive this treatment. The outcomes measured include sleep quality (Pittsburgh Sleep Quality Index), diary of sleep, symptoms of depressed mood (Yesavage Geriatric Depression Scale), and quality of life with the World Health Organization Quality of Life-Old (WHOQOL-OLD). Scores were collected at baseline, after 10 and 20 sessions, and 3 months after finishing the treatment. Results: The intervention group exhibited a notable improvement in sleep quality (p = 0.05). Additionally, there were fewer nocturnal awakenings. The quality of life also showed better scores, especially in relation to social relations and physical and mental health, which matches the slight decrease in scores and clinical improvement regarding depressive symptoms. In contrast, the control group demonstrated no improvement in symptoms, and in some cases, there was a worsening of symptoms. Conclusions: Our findings indicate that NESA non-invasive neuromodulation therapy is likely to enhance sleep quality and health-related measures in institutionalized older adults. Despite the limitations of the current study, the results support the potential of NESA microcurrents to enhance the well-being of this population. Full article

Background/Objectives: Narcolepsy is a chronic neurologic disorder associated with substantial challenges that affect the social, emotional, and financial quality-of-life domains. A social listening analysis and structured survey were conducted to better understand the candid perspective of people with narcolepsy (PWN) and their experience with twice-nightly sodium oxybate (SXB). Methods: To characterize conversations and experiences in narcolepsy communities where SXB was mentioned, a social media analysis was conducted from August 2011 to October 2022. A structured survey was administered to PWN taking oxybate therapy from October 2022 to November 2022. Results: From the social media analysis, the largest topic was related to “cataplexy”, with 537 posts/comments. The most frequent term was “xyrem”, with 22,200 mentions. Of the 87 survey respondents, 85 respondents had narcolepsy, 75.3% (64/85) reported missing their second dose of immediate-release SXB or mixed-salt oxybates, and 58.8% (50/85) of respondents reported that they took their second dose of oxybate > 4 h after the first dose. Respondents reported poor sleep quality as the greatest effect or issue experienced after missing their second oxybate dose. When respondents were asked whether they had ever been injured after waking to take their second oxybate dose, 31.8% (27/85) of respondents reported an injury. Conclusions: PWN taking twice-nightly oxybates often report inconsistent adherence to the prescribed dosing, which results in negative consequences in their lives. This research provided an anonymized forum for PWN to voice challenges with middle-of-the-night awakenings that they may be reluctant to explain to their clinician. Full article

Background/Objectives: Sleep disturbance is often observed in the context of chronic pain. We hypothesize that, by providing an immersive Virtual Reality (VR) experience with a serious game to chronic pain patients an hour before bedtime, attention can be diverted from the pain condition, consequently leading to improved sleep quality. The aim is to evaluate the efficacy of VR compared to usual care in reducing the number of awakenings during the night and increasing sleep efficiency in patients suffering from painful diabetic polyneuropathy (PDPN). Methods: Eight patients with PDPN were randomized to either two weeks of VR or two weeks of usual care, followed by a cross-over. The primary outcome measurements were sleep efficiency and number of awakenings during the night. As secondary outcomes, self-reported sleep quality, insomnia, pain catastrophizing, anxiety, depression, pain intensity, side effects and impression of change were evaluated. Results: Data of seven patients were analysed. Actigraphy data, self-reported sleep quality, insomnia, pain catastrophizing, anxiety, depression and pain intensity scores did not differ between usual care and VR. As for impression of change, more patients improved after VR compared to usual care (V = 21, p = 0.03). Conclusions: A 2-week period of pain neuroscience education through VR did not result in increased sleep efficiency or fewer awakenings compared to usual care in patients with PDPN. These pilot results indicate that patients subjectively experience an improvement, yet this is not substantiated by either self-reported or objective measurements. Full article