Search Results (189)

Objective: The development of a normal sleep–wake rhythm in the first weeks of life depends on the physiological sensory needs of the newborn as well as the environment surrounding them. This includes, for example, avoiding pain, exposure to bright light at night and high noise levels. In high-risk newborns, this process can be influenced by immaturity of the central and peripheral nervous systems, therapeutic strategies and the work organization of an intensive care unit. Methods: This study used a narrative review to examine the literature on the interrelationship of sensory modalities on sleep–wake behavior in the context of neonatal intensive care. The current Cochrane reviews on cycled lighting’s effect on premature infants’ circadian rhythm development and noise or sound management in the neonatal intensive care unit, as well as the World Health Organization (WHO) global position paper on kangaroo mother care, were included. Results: An extensive body of literature relates to fetal and neonatal development of the five sensory modalities: touch, taste, smell, hearing and sight. In contrast, there is a lack of evidence regarding the choice of optimal lighting and suitable measures for noise reduction. Since 2023, the WHO has recommended that, from the moment of birth, every “small and sick” newborn should remain in skin-to-skin contact (SSC) with their mother. Developmental support pursues a multimodal approach with the goal of fostering early parent–child bonding, including the child’s needs and environmental conditions. Discussion: The implementation of early SSC and attention to the sleep–wake cycle require systemic changes in both the obstetric and neonatal settings to ensure seamless perinatal management and subsequent neonatal intensive care. Since there is a lack of evidence on the optimal sensory environment, well-designed, well-conducted and fully reported randomized controlled trials are needed that analyze short-term effects and long-term neurodevelopmental outcomes. Full article

Background/Objectives: Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the sinonasal mucosa lasting for at least three months. For patients, CRS-related sleep disturbances can significantly disrupt circadian rhythms, leading to further health complications such as cognitive impairment. Despite the well-documented sleep disturbances associated with CRS, there is limited research on objective assessment methods. Additionally, the severity of these issues can vary among patients. This study aims to assess sleep quality and timing in CRS patients and investigate their impact on cognition, providing guidance for personalized and tailored assessment and management of CRS. Methods: Our case–control study compares sleep patterns and cognitive function between CRS patients and healthy controls utilizing actigraphy, a non-invasive device for measuring sleep–wake cycles and circadian rhythms. The actigraphy-derived sleep variables include inter-daily variability, intra-daily variability, highest 10 h activity (M10), lowest 5 h activity (L5), relative amplitude (RA), sleep onset latency, sleep efficiency, sleep and wake time, time spent in bed, total sleep time, and wakefulness after sleep onset. We also used a standard questionnaire assessing sleep quality, the Pittsburgh Sleep Quality Index (PSQI). Results: Our study enrolled 44 CRS and 43 control participants. Our findings indicate that the actigraphy-derived sleep variables were comparable between groups, all with a p-value > 0.05. However, CRS patients exhibited greater early morning activity and significantly lower PSQI-reported sleep quality compared to controls (8.78 ± 3.45, 4.71 ± 2.96, respectively; adjusted p < 0.001). Actigraphy-derived sleep variables showed trends towards significance in association with episodic memory (p = 0.051) and executive function (p = 0.15). Conclusions: Actigraphy-derived sleep outcomes revealed associations with episodic and executive function, underscoring the potential of actigraphy in understanding the individualized sleep-related cognitive impacts in CRS patients. This highlights the importance of personalized assessment and management strategies to address the unique sleep and cognitive challenges faced by each patient. Full article

The importance of sleep has been reported for decades. Epilepsy is a heterogeneous disorder comprising multiple elements that might influence sleep and wakefulness. Notably, animal studies show disruptions of the circadian molecular system in different models of epilepsy, along with altered rest–activity and other circadian rhythms. So far, studies of molecular circadian systems in people with epilepsy are lacking, prompting further research. Seizures—the primary and most debilitating symptom of epilepsy—and interictal activity disrupt regular sleep and sleep–wake rhythms. Alterations in one’s sleep structure are seen in both drug-naïve and drug-resistant patients with epilepsy. In particular, low sleep efficiency, a reduction in total sleep time, and changes in sleep stages were found in both homogenous and mixed samples of epilepsy patients. Both ictal and interictal activity were also shown to be associated with changes in peripheral circadian phase biomarkers such as melatonin and cortisol. Moreover, epilepsy comorbidities, antiseizure medications, and a variety of syndromes can be a cause of sleep problems or even sleep disorders. Sleep disorders vary depending on various comorbidities and syndromes, and encompass all major groups of sleep disorders defined in the International Classification of Sleep Disorders. Controversial findings on the effects of various antiseizure medications were found in the literature. However, medications such as benzodiazepines, gabapentinoids, and barbiturates are particularly associated with excessive daytime sleepiness. Overall, a sleep evaluation must be included in the management of every patient with epilepsy. Full article

Background and Objectives: Shift work and night work are common among emergency physicians. It is necessary to provide continuous care to patients, especially with acute diseases, including throughout the night. Literature studies show that shift and night workers have an altered light exposure, timing of sleep and intake of food. The consequence of this desynchronization with the biological clock can lead these workers to be more exposed to developing some acute and chronic health conditions. In particular, the alteration of the sleep–wake cycle, fatigue, the shortened sleep duration and the misalignment of the body’s hormone production is a codified risk factor of gut dysbiosis that can lead to acute and chronic diseases, also gastrointestinal ones. the aim of this narrative review is to collect and summarize evidence about the association between the disruption of the circadian rhythm, sleep and food timing alterations, gut dysbiosis and the risk of gastrointestinal diseases among shift and night workers. Materials and Methods: we searched for evidence about the association of shift and night work, dysbiosis, gut microbiota and gastrointestinal diseases among shift workers in healthcare settings. Results: shift work and night work are associated with a higher risk of diseases, an inflammatory state and the alteration of the gut microbiota composition; but definitive data are still inconsistent. Conclusions: Until now, obtaining conclusive results in regard to the relationship between shift work, the gut microbiota and the increased risk of gastrointestinal disorders has been particularly complex and not yet feasible. More confirmatory studies are needed to better characterize risk factors and realize preventive measures. Full article

The sleep–wake rhythm, regulated by the suprachiasmatic nucleus (SCN) and peripheral clocks, is influenced by light, nutrition, stress, and exercise. Recent findings suggest that estrogen receptors in the SCN may link ovarian hormone regulation to circadian rhythms, highlighting the need to consider hormonal fluctuations throughout the menstrual cycle when examining the effects of exercise on the sleep–wake rhythm in females. Therefore, we conducted a scoping review to compile existing studies involving human participants, aiming to provide a foundation for research focused on the specific physiological phenomena in females. Based on 228 literature sources, only 6 met the inclusion criteria. Despite variations in the exercise type, intensity, and duration, transient exercise demonstrated a significant impact on the expression of the clock genes BMAL1, PER2, and CRY1, suggesting their susceptibility to such activities. This review highlights the absence of studies examining the effects of exercise on clock gene expression in females, particularly in relation to menstrual cycles and ovarian hormone fluctuations, emphasizing the need for future investigations that incorporate these factors. Full article

Artificial light exposure, particularly from blue-rich sources, has raised concerns about its impact on sleep and circadian rhythms. While blue light’s effects are well-documented, the comparative impact of longer wavelengths, such as orange light (590–635 nm), remains underexplored. This study investigated the effects of 8 h blue (470–490 nm) and orange light exposures (500 lux) on sleep architecture in the next consecutive three days in Sprague-Dawley rats during the light or dark phase of a 12:12 h light–dark cycle. Sleep–wake states were assessed via electroencephalography (EEG) over 72 h. Blue light during the light period suppressed rapid eye movement (REM) sleep acutely and enhanced non-NREM sleep on Days 2 and 3. Orange light during the light period induced no immediate changes but increased NREM sleep on Day 2 with a biphasic REM response—suppression followed by rebound—persisting into Day 3. Blue light during the dark period increased NREM sleep during exposure, followed by suppression in the subsequent light period, with effects normalizing by Day 2. Blue light exposure suppressed melatonin levels compared to controls. These findings highlight spectral and temporal influences on sleep, with blue light exerting stronger acute effects and orange light eliciting delayed, biphasic responses. The results suggest implications for managing light exposure to mitigate sleep disruptions in modern environments. Full article

Melatonin is an indolamine derived from tryptophan, which is highly conserved throughout evolution, including in zebrafish, where it controls important cellular processes, such as circadian rhythms, oxidative stress, inflammation, and mitochondrial homeostasis. These functions of melatonin and its synthesis route are quite similar to those in humans. One of the most important enzymes in melatonin synthesis is acetylserotonin O-methyltransferase (ASMT), the rate-limiting enzyme, which catalyzes its final step. Due to genome duplication, zebrafish has two genes for this enzyme, asmt1 and asmt2. These genes show differential expression; asmt1 is primarily expressed in the retina and the pineal gland, and asmt2 is expressed in peripheral tissues, indicating different functions. Therefore, the aim of this work was to develop a mutant model for each asmt gene and to analyze their phenotypic effects in zebrafish. The results showed that the loss of 80% of the asmt2 gene affected melatonin concentration and consequently disrupted the sleep/wake rhythm in larvae, decreasing by 50% the distance traveled. In contrast, the loss of asmt1 had a greater influence on the physical condition of adults, as locomotor activity decreased by 50%, and 75% showed malformations. These data reveal distinct functional roles of melatonin depending on their site of production that may affect the development of zebrafish. Full article

Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) is an X-linked rare neurodevelopmental disorder associated with severe sleep disturbances. However, little is known about the mechanisms underlying sleep disturbances in CDD patients. Here, we employed the electroencephalogram (EEG) recording to characterize sleep–wake behaviors and EEG activity in male CDKL5-deficient mice. We found that young adult and middle-aged Cdkl5 knockout (KO) mice recapitulated sleep phenotypes in patients with CDD, including difficulties in initiating and maintaining sleep, reduction in total sleep time, and frequent night awakenings. Cdkl5 KO mice exhibited pre-sleep arousal, but normal circadian rhythm and homeostatic sleep response. Conditional knockout (cKO) of Cdkl5 in glutamatergic neurons resulted in reduced sleep time and difficulty in sleep maintenance. Further, the rate of age-associated decline in sleep and EEG activity in Cdkl5 KO mice was comparable to that of wild-type littermates. Together, these results confirm a causative role for CDKL5 deficiency in sleep disturbances observed in CDD patients and establish an animal model for translational research of sleep treatment in CDD. Moreover, our results provide valuable information for developing therapeutic strategies and identifying sleep and EEG parameters as potential biomarkers for facilitating preclinical and clinical trials in CDD. Full article

Sleep is a crucial physiological process for cognitive, emotional, and physical development during childhood. Despite its importance, a significant percentage of school-aged children experience sleep disturbances, which can impact academic performance and overall well-being. This cross-sectional study aims to investigate sleep habits and disorders in children aged 6–13 years, identifying issues such as difficulties falling asleep, frequent awakenings, and parasomnias, as well as their correlations with daytime consequences. Methods: A structured questionnaire, based on the Sleep Disturbance Scale for Children (SDSC), was administered to 100 parents of school-aged children. The sample included participants without diagnosed neurological disorders, neurodevelopmental disorders, or chronic illnesses interfering with sleep. The data were statistically analyzed to assess the frequency and severity of sleep disturbances and their correlations with daytime symptoms. Results: Although most children (44.1%) slept 8–9 h per night, 32.4% exhibited bedtime resistance, and 29.4% had difficulty falling asleep. Common sleep disturbances included occasional snoring (44.1%), bruxism (11.8%), morning fatigue (41.2%), and daytime sleepiness (15.2%). Additionally, 23.5% of the children experienced confusion upon waking. The analysis also revealed a correlation between sleep fragmentation and mood alterations or cognitive difficulties. Conclusions: The study confirms the high prevalence of sleep disorders in pediatric populations, emphasizing the need for routine screening during clinical check-ups. Educational interventions on sleep hygiene practices—such as reducing evening screen exposure—and school policies that align with pediatric circadian rhythms could mitigate negative effects. The lack of objective measures such as actigraphy and polysomnography is a limitation, highlighting the need for integrated approaches in future studies. A multidisciplinary approach is essential to optimizing sleep health and overall child development. Full article

Ageing is associated with alterations in circadian rhythms and thermoregulation, contributing to a fragmentation of the sleep–wake cycle and possibly age-related changes in cognitive performance. In this study, we investigated the relationship between visuo-spatial working memory (vsWM) performance and thermoregulation in young (18–34 years) and old (64–84 years) healthy human adults. Variations in the distal–proximal skin temperature gradient (DPG) were continuously monitored over the 24 h cycle in a field setting. vsWM was assessed during morning (09:00) and evening sessions (17:00) using an object–location binding task. As expected, a reduced circadian DPG amplitude was observed in old as compared to young participants. Likewise, old participants produced more errors than the young ones in object identification and location, suggesting reduced vsWM ability. Notwithstanding this, no significant association was found between circadian DPG modulation and vsWM performance, nor between testing time-of-day and cognitive performance. Further research is needed to explore environmental factors and the timing of peak circadian rhythms to better understand the interplay between circadian biology and cognitive ageing. Full article

Background/Objectives: Bipolar disorder (BD) is a chronic, severe mental health condition characterized by episodes of mood instability, including manic and depressive episodes. While pharmacological interventions remain foundational in BD treatment, psychotherapy offers significant benefits by addressing the psychological and behavioral components that contribute to mood episodes and overall functioning. The primary objective of this short communication is to propose new directions in psychotherapy for treating bipolar disorder, focusing on integrative models that combine evidence-based therapies such as Cognitive Behavioral Therapy (CBT), Interpersonal and Social Rhythm Therapy (IPSRT), Family-Focused Therapy (FFT), and mindfulness-based approaches. By integrating these therapies, clinicians can target both cognitive distortions and emotional dysregulation while simultaneously stabilizing sleep–wake cycles and improving interpersonal functioning. The secondary objective emphasizes the importance of better understanding and psychoeducation in family therapy, which can promote a better understanding of BD among family members and ensure more effective management of the disorder in daily life. Methods: We explore the potential of Cognitive Behavioral Therapy (CBT), Interpersonal and Social Rhythm Therapy (IPSRT), Family-Focused Therapy (FFT), and mindfulness-based interventions in enhancing symptom management and preventing relapse. Results: We identified psychoeducation and family therapy as critical components in supporting patients and improving treatment adherence. These therapeutic interventions play a pivotal role in enhancing patient engagement, improving coping strategies, and facilitating better overall treatment outcomes. Conclusions: We propose a multidisciplinary approach, integrating psychotherapy with pharmacotherapy, to optimize long-term outcomes and improve the overall quality of life for individuals with bipolar disorder. Full article

Growing evidence suggests that abnormal diurnal blood pressure rhythms may be associated with many adverse health outcomes, including increased risk of cognitive impairment and dementia. This study evaluates methodological aspects of research on bidirectional associations between ambulatory blood pressure monitoring (ABPM) patterns and cognitive function. By examining the 28 recent studies included in a recent systematic review on the association between ABPM patterns with cognitive function and risk of dementia, our review revealed several significant limitations in study design, sample characteristics, ABPM protocol, cognitive assessment, and data analysis. The major concerns include a lack of diversity in study populations with underrepresentation of Blacks and Latinos, a predominant focus on Alzheimer’s disease or all-cause dementia without distinguishing other dementia subtypes, different and not standardized measures of cognition or dementia, prevalent use of 24 h monitoring without considering the adaption effect, inconsistent definitions of dipping status, and ignorance of individual differences in timings of daily activities such as bed and awakening times. In addition, confounding variables such as class, dose, and timing of antihypertensive medication are inadequately controlled or considered. Further, longitudinal studies were scarce examining the bidirectional relationship between ABPM patterns and cognitive decline over time. Collectively, these deficiencies undermine the reliability and generalizability of current findings. Addressing these methodological challenges is crucial for a more comprehensive understanding of diurnal blood pressure rhythms in diverse populations and for developing an evidence-based guideline for ambulatory monitoring and control of blood pressure across the sleep-wake cycle to prevent cognitive decline and dementia. Full article

Background/Objectives: Dysregulation of Mood, Energy, and Social Rhythms Syndrome (DYMERS) characterizes the poor regulation of biological (sleep/waking), social, and behavioral rhythms that affected the level of burnout in healthcare professionals during the pandemic in particular. The aim is to provide an initial scoping review of publications on this topic. Methods: The keywords “Stress Rhythms Dysregulation Bipolar Disorder Burnout DYMERS Healthcare professionals COVID-19” were searched on 9 December 2024 following PRISMA 2020 guidelines, using five primary databases (OVID, ProQuest, PubMed, Scopus, Web of Science), one register (Cochrane COVID-19 register), and one supplementary database (Google Scholar). Included were peer-reviewed publications. Excluded were duplicates, reports lacking either a research study or any keywords, or including irrelevant information regarding them. Results: The returns for all the databases were (n = 0) except for ProQuest (n = 4) and Google Scholar (n = 14). Of these, three ProQuest returns were duplicates of the Google Scholar search. The remaining report contained irrelevant information on healthcare professionals. The Google Scholar search results produced two relevant reports—neither duplicated with ProQuest. The excluded contained a duplicate in the search itself, three that did not mention healthcare professionals, two that contained irrelevant information concerning them, four returns that were not a research study, and three that were not peer-reviewed. Conclusions: The two studies published on this topic are by various members of the same investigating institution. DYMERS has provided valuable insights regarding burnout in healthcare professionals. The suggestion is for further DYMERS research by this team and others, anticipating future pandemics. Full article

Modern treat-to-target management of rheumatoid arthritis (RA) involves titration of drug therapy to achieve remission, requiring close monitoring of disease activity through frequent clinical assessments. Accelerometry offers a novel method for continuous remote monitoring of RA activity by capturing fluctuations in mobility, sedentary behaviours, physical activity and sleep patterns over prolonged periods without the expense, inconvenience and environmental impact of extra hospital visits. We aimed to (a) assess the feasibility, usability and acceptability of wearable devices in patients with active RA; (b) investigate the multivariate relationships within the dataset; and (c) explore the robustness of accelerometry outcomes to downsampling to facilitate future prolonged monitoring. Eleven people with active RA newly starting an arthritis drug completed clinical assessments at 4-week intervals for 12 weeks. Participants wore an Axivity AX6 wrist device (sampling frequency 100 Hz) for 7 days after each clinical assessment. Measures of macro gait (volume, pattern and variability), micro gait (pace, rhythm, variability, asymmetry and postural control of walking), sedentary behaviour (standing, sitting and lying) and physical activity (moderate to vigorous physical activity [MVPA], sustained inactive bouts [SIBs]) and sleep outcomes (sleep duration, wake up after sleep onset, number of awakenings) were recorded. Feasibility, usability and acceptability of wearable devices were assessed using Rabinovich’s questionnaire, principal component (PC) analysis was used to investigate the multivariate relationships within the dataset, and Bland–Altman plots (bias and Limits of Agreement) and Intraclass Correlation Coefficient (ICC) were used to test the robustness of outcomes sampled at 100 Hz versus downsampled at 50 Hz and 25 Hz. Wearable devices obtained high feasibility, usability and acceptability scores among participants. Macro gait outcomes and MVPA (first PC) and micro gait outcomes and number of SIBs (second PC) exhibited the strongest loadings, with these first two PCs accounting for 40% of the variance of the dataset. Furthermore, these device metrics were robust to downsampling, showing good to excellent agreements (ICC ≥ 0.75). We identified two main domains of mobility, physical activity and sleep outcomes of people with RA: micro gait outcomes plus MVPA and micro gait outcomes plus number of SIBs. Combined with the high usability and acceptability of wearable devices and the robustness of outcomes to downsampling, our real-world data supports the feasibility of accelerometry for prolonged remote monitoring of RA disease activity. Full article

Circadian rhythms are intrinsic, 24 h cycles that regulate key physiological, mental, and behavioral processes, including sleep–wake cycles, hormone secretion, and metabolism. These rhythms are controlled by the brain’s suprachiasmatic nucleus, which synchronizes with environmental signals, such as light and temperature, and consequently maintains alignment with the day–night cycle. Molecular feedback loops, driven by core circadian “clock genes”, such as Clock, Bmal1, Per, and Cry, are essential for rhythmic gene expression; disruptions in these feedback loops are associated with various health issues. Dysregulated lipid metabolism in the brain has been implicated in the pathogenesis of neurological disorders by contributing to oxidative stress, neuroinflammation, and synaptic dysfunction, as observed in conditions such as Alzheimer’s and Parkinson’s diseases. Disruptions in circadian gene expression have been shown to perturb lipid regulatory mechanisms in the brain, thereby triggering neuroinflammatory responses and oxidative damage. This review synthesizes current insights into the interconnections between circadian rhythms and lipid metabolism, with a focus on their roles in neurological health and disease. It further examines how the desynchronization of circadian genes affects lipid metabolism and explores the potential mechanisms through which disrupted circadian signaling might contribute to the pathophysiology of neurodegenerative disorders. Full article