Search Results (379)

Background: Obstructive sleep apnea (OSA) is a common but underrecognized sleep-related breathing disorder characterized by intermittent hypoxemia and autonomic dysfunction. OSA prevalence and clinical relevance in Type 1 Diabetes Mellitus (T1DM), particularly in relation to diabetes-related vascular complications, remain insufficiently explored. Objective: The aim of this study was to evaluate the prevalence of high-risk OSA in adults with T1DM and controls, and to investigate the association between high-risk OSA and microvascular complications among individuals with T1DM. Methods: In this cross-sectional case–control study, 102 adults with T1DM and 126 controls were included. OSA risk was assessed using the modified Berlin Questionnaire (mBQ). Analyses of vascular complications were restricted to participants with T1DM. Multivariable logistic regression models adjusted for age and sex were used to assess associations, with additional adjustments for body mass index, hypertension, current smoking, alcohol use and glycated hemoglobin A1c. Results: High-risk OSA was identified in 18.6% of individuals with T1DM and 11.9% of controls, with no significant difference between groups. Among participants with T1DM, the prevalence of microvascular complications (retinopathy and/or neuropathy) was substantially higher in those with high-risk OSA compared with those at low risk (68.4% vs. 18.07%, p <0.001). In univariate logistic regression analysis, high-risk OSA was significantly associated with microvascular complications (odds ratio [OR] 4.85; 95% confidence interval [CI] 1.65–14.24; p = 0.004). This association remained significant in the fully adjusted model (OR 5.55; 95% CI 1.36–22.65; p = 0.017). Conclusions: High-risk OSA is not more prevalent in adults with T1DM compared with controls; however, among individuals with T1DM, high-risk OSA is strongly and independently associated with microvascular complications. Given the potential contribution of diabetic microvascular and autonomic neuropathy to upper airway dysfunction, the relationship between OSA and vascular complications in T1DM may be bidirectional, warranting further longitudinal investigation. Full article

Background: Sleep disturbance and psychosocial stress are emerging contributors to hypertensive disorders of pregnancy. The present cohort was recruited during the COVID-19 period, a time marked by substantial changes in prenatal care delivery, social support, and daily routines, which may have influenced maternal sleep and stress burden. Objective: This study aimed to evaluate the independent and integrated associations between maternal sleep quality, psychological stress, and pregnancy outcomes in women at moderate to high risk for preeclampsia. Methods: In a single-center observational cohort of 170 pregnant women enrolled at 16 weeks’ gestation, sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fitbit Sense 2™ wearable data, while stress was measured through the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and morning salivary cortisol. Associations with preeclampsia, birth weight, gestational age, and NICU admission were analyzed using multivariate regression and receiver operating characteristic (ROC) models. The COVID-19 period was treated as the contextual background of recruitment rather than as a directly compared exposure. Results: Poorer subjective sleep quality (higher PSQI) correlated negatively with birth weight (r = −0.34, p = 0.008) and gestational age (r = −0.28, p = 0.04). Elevated morning cortisol was significantly associated with NICU admission (r = 0.28, p = 0.002). The combined sleep + stress model predicted birth weight (R² = 0.26, p = 0.003) and preeclampsia (pseudo R² = 0.15, p = 0.015) more accurately than individual domains, achieving an ROC-AUC of 0.86 (95% CI: 0.78–0.92). Conclusions: In high-risk pregnancies, integrated evaluation of sleep and stress parameters may improve the prediction of fetal growth impairment and preeclampsia beyond single-domain models. These findings support the incorporation of psychosocial and behavioral markers into antenatal risk stratification. Because no pre-pandemic or post-pandemic comparator group was included, the COVID-19 period should be interpreted as the contextual background of the study rather than as an independently tested exposure. Full article

Background: Obesity remains a major public health challenge, with central and visceral fat distribution conferring particularly high cardiometabolic risk. Lifestyle factors, including diet, physical activity, and sleep quality, have been implicated in adiposity, yet their combined and interactive effects in working populations remain insufficiently characterized. Methods: We conducted a cross-sectional study in 88,343 Spanish employees (53,122 men, 35,221 women) attending occupational health examinations between 2021 and 2024. Obesity was assessed using four complementary indices: body mass index (BMI), waist-to-height ratio (WHtR), Clínica Universidad de Navarra–Body Adiposity Estimator (CUN-BAE), and Metabolic Score for Visceral Fat (METS-VF). Lifestyle factors included sleep quality (Pittsburgh Sleep Quality Index), Mediterranean diet adherence (MEDAS), and physical activity (IPAQ). Multivariable logistic regression models were adjusted for sociodemographic and lifestyle variables, with interaction, stratified, joint exposure, and dose–response analyses. Results: Obesity prevalence varied widely by index, ranging from 18.9% (BMI) to 55.6% (CUN-BAE). Poor sleep quality was independently associated with higher odds of obesity across all indices, particularly central obesity (WHtR OR 1.58, 95% CI 1.48–1.69), with stronger associations observed in women. Physical inactivity and non-adherence to the Mediterranean diet were robust predictors, with inactivity showing the largest effect sizes (METS-VF OR 9.92, 95% CI 8.70–11.15). Interaction analyses indicated that both Mediterranean diet adherence and regular physical activity attenuated the adverse association between poor sleep and obesity outcomes. Restricted cubic spline models revealed a progressive dose–response relationship between increasing PSQI score and central obesity. Joint exposure analyses showed nearly five-fold higher odds of central obesity among workers with concurrent poor sleep, physical inactivity, and low Mediterranean diet adherence. A graded inverse association was observed between a composite healthy lifestyle score (0–3) and obesity, with a score of 3 associated with 72–75% lower odds of BMI-obesity and WHtR-high. Conclusions: In this large occupational cohort, poor sleep quality, physical inactivity, and low Mediterranean diet adherence emerged as independent and combined determinants of general, central, and visceral obesity. Integrated workplace strategies promoting sleep hygiene, physical activity, and dietary quality—particularly among women and lower socioeconomic groups—may represent an effective approach to reducing obesity risk in working populations. Full article

Objectives: The reduction in intrinsic capacity significantly impacts the functional abilities of older individuals, and is strongly linked to adverse health consequences. Safeguarding and enhancing an elderly person’s intrinsic capacity can lead to better life quality and improved social well-being. This research seeks to explore the relationships between social engagement, physical activity, and the likelihood of decline in intrinsic capacity among the elderly in China. Methods: Utilizing the CHARLS data from 2015, individuals with incomplete information were removed from our study. Our analysis included a total of 3502 samples. Social participation and physical activity were assessed through self-reported surveys. The evaluation of intrinsic capacity, based on WHO criteria, thoroughly examined participants in five areas: mobility, sensory functions, vitality, mental health and cognitive abilities. The links between social participation, physical activity and intrinsic capacity decline were revealed through logistic regression. Restricted cubic splines (RCS) were employed as a statistical model, exploring the relationships between dose and response. Interaction analysis was used to examine the interaction between social participation and physical activity. Analyses of subgroups facilitated the evaluation of variations based on factors including age, gender, duration of sleep, and chronic disease numbers. Results: In contrast to the low-level group, individuals with moderate to high degrees of social participation (OR = 0.80, p = 0.012; OR = 0.56, p < 0.001) and those with moderate to high levels physical activity (OR = 0.72, p = 0.019; OR = 0.74, p = 0.016) demonstrated a notably lower risk of decline in intrinsic capacities. A negative correlation was identified in a dose-response manner between social participation and the risk of IC decline. A U-shaped relationship was established between physical activity levels and the risk of intrinsic capacity decline. The fully adjusted interaction model showed that no significant interaction was observed between social participation and physical activity (p = 0.778). Furthermore, subgroup analyses showed that these associations remained generally consistent across older adults of different age groups, genders, sleep duration, and numbers of chronic diseases. Conclusions: In order to slow down the deterioration of intrinsic capacity in older adults in China, it may be beneficial to focus on sustaining elevated levels of social participation and engaging in moderate physical activity. Higher levels of social participation are associated with a lower risk of experiencing a decline in intrinsic capacity, whereas both insufficient and excessive physical activity are associated with an increased risk of intrinsic capacity decline. Full article

Background/Objectives: Wildfires are increasing in frequency and intensity worldwide, leading to widespread exposure to wildfire smoke and associated environmental stressors. While the respiratory and cardiovascular effects of wildfire smoke are well established, the potential neurological and mental health consequences have received growing attention. This narrative review synthesizes evidence from animal and human studies examining the effects of wildfire exposure on neurological function, behavior, and mental health, and explores the potential role of epigenetic mechanisms. Methods: A structured literature search was conducted using PubMed to identify original research articles examining wildfire exposure in relation to neurological, behavioral, mental health, or epigenetic outcomes. Both human and animal studies were included. Results: Experimental animal studies suggest that wildfire smoke exposure can induce neuroinflammation, blood–brain barrier disruption, metabolic alterations, and behavioral changes. Human studies conducted in wildfire-affected populations frequently report an elevated prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and sleep disturbances. However, many of these studies reflect mental health outcomes associated with wildfire disaster exposure, including evacuation and psychosocial stress, whereas only a subset of studies quantify wildfire smoke or PM_2.5 exposure. Emerging evidence from both animal models and human studies indicates that wildfire exposure may be associated with changes in epigenetic regulation, including alterations in DNA methylation and miRNA expression. Conclusions: Current evidence suggests that wildfire exposure may influence neurological and mental health outcomes through biological and psychosocial pathways. However, the literature remains heterogeneous, and the independent effects of wildfire smoke exposure are often difficult to disentangle from disaster-related stressors. In addition, human evidence linking wildfire exposure to epigenetic changes remains limited, restricting causal inference. Further longitudinal and mechanistic studies integrating exposure assessment, neurological outcomes, and molecular profiling are needed to clarify these relationships. Full article

Driving simulators offer a safe and controlled way to study fatigue in truck drivers, but variation in scenario design and incomplete reporting limit reproducibility and cross-study comparison. This systematic review synthesized scenario parameters used in truck-driving simulators to induce fatigue-related reductions in alertness and identified recurring protocol patterns associated with interpretable fatigue-related change. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and a prospectively registered protocol (PROSPERO CRD420261302272), systematic searches were conducted in February 2026 in Scopus, Web of Science, IEEE Xplore, PubMed, and ScienceDirect. Peer-reviewed original studies published in English were eligible if they involved truck drivers, used a driving simulator, reported fatigue-relevant scenario parameters, and measured at least one fatigue-related outcome; no restriction was applied to publication year. Twenty-three studies comprising 419 participants met the eligibility criteria and were synthesized narratively. Risk of bias was appraised using an adapted 11-item checklist for driving simulator experiments, developed with the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools as a reference framework. Across the qualitative evidence base, fatigue-related change was reported more consistently in protocols combining sustained time on task with low-variability driving demands, typically implemented through monotonous road environments and reduced traffic complexity. Effects were more readily interpretable when sessions were scheduled at night or after work shifts and when outcomes were assessed repeatedly during the drive. However, incomplete control or reporting of baseline sleep pressure, stimulant intake, counterbalancing, familiarization, simulator sickness, and outlier handling limited causal interpretation and confidence in cross-study comparison. Overall, the evidence supports recurring design patterns rather than a single optimal protocol and highlights the need for standardized scenario descriptions and minimum reporting requirements. Full article

Objective: This study examined whether changes in electroencephalography (EEG)-derived indices, photoplethysmography (PPG)-derived autonomic nervous system indices, heart rate, and rating of perceived exertion (RPE) post-high-intensity exercise differ depending on sleep duration. Methods: Forty physically healthy female university students in their twenties were randomly assigned to the sleep restriction (SR) or normal sleep (NS) group. EEG-derived indices—the theta-to-beta ratio (TBR) and spectral edge frequency at 90% (SEF-90)—and PPG-derived autonomic nervous system indices (HRV index, sympathetic activity, and parasympathetic activity) were measured for one minute at rest before exercise and for one minute immediately after exercise. Heart rate was assessed at rest, immediately after exercise, and at 5, 10, and 15 min post-exercise. The group × time interaction effects were assessed using two-way mixed-design analysis of variance, followed by post hoc analyses. Results: TBR increased significantly post-exercise in the SR group (p = 0.002) with no significant change in the NS group. SEF-90 decreased significantly in the SR group (p < 0.001) with no significant change in the NS group. The HRV index decreased significantly in the SR group (p = 0.004) with no significant change in the NS group. Sympathetic activity increased and parasympathetic activity decreased significantly in the SR group (both p < 0.001). Heart rate was significantly higher in the SR group at rest (p < 0.001), immediately after exercise (p = 0.020), and 5 min post-exercise (p = 0.009). RPE was significantly higher in the SR group (p = 0.003). Conclusions: In healthy young adult women, the central and autonomic nervous systems respond differently to high-intensity exercise depending on sleep duration. Full article

Background: Chronic non-cancer pain (CNCP) is an increasing global health concern and a multidimensional condition shaped by biological, psychological, social, and cultural factors, with impacts on functioning, quality of life, and healthcare. However, evidence remains fragmented, limiting integrated understanding and care. Objective: This study aimed to synthesize and critically analyze existing evidence on the biological, psychological, social, and cultural dimensions characterizing individuals with CNCP, and their impact on functionality, quality of life, and healthcare. Methodology: An integrative review was conducted following the Whittemore and Knafl framework. Searches were performed in Medline, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), PsycINFO, Scopus, Web of Science, and grey literature in English and Spanish, without time restrictions. Studies were screened using predefined eligibility criteria and appraised with Joanna Briggs Institute tools. Data were systematically extracted and synthesized using thematic analysis to identify key attributes of people living with CNCP. Quantitative findings were summarized descriptively and mapped to thematic domains, while qualitative data were analyzed interpretively. Both evidence streams were integrated through convergent thematic synthesis. Results: Forty-four studies were included, predominantly cross-sectional and observational. Five themes emerged: biological aspects; functioning and quality of life; psychological and mental factors; social support and peer relationships; and social and gender determinants. CNCP was consistently associated with multimorbidity, sleep disturbance, psychological distress, and maladaptive coping, contributing to reduced functional capacity, greater disability, poorer quality of life, and increased healthcare utilization. Socioeconomic disadvantages and environmental constraints were linked to higher pain burden, whereas resilience and social support emerged as protective factors mitigating functional and psychosocial impact. Conclusions: Evidence largely concentrates on biomedical, functional, and psychological dimensions, whereas social determinants and healthcare quality remain comparatively underexplored. Broadening these perspectives is essential to inform public health strategies and support multidisciplinary, equitable care for individuals living with CNCP. Full article

Pediatric obstructive sleep apnea (OSA) is a prevalent and underdiagnosed condition associated with significant neurocognitive, behavioral, and systemic consequences. Sleep-related breathing disorders (SRBDs) in children range from primary snoring to OSA, with even mild forms increasingly linked to adverse outcomes. Given their frequent contact with pediatric patients, pediatric dentists and orthodontists are uniquely positioned to contribute to early identification and management within a multidisciplinary framework. Objectives: This narrative review aimed to summarize and critically appraise current evidence to clarify the clinical role, scope of practice, and responsibilities of pediatric dentists and orthodontists within the multidisciplinary management of pediatric obstructive sleep apnea. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and EMBASE up to 1 November 2025. Review articles addressing the involvement of pediatric dentists and orthodontists in pediatric OSA were included. No restriction was applied to language or publication year. Two authors independently performed study selection and data extraction. The methodological quality and data extraction of the studies were structured according to the SANRA scale. Ten studies were deemed suitable for inclusion in the current review. After examination of the full texts, the available evidence was filtered into specific clinical domains aimed at clarifying the role of the pediatric dentist and orthodontist in the management of pediatric obstructive sleep apnea (OSA). Qualitative thematic analysis of the included studies identified three main areas in which pediatric dentists and orthodontists contribute to the management of pediatric OSA. The first area involves screening through recognition of clinical signs and symptoms, use of validated questionnaires, and identification of craniofacial and occlusal features associated with increased airway risk. The second area concerns participation in the diagnostic–therapeutic pathway and multidisciplinary care, including timely referral, clinical documentation, and collaboration with pediatricians, otolaryngologists, and sleep specialists. The third area relates to orthodontic treatments such as rapid maxillary expansion and mandibular advancement appliances, which may provide adjunctive benefits in selected patients, although current evidence is limited by heterogeneity and growth-related confounding factors. Pediatric dentists and orthodontists play a pivotal yet complementary role in the management of pediatric OSA. In particular, all the involved specialists are encouraged to actively participate in the screening process, interdisciplinary communication, and diagnostic and therapeutic decision-making processes. Full article

Partial sleep deprivation is common in sports, particularly before competitions. This study examined whether two nights of severe sleep restriction (<4 h/night), compared with mild sleep restriction (control), are associated with changes in SJ and CMJ in physically active female students. Twenty-three female students (n = 12 experimental; n = 11 control) were randomly assigned to their respective groups. The experimental group underwent two nights of severe sleep restriction (<4 h/night), while the control group experienced mild sleep restriction. Differences between groups were analyzed using Quade’s nonparametric ANCOVA (sleep duration as covariate), and within-group pre–post changes were evaluated using paired-samples t-tests. No significant differences were found between groups after two nights in CMJ (p = 0.92) or SJ (p = 0.73) performance. Within the experimental group, SJ performance significantly decreased from the initial to the final assessment (p = 0.02), with a large effect size (d = −0.81). CMJ performance in the experimental group showed a non-significant decrease with a moderate effect size (d = −0.45). No significant differences or notable effect sizes were found in the control group (d = 0.01 to 0.23). Within-group results suggest that SJ decreased after severe sleep restriction, while CMJ changes were smaller and not statistically significant; between-group comparisons were not significant, and results appear sensitive to the analytical approach. These exploratory findings suggest that monitoring sleep before power-related tasks may be warranted. Coaches may consider monitoring sleep duration before high-intensity power training, as two nights of severe sleep restriction may be associated with reduced SJ performance. Full article

Type 2 diabetes mellitus (T2DM) and obesity affect hundreds of millions of adults worldwide and represent leading drivers of cardiovascular disease, chronic kidney disease, and escalating healthcare expenditures. Incretin-based therapies have fundamentally reshaped cardiometabolic disease management, with dual- and triple-receptor agonists extending the benefits of traditional glucagon-like peptide-1 (GLP-1) receptor agonism. By synthesizing clinical, mechanistic, and real-world data, this review examines the evolving therapeutic landscape of GLP-1-based multi-agonists. Dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists demonstrate superior metabolic efficacy compared with GLP-1 receptor agonists alone, achieving greater reductions in body weight and glycemic indices across diverse patient populations. Emerging triple agonists targeting GLP-1, GIP, and glucagon receptors further enhance metabolic outcomes, with weight loss approaching that observed following bariatric surgery in late-phase clinical trials. Mechanistically, multi-receptor co- agonism produces synergistic effects through complementary pathways, including appetite suppression, glucose-dependent insulin secretion, improved adipose tissue metabolism, increased energy expenditure, enhanced hepatic lipid oxidation, and reductions in hepatic steatosis. Beyond glycemic and weight endpoints, GLP-1-based therapies confer clinically meaningful cardiovascular and renal protection. Trials consistently demonstrate reductions in major adverse cardiovascular events across populations with and without T2DM, while kidney-specific trials show significant slowing of disease progression. However, gastrointestinal adverse events remain common and contribute to substantial treatment discontinuation, particularly in real-world settings. Despite their transformative efficacy, the population-level impact of these therapies is constrained by significant implementation barriers, including high drug costs, limited insurance coverage, restrictive utilization management policies, and pronounced racial and socioeconomic disparities in access. Emerging innovations including oral formulations, longer-acting injectables, and novel peptide combinations look to improve tolerability, adherence, and scalability, while therapeutic indications continue to expand to conditions such as metabolic dysfunction-associated steatohepatitis, chronic kidney disease, obstructive sleep apnea, and neurodegenerative disease. This review provides a comprehensive framework for understanding the clinical potential, mechanistic basis, and real-world challenges of GLP-1-based multi-agonists and outlines key priorities for optimizing implementation and maximizing their impact on global cardiometabolic health. Full article

Background and objective: Obstructive sleep apnea (OSA) is a common pediatric sleep disorder, most often caused by adenotonsillar hypertrophy. Although adenotonsillectomy (AT) is the standard first–line treatment, a substantial proportion of children experience residual OSA (rOSA). This systematic review aimed to synthesize current evidence on risk factors associated with rOSA in children following AT. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed and the Cochrane Library were searched without date restrictions using English–language terms related to rOSA, children, and adenotonsillectomy. Studies assessing postoperative persistence of OSA and associated risk factors were included. Results: Thirteen studies published between 2010 and 2024 met the inclusion criteria. The reported prevalence of rOSA varied widely (18.6–85.0%), reflecting heterogeneity in study design, patient populations, baseline disease severity, and follow–up methods. Obesity emerged as the most consistently identified risk factor, with significantly higher rOSA rates reported among children with elevated body mass index. Age also influenced outcomes, with both very young (<3 years) and older (>7 years) children demonstrating an increased likelihood of persistent disease. Comorbid conditions, particularly asthma and Down syndrome, were associated with poorer postoperative improvement. Additional contributors included craniofacial or developmental abnormalities and higher preoperative apnea–hypopnea index. Limited evidence also suggested that socioeconomic and environmental factors may affect postoperative outcomes. Conclusions: Residual OSA is common following adenotonsillectomy in children. Obesity, age, and comorbidities are key predictors, underscoring the need for comprehensive preoperative risk stratification and structured postoperative follow–up. Full article

Sleep banking, i.e., preemptively obtaining extra sleep prior to anticipated sleep loss, has been proposed as a strategy to reduce the cognitive and physiological consequences of sleep deprivation. However, our understanding remains incomplete regarding the effectiveness of preemptive sleep extension in enhancing resilience to sleep loss. A comprehensive literature search was conducted using PubMed, MEDLINE, and Embase for studies published between 2004 and 2025. Following a comprehensive literature search, we identified 12 studies meeting the inclusion criteria—seven primary experimental trials comprising approximately 140 participants, predominantly healthy young adults aged 18–39 years. We evaluated the effects of sleep banking on cognitive performance, mood, physiological parameters, and real-world outcomes. Included studies encompassed experimental laboratory trials, observational research, and field studies in occupational and athletic settings. Although the number of studies on sleep banking remains limited, experimental evidence demonstrates that preemptive sleep extension improves objective alertness and vigilance during subsequent sleep restriction or total sleep deprivation. Individuals who obtained additional sleep exhibited fewer attentional lapses, faster reaction times, and improved mood, although subjective sleepiness often remained high. Preliminary field evidence suggests that preemptive sleep extension enhances workplace safety, reduces errors, and improves sustained attention in shift workers. In athletic contexts, sleep banking has been associated with improved physical endurance and reaction speed. Importantly, this review primarily addresses the homeostatic dimension of sleep regulation (Process S); circadian factors (Process C), including chronotype, social jetlag, and circadian timing of sleep extension and testing, were not systematically addressed in the included studies and represent important limitations of the current evidence base. Overall, sleep banking appears to be a viable strategy for enhancing resilience to acute sleep loss. It confers measurable benefits in performance, cognitive function, and physiological markers, supporting its application in high-demand occupations and competitive environments. Although it does not fully eliminate subjective fatigue, sleep banking may serve as a valuable complement to other fatigue mitigation strategies for anticipated short-term sleep loss. Full article

Trouble sleeping has become a global public health challenge. However, the relationship between organophosphate flame retardant (OPFR) exposure and trouble sleeping remains unclear. This study integrated epidemiological analysis, network toxicology, molecular docking, molecular dynamics simulations, and adverse outcome pathway (AOP) construction to identify OPFRs linked to trouble sleeping and attempted to elucidate underlying molecular mechanisms. We analyzed cross-sectional data from the U.S. National Health and Nutrition Examination Survey (NHANES 2013–2018) involving 4585 eligible adults. Logistic regression confirmed dibutyl phosphate (DBuP) as significantly correlated with trouble sleeping. Restricted cubic splines (RCSs) revealed a significant non-linear, J-shaped relationship between dibutyl phosphate (DBuP) levels and trouble sleeping. Weighted quantile sum (WQS) analysis determined that DBuP accounted for the majority contribution (58.23%) to the observed effects within exposure mixtures. These findings indicated that DBuP, a metabolite of tributyl phosphate (TnBP), was closely related to trouble sleeping, suggesting that the environmental health risks of TnBP may be jointly contributed to by itself and DBuP. We used network analysis to identify five core target genes (PPARG, MMP9, PTGS2, APP, EGFR) that interact with DBuP and its parent compound TnBP. Molecular docking predicted binding poses of TnBP and DBuP toward these five core targets; all showed moderate binding affinity (ΔG ≤ −5.0 kcal/mol) except MMP9, which exhibited weak binding. Molecular dynamics simulations further supported this putative binding. Enrichment analysis highlighted inflammatory response pathways. Ultimately, we elucidated the process from molecular exposure to trouble sleeping by constructing an AOP framework. In conclusion, we proposed that TnBP and DBuP may contribute to trouble sleeping through multi-target interactions, primarily through PPARG-driven inflammatory dysregulation. These findings suggest a potential link between OPFR exposure and trouble sleeping, providing insights that warrant further mechanistic investigation. Full article

Background/Objectives: Insomnia is common among adolescents and is associated with emotional, behavioral, and academic difficulties. Although high rates have been reported globally, evidence in Latin America—particularly in Peru—remains limited and heterogeneous. Many previous studies relied on small samples, descriptive designs, omitted key psychosocial variables, or were conducted during early pandemic waves, despite the rise in sleep disturbances following COVID-19 restrictions. This study aimed to estimate the prevalence of insomnia and identify associated factors among adolescents in northern Peru. Methods: An analytical cross-sectional study was conducted using secondary data from students attending five schools in Lambayeque, Peru. Insomnia was assessed using the Insomnia Severity Index (ISI). Sociodemographic, psychosocial, behavioral, and health-related variables—including self-esteem, family dysfunction, eating disorders, acne severity, mental health help-seeking, and digital behavior—were evaluated. Generalized linear models estimated prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Among 1313 adolescents (54.3% male; mean age 14.6 years), the prevalence of insomnia was 38.9% (95% CI: 36.1–41.5). In adjusted analyses, insomnia was associated with urban residence, non-Catholic religion, seeking mental health support, high social media use, internet use of 6–10 h/day, low self-esteem, eating disorders, greater acne severity, and experiencing the death of a family member due to COVID-19. Conclusions: Nearly four in ten adolescents reported insomnia, influenced by sociodemographic, psychosocial, and lifestyle-related factors. These findings provide updated post-pandemic evidence for the Peruvian context and highlight the multifactorial nature of adolescent insomnia. Further research is needed to clarify causal pathways and understand the long-term mental health implications of large-scale stressors such as the COVID-19 pandemic. Full article