Nature and Science of Sleep最新文献

{"title":"Beyond a Single Hypoxic Burden Value: Hypoxic Burden Ratio Assessed by Peripheral Arterial Tonometry in Obstructive Sleep Apnea.","authors":"Diego Ignacio Vanegas-Cadavid, Andrés Felipe Blanco-Ruiz","doi":"10.2147/NSS.S631688","DOIUrl":"10.2147/NSS.S631688","url":null,"abstract":"<p><strong>Purpose: </strong>Hypoxic burden (HB) integrates the depth and duration of nocturnal oxygen desaturation in obstructive sleep apnea (OSA), but a single HB value may conceal distinct hypoxemic profiles. We explored the relationship between two automated HB measures derived from peripheral arterial tonometry-based home sleep apnea testing (PAT-HSAT) data: desaturation area under the SpO₂ baseline (HB_baseline) and area under 90% SpO₂ (HB_<90%).</p><p><strong>Methods: </strong>We performed a retrospective cross-sectional study of 2136 adults with OSA, diagnosed by a peripheral arterial tonometry-derived apnea-hypopnea index based on 3% desaturation criteria (pAHI3%) ≥5 events/h. Three operational HB groups were designated according to the relationship between HB_baseline and HB_<90%. Type 1 was characterized by measurable HB_baseline (>0%·min/h) and HB_<90% = 0%·min/h; the HB_baseline/HB_<90% ratio was not calculable because the denominator was zero. Among patients with measurable HB_<90%, Type 2 was defined by an HB ratio ≥1 and Type 3 by an HB ratio <1. These three groups were prespecified as exploratory operational categories.</p><p><strong>Results: </strong>Type 1, Type 2, and Type 3 comprised 506 (23.7%), 1108 (51.9%), and 522 (24.4%) patients, respectively. The percentage of total sleep time (TST) with SpO₂ below 90% (T90) had median values of 0.1%, 5.4%, and 63.6% in Types 1, 2, and 3, respectively. Types 2 and 3 had similar median pAHI3% (26.3 and 28.8 events/h) but markedly different median HB_<90% (6.0 and 86.5%·min/h). HB_baseline correlated strongly with pAHI3% across all groups (Spearman ρ, 0.9295-0.9378), whereas HB_<90% correlated moderately with pAHI3% in Types 2 and 3 (ρ=0.6292 and 0.6209; all P<0.001).</p><p><strong>Conclusion: </strong>The relative magnitude of HB_baseline and HB_<90% provides an exploratory operational framework for describing distinct hypoxemic profiles in OSA beyond a single HB value. The framework is descriptive and hypothesis-generating; its clinical, prognostic, mechanistic, and therapeutic utility has not been established and requires external and longitudinal validation.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"631688"},"PeriodicalIF":3.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Vitamins Related to Brain Development and Sleep in Children with Autism Spectrum Disorders.","authors":"Hongyu Chen, Xueli Xiang, Tingyu Li, Jie Chen, Qionghui Wu, Qiuhong Mou, Qian Zhang, Ting Yang","doi":"10.2147/NSS.S597708","DOIUrl":"https://doi.org/10.2147/NSS.S597708","url":null,"abstract":"<p><strong>Purpose: </strong>Sleep problems and nutritional abnormalities are common in children with autism spectrum disorder (ASD), yet the relationships between specific vitamin status, sleep characteristics, and ASD symptoms remain unclear. This study investigated the associations between neurodevelopment-related vitamin levels, sleep problems, and clinical features in children with ASD.</p><p><strong>Patients and methods: </strong>This cross-sectional study included 605 children with ASD aged 2-7 years. Blood vitamin levels were measured using high-performance liquid chromatography-tandem mass spectrometry. Sleep problems were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and ASD symptoms were evaluated using the Social Responsiveness Scale (SRS), Childhood Autism Rating Scale (CARS), and Autism Diagnostic Observation Schedule-Second Edition (ADOS-2).</p><p><strong>Results: </strong>Vitamin A (VA) deficiency was the most prominent nutritional abnormality, followed by vitamin D (VD) deficiency. VA levels differed significantly by sex, whereas VD levels varied across age groups. Several dimensions of sleep problems showed significant differences according to both sex and age. Lower VA levels were associated with greater sleep problems, including higher bedtime resistance, daytime sleepiness, and higher total CSHQ scores (all P < 0.05). Lower VD levels were associated with greater severity of core ASD symptoms (all P < 0.05), but not with sleep problems. Greater sleep problems were consistently associated with more severe ASD symptoms.</p><p><strong>Conclusions: </strong>VA and VD deficiencies are prevalent among children with ASD. VA levels were associated with sleep problems, whereas VD status was associated with ASD symptom severity. These findings suggest that nutritional status may be associated with specific clinical features of ASD and warrant further investigation in longitudinal studies.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"597708"},"PeriodicalIF":3.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Sleep Perception: Does the Largest WASO Bias Reflect Impaired Memory Rather Than Blunted Perception? [Response to Letter].","authors":"Xiaoyu Xiao, Shuo Liu, Wenjing Jiang, Zhuqing Xu, Fanzun Meng, Fangchun Huang, Xiaochan Bi, Zixiang Guo, Yuqi Li","doi":"10.2147/NSS.S654835","DOIUrl":"https://doi.org/10.2147/NSS.S654835","url":null,"abstract":"","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"654835"},"PeriodicalIF":3.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Electroacupuncture in Patients with Treatment-Resistant Insomnia: A Randomized, Assessor-Blinded, Waitlist-Controlled Pilot Trial [Response to Letter].","authors":"So-Hyeon Park, Jung-Hwa Lim, Kyeong-Ok Kim, Chang-Wan Kang, Eun Cho, Bo-Kyung Kim","doi":"10.2147/NSS.S652139","DOIUrl":"https://doi.org/10.2147/NSS.S652139","url":null,"abstract":"","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"652139"},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Theory-Based Sleep Hygiene Education Intervention for Adults with Insomnia: An Intervention Mapping and Content Validation Study.","authors":"Yan Yi Fong, Ying Xiong, Jia Yin Ruan, Fiona Yan Yee Ho, Heidi Ka Ying Lo, Ka Fai Chung, Branda Yee Man Yu, Shu Cheng Chen, Wing Fai Yeung","doi":"10.2147/NSS.S632508","DOIUrl":"https://doi.org/10.2147/NSS.S632508","url":null,"abstract":"<p><strong>Study objectives: </strong>Sleep hygiene education (SHE) is commonly used in insomnia management, yet its observed effectiveness is modest, potentially reflecting limitations in its implementation, including simplified content, limited standardization, and suboptimal delivery formats. This study aimed to systematically develop a theory-based SHE program for adults with insomnia.</p><p><strong>Methods: </strong>The SHE intervention was developed following Phase I of the Medical Research Council framework and operationalized using Steps 1-4 of intervention mapping. Stakeholders, including 10 experts and 10 individuals with insomnia, were engaged throughout development to review and validate the program content, enhance its acceptability, and ensure its appropriateness.</p><p><strong>Results: </strong>The resulting theory-based SHE program comprises two integrated components: (1) an educational module addressing insomnia knowledge, evidence-based sleep hygiene behaviors, and self-regulatory strategies for initiating and sustaining practice; and (2) brief follow-up telephone consultations designed to reinforce adherence and support implementation planning. Experts and individuals with insomnia endorsed the program's overall appropriateness, with minor refinements suggested for specific elements.</p><p><strong>Conclusion: </strong>This study presents a structured development and content validation of a theory-driven SHE program informed by behavioral science, empirical evidence, and stakeholder input. The intervention targets key limitations of traditional SHE approaches and provides a strong foundation for future feasibility testing.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"632508"},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nighttime Respiratory Disturbance and Hypoxemia Associated with Impaired Linear Growth in Children with Obstructive Sleep Apnea.","authors":"Yuan Shi, Zhaohua Chen, Xujun Feng, Fei Lei, Lu Tan, Taomei Li, Junying Zhou, Yuanfeng Sun, Ye Zhang, Rong Ren, Jian Jiao, Yun Li, Yanyan Wang, Larry D Sanford, Michael V Vitiello, Xiangdong Tang","doi":"10.2147/NSS.S631079","DOIUrl":"https://doi.org/10.2147/NSS.S631079","url":null,"abstract":"<p><strong>Objectives: </strong>Although obstructive sleep apnea (OSA) related hypoxia shows stronger associations with multiple complications than respiratory disturbance, its impact on linear growth, a major pediatric concern, remains unclear. This study investigates independent effects of hypoxia and respiratory disturbance on the height of children with OSA.</p><p><strong>Methods: </strong>This retrospective, cross-sectional study clinically evaluated children with suspicious OSA from January 2013 to June 2025. Individuals with other sleep disorders, severe neuropsychiatric disorders and physical disorders were excluded. Subjects underwent overnight polysomnography (PSG) and height measurement. OSA was defined as apnea-hypopnea index (AHI) ≥1 event/hour, and those with AHI <1 event/hour served as the non-OSA reference group. AHI and percentage of total sleep time with oxygen saturation < 90% (T90%), were separately used to evaluate the severity of respiratory disturbance (mild, 1≤AHI < 5 events/h; moderate, 5≤AHI < 10 events/h; severe, AHI ≥10 events/h) and hypoxia (T90% quartiles). Height z-scores ≤-1 SD defined subclinical growth impairment. Linear and logistic regression models analyzed the independent associations between AHI and T90% and height and subclinical growth impairment. Nutrition, endocrine disorders, chronic illnesses, and parental height were not collected and adjusted in this study.</p><p><strong>Results: </strong>A total of 2443 children were included (348 children without OSA, 2095 children with OSA). In linear regression models, higher T90% was associated with a lower height z-score in the full sample (<i>B</i> = -0.005, 95% CI: -0.010 to -0.000, <i>P</i> = 0.033) and children with OSA (<i>B</i> = -0.005, 95% CI: -0.010 to -0.000, <i>P</i> = 0.034), whereas AHI was not (full sample: <i>B</i> = -0.003, 95% CI: -0.006 to 0.001, <i>P</i> = 0.111; children with OSA: <i>B</i> = -0.002, 95% CI: -0.005 to 0.002, <i>P</i> = 0.330).Logistic models showed higher odds of subclinical growth impairment in children with moderate (OR = 1.73, 95% CI: 1.05-2.84) or severe OSA (OR = 1.96, 95% CI: 1.19-3.21) and in those in the highest T90% quartile (OR = 2.17, 95% CI: 1.30-3.60), compared with children without OSA. These associations remained stable in females and children aged 2-9 years.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first study to show that greater respiratory disturbance and nocturnal hypoxemia are associated with a higher risk of short stature in children with OSA. These findings support routine height assessment in the clinical management of pediatric OSA.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"631079"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polysomnographic Sleep in Idiopathic Nightmares: A Systematic Review and Meta-Analysis.","authors":"Jiaxue Huang, Meiou Wang, Wenxin Bao, Wenqi Lyu, Yongming Wang, Shuyao Wu, Xiangdong Tang, Rong Ren, Ye Zhang","doi":"10.2147/NSS.S602539","DOIUrl":"https://doi.org/10.2147/NSS.S602539","url":null,"abstract":"<p><strong>Objectives: </strong>This study conducted a systematic evaluation of polysomnographic differences between individuals with nightmares and healthy controls.</p><p><strong>Methods: </strong>Electronic searches of All EBM databases, EMBASE, Web of Science, and MEDLINE identified 14 eligible case-control studies; seven studies involving 112 individuals with nightmares and 112 controls were included in meta-analysis.</p><p><strong>Results: </strong>The meta-analysis of sleep macro-architecture (such as total sleep time, wake after sleep onset, and sleep stage percentages) revealed no significant differences between individuals with nightmares and healthy controls. Furthermore, the limited available data regarding sleep micro-architecture (cyclic alternating patterns (CAP) and power spectral analysis (PSA)) and autonomic measures (heart rate and heart rate variability) in studies not subjected to meta-analysis makes it difficult to draw confident conclusions.</p><p><strong>Conclusions: </strong>Our meta-analysis revealed no significant differences in sleep macro-architecture. This finding highlights the importance of investigating sleep micro-architecture (such as CAP and PSA), which may be relevant to the physiology of nightmares. However, these findings should be interpreted cautiously and validated in future studies because of the limited available data.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"602539"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Network Analysis of Symptom-Level Interrelationships Between Adverse Childhood Experiences and Insomnia Symptoms in Adolescents: A Large-Sample Study.","authors":"Lei-Lei Wang, Xian-Mei Ji, Jiu-Ju Li, Hong-Juan Li, Meng Qi, Shuang-Jiang Zhou, Jing Zhao, Yun-Long Tan, Jing-Xu Chen","doi":"10.2147/NSS.S598843","DOIUrl":"https://doi.org/10.2147/NSS.S598843","url":null,"abstract":"<p><strong>Background: </strong>Sleep is essential for the physical and mental health of adolescents. Previous international studies have indicated a strong association between adverse childhood experiences (ACEs) and insomnia, although relevant reports focusing on Chinese adolescents remain limited.</p><p><strong>Methods: </strong>This online cross-sectional study ultimately included 6670 adolescents aged 12-18 years. Childhood adversity and insomnia symptoms were assessed using the Adverse Childhood Experiences Questionnaire and the Insomnia Severity Index (ISI), respectively. Statistical analyses included chi-square tests to compare ACE prevalence between groups, binary logistic regression to identify risk factors for insomnia symptoms, and Network analysis explored interrelationships among specific ACEs and insomnia symptoms, using centrality indices (strength, closeness, betweenness) to evaluate symptom influence.</p><p><strong>Results: </strong>The prevalence of ACEs was 47.6% and insomnia symptoms was 20.6%. ACEs showed a cumulative dose-effect relationship with insomnia. Adolescents with ACEs had a significantly higher incidence of insomnia than those without. Physical abuse (OR = 1.41), emotional neglect (OR = 1.32), social isolation or exclusion (OR = 2.52), and witnessing community violence (OR = 1.57) were identified as significant risk factors for insomnia symptoms. Network analysis showed that ACE10 (family crime, strength z = 2.084) and ACE12 (Isolated or excluded, betweenness z = 3.594) were the most central ACE nodes. The strongest cross-domain connections were ISI4 (sleep dissatisfaction) and ACE12 (edge weights = 0.081), and between ISI1 (difficulty falling asleep) and ACE12 (edge weights = 0.077).</p><p><strong>Conclusion: </strong>ACEs and insomnia symptoms are prevalent and closely interrelated among Chinese adolescents. These findings highlight the need to strengthen the assessment of ACEs in this population and implement timely interventions to reduce the incidence of insomnia. However, as this is a cross-sectional study from a single province, further research is needed in terms of its generalizability.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"598843"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Indicators and Neutrophil-to-Lymphocyte Ratio Associated with Moderate-to-Severe Obstructive Sleep Apnea in Patients with Acute Ischemic Stroke: A Single-Center Retrospective Study.","authors":"Yan Liu, Tianqi Zou, Zhaoyang Jia, Yuxin Ye, Tianyu Jing, Zhiwen Wu, Weixiao Lv, Tieyu Tang, Gang Xu, Ning Luo, Cheng Chu","doi":"10.2147/NSS.S633367","DOIUrl":"10.2147/NSS.S633367","url":null,"abstract":"<p><strong>Objective: </strong>To examine the associations of readily available clinical indicators and the neutrophil-to-lymphocyte ratio (NLR) with moderate-to-severe obstructive sleep apnea (OSA) in patients with acute ischemic stroke and to explore the discriminatory performance of BMI, NLR, and a combination of BMI, snoring, and NLR.</p><p><strong>Methods: </strong>This single-center retrospective study included 220 patients with acute ischemic stroke who completed overnight polysomnography during hospitalization between October 2024 and April 2026. Moderate-to-severe OSA was defined as an apnea-hypopnea index ≥15 events/h. Clinical characteristics, laboratory indicators, and polysomnographic parameters were compared between groups. Multivariable logistic regression was used to evaluate factors associated with moderate-to-severe OSA, and receiver operating characteristic analysis assessed discriminatory performance. Spearman correlation and NLR tertile analyses explored the relationships between NLR and sleep-disordered breathing and nocturnal hypoxia.</p><p><strong>Results: </strong>Moderate-to-severe OSA was present in 109 of 220 patients (49.5%). After multivariable adjustment for prespecified clinical covariates, higher BMI (aOR 1.204, 95% CI 1.088-1.332), snoring (aOR 2.910, 95% CI 1.485-5.705), and higher NLR (aOR 2.291, 95% CI 1.449-3.622) remained associated with moderate-to-severe OSA. Modified Poisson sensitivity analyses yielded consistent associations for BMI, snoring, and NLR. The combined model had an AUC of 0.798 (95% CI, 0.736-0.851), indicating moderate discriminatory ability. Higher NLR was also associated with greater sleep-disordered breathing and nocturnal hypoxia burden.</p><p><strong>Conclusion: </strong>BMI, snoring, and NLR were associated with moderate-to-severe OSA in this single-center acute ischemic stroke cohort. Their combined discriminatory performance was moderate. These observational findings are hypothesis-generating and require prospective multicenter validation before clinical application.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"633367"},"PeriodicalIF":3.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia-Informed Approaches to Insomnia: Shared Neural Circuits, Biomimetic Sleep, and Emerging Interventional Strategies.","authors":"Yu Wu, Xiongwei Yu, Houxin Sun, Fang Huang, Jinbao Wang","doi":"10.2147/NSS.S636790","DOIUrl":"10.2147/NSS.S636790","url":null,"abstract":"<p><strong>Background: </strong>Insomnia affects approximately 10-30% of adults, burdening quality of life, cognition, and health. Although cognitive behavioral therapy for insomnia (CBT-I) and approved pharmacotherapies remain standard care, limited accessibility, durability, and efficacy in refractory populations have motivated interest in mechanism-based alternatives, including approaches derived from anesthetic pharmacology.</p><p><strong>Objective: </strong>This narrative review examines the convergent neural circuits underlying anesthesia-induced and physiological sleep, critically appraises evidence for anesthetic agents-dexmedetomidine, ketamine/esketamine, and propofol-delivered through non-traditional modalities, and evaluates perioperative sleep optimization, with explicit attention to evidence level and limitations.</p><p><strong>Methods: </strong>We searched PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library for English-language publications through June 2026. Evidence from randomized controlled trials (RCTs), systematic reviews, observational studies, case reports, and mechanistic studies was synthesized narratively and graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.</p><p><strong>Results: </strong>Dexmedetomidine induces \"biomimetic sleep\" via alpha-2 adrenergic agonism, resembling natural non-rapid eye movement stage 2 sleep more closely than propofol. However, most supporting evidence is mechanistic, perioperative, or from small pilot studies rather than insomnia-specific RCTs. Patient-controlled sleep systems, intranasal delivery, and bionic sleep therapy are promising but preliminary, with incomplete long-term safety data, particularly regarding cardiovascular effects and withdrawal. Ketamine and esketamine may enhance slow-wave sleep, but most data derive from comorbid depression, confounding attribution. Stellate ganglion block, acupuncture, and closed-loop stimulation remain investigational and susceptible to placebo effects. Perioperative strategies improve postoperative sleep in RCTs, but extrapolation to chronic insomnia is limited by fundamental etiological differences.</p><p><strong>Conclusion: </strong>Anesthesia-informed approaches provide mechanistic insights and investigational directions rather than established alternatives to CBT-I or approved hypnotics. Priorities include adequately powered insomnia-specific RCTs, comparison with standard treatments, long-term safety evaluation, and phenotype-guided selection.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"636790"},"PeriodicalIF":3.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}