Nature and Science of Sleep最新文献

{"title":"Construction of an e-Health Literacy Program for Patients with Obstructive Sleep Apnea-Hypopnea Syndrome Based on Integrative Model of eHealth Use.","authors":"Wenchen Zhao, Xinxia Li","doi":"10.2147/NSS.S615908","DOIUrl":"10.2147/NSS.S615908","url":null,"abstract":"<p><strong>Objective: </strong>To develop a scientifically sound and practical electronic health (eHealth) literacy intervention plan for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to provide a reference for its clinical implementation.</p><p><strong>Methods: </strong>This study utilized the Integrated Model of e-Health Use (IMeHU) as the theoretical framework and constructed an evidence-based model based on the PICO principles. A preliminary draft of the intervention protocol was developed through a comprehensive literature review, and an expert panel meeting was convened to evaluate its feasibility and scientific validity. Subsequently, expert feedback was collected via a questionnaire survey and analyzed accordingly. On this basis, a small-scale pilot study was conducted to gather patient feedback. Ultimately, the intervention protocol was refined and revised by integrating expert opinions with patient feedback, leading to the finalization of the e-health literacy intervention program for patients with OSAHS.</p><p><strong>Results: </strong>The final eHealth literacy intervention program comprises 3 first-level, 8 second-level, and 22 third-level indicators. A single round of expert consultation was conducted with 10 experts. The questionnaire response rate was 100%, the expert authority coefficient was 0.90, the coefficient of variation ranged from 0.09 to 0.27, and the Kendall coefficient of concordance was 0.185 (P < 0.05).</p><p><strong>Conclusion: </strong>This study focuses on the systematic development and rigorous expert validation of the intervention. Through evaluation and optimization, the resulting eHealth literacy intervention program for OSAHS patients features comprehensive content and a rigorous structure, fully demonstrating the feasibility of the proposed program with expert endorsement.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"615908"},"PeriodicalIF":3.4,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795741","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":"From Gut to Brain: Probiotics as an Emerging Adjunctive Strategy for Insomnia and Sleep Disturbances.","authors":"Yutao Yang, Haoran Zhang","doi":"10.2147/NSS.S604978","DOIUrl":"https://doi.org/10.2147/NSS.S604978","url":null,"abstract":"<p><strong>Objective: </strong>Too little sleep and incidental insomnia are two common conditions in which sleep is disrupted. Insomnia is often accompanied by emotional, metabolic, and immunological deterioration. The purpose of this narrative review is to better understand the gut-brain axis and evaluate the potential usefulness of probiotics in the treatment of insomnia and related sleep problems.</p><p><strong>Methods: </strong>This study was designed as a narrative review of the literature on probiotics, gut microbiota, and sleep. A hierarchical method was used to synthesize mechanistic and clinical evidence, differentiating between upstream immune-inflammatory and HPA-axis control and downstream neuroactive metabolites and vagal signaling. Differences in probiotic strains, doses, intervention durations, and outcome measures were also investigated. As this study was designed as a narrative review rather than a systematic review, a formal risk-of-bias or quality assessment of the included randomized controlled trials was not performed.</p><p><strong>Findings: </strong>Current research indicates that probiotics may regulate sleep via multiple gut-brain axis routes. Upstream processes in the proposed framework are immune-inflammatory modulation and hypothalamic-pituitary-adrenal (HPA) axis regulation, whereas downstream mediators are neuroactive metabolites and vagal signaling. Clinical research show that probiotics have small and diverse impacts on sleep outcomes, with improvements more frequently reported in subjective sleep assessments than objective tests.</p><p><strong>Conclusion: </strong>By altering the functioning of the brain-gut axis, probiotics may provide a emerging therapeutic option for insomnia. On the other hand, it is uncertain which probiotic strains and dosages will be most effective, as well as the relevant mechanisms; thus, additional well-controlled human intervention studies are warranted.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"604978"},"PeriodicalIF":3.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795735","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":"When the Sleeper Becomes the Photographer: Recurrent Smartphone Photography During NREM Parasomnia-A Case Report.","authors":"Jiri Nepozitek, Karel Sonka","doi":"10.2147/NSS.S619779","DOIUrl":"10.2147/NSS.S619779","url":null,"abstract":"<p><p>Disorders of arousal from non-rapid eye movement (NREM) sleep are characterized by complex behaviors arising from incomplete awakenings. These behaviors can occasionally involve sophisticated motor actions and interactions with the environment. We report an apparently previously unreported case of a patient who repeatedly took photographs with a smartphone during somnambulistic episodes. A woman with lifelong NREM parasomnia presented with frequent sleepwalking episodes that worsened after the onset of irregular shift work. During clinical evaluation, she reported that she occasionally took photographs during nocturnal episodes. She subsequently provided 77 smartphone photographs taken between 2018 and 2026. Twenty-seven images were completely dark, whereas 50 photographs contained identifiable objects. Many photographs showed poor framing, motion blur, prominent light sources, or light-shadow contrasting patterns. In several images, the patient's hand appeared within the frame, suggesting directed attention toward specific objects. The timestamps of the photographs clustered during the first half of the night sleep, typical for periods of NREM parasomnia occurrence. The patient was able to partially recall the dream content of the photo shooting episodes. In-lab video-polysomnography demonstrated repeated awakenings from N3 sleep, supporting the diagnosis of a disorder of arousal. This case illustrates an apparently previously unreported form of goal-directed behavior during sleepwalking. Although the photographic behavior was not directly documented during video-polysomnography, the temporal pattern, clinical presentation, and objective photographic evidence support its occurrence during parasomnia episodes. The findings provide insight into the interaction between dream mentation, environmental stimuli, and complex motor behavior during incomplete arousal, and suggest that highly automatized technology-mediated behaviors may become incorporated into the behavioral spectrum of NREM parasomnias.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"619779"},"PeriodicalIF":3.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706956","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":"Diagnostic Performance of a Combined Reflective Photoplethysmography and Ultra-Wideband Radar Device for Obstructive Sleep Apnea: Comparison with Polysomnography.","authors":"Ming Qiao, Hui Zhang, Luhua Yuan, Ying Huang, Qiuchi Zhang, Shengjie Pan, Limin Xu, Cong Fu, Huan Yu","doi":"10.2147/NSS.S602209","DOIUrl":"10.2147/NSS.S602209","url":null,"abstract":"<p><strong>Objective: </strong>Obstructive sleep apnea (OSA) exhibits high prevalence, yet limited polysomnography (PSG) resources highlight an urgent need for large scale screening. This study assessed the diagnostic efficacy of a combined reflective photoplethysmography and ultra-wideband radar device (Zhao-Guan wireless monitoring system, ZG-Sys) compared to PSG. The aims were to establish ZG-Sys OSA severity cutoff values and define its clinical implementation prospects.</p><p><strong>Methods: </strong>This prospective, open-label diagnostic study was conducted in a sleep center, collecting 433 valid datasets for suspected sleep disorders from June 2023 to April 2024, via synchronous Type 1 PSG and ZG-Sys monitoring. ZG-Sys consists of a ring-style pulse oximeter (Circul) and an IR-UWB radar device (OrbSense). Statistical analysis utilized Spearman rank correlation, Bland-Altman analysis, and Receiver Operating Characteristic (ROC) curves to evaluate agreement and determine optimal ZG-AHI cutoff values against PSG-AHI standards (5, 15, and 30 events/h).</p><p><strong>Results: </strong>ZG-AHI showed a significant correlation with PSG-AHI (Spearman r = 0.800, ICC = 0.908, P < 0.001). The optimal ZG-AHI cutoff for detecting moderate-to-severe OSA (PSG-AHI ≥15) was 20.8 events/h, yielding a high area under the curve (AUC) of 0.943. ZG-Sys demonstrated high sensitivity (89.10-90.80%) and specificity (85.30-88.80%) for identifying moderate-to-severe OSA. Although consistency was good across multiple sleep disorders (eg, parasomnias), weaker correlations were observed in the continuous positive airway pressure (CPAP) treatment group.</p><p><strong>Conclusion: </strong>ZG-Sys demonstrated moderate consistency with PSG across multiple sleep disorders, proving significant clinical value for screening and diagnosing moderate to severe OSA. Featuring simple charging, reusability, and real-time monitoring capabilities, ZG-Sys shows potential for clinical screening in sleep center settings.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"602209"},"PeriodicalIF":3.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706940","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":"Incretin-Based Therapies in Obesity-Related Obstructive Sleep Apnea: A Narrative Review of Evidence Tiers and Mechanistic Plausibility.","authors":"Xize Zhang, Yuxin Jiang, Xiaotong Wei, Siping Wang, Xiaoyu Zhang, Shaodan Hu, Li Shi","doi":"10.2147/NSS.S611573","DOIUrl":"10.2147/NSS.S611573","url":null,"abstract":"<p><p>Obesity-related obstructive sleep apnea (OSA) is common, clinically heterogeneous, and tightly linked to cardiometabolic dysfunction, impaired daytime function, and reduced quality of life. Positive airway pressure (PAP) remains the standard device-based treatment for moderate-to-severe disease because it immediately stabilizes the upper airway, but it does not directly reverse the obesity that drives disease in many patients and its long-term effectiveness is often constrained by adherence. This narrative, non-systematic review synthesizes direct OSA-specific randomized evidence, indirect obesity-trial evidence, and mechanistic literature to clarify what is established, what is inferred, and what remains hypothetical. The clinical evidence for incretin therapy in OSA is promising but uneven. Direct OSA-specific randomized evidence is concentrated in liraglutide and tirzepatide: SCALE Sleep Apnea established proof of concept that pharmacologic weight loss can improve the primary apnea-hypopnea index (AHI) outcome, whereas in SURMOUNT-OSA change in AHI was the primary endpoint. Reductions in body weight, sleep apnea-specific hypoxic burden, selected patient-reported sleep outcomes, hsCRP, and systolic blood pressure were reported as key secondary or additional secondary findings, supporting a broader disease-burden signal but not proving long-term cardiovascular event reduction. Discordant vascular-imaging evidence further cautions that GLP-1-mediated weight loss should not be assumed to reproduce all vascular effects of PAP or to prove cardiovascular event reduction. Semaglutide provides important indirect obesity and cardiometabolic evidence, but direct OSA-specific outcome data remain limited; evidence from other incretin agents also remains largely indirect because most trials were designed for obesity or cardiometabolic endpoints rather than sleep outcomes. The most parsimonious mechanistic interpretation is weight-loss-mediated anatomical unloading. This interpretation is supported by non-incretin weight-loss imaging studies and upper-airway physiology, but it has not yet been directly confirmed by serial upper-airway imaging, Pcrit measurement, or physiological endotyping within incretin-treated OSA cohorts. This narrative review organizes the field into three evidence tiers: direct OSA-specific randomized trials, indirect obesity-trial evidence relevant to OSA, and mechanistic extrapolation. We argue that the current evidence is strong enough to position incretin therapy as a disease-modifying adjunct for selected patients with obesity-driven, anatomically dominant OSA, but not yet strong enough to support class-wide claims, routine PAP replacement, or confident attribution of benefit to direct modulation of non-anatomical endotypes.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"611573"},"PeriodicalIF":3.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727332","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":"REM Sleep Behavior Disorder Following Focal Brainstem Ischemia: A Case Series with Polysomnographic Characterization.","authors":"Jiri Nepozitek, Simona Dostalova, Evzen Ruzicka, Karel Sonka","doi":"10.2147/NSS.S617979","DOIUrl":"10.2147/NSS.S617979","url":null,"abstract":"<p><p>Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream-enacting behaviors occurring in the presence of REM sleep without atonia (RWA) and is most commonly associated with synucleinopathies. Structural lesions of the brainstem have been reported as a potential substrate of secondary RBD, yet polysomnographically confirmed cases remain sparsely documented. We report two patients with focal ischemic brainstem lesions and clinically suspected RBD who underwent detailed neurological evaluation, neuroimaging, and video-polysomnography. In both patients, polysomnography demonstrated RWA consistent with RBD. The first patient, a 75-year-old woman, exhibited prominent vocalizations and complex motor behaviors during REM sleep with RWA affecting 91% of REM sleep duration. Brain magnetic resonance imaging revealed bilateral pontine gliotic changes and a punctate subacute ischemic lesion in the right pontine tegmentum. The second patient, a 41-year-old man with a prior ischemic stroke involving the right medulla oblongata at the ponto-bulbar junction, presented with dream-enacting behaviors and with RWA affecting 41% of REM sleep duration. In both cases, motor manifestations during REM sleep were not attributable to respiratory events. Clinical context and neuroimaging findings supported a structural ischemic etiology. These cases highlight focal brainstem ischemia as a plausible structural substrate of RBD and underscore the importance of detailed polysomnographic and neuroimaging assessment in patients with cerebrovascular disease presenting with dream-enacting behaviors. Focal ischemic brainstem lesions should be considered among the potential contributors to RBD, and their recognition may have important implications for diagnostic evaluation and clinical decision-making.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"617979"},"PeriodicalIF":3.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701624","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":"Efficacy of Acupuncture for Insomnia After Chemotherapy in Breast Cancer: A Randomized Sham-Controlled Trial.","authors":"Jie Li, Zhen Liu, Lianbo Li, Mingyue Xia, Xinyu Chen, Yuting Mei, Yijia Zhang, Yunfei Chen","doi":"10.2147/NSS.S604964","DOIUrl":"10.2147/NSS.S604964","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Post-chemotherapy insomnia is a prevalent complication among breast cancer patients. No relevant sham-controlled studies have employed polysomnography to objectively verify acupuncture treatment effects. This single-blind randomized controlled trial assessed the short-term therapeutic effect and safety of acupuncture for insomnia occurring after breast cancer chemotherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;This single-center study recruited 76 patients diagnosed with stage I-III breast cancer. All participants completed chemotherapy treatment, fulfilled ICSD-3 chronic insomnia diagnostic standards, and conformed to the TCM syndrome of Yin deficiency with excessive fire. Subjects were allocated into acupuncture group and sham acupuncture group at a 1:1 ratio with sealed opaque envelope randomization. The research spanned 9 months, including 5 weeks of biweekly intervention with 10 treatment sessions, alongside follow-up visits conducted at one week and one month after treatment termination. Clinical assessments were carried out at baseline, treatment completion, 1-week and 1-month follow-up. The primary outcome was Insomnia Severity Index score. Secondary outcomes contained PSQI, polysomnographic parameters, BAI, BDI, BFI-C and TCMSRS. All 76 randomized participants (38 cases per group) were analyzed based on intention-to-treat approach via MMRM statistical model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline clinical features showed no statistical difference between two groups (all &lt;i&gt;p&lt;/i&gt; &gt; 0.05). Significant group-time interaction was detected in ISI assessment (&lt;i&gt;F&lt;/i&gt; = 2.80, &lt;i&gt;p&lt;/i&gt; = 0.047). The acupuncture group exhibited more favorable symptom improvement compared with sham group. Between-group mean differences reached -1.61 (95% CI: -2.71 to -0.50, &lt;i&gt;p&lt;/i&gt; = 0.005) after treatment, -1.75 (95% CI: -3.15 to -0.35, &lt;i&gt;p&lt;/i&gt; = 0.015) at 1-week follow-up, and -1.77 (95% CI: -3.22 to -0.32, &lt;i&gt;p&lt;/i&gt; = 0.017) at 1-month follow-up. Remarkable group-time interaction was also observed in PSQI (&lt;i&gt;F&lt;/i&gt; = 4.67, &lt;i&gt;p&lt;/i&gt; = 0.005), with acupuncture group presenting better sleep improvement at post-treatment, with mean difference of -1.18 (95% CI: -2.01 to -0.36, &lt;i&gt;p&lt;/i&gt; = 0.006). Statistically significant interactive results were obtained in BFI-C (&lt;i&gt;F&lt;/i&gt; = 4.07, &lt;i&gt;p&lt;/i&gt; = 0.010), and acupuncture brought obvious fatigue relief with mean difference of -1.95 (95% CI: -3.22 to -0.68, &lt;i&gt;p&lt;/i&gt; = 0.003). TCMSRS also showed notable interaction effect (&lt;i&gt;F&lt;/i&gt; = 5.85, &lt;i&gt;p&lt;/i&gt; = 0.001), and intergroup difference stood at -1.47 (95% CI: -2.34 to -0.60, &lt;i&gt;p&lt;/i&gt; = 0.001) at 1-month follow-up. BDI scores presented significant group-time interaction (&lt;i&gt;F&lt;/i&gt; = 3.00, &lt;i&gt;p&lt;/i&gt; = 0.039), yet no evident pairwise difference was found in post-hoc comparison. No interactive variation existed in BAI evaluation (&lt;i&gt;F&lt;/i&gt; = 1.69, &lt;i&gt;p&lt;/i&gt; = 0.176). Polysomnography results demonstrated distinct advantages of acupuncture interve","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"604964"},"PeriodicalIF":3.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701642","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":"Integrating Complete Blood Count Parameters with Demographic Characteristics for Obstructive Sleep Apnea Prediction in Chinese Adults: A Machine Learning Approach.","authors":"Jianwei Ge, Yi Ling, Yingchen Wang, Fanxia Meng, Fangping He, Nan Ye, Fangfei Tao, Hanxiao Wang, Guoping Peng, Benyan Luo","doi":"10.2147/NSS.S593135","DOIUrl":"10.2147/NSS.S593135","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate machine learning models integrating complete blood count (CBC) parameters with demographic characteristics for obstructive sleep apnea (OSA) risk stratification in adults with suspected OSA referred to a tertiary sleep clinic in China.</p><p><strong>Methods: </strong>This retrospective study analyzed 5,828 adults with suspected OSA referred to a tertiary sleep clinic in China (2018-2024) who underwent home sleep apnea testing (HSAT), with OSA defined as an apnea-hypopnea index (AHI) ≥ 5 events/h. The cohort was temporally partitioned into a training cohort (January 2018 - December 2022, n = 4,330) and a validation cohort (January 2023 - March 2024, n = 1,498) for independent temporal validation. Feature selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression with 10-fold cross-validation exclusively within the training cohort, identifying 9 predictors from 16 candidates: three demographic variables (gender, age, body mass index [BMI]) and six CBC parameters (hemoglobin, mean corpuscular hemoglobin [MCH], lymphocyte count, red cell distribution width-coefficient of variation [RDW-CV], mean platelet volume [MPV], and platelet count). Four machine learning algorithms (logistic regression, Naive Bayes, random forest, XGBoost) were developed using the selected features. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration metrics (Brier score, calibration slope), bootstrap optimism correction (1,000 resamples), and decision curve analysis (DCA).</p><p><strong>Results: </strong>LASSO regression identified nine robust predictors from 16 candidate variables. In the final logistic regression model, hemoglobin demonstrated the largest standardized coefficient (1.38), followed by BMI (0.61), age (0.60), gender (|β| =0.40, with male gender associated with higher OSA risk), and MCH (0.36). Logistic regression achieved the best validation performance (AUC, 0.901, 95% confidence interval (CI): 0.882-0.919; sensitivity, 84.6%; specificity, 81.7%), with good calibration (Brier score, 0.084, calibration slope, 1.208) and minimal optimism (bootstrap-corrected AUC, 0.907). Five-fold cross-validation within the training cohort confirmed model stability (mean AUC, 0.906 ± 0.011). All models demonstrated superior net clinical benefit compared with treat-all or treat-none strategies in DCA. Secondary analyses at AHI ≥ 15 and AHI ≥ 30 thresholds confirmed sustained discriminative ability (validation AUCs 0.820 and 0.809, respectively).</p><p><strong>Conclusion: </strong>Machine learning models integrating CBC parameters with demographic characteristics demonstrated good discriminative ability for OSA risk stratification in Chinese adults referred to a tertiary sleep clinic. These readily available biomarkers may facilitate risk stratification in pre-HSAT triage settings.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"593135"},"PeriodicalIF":3.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701650","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":"A Tripartite Framework of Conflict-Induced Stress, Acoustic Hypervigilance, and Ramadan Observance as Convergent Determinants of Circadian Decoherence in Athletes.","authors":"Wissem Dhahbi, Karim Chamari, Ismail Dergaa, Khaled Trabelsi, Meriem Gaddas, Achraf Ammar, Ahmed S BaHammam, Helmi Ben Saad","doi":"10.2147/NSS.S621788","DOIUrl":"10.2147/NSS.S621788","url":null,"abstract":"<p><p>Athletes living and training in active conflict zones face a combination of distinct biological pressures that disrupt the body's internal 24-hour clock and stress-hormone systems. The constant psychological threat of conflict keeps the body's stress-hormone axis chronically active, raising cortisol levels, heightening alertness, and making it harder to fall and stay asleep. A key problem in the existing research is that nighttime sleep disruption in conflict zones has often been incorrectly described as ordinary screen-related sleep loss. In reality, government-issued missile warning sirens and emergency phone alerts force athletes fully awake, trigger an acute surge of stress hormones, and, over time, condition the nervous system to treat all nighttime sounds as threats. This pathway, which we call conflict-specific acoustic hypervigilance, is biologically distinct from the sleep disruption caused by voluntary smartphone use. For Muslim athletes in these regions, Ramadan fasting adds further strain: eating and drinking only after sunset shifts the body's internal timing, causes progressive daytime dehydration, and may delay the hormonal signals that govern sleep. This review argues that when all three pressures operate at the same time, their combined effect on sleep, hormones, and recovery may exceed what any one pressure would cause alone, a state we call circadian decoherence. Our proposed Tripartite Athletic Stress Framework maps how these three stressors interact and amplify each other. We propose two measurable cortisol markers as practical tools for monitoring biological overload in affected athletes. Practical countermeasures, including noise management, adjusted meal timing, strategic napping, and psychological resilience training, are outlined with direct reference to the framework's intervention targets.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"621788"},"PeriodicalIF":3.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706968","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":"\"Schrödinger's Rat\": Testing Consciousness Under Anesthesia Alters Brain State and Neuronal Responses in Auditory Cortex.","authors":"Aaron J Krom, Lottem Bergman, Yaniv Sela, Hanna Cattan-Hayat, Noa Regev, Yuval Nir","doi":"10.2147/NSS.S522955","DOIUrl":"10.2147/NSS.S522955","url":null,"abstract":"<p><strong>Purpose: </strong>In anesthesia research and clinical practice, the level of consciousness is often assessed by stimulating subjects and observing their responses. It is possible that such stimulation alters the very state of consciousness being assessed. Whether this phenomenon is accompanied by specific cortical activities remains unknown. Here, we tested the effects of behavioral assessments on neuronal activity in the rat primary auditory cortex (A1) and perirhinal cortex (PrC).</p><p><strong>Methods: </strong>Neuronal spiking activity was recorded from microwire arrays targeting A1 and/or PrC in rats (n = 9), whilst presenting 40 Hz click-trains and gradually increasing infusion rates of propofol, remifentanil, ketamine or dexmedetomidine. We assessed righting reflex, pain withdrawal, whisking reflex, and corneal reflex every 12 minutes (every 360 auditory trials). We searched for significant changes in baseline firing rate and stimulus-evoked activities (where present) due to the behavioral assessments, by comparing 4 min intervals before and after the behavioral tests.</p><p><strong>Results: </strong>Out of 1004 units in 20 sessions, we found significantly elevated activity (p < 0.01) following behavioral tests in 32% and 20% of A1 auditory-responsive units and 8.6% and 5.3% of auditory-unresponsive units under propofol and dexmedetomidine, respectively, but not under remifentanil or ketamine. A higher proportion of units modulated their firing following behavioral tests in A1 compared to PrC, with median gains ranging from +0.23 to +1.06, depending on the specific response feature.</p><p><strong>Conclusion: </strong>Behavioral testing increases ongoing firing rate and responses to sounds in some cortical neurons. This increase is more prevalent in A1 than in PrC, mirroring clinical observations that patients exhibit basic responses under sedation, while complex processing, such as memory encoding, is impaired. The degree of neuronal modulation due to behavioral testing varies between anesthetic agents, mirroring their clinical phenotypes.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"522955"},"PeriodicalIF":3.4,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679603","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}