Nature and Science of Sleep最新文献

{"title":"A Nomogram Model for Predicting Moderate to Severe OSA in Western China: A Retrospective Analysis.","authors":"Aman Gul, Ainiwaer Talifu, Maimaiti Aili, Xuejiao Xie, Yilifanjiang Kuerban, Zulipikaer Wusiman, Palidan Wushuer, Fuxian Huang, Jingcheng Dong, Zhijian Li","doi":"10.2147/NSS.S592761","DOIUrl":"10.2147/NSS.S592761","url":null,"abstract":"<p><strong>Objective: </strong>To develop an interpretable nomogram model for predicting moderate-to-severe obstructive sleep apnea (OSA).</p><p><strong>Methods: </strong>This retrospective study analyzed 11,030 OSA patients who underwent polysomnography between 2012 and 2020. Patients were randomly divided into a modeling cohort (n=7,721) and a validation cohort (n=3,309) in a 7:3 ratio. Based on disease severity, patients were further classified into mild and moderate-to-severe subgroups. General clinical data were collected. Independent risk factors were identified using multivariate logistic regression, and a nomogram prediction model was constructed using the R \"rms\" package.</p><p><strong>Results: </strong>Univariate analysis showed significant differences in age, BMI, neck circumference, gender, hypertension, diabetes, smoking status, alcohol consumption, and coronary heart disease between the mild and moderate-to-severe groups in both cohorts (all <i>P</i> < 0.05). Multivariate logistic regression identified age, BMI, neck circumference, male gender, hypertension, and diabetes as independent risk factors for moderate-to-severe OSA (all <i>P</i> < 0.05). The nomogram model demonstrated good fit (Hosmer-Lemeshow test: modeling cohort <i>χ</i> ²=10.754, <i>P</i>=0.216; validation cohort <i>χ</i> ²=8.383, <i>P</i>=0.397). Decision curve analysis confirmed the model's clinical utility within specific risk thresholds. The area under the ROC curve was 0.676 (95% <i>CI</i>: 0.664-0.688) for the modeling cohort and 0.613 (95% <i>CI</i>: 0.593-0.632) for the validation cohort, indicating strong predictive performance.</p><p><strong>Conclusion: </strong>The nomogram model based on age, BMI, neck circumference, gender, hypertension, and diabetes provides a valuable tool for predicting and assessing moderate-to-severe OSA, offering important strategic guidance for clinical practice.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"592761"},"PeriodicalIF":3.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13316818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361586","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":"Prevalence of Insomnia in Healthcare Profession - PIHEP Study: A Large-Scale National Study in Vietnam.","authors":"Sy Duong-Quy, Dung Nguyen-Thi-Thu, Huong Hoang-Thi-Xuan, Lam Nguyen-Tung, Hoa Bui-Ngoc-Phuong, Linh Tran Thanh Duy, Thu Nguyen-Ngoc-Phuong, Tram Tang-Thi-Thao, Thai Nguyen-Duy, Bang Nguyen-Trong, Lien Nguyen-Thi-Hong, Trang Tran-Thi-Doan, Thuy Phan-Thanh, Khue Bui-Diem, Bo Tran-Thi-Mong, Phap Tran-Quang, Toi Nguyen-Van, Anh Nguyen-Tuan, Tram Vu-Doan, Thuc Pham-Van, Trung Mai-Xuan, Nghia Thanh Phan, Viet Nguyen-Ba, Tuyen Hoang-Thanh, Thuy Tran-Phan-Chung, Huong Le-Thi-Minh, Vinh Nguyen-Nhu, Linh Pham-Van, Bao Le-Khac, Giap Vu-Van, Franck Soyez, Thomas Penzel, Clete Kushida, Francis Martin","doi":"10.2147/NSS.S597038","DOIUrl":"10.2147/NSS.S597038","url":null,"abstract":"<p><strong>Background: </strong>Insomnia is a prevalent sleep disorder worldwide, yet data among healthcare professionals in Southeast Asia remain limited. Occupational stressors, rotating shifts, and high emotional demands may increase vulnerability to sleep disturbance in this population.</p><p><strong>Objective: </strong>To estimate the prevalence of insomnia among Vietnamese healthcare professionals and to identify associated nocturnal symptoms, daytime impairments, and clinical associated factors.</p><p><strong>Methods: </strong>We conducted a nationwide multi-region cross-sectional survey of 1655 healthcare professionals across Vietnam. Participants completed a structured questionnaire assessing insomnia symptoms, daytime consequences, comorbidities, and occupational factors. Insomnia was ascertained per ICSD-3 criteria for chronic insomnia, requiring (i) ≥ 1 nocturnal symptom (DIMS: difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening); (ii) ≥ 1 associated daytime impairment; (iii) symptom frequency ≥ 3 nights/week; and (iv) chronicity ≥ 3 months, despite adequate sleep opportunity. Severity was evaluated using the Insomnia Severity Index (ISI). Logistic regression models estimated odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs), adjusting for age, sex, occupation, marital status, and stimulant use.</p><p><strong>Results: </strong>The prevalence of insomnia was 24.2% (95% CI, 22.2-26.3), higher in women than men and increasing with age. The most common nocturnal symptoms were nocturnal awakenings (84.2%) and sleep-onset difficulty (57.2%), while daytime impairments included memory complaints (74.6%), mood disturbances (55.4%), and excessive daytime sleepiness (59.5%). In multivariable analysis, independent associated factors of insomnia included nocturnal awakenings (aOR 6.11), sleep-onset difficulty (aOR 2.89), mood disturbance (aOR 2.20), morning headache (aOR 2.18), and memory impairment (aOR 1.63). Stimulant consumption, particularly tea or coffee (aOR 2.10) and alcohol (aOR 1.98), was also independently associated.</p><p><strong>Conclusion: </strong>Approximately one in four Vietnamese healthcare professionals experience insomnia, characterized by substantial nocturnal fragmentation and daytime dysfunction. Given its potential implications for clinician well-being and patient safety, systematic screening and integrated occupational sleep-health interventions are warranted.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"597038"},"PeriodicalIF":3.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352562","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":"Follow-up Study on the Sleep Status of Anti-Epidemic Staff: A Study Based on Wearable Sleep Trackers.","authors":"Yiqing Zhou, Xiaohui Wang, Cunyou Gao, Rongqin Wu, Chao Li, Kaiming Zhuo","doi":"10.2147/NSS.S596230","DOIUrl":"10.2147/NSS.S596230","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare sleep architecture, as estimated by a wearable pulse oximeter, between healthcare staff who worked in designated hospitals during the COVID-19 pandemic in Wuhan and a control group, and across a one-year follow-up, and identify factors associated with insomnia risk in this population.</p><p><strong>Methods: </strong>Thirty healthcare professionals who worked in Wuhan during the initial COVID-19 outbreak in 2020 and 28 healthy control healthcare professionals who did not participate in epidemic control were recruited. All participants underwent one night of overnight sleep monitoring with a ring-shaped medical pulse oximeter. Psychological health conditions were assessed using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Perceived Stress Scale (PSS-10), Insomnia Severity Index (ISI), and Self-reporting Questionnaire (SRQ-20). A one-year follow-up, including repeat one-night sleep monitoring, was conducted for 28 of the anti-epidemic staff.</p><p><strong>Results: </strong>Twenty-eight anti-epidemic staff and 28 controls completed the study. The difference in total sleep time (TST) among the healthcare staff at the post-deployment assessment, the 1-year follow-up, and the control group was statistically significant (F=9.942, p<0.001). TST of the anti-epidemic group at the post-deployment assessment was significantly longer than that at the 1-year follow-up and that of the control group. A non-significant trend toward a relative decrease in the proportion of deep sleep was observed in the anti-epidemic group after 1 year (F=2.456, p=0.092). In an exploratory analysis, this trend appeared to be driven by a numerical decrease in deep sleep and a numerical increase in light sleep at the follow-up. In a logistic regression model, higher SRQ-20 score and older age were independently associated with increased risk of insomnia, while higher BMI and higher PHQ-9 score showed inverse associations.</p><p><strong>Conclusion: </strong>In this exploratory study, stress exposure may have a sustained impact on the sleep of healthcare staff. SRQ-20 score, age, BMI, and PHQ-9 score were independently associated with insomnia in this cohort. The application of wearable pulse oximeters may serve as a convenient tool for large-scale sleep health screening, but sleep architecture findings derived from these devices require confirmation by polysomnography and should be interpreted with caution.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"596230"},"PeriodicalIF":3.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13316815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361602","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":"Validation of the Richards-Campbell Sleep Questionnaire Against Actigraphy in Hospitalized Patients and Its Association with Delirium Risk.","authors":"Martin Milata, Hana Locihová, Karel Sonka, Marek Susta","doi":"10.2147/NSS.S607779","DOIUrl":"10.2147/NSS.S607779","url":null,"abstract":"<p><strong>Purpose: </strong>To validate the Richards-Campbell Sleep Questionnaire (RCSQ) relative to actigraphy on general hospital wards and to examine the predictive value of sleep parameters for delirium.</p><p><strong>Patients and methods: </strong>This multicenter, prospective observational study was conducted on internal medicine, surgical, and neurology wards across seven healthcare institutions in the Czech Republic. The analysis included 133 patients (424 nights). Individual RCSQ items and corresponding nocturnal actigraphic sleep parameters (MotionWatch 8) were compared using linear mixed-effects models (LMM). Associations with delirium occurrence were evaluated using binary logistic regression.</p><p><strong>Results: </strong>Patients rated their sleep as moderately good on the RCSQ despite objectively impaired sleep on actigraphy. Only the sleep-depth item showed significant associations, with higher scores linked to higher immobile time and lower fragmentation. No significant associations were found for remaining parameters. The RCSQ total score showed only weak associations with sleep efficiency and percent sleep. Subjective sleep ratings did not predict delirium, whereas higher actigraphic sleep efficiency was associated with lower delirium risk.</p><p><strong>Conclusion: </strong>In hospitalized patients, only the RCSQ item assessing sleep depth showed meaningful correspondence with actigraphic measures. The RCSQ total score showed limited concurrent validity against actigraphy and was not useful for predicting delirium, whereas low actigraphy-measured sleep efficiency appeared to be a clinically relevant marker of delirium risk.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"607779"},"PeriodicalIF":3.4,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352477","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 Therapeutic Heterogeneity to Precision Neuromodulation: Non-Invasive Brain Stimulation for Chronic Insomnia.","authors":"Wu-Lan Ao, Zheng Liu, Zi-Yi Zhao, Wen-Chang Zhu, Si-Qi Guan, Yong-Su Zheng, Hao Huang","doi":"10.2147/NSS.S495420","DOIUrl":"10.2147/NSS.S495420","url":null,"abstract":"<p><p>Chronic insomnia is linked to impaired daytime functioning, diminished quality of life, and heightened psychiatric and cardiometabolic risks. While cognitive behavioral therapy for insomnia and pharmacotherapy are well-established treatments, their clinical effectiveness may be constrained by limited accessibility, incomplete response, relapse, adherence challenges, or adverse effects. Non-invasive brain stimulation (NIBS) has therefore attracted increasing interest as a potential adjunctive or alternative intervention because it may modulate cortical excitability, large-scale brain networks, sleep-related oscillations, and autonomic function. This narrative review synthesizes current evidence on repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and transcutaneous auricular vagus nerve stimulation (taVNS) for chronic insomnia. Particular attention is given to therapeutic heterogeneity across stimulation targets, parameters, treatment schedules, patient phenotypes, and outcome measures. Available studies suggest potential improvements in subjective sleep quality and selected objective sleep parameters; however, the evidence remains limited by small sample sizes, variable sham designs, short follow-up durations, and inconsistent findings across modalities. We further propose a precision neuromodulation framework based on individualized functional targeting, biomarker-informed patient stratification, closed-loop feedback regulation, and integration with behavioral or pharmacological treatment pathways. This review highlights the translational promise of NIBS and outlines methodological priorities needed to move from heterogeneous evidence toward clinically reliable precision neuromodulation.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"495420"},"PeriodicalIF":3.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345849","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":"Gut Microbiota, Immune Phenotypes, and Insomnia: A Two-Sample Mendelian Randomization Study.","authors":"Xiaofeng Jiang, Bin Yu","doi":"10.2147/NSS.S597195","DOIUrl":"10.2147/NSS.S597195","url":null,"abstract":"<p><strong>Purpose: </strong>The microbiota-gut-brain axis offers a novel framework for understanding insomnia; however, the hypothesis that specific immune pathways mediate the causal effects of gut microbial taxa on insomnia requires supporting genetic evidence. This study aimed to explore the genetic evidence supporting the causal interplay between the gut microbiota, immune phenotypes, and insomnia using large-scale genetic data.</p><p><strong>Patients and methods: </strong>We employed two-sample bidirectional Mendelian Randomization (MR) using large-scale genome-wide association study (GWAS) summary statistics for gut microbiota, 731 immune cell phenotypes, and insomnia (FinnGen R12). Mediation analysis was conducted to quantify the specific indirect effects of immune cells.</p><p><strong>Results: </strong>We found suggestive genetic evidence linking 13 gut microbial taxa to insomnia risk. Notably, a directional divergence was observed within the <i>Blautia</i> genus at the species level, where Blautia A sp900066355 showed a robust protective association (surviving FDR correction), whereas other species within the genus increased risk at a nominal significance level (uncorrected P < 0.05). Furthermore, 17 immune phenotypes were found to be associated with insomnia. Exploratory mediation analysis suggested that monocytic myeloid-derived suppressor cells (M-MDSCs) may mediate the pathway linking the uncultured bacterium CAG-177 to insomnia, accounting for 10.7% of the total effect.</p><p><strong>Conclusion: </strong>This study provides preliminary genetic evidence linking specific gut microbial taxa and immune phenotypes to insomnia risk, with Blautia A sp900066355 demonstrating robust protective effects. As a secondary hypothesis-generating observation, we propose a preliminary hypothesis that the depletion of protective M-MDSCs, rather than solely pro-inflammatory activation, may contribute to insomnia pathogenesis. Given the borderline statistical significance of this mediation finding, drawing direct therapeutic implications is currently premature.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"597195"},"PeriodicalIF":3.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345846","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":"The Effectiveness of a Novel Sleep Test Based on Cardiopulmonary Coupling to Detect Obstructive Sleep Apnea: A Multicenter Prospective Study.","authors":"Chuan-Yen Sun, Liang-Wen Hang, En-Ting Chang, Diahn-Warng Perng, Shiang-Fen Huang, Fang-Chi Lin, Kang-Cheng Su, Tsu-Hui Shiao, Yung-Yang Liu, Yuh-Min Chen, Kun-Ta Chou","doi":"10.2147/NSS.S581103","DOIUrl":"10.2147/NSS.S581103","url":null,"abstract":"<p><strong>Purpose: </strong>Obstructive sleep apnea (OSA) is common and requires early detection and timely management to relieve symptoms and lower the risk of long-term complications. Although established home sleep apnea testing systems are available, many require multiple sensors, and simplified ECG-based approaches may reduce setup burden and improve ease of use. This study aimed to evaluate the diagnostic performance of a cardiopulmonary coupling-based sleep test against polysomnography-derived apnea-hypopnea index (AHI) in adults with clinically suspected OSA.</p><p><strong>Patients and methods: </strong>In this prospective study at three tertiary medical centers in Taiwan, adults with suspected OSA received simultaneous in-laboratory polysomnography and a novel home sleep apnea test (Largan Health AI-Tech). The wearable device used a wireless electrocardiogram Holter monitor placed on the left anterior chest to record electrocardiogram signals during sleep. Signals were processed with cardiopulmonary coupling analysis to derive a respiratory event index, which was compared with the AHI from polysomnography.</p><p><strong>Results: </strong>Among 479 participants, 200 were enrolled from CMUH, 193 from TVGH, and 86 from HTCH. The respiratory event index correlated strongly with the AHI (<i>ρ</i> = 0.889, p < 0.001), with high cohort-level consistency by intraclass correlation coefficient (ICC = 0.955). For identifying OSA, the area under the receiver operating characteristic curve was 0.923 (95% confidence interval 0.91-0.95) at an AHI of at least 5 events per hour, 0.929 (95% confidence interval 0.90-0.95) at least 15 events per hour, and 0.967 (95% confidence interval 0.95-0.98) at least 30 events per hour. In the subgroup with supplemental pulse oximetry, the combined approach showed higher areas under the receiver operating characteristic curve of 0.981, 0.984, and 0.992 at the corresponding thresholds.</p><p><strong>Conclusion: </strong>CPC-derived REI showed good diagnostic performance against PSG-derived AHI in adults with clinically suspected OSA referred to tertiary sleep centers in Taiwan, supporting its potential role as a simplified adjunctive tool for OSA evaluation in this referred clinical setting.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"581103"},"PeriodicalIF":3.4,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345822","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":"Translating Evidence into Obstetric Care: Developing a Best Practice-Informed Stepped-Care Clinical Algorithm for the Management of Gestational Insomnia.","authors":"Fei-Yi Zhao, Li-Ping Yue, Yuen-Shan Ho, Peijie Xu, Jillian H Broadbear, Wen-Jing Zhang, Yan-Mei Wang, Qiang-Qiang Fu, Russell Conduit","doi":"10.2147/NSS.S607896","DOIUrl":"10.2147/NSS.S607896","url":null,"abstract":"<p><strong>Background and aims: </strong>Insomnia during pregnancy is potentially associated with adverse outcomes, including gestational diabetes mellitus, pre-eclampsia, cesarean delivery, preterm birth, and depression. This study aimed to synthesize available evidence on the management of gestational insomnia and develop a clinical algorithm to inform obstetric care practice.</p><p><strong>Methods: </strong>Based on the best available evidence, a clinical algorithm was developed as follows. First, a systematic search was conducted following the 6S evidence pyramid, including clinical practice guidelines, expert consensus statements, evidence summaries, and algorithms or decision aids published from database inception to January 2026. Second, four reviewers independently screened and appraised the literature. Third, two sleep medicine physicians extracted and synthesized the evidence using the JBI Grading of Evidence and Recommendation System. Finally, the clinical algorithm was constructed based on the synthesized evidence.</p><p><strong>Results: </strong>Nineteen publications were included, i.e., nine expert consensus statements, eight clinical guidelines, one clinical decision aid, and one evidence summary, from which 31 practice recommendations were derived. These recommendations fit within five key domains: (1) overarching principles emphasizing symptom control, stress management, and family support; (2) lifestyle-based interventions; (3) CBT-i and its digital delivery modalities; (4) pharmacotherapy; and (5) complementary and alternative medicine (CAM). Collectively, they create a stepped-care management pathway for gestational insomnia, beginning with lifestyle modifications, followed by CBT-i for patients with more severe symptoms (which can be supplemented by CBT-i Coach app to enhance self-management during treatment), and finally considers pharmacotherapy (at the lowest effective dose and shortest feasible duration) or CAM therapies (e.g. acupuncture) for women who respond poorly to psychotherapy or present with comorbid somatic/emotional disorders.</p><p><strong>Conclusion: </strong>This study proposes a stepped-care algorithm for managing gestational insomnia. As it is based on evidence synthesis rather than prospective clinical validation, its real-world effectiveness remains to be established. Furthermore, its implementation should be tailored to patient preferences and local healthcare resources to ensure contextual relevance and clinical feasibility.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"607896"},"PeriodicalIF":3.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318138","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":"Night-to-Night Sleep Variability Modulates Subjective Sleep Perception in Chronic Insomnia: A Multilevel Analysis.","authors":"Xiaoyu Xiao, Shuo Liu, Wenjing Jiang, Zhuqing Xu, Fanzun Meng, Fangchun Huang, Xiaochan Bi, Zixiang Guo, Yuqi Li","doi":"10.2147/NSS.S602062","DOIUrl":"10.2147/NSS.S602062","url":null,"abstract":"<p><strong>Introduction: </strong>Subjective sleep perception often differs from objective sleep measures in chronic insomnia, but the role of night-to-night sleep variability remains insufficiently understood. This study examined the effects of daily within-individual sleep fluctuations and between-individual sleep variability on subjective sleep perception in patients with chronic insomnia.</p><p><strong>Methods: </strong>Fifty patients with chronic insomnia completed home-based sleep monitoring and sleep diaries for five to seven consecutive nights, yielding 312 valid nights. Sleep perception bias was defined as the difference between objective sleep parameters and subjective estimates. Sleep variability was quantified using the coefficient of variation. Linear mixed-effects models examined within-individual associations, between-individual variability effects, and cross-level interactions.</p><p><strong>Results: </strong>Nightly objective changes in total sleep time, sleep efficiency, wake after sleep onset, and sleep onset latency were significantly associated with corresponding subjective-objective discrepancies. Subjective perception changed less than objective sleep parameters, suggesting reduced subjective responsiveness to nightly sleep changes. Between individuals, lower total sleep time variability was associated with greater bias in perceived sleep duration and sleep efficiency. Higher N2 percentage variability was associated with greater wake after sleep onset perception bias and moderated the association between objective wake time and subjective perception.</p><p><strong>Discussion: </strong>These findings suggest that subjective sleep perception in chronic insomnia is influenced by nightly objective sleep changes and longer-term sleep variability. N2-related findings should be interpreted cautiously given the exploratory sleep-stage-specific analyses and portable EEG monitoring.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"602062"},"PeriodicalIF":3.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318017","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":"An Exploration of Craniofacial Features in Obstructive Sleep Apnea Using the Explainable Deep Learning Approaches.","authors":"Liuyi Luo, Ruicong Yang, Zitong Pei, Min Yu, Xu Gong, Yi Lei, Qing Wang, Xuemei Gao","doi":"10.2147/NSS.S609113","DOIUrl":"10.2147/NSS.S609113","url":null,"abstract":"<p><strong>Purpose: </strong>Traditional craniofacial phenotyping of obstructive sleep apnea (OSA) relies on predefined anatomical hypotheses, often yielding incomplete assessments. This study aimed to apply multiple explainable deep learning (DL) approaches to explore novel craniofacial phenotypes.</p><p><strong>Patients and methods: </strong>A multimodal DL model was trained using frontal and lateral facial images, lateral cephalograms, and demographic data from 130 participants (65 OSA patients diagnosed by overnight polysomnography, and 65 age- and sex-matched controls). Explainability analysis of the model's prediction was conducted in a subset of 56 participants per group using average face analysis, feature importance analysis, and gradient-weighted class activation mapping (Grad-CAM). Targeted measurements were then performed on the identified non-traditional regions to validate morphological differences.</p><p><strong>Results: </strong>The model achieved an area under the curve of 0.87. The explainability analysis identified not only anatomical structures that have been confirmed to predict OSA (such as the mandible, chin, and hyoid regions), but also the middle and upper facial third (e.g. the forehead, eyebrows, and upper eyelids), which has not been fully emphasized in previous studies. Targeted measurements confirmed a significantly smaller inter-eyebrow distance, increased frontal protrusion (<i>p</i> < 0.001) and frontal sinus area (<i>p</i> < 0.001) in OSA patients.</p><p><strong>Conclusion: </strong>Explainable DL expanded OSA-related craniofacial phenotypes. Future studies are needed to validate these upper-face traits in larger cohorts and clarify their relevance to OSA subtyping and mechanisms.</p>","PeriodicalId":18896,"journal":{"name":"Nature and Science of Sleep","volume":"18 ","pages":"609113"},"PeriodicalIF":3.4,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318045","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}