Sleep medicine最新文献

{"title":"Overnight monitoring of sleep biomechanics: A scoping review","authors":"Nicholas Buckley ,&nbsp;Lynn Jensen ,&nbsp;Kevin Gilbert Baptist ,&nbsp;Bas Jansen ,&nbsp;Amity Campbell ,&nbsp;Jenny Downs","doi":"10.1016/j.sleep.2025.106481","DOIUrl":"10.1016/j.sleep.2025.106481","url":null,"abstract":"<div><h3>Background</h3><div>Body position and movement during sleep is assessed for both clinical and research purposes. A diverse array of both assessment tools and classification systems are used to capture and code sleep biomechanics data.</div></div><div><h3>Objectives</h3><div>The aim of this scoping review was to identify the assessment tools and classification systems used to examine sleep biomechanics, and the strengths and limitations of current approaches.</div></div><div><h3>Methods</h3><div>MEDLINE, EMBASE and CINAHL databases were searched from inception to July 2024, from which 73 publications were selected that assessed body position distribution and/or repositioning rate, for at least one night of sleep. Qualitative content analysis was completed to extract strengths and limitations of current approaches.</div></div><div><h3>Results</h3><div>Nearly half (44 %) of studies assessed rate of repositioning; 26 % of studies assessed position distribution, and 30 % studies examined both rate of repositioning and position distribution. Common assessment tools were Wearable Accelerometry (26 %) and Polysomnography (22 %). The most frequent repositioning rate classification system was 90° trunk rotation (10 %) and the most frequent position distribution classification system was Supine/Left Side Lying/Right Side Lying/Prone (29 %). Strengths included richness of data set (wearable accelerometry), while limitations included cost and unfamiliar sleep environment (e.g. polysomnography).</div></div><div><h3>Conclusions</h3><div>While different methods are needed to accommodate various research and clinical needs, a frequent challenge is the lack of detail in how sleep biomechanics are recorded and coded. Wearable sensors offer significant advantages in ease of implementation and granularity of data capture. These devices, in combination with a detailed sleep biomechanics coding system, show potential as future research tools to overcome this limitation.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106481"},"PeriodicalIF":3.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783164","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":"Are trajectories of insomnia symptoms associated with clinically significant depressive symptoms or vice versa? Evidence from a 5-year longitudinal study","authors":"Si-Jing Chen ,&nbsp;Hans Ivers ,&nbsp;Josée Savard ,&nbsp;Mélanie LeBlanc ,&nbsp;Charles M. Morin","doi":"10.1016/j.sleep.2025.106489","DOIUrl":"10.1016/j.sleep.2025.106489","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the association between different insomnia symptom trajectories and subsequent depressive symptoms, as well as the reverse.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of a population-based study on the natural course of insomnia in Canada, and 3030 participants (18–94 years) with valid data were included. Two separate analyses were conducted for the distinct objectives of the current study, which required different samples. Participants who exhibited the designated outcomes at baseline were excluded from each analysis. Growth mixture modeling was used to identify insomnia and depressive symptom trajectories over five years, measured by Insomnia Severity Index (ISI) and Beck Depression Inventory-II (BDI-II), respectively. Cases with clinically significant depressive symptoms at follow-ups were defined as reporting at least moderate depressive symptoms (BDI-II ≥ 20) and one core symptom of depression, while insomnia disorder at follow-ups was identified according to a validated algorithm using a combination of criteria from DSM-4 and ICSD-3 and self-reported use of sleep medication.</div></div><div><h3>Results</h3><div>Five insomnia symptom trajectories were identified over five years: stable good sleepers (24 %), stable low insomnia severity (35 %), gradual improvements in symptoms (6 %), persistent insomnia symptoms (31 %), and progressive worsening of symptoms (5 %). Compared with good sleepers, the other insomnia trajectory groups all had higher risks of clinically significant depressive symptoms at follow-ups, especially those with progressive symptoms (harzad ratio [HR]: 19.77 [10.30 to 37.93]). In a parallel analysis, four depression trajectories emerged: noncases (49 %), stable low depressive severity (38 %), moderate symptoms improving over time (7 %), and progressive worsening of symptoms (6 %). Compared with noncases, the other depression trajectory groups all showed elevated risks of insomnia disorder, especially those with progressive worsening of symptoms (HR: 6.85 [5.26 to 8.93]).</div></div><div><h3>Conclusions</h3><div>Our findings support a close relationship between insomnia and depressive symptoms, especially when both symptoms become progressive or persistent.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106489"},"PeriodicalIF":3.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777534","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":"Obesity hypoventilation syndrome: Current status and future directions for optimizing care of a complex and diverse condition (a narrative review)","authors":"Jean-Louis Pépin,&nbsp;Sébastien Baillieul,&nbsp;Renaud Tamisier","doi":"10.1016/j.sleep.2025.106491","DOIUrl":"10.1016/j.sleep.2025.106491","url":null,"abstract":"<div><div>The global obesity pandemic contributes to an increase in the prevalence of obesity hypoventilation syndrome (OHS). OHS is associated with poor prognosis and early mortality. Definitions of OHS and disease severity classifications differ between international guidelines, and consideration of polysomnographic features is often lacking. To address this, the European Respiratory Society has proposed a severity classification approach. It is also important to consider the possibility that patients with OHS might have multiple factors contributing to hypercapnia, including obesity-related changes in the respiratory system, alterations in central respiratory drive, and different sleep-disordered breathing (SDB) abnormalities. There are also multiple health trajectories that occur before an OHS diagnosis. Positive airway pressures such as continuous positive airway pressure or non-invasive ventilation are the mainstay of OHS treatment. The choice of therapy needs to be guided by appropriate SDB phenotyping and daytime hypercapnia severity. Comorbidities are common in patients with OHS and these trigger and increase the risk of acute on chronic respiratory failure. Appropriate management of comorbidities, and weight loss management, are essential (including behavioral interventions, physical activity, pharmacotherapy, and metabolic/bariatric procedures, as appropriate for each individual). Newer pharmacological treatments such as glucagon-like peptide-1 receptor agonists, recombinant human leptin, and orexin receptor antagonists are promising, but have not yet been specifically investigated in OHS populations. Overall, there is a need for a significant redesign in assessment and care to facilitate the evidence-based management of the complex and diverse OHS presentations in clinical practice.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106491"},"PeriodicalIF":3.8,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reallocation of 24-h movement behaviours in cardiovascular risk in Brazilian adults: An isotemporal analysis","authors":"Samara Silva de Moura ,&nbsp;Luiz Antônio Alves de Menezes-Júnior ,&nbsp;George Luiz Lins Machado-Coelho ,&nbsp;Júlia Cristina Cardoso Carraro ,&nbsp;Adriana Lúcia Meireles","doi":"10.1016/j.sleep.2025.106487","DOIUrl":"10.1016/j.sleep.2025.106487","url":null,"abstract":"<div><h3>Background</h3><div>Movement behaviours (MB) over a 24-h period, including sleep, sedentary behaviour (SB), and physical activity (PA), are crucial for preventing and treating cardiovascular diseases.</div></div><div><h3>Objective</h3><div>To use isotemporal substitution modelling to examine the relationship between MB and cardiovascular risk (CVR).</div></div><div><h3>Methods</h3><div>A population-based study conducted in two Brazilian cities. Data were collected through face-to-face interviews using a structured electronic questionnaire. Sleep was assessed via the Pittsburgh Sleep Quality Index (PSQI) and expressed in minutes. PA was quantified in minutes by multiplying weekly frequency by daily time spent on each activity type. SB was measured by the total sitting time in minutes. CVR was estimated using the Framingham risk score (FRS) and categorised as low risk (&lt;5 %) or intermediate to high risk (≥5 %). Isotemporal substitution models were applied to evaluate the association of substituting one MB for another on CVR.</div></div><div><h3>Results</h3><div>Among the 1550 participants analysed, 41.3 % had intermediate or high CVR. Substituting minutes of moderate to vigorous physical activity (MVPA) for sleep increased the chances of CVR, with odds ratios (ORs) ranging from 1.05 to 1.87 as the time of substitution increased. In contrast, replacing minutes of SB or sleep with MVPA led to a reduction in the chances of CVR, with ORs ranging from 0.95 to 0.58 for SB and from 0.94 to 0.53 for sleep.</div></div><div><h3>Conclusion</h3><div>This study suggests that replacing SB or sleep with MVPA is associated with a significant reduction in the prevalence of CVR. Maintaining a healthy balance between sleep, SB and MVPA is fundamental to good cardiovascular health.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106487"},"PeriodicalIF":3.8,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Separating obstructive and central respiratory events during sleep using breathing sounds: Utilizing transfer learning on deep convolutional networks","authors":"Shumit Saha ,&nbsp;Nasim Montazeri Ghahjaverestan ,&nbsp;Azadeh Yadollahi","doi":"10.1016/j.sleep.2025.106485","DOIUrl":"10.1016/j.sleep.2025.106485","url":null,"abstract":"<div><div>Sleep apnea diagnosis relies on polysomnography (PSG), which is resource-intensive and requires manual analysis to differentiate obstructive sleep apnea (OSA) from central sleep apnea (CSA). Existing portable devices, while valuable in detecting sleep apnea, often do not distinguish between the two types of apnea. Such differentiation is critical because OSA and CSA have distinct underlying causes and treatment approaches. This study addresses this gap by leveraging tracheal breathing sounds as a non-invasive and cost-effective method to classify central and obstructive events.</div><div>We employed a transfer learning strategy on six pre-trained deep convolutional neural networks (CNNs), including Alexnet, Resnet18, Resnet50, Densenet161, VGG16, and VGG19. These networks were fine-tuned using spectrograms of tracheal sound signals recorded during PSG. The dataset, comprising 50 participants with a combination of central and obstructive events, was used to train and validate the model. Results showed high accuracy in differentiating central from obstructive respiratory events, with the combined CNN architecture achieving an overall accuracy of 83.66 % and a sensitivity and specificity above 83 %.</div><div>The findings suggest that tracheal breathing sounds can effectively distinguish between OSA and CSA, providing a less invasive and more accessible alternative to traditional PSG. This methodology could be implemented in portable devices to enhance the diagnosis of sleep apnea, enabling targeted treatment. By facilitating earlier and more accurate diagnoses, this method supports personalized treatment strategies, optimizing therapy selection (e.g., CPAP for OSA, ASV for CSA) and ultimately enhancing clinical outcomes.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106485"},"PeriodicalIF":3.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polysomnographic characteristics of patients with heart failure combined with sleep apnea: A systematic review and meta-analysis","authors":"Feng Yu ,&nbsp;Yujing Sun ,&nbsp;Shuo Ye ,&nbsp;Zhexi Li ,&nbsp;Dongxue Yang ,&nbsp;Rui Zheng ,&nbsp;Sheng Guo ,&nbsp;Xuejiao Zhang ,&nbsp;Chenhao Zhao ,&nbsp;Min Zhang ,&nbsp;Guoan Zhao ,&nbsp;Sizhi Ai","doi":"10.1016/j.sleep.2025.106486","DOIUrl":"10.1016/j.sleep.2025.106486","url":null,"abstract":"<div><h3>Aims</h3><div>Objective sleep parameters in patients with HF and their comorbidity with sleep-disordered breathing (SDB) are not fully understood. We aimed to investigate the polysomnography-measured sleep characteristics in HF patients using a systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Web of Science databases were searched for studies on PSG in HF patients. Meta-analyses were conducted to compare PSG parameters between HF patients and Non-HF, HF patients with and without SDB, HF patients with different types of SDB, and HF patients before and after SDB treatments.</div></div><div><h3>Results</h3><div>HF patients showed decreased sleep efficiency (MD = −7.5 %, 95 %CI: [-10.8 %, −4.1 %], P &lt; 0.001) and reduced slow wave sleep (MD = −3.2 %, 95 %CI: [-5.7 %, −0.7 %], P = 0.013) compared with those without HF. With comorbid SDB, HF patients experienced further decreases in sleep efficiency and total sleep time, and disruptions in sleep architecture, including decreased rapid-eye-movement sleep (MD = −3.4 %, 95 %CI: [-6.2 %, −0.5 %], P = 0.020) and SWS (MD = −3.1 %, 95 %CI: [-4.1 %, −2.1 %], P &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>HF patients showed poorer sleep continuity and less restorative sleep. Additionally, SDB was associated with poor objective sleep architecture in HF patients, indicated by a decrease in the percentage of deep sleep and an increase in sleep fragmentation. SDB treatments, such as adaptive servo-ventilation (ASV) and continuous positive airway pressure (CPAP), were associated with improved sleep quality and quantity in HF patients with SDB.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106486"},"PeriodicalIF":3.8,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-rater reliability of video clips to assess for obstructive sleep apnea in children","authors":"S.L. Katz ,&nbsp;H. Blinder ,&nbsp;N. Dussah ,&nbsp;V. Bijelić ,&nbsp;N. Barrowman ,&nbsp;G. Cox ,&nbsp;A.R. Leitman ,&nbsp;R. Hamutcu Ersu","doi":"10.1016/j.sleep.2025.106483","DOIUrl":"10.1016/j.sleep.2025.106483","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric obstructive sleep apnea (OSA) involves repeated breathing interruptions during sleep and is linked to neurocognitive impairment and cardiovascular issues. Early diagnosis is crucial, but the current gold-standard —overnight polysomnography–is expensive, complex, and scarce, causing long wait times. This underscores the need for a more efficient screening tool for pediatric OSA.</div></div><div><h3>Method</h3><div>This cross-sectional study recruited children aged 3–18 years referred for polysomnography for suspected OSA (2019–2024). Parents recorded 3-min videos of their children sleeping. Two blinded pediatric sleep physicians scored videos for OSA using clinical impressions and the Monash score. Inter-rater reliability was evaluated with Cohen's Kappa. Monash score's ability to predict OSA was evaluated with receiver operating characteristic (ROC) analysis.</div></div><div><h3>Results</h3><div>109 children (median age: 7.2 years, 61 % male) participated, including 66 healthy children, 21 with Down syndrome, 9 with obesity, and 13 with autism. Inter-rater reliability was high for both Monash score severity and dichotomized Monash score (kappa 0.94 and 0.79, both p &lt; 0.001), with strong agreement on clinician impression of OSA presence and severity (kappa 0.84 and 0.70, both p &lt; 0.001). Inter-rater reliability was highest in healthy children, with no significant differences between groups. The Monash score effectively discriminated OSA presence (area under curve 0.99 (95 % CI: 0.98, 1.00), with excellent performance across groups.</div></div><div><h3>Discussion</h3><div>Video assessments showed high inter-rater reliability for OSA presence and severity. Although videos are promising for OSA screening, further research comparing them to polysomnography is needed to confirm clinical validity.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106483"},"PeriodicalIF":3.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positional therapy for the treatment of positional obstructive sleep apnea in children: A randomized controlled crossover trial","authors":"Lena Xiao ,&nbsp;Adele Baker ,&nbsp;Colin Massicotte ,&nbsp;Myrtha E. Reyna ,&nbsp;Jenny Shi ,&nbsp;Nikolaus E. Wolter ,&nbsp;Evan J. Propst ,&nbsp;Sanjay Mahant ,&nbsp;Reshma Amin ,&nbsp;Rulan S. Parekh ,&nbsp;Indra Narang","doi":"10.1016/j.sleep.2025.03.022","DOIUrl":"10.1016/j.sleep.2025.03.022","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) is prevalent in children, but many children remain untreated. Up to one half of children with OSA have positional OSA, a phenotype characterized by the predominance of airway obstruction while supine. Positional devices that prevent sleeping supine may be beneficial for positional OSA. We evaluated the efficacy of positional devices for treating positional OSA in children.</div></div><div><h3>Study design and methods</h3><div>This was a randomized crossover trial of children aged 4–18 years old with positional OSA. There were two treatment periods separated by 1–4 weeks. Each period consisted of a one-night in-laboratory polysomnogram with the experimental intervention (positional device with inflated cushions) or the inactive control (positional device with no cushions). The primary outcome was the difference in the obstructive apnea-hypopnea index (OAHI) between positional therapy and the control.</div></div><div><h3>Results</h3><div>24 participants were randomized (median age = 9.0 years, 63% males). The adjusted relative percentage difference in the OAHI (positional therapy minus control) was −29.9% (95% CI -55.9% to 11.6%; p = 0.13). The adjusted relative percentage differences for the desaturation index, arousal index, and percentage of total sleep time supine were −23.4% (95% CI -45.0% to 6.7%; p = 0.11), −16.7% (95% CI -30.8% to 0.22%; p = 0.053), and −65.9% (95% CI -79.3% to −43.9%; p&lt;0.001), respectively. There were no significant differences in comfort scores or adverse events.</div></div><div><h3>Interpretation</h3><div>Positional therapy reduced supine sleep time, but did not reduce the OAHI in all participants. Future studies with larger sample sizes to evaluate heterogeneity of treatment effects are warranted.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"130 ","pages":"Pages 48-55"},"PeriodicalIF":3.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Default Mode Network and Glymphatic Function in Insomnia with Depression: A Multimodal MRI Study","authors":"Yongqiong Tao ,&nbsp;Yonghong Zhou ,&nbsp;Wenqing Li ,&nbsp;Yitong Ding ,&nbsp;Peng Wu ,&nbsp;Zhouquan Wu ,&nbsp;Haifeng Shi","doi":"10.1016/j.sleep.2025.106482","DOIUrl":"10.1016/j.sleep.2025.106482","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to evaluate functional changes in the default mode network (DMN) and glymphatic system in individuals of chronic insomnia disorder (CID) with comorbid major depression disorder (MDD).</div></div><div><h3>Methods</h3><div>A total of 112 CID patients and 56 healthy controls with good sleep (GS) were enrolled. CID patients were divided into were further divided into a CID-only group and a group with CID and comorbid MDD. Resting-state functional magnetic resonance imaging (rs-fMRI) assessed DMN dysfunction and its connectivity with external networks. To determine whether comorbid MDD exacerbated the decline in glymphatic function in patients with CID, the diffusion tensor imaging along the perivascular space (DTI-ALPS) index was calculated. Binary logistic regression identified key imaging features for diagnostic modeling.</div></div><div><h3>Results</h3><div>Patients with CID and comorbid MDD exhibited significantly weakened functional connectivity within the DMN. In contrast, the key node posterior cingulate cortex(PCC) of the default mode network showed enhanced functional connectivity with brain regions outside the DMN, including middle cingulate cortex and supplementary motor area. Regarding the glymphatic system, the lower ALPS index in CID patients with comorbid MDD was lower than in CID patients, indicating reduced glymphatic function compared to those without depression. HAMD scores were significantly associated with bilateral Dyproj values (P &lt; 0.001) and the functional connectivity values of PCC_L-SMA_L and TempP_L-PHC_L (P &lt; 0.01). The diagnostic model developed based on these findings demonstrated high diagnostic efficacy for CID with comorbid MDD.</div></div><div><h3>Conclusion</h3><div>The destabilization of subsystems within the DMN may represent the neurological mechanism through which depression contributes to insomnia. Comorbid depressive disorders may exacerbate glymphatic dysfunction in patients with CID, highlighting the importance of early clinical intervention for depressive symptoms in insomnia disorder.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"131 ","pages":"Article 106482"},"PeriodicalIF":3.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep incubation [enkoimesis] in medical practice at Asclepieia of ancient Greece – The ancient Greek sleep medicine","authors":"George Kapotsis ,&nbsp;Paschalis Steiropoulos ,&nbsp;Nikoletta Rovina ,&nbsp;Emmanouil Vagiakis ,&nbsp;Georgia Trakada","doi":"10.1016/j.sleep.2025.03.023","DOIUrl":"10.1016/j.sleep.2025.03.023","url":null,"abstract":"<div><div>The ancient Greeks gave a special importance to sleep, both because of the interpretation of dreams and because of its healing properties. Therapeutic incubation [enkoimesis] was a ritual practice, resorted at the healing sanctuaries of antiquity in Greece, such as those of Asclepius [Asclepieia] and was the culmination of a process of sleeping in a sacred space in order to receive an apocalyptic dream. Although the early character of therapeutic incubation was purely ritual and mystical, however, the concept of this process seems to be matched with that of the holistic and personalized modern medical approach. Moreover, the importance of its role is in the transition of medicine from its pioneer empirical practices to the most modern scientific concepts, since it was incubation that sowed the seeds of modern medicine and established it from art to science. The aim of this study is to investigate the role of therapeutic incubation, either as an holistic approach to the patient and as a placebo effect, as well as its relationship with modern procedures of therapy.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"130 ","pages":"Pages 31-35"},"PeriodicalIF":3.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724194","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}