Sleep medicine最新文献

{"title":"Evaluating reduced cognitive flexibility as a link between Insomnia and future depression: A systematic review","authors":"Christopher A. Crawford,&nbsp;Kyle S. Minor,&nbsp;Melissa A. Cyders,&nbsp;Jesse C. Stewart","doi":"10.1016/j.sleep.2025.106824","DOIUrl":"10.1016/j.sleep.2025.106824","url":null,"abstract":"<div><h3>Background</h3><div>Insomnia is a causal risk factor for depression, but the underlying mechanisms are unclear. Reduced cognitive flexibility, a component of executive function, is linked to both insomnia and depression and may mediate their relationship. This systematic review evaluated this potential mediation model by examining studies reporting associations among insomnia, cognitive flexibility, and depression.</div></div><div><h3>Methods</h3><div>A comprehensive search identified 35 studies reporting associations between insomnia and cognitive flexibility (<em>a</em> path) and 11 studies examining cognitive flexibility as a predictor of future depression (<em>b</em> path). No studies formally tested cognitive flexibility as a mediator of the insomnia-depression relationship (<em>ab</em> path). Studies were assessed for quality and capacity for directional and causal inference. Findings were synthesized to evaluate the mediation model.</div></div><div><h3>Results</h3><div>For the <em>a</em> path, 35 studies reported 117 eligible associations. Longitudinal studies consistently reported null associations between insomnia and cognitive flexibility. Cross-sectional findings were also predominantly null. Significant associations generally did not withstand covariate adjustment or were observed only in older participants or those taking benzodiazepines. For the <em>b</em> path, 11 prospective cohort studies reported 37 eligible associations. Most associations were null, but significant associations emerged in participants without baseline depression, suggesting cognitive flexibility may relate more to depression risk than prognosis.</div></div><div><h3>Conclusions</h3><div>Current evidence does not support reduced cognitive flexibility as a mediator in the insomnia-depression pathway. Subjective cognitive concerns may offer a more promising explanatory mechanism. Future research should integrate objective and subjective cognitive assessments, test formal mediation models, and evaluate alternative pathways.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106824"},"PeriodicalIF":3.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158420","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":"Patients’ experiences of group-delivered sleep restriction therapy in primary care: a qualitative study undertaken alongside a randomized controlled trial","authors":"Christina Bini ,&nbsp;Josefin Bäckström ,&nbsp;Kristofer Årestedt ,&nbsp;Markus Jansson-Fröjmark ,&nbsp;Christina Sandlund","doi":"10.1016/j.sleep.2025.106822","DOIUrl":"10.1016/j.sleep.2025.106822","url":null,"abstract":"<div><h3>Background</h3><div>Sleep restriction therapy (SRT) is an effective and brief behavioral treatment for insomnia and could serve as a valuable complement to insomnia care. This study explores patients’ experiences of being offered and attending group-SRT at their primary care centers, including experiences of feasibility and mechanisms of impact.</div></div><div><h3>Methods</h3><div>This qualitative study was undertaken alongside a randomized controlled trial on nurse-led group-SRT in Swedish primary care, involving adults with insomnia disorder. Semi-structured interviews were conducted within three months post-intervention with fourteen patients. Verbatim transcripts were analyzed using qualitative content analysis before trial results were examined. The study was guided by the Medical Research Council framework for process evaluation of complex interventions.</div></div><div><h3>Results</h3><div>The result is presented in two themes: <em>Increased knowledge, motivation, and flexibility in enhancing adherence to group-SRT</em> and <em>Struggles, solutions, and group dynamics: A path to empowerment</em>. Patients found that understanding sleep reinforced their commitment to group-SRT by providing a rationale for participation. Adherence was influenced by treatment flexibility, personal motivation, and group dynamics. Patients experienced that while group-SRT was challenging, it also offered solutions for better sleep. However, life circumstances and depressive symptoms hindered compliance.</div></div><div><h3>Conclusions</h3><div>Patients' experience of group-SRT were influenced by the patient-provider relationship, motivation, and comorbid depression, all which impacted engagement. This study provides valuable insights into how patients perceive group-SRT, contributing to the refinement of future insomnia treatments. Further research should explore healthcare providers’ perspectives on both the challenges and opportunities for implementing group-SRT in primary care.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106822"},"PeriodicalIF":3.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158422","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":"Excessive daytime sleepiness and sex-related differences in the clinical presentation of obstructive sleep apnea in Italian patients","authors":"Giuseppe Insalaco ,&nbsp;Alberto Braghiroli ,&nbsp;Francesca Buzzi ,&nbsp;Simone Cappellano ,&nbsp;Alessandro Castelli ,&nbsp;Alessandra Castelnuovo ,&nbsp;Francesco Fanfulla ,&nbsp;Luigi Ferini Strambi ,&nbsp;Anna Lo Bue ,&nbsp;Sara Marelli ,&nbsp;Fabio Pizza ,&nbsp;Fabio Placidi ,&nbsp;Giuseppe Plazzi ,&nbsp;Caterina Pronzato ,&nbsp;Andrea Romigi ,&nbsp;Tommaso Sacco ,&nbsp;Adriana Salvaggio ,&nbsp;Maria Rosaria Bonsignore","doi":"10.1016/j.sleep.2025.106819","DOIUrl":"10.1016/j.sleep.2025.106819","url":null,"abstract":"<div><h3>Background</h3><div>Excessive Daytime Sleepiness (EDS) is a key symptom of Obstructive Sleep Apnea (OSA). The clinical presentation of OSA differs between sexes. EDS and sex-related clinical differences were studied in Italian OSA patients.</div></div><div><h3>Objectives</h3><div>This multicenter study in Italian OSA patients at diagnosis assessed: 1) the EDS prevalence and its association with OSA severity, comorbidities, and other symptoms; 2) sex-related differences in clinical features of OSA.</div></div><div><h3>Methods</h3><div>Patient-reported data on symptoms and comorbidities were retrospectively collected from eCRF in 2663 patients (age, mean ± SD 55.7 ± 9.4 years, M 77.4 %, BMI 31.2 ± 4.6 kg/m²). EDS was defined as an Epworth Sleepiness Score &gt;10.</div></div><div><h3>Results</h3><div>Overall, 39.5 % of patients reported EDS at diagnosis, especially younger and obese patients.</div><div>Referral patterns and symptoms driving OSA evaluation were affected by both occurrences of EDS and sex. OSA was more severe in patients with than without EDS. At multivariate analysis, predictors of EDS were: fatigue, subjectively impaired cognitive function, and % time spent at oxygen saturation&lt;90 %, while being on a hypocaloric diet was protective. Women showed milder OSA severity but similar prevalence of EDS, and a different clinical phenotype and comorbidities, i.e., higher rates of fatigue, anxiety, depression, arterial hypertension, cognitive dysfunction, type 2 diabetes, gastroesophageal reflux, and asthma.</div></div><div><h3>Conclusion</h3><div>EDS occurred in &lt;50 % of Italian untreated OSA patients and appeared modulated by several symptoms and hypoxemia. Compared to men, women showed similar EDS and a different pattern of symptoms/comorbidities. These findings provide insights for tailoring clinical management strategies in the Italian population.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106819"},"PeriodicalIF":3.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158424","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":"Efficacy and safety of lemborexant in patients with insomnia: a systematic review and meta-analysis","authors":"Allahdad Khan ,&nbsp;Shree Rath ,&nbsp;Hamza Khan ,&nbsp;Umama Alam ,&nbsp;Hammad Javaid ,&nbsp;Zaryab Bacha ,&nbsp;Asad Ali Ahmed Cheema ,&nbsp;Umair Hayat ,&nbsp;Muhammad Abdullah Ali ,&nbsp;Abdul Qadeer ,&nbsp;Charles Dominic Ward ,&nbsp;Raheel Ahmed","doi":"10.1016/j.sleep.2025.106823","DOIUrl":"10.1016/j.sleep.2025.106823","url":null,"abstract":"<div><h3>Background</h3><div>Insomnia is a prevalent sleep disorder that significantly impacts quality of life and overall health. Lemborexant, a dual orexin receptor antagonist, has emerged as a promising treatment. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Lemborexant in adults with insomnia.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Cochrane, and clinicaltrials.gov through March 5, 2025, for randomized controlled trials (RCTs) comparing lemborexant with placebo. Primary outcomes included changes in wake after sleep onset (WASO), sleep efficiency, and sleep onset latency. Safety outcomes included treatment-emergent adverse events (TEAEs), treatment-related TEAEs, and headache. Data were synthesized using a random-effects model and assessed for heterogeneity. Meta-analyses used a random-effects model and heterogeneity was assessed using the I² statistic.</div></div><div><h3>Results</h3><div>Six RCTs involving 2257 patients were included. Lemborexant significantly reduced WASO (MD: 20.73 min; 95 % CI: 28.58 to −12.88), improved sleep efficiency (MD: 4.84 %; 95 % CI: 2.69 to 7.00), and reduced sleep onset latency (MD: 10.85 min; 95 % CI: 18.47 to −3.23). Lemborexant was associated with a higher risk of treatment-related TEAEs (RR: 1.82; 95 % CI: 1.41 to 2.34) but showed no significant difference in overall TEAEs or headache compared to placebo.</div></div><div><h3>Conclusion</h3><div>Lemborexant demonstrates significant efficacy in improving sleep parameters in patients with insomnia and has a generally favorable safety profile. These findings support its role as an effective pharmacological option. Further high-quality studies are needed to confirm its efficacy and safety.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106823"},"PeriodicalIF":3.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158421","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":"Procedural learning worsens with OSA severity in older adults and is insensitive to short exposure supplemental oxygen therapy","authors":"Christian D. Harding ,&nbsp;Breanna M. Holloway ,&nbsp;Pamela N. DeYoung ,&nbsp;Crystal Kwan ,&nbsp;Ina Djonlagic ,&nbsp;Sonia Ancoli-Israel ,&nbsp;Xiaoying Sun ,&nbsp;Sonia Jain ,&nbsp;Sarah J. Banks ,&nbsp;Atul Malhotra","doi":"10.1016/j.sleep.2025.106821","DOIUrl":"10.1016/j.sleep.2025.106821","url":null,"abstract":"<div><h3>Study objectives</h3><div>Obstructive sleep apnea (OSA) has been associated with cognitive deficiencies in young and middle aged adults but the impact on cognition in older adults, who are at greater risk of age-related cognitive decline, is less well understood. We investigated how OSA severity impacts cognitive performance in older adults and whether short exposure to supplemental oxygen can modify this relationship, whilst also leveraging pathophysiology to identify oxygen treatment candidates.</div></div><div><h3>Methods</h3><div>65 participants (65+ years) not currently receiving OSA treatment were recruited from the San Diego community, most of whom presented with moderate or severe OSA. Participants undertook two nights of in-laboratory polysomnography under room air or nocturnal oxygen supplementation (NOS) conditions in randomized order. Participants performed sleep-dependent cognitive tests both before and after sleep.</div></div><div><h3>Results</h3><div>Nocturnal hypoxemia was reduced with NOS treatment. There was no reduction in the frequency of apnea-hypopnea events (AHI) in the full sample, however we found a significant treatment effect on AHI among participants with OSA severity &gt;15 events/hour or among those with below-median pharyngeal collapsibility. Motor sequence task improvement was negatively correlated with AHI within a night but NOS treatment did not improve performance between nights in either the full sample or a responsive sub-group.</div></div><div><h3>Conclusions</h3><div>As in younger adults, more severe sleep apnea is associated with worse motor procedural learning in older adults. However, a single night of NOS treatment had no effect on procedural learning, suggesting that OSA-related cognitive deficits result from chronic impacts of sleep disruption and hypoxia.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106821"},"PeriodicalIF":3.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158474","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":"The galectin-3/NLRP3 inflammasome axis: A unifying mechanism linking insomnia and heart failure","authors":"Artur Dziewierz ,&nbsp;Natalia Maruszak ,&nbsp;Tomasz Rakowski","doi":"10.1016/j.sleep.2025.106818","DOIUrl":"10.1016/j.sleep.2025.106818","url":null,"abstract":"","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106818"},"PeriodicalIF":3.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150643","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":"Trajectories of sleep characteristics and incident cardiovascular disease","authors":"Jie Guo ,&nbsp;Linda L. Magnusson Hanson ,&nbsp;Torbjörn Åkerstedt ,&nbsp;Anna Karin Hedström","doi":"10.1016/j.sleep.2025.106820","DOIUrl":"10.1016/j.sleep.2025.106820","url":null,"abstract":"<div><div>While sleep characteristics have been associated with cardiovascular disease (CVD), most studies have focused on single timepoints or isolated aspects. The prognostic value of broader, long-term sleep patterns remains unclear.</div><div>We used data from 24,223 participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH), with biennial follow-up between 2010 and 2018. Sleep characteristics were assessed via self-report and incident cardiovascular outcomes were identified through linkage to national registers. Cox proportional hazards models estimated associations between sleep variables and incident cardiovascular disease, and mixed-effects models assessed sleep trajectories.</div><div>During follow-up, 1,687 developed cardiovascular outcomes. Nighttime insomnia was not associated with increased CVD risk unless accompanied by daytime symptoms (HR 1.22, 95 % CI 1.03–1.44; reference: no insomnia and no daytime symptoms). Similarly, long sleep duration (&gt;8 h) was associated with higher risk only when combined with daytime symptoms (HR 1.35, 95 % CI 1.13–1.61; reference: 6–8 h of sleep and no daytime symptoms). Trajectory analyses showed that participants with long sleep at baseline who later developed CVD had a gradual increase in sleep duration over time (β for CVD &gt;8 h × time = 0.06, 95 % CI 0.04–0.07; β × time² = −0.005, 95 % CI –0.01 to 0.00), while long sleepers who remained free of CVD showed stable or declining patterns.</div><div>Daytime symptoms, particularly when accompanied by prolonged or increasing sleep, may reflect early physiological changes preceding cardiovascular disease. These findings highlight the importance of considering sleep patterns and changes over time rather than static measures alone.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106820"},"PeriodicalIF":3.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207813","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 neurovascular-cerebrospinal fluid synergy in chronic insomnia disorder","authors":"Shaoxiang Zhong ,&nbsp;Yuan He ,&nbsp;Kang Chen ,&nbsp;Rui Qu ,&nbsp;Weicheng Luo ,&nbsp;Hongyu Zhang ,&nbsp;Shang Zhang ,&nbsp;Wenjun Zhou ,&nbsp;Liang Gong","doi":"10.1016/j.sleep.2025.106815","DOIUrl":"10.1016/j.sleep.2025.106815","url":null,"abstract":"<div><h3>Background</h3><div>Chronic insomnia disorder (CID) is associated with neurophysiological dysfunction; however, its effects on neurovascular and glymphatic interactions remain inadequately understood.</div></div><div><h3>Methods</h3><div>This study examined the coupling strength between global blood-oxygen-level-dependent (gBOLD) signals and cerebrospinal fluid (CSF) inflow dynamics in CID patients (n = 137) and healthy controls (HC, n = 72) using resting state functional magnetic resonance imaging.</div></div><div><h3>Results</h3><div>Results demonstrated significantly diminished gBOLD-CSF coupling in CID patients compared to HC. Across all participants, coupling strength exhibited a negative correlation with age and a positive correlation with educational attainment. Counterintuitively, higher Pittsburgh Sleep Quality Index (PSQI) scores, indicative of poorer sleep quality, were associated with stronger BOLD-CSF coupling, potentially reflecting compensatory mechanisms during infrequent deep sleep episodes.</div></div><div><h3>Conclusion</h3><div>These findings underscore disrupted neurovascular-glymphatic communication in chronic insomnia, which may predispose individuals to neurodegenerative risks. This study highlights the necessity for reevaluating insomnia as a systemic threat to brain health, necessitating longitudinal investigations and therapeutic strategies targeting glymphatic preservation.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106815"},"PeriodicalIF":3.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109169","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 characteristics in children, adolescents, and adults with Specific Learning Disorders: a systematic review and a meta-analysis","authors":"Alice Paggetti ,&nbsp;Giulia Lazzaro ,&nbsp;Valeria Bacaro ,&nbsp;Nicola Vanacore ,&nbsp;Stefano Vicari ,&nbsp;Deny Menghini","doi":"10.1016/j.sleep.2025.106817","DOIUrl":"10.1016/j.sleep.2025.106817","url":null,"abstract":"<div><div>Sleep is a fundamental psychophysiological process throughout lifespan, playing a crucial role in memory consolidation and learning. Sleep disturbances are highly prevalent among individuals with neurodevelopmental disorders; however, sleep characteristics and patterns in those with Specific Learning Disorders (SLDs) have been largely overlooked, and a comprehensive systematically synthesis lacks. This systematic review and meta-analysis (PROSPERO ID: CRD42021257350) aims to assess differences in sleep characteristics between individuals with SLDs and controls or individuals with neurodevelopmental disorders other than SLDs. Multiple search strategies identified a total of 13 independent studies, including case-control and cross-sectional designs, with a total sample of 695 children and adolescents and 55 adults with SLDs, and 7459 children and adolescents and 55 adults without SLDs. The risk of bias was evaluated using the Newcastle-Ottawa Scale for Assessing the Quality of Nonrandomized Studies in Meta-Analysis. Findings were synthesized narratively and through meta-analysis for both Objective and Subjective sleep outcomes. Meta-analyses of several Objective sleep macroarchitecture parameters showed no difference between groups. Conversely, children and adolescents with SLDs exhibited a significantly higher prevalence of sleep disturbances measured as Subjective outcomes compared to controls without SLDs. This study identifies gaps in literature and outlines priorities for future research.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106817"},"PeriodicalIF":3.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201283","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":"Impact of procedural pain during NICU hospitalization on sleep, physical growth, brain maturation and neurobehavioral development in preterm infants: A prospective longitudinal study","authors":"Shiting Lv ,&nbsp;Qian Wang ,&nbsp;Yuqi Wei ,&nbsp;Lei Chen ,&nbsp;Qiling Zhang ,&nbsp;Jing Zhang ,&nbsp;Yao Fang ,&nbsp;Hui Rong ,&nbsp;Jing Zhou ,&nbsp;Haixia Gao","doi":"10.1016/j.sleep.2025.106816","DOIUrl":"10.1016/j.sleep.2025.106816","url":null,"abstract":"<div><h3>Study objectives</h3><div>To assess procedural pain's effects on sleep patterns from discharge through 3 months corrected age (CA), physical growth trajectories from admission through 3 months CA, brain maturation at discharge and neurobehavior at term-equivalent age, while investigating sleep's moderating role in these pain-development relationships.</div></div><div><h3>Methods</h3><div>In 99 preterm infants (gestational age &lt;37 weeks), procedural pain frequency was recorded. Sleep was assessed using amplitude-integrated electroencephalography (aEEG) combined with behavioral observation at discharge and the Brief Infant Sleep Questionnaire at 1 and 3 months CA. Growth parameters were measured and converted to Z-scores. Brain maturation and neurobehavior were quantified using Burdjalov aEEG score and Neonatal Behavioral Neurological Assessment (NBNA), respectively. Linear mixed-effects models, multivariate regression, and PROCESS moderation analyses were employed.</div></div><div><h3>Results</h3><div>Higher procedural pain exposure was associated with: (1) Reduced active sleep at discharge (B = −1.42, p = 0.006), persisting as less nighttime sleep at 1 month CA (B = −1.14, p = 0.013) and more awakenings at 3 months CA (B = 1.57, p &lt; 0.001); (2) lower weight Z-scores up to 3 months CA (B = −0.44, p = 0.016), with no significant associations in length or head circumference Z-scores after correction; and (3) poorer brain maturation at discharge (B = −1.50, p = 0.002), but not with NBNA score at 40 weeks. Sleep moderated the pain–weight relationship (p &lt; 0.05), but not pain-brain maturation.</div></div><div><h3>Conclusions</h3><div>Procedural pain persistently disrupts sleep, weight growth, brain maturation, but not early neurobehavior in preterm infants. Sleep moderates its impact on weight growth, suggesting dual interventions-pain reduction and sleep optimization-are critical for mitigating developmental impairment.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"136 ","pages":"Article 106816"},"PeriodicalIF":3.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158423","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}