Sleep medicine最新文献

{"title":"The mediating role of sleep bedtime regularity in the association between neighborhood factors and childhood obesity","authors":"MinKyoung Song ,&nbsp;Andrew W. McHill ,&nbsp;Nathan F. Dieckmann ,&nbsp;Carol M. Musil ,&nbsp;Jonathan Q. Purnell ,&nbsp;Laura L. Hayman","doi":"10.1016/j.sleep.2025.106736","DOIUrl":"10.1016/j.sleep.2025.106736","url":null,"abstract":"<div><h3>Background</h3><div>Regular bedtime patterns have been inversely associated with obesity. In turn, safe and supportive neighborhoods positively associate with children's bedtime regularity. We sought to determine whether bedtime regularity mediates between these two neighborhood factors and obesity among US children aged 6–17.</div></div><div><h3>Methods</h3><div>Using data from the 2021-22 National Survey of Children's Health (n = 59,078), two mediation models tested the effect of bedtime regularity on associations between neighborhood factors and obesity. Both models adjusted for sex, age, race/ethnicity, household poverty, physical activity, and caregiver's education. Caregivers reported on neighborhood factors, obesity, and sleep.</div></div><div><h3>Results</h3><div><strong><em>Unsafe neighborhoods</em>:</strong> In Model 1, living in unsafe neighborhoods associated with irregular bedtime (OR = 1.82 [95 % CI: 1.46, 2.28]). In Model 2, living in unsafe neighborhoods did not significantly associate with obesity (OR = 1.12 [0.89, 1.40]); irregular bedtime significantly associated with obesity (OR = 1.22 [1.07, 1.40]). Bootstrap CIs derived from 1000 samples indicated a significant indirect mediating effect (adjusted β = 0.02 [0.01, 0.022]). <strong><em>Unsupportive neighborhoods:</em></strong> In Model 1, living in unsupported neighborhoods associated with irregular bedtime (OR = 1.58 [1.41, 1.76]). In Model 2, living in unsupported neighborhoods and irregular bedtime significantly associated with obesity (OR = 1.14 [1.03, 1.26] and 1.21 [1.06, 1.39]). Bootstrap CIs indicated a significant indirect mediating effect (adjusted β = 0.01 [0.007, 0.014]).</div></div><div><h3>Conclusions</h3><div>Our findings highlight the impact of living in disadvantaged neighborhoods and suggest promoting bedtime regularity may be a suitable obesity intervention target for youth living in these settings. Due to the small effect sizes and the cross-sectional design of our study, our findings should be considered along with other established targets.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106736"},"PeriodicalIF":3.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830127","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":"Initial experience and establishment of a hypersomnia board: A multidisciplinary approach to complex hypersomnia cases","authors":"Antara Mallampalli ,&nbsp;Ritwick Agrawal ,&nbsp;Supriya Singh ,&nbsp;Lequan Dang ,&nbsp;Shahram Moghtader ,&nbsp;Kanta Velamuri ,&nbsp;Tara Thomas ,&nbsp;Amir Sharafkhaneh","doi":"10.1016/j.sleep.2025.106735","DOIUrl":"10.1016/j.sleep.2025.106735","url":null,"abstract":"<div><h3>Background</h3><div>Hypersomnia disorders are complex both diagnostically and management wise. Complex medical conditions benefit from multidisciplinary board (MDB). We describe the structure, implementation, and preliminary outcomes of a hypersomnia MDB established to improve diagnosis and management of complex hypersomnia cases.</div></div><div><h3>Methods</h3><div>We implemented a monthly virtual case-based conference at a large VA medical center, involving clinicians from sleep medicine, psychiatry, neurology, clinical psychology, and pharmacy. Patients with central hypersomnia disorders, diagnostic uncertainty, or management challenges were selected for discussion. Presenting providers summarized patient histories, diagnostics, and treatment concerns. A multidisciplinary group reviewed each case, and consensus recommendations were documented in the electronic health record.</div></div><div><h3>Results</h3><div>Over two years, 33 unique patients were presented. Final diagnoses included narcolepsy type 1 (9/33), narcolepsy type 2 (9/33), idiopathic hypersomnia (6/33), and primary obstructive sleep apnea (6/33). Comorbid mental illness (e.g., depression in 15/33, post-traumatic stress disorder or PTSD in 9/33) and obstructive sleep apnea (18/33) were common. The board recommended medication changes in 8/33 patients, mental health referrals in 5/33, and further diagnostic testing in 8/33. Clinician feedback indicated improved diagnostic clarity, enhanced collaboration, and educational benefit, especially for sleep medicine trainees.</div></div><div><h3>Conclusions</h3><div>Establishing a hypersomnia MDB is feasible and promotes collaborative care, improves diagnostic accuracy and treatment plans for patients with complex hypersomnia, and enhances trainee education. Future directions include measuring treatment outcomes, assessing care barriers, tracking clinical responses over time, and expanding to larger scale operations.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106735"},"PeriodicalIF":3.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144842532","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":"Maternal vulnerability to insomnia: Relationship with poor newborn sleep and peripartum psychopathology","authors":"Laura Palagini ,&nbsp;Oliviero Bruni ,&nbsp;Marco Colizzi ,&nbsp;Carla Comacchio ,&nbsp;Angelo Gemignani ,&nbsp;Lino Nobili ,&nbsp;Matteo Balestrieri ,&nbsp;Christopher L. Drake ,&nbsp;Insomnia in Pregnancy Research Group (IPRG)","doi":"10.1016/j.sleep.2025.106732","DOIUrl":"10.1016/j.sleep.2025.106732","url":null,"abstract":"<div><h3>Purpose</h3><div>Sleep reactivity, defined as the degree to which sleep is disrupted due to exposure to stress, serves as a distinctive trait and an indicator of an individual's vulnerability to insomnia. While insomnia may be a risk factor for maternal psychopathology, we aimed to study maternal insomnia vulnerability and its relationship with perinatal psychopathology and newborn sleep.</div></div><div><h3>Method</h3><div>Pregnant women were recruited during their last routine assessment before being hospitalized for delivery at the Gynecological Unit of the University Hospital of Ferrara and Udine, Italy. The assessment included baseline evaluation (T0), and evaluations at 1 months (T1) in the postpartum period with specific questionnaires for insomnia vulnerability such as the Ford Insomnia Response to Stress Test (FIRST), Insomnia Disorder such as Sleep Condition Indicator (SCI), mood and anxiety symptoms such as Edinburgh Postnatal Depression Scale (EPDS), Mood Disorder Questionnaire (MDQ), State-Trait Anxiety Inventory (STAI) and newborn sleep Disturbance Scale for Children (SDSC).</div></div><div><h3>Results</h3><div>At T0, 151 pregnant women were included. Elevated sleep reactivity affected the 36.4 % at T0. Women with elevated prenatal sleep-reactivity were significantly more affected by prenatal, insomnia, anxiety and mood symptoms. Prenatal elevated sleep reactivity predicted post natal insomnia (OR 4.50,p = 0.014), anxiety (OR 3.44, p = 0.002) and depressive symptoms (OR. 4.45, p = 0.008), It also predicted poor newborn sleep (OR 3.43, p = 0.032).</div></div><div><h3>Conclusions</h3><div>Maternal vulnerability to insomnia is an important prenatal factor that may contribute to concurrent and postpartum psychopathology and to poor newborn sleep. Findings may suggest a potential hereditary aspect of insomnia in newborns born to women with insomnia disorder and exhibiting elevated sleep reactivity.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106732"},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827429","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":"Partial endorsement of “Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline” by the World Sleep Society","authors":"Raffaele Ferri ,&nbsp;Yuichi Inoue ,&nbsp;Mauro Manconi ,&nbsp;Michael H. Silber ,&nbsp;Claudia Trenkwalder ,&nbsp;Clete A. Kushida","doi":"10.1016/j.sleep.2025.106734","DOIUrl":"10.1016/j.sleep.2025.106734","url":null,"abstract":"<div><h3>Background</h3><div>The 2025 American Academy of Sleep Medicine (AASM) clinical practice guideline for the treatment of Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) provides updated, evidence-based recommendations. The World Sleep Society (WSS) conducted an international review to assess the guideline's global applicability and implementation feasibility.</div></div><div><h3>Methods</h3><div>A structured questionnaire was distributed to representatives of 53 national sleep societies affiliated with the WSS. The survey addressed guideline familiarity, perceived applicability, agreement with 20 treatment recommendations, and availability of key therapies. Responses were analyzed using descriptive statistics and the within-group interrater agreement coefficient (rWG) to assess consensus levels.</div></div><div><h3>Results</h3><div>Twenty-three national societies (43.9 %) from all inhabited continents responded. The AASM guideline was perceived as fully or partially applicable in most countries. Twelve recommendations were fully supported by the WSS, five partially supported, two (regarding dopamine agonists) endorsed with caveats, and one (dipyridamole) not supported. Key barriers included limited access to certain medications (e.g., IV iron, gabapentin enacarbil), regulatory restrictions, and divergent treatment traditions. There was strong global consensus on discouraging ineffective or harmful treatments (e.g., cabergoline, valproic acid), while the avoidance of dopaminergic agents generated regional disagreement.</div></div><div><h3>Conclusions</h3><div>The AASM guidelines received broad international support but require region-specific adaptation for optimal implementation. The WSS endorses the guideline's structure and scientific foundation while recommending flexible dissemination strategies and greater clarity in therapeutic algorithms. These findings support the development of globally relevant, context-sensitive guidance in sleep medicine.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106734"},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863180","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 American academy of sleep medicine position statement on sleepiness: A world sleep society international sleep medicine practice recommendations committee perspective","authors":"Raffaele Ferri,&nbsp;Claudio L.A. Bassetti,&nbsp;Clete A. Kushida","doi":"10.1016/j.sleep.2025.106733","DOIUrl":"10.1016/j.sleep.2025.106733","url":null,"abstract":"","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106733"},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809336","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":"Social jetlag and obstructive sleep apnea severity: A retrospective study based on polysomnography","authors":"Shuai Wu ,&nbsp;MaoHuan Peng ,&nbsp;YuHua Zuo ,&nbsp;MengMeng Wang ,&nbsp;ZhaoYan Feng ,&nbsp;HuanHuan Wang ,&nbsp;MingZe Sun ,&nbsp;JiaHui Gu ,&nbsp;XinRu Wang ,&nbsp;Fang Han ,&nbsp;XiaoSong Dong","doi":"10.1016/j.sleep.2025.106722","DOIUrl":"10.1016/j.sleep.2025.106722","url":null,"abstract":"<div><h3>Background</h3><div>Social jetlag, representing the misalignment between endogenous circadian rhythms and socially imposed sleep schedules, has been associated with various adverse health outcomes. However, its potential relationship with obstructive sleep apnea (OSA) severity, as quantified by the apnea-hypopnea index (AHI), remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from participants with OSA (AHI ≥5 events/hour) who completed sleep questionnaires and underwent polysomnography at our sleep center. Exclusions included non-OSA, prior OSA treatment, shift work, sleep-affecting medication use, or incomplete data. Social jetlag was defined as the actual difference between mid-sleep on work days and free days, and categorized as minimal (&lt;1 h), moderate (1 to &lt;2 h), and severe (≥2 h). Multiple linear regression assessed the association between social jetlag and AHI, adjusting for age, gender, body mass index (BMI), history of smoking and alcohol, hypertension, hyperlipidemia, and diabetes. Mediation analysis evaluated the Epworth Sleepiness Scale (ESS) as a mediator, with subgroup analyses and generalized additive models (GAM) exploring effect modification and non-linearity.</div></div><div><h3>Results</h3><div>Among 2383 analyzed participants, severe social jetlag was independently associated with higher AHI (β = 6.90; 95 % CI: 2.18 to 11.61; p = 0.004; p-trend = 0.014), unlike the moderate group (p = 0.389). ESS mediated 19.4 % of this effect (indirect effect β = 0.46; 95 % CI: 0.22 to 0.72; p &lt; 0.001). In a matched cohort analysis stratified by social jetlag severity (n = 637), AHI and ESS rose with social jetlag severity (AHI: 34.9 vs. 39.4 vs. 45.5 events/hour, p &lt; 0.001; ESS: 10.1 vs. 11.2 vs. 11.8, p = 0.015), while habitual sleep duration decreased (7.0 vs. 6.8 vs. 6.6 h; p = 0.013). Stronger associations were observed in males (β = 2.94; 95 % CI: 1.34 to 4.54; p &lt; 0.001; p-interaction &lt;0.001) and smokers (β = 3.31; 95 % CI: 0.90 to 5.71; p = 0.007; p-interaction = 0.003), with significant effects in BMI 24–28 kg/m², non-hypertensive, and non-diabetic subgroups (all p &lt; 0.05). GAM analysis revealed a gradual, non-linear AHI increase with social jetlag below 2 h, accelerating beyond 2 h.</div></div><div><h3>Conclusions</h3><div>Severe Social jetlag independently increases AHI in individuals with OSA, partially mediated by daytime sleepiness, with pronounced effects in males and smokers. These findings suggest circadian misalignment as a potentially modifiable factor influencing OSA severity.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106722"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830128","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":"A comprehensive model for the converging biologies that underpin the homeostatic sleep signal","authors":"Fabian-Xosé Fernandez ,&nbsp;Michael A. Grandner","doi":"10.1016/j.sleep.2025.106723","DOIUrl":"10.1016/j.sleep.2025.106723","url":null,"abstract":"<div><div>Sleep has long been understood as a process regulated primarily by central mechanisms, including homeostatic pressure and circadian rhythms. However, emerging research reveals that skeletal muscle actively participates in sleep regulation, functioning as an endocrine organ that releases bioactive molecules capable of influencing brain function. This review examines the growing body of evidence supporting a muscle-derived contribution to sleep homeostasis, focusing on key signaling molecules such as interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), irisin, lactate, and methylglyoxal. We explore their molecular pathways, receptor interactions, and integration with well-established central regulators of sleep, including adenosine and cytokine signaling networks. Compelling genetic evidence, particularly from studies manipulating <em>Bmal1</em> expression specifically in muscle, demonstrates that peripheral tissues can modulate sleep depth and recovery independently of the brain's central mechanisms. These findings support the idea that skeletal muscle functions as a systemic sensor of fatigue, relaying metabolic and inflammatory cues to the brain that help calibrate sleep need. Recognizing this muscle–brain crosstalk opens new directions for translational research, including exercise-based therapies and pharmacological strategies targeting myokine pathways to enhance sleep quality. This evolving perspective challenges the traditional view of sleep as a process governed solely by the brain, positioning skeletal muscle as an active and essential regulator of sleep–wake dynamics.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106723"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780826","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":"Comment on: “Efficacy and safety of GLP-1 receptor agonists in obstructive sleep apnea – a systematic review and meta-analysis” by Kow et al.","authors":"Arkansh Sharma","doi":"10.1016/j.sleep.2025.106708","DOIUrl":"10.1016/j.sleep.2025.106708","url":null,"abstract":"","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106708"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772072","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":"Does your baby have a sleep problem? Auto-videosomnography and parent-reported correlates of perceived infant sleep problems","authors":"Michal Kahn ,&nbsp;Maya Poches ,&nbsp;Natalie Barnett ,&nbsp;Michael Gradisar","doi":"10.1016/j.sleep.2025.106710","DOIUrl":"10.1016/j.sleep.2025.106710","url":null,"abstract":"<div><div>Seeking professional help to improve infant sleep is typically based on parental beliefs that their child has a sleep problem. Such perceptions may reflect not only the child's actual sleep, but also parental behaviors and emotions. This study examined which objective infant sleep measures and parent factors are most strongly associated with perceived infant sleep problems, and whether these associations differed by parent gender.</div><div>Parents of 3158 infants aged 1–18 months (<em>M</em> = 8.4 months, <em>SD</em> = 4.5; 46 % girls) participated in this cross-sectional study. Infant sleep and parental crib visits were assessed using auto-videosomnography. Perceived sleep problems, parent depression, daytime sleepiness, cry tolerance, and sociodemographic characteristics were assessed via an online survey. Associations were analyzed using generalized estimating equations and dominance analysis.</div><div>Parental nighttime crib visits were the strongest correlate of perceived infant sleep problems (Wald = 105.88, <em>p</em> &lt; 0.001): each additional visit increased the odds of perceiving a problem by 18 %. Other significant correlates included lower parental cry tolerance, greater depressive symptoms, shorter infant sleep duration, higher parental sleepiness, breastfeeding, higher education, and earlier infant sleep offset times. Gender-stratified analyses indicated that infant sleep duration and parental sleepiness were associated with problem perception among mothers only, while cry tolerance was a stronger predictor for fathers.</div><div>Parental perceptions of infant sleep problems are shaped more by parents’ behaviors and emotions than by infant sleep patterns. Findings highlight the importance of supporting parental well-being and involving both mothers and fathers in clinical and research efforts targeting early sleep concerns.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106710"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781422","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":"Circadian rhythm types and sleep health in college students: Insights from 24-hour heart rate variability monitoring","authors":"Lixia Zhu,&nbsp;Guangyuan Liu,&nbsp;Wanhui Wen","doi":"10.1016/j.sleep.2025.106696","DOIUrl":"10.1016/j.sleep.2025.106696","url":null,"abstract":"<div><div>Circadian rhythm (CR) disruptions are prevalent among college students; however, systematic investigations of autonomic nervous system (ANS) dynamics across distinct CR types remain limited. This study employed a multimodal framework integrating actigraphy and self-reported activity logs to classify 145 college students into three CR types: entrained, delayed, and fragmented. We analyzed 24-hour heart rate variability (HRV) patterns, focusing on high-frequency (HF), low-frequency (LF), and the LF/HF ratio across 288 time slots within a single CR cycle. Non-parametric statistical analyses with Benjamini–Hochberg correction were applied to assess group differences. Results revealed distinct ANS profiles associated with CR stability. The entrained group exhibited robust circadian HRV oscillations, characterized by nocturnal parasympathetic dominance and clear day-night transitions in HF. In contrast, the fragmented group displayed globally suppressed HF, elevated LF/HF ratios, and attenuated circadian rhythmicity, indicative of chronic sympathetic dominance and impaired parasympathetic recovery. The delayed group retained circadian ANS rhythmicity but exhibited a 2–3 h phase delay in nocturnal HF peaks, reflecting misalignment with socially imposed schedules. Temporal analyses of 12-hour HF-defined epochs further demonstrated that only the entrained group exhibited structured transitions between consolidated nocturnal sleep and clustered daytime activity, a pattern absent in fragmented and delayed types. These findings underscore the critical role of CR stability in maintaining ANS equilibrium and sleep health. Targeted interventions that address CR-specific autonomic dysregulation – such as enhancing parasympathetic activity in fragmented type and gradual phase realignment in delayed type – may help mitigate the adverse consequences of circadian misalignment in college populations.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"134 ","pages":"Article 106696"},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781421","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}