Sleep Medicine Reviews最新文献

{"title":"Optimizing timing and dose of exogenous melatonin administration in neuropsychiatric pediatric populations: a meta-analysis on sleep outcomes","authors":"Simone Bruno ,&nbsp;Giovanni Cenerini ,&nbsp;Letizia Lo Giudice ,&nbsp;Francy Cruz-Sanabria ,&nbsp;Davide Benedetti ,&nbsp;Alessio Crippa ,&nbsp;Simona Fiori ,&nbsp;Raffaele Ferri ,&nbsp;Gabriele Masi ,&nbsp;Ugo Faraguna","doi":"10.1016/j.smrv.2025.102158","DOIUrl":"10.1016/j.smrv.2025.102158","url":null,"abstract":"<div><div>Melatonin is known to be effective in improving sleep in pediatric patients affected by neurological and psychiatric conditions. However, no guidelines exist advising the most effective treatment schedule. This systematic review and meta-analysis aimed to identify the dose, time of administration and treatment duration associated with the maximal treatment efficacy. The systematic search, conducted across multiple databases following PRISMA guidelines and including studies published up to April 30, 2024, yielded 21 studies. Mean differences in sleep-related variables between the treatment and the placebo group were considered as study outcomes. Dose-response curves and meta-regression models were fitted to test the effect of treatment-related parameters. Melatonin significantly reduced Sleep onset latency and increased Sleep efficiency and Total sleep time. Sleep onset latency reduction was associated with an advancement in the time between administration with respect to bedtime, while increased Sleep efficiency and Total sleep time with longer treatment durations. Melatonin reached the maximal efficacy between 2 and 4 mg/day. Our results suggest a dose and time of administration that may enhance melatonin's sleep promoting effects (2–4 mg, 3 h before bedtime) and, if replicated by large clinical trials, could guide clinical practice in managing sleep disturbances in children experiencing neuropsychiatric conditions.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102158"},"PeriodicalIF":9.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of heart rate variability analysis in differentiating patients with idiopathic REM sleep behaviour disorders from healthy subjects. A systematic review with meta-analysis","authors":"Clara Gino ,&nbsp;Laura Adelaide Dalla Vecchia ,&nbsp;Monica Parati ,&nbsp;Davide Sattin ,&nbsp;Serena Covino ,&nbsp;Graziella Cappelletti ,&nbsp;Alessandro Pincherle ,&nbsp;Beatrice De Maria","doi":"10.1016/j.smrv.2025.102160","DOIUrl":"10.1016/j.smrv.2025.102160","url":null,"abstract":"<div><h3>Introduction</h3><div>Autonomic nervous system (ANS) alteration has been acknowledged for disrupted sleep and α-synucleopaties. Since idiopathic REM sleep behavior disorder (iRBD) precedes α-synucleopaties, ANS function indices could predict conversion. Heart rate variability (HRV) analysis could better define cardiac ANS in iRBD.</div><div>This systematic review with meta-analysis purpose was to investigate the HRV indices role in differentiating iRBD and controls.</div></div><div><h3>Method</h3><div>Included studies (three databases screened) compare HRV indices in iRBD and controls during REM, non-REM (NREM) or wake phases. Outcomes included HRV indices in time and frequency domains. Meta-analysis performed for HRV indices computed standardized mean difference with 95 % confidence intervals.</div></div><div><h3>Results</h3><div>The 22 included studies had unbalanced age groups, mostly composed of males. An overall lower HRV and cardiac vagal modulation emerged in iRBD. Almost all studies evaluated HRV parameters only during wakefulness and most of those separated NREM and REM phases, better highlighting differences between iRBD and controls.</div></div><div><h3>Conclusion</h3><div>Results suggest an overall reduced HRV and cardiac vagal modulation in iRBD patients. Furthermore, separated analysis of the different sleep stages better differentiate subjects with iRBD.</div><div>Further longitudinal studies on larger populations would reach more conclusions defining relationships between HRV and neurodegenerative diseases in prodromic stages.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102160"},"PeriodicalIF":9.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting the mandibular jaw movement signal in pediatric obstructive sleep apnea diagnosis: A technical and practical review","authors":"Jean-Benoit Martinot ,&nbsp;Nhat-Nam Le-Dong ,&nbsp;Julie Cassibba ,&nbsp;Didier Clause ,&nbsp;Jean-Louis Pépin ,&nbsp;David Gozal","doi":"10.1016/j.smrv.2025.102159","DOIUrl":"10.1016/j.smrv.2025.102159","url":null,"abstract":"<div><div>Pediatric obstructive sleep apnea (OSA) is a common yet often underdiagnosed condition, partly due to limited access to polysomnography. Mandibular jaw movement (MJM) analysis offers a promising alternative to conventional home sleep apnea testing in children, capturing the dynamic interactions between respiratory drive and upper airway musculature, enabling accurate identification of, and critical insights into, sleep-disordered breathing events.</div><div>This technical and practical review provides a structured framework for understanding and interpreting MJM signals during sleep in pediatric patients. It begins with the physiological basis and technical aspects of using a single-point contact device with integrated inertial sensors. It offers step-by-step instructions for interpreting MJM signals, from distinguishing sleep stages to identifying obstructive and central apneas, hypopneas, and respiratory effort-related arousals. The review is accompanied by an atlas of 30 annotated examples that illustrate key MJM signal patterns across scoring tasks.</div><div>Key findings from several clinical studies on the utility of MJM analysis in pediatric OSA are also summarized.</div><div>As the demand for accessible and accurate home-based diagnostic tools grows, MJM analysis stands out as an effective option for both the diagnosis and monitoring of pediatric OSA, with the potential to transform routine clinical practice and improve patient access to care.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102159"},"PeriodicalIF":9.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of cannabinoids on subjective sleep quality in people with and without insomnia or poor sleep: A systematic review and meta-analysis of randomised studies","authors":"Giovanna Hanike Santos da Silva ,&nbsp;Eduardo Cerchi Barbosa ,&nbsp;Fernanda Ribeiro de Lima ,&nbsp;Douglas Carneiro Barroso ,&nbsp;Loyná Euá Flores E. Paez ,&nbsp;Felipe Bandeira de Melo Guimarães ,&nbsp;Saulo Bernardo Lança ,&nbsp;Stephanie Brito Ceolin de Faria ,&nbsp;Arthur Bezerra Cavalcanti Petrucci ,&nbsp;Alicja Garbacka ,&nbsp;Jennifer H. Walsh","doi":"10.1016/j.smrv.2025.102156","DOIUrl":"10.1016/j.smrv.2025.102156","url":null,"abstract":"<div><h3>Study objectives</h3><div>This systematic review and meta-analysis assessed the efficacy of cannabinoids compared to placebo for improving sleep quality.</div></div><div><h3>Methods</h3><div>Searches were conducted in MEDLINE, Embase, and Cochrane databases for randomised controlled trials comparing cannabinoids vs. placebo for improving sleep quality in adults with or without insomnia or poor sleep. The primary outcome was self-reported sleep quality (PROMIS, PSQI, LSEQ, Sleep Diary). Secondary outcomes included actigraphy parameters, anxiety (GAD-7, STAI-T), well-being (WHO-5 index), and insomnia severity (ISI). Additional analyses focused on sleep quality in (1) participants with insomnia or poor sleep, and (2) cannabidiol (CBD) vs. non-CBD interventions. Statistical analysis was performed using RevMan 5.4.1, with p &lt; 0.05 considered significant.</div></div><div><h3>Results</h3><div>Six trials (1077 patients) were included. Cannabinoids significantly improved sleep quality compared to placebo [SMD 0.53; 95 % CI 0.03–1.02; p = 0.04; I2 = 88 %], particularly in those with insomnia or poor sleep [SMD 0.60; 95 % CI 0.09–1.11; p = 0.02; I2 = 89 %]. Non-CBD cannabinoids demonstrated greater efficacy [SMD 0.82; 95 % CI 0.24–1.40; p = 0.005], whereas CBD-only therapies showed no significant effect [SMD 0.13; 95 % CI -0.38-0.65; p = 0.61].</div></div><div><h3>Conclusion</h3><div>Cannabinoids, particularly non-CBD formulations, improve sleep quality, justifying further investigation as therapeutic options for insomnia or poor sleep.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102156"},"PeriodicalIF":9.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing subjective and objective nighttime- and daytime variables between patients with insomnia disorder and controls – a systematic umbrella review of meta-analyses","authors":"Elisabeth Hertenstein ,&nbsp;Marie Angelillo ,&nbsp;Pauline Henckaerts ,&nbsp;Carlotta L. Schneider ,&nbsp;Kristoffer D. Fehér ,&nbsp;Dieter Riemann ,&nbsp;Bernd Feige ,&nbsp;Kai Spiegelhalder ,&nbsp;Anna Johann ,&nbsp;Cagdas Türkmen ,&nbsp;Christoph Nissen","doi":"10.1016/j.smrv.2025.102153","DOIUrl":"10.1016/j.smrv.2025.102153","url":null,"abstract":"<div><div>Insomnia disorder is a prevalent health problem with adverse consequences for mental health and quality of life. Although insomnia disorder is defined in diagnostic systems as a subjective complaint about sleep, this understanding is not consistently applied in clinical settings. There remains a lack of clarity regarding the mechanisms underlying subjective sleep complaints and associated daytime impairments.</div><div>This systematic umbrella review of meta-analyses aimed to compare subjective and objective health-related variables between patients with insomnia disorder and controls, characterizing insomnia comprehensively. After a systematic literature search, we included six meta-analyses comparing patients with insomnia disorder and controls in terms of subjective sleep (sleep diaries), objective sleep (polysomnography), peripheral brain-derived neurotrophic factor, cortisol, objective cognitive performance, blood pressure and EEG spectral power.</div><div>The pattern of results suggests that differences between patients with insomnia disorder and healthy controls are largest and most consistent for subjective sleep. Objective between-group effect sizes were largest for unspecific stress markers such as brain-derived neurotrophic factor and cortisol. Variables expected to be abnormal in those with objective sleep deprivation, such as objective attention and alertness, showed minimal group differences. Also in terms of sleep, effect sizes for subjective variables were consistently larger than those for objective variables. Critical appraisal of the quality of the included meta-analyses using the AMSTAR 2 tool suggested moderate overall confidence in the results, whereby shortcomings in several critical domains such as pre-registration of the study protocol and justification for the inclusion of individual studies have been identified.</div><div>Our findings highlight that insomnia disorder is characterized by large reductions in subjective sleep quality, in the absence of large objective alterations. This body of evidence supports a biopsychosocial conceptualization of chronic insomnia disorder with a strong psychological component.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"83 ","pages":"Article 102153"},"PeriodicalIF":9.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Winding down for sleep: How behavioral, cognitive, motivational, and emotional factors interact to influence sleep regulation and health","authors":"Debora Meneo ,&nbsp;Chiara Baglioni","doi":"10.1016/j.smrv.2025.102154","DOIUrl":"10.1016/j.smrv.2025.102154","url":null,"abstract":"<div><div>Animals do not simply fall asleep when they need rest. Without conscious effort, most animals engage in a series of sleep-preparatory behaviors, such as nesting. These are stereotypical actions performed in a temporally structured pre-sleep phase. Researchers have examined these behaviors from an evolutionary perspective, as they must provide some advantage. One hypothesis is that they have an indirect fitness benefit by facilitating de-arousal, making it easier to transition from wakefulness to sleep. In humans, regular positive bedtime routines are considered a main pediatric dimension of sleep health. In adults, difficulty in de-arousal at bedtime is a major issue for people with insomnia. Cognitive models of insomnia stress the strict association between arousal and cognitive-emotional factors driving behaviors. However, there is a lack of a unified framework to address the interplay between pre-sleep behaviors, psychological processes, and arousal levels in promoting or inhibiting evening winding down and wake-to-sleep transition. This narrative review aims to explore the role of behavioral components of sleep regulation, by focusing on the dynamical association between pre-sleep behaviors, cognitions, motivations, emotions, and arousal in relation to sleep health. We propose a framework to understand and investigate winding down behaviors as part of sleep regulation in humans.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"83 ","pages":"Article 102154"},"PeriodicalIF":9.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond explainable AI: Enhancing trust and robustness in machine learning for sleep apnea diagnosis","authors":"Yoshiyasu Takefuji","doi":"10.1016/j.smrv.2025.102152","DOIUrl":"10.1016/j.smrv.2025.102152","url":null,"abstract":"<div><div>Kilic et al. reviewed machine learning (ML) and deep learning (DL) for sleep apnea detection, emphasizing explainable AI (XAI) while noting challenges like Apnea-Hypopnea Index (AHI) discrepancies. This paper extends their critique, arguing that XAI tools like SHAP inherit model biases, and high prediction accuracy does not guarantee reliable feature importances, which inherently lack ground truth validation. To overcome these limitations and build clinical trust, we advocate for a comprehensive approach combining unsupervised ML (e.g., feature agglomeration, highly variable gene selection) with nonlinear nonparametric statistical methods (e.g., Spearman's correlation). This strategy robustly evaluates variable relationships and p-values, particularly for monotonic associations, mitigating misapplications stemming from assumption violations and inadequate interpretation of model ground truth, thus fostering real-world applicability.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"83 ","pages":"Article 102152"},"PeriodicalIF":9.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"The impact of maternal sleep during pregnancy on childhood health: A systematic review\"","authors":"Lili Yi","doi":"10.1016/j.smrv.2025.102151","DOIUrl":"10.1016/j.smrv.2025.102151","url":null,"abstract":"","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"83 ","pages":"Article 102151"},"PeriodicalIF":9.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variants of time in bed manipulation therapy for patients with insomnia: A scoping review","authors":"Ann Rosén ,&nbsp;Maria Cassel ,&nbsp;Johanna Stjernberg ,&nbsp;Joel Stenfalk ,&nbsp;Kerstin Blom ,&nbsp;Sandra Tamm ,&nbsp;Torbjörn Åkerstedt ,&nbsp;Rickard Carlsson ,&nbsp;Susanna Jernelöv","doi":"10.1016/j.smrv.2025.102150","DOIUrl":"10.1016/j.smrv.2025.102150","url":null,"abstract":"<div><div>Cognitive behavioural therapy for insomnia includes methods to adjust bedtimes and risetimes. The most well-known is sleep restriction therapy, but alternatives like sleep compression therapy and bedtime regularization also exist. Instructions and terminology vary. This scoping review uses \"time-in-bed manipulation therapy\" to encompass all such interventions, aiming to synthesize information on their implementation in adult populations, focusing on different instructions found in the literature.</div><div>We searched five electronic databases. Two independent reviewers screened full-text papers, followed by data extraction. Both quantitative (e.g., instruction frequencies) and qualitative (e.g., analysis of content) syntheses were conducted.</div><div>Of 7474 citations and 500 full-text papers, 52 studies met inclusion criteria, covering 60 therapies. Most interventions were termed sleep restriction therapy, but other names, such as sleep compression and bedtime restriction, were also used. Nine different methods for calculating the initial sleep window were identified, with further variation in other instructions. About half of the studies were randomized controlled trials.</div><div>This review provides a comprehensive overview of time-in-bed manipulation therapies, aiding researchers and clinicians in selecting appropriate approaches. It highlights the need for clearer reporting, increased direct comparisons, and suggests a new model, The Restriction and Flexibility Model, describing key dimensions of these interventions.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"83 ","pages":"Article 102150"},"PeriodicalIF":9.7,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144865998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic association between sleep quality, insomnia, and psychological distress: a systematic review and meta-analysis","authors":"Federico J. Blanco-García ,&nbsp;José A. López-López ,&nbsp;Juan R. Ordoñana ,&nbsp;Juan J. Madrid-Valero","doi":"10.1016/j.smrv.2025.102149","DOIUrl":"10.1016/j.smrv.2025.102149","url":null,"abstract":"<div><div>There is a well-established link between sleep disorders and psychological problems such as anxiety and depression. Twin studies and genome-wide association studies (GWAS) have consistently found significant genetic overlap between these traits. However, there is considerable variation among studies. The aims of this meta-analysis were therefore: 1) to estimate the mean genetic correlation between sleep problems and psychological distress; 2) to assess heterogeneity among the included studies; and 3) to search for potential moderators that could contribute to this heterogeneity. To this end, we performed several multivariate meta-analyses. The mean genetic correlations were estimated to be 0.55 (CI: 0.47–0.63) for sleep quality and depression, 0.72 (CI: 0.59–0.85) for insomnia symptoms and depression, 0.42 (CI: 0.30–0.54) for sleep quality and anxiety, and 0.75 (CI: 0.59–0.91) for insomnia symptoms and anxiety. Similar results were obtained when depression and anxiety were collapsed (0.54 [CI: 0.44–0.64] for sleep quality and 0.77 [CI: 0.63–0.91] for insomnia symptoms). Sex did not significantly moderate these associations. Study type (twin studies vs GWAS) and age, however, were significant moderators (p &lt; 0.001). These findings highlight the substantial genetic overlap between psychological distress and sleep problems, which appears to be stronger for insomnia symptoms than for sleep quality.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"83 ","pages":"Article 102149"},"PeriodicalIF":9.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}