Journal of Clinical Sleep Medicine最新文献

{"title":"Comparative effectiveness and predictors of cognitive behavioral therapy for insomnia and its components in older adults: main outcomes of a randomized dismantling trial.","authors":"Kathleen P O'Hora, Allison B Morehouse, Leah Freidman, Donn Posner, Maryam Ahmadi, Beatriz Hernandez, Kristen Faye Burda, Clete Kushida, Jamie M Zeitzer, Laura C Lazzeroni, Rachel Manber, Jerome Yesavage, Andrea N Goldstein-Piekarski","doi":"10.5664/jcsm.11756","DOIUrl":"https://doi.org/10.5664/jcsm.11756","url":null,"abstract":"<p><strong>Study objectives: </strong>To determine the relative effectiveness and predictors of cognitive therapy (CT), behavioral therapy (BT), and cognitive behavioral therapy (CBT) for insomnia in older adults.</p><p><strong>Methods: </strong>In a registered clinical trial (NCT02117388), 128 older adults with insomnia disorder were randomized to receive CBT, BT, or CT. Insomnia Severity Index (ISI) score was the primary outcome. Sleep diaries, fatigue, beliefs about sleep, cognitive arousal, and stress were secondary outcomes. Split-plot linear mixed models assessed within and between subject changes in outcomes among the treatments. As a secondary analysis, we used linear regression to test predictors of insomnia symptoms improvement, including sleep diary measures, cognitive arousal, stress, beliefs about sleep, baseline ISI score, and age. Benjamini-Hochberg correction was applied.</p><p><strong>Results: </strong>All groups exhibited insomnia symptom reduction at post-treatment (CT: <i>d=</i>-2.53, <i>P</i><.001; BT: <i>d=</i>-2.39, <i>P</i><.001; CBT: <i>d</i>=-2.90, <i>P</i><.001) and 6FU (CT: <i>d=</i>-2.68, <i>P</i><.001; BT: <i>d=</i>-2.85, <i>P</i><.001; CBT: <i>d</i>=-3.14, <i>P</i><.001). There were no group differences in the magnitude of ISI improvement (<i>P_adj</i>=.63), response (<i>P_adj</i>>.63), or remission (ISI<8; <i>P_adj</i>>.27). All groups exhibited significant improvements in secondary outcomes at post-treatment (<i>P_adj</i> <.05) and 6FU (<i>P_adj</i><0.05). At post-treatment, the CT and CBT groups showed greater reductions in beliefs about sleep than the BT group (F_Interaction(2,185)=5.99, <i>P_adj</i>=.03), and the CBT group showed a greater time in bed reduction than the CT group (F_Interaction(2,185)=7.05, <i>P_adj</i>=.01). Baseline ISI was the only treatment predictor (<i>b</i>=1.95, <i>P_adj</i><.001).</p><p><strong>Conclusions: </strong>CBT-I and its components each independently result in significant improvements in subjective insomnia symptoms, beliefs about sleep, worry, and fatigue in older adults.</p><p><strong>Clinical trial registration: </strong>Name: Treatments for Insomnia: Mediators, Moderators and Quality of Life; Registry: ClinicalTrials.gov; Identifier: NCT02117388.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of bariatric surgery on the resolution of obesity hypoventilation syndrome at one-year follow-up: a retrospective study.","authors":"Shuai Ma, Wenwen Yu, Chengcan Yang, Yining He, Dongzi Zhu, Fen Gu, Bei Xu, Xiaozhen Xu, Kan Yao, Xiurong Tao, Min Zhu, Bing Wang","doi":"10.5664/jcsm.11750","DOIUrl":"https://doi.org/10.5664/jcsm.11750","url":null,"abstract":"<p><strong>Study objectives: </strong>This study aimed to assess the effectiveness of metabolic and bariatric surgery (MBS) in patients with obesity comorbid with obesity hypoventilation syndrome (OHS) at 1-year follow-up.</p><p><strong>Methods: </strong>This retrospective study was conducted between January 2020 and June 2023 at an MBS center in a university-affiliated tertiary hospital in China. Clinical data, including body mass index (BMI), arterial blood gas (ABG) values, portable sleep study results, and anthropometric parameters, were recorded pre- and postoperatively. Correlations between variables and risk factors for OHS resolution were analyzed.</p><p><strong>Results: </strong>Among 1134 MBS candidates, 187 (16.5%) had comorbid OHS;151 patients with OHS met inclusion criteria and completed the 1-year follow up visit (BMI 39.1 ± 6.8 kg/m² with PaCO₂ 48.6 ± 3.0 mmHg). At 1-year follow-up, BMI decreased to 29.0 ± 6.0 kg/m² (<i>P</i><0.001) while PaCO₂ dropped to 43.8 ± 5.5 mmHg (<i>P</i><0.001). Resolution of OHS, defined as awake PaCO₂ <45mmHg with discontinuation of PAP therapy for a minimum of 6 months before obtaining the ABG at the 12-month visit, was achieved in 105 (69.5%) of the patients. Nonlinear analysis indicated that PaCO₂ did not significantly decrease until percentage total weight loss (%TWL) exceeded approximately 20%. Larger reduction in waist circumference was associated with greater reduction in PaCO₂, particularly when waist circumference reached less than 25 cm. Beyond this point, ΔPaCO₂ plateaud. In multivariate analysis, larger preoperative waist circumference (OR: 1.046, 95% CI: 1.031-1.118, <i>P</i> = 0.025) and ABG pH < 7.35 (OR: 3.921, 95% CI: 2.305-9.140, <i>P</i> < 0.001) were associated with lack of resolution of OHS, while larger %TWL after bariatric surgery (OR: 0.917, 95% CI: 0.846-0.965, <i>P</i> = 0.001) was independently associated with OHS resolution.</p><p><strong>Conclusions: </strong>MBS is an effective treatment for OHS. Achieving a sufficient %TWL is critical for the resolution of OHS.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home sleep testing in children: we probably can, but should we?","authors":"Lee J Brooks","doi":"10.5664/jcsm.11792","DOIUrl":"https://doi.org/10.5664/jcsm.11792","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological management of sleep apnea and obesity, a new frontier.","authors":"Pahnwat Tonya Taweesedt, Nnamdi Orakpo, Rafael Pelayo","doi":"10.5664/jcsm.11798","DOIUrl":"https://doi.org/10.5664/jcsm.11798","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When legs move and airways close: kicking up an old controversy.","authors":"Brian B Koo","doi":"10.5664/jcsm.11794","DOIUrl":"https://doi.org/10.5664/jcsm.11794","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age matters: the differential impact of OSA on metabolic health by age group.","authors":"Mehrnaz Azarian","doi":"10.5664/jcsm.11796","DOIUrl":"https://doi.org/10.5664/jcsm.11796","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep quality measured by cardiopulmonary coupling spectrum in pregnant women predicts neonatal outcomes.","authors":"Yue-Nan Ni, Hugi Hilmisson, Solveig Magnusdottir, Zongan Liang, Ying Chen, Robert Joseph Thomas","doi":"10.5664/jcsm.11768","DOIUrl":"https://doi.org/10.5664/jcsm.11768","url":null,"abstract":"<p><strong>Study objectives: </strong>To assess the impact of objective sleep quality during pregnancy, estimated using cardiopulmonary coupling (CPC) sleep spectrograms, on neonatal outcomes.</p><p><strong>Methods: </strong>A secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) study. Cardiopulmonary coupling analysis was done using the raw photoplethysmogram (PLETH) signal within the oximetry-sensor (PPG) from a home apnea sleep test. High and low frequency coupling (HFC, LFC) reflect stable and unstable sleep, respectively. A multi-component Sleep Quality Index integrates sleep stability, and fragmentation. Regression analysis was done to identify the relationship between CPC metrics and neonatal outcomes.</p><p><strong>Results: </strong>Oximetry/PPG data from the early and middle term of pregnancy (3003 and 2168 subjects, ETP and MTP respectively) was available. A high SQI in ETP decreased the risk of small for gestational age (SGA) (OR 0.297, 95% CI 0.147-0.603, <i>p</i> < 0.01) and Apgar score < 7 at 5 minutes (OR 0.368, 95% CI 0.158-0.857, <i>p</i>: 0.02). A higher SQI in MTP was associated with Apgar score < 7 at 1(OR 0.472, 95% CI 0.275-0.810, <i>p</i> < 0.01) and 5 minutes (OR 0.274, 95% CI 0.107-0.704, <i>p</i> < 0.01). An increased HFC/LFC ratio in ETP was a predictor for reduced preterm birth risk (OR 0.955, 95% CI 0.920-0.991, <i>p</i>: 0.01) and it in MTP was related with increased preterm birth (OR 0.828, 95% CI 0.749-0.916, <i>p</i>: 0.01) and Apgar score < 7 at 5 minutes (OR 0.784, 95% CI 0.659-0.932, <i>p</i> < 0.01) risks. The increasing of eLFC_NB across pregnancy, which is a biomarker of sleep fragmentation, added the risk of SGA (OR 1.053, 95% CI 1.009-1.099, <i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Sleep quality measured by CPC spectrograms were associated with neonatal outcomes. Sleep quality may be a target for clinical care during pregnancy.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actigraphy-derived sleep fragmentation index: convergent validity and associations with clinical outcomes.","authors":"Dana Saleh, Suzanne M Bertisch, Michelle Reid, Andrew Lim, Shaun Purcell, Susan Redline","doi":"10.5664/jcsm.11754","DOIUrl":"https://doi.org/10.5664/jcsm.11754","url":null,"abstract":"<p><strong>Study objectives: </strong>Wake after sleep onset (WASO) and sleep efficiency (SE) derived from actigraphy are common assessments of sleep fragmentation (or continuity). The sleep fragmentation index (SFI), measuring the frequency of sleep-wake transitions, is less understood. This study examined (1) the convergent validity between SFI and other sleep metrics obtained by actigraphy and polysomnography; and (2) associations of SFI with sleep symptoms, obstructive sleep apnea (OSA), periodic limb movement index (PLMI), and cognition (Digit Symbol Coding test (DSC)).</p><p><strong>Methods: </strong>Cross-sectional analysis using logistic and multiple regression analyses adjusted for potential confounders. 1,908 participants in the Multi-Ethnic Study of Atherosclerosis study who underwent 7-day actigraphy and polysomnography. The sample was 53.9% female; age 68.3 ± 9.1 years (mean ±SD); apnea-hypopnea index (AHI) 19.5 ± 17; and SFI 20.09 ± 6.99.</p><p><strong>Results: </strong>Higher SFI was associated with older age, male sex, Black race, smoking, body mass index, OSA, and polysomnography-based metrics of sleep architecture. SFI was strongly correlated with actigraphy-measured SE (r= -0.75; p<0.0001) and WASO (r= 0.63; p<0.0001), and modestly correlated with polysomnography-WASO, AHI, and arousal index (r's=0.23 to 0.27; p's<0.0001). In adjusted analyses, each standard deviation unit increase in SFI was associated with 1.1 to 1.4 higher odds of insomnia symptoms, sleepiness, OSA, an elevated PLMI, and with lower DSC scores (p<0.05).</p><p><strong>Conclusions: </strong>The results support the convergent validity between actigraphy-estimated SFI and actigraphy-WASO and SE. SFI showed modestly stronger associations with clinical symptoms compared to other fragmentation variables, supporting its utility as a marker of sleep continuity.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atomoxetine plus oxybutynin for symptomatic snoring and airflow limitation in individuals without moderate-to-severe obstructive sleep apnea.","authors":"Nicole Calianese, Lauren B Hess, Daniel Vena, Robert Konefal, Dwayne Mann, Luigi Taranto-Montemurro, Suzanne M Bertisch, Tamar Sofer, Ali Azarbarzin, Laura K Gell, Scott A Sands","doi":"10.5664/jcsm.11760","DOIUrl":"https://doi.org/10.5664/jcsm.11760","url":null,"abstract":"<p><strong>Study objectives: </strong>Sleep disordered breathing is incompletely characterized by the apnea-hypopnea index (AHI). Although typically viewed as milder disease, snoring and flow limitation can yield major deficits in sleep health for both patients and their bed partners. Here we tested whether a combined noradrenergic and antimuscarinic intervention to activate pharyngeal muscles yields improved snoring loudness and flow limitation severity, plus self-reported outcomes, by snorers and their bed-partners.</p><p><strong>Methods: </strong>In a randomized placebo-controlled double-blind crossover study, adults with loud habitual snoring took atomoxetine-plus-oxybutynin (AtoOxy) for 10 days before bedtime at full adult doses (80/5 mg respectively; half dose run-in on days 1-3) and at half doses (40/2.5 mg). Baseline polysomnography with tracheal sound recording established baseline snoring (mean loudness >75 dB) and AHI <15/hr. Mixed models compared full and half doses to placebo in snoring loudness, flow limitation and snoring self-evaluation and bed-partner evaluation scores, adjusting for baseline and period effects (intention-to-treat analysis).</p><p><strong>Results: </strong>15 participants were randomized and 13 completed all treatment periods. Snoring loudness was reduced with full dose (-9.3[-19.6,-2.9] dB; difference[95%CI]) and half dose (-9.0[-17.8,-3.2] dB) versus placebo (102.2 dB), equivalent to two-thirds reduction in snoring amplitude. Flow-limitation severity was also meaningfully reduced (both doses). The Snoring <i>Bed-Partner</i> Evaluation Scale was reduced with the half dose only (-2.8[-5.3,-0.4] points from 10.1 on placebo). <i>Self-</i>Evaluation scores were lowered exclusively in N=7/15 with bothersome snoring at baseline (treatment×subgroup interactions).</p><p><strong>Clinical trial registration: </strong>Registry: ClinicalTrials.gov; Name: Pharmacological Intervention for Symptomatic Snoring; Identifier: NCT03720353; URL: https://clinicaltrials.gov/study/NCT03720353.</p><p><strong>Conclusions: </strong>In patients with habitual snoring, atomoxetine-plus-oxybutynin at half and full doses improves snoring and flow limitation. A half-dose may also improve bed-partner outcomes.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Patient-reported Longitudinal Assessment Tool for OSA (PLATO): development and validation of a new clinical tool to assess response to obstructive sleep apnea treatment in adults.","authors":"Douglas Kirsch, Fariha Abbasi-Feinberg, Charles Davies, Charlene Gamaldo, Sherene Thomas, Patricia Koochaki, Christiane Otto, Kelly Lipman, Carol L Rosen","doi":"10.5664/jcsm.11790","DOIUrl":"https://doi.org/10.5664/jcsm.11790","url":null,"abstract":"<p><strong>Study objectives: </strong>To develop and validate a publicly available, patient-reported outcome (PRO) tool specific to obstructive sleep apnea (OSA) in adults, designed for clinical use to monitor treatment response and longitudinal symptom progression.</p><p><strong>Methods: </strong>The PRO tool was developed in accordance with FDA guidance for PRO measures, utilizing a multi-phase, mixed-methods approach. Part 1 involved concept elicitation and cognitive interviews with patients to identify key symptoms and impacts. Part 2 consisted of pilot testing the draft tool in 10 AASM-accredited sleep centers. Part 3 included psychometric validation using longitudinal online surveys in 560 adults with OSA and 40 controls. Analyses included exploratory factor analysis, Rasch modeling, test-retest reliability, internal consistency, construct validity, responsiveness to change, and determination of clinically important difference thresholds.</p><p><strong>Results: </strong>The final 11-item Patient-reported Longitudinal Assessment Tool for OSA (PLATO-11) has a 7-day recall period and assesses both daytime and nighttime OSA symptoms. It demonstrated strong internal consistency (α = 0.94), test-retest reliability (ICC = 0.91-0.97), and construct validity through moderate-to-strong correlations with established measures. PLATO-11 scores discriminated between OSA severity and BMI groups and were responsive to symptom improvement. The mean completion time was under 4 minutes. The tool can be used in both paper and electronic formats and has been translated into Spanish.</p><p><strong>Conclusions: </strong>PLATO-11 is a valid, reliable, and feasible PRO instrument for assessing OSA-related symptoms in clinical practice. It enables efficient monitoring of patient-reported outcomes across treatment stages.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}