Journal of Clinical Sleep Medicine最新文献

{"title":"A photoplethysmography-based home sleep apnea test compared with polysomnography in children 2 to 6 years of age.","authors":"Ann M Murray, Christine A Matarese, Robin M Lloyd, Channing Sorensen, Allison LeMahieu, Dennis Reckward, Robyn Tullis, Mark Bellinger, Virginia Brown, Daniel L Herold, Timothy I Morgenthaler, Julie M Baughn","doi":"10.1007/s44470-026-00156-x","DOIUrl":"https://doi.org/10.1007/s44470-026-00156-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine the accuracy and feasibility of utilizing a photoplethysmography-based home sleep apnea test (PPG-HSAT) in children ages 2 to 6 years.</p><p><strong>Methods: </strong>Fifty children aged 2 to 6 years referred for polysomnography (PSG) for evaluation of obstructive sleep apnea (OSA) were prospectively enrolled to wear the SleepImage PPG-HSAT concurrently during in-lab PSG. This is a ring-worn PPG-HSAT scored using proprietary SleepImage software. Thirty-nine participants completed testing. A \"limited PSG\" dataset was created by trimming PSG data to match periods when PPG-HSAT data were available. The apnea-hypopnea index (AHI) and presence of OSA were compared between methods.</p><p><strong>Results: </strong>Device-related issues (e.g., detachment, intolerance, user setup error) that precluded successful data collection occurred in 11% of studies; an additional 25% had less than 2 h of total sleep time recorded on PPG-HSAT. Using automated SleepImage scoring, the mean difference in total sleep time between PPG-HSAT and PSG was - 220 min (95% CI - 278 to - 62; p < .001). When PPG-HSAT was compared with limited PSG, the mean difference was - 11 min (95% CI - 38 to 16; p = .83). Sensitivity for diagnosing OSA was 94.1%, specificity 22.7%, positive predictive value 0.48, and negative predictive value 0.83. The obstructive AHI was higher with PPG-HSAT than with both PSG and limited PSG (p < 0.001). PPG-HSAT detected no central events. Caregivers reported good ease of use and tolerance of the device.</p><p><strong>Conclusion: </strong>This PPG-HSAT was technically inadequate and diagnostically inaccurate in diagnosing OSA in children 2 to 6 years of age.</p><p><strong>Current knowledge/study rationale: </strong>An accurate and reliable home sleep apnea test would significantly impact pediatric OSA diagnosis. This study aimed to determine the accuracy and feasibility of utilizing the home sleep apnea test Sleep Image in 50 children ages 2 to 6 years.</p><p><strong>Study impact: </strong>The PPG-HSAT was technically inadequate and diagnostically inaccurate in diagnosing OSA in children 2 to 6 years of age. The need for continued rigorous evaluation of pediatric HSAT devices is illustrated. Future research is needed to determine the best technology and age of use prior to recommending the widespread use of any HSAT device in children.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the sleep-memory link after insomnia therapy in older adults.","authors":"Wenfang Zhang, Xuanqi Guo","doi":"10.1007/s44470-026-00160-1","DOIUrl":"10.1007/s44470-026-00160-1","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13468826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying COMISA in diabetes: distinguishing true insomnia comorbidity from OSA-related sleep disruption.","authors":"Shali Xu, Xiaoxia Liu, Chunyu Liu","doi":"10.1007/s44470-026-00154-z","DOIUrl":"10.1007/s44470-026-00154-z","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13469046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"Limitations in study of actigraphic estimates of sleep\".","authors":"Kelly Glazer Baron, Joshua Landvatter","doi":"10.1007/s44470-026-00136-1","DOIUrl":"10.1007/s44470-026-00136-1","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The need to integrate spirituality into sleep medicine as a dimension of whole-person, person-centered care.","authors":"Rupsha Singh, Christina M Puchalski, Alexander Moreira-Almeida, Brian Merry, David H Rosmarin, Harold G Koenig, Chandra L Jackson","doi":"10.1007/s44470-026-00137-0","DOIUrl":"10.1007/s44470-026-00137-0","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep homeostasis impairment across obstructive sleep apnea severity: findings from a population-based cohort study.","authors":"Rama Maganti, Jun Wang, Scott Hetzel","doi":"10.1007/s44470-026-00131-6","DOIUrl":"10.1007/s44470-026-00131-6","url":null,"abstract":"<p><strong>Purpose: </strong>Obstructive sleep apnea (OSA) is a sleep disorder that causes recurrent airway obstruction and sleep fragmentation and increases cardiometabolic, cognitive, and mortality risk. Although slow-wave activity (SWA) and sleep homeostasis (SH) are central to restorative sleep and synaptic regulation, the extent to which SH is disrupted across OSA severity remains unclear.</p><p><strong>Methods: </strong>In this population-based cohort study, we analyzed 945 polysomnography (PSG) studies from adults with mild, moderate, severe OSA, or no OSA. Sleep parameters including apnea-hypopnea index (AHI) and slow wave activity (SWA 0.5-4 Hz) from electroencephalography (EEG) in non-rapid eye movement (NREM) sleep were extracted. SH was assessed with overnight decay of SWA, slopes of slow waves, and change in SWA with wake after sleep onset (WASO). Liner regression models were used to identify independent predictors of SH measures.</p><p><strong>Results: </strong>SWA decay across successive NREM episodes was attenuated in severe OSA group. Higher AHI (p < 0·001) and greater WASO (p < 0·001) were associated with a flatter decay of SWA. For a given level of SWA decay, males exhibited higher AHI than females (p < 0·0001). Slope of slow waves decreased from the first to last hour of NREM sleep in all groups (p < 0.01) except severe OSA. Multivariable models revealed that diabetes, use of antidepressant, anti-anxiety, antihypertensive, and sedative medications and high caffeine intake independently predicted impaired SH, whereas greater N3 sleep percentage was associated with preserved SWA decline.</p><p><strong>Conclusion: </strong>These data demonstrate SH is disrupted in OSA but additionally modulated by metabolic and pharmacologic factors. Targeting SH may represent a strategy to mitigate neurocognitive and physiological consequences of OSA. Obstructive sleep apnea (OSA) is associated with adverse health outcomes including hypertension, cardiovascular complications, cognitive decline as well as mortality. Impaired sleep homeostasis in OSA may represent a mechanistic link between sleep-disordered breathing and adverse health outcomes as slow wave activity is critical for synaptic downscaling, memory consolidation, and metabolic regulation. OSA is known to impair sleep homeostasis though it is unknown if OSA severity matters. Our data suggested that severe OSA impaired sleep homeostasis but clinical factors should be considered as they can impact sleep homeostasis as well. Future research should evaluate whether therapeutic interventions for OSA can reverse all these impairments and whether treatments should also be directed towards correcting sleep homeostasis impairment as well.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a deep learning-based system for sleep staging, arousal detection, and respiratory event scoring in atrial fibrillation patients.","authors":"Susana Sousa, Carlos Teixeira, Thóra Sigmarsdóttir, Eysteinn Finnsson, Jón Ágústsson, Sindri Sigþórsson, Snorri Bjarkason, Marta Drummond, António Bugalho","doi":"10.1007/s44470-026-00145-0","DOIUrl":"10.1007/s44470-026-00145-0","url":null,"abstract":"<p><strong>Purpose: </strong>Obstructive sleep apnea is a common yet underdiagnosed sleep disorder in patients with atrial fibrillation (AF). Although polysomnography (PSG) is the gold standard, its costs and complexity limit routine use. Home sleep apnea testing (HSAT) is a more accessible alternative, but it lacks electroencephalography (EEG), limiting direct assessment of sleep stages and arousals. This study evaluates the performance of DeepRESP, an automated scoring solution that infers sleep stages and arousals using respiratory inductance plethysmography (RIP) signals and scoring respiratory events, in a cohort of patients with AF.</p><p><strong>Methods: </strong>In this prospective cohort study, consecutive AF patients underwent ambulatory type II PSG. Automated respiratory event scoring, sleep staging and arousal identification were performed with DeepRESP using only HSAT signals. Performance metrics included epoch-level positive and negative percent agreement, complemented by concordance analyses for the apnea-hypopnea index (AHI), arousal index (ArI), and total sleep time (TST), using Bland-Altman analysis and intraclass correlation coefficients (ICC), with manually scored PSG as reference.</p><p><strong>Results: </strong>A total of 88 patients (67.0% male) were included. Women were older than men (66.7 ± 7.2 vs. 61.27 ± 10.3 years, p = 0.015). Epoch-level overall percent agreement (OPA) with manual scoring was 0.91 for Wake, 0.95 for rapid eye movement sleep (REM), and 0.87 for non-rapid eye movement sleep (NREM). Arousal detection OPA was 0.80. Strong agreement was observed for the apnea-hypopnea index (ICC = 0.92), TST (ICC = 0.82), and ArI (ICC = 0.83).</p><p><strong>Conclusion: </strong>In AF patients, DeepRESP reliably estimates sleep architecture, arousals, and sleep apnea severity from HSAT signal, offering a scalable, EEG-independent diagnostic approach.</p><p><strong>Current knowledge/study rationale: </strong>Obstructive sleep apnea is highly prevalent and often underdiagnosed in atrial fibrillation patients, yet standard home testing lacks the neurophysiological channels necessary to detect arousals and accurate sleep architecture. This study was conducted to validate a deep learning-based system capable of inferring these critical metrics exclusively from home sleep testing signals, improving diagnostics performance within this specific cardiovascular population.</p><p><strong>Study impact: </strong>The findings demonstrate that artificial intelligence-driven analysis of breathing patterns achieves high concordance with polysomnography for key diagnostic indices, including arousal index, total sleep time and apnea severity via the apnea-hypopnea index. This provides a scalable, precise diagnostic pathway that bypasses the confounding effects of arrhythmias and cardiac medications, facilitating improved management of sleep-disordered breathing in atrial fibrillation patients.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic and racial/ethnic patterns of polysomnography use among children enrolled in Medicaid, 2017-2019.","authors":"Colleen C McLaughlin, Jesse L Hawke, Emily F Boss, Guy M Brock, Meredith M Lind, Tasleem J Padamsee, Prasanth Pattisapu, Deena J Chisolm, Laura J Chavez","doi":"10.1007/s44470-026-00149-w","DOIUrl":"10.1007/s44470-026-00149-w","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this cross-sectional observational study was to describe the geographic distribution of utilization of polysomnography (PSG) among children enrolled in Medicaid/Child Health Insurance Program from 2017 to 2019.</p><p><strong>Methods: </strong>The data source was the Transformed Medicaid Information System (T-MSIS) research analytic files. PSG among children ages 0 to 18 years was identified from the claims data. All children enrolled in Medicaid with at least one service utilization claim formed the denominators for calculation of age-adjusted rates per 10,000 children at the US Census Bureau Division, state and local levels. Geographic patterns were visualized with maps and plots. PSG rates were modeled by Rural-Urban Commuting Area (RUCA) classification and race-ethnicity composition at the ZIP code level. Data quality concerns resulted in exclusion of Rhode Island and Vermont.</p><p><strong>Results: </strong>There were 478,568 PSGs identified among eligible children in the claims data, resulting in a national rate of 50.1 PSGs per 10,000 Medicaid enrolled children per year. There was a fourfold difference in rates at the state level, ranging from 23 PSGs per 10,000 person-years (Kansas) to 93 per 10,000 (Michigan). New England and the Great Lakes regions had the highest local levels, while the Pacific and West South Central divisions had the lowest. ZIP codes with higher percent White population (> 90%) and those in metropolitan areas had the highest PSG rates.</p><p><strong>Conclusion: </strong>This descriptive study of pediatric PSG utilization in the USA can inform efforts to provide more equitable access to PSG and refinement of practice guidelines for referral to PSG.</p><p><strong>Current knowledge/study rationale: </strong>Polysomnography provides a definitive diagnosis for obstructive sleep apnea and other sleep problems. Although there are concerns about variation in access, the utilization patterns of pediatric polysomnography in the USA is unknown.</p><p><strong>Study impact: </strong>At the state level, polysomnography among children enrolled in Medicaid exhibited a fourfold difference in rates. ZIP codes in metropolitan areas and those with a high proportion of White non-Hispanic population had the highest utilization rates. These data can inform consensus among professional groups and healthcare policy researchers to improve equitable utilization.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance and commitment therapy for insomnia: an updated meta-analysis of randomized controlled trials.","authors":"Douglas Barroso, Natanael de Paula Portilho, Alicja Garbacka-Struzik, Diogo Carrazzoni Godoi, Maurício Prätzel Ellwanger, Thaís Pereira Mendes, Vitor Expedito Alves Ribeiro, Victor Gonçalves Soares, Larissa C Hespanhol, Maria Luísa Siegloch, Ibrahim Radi Zahran, Victoria Stadler de Abreu, Helen Michaela de Oliveira, Brandon Peluffo, Eduardo Cerchi, Daniel B Kay, Renatha El Rafihi-Ferreira","doi":"10.1007/s44470-026-00125-4","DOIUrl":"10.1007/s44470-026-00125-4","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effects of acceptance and commitment therapy (ACT) for insomnia compared with waitlist/standard control conditions and cognitive behavioral therapy for insomnia (CBT-I).</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials was conducted. We searched on PubMed, Embase, and the Cochrane Library for studies comparing ACT or ACT-based interventions with non-ACT conditions in patients with insomnia. Continuous outcomes were pooled using a restricted maximum likelihood random-effects model on R.</p><p><strong>Results: </strong>ACT showed moderate-to-large improvement in insomnia symptom severity compared with waitlist/standard controls (SMD - 0.67, 95% CI - 1.08 to - 0.25). We observed no significant difference in insomnia severity between ACT and CBT-I at posttreatment (SMD 0.21, 95% CI - 0.02 to 0.43) or at 6-month follow-up (SMD 0.14, 95% CI - 0.15 to 0.42). CBT-I showed significant improvement in remission (ISI < 8 at posttreatment) compared to ACT at posttreatment (RR 0.81; 95% CI 0.67 to 0.98), but not at follow-up (RR 0.78; 95% CI 0.47 to 1.29). Treatment response rates (> 7-point ISI reduction) did also not differ significantly. Compared with waitlist/standard control, ACT produced a small-to-moderate reduction in depression (SMD - 0.34, 95% CI - 0.57 to - 0.12) and anxiety symptoms (SMD - 0.42, 95% CI - 0.67 to - 0.17).</p><p><strong>Conclusion: </strong>ACT can be an efficacious treatment for insomnia with particularly strong outcomes for its psychological symptoms. Nevertheless, CBT-I remains the gold standard due to its more extensive and consistent evidence base.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric sleep disorders are common and costly: how can we help?","authors":"Sally L Davidson Ward","doi":"10.1007/s44470-026-00152-1","DOIUrl":"10.1007/s44470-026-00152-1","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}