Frontiers in sleep最新文献

{"title":"Real-world reduction in nightmare frequency and distress among San Francisco first responders treated with a prescription wearable device: a 60-day open-label pilot.","authors":"Brian D Robertson, Emily F Wargo, Joel Fay","doi":"10.3389/frsle.2026.1941077","DOIUrl":"10.3389/frsle.2026.1941077","url":null,"abstract":"<p><strong>Objective: </strong>Nightmares are a common, distressing condition among individuals with post-traumatic stress disorder (PTSD) and are associated with impaired sleep quality and elevated suicide risk. First responders carry a substantial burden of occupational trauma and PTSD yet are under-represented in nightmare-treatment research. NightWare is an FDA-authorized prescription wearable that monitors heart rate and movement during sleep and delivers vibrotactile feedback intended to interrupt nightmares and improve sleep quality. We evaluated the real-world response to NightWare among San Francisco first responders.</p><p><strong>Methods: </strong>First responders (law enforcement and fire service) prescribed NightWare in routine clinical care completed structured self-report assessments at Day 0, 30, and 60. First responders were aged 35-65, half were male and half were female. They had a PTSD diagnosis and at least 3 nightmares per week. The co-primary endpoints were nightmare frequency (self-reported nights with nightmares per week, 0-7) and nightmare-related distress (5-point ordinal scale, 0-4). Change was assessed with paired <i>t</i>-tests (with Cohen's d) and one-way repeated-measures analysis of variance (RM-ANOVA).</p><p><strong>Results: </strong>Of 11 first responders who initiated treatment, 10 (91%) completed all assessments. Mean nightmare frequency decreased from 5.2 to 3.6 nights/week [mean change -1.6; 95% CI -2.7 to -0.5; <i>t</i> ₍₉₎ = -3.21, <i>p</i> = 0.011; <i>d</i> = 1.0] and mean distress decreased from 2.9 to 1.3 [mean change -1.6; 95% CI -2.2 to -1.0; <i>t</i> ₍₉₎ = -6.00, <i>p</i> = 0.0002; <i>d</i> = 1.9]. RM-ANOVA confirmed a significant decline across the three time points for both endpoints (frequency <i>p</i> = 0.009; distress <i>p</i> = 0.003). Seven of ten reduced nightmare frequency and nine of ten improved on distress; no participant worsened on either measure. Self-reported sleep quality and treatment satisfaction improved. The participants in this survey used the NightWare device a mean of 76% of nights (45.6 days of the 60-day survey time period). The range of usage was 55-100% (33-60 days) of the study nights.</p><p><strong>Conclusions: </strong>In this small, open-label, real-world pilot, treatment with NightWare was associated with clinically meaningful reductions in nightmare frequency and distress and high patient acceptability among first responders. These findings are hypothesis-generating; controlled studies with validated instruments are warranted.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1941077"},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between sleep duration and co-existing chronic conditions in adults: insights from the 2017-2018 Canadian Community Health Survey.","authors":"Shirmin Bintay Kader, Jubayer Mumin, Nahin Shakurun, Sumsun Nahar Zinia, Zoe Schipper, Nusrat Sharmin Ritu, Sheikh Ahmedul Haque, Md Marufur Rahman","doi":"10.3389/frsle.2026.1714511","DOIUrl":"10.3389/frsle.2026.1714511","url":null,"abstract":"<p><strong>Background: </strong>Sleep duration plays a crucial role in overall health, with far-reaching implications for individuals globally. Although research has extensively explored the association between sleep and chronic conditions, few studies have investigated the association between multiple co-existing chronic conditions on sleep duration. This study examines the association between sleep duration and the prevalence of chronic conditions in the Canadian adults from four provinces and two territories.</p><p><strong>Methodology: </strong>Canadian Community Health Survey (CCHS) 2017-2018, a population-based cross-sectional survey, was used for this study. The outcome variable, sleep duration, was assessed based on the question \"Number of hours per night usually spent sleeping?\" and categorized into three groups: \"In between 7 and 9 h,\" \"Short sleep duration (< 7 h),\" and \"Long sleep duration (>9 h).\" The primary predictor, chronic conditions, was aggregated with a response of \"yes\" and subsequently categorized into no chronic condition, one chronic condition, two chronic conditions, and three or more chronic conditions, based on 12 recorded chronic conditions.</p><p><strong>Results: </strong>Approximately 41% of respondents reported short sleep duration, while 7.73% reported long sleep duration. Compared with respondents with fewer or no chronic conditions, those with three or more co-existing chronic conditions had significantly higher odds of reporting abnormal sleep duration. Specifically, respondents with three or more chronic conditions were 1.70 times more likely to report short sleep duration (95% CI: 1.52-1.91) and 2.58 times more likely to report long sleep duration (95% CI: 1.96-3.41). The odds of both short and long sleep duration increased progressively with a higher number of chronic conditions, indicating a graded association between chronic conditions and abnormal sleep duration.</p><p><strong>Conclusion: </strong>The study underscores a strong association between the number of chronic conditions and sleep duration among adults, highlighting that multimorbidity is associated with abnormal sleep patterns.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1714511"},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and effectiveness of a clinical model of sleep education for children with IDD: a record review.","authors":"Beth A Malow, Kasey A Fitzpatrick, Whitney A Loring","doi":"10.3389/frsle.2026.1937989","DOIUrl":"10.3389/frsle.2026.1937989","url":null,"abstract":"<p><strong>Introduction: </strong>This study was undertaken to evaluate the effectiveness and feasibility of implementing a brief community-based sleep education intervention within a collaborative clinical in academic medical setting for children with intellectual and developmental disabilities.</p><p><strong>Methods: </strong>Record reviews were conducted from a behavioral sleep clinic serving children with IDD (age ≤ 18 years). Sixty-five children and caregiver received individualized insomnia recommendations. A follow-up visit occurred 1-3 months later. Clinical notes were evaluated using a modified Pediatric Sleep and Autism Clinical Global Impressions Scale to assess effectiveness and feasibility.</p><p><strong>Results: </strong>At first follow-up, 85% of caregivers reported compliance with recommendations; 85% of whom reported significant sleep improvement. Only 20% of non-compliant families reported improvement. Compliance at first follow-up was significantly associated with improvement in insomnia (Pearson chi-square and Fisher's exact test <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>Brief collaborative sleep education interventions are feasible and effective for improving insomnia in most children with IDD.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1937989"},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EEG correlates of sleep stages, sleep discrepancy, and insomnia: a comparative analysis of people with insomnia and healthy sleepers using spectral power and sample entropy.","authors":"Joseph T LeCheminant, Daniel B Kay, Brent Feland, Chongming Yang, Jonathan Blotter","doi":"10.3389/frsle.2026.1882890","DOIUrl":"10.3389/frsle.2026.1882890","url":null,"abstract":"<p><p>This study investigated neurophysiological differences between individuals with and without insomnia across sleep stages and sleep discrepancy conditions using electroencephalography (EEG). EEG band powers (Delta, Beta) and entropy metrics (Sample Entropy and Multiscale Sample Entropy) were analyzed from each epoch of overnight polysomnography in 64 participants. Linear mixed-effects modeling was used to examine the influence of insomnia status, sleep stage, and electrode location on these EEG metrics. Results indicated that the EEG metrics were strongly correlated with physiological sleep stages but did not effectively distinguish self-reported sleep perception within the same polysomnographic sleep stage. Additionally, these metrics did not consistently differentiate individuals with insomnia from good sleeper controls across all conditions. Rather, individuals with insomnia exhibited regional patterns of Delta power during wakefulness, increased sample entropy during REM sleep, and decreased Beta power during positive discrepancy. These findings highlight physiological features associated with sleep stages, insomnia, and sleep discrepancy while emphasizing their complexity and the limitations of standard EEG metrics alone. Future work integrating physiological measures with self-report data may provide enhanced characterization of insomnia-related neurophysiological changes.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1882890"},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of electronic gadget usage, sleep quality & daytime sleepiness with working memory in Indian young adults.","authors":"Ishan Gupta, Nasreen Akhtar","doi":"10.3389/frsle.2026.1707437","DOIUrl":"10.3389/frsle.2026.1707437","url":null,"abstract":"<p><strong>Aim: </strong>To assess the correlation of screen time, daytime sleepiness and quality of sleep with working memory in young adults.</p><p><strong>Methods: </strong>A cross sectional study of 119 young adults of the age group 18-30 years, who were administered a structured online questionnaire which collected details pertaining to basic socio denographic data, record of sleep wake activity and study habits, electronic gadget usage, working memory, as well as the standardized questionnaires Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (LSS).</p><p><strong>Results: </strong>Poor sleep quality which is indicated by a global PSQI score of more than was noted in 72/114 (6.3%) young adults Correlation of ISS score with working nomory was statistically significant with spearman's cho of 8.2607 The fitted regression model on multiple linear regression was: Working memory 68.8 0.779 (daily average screen time) + 8.55% (global PSQT score) 0.47 (ESS score) with the overall model being statistically significant [R28.073, Γ (3, 110)2.88, <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Increased daytime sleepiness is correlated with a worse working memory among.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1707437"},"PeriodicalIF":2.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the apnea-hypopnea index: a call to action for a multidimensional evaluation in obstructive sleep apnea.","authors":"Peter C Gay, Luigi Taranto-Montemurro, Lenise J Kim, Ali Azarbarzin","doi":"10.3389/frsle.2026.1881431","DOIUrl":"10.3389/frsle.2026.1881431","url":null,"abstract":"<p><p>Obstructive sleep apnea (OSA) is a highly heterogeneous chronic disease, in which the conventional measure of disease severity, the apnea-hypopnea index (AHI), correlates poorly with patient-reported symptoms and inconsistently with cardiovascular outcomes. The present perspective proposes an initial discussion of a new concept for multidimensional evaluation of patients with OSA that integrates both objective measures of upper airway obstruction (AHI) and chronic intermittent hypoxia (hypoxic burden), along with subjective assessments of nighttime and daytime symptoms burden including snoring, subjective sleep quality, daytime sleepiness, fatigue, and quality of life. This integrated approach aims to improve characterization of patients and guide more individualized therapeutic goals, including improvements in quality of life and reduction in cardiovascular and metabolic consequences. It also supports a call to action in the OSA field, encouraging the development of a more comprehensive assessment of treatment response and clinical meaningfulness in OSA.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1881431"},"PeriodicalIF":2.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polysomnographic characteristics of excessive daytime sleepiness in postmenopausal women with obstructive sleep apnea.","authors":"Thanida Manitchotpisit, Pansak Sugkraroek, Charnsiri Segsarnviriya, Naricha Chirakalwasan, Mart Maiprasert","doi":"10.3389/frsle.2026.1853970","DOIUrl":"10.3389/frsle.2026.1853970","url":null,"abstract":"<p><strong>Introduction: </strong>Excessive daytime sleepiness (EDS) in obstructive sleep apnea (OSA) is linked to adverse cardiometabolic and safety outcomes, but established correlates may not apply to postmenopausal women. Data on polysomnographic determinants of EDS in this group remain limited. We examined associations between polysomnographic parameters and EDS and identified key parameters that may help discriminate EDS in postmenopausal women with OSA.</p><p><strong>Methods: </strong>In this retrospective cross-sectional study, 216 postmenopausal women with OSA, confirmed by Level 1 polysomnography (PSG), were classified as having EDS based on the Epworth Sleepiness Scale (ESS 10; <i>n</i> = 110) or as non-EDS (ESS < 10; <i>n</i> = 106). Polysomnographic variables were compared, and multivariable logistic regression was used to build a polysomnographic multivariable model.</p><p><strong>Results: </strong>Women with EDS were younger and had higher BMI and neck circumference than those without EDS (<i>p</i> < 0.05). Higher respiratory disturbance index (RDI) values (total, supine, REM, and NREM) and lower minimum oxygen saturation were independently associated with EDS. A four-variable model (RDI, REM RDI, mean, and minimum oxygen saturation) showed moderate discrimination (AUROC 0.693).</p><p><strong>Discussion: </strong>EDS was more frequent among women with greater respiratory burden and worse nocturnal hypoxemia. Future studies using multidimensional data may improve model performance and clinical applicability.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1853970"},"PeriodicalIF":2.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13549838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized comfort settings in positive airway pressure machines using a causal inference approach: a retrospective observational analysis.","authors":"Chinh Nguyen, Himani Jayawardane, Hussein Emami, Nathan Liu, Bhavana Achary, Jeff Armitstead, Alison Wimms","doi":"10.3389/frsle.2026.1883557","DOIUrl":"10.3389/frsle.2026.1883557","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate whether data-driven personalization of positive airway pressure (PAP) comfort settings improves adherence by developing and evaluating a causal machine learning (ML) model for individualized recommendations.</p><p><strong>Methods: </strong>The model was developed using AirSense 10 data and independently validated in temporally separated AirSense 10 and AirSense 11 cohorts, including 90-day and 1-year follow-up. The primary outcome was Centers for Medicare & Medicaid Services (CMS)-defined PAP adherence (device usage ≥ 4 h/night on ≥ 70% of nights during the first 90 days). Group-level average treatment effect (ATE) was estimated using backdoor adjustment methods. A causal forest model was applied to estimate the conditional average treatment effect for recommending personalized settings. A propensity score-matched analysis compared outcomes between patients whose actual settings matched model recommendations vs. those remaining on device default settings.</p><p><strong>Results: </strong>The model estimated ATE at the group level was 2.9 percentage points (p < 0.001), indicating that personalized settings were associated with improved CMS adherence. Covariate balance was achieved (standardized mean difference < 0.1), and model calibration was strong (expected calibration error 0.91%). Patients whose actual PAP settings matched the model-recommended configuration had higher device usage than matched controls who remained on default settings. Subgroup analyses confirmed consistent benefits across age groups, gender, apnea-hypopnea index, and mask type. SHapley Additive exPlanations analysis identified minimum pressure, start pressure and age as key drivers of personalization. Independent validation showed sustained usage benefits across AirSense 10 and AirSense 11 cohorts, with residual AHI remaining below the clinical reference threshold and no clinically meaningful deterioration in mask leak.</p><p><strong>Discussion: </strong>Causal ML-based personalization of PAP comfort settings was associated with improved CMS adherence/device usage. Integration of comfort setting personalization into setup workflows may enhance PAP therapy usage. As a retrospective observational analysis, these findings are associative and hypothesis-generating; the causal-inference framework, refutation testing, and large-scale independent validation provide robustness beyond that of conventional observational studies, although prospective randomized evaluation remains the definitive next step.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1883557"},"PeriodicalIF":2.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seafarer Fatigue: a qualitative study of customer-facing staff working on UK ferries.","authors":"Sally Maynard, Wendy Jones, Adam Asmal, Anna Anund, Andrew Pooley, Ashleigh Filtness","doi":"10.3389/frsle.2026.1906714","DOIUrl":"10.3389/frsle.2026.1906714","url":null,"abstract":"<p><strong>Introduction: </strong>This study explores the experiences and opinions of customer-facing seafaring staff on the subject of fatigue and how it affects their work and interactions with passengers. This group is of particular interest as were there to be an emergency at sea it is those in customer-facing roles that would take responsibility for passenger safety.</p><p><strong>Methods: </strong>Data was collected from focus groups with customer-facing staff (n = 45 participants across nine discussions).</p><p><strong>Results: </strong>Fatigue was seen to be a problem, with all focus group participants having experienced sleepiness while at work and being able to detect fatigue in others. Factors identified as contributors to fatigue included: commuting, external factors such as the weather and onboard noise and shift and roster patterns. A variety of informal, self-devised (that is, not directed by a manager) countermeasures were being employed by the focus group participants, with caffeine in the form of coffee being the most common. Participating seafarers suggested that adrenaline carries them through emergency situations so that fatigue experienced after an incident was more of a concern to them than that encountered during it.</p><p><strong>Discussion: </strong>The research represents one of the first qualitative studies to subjectively investigate fatigue amongst customer-facing staff on UK ferries, understanding their lived experience is a first step toward mitigating sleep related risks for this job role. Recommendations for ferry operating companies are made.</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1906714"},"PeriodicalIF":2.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13556293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring nightly variability in sleep apnea and changes in severity classification with multi night sleep testing in a population based cohort of young children.","authors":"Solveig Magnusdottir, Ingibjorg Ingolfsdottir, Hugi Hilmisson, Laufey Hrolfsdottir, Magnus Birkisson, Erla Hallgrimsdottir, Groa Johannesdottir, Hannes Petersen","doi":"10.3389/frsle.2026.1903809","DOIUrl":"10.3389/frsle.2026.1903809","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is typically evaluated with single-night sleep studies. In adults, night-to-night variability (NtNV) is well documented, but less so in children. The current study evaluated NtNV in apnea events for misclassification in disease severity in young children to investigate if multi-night sleep-recordings may be clinically relevant to improve diagnostic accuracy and affect treatment decisions.</p><p><strong>Methods: </strong>Parents/guardians of healthy 4-9-year-old children participating in a study to evaluate prevalence of OSA were asked to record the child's sleep for up to 5-nights. This analysis is from children who completed three consecutive night sleep recordings.</p><p><strong>Results: </strong>Average age of participants was 6.1 years (<i>n</i> = 200, 58.0%-girls/42.0%-boys), prevalence of overweight/obesity was 25% and moderate-severe-OSA (AHI_3% ≥ 5) based on single-night testing protocol was 29.0%. Using the highest AHI_3% value from the three recordings, the first-night correctly identified 57.0% of participants and adding a second night identified 86.0% of participants, with 14% of participants not identified until the third night of sleep testing.Bland-Altman plots (BA_plots) demonstrated non-statistically significant mean-differences and 95% upper and lower-limits (LOA_95%) close in absolute terms night-one/night-two; -0.024 events/hour-of-sleep LOA_95% [-5.062, 5.013], 8.0% of observations outside the LOA_95% (<i>p</i> = 0.894) and night-two/night-three; -0.009 events/hour of sleep, LOA_95% [-5.227, 5.209] and 6.0% of observations outside LOA_95%, (<i>p</i> = 0.9620).The intra-class correlation coefficient (ICC) for AHI_3% for all 3 nights was 0.45 [0.37, 0.54], <i>p</i> < 0.001, for night-one/night-two (0.44; <i>p</i> < 0.001), and night-two/night-three (0.44; <i>p</i> < 0.001). Cohens Kappa (0.304-0.462) and Brennan-Prediger Kappa (0.403-0.490), respectively indicated low-to-moderate interrater agreement, with quadratic-weighted Cohen's Kappa for the four ordinal severity categories of 0.37 and 0.48 for the two night-pairs, demonstrating NtNV, which is consistent with the variability demonstrated by the BA_plots.</p><p><strong>Conclusion: </strong>Observed NtNV in apnea events affected severity categorization, suggesting that multi-night sleep testing may have clinical value and improve accuracy of sleep apnea evaluation in young children.</p><p><strong>Clinical trial registration: </strong>URL: clinicaltrials.gov/study/NCT05479201, identifier NCT0547920 .</p>","PeriodicalId":73106,"journal":{"name":"Frontiers in sleep","volume":"5 ","pages":"1903809"},"PeriodicalIF":2.0,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}