Sleep problems affect a substantial proportion of individuals, and negative thoughts, rumination, and worry are considered key factors underlying persistence and severity. While extensive research has examined how these states disrupt sleep before falling asleep, much less is known about how mental concepts, including thoughts, expectations, intentions, and emotions, continue to influence sleep during sleep itself. Likewise, the potential benefits of sleep-promoting mental concepts during sleep remain underexplored. Here, we propose the Mental Concept Reactivation (MCR)-Hypothesis of Sleep, suggesting that mental concepts activated before sleep continue to influence sleep by spontaneous reactivations during sleep. Drawing on appraisal theories of emotion and evidence for endogenous memory reactivation, the hypothesis rests on three core premises. First, mental concepts relevant to sleep are activated during the day and particularly before bedtime. Second, these pre-sleep appraisals undergo spontaneous reactivations during sleep, with the intensity depending on their self-relevance. Third, these reactivations affect subjective restoration and objective sleep parameters. We present research supporting our hypothesis, particularly focusing on studies from our lab that began to systematically test key aspects of the MCR-Hypothesis and discuss limitations, alternative explanations, and open questions. Overall, the MCR-Hypothesis offers a testable framework for understanding how cognitive and emotional mental concepts influence sleep during this state. It may help to explain interindividual differences in sleep reactivity to stress, worry, and pre-sleep expectations. It offers a theoretical basis for developing non-pharmacological interventions aimed at reducing maladaptive mental concepts and strengthening beneficial ones, enhancing sleep quality in both clinical and non-clinical populations.
Daytime sleepiness and excessive sleep are frequent symptoms. When these symptoms are recognized, they are often attributed to comorbid depression or, following ambulatory screening, to obstructive sleep apnea (OSA). While OSA affects 20-50% of the population, more frequently in men, its contribution to sleepiness in the general population is modest, and subjective sleepiness shows stronger associations with depression, insufficient sleep, and shift work. As a result, mild OSA in the presence of sleepiness is often overtreated. Further, stimulants are used as adjunct therapy in depression despite limited evidence. When referred to sleep disorder specialists, after exclusion of OSA, these patients are typically evaluated using a daytime nap test, the Multiple Sleep Latency Test (MSLT). The MSLT is used to diagnose Narcolepsy or Idiopathic Hypersomnia. Problematically, the MSLT performs well only to confirm narcolepsy type 1, a disorder with cataplexy and caused by orexin deficiency. A high false positive rate occurs in the absence of cataplexy, leading to questionable diagnoses of narcolepsy type 2 and idiopathic hypersomnia. A return to four historical subtypes of central nervous system hypersomnolence independent of MSLT testing is proposed. Narcolepsy Type 1: cataplexy, refreshing naps, sleep-onset REM periods. It is caused by orexin deficiency, responds to oxybate, antidepressants, stimulants, and low dose orexin receptor 2 agonists (in development). Narcolepsy-like hypersomnolence: Irresistible sleep attacks with short, refreshing naps. Insufficient Sleep must be excluded. It is often responsive to modafinil. Idiopathic Hypersomnia with sleep inertia and unrefreshing sleep: Excessive sleep amounts, severe sleep inertia, and long, unrefreshing naps. Association with psychiatric comorbidities, notably resolved depression, is frequent. Sodium oxybate can be transformative. Kleine-Levin Syndrome: periodic extreme hypersomnia with apathy and derealization. Responds to lithium in ∼50% of cases. A pathophysiological overlap with bipolar disorder is likely. A greater collaboration between psychiatry and sleep medicine is needed considering the emergence of orexin receptor agonists as potential therapies for hypersomnia.
Sleep disturbances are prevalent after acquired brain injury and negatively affect quality of life. Sensory hypersensitivity may cause or exacerbate sleep disturbances, yet evidence on this relationship after acquired brain injury is lacking. The aim of this study was to investigate the hypothesised positive relationship between the severity of sleep disturbances and sensory hypersensitivity after acquired brain injury. In a cross-sectional study, 556 individuals with acquired brain injury (e.g., stroke, traumatic brain injury and meningioma) completed the Insomnia Severity Index (ISI) to assess the severity of sleep disturbances, and the Multi-Modal Evaluation of Sensory Sensitivity (MESSY) to assess sensory hypersensitivity as part of an online survey. Associations between the severity of sleep disturbances, core insomnia symptoms (i.e., difficulty initiating sleep, maintaining sleep and problems with waking too early), sensory hypersensitivity, and hypersensitivity for individual sensory modalities (i.e., visual, auditory, tactile, olfactory, gustatory, motion and temperature) were analysed using bivariate and multivariate linear regression. Greater sensory hypersensitivity was associated with more severe sleep disturbances (β = 0.47, p < 0.001), explaining 24% of the variance. Greater severity across the core insomnia symptoms was associated with increased sensory hypersensitivity (ρ = 0.33-0.40, p < 0.001). Hypersensitivity in all sensory modalities was related to more severe sleep disturbances (β = 0.19-0.41, p < 0.001). These findings support a robust association between sensory hypersensitivity and the severity of sleep disturbances in individuals with acquired brain injury. The results stress the importance of assessing sleep disturbances and sensory hypersensitivity after acquired brain injury. Longitudinal and multimodal research is warranted to elucidate causal mechanisms and inform treatment strategies.
A common misconception is that, with age, cognition deteriorates across all domains. Instead, certain aspects are negatively impacted, while others are relatively spared, or, continue to improve. Specifically, fluid intelligence (i.e., problem-solving skills) peaks in early adulthood and declines, whereas crystallized intelligence (i.e., ability to use and remember facts) increases into older age. Sleep supports cognition, but, sleep quality/quantity are reduced with age. It is unknown how age-related differences in sleep contribute to the preservation or decline of different domains of intelligence. Here, we investigated if sleep quantity/quality were associated with the trajectories of fluid and crystallized intelligence with age. In Study 1, N = 12,182 participants completed a sleep questionnaire and the Cambridge Brain Sciences (CBS) cognitive test battery. In Study 2, 60 healthy adults underwent polysomnographic recording, 10 days of actigraphy and the CBS tests. In Study 1, subjective sleep assessments from the general population revealed that crystallized intelligence was preserved whereas fluid intelligence declined as a function of age. However, sleep did not account for these different trajectories. In Study 2, objective sleep assessments in a sample of very healthy individuals, revealed the opposite pattern; crystallized intelligence declined, whereas fluid intelligence was relatively preserved. Age-related differences in total sleep time, wake after sleep onset, the regularity and strength of the sleep-wake cycle accounted for the different trajectories of crystallized and fluid intelligence. Thus, controlling for confounding variables and using objective sleep assessments shows that regular, higher-quality sleep is protective for fluid intelligence with increasing age.
The rising incidence of chronic lung disease (CLD) has emerged as a critical health problem. While numerous studies have explored lifestyle factors contributing to CLD, the critical role of sleep remains understudied. This cohort study aimed to assess the association between night sleep duration and incidence of CLD through a 9-year follow-up survey: 10527 participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS), and the data on incident CLD from the 2011 baseline survey and four subsequent follow-up waves were analysed statistically. Night-time sleep duration was categorized into three groups: short (< 7 h per night), optimal (7-9 h), and long night-time sleep duration (> 9 h). We used multivariate Cox regression modelling to examine the effect of baseline night sleep duration on the onset of CLD. After the 9-year follow-up, the incidence of CLD in participants with short, optimal, and long night-time sleep duration was 17.71, 13.76 and 19.76/1000 person-years, respectively. Compared with individuals with optimal night sleep duration, individuals with short night sleep duration had a 26.3% higher risk of developing CLD (HR: 1.263, 95% CI: 1.136-1.404), and those with long night sleep duration had a 39.0% higher risk of developing CLD (HR: 1.390, 95% CI: 1.095-1.764). Longer or shorter night sleep duration is associated with an increased risk of developing CLD. Maintaining an optimal night-time sleep schedule may help reduce the risk of CLD in middle-aged and older adults.
Previous research has extensively investigated the impact of post-training sleep and wakefulness on procedural memory consolidation across development. However, results regarding how offline processes specifically affect the explicit and implicit components of newly acquired procedural skills in children and adults remain controversial. To address this issue, we investigated differences between 42 children (9.7 ± 1.8 years) and 58 young adults (21.7 ± 2.5 years) in the consolidation and explicit knowledge of a visuo-motor sequence learned in a Serial Reaction Time Task. Participants were assigned to either a nocturnal sleep or a daytime wakefulness offline interval condition between learning and retest (~11 h). Offline (between-session) and online (within-session) performance changes were assessed, and explicit sequence knowledge was quantified using the Process Dissociation Procedure (PDP). Results showed similar offline performance improvements in the two age groups and offline interval conditions. PDP results revealed that children had higher explicit knowledge of the sequence as compared to adults, irrespective of the offline interval condition. Furthermore, children exhibited a shift from online performance deterioration to online performance improvements that was consistent across sleep and wake conditions. The absence of a differential impact of sleep versus wakefulness intervals suggests that time-dependent mechanisms primarily drive procedural memory consolidation and the development of stronger related explicit knowledge in children. Our findings also highlight a developmental dissociation between the offline consolidation of procedural learning skills, which appears age-invariant and the resulting explicit knowledge, which developed more strongly in children.
Maternal sleep deprivation (MSD) is a common but usually unnoticed issue during pregnancy, and in recent years, it has been increasingly recognised as an important prenatal stressor that may adversely influence maternal physiology, placental function, and fetal neurodevelopment. Sleep disturbances during pregnancy, including reduced sleep duration, fragmented sleep, poor sleep quality, circadian disruption, and rapid eye movement sleep restriction, have been associated with altered hypothalamic-pituitary-adrenal axis activity, systemic inflammation, oxidative stress, and impaired circadian regulation. Emerging evidence from clinical and preclinical studies suggests that these alterations may affect fetal neurogenesis, synaptic development, neuroimmune signaling, and maturation of brain circuits involved in cognition and emotional regulations. Within the framework of the Developmental Origins of Health and Disease, maternal sleep disturbances may contribute to epigenetic modifications, mitochondrial dysfunction, microglial activation, and altered neuroplasticity-related pathways, which are increasingly implicated in long-term neurological vulnerability. Experimental findings further indicate that prenatal sleep disruption may impair offspring cognitive performance, emotional behavior, and stress responsiveness, while potentially influencing biological pathways associated with brain aging-related processes. However, the extent to which MSD directly contributes to pathological brain aging in humans remains incompletely understood. Factors such as timing and duration of exposure, sex-specific responses, and postnatal environmental conditions may further influence offspring outcomes. Therefore, this narrative review critically summarizes current evidence regarding MSD and examines the molecular, cellular, and neurodevelopmental mechanisms through which prenatal sleep disturbances may influence long-term neurological health and vulnerability to brain aging-associated alterations in offspring.This graphical abstract illustrates the mechanistic framework connecting maternal sleep deprivation to the developmental programming of brain aging in offspring. [ MSD: maternal sleep deprivation; DOHaD: Developmental Origins of Health and Disease; 11β HSD2: 11β hydroxysteroid dehydrogenase type 2; ROS: reactive oxygen species; REM: rapid eye movement; HPA axis: hypothalamic pituitary adrenal axis; BDNF: brain derived neurotrophic factor].
With the ever-increasing globalizing of aging, chronic comorbidity has become both common among the old population. The senile comorbidities pose as notable challenges of escalation of medication and medical expenditures, and loss in the quality of life of the mature patients. The increase in medication literacy would help reduce the land of unsafe drug administration, unfavorable feelings, and also improve the treatment rates among persons. But there is variation in the rate of medication literacy among the older adults living with varying comorbidities of chronic diseases. Thus, this paper utilizes latent profile analysis to segment medication literacy in this population group in an attempt to clarify the features that accompany medication Literacy among the older adults who with the presence of chronic comorbidities. Additionally, it discusses factors that contribute to medication literacy when using different types of chronic conditions, hence developing theoretical underpinnings to the upcoming individualized medication literacy interventions programs as per older adults patients with chronic comorbidities. The study is a cross-sectional study of 611 hospitalized patients over the age of 60 years with chronic comorbidities through Grade III hospitals in Shizuishan City in the period between January, 2024 and March, 2024 using the convenience sampling method. The General Data Scale, the Medication Literacy Scale among the Elderly Patients with Chronic Diseases, the Self-perceived Burden Scale and the Technophobia Scale were used to collect information. Latent profile analysis (LPA) disclosed that medication literacy of the older adults patients with chronic diseases could be classified into four different groups namely; high medication literacy (17.02%), medication Literacy-low critical type (38.13%), medication Literacy-high critical type (31.26%), and low medication Literacy (13.58%). Influential factor analysis showed that drinking history, educational level, marital status, occupational status, personal monthly income, family location, caregiver involvement, living style, type of medical insurance, daily exercise time, time duration of disease, number of hospitalizations in the past year, personal view of sleep status, age, and self-perceived burden, technophobia, had significant impact among the varied category of chronic disease patients in terms of medication literacy (p < 0.05). Medication literacy among chronic comorbidity patients is largely heterogeneous. It is advised that clinicians should do more specific interventional programs based on the nature of different levels of medication literacy to achieve better medication literacy rates within this category of population to improve treatment effects.
Psychoneurological symptom clusters (PNSCs) are common in patients with ovarian cancer and are associated with reduced quality of life, treatment interruption, and poor prognosis. However, effective interventions for PNSCs remain limited. Traditional Chinese medicine may provide comprehensive benefits for symptom management. This study aims to evaluate the efficacy and safety of the TiaoShenZhiAi (TSZA) regimen in alleviating PNSCs in patients with ovarian cancer and to assess its effects on quality of life and survival outcomes. A total of 316 patients with ovarian cancer aged 18 to 70 years with PNSCs will be included and randomly divided into 2 parallel groups. Both groups will receive standard treatment for ovarian cancer as the basic treatment. The intervention group will receive the TSZA regimen, that is, Compound Ciwujia Granules (containing Acanthopanax senticosus and Schisandra chinensis) combined with psychological intervention. The control group will receive a low-dose active control (simulated Compound Ciwujia Granules) combined with psychological intervention. The primary outcome is the remission rate of PNSCs at 3 months. The secondary outcome measures include the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the revised Piper Fatigue Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 Quality of Life Scale, the traditional Chinese medicine syndrome scale, sleep quality, sleep diary, and the 1-year survival analysis. In addition, this study also includes a series of exploratory indicators (including functional magnetic resonance imaging, biomarkers of peripheral blood and tumor tissue, proportion of immune cells, cytokine levels, hypothalamic-pituitary-adrenal axis function, and immune gene expression analysis) and safety indicators (including vital signs, liver and kidney function, and electrocardiogram). The study outcomes will be evaluated based on different indicators during the treatment period (baseline and the 1st, 2nd, and 3rd mo of enrollment) and the follow-up period (the 6th, 9th, and 12th mo of enrollment). Data analysis will be conducted using R (version 4.5.3) software. A one-sided P value of <.03 will be considered statistically significant. This study is designed to enroll a total of 316 participants. Participant enrollment is set to commence in October 2025, with no recruitment having occurred as of April 2026. The recruitment period will extend until September 2028 or until the target enrollment is met. Data analysis is scheduled for November 2028, with submission of the trial results to a peer-reviewed journal anticipated by May 2029. This study will evaluate the efficacy of the TSZA regimen in managing PNSCs in patients with ovarian cancer and generate clinical evidence for a new therapeutic option that improves quality of life and alleviates the symptom burden.
Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder characterized by repeated upper airway obstruction during sleep, leading to poor sleep quality, excessive daytime sleepiness, and reduced psychosocial functioning. Obesity is a major risk factor that increases both the likelihood and severity of OSA, further affecting physical and mental health. Although continuous positive airway pressure (CPAP) is the standard treatment, alternative non-pharmacological approaches such as Pilates and myofunctional therapy may provide additional benefits. This study aimed to evaluate the effectiveness of combining Pilates and myofunctional therapy in improving sleep quality and psychosocial well-being in an individual with obesity-associated OSA. A case study was conducted in a clinical rehabilitation setting involving a 45-year-old male diagnosed with moderate OSA (Apnea-Hypopnea Index = 25) and obesity (BMI = 34 kg/m²). The participant completed an 8-week intervention program consisting of Pilates and myofunctional therapy, each performed for 30 minutes, three times per week. Outcome measures included the Pittsburgh Sleep Quality Index (PSQI) and the Short Form-36 (SF-36), which assessed physical health, mental health, and vitality. Pre- and post-intervention scores were compared. Post-intervention results demonstrated improvements in both sleep quality and quality of life. The PSQI score decreased from 7 to 4. SF-36 scores improved in physical health (55 to 68), mental health (48 to 62), and vitality (60 to 68). The participant also reported reduced daytime sleepiness, better mood, enhanced social interaction, and increased confidence. The findings suggest that combining Pilates and myofunctional therapy may be a useful non-pharmacological strategy to improve sleep and psychosocial outcomes in individuals with obesity-associated OSA.
Specific brain oscillations can be manipulated during sleep to improve sleep quality and memory performance. We previously demonstrated that continuous rocking stimulation (0.25 Hz, lateral movement) applied to good sleepers during sleep enhanced stable deep sleep, boosted NREM oscillations (spindles and slow waves) and memory consolidation. Here, we investigated whether nocturnal rocking could benefit individuals suffering from sleep difficulties. We recruited 16 young adults with subjective difficulties initiating and/or maintaining sleep and who presented with objective poor sleep quality. After a habituation night, each participant spent two nights of sleep at the laboratory, one rocking and one stationary, during which we assessed sleep and declarative memory consolidation. We found that a whole night of gentle rocking in individuals with poor sleep decreased sleep fragmentation, time spent awake and in light sleep (N1), with an associated increase in objective sleep efficiency and subjective sleep quality. Additionally, we replicated the neural entrainment or synchronising effect of the rocking motion, yielding a boost in NREM fast spindles and slow oscillations. Yet, these changes in sleep did not modulate overnight memory performance. By alleviating some difficulties encountered in this population of poor sleepers, these findings provide preliminary evidence that rocking may represent an alternative or complementary intervention for the management of some forms of chronic insomnia.
Sleep paralysis (SP) is a REM sleep parasomnia characterized by transient motor paralysis during sleep onset or awakening. It is a terrifying experience often accompanied by vivid hallucinations. Although it is classically linked to narcolepsy, isolated SP in healthy individuals offers a valuable model to investigate the interaction between REM sleep physiology and conscious awareness. In a sample of 210 adults from the Italian population, we examined the prevalence, phenomenology and cognitive-emotional landscape of SP. Importantly, this study provides preliminary evidence to integrate measures of interoception to investigate how body awareness might influence this experience. One out of four participants reported at least one episode of SP. The most common sensations echoed REM physiology, including the inability to move or speak, tingling and sealed eyelids. However, despite this paralysis, the mind conjured up vivid cognitive scenes and the felt presence of another being, as well as an overpowering fear of death. Contrary to earlier findings, SP was not tied to poorer sleep quality or chronic anxiety. Instead, it was associated with insomnia symptoms and hyper-attuned body awareness. Individuals experiencing SP showed greater interoceptive sensitivity, noticing subtle bodily cues and regulating attention and emotion through them. This convergence between sleep physiology and interoceptive awareness suggests that SP may emerge where the boundaries among body, sleep and consciousness become blurred, a dissociated state in which REM-related atonia coexists with preserved or re-emerging conscious awareness. These findings suggest potential avenues of interoception as a target for future investigations into parasomnias.
Mounting evidence shows sex-based differences in sleep experiences and outcomes, including the prevalence of insomnia disorder. However, the impact of biological sex on brain oscillations during sleep remains poorly understood, especially in the context of insomnia disorder. This is a notable gap, given that neurophysiological aspects of sleep are associated with brain health and overall sleep quality. We systematically reviewed and meta-analysed data from studies reporting spindle and slow wave activity in adults with and without insomnia disorder. We conducted systematic searches in PubMed, Embase, Scopus, and PsycInfo. Risk of bias was evaluated using the Newcastle Ottawa and the PEDro scales. Forty-three studies met our inclusion criteria, with thirteen studies of normal sleepers (N = 668) reporting sufficient data for random-effects meta-analyses. Compared with males, female normal sleepers had higher spindle density, sigma and delta power. Most studies recruited individuals with primary insomnia, and data pooling for insomnia and mixed groups was not possible due to insufficient statistical reporting. Moreover, group-by-sex interactions were limited, inconsistent, and varied across studies and sample characteristics. Further research is needed to explore sex-specific differences in sleep microarchitecture and their role in normal sleep and the manifestation of insomnia disorder.
Sleep disturbance and fatigue were highly prevalent during the COVID-19 pandemic, in both infected and non-infected individuals, though mostly assessed cross-sectionally. To assess these symptoms after lockdown cessation, we conducted a prospective longitudinal study in a large UK cohort. Validated questionnaires assessing sleep disturbances, fatigue, depression, and anxiety were administered to COVID Symptom Study Biobank participants at two time periods-Autumn 2021 and Spring 2022 equinoxes-corresponding to lockdown and lifting of restrictions, respectively. After adjusting for differential participation using inverse probability weighting, data from 2390 participants were analysed. Generalised linear models examined SARS-CoV-2 infection, post-COVID-19 syndrome [PCS], and longitudinal changes of sleep disturbances and fatigue, adjusting for potential confounders. Despite lifting of lockdown, high levels of sleep disturbance and fatigue persisted, with no significant improvement over time, independently of baseline or new SARS-CoV-2 infection or PCS. De novo SARS-CoV-2 marginally worsened STOP-Bang scores although below clinical significance. There was a trend for interaction between baseline SARS-CoV-2 status and Chalder Fatigue scores on follow-up fatigue (B = 0.19, 95% CI = -0.01 to 0.39, p = 0.057). Receipt of booster vaccination lowered Epworth Sleepiness Scale scores (B = -0.53, 95% CI = -0.96 to -0.10, p = 0.016) but doubled likelihood of restless legs syndrome symptoms (OR = 2.45, 95% CI = 1.38 to 4.37, p = 0.002). Overall, the high rates of sleep disturbances and fatigue observed during lockdown persisted after restrictions were lifted, independent of SARS-CoV-2 infection. Sleep disruption reported during lockdown may endure unless actively addressed. Given the high prevalence of both sleep disturbance and fatigue, routine assessment of sleep is recommended for individuals presenting with persistent post-pandemic fatigue, including PCS.
Insomnia and obstructive sleep apnea (OSA) are common sleep disorders that often co-occur as comorbid insomnia and sleep apnea (COMISA), worsening health outcomes. This study characterized and compared the physiological and sleep profiles of insomnia, OSA and COMISA in population-based datasets from Portugal (n = 147) and Spain (n = 264), excluding patients with cardiovascular disease. Classification followed clinical guidelines, and analyses included polysomnography and heart rate variability (HRV) data. Conventional HRV metrics in the time and frequency domains, along with condition-specific frequency bands (BWMS, BWOSA, BWCOMISA, BWRes) were compared alongside demographic and clinical variables. The Portuguese and Spanish datasets differed significantly in gender distribution, daytime sleepiness, sleep efficiency and apnea-hypopnea index (AHI), with Spanish patients showing a higher severity of AHI and a predominantly male composition. COMISA patients were older, had higher BMI, and showed a hypopnea-dominant respiratory profile in both datasets. Classical HRV indices did not differ significantly between groups, although trends suggested decreased parasympathetic activity in OSA. Condition-specific bands were largely non-discriminative in Portugal, while BWOSA emerged as a significant marker of respiratory burden in Spain. When the populations were analysed jointly, age and obesity remained significant risk factors and COMISA maintained its hypopnea-dominant profile. The combined dataset revealed significant differences in several HRV features. OSA and COMISA patients exhibited a higher cardiovascular burden and autonomic imbalance (lower HF, higher LF/HF and LFn), while condition-specific bands all showed discriminatory power across groups. BWOSA may represent a useful spectral biomarker for OSA, although population and methodological factors strongly influence discriminative power.
Asthma, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are prevalent chronic respiratory diseases associated with increased comorbidity, mortality and healthcare costs. Physical activity and exercise are widely recommended as part of treatment for these conditions, yet the specific effects of Nordic walking (NW) remain underexplored. The aims of this randomised controlled trial (RCT) are to improve physical fitness, functional capacity and respiratory health and increase regular physical activity and quality of life of older adults with asthma and/or COPD and/or OSA through a supervised 3-month group-based NW intervention combined with resistance, balance and mobility training. This single-blinded, parallel-group RCT will recruit 100 adults aged 55-80 years diagnosed with asthma and/or COPD and/or OSA in the Northern Savo region of Finland. Participants will be randomly allocated to either an intervention group or a control group.The intervention group will participate in a 12-week supervised exercise programme consisting of progressive NW sessions twice per week and resistance, balance and mobility training once per week. The primary outcome is a change in cardiorespiratory endurance. Secondary outcomes include functional capacity, physical activity level, spirometry parameters and quality of life. The control group will continue their usual physical activity and receive physical activity guidance after 12 weeks. Measurements were conducted at baseline, three and 9 months. Data will be analysed according to the intention-to-treat principle. Group differences over time will be examined using appropriate parametric or non-parametric methods depending on data distribution. Ethical approval was obtained from the Regional Medical Research Ethics Committee of Eastern Finland Collaborative Area (892/13.00/2023). Findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences. The trial is registered at ISRCTN12097135, registration date: 7 June 2024.
Current systematic review analysed the content of generic patient-reported sleep measures (PRSMs) using (1) the International Classification of Functioning, Disability and Health (ICF) and (2) semantic analysis. A literature search identified 27 PRSMs applicable across multiple sleep disorders. Meaningful concepts within items of these PRSMs were linked to ICF categories using standardised linking rules. Additionally, semantic relations (contextual, causal, temporal or state descriptive) among these concepts were explored. An overview of the ICF content covered within and across questionnaires was compiled. Three main findings emerged. First, the majority of concepts were linked to the ICF component body functions (71.5%), indicating a focus on physiological and psychological symptoms, while activities and participation (14.7%), environmental factors (3.5%), and personal factors (2.2%) were less represented. Second, semantic analysis revealed that multidimensional content often framed symptoms within activities rather than measuring the functional or environmental impact of sleep disorders. Third, the operationalization of similar constructs varied across PRSMs, and their questionnaire labels could diverge from actual item content. This study provides a standardised database source for content-based evaluation, comparison and selection of PRSMs. Clinicians and researchers should be aware of the conceptual scope of PRSMs to ensure alignment with their specific clinical or research objectives. Recommendations are offered to guide sleep medicine measurement towards a more comprehensive approach integrating biological, psychological, social, environmental and personal aspects.
Dementia caregiving entails chronic, fluctuating stress with downstream risks to caregivers' mental health and quality of care. Mindfulness-based interventions can reduce caregiver stress; however, moment-to-moment fluctuations in stress may limit receptivity to practice at any given time. We developed a brief mindfulness just-in-time adaptive intervention (JITAI) that aims to deliver support at the right moment by using machine learning algorithms to optimize notification timing based on receptivity to engage in brief mindfulness practices. This study aims to evaluate the feasibility, acceptability, and effectiveness of a brief mindfulness JITAI for caregivers of people with dementia on stress, depressive symptoms, caregiver burden, sleep, quality of life, and trait mindfulness. A single-arm, pretest or posttest design was adopted. A total of 120 community-dwelling caregivers were recruited to participate in the 18-day intervention, which included 4 days of psychoeducation delivered via videos and phone coaching, alongside an in-app brief, low-dose mindfulness-based stress reduction component. From days 5 to 11, prompts were delivered either by a static machine learning model trained on prior pilot data or at random times, with equal probability. From days 12 to 18, three delivery models were used with equal probability, namely static, random, and adaptive models, which updated per participant using accumulating receptivity data. Feasibility and acceptability were assessed post intervention. Standardized measures of stress, depressive symptoms, caregiver burden, positive aspects of caregiving, sleep, quality of life, and trait mindfulness were collected via phone interviews at baseline and post intervention. Retention was 100%. Most participants (111/120, 92.5%) found the app easy to use, 81.7% (98/120) perceived it as helpful for stress management, and 80% (96/120) would recommend it to other caregivers. Pre-post analyses indicated significant reductions in perceived stress (P<.001), depressive symptoms (P<.001), and caregiver burden (P=.003), as well as a significant increase in positive aspects of caregiving (P<.001) and subjective sleep quality (P=.02). Health-related quality of life and trait mindfulness did not change significantly. A brief, smartphone-delivered mindfulness JITAI for caregivers of people with dementia was feasible and acceptable, with high retention and positive user evaluations. Pre-post findings suggest reductions in perceived stress, depressive symptoms, and caregiving burden, alongside increased positive aspects of caregiving and improved sleep, supporting the potential of adaptive, technology-enabled interventions to provide timely support to caregivers.
To evaluate the association between the parameters of sleep macrostructure and the short-term post-stroke functional outcome (modified Rankin scale (mRS) at discharge). In this open, observational, cohort study, we enrolled 78 patients with verified acute ischemic stroke admitted to the Stroke Unit within 24 h after symptom onset. All patients underwent standard diagnostic and clinical procedures and treatments. In addition, they underwent a full polysomnography in the acute phase of stroke within 14 days of admission to the hospital. Univariate and multivariate linear regression analyses were applied to define predictors of functional outcome (mRS) at discharge. According to the linear regression model (it explains ≈40% of the variability of mRS at discharge) the following factors appeared to be independent predictors: total sleep time, proportion of NREM stage 2 (NREM N2%), National Institutes of Health Stroke Scale (NIHSS) at 24 hours after admission, and Charlson index (R2=0.398, p<0.001). Each additional hour of sleep was associated with a decrease in mRS by 0.15 points, an increase in the proportion of NREM N2% by 1%, and a decrease in mRS by 0.032 points. Alterations in sleep macrostructure following ischemic stroke, specifically reduced total sleep time and decreased NREM stage 2 percentage, are associated with short-term functional outcomes as measured by the modified Rankin scale (mRS) at discharge. Assessment and management of sleep disorders should be integrated into comprehensive rehabilitation strategies for ischemic stroke. Оценка связи изменений макроструктуры сна с ранним функциональным исходом (по данным модифицированной шкалы Рэнкина (mRS) при выписке) у пациентов с ишемическим инсультом (ИИ). В когортное обсервационное исследование включено 78 пациентов с ИИ, поступивших в течение 24 ч от момента появления симптомов в отделение нейрореанимации. Все пациенты прошли обследование и лечение согласно существующим стандартам ведения пациентов с ИИ. Также всем пациентам выполнено полисомнографическое исследование (ПСГ) в сроки до 14 дней от поступления в стационар. Для оценки предикторов краткосрочного функционального исхода (mRS при выписке) проведен линейный регрессионный анализ. В многофакторной регрессионной модели (объясняющей ≈40% дисперсии mRS при выписке, коэффициент детерминации R2=0,398, p<0,001) независимыми предикторами неблагоприятного функционального исхода оказались уменьшение длительности сна и доли стадии 2 сна без быстрых движений глаз (медленный сон) — NREM-сна (NREM N2%) наряду с общепризнанными факторами, влияющими на исход, — тяжестью инсульта по шкале инсульта Национальных институтов здоровья США (NIHSS) через 24 ч и индексом коморбидности Чарлсона. Каждый дополнительный час сна сопровождается снижением mRS на 0,15 балла, а увеличение доли NREM N2% на 1% — на 0,032 балла. Нарушение макроструктуры сна в острейшем и остром периодах ИИ, а именно уменьшение длительности сна и доли NREM N2%, ассоциировано с функциональным исходом пациентов при выписке (mRS). Оценку и коррекцию нарушений сна следует рассматривать как часть комплексной стратегии реабилитации пациентов после ИИ.
Current literature supports exercise for the management of fibromyalgia (FM), although the optimal type of exercise remains unclear. This systematic review aims to summarize the effectiveness of qigong, yoga, and tai chi for FM-related symptoms beyond pain. Searches were conducted in CINAHL (via EBSCOhost), Embase, PsycINFO, PubMed, SPORTDiscus (via EBSCOhost), and the Cochrane Library from inception to September 2023 (updated in February 2026). Randomized controlled trials (RCTs) including measures of fatigue, anxiety, depression, health status, sleep quality, and overall quality of life were included. The Cochrane Risk of Bias tool 2 (ROB-2) was used to assess the risk of bias in primary studies. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach judged the certainty of the evidence. Sensitivity analyses and meta-regressions were performed. Twenty-three RCTs with 1734 participants were included. Meta-analyses showed that mindful exercises were more effective than control interventions (active and inactive) across all measures, i.e., fatigue (standard mean difference [SMD]: 0.63, 95% confidence interval [CI]: 0.08 to 1.17; P = 0.04), except for sleep quality and overall quality of life. Subgroup analyses demonstrated that the type of intervention may influence the results. Most RCTs had a high risk of bias, and the certainty of the evidence was very low. Qigong, tai chi, and yoga positively impact FM-related symptoms beyond pain, including fatigue, mental health, and health status. However, given the very low certainty of the evidence, these findings should be interpreted with considerable caution in clinical practice.