SLEEP

Cesari, Matteo; Heidbreder, Anna; St. Louis, Erik K; Sixel-Döring, Friederike; Bliwise, Donald L; Baldelli, Luca; Bes, Frederik; Fantini, Maria Livia; Iranzo, Alex; Knudsen-Heier, Stine; Mayer, Geert; McCarter, Stuart; Nepozitek, Jiri; Pavlova, Milena; Provini, Federica; Santamaria, Joan; Sunwoo, Jun-Sang; Videnovic, Aleksandar; Högl, Birgit; Jennum, Poul; Christensen, Julie A E; Stefani, Ambra

doi: 10.1093/sleep/zsac276pmid: 36519899

We welcome the remarks by Ferri and colleagues regarding the practical application of the International rapid eye movement (REM) sleep Behavior Disorder (RBD) Study Group (IRBDSG) video-polysomnography (vPSG) guidelines for RBD diagnosis. As highlighted in their letter, the rich body of literature continuously confirming isolated RBD (iRBD) as a neurodegenerative disease in the prodromal phase is based on polysomnography (PSG)-confirmed RBD cases, underlying the “necessary objective role played by the PSG.” Starting from this shared view, we would like to drive attention to the fact that the list of concerns raised by Ferri et al. (with the exception of point 8) also applies to the current ICSD-3 criteria for RBD and for other sleep disorders, for example, narcolepsy [1]. No return to the previous ICSD-2 criteria is desirable, as it is clear that mimics [2, 3] and unawareness of disease [4] make a diagnosis of RBD based on clinical history not possible. Ferri et al. refer to the common knowledge that capturing an RBD episode is difficult, and support this affirmation with unpublished data from the center of one of the authors, based on the application of a scale [5] developed to assess RBD symptoms’ severity in patients already diagnosed with RBD, and not for identifying RBD episodes. Moreover, it is unclear if the entire video recording during REM sleep was analyzed, or if only video segments with an associated muscular activity or movement artifact were inspected. The latter method would miss some RBD episodes, particularly if muscular activity in the upper extremities is not recorded [6]. According to the IRBDSG guidelines, an RBD episode consists of one or more motor events and/or vocalizations that can be interpreted as related to dream enactment [7]. Thus, this can include not only complex but also simple movements (e.g. punching or more subtle movements) and vocalizations representing dream enactment behaviors. The vPSG guidelines, which provide minimal requirements for video acquisition, shorten the odds of capturing an RBD episode, as demonstrated by previous studies with high-quality standards for video acquisition and analysis. In a large cohort of iRBD patients from Barcelona, a second PSG (because of insufficient REM sleep, absent REM sleep without atonia, or absence of RBD episodes) was needed in 15.8% [4]. Another study analyzing movements and vocalizations in iRBD reported purposeful motor episodes in all patients except one, who, however, had intelligible sleep talking and had only 19 minutes of REM sleep [8]. In RBD patients with overt alpha-synucleinopathies assessed with two nights of vPSG, at least three complex RBD movements were visible each night [9]. Data from these previous studies are in line with the experience from several centers that, in most cases, at least one RBD episode can be detected each night, in particular when applying the IRBDSG vPSG guidelines; thus in most cases, repeated vPSG would not be necessary. We thank Ferri et al. for bringing up insurance coverage issues in the context of RBD diagnosis, which have far-reaching implications for RBD patients. Despite being a relevant point to be considered, health insurance coverage should not determine how guidelines are developed. On the contrary, guidelines provide evidence-based guidance and should guide changes in health insurance policies for routine diagnostic procedures. As an example, MRI is required to diagnose multiple sclerosis [10], despite not being readily available worldwide. The diagnostic and treatment implications of a diagnosis of multiple sclerosis do not allow diagnostic uncertainty. The same applies to iRBD, being a prodromal synucleinopathy with relevant clinical and ethical implications related to its diagnosis. In the absence of documented RBD episodes, a diagnosis of provisional RBD is possible based on a clinical judgment if REM sleep without atonia and a clinical history of RBD are present [7], similarly to the cases with typical behaviors during vPSG and clinical history of RBD, but with preserved atonia during REM sleep [1]. Considering the variability of REM sleep-related metrics needed to establish a diagnosis of RBD (i.e. REM sleep duration, REM sleep without atonia, and dream enactment behaviors), we acknowledge the different significance of missing REM sleep without atonia versus missing a RBD episode in reaching RBD diagnosis. Future revisions of the IRBDSG vPSG guidelines may improve this classification. However, it allows recognition and prompts symptomatic treatment of cases not fully meeting RBD diagnostic criteria, at the same time highlighting the need for future confirmation. The IRBDSG vPSG guidelines for RBD diagnosis underline the need to distinguish between provisional and definite RBD, due to the relevant implications of an RBD diagnosis [11, 12], both as isolated and in the context of other diseases. We disagree with Ferri et al. that the application of the IRBDSG guidelines would interfere with RBD diagnosis. On the contrary, the guidelines will improve accurate diagnosis and the quality of clinical and research data, ultimately benefitting patient care. Application of IRBDSG guidelines will not impede, but speed up advancements in RBD knowledge, paving a path for acquiring good quality and harmonized data to provide the basis of collaborative multicenter studies, and allowing reproducibility of findings. The recently published IRBDSG vPSG guidelines for RBD diagnosis represent the initial IRBDSG guideline, which will continue to evolve based on the scientific advances in RBD research. These authors believe that the IRBDSG vPSG guidelines for RBD diagnosis and the RBD medical and scientific community are poised to advocate for changes in health insurance coverage policies, as vPSG remains needed for a definite RBD diagnosis. Funding agencies and companies performing clinical trials should be aware of the importance of video documentation of RBD episodes for a definite RBD diagnosis to avoid selection bias impairing the quality of clinical trials and research studies. A definite iRBD diagnosis is particularly relevant due to the implications of iRBD as prodromal synucleinopathy. Disclosure Statement None related to this work. References 1. American Acedamy of Sleep Medicine. International Classification of Sleep Disorders . 3rd ed. Darien, IL: AASM ; 2015 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 2. Gaig C , et al. . Periodic limb movements during sleep mimicking REM sleep behavior disorder: A new form of periodic limb movement disorder . Sleep . 2017 ; 40 ( 3 ): zsw063 . Google Scholar Crossref Search ADS WorldCat 3. Iranzo A , et al. . Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder . Sleep . 2005 ; 28 ( 2 ): 203 – 206 . doi:10.1093/sleep/28.2.203. Google Scholar Crossref Search ADS PubMed WorldCat 4. Fernández-Arcos A , et al. . The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation: a study in 203 consecutive patients . Sleep. 2016 ; 39 ( 1 ): 121 – 132 . Google Scholar Crossref Search ADS PubMed WorldCat 5. Sixel-Döring F , et al. . Intraindividual variability of REM sleep behavior disorder in Parkinson’s disease: a comparative assessment using a new REM sleep behavior disorder severity scale (RBDSS) for clinical routine . J Clin Sleep Med. 2011 ; 7 ( 1 ): 75 – 80 . Google Scholar Crossref Search ADS PubMed WorldCat 6. Iranzo A , et al. . Usefulness of the SINBAR electromyographic montage to detect the motor and vocal manifestations occurring in REM sleep behavior disorder . Sleep Med. 2011 ; 12 ( 3 ): 284 – 288 . doi:10.1016/j.sleep.2010.04.021. Available from http://www.ncbi.nlm.nih.gov/pubmed/21317034. [Internet] cited December 28, 2014. 7. Cesari M , et al. . Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: guidelines from the International RBD Study Group . Sleep . 2022 ; 43 ( 3 ). Available from https://pubmed.ncbi.nlm.nih.gov/34694408/. [Internet] cited November 4, 2021. Google Scholar OpenURL Placeholder Text WorldCat 8. Manni R , et al. . Motor-behavioral episodes in REM sleep behavior disorder and phasic events during REM sleep . Sleep. 2009 ; 32 ( 2 ): 241 – 245 . doi:10.1093/sleep/32.2.241. Google Scholar Crossref Search ADS PubMed WorldCat 9. Frauscher B , et al. . Video analysis of motor events in REM sleep behavior disorder . Mov Disord. 2007 ; 22 ( 10 ): 1464 – 1470 . doi:10.1002/mds.21561. Available from http://www.ncbi.nlm.nih.gov/pubmed/17516467. [Internet] cited December 28, 2014. 10. Thompson AJ , et al. . Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria . Lancet Neurol. 2018 ; 17 ( 2 ): 162 – 173 . doi:10.1016/S1474-4422(17)30470-2. Google Scholar Crossref Search ADS PubMed WorldCat 11. Teigen LN , et al. . Specialist approaches to prognostic counseling in isolated REM sleep behavior disorder . Sleep Med. 2021 ; 79 : 107 – 112 . doi:10.1016/j.sleep.2020.12.014. Google Scholar Crossref Search ADS PubMed WorldCat 12. Gossard TR , et al. . Patient values and preferences regarding prognostic counseling in isolated REM sleep behavior disorder . Sleep . 2022 : zsac244 . Available from https://doi.org/10.1093/sleep/zsac244. [Internet]. Google Scholar OpenURL Placeholder Text WorldCat Author notes Shared first authorship. © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected]

Stokes, Patrick A; Rath, Preetish; Possidente, Thomas; He, Mingjian; Purcell, Shaun; Manoach, Dara S; Stickgold, Robert; Prerau, Michael J

doi: 10.1093/sleep/zsac223pmid: 36107467

Transient oscillatory events in the sleep electroencephalogram represent short-term coordinated network activity. Of particular importance, sleep spindles are transient oscillatory events associated with memory consolidation, which are altered in aging and in several psychiatric and neurodegenerative disorders. Spindle identification, however, currently contains implicit assumptions derived from what waveforms were historically easiest to discern by eye, and has recently been shown to select only a high-amplitude subset of transient events. Moreover, spindle activity is typically averaged across a sleep stage, collapsing continuous dynamics into discrete states. What information can be gained by expanding our view of transient oscillatory events and their dynamics? In this paper, we develop a novel approach to electroencephalographic phenotyping, characterizing a generalized class of transient time-frequency events across a wide frequency range using continuous dynamics. We demonstrate that the complex temporal evolution of transient events during sleep is highly stereotyped when viewed as a function of slow oscillation power (an objective, continuous metric of depth-of-sleep) and phase (a correlate of cortical up/down states). This two-fold power-phase representation has large intersubject variability—even within healthy controls—yet strong night-to-night stability for individuals, suggesting a robust basis for phenotyping. As a clinical application, we then analyze patients with schizophrenia, confirming established spindle (12–15 Hz) deficits as well as identifying novel differences in transient non-rapid eye movement events in low-alpha (7–10 Hz) and theta (4–6 Hz) ranges. Overall, these results offer an expanded view of transient activity, describing a broad class of events with properties varying continuously across spatial, temporal, and phase-coupling dimensions.

Drummond, Sean P A; Wiley, Joshua F; Boardman, Johanna M; Aidman, Eugene; Kensinger, Elizabeth A; Cunningham, Tony J

doi: 10.1093/sleep/zsac249pmid: 36242776

Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close This content is only available as a PDF. © Sleep Research Society 2022. Published by Oxford University Press on behalf of the Sleep Research Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] © Sleep Research Society 2022. Published by Oxford University Press on behalf of the Sleep Research Society.

Vozoris, Nicholas T

doi: 10.1093/sleep/zsac266pmid: 36335512

Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close PDF This content is only available as a PDF. © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected]

Ferri, Raffaele; Lewis, Simon J G; De Cock, Valérie Cochen; Tachibana, Naoko; Kushida, Clete A; Schenck, Carlos H

doi: 10.1093/sleep/zsac261pmid: 36472560

Dear Editor, In recent years, REM sleep behavior disorder (RBD) has been the focus of a continuously growing number of articles [1], including the increased attention to identifying the most promising biomarkers in forecasting its phenol conversion from isolated RBD (iRBD) to a neurodegenerative disorder [2]. This rich body of literature is based on data from patients diagnosed in accordance with the criteria set forth in the International Classification of Sleep Disorders 3rd edition (ICSD-3) [3]. The polysomnographic (PSG) demonstration of REM sleep without atonia (RSWA) is one of the required criteria for the diagnosis of RBD in the ICSD-3. This calls attention to the necessary objective role played by the PSG in evaluating patients with suspected RBD. For this reason, we have read with interest the recent guidelines proposed by members of the International RBD Study Group (IRBDSG) for the video-PSG procedures needed to diagnose RBD that were published in SLEEP [4]. These guidelines were believed to be necessary in order to fill gaps in the current ICSD-3 diagnostic criteria that, in the authors’ opinion, needed to be filled and included recommendations on video-PSG technical settings; REM sleep staging; scoring of RSWA; methods for the analysis of video and audio recordings; video-PSG guidelines for the diagnosis of RBD; and the identification of its neurodegenerative prodromal stages. The authors also clearly state that their recommendations are intended for both practicing clinicians and researchers, including the assessment of REM sleep motor events, RBD behavioral episodes, and vocalizations for research purposes only. The authors conclude that their guidelines will ensure the collection of homogeneous objective data, favoring future multicenter studies and clinical trials. Among the most impactful novel requirements of these guidelines, with respect to the ICSD-3 [3] criteria that only require the PSG demonstration of RSWA, is the need to obtain at least one video-PSG recording in which a clear RBD behavioral episode occurs. It is common knowledge that capturing an RBD behavioral event during video-PSG can be difficult and thus this approach would imply the probable need for repeated video-PSG recordings, in cases where a RBD behavioral episode does not occur during the first recording night, none of which may be reimbursable by health insurance. For example, among 72 recordings of patients with iRBD (65 males and seven females, aged 53.1–83.1 years, diagnosed at the Sleep Research Centre of the Oasi Research Institute—IRCCS, Troina, Italy) for whom the RBD severity scale (RBDSS) [5] score was available, 20 had a score of 0 (“no visible movement”), 28 had a score of 1 (“slight movements or jerks”) and 24 a score of 2 or 3 (“movements involving proximal extremities, including violent behavior” or “axial involvement including bed falls”). This indicates that only one third of patients might be presenting a clear-cut behavioral episode during a single video-PSG recording. If we consider those with a score of 1 and the presence of vocalizations, the number increases to 43, which still means that about 40% of patients do not show a clear behavioral episode during a single night recording. We must keep in mind that guidelines put forth by an international organization, such as the IRBDSG, should be first of all feasible and able to be applied in most, if not all, the countries and socioeconomic environments. However, a series of concerns arises when reading the various recommendations published by Cesari et al. [4], which were not taken into account by the authors: Do most sleep labs in all countries have a sleep technologist in attendance all night during PSGs? Is there sleep technologist certification in all countries? If there is no sleep technologist certification in a country, then what is the training background/clinical experience for sleep technologists in that country (courses in neurophysiology/EEG technology, in respiratory medicine and mechanical ventilation, or trained by the sleep doctor when they start to work at the sleep lab)? Is there public/private health insurance coverage for PSG studies (including the chin EMG, EEG, EKG, respiratory monitoring) needed to diagnose RBD in all countries? Does health insurance cover in-lab PSG studies with the stated indication of “Suspected RBD” or is another diagnosis is needed, such as “Suspected OSA” or “Suspected nocturnal seizures”? Does health insurance only cover home (unattended) PSG studies for RBD? Does health insurance cover a second PSG study? If yes, in which cases? (One indication would be if there is comorbid OSA that needs treatment with CPAP, and then a second PSG study would confirm, or not confirm, the diagnosis of RBD. Is video used during PSG studies for RBD in all countries? Are PSG machines with sufficient specification to record and analyze RSWA available in all countries? All these considerations refer to specific and practical implications of the guidelines by Cesari et al. [4] and appear to represent a clear obstacle to their implementation across clinical practice. The obvious consequence of this problem is that if the proposed guidelines are endorsed by the health systems and the medical community across the world, the application of these guidelines would strongly interfere with the diagnosis of RBD in a large portion of patients who would not be able to receive the required (often repeated) video-PSG evaluation. Furthermore, the delay in making the diagnosis of RBD may also delay the initiation of therapy of patients at risk for injurious, and potentially life-threatening, dream-enacting behaviors [6, 7]. Moreover, the application of these rigorous guidelines to the research arena is also not risk-free. Indeed, while we do agree that these guidelines would allow the identification of patients with a clear-cut and homogenous diagnosis of RBD, a substantial number of research studies would not be sponsored by the academic and commercial funding agencies given the limited budgets (that are often the case). Thus, an unintended consequence of these guidelines might in fact be the restriction of future RBD research studies. Similarly, sponsored clinical trials, which are definitely needed studies [8], might become more expensive with the endorsement of all these guidelines, which would be likely to limit the number of eligible patients and reduce the pool of who could be enrolled. The final effect is most probably the slowing of the advancement of the knowledge of RBD and its heralding of evolving neurodegeneration. In conclusion, we believe that while reconsiderations related to diagnosis and optimal procedures should be encouraged, they need to be balanced against clinical and research feasibility. In the best of all possible scenarios, the guidelines proposed by Cesari et al. [4] would be welcomed, but the real-world limitations described above need to be considered. Therefore, we believe that the current ICSD-3 [3] criteria should be still kept as the reference for the diagnosis of RBD and that further discussions among members of the IRBDSG take place to ensure the feasibility of any changes (four of the authors of this letter are members of the IRBDSG). Clearly, where funding allows, the guidelines proposed by Cesari et al. [4] should first be applied across multiple centers to determine their further utility. Disclosure Statement Raffaele Ferri: no relevant COI; Simon J.G. Lewis: NHMRC Leadership Fellow (#1195830); consultancy fee Pharmaxis Ltd.; Naoko Tachibana: no relevant COI; Clete A. Kushida: no relevant COI; Carlos H. Schenck: one-lecture lecture honorarium, Eisai, Inc. References 1. Schenck CH , Högl B, Videnovic A., eds. Rapid-Eye-Movement Sleep Behavior Disorder . Cham, Switzerland : Springer Nature Switzerland AG , 2018 ; doi:10.1007/978-3-319-90152-7. ISBN 978-3-319-90151-0. Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 2. Miglis MG , et al. . Biomarkers of conversion to alpha-synucleinopathy in isolated rapid-eye-movement sleep behaviour disorder . Lancet Neurol. 2021 ; 20 : 671 – 684 . doi:10.1016/S1474-4422(21)00176-9. Google Scholar Crossref Search ADS PubMed WorldCat 3. American Academy of Sleep Medicine. International Classification of Sleep Disorders , 3rd ed. Darien, IL : American Academy of Sleep Medicine ; 2014 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 4. Cesari M , et al. . Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: guidelines from the International RBD Study Group . Sleep. 2022 ; 45 ( 3 ): zsab257 . doi:10.1093/sleep/zsab257. Google Scholar Crossref Search ADS PubMed WorldCat 5. Sixel-Doring F , et al. . Intra-individual variability of REM sleep behavior disorder in Parkinson’s disease: a comparative assessment using a new REM sleep behavior disorder severity scale (RBDSS) for clinical routine . J Clin Sleep Med. 2011 ; 7 : 75 – 80 . Google Scholar Crossref Search ADS PubMed WorldCat 6. Schenck CH , et al. . Potentially lethal behaviors associated with rapid eye movement sleep behavior disorder: review of the literature and forensic implications . J Forensic Sci. 2009 ; 54 ( 6 ): 1475 – 1484 . doi:10.1111/j.1556-4029.2009.01163.x. Google Scholar Crossref Search ADS PubMed WorldCat 7. McCarter SJ , et al. . Factors associated with injury in REM sleep behavior disorder . Sleep Med. 2014 ; 15 ( 11 ): 1332 – 1338 . doi:10.1016/j.sleep.2014.06.002. Google Scholar Crossref Search ADS PubMed WorldCat 8. Schenck CH , et al. . Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group . Sleep Med. 2013 ; 14 : 795 – 806 . doi:10.1016/j.sleep.2013.02.016. Google Scholar Crossref Search ADS PubMed WorldCat © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected]

Xu, Liyue; Xu, Guowang; Han, Fang

doi: 10.1093/sleep/zsac268pmid: 36346440

Accepted manuscripts Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout. Article PDF first page preview Close PDF This content is only available as a PDF. © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected] This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) © The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: [email protected]

Walsh, Neil P; Kashi, Daniel S; Edwards, Jason P; Richmond, Claudia; Oliver, Samuel J; Roberts, Ross; Izard, Rachel M; Jackson, Sarah; Greeves, Julie P

doi: 10.1093/sleep/zsac222pmid: 36112383

Study ObjectivesProspectively examine the association between sleep restriction, perceived sleep quality (PSQ) and upper respiratory tract infection (URTI).MethodsIn 1318 military recruits (68% males) self-reported sleep was assessed at the beginning and end of a 12-week training course. Sleep restriction was defined as an individualized reduction in sleep duration of ≥2 hours/night compared with civilian life. URTIs were retrieved from medical records.ResultsOn commencing training, approximately half of recruits were sleep restricted (52%; 2.1 ± 1.6 h); despite the sleep debt, 58% of recruits with sleep restriction reported good PSQ. Regression adjusted for covariates showed that recruits commencing training with sleep restriction were more likely to suffer URTI during the course (OR = 2.93, 95% CI 1.29–6.69, p = .011). Moderation analysis showed this finding was driven by poor PSQ (B = −1.12, SE 0.50, p = .023), as no significant association between sleep restriction and URTI was observed in recruits reporting good PSQ, despite a similar magnitude of sleep restriction during training. Associations remained in the population completing training, accounting for loss to follow-up. Recruits reporting poor PSQ when healthy at the start and end of training were more susceptible to URTI (OR = 3.16, 95% CI 1.31–7.61, p = .010, vs good PSQ).ConclusionGood perceived sleep quality was associated with protection against the raised risk of respiratory infection during sleep restriction. Studies should determine whether improvements in sleep quality arising from behavioral sleep interventions translate to reduced respiratory infection during sleep restriction.

Fritz, Josef; Huang, Tianyi; Depner, Christopher M; Zeleznik, Oana A; Cespedes Feliciano, Elizabeth M; Li, Wenjun; Stone, Katie L; Manson, JoAnn E; Clish, Clary; Sofer, Tamar; Schernhammer, Eva; Rexrode, Kathryn; Redline, Susan; Wright, Kenneth P; Vetter, Céline

doi: 10.1093/sleep/zsac226pmid: 36130143

Short and long sleep duration are associated with adverse metabolic outcomes, such as obesity and diabetes. We evaluated cross-sectional differences in metabolite levels between women with self-reported habitual short (<7 h), medium (7–8 h), and long (≥9 h) sleep duration to delineate potential underlying biological mechanisms. In total, 210 metabolites were measured via liquid chromatography-mass spectrometry in 9207 women from the Nurses’ Health Study (NHS; N = 5027), the NHSII (N = 2368), and the Women’s Health Initiative (WHI; N = 2287). Twenty metabolites were consistently (i.e. praw < .05 in ≥2 cohorts) and/or strongly (pFDR < .05 in at least one cohort) associated with short sleep duration after multi-variable adjustment. Specifically, levels of two lysophosphatidylethanolamines, four lysophosphatidylcholines, hydroxyproline and phenylacetylglutamine were higher compared to medium sleep duration, while levels of one diacylglycerol and eleven triacylglycerols (TAGs; all with ≥3 double bonds) were lower. Moreover, enrichment analysis assessing associations of metabolites with short sleep based on biological categories demonstrated significantly increased acylcarnitine levels for short sleep. A metabolite score for short sleep duration based on 12 LASSO-regression selected metabolites was not significantly associated with prevalent and incident obesity and diabetes. Associations of single metabolites with long sleep duration were less robust. However, enrichment analysis demonstrated significant enrichment scores for four lipid classes, all of which (most markedly TAGs) were of opposite sign than the scores for short sleep. Habitual short sleep exhibits a signature on the human plasma metabolome which is different from medium and long sleep. However, we could not detect a direct link of this signature with obesity and diabetes risk.

Nyarko, Samuel H; Luo, Liying; Schlundt, David G; Xiao, Qian

doi: 10.1093/sleep/zsac225pmid: 36124765

Study ObjectivesSleep duration can change over the life course; however, previous studies rarely investigated the association between socioeconomic status (SES) and individual sleep trajectories over time. We examined the association between baseline socioeconomic characteristics and long-term sleep trajectories among Black and White adults.MethodsThis study used data from the Southern Community Cohort Study (N = 45 035). Diverse trajectories of sleep duration were constructed using self-reported sleep duration at baseline and after ~10 years of follow-up. The associations between baseline socioeconomic characteristics and sleep trajectories were examined using multinomial logistic regression.ResultsBoth Black and White participants experienced similar long-term individual sleep trajectories for baseline educational attainment and employment status albeit the associations appeared stronger among White participants. Lower education and unemployment were associated with higher odds of various suboptimal sleep trajectories suggesting worsening long-term sleep patterns among both racial groups. However, there were some racial differences in the experience of long-term sleep trajectories for household income and neighborhood SES. Household income was notably more important among White than Black individuals; lower household income was associated with higher odds of more suboptimal long-term sleep trajectories for White than Black individuals. Also, neighborhood SES was slightly more important among White than Black individuals; lower neighborhood SES was associated with higher odds of a few suboptimal long-term sleep trajectories for both racial groups.ConclusionsLower socioeconomic characteristics were associated with various suboptimal long-term sleep trajectories among Black and White participants. Substantial improvements in socio-economic characteristics may contribute to improved sleep patterns.