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In this narrative review, we examined what level of research evidence is available that shift workers' sleep-wake disturbances can be minimized through ergonomie shift scheduling. We classified the pertinent studies conducted on real shift workers in field conditions by the type of shift system and study design (ie, whether the shift systems were modified or not— \"treatment\" versus \"no treatment\"). The results of the observational studies in which no changes to the shift system were made (ie, no treatment) showed that, irrespective of the shift system, night and early-morning shifts and quick returns are associated with short sleep and increases in sleepiness. The same is true for very long shifts (> 16 hours) and extremely long weekly working hours (> 55 hours). For all categories of shift systems, there were a lack of controlled intervention studies, limiting the possibility to provide solution-focused recommendations for shift scheduling. Most of the controlled intervention studies had been conducted on workers under regular 3-shift systems. These studies suggested that a change from slowly backward-rotating shifts to rapidly forward-rotating shifts is advantageous for alertness and, to some degree, sleep. We also found that a change from an 8-to 12-hour shift system does not necessarily result in impairments in the sleep-wake pattern. The level of research evidence was affected by many of the studies' frequent methodological limitations in measuring sleep and sleepiness. In all, to have reliable and solution-focused recommendations for shift scheduling, methodologically sound controlled intervention studies are required in different categories of shift systems.

One must process others’ facial affect proficiently to facilitate social functioning, and both social functioning and processing of facial affect can be impaired in sleep-deficient states. Based on mood-salience, decreased positive affect and increased negative affect experienced from sleep deficits or from depression might differentially modulate attentional responses to others’ positive and negative facial expressions. The present study examined this possibility by assessing college students’ subjective sleep–wake experience and their P3 event-related potentials responses, which indicate attention allocation. Fifty-five participants completed the Pittsburgh Sleep Quality Index (PSQI), assessments of current and past depressive symptoms, and a modified oddball task including affective facial expression stimuli. Factor analysis was conducted on PSQI data, and structural equation models were estimated to examine associations between PSQI latent factors and oddball P3 amplitude, controlling for current and past depressive symptomatology. Results indicated that one of the two identified PSQI factors (dysfunctional sleep insufficiency) was negatively associated with P3 amplitude in response to happy facial stimuli, while PSQI factor associations with sad and neutral stimuli were non-significant. Findings suggest that particular self-reported sleep–wake problems (dynamic interplay of sleep duration, sleep quality, and psychosocial functioning) can be related to decreased elaborated attention towards others’ positive facial expressions, potentially a marker of decreased inclination towards social rewards. This pattern may be particularly relevant in college, a context that can present important social opportunities and reinforce problematic sleep habits. Future longitudinal research that includes assessments of social functioning and diverse samples would be beneficial.

Generally applicable qualifications of sleep and principles for achieving better sleep are difficult to design, because sleep quality can depend on individual demographic characteristics and lifestyles. In this study, the static and dynamic features of sleep–wake patterns were analyzed in association with quantitative sleep-related parameters and self-rated sleep quality to serve as a practical selection of sleep–wake patterns fitted to individual conditions. Data obtained over a 2-week period by actigraphy from university students and information technology workers were measured to obtain a daily subjective rating of sleep quality using the Oguri–Shirakawa–Azumi (OSA) sleep inventory. Qualitative sleep quality in terms of OSA score and quantitative sleep-related and chronobiological features were analyzed with regard to their dependency on the demographic characteristics, habitual sleep–wake patterns (HSWP), and distinction of weekdays/weekends. Multi-factor ANOVA was used to further investigate their dependencies regarding multiple ways of interactions between the demographic characteristics, HSWP, and distinction of weekdays/weekends. Subjective sleep quality and quantitative sleep-related parameters depended on the demographic characteristics, and so did their associations. The classification of day-to-day variations in HSWP showed four clusters that were effective factors for understanding their dependencies. Multi-factor analysis revealed demographic characteristics, HSWP, distinction of weekdays/weekends, and their multi-way interactions up to 3rd order as significant effectors of qualitative and quantitative quality of sleep. This study clarified how quantitative sleep-related parameters, subjective sleep quality, and their associations depended on demographic characteristics. Furthermore, their dependency was understood as a combination of multi-way interactions between the demographic characteristics, HSWP, and the distinction of weekdays/weekends. Our findings could provide a basis for the design of individually matched sleep–wake patterns.

One hundred and eleven youth with mental ill-health underwent systematic clinical, laboratory and actigraphy monitoring to report associations between 24-h sleep–wake patterns and cardiometabolic risk factors. Multiple linear regression analyses, controlling for medication usage and class, age and sex, found significant associations between: later sleep onset and BMI; standard variation (SV) in the sleep offset with both insulin values and the updated homeostatic model assessment of insulin resistance (HOMA2-IR) values; and the SV of the sleep midpoint with both poorer fasting insulin, and HOMA2-IR values. Further longitudinal research is required to determine the causative relationships between 24-h sleep–wake cycle patterns, and cardiometabolic outcomes.

Sleep disturbance is common but often overlooked after stroke. Regular sleep is increasingly recognised as important for overall health, yet little is known about how sleep regularity changes after stroke. This study examined differences in the Sleep Regularity Index (SRI) between stroke survivors and healthy controls using actigraphy data from an existing dataset (~ 1 week per participant). Data were analysed for 162 stroke survivors (mean age 61 ± 14 years, 5 ± 5 years post-stroke, 89 males) and 60 controls (mean age 57 ± 17 years, 32 males). Stroke survivors had significantly lower SRI scores than controls ( p = 0.001), indicating less regular sleep. In the stroke group, higher SRI correlated with longer total sleep time ( p = 0.003) and better self-reported sleep quality ( p = 0.001) but not with other sleep metrics. Lower SRI was associated with worse depressive symptoms ( p = 0.006) and lower quality of life ( p = 0.001) but not with disability ( p = 0.886) or time since stroke ( p = 0.646). These findings suggest that sleep regularity is disrupted post-stroke and may influence well-being. Future research should explore interventions to improve sleep regularity and related health outcomes in stroke survivors.

Abstract Parkinson’s disease (PD) is a complex neurodegenerative disorder, characterized by the aggregation of α-synuclein (α-syn). Current research increasingly indicates the prevalence of sleep–wake disorders in early-stage PD, although the underlying pathogenic mechanisms remain unclear. In this study, transgenic Drosophila models were utilized to observe excessive daytime sleepiness and impaired anticipation in flies overexpressing α-syn in pan-neurons and circadian clock neurons. Additionally, deficits in projection of Pigment Dispersing Factor (PDF) neuron terminals, which are involved in Drosophila sleep and circadian rhythm, were identified. An imbalance in lipid metabolism homeostasis was detected in the brains of α-syn overexpressing mutants. Ultimately, the inhibition of Sterol Regulatory Element-Binding Protein (SREBP) activity led to an improvement in the reduced daytime sleep duration phenotype. Our results suggest that lipid pathways play a role in sleep–wake disorders triggered by α-syn mutation and aggregation, thereby providing valuable insights into potential therapeutic avenues for disrupted sleep patterns associated with PD. Graphical Abstract Graphical Abstract

Background Following the termination of China’s dynamic zero-COVID policy on December 7, 2022, a substantial rise in COVID-19 infections among infants and toddlers was observed. Clinical practice revealed that many infected infants and toddlers subsequently developed sleep-wake disturbances. However, research on this specific population remains limited. Objectives This study aimed to examine the impact of COVID-19 infection on sleep patterns in infants and toddlers to inform clinical practice and management strategies. Methods We conducted a prospective study of children aged 0–35 months, including COVID-19-positive patients from the pediatric respiratory department and age-matched healthy controls from child healthcare department between January 1 and December 31, 2023. Parents completed the Brief Infant Sleep Questionnaire and a demographic questionnaire at baseline, with follow-up assessments conducted over six months. Results COVID-19 infection significantly affected multiple sleep parameters: nighttime sleep duration, daytime sleep duration, nighttime awakening duration, sleep latency and bedtime. Nighttime awakening duration was the most significantly affected sleep parameter, with persistent disturbances lasting up to 6 months post-COVID infection without returning to baseline levels. Age ≥ 12 months was a protective factor against night waking, sleeping while feeding and screen time ≥ 1 h were independent risk factors for night waking. Conclusion Our findings demonstrate that COVID-19 infection causes significant and prolonged disruptions to sleep architecture in infants and toddlers, with these effects persisting beyond the acute infection phase and being moderated by specific environmental factors, highlighting the need for routine sleep assessments in pediatric COVID-19 patients, targeted parental education on modifiable risk factors, and the development of interventions to mitigate sleep disturbances during future public health emergencies.

Study Objectives: The current study examined the impact of home confinement (lockdown) because of the COVID-19 pandemic on the sleep patterns of children and adolescents with attention-deficit hyperactivity disorder (ADHD). Methods: Nine hundred ninety-two parents of children and adolescents with ADHD filled out an anonymous online survey through the ADHD family association website. The survey investigated the sleep patterns and disturbances (using a modified version of the Sleep Disturbance Scale for Children) and screen exposure time before and during lockdown. Results: During lockdown, 59.3% of children and 69.4% of adolescents with ADHD reported a change of bedtime, with a significant increase in patients with ADHD who went to sleep at 11 pm or later. Sleep duration, in contrast, resulted in 2 opposing processes with more children and adolescents sleeping either less than 6 hours/night or 10–11 hours/night. Among children and adolescents, respectively, 19.9% and 22% slept less than they did before lockdown, whereas 21.4% and 27.4% slept for more hours. Bedtime delay and decreased sleep duration were associated with an increase in screen time exposure. Moreover, patients with ADHD reported an increase in sleep disturbances when compared to their previous condition, mainly including difficulties falling asleep, anxiety at bedtime, night awakenings, nightmares, and daytime sleepiness. Conclusions: Lockdown impacted sleep-wake rhythms by strengthening the maladaptive sleep patterns reported in usual-life conditions in children and adolescents with ADHD. Citation: Bruni O, Giallonardo M, Sacco R, Ferri R, Melegari MG. The impact of lockdown on sleep patterns of children and adolescents with ADHD. J Clin Sleep Med. 2021;17(9):1759–1765.

Sleep changes have been associated with increased risks of developing cognitive disturbances and Alzheimer's disease (AD). A bidirectional relation is underlined between amyloid-beta (Aß) and sleep disruptions. The sleep profile in participants at risk to develop AD is not fully deciphered. We aim to investigate sleep-wake changes with objective sleep measurements in elderly participants without cognitive impairment depending on their brain amyloid status, positive (Aß+) or negative (Aß-) based on standard absorption ratios (SUVr) positron emission tomography-florbetapir imaging. Sixty-eight participants without cognitive impairment who have accepted to be involved in the sleep ancillary study from the InveStIGation of Alzheimer's Predictors in Subjective Memory Complainers (INSIGHT-pre AD) cohort, aiming to record sleep profile based on the analyses of an ambulatory accelerometer-based assessment (seven consecutive 24-hour periods). Neuropsychological tests were performed and sleep parameters have been individualized by actigraph. Participants also underwent a magnetic resonance imaging scan to assess their hippocampal volume. Based on SUVr PET-florbetapir imaging, two groups Aß+ and Aß- were compared. Participants were divided into two groups: Aß+ (n = 24) and Aß- (n = 44). Except for the SUVr, the two subgroups were comparable. When looking to sleep parameters, increased sleep latency, sleep fragmentation (wake after sleep onset [WASO] score and awakenings) and worst sleep efficiency were associated with cortical brain amyloid load. Actigraphic sleep parameters were associated with cortical brain amyloid load in participants at risk to develop AD. The detection of sleep abnormalities in those participants may be of interest to propose some preventive strategies.

Study Objectives: Giftedness is a multidimensional condition. It is increasingly put forward that gifted children (GC) could be a population at high risk for sleep problems. The current study investigated GC and typically developing children for their habitual sleep, night-to-night sleep variability, and parental reports of child sleep. Methods: The sample consisted of 62 GC (31 girls; mean age = 9.63 ± 1.71 years) and 62 typically developing children (31 girls; mean age = 9.68 ± 1.68 years). Groups were age and sex matched. Giftedness was identified using Renzulli’s 3-factor definition of giftedness. Sleep duration, quality, and night-to-night variability were assessed using actigraphy. Parents were asked to complete the short-form version of the Children’s Sleep Habits Questionnaire to report on their child’s sleep. Groups were compared with independent sample t -tests and chi-square analyses. Results: GC displayed lower sleep efficiencies, more wake time after sleep onset, and more night-to-night sleep variability than typically developing children. GC were found to experience less social jetlag compared to typically developing children, and they also showed more clinically significant sleep problems as reported by parents. Conclusions: Sleep maintenance and stability tend to be challenged in GC. While there is growing evidence that greater sleep variability is associated with poorer physical and emotional health, studies have yet to examine these associations in GC specifically to get a better understanding of giftedness. Overall, there is a need for research focused on both predictors and consequences of sleep patterns and sleep variability in GC. Citation: Bastien L, Théoret R, Bernier A, Godbout R. Habitual sleep and intraindividual variability of sleep in gifted children: An actigraphy study. J Clin Sleep Med . 2023;19(5):925–934.