Evaluating Sleep in Autism Using CSHQ and CSHQ-Autism - A Perspective Through the Cultural Lens.

The Child Sleep Hygiene Questionnaire (CSHQ) and its adapted version for autistic children, known as CSHQ-Autism, have gained recognition as essential tools for studying pediatric sleep patterns. 67 autistic children were evaluated using these questionnaires. 52 children screened positive on the CSHQ while 18 were screened positive on the CSHQ-Autism. Notably, both tools showed elevated ratings in the domains of sleep anxiety and co-sleeping, which may hinder their ability to accurately distinguish sleep disturbances. However, the prevalence of sleep anxiety/co-sleeping in Indian culture was found to be linked to more severe sleep disorders, while also serving as a protective factor against separation anxiety and sudden infant death syndrome (SIDS). Therefore, while the CSHQ and CSHQ-Autism serve as valuable assessment tools, their scores may be inflated by ingrained cultural norms in the Indian context.

Sleep Disturbances and Co-sleeping in Italian Children and Adolescents with Autism Spectrum Disorder.

The current study aimed (1) to provide an analysis of the frequency and prevalence of sleep disturbances in a large Italian sample of children and adolescents with ASD, detecting specific predictors of the presence/absence of sleep disorders, (2) to examine the phenomenon of co-sleeping within a subgroup of participants with ASD. A total of 242 children and adolescents with ASD (194 males, mean age 5.03 ± 3.15 years) were included. After the diagnostic procedure, caregivers were requested to complete the Sleep Disturbance Scale for Children (SDSC) to assess sleep disorders among participants. The presence of co-sleeping was investigated in a subgroup of 146 children and adolescents with ASD. An elevated or clinically relevant global score for sleep disorders (≥ 60) was found in 33% of participants. The most prevalent sleep disorder in our group was related to difficulties with sleep onset and sleep maintenance (~ 41% of cases). Sleep disturbances were predicted by higher intelligence quotient (IQ)/developmental quotient (DQ), increased internalizing problems, and elevated parental stress. The subgroup of participants engaged in co-sleeping (N = 87) were younger and had lower IQ/DQ scores, reduced adaptive functioning, and diminished psychological wellbeing than the non-co-sleeping group. Our findings are consistent with the current literature highlighting that insomnia is the most widespread sleep problem associated with ASD. The relationship between IQ/DQ and sleep alterations is a crucial topic that deserves additional research. Future studies should assess sleep by objective measures such as EEG topography to better understand the mechanisms underlying sleep alterations in this neurodevelopmental disorder.

Exploring the Relationship between Co-Sleeping, Maternal Mental Health and Expression of Complaints during Infancy, and Breastfeeding.

BACKGROUND: This study explores whether the implementation of co-sleeping in infants aged 6-12 months (a) is associated with maternal complaints and mothers' difficulties regarding their infant's sleep, (b) is associated with maternal mental health, (c) affects infant sleep characteristics and maternal sleep quality, and (d) is associated with breastfeeding. METHODS: This study is a cross-sectional study conducted from July to November 2021. A total of 151 new mothers of infants aged 6-12 months participated. All participants were divided into two different groups, the group of mothers who adopted the co-sleeping method from birth up to the time of the survey and the group of those who did not adopt co-sleeping at that time. The Brief Infant Sleep Questionnaire-Revised Short Form (BISQ-R SF), the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), and a questionnaire on mothers' demographics were administered. RESULTS: Regarding the mothers' complaints, mothers who co-sleep with their children have lower sleep quality than those who do not co-sleep. In respect of the mothers' mental health, there did not seem to be a statistically significant difference in the two groups. Regarding the difficulties during the sleep process, children who sleep with their parents seem to have more difficulties compared to the others (p = 0.008). It was also shown that co-sleeping children seem to have more disturbed sleep compared to those who sleep alone (p = 0.018), and a general trend obtained of a significantly higher number of awakenings for co-sleeping children (p < 0.001). Finally, breastfeeding appeared to be more related to the children of the present sample sleeping with their parents (p < 0.001). CONCLUSIONS: This study showed that co-sleeping is associated with more difficulties in infant and maternal sleep, but no direct correlation with maternal mental health was found. In addition, it showed a positive correlation of co-sleeping with breastfeeding.

Sources of attitudes towards parent-child co-sleeping and their effects: A systematic scoping review.

Parent-child co-sleeping is a common practice in many cultures, although in Western countries, families who engage in parent-child co-sleeping can encounter attitudes about co-sleeping that feel critical from the people around them, as it is not commonly accepted and often stigmatized. This systematic scoping review examined and synthesized the available literature on the attitudes about parent-child co-sleeping that people encounter, their origins, and their effect on parents' own attitudes and behaviors. A total of 9796 abstracts were screened, and 33 studies were included. While the scope of the literature on this topic was narrow, this review demonstrated that parents/caregivers mostly encounter encouraging attitudes about co-sleeping from their extended family members and within their culture and discouraging attitudes from healthcare professionals. Findings suggest that encouraging attitudes enhance the likelihood of parents engaging and continuing with co-sleeping behavior, while discouraging attitudes can lead to the avoidance of parents discussing sleep with their healthcare professionals and can cause conflicts with other family members, including partners. Based on these findings, we conclude that further research is needed in several areas related to co-sleeping in Western culture, most specifically in how external attitudes influence the decision to co-sleep, as well as other behaviors and cognitions such as engagement with healthcare professionals, family satisfaction, parental self-efficacy, and overall mental health.

Photos Shared on Facebook in the Context of Safe Sleep Recommendations: Content Analysis of Images.

Background: Sudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers' group is instrumental for policy makers, health care providers, and researchers. Objective: This study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed. Methods: Data were extracted from a Facebook mothers' group in May 2019. After trialing various search terms, searching for the term "SIDS" on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers. Results: Of the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified. Conclusions: This study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers.

Association between co-sleeping in the first year of life and preschoolers´ sleep patterns.

This study aimed to investigate the association between co-sleeping practiced during the first year of life and preschoolers' sleep patterns. A cross-sectional study including toddlers was designed to analyze their sleep patterns. The Brief Infant Sleep Questionnaire, validated in Spanish, was used to measure sleep quality. A latent class analysis was performed to identify qualitative subgroups in the sample and explore the effects of co-sleeping. The sleep patterns of 276 children were analyzed. A total of 181 (65%) parents reported having practiced co-sleeping with their children. The latent class analysis identified a two-class solution with two different sleep patterns. One of them showed a worse quality sleep pattern, which had a significant association with having practiced co-sleeping during the first year of life, and with the fact that they were still sleeping in the parents' room, among other characteristics related to co-sleeping and parental concerns. Breastfeeding also showed association with a worse quality sleep pattern.  Conclusion: Based on the present findings, co-sleeping during the first year of life appears to be associated with poor sleep patterns in young preschoolers. What is Known: • Co-sleeping shows benefits for infants and parents, mainly facilitating successful breastfeeding. • Literature on the effect of co-sleeping in lately sleep quality in children and their parents is very limited. What is New: • Co-sleeping practiced during the first year of life could be associated with a worse sleep pattern measured with BISQ-E tool. • A balance between the correct practice of co-sleeping and the achievement of a healthy sleep routine in preschool should probably be part of parents' health education.

Sleep disorders in children with epilepsy.

INTRODUCTION: Children with epilepsy present greater prevalence of sleep disorders than the general population. Their diagnosis is essential, since epilepsy and sleep disorders have a bidirectional relationship. OBJECTIVE: Determine the incidence of sleep disorders and poor sleep habits in children with epilepsy. METHODS: We conducted a cross-sectional study of patients under 18 years of age with epilepsy, assessing sleep disorders using the Spanish-language version of the Sleep Disturbance Scale for Children (SDSC), and sleep habits using an original questionnaire. RESULTS: The sample included 153 patients. Eighty-four percent of our sample presented some type of sleep alteration. The most frequent alterations were sleep-wake transition disorders (53%), sleep initiation and maintenance disorders (47.7%), and daytime sleepiness (44.4%). In 70% of cases, the patients' parents reported that their child "slept well," although sleep disorders were detected in up to 75.7% of these patients. Many patients had poor sleep habits, such as using electronic devices in bed (16.3%), requiring the presence of a family member to fall asleep (39%), or co-sleeping or sharing a room (23.5% and 30.5%, respectively). Those with generalised epilepsy, refractory epilepsy, nocturnal seizures, and intellectual disability were more likely to present sleep disorders. In contrast, poor sleep habits were frequent regardless of seizure characteristics. CONCLUSIONS: Sleep disorders and poor sleep habits are common in children with epilepsy. Their treatment can lead to an improvement in the quality of life of the patient and his/her family, as well as an improvement in the prognosis of epilepsy.

Natural Course of IQSEC2-Related Encephalopathy: An Italian National Structured Survey.

Pathogenic loss-of-function variants in the IQ motif and SEC7 domain containing protein 2 (IQSEC2) gene cause intellectual disability with Rett syndrome (RTT)-like features. The aim of this study was to obtain systematic information on the natural history and extra-central nervous system (CNS) manifestations for the Italian IQSEC2 population (>90%) by using structured family interviews and semi-quantitative questionnaires. IQSEC2 encephalopathy prevalence estimate was 7.0 to 7.9 × 10-7. Criteria for typical RTT were met in 42.1% of the cases, although psychomotor regression was occasionally evidenced. Genetic diagnosis was occasionally achieved in infancy despite a clinical onset before the first 24 months of life. High severity in both the CNS and extra-CNS manifestations for the IQSEC2 patients was documented and related to a consistently adverse quality of life. Neurodevelopmental delay was diagnosed before the onset of epilepsy by 1.8 to 2.4 years. An earlier age at menarche in IQSEC2 female patients was reported. Sleep disturbance was highly prevalent (60 to 77.8%), with mandatory co-sleeping behavior (50% of the female patients) being related to de novo variant origin, younger age, taller height with underweight, better social interaction, and lower life quality impact for the family and friends area. In conclusion, the IQSEC2 encephalopathy is a rare and likely underdiagnosed developmental encephalopathy leading to an adverse life quality impact.

Possible contribution of better maternal psychological well-being to the acquisition of sleeping through the night in infants during the early postpartum period.

The objective of this study was to elucidate whether better maternal psychological well-being contributes to the acquisition of "sleeping through the night" (STN) in infants during the early postpartum period. Fifty-two primiparous mothers completed the General Health Questionnaire-28 (GHQ-28) in the third trimester (prenatal) and when the conceptional ages of their babies reached 8-9 weeks (hereafter, 2 months), 12-13 weeks (3 months), and 16-17 weeks (4 months). They also recorded babies' nocturnal sleep patterns in a timetable for 5 consecutive days each month postpartum. "Regular STN" was defined when the mean of longest nocturnal sleep duration for 5 consecutive days was > 8 h or between 6 and 8 h with < 1.0 nocturnal awakenings. According to these criteria, a total of 14 infants (27 %) acquired regular STN at 4 months (referred to as "STN infants"), with STN infants showing a marked increase in longest nocturnal sleep duration and a decrease in nocturnal awakenings from 2 to 3 months of age. The mothers of STN infants demonstrated steady reductions in postnatal GHQ-28 scores and had significantly lower prenatal GHQ-28 scores compared with the mothers of non-STN infants (3.7 ± 3.0 vs. 6.4 ± 4.1, p = 0.027). In random forest models for binomial classification, both prenatal and postnatal (at 4 months) GHQ-28 scores were identified as significant covariates for distinguishing STN infants, and other important covariates, including weeks of delivery, stepfamily, birth weight of the infant, and maternal co-sleeping at bedtime, were selected. Among these covariates, maternal co-sleeping at bedtime had relatively stronger correlations with both STN infants (r = - 0.440) and prenatal maternal GHQ-28 scores (r = 0.377). In conclusion, because prenatal maternal psychological well-being was thought to predict the acquisition of STN in infants, infants born from mothers with better psychological well-being appear to have some advantages in acquiring STN. These cross-lagged correlations suggest that the pathway from mothers to infants may be mediated by certain parenting behaviors, such as maternal co-sleeping at bedtime.

How do infant feeding method, sleeping location, and postpartum depression interact with maternal sleep quality?

New mothers generally experience poor and/or disrupted sleep. A range of infant care and mental health factors may impact new mothers' sleep quality. A cross-sectional online survey was completed by a sample of 101 Australian new mothers with children under 12 months (M = 5.52 months, SD = 3.29 months) to examine the relationship between infant feeding method, infant sleeping location, and postpartum depression with maternal sleep quality. Subjective maternal sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and postpartum depression was measured using the Edinburgh Postpartum Depression Scale (EPDS). Overall, new mothers experienced poor subjective sleep quality, with high average PSQI scores, above the cut-off of 5 (M = 9.63, SD = 4.07). The majority of new mothers did not experience postpartum depression, with an average EPDS score below the cut-off of 11 (8.66, SD = 5.20). Mothers who breastfed their infants experienced significantly better subjective sleep quality than mothers who bottle-fed, with a medium effect size (ηp2 = 0.458). Subjective maternal sleep quality did not differ based on infant sleeping location. Poor subjective maternal sleep quality was a significant predictor of postpartum depression. While poor sleep was common in this sample of Australian new mothers, this study demonstrated that new mothers who breastfeed may experience slightly better subjective sleep quality than other feeding methods. Further research into, and better services for the education and advocation of, new mothers' sleep quality will be beneficial to both new mothers and clinicians.

Sleeping Like a Baby: An Investigation of Bed-Sharing, Co-Sleeping, and Breastfeeding Among Pregnant Adults During the COVID-19 Pandemic.

Introduction: Given the lack of clarity in the literature related to the impact of breastfeeding intentions on sleeping practices, the current research aimed to investigate the relationship between co-sleeping or bed-sharing and breastfeeding intentions among a sample of pregnant adults, during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Pregnant adults from a large nationally representative sample, responded to a one-time, online Qualtrics survey between October and November 2020. Pregnant adults (n = 544) were asked closed and open-ended questions about their family characteristics, sociodemographic factors, sleeping and breastfeeding habits, and intentions. This protocol was approved by the Wesleyan University Institutional Review Board. Results: Bed-sharing (odds ratio [OR] = 2.47) and co-sleeping (OR = 3.52) intentions doubled and tripled, respectively, intentions to breastfeed at 3 months. Additionally, income at some higher levels (i.e., $150,000+/year) significantly increased breastfeeding intentions at 3 months compared with the lowest income category (OR = 5.74, p = 0.011). There was also a significant relationship between intentions to bed-share (OR = 2.96, p = 0.012) and co-sleep (OR = 3.62, p < 0.001) with breastfeeding at 6 months. Prior breastfeeding experience was significantly associated with breastfeeding intention at 6 months (OR = 1.88, p = 0.035). Based on the qualitative findings, breastfeeding ease was by far the most common motivation for co-sleeping or bed-sharing, followed by security/safety, closeness, and past experience. Conclusion: Plans to bed-share and co-sleep, significantly increased the odds of breastfeeding intentions up to 6 months postpartum. Supporting breastfeeding should include conversations about parent-infant sleeping modality, style, and preference. Future research is necessary to understand the directional impacts of these decisions and the predictive role of prenatal intentions on postpartum behaviors in this context.

Increased Sleep Latency and Decreased Sleep Duration are Associated With Elevated Risk of Bed Sharing Among Mother-Infant Dyads.

Bed sharing increases risk of sleep-related infant deaths. We hypothesized that infant sleep difficulties increase bed sharing, independent of social determinants of health (SDOH). In total, 191 mother-infant dyads in a prospective, longitudinal cohort study completed the Brief Infant Sleep Questionnaire at 1, 4, 6, and 12 months. Sleep characteristics at 1 month (latency, duration, night awakenings) were compared between dyads with/without bed sharing in the first 12 months. Infants who participated in bed sharing slept fewer hours at night (7.1 ± 1.7 hours vs 8.3 ± 1.5 hours, P = .001, d = -0.79), and took longer to fall asleep (0.7 ± 0.6 hours vs 0.5 ± 0.5 hours, P = .021, d = 0.43), even when controlling for SDOH variables that influence bed sharing. Maternal perception of sleep problems did not differ between groups (P = .12). Our findings suggest that infants with quantifiable sleep difficulties at 1 month are more likely to bed share.

Neck Hair-Thread Tourniquet Syndrome by Co-sleeping With Family: A Case Report and Literature Review.

Neck hair-thread tourniquet syndrome (NHTTS) is a rare condition that can be a pediatric emergency, occurring when a hair or thread becomes tightly wrapped around a body part, leading to vascular or tissue damage. NHTTS commonly affects infants and young children and can result in severe complications if not promptly diagnosed and treated. The unusual nature of this event, the diffuse petechial hemorrhage on the face, and the presentation of ligature marks extending around the neck led us to admit the child to the general pediatric ward for follow-up and further investigation of the possibility of non-accidental trauma. Co-sleeping is a common cultural practice in Japan where parents sleep in close proximity to their infants. This case report aims to raise awareness among pediatricians and parents about the possibility of NHTTS occurring in infants who co-sleep, particularly when a strand of hair becomes entangled around their neck, about the early detection and appropriate management of NHTTS. And we also summarize the reported NHTTS cases.

Co-Sleeping as a Protector against Malocclusion in the Primary Dentition: A Cross-Sectional Study.

Mothers practice co-sleeping and breastfeeding simultaneously, for convenience and to strengthen bonding. Due to the scarcity of studies analyzing the impact of co-sleeping on primary dentition, this study aimed to analyze the possible effects of co-sleeping on children's occlusion. In this cross-sectional study, mothers of 221 children aged 2−5 years who had been breastfed for less than 6 months completed a questionnaire about non-nutritive sucking habits. The WHO (World Health Organization) and IOTN-AC indices (the Aesthetic Component of the Index of Orthodontic Treatment Need) were used to assess malocclusion. The type of sagittal (dental and skeletal), transverse and vertical malocclusion was recorded. The non-co-sleeping group showed significantly higher pacifier use (p < 0.05), digital sucking (p < 0.05) and atypical swallowing (p < 0.05) habits. The non-co-sleeping group showed significantly higher mean scores on the IOTN-AC (p < 0.05) and WHO (p < 0.01), a significantly higher presence of canine class II (p < 0.05), anterior open bite (p < 0.05), posterior crossbite (p < 0.05), overbite (p < 0.05), skeletal class II (p < 0.01) and protrusion (p < 0.05). In conclusion, children who practice co-sleeping appear to have a lower frequency and duration of non-nutritive sucking habits. Co-sleeping may contribute to a lower development of malocclusions in children who are weaned early (before six months of age).

Using complexity science to understand the role of co-sleeping (bedsharing) in mother-infant co-regulatory processes.

Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a "complex adaptive system" (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.

Reasons mothers bedshare: A review of its effects on infant behavior and development.

Bedsharing is controversial for nighttime caregiving in the U.S. today, as in most of the West. However, from the standpoint of evolutionary pediatrics, anthropology, and cultural psychology, bedsharing is not controversial at all, representing the context for human infant evolution and conferring a host of physiological benefits to the infant as well as the mother. In an effort to understand the rise in Western bedsharing in recent decades (and following Ball, 2002; McKenna & Volpe, 2007), Salm Ward (2015) systematically reviewed the literature on mother-infant bedsharing and identified ten reasons why mothers choose to bedshare: (1) breastfeeding, (2) comforting for mother or infant, (3) better/more sleep for infant or parent, (4) monitoring, (5) bonding/ attachment, (6) environmental reasons, (7) crying, (8) cultural or familial traditions, (9) disagree with danger, and (10) maternal instinct. The current paper offers the "review behind the review," highlighting the scientific evidence behind the reasons mothers give for their decision to bedshare, focusing on how mothers' decisions about infant sleep location influence infant behavior and development.

Napping alone in the snow and cuddling with mommy at night: An exploratory, qualitative study of Norwegian beliefs on infant sleep.

This study addresses Norwegian infants' sleeping places during the day and night. In the first part we asked the general public to indicate where they think infants should sleep by placing stickers on a depiction of different sleeping places. This revealed that infants were expected to predominantly sleep outside in a stroller during the day and either bedshare, room share or sleep independently from their parents at night. Interviews with Norwegian mothers confirmed these patterns and revealed that mothers emphasized the benefits of fresh air and being out in nature. They expressed valuing independence, though their opinions on how this could be achieved diverged, some proposing independent, other co-sleeping. Other outcomes of sleeping arrangements were rarely mentioned. Some, particularly mothers whose children bedshared or had different sleeping places from one night to the other or throughout the night, emphasized the infants' right to choose how to sleep. None of the mothers endorsed letting infants cry themselves to sleep but many mentioned the importance of the child feeling secure. We argue that the seemingly contradictory sleeping patterns is in line with cultural values for independence, social cohesion and a love of nature.

Sleep disorders in children with epilepsy. / Trastornos del sueño en niños con epilepsia.

INTRODUCTION: Children with epilepsy present greater prevalence of sleep disorders than the general population. Their diagnosis is essential, since epilepsy and sleep disorders have a bidirectional relationship. OBJECTIVE: Determine the incidence of sleep disorders and poor sleep habits in children with epilepsy. METHODS: We conducted a cross-sectional study of patients under 18 years of age with epilepsy, assessing sleep disorders using the Spanish-language version of the Sleep Disturbance Scale for Children (SDSC), and sleep habits using an original questionnaire. RESULTS: The sample included 153 patients. Eighty-four percent of our sample presented some type of sleep alteration. The most frequent alterations were sleep-wake transition disorders (53%), sleep initiation and maintenance disorders (47.7%), and daytime sleepiness (44.4%). In 70% of cases, the patients' parents reported that their child "slept well," although sleep disorders were detected in up to 75.7% of these patients. Many patients had poor sleep habits, such as using electronic devices in bed (16.3%), requiring the presence of a family member to fall asleep (39%), or co-sleeping or sharing a room (23.5% and 30.5%, respectively). Those with generalised epilepsy, refractory epilepsy, nocturnal seizures, and intellectual disability were more likely to present sleep disorders. In contrast, poor sleep habits were frequent regardless of seizure characteristics. CONCLUSIONS: Sleep disorders and poor sleep habits are common in children with epilepsy. Their treatment can lead to an improvement in the quality of life of the patient and his/her family, as well as an improvement in the prognosis of epilepsy.

Couple Relationships Are Associated With Increased REM Sleep-A Proof-of-Concept Analysis of a Large Dataset Using Ambulatory Polysomnography.

Background/Objectives: Rapid Eye Movement (REM) sleep is associated with memory consolidation and several health effects including stress response, mental health, and longevity. Recently, it has been shown that regularly co-sleeping couples have increased and stabilized REM sleep when co-sleeping as compared to sleeping individually. However, it remained unclear whether this is due to a specific effect of altering the usual sleeping environment by partner deprivation or due to a generalizable REM-sleep promoting effect of couple relationships. The present study aims to clarify this ambiguity. Methods: Married or never married individuals were taken from the Sleep Heart Health Study (n = 5,804) and matched regarding sociodemographic and health parameters. Matching was done using propensity score matching (1:1, nearest neighbor) and resulted in two groups of n = 69 each (married vs. never married). After confirmation of successful matching, samples were compared regarding REM sleep and other polysomnographic parameters (paired Students t-tests or Wilcoxon signed-rank tests). Results: Married individuals showed significantly higher levels of total and relative REM sleep as compared to never married individuals (all p's ≤ 0.003). Neither other sleep stages nor REM-sleep fragmentation differed between groups (all p's ≥ 0.29). Results regarding number of sleep cycles were ambiguous. Conclusion: This is the first between-subjects study to show that couple relationships are associated with increased REM sleep. This finding represents a necessary (but not sufficient) condition for the previously hypothesized self-enhancing feedback loop of REM sleep and sociality as well as for REM-sleep promotion as a mechanism through which couple relationships prevent mental illness.