The effect of nonrestorative sleep on incident hypertension 1-2 years later among middle-aged Hispanics/Latinos.

BACKGROUND: Insomnia is known to be a major risk factor for incident hypertension. Nonrestorative sleep (NRS), which refers to insufficiently rested sleep, has reported to associate with various diseases. This study aimed to investigate the longitudinal association between insomnia-related symptoms including NRS and incident hypertension 1-2 years later by age group (young, 18-39 years and middle-age, 40-64 years) using existing cohort data involving Hispanics/Latinos. METHODS: This study included 1100 subjects who had participated in both the Hispanic Community Health Study/Study of Latinos and its follow-up study, the Sueño Ancillary Study, and met additional eligibility criteria. Incident hypertension was assessed by self-reported history and/or the use of antihypertensives. The Women's Health Initiative Insomnia Rating Scale (WHIIRS) was used to evaluate insomnia-related symptoms (difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, difficulty returning to sleep, and NRS). Logistic regression analyses were conducted to assess the degree to which insomnia-related symptoms at baseline predicted incident hypertension. RESULTS: Among the participants (64% middle-aged, 36% young adults), 140 (12.7%) developed hypertension during the follow-up period. Among the sleep-related symptoms, only NRS predicted incident hypertension after adjusting for sociodemographic factors and physical condition (odds ratio: 1.88, 95% confidence interval: 1.10-3.21, p = 0.022) in middle-aged adults. None of the insomnia-related symptoms were associated with incident hypertension in the young adults. No association was found between WHIIRS-defined insomnia (total score ≥ 9) and incident hypertension in middle-aged adults or young adults. CONCLUSION: The present findings suggest the importance of focusing on NRS to help prevent the development of hypertension in middle-aged adults.

Enlarged rete pegs with excessive accumulation of melanosomes leading to darker aging spots revealed by histomorphological measurements of internal structures of the epidermis.

OBJECTIVE: Various histological studies of facial pigmented spot sites such as solar lentigo have been reported, but few studies have used quantitative indices by histomorphometric analysis of the internal structure of pigmented spot sites using non-invasive methods. In the present study, to quantitatively elucidate morphological changes in the epidermis in male, darker-pigmented spots and female, light-pigmented spots, indices that characterize the internal structure of the epidermis in pigmented spot sites were measured using in vivo confocal laser scanning microscopy (CLSM). METHODS: The darkness of pigmented spots on the cheeks of 69 women and 43 men was analysed using image analysis software. The L* value was calculated from RGB values obtained from facial images. The internal structures of pigmented spots on the cheeks of 13 subjects were observed by CLSM. Various parameters were measured using CLSM images from the surface of the stratum corneum to the bottom of the dermal papillae, including the thickness of the epidermis, melanosome content, and shape of the dermal papillae. RESULTS: Mean ΔL* values between pigmented spots and non-pigmented areas of male subjects were significantly increased in the 40s and 50s compared with those of female subjects. Conspicuous pigmented spots increased in the 40s in male subjects and the 50s in female subjects. In CLSM observations, significant increases in the thickness of the epidermis and melanosome content were confirmed in pigmented spots compared with surrounding non-pigmented areas. In particular, melanosome content in the male subject group with dark-coloured pigmented spots increased significantly to about eight times that of non-pigmented areas, and more than double that of the male subject group with light-coloured pigmented spots. CONCLUSION: From the measurements of quantitative parameters, morphological changes in the epidermis were clearly related to the surface colour tone of pigmented spots. Darker pigmented spot sites tended to show longer rete pegs in the epidermis. Accumulation of melanosomes in epidermal basal cells could be considered to increase with the degree of elongation of rete pegs at pigmented spot sites and, thus, induce darker pigmented spots.

OBJECTIF: Même si diverses études histologiques des taches pigmentées du visage, tels que les lentigos solaires, ont été publiées, il n'existe que peu d'études ayant utilisé des indices quantitatifs par analyse histomorphométrique de la structure interne des taches pigmentées via des méthodes non invasives. Dans la présente étude, afin d'expliquer quantitativement les changements morphologiques dans l'épiderme des taches pigmentées plus foncées chez l'homme et des taches pigmentées légères chez la femme, les indices qui caractérisent la structure interne de l'épiderme dans les taches pigmentées ont été mesurés par microscopie confocale à balayage laser (MCBL) in vivo. MÉTHODES: L'aspect foncé des taches pigmentées sur les joues de 69 femmes et 43 hommes a été analysé à l'aide d'un logiciel d'analyse d'images. La valeur L* a été calculée à partir des valeurs RVB obtenues des images du visage. Sur les joues de 13 sujets, les structures internes des taches pigmentées ont été observées par MCBL. Divers paramètres ont été mesurés à l'aide des images provenant de la MCBL, de la surface de la couche cornée jusqu'au bas des papilles dermiques, y compris l'épaisseur de l'épiderme, la teneur en mélanosome et la forme des papilles dermiques. RÉSULTATS: Les valeurs moyennes de ΔL* entre les zones de taches pigmentées et non pigmentées des hommes ont augmenté de manière significative chez les sujets dans la quarantaine et la cinquantaine par rapport aux valeurs des femmes. Chez les hommes, les taches pigmentées visibles ont augmenté dans la quarantaine, tandis qu'elles ont augmenté dans la cinquantaine chez les femmes. Dans les observations par MCBL, des augmentations significatives de l'épaisseur de l'épiderme et de la teneur en mélanosome ont été confirmées dans les zones de taches pigmentées par rapport aux zones de taches non pigmentées environnantes. Dans le groupe d'hommes présentant des taches pigmentées de couleur foncée en particulier, la teneur en mélanosomes a augmenté de façon significative jusqu'à environ 8 fois celle des zones non pigmentées, et jusqu'à plus du double de celle du groupe d'hommes présentant des taches pigmentées de couleur claire. CONCLUSION: D'après les mesures des paramètres quantitatifs, les changements morphologiques dans l'épiderme étaient clairement liés à la couleur à la surface des taches pigmentées. Les sites de taches pigmentées plus foncées montraient généralement des extensions des crêtes épidermiques dans l'épiderme. On pourrait envisager que l'accumulation de mélanosomes dans les cellules basales épidermiques augmente selon le degré d'allongement des crêtes épidermiques au niveau des sites de taches pigmentées, et entraîne ainsi des taches pigmentées plus foncées.

Associations of nonrestorative sleep and insomnia symptoms with incident depressive symptoms over 1-2 years: Longitudinal results from the Hispanic Community Health Study/Study of Latinos and Sueño Ancillary Study.

BACKGROUND: Nonrestorative sleep (NRS), defined as insufficiently rested or refreshed sleep, is considered to play an important role in the development of depression. The aim of this study is to investigate the predictive ability of insomnia-related symptoms, including NRS, for incident depressive symptoms (DEPs) in a longitudinal manner. METHODS: We used data of 1196 samples aged 18-64 years who participated in both the Hispanic Community Health Study/Study of Latinos conducted in 2008-2010 and the follow-up study (Sueño Ancillary Study) conducted in 2010-2013. DEPs and insomnia-related symptoms (difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], early morning awakening [EMA], difficulty returning to sleep [DRS], and NRS) were evaluated by the 10-item Center for Epidemiologic Studies Depression Scale and the Women's Health Initiative Insomnia Rating Scale, respectively. A logistic regression analysis was used to evaluate the predictive ability of each insomnia-related symptom at baseline for incident DEPs in couple-years. RESULTS: In the univariate logistic regression analysis, all insomnia-related symptoms had significant associations with incident DEPs (DIS, odds ratio [OR] = 1.6; DMS, OR = 1.6; EMA, OR = 1.5; DRS, OR = 1.9; NRS, OR = 2.5). After adjusting for sociodemographic factors and the confounding effects of other insomnia-related symptoms, only NRS (OR = 2.2, 95% confidence interval = 1.4-3.5, p = .001) was significantly associated with incident DEPs. CONCLUSIONS: NRS was a risk factor for incident DEPs, which includes a predictive ability for other insomnia-related symptoms. Our results suggest that focusing on NRS is an effective strategy for preventing depression in public health promotions.

Effects of Cognitive Behavioral Therapy for Insomnia on Subjective-Objective Sleep Discrepancy in Patients with Primary Insomnia: a Small-Scale Cohort Pilot Study.

BACKGROUND: Cognitive behavioral therapy for insomnia (CBT-I) is a first-line therapy for insomnia disorders. We assessed changes in discrepancies between subjective and objective sleep measures and correlations between discrepancy changes and clinical insomnia severity for CBT-I in patients with primary insomnia METHODS: Fifty-two outpatients (mean age, 60.3 years; 26 women) with primary insomnia were treated by individual CBT-I (50 min, maximum six sessions, once every 1-2 weeks). One week before and after CBT-I, patients recorded a sleep log and wore an actigraphy device. Subjective and objective time in bed (TIB), total sleep time (TST), sleep-onset latency (SOL), wake time after sleep onset (WASO), and sleep efficiency (SE) were evaluated by averaging 1-week records. Relative values of sleep discrepancy in TIB, TST, SOL, WASO, and SE were calculated for estimating effects of CBT-I. The therapeutic effects were also evaluated using psychological scales before and after CBT-I. RESULTS: Subjective and objective discrepancies in sleep measures decreased by 36, 25, and 37 min in TST, SOL, and WASO, respectively, and 7% in SE (all P < 0.001) after CBT-I. Seven patients transitioned from underestimating SE before CBT-I to overestimating SE after CBT-I. Although CBT-I improved relative values of discrepancy in WASO and SE, alongside ISI, the improvement in insomnia severity only correlated with SOL discrepancy. CONCLUSIONS: CBT-I may reduce the discrepancy between subjective and objective sleep measures in patients with primary insomnia. However, a greater therapeutic effect of CBT-I was observed in reducing the ISI, which was slightly influenced by improvements in sleep discrepancies.

Contribution of Somatosensory and Parietal Association Areas in Improving Standing Postural Stability Through Standing Plantar Perception Training in Community-Dwelling Older Adults.

Although standing plantar perception training (SPPT) may improve standing postural stability, the underlying neural mechanisms remain unclear. The authors investigated the relationship between regional cortical responses to SPPT using a balance pad and training outcomes in 32 older participants (mean ± SD:72.2 ± 6.0, range:60-87). Regional cortical activity was measured in the bilateral supplementary motor area, primary sensorimotor area, and parietal association area using near-infrared spectroscopy. Postural sway changes were compared before and after SPPT. Changes in two-point plantar discrimination and regional cortical activity during SPPT, associated with standing postural stability improvements, were examined using multiple regression and indicated improved standing postural stability after SPPT (p < .0001). Changes in right parietal association area activity were associated with standing postural stability improvements while barefoot. Overall, the results suggest that right parietal association area activation during SPPT plays a crucial role in regulating standing postural stability and may help develop strategies to prevent older adults from falling.

Bright light exposure advances consolidation of motor skill accuracy in humans.

Light has attracted increasing attention as a critical determinant of memory processing. While sleep selectively consolidates newly encoded memories according to their future relevance, the role of light in human memory consolidation is largely unknown. Here, we report how bright light (BL), provided during encoding, influences online and offline consolidation of motor skill learning. We sought to determine whether relatively slower and faster key-press transitions within individuals were differentially consolidated by BL. Healthy human subjects were briefly exposed to either BL (>8000 lx) or control light (CL; <500 lx) during memory encoding at 13:00 h, when light minimally affects circadian phase-shifting, and were retested 24 h later. The effects of BL on online and offline performance gains were determined by accuracy and speed. BL-exposed subjects showed better overall performance accuracy during training and lower overnight accuracy gains after a subsequent night of sleep than did CL-exposed subjects. BL preferentially improved the initially most difficult individual key-press transitions during practice; these were only improved overnight under CL. By contrast, accuracy during what had been the easiest key-press transitions at the beginning of the experiment was unaffected by light conditions or online/offline learning processes. BL effects were not observed for performance speed, mood, or sleep-wake patterns. Brief BL exposure during training may advance motor memory selection and consolidation that optimally meet individual requirements for potential gains, which would otherwise depend on post-training sleep. This suggests a new way of enhancing brain plasticity to compensate for impaired sleep-dependent memory consolidation in neuropsychiatric conditions.

COMT genotype is associated with plasticity in sense of body ownership: a pilot study.

The sense of body ownership constantly adapts to new environments, and awareness of a distinction between oneself and others is a fundamental ability. However, it remains unclear whether plasticity in the sense of body ownership is dependent on genetic factors. The present study investigated the influence of the catechol-O-methyltransferase (COMT) Val158Met genotype on illusory learning of a sense of body ownership and dissociation. 76 healthy Japanese participants experienced the rubber hand illusion (RHI), which is produced by sensory integration of conflicting modalities, with the intent to experimentally alter objective perceived locations and subjective ownership ratings. We found that Val/Val homozygous participants had more intense RHI experiences than Val/Met heterozygous and Met homozygous participants. Furthermore, RHI sensation was correlated with a dissociative personality trait in Val/Val homozygous participants. Our findings indicate an interaction between COMT genotype, RHI sensation, and dissociative personality traits: Val/Val genotypes were associated with RHI induction and greater vulnerability to dissociation. The findings suggest that Val/Val homozygous individuals may be more flexible regarding self-attribution/body ownership and that biological factors may contribute to reduced awareness regarding the distinction between self and others.

Self-awakening improves alertness in the morning and during the day after partial sleep deprivation.

The ability to awaken at a predetermined time without an alarm is known as self-awakening. Self-awakening improves morning alertness by eliminating sleep inertia; however, the effects of self-awakening on daytime alertness and alertness that has deteriorated as a result of sleep loss are unknown. The aim of this study was to determine the effects of self-awakening on both morning and daytime alertness after partial sleep deprivation. Fifteen healthy males without the habit of self-awakening participated in a cross-over trial including forced awakening and self-awakening conditions. In each condition, participants' sleep was restricted to 5 h per night in their homes for 4 consecutive days. They completed a psychomotor vigilance task and subjective ratings of sleepiness immediately upon awakening each morning. On the fourth day, participants completed subjective ratings of sleepiness, a psychomotor vigilance task and sleep latency tests in the laboratory seven times at 1-h intervals during the day. The response speed on the psychomotor vigilance task, in the morning and during the day, was higher in the self-awakening than the forced awakening condition. Our results showed that self-awakening improved alertness (assessed by response speeds) by reducing sleep inertia and alleviated daytime sleepiness heightened by partial sleep deprivation.

Development and validation of the Japanese version of the Bedtime Procrastination Scale (BPS-J).

BACKGROUND: The average sleep duration of Japanese people is shorter than that of people from other countries, and bedtime procrastination is suspected to be one of the factors contributing to this issue. This study aimed to develop and validate the Japanese version of the Bedtime Procrastination Scale (BPS-J). METHODS: The BPS-J was developed through procedures including the translation and back-translation of the scale, cognitive interviews with 100 participants who reported having experiences of being diagnosed with insufficient sleep syndrome (ISS) or receiving treatment for ISS using open-ended online questionnaires, and expert checking. To investigate the scale's validity and reliability, an online survey was conducted with daytime workers aged 20 - 65 years without a history of sleep disorders other than ISS. Half the participants were retested using the same survey after 14 days. Participants' responses to the Brief Self-Control Scale (BSCS), General Procrastination Scale (GPS), and Munich ChronoType Questionnaire (MCTQ), and data on sleep-related variables such as sleep duration on workdays and the days per week of fatigue or sleep loss, sex, and age, were collected. RESULTS: We analyzed data from 574 participants to assess scale validity. We then analyzed data from 280 participants to determine test-retest reliability. Confirmatory factor analyses revealed that the two-factor model without Item 2 was most suitable for the BPS-J, unlike other language versions. Regardless of the full-item model or the model with Item 2 eliminated, sufficient reliability and significant correlations with the BSCS, GPS, MCTQ, and sleep-related variables such as sleep duration per night on work days, days per week of feeling fatigued, and days per week of sleep loss were observed. Logistic and linear regressions showed that the relationships between the BPS-J, sleep-related variables, and MCTQ were maintained after adjusting for sex and age. CONCLUSION: The BPS-J had sufficient validity and reliability. Further, eliminating Item 2 from the original version of the BPS strengthened the ability to survey Japanese daytime workers.

Association of COVID-19 preventive behavior and job-related stress with the sleep quality of healthcare workers one year into the COVID-19 outbreak: a Japanese cross-sectional survey.

BACKGROUND: This study aimed to evaluate the association of COVID-19 preventive behavior and job-related stress with sleep quality among healthcare workers (HCWs). We conducted a cross-sectional survey using a questionnaire at the National Center of Neurology and Psychiatry, Tokyo, Japan. METHODS: A total of 586 participants who completed the questionnaire were eligible for the study. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. We examined the level of engagement between poor sleep and COVID-19-related infection preventive behaviors, such as avoiding closed spaces, crowded places, and close contact (three Cs), a distance of at least one meter from others, wearing a face mask regularly, washing hands regularly, and working remotely, as well as job-related stress in the work environment, exposure to patients, potential risk of infection, fear of infecting others, need for social confinement, and financial instability. We conducted a hierarchical logistic regression analysis to examine the relationship between poor sleep and COVID-19 preventive behavior, job-related stress, and other covariates, including age, sex, and the Kessler Psychological Distress Scale (K6), which was used to measure non-specific psychological distress. RESULTS: Poor sleep was observed in 223 (38.1%) participants. Adherence to COVID-19 preventive measures was relatively high: 84.1% of participants answered "always" for wearing a face mask regularly and 83.4% for washing hands regularly. In the multivariate logistic regression analysis, stress in the work environment (odds ratio [OR] = 2.09, 95% confidence interval [CI], 1.37-3.20; p < 0.001), financial instability (OR = 1.73, 95% CI, 1.12-2.67; p < 0.05), and low adherence to working remotely (OR = 1.65, 95% CI, 1.06-2.57; p < 0.05) were independently and significantly associated with poor sleep after controlling for the covariates. CONCLUSIONS: One year into the COVID-19 pandemic, the poor sleep rates of HCWs remained high. These results emphasize the need to protect HCWs from work environment stress and financial concerns.

Treatment strategies for insomnia in Japanese primary care physicians' practice: A Web-based questionnaire survey.

BACKGROUND: It is unclear how primary care physicians manage insomnia after the introduction of novel hypnotics such as orexin receptor antagonists and melatonin receptor agonists. This Web-based questionnaire survey aimed to examine treatment strategies for insomnia in Japanese primary care practice. METHODS: One-hundred-and-seventeen primary care physicians were surveyed on the familiarity of each management option for insomnia on a binary response scale (0 = "unfamiliar"; 1 = "familiar") and how they managed insomnia using a nine-point Likert scale (1 = "I never prescribe/perform it"; 9 = "I often prescribe/perform it"). Physicians who were unfamiliar with a management option were deemed to have never prescribed or performed it. RESULTS: Regarding medication, most physicians were familiar with novel hypnotics. Suvorexant was the most used hypnotic, followed by lemborexant and ramelteon. These novel hypnotics averaged 4.8-5.4 points and 4.0-4.7 points for sleep onset and sleep maintenance insomnia, respectively. By contrast, most benzodiazepines were seldom used below two points. Regarding psychotherapy, only approximately 40% of the physicians were familiar with cognitive behavioral therapy for insomnia (CBT-I) and they rarely implemented it, at an average of 1.5-1.6 points. More physicians were familiar with single-component psychotherapies (i.e., relaxation, sleep restriction therapy, and stimulus control) compared to CBT-I, and 48-74% of them implemented it slightly more often, with scores ranging from 2.6 to 3.4 points. CONCLUSION: This study suggests that Japanese primary care physicians seldom use CBT-I to treat insomnia. In addition, they use novel sleep medications more frequently than benzodiazepines in terms of pharmacotherapy. The use and availability of CBT-I in Japanese primary care might be facilitated by: educating primary care physicians, implementing brief or digital CBT-I, and/or developing collaborations between primary care physicians and CBT-I specialists.

Longitudinal assessment of lifestyle factors associated with nonrestorative sleep in Japan.

OBJECTIVE: Nonrestorative sleep (NRS) is common in the general global population. This study surveyed the incident/remission rate of NRS and identified related lifestyle factors in a general Japanese adult cohort. METHODS: Data from a Japanese health check-based cohort between the fiscal years 2011 and 2018 were obtained. NRS was assessed through a single item question, and socio-demographic and clinical data were assessed through self-reports. To identify potential correlates of NRS incidence/remission, Cox regression analysis (or survival analysis) was performed. RESULTS: Among the 135 609 individuals surveyed at baseline, data from 93 548 were considered for analysis. NRS exhibited incidence and remission rates of 11.3% and 15.4%, respectively. New NRS incidence was predicted by eating fast (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.04-1.10), dining close to bedtime (HR: 1.33, 95% CI: 1.27-1.38), midnight snacking (HR: 1.09, 95% CI: 1.04-1.13), skipping breakfast (HR: 1.16, 95% CI: 1.10-1.22), non-regular exercise (HR: 1.12, 95% CI: 1.07-1.17), lower levels of physical activity (HR: 1.19, 95% CI: 1.14-1.24), and slow walking speed (HR: 1.34, 95% CI: 1.29-1.39), while heavy drinking was less predictive of NRS. However, the same factors (except for heavy drinking) were found to predict NRS remission. CONCLUSIONS: We found that unhealthy lifestyle behaviors, particularly dining close to bedtime and slow walking speed, were positively associated with NRS incidence, while they were negatively associated with NRS remission. These results can be useful in developing more effective health promotion policies to achieve good sleep.

A prospective study of the association of weekend catch-up sleep and sleep duration with mortality in middle-aged adults.

Health effects of weekend catch-up sleep (CUS) could differ depending on both the ability to obtain sufficient sleep during weekdays and amount of weekend CUS required to compensate for sleep lost during the week. Using data from 3128 middle-aged (40-64 years) participants of the Sleep Heart Health Study, we examined the longitudinal association of these two aspects of sleep with all-cause mortality. CUS was calculated as the difference in self-reported habitual sleep duration between weekends and weekdays, and classified into no, short (1 h), and long (2 h or more) CUS. Polysomnography-measured total sleep time, representing the ability to obtain sufficient sleep, was classified into short (< 360 min) or normal (≥ 360 min) sleep durations. We estimated multivariable-adjusted mortality hazard ratios (HRs) and 95% confidence intervals (CIs) for six groups divided by the extent of CUS and sleep duration. Participants were followed up for a median (interquartile range) of 12.3 (11.3-13.5) years. Short weekend CUS with normal sleep duration was associated with lower mortality compared to no CUS with normal sleep duration (HR, 0.48; 95% CI 0.27-0.83). When stricter cutoffs were applied for sleep durations, while the protective effect of short CUS with normal sleep duration (≥ 390 min) was strengthened (HR, 0.36; 95% CI 0.17-0.78), the harmful effect of short CUS with short sleep duration (< 330 min) emerged (HR, 1.84; 95% CI 1.08-3.14). Results highlight the importance of balancing sleep ability and CUS. Sufficient sleep may reduce weekday sleep debt and only a short CUS would be required on weekends, improving mortality in middle-aged adults. Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-023-00460-6.

Treatment of sleep-related eating disorder with suvorexant: A case report on the potential benefits of replacing benzodiazepines with orexin receptor antagonists.

Background: Nocturnal eating behavior in patients with sleep-related eating disorder (SRED) is difficult to control and can become chronic, causing weight gain and psychological distress. Here, we report a case of SRED comorbid with major depressive disorder successfully treated by switching from brotizolam to suvorexant, that is, from a benzodiazepine to an orexin receptor antagonist. Case Presentation: A 25-year-old woman complained of night snacking with partial/complete amnesia and sleepwalking for 1 year. She had a diagnosis of major depressive disorder at age 20 and was on paroxetine and brotizolam for depression and insomnia. At 24 years of age, she experienced her second depressive episode, then her amnestic nocturnal eating became prominent. Even after improvement in depressive symptoms, she experienced uncontrollable nocturnal eating episodes every 2 days, resulting in weight gain of over 10 kg. After a partial amnestic eating episode following an awakening from stage N2 sleep was confirmed through video polysomnography, she was diagnosed with SRED. Considering her strong desire to resolve involuntary eating, we instructed her to discontinue brotizolam and start suvorexant. Subsequently, her nocturnal eating completely disappeared. She experienced rebound insomnia, which improved within 1 month. She was then continued on 10 mg of suvorexant and has not experienced nocturnal eating for 2 years. Conclusion: This case highlights the importance of discontinuing benzodiazepines in the treatment of SRED, but also suggests the potential benefit of orexin receptor antagonists in the treatment of SRED. The efficacy of orexin receptor antagonists in idiopathic SRED should be tested in future studies.

Effect of discontinuation of lemborexant following long-term treatment of insomnia disorder: Secondary analysis of a randomized clinical trial.

Discontinuing long-term pharmacotherapy for insomnia can result in rebound insomnia or withdrawal symptoms and suboptimal treatment. Post hoc analyses evaluated rebound insomnia and withdrawal symptoms among the subset of subjects from a phase III, 12-month, global, multicenter, randomized, double-blind, parallel-group study who completed 12 or 6 months of active treatment and follow-up period. Study E2006-G000-303 (Study 303) included adults (N = 655) with subjective sleep-onset latency ≥30 min and/or subjective wake-after-sleep onset ≥60 min at least three times weekly during the 4 weeks before enrollment. Subjects were randomized 1:1:1 to lemborexant 5 mg (LEM5) or 10 mg (LEM10) or placebo for 6 months. Thereafter, for an additional 6 months, LEM5- and LEM10-treated subjects continued lemborexant and the placebo group was rerandomized 1:1 to LEM5 or LEM10. Month 12 was followed by abrupt discontinuation and a 2-week end-of-study follow-up. Using daily electronic sleep diaries, patients reported (subjective) sleep end points (sleep-onset latency, wake-after-sleep onset, sleep efficiency, and total sleep time). Withdrawal symptoms were assessed using the Tyrer Benzodiazepine Withdrawal Symptoms Questionnaire (T-BWSQ). Sleep outcome improvements with lemborexant at month 12 were generally maintained throughout the 2-week off-treatment period wherein <20% of subjects experienced significant worsening of insomnia symptoms versus screening. There was no evidence of withdrawal symptoms by T-BWSQ following lemborexant discontinuation. This analysis demonstrates rebound insomnia is unlikely to occur with lemborexant, and its effectiveness is maintained after abrupt discontinuation without placebo replacement following 6-12 months of treatment.

Nonrestorative sleep is a risk factor for metabolic syndrome in the general Japanese population.

BACKGROUND: This longitudinal study aimed to investigate the effects of nonrestorative sleep on developing metabolic syndrome (MetS) and related diseases in a general Japanese middle-aged population. METHODS: Overall, 83,224 adults without MetS (mean age: 51.5 ± 3.5 years) from the Health Insurance Association in Japan were followed up for a maximum of 8 years between 2011 and 2019. The Cox proportional hazard method was used to determine whether nonrestorative sleep, assessed using a single-item question, was significantly associated with the respective development of MetS, obesity, hypertension, diabetes, and dyslipidemia. The MetS criteria were adopted by the Examination Committee for Criteria of Metabolic Syndrome in Japan. RESULTS: The mean follow-up duration was 6.0 years. The incidence rate of MetS was 50.1 person-years/1,000 during the study period. Data suggested that nonrestorative sleep was associated with MetS (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.08-1.16) and other disorders, such as obesity (HR: 1.07, 95% CI: 1.02-1.12), hypertension (HR: 1.07, 95% CI: 1.04-1.11), and diabetes (HR: 1.07, 95% CI: 1.01-1.12) but not with dyslipidemia (HR: 1.00, 95% CI: 0.97-1.03). CONCLUSIONS: Nonrestorative sleep is associated with the development of MetS and many of its core components in the middle-aged Japanese population. Therefore, assessing nonrestorative sleep may help identify individuals at a risk of MetS development.

Corrigendum: Decrease in social zeitgebers is associated with worsened delayed sleep-wake phase disorder: findings during the pandemic in Japan.

[This corrects the article DOI: 10.3389/fpsyt.2022.898600.].

Correction to: Comparison of the usability of an automatic sleep staging program via portable 1-channel electroencephalograph and manual sleep staging with traditional polysomnography.

[This corrects the article DOI: 10.1007/s41105-022-00421-5.].

Comparison of the usability of an automatic sleep staging program via portable 1-channel electroencephalograph and manual sleep staging with traditional polysomnography.

Automatic algorithms are a proposed alternative to manual assessment of polysomnography data for analyzing sleep structure; however, none are acceptably accurate for clinical use. We investigated the feasibility of an automated sleep stage scoring system called Sleep Scope, which is intended for use with portable 1-channel electroencephalograph, and compared it with the traditional polysomnography scoring method. Twenty-six outpatients and fourteen healthy volunteers underwent Sleep Scope and polysomnography assessments simultaneously. Polysomnography records were manually scored by three sleep experts. Sleep Scope records were scored using a dedicated auto-staging algorithm. Sleep parameters, including total sleep time, sleep latency, wake after sleep onset, and sleep efficiency, were calculated. The epoch-by-epoch pairwise concordance based on the classification of sleep into five stages (i.e., wake, rapid eye movement, N1, N2, and N3) was also evaluated after validating homogeneity and bias between Sleep Scope and polysomnography. Compared with polysomnography, Sleep Scope seemed to overestimate sleep latency by approximately 3 min, but there was no consistent tendency in bias in other sleep parameters. The Κ values ranged from 0.66 to 0.75 for experts' inter-rater polysomnography scores and from 0.62 to 0.67 for Sleep Scope versus polysomnography scores, which indicated sufficient agreement in the determination of sleep stages based on the Landis and Koch criteria. We observed sufficient concordance between Sleep Scope and polysomnography despite lower concordance in sleep disorder patients. Thus, this auto-staging system might serve as a novel clinical tool for reducing the time and expenses required of medical staff and patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-022-00421-5.