Improvement in sleep latency with extended-release once-nightly sodium oxybate for the treatment of adults with narcolepsy: Analysis from the phase 3 REST-ON clinical trial

Background
In the REST-ON clinical trial (NCT02720744), mean sleep latency on the Maintenance of Wakefulness Test (MWT) was significantly improved with extended-release once-nightly sodium oxybate (ON-SXB) vs placebo (P < 0.001) in participants with narcolepsy. This post hoc analysis assessed response to treatment and improvement in excessive daytime sleepiness.
Methods
Participants with narcolepsy aged >=16 years were randomized 1:1 to receive ON-SXB (4.5 g, week 1; 6 g, weeks 2-3; 7.5 g, weeks 3-8; and 9 g, weeks 9-13) or placebo. Mean sleep latency on the MWT was measured across 5 trials of <=30 min each. Post hoc assessments included percentage of participants whose sleep latency improved >=5, >=10, >=15, and >=20 min and with a mean sleep latency of 30 min.
Results
Significantly more participants receiving ON-SXB vs placebo experienced increased mean sleep latency >=5 min (all doses P < 0.001), >=10 min (all doses P < 0.001), >=15 min (6 and 7.5 g, P < 0.001; 9 g, P < 0.01), and >=20 min (6 g, P < 0.01; 7.5 g, P < 0.001; 9 g, P < 0.05). More participants receiving ON-SXB had mean sleep latency of 30 min vs placebo (6 g, 5.7 % vs 0 %, respectively [P < 0.05]; 7.5 g, 10.5 % vs 1.3 % [P < 0.05]; 9 g, 13.2 % vs 5.1 % [P = 0.143]).
Conclusions
Significantly more participants who received ON-SXB experienced increased mean sleep latency >=5 to >=20 min; at the 2 highest doses, >10 % remained awake for the entirety of the MWT. ON-SXB offers a once-at-bedtime treatment option for adults with narcolepsy.

Thorpy, M. J., Kushida, C. A., Bogan, R., Winkelman, J., Ohayon, M. M., Shapiro, C. M., Gudeman, J. "Improvement in sleep latency with extended-release once-nightly sodium oxybate for the treatment of adults with narcolepsy: Analysis from the phase 3 REST-ON clinical trial." SLEEP MEDICINE: X (2024); 7:100113. https://doi.org/10.1016/j.sleepx.2024.100113

Overlap between Hypersomnia and Hypersomnolence and its Consequences on Diagnosis Identification.

March 23rd, 2024, EVAL Research Institute (EVALRI), Carmichael.
Background: Idiopathic Hypersomnia (IH) and Narcolepsy are rare diseases with a classical prevalence around 0.02% and 0.04% respectively in the general population. In the past few years, higher estimates were published and challenged the rare disease status, jeopardizing the attribution of orphan drug designation for new treatments of narcolepsy.
Objectives:

• To present and discuss past and current studies on prevalence and incidence of IH and Narcolepsy.
• To discuss current categorization of the diagnosis of Narcolepsy and IH inside of the classifications and how it impacts their prevalence.
• To examine the symptomatological association of sleepiness, sleep attacks and cataplexy with hypnagogic and hypnopompic hallucinations, sleep paralysis, and sleep inertia.
• To define sleepiness in terms of severity, evolution, through new tools able to evaluate the impact on vigilance and psychosocial life.
• Finally, to write a report on the actual epidemiological status on these different topics and to present a consensus for their categorization under the form of a position paper or white paper.

Efficacy outcomes among male and female participant subgroups: a post hoc analysis from Rest-On.

Thorpy, M., Ajayi, A., Corser, B., Kushida, C., Ohayon, M., Bogan, R., Gudeman, J.
OXFORD UNIV PRESS INC. 2024.

[Health consequences of insomnia].

[Article in French]
Ohayon, M. M.
La Revue du praticien, 2024; 74 (3): 268-269.

Short or Long Sleep Duration and its Link with Mood, Psychomotor and Immune Disorders.

January 13th, 2024, EVAL Research Institute (EVALRI), Carmichael.
Background: Duration of Sleep has a heavy impact not only on the quality of vigilant states, anxious and thymic rhythms but also on biological states such as immune responses. Short or Long Sleep duration may be identified by disorders like insomnia or hypersomnia. However, Sleepiness is the best symptom to express the struggle between being Asleep or Awake.
Objective: This Symposium has for objective to be a place where psychiatrists, psychologists, mental health specialists, psychopharmacologists may meet to discuss what they could bring in terms of diagnosis, treatment and support.
Focus: This Symposium will focus on Insomnia, Hypersomnia and Hypersomnolence and will look at their relationship with Depression. Are they predictors? Are they only a part of the depression? Do they define clinical forms of Depression? Are they modifying the answer to the antidepressant treatment? Are they an indication for specific antidepressant molecules? All these questions need longitudinal studies which will be appropriate to define prevalence, incidence and natural evolution of Depression.
Visit @EVALRI YouTube channel for recorded presentations.

Prevalence and incidence of narcolepsy symptoms in the US general population

Background
Objective: The objectives of this study are to evaluate the prevalence and incidence of Narcolepsy type 1 and type 2 and to determine the prevalence of narcolepsy diagnosis criteria in the US general population.
Methods: This longitudinal study was conducted in the adult US general population in two occasions. The initial interviews included 15 states (Arizona, California, Colorado, Florida, Idaho, Missouri, New York, North Carolina, North Dakota, Oregon, Pennsylvania, South Dakota, Texas, Washington, and Wyoming). The follow-up interviews, was done three years later in eight of these states. Of the 19,136 contacted individuals, 15,929 completed the initial interview and 10,931 completed the follow-up. Participants were interviewed using the Sleep-EVAL system, an artificial intelligence tool. Narcolepsy Type 1 (with cataplexy) and Narcolepsy Type 2 (without cataplexy) were defined according to the ICSD-3 classification. Symptoms of narcolepsy were assessed by frequency per week and duration. Medical visits and diagnoses were also collected.
Results: Participants were aged between 18 and 102 years of age (mean 45.8 +- 17.9 years), 51.3 % were women. The prevalence of narcolepsy with cataplexy was 12.6 per 100,000 individuals (95 % C.I., 0 to 30) and narcolepsy without cataplexy was 25.1 per 100,000. The incidence per year was 2.6 per 100,000 individuals (95 % C.I., 0 to 11).
Conclusions: Narcolepsy is a rare condition affecting 37.7/100,000 individuals (126,191 individuals in the current US population). Our US general population prevalence is in line with rates found in community-based studies but lower than what is reported in claim database studies.

Ohayon, M. M., Duhoux, S., Grieco, J., Cote, M. L. "Prevalence and incidence of narcolepsy symptoms in the US general population." Sleep Med X. 2023 Nov 30:6:100095. doi: 10.1016/j.sleepx.2023.100095. eCollection 2023 Dec 15.PubMedID 38149177.

How Studying Anxiety, Irritability and Anhedonia Improves the Knowledge of Depression.

November 4th, 2023, EVAL Research Institute (EVALRI), Carmichael.
Background: Depression is a mood variation very well known by everyone of us: we all at some moments of our life live it personally or for one of our loved ones. Depression is better defined by the suffering: we know that suffering could be psychological, but it could be also physical. Depression could generate anxiety, irritability, lack of pleasure and interest. At its extreme, it could become a mode of life: anhedonia may represent a lack of motivation, of pleasure, of interest in any kind of relationship.
Objective: This Symposium has for objective to be a place where psychiatrists, psychologists, mental health specialists, psychopharmacologists may meet to discuss what they could bring in terms of diagnosis, treatment and support.
Focus: This Symposium will focus on Anxiety, Irritability and Anhedonia and will look at their relationship with Depression. Are they predictors? Are they only a part of the depression? Do they define clinical forms of Depression? Are they modifying the answer to the antidepressant treatment? Are they an indication for specific antidepressant molecules? All these questions need longitudinal studies which will be appropriate to define prevalence, incidence and natural evolution of Depression.
Visit @EVALRI YouTube channel for recorded presentations.

Institute For Orphan and Rare Diseases (IFORD) Inaugural Symposium.

July 21st-22nd, 2023, EVAL Research Institute (EVALRI), Carmichael.
The mission of IFORD is to contribute to the study of orphan and rare diseases by using AdInfer AI system to address specific challenges associated with very small numbers of individuals with specific diseases in the general population.
More specifically, its goals are to:

• Study the prevalence and incidence of rare diseases in the general population.
• Foster innovative research for the screening and early detection of rare diseases.
• Contribute to the development of treatments.
• Generate insights for public health and regulatory considerations.

Visit @IFORD symposia YouTube channel for recorded presentations.

Improvement in sleep latency with FT218 (once-nightly sodium oxybate): analysis from the phase 3 Rest-on clinical trials.

Thorpy, M., Shapiro, C., Kushida, C., Ohayon, M., Dubow, J., Gudeman, J.
OXFORD UNIV PRESS INC. 2023.

Prevalence and incidence of narcolepsy in the US general population.

Ohayon, M., Cote, M.
OXFORD UNIV PRESS INC. 2023: A256.

Natural evolution of insomnia in Major Depressive Disorders.

Ohayon, M., Cote, M.
OXFORD UNIV PRESS INC. 2023.

The effect of brain-derived neurotrophic factor Val66Met polymorphism on adolescent activity and rest rhythms, circadian preferences and attentional performance.

Background: Variations in circadian regulating mechanisms generate different individual preferences in respect of sleep and activity timing, which are known as chronotypes. In this sense, specifically during adolescence, there is a greater tendency for an eveningness chronotype. One factor that has been shown to have an impact on circadian rhythm patterns, as well as on some aspects of cognitive function, is the relatively common Val66Met (rs6265) polymorphism in the human brain-derived neurotrophic factor gene.
Objective: This study aimed to evaluate the effect of the BDNF Val66Met polymorphism on the performance of adolescents in attentional tests, circadian preferences and activity-rest rhythm.
Methods: 85 healthy high school students completed the Morningness-Eveningness Questionnaire to assess their circadian preferences; were evaluated using the Psychological Battery for Attention Assessment; and were categorized as carriers and non-carriers of the rs6265 polymorphism using the TaqMan rt-PCR technique. A subsample of 42 students had their activity/rest rhythm recorded by actigraphy for nine days from which sleep parameters were estimated.
Results: Circadian preference did not affect attentional performance (p > 0.1), but the time that the students attended school had an impact on all types of attention with morning shift students scoring higher, regardless of chronotype (p < 0.05). The presence of the BDNF Val66Met polymorphism was associated only with alternate attention performance (p < 0.05). Regarding actigraphy evaluation, the carriers of the polymorphism demonstrated significantly higher total time in bed, total sleep time, social jetlag, and earlier sleep onset.
Conclusions: The results indicate some degree of adaptation in the students' attentional performance, according to their school schedules. The presence of BDNF polymorphism demonstrated a counterintuitive impact on attentional performance, comparing to previous findings. The findings reinforce the effect of genetic traits on sleep-wake rhythm parameters, when objectively evaluated.

da Costa Lopes, L., Rollemberg Poyares, D. L., Tufik, S., La Banca de Oliveira, S., Ribeiro da Silva Vallim, J., Kiyomi Ota, V., Melaragno, M. I., Ohayon, M., Berlim de Mello, C. "The effect of brain-derived neurotrophic factor Val66Met polymorphism on adolescent activity and rest rhythms, circadian preferences and attentional performance." SLEEP MEDICINE (2023); 104: 64-72. DOI 10.1016/j.sleep.2023.02.017.PubMedID 36898188.

Longitudinal study to assess antidepressant treatment patterns and outcomes in individuals with depression in the general population.

Background: Major depressive disorder (MDD) is largely managed in primary care, but physicians vary widely in their understanding of symptoms and treatments. This study aims to better understand the evolution of depression from initial diagnosis over a 3-year period.
Methods: This was a noninterventional, retrospective, longitudinal study, with 2 waves of participant interviews approximately 3 years apart. Phone interviews were conducted using the hybrid artificial intelligence (AI) Sleep-EVAL system, an AI-driven diagnostic deep learning tool. Participants were noninstitutionalized adults representative of the general population in 8 US states. Diagnosis was confirmed according to the DSM-5 using the Sleep-EVAL System.
Results: 10,931 participants completed Wave 1 and 2 (W1, W2) interviews. The prevalence of MDD, including partial and complete remission, was 13.4 % and 19.6 % in W1 and W2, respectively. About 42 % of MDD participants at W1 continued to report depressive symptoms at W2. Approximately half of antidepressant (AD) users in W1 were moderately to completely dissatisfied with their treatment; 29.6 % changed their AD for a different one, with 16.4 % switching from one SSRI to another between W1 and W2. Primary care physicians were the top AD prescribers, both in W1 (45.7 %) and W2 (59%), respectively.
Limitations: Data collected relied on self-reporting by participants. As such, the interpretation of the data may be limited.
Conclusions: Depression affects a sizeable portion of the US population. Dissatisfaction with treatment, frequent switching of ADs, and changing care providers are associated with low rates of remission. Residual symptoms remain a challenge that future research must address.

Ohayon, M. M., McCue, M., Krystal, A., Selzler, K. J., Chrones, L., Lawrence, D., Cote, M. "Longitudinal study to assess antidepressant treatment patterns and outcomes in individuals with depression in the general population." JOURNAL OF AFFECTIVE DISORDERS (2023);321:272-278.doi:10.1016/j.jad.2022.10.034.PubMedID 36280197.

Inflammation/Allergy: Interaction with Immunology and Sleep.

December 3rd, 2022, EVAL Research Institute (EVALRI), Carmichael.
Background: lt is increasingly accepted that one function of sleep is to support host defense. The circadian rhythm includes neuroendocrine changes that regulate human leukocyte traffic with overall immuno-supportive effects during nocturnal sleep. A normal circadian rhythm appears to enhance the efficiency of helper T cell responses. The reverse, sleep deprivation, leads to single cell alterations (including dysregulation of helper T cell function) which can result into inefficient clearance of pathogens and can cause (auto-) inflammatory diseases and auto-immunity. As we start to understand role of the sleep in (auto-) inflammatory diseases and auto-immunity, we know very little about sleep problems and the risk of developing allergic/immunological conditions. Nevertheless, there are hints of at least a moderating effect of sleep coming from 2 studies:

• An allergic response can, not only be conditioned to a specific cue, but also be triggered by merely reencountering the environmental context in which an allergen was previously encountered. However, the allergic response to the reencountering experience only occurs with normal sleep. lt does not occur when subjects are forced to stay awake. This shows the critical role of sleep in the formation of a memory for allergic responses.
• ln mice, poor sleep quality contributes to a more severe form of asthma: the progression of allergen-induced eosinophilic lung inflammation to a corticosteroid-refractory neutrophilic manifestation.
• Sleep disturbance is associated with a decrease in regulatory T cells. ln lnfants, the decrease in regulatory T cells is shown to be linked to hyper-responsiveness in food allergy.

Objective: This symposium aimed to explore the fields of sleep, immunology and allergies with experts from around the world and discuss the latest advancements in these respective fields. Finally, our objective was to have a better understanding of the inter-relations between sleep, immunology and allergies.
Visit @EVALRI YouTube channel for recorded presentations.

Prevalence of narcolepsy type 1 and type 2 in representative samples of the general population of North America, Europe and South Korea.

ABSTRACT

Ohayon, M. M., Dave, S., Shah, A., Swick, T., Cote, M.
ELSEVIER. 2022: S164.

Reply to Liu et al.: "Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis".

Alimoradi, Z., Broström, A., Ohayon, M. M., Lin, C. Y., Griffiths, M. D., Jernelöv, S., Kaldo, V., Pakpour, A. H. SLEEP MEDICINE REVIEWS (2022); 66: 101699.DOI 10.1016/j.smrv.2022.101699.PubMedID 36332409.

Prevalence, incidence, evolution and associated factors of sleep paralysis in a longitudinal study of the US general population.

BACKGROUND AND OBJECTIVE: Sleep paralysis is a common phenomenon which causes and consequences are seldomly studied. The aim of this study was to investigate the incidence and prevalence of sleep paralysis (SP) in the American adult population and its evolution on a 3-year period.
METHODS: This longitudinal study was conducted between 2002 and 2015 and included a representative sample of the US general population. A total of 12,218 subjects were initially interviewed (W1) and 10,931 were re-interviewed three years later (W2). The subjects participated in telephone interviews using the Sleep-EVAL expert system. Each interview lasted for about 1h. SP episodes were assessed according to their frequency and duration.
RESULTS: At W1, 9.7% (95%CI: 9.1%-10.3%) reported having >=1 episode of SP in the previous year. At W2, 15.1% (95%CI: 14.4%-15.8%) reported SP. A total of 29.9% of subjects with SP at W1 still reported episodes at W2. The 1-year incidence was 2.7% (95%CI: 2.4-3.0%). After adjusting for age and sex, prevalent SP (i.e., present at W2) was predicted by age and race and the following factors present at W1: major depressive disorder, pain, hypersomnolence, cataplexy, hypnagogic and hypnopompic hallucinations, posttraumatic stress disorder, a reduction in sleep duration of >=60min, and the use of analgesic/antipyretic medication. Incident SP (i.e. new cases at W2) had similar predictive factors.
DISCUSSION: Episodes of SP are frequent in the general population. Its persistence is predicted by several factors associated with narcolepsy like hypersomnolence and cataplexy but also by other factors like posttraumatic stress disorder or pain.

Ohayon, M. M., Pakpour, A. H. "Prevalence, incidence, evolution and associated factors of sleep paralysis in a longitudinal study of the US general population." SLEEP MEDICINE (2022); 98: 62-67.DOI 10.1016/j.sleep.2022.06.003.PubMedID 35785587.

Prevalence and incidence of hypnagogic hallucinations in a longitudinal study of the American general population.

Ohayon, M., Pakpour, A., Cote, M.
OXFORD UNIV PRESS INC. 2022: A245.

The role of hypersomnolence in depression: results from a longitudinal study of the American general population.

Ohayon, M., Pakpour, A., Cote, M.
OXFORD UNIV PRESS INC. 2022: A293-A294.

Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis.

The effects of cognitive behavioral therapy for insomnia (CBT-I) have consistently been shown to improve insomnia symptoms and other health-related outcomes, but the effects on QoL have been inconsistent. Many factors including the type CBT-I delivery and type of instrument used to assess QoL make the topic complex. The present systematic review and meta-analysis synthesized the evidence of CBT-I efficacy on QoL outcomes across different populations, delivery modes, and methodological aspects. Following the guidelines on preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a literature search was conducted through PubMed, Web of Science, Scopus, and PsycINFO using keywords from relevant MeSH terms based on PICOS (Participants, Intervention, Comparison, Outcome and Study) criteria. Clinical trials investigating the effect of CBT-I as an intervention on QoL with any kind of control group were eligible if they reported mean scores and variation of QoL. Meta-analysis using a random-effect model was conducted to calculate the standardized mean differences (SMDs) in a set including all identified studies, as well as in three sub-sets: face-to-face CBT-I using randomized controlled trials (RCTs), online CBT-I using RCTs, and one-group pre- and post-treatment design. A total of 24 studies comprising 1977 participants (808 in an intervention group) from 12 countries were eligible for meta-analysis. The overall pooled estimate of SMD of QoL when all 24 studies were included was 0.47 (95% CI: 0.22; 0.72; I2=84.5%; tau2=0.31; p<0.001). The overall pooled estimate of SMD of QoL was 0.46 (95% CI: 0.01-0.90; I2=87.5%; tau2=0.48, p<0.001) for intervention groups with face-to-face CBT-I compared to controls; 0.47 (95% CI: 0.02-0.92; I2=88.3%; tau2=0.36; p=0.04) for intervention groups with digital CBT-I compared to controls, and 0.46 (95% CI: 0.12-0.80; I2=52.9%; tau2=0.07; p=0.08) for one-group pre- and post-comparison using CBT-I intervention compared to baseline. Moreover, effects of CBT-I on QoL were different across populations (pooled SMD=0.59 for patients with insomnia; 0.29 for patients with insomnia comorbid with another major disorder; and 0.48 for other conditions) and types of QoL instruments (pooled SMD=0.36 for disease-specific QoL instrument not on insomnia, 0.43 for generic QoL instrument, and 0.67 for a single-QoL-item instrument). The probability of publication bias was ruled out in overall and design specific sub-group analysis based on funnel plot and Egger's test. In conclusion, this meta-analysis confirmed a moderate, overall effect of CBT-I in improving QoL. However, due to small power and heterogeneity, future studies are needed to better explore the impact of moderating factors such as mode of delivery and type of QoL measure for assessment used.

Alimoradi, Z., Jafari, E., Brostrom, A., Ohayon, M. M., Lin, C., Griffiths, M. D., Blom, K., Jernelov, S., Kaldo, V., Pakpour, A. H. "Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis." SLEEP MEDICINE REVIEWS (2022); 64: 101646.DOI 10.1016/j.smrv.2022.101646PubMedID 35653951.

Associations of the Severity of Obstructive Sleep Apnea With Age-Related Comorbidities: A Population-Based Study.

Aging is accompanied by changes in the quantity and quality of sleep. Obstructive sleep apnea (OSA) is also more prevalent in the older population. Although severe OSA has been linked to a higher risk of cardiovascular disease regardless of adult age, clinical consequences of mild-to-moderate OSA in the older adults are still uncertain.To investigate the relationships between severity and metabolic, cognitive, and functional characteristics in community-dwelling older adults from a representative sample of the city of São Paulo.In total, 199 participants of the first follow-up of the São Paulo Epidemiologic Sleep Study (EPISONO, São Paulo, Brazil) >60 years were cross-sectionally assessed through questionnaires, physical evaluations, laboratory tests, and full in-lab polysomnography (PSG). Three groups according to the OSA severity were compared according to sociodemographic characteristics, anthropometric measures, PSG parameters, the frequency of comorbidities, and the use of medications.Participants' age ranged from 60 to 87 years with a mean of 70.02 ± 7.31, 59.8% female. In the univariate analysis, body mass index (BMI, kg/m2) (p = 0.049) and waist circumference (p = 0.005) were significantly higher in the participants with moderate OSA, but not among those with severe OSA. Participants with severe OSA had a higher arousal index (p = 0.007). Multivariate analysis showed that severe OSA was significantly associated with hypertension (p = 0.005), heart diseases (p = 0.025), and the use of two or more medications (p = 0.035).In a population-based study, severe, but not mild-to-moderate, OSA in older adults was associated with hypertension and the use of more medications. As age advances, anthropometric indicators of obesity may not increase the risk of severe OSA.

Silva, M. D., Poyares, D., Silva, L. O., Souza, K. M., Andersen, M. L., Ohayon, M. M., Tufik, S., Piovezan, R. D. "Associations of the Severity of Obstructive Sleep Apnea With Age-Related Comorbidities: A Population-Based Study." FRONTIERS IN NEUROLOGY (2022); 13: 802554.DOI 10.3389/fneur.2022.802554.PubMedID 35620781.

Fear of COVID-19 and its association with mental health-related factors: systematic review and meta-analysis.

BACKGROUND: The severity of COVID-19 remains high worldwide. Therefore, millions of individuals are likely to suffer from fear of COVID-19 and related mental health factors.AIMS: The present systematic review and meta-analysis aimed to synthesize empirical evidence to understand fear of COVID-19 and its associations with mental health-related problems during this pandemic period.
METHOD: Relevant studies were searched for on five databases (Scopus, ProQuest, EMBASE, PubMed Central, and ISI Web of Knowledge), using relevant terms (COVID-19-related fear, anxiety, depression, mental health-related factors, mental well-being and sleep problems). All studies were included for analyses irrespective of their methodological quality, and the impact of quality on pooled effect size was examined by subgroup analysis.
RESULTS: The meta-analysis pooled data from 91 studies comprising 88 320 participants (mean age 38.88 years; 60.66% females) from 36 countries. The pooled estimated mean of fear of COVID-19 was 13.11 (out of 35), using the Fear of COVID-19 Scale. The associations between fear of COVID-19 and mental health-related factors were mostly moderate (Fisher's z = 0.56 for mental health-related factors; 0.54 for anxiety; 0.42 for stress; 0.40 for depression; 0.29 for sleep problems and -0.24 for mental well-being). Methodological quality did not affect these associations.
CONCLUSIONS: Fear of COVID-19 has associations with various mental health-related factors. Therefore, programmes for reducing fear of COVID-19 and improving mental health are needed.

Alimoradi, Z., Ohayon, M. M., Griffiths, M. D., Lin, C., Pakpour, A. H. "Fear of COVID-19 and its association with mental health-related factors: systematic review and meta-analysis." BJPsych open (2022); 8 (2): e73.DOI 10.1192/bjo.2022.26.PubMedID 35307051.

Suicidal Ideation during the COVID-19 Pandemic among A Large-Scale Iranian Sample: The Roles of Generalized Trust, Insomnia, and Fear of COVID-19.

The novel 2019 coronavirus disease (COVID-19) is still not under control globally. The pandemic has caused mental health issues among many different cohorts and suicidal ideation in relation to COVID-19 has been reported in a number of recent studies. Therefore, the present study proposed a model to explain the associations between generalized trust, fear of COVID-19, insomnia, and suicidal ideation during the COVID-19 pandemic among a large-scale Iranian sample. Utilizing cluster sampling with multistage stratification, residents from Qazvin province in Iran were invited to participate in the present study. Adults aged over 18 years (n = 10,843; 6751 [62.3%] females) completed 'paper-and-pencil' questionnaires with the assistance of a trained research assistant. Structural equation modeling (SEM) was applied to understand the associations between generalized trust, fear of COVID-19, insomnia, and suicidal ideation. Slightly over one-fifth of the participants (n = 2252; 20.8%) reported suicidal ideation. Moreover, the SEM results indicated that generalized trust was indirectly associated with suicidal ideation via fear of COVID-19 and insomnia. Furthermore, generalized trust was not directly associated with suicidal ideation. The proposed model was invariant across gender groups, age groups, and participants residing in different areas (i.e., urban vs. rural). Generalized trust might reduce individuals' suicidal ideation during the COVID-19 pandemic period via reduced levels of fear of COVID-19 and insomnia. Healthcare providers and policymakers may want to assist individuals in developing their generalized trust, reducing fear of COVID-19, and improving insomnia problems to avoid possible suicidal behaviors.

Lin, C., Alimoradi, Z., Ehsani, N., Ohayon, M. M., Chen, S., Griffiths, M. D., Pakpour, A. H. "Suicidal Ideation during the COVID-19 Pandemic among A Large-Scale Iranian Sample: The Roles of Generalized Trust, Insomnia, and Fear of COVID-19." Healthcare (Basel, Switzerland) (2022);10(1):93. Published 2022 Jan 4.doi:10.3390/healthcare10010093.PubMedID 35052258.

Is alexithymia associated with sleep problems? A systematic review and meta-analysis.

Alexithymia, a difficulty identifying and expressing emotions experienced by oneself or others, measurably harms quality of sleep. Research has observed the association between alexithymia and sleep problems; however, the cumulative effect of this association is still unknown. Therefore, this systematic review and meta-analysis was conducted to present scientific evidence regarding the relationship between alexithymia and sleep quality. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and using relevant keywords, we searched six databases: Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, EMBASE, and Science Direct. We selected observational studies on the association between alexithymia and sleep. We conducted meta-analysis using a random-effect model to calculate the effect size (ES) with Fisher's z transformation. Eligible studies (N=26) in 24 papers included 7546 participants from 12 countries. The entire ES for the association between alexithymia and sleep was 0.44 (95 % CI: 0.31, 0.56). Additionally, patient populations had a larger ES (ES=0.55; 95 % CI: 0.30, 0.79) than healthy populations (ES=0.30; 95 % CI: 0.20, 0.41). The results of the present systematic review and meta-analysis revealed a significant association between alexithymia and sleep problems, especially among people with any medical condition.

Alimoradi Z, Majd NR, Broström A, et al. "Is alexithymia associated with sleep problems? A systematic review and meta-analysis." NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS (2022);133:104513.DOI 10.1016/j.neubiorev.2021.12.036.PubMedID 34958823.

Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis.

The outbreak of the novel coronavirus disease 2019 (COVID-19) changed lifestyles worldwide and subsequently induced individuals' sleep problems. Sleep problems have been demonstrated by scattered evidence among the current literature on COVID-19; however, little is known regarding the synthesised prevalence of sleep problems (i.e. insomnia symptoms and poor sleep quality) for males and females separately. The present systematic review and meta-analysis aimed to answer the important question regarding prevalence of sleep problems during the COVID-19 outbreak period between genders. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Newcastle-Ottawa Scale checklist, relevant studies with satisfactory methodological quality searched for in five academic databases (Scopus, PubMed Central, ProQuest, Web of Science , and EMBASE) were included and analysed. The protocol of the project was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identification code CRD42020181644). A total of 54 papers (N=67,722) in the female subgroup and 45 papers (N=45,718) in the male subgroup were pooled in the meta-analysis. The corrected pooled estimated prevalence of sleep problems was 24% (95% confidence interval [CI] 19%-29%) for female participants and 27% (95% CI 24%-30%) for male participants. Although in both gender subgroups, patients with COVID-19, health professionals and general population showed the highest prevalence of sleep problems, it did not reach statistical significance. Based on multivariable meta-regression, both gender groups had higher prevalence of sleep problems during the lockdown period. Therefore, healthcare providers should pay attention to the sleep problems and take appropriate preventive action.

Alimoradi, Z., Gozal, D., Tsang, H. W., Lin, C., Brostrom, A., Ohayon, M. M., Pakpour, A. H. "Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis." JOURNAL OF SLEEP RESEARCH (2022);31(1):e13432.DOI 10.1111/jsr.13432.PubMedID 34245055.

Public Health Issues in Sleep, Stanford Mexico Sleep Epidemiology Satellite Center.

December 9th, 2021.
Organizadores: Prof. Alejandro Jiménez Genchi, INPRFM; Prof. Maurice Ohayon, Universidad de Stanford
Temática:

• Narcolepsia: diagnóstico y tratamiento.
• Somnolencia excesiva en población mexicana.
• Evaluación de la somnolencia excesiva.
• Hipoxemia nocturna post COVID-19.
• Neurocognición y sueño en cirrosis no alcohólica.
• Duración corta de sueño en depresión mayor e insomnio.
• Correlatos clínicos de la duración corta de sueño.
• Hábitos de sueño en personas adultas mexicanas.
• Tratamiento conductual breve por telemedicina.

Sleep latency response with FT218, a once-nightly sodium oxybate: post-hoc responder analyses from the phase 3 Rest-on clinical trial.

Winkelman, J., Ohayon, M., Thorpy, M., Seiden, D., Bogan, R., Dubow, J., Shapiro, C. "Sleep latency response with FT218, a once-nightly sodium oxybate: post-hoc responder analyses from the phase 3 Rest-on clinical trial." ELSEVIER. 2021: 2426A-2428A.

Predictors for Chronic Sleep Paralysis in a Longitudinal Study of the American General Population.

Ohayon, M. M. WILEY. 2021: S243.

Chronic Nausea and Vomiting as a Risk Factor for Circadian Shift and Shortened Sleep.

Ohayon, M. M., Chen, Y. J., Cote, M. WILEY. 2021: S242-S243.

Assessing the impact of sodium oxybate treatment on functioning, productivity, and health-related quality of life in patients with narcolepsy: findings from the Nexus Narcolepsy Registry (waves 1-4).

Background: The aim of this study was to evaluate the impact of different therapy regimens, including sodium oxybate (SXB)-containing regimens, on patient-reported outcomes (PROs) in people with narcolepsy.
Methods: Online surveys were used to collect information from persons with narcolepsy in the Nexus Narcolepsy Registry. Surveys contained questionnaires assessing self-reported sleep quality (SQ; via single question), daytime sleepiness and function (Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire), health-related quality of life (HRQoL; 36-Item Short Form Health Survey [SF-36]), work productivity and impairment (Work Productivity and Activity Impairment: Specific Health Problem), and history of injuries or motor vehicle accidents. Treatment with SXB (including monotherapy or combination therapy; SXB group) was compared with non-SXB therapy (No SXB group). The P values presented are nominal, as there are no adjustments for multiplicity.
Results: From June 2015 through December 2017, 983 participants completed 1760 surveys. SQ and daytime functioning scores were better in the SXB group compared with the No SXB group (all P < 0.001). HRQoL scores were better for the SXB group compared with the No SXB group for the SF-36 Physical Component (P = 0.016), Mental Component (P < 0.001), and all 8 subscales. Additionally, PROs were better for the SXB group for presenteeism, overall work and activity impairment, and risk of motor vehicle accidents (all P <= 0.001).
Conclusion: Based on participants' self-assessments, treatment regimens with SXB were associated with better outcomes than regimens not containing SXB across many PROs, including SQ, HRQoL, work and activities, and risk of traffic accidents. CLINICALTRIALS Gov identifier: NCT02769780.

Thorpy, M. J., Ohayon, M. M., Carls, G., Black, J., Pasta, D. J., Hyman, D. L., Villa, K. F. "Assessing the impact of sodium oxybate treatment on functioning, productivity, and health-related quality of life in patients with narcolepsy: findings from the Nexus Narcolepsy Registry (waves 1-4)." SLEEP MEDICINE 2021; 84: 380-388.DOI: 10.1016/j.sleep.2021.06.010PubMedID 34247126.

The Nexus Narcolepsy Registry: methodology, study population characteristics, and patterns and predictors of narcolepsy diagnosis.

Objective/background: The real-world experience of people with narcolepsy is not well understood.
Patients/methods: The Nexus Narcolepsy Registry (NCT02769780) is a longitudinal, web-based patient registry of self-reported data from adults with physician-diagnosed narcolepsy. Surveys were electronically distributed every 6 months; the current analysis reports registry population demographics, narcolepsy diagnosis journey, and predictors of diagnostic delays.
Results: The registry population included in this analysis (N = 1024) was predominantly female (85%) and White (92%), with a mean age of 37.7 years. Most participants had education/training beyond high school (93%). Mean (median) reported ages at narcolepsy symptom onset, first consultation for symptoms, and narcolepsy diagnosis were 18.1 (16), 26.4 (24), and 30.1 (28) years, respectively. A majority (59%) of participants reported >=1 misdiagnosis, and 29% reported consulting >=5 physicians before narcolepsy diagnosis. More than half (56%) of participants' first consultations for narcolepsy symptoms were with a general practitioner, whereas the diagnosing clinician was usually a sleep specialist (64%) or neurologist (27%). Pediatric symptom onset was associated with a longer mean interval to first consultation than adult symptom onset (10.7 and 4.6 years, respectively; P < 0.001) and a longer mean interval between first consultation and diagnosis (4.5 and 2.2 years, respectively; P < 0.001). Overall, mean (95% CI) time from symptom onset to diagnosis was 11.8 (11.1-12.5) years.
Conclusions: The Nexus Narcolepsy Registry data indicate that onset of narcolepsy symptoms frequently occurs in childhood or adolescence. In many individuals, the diagnostic process is long and involves multiple physicians and frequent misdiagnosis.

Ohayon, M. M., Thorpy, M. J., Carls, G., Black, J., Cisternas, M., Pasta, D. J., Bujanover, S., Hyman, D., Villa, K. F. "The Nexus Narcolepsy Registry: methodology, study population characteristics, and patterns and predictors of narcolepsy diagnosis." SLEEP MEDICINE 2021; 84: 405-414.DOI: 10.1016/j.sleep.2021.06.008PubMedID 34304148.

Internet gaming disorder and comorbidities among campus-dwelling U.S. university students.

This study investigates the prevalence and associations of DSM-5 Internet Gaming Disorder (IGD) with sleep impairment, daytime functioning, psychiatric disorders, and health status among young adults living in student houses on the campus of an American university. A random sample of students living on the campus underwent phone interviews during the 2007 & 2015 academic years. The sample included 1,871 undergraduate and 1,113 graduate students (2,984 in total). Students were considered to have IGD if they recreationally spent >=15 hours per week on an electronic device (39.4% of the students) and displayed >=5 addiction-related symptoms; 5.3% of the sample met these 2 criteria. In bivariate analyses, IGD students had a greater proportion of suicidal thoughts (16.9% vs. 6.6%), suicide attempts (9.7% vs. 3.3%), major depressive disorder (9.7% vs. 3.0%), and social anxiety disorder (24.8% vs. 8.5%) than the no-IGD group. In multivariate analyses, IGD predicted non-restorative sleep, excessive fatigue, less close friends, depressive mood, bipolar disorder, social anxiety disorder, and a poor to fair health status. IGD is highly prevalent in this student population, affecting one in 20 students. IGD was associated with a variety of sleep, psychiatric, and health factors which may impact functioning and academic performance.
< br> Ohayon, M. M., Roberts, L. "Internet gaming disorder and comorbidities among campus-dwelling U.S. university students." PSYCHIATRY RESEARCH (2021); 302: 114043.DOI: 10.1016/j.psychres.2021.114043PubMedID 34129998.

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis.

Background: The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.
Methods: Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.
Findings: 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.
Interpretation: Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

Alimoradi, Z., Brostrom, A., Tsang, H. W., Griffiths, M. D., Haghayegh, S., Ohayon, M. M., Lin, C., Pakpour, A. H. "Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis." EClinicalMedicine (2021);36:100916. doi:10.1016/j.eclinm.2021.100916.DOI: 10.1016/j.eclinm.2021.100916PubMedID 34131640.

Factorial structure of hypersomnolence as measured by the Epworth Sleepiness Scale.

Ohayon, M., Poyares, D., Cote, M. OXFORD UNIV PRESS INC. 2021: A203.

Excessive daytime sleepiness: beyond the Epworth Sleepiness Scale results from a population-based study.

Treptow, E., Ohayon, M., Piovesan, R., Oliveira, L., Drager, L., Andersen, M., Tufik, S., Poyares, D. OXFORD UNIV PRESS INC. 2021: A202-A203.

Impacts of chronic nausea and vomiting on daytime sleepiness and fatigue

Ohayon, M., Chen, Y. J., Cote, M. OXFORD UNIV PRESS INC. 2021: A203.

A longitudinal study to assess antidepressant treatment patterns and outcomes in individuals with depression in the general population.

Ohayon, M. M., McCue, M., Krystal, A., Chrones, L., Touya, M., Lawrence, D., Patel, S., Cote, M. L. CNS spectrums 2021; 26 (2): 180.

Longitudinal Relationships between Nomophobia, Addictive Use of Social Media, and Insomnia in Adolescents.

Lin, C. Y., Potenza, M. N., Ulander, M., Broström, A., Ohayon, M. M., Chattu, V. K., Pakpour, A. H. Healthcare (Basel, Switzerland) 2021; 9 (9).

TOPICAL: The Impact of the Schumann Resonances on Human and Mammalian Physiology Ground-based Investigations to Support Human and Mammalian Studies Beyond Low Earth Orbit.

Stolc, V., Ohayon, M. M., Freund, F., Loftus, D. J. "TOPICAL: The Impact of the Schumann Resonances on Human and Mammalian Physiology Ground-based Investigations to Support Human and Mammalian Studies Beyond Low Earth Orbit." National Academies of Sciences, Engineering, and Medicine's Biological and Physical Sciences in Space. 2021.

Advanced psychometric testing on a clinical screening tool to evaluate insomnia: sleep condition indicator in patients with advanced cancer.

Purpose: To examine the psychometric properties of the Sleep Condition Indicator (SCI) using different psychometric approaches [including classical test theory, Rasch models, and receiver operating characteristics (ROC) curve] among patients with advanced cancer.
Methods: Through convenience sampling, patients with cancer at stage III or IV (n = 859; 511 males; mean ± SD age = 67.4 ± 7.5 years) were recruited from several oncology units of university hospitals in Iran. All the participants completed the SCI, Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire (GHQ), and Edmonton Symptom Assessment Scale (ESAS). In addition, 491 participants wore an actigraph device to capture objective sleep.
Results: Classical test theory [factor loadings from confirmatory factor analysis = 0.76–0.89; test–retest reliability = 0.80–0.93] and Rasch analysis [infit mean square (MnSq) = 0.63–1.31; outfit MnSq = 0.61–1.23] both support the construct validity of the SCI. The SCI had significant associations with ISI, PSQI, ESS, HADS, GHQ, and ESAS. In addition, the SCI has satisfactory area under ROC curve (0.92) when comparing a gold standard of insomnia diagnosis. Significant differences in the actigraphy measure were found between insomniacs and non-insomniacs based on the SCI score defined by ROC.
Conclusion: With the promising psychometric properties shown in the SCI, healthcare providers can use this simple assessment tool to target the patients with advanced cancer who are at risk of insomnia and subsequently provide personalized care efficiently.

Lin, C., Cheng, A. K., Imani, V., Saffari, M., Ohayon, M. M., Pakpour, A. H. "Advanced psychometric testing on a clinical screening tool to evaluate insomnia: sleep condition indicator in patients with advanced cancer." SLEEP AND BIOLOGICAL RHYTHMS (2020); 18, 343-349.https://doi.org/10.1007/s41105-020-00279-5

Concomitant Evolution of Treatment and Symptoms of Narcolepsy in a Longitudinal Study.

Ohayon, M. M., Krystal, A., Swick, T., Black, J., Sullivan, S., Shapiro, C., Wells, C. LIPPINCOTT WILLIAMS AND WILKINS. 2020.

Hypersomnolence is a Significant Predictor of New Medical Conditions Among Elderly People in a Longitudinal Study of the General Population.

Ohayon, M. M., Sullivan, S., Cote, M. LIPPINCOTT WILLIAMS AND WILKINS. 2020.

Evolution of nonrestorative sleep and its interactions with insombia symptoms in a longituidnal survey of the American population.

Ohayon, M. M. OXFORD UNIV PRESS INC. 2020: A179.

Factors associated with the continuous use of psychotropic treatments for narcolepsy.

Ohayon, M. M., Krystal, A. D., Black, J., Shapiro, C. M., Sullivan, S., Swick, T. J., Wells, C. C. OXFORD UNIV PRESS INC. 2020: A294.

Efficacy of a Theory-Based Cognitive Behavioral Technique App-Based Intervention for Patients With Insomnia: Randomized Controlled Trial.

Background: Sleep hygiene is important for maintaining good sleep and reducing insomnia.
Objective: This study examined the long-term efficacy of a theory-based app (including cognitive behavioral therapy [CBT], theory of planned behavior [TPB], health action process approach [HAPA], and control theory [CT]) on sleep hygiene among insomnia patients.
Methods: The study was a 2-arm single-blind parallel-group randomized controlled trial (RCT). Insomnia patients were randomly assigned to a treatment group that used an app for 6 weeks (ie, CBT for insomnia [CBT-I], n=156) or a control group that received only patient education (PE, n=156) through the app. Outcomes were assessed at baseline and 1 month, 3 months, and 6 months postintervention. Primary outcomes were sleep hygiene, insomnia, and sleep quality. Secondary outcomes included attitudes toward sleep hygiene behavior, perceived behavioral control, behavioral intention, action and coping planning, self-monitoring, behavioral automaticity, and anxiety and depression. Linear mixed models were used to evaluate the magnitude of changes in outcomes between the two groups and across time.
Results: Sleep hygiene was improved in the CBT-I group compared with the PE group (P=.02 at 1 month, P=.04 at 3 months, and P=.02 at 6 months) as were sleep quality and severity of insomnia. Mediation analyses suggested that perceived behavioral control on sleep hygiene as specified by TPB along with self-regulatory processes from HAPA and CT mediated the effect of the intervention on outcomes.
Conclusions: Health care providers might consider using a CBT-I app to improve sleep among insomnia patients.
Trial registration: ClinicalTrials.gov NCT03605732;

Majd, N. R., Broström, A., Ulander, M., Lin, C. Y., Griffiths, M. D., Imani,, V., Ahorsu, D. K., Ohayon, M. M., Pakpour, A. H. "Efficacy of a Theory-Based Cognitive Behavioral Technique App-Based Intervention for Patients With Insomnia: Randomized Controlled Trial." JOURNAL OF MEDICAL INTERNET RESEARCH (2020); 22(4):e15841. Published 2020 Apr 1.DOI: 10.2196/15841PubMedID 32234700.

Editorial: "A Good Sleep: The Role of Factors in Psychosocial Health."

Pakpour AH, Griffiths MD, Ohayon MM, Broström A, Lin CY. FRONTIERS IN NEUROSCIENCE (2020);14:520. DOI: 10.3389/fnins.2020.00520

Workshop on the Definitions of Idiopathic Hypersomnia.

Stanford Sleep Epidemiology Symposium on January 25th, 2020.

Excessive internet use and sleep.

Ohayon, M. M. ELSEVIER. 2019: S285.

Sleep impacts of nocturia in a longitudinal study.

Ohayon, M. M., Krystal, A. D. ELSEVIER. 2019: S284-S285.

Pain and hypersomnolence: a longitudinal study.

Ohayon, M. M. ELSEVIER. 2019: S284.

Narcolepsy Symptoms are Highly Persistent over Time Despite Treatment.

Ohayon, M. M., Sullivan, S. S., Krystal, A. D., Black, J., Swick, T. J., Shapiro, C. M., Wells, C. C. WILEY. 2019: S122.

Longitudinal Assessment of Psychotropic Treatments for Narcolepsy.

Ohayon, M. M., Sullivan, S. S., Black, J., Krystal, A. D., Shapiro, C. M., Swick, T. J., Wells, C. C. WILEY. 2019: S212.

Longitudinal Relationships between Chronic Pain, Major Depressive Disorder, and Use of Antidepressants.

Ohayon, M. M., Sullivan, S. S. WILEY. 2019: S169-S170..

Longitudinal Survey of Hypersomnolence and Its Treatment in the General Population.

Ohayon, M. M., Sullivan, S. S. WILEY. 2019: S121-S122.

Misdiagnoses and Comorbidities among Participants in the Nexus Narcolepsy Registry.

Ohayon, M., Thorpy, M., Black, J., Williams, M. J., Pasta, D. J., Hyman, D., Villa, K. F. LIPPINCOTT WILLIAMS AND WILKINS. 2019.

A Longitudinal Study of Hypersomnolence in the US General Population and its Chronicity.

Ohayon, M. LIPPINCOTT WILLIAMS AND WILKINS. 2019.

Sodium oxybate dosing utilization patterns in the Nexus narcolepsy registry.

Ohayon, M. M., Thorpy, M. J., Short, S. A., Williams, M. J., Yang, M., Black, J., Hyman, D. L., Profant, J., Villa, K. F. OXFORD UNIV PRESS INC. 2019.

Hypersomnolence prevalence and evolution in a longitudinal survey of the US general population.

Sullivan, S., Ohayon, M. M., Cote, M. OXFORD UNIV PRESS INC. 2019.

The National Sleep Foundation's Sleep Satisfaction Tool.

Objectives: The National Sleep Foundation (NSF) sought to test, refine, and add statistical rigor to its previously described provisional Sleep Satisfaction Tool (SST). The tool assesses the general population's sleep satisfaction.
Design: In 2017, NSF created a provisional tool through systematic literature review and an expert consensus panel process. This tool was expanded, refined, and tested through an open-ended survey, 2 rounds of cognitive testing, and a national survey of a random sample of Internet users (aged 18-90). Factor analysis and final consensus panel voting produced the robust SST.
Results: The exploratory, open-ended surveying for identifying additional factors important to the public led to question formulation around mind relaxation. Cognitive testing yielded significant refinement to question and response option formatting. Factor analysis of questions from field testing indicated loading on one construct identified as "sleep satisfaction." The final 9-item SST demonstrated strong reliability and internal validity with overall SST scores of 56/100 (higher scores indicating greater sleep satisfaction). Individual SST item mean scores ranged from 39 to 66, and overall SST scores varied substantially across demographic groups.
Conclusions: NSF used a series of development and validation tests on its provisional SST, producing a novel and reliable research tool that measures the general population's sleep satisfaction. The SST is a short, reliable, nonclinical assessment that expands the set of tools available to researchers that implements the individual, social, and environmental factors related to sleep satisfaction. Further research will explore refined scoring methods along with factor weighting and use within different populations.

Ohayon, M. M., Paskow, M., Roach, A., Filer, C., Hillygus, D., Chen, M. C., Langer, G., Hirshkowitz, M. "The National Sleep Foundation's Sleep Satisfaction Tool." SLEEP HEALTH (2019);5(1):5-11.DOI: 10.1016/j.sleh.2018.10.003PubMedID 30670166.

Snoring and breathing pauses during sleep: interview survey of a United Kingdom population sample reveals a significant increase in the rates of sleep apnoea and obesity over the last 20 years - data from the UK sleep survey.

Study objectives: (1) To determine the prevalence of snoring, breathing pauses during sleep and obstructive sleep apnoea syndrome in the United Kingdom (UK) and determine the relation between these events and obesity and other sociodemographic variables. (2) To compare and integrate this data with published UK population data.
Methods: A total of 664 women and 575 men aged 18-100 years who formed a representative sample of the non-institutionalised UK population participated in an online interview survey directed by a previously validated computerised system.
Results: Overall, 38% of men and 30.4% of women report that they snore at night. Furthermore, 8.7% of men and 5.6% of women state that they stop breathing at night. Comparing our data to published data from the 1990s, this study observes a highly significant increase in the rates of reported breathing pauses during sleep (sleep apnoea) in the UK over the last 20 years (p < 0.0001). In addition, we observe a highly significant increase in the prevalence of obesity (BMI>30) in the UK population between 1994 and 2015 (p < 0.0001). Integration of our data with NHS and public health England data on obesity confirms this increase.
Conclusions: Our data demonstrate a significant increase in the rates of reported breathing pauses during sleep (sleep apnoea) and obesity in the UK over the last 20 years. Sociodemographic and behavioural changes have likely contributed to this. Moreover, our data also suggests that sleep disordered breathing (SDB) is widely underdiagnosed in the UK.

Lechner, M., Breeze, C. E., Ohayon, M. M., Kotecha, B. "Snoring and breathing pauses during sleep: interview survey of a United Kingdom population sample reveals a significant increase in the rates of sleep apnoea and obesity over the last 20 years - data from the UK sleep survey." SLEEP MEDICINE (2019); 54: 250-56. DOI: 10.1016/j.sleep.2018.08.029PubMedID 30597439.

The potential for impact of man-made super low and extremely low frequency electromagnetic fields on sleep.

An ever-growing number of electromagnetic (EM) emission sources elicits health concerns, particularly stemming from the ubiquitous low to extremely low frequency fields from power lines and appliances, and the radiofrequency fields emitted from telecommunication devices. In this article we review the state of knowledge regarding possible impacts of electromagnetic fields on melatonin secretion and on sleep structure and the electroencephalogram of humans. Most of the studies on the effects of melatonin on humans have been conducted in the presence of EM fields, focusing on the effects of occupational or residential exposures. While some of the earlier studies indicated that EM fields may have a suppressive effect on melatonin, the results cannot be generalized because of the large variability in exposure conditions and other factors that may influence melatonin. For instance, exposure to radiofrequency EM fields on sleep architecture show little or no effect. However, a number of studies show that pulsating radiofrequency electromagnetic fields, such as those emitted from cellular phones, can alter brain physiology, increasing the electroencephalogram power in selective bands when administered immediately prior to or during sleep. Additional research is necessary that would include older populations and evaluate the interactions of EM fields in different frequency ranges to examine their effects on sleep in humans.

Ohayon MM, Stolc V, Freund FT, Milesi C, Sullivan SS. "The potential for impact of man-made super low and extremely low frequency electromagnetic fields on sleep." SLEEP MEDICINE REVIEWS (2019);47:28-38.DOI: 10.1016/j.smrv.2019.06.001PubMedID 31252334.

Internet addiction and sleep problems: A systematic review and meta-analysis.

The pathological use of the internet - conceptualized as 'internet addiction' - might be crucial in initiating and increasing sleep disturbances in the community. While inconsistent evidence is reported regarding the association of internet addiction and sleep disturbances, the severity of this association remains unclear. This systematic review and meta-analysis were conducted to increase our understanding of the relationship between internet addiction and sleep disturbances. A systematic review was conducted through Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and EMBASE using keywords related to internet addiction and sleep problems. Observational studies (cohort, case-control or cross-sectional studies) focusing on association between internet addiction and sleep disturbances including sleep problems and sleep duration were selected. A meta-analysis using random-effect model was conducted to calculate the odds ratio (OR) for experiencing sleep problems and standardized mean differences (SMDs) for sleep duration. Eligible studies (N = 23) included 35,684 participants. The overall pooled OR of having sleep problems if addicted to the internet was 2.20 (95% CI: 1.77-2.74). Additionally, the overall pooled SMDs for sleep duration for the IA group compared to normal internet users was -0.24 (95% CI: -0.38, -0.10). Results of the meta-analysis revealed a significant OR for sleep problems and a significant reduced sleep duration among individuals addicted to the internet.

Alimoradi, Z. n., Lin, C. Y., Broström, A. n., Bülow, P. H., Bajalan, Z. n., Griffiths, M. D., Ohayon, M. M., Pakpour, A. H. "Internet addiction and sleep problems: A systematic review and meta-analysis." SLEEP MEDICINE REVIEWS (2019);47:51-61. DOI: 10.1016/j.smrv.2019.06.004PubMedID 31336284.

Longitudinal study of narcolepsy symptoms in first, second, and third-degree relatives of simplex and multiplex narcolepsy families.

Objective: To assess the evolution of narcolepsy symptoms in first-, second, and third-degree relatives and to compare multiplex and simplex families.
Methods: A total of 4045 family members and 362 narcoleptic individuals were entered in the study; with 3255 family members interviewed twice, five to seven years apart. A control group (n = 178) composed of spouses or housemates was also interviewed twice. Family members were divided according to their blood relationship with the probands and further divided into multiplex (ie, more than one narcolepsy cases) and simplex (only one narcolepsy case) families. Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy probands were evaluated and diagnosed by a Sleep Specialist in a Sleep Clinic Center.
Results: A total of 1123 family members from 72 families were identified as members of multiplex families while the rest of the sample were a part of simplex families (n = 2132). Multiplex families had higher incidence and chronicity of hypersomnolence than the simplex family members and the control group. For cataplexy-like symptoms, only prevalence at the time of the first assessment distinguished multiplex (5.5%) and simplex (2.9%) families. Prevalence of sleep paralysis was higher among the first- and second-degree relatives coming from multiplex families, while incidence was the highest among second- and third-degree relatives. Hypnagogic hallucinations had similar prevalence between multiplex and simplex families but the incidence and chronicity were significantly higher among multiplex families. For each symptom, predictive factors were also determined in simplex and multiplex families.
Conclusions: Our results show that individuals coming from multiplex families are at greater risks of a broad range of narcolepsy symptoms compared to simplex families.

Ohayon, M. M., Black, J., Krystal, A. D., Shapiro, C. M., Swick, T. J., Bogan, R., Wells, C. C. "Longitudinal study of narcolepsy symptoms in first, second, and third-degree relatives of simplex and multiplex narcolepsy families. SLEEP MEDICINE. 2019;53:88-93.DOI: 10.1016/j.sleep.2018.06.015PubMedID 30496948.

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