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Alcohol acts as a sedative that interacts with several neurotransmitter systems important in the regulation of sleep. Acute administration of large amounts of alcohol prior to sleep leads to decreased sleep-onset latency and changes in sleep architecture early in the night, when blood alcohol levels are high, with subsequent disrupted, poor-quality sleep later in the night. Alcohol abuse and dependence are associated with chronic sleep disturbance, lower slow-wave sleep, and more rapid-eye-movement sleep than normal, that last long into periods of abstinence and may play a role in relapse. This chapter outlines the evidence for acute and chronic alcohol effects on sleep architecture and sleep electroencephalogram, evidence for tolerance with repeated administration, and possible underlying neurochemical mechanisms for alcohol's effects on sleep. Also discussed are sex differences as well as effects of alcohol on sleep homeostasis and circadian regulation. Evidence for the role of sleep disruption as a risk factor for developing alcohol dependence is discussed in the context of research conducted in adolescents. The utility of sleep-evoked potentials in the assessment of the effects of alcoholism on sleep and the brain and in abstinence-mediated recovery is also outlined. The chapter concludes with a series of questions that need to be answered to determine the role of sleep and sleep disturbance in the development and maintenance of problem drinking and the potential beneficial effects of the treatment of sleep disorders for maintenance of abstinence in alcoholism.…

PMID: 25307588

The development of alcohol use disorder (AUD) involves binge or heavy drinking to high levels of intoxication that leads to compulsive intake, the loss of control in limiting intake, and a negative emotional state when alcohol is removed. This cascade of events occurs over an extended period within a three-stage cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. These three heuristic stages map onto the dysregulation of functional domains of incentive salience/habits, negative emotional states, and executive function, mediated by the basal ganglia, extended amygdala, and frontal cortex, respectively. Sleep disturbances, alterations of sleep architecture, and the development of insomnia are ubiquitous in AUD and also map onto the three stages of the addiction cycle. During the binge/intoxication stage, alcohol intoxication leads to a faster sleep onset, but sleep quality is poor relative to nights when no alcohol is consumed. The reduction of sleep onset latency and increase in wakefulness later in the night may be related to the acute effects of alcohol on GABAergic systems that are associated with sleep regulation and the effects on brain incentive salience systems, such as dopamine. During the withdrawal/negative affect stage, there is a decrease in slow-wave sleep and some limited recovery in REM sleep when individuals with AUD stop drinking. Limited recovery of sleep disturbances is seen in AUD within the first 30 days of abstinence. The effects of withdrawal on sleep may be related to the loss of alcohol as a positive allosteric modulator of GABA…

PMID: 31234199

Rats were sleep deprived by the platform method to look for differential effects on light and deep slow wave sleep depending on platform size. Diameters of large and small platforms were 15 cm and 5.1 cm respectively. Sleep was recorded during a baseline light period (09.00-19.00 h), continuously during 48 h of sleep deprivation and during the first lights on recovery period (09.00-19.00 h). In both platform conditions REM sleep was virtually abolished during the first light period (hours 0-10 of sleep deprivation), while NREM sleep was reduced to approximately half of control values. During the second light period (hours 22-34 of sleep deprivation) REM sleep recovered somewhat in the large platform group. Light slow wave sleep (SWS-1) was comparable to baseline while deep slow wave sleep (SWS-2) was still significantly reduced. In the small platform group both SWS-2 and REM sleep was considerably reduced on day 2. Over the whole deprivation period there was an effect of platform size on SWS-1 (higher in the small platform group), and on SWS-2 and REM sleep (lower in the small platform group). During the 9 h light-time recovery sleep there was an REM sleep rebound in both groups. SWS-1 was reduced in both groups while SWS-2 was not significantly increased. The ratio SWS-2/SWS-1 was, however, significantly increased only in the small platform group recovery sleep. The results suggest that platform sleep deprivation deprives the animals of deep slow wave sleep in addition to REM sleep. This has implications for conclusions on REM sleep function based upon REM sleep deprivation.…

PMID: 4091961

Chronic kidney disease (CKD) describes the long-term condition of impaired kidney function from any cause. CKD is common and associated with a wide array of complications including higher mortality, cardiovascular disease, hypertension, insulin resistance, dyslipidemia, sarcopenia, osteoporosis, aberrant immune function, cognitive impairment, mood disturbances and poor sleep quality. Glucocorticoids are endogenous pleiotropic steroid hormones and their excess produces a pattern of morbidity that possesses considerable overlap with CKD. Circulating levels of cortisol, the major active glucocorticoid in humans, are determined by a complex interplay between several processes. The hypothalamic-pituitary-adrenal axis (HPA) regulates cortisol synthesis and release, 11β-hydroxysteroid dehydrogenase enzymes mediate metabolic interconversion between active and inactive forms, and clearance from the circulation depends on irreversible metabolic inactivation in the liver followed by urinary excretion. Chronic stress, inflammatory states and other aspects of CKD can disturb these processes, enhancing cortisol secretion…

PMID: 36733794

Central sensitization (CS) is increasingly recognized as a key mechanism underlying chronic low back pain (CLBP), and has been linked to disturbed sleep, psychological distress, altered hypothalamic-pituitary-adrenal (HPA) axis function, low-grade inflammation, and cognitive dysfunction. However, few studies have simultaneously examined these domains in patients with different levels of CS compared with pain-free individuals. In this cross-sectional study, adults with CLBP were classified into severe and mild CS groups using the Central Sensitization Inventory and were compared with healthy controls. Sleep quality, psychological distress, and pain-related cognition were assessed using the Pittsburgh Sleep Quality Index, Depression Anxiety Stress Scales-21, and pain measures. Morning salivary cortisol, interleukin-6 (IL-6), and fasting blood glucose were obtained as biological markers, and cognitive performance was evaluated using the Corsi Block-Tapping and Tower of London tasks. Group differences were analyzed using one-way ANOVA with Tukey post-hoc tests. Forty-two participants (patients with CLBP and pain-free controls) completed the study. Compared with both mild CS patients and controls, the severe CS group showed markedly poorer sleep quality and higher levels of psychological distress. Morning cortisol concentrations were significantly elevated only in the severe CS group, whereas no statistically significant differences were detected for fasting glucose or IL-6 between groups. On the Corsi Block-Tapping task, healthy controls outperformed both CS groups, indicating reduced visuospatial working memory in patients, whereas no significant group differences were observed on the Tower of London planning task. Severe central sensitization in CLBP is associated with poor sleep, increased emotional distress, elevated morning cortisol, and deficits in visuospatial working memory, even in the absence of clear differences in IL-6 or fasting glucose. These findings support a biopsychosocial profile characterized by both neuroendocrine and cognitive alterations in patients with high levels of CS and highlight potential targets for multimodal assessment and intervention. Chronic low back pain is very common and often does not respond well to usual treatments. One important reason may be “central sensitization”, which means that the brain and spinal cord become overly sensitive and keep amplifying pain signals. People with chronic pain and central sensitization often also have poor sleep, emotional distress, and problems with thinking skills, but these relationships are not fully understood. In this study, we examined adults with non-specific chronic low back pain who attended orthopedic clinics. We divided them into two groups based on their score on the Central Sensitization Inventory: a high central sensitization group and a low central sensitization group. We measured sleep quality, symptoms of depression, anxiety, and stress, morning levels of the stress hormone cortisol, inflammatory and metabolic markers (interleukin-6 and fasting blood glucose), and performance on tests of visuospatial working memory and planning. People with high central sensitization reported worse sleep and higher emotional distress. They also showed higher morning cortisol levels and slightly poorer visuospatial working memory. In contrast, interleukin-6 and fasting blood glucose did not clearly differ between the groups. These findings suggest that poor sleep, psychological distress, stress-system changes, and subtle cognitive problems are important features of chronic low back pain with central sensitization, and they should be considered in assessment and treatment.…

PMID: 41716819

<h4>Background</h4>Nutritional deficiency and poor sleep quality are well-established independent risk factors for cognitive decline. However, few studies have examined their combined effects on cognitive decline. This study evaluated the synergistic association between nutritional deficiency, poor sleep quality, and cognitive decline in Chinese older adults aged 65 years and above.<h4>Methods</h4>Data from 10,152 participants were analyzed. Univariate and multivariate logistic regression analyses were conducted to determine the relationship between nutritional deficiency, poor sleep quality, and cognitive decline. Interactive effects were evaluated using the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S).<h4>Results</h4>The prevalence of cognitive decline was 13.02%. Multivariate analysis revealed that the odds ratios (ORs) for cognitive decline associated with nutritional deficiency and poor sleep quality were 3.587 (95% confidence interval [CI]: 3.125-4.118) and 1.174 (95% CI: 1.024-1.347), respectively. A significant synergistic interactive effect on cognitive decline was observed, with RERI (95% CI) = 1.037 (0.079-1.995), AP (95% CI) = 0.231 (0.052-0.411), and S (95% CI) = 1.424 (1.041-1.949). In the sex-stratified analysis, after full adjustment, the significant association between poor sleep quality and cognitive decline remained in women, but not in men (OR = 1.139, 95% CI: 0.917-1.415). Conversely, the significant additive interactive effects were only observed in men.<h4>Conclusion</h4>Among the elderly Chinese population, nutritional deficiency and poor sleep quality are independently associated with cognitive decline, and these two variables demonstrate a synergistic effect. These findings underscore the necessity of implementing integrated interventions that simultaneously address both nutritional and sleep-related factors in this population.…

PMID: 41566426

Menopause is more than simply the end of menstrual cycles or having hot flushes-it marks a time of profound hormonal change which can cause a range of symptoms from poor sleep to anxiety, low mood, cognitive decline and difficulties with memory. These effects can be life-altering and can lead to social withdrawal, relationship strain and reduced capacity to work. With key neurotransmitter systems including serotonin, allopregnanolone and gamma-aminobutyric acid (GABA) being modulated by fluctuating levels of oestradiol, progesterone and testosterone, some women experience severe hormonally related depression and suicidality, as evidenced by the peak of women's suicide rates in midlife. Despite National Institute of Clinical Excellence (NICE) guidance recommending hormone replacement therapy (HRT) as a first-line treatment for perimenopausal mood disturbance, inconsistencies in clinical knowledge and lack of clinician awareness and confidence in prescribing HRT leave many women feeling unsupported and struggling to improve. By providing individualised menopause management through a biopsychosocial lens, supported by improved clinician training and further research, and offering treatment such as HRT alongside lifestyle and psychological support, there is potential not only to transform the lives of affected women but also to safeguard their long-term health. With nearly 40% of women's lives spent post-menopause, combined with the extensive amount of time women sometimes spend in perimenopause (up to 12%), when mental health challenges are noted to be most acute, effective menopause management should be an urgent public health priority.…

PMID: 41269515

Eighty subjects, 40 men and 40 women, were allocated to one of two groups according to their self-estimated high or low sensitivity to noise. In the first part of the experiment, they were exposed to sequences of common noises during the morning or the afternoon. The heart-rate and finger-pulse responses were measured and recorded in relation to sensitivity, sex of subjects, and time of day. The different types of noise were compared for both responses. The heart-rate response showed differences between sensitivity groups but not between noises. In contrast, no significant differences were obtained between sensitivity groups when using the finger-pulse response, but clear differences were observed between noises. In a second part of the experiment, 10 men and 10 women subjects were selected from the previous two sensitivity groups. These 20 subjects were exposed during sleep to the same noises as during the daytime. Heart-rate and finger-pulse responses during sleep were significantly greater than during waking, and they did not differ significantly with respect to sensitivity to noise or gender. These two autonomic responses showed differences between noises that appeared to be related to their noise-equivalent-level value. Compared with the silent baseline night, the sleep pattern showed no significant modification in the night of noise disturbance, except for the frequency of transient activation phases, which was significantly increased in the latter.…

PMID: 2330471

Obstructive sleep apnea (OSA) in women is often underdiagnosed due to various and different symptoms, significant delay of referrals, sex-specific polysomnographic patterns that are usually not detected by standard severity indices from the home sleep apnea test, and limitations of current screening tools. Up to 75% of women with OSA remain undiagnosed, with relevant clinical and socioeconomic consequences. Women often report daytime fatigue, insomnia, depression, anxiety, and poor sleep quality rather than excessive daytime sleepiness or snoring, which may lead to fewer sleep clinic referrals. Additionally, the menstrual phase significantly influences symptom expression. Comorbidities also exhibit sex-based differences: OSA in premenopausal women is strongly linked to depression, metabolic syndrome, and polycystic ovary syndrome, while postmenopausal women with OSA reported hypertension and diabetes more frequently, leading to a greater cardiometabolic risk in postmenopausal women with OSA. The screening questionnaires showed numerous limitations in women due to the lack of items concerning symptoms. Women's typical polysomnographic pattern, especially in the premenopause period, is characterized by predominant hypopneas, mild OSA with prevalent rapid eye movement (REM)-OSA, respiratory effort-related arousals (RERAs), and low arousal threshold, highlighting the crucial role of sleep fragmentation evaluation, beyond the apnea-hypopnea index (AHI). New indices such as hypoxic burden, pulse wave amplitude drops index and arousal burden may provide more appropriate OSA severity classification and risk stratification in women.After a review of the literature, we proposed four women phenotypes, highlighting the heterogeneity of OSA in women and the key role of sex-tailored OSA management. From a therapeutic perspective, women differ in apnea-hypopnea index (PAP) compliance, required lower PAP levels for the same disease severity as men, and experience mask-related side effects. However, we have to mention that this is suspected to be biased due to significant lower number of women included in cohorts and even lower in randomized controlled trials (RCTs). Mandibular advancement devices (MADs) and endotype-based pharmacotherapy may be beneficial in women with mild OSA and low arousal threshold or low muscle responsiveness. Emerging evidence suggests that a sex-centered approach to screening, diagnosis, and treatment may reduce the clinical and socioeconomic burden of OSA in women in the future.…

PMID: 41758319

The complex relationship among long-term exposure to environmental noise, self-reports of health, and sleep was investigated in a multifactorial design. Forty-seven women and 35 men living beside a street with moderate to heavy traffic took part. They answered questions concerning health complaints, usual sleep patterns, sleep the actual week of testing, their subjective responses to noise, psychosocial relations, anxiety, stressful life events, type A behavior, and attitudinal factors that could explain their responses to noise. No detrimental relations among objective noise levels, health, and sleep could be shown. There were, however, strong correlations between the subjective noise responses of annoyance and sensitivity and health complaints. Only women revealed a relationship between poor sleep quality and sensitivity. The stronger relationship among noise sensitivity, health complaints, and poor sleep quality for women than for men could be explained by the degree of exposure to noise as evidenced by their longer residence and greater time spent at home.…

PMID: 8350341

Nighttime transportation noise elicits awakenings, sleep-stage changes, and electroencephalographic (EEG) arousals. Here, we investigated the potential sleep-protective role of sleep spindles on noise-induced sleep alterations. Twenty-six young (19-33 years, 12 women) and 18 older (52-70 years, 9 women) healthy volunteers underwent a repeated measures polysomnographic 6-day laboratory study. Participants spent one noise-free baseline night, followed by four transportation noise-exposure nights (road traffic or railway noise; continuous or intermittent: average sound levels of 45 dB, maximum sound levels of 50-62 dB), and one noise-free recovery night. Sleep stages were scored manually and fast sleep spindle characteristics were quantified automatically using an individual band-pass filtering approach. Nighttime exposure to transportation noise significantly increased sleep EEG arousal indices. Sleep structure and continuity were not differentially affected by noise exposure in individuals with a low versus a high spindle rate. Spindle rates showed an age-related decline along with more noise-induced sleep alterations. All-night spindle rates did not predict EEG arousal or awakening probability from single railway noise events. Spindle characteristics were affected in noise-exposure nights compared to noise-free nights: we observed a reduction of the spindle amplitude in both age groups and of the spindle rate in the older group. We have evidence that spindle rate is more likely to represent a trait phenomenon, which does not seem to play a sleep-protective role in nighttime transportation noise-induced sleep disruptions. However, the marked reduction in spindle amplitude is most likely a sensitive index for noise-induced sleep alterations.…

PMID: 29697833

<h4>Objective</h4>Residential air-source heat-pump (AHP) installations are increasing, yet their impacts on sleep and noise annoyance remain insufficiently understood. This study is the first to combine multi-night polysomnography (PSG) and daytime testing to assess the effects of AHP noise on sleep and daytime annoyance, concentration, and mood.<h4>Methods</h4>The sleep study involved PSG examining sleep patterns and noise-associated arousals across three nights, each with a different condition: (1) no noise (baseline condition), (2) AHP noise levels simulating tilted windows, and (3) AHP noise levels simulating closed windows. The daytime study exposed subjects to AHP noise while reading texts, and responses were compared to a quiet baseline. Questionnaires measured sleep disturbance, noise annoyance, and concentration.<h4>Results</h4>Out of the 42 initial subjects included, 2 discontinued for personal reasons. Forty subjects (f = 21, m = 19) completed both studies. In the sleep study, no differences were found for Total Sleep Time [418.20 min (363.10, 438.50), 408.20 min (352.90, 435.80), 405.70 min (375.00, 430.20)] or Sleep Efficiency [87.10% (75.60, 91.30), 85.00% (73.50, 90.70), 84.50% (78.10, 89.60)] across conditions. However, AHP noise with tilted windows led to significantly more noise-related arousals (7.60 ± 5.90 vs. 5.50 ± 3.60, pP< 0.050) than with closed windows. Sleep disturbance was significantly greater in the tilted window condition. Daytime exposure to AHP noise increased noise annoyance, concentration difficulties, and mood disturbances, with a pronounced effect of the order of conditions on annoyance when noise followed the quiet condition (2.58 ± 1.22 vs. 1.57 ± 0.60).<h4>Conclusions</h4>This study demonstrates that residential AHP noise can impair both sleep parameters and daytime functioning, underscoring the need to consider its health impact in residential settings. Future studies should explore the long-term impact of noise exposure and potential interventions through -multicenter research. A laboratory setting limits the generalizability of the results.…

PMID: 41800689