Sleep health is a novel concept, a multidimensional sleep-wakefulness pattern that adapts to individual, social, and environmental demands to promote physical and mental well-being. Current research has found that sleep health is not only associated with physiological health issues such as diabetes, overweight/obesity, and cardiovascular risks but also has significant impacts on mental health issues such as anxiety and depression. Previous sleep-related studies have primarily focused on identifying and treating sleep disorders and problems, with less attention to the positive attributes of sleep health. This review summarizes studies on sleep health, including its definition, measurement tools, and correlations with health outcomes, aiming to foster a more comprehensive understanding of sleep health and provide a reference for research on sleep health among Chinese residents.
Insomnia disorder is a common mental health condition that significantly impacts patients' lives and well-being. Traditional cognitive-behavioral therapy for insomnia (CBT-I) is an effective non-pharmacological treatment method, but its complexity, time-consuming nature, and low compliance limit its real-world application. Brief behavioral therapy for insomnia (BBT-I), based on CBT-I principles, offers comparable efficacy while being more suitable for real-world dissemination. However, the applicability of BBT-I to the Chinese population with insomnia disorder remains unclear, and research on BBT-I conducted online is lacking.
This study aims to investigate the efficacy of online e-aid brief behavioral therapy for insomnia (eBBT-I) delivered via WeChat Mini Program in improving insomnia symptoms among Chinese patients with insomnia disorder. Additionally, the study explores its impact on patients' sleep beliefs and attitudes.
This study employed a prospective non-randomized controlled design. Insomnia disorder patients from the Sleep Clinic at the First Affiliated Hospital of Jinan University between February and November 2023 were assigned to the intervention group. Insomnia disorder volunteers recruited online and offline were assigned to the control group. The intervention group received a 2-week eBBT-I (e-aid brief behavioral therapy for insomnia) treatment, while the control group received a sham intervention of mental health education. The severity of insomnia was assessed using the Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16) questionnaire before and after the intervention to evaluate its effectiveness.
The study ultimately included 35 patients in the intervention group and 30 patients in the control group. Key outcome measures: there was a significant interaction effect between group and time for ISI scores (P<0.05). Group and time separately had significant main effects on ISI scores (P<0.05). No statistically significant difference in ISI scores was observed between the two groups at baseline (pre-intervention) (P>0.05). After 14 days of intervention, the intervention group had lower ISI scores than the control group (P<0.05). Within the intervention group, ISI scores decreased after 14 days compared to baseline (P<0.05). Secondary outcome measures: there was no interaction effect between group and time for DBAS-16 scores (P>0.05). Time had a significant main effect on DBAS-16 scores (P<0.05). Group did not have a significant main effect on DBAS-16 scores (P>0.05). No statistically significant difference in DBAS-16 scores was found between the two groups at baseline or after 14 days (P>0.05). However, within the intervention group, DBAS-16 scores increased after 14 days compared to baseline (P<0.05) .
This indicates that eBBT-I effectively improved insomnia symptoms and negative impact in patients with insomnia disorder, but further improvement in sleep beliefs and attitudes is still needed. This study supports the feasibility and effectiveness of eBBT-I in the treatment of insomnia disorder among Chinese patients.
Insomnia not only decreases the quality of life and working efficiency, but also relates to other deceases. Suitable exercises may be useful to improve sleep quality. However, comparative studies on the effects of different types of exercise on sleep outcomes are currently lacked.
To compare the effects of different exercise types on sleep in insomnia patients and to provide insights for developing exercise prescriptions to improve sleep in this population.
Randomized controlled trials (RCT) investigating the effects of different types of exercises on the sleep of people with insomnia were retrieved from the PubMed, Web of Science, EBSCO, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform from database inception to December 2023. The quality of the literatures was assessed using the Jadad scale. A network meta-analysis was performed using the random-effects model of the frequency framework in Stata 17.0 software, and publication bias was observed using a funnel plot.
A total of 36 articles representing 2 706 participants were included in this study. Exercise interventions were categorized into five types, including the aerobic exercise (AE), resistance training (RT), mind-body exercise (ME), prolonged time of exercise (PTE), and AE combined with RT (AE+RT). The results of the network meta-analysis showed that there was a significant difference in the total score of the subjective evaluation tools between AE group and blank control group (SMD=2.20, 95%CI=0.35-4.05, P<0.05). The maximum surface under the cumulative ranking curve (SUCRA) of the total score of the subjective evaluation tools was detected in AE group (82.2%), followed by ME (71.1%), AE+RT (54.2%), RT (38.9%), controlled trial (CT) (29.2%) and PTE groups (24.4%). There was a significant difference in sleep latency (SL) between PTE group versus AE+RT group (SMD=-14.66, 95%CI=-28.60 to -0.72), between AE+RT group versus RT group (SMD=21.32, 95%CI=6.24-36.40), and between AE+RT group versus AE group (SMD=11.19, 95%CI=1.56-20.81) (all P<0.05). The maximum SUCRA of SL was detected in AE+RT group (96.7%), followed by CT (77.1%), ME (49.5%), AE (42.6%), PTE (27.9%) and RT groups (6.1%). There was a significant difference in sleep efficacy (SE) between AE group versus CT group (SMD=4.59, 95%CI=1.59-7.58, P<0.05). The maximum SUCRA of SE was detected in the AE group (83.1%), followed by AE+RT (59.9%), RT (50.7%), ME (46.9%), PTE (35.5%) and CT groups (23.9%). There was a significant difference in wake time after sleep onset (WASO) between PTE group versus RT group (SMD=23.39, 95%CI=14.67-32.02), between PTE group versus AE group (SMD=14.86, 95%CI=4.64-36.40), between PTE group versus CT group (SMD=12.11, 95%CI=7.62-16.59), between RT group versus ME group (SMD=-27.61, 95%CI=-40.49 to -14.73), between RT group versus CT group (SMD=-11.28, 95%CI=-20.86 to -1.70), between ME group versus AE group (SMD=19.08, 95%CI=5.18-32.98), and between ME group versus CT group (SMD=16.33, 95%CI=7.26-25.40) (all P<0.05). The maximum SUCRA of WASO was detected in the RT group (94.7%), followed by CT (80.2%), AE (41.8%), ME (31.5%) and PTE groups (1.7%). There was a significant difference in the total sleep time (TST) between RT group versus AE group (SMD=-20.84, 95%CI=-38.46 to -3.23), between AE group versus CT group (SMD=12.02, 95%CI=2.96-21.08) (all P<0.05). The maximum SUCRA of TST was detected in the AE group (87.2%), followed by AE+CT (71.6%), PTE (53.8%), ME (40.6%), CT (35.9%) and RT groups (10.8%). There was no significant difference in the sleep quality (SQ) among groups (P>0.05). The maximum SUCRA of SQ was detected in the AE group (84.2%), followed by AE+CT (75.5%), ME (24.9%) and CT groups (15.4%). Publication bias analysis of the total score of subjective evaluation tools, SL, SE, WASO, TST, and SQ revealed some asymmetry in all six outcome indicators, indicating a certain risk of publication bias.
Given the favorable effects of AE on multiple sleep parameters, we recommend insomnia patients engage in moderate-intensity AE, such as jogging or brisk walking, three times a week for approximately 30 minutes. Additionally, options include moderate-intensity RT or AE+RT four to five times a week. When engaging in the above exercises, attention should be paid to the choice of time period, and exercise within 3 hours before bedtime should be avoided as much as possible.
Comorbid insomnia and sleep apnea is a highly prevalent disorder characterized by both insomnia and sleep apnea, leading to more severe impairment of daytime function and quality of life than in patients with either insomnia or obstructive sleep apnea (OSA) alone. Non-benzodiazepine drugs (NBZDs) are frontline medications for insomnia treatment, as they can improve insomnia symptoms and enhance sleep quality. However, they are not recommended for OSA treatment due to their potential to increase the apnea-hypopnea index (AHI) and worsen the severity of sleep-disordered breathing. Currently, the therapeutic effects of NBZDs on COMISA are not well-established and require further investigation. Therefore, this article adopts a systematic review approach to compile relevant literature on the use of NBZDs in patients with OSA and COMISA, analyzing the impact of NBZDs on various indicators such as AHI, oxygen desaturation index, and sleep quality. It evaluates the clinical efficacy and safety of medications including zopiclone, eszopiclone, zolpidem, and zaleplon in the treatment of COMISA, aiming to provide guidance on the rational use of NBZDs for these patients.
