Subjective cognitive decline (SCD) usually predicts the risk of future cognitive decline, and sleep disturbances are very common in patients with SCD and often precede detectable cognitive changes. Although there is a lack of clarity regarding the relationship between sleep and SCD and the underlying mechanisms of sleep-related cognitive deterioration, studies in recent years have shown a strong link between sleep and cognitive decline. Cognitive decline may be triggered by either sleep deprivation or decreased sleep quality. Therefore, the aim of this review is to provide a comprehensive overview of the research progress on sleep and subjective cognitive decline, and to explore in depth the mechanism of their interaction, with a view to providing new ideas and methods for preventing and delaying cognitive decline, and providing useful references for research and practice in related fields.

Patients with stroke often experience sleep disturbances and imbalances, which are easily overlooked in clinical treatment. Moreover, there is currently limited research on whether sleep status affects the prognosis of such diseases.

Exploration of factors influencing sleep state changes and prognosis in patients with acute posterior circulation ischemic stroke.

A total of 60 patients with acute posterior circulation ischemic stroke, admitted to Kailuan General Hospital Affiliated to North China University of Science and Technology, from December 2019 to December 2023, were selected as the case group. Based on the modified Rankin Scale (mRS) score at discharge, the case group was divided into a good prognosis subgroup (45 cases) and a poor prognosis subgroup (15 cases) . Additionally, 52 patients without cerebral vascular stenosis and acute ischemic stroke during the same period were selected as the control group. General and clinical data of the patients were collected to compare the circadian sleep-wake rhythms, daytime sleep-wake rhythms, nighttime sleep-wake rhythms, and the distribution of infarcted brain regions between the good prognosis subgroup and the poor prognosis subgroup. Multivariate Logistic regression analysis was used to identify the prognostic factors influencing the outcomes of patients with acute posterior circulation ischemic stroke.

The apnea-hypopnea index (AHI) in the case group was higher than in the control group (P<0.05) . The proportions of patients in the case group with reversed sleep cycles, increased daytime sleep, and difficulty falling asleep were higher than those in the control group, with statistically significant differences (P<0.05) . The case group showed higher total daytime sleep time, wake time after sleep onset, light sleep duration, deep sleep duration, NREM sleep duration, REM sleep duration, REM sleep proportion, and deep sleep proportion compared to the control group, whereas the proportions of NREM sleep and light sleep were lower, all with statistically significant differences (P<0.05) . The case group also exhibited longer total nighttime sleep time, light sleep duration, and NREM sleep duration than the control group, with statistically significant differences (P<0.05) . The proportion of pontine infarction in the poor prognosis subgroup was higher than in the good prognosis subgroup, with a statistically significant difference (P<0.05) . Multivariate Logistic regression analysis showed that daytime deep sleep duration (OR=1.203, 95%CI=1.032-1.401) and pontine infarction (OR=16.497, 95%CI=1.142-238.391) were influencing factors for the prognosis of acute posterior circulation ischemic stroke (P<0.05) .

Patients with acute posterior circulation ischemic stroke exhibit an increased AHI and present with sleep characteristics such as reversed sleep cycles, increased daytime sleep, and difficulty falling asleep at night. Additionally, daytime deep sleep duration and pontine infarction are factors that adversely affect the prognosis of these 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.

Obstructive sleep apnea (OSA) is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases, and affects cognitive function and multi-system organ function in the elderly. Therefore, it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society, as the initiator, organized domestic experts in related fields to repeatedly discuss the operation process, requirements, specific ways and methods of noninvasive positive pressure ventilation (NPPV) treatment for elderly OSA patients with reference to domestic and international clinical studies, and finally made this expert consensus, which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.

With the aging and life expectancy increasing in China, sleep disorders in the elderly (≥80 years old) have received widespread attention. As one of the common problems, sleep disorders seriously affect the quality of life and physical and mental health among the elderly, and can also aggravate or induce multiple diseases.

To conduct a scoping review of studies on sleep disorders in community dwelling older adults over 80 years and provide guidance for the early diagnosis and treatment of sleep disorders in community dwelling older adults in China.

PubMed, Embase, CINAHL, Web of Science, Cochrane Library, OpenGrey, SinoMed, CNKI, Wanfang Data, and VIP databases were searched for literature on sleep disorders in community dwelling older adults from inception to March 15, 2023. Literature was independently screened by 2 investigators and basic characteristics of the literature were extracted (authors, time of publication, country, type of study, sample size, assessment tool or modality, prevalence, findings) .

A total of 10 486 papers were searched, and 21 papers were finally included, of which 14 were in English and 7 were in Chinese, 16 were cross-sectional studies, 2 were quasi-experiment studies and 3 were longitudinal studies. The results of the analysis indicated that sleep disorders were more prevalent with serious adverse effects in the community dwelling older adults aged over 80 years (the prevalence rate ranged from 10.0% to 60.3%), which were assessed by nine tools or modalities, including three structured scales with the more commonly used scale being Pittsburgh Sleep Quality Index (PSQI). The influencing factors of sleep disorders were divided into three categories of social demographic factors, physical health and disease-related factors, psychological and behavioral characteristic factors. Interventions such as music therapy, therapy combined with interaction mode groups were found to be effective in improving sleep disorders. However, few prevention and intervention studies were conducted.

The high prevalence of sleep disorders among older people in the community is high with serious effects, there is insufficient knowledge about sleep disorders among community dwelling older adults and fewer types of assessment tools lacking specificity in China. The influencing factors of sleep disorders among older people are complex and diverse, with a lack of research on prevention and intervention.

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) and asthma are two prevalent chronic respiratory diseases. Recent research has revealed that OSAHS not only shares several common risk factors with asthma but also exhibits a high comorbidity rate with it. This mutual interaction complicates the course of both diseases and increases complexity to clinical diagnosis and treatment. This review aims to provide a comprehensive summary and analysis, from an epidemiological and pathophysiological perspective, of the research progress and challenges concerning the OSAHS comorbided with asthma, particularly in severe asthma.

Hypertension and obstructive sleep apnea (OSA) often coexist, posing challenges in the management of blood pressure in these patients. A reliable and objective predictor is needed to anticipate the occurrence of hypertension and assess the status of blood pressure control in OSA patients, which would facilitate their blood pressure management.

To explore the correlation between red blood cell distribution width (RDW) and hypertension in patients with OSA.

A retrospective study was conducted at the Sleep Center of Peking University International Hospital, involving 510 patients who were diagnosed with OSA using polysomnography between January 2019 and September 2022. The derivation cohort comprised of 370 enrolled patients between January 2019 and December 2021, while the validation cohort included the remaining 140 patients enrolled between January and September 2022. Within the derivation cohort, patients were categorized into two groups based on their adherence to the definition of hypertension: hypertension group (n=211) and non-hypertension group (n=159). Subsequently, the hypertension group was further divided into two subgroups: blood pressure control subgroup (n=107) and blood pressure uncontrolled subgroup (n=104). The clinical characteristics and laboratory examination results of patients in the hypertension group and non-hypertension group, as well as those in the blood pressure control subgroup and blood pressure uncontrolled subgroup, were analyzed. Univariate and multivariate Logistic regression analyses were employed to investigate the predictors of hypertension in OSA patients and the status of blood pressure control in OSA patients with combined hypertension. The receiver operating characteristic (ROC) curve was plotted to evaluate the sensitivity and specificity of RDW in predicting the occurrence of hypertension among OSA patients, with its validity confirmed in the validation cohort.

The multivariate Logistic regression analysis revealed that an increased BMI (OR=1.087, 95%CI=1.007-1.174, P=0.032), diabetes (OR=3.310, 95%CI=1.484-7.380, P=0.003), and a decreased RDW (OR=0.598, 95%CI=0.507-0.704, P<0.001) were independent predictors of hypertension in OSA patients. Furthermore, an increased hemoglobin level (OR=1.027, 95%CI=1.005-1.050, P=0.016) and a decreased RDW (OR=0.804, 95%CI=0.669-0.965, P=0.019) were identified as independent predictors of poor blood pressure control status in OSA patients with combined hypertension. The results of ROC curve analysis for RDW in predicting hypertension in OSA patients showed that the area under the ROC curve was 0.779 (95%CI=0.732-0.826, P<0.001), with an optimal cut-off value identified at 39.9 fL. Considering the clinical usability, when using an RDW≤40 fL as the threshold value, the sensitivity and specificity for predicting hypertension in OSA patients were 70.14% and 81.76%, respectively. The validation cohort, utilizing an RDW cutoff value of ≤40 fL, demonstrated that RDW predicted the hypertension in OSA patients with a sensitivity of 63.64% and a specificity of 80.95%. The area under the ROC curve was 0.757 (95%CI=0.678-0.835, P<0.001) .

The reduction of RDW is associated with the occurrence of hypertension and poor blood pressure control status in patients with OSA. OSA patients exhibiting decreased RDW level are at an elevated risk for hypertension.

Sleep disturbances are the most common health issues in high-altitude environments. Current research on the sleep architecture of healthy populations is limited to the same altitude and involves a small number of subjects, lacking sufficient reliability.

This study aims to analyze the differences in sleep monitoring indicators among healthy adults of different ages and genders across various altitudes, exploring the impact of altitude, age, and gender interactions on these indicators.

Healthy volunteers recruited from the plains of Chengdu, Sichuan Province, and the plateau area of Kunming, Yunnan Province, from January 2020 to September 2022 were selected as study subjects. Volunteers' gender, height, body mass, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were collected. Total sleep time (TST), sleep efficiency, and sleep parameters [percentage of stage N1 (N1%), stage N2 (N2%), stage N3 (N3%) of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep in total sleep time] were recorded. Age was categorized into two groups (20-39 and 40-60 years) for a two-way ANOVA to explore the effects of age, gender, and altitude on sleep parameters.

A total of 91 people were recruited in low-altitude areas, including 48 men and 43 women. A total of 90 people were recruited for the high-altitude area, including 46 men and 44 women. In females, TST was higher in high-altitude areas compared to low-altitude areas (P<0.05). In both males and females, N1% was higher and N2% was lower in high-altitude areas (P<0.05). N3% was higher in females than in males in high-altitude areas (P<0.05). In males, REM% was higher in high-altitude areas (P<0.05). TST was higher in the 20-39 age group than in the 40-60 age group in high-altitude areas (P<0.05). Sleep efficiency was higher in the 40-60 age group in low-altitude areas compared to high-altitude areas, with the 20-39 age group showing higher sleep efficiency in high-altitude areas (P<0.05). In both age groups, N1% was higher in high-altitude areas (P<0.05). In low-altitude areas, N1% was higher in the 20-39 age group than in the 40-60 age group, whereas in high-altitude areas, it was lower in the 20-39 age group (P<0.05). N2% was higher in low-altitude areas in both age groups (P<0.05), with the 40-60 age group having a higher N2% in high-altitude areas (P<0.05). N3% was higher in the 20-39 age group in high-altitude areas (P<0.05). In low-altitude areas, N3% was lower in the 20-39 age group compared to the 40-60 age group, while in high-altitude areas, it was higher in the 20-39 age group (P<0.05). REM% was higher in high-altitude areas in both age groups (P<0.05) .

The factors of age and altitude have varying degrees of influence on total sleep time, sleep efficiency, N1%, N2%, and REM%. Age factors have a greater impact on sleep structure, the older the age, the shorter TST, the lower the sleep efficiency, the higher the proportion of N1. The higher the altitude, the greater the influence of age on sleep structure. In the high altitude area, the TST, sleep efficiency and N3% of the elderly population are lower, and the proportion of N1% is higher.

Respiratory problems in chronic obstructive pulmonary disease (COPD) patients are prone to poor sleep quality, anxiety and depression, but they are often ignored by medical staff and patients themselves. Understanding the sleep quality, anxiety and depression symptoms of patients with COPD and their influencing factors can help to improve the quality of life of patients, however, there are few relevant studies.

To investigate the sleep quality, anxiety and depression of patients with COPD and explore the influencing factors.

Convenience sampling was used to recruit COPD patients who visited the Department Respiratory Diseases and Critical Care Medicine of seven hospitals in Anhui Province from August to November 2022. Demographic characteristics, dyspnea grade, airflow restriction severity, risk of malnutrition, physical activity level, vaccination, and acute exacerbations in the last 1 year were collected. The Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate the sleep quality and anxiety and depression symptoms of COPD patients, and the influencing factors were analyzed by multivariate Logistic regression.

A total of 248 patients with COPD were investigated, among which the incidence of poor sleep quality was 60.9% (151/248), only 8.9% (22/248) of the patients thought they had good sleep quality, and more than half of the patients actually had insufficient sleep time (54.4%) or low sleep efficiency (60.1%). 29.4% (73/248) of COPD patients had at least one of the symptoms of anxiety or depression, of which 35 had anxiety symptoms, 61 had depression symptoms, and 23 had both anxiety and depression symptoms. Multivariate Logistic regression analysis showed that older ages (OR=1.052, 95%CI=1.018-1.086) and risk of malnutrition (OR=3.393, 95%CI=1.855-6.206) were risk factors for poor sleep quality in COPD patients. Regular physical activity was a protective factor for poor sleep quality in COPD patients (OR=0.450, 95%CI=0.242-0.834) (P<0.05). Acute exacerbations ≥2 times (OR=2.220, 95%CI=1.093-4.510) and malnutrition risk (OR=1.961, 95%CI=1.044-3.683) were risk factors for anxiety and depression symptoms in COPD patients (P<0.04). In COPD patients, PSQI score was positively correlated with HADS-A (r_s=0.413) and HADS-D score (r_s=0.430), and there was a positive correlation between HADS-A score and HADS-D score (r_s=0.719, P<0.05) .

The incidence of poor sleep quality, anxiety and depression symptoms was high in COPD patients, and age, malnutrition risk, regular physical activity and number of acute exacerbations in the past year are important influencing factors. Medical staff, family members and patients themselves should improve the awareness of sleep quality, anxiety and depression, and actively carry out screening and intervention work for key patients to improve the sleep quality and mental health of patients.

The prevalence of obstructive sleep apnea (OSA) has been increasing year by year, but the current diagnostic criteria of apnea-hypopnea index (AHI) >5 times/h commonly used for OSA has gradually revealed drawbacks in the diagnosis, severity evaluation, treatment effect and long-term complications prediction of the disease. This study proposed that there is a need for more information about the duration of apnea-hypopnea for assessing OSA in addition to AHI.

To investigate the significance of duration of respiratory events in nocturnal hypoxemia in adults with OSA.

A total of 296 patients with suspected OSA who were admitted to the sleep monitoring room of the First Hospital of Shanxi Medical University from October 2021 to March 2022 were selected as the study subjects. Before PSG, the subjects underwent a physical examination in terms of height, body mass, neck circumference, and were asked about their sleep history, as well as history of hypertension and diabetes. The subjects were divided into three groups according to AHI of 5 times/h≤AHI<15 times/h as the mild OSA group (n=56), 15 times/h≤AHI<30 times/h as the moderate OSA group (n=62), AHI≥30 times/h as the severe OSA group (n=178). The three groups were compared for blood oxygen indexes[lowest oxygen saturation (LSpO₂), mean oxygen saturation (MSpO₂), baseline oxygen saturation (BSpO₂), oxygen desaturation index (ODI), oxygen saturation (SpO₂) below 90% in total sleep time (T90) ]and duration parameters of respiratory events [mean total apnea duration (MTAD), mean hypopnea duration (MHD), mean apnea-hypopnea duration (MAD), the longest apnea duration (LTAD), the longest hypopnea duration (LHD), the longest apnea-hypopnea duration (LAD), total apnea-hypopnea duration (TAD), AHI, percentage of apnea/hypopnea time from total sleep time (AHT%) ]. Spearman rank correlation analysis was used to investigate the correlation between respiratory event duration parameters and blood oxygen indexes. The OSA patients were divided into the short event group (short TAD subgroup, short AHT% subgroup, n=74) and long event group (long TAD subgroup, long AHT% subgroup, n=222) according to the median of TAD and AHT% (69.78 min and 14.33%, respectively), and the correlation of TAD, AHT% and AHI with blood oxygen indexes in each group was further analyzed.

There were significant differences in gender, age, BMI, neck circumference, daytime sleepiness, history of hypertension and diabetes among the mild, moderate and severe OSA groups (P<0.05). ODI and T90 in the severe OSA group were higher than those in the mild and moderate OSA groups, and LSpO₂ and MSpO₂ were lower than those in the mild and moderate OSA groups (P<0.05) ; LSpO₂ in the moderate OSA group was lower than that in the mild OSA group, ODI and T90 were higher than that in the mild OSA group (P<0.05). MTAD, LTAD, TAD, AHT% in the severe OSA group were higher than those in the mild and moderate OSA groups, and MHD was lower than that in the mild and moderate OSA groups (P<0.05) ; LHD in the severe OSA group was lower than that in the moderate OSA group, LAD was higher than that in the mild OSA group. MTAD, LTAD, TAD and AHT% in the moderate OSA group were higher than those in the low OSA group (P<0.05). The scatter plot and loess fitting curve showed that the values of MTAD, MHD, MAD, LTAD, LHD and LAD all increased first and then decreased with AHI. TAD and AHT% were prolonged with increasing AHI. Spearman rank correlation analysis showed that AHI, MTAD, LTAD, TAD, AHT% were negatively correlated with LSpO₂ and MSpO₂, but positively correlated with ODI and T90 in OSA patients (P<0.05) ; MHD and LHD were positively correlated with LSpO₂ and MSpO₂, and negatively correlated with ODI and T90 (P<0.05) ; MAD was negatively correlated with ODI (P<0.05) ; LAD was negatively correlated with LSpO₂ (P<0.05). Further subgroup Spearman rank correlation analysis showed that TAD, AHT% and AHI were negatively correlated with LSpO₂ and positively correlated with ODI in short TAD subgroup, short AHT% subgroup, long TAD subgroup and long AHT% subgroup (P<0.05), and had no correlation with BSpO₂ (P>0.05) ; TAD, AHT%, and AHI were all negatively correlated with MSpO₂ and positively correlated with T90 in the long event group (P<0.05) .

Duration of respiratory events plays an important role in the evaluation of nocturnal hypoxemia in OSA patients, and can be used as a supplement to the existing diagnostic and evaluation index AHI, and indexes such as TAD and AHT% are even more representative than AHI in some cases. The combination of AHI and LSpO₂ with the duration of respiratory events can more objectively assess the severity of OSA patients.

There is a close association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and stroke. The coexistence of the two diseases not only affects the rehabilitation process of patients, prolongs their hospitalization time, but also may increase the risk of death. At present, there is still a lack of clinical research on continuous positive airway pressure (CPAP) combined with respiratory training for stroke patients with OSAHS.

To examine the impact of threshold inspiratory muscle training (TIMT) in conjunction with CPAP on sleep status, pulmonary function, and respiratory muscle strength in stroke patients with OSAHS.

Sixty-nine patients with stroke and OSAHS who met the enrollment criteria were selected from the Second Affiliated Hospital of Zhengzhou University from April 2022 to August 2023. The patients were divided into experimental group (n=35) and control group (n=34) by random number table method. The control group received CPAP and conventional treatment, and the experimental group received TIMT on this basis for 6 weeks. The sleep status, lung function and respiratory muscle function of the two groups were compared before and after intervention.

Six weeks after the intervention, the mean blood oxygen saturation (SpO₂), proportion of deep sleep (proportion of N3 sleep in total sleep time), minimum arterial oxygen saturation (LSaO₂), forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), one-second rate (FEV₁/FVC), maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were all higher than those before intervention in the 2 groups (P<0.05) ; After 6 weeks of intervention, SpO₂, proportion of deep sleep (proportion of N3 sleep in total sleep time), LSaO₂, FEV₁, FVC, FEV₁/FVC, MEP and MIP in experimental group were higher than those in control group (P<0.05). Sleep apnea hypopnea index (AHI), oxygen loss index (ODI), arousal index and Epworth lethargy scale (ESS) scores in the 2 groups were lower than those before intervention (P<0.05). After 6 weeks of intervention, the ODI, arousal index and ESS scores of experimental group were lower than those of the control group (P<0.05) .

TIMT combined with CPAP can significantly improve the sleep disorder of stroke patients with OSAHS, and improve arterial oxygen partial pressure, respiratory muscle strength and pulmonary function.

In recent years, in the context of global aging, the number of patients with chronic diseases in China has increased significantly, and the the coexistence of multiple diseases has become more and more common, which seriously threatens the life safety and quality of life of the older adults in China.

To investigate the status of multimorbidity of older adults, and explore the relationship and pathways of action between sleep, physical activity, social network and multimorbidity of older adults, providing ideas for the effective prevention of multimorbidity and health improvement of older adults.

Elderly people aged≥60 years in the Community Health and Behavior of the Elderly Panel Study (CHBEPS) established by our team in 2021 were selected as the subjects of the survey, a questionnaire was used to investigate the study population, the research objects were investigated by questionnaire, and the general situation was collected by self-designed basic information collection form, IPAQ-S-C, LSNS-6 and PSQI were used to assess the physical activity, social network and sleep of the subjects. AMOS 28.0 statistical software was used to set up the structural equation model.

A total of 3 392 valid questionnaires were collected from 3 531 people over 60 years old, with an effective recovery rate of 96.06%. The average score of physical activity was 2 426.42 (495.00, 3 060.00) MET-min/w, the average score of social network was (15.91±6.43), and the average score of sleep was (5.49±3.53). There were 788 (23.23%) older adults with insufficient social network and 353 (10.41%) older adults with fair or very poor sleep quality. The prevalence of multimorbidity among the survey respondents was 41.13% (1 395/3 392). The results of correlation analysis showed that social network was negatively correlated with sleep level (r_s=-0.113, P<0.01) and multimorbidity (r_s=-0.049, P<0.01), and was positively correlated with physical activity (r_s=0.073, P<0.01). Multivariate Logistic regression analysis showed that physical activity of 0-600 MET-min/w (OR=0.576, 95%CI=0.342-0.970) and good sleep quality (OR=0.409, 95%CI=0.209-0.803) were protective factors for multimorbidity (P<0.05). The results of structural equation modeling showed that social networks could affect physical activity and sleep quality (standardized path coefficient=0.096, t=4.982, P<0.001; standardized path coefficient=-0.043, t=-5.981, P<0.001), physical activity and sleep quality could affect multimorbidity (standardized path coefficient=0.023, t=5.280, P<0.001; standardized path coefficient=0.111, t=9.409, P<0.001). Social network had no direct effect on multimorbidity, but an indirect effect on it through two mediators of physical activity and sleep. The indirect effect of social network on multimorbidity through physical activity accounted for 10% of the total effect, and the indirect effect of social network on multimorbidity through sleep accounted for 36.5% of the total effect.

The prevalence of multimorbidity is high in the older adults (41.13%). The social network of the elderly group should be appropriately expanded to encourage them to maintain a moderate amount of physical activity and a good quality of sleep, alleviate and prevent the occurrence of multimorbidity.

Obstructive sleep apnea hypopnea syndrome (OSAHS) in adults is a common sleep-breathing disorder closely associated with hypertension, diabetes, cardiovascular diseases, and other health concerns. Despite its widespread impact on global health, the screening and diagnosis of OSAHS is still not widely available in clinical practice. In this context, the U.S. Preventive Services Task Force (USPSTF) has recently released updated recommendations for adult OSAHS screening to help more people identify and treat potential sleep-breathing disorders. This article interprets the latest recommendations and consider the practical situation in China, providing reference for OSAHS screening of adults in China.

With the accelerated aging of the national population, the rapid increase of the elderly with dementia has become an increasingly prominent problem. Sleep is the basic need of the human body, and sleep problems have become an independent risk factor for the cognitive function of the elderly. Moderate sleep duration is essential for the removal of brain wastes, synaptic plasticity, and the maintenance of normal function of the nervous system. However, the current sleep problems of the elderly have not attracted widespread attention, and the sleep time of the elderly needs to be further studied.

To explore the dose-response relationship between sleep duration and risk of senile dementia.

CNKI, Wanfang Data, VIP, CBM, PubMed, Cochrane Library, Embase and Web of Science databases were searched for prospective cohort studies on the relationship between sleep duration and risk of senile dementia from inception to June 2023. Literature data were independently extracted by two researchers, and literature quality evaluation was performed. Dose-response Meta-analysis was performed by applying restricted cubic spline regression model in Stata 16.0 software.

A total of 9 papers with 58 342 study subjects and 9 887 exposures were included. Meta-analysis showed that sleep duration was associated with the risk of senile dementia (RR=1.32, 95%CI=1.17-1.48, P<0.05). The results of the subgroup analysis showed that the risk of senile dementia was increased by 19.2% in those with ≤6 h/d of sleep (RR=1.19, 95%CI=1.07-1.33, P<0.05) ; sleeping duration≥8 h/d increased the risk of senile dementia by 55.02% (RR=1.55, 95%CI=1.32-1.82, P<0.05). Dose-response meta-analysis results showed a U-shaped nonlinear relationship between sleep duration and risk of senile dementia (P<0.001). Compared with the reference sleep duration of 7 h/d, the risk of morbidity at each time point was as follows 5 h/d: RR=1.024, 95%CI=0.928-1.130; 5.5 h/d: RR=1.036, 95%CI=0.938-1.143; 6 h/d: RR=1.034, 95%CI=0.952-1.124; 6.5 h/d: RR=1.015, 95%CI=0.973-1.059; 7.5 h/d: RR=1.014, 95%CI=0.993-1.035; 8 h/d: RR=1.056, 95%CI=1.023-1.091; 8.5 h/d: RR=1.124, 95%CI=1.062-1.190; 9 h/d: RR=1.212, 95%CI=1.098-1.338; 9.5 h/d: RR=1.316, 95%CI=1.133-1.528; 10 h/d: RR=1.431, 95%CI=1.169-1.752.

There is a U-shaped nonlinear dose-response relationship between sleep duration and the risk of senile dementia, and the daily sleep duration ≥8 h will increase the risk of senile dementia.

With the rapid progression of aging in China, the challenge of multimorbidity has become a significant concern for both public health and clinical practice. Nocturnal sleep status, including sleep duration and quality, is crucial for regulating body metabolism and physiological functions in the elderly. However, current research on the relationship between nocturnal sleep status and multimorbidity was limited to specific regions or the middle-aged population. The association between nocturnal sleep status and prevalence of multimorbidity among community-dwelling older adults remains ambiguous.

To investigate the association between nocturnal sleep status and prevalence of multimorbidity among community-dwelling older adults.

In April 2023, a total of 11 917 community-dwelling older adults from the Chinese Longitudinal Healthy Longevity and Happy Family Study (CLHLS-HF, wave 2018) were selected as the participants. Multivariate Logistic regression was used to explore the association of sleep duration and sleep quality with the prevalence of multimorbidity, represented by odds ratios (OR) and 95% confidence intervals (95%CI). Additionally, restrictive cubic splines (RCS) based on Logistic regression analysis were utilized to analyze the dose-response relationship between sleep duration and prevalence of multimorbidity.

Of the 11 917 community-dwelling older adults, with an average age of (84.4±11.4) years ranged from 65.0 to 117.0 years, 6 477 were females (54.35%) and 5 440 were males (45.65%). Multivariate Logistic regression results after adjusting for covariates such as gender, age, region, and years of education, indicated that compared to those with 6-8 h of nocturnal sleep duration, older adults with shorter sleep duration (<6 h) had a higher prevalence of multimorbidity (OR=1.51, 95%CI=1.36-1.67, P<0.05) ; compared to those with good sleep quality, individuals with fair sleep quality (OR=1.34, 95%CI=1.22-1.46, P<0.05) and poor sleep quality (OR=2.14, 95%CI=1.91-2.40, P<0.05) were associated with higher prevalence of multimorbidity. RCS plots revealed a "U" -shaped nonlinear association between sleep duration and prevalence of multimorbidity, with an optimal sleep duration of approximately 7 hours.

Community-dwelling older adults with sleep durations less than 6 hours, fair or poor sleep quality, are associated with an increased prevalence of multimorbidity. The optimal sleep duration for community-dwelling older adults is approximately 7 hours. Normal sleep duration and good sleep quality are important for the prevention of multimorbidity.

Lipid metabolism of middle-aged and older adults may be influenced by their late bedtime behavior, but the association between the above two still needs to be analyzed in-depth.

To explore the association between chronotype and dyslipidemia among populations with different gender, central obesity, late evening snacks and smoking.

A questionnaire survey was conducted among the population aged 40-65 years who received health examination in physical examination center, the First People's Hospital of Fuquan City from March to August, 2022 (n=697). General information and sleep conditions of the included patients were collected and chronotype was evaluated by single-item question of the Morning and Evening Questionnaire. Unconditional binary Logistic regression model was used to evaluate the association between chronotype and the risk of dyslipidemia. Stratified analysis was also performed by gender, central obesity and late evening snacks among the whole population, and performed by smoking among male population. Sensitivity analysis was used to exclude the effect of shift work.

Among the included subjects, morningness preference chronotype accounted for 56.4% (n=393), while eveningness preference chronotype accounted for 43.6% (n=304), with 334 cases (47.9%) detected with dyslipidemia. Unconditional binary Logistic regression analysis showed that chronotype was an influencing factor of dyslipidemia〔OR (95%CI) =1.54 (1.10, 2.16) 〕, the risk of hypertriglyceridemia〔OR (95%CI) =1.48 (1.04, 2.12) 〕and low high-density lipoprotein cholesterol〔OR (95%CI) =1.79 (1.18, 2.72) 〕was higher in the adults with eveningness chronotype than those with morningness chronotype (P<0.05). Stratified analysis of the whole population showed that the risk of low high-density lipoprotein cholesterol was 1.80 times (95%CI: 1.12, 2.91) and 1.73 times (95%CI: 1.02, 2.81) in adults with eveningness chronotype of that in adults with morningness chronotype among male population and the central obesity population, respectively (P<0.05) ; the risk of hypertriglyceridemia was 3.43 times (95%CI: 1.30, 8.99) in adults with eveningness chronotype of that in adults with morningness chronotype among population with late evening snacks (P<0.05) ; while there was no significant effect of chronotype on dyslipidemia and other lipid indexes in female and non central obesity populations (P>0.05). The stratified analysis by smoking in male population showed that the risk of low high-density lipoprotein cholesterol was 1.83 times (95%CI: 1.03, 3.26) in adults with eveningness chronotype of that in adults with morningness chronotype in smoking population (P<0.05) ; while there was no significant of chronotype on hypercholesterolemia, hyper-LDL cholesterolemia and non-HDL-C abnormalities in both smoking and non-smoking populations (P>0.05) .

Eveningness preference chronotype may be a risk factor for dyslipidemia in adults aged 40-65 years, and the associations between dyslipidemia and chronotype may vary across populations with different gender, central obesity, late evening snacks, and smoking status.

The scale and follow-up time of studies related to the association between sleep duration and all-cause mortality in middle-aged and older adults vary widely, and the results of studies such as correlations and recommended sleep duration remain controversial.

To explore the association between sleep duration and the risk of all-cause mortality in middle-aged and older adults.

From January to December 2022, the longitudinal study cohort was created based on the case ID numbers of coding manual combined with baseline and follow-up data of the China Health and Retirement Longitudinal Study (CHARLS) and Chinese Longitudinal Healthy Longevity Study (CLHLS) databases from January to December in 2022, which ultimately included 43 922 respondents. Social demographics, health status and health-related behaviors, sleep duration and death related information were extracted from CHARLS and CLHLS databases, recoding and variable transformations were performed according to the measurement and evaluation criteria of relevant indicators. The Kaplan-Meier method of Log-Rank test was used to plot survival curves, and the Cox proportional hazard regression model was used to explore the relationship between sleep duration and mortality risk in the middle-aged and older adults, followed by unrestricted cubic spline to observe the effect of the continuous-type variable of sleep duration on mortality risk.

Among 43 922 middle-aged and older adults with a median follow-up of 6 years and an average sleep duration of 7.32 h, 9 369 cases (21.33%) had sleep duration of≤5 h, 7 779 cases (17.71%) had sleep duration of >5-6 h, 295 cases (0.67%) had sleep duration of >6-7 h, 15 611 cases (35.54%) had sleep duration of >7-8 h, 2 567 cases (5.84%) had sleep duration of >8-9 h, 5 011 cases (11.41%) had sleep duration of >9-10 h and 3 290 cases had sleep duration >10 h (7.49%) . Kaplan-Meier survival analysis showed that middle-aged and older adults with moderate sleep duration (>6-7 h) had the highest probability of survival, and those with extra-long sleep duration (>10 h) had the lowest probability of survival. Cox regression model results showed that compared with middle-aged and older adults with sleep duration >10 h, middle-aged and elderly adults with sleep duration of ≤5 h〔HR (95%CI) =1.19 (1.09, 1.29) , P<0.05〕, >7-8 h〔HR (95%CI) =1.16 (1.08, 1.25) , P<0.05〕, >8-9 h〔HR (95%CI) =1.32 (1.19, 1.46) , P<0.05〕, and >9-10 h〔HR (95%CI) =1.12 (1.04, 1.22) , P<0.05〕 had increased risk of death. Restricted cubic spline showed an S-shaped non-linear association between sleep duration and risk of all-cause death (P=0.023) , with no significant association of sleep duration of 4.62-7.97 h with the risk of death, significant association of sleep duration <4.62 h and >7.97-10.00 h with all-cause mortality risk.

Middle-aged and older adults with moderate sleep duration had the highest probability of survival, so the recommended sleep duration for middle-aged and older adults is 5-7 h.

Acupuncture is one of the non-pharmacological methods for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). The progression of research evidence on acupuncture for OSAHS to high quality islimited by the defects in the outcome indicators of randomized controlled trials (RCTs) of acupuncture for OSAHS. Therefore, it is of reference value to analyze the outcome indicators of RCTs of acupuncture for OSAHS.

To analyze the outcome indicators of RCTs of acupuncture for OSAHS in the past 10 years, clarify the existing problems and provide suggestions for the guidance of further studies.

CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials.gov were searched for the RCTs of acupuncture for OSAHS from 2012-01-01 to 2022-11-18 with a combination of subject terms and free terms. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the included literature and sort out outcome indicators.

A total of 2 085 relevant papers were obtained from the preliminary search, and 12 papers were included after duplicating and multiple screening, and the outcome indicators were classified into traditional Chinese medicine (TCM) syndrome indicators, clinical symptom indicators, clinical efficacy indicators, neuroimaging indicators, polysomnography indicators, other examination indicators, serological indicators, life quality indicators and safety indicators. The most frequently reported outcome indicators were polysomnography indicators, followed by clinical symptom indicators.

The outcome indicators of RCTs of acupuncture for OSAHS have problems such as indistinguishable priorities, various clinical symptom indicators, inadequate application of serological indicators, limited safety evaluation, lack of standard for TCM characteristic syndrome differentiation indicators and long-term efficacy and economic evaluation. It is recommended to conduct more high-quality researches to strengthen the connection between TCM characteristic syndrome differentiation indicators, modern science and technology indicators and clinical studies, unify standard of syndrome differentiation of OSAHS, strengthen the awareness of conducting economic and safe clinical researches, so as to establish a core set of indicators of acupuncture treatment for OSAHS.

Obstructive sleep apnea syndrome (OSAS) patients have severe multisystem metabolic disorders in the body, with a high comorbidity rate with various metabolic diseases and poor prognosis. The adipokine Metrnl is a newly identified target for regulating lipid and glycolipid metabolism. The correlation of Metrnl with OSAS and OSAS-related metabolic disorders has been rarely reported.

To observe the differences of adipokine Metrnl in patients with OSAS, and explore its relationship with inflammation and insulin resistance caused by OSAS.

A total of 119 participants who were hospitalized and physically examined in the geriatric department of the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from 2021 to 2022, were selected and divided into the mild OSAS group (n=57), moderate-to-severe OSAS group (n=26) and control group (n=62) according to the results of standard polysomnography monitoring. General data of the 3 groups was collected, including fasting blood glucose (FBG), fasting insulin (FINS), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin A_1c (HbA_1c), uric acid (UA), Metrnl, nuclear factor-κB (NF-κB), IL-6, TNF-α, IL-10 and IL-4 levels. The homeostatic model assessment for insulin resistance (HOMA-IR) was used to assess insulin resistance.

BMI in the moderate-to-severe OSAS group was higher than the control group and mild OSAS group (P<0.05) ; FINS level in the moderate-to-severe OSAS group was higher than the mild OSAS group and control group, and FINS level in the mild OSAS group was higher than the control group (P<0.05) ; Metrnl level of the moderate-to-severe OSAS group was lower than the mild OSAS group and control group, and Metrnl level in the mild OSAS group was lower than the control group (P<0.01) ; NF-κB, TNF-α, IL-6, and HOMA-IR in the OSAS group were higher than the control group, TNF-α and HOMA-IR in the moderate-to-severe OSAS group were higher than the mild OSAS group and control group, TNF-α and HOMA-IR in the mild OSAS group were higher than the control group (P<0.01), IL-10 in the OSAS group was lower than the control group (P<0.01). Partial correlation analysis showed that Metrnl level was negatively correlated with NF-κB (r=-0.30), IL-6 (r=-0.40), TNF-α (r=-0.37), HOMA-IR (r=-0.36), FBG (r=-0.32), HbA_1c (r=-0.33) and AHI (r=-0.51), and positively correlated with IL-10 (r=0.27) (P<0.05). Multiple linear regression analysis showed that IL-6, TNF-α, HOMA-IR were independent influencing factors for Metrnl level (P<0.05) .

The expression level of Metrnl is reduced in OSAS patients and negatively correlated with the severity of OSAS. HOMA-IR, IL-6, TNF-α are independent influencing factors for Metrnl level in OSAS patients.

Obstructive sleep apnea (OSA) has a high prevalence, and it has been shown to be an independent risk factor for various diseases. Therefore, it is important to strengthen screening for population at highrisk of OSA. OSA patients are prone to combine with lipid metabolism disorders, but it remains unclear whether the atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP), cardiometabolic index (CMI), and Chinese visceral adiposity index (CVAI), which are used asmetabolic indexes, can be used to predict OSA.

To analyze the correlation between metabolic indexes and OSA, and evaluate the predictive efficacy of each metabolic index through a case-control study.

A total of 2 968 inpatients with suspected OSA and aged ≥18 years who completed polysomnography (PSG) in the First Affiliated Hospital of Xinjiang Medical University from March 2017 to June 2022 were selected, with 2 850 patients finally included based on the inclusion and exclusion criteria and divided into the OSA group 〔apnea-hypopnea index (AHI) ≥5 times/h, n=2 193〕 and non-OSA group (AHI<5 times/h, n=657) according to the AHI. The clinical data and laboratory test results of these patients were collected through the electronic medical record system. Univariate and multivariate Logistic regression analyses were used to investigate the correlation of AIP, VAI, LAP, CMI, and CVAI with OSA. The receiver operating characteristic (ROC) curve was plotted to analyze the efficacy of metabolic indexes in predicting OSA. A gender-stratified analysis was performed to explore the relationship between metabolic indexes and OSA in different populations.

Age, gender (male proportion), neck circumference, height, total cholesterol, triacylglycerol, AHI, AIP, VAI, LAP, CMI, and CVAI were significantly higher in the OSA group than the non-OSA group, high-density lipoprotein cholesterol (HDL-C), mean oxygen saturation and minimum oxygen saturation were significantly lower than the non-OSA group (P<0.05). After dividing the five metabolic indexes into quartiles (Q1 to Q4), them ultivariate Logistic regression analysis showed that AIP〔OR=2.241, 95%CI (1.689, 2.972), P<0.001〕, VAI〔OR=2.517, 95%CI (1.919, 3.301), P<0.001〕, LAP〔OR=2.313, 95%CI (1.761, 3.038), P<0.001〕, CMI〔OR=2.732, 95%CI (2.054, 3.633), P<0.001〕, and CVAI〔OR=6.060, 95%CI (4.411, 8.324), P<0.001〕 were associated with the risk of OSA (P<0.05). Further analysis stratified by gender showed that in female patients, AIP, VAI, LAP, CMI, and CVAI were associated with the risk of OSA (P<0.05) ; in male patients, CMI, LAP, and VAI were not associated with OSA (P>0.05), but AIP and CVAI were associated with OSA (P<0.05). The areas under the ROC curves (AUCs) of AIP, VAI, LAP, CMI, and CVAI for predicting OSA were〔0.593, 95%CI (0.568, 0.618) 〕〔0.607, 95%CI (0.583, 0.632) 〕〔0.594, 95%CI (0.569, 0.619) 〕〔0.616, 95%CI (0.591, 0.640) 〕, and〔0.728, 95%CI (0.706, 0.751) 〕, respectively.Further analysis stratified by gender for the clarification of the predictive efficacy of five metabolic indexes for OSA showed that the AUCs of the five metabolic indices for predicting OSA were higher in the female population than the total population, and the AUCs of the five metabolic indexes were lower in the male population than the total population. The AUC of CVAI was higher than other indexes in the total population, male and female populations (AUC=0.728 for the overall population, AUC=0.764 for the female population, AUC=0.681 for the male population) .

As the quartiles of AIP, VAI, LAP, CMI, and CVAI increase, the risk of OSA rises. CVAI has a better predictive efficacy for OSA than other indexes, therefore, CVAI may be used as a predictor for screening of population at high risk of OSA.

Obstructive sleep apnea (OSA) is a common sleep-related respiratory disorder that can easily induce or aggravate a variety of diseases, often causing different levels of decline in the patient's quality of life. Patient-reported outcome (PRO) assessment tools provide effective means for evaluating both quality of life and clinical efficacy. There are numerous OSA-PRO assessment tools available, primarily developed in foreign countries, mainly covering domains such as symptoms, daily activities, social activities, and psychological emotions, with items ranging in number from one to 84, and Likert scale as the main type of response scale. The development and evaluation of these tools employ the classical test theory (CTT). We provide the following recommendations for future research: evaluating the psychometric properties and methodological quality of OSA-PRO assessment tools; combining CTT with modern test theory to develop, revise, and evaluate OSA-PRO assessment tools; strengthening the research on the minimal clinically important difference of OSA-PRO assessment tools; developing OSA-PRO assessment tools highlighting the clinical efficacy of traditional Chinese medicine.

Gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) are both common clinical diseases with the increasing prevalence year by year. There is still controversy as to whether continuous airway positive pressure ventilation (CPAP) can improve both OSA and GERD at the same time.

To investigate the efficacy of CPAP on OSA complicated with GERD.

A total of 169 patients diagnosed with OSA complicated with GERD in the geriatric and respiratory departments of Peking University People's Hospital from September 2020 to January 2023 were selected as research subjects, their general data were collected. The included patients were followed up regularly with the endpoint of GERD remission or 8 weeks of treatment, excluding those with no treatment compliance. The included patients were divided into the patients without proton pump inhibitor (PPI) and patients with PPI according to whether they received PPI. The patients without PPI were further divided into the CPAP group (n=43) and non-treatment group (n=53), the patients with PPI were divided into the CPAP+PPI group (n=32) and PPI group (n=41) according to whether they received CPAP treatment. The Kaplan-Meier method was used to plot the survival curves of GERD remission rates in the CPAP group and non-treatment group, and the differences were compared by Log-rank test. Multivariate Cox proportional risk regression model was used to explore the effects of CPAP on GERD remission in patients with OSA complicated with GERD.

The median remission time to remission was 6 weeks in the CPAP group and 7.5 weeks in the non-treatment group; the cumulative GERD remission rate in the CPAP group was higher than the non-treatment group and the difference was statistically significant (χ²=4.182, P=0.041). The median remission time to remission was 3.9 weeks in the CPAP+PPI group and 6.1 weeks in the PPI group; the cumulative GERD remission rate in the CPAP+PPI group was higher than the PPI group and the difference was statistically significant (χ²=14.333, P<0.001). The results of the multivariate Cox proportional risk regression showed that CPAP was an influential factor for GERD remission in patients with OSA complicated with GERD without PPI〔HR=2.360, 95%CI (1.044, 5.338), P<0.05〕, CPAP was an influential factor for GERD remission in patients with OSA complicated with GERD treated with PPI〔HR=6.123, 95%CI (2.562, 14.635), P<0.05〕.

CPAP can improve GERD symptom in patients with OSA complicated with GERD. The efficacy of CPAP+PPI on GERD is superior to PPI alone.

Sleep disorders combined with subjective cognitive decline (SCD) in older adults are associated with an increased risk of cognitive decline and dementia conversion. However, sleep problems in older adults with SCD have not received sufficient attention, the sleep subtypes of older adults with SCD and their influencing factors need to be further investigated.

To explore potential sleep subtypes in older adults with SCD and analyze the influencing factors of different sleep subtypes.

From May to August 2022, older adults with SCD were selected as subjects from the communities in Nanjing, Changzhou, Nantong, and Xuzhou in Jiangsu Province using a stratified convenience sampling method. The general information questionnaire, Subjective Cognitive Decline Questionnaire (SCD-Q9), Beijing Version of the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (FRAIL) were used to conduct the survey. The latent profile analysis of sleep in older adults with SCD was performed based on the dimension scores of the PSQI scale, unordered multinomial Logistic regression analysis was used to examine the influencing factors of sleep subtypes in older adults with SCD.

A total of 287 older adults with SCD were enrolled, and the results of the latent profile analysis showed that sleep in older adults with SCD can be classified into 3 potential subtypes: relatively good sleep subtype (n=200), sleep deprivation subtype (n=63), and difficulty falling asleep-medicated hypnosis subtype (n=24), accounting for 69.7%, 21.9%, and 8.4% of all respondents, respectively. There were significant differences in gender, smart phone use, PHQ-9 scores and FRAIL scores among different sleep subtypes (P<0.05). Using the relatively good sleep type as a reference, the unordered multinomial Logistic regression analysis showed that gender 〔sleep deprivation subtype: female, OR=2.479, 95%CI (1.279, 4.808) 〕, smart phone use 〔sleep deprivation subtype: yes, OR=0.269, 95%CI (0.090, 0.808) 〕, PHQ-9 score 〔sleep deprivation subtype: OR=1.755, 95%CI (1.416, 2.175); difficulty falling asleep-medicated hypnosis subtype: OR=1.992, 95%CI (1.540, 2.576) 〕were influencing factors of sleep subtyping (P<0.05) .

Sleep in older adults with SCD showed significant population heterogeneity, and more attention should be paid to the sleep status of older adults with SCD who are female, use smart phones, and have depressive tendencies. Early and precise interventions for different sleep subtypes need to be performed early to improve sleep quality and prevent or delay the development of cognitive impairment.

Obstructive sleep apnea syndrome (OSAS) is a sleep-related disease. Evidence has shown that OSAS may increase the risk of developing arterial stiffness (AS) , but the mechanism of action still needs to be further explored.

To explore the mediating effect of waist circumference (WC) and fasting plasma glucose (FPG) on the association between OSAS and AS.

A total of 1 053 health examinees were selected from Physical Examination Center, the First People's Hospital of Fuquan City from March 23 to November 30, 2022. General demographic data were collected. The risk of OSAS was assessed using the STOP-Bang Questionnaire (high or low risk of OSAS was diagnosed by STOP-Bang score ≥4 points or <4 points) . AS was assessed, and 553 cases with AS and 500 without were assigned to AS and non-AS groups, respectively. Multivariate Logistic regression analysis was used to explore the factors associated with AS. FPG was converted to exponential form (-2.576 1) to obtain the exponential value of FPG (FPGa) . Multiple linear model was used to analyze the relationship of OSAS with WC and FPGa. The mediation effect of WC and FPG between OSAS and AS was analyzed using Hayes Process models 4 and 6 in R.

AS and non-AS groups had statistically significant differences in mean age, sex ratio, prevalence of smoking and hypertension, mean body mass index, WC, neck circumference, FPG, triglyceride, and high-density lipoprotein cholesterol as well as the level of OSAS risk (P<0.05) . Multivariate Logistic regression analysis showed that compared with individuals with low-risk OSAS, the risk of AS increased in those with high-risk OSAS (P<0.05) , and the risk of AS increased by 0.048 times for every 1 cm increase in WC and 0.512 times for every 1 mmol/L increase in FPG (P<0.05) . Multiple linear regression analysis showed that OSAS was associated with WC and FPGa (P<0.05) , and WC was an associated factor of FPGa (P<0.05) . The chained multimediator model showed that OSAS directly affected the incidence of AS〔β=0.661, 95%CI (0.284, 1.038) 〕. The indirect mediation effect value (β) of the "OSAS→WC→AS" path was 0.224〔95%CI (0.073, 0.398) 〕, accounting for 20.86% of the total effect. The indirect mediation effect value (β) of the "OSAS→FPGa→AS" path was 0.115〔95%CI (0.024, 0.216) 〕, accounting for 10.71% of the total. The indirect mediation effect value (β) of the "OSAS→WC→FPGa→AS" path was 0.074〔95%CI (0.036, 0.126) 〕, accounting for 6.89% of the total.

WC and FPG may partially mediate the relationship between OSAS and AS. In addition, they are involved in the process of "OSAS→WC→FPGa→AS" as chained mediators. People with high risk of OSAS should actively control WC to reduce the possibility of developing central obesity, and regulate FPG to prevent the occurrence of AS.

General medicine and sleep medicine are two emerging clinical disciplines in China. They have many common things with complementarity in their own developments, and some crossovers in academic development of disciplines and talent training. The China National Accreditation Service for Conformity Assessment has opened up a way for general practitioners to engage in sleep medicine, which may be a basis and a necessity for sound cooperative development of general medicine and sleep medicine. We analyzed the basis and necessity of the cooperative development of general medicine and sleep medicine, introduced relevant experiences of Nanjing Medical University Affiliated Wuxi People's Hospital in the co-construction of general medicine and sleep medicine, and invited relevant experts to discuss the current issues.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is highly prevalent but is underdiagnosed in hypertensive patients. There are few studies on the internal association of OSAHS with two predictors of cardiovascular events, namely heart rate variability (HRV) and blood pressure variability (BPV), in hypertensive patients.

To explore the influence of OSAHS on HRV and BPV in hypertension patients, and to develop and validate a nomogram for predicting the risk of OSAHS in these patients using HRV and BRV related indicators.

Two hundred and twenty-eight hypertensive patients〔including 114 without OSAHS (simple hypertension subgroup) and 114 with OSAHS (hypertension with OSAHS subgroup) assessed by the diagnostic criteria of OSAHS〕were selected as internal validation group from the Second Xiangya Hospital of Central South University from January 2018 to December 2020, and other 34 hypertensive patients with or without OSAHS who hospitalized in the same hospital during January to February 2021 were selected as an independent external verification group. General information (age, gender, BMI, etc.〕, average blood pressure level〔nighttime systolic blood pressure (nSBP), etc.〕, BPV related indices〔nighttime systolic blood pressure standard deviation (nSSD), nighttime diastolic blood pressure standard deviation (nDSD), 24-hour diastolic blood pressure standard deviations (24 hDSD), etc〕, blood pressure circadian rhythm, HRV related parameters〔standard deviation of the mean RR intervals (SDANN), low frequency (LF), etc.〕, polysomnography parameters〔oxygen desaturation index (ODI), apnea hypopnea index (AHI), minimum oxygen saturation (MinSpO₂), etc.〕. Multiple linear regression analysis were used to explore the influencing factors of HRV and BPV. Restricted cubic splines were used to test the correlation of the average blood pressure level, BPV and HRV related indicators with the risk of OSAHS. Multivariate Logistic regression model was used to analyze the influencing factors of OSAHS, and the screened factors were used to construct a nomogram for predicting OSAHS risk. The Bootstrap method was used to validate the performance of the internal and external groups in the nomogram model. And its predictive value for OSAHS risk in the two groups was assessed using the receiver operating characteristic (ROC) curve with the area under the curve (AUC) and other indicators calculated.

Multiple linear regression analysis showed that BMI, ODI and MinSpO₂ were independently associated with nSSD, nDSD or HRV related indices in hypertensive patients with OSAHS (P<0.05). Restricted cubic splines revealed that BPV related indices had a nonlinear relationship with OSAHS, and so did HRV related indices (P<0.05). Multivariate Logistic regression analysis showed that nSBP, nSSD, 24 hDSD, SDANN, LF, age and BMI were associated with OSAHS in hypertensive patients (P<0.05). The Bootstrap method showed that, the absolute error of the nomogram constructed using age, BMI, nSBP, nSSD, 24 hDSD, SDANN and LF was 0.013 in internal verification group, and was 0.021 in external verification group, indicating that the model had good calibration. The values of the AUC of the nomogram in predicting the risk of OSAHS in hypertension in internal and external validation groups were 0.861〔95%CI (0.818, 0.919), P<0.001〕 and 0.744〔95%CI (0.691, 0.839), P<0.001〕, respectively.

OSAHS can increase the nSSD and nDSD and decrease HRV in hypertensive patients. Both HRV and BPV are closely related to the severity of OSAHS. Nocturnal hypoxia may be more likely to cause changes in blood pressure and heart rate. Our nomogram could be used to facilitate individualized prediction of OSAHS risk in hypertensive patients. HRV and BPV parameters might be powerful tools to screen for OSAHS.

Bronchial asthma (BA) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are two major chronic diseases affecting the health of children. OSAHS may aggravate BA, adding to the difficulties in BA control, and BA can lead to the occurrence or progression of OSAHS through various mechanisms, such a relationship between them has attracted increasing attention.

To explore the clinical features and influencing factors of children with BA complicated with OSAHS.

One hundred and nine children with BA who were admitted to Children's Asthma Center, Gansu Provincial Maternity and Child Health Care Hospital from September 2021 to August 2022 were selected, including 49 with OSAHS (BA with OSAHS group) and 60 without (simple BA group). The general clinical data, pulmonary function test results, and serum levels of inflammatory cytokines, 25-hydroxyvitamin D 〔25 (OH) D〕 and C-reactive protein (CRP) were collected. The clinical features were analyzed, and factors associated with OSAHS in BA were analyzed by multivariate Logistic regression.

Multivariate Logistic regression analysis showed that obesity〔OR=4.803, 95%CI (1.011, 2.822) 〕, enlarged neck circumference〔OR=1.318, 95%CI (1.003, 1.732) 〕 and gastroesophageal reflux disease (GERD) 〔OR=7.756, 95%CI (1.398, 43.045) 〕 were independent risk factors for OSAHS in BA children (P<0.05), while elevated 25- (OH) D〔OR=0.830, 95%CI (0.757, 0.910) 〕 was a protective factor for OSAHS in BA children (P<0.05) .

The values of pulmonary function indices of children with BA complicated with OSAHS were lower than those of children with simple BA. Obesity, enlarged neck circumference, GERD and 25- (OH) D level were the influencing factors of OSAHS in BA children.

With the rapid population aging in China, cognitive impairment in older adults has become a growing public health concern.

To examine the association between nighttime sleep duration and cognitive impairment among community-dwelling older adults.

Data were derived from the cohort of Older Adult Health and Modifiable Environmental Factors established in Fuyang City from July to September 2018, among whom a total of 4 837 older adults with complete data on cognitive function and sleep time were included in this study. General demographic characteristics〔gender, age, living area (urban or rural), education level, occupation, marital status〕, living habits, the history of chronic diseases, sleep duration, and overall cognitive function were extracted. Binary Logistic regression models were used to analyze the association between nighttime sleep duration and cognitive impairment. Restrictive cubic splines were used to further determine potential dose-response relationships between them.

The participants had a mean nighttime sleep duration of (6.95±1.75) hours, among whom 1 773 (36.65%) slept ≤6 hours per day, 2 088 (43.17%) slept >6-8 hours per day, and 976 (20.18%) slept >8 hours per day. The detection rate of cognitive impairment was 37.44% (1 811/4 837). After adjusting for gender, age, living area, education level and other confounding factors, the detection rate of cognitive impairment was 1.26〔95%CI (1.09, 1.46) 〕 times higher in older adults with nighttime sleep duration of ≤6 hours, and was 1.22〔95%CI (1.03, 1.46) 〕 times higher in older adults with nighttime sleep duration of >8 hours than in those with nighttime sleep duration of >6-8 hours (P<0.05). The detection rate of cognitive impairment in male older adults with nighttime sleep duration of >8 hours was 1.35〔 (95%CI (1.06, 1.72) 〕 times higher than in those with nighttime sleep duration of >6-8 hours (P<0.05). The detection rate of cognitive impairment in female older adults with nighttime sleep duration of≤6 hours was 1.29〔95%CI (1.06, 1.58) 〕 times higher than in those with nighttime sleep duration of >6-8 hours (P<0.05). The restriction cube spline curve showed an approximate U-shaped relationship between nighttime sleep duration and the risk for cognitive impairment, with the lowest risk at 7 hours.

Both shorter and longer nighttime sleep duration may be independent and dose-dependent risk factors for cognitive impairment in older adults. The optimal sleep time is about 7 hours. The association between longer sleep duration and cognitive impairment is pronounced in males, while the association between shorter sleep duration and cognitive impairment is pronounced in females.

Obstructive sleep apnea (OSA) is a common sleep-disordered breathing in pregnant population, which is associated with adverse perinatal outcomes, and may have long-term health consequences on both mothers and children. Currently, the vast majority of pregnant women are underdiagnosed due to the difficulties in extensively performing polysomnography, a gold standard in OSA diagnosis. So it is essential to seek other screening strategies and tools to accurately identify pregnant women with high risk of OSA to improve their perinatal outcomes. We reviewed the prevalence of OSA in pregnancy, screening status, screening timing, target population and recent advances in screening tools, to providing a theoretical basis for implementing the screening in this group.

Chinese aging population degree will transform mild to moderate. During addressing aging issues by proactive national strategies and healthy aging strategies, the sleep health of older peoplecannot be ignored.

To explore the effect of working after retirement on sleep quality in Chinese older people, providing relevant reference data for improving sleep quality in this group of people.

In August 2021, data of working after retirement prevalence and sleep health in subjects aged ≥60 years (n=7 862) were obtained from the 2018 China Family Panel Studies (CFPS) conducted by Peking University with permission. They were divided into working after retirement and non-working after retirement groups by working after retirement prevalence. Normal sleep duration (within 4 to 10 hoursper night) , abnormal sleep duration (≤4 or ≥10 hours per night) , sleeping late (going to bed after 23 o'clock) in accordance with relevant diagnostic criteria used in international studies on sleep health in middle-aged and older people. Self-reported perceptions of sleep quality were classified into optimistic and pessimistic according to subjective evaluation of sleep efficiency and effect. Binary Logistic regression model was used to explore the effect of working after retirement on sleep duration, perception of sleep quality and the time to go to sleep.

Among the subjects, 5 705 (72.56%) had optimistic sleep quality, 6 508 (82.78%) had normal sleep duration, and 7 464 (94.94%) went to sleep earlier than 23: 00, and 4 005 (50.94%) still worked after retirement. After controlling for age, gender, maritalstatus, education level, personality traits and other factors, working after retirement was associated with increased probability of higher optimism with sleep quality〔OR (95%CI) =1.205 (1.069, 1.358) 〕, more normal sleep duration〔OR (95%CI) =1.306 (1.137, 1.499) 〕, and earlier time to go to sleep〔OR (95%CI) =1.596 (1.253, 2.033) 〕.Working after retirement was associated with increased probability of good sleep quality (P<0.05) .

As working after retirement may be contributive to good sleep quality in older people, it should be supported and guaranteed by governmental policies.

Sleep duration is strongly associated with hypertension, but its effect on H-type hypertension in female population is not well characterized.

The examine the effect of sleep duration on the prevalence of H-type hypertension in female population.

A cross-sectional study design was used. One thousand seven hundred and nine female hypertensive inpatients were selected from Department of General Medicine and Geriatric Department of Hunan Provincial People's Hospital from July 2018 to December 2020, among whom those who with serum Hcy≥10 μmol/L and the others were assigned into H-type hypertension and non-H-type hypertension groups, respectively. Binary Logistic regression was used to assess the correlation of between sleep duration and H-type hypertension across three groups with different self-reported mean daily sleep durations in the past month (<7 h, 7-8 h, and >8 h) , and to further assess the correlation between the two across by age (≤60 and >60) .

The distribution of age, education level and marital status differed across three groups with different daily sleep durations (P<0.05) . 901 (52.72%) with daily sleep duration of <7 h, 697 (40.78%) with daily sleep duration of 7-8 h, and 111 (6.50%) with daily sleep duration of >8 h. The distribution of age, education level, living area (urban or rural) , marital status, BMI, exercise status, and daily sleep duration, as well as prevalence of drinking between H-type hypertension group〔973 (56.93%) 〕 and non-H-type hypertension group〔736 (43.07%) 〕 (P<0.05) . The risk of H-type hypertension in those with <7 h of daily sleep duration was 1.291 times higher than that in those with 7-8 h of daily sleep duration〔95%CI (1.032, 1.615) , P<0.05〕after adjusting for confounding factors such as age, education level, living area, marital status, BMI and exercise status. Further analysis revealed that <7 h of daily sleep duration was associated with increased risk of H-type hypertension only in those aged greater than 60 years〔OR (95%CI) =1.421 (1.021, 1.978) , P<0.05〕.

Less than 7 h of daily sleep duration was a risk factor for H-type hypertension in female over 60 years old. In view of this, it is suggested to put more attention to sleep health to improve blood pressure in this group.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) can cause secondary polycythemia and elevated hemoglobin, but the prevalence and predictive value of elevated hemoglobin in OSAHS patients remain unclear.

To explore the prevalence and associated factors of elevated hemoglobin (HGB) and its potential role in predicating pulmonary hypertension and type Ⅱ respiratory failure in OSAHS patients.

We conducted a retrospective analysis of 1 035 patients with OSAHS diagnosed by polysomnography who were hospitalized at Sleep Medical Center, First People's Hospital of Yunnan Province from 2018 to 2020. Data of polysomnography, clinical parameters, and comorbidity were compared between 145 cases with polycythemia and 145 cases with normal HGB. The propensity score matching (PSM) was used to balance the baseline variables of the age, sex and BMI. Spearman correlation and multiple regression analysis were used to explore the associated factors of HGB level. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of elevated HGB for pulmonary hypertension and type Ⅱ respiratory failure in OSAHS.

The overall prevalence of polycythemia was 16.8% (174/1 035) in OSAHS patients. Males (25.7%, 157/610) had higher prevalence of polycythemia than females (4.0%, 17/425) (P<0.05) . Patients with a high apnea-hypopnea index (AHI) had higher mean HGB level and prevalence of polycythemia than those with a mild or moderate AHI (P<0.05) . In comparison to patients with normal HGB, those with elevated HGB had higher AHI, longer maximum apnea time (maxAT) and sleep time spent at SpO₂<90% (TS90%) , higher values in laboratory and clinical parameters including red blood cell count, HGB, hematocrit, mean corpuscular hemcglobin concentration, aspartate aminotransferase, alanine aminotransferase, uric acid (UA) , total cholesterol, triglyceride, T₄, T₃, partial pressure of carbon dioxide (PaCO₂) , tetraiodothyronine and triiodothyronine, but mean oxygen saturation (MSpO₂) , the lowest oxygen saturation (LSpO₂) and partial pressure of oxygen (PaO₂) (P<0.05) . Higher prevalence of hyperuricemia, proteinuria, and hypercapnia and lower prevalence of hypothyroidism were also seen in those with elevated HGB (P<0.05) . Spearman correlation showed that in patients with elevated HGB, HGB level increased with the increase of BMI, AHI, maxAT, TS90%, PaCO₂ and UA, but decreased with the increase of MSpO₂, LSpO₂ and PaO₂ (P<0.05) . Age, BMI, maxAT, MSpO₂, LSpO₂, PaCO₂, creatinine and UA were the factors affecting the level of HGB in multiple regression analysis. ROC curve analysis showed that in male patients, the AUC of HBG in predicting the risk of pulmonary hypertension was 0.699〔95%CI (0.504, 0.893) , P=0.033〕with a cutoff value of 169.5 g/L, and its AUC was 0.836〔95%CI (0.682, 0.989) , P=0.005〕in predicting the risk of type Ⅱrespiratory failure with a cutoff value of 181.5 g/L.

The prevalence of elevated HGB was high in patients with OSAHS in Kunming, which may be associated with the severity of hypoxemia and lung ventilation during sleep. Patients with elevated HGB had severer conditions and higher prevalence of comorbidities. Elevated HGB may be a predictor of higher risk of pulmonary hypertension and type Ⅱrespiratory failure in male patients.

Sleep duration of the undergraduates are closely related to their health, but there is no conclusion about the best sleep duration for undergraduates. And there is a lack of research about the dose-response relationship between sleep duration and Traditional Chinese Medicine (TCM) constitution.

To explore the relationship between sleep duration and TCM constitution for undergraduates, and to provide reference for their health education about sleep duration.

This study used a combination of purposeful sampling and snowball sampling methods to conduct on-site questionnaire survey on students from 143 universities including Beijing University of Chinese Medicine, Harbin Institute of Technology (Weihai), Peking University, Northwestern Polytechnical University from January to June 2019. We used the Constitution in Chinese Medicine Questionnaire of 41-item (CCMQ-41) to assess the TCM constitution of undergraduates, and used a self-designed questionnaire to measure socio-demographic information and lifestyle behaviors. This study used the restricted cubic spline fitting multiple linear regression model to analyze the dose-response relationship between sleep duration and TCM constitution with taking sleep duration as the independent variable and TCM constitution score as the dependent variable, and controlling for related confounding variables.

This study collected 1 003 valid questionnaires. The response rate was 98.2%. Pearson correlation analysis showed that the sleep duration was negatively correlated with the score of qi depression (r=-0.067, P=0.034). After controlling for confounders, multiple linear regression analysis showed that there was no linear relationship between sleep duration and TCM constitution scores (P>0.05). The dose-response relationship analysis showed that the highest point of gentleness score and the lowest point of biased constitutions score (except specific diathesis) had a sleep duration of about 8 h. When the sleep duration was >8.5 h, the gentleness score showed a tendency to decrease, and the scores of qi deficiency and qi depression had a tendency to increase (P<0.05) .

Considering the health status of TCM constitutions, the best daily sleep duration for undergraduates is about 8 h. The sleep duration should be restricted to be less than 8.5 h to prevent the possibility of biased constitution.

There are less studies on sleep disturbance and limited effective screening and assessment scales for sleep disturbance in Chinese preschoolers.

To assess the reliability and validity of the Chinese version of Sleep Disturbance Scale for Children (SDSC-C) in Chinese preschoolers, providing evidence for expanding the application of SDSC in preschoolers.

By use of convenience sampling, preschool children (3-5 years old) were selected as survey participants for testing the psychometrics of the draft of the SDSC-C from one urban community and one rural community in each of five cities (Fuzhou, Quanzhou, Longyan, Sanming and Nanping) of Fujian Province from June to November 2021 with the assistance of the Fujian Family Planning Association Network, and their parents were selected as their agents to complete the questionnaire survey. Then its items were modified, screened and evaluated by an expert group, after that, the draft was developed into a formal version consisting of six domains and 23 items. The reliability and validity of the scale were assessed by item analysis, reliability analysis, validity analysis, exploratory factor analysis, and confirmatory factor analysis.

The survey obtained a response rate of 92.04% (370/402) . The high-score group〔n=106, ranked the top 27% in terms of total score of SDSC-C (≥49 points) 〕and low-score group〔n=113, ranked the bottom 27% in terms of total score of SDSC-C (≤37 points) 〕divided by critical ratio method had significant differences in the score of each item of the SDSC-C (P<0.05) . The Cronbach's α of the scale was 0.86, with 0.87 of estimating interrater agreement. The I-CVI for each item was >0.78, with kappa values were > 0.74. The S-CVI/UA was 0.87 and S-CVI/Ave was 0.98. For SDSC-C , KMO= 0.85, results of Bartlett's test of sphericity were χ²=3 013.30, P<0.001. By principal component analysis, 7 factors with an engivalue >1 were extracted, explaining 65.125% of the total variance. However, a six-factor solution (i.e. six types of sleep disorder) based on parent-reported sleep disorder symptoms in our study indicated the factor loading of items ranged from 0.34-0.85, which could explain 60.539% of the total variance. The confirmatory factor analysis showed the values of fitting indicator as follows: χ²/DF=2.66, CFI=0.84, TLI=0.81, SRMR=0.08, and RMSEA=0.08.

This study revealed that the SDSC-C is a valid and reliable scale that can provide a comprehensive and detailed assessment of sleep disturbances in Chinese preschool children, which is beneficial to clinicians for early screening and assessment of sleep-related problems in preschool children.

There are few studies on the relationship between sleep time and falls at present, and the research results are inconsistent.

To explore the relationship between sleeping time and falls in middle-aged and elderly residents in China, and to provide reference for preventing falls in this population.

The study based on the data from China Health and Retirement Longitudinal Survey (CHARLS) data in 2015. 18 181 subjects aged ≥45 years with complete key data were included. Collect the indicators of the middle-aged and old people in the past two years, such as falls and medical treatment, sleep time, demographic characteristics, behavior and lifestyle, health status, self-life satisfaction and self-rated health. The subjects were divided into 5 groups according to the sleep time per night: <5 h (2 945 cases) , 5-<6 h (2 755 cases) , 6-<7 h (reference group, 3 824 cases) , 7 to <8 hours (3 257 cases) and ≥8 hours (5 400 cases) . Logistic regression model was used to adjust different variables to gradually evaluate the relationship between sleep time and the occurrence of falls and medical treatment for falls in the past two years.

The average sleeping time of middle-aged and elderly people was (6.4±1.9) hours, the incidence of falls in the past two years was 17.01% (3 092/18 181) , and the rate of medical treatment for falls was 6.95% (1 264/18 181) . The incidence of falls in subjects with sleep time <5 h, 5-<6 h, 6-<7 h, 7-<8 h and≥8 h were 25.26% (744/2 945) , 19.82% (546/2 755) , 15.51% (593/3 824) , 14.03% (457/3 257) , 13.93% (752/5 400) , the incidence of falling to hospital was 10.97% (323/2 945) , 8.09% (223/2 755) , 6.04% (231/3 824) , 5.43% (177/3 257) and 5.74% (310/5 400) , which were significant differences demonstrated by the trend chi-square test, and the difference was statistically significant (P<0.05) . Compared with 6-<7 hours after adjusting factors such as age, gender, those with sleeping time ≥8 hours had a significantly lower risk of falling〔OR (95%CI) =0.88 (0.78, 0.99) 〕, and those with sleeping time <5 h and 5-<6 h had a significantly higher risk of falling〔OR (95%CI) _{<5 h}=1.31 (1.16, 1.49) , OR (95%CI) _{5-<6 h}=1.14 (1.00, 1.30) 〕. The middle-aged and old people who slept less than 5 hours per night had a higher risk of falling and seeking medical treatment〔OR (95%CI) =1.30 (1.08, 1.56) 〕.

The incidence of falls in middle-aged and elderly people in China is relatively high, sleep time <6 hours per night will increase the risk of falls, and sleeping≥8 hours may reduce the risk of falls. Adjusting sleeping time of middle-aged and elderly people and strengthening lifestyle intervention can effectively reduce the incidence of falls in the middle-aged and elderly people.

The treatment adherence is closely related to the effect of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) , which is also strongly influenced by patients' psychosocial characteristics. However, the influence of depression symptoms on the adherence to CPAP needs to be further explored.

To evaluate the relationship of depression symptoms with adherence to CPAP, and the pathwaybetween the associated factors in OSA patients.

A total of 177 patients who were diagnosed with OSA and treated with CPAP in the Respiratory and Sleep Medicine Center, Peking University People's Hospital from May 2019 to July 2021 were selected. The general information, disease severity and adherence to CPAP were evaluated. The prevalence of depression symptoms was measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) . The severity of insomnia was assessed by the Insomnia Severity Index (ISI) . The influence of daytime sleepiness on activities of daily living was measured by the 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10) . The 12-item Short Form Health Survey (SF-12) was used to evaluate the quality of life. The relationships among variables were determined by path analysis.

The prevalence of depressive symptoms in OSA patients was relatively high (19.7%, 35/177) in our study. Depression symptoms were associated with increased insomnia prevalence (r=0.65, P<0.05) , and decreased levels of activities of daily living (r=-0.51, P<0.05) and quality of life (r_PCS=-0.27, P<0.05; r_MCS=-0.72, P<0.05) . In addition, depressive symptoms had no relationship on the adherence to CPAP (r=0.09, P>0.05) , but could increase the adherence to CPAP by decreasing the activities of daily living (β=0.078, P<0.01) .

Depressive symptoms were significantly associated with insomnia, decreased quality of life and activities of daily living in OSA patients, and could increase patients' adherence to CPAP through decreasing the activities of daily living.