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.

Arrhythmias are common complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) , however their occurrence and severity are not completely consistent with the severity of their disease per se. Our previous study found that pulse oxygen desaturation rate (ODR) was an independent predictor of the development of hypertension in OSAHS patients. We hypothesized that sleep apnea related ODR and heart rate fluctuation rate (HRFR) may predict the occurrence of arrhythmias in OSAHS patients.

To observe the correlation between ODR, HRFR and the occurrence of arrhythmias, and to explore the predictive value of ORD and HRFR on the occurrence of arrhythmias.

Polysomnography and Holter monitoring were performed on 36 patients who visited the sleep disordered breathing specialized outpatient clinic of the First Affiliated Hospital of Nanjing Medical University between January and June 2021, while basic clinical information of the patients was collected. Taking the median number of arrhythmic events as the cutoff value, the patients were divided into two groups: the patients with low incidence of arrhythmia group (<105 events) and with high incidence of arrhythmias group (≥105 events) . ODR and HRFR were analyzed for correlation with arrhythmias and Logistic regression was performed for analysing the predictors of arrhythmia.

Compared with low incidence of arrhythmia group, the patients with high incidence of arrhythmias had higher ODR and HRFR (P<0.05) . Correlation analysis showed that the number of total arrhythmic events was positively correlated with ODR, mean heart rate fluctuation value, and HRFR (r_s=0.472, 0.719, 0.360, and 0.393, respectively, P<0.05) . Multivariate Logistic regression analysis showed that ODR〔OR=77.849, 95%CI (5.250, 1 154.301) , P<0.05〕and HRFR 〔OR=9.981, 95%CI (1.000, 105.600) , P=0.05〕were independent risk factors for arrhythmic events. The area under the receiver operator characteristic (AUC) of ODR and HRFR for predicting multiple arrhythmias were 0.932 〔95%CI (0.830, 0.941) 〕 and 0.753 〔95%CI (0.590, 0.916) , respectively.

ODR and HRFR are associated with the occurrence of arrhythmias and can be used for predicting the occurrence of arrhythmic events in patients with OSAHS.

Sleep disorder is a common complication of stroke with various clinical manifestations. Among them, periodic limb movements in sleep (PLMS) are characterized by repetitive and stereotyped limb movements during sleep. Due to limited clinical date, the pathogenesis of PLMS and their impact on prognosis of stroke are still in the exploratory stage. Studies about the effect of PLMS on sleep in stroke patients are few in worldwide.

To explore the sleep structure of stroke patients with PLMS.

From December 2020 to February 2022, a total of 81 stroke patients with sleep disorders were selected from the Second Affiliated Hospital of Zhengzhou University, in which polysomnography (PSG) was performed. The clinical information and PSG sleep monitoring data of patients were collected. According to the Periodic Limb Movement Index (PLMI) , the patients were divided into non-PLMS patients (control group, PLMI<15 times/h) and PLMS patients (experimental group, PLMI≥15 times/h) . The parameters between two groups were compared. These parameters include awake PLMI, sleep efficiency, proportion of stage N1 sleep in total sleep time, proportion of stage N2 sleep in total sleep time, proportion of stage N3 sleep in total sleep time, REM sleep in total sleep time, sleep apnea hypopnea index (AHI) , sleep latency, arousal index, and periodic limb movement arousal index (PLMAI) . Moreover, the correlation between PLMS and sleep structure and related parameters was analyzed.

There were 42 cases in the control group and 39 cases in the experimental group. The awake PLMI, proportion of stage N1 sleep in total sleep time, proportion of stage N2 sleep in total sleep time, arousal index and PLMAI in experimental group were higher than those in control group (P<0.05) . However, the sleep efficiency and proportion of stage N3 sleep in total sleep time of experimental group were lower than those of control group (P<0.05) . There was no significant difference between two groups in sleep latency, AHI and REM stage sleep in total sleep time (P>0.05) . The results of Spearman rank correlation analysis showed that PLMS was positively correlated with awake PLMI, proportion of stage N2 sleep in total sleep time, sleep latency, arousal index, and PLMAI (r_s values were 0.619, 0.250, 0.271, 0.312, 0.828, respectively; P values were <0.001, 0.024, 0.014, 0.005, <0.001) , which were negatively correlated with sleep efficiency (r_s=-0.345, P=0.002) .

Stroke patients with PLMS have objective sleep disturbance and reduced sleep efficiency, and PLMS may be one of the signs of poor prognosis of stroke.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with bone metabolism in Western population. Chinese population manifest different development progress of OSAHS and bone metabolism owing to their own specific physiological characteristics compared to the Western population. Although the association between OSAHS and bone metabolism may be confounded by underlying diseases, the association between them among healthy Chinese people remains unknown.

To examine the relationship between OSAHS and bone metabolism in Chinese people without underlying conditions using a review and Meta-analysis, providing evidence for improving bone health.

This review was conducted following the PRISMA guidelines. Electronic databases, such as PubMed, Embase, and CINAHL, were searched from inception to December 2020 for studies regarding bone metabolism and OSAHS in Chinese adults (aged≥18 years) in which those with and without OSAHS were classified as OSAHS and control groups, respectively (OSAHS was diagnosed based on the Guidelines for the Diagnosis and Management of Obstructive Sleep Apnea Hypopnea Syndrome) . Outcome indicators include one or more bone metabolism indicators. Three researchers independently performed literature screening and data extraction. Two researchers independently performed the quality appraisal using the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Data were analyzed using Stata 15.1.

Ten studies were included, with a total of 898 participants, and 653 of whom had OSAHS. Nine were cross-sectional studies and one was a quasi-experimental study. According to the JBI quality assessment tool, the nine cross-sectional studies were of high quality on items 1 to 5, and 4 of which did not control for the confounding factors. Based on the Meta-analysis, compared to the control group, OSAHS group had lower lumbar BMD 〔SMD (95%CI) =-1.758 (-2.300, -1.217) 〕, lower femoral neck BMD〔SMD (95%CI) =-1.260 (-1.949, -0.571) 〕, higher β-CTX〔SMD (95%CI) =0.803 (0.122, 1.484) 〕, and higher P1NP〔SMD (95%CI) =0.820 (0.318, 1.321) 〕. Apnea-hypopnea index had a negative correlation with lumbar BMD〔r (95%CI) =-0.36 (-0.57, -0.12) 〕 and positive correlations with β-CTX〔r (95%CI) =0.39 (0.29, 0.47) 〕and P1NP〔r (95%CI) =0.36 (0.16, 0.53) 〕.

Among Chinese adults without underlying conditions, OSAHS may reduce BMD by increasing bone resorption, thereby elevating the risk of osteoporosis or fractures.

Noninvasive positive pressure ventilation (NPPV) is the most common treatment for obstructive sleep apnea hypopnea syndrome (OSAHS) , which can effectively improve the hypopnea condition. At present, there are various NPPV programs with no summary of the relevant best evidence in China.

To search and evaluate studies related to NPPV management in OSAHS patients, then summarize the best evidence, to inform clinical practice.

All evidence (including guideline, expert consensus, randomized controlled trial, evidence summary, systematic evaluation and meta-analysis) on the management of NPPV in patients with OSAHS was retrieved from databases and websites including BMJ Best Practice, Up To Date, Scottish Intercollegiate Guidelines Network, Guidelines International Network, National Institute for Health and Care Excellence, National Guideline Clearinghouse, Registered Nurses' Association of Ontario, New Zealand Guidelines Group, Chinese Guideline Network, the Joanna Briggs Institute Evidence-based Health Care Center, Cochrane Library, Web of Science, Embase, PubMed, Scopus, Wanfang Data, CNKI, VIP and American Academy of Sleep Medicine from inception to December, 2021. The methodological quality of the included literature was evaluated using corresponding quality evaluation criteria. The evidence was described and summarized using JBI levels of evidenceand and JBI grades of recommendation (2014) , then the recommended strength of the evidence is determined according to the FAME scale (feasibility, appropriateness, meaningfulness and effectiveness) .

A total of 10 studies were included, including 6 guidelines, 2 expert consensuses, 1 Meta-analysis and 1 randomized controlled trial. Finally, 27 pieces of best evidence were summarized, involving 8 aspects: scope of application, duration of use, mode selection, pressure regulation, efficacy evaluation, nursing intervention, follow-up and alternative treatment.

We summarized the best evidence involving the above-mentioned 8 aspects for NPPV management in OSAHS patients, providing an evidence-based basis for the implementation of standardized NPPV treatment.

Noninvasive positive-pressure ventilation (NPPV) is the first choice for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) , a common sleep-related breathing disorder. But low patient adherence to NPPV limits its clinical application and promotion.

To explore the situation of acceptance of NPPV and associated factors in adult OSAHS patients.

OSAHS patients (age≥18) with clinical indications for NPPV were selected from Sleep Medicine Department, Sanya Central Hospital (Hainan Third People's Hospital) , from December 2019 to December 2021. Demographic and clinical data were compared in groups defined by the acceptance of NPPV titration (acceptors and rejecters of NPPV titration) and treatment (acceptors and rejecters of NPPV) .

In all, 402 OSAHS patients were included. Three hundred and twenty-seven rejected NPPV, 245 (74.5%) of them directly rejected the treatment at the time of diagnosis without NPPV titration, and the most common reason was perceived unnecessity of NPPV treatment due to insufficient understanding of OSAHS and its related risks, and 82 (25.1%) rejected the treatment after NPPV titration, and the most common reason was perceived inconvenience of long-term NPPV. Only 75 (75/402, 18.7%) patients accepted NPPV. No differences were found between acceptors and rejecters of titration in demographic data, clinical characteristics (P>0.05) . Multivariable Logistic regression analysis revealed none of above-mentioned factors were related to titration acceptance (P>0.05) . Univariable analysis showed that compared with NPPV rejecters, NPPV acceptors had higher prevalence of middle-aged (45-59 years old) individuals (49.3 % vs 33.3%) , lower prevalence of older individuals (age≥60) (12.0% vs 32.1%) , higher prevalence of nighttime awakening due to shortness of breath (38.7% vs 26.3%) , and severe condition (64.0% vs 47.4%) , lower mean nocturnal SpO₂ and nadir SpO₂, and longer mean duration with SpO₂ below 90% (T90, P<0.05) . Multivariable Logistic regression analysis revealed that age and T90 were independently associated with NPPV acceptance (P<0.05) . After controlling for other factors, age〔OR=0.39, 95%CI (0.16, 0.93) , P<0.05〕and T90〔OR=1.14, 95%CI (1.01, 1.29) , P<0.05〕were still the independently associated with NPPV acceptance.

The prevalence of NPPV acceptance was low in OSAHS patients, which was mainly associated with age and T90. In view of this, to improve the adherence to NPPV, relevant health education and cognitive and behavioral interventions for the patients, especially the older individuals (age≥60) , should be strengthened. Meanwhile, close attention should be paid to whole course management of NPPV in these patients.

Along with the development of aging, much attention has been paid to geriatric health issues in China. Sleep disturbance is a common sleep problem endangering older people's health.

To systematically assess the prevalence of sleep disturbances in Chinese older people.

Studies about sleep disturbance in Chinese elderly were searched in database of CNKI, CQVIP, SinoMed, WanFang Data, PubMed, EmBase, The Cochrane Library, Web of Knowledge and PsycINFO from inception to 31st May, 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies using the 11 criteria recommended by the Agency for Healthcare Research and Quality. Stata 16.0 was used for meta-analysis.

A total of 91 studies, with a sample of 81 354 cases were included. Meta-analysis showed that the overall prevalence rate of sleep disturbances among Chinese older people was 46.0%〔95%CI (41.7%, 50.4%) 〕. Further analysis indicated that the prevalence of sleep disturbances among men and women was 40.0%〔95%CI (30.9%, 49.2%) 〕and 49.4%〔95%CI (42.8%, 55.9%) 〕, respectively. And it was 35.1%〔95%CI (28.8%, 41.4%) 〕 for the 60-70-year-olds, 46.1%〔95%CI (33.8%, 58.4%) 〕 for the 70-80-year-olds, and 44.4%〔95%CI (32.7%, 56.2%) 〕 for the 80-and-over-year-olds. The sleep disturbance prevalence rate among those living in urban and rural areas was 41.5%〔95%CI (32.8%, 50.2%) 〕and 44.0%〔95%CI (36.4%, 51.7%) 〕, respectively. And it was 46.3%〔95%CI (37.6%, 55.1%) 〕for those with junior high school or lower education level, and 37.9%〔95%CI (26.7%, 49.1%) 〕for those with senior high school or higher education level. Meta-regression analysis showed that marital status and chronic disease prevalence were associated with sleep disturbances (P<0.05) .

The prevalence of sleep disturbances in Chinese older people is high. To reduce the risk of sleep disturbances and improve the sleep quality in this group, the prevention and intervention of sleep disturbances should be valued and targeted interventions should be delivered.

The prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) is high. The development of telemedicine and mobile applications play an important role in the diagnosis and screening of OSAHS patients.

To evaluate the value of smartphone snoring analysis software Mianyun Sara in screening of Chinese adults with OSAHS.

One hundred and thirty patients〔mean age (49.7±17.4) years old, 70% male and 30% female, mean body mass index (28.2±5.0) kg/m²〕who were admitted to the Sleep Center of Peking University People's Hospital from April to December 2020 were selected and underwent overnight monitoring with Mianyun Sara and polysomnography (PSG) simultaneously. The relevant indicators generated by Mianyun Sara's automatic analysis and the relevant indicators interpreted by sleep professional technicians according to the recommended guidelines, the agreement between the apnea hypopnea index (AHI) derived from this method and PSG were evaluated, as well as the sensitivity and specificity of the diagnosis of OSAHS.

(1) The total sleep time (TST) monitored by Mianyun Sara was 523.67 (497.50, 542.64) min, and the TST monitored by PSG was 408.25 (364.25, 462.50) min, the difference was statistically significant (Z=-9.540, P<0.001) . The AHI monitored by Mianyun Sara was 15.83 (6.18, 27.49) times/h, and the AHI monitored by PSG was 18.25 (6.15, 35.68) times/h, the difference was statistically significant (Z=-2.601, P=0.009) . (2) There was a positive correlation between the AHI obtained by the two monitoring methods (r=0.645, P<0.001) . Bland-Altman analysis showed that the AHIs measured by Mianyun Sara and PSG were statistically consistent, with an average difference of -5.7 times/h, and the 95% consistency limit of (-40.5, 29.2) times/h. (3) Taking AHI≥5 times/h as the gold standard for the diagnosis of OSAHS, Mianyun Sara's optimal diagnostic value for OSAHS was AHI>8.34 times/h, with a corresponding sensitivity of 83.81% and a specificity of 92.00%. The area under the curve (AUC) was 0.91 (0.84, 0.95) , the positive predictive value (PPV) was 97.8%, and the negative predictive value (NPV) was 57.5%, at different AHI thresholds (5, 15, 30 times/h) , the sensitivity/specificity corresponding to the best diagnostic value were 83.8%/92.0%, 88.2%/74.1% and 64.9%/91.4%, respectively.

Mianyun Sara has a good screening value for adult OSAHS patients and there is close agreement between Mianyun Sara and PSG.

Cardiopulmonary problems will increase the risk of health harms yet they are often neglected in clinical rehabilitation treatment for stroke patients. In addition, sleep problems also often affect the rehabilitation effect in these patients, while routine drug treatment could not achieve satisfactory effect.

To assess the effect of precisely prescribed exercise on cardiopulmonary fitness and sleep quality in stroke patients.

Sixty-four stroke inpatients were recruited from Rehabilitation Department, Changzhou Dean Hospital from April 2020 to August 2021, and equally randomized into a control group and an experimental group. At baseline, cardiopulmonary fitness was assessed using cardiopulmonary exercise testing (CPET) , and sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) for both groups. Then control group received 12-week routine rehabilitation training, while experimental group received 12-week routine rehabilitation training plus aerobic exercise precisely prescribed based on baseline CPET parameters. Intra- and inter-group comparisons were made between pre- and post-training major CPET parameters, dyspnea and leg fatigue measured by the Borg Scale and sleep quality.

At the end of training, the experimental group demonstrated higher peak oxygen uptake (VO₂peak) , percentage of predicted peak oxygen uptake (VO₂peak%pred) , peak metabolic equivalent (METpeak) , peak heart rate (HRpeak) , peak load, and anaerobic threshold (AT) , and lower intensity of perceived dyspnea and leg fatigue than the control group (P<0.05) . The above-mentioned eight parameters improved significantly after training in the experimental group (P<0.05) . The experimental group had lower post-training scores of six domains (subjective sleep quality, sleep latency, sleep duration, sleep disturbances, use of sleep medication, daytime dysfunction) and lower post-training total score of PSQI than the control group (P<0.05) . The total score of PSQI and the scores of its seven domains were all lowered significantly when the training was finished (P<0.05) .

The precisely prescribed aerobic exercise by the results of CPET could effectively improve the cardiopulmonary fitness, exercise intensity, exercise endurance, and sleep quality as well as the sense of exercise fatigue in stroke patients.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disorder. At present, there are great differences in evaluation indicators of clinical randomized controlled trials (RCTs) on OSAHS treated by traditional Chinese medicine (TCM ) . Therefore, it is of great significance to further explore the evaluation indicators of clinical RCTs of OSAHS.

To analyze the evaluation indicators of clinical RCTs on OSAHS treated by TCM, in order to provide reference for the selection of appropriate Chinese medicine for the treatment of OSAHS in RCTs outcome indicators.

The RCTs in the TCM treatment of OSAHS were retrieved from CNKI, WanFang Data, VIP, CBM, PubMed and other data bases from 2015-01-01 to 2021-10-20. The basic characteristics of the collected literature included the first author, sample size, gender, age, course of disease, intervention measures, TCM syndrome type, course of treatment, and outcome indicators. According to the functional attributes, the evaluation indicators were divided into TCM syndrome, physical and chemical indicators, life quality indicators, long-term prognosis indicators, safety events indicators, and Western medicine signs indicators. The quality of the included literature was evaluated using a systematic bias risk assessment tool recommended by the Cochrane Collaboration, and the literature quality was evaluated using RevMan 5.4 software.

A total of 41 RCTs were included, including 2 971 patients, involving 270 outcomes of 70 indicators, which were classified as TCM syndrome, physical and chemical indicators, safety events indicators, Western medicine signs indicators, and quality of life indicators. Among them, physical and chemical indicators, symptoms and signs indicators are the most, quality of life indicators are less. There are 14 items of 2 kinds of combination indicators, 16 items of 3 kinds of combination indicators and 7 items of 4 kinds of combination indicators. The measurement time ranged from 7 days to 6 months, and the most was 1 month (15 RCTs, 36.59%) , followed by 3 months (11 RCTs, 31.70%) .

At present, there are large differences in evaluation indicators of TCM treatment of OSAHS, relatively insufficient attention on TCM syndrome score, poor attention on quality of life indicators, no unified standard for evaluation indicators, large span of measurement time points, and no long-term prognostic indexes.

Sleep problems are increasingly common in residents with the acceleration of pace of life. Studies have shown that sleep duration is associated with chronic diseases such as hypertension and diabetes, but there is a lack of research on its association with hyperuricemia.

To assess the association and its dose-response level between sleep duration and hyperuricemia.

Data stemmed from the 2019 surveillance of epidemiology and risk factors of chronic diseases in adult residents in Haidian District, Beijing, involving individuals aged 18-79 years old, with an experience of living in Haidian District at least six months. The information was obtained via a face-to-face questionnaire survey, including the following aspects: demographics (sex, age, education level, marital status, occupation) , lifestyle factors (smoking and drinking, physical activity level, sleep duration) , history of chronic diseases (hypertension and diabetes) , height, weight, blood pressure, laboratory indices (fasting blood glucose, serum uric acid, and serum creatinine) . A multivariable Logistic regression model was used to assess the association between sleep duration and the risk of hyperuricemia, whose dose-response relationship was analysed using restricted cubic spline regression.

A total of 5 380 people were enrolled, with an average age of (46.9±16.0) years and an average sleep duration of (7.24±1.16) hours. Univariate Logistic regression analysis showed that, compared with those with 7-9 hours of sleep duration, the risk of hyperuricemia increased in those with less than 7 hours of sleep duration and in those with greater than 9 hours of sleep duration 〔OR (95%CI) =1.30 (1.12, 1.51) ; OR (95%CI) =1.48 (1.15, 1.89) 〕. After adjusting for age, gender, education level, marital status, occupation, smoking, drinking, physical activity level, BMI, hypertension, diabetes, and serum creatinine, the risk of hyperuricemia still increased in those with less than 7 hours of sleep duration and in those with greater than 9 hours of sleep duration 〔OR (95%CI) =1.37 (1.17, 1.62) ; OR (95%CI) =1.39 (1.07, 1.81) 〕. Restricted cubic spline regression analysis showed that sleep duration had a U-shaped association with hyperuricemia (non-linear test, χ²=27.530, P<0.001) .

Too longer or shorter sleep duration was a factor responsible for increased risk of hyperuricemia among adults in Haidian District of Beijing.

Sleep research has a major part to play in facilitating the development of sleep medicine. In China, the development of sleep medicine started later compared with other medical disciplines, and related advances have been seldom reported.

To review the development of sleep research in China by analyzing sleep research projects supported by the National Natural Science Foundation of China (NSFC) , providing data for future development of sleep research.

Data were collected from the NSFC, including the supported projects regarding sleep-disordered breathing (code H0113) and sleep and sleep disorders (code H0916) as well as those with corresponding codes involving sleep or sleep disorder of Department of Health Sciences, and supported projects involving sleep or sleep disorder in Departments of Life Sciences. The number and composition of supported projects and funding amount, geographical, regional and institutional distribution of supported projects in terms of number and funding amount were statistically analyzed.

From 1988 to 2019, the sleep research projects supported by the NSFC numbered 399 in total. The number of these projects and the founding amount for them showed an increasing trend, particularly after 2010. The types of projects were gradually enriched, among which four were key projects, while no key talent projects had been supported. The geographical and institutional distribution of supported projects was uneven, presenting a tendency of aggregation in some specific regions and institutions, and a pattern of Matthew effect. Colleges and universities were the main body of sleep research. At present, sleep research is mainly based on basic experiments and clinical applications.

In general, the level and composition distribution of sleep research projects supported by the NSFC during the period demonstrated a trend of gradual enhancement, but still need improvements. To promote the development of sleep medicine, it is recommended to strengthen the reserve force via improving the top-level design and macro layout concerning NSFC supported projects, and to achieve early prevention, appropriate diagnosis and treatment of sleep disorders via taking advantage of interdisciplinary cooperation and integration.

Many factors are associated with hypertension, the most prevalent chronic disease, among which, the association of sleep disturbance and hypertension has received wide attention as sleep medicine advances rapidly in recent years. However, relevant studies on sleep disturbance and hypertension have some limitations, and there is no bibliometric analysis of hotspots about sleep disturbance and hypertension.

To review and summarize the research hotspots and trends of literature related to sleep disturbances and hypertension.

Studies about sleep disturbance and hypertension were searched in Web of Science Core Collection from inception to June 30, 2021 using "hypertension" and "sleep disturbance" "insomnia" "sleep deprivation" "sleep fragmentation" and "short-term sleep" as subject headings. CiteSpace 5.7.R5W was used for visual analysis.

In total, 4 589 studies were included for analysis. The number of studies generally showed an increasing trend, with a peak in 2018, and a rapider growth rate between 2011 and 2021. The top 10 most frequently used keywords in the studies published between 2011 and 2021 were hypertension, blood pressure, prevalence, obstructive sleep apnea, risk factor, sleep, cardiovascular disease, positive airway pressure, obesity and insomnia. The tag clusters were sleep time, sleep quality, sleep-disordered breathing, obstructive sleep apnea, sleep apnea, insomnia, stress, sleep, epidemiology, heart failure and symptoms. Keyword clustering analysis revealed that major directions in the studies published between 2011 and 2021 were: (1) the association of sleep-disordered breathing, especially obstructive sleep apnea, and hypertension; (2) the association of sleep time and blood pressure; (3) the association of sleep quality and blood pressure. The most frequently cited studies were mainly about sleep apnea, obstructive sleep apnea and short-term sleep. REDLINE was the most prolific author, and the largest group of authors was formed with her as the core. The US was the most prolific country, and the most prolific institution was the University of Pittsburgh.

The research on sleep disturbance and hypertension had become increasingly popular. The research hotspots of this field had changed greatly in 2011 and 2018. The effects of obstructive sleep apnea and sleep duration on hypertension were the mostly focused hotspots.