Search Results (3,208)

Background: Chronotype refers to an individual’s preferred timing of activity and rest within a 24-h period, reflecting behavioral manifestations of the endogenous circadian rhythm. Variations in circadian timing may contribute to the temporal characteristics and pathophysiology of tension-type headache (TTH). TTH is the most common primary headache disorder and can have a significant impact on quality of life. While chronotype has been shown to influence pain perception, mood, and sleep quality in various chronic pain conditions, its relationship to TTH remains insufficiently explored. Aim: We aimed to determine the distribution of chronotypes among patients with TTH and to assess their associations with pain characteristics, depression, sleep quality, and quality of life. Methods: This cross-sectional study involved 77 adult patients diagnosed with TTH according to the International Classification of Headache Disorders (ICHD)-III criteria. Patients were recruited from the neurology outpatient clinic at SANKO University Hospital between June 2021 and June 2022. Data were collected using the Morningness–Eveningness Questionnaire (MEQ), the Visual Analogue Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the Short Form-36 (SF-36). Chronotypes were categorized as morning, intermediate, or evening. Group differences were analyzed using ANOVA, Kruskal–Wallis and linear regression models. Results: The mean age of the study sample was 29.0 [24.0–35.0] years. Fifty-five participants (71.4%) had an intermediate chronotype, 14 (18.2%) had a morning chronotype, and 8 (10.4%) had an evening chronotype. Those with an evening chronotype had a significantly lower BMI than those with an intermediate chronotype (p = 0.035) and lower scores on the SF-36 Role Limitations due to Physical Problems domain than those with a morning chronotype (p = 0.039). Chronotype (as assessed by the MEQ) was negatively correlated with sleep quality, with evening chronotypes showing poorer PSQI scores. No significant differences were found in VAS (pain intensity) and HADS (depression) scores among chronotypes. Linear regression analyses indicated that chronotype significantly predicted SF-36 Bodily Pain scores, whereas sex significantly predicted VAS pain intensity (p = 0.001). Conclusions: Evening chronotype is associated with poorer sleep quality and greater role limitations due to physical problemsin patients with TTH, which can potentially exacerbate the disabilities associated with headaches. Tailored interventions targeting chronotype and sleep may improve quality of life in this population. Full article

Sleep spindles, together with K-complexes, are the distinctive patterns of neuronal activity in EEG recordings during stage 2 sleep. When the mechanisms of sleep spindle generation are impaired, e.g., in epilepsy, their quantitative parameters change. The analysis of these changes can provide valuable insights into the formation of epileptiform activity patterns and help to develop an additional tool for more accurate medical diagnosis. Despite the central role of EEG in the diagnosis of epilepsy, disorders of consciousness, and neurological research, resources specifically dedicated to large-scale EEG data analysis are under-represented. In our study, we collect a specialized database of clinical EEG recordings from epilepsy patients and controls during N2 sleep, characterized by rhythmic spindle activity in frontocentral and vertex regions, and manually annotate them. We then quantify four key sleep spindle characteristics using a comparison of manual annotation by a clinician and artificial intelligence technologies. A thorough evaluation of state-of-the-art deep learning architectures for detecting and characterizing sleep spindles in EEG recordings from epilepsy patients is conducted. The results show that the 1D U-Net and SEED architectures achieve competitive overall performance, but their precision-to-recall ratios differ markedly in clinical settings. This suggests that different approaches may be appropriate for each clinical situation. Furthermore, our results demonstrate that epilepsy is associated with significant and quantifiable changes in sleep spindle morphology and frequency. Automated analysis of these characteristics using artificial intelligence provides a reliable biomarker that provides a detailed picture of thalamocortical dysfunction in epilepsy. This approach has great potential for accelerated diagnosis and the development of targeted therapeutic strategies for epilepsy. Full article

Our understanding of Ghrelin, an endogenous ligand of the growth hormone secretagogue receptor 1a (GHSR1a), has expanded from considering it to be a “hunger hormone” to a pleiotropic regulator of whole-body physiology. This review synthesizes the current advances spanning ghrelin biogenesis, signaling, and systems biology. Physiologically, preproghrelin processing and O-acylation by ghrelin O-acyltransferase (GOAT) generate acyl-ghrelin, a high-potency GHSR1a agonist; des-acyl ghrelin predominates in circulation and exerts context-dependent, GHSR1a-independent, or low-potency effects, while truncated “mini-ghrelins” can act as competitive antagonists. The emergence of synthetic ligands, agonists, antagonists, and reverse-agonists has provided the necessary tools to decipher GHSR1a activity. Recent cryo-EM structures of GHSR1a with peptide and small-molecule ligands reveal a bipartite binding pocket and provide a framework for biased signaling, constitutive activity, and receptor partner selectivity. Beyond the regulation of feeding and growth-hormone release, ghrelin modulates glucose homeostasis, gastric secretion and motility, cardiovascular tone, bone remodeling, renal hemodynamics, and innate immunity. Ghrelin broadly dampens pro-inflammatory responses and promotes reparative macrophage phenotypes. In the emerging scholarship on ghrelin’s activity in the central nervous system, ghrelin has been found to influence neuroprotection, stress reactivity, and sleep architecture, and has also been implicated in depression, Alzheimer’s disease, and substance-abuse disorders. Practical and transitional aspects are also highlighted in the literature: approaches for ghrelin stabilization; recent GHSR1a agonists/antagonists and inverse agonists findings; LEAP-2-based strategies; and emerging GOAT inhibitors. Together, structural insights and pathway selectivity position the ghrelin system as a druggable axis for the management of inflammatory diseases, neuropsychiatric and addiction conditions, and for obesity treatment in the post-GLP-1 receptor agonist era. Full article

Background and Clinical Significance: Intracerebral hemorrhage (ICH) is a very rare complication following endovascular closure of direct carotid-cavernous fistulas (CCFs). When reported, ICH typically appears within the first 48 h after CCF closure. We performed an extensive literature review, starting from the case of a 48-year-old patient presenting with an intracerebral hemorrhage after CCF closure. Case Presentation: A 48-year-old woman with arterial hypertension developed an intracerebral hemorrhage in the right frontal lobe 12 days after successful closure of a traumatic CCF. The patient exhibited acute neurological deterioration in a previously hypoperfused territory. A narrative review identifies the classical molecular theory of hemodynamic dysregulation, known as Normal Perfusion Pressure Breakthrough (NPPB), as the principal pathophysiological mechanism. Other mechanisms such as oxidative stress, microglial activation, blood–brain barrier disruption, metalloproteinase expression, and possible genetic alterations such as ICA1L variants are also implicated. Conclusions: This case underscores the importance of considering molecular mechanisms in the pathophysiology of delayed post-endovascular treatment of ICH, as well as the need for hemodynamic monitoring and follow-up in patients with vascular comorbidities. Full article

Due to the highly individualised presentation of sport-related concussion (SRC), multi-domain assessments examining cognitive, migraine, vestibular, ocular, mood, sleep, and neck-related function have been suggested to assist clinicians with diagnosis, management, and rehabilitation. Normative data on such assessments for female, community players from countries outside the U.S. are needed. This study aimed to (i) describe normative data from community-level Ladies Gaelic Football players using a multi-domain assessment, and (ii) compare findings between adolescent and adult players. A total of 138 LGF players without SRC (101 adults, 37 adolescents) completed a multi-domain SRC assessment including Sport Concussion Assessment Tool 5th Edition, Concussion Clinical Profiles Screening, Vestibular/Ocular Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT^®), Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Pittsburgh Sleep Quality Index, Migraine Disability Assessment, and Neck Bournemouth Questionnaire, and neck dynamometry. Normative data were summarised using descriptive statistics, while differences in test scores between adolescents and adults were examined using parametric or non-parametric tests. While adolescents and adults scored similarly on most measures, adolescents scored worse on ImPACT^® visual–motor speed (d = 0.09) and reaction time (r = 0.52), SCAT5 concentration (V = 0.38), total modified Balance Error Scoring System (r = 0.42), and CP Screen vestibular profile (r = 0.38) (p < 0.05). This is the first study to describe and compare normative data for multidomain SRC assessments in adolescent and adult female, community athletes. Differences in some tests between adolescents and adults highlight the need for demographic-specific normative data when interpreting post-SRC assessment results. Full article

Sleep disorders represent a growing global health concern with significant socio-economic impacts. GABA, a natural bioactive compound abundant in various fermented foods, especially probiotic-fermented foods, has garnered increasing attention for its potential to improve sleep quality. This review systematically elucidates the multi-pathway mechanisms by which GABA regulates sleep, focusing on (1) indirect modulation of central sleep–wake circuits via the gut–brain axis through vagal nerve, neuroendocrine, and immune pathways; (2) potential entry into the brain by leveraging the dynamic permeability of the blood–brain barrier (BBB) and transporter-mediated active transport; and (3) metabolic conversion into active substances like γ-hydroxybutyrate (GHB), which synergistically optimizes sleep architecture via multiple receptor systems and energy metabolism. Furthermore, we summarize the sleep-promoting effects of GABA-enriched foods observed in animal and clinical studies and discuss emerging applications, including high-GABA-yielding probiotics and personalized nutrition strategies for sleep intervention. This review provides a theoretical basis and innovative directions for the development of GABA-based functional foods and sleep health management. Full article

Background: Although the participation of children with autism spectrum disorder (ASD) in team sports presents challenges, group-based physical activities could offer specific benefits for their core symptoms. Therefore, the aim of this systematic review was to analyze the benefits of mini-basketball for children with ASD. Methods: A systematic review was conducted following PRISMA guidelines and was registered in PROSPERO (CRD420251144800). Four databases (Web of Science, SPORTDiscus, PubMed, and Scopus) were searched to select randomized controlled trials reporting the effects of mini-basketball interventions on children with ASD from their inception to August 2025. Results: Eight randomized controlled trials involving 436 participants (aged 3–12 years, 87.3% male) met the inclusion criteria. All studies were conducted in China using 12-week interventions (40–45 min, 2–5 days/week at moderate intensity). The quality was rated as good in two studies and fair in six. Five studies assessed social responsiveness, with four showing significant pre–post reductions in the experimental groups and all demonstrating superior outcomes versus those of the controls. One study reported significant reductions in repetitive behaviors, self-injurious behaviors, and restricted behaviors compared to that of the controls. Joint attention improvements were observed through eye-tracking measures, with increased fixation counts, shorter time to first fixation, and more accurate gaze shifts. Physical fitness benefits included improved shuttle run times and standing long jump performance. Finally, one study demonstrated better inhibition control and improvements in sleep quality, including increased sleep duration and efficiency. Conclusions: Mini-basketball interventions can improve social responsiveness and related outcomes in children with ASD. These findings support mini-basketball as a feasible, safe, and effective intervention that could be integrated with existing therapeutic approaches. Full article

Premenstrual dysphoric disorder (PMDD) is a psychological condition that significantly influences female students’ behavior, cognitive ability, and mental health status. It has a critical role in mental health and well-being and in the academic success and professional performance of nursing students. Objectives: This study aimed to assess the relationship between PMDD, perceived stress levels and sleep quality among female nursing students in Saudi Arabia. Methods: This study utilized a cross-sectional, correlational, descriptive design. The sample size was 144 students, and we used a convenience sampling technique. Data were collected using the following tools: Demographics and Gynecological Data Sheet, Premenstrual Symptoms Screening Tool, Pittsburgh Sleep Quality Index, and Perceived Stress Scale. Results: The levels of premenstrual symptoms and sleep disturbances among the participants can be regarded as moderate, whereas the level of perceived stress was found to be at its highest level, with 63.9% of participants experiencing a moderate level and 14.6% reporting severe stress. There was a significant positive correlation between premenstrual symptoms and perceived stress (r = 0.39, p = 0.005). Thus, as premenstrual symptoms increase, so does perceived stress. Additionally, there is a noteworthy correlation between perceived stress and sleep disturbance (r = 0.28, p = 0.04), indicating that higher levels of stress are associated with more sleep disturbances. Conclusions: PMDD symptoms have a detrimental influence on female students’ emotional state; thus, mental health experts play an important role in identifying variables that mitigate the severity of PMDD among female’s students. Full article

Background: Social media addiction is a growing concern among undergraduates, with nursing students particularly vulnerable as their stressful academic and clinical context may promote excessive use, impaired sleep, and higher depression risk. Therefore, we aimed to evaluate whether sleep disturbance mediates the association between problematic social media use and symptoms of depression among nursing students in Mexico. Methods: We conducted a multicenter, cross-sectional, analytical study using a random sample of 638 nursing students from three Mexican public universities. Between August and December 2024, participants completed validated scales for social media addiction, sleep quality, and depression. Counterfactual causal mediation analysis was performed using logistic regression with robust errors. Results: Sleep disturbance affected 51.7% of students, and 27.5% reported depression. Social media addiction showed a dose–response association with both outcomes. Mediation analysis revealed a total effect on depression (OR = 2.19; 95% CI = 1.45–3.30) and an indirect effect via sleep disturbance (OR = 1.22; 95% CI = 1.01–1.38), explaining 31.4% of the effect. Conclusions: Sleep disturbance partially mediates this association. Interventions addressing digital behavior and sleep hygiene may improve mental health in nursing students. Full article

Background/Objectives: To evaluate the prevalence, age at diagnosis, non-invasive ventilation pressures used in management, and clinical predictors for sleep disordered breathing (SDB) in pediatric patients with muscular dystrophies (MDs). Methods: A retrospective analysis of 195 polysomnography (PSG) studies conducted over 20 years for 98 children with different MDs was performed. Diagnosis of SDB was established if a child met the diagnostic criteria for one or more of the following conditions: obstructive sleep apnea (OSA), central apnea, nocturnal hypoxemia, or nocturnal hypoventilation. Outcomes were assessed and compared between MDs. Positive and negative predictive values (PPV, NPV), sensitivity, and specificity for detecting SDB were calculated for certain clinical parameters. Results: SDB was diagnosed in 73.6% of children with MDs, including OSA in 67%, followed by nocturnal hypoxemia (15.3%), nocturnal hypoventilation (7.7%), and central apnea (6.6%). The age at diagnosis and BiPAP pressures used varied between MDs. Patients with Congenital MD had the lowest mean age and required higher pressures (p < 0.05). PPV was high for maximum inspiratory or expiratory pressures (MIP, MEP) < 40% or <60%, forced vital capacity < 50% or <80%, total lung capacity < 60%, left ventricular ejection fraction < 50%, non-ambulation, and body mass index ≥ 95% for the presence of SDB. However, NPV, sensitivity, and specificity varied. Conclusions: SDB is common in pediatric patients with MDs, with OSA being the most prevalent disorder. The age at diagnosis and required BiPAP pressures for management differ among MD groups. Certain clinical measures may help identify some patients with the disease given the high PPV. Full article

Objective: An association between sleep apnea and various urological symptoms has been reported in the literature. Therefore, the aim of this study is to analyze sex-related differences in the association between sleep apnea und subsequent urinary incontinence diagnosis. Methods: This study examined the incidence of urinary incontinence in a matched pair cohort with and without sleep apnea treated in 1293 general practices in Germany between January 2005 and December 2022 (74,453 vs. 372,256 individuals). The five-year cumulative incidence of urinary incontinence in the cohorts with and without sleep apnea was studied using Kaplan–Meier curves and log-rank tests. Finally, a univariable Cox regression analysis was conducted to assess the association between sleep apnea and urinary incontinence. Stratified analyses were conducted by sex (male/female) and age group (18–50 years, 51–60 years, 61–70 years, >70 years). Results: Sleep apnea was significantly associated with urinary incontinence as compared to individuals without sleep disorder diagnosis (5.1% vs. 4.3%; p < 0.001), and this association remained robust in females (HR: 1.38; 95% CI: 1.29–1.46), but not in males (HR: 1.02; 95% CI: 0.96–1.08) In females, the association was strongest in the age group 51–60 years (HR: 1.98; 95% CI: 1.71–2.30). Conclusions: In conclusion, this study reports a significant association between sleep apnea and subsequent urinary incontinence diagnosis. Sex- and age-related differences should be taken into account, as associations were stronger for middle-aged females followed by younger females and no significant association was found regarding males. Full article

Memory consolidation is the process by which newly acquired experiences are stabilized into long-term memory, involving coordinated cellular and network-level activity across brain regions such as the hippocampus and prefrontal cortex. Dysregulation of this process has been implicated in psychiatric disorders including post-traumatic stress disorder (PTSD), which is characterized by the over-consolidation of traumatic memories. LIM kinase 1 (LIMK1), a key regulator of synaptic plasticity, is believed to play an important role in memory consolidation across hippocampal–cortical circuits. In this study, we investigated the function of LIMK1 using Limk1 knockout mice. Behavioral tests such as the novel object location memory task revealed significant memory impairments in knockout animals. In vivo recordings during sleep showed disrupted communication between the hippocampus and prefrontal cortex, suggesting impaired systems-level consolidation. Furthermore, in an underwater trauma exposure model, pharmacological inhibition of LIMK1 with LIMK-i3 alleviated trauma-induced behavioral abnormalities. These findings highlight LIMK1 as a critical mediator of hippocampal–cortical memory consolidation and provide experimental evidence that LIMK1 inhibition can modulate maladaptive memory processes associated with PTSD-like symptoms. Full article

Background/Objectives: The etiology of dementia is complex and multifactorial, with both genetic and environmental factors contributing to its onset. The Lancet Commission has identified several risk factors for this condition, but it is increasingly urgent to confirm their etiological role while accounting for both measured and unmeasured confounding effects. Our study, conducted on a population-based sample of Italian twins, examines the link between known risk factors and cognitive impairment, and the contribution of genetic and environmental influences to this link. Methods: Study participants were adult twins from the Italian Twin Registry who completed self-administered questionnaires. Cognitive impairment was evaluated by the SAGE questionnaire, while risk factors were assessed using the checklist proposed by the Lancet Commission. Individual-level and matched-pair analyses were performed for each risk factor, and their results were compared to detect potential genetic or environmental confounding, and to infer “quasi-causality” in the examined associations. Results: A total of 483 twins participated in the study (mean age 69.14 years, 63% women, 47% monozygotic twins). In matched-pair analyses, the association between hearing loss and cognitive impairment decreased in magnitude and became non-significant, suggesting confounding by genetics or early-life environment; in contrast, the association with sleep disturbances resulted strong and significant in both individual-level and matched-pair analyses, indicating a genuine effect of sleep on cognition. Conclusions: Our findings suggest a potential “quasi-causal” role of sleep disorders in cognitive decline. This relationship should be clarified through well-powered longitudinal studies incorporating precise clinical definitions and biomarker data. Full article

Background/Objectives: Sleep disturbances are increasingly recognized as dynamic biomarkers of cognitive decline; however, longitudinal and multimodal studies directly comparing amnestic (aMCI) and non-amnestic mild cognitive impairment (naMCI) remain limited. Methods: In a three-wave longitudinal design (~24 months), 179 older adults (46 healthy controls [HCs], 75 aMCI, 58 naMCI; mean age = 70.2 years, education = 12.3 years) were assessed with actigraphy and validated questionnaires (Athens Insomnia Scale, Pittsburgh Sleep Quality Index, STOP-BANG). Mixed ANOVAs and structural equation modeling tested group, time and mediation effects. Results: Subjective measures revealed a progressive worsening of insomnia and sleep quality in MCI, with naMCI exhibiting the steepest decline, while HCs remained largely stable. STOP-BANG trajectories indicated increasing sleep-disordered breathing risk across groups, most pronounced in naMCI. Objective indices corroborated these findings: total sleep time (TST) and sleep efficiency (SE) declined significantly in MCI, especially naMCI, while wake after sleep onset (WASO) increased longitudinally. By the third assessment, naMCI consistently showed the shortest TST and lowest SE. Mediation analyses identified SE as a central predictor of future subjective complaints, with indirect contributions from WASO and PSQI. Conclusions: Longitudinal trajectories, rather than cross-sectional comparisons, best differentiated MCI subtypes. NaMCI demonstrated the most aggressive deterioration in both objective and subjective sleep measures, highlighting its heightened vulnerability to sleep dysregulation and potential relevance for neurodegenerative progression. Clinically, sustained monitoring of SE, TST, and sleep-disordered breathing risk may provide prognostic value and inform early, targeted interventions in at-risk populations. Full article

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent disorder associated with increased cardiovascular (CV) risk. Materials and Methods: We conducted a PRISMA-compliant systematic review and meta-analysis of prospective cohort studies assessing OSA and incident CV outcomes. Results: From 2463 records, 18 studies (>25,000 participants; median follow-up 9 years) were included. OSA was associated with increased CV risk (pooled HR 1.82, 95% CI 1.45–2.28). Dose–response analysis showed a progressive risk increase: mild OSA (HR 1.21, 95% CI 0.98–1.50), moderate (HR 1.56, 95% CI 1.20–2.03), and severe (HR 2.45, 95% CI 1.85–3.25). Continuous positive airway pressure (CPAP) adherence (≥4 h/night) reduced risk (HR 0.76, 95% CI 0.60–0.96). Conclusions: OSA confers a severity-dependent CV risk, which is mitigated by adequate CPAP adherence. Systematic screening and adherence support may reduce CV morbidity and mortality. PROSPERO: CRD420251168363. Full article