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There remains an unmet need for a targeted treatment to address residual excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA) after primary treatment. This network meta-analysis evaluated the efficacy and safety of wake-promoting agents (WPAs), namely solriamfetol, pitolisant, modafinil, and armodafinil, for treating residual EDS in patients with OSA. We conducted a comprehensive search which ultimately included 18 studies in the final analysis. All 4 WPAs demonstrated significant therapeutic benefits for the Epworth sleepiness scale (ESS) and maintenance of wakefulness test (MWT). Based on the surface under the cumulative ranking curve (SUCRA) score, solriamfetol, pitolisant, modafinil and armodafinil were ranked from highest to lowest for the ESS. A similar ranking was observed for MWT, where pitolisant was not included in the analysis. The subgroup analysis also evaluated the efficacy of WPAs in the primary treatment adherent and nonadherent subgroups. Regarding adverse reactions, solriamfetol demonstrated the lowest risk of all-cause discontinuation, whereas pitolisant exhibited minimal risks of adverse events leading to treatment discontinuation and treatment-emergent adverse events. Our analysis comprehensively compared the effects and adverse reactions of different WPAs in treating residual EDS in treated patients with OSA. This has significant implications for the practical clinical use of WPAs and future research.

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Sleeping animals can be woken up rapidly by external threat signals, which is an essential defense mechanism for survival. However, neuronal circuits underlying the fast transmission of sensory signals for this process remain unclear. Here, we report in mice that alerting sound can induce rapid awakening within hundreds of milliseconds and that glutamatergic neurons in the pontine central gray (PCG) play an important role in this process. These neurons exhibit higher sensitivity to auditory stimuli in sleep than wakefulness. Suppressing these neurons results in reduced sound-induced awakening and increased sleep in intrinsic sleep/wake cycles, whereas their activation induces ultra-fast awakening from sleep and accelerates awakening from anesthesia. Additionally, the sound-induced awakening can be attributed to the propagation of auditory signals from the PCG to multiple arousal-related regions, including the mediodorsal thalamus, lateral hypothalamus, and ventral tegmental area. Thus, the PCG serves as an essential distribution center to orchestrate a global auditory network to promote rapid awakening.

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BACKGROUND: Firefighters are exposed to shift work, as well as unpredictable emergency calls and traumatic events, which can lead to sleep problems. This study aimed to investigate the risk of insomnia by work schedule instability in Korean firefighters. METHODS: This study used the Insomnia Severity Index to assess the insomnia in firefighters. The work schedule stability was classified with the frequency of the substitute work and the timing of notification for work schedule changes. Logistic regression analysis was used to assess the adjusted odds ratio of insomnia by work schedule stability with covariates including sex, age, education, smoking, alcohol, caffeine intake, shift type, job, and underlying conditions. RESULTS: Of the 8,587 individuals, 751 (8.75%) had moderate to severe insomnia (Insomnia Severity Index ≥ 15). The prevalence of insomnia was statistically significantly higher as the frequency of substitute work increased: <1 time per month (6.8%), 1-2 times (9.5%), 3-5 times (13.4%), and more than 5 times (15.7%) (p < 0.001). Additionally, the prevalence of insomnia was statistically significantly higher when the timing of the schedule change notification was urgent or irregular: no change or several weeks before (5.4%), several days before (7.9%), one day before or on the day (11.2%), irregularly notification (11.6%) (p < 0.001). In comparison to the group with good frequency of the substitute work/good timing of schedule change notification group, the adjusted odds ratios of insomnia were 1.480 (95% confidence interval [CI]: 1.237-1.771) for Good/Bad group, 1.862 (95% CI: 1.340-2.588) for Bad/Good group, and 1.885 (95% CI: 1.366-2.602) for Bad/Bad group. CONCLUSIONS: Work schedule instability was important risk factor of insomnia in firefighters. It suggests that improving the stability of work schedules could be a key strategy for reducing sleep problems in this occupational group.

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Sleep-wake disorder is one of the most common nonmotor symptoms of Parkinson's disease (PD). Melatonin has the potential to improve sleep-wake disorder, but its mechanism of action is still unclear. Our data showed that melatonin only improved the motor and sleep-wake behavior of a zebrafish PD model when melatonin receptor 1 was present. Thus, we explored the underlying mechanisms by applying a rotenone model. After the PD zebrafish model was induced by 10 nmol/L rotenone, the motor and sleep-wake behavior were assessed. In situ hybridization and real-time quantitative PCR were used to detect the expression of melatonin receptors and lipid-metabolism-related genes. In the PD model, we found abnormal lipid metabolism, which was reversed by melatonin. This may be one of the main pathways for improving PD sleep-wake disorder.

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Background: Shift work implementation is essential for providing continuous patient care in hospitals. However, working in shifts on a routine basis may disrupt the circadian pattern and alter the sleep-wakefulness cycle in nurses. Stress due to shift work can influence the adaptability of the cardiovascular system, produce psychophysiological strain and deteriorate work performance in female nurses. Objective: This study investigated the effect of morning and night shift work on sleep quality and circadian patterns governing heart rate variability (HRV) in female nurses working in a tertiary care hospital. Methods: Thirty-eight healthy female nurses were recruited. Frequency and time domain parameters of HRV were recorded as markers of cardiac autonomic function. A student t-test was used to investigate differences in HRV between morning and night shift workers. Mann-Whitney non-parametric test was applied for the difference between Pittsburgh Sleep Quality Index (PSQI) scores in the two groups. Results: Standard deviation of the normal-to-normal interval (SDNN) (msec), total power (ms2) and high-frequency (HF) band power (ms2) were significantly reduced in night shift nurses than in morning shift nurses. The low-frequency (LF)/HF ratio was significantly increased in night shift nurses. The differences in standard deviation of the averages of NN intervals (SDaNN) (msec), root mean square of successive differences between adjacent NN intervals (RMSSD), mean NN, very low-frequency (VLF) band power (ms2) and LF band power (ms2) were not statistically significant. The global PSQI score was significantly higher among night shift workers than in morning shifts. Conclusion: Inadequate sleep can disrupt the body's ability to regulate heart rhythm and increase the risk of cardiovascular diseases and mortality. The research suggests a propensity for autonomic imbalance in night shift workers when compared to their counterparts on morning shifts.

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Internal circadian phase assessment is increasingly acknowledged as a critical clinical tool for the diagnosis, monitoring, and treatment of circadian rhythm sleep-wake disorders and for investigating circadian timing in other medical disorders. The widespread use of in-laboratory circadian phase assessments in routine practice has been limited, most likely because circadian phase assessment is not required by formal diagnostic nosologies, and is not generally covered by insurance. At-home assessment of salivary dim light melatonin onset (DLMO, a validated circadian phase marker) is an increasingly accepted approach to assess circadian phase. This approach may help meet the increased demand for assessments and has the advantages of lower cost and greater patient convenience. We reviewed the literature describing at-home salivary DLMO assessment methods and identified factors deemed to be important to successful implementation. Here, we provide specific protocol recommendations for conducting at-home salivary DLMO assessments to facilitate a standardized approach for clinical and research purposes. Key factors include control of lighting, sampling rate, and timing, and measures of patient compliance. We include findings from implementation of an optimization algorithm to determine the most efficient number and timing of samples in patients with Delayed Sleep-Wake Phase Disorder. We also provide recommendations for assay methods and interpretation. Providing definitive criteria for each factor, along with detailed instructions for protocol implementation, will enable more widespread adoption of at-home circadian phase assessments as a standardized clinical diagnostic, monitoring, and treatment tool.

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Orexin is exclusively produced in neurons localized within the lateral hypothalamic area (LHA) and perifornical area (PFA). Orexin has been identified as a key promotor of arousal. The selective loss of orexinergic neurons results in narcolepsy. It is known that the intrinsic electrophysiological properties are critical for neurons to perform their functions in corresponding brain regions. In addition to hypothalamic orexin, other brain nuclei are involved in the regulation of sleep and wakefulness. Quite a lot of studies focus on elucidating orexin-induced regulation of sleep-wake states and modulation of neuronal electrophysiological properties in several brain regions. Here, we summarize that the orexinergic neurons exhibit spontaneous firing activity which is associated with the states of sleep-wake cycle. Orexin mainly exerts postsynaptic excitatory effects on multiple brain nuclei associated with the process of sleep and wakefulness. This review may provide a background to guide future research about the cellular mechanisms of orexin-induced maintaining of arousal.

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It is estimated that 45% of individuals with cognitive impairment experience sleep disturbances prior to the onset of cognitive symptoms. Assessing sleeping problems and enhancing sleep quality are critical first steps to reduce the risk of cognitive impairment. Objective: To review existing literature based on predefined eligibility criteria to understand the connection between sleep disturbance and Alzheimer's disease. Methods: A thorough and systematic evaluation of numerous studies was carried out to assess one or more of the following epidemiological factors: (1) sleep disorders, (2) cognitive impairment, and (3) risk estimates for cognitive impairment due to sleep. Results: Studies suggest that individuals who experience memory loss may encounter sleep disturbances before noticing other symptoms. Numerous sleep disorders, such as excessive and inadequate sleep duration, poor sleep quality, circadian rhythm abnormalities, insomnia, and obstructive sleep apnea were found to increase the risk of cognitive dysfunction and dementia. Additionally, lower sleep quality and shorter sleep duration have been linked to higher cerebral-ß-amyloid levels. Objective evidence for the development of cognitive impairment is provided by the architecture of sleep stages. Patients experiencing sleep problems may benefit from specific types of sleep medicine as a preventative measure against cognitive decline. Conclusion: Sleep disorders can have adverse effects on cognitive health. The duration and quality of sleep are fundamental factors for maintaining a healthy brain as we age. Proper sleep can aid prevent cognitive impairment, particularly Alzheimer's disease and dementia.

Acredita-se que 45% dos indivíduos com comprometimento cognitivo experimentem distúrbios do sono antes do início dos sintomas cognitivos. Avaliar problemas de sono e melhorar a qualidade do sono são passos críticos iniciais para reduzir o risco de comprometimento cognitivo. Objetivo: Revisar a literatura existente com base em critérios de elegibilidade predefinidos para entender a conexão entre distúrbios do sono e a Doença de Alzheimer. Métodos: Uma avaliação completa e sistemática de vários estudos foi realizada para avaliar um ou mais dos seguintes fatores epidemiológicos: (1) distúrbios do sono, (2) comprometimento cognitivo e (3) estimativas de risco de comprometimento cognitivo decorrente do sono. Resultados: Os estudos sugerem que indivíduos que experimentam perda de memória podem enfrentar distúrbios do sono antes de notarem outros sintomas. Foi constatado que vários distúrbios do sono, como duração excessiva e inadequada do sono, má qualidade do sono, anormalidades no ritmo circadiano, insônia e apneia obstrutiva do sono, podem aumentar o risco de disfunção cognitiva e demência. Além disso, menor qualidade do sono e duração mais curta do sono têm sido associadas a níveis mais altos de ß-amiloide cerebral. Evidências objetivas para o desenvolvimento de comprometimento cognitivo são fornecidas pela arquitetura dos estágios do sono. Pacientes que experimentam problemas de sono podem se beneficiar de tipos específicos de medicamentos para o sono como medida preventiva contra o declínio cognitivo. Conclusão: Os distúrbios do sono podem ter efeitos adversos na saúde cognitiva. A duração e a qualidade do sono são fatores fundamentais para manter um cérebro saudável à medida que envelhecemos. Um sono adequado pode ajudar a prevenir o comprometimento cognitivo, especialmente a Doença de Alzheimer e a demência.

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Chronotype may affect tolerance for circadian disruption induced by shift work. This study examines the association between chronotype, self-reported sleep timing, shift type preference, and sleep problems among nurses, and studies chronotype stability over time. The study included 37,731 Dutch female nurses who completed a baseline (2011) and follow-up questionnaire (2017), with information on shift work (e.g., job history, shift type preference [collected in 2017 only]), and sleep characteristics (e.g., chronotype, preferred sleep-wake time in a work-free period [collected in 2017 only], and sleep problems between working days according to Medical Outcomes Study-Sleep Problem Index II [MOS-SPI-II]). The association between chronotype and sleep timing was examined using (age-adjusted) linear regression. Associations between chronotype and shift type preference and sleep problems (MOS-SPI-II >30) were examined using ordered logistic and Poisson regression, respectively. With later chronotype, midsleep time increased (definite evening vs. intermediate types [reference]: ß = 55 min, 95% confidence interval [95% CI]: 54-55), the odds ratio (OR) for 1-point increase in preference for night (2.68; 95% CI: 2.48-2.90) and evening shifts increased (OR 2.20; 95% CI: 2.03-2.38), while the odds for day (OR 0.17; 95% CI: 0.16-0.18) and morning shifts (OR 0.22; 95% CI: 0.21-0.24) decreased. Intermediate chronotype was associated with fewer sleep problems (median MOS-SPI-II = 27.2, p < 0.01), compared with definite morning (28.9) and evening types (31.7). This study shows that chronotype is associated with sleep-wake times in a work-free period, shift type preference, and sleep problems in nurses. Future studies on the association of shift work-induced circadian disruption and health outcomes should therefore consider chronotype as effect-modifier.

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Little is known about the healthy aging of the circadian timing system under natural living conditions. This study explores changes in the circadian rhythm of distal skin temperature (DST) with aging and relates these changes to sleep-wake timing and environmental influences. DST, sleep-wake timing, 24-h light exposure, and physical activity were measured and averaged over seven consecutive days using temperature sensors, actigraphy with a light meter, and sleep diaries in 35 healthy older women (60-79 years) and 30 young women (20-34 years). Circadian rhythm characteristics, describing strength (amplitude) and timing (acrophase) of the DST rhythm, were calculated using cosinor analysis. The older adults displayed an 18-19% smaller amplitude and a 66-73 min earlier acrophase (peak time) for DST rhythm than the young adults, indicating a weaker and phase-advanced DST rhythm. The phase advance for DST was not due to an earlier evening increase, but to a shorter nocturnal plateau period. Daytime light exposure inversely affected strength (amplitude) but not phasing of the DST rhythm in older adults. The DST rhythm was 3.5 times more advanced than the sleep-wake rhythm, showing an altered phase relationship (phase angle) between both rhythms with aging. The phase angle was more heterogeneous among older adults, showing differential aging. The phase advance for DST rhythm and the altered and heterogeneous phase relationship between DST and sleep-wake rhythms were not related to ambient light exposure and the physical activity of older adults. This suggests that healthy aging of the circadian system might be due to endogenous mechanisms such as an internal rearrangement rather than external influences.

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Purpose: Sleeping disorders were reported in many patients who took vaccines during previous pandemics. We aim to investigate the relationship between coronavirus disease 2019 (COVID-19) vaccines and the incidence of narcolepsy symptoms in the Jordanian population. Materials and Methods: We used a descriptive, cross-sectional, online self-administered survey conducted between December 2022 and May 2023. The survey targeted males and females above the age of 18 years who took any type of COVID-19 vaccine, had no chronic diseases, and had no sleep disorders prior to taking the vaccine. The survey was distributed via social media platforms. Results: A total of 873 participants were included in this study, consisting of 44.4% males and 55.6% females, with the majority being in the 18-29 age group. Most participants (79.8%) received two vaccine doses, with the Pfizer vaccine being the most common. Nearly half of the participants reported excessive daytime sleepiness. Sleep paralysis and hypnagogic hallucinations were reported by a notable proportion of participants, but no significant differences were found among the vaccine types. Sleep attacks and fragmented nighttime sleep were associated with the number of vaccine doses received, suggesting a possible influence of the dose count on these symptoms. The presence of excessive daytime sleepiness, sudden loss of muscle tone, sleep paralysis, and hypnagogic hallucinations showed no significant association with the number of doses taken. Conclusion: We hypothesize a possible link between COVID-19 vaccination and the emergence of narcolepsy symptoms in Jordanian individuals. Additional investigations and continuous monitoring to determine the extent of the risk and uncover potential mechanisms behind this connection should be performed.

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OBJECTIVE: Sleep is a potential risk factor for metabolic syndrome. We investigated the associations of various sleep characteristics with the status and incidence of metabolic syndrome in middle-aged Koreans. METHODS: Using data from a community-based Korean Medicine Daejeon Citizen Cohort study on participants aged 30-50years, cross-sectional (n = 1984) and longitudinal (n = 1216, median follow-up: 2.1years) analyses were performed. To study the association of metabolic syndrome and five components with various sleep characteristics, measured using the Pittsburgh Sleep Quality Index, we used Poisson and logistic regression and Cox proportional hazard regression analyses, adjusting for covariates. RESULTS: Of 1984 participants, 66%, 19%, and 15% belonged to the non-metabolic syndrome, pre-metabolic syndrome, and metabolic syndrome groups, respectively. After covariate adjustments, the pre-metabolic syndrome group was associated with late mid-sleep time (≥5:00; prevalence ratios 1.61, 95% confidence interval 1.01-2.54) and late bedtime (≥2:00; prevalence ratios 1.55, 95% confidence interval 1.03-2.34), and the metabolic syndrome group was associated with long sleep latency (prevalence ratios 1.33, 95% confidence interval 1.03-1.73), poor sleep quality (prevalence ratios 1.38, 95% confidence interval 1.07-1.78), and early wake time (<6:00; prevalence ratios 1.29, 95% confidence interval 1.01-1.63). Longitudinal analysis of participants without metabolic syndrome at baseline indicated a significant increase in metabolic syndrome risk associated with very short sleep duration (<6 hours; hazard ratio 1.72, 95% confidence interval 1.06-2.79), long sleep latency (>30 minutes; hazard ratio 1.86, 95% confidence interval 1.1-3.12), and early wake time (<6:00 o'clock; hazard ratio 1.73, 95% confidence interval 1.01-2.97). CONCLUSION: Sleep characteristics, such as short duration, long latency, and early wake time, were associated with an increased risk of metabolic syndrome in middle-aged adults.

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The first night in an unfamiliar environment is marked by reduced sleep quality and changes in sleep architecture. This so-called First-Night Effect (FNE) is well established for two consecutive nights and lays the foundation for including an adaptation night in sleep research to counteract FNEs. However, adaptation nights rarely happen immediately before experimental nights, which raises the question of how sleep adapts over non-consecutive nights. Furthermore, it is yet unclear, how environmental familiarity and hemispheric asymmetry of slow-wave sleep (SWS) contribute to the explanation of FNEs. To address this gap, 45 healthy participants spent two weekly separated nights in the sleep laboratory. In a separate study, we investigated the influence of environmental familiarity on 30 participants who spent two non-consecutive nights in the sleep laboratory and two nights at home. Sleep was recorded by polysomnography. Results of both studies show that FNEs also occur in non-consecutive nights, particularly affecting wake after sleep onset, sleep onset latency, and total sleep time. Sleep disturbances in the first night happen in both familiar and unfamiliar environments. The degree of asymmetric SWS was not correlated with the FNE but rather tended to vary over the course of several nights. Our findings suggest that non-consecutive adaptation nights are effective in controlling for FNEs, justifying the current practice in basic sleep research. Further research should focus on trait- and fluctuating state-like components explaining interhemispheric asymmetries.

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OBJECTIVE: To identify risk factors associated with childhood enuresis. METHODS: We conducted a retrospective analysis of 146 children aged 6 to 13 years diagnosed with enuresis at Anhui Province Children's Hospital between June 2020 and June 2023. Children were categorized based on bedwetting frequency: those with less frequent episodes (once a week to twice a month) were placed in the mild group (60 cases), and those with frequent episodes (two or more times per week) were placed in the severe group (86 cases). We compared demographic data, family histories, and personal characteristics between the groups and performed logistic regression to determine significant risk factors. RESULTS: The analysis revealed that a stubborn personality, nocturnal polyuria, sleep-wake disorders, and bladder dysfunction significantly increased the risk of enuresis (P < 0.05). These findings underscore the importance of a holistic approach in evaluating psychological aspects, nocturnal urination patterns, sleep quality, and bladder health in managing enuresis. CONCLUSION: The study identifies stubborn personality, nocturnal polyuria, sleep-wake disorders, and bladder dysfunction as independent risk factors for childhood enuresis. Understanding these factors is crucial for developing targeted interventions that can enhance the management and outcomes of enuresis. Future research should explore the interrelationships among these factors to refine preventive and therapeutic strategies for early childhood enuresis.

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This case underscores the importance of treating neurological deficits of an acute stroke presentation despite initial negative diffusion-weighted imaging (DWI), especially in the acute phase when there is high clinical suspicion of stroke. Additionally, it highlights the appropriate use of a WAKE-UP protocol for patients that present with stroke symptoms without a well-defined inception time. A 71-year-old female presented to the emergency department with symptoms of dizziness and double vision upon wake-up. While clinical exam findings revealed left intranuclear ophthalmoplegia (INO) and inability to ambulate due to gait ataxia, magnetic resonance imaging (MRI) was negative for acute stroke. Despite negative DWI MRI, this patient's clinical exam findings of a left INO and gait ataxia were indicative of an ischemic stroke localizing to the medial longitudinal fasciculus (MLF), and the patient received thrombolytics. Repeat MRI about 48 h later revealed an acute infarct in the left midbrain with a DWI lesion in the MLF.

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BACKGROUND: Traumatic brain injury (TBI) is a hallmark of wartime injury and is related to numerous sleep wake disorders (SWD), which persist long term in veterans. Current knowledge gaps in pathophysiology have hindered advances in diagnosis and treatment. OBJECTIVE: We reviewed TBI SWD pathophysiology, comorbidities, diagnosis and treatment that have emerged over the past two decades. METHODS: We conducted a literature review of English language publications evaluating sleep disorders (obstructive sleep apnea, insomnia, hypersomnia, parasomnias, restless legs syndrome and periodic limb movement disorder) and TBI published since 2000. We excluded studies that were not specifically evaluating TBI populations. RESULTS: Highlighted areas of interest and knowledge gaps were identified in TBI pathophysiology and mechanisms of sleep disruption, a comparison of TBI SWD and post-traumatic stress disorder SWD. The role of TBI and glymphatic biomarkers and management strategies for TBI SWD will also be discussed. CONCLUSION: Our understanding of the pathophysiologic underpinnings of TBI and sleep health, particularly at the basic science level, is limited. Developing an understanding of biomarkers, neuroimaging, and mixed-methods research in comorbid TBI SWD holds the greatest promise to advance our ability to diagnose and monitor response to therapy in this vulnerable population.

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BACKGROUND: The medullary nucleus of solitary tract (NTS) and its afferents of vagus nerve have long been investigated in regulation of cortical activity and sleep promotion. However, the underlying neural circuit by which the NTS regulates electroencephalogram (EEG) and sleep remain unclear. As the NTS has a strong projection to the pontine arousal site, the parabrachial nucleus (PB), we proposed the NTS via the pontine parabrachial nucleus (PB) regulates cortical activity and sleep. METHODS: We bilaterally and directly stimulated the NTS neurons by chemogenetic approach and NTS terminals in the PB by optogenetic approach and examined changes in EEG and sleep in rats. RESULTS: Opto- and chemo-stimulation of the NTS and NTS-PB pathway altered neither sleep amounts nor patterns; however, both stimulations consistently increased EEG delta (0.5-4.0 Hz) EEG power during non-rapid-eye-movement (NREM) sleep and alpha-beta (10-30 Hz) EEG power during wake and REM sleep. CONCLUSION: Our results indicate that the NTS via its projections to the PB synchronizes low frequency EEG during NREM sleep and high frequency EEG during wake and REM sleep. This pathway may serve the neural foundation for the vagus nerve stimulation (VNS) treating cortical disorders.

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Background: Resilience can mitigate the negative impact produced by the COVID-19 pandemic. Medical students endure significant academic stress, so adjusting to sudden changes can present greater mental health challenges. The aim is to identify the level and prevalence of resilience and to know what are the educational variables and is sleep quality associated with resilience. Methods: A cross-sectional study was conducted using an online questionnaire. The survey was elaborated in Google Forms and shared through social networks. The outcome was resilience, measured with the Connor Davidson Resilience Scale. Its association was assessed with sleep quality (measured with the Pittsburgh Sleep Quality Index), daytime sleepiness (measured with the Epworth Sleepiness Scale), and selected academic/sociodemographic variables. Generalized linear models were used to identify the association between the variables. Results: Of 1277 participants, 35.7% experienced high resilience. Poor sleep quality and sleepiness were present in 88.4% and 36.0% of students, respectively. High resilience was associated with good sleep quality (PR:1.56; 95%CI: 1.34 - 1.83; p-value<0.001), absent sleepiness (PR:1.59; 95%CI: 1.32-1.91; p-value<0.001), male sex (PR: 1.21; 95%CI: 1.05-1.39; p-value 0.006), working (PR:1.14), having family responsibilities (PR: 1.36; 95%CI: 1.09-1.70; p-value 0.005) and spending more than 6 hours studying (PR: 1.35; 95%CI: 1.17-1.54; p-value<0.001). Conclusion: 4 out of 10 students presented high levels of resilience. The development of resilience depended on multiple individual and sociodemographic factors. These findings are important to support universities in developing resilience-building measures and strategies that can be implemented to mitigate the adverse pandemic event.

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Background and Objectives: COVID-19 disease, caused by the SARS-CoV-2 virus, has presented significant challenges to global health, with acute and chronic implications for various aspects of well-being, including sleep and quality of life. This study aimed to investigate the impact of SARS-CoV-2 infection on sleep quality, daytime sleepiness, and quality of life in hospitalised and home-treated patients after three and six months. Materials and Methods: A longitudinal cohort study was conducted, enrolling hospitalised patients from a single clinical university hospital and home-treated participants through a survey spread through social networks. Individuals who had tested positive for the SARS-CoV-2 virus in the past three months and had a symptomatic course of the disease were included in the study. Participants with previously diagnosed sleep disorders were excluded from the study. Participants were evaluated using internationally validated self-evaluation scales, including the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Fatigue Severity Scale (FSS). Data were collected three and six months after laboratory-confirmed SARS-CoV-2 infection, with informed consent obtained from all participants. Statistical analysis was performed using the Wilcoxon signed rank test, Fisher-Freeman-Halton exact, Pearson Chi tests and Spearman correlation. Results were considered statistically significant with p value < 0.05. Results: In total, 66 participants with a mean age of 44.05 ± 21.61 years were enrolled in the study. Most patients (n = 36) were treated at home and 30 at hospital. Six months after SARS-CoV-2 infection, home-treated patients reported a higher prevalence of poor sleep quality (52.8%, n = 19, p = 0.015, PSQI) and hospitalised patients showed a lower prevalence of depressive symptoms (p < 0.001, PHQ-9) as 90% (n = 27) had minimal or no symptoms compared to 30.6% (n = 11) in a home-treated group. Conclusions: These findings mark the importance of the COVID-19 patients' management settings as people treated at home had worse sleep quality and more depressive symptoms six months after infection indicating worse life quality.

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STUDY OBJECTIVES: To synthesize findings of original articles examining the association between sleep-wake patterns of typically developing infants aged 0-to-18 months and cognitive and psychomotor development. METHODS: A systematic search strategy was used to identify articles assessing the association between infant sleep (0-to-18 months) and cognitive/psychomotor development (Medline, PsycINFO, SCOPUS). Of 7,136 articles screened, 22 articles met inclusion criteria, and the results were subsequently synthesized. A quality assessment was conducted, and studies were categorized as "poor", "fair", or "good". RESULTS: Out of 22 studies, two found exclusively significant associations between infant sleep and cognitive/psychomotor development, three found no significant associations and 17 found mixed results. Studies with exclusively significant results used a single sleep variable and single timepoint designs. Studies finding mixed results or no significant associations used multiple sleep, developmental variables, or multi-timepoint designs. Eight out of 10 studies and seven out of eight studies investigating nocturnal and total sleep duration, respectively, found no significant association with developmental outcomes. While 63% of studies were rated as having good methodological quality, all studies but one had estimated power of less than 0.80. CONCLUSION: Findings of this review do not support conclusive associations between sleep-wake patterns in infancy and cognitive/psychomotor development. This conclusion contrasts with the literature in older populations, questioning if the association between sleep and development is of a different nature in infancy, potentially because of brain maturation. More studies including larger samples will be needed to clarify the presence or absence of such an association.