Sleep Disorders
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Submission to final decision131 days
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Research Article

Respiratory Event-Induced Blood Pressure Oscillations Vary by Sleep Stage in Sleep Apnea Patients

Obstructive sleep apnea (OSA) pathologically stresses the cardiovascular system. Apneic events cause significant oscillatory surges in nocturnal blood pressure (BP). Trajectories of these surges vary widely. This variability challenges the quantification, characterization, and mathematical modeling of BP surge dynamics. We present a method of aggregating trajectories of apnea-induced BP surges using a sample-by-sample averaging of continuously recorded BP. We applied the method to recordings of overnight BP (average total sleep time:  h) for 10 OSA patients (mean AHI: 63.5 events/h; range: 18.3-105.4). We studied surges in blood pressure due to obstructive respiratory events separated from other such events by at least 30 s (274 total events). These events increased systolic (SBP) and diastolic (DBP) BP by  mmHg (14.8%) and  mmHg (15.5%), respectively, relative to mean values during wakefulness. Further, aggregated SBP and DBP peaks occurred on average 9 s and 9.5 s after apnea events, respectively. Interestingly, the amplitude of the SBP and DBP peaks varied across sleep stages, with mean peak ranging from to  mmHg for SBP and from to  mmHg for DBP. The aggregation method provides a high level of granularity in quantifying BP oscillations from OSA events and may be useful in modeling autonomic nervous system responses to OSA-induced stresses.

Research Article

Assessment of Perioperative Sleep Characteristics Using Subjective and Objective Methods: A Secondary Analysis of Prospective Cohort Study

Perioperative sleep disturbances may impact healing and negatively affect the patient’s perception of well-being. Therefore, accurately assessing postoperative sleep characteristics is necessary to treat sleep disturbances. This study is a secondary data analysis of research investigating the association between sleep and cognition in a perioperative setting. This study compares sleep characteristics between the St. Mary’s Hospital Sleep Questionnaire and WatchPAT, a portable sleep apnea testing device. The goal of this study is to compare an objective measurement of sleep quality (WatchPAT) with a traditional questionnaire. One hundred and one patients who underwent elective, noncardiac surgical procedures wore a WatchPAT and completed the St. Mary’s Hospital Sleep Questionnaire for three nights: two preoperative and one postoperative night. In the preoperative period, a Bland-Altman analysis showed an agreement Watch PAT and the St Mary’s hospital sleep questionnaire except for sleep fragmentation. A good to fair correlation during the preoperative period was observed with both sleep latency and total sleep time. In the postoperative period, no correlation was observed between the St. Mary’s Hospital Sleep Questionnaire data and WatchPAT data. Our study indicates that some potential factors affecting sleep and cognition such as admission type, depression, anesthesia type, and sleep apnea may limit patients’ ability to report their sleep characteristics after surgery. Therefore, relying solely on one sleep assessment method is not advisable.

Research Article

Association between Poor Quality of Sleep and Metabolic Syndrome in Ghanaian University Students: A Cross-Sectional Study

Aim. This study aimed to determine the association between quality of sleep and metabolic syndrome (MetS) and physical activity level in young adults at the University of Ghana. Method. In a cross-sectional design, 340 university students, aged between 20-30 years were recruited. Quality of sleep was assessed using the Pittsburgh Sleep Quality index (PSQI) and physical activity with the short form of the International Physical Activity Questionnaire (IPAQ-SF). Poor quality of sleep was defined as a global PSQI score>5 and low physical activity level as those not meeting the criteria for vigorous-moderate physical activity. Anthropometric features and blood pressures were measured, and fasting blood samples were collected from the participants to measure plasma levels of glucose, lipid profile, urea, and creatinine. MetS was defined using the Joint Scientific Statement criteria. Results. In our study population of young adults from Ghana, the prevalence of poor quality of sleep as measured by PSQI was 54.1%, and MetS was 12.4%. MetS was associated with poor quality of sleep in females [ (1.04–4.25), ] and entire study participants [2.18 (1.09–4.37) ] in both crude and adjusted models; no association was found in male participants. Low physical activity status was not associated with poor sleep status. Obesity [1.32 (1.02–3.56), ], but not overweight [0.99 (0.58–2.34), ], was associated with poor quality of sleep. Conclusion. Young adults in a Ghanaian university have a high prevalence of poor quality of sleep and is associated with MetS and obesity. Physical activity status was not associated with poor quality of sleep.

Research Article

Assessment of Central Sleep Apnea Events in Children with Sleep-Disordered Breathing

Purpose. To determine the prevalence of central apnea (CA) events and central sleep apnea (CSA) in children with sleep-disordered breathing (SDB) and to assess the effect of tonsillectomy and adenoidectomy (TA) on CSA in children with obstructive sleep apnea (OSA). Material and Methods. The medical charts of children with SDB were reviewed to obtain information on past medical history, polysomnography (PSG) findings, and surgical management. Counts and indexes of obstructive apnea, obstructive hypopnea, and central apnea were evaluated before and after TA. The prevalence of CSA and the effect of age, gender, obesity, and comorbid conditions on CSA were assessed in children with SDB as well as in children with PSG proven OSA. Results. Seven hundred twelve children with SDB (age range: 1 to 18 yrs, mean: ) were identified. CA events occurred in 640 of 712 (89.5%) patients. Of the 712 patients, 315 (44.2%) met the criteria for the diagnosis of CSA. CSA was more prevalent in toddlers and preschoolers (). Obese children had a higher prevalence of CSA compared to nonobese children (). The prevalence of CSA in patients with OSA was 45.4%. The number of CA events, CAI, and OAHI after TA was less than that of before TA (). Residual CSA after TA occurred in 20 children (26%). Conclusion. Central apnea events and central sleep apnea occur in children who present to a pediatric otolaryngology clinic for evaluation of sleep disordered breathing. Central sleep apnea and obstructive sleep apnea both improve after tonsillectomy and adenoidectomy.

Research Article

Effect of Sleep Intervention Programs during Cardiac Rehabilitation on the Sleep Quality of Heart Patients

Background and Objective. Patients with cardiovascular problems experience sleep disorders. Due to the importance of adequate sleep and rest for the growth and repair of damaged cells, it is necessary to use appropriate interventions to improve it. This study determined the effect of sleep intervention programs during cardiac rehabilitation on patients’ sleep quality. Materials and Methods. In this quasi-experimental study with unequal control group design, 35 individuals participated in the cardiac rehabilitation program as the experimental group and 35 served as the control group. The program included 12 weeks of exercise, 3 sessions per week, 3 sessions of training programs each lasting for 45 minutes, and a special two-session sleep improvement program. Data were collected using the Pittsburgh Sleep Quality Index and analysed with descriptive and inferential statistical methods. Results. There were not any significant differences between the two groups in age, sex, marital status, smoking, and indication for cardiac rehabilitation (). The scores of sleep quality of patients were before and after intervention in the experimental group and before and after intervention in the control group. There was no significant difference between the two groups before intervention (). yet there was a significant difference after intervention (). In addition, scores of sleep quality of patients were significantly different in the experimental and control groups before and after intervention (). Conclusion. Findings indicated that the quality of sleep of cardiac patients improved after the sleep intervention program during the cardiac rehabilitation program. Therefore, it is suggested to implement sleep improvement programs for cardiac patient care as an effective, easy, and feasible technique. In addition, it is necessary to pay more attention to the sleep improvement program in cardiac rehabilitation. Trial Registration. The trial was retrospectively registered on https://en.irct.ir/trial/50799 on 14 September 2020 (14.09.2020) with registration number IRCT20140307016870N6.

Research Article

Assessment of the Psychometric Properties of the Holland Sleep Disorders Questionnaire in the Iranian Population

Background. Assessing sleep disorders and understanding their causes are essential for the proper treatment and management of the disorders. The Holland Sleep Disorders Questionnaire (HSDQ) is a self-assessment questionnaire that measures sleep problems and symptoms based on the six categories of sleep disorders described in the International Classification of Sleep Disorders-2 (ICSD-2). The aim of this study was at validating and assessing the psychometric properties of the HSDQ in Iranian adults. Method. The study was carried out as a methodological and validation work. The guidelines for translation and cultural adaptation of patient-reported outcome measures were followed for the translation and the cultural validation of the tool. To examine construct validity, exploratory factor analysis (EFA) with 216 participants and confirmatory factor analysis (CFA) with 355 participants were used. As to the reliability, the test-retest method and, as to internal consistency, Cronbach’s alpha were employed. Data analyses were done in SPSS-25 and LISREL-8. Results. The CFA and EFA results confirmed the tool with six factors and 31 items. The index of the model was 0.99, which indicated that 99% of changes in the dependent variable (adults’ sleep problem) were attributed to the independent variable (the 31 items). In other words, 0.99 of the changes in the dependent variable were due to the independent variables. The main indices of CFA (, , , ) were acceptable. In addition, a correlation coefficient below 0.05 was considered as significant. Reliability of the tool based on internal correlation (Cronbach’s alpha) was in the 0.701–0.924 range for the subscales and equal to 0.789 for the whole tool. Conclusion. In general, the results showed that the Farsi version of HSDQ (six factors and 31 items) had acceptable and applicable indices and it can be used as a valid tool in the Iranian society. The tool can be used as a reliable tool in different fields of medical sciences.

Sleep Disorders
 Journal metrics
See full report
Acceptance rate7%
Submission to final decision131 days
Acceptance to publication34 days
CiteScore-
Journal Citation Indicator-
Impact Factor-
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