Faculty Profiles - MIYATA Seiko

Papers - MIYATA Seiko

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Gaze behaviors during free viewing revealed differences in visual salience processing across four major psychiatric disorders: a mega-analysis study of 1012 individuals. Open Access

Miura K, Yoshida M, Morita K, Fujimoto M, Yasuda Y, Yamamori H, Takahashi J, Miyata S, Okazaki K, Matsumoto J, Toyomaki A, Makinodan M, Hashimoto N, Onitsuka T, Kasai K, Ozaki N, Hashimoto R

Molecular psychiatry Vol. 30 ( 4 ) page： 1594 - 1600 2025.4

Language：English Publishing type：Research paper (scientific journal) Publisher：Molecular Psychiatry

Aberrant salience processing has been proposed as a pathophysiological mechanism underlying psychiatric symptoms in patients with schizophrenia. The gaze trajectories of individuals with schizophrenia have been reported to be abnormal when viewing an image, suggesting anomalous visual salience as one possible pathophysiological mechanism associated with psychiatric diseases. This study was designed to determine whether visual salience is affected in individuals with schizophrenia, and whether this abnormality is unique to patients with schizophrenia. We examined the gaze behaviors of 1012 participants recruited from seven institutes (550 healthy individuals and 238, 41, 50 and 133 individuals with schizophrenia, bipolar disorder, major depressive disorder and autism spectrum disorder, respectively) when they looked at stationary images as they liked, i.e., free-viewing condition. We used an established computational model of salience maps derived from low-level visual features to measure the degree to which the gaze trajectories of individuals were guided by visual salience. The analysis revealed that the saliency at the gaze of individuals with schizophrenia were higher than healthy individuals, suggesting that patients’ gazes were guided more by low-level image salience. Among the low-level image features, orientation salience was most affected. Furthermore, a general linear model analysis of the data for the four psychiatric disorders revealed a significant effect of disease. This abnormal salience processing depended on the disease and was strongest in patients with schizophrenia, followed by patients with bipolar disorder, major depressive disorder, and autism spectrum disorder, suggesting a link between abnormalities in salience processing and strength/frequency for psychosis of these disorders.

DOI： 10.1038/s41380-024-02773-5

Association of sleep-wake state discrepancy and depressive symptoms with restorative sleep in patients with depression. Open Access

Kawai K, Iwamoto K, Miyata S, Okada I, Ando M, Fujishiro H, Noda A, Ozaki N, Ikeda M

Sleep medicine Vol. 127 page： 166 - 169 2025.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Sleep Medicine

Objective: One of the common symptoms of mood disorders is insomnia, and the recovery processes can be negatively impacted by a lack of restorative sleep. Although factors related to restorative sleep in healthy subjects have been investigated, evaluations of these factors in patients with depression have been rarely done. Patients with depression are known to have sleep-wake state discrepancy, which can further influence their restorative sleep beyond that associated with depressive symptoms. Thus, we investigated restorative sleep in depressed patients in our current study, and attempted to identify associated factors, with a particular focus on sleep-wake state discrepancy. Methods: In the 91 participants evaluated in this cross-sectional study, all subjects filled out questionnaires on their symptoms prior to undergoing polysomnography (PSG). Sleep duration and restorative sleep were evaluated on the morning after the PSG. The association between restorative sleep and various factors was then examined using multiple regression analysis. Results: A negative association with restorative sleep was found through multiple regression analysis for depressive symptoms (β = −0.055, p = 0.007), daytime sleepiness (β = −0.106, p = 0.020), and overestimation of wake after sleep onset (β = −0.006, p = 0.030). Conclusions: By subjectively and objectively assessing sleep, addressing depressive symptoms, and implementing appropriate sleep hygiene, clinicians could be able to improve restorative sleep in depressed patients.

DOI： 10.1016/j.sleep.2025.01.021

MR Imaging Indices for Brain Interstitial Fluid Dynamics and the Effects of Orexin Antagonists on Sleep

Taoka Toshiaki, Iwamoto Kunihiro, Miyata Seiko, Ito Rintaro, Nakamichi Rei, Nakane Toshiki, Okada Ippei, Ichikawa Kazushige, Kan Hirohito, Kamagata Koji, Kikuta Junko, Aoki Shigeki, Fujimoto Akihiro, Kogo Yuki, Ichinose Nobuyasu, Naganawa Shinji, Ozaki Norio

Magnetic Resonance in Medical Sciences Vol. advpub ( 0 ) 2025.2

Language：English Publishing type：Research paper (scientific journal) Publisher：Japanese Society for Magnetic Resonance in Medicine

<p>Purpose: The purpose of this study was to assess the extent to which improvement in sleep with lemborexant contributed to changes in interstitial fluid dynamics.</p><p>Methods: The 3 methods including diffusion tensor image analysis along the perivascular space (DTI-ALPS), dynamic contrast-enhanced method to assess tissue vascular permeability (Ktrans), and choroid plexus volume (CPV) were used. Correlations between these imaging indices and sleep parameters (latency to persistent sleep [LPS], wake after sleep onset [WASO], total sleep time [TST], and sleep efficiency [SE]) were evaluated using Pearson correlation analysis. Additionally, multiple regression analysis and linear mixed model analysis were employed to assess the relationship between baseline sleep status and imaging parameter changes. MRI and sleep assessments were performed before treatment initiation (week 0, w0) and at 12 weeks after lemborexant administration (week 12, w12).</p><p>Results: The ALPS-index was inversely correlated with LPS and positively correlated with TST and SE at w0. In multiple regression analysis, ALPS-index was lower when sleep parameters other than LPS were poor at w0. A linear mixed model analysis suggested that poor sleep status in LPS and SE at w0 may have an effect on greater ALPS-index. In the evaluation of Ktrans measurement, the single regression analysis showed a statistically significant correlation between the reduction in Ktrans and the shortening in LPS. Examination of CPV and sleep parameters showed a significant negative correlation between TST and CPV at w0 and w12. Multiple regression analysis also showed that TST of w12 had a significant effect on CPV at w12.</p><p>Conclusion: Our results suggested that poor sleep status is related to the greater change of ALPS-index and CPV improvement after lemborexant administration may be related to in part to sleep parameter improvement.</p>

DOI： 10.2463/mrms.mp.2024-0176

Sleep Deprivation Elevates Resting and Exercise Blood Pressures and Augments Pressor Response at Exercise Onset.

Hori A, Su X, Sagasaki S, Saito R, Suijo K, Miyata S, Hasegawa D, Mizuno M, Hotta N

Medicine and science in sports and exercise 2024.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Medicine and Science in Sports and Exercise

Purpose: Sleep deprivation and elevated blood pressure (BP) increase the risk of cardiovascular diseases. However, the effects of sleep deprivation on BP response, especially at exercise onset remain unclear. We aimed to elucidate the effects of experimental sleep deprivation (ESD) on resting and exercise BPs, including that at exercise onset, and investigate whether a night-time nap during ESD changes the ESD-altered BP. Methods: Twelve healthy young men underwent 2-min submaximal isometric elbow flexion (IEF) exercise to measure BP after 7 days of normal sleep (control trial), 24-h ESD (ESD trial), and ESD with a 2-h night-time nap (ESD+NAP trial), which were randomly performed. Results: ESD significantly elevated the mean arterial pressure (MAP) at rest (85.8 ± 8.0 to 93.3 ± 5.1 mmHg, P = 0.003) and at the last minute of IEF (116.9 ± 13.0 to 126.2 ± 11.8 mmHg, P = 0.003) compared with that observed in the control trial. At IEF onset (the initial 15 s), ESD significantly elevated the MAP (88.7 ± 12.6 to 103.1 ± 8.8 mmHg, P < 0.001) and augmented the MAP responsiveness from baseline, compared with that observed in the control trial (Δ2.9 ± 11.4 to Δ9.8 ± 6.6 mmHg, P = 0.017). The MAP responsiveness in the ESD+NAP trial (Δ7.3 ± 5.2 mmHg) was not significantly different from that in the control trial (P = 0.165) and the ESD trial (P = 0.129). Conclusions: ESD significantly elevated both resting BP and the BP during submaximal isometric exercise and significantly augmented the initial pressor response to the exercise. A 2-h night-time nap during ESD appears to be insufficient to completely attenuate ESD-induced augmented pressor responses.

DOI： 10.1249/MSS.0000000000003640

Phenotypes for general behavior, activity, and body temperature in 3q29 deletion model mice. Open Access

Mori D, Ikeda R, Sawahata M, Yamaguchi S, Kodama A, Hirao T, Arioka Y, Okumura H, Inami C, Suzuki T, Hayashi Y, Kato H, Nawa Y, Miyata S, Kimura H, Kushima I, Aleksic B, Mizoguchi H, Nagai T, Nakazawa T, Hashimoto R, Kaibuchi K, Kume K, Yamada K, Ozaki N

Translational psychiatry Vol. 14 ( 1 ) page： 138 2024.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Translational Psychiatry

Whole genome analysis has identified rare copy number variations (CNV) that are strongly involved in the pathogenesis of psychiatric disorders, and 3q29 deletion has been found to have the largest effect size. The 3q29 deletion mice model (3q29-del mice) has been established as a good pathological model for schizophrenia based on phenotypic analysis; however, circadian rhythm and sleep, which are also closely related to neuropsychiatric disorders, have not been investigated. In this study, our aims were to reevaluate the pathogenesis of 3q29-del by recreating model mice and analyzing their behavior and to identify novel new insights into the temporal activity and temperature fluctuations of the mouse model using a recently developed small implantable accelerometer chip, Nano-tag. We generated 3q29-del mice using genome editing technology and reevaluated common behavioral phenotypes. We next implanted Nano-tag in the abdominal cavity of mice for continuous measurements of long-time activity and body temperature. Our model mice exhibited weight loss similar to that of other mice reported previously. A general behavioral battery test in the model mice revealed phenotypes similar to those observed in mouse models of schizophrenia, including increased rearing frequency. Intraperitoneal implantation of Nano-tag, a miniature acceleration sensor, resulted in hypersensitive and rapid increases in the activity and body temperature of 3q29-del mice upon switching to lights-off condition. Similar to the 3q29-del mice reported previously, these mice are a promising model animals for schizophrenia. Successive quantitative analysis may provide results that could help in treating sleep disorders closely associated with neuropsychiatric disorders.

DOI： 10.1038/s41398-023-02679-w

Assessment of cognitive function and sleep-wake rhythms in community-dwelling older adults. Open Access

Okuda M, Noda A, Iwamoto K, Hishikawa N, Miyata S, Yasuma F, Taoka T, Ozaki N, Suhr JA, Miyazaki S

Sleep and biological rhythms Vol. 22 ( 1 ) page： 137 - 145 2024.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Sleep and Biological Rhythms

Disruption of the circadian rhythm and sleep–wake cycles is a consequence of aging and is associated with the cognitive decline and many neurodegenerative conditions. We investigated the bedtime, wake-up time, sleep timing (midpoint between bedtime and wake-up time), and sleep timing standard deviation (SD) using the actigraphy among 80 consecutive volunteers aged ≥ 60 years. Global cognitive function and executive function of detailed cognitive domains were evaluated using the mini-mental state examination (MMSE) and Wisconsin card sorting test (WCST) and subjective daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). The category achievement (CA), total errors (TE), perseverative errors of Nelson (PEN), non-perseverative errors (NPE), and difficulties in maintaining set (DMS) on the WCST were significantly correlated with sleep timing SD (CA: r = − 0.276, p = 0.013, TE: r = 0.311, p = 0.005, PEN: r = 0.241, p = 0.032, NPE: r = 0.250, p = 0.025, DMS: r = 0.235, p = 0.036), but not with the MMSE score. Multiple regression analyses with the stepwise forward selection method including age, ESS score, bedtime, sleep timing, and sleep timing SD, revealed that the ESS score, and sleep timing SD were significant factors related to CA on the WCST (ESS score: β = − 0.322, p = 0.004; sleep timing SD: β = − 0.250, p = 0.022). Assessment of sleep–wake rhythms, daytime sleepiness, and cognitive function using the MMSE and WCST is valuable for the prediction of cognitive decline in the geriatric population.

DOI： 10.1007/s41105-023-00491-z

Assessing the Real-World, Long-Term Impact of Lemborexant on Sleep Quality in a Home-Based Clinical Study. Open Access

Miyata S, Iwamoto K, Okada I, Fujimoto A, Kogo Y, Mori D, Amano M, Matsuyama N, Nishida K, Ando M, Taoka T, Naganawa S, Ozaki N

Nature and science of sleep Vol. 16 page： 291 - 303 2024

Language：English Publishing type：Research paper (scientific journal) Publisher：Nature and Science of Sleep

Purpose: Both subjective and objective evaluations are essential for the treatment of insomnia. Lemborexant has been shown to be effective in the long-term based solely on a subjective basis, and no long-term objective measures have been evaluated under natural sleep conditions. Small, lightweight sleep electroencephalogram (EEG) monitor was used, instead of polysomnography, to objectively evaluate sleep at home 4 and 12 weeks after lemborexant treatment. Patients and Methods: Adults and elderly subjects with insomnia disorder, per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were enrolled in this open-label, single-arm, single-center trial. Objective and subjective measures of sleep were prospectively assessed. Sleep disturbance, excessive sleepiness, and depressive symptoms were assessed using questionnaires. Results: A total of 45 subjects were screened, of which 33 were enrolled. Paired t-tests were conducted to evaluate changes in sleep variables and compared with the baseline; subjects showed significant improvements in objective sleep efficiency (SE) and subjective sleep parameters at weeks 4 and 12 following treatment with lemborexant. When baseline values were taken into account, a repeated-multivariate analysis of variance (MANOVA) revealed statistically significant changes in the objective measures. Sleep disturbance, excessive sleepiness, and depressive symptoms improved after three months of lemborexant treatment. Conclusion: Furthermore, lemborexant therapy improved nocturnal sleep, when measured objectively using sleep EEG monitoring at home, and improved daytime sleepiness and depressive symptoms in older adults with insomnia disorder.

DOI： 10.2147/NSS.S448871

LPS and its relationship with subjective-objective discrepancies of sleep onset latency in patients with psychiatric disorders.

Kawai K, Iwamoto K, Miyata S, Okada I, Ando M, Fujishiro H, Ando M, Noda A, Ozaki N

Scientific reports Vol. 13 ( 1 ) page： 22637 2023.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Scientific Reports

Subjective–objective discrepancies in sleep onset latency (SOL), which is often observed among psychiatric patients, is attributed partly to the definition of sleep onset. Recently, instead of SOL, latency to persistent sleep (LPS), which is defined as the duration from turning out the light to the first consecutive minutes of non-wakefulness, has been utilized in pharmacological studies. This study aimed to determine the non-awake time in LPS that is most consistent with subjective sleep onset among patients with psychiatric disorders. We calculated the length of non-awake time in 30-s segments from lights-out to 0.5–60 min. The root mean square error was then calculated to determine the most appropriate length. The analysis of 149 patients with psychiatric disorders showed that the optimal non-awake time in LPS was 12 min. On the other hands, when comorbid with moderate or severe obstructive sleep apnea (OSA), the optimal length was 19.5 min. This study indicates that 12 min should be the best fit for the LPS non-awake time in patients with psychiatric disorders. When there is comorbidity with OSA, however, a longer duration should be considered. Measuring LPS minimizes discrepancies in SOL and provides important clinical information.

DOI： 10.1038/s41598-023-49261-4

Comparison of Polysomnography, Single-Channel Electroencephalogram, Fitbit, and Sleep Logs in Patients With Psychiatric Disorders: Cross-Sectional Study. Open Access

Kawai K, Iwamoto K, Miyata S, Okada I, Fujishiro H, Noda A, Nakagome K, Ozaki N, Ikeda M

Journal of medical Internet research Vol. 25 ( 1 ) page： e51336 2023.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Medical Internet Research

Background: Sleep disturbances are core symptoms of psychiatric disorders. Although various sleep measures have been developed to assess sleep patterns and quality of sleep, the concordance of these measures in patients with psychiatric disorders remains relatively elusive. Objective: This study aims to examine the degree of agreement among 3 sleep recording methods and the consistency between subjective and objective sleep measures, with a specific focus on recently developed devices in a population of individuals with psychiatric disorders. Methods: We analyzed 62 participants for this cross-sectional study, all having data for polysomnography (PSG), Zmachine, Fitbit, and sleep logs. Participants completed questionnaires on their symptoms and estimated sleep duration the morning after the overnight sleep assessment. The interclass correlation coefficients (ICCs) were calculated to evaluate the consistency between sleep parameters obtained from each instrument. Additionally, Bland-Altman plots were used to visually show differences and limits of agreement for sleep parameters measured by PSG, Zmachine, Fitbit, and sleep logs. Results: The findings indicated a moderate agreement between PSG and Zmachine data for total sleep time (ICC=0.46; P<.001), wake after sleep onset (ICC=0.39; P=.002), and sleep efficiency (ICC=0.40; P=.006). In contrast, Fitbit demonstrated notable disagreement with PSG (total sleep time: ICC=0.08; wake after sleep onset: ICC=0.18; sleep efficiency: ICC=0.10) and exhibited particularly large discrepancies from the sleep logs (total sleep time: ICC=–0.01; wake after sleep onset: ICC=0.05; sleep efficiency: ICC=–0.02). Furthermore, subjective and objective concordance among PSG, Zmachine, and sleep logs appeared to be influenced by the severity of the depressive symptoms and obstructive sleep apnea, while these associations were not observed between the Fitbit and other sleep instruments. Conclusions: Our study results suggest that Fitbit accuracy is reduced in the presence of comorbid clinical symptoms. Although user-friendly, Fitbit has limitations that should be considered when assessing sleep in patients with psychiatric disorders.

DOI： 10.2196/51336

Assessment of cognitive function and sleep-wake rhythms in community-dwelling older adults

Okuda Masato, Noda Akiko, Iwamoto Kunihiro, Hishikawa Nozomi, Miyata Seiko, Yasuma Fumihiko, Taoka Toshiaki, Ozaki Norio, Suhr Julie A., Miyazaki Soichiro

SLEEP AND BIOLOGICAL RHYTHMS 2023.9

Late-onset depressive disorder and psychiatric-onset of prodromal dementia with Lewy bodies

Fujishiro Hiroshige, Torii Youta, Miyata Seiko, Iwamoto Kunihiro

Suicide Prevention and Crisis Intervention Vol. 43 ( 2 ) page： 81 - 89 2023.9

Evaluating sleep-wake rhythm using a wearable device in patients with mental disorders.

Miyata S, Iwamoto K, Ozaki N

Psychiatry and clinical neurosciences Vol. 77 ( 8 ) page： 419 - 419 2023.8

LONG-TERM EFFICACY OF LEMBOREXANT ON OBJECTIVE SLEEP MEASURES IN CLINICAL PRACTICE

Miyata Seiko, Iwamoto Kunihiro, Okada Ippei, Fujimoto Akihiro, Kogo Yuki, Amano Manabu, Matsuyama Nao, Ozaki Norio

SLEEP Vol. 46 2023.5

Temporal trajectories of proposed biomarkers in psychiatric-onset prodromal dementia with Lewy bodies: a case report.

Fujishiro H, Arafuka S, Ogasawara K, Iwamoto K, Miyata S, Torii Y, Iritani S, Ozaki N

Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society Vol. 23 ( 1 ) page： 196 - 200 2023.1

Feasibility of a wrist-worn wearable device for estimating mental health status in patients with mental illness. Open Access

Nakagome K, Makinodan M, Uratani M, Kato M, Ozaki N, Miyata S, Iwamoto K, Hashimoto N, Toyomaki A, Mishima K, Ogasawara M, Takeshima M, Minato K, Fukami T, Oba M, Takeda K, Oi H

Frontiers in psychiatry Vol. 14 page： 1189765 2023

Language：English Publishing type：Research paper (scientific journal) Publisher：Frontiers in Psychiatry

Object: Real-world data from wearable devices has the potential to understand mental health status in everyday life. We aimed to investigate the feasibility of estimating mental health status using a wrist-worn wearable device (Fitbit Sense) that measures movement using a 3D accelerometer and optical pulse photoplethysmography (PPG). Methods: Participants were 110 patients with mental illnesses from different diagnostic groups. The study was undertaken between 1 October 2020 and 31 March 2021. Participants wore a Fitbit Sense on their wrist and also completed the State–Trait Anxiety Inventory (STAI), Positive and Negative Affect Schedule (PANAS), and EuroQol 5 dimensions 5-level (EQ-5D-5L) during the study period. To determine heart rate (HR) variability (HRV), we calculated the sdnn (standard deviation of the normal-to-normal interval), coefficient of variation of R-R intervals, and mean HR separately for each sleep stage and the daytime. The association between mental health status and HR and HRV was analyzed. Results: The following significant correlations were found in the wake after sleep onset stage within 3 days of mental health status assessment: sdnn, HR and STAI scores, HR and PANAS scores, HR and EQ-5D-5L scores. The association between mental health status and HR and HRV was stronger the closer the temporal distance between mental health status assessment and HR measurement. Conclusion: A wrist-worn wearable device that measures PPG signals was feasible for use with patients with mental illness. Resting state HR and HRV could be used as an objective assessment of mental health status within a few days of measurement.

DOI： 10.3389/fpsyt.2023.1189765

Prevalence of obstructive sleep apnea as assessed by polysomnography in psychiatric patients with sleep-related problems.

Okada I, Miyata S, Iwamoto K, Fujishiro H, Noda A, Ozaki N

Sleep & breathing = Schlaf & Atmung Vol. 26 ( 4 ) page： 1983 - 1991 2022.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Sleep and Breathing

Purpose: Patients with psychiatric disorders often complain of sleep disturbances and are frequently suspected of obstructive sleep apnea (OSA). However, data regarding sleep problems evaluated by attended polysomnography (PSG) remain limited in this population. We analyzed the results of attended PSG from psychiatric patients with sleep-related problems to determine the prevalence and features of sleep disorders among this population. Methods: We retrospectively investigated the attended PSG results of patients with psychiatric disorders: major depressive disorder, bipolar disorder, neurodevelopmental disorder, schizophrenia, neurocognitive disorder, anxiety disorder, somatic symptom disorder. Results: Of 264 patients, 158 men (60%), mean age was 47 ± 19.9 years. More than half of the patients with major depressive disorder (62%), bipolar disorder (70%), schizophrenia (58%), neurocognitive disorders (55%), and somatic symptom disorder (56%) had OSA. Among the psychiatric patients with OSA, 62% of these patients had moderate to severe OSA. The risk factors for OSA were snoring, male, age, and body mass index. The presence of OSA was not associated with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale score, or benzodiazepine, antipsychotic, or antidepressant use. Other sleep disorders were insomnia (19%), central disorders of hypersomnia (8%), restless legs syndrome/periodic limb movement of sleep (8%), rapid eye movement sleep behavior disorder (7%), and central sleep apnea syndrome (3%). Conclusions: PSG revealed that moderate to severe OSA was common in psychiatric patients with or without snoring. Subjective symptoms and psychotropics did not predict OSA. Therefore, PSG is needed to reveal sleep conditions in patients with psychiatric disorders.

DOI： 10.1007/s11325-022-02566-6

Polysomnographic characteristics and predictors of positional obstructive sleep apnea in Japanese elderly. Open Access

Miyata S, Otake H, Fujishiro H, Iwamoto K, Noda A, Sone M, Ozaki N

Sleep and biological rhythms Vol. 20 ( 3 ) page： 403 - 411 2022.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Sleep and Biological Rhythms

Sleep problems and obstructive sleep apnea (OSA) increase with age and disturb life in old age. Positional therapy is one option to treat OSA, but the differences in clinical pathophysiology between elderly and other age groups have not been fully investigated. We explored the pathophysiological features of sleep apnea, factors that are independently associated with positional OSA and the prevalence in elderly patients. We studied demographic and polysomnographic data of 85 elderly individuals with OSA (age ≥ 65 years) and 124 non-elderly patients with OSA (age, 20–64 years). The Amsterdam Positional OSA Classification (APOC) was used to evaluate positional OSA. Body mass index (BMI) and Epworth sleepiness scale were both significantly lower in the elderly group than in the non-elderly group, although apnea/hypopnea index (AHI) did not differ between groups. OSA severity affected total sleep time, sleep efficiency, and waking after sleep onset more in the elderly than in the non-elderly. AHI in the lateral position was significantly lower in elderly than in non-elderly, although AHI in the supine position was almost the same between two groups. The distribution of APOC 1 and 2 (lateral sleep effective) was significantly higher in the elderly than in the non-elderly. Relative factors such as BMI, rate of hypopnea, and lowest SpO2 associated with positional OSA in non-elderly groups did not differ significantly among APOC subgroups in elderly patients. Our findings are suggesting that characteristics of the positional OSA is different between elderly and younger-age OSA patients.

DOI： 10.1007/s41105-022-00385-6

A Study of Factors Causing Sleep State Misperception in Patients with Depression. Open Access

Kawai K, Iwamoto K, Miyata S, Okada I, Ando M, Fujishiro H, Noda A, Ozaki N

Nature and science of sleep Vol. 14 page： 1273 - 1283 2022

Language：English Publishing type：Research paper (scientific journal) Publisher：Nature and Science of Sleep

Purpose: Sleep state misperception, which is the discrepancy between subjective and objective sleep, is often observed in patients with depression. This phenomenon may delay the remission of depression. Previous studies have focused on the total sleep time (TST) misperception, with many of these studies using actigraphy. Thus, our study investigated depressed patients with the exploratory aim of clarifying factors associated with the sleep state misperception including the wake after sleep onset (WASO) misperception, with their objective sleep additionally evaluated by polysomnography (PSG). Patients and Methods: We conducted a cross-sectional study. Before undergoing overnight PSG monitoring, 40 patients with depression completed questionnaires that included the Beck Depression Inventory (BDI), Epworth sleepiness scale, Temperament and Character Inventory, and the Pittsburgh sleep quality index. Patients were also asked to estimate their subjective sleep duration after they woke up in the morning. Based on this data, we calculated the misperception using the following formula: subjective sleep duration minus objective sleep duration. We compared each factor between negative and positive misperception groups and the multiple regression analysis was performed for TST and WASO misperception, respectively. Results: Although sleep architectures, age, severity of depression and obstructive sleep apnea (OSA) exhibited differences in underestimating or overestimating the WASO, only sex differences were associated with underestimating or overestimating their total sleep time (TST). Moreover, BDI, the severity of OSA, sleep architectures (N1% and N2%), and benzodiazepine (BZD) use were significantly correlated with WASO misperception, whereas only OSA severity was significantly correlated with TST misperception. A subsequent multiple regression analysis demonstrated the BDI was independently correlated with the WASO misperception (β=0.341, p=0.049). Conclusion: In clinical practice, interventions especially for OSA, and the reduction of depressive symptoms are an important method for improving patient sleep perception. Moreover, current results suggest that BZD prescriptions should be avoided as well.

DOI： 10.2147/NSS.S366774

FLUID study: study protocol for an open-label, single-centre pilot study to investigate the efFect of Lemborexant on sleep management in Japanese sUbjects aged 50 years and older with Insomnia Disorder. Open Access

Okada I, Iwamoto K, Miyata S, Fujimoto A, Tanaka M, Amano M, Matsuyama N, Taoka T, Naganawa S, Ozaki N

BMJ open Vol. 11 ( 11 ) page： e054885 2021.11

Language：English Publishing type：Research paper (scientific journal) Publisher：BMJ Open

Introduction Bidirectional associations have been reported between sleep disturbance and both cognitive impairment, including Alzheimer’s disease and amyloid beta-peptide (Aβ) accumulation. These relationships can be explained by the glymphatic system, which acts as a garbage drainage system in the brain. As interstitial fluid dynamics are suggested to increase during sleep, clearance of Aβ can be influenced by sleep disturbance or deprivation. We hypothesised that using lemborexant, an orexin receptor antagonist, to improve sleep quality would also improve the function of the glymphatic system. We plan to examine the effect of lemborexant on sleep quality and the glymphatic system among patients with insomnia disorder. Methods and analysis This pilot study is designed as an open-label, single-arm, single-centre trial. Thirty patients aged 50 years and over with insomnia will be recruited. The participants will take lemborexant (5 mg) at bedtime for 12 weeks and undergo a home-based sleep study at baseline and weeks 4 and 12, as well as MRI examinations to evaluate the glymphatic system at baseline and week 12. The primary outcome will be changes in objective sleep parameters as evaluated using a sleep monitoring system. The secondary outcomes will be changes in subjective sleep parameters. The relationships between changes in sleep parameters and the glymphatic system will be evaluated using diffusion tensor image analysis along the perivascular space, which is called the ALPS-index. Sleep parameters and the ALPS-index will be analysed using a paired t-test or Pearson’s correlation coefficient. Ethics and dissemination The study protocol was approved by Nagoya University Certified Review Board. The findings from this research will be published in peer-reviewed journals and be presented at local, national and international conferences.

DOI： 10.1136/bmjopen-2021-054885

Performance of an ambulatory electroencephalogram sleep monitor in patients with psychiatric disorders.

Miyata S, Iwamoto K, Banno M, Eguchi J, Kaneko S, Noda A, Ozaki N

Journal of sleep research Vol. 30 ( 4 ) page： e13273 2021.8

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Sleep Research

Key clinical symptoms observed among individuals with psychiatric disorders include difficulty falling asleep or maintaining sleep, poor sleep quality and nightmares. Those suffering from sleep disorders often present with symptoms of discontent with regard to sleep quality, timing and quantity, and these symptoms have an adverse impact on function and quality of life. A minimally invasive technique would be preferable in patients with psychiatric disorders, who tend to be sensitive to environmental change. Accordingly, we evaluated the performance of Zmachine Insight Plus, an ambulatory electroencephalography sleep monitor, in patients with psychiatric disorders. One hundred and three patients undergoing polysomnography were enrolled in this study. Zmachine Insight Plus was performed simultaneously with polysomnography. Total sleep time, sleep efficiency, wake after sleep onset, rapid eye movement (REM) sleep, light sleep (stages N1 and N2) and deep sleep (stage N3) were assessed. Total sleep time, sleep efficiency, wake after sleep onset, REM sleep duration and non-REM sleep duration of Zmachine Insight Plus showed a significant correlation with those of polysomnography. Lower sleep efficiency and increased frequency of waking after sleep onset, the arousal index and the apnea–hypopnea index on polysomnography were significantly associated with the difference in sleep parameters between the two methods. Among patients with psychiatric disorders who are sensitive to environmental change, Zmachine Insight Plus would be a useful technique to objectively evaluate sleep quality.

DOI： 10.1111/jsr.13273

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