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Open research questions in Sleep and related disorders

316 unresolved questions extracted from the limitations and future-work sections of 3,674 Sleep and related disorders papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • For nighttime sleep duration, restricted cubic splines suggested a U-shaped association in ELSA before adjustment, but this weakened after full adjustment, and findings were inconsistent across cohorts.

    Sleep duration, sleep quality, and daytime napping in relation to incident cardiometabolic multimorbidity across three national aging cohorts: a prospective, interpretable machine learning study · 2026 · DOI

  • Evidence remains limited on whether nighttime sleep duration, sleep quality, and daytime napping predict cardiometabolic multimorbidity (CMM), defined as two or more of hypertension, type 2 diabetes mellitus, coronary heart disease, and stroke, across populations.

    Sleep duration, sleep quality, and daytime napping in relation to incident cardiometabolic multimorbidity across three national aging cohorts: a prospective, interpretable machine learning study · 2026 · DOI

  • Universities may consider implementing periodic screening strategies that integrate sleep quality measures (e.g., PSQI) along- side brief indicators of anxiety, stress, and depression, framed as a descriptive and preventive approach rather than a diagnostic path- way [41,43]. These efforts can be complemented by the dissemi- nation of evidence-informed information about sleep regulation and common sleep difficulties, as well as the incorporation of clear referral pathways within university settings [23,44]. In line with current guidelines and research evidence, institu- tions may prioritize non-pharmacological approaches to sleep problems, particularly CBT-I, while avoiding the prescriptive ap- plication of clinical interventions in non-clinical academic con- texts [21,23,44]. In this regard, digital and app-based tools with personalized feedback may serve as scalable options for health promotion and self-management support, with demonstrated ef- fectiveness in improving sleep outcomes and reducing insomnia severity among university students [22]. Johanna Cristina Bocanegra Sandoval, et al 104 / CIM Finally, prevention and intervention strategies should adopt a context-sensitive perspective, taking into account sex differences, patterns of stress and daytime functioning, and fluctuations asso- ciated with academic demands [15,16,45]. Although causal rela- tionships cannot be inferred, integrating sleep-related indicators into broader awareness and referral frameworks for psychologi- cal distress and suicidal ideation may support early identification and prevention efforts in university populations [12,13,45,46].

    Sleep Quality in the Emotional Symptoms and Well-Being of University Students · 2026 · DOI

  • Additional studies are needed to assess the long-term impact on sleep quality and mental health of stressors faced by healthcare professionals during the pandemic and effective means of identifying clinical staff at risk of poor sleep quality during future health emergencies, with the goal of ensuring they can continue providing safe and high-quality care.

    Analysis of factors influencing post-pandemic sleep quality among hospital clinical staff in Haikou, China · 2026 · DOI

  • 14 Although promoting physical activity and reducing sedentary behavior can improve mental health among ado- lescents, further research is necessary to clarify these effects in pre- school-aged children. However, the directionality of this relationship remains uncertain: sedentary behaviors may influence NPD risk, and NPDs may also affect the extent of sedentary behavior.

    Associations between sedentary behavior, mental well-being, and sleep dysregulation: cross-sectional evidence from student populations · 2026 · DOI

  • Psychological inflexibility (PI) and experiential avoidance (EA), operationalized through the Acceptance and Action Questionnaire-II (AAQ-II), have been associated with poorer sleep among adults; however, evidence in adolescents remains scarce.

    Exploring the Association Between Psychological Inflexibility, Experiential Avoidance and Sleep-Related Problems Among Adolescents: The EHDLA Study · 2026 · DOI

  • Further research is needed to elucidate mechanisms contributing to subjective-objective sleep discrepancies—potentially including specific aspects of cognitive impairment, striatal hyperactivity, or sleep pressure homeostasis—which may inform novel targets for post-TBI insomnia treatments among those with more severe injuries.

    Changes in Subjective-Objective Sleep Discrepancies Among Participants With Post-acute Moderate-to-Severe Traumatic Brain Injury Following Computerized Cognitive Behavioral Therapy for Insomnia · 2026 · DOI

  • Despite moderate agreement after adaptation, performance, especially for REM and N1 remains insufficient for fully automated diagnostic use in clinical populations.

    Automatic sleep staging in patients with suspected sleep disorders: a comparison of existing methods on portable setups · 2026 · DOI

  • Universities should integrate structured sleep health components into existing staff wellness programmes as a preventive occupational health strategy. A practical first step should include a multi-component approach delivered through staff development units or occupational health services. This should combine sleep hygiene education to address lifestyle factors such as caffeine use, screen exposure, and sleep scheduling; stimulus control guidance to re-establish consistent sleep–bedroom associations; brief relaxation training to reduce cognitive and somatic arousal before bedtime; and basic nutrition and physical activity counselling suited for the demands of academic work. Delivery can use low-cost formats such as group workshops, and brief one-on-one consultations to ensure scalability across resource-constrained settings. Implementation should include monitoring of uptake, adherence, and short- and long-term sleep outcomes. Evaluating these outcomes will provide empirical grounding for refining the model and informing scale-up across Nigerian universities and similar academic contexts.

    Non-pharmacological correlates of insomnia among university lecturers in Nigeria · 2026 · DOI

  • Geographically, despite using expansive Boolean strings covering the Asian continent, our final literature pool was heavily polarized toward East Asian contexts—yielding only a single representation from Southeast Asia and none from West Asia, and completely lacking data from Central, North, and South Asia.

    A scoping review on non-pharmacological sleep interventions among Asian undergraduate students · 2026 · DOI

  • Future research should explore the intersection of sleep duration, caloric availability, and environmental stressors to This paper proposes reframing sleep as an understand better how humans modulate energy energetically significant component of human life investments across the life course.

    The Sleep Gamble: Energetic Trade-offs and the Consequences of Sleep Deprivation · 2026 · DOI

  • Swanson et al., 2018). These studies have tended to focus heavily on the biological mechanisms of sleep Regarding the trade-off between sleep and and associated sleep-related disorders. reproduction, females remain understudied. While the hormone imbalance is evident in females who are sleep deprived, thus affecting their overall reproduction and fertility, little is known about the underlying mechanisms. The challenge with studying sleep deprivation in a clinical setting is the need to focus on the solution rather than the problem. Take, for example, Tamura et al.'s (2008) paper on the effects of melatonin on oocyte Anthropological studies, however, have suggested that sleep behaviours and attitudes differ cross- culturally and are influenced by environmental factors, sleeping arrangements, and sleep segmentation. An argument can be made that sleep is very much a social behaviour, one that cannot be confined to universal prescriptions (Cheung et al., 2021). Ethnographic research has highlighted the diversity in sleeping practices worldwide, protection. The study demonstrated a clear particularly between industrialized and non- 62 Vol. 26, Issue 1 2026 industrialized nations. Furthermore, Cheung et al. deprivation results in measurable biological costs, (2021) reported that, while Japanese university reduced fertility, weakened immunity, and impaired students have shorter sleep durations than Canadian tissue repair that parallel the consequences of caloric university students, Japanese students tend to underinvestment. allocate more time during the day to segmented Therefore, sleep should be considered not sleep (i.e., napping) and have reported being less merely a restorative necessity but also an active tired and having better overall health scores than biological investment with life history implications. their Canadian counterparts. Variable sleeping Recognizing sleep as a strategic allocation of energy patterns, which are culturally determined, should be and time expands current life history frameworks considered with the energetic trade-offs of sleep and enables a more holistic understanding of human deprivation.

    The Sleep Gamble: Energetic Trade-offs and the Consequences of Sleep Deprivation · 2026 · DOI

  • Future research should focus on the responsiveness of the JSS–TR to therapeutic interventions, including cognitive behavioral therapy for insomnia and pharmacologic treatments, to further establish its utility in both clinical and research settings.

    Assessing Sleep in Late Life: Validation of the Turkish Jenkins Sleep Scale and Identification of Older Population-Specific Cut-Off · 2026 · DOI

  • Future research should examine the relationship between the NPS-6 and prospective diary measures of nightmares to clarify predictive validity in real-time assessments. While further replication is warranted, the present findings support its use in research contexts requiring efficient assessment of individual differences in susceptibility to nightmares.

    Validity, Reliability, and Incremental Prediction of Nightmares Using a Shortened Form of the Nightmare Proneness Scale (NPS-6) · 2026 · DOI

  • We also examine the limited literature on integrating sleep-focused strategies into established evidence-based behavioral treatments for ADHD, highlighting opportunities and challenges for embedding sleep within existing care models.

    Behavioral Sleep Treatment in ADHD Across Child and Adolescent Development: Recent Findings, Integration with Existing Interventions, and Emerging Directions · 2026 · DOI

  • The Empatica E4 wristband provides continuous multi-modal physiological monitoring including blood volume pulse (BVP), electrodermal activity (EDA) and skin temperature (TEMP) but its validity for sleep-stage-specific autonomic and thermoregulatory monitoring has not been systematically evaluated against concurrent polysomnography (PSG).

    Validity and Limitations of the Empatica E4 Wristband for Autonomic and Thermoregulatory Sleep Monitoring Against Concurrent Polysomnography: A Wearanize+ Dataset Study · 2026 · DOI

  • From a 24-hour movement behaviour perspective, sleep, sedentary behaviour and physical activity are interdependent components of a fixed time budget, yet little is known about how distinct combinations of these behaviours cluster among Chinese university students and how such patterns relate to negative affect.

    Distinct 24-hour movement behaviour profiles and their associations with negative affect among Chinese university students · 2026 · DOI

  • We present research supporting our hypothesis, particularly focusing on studies from our lab that began to systematically test key aspects of the MCR‐Hypothesis and discuss limitations, alternative explanations, and open questions.

    How Mental Concepts Shape Sleep: Introducing the Mental Concept Reactivation Hypothesis of Sleep · 2026 · DOI

  • Objectives: Self-applied, low-density EEG offers opportunities to examine sleep in the home environment, yet its feasibility during behavioural sleep interventions remains unexplored.

    Insights from nine nights of self-applied, low-density sleep EEG during sleep restriction therapy: a proof-of-concept evaluation · 2026 · DOI

  • However, it remains unclear how habitual 24-hour movement behavior composition, encompassing sleep, sedentary behavior (SB), and light and moderate-to-vigorous physical activity (LPA and MVPA) levels, may shape this baseline neurocognitive state, thereby influencing responsiveness to an acute exercise stimulus.

    Compositional Structure of 24-Hour Movement Behaviors Moderates Neurocognitive Responses to Acute Aerobic Exercise in Healthy Adults: A Multimodal Investigation · 2026 · DOI

  • Sleep disturbances were reported in some BN samples with and without comorbid mood disorders, although the specific contribution of mood pathology remains unclear.

    Sleep Health in Bulimia Nervosa: A Systematic Review · 2026 · DOI

  • Although this study took great care to purposively sample adolescents from a variety of ages, genders, ethnicities, and levels of socioeconomic deprivation, our findings will not be reflective of all UK adolescents’ experiences. Although we purposively sampled interviewees who had not engaged with the app, people who had more positive experiences and views of the app will have been more likely to agree to be interviewed. For this reason, while the encouraging views expressed by many of our interviewees provide an indication of the benefits it can provide, particularly for adolescents from underserved and low SES populations, these findings cannot be used to generalize or estimate the likely benefits at a population level. In addition, the reported benefits of the app are subjective; the duration of participants’ sleep was not objectively measured during this study, instead relying on self-reported changes in sleep behavior over time. Future work could mitigate the effects of these limitations. For example, a large randomized controlled trial would miti- gate the effects of self-selection bias by randomly select- ing participants to take part in the intervention, potentially engaging with users who had fewer positive experiences or who did not engage with the Sleep Solved app. Future mixed methods results, exploring both quantitative and qualitative data, would enable any patterns to be investigated in greater depth.

    Inclusivity in Insomnia: Adolescents' Perspectives on the Sleep Solved App: Qualitative Interview Study. · 2026 · DOI

  • Many participants expressed a desire to continue using Sleep Solved in the future, even beyond the end of this research study. User enthusiasm for the Sleep Solved app, and participants reporting positive promotion of Sleep Solved to friends and family members, was an unexpected but encouraging finding. Future iterations of Sleep Solved could potentially be tailored to different age ranges, such as versions for children, young adults, or older adults. JMIR Form Res 2026 | vol. 10 | e82410 | p.

    Inclusivity in Insomnia: Adolescents' Perspectives on the Sleep Solved App: Qualitative Interview Study. · 2026 · DOI

  • Several limitations of the present study warrant acknowledgment. First, the cross-sectional design precludes causal inference regarding the temporal sequence or directionality of the observed associations. Longitudinal investigations are necessary to elucidate the dynamic interrelationships among insomnia, frailty, anxiety symptoms, and cognitive decline over time. Second, the sample was recruited exclusively from a single tertiary hospital, which may limit the generalizability of the findings to community-dwelling or more heterogeneous populations. Third, all assessments relied on subjective self-report and rater-administered instruments. The incorporation of objective measures—such as actigraphy, polysomnography, or neuroimaging biomarkers—would substantially strengthen the validity and reproducibility of future studies. Fourth, this study did not differentiate among clinically distinct insomnia subtypes, including sleep-onset insomnia, sleep-maintenance insomnia, and early-morning awakening. Given the pathophysiological heterogeneity of insomnia, different phenotypes may exhibit divergent associations with affective symptoms and cognitive outcomes. Consequently, it remains uncertain whether the moderated mediation model identified herein applies uniformly across specific insomnia presentations. Future studies with larger, phenotypically well-characterized samples are needed to address this question. Fifth, the present investigation examined dimensional symptom severity on the HAMA, and MoCA-B rather than formally diagnosed clinical syndromes. Accordingly, the findings pertain to the burden of anxiety symptoms, depressive symptoms, and cognitive symptoms in the context of insomnia and frailty, rather than to established psychiatric or neurocognitive disorders. Moreover, cognitive performance was assessed globally using a brief screening tool, which precludes inferences regarding domain-specific impairments (e.g., in memory, executive function, or attentional control). Future studies should employ comprehensive neuropsychological batteries to determine whether the observed effects are specific to certain cognitive domains. Sixth, the HAMA includes items that assess insomnia symptoms (e.g., difficulty falling asleep, restless sleep), which may partially overlap with the PSQI measure of insomnia severity. This potential item overlap could inflate the observed association between insomnia and anxiety and should be considered when interpreting the insomnia–anxiety relationship.

    The interrelationships among insomnia, frailty, anxiety, and cognitive function in middle-aged and older adults: a cross-sectional study · 2026 · DOI

  • While the statistical methodology is robust, several distinct limitations must be acknowledged to contextualize the findings accurately. First, the necessary exclusion of the "high insomnia" category due to an insufficient sample size (n=1) restricts the generalizability of our conclusions, preventing us from predicting academic outcomes for students experiencing severe, chronic clinical insomnia. Second, the significant result from Levene’s test indicates the presence of heteroscedasticity, meaning that the variance in academic scores is not uniform across all subgroup combinations. Although we applied secondary heteroscedasticity tests to validate the primary findings, the reliance on linear models may still fail to capture the full complexity of data dynamics. Third, the study relies entirely on self-reported psychometric scales to categorize insomnia levels, which may introduce subjective reporting biases that objective physiological measurements would otherwise eliminate.

    Evaluating the Impact of Insomnia and Gender on Undergraduate Academic Performance: A Statistical Analysis · 2026 · DOI

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316 open questions have been extracted from the limitations and future-work passages of 3,674 Sleep and related disorders papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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