{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:59:33Z","timestamp":1791647973656,"version":"4.3.4"},"reference-count":114,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science, Technological Development, and Innovation","award":["200110"],"award-info":[{"award-number":["200110"]}]},{"award":["200110"],"award-info":[{"award-number":["200110"]}],"id":[{"id":"https:\/\/ror.org\/01znas443","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clocks &amp; Sleep"],"abstract":"<jats:p>Rising global temperatures and more frequent heat waves pose a growing threat to public health, particularly among older adults. Age-related declines in thermoregulatory capacity such as reduced sweating, impaired vasodilation, and diminished hypothalamic responsiveness make it more difficult to cope with elevated nighttime temperatures. These thermal challenges disrupt sleep by prolonging sleep onset, fragmenting slow-wave and REM sleep, and suppressing melatonin secretion. Importantly, sex-related differences in thermoregulatory aging\u2014particularly menopause-associated vasomotor instability in women and testosterone-related autonomic changes in men\u2014further modulate individual vulnerability to heat-induced sleep disruption. Beyond sleep, heat-induced stress affects metabolic, cardiovascular, and immune systems, promoting insulin resistance, endothelial dysfunction, sympathetic overactivation, and chronic inflammation. Socioeconomic disparities, urban heat island exposure, and differential access to cooling infrastructure function as critical environmental modifiers that amplify biological vulnerability, particularly in disadvantaged older populations. This narrative review aims to synthesize current knowledge on the specific thermoregulatory mechanisms of sleep disruption induced by heat stress in older adults. Understanding these interactions is crucial for developing effective interventions, including environmental cooling, circadian-aligned behaviors, and targeted public health strategies, to mitigate the compounded risks of heat exposure and preserve healthy sleep in aging populations. However, many proposed mechanistic pathways are primarily derived from animal models, and controlled human studies specifically targeting heat-exposed older adults remain scarce.<\/jats:p>","DOI":"10.3390\/clockssleep8030043","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:16:18Z","timestamp":1783527378000},"page":"43","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mechanisms of Heat-Induced Sleep Disruption in Aging: A Narrative Review"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7016-2334","authenticated-orcid":false,"given":"Neriman","family":"Ezgin","sequence":"first","affiliation":[{"name":"Institute of Medical Physiology \u201cRichard Burian\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Biotechnology, Institute of Natural and Applied Sciences, Cukurova University, Adana 01330, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Kr\u010dum","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9499-3247","authenticated-orcid":false,"given":"Nikola","family":"\u0160utulovi\u0107","sequence":"additional","affiliation":[{"name":"Institute of Medical Physiology \u201cRichard Burian\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5017-5912","authenticated-orcid":false,"given":"Maja","family":"Pavlovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Sciences and Mathematics, University of Pri\u0161tina in Kosovska Mitrovica, Lole Ribara 29, 38220 Kosovska Mitrovica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2375-7420","authenticated-orcid":false,"given":"Emilija","family":"Djuri\u0107","sequence":"additional","affiliation":[{"name":"Institute of Medical Physiology \u201cRichard Burian\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8921-6232","authenticated-orcid":false,"given":"Du\u0161an","family":"Mladenovi\u0107","sequence":"additional","affiliation":[{"name":"Institute of Pathophysiology \u201cLjubodrag Buba Mihailovic\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7505-5466","authenticated-orcid":false,"given":"Milena","family":"Veskovi\u0107","sequence":"additional","affiliation":[{"name":"Institute of Pathophysiology \u201cLjubodrag Buba Mihailovic\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0788-8108","authenticated-orcid":false,"given":"Arif E.","family":"Cetin","sequence":"additional","affiliation":[{"name":"Izmir Biomedicine and Genome Center, Balcova, Izmir 35340, Turkey"},{"name":"Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Balcova, Izmir 35340, Turkey"},{"name":"Department of Electrical and Electronics Engineering, Istanbul Atlas University, Kagithane, Istanbul 34408, Turkey"},{"name":"Department of Biophysics, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1131-2328","authenticated-orcid":false,"given":"Aleksandra","family":"Ra\u0161i\u0107-Markovi\u0107","sequence":"additional","affiliation":[{"name":"Institute of Medical Physiology \u201cRichard Burian\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5317-3827","authenticated-orcid":false,"given":"Olivera","family":"Stanojlovi\u0107","sequence":"additional","affiliation":[{"name":"Institute of Medical Physiology \u201cRichard Burian\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0806-444X","authenticated-orcid":false,"given":"Dragan","family":"Hrn\u010di\u0107","sequence":"additional","affiliation":[{"name":"Institute of Medical Physiology \u201cRichard Burian\u201d, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"120862","DOI":"10.1016\/j.jns.2023.120862","article-title":"Heatwaves and human sleep: Stress response versus adaptation","volume":"454","author":"Buguet","year":"2023","journal-title":"J. Neurol. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109942","DOI":"10.1016\/j.envint.2025.109942","article-title":"Impact of heat exposure on sleep health and its population vulnerability in the United States","volume":"206","author":"Liao","year":"2025","journal-title":"Environ. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1038\/s41467-025-57781-y","article-title":"Climate warming may undermine sleep duration and quality in repeated-measure study of 23 million records","volume":"16","author":"Li","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"108348","DOI":"10.1016\/j.envint.2023.108348","article-title":"Heatwave exposure in relation to decreased sleep duration in older adults","volume":"183","author":"Zhou","year":"2024","journal-title":"Environ. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5100","DOI":"10.1038\/s41467-025-60218-1","article-title":"Global warming may increase the burden of obstructive sleep apnea","volume":"16","author":"Lechat","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101915","DOI":"10.1016\/j.smrv.2024.101915","article-title":"A systematic review of ambient heat and sleep in a warming climate","volume":"75","author":"Chevance","year":"2024","journal-title":"Sleep Med. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2333721420932432","DOI":"10.1177\/2333721420932432","article-title":"Impairments to thermoregulation in the elderly during heat exposure events","volume":"6","author":"Millyard","year":"2020","journal-title":"Gerontol. Geriatr. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1152\/japplphysiol.00202.2003","article-title":"Aging and human temperature regulation","volume":"95","author":"Kenney","year":"2003","journal-title":"J. Appl. Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Rothhaas, R., and Chung, S. (2021). Role of the preoptic area in sleep and thermoregulation. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.664781"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.neuron.2017.02.004","article-title":"Sleep and human aging","volume":"94","author":"Mander","year":"2017","journal-title":"Neuron"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s41606-018-0021-3","article-title":"Sleep and aging","volume":"2","author":"Lavoie","year":"2018","journal-title":"Sleep Sci. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5937\/mp75-54248","article-title":"Sleep in the elderly: Healthy sleep for healthy ageing","volume":"75","year":"2024","journal-title":"Med. Podml."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Voumvourakis, K.I., Sideri, E., Papadimitropoulos, G.N., Tsantzali, I., Hewlett, P., Kitsos, D., Stefanou, M., Bonakis, A., Giannopoulos, S., and Tsivgoulis, G. (2023). The dynamic relationship between the glymphatic system, aging, memory, and sleep. Biomedicines, 11.","DOI":"10.3390\/biomedicines11082092"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1007\/s12264-022-00925-7","article-title":"Dopamine control of REM sleep and cataplexy","volume":"38","author":"Zhang","year":"2022","journal-title":"Neurosci. Bull."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.autneu.2016.02.010","article-title":"Central neural control of thermoregulation and brown adipose tissue","volume":"196","author":"Morrison","year":"2016","journal-title":"Auton. Neurosci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/B978-0-444-63912-7.00002-3","article-title":"Peripheral thermoreceptors in innocuous temperature detection","volume":"156","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/B978-0-444-63912-7.00016-3","article-title":"Afferent pathways for autonomic and shivering thermoeffectors","volume":"156","author":"Nakamura","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"453","DOI":"10.3923\/pjbs.2023.453.457","article-title":"Thyroid hormones regulate the thermoregulatory mechanisms of the body: Review","volume":"26","author":"Filfilan","year":"2023","journal-title":"Pak. J. Biol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S157","DOI":"10.1086\/317521","article-title":"Role of the preoptic-anterior hypothalamus in thermoregulation and fever","volume":"31","author":"Boulant","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Harding, E.C., Franks, N.P., and Wisden, W. (2019). The temperature dependence of sleep. Front. Neurosci., 13.","DOI":"10.3389\/fnins.2019.00336"},{"key":"ref_21","first-page":"R1240","article-title":"Neuronal discharge of preoptic\/anterior hypothalamic thermosensitive neurons: Relation to NREM sleep","volume":"269","author":"Alam","year":"1995","journal-title":"Am. J. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3283","DOI":"10.1016\/j.neuron.2021.10.001","article-title":"A synaptic temperature sensor for body cooling","volume":"109","author":"Kamm","year":"2021","journal-title":"Neuron"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12576-024-00937-0","article-title":"TRPM3, TRPM4, and TRPM5 as thermo-sensitive channels","volume":"74","author":"Uchida","year":"2024","journal-title":"J. Physiol. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100008","DOI":"10.1016\/j.jphyss.2025.100008","article-title":"Thermosensitive TRPM2: The regulatory mechanisms of its temperature sensitivity and physiological functions","volume":"75","author":"Kashio","year":"2025","journal-title":"J. Physiol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1126\/science.aaf7537","article-title":"The TRPM2 channel is a hypothalamic heat sensor that limits fever and can drive hypothermia","volume":"353","author":"Song","year":"2016","journal-title":"Science"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"151565","DOI":"10.1016\/j.aanat.2020.151565","article-title":"Changes in TRPV1 expression in the POA of ovariectomized rats regulated by NE-dependent \u03b12-ADR may be involved in hot flashes","volume":"232","author":"Sun","year":"2020","journal-title":"Ann. Anat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3462","DOI":"10.1523\/JNEUROSCI.2718-20.2021","article-title":"Glutamatergic neurons in the preoptic hypothalamus promote wakefulness, destabilize NREM sleep, suppress REM sleep, and regulate cortical dynamics","volume":"41","author":"Mondino","year":"2021","journal-title":"J. Neurosci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/978-981-97-4584-5_12","article-title":"Circadian clock and body temperature","volume":"1461","author":"Miyake","year":"2024","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1080\/23328940.2020.1743605","article-title":"Circadian rhythmicity of body temperature and metabolism","volume":"7","author":"Refinetti","year":"2020","journal-title":"Temperature"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.cophys.2019.11.008","article-title":"Sleep and thermoregulation","volume":"15","author":"Harding","year":"2020","journal-title":"Curr. Opin. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hameed, N.A., and Barber, A.F. (2024). Circadian regulation of sleep: From genes to circuits. Genetics of Sleep and Sleep Disorders, Springer.","DOI":"10.1007\/978-3-031-62723-1_14"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"RP101302","DOI":"10.7554\/eLife.101302","article-title":"Repeated activation of preoptic area recipient neurons in posterior paraventricular nucleus mediates chronic heat-induced negative emotional valence and hyperarousal states","volume":"13","author":"Cao","year":"2025","journal-title":"eLife"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"N\u00fa\u00f1ez-Rodr\u00edguez, S., Collazo-Riob\u00f3, C., Sedano, J., S\u00e1nchez-Iglesias, A.I., and Gonz\u00e1lez-Santos, J. (2025). Heat tolerance in older adults: A systematic review of thermoregulation, vulnerability, environmental change, and health outcomes. Healthcare, 13.","DOI":"10.3390\/healthcare13212785"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.jsams.2020.12.007","article-title":"Temperature regulation during exercise in the heat: Insights for the aging athlete","volume":"24","author":"Kenney","year":"2021","journal-title":"J. Sci. Med. Sport"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/B978-0-444-63912-7.00001-1","article-title":"The thermoregulation system and how it works","volume":"156","author":"Romanovsky","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1007\/s00484-024-02758-7","article-title":"Effects of individual characteristics and local body functions on sweating response: A review","volume":"68","author":"Niu","year":"2024","journal-title":"Int. J. Biometeorol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1152\/japplphysiol.00298.2010","article-title":"Mechanisms and modifiers of reflex induced cutaneous vasodilation and vasoconstriction in humans","volume":"109","author":"Charkoudian","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1152\/japplphysiol.00338.2010","article-title":"Peripheral mechanisms of thermoregulatory control of skin blood flow in aged humans","volume":"109","author":"Holowatz","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1139\/apnm-2013-0317","article-title":"Do older adults experience greater thermal strain during heat waves?","volume":"39","author":"Stapleton","year":"2014","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2042","DOI":"10.1073\/pnas.1616255114","article-title":"A hypothalamic circuit that controls body temperature","volume":"114","author":"Zhao","year":"2017","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e12846","DOI":"10.1111\/acel.12846","article-title":"Hypothalamic gene transfer of BDNF promotes healthy aging in mice","volume":"18","author":"McMurphy","year":"2019","journal-title":"Aging Cell"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.cell.2016.08.028","article-title":"Warm-sensitive neurons that control body temperature","volume":"167","author":"Tan","year":"2016","journal-title":"Cell"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"604","DOI":"10.2741\/3636","article-title":"The interrelationship between sleep regulation and thermoregulation","volume":"15","author":"Deboer","year":"2010","journal-title":"Front. Biosci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1093\/brain\/awm315","article-title":"Skin deep: Enhanced sleep depth by cutaneous temperature manipulation","volume":"131","author":"Raymann","year":"2008","journal-title":"Brain"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1080\/23328940.2025.2484499","article-title":"Effects of menopause on temperature regulation","volume":"12","author":"Vesterdorf","year":"2025","journal-title":"Temperature"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"bqab087","DOI":"10.1210\/endocr\/bqab087","article-title":"The effects of estrogens on neural circuits that control temperature","volume":"162","author":"Zhang","year":"2021","journal-title":"Endocrinology"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Bellesi, M., Riedner, B.A., Garcia-Molina, G.N., Cirelli, C., and Tononi, G. (2014). Enhancement of sleep slow waves: Underlying mechanisms and practical consequences. Front. Syst. Neurosci., 8.","DOI":"10.3389\/fnsys.2014.00208"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1880-6805-31-14","article-title":"Effects of thermal environment on sleep and circadian rhythm","volume":"31","author":"Mizuno","year":"2012","journal-title":"J. Physiol. Anthropol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e1601555","DOI":"10.1126\/sciadv.1601555","article-title":"Nighttime temperature and human sleep loss in a changing climate","volume":"3","author":"Obradovich","year":"2017","journal-title":"Sci. Adv."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"108988","DOI":"10.1016\/j.envint.2024.108988","article-title":"Identifying groups at-risk to extreme heat: Intersections of age, race\/ethnicity, and socioeconomic status","volume":"191","author":"Clark","year":"2024","journal-title":"Environ. Int."},{"key":"ref_51","unstructured":"Minor, K., Bjerre-Nielsen, A., Jonasdottir, S.S., Lehmann, S., and Obradovich, N. (2020). Ambient heat and human sleep. arXiv."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kim, J.W., Heo, S., Lee, D., Hong, J., Yang, D., and Moon, S. (2025). Polysomnographic evidence of enhanced sleep quality with adaptive thermal regulation. Healthcare, 13.","DOI":"10.20944\/preprints202507.2352.v1"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"8306154","DOI":"10.1155\/2018\/8306154","article-title":"Aging and thermoregulatory control: The clinical implications of exercising under heat stress in older individuals","volume":"2018","author":"Balmain","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Cede\u00f1o Laurent, J.G., Williams, A., Oulhote, Y., Zanobetti, A., Allen, J.G., and Spengler, J.D. (2018). Reduced cognitive function during a heat wave among residents of non-air-conditioned buildings: An observational study of young adults in the summer of 2016. PLoS Med., 15.","DOI":"10.1371\/journal.pmed.1002605"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/S0531-5565(00)00191-1","article-title":"Circadian and sleep disturbances in the elderly","volume":"35","year":"2000","journal-title":"Exp. Gerontol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/S1568-1637(02)00030-2","article-title":"Circadian and age-related modulation of thermoreception and temperature regulation: Mechanisms and functional implications","volume":"1","author":"Raymann","year":"2002","journal-title":"Ageing Res. Rev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1152\/physiol.2024.39.S1.683","article-title":"Responses of healthy young and older adults to short-term passive heat acclimation","volume":"39","author":"Deshayes","year":"2024","journal-title":"Physiology"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"R320","DOI":"10.1152\/ajpregu.00114.2024","article-title":"Sex differences in heat stress vulnerability among middle-aged and older adults (PSU HEAT Project)","volume":"327","author":"Leach","year":"2024","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.arr.2009.07.003","article-title":"Circadian temperature variation and ageing","volume":"9","author":"Weinert","year":"2010","journal-title":"Ageing Res. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Cavaill\u00e8s, C., Stone, K.L., Leng, Y., Peltz, C., and Yaffe, K. (2025). Objective sleep quality in diverse older adults: The importance of race and ethnicity and sex. medRxiv.","DOI":"10.1101\/2025.03.12.25323859"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"103294","DOI":"10.1016\/j.autneu.2025.103294","article-title":"Sex-related differences in temperature regulation during heat stress from childhood to older age","volume":"260","author":"Debray","year":"2025","journal-title":"Auton. Neurosci."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Sriram, S., Carstens, K., Dewing, W., and Fiacco, T.A. (2024). Astrocyte regulation of extracellular space parameters across the sleep\u2013wake cycle. Front. Cell. Neurosci., 18.","DOI":"10.3389\/fncel.2024.1401698"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"147ra111","DOI":"10.1126\/scitranslmed.3003748","article-title":"A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid \u03b2","volume":"4","author":"Iliff","year":"2012","journal-title":"Sci. Transl. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1126\/science.1241224","article-title":"Sleep drives metabolite clearance from the adult brain","volume":"342","author":"Xie","year":"2013","journal-title":"Science"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12987-025-00676-3","article-title":"Are diurnal variations in glymphatic clearance driven by circadian regulation of aquaporin-4 expression?","volume":"22","author":"Frey","year":"2025","journal-title":"Fluids Barriers CNS"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1038\/s41583-021-00514-z","article-title":"Aquaporin 4 and glymphatic flow have central roles in brain fluid homeostasis","volume":"22","author":"Salman","year":"2021","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Costea, D., Dobrin, N., Tataru, C.-I., Toader, C., \u0218erban, M., Covache-Busuioc, R.-A., Munteanu, O., and Diaconescu, I.B. (2025). The glymphatic\u2013venous axis in brain clearance failure: Aquaporin-4 dysfunction, biomarker imaging, and precision therapeutic frontiers. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262110546"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s10571-024-01487-0","article-title":"Sleep and oxidative stress: Current perspectives on the role of NRF2","volume":"44","author":"Davinelli","year":"2024","journal-title":"Cell. Mol. Neurobiol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Tian, Y., Liu, X., and Liu, D. (Free Radic. Biol. Med., 2025). Physiological roles of reactive oxygen species in sleep homeostasis, Free Radic. Biol. Med., in press.","DOI":"10.1016\/j.freeradbiomed.2025.10.273"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2262913","DOI":"10.1155\/2021\/2262913","article-title":"Anxiogenic potential of experimental sleep fragmentation is duration-dependent and mediated via oxidative stress state","volume":"2021","author":"Macut","year":"2021","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2576643","DOI":"10.1080\/07853890.2025.2576643","article-title":"Circadian clock genes and insomnia: Molecular mechanisms and therapeutic implications","volume":"57","author":"Ren","year":"2025","journal-title":"Ann. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1172\/JCI46043","article-title":"Circadian rhythms, sleep, and metabolism","volume":"121","author":"Huang","year":"2011","journal-title":"J. Clin. Investig."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1080\/23328940.2022.2109932","article-title":"Sleep disruption induces activation of inflammation and heightens risk for infectious disease: Role of impairments in thermoregulation and elevated ambient temperature","volume":"10","author":"Irwin","year":"2022","journal-title":"Temperature"},{"key":"ref_74","first-page":"6S30","article-title":"La r\u00e9gulation thermique au cours du sommeil [Thermal regulation during sleep]","volume":"159","author":"Libert","year":"2003","journal-title":"Rev. Neurol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1101\/sqb.2007.72.064","article-title":"Sleep and circadian rhythms in humans","volume":"72","author":"Czeisler","year":"2007","journal-title":"Cold Spring Harb. Symp. Quant. Biol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"4669","DOI":"10.1038\/s41598-024-53839-x","article-title":"Enhanced conductive body heat loss during sleep increases slow-wave sleep and calms the heart","volume":"14","author":"Herberger","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1016\/j.cub.2019.05.009","article-title":"Dynamic REM sleep modulation by ambient temperature and the critical role of the melanin-concentrating hormone system","volume":"29","author":"Komagata","year":"2019","journal-title":"Curr. Biol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1093\/jas\/skx083","article-title":"Short-term heat stress altered metabolism and insulin signaling in skeletal muscle","volume":"96","author":"Ganesan","year":"2018","journal-title":"J. Anim. Sci."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1210\/jc.2014-3911","article-title":"Subchronic sleep restriction causes tissue-specific insulin resistance","volume":"100","author":"Rao","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1134\/S0022093022050131","article-title":"Neuroendocrine control of hyperglutamatergic states in brain pathologies: The effects of glucocorticoids","volume":"58","author":"Gulyaeva","year":"2022","journal-title":"J. Evol. Biochem. Physiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1159\/000514095","article-title":"The role of sleep curtailment on leptin levels in obesity and diabetes mellitus","volume":"14","author":"Mosavat","year":"2021","journal-title":"Obes. Facts"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jsmc.2023.02.003","article-title":"Sleep and inflammation: Bidirectional relationship","volume":"18","author":"Veler","year":"2023","journal-title":"Sleep Med. Clin."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s12192-022-01314-9","article-title":"Nutri-stress, mitochondrial dysfunction, and insulin resistance\u2014Role of heat shock proteins","volume":"28","author":"Kuppuswami","year":"2023","journal-title":"Cell Stress Chaperones"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Fan, Y., Wang, Y., Gu, P., Han, J., and Tian, Y. (2022). How temperature influences sleep. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232012191"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"H1336","DOI":"10.1152\/ajpheart.00911.2014","article-title":"The role of cardiac sympathetic innervation and skin thermoreceptors on cardiac responses during heat stress","volume":"308","author":"Shibasaki","year":"2015","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1539\/joh.49.199","article-title":"Evaluation of the effect of heat exposure on the autonomic nervous system by heart rate variability and urinary catecholamines","volume":"49","author":"Yamamoto","year":"2007","journal-title":"J. Occup. Health"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"197","DOI":"10.59249\/HGAL4894","article-title":"Heat and the heart","volume":"96","author":"Desai","year":"2023","journal-title":"Yale J. Biol. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1177\/07487304231178950","article-title":"Circadian regulation of the neuroimmune environment across the lifespan: From brain development to aging","volume":"38","author":"Chen","year":"2023","journal-title":"J. Biol. Rhythm."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1152\/physrev.00010.2018","article-title":"The sleep\u2013immune crosstalk in health and disease","volume":"99","author":"Besedovsky","year":"2019","journal-title":"Physiol. Rev."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1038\/npp.2016.148","article-title":"Sleep health: Reciprocal regulation of sleep and innate immunity","volume":"42","author":"Irwin","year":"2017","journal-title":"Neuropsychopharmacology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e202402681","DOI":"10.26508\/lsa.202402681","article-title":"Regulation of proteostasis by sleep through autophagy in Drosophila models of Alzheimer\u2019s disease","volume":"7","author":"Lobato","year":"2024","journal-title":"Life Sci. Alliance"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"zsad246","DOI":"10.1093\/sleep\/zsad246","article-title":"Sleep deprivation and aging are metabolically linked across tissues","volume":"46","author":"Sengupta","year":"2023","journal-title":"Sleep"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1038\/ijo.2008.116","article-title":"AMPK: A key regulator of energy balance in the single cell and the whole organism","volume":"32","author":"Hardie","year":"2008","journal-title":"Int. J. Obes."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00360-024-01590-0","article-title":"Sleep deprivation stimulates adaptive thermogenesis by activating AMPK pathway in mice","volume":"195","author":"Zheng","year":"2025","journal-title":"J. Comp. Physiol. B"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.3390\/cimb46030138","article-title":"Effects of chronic sleep restriction on transcriptional SIRT1 signaling regulation in male mice white adipose tissue","volume":"46","author":"Rendine","year":"2024","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1600-079X.2009.00704.x","article-title":"Melatonin preserves longevity protein (SIRT1) expression in the hippocampus of total sleep-deprived rats","volume":"47","author":"Chang","year":"2009","journal-title":"J. Pineal Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"067003","DOI":"10.1289\/EHP11651","article-title":"Efficacy of cooling centers for mitigating physiological strain in older adults during daylong heat exposure: A laboratory-based heat wave simulation","volume":"131","author":"Meade","year":"2023","journal-title":"Environ. Health Perspect."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1001\/jamainternmed.2025.6595","article-title":"Air conditioning in nursing homes and mortality during extreme heat","volume":"186","author":"Katz","year":"2026","journal-title":"JAMA Intern. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"165623","DOI":"10.1016\/j.scitotenv.2023.165623","article-title":"Nighttime ambient temperature and sleep in community-dwelling older adults","volume":"899","author":"Baniassadi","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"e78257","DOI":"10.2196\/78257","article-title":"Association of indoor temperature level and mental health among community-dwelling older adults: Systematic review","volume":"11","author":"Park","year":"2025","journal-title":"JMIR Public Health Surveill."},{"key":"ref_101","unstructured":"World Health Organization (2026, March 09). Climate Change, Heat and Health. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/climate-change-heat-and-health."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"102240","DOI":"10.1016\/j.jhealeco.2019.102240","article-title":"Temperature and mental health: Evidence from the spectrum of mental health outcomes","volume":"68","author":"Mullins","year":"2019","journal-title":"J. Health Econ."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1080\/07420520600650612","article-title":"The circadian body temperature rhythm in the elderly: Effect of single daily melatonin dosing","volume":"23","author":"Gubin","year":"2006","journal-title":"Chronobiol. Int."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Wade, A.G., Ford, I., Crawford, G., McConnachie, A., Nir, T., Laudon, M., and Zisapel, N. (2010). Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: A randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety. BMC Med., 8.","DOI":"10.1186\/1741-7015-8-51"},{"key":"ref_105","first-page":"297","article-title":"Melatonin to treat insomnia in older adults","volume":"104","author":"Neher","year":"2021","journal-title":"Am. Fam. Physician"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2147\/CIA.S361519","article-title":"Current insights into the risks of using melatonin as a treatment for sleep disorders in older adults","volume":"18","author":"Tuft","year":"2023","journal-title":"Clin. Interv. Aging"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"afaf333","DOI":"10.1093\/ageing\/afaf333","article-title":"Melatonin for sleep and cognitive outcomes in older adults with cognitive impairment: A meta-analysis of randomised controlled trials","volume":"54","author":"Mdluli","year":"2025","journal-title":"Age Ageing"},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Ferracioli-Oda, E., Qawasmi, A., and Bloch, M.H. (2013). Meta-analysis: Melatonin for the treatment of primary sleep disorders. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0063773"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Marupuru, S., Arku, D., Campbell, A.M., Slack, M.K., and Lee, J.K. (2022). Use of melatonin and\/on ramelteon for the treatment of insomnia in older adults: A systematic review and meta-analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11175138"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1038\/s44435-025-00002-1","article-title":"High performance wearable thermoelectric coolers with 3D structural thermoelectric pillars","volume":"1","author":"Wang","year":"2026","journal-title":"npj Therm. Sci. Eng."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Vu, A., Rutherford, S., and Phung, D. (2019). Heat health prevention measures and adaptation in older populations\u2014A systematic review. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16224370"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.envres.2018.05.021","article-title":"Vulnerability to heatwaves and implications for public health interventions\u2014A scoping review","volume":"166","author":"Mayrhuber","year":"2018","journal-title":"Environ. Res."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"e002332","DOI":"10.1136\/bmjph-2024-002332","article-title":"Evaluation of community-based heat adaptation interventions: A systematic review","volume":"3","author":"Das","year":"2025","journal-title":"BMJ Public Health"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s10584-018-2274-3","article-title":"Temperature-related mortality impacts under and beyond Paris Agreement climate change scenarios","volume":"150","author":"Guo","year":"2018","journal-title":"Clim. Change"}],"container-title":["Clocks &amp; Sleep"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2624-5175\/8\/3\/43\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:25:00Z","timestamp":1784089500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2624-5175\/8\/3\/43"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":114,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["clockssleep8030043"],"URL":"https:\/\/doi.org\/10.3390\/clockssleep8030043","relation":{},"ISSN":["2624-5175"],"issn-type":[{"value":"2624-5175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]}}}