Background

Obstructive sleep apnea (OSA) is associated with obesity and cardiovascular disease (CVD). Obesity contributes to insulin resistance and inflammation, key factors in CVD pathophysiology in OSA. Few studies have explored CV risk factors and cardiometabolic biomarkers in OSA patients versus controls, or across OSA severity. To address this, we investigated clinical characteristics, biomarkers, and CVD burden in OSA vs. no OSA patients, and examined correlations across OSA severity grades.

Methods

From January 2016 to December 2018, 2,401 patients with suspected OSA underwent respiratory polygraphy, questionnaires, and blood samples.

OSA was defined as apnea-hypopnea index (AHI) ≥15 events per hour regardless of symptoms, and classified into severity grades (AHI ≤5 as no OSA, AHI 5-14.9 as mild, AHI 15-29.9 as moderate, AHI ≥30 as severe OSA). More than 3 cardiometabolic risk factors, including obesity, diabetes, hypertension, hypercholesterolemia and low HDL-cholesterol, were used as surrogate for metabolic syndrome.

Results

In the study population, mean age was 49.6±14.0 years, 68.8% men, and 36.2% had OSA. Patients with OSA were older compared with no OSA (54.9±12.2 vs 46.6±14.0, p<0.001). The prevalence of non-obese OSA (NOOSA, BMI <30) was 41.8% and obese-OSA 58.2%. Hypertension (72.7%), overall CVD (10.7 %) and atrial fibrillation (6.6%) were more prevalent in OSA (all P <0.001). Patients with OSA had higher levels of glycemic biomarkers, and lower levels of serum HDL cholesterol (in men only). OSA was associated with 2-fold increased CVD risk in the population (P <0.001). Age did not affect the interaction between OSA and CVD. The prevalence of ≥3 cardiometabolic risk factors was 50.5% (n=434) and significantly increased across the OSA severity grade (18% in no OSA, 34% in mild OSA, 45% in moderate OSA, 57% in severe OSA, p<0.001). The prevalence of ≥3 cardiometabolic risk factors was 16.3% in NOOSA and 75.2% in obese-OSA (p<0.001).

Conclusions

In this large outpatient clinic cohort, we found significant differences in CVD burden and metabolic dysfunction between patients with OSA and no OSA controls. Cardiometabolic biomarkers and risk factors had a dose-dependent association with OSA severity. Epidemiological assessments are needed to better prepare for the projected rise in obesity-related OSA and associated cardiovascular complications.

Shotgun metagenomics reveals alteration of gut microbiota in adults with poor sleep quality

Background

Although treatment with immune checkpoint inhibitors (ICIs) has improved survival, patients with advanced non-small cell lung cancer (NSCLC) still face poor prognosis. Acting through immune activation, ICIs may contribute to sleep disturbances and circadian disruption, both of which are linked to adverse health outcomes. Yet, longitudinal trajectories of sleep and circadian rhythms remain understudied in immuno-oncology, particularly in relation to psychological burden and prognosis.

Methods

In this prospective study, 49 patients with NSCLC who initiated ICIs were followed for five months. Sleep and circadian rhythms were assessed using actigraphy, sleep diaries, and questionnaires. Measures included the Circadian Function Index (CFI), Insomnia Severity Index (ISI), Total Sleep Time (TST), fatigue, depression, and stress. Prognostic outcomes (treatment discontinuation, progression, and cancer-related death) were obtained from medical records 1,5 years post treatment. Associations between sleep and circadian measures and psychological or prognostic outcomes were examined using mixed models and Cox regression analyses.

Results

At baseline, patients averaged 5.8 hours of sleep per night, and 49% reported clinical insomnia (ISI³10). Insomnia severity and TST improved during the five months, with modest but non-significant improvements in circadian robustness. More insomnia was associated with higher fatigue (p=.004), depression (p=.007), and stress (p=.033). Lower circadian robustness was associated with increased fatigue (p=.021). Cox regression analyses indicated that patients with circadian robustness below the median had a significantly higher risk of progression (HR = 3.75, 95% CI [1.48–9.54]; p=.005) and death (HR = 3.07, 95% CI [1.13–8.36]; p=.028).

Conclusion

Levels of sleep disturbances, circadian disruption, and psychological burden were highest before and shortly after ICI initiation and gradually improved over time. Notably, reduced circadian robustness was associated with fatigue, earlier disease progression, and death, suggesting that the circadian rhythm may serve as a modifiable biomarker with the potential to improve patient well-being and treatment outcomes.

Many Naps: an upcoming, pre-registered, multi-lab collaboration examining the effect of sleep on emotional memories.

Background

Insomnia afflicts about half of outpatients with coronary heart disease (CHD), is associated with an impaired cardiovascular prognosis and poor quality of life.1-3 Cognitive-behavioural therapy for insomnia (CBT-I) is the recommended first line treatment,4,5 yet limited knowledge of its cost-utility in this population is a potential barrier for implementation into clinical practice.

Objective

To simulate the potential socioeconomic savings of integrating nurse-delivered, manualised group cognitive-behavioural therapy for insomnia (gCBT-I) into cardiac outpatient care for patients with CHD compared with usual care, focusing on potential savings related to: (1) revascularizations and hospitalizations due to a recurrent CHD event; and (2) effects on sick leave.

Methods

Representative data on healthcare consumption and sick leave rates in working-age individuals (18-62 years) were collected from the NORwegian CORonary (NORCOR) cohort study (n=528).6 Costs of productivity loss were drawn from public sources and calculated using a conservative human capital approach. Therapeutic effectiveness estimates were informed by empirical data.7 The comparator conditions were weekly sessions of group CBT-I over five weeks versus usual care in 100 hypothetical outpatients with coronary heart disease and insomnia.8,9

Results

Insomnia was reported by 49.6% of patients. Rates of healthcare consumption and sick leave were higher in outpatients with CHD and insomnia compared to those without insomnia. Our model indicated that treating 100 patients with group CBT-I would cost €2,406 and that there is a maximum potential saving of €117,221 per 100 patients tied to healthcare consumption. Similarly, the maximum potential savings related to reduced productivity loss from sick leave were €53,244–€692,172.

Conclusion

Treating insomnia among outpatients with CHD has the potential for substantial reduction of socioeconomic costs related to healthcare consumption and sick leave. Implementation into routine outpatient care seems relevant but randomized controlled trials investigating the effects of gCBT-I in this population are warranted.

Reference 1

1. Frøjd LA, et al. J Clin Sleep Med 2021;17(5):931–8. 2. Frøjd LA, et al. SLEEP Adv 2022;3(1):zpac007. 3. Frøjd LA, et al. Front Psychol 2023;14:1119093. 4. Riemann D, et al. J Sleep Res 2023;32(6):e14035.

Reference 2

5. Qaseem A, et al. Ann Intern Med 2016;165(2):125–33. 6. Munkhaugen J, et al. Scand Cardiovasc J 2016;50(1):1–8. 7. Wu JQ, et al. JAMA Intern Med 2015;175(9):1461–72. 8. Støme LN, et al. Int J Technol Assess Health Care 2019;35(1):17–26. 9. Espie CA, et al. Sleep 2007;30(5):574–84.

Predicting Sleep Quality and Quantity Profiles in Danish Adults: A Machine Learning Analysis

Background

Insomnia is common yet often unidentified or inadequately treated in patients with coronary heart disease (CHD), despite being associated with impaired quality of life and adverse cardiovascular outcomes. We are conducting a randomized controlled trial comparing a five-session nurse-led cognitive-behavioural therapy for insomnia (CBT-I) delivered in-person weekly in a group format with written insomnia management advice (NCT06749951). Understanding how patients with CHD and insomnia experience this treatment may facilitate future implementation and delivery in this patient group.

Objective

To explore patients’ experiences of CBT-I delivered in a nurse-led group format.

Methods

Ten participants (mean age 55.8 years [range: 40–62], n=5 women) who had completed group CBT-I within the RCT were invited to post-intervention semi-structured interviews (20–74 min duration). Interviews were audio recorded, transcribed verbatim, and analysed according to principles of thematic analysis.

Results

Our preliminary analysis identified two key themes. First, Group Accountability and Support included the group format delivery, which was perceived as providing participants with a sense of shared purpose and feeling accountable regarding testing treatment components. Moreover, normalisation and validation by group members were described as helpful.

Second, we identified A Worthwhile Investment of Time and Effort. For instance, adhering to the therapeutic sleep window required determination but was associated with improvements in daytime energy levels, sociability and positive affect.

Conclusion

Participants experienced the five-week group CBT-I as supportive, acceptable, and helpful in facilitating behavioural change to manage insomnia. These preliminary qualitative findings may complement forthcoming quantitative outcomes and contribute to future implementation and dissemination.

General practitioners’ pathway to improve sleep health in community-dwelling older adults receiving home health care

Background

Adequate sleep is crucial for physical and mental wellbeing in adolescents. In females, one of the unique factors affecting sleep is menstrual health. Although some work has investigated the relationship between sleep and menstrual health, most of the literature focuses on women ≥ 18 years.

Objectives

Synthesize evidence on the relationship between sleep and menstrual health in adolescents.

Methods

Databases PubMed, EMBASE, and Web of Science were searched to identify studies that measured both sleep and menstrual health variables in adolescents. Sixteen studies met the inclusion criteria.

Results

Within the included studies, seven different sleep variables were reported: sleep duration, daytime sleepiness, chronotype, insomnia, nighttime awakenings, subjective sleep quality, and sleep stage breakdown. Except for sleep stage breakdown, all sleep variables demonstrated significant relationships across multiple domains of menstrual health including age at menarche, gynecological age, cycle regularity, dysmenorrhea, cycle duration, menstrual period duration, menstrual cycle dysfunction, pre-menstrual syndrome symptoms, and experience with blood seepage. These significant relationships support a link between poor sleep and menstrual health issues. Mental health variables were also repeatedly highlighted in the included studies, with many demonstrating a significant association either with sleep, menstrual health, or both.

Conclusion

The results reflect a complex, three-way relationship between poor sleep, menstrual health issues, and poor mental health. These results closely mirror findings from adult studies. However, study heterogeneity, study design, and unclear reporting limit the strength of this evidence. Future work should focus on longitudinal studies comparing sleep quality at different phases of the menstrual cycle to understand the relationship between sleep, menstrual health, and mental health over time and should engage young women to understand their priorities around sleep, menstruation, and general wellbeing.

Validation of a short questionnaire to measure Informational needs among Patients with Restless Legs Syndrome

Background

Emerging evidence suggests that the gut microbiome plays a role in sleep disturbance. This study explored the characteristics of the gut microbiome and the functional metabolic pathways related to sleep quality.

Materials and Methods

A total of 588 participants were recruited. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, employing a cutoff score of 8.5. Based on this criterion, 42 individuals with poor sleep quality (PSQ) and 546 healthy controls with good sleep quality (GSQ) were identified. The fecal microbiome was analyzed using shotgun whole-metagenome sequencing, and groups were compared based on diversity metrics, differentially abundant species, metabolic pathways and metabolites.

Results

No significant differences in alpha and beta diversity indices were observed between individuals experiencing subjective sleep disturbances and those who did not. Klebsiella pneumoniae was more abundant in the PSQ group (b = 0.476; q = 0.017). Additionally, the following metabolic pathways were enriched in the PSQ group: octane oxidation (coefficient = 0.495, q = 0.033), the superpathway of acetyl-CoA biosynthesis (coefficient = 0.377, q = 0.025), superpathway of (Kdo)2-lipid A biosynthesis (coefficient = 0.367, q = 0.026), petroselinate biosynthesis (coefficient = 0.353, q = 0.034), and superpathway of histidine, purine, and pyrimidine biosynthesis (coefficient = 0.349, q = 0.042). When metabolites levels associated with poor sleep quality were inferred using MelonnPan, higher xanthine levels were observed in the PSQ group (coefficient = 0.018; q = 0.025).

Conclusion

In summary, this study poses significant questions regarding the relationship between the gut microbiome and poor sleep quality.

Sleep disturbances and fatigue contribute to cognitive function in melanoma patients undergoing adjuvant immunotherapy

Background

This study investigated whether cognitive behavioral therapy for insomnia (CBT-I) modulates neural activation underlying cognitive control during emotional and sleep-related interference in patients with chronic insomnia disorder (CID), and whether these neural changes are associated with symptom improvement.

Materials and Methods

Twenty-six CID patients and 19 good sleepers (GS) participated. Subjective sleep and emotional distress were assessed via questionnaires, and sleep parameters were measured using sleep diaries and actigraphy. Participants completed an emotional Stroop task (negative emotional, sleep-related, and neutral words) during fMRI. Neural activation pre- and post-CBT-I in CID and at baseline and 5-week follow-up in GS were compared. Repeated-measures ANOVA tested group × time interactions to control for time, learning, and placebo effects. Correlations between changes in brain activation and sleep/emotion variables were also analyzed in CID.

Results

Post-CBT-I, CID patients showed increased activation in the left supramarginal gyrus (SMG), right visual association area (VAA), and right superior temporal gyrus (STG) during negative emotional words (all ps < 0.001), with no corresponding changes in GS (group × time interaction, all ps < 0.05). Increased right VAA activation correlated with reduced wake after sleep onset (WASO) from sleep diaries (r = −0.322, p = 0.046), and increased right STG activation correlated with reduced Beck Depression Inventory scores (r = −0.327, p = 0.037).

Conclusion

CBT-I enhances activation in the SMG, VAA, and STG during processing of negative emotional stimuli, suggesting improved top-down cognitive control over emotional interference, likely mediated by improvements in subjective sleep quality and depressive symptoms.

Changes in prevalence of sleep medication use in Swedish adolescents by relative age

Objective

Children with type 1 diabetes (T1D) often experience reduced sleep quality. Using continuous glucose monitoring (CGM) devices and actigraphy (AG), this study aimed to explore how glycemic variability is associated with sleep outcome measures in short time intervals.

Research Design and Methods

This study utilized pooled data from 498 nights from 69 children and adolescents (mean age 12.4 ± 2.5 years; 46.4% male) with T1D who wore CGM and AG devices concurrently. Sleep quality was graded using a 0–3-point system based on sleep onset latency (SOL >30 min), wake after sleep onset (WASO >40 min), and sleep efficiency (SE <85%), where 3 points indicate poorest quality. Glycemic variability was assessed using coefficient of variation (CV). Data were analyzed using linear and cumulative mixed-effects models.

Results

Participants experienced poor sleep (score 2 or 3) on 53.1% of nights. A 10% increase in CV was associated with: (i) a 21% higher odds of poorer sleep quality overnight (OR 1.21, 95% CI: 1.01–1.44, p = 0.038); (ii) a 1.12 minutes longer WASO per hour (95% CI: 0.63–1.63, p < 0.001); and (iii) a 0.78% decrease in SE overnight (95% CI: –1.42 to –0.15, p = 0.017). No association between other glycemic outcomes and sleep outcomes were found.

Conclusion

In this study of children with T1D, increased CV was associated with worse sleep outcome measures. The clinical relevance of these modest effect sizes remain uncertain. Further research using more in-depth objective (e.g., polysomnography) combined with subjective (e.g., validated questionnaires) measures is warranted to better understand this relationship.

Reference 1

Monzon A, McDonough R, Meltzer LJ, Patton SR (2019) Sleep and type 1 diabetes in children and adolescents: Proposed theoretical model and clinical implications. Pediatr Diabetes 20(1):78–85. https://doi.org/10.1111/pedi.12797

Reference 2

İpar N, Boran P, Barış HE, et al (2023) Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes. Sleep Med 109:132–142. https://doi.org/10.1016/j.sleep.2023.06.018

Impaired emotion recognition is associated with sleep-related hypoxic burden

Background

Obstructive sleep apnea (OSA) is underdiagnosed globally, and diagnostic pathways vary widely between countries. In Latvia, referral patterns for sleep diagnostics have not been systematically described, and little is known about how different referral sources contribute to diagnostic yield or patient characteristics.

Objective

To evaluate how the current diagnostic pathway for OSA functions in Latvia by examining referral sources, diagnostic outcomes, disease severity, and waiting times in an ambulatory sleep diagnostics center.

Methods

We analyzed 164 adults undergoing ambulatory polygraphy. Referral sources were categorized as self-referral, family physicians, neurologists, sleep specialists, and other specialists (otorhinolaryngologists, cardiologists, pulmonologists). OSA was defined as apnea–hypopnea index (AHI) ≥5/h and clinically significant OSA as AHI ≥15/h. Group differences were assessed using χ² tests, Kruskal–Wallis analysis with Dunn’s post-hoc tests, and multivariable logistic regression adjusting for age, sex, and BMI-group. Waiting time was defined as the interval from recording to the written report.

Results

Mean age was 51.1±14.5 years; mean BMI 30.6±6.5; median AHI 12.5/h. OSA prevalence was 74.4%, and 44.5% of patients had clinically significant OSA.

Clinically significant OSA differed across referral groups (χ²(4)=10.25, p=0.036), highest among family physicians (61.5%), sleep specialists (58.8%), and other specialists (55.6%), and lowest among neurologists (32.5%). AHI severity also varied (Kruskal–Wallis χ²=14.50, p=0.006), with sleep specialist referrals showing higher AHI than neurologists (p=0.028). BMI-group (p<.001) and age (p=0.008) independently predicted AHI ≥15.

Median waiting time was 28 days; 13.4% received results within <15 days, 42.7% within 15–30 days, and 43.9% waited >30 days.

Conclusion

Referral patterns in Latvia lead to observable differences in OSA detection and severity. These findings provide an initial structural overview of the diagnostic pathway and highlight opportunities to improve referral alignment and reduce reporting delays. Further full-cohort analyses are ongoing.

REM sleep fragmentation and arousability distinguish chronic insomnia subtypes and reflect subjective-objective sleep discrepancy

Background

Obstructive sleep apnea (OSA) is a prevalent sleep disorder linked to major health risks, affecting nearly one billion adults worldwide. Evidence shows that exercise can reduce OSA severity and improve health, yet the characteristics of effective exercise programs remain unclear.

Objective

To synthesize the characteristics of exercise programs and their effectiveness in reducing the apnea-hypopnea index (AHI) in patients with OSA. Methods: A narrative review was conducted in PubMed and Web of Science. Inclusion criteria: adults with OSA; clinical, randomized, or crossover trials; exercise interventions compared with a control or another intervention; AHI as outcome; and publication in English. From each study, data were extracted on author, year, design, sample, comorbidities, BMI and AHI pre/post intervention, intervention characteristics, and main findings.

Results

Twenty-seven studies were included from 964 screened records, mostly RCTs with middle-aged and mainly male participants. Most samples involved overweight or obese individuals with common comorbidities such as hypertension and diabetes.

Conclusions

The conclusions of this study were: (i) the analyzed studies comparing an exercise-based group with a control group (no intervention) generally included between 25 and 50 participants; (ii) no study was conducted exclusively in women; (iii) the most common structure was programs lasting 12 weeks with three weekly sessions of 60 minutes; (iv) the exercise programs were primarily based on aerobic exercise, either alone or combined with resistance training (concurrent exercise); (v) the prescription of exercise intensity was poorly detailed, with virtually no control of training load, which would hinder study replicability; (vi) exercise programs achieved reductions in AHI, in some cases even without changes in BMI. However, although 83% of the studies achieved a reduction in AHI, the magnitude of this decrease was highly heterogeneous (ranging from 13% to 92%).

Reference 1

Saavedra, J. M., Lins-Filho, O., Mendelson, M., & Escalante, Y. (2025). Exercise interventions in obstructive sleep apnea: Program features and clinical benefits. Current Pulmonology Reports, 14, 31. https://doi.org/10.1007/s13665-025-00396-x

Experiences of cognitive-behavioural therapy for insomnia in coronary heart disease: Preliminary qualitative results

Background

Sleep is highly comorbid with nociceptive and neuropathic pain. Peripheral neuropathies are source of neuropathic pain, and constitute common neurological disorders affecting sensory, autonomic, and motor nerves, with an estimated prevalence exceeding 2% in the general population. Typical symptoms include neuropathic pain resulting from somatosensory nerve damage.

Objective

Here, we wanted to understand the genetic architecture of mono- and polyneuropathies and their relationship with sleep and related comorbid traits.

Methods

We utilized association studies (GWASs) on cohorts within the FinnGen and the UK Biobank research projects. Meta-analysis was used to combine datasets from the two cohorts. PheWAS database searches, HLA fine-mapping, colocalization, genetic correlation, and Mendelian randomization analyses supported shared genetic links of neuropathies with sleep problems, chronic pain, and psychiatric disorders.

Results

Our GWAS meta-analysis identified 48 genome-wide significant (p < 5 × 10⁻⁸) independent loci and 66 fine-mapped signals. These included associations with genes involved in neurotransmitter signaling (HTR3A), immune function (HLA-DQB1, BCL11A), extracellular matrix remodeling (COL11A1, ADAMTS17, LOXL4), axon guidance and neural development (DCC, ETV1, NEGR1), and carpal tunnel syndrome (DIRC3).

Conclusions

Together, our results highlight a strong polygenic basis for neuropathies and establish their complex genetic relationships with sleep, pain, psychiatric, and autoimmune traits.

Impact of Nightly Blood Glucose Fluctuations on Actigraphy-Measured Sleep in Children with Type 1 Diabetes

Background

Musculoskeletal pain and insomnia frequently co-occur. Although insomnia is often treated with hypnotics, long-term use is not recommended due to possible dependency, tolerance and adverse side effects. The prevalence of prolonged hypnotic prescriptions among individuals with both conditions remains unknown. This study examined whether chronic musculoskeletal pain affects the prevalence of prolonged prescriptions among individuals with insomnia.

Methods

In this cross-sectional study, data from 40,790 participants in the Trøndelag Health Study (HUNT4) were linked to the Norwegian Prescription Database for Z-hypnotics and benzodiazepines prescriptions during the participation year. Prolonged prescriptions were defined as ≥90 defined daily doses. Prevalence estimates were calculated by insomnia and chronic pain status, stratified by age, sex and pain severity.

Results

Among participants with insomnia, prolonged prescription prevalence was higher in those with chronic pain (14.3%) compared to insomnia alone (9.7%). Stratification revealed marked age and sex differences: women aged 45-69 had prevalences of 14.9% (pain) versus 11.1% (insomnia alone), increasing to 34.3% and 29.3% for women ≥70 years. For men, rates were 9.1% versus 10.1% at ages 45-69 years and 20.9% versus 16.5% at ≥70 years. Younger participants had prevalences between 1.6% and 4%. Pain severity influenced prevalence only among participants aged ≥70 years, and more strongly among men (24% with high impact pain versus 16.5% without pain). Prevalence differences, adjusted for education and age, between individuals with and without pain, were not statistical significant.

Conclusion

Prolonged Z-hypnotics and benzodiazepines prescriptions increased with age, with women receiving more than men. Chronic musculoskeletal pain was associated with higher prescription rates, though not statistically significant, and pain severity had limited influence except among older individuals. Reducing reliance on pharmacological treatments for insomnia requires addressing drivers of prolonged prescriptions. Equally important is expanding access to and further development of evidence based non-pharmacological treatments, which can offer safer and more sustainable alternatives to long-term pharmacotherapy.

Real-world data on the abuse potential of medications for the treatment of insomnia

Study Objectives

To characterize rapid eye movement (REM) sleep structure in chronic insomnia (CIN) subtypes with (CIN-AP) or without (CIN-NP) polysomnography (PSG)-defined macrostructural alterations, and to determine how these subtypes differ from each other and from good sleepers (GS).

Methods

We analyzed 1,049 participants: 141 GS, 214 CIN-NP, and 694 CIN-AP. CIN was defined by ICSD-3 criteria. Automated algorithms quantified sleep stages, arousals, and REM features including percentage and duration (total, phasic, tonic), number of arousals and awakenings per hour, and rapid eye movements per hour (REM density). Secondary analyses examined arousal dynamics via odds ratio product (ORP) and awakening duration distributions. Group differences were assessed with multinomial logistic regression, and stepwise regression identified independent predictors of CIN-AP versus CIN-NP.

Results

Both CIN subtypes showed more REM arousals and awakenings per hour, higher REM density, and greater phasic REM proportion compared with GS. CIN-AP exhibited longer REM awakening duration than CIN-NP, but no difference in arousal or awakening indices, despite otherwise normal PSG metrics for CIN-NP. Multivariate analysis identified CIN-AP as independently associated with male sex, older age, lower REM duration but higher %REM, increased phasic REM, and longer REM awakenings. The predictive model achieved an AUC of 0.752 (65.6% sensitivity, 72.3% specificity), with modest improvement when adding ORP and awakening duration variables (AUC 0.755, 68.4% sensitivity, 69.7% specificity).

Conclusions

REM instability distinguishes CIN subtypes and reflects subjective-objective sleep discrepancies. REM structure metrics may serve as neurophysiological signatures of the insomnia experience, with potential to inform personalized diagnostics and therapy.

Seasonal, Social, and Biological Drivers of Sleep: Findings from a Year of Nocturnal EEG Monitoring

Background

Restless legs syndrome (RLS) is a neurological condition that affects sleep and quality of life, where pharmacological treatment is difficult to optimize. Physical activity may be an important self-care strategy, but knowledge about the association between physical activity and RLS symptoms is limited.

Objective

To analyze the association between self-reported physical activity and symptoms related to RLS.

Materials and Methods

A cross-sectional design was used. All (approximately 1500) members of the Swedish RLS Association were invited to participate. Physical activity was measured using items from the Swedish National Board of Health and Welfare, covering physical exercise, everyday physical activity, and muscle-strengthening activities. RLS symptoms (i.e., sleep quality, nighttime RLS, daytime RLS manifestations during relaxation) were assessed with the Restless Legs Syndrome-6 Scale (RLS-6). RLS symptom levels were compared across low, medium, and high physical activity groups within two age strata (<73 years, n=374 vs ≥73 years, n=368). Linear regression analyses were also conducted, adjusting for age, gender, and BMI.

Results

A total of 742 participants (mean 70.5 yrs, Sd 11.4; 65% women) completed the questionnaire. In the total sample, low, moderate and high physical activity was rated by 140 (19%), 240 (32%), and 362 (49%) participants, respectively. Younger participants with high levels of physical activity (n=208) reported significantly lower RLS symptom levels compared to those with low (n=53) or medium (n=113) activity (p=0.012). A similar pattern was observed among older participants; however, the difference was not statistically significant. In the linear regression analysis, a significant negative association was observed between physical activity and RLS symptoms (β = -0.249, p=0.006), which remained statistically significant after adjusting for age, gender, and BMI.

Conclusions

Self-assessed physical activity appears to be associated with RLS symptoms. Future studies should use objective assessments to investigate how intensity, type, and timing of physical activity influence RLS symptoms.

Keywords: Restless legs syndrome, self-care, physical activity, age, RLS symptoms

Associations Between Psychological Distress and Sleep in Patients with Untreated Obstructive Sleep Apnea

Background

After encoding, most everyday memories rapidly fade, some are remembered for short periods, and a few become durable. Is it the neural mechanisms under initial encoding that determine the lifetime of a memory, or is it the result of later consolidation processes?

Materials and Methods

We tested how encoding and sleep-associated consolidation interact using auditory targeted memory reactivation (TMR) during sleep. Healthy young adults (n = 81) learned object–face/place pairs in the evening and rated the subjective vividness of each association. Retrieval was tested immediately (pre-sleep), after 12 hours (post-sleep), and after 5 days. Overnight EEG was used to monitor sleep and auditory cues tied to learned items were played during NREM stages 2–3. Memory was analyzed at the item level with mixed-effects logistic regression predicting recall at 12 hours and 5 days from encoding vividness and whether the item was cued or not during sleep. Models were fitted separately for items that were correctly and incorrectly recalled immediately after learning, operationalizing strong and weak initial memories, respectively.

Results

For strong (pre-sleep correct) memory items, higher encoding vividness increased retention (p<0.001, OR=1.26 with each increasing vividness level), while TMR had no measurable effect (p=0.83, OR ≈ 1). For weak (pre-sleep incorrect) items, vividness had smaller influence (p=0.042, OR = 1.10), but nocturnal cueing increased recall (main effect of TMR: p=0.002) at 12 hours (OR = 1.44) and at 5 days (OR = 1.20).

Conclusions

Strongly encoded memories are likely to persist regardless of sleep-associated consolidation. In contrast, sleep-associated consolidation selectively rescues weakly encoded traces, producing durable benefits that persist for at least five days. As such, encoding strength sets baseline durability, while sleep-associated consolidation can selectively bolster fragile memories.

Sleep-related subtypes in de novo and mild-moderate Parkinson’s disease patients

Introduction

Worry and rumination are driving mechanisms in insomnia, anxiety, and depression. Rumination-focused CBT (RFCBT) reduces depression and anxiety. However, RFCBT have been less studied regarding insomnia. In a previous study on patients with anxiety, depression and/ or insomnia, we found that the greatest effects were found on insomnia, despite not adressing sleep during the treatment. The current aim was to evaluate the treatment protocol in a more homogenous sample of patients with insomnia.

Methods

In this within-group design, 49 participants with insomnia participated in group RFCBT treatment (7 groups; 8 sessions) at two primary healthcare units. Insomnia, general worry, sleep related worry and rumination were measured before treatment, weekly throughout treatment and at 3-month follow-up. Data collection is on-going but will be completed in time for the poster. Data was analyzed with repeated measures ANOVA.

Results

Preliminary results show that there was a significant effect of time on insomnia F(2,52)=19.47, p , rumination F(2,52)=9.41, p and sleep related worry F(1.74,45.17)=8.10, p=.002. There was no significant effect of time for general worry F(1.66,43.25)=2.00, p=.15. Pairwise comparisons showed that insomnia symptoms decreased from pre- to mid-treatment (2.78, p= .034) and from mid- to post treatment (3.33, p. For rumination the decrease was significant from pre- to mid-treatment (1.04, p=.04), but not from mid- to post treatment (.41, p=.45). Sleep related worry decreased significantly from mid- to post treatment (10.74, p=.004) but not from pre- to mid treatment (4.41, p=.82).

Discussion

Participants’ levels of insomnia, rumination and sleep related worry improved over the course of treatment whereas there was no effect on general worry. The mean score on the Insomnia Severity Index indicated that insomnia levels went from moderate before treatment (M=18.30) to sub-threshold at the end of treatment (M=12.19) on a group level. Our results also indicate that decreases in insomnia and rumination may precede changes in sleep related worry. Group RFCBT might be a promising and resource efficient treatment within primary health care for insomnia patients. RFCBT may also be efficient in reducing levels of rumination and sleep related worry in insomnia patients.

Analytical evaluation and method comparison of an orexin A radioimmunoassay in cerebrospinal fluid

Background

Previous research has indicated that sleep is beneficial for memory consolidation. It has further often been suggested that sleep mainly consolidates emotional memories, and that sleep reduces the emotional reactivity associated with aversive experiences. Recent meta-analytic work has, however, revealed that previous studies on this topic have been massively underpowered, and that selective publishing of positive findings is a major problem in the field.

Objective

Here we aim to remedy this through a pre-registered, well-powered, multi-lab collaboration study in which we will examine A) whether sleep, as compared to wake, increases memory consolidation, B) whether this potential sleep-dependent consolidation benefit is more pronounced for negative compared to neutral items, C) whether sleep, to a larger degree than time spent awake, decreases the emotional reaction associated with previously viewed negative images, and D) whether any sleep stage will be particularly involved in either memory consolidation or in decreasing emotional responses. Over 10 labs from all over the world have agreed to participate in what will be the largest experimental study on sleep and memory conducted to date.

Methods

This will be a pre-registered, within-subject design where all participants complete both conditions. Participants will come to the lab at noon and view neutral and negative images, and be asked to rate these images for valence and arousal. Participants will then perform an immediate memory test and perform the emotional rating task again. After that, they will have a delay interval containing either a two-hour nap opportunity or an equivalent amount of time spent awake. After the delay interval, they will perform a second memory test and emotional rating task.

Results

This will allow us to answer the research questions mentioned above in a more robust and reliable way than has been done previously.

Reference 1

Davidson, P., Jönsson, P., Carlsson, I., & Pace-Schott, E. (2021). Does Sleep Selectively Strengthen Certain Memories Over Others Based on Emotion and Perceived Future Relevance? Nature and science of sleep, 13, 1257-1306. https://doi.org/10.2147/nss.S286701

Reference 2

Davidson, P., & Pace-Schott, E. (2021). Go to Bed and You MIGHT Feel Better in the Morning—the Effect of Sleep on Affective Tone and Intrusiveness of Emotional Memories. Current Sleep Medicine Reports, 7(2), 31-46. https://doi.org/10.1007/s40675-020-00200-z

Memory durability – associations with sleep, future relevance, vividness and age

While sleep after encoding has an immediate promoting effect on memory recall, it is unknown

whether this effect endures or fades over time. The aim of the present study was to test whether

immediate memory benefits due to sleep also would be related to better episodic memory over longer

time intervals, i.e., durable memory. Following an associative encoding task, younger and older adults

had their memory tested 12 hours later – both after a night’s sleep and after a day’s wake – and again

after 6 days. After encoding, the participants were informed that they later would be relatively more

rewarded for remembering specific half of the encoded associations, manipulating the future

relevance of the encoding material.

Polysomnographic data was collected during the sleep interval.

Binary logistic regression analyses showed that while there was an immediate positive effect of sleep

on memory, this did not persist over six days. Perceived future relevance and high vividness was

associated with improved memory both after twelve hours and six days, but there was no additional

effect of sleep on these relationships. The effects of sleep and relevance on memory were not different

between age groups, suggesting that early memory consolidation in older adults is facilitated to the

same extent as in the young. Finally, slow wave sleep duration was not associated with memory

success. In conclusion, sleep-related benefits on memory performance may be short-lived, with no

lasting beneficial effects on consolidation.

Metabolic–Neural Crosstalk: Anti-Obesity Drug Reshapes Sleep Architecture and Slow-Wave Activity in Mice

Background

Emotion recognition is a key prosocial skill essential for interactions and psychological well-being. Little is known about the impact of obstructive sleep apnea (OSA) on emotion recognition performance.

Objective

To identify the correlation of emotion recognition performance with sleep metrics, including OSA and sleep architecture.

Methods

Adults from the Icelandic population were recruited to assess facial expressions presented with different intensities using the Penn Emotion Recognition Task. Subsequently, participants underwent three consecutive nights with self-applied polysomnography. Sleep parameters were averaged across nights. Overnight hypoxic burden was calculated from oximetry signal. Regression analyses, adjusted for age, gender, and depressive symptoms were used to examine associations between sleep and emotion recognition.

Results

In total 55 participants (47.3% males, mean age 46.4 ± 14.4 years, body mass index 27.9 ± 4.6 kg/m², apnea-hypopnea index (AHI)15.1 ± 15.6 events/hour, AHI ≥ 5 in 65%) completed the study. Mean reaction times (milliseconds) were 2746 ± 1294 for high intensity emotion, 2786 ± 995 for low intensity emotion, and 3308 ± 2192 for neutral stimuli, while recognition accuracy was 88.8 ± 8.9% for high intensity emotion, 73.3 ± 10.2% for low intensity emotion, and 85.0 ± 19.2% for neutral stimuli. Hypoxic burden metrics and sleep architecture, particularly desaturation severity (B = 363 ms for low intensity emotion, p <0.01), sleep efficiency (B = -335 ms for low p = 0.01, B = -415 ms for high intensity emotion p = 0.02) and REM percentage (B = -310 ms for low intensity, p = 0.02), independently predicted performance. Using multiple-night polysomnography improved the strength of the linear models compared to data from a single-night.

Conclusions

OSA-related hypoxic burden and sleep architecture are significantly associated with emotion recognition, underlying the importance of sleep for neurocognitive vulnerability.

Impulsivity as a mediator between insomnia and cannabis consumption

Background

Sleep-disordered breathing and impaired cellular "waste" clearance (due to autophagy dysregulation) contribute independently to cardiovascular morbidity in ageing populations, yet their interactive effects on cognitive function and cardiovascular outcomes remain incompletely characterized. We investigated associations between obstructive sleep apnea (OSA) severity indices, autophagy biomarkers, and cognitive function. Moreover, we identified predictors of cardiovascular outcomes in a community-dwelling cohort [1].

Materials and Methods

We conducted a prospective longitudinal analysis of 518 participants (mean age 49·4 years, 54·8% male) from The Akershus Sleep APnea (ASAP) cohort. Sleep parameters included the apnea-hypopnoea index (AHI), and average oxygen saturation (SpO₂) measured in all participants. Serum levels of Unc-51 like autophagy activating kinase 1 (ULK1) were quantified by ELISA in 503 participants as a marker of autophagy. Cognitive performance was assessed in 276-277 participants using the Rey Auditory Verbal Learning Test and Stroop interference measures. Associations between SpO2, natural logarithm transformed (ln) ULK1 and ln AHI with the two cognitive measurements were assessed using linear regression models adjusting for age, sex, education, cardiovascular disease, hypertension, diabetes, total sleep time and sleep efficiency. The longitudinal outcome was major adverse cardiovascular events (MACE) over 15 years in the full cohort (n=518).

Results

Higher ULK1 concentrations were associated with higher verbal learning over trials (β=0·69, 95% CI 0·09–1·29, p=0·023). Higher oxygen saturation was associated with enhanced total recall performance (β=0·57, 95% CI 0·01–1·13, p=0·044). Cardiovascular survival analysis (n=503) revealed participants with concurrent low ULK1 and low SpO₂ had nearly 3-fold increased MACE risk (HR 2·92, 95% CI 1·20–7·12, p=0·018) compared to those with either ULK1 and/or SpO₂ above median.

Conclusions

These findings illuminate mechanistic pathways linking OSA severity indices, autophagy biomarkers and cardiovascular health from middle-age adulthood into ageing populations. The combined use of blood based, and sensor-based biomarkers enhances cardiovascular risk prediction. ULK1 showed differential associations with learning capacity independent of sleep parameters, suggesting distinct neuroprotective mechanisms [2]. The study supports development of targeted interventions addressing both autophagy regulation and respiratory optimization for promoting healthy longevity.

Reference 1

Hrubos-Strom H, Nordhus IH, Einvik G, et al. Obstructive sleep apnea, verbal memory, and executive function in a community-based high-risk population identified by the Berlin Questionnaire Akershus Sleep Apnea Project. Sleep Breath 2012; 16(1): 223-31.

Reference 2

Zhang J, Wang HL, Veverova K, Vyhnalek M, Fang EF. Identification and potential clinical applications of novel autophagy/mitophagy proteins in the biofluids of Alzheimer's disease patients. Ageing Res Rev 2024; 99: 102378.

Automated sleep staging: multicentre validation of U-Sleep for Parkinson’s disease and REM sleep behaviour disorder

Introduction

People with dementia often suffer from behavioral and psychological symptoms such as psychosis, anxiety and agitation. In dementia, circadian rhythms become less robust, and this dysregulation can potentiate the symptoms (1). Virtual darkness therapy (VDT), i.e. blue wavelength depleted evening light, is effective for mania in bipolar disorders (2) and represents a promising treatment approach.

Objective: Determine the effectiveness, feasibility and safety of VDT in the evening and night as adjunctive treatment of agitation in patients with dementia.

Methods

DARK.DEM. is an open label single randomized controlled trial running from 2024-2027 at NKS Olaviken Gerontopsychatric Hospital, Norway. Participants are eligible for inclusion if they have dementia, all stages and etiologies, ≥50 years, and have clinically significant agitation (≥45 on Choen-Mansfield-Agitation Inventory (CMAI)). Exclusion criteria are total blindness, use of melatonin, clinically significant pain, depression or abstinence. A total of 72 patients will be allocated to either treatment as usual encompassing psychotropic drugs and environmental interventions or treatment as usual plus 14 days of blue wavelength depleted light from 20.00-07:30, defined as melanopic EDI ≤1 lux measured at eye level. Data will be collected at baseline, day 7, day 14 and at discharge. Digital data will be collected with Empatica Embrace Wristband and the sleep radar Somnofy providing information on movement, heart rate, respiration, sleep stages, skin electrical properties and temperature, data on light exposure will be collected with GeneActive. Primary outcome is 14 days change in agitation, secondary outcomes are other behavioral and psychological symptoms, circadian rhythm and sleep parameters, activities of daily living, quality of life, psychotropic drug use, medical restraints use and other resources.

Results

We will provide preliminary results on recruitment, feasibility and safety.

Conclusion

This is the first randomized controlled trial to explore the clinical usability of VDT on agitation in people with dementia. If effective and well-tolerated, it is a novel treatment that can be implemented in daily clinical practice at different levels of dementia care.

Reference 1

Leng Y, Musiek ES, Hu K, Cappuccio FP, Yaffe K. Association between circadian rhythms and neurodegenerative diseases. Lancet Neurol. 2019;18(3):307-18.

Reference 2

Henriksen TE, Skrede S, Fasmer OB, Schoeyen H, Leskauskaite I, Bjorke-Bertheussen J, Assmus J, Hamre B, Grønli J, Lund A. Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial. Bipolar Disord. 2016;18(3):221-32

The Impact of Insomnia on Wearable and Digital Sleep Diary Accuracy Against Polysomnography

Background

Sleep is regulated through coordinated brain–body communication, yet the influence of metabolic hormones on sleep architecture remains poorly understood. Glucagon-like peptide-1 (GLP-1) receptor agonists, widely used for obesity and diabetes, activate hypothalamic circuits involved in both metabolic and sleep homeostasis. Understanding the sleep-related effects of GLP-1 signaling has become increasingly important given the rapid expansion of GLP-1 agonist use.

Objective

To determine how GLP-1 receptor agonists influence sleep–wake architecture and sleep pressure in mice.

Methods

Adult male mice implanted with EEG/EMG electrodes received Semaglutide (10 nmol/kg), a GLP-1 receptor agonist, or saline for 14 days. Sleep–wake states were scored using standard EEG/EMG criteria during 24-hour baseline recordings and 24-hour recordings following treatment on days 0, 7, and 14.

Results

Semaglutide treatment increased non-rapid eye movement (NREM) sleep and reduced wakefulness, with the strongest effects observed in the early dark phase. Treatment also affected bout length and bout length distribution across wake, NREM, and rapid eye movement (REM) sleep, with longer NREM and REM bouts and shorter wake bouts. Additionally, slow-wave activity was reduced across the 24-hour cycle, indicating altered sleep-homeostatic regulation. These effects were consistently observed on day 0, 7, and 14.

Conclusion

This study provides one of the first detailed characterizations of how chronic GLP-1 receptor activation modulates neural sleep architecture. The findings demonstrate that peripheral metabolic signals can reshape central sleep-regulatory dynamics, highlighting the interaction between metabolic state and sleep homeostasis. These results have direct translational relevance, suggesting that metabolic therapies may influence sleep quality in individuals using GLP-1 receptor agonists.

Neurophysiological Dysfunctions in Polio Patients with Post-Polio Syndrome: A Descriptive Study

Background

Psychological well-being is markedly reduced in patients with depression. This study examined the association between self-reported sleep problems and psychological well-being in a large cohort of patients with depression prior to treatment initiation.

Materials and Methods

We included 7,051 adults with a primary diagnosis of depression or dysthymia (ICD-10 F32, F33, or F34.1) enrolled in a standardized depression treatment program in the Capital Region of Denmark between 2007 and 2022. Sleep problems were assessed using the sleep item from the Major Depression Inventory (MDI), and psychological well-being was measured by the 5-item World Health Organization Well-Being Index (WHO-5). Associations were estimated using multivariable linear regression with robust standard errors, adjusting for demographic and clinical variables including depression severity, anxiety, medication use, and somatic comorbidities.

Results

Sleep problems were highly prevalent, with only 5.5% of patients reporting no sleep problems. Complaints of problem with too little sleep were more common than complaints of too much sleep. Self-reported sleep problems were associated with lower psychological well-being in a stepwise manner. Compared with patients without sleep problems, those reporting short sleep, long sleep or with both had lower well-being scores (β = -11.1, -9.8, and -12.5, respectively), and associations remained robust after multivariable adjustment. No interaction by sex was observed.

Conclusions

In this large clinical sample of patients with depression, self-reported sleep problems were highly prevalent and associated with graduated lower psychological well-being. These findings highlight the importance of routine sleep assessment in patients with depression treatment.

Sleep regularity as a modifiable factor for blood pressure reduction: an exploratory randomized clinical trial

REM Sleep Without Atonia (RSWA) is associated with Parkinson’s disease and may serve as an early-stage biomarker. Polysomnography (PSG) is the diagnostic standard, but because RSWA fluctuates across nights, single-night PSG can miss or under-quantify it. Ear-EEG enables longitudinal assessment but poses challenges in assessing data quality. The sleep staging model USleep has shown strong performance on both PSG and ear-EEG, with low confidence scores identifying poor-quality recordings [1]. However, abnormal sleep physiology in RSWA may affect model performance and confidence scores. This study investigates the feasibility of applying the model and confidence-score–based exclusion procedure for reliable sleep scoring in an RSWA population.

The dataset included 26 subjects, each with one PSG night recorded simultaneously with ear-EEG at home and annotated by sleep experts. Models pretrained on large datasets were fine-tuned on RBD and Parkinson’s populations. The PSG model used scalp-EEG and EOG, while the ear-EEG model used mastoid EEG. Confidence scores were computed for each recording to identify poor-quality data following our proposed procedure.

The PSG and ear-EEG models achieved Cohen’s kappa of 0.64 ± 0.15 and 0.44 ± 0.22, with REM F1-scores of 0.71 ± 0.27 and 0.62 ± 0.37, respectively. Confidence scores were moderately correlated with kappa (R² = 0.43). The proposed method excluded eight ear-EEG recordings. Human evaluators identified two poor-quality and three questionable-quality recordings, all of which were automatically excluded by the proposed procedure. Mean kappa values were 0.30 ± 0.17 for excluded recordings and 0.46 ± 0.14 for included recordings.

Among the included recordings, sleep metrics from ear-EEG, such as per-stage percentages and REM Stability Index, did not differ from human scoring, except for number of stage transitions (p < 0.01).

This demonstrates the feasibility of using ear-EEG for sleep studies in RSWA together with automated sleep staging and confidence score–based quality assessment.

Reference 1

[1] Banluesombatkul, Nannapas, et al. "Sleep Analysis Using Longitudinal Ear-EEG Recordings." Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference. Vol. 2025. 2025.

Brain alterations following cognitive behavioral therapy for insomnia: A systematic review of the neuroimaging literature

Background

Targeted Memory Reactivation (TMR) during NREM sleep can strengthen recently encoded memories. However, demonstrating these effects during simultaneous EEG–fMRI remains challenging due to the difficulty of achieving stable sleep in the scanner. This study aimed to examine whether associative memories can be selectively strengthened inside the MRI environment during sleep, and whether such reactivation leads to observable improvements in memory.

Materials and Methods

Participants (N=30) completed an associative learning task before undergoing an EEG–fMRI scanning period, in which they attempted to sleep. If stable NREM sleep was detected, auditory cues corresponding to a subset of previously learned items were presented. Memory performance was assessed using an 8-alternative forced-choice test before sleep (AFC1), immediately after (AFC2), and again five days later (AFC5). Memory for cued and uncued items were compared using within-subject analyses of variance.

Results

16 participants had periods of stable NREM sleep in the scanner, ranging between 23 and 113 min (median=78). As verified by offline sleep staging, ~75% of the cues were played during NREM sleep stages 2 or 3. There was a clear TMR benefit at the post-sleep test, with cued items remembered more accurately than uncued items (F(1,15) =13.55, p = .002, η² = .03). Whereas memory performance declined after 5 days recall (F(1,15) = 180.72, p < 0.001, η² = 0.85), the interaction between TMR and time was not significant, indicating a durable effect of nocturnal cueing up to 5 days after encoding.

Conclusion

These findings demonstrate that it is feasible to obtain stable NREM sleep and elicited TMR inside the MRI scanner. Moreover, memory reactivation during N2/N3 sleep yields detectable behavioral benefits even under the highly constrained conditions of the EEG-fMRI acquisition. This work highlights the potential of combined EEG-fMRI to uncover the neural mechanisms supporting sleep-dependent memory consolidation.

EVIDENCE-BASED OVERVIEW OF EXERCISE-BASED THERAPIES FOR OBSTRUCTIVE SLEEP APNEA: PROGRAM DESIGN AND OUTCOMES

Background

Around one-third of patients with major depressive disorder (MDD) have treatment-resistant depression (TRD). Obstructive sleep apnea (OSA) is more prevalent among individuals with MDD, and its treatment reduces depressive symptoms. Therefore, untreated OSA could even explain a substantial proportion of TRD – yet the prevalence of OSA in TRD patients remains unclear to date.

Objective

The aim was to estimate the prevalence of OSA in TRD through a systematic review and meta-analysis.

Methods

A systematic literature search was conducted in 07/2025 for Embase, PsycINFO, PubMed, and ProQuest databases. Articles were included if they reported a prevalence estimate of OSA in individuals characterized as having TRD. The review was conducted in accordance with PRISMA guidelines. Study quality was assessed using Joanna Briggs Institute’s critical appraisal tools. A meta-analysis was performed using a random-effects generalized linear mixed model with a logit link function, and heterogeneity was quantified and explored using leave-one-out analyses.

Results

The search identified 1148 records of which 914 remained after duplicate removal, and six studies (k = 6) met the inclusion criteria. Key qualitative findings were the scarcity of studies reporting OSA prevalence, varying sample sizes, and methodological biases in the literature, including ascertainment bias. The pooled prevalence estimate of OSA in TRD patients was 38.8% (95% CI, 0.204–0.609) with very high heterogeneity (I² = 96%).

Conclusion

The results illustrate the need for future studies that systematically screen TRD patients for OSA and useharmonized criteria for both OSA and TRD. The pooled prevalence estimate of 38.8% should be interpreted with caution due to the limited number of studies, their heterogeneity, and biases. The estimate nevertheless suggests that systematic OSA screening in MDD patients should be implemented, particularly in those who do not respond to treatment.

Prolonged prescription rates of Z-hypnotics and benzodiazepines among individuals with chronic musculoskeletal pain and insomnia

Parkinson’s Disease (PD) is one of the most common and debilitating neurological disorders worldwide. Currently, the disease is often being diagnosed at a too advanced degree of progression to be treated effectively. However, clinical evidence suggests that early disease symptoms, such as alterations to the autonomic physiology, can be observed during a full night sleep monitoring. In this study, we investigated the potential of heart rate variability (HRV)-based biomarkers for differentiating clinical phenotypes reflecting distinct degrees of progression and manifestations of the α-synuclein–related pathology, both at the group level and the individual level.

A total number of 175 full nights of sleep from 52 healthy controls, 33 patients with idiopathic REM behavior disorder (iRBD), 33 patients with PD without RBD (PD-RBD) and 50 patients with PD and RBD (PD+RBD) were analyzed. The HRV biomarkers were computed on a per–sleep-stage basis, from the electrocardiogram (ECG) excerpts characterized by predominant sinus rhythm, during stable sleep stages. Multivariate Linear Mixed Modelling approach was used to identify autonomic markers sensitive to the patient group, also in interaction with the sleep stages. Furthermore, a Multiclass Logistic Regression classifier was trained and used to predict the patient group based on a selected subset of the autonomic markers across sleep stages. Importantly, predictions were made based on a simplified representation of the autonomic function (combination of HRV features) throughout the entire night.

Firstly, a marker representing slow oscillations in the HRV throughout the night (Low Frequency (LF) Spectrum component) differed significantly between patient groups (F(3, 175,5) = 4.05, p < 0.01). Secondly, a Multiclass Logistic Regression classifier was able to identify the patient group with above-chance level accuracy 61.97% ± 7.88% across 7 fully independent data splits.

This study indicates that information about the individual’s autonomic function throughout the night may be used to identify early signs of Parkinson’s Disease.

Introduction

NT1 is a rare neurological disorder associated with the loss of neurons that synthesize orexin and characterized by excessive daytime sleepiness, cataplexy, and disturbed nocturnal sleep. Oveporexton, a selective oral agonist of the orexin receptor 2, restores orexin signaling. Two Phase 3 studies, The First Light and The Radiant Light, evaluated the efficacy, safety, and impact of oveporexton in patients with NT1.

Materials and methods

Both randomized, double-blind, placebo-controlled studies recruited adults aged 16-70 diagnosed with NT1 according to ICSD3/ICSD3-TR criteria, supported by daytime sleep latency tests and orexin concentration in CSF ≤110 pg/mL, with an ESS score ≥11 and ≥4 episodes of weekly cataplexy in the absence of treatment. Patients received oral oveporexton (1 mg [First Light only] or 2 mg, twice daily) or placebo for 12 weeks. The primary endpoints were change in sleep latency on the maintenance of wakefulness test (MWT) and reduction in sleepiness (Epworth Sleepiness Scale, ESS) from baseline to week 12. Weekly frequency of cataplexy (Weekly Cataplexy Rate, WCR) at week 12, and the occurrence of treatment-emergent adverse events (TEAEs) were evaluated.

Results

In both trials, oveporexton demonstrated statistically and clinically significant improvements in sleep onset latency (MWT), sleepiness (ESS) and cataplexy (WCR) (Table). TEAEs were experienced by 111/126 (88%) and 60/70 (86%) of oveporexton-treated participants in the First Light and Radiant Light trials, respectively. The most common TEAEs were pollakiuria and insomnia; no drug-related serious TEAEs were observed. Overall, 258 (94.5%) participants completed the studies, of whom 250 (97%) continued into the extension study.

Conclusions

In these two phase 3 studies, oveporexton, administered over 12 weeks, demonstrated significant efficacy in improving wakefulness, reducing sleepiness, and decreasing the frequency of cataplexy attacks in people with NT1, with overall satisfactory tolerability, paving the way for a new era in treatment.

Efficacy of a Transdiagnostic Sleep and Circadian Intervention for Psychiatric Outpatients with Sleep Problems

Background

Patients with mental disorders frequently experience sleep disturbances such as insomnia or circadian rhythm disorders, which exacerbate symptoms and reduce quality of life.

Objective

This trial investigated the efficacy of a Danish adaptation of a transdiagnostic sleep and circadian intervention (TranS-C) combining cognitive behavioural therapy for insomnia (CBT-I) with chronotherapy in outpatients with depression, attention deficit disorder, or bipolar disorder.

Methods

Eighty-eight outpatients with comorbid insomnia or circadian rhythm disorders were randomized to the intervention group (six individual sessions over six weeks) or to a control group (single session of sleep hygiene education). Primary outcomes were sleep quality and insomnia severity. Secondary outcomes included well-being, personal recovery, work ability, perceived overall health, sleep efficiency, sleep onset latency, wake after sleep onset, nocturnal awakenings, and use of sleep medication. Data were collected through validated questionnaires, actigraphy, and sleep diaries at baseline, week 2, and week 6; actigraphy and diaries were applied continuously throughout the trial.

Results

From baseline to week 6, the intervention group showed significant improvements compared with controls in sleep quality (p < 0.001) and insomnia severity (p < 0.001). Significant gains were also observed in well-being (p = 0.002), personal recovery (p = 0.037), work ability (p < 0.001), and perceived overall health (p = 0.004). No significant between-group differences were found in objective sleep measures derived from actigraphy or diaries.

Conclusions

The transdiagnostic intervention was effective in improving subjective sleep quality and insomnia severity and was associated with broader benefits in well-being, recovery, work ability, and perceived health among psychiatric outpatients. These findings indicate that structured sleep-focused interventions can play a valuable role in routine mental health care.

Evaluating Short- and Long-Delay Effects of Targeted Memory Reactivation During Sleep in the MRI Environment

Background

Wearable consumer health trackers (CHTs) are typically only validated on small healthy samples. Insomnia is the most prevalent, nonorganic sleep disorder, and being often excluded from validations might introduce additional bias.

Objective

To determine if measurement bias in CHTs and digital sleep diaries differs between individuals with and without insomnia symptoms.

Methods

A total of 46 participants with a valid polysomnography (PSG) ≥4h wore a CHT, answered a diary (n=42), and completed the Insomnia Severity Index (ISI, n=41). The cohort was stratified into 2 groups based on ISI score: Few Symptoms (Healthy/Subthreshold, n=22) and Clinical Symptoms (Moderate to Severe, n=19). Total Sleep Time (TST) of the same night was analyzed and compared using Bland-Altman (BA) plots. To address measurement differences between ISI groups, Mann-Whitney test was used.

Results

BA analysis showed a lower Mean Bias (MB) and narrower Limits of Agreement (LoA) in diaries (MB = 20.92 min; LoA Low = -83.33, LoA High = 125.17) than wearables (MB = 59.11 min; LoA low = -151.75, LoA High = 269.98). No significant difference in measurement bias was found between the ISI groups for diaries (U = 195.0, p = 0.455) or CHTs (U = 236.5, p = 0.48). However, a visible trend for increased variability within the Clinical Symptoms ISI group was found (Figure 1).

Conclusion

Though diary-reported TST was, on average, more accurate, the individual variability was large in both measurements. Insomnia severity did not introduce significant bias to the measurements but a trend for a CHT difference was seen. Therefore, CHT may be more sensitive to clinical conditions due to a lack of validation but this requires more research on larger mixed cohorts.

Acknowledgments

This work was funded by the European Union's Horizon 2020 Research and Innovation Programme (965417).

The relationship between sleep and menstrual health in adolescents: A scoping review

Background

Sleep occupies nearly one-third of human life, yet its quality and patterns fluctuate daily due to a mix of internal and external factors. Historically, understanding these multiday variations has been limited by the difficulty of collecting reliable, long-term EEG data outside clinical environments. Recent advances in ultra long-term subcutaneous EEG (sqEEG) technology now enable continuous, yearlong home-based sleep monitoring, opening new avenues for investigating how seasonal changes, weekdays, holidays, weather, and physical activity affect sleep.

Objective

This study aimed to characterize multiday sleep periodicities and assess the impact of both internal biological rhythms and external cues, including environmental and behavioral factors, on sleep architecture over a full year.

Methods

Twenty healthy subjects underwent continuous sqEEG recording at home for 365 nights. Sleep macrostructure was quantified using hypnograms, measuring total sleep time (TST), sleep stages (N1, N2, N3, REM), sleep onset/offset, latency, efficiency, and wake after sleep onset (WASO). Analyses included permutation tests for seasonal, weekly, and holiday effects, correlations with meteorological data, and smartwatch-derived activity metrics. Sex differences and menstrual cycle effects were also explored.

Results

Most subjects (70–100%) exhibited individual multiday cyclicity in sleep parameters (TST, latency, REM latency, WASO) over individual cycles between 8-60 days, largely independent of external factors. Seasonal effects included reduced TST and WASO in summer, with more N3 and less REM sleep. Weather variables, especially temperature and sunlight, are negatively correlated with TST. Weekends and holidays shifted sleep timing later, with altered sleep composition and reduced sleep on New Year’s Eve. While males and females showed similar overall trends, seasonal patterns differed by sex.

Conclusion

Sleep is governed by complex interactions between intrinsic biological cycles and external influences. While environmental and social factors can temporarily disrupt natural sleep rhythms, individual multiday patterns persist, highlighting the importance of personalized approaches to sleep health.

Reference 1

Helge AW, Arguissain FG, Lechner L, Gritsch G, Duun-Henriksen J, Ahrens E, Kluge T, Hartmann M. Longitudinal, EEG-based assessment of sleep in people with epilepsy: An automated sleep staging algorithm non-inferior to human raters. Clin Neurophysiol Pract. 2025 Jan 27;10:30-39. doi: 10.1016/j.cnp.2025.01.001

Serum Biomarkers and Association with Severity of Obstructive Sleep Apnea

Background

Valerian (Valeriana officinalis L.) has been historically used as an anxiolytic and sedative and has become commonly used as self-treatment, however its effectiveness on improving sleep issues, specifically sleep onset latency (SOL), remains uncertain due to mixed findings. While previous reviews focused on individuals with diagnosed insomnia, it is important to examine the effects of valerian on individuals with milder sleep disturbances, who might be common users of such products.

Objective

This review aimed to address these gaps by focusing on single-ingredient valerian preparations and evaluate the effects of valerian on SOL in populations with and without sleep disorders.

Methods

A systematic literature search was conducted across multiple databases (Scopus, PubMed, Web of Science) to identify randomised controlled trials assessing the impact of valerian on SOL. Data extraction and quality assessment of studies were carried out independently by two reviewers, the latter by using the Cochrane Risk of Bias tool 1.0.

Results

Of 1189 papers, 16 studies with 1593 subjects met inclusion criteria and were assessing SOL, including six cross-over and ten parallel-group trials. Study duration ranged from 1 to 56 days, with valerian doses between 200 and 900 mg/day. Populations varied across studies, with some including participants without comorbidities, while others focused on individuals with sleep disorders or other conditions (e.g. cancer). SOL was assessed using both objective methods (actigraphy, polysomnography, EEG) and subjective measures, although only nine studies reported SOL in minutes. Overall, findings regarding the effects of valerian on SOL were inconsistent across studies. Risk of bias varied, with most domains judged as unclear due to limited methodological reporting. High risk of bias was most frequently identified for incomplete outcome data and selective reporting.

Conclusion

The available evidence on the effects of valerian on SOL is limited and highly heterogeneous, since the studies varied considerably in terms of interventions and methodologies, resulting in inconsistent findings and making it difficult to draw definitive conclusions about effect size. In conclusion, the variability and methodological differences across studies highlight the need for more rigorous and standardized research in this area.

Efficacy and safety of oveporexton (TAK-861) in narcolepsy type 1 in two phase 3 trials

Background

Restless legs syndrome (RLS) is a chronic condition that poses significant challenges in diagnosis and treatment due to its variability, affecting both individuals and their families. Although the process of adapting to chronic illness is well documented, few qualitative studies have explored this experience among family members who live together with individuals with RLS.

Objective

To explore and describe the experiences of daily life among family members living together with an individual diagnosed with RLS.

Methods

An inductive exploratory design with qualitative content analysis was selected as the most appropriate method. The participants (n = 25) were strategically chosen family members recruited through a national RLS organization. Semi-structured interviews were conducted after their relatives with RLS had given consent to be contacted for a qualitative interview. An informational letter was sent to all 25 family members, and all agreed to participate. A semi-structured interview guide was used for telephone interviews. The interviews, lasting 25–90 minutes were audio-recorded and transcribed.

Results

Thirteen men and twelve women (average age 65.4 years, range 53–82) participated in interviews. The family members’ experiences were categorized into four categories: managing the effects on the person with RLS; assessing their own situation in relation to the person with RLS; adjusting to the impact of the person with RLS; and supporting the person with RLS. Participants highlighted the importance of finding effective ways to cope with both emotional and practical challenges associated with their relatives’ RLS.

Conclusion

Gaining a deeper understanding of how family members experience living with an individual who has RLS can improve healthcare professionals’ knowledge of the condition’s impact on daily life. This increased insight can also emphasize the important role family members play in the context of RLS.

Keywords: family, family nursing, qualitative content analysis, sleep, support, Willis Ekbom Disease

Altered sleep architecture in people with mild to severe dementia

Figure 1. The contribution of season to z- and log-transformed aMT6s/Cr. The grey area represents the 95 % confidence interval.

Background

Nocturnal melatonin secretion increases in response to prolonged scotoperiods in many species (1). In humans, nocturnal melatonin concentrations are closely related to sleeping behavior. With accumulating evidence for the involvement of melatonin in metabolic disease (2), it has become increasingly important to identify potential factors that influence melatonin levels.

Objective

To examine how seasonal photoperiod and self-reported quality of sleep were related to nocturnal melatonin concentrations in an urban, population-based setting.

Methods

Within the Malmö Offspring Study, overnight urine samples and data on self-reported sleep were obtained at baseline (year 2013-2021) from > 5000 adult individuals. In Malmö (55.6° N), the length of the photoperiod varies from ~ 7 to 17 hours depending on season. We analyzed the melatonin metabolite 6-Sulfatoxymelatonin (aMT6s) and creatinine (Cr) in urine. The cross-sectional relationship between month of the year and sex-stratified standardized log-transformed ratio (aMT6s/Cr) was modelled using a cubic cyclic spline regression. ANOVA-test was used to compare aMT6s/Cr between five groups based on frequency of sleep disruption on an average week.

Results

Seasonal variation in aMT6s/Cr was statistically significant but modest (p=0.005), with the highest concentrations in summer and lowest in winter (Figure 1). The median levels were 34 ng/mg in winter (Dec-Feb) compared to 38 ng/mg in summer (Jun-Aug). A higher self-reported frequency of sleep disruption was associated with lower aMT6s/Cr levels (p=0.024).

Conclusion

In an urban environment, the influence of both seasonal photoperiod and the frequency of sleep disruption on nocturnal melatonin concentrations appears to be limited. Given the well-established melatonin-suppressing effect of light exposure, the slightly lower nocturnal melatonin concentrations observed during the darkest months in our study may be attributable to exposure to artificial light. Future studies are warranted to identify factors contributing to the substantial interindividual variation in melatonin levels.

Reference 1

Wehr TA, Moul DE, Barbato G, Giesen HA, Seidel JA, Barker C, et al. Conservation of photoperiod-responsive mechanisms in humans. Am J Physiol. 1993;265(4 Pt 2):R846-57.

Reference 2

McMullan CJ, Schernhammer ES, Rimm EB, Hu FB, Forman JP. Melatonin secretion and the incidence of type 2 diabetes. JAMA. 2013;309(13):1388-96.

Video-polysomnography (vPSG) is essential for diagnosing REM sleep behavior disorder (RBD), but sleep staging is time-consuming and especially challenging in Parkinson’s disease (PD) and isolated RBD (iRBD). As iRBD remains the strongest prodromal marker of α-synucleinopathy1, screening efforts are expanding, leading to increased demand for vPSG and sleep staging.

We aimed to adapt U-Sleep for automated sleep staging in PD and iRBD by fine-tuning it on two research datasets (116 PD, 137 iRBD, 86 controls). We evaluate its robustness across datasets, including an independent clinical dataset from the Danish Center of Sleep Medicine (DCSM, 81 PD, 36 iRBD, 87 controls). Linear mixed-effects models and blinded re-assessments by a second human rater were used to identify predictors and patterns of low agreement between human raters and the model. Finally, we leveraged the U-Sleep confidence estimates to improve REM sleep staging.

The fine-tuned U-Sleep model improved the mean Cohen’s κ from 0.66 to 0.74 compared to a pretrained model (p < 0.001), and F1 scores significantly improved across all sleep stages (p < 0.001). This model achieved an average κ of 0.64 on the clinical hold-out dataset from the DCSM. Further site-specific fine-tuning provided only marginal improvements. Interrater comparisons demonstrated that PSGs with low agreement between the model and the initial scorer are inherently challenging to score, as evidenced by low interrater agreement among human scorers. U-Sleep confidence proved to be an independent and significant predictor of κ. By applying a REM sleep confidence threshold of 0.8, the percentage of correctly identified REM epochs rose from 85% to 95%.

This adapted U-Sleep model provides a scalable and standardized approach to sleep staging and REM detection in PD and iRBD. Automated sleep staging may facilitate future clinical workflows and enable the use of scalable EEG devices for home-based sleep staging and RBD detection.

Reference 1

Heinzel, S. et al. Update of the MDS research criteria for prodromal Parkinson's disease. Movement disorders 34, 1464-1470 (2019).

Automatic Sleep Scoring using Ear-EEG in RSWA-population

Background

Restless Legs Syndrome (RLS) is a neurological disorder affecting 3% of the global population. It is characterized by an irresistible urge to move the limbs and discomfort in the evening which significantly disrupts sleep. Diagnosis depends largely on patient-reported symptoms and interpretation by the physician. While there are treatments available, their effectiveness varies, making communication crucial. To overcome the limited understanding of how patients with RLS communicate their experiences or engage in decisions is vital.

Objective of the project

To investigate communication and shared decision-making between patients with RLS and physicians.

Specific objectives (in the sub-studies)

(1) To explore how patients communicate symptoms and engage in shared decision-making during consultations at specialized neurological clinics.

(2) To examine patients’ perceptions of communication and shared decision-making during initial visits.

(3) To evaluate the psychometric properties of the Four Habits Patient Questionnaire (4HPQ) and the Observing Patient Involvement (OPTION) scale in the context of RLS treatment discussions.

(4) To assess sociodemographic and clinical factors associated with 4HPQ and OPTION scores among working and retired patients.

(5) To examine the mediating roles of communication and treatment attitudes in the relationship between RLS symptoms and patient involvement.

Methods

A mixed-methods approach will be used. Studies I and II employ abductive designs, including multimodal conversation analysis of 20 video-recorded consultations between patients with RLS and neurologists at specialized clinics. Two weeks later, interviews will be conducted with the patients. Studies III–V use a cross-sectional design with 200 primary healthcare patients with RLS. Inclusion criteria: age ≥18 years, RLS diagnosis and written informed consent. Questionnaires for RLS symptoms, sleep quality, communication, shared decision-making, and patient involvement will be used.

Conclusion

This project will clarify how patients with RLS communicate with physicians and engage in shared decision-making, identify factors influencing patient involvement, and validate assessment tools.

Keywords: Communication, shared decision-making, patient involvement, protocol, Willis Ekbom Disease

Content and evaluation of a digital CBT intervention to improve QoL for patients with RLS

Background

Adolescents who are relatively younger within their classroom (i.e., born later in the year) have been related with poorer academic achievement and higher levels of psychological distress, which may also affect sleep patterns. Regarding this, little is known about whether relative age influences sleep medication use.

Objectives

This study aimed to examine trends in sleep medication use among adolescents with sleep difficulties and to explore differences according to relative age.

Methods

Data were drawn from the 2017/18 and 2021/22 Swedish Health Behavior in School-aged Children (HBSC) surveys. Total sample included 4,411 participants with sleep difficulties (54% girls; n=2,383), of whom 47.9% (n=2,113) were relatively younger. Self-reported sleep difficulties and past-month sleep medication use were assessed. Prevalence ratios were calculated to examine differences across cohorts and age groups.

Results

Between 2017 and 2021, the prevalence of sleep problems increased by 6.8% (X2=39.6; p<0.001). This increase was associated with a rise in the prevalence of sleep medication use among adolescents with sleep problems, from 11.1% in 2017 to 14.1% in 2021 (prevalence ratio=1.27; X2=8.3; p=0.004). The increase was more pronounced among relatively younger adolescents, whose prevalence rose from 11.0% to 16.2 %, representing 1.47 times higher prevalence than in the previous cohort (X2=10.8; p=0.001). Among relatively older adolescents, prevalence increased from 10.9 % to 12.0% with no significant differences (prevalence ratio=1.11; X2=0.6; p=0.435).

Conclusions

Sleep medication use among Swedish adolescents with sleep problems increased between 2017 and 2021, with a more pronounced rise among relatively younger adolescents. This suggests that relative immaturity may be more frequently interpreted as a clinical problem. The higher prevalence of medication use in this group highlights the need to consider age-related factors when assessing sleep problems and deciding on treatment strategies, to avoid potential overmedicalization.

Chewing efficiency and tongue strength outcomes of orofacial myofunctional therapy for obstructive sleep apnea

Background

Insomnia has been linked to alterations in the reward system, which may promote immediate reward-seeking behaviors, such as substance use. In this context, cannabis is commonly used as a sleep aid despite being associated with adverse health outcomes. The relationship between insomnia, impulsivity, and cannabis use remains poorly understood. Therefore, this study aimed to examine the mediating role of impulsivity in the relationship between insomnia and cannabis use among college students.

Method

Data were drawn from the ANSWERS survey, which included a sample of 971 U.S. college students (mean age= 20.6±4.1 years; 73.4% women). Participants completed standardized measures assessing insomnia severity, trait impulsivity, frequency of cannabis use, and its use as sleep aid. Mediation analyses were performed to test both direct and indirect associations between insomnia and cannabis use via impulsivity.

Results

Overall, 20% (n=194) of participants reported weekly cannabis use, among whom 54.1% (n=109) reported using it regularly to help them sleep. Mediation analyses showed that insomnia severity was significantly associated with impulsivity (aβ=0.21; p<0.001), and in turn, impulsivity was related to weekly cannabis use (bβ=0.20; p<0.001). The indirect effect of insomnia on cannabis use via impulsivity was significant (abβ=0.04; p<0.001), whereas the direct association was not statistically significant (c’β=0.06; p=0.081). Regarding cannabis self-medication, both the indirect effect via impulsivity (abβ=0.03; p<0.001) and the direct effect of insomnia were significant (c'β=0.08; p=0.019).

Conclusions

These findings suggest that the association between insomnia severity and weekly cannabis use among college students is partially explained by increased impulsivity. In contrast, cannabis use as a sleep aid appears to be driven by both greater impulsivity and the direct effect of insomnia, suggesting an additional motivation for use. Interventions aimed at improving sleep may help reduce impulsivity and prevent the maladaptive substance use among young adults.

Insomnia and suicidal ideation: exploring the role of interpersonal factors in college students

Background

Obstructive sleep apnea (OSA) affects over 70% of stroke survivors and is associated with worse recovery and increased cardiovascular risk. Continuous Positive Airway Pressure (CPAP) is the first-line treatment for OSA, effectively reducing apneic and hypopneic events and improving nocturnal oxygenation, but its effects on major adverse cardiovascular events (MACE) and mortality are still uncertain. The effect of CPAP may differ by stroke subtype, due to differences in pathophysiology, lesion location, and autonomic regulation, which could influence cardiovascular responses to therapy.

Objective

This work aimed to investigate the differential effects of CPAP on MACE and mortality across stroke subtypes.

Study design and methods

We conducted a retrospective cohort study using the TriNetX US network to evaluate outcomes in stroke survivors with OSA. Two cohorts were established: patients with hemorrhagic stroke and those with ischemic stroke, both treated with CPAP within one year of OSA diagnosis. Propensity score matching (PSM) (1:1 ratio) was applied to balance baseline characteristics, including demographics, comorbidities, medications, and stroke severity. The primary outcomes were one-year major adverse cardiovascular events (MACE) and all-cause mortality, reported as hazard ratios (HR) with 95% confidence intervals (CI). Sensitivity analyses excluded events within the first 30 days after CPAP initiation to minimize reverse causation.

Results

After PSM, 2,163 patients per group had balanced baseline characteristics. Among those with CPAP therapy, hemorrhagic stroke survivors had higher all-cause mortality compared to ischemic stroke survivors (HR 1.48, 95% CI 1.26–1.74). Conversely, the risk of MACE was lower for hemorrhagic stroke survivors (HR 0.54, 95% CI 0.39–0.74). Sensitivity analyses confirmed these results, showing HRs of 1.70 (95% CI 1.35–2.13) for all-cause mortality and 0.67 (95% CI 0.46–0.98) for MACE.

Conclusion

Stroke subtype may influence the effectiveness of CPAP on clinical outcomes, as hemorrhagic stroke survivors exhibited higher mortality but lower risk of MACE compared with ischemic stroke survivors. These results underscore the need for subtype-specific risk stratification and management in stroke patients with OSA, suggesting that tailored monitoring and interventions may improve survival and cardiovascular outcomes.

Keywords: Stroke, OSA, CPAP.

Reference 1

Sampsonas, F., Karamouzos, V., Doulberis, M., Karkoulias, K., Lykouras, D., Steiropoulos, P., & Tzouvelekis, A. (2025). Post-stroke sleep disordered breathing and the effect of positive airway pressure treatment: An updated systematic review and meta-analysis of randomized control trials. Sleep medicine reviews, 85, 102207. Advance online publication. https://doi.org/10.1016/j.smrv.2025.102207

Reference 2

Akyea, R. K., Georgiopoulos, G., Iyen, B., Kai, J., Qureshi, N., & Ntaios, G. (2022). Comparison of Risk of Serious Cardiovascular Events after Hemorrhagic versus Ischemic Stroke: A Population-Based Study. Thrombosis and haemostasis, 122(11), 1921–1931. https://doi.org/10.1055/a-1873-9092

Effectiveness of Barbed Reposition Pharyngoplasty with Tonsillectomy in Treating Obstructive Sleep Apnea: Danish Retrospective Study

Background

Restless Legs Syndrome (RLS) is a chronic condition that affects approximately 3% of people worldwide. The condition leads to uncomfortable sensory-motor symptoms, sleep problems, and a significant symptom burden, which affects daily life. Successful pharmacological treatment is difficult to establish, which means that patients often experience persistent symptoms. This highlights the need to explore which self-care strategies are used and beneficial by patients.

Objective

To describe the self-reported use and perceived benefits of self-care among patients with RLS.

Methods

A nationwide cross-sectional survey was conducted through a national RLS organization. Data on self-care behaviors (RLS-ScBq), RLS symptoms (RLS-6), sleep quality (PSQI), daytime sleepiness (ESS), depressive symptoms (PHQ-9), overall perceived health (GPH), and eHealth literacy (eHEALS) were collected by validated questionnaires. Use and benefit of self-care activities are presented with percentages.

Results

The study included 788 participants (mean age 70.8 years; response rate 52%). Most were women (65%) and used dopamine agonists (79%). Only 20% were satisfied with treatment. Severe RLS symptoms were reported by 44% at night and 37% during the day. The global PSQI score was 12 (q1-q3: 10,14) and 43% indicated excessive daytime sleepiness. The self-care activities with highest scores on use were physical exercise, distraction, listening to music, and reading books, which were reported as “often used” by 42%, 29%, 28% and 26% of the patients, respectively. The self-care activities with highest scores on benefit were physical exercise, using stretching, listening to music and distraction, which were reported as “moderately useful” by 41%, 30%, 30% and 26% of the patients, respectively.

Conclusion

These results highlight the importance of a more integrated care approach that combines pharmacological treatment with personalized self-care guidance considering both use and benefits of RLS specific self-care activities to improve symptom management.

Keywords: self-care, symptom burden, sleep, Willis Ekbom Disease

Examining visual and circadian system integrity in a sighted patient with non-24-hour sleep-wake disorder (N24SWD)

Background

Insomnia disorder is a chronic medical condition affecting 12% of adults. Although CBTi is recognized as an important first line therapy it can be challenging to access and implement. Therefore, many individuals with insomnia disorder receive medications, often for prolonged periods of time. The potential for abuse of hypnotics can prevent patients from accessing necessary medications to effectively treat insomnia as a chronic condition. This study examined the real-world abuse potential of approved and off-label medications used for the treatment of insomnia, employing data from the FDA Adverse Event Reporting System (FAERS) database.

Method

Data from 1 January 2014 to 31 March 2024 were retrieved from the FAERS database. We compared the occurrence of unsolicited reported drug abuse events in Schedule IV drugs (benzodiazepines, Z-drugs, dual orexin receptor antagonists [DORAs]) and non-scheduled drugs (trazodone, doxepin, ramelteon). Trazodone was selected for comparison as it is one of the most widely prescribed medications for insomnia in the US, despite it not being Presentation: this condition. Relevant reported adverse events denoting drug abuse were identified if they contained an event with any preferred terms (PTs) from the categories: drug abuse, dependence, and withdrawal. Only PT's with a frequency threshold > 1% in any drug group are reported. Trazodone and zolpidem were used as reference drugs. Reporting odds ratios (ROR) and proportional reporting ratios (PRR) were used as disproportionality measures.

Results

Rates of adverse event cases of abuse, dependence, and withdrawal were highest for benzodiazepines Presentation: any indication (27.7%), followed by benzodiazepines Presentation: insomnia (23.0%), trazodone (22.7%), doxepin (22.3%), Z-drugs (15.3%), ramelteon (8.0%), and DORAs (2.6%). DORAs were associated with a low ROR value relative to Z-drugs (ROR = 0.150; 95% CI [0.131, 0.171]), and to trazodone (ROR = 0.092; 95% CI [0.081, 0.105]). Similar results were obtained using the PRR to measure disproportionality.

Conclusion

This study identified significantly fewer reported cases of abuse, misuse, overdose, dependence and withdrawal for DORAs compared with benzodiazepines and z-drugs. The DORA class had significantly lower odds of reporting for adverse events denoting drug abuse when compared with both zolpidem and trazodone.

Referral Pathways for Obstructive Sleep Apnea in Latvia: Insights from an Ambulatory Sleep Diagnostics Center

Introduction

Daridorexant is a dual orexin receptor antagonist Presentation: the treatment of adult patients with insomnia disorder. Following single-dose administration at bedtime to healthy non-elderly and elderly subjects, pharmacodynamics (PD) and safety were investigated in the middle of the night (MOTN) after forced awakening to a noise stimulus.

Methods

Double-blind, placebo-controlled, randomized, 3-way crossover study (placebo, 25, and 50 mg daridorexant in the evening) in 36 male and female non-elderly and elderly subjects (1:1 sex/age ratio). Four hours after bedtime administration, the auditory awakening threshold (AAT) was determined (increasing noise signal up to 100 dB). Next, the main PD endpoint postural stability (body sway) as well as basic functional mobility (Timed Up and Go (TUG) test), and cognitive function/memory using the Visual Verbal Learning Test (VVLT) were assessed. Thereafter, subjects returned to bed.

Results

All 36 subjects completed the study. The average AAT was approximately 60 dB across treatments with no differences between daridorexant and placebo. Body sway showed a small, dose-dependent increase vs placebo with differences in least square means (LSM) 95% confidence interval (CI) of 36.7 (2, 71) mm and 65.9 (31, 100) mm, for daridorexant 25 and 50 mg, respectively. The overall increased body sway was driven by non-elderly subjects, as effects in elderly were similar to placebo. Subjects completed the TUG test in 6–8 s across treatments, with a small, dose-dependent increase vs placebo with a difference in LSM (95% CI) of 0.14 (0.02, 0.27) s and 0.47 (0.34, 0.59) s for daridorexant 25 and 50 mg, respectively. The VVLT (immediate and delayed number of correctly recalled words) showed minimal differences in LSM (95% CI) to placebo of up to –1.0 (–1.5, –0.5) words and –0.7 (–1.2, –0.2) words for daridorexant 25 and 50 mg, respectively. During delayed word recognition, subjects correctly recognized 77–79% true positive and true negative words across treatments with no difference to placebo for either daridorexant dose.

Conclusion

Following bedtime administration, daridorexant preserved the ability to respond to external noise stimuli and subjects were able to operate safely during the night.

Nocturnal Heart Rate Variability as a Biomarker of the Autonomic Function in Progressing Parkinson’s Disease

Introduction

Daridorexant is a dual orexin receptor antagonist Presentation: the treatment of adult patients with insomnia disorder. In a previous phase 1 trial, daridorexant was shown to have no negative effect on sleep-disordered breathing in patients with mild to moderate obstructive sleep apnea (OSA)1.

Methods

This randomized, double-blind, placebo-controlled, crossover phase 1 trial evaluated, in one sleep center, whether repeated dosing (5 nights) of the therapeutic dose of 50 mg daridorexant is also safe in sixteen patients with severe OSA without insomnia, based on whether the treatment difference (daridorexant–placebo) was not ≥ 10 events/h for apnea/hypopnea index (AHI) and/or ≤ -2% for mean nocturnal oxygen saturation (SpO2). Other respiratory variables, including indices of disease severity, were explored using treatment difference (daridorexant– placebo) and its two-sided 90% CI. The effect of daridorexant on sleep was explored based on total sleep time (TST), rapid eye movement (REM), and non-REM sleep.

Results

Baseline AHI and mean nocturnal SpO2 were 51.2 events/h (standard deviation [SD]: 17.0) and 92.1% (SD: 1.7), respectively. No clinically meaningful effect of 50 mg daridorexant on AHI and mean nocturnal SpO2 were detected. Treatment differences were -3.74 events/h (upper 95% CI: ≤ 4.23 events/h) and -0.12 % (lower 95% CI: ≥ -0.62 %), respectively. AHI and mean SpO2 during non-REM were comparable after daridorexant and placebo administration. AHI showed improvement during REM sleep after daridorexant administration as treatment difference (daridorexant–placebo) was -8.2 events/h (90% CI: -13.7, -2.7). No treatment difference was observed for the evaluated indices of disease severity, e.g., the total number of apneas and hypopneas and their longest duration, lowest SpO2 during respiratory events, or %TST with SpO2 < 90%. Compared with placebo, daridorexant increased TST by 32.5 min mainly via the increased duration of REM sleep. Three out of six adverse events were under daridorexant (all mild), none were related to respiratory function.

Conclusions

Daridorexant does not impair sleep-disordered breathing and may improve sleep in patients with severe OSA. Daridorexant does not impair sleep-disordered breathing, independent of OSA severity.

Reference 1

Boof et al. SLEEP 2021;44:zsaa275

Daridorexant or zolpidem on wakefulness throughout the night in insomnia disorder: A post hoc analysis

Introduction

Daridorexant, a dual orexin receptor antagonist [DORA] which works by selectively reducing the orexin-induced wake signalling, has been shown to induce a dose-dependent reduction in wake time after sleep onset [WASO] in patients with insomnia disorder.1

Objectives

This exploratory analysis examined the efficacy of daridorexant in reducing the duration of awakenings in each quarter of the night, when compared to placebo and to the GABA-receptor agonist zolpidem, which induces sleep through widespread CNS sedation.

Methods

This was a multi-centre, double-blind trial (NCT02839200), including adult (18–64y) patients with insomnia randomized (1:1:1:1:1:1) to placebo, daridorexant (5, 10, 25, or 50mg), or zolpidem (10mg) for 30 days. Polysomnography [PSG]-determined WASO was evaluated using descriptive statistics by quarter of the night (Q1–Q4) i.e. every 2 hours over 8 hours at Days 1 & 2, 15 & 16, and 28 & 29. Baseline was defined as the mean of the two PSG nights during the run-in period and Days 1&2 as the mean of the first two PSG treatment nights; Days 15&16 and 28&29 were defined similarly.

Results

Dose-dependent decreases in mean change from baseline in Q1–Q4 WASO were observed with daridorexant (5–50mg) at Days 1 & 2 (Figure 1). Whereas the approved doses of daridorexant (25mg and 50mg) provided similar response to zolpidem 10mg in the first half of the night, mean reductions from baseline in WASO were numerically greater with daridorexant 50mg versus zolpidem 10mg during the second half of the night – with the difference most pronounced in the fourth quarter (mean WASO change from baseline Q3: –13.49 min versus –9.73 min; Q4: –17.51 min versus –7.81 min). Similar effects were seen at Days 15 & 16, and Days 28 & 29.

Conclusions

In patients with insomnia disorder, daridorexant reduces the duration of awakenings throughout the entire night, including the last two quarters.

Reference 1

Dauvilliers et al. Ann Neurol 2020; 87 347–356

Digital CBT for insomnia in older adults: secondary analysis from a population-based randomized controlled trial

Background

Narcolepsy type 1 (NT1) is a chronic sleep disorder with a heterogenous presentation and course. After the Pandemrix (H1N1) vaccination campaign in 2009–10, the incidence of NT1 increased, but there are few long-term studies that have prospectively followed vaccinated cohorts.

Objective

To describe longitudinal changes in subjective and objective measures of NT1 and to identify predictors of long‑term severity.

Methods

We performed a prospective observational study of 130 HLA‑DQB1*06:02‑positive, hypocretin‑deficient children and adults with NT1 (mean follow‑up 5.5 years). Most patients were Pandemrix‑vaccinated. Disease severity was evaluated with subjective measures (Epworth Sleepiness Scale (ESS), frequency of repaid eye movement (REM)-related phenomena) and objective measures from polysomnography and multiple sleep latency tests (mean sleep latency, sleep stage shift, arousal index, presence of sleep onset rapid eye movement sleep). Predictors tested in multivariable regression models included cerebrospinal fluid hypocretin-1 level, Pandemrix vaccine exposure, and disease duration. Models were adjusted for age, sex and medication.

Results

At group level, both objective and subjective sleepiness improved over follow-up (ESS decreased from 18.0 to 14.1, p<0.001; mean sleep latency increased from 2.1 to 4.6, p<0.001) and the frequency of REM-related phenomena decreased markedly. Female participants reported higher subjective sleepiness across follow-up (β=1.9, p=0.028). Undetectable hypocretin was associated with greater objective sleepiness (β=-2.7, p=0.018). Patients vaccinated with Pandemrix presented with a more severe phenotype at baseline but experienced greater symptomatic improvement over time compared with non-vaccinated patients.

Conclusion

Out findings demonstrates that NT1 shows heterogeneous long‑term courses: many patients had reduction in symptoms in both objective and subjective domains, whereas a clinically important subgroup remains symptomatic. Early prognostic stratification using CSF hypocretin and baseline phenotype, may help to predict long‑term morbidity and guide targeted management and therapeutic decisions.

Daridorexant in patients with severe obstructive sleep apnea: Effect on sleep-disordered breathing and sleep

Background

Narcolepsy type 1 (NT1) is a chronic sleep disorder frequently accompanied by psychiatric comorbidity. Longitudinal data on the course of psychopathology in NT1 are limited.

Objective

To describe longitudinal changes in emotional and behavioural problems in patient with NT1.

Method

We conducted a prospective observational cohort study of 150 children and adults with NT1 attended at a national specialty centre between 20015 and 2024. Mean follow-up was 5.5 years. All participants were HLA DQB1*06:02–positive and hypocretin deficient, and most had previously received Pandemrix (H1N1) vaccination. Psychiatric symptoms were assessed with the validated Achenbach System of Empirically Based Assessment (ASEBA) questionnaire (parent-report for children; self-report for adolescents and adults). We examined baseline prevalence of clinically elevated ASEBA scores, longitudinal changes in ASEBA T-scores, and trajectories at domain and syndrome levels.

Results

At baseline, clinically elevated total ASEBA scores were present in >60% of children and in >40% of adolescents and adults. Elevated scores were driven predominantly by internalizing problems across age groups. Somatic complaints and thought problems were consistently elevated in children, adolescents and adults. Adolescents reported particularly high withdrawn/depressed syndrome scores, while adults showed prominent attention problems. At group level, total ASEBA T-scores improved by 2.6 T-scores (95% CI 0.5-4.0, p= 0.01) over the follow-up period, driven mainly by a reduction in aggressive-behaviour and through- and anxious/withdrawn/depressed problems. In contrast, somatic complaints and attention problems remained largely persistent with little or no decline.

Conclusions

Psychiatric symptoms are common in NT1 but show modest overall improvement over a 5.5-year follow-up. Persistent somatic complaints and attention problems may require targeted assessment and sustained management in this population.

The DARK.DEM. trial: Virtual darkness therapy for agitation in people with dementia

Insufficient sleep among Danish adults increased from 10.3% in 2013 to 15.9% in 2023. Sleep problems encompass both quantity (duration) and quality (difficulty initiating/maintaining sleep, non-restorative sleep, and fatigue), with both dimensions associated with adverse health and social outcomes. Clinical studies suggest that sleep problems related to quality and quantity represent distinct phenotypes; however, population-level characterization of individuals experiencing different quantitative and qualitative sleep profiles remains limited

The aim of this study is to identify distinct sleep profiles in Danish adults using latent class analysis, examine whether quality and quantity problems separate into distinct subgroups, and characterize these profiles using machine learning and national register data.

We analyzed Danish National Health Survey (DNHS) data (2010-2021, age ≥15 years) on 294,609 individuals (median age 53 years [IQR: 38-66]; 54.1% female) linked to national registers on sociodemographic and health information. We applied Latent Class Analysis on Three self-reported sleep indicators from the health survey (sleep duration, quality, and rest) to identify distinct sleep profiles, accounting for survey weights.

We identified four distinct sleep phenotypes: healthy sleepers (57.9%) with 7-9 hours of sleep and adequate rest; insufficient rest sleepers (28.3%) with normal duration but persistent inadequate rest; severe short sleepers (8.8%) with 4-7 hours of sleep and poor rest quality; and well-adapted short sleepers (5.0%) with 6-7 hours of sleep but preserved rest. We will present results from XGBoost with SHAP values to characterize these profiles by sociodemographic and morbidity data at the conference.

Prevalence of obstructive sleep apnea in patients with treatment-resistant depression: a systematic review and meta-analysis

Background

Elevated blood pressure is a prognostic marker of cardiovascular disease. Recent evidence suggest that irregular sleep patterns, defined as day-to-day differences in sleep timing, has also been identified as a potential cardiovascular risk factor. The impact of sleep irregularity on blood pressure has not been thoroughly analyzed. Therefore, this study aimed to examine the effect of sleep variability on blood pressure markers.

Material and methods

We carried out a randomized, 12-wk parallel-arm outpatient pilot study (N= 14). Inclusion criteria included having pre-diabetes, age ≥25 y, BMI 25-39.9 kg/m2, sleep duration ≥ 6h/night and irregular sleep (IS= SD of bedtime >60 min over 14 nights). Participants were randomized to either maintain their IS or follow a fixed sleep (FS) schedule for 12 wk (target bedtime SD ≤45 min). Diastolic (DBP) and systolic blood pressure (SBP) were measured at baseline and endpoint and ambulatory blood pressure monitoring (ABPM) was performed at endpoint. General linear model adjusted by sex and age were used to test the intervention effects.

Results

The intervention had a significant impact on clinic-based diastolic blood pressure (DBP), which improved from baseline to endpoint in FS compared to IS (-4.3±4.4% vs. -0.6±13.1%, p=0.01). In contrast, change in clinic systolic blood pressure (SBP) did not differ between conditions (FS: -0.1±10.5% vs. IS: -2.0±8.9 %, p=0.13). Although endpoint ABPM values for SBP and DBP tended to be lower in FS vs. IS, none of the between-group differences were statistically significant; this was true for data collected over 24-h, sleep (SBP: 101.5±7.4 mmHg vs. 115.2±16.5, p=0.13; DBP: 60.0±9.1 mmHg vs.69.2±7.3, p=0.29), and wake (SBP: 114.5±11.0 mmHg vs. 122.3±16.8, p=0.53; DBP: 72.3±7.8 mmHg vs. 75.3±5.8, p=0.59).

Conclusion

These exploratoy results suggest that improving sleep regulariy may be a promising intervention to improve blood pressure. Further studies, particularly among participants with elevated blood pressure, are needed.

Reference 1

Makarem N, Zuraikat FM, Aggarwal B, Jelic S, St-Onge MP. Variability in Sleep Patterns: an Emerging Risk Factor for Hypertension. Curr Hypertens Rep. 2020 Feb 21;22(2):19. doi: 10.1007/s11906-020-1025-9. PMID: 32086595; PMCID: PMC7176028.

Reference 2

Xu, Y., Barnes, V. A., Harris, R. A., Altvater, M., Williams, C., Norland, K., Looney, J., Crandall, R., Su, S., & Wang, X. (2023). Sleep Variability, Sleep Irregularity, and Nighttime Blood Pressure Dipping. Hypertension (Dallas, Tex. : 1979), 80(12), 2621–2626. https://doi.org/10.1161/HYPERTENSIONAHA.123.21497

Sleep strategies in the general population

Background

Sleep disturbances are highly prevalent in cancer patients and may increase their risk of cancer-related cognitive impairment (CRCI). Immune checkpoint inhibitors (ICIs), widely used in melanoma treatment, may further disrupt sleep through immune-modulating effects. Yet, longitudinal data on sleep during ICI therapy and its clinical relevance remain limited. We therefore examined sleep quality and insomnia severity across four time points (pre-treatment, 8 and 24 weeks into treatment, and 12 weeks post-treatment) and investigated their associations with cognitive outcomes in melanoma patients (MPs) receiving ICIs compared with healthy controls (HCs).

Methods

Newly resected MPs scheduled for adjuvant ICIs and age-matched HCs completed the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), neuropsychological testing, and a questionnaire assessing cancer-related fatigue (FACIT-F). Linear mixed-effects models were used to evaluate the trajectories for each outcome. Psychological variables were decomposed into between-person and within-person components to examine their contributions to cognitive performance.

Results

Compared to HCs, MPs reported significantly higher PSQI and ISI scores and greater fatigue (FACT-F) at all time points (all p’s < .05), indicating poorer sleep and more fatigue. Clinically relevant insomnia (ISI>10) was observed in 20.4%, 21.7%, 19.0%, and 21.4% of MPs from T1 to T4, respectively, whereas lower proportions were observed in HCs (9.8%, 15.7%, 9.8%, and 8.2%). MPs performed worse than HCs across all cognitive domains. Within-person elevations in ISI predicted poorer attention and working memory (β = −0.096, p = .042), and higher average fatigue was associated with slower processing speed (β = 0.253, p = .044), 24 weeks into treatment and 12 weeks post-treatment.

Conclusion

Sleep disturbances and fatigue are prevalent and persistent during and following adjuvant ICI therapy. Both insomnia symptoms and fatigue were associated with poorer cognitive performance, supporting sleep and fatigue as potentially modifiable markers of cognitive vulnerability in cancer patients.

Sleep problems and psychological well-being in patients with depression: A cross-sectional study of 7,051 individuals

Background

It is known that patients who have insomnia present specific personality characteristics that form the premises for all three factors involved in the pathophysiology of insomnia - predisposing, precipitating and perpetuating. This fact needs to be taken into account in diagnosing and treating insomnia.

Objective

The purpose of the study was to investigate the relationship between the specificity of certain insomnia symptoms and patients' personality characteristics.

Methods

The study was conducted on a group of 284 patients (135 men, 149 women, aged 18-72 years). The Symptom Checklist-90 (SCL-90) questionnaires (for data collection on insomnia symptoms) and the Personality Inventory for DSM-5 (PID-5) (as a self-assessment tool for maladaptive personality traits according to the Alternative Model for Personality Disorders (AMPD)) were used. The statistical analysis was performed using the Open Source Solution Python.

Results

More than 80% (p<0.001) of participants with difficulty falling asleep showed significantly higher scores on maladaptive traits in the higher-order domains of Negative Affect and Detachment, according to the PID-5. These results suggest that emotional lability, anxiety and increased autonomic reactivity generate a psychophysiological mechanism of hyperarousal that delays the transition to sleep. In contrast, 65% (p = 0.04) of the participants with restless sleep showed significantly increased scores of maladaptive traits belonging to the higher-order domains of Disinhibition and Antagonism, suggesting that impulsivity, difficulty in regulating behavior and conflicting relational tendencies can contribute to the disruption of sleep continuity and the subjective perception of insufficient rest.

Conclusion

The data obtained suggest that the assessment of personality characteristics in the management process of patients with insomnia allows the determination of maladaptive traits, contributing to a more specific diagnosis and at the same time opens the possibilities for a more targeted and effective psychotherapeutic treatment.

INSOMNIAC – Internet-Based Cognitive Behavioral Therapy and Physical Activity for Insomnia

Introduction

Obstructive sleep apnea (OSA) is highly prevalent worldwide. Orofacial myofunctional therapy (OMT) targets upper airway muscle function. We hypothesized improvements in chewing efficiency, lip strength, and tongue strength after 12 weeks of OMT in treatment of OSA.

Material and methods

The “OMT with autofeedback for OSA” multicenter randomized controlled trial (OMTAOSA RCT) included 104 newly diagnosed participants with mild to moderate OSA and body mass index below 30. Participants were randomized to a 12-week standardized OMT protocol or waitlist. Sleep was measured with self-applied polysomnography three consecutive nights at project start and end. Masticatory efficiency was assessed by a standardized test measuring number of chewed particles (NP) and average particle size (PS), where higher NP and lower PS indicated better efficiency. Maximal anterior tongue strength (MTS) and maximal lip strength (MLS) were measured by the Iowa Oral Performance Instrument (IOPI) which measures pressure (kPa) exerted on a small air-filled bulb. Analyses followed the intention-to-treat principle. Between-group differences in effect of OMT were analyzed with independent t-tests and within-group changes with paired t-tests.

Results

Patients were randomized to a treatment group (n=52; age=46,3 years; BMI=26,4; AHI=13,77; 72,9% male) or a waitlist group (n=52; age=48 years; BMI=26,1; AHI=15,10; 66,0% male). Between-group differences in post-intervention outcomes were not significant for NP, PS, MTS or MLS. Within-group analyses showed significant NP increase in both treatment (p=0,02) and waitlist groups (p<0,01), but no significant PS changes. MTS increased significantly only in the waitlist group (p=0,04), but not in the treatment group. No significant changes were observed in MLS within either group.

Conclusion

The results did not support our hypothesis that twelve weeks of OMT would improve chewing function, lip strength, or tongue strength. Future analyses will examine per-protocol and subgroup potential effects after adjustment for treatment adherence and baseline OSA severity.

Reference 1

Rueda, J. R., Mugueta-Aguinaga, I., Vilaró, J., & Rueda-Etxebarria, M. (2020). Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database of Systematic Reviews, (11)

Reference 2

Hrubos-Strøm, H. et al. (2025). Effect of Orofacial Myofunctional Therapy with Auto-Monitoring on the Apnea–Hypopnea Index and Secondary Outcomes in Treatment-Naïve Patients with Mild to Moderate Obstructive Sleep Apnea (OMTaOSA): A Multicenter Randomized Controlled Trial Protocol. International Journal of Orofacial Myology and Myofunctional Therapy, 51(2), 8.

Communication between patients with RLS and physicians in neurological clinics – a study protocol

Background

Craniofacial morphology, particularly maxillary arch form and palatal shape, is increasingly recognized as a contributing factor in sleep-disordered breathing (SDB). While orthodontic features have been linked to obstructive sleep apnea (OSA), detailed three-dimensional assessments of palatal morphology in relation to contemporary sleep parameters remain limited.

Objective

To explore associations between three-dimensional palatal morphology and severity markers of sleep-disordered breathing in adults with mild to moderate OSA.

Methods

This exploratory analysis was conducted within a blinded randomized controlled trial framework (OMTaOSA, NCT06079073), using a previously published and validated morphometric methodology. Intraoral digital scans were obtained and analyzed three-dimensionally to quantify maxillary arch widths, lengths, and palatal depth and angulation. Sleep parameters were derived from baseline sleep studies, including oxygen saturation metrics and flow limitation indices. Participants with previous premolar extractions were excluded to reduce morphological bias, resulting in a final sample of 65 adults.

Results

Lower average nocturnal oxygen saturation (<92%) and lower minimum SpO₂ (<80%) were associated with significantly longer maxillary dental arch perimeters. Elevated flow limitation index (>10 events/hour) was associated with increased palatal height in the canine and premolar regions and reduced transverse dimensions in the superior aspect of the palate. In the supine position, higher flow limitation was further associated with narrower maxillary widths across canine, premolar, and molar regions. No significant associations were observed for minimum SpO₂ thresholds of 85% or 88%.

Conclusion

Distinct patterns of palatal morphology appear to be associated with non-apnoeic markers of SDB severity, particularly oxygen desaturation and flow limitation. These findings highlight the potential clinical relevance of detailed palatal assessment in interdisciplinary management of sleep-disordered breathing and support further confirmatory analyses.

Patient-reported sleep quality is associated with CPAP adherence in obstructive sleep apnea: ASAP3

Background

Obstructive sleep apnea (OSA) is a multifactorial disorder characterized by recurrent upper airway collapse during sleep. Drug-induced sedation endoscopy (DISE) is used to evaluate sites and pattern of airway obstruction [1]. However, its inherent subjectivity and the potential effects of sedation on airway dynamics have prompted interest in alternative or complementary imaging modalities [2]. We present a case study focusing on the role of dynamic magnetic resonance imaging (MRI) in the assessment of upper airway obstruction in OSA.

Materials and Methods

The case involves a 56-year-old male referred to the sleep clinic for OSA and poor adherence to continuous positive airway pressure therapy. The patient underwent both DISE and dynamic MRI for upper airway evaluation. Collapsibility was scored with the “velum, oropharynx, tongue base and epiglottis (VOTE)” score for DISE while literature was searched for a validated MRI scoring system.

Results

The VOTE score identified partial lateral collapse at the level of velum, no collapse was observed at the level of oropharynx, tongue base and epiglottis. Although our case did not fall asleep during MRI, an inspection of dynamic muscle contractions was consistent with the temporal changes observed during DISE. Moreover, MRI provided enhanced anatomical detail and demonstrated a three-dimensional overview.

Conclusion

This case report and literature review highlight the potential role and challenges of dynamic MRI as an alternative tool for assessing upper airway dynamics in patients with OSA. Achieving natural sleep during the MR examination and accurately capturing airway collapse patterns remain challenging.

Reference 1

Kim JS, Heo SJ: Test-retest reliability of drug-induced sleep endoscopy using midazolam. J Clin Sleep Med 2020, 16(5):675-678.

Reference 2

Volner K, Chao S, Camacho M: Dynamic sleep MRI in obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022, 279(2):595-607.

Effect of orofacial myofunctional therapy on apnea-hypopnea index in mild-to-moderate sleep apnea-A randomized controlled trial

Background

Parkinson’s disease (PD) comprises heterogeneous subtypes, including clinical, data-driven, and etiological approaches. In the proposed brain-first versus body-first subtypes, REM sleep behaviour disorder (RBD) is a key clinical marker of the body-first subtype1. Yet, other sleep disturbances – such as obstructive sleep apnea (OSA) and insomnia – are also highly prevalent and clinically relevant2. Nonetheless, it remains unexplored whether patterns of sleep dysfunction may define independent sleep-related subtypes in PD, and whether non-RBD-related sleep characteristics align with the brain-first and body-first subtypes.

Objective

We aim to identify sleep-related subtypes in patients with Parkinson’s disease using a data-driven approach and examine how these relate to the brain-first and body-first clinical subtypes. We also evaluate the utility of sleep questionnaires for differentiating subtypes and detecting associated sleep disturbances.

Methods

This study included a total of 233 individuals: 65 de novo PD patients, 31 mild-moderate PD patients, and 137 patients with isolated REM sleep behaviour disorder (iRBD) who underwent video-polysomnography (vPSG) and clinical assessments. To explore sleep-related subtypes in PD, K-means cluster analysis was performed using PSG-based parameters as clustering variables. To assess the utility of sleep questionnaires, correlation analyses between the Epworth Sleepiness Scale (ESS) and the REM Sleep Behaviour Disorder Questionnaire (RBDSQ) and objective PSG markers were performed.

Results

Preliminary K-means cluster analysis revealed three sleep-related subtypes in PD: A good sleep cluster with relatively preserved objective sleep quality, a sleep apnoea cluster with elevated apnoea-hypopnea index, and an insomnia cluster with increased wake after sleep onset. The sleep clusters were unrelated to the brain-first and body-first subtypes. Sleep questionnaires did not reliably identify sleep-related disorders or sleep subtypes. Yet, RBDSQ showed potential for identifying brain-first versus body-first PD subtypes.

Conclusion

This study identified distinct sleep-related subtypes in PD, yet these appear independent of the brain-first and body-first subtypes.

Reference 1

Horsager, J. (2020). Brain-first versus body-first Parkinson’s disease: A multimodal imaging case-control study. Brain, 143(10), 3077–3088. DOI: 10.1093/brain/awaa238

Reference 2

Xu, Z. (2022). Longitudinal Studies of Sleep Disturbances in Parkinson’s Disease. Current Neurology and Neuroscience Reports, 22(10), 635–655. DOI: 10.1007/s11910-022-01223-5

The course of psychiatric comorbidity in narcolepsy type 1: A prospective cohort study

Background

Positive airway pressure (PAP) adherence is challenging in obstructive sleep apnea (OSA). High loop gain may contribute to poor adherence and can be evaluated by a simple wake breath-holding test. Patient-reported sleep measures may identify individuals at risk. We aim to investigate whether the Pittsburgh Sleep Quality Index (PSQI) is associated with self-reported PAP adherence, and explore the role of breath-holding test in predicting adhernece.

Methods

ASAP3 is a questionnaire-based data collection in patients with OSA including demographics, comorbidities, medications, sleepiness, PAP-use, adherence, and the PSQI. PSQI score (0–21) was calculated. Self-reported PAP-adherence was defined as current PAP use, ≥5 nights/week, and ≥4 hours/night. Associations between PSQI and adherence were evaluated using logistic regression adjusted for age and sex. A Messineo breath-holding test was performed during wakefulness; breath-hold duration (seconds) was used as a simplified proxy for loop gain (shorter duration indicating higher loop gain) and compared between adherence vs non-adherence groups using the Wilcoxon rank-sum test.

Results

419 participants comppleted PSQI questionnaire (mean age 58.1±11.9 years; 62.2% male). 211 patients (50.4%) had PSQI>5. PAP use was reported by 196 patients (46.8%), more frequently in PSQI≤5 than PSQI>5 (54.8% vs 38.9%). PAP-adherence was lower in PSQI>5 compared with PSQI≤5 (65.9% vs 90.4%). In participants with complete PSQI and PAP-adherence data (n=196), higher PSQI was associated with lower odds of PAP-adherence (age- and sex-adjusted OR 0.74, 95% CI 0.66–0.85; p<0.001). Breath-holding test data were available in 62 participants; overlap with adherence data was limited (n=24; 3 non-adherent). Breath-hold duration did not differ between adherent and non-adherent participants (p=0.83).

Conclusions

Poorer self-reported sleep quality was significantly associated with poor PAP-adherence. Breath holding test was feasible, but larger samples with greater overlap with adherence data are needed to assess its ability to predict adherence as a proxy of loop gain.

Potential societal savings of treating insomnia in outpatients with coronary heart disease versus usual care

Background

Insomnia is the most common sleep disorder associated with impaired daytime functioning and reduced quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment and has demonstrated robust effects on insomnia symptoms. Given that the major functions of sleep are related to brain restoration, improving sleep through CBT-I has the potential to improve brain health and functioning. Nevertheless, the neurobiological mechanisms of CBT-I remain poorly understood. Neuroimaging has the potential to provide insight into how CBT-I may be associated with brain functional and structural alterations.

Objective

The primary aim was to review the literature investigating structural and functional brain alterations measured with neuroimaging following CBT-I.

Methods

We conducted a systematic review and narrative synthesis of the literature. Relevant scientific databases were searched for studies examining structural or functional brain alterations following CBT-I. Two authors independently screened studies and extracted data. Due to heterogeneity in study designs, imaging modalities, and outcomes, only a narrative synthesis was performed.

Results: 1552 studies were screened. Ten studies met the inclusion criteria, including five randomized controlled trials and five uncontrolled pre–post studies. Two studies used structural magnetic resonance imaging (MRI): one examined white matter microstructure and one gray matter morphology. Seven studies used functional MRI (fMRI) and one used EEG. Nine studies reported statistically significant alterations, including altered task-based activation and in resting-state connectivity. However, findings varied considerably across studies with respect to brain regions, analytical approaches, and neuroimaging outcomes.

Conclusion

This review provides preliminary evidence that CBT-I is associated with structural and functional brain alterations. Interpretation is limited by the small number of studies, sample sizes, and heterogeneity in neuroimaging modalities. Further, adequately powered and methodologically rigorous studies are needed to clarify the potential effects of CBT-I on brain outcomes.

Central venous pressure elevations are associated with intracranial pres-sure spikes in a model of acute obstructive sleep apnea

Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden

Background

Poor sleep health is frequently reported among older adults, often occurring alongside chronic diseases. Community-dwelling older adults enrolled in home health care in Sweden, receive their medical treatment from the General practitioners (GPs) sited at the primary health care center. However, little is known how GPs view sleep health or how they respond when sleep problems are identified or reported in this population.

Objective

To explore and describe GPs experiences of identifying, promoting, and evaluating sleep health in community-dwelling older adults, enrolled in home health care.

Methods

A qualitative study using an inductive approach and latent qualitative content analysis. During 2025, ten GPs (mean age 49.7), from nine primary health care centers across three Swedish regions, were individually interviewed after giving consent to participate in the study. The study was approved by the Swedish Ethical Review Authority (Dnr: 2023-03818-01, 2024-02325-02).

Results

The preliminary results show that the participating GPs, with an average of 14 years’ experience of home healthcare, experience sleep problems as common among older patients enrolled in home health care. GPs identified insomnia and disrupted circadian rhythms which they linked to factors such as anxiety, loneliness, depression, disease symptoms, snoring, inactivity, limited daylight exposure, medication side effects, and alcohol use. A common first step was to investigate underlying causes, and/or to reassure patients that shorter sleep duration is normal with aging. When treatment was needed, pharmacological options were prioritized, including sleep medication, antidepressants, sedatives, and somatic symptom‑relief strategies. Non‑pharmacological measures such as sleep education interventions were less frequently used and often difficult to implement because they required clinic visits. Sleep evaluation was informal, generally delegated to nurses, and routines focused mainly on discussions related to medication. The common perception was that current sleep practices were sufficient.

Conclusion

Improving sleep health in community-older adults older receiving home health care is challenging due to their complex care needs. The preliminary results indicates that reliance of medication to treat sleep health could be redacted by strengthening sleep hygiene education, implementing more structured evaluations, and receiving access to non‑pharmacological strategies offered on clinics.

Reference 1

National Board of Health and Welfare. (2025). Services and care for older people. Report of the situation 2024. (In Swedish). Public Health Agency in Sweden. (2021). Mental Health and Suicide Prevention – Status Report 2020. (In Swedish)

Reference 2

Buysse, D. J. (2014). Sleep health: can we define it? Does it matter? Sleep, 37(1), 9-17. https://doi.org/10.5665/sleep.3298 Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today, 24(2), 105-112. https://doi.org/10.1016/j.nedt.2003.10.001

Genome-Wide Meta-Analysis Identifies Genetic Risk Loci for Mono- and Polyneuropathies in 983,477 Individuals

Background

Restless legs syndrome (RLS) is a chronic condition characterized by an irresistible urge to move the legs, which significantly disrupts sleep. Pharmacological treatment and self-care relieve symptoms but cannot cure them. Patient knowledge is important for optimizing care, but there is a lack of questionnaires to measure information needs. Therefore, this study aims to develop a brief psychometrically robust questionnaire suitable for clinical care of patients with RLS.

Materials and Methods

This cross-sectional study recruited 1,500 RLS patients from a nationwide patient organization. Patients completed the Informational Needs of RLS Inventory (INR-I), which includes seven items assessing the importance of information regarding; the causes and consequences of RLS, its pharmacological and non-pharmacological management, and the behavioural and lifestyle adaptations needed to reduce symptoms and improve sleep and daily functioning. The seven items are rated on a 5-point Likert-type scale and range from unimportant (1) to very important (5). Validity and reliability of the INR-I were investigated using exploratory factor analysis (EFA) models.

Results

A total of 788 patients (60% women, 70,8 SD 11,3 years) participated. The EFA supported a unidimensional structure of the INR-I. Sampling adequacy was excellent (KMO=0.85), and Bartlett’s test of sphericity was significant (χ² = 2278.6, df = 21, p < .001), confirming suitability for factor analysis. One factor was extracted using principal axis factoring, explaining 47.1% of the total variance. All seven items loaded on the single factor (factor loadings range: 0.39–0.85). Internal consistency was good (Cronbach’s α = 0.827; McDonald’s ω = 0.824).

Conclusions

The INR-I is a psychometrically robust instrument for assessing informational needs among patients with RLS. Its unidimensional structure, strong internal consistency, and clinical relevance make it suitable for clinical care and research. Use of the INR-I may help to identify unmet informational needs and tailor patient education

What self-care activities do patients with restless legs syndrome use and find beneficial?

Despite the high prevalence of insomnia symptoms in the general population, many people do not seek treatment. Instead they rely on self-help strategies to improve sleep. The aim of this study was to investigate the strategies used to improve sleep in the Danish population and examine how the strategies relate to individual characteristics such as insomnia severity and age. Based on previous research on self-help strategies to improve sleep (Morin et al. 2006), we developed a survey that was distributed online among the Danish adult population via social media. Among 3667 respondents, we selected a random sample matching the Danish population in terms og age and sex (n = 1195).

Results showed that nearly all participants used one or more strategies to aid their sleep, with the most common strategies being ‘following a routine’ (73%), ‘reducing caffeine in the afternoon/evening’ (65%) and ‘lowering the temperature in the bedroom’ (62%). Individuals with insomnia used significantly more strategies (average 8.4 strategies) compared to those without insomnia (average 6.6 strategies). Similarly, some strategies were more common among young adults compared to older adults, for example the use of music as a sleep strategy (Buus et al., 2025). Since many people report using several strategies to improve their sleep, we are currently investigating the relationship between the different strategies to discover potential relationships or patterns in the use of sleep strategies. These results will be presented at the conference.

By evaluating both prevalence and frequency of 24 different sleep strategies, this study shows that people do several things to promote sleep in their daily lives. The findings enhance our understanding of sleep behaviour in the general population, providing an important fundament for targeting future public health interventions for sleep health.

Reference 1

Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Merette, C. (2006). Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep medicine, 7(2), 123-130.

Reference 2

Buus, R. M., Genovese, S., & Jespersen, K. V. (2025). The art of sleep: examining sleep strategies in the general population with a focus on the use of music for sleep. Journal of Sleep Research, e70006.

Sleep-associated consolidation selectively strengthens weak memories

Background

Restless legs syndrome (RLS) is a chronic condition that negatively impacts sleep and quality of life (QoL). Several pharmacological alternatives are available, but treatment is difficult to optimize, making self-care an additional but seldom used option for coping with symptoms. Internet-delivered cognitive behavioral therapy (I-CBT) provides patients with chronic conditions the capabilities to maintain, monitor, and manage symptoms over time. However, I-CBT has not yet been used in patients with RLS, and the development and evaluation of such an intervention are important.

Objective

To describe the development, content, and evaluation of a person-centered I-CBT intervention to improve RLS symptoms, insomnia, and QoL in patients with RLS.

Content and evaluation of the I-CBT intervention

Researchers, clinicians, and patients have co-designed the I-CBT intervention. Initially, a quasi-experimental design will be used in a pilot study of 40 patients with RLS at one primary care center. The I-CBT program consists of two parts: one focusing on insomnia and one on RLS (4 weeks each). Each module includes text, images, and videos, as well as patient-based cases, exercises, and measurements. "Acceptance and Commitment Therapy" forms the basis of treatment.

In the next step, a parallel two-arm RCT with a 2:1 allocation between intervention and control groups will be used to evaluate the short- and long-term (12-month) effects of the I-CBT intervention in 400 patients from eleven primary care centers. The control group will receive four weeks of digital sleep hygiene and self-care advice without CBT. Questionnaires, e.g., for RLS symptoms (RLS-6), sleep (PSQI), depression (PHQ-9), and QoL (RLS-QoL), will be used to evaluate long-term effects, and interviews will be used to explore facilitators and barriers to implementation.

Conclusions

If the project's I-CBT treatment shows positive results, patients can be offered digital, person-centred, and safe care to facilitate the management of the complex symptomatology seen in RLS.

Course and severity of narcolepsy type 1: a long-term prospective cohort study

Background

Digital cognitive behavioural therapy for insomnia (dCBT-I) is an evidence-based, scalable intervention that has demonstrated robust effects in large population-based trials. However, much less is known about how well fully automated dCBT-I works in specific subpopulations, such as older adults, who often have multimorbidity and age-related changes in sleep continuity. Clarifying treatment response and engagement in this group is important to inform how dCBT-I are used and targeted in routine care

Methods

To address this gap, we conducted a secondary analysis of the SHUTi randomized controlled trial (N=1721 aged ≥18 years), to examine the effectiveness of dCBT-I for individuals aged ≥65 years. 139 older adults (mean age 70 years) were randomized to either a fully automated dCBT-I programme or a patient education control. Outcomes were assessed at baseline, 9 weeks, and 6 months and included the Insomnia Severity Index (ISI; primary outcome), psychological distress (HADS), fatigue (CFQ), and sleep-diary parameters. Treatment effects were estimated using mixed-effects models examining change over time by group.

Results

Participants receiving dCBT-I showed significantly greater reductions in insomnia severity at both 9 weeks (Cohen’s d = –1.16) and 6 months (Cohen’s d = –0.67) compared to the control group. dCBT-I also showed improvements in fatigue (Cohen’s d = 0.58) and multiple sleep-diary variables, including wake after sleep onset, early-morning awakenings, and sleep efficiency. Reductions in anxiety and depression were observed at 9 weeks, though effects were not maintained at 6 months. The majority of older adults engaged actively with the digital programme.

Conclusion

Older adults can effectively benefit from dCBT-I, with clinical improvements across both subjective sleep symptoms and behavioural sleep parameters. The results support the acceptability and therapeutic potential of digital interventions within ageing populations.

Dynamic visualization of upper airway in obstructive sleep apnea patients: A case report

Introduction

Untreated obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular disease, cognitive decline, and mortality. While the physiological consequences are well established, the impact of OSA on mental health remains insufficiently understood. OSA frequently co-occurs with symptoms of depression, anxiety, and elevated stress, highlighting the need to clarify how psychological distress interacts with both subjective and objective sleep disturbances.

Methods

N= 125 patients with diagnosed OSA (65.6% male; age 27–81 years, mean 52 ± 12.3; BMI 29.5 ± 4.7 kg/m²) using one night of in-laboratory polysomnography (PSG) and standardized questionnaires. Subjective sleep measures included the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Pittsburgh Sleep Quality Index (PSQI). Objective PSG parameters included total sleep time (TST), sleep efficiency, sleep onset latency (SOL), oxygen saturation (SpO₂), arousal index, and sleep stage distribution (N1–N3, REM, REM latency). Mental health was assessed using the Depression Anxiety Stress Scales (DASS-21). OSA severity was categorized by AHI: mild (5–14), moderate (15–29), and severe (≥30).

Results

Higher depression, anxiety, and stress scores were significantly associated with poorer subjective sleep outcomes. Specifically, elevated distress predicted greater insomnia severity (ISI; β = 0.31–0.34), increased daytime sleepiness (ESS; β = 0.24–0.31), fatigue (FSS; β = 0.58–0.87), and poorer sleep quality (PSQI; β = 0.56). Regarding objective sleep, higher depression scores were associated with longer SOL (β = 0.90), while no significant associations were observed with TST, sleep efficiency, SpO₂, arousal index, or sleep stage distribution. Significant interactions between psychological distress and OSA severity were identified: anxiety interacted with severe OSA (β = −0.32, p = 0.007), and stress interacted with moderate OSA (β = 0.61, p = 0.028).

Conclusion

In patients with untreated OSA, psychological distress is closely linked to poorer subjective sleep and prolonged sleep onset latency. These effects are partially moderated by OSA severity, suggesting that both psychological and physiological factors contribute to sleep disturbances in this population. Addressing mental health may therefore be a crucial component of comprehensive OSA management.

Reference 1

Baglioni,C.,Nanovska,S.,Regen,W.,Spiegelhalder,K.,Feige,B.,Nissen,C.,Reynolds,C.F.,& Riemann, D. (2016). Sleep andmental disorders: Ameta-analysis of polysomnographic research. Psychologicalbulletin, 142(9), 969–990. https://doi.org/10.1037/bul0000053

Associations of UNC-51-like kinase 1, cognition, and cardiovascular events in the Akershus Sleep APnea cohort

Introduction

More than 50% of polio patients are affected by Post-Polio Syndrome (PPS) after they have experienced a period with neurological and functional stability following the acute poliomyelitis. PPS can, beside diminished muscle strength, result in fatigue or sleep disturbances. This leaves some polio patients to need medical attention later in life. The specific mechanism behind the development of PPS is however still unknown. In the present study we want to investigate whether neurophysiological and sleep dysfunction somehow should contribute to the PPS symptomatology. New knowledge is essential for optimizing the treatment of PPS.

Methods

We included 42 PPS patients (52% women, <75 years of age) recruited among Danish polio survivors formerly treated for acute paralytic poliomyelitis. Data collection included 1) self-report questionnaires on, among others, sleep disturbances and fatigue, 2) a clinical somatic and neurological examination, 3) nerve conduction study (NCS), 4) electromyography (EMG), 5) ambulant polysomnography, 6) long-term blood pressure measurement.

Results

Epworth Sleepiness Scale was between 0-16 and The Self-Reported Impairments in Persons with Late Effects of Polio Rating Scale was between 4-27 (mean 12±5,62), which indicates a considerable variability of the subjective symptoms. NCS was normal in 15 (35,7%) and abnormal in 27 patients (64,3%). EMG-abnormalities typical for previous poliomyelitis, in clinically affected muscles, were seen in all patients. 37 patients (88,1%) had obstructive sleep apnea. 12 patients (29%) had abnormal Periodic Limb movements in sleep. Long-term blood pressure measurement during polysomnography was available in 31 participants and demonstrated elevated blood pressure in 16 (51,5%).

Conclusions

The results of the study showed different neurophysiological dysfunctions in PPS patients and thereby contribute to improved possibilities for proper assessment and intervention for the symptoms of these.

Nighttime Safety of Daridorexant: Response to Noise and effects on Postural Stability, Walking and Memory

Background

Insomnia remains a prevalent sleep disorder among young adults associated with an increased risk of suicidal ideation and behaviour. While several affective and cognitive factors have been studied to understand this association, recent evidence indicates the importance of interpersonal factors, particularly social disconnection. Therefore, the aim of this study was to examine the mediating role of two specific variables of social disconnection (burdensomeness and thwarted belongingness) in the association between insomnia severity and suicidal ideation among college students.

Method

Data were drawn from the ANSWERS survey, which included a sample of 971 U.S. college students (mean age=20.6±4.1 years; 73.4% women). Participants completed measures of insomnia severity, interpersonal needs, and suicidal ideation. Bivariate and mediation analyses were conducted.

Results

The sample comprised 45.5% (n=442) students without insomnia, 42.0% (n=408) with subclinical insomnia, and 11.3% (n=110) with clinical insomnia. The proportion of individuals reporting suicidal ideation increased significantly across levels of insomnia severity (19.9%, 37.3%, and 52.9%, respectively; χ²=59.7; p<0.001; φc=0.25). Mediation analyses revealed significant indirect effects of insomnia on suicidal ideation through both perceived burdensomeness (indirect effect range=0.51–0.94) and thwarted belongingness (indirect effect range=0.20–0.31). For subclinical insomnia, the relationship with suicidal ideation was fully mediated by these interpersonal needs (direct effect p value=0.121).

Conclusions

Insomnia severity was associated with a graded increase in suicidal ideation. Specifically, greater insomnia severity was linked to higher levels of perceived burdensomeness and thwarted belongingness, which in turn were associated with increased suicidal ideation. These findings underscore the importance of addressing both sleep problems and unmet interpersonal needs in interventions aimed at reducing suicide risk in this population.

Insomnia symptoms depend on the patient's personality peculiarities

Background

Insomnia has been widely studied in individuals with and without suicidal ideation. However, it remains unclear whether commonly used sleep measures are invariant across these groups. Suicidal ideation might alter the perception of sleep experience (e.g., due to attentional biases), potentially biasing self-reports. This study examined whether group differences in insomnia severity reflect true variations in the underlying construct rather than measurement limitations.

Method

A sample of 971 U.S. college students (mean age=20.6±4.1 years; 73.4% women) completed the self-reports Insomnia Severity Index (ISI), along with the Columbia‑Suicide Severity Rating Scale (C‑SSRS). Measurement invariance (MI) analyses for the ordinal ISI items were conducted using the Diagonally Weighted Least Squares (DWLS) estimator to compare a unidimensional versus a two-factor structure.

Results

Overall, 31.3% (n=304) of participants reported suicidal ideation, with a significantly higher percentage in women (34.1%) than in men (26.6%; χ²=9.1; φc=0.1). Participants with suicidal ideation indicated significantly more severe insomnia (mean=7.1 vs 10.4; Z=7.9; p<0.001) and also significant differences in the two ISI factors (p<0.001). MI results indicated that the unidimensional ISI model failed to meet invariance criteria at the configural, loadings/metric, and thresholds/scalar levels (RMSEA=0.168, 0.118, 0.141, respectively). In contrast, the two-factor model demonstrated acceptable invariance, including configural (CFI=0.983; TLI=0.972; SRMR=0.046), loadings/metric (CFI=0.985; TLI=0.986; SRMR=0.047), and thresholds/scalar invariance (CFI=0.982; TLI=0.981; SRMR=0.046). Chi-square difference tests were non-significant across steps (Δχ² p-values=0.406).

Conclusion

These findings suggest that suicidal ideation may be associated with a differential organization of insomnia symptoms. Comparisons of total ISI scores between individuals with and without suicidal ideation should be interpreted with caution. While insomnia does not appear to function as an equivalent unidimensional construct across groups, it does exhibit equivalence when conceptualized as a bidimensional construct.

Linking Sleep and Circadian Dysregulation to Psychological Burden and Prognosis in Lung Cancer Undergoing Immunotherapy

Background

Sleep plays a critical role in brain function. In addition to supporting physiological homeostasis, sleep provides clearance of amyloid‑β and tau-proteins. Recent findings indicate that different sleep parameters play distinct roles in the early biological processes that lead to Alzheimer’s disease. Individuals with dementia often exhibit prolonged total sleep duration coupled with altered sleep architecture. Disruptions in non-rapid eye movement (NREM) and rapid eye movement (REM) -sleep are increasingly recognized as a hallmark of dementia. While sleep changes are well-documented in dementia, there is limited understanding of how specific sleep architecture parameters, particularly deep sleep, deteriorate as cognitive decline progresses from mild to severe stages.

Objective

This study aims to explore differences in sleep architecture in people with different stages of cognitive decline, from mild to severe dementia.

Methods

As part of the larger project Decoding Death and Dying in people with Dementia using Digital thanotyping (5-D), this study was conducted in Norwegian nursing homes. Participants (n=123, >64 years of age) were recruited based on cognitive impairment, assessed by the clinical dementia rating scale (CDR), with inclusion criteria of CDR ≥ 1. Somnofy sensors (VitalThings AS, Norway) were used to detect sleep parameters. The average sampling rate was 23.8 Hz with 30 second epochs, mimicking the gold standard polysomnography.

Results

Our preliminary findings revealed significant changes in deep sleep and sleep efficiency related to the degree of cognitive impairment. Higher degree of cognitive decline was associated with reduced sleep efficiency (p = 0.019) and less deep sleep (p = 0.038). No significant changes were observed for light sleep (p = 0.190), REM sleep (p = 0.625), or wake after sleep onset (p=0.073).

Conclusion

Our findings suggest that changes in sleep progress as cognitive decline advances. Further analysis is required for exploration of these changes in depth.

An Evaluation of Group Rumination-Focused Cognitive Behavioral Therapy for Insomnia: A Study within Primary Care.

This study aimed to validate an in-house radioimmunoassay (RIA) for cerebrospinal fluid (CSF) orexin-A measurement and establish a diagnostic cut-off for narcolepsy type 1 (NT1)

Control samples were utilized to compare the performance of the in-house RIA method developed at Sahlgrenska University Hospital with the commercial Phoenix Pharmaceuticals RIA kit. CSF samples from individuals evaluated for central hypersomnolence disorders were analyzed using both RIA kits. Diagnostic thresholds were assessed.

The in-house RIA yielded significantly higher orexin-A levels in controls (540.5 ± 166.9 pg/mL) than the Phoenix kit (369.2 ± 96.2 pg/mL), with a mean ratio of 1.54. The in-house method established a diagnostic cut-off for NT1 of 153 pg/mL (100% sensitivity, 95.9% specificity), approximately 38% higher than the standard cut-off. Intermediate orexin-A levels (153–400 pg/mL) were found in 9.7% of cases.

The in-house RIA method is reliable and yields higher orexin-A levels than the commercial kit.

Associations between Glycemic Variability and Sleep Architecture in Children and Adolescents with Type 1 diabetes

Background

Orofacial myofunctional therapy (OMT) is a promising treatment for obstructive sleep apnea (OSA), but existing protocols vary and reported effects are inconsistent. There is a need for strengthened evidence of the effect of a standardized OMT protocol in newly diagnosed OSA patients.

Objectives

The primary aim was to evaluate the effect of a standardized OMT protocol on AHI in treatment naïve adults diagnosed with mild or moderate OSA. Moreover, we aimed to assess treatment adherence and its association with primary and secondary outcomes.

Methods

We conducted a multicenter, single-blinded randomized controlled trial with blinded outcome assessment in non-obese, treatment-naïve adults newly diagnosed with mild or moderate OSA. Participants in the intervention group received 12 weeks of OMT, whereas the control group was assigned to a waitlist condition. The intervention consisted of a revised OMT protocol described by Guimarães et al.. Participants underwent three nights of polysomnography before and after intervention. The primary outcome was change in the apnea hypopnea index (AHI). Pre-defined secondary outcomes were self-reported adherence and change in the Epworth Sleepiness Scale (ESS). Other indices derived from a standard sleep report were regarded as exploratory, tertiary outcomes.

Results

A total of 104 participants (mean age 47.1 ± 12.2 years) were recruited. Intention-to-treat analysis (n = 80; 41 treatment, 39 waitlist) showed no significant effect of OMT on AHI, with an adjusted between-group difference in change of 1.10 (-2.94 to 5.13; p = 0.590). Mean adherence was 72.53% (95% CI: 64.35 to 80.71) and was not associated with AHI reduction (B = -0.07, -0.21 to 0.07; p = 0.320). No significant change was observed in ESS (effect estimate -0.90, -2.24 to 0.45; p = 0.189). Per-protocol analysis (n = 55) showed similar results, except for a small yet significant decrease in snoring time (effect estimate -5.80, -11.53 to -0.07; p = 0.047).

Conclusion

Twelve weeks of standardized OMT had no effect on pre-defined primary and secondary outcomes respectively in treatment naïve, newly diagnosed OSA patients. Mean snoring time was significantly reduced in the intervention group compared to the waitlist group.

Effect of Stroke Subtype on CPAP Therapy Outcomes

Background

Internet-based cognitive behavioral therapy for insomnia (iCBT-I) and physical activity are both evidence-based treatments for insomnia. However, combined internet-based interventions integrating iCBT-I with support for physical activity remain insufficiently explored.

Aim

The INSOMNIAC project aims to evaluate and further develop iCBT-I within primary care by informing the design of an adjunct internet-based physical activity module.

Methods

Semi-structured interviews were conducted with 15 former patients and 5 treating healthcare professionals who had experience with iCBT-I. Data were analyzed using reflexive thematic analysis.

Results

Three main themes were identified: Experiences of iCBT-I – navigating sleep in a digital space, Agency through understanding, and Windows of opportunity. iCBT-I was perceived as an accessible alternative to sleep medication, offering flexibility and promoting behavioral change. However, participants described an initially high workload, challenges related to extensive written material, technical limitations, and occasional uncertainty regarding treatment choices. Both patients and clinicians emphasized the importance of personalization and adequate assessment prior to treatment initiation, particularly in relation to comorbidities, shift work, and complex life circumstances.

Despite initial concerns about limited personal contact, therapeutic alliance and trust were often successfully established over time, especially when complemented by personal communication such as telephone contact. Gaining insight through self-monitoring and cognitive strategies reduced catastrophizing and increased perceived control over sleep. Many participants experienced iCBT-I as a window of opportunity for broader behavioral change, including physical activity. Patients and clinicians emphasized that physical activity support should be individualized, identity-congruent, and accompanied by motivational and social support.

Conclusions

iCBT-I was experienced as flexible and empowering, but personalization and human support remain crucial in digital insomnia care. Both patients and clinicians expressed strong support for integrating tailored physical activity modules into iCBT-I, highlighting the potential for synergistic behavioral change.

Is Insomnia Severity Index Comparable Across Suicidal Ideation Status? A Measurement Invariance Analysis

Background

Non‑24‑hour sleep‑wake disorder (N24SWD) features a free‑running circadian rhythm with progressively drifting sleep‑wake timing. Sighted cases are rare; diagnostics and personalised treatment remain underdeveloped1. We report a sighted 18‑year‑old with lifelong irregular sleep‑wake timing, daytime sleepiness, and somatic symptoms. At‑home melatonin sampling failed to yield reliable DLMO because of low secretion (AUC 16.32-76.6 pg/mL·h) and apparent light‑mediated suppression, motivating robust assessment of intrinsic timing and photic sensitivity.

Objective

Here, we characterise the intrinsic circadian rhythm in a sighted suspected N24SWD case and test non‑image‑forming pathway sensitivity via hormonal and pupillary responses to light.

Methods

Four unequally spaced 48‑hour at‑home urinary aMT6s collections (intervals 4, 6, and 8 days) under habitual light were used to model phase angle and intrinsic period. After 10 days, a mixed at‑home/laboratory protocol collected saliva half‑hourly with Karolinska Sleepiness Scale ratings and implemented melatonin suppression: dim light (<5 lux) 01:00-06:00; 2-hour bright-light exposure (7,000-11,000 lux); and dim light 08:00-09:00 hours relative to predicted melatonin trough. Pupillometry took place 2 days later 1:00 hour after predicted melatonin trough, quantifying PIPR to narrowband red/blue pulses and LMS‑ and melanopsin‑directed silent‑substitution stimuli using a 6‑primary Maxwellian system.

Results

Iterative cosine fitting (τ=[20-40] hours; 5‑min steps; AIC and visual inspection) identified a dominant rhythm with τopt=25.625 hours (AIC=644.99; R2=61.57%), that guided the bright‑light exposure timing. Participant reported migraine following intervention. Confirmation of phase angle and melatonin suppression is pending biological sample analyses. Pupillometry will be benchmarked against controls from HELIOS‑BD2.

Discussion

Integrating aMT6s‑based period estimation, controlled melatonin suppression, and photoreceptor‑specific pupillometry can characterise circadian dynamics and photic sensitivity in sighted N24SWD. Cross‑validation of hormonal and pupillary markers will clarify integrity of non‑image‑forming signalling and guide personalised management. Findings will inform feasibility of early‑morning bright‑light therapy; a structured intervention is planned for 2026 to evaluate entrainment potential and symptom improvement.

Reference 1

[1] Emens JS, St Hilaire MA, Klerman EB, et al. Behaviorally and environmentally induced non–24-hour sleep-wake rhythm disorder in sighted patients. J Clin Sleep Med. 2022;18(2):453–459.

Reference 2

[2] Roguski A, Needham N, MacGillivray T et al. Investigating light sensitivity in bipolar disorder (HELIOS-BD) [version 2; peer review: 4 approved, 1 approved with reservations]. Wellcome Open Res 2024, 9:64 (https://doi.org/10.12688/wellcomeopenres.20557.2)

This pilot observational study evaluated whether frequent overnight sampling of ventricular cerebrospinal fluid could clarify how sleep, hypocretin, and lactate relate to amyloid-β42 dynamics in adults with hydrocephalus. Seven participants underwent hourly ventricular cerebrospinal fluid sampling from early evening to late morning during inpatient monitoring, combined with full polysomnography. Concentrations of amyloid-β42, hypocretin, lactate, melatonin, and electrolytes were measured and normalized to each individual’s mean. Relationships with sleep stage and circadian patterns were examined using correlation analysis and cosinor modeling. Sleep was markedly disrupted, with obstructive sleep apnea common and analyzable sleep data available for six participants. Non-rapid eye movement sleep peaked at approximately 4 AM Amyloid-β42 rose in the evening, plateaued during peak non-rapid eye movement sleep, and increased sharply after 8 AM Hypocretin and lactate were positively correlated and each preceded and correlated with amyloid-β42 surges. Melatonin peaked near 6 AM and was associated with non-rapid eye movement sleep. Intracranial pressure displayed a strong circadian rhythm, peaking during non-rapid eye movement sleep, whereas hypocretin and amyloid-β42 exhibited only modest rhythmicity. These findings demonstrate that overnight ventricular cerebrospinal fluid sampling is feasible in adults with hy-drocephalus. Preliminary evidence suggests that processes linked to wakefulness, rather than sleep or intrinsic circadian timing, may be the primary drivers of overnight amyloid-β42 variation. Hypocretin pathways may rep-resent potential therapeutic targets in Alzheimer’s disease, but conclusions are limited by abnormal sleep architec-ture and underlying neurological disease. Validation in larger and more representative populations is warranted.

Palatal Morphology and Its Association With Sleep-Disordered Breathing Severity in Adults With Mild–Moderate OSA

Obstructive sleep apnea (OSA) is associated with increased cerebrovascular disease, but acute intracranial dy-namics during obstructive events remain uncertain. We hypothesized that negative intrathoracic pressure elevates intracranial pressure (ICP) by increasing central venous pressure (CVP) and impairing cerebral venous outflow. In an anesthetized porcine model, we measured ICP during simulated OSA with intermittent negative airway pressure (INAP) or positive end-expiratory pressure (PEEP) under controlled blood gas conditions. INAP con-sistently produced post-apneic ICP surges (+10 mmHg) that were time-locked to CVP spikes with strong ICP–CVP coupling during INAP (r=0.74) and moderate pooled correlation across all epochs (r=0.48). Pooled associa-tions with arterial blood pressure (r=–0.02) and cerebral blood flow (r=0.24) were negligible. The magnitude of responses was modulated by blood gases: hyperoxia attenuated ICP/CVP changes, whereas hypercapnia aug-mented pressure surges and was associated with modest changes in global cerebral blood flow without propor-tionally increasing peak ICP. PEEP was accompanied by immediate increase in ICP and CVP, consistent with direct pressure transmission to the venous system. Collectively, these findings support a venous-mechanical con-tribution as a key driver of acute ICP elevation during obstructive events, with chemoregulatory effects modulat-ing the response, and provide a hemodynamic context for OSA’s established cerebrovascular risk associations.

Changes in neural activation underlying cognitive control in patients with insomnia disorder after cognitive–behavioral therapy