Sleep medicine最新文献

{"title":"Correlation between changes of sleep quality and brain functional connectivity patterns in COVID-19 patients: A three-month longitudinal cohort study","authors":"Bei Peng ,&nbsp;Ying Liu ,&nbsp;Yuxin Chen ,&nbsp;Xiaoyan Zhou ,&nbsp;Yan Zhang ,&nbsp;Jinli Huang ,&nbsp;Jiazhu Huang ,&nbsp;Ruijing Sun ,&nbsp;Shihuan Lin ,&nbsp;Lixia Qin ,&nbsp;Yian Lu ,&nbsp;Mingming Zhao ,&nbsp;Demao Deng","doi":"10.1016/j.sleep.2025.02.016","DOIUrl":"10.1016/j.sleep.2025.02.016","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore variations of brain functional connectivity patterns among post-COVID-19 patients with different outcomes of sleep quality.</div></div><div><h3>Methods</h3><div>Post-COVID-19 patients were prospectively enrolled and categorized into improvement or deterioration groups based on changes in sleep quality after a three-month follow-up. Functional MRI and blood samples were collected, while a battery of assessments was administered to evaluate sleep quality, mental status, and cognition. Baseline and follow-up data were compared to identify post-infection alterations. Brain functional networks and graph theory analysis were employed to derive network properties, with subsequent investigation into the correlation between these properties, sleep and psychological assessment scores, and blood test outcomes.</div></div><div><h3>Results</h3><div>The graph theory analysis revealed a significantly increase in global efficiency (Eglob) and local efficiency (Eloc), and a decrease in λ, in the improvement group. A notable enhancement of frontoparietal network (FPN) were observed. The deterioration group exhibited a significant increase in Eloc and λ, along with a decrease in Eglob. Furthermore, the deterioration group demonstrated a lower level of Eglob at follow-up. With respect to network strength, all networks except FPN showed significantly higher values in the improvement group. Pittsburgh Sleep Quality Index and Self-Rating Anxiety Scale scores differed between two groups.</div></div><div><h3>Conclusion</h3><div>Changes in sleep quality following COVID-19 infection are associated with brain functional connectivity patterns. Decreased Eglob is related to worsened sleep quality. The normalized strength of FPN serves as a key indicator for improved sleep quality, while other networks also play roles in regulating sleep quality.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"128 ","pages":"Pages 187-194"},"PeriodicalIF":3.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143420443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic and therapeutic value of time in bed extension in Insufficient Sleep Syndrome","authors":"Marco De Pieri ,&nbsp;Anna Castelnovo ,&nbsp;Silvia Miano ,&nbsp;Mauro Manconi","doi":"10.1016/j.sleep.2025.02.013","DOIUrl":"10.1016/j.sleep.2025.02.013","url":null,"abstract":"<div><h3>Background</h3><div>Insufficient sleep syndrome (ISS) represents an emerging health concern but remains poorly defined as a diagnostic entity, though included in the international classification of sleep disorders. In the present study, we aimed to clarify the longitudinal course of ISS and to identify prognostic factors by comparing remitting and non-remitting patients.</div></div><div><h3>Methods</h3><div>A chart-review was realized, retrieving fifty-five patients with ISS (aged 39.8 ± 16.6 years, with 44.6 % of women) who underwent a comprehensive clinical evaluation at baseline and during a follow-up visit after 3–6 months. This evaluation included sleep symptoms, sleep logs, medications, and comorbidities. Additionally, actigraphy, video-polysomnography, and a multiple sleep latency test were conducted at baseline, and at the same moment standard psychoeducation on sleep was provided.</div></div><div><h3>Results</h3><div>During the follow-up visit, 69 % of patients still met the criteria for a clinical diagnosis of ISS, experiencing symptoms such as daytime sleepiness, disrupted nighttime sleep, unrefreshing sleep, and sleep attacks. Comparing sleep patterns of remitters and non-remitters based on sleep diaries, we observed that remission is associated with not only an increase in total sleep time but also a more regular sleep schedule. This regularity includes a reduction in napping and a lesser difference in sleep timings between weekdays and weekends. However, comparing baseline clinical and instrumental data between remitters and non-remitters revealed no significant differences, hindering the use of these features as prognostic factors.</div></div><div><h3>Conclusions</h3><div>Given the low remission rate with standard treatment (i.e. psychoeducation on sleep), we propose the following: (1) Criterion E (extension of total sleep time results in resolution of the symptoms of sleepiness) should be considered as a therapeutic advice, and supportive rather than necessary for the diagnosis; (2) specific cognitive-behavioral therapy protocols targeting the cognitive factors underlying sleep-depriving behaviors are required, as single routine behavioral interventions are insufficient.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"128 ","pages":"Pages 219-228"},"PeriodicalIF":3.8,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary coupling estimated sleep quality and memory in children with obstructive sleep-disordered breathing","authors":"Zhang Yuanjie ,&nbsp;Wu Yunxiao ,&nbsp;Robert Joseph Thomas ,&nbsp;Tang Yufen ,&nbsp;Zhengli ,&nbsp;Xu Zhifei","doi":"10.1016/j.sleep.2025.01.024","DOIUrl":"10.1016/j.sleep.2025.01.024","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between sleep quality/stability and memory in children with sleep-disordered breathing.</div></div><div><h3>Methods</h3><div>Children aged 5–12 years with suspected sleep-disordered breathing who visited the Sleep Center of Beijing Children's Hospital, from June 2022 to March 2023 were enrolled. All patients underwent polysomnography (PSG) and cardiopulmonary coupling monitoring (CPC) analysis based on the photoplethysmogram, and memory tests (immediate and delayed recognition and recall) before sleep and after sleep, respectively. In the CPC analysis, high frequency coupling (HFC) as percentage of total sleep time is stable sleep. A sleep quality index (SQI) integrates HFC, sleep duration and sleep fragmentation. The correlation between memory function and sleep quality/stability was analyzed. Cyclic variation in heart rate was quantified as a sleep apnea indicator (SAI).</div></div><div><h3>Results</h3><div>Patients were divided into three groups based on HFC: low (&lt;60), moderate (60–80) and high (&gt;80). A total of 152 children were included in the study, 100 males and 52 females, with an average age of 8.2 ± 1.7 years.HFC% was negatively correlated with AHI and OAHI (r: −0.32,p: &lt;0.01; r: −0.31, p: &lt;0.01), while LFC% was positively correlated with AHI and OAHI (r: 0.29, p: &lt;0.01; r: 0.28, p: &lt;0.01). The SQI and HFC was positively correlated with the delayed recall test score(r: 0.19, p: &lt;0.05), and with the recognition consolidation rate (r: 0.23, p: &lt;0.05). In contrast, LFC was negatively correlated with delayed recall test score (r:0.19, p: &lt;0.05), delayed recognition score (r:0.15,p &lt; 0.05), and recognition consolidation rate (r:0.21, p: &lt;0.01). SAI was negatively correlated with Recognition consolidation rate score (r: −0.17, p: &lt;0.05).</div></div><div><h3>Conclusions</h3><div>Sleep stability assessed via CPC may reflect a risk biomarker for memory function in children with OSA.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"129 ","pages":"Pages 8-13"},"PeriodicalIF":3.8,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interim analysis of a post-authorization safety study of pitolisant in treating narcolepsy: A real-world European study","authors":"Giuseppe Plazzi ,&nbsp;Geert Mayer ,&nbsp;Ralf Bodenschatz ,&nbsp;Enrica Bonanni ,&nbsp;Alessandro Cicolin ,&nbsp;Giacomo Della Marca ,&nbsp;Pierluigi Dolso ,&nbsp;Luigi Ferini Strambi ,&nbsp;Raffaele Ferri ,&nbsp;Peter Geisler ,&nbsp;Svenja Happe ,&nbsp;Anna Heidbreder ,&nbsp;Jürgen Herold ,&nbsp;Ulf Kallweit ,&nbsp;Laurène Leclair-Visonneau ,&nbsp;Katharina Lederer ,&nbsp;Claudio Liguori ,&nbsp;Johan Meurling ,&nbsp;Liborio Parrino ,&nbsp;Paola Proserpio ,&nbsp;Yves Dauvilliers","doi":"10.1016/j.sleep.2025.02.012","DOIUrl":"10.1016/j.sleep.2025.02.012","url":null,"abstract":"<div><h3>Background</h3><div>Narcolepsy is a chronic sleep disorder characterized mainly by excessive daytime sleepiness (EDS) and cataplexy in the case of narcolepsy type 1 (NT1). Pitolisant is a histamine 3 receptor antagonist/inverse agonist that reduces EDS and cataplexy in patients with narcolepsy.</div></div><div><h3>Methods</h3><div>We performed a prospective 5‐year follow‐up, non‐interventional study of adults with NT1 and NT2 receiving pitolisant. The primary objectives were to collect information on the long-term safety of pitolisant and analyze the utilization patterns of pitolisant. The secondary objectives were to assess clinical benefit, adherence, impact on patients’ quality of life, disease burden, and patient satisfaction. We reported the results of an interim analysis after 42.6 months.</div></div><div><h3>Results</h3><div>The population comprised 370 patients (mean age, 40 ± 15 years; 51.4 % women; NT1, 71.4 %; NT2, 28.6 %); 364 received ≥1 dose of pitolisant. Data were available for 356 patients (97.8 %).</div><div>Most patients (68.4 %) had ≥1 comorbidity (obesity [BMI≥30], 31.9 %; neuropsychiatric, 31 %; and cardiovascular, 22.8 %). Forty-eight patients (13.2 %) had received no prior narcoleptic treatment, while 98 (31 %) were taking a previous therapy, which was switched to pitolisant. Treatment was combined with pitolisant in 218 (69 %) patients. Pitolisant was discontinued by 131 patients (35.4 %), mainly for safety reasons (14.3 %), lack of response (8.7 %), and patient decision (7.6 %). Overall, 355 treatment-emergent adverse events (3 serious) were reported by 156 patients (42.9 % of safety population), with 218 possibly treatment-related (61.4 %) in 109 patients (29.9 %). Improvements were observed in EDS, cataplexy, and quality of life.</div></div><div><h3>Conclusions</h3><div>Pitolisant was generally safe and well tolerated in patients with NT1 and NT2 and can be used in both types. Improvements were found in EDS, cataplexy, and quality of life, with good adherence and satisfaction.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"129 ","pages":"Pages 20-30"},"PeriodicalIF":3.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An inter-rater variability study between human and automatic scorers in 5-s mini-epochs of sleep","authors":"Louise Frøstrup Follin ,&nbsp;Alexander Neergaard Zahid ,&nbsp;Rannveig Viste ,&nbsp;Janita Vevelstad ,&nbsp;Tobias Kaufmann ,&nbsp;Anette Ramm-Pettersen ,&nbsp;Hilde T. Juvodden ,&nbsp;Berit Hjelde Hansen ,&nbsp;Julie Anja Engelhard Christensen ,&nbsp;Stine Knudsen-Heier","doi":"10.1016/j.sleep.2025.02.005","DOIUrl":"10.1016/j.sleep.2025.02.005","url":null,"abstract":"<div><h3>Study objective</h3><div>Sleep is traditionally scored using 30-s epochs of polysomnographies. As sleep is physiologically dynamic and 30-s epochs may conceal important characteristics, we aim to challenge this standard by scoring sleep in 5-s mini-epochs and analyzing inter-rater variability between human and automatic scorers.</div></div><div><h3>Methods</h3><div>In 40 polysomnography recordings, 120 mini-epochs per polysomnography were scored manually by three human experts (expert1_5s, expert2_5s and expert3_5s) and automatically by a validated sleep classifier (USleep_5s). Additionally, 5-s mini-epochs (clinical_5s) extracted from conventional human-scored 30-s epochs were considered. We assessed inter-rater variability and stage shifting in epochs and mini-epochs and further in narcolepsy type 1 (NT1) patients and siblings.</div></div><div><h3>Results</h3><div>Agreement for mini-epochs was κ = 0.50 ± 0.11 (expert1_5s vs clinical_5s) and κ = 0.51 ± 0.12, (expert1_5s vs USleep_5s). Between human experts, agreement was κ = 0.51 ± 0.16 (expert1_5s vs expert2_5s), and κ = 0.57 ± 0.11 (expert1_5s vs expert3_5s). Stage shift percentages were significantly higher in mini-epochs scored by expert1_5s (27.75 %) and USleep_5s (22.88 %) than corresponding conventional epochs (5.12 %), with no significant difference between NT1 patients and siblings.</div></div><div><h3>Conclusion</h3><div>While mini-epoch scoring agreement was generally high, it was still lower than within epochs, likely due to a lack of standard mini-epoch scoring procedure and the automatic classifier being trained on epochs. However, stage discrepancies between epochs and mini-epochs and increased stage shifting in mini-epochs support that epochs can contain several stages, and that mini-epochs could supplement more detailed sleep characterization potentially enabling more precise diagnosis and finding new polysomnographic biomarkers. Future studies should include larger datasets to refine mini-epoch scoring rules and exploit automatic classifiers e.g. via transfer learning.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"128 ","pages":"Pages 139-150"},"PeriodicalIF":3.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered brain dynamic functional connectivity in patients with obstructive sleep apnea and its association with cognitive performance","authors":"Jing Wang ,&nbsp;Zhijun Wang ,&nbsp;Xin Wang ,&nbsp;Lirong Ji ,&nbsp;Yezhou Li ,&nbsp;Chaohong Cheng ,&nbsp;Tong Su ,&nbsp;Erlei Wang ,&nbsp;Fei Han ,&nbsp;Rui Chen","doi":"10.1016/j.sleep.2025.02.009","DOIUrl":"10.1016/j.sleep.2025.02.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Obstructive sleep apnea (OSA) is associated with potential disruptions in brain function and structure. The aim was to investigate alterations in dynamic functional connectivity (dFC) in OSA patients utilizing resting-state functional magnetic resonance imaging (rs-fMRI) and multiplication of temporal derivatives (MTD) to better understand the neurological implications of OSA.</div></div><div><h3>Methods</h3><div>This cross-sectional study eventually recruited 111 patients, aged 25–65 years. We categorized participants based on the apnea-hypopnea index (AHI) assessed via polysomnography (PSG), 43 patients were groupAHI &lt;15 and 68 patients were group AHI ≥15. Rs-fMRI and neuropsychological assessments were conducted to assess the brain function and visual-spatial memory, respectively. We evaluated the intergroup differences in dFC as well as its correlation with clinical parameters.</div></div><div><h3>Results</h3><div>The dFC analysis identified five distinct connectivity states, comprising four hyperconnected states (State 1, 2, 3, and 5) and one hypoconnected state (State 4). Group AHI≥ 15 showed altered fraction time (FT) and mean dwell time (MDT) in States 1, 3, and 4. The partial correlation showed that the FT/MDT of State 1 negatively correlated with hypoxia parameters, while the FT/MDT of State 3 positively correlated with total sleep time in Group AHI≥ 15. Group AHI≥ 15 exhibited a negative association between FT of state 3 and Visuospatial/Executive score in MoCA (r = −0.297, p = 0.033).</div></div><div><h3>Conclusions</h3><div>Untreated male moderate to severe OSA patients exhibited altered in dFC, which significantly correlated with hypoxia parameters and cognitive performance, high lighting that dFC changes may be an indicator of the neurological consequence of OSA, especially moderate to severe OSA.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"128 ","pages":"Pages 174-182"},"PeriodicalIF":3.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep disturbances in children with ADHD on methylphenidate monotherapy: The role of dysregulation profile","authors":"Barbara D'Aiello ,&nbsp;Ludovica Gessi ,&nbsp;Deny Menghini ,&nbsp;Stefano Vicari ,&nbsp;Pietro De Rossi","doi":"10.1016/j.sleep.2025.02.001","DOIUrl":"10.1016/j.sleep.2025.02.001","url":null,"abstract":"<div><div>Dysregulation profile has been associated with Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents, influencing its progression, outcomes, and potentially the response to treatment with methylphenidate, a commonly prescribed stimulant medication. Sleep disturbances are also closely linked to ADHD, as they significantly impact clinical outcomes and overall functioning, with variable responses to methylphenidate treatment.</div><div>This study aimed to investigate whether methylphenidate improves sleep disturbances in children with ADHD and whether the presence of dysregulation profile negatively predicts this improvement. To explore this, we examined the role of baseline dysregulation profile (assessed with the Child Behavior Checklist), age, ADHD symptom severity (assessed with SNAP-IV scores), and functional impairment (assessed with ABAS-II scores) as potential predictors of changes in sleep disturbances (assessed with SDSC scores) following six months of methylphenidate monotherapy.</div><div>A total of 115 participants (98 males) aged 6–17 years (mean age 10.32 ± 2.78 years) were included in the study. A hierarchical linear regression model was used to determine whether these baseline factors could predict changes in sleep disturbances, while accounting for initial sleep severity.</div><div>The results showed that the presence of dysregulation profile at baseline was associated with higher sleep disturbances after treatment. While ADHD severity at baseline was associated with sleep disturbances at follow-up, it did not demonstrate any significant predictive value for sleep outcomes over time.</div><div>In conclusion, dysregulation profile may act as a negative predictor of sleep outcomes following methylphenidate treatment. These findings highlight the importance of systematically assessing dysregulation profile before starting treatment. Future research with larger sample sizes and longer follow-up periods is needed to confirm these results and identify additional factors that contribute to sleep disturbances in children and adolescents with ADHD.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"128 ","pages":"Pages 153-158"},"PeriodicalIF":3.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding “Effect of lemborexant on sleep architecture in participants with insomnia disorder and mild obstructive sleep apnea” by Kushida et al","authors":"Shubham Kumar,&nbsp;Rachana Mehta,&nbsp;Ranjana Sah,&nbsp;Amogh Verma","doi":"10.1016/j.sleep.2025.02.015","DOIUrl":"10.1016/j.sleep.2025.02.015","url":null,"abstract":"","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"128 ","pages":"Pages 151-152"},"PeriodicalIF":3.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of pitolisant in residual excessive daytime sleepiness for patients with obstructive sleep apnea adhering to continuous positive airway pressure therapy in the HAROSA studies: An individual patient meta-analytical approach","authors":"Dries Testelmans ,&nbsp;Philippe Lehert ,&nbsp;Jerryll Asin ,&nbsp;Johan Imschoot ,&nbsp;Christian Caussé ,&nbsp;Jean-Louis Pépin","doi":"10.1016/j.sleep.2025.02.003","DOIUrl":"10.1016/j.sleep.2025.02.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Obstructive sleep apnea (OSA) is typically treated with continuous positive airway pressure (CPAP) therapy. Some patients experience residual excessive daytime sleepiness (EDS) under CPAP. Pitolisant demonstrated effectiveness in reducing EDS. An individual patient meta-analysis was conducted assessing the efficacy and safety of pitolisant 20 mg and 40 mg versus placebo to treat EDS in patients with OSA using CPAP.</div></div><div><h3>Methods</h3><div>A study-patient, hierarchical, random-effects model was used. Epworth Sleepiness Scale (ESS) and Oxford Sleep Resistance test (OSLER) were co-primary endpoints. Secondary endpoints included EDS-Z scores, fatigue, clinical global impression, and quality of life (QoL).</div></div><div><h3>Results</h3><div>The searches identified three randomized controlled trials. Individual patient data were derived from 423 patients (placebo: n = 120, pitolisant 20 mg: n = 183, pitolisant 40 mg: n = 120). Treatment effects on ESS were −3.20 (95 % confidence interval [CI]: 4.37, −2.00; <em>P</em> &lt; 0.001) and −3.57 (95 % CI: 4.87, −2.80); <em>P</em> &lt; 0.001) for the 20 mg and 40 mg doses, with corresponding standardized mean differences (SMD) of −0.71 (95 % CI: 0.45, −0.97) and −0.79 (95 % CI: 0.51, −1.08). Treatment effects in minutes for OSLER were 1.24 (95 % CI: 0.60, 1.10, SMD = 0.61; <em>P</em> = 0.001) and 1.21 (95 % CI: 0.06, 1.38, SMD = 0.51; <em>P</em> = 0.006). Pitolisant 40 mg was superior to the 20-mg dose for older age (≥50 years) and higher baseline apnea-hypopnea index values (≥15). No significant differences were observed for safety outcomes.</div></div><div><h3>Conclusion</h3><div>Pitolisant 20 mg and 40 mg were significantly therapeutically superior to placebo in treating residual EDS in patients with OSA who received CPAP on the outcomes for ESS, OSLER, and QoL.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"129 ","pages":"Pages 1-7"},"PeriodicalIF":3.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific differences in overnight nitrate levels in persons with obstructive sleep apnea and type 2 diabetes","authors":"Gregory Pappas ,&nbsp;Andrew Gow ,&nbsp;Naresh M. Punjabi ,&nbsp;R. Nisha Aurora","doi":"10.1016/j.sleep.2025.02.011","DOIUrl":"10.1016/j.sleep.2025.02.011","url":null,"abstract":"<div><h3>Study objectives</h3><div>Sex-specific differences in OSA-associated symptoms and polysomnographic findings are well recognized. However, sex differences in intermediate pathways potentially linking OSA and cardiometabolic outcomes are limited. OSA is known to be associated with decreased nitric oxide (NO)-related vasodilation and endothelial dysfunction. The current study sought to characterize the independent association between OSA severity and overnight NO metabolites (i.e. markers of oxidative stress) and determine if there were differences by sex in persons with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>Adults with T2DM and undiagnosed OSA were recruited from the community. Demographic information, an overnight polysomnogram, and pre- and post-sleep plasma samples were collected. The association between OSA and nitrite and nitrate levels were examined using multivariable linear regression. Analyses were done for the entire sample and stratified by sex.</div></div><div><h3>Results</h3><div>The sample included 83 participants with 52 % men. Stratified, fully adjusted models showed that compared to women with mild OSA, women with moderate or severe OSA did not exhibit the expected decline in overnight nitrate levels: 4.84 μM (−12.3, 2.7: p = 0.09) and 5.82 μM (−4.7, 16.3: p &lt; 0.01) for moderate and severe OSA, respectively. Overnight nitrate levels decreased in males regardless of OSA severity, without significant differences across severity categories. An interaction between OSA severity and sex was seen for post-sleep nitrates in women with severe OSA.</div></div><div><h3>Conclusion</h3><div>The association between OSA and overnight nitrates varies by sex and OSA severity. Women with severe OSA did not have a decline in overnight nitrate levels whereas men did, suggesting they have higher overnight oxidative stress.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"128 ","pages":"Pages 159-164"},"PeriodicalIF":3.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}