Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-01-30DOI: 10.1016/j.smrv.2026.102240
Gorica Micic , Amy C. Reynolds , Andrew J.K. Phillips , Phyllis Zee , Cele Richardson , Helen J. Burgess , Leon Lack , Peter Catcheside , Cathy A. Goldstein , Hannah Scott , Sean Cain , Robert Adams , Nicole Lovato
{"title":"Understanding delayed sleep-wake phase disorder (DSWPD): Mechanisms, comorbidities, and evolving approaches to diagnosis and treatment","authors":"Gorica Micic , Amy C. Reynolds , Andrew J.K. Phillips , Phyllis Zee , Cele Richardson , Helen J. Burgess , Leon Lack , Peter Catcheside , Cathy A. Goldstein , Hannah Scott , Sean Cain , Robert Adams , Nicole Lovato","doi":"10.1016/j.smrv.2026.102240","DOIUrl":"10.1016/j.smrv.2026.102240","url":null,"abstract":"<div><h3>Background</h3><div>Delayed Sleep-Wake Phase Disorder (DSWPD) is a circadian rhythm disorder marked by a consistent and distressing delay in sleep timing relative to societal norms. While traditionally viewed as a circadian phase disorder, growing evidence shows psychological, behavioural, and physical health factors interact with circadian biology to influence onset, maintenance, and outcomes.</div></div><div><h3>Purpose</h3><div>of review: This review synthesises recent literature on DSWPD's multifactorial nature, focusing on aetiology, nosology, comorbidities, and treatment. It highlights emerging evidence supporting a multidimensional diagnostic approach and personalised, multimodal management.</div></div><div><h3>Recent findings</h3><div>Some individuals with DSWPD exhibit a significantly delayed circadian phase, while others show normal circadian timing but persistently delayed sleep behaviour. A spectrum approach or subtyping into circadian and behavioural variants has been proposed. Comorbidities with psychiatric conditions including depression, anxiety, ADHD and autism are common and may affect treatment response. Chronobiotic treatments remain core, but cognitive-behavioural and psychotherapeutic interventions are increasingly essential, especially in non-circadian or comorbid cases. Advances in wearable technology and circadian modelling offer promising tools for diagnosis, monitoring, intervention.</div></div><div><h3>Summary</h3><div>DSWPD is heterogeneous and requires an integrative, individualised approach considering circadian biology, behaviour and psychiatric comorbidities. A multidimensional diagnostic and treatment model could improve outcomes and functioning.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102240"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146174192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-01-28DOI: 10.1016/j.smrv.2026.102245
Valentina Baldini , Martina Gnazzo , Giorgia Varallo , Diana De Ronchi , Fabio Pizza , Giuseppe Plazzi , Elena Antelmi
{"title":"Investigating the association between post-traumatic stress disorder and REM sleep behavior disorder: a systematic review","authors":"Valentina Baldini , Martina Gnazzo , Giorgia Varallo , Diana De Ronchi , Fabio Pizza , Giuseppe Plazzi , Elena Antelmi","doi":"10.1016/j.smrv.2026.102245","DOIUrl":"10.1016/j.smrv.2026.102245","url":null,"abstract":"<div><div>Post-traumatic stress disorder (PTSD) is frequently accompanied by additional sleep disturbances, such as nightmares and insomnia. Recent findings suggest a potential association between PTSD and REM sleep behavior disorder (RBD). This systematic review evaluates the current evidence on the PTSD–RBD relationship, with attention to prevalence, diagnostic approaches, shared pathophysiological mechanisms, and clinical implications.</div><div>A comprehensive search of PubMed, Web of Science, EMBASE, and PsycINFO was conducted up to July 2025. Eligible studies included observational, cohort, and experimental designs assessing RBD in individuals with PTSD. Methodological quality was appraised using the Newcastle–Ottawa Scale.</div><div>Seven studies, encompassing 4152 participants, met the inclusion criteria. Overall, PTSD was linked to a higher prevalence of probable or confirmed RBD, particularly among veterans. Adding to this, patients with isolated RBD appeared more likely to report comorbid PTSD than those diagnosed with other parasomnias. Evidence also indicated that PTSD-related RBD may be associated with more severe psychopathology, including heightened depressive symptoms, recurrent nightmares, and emotional dysregulation.</div><div>From a clinical standpoint, it is advisable to evaluate PTSD patients presenting with parasomnia symptoms for possible RBD, and to investigate PTSD history in those exhibiting dream enactment behaviors.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102245"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-02-19DOI: 10.1016/j.smrv.2026.102260
Cátia Reis , Ana Rita Peralta , Charles A. Czeisler , Shantha M.W. Rajaratnam
{"title":"Toward precision medicine in delayed sleep-wake phase disorder: Definitions, dimensions, and the path to personalised care","authors":"Cátia Reis , Ana Rita Peralta , Charles A. Czeisler , Shantha M.W. Rajaratnam","doi":"10.1016/j.smrv.2026.102260","DOIUrl":"10.1016/j.smrv.2026.102260","url":null,"abstract":"","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102260"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnostic accuracy of the neck circumference, obesity, snoring, age, and sex score in screening obstructive sleep apnea: A systematic review and meta-analysis","authors":"Muhammad Amirul Mukminin , Li-Pang Chuang , Pin-Yuan Chen , Huan-Xi Huang , Iftitakhur Rohmah , Hsiao-Yean Chiu","doi":"10.1016/j.smrv.2026.102254","DOIUrl":"10.1016/j.smrv.2026.102254","url":null,"abstract":"<div><div>Obstructive sleep apnea (OSA) is a prevalent yet underdiagnosed condition. Although the Neck Circumference, Obesity, Snoring, Age, and Sex (NoSAS) score is commonly used in clinical practice. This study aimed to evaluate the performance of the NoSAS score in detecting mild, moderate, and severe OSA, based on the apnea–hypopnea index (AHI) or respiratory event index (REI). PubMed, Embase, ProQuest Dissertations and Theses A&I, Ovid Medline, CINAHL Plus, and Web of Science were searched for relevant articles published before August 29, 2025. We included studies evaluating the sensitivity and specificity of the NoSAS score compared with polysomnography or other validated references. A bivariate random-effects model was used for data analysis. Our meta-analysis included 31 studies, 25 on mild or AHI/REI ≥5 events/h, 31 on moderate or AHI/REI ≥15 events/h, and 24 on severe or AHI/REI ≥30 events/h. The pooled sensitivity and specificity were 71% and 66% for mild OSA, 73% and 62% for moderate OSA, and 82% and 50% for severe OSA, respectively. Moderator analysis revealed an association between BMI and higher sensitivity for mild and severe OSA. Larger sample sizes were associated with higher specificity for mild OSA. Advanced age was associated with pooled specificity in severe OSA. Caucasian countries increased sensitivity in all OSA severity and increased specificity in severe OSA compared to Asian countries. Sleep-related clinic has higher specificity in both of moderate and severe OSA and increased sensitivity in moderate OSA (all p < 0.05) compared to community-based settings. We suggest that the NoSAS score performed consistently across OSA severities, making it useful in resource-limited settings. Nevertheless, our findings should be interpreted with caution due to the high degree of heterogeneity.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102254"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-02-05DOI: 10.1016/j.smrv.2026.102255
Tak Hou Calvin Chang , Joshua B. Hicks , Zahra Izadi , Arshdeep Marwaha , AJ Hirsch Allen , Mohammadreza Hajipour , Annalijn I. Conklin , Najib T. Ayas
{"title":"Circulating markers of biological aging associated with obstructive sleep apnea or insomnia in adults: A systematic review and meta-analysis","authors":"Tak Hou Calvin Chang , Joshua B. Hicks , Zahra Izadi , Arshdeep Marwaha , AJ Hirsch Allen , Mohammadreza Hajipour , Annalijn I. Conklin , Najib T. Ayas","doi":"10.1016/j.smrv.2026.102255","DOIUrl":"10.1016/j.smrv.2026.102255","url":null,"abstract":"<div><div>Obstructive sleep apnea (OSA) and insomnia could accelerate biological aging through pathways including oxidative stress and systemic inflammation. This systematic review aimed to determine the association of sleep disorders with circulating markers of biological aging. We searched MEDLINE, Embase, CINAHL, Cochrane, PsycINFO from inception to October 2024. Eligibility criteria included full manuscript English studies on adult humans examining OSA or insomnia and circulating markers of aging. Of the 1839 deduplicated records screened, 49 full-text studies were eligible for inclusion. Included studies ranged from poor to good quality and assessed telomere length (TL), DNA methylation clocks (epigenetics), mitochondrial alterations, sirtuin levels and activity, autophagy protein levels, and <em>klotho</em> gene expression. Telomeres were the most extensively studied marker, with our findings showing a significant association between TL and OSA, based on both unadjusted and adjusted values (SMD = −0.451, 95% CI: 0.688 to −0.215, p = 0.0026 and SMD = −3.01, 95% CI: 4.98 to −1.04, p = 0.033, respectively). Most studies linked insomnia and poor sleep quality to shorter TL. Although evidence for other aging biomarkers was more limited, the published literature supports the role of OSA and insomnia in accelerating biological aging, especially for telomere length.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102255"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-01-29DOI: 10.1016/j.smrv.2026.102241
Perran Boran , Lourdes M. DelRosso
{"title":"Nurturing care for early childhood sleep interventions with tailored care: the NEST Approach","authors":"Perran Boran , Lourdes M. DelRosso","doi":"10.1016/j.smrv.2026.102241","DOIUrl":"10.1016/j.smrv.2026.102241","url":null,"abstract":"<div><div>Early childhood insomnia (ECI) affects 20–30 % of children aged 6–36 months, making it the most common sleep disturbance in this age group. Current interventions often focus on independent sleep through extinction-based behavioral methods, with less emphasis on broader socioecological influences such as caregiving quality and feeding practices. This paper introduces a conceptual model to reframe ECI interventions using the World Health Organization endorsed Nurturing care framework (NCF), which includes five components: good health, adequate nutrition, safety and security, responsive caregiving and opportunities for learning. Sleep is essential for health, and early childhood represent a critical window for shaping lifelong sleep patterns. Breastfeeding helps integration of all five components while responsive caregiving, supports the other four components. Sensory-motor nourishment fosters a sense of safety and early learning opportunities promote self-regulation. The model outlines actionable strategies under each NCF components, offering guidance for researchers and supporting adaptation across diverse settings, viewing sleep health as part of a broader caregiver ecosystem rather than isolated behavioral problem.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102241"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-02-17DOI: 10.1016/j.smrv.2026.102258
Natasha J. Sneddon , Angela L. D'Rozario , Armando Teixeira-Pinto , Clement T. Loy
{"title":"What is the prevalence of sleep disturbances among people with Huntington disease and pre-manifest genetic expansion carriers? A systematic review and meta-analysis","authors":"Natasha J. Sneddon , Angela L. D'Rozario , Armando Teixeira-Pinto , Clement T. Loy","doi":"10.1016/j.smrv.2026.102258","DOIUrl":"10.1016/j.smrv.2026.102258","url":null,"abstract":"<div><div>Anecdotally, sleep disturbances are common among manifest and pre-manifest Huntington disease genetic expansion carriers (HDGECs), but their prevalence has not been systematically studied. To address this gap, we systematically searched MEDLINE, EMBASE, PsychINFO, CINAHL-Plus, and PubMed (inception to October 2025), using exploded headings and text-words based on sleep-related terms intersected with “Huntington disease”. We meta-analysed data where four or more studies used the same measure. 28 articles were included, with study design including case-series and case-control studies (sample sizes 6-14,791). Measures of sleep disturbances were objective (n = 10), including polysomnography (n = 8) or circadian biomarkers (n = 2), or subjective (n = 20); with studies including multiple measures or heterogenous populations. Meta-analysed prevalence of objectively-measured sleep disturbances include: 35% for periodic limb movements (PLM index>15/hour), 3% for REM sleep behaviour disorder, 5% for REM sleep without atonia, and 9% for sleep-disordered breathing (AHI>5/hour); and of self-reported measures: 29% for use of sleep medications, 59% for poor sleep quality (Pittsburgh sleep quality index), and 15% for excessive daytime sleepiness (Epworth sleepiness scale). Periodic limb movements during sleep, use of sleep medications, and poor sleep quality were prevalent. Further research is crucial for characterising changes in sleep which may inform sleep interventions improving quality of life among HDGECs.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102258"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-01-30DOI: 10.1016/j.smrv.2026.102246
Andrew Krystal , Ruth Benca , William V. McCall , Michael L. Perlis , Nathaniel F. Watson , John W. Winkelman , Matt Fisher , Charles M. Morin
{"title":"Pharmacologic treatment data from chronic insomnia studies and the application to individuals with acute insomnia, a narrative review","authors":"Andrew Krystal , Ruth Benca , William V. McCall , Michael L. Perlis , Nathaniel F. Watson , John W. Winkelman , Matt Fisher , Charles M. Morin","doi":"10.1016/j.smrv.2026.102246","DOIUrl":"10.1016/j.smrv.2026.102246","url":null,"abstract":"<div><div>A variety of pharmacologic treatments are approved for insomnia, encompassing a range of mechanisms of action, including some treatments with published data in models of acute insomnia. However, most studies are conducted in individuals with chronic insomnia. Thus, it is unclear whether data from studies in individuals with chronic insomnia apply to individuals with acute insomnia symptoms. In this review, we discuss the generalizability of pharmacologic treatment data from chronic insomnia studies to individuals experiencing acute insomnia. Data from chronic insomnia treatment trials can be generalized to those with acute insomnia based on 1) the pathophysiology and evolution of insomnia and 2) data indicating medications effective for chronic insomnia are also effective for acute/induced insomnia. The pharmacologic management of acute insomnia should be based on a careful benefit-risk evaluation of each treatment option, data for acute insomnia or acute relief of chronic insomnia symptoms, and clinical practice guideline considerations. Given the limitations of available self-treatment options for acute insomnia symptoms, proven pharmacologic approaches are needed. Based on the available information, and the indications outlined in the United States (US) prescribing information, certain pharmacologic treatments are reasonable recommendations for treatment of acute insomnia.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102246"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-01-29DOI: 10.1016/j.smrv.2026.102239
Zhide Liang , Shiao Zhao , Shudong Tian , Chuanzhi Wang , Meng Zhang , Kai Xu , Mingyue Yin , Sanfan Ng , Ziheng Ning
{"title":"Determinants and interrelations of exercise effects on sleep quality: A multimethod meta-analysis","authors":"Zhide Liang , Shiao Zhao , Shudong Tian , Chuanzhi Wang , Meng Zhang , Kai Xu , Mingyue Yin , Sanfan Ng , Ziheng Ning","doi":"10.1016/j.smrv.2026.102239","DOIUrl":"10.1016/j.smrv.2026.102239","url":null,"abstract":"<div><h3>Background</h3><div>This systematic review and Bayesian meta-analysis examined determinants of exercise effects on subjective sleep quality.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus and CINAHL from inception to August 2025 for randomised controlled trials in adults (≥18 years) comparing exercise with non-exercise controls. Two reviewers independently assessed risk of bias (RoB 2). Bayesian multilevel models, MetaForest and structural equation modelling estimated pooled effects and moderators, expressed as standardised mean differences (Hedges’ g).</div></div><div><h3>Results</h3><div>Two hundred trials (n = 23,523) were included. Compared with active controls, qigong, walking and high-intensity interval training showed the largest benefits. In 20 trials reporting objective sleep efficiency, exercise produced a small but significant improvement, consistent with subjective outcomes. Baseline sleep quality (assessed with Pittsburgh Sleep Quality Index) and population type were the main determinants of response. Populations with poorer baseline sleep quality were much more likely to achieve a clinically important improvement than good sleepers. Intervention duration showed a U-shaped association with benefit, peaking at 25 weeks. Certainty of evidence was very low.</div></div><div><h3>Conclusion</h3><div>Exercise improves subjective sleep quality in a benefit-on-demand pattern, supporting prioritisation of approximately 25-week programmes for adults with moderate-to-severe sleep problems while acknowledging very low certainty.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102239"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep Medicine ReviewsPub Date : 2026-04-01Epub Date: 2026-02-18DOI: 10.1016/j.smrv.2026.102262
Mariana Moysés-Oliveira , Sergio Tufik
{"title":"Measuring the invisible: Anosognosia and the paradox of sleep assessment in early Huntington's disease","authors":"Mariana Moysés-Oliveira , Sergio Tufik","doi":"10.1016/j.smrv.2026.102262","DOIUrl":"10.1016/j.smrv.2026.102262","url":null,"abstract":"","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"86 ","pages":"Article 102262"},"PeriodicalIF":9.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}