Journal of Clinical Sleep Medicine最新文献

{"title":"Sleep-disordered breathing increases mortality in patients with diabetes.","authors":"Teodora Vichova, Marek Petras, Petr Waldauf, Katerina Westlake, Zuzana Vimmerova-Lattova, Jan Polak","doi":"10.5664/jcsm.11320","DOIUrl":"https://doi.org/10.5664/jcsm.11320","url":null,"abstract":"<p><strong>Study objectives: </strong>Sleep-disordered breathing (SDB) and diabetes mellitus (DM) are often concomitant; however, data on the impact of SDB on mortality in the population with diabetes remain scarce.</p><p><strong>Methods: </strong>The population from the Sleep Heart Health Study, a multicenter prospective observational study representing 5780 patients with polysomnography and mortality data, including 453 patients with DM, was analyzed to assess the impact of SDB variables and the presence of DM on all-cause, cardiovascular disease (CVD), and non-CVD associated mortality. Survival analysis and proportional hazard regression models were used to calculate the adjusted hazard ratios (aHR) for mortality.</p><p><strong>Results: </strong>Patients with DM and the average SpO₂ >91.4% had significantly lower all-cause (aHR 0.52, CI 0.34-0.80) and CVD mortality risk (aHR 0.44, CI 0.22-0.87) as compared with patients with SpO₂ below this value. Apnea-hypopnea index >31 (aHR 1.58, CI 1.10-2.28) and oxygen desaturation index >13.3 (aHR 1.58, CI 1.10-2.25) were associated with increased all-cause mortality in participants with DM on treatment. Sleep efficiency and proportion of rapid-eye movement (REM) sleep did not have any impact on mortality in patients with DM and thus differed significantly from individuals without DM, where increased all-cause mortality was observed in those with sleep efficiency <81.4% (aHR 0.77, CI 0.68-0.87) or REM sleep <14.9% (aHR 0.78, CI 0.68-0.89).</p><p><strong>Conclusions: </strong>Patients with diabetes on treatment and moderate to severe sleep-disordered breathing experience increased all-cause mortality. Reduced average oxygen saturation predicted both all-cause and cardiovascular death in the population with diabetes.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we stop hitting the snooze button on wearable sleep technology?","authors":"Rodolfo Soca, Meghan Johnston","doi":"10.5664/jcsm.11342","DOIUrl":"https://doi.org/10.5664/jcsm.11342","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and phenoconversion in isolated REM sleep behavior disorder: a prospective single-center study in Korea, compared with Montreal cohort.","authors":"Jung-Ick Byun, Jun-Sang Sunwoo, Yong Woo Shin, Jung-Won Shin, Tae-Joon Kim, Jin-Sun Jun, Jung Hwan Shin, Han-Joon Kim, Jacques Montplaisir, Jean-François Gagnon, Amelie Pelletier, Aline Delva, Ronald B Postuma, Ki-Young Jung","doi":"10.5664/jcsm.11318","DOIUrl":"https://doi.org/10.5664/jcsm.11318","url":null,"abstract":"<p><strong>Study objectives: </strong>Isolated rapid-eye movement behavior disorder (iRBD) is a prodromal synucleinopathy, but its conversion rate and subtypes can vary among different cohorts. We report the clinical characteristics and phenoconversion rate of the large single-center iRBD cohort in Korea and compared it to the Montreal cohort.</p><p><strong>Methods: </strong>This prospective cohort study examined 238 patients with polysomnography confirmed iRBD from Seoul National University Hospital (SNUH) who completed at least one follow-up evaluation. We compared the baseline and phenoconversion data of the SNUH cohort to those of 242 iRBD patients in the Montreal cohort.</p><p><strong>Results: </strong>In the SNUH cohort, age at RBD diagnosis was similar (66.4±7.8 vs 65.6±8.4, p=0.265), but the proportion of men was lower (63.0% vs. 74.0%, p=0.001), and the duration of follow-up was shorter than that in the Montreal cohort (3.7±2.0 vs. 4.8±3.6 years, p<0.001). During follow-up, 34 (11.8%) patients in the SNUH cohort converted to neurodegenerative disease: 18 (52.9%) to Parkinson's disease, 9 (26.5%) to dementia with Lewy bodies (DLB), and 7 (20.6%) to multiple system atrophy. The conversion rate in the SNUH cohort was 15% after 3 years, 22% after 5 years, and 32% after 7 years, which was significantly lower than that of the Montreal cohort (log-rank test, p=0.002). Among phenoconversion subtype, fewer subjects in the SNUH group than in the Montreal group converted to DLB (Gray's test p=0.001).</p><p><strong>Conclusions: </strong>Through a comparative analysis between the SNUH and Montreal cohorts, we identified a significant difference in phenoconversion rates, particularly for DLB patients. These findings underscore the importance of further research into the underlying factors, such as racial and geographical factors contributing to such disparities.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep disturbances associated with <i>DEAF1</i> pathogenic variants.","authors":"Pedro Guerreiro, Mariana Moysés-Oliveira, Mayara Paschalidis, Anna Kloster, Lais Cunha, Tais Bassani Deconto, Amanda Cristina Mosini, Bruna Pereira Marquezini, Luana Nayara Gallego Adami, Monica L Andersen, Sergio Tufik","doi":"10.5664/jcsm.11316","DOIUrl":"https://doi.org/10.5664/jcsm.11316","url":null,"abstract":"<p><p>Neurodevelopmental disorders and sleep disturbances share genetic risk factors. <i>DEAF1</i> genetic variants are associated with rare syndromes in which sleep disturbances are commonly reported, yet the specific sleep disorders in these patients, and the molecular mechanisms underlying this association, are unknown. We aimed to pinpoint specific biological processes that may be disrupted by pathogenic variants in this gene, comparing a list of DEAF1 regulatory target genes with a list of insomnia-associated genes, and using the intersect gene list as the input for pathway enrichment analysis. Thirty-nine DEAF1 regulatory targets were also identified as insomnia-associated genes, and the intersecting gene list was found to be strongly associated with immune processes, ubiquitin-mediated proteolysis pathways and regulation of the cell cycle. This preliminary study highlights pathways that may be disrupted by <i>DEAF1</i> pathogenic mutations and might be putative factors underlying the manifestation of insomnia in patients harboring such variants.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of graduated drug therapy for moderate to severe chronic insomnia on the severity of disease: an observational study in Germany.","authors":"Jolijn Boer, Theresa Toncar, Arne Stange, Lisa Rosenblum, Ingo Fietze","doi":"10.5664/jcsm.11334","DOIUrl":"https://doi.org/10.5664/jcsm.11334","url":null,"abstract":"<p><strong>Study objectives: </strong>Severe chronic insomnia is a common sleep disorder that is mostly persistent and needs to be treated. Pharmacologic treatment options and guidelines are sparse, particularly for long-term treatment. Our study aims to investigate a graduated therapy scheme for moderate to severe chronic insomnia in practice, considering the effects on self-reported sleep quality and quality of life.</p><p><strong>Methods: </strong>Patients with moderate to severe chronic insomnia are given appropriate medication according to a graduated therapy scheme, ranging from L-tryptophan (as the first choice, least potent) to Z-drugs and combination therapies (as the last option, most potent). Each step of the graduated therapy scheme was tested for at least 4 weeks. Sleep- and quality of life-related data were collected in questionnaire form (ISI, PSQI, BDI-II, SF-36) at baseline and during the course of the treatment after 1, 3, 6, 9, and 12 months.</p><p><strong>Results: </strong>Of 86 eligible patients, 60.5% started treatment with L-tryptophan and 8.1% with melatonin. After 3 months, 12.5% were still taking L-tryptophan and 12.5% were taking melatonin. There was a significant decrease in mean ISI, PSQI, BDI-II, and SF-36 scores after 3 months of treatment for all patients in the study (n=64). After 6 months, 22.2% were still taking L-tryptophan, melatonin, or agomelatine, and the remainder had switched to more potent drugs such as antidepressants, hypnotics, daridorexant, or combination therapies.</p><p><strong>Conclusions: </strong>A significant number of patients already responded favorably to mild sleep medications, while others demonstrated their need for more potent treatments. Ongoing monitoring will evaluate the long-term effectiveness of both approaches.</p><p><strong>Clinical trial registration: </strong>Registy: German Clinical Trials Register; Title: Schlafqualität und Lebensqualität mit einer medikamentösen Langzeittherapie bei moderater bis schwerer Insomnie; Identifier: DRKS00033175; URL: https://drks.de/search/de/trial/DRKS00033175.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep misperception in women with myofascial temporomandibular disorder.","authors":"Christy Chan, Boris Dubrovsky, Maude Bouchard, Vivien C Tartter, Karen G Raphael","doi":"10.5664/jcsm.11330","DOIUrl":"https://doi.org/10.5664/jcsm.11330","url":null,"abstract":"<p><strong>Study objectives: </strong>Temporomandibular disorders (TMD) were linked to poor sleep on the Pittsburgh Sleep Quality Index (PSQI), whereas polysomnography (PSG) revealed no major sleep disturbances, implying sleep state misperception (SSM). This study investigates SSM in TMD and control participants; correlates SSM with objective short sleep duration (SSD), depression symptoms, daytime sleepiness, and orofacial pain; and compares objective SSD between the groups.</p><p><strong>Methods: </strong>General linear models were used to compare second-night PSG total sleep time (TST), sleep latency (SL), sleep efficiency (SE) and wake after sleep onset (WASO) with homologous PSQI-derived variables in 124 women with myofascial TMD and 46 age and BMI matched controls. PSQI variables were regressed onto objective SSD, depression symptoms, daytime sleepiness, and pain. Lastly, objective SSD was related to TMD presence.</p><p><strong>Results: </strong>Compared to controls, TMD cases misperceived SE (<i>p</i> = 0.02); depression symptoms explained PSQI-derived SE (<i>p</i> = 0.002) and mediated the effect of pain (<i>p</i> <.001). PSQI variables were unrelated to respective PSG measures or objective SSD, except a significant subjective-objective correlation in SE among controls only (<i>p</i> = 0.002). Objective SSD was more frequent in TMD cases (<i>p</i> = 0.02, OR = 2.95), but it was unrelated to depression symptoms, daytime sleepiness or pre-PSG pain.</p><p><strong>Conclusions: </strong>The study demonstrates misperception of SE among TMD cases, which was accounted for by depression symptoms. Objective SSD nearly tripled in TMD cases; however, it was unrelated to PSQI variables, depression, daytime sleepiness, or pain, suggesting that SSM and objective SSD are two independent sleep features in TMD.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum ferritin measurements differ according to assay used: implications for iron therapy in restless legs syndrome.","authors":"Michael H Silber, Darci R Block, Erik K St Louis","doi":"10.5664/jcsm.11332","DOIUrl":"https://doi.org/10.5664/jcsm.11332","url":null,"abstract":"<p><strong>Study objectives: </strong>Serum ferritin levels are used to determine the need for iron supplementation in patients with RLS. The purpose of the study was to determine whether immunoassay measurement of serum ferritin yields varying levels according to different manufacturer assays, with resultant variation in cut off values.</p><p><strong>Methods: </strong>We compared serum ferritin levels using 116 clinical samples assessed by the Beckman and Roche methods.</p><p><strong>Results: </strong>While there was a high correlation between results obtained from the 2 methods (R² = 0,99), the absolute values differed. The equivalent ferritin measures determined by Beckman, Roche were: 50 mcg/dL, 83 mcg/dL; 75 mcg/dL, 121 mcg/dL; 100 mcg/dL, 158 mcg/dL; and 300 mcg/dL, 457 mcg/dL.</p><p><strong>Conclusions: </strong>It is uncertain which assays were used to measure serum ferritin in the seminal studies on which current guidelines for iron therapy for RLS are based. In view of this uncertainty, as well as the limited data on which current recommendations are based, clinicians should be flexible in using recommended serum ferritin cut off values, also utilizing percentage transferrin saturation. Assuming that Beckman or equivalent assays were used, centers using the Roche method need to adjust the cut offs for administration of oral iron and intravenous iron recommended by current practice guidelines to avoid withholding treatment for RLS patients who might benefit from iron supplementation.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between insomnia and cardiovascular diseases: a meta-review and meta-analysis of observational and Mendelian randomization studies.","authors":"Xuejiao Zhang, Yujing Sun, Shuo Ye, Qingqing Huang, Rui Zheng, Zhexi Li, Feng Yu, Chenhao Zhao, Min Zhang, Guoan Zhao, Sizhi Ai","doi":"10.5664/jcsm.11326","DOIUrl":"https://doi.org/10.5664/jcsm.11326","url":null,"abstract":"<p><strong>Study objectives: </strong>Observational studies suggest associations between insomnia and cardiovascular diseases (CVDs), but the causal mechanism remains unclear. We investigated the potential causal associations between insomnia and CVDs by a combined systematic meta-review and meta-analysis of observational and Mendelian randomization (MR) studies.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, and Embase for English-language articles from inception to 7/11/2023. Two reviewers independently screened the articles to minimize potential bias. We summarized the current evidence on the associations of insomnia with coronary artery disease (CAD), atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), hypertension (HTN), and stroke risk by combining meta-analyses of observational and MR studies.</p><p><strong>Results: </strong>Four meta-analyses of observational studies and 9 MR studies were included in the final data analysis. A systematic meta-review of observational studies provided strong evidence that insomnia is an independent risk factor for many CVDs, including AF, MI, and HTN. A meta-analysis of MR studies revealed that insomnia may be potentially causally related to CAD (odds ratio (OR)=1.14, 95% confidence interval (CI)=1.10-1.19, I²=97%), AF (OR=1.02, 95% CI=1.01-1.04, I²=94%), HF (OR=1.04, 95% CI=1.03-1.06, I² =97%), HTN (OR=1.16, 95% CI=1.13-1.18, I²=28%), large artery stroke (OR=1.14, 95% CI=1.05-1.24, I²=0%), any ischemic stroke (OR=1.09, 95% CI=1.03-1.14, I²=60%), and primary intracranial hemorrhage (OR=1.16, 95% CI=1.05-1.27, I²=0%). No evidence suggested that insomnia is causally associated with cardioembolic or small vessel stroke.</p><p><strong>Conclusions: </strong>Our results provide strong evidence supporting a possible causal association between insomnia and CVD risk. Strategies to treat insomnia may be promising targets for preventing CVDs.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How we measure hypoglossal nerve stimulator outcome matters: titration versus single amplitude efficacy sleep studies.","authors":"Thomas M Kaffenberger, Elliott M Sina, Bryce Hambach, Praneet Kaki, Antony Fuleihan, Maurits Boon, Colin Huntley","doi":"10.5664/jcsm.11328","DOIUrl":"https://doi.org/10.5664/jcsm.11328","url":null,"abstract":"<p><strong>Study objectives: </strong>Hypoglossal nerve stimulation (HGNS) is a common treatment for obstructive sleep apnea (OSA). Objective assessment of HGNS efficacy measures apnea-hypopnea index (AHI) by multi-amplitude titration polysomnography (tPSG) and/or a single amplitude efficacy sleep study (eHST). Both tests have been used to determine efficacy despite significantly different protocols. This project's aim was to determine differences in objective outcomes in HGNS patients who underwent both tPSG and eHST post-operatively.</p><p><strong>Methods: </strong>Data from 379 consecutive HGNS patients were retrospectively reviewed. Inclusion requirements were a pre-operative sleep study, a post-operative tPSG, and then an eHST, which at our institution is a type 3 home study. AHI mean and differences were calculated. Wilcoxon rank sum tests were used to analyze differences between tPSG and eHST. Sher₁₅ criteria (post-operative AHI≤15 events/hour and ≥50% reduction from baseline) was calculated and compared by <b>χ²</b> tests.</p><p><strong>Results: </strong>Ultimately 61 patients met inclusion criteria with an average pre-operative AHI=33.2. When comparing the subject's tPSG versus eHST, tPSG AHI was significantly lower (AHI=8.8 versus AHI=17.6; respectively, p<0.001). There was also a difference in the percentage of patients that met Sher₁₅ criteria when using tPSG (80.3%) versus eHST AHI (45.9%).</p><p><strong>Conclusions: </strong>HGNS patient's postoperative tPSG AHI was significantly lower than their eHST outcome. This work highlights the importance of reporting the type of post-operative study used in evaluating HGNS efficacy and the need for single amplitude, full-night studies to assess HGNS efficacy more accurately.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dreams interrupted: characteristics of REM sleep-associated seizures and status epilepticus.","authors":"Graham A McLeod, Paul A Szelemej, Darion Toutant, Marna B McKenzie, Marcus C Ng","doi":"10.5664/jcsm.11336","DOIUrl":"https://doi.org/10.5664/jcsm.11336","url":null,"abstract":"<p><strong>Study objectives: </strong>Seizures are rare in rapid eye movement sleep (REM). However; seizures sometimes occur in REM, and a small number of focal epilepsy patients display their maximum rate of interictal epileptiform discharges in REM. We sought to systematically identify and characterize seizures in REM.</p><p><strong>Methods: </strong>We reviewed all admissions to the Epilepsy Monitoring Unit (EMU) at the Winnipeg Health Sciences Centre over 12-months in 2014-2015. American Academy of Sleep Medicine sleep-stage scoring was initially applied in the standard 30-second epochs. Then, to capture sudden changes in sleep-wake state on shorter timescales that are associated with seizure formation and propagation, we re-scored ictal and peri-ictal EEG epochs every 1 second. Patients found to have seizures in REM were subject to chart review spanning three years pre- and post-admission.</p><p><strong>Results: </strong>REM seizures occurred in 3/63 EMU patients. Notably, one patient exhibited continuous epileptiform activity, consistent with focal nonconvulsive electrographic status epilepticus, throughout REM cycles for each night of her admission. Otherwise, discrete REM seizures constituted a small fraction of the other patients' total seizures (range 5.0-8.3%), occurred shortly after REM onset from non-REM 2, and were manifest as minor epileptic arousals.</p><p><strong>Conclusions: </strong>Our results confirm that REM seizures are rare, while highlighting outliers who widen the known spectrum of heterogeneous sleep effects on seizures/epilepsy. We also report the first case of paradoxical status epilepticus in REM.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}