Journal of Clinical Sleep Medicine最新文献

{"title":"Impaired attention in pediatric narcolepsy type 1.","authors":"Elizabeth Montesano Scheibe, Bo Zhang, Grace Wang, Jennifer Worhach, Kiran Maski","doi":"10.1007/s44470-026-00064-0","DOIUrl":"10.1007/s44470-026-00064-0","url":null,"abstract":"<p><strong>Purpose: </strong>Attentional complaints are common among youth with Narcolepsy Type 1 (NT1), yet objective data are limited. We hypothesized that adolescents with NT1 would show worse attention on a 3-min Psychomotor Vigilance Task (PVT) than healthy controls (HC), with performance correlating to self-reported sleepiness and increased sleep stage transition.</p><p><strong>Methods: </strong>Twenty-six NT1 participants (mean 15.9 years) and 16 HC (mean 16.3 years) completed 3-min PVT testing in the evening and morning pre/post nocturnal polysomnography (PSG). Sleep to Wake/N1 transitions and N1% were extracted from PSG data as measures of disrupted nighttime sleep and Epworth Sleepiness Scale (ESS) scores were collected. PVT outcomes included lapses, mean 1/RT, and slowest 10% 1/RT. Linear mixed models examined group differences and effects of age, gender, test timing, and group-time interactions.</p><p><strong>Results: </strong>NT1 participants had more lapses (p < .001), slower mean 1/RT (p = .003), and slower slowest 10% 1/RT (p = .021). Across all participants, poorer PVT performance moderately correlated with higher ESS scores (partial correlation r = .48) and increased Wake/N1 (r = .35) and N1% (r = .49, all p's < .005). Results remained significant after adjusting for cofounders. No within group associations were observed.</p><p><strong>Conclusion: </strong>Adolescent NT1 patients exhibit impaired attention vs. HC as measured by 3-min PVT. While daytime sleepiness and poor sleep quality contribute, modest correlations suggest additional factors. Given that orexin receptors reside in attention-related cortical areas, deficient orexin signaling may play a more direct role in these deficits and warrants further investigation.</p><p><strong>Study rationale: </strong>Adolescents with Narcolepsy Type 1 (NT1) frequently report problems with attention, yet objective data on attention in this population are limited. This study aimed to assess objective measures of attention in pediatric NT1 using psychomotor vigilance testing and understand their relationship with sleep quality and subjective sleepiness.</p><p><strong>Study impact: </strong>Our findings reveal significant objective attention deficits in NT1 youth compared to healthy controls suggesting psychomotor vigilance testing could be a useful tool to objectively measure attention concerns in clinic and research settings.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the patient-reported and nurse-rated Richards-Campbell Sleep Questionnaire in neurorehabilitation inpatients.","authors":"Shao-Yu Chen, Yu-Hsuan Lin, Huey-Wen Liang","doi":"10.1007/s44470-026-00048-0","DOIUrl":"10.1007/s44470-026-00048-0","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality in US veterans with insomnia, sleep apnea, and comorbid insomnia and sleep apnea (COMISA); an exploratory, hypothesis-generating cohort study.","authors":"Javad Razjouyan, Alexander Sweetman, Earl Crew, Mehrnaz Azarian, Pegah Soltani, Manasa Kokonda, Douglas Wallace, Luis Buenaver, Amir Sharafkhaneh","doi":"10.1007/s44470-026-00065-z","DOIUrl":"10.1007/s44470-026-00065-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study examined the association of insomnia, sleep apnea, and comorbid insomnia and sleep apnea (COMISA) with all-cause mortality in a large Veteran sleep clinic cohort.</p><p><strong>Methods: </strong>We retrospectively identified Veterans with insomnia and/or SA using ICD-9/10 codes, requiring two diagnoses within 13 months (≥ 30 days apart). Insomnia cases also required relevant prescriptions and/or cognitive behavioral therapy for insomnia (CBT-I); SA cases required positive airway pressure prescriptions within three years. Patients were classified as insomnia only (INS), SA only, or COMISA. Adjusted odds ratios (aOR) for mortality were estimated using SA as the reference. Model 1 adjusted for age, sex, race, ethnicity, and Charlson Comorbidity Index (CCI); Model 2 additionally adjusted for trazodone and quetiapine; Model 3 additionally adjusted for benzodiazepines and benzodiazepine receptor agonists. Model 4 included all Model 3 covariates plus CBT-I.</p><p><strong>Results: </strong>Among the 1,720,090 patients, 47.6% had SA (mean age 56.3 ± 13.7; 93.3% male; 69% White; 26.2% with CCI > 2), 41.1% had INS (mean age 57.0 ± 16.8; 87.1% male; 70.3% White; 25.4% with CCI > 2), and 11.2% had COMISA (mean age 51.9 ± 13.2; 89.4% male; 66.7% White; 19.6% with CCI > 2). Compared with SA, unadjusted ORs for mortality were 1.75 (95% CI: 1.73-1.76) for INS and 0.68 (95% CI: 0.67-0.69) for COMISA. Fully adjusted aORs were 1.51 (95% CI: 1.49-1.52) for INS and 0.79 (95% CI: 0.78-0.80) for COMISA.</p><p><strong>Conclusion: </strong>Among the Veterans referred to sleep clinics, insomnia alone was associated with the highest mortality, followed by SA, and the lowest in COMISA. These findings contrast with published studies and need to be seen considering the limitations of our approach, including the possibility that lack of a pre-specified hypothesis increases the risk of spurious findings.</p><p><strong>Study rationale: </strong>Insomnia and sleep apnea commonly coexist as comorbid insomnia and sleep apnea (COMISA), which has been linked to increased mortality in population-based studies. Evidence from clinical cohorts, particularly among Veterans, remains limited.</p><p><strong>Study impact: </strong>In this exploratory, hypothesis-generating large cohort of Veterans referred to sleep clinics, insomnia alone was associated with the highest mortality, followed by sleep apnea, and the lowest in COMISA. These results contrast with prior population studies and should be interpreted cautiously given study limitations (including possible chance findings without a pre-specified hypothesis), warranting confirmation.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YASA automated sleep staging performance across seven nights of normal sleep and sleep restriction.","authors":"Zhiyi Chen, Natalya Pruett, Michael K Scullin","doi":"10.1007/s44470-026-00059-x","DOIUrl":"10.1007/s44470-026-00059-x","url":null,"abstract":"<p><strong>Study objectives: </strong>This study aimed to compare YASA's automated sleep staging to manual staging in the context of a multi-night experimental sleep restriction protocol.</p><p><strong>Methods: </strong>Seventy-five adults (58% female; 57% nonwhite) participated in up to seven nights of laboratory-based polysomnography measurements. The study involved one adaptation night, followed by three nights of normal sleep (9 h time in bed) and three nights of sleep restriction (5.5 h time in bed). Condition order was counterbalanced. Manual sleep staging was performed by a registered polysomnographic technician. Sleep data were exported and processed using Python 3.12, MNE 1.8.0, and YASA 0.6.5 for automated sleep staging.</p><p><strong>Results: </strong>Across 483 valid sleep nights, there was 82.9% overall agreement between YASA scoring and manual scoring. Stage-specific agreement was 40.3% (N1), 85.1% (N2), 86.9% (N3), and 78.7% (REM). Agreement was higher during normal sleep nights than sleep restriction nights, particularly for wake, N1, and REM sleep classifications.</p><p><strong>Conclusions: </strong>YASA-based staging exhibited good overall agreement with manual scoring during normal sleep nights. However, caution is needed when interpreting N1 estimates, as well as in interpreting data during short sleep nights.</p><p><strong>Current knowledge/study rationale: </strong>Sleep stage scoring is typically conducted manually by at least one experienced technician, but this process is laborious and subject to biases. This study investigated whether a machine-learning-based open tool-YASA-could automatically stage polysomnography data with acceptable accuracy.</p><p><strong>Study impact: </strong>Across 430,813 epochs, YASA showed acceptable accuracy in sleep staging, making it an efficient tool for the sleep community. However, caution is still needed for some applications, such as interpreting YASA's N1 estimates as well as data from short sleep nights.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of obstructive sleep apnea and comorbid insomnia on all-cause mortality: a prospective cohort study of 2401 patients with 6-year follow-up.","authors":"Sahrai Saeed, Ragnhild Stokke Lundetræ, Andrea Romarheim, Ingvild West Saxvig, Sverre Lehmann, Bjørn Bjorvatn","doi":"10.1007/s44470-026-00068-w","DOIUrl":"10.1007/s44470-026-00068-w","url":null,"abstract":"<p><strong>Study objectives: </strong>The impact of obstructive sleep apnea (OSA) on all-cause mortality needs further research as earlier data are inconclusive. Between 30 and 50% of patients with OSA have comorbid insomnia (COMISA), which may increase the risk of morbidity and mortality. The present study was aimed at investigating the association between OSA and COMISA and the subsequent risk of all-cause mortality in a cohort of patients recruited from a hospital sleep clinic setting.</p><p><strong>Methods: </strong>Between January 2016 and December 2018, 2401 patients with suspected OSA underwent standard respiratory polygraphy and were recruited in the present analysis. OSA was categorized according to the respiratory event index (REI). Insomnia diagnosis was assessed with the Bergen Insomnia Scale. All-cause mortality was the primary endpoint.</p><p><strong>Results: </strong>Mean age was 49.6 ± 14.0 years, 68.8% were males, and 36.2% had OSA with REI ≥ 15, 49.5% insomnia, and 16.9% COMISA (comorbid insomnia and OSA with REI ≥ 15). A progressive increase in the risk of all-cause mortality was observed with increasing OSA severity (REI < 5; 5-14.9; 15-29.9; ≥ 30). In a multivariable Cox regression analysis, OSA (REI ≥ 15) was independently associated with all-cause mortality (HR 2.65; 95% CI 1.12-6.30, p = 0.027). This relative risk was further increased to threefold (HR 3.02; 95% CI 1.30-7.04, p = 0.010) when OSA was replaced by COMISA in the same model.</p><p><strong>Conclusion: </strong>This study demonstrates that OSA severity is an important determinant of long-term survival. Patients with moderate-to-severe OSA are at particularly increased risk, and the coexistence of insomnia appears to substantially amplify this risk. These findings underscore the prognostic significance of considering both sleep-disordered breathing and comorbid insomnia when assessing mortality risk in patients evaluated for OSA. Obstructive sleep apnea (OSA) is linked to cardiovascular disease, but its impact on mortality, especially when combined with insomnia (COMISA), remains underexplored. This study investigated the prognostic OSA severity and COMISA in a large cohort of 2401 patients with suspected OSA. Our findings showed that moderate to severe OSA significantly predicted all-cause mortality, independent of traditional risk factors. The presence of COMISA tripled this risk, highlighting a synergistic negative effect. These results emphasize the importance of recognizing COMISA as a distinct, high-risk phenotype. Future clinical practice should include systematic screening and treatment of both OSA and insomnia to improve survival outcomes in affected patients.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging evidence reinforces and expands the case for later school start times.","authors":"Muhammad A Rishi, Ayan De, Jocelyn Cheng, Andrew Neman, Stanley Thomas","doi":"10.1007/s44470-026-00056-0","DOIUrl":"10.1007/s44470-026-00056-0","url":null,"abstract":"","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of parenting in associations of weight status with sleep duration and timing for children with mild sleep-disordered breathing.","authors":"Carolyn E Ievers-Landis, Sally Ibrahim, H Gerry Taylor, Ronald D Chervin, Ariel A Williamson, Melissa C Cole, Neepa Gurbani, Kristie R Ross, Dongdong Li, Zhuoran Wei, Rui Wang, Susan Redline, Carol L Rosen","doi":"10.1007/s44470-026-00066-y","DOIUrl":"10.1007/s44470-026-00066-y","url":null,"abstract":"<p><strong>Purpose: </strong>Examine associations between sleep patterns (duration, timing, and regularity) and weight status and explore moderating effects of parenting/family functioning among children with mild sleep-disordered breathing (SDB) from the Pediatric Adenotonsillectomy Trial for Snoring.</p><p><strong>Methods: </strong>Two age groups (3-5 and 6-12-year-olds) were examined separately with waist circumference (WCz) and body mass index (BMIz) z-scores as the primary and secondary endpoints, respectively.</p><p><strong>Results: </strong>Participants were 207 younger and 252 older children in a socio-demographically diverse sample. In adjusted models with older children, shorter sleep was associated with higher WCz, controlling for weekend mid-sleep timing (coefficient estimate beta =  - 0.137, p = 0.027) with a similar finding for BMIz (beta =  - 0.144, p = 0.041); later timing was related to higher WCz, controlling for sleep duration (beta = 0.122, p = 0.032). Shorter sleep duration was associated with higher WCz among the older children with greater parental distress (interaction p = 0.005), parent-child dysfunctional interactions (interaction p = 0.020), and less authoritative parenting (interaction p = 0.023) compared to those with more optimal parent-child relationships. There were no statistically significant associations or interactions among younger children.</p><p><strong>Conclusions: </strong>In school-aged children, shorter sleep duration and later midpoint, but not social jet lag, tended to be associated with weight status. When mutually adjusting for duration and midpoint, a stronger statistically significant association was observed. Children subject to less optimal parenting practices were at the greatest risk of shorter sleep. Accounting for sleep timing and parenting factors that might further increase children's biological propensity for obesity is recommended in future studies in this area.</p><p><strong>Current knowledge/study rationale: </strong>Initial evidence suggests that shorter sleep duration and sleep-disordered breathing (SDB) increase the risk of becoming overweight in later childhood. This study examined relationships of additional sleep patterns-timing and regularity-and possible moderating effects of parenting/family factors using a well-characterized cohort of children with mild SDB from the Pediatric Adenotonsillectomy Trial for Snoring.</p><p><strong>Study impact: </strong>This study demonstrates that both shorter sleep duration and later timing relate to higher waist circumference and body mass index z-scores among school-aged children. Parenting factors (i.e., stress, parent-child dysfunctional relationships, and less use of an authoritative parenting style) may moderate sleep pattern-weight status relationships and therefore identify children most vulnerable to obesity because of insufficient sleep.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13057092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive sleep apnea risk is associated with poor physical performance: a cross-sectional analysis of the U.S. health and retirement study.","authors":"Rajani Khanal, Kimberley S van Schooten, Ronaldo Piovezan, Robert Adams, Kelly Sansom, Andrew Vakulin","doi":"10.1007/s44470-026-00070-2","DOIUrl":"10.1007/s44470-026-00070-2","url":null,"abstract":"<p><strong>Study objectives: </strong>Obstructive sleep apnoea (OSA) may be linked to poor physical performance and fall risk, yet this association remains underexplored. This study examined associations between OSA risk, balance, gait speed and handgrip strength (HGS) in community living adults across age-groups and sexes.</p><p><strong>Methods: </strong>Cross-sectional data from the 2016 Health and Retirement Study were analysed. Probable OSA was estimated with an adapted STOP-Bang questionnaire. Poor balance was defined as the inability to hold a semi-tandem stance for 10 s; slow gait speed as walking < 0.8 m/s over 2.5 m; and weak HGS as HGS-to-body mass index ratio < 1.00 m² for males and < 0.56m² for females.</p><p><strong>Results: </strong>6,918 participants (mean age 66 ± 11 years; 57% female) were included. Probable OSA was associated with higher odds of: (i) poor balance in the overall sample (OR:1.23, 95% bootstrapped confidence interval (BCI):1.07-1.39, p = 0.002), 50-64 years (OR: 1.41, BCI: 1.15- 1.72, p < 0.001) and females (OR: 1.30, BCI: 1.10-1.56, p = 0.004); (ii) slow gait speed in the overall sample (OR:1.29, BCI:1.07-1.57, p = 0.007), 80 + years (OR:1.61, BCI:1.07-2.42, p = 0.028) and females (OR:1.39, BCI:1.03-1.91, p = 0.024); and (iii) weak HGS in the overall sample (OR:2.22, BCI:1.90-2.63, p = 0.001), 50-64 years (OR:3.40, BCI: 2.58-4.61, p < 0.001), 65-79 years (OR: 1.93, BCI:1.52- 2.47, p < 0.001), males (OR = 1.87, BCI:1.49-2.35, p < 0.001) and females (OR = 2.67, BCI 2.15-3.33, p < 0.001).</p><p><strong>Conclusions: </strong>Poor balance, slow gait speed and weak HGS are common among older adults at high risk of OSA. Further research should evaluate causality and assess co-screening to potentially enable early detection of fall risk in older adults.</p><p><strong>Study rationale: </strong>OSA is a common but often undiagnosed condition that may contribute to accelerated age-related physical decline and increased fall risk. Despite known links between diagnosed OSA and motor deficits, little is known about how undiagnosed OSA relates to fall-related physical performance measures in large, community-based populations. Study Impact: This study suggests that individuals at high risk of OSA are more likely to have poor balance, slow gait speed, and weak handgrip strength, which are key predictors of fall risk. The observation of these associations in adults as young as 50 years of age warrants future research to evaluate causality and determine if co-screening of OSA and fall risk can help identify those most vulnerable.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13057046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dream-enactment behaviors without REM sleep without atonia.","authors":"Giuseppe Lanza, Maria P Mogavero, Giovanni Sorte, Angelica Quercia, Filomena I I Cosentino, Angelo Garifoli, Bartolo Lanuzza, Manuela Morreale, Giovanni Pastorello, Mariangela Tripodi, Manuela Pennisi, Rita Bella, Carlos H Schenck, Raffaele Ferri","doi":"10.1007/s44470-026-00062-2","DOIUrl":"10.1007/s44470-026-00062-2","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical and polysomnographic features of patients with isolated REM sleep behavior disorder (iRBD) and patients with clinically reported dream-enactment behaviors (DEB) occurring in the absence of REM sleep without atonia (RSWA), and to clarify the clinical significance of DEB without RSWA.</p><p><strong>Methods: </strong>We retrospectively reviewed clinical records and polysomnography of consecutive patients referred to a tertiary sleep and neurology center. Twenty-six patients with polysomnography-confirmed iRBD, 21 patients with DEB without RSWA, and 24 control subjects were included. Clinical features related to prodromal neurodegeneration, neuroimaging findings, sleep architecture, REM atonia indices, limb movements, and respiratory parameters were analyzed using age-adjusted comparisons with effect size estimation.</p><p><strong>Results: </strong>Compared with DEB patients, iRBD patients were older and showed a higher prevalence of subtle extrapyramidal signs, lower cognitive performance, and a greater burden of vascular neuroimaging abnormalities. Clinically reported hyposmia and depression were infrequent and did not differ between groups. Both clinical groups exhibited increased sleep fragmentation and instability, most pronounced in iRBD, with DEB patients showing intermediate values. REM atonia robustly differentiated groups, whereas periodic limb movements during sleep and respiratory disturbance did not differ significantly after age adjustment.</p><p><strong>Conclusion: </strong>DEB occurring without RSWA are associated with a clinical and polysomnographic profile distinct from iRBD, characterized by preserved REM atonia and a lower burden of markers linked to prodromal neurodegeneration. These findings highlight the heterogeneity of DEB and support characterization beyond conventional RBD diagnostic criteria. Current knowledge/study rationale: Isolated REM sleep behavior disorder (iRBD) is defined by dream-enactment behaviors (DEB) with REM sleep without atonia (RSWA), whereas clinically reported DEB without RSWA presents a diagnostic challenge and unclear significance in relation to prodromal neurodegeneration. Study impact: In this retrospective tertiary-center cohort, iRBD patients had more extrapyramidal signs, lower cognitive performance, and greater vascular imaging abnormalities compared with DEB without RSWA, whereas both groups showed increased sleep instability. These findings highlight that DEB without RSWA has a distinct clinical and polysomnographic profile, supporting the need for characterization beyond conventional RBD diagnostic criteria.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13057085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective and objective measures of sleep-related function from the Cardiovascular Endpoints For Obstructive Sleep Apnea with Twelfth Cranial Nerve Stimulation (CARDIOSA-12) trial : Sleep-related functional outcomes in CARDIOSA-12.","authors":"Akshay Tangutur, Phoebe K Yu, Mathias Basner, Brendan T Keenan, Raj C Dedhia","doi":"10.1007/s44470-026-00067-x","DOIUrl":"10.1007/s44470-026-00067-x","url":null,"abstract":"<p><strong>Purpose: </strong>The effect of therapeutic versus partially therapeutic levels of hypoglossal nerve stimulation (HGNS) therapy on cognitive measures and patient-reported outcomes (PROs) was evaluated in patients with moderate-severe obstructive sleep apnea (OSA).</p><p><strong>Methods: </strong>In a 10-week, double-blind, randomized crossover therapy trial, subjects optimized on HGNS therapy underwent 4 weeks each of active and control (partially therapeutic) HGNS therapy. Cognitive measures (psychomotor vigilance test [PVT], digit symbol substitution test [DSST]) and sleep-related PROs were assessed after each 4-week treatment period.</p><p><strong>Results: </strong>Sixty subjects were randomized and completed the primary study protocol, including PROs. A subset of randomized subjects (n = 43) underwent cognitive testing. This subset was, on average, older (65.7 ± 10.2 years), overweight/obese (body mass index [BMI] 29.7 ± 4.6 kg/m²), and had severe OSA at baseline (apnea-hypopnea index [AHI] 34.2 ± 15.0 events/h). There were no differences in cognitive performance measures between active and control (partially therapeutic) HGNS conditions in all subjects; in the per-protocol analysis, however, improvement in DSST reaction time with active HGNS was demonstrated (mean [95% CI] change on active therapy = - 153.6 [- 285.3, - 22.0] ms; p = 0.025). Significant improvements in all PROs (Epworth Sleepiness Scale, Insomnia Severity Index, Functional Outcomes of Sleep Questionnaire, and Snoring Visual Analog Scale) were observed in the active HGNS condition.</p><p><strong>Conclusions: </strong>In this secondary analysis of the CARDIOSA-12 randomized crossover trial of subjects using HGNS, subjective PROs, but not objective cognitive measures, were improved with active HGNS compared to control (partially therapeutic) HGNS therapy. These findings warrant additional investigation examining the relationship between subjective and objective neurocognitive outcomes in OSA. The effect of hypoglossal nerve stimulation (HGNS), a novel and promising therapy for obstructive sleep apnea (OSA), on neurocognitive deficits remains underexplored. This study evaluated whether HGNS therapy improves cognitive performance using the psychomotor vigilance test (PVT) and digit symbol substitution test (DSST), along with patient-reported outcomes (PROs) related to sleepiness, snoring, insomnia, and sleep-related function. In the modified intention-to-treat analysis, no significant differences in PVT or DSST outcomes were observed between active and control (partially therapeutic) HGNS therapy; however, in a subset of participants with ≥ 50% reduction in AHI with active HGNS, improvement in DSST reaction time was noted. All PROs significantly improved with active HGNS, suggesting benefits in subjective measures without substantial changes in objective cognitive measures.</p>","PeriodicalId":50233,"journal":{"name":"Journal of Clinical Sleep Medicine","volume":"22 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13057149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}