PurposeAlthough cognitive behavioral therapy for insomnia (CBT-I) is considered the preferred treatment for insomnia in patients with comorbid insomnia and obstructive sleep apnea (COMISA), the remission rate with CBT-I is generally considered lower than in insomnia-only populations. There is also a sizable variability in individual treatment responses. Due to the limited availability of CBT-I, we sought to identify specific clinical attributes that predict benefit from Brief Behavioral Therapy for Insomnia (BBTI)-an adaptation of CBT-I-in patients with COMISA.MethodsWe conducted a retrospective analysis of the National Veterans Health Administration (VHA) electronic medical records covering veterans diagnosed with COMISA between January 2021 and December 2023. Insomnia Severity Index (ISI) scores were recorded at baseline and after 12±1 weeks after BBTI. A positive response to BBTI was defined as a reduction in ISI score of ≥ 8 from baseline. A multivariate generalized linear model analysis was performed to delineate predictive factors of BBTI responsiveness.Results131 eligible cases received BBTI over 6 weeks, 56 (43%) of whom did not respond. Non-whites (OR 3.5, 95% CI [1.4, 8.8]) and shorter sleep time (OR 0.98, 95% CI [0.98, 0.99] were independent predictors of blunted response to BBTI. These findings remained true even when depression and AHI were forced into the regression model. Patients with a total sleep duration of < 4.1 h were at greatest risk of being nonresponsive to BBTI.ConclusionThese findings indicate that identifying insomnia phenotypes in patients with COMISA would help deliver personalized care while maximizing BBTI treatment resources.

PurposeObstructive sleep apnoea syndrome (OSAHS) is a respiratory disorder that greatly affects the health and quality of life of patients. OSAHS affects up to 5.7% of children aged up to 18 years old, and its prevalence is doubled in children with risk factors such as obesity, craniofacial syndromes, Prader-Willi syndrome or trisomy 21. The most common aetiology of OSAHS in children is tonsil hypertrophy, and the first line treatment proposed for the majority of patients is the surgical removal of these tonsils. However, the risk of residual OSAHS after surgery is approximately 10–20%, and, thus, other therapeutic options are being developed to improve patient care. The objective of this scoping review is to assess the extent of the evidence regarding the effectiveness of the different types of treatments offered for OSAHS in children.MethodsRelevant studies over a 13 year period were identified using three search engines: PubMed, Scopus and Web of Science. The selection of studies was made using previously defined inclusion and exclusion criteria based on a review of the title and abstracts initially, followed by a full reading of the texts. The studies were classified based on their design and following the grades and level of scientific proof defined by the Health High Authority.ResultsTwenty-nine manuscripts were included for synthesis. The first-line treatment proposed for the majority of patients with OSAHS is surgical removal of the tonsils, but the risk of residual OSAHS after surgery remains significant, and other less invasive options, such as orthodontics, are also useful for improving the management of these patients.ConclusionOSAHS treatment recommendations should consider orthodontic treatment as a minimally invasive approach with beneficial effects.

PurposeSolriamfetol is approved for use in the European Union to treat excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA). SURWEY characterized real-world evidence regarding physician initiation and titration strategies and patient experiences with solriamfetol. We report SURWEY data for patients with OSA and EDS in Germany (N = 83).MethodsSURWEY was a retrospective chart review conducted among physicians in Germany. Eligible patients were age ≥ 18 years who reached a stable solriamfetol dose and completed ≥ 6 weeks of treatment. Patients were grouped by solriamfetol initiation strategy: changeover, add-on, new-to-therapy.ResultsPatients’ mean (SD) age was 49 (14) years. New-to-therapy was the most common initiation strategy. Solriamfetol was initiated at 37.5 mg/day in most patients (n = 57, 69%) and titrated in 53 patients (64%); 30 (57%) completed titration within 2 weeks. In a post-hoc analysis, mean (SD) Epworth Sleepiness Scale (ESS) score was 16.0 (3.2) at baseline and decreased by 5.4 (3.6) at final follow-up (~ 16 weeks; p <.001). Improvement in patient- and physician-rated EDS was reported by ~ 90% of patients. Most patients (55%) reported effects of solriamfetol lasting ≥ 8 h; 91% of patients reported no change in nighttime sleep quality. The most frequent adverse events were headache (8%), decreased appetite (7%), and insomnia (6%).ConclusionMost patients in this study were new to therapy. Solriamfetol was typically initiated at 37.5 mg/day; titration was common. ESS scores improved with solriamfetol treatment, and most patients self-reported improvement in EDS symptoms. Common adverse events were consistent with those reported in previous clinical trials.

PurposeThe effect of mandibular advancement device therapy on daytime sleepiness remains unclear. Here, we evaluate the effect of a mandibular advancement device on daytime sleepiness using the Karolinska Sleepiness Scale.MethodsWe randomized 88 snoring patients with an apnea-hypopnea index < 30 and daytime sleepiness to a mandibular advancement device or a sham device for four months. The Karolinska Sleepiness Scale, which measures grades of sleepiness from 1 (very alert) to 9 (very sleepy), was used for seven consecutive days, four times each day. The results were analyzed with quantile regression at quartiles controlling for baseline, age, body mass index (kg/m2), sex, apnea-hypopnea index, and full-time work.ResultsThe Karolinska Sleepiness Scale score was lower with the mandibular advancement device than with the sham device at specific time intervals. The positive effect of mandibular advancement device therapy occurred at wake up and before lunch during the whole week and before lunch on weekdays at the middle quartile. The adjusted differences between the interventions favored mandibular advancement device therapy by almost one unit and normalized the Karolinska Sleepiness Scale scores at wake up and before lunch. In addition, there were positive effects of mandibular advancement device therapy before dinner at the highest quartile during the whole week, on weekdays, and on the weekend.ConclusionMandibular advancement devices used for snoring and sleep apnea reduce daytime sleepiness, particularly at wake up and before lunch, but provide some benefit before dinner.

AimTo analyze sex differences in age trajectories of supine positional obstructive sleep apnea (POSA).MethodsWe conducted retrospective analysis of polysomnography studies from 13,144 individuals aged from 2 to 103 years with at least 30 min of both supine and lateral sleep. We used generalized linear mixed-effects models to estimate position-specific mean apnea-hypopnea index (AHI) values and logistic regression to estimate the proportion with POSA or with exclusive POSA among individuals with obstructive sleep apnea (OSA). Predictors included sex, 5-y age group, sleep position, and their interactions.ResultsSupine AHI was higher than lateral AHI regardless of age or sex except under age 5 y. The ratio of supine AHI to lateral AHI reliably exceeded 2 after age 30–35 in males and age 50–55 in females. For both sexes, the proportion with POSA among individuals with OSA increased rapidly with age until 30–35 and then stabilized. The proportion with POSA among individuals with OSA was significantly higher in males than females for each age group between 40 and 75 (p < 0.03). Among individuals with OSA in those 20 and older, the proportion with POSA was 64.6% (95% CI: 62.7%, 66.5%) in males and 55.8% (95% CI: 53.6%, 57.8%) in females. The proportion of individuals showing exclusive POSA also increased with age and peaked near 41% at age 15–20 in males and at age 20–25 in females.ConclusionPOSA becomes more common with age in both sexes; in women, its prevalence is generally lower but continues to increase after age 65.

PurposeTo assess sinonasal function after preservation maxillomandibular advancement (MMA), as initial reports have shown it may decrease postoperatively.MethodsThis prospective study was performed at a tertiary referral center starting January 2023. MMA was performed with previously published nasal modifications to help mitigate negative sinonasal outcomes. Sino-nasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Survey (NOSE) were collected preoperatively, and one and three months postoperatively. Repeated measures ANOVAs with a Bonferroni adjustment were performed for total score, total sinonasal score (sum of questions 1–12), and each symptom. Both p-values and partial eta squared (np2) were reported.ResultsTwenty patients were included. Median age was 50.7 years (range 31–65), with 20.0% being female. Preoperative AHI (65.1 ± 28.9) and SpO2 Nadir (78.0% [69.0–82.0]) improved to 12.1 ± 12.1 and 86.0 ± 3.2%. NOSE significantly decreased at one month (55.9 ± 28.4 vs. 8.11 ± 12.0, p < 0.001). Total score and total sinonasal scores significantly decreased postoperatively (49.0 ± 21.6 vs. 18.1 ± 17.4 vs. 12.5 ± 14.1, p < 0.001; 17.3 ± 12.5 vs. 9.2 ± 9.3 vs. 6.3 ± 7.3, p = 0.003) with MMA having large effects on both variables (np2=0.72 and 0.35, respectively). MMA had large significant effects on improvement in need to blow nose, nasal blockage, sneezing, runny nose, cough, post-nasal discharge, dizziness, and ear pain at one and three months postoperatively. Facial pain/pressure significantly worsened at one-month but then improved to baseline at three months postoperatively ((1.2 ± 1.4 vs. 1.9 ± 1.5 vs. 1.2 ± 1.4, p = 0.026).ConclusionPatients who underwent preservation MMA did not show evidence of worsening sinonasal function, with some evidence that sinonasal function may improve after MMA at three months postoperatively. Long-term follow-up with more patients is needed to support these findings.

BackgroundNarcolepsy impacts quality of life (QoL) with its symptomatology in hobbies and everyday activities, work and productivity and has social and economic consequences. The aim of this review is to map and synthesize evidence about QoL in narcolepsy patients and to focus on research strategies and publications in the matter.MethodsA scoping review of articles published between 2014–2025. The initial search of WoS resulted in 7748 articles and 2583 in PubMed being screened for eligibility. Intervention, comorbidity, non-narcolepsy, prevalence and medical trials studies were excluded. We extracted data on bibliometric characteristics, research questions, sample and recruitment method, design, concepts and measures, and the main findings. Two independent reviewers did the screening and analyses. The analyzed data were consulted on with stakeholders to settle gaps, possibilities and directions for future research. This study followed the PRISMA-ScR guidelines.ResultsTwenty papers were included in this study. There is an increasing trend in publishing studies focused on QoL in narcolepsy patients, but its spread is very limited across various audiences. Most of the studies assess the association of narcolepsy symptoms, treatment, mental health or nutritional status and QoL in narcolepsy patients. Most used was a questionnaire-based cross-sectional design comparing a control group vs narcolepsy patients recruited through regular follow up at a sleep clinic or national reference centers or patients’ organization.ConclusionThere is a need to spread knowledge beyond the neurology audience, to widen the scope of research beyond the burden of the symptoms and to employ explorative qualitative designs.

PurposeDespite increased awareness of sleep hygiene, over 80% of sleep apnea cases remain undiagnosed, underscoring the need for accessible screening methods. This study presents a method for detecting sleep apnea using data from the Apple Watch’s inertial measurement unit (IMU).MethodsAn algorithm was developed to extract seismocardiographic and respiratory signals from IMU data, analyzing features such as breathing and heart rate variability, respiratory dips, and body movements. In a cohort of 61 adults undergoing polysomnography, we analyzed 52,337 30-second epochs, with 12,373 (23.6%) identified as apnea/hypopnea episodes. Machine learning models using five classifiers (Logistic Regression, Random Forest, Gradient Boosting, k-Nearest Neighbors, and Multi-layer Perceptron) were trained on data from 41 subjects and validated on 20 subjects.ResultsThe Random Forest classifier performed best in per-epoch respiratory event detection, achieving an AUC of 0.827 and an F1 score of 0.572 in the training group, and an AUC of 0.831 and an F1 score of 0.602 in the test group. The model’s per-subject predictions strongly correlated with the apnea-hypopnea index (AHI) from polysomnography (r = 0.93) and identified subjects with AHI ≥ 15 with 100% sensitivity and 90% specificity.ConclusionUtilizing the widespread availability of the Apple Watch and the low power requirements of the IMU, this approach has the potential to significantly improve sleep apnea screening accessibility.

PurposeThe expression of the respiratory events in OSA is influenced by different mechanisms. In particular, REM sleep can highly increase the occurrence of events in a subset of OSA patients, a condition dubbed REM-OSA (often defined as an AHI 2 times higher in REM than NREM sleep). However, a proper characterization of REM-OSA and its pathological sequelae is still inadequate, partly because of limitations in the current definitions.MethodsWe propose a new interpretation of the REM-OSA definition, extending it from a AHI-ratio to a two-dimensional space, considering both time and events ratios in REM over NREM separately. Within this space, we analyzed current definitions of REM-OSA in three large clinical dataset and identified the underlying sources of heterogeneity.ResultsWe observed that REM-OSA and REM-independent-OSA subgroups exist. Some subgroups exhibited abnormal REM characteristics (e.g., REM-OSA with reduced time in REM). Others had OSA features that are intermediate between REM-independent-OSA participants and those with a clear disproportion of REM events.ConclusionWe found that a time and events’ ratio of REM and NREM allow a more precise characterization of REM-OSA subgroups. Our new interpretation can be used to bolster new research into REM-OSA pathophysiological mechanisms.