Excessive daytime sleepiness in patients with idiopathic normal pressure hydrocephalus: A controlled cross-sectional study.

To assess the efficacy and safety of pitolisant, a selective histamine H₃ receptor antagonist/inverse agonist, for excessive daytime sleepiness (EDS) in narcolepsy or obstructive sleep apnea (OSA). PubMed, Cochrane, Embase, Scopus, and Web of Science were searched through August 2025 for randomized placebo-controlled trials (RCTs). Eligible RCTs reported Epworth Sleepiness Scale (ESS) or Pediatric Daytime Sleepiness Scale (PDSS), mean sleep latency, EQ-5D, or global impression outcomes. Two reviewers independently screened studies, extracted data, and assessed bias using Cochrane RoB 2.0. Publication bias was evaluated using funnel plots and Egger's test; certainty of evidence was rated with GRADE. Six RCTs (n = 1149) met the inclusion criteria. Compared with placebo, pitolisant significantly reduced Sleepiness Scale scores (SSS) (mean difference [MD] = -2.97; 95% confidence interval [CI] -3.62 to -2.33), increased mean sleep latency (MD = 3.06; 95% CI 2.12-3.99), and improved EQ-5D scores (MD = 2.68; P = 0.009). Patient global opinion (risk ratio [RR] = 1.40) and clinical global impression of change (CGI-C) (RR = 1.41) also favored pitolisant. Rates of treatment-emergent adverse events, serious adverse events, and withdrawals were comparable with placebo, and common adverse effects, such as headache, insomnia, nausea, and anxiety, were infrequent and not significantly increased. Pitolisant provides an effective, nonstimulant option for EDS in narcolepsy and OSA, including residual symptoms despite continuous positive airway pressure (CPAP). Its distinct mechanism and tolerability profile make it a valuable alternative or adjunct to existing therapies, supporting personalized care and enhanced daily functioning. Pitolisant significantly improves subjective and objective wakefulness and quality of life in EDS due to narcolepsy or OSA, with robust evidence for ESS benefit and a favorable safety profile.

Narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2) are rare, chronic neurologic disorders of hypersomnolence. Narcolepsy type 1 results from the selective loss of orexin-producing neurons, leading to markedly reduced levels of orexin neuropeptides in the brain and CSF. NT2 shares some symptoms with the former but has no orexin deficiency. Both disorders manifest as a spectrum of debilitating symptoms, including excessive daytime sleepiness (EDS), cataplexy (NT1 only), fragmented nocturnal sleep, sleep paralysis, and hallucinations. Diagnosis is particularly challenging, especially in pediatric patients. We describe 7 pediatric patients presenting with complex narcolepsy phenotype of EDS or cataplexy with a diverse array of comorbid genetic, neurologic, and neuropsychiatric conditions. These cases illustrate the diagnostic challenges in differentiating "primary narcolepsy" from "narcolepsy because of a medical disorder" (e.g., Prader-Willi Syndrome) or "narcolepsy associated with autism spectrum disorder or very early-onset schizophrenia." The patients underwent a comprehensive diagnostic workup, including polysomnography, multiple sleep latency testing (performed after wash-out of concomitant medications), brain magnetic resonance imaging, CSF hypocretin-1 assay, and, in case of consistent clues, autoimmune, and genetic testing. Ensuring accurate and prompt narcolepsy diagnosis allows effective and patient-centered management.

What is the prevalence of sleep disturbances among people with Huntington disease and pre-manifest genetic expansion carriers? A systematic review and meta-analysis.

Endogenous circadian rhythm sleep disorders through the lens of nonparametric variables of actigraphy: an exploratory study in myotonic dystrophy type 1.

The 2025 edition of the Guidelines for the Diagnosis and Treatment of Adults with Obstructive Sleep Apnea in adults represents a major milestone in the sleep medicine field in China, marking a transition in obstructive sleep apnea management from an "experience-based" to an "evidence-based" approach, and heralding a new era of "evidence-driven, phenotype-oriented, and whole-course management". The new guideline systematically addresses 18 key clinical questions, employing the structured PICOS framework and adheres strictly to international AGREE Ⅱ and RIGHT standards to ensure scientific rigor and transparency in its recommendations. Several important advances distinguish the updated version: it introduces composite indices such as hypoxic burden (HB) and sleep breathing impairment index (SBII Obstructive Sleep Apnea I), shifting assessment from "event frequency" to "pathophysiological load"; it adopts precise classification based on clinical phenotypes (e.g., excessive daytime sleepiness or asymptomatic types) and endotypes (PALM model), facilitating personalized therapy. Pharmacological treatment has advanced from a state of "no effective drugs" to "targeted precision therapy" with clear indications for wake-promoting agents and GIP/GLP-1 agonists; and it integrates telemedicine and home monitoring technologies to establish a structured follow-up system. Compared with the 2011 edition, which was largely consensus-based, the 2025 guideline is fully grounded in high-quality domestic and international evidence, incorporating the data from Chinese populations. It promotes the standardization, systematization, and individualization of obstructive sleep apnea diagnosis and treatment, providing an authoritative practical framework for achieving the goal of "optimal therapy for every patient".

Background: Sexual dysfunction (SD) and sleep disturbances are frequent but underrecognized non-motor symptoms in Parkinson's disease (PD) and significantly affect quality of life. However, the relationships among sexual dysfunction, sleep quality, and excessive daytime sleepiness (EDS) and the possible sex-related differences remain insufficiently investigated. Methods: In this cross-sectional case-control study, we evaluated these non-motor symptoms in 147 Turkish patients with PD and 160 age- and sex-matched healthy controls, and we assessed their associations and impact on quality of life, with particular attention to sex-specific patterns. Sexual function was assessed using the Arizona Sexual Experiences Scale (ASEX), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness using the Epworth Sleepiness Scale (ESS), quality of life using the 39-item Parkinson's Disease Questionnaire (PDQ-39), and disease severity using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (H&Y) staging scale. Group comparisons, correlation analyses, and sex-stratified subgroup analyses were performed. Results: Patients with PD had significantly higher ASEX, PSQI, and ESS scores compared with controls (p < 0.01), and women with PD had significantly higher total ASEX scores than men, indicating greater sexual dysfunction. Sexual dysfunction was significantly associated with poor sleep quality and excessive daytime sleepiness but showed no significant association with the motor severity measures (UPDRS, H&Y stage). Sleep quality, as measured via PSQI scores, was worse in patients with PD, and poor sleep quality and excessive daytime sleepiness were both associated with significantly worse quality of life. Conclusions: According to our findings, sexual dysfunction and sleep disturbances are interrelated non-motor symptoms that significantly impair quality of life, largely independently of motor severity, and these associations were particularly pronounced among women. A combined evaluation of sleep and sexual function may therefore improve the recognition and management of the non-motor burden in PD.

Background: Excessive Daytime Sleepiness (EDS) is a prevalent sleep disorder that is associated with considerable health hazards and an elevated risk of Road Traffic Accidents (RTA). Commercial drivers are especially vulnerable due to their lengthy driving hours and unpredictable sleep patterns. This aimed to determine prevalence of EDS and its factors among long-distance bus drivers at the Ubungo Bus Terminal (UBT) in Dar es Salaam, Tanzania Methodology: A cross-sectional descriptive study was undertaken at UBT with 250 consenting long-distance bus drivers. Structured questionnaires, the Epworth Sleepiness Scale (ESS), clinical and anthropometric assessments, and random blood glucose monitoring were used to collect information. EDS characterized as an ESS score of ≥9. Data was analyzed using SPSS version 25.0 and p&lt;0.05 was considered statistically significant. Results: The average age of participants was 43.5 ± 8.6 years, with 99% being male. The prevalence of EDS was 46.8% (117/250). Individuals with EDS had similar clinical and anthropometric characteristics as those without EDS, with the exception of neck circumference, which was borderline significant (p=0.05). EDS and non-EDS participants shared similar substance use tendencies (alcohol, khat, cannabis, and cigarettes). Drivers with EDS had considerably higher rates of major accidents (0.68 vs. 0.46, p=0.04), while rates of minor accidents were comparable. Conclusion: EDS is extremely common among long-distance bus drivers in Dar es Salaam and is linked to an increased risk of catastrophic road traffic incidents. Screening for EDS is necessary, as is the implementation of preventive methods such as driving laws and health promotion initiatives.

Objective: To evaluate factors associated with poor sleep quality among patients receiving maintenance hemodialysis.Methods: This cross-sectional observational study was conducted from April to July 2025 at the Department of Nephrology, Tabba Kidney Institute. Adults aged 18–80 years with CKD stage 5D on stable maintenance hemodialysis for 6 months were included. Data were collected using a structured questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale(ESS). Continuous variables were expressed as mean ± SD, and categorical variables as n (%). Independent samples t-tests were used for group comparisons. Odds ratios (ORs) with 95% confidence intervals were calculated using 2×2 contingency tables to determine factors associated with poor sleep quality (PSQI &gt;5).Results: A total of 74 patients participated (mean age 52.9 ± 14.1 years; 62.2% females). The mean ESS score was 10.4 ± 0.4, indicating excessive daytime sleepiness. The mean global PSQI score was 6.9 ± 0.9, suggesting poor sleep quality. Poor sleep quality was significantly associated with female gender (OR 2.6; 95% CI 1.03–6.76), intradialytic weight gain &gt;2 kg (OR 2.4; 95% CI 1.8–4.9), legdiscomfort (OR 3.9; 95% CI 2.7–9.2), and tingling/numbness (OR 4.1; 95% CI 3.4–11.8).Conclusion: Poor sleep quality and excessive daytime sleepiness are common among hemodialysis patients. Female gender, higher IDWG, and lower-limb symptoms were significantly associated factors. Routine sleep assessment in dialysis units is recommended

Excessive daytime sleepiness as a predictor of suicidal behavior in first-episode youth major depressive disorder.

Association between Epworth Sleepiness Scores and CPAP compliance in patients with obstructive sleep apnea.

Sleep disorders are common in Parkinson's disease (PD) and respond poorly to current pharmacological treatments, partly due to limited understanding of their underlying mechanisms. Using polysomnographic recordings, we investigated the role of dopamine- and cAMP-regulated phosphoprotein 32 kDa (DARPP-32) in sleep-wake regulation and PD-related sleep dysfunction. In naive mice, the selective ablation of DARPP-32 in striatal projection neurons (SPN) co-expressing dopamine D2 and adenosine A2A receptors reduced NREM sleep during the active phase of the circadian cycle, whereas its deletion in dopamine D1 receptor-expressing SPN increased NREM sleep stability during the inactive phase. In a mouse model of PD, excessive daytime sleepiness (EDS), a common non-motor symptom in PD, was abolished by DARPP-32 deletion in D2R/A2AR-expressing SPN but not in D1R-expressing SPN, which also failed to improve sleep fragmentation. Together, these findings identify DARPP-32 as a key regulator of sleep-wake function and a cell-specific target for alleviating PD-related EDS.

Paediatrics obstructive sleep apnoea syndrome (OSAS) is often underdiagnosed by medical practitioners due to its subtle and nonspecific symptoms in children. This study aimed to determine the prevalence of OSAS and identify clinical predictors of its occurrence and severity. Medical records of children (2-18 years) who underwent polysomnography (PSG) at a sleep laboratory in Myanmar during 2012-2023 were reviewed retrospectively. Children with incomplete PSG data, a prior PSG record in the same sleep laboratory, or a history of adenotonsillectomy were excluded from the study. This study included 349 children with mean ± SD age 6.8 ± 2.8 year. OSAS was identified in 82.2% (289/349). Boys, overweight/obesity and tonsil grade-4 were independently associated with OSAS and boys, overweight/obesity, lower resting SpO2, witnessed apnoea, abnormal daytime sleepiness and tonsil grade-4 were independently associated with severe OSAS on multivariable logistic regression. Among 2-8-year-old children, there was a significant mild positive correlation between AHI and tonsil grades (r = 0.29, p < 0.001) and between AHI and BMI (r = 0.21, p < 0.001). Among 9-18-year-old children, there is a moderate positive correlation between AHI and BMI (r = 0.34, p = 0.003); however, the correlation between AHI and tonsil grades was not significant r = 0.08 (p = 0.51). Male sex, overweight/obesity and tonsil grade-4 can predict OSAS and its severity in children. Lower SpO2 levels, witnessed apnoea and excessive daytime sleepiness can also predict severe OSAS. Although the degree of obesity is correlated with OSAS severity in both older and younger children, the degree of tonsil grades is correlated with its severity only in younger children.

This study aimed to develop a suitable instrument for assessing excessive daytime sleepiness (EDS) in Slovenian children and adolescents by translating the ESS-CHAD and psychometrically validating its Slovenian version (ESS-CHAD-SI). The ESS-CHAD was translated and back-translated according to established cross-cultural adaptation guidelines, and content validity was assessed by eleven experts from relevant clinical and research disciplines. A nationwide sample of 3,314 adolescents (≈52% females), with an overall mean age of 15.4±1.7 years, completed the questionnaire. Reliability was evaluated using Cronbach's α and Guttman's λ2, and construct validity was examined using exploratory and confirmatory factor analyses. All items met the predefined thresholds for content relevance, while clarity indices were acceptable for the majority of items. Factor analyses indicated that a two-factor model provided a better fit to the data than the original unidimensional structure, distinguishing between passive sleepiness and more clinically concerning manifestations of sleepiness. The ESS-CHAD-SI demonstrated adequate internal consistency. The ESS-CHAD-SI is a reliable, valid, and culturally adapted instrument for assessing excessive daytime sleepiness in Slovenian adolescents. The identified two-factor structure enhances its clinical and public health relevance by enabling differentiation between sleepiness related to modifiable sleep behaviours and potentially pathological somnolence. The scale is suitable for use in school-based screening, clinical practice, and epidemiological research.

Mazindol, an imidazo[2,1-a]-isoindole anorectic from the 1970s, has recently re-emerged as a candidate therapy for disorders of arousal and reward dysregulation, due to its unique multimodal receptor profile. Despite its 1999 withdrawal from US/EU markets, off-label narcolepsy efficacy spurred immediate-release/sustained-release (IR/SR) development. Clinical trials demonstrate mazindol IR/SR efficacy, reducing excessive daytime somnolence and cataplexy in narcolepsy and attention-deficit/hyperactivity disorder (ADHD) severity symptomatology, with mild adverse events (e.g., dry mouth). Preclinical studies demonstrate potent monoamine transporter inhibition (dopamine, norepinephrine, serotonin) with minimal dopamine release, reducing abuse liability compared with amphetamines. Novel interactions orexin-2, 5-HT1A, and mu-opioid receptors suggest reward modulation, low abuse potential, and utility in polydrug dependence (e.g., fentanyl-cocaine co-use). This review, covering the period 1970-2025, emphasizes the potential for repositioning mazindol, including its potential utility in managing opioid-stimulant co-dependence and attention-related disorders, and underscores its relevance for future therapeutic repurposing. Although this is a narrative review, we conducted targeted searches of PubMed, Scopus, and ClinicalTrials.gov from this period of time, using terms including "mazindol," "narcolepsy," "ADHD," and "substance use disorder."

Objective versus subjective excessive daytime sleepiness in OSA: Quantifying the impact of fatigue.

This study estimates the prevalence and workplace productivity burden of obstructive sleep apnoea (OSA) syndrome in the UK and USA, using self-reported breathing pauses and excessive daytime sleepiness as a proxy. The prevalence of OSA syndrome was 22.8% in the USA and 19.5% in the UK. Annual productivity losses were estimated at US$180.2 billion in the USA and £4.22 billion in the UK. In the UK and USA, individual-level productivity losses exceeded the cost of continuous positive airway pressure (CPAP) treatment, suggesting that improved identification, access to treatment and adherence could yield significant economic benefits in both countries.

Abstract Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep disorder that significantly compromises human health. While continuous positive airway pressure (CPAP) remains the gold standard for treatment, its clinical effectiveness is often limited by poor patient adherence, underscoring the need for alternative therapies. Emerging evidence suggests that physical stimulation therapies may offer a promising non-invasive approach by activating upper airway dilator muscles to maintain airway patency, thereby reducing the severity of OSAS and alleviating related symptoms. This review summarizes recent advances in physical stimulation-based interventions for OSAS, with a comprehensive analysis of clinical trials involving hypoglossal nerve stimulation (HGNS), transcutaneous electrical stimulation (TES), intraoral neuromuscular stimulation, and transcranial magnetic stimulation (TMS). These studies primarily focus on improving upper airway collapsibility, mitigating excessive daytime sleepiness, and enhancing patients’ quality of life. Notably, physical stimulation therapies have demonstrated therapeutic potential by significantly reducing the apnea–hypopnea index (AHI) and oxygen desaturation index (ODI), indicating symptom relief and improved sleep architecture in OSAS patients. This review aims to elucidate the underlying mechanisms of physical stimulation approaches and to reinforce their role as viable alternatives to CPAP therapy, thereby advancing clinical strategies for OSAS management.

Background and Objectives: People with epilepsy frequently complain of poor sleep quality, excessive daytime sleepiness (EDS), and insomnia. Therefore, this study aimed to evaluate differences in anxiety and depression symptoms, as well as clinical characteristics, across groups defined by sleep quality in patients with epilepsy. Materials and Methods: Seventy-eight adults with epilepsy were assessed using standardized questionnaires for sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), insomnia severity (Insomnia Severity Index, ISI), and psychiatric symptoms (PHQ-9, GAD-7, and HADS). Demographic data (age and sex), seizure frequency and characteristics, use of antiepileptic drugs (AEDs), and EEG findings were collected. Patients were divided into groups based on sleep quality scores, and comparisons were made regarding anxiety, depression, and selected clinical variables. Associations were analyzed using t-tests, chi-squared tests, and Spearman correlation coefficients. Results: Poor sleep quality (PSQI > 5) was present in 70.9% of patients and was significantly associated with insomnia, daytime sleepiness, depression, and anxiety symptoms (p < 0.001 for all comparisons). Patients who had experienced generalized tonic-clonic seizures (GTCS) in the past year had significantly worse sleep quality compared to those without GTCS (p = 0.025). Clinical insomnia (ISI ≥ 15) was observed in 23.1% of cases and was significantly associated with the presence of seizures (p = 0.015). EDS was present in 19% of cases and was associated with depressive symptoms (p = 0.019). A higher concentration of levetiracetam was associated with better sleep quality, whereas a higher concentration of lamotrigine was associated with worse sleep quality (p = 0.024 for both). EEG abnormalities, seizure frequency, and duration of epilepsy were not associated with sleep quality. Conclusions: Poor sleep quality was reported in 70% of the study patients and was associated with increased insomnia severity, EDS, and psychiatric comorbidities. People with EDS were more likely to have higher levels of depression and anxiety. Patients who experienced GTCS within the past year were significantly more likely to report poor sleep quality. Insomnia was associated with older age and female sex. Seizure-free patients had less insomnia. Nevertheless, no associations were found between sleep evaluation scores and other demographic or clinical epilepsy characteristics.

Both home accidents and sleep problems are prevalent health issues among young children. This study aimed to investigate the association between the sleep characteristics of both preschool children and their mothers and the occurrence of home accidents among children. In this analytical cross-sectional study, the home accident group consisted of 90 children who presented to the Mersin University Hospital Pediatric Emergency Department due to home accidents. The control group comprised 90 healthy children, matched for age and sex with the home accident group. Sleep patterns of both children aged 12-72 months and their mothers, as primary caregivers, were evaluated through face-to-face interviews with the mothers. Each one-hour increase in the child's total nocturnal sleep duration increased the risk of being in the home accident group by 1.63 times (95% CI: 1.19-2.21, p = 0.002). Conversely, each one-hour increase in the mother's total nocturnal sleep duration reduced the risk of child home accidents by a factor of 0.72 (95% CI: 0.58-0.91, p = 0.006). Maternal excessive daytime sleepiness increased the risk of home accidents in children by 11.35 times (95% CI: 2.38-54.26, p = 0.002). Preschool children who have had home accidents and their mothers should be evaluated for sleep problems. To reduce the frequency and severity of injuries associated with home accidents, greater focus must be placed on improving the sleep hygiene of both children and their mothers.