Sleep Disorders In Adults Research Articles

Stem cell-specific ecdysone signaling regulates the development of dorsal fan-shaped body neurons and sleep homeostasis

Complex behaviors arise from neural circuits that assemble from diverse cell types. Sleep is a conserved behavior essential for survival, yet little is known about how the nervous system generates neuron types of a sleep-wake circuit. Here, we focus on the specification of Drosophila 23E10-labeled dorsal fan-shaped body (dFB) long-field tangential input neurons that project to the dorsal layers of the fan-shaped body neuropil in the central complex. We use lineage analysis and genetic birth dating to identify two bilateral type II neural stem cells (NSCs) that generate 23E10 dFB neurons. We show that adult 23E10 dFB neurons express ecdysone-induced protein 93 (E93) and that loss of ecdysone signaling or E93 in type II NSCs results in their misspecification. Finally, we show that E93 knockdown in type II NSCs impairs adult sleep behavior. Our results provide insight into how extrinsic hormonal signaling acts on NSCs to generate the neuronal diversity required for adult sleep behavior. These findings suggest that some adult sleep disorders might derive from defects in stem cell-specific temporal neurodevelopmental programs.

Relationship between temporomandibular and sleep disorders in adults: An overview of systematic reviews

ObjectiveThis study emphasizes the general relevance of sleep disorders (SD) and temporomandibular disorders (TMD), explores their bidirectional relationship, and describes the importance of systematic reviews in the critical analysis of the literature. This review aimed to comprehensively summarize the relationship between SD and TMD in adults while ensuring a reliable and objective analysis of data from the existing literature. MethodsSystematic reviews were evaluated to investigate this association between two conditions in adults. The study was registered with Prospero and followed the PECOT structure in identifying the research question. Searches in multiple databases were conducted until February 2024 using relevant keywords. The risk of bias was assessed using the Risk of Bias in Systematic Reviews tool, involving two independent reviewers. ResultsData were extracted using different evaluation instruments, and results were analyzed and presented through the synthesis of information collected in selected systematic reviews. The selection included seven systematic reviews of observational studies, with exclusion criteria defined to ensure methodological quality. The results showed that reviewed studies presented clarity and relevance in defining the eligibility criteria, but that the identification and selection of studies, data collection, and synthesis of results varied. Most studies considered the potential risks, but some require greater transparency and methodological rigor. ConclusionsThis review points out the association between SD and TMD in adults, with most studies presenting a low risk of bias, although some uncertainties were observed.

Australasian Sleep Association 2024 guidelines for sleep studies in adults.

Executive summary: This document is a consensus statement of a subcommittee of experienced sleep physicians and scientists, tasked to review the literature and formulate recommendations on the indications, performance, and reporting of sleep studies, to update clinical practice from the 2017 Australasian Sleep Association (ASA) guidelines for sleep studies in adults (Douglas JA, Chai-Coetzer CL, McEvoy D, et al. Guidelines for sleep studies in adults - a position statement of the Australasian Sleep Association. Sleep Med. 2017;36(Suppl 1):S2-S22. doi:10.1016/j.sleep.2017.03.019). This document moves the focus beyond important discussions outlined in the 2017 guidelines, particularly surrounding the sensitivity and specificity of validated questionnaires and home sleep studies. The 2024 guide outlines the performance of the broad range of sleep testing available for the investigations of sleep disorders in adults including indications, strengths, limitations, and reporting standards.

Initial validation of the new browser-based application DREEP for diagnosis of common chronic sleep disorders

Abstract Background Traditionally, individuals with chronically disordered sleep are referred to a sleep specialist, who would usually arrange diagnostic investigations including polygraphy and/or polysomnography (PSG). Dr. Sleep (DREEP) is a browser-based application developed for diagnosing common chronic sleep disorders such as obstructive sleep apnea (OSA), periodic leg movements (PLMD), and insomnia in adults. The DREEP algorithm is based on disease-specific questions adapted from validated sleep questionnaires. This study evaluated the preliminary performance of DREEP for the diagnosis and severity assessment of sleep disorders in adults with chronically disordered sleep. Methods Sixty-four individuals admitted to the sleep laboratory of the Department of Sleep Medicine at the University of Essen, Germany, were recruited. Medical sleep history was taken by a sleep specialist. Each participant underwent full-night PSG and used the DREEP application on a tablet in the evening of admission or the morning after diagnostic sleep testing. Results DREEP predicted OSA with a sensitivity of 97%, but specificity was low at 25% (it had a tendency to overestimate OSA). DREEP had sensitivity of 79.2% and specificity of 80% for detecting PLMD/restless legs syndrome (RLS). The application showed the best performance for detection of insomnia (sensitivity 90%, specificity 83%), and successfully detected one individual with clinically confirmed narcolepsy. Conclusion This initial validation study has shown that the browser-based application DREEP is adequately able to assess risk and improve the pre-test probability for prescribing further tests in individuals with common chronic sleep disorders, including OSA, PLMD/RLS, and insomnia. In addition, DREEP was able to correctly identify most individuals without these conditions despite a tendency to overestimate. In a follow-up study, the promising clinical accuracy of DREEP needs to be substantiated by adding a healthy control group.

Psychiatric comorbidities of attention deficit/hyperactivity disorder in Japan: a nationwide population-based study.

This study aimed to estimate prevalence and incidence of attention deficit/hyperactivity disorder (ADHD) and comorbid relationships between ADHD and other psychiatric disorders in Japan. Using the real-world JMDC Claims Database, we conducted a cross-sectional study (analysis years 2017-2021) and retrospective cohort study (observation 2 years before/after the initial ADHD diagnosis; data collection 2005-2021; enrollment 2017-2019). Patients were male or female, aged 0-57 years. Cross-sectional study patients had an ADHD or other psychiatric disorder diagnosis (with or without medication) and were continuously registered in each analysis year; retrospective study patients had an ADHD diagnosis and ≥2 years' observation before and after diagnosis. Endpoints were annual prevalence and incidence of ADHD in Japan, prevalence and risk ratio of each psychiatric comorbidity in patients with ADHD, prevalence and risk ratios of ADHD in patients with each psychiatric comorbidity, and prevalence of psychiatric disorders before/after the initial ADHD diagnosis. ADHD prevalence in children/adolescents and adults increased each year from 2017 to 2021. Prevalence in boys was 3.5-4.1 times higher than in girls. Prevalence in adults was lower than in children/adolescents, with a small sex difference. ADHD was highly comorbid with various psychiatric disorders. In 2019, the most common comorbidity in children/adolescents with ADHD was autism spectrum disorder (ASD; 54.4%); in adults, it was mood disorders (60.9%). ADHD prevalence in patients with various psychiatric disorders was higher than in the control population. ADHD prevalence was highest in patients with oppositional defiance disorder among both children/adolescents and adults (77.2% and 69.2%, respectively). In the retrospective cohort study (N = 14,940), the most common psychiatric disorders diagnosed prior to ADHD diagnosis were ASD in children/adolescents (33.9% of patients), and mood disorders and sleep disorders in adults (36.9% and 23.8% of patients, respectively). ADHD was comorbid with various psychiatric disorders in Japan. In children and adolescents with ADHD, ASD was often diagnosed prior to ADHD. Psychiatric disorders, especially mood disorders and sleep disorders, were frequently diagnosed prior to the initial ADHD diagnosis in adults. The likelihood of comorbid ADHD should be considered when diagnosing adult patients with psychiatric disorders.

Edward O. Bixler, PhD: from the Apollo project and chimpanzees to sleep epidemiology.

What an honor to write about Dr. Edward O. Bixler's contributions to the sleep field. In 1967, Dr. Bixler published a case report on a chimpanzee with implanted brain electrodes while working at an Air Force base in New Mexico. A few years later, in 1971, he published on the sleep effects of flurazepam in individuals with insomnia together with Dr. Anthony Kales, data that he had collected when the Sleep Research & Treatment Center (SRTC) was housed at the University of California Los Angeles. Dr. Bixler, a meticulous scientist, learned from Dr. Kales, a devoted clinician, to study "the whole patient, and all aspects of sleep," a legacy that continued when the SRTC moved to Penn State in Hershey. Indeed, Dr. Bixler's tenure at Penn State from 1971 until 2019 kept the science of the SRTC focused on that premise and helped translate scientific evidence into clinical care. He not only contributed early to the pharmacology of sleep and the effects of hypnotics, but he was also a pioneer in "sleep epidemiology." His "Prevalence of sleep disorders in the Los Angeles metropolitan area" study of 1979 was the first rigorous epidemiological study on sleep disturbances. Starting in 1990, he established the Penn State Adult Cohort to estimate the prevalence and natural history of sleep-disordered breathing and other sleep disorders in adults. Inspired by life-course epidemiology, he established in 2001 the Penn State Child Cohort to estimate the same phenomena in children. This Living Legend paper captures and highlights Dr. Bixler's enduring legacy to sleep science.

Association Between Vision-Related Functional Burden andSleep Disorders in AdultsAged 20 and Over in the UnitedStates.

The impact of functional vision, rather than visual acuity, on sleep disorders is not well understood. This study estimated the relationship between vision-related functional burden and sleep disorders among a nationally representative sample in the United States. Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 were analyzed, which included a total of 10,914 US adults 20 years and older. Sleep disorders and vision-related functional burden were measured by the NHANES questionnaire sleep disorders section and vision section, respectively. Logistic regression was used to explore the association between vision-related functional burden and sleep disorders. A total of 9384 NHANES participants had complete functional vision and sleep disorders data. The mean age at baseline was 47.8 years, and the weighted prevalence of sleep disorders among adults with vision-related functional burden was 20.3%. After controlling for age, gender, race, smoking status, drinking frequency, general health condition, hypertension, diabetes, coronary heart disease, and depression, vision-related functional burden remained significantly associated with sleep disorders (adjusted odds ratio, 1.502; 95% confidence interval, 1.210-1.864; P < 0.001), whereas the association between presenting visual acuity and sleep disorders was not statistically significant. Vision-related functional burden rather than impairment of visual acuity was related to the increased prevalence of sleep disorders in adults 20 years and older in the United States. Our study provides insight into the relationship between functional vision and sleep disorders. It should be noted that individuals who report vision-related functional burden might be at risk of sleep disorders.

Sleep disorders after COVID-19 in Czech population: Post-lockdown national online survey

ObjectiveThis study aimed to determine the frequency, type, and correlates of a broad spectrum of sleep disorders in adults with COVID-19 up to 32 months after infection. MethodsWe conducted a national online survey (Jun 2021–Dec 2022), gathering information on COVID-19 diagnosis, acute disease course, and the subsequent development of sleep disorders from 1507 respondents (mean age 44.5 ± 13.1 years, 64.1% women). Results81.3% (1223) reported at least one sleep difficulty that either worsened or first appeared with COVID-19. Females reported a higher number of symptoms (2.03 ± 1.44 versus 1.72 ± 1.43 in men, p < 0.0001). Most common were insomnia symptoms (59.4%), followed by night sweats (38.4%), hypersomnolence (33.3%), vivid dreams or nightmares (26.4%), restless leg syndrome (RLS) (22.8%), and sleep-related breathing disorders (11.1%). All symptoms were associated with a more severe acute disease. A mild decreasing trend in the persistence of sleep symptoms with a longer latency since infection was observed, with 66.7% reporting at least half of their symptoms present at 3–5 months after acute infection, compared to 64.9% at 6–8 months, and 62.4% at 9–11 months (p = 0.0427). However, among those after 12 or more months, over half of the symptoms persisted in 69.5%. The frequency of vivid dreams and nightmares increased in association with COVID-19 in 32.9% (p < 0.001). 9.4% (141) reported new-onset or increased parasomnic manifestations after the infection. ConclusionsOur research shows that sleep disturbances are a common and persistent manifestation of COVID-19 that affects a large proportion of the population and deserves careful monitoring.

At-Home Polysomnography Versus In-Clinic Polysomnography for Sleep Disorders

&#x0D; Level 2 PSG may have moderate accuracy compared to Level 1 PSG for diagnosing obstructive sleep apnea. This conclusion was based on 1 study with limitations in reporting that reduce our certainty in the findings.&#x0D; There may be no significant differences in daytime sleepiness, hypertension, treatment adherence, and most quality-of-life measures for patients with OSA who were diagnosed with a Level 2 PSG compared with a Level 1 PSG (1 study).&#x0D; We did not find any studies on the diagnostic test accuracy or clinical utility of Level 2 PSG for the screening or diagnosing of other sleep disorders (e.g., central disorders of hypersomnolence, sleep-related movement disorders, parasomnias) that met our inclusion criteria.&#x0D; We did not find any studies on the cost-effectiveness of Level 2 PSG for screening or diagnosis of any sleep disorders in adults that met our inclusion criteria.&#x0D;

Influence of anxiety on the presence of temporomandibular dysfunction and sleep disorders in adult patients

The aim of this study was to evaluate the influence of anxiety on the presence of TMD and sleep disorders in adults by using regression and correlation. The methodology applied consisted of a quantitative cross-sectional study, where 113 patients aged between 20 and 45 years, with one or more symptoms of anxiety and/or temporomandibular dysfunction and/or sleep disorders. Volunteers answered the Beck-BAI, RDC/TMD and Fletcher &amp; Luckett questionnaires for symptom analysis. The results showed that anxiety had a statistically significant influence on all evaluated variables of TMD and sleep disorders. Thus, it was concluded that the signs and symptoms of TMD and sleep disorders are influenced by anxiety.

Exposures to ambient air pollutants increase prevalence of sleep disorder in adults: Evidence from Wuhan Chronic Disease Cohort Study (WCDCS)

BackgroundSleep disorder contributes to memory dysfunction and chronic diseases. Clear evidence of environment disturbance, such as residential noise, are associated with an increased risk of sleep disorder. However, not enough studies have been conducted on association between residential air pollutants and sleep disorder. We sought to determine whether exposures to residential air pollutants associated with risk of sleep disorder among adults. MethodsUsing the dataset of the Wuhan Chronic Disease Cohort Study (WCDCS), we investigated the prevalence of sleep disorder and five sleep disorder symptoms in the study. The data of air pollutants (including PM10, PM2.5, NO2, SO2 and O3) were obtained from 10 air quality monitoring stations in Wuhan. We utilized logistic regression model to evaluate the associations of five types of air pollutants with odds ratio (OR) of sleep disorder and symptoms. The potential moderating effects of socio-demographic factors in the associations were explored using the interaction effects model. ResultsOf the study participants, 52.1 % had sleep disorder. Exposures to higher concentrations of air pollutants were associated with increased prevalence of sleep disorder. For example, per interquartile range (IQR) increases in concentrations of PM10, PM2.5 or SO2 corresponded to the increase of sleep disorder increased prevalence at 14.7 % (adjusted odds ratio (aOR) = 1.147, 95 %CI:1.062, 1.240), 8.9 % (aOR = 1.089, 95 %CI: 1.003, 1.182) and 15.8 % (aOR = 1.158, 95 %CI: 1.065, 1.260). For symptoms specific analyses, significant linkages of PM10, PM2.5, SO2 with difficulty in falling asleep, wake up after falling asleep and early awaken were observed. Moderating effects of age and place of residence on the linkages of PM10 with increased prevalence of sleep disorder were identified. ConclusionHigher level of air pollution exposure could increase the prevalence of sleep disorder. Middle-aged and elderly population, as well as the rural residents are more likely to suffer from sleep disorder.

Problems in the Development of the Sleep-Wake Rhythm Influence Neurodevelopmental Disorders in Children.

Development of the sleep-wake rhythm has a significant effect on the physical and mental development of children. The sleep-wake rhythm is controlled by aminergic neurons in the brainstem's ascending reticular activating system, which is associated with synaptogenesis and the promotion of brain development. The sleep-wake rhythm develops rapidly within the first year after birth. At 3-4 months of age, the framework of the circadian rhythm is established. The objective of the present review is to assess a hypothesis concerning problems in the development of the sleep-wake rhythm and their effect on neurodevelopmental disorders. Autism spectrum disorder is characterised by a delay in the development of sleep rhythms at 3-4 months of age and also insomnia and night-time awakenings, as supported by several reports. Melatonin may shorten the sleep latency in ASD. Rett syndrome sufferers kept awake during the daytime were analysed by the Sleep-wake Rhythm Investigation Support System (SWRISS) (IAC, Inc., (Tokyo, Japan)), and the cause was found to be the dysfunction of aminergic neurons. Children and adolescents with attention deficit hyperactivity disorder show sleep problems such as resistance to bedtime, difficulty falling asleep, sleep apnoea, and restless legs syndrome. Sleep deprivation syndrome in schoolchildren is deeply influenced by Internet use, games, and smartphones, and this syndrome affects emotion, learning, concentration, and executive functioning. Sleep disorders in adults are strongly considered to affect not only the physiological/autonomic nervous system but also neurocognitive/psychiatric symptoms. Even adults cannot avoid serious problems, much less children, and the impact of sleep problems is considerably greater in adults. Paediatricians and nurses should be aware of the significance, from birth, of sleep development and sleep hygiene education for carers and parents. This research was reviewed and approved by the ethical committee of the Segawa Memorial Neurological Clinic for Children (No. SMNCC23-02).

Childhood adversity and acute stress vulnerability at adulthood: The mediating role of sleep

IntroductionNumerous preclinical and clinical studies established the contribution of childhood adversity to acute stress vulnerability at adulthood. Several different physiological, psychological and behavioral factors have been suggested as putative mediators of this association. Sleep, and more specifically sleep disruption, has emerged as one such promising candidate. First, adverse childhood experiences have been repeatedly associated with adult sleep disorders. Second, individuals that suffer from stress-related psychopathology at adulthood often exhibit sleep disturbances, to the extent that sleep difficulties are diagnostic criteria for many of these disorders. Third, inefficient sleep pre and post exposure to acute stress was shown to increase the likelihood for maladaptive outcome, potently by impairing critical processes that occur during sleep as arousal regulation and memory consolidation.ObjectivesTo date, very few studies integrated these independent lines of research. Also, previous studies mostly assessed sleep via self-reported diary or a single night measurement at laboratory settings. The current study aimed to provide a more ecological and continuous account for sleep patterns, and their putative associations with childhood adversity on the one hand and vulnerability to acute stress at adulthood on the other hand.MethodsNinety-six healthy adult female participants completed the well-established childhood trauma questionnaire (CTQ) before wearing a wearable sensor for seven consecutive days and nights while maintaining their regular life routine. Following that, participants all underwent an acute laboratory stress induction procedure while their psychological and endocrine responses were recorded at multiple time points throughout.ResultsSleep patterns fully mediated the association between childhood adversity and psychological response to acute stress at adulthood (Figure 1). Specifically, elevated levels of childhood trauma were associated with more variation in sleep duration across the recording period, which in turn was associated with higher stress-induced negative affect. Interestingly, this association did not emerge with respect to mean sleep time nor with stress-induced cortisol release.ConclusionsResults imply that childhood trauma may lead to irregular sleep patterns which in turn contribute to exaggerated emotional response to acute stress at adulthood. These findings support the mediating role of sleep in the link between childhood adversity and acute stress vulnerability at adulthood, and highlight sleep as a viable target for early or even preventive intervention.Disclosure of InterestNone Declared

Effects of Obstructive Sleep Apnea and Insomnia on Cognitive Function

Purpose of Review. Obstructive sleep apnea and chronic insomnia are the most common sleep disorders in adults. Both sleep disorders can adversely affect physical and mental well-being. Cognitive function has been extensively studied in relation to chronic insomnia and obstructive sleep apnea. This paper reviews the recent studies investigating the cognitive effects of insomnia and obstructive sleep apnea as well as the potential benefits of treatment. Recent Findings. Recent studies indicate that insomnia is associated with impairments in attention, memory, and executive function. Chronic insomnia may have a moderating role in mild cognitive impairment and Alzheimer’s dementia. Mood and anxiety disorders may moderate the effects of insomnia on cognitive function. Hyperarousal and short sleep time associated with insomnia are risk factors for cognitive impairment. Cognitive behavior therapy for insomnia may improve cognitive function but more studies are needed. Nonbenzodiazepine receptor agonists improve insomnia without causing cognitive impairment. Benzodiazepine use is associated with cognitive impairment. Obstructive sleep apnea is associated with impairments in attention, concentration, memory, and executive function with apnea severity as measured by the apnea hypopnea index and severity of nocturnal hypoxemia being the largest risk factors. Untreated obstructive sleep apnea may have a significant impact on the progression of mild cognitive impairment and Alzheimer’s dementia. The impact of obstructive sleep apnea treatment, particularly with continuous positive airway pressure, appears to mitigate and slow the rate of cognitive decline but more randomized controlled studies are needed. Summary. Standardized cognitive assessments and larger, long-term controlled prospective studies with diverse populations are needed to further elucidate the cognitive impairments associated with chronic insomnia and obstructive sleep apnea. More studies are needed on the benefits of various treatments for obstructive sleep apnea and insomnia.

Molecular basis of ligand selectivity for melatonin receptors.

Sleep disorders in adults are related to adverse health effects such as reduced quality of life and increased mortality. About 30-40% of adults are suffering from different sleep disorders. The human melatonin receptors (MT1 and MT2) are family A G protein-coupled receptors that respond to the neurohormone melatonin MEL which regulates circadian rhythm and sleep. Many efforts have been made to develop drugs targeting melatonin receptors to treat insomnia, circadian rhythm disorders, and even cancer. However, designing subtype-selective melatonergic drugs remains challenging due to their high similarities in both sequences and structures. MEL (a function-selective compound with a bulky β-naphthyl group) behaves as an MT2-selective antagonist, whereas it is an agonist of MT1. Here, molecular dynamics simulations were used to investigate the ligand selectivity of MT receptors at the atomic level. We found that the binding conformation of MEL differs in different melatonin receptors. In MT1, the naphthalene ring of MEL forms a structure perpendicular to the membrane surface. In contrast, there is a 130° angle between the naphthalene ring of MEL and the membrane surface in MT2. Because of this conformational difference, the MEL leads to a constant water channel in MT1 which activates the receptor. However, MEL hinders the formation of continuous water channels, resulting in an inactive state of MT2. Furthermore, we found that A1173.29 in MT2 is a crucial amino acid capable of hindering the conformational flip of the MEL molecule. These results, coupled with previous functional data, reveal that although MT1 and MT2 share highly similar orthosteric ligand-binding pockets, they also display distinctive features that could be used to design selective compounds. Our findings provide new insights into functionally selective melatonergic drug development for sleep disorders.

Sleep disorders in adults with tuberous sclerosis complex: a questionnaire-based study

Sleep disorders in adults with tuberous sclerosis complex: a questionnaire-based study

Could Melatonin Be an Alternative to Benzodiazepine for Chronic Obstructive Pulmonary Disease With Insomnia?

Chronic obstructive pulmonary disease (COPD) is common, with a 10% global prevalence and a significant health problem, and is one of the main causes of morbidity. Patients with COPD experience various types of sleep problems with insomnia as the most common sleep disorder. The presence of sleep disorders further deteriorates their quality of life. Benzodiazepines (BZDs) are commonly prescribed drugs for insomnia. Several meta-analyses have shown that BZDs effectively reduce insomnia; however, severe side effects including rebound insomnia, next-day hangover, anterograde amnesia, and cognitive impairment occur. Since COPD patients often complain of symptoms such as shortness of breath, safe treatment for sleep disorders is needed. Melatonin supplements have a safe profile and are well-tolerated. Therefore, melatonin can be safely prescribed to treat insomnia in patients with COPD. In addition, due to the anti-inflammatory activity of melatonin, it can be an alternative to BZDs for improving insomnia symptoms without exacerbating respiratory symptoms. It would be helpful to more actively screen and detect sleep disorders in adults with COPD, and to provide safe melatonin treatment for improving their quality of life.

The prevalence of sleep disorders in adults with learning disabilities: A systematic review

AbstractBackgroundPrevious research indicated a high prevalence of disordered sleep among adults with learning disabilities, however issues with design impacted findings. The current systematic review aims to: (a) present how disordered sleep and sleep disorders amongst adults with learning disabilities are described in the literature, and (b) report on the prevalence of disordered sleep and sleep disorders among adults with learning disabilities.MethodsFive databases (EMBASE, MEDLINE, PsycARTICLES, PsycINFO and PubMed) were searched for articles published from 1900 to October 2021 that examined the prevalence of disordered sleep and/or sleep disorders in adults aged 18 or older with learning disabilities. The Joanna Briggs Institute critical appraisal checklist for prevalence studies was used to assess study quality and prevalence is described and reported as ranges. The study was registered on PROSPERO (ID: CRD42019134550).FindingsA total of 27 studies were selected. Twenty studies (n = 8043 participants) examined the prevalence of disordered sleep and identified prevalence ranging from 6.1% to 74.2% across a range of sleep parameters. Twelve studies examined sleep‐related breathing disorders (n = 2558 participants) and identified prevalence which ranged from 0.5% to 100%. There was notable heterogeneity between studies in terms of quality, definition of disordered sleep, measurement of sleep, and study design.ConclusionThere was a variable prevalence of disordered sleep among people living with learning disabilities. There were problems in meaningfully synthesising results due to heterogeneity in measurement, diagnosis, study design and study quality. Based on these limitations, we suggest that future studies should seek to utilise objective, replicable and consistent measures of sleep in this population and control for physical health factors which could influence prevalence such as epilepsy and iatrogenic effects.

Polisomographic Investigation of Sleep Disorders in Patients with Sickle Cell Anemia and Evaluation of the Effect on the Prognosis.

objective:The aim of this study is to identify sleep disorders in adults with sickle cell disease and to examine the effects of accompanying sleep disorders on the prognosis of sickle cell disease.MATERIAL AND METHODS:Twenty-eight patients followed up with a diagnosis of sickle cell disease and 22 healthy volunteers were included in our study.Results:Both groups had similar characteristics in terms of age, gender, and body mass index. More obstructive sleep apnea syndrome was detected in the sickle cell group than in healthy volunteers. Statistically, the sickle cell patient group had higher apnea–hypopnea index and lower nighttime oxygen desaturation. As the degree of obstructive sleep apnea syndrome increased in the sickle cell group, it was found that there were more emergency admissions and hospitalization due to painful crises and/or acute chest syndrome in the last 1 year. Also, lower sleep efficiency was found in the sickle cell disease patient group. In the sickle cell group, it was found that the restless leg syndrome severity was statistically significantly more.Conclusion:As hypoxia deepens in sickle cell patients, mortality and morbidity due to the disease increase significantly. Comorbid sleep disturbances in sickle cell patients exacerbate nocturnal hypoxia and negatively affect the prognosis of the disease. Therefore, patients with sickle cell disease should be questioned in detail in terms of obstructive sleep apnea syndrome and, if necessary, polysomnographic evaluation should be performed to provide treatment for sleep disorders in the early period.

Sleep Disorders in Adults with Prader-Willi Syndrome: Review of the Literature and Clinical Recommendations Based on the Experience of the French Reference Centre.

Prader–Willi syndrome (PWS) is a rare, genetic, multisymptomatic, neurodevelopmental disease commonly associated with sleep alterations, including sleep-disordered breathing and central disorders of hypersomnolence. Excessive daytime sleepiness represents the main manifestation that should be addressed by eliciting the detrimental effects on quality of life and neurocognitive function from the patients’ caregivers. Patients with PWS have impaired ventilatory control and altered pulmonary mechanics caused by hypotonia, respiratory muscle weakness, scoliosis and obesity. Consequently, respiratory abnormalities are frequent and, in most cases, severe, particularly during sleep. Adults with PWS frequently suffer from sleep apnoea syndrome, sleep hypoxemia and sleep hypoventilation. When excessive daytime sleepiness persists after adequate control of sleep-disordered breathing, a sleep study on ventilatory treatment, followed by an objective measurement of excessive daytime sleepiness, is recommended. These tests frequently identify central disorders of hypersomnolence, including narcolepsy, central hypersomnia or a borderline hypersomnolent phenotype. The use of wake-enhancing drugs (modafinil, pitolisant) is discussed in multidisciplinary expert centres for these kinds of cases to ensure the right balance between the benefits on quality of life and the risk of psychological and cardiovascular side effects.