Pub Date : 2025-09-15DOI: 10.1016/j.smrv.2025.102167
Jian Eu Tai , Sheila Sivam , Angela D'Rozario , David Wang , Garry Cho , Brendon J. Yee
Central disorders of hypersomnolence are currently diagnosed in clinical practice from overnight polysomnography and multiple sleep latency test (MSLT). Cerebrospinal fluid (CSF) orexin levels are also a useful confirmatory test for type 1 narcolepsy. The diagnosis and differentiation of disorders of hypersomnolence remain limited by the lack of repeatability of MSLT and the absence of any known biomarkers for type 2 narcolepsy (NT2) and idiopathic hypersomnolence (IH). There remains limited understanding of the pathophysiology and neural pathways involved in NT2 and IH. In this narrative review, we explore the research on serum and CSF testing, neuroimaging, polysomnography and other modalities in improving the sensitivity and specificity of diagnosing these disorders.
{"title":"Central disorders of hypersomnolence – A narrative review on current and potential biomarkers","authors":"Jian Eu Tai , Sheila Sivam , Angela D'Rozario , David Wang , Garry Cho , Brendon J. Yee","doi":"10.1016/j.smrv.2025.102167","DOIUrl":"10.1016/j.smrv.2025.102167","url":null,"abstract":"<div><div>Central disorders of hypersomnolence are currently diagnosed in clinical practice from overnight polysomnography and multiple sleep latency test (MSLT). Cerebrospinal fluid (CSF) orexin levels are also a useful confirmatory test for type 1 narcolepsy. The diagnosis and differentiation of disorders of hypersomnolence remain limited by the lack of repeatability of MSLT and the absence of any known biomarkers for type 2 narcolepsy (NT2) and idiopathic hypersomnolence (IH). There remains limited understanding of the pathophysiology and neural pathways involved in NT2 and IH. In this narrative review, we explore the research on serum and CSF testing, neuroimaging, polysomnography and other modalities in improving the sensitivity and specificity of diagnosing these disorders.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102167"},"PeriodicalIF":9.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145106716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.smrv.2025.102164
Rob Velzeboer , Adeeb Malas , Sabrina Wei , Renee Berger , Varinder Parmar , Wayne W.K. Lai
Cannabis use for sleep is increasingly prevalent, yet its effects on sleep architecture remain unclear. This systematic review and meta-analysis examined polysomnographic evidence on cannabis’ impact on sleep parameters. Eighteen studies were identified, with nine suitable for meta-analysis. Findings indicate that cannabis administration does not consistently alter sleep duration, latency, wake time, efficiency, or sleep staging. While early studies suggested reductions in rapid eye movement sleep, these were primarily based on small-scale trials with high tetrahydrocannabinol doses and significant methodological limitations. More recent studies using larger samples and lower therapeutic doses of tetrahydrocannabinol have reported mixed (and often no) evidence of rapid eye movement (REM) suppression, and the evidence base remains very limited. However, withdrawal from active cannabis use was consistently associated with sleep disturbances, including reduced total sleeping times and prolonged sleep onset latency, as well as REM rebounds. Variability in study outcomes highlights the influence of factors such as dosage, cannabinoid composition, prior cannabis use, and health conditions. Further research using standardised protocols and larger samples is needed to clarify the relationship between cannabis and sleep architecture and to address the discrepancies between subjective sleep improvements and objective sleep metrics.
{"title":"Cannabis and sleep architecture: A systematic review and meta-analysis","authors":"Rob Velzeboer , Adeeb Malas , Sabrina Wei , Renee Berger , Varinder Parmar , Wayne W.K. Lai","doi":"10.1016/j.smrv.2025.102164","DOIUrl":"10.1016/j.smrv.2025.102164","url":null,"abstract":"<div><div>Cannabis use for sleep is increasingly prevalent, yet its effects on sleep architecture remain unclear. This systematic review and meta-analysis examined polysomnographic evidence on cannabis’ impact on sleep parameters. Eighteen studies were identified, with nine suitable for meta-analysis. Findings indicate that cannabis administration does not consistently alter sleep duration, latency, wake time, efficiency, or sleep staging. While early studies suggested reductions in rapid eye movement sleep, these were primarily based on small-scale trials with high tetrahydrocannabinol doses and significant methodological limitations. More recent studies using larger samples and lower therapeutic doses of tetrahydrocannabinol have reported mixed (and often no) evidence of rapid eye movement (REM) suppression, and the evidence base remains very limited. However, withdrawal from active cannabis use was consistently associated with sleep disturbances, including reduced total sleeping times and prolonged sleep onset latency, as well as REM rebounds. Variability in study outcomes highlights the influence of factors such as dosage, cannabinoid composition, prior cannabis use, and health conditions. Further research using standardised protocols and larger samples is needed to clarify the relationship between cannabis and sleep architecture and to address the discrepancies between subjective sleep improvements and objective sleep metrics.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102164"},"PeriodicalIF":9.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.smrv.2025.102169
Steven Luu , Daryl Emery Chee Yeow Chan , Nathaniel S. Marshall , Craig L. Phillips , Ronald R. Grunstein , Brendon J. Yee
Positive airway pressure therapy remains the gold standard treatment for obstructive sleep apnea (OSA), but challenges with adherence, acceptability, and side effects persist. Interest in pharmacological therapies has grown, culminating in the recent U.S. Food and Drug Administration approval of tirzepatide as the first pharmacotherapy for OSA. Our review critically examines the efficacy of pharmacologic treatments for OSA and highlights current limitations and future research directions.
We conducted a search of Medline and Embase for randomized controlled trials published from January 2005 to February 2025, identifying 41 studies investigating 37 different drugs or drug combinations.
Weight-loss therapies showed the most consistent and substantial improvements in OSA severity. Tirzepatide produced the largest reduction in apnea-hypopnea index and improved patient-reported outcomes and cardiometabolic risk factors. Other pharmacotherapies demonstrated modest and inconsistent effects on OSA severity, sometimes with side-effects that contradict the treatment goal to reduce daytime sleepiness.
Weight-loss agents, particularly tirzepatide, represent a promising and now clinically viable treatment option. While endotype-targeted approaches are conceptually attractive, many agents were too early in their testing/re-purposing phase to demonstrate improvements in sleepiness, quality of life or sustained reductions of OSA severity; or were insufficiently targeted at the endotype they might best treat.
{"title":"Pharmacotherapy for obstructive sleep apnea: a critical review of randomized placebo-controlled trials","authors":"Steven Luu , Daryl Emery Chee Yeow Chan , Nathaniel S. Marshall , Craig L. Phillips , Ronald R. Grunstein , Brendon J. Yee","doi":"10.1016/j.smrv.2025.102169","DOIUrl":"10.1016/j.smrv.2025.102169","url":null,"abstract":"<div><div>Positive airway pressure therapy remains the gold standard treatment for obstructive sleep apnea (OSA), but challenges with adherence, acceptability, and side effects persist. Interest in pharmacological therapies has grown, culminating in the recent U.S. Food and Drug Administration approval of tirzepatide as the first pharmacotherapy for OSA. Our review critically examines the efficacy of pharmacologic treatments for OSA and highlights current limitations and future research directions.</div><div>We conducted a search of Medline and Embase for randomized controlled trials published from January 2005 to February 2025, identifying 41 studies investigating 37 different drugs or drug combinations.</div><div>Weight-loss therapies showed the most consistent and substantial improvements in OSA severity. Tirzepatide produced the largest reduction in apnea-hypopnea index and improved patient-reported outcomes and cardiometabolic risk factors. Other pharmacotherapies demonstrated modest and inconsistent effects on OSA severity, sometimes with side-effects that contradict the treatment goal to reduce daytime sleepiness.</div><div>Weight-loss agents, particularly tirzepatide, represent a promising and now clinically viable treatment option. While endotype-targeted approaches are conceptually attractive, many agents were too early in their testing/re-purposing phase to demonstrate improvements in sleepiness, quality of life or sustained reductions of OSA severity; or were insufficiently targeted at the endotype they might best treat.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102169"},"PeriodicalIF":9.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-11DOI: 10.1016/j.smrv.2025.102163
Yixuan Cao , Tian Xie , Ning Ma
This meta-analysis quantified the impact of sleep loss (including both total sleep deprivation and partial sleep restriction) on core components of executive function: working memory, inhibitory control, and cognitive flexibility. A systematic search of Scopus, Web of Science, and PubMed identified 79 relevant publications. Using random-effects models, pooled effect sizes for reaction time and accuracy metrics were estimated separately within each task category. All reaction time metrics, except for cognitive flexibility, increased significantly following sleep loss, with medium to near-large effect sizes. Analysis of accuracy metrics revealed medium to large effect sizes on task-switching and task-repeat performance of cognitive flexibility, as well as on working memory maintenance, whereas a small effect size was observed on resolving interference inhibition. These findings highlight pervasive damage to all executive function components and suggest that the impaired common factor of executive functions may underpin sleep loss–related deterioration. Furthermore, the discrepancies between reaction time and accuracy effect sizes indicate opposite speed-accuracy trade-offs following sleep loss between interference inhibition and cognitive flexibility. This study provides essential evidence for understanding how sleep loss affects different components of executive function, emphasizing the importance of exploring sleep loss–related impairments from a comprehensive perspective.
这项荟萃分析量化了睡眠缺失（包括完全睡眠剥夺和部分睡眠限制）对执行功能核心组成部分的影响：工作记忆、抑制控制和认知灵活性。通过对Scopus、Web of Science和PubMed的系统搜索，确定了79篇相关出版物。使用随机效应模型，在每个任务类别中分别估计反应时间和准确性指标的综合效应大小。除认知灵活性外，所有反应时间指标在睡眠不足后都显著增加，效应大小中等至接近于大。准确度指标分析显示，在认知灵活性的任务转换和任务重复表现以及工作记忆维持方面存在中等到较大的效应，而在解决干扰抑制方面存在较小的效应。这些发现强调了对所有执行功能组成部分的普遍损害，并表明执行功能受损的共同因素可能是睡眠不足相关恶化的基础。此外，反应时间和准确性效应大小之间的差异表明，睡眠不足后，干扰抑制和认知灵活性之间的速度-准确性权衡是相反的。这项研究为理解睡眠不足如何影响执行功能的不同组成部分提供了必要的证据，强调了从全面的角度探索睡眠不足相关损伤的重要性。
{"title":"The impairments of sleep loss on core executive functions: General and task-specific effects","authors":"Yixuan Cao , Tian Xie , Ning Ma","doi":"10.1016/j.smrv.2025.102163","DOIUrl":"10.1016/j.smrv.2025.102163","url":null,"abstract":"<div><div>This meta-analysis quantified the impact of sleep loss (including both total sleep deprivation and partial sleep restriction) on core components of executive function: working memory, inhibitory control, and cognitive flexibility. A systematic search of Scopus, Web of Science, and PubMed identified 79 relevant publications. Using random-effects models, pooled effect sizes for reaction time and accuracy metrics were estimated separately within each task category. All reaction time metrics, except for cognitive flexibility, increased significantly following sleep loss, with medium to near-large effect sizes. Analysis of accuracy metrics revealed medium to large effect sizes on task-switching and task-repeat performance of cognitive flexibility, as well as on working memory maintenance, whereas a small effect size was observed on resolving interference inhibition. These findings highlight pervasive damage to all executive function components and suggest that the impaired common factor of executive functions may underpin sleep loss–related deterioration. Furthermore, the discrepancies between reaction time and accuracy effect sizes indicate opposite speed-accuracy trade-offs following sleep loss between interference inhibition and cognitive flexibility. This study provides essential evidence for understanding how sleep loss affects different components of executive function, emphasizing the importance of exploring sleep loss–related impairments from a comprehensive perspective.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102163"},"PeriodicalIF":9.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-11DOI: 10.1016/j.smrv.2025.102166
Yaqi Li , Tingting Zhao , Lizhuo Lin , Jingyuan Zhang , Sunliu Liu , Yueyi Wu , Carlos Flores-Mir , Fang Hua , Hong He
This umbrella review evaluated the effects of mandibular advancement devices (MADs) on pediatric obstructive sleep apnea (PedOSA). We searched six databases for systematic reviews published up to June 2025, that included children with polysomnography (PSG)-diagnosed OSA managed with MADs. The primary outcome was the change in the apnea-hypopnea index (AHI). Secondary outcomes included oxygen saturation and skeletal/dental changes. Twelve systematic reviews, including 7 meta-analyses, were included. Management with MADs resulted in a reduction in AHI and a slight improvement in sagittal mandibular position. However, significant heterogeneity was observed due to variations in device designs, treatment duration, and patient characteristics. Most findings were based on before-after studies, with limited randomized controlled trials, reducing the robustness of the results. The methodological quality of the included systematic reviews, assessed using AMSTAR 2, was predominantly low or critically low, indicating significant flaws. A corrected covered area (CCA) analysis revealed substantial overlap (20.7 %) in primary studies. While MADs show promise as an adjunctive therapy for PedOSA management in indicated cases, the low methodological quality of the included systematic reviews limits the strength of the evidence. High-quality primary studies and systematic reviews are needed to confirm the impact of MADs in PedOSA management and guide clinical practice.
{"title":"The effects of mandibular advancement devices on pediatric obstructive sleep apnea: An umbrella review","authors":"Yaqi Li , Tingting Zhao , Lizhuo Lin , Jingyuan Zhang , Sunliu Liu , Yueyi Wu , Carlos Flores-Mir , Fang Hua , Hong He","doi":"10.1016/j.smrv.2025.102166","DOIUrl":"10.1016/j.smrv.2025.102166","url":null,"abstract":"<div><div>This umbrella review evaluated the effects of mandibular advancement devices (MADs) on pediatric obstructive sleep apnea (PedOSA). We searched six databases for systematic reviews published up to June 2025, that included children with polysomnography (PSG)-diagnosed OSA managed with MADs. The primary outcome was the change in the apnea-hypopnea index (AHI). Secondary outcomes included oxygen saturation and skeletal/dental changes. Twelve systematic reviews, including 7 meta-analyses, were included. Management with MADs resulted in a reduction in AHI and a slight improvement in sagittal mandibular position. However, significant heterogeneity was observed due to variations in device designs, treatment duration, and patient characteristics. Most findings were based on before-after studies, with limited randomized controlled trials, reducing the robustness of the results. The methodological quality of the included systematic reviews, assessed using AMSTAR 2, was predominantly low or critically low, indicating significant flaws. A corrected covered area (CCA) analysis revealed substantial overlap (20.7 %) in primary studies. While MADs show promise as an adjunctive therapy for PedOSA management in indicated cases, the low methodological quality of the included systematic reviews limits the strength of the evidence. High-quality primary studies and systematic reviews are needed to confirm the impact of MADs in PedOSA management and guide clinical practice.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102166"},"PeriodicalIF":9.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-11DOI: 10.1016/j.smrv.2025.102155
Jacob S. Shaw , Kaylee Woodard , Akshay Krieg , Barry R. Bryant , Sabrina Kentis , Aaron I. Esagoff , Anne Reisch , Rachel M. Salas , Matthew E. Peters , Michael J.C. Bray
Sleep disturbances are among the most common neuropsychiatric symptoms following traumatic brain injury (TBI). However, no review has sought to identify the major neuroimaging correlates of post-TBI sleep disturbances across multiple imaging modalities. This systematic review aimed to describe post-TBI neuroimaging changes associated with self-reported and objective markers of sleep disturbance using computed tomography (CT), magnetic resonance imaging (MRI), and quantitative electroencephalography (qEEG). 21 studies were included in this review, comprising the data of 3176 individual with TBI and 396 individuals without TBI. While acute intracranial abnormalities on CT were not reliable predictors of self-reported symptoms of insomnia, measures of axonal integrity on diffusion tensor imaging (DTI), particularly involving cortico-subcortical white matter tracts such as the uncinate fasciculus, were highly associated with self-reported sleep disturbance. Individuals with TBI were also found to have decreased delta power and increased beta power on qEEG during sleep, providing preliminary support for the functional role of the hypothalamus in the pathogenesis of post-TBI sleep disturbance. Key study limitations include small sample sizes and heterogeneity of TBI severity and chronicity. Functional neuroimaging studies are needed that elucidate which alterations in white matter connectivity may be most implicated in the neurocircuitry of post-TBI sleep disturbance.
{"title":"The impact of traumatic brain injury on sleep and associated neuroimaging changes: A systematic review","authors":"Jacob S. Shaw , Kaylee Woodard , Akshay Krieg , Barry R. Bryant , Sabrina Kentis , Aaron I. Esagoff , Anne Reisch , Rachel M. Salas , Matthew E. Peters , Michael J.C. Bray","doi":"10.1016/j.smrv.2025.102155","DOIUrl":"10.1016/j.smrv.2025.102155","url":null,"abstract":"<div><div>Sleep disturbances are among the most common neuropsychiatric symptoms following traumatic brain injury (TBI). However, no review has sought to identify the major neuroimaging correlates of post-TBI sleep disturbances across multiple imaging modalities. This systematic review aimed to describe post-TBI neuroimaging changes associated with self-reported and objective markers of sleep disturbance using computed tomography (CT), magnetic resonance imaging (MRI), and quantitative electroencephalography (qEEG). 21 studies were included in this review, comprising the data of 3176 individual with TBI and 396 individuals without TBI. While acute intracranial abnormalities on CT were not reliable predictors of self-reported symptoms of insomnia, measures of axonal integrity on diffusion tensor imaging (DTI), particularly involving cortico-subcortical white matter tracts such as the uncinate fasciculus, were highly associated with self-reported sleep disturbance. Individuals with TBI were also found to have decreased delta power and increased beta power on qEEG during sleep, providing preliminary support for the functional role of the hypothalamus in the pathogenesis of post-TBI sleep disturbance. Key study limitations include small sample sizes and heterogeneity of TBI severity and chronicity. Functional neuroimaging studies are needed that elucidate which alterations in white matter connectivity may be most implicated in the neurocircuitry of post-TBI sleep disturbance.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102155"},"PeriodicalIF":9.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a meta-analysis and systematic review of research on the relationships between various aspects of naps and stroke risk. Two searches were conducted: a bibliographic search in four electronic databases for published articles that considered associations between the duration of napping and stroke risk versus a reference group (who did not nap) (n = 13) from inception up to July 15, 2024. The second search analyzed different features of napping (e.g., frequency, mild or severe napping, planned or unplanned, etc.) and stroke risk (n = 7). We found that the studies were very methodologically heterogeneous. Several publications reported more than one effect size. These differences allowed us to build models that describe the associations between napping and stroke. We used a funnel plot to estimate publication bias and employed a model of random effects for the analysis. The duration of naps was significantly associated with stroke risk; naps of 1–30 min had an odds ratio (OR) of 1.27, whereas naps >90 min had an OR of 1.79. Mutated forest plots were used to visualize the overall effects. We describe the pathomechanisms associated with an increased risk of hypertension and diabetes, mild inflammation, and other risk factors for stroke.
{"title":"Nonobvious connections between napping and stroke: a systematic review and meta-analysis","authors":"Radosław Kaźmierski , Szymon Jurga , Izabela Wojtasz , Joanna Kostanek , Maria Łukasik , Cezary Watala","doi":"10.1016/j.smrv.2025.102157","DOIUrl":"10.1016/j.smrv.2025.102157","url":null,"abstract":"<div><div>We present a meta-analysis and systematic review of research on the relationships between various aspects of naps and stroke risk. Two searches were conducted: a bibliographic search in four electronic databases for published articles that considered associations between the duration of napping and stroke risk versus a reference group (who did not nap) (n = 13) from inception up to July 15, 2024. The second search analyzed different features of napping (e.g., frequency, mild or severe napping, planned or unplanned, etc.) and stroke risk (n = 7). We found that the studies were very methodologically heterogeneous. Several publications reported more than one effect size. These differences allowed us to build models that describe the associations between napping and stroke. We used a funnel plot to estimate publication bias and employed a model of random effects for the analysis. The duration of naps was significantly associated with stroke risk; naps of 1–30 min had an odds ratio (OR) of 1.27, whereas naps >90 min had an OR of 1.79. Mutated forest plots were used to visualize the overall effects. We describe the pathomechanisms associated with an increased risk of hypertension and diabetes, mild inflammation, and other risk factors for stroke.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102157"},"PeriodicalIF":9.7,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-30DOI: 10.1016/j.smrv.2025.102158
Simone Bruno , Giovanni Cenerini , Letizia Lo Giudice , Francy Cruz-Sanabria , Davide Benedetti , Alessio Crippa , Simona Fiori , Raffaele Ferri , Gabriele Masi , Ugo Faraguna
Melatonin is known to be effective in improving sleep in pediatric patients affected by neurological and psychiatric conditions. However, no guidelines exist advising the most effective treatment schedule. This systematic review and meta-analysis aimed to identify the dose, time of administration and treatment duration associated with the maximal treatment efficacy. The systematic search, conducted across multiple databases following PRISMA guidelines and including studies published up to April 30, 2024, yielded 21 studies. Mean differences in sleep-related variables between the treatment and the placebo group were considered as study outcomes. Dose-response curves and meta-regression models were fitted to test the effect of treatment-related parameters. Melatonin significantly reduced Sleep onset latency and increased Sleep efficiency and Total sleep time. Sleep onset latency reduction was associated with an advancement in the time between administration with respect to bedtime, while increased Sleep efficiency and Total sleep time with longer treatment durations. Melatonin reached the maximal efficacy between 2 and 4 mg/day. Our results suggest a dose and time of administration that may enhance melatonin's sleep promoting effects (2–4 mg, 3 h before bedtime) and, if replicated by large clinical trials, could guide clinical practice in managing sleep disturbances in children experiencing neuropsychiatric conditions.
{"title":"Optimizing timing and dose of exogenous melatonin administration in neuropsychiatric pediatric populations: a meta-analysis on sleep outcomes","authors":"Simone Bruno , Giovanni Cenerini , Letizia Lo Giudice , Francy Cruz-Sanabria , Davide Benedetti , Alessio Crippa , Simona Fiori , Raffaele Ferri , Gabriele Masi , Ugo Faraguna","doi":"10.1016/j.smrv.2025.102158","DOIUrl":"10.1016/j.smrv.2025.102158","url":null,"abstract":"<div><div>Melatonin is known to be effective in improving sleep in pediatric patients affected by neurological and psychiatric conditions. However, no guidelines exist advising the most effective treatment schedule. This systematic review and meta-analysis aimed to identify the dose, time of administration and treatment duration associated with the maximal treatment efficacy. The systematic search, conducted across multiple databases following PRISMA guidelines and including studies published up to April 30, 2024, yielded 21 studies. Mean differences in sleep-related variables between the treatment and the placebo group were considered as study outcomes. Dose-response curves and meta-regression models were fitted to test the effect of treatment-related parameters. Melatonin significantly reduced Sleep onset latency and increased Sleep efficiency and Total sleep time. Sleep onset latency reduction was associated with an advancement in the time between administration with respect to bedtime, while increased Sleep efficiency and Total sleep time with longer treatment durations. Melatonin reached the maximal efficacy between 2 and 4 mg/day. Our results suggest a dose and time of administration that may enhance melatonin's sleep promoting effects (2–4 mg, 3 h before bedtime) and, if replicated by large clinical trials, could guide clinical practice in managing sleep disturbances in children experiencing neuropsychiatric conditions.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102158"},"PeriodicalIF":9.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-30DOI: 10.1016/j.smrv.2025.102160
Clara Gino , Laura Adelaide Dalla Vecchia , Monica Parati , Davide Sattin , Serena Covino , Graziella Cappelletti , Alessandro Pincherle , Beatrice De Maria
Introduction
Autonomic nervous system (ANS) alteration has been acknowledged for disrupted sleep and α-synucleopaties. Since idiopathic REM sleep behavior disorder (iRBD) precedes α-synucleopaties, ANS function indices could predict conversion. Heart rate variability (HRV) analysis could better define cardiac ANS in iRBD.
This systematic review with meta-analysis purpose was to investigate the HRV indices role in differentiating iRBD and controls.
Method
Included studies (three databases screened) compare HRV indices in iRBD and controls during REM, non-REM (NREM) or wake phases. Outcomes included HRV indices in time and frequency domains. Meta-analysis performed for HRV indices computed standardized mean difference with 95 % confidence intervals.
Results
The 22 included studies had unbalanced age groups, mostly composed of males. An overall lower HRV and cardiac vagal modulation emerged in iRBD. Almost all studies evaluated HRV parameters only during wakefulness and most of those separated NREM and REM phases, better highlighting differences between iRBD and controls.
Conclusion
Results suggest an overall reduced HRV and cardiac vagal modulation in iRBD patients. Furthermore, separated analysis of the different sleep stages better differentiate subjects with iRBD.
Further longitudinal studies on larger populations would reach more conclusions defining relationships between HRV and neurodegenerative diseases in prodromic stages.
{"title":"Role of heart rate variability analysis in differentiating patients with idiopathic REM sleep behaviour disorders from healthy subjects. A systematic review with meta-analysis","authors":"Clara Gino , Laura Adelaide Dalla Vecchia , Monica Parati , Davide Sattin , Serena Covino , Graziella Cappelletti , Alessandro Pincherle , Beatrice De Maria","doi":"10.1016/j.smrv.2025.102160","DOIUrl":"10.1016/j.smrv.2025.102160","url":null,"abstract":"<div><h3>Introduction</h3><div>Autonomic nervous system (ANS) alteration has been acknowledged for disrupted sleep and α-synucleopaties. Since idiopathic REM sleep behavior disorder (iRBD) precedes α-synucleopaties, ANS function indices could predict conversion. Heart rate variability (HRV) analysis could better define cardiac ANS in iRBD.</div><div>This systematic review with meta-analysis purpose was to investigate the HRV indices role in differentiating iRBD and controls.</div></div><div><h3>Method</h3><div>Included studies (three databases screened) compare HRV indices in iRBD and controls during REM, non-REM (NREM) or wake phases. Outcomes included HRV indices in time and frequency domains. Meta-analysis performed for HRV indices computed standardized mean difference with 95 % confidence intervals.</div></div><div><h3>Results</h3><div>The 22 included studies had unbalanced age groups, mostly composed of males. An overall lower HRV and cardiac vagal modulation emerged in iRBD. Almost all studies evaluated HRV parameters only during wakefulness and most of those separated NREM and REM phases, better highlighting differences between iRBD and controls.</div></div><div><h3>Conclusion</h3><div>Results suggest an overall reduced HRV and cardiac vagal modulation in iRBD patients. Furthermore, separated analysis of the different sleep stages better differentiate subjects with iRBD.</div><div>Further longitudinal studies on larger populations would reach more conclusions defining relationships between HRV and neurodegenerative diseases in prodromic stages.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102160"},"PeriodicalIF":9.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-30DOI: 10.1016/j.smrv.2025.102161
Andrea Romigi , Valentina Franco , Egeria Scoditti , Giulia Milan , Francesco Ceriello , Diego Centonze , Sergio Garbarino
Background
Daylight Saving Time (DST) has been a subject of debate concerning its impact on human health, particularly sleep patterns and daytime sleepiness. This systematic review aims to synthesize existing research on the effects of DST on sleep quality, duration, and sleepiness, identifying gaps, and setting a future research agenda.
Methods
A comprehensive literature search was conducted across multiple databases, according to the PRISMA guidelines. The included studies were those that examined the impact of DST on sleep outcomes and daytime sleepiness in populations aged 6–85 years, using objective and subjective measures of sleep.
Results
The review analyzed 27 studies, revealing heterogeneous findings. The transition to DST was associated with adverse effects on sleep duration and quality, as well as increased sleepiness, more evident in evening chronotypes.
Conclusions
Although the transition to DST appears to negatively affect sleep patterns, particularly in spring and among evening chronotypes, definitive conclusions are hampered by methodological inconsistencies and external influences. This review highlights the need for future research employing standardized, objective measures across representative samples to elucidate the true impact of transitions to and from DST and the difference between standard time and permanent DST on sleep and daytime functioning. Addressing these gaps is crucial for informed public health policies.
{"title":"The effects of daylight saving time and clock time transitions on sleep and sleepiness: a systematic review","authors":"Andrea Romigi , Valentina Franco , Egeria Scoditti , Giulia Milan , Francesco Ceriello , Diego Centonze , Sergio Garbarino","doi":"10.1016/j.smrv.2025.102161","DOIUrl":"10.1016/j.smrv.2025.102161","url":null,"abstract":"<div><h3>Background</h3><div>Daylight Saving Time (DST) has been a subject of debate concerning its impact on human health, particularly sleep patterns and daytime sleepiness. This systematic review aims to synthesize existing research on the effects of DST on sleep quality, duration, and sleepiness, identifying gaps, and setting a future research agenda.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across multiple databases, according to the PRISMA guidelines. The included studies were those that examined the impact of DST on sleep outcomes and daytime sleepiness in populations aged 6–85 years, using objective and subjective measures of sleep.</div></div><div><h3>Results</h3><div>The review analyzed 27 studies, revealing heterogeneous findings. The transition to DST was associated with adverse effects on sleep duration and quality, as well as increased sleepiness, more evident in evening chronotypes.</div></div><div><h3>Conclusions</h3><div>Although the transition to DST appears to negatively affect sleep patterns, particularly in spring and among evening chronotypes, definitive conclusions are hampered by methodological inconsistencies and external influences. This review highlights the need for future research employing standardized, objective measures across representative samples to elucidate the true impact of transitions to and from DST and the difference between standard time and permanent DST on sleep and daytime functioning. Addressing these gaps is crucial for informed public health policies.</div></div>","PeriodicalId":49513,"journal":{"name":"Sleep Medicine Reviews","volume":"84 ","pages":"Article 102161"},"PeriodicalIF":9.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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