This study conducted a bibliometric and visualization analysis of research on stroke-related sleep disorders from 2015 to 2026. It aims to elucidate the current research landscape, identify key hotspots, and discern potential future trends within this field. We retrieved relevant publications on stroke-related sleep disorders from the Web of Science Core Collection database for the period from January 1, 2016, to December 31, 2025. Using Citespace (Version 6.2.R4), we generated and visualized knowledge maps encompassing analyses of authors, countries, institutions, keywords, co-cited references, co-cited authors, and co-cited journals. A total of 607 publications were ultimately included. The annual publication count demonstrated a general upward trend over the past decade. Publication output peaked in 2025 with a transient decline in 2019. The United States emerged as the most productive country, followed closely by China. Network analyses revealed strong collaborative relationships among countries, institutions, and authors, shaping influential research clusters represented by scholars such as Devin L. Brown and Ronald D. Chervin. Among institutions, Harvard University contributed the most publications and exhibited a notably high centrality (0.06). Keyword co-occurrence analysis identified eight major thematic clusters and 20 keywords with the strongest citation bursts, with “ischemic stroke” and “apnea” emerging as the predominant core keywords. Sleep apnea, particularly obstructive sleep apnea (OSA) and insomnia, remains the most extensively investigated sleep disorder in stroke populations. Hypertension emerged as one of the most frequent keywords among the identified influencing factors. Acute ischemic stroke represented the most common stroke type linked to sleep disturbances. Future investigations are likely to emphasize the identification of underlying pathophysiological mechanisms, systematic exploration of influencing factors, and the development of robust risk prediction models, ultimately aiming to inform clinical decision-making and improve long-term patient outcomes.
Sarcopenia, a geriatric syndrome of muscle and functional loss that increases the risks of falls and mortality, may be aggravated by sleep disturbances that impair protein synthesis and promote catabolism via inflammation. The present study aimed to investigate the association between sleep patterns, inflammatory markers, and muscle function in older adults with and without sarcopenia. This prospective controlled study included 63 older adults (> 65 years), classified into sarcopenic (ES, n = 31) and non-sarcopenic (ENS, n = 32) groups. Assessments included body composition, muscle function, inflammatory biomarkers, mood, and sleep (polysomnography, actigraphy, questionnaires). The ES showed lower handgrip strength (21.7 ± 7.6 vs. 27.6 ± 10.4 kg; p < 0.05) and poorer physical performance (SPPB: 8.8 ± 2.3 vs. 11.2 ± 1.0; p < 0.05). They presented reduced thigh extension torque (82.7 ± 35.1 vs. 113.0 ± 26.8 N·m; p < 0.05) and flexion torque (44.4 ± 23.7 vs. 53.3 ± 16.0 N·m; p < 0.05). Sleep alterations included shorter total sleep time (p < 0.05), lower sleep efficiency (p < 0.05), higher WASO (p < 0.05), and increased apnea-hypopnea index (p < 0.05). TNF-α levels were higher in ES (p < 0.05). Mood disturbances were also greater, with lower vigor (p < 0.05) and higher TMD (p < 0.05). Sarcopenic older adults exhibit muscle impairments, sleep disturbances, and increased inflammation, which may accelerate sarcopenia progression, making sleep and inflammation important targets for intervention.
Sleep bruxism (SB) is a sleep-related movement behavior characterized by rhythmic or non-rhythmic masticatory muscle activity that may contribute to tooth wear, jaw discomfort, and temporomandibular disorders. While SB is commonly assessed using polysomnography (PSG) and electromyography (EMG), daytime functional markers that predict SB intensity and phenotype remain insufficiently defined. Chewing patterns reflect neuromuscular coordination of mandibular movement and may share motor control pathways with SB-related masticatory activity. To investigate whether mandibular chewing patterns are associated with SB characteristics, including episode frequency, EMG intensity, and activity phenotype. In this clinical observational study, 120 adults underwent standardized chewing assessments with three-dimensional jaw tracking during controlled chewing tasks. Chewing patterns were classified into: (i) bilateral alternating, (ii) unilateral preferred-side, and (iii) irregular/unstable pattern. Participants then completed one-night laboratory PSG with bilateral masseter EMG and audio-video monitoring. SB characteristics were quantified as Bruxism Episode Index (BEI, episodes/hour), phenotype distribution (phasic/tonic/mixed), burst count, episode duration, peak EMG amplitude (
While chronic exposure to high-altitude hypoxia is known to impair sleep and mental health, whether these effects are sex-dependent remains unclear. This study addresses a critical gap by investigating how sex modifies the association between high-altitude hypoxia and risks of poor sleep quality, depressive symptoms, and their co-occurrence in children and adolescents. In this cross-sectional study (March–May 2024), we enrolled 1,345 long-term residents of the Shannan Tibet Autonomous Prefecture (altitude: 3,650–4,800 m) and 2,909 age-matched controls from low-altitude plains (Anhui Province, China). Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Montgomery-Asberg Depression Rating Scale (MADRS), respectively. Sex-stratified analyses and interaction metrics (RERI/AP/SI) were employed to evaluate additive and multiplicative effects. High-altitude residents exhibited significantly higher prevalence of poor sleep (24.2
Obstructive sleep apnea (OSA) is a common but underdiagnosed sleep disorder characterized by intermittent hypoxia and systemic inflammation. Soluble low-density lipoprotein receptor-related protein-1 (sLRP-1) is a multifunctional receptor involved in lipid metabolism, inflammation, and vascular regulation, potentially linking metabolic and vascular pathways to OSA pathophysiology. This case-control study included 180 adults presenting with snoring symptoms. Participants underwent overnight polysomnography (PSG) and were categorized into OSA (AHI ≥ 5/h, n = 100) and non-OSA (AHI < 5/h, n = 80) groups. Serum soluble low-density lipoprotein receptor-related protein 1 (sLRP-1) levels were measured using ELISA. Multivariable logistic regression and subgroup analyses were conducted to assess associations. Machine learning models, including XGBoost, were developed to evaluate classification performance and identify important features associated with OSA. Serum sLRP-1 levels were significantly lower in the OSA group compared to the non-OSA group (P < 0.001). Logistic regression revealed that sLRP-1 was independently and inversely associated with OSA risk (fully adjusted OR = 0.35; 95
Hypertension in obstructive sleep apnea (OSA) is incompletely explained by intermittent hypoxia and respiratory events alone. Periodic limb movements of sleep (PLMS) induce repetitive nocturnal sympathetic activation and blood pressure surges, yet their contribution to established daytime hypertension in OSA is poorly characterised. In a retrospective cohort of 60 PSG-confirmed OSA patients, participants were stratified by PLMS Index (PLMS-I) threshold of ≥ 15 events/hr. Hypertension prevalence, cardiovascular risk indices (Framingham Risk Score, FRS; Charlson Comorbidity Index, CCI), gender distribution, and polysomnographic parameters were compared between groups using chi-square, independent t-test, Mann-Whitney U test, and Spearman correlation. Binary logistic regression was performed with hypertension as the outcome variable and PLMS-I group, age, and gender as covariates. Partial Spearman correlations between PLMS-I and FRS/CCI were computed after controlling for age. Patients with PLMS-I ≥ 15/hr (n = 41) had a significantly higher hypertension prevalence than those with PLMS-I < 15/hr (n = 19): 76.7
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent upper airway obstruction during sleep and associated with important systemic health risks. Oral appliance (OA) therapy, particularly mandibular advancement devices (MADs), is an established treatment option for patients with mild to moderate OSA and for those who are unable to tolerate continuous positive airway pressure. However, in patients with dental implants, prosthodontic and biomechanical factors may influence the indication, design, retention, and safety of OA therapy. Therefore, the purpose of this review was to examine the existing literature on OA therapy in patients with OSA who have dental implants. Scopus and PubMed were searched on April 2, 2026, for English-language articles published during the predefined 20-year period from January 1, 2006, through December 31, 2025. Eligible studies described patients with OSA whose dental implants or implant-supported prostheses influenced OA therapy. Data were synthesized descriptively. Of 36 records, four studies were included: two case reports, one case series, and one finite element analysis. Most patients were edentulous. Reported approaches included implant-retained mandibular advancement appliances, overdentures worn during sleep, and biomechanical evaluation of implant-supported OAs. Benefits included improved retention and favorable sleep-related outcomes, whereas mucosal discomfort and limited long-term safety data remained concerns. Evidence remains sparse, but implant-assisted OA therapy may be feasible in carefully selected patients, especially edentulous individuals with poor conventional OA retention.
Mouth breathing (MB), a common manifestation of sleep-disordered breathing in children may induce craniofacial developmental abnormalities leading to adenoid facies. Although adenoidectomy and/or tonsillectomy (A T) represents the primary therapeutic intervention, a substantial proportion of pediatric patients exhibit residual mouth breathing postoperatively. Why a substantial subset of children exhibit residual MB remains a critical clinical question. Among the overlooked explanations for this incomplete recovery may be sensitization to airborne allergens—a hidden determinant of postoperative outcomes. This study sought to define the role of this under-investigated risk factor in the failure to resolve MB following A T. A retrospective analysis was conducted on a cohort of children who underwent A T at our hospital from June 2023 to June 2024. Incomplete lip seal during sleep was used as the diagnostic criterion for mouth breathing. Allergic rhinitis and rhinosinusitis symptoms were quantified using the Total Nasal Symptom Score (TNSS). Preoperative serum allergen screening was performed in all cases. Multivariate analyses were employed to assess associations between postoperative mouth breathing resolution and age, gender, BMI, allergen sensitization and TNSS. The study included 502 children. Residual mouth breathing was observed in 39.44
While the high prevalence and health impacts of sleep in hemodialysis patients are well-documented, there has been limited exploration of multidimensional sleep health in Chinese cohorts. This study aimed to investigate the association between multidimensional sleep health and fatigue among patients undergoing hemodialysis in China. A cross-sectional study was conducted in patients undergoing hemodialysis at a hospital in Nanjing, China. The Fatigue Scale-14 and RU_SATED 2.0 were administered to measure fatigue and sleep health, respectively. Sociodemographic and lifestyle characteristics and disease-related laboratory indices were concurrently collected. Multivariable linear regression was employed to examine the relationship between multidimensional sleep health and fatigue, with an interaction term included to assess the moderating effects of age. A total of 249 patients (69.1
We sought to estimate the prevalence of low arousal threshold (LAT) in individuals with multiple sclerosis (MS). We conducted a retrospective non-matched study of individuals with documented MS as well as non-MS controls who were diagnosed with obstructive sleep apnea (OSA). Demographic, clinical characteristics, and polysomnographic measurements were extracted from the medical records. LAT was estimated from overnight polysomnography and defined as 2 or more of the following conditions: apnea-hypopnea index (AHI) < 30 events/hour, minimum oxygen saturation > 82.5
This overview of systematic reviews aimed to compare continuous positive airway pressure and mandibular advancement devices for the treatment of obstructive sleep apnea by distinguishing objective physiological outcomes from patient-centered outcomes and critically appraising the methodological quality of the available evidence. Following PRISMA guidelines and PROSPERO registration (CRD42021268587), we systematically searched five databases to identify systematic reviews comparing continuous positive airway pressure and mandibular advancement devices in obstructive sleep apnea based on a PICO framework. The outcomes of interest included the Apnea–Hypopnea Index, oxygen desaturation index, treatment adherence, and quality of life. Methodological quality was assessed using AMSTAR-2, and overlap among reviews was evaluated using a citation matrix and the corrected covered area. Fourteen systematic reviews were included. CPAP demonstrated greater efficacy than mandibular advancement devices in improving objective physiological outcomes, particularly the apnea–hypopnea index and oxygen desaturation indices. Both therapies showed comparable effects on daytime sleepiness, while some reviews reported better treatment adherence and more favorable patient-centered outcomes with MADs. Methodological quality was limited: no review was classified as high quality, and most were assessed as low or critically low quality. Analysis of the corrected coverage area indicated a high overlap between the primary studies included in the different reviews. Continuous positive airway pressure is more effective than mandibular advancement devices in improving the apnea–hypopnea index and oxygen desaturation index. However, mandibular advancement devices were associated with positive effects on quality of life and sleep, though certainty regarding the sustainability of these outcomes and their long-term efficacy remains limited in the current literature. Treatment choice should be individualized, and evidence should be interpreted with caution due to methodological limitations and the high overlap between the included systematic reviews. CRD2021268587.
Primary aldosteronism (PA) is frequently accompanied by sleep-disordered breathing, yet the physiological consequences of nocturnal hypoxemia in this population remain poorly understood. Although intermittent hypoxemia is known to activate both the sympathetic nervous system and the renin–angiotensin–aldosterone system in obstructive sleep apnea, whether these responses are preserved in PA, where plasma renin activity (PRA) is chronically suppressed, remains unclear. We investigated the associations between nocturnal hypoxemic burden and autonomic, hormonal, and cardiac markers in patients with PA. Fifty consecutive patients with PA underwent overnight portable sleep monitoring. Nocturnal hypoxemia was assessed using the 3
To investigate whether the functional catechol-O-methyltransferase (COMT) rs4680 polymorphism is related to a predicted low respiratory arousal threshold (LAT) phenotype in adults with polysomnography-confirmed obstructive sleep apnea (OSA), and to assess selected dopaminergic pathway-related polymorphisms. In this prospective observational study, 144 adults with OSA underwent polysomnography. LAT was estimated non-invasively using the Edwards criteria based on apnea-hypopnea index < 30 events/h, nadir oxygen saturation > 82.5
To determine the prevalence of restless genital syndrome (RGS) among pregnant women presenting with vaginal discharge or genital complaints and to evaluate the association between RGS and levels of anxiety and depression. The reported prevalence reflects a symptom-based clinical subgroup rather than that of the general pregnant population. This cross-sectional, questionnaire-based study included 305 pregnant women who presented at the Obstetrics Outpatient Clinic with vaginal discharge or other genital complaints during the second or third trimester of pregnancy. Sociodemographic characteristics were recorded, and all participants completed the Restless Genital Syndrome diagnostic questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). RGS symptoms were identified in 140 (45.9
This study aimed to evaluate the relationship between lung volume and apnea-hypopnea index (AHI) in patients with overlap syndrome (OVS). Chronic obstructive pulmonary disease (COPD) patients diagnosed by spirometry were recruited from Renmin Hospital of Wuhan University. They were asked to take an overnight polysomnography (PSG). Multiple regression analyses were used to assess the relationships between lung volume measures and AHI in OVS patients. Finally, 354 OVS patients and 229 patients with only COPD met the study’s entry criteria. After adjusting for age, sex, BMI, neck size, economic status, smoking, alcohol use, and hypertension, residual volume (RV), total lung capacity (TLC), and the RV/TLC ratio each had a negative link with the AHI in OVS patients (RV: exp(β) = 0.903; 95
Obstructive sleep apnea (OSA) commonly coexists with Restless Legs Syndrome (RLS). Positive Airway Pressure (PAP) treatment for coexisting OSA may alleviate RLS symptoms. However, RLS often contributes to insomnia, leading to difficulties with sleep initiation and maintenance that may compromise PAP adherence. Objective long-term adherence data in patients with comorbid RLS and OSA remains limited. This study evaluated PAP therapy adherence and its determinants in patients with comorbid RLS and OSA. This retrospective cohort study included patients with RLS who reported snoring and underwent overnight polysomnography (PSG) from Jan 2022 to July 2024, at the Division of Sleep Medicine in the Peking University People’s Hospital. Clinical features and objective PAP adherence were collected. And factors influencing adherence were assessed through semi-structured interviews. Patients were followed up 1 year after PAP initiation. Good adherence was defined as device use for ≥ 4 h/night on ≥ 70
Obstructive sleep apnea (OSA) is closely associated with obesity and fluid retention. Our previous study suggested that, in patients with heart failure, the sodium-glucose cotransporter 2 inhibitor, tofogliflozin, promotes diuresis and weight loss and improves OSA severity. However, whether changes in the apnea-hypopnea index (AHI) are chronologically associated with body composition parameters remains unclear. We enrolled 10 patients (six men) with OSA. They received tofogliflozin (20 mg) daily for 6 months. The AHI was assessed using WatchPAT® at baseline, 3, and 6 months. Body composition, including water content and fat mass, was also measured. AHI changes measured using the WatchPAT peripheral arterial tonometry-derived AHI (pAHI) and their correlations with changes in body composition parameters were analyzed. Tofogliflozin administration significantly reduced pAHIs at 3 and 6 months compared to baseline, but more at 3 months, whereas body weight and body water content decreased over time. The
Obstructive sleep apnea (OSA) is a known risk factor for coronary artery disease (CAD), but its phenotypic variations and their impact on cardiovascular risk remain unclear. Recent studies suggest that a high periodic limb movement index (PLMI) and a high arousal index OSA phenotype may contribute to cardiovascular disease. This study aims to assess the association between this phenotype and CAD in patients undergoing preprocedural screening for coronary artery bypass grafting (CABG). This case-comparison study analyzed a prospective adult patient group undergoing polysomnography before CABG, compared to an age- and gender-matched retrospective group undergoing polysomnography for employment screening. Sleep parameters, including PLMI, arousal index, apnea-hypopnea index (AHI), and sleep onset latency, were assessed. Statistical analysis, including chi-square tests, Fisher’s exact test, and multivariable logistic regression, was conducted to evaluate associations between sleep disturbances and CAD. CAD patients had significant differences in the amount of abnormal PLMI, arousal index, and AHI values compared to the non-CAD group (p = 0.0002, p = 0.002, and p = 0.015, respectively). Multivariable regression identified high PLMI and arousal index as the strongest associations of CAD. A high PLMI/high arousal index OSA phenotype may increase cardiovascular risk. Identifying high-risk OSA phenotypes could improve early CAD screening and intervention strategies. Further research is needed to explore underlying mechanisms. Created in BioRender. Dardir, H. (2025) https://BioRender.com/9ifvxgl .
The aim of this clinical study was to investigate the effects of functional treatment with twin block (TB) and Herbst appliances on sleep quality. A total of 46 patients having mandibular retrognathia and identified with OSA were divided randomly into two groups: Twin Block (TB) and Herbst appliances. Changes in sleep parameters (apnoea-hypopnea index (AHI), supine AHI, oxygen desaturation index (ODI), minimum oxygen saturation) at baseline (B/L) and an average of 8-month follow-up (F/U) detected by polygraphy and Pittsburgh Sleep Quality Index (PSQI) were the primary outcomes. Treatment of the mandibular retrognathia was the secondary outcome. Shapiro Wilk test and Q-Q graphs were used to evaluate the distribution of variables according to groups, Mann Whitney U test was used to evaluate the two independent group means of measurements. Paired sample t test was used to evaluate the differences between the B/L and F/U times at p < 0.05 significance level. Among 46 patients randomized, AHI changed from B/L to F/U in Herbst group statistically significant (1.08 (-0.47–2.63), p = 0.031). While the change from B/L to F/U in the supine AHI was significant in Herbst group (3.29 (-0.20–6.78), 95
Obstructive Sleep Apnoea (OSA) is a common, yet underdiagnosed disorder, with significant health implications. Continuous positive airway pressure (CPAP) remains the reference standard and first-line therapy. However, successful CPAP usage is influenced by factors such as access, cost, tolerance, patient education, early troubleshooting, and long-term adherence, all of which can be challenging and resource-demanding. Adding therapeutic options to the armamentarium is therefore welcome. There is a need for clinicians to be abreast of all the available therapeutic options for treatment of OSA. We conducted an extensive literature review of the published studies that were conducted using non-CPAP pharmacotherapeutic modalities for OSA.Results: This narrative review summarises the current landscape of OSA pharmacotherapy, focusing on mechanisms of action, clinical trial evidence, and endotype-based selection strategies. Emerging therapies such as the atomoxetine–oxybutynin combination and topiramate show promise in reducing severity of OSA, and improving sleep quality. GLP-1 receptor agonists like liraglutide and tirzepatide offer benefits beyond reducing the severity of OSA. Other agents such as sulthiame, solriamfetol, and pitolisant have also demonstrated efficacy. Wake-promoting agents like modafinil and armodafinil target the commonest symptom of OSA, sleepiness. This review provides a practical, endotype-aligned summary of pharmacologic options for the management of OSA.
