Objective:To systematically map the patient journey and identify unmet needs in children with adenoid hypertrophy and their caregivers. Methods:A qualitative study using in-depth interviews with 25 caregivers of children aged 3-9 years was conducted. Adenoid hypertrophy was confirmed by nasoendoscopy (≥70% obstruction) and/or polysomnography (OAHI >1 event/hour). Data were analyzed through reflexive thematic analysis to construct a comprehensive journey map. The emotional curve was derived qualitatively from caregiver narratives as a heuristic visualization of emotional trajectories across care stages, not as a quantitative measure. Results:Analysis revealed two distinct emotional trajectories: surgical path caregivers experienced a post-discharge crisis due to support vacuum, while conservative path caregivers endured persistent anxiety from efficacy uncertainty. We identified both pathway-specific needs (post-discharge support, efficacy feedback) and cross-cutting needs (proactive information, holistic habit guidance). Conclusion:This journey mapping provides an evidence-based framework for developing targeted interventions to inform caregiver education, discharge planning, follow-up strategies, and multidisciplinary care pathways, addressing critical system failures and enhancing patient-centered care in pediatric adenoid hypertrophy.
Carlos Mas Bermejo,1,2 Carlos Mas Gómez,2 Luis-Alberto Bravo-González31Faculty of Dentistry, University of Murcia, Murcia, Spain; 2Dr. C. Mas Bermejo Centre for Integrated Adult Dentistry, Murcia, Spain; 3Orthodontics Docent Unit, University Dental Clinic, University of Murcia, Murcia, SpainCorrespondence: Carlos Mas Bermejo, Faculty of Dentistry, University of Murcia, Murcia, Spain, Email cmasbmac@mac.comBackground: Patients with cancer frequently experience sleep-related symptoms and physiological disturbances that may be associated with sleep-disordered breathing (SDB) and nocturnal hypoxia. Although these conditions have attracted increasing attention in oncology, the potential contribution of craniofacial restriction and upper airway dysfunction remains insufficiently recognized in routine clinical practice.Objective: To propose a stomatological and upper airway assessment framework for the identification of anatomical factors that may contribute to sleep-disordered breathing and nocturnal hypoxia in adults with cancer.Methods: This narrative review integrates current evidence on sleep-disordered breathing, nocturnal hypoxia, craniofacial development, and upper airway dysfunction. The proposed framework was developed from recurrent clinical observations in adults with cancer together with a narrative synthesis of the available literature, with emphasis on anatomical findings identifiable during routine stomatological examination.Main Findings: Current evidence indicates that anatomical features such as maxillary constriction, nasal airway narrowing, altered craniofacial development, and ankyloglossia may contribute to upper airway dysfunction and nocturnal hypoxia. Despite increasing recognition of the systemic consequences of nocturnal hypoxia, these upstream anatomical factors are rarely incorporated into routine oncological assessment. Based on the available evidence, a practical clinical framework is proposed to facilitate early identification of patients who may benefit from further respiratory evaluation.Conclusion: Integrating stomatological and upper airway assessment into the multidisciplinary evaluation of adults with cancer may improve recognition of previously unrecognized sleep-disordered breathing and nocturnal hypoxia. This framework provides a clinically applicable approach for identifying potentially modifiable anatomical contributors to respiratory dysfunction and may support future research evaluating their relevance in supportive cancer care.Keywords: sleep-disordered breathing, nocturnal hypoxia, obstructive sleep apnea, craniofacial abnormalities, upper airway dysfunction, cancer, hypoxic burden, stomatological assessment
Kerk L Phillips,1 Mark H Showalter,2 Eric R Eide,2 James H Cardon21Independent Researcher, Salt Lake City, UT, USA; 2Department of Economics, Brigham Young University, Provo, UT, USACorrespondence: Eric R Eide, Department of Economics, Brigham Young University, 2120 WVB, Provo, UT, 84602, USA, Email eide@byu.eduBackground: Sleep in wild animals reflects both physiological regulation and ecological demands. Nesting chinstrap penguins exhibit extreme sleep fragmentation, obtaining substantial sleep through thousands of brief microsleep episodes while maintaining vigilance.Objective: To examine whether a dynamic model integrating sleep regulation with ecological trade-offs can account for the fragmented sleep patterns observed in nesting chinstrap penguins.Methods: We adapted a dynamic model of sleep choice in which an animal switches between sleep and wakefulness on the basis of homeostatic sleep pressure, circadian alignment, switching costs, and stochastic waking opportunities. The model was calibrated to published sleep data from 14 nesting chinstrap penguins using five simulated moments: average hours of sleep per day, the standard deviation of hours of sleep per day, the number of sleep events, the maximum sleep duration, and the percentage of sleep durations less than 10 seconds.Results: The model reproduced several key qualitative features of penguin sleep. Simulated sleep episodes were very short, with an average duration of 2.774 seconds compared with 3.91 seconds in the observed data. The model also generated frequent transitions between sleep and wake, closely matching the observed number of daily sleep events and reproducing the maximum observed sleep duration. However, it underestimated total sleep time and produced a larger share of very short episodes than observed in the data. Estimated parameters implied minimal switching costs, rapid homeostatic adjustment over seconds-long bouts, and a strong relative weight on sleep utility within the fitted model.Conclusion: A dynamic optimization framework can capture important qualitative features of fragmented sleep in nesting chinstrap penguins. The findings suggest that microsleeps may reflect adaptive trade-offs between restorative sleep and wakeful activity under ecological constraint. Because the model treats sleep as a binary behavioral state, it does not distinguish unihemispheric from bihemispheric slow-wave sleep. We therefore interpret the model primarily as a model of microsleep timing and fragmentation rather than as a complete model of penguin sleep architecture or fragmented sleep across wild animals.Keywords: sleep, opportunity cost, dynamic models
Rahaf A Jereisat, Hala Qaryouti, Hakam Alsawalha, Alfred Maksoud, Yazan AbdeenInternal Medicine Department, University of Houston/ HCA Healthcare Clear Lake, Houston, TX, USACorrespondence: Rahaf A Jereisat, University of Houston/ HCA Healthcare Clear Lake, Houston, TX, USA, Email rahafjreisat@gmail.comIntroduction: Obstructive sleep apnea is a risk factor for cardiovascular diseases. Positional sleep apnea is a subtype of obstructive sleep apnea where severity is influenced by the patient’s sleeping position. Previous studies have compared supine to non-supine positions; the effect of right lateral versus left lateral position remains in question. Our objective is to study and compare the severity of obstructive sleep apnea across different sleeping positions.Methods: We conducted a retrospective, single-centered study on 338 adult patients (age ≥ 18 years) diagnosed with Obstructive Sleep Apnea on home sleep study test in the time period between January 2023 and January 2025 in an outpatient community clinic. Linear mixed-effects models were used for statistical analyses.Results: The mean age of the participants was 55.29 years, with an average AHI of 29.54. Supine position was associated with a higher AHI than prone position (Adjusted model SE= 1.06, p=0.001). However, there were no significant differences between left and right positions across different patients (p =0.327) nor within the same patient (SE 1.31, P 0.65). Comparing sleep positions that were observed more than 20% of the time showed that supine positioning was associated with a significantly higher AHI than right-lateral positioning (CI 15.08– 20.61; P< 0.001) and left-lateral positioning (95% CI 14.49– 20.23; P< 0.001). No significant difference was identified between left- and right-lateral positioning (95% CI − 2.64 to 3.61; P=0.762).Conclusion: There was no statistically significant difference between right lateral and left lateral positions on sleep apnea severity, whereas supine position had the highest AHI in comparison to all sleeping positions. Positional therapy remains a valid option for patients with supine‑predominant OSA. Further large scale studies are recommended to compare the true nature and severity of sleep apnea of each sleeping position.Keywords: Home sleep study, positional apnea, obstructive sleep apnea
Hsiao-Yen Wu,1,2 Pey-Ling Shieh,1,3 Yen-Chun Liu41Department of Psychology, Chung Shan Medical University, Taichung City, 402306, Taiwan; 2Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, 333423, Taiwan; 3Department of Psychiatry, Chung Shan Medical University Hospital, Taichung City, 402306, Taiwan; 4Department of Psychology and Counseling, National Taipei University of Education, Taipei City, 106320, TaiwanCorrespondence: Pey-Ling Shieh, Department of Psychology, Chung Shan Medical University, No. 110, Section 1, Jianguo North Road, South District, Taichung City, 402306, Taiwan, Tel +886-4-24730022#12376, Email peylings@gmail.comBackground and Aims: Toddler sleep is more consolidated than infant sleep and may better reflect long-term sleep regulation. Despite growing interest in maternal mental health, evidence linking maternal depression to toddler sleep remains limited. Moreover, sleep parenting practices may shape this relationship. This study aimed to examine the status of maternal depression, toddler sleep, and sleep parenting practices, as well as the moderating role of these practices in the association between maternal depression and toddler sleep.Methods: This research employed a cross-sectional design conducted between November 2022 and March 2023 among mothers of toddlers in Taiwan. A total of 126 mothers of toddlers aged 1 to 3 years completed an online survey. The mean age of mothers was 33.01 years (SD = 4.33), and the mean age of toddlers was 1.79 years (SD = 0.58). Maternal depression was assessed using the Beck Depression Inventory-II (BDI-II, Beck, 1996). Toddler sleep was measured using the Brief Infant Sleep Questionnaire-Reviesd (Mindell et al, 2019), including four indicators: maternal perceived sleep problem, sleep latency, number of nocturnal awakenings, and nighttime sleep duration. Two sleep parenting practices were assessed: co-sleeping (co-sleep vs not co-sleep) and consistency of sleep routines. Data were analyzed using descriptive statistics, group comparisons, correlation analyses, and multiple regression analyses.Results: Approximately 33.3% of mothers exhibited depressive tendencies (BDI-II > 13). Most toddlers had nighttime sleep duration shorter than 12 hours (91.3%). Around half of the toddlers had sleep latency longer than 45 minutes (50.8%), 34.9% experienced at least two nocturnal awakenings, and 11.9% were reported to have sleep problem. Co-sleep was reported by 51.6% of mothers, and 45.2% had low consistency in their sleep routines (≤ 5 nights/week). After controlling for child health status, maternal income, and education level, higher maternal depressive symptoms were associated with greater toddler sleep problem severity and longer sleep latency (Bs = 0.02 and 0.87, ps < 0.05 and 0.01, respectively). Co-sleep moderated the association between maternal depression and toddler sleep problem (B = − 0.05, p < 0.05). Simple slope analyses indicated that higher maternal depression was associated with more severe toddler sleep problem in the co-sleep group (B = 0.05, p < 0.01), but not in the not co-sleep group (B = 0.00, p > 0.05). No moderating effect was found for sleep routine consistency.Conclusion: Maternal depression is associated with more severe sleep problem and longer sleep latency in toddlers. Co-sleep may amplify the spillover associations of maternal depression on toddler sleep. For mothers with elevated depressive symptoms, encouraging separate sleeping arrangements may help buffer the association between maternal depression and maternal perceived toddler sleep problem. Further studies to validate these findings are warranted.Keywords: bedtime routine consistency, co-sleep, maternal depression, moderation, sleep parenting practices, toddler sleep
Insomnia disorder is increasingly linked to abnormalities in resting-state functional connectivity (rsFC). We systematically synthesized rs-fMRI studies published from January 2020 to July 2025 to characterize disorder-related connectivity patterns and methodological limitations. Twenty-four study reports met the eligibility criteria; reported sample sizes summed to 1,229 participants with insomnia disorder and 1,077 healthy controls, although some cohorts may overlap across publications. Alterations involved the default mode, salience, executive-control, emotion, and sensorimotor systems and sleep-wake regulatory hubs, including the thalamus and hypothalamus. The overall pattern is compatible with hyperarousal, but both increased and decreased connectivity were reported; diagnostic definitions, sex, symptom severity and duration, medication exposure, acquisition conditions, and seed-based versus data-driven analyses may moderate direction and magnitude. A formal study-level appraisal with the JBI analytical cross-sectional checklist identified predominantly low risk or some concerns, most often related to confounding control. Because all included comparisons were cross-sectional, rsFC alterations cannot be interpreted as causes rather than consequences or correlates of insomnia. Methodological heterogeneity precluded quantitative pooling. Standardized phenotyping, medication control, acquisition and preprocessing, preregistered longitudinal studies, and external validation are required before connectivity markers can be used clinically.
Sleep disorders are increasingly prevalent clinical conditions that significantly impair physical and mental health. Given the observed limitations of pharmacological therapies, there has been increasing research interest in effective non-pharmacological interventions. Vagus nerve stimulation (VNS), including invasive VNS and non-invasive methods such as transcutaneous auricular VNS (taVNS), has emerged as a promising neuromodulatory strategy. This review summarizes current evidence on VNS for insomnia, central hypersomnia, restless legs syndrome, and sleep-related breathing disorders, highlighting both clinical findings and proposed mechanisms. Relevant literature was identified through searches of PubMed and Web of Science up to May 2026 using terms related to VNS (eg, "vagus nerve stimulation" and "taVNS") and sleep disorders (eg, "insomnia", "narcolepsy", "hypersomnia", and "sleep-related breathing/movement disorders"). The proposed mechanisms include multilevel regulation of sleep-wake neural pathways; immunomodulation via anti-inflammatory pathways; inhibition of cortical spreading depression; and enhancement of neuroplasticity, cerebral blood flow, and blood-brain barrier integrity. Finally, we discuss key challenges regarding inter-individual variability and stimulation parameter optimization, as well as outline future directions centered on precision neuromodulation. These include the development of intelligent closed‑loop stimulation systems (ie, devices that automatically adjust stimulation parameters based on real time physiological feedback) and the testing of state dependent neuromodulation hypotheses. Taken together, this review not only summarizes current evidence but also proposes a theoretical framework and translational perspective to inform future research and clinical applications.
Shidi Xu,1,* Xiaoyan Feng,2,* Minjuan Yu,1 Tianhong Xu,1 Zhenzhen Pan,1 Ling Li11Department of Respiratory Medicine, Affiliated Children’s Hospital of Jiangnan University (Wuxi Children’s Hospital), Wuxi, Jiangsu, People’s Republic of China; 2Nursing Department, Affiliated Children’s Hospital of Jiangnan University (Wuxi Children’s Hospital), Wuxi, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ling Li, Department of Respiratory Medicine, Affiliated Children’s Hospital of Jiangnan University (Wuxi Children’s Hospital), Wuxi, Jiangsu, 214023, People’s Republic of China, Email liling@njmu.edu.cn Zhenzhen Pan, Department of Respiratory Medicine, Affiliated Children’s Hospital of Jiangnan University (Wuxi Children’s Hospital), Wuxi, Jiangsu, 214023, People’s Republic of China, Email 834312855@qq.comObjective: To systematically map the patient journey and identify unmet needs in children with adenoid hypertrophy and their caregivers.Methods: A qualitative study using in-depth interviews with 25 caregivers of children aged 3– 9 years was conducted. Adenoid hypertrophy was confirmed by nasoendoscopy (≥ 70% obstruction) and/or polysomnography (OAHI > 1 event/hour). Data were analyzed through reflexive thematic analysis to construct a comprehensive journey map. The emotional curve was derived qualitatively from caregiver narratives as a heuristic visualization of emotional trajectories across care stages, not as a quantitative measure.Results: Analysis revealed two distinct emotional trajectories: surgical path caregivers experienced a post-discharge crisis due to support vacuum, while conservative path caregivers endured persistent anxiety from efficacy uncertainty. We identified both pathway-specific needs (post-discharge support, efficacy feedback) and cross-cutting needs (proactive information, holistic habit guidance).Conclusion: This journey mapping provides an evidence-based framework for developing targeted interventions to inform caregiver education, discharge planning, follow-up strategies, and multidisciplinary care pathways, addressing critical system failures and enhancing patient-centered care in pediatric adenoid hypertrophy.Keywords: adenoid hypertrophy, sleep-disordered breathing, patient journey mapping, qualitative research, unmet needs, caregiver experience
Study Objectives:Obstructive sleep apnea (OSA) is prevalent among professional drivers and is associated with an increased risk of aberrant driving behaviors (ADBs). This study evaluated and compared the effectiveness of continuous positive airway pressure (CPAP) and conservative treatments in mitigating ADBs and improving sleep health among urban taxi drivers. Methods:In this prospective non-randomized comparative study, taxi drivers diagnosed with OSA through polysomnography were assigned to either the CPAP group or the conservative treatment group. Home-based sleep parameters (oxygen desaturation index [ODI], cyclic variation of the heart rate index [CVHRI], and chest effort index [CEI]) were measured using wearable devices. Driving data were recorded with a validated navigation application. Subjective measures such as Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the 27-item Driving Behavior Questionnaire (DBQ) were also collected. Pre- and post treatment outcomes were compared within and between groups using non-parametric statistical tests following the 3-month treatment. Results:Twenty-four taxi drivers were enrolled, with 13 in the CPAP group and 11 in the conservative treatment group. CPAP treatment significantly improved objective and subjective measures of sleep health and driving performance, evidenced by decreases in PSQI (p=0.04), ESS (p=0.01), and DBQ errors (p<0.01) and lapses (p=0.03). Additionally, the occurrence of ADBs per 20 km decreased (p<0.01), and sleep disorder indices improved (ODI, p<0.01; CEI, p=0.03). Conclusion:The conservative treatment group showed no significant changes in these measures. CPAP demonstrated its potential as a primary intervention for occupational drivers with severe OSA. Conservative treatment showed limited effectiveness and could serve as a supplementary approach.
Introduction:Middle Eastern and North African (MENA) populations face a high burden of metabolic syndrome; however, the potential associations between poor sleep and adiposity remain unexplored in these groups. To address this gap, the present systematic review evaluated the correlations between sleep duration, sleep quality, sleep disorders (specifically, obstructive sleep apnea [OSA] and insomnia) and markers of adiposity. Unlike Western cohorts, MENA populations may exhibit distinct circadian-dietary phenotypes shaped by nighttime social engagement and religiously driven sleep fragmentation. Methods:We conducted a systematic search of the literature on April 2, 2025, across four databases: PubMed, Scopus, Web of Science, and Embase. Data were synthesized narratively because of heterogeneity in study designs and outcome measures. Results:Our screening identified 517 studies, of which 10 (primarily cross-sectional) met the inclusion criteria. Poor sleep quality was disproportionately prevalent in women (up to 77% vs 49% in men). Subjective sleep duration (<6-7 hours) was associated with higher odds of excessive weight (OR=1.55-1.60), whereas actigraphy-verified sleep metrics were inversely correlated with BMI. Insomnia symptoms or disorders were observed in up to 50% of women and 35% of men, although no significant associations were found between insomnia and adiposity measures. OSA prevalence ranged from 6.1% in general population samples to 71% in clinical cohorts. Severe OSA was driven by increased neck circumference (OR=1.26, 95% CI: 1.09, 1.45) and waist circumference (OR=1.06, 95% CI: 1.02, 1.10). Sex-specific associations remain uncertain, as only a few of the included studies conducted stratified analyses. Conclusion:Cross-sectional associations between poor sleep and markers of adiposity have been observed, although the sparse literature and lack of longitudinal, objective data preclude any causal inferences. Whether MENA women are more vulnerable than men to poor sleep and subsequent adiposity remains unknown, but this is plausible considering their disproportionate obesity rates. The synthesis of current evidence exposes literature gaps that necessitate longitudinal research to clarify the magnitude and directionality of these metabolic risks.
Background:Sleep disorders are highly prevalent among middle-aged and older adults and represent a crucial modifiable risk factor for cognitive decline. Impaired brain waste clearance is hypothesized to underlie this association, but clinical evidence remains limited. We utilized global blood-oxygen-level-dependent and cerebrospinal fluid (gBOLD-CSF) coupling as a non-invasive macro-scale surrogate of fluid clearance dynamics to investigate its associations across distinct clinical phenotypes, including obstructive sleep apnea (OSA), insomnia, and comorbid insomnia and sleep apnea (COMISsA) and to delineate how objective respiratory metrics and subjective insomnia severity differentially relate to domain-specific cognitive impairment. Methods:A total of 143 adults were enrolled and categosrized into four groups: healthy controls (HCs, n = 30), obstructive sleep apnea (OSA, n = 46), insomnia (n = 32), and comorbid insomnia and sleep apnea (COMISA, n = 35). Participants underwent home sleep apnea testing, comprehensive neuropsychological assessments, and 3.0 T magnetic resonance imaging. gBOLD-CSF coupling strength was quantified by computing the peak negative cross-correlation between the global cortical BOLD signal and the signal extracted from the CSF regions at the bottom slice of the fMRI acquisition. Results:Compared with HCs, individuals with sleep disorders exhibited significantly reduced gBOLD-CSF coupling strength (all Bonferroni-corrected p < 0.05). This attenuation correlated with advancing age (r = 0.185, p = 0.027) and greater global sleep disturbances (as indexed by higher PSQI total scores, r = 0.261, FDR-corrected p = 0.012). Using the entropy balancing (EBAL) weighted dataset, structural equation modeling revealed that in participants with sleep apnea (OSA and COMISA), reduced gBOLD-CSF coupling strength statistically mediated the relationship between nocturnal hypoxia and episodic memory deficits. Specifically, elevated apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and the percentage of total sleep time with oxygen saturation below 90% (T90) were associated with a positive shift in coupling values toward zero (all a coefficients > 0, p < 0.05), representing weakened glymphatic coupling strength. This diminished coupling, in turn, predicted poorer delayed episodic memory (AVLT-20 min delayed recall; indirect effects: AHI, -0.029; ODI, -0.079; T90, -0.111). Notably, the direct effects of these hypoxic parameters on memory consolidation were non-significant. In contrast, no significant glymphatic mediation pathways were identified for the insomnia-executive function model, even after adjusting for depressive burden. Conclusion:In summary, gBOLD-CSF coupling characteristically tracks distinct sleep disorder subtypes, showing significant reductions in middle-aged and older adults with OSA, insomnia, and COMISA. Our findings suggest that respiratory event-related hypoxic stress is associated with increased susceptibility to delayed episodic memory deficits in relation to glymphatic impairment, highlighting that cross-disciplinary sleep interventions may represent a promising strategy for preserving brain clearance and mitigating cognitive aging.
Yani Zhang,1,* Yiwen Zhang,2,* Caili Shi,1 Tian Wang,1 Rong Xian,1 Dongdong Wu,1 Shuochen Fan,1 Haijing Liu11Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China; 2First Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Haijing Liu, Second Clinical Medical College, Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China, Tel +86-18088441816, Email 619198938@qq.comAbstract: Insomnia disorder is increasingly linked to abnormalities in resting-state functional connectivity (rsFC). We systematically synthesized rs-fMRI studies published from January 2020 to July 2025 to characterize disorder-related connectivity patterns and methodological limitations. Twenty-four study reports met the eligibility criteria; reported sample sizes summed to 1,229 participants with insomnia disorder and 1,077 healthy controls, although some cohorts may overlap across publications. Alterations involved the default mode, salience, executive-control, emotion, and sensorimotor systems and sleep–wake regulatory hubs, including the thalamus and hypothalamus. The overall pattern is compatible with hyperarousal, but both increased and decreased connectivity were reported; diagnostic definitions, sex, symptom severity and duration, medication exposure, acquisition conditions, and seed-based versus data-driven analyses may moderate direction and magnitude. A formal study-level appraisal with the JBI analytical cross-sectional checklist identified predominantly low risk or some concerns, most often related to confounding control. Because all included comparisons were cross-sectional, rsFC alterations cannot be interpreted as causes rather than consequences or correlates of insomnia. Methodological heterogeneity precluded quantitative pooling. Standardized phenotyping, medication control, acquisition and preprocessing, preregistered longitudinal studies, and external validation are required before connectivity markers can be used clinically.Keywords: insomnia disorder, resting-state fMRI, functional connectivity, brain networks, hyperarousal, systematic review
Plamen Bokov,1 Benjamin Dudoignon,2 Amina Baydoun,3 Jacques Dahan,4 Philippe Amat,5 Fayrouz Sghaier,4 Imene Boujemla,6 Anne-Laure Bonnet,7 Christophe Delclaux11Service de Physiologie Pédiatrique-Centre du Sommeil, Hôpital Robert Debré, AP-HP, Université Paris Cité, INSERM NeuroDiderot, Paris, France; 2Service de Physiologie Pédiatrique-Centre du Sommeil, Hôpital Robert Debré, AP-HP, INSERM NeuroDiderot, Paris, France; 3Service de Néonatalogie, Hôpital Simone Veil, Eaubonne, France; 4Service de Stomatologie et Chirurgie maxillo-faciale, Hôpital Robert Debré, AP-HP, Paris, France; 5Cabinet d’orthodontie, Le Mans, France; 6Service de Chirurgie ORL et cervico-faciale pédiatrique, Hôpital Robert Debré, AP-HP, Paris, France; 7Unité fonctionnelle d’Odontologie Pédiatrique, Hôpital Robert Debré, AP-HP, UFR Odontologie, Université Paris Cité, Paris, UMR 1333 INSERM Oral Health, Montrouge, FranceCorrespondence: Christophe Delclaux, Service de Physiologie Pédiatrique, Hôpital Robert Debré, 48, boulevard Sérurier, Paris, 75019, France, Email christophe.delclaux@aphp.frPurpose: The ERS Statement dealing with childhood obstructive sleep apnea (OSA) declared that cephalometry and acoustic pharyngometry may be useful exams for the management of OSA. The objective of our cross-sectional study was to evaluate the correlations between the severity of OSA, namely obstructive apnea-hypopnea index (OAHI), and indices obtained from both acoustic pharyngometry and cephalometry in children referred for OSA treatment.Methods: Children referred for treatment of their moderate to severe OSA (AHI ≥ 5/hour) underwent acoustic pharyngometry in sitting and supine positions (measurement of pharyngeal volume and calculation of estimated pharyngeal compliance) and cephalometry (measurement of Frankfort Mandibular plane Angle: FMA and Frankfort Mandibular Incisal Angle: FMIA, hyoid bone distance to mandibular plane).Results: Two hundred and five consecutive children were enrolled (mean age ± SD: 11.2 ± 3.7 years, 73 females, type 1 OSA "enlarged tonsils”: 55 children, type 2 "obese”: 80, type 3 "syndromes”: 70). In a multiple regression analysis, only FMA and hyoid bone distance remained independently linked to OAHI (adjusted r2 of the model: 0.12, p< 0.001, weak explanatory power). The FMA angle allowed differentiating normodivergence (21°< FMA < 29°: 41% of the children), hyperdivergence (FMA ≥ 29°: 32%), and hypodivergence (≤ 21: 27%). The participants with hyperdivergence were younger, less obese, and had a longer lower face (adenoid facies). In a multiple regression analysis, only height and FMIA remained independently linked to pharyngeal volume (adjusted r2 of the model: 0.32, p< 0.001, moderate explanatory power).Conclusion: Childhood OSA can be associated with hypodivergence. Its severity is linked to craniofacial morphology, and cephalometry provides additional endotypic information in selected children.Keywords: obstructive sleep apnea, cephalometry, acoustic pharyngometry, childhood
Xinyi Wang,1,2,* Qingqing Sun,1,2,* Yanan Zhang,1,2 Yaru Wang,1,2 Lijia Cai,1,2 Zan Wang1,21Sleep Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People’s Republic of China; 2Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zan Wang, Sleep Center, Department of Neurology, The First Hospital of Jilin University, Xinmin Street 1#, Chang Chun, 130021, People’s Republic of China, Tel +86-0431-88782567, Email wangzan@jlu.edu.cnAbstract: Sleep disorders are increasingly prevalent clinical conditions that significantly impair physical and mental health. Given the observed limitations of pharmacological therapies, there has been increasing research interest in effective non-pharmacological interventions. Vagus nerve stimulation (VNS), including invasive VNS and non-invasive methods such as transcutaneous auricular VNS (taVNS), has emerged as a promising neuromodulatory strategy. This review summarizes current evidence on VNS for insomnia, central hypersomnia, restless legs syndrome, and sleep-related breathing disorders, highlighting both clinical findings and proposed mechanisms. Relevant literature was identified through searches of PubMed and Web of Science up to May 2026 using terms related to VNS (eg, "vagus nerve stimulation” and "taVNS”) and sleep disorders (eg, "insomnia”, "narcolepsy”, "hypersomnia”, and "sleep-related breathing/movement disorders”). The proposed mechanisms include multilevel regulation of sleep–wake neural pathways; immunomodulation via anti-inflammatory pathways; inhibition of cortical spreading depression; and enhancement of neuroplasticity, cerebral blood flow, and blood–brain barrier integrity. Finally, we discuss key challenges regarding inter-individual variability and stimulation parameter optimization, as well as outline future directions centered on precision neuromodulation. These include the development of intelligent closed‑loop stimulation systems (ie, devices that automatically adjust stimulation parameters based on real time physiological feedback) and the testing of state dependent neuromodulation hypotheses. Taken together, this review not only summarizes current evidence but also proposes a theoretical framework and translational perspective to inform future research and clinical applications.Keywords: Vagus nerve stimulation, VNS, transcutaneous auricular vagus nerve stimulation, taVNS, sleep disorders, insomnia, neuromodulation
Purpose:The dysregulation of rapid eye movement (REM) sleep is an intrinsic nature of narcolepsy. This study aimed to evaluate the performances of REM sleep-related clinical features and the parallel objective indicators for distinguishing narcolepsy type 1 (NT1) and, more specifically, narcolepsy type 2 (NT2) from patients with hypersomnias. Patients and Methods:Drug-free patients with excessive daytime sleepiness (EDS) were consecutively recruited between January 2020 and March 2023. All the patients were categorized into three groups, including NT1, NT2, and EDS controls. The REM sleep-related clinical features and REM sleep parameters were compared across these three groups. Receiver operating characteristic (ROC) analyses were applied to quantify the diagnostic performances of REM sleep-related indicators in differentiating NT1 and NT2 from patients with hypersomnias, with bootstrap resampling to stabilize cut-offs and related metrics. Results:A total of 206 patients were enrolled in this study (NT1 = 87, NT2 = 27, EDS controls = 92). In the multiple sleep latency test (MSLT), a daytime REM sleep duration of ≥ 11.91 (7.90-18.75) minutes for NT1 (AUC: 0.943 [0.908-0.974], sensitivity: 0.87 [0.76-0.95], specificity: 0.93 [0.84-1.00]) and ≥ 8.41 (3.00-12.50) minutes for NT2 (AUC: 0.922 [0.852-0.973], sensitivity: 0.90 [0.77-1.00], specificity: 0.88 [0.73-0.96]) yielded optimal differentiation from other hypersomnias. Stratified subgroup ROC analyses focusing on NT1 vs IH (AUC: 0.948 [0.897-0.986], cut-off: 12.67 [0.50-18.50] min, sensitivity: 0.85 [0.72-0.99], specificity: 0.97 [0.80-1.00]) and NT2 vs IH (AUC: 0.918 [0.819-0.986], cut-off: 7.18 [1.75-17.50] min, sensitivity: 0.89 [0.60-1.00], specificity: 0.86 [0.67-1.00]) further support the promising discriminatory potential of this marker. Additionally, ROC analyses showed high AUC values for any REM sleep without atonia (RSWA) index during MSLT in discriminating NT1 (AUC: 0.882 [0.826-0.930], cut-off value: 36.61% [3.71-71.81%], sensitivity: 0.91 [0.81-0.98], specificity: 0.80 [0.69-0.89]) and NT2 (AUC: 0.865 [0.796-0.924], cut-off value: 18.83% [7.41-43.85%], sensitivity: 0.99 [0.90-1.00], specificity: 0.75 [0.65-0.85]) from other hypersomnias. Comparable separation performance was also seen in separate NT1 vs IH (AUC: 0.885 [0.772-0.968], cut-off: 42.81% [3.71-82.58%], sensitivity: 0.86 [0.67-0.99], specificity: 0.86 [0.65-1.00]) and NT2 vs IH (AUC: 0.863 [0.701-0.974], cut-off: 20.09% [7.41-82.29%], sensitivity: 0.97 [0.71-1.00], specificity: 0.77 [0.54-1.00]) subgroup analyses. The co-occurrence of REM sleep-related symptoms of sleep paralysis, hypnagogic hallucinations, and REM sleep behavior disorder exhibited a high specificity in diagnosing patients with NT1 (AUC: 0.711 [0.647-0.773], specificity: 0.87 [0.80-0.94]). Conclusion:The daytime REM sleep duration, any RSWA in MSLT, and REM sleep-related symptoms represent promising candidate biomarkers in distinguishing between narcolepsy subtypes and other hypersomnias, with particular utility for identifying NT2.
Purpose:Obstructive sleep apnea (OSA) and hypertension are known cardiovascular risk factors, but the effect of hypertension on OSA-related left ventricular diastolic dysfunction remains unclear. Patients and Methods:This cross-sectional study enrolled 289 patients from the Second Affiliated Hospital of Fujian Medical University (January 2013-January 2023). Participants were classified as healthy controls (HC), OSA-only (OSA), hypertension only (HTN), and OSA with hypertension (OSA-HTN). Furthermore, based on the AHI (Apnea-Hypopnea Index) values, the OSA group and the OSA-HTN group were further divided into three subgroups: mild (5≤AHI<15 events/hour), moderate (15≤AHI<30 events/hour), and (AHI≥30 events/hour). Participants underwent biochemical testing, echocardiography, and polysomnography. Echocardiographic parameters of diastolic function-interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPW), left atrial volume index (LAVI), E/A ratio, and E/e' ratio-were compared among the groups. One-way analysis of variance and statistical interaction analysis evaluated the independent and interactive effects of hypertension and OSA severity on E/e'. Results:Compared with the HC group, the HTN, OSA, and OSA-HTN groups showed significantly higher IVST, LVPW, LAVI, and E/e' ratio (p<0.05), with the OSA-HTN group exhibiting the greatest impairment. The E/e' ratio increased with OSA severity and correlated positively with systolic blood pressure and diastolic blood pressure, most strongly in the OSA-HTN group. Hypertension (mean difference=-1.784, 95% CI: -2.868 to -0.701, p=0.001) and OSA severity independently affected E/e' with a significant multiplicative interaction (p<0.05). Conclusion:Both hypertension and severe obstructive sleep apnea are independently associated with impaired left ventricular diastolic function, and their coexistence may have a potential synergistic effect.
Purpose:This study aimed to evaluate the quality and reliability of social media videos addressing weight loss for OSA across three major platforms (YouTube, TikTok, Bilibili) and to identify key determinants of trustworthy content. Methods:We conducted a cross-platform content analysis of publicly available videos on weight loss for OSA from YouTube, TikTok, and Bilibili, representing major video-sharing platforms with different regional audiences and content formats. The top 100 default search results from each platform were screened using predefined criteria, yielding 235 eligible videos. Video and uploader characteristics, engagement metrics, and quality scores were extracted. Videos were assessed using PEMAT, VIQI, GQS, mDISCERN, and JAMA benchmarks. The primary outcome was overall video quality assessed by the Global Quality Score (GQS), while other assessment tools were considered secondary outcomes. For TikTok, we used English-language search terms ("obstructive sleep apnea and weight loss" and "OSA and weight loss") to capture content comparable with YouTube. The Chinese-language TikTok counterpart (Douyin) was not included because it operates under a distinct platform ecosystem with different content algorithms, regional audience, and moderation policies. Results:YouTube videos scored significantly higher in understandability, actionability, and overall quality compared with TikTok and Bilibili. Content from verified institutions and healthcare professionals consistently received higher ratings across all tools. Engagement metrics (likes, shares, comments) showed weak correlations with information quality. In regression models, production quality (VIQI) and source transparency (JAMA benchmarks) emerged as the strongest predictors of content reliability, while video duration had minimal effect. Conclusion:Within digital health environments, popular engagement does not equate to informational quality for OSA-related weight-loss content. Platform- and uploader-level characteristics-particularly verification status and production standards-are key markers of reliability. These findings underscore the need for platform-level governance that prioritizes verified health sources, algorithmic transparency, and integrated digital health literacy efforts to safeguard patients navigating lifestyle advice for OSA online.
Wenfang Zhang,1 Xuanqi Guo21Department of Sleep Medicine, Baotou Sixth Hospital; School of Mental Health, Baotou Medical College, Baotou, Inner Mongolia Autonomous Region, People’s Republic of China; 2Beijing Children’s Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Wenfang Zhang, Email Zwf159471@126.com
Background:Social jetlag is commonly attributed to externally imposed schedules that conflict with biological sleep timing. However, individuals also make daily decisions about how to allocate time between sleep and waking activities, suggesting that behavioral tradeoffs may contribute to within-week variation in sleep patterns. Objective:To examine whether weekly patterns in sleep timing and duration, including social jetlag, can emerge endogenously from the interaction of biological sleep regulation and time allocation decisions. Methods:We develop a dynamic model of sleep timing that integrates the two-process model of sleep regulation with decision-making over time use. Individuals choose sleep onset and offset each day while a stock of sleep evolves over time, determining sleep pressure. The model is calibrated to a steady-state schedule and simulated under alternative workweek structures, with and without preferences for leisure and direct, external constraints on the choice variables, such as fixed wake times and delayed sleep onset. Results:The model produces a stable weekly pattern in which individuals sleep less during the workweek and sleep longer on free days. Weekend sleep is also later, generating a workday-free-day shift in midsleep similar to the pattern commonly described as social jetlag. These patterns can arise even without imposing fixed wake times or required bedtimes, suggesting that the scarcity of discretionary time on workdays may contribute to delayed sleep and weekend recovery sleep. Adding realistic constraints, such as early weekday wake times and later weekend bedtimes, increases the size of the midsleep shift and brings the simulated pattern closer to empirical estimates of social jetlag. Conclusion:The model suggests that behavioral tradeoffs over scarce workday leisure can account for part of the weekday-free-day variation in sleep timing and duration, producing shorter workday sleep, weekend recovery sleep, and later free-day midsleep. Social jetlag may therefore reflect both externally imposed schedules and endogenous responses to the changing value of waking time across the week.
