Genetic susceptibility to obstructive sleep apnea (OSA) may vary by ancestry. We have conducted a systematic review and random-effects meta-analysis of observational studies (International Prospective Register of Systematic Reviews [PROSPERO] CRD42024548801) to test whether ancestry modifies the associations involving specific genetic polymorphisms and OSA risk and severity. We searched databases until June 2024 for studies examining variants (interleukin-6 (IL6) rs1800795, tumor necrosis factor (TNF) rs1800629, solute carrier family 6 member 4 (serotonin-transporter gene) (SLC6A4) serotonin-transporter-linked polymorphic region (5-HTTLPR)/serotonin transporter intron 2 (VNTR) (STin2), 5-hydroxytryptamine (serotonin) receptor 2A gene (HTR2A) rs9526240, leptin receptor (LEPR) rs3790435) and pooled odds ratios (ORs) with 95% confidence interval (CIs); ancestry-specific effects were explored. Five studies included 3,606 participants. The overall association showed an OR = 1.25 (95%CI: 0.85-1.86; I 2 = 76%). By ancestry, Brazilian participants of European descent demonstrated higher risk (OR = 2.80; 95%CI: 1.11-7.08), while those of West-African ancestry showed protection (OR = 0.26; 95%CI: 0.09-0.74). Genetic associations with OSA differ significantly by ancestry, supporting ancestry-informed study designs and larger multiethnic cohorts for personalized OSA management.
Video-polysomnography (VPSG) is indicated for cases of nocturnal motor behaviors, particularly rapid eye movement (REM) sleep behavior disorder (RBD), and different sleep complaints in the context of neurological disease, particularly neurodegenerative disease. In a location with limited VPSG availability, referral and poststudy diagnoses were reviewed to help create flow protocols for sleep centers in economically-disadvantaged areas. A total of 115 VPSG studies conducted at a public university-affiliated hospital in Porto Alegre, Southern Brazil, were divided into groups related to sleep complaints that were primarily motor (M; n = 54) or non-motor (NM; n = 61). Abnormal motor activity was more common in the M group, suggesting that clinical history was sensitive in identifying motor behaviors. However, while most M group referrals were related to RBD suspicion ( n = 43; 79.6%), less than half of these were confirmed ( n = 21; 48.8%). There was a high ( n = 38; 70.4%) prevalence of obstructive sleep apnea (OSA) in the M group, with 14 (25.9%) subjects fully meeting the criteria for moderate-to-severe OSA. In cases of suspected RBD ( n = 43), the rate of moderate-to-severe OSA ( n = 20; 46.5%) was nearly the same as the rate of positive RBD diagnosis ( n = 21; 48.8%). Prevalence of any severity OSA ( n = 35; 81.4%) exceeded positive or incomplete findings for RBD ( n = 28; 65.1%). The findings suggest that the suspicion accuracy for OSA and RBD could improve through more thorough history-taking in the prediagnostic workup. In world regions with limited VPSG availability, clinicians must recognize the likelihood of sleep apnea related to nocturnal motor activity. We suggest prioritizing type 1 polysomnography (PSG) to treat or exclude OSA rather than starting an empirical treatment for RBD while waiting for a VPSG study.
Introduction:Insomnia affects health, well-being, and productivity. Despite recommendations favoring Cognitive Behavioral Therapy for Insomnia (CBT-I) as first-line treatment, hypnotic medications remain widely used. Objective:To examine the frequency and types of sleep medications used by individuals with insomnia symptoms seeking psychological treatment, as well as factors associated with hypnotic use. Materials and Methods:The present cross-sectional study included 1,158 adults with insomnia symptoms recruited from a specialized service between 2021 and 2022. Participants completed online questionnaires assessing sociodemographic characteristics, medication use, and standardized measures of insomnia severity (Insomnia Severity Index), anxiety, and depression (Hospital Anxiety and Depression Scale). Descriptive analyses and multivariate logistic regression were performed. Results:From the total (n = 1,158), 60% of participants reported current use of sleep medication. The most frequently used classes were Z-drugs and benzodiazepines, followed by sedative antidepressants. Greater insomnia severity was the primary factor associated with hypnotic use (odds ratio = 1.14; p < 0.001). White participants were also more likely to use hypnotics, regardless of insomnia severity. Conclusions:Pharmacological treatment remains predominant among individuals with insomnia symptoms, despite recommendations for CBT-I as the first-line treatment. These findings highlight the importance of expanding access to behavioral interventions and promoting the rational use of sleep medications in Brazil.
Objective:To examine the effect of aspects of sleep health on the likelihood of the occurrence of major public health outcomes. Materials and Methods:This is a cross-sectional study which analyzed data from 2 editions of the National Health and Nutrition Examination Survey (NHANES; 2017-March 2020), a nationally-representative survey from the United States, with a final sample size ranging from 7,361 to 7,373 participants. Five domains of sleep health were evaluated: symptoms of sleep breathing disorders, symptoms of other sleep disorders, sleepiness, circadian misalignment (social jetlag), and chronotype (mid-sleep on free days corrected for sleep debt on workdays). The primary outcomes were the odds of being diagnosed with cardiovascular and respiratory diseases, thyroid disorders, stroke, and cancer. Binary logistic regression models were used for data analysis. Results:The mean age of the participants was of 49.94 years. Regarding the sleep-related variables, 27.5% of the respondents reported difficulties with sleep, 47.4%, snoring, 12.3%, episodes of breathing cessation during sleep, and 25%, symptoms of daytime sleepiness. The mean social jetlag was of approximately 3 hours. Difficulties with sleep were connected with a higher odds ratio of all outcomes. Greater monthly frequency of daytime sleepiness was significantly associated with increased probability of presenting all chronic conditions. Later chronotype was related to an increased probability of developing thyroid, cardiovascular and respiratory diseases. Cessation of breathing during sleep was linked to cardiovascular and respiratory health issues. Conclusion:Impaired sleep health, particularly insomnia and sleep apnea symptoms, as well as later chronotype, were significantly associated with an increased likelihood of being diagnosed with all the outcomes tested.
Adapting the American Academy of Sleep Medicine (AASM) Guidelines for restless legs syndrome (RLS) to Latin America is a complex challenge, given the region's 33 countries and vast socioeconomic diversity. Such an endeavor requires comprehensive data and consensus from a broader representation of these populations. There is a need to assess the effect of social vulnerability on the prevalence of symptoms of periodic leg movements that may be erroneously called RLS and mimic the primary nosological diagnosis for itself. We aim to discuss the Asociación Lationoamericana de Sueño's (Latin American Sleep Association, ALADS, in Spanish) position statement to contextualize the 2025 AASM clinical practice guidelines for the treatment of RLS and periodic limb movement disorder. Their intention of advocating for future systematic studies employing standardized criteria in Latin America. While the Scientific Committee for Sleep Disorders of the Brazilian Academy of Neurology partially endorses those opinions, offering some counterpoints concerning, especially, the following issues: 1) challenges to the reportedly wide variability in Latin American RLS prevalence, with apparently very high prevalences exceeding the expected values in some locations; 2) the importance of complementing clinical history with structured RLS diagnostic questionnaires; and 3) amendments to the proposed summary of treatment recommendations, particularly regarding Iron supplementation. Finally, the presence of comorbidities and RLS in epidemiological studies must be considered and data from Latin America can contribute to the discussion on global criteria applied worldwide for RLS that need to be revised according to regional, social, and cultural issues.
Shift workers are often subject to changes in food intake, mealtimes, and sleep patterns. The present study aimed to investigate the relationships involving calorie and macronutrient intake, mealtimes, and total sleep duration and wake-up time after sleep onset among military police officers alternating between working and non-working days. This is a cross-sectional and quantitative study performed with 31 male military police officers who worked alternating shifts. The sample was collected between December 2022 and July 2023 in the city of Rio Branco, state of Acre, Brazil. Calorie and macronutrient intake and mealtimes were determined by food recall over 3 non-consecutive days. Sleep data was obtained through actigraphy over 14 consecutive days. Linear regression analysis was used to assess the associations regarding mealtimes, calorie and macronutrient intake, and sleep parameters. During night shifts, higher protein intake was significantly associated with longer sleep duration (beta = 0.147; p = 0.006), whereas on days off, a higher number of meals (beta = -0.520; p = 0.025), a longer eating window (beta = -0.237; p = 0.003), and higher total calorie intake (beta = -0.048; p = 0.031) were significantly associated with shorter sleep duration. The results showed the association between food intake and mealtimes in some sleep parameters and reinforce the need for reflection and proposal of interventions capable of minimizing this problem.
Abstract Recent studies suggest that physical exercise can be an alternative intervention to reduce the severity of obstructive sleep apnea (OSA). However, whether physical activity (PA) recommendations are suitable for patients with OSA remains unclear. To evaluate the effectiveness of general physical activity recommendations in improving OSA in adults. A comprehensive search was conducted in the PubMed/MedLine, Scopus, Cochrane Library, and EMBASE databases, including studies published up to August 2025. This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (#CRD42023430359). Metanalyses were performed using the Review Manager software. A total of 3818 studies were found, of which 40 were included in the qualitative analysis and 25 in the quantitative analysis. There is a greater range of studies combining aerobic and resistance exercises, particularly using moderate intensity. In the quantitative analysis, it was observed that physical exercise significantly reduced the apnea-hypopnea index (AHI), by 10.95 events/hour (95%CI = -12,62 to -9.29; p < 0.001). Moreover, programs which achieved the PA recommendations reduced the AHI (mean difference = −11.23; 95%CI = -15.21 to -7.24; p < 0.001), whereas the ones that did not, also reduced (mean difference = -12.90; 95%CI = -16.01 to -9.80; p < 0.001). Physical exercise significantly reduces AHI in adults with OSA regardless of meeting the PA recommendations.
Introduction:Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia. Mounting evidence positions RBD as a critical prodromal indicator of synucleinopathies-particularly Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA)-with a significant link to progressive cognitive decline. Objective:To explore the underlying pathophysiological mechanisms connecting RBD with cognitive impairment, to delineate the neuropsychological profile of the affected individuals, and to critically evaluate the current diagnostic tools and therapeutic challenges. Materials and Methods:We synthesized data from clinical cohort studies, structural and functional neuroimaging modalities (magnetic resonance imaging [MRI], fluorodeoxyglucose positron-emission tomography [FDG-PET], and single-photon emission computed tomography [SPECT]), molecular biomarkers-including alpha-synuclein seeding assays-and genetic studies focusing on mutations such as glucocerebrosidase, β, acid ( GBA ) and synuclein alpha ( SNCA ). Results:Individuals with idiopathic RBD (iRBD) frequently exhibit early deficits in executive function, attention, visuospatial abilities, and episodic memory-often years before motor symptoms manifest. Pathologically, the spread of alpha-synuclein aggregates from REM sleep-regulating nuclei in the brainstem to limbic and neocortical areas mirrors the trajectory of cognitive decline. Cholinergic-system degeneration, particularly in the pedunculopontine nucleus and basal forebrain, further contributes to the neurocognitive symptoms. Neuroimaging consistently reveals frontal and temporal cortical thinning, along with posterior hypometabolism characteristic of synucleinopathies. Biomarker analysis shows altered cerebrospinal fluid (CSF) amyloid-beta and -tau levels, as well as positive alpha-synuclein real-time quaking-induced conversion (RT-QuIC) assay results. Genetic predispositions strongly influence the risk and rate of progression. Conclusion:A powerful early biomarker for cognitive decline associated with synucleinopathies, the early identification of RDB through comprehensive neuropsychological profiling, advanced imaging techniques, and molecular diagnostic methods is essential for risk stratification and monitoring. Although disease-modifying therapies remain elusive, a deeper understanding of shared pathogenic pathways offers promising avenues for targeted neuroprotective strategies.
