Kleine-Levin syndrome (KLS) is a rare sleep disorder marked by recurrent episodes of hypersomnia, cognitive impairment, and behavioral disturbances. Intravenous corticosteroids have been reported to shorten episodes, but evidence for oral steroid therapy remains limited. We describe two patients with KLS whose episodes improved with oral prednisone. Case 1 was a 17-year-old male patient with recurrent hypersomnia and behavioral changes. Steroid-responsive encephalopathy associated with autoimmune thyroiditis was initially considered but later excluded. He demonstrated improvement with intravenous steroids, and subsequent episodes were managed with oral prednisone. Case 2 was a 10-year-old male patient with early-onset KLS who experienced shortened episode duration after oral prednisone following failure of carbamazepine therapy. These cases suggest that oral prednisone may represent an effective alternative to intravenous corticosteroids for reducing episode duration in KLS. Oral therapy provides several advantages, including patient convenience and the feasibility of outpatient care. Therefore, oral steroid therapy warrants further investigation in KLS.
Objectives: Evidence regarding the association between obstructive sleep apnea (OSA) and mortality following acute myocardial infarction (MI) remains inconsistent. This study aimed to clarify this relationship through a systematic review and meta-analysis.Methods: A comprehensive search of six international databases (PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and Embase) was conducted on November 11, 2024, without time restrictions. Statistical analyses included a random-effects model stratified by adjusted odds ratio (aOR) and adjusted hazard ratio (aHR). Short-term mortality was defined as in-hospital or ≤30-day mortality, whereas long-term mortality referred to outcomes assessed after a minimum follow-up of 3 months. Data synthesis was performed using Comprehensive Meta-Analysis software (Version 2).Results: Six studies, including a total of 7,032,232 individuals, showed that short-term post–acute MI mortality was lower among individuals with OSA (aOR=0.67; 95% confidence interval [CI] 0.61–0.74). In contrast, pooled analysis of seven additional studies (n=12,545) reporting aHR indicated that OSA was associated with a 53% increased risk of long-term mortality (aHR=1.53; 95% CI 1.22–1.92). Egger’s test showed no evidence of publication bias.Conclusions: OSA did not show a significant association with increased short-term post-MI mortality in aOR-based analyses but was linked to a higher risk of long-term mortality in aHR-based analyses. This discrepancy may reflect methodological differences, including the absence of time-to-event modeling in aOR and the greater sensitivity of aHR, as well as variations in study design and follow-up duration. Further well-designed studies are required to confirm these findings.
Idiopathic hypersomnia (IH) is a central hypersomnolence disorder characterized by excessive daytime sleepiness and prolonged unrefreshing sleep. Postinfectious IH has been reported following viral illnesses, including COVID-19, typically in young adults shortly after infection. We report the unique case of a 54-year-old man who developed persistent and progressive hypersomnolence two years after recovering from COVID-19. Polysomnography revealed normal sleep architecture without sleep-disordered breathing, and a multiple sleep latency test showed a mean sleep latency of 2.6 minutes without sleep-onset REM periods, confirming severe hypersomnolence. Results of extensive neurological, metabolic, and autoimmune evaluations were unremarkable. Given the delayed onset, and excluding other etiologies, his condition was attributed to a potential temporal link to post-COVID IH. This case expands the spectrum of post-COVID neurological sequelae, highlighting a need for long-term surveillance for late-onset hypersomnia following SARS-CoV-2 infection.
Shift work disorder is common among nurses who work night shifts. It is characterized by insomnia after the shift and excessive daytime somnolence the day after for a period of three months or longer. The objective of this review was to synthesize evidence regarding the improvement of shift work disorder symptoms following light-control-based therapies in nurses. We searched the PubMed and Google Scholar databases for relevant articles. Of the articles that contained Medical Subject Headings (MeSH) descriptors, those that did not fulfill the objective of the search were rejected. Finally, 10 articles were included in the review. The literature search showed that light-based intervention is a plausible nonpharmacological therapy for shift work disorder symptoms in nurses. In some studies, exposure to red light, or blue light depletion, during the shift was also used with good results. Light-based interventions and their variants are potentially useful nonpharmacological therapeutic measures for treating insomnia and daytime somnolence in nurses.
Objectives: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction, which leads to oxygen desaturation and fragmented sleep. Despite its significant impact on cardiometabolic health, data on OSA in the Egyptian population remain limited. Sleep Breathing Disorders Cairo University Registry (SBDCUR) aims to investigate the clinical characteristics and comorbidities of Egyptian patients with OSA. Methods: This retrospective, cross-sectional study enrolled 403 patients between 2022 and 2024, of whom 324 (80.4%) were confirmed to have OSA based on full-night polysomnography. Comprehensive demographic, clinical, and polysomnographic data were collected.Results: The cohort had a mean age of 56.1±13.0 years, with a male-to-female ratio of 1:1.3. Cardiometabolic comorbidities were highly prevalent, including systemic hypertension (41%) and diabetes mellitus (32.7%). Binary logistic regression identified diabetes mellitus (odds ratio [OR]=3.426, 95% confidence interval [CI]: 1.414–8.301, p=0.006) and Epworth Sleepiness Scale (ESS) score (OR=1.136, 95% CI: 1.065–1.212, p=0.001) as independent predictors of moderate-to-severe OSA. Correlation analysis revealed a significant positive relationship between ESS and the oxygen desaturation index (r=0.272, p=0.001), while no significant correlation was observed between body mass index and apnea-hypopnea index (r=0.063, p=0.260).Conclusions: The SBDCUR provides critical insights into the clinical and demographic profiles of Egyptian patients with OSA, highlighting a notable female proportion and strong associations with cardiometabolic comorbidities. These findings emphasize the need for early screening and multidisciplinary management of OSA to mitigate its long-term health impacts in the Egyptian population.
Objectives: This study evaluated the effects of a 12-week urban gardening program on the subjective and objective sleep quality of adults with sleep disturbances living in urban settings. Methods: Adults aged ≥40 years with impaired sleep quality participated in weekly urban gardening sessions over 12 weeks in Songdo, Incheon, Republic of Korea. Sleep quality, insomnia severity, perceived stress, and depressive symptoms were assessed at baseline, post-intervention, and 12-week follow-up using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and visual analog scales. Objective sleep parameters were measured using polysomnography at baseline and post-intervention. Salivary cortisol levels were assessed at all three time points. Results: Participants showed significant improvements in sleep efficiency, sleep-onset latency, and insomnia severity following the intervention, with benefits maintained at the 12-week follow-up. Participants with objectively impaired sleep efficiency (<85%) showed pronounced improvement. Subjective stress and depressive symptoms also improved; however, the salivary cortisol levels did not show a consistent pattern of change. Conclusions: Urban gardening may serve as a feasible, community-based, and non-pharmacological intervention for improving sleep quality in adults with sleep disturbance. Larger randomized controlled studies are warranted to confirm these findings and further explore the underlying physiological and psychological mechanisms.
Focal segmental glomerulosclerosis (FSGS) is a progressive glomerular disease characterized by proteinuria and an increased risk of kidney failure. Although obstructive sleep apnea (OSA) is associated with adverse renal outcomes, improvements in FSGS-related proteinuria following OSA treatment have not been established. We report a 51-year-old female patient with biopsy-confirmed FSGS and persistent proteinuria, despite stable weight and maximal angiotensin II receptor blocker therapy, who was diagnosed with severe OSA (apnea-hypopnea index, 87.3 events/hour). Continuous positive airway pressure (CPAP) effectively controlled the OSA. Within 2 months, proteinuria decreased by 49%, accompanied by a reduction in blood pressure without any changes in medication. Renal function remained stable, and further improvement in proteinuria was observed with ongoing CPAP adherence. This case suggests that CPAP therapy in patients with concomitant FSGS and OSA may significantly reduce proteinuria and preserve renal function. Further studies are warranted to clarify the potential therapeutic benefits of CPAP in this patient population.
Objectives: This study aimed to examine the relationship between comprehensive genetic risk profiles and sleep parameters in healthy young adults.Methods: This study included 85 healthy Korean adults (mean age 28.18±4.3 years, 77.6% female). The participants completed validated self-report questionnaires and 14-day sleep diaries. Genetic testing was performed using direct-to-consumer panels to analyze 230 health-related and 317 disease-related markers. Three complementary analytical approaches were employed: Spearman’s correlations between ordinal genetic risk scores and sleep parameters, group-based analysis of variance (ANOVA) to compare sleep variables across genetic risk groups, and individual single-nucleotide polymorphism–level analyses. Associations were required to demonstrate consistent directional trends across ≥3 sleep parameters for inclusion.Results: Significant and consistent correlations with three or more sleep parameters were observed for the following genetic markers: calcium deficiency, coenzyme Q10 (CoQ10) deficiency, nicotine metabolism, chronotype, gallbladder cancer, and skin cancer. Comprehensive analysis revealed three distinct genetic-sleep phenotypes: 1) compensatory patterns in which metabolic deficiencies (calcium and CoQ10) were associated with altered sleep architecture; 2) pharmacological validation of nicotine metabolism; and 3) disease susceptibility paradoxes, where variants associated with health risks demonstrated superior sleep outcomes.Conclusions: These findings represent a paradigm shift emphasizing that genetic architecture involves complex trade-offs between different physiological systems, with profound implications for personalized sleep medicine that moves beyond one-size-fits-all approaches toward treatment strategies optimized for individual genetic profiles.
Objectives: This study aimed to investigate and compare the clinical characteristics of obstructive sleep apnea (OSA) and co-morbid insomnia and sleep apnea (COMISA) using sleep questionnaires and polysomnographic findings. Methods: We enrolled 850 patients who completed sleep questionnaires and underwent level 1 polysomnography (PSG) with an apnea-hypopnea index (AHI) ≥15. Patients were classified as OSA if the Insomnia Severity Index (ISI) <15, or as COMISA if ISI ≥15. Demographic and clinical characteristics, as well as PSG parameters, were compared between the groups. Results: The COMISA group showed greater daytime sleepiness, lower sleep quality with increased sleep fragmentation, and longer sleep latency than the OSA group, as measured by the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, and PSG (p<0.05). The OSA group reported more frequent snoring and more severe sleep apnea, with a higher AHI than the COMISA group (p<0.05). The COMISA group underestimated their sleep quality, while the OSA group had less insight into sleep problems. Conclusions: Patients with COMISA and OSA have different subjective and objective sleep profiles and perceptions of sleep. Understanding each characteristic and properly differentiating between COMISA and OSA in the clinic for tailored management is needed.
Restless legs syndrome (RLS) is a chronic neurological disorder characterized by an overwhelming urge to move the legs, typically accompanied by unpleasant sensations that worsen at rest, particularly in the evening and night. The diagnosis of RLS is primarily symptom-based, with a recent revision of the diagnostic criteria in 2012 emphasizing the distinction between true RLS and conditions that mimic it, such as leg cramps or arthritis. This has led to variations in the prevalence of RLS, particularly in different diagnostic criteria and methodologies, with higher rates observed in simple questionnaires and lower rates in differential diagnoses and detailed interviews. The pathophysiology of RLS is complex and involves dopaminergic dysfunction and brain-specific iron deficiency. Dopamine dysregulation contributes significantly to this disorder, as evidenced by the efficacy of dopaminergic treatment. Additionally, iron deficiency in the brain, especially in areas such as the striatum and substantia nigra, plays a critical role in RLS, with studies indicating reduced iron levels in affected individuals and improvement in symptoms following iron supplementation. This article provides an in-depth review of the epidemiology and pathophysiology of RLS, particularly in Asia, focusing on the importance of accurate diagnostic criteria and the roles of dopamine and iron in the development of this disorder.
Objectives: To assess the relationship between anxiety and sleep behavior among adolescents during the coronavirus disease 2019 pandemic. Methods: Three cross-sectional surveys were conducted among ninth-grade students in Barrow County, Georgia, during the pre-pandemic, peak pandemic, and transitional phases from 2020 to 2022. The association between anxiety diagnosis, self-reported symptoms (Generalized Anxiety Disorder Criteria for Adolescents [GAD-C]), and sleep behavior was examined using logistic regression. Results: At baseline, 475 students completed the survey, with 36.4% reporting symptoms of anxiety. Students diagnosed with clinical anxiety were more likely to report daily sleep disturbances (adjusted prevalence ratio: pre-pandemic [PRadj,pre]=5.9; 95% confidence interval [CI], 3.2–10.5). Moreover, elevated GAD-C scores were also associated with sleep disturbances (PRadj,pre=14.5; 95% CI, 8.1–26.0). The association remained consistent across all time points. Conclusions: This study demonstrated that adolescents with anxiety were more likely to report poor sleep behaviors, thereby extending previous findings to adolescents in understudied communities. Addressing anxiety and sleep health behaviors should be prioritized among adolescents from low-income semi-rural areas.
Objectives: Sleep-disordered breathing is a common comorbidity in patients who have experienced ischemic stroke. It is typically diagnosed using polysomnography (PSG); however, no guidelines have been established regarding the appropriate timing for this test. We investigated whether polysomnographic findings obtained during hospitalization for acute ischemic stroke differ from findings obtained after discharge following symptom stabilization. Methods: We retrospectively analyzed the medical records of patients who underwent PSG at the Department of Neurology, Chungnam National University Hospital, between January 1, 2024, and January 31, 2025. Among patients diagnosed with ischemic stroke and admitted to our hospital within one year prior to the date of PSG, we compared the clinical characteristics and polysomnographic findings between those who underwent PSG during hospitalization and those who underwent it after discharge. Results: No significant differences in clinical characteristics or polysomnographic findings were observed between patients who underwent PSG while hospitalized and those who underwent PSG after discharge. Conclusions: Unless the patient is clinically unstable, the timing of PSG—whether during hospitalization or after discharge following an ischemic stroke—does not appear to make a difference.
This systematic review presents the known sleep characteristics of patients with autism spectrum disorder (ASD). Together with ASD, different diagnoses and comorbidities hinder the proper management of these patients. One of the most prevalent pathologies in patients with ASD is sleep disorder, with 50%–80% of children with ASD having insomnia. The literature describes that patients with ASD who have sleep problems will present an increase in their “core” symptoms: earlier development of attention deficit and hyperactivity disorder, irritability, aggressiveness, stereotypies, anxiety, and greater delay in language acquisition. Therefore, we consider it important to begin with a description of the sleep characteristics of patients with ASD, as this can serve as a foundation for establishing guidelines that support accurate identification and diagnosis, which is an important first step toward implemented targeted treatment both in terms of therapies and pharmacological management.
Objectives: Sarcopenia, characterized by loss of skeletal muscle mass and function, is a growing health issue, especially in the elderly. Sleep disorders have recently been implicated as potential contributors to its development. This study investigated the association between Periodic Limb Movements during Sleep (PLMS) and sarcopenia using polysomnography (PSG) and bioelectrical impedance analysis (BIA). Methods: We analyzed the data of 663 patients (404 males and 259 females) who underwent type I PSG and BIA at Samsung Medical Center from January 2019 to May 2024. PLMS was defined as a periodic limb movement index (PLMI) of ≥15/h. Sarcopenia was defined based on skeletal muscle index (SMI) cutoffs of <7 kg/m2 for males and <5.7 kg/m2 for females. Statistical analyses included chi-squared tests, Fisher’s exact tests, t-tests, and Wilcoxon rank-sum tests using R version 4.3.1. Results: PLMI of ≥15/h was observed in 204 males and 126 females. Among males, those with PLMS had significantly lower SMI (8.02±0.66 kg/m2 vs. 8.19±0.68 kg/m2) and fat-free mass index (18.90±1.48 kg/m2 vs. 19.31±1.51 kg/m2). In contrast, females with PLMS showed higher muscle mass percentage (37.97%±1.10% vs. 36.89%±3.66%). Sarcopenia prevalence was higher in males with PLMS (6.86%) compared to those without (2.00%), with no significant difference in females. After adjusting for age, exercise, and alcohol consumption, PLMI ≥15/h remained an independent risk factor for sarcopenia in males (adjusted prevalence ratio: 5.808; 95% confidence interval, 1.338–25.215). Conclusions: PLMS is independently associated with sarcopenia in males, suggesting the need to assess sleep disorders in sarcopenia management.
Objectives:Sleep disorders can significantly worsen the quality of life in Parkinson's disease (PD). Variants in LRRK2 and GBA1, the most common genetic contributors to PD, may lead to different clinical features, including more REM sleep behavior disorder (RBD) in PD associated with GBA1 mutations (GBA PD). However, there is a dearth of information about differences in non-RBD sleep disorders among these genetic subgroups. Methods:Seventy-nine participants with PD (18 LRRK2 G2019S carriers with PD [LRRK2 PD], 22 GBA1 [GBA PD], 2 LRRK2 GBA PD and 37 idiopathic PD [iPD]) underwent actigraphy (Actiwatch-2) for 1 week. Subjective sleep quality was assessed using questionnaires. Results:LRRK2 PD participants demonstrated better sleep actigraphy, including reduced wake after sleep onset (-25 minutes; p<0.001) and higher sleep efficiency (6.3%; p=0.015), than iPD and GBA PD in models adjusted for age, age at disease onset, and gender. While sleep onset times did not differ between groups, all groups had mean sleep onset times after 11:00 PM, and did not demonstrate phase advancement. Sleep questionnaires showed only an increased prevalence of RBD in GBA PD and iPD. Conclusions:LRRK2 PD is associated with less fragmented sleep than GBA PD and iPD, suggesting that despite similar objective sleep complaints, genotypic sleep differences extend beyond RBD. These differences support the need for personalized and genotypic approaches to sleep disturbances in PD. The absence of phase advancement in all groups suggests that lighting interventions to improve sleep disorders should be considered for the morning rather than later in the day.
Objectives: Narcolepsy significantly affects the daily life of individuals due to excessive daytime sleepiness and cataplexy, reducing the quality of life and increasing the risk of accidents and social difficulties. Despite its profound impact on daily life, only a few studies have investigated the specific difficulties and awareness of patients with narcolepsy. Therefore, in this study, we aimed to assess the daily challenges and disease awareness of patients with narcolepsy. Methods: We conducted an online survey of 299 patients with narcolepsy. The survey included questions on patient demographics, clinical characteristics, difficulties, and disease awareness. Results: The patients reported considerable difficulties in academic performance, memory, and driving, with those with narcolepsy type 1 reporting greater difficulties than those with narcolepsy type 2. Older age and depression were positively associated with higher difficulty scores, whereas female sex was associated with lower difficulty scores. Notably, disease awareness varied, with 30.4% and 5.4% of participants showing moderate and no awareness of narcolepsy, respectively. Conclusions: Overall, this study highlights the daily life challenges and varying disease awareness of patients with narcolepsy. Our findings emphasize the need for targeted education and effective policy interventions to reduce the difficulties and improve the quality of life of patients with narcolepsy.
Objectives: Obstructive sleep apnea (OSA) is a multi-level airway disease, and the specific site of obstruction may influence associated conditions such as eustachian tube dysfunction (ETD) and gastroesophageal reflux disease (GERD). This study aimed to explore the relationship between OSA, ETD, acid reflux, and the anatomical site of obstruction. Methods: Participants were assessed using validated questionnaires for OSA, ETD, and reflux symptoms. The site of upper airway collapse was determined objectively using apneagraphy or sleep MRI. Acid reflux symptoms were evaluated using a standardized reflux symptom questionnaire, and 24-hour pH monitoring was done when indicated. ETD was assessed both subjectively and objectively through the Toynbee maneuver. Results: Sixty-three individuals completed the evaluation. The mean age was 40.4 years, and the mean BMI was 28.1 kg/m2. Retroglossal obstruction was observed in 76.1% (48/63), while 23.9% (15/63) had retropalatal obstruction. ETD was diagnosed in 53% of participants, and GERD in 38% by objective testing. A statistically significant association was found between retroglossal collapse and complete ETD (p=0.02). However, no significant link was noted between the obstruction site and laryngopharyngeal reflux or partial ETD. Additionally, salivary pepsin levels showed no correlation with reflux (p=0.412). Conclusions: OSA is frequently accompanied by ETD and GERD. Notably, retroglossal obstruction appears to be significantly associated with complete ETD, suggesting a potential site-specific impact. These findings underscore the importance of anatomical localization in understanding OSA-related comorbidities and warrant further investigation in larger multicenter studies.
Hypoventilation in obesity has four stages, and the first two stages are associated with intermittent nocturnal hypercapnia. We report a 46-year-old man who belongs to Stage 1, with complete washout of nocturnally accumulated carbon dioxide (CO2) and associated concomitant severe obstructive sleep apnea and severe hypoxemia. That condition will lead to progressive right heart dysfunction secondary to persistently nocturnal impaired ventilation and hypoxemia via the pathomechanism of hypoxic pulmonary vasoconstriction and pulmonary vascular remodeling by cytokines and growth factors, supposedly once it is missed for early diagnosis and appropriate PAP therapy is not introduced in time. Early identification and diagnosis of such conditional disease and in-time appropriate treatment are very important before sequelae of disease develop so that we could be able to prevent cardiovascular morbidity and mortality before disease progression.
Obstructive sleep apnea (OSA), characterized by nocturnal airway obstruction, hypoxia, and arousal, is a significant risk factor for cardiovascular diseases, including arrhythmia. This case report describes the association between OSA and nocturnal sinus tachycardia in a 58-year-old woman who presented with sleep maintenance difficulties and recurrent nocturnal tachycardia. Polysomnography confirmed a direct correlation among the apnea/hypopnea episodes, tachycardia, and sleep maintenance difficulties. Continuous positive airway pressure therapy effectively resolved tachycardia and sleep maintenance difficulties, reducing the number of medications required to alleviate the symptoms. This report highlights the importance of considering OSA as a possible cause of unexplained nocturnal tachycardia.
