Fatigue and insufficient sleep remain critical challenges for health, safety, and readiness in naval operations and other high-demand occupations. This study examined whether nap frequency was associated with occupational stress, burnout, impaired functioning, and health outcomes in a large sample of active-duty US Navy sailors. Napping frequency was associated with lower odds of high job stress and impaired functioning, a pattern consistent with the broader experimental and operational literature suggesting that naps may support acute fatigue management when sleep opportunities are constrained. However, more frequent napping was also linked to higher odds of burnout, and US Navy sailors who napped on five or more days per week had higher odds of reporting an elevated number of poor mental health days. By contrast, nap frequency was not significantly associated with the number of poor physical health days. These findings suggest that planned nap opportunities may be useful within fatigue management programs when sleep opportunities are constrained, but nap frequency should not be viewed as a substitute for sufficient total sleep opportunity or systemic approaches to chronic occupational strain. The results carry implications for both military and civilian domains, including healthcare, aviation, and transportation, where fatigue countermeasures are essential to individual well-being and organisational safety.
Obstructive sleep apnoea (OSA) is a common chronic multisystem disorder, and cortical structural alterations have been detected via conventional neuroimaging techniques. Recent advances in diffusion-weighted imaging have yielded novel techniques for investigating neural microstructure, which may potentially offer supplementary insights into neurodegenerative processes associated with OSA. In the present study, we employed the neurite orientation dispersion and density imaging (NODDI) model to explore cortical microstructure in patients with OSA. Multi-shell diffusion magnetic resonance imaging (MRI) was acquired to fit the NODDI diffusion models. Scanned participants included individuals with mild OSA (n = 24), moderate OSA (n = 26), severe OSA (n = 23) and healthy controls (n = 24). Grey matter-based spatial statistics (GBSS) were used to compare NODDI-derived microstructural measures, orientation dispersion index (ODI) and neurite density index (NDI), among the four groups. The results demonstrated significant alterations (both increases and decreases) in NODDI metrics across OSA groups with different severity levels, with relatively more pronounced and widespread ODI changes observed compared with those of NDI. Our findings suggest a potential association between OSA and widespread alterations in grey matter cytoarchitecture. Neurite parameters provide important insights into the microstructure of grey matter in OSA.
Light interventions have been investigated for treating sleep disturbances in older adults; however, findings are mixed. This proof-of-concept trial investigated the effect of blue-enriched ambient light on electroencephalographic (EEG) sleep in older adults with self-reported poor sleep. Twelve participants (65.6 ± 8.7 years) were randomly exposed to two 72-h in-laboratory light conditions separated by 2 weeks. During the day, participants were exposed to either blue-enriched light (intervention: melanopic equivalent daylight illuminance (EDI) = 843.6 lx) or standard light (control: melanopic EDI = 215.8 lx). Three hours before habitual bedtime, illuminance was reduced, with greater blue light attenuation in the intervention (melanopic EDI = 49.5 lx) than control (melanopic EDI = 60.8 lx). On the third night, high-density EEG sleep, cognitive performance and body temperature were assessed. The primary outcome was wake-after-sleep-onset (WASO). Secondary outcomes included polysomnography-derived sleep parameters, sleep spindles, cognitive performance and body temperature. High-density EEG spectral power analyses were exploratory. There was no significant difference in WASO (136.1 ± 52.6 min vs. 117.2 ± 43.9 min; p = 0.338) between intervention and control. Intervention light significantly increased sigma activity (12-16 Hz) during N1 (p = 0.010) and N2 (p = 0.017) sleep. The distal-proximal skin temperature gradient (surrogate of peripheral heat dissipation) before and after lights out increased under intervention compared to control (-1.21°C ± 1.44°C vs. -1.85°C ± 1.39°C, p < 0.001). Daytime enrichment and evening depletion of blue light did not improve objective sleep outcomes in older people with sleep disturbance, but exploratory analyses showed increased sigma activity during sleep. Lighting interventions to improve sleep in older populations require further investigation. Trial Registration: ACTRN12619000138189.
This case report describes a 40-year-old woman with maternally inherited diabetes and deafness (MIDD), a rare mitochondrial disorder, who received treatment with daridorexant due to severe chronic insomnia. She developed progression of her MIDD symptoms during treatment. Caution is warranted when initiating daridorexant treatment in patients with mitochondrial disorders.
Sleep and epilepsy share a bidirectional relationship, with epilepsy disrupting sleep microstructure in ways that remain poorly understood in children. The cyclic alternating pattern (CAP) quantifies non-rapid eye movement sleep instability through cortical arousal fluctuations, but paediatric-specific evidence is scarce. We systematically searched four databases through December 2025 for studies reporting CAP parameters in children with epilepsy compared with healthy controls. Pooled mean differences were estimated using random-effects models, and risk of bias and certainty of evidence were assessed using standardised frameworks. Four study comparisons (87 children with epilepsy, 53 healthy controls) from five publications met the inclusion criteria. Total CAP rate did not differ significantly between groups (mean difference 3.79%; p = 0.636), with extreme heterogeneity reflecting syndrome-related variation. Among subtype indices, the A3 Index was lower in children with epilepsy (mean difference -1.87 events per hour, 95% confidence interval -3.09 to -0.65; p = 0.003) with low heterogeneity, though significance was lost when the largest study was excluded and under conservative sensitivity analyses. The A2 Index reduction was statistically significant but not robust in sensitivity analyses. No significant differences were observed for the A1 Index or subtype percentages. Available evidence suggests that CAP alterations in paediatric epilepsy are heterogeneous and syndrome-specific rather than uniform. The A3 Index reduction emerged as the most consistent finding, but should be regarded as preliminary given the limited evidence base. Larger, longitudinal, syndrome-specific studies are needed before CAP measures can be considered clinically relevant.
Light sleep, including Stages N1 and N2, constitutes more than half of total human sleep duration. It serves essential functions in transitioning from wakefulness to deep sleep and in memory processing. Previous studies have identified four consistent electroencephalogram (EEG) microstates during wakefulness and sleep. Simultaneous EEG and functional magnetic resonance imaging (fMRI) studies have shown that EEG microstates are associated with specific brain functional networks during wakefulness and slow wave sleep. However, the relationship between microstates and brain networks during light sleep remains unexplored. To address this gap, simultaneous EEG-fMRI data acquired during light sleep were used to examine the correspondence between microstates and brain networks. The EEG microstate informed fMRI analysis revealed that Microstate C was associated with the cerebellum, and Microstate D was associated with the thalamus and motor areas during both N1 and N2 sleep. No significant results were found in Microstate A or B during N1. Additionally, linear mixed-effect analysis verified that Microstate D's association with the motor network and thalamus persisted during both N1 and N2, though their activity showed opposing trends between stages: Microstate D-related thalamic activity was lower in N1 than in N2, whereas the motor cortex exhibited the opposite pattern. These findings highlight distinct relationships between EEG microstates and brain networks during N1 and N2 sleep and implicate the thalamus and motor cortex as key neural substrates during light sleep.
Sleep bruxism (SB) is a motor activity characterized by repetitive masticatory muscle contractions during sleep, commonly associated with tooth damage and jaw pain or headache. Pharmacological management strategies targeting its central nervous system-related mechanisms remain limited. This study aimed to evaluate whether a low dose of a central muscle relaxant, cyclobenzaprine, reduces SB-related muscle activity, maximum voluntary bite force and self-reported bruxism awareness. A randomized, double-blind, placebo-controlled, crossover clinical trial was conducted. Twenty participants underwent baseline SB motor activity recordings followed by two intervention phases consisting of 5 mg of cyclobenzaprine or placebo for three consecutive nights. Masticatory muscle activity during sleep was quantified using portable surface electromyography. Maximum voluntary bite force was measured using a bite force-recording device. Self-reported outcomes related to SB and secondary effects (e.g., dry mouth) were collected each morning. Comparison of cyclobenzaprine to placebo and baseline nights failed to show a difference in mean frequency of masticatory muscle activity during sleep and maximum voluntary bite force. No self-reported differences were observed for SB awareness. Few secondary effects were identified between cyclobenzaprine use and placebo; a significant increase in perception of tolerable dry mouth upon awakening (p = 0.034) and a marginally statistically significant reduction in the perceived leg movements during sleep (p = 0.046). In conclusion, low-dose cyclobenzaprine was not effective in modifying SB-related muscle activity or masticatory muscle force, suggesting limited clinical utility for SB. Future studies using higher doses of cyclobenzaprine are warranted before ruling out its clinical utility, within a safety profile.
To assess the prevalence of hypertension, risk of developing hypertension, and risk of mortality among individuals with narcolepsy or idiopathic hypersomnia in Denmark, we performed a retrospective, nationwide, cohort analysis of the Danish National Patient Registry (DNPR). Adults (aged ≥ 18 years) diagnosed with narcolepsy or idiopathic hypersomnia between 1 January 1998 and 31 December 2020 were matched 1:4 with non-narcolepsy/non-idiopathic hypersomnia controls based on key demographics (age, sex, marital status, geographic location). Outcomes included hypertension prevalence at diagnosis, incident hypertension after diagnosis, and mortality risk. For individuals with narcolepsy (n = 1760) versus matched controls (n = 7012), the odds ratio (OR) for having prevalent hypertension at diagnosis was 1.50 (95% confidence interval [CI], 1.28-1.76); individuals with narcolepsy also had higher risk (hazard ratio [HR; 95% CI]) of developing hypertension after diagnosis (1.40 [1.23-1.60]) and of mortality (1.25 [1.08-1.44]). Individuals with idiopathic hypersomnia (n = 3067) versus matched controls (n = 12,241) had higher odds (OR [95% CI]) of having prevalent hypertension at diagnosis (1.84 [1.64-2.05]) and higher risk (HR [95% CI]) of developing hypertension after diagnosis (1.38 [1.28-1.50]); mortality risk was similar for idiopathic hypersomnia versus controls (HR [95% CI]: 0.94 [0.84-1.06]). These data provide one of the first DNPR examinations of cardiovascular burden and mortality in individuals with idiopathic hypersomnia, finding greater prevalence and risk of developing hypertension in people with narcolepsy or idiopathic hypersomnia compared with matched controls. Mortality risk was also higher in people with narcolepsy. Findings support that the cardiovascular burden experienced by these populations should be considered during treatment evaluation. Please find the PLS file attached for your reference.
Although many studies have reported the presence of daytime sleepiness in Parkinson's disease (PD), either a weak or no association has been found between self-reported and current objective measures of daytime sleepiness in this population. Changes in resting state quantitative electroencephalography (qEEG) have been associated with increased subjective sleepiness induced by sleep deprivation in young and older adults. The aim of this study was to investigate the relationship between resting state qEEG and self-reported daytime sleepiness in adults with PD. Sixty-two participants with PD underwent polysomnographic recording and clinical assessment. Daytime sleepiness severity was measured with the Epworth Sleepiness Scale (ESS). Resting state EEG was recorded 30 min after awakening. Spectral power and functional connectivity analyses (weighted-phase lag index, amplitude-amplitude coupling) were performed on artefact-free resting state EEG in 2 Hz mini bands from 0.5 to 12 Hz. Partial correlations and a hierarchical regression were used to evaluate the relationship between the qEEG metrics and ESS scores. Lower phase synchronisation in the low alpha band (8-10 Hz) within the occipital cortex was the best EEG predictor of higher daytime sleepiness severity in PD. Our results are in line with some findings of previous studies conducted in healthy young participants that reported lower alpha connectivity after sleep deprivation, suggesting disrupted arousal networks may contribute to daytime sleepiness in PD. Lower alpha phase synchronisation within the occipital cortex could serve as a proxy for daytime sleepiness in PD.
Nasal breathing is the preferred route of breathing during sleep. Indeed, nasal blockage can cause obstructive sleep apnoea (OSA) in otherwise healthy people. Whilst multi-level pharyngeal surgery reduces OSA severity, efficacy varies and changes in OSA pathophysiology post-surgery have not been well characterised. Similarly, whether isolated nasal surgery improves upper airway collapsibility and OSA severity remains unclear. Accordingly, this study aimed to assess changes in upper airway collapsibility and estimated OSA endotypes following nasal and multi-level upper-airway surgery. In-laboratory polysomnography was performed pre- and post-nasal or multi-level upper airway surgery in 10 people with OSA. Brief (250 ms) negative pressure pulses (~-12 cmH2O) were also applied in early inspiration and early expiration during wakefulness to calculate the upper airway collapsibility index (UACI). Endotype changes were estimated from polysomnography. Multi-level upper-airway surgery reduced OSA severity with a corresponding 76% reduction in the UACI (38% ± 26% vs. 9% ± 19%, p = 0.02) during inspiration with similar improvements during expiration (69% ± 36% vs. 21% ± 31%, p = 0.01). Similarly, upper-airway collapsibility and loop gain endotypes improved following multi-level surgery. For isolated nasal surgery, OSA severity, upper-airway collapsibility and OSA endotypes were not systematically different pre- versus post-surgery. These findings indicate major improvements in upper-airway collapsibility during wakefulness and sleep, and reductions in loop gain following multi-level upper-airway surgery but no systematic changes in key OSA pathophysiology/severity measures following isolated nasal surgery, although the sample size for this comparison was small. Further application of these physiological measures may help explain, at least in part, between patient differences in therapeutic efficacy with different upper airway surgical approaches.
In the central disorders of hypersomnolence (CDH) narcolepsy types 1 and 2 (NT1, NT2) and idiopathic hypersomnia (IH), mental health problems are highly prevalent, and quality of life is decreased. The aim was to gain insight into relationships between CDH-related symptoms, mental health, and quality of life (QoL) in CDH, using network analysis. Variables involved CDH symptoms, levels of self-reported sleepiness, fatigue, mood, anxiety, attention, hyperactivity/impulsivity, apathy, and QoL indicators in CDH. Associations with diagnosis, sex, and treatment status were examined. The network analysis was on cross-sectional questionnaire data of N = 314 with CDH (NT1 n = 203; NT2/IH n = 111). A Mixed Graphical Model (MGM) with 16 nodes was estimated. Edges were selected using Regularization with EBIC-LASSO; network stability was determined with bootstrapping. Network comparison tests (NCTs) were performed between sub-groups for diagnosis (NT1 vs. NT2/IH), sex, and treatment status. We found that fatigue and depressive symptoms had the highest conditional associations with QoL variables. QoL outcome 'Energy, attention, and activities' had the most conditional associations with other variables in the network, indicating relative importance. Typical CDH symptoms clustered together, of which sleep inertia had the highest conditional association with QoL 'Coping with CDH'. Subjective sleepiness was not directly related to any variables in the network. NCTs showed no significant differences between diagnoses, sexes, or treatment statuses. This study indicates that, within the examined network, fatigue and depressive symptoms are most associated with QoL in CDH, signalling potential relevance in treatment. The impact of treatment on the symptom network should be further investigated using longitudinal data.
This study aimed at assessing the inter-procedural reliability (compared to the in-office consultation) and the diagnostic accuracy (compared to the reference standard) of the telemedicine consultation to guide the diagnostic workup of adults and children when complaint of excessive daytime sleepiness, possibly due to narcolepsy, is suspected. A cross-sectional diagnostic study was initiated in 2019 and completed in 2023. Consecutive people of any age referred for excessive daytime sleepiness complaint to the Clinic for Narcolepsy in Bologna were eligible for inclusion. The telemedicine consultation was conducted via tablet for the patient and via equipped personal computer in another room for the physician (interviewer). Interviewers expressed diagnostic orientation indicating narcolepsy as 'probable', 'possible' and 'excluded'. The final diagnosis was established by applying the International Classification of Sleep Disorders criteria. Inter-procedural reliability and diagnostic accuracy measures were calculated. Two hundred and twenty-one participants were included in the reliability study, 198 in the diagnostic accuracy study. The agreement between the two consultation modalities on diagnostic orientation was 'substantial' (Kappa 0.74, 95% CI 0.66-0.82). Agreement on the presence of narcoleptic pentad symptoms was 'substantial' (excessive daytime sleepiness, hypnagogic hallucinations, disrupted nocturnal sleep) or 'almost perfect' (cataplexy, sleep paralysis). In children reliability for excessive daytime sleepiness, cataplexy and hypnagogic hallucinations was lower. Telemedicine and in-office consultation had identical sensitivity (100%, 95% CI 94-100) and similar specificity (43%, 95% CI 35-52, vs. 40%, 95% CI 32-49). Telemedicine consultation is a reliable diagnostic triage procedure when excessive daytime sleepiness possibly due to narcolepsy is suspected, in particular to exclude people who do not suffer from narcolepsy without the risk of false negatives.
Women with obstructive sleep apnoea (OSA) report more severe functional impairments than men, despite lower apnoea-hypopnoea index (AHI) values. This raises questions about the adequacy of AHI for capturing OSA severity. We explored sex differences in functional outcomes in OSA patients and examined whether AHI or hypoxic burden (HB) better explained these differences. We analysed cross-sectional data from Sydney Sleep Biobank (2018-2023). Adults with OSA (AHI ≥ 5 events/h on polysomnography) with data on mood (Depression, Anxiety and Stress Scale; DASS-21) and daytime functioning (Functional Outcomes of Sleep Questionnaire; FOSQ-10) were included. Linear regression models examined associations between sex, AHI, HB and functional outcomes. Interaction effects of sex and AHI/HB were explored. Among 518 untreated OSA patients (67.7% men, mean age = 54.0, SD = 14.6 years), women had significantly higher DASS-21 (15.4 vs. 12.1, p < 0.01) and lower FOSQ-10 (14.1 vs. 16.0, p < 0.0001) scores, despite lower AHI (28.7 vs. 32.9, p = 0.10) and HB (47.4 vs. 82.7, p < 0.001). Neither AHI nor HB was associated with worse mood, although AHI was linked to poorer mood in women in sensitivity analyses. AHI and HB were associated with worse FOSQ-10. In multivariable models adjusting for demographics, anthropometry, comorbidities and medications, neither AHI nor HB consistently predicted mood or daytime functioning. Sex differences in mood were explained by comorbid mood disorders, insomnia and chronic pain. Women had more severe functional impairments despite milder respiratory indices. Given the greater influence of comorbidities on functional outcomes than respiratory metrics, comprehensive comorbidity assessment in OSA evaluation is warranted, especially in females.
In this study, we aim to establish risk factors for sleepiness while driving, motor-vehicle accidents and near miss incidents in obstructive sleep apnoea patients with long-term continuous positive airway pressure (CPAP) therapy. We performed a cross-sectional study on 1327 consecutive CPAP-treated obstructive sleep apnoea (OSA) patients who were scheduled for a routine 5-year follow-up in 2019-2020 at Turku University Hospital. We obtained data of self-reported sleepiness while driving, motor vehicle accidents and near-miss events via questionnaires and classified patients accordingly in different groups. We then compared demographic parameters, CPAP adherence, blood gas samples and OSA-related symptoms via standardised questionnaires and applied standard statistical tests. Sufficient data was available from 1018 (76.7%) of 1327 patients. Two hundred and seventeen patients (21.3%) reported sleepiness while driving, near-miss situations or motor vehicle accidents while driving. These patients were younger (mean age 60 vs. 66 years), and scored higher on Epworth Sleepiness Scale (mean 6.7 vs. 4.3), Insomnia Severity Index (mean 3.1 vs. 1.9) and Depression Scale (mean 7.1 vs. 4.8) than other patients (p < 0.001 on all scores). Sleepiness while driving was more likely in those with weight gain of more than 5 kg within 5 years (58.6% vs. 40.0%, p = 0.019). CPAP adherence was similar across the groups. Capillary blood gases did not correlate with poor CPAP adherence or sleepiness while driving. In conclusion, sleepiness while driving in OSA patients with long-term CPAP therapy was associated with weight gain as well as depressive and insomnia symptoms.
Sleep irregularity, characterised by inconsistent sleep duration and timing, is increasingly linked to adverse health outcomes including hypertension. However, the persistence and long-term effects of irregular sleep remain unclear, largely due to short sleep monitoring periods in past studies. This study aimed to examine the chronic, cumulating impacts of irregular sleep on sleep health (sleep duration, efficiency, timing) and blood pressure. We analysed approximately 20 months of under-mattress sleep sensor data from 95,819 global participants. Each person-month of sleep data was classified as 'irregular' if sleep duration variability was ≥ 90 min and sleep midpoint variability was ≥ 60 min (intra-individual standard deviation): thresholds that were previously found to correlate with poor cardiovascular health. Approximately 20% of person-months were classified as irregular by these criteria. Participants with chronic irregular sleep (≥ 75% of months irregular) exhibited 8% lower sleep efficiency, 40 min more wake after sleep onset, and 46% higher odds of hypertension compared to those with regular sleep (0%-25% of months irregular). Irregular sleep patterns were persistent, with over 80% likelihood of continuation after six consecutive irregular months. These findings suggest that chronic sleep irregularity is common, persistent, and associated with poorer sleep quality and elevated blood pressure. This underscores the need for interventions to promote consistent sleep patterns to support cardiovascular health.
Idiopathic hypersomnia (IH) and narcolepsy type 2 (NT2) are central disorders of hypersomnolence characterised by excessive daytime sleepiness and substantial functional burden. Narcolepsy type 1 (NT1), defined by orexin deficiency, serves as an established biologic standard for evaluating therapies targeting the orexin system. Alixorexton (ALKS 2680) is a highly potent, oral, selective orexin 2 receptor (OX2R) agonist in clinical development for IH, NT2 and NT1. In this phase 1b, randomised, double-blind, placebo-controlled, four-way crossover study (ISRCTN98204977), adults aged 18-65 years with IH (n = 8), NT2 (n = 9) or NT1 (n = 10) received single oral doses of alixorexton (IH/NT2: 5, 12, 25 mg; NT1: 1, 3, 8 mg) and placebo across four treatment periods. The primary endpoint was safety and tolerability. Wakefulness was assessed by mean sleep latency on the Maintenance of Wakefulness Test (MWT) over 8 h post-dose and subjective alertness by the Karolinska Sleepiness Scale (KSS). Alixorexton was generally well tolerated; all treatment-emergent adverse events (TEAEs) were mild or moderate, with no serious TEAEs and no discontinuations due to TEAEs. In IH and NT2, alixorexton demonstrated statistically significant, clinically meaningful, dose-dependent increases in MWT sleep latency versus placebo and improved self-reported alertness. NT1 showed a similarly robust, dose-dependent response at lower doses, consistent with orexin-deficient biology. These findings support OX2R agonism as a therapeutic approach for central disorders of hypersomnolence, including conditions with uncertain orexin dysfunction and informed ongoing phase 2 evaluation in IH and narcolepsy. Trial Registration: A study in healthy subjects to see the effects of the test medicine ALKS 2680 in single- and multi-dose regimen; prospectively registered at ISRCTN on October 17, 2022 (identifier: ISRCTN98204977; URL: https://www.isrctn.com/ISRCTN98204977).
Obstructive sleep apnea, characterised by intermittent hypoxia and sleep fragmentation, may influence thyroid hormone regulation. However, evidence regarding thyroid function in obstructive sleep apnea remains inconsistent, particularly for free triiodothyronine. We conducted a cross-sectional study including 168 adults with polysomnography-confirmed obstructive sleep apnea, rigorously selected to exclude overt thyroid disease, thyroid autoimmunity, and the use of thyroid-active medications. Demographic characteristics, body mass index, polysomnographic indices, and serum levels of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were collected. Disease severity was assessed using the apnea-hypopnea index, oxygen desaturation index, mean nocturnal oxygen saturation, and the percentage of sleep time spent with oxygen saturation below 90%, and patients were stratified according to median values. Individuals with apnea-hypopnea index values above the cohort median exhibited significantly higher free triiodothyronine concentrations (p = 0.014), whereas no differences were observed for free thyroxine or thyroid-stimulating hormone. In multivariable linear regression analyses, free triiodothyronine independently predicted both the apnea-hypopnea index (p = 0.004) and the oxygen desaturation index (p = 0.001), alongside age, sex, and body mass index. No significant associations were observed between free triiodothyronine levels and mean nocturnal oxygen saturation or the percentage of sleep time spent with oxygen saturation below 90%. No independent associations with any respiratory index were identified for free thyroxine or thyroid-stimulating hormone. These findings indicate that higher free triiodothyronine concentrations reflect respiratory event burden rather than hypoxemia severity, supporting its role as a sensitive marker of the response to intermittent hypoxia in obstructive sleep apnea.
The Maintenance of Wakefulness Test (MWT) is a widely used objective measure of daytime alertness, especially in patients with sleep disorders at increased risk of accidents. Anxiety and depression are common in this population and may influence subjective sleepiness and objective alertness. This study aimed to assess the relationship between acute emotional states, including state anxiety, as well as chronic anxiety and depression, with objective alertness measured by the MWT, alongside subjective sleepiness. In this prospective single-centre study, 100 patients undergoing polysomnography and MWT completed validated questionnaires including the State (STAI-A) and Trait (STAI-B) Anxiety Inventory, Hospital Anxiety (HAD-A) and Depression (HAD-D) scale, Epworth Sleepiness Scale (ESS) and the Self-Assessment Manikin (SAM) for acute emotional states. Correlations and regression analyses examined the relationships of anxiety, depression and emotional states with objective alertness and subjective sleepiness. The mean age was 44.8 ± 11.2 years; 75% patients were treated for sleep apnea and 25% for central disorders of hypersomnolence. STAI-B and HAD-A showed mild negative correlations with mean sleep latency on MWT (ρ≈-0.21 to -0.25, p < 0.05), whereas STAI-A, SAM and HAD-D did not. STAI-B, HAD-A and HAD-D positively correlated with subjective sleepiness (ESS) (ρ≈0.23 to 0.38, p < 0.05). Univariate logistic regression identified STAI-B but not STAI-A as a significant independent predictor of MWT sleep onset among emotional, anxiety and depression variables. Chronic, but not acute, anxiety is linked to reduced residual objective alertness and increased subjective sleepiness, underscoring the need to assess and manage anxiety in patients with hypersomnolence.
Sleep medicine relies on patient-reported outcome measures (PROMs) to complement clinical interviews and objective sleep tests. Available sleep questionnaires focus on isolated symptoms or single disorders, limiting their ability to capture the complexity of sleep conditions. Also, many PROMs remain poorly validated. The European Sleep Questionnaire (ESQ) is being developed as a generic transdiagnostic sleep PROM designed to address these limitations. By integrating relevant interview components, it aims to streamline clinical assessment and better reflect real-world phenotypes across the full spectrum of sleep disorders. The ESQ has been initiated within the EU-funded Sleep Revolution project and is still being developed through an iterative process. Its design is informed by a comprehensive literature review as well as expert and patient input. The ESQ prototype contains 119 items organized into nine sections and uses Likert-type scales to assess symptom severity, frequency, and bothersomeness over the past month. It is equipped with an additional module for follow-up assessment. It is translated into 17 languages and is digitally implemented to support multicenter studies. Initial validation includes cognitive interviews and evaluation of psychometric properties in patients with various sleep disorders. Item refinement and scoring key creation will guide the further development of the ESQ, after which it will be made available for public use. The ESQ aims to support personalized clinical diagnosis and appraisal of treatment results. Future research will extend into other sleep disorders and specific populations, strengthening the ESQ as a comprehensive tool for clinical practice, research, and preventive strategies.
Sleep problems are increasingly prevalent in society. One group that is disproportionately affected includes transgender and non-binary individuals, whose sex assigned at birth does not match their identified gender. This mismatch can lead to gender minority stress and increases the risk of mental disorders. However, research on sleep in this population remains extremely limited, especially when considering potential effects of gender-affirming care, including gender-affirming hormone therapy. Therefore, we conducted an anonymous, Germany-wide online study with 469 trans and non-binary individuals to investigate sleep quality and insomnia severity using standardised questionnaires, accounting for structural and psychosocial factors. Poor sleep quality and subclinical insomnia were highly prevalent, at levels two to four times higher than published cisgender population benchmarks. Sleep quality and insomnia severity scores were worse in non-binary individuals than in trans women. Transition options did not significantly impact sleep quality and insomnia severity scores, whereas psychosocial factors explained substantially more variance than structural variables or gender identity alone. Additionally, people using feminising hormone treatment had lower insomnia severity scores than those not using hormone treatment. Trans women woke up significantly more often due to nocturia, whereas trans men and non-binary individuals had more sleep initiation problems. Non-binary individuals used sleep medication significantly more often than binary trans individuals. Over 30% of the participants experienced frequent sleep maintenance problems. This cross-sectional study found alarming rates of poor sleep and insomnia among trans and non-binary individuals. Future studies should further investigate and address potential moderating factors underlying poor sleep in this population.
