Expert panels have long recommended delayed school start-times (SSTs) as necessary for addressing widespread adolescent sleep loss; nevertheless, adoption of recommendations has been slow. The major goals of this umbrella review were to explore the consistency of review teams' recommendations while describing and assessing review quality. We used systematic procedures to identify five meta-analyses and four narrative reviews. Authors of all nine reviews concluded that adolescent sleep duration (ASD) likely increased when SSTs were later but usually recommended limited adoption. Reviewers' hesitancy to recommend widespread adoption reflected (a) the modest average sleep gains reported in two reviews that met all AMSTAR2 critical criteria for producing sound estimates of effectiveness, (b) the lack of evidence that gains in sleep were sustained, and (c) the limited quality of primary studies. Potential moderating factors (e.g., students' background, school type and size) were explored but little progress was made due to missing data; however geographic location was identified as a potential moderator of SSTs’ impact on ASD. Our results support the need for well-controlled local studies of SST delays that are guided by standard reporting protocols. We also recommend needs assessments to capture local sleep norms and unique community conditions. Registration: PROSPERO CRD42023373423.
Restless legs syndrome (RLS) is a sleep-related sensorimotor disorder affecting approximately 3% of adults worldwide. This review aims to synthesize current evidence on associations between RLS and major neurological conditions, provide an exploratory quantitative synthesis summarizing association patterns and heterogeneity, and identify priority mechanistic and clinical research gaps. Databases were searched from inception until August 2026. In our exploratory synthesis of 119 unique studies, RLS was significantly associated with Parkinson's disease (case-control OR 3.22, 95% CI 2.35–4.41; cohort RR 1.74, 95% CI 1.02–2.95), multiple sclerosis (OR 4.04, 95% CI 3.26–5.00), neuromyelitis optica spectrum disorder (OR 2.91, 95% CI 1.45–5.84), migraine or headache disorders (forward OR 2.72, 95% CI 2.19–3.38; reverse adjusted OR 1.53, 95% CI 1.36–1.73), peripheral neuropathy (OR 3.82, 95% CI 2.49–5.83), epilepsy (OR 2.11, 95% CI 1.58–2.82), and amyotrophic lateral sclerosis (OR 7.69, 95% CI 2.74–21.59). This work is an evidence-mapping review with exploratory pooling and is not intended as a definitive evidence synthesis. RLS is likely associated with neurodegenerative and other specific neurological conditions. Recognition of these associations may support earlier identification of comorbid conditions and targeted management strategies. However, the current evidence remains observational and heterogeneous.
