Objectif Évaluer si une perfusion nocturne d’apomorphine, un agoniste dopaminergique, peut moduler les caractéristiques des ondes lentes du sommeil lent chez des patients parkinsoniens insomniaques. Méthodes Étude ancillaire d’un essai randomisé, multicentrique, en double aveugle et en cross-over (apomorphine nocturne vs placebo). Trente-trois participants ont bénéficié de deux polysomnographies en fin de période de traitement. Les ondes lentes, définies par une amplitude ≥10μV, ont été analysées dans les stades N2 et N3 combinés, au niveau des régions frontale et centrale. Les paramètres étudiés étaient l’amplitude, la durée, la pente et la densité (nombre d’ondes lentes/heure). Les comparaisons ont été réalisées à l’aide de modèles linéaires mixtes (effets fixes : traitement, nuit, séquence ; effet aléatoire : sujet). Des corrélations cliniques ont été explorées avec le test de Spearman. Résultats Sous apomorphine, les ondes lentes présentaient des modifications significatives de leur morphologie, avec notamment une tendance à une pente plus faible, une durée plus longue et une densité réduite, en frontal comme en central. L’amplitude apparaissait globalement diminuée, avec des variations régionales. Par ailleurs, certaines caractéristiques des ondes lentes, en particulier leur durée, étaient associées à une sévérité accrue de l’insomnie et à une perception altérée de la qualité du sommeil. Conclusion Chez les patients parkinsoniens insomniaques, l’administration nocturne d’apomorphine influence la dynamique des ondes lentes. Ces résultats suggèrent un effet spécifique de la stimulation dopaminergique sur le sommeil lent. L’association entre la durée des ondes lentes, la sévérité de l’insomnie et la qualité perçue du sommeil souligne l’importance de poursuivre ces analyses pour mieux comprendre le lien entre perception du sommeil et caractéristiques polysomnographiques.

Context The hypersomnolence disorder diagnostic criteria of the DSM-5-TR rely on the report of a ‘hypersomnolence’ syndrome, without defining the term or proposing any measuring tool to assess this. Among the vast diversity of tools to measure hypersomnolence, the Hypersomnia Severity Index (HSI) has been specifically designed to account for the multidimensionality of hypersomnolence. Showing good psychometric validity in two previous validation studies, the HSI has never been validated against the gold-standard Multiple Sleep Latency Test (MSLT). Objective This preliminary study aims to validate the French version of the HSI and to provide a first exploration of the link between HSI and the MSLT in a group of French subjects clinically diagnosed with hypersomnolence disorders. In addition, we propose an original visualization of the dimensions of the HSI. Method This study is a secondary analysis of a cohort of 34 patients diagnosed with hypersomnolence disorders without comorbidity. They underwent a MSLT and filled out the French version HSI as well as classical sleep medicine questionnaires. The HSI has undergone a rigorous translation and psychometric validation, which we compare with two previous psychometric validation studies. Results We obtained the same level of psychometric validity as previous studies, validating our French version on a population of patients with hypersomnolence disorder. However, we did not find any correlation between the HSI and the MSLT. Nevertheless, the dimensional approach offered by the HSI combined with our data visualization provide a valuable tool for sleep medicine clinical practice and research.

La prise en compte du sexe et du genre en médecine du sommeil demeure limitée, avec une sous-représentation des femmes dans les études cliniques et des biais diagnostiques et thérapeutiques encore fréquents. Dans le champ des hypersomnies centrales (HC), ces enjeux sont particulièrement importants. Sur le plan épidémiologique, la distribution selon le sexe varie selon les entités nosologiques. La narcolepsie de type 1 (NT1) présente globalement un sex-ratio équilibré, tandis que l’hypersomnie idiopathique (HI) touche majoritairement les femmes et que le syndrome de Kleine-Levin (SKL) est plus fréquent chez les hommes. Ces différences soulèvent la question de mécanismes physiopathologiques distincts, mais aussi de possibles biais diagnostiques. Cliniquement, certaines dimensions symptomatiques apparaissent plus marquées chez les femmes atteintes d’HC, notamment la fatigue, l’inertie du sommeil et les plaintes cognitives. De plus, la prévalence des comorbidités anxiodépressives est plus élevée. Ces éléments peuvent complexifier l’évaluation diagnostique et contribuer à des délais de prise en charge plus longs. La stratégie thérapeutique doit intégrer des enjeux spécifiques aux femmes, en particulier les interactions médicamenteuses avec la contraception hormonale, l’anticipation des projets de grossesse et les adaptations nécessaires lors des périodes de vulnérabilité fonctionnelle, comme la grossesse sans traitement ou le post-partum. Enfin, les fluctuations symptomatiques liées au cycle menstruel, à la grossesse et à la ménopause constituent des périodes clés encore insuffisamment explorées. Une approche intégrée, tenant compte des dimensions biologiques, psychologiques et sociales, est indispensable pour améliorer la compréhension des hypersomnies centrales et proposer une prise en charge personnalisée chez les femmes.

The Hypersomnia Severity Index (HSI) is a self-report instrument assessing hypersomnolence using a dimensional approach based on two factors: symptoms and distress/impairment. This study aimed to translate, adapt, and validate the French version of the HSI in a large quota-based sample of the French general population, and to propose an original dimensional visualization of hypersomnolence profiles. Following a forward–backward translation procedure, the French HSI was administered to 1000 adults aged 18–65 from the general French population. Internal consistency and structural validity were assessed using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) when necessary. External validity was examined through correlations with validated self-report measures of hypersomnolence and sleep-related parameters. An original polar chart visualization was developed to represent item-level HSI profiles. The French HSI demonstrated good internal consistency (Cronbach’s α = 0.82). CFA did not confirm an adequate fit for the original two-factor model. EFA confirmed the distress/impairment factor but split the symptoms factor into two subfactors, labeled “sleepiness symptoms” and “alertness symptoms.” HSI scores were significantly correlated with established hypersomnolence and sleep-related measures, supporting convergent validity. Polar chart visualizations revealed distinct symptom patterns across subgroups, supporting the identification of dimensional hypersomnolence symptom profiles. The French version of the HSI is a reliable and clinically meaningful instrument for the dimensional assessment of hypersomnolence. Its cross-cultural validation supports its use in research and clinical practice. The HSI provides a multidimensional and easily administered measure, with potential utility for symptom profiling and monitoring hypersomnolence. Future studies should examine its longitudinal sensitivity and prognostic value.

STUDY OBJECTIVES:Narcolepsy type 1 (NT1) is increasingly recognized as a multidimensional disorder in which psychiatric and psychosocial difficulties contribute to disability. Yet little is known about how these difficulties are perceived by patients compared with close informants. This study examined discrepancies between self-reported and informant-reported psychobehavioral symptoms in adults with NT1. METHODS:Within the multicenter French NarcoScol-NarcoVitae cross-sectional case-control study, 174 adults with NT1 (18-58 years) and 126 age- and sex-matched non-relative controls completed the Adult Self-Report (ASR), a standardized measure of adult psychobehavioral problems. A close informant completed the parallel Adult Behavior Checklist (ABCL), yielding 97 NT1 and 96 control ASR-ABCL dyads. T-scores were computed for internalizing and externalizing scales, and the total problems score. Between-group differences (NT1 vs non-relative controls) and within-individual discrepancies between self- and informant-reported symptoms were analyzed. Narcolepsy severity (NSS), sleepiness (ESS), age at diagnosis, and a composite professional prognosis score were compared across concordant and discordant dyads. RESULTS:Patients with NT1 reported significantly higher psychiatric symptom severity than controls across all ASR scales, with 44.8% versus 19.1% in the clinical range for internalizing difficulties. Informants generally rated patients' symptom severity as lower than patients' self-reports, particularly for internalizing symptoms. Discordant dyads in which informants rated internalizing symptoms as more severe than patients were characterized by lower NT1 symptom burden (NSS). Concordant patient-informant evaluations were associated with a more favorable professional prognosis. CONCLUSION:Adults with NT1 report substantial psychobehavioral impairments that are not consistently identified by close informants, especially internalizing difficulties. This perception gap highlights the complementary value of patient and informant perspectives and calls for improved recognition of less visible symptoms within patients' close environment. CLINICAL TRIALS:NCT03765892.

Objectif Traduction française et validation psychométrique de l’HSI en population générale. Identification des facteurs prédictifs des différentes dimensions de l’hypersomnolence avec proposition d’une visualisation originale des scores pour identifier des profils symptomatiques. Méthodes Étude transversale prospective menée auprès d’un échantillon représentatif de 1000 adultes français (18–65 ans, 50 % de femmes). La traduction de l’HSI a suivi un protocole de rétro-traduction validé par l’auteure originale. Les participants ont complété l’HSI (9 items, score 0–36), l’échelle d’Epworth pour la somnolence, la Bordeaux Sleepiness Scale pour le risque accidentel, la Patient Health-Questionnaire-4 pour l’anxiété et la dépression. La validité interne a été testée par l’alpha de Cronbach et les corrélations des items avec le score global (IRC). La structure a été étudiée par analyse confirmatoire (CFA) puis exploratoire (EFA) en cas de résultats non satisfaisants. La validité externe a été évaluée par validité convergente et discriminante et des courbes ROC ont été générées afin d’évaluer la capacité de la HSI (seuil proposé≥11) à prédire la somnolence diurne excessive (ESS≥11) et le risque accidentel (BOSS≥3). Enfin une visualisation originale des profils d’hypersomnolence a été développée via un graphique polaire. Résultats L’HSI présentait une bonne cohérence interne (α=0,82 ; IRC 0,30–0,70) (Fig. 1). Trois items (1, 3, 9) montraient un effet plancher (> 50 % de réponse). La CFA n’a pas confirmé le modèle à deux facteurs. L’EFA a identifié trois dimensions : F1a (items 1, 3, 9, symptômes rares), F1b (items 2, 4, symptômes communs) et F2 (items 5, 6, 7, 8, retentissement). La validité externe était satisfaisante (corrélations faibles à modérées avec la somnolence et le risque accidentel) et les analyses ROC confirmaient un seuil≥11. Les principaux facteurs prédictifs retrouvés étaient cohérents avec la littérature tout en faisant émerger des divergences entre les sous-groupes. Les visualisations graphiques générées ont ainsi mis en évidence des profils d’hypersomnolence distincts. Conclusion Cette étude valide pour la première fois la version française de l’HSI en population générale qui apparaît comme un outil robuste et cliniquement pertinent pour évaluer de manière dimensionnelle l’hypersomnolence et adapté pour une utilisation en pratique clinique comme en recherche.

To explore the effect of PuM and combined PuM/ANT DBS on sleep in drug-resistant epilepsy (DRE). We retrospectively collected data from DRE patients with PuM-DBS or combined PuM/ANT-DBS and at least one night of EEG recording. Visual scoring of the whole night and quantitative power spectrum analysis on the first and last NREM sleep cycles were performed. We compared sleep characteristics of intra- and inter-patients with PuM-DBS and combined PuM/ANT-DBS. Five nights were analyzed across three patients. Patient 1 underwent three sequential nights with different DBS settings: ANT + /PuM + , ANT + /PuM-, and ANT + /PuM + . ANT-DBS, either alone or in combination, was associated with disrupted sleep architecture, particularly in the latter part of the night. Visual staging showed no clear differences over the nights. Quantitative analysis however showed a worst sleep architecture in the last NREM cycle, as disclosed by a lower normalized delta power, in the second night (ANT + /PuM-) compared with the first and third nights (ANT + /PuM +). In patients with PuM-DBS alone, in cyclic or continuous stimulation modalities, sleep structure appeared preserved, with normal sleep efficiency and a normalized delta power higher than that of patient one. PuM-DBS, compared to ANT-DBS, appeared not to disrupt sleep architecture.

OBJECTIVE:This work was undertaken to study the association between vagus nerve stimulation (VNS) parameters and the apnea-hypopnea index (AHI) measured by polysomnography in patients with drug-resistant epilepsy. METHODS:Patients with epilepsy who underwent polysomnography with an active VNS device between 2018 and 2023 were retrospectively included. VNS output current and cycle speed, defined as the interval between two stimulation-ON (Stim-ON) periods, were correlated with AHI. Demographic, clinical, and polysomnography characteristics were compared between patients with low (≤1.5 mA) or high (>1.5 mA) output current, and between patients with slow VNS cycle (interval between two Stim-ON of >108 s) and fast cycle (interval between two Stim-ON of ≤108 s). Multiadjusted linear regression analysis was performed. RESULTS:Twenty-two patients were included. Output current significantly correlated with AHI, but no difference was found between patients with low versus high output current. Patients with a fast VNS cycle had a significantly higher AHI than patients with a slow VNS cycle. After adjustment for age, number of antiseizure medications, body mass index, and gender, only the cycle speed remained significant, with no significant association with output current. SIGNIFICANCE:Cycle speed, defined as a short interval between two stimulations, is associated with increased sleep-related respiratory events in patients with epilepsy treated with VNS. Increasing the duration between two stimulations may help clinicians to reduce VNS-induced sleep-related breathing disorder.

Objective Memory impairment is a frequent comorbidity of focal epilepsy, incompletely explained by seizure frequency or structural pathology. Ictal and postictal hippocampal dysfunction disrupt memory processes, but their cumulative impact remains poorly quantified. This study introduces cumulative hippocampal seizure-related burden metrics and examines their association with long-term memory consolidation. Methods Twenty consecutive patients undergoing stereo-EEG in Marseille (2016-2018) were prospectively included. Continuous stereo-EEG recordings between two memory assessments (30 minutes and one week post-encoding) were analysed. Hippocampal ictal involvement and durations were assessed using epileptogenicity markers and visual stereo-EEG analysis. The postictal period was quantified using permutation entropy. Cumulative hippocampal seizure-related burden metrics (ictal, postictal and combined: c-HipSZB) were computed across hippocampus-involving ictal events. Verbal and visual memory were assessed using standardized recall and recognition tasks. Associations were examined using univariate and multivariate analyses. Results Higher dominant-hemisphere hippocampal burden was associated with poorer one-week verbal memory (performance and retention), independently of most covariates. Higher c-HipSZB was associated with lower total recall performance (RT; free + cued) and RT retention (β = -25.04 and -23.88; R2 = 0.57 and 0.53; p < 0.05) and accounted for the greatest variance in both outcomes (adjusted R2= 0.59 and 0.53; β = -25.45 and -24.27; p < 0.01), particularly when adjusting for epilepsy duration. No robust associations were observed between non-dominant-hemisphere hippocampal seizure-related burden metrics and visual memory. Effects predominantly involved recall. Interpretation Cumulative ictal-postictal hippocampal dysfunction is a major determinant of impaired long-term verbal memory consolidation in focal epilepsy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The project leading to this publication has received support from the French government under the France 2030 investment plan managed by the French National Research Agency (reference: ANR-16-CONV000X/ANR-17-EURE-0029), from Excellence Initiative of Aix-Marseille University (AMX-19-IET-004) and from the VESTISELF project (Reference: ANR-19-CE37-0027). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study complied with the Declaration of Helsinki. All participants provided written informed consent and the protocol was approved by the French Institute of Health (IRB-15226). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The AnyWave software and dedicated plug-ins (Epileptogenicity Index - EI and Connectivity Epileptogenicity Index - cEI) are freely available at https://meg.univ-amu.fr/AnyWave/download.html and https://meg.univ-amu.fr/doku.php?id=plugins:ei. The Virtual Epileptic Patient (VEP) brain atlas parcellation is available open source at https://ins-amu.fr/vep-atlas. The Permutation Entropy plug-in, the Postictal Alteration Time code and the datasets generated and analysed during the current study are available from the corresponding author upon reasonable request. Agence Nationale de la Recherche, ANR-16-CONV000X/ANR-17-EURE-0029, ANR-19-CE37-0027 Excellence Initiative of Aix-Marseille University, AMX-19-IET-004

Accurate diagnostic boundaries between normal and pathological sleep are essential for appropriate care. Among diagnostic criteria, the "Not Better Explained" (NBE) exclusion criterion prevents misclassification by ensuring that symptoms are not attributable to another disorder. Despite its importance, the NBE criterion has never been systematically analysed across the International Classification of Sleep Disorders-Third Edition Text Revision (ICSD-3-TR) and the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition Text Revision (DSM-5-TR). A systematic content analysis was conducted using a validated methodology for diagnostic criteria evaluation. Ten major sleep disorders were selected based on prevalence and clinical relevance. For each disorder in both classifications, NBE formulations were identified, extracted, and categorised by excluded condition and causal wording. The Jaccard index quantified overlap, and visualisations compared exclusion patterns. The ICSD-3-TR included the NBE criterion in 9 of 10 disorders, whereas the DSM-5-TR included it in 7 of 10. Overall overlap was strong (Jaccard index = 0.75). Differences were mainly semantic. The ICSD-3-TR more often excluded "sleep disorders," "substance use," and "sleep behaviours," while the DSM-5-TR emphasised "medical" and "mental disorders." The ICSD-3-TR predominantly used "not better explained," whereas the DSM-5-TR employed more variable formulations ("not attributable," "not adequately explained"…). By highlighting the strengths and inconsistencies in the use of the NBE criterion, we aim to contribute to a more empirically and conceptually grounded framework for sleep disorder diagnosis. Our work aims to inform ongoing efforts to improve the reliability, validity, and clinical utility of diagnostic classifications in sleep medicine.

Objectif La narcolepsie de type 1 (NT1) est une hypersomnolence centrale liée à un déficit en orexine. Les études post-mortem ont montré une perte de neurones à orexine localisée dans l’hypothalamus. Nous avons étudié le volume et les propriétés microstructurales des noyaux hypothalamiques chez des patients atteints de NT1, comparés à des témoins appariés. Méthodes Douze patients présentant une NT1 confirmée par un taux d’orexine dans le liquide céphalorachidien<110pg/mL et 24 témoins sains appariés sur l’âge et le sexe ont été étudiés in vivo par Imagerie par Résonance Magnétique quantitative T1 à haut champ 7 Tesla (voxel isotrope 0,6mm). La segmentation des noyaux hypothalamiques a été réalisées à l’aide de l’atlas développé par Neudorfer et al. Les volumes ont été ajustés au volume cérébral total. Les volumes et les valeurs de relaxation T1 sont exprimés en Z-scores, calculés sur la base des témoins. Résultats Les patients NT1 présentent une réduction significative du volume de la région hypothalamique antérieure droite (Z-score : −0,76±0,62, p=0,038), incluant les noyaux paraventriculaire, périventriculaire, antérieur, suprachiasmatique et supraoptique. En revanche, les noyaux antérieurement décrits comme contenant des neurones à orexine, tels que l’hypothalamus latéral et le noyau tubéromamillaire, ne montrent pas de différence volumétrique entre patients et témoins. Concernant les mesures microstructurales, le noyau dorso-périventriculaire gauche présente une valeur T1 significativement plus basse chez les patients NT1 (Z-score : −0,85±1,08, p=0,026) et comportant une corrélation négative avec la durée de la maladie (ρ de Spearman=−0,82, p=0,002), ce qui pourrait refléter une accumulation de dépôts de fer liée à une perte neuronale dans ce noyau. Conclusion La NT1 semble être associée à des altérations micro et macrostructurales significatives des noyaux hypothalamiques, touchant principalement la région antérieure de l’hypothalamus, incluant des noyaux impliqués notamment dans la régulation circadienne et la prise alimentaire.

OBJECTIVE:Memory impairment is a frequent comorbidity of focal epilepsy, incompletely explained by seizure frequency or structural pathology. Ictal and postictal hippocampal dysfunction disrupt memory processes, but their cumulative impact remains poorly quantified. This study introduces cumulative hippocampal seizure-related burden metrics and examines their association with long-term memory consolidation. METHODS:A total of 20 consecutive patients undergoing stereo-electroencephalography in Marseille (2016-2018) were prospectively included. Continuous stereo-electroencephalogram recordings between 2 memory assessments (30 minutes and 1 week postencoding) were analyzed. Hippocampal ictal involvement and durations were assessed using epileptogenicity markers and visual stereo-electroencephalogram analysis. The postictal period was quantified using permutation entropy. Cumulative hippocampal seizure-related burden metrics (ictal, postictal, and combined) were computed across hippocampus-involving ictal events. Verbal and visual memory were assessed using standardized recall and recognition tasks. One-week performance was defined as the percentage score obtained at the 1-week assessment, whereas retention was defined as 1-week performance expressed as a percentage of 30-min performance. Associations were examined using univariate and multivariate analyses. RESULTS:Higher dominant-hemisphere hippocampal burden was associated with poorer 1-week verbal memory (performance and retention), independently of most covariates. Higher cumulative hippocampal seizure-related burden was associated with lower total recall performance (free + cued) and total recall retention (β = -25.04 and -23.88; R2 = 0.57 and 0.53; p < 0.05), and accounted for the greatest variance in both outcomes (adjusted R2 = 0.59 and 0.53; β = -25.45 and -24.27; p < 0.01), particularly when adjusting for epilepsy duration. No robust associations were observed between nondominant-hemisphere hippocampal seizure-related burden metrics and visual memory. Effects predominantly involved recall. INTERPRETATION:Cumulative ictal-postictal hippocampal dysfunction is a major predictor of impaired long-term verbal memory consolidation in focal epilepsy. ANN NEUROL 2026.

Le médecin du sommeil est fréquemment amené au cours de sa consultation : (i) à évaluer le risque accidentel en lien avec l’hypersomnolence, (ii) à informer le patient de son risque accidentel majoré et du cadre médico-légal relié, (iii) à faciliter le lien entre patient et médecin agréé par la préfecture pour le contrôle médical de l’aptitude à la conduite et le service de santé au travail lorsque le patient est amené à conduire dans le cadre professionnel. Pour aider le médecin du sommeil dans sa pratique, nous avons réalisé une analyse légale et réglementaire, un état des lieux des pratiques des centres de référence et de compétence maladies rares « narcolepsies et hypersomnies rares », et une concertation avec des médecins de santé au travail et de juristes spécialisés dans le droit de la santé. Sa caractérisation repose sur l’évaluation de l’hypersomnolence, du terrain et du niveau d’exposition. Aucun examen complémentaire n’est indispensable pour l’évaluation initiale, avant la prise en charge thérapeutique, mais un test de maintien de l’éveil (TME) peut être réalisé. S’il n’y a pas de sur-risque accidentel en lien avec l’hypersomnolence, le médecin le notifie dans son courrier de consultation et n’informe pas nécessairement le patient de la réglementation. Dans le cas contraire, l’information du risque au patient doit être transcrite dans le courrier de la consultation, remise en main propre et/ou par voie postale au patient, mentionner le risque accidentel majoré en lien avec l’hypersomnolence et la nécessité de consulter sans délai le médecin agréé, et si nécessaire le service de santé au travail et de prévenir son employeur. Le permis reste théoriquement valide jusqu’à l’avis du médecin agréé transmis à la préfecture, mais le patient engage sa responsabilité individuelle. L’interruption de la conduite est conseillée (mais non imposée) en particulier en cas de risque évalué comme sévère. La déclaration d’inaptitude, l’interdiction de conduite et/ou la rédaction de tout certificat médical limitant la conduite revient au médecin agréé. L’arrêt de travail est réservé aux situations rapidement réversibles, d’urgence évidente, et/ou de mauvaise compréhension. Le médecin du sommeil transmet son évaluation du risque accidentel au médecin agréé et si nécessaire au service de santé au travail par le biais du patient en respect du secret médical. Le TME est légalement requis pour la réévaluation du risque accidentel suite à la mise en place des mesures thérapeutiques requises et doit être répété annuellement pour les permis de conduire des véhicules lourds et tous les 3 ans pour les permis de véhicule léger. Des recherches sont encore nécessaires pour optimiser les stratégies d’évaluation et de la prise en charge du risque accidentel en lien avec l’hypersomnolence qui bénéficieront au patient et à la sécurité routière tout en veillant à limiter les conséquences handicapantes et professionnelles liées à la restriction de la conduite automobile.

Objectif Les manifestations dissociatives psychogènes associées au sommeil ont été relativement peu étudiées mais peuvent néanmoins constituer un motif de consultation pour une plainte de trouble du sommeil ou de l’éveil. L’objectif de cette étude est de décrire les caractéristiques cliniques et polysomnographiques des patients et de décrire les caractéristiques électro-cliniques des manifestations à expression « sommeil ». Méthodes Ont été rétrospectivement inclus les patients explorés au centre du sommeil d’un CHU entre 2016 et 2024, pour lesquels les manifestations dissociatives ont fait l’objet d’une diagnostic positif (clinique et éventuellement électrophysiologique). Le motif de consultation, les caractéristiques cliniques et électrophysiologiques (polysomnographies et TILE) ont été rapportées, ainsi que les caractéristiques cliniques et électrophysiologiques des manifestations dissociatives. Résultats Onze patients (8 femmes) avec un âge moyen de 41 ans ont été inclus. Le motif de consultation principal était une plainte de somnolence diurne excessive chez tous les patients. Chez près de deux tiers d’entre eux (7/11), une plainte d’insomnie était également associée et chez 6/11 une plainte de parasomnie. L’ESS moyen était de 15,3 (ET 4,5) avec 10/11 patients ayant un score>10. Aucun patient n’avait de SAHOS sévère ni de mouvements périodiques du sommeil et 1/11 avait une efficacité du sommeil<85 %. La latence moyenne au TILE était supérieure à 8min chez l’ensemble des patients, entre 8 et 10min chez un patient. Chez 6/11 patients, les manifestations dissociatives objectivées avaient une expression clinique pouvant évoquer un trouble hypersomnolence : accès brutaux d’endormissement (3/11) ou inertie du sommeil matinale (1/11), associées à un enregistrement polysomnographique concomitant mettant en évidence une activité d’éveil calme (« pseudosleep »), ou manifestations hypotoniques ayant fait suspecter des cataplexies (2/11). Au total, 6/11 patients associaient plusieurs types de manifestations dissociatives. Conclusion La plainte de somnolence diurne excessive était le motif principal de consultation chez nos patients, ce qui contrastait avec l’absence de latence anormale au TILE chez l’ensemble des patients. Près de la moitié des manifestations dissociatives pouvaient orienter vers un trouble hypersomnolence à la fois sous forme d’accès de sommeil psychogènes ou lors du réveil (inertie psychogène).

Objectives: In this multi-center cross-sectional study, we compared substance use patterns (SUPs) between patients with narcolepsy type 1 (NT1) and controls, and investigated, among patients, factors associated with the consumption of the main psychoactive substances. Methods: Adult patients with NT1 and controls completed questionnaires about tobacco, alcohol, and cannabis use patterns. Unadjusted bivariable then multivariate analyses (adjusted for sex, age, education, family status, and depression) were performed to compare SUPs between controls and patients, and to explore sociodemographic, psycho-behavioral, and clinical determinants of consumptions. Results: We included 235 patients (63.8 % women, 36.4 +/- 14.7 years) and 166 controls (69.9 % women, 40.3 +/- 14.4 years). Substances co-consumptions were frequent in both groups. Patients with NT1 were more frequently current smokers (32.3 % vs. 20.1 %, p < 0.01) ore-cigarettes users (12.1 % vs 2.4 %, p < 0.001) than controls, while no difference was observed for cannabis use and alcohol misuse. Only the increased likelihood of vaping remained significant in adjusted analysis. Among NT1 patients, smoking was associated with disrupted nighttime sleep (OR[95%CI] = 2.28[1.02-5.12], p < 0.05) and less obesity (OR = 0.24[0.09-0.59], p < 0.05). Alcohol misuse was associated with sleep paralysis (OR = 2.11[1.13-3.91], p < 0.05) and treatments (modafinil: OR = 2.14[1.15-4.01], p < 0.05; sodium oxybate: OR = 0.41[0.17-0.97], p < 0.05). Tobacco and cannabis consumptions were associated with lower physical activity (OR = 0.46 [0.24-0.87], p < 0.05 and OR = 0.25 [0.10-0.66], p < 0.01). Alcohol misuse and cannabis use were associated with rule breaking behaviors (OR = 5.89[1.61-21.60], p < 0.05 and OR = 8.52[1.79-40.48], p = 0.01). Conclusion: Patients with NT1 do not seem less vulnerable to psychoactive substance use/misuse. Consumptions patterns are associated with multiple dimensions of the disease including sleep-related symptoms, comorbidities, treatments, and psycho-behavioral factors.

This multicenter comparative cross-sectional study aimed to describe educational and occupational pathways, quantify effort/reward imbalance at work, and identify factors associated with professional prognosis in patients with narcolepsy type 1. Adult patients with narcolepsy type 1 and controls answered online questionnaires (Epworth Sleepiness Scale, Beck Depression Inventory II, Siegrist questionnaire, adult self-report, and a questionnaire on academic and professional trajectories) and were compared using sex- and age-adjusted logistic regressions. Clinical, demographic, and psycho-social factors associated with patients’ professional prognosis, as assessed by a composite score based on occupational-related outcomes, were explored with a generalized linear model. We included 235 patients (63.8 Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: NARCOSCOL-NARCOVITAE; URL: https://clinicaltrials.gov/study/NCT03765892 ; Identifier: NCT03765892. Peter-Derex L, Fort E, Putois B, et al. Effort/reward imbalance and comorbidities burden in academic and professional careers of patients with narcolepsy type 1. J Clin Sleep Med. 2025;21(6):983–997.

Epilepsy is a cortico-subcortical network disease. Thalamo-cortical relationships in focal epilepsies, studied by stereoelectroencephalography in complex patients during pre-surgical evaluation, might help refine epilepsy surgery prognostic indicators and patient-specific treatments (i.e. thalamic deep brain stimulation). To this aim, we studied interictal thalamic traces, during rest and sleep recordings, in a cohort of 121 patients, delving into thalamo-cortical connectivity, hyperexcitability biomarkers and their correlation with treatment outcome. We retrospectively gathered stereoelectroencephalography recordings and clinical variables from patients who underwent stereoelectroencephalography with mainly a posterior-thalamic implantation, aiming at the pulvinar. Interictal recordings during rest and sleep were analysed to detect spikes and fast ripples automatically. Functional connectivity between the thalamus and other brain regions (involved or non-involved in the epileptogenic network) was examined using linear regression analysis. Higher thalamic hyperexcitability biomarker rates during sleep were linked to unfavourable surgical outcomes (Engel Class III/IV) compared to favourable outcomes (Engel Class I/II) (spikes: N = 117, P = 0.009, effect size = 0.25; fast ripples: N = 17, P = 0.036, effect size = 0.52). Thalamo-cortical functional connectivity analysis revealed heightened thalamic strength, particularly in the beta (P < 0.001, effect size = 0.38) and gamma (P = 0.012, effect size = 0.24) bands during sleep, among patients with poor surgical outcomes, especially with non-involved networks. Conversely, during rest, lower hyperexcitability biomarkers (spikes r = -0.2, P = 0.048; fast ripples r = -0.52, P = 0.045) and lower values of thalamic strength (delta band r = -0.28, P = 0.025; broadband r = -0.23, P = 0.01) were observed in patients with longer epilepsy duration. Furthermore, thalamic strength values during rest were lower in patients of older age (broadband r = -0.19, P = 0.045). These findings confirmed the important role of the thalamus in focal epilepsy. According to this exploratory group-level study, thalamic recordings could potentially improve pre-surgical assessment and help identify patients who may have a less severe outcome. Additionally, diminished thalamic activity and connectivity associated with epilepsy duration and age prompt speculation on the role of thalamo-cortical interactions in ageing-related physiological and pathological processes.

ObjectifÉtudier l’apport du maintien des capteurs respiratoires et moteurs lors de la deuxième nuit d’enregistrement prolongé (en condition BEDREST) pour diagnostiquer et évaluer la sévérité du syndrome d’apnées/hypopnées obstructives du sommeil (SAHOS) et des mouvements périodiques des jambes pendant le sommeil (MPJS).MéthodesNous avons rétrospectivement inclus les bilans réalisés du 21/08/2019 au 28/06/2023 selon un protocole Polysomnographie-TILE-BEDREST de patients rapportant une hypersomnolence sans point d’appel pour un SAHOS ou un trouble moteur du sommeil (centre de compétences hypersomnies rares). Le pourcentage de changement de stades de sévérité inter-nuits du SAHOS et des MPJS selon les seuils d’IAH de 0, 5, 15 et 30/h et le seuil de 15/h pour l’index de MPJS a été calculé.Résultats181 bilans ont été inclus. Sur 179 bilans (2 exclus), la prévalence de SAHOS modéré et sévère était comparable sur les deux nuits (31 bilans, soit 17.3 %). On retrouvait un changement de stade de sévérité du SAHOS inter-nuits dans 44 bilans (24,6 %) avec un passage à un stade plus sévère la deuxième nuit dans 21 bilans (11 %) : 13 à un stade léger, 5 à un stade modéré et 3 à un stade sévère. Sur 177 bilans (4 exclus), les MPJS atteignaient le seuil de 15/h au cours d’une des deux nuits dans 18 bilans (10,2 %) dont 11 bilans (6,2 %) au cours de la 22 nuit.ConclusionLe maintien des capteurs respiratoires et moteurs au cours de l’enregistrement continu des protocoles d’évaluation de l’hypersomnolence peut améliorer la rentabilité diagnostique et modifier la prise en charge thérapeutique des patients.

Background and objectives Narcolepsy type 1 (NT1) is a chronic, disabling neurological disease. Sleep-related symptoms and comorbidities such as psycho-cognitive disturbances, and a frequent childhood onset of the disease may negatively impact patients’ career. We conducted a multicentric comparative cross-sectional study in Reference/Competence Centers for Narcolepsy in France to investigate the educational and occupational paths of patients with NT1. Methods Between February 2020 and 2023, adult patients with NT1 regularly followed-up in the participating centers were invited to complete online questionnaires including the Epworth sleepiness Scale, Narcolepsy Severity Scale, Beck Depression Inventory II, Siegrist questionnaire, Adult Self-Report and Adult Behavior Checklist, and a customized questionnaire on academic and professional trajectories. Controls were selected from within the patients’ close circle. Comparisons were adjusted for sex and age, and the determinants of patients’ professional prognosis were quantified by a composite score including professional-related outcomes. Results Questionnaires were filled by 235 patients (63.8% women, 36.4±14.7 years, 86.5% treated, 66.4% with childhood onset) and 166 controls (69.9% women, 40.3±14.4 years). No difference was observed between patients and controls for grade repetition and graduation level distribution, but patients reported more interruptions in their scolarity which was considered difficult, with more absenteeism and lateness. No difference was observed for employment rate (69.5% vs 77.0%) and socio-professional category distribution, but income was lower in patients who reported more unwanted changes in position and part-time work, with increased effort-reward imbalance (OR=2.28 95% CI [1.20-4.33], p=0.01). Almost half of the patients benefited from an official disability recognition and 10.2% received invalidity benefits. Impaired professional prognosis was associated with depression (p<0.0001) and attention disorders (p=0.03), while being narcoleptic during schooling was a protective factor (p=0.02). Residual sleep-related symptoms were not significant predictors. Discussion Most patients with NT1 manage to achieve their careers goals, but at the cost of an effort/reward imbalance. Early diagnosis during childhood might allow a better adjustment to the disease. The critical role of co-morbidities in professional trajectories suggests that, in treated patients, psycho-cognitive disturbances have greater impact on daily functionning than sleep-related symptoms, and stresses the need to consider psycho-cognitivo-social dimensions in patient care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The project was founded by a research grant from the Rare Disease Foundation (2017). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The trial was approved by the Ethic Review Board (CPP Nord-Ouest I, France, 2018-A01586-49), and by the National Commission for Data Protection. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes