BACKGROUND:Nightmares can trigger stress responses and lead to insufficient or poor-quality sleep, which are associated with cardiometabolic diseases (CMD) and their risk factors. However, research on the association and underlying mechanisms between nightmares and CMD in the general population remains limited. METHOD:Data from three follow-ups of the CoLaus|PsyCoLaus study (Lausanne, Switzerland). Frequent nightmares were assessed through questionnaires, with additional ecological momentary assessment (EMA) in the second and third follow-ups. Salivary cortisol levels (as a biomarker of stress), and polysomnographic data including the pulse wave amplitude drops index (PWAD) were also analysed. RESULTS:Data from 4223, 2850 and 2009 participants from the first, second, and third follow-ups was analysed. Prevalence of frequent nightmares was 11.7%, 8.1% and 7.7% in the first, second, and third follow-ups, respectively. Across three follow-ups, the frequent nightmares group tended to present with higher body mass index and higher prevalence of hypertension and diabetes than the no-nightmare group. EMA data confirmed these findings: multivariable-adjusted odds ratio and (95% CI) for hypertension 2.53 (1.32-4.85) and 1.78 (0.92-3.41) in the second and third follow-ups, respectively. Polysomnography data showed that the frequent nightmares group had a significantly lower PWAD: multivariable adjusted mean ± SE 46.31 ± 1.34 vs. 52.02 ± 0.49. Salivary cortisol levels did not differ between the frequent nightmares and the no-nightmare groups. CONCLUSION:Frequent nightmares show a significant association with CMD, although this association should be confirmed. The underlying mechanisms are not fully explained by dysregulation of the hypothalamic-pituitary-adrenalaxis or autonomic nervous system alone.

This study assessed the prevalence, clinical correlates and polysomnographic features of insomnia symptoms in a population-based cohort (HypnoLaus, Lausanne, Switzerland). Data were obtained from 3947 participants (mean age 57.5 ± 10.5 years; range 40-82; 52.0% female). Insomnia symptoms were defined as difficulty initiating or maintaining sleep ≥ 3 nights/week during the past month or regular hypnotic use. Independent correlates of insomnia symptoms were examined using logistic regression. In the subset of 1718 participants who underwent polysomnography (performed 1.1 ± 0.9 years after insomnia symptom assessment), associations between insomnia symptoms and sleep variables were examined using linear regression models adjusted for age, sex, depression, anxiety and psychotropic use. Insomnia symptoms affected 32.0% of participants, and 4.2% of the total sample reported regular hypnotic use. Independent correlates included older age, female sex, lower education, dyslipidaemia, lower likelihood of current smoking, excessive alcohol consumption, depression, anxiety, psychotropic use and daytime sleepiness. Compared with those without symptoms, participants with insomnia showed shorter total sleep time, longer sleep onset latency, longer wake after sleep onset and lower sleep efficiency (all small effect sizes). Sleep microstructure analysis showed higher odds ratio product (ORP) values (in wake, NREM, and N2, and ORP-9), higher normalised EEG power, higher beta power and higher gamma power (all small effect sizes). Insomnia symptoms are highly prevalent in this population-based cohort and are linked to multiple sociodemographic and clinical factors. Polysomnographic findings indicate modest sleep macrostructural differences, whereas microstructural alterations, although subtle in magnitude, appeared more consistently associated with insomnia symptoms.

Background Data on how urbanisation and modern lifestyles affect sleep health in Africa are scarce. This study compared rural and urban populations in Benin to examine associations between residence and sleep quality, insomnia, chronotype, and rest–activity patterns. Methods In the population-based Benin Society and Sleep (BeSAS) study, adults aged ≥25 years were recruited from Tanve (rural village with limited electricity/digital devices) and nine urban Cotonou districts. Sleep quality and insomnia were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI); chronotype with the reduced Morningness–Eveningness Questionnaire. A subsample underwent 7-day wrist actigraphy (GENEActiv). Multivariable logistic regression examined correlates of poor sleep quality (PSQI >5) and insomnia, including residence, sociodemographic, behavioural, clinical, and environmental factors. Findings Among 2909 participants (1780/2909, 61·2% women; mean age 44·7 years [SD 14·5]), poor sleep quality was more frequent in rural than urban residents (668/1201, 55·6% vs 703/1708, 41·2%; p < 0·0001). Rural residence was associated with poor sleep quality (aOR 2·02, 95% CI 1·34–3·10; p = 0·001) after several adjustments. Morning chronotype was more common in rural residents (456/1201, 38·0% vs 259/1708, 15·2%; p < 0·0001). In the actigraphy subsample (n = 1079), rural residents showed slightly longer nocturnal sleep (6·8 h vs 6·5 h), higher wake-after-sleep-onset, similar efficiency, higher 24-h activity, greater relative amplitude, and lower intradaily variability, indicating stronger day–night rhythm contrast. Interpretation In West Africa, rural residence was associated with poorer subjective sleep despite longer sleep, preserved efficiency, and more robust circadian rhythms. These findings highlight environmental hardship and living conditions as critical determinants of sleep health in sub-Saharan Africa. Funding Ligue Pulmonaire Vaudoise, Switzerland.

Background A screening tool for obstructive sleep apnoea (OSA) is useful in low-income countries where it may be difficult to access sleep recordings. The objective of this study was to assess the performance of six screening scores compared with objective sleep recording. Methods This analysis is based on the “Benin Sleep and Society” (BeSAS) study, in which respiratory polygraphy (PG) was performed using a type III device and OSA screening questionnaires (STOP, STOP-Bang, Berlin, NOSAS [≥8 and ≥5), No-Apnea, GOAL) were administered to participants. PG-defined OSA severity categories were defined according to the apnoea-hypopnoea index (AHI): mild (AHI 5 to <15/h), moderate (AHI 15 to <30/h) or severe (AHI ≥30/h), and these were compared to score findings. Results A total of 1810 subjects (mean age 45.4±14.6 years; 64.3% women) were included. For moderate to severe OSA, the area under the receiver operating characteristic curve was greatest for GOAL and No-Apnea (0.70, CI 0.67-0.73; 0.70, CI 0.68-0.73), followed by NoSAS5 (0.69, CI 0.65-0.73). The highest sensitivity values were for NoSAS5 (0.73, CI 0.67-0.79), No-Apnea (0.72, CI 0.66-0.78), and GOAL (0.69, CI 0.67-0.79), while NoSAS8 had the highest specificity (0.91, CI 0.90-0.93), followed by Berlin (0.88, CI 0.87-0.90) and GOAL (0.71, CI 0.69-0.73). All scores performed poorly with respect to the positive predictive value (PPV), which was highest with NoSAS8 (0.38, CI 0.31-0.44). Conclusion Although overall performance was modest for all instruments, NoSAS8 showed the highest PPV among the evaluated scores. These findings suggest that NoSAS8 may be a useful option to support OSA risk stratification in resource-constrained settings, but should be interpreted with caution.

Background: The digitalization of work has increased employees’ exposure to work-related information and communication demands, sparking interest in technology-related workplace stressors. Workplace Fear of Missing Out (wFoMO) refers to concerns about missing important work-related information (Informational wFoMO) and social interactions (Relational wFoMO). This study examines the psychometric properties of a French translation of the original 10-item wFoMO scale and develops and evaluates a more concise, 6-item version. Methods The study sample comprised 347 French-speaking employees in Switzerland who completed a survey assessing wFoMO, occupational variables, and wellbeing indicators. Confirmatory factor analyses were performed to test the structures of the 10- and 6-item versions. Reliability, as well as convergent and discriminant validity, were evaluated. Measurement invariance and group differences were examined according to gender, age, managerial position, and frequency of work-related ICT use during leisure time. Construct validity was assessed through associations with both previously examined constructs and theoretically relevant constructs tested for the first time in the context of wFoMO, encompassing personality traits (neuroticism, conscientiousness), mindfulness, workplace telepressure, workaholism, ICT availability expectations, work–home segmentation preferences and supplies, technostress creators, psychological detachment from work, and wellbeing indicators (depression, anxiety, stress, insomnia). Results: Analyses supported the proposed two-factor structure, distinguishing Relational and Informational wFoMO for both scale versions, with good model fit. Both scales demonstrated good reliability and validity, and measurement invariance across the tested groups. Relational and Informational wFoMO were positively associated with neuroticism, workplace telepressure, workaholism, ICT availability expectations, technostress creators, and mental health indicators, and negatively associated with mindfulness and psychological detachment from work, while showing no significant association with conscientiousness. Dimension-specific differences emerged for work–home segmentation variables. Group comparisons revealed no differences across gender or age but significant differences according to managerial position and work-related ICT use during leisure time. Conclusions: This study supports the validity of the French wFoMO scale and its 6-item short version and extends knowledge on the distinct relationships between wFoMO dimensions, digital work factors, and employee psychological health.

Background: Sleep apnoea is associated with increased postoperative morbidity and worsens after surgery under general anaesthesia. A thermoplastic mandibular advancement device (MAD) might prevent postoperative sleep apnoea worsening. This randomised, controlled, single-blind trial tested the hypothesis that a thermoplastic MAD would reduce apnoea-hypopnoea index (AHI) on the first postoperative night after general anaesthesia. Methods: One hundred patients undergoing various elective orthopaedic procedures on the lower limb under general anaesthesia were randomly allocated to two groups: use of a thermoplastic MAD during the first postoperative night (intervention) or no MAD during the first postoperative night (control). All patients underwent respiratory polygraphy on the first postoperative night. The primary outcome was the AHI on the first postoperative night. Secondary outcomes included the obstructive apnoea index, mixed apnoea index, central apnoea index, hypopnoea index, oxygen desaturation index, and self-reported tolerance of the device (on a numeric rating scale from 0 to 10, where higher scores indicate better tolerability), all measured during the first postoperative night. Results: The mean [95% confidence interval] AHI was similar in the MAD and control groups (9 [6-12] and 11 [7-15] events·h-1, respectively; p = 0.26). There were no significant between-group differences in the secondary outcomes. The median (interquartile range) score for MAD tolerance was 7.5 (5.0, 8.5). Conclusions: In conclusion, a thermoplastic MAD did not demonstrate to reduce AHI after general anaesthesia for lower limb orthopaedic surgery on the first postoperative night. However, this finding should be interpreted cautiously, as dexamethasone administered to all participants may have reduced postoperative respiratory events or increased nocturnal wakefulness, thereby artificially lowering the apnoea-hypopnoea index calculated.

STUDY OBJECTIVES:To investigate the associations of periodic limb movements during sleep (PLMS) and restless legs syndrome (RLS) symptoms with longitudinal changes in cognitive performance among older adults. METHODS:We analyzed data from 382 community-dwelling older adults without dementia participating in the HypnoLaus study (mean age: 71.0 ± 4.1 years; 42.9% male). Participants underwent polysomnography and baseline cognitive testing, followed by a second cognitive assessment after 4.7 ± 0.6 years. Individuals were categorized by PLMS index (PLMI) as <15/h (reference), 15-29.9/h, and ≥30/h. Associations between PLMI categories and annualized changes in executive function (Stroop Test), verbal fluency, and verbal memory were examined using multiple linear regression models adjusted for potential confounders. Additional analyses evaluated the role of RLS symptoms and PLMI × RLS symptoms interactions. RESULTS:A PLMI ≥30/h was associated with a steeper deterioration in executive function compared with the reference group (B = -0.06 standard deviations [SD]/year, p = .010), equivalent to -0.3 SD and -1.5 SD declines over 5 years relative to the baseline performance and to the distribution of change scores, respectively. This association was independent of RLS symptoms and other sleep-related conditions. No significant associations were observed between PLMI and changes in verbal fluency or verbal memory. RLS symptoms were not associated with changes in any cognitive outcome, and no PLMI × RLS symptoms interaction was detected. CONCLUSIONS:High PLMS frequency was independently associated with accelerated deterioration in executive function, suggesting a link between PLMS and cognitive aging. In contrast, RLS symptoms showed no association with changes in cognitive function. Statement of Significance This study suggests that periodic limb movements during sleep (PLMS) may be related to early cognitive vulnerability and could represent an early marker of accelerated cognitive aging. A higher frequency of PLMS was associated with a steeper deterioration in executive function over about 5 years in community-dwelling older adults, independent of restless legs syndrome symptoms, other sleep conditions, and relevant clinical factors. These findings highlight the need for future research to elucidate the neurobiological mechanisms linking PLMS to accelerated cognitive aging, and to determine whether reducing PLMS could help preserve cognitive health, or whether PLMS primarily represent a marker rather than a direct contributor to cognitive deterioration.

OBJECTIVE:To assess the impact of acute hypoxia-induced periodic breathing on respiratory efficiency in young healthy males. METHODS:20 healthy male (median (IQR) age: 24 (22 to 25) years; body mass index: 22.5 (20.9 to 24.9) kg/m2)-no sleep-disordered breathing in normoxia-underwent polysomnography in normobaric hypoxia simulating 3500 m altitude. Measurements included oesophageal pressure-time curve, airflow and exhaled fraction of carbon dioxide (CO2). Inspiratory pressure-time product (iPTP, index of respiratory muscle effort) was calculated from oesophageal pressure. Physiological dead-space volume, ventilation ([Formula: see text]Dest) and alveolar ventilation ([Formula: see text]Aest) were calculated from exhaled fractions of CO2 (Bohr equation). Within-subject comparisons of periodic (PB) and regular breathing (RB) periods were made using the Wilcoxon signed-rank test. RESULTS:In hypoxia, 17 participants had sufficient (>3 min) breathing periods of both periodic and non-periodic breathing for analysis. The median (IQR) Apnoea-Hypopnoea Index was 76.9 (62.8 to 122.7)/hour and participants spent 40.8% (27.3% to 64.6%) of sleep in periodic breathing (n=17). Tidal volume was greater in periodic breathing (n=17, median (IQR), PB vs RB; 0.815 (0.636 to 0.928) L vs 0.633 (0.517 to 0.673) L, p<0.001). Physiological dead space was similar in both breathing patterns (n=17, PB vs RB, 0.172 (0.160 to 0.196) L vs 0.184 (0.162 to 0.205) L, p=0.782). Respiratory rate was lower in periodic breathing (n=17; PB vs RB; 10.6 (9.8 to 13.6)/min vs 16.8 (15.4 to 17.7)/min, p<0.001). [Formula: see text]Dest was lower in periodic breathing (n=17; PB vs RB; 1.9 (1.7 to 2.2) L/min vs 3.0 (2.6 to 3.4) L/min, p<0.001), while [Formula: see text]Aest remained similar (n=17, PB vs RB; 6.9 (6.3 to 7.4) L/min vs 7.3 (6.8 to 7.7) L/min, p=0.102). iPTP/min was lower in PB (n=14, PB vs RB; 185.4 (154.3 to 203.8) cmH2O×s/min vs 221.5 (189.2 to 291.9) cmH2O×s/min, p=0.002). CONCLUSIONS:Periodic breathing in acute normobaric hypoxia reduces inspiratory effort without impairing alveolar ventilation, suggesting an adaptive mechanism to optimise respiratory efficiency in young healthy males.

BACKGROUND:Positive airway pressure (PAP) has shown inconsistent effects on cardiovascular (CV) outcomes in obstructive sleep apnoea (OSA). Physiological biomarkers derived from sleep studies such as sleep apnoea-specific hypoxic burden (SASHB) and event-related heart rate response (ΔHR) may help identify OSA patients with modifiable CV risk. METHODS:3370 PAP-treated moderate-to-severe OSA patients, from the Pays de la Loire sleep-clinic cohort linked to the French health database (SNDS), were stratified by a high-risk status defined by SASHB >40.6%·min·h⁻1 or ΔHR >21.7 bpm, using percentile-based approach for threshold estimation. The primary composite outcome was defined using the first occurrence in SNDS of major adverse CV event (MACE). Cox models assessed the association between PAP adherence (mean PAP use ≥4 h/night) and MACE occurrence. RESULTS:Over a median follow-up of 9 years, 740 patients experienced a MACE. PAP adherence versus non-adherence was associated with a reduced risk of MACE (adjusted hazard ratio [HR] 0.53, 95% CI [0.46-0.62], p<0.001), but the association was greater in patients with (71.7%) versus without (28.3%) high risk status (interaction HR 0.61 [0.43-0.87]; interaction p value =0.006). Similar findings were obtained using a simplified version of SASHB and ΔHR automatically derived from the single oximetry signal. The interaction of high-risk status between PAP adherence and MACE appeared stronger in non-sleepy patients. CONCLUSIONS:In sleep-clinic, the association of PAP adherence with reduced MACE risk was stronger in high risk OSA. These findings support the integration of hypoxic and autonomic biomarkers into clinical decision pathways for CV risk reduction in OSA.

BACKGROUND:Adaptive servo-ventilation (ASV) effectively treats central sleep apnea (CSA), with or without coexisting obstructive sleep apnea (CSA-OSA). However, this is a diverse patient group, and the characteristics of patients who are most likely to benefit from ASV therapy, outside of traditional etiology-based subgroups, are unknown. OBJECTIVES:To identify clusters of ASV-treated patients based on anthropometric data and comorbidities, and to evaluate the differential response to ASV in these patient clusters. METHODS:This analysis used data from the READ-ASV registry, which enrolled adults with CSA prescribed ASV from September 2017-March 2021. Evaluations included the Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Pittsburg Sleep Quality Index, EuroQol-5-dimension, and sleep study data. Latent class analysis was used to identify patient clusters based on baseline anthropometric data and comorbidities. RESULTS:Of 812 patients, 421 (52%) were in Cluster (C) 1 (older, high rate of cardiovascular comorbidities [including stroke], high body mass index [BMI]), 239 (29%) were in C2 (elderly/middle-aged, average-low cardiovascular comorbidity rate, high stroke rate, lower BMI, low diabetes rate), and 152 (19%) were in Cluster 3 (younger, low cardiovascular comorbidity rate, higher BMI, high depression rate). Patients from C3 versus C1/C2 had the highest apnea-hypopnea index at baseline (55 vs. 48/39.5 events/h), were the most symptomatic, had the worst quality of life (QoL), and had the greatest symptomatic and QoL improvement on ASV. They remained the most symptomatic cluster after treatment. CONCLUSIONS:The identification of subgroups of ASV users with differing responses to therapy and residual symptom burden could facilitate a more personalized approach to ASV prescription and therapy management. CLINICAL TRIAL REGISTRATION:https://www. CLINICALTRIALS:gov; NCT03032029.

Obstructive sleep apnea (OSA) screening tools such as the NoSAS score rely on neck circumference measurement, which may be inconsistently recorded in routine practice. In 449 consecutive patients referred for suspected OSA, patient-performed neck encirclement markedly improved availability compared with measured neck circumference (94.0% vs 71.3%) while maintaining similar diagnostic performance when incorporated into the NoSAS score. This simple equipment-free maneuver facilitates implementation of OSA screening in routine clinical practice.

The onset of altitude-induced central sleep apnea (CSA) varies among individuals and may be influenced by genetic factors affecting respiratory control. Tibetans, who have undergone high-altitude adaptation over generations, may exhibit physiologic traits that protect against CSA. This study investigated the impact of Tibetan ancestry on respiratory control and hypoxia-induced CSA. Nine healthy unacclimatized Tibetans living in Switzerland for at least 5 years and 20 Caucasians (all males; median[IQR] age: 28 [27-32] vs. 24 [23.5-26] years; median[IQR] BMI: 23.8 [23.1-28] vs. 22.1[21.2-23.1]kg/m2) underwent two full polysomnographies, one at low altitude and one in a hypoxic chamber simulating 3500 m. The apnea-hypopnea index (AHI) and the percentage of sleep spent in periodic breathing (PB) were calculated. A hyperoxic hypercapnic ventilatory response (HCVR) test and hypoxic ventilatory response tests at rest (HVRr) and during exercise (HVRe) were performed. Parameters were compared between groups using non-parametric tests. At simulated altitude, Tibetans exhibited a significantly lower AHI (51.2 [12.7-72.1]/h vs. 107.0 [36.7-140.3]/h; p = 0.0231) and spent less sleep time in PB (27.6 [2.6-44.5]% vs. 58.8 [14.0-89.0]%; p = 0.0334) compared to Caucasians. HCVR did not differ significantly between groups (Tibetans: 1.983 [1.349-2.224] L/min/mmHg; Caucasians: 2.227 [1.698-3.071] L/min/mmHg; p = 0.2167). Tibetans showed a significantly lower HVRr (Tibetans: 0.001 [-0.211-0.074] L/min/%/kg; Caucasians: 0.384 [0.160-0.637] L/min/%/kg; p = 0.0112) and a blunted HVRe (Tibetans: 0.311 [0.225-0.789] L/min/%/kg; Caucasians: 0.806 [0.518-1.196] L/min/%/kg; p = 0.0448). These results indicate that Tibetan ancestry is associated with a partial protection from hypoxia-induced central sleep apnea, likely related to a blunted hypoxic ventilatory response. These findings suggest that inherited differences in ventilatory control may modulate breathing stability during sleep at high altitude.

Rationale and study objectives:To develop a method for apnea-hypopnea index (AHI) estimation using a chest-worn accelerometer, as an approach to obstructive sleep apnea diagnosis and long-term monitoring of treatment, for example through positional therapy. Methods:We developed a method for AHI estimation by combining a cardiorespiratory sleep staging algorithm with an adapted neural network for detecting respiratory events. Originally based on electrocardiography and respiratory impedance plethysmography, the network was retrained using chest-wall accelerometry-based instantaneous heart rate and respiratory effort. Training and validation utilized accelerometer data from 413 participants across two centers, recorded during diagnostic overnight polysomnography (PSG), in absence of any therapy. The dataset was split equally: half was used to train the neural network, and the remaining half to evaluate its performance. This evaluation compared the accelerometry-derived overnight AHI against the reference from PSG, both overall and separately for supine and non-supine sleeping positions. Results:Sleep staging reached substantial agreement with polysomnography, achieving a Cohen's kappa coefficient of agreement of 0.67 for four-class sleep staging (Wake/REM/N1-N2/N3). AHI was estimated with highly reliable, showing an intraclass correlation coefficient of 0.90 (95% CI: 0.86-0.92) when compared to polysomnography-derived values. Performances were consistent in both supine and non-supine sleeping positions. Positive likelihood ratios were high (7.1, 16.0, and 165.7 for the mild, moderate, and severe OSA severity classes, using near-boundary double labeling). Negative likelihood ratios were low (0.095, 0.153, and 0.069 for the same cases). Conclusion:AHI can be reliably estimated using chest-wall accelerometry. This approach may be used in diagnostic tests for OSA but also to assess residual AHI during positional therapy.

Study Objectives:Obstructive sleep apnea (OSA) carries increased cardiovascular (CV) risk. However, this risk is not fully captured by the apnea-hypopnea index (AHI). We investigated whether a validated coronary artery disease polygenic risk score (CAD-PRS) refines CV risk assessment in OSA. Methods:We derived CAD-PRS using genome-wide genotyping data for 1379 participants of the CoLaus|HypnoLaus cohort who underwent polysomnography. Associations between OSA, CAD-PRS, clinical factors, and incident CV events were assessed using multivariable Cox proportional hazards models. Risk stratification improvement was assessed with reclassification analyses compared to clinical risk scores (SCORE2/SCORE2-OP). Results:During 7.2 years of median follow-up, 100 participants experienced CV events. A significant interaction between OSA and CAD-PRS was observed (p=.013). The effect of OSA on CV risk differed across PRS categories. In the intermediate genetic-risk group (CAD-PRS quintiles 2-4), OSA patients (AHI ≥15/h) had a markedly higher CV risk compared to non-OSA (HR[95% CI]: 2.68[1.54-4.66]), whereas OSA did not significantly increase CV risk in either the low or high PRS strata. The complete model with OSA, CAD-PRS and their interaction allowed a significant reclassification (Net Reclassification Index 0.171, p=.014) compared to SCORE2/SCORE2-OP and 52% of individuals at intermediate risk were reclassified as low or high CV risk. Conclusions:In this population-based cohort, a CAD-PRS was associated with CV risk stratification in individuals with OSA. The impact of OSA on CV risk was greatest in individuals with intermediate genetic risk. Adding CAD-PRS and OSA to SCORE2 was associated with improved model performance and reclassification, supporting more precise CV risk assessment in OSA.

A European Respiratory Society research seminar entitled "Sleep Apnoea and Its Consequences: From Animal Models to Precision Medicine" was held in January 2024 in Lisbon, Portugal. It provided an in-depth analysis of the current landscape and future directions in OSA research, integrating recent findings from metabolomics, animal models, clinical predictors of cardiometabolic consequences of OSA, artificial intelligence (AI), and advances in diagnostic algorithms. This article presents a narrative review of the seminar’s key discussions and conclusions.The limitations of current randomized controlled trials (RCTs) in assessing OSA treatment, such as low adherence and patient selection bias (e.g., absence of sleepiness or severe hypoxemia), were critically discussed. The expert panel recommended the use of real-world data, including patients commonly seen in clinical practice, and the use of digital tools for real-time monitoring of adherence and side effects. The concept of platform "disease-focused" trials was discussed as a more efficient and adaptable research design that could allow clinical trials to be more representative of the general OSA population and to compare CPAP with emerging treatments such as new drugs, devices and lifestyle interventions to gain a broader understanding of effective management strategies.The seminar concluded that a multifaceted approach to OSA research that leverages the strengths of animal models, advanced AI, metabolomics, and improved diagnostic algorithms is needed to gain deeper insights into the mechanisms of OSA and its treatment response. This new approach, coupled with new "platform" clinical trial designs, could contribute to improved outcomes in patients with OSA.

Abstract Purpose Comorbid restless legs syndrome (RLS) and obstructive sleep apnea (OSA) -(COROSA)- is poorly characterized in African populations. We estimated its prevalence and correlates in a population-based sample in Benin. Methods This was a cross-sectional analysis of 1,810 adults aged ≥25 years from the Benin Society and Sleep (BeSAS) study. RLS was defined by International RLS Study Group criteria and OSA by an apnea–hypopnea index ≥5 events/h on home respiratory polygraphy; COROSA required both. Correlates were assessed by multivariable logistic regression; multinomial models compared COROSA with OSA only, RLS only, and neither disorder. An exploratory analysis examined hypertension across eight mutually exclusive sleep-disorder groups, including comorbid insomnia, RLS and OSA (COMIROSA). Results COROSA prevalence was 3.5% (95% CI 2.7–4.4). Independent correlates were age 40–59 years (aOR 2.91, 95% CI 1.38–6.73), age ≥60 years (aOR 3.76, 1.61–9.35), rural residence (aOR 10.54, 4.94–25.43), overweight (aOR 2.29, 95% CI: 1.16–4.49), obesity (aOR 3.83, 95% CI: 1.75–8.31), and insomnia (aOR 2.49, 1.37–4.50). Relative to OSA only, COROSA was associated with hypertension and insomnia; relative to RLS only, obesity was the main distinguishing factor. Hypertension was associated with COROSA and COMIROSA, with a larger estimate for COMIROSA (aOR 4.03 vs 2.64). Conclusion COROSA affected 3.5% of adults in Benin and co-occurred with obesity, hypertension and insomnia. Screening for overlapping sleep disorders may improve identification of high-risk individuals. COMIROSA remains a hypothesis requiring validation in larger longitudinal studies. Brief summary The coexistence of obstructive sleep apnea and restless legs syndrome is insufficiently documented in African populations despite the growing burden of sleep disorders in the region. This study provides the first population-based study estimate of comorbid obstructive sleep apnea and restless legs syndrome in sub-Saharan Africa. Our findings suggest that individuals with both disorders represent a clinically important subgroup with substantial cardiometabolic burden and insomnia. They also raise the possibility of an even more complex overlap involving chronic insomnia, restless legs syndrome, and obstructive sleep apnea, which warrants validation in future studies. These results support more integrated approaches to screening and management of these coexisting sleep disorders in resource-limited settings.

Many individuals turn to supplements like magnesium, believing them to offer a natural way to improve sleep quality. Yet, research on magnesium’s effects has produced inconsistent results. We assessed the relationships between magnesium supplementation and subjective/ or objective sleep parameters, including night cramps. Data from three follow-ups of the population based CoLaus|PsyColaus cohort: 2009–12 (first), 2014–17 (second), and 2018–21 (third). Magnesium supplement use was self-reported, and participants were categorized either as users or non-users. Subjective sleep parameters were measured through questionnaires, and objective sleep parameters with polysomnography. The researchers computed a polygenic risk score (PRS) including five single nucleotide polymorphisms related to magnesium levels. The number and characteristics of the participants in the first, second, and third follow-ups were 3887 (52.6

BACKGROUND:Workplace telepressure and private life telepressure refer to the preoccupation with and the urge to respond quickly to electronic messages from people at work or in private life, respectively. We aimed to adapt and validate workplace and private life telepressure measures in French and to explore their nomological networks and relationships with psychological health and wellbeing. METHODS:Participants were recruited via flyers, local press, and social media to complete two online surveys. Participants had to be French-speaking employees working in Switzerland and regularly using information and communication technologies for work purposes. The sample included 347 employees (200 females, 146 males, one nonbinary individual; mean age: 36.8 years) who completed both surveys. The first questionnaire assessed sociodemographic characteristics and the workplace and private life telepressure measures. The second questionnaire, which was administered approximately two weeks later, assessed complementary sociodemographic characteristics, nomologicals (five technostress creators, workaholism, neuroticism, conscientiousness, and mindfulness), measures of psychological health and wellbeing (depression, anxiety, stress, and psychological detachment from work), and the two telepressure measures. RESULTS:Both telepressure measures exhibited strong psychometric properties, including validity, reliability, and measurement invariance across age, gender, and time. Confirmatory factor analysis revealed that the two-factor model (preoccupation and urge factors) provided a better fit than did the one-factor model for both measures. Correlation analyses revealed that both telepressure measures were significantly positively associated with techno-invasion, techno-complexity, techno-insecurity, workaholism, and neuroticism and negatively associated with mindfulness. However, only workplace telepressure was significantly associated with techno-overload, and neither telepressure measure was significantly associated with techno-uncertainty. Structural equation modeling showed that workplace telepressure significantly predicted stress, anxiety, depression, and psychological detachment from work, whereas private life telepressure significantly predicted stress, anxiety, and psychological detachment from work, but not depression. Most effects were significantly greater for workplace telepressure than for private life telepressure. CONCLUSIONS:This study confirms the validity of the workplace telepressure and private life telepressure measures for use in French-speaking populations and contributes to our understanding of the role of these two constructs in employees' psychological health and wellbeing.