PURPOSE:Positional obstructive sleep apnea (POSA) is the most common phenotype of obstructive sleep apnea, yet patient selection for positional therapy (PT) remains suboptimal. With this analysis we aimed to clarify how many patients with POSA may not require PT because they do not habitually sleep supine at home, and how many fail vibrotactile PT despite appropriate indication. METHODS:We conducted a retrospective observational study of consecutive adults with POSA evaluated at a tertiary sleep center between 2021 and 2024. All patients underwent a home-based trial with a neck-based vibrotactile positional therapy device (Night Shift™), consisting of monitoring mode followed by therapy mode. Outcomes included the proportion of non-supine sleepers at home, failure rate of vibrotactile PT, device compliance and differences in supine sleep time between diagnostic testing and home monitoring. RESULTS:Of 92 screened patients, 74 met inclusion criteria (mean age 60.3 ± 13.2 years; mean AHI 22.9 ± 13.3 events/h). Fifteen percent (11/74) did not habitually sleep supine at home, indicating no clinical need for PT, and an additional 14.8% (11/74) failed vibrotactile PT. Overall, 30% of patients were either unlikely to benefit from PT or failed therapy. Non-response was frequently associated with psychotropic or sedative medication use and neurological or sleep-related comorbidities. CONCLUSION:A substantial proportion of patients diagnosed with POSA either do not require or fail vibrotactile treatment in real-world conditions. Incorporating a brief home monitoring and therapy trial into routine clinical practice may optimize patient selection, reduce unnecessary costs, and improve personalized management of POSA.

Excessive daytime sleepiness (EDS) is a frequent complaint in the general population. Other than being a common symptom associated with various sleep disorders, EDS may be a consequence of chronic sleep deprivation or the primary symptom of central disorders of hypersomnolence (CDH). In addition to narcolepsy type 1 (NT1), the other conditions within the CDH spectrum are less well-defined and share considerable clinical and neurophysiological similarities. Herein, we describe the clinical management of a complex case that highlights several challenges in the diagnostic process of a patient with EDS and a history of obsessive-compulsive disorder (OCD). In the absence of other sleep disorders, secondary structural causes, and orexin deficiency as possible causes for EDS, the patient was initially diagnosed with NT2 based on electrophysiological criteria. However, the clinical course, which showed only a partial response to various stimulant medications for subjective and objective daytime sleepiness, led us to question the diagnosis. A detailed psychiatric and neuropsychological assessment revealed, in addition to the previously identified severe OCD and anxiety, a diagnosis of attention deficit hyperactivity disorder (ADHD), subsequently leading to a revised diagnosis of hypersomnia associated with a psychiatric disorder (HPSY). The literature regarding OCD and sleep disorders remains scarce but the connection between ADHD and hypersomnia, as well as narcolepsy, is well-established. Our case report illustrates that a psychiatric and neuropsychological assessment should be considered mandatory for patients with objective EDS.

Pregnancy is a significant risk factor for the development of restless legs syndrome (RLS). Apart from its negative impact on sleep and general quality of life, RLS is also associated with pregnancy complications and negative outcomes. To elucidate the prevalence, trajectory, severity, and risk factors of RLS throughout pregnancy and the postpartum period, we analyzed data from the multicenter Life-ON Cohort Study (NCT02664467), which recruited 439 pregnant women in the 10th-15th gestational week and followed them up until 12 months after delivery. About 26.03% of women (n = 113, 95% CI = 22.0% to 30.4%) met the diagnostic criteria for RLS in at least one of the three visits during pregnancy. RLS severity was similar during all trimesters and during the postpartum period with however higher values in women who screened positive for RLS in all the three or two trimesters compared to those who screened positive in just one. A previous history of RLS was found in 50.68% of women who reported RLS during the current pregnancy and 18.7% had a positive family history. During the entire follow-up period out of 386 women, 134 were diagnosed with RLS, corresponding to a cumulative incidence of 34.7%. Previous history of depression, positive family history for RLS and previous RLS were statistically significant risk factors for RLS during pregnancy. Around 20% of women experienced severe to very severe symptoms (IRLS >20 pts), representing a possible target to be carefully considered for a pharmacological treatment. A systematic screening approach and treatment of eligible women could greatly improve quality of life and reduce comorbidity during pregnancy. Statement of Significance In this secondary analysis, we aimed to track the natural progression of RLS during pregnancy and after delivery, using data from the Life-ON Cohort Study. The study found that 26.03% of pregnant women experienced restless legs syndrome (RLS) with 20% of those reporting moderate/severe symptom intensity (IRLS >20). Those findings underline the high prevalence of RLS during pregnancy with the new finding of relative symptom-stability independent of the trimester of pregnancy and 1 in 5 patients exhibiting severe to very severe symptoms. The correct identification and treatment of RLS during pregnancy could potentially greatly improve womens' sleep quality and generally quality of life during pregnancy and reduce associated pregnancy complications and negative pregnancy outcomes.

This systematic review analyzed 37 studies on sleep-disordered breathing during pregnancy, involving over 7000 women, predominantly pregnant, with a subgroup of non-pregnant controls. Most studies were conducted in the United States, using in-laboratory polysomnography and focusing on the third trimester. The meta-analysis estimated a prevalence of nearly 20 %, although results showed considerable heterogeneity, reflecting variations in study methodologies, diagnostic criteria, and sample characteristics.Sleep-disordered breathing was generally mild, with body mass index identified as the main risk factor, while age did not appear to significantly influence prevalence. Monitoring body mass index throughout pregnancy and screening for sleep-disordered breathing in women with gestational diabetes or hypertensive disorders is crucial, as these conditions are associated with higher prevalence.Findings highlight the need for future studies to adhere to standardized guidelines, use objective diagnostic tools, and include larger, well-characterized samples of normal pregnancies. Comparative studies with matched non-pregnant controls by body mass index and age, longitudinal cohort designs, and interventional trials using continuous positive airway pressure for moderate-to-severe obstructive sleep apnea are essential to enhance understanding and improve maternal-fetal outcomes.

Pregnancy is a significant risk factor for the development of Restless Legs Syndrome. The natural course and impact of advancing pregnancy and the postpartum period on RLS prevalence and symptom severity is still scarcely studied. We aimed to elucidate the prevalence, trajectory, and inadequately understood factors such as cumulative incidence, severity, and risk factors of RLS throughout pregnancy and the postpartum. We used data from the multicenter Life-ON Cohort Study which recruited 439 pregnant women in the 10-15 gestational week and followed them up until 12 months after delivery. Participants had 11 scheduled visits. RLS was assessed based on the five essential criteria proposed by the International RLS Study Group. Women meeting the diagnostic criteria were further evaluated using the International RLS Study Group Rating Scale (IRLS). All women received one full polysomnograpy performed at the second trimester of pregnancy. 26.03% of women (n=113, 95% CI 22.0–30.4%) met the diagnostic criteria for RLS. A previous history of RLS outside of pregnancy was found in 50.68% of women who reported RLS during the current pregnancy (OR = 2.717, 95% CI: 1.791–3.782) and 18.7% had a positive family history. During the entire follow-up period we found a cumulative incidence of 34.7%. Previous history of depression ((HR 2.03, 95%CI 1.003 – 4.09, p= 0.049), positive family history for RLS (HR 2.00 95%CI 0.92 – 4.35, p= 0.08) and previous RLS (HR 7.86, 95%CI 4.09 – 15.07, p= < 0.0001) were statistically significant risk factors to RLS. Around 20% of women experienced severe to very severe symptoms (IRLS >20 pts). A PLMS index > 15 was found in 26% of women. RLS is a highly frequent complaint during pregnancy, with women who have a positive personal or family history for RLS being especially predisposed to develop manifest symptoms. The symptom severity remains relatively stable across pregnancy with a significant proportion (20%) warranting evaluation for a specific pharmacologic treatment. A screening approach and treatment of eligible women could greatly improve quality of life and reduce comorbidity during pregnancy. Swiss National Foundation. Italian Ministry of Health.

Sleep-disordered breathing (SDB) encompasses abnormal respiratory patterns during sleep which can negatively affect maternal and fetal health. While late pregnancy is known to carry a heightened risk for SDB, less research focuses on the second trimester, a critical period for maternal physiological changes. This study aims to estimate the prevalence of SDB in the second trimester and explore their relationship with demographic and sleep-related factors. This study is a secondary analysis of the LifeON Study, which recruited pregnant women aged 18-55. A total of 353 women underwent home-based polysomnography at 23-25 weeks of gestation and completed sleep assessments (ESS, ISI and PSQI). Women were categorized with SDB if their respiratory disturbance index (RDI) was ≥5, and OSA was defined as RDI ≥5 plus ESS ≥10. Fifteen women (4.2%) were diagnosed with SDB (mean AHI = 8.61 ± 3.44), mostly mild cases except for one moderate; of these, 4 (1.1%) were classified as OSA. Women with SDB had higher BMI (28.39 ± 3.15 vs. 24.49 ± 3.67, p < 0.001) and neck circumference (34.46 ± 1.81 cm vs. 33.18 ± 4.19 cm, p = 0.006) than those without. No significant differences emerged in subjective sleep scores. ODI 3% correlated with BMI (ρ = 0.364, p < 0.01) and neck circumference (ρ = 0.159, p < 0.01); similar correlations were observed for AHI. BMI predicted ODI 3% (β = 0.275, p < 0.001), while neck (β = 0.151, p = 0.01) and abdominal circumference (β = 0.27, p < 0.001) predicted AHI. Furthermore, supine AHI was higher compared to the non-supine position and greater in women who spent more time in the supine position. Although lower than in late pregnancy, the prevalence of SDB in the second trimester highlights the importance of identifying pregnant women at risk, particularly those with higher BMI or neck circumference. These anthropometric measures, along with the supine position, emerged as significant predictors and could serve as simple, non-invasive tools for early screening. Timely identification and management of SDB during pregnancy may help reduce maternal and fetal complications, emphasizing the need for routine evaluation in clinical practice.

Abstract Introduction RLS is associated with a lower quality of life. During pregnancy, RLS is highly frequent and peaks in the third trimester. The main objective of the present study was to evaluate the impact of RLS on sleep during pregnancy and puerperium by using subjective and objective data. Methods This study was part of the multicenter study “Life-ON”, prospective, cohort investigation on sleep and mood changes during early pregnancy until 12 months after delivery. The presence of Restless legs Syndrome (RLS) was assessed in interview, according to essential criteria for diagnosis of RLS proposed by the International RLS Study Group (IRLSSG) during 11 visits (1 º, 2 º and 3 º trimester; and after delivery – 8 visits). Sleep was evaluated by PSG during the 2º trimester. Mood (MADRS, EPDS, HDRS-21), sleep quality (PSQI), insomnia (ISI), sleepiness (ESS) were also assessed at visits. Results Out of the 439 pregnant women recruited, 113 (26.037%) met the criteria for diagnosis of RLS. Together with the prevalence, the severity of RLS get worse in the third trimester. Pregnant women suffering from RLS had a worse sleep quality and insomnia then non-RLS women. A reduction in Sleep Efficiency and an increase in PLMS have also been demonstrated by polysomnography. Mood deflection was also associated with RLS; while RLS was not associated with adverse fetal outcomes and pregnancy related complications. Conclusion RLS is confirmed to be highly prevalent in late pregnancy. A negative impact of RLS on mood and sleep was evident from both subjective and objective tests. Support (if any)

Sleep disordered breathing is extremely common in pregnancy and is a risk factor for maternal complications. Animal models demonstrate that intermittent hypoxia causes abnormal fetal growth. However, there are conflicting data on the association between maternal sleep disordered breathing and offspring growth in humans. We investigated this association by conducting a systematic review and meta-analysis. Sixty-three manuscripts, and total study population of 67, 671, 110 pregnant women were included. Thirty-one studies used subjective methods to define sleep disordered breathing, 24 applied objective methods and eight used international codes. Using a random effects model, habitual snoring, defined by subjective methods, and obstructive sleep apnea, diagnosed by objective methods, were associated with an increased risk for large for gestational age (OR 1.46; 95%CI 1.02-2.09 and OR 2.19; 95%CI 1.63-2.95, respectively), while obstructive sleep apnea, identified by international codes, was associated with an increased risk for small for gestational age newborns (OR 1.28; 95% CI 1.02-1.60). Our results support that maternal sleep disordered breathing is associated with offspring growth, with differences related to the type of disorder and diagnostic methods used. Future studies should investigate underlying mechanisms and whether treatment of sleep disordered breathing ameliorates the neonatal growth.

Pregnant women benefit greatly from exercise due to its powerful impact on maternal and perinatal outcomes. The purpose of our study was to assess whether exercise improves objective sleep quality in pregnant women suffering from restless legs syndrome. This cross-sectional study is based on data from a large, naturalistic, consecutive cohort study in pregnant women recruited by four sleep centres, in Bologna, Milan and Turin (Italy), and Lugano (Switzerland), named the Life-ON study. Objective sleep parameters of 316 pregnant women were measured using polysomnographic recordings during the second trimester of pregnancy, and a self-reported assessment was used to evaluate physical activity. Pregnant women with restless legs syndrome (n = 91) who engaged in physical activity (n = 28) experienced better sleep efficiency (84.20% versus 82.10%, p = 0.01), less stage 1 sleep (10.50% versus 11.40%, p = 0.04) and wake after sleep onset (52.20 min versus 76.40 min, p <= 0.001), as well as reduced periodic leg movements during sleep (5.50 per hr versus 16.40 per hr, p < 0.001) when compared with the sedentary restless legs syndrome group (n = 63). Sleep structure was also better conserved in physically active pregnant women without restless legs syndrome compared with the inactive restless legs syndrome negative group. Overall, this study provides further evidence of the benefits of physical activity in pregnant women by illustrating its positive impact on sleep structure.

Restless legs syndrome is a prevalent, sleep-related sensorimotor disorder with relevant impact on the patients’ quality of life. For patients suffering from severe, pharmacoresistant restless legs syndrome, few therapeutic options remain to alleviate symptoms. In this case series, two patients with severe, pharmacoresistant restless legs syndrome were treated with epidural spinal cord stimulation and repeatedly assessed with polysomnography, including sleep structure and periodic limb movements as objective biomarkers not subject to placebo effects, during a 6-month follow-up period. One of the patients experienced excellent short- and long-term efficacy on subjective symptom severity (International RLS Study group rating scale 1 vs. 34 points at 3 months) and objective sleep parameters such as sleep architecture and periodic limb movements during sleep, while the second patient only reported short-term benefits from spinal cord stimulation. Ultimately, both patients opted for removal of the device for inefficacy. Based on the complex pathophysiology of restless legs syndrome and presumed mechanism of action of spinal cord stimulation in chronic pain disorders, we provide a detailed hypothesis on the possible modulating effect of spinal cord stimulation on the key symptoms of restless legs syndrome. Apart from describing a new therapeutic option for pharmacoresistant restless legs syndrome, our findings might also provide further insights into the pathophysiology of the syndrome.

BACKGROUND:Perinatal depression (PND) is a severe complication of pregnancy, but there are no established risk factors predicting the disease. Evening chronotype has been associated with unhealthy lifestyle habits and adverse outcomes during pregnancy. In this study, we aimed to clarify whether chronotype can predict symptoms and/or occurrence of PND. METHODS:Two hundred ninety-nine women were followed-up from the first trimester of pregnancy until 6 months postpartum. Chronotype was assessed at baseline using the MEQ, while mood was repeatedly assessed by depression rating scales (EPDS, HDRS, MADRS). The influence of time and chronotype on EPDS, HDRS and MADRS, was estimated by constructing multilevel linear mixed regression models. A Cox proportional-hazard regression model was built to evaluate the association between chronotype and incidence of depression. RESULTS:Chronotype modulated PND symptom severity depending on time of assessment, with evening chronotypes having a higher risk for developing PND symptoms, as assessed by EPDS, at postpartum visits V4 (5-12 days) and V5 (19-26 days). These also had less healthy lifestyle habits and were more likely to suffer from gestational diabetes mellitus and undergo cesarean delivery as compared to other chronotypes. LIMITATIONS:Only a minority of women were classified as evening chronotypes. The long follow-up phase of the study led to missing data. CONCLUSIONS:Pregnant evening chronotypes show unhealthy lifestyle habits and sociodemographic characteristics commonly associated with a higher risk for PND. They also have a higher risk of developing PND symptoms in the first month after delivery. Chronotype should therefore be routinely assessed during pregnancy to identify women potentially at risk for developing PND.

OBJECTIVE:Perinatal depression (PND) is a severe complication of pregnancy, affecting both mothers and newborns. Bright light therapy (BLT) has only been tested in a few studies for treating either antenatal or postnatal depression. We conducted a pilot trial to investigate the efficacy and safety of BLT for PND occurring at any time across the perinatal period.METHODS:A single-blind RCT was carried out in women with an EPDS >12 from the 2nd gestational trimester until 9 months postpartum. Participants received either 30-minutes morning BLT (10'000 lux) or dim red light (DRL, 19 lux) for 6 weeks.RESULTS:Twenty-two women were randomised to BLT (n = 11) or DRL (n = 11). Among those receiving BLT, 73% achieved remission (improvement ≥50%, EPDS score ≤ 12), in contrast to 27% in the DRL group (p = 0.04). A significant influence of time on EPDS score and group-time interaction emerged, with a greater reduction in the BLT-group across the follow-up period. No women in either group reported major side effects.CONCLUSION:Morning BLT induced a significant remission from PND as compared to DRL and this effect was maintained across the perinatal period. BLT showed an excellent safety profile and was well-tolerated, thus representing a valid therapeutic strategy in this vulnerable perinatal population.

Symptoms of sleep disturbances are common among pregnant women and generally worsen across gestation. Pregnancy-related sleep disorders are not only associated with a poor quality of life of the affected mothers, but also with adverse perinatal outcomes, including perinatal depression, gestational diabetes, preeclampsia, and preterm birth. The current knowledge about the impact of sleep disorders during pregnancy largely derives from the results of sleep surveys conducted in various populations. However, the number of studies examining changes in objective sleep variables during pregnancy via polysomnography has progressively increased in recent years. Here we systematically reviewed the polysomnographic studies available in the literature with the aim to describe the sleep pattern and to identify possible markers of sleep disruption in pregnant women. Based on our analysis, subjective worsening of sleep quality across gestation is related to objective changes in sleep macrostructure, which become particularly evident in the third trimester. Pregnancy per se does not represent an independent risk factor for developing major polysomnography-assessed sleep disorders in otherwise healthy women. However, in women presenting predisposing factors, such as obesity or hypertension, physiological changes occurring during pregnancy may contribute to the onset of pathological conditions, especially sleep-disordered breathing, which must be carefully considered.

Background: Subjective symptoms, which are retrospectively assessed during clinical interviews in the office, may be influenced by patient recall in Parkinson’s disease (PD). Prospective collection of subjective data might be an effective tool to overcome this bias. Objective: We investigated the correspondence between prospectively and retrospectively assessed motor symptoms in PD. Methods: Forty-two consecutive patients (9 females, 67±9.8 years old) with mild to moderate PD reported their symptoms four times a day for two weeks, using the “ SleepFit ” application (app) for tablets. This app incorporates a new Visual Analogue Scale assessing global mobility (m-VAS), and the Scales for Outcome in Parkinson Assessment Diary Card (SCOPA-DC). At day 14, the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) parts II and IV questionnaires were completed at the hospital. Agreement (root mean square difference) and the tendency to under- or overestimate their symptoms by patients (relative difference after normalization) were calculated to compare prospectively vs. retrospectively collected information. Results: Although agreement was good for overall scores (m-VAS: 10.0%; SCOPA-DC: 18.3%), and for single motor symptoms (involuntary movements, hand dexterity, walking, changing position; each <20%), some individuals with more advanced disease, higher fatigue or worse sleep quality showed poor symptom recall in retrospect. Moreover, a subgroup of patients (16.7%) either over- or underestimated symptom severity. Conclusions: Regular, prospective monitoring of motor symptoms is suitable in PD patients. SleepFit might be a useful tool in routine practice to identify patients tending to under- or overestimate their symptoms, and for their follow-up.