The need to prioritize "insomnia disorder" in public health agendas: "a wakeup call" position paper from European and Canadian experts in sleep and mental health.

Objective: Insomnia Disorder is a chronic mental disorder with significant impact on the population across Europe and Canada. While some countries reimburse evidence-based treatments, others fail to recognize insomnia as a chronic condition and do not provide the resources to ensure consistent care for those affected. This document serves as a position paper from sleep and mental health experts across Europe, Switzerland the UK, and Canada, emphasizing the critical need for public health systems to recognize chronic insomnia as a disorder in order to enhance support for patients.

Exploring the Role of Ferroptosis in the Pathophysiology and Circadian Regulation of Restless Legs Syndrome.

The study objectives were to investigate the role of ferroptosis, the mechanism linking iron accumulation, oxidative stress, and dopaminergic dysfunction, in restless legs syndrome (RLS), and to explore its connection with circadian regulation, a key feature of RLS and a known modulator of ferroptosis. We conducted pathway and gene expression analyses in 17 RLS patients and 39 controls, focusing on pathways related to ferroptosis, oxidative stress, iron metabolism, dopaminergic signaling, circadian rhythms, and immune responses. Enrichment analysis, differential gene expression, and cross-pathway gene overlaps were assessed.

Usefulness of the adult concentration inventory in the psychological assessment of adult sleep disorder patients.

Study Objective: Sleep disorders and Cognitive Disengagement Syndrome (CDS), a persistent condition involving inappropriate cognitive and motor symptoms, can be interconnected. Here, we aimed to evaluate the usefulness of self-reports of adult CDS in sleep disorders population.

Methods: 242 participants (male = 110, 45.

Pharmacological impact on sleep architecture and polysomnographic measures in Restless Legs Syndrome: A systematic review.

Restless Legs Syndrome (RLS) is a sensorimotor disorder with diverse clinical manifestations that significantly impact sleep and quality of life, particularly among women. Polysomnography (PSG) plays a key role in evaluating motor features of RLS, such as periodic leg movements during sleep (PLMS). This review examines the effects of pharmacological treatments on PSG parameters and sleep architecture in RLS.

Daridorexant and Insomnia in Clinical Practice: A Nominal Group Technique Consensus Study among Italian Sleep and Insomnia Experts.

Introduction: Chronic insomnia disorder significantly affects cognitive, emotional, and physical health. Recently, the dual orexin receptor antagonist (DORA) daridorexant was approved for treating chronic insomnia in several countries. Given the limited evidence available, expert consensus was sought to clarify key clinical issues, inform practice, and guide future research.

Autonomic Correlates of Large Muscle Group Movements During NREM Sleep in Restless Legs Syndrome: A Comparative Analysis with Periodic and Non-Periodic Leg Movements.

Study Objectives: Large muscle group movements during sleep (LMMS) have recently been recognized as a prevalent feature in patients with Restless Legs Syndrome (RLS), yet their autonomic profile remains insufficiently characterized. This study aimed to compare heart rate (HR) changes associated with LMMS to those accompanying short-interval (SILMS), periodic (PLMS), and isolated leg movements (ISOLMS) during non-REM sleep in RLS.

Methods: Thirty drug-free RLS patients (20 women, mean age 57.

Age-related changes in large muscle group movements during sleep.

This study aims to investigate large muscle group movements (LMM) during sleep across the lifespan, from school-aged children to older adults, and to examine their relationship with sleep architecture (REM and NREM). A total of 141 healthy participants were included, divided into five age groups: school-aged children (n = 43), adolescents (n = 31), young adults (n = 27), adults (n = 16), and older adults (n = 24). Polysomnography (PSG) was used to record sleep data and LMM, along with LMM associated with arousals (LMMA) and awakenings (LMMW), were scored according to recently established criteria.

HLA-DQB1*03:01 strongly affects age of onset of type 1 narcolepsy independently of DQA1 and ethnicity.

In this study, we investigated the effects of HLA-DQB1*03:01 on the onset age of type-1 narcolepsy. We pooled data from 5,339 cases from China, Europe, Korea, Japan, and the United States to conduct the first transethnic study on age of onset (OA). GWAS was used to detect the associated genes.

Tracking Prodromal α-Synucleinopathies: Novel Fluid and Tissue-Based Biomarker Approaches for iRBD Phenoconversion.

Isolated rapid eye movement sleep (REM) behavior disorder (iRBD) represents the strongest predictor of α-synucleinopathies, with over 90% of patients developing Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy after a decade. As such, iRBD provides a critical window for early diagnosis and intervention. While molecular imaging techniques have been widely explored as powerful biomarkers for early disease detection, validated, more accessible tests based on biospecimens capable of reliably predicting phenoconversion remain lacking, creating a crucial gap in the clinical management of at-risk individuals.

Gender Differences in Obstructive Sleep Apnea: A Preliminary Clinical and Polysomnographic Investigation.

Background/objectives: Gender differences influence the clinical manifestations, progression, and treatment response in obstructive sleep apnea (OSA) syndrome, suggesting the existence of distinct gender-related phenotypes potentially driven by anatomical, physiological, and hormonal factors. However, the impact of gender on OSA-related cognitive profiles remains unknown. This study aimed to investigate the neuropsychological and polysomnographic (PSG) differences between OSA females and males in order to detect the impact of gender on clinical manifestation and PSG features.

The dual effect of cholesterol on cognitive functions in REM sleep behavior disorder: A pilot study.

Isolated REM sleep behavior disorder (iRBD) is widely recognized as a prodromal stage of α-synucleinopathies. However, the factors influencing its clinical progression to a neurological syndrome remain poorly understood. Cholesterol metabolism has increasingly been implicated in the pathophysiology of neurodegenerative diseases, including Parkinson's disease and Dementia with Lewy Bodies.

Hypersomnolence in focus: a white paper of the 6th Think Tank World Sleep Forum.

An international expert group (European Sleep Foundation Think Tank) convened in 2022 to discuss the state of the evidence in the domain of hypersomnolence. The expert group considered the current state of knowledge based on the most relevant recent publications, discussed the current challenges in the field and identified future priorities. The purpose of this white paper is to summarize the definition, diagnosis, and pathophysiology of hypersomnolence, the epidemiology, phenotype, and management of hypersomnolence in obstructive sleep apnea and in neurological and psychiatric disorders, and the impact of hypersomnolence on daily activities, workability and health-related quality of life.

Sex differences in cerebrospinal fluid proteomics of patients with restless legs syndrome.

Study Objectives: The pathobiology of restless legs syndrome (RLS) remains poorly understood, complicating effective treatment. This observational cross-sectional study aimed to identify a cerebrospinal fluid proteomic signature of RLS and to explore sex-specific differences in cerebrospinal fluid proteomics.

Methods: Cerebrospinal fluid samples were collected from 22 untreated RLS patients and 18 controls, matched for age, body mass index, and sex.

Isolated Rem Sleep Behavior Disorder: A Model to Assess the Overnight Habituation of Emotional Reactivity.

(1) Background: Phasic events in rapid eye movement (REM) sleep are a core feature of isolated REM behavior disorder (iRBD), which is often associated with emotion dysregulation. This study explores the relationship between sleep and the overnight habituation of emotional reactivity in healthy controls (HCs) and iRBD patients, focusing on the role of REM phasic events and a specific non-REM waveform, namely sleep spindles. (2) Methods: Participants underwent polysomnography and completed arousal rating tasks and mood scales before and after sleep.

Sleep alterations in major depressive disorder and insomnia disorder: A network meta-analysis of polysomnographic studies.

Major depressive disorder (MDD) and Insomnia disorder (ID) are characterized by sleep alterations. To define their polysomnographic profiles, we conducted a Network Meta-Analysis comparing MDD and ID patients versus healthy controls (HCs). The literature search, conducted from 2008 up to January 2023 and following PRISMA guidelines, covered PubMed, Web of Science, Scopus, and Embase databases.

Novel perspective of 'poor sleep' in public health: a narrative review.

A high percentage of people worldwide complain of sleep disturbances; however, the vast majority do not meet the diagnostic criteria for insomnia or other classic sleep disorders. Therefore, the 'classical' concept of remains undetected, and patients stay ignored and unidentified. Also, has been strongly associated with increased daytime function impairment, morbidity and mortality and is considered a risk factor for developing mental disorders.

Interim analysis of a post-authorization safety study of pitolisant in treating narcolepsy: A real-world European study.

Background: Narcolepsy is a chronic sleep disorder characterized mainly by excessive daytime sleepiness (EDS) and cataplexy in the case of narcolepsy type 1 (NT1). Pitolisant is a histamine 3 receptor antagonist/inverse agonist that reduces EDS and cataplexy in patients with narcolepsy.

Methods: We performed a prospective 5-year follow-up, non-interventional study of adults with NT1 and NT2 receiving pitolisant.

K-Complex morphological alterations in insomnia disorder and their relationship with sleep state misperception.

Insomnia disorder (ID) is characterized by electroencephalographic indexes of hyperarousal, often associated with the underestimation of sleep duration (i.e. sleep state misperception).

Insomnia disorder.

Insomnia is a prevalent public health issue, characterized by dissatisfaction with the duration, continuity, and quality of sleep. It is closely associated with daytime symptoms, which are essential for diagnosing insomnia disorder. The condition is more common among women, middle-aged and older adults, and individuals with coexisting mental or physical health conditions.

Clinical practice guidelines for switching or deprescribing hypnotic medications for chronic insomnia: Results of European neuropsychopharmacology and sleep expert's consensus group.

Introduction: Current guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as the first-line treatment for chronic insomnia. Pharmacological recommendations by European guidelines for the treatment of insomnia disorder include positive GABAergic modulators such as short and medium acting benzodiazepines and "Z-drugs" (eszopiclone, zaleplon, zolpidem, zopiclone), dual orexin receptor antagonists (DORAs; daridorexant), melatonin receptor agonists (melatonin 2 mg prolonged release - PR). Given the chronic nature of insomnia, the presence of non-responders to some treatments it is often necessary switching between various therapeutic approaches and medications.

Evidence of Involvement of the Calcitonin Gene-Related Peptide in Restless Legs Syndrome.

Background: Restless legs syndrome (RLS) is a common sensory-motor disorder characterized by an urge to move the legs, often with unpleasant sensations, particularly during rest. Current treatments include iron supplementation, dopamine agonists, and opioids, but new therapeutic approaches are needed. The dysfunction of the A11 nucleus, which modulates dopaminergic transmission to the spinal cord, is thought to play a role in RLS pathophysiology.

Impact of sleep deprivation on dynamic functional connectivity states.

Sleep deprivation (SD) is an experimental procedure to study the effects of sleep loss on the human brain. Neuroimaging techniques, such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG), have been pivotal in studying these effects. The present chapter aims to retrace the state of the art regarding the literature that examines the SD effects on the brain through functional connectivity (FC) evaluated in fMRI and EEG settings, separately.

Evaluating the differential effects of dopamine agonists and clonazepam on large muscle group movements in restless legs syndrome.

Study Objectives: This study aimed to investigate the effect of dopamine agonists (DA) and Clonazepam on Large Muscle Group Movements during sleep (LMM), a distinct motor phenomenon, in Restless Legs Syndrome (RLS).

Methods: A retrospective analysis was conducted on 51 drug-free adult patients with RLS, divided into three groups: 33 received a DA (pramipexole or ropinirole), 15 received clonazepam, and 18 received a placebo. Each patient underwent two consecutive nocturnal polysomnographic (PSG) recordings: one baseline and one following treatment administration.

Duration of major depressive episodes and sleep architecture: an exploratory study.

Growing evidence supports sleep-wake disruption as a mechanism involved in mood disorders pathogenesis. Duration of depressive episodes varies widely, and longer depressive episodes have been connected to worse outcomes. We aimed to explore if the length of depressive episodes is related to objective modifications of sleep features.