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COVID-19 infection has resulted in a high prevalence of a post-infectious syndrome, known as post-acute sequelae of SARS-CoV-2 (PASC) or "Long COVID". PASC is a heterogeneous disease with a high prevalence of sleep disturbances, varying from an insomnia disorder to excessive daytime sleepiness. Patients seen in the Covid Survivorship Program at the Beth Israel Deaconess Medical Center Boston, USA, were screened for sleep disorders as part of a comprehensive multi-system evaluation. Those who screened positive were referred for a comprehensive sleep evaluation in a dedicated COVID-19-Sleep clinic, followed by diagnostic sleep testing and treatment. This report summarizes patients who completed an American Academy of Sleep Medicine (AASM) accredited facility-based diagnostic evaluation. International Classification of Sleep Disorders 3rd Edition-Revised criteria were met for all diagnoses. In 42 patients with PASC, five categories of sleep disorder syndromes were observed following a sleep clinic evaluation, including obstructive sleep apnea, chronic insomnia disorder, primary hypersomnia, REM behavior disorder (RBD), and new onset circadian phase delay. Seven patients met criteria for idiopathic hypersomnia, and two had narcolepsy type 2. RBD patients were infected in three different waves; circadian disturbance patients were all infected in the winter wave of 2020/21, and the primary hypersomnolence group occurred during all waves, predominantly the initial wave of 2020. A peculiar form of insomnia was a persistent loss of sleep regularity. Specific sleep symptoms/syndromes are reported in this select group of patients with PASC/Long Covid. As new onset sleep complaints are prevalent in PASC, we recommend a complete clinical and investigative sleep evaluation for persistent severe sleep symptoms following COVID-19 infection. • Sleep complaints in PASC are frequent, varying from insomnia to excessive daytime sleepiness. • Noted syndromes: sleep apnea, insomnia, primary hypersomnia, REM behavior disorder, and circadian phase delay. • All circadian disturbances patients were infected in the Winter 20/21 wave. • The response to therapy for hypersomnia and narcolepsy has so far been unremarkable. • Vaccination could have influenced the incidence of PACS patients and their sleep syndromes. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to progress the understanding of idiopathic hypersomnia (IH) by assessing the moderating influence of individual characteristics, such as age, sex, and body mass index (BMI) on sleep architecture. In this retrospective study, 76 IH participants (38.1 ± 11.3 years; 40 women) underwent a clinical interview, an in-laboratory polysomnography with a maximal 9-h time in bed and a multiple sleep latency test (MSLT). They were compared to 106 healthy controls (38.1 ± 14.1 years; 60 women). Multiple regressions were used to assess moderating influence of age, sex, and BMI on sleep variables. We used correlations to assess whether sleep variables were associated with Epworth Sleepiness Scale scores and mean sleep onset latency on the MSLT in IH participants. Compared to controls, IH participants had shorter sleep latency (p = 0.002), longer total sleep time (p

Hypersomnolence or narcolepsy may be the initial finding in neuromyelitis optica spectrum disorders (NMOSD); therefore, it is important in clinical evaluation. Aquaporin 4 (AQP4) is densely located in the periventricular zone of the hypothalamus, where hypocretin is concentrated. Therefore, anti-AQP4 antibodies in NMOSD may cause damage to this zone, resulting in decreased hypocretin and hypersomnia or narcolepsy. In our study, 10 NMOSD patients diagnosed with clinical, radiological, and laboratory findings were compared with 22 multiple sclerosis patients selected as the control group and 22 healthy individuals. The Epworth sleepiness scale and the Stanford sleepiness scale were used to assess excessive daytime sleepiness. Our study supports the fact that hypersomnolence is higher in the NMOSD group, independent of other factors that may cause the tendency to sleep.

Background: One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it. Methods: Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self‐report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information. Results: Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre‐indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post‐indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression. Conclusion: This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences. [ABSTRACT FROM AUTHOR]

This study aimed to progress the understanding of idiopathic hypersomnia (IH) by assessing the moderating influence of individual characteristics, such as age, sex, and body mass index (BMI) on sleep architecture. In this retrospective study, 76 IH participants (38.1 ± 11.3 years; 40 women) underwent a clinical interview, an in-laboratory polysomnography with a maximal 9-h time in bed and a multiple sleep latency test (MSLT). They were compared to 106 healthy controls (38.1 ± 14.1 years; 60 women). Multiple regressions were used to assess moderating influence of age, sex, and BMI on sleep variables. We used correlations to assess whether sleep variables were associated with Epworth Sleepiness Scale scores and mean sleep onset latency on the MSLT in IH participants. Compared to controls, IH participants had shorter sleep latency (p = 0.002), longer total sleep time (p < 0.001), more time spent in N2 sleep (p = 0.008), and showed trends for a higher sleep efficiency (p = 0.023) and more time spent in rapid eye movement (REM) sleep (p = 0.022). No significant moderating influence of age, sex, or BMI was found. More severe self-reported sleepiness in IH patients was correlated with shorter REM sleep latency and less N1 sleep in terms of proportion and duration (ps < 0.01). This study shows that, when compared to healthy controls, patients with IH had no anomalies in their sleep architecture that can explain their excessive daytime sleepiness. Moreover, there is no moderating influence of age, sex, and BMI, suggesting that the absence of major group differences is relatively robust. [ABSTRACT FROM AUTHOR]

Idiopathic hypersomnia typically is a chronic and potentially debilitating neurologic sleep disorder, and is characterized by excessive daytime sleepiness. In addition to excessive daytime sleepiness, idiopathic hypersomnia symptoms can include severe sleep inertia; long, unrefreshing naps; long sleep time; and cognitive dysfunction. Patients with idiopathic hypersomnia may experience a significant impact on their quality of life, work or school performance, earnings, employment, and overall health. Given the complex range of symptoms associated with idiopathic hypersomnia and the array of treatments available, there is a need to provide guidance on the treatment of idiopathic hypersomnia and the clinically relevant recommendations that enhance effective disease management. Identifying appropriate treatment options for idiopathic hypersomnia requires timely and accurate diagnosis, consideration of individual patient factors, and frequent reassessment of symptom severity. In 2021, low-sodium oxybate was the first treatment to receive approval by the US Food and Drug Administration for the treatment of idiopathic hypersomnia in adults. However, many off-label treatments continue to be used. Adjunct nonpharmacologic therapies, including good sleep hygiene, patient education and counseling, and use of support groups, should be recognized and recommended when appropriate. This narrative review describes optimal treatment strategies that take into account patient-specific factors, as well as the unique characteristics of each medication and the evolution of a patient's response to treatment. Perspectives on appropriate symptom measurement and management, and potential future therapies, are also offered. [Display omitted] • Treatment options and strategies considering patient-specific factors are reviewed. • Low-sodium oxybate is the only FDA-approved medication for idiopathic hypersomnia. • Clinical experience in and perspectives on proper symptom management are discussed. • Interactions between medications used to treat idiopathic hypersomnia are summarized. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the prevalence, clinical correlates and the relationship between hypersomnolence and clinical outcomes in a cohort of MDD patients. This is a cross-sectional study of a MDD cohort in an university-affiliated adult psychiatric outpatient clinic. The diagnosis of MDD and severity of depression were ascertained by the clinician with structured clinical interviews. Each participant completed the Epworth Sleepiness Scale (ESS), 1-week sleep diary, and a battery of questionnaires that assessed usual sleep pattern, insomnia, anxiety, depression, fatigue and circadian preference. Hypersomnolence was defined as ESS score ≥14 among those reported ≥7 h of nighttime sleep. Univariate analysis and multiple logistic regression were used to analyze the relationships between the variables. Among 252 recruited subjects, 11 % met the criteria of hypersomnolence as defined by a ESS score ≥14 despite ≥7 h of nighttime sleep. Patients with hypersomnolence had greater depression ratings, higher rates of suicidal ideations over the past week, and more likely to meet a diagnosis of atypical depression (p < 0.05) than those without hypersomnolence. Step-wise logistic regression demonstrated that hypersomnolence was an independent risk factor associated with a 3-fold increase in the risk of depression non-remission (adjusted OR 3.13; 95 % CI 1.10–8.95; p = 0.034). Patients with hypersomnolence despite seemingly adequate sleep represent a subgroup of MDD patients who have a more severe illness profile with higher non-remission rate and suicidality. The findings highlight the importance of addressing both sleep and mood symptoms in the management of MDD. • EDS despite adequate sleep is a common problem in MDD (11 %). • Hypersomnolence is associated with a 3-fold increase in risk of non-remission. • Comprehensive assessment of hypersomnolence is needed to improve the depression outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to develop a screening tool that is simple and easy to use for assessing sleep problems, including hypersomnolence, restless legs syndrome, and insomnia. We also examined the reliability and validity of this tool. Methods: We developed the Sleep Problem Screening Questionnaire (SPSQ), which consists of three sub-sections: insomnia (SPSQi), hypersomnolence (SPSQh), and restless legs syndrome (SPSQr). Subsequently, the participants, consisting of 222 patients with insomnia disorder and 78 healthy individuals, completed both the SPSQ and the comparative scale (Korean version of the Insomnia Severity Index). The analysis was then conducted using this data. Results: The SPSQ demonstrated good convergent and discriminant validity, as well as satisfactory internal consistency. A cutoff score of 6 on the SPSQi was found to be optimal for distinguishing individuals with insomnia. Conclusion: The results of this study suggest that the SPSQ is a reliable and valid tool for screening sleep problems among general adult population. However, there is a limitation as a comparison and validation with scales related to restless legs syndrome and hypersomnolence were not conducted. [ABSTRACT FROM AUTHOR]

Hypersomnolence or narcolepsy may be the initial finding in neuromyelitis optica spectrum disorders (NMOSD); therefore, it is important in clinical evaluation. Aquaporin 4 (AQP4) is densely located in the periventricular zone of the hypothalamus, where hypocretin is concentrated. Therefore, anti-AQP4 antibodies in NMOSD may cause damage to this zone, resulting in decreased hypocretin and hypersomnia or narcolepsy. In our study, 10 NMOSD patients diagnosed with clinical, radiological, and laboratory findings were compared with 22 multiple sclerosis patients selected as the control group and 22 healthy individuals. The Epworth sleepiness scale and the Stanford sleepiness scale were used to assess excessive daytime sleepiness. Our study supports the fact that hypersomnolence is higher in the NMOSD group, independent of other factors that may cause the tendency to sleep. [ABSTRACT FROM AUTHOR]

PurposeObstructive sleep apnea (OSA) is underdiagnosed, partially from variable clinical presentations. Emphasis is often placed on Epworth Sleepiness Scale (ESS), a subjective measure of sleepiness, but variable in OSA. We hypothesized that daytime complaints measured with Language of Sleepiness Questionnaire (LOS) in OSA are not being captured by ESS.MethodsAdults referred to a tertiary sleep clinic undergoing sleep studies completed ESS and LOS questionnaires (20 items with various patient-reported descriptors). LOS was examined in patients who had or did not have OSA without sleepiness based on ESS

The thalamus is a deep structure located in the diencephalon, whose arterial blood supply is mainly from four branches of posterior cerebral artery. The artery of percheron (AOP) is an infrequent variation of thalamic perfusion, occlusion of which presents with a heterogenous, atypical list of symptoms without focal signs. This is in contrast to the typical, easily recognizable focal neurology of other ischemic infarcts. Therefore, AOP infarctions may be misdiagnosed, delayed in diagnosis or missed altogether. It is a rare, but vital area of neurology that needs to be studied by clinicians to facilitate an overall care for patients. We report the case of a 59-year-old lady who presented to us with bilateral complete ptosis with bilateral vertical gaze palsy and nystagmus, whose initial NCCT brain was normal. Subsequent MRI showed bilateral thalamic and midbrain ischemic infarctions in the artery of Percheron distribution. Our case highlights the importance of high degree of suspicion, early diagnosis and role of MRI in the diagnosis when initial CT is normal.

Disorders of consciousness impair early recovery after aneurysmal subarachnoid hemorrhage (aSAH). Modafinil, a wakefulness-promoting agent, is efficacious for treating fatigue in stroke survivors, but data pertaining to its use in the acute setting are scarce. This study sought to assess the effects of modafinil use on mental status after aSAH. Modafinil timing and dosage, neurological examination, intubation status, and physical and occupational therapy participation were documented. Repeated-measures paired tests were used for a before-after analysis of modafinil recipients. Propensity score matching (1:1 nearest neighbor) for modafinil and no-modafinil cohorts was used to compare outcomes. Modafinil (100–200 mg/day) was administered to 21% (88/422) of aSAH patients for a median (IQR) duration of 10.5 (4–16) days and initiated 14 (7–17) days after aSAH. Improvement in mentation (alertness, orientation, or Glasgow Coma Scale score) was documented in 87.5% (77/88) of modafinil recipients within 72 hours and 86.4% (76/88) at discharge. Of 37 intubated patients, 10 (27%) were extubated within 72 hours after modafinil initiation. Physical and occupational therapy teams noted increased alertness or participation in 47 of 56 modafinil patients (83.9%). After propensity score matching for baseline covariates, the modafinil cohort had a greater mean (SD) change in Glasgow Coma Scale score than the no-modafinil cohort at discharge (2.2 [4.0] vs. −0.2 [6.32], P = 0.003). A temporal relationship with improvement in mental status was noted for most patients administered modafinil after aSAH. These findings, a favorable adverse-effect profile, and implications for goals-of-care decisions favor a low threshold for modafinil initiation in aSAH patients in the acute-care setting. [ABSTRACT FROM AUTHOR]

Hypersomnolence is common in major depressive disorder (MDD), associated with more severe episodes, suicide and antidepressant resistance. Nevertheless, few studies used polysomnography (PSG) and multiple sleep latency test (MSLT) to characterize these patients. In this context, we compared patients visiting a sleep center for hypersomnolence complaint with MDD (HSC/MDD+) and without MDD (HSC/MDD-). HSC/MDD+ and HSC/MDD- groups were defined according to DSM-5 criteria and CES-D scale, and had a 30 h-PSG with ad libitum -sleep and PSG followed by MLST. HSC/MDD+ had an increased self-declared total sleep time (sTST) of about 10 h30 similar to HSC/MDD- (630.8 ± 17.3 min- vs -616.5 ± 18.1 min, respectively, p = 0.39). Nevertheless, their objective TST (oTST) on ad libitum PSG was significantly longer and about 10 h50 (648.6 ± 23.9 min- vs -587.4 ± 19.0 min, respectively, p = 0.038). HSC/MDD+ also significantly better estimated their sleep duration, with a lower difference between their sTST and oTST compared to HSC/MDD- (10.0 ± 1.7 %- vs -17.4 ± 2.1 %, respectively, p = 0.009) and confirmed significantly more frequently the hypersomnia diagnosis - i.e. oTST>10H- (82.6 ± 8.1 %- vs -54.6 ± 10.9 %, respectively, p = 0.046). Using the Kupfer index (KI), we confirmed a reduced REM sleep latency in patients MDD/HSC+ (15.2 ± 10.0 %- vs -2.3 ± 2.3 %, respectively, p = 0.039). Both groups had comparable increased diurnal sleepiness assessed with the Epworth scale (14.1 ± 1.1- vs -14.8 ± 1.1, respectively, p = 0.65). HSC/MDD+ had less MSLT sleep latency <8 min (9.1 ± 5.1 %- vs -27.3 ± 6.8 %, respectively, p = 0.048). Retrospective cross-sectional study. HSC/MDD+ accurately estimated their sleep duration, objectively confirmed hypersomnia and may specifically had a decreased Kupfer index. • HSC/MDD+ have an extended sTST and oTST. • HSC/MDD+ accurately estimate their sleep duration and it is essential to consider it during the medical interview. • HSC/MDD+ have a shortened REM latency using the Kupfer index. • HSC/MDD+ are complaining from excessive daytime sleepiness with normal sleep latencies on MLST. • Psychiatrists should also be aware that the prevalence of sleep apnea is increased in this at-risk population. [ABSTRACT FROM AUTHOR]

Summary: Little attention has been paid to the long‐term development of idiopathic hypersomnia symptoms and idiopathic hypersomnia comorbidities. The aim of this study was to describe the general health of patients with idiopathic hypersomnia years after the initial diagnosis, focusing on current subjective hypersomnolence and the presence of its other possible causes. Adult patients diagnosed with idiopathic hypersomnia ≥ 3 years ago at sleep centres in Prague and Kosice were invited to participate in this study. A total of 60 patients were examined (age 47.3 ± SD = 13.2 years, 66.7% women). In all participants, their hypersomnolence could not be explained by any other cause but idiopathic hypersomnia at the time of diagnosis. The mean duration of follow‐up was 9.8 + 8.0 years. Fifty patients (83%) reported persisting hypersomnolence, but only 33 (55%) had no other disease that could also explain the patient's excessive daytime sleepiness and/or prolonged sleep. In two patients (3%), the diagnosis in the meantime had changed to narcolepsy type 2, and 15 patients (25%) had developed a disease or diseases potentially causing hypersomnolence since the initial diagnosis. Complete hypersomnolence resolution without stimulant treatment lasting longer than 6 months was reported by 10 patients (17%). To conclude, in a longer interval from the diagnosis of idiopathic hypersomnia, hypersomnolence may disappear or may theoretically be explained by another newly developed disease, or the diagnosis may be changed to narcolepsy type 2. Thus, after 9.8 years, only 55% of the examined patients with idiopathic hypersomnia had a typical clinical picture of idiopathic hypersomnia without doubts about the cause of the current hypersomnolence. [ABSTRACT FROM AUTHOR]

The gold standard investigation for central disorders of hypersomnolence is the Multiple Sleep Latency Test (MSLT). As the clinical features of these disorders of hypersomnolence evolve with time in children, clinicians may consider repeating a previously non-diagnostic MSLT. Currently there are no guidelines available regards the utility and timing of repeating paediatric MSLTs. Retrospective review of children aged 3–18years with ≥2MSLTs between 2005 and 2022. Narcolepsy was defined as mean sleep latency (MSL) <8min with ≥2 sleep onset REM (SOREM); idiopathic hypersomnia (IH) was defined as MSL <8min with <2 SOREM. MSLTs not meeting these criteria were labelled non-diagnostic. 19 children (9 female) with initial non-diagnostic MSLT underwent repeat MSLT, with 6 proceeding to a 3rd MSLT following 2 non-diagnostic MSLTs. The 2nd MSLT resulted in diagnosis in 6/19 (32 %) (3 narcolepsy, 3 IH); and 2/6 (33 %) 3rd MSLT were diagnostic (2 IH). Median age at initial MSLT was 7.5y (range 3.4–17.8y), with repeat performed after median of 2.9y (range 0.9–8.2y), and 3rd after a further 1.9 years (range 1.2–4.2y). Mean change in MSL on repeat testing was -2min (range −15.5min to +4.9min, p = 0.18). Of the 8 diagnostic repeat MSLTs, in addition to the MSL falling below 8 min, 2 children also developed ≥2 SOREM that had not been previously present. A third of repeat MSLTs became diagnostic, suggesting repeat MSLT should be considered in childhood if clinical suspicion persists. Further work needs to address the ideal interval between MSLTs and diagnostic cut-points specific to the paediatric population. • Narcolepsy and idiopathic hypersomnia symptoms often begin in childhood • Diagnosis with the multiple sleep latency test (MSLT) is based on adult criteria • The utility or timing of repeating a non-diagnostic paediatric MSLT is unknown • A third of repeat MSLTs in children met diagnostic criteria • Repeat MSLT should be considered in childhood if clinical suspicion persists [ABSTRACT FROM AUTHOR]

Abstract:Introduction: Sleep is crucial for athletes' recovery and performance while overtraining can negatively affect sleep quantity and sleep quality. We present a case of a 16-year-old female athlete exploring the reciprocal negative effects of overtraining and sleep problems on each other. Methods: A flyer of a high school cheerleading team with a history of injuries, irregular menses, chronic fatigue, and various sleep-related complaints presented with declining athletic performance. Results: After medical causes were ruled out, sleep disorders such as insomnia, restless legs syndrome and delayed sleep phase were identified and treated. Despite treatment, her daytime sleepiness and sleep attacks persisted and thus necessitated further investigation. Comprehensive sleep studies, including actigraphy, polysomnography, and multiple sleep latency testing, ultimately revealed insufficient sleep syndrome as the underlying cause. Notably, periods of reduced training intensity coincided with significant improvements in her daytime sleepiness. Conclusion: This case highlights the importance of comprehensive sleep-wake assessments for adolescent athletes to accurately diagnose sleep disorders in the context of overtraining. Prioritizing sleep is crucial for optimizing athletic performance in young athletes by preventing and managing overtraining-related sleep disorders. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Sleep is crucial for athletes’ recovery and performance while overtraining can negatively affect sleep quantity and sleep quality. We present a case of a 16-year-old female athlete exploring the reciprocal negative effects of overtraining and sleep problems on each other. Methods: A flyer of a high school cheerleading team with a history of injuries, irregular menses, chronic fatigue, and various sleep-related complaints presented with declining athletic performance. Results: After medical causes were ruled out, sleep disorders such as insomnia, restless legs syndrome and delayed sleep phase were identified and treated. Despite treatment, her daytime sleepiness and sleep attacks persisted and thus necessitated further investigation. Comprehensive sleep studies, including actigraphy, polysomnography, and multiple sleep latency testing, ultimately revealed insufficient sleep syndrome as the underlying cause. Notably, periods of reduced training intensity coincided with significant improvements in her daytime sleepiness. Conclusion: This case highlights the importance of comprehensive sleep-wake assessments for adolescent athletes to accurately diagnose sleep disorders in the context of overtraining. Prioritizing sleep is crucial for optimizing athletic performance in young athletes by preventing and managing overtraining-related sleep disorders.

Background and purpose: Despite their detrimental impact on the quality of life in autoimmune encephalitis, sleep disorders have not been investigated in anti‐glutamic acid decarboxylase (GAD65) associated neurological syndromes. Methods: Six consecutive adult patients diagnosed with anti‐GAD65‐associated neurological syndromes (four with limbic encephalitis and two with stiff‐person syndrome) and 12 healthy controls were enrolled. Participants underwent sleep interviews and sleep studies including night‐time video‐polysomnography, followed by five daytime multiple sleep latency tests (MSLTs, to assess propensity to fall asleep) and an 18 h bed rest polysomnography (to assess excessive sleep need). Results: Patients reported the need for daily naps and that their cognition and quality of life were altered by sleepiness, but they had normal scores on the Epworth sleepiness scale. Compared with controls, sleep latencies during the MSLT were shorter in the patient group (median 5.8 min, interquartile range [IQR] 4.5, 6.0 vs. 17.7 min, IQR 16.3, 19.7, p = 0.001), and the arousal index was reduced (2.5/h, IQR 2.3, 3.0 vs. 22.3/h, IQR 13.8, 30.0, p = 0.002), although total sleep time was similar between groups (621 min, IQR 464, 651 vs. 542.5 min, IQR 499, 582, p = 0.51). Remarkably, all six patients had MSLT latencies ≤8 min, indicating severe sleepiness. No parasomnia or sleep‐disordered breathing was detected. Conclusion: Central hypersomnia is a relevant characteristic of anti‐GAD65‐associated neurological syndromes. [ABSTRACT FROM AUTHOR]

Excessive daytime sleepiness (EDS) is common in childhood and is currently quantified using adult criteria on a multiple sleep latency test (MSLT). This study aimed to describe paediatric MSLT results, particularly focussing on a previously proposed alternative mean sleep latency (MSL) threshold for children of 12 min, and assess the impact of a 5th nap. We performed a retrospective analysis of MSLTs at a single paediatric centre from 2004 to 2021. Narcolepsy was defined as a mean sleep latency (MSL) ≤8min with ≥2 sleep onset REM (SOREM) periods. Idiopathic Hypersomnia (IH) was defined as a MSL ≤8min with <2 SOREMs. An ambiguous MSLT result was defined as a MSL 8–12min and/or ≥2 SOREM periods. Of 214 MSLTs [50 % female, median age 14.0y (range 3.3–20.1y)], narcolepsy was diagnosed in 48 (22 %), IH in 22 (10 %) and the result was ambiguous in 44 (21 %). Those with ambiguous MSLT results were older (15.6 vs 13.4y, p = 0.006) with a higher proportion of females (61 % vs 35 %, p = 0.01) in comparison to the narcolepsy group. A 5th nap was performed in 60 (28 %) of MSLTs and only changed the outcome in one case. In conclusion, MSLT results are borderline in 21 % of paediatric cases, suggesting that current adult diagnostic criteria may miss narcolepsy and IH in children. A 5th nap usually makes no difference or increases the MSL, suggesting that a four nap MSLT protocol could be used apart from rare cases where the result is borderline after the 4th nap. • An MSL ≤12 min and/or ≥2 SOREMs reflects an ambiguous MSLT result in children. • 1 in 5 multiple sleep latency tests in children are ambiguous. • Clinical features of this group suggest many have a disorder of hypersomnolence. • Broadening paediatric MSLT diagnostic criteria would facilitate timely diagnosis. • A fifth nap rarely changes the MSLT result, supporting a revised 4-nap protocol. [ABSTRACT FROM AUTHOR]

Biological, environmental, behavioral, and social factors can influence sleep and lead to sleep disorders or diseases. Sleep disorders are common, numerous, and heterogeneous in terms of their etiology, pathogenesis, and symptomatology. The management of sleep–wake circadian disorders (SWCDs) includes education on sleep hygiene, behavioral strategies, psychotherapy (cognitive behavioral therapy (CBT), particularly), instrument-based treatments (i.e., positive airway pressure therapy, hypoglossal nerve stimulation), and pharmacotherapy. Depending on the disease, therapy varies and is executed sequentially or can be a combination of several forms of therapy. Drugs used for SWCDs include traditional sleep- or wake-promoting agents and chronotherapeutic agents. Recently, novel medications, which more precisely act on specific neurochemical systems (i.e., the orexin system) important for sleep and waking, are also increasingly being used. In this review, the pharmacotherapy of common sleep disorders (insomnia, sleep-related breathing disorder, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders) embedded in the overall therapeutic concept of each disorder is presented. There is also an outlook on possible future pharmacotherapies. [ABSTRACT FROM AUTHOR]

Study objectivesTo evaluate the clinical utility of actigraphy as compared with sleep questionnaires prior to the Multiple Sleep Latency Test (MSLT) in a sleep disorders clinic population.MethodsTwenty-eight clinically referred participants (mean age: 42.3 ± 18.8 years) completed the study protocol. On day 1, participants completed the following questionnaires: Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (affect, vigor), Patient Health Questionnaire, and Multidimensional Fatigue Symptom Inventory-Short Form. On days 1-8, participants wore an actigraph and completed a sleep diary to assess mean nighttime and mean daytime total sleep time and sleep efficiency or sleep percentage. On day 9, participants repeated the ESS and completed an MSLT. Correlations assessed mean MSLT sleep-onset latency (MSLT-SOL) vs actigraphy, sleep diary, and questionnaires. Chi-square analyses assessed abnormal MSLT-SOL (≤ 8 minutes) or daytime sleepiness (ESS ≥ 10) and referral question (ie, sleep-disordered breathing vs hypersomnolence disorder).ResultsMean MSLT-SOL was correlated with nighttime total sleep time assessed via both actigraphy and diary, but not with questionnaires. Significant correlations emerged for ESS score on day 1 vs 9, actigraphy vs sleep diary mean nighttime total sleep time, and PSQI vs mean sleep diary sleep efficiency. There was no significant relationship between mean MSLT-SOL and referral question.ConclusionsOur finding that total sleep time measured by actigraphy was associated with MSLT-SOL suggests it is useful in informing the interpretation of MSLT findings; however, it does not appear to be a viable substitute for MSLT for the measurement of objective sleepiness in clinical settings.CitationKelly MR, Zeidler MR, DeCruz S, et al. Actigraphy prior to Multiple Sleep Latency Test: nighttime total sleep time predicts sleep-onset latency. J Clin Sleep Med. 2022;18(1):161-170.

Logan D Schneider,1 Anne Marie Morse,2 Michael J Strunc,3 Joyce K Lee-Iannotti,4 Richard K Bogan5 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; 2Janet Weis Children’s Hospital, Geisinger Medical Center, Danville, PA, USA; 3The Center for Pediatric Sleep Medicine, Children’s Hospital of The King’s Daughters, Norfolk, VA, USA; 4Department of Neurology, The University of Arizona College of Medicine, Phoenix, AZ, USA; 5Department of Pulmonology, University of South Carolina School of Medicine, Columbia, SC, USACorrespondence: Logan D Schneider, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 450 Broadway St, Pavilion C 2nd Fl MC 5704, Redwood City, CA, 94063, USA, Tel +1 650 723-6601, Fax +1 650 721-3448, Email logands@gmail.comAbstract: Narcolepsy and idiopathic hypersomnia are chronic conditions that negatively affect alertness, mental and physical energy, functioning, and quality of life (QoL). Calcium, magnesium, potassium, and sodium oxybates (low-sodium oxybate; LXB) is an oxybate formulation with 92% less sodium than sodium oxybate (SXB; a treatment for narcolepsy) and the same active moiety. LXB is approved in the US for treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age or older with narcolepsy, and idiopathic hypersomnia in adults. In Phase 3 clinical trials, LXB exhibited a safety profile consistent with that of SXB in narcolepsy. Besides continued efficacy in treating symptoms, potential benefits of long-term LXB treatment include flexible optimization of dosing and regimen, improvement of QoL and functioning, weight loss, and (relative to SXB in narcolepsy) health benefits of reduced sodium content. Dosing of LXB is twice nightly (for narcolepsy) or once or twice nightly (for idiopathic hypersomnia) based on patient characteristics and response, and individualized titration can be leveraged over the long term as a patient’s life circumstances change. Patients with narcolepsy transitioning from SXB initiate LXB at the same dose, and most patients require no further changes to achieve similar efficacy and tolerability. Improvements in functioning and QoL with LXB treatment could have cascading positive effects in multiple domains, particularly in younger patients. In clinical trials, LXB was associated with weight loss in both narcolepsy (in which obesity is a well-established comorbidity) and idiopathic hypersomnia, only occasionally leading participants to be underweight. As both narcolepsy and idiopathic hypersomnia are associated with increased risk of cardiometabolic and cardiovascular comorbidities, limiting medication-related sodium intake with LXB may have significant health benefits, although this has not yet been verified prospectively due to the prolonged follow-up required. LXB is a promising long-term treatment for narcolepsy and idiopathic hypersomnia.Plain Language Summary: Narcolepsy and idiopathic hypersomnia are disorders that make people feel very sleepy. Low-sodium oxybate (LXB) is a medicine for these disorders. Doctors think LXB works on parts of the brain that keep people awake. LXB may quiet those brain parts down at night by reducing their electrical activity, which helps people sleep better. LXB wears off by the morning, so people can wake up normally and feel more alert the next day. LXB has less sodium (which is part of salt) than a medicine called sodium oxybate. Sodium oxybate has been used for narcolepsy for more than 20 years. LXB has several benefits. First, LXB may be healthier than medicines that contain a lot of sodium, such as a high-sodium oxybate. This is because sodium can increase blood pressure and risk of heart disease. Second, LXB can be taken twice each night for narcolepsy, or once or twice each night for idiopathic hypersomnia. This depends on a person’s lifestyle, how well the medicine is working, and side effects. Third, people taking LXB are more able to work and do other activities and have better quality of life. Finally, people taking LXB may lose weight. This can help overweight or obese people.Keywords: cardiovascular, dosing, LXB, hypersomnolence, quality of life, weight loss

Joanne Stevens,1 Logan D Schneider,2 Aatif M Husain,3 Diane Ito,4 Douglas S Fuller,5 Phyllis C Zee,6 Wayne Macfadden1 1Global Medical Affairs, Jazz Pharmaceuticals, Philadelphia, PA, USA; 2Stanford University Sleep Medicine Center, Stanford University School of Medicine, Stanford, CA, USA; 3Duke University Department of Neurology, Duke University Medical Center, Durham, NC, USA; 4Stratevi, Santa Monica, CA, USA; 5Biostatistics, Jazz Pharmaceuticals, Philadelphia, PA, USA; 6Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USACorrespondence: Wayne Macfadden, Jazz Pharmaceuticals, 2005 Market Street, Philadelphia, PA, 19103, USA, Tel +1 215-832-3750, Email wayne.macfadden@jazzpharma.comPurpose: Idiopathic hypersomnia is a debilitating neurologic sleep disorder characterized by excessive daytime sleepiness, sleep inertia, and prolonged sleep. Its impact on patients’ quality of life and daily functioning has not been fully elucidated. The Real World Idiopathic Hypersomnia Outcomes Study (ARISE) evaluated the daily functioning, relationships, cognition, emotional well-being, and productivity/employment of participants with idiopathic hypersomnia.Patients and Methods: ARISE was a US-based virtual cross-sectional survey comprising multiple patient-reported outcome measures (Functional Outcomes of Sleep Questionnaire, short version [FOSQ-10], Quality of Life in Neurological Disorders [Neuro-QoL] Social Roles and Stigma domains, British Columbia Cognitive Complaints Inventory [BC-CCI], Patient Health Questionnaire [PHQ-9], and the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP]). Participants were adults 21– 65 years of age with idiopathic hypersomnia. Data were analyzed for all participants and for subgroups with/without long sleep time (LST; self-reported sleep ≥ 11 hours in 24 hours).Results: Of 75 participants enrolled, most were female (81.3%) and the mean (SD) age was 34.1 (10.7) years. Participants’ scores on the FOSQ-10 (mean [SD] score: 10.7 [2.8]) and the Neuro-QoL Social Roles (43.4 [4.2]) and Stigma (57.3 [5.9]) domains reflected impairments in daily functioning and quality of life. More than half of participants reported moderate to severe cognitive complaints (BC-CCI; 62.7%) and moderate to severe depressive symptoms (PHQ-9; 66.7%). Scores on the WPAI:SHP showed substantial impairments in absenteeism, presenteeism, overall work productivity, and overall regular daily activity (mean percent [SD]: 12.3 [23.6], 47.6 [22.7], 51.4 [24.7], and 64.0 [21.9], respectively). These considerable impairments were found in participants with and without LST.Conclusion: ARISE participants with idiopathic hypersomnia demonstrated poor quality of life and impaired functioning across multiple symptom domains.Keywords: relationships, social, work productivity, cognitive function, hypersomnolence, long sleep time

Objective: The objectives of this study are to evaluate the prevalence and incidence of Narcolepsy type 1 and type 2 and to determine the prevalence of narcolepsy diagnosis criteria in the US general population. Methods: This longitudinal study was conducted in the adult US general population in two occasions. The initial interviews included 15 states (Arizona, California, Colorado, Florida, Idaho, Missouri, New York, North Carolina, North Dakota, Oregon, Pennsylvania, South Dakota, Texas, Washington, and Wyoming). The follow-up interviews, was done three years later in eight of these states. Of the 19,136 contacted individuals, 15,929 completed the initial interview and 10,931 completed the follow-up. Participants were interviewed using the Sleep-EVAL system, an artificial intelligence tool. Narcolepsy Type 1 (with cataplexy) and Narcolepsy Type 2 (without cataplexy) were defined according to the ICSD-3 classification. Symptoms of narcolepsy were assessed by frequency per week and duration. Medical visits and diagnoses were also collected. Results: Participants were aged between 18 and 102 years of age (mean 45.8 ± 17.9 years), 51.3 % were women. The prevalence of narcolepsy with cataplexy was 12.6 per 100,000 individuals (95 % C.I., 0 to 30) and narcolepsy without cataplexy was 25.1 per 100,000. The incidence per year was 2.6 per 100,000 individuals (95 % C.I., 0 to 11). Conclusions: Narcolepsy is a rare condition affecting 37.7/100,000 individuals (126,191 individuals in the current US population). Our US general population prevalence is in line with rates found in community-based studies but lower than what is reported in claim database studies.

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Objectives: The purpose of this study was to develop a screening tool that is simple and easy to use for assessing sleep problems, including hypersomnolence, restless legs syndrome, and insomnia. We also examined the reliability and validity of this tool. Methods: We developed the Sleep Problem Screening Questionnaire (SPSQ), which consists of three sub-sections: insomnia (SPSQi), hypersomnolence (SPSQh), and restless legs syndrome (SPSQr). Subsequently, the participants, consisting of 222 patients with insomnia disorder and 78 healthy individuals, completed both the SPSQ and the comparative scale (Korean version of the Insomnia Severity Index). The analysis was then conducted using this data. Results: The SPSQ demonstrated good convergent and discriminant validity, as well as satisfactory internal consistency. A cutoff score of 6 on the SPSQi was found to be optimal for distinguishing individuals with insomnia. Conclusion: The results of this study suggest that the SPSQ is a reliable and valid tool for screening sleep problems among general adult population. However, there is a limitation as a comparison and validation with scales related to restless legs syndrome and hypersomnolence were not conducted. [ABSTRACT FROM AUTHOR]

Michael J Thorpy,1 Isabelle Arnulf,2 Nancy Foldvary-Schaefer,3 Anne Marie Morse,4 Karel Šonka,5 Patricia Chandler,6 Luke Hickey,7 Abby Chen,6 Jed Black,6,8 Amanda Sterkel,6 Dan Chen,9 Richard K Bogan,10 Yves Dauvilliers11,12 1Albert Einstein College of Medicine, Bronx, NY, USA; 2Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France; 3Cleveland Clinic Sleep Disorders Center, Department of Neurology, Lerner College of Medicine, Cleveland, OH, USA; 4Janet Weis Children’s Hospital, Geisinger, Danville, PA, USA; 5Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; 6Jazz Pharmaceuticals, Palo Alto, CA, USA; 7Jazz Pharmaceuticals, Philadelphia, PA, USA; 8Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA, USA; 9Formerly Jazz Pharmaceuticals, Palo Alto, CA, USA; 10University of South Carolina School of Medicine, Columbia, SC, USA; 11Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France; 12University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, FranceCorrespondence: Michael J Thorpy, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA, Tel +1 718 920-4841, Fax +1 718 798-4352, Email michael.thorpy@einsteinmed.orgPurpose: To report the efficacy and safety of lower-sodium oxybate (LXB; Xywav®) during the open-label titration and optimization period (OLT) and stable-dose period (SDP) in a clinical study for the treatment of idiopathic hypersomnia.Patients and Methods: Data were collected during treatment titration and optimization in a phase 3 randomized withdrawal trial in adults (18– 75 years of age) with idiopathic hypersomnia who took LXB treatment (once, twice, or thrice nightly, administered orally) in the OLT (10– 14 weeks), followed by the 2-week, open-label SDP. Endpoints included the Epworth Sleepiness Scale (ESS), Idiopathic Hypersomnia Severity Scale (IHSS), Patient Global Impression of Change, Clinical Global Impression of Change, Functional Outcomes of Sleep Questionnaire (FOSQ)-10, and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP).Results: The safety population included 154 participants; the modified intent-to-treat population comprised 115 participants. During open-label treatment, mean (SD) ESS scores improved (decreased) from 15.7 (3.8) at baseline to 6.1 (4.0) at end of SDP, and IHSS scores improved (decreased) from 31.6 (8.3) to 15.3 (8.5). Improvements were also observed during OLT in each individual IHSS item and in FOSQ-10 and WPAI:SHP scores. Thirty-five (22.7%) participants discontinued during OLT and SDP, 22 (14.3%) due to treatment-emergent adverse events (TEAEs) during OLT and SDP. The most frequent TEAEs in the first 4 weeks were nausea, headache, dizziness, and dry mouth; TEAE incidence decreased throughout OLT and SDP (weeks 1– 4, n = 87 [56.5%]; weeks 13– 16, n = 39 [31.7%]).Conclusion: During open-label treatment with LXB, participants showed clinically meaningful improvements in idiopathic hypersomnia symptoms and in quality of life and functional measures. TEAE incidence declined over LXB titration and optimization.Keywords: excessive daytime sleepiness, hypersomnolence, quality of life, pharmacotherapy

Background: Hypersomnolence has been considered a prominent feature of seasonal affective disorder (SAD) despite mixed research findings. In the largest multi-season study conducted to date, we aimed to clarify the nature and extent of hypersomnolence in SAD using multiple measurements during winter depressive episodes and summer remission. Methods: Sleep measurements assessed in individuals with SAD and nonseasonal, never-depressed controls included actigraphy, daily sleep diaries, retrospective self-report questionnaires, and self-reported hypersomnia assessed via clinical interviews. To characterize hypersomnolence in SAD we (1) compared sleep between diagnostic groups and seasons, (2) examined correlates of self-reported hypersomnia in SAD, and (3) assessed agreement between commonly used measurement modalities. Results: In winter compared to summer, individuals with SAD (n = 64) reported sleeping 72 min longer based on clinical interviews (p < 0.001) and 23 min longer based on actigraphy (p = 0.011). Controls (n = 80) did not differ across seasons. There were no seasonal or group differences on total sleep time when assessed by sleep diaries or retrospective self-reports (p 's > 0.05). Endorsement of winter hypersomnia in SAD participants was predicted by greater fatigue, total sleep time, time in bed, naps, and later sleep midpoints (p 's < 0.05). Conclusion: Despite a winter increase in total sleep time and year-round elevated daytime sleepiness, the average total sleep time (7 h) suggest hypersomnolence is a poor characterization of SAD. Importantly, self-reported hypersomnia captures multiple sleep disruptions, not solely lengthened sleep duration. We recommend using a multimodal assessment of hypersomnolence in mood disorders prior to sleep intervention. [ABSTRACT FROM AUTHOR]

Hypersomnia is common in psychiatric disorders, yet there are few self-report measures that adequately characterize this sleep disturbance. The objective of this study was to validate the Hypersomnia Severity Index (HSI), a tool designed to measure severity, distress and impairment of hypersomnia in psychiatric populations. Psychometric properties were evaluated in an undergraduate Scale Development sample (N = 381) and two psychiatric Scale Validation samples: euthymic bipolar participants with a range of sleep complaints (N = 89), and unmedicated unipolar depressed participants (N = 21) meeting operational criteria for hypersomnolence disorder. Exploratory factor analysis and confirmatory factor analysis in the Scale Development and Validation samples, respectively, suggested a two-factor structure representing Hypersomnia Symptoms and Distress/Impairment best fit the data. Convergent validity was established by significant associations with the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and the Sheehan Disability Scale in both samples. Construct validity was further supported by significant correlations between the Scale Validation sample and two weeks of diary- and actigraphy-determined total sleep time and time in bed. A cutoff score of 10 maximally discriminated between those with hypersomnia and those without. The HSI shows promise as a measure of hypersomnia that is commonly seen in psychiatric disorders, and may be of use to both researchers and clinicians. SUPPORT: This work is supported by grants from the American Sleep Medicine Foundation (76-JF-12), the Brain and Behavior Research Foundation (19193), and NIMHK23MH099234 (DTP); National Science Foundation Graduate Research Fellowship Program and Stanford Child Health Research Institute (KAK); and R34MH080958 and R01MH105513 (AGH).

Abstract Background Excessive daytime sleepiness (EDS), a primary symptom of obstructive sleep apnea (OSA), negatively affects functioning and quality of life (QoL). EDS can persist despite primary airway therapy, and often remains unmanaged, potentially due to inadequate provider-patient communication. Ethnographic research was conducted to assess provider-patient communication about EDS. Methods Participating physicians (primary care n = 5; pulmonologists n = 5; sleep specialists n = 3) identified adult patients (n = 33) diagnosed with OSA who were prescribed positive airway pressure (PAP) therapy ≥6 months prior and previously reported EDS. Visits and post-visit interviews were video-recorded and analyzed using standardized, validated sociolinguistic techniques. Results Despite 55% of patients (18/33) reporting QoL impacts post-visit, this was discussed during 28% (5/18) of visits. Epworth Sleepiness Scale was administered during 27% (9/33) of visits. Many patients (58% [19/33]) attributed EDS to factors other than OSA. Physicians provided EDS education during 24% of visits (8/33). Prior to the visit, 30% (10/33) of patients were prescribed EDS medication, of which 70% (7/10) reported currently experiencing EDS symptoms. Conclusions EDS was minimally discussed and rarely reassessed or treated after PAP therapy initiation in this study. Patients often attributed EDS to factors other than OSA. The findings suggest physicians and patients may benefit from dialogue tools, routine use of screening tools, and patient education.

Biological, environmental, behavioral, and social factors can influence sleep and lead to sleep disorders or diseases. Sleep disorders are common, numerous, and heterogeneous in terms of their etiology, pathogenesis, and symptomatology. The management of sleep–wake circadian disorders (SWCDs) includes education on sleep hygiene, behavioral strategies, psychotherapy (cognitive behavioral therapy (CBT), particularly), instrument-based treatments (i.e., positive airway pressure therapy, hypoglossal nerve stimulation), and pharmacotherapy. Depending on the disease, therapy varies and is executed sequentially or can be a combination of several forms of therapy. Drugs used for SWCDs include traditional sleep- or wake-promoting agents and chronotherapeutic agents. Recently, novel medications, which more precisely act on specific neurochemical systems (i.e., the orexin system) important for sleep and waking, are also increasingly being used. In this review, the pharmacotherapy of common sleep disorders (insomnia, sleep-related breathing disorder, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders) embedded in the overall therapeutic concept of each disorder is presented. There is also an outlook on possible future pharmacotherapies.

The selective serotonin reuptake inhibitor (SSRI), sertraline, enhances serotonergic transmission and is used in the treatment of major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder and premenstrual dysphoric disorder. Sertraline use is associated with a higher prevalence of anxiety, agitation, insomnia, and restlessness than other selective SSRIs, with the exception of fluoxetine. Given these activating properties, it is usually administered in the morning to prevent insomnia. However, a small number of individuals experience sedation during SSRI treatment. While the underlying mechanism remains poorly characterized, we present a series of cases in which the sedating effect of sertraline were effectively exploited to treat insomnia in patients with comorbid psychiatric conditions such as posttraumatic stress disorder (PTSD) and depression.

Background and Objective: Sleep paralysis is a common phenomenon which causes and consequences are seldomly studied. The aim of this study was to investigate the incidence and prevalence of sleep paralysis (SP) in the American adult population and its evolution on a 3-year period.Methods: This longitudinal study was conducted between 2002 and 2015 and included a representative sample of the US general population. A total of 12,218 subjects were initially interviewed (W1) and 10,931 were re-interviewed three years later (W2). The subjects participated in telephone interviews using the Sleep-EVAL expert system. Each interview lasted for about 1 h. SP episodes were assessed according to their frequency and duration.Results: At W1, 9.7% (95%CI: 9.1%-10.3%) reported having ≥1 episode of SP in the previous year. At W2, 15.1% (95%CI: 14.4%-15.8%) reported SP. A total of 29.9% of subjects with SP at W1 still reported episodes at W2. The 1-year incidence was 2.7% (95%CI: 2.4-3.0%). After adjusting for age and sex, prevalent SP (i.e., present at W2) was predicted by age and race and the following factors present at W1: major depressive disorder, pain, hypersomnolence, cataplexy, hypnagogic and hypnopompic hallucinations, posttraumatic stress disorder, a reduction in sleep duration of ≥60 min, and the use of analgesic/antipyretic medication. Incident SP (i.e. new cases at W2) had similar predictive factors.Discussion: Episodes of SP are frequent in the general population. Its persistence is predicted by several factors associated with narcolepsy like hypersomnolence and cataplexy but also by other factors like posttraumatic stress disorder or pain. [ABSTRACT FROM AUTHOR]

Background: Although central disorders of hypersomnolence (CDH) and attention-deficit/hyperactivity disorder (ADHD) are frequently comorbid, they often remain underdiagnosed, leading to insufficient treatment and sociopsychological outcomes., Case Presentation: Here, we present a case of a male in his late 20s with ADHD and autism spectrum disorder who exhibited symptoms suggestive of idiopathic hypersomnia (IH), a subtype of CDH. The patient experienced difficulty waking up and dropped out of university. Additionally, although methylphenidate extended-release was prescribed, he often forgot to take his medication, resulting in difficulty waking up until late afternoon. No symptoms related to rapid eye movements sleep were observed. Considering the possibility of concurrent hypersomnia with neurodevelopmental disorders, we conducted 24-h polysomnography (PSG). The results demonstrated total sleep time of 774.5 min (≥660 min). Together with other criteria, we diagnosed him as having IH. Following discharge and discussion with the patient, we provided sleep hygiene education for him, and he resumed day care attendance to establish a social routine., Conclusion: In cases where hypersomnia may co-occur with neurodevelopmental disorders, active utilization of 24-h PSG enables detailed evaluation of sleep-wake patterns and behaviors, facilitating effective guidance on sleep hygiene and promoting improvements in social rhythms and sociability., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Hypersomnolence, a broad presentation encompassing excessive daytime sleepiness, hypersomnia and sleep inertia, affects around 25 % of patients with a major depressive disorder. Yet, hypersomnolence is often overlook in clinical settings - which can prevent remission of the mood disorder in addition to significantly interfering with quality of life. Clinical guidelines are lacking to support clinicians in the diagnosis and treatment of hypersomnolence in depression. Pharmacological treatment with selective serotonin reuptake inhibitors is insufficient and noradrenaline and dopamine reuptake inhibitors or similar molecules are generally indicated. Low-sodium oxybate was recently approved for Idiopathic Hypersomnia, but studies are needed to assess its efficacy in patients with comorbid depression. In parallel, cognitive behavioral therapy for hypersomnia is being developed as adjunct non-pharmacological treatment. Light therapy might also be beneficial in these populations. This narrative review aims at proposing a diagnostic approach reconciliating psychiatry and sleep medicine nosologies, as well as offering a multimodal treatment algorithm for hypersomnolence in depression., Competing Interests: Declaration of competing interest Dr Moderie reports no biomedical financial interests or potential conflicts of interest. Dr Boivin provides conferences and legal expert advice on sleep-related topics., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Sex differences in sleep disturbances during major depressive episodes (MDE) have been suggested. This study compares the prevalence, sociodemographic characteristics, and psychiatric comorbidity associated with sleep complaints specific to each sex among adults with MDE. These findings are crucial for precise diagnosis, personalized treatment, and improved clinical outcomes., Methods: In a large nationally representative prospective survey, we used multi-adjusted logistic regression models including sociodemographic characteristics, psychiatric comorbidity, and depression severity to examine whether associations differ between men and women., Results: Among women, 93.3 % reported at least one type of sleep complaints (i.e., trouble falling asleep, early morning awakening or hypersomnia) while 91.0 % of men did, with respectively 78.3 % and 77.2 % of insomnia complaints, and 46.2 % and 41.3 % of hypersomnia complaints. Women with sleep complaints were more likely to be black, with lower individual incomes, have histrionic personality disorder or a specific phobia. Conversely, men with sleep complaints were more likely to have a lifetime diagnosis of mania spectrum disorder, generalized anxiety disorder, drug use disorder, as well as dependent and schizotypal personality disorders. Surprisingly, being "never married" has emerged as a protective factor against sleep complaints in women, while posing as a risk factor in men compared to other marital statuses. Differences and specificities were also noted concerning subtypes of insomnia and hypersomnia complaints., Limitations: The cross-sectional design means the associations found do not imply causality., Conclusions: These findings provide insights into the complex relationship between sleep and depression in men and women, highlighting the need for personalized interventions., Competing Interests: Declaration of competing interest Authors report no conflicts of interest related to this work., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a multicenter research initiative to identify new biomarkers in central disorders of hypersomnolence (CDH). Whereas narcolepsy type 1 (NT1) is well characterized, other CDH disorders lack precise biomarkers. In SPHYNCS, we utilized Fitbit smartwatches to monitor physical activity, heart rate, and sleep parameters over 1 year. We examined the feasibility of long-term ambulatory monitoring using the wearable device. We then explored digital biomarkers differentiating patients with NT1 from healthy controls (HC). A total of 115 participants received a Fitbit smartwatch. Using a adherence metric to evaluate the usability of the wearable device, we found an overall adherence rate of 80% over 1 year. We calculated daily physical activity, heart rate, and sleep parameters from 2 weeks of greatest adherence to compare NT1 (n = 20) and HC (n = 9) participants. Compared to controls, NT1 patients demonstrated findings consistent with increased sleep fragmentation, including significantly greater wake-after-sleep onset (p = .007) and awakening index (p = .025), as well as standard deviation of time in bed (p = .044). Moreover, NT1 patients exhibited a significantly shorter REM latency (p = .019), and sleep latency (p = .001), as well as a lower peak heart rate (p = .008), heart rate standard deviation (p = .039) and high-intensity activity (p = .009) compared to HC. This ongoing study demonstrates the feasibility of long-term monitoring with wearable technology in patients with CDH and potentially identifies a digital biomarker profile for NT1. While further validation is needed in larger datasets, these data suggest that long-term wearable technology may play a future role in diagnosing and managing narcolepsy., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Resumen: La hipersomnia idiopática (HI) es una patología frecuentemente crónica, incapacitante, polimórfica, de etiología y prevalencia desconocida. No existen marcadores biológicos ni test diagnósticos específicos, alcanzando el diagnóstico definitivo por exclusión de otras enfermedades.Clínicamente el cuadro se caracteriza por somnolencia diurna excesiva, despertar emborrachado, performance reducido con problemas de atención y memoria asociados a manifestaciones autonómicas. La terapia continúa siendo sintomática, utilizando fármacos que han resultado efectivos en narcolepsia.En este artículo revisaremos algunos puntos claves en relación a la prevalencia, etiología, criterios diagnósticos y manejo de la HI. Summary: Idiopathic hypersomnia (HI) is a chronic polymorphic disorder that frequently reduces the quality of life, with unknown prevalence and etiology. There are neither biomarkers nor specific diagnostic tests and the definitive diagnosis is only achieved by exclusion of other causes.Clinically this disorder is characterized by excessive daytime sleepiness, sleep drunkenness, suboptimal performance, impairment of attention and memory, and some autonomic manifestations. Until now the treatment has been directed to symptomatic management, with medication frequently used in narcolepsy.This article reviews some keys points in relation to the prevalence, etiology, diagnostic criteria and treatment of HI.

Objective Adult attention-deficit/hyperactivity disorder (ADHD) is characterized by a dysexecutive syndrome reflected in cognitive, emotional, and behavioral areas. Independently of a formal diagnosis of ADHD, higher ADHD symptoms are associated with higher levels of insomnia and sleepiness symptoms in adult population-based samples. Insomnia and sleepiness are sleep disorders that are both associated with deficits in several aspects of executive functions which in turn are likely to mimic a range of ADHD symptoms. Our objective was to explore the interrelationships between ADHD, insomnia, and sleepiness symptoms and executive functioning in community-dwelling adults. Method A total of 442 participants (18–89 years, 56% females) underwent a semistructured clinical interview and completed questionnaires for insomnia, sleepiness, and everyday behaviors in which executive functions are implicated. Mediation Models were applied. Results Insomnia and sleepiness symptoms did not play a mediating role between ADHD symptoms and executive functioning. Conversely, our results highlighted a mediating effect of daytime insomnia consequences and sleepiness on ADHD symptoms via behavioral regulation executive symptoms (respectively, β  = −0.32, p  < .001, 95% CI [−0.46, −0.20]; β  = 0.09, p  < .05, 95% CI [0.02, 0.16]) and metacognitive executive symptoms (respectively, β  = −0.30, p  < .001, 95% CI [−0.44, −0.18]; β  = 0.12, p  < .01, 95% CI [0.04, 0.22]). Conclusions Daytime insomnia consequences and sleepiness symptoms could lead to ADHD-like symptoms through their associated executive symptoms expressed in daily life. When faced with symptoms suggestive of ADHD in adults, insomnia and sleepiness should be systematically screened with standardized instruments. [ABSTRACT FROM AUTHOR]

La plainte de somnolence concerne un Français sur cinq et comporte un risque accidentel grave. La notion récente d'hypersomnolence intègre la somnolence diurne excessive et le besoin excessif de sommeil. La démarche diagnostique devant une plainte d'hypersomnolence débute par une exploration clinique par entretien et agenda de sommeil afin d'en préciser les symptômes, de les confronter à la typologie et au besoin de sommeil individuel du patient pour éliminer une privation chronique de sommeil et un trouble du rythme circadien. Devant une plainte de mauvaise qualité de sommeil (ou dyssomnie) associée, on recherchera un syndrome d'apnées du sommeil ou un syndrome des jambes sans repos avec mouvements périodiques de jambes. Les causes secondaires comprennent les pathologies psychiques, somatiques ou une origine toxique. Le diagnostic d'hypersomnie rare peut être suspecté d'emblée selon les caractéristiques de la plainte d'hypersomnolence ou au terme de la démarche diagnostique. Il nécessitera d'avoir éliminé les causes les plus fréquentes d'hypersomnolence et les facteurs perturbants les enregistrements de sommeil. Les causes et conséquences associées à l'hypersomnolence nécessitent une détection précoce, un diagnostic précis et une prise en charge globale. Sleepiness concerns one in five French people and involves a severe accidental risk. The recent notion of hypersomnolence includes excessive daytime sleepiness and the excessive need for sleep. The diagnostic approach to hypersomnolence begins with a clinical exploration by interview and sleep diary in order to specify the symptoms, to compare them with the typology and the patient's individual sleep need to rule out chronic sleep deprivation and a circadian rhythm disorder. In case of poor quality of sleep (or dyssomnia) associated, one must investigate for sleep apnea syndrome or restless legs syndrome with periodic legs movements. Secondary causes include mental or somatic diseases or a toxic origin. The diagnosis of central hypersomnia can be suspected on the characteristics of hypersomnolence or at the end of the diagnostic process. It will require ruling out the most frequent causes of hypersomnolence and the confounding factors for polysomnography interpretation. The causes and consequences associated with hypersomnolence require early detection, precise diagnosis and comprehensive management. [ABSTRACT FROM AUTHOR]

Summary: Patients with narcolepsy or idiopathic hypersomnia (IH) are at increased risk of driving accidents. Both excessive daytime sleepiness, i.e. unwanted sleep episodes during the day, and disturbed vigilance are core features of these disorders. We tested on‐the‐road driving performance of patients with narcolepsy or IH coming in for a routine driving fitness evaluation and examined: (1) correlations between driving performance and the Maintenance of Wakefulness Test (MWT), Sustained Attention to Response Task (SART) and Psychomotor Vigilance Test (PVT) as objective tests; (2) the predictive power of the MWT and SART for increased risk of impaired driving; (3) the best set of objective predictors for increased risk of impaired driving. Participants were 44 patients (aged 18–75 years) with narcolepsy type 1 (NT1), type 2 (NT2) or IH. They completed the MWT, SART, PVT, a subjective sleepiness questionnaire, and a standardised on‐the‐road driving test. The standard deviation of the lateral position (SDLP) was used as outcome measure of driving performance. The MWT had low correlation with the SDLP (ρ = −0.41 to −0.49, p < 0.01). The SART and PVT had low correlations with SDLP (ρ = 0.30 and ρ = 0.39, respectively, both p < 0.05). The predictive power of MWT for an increased risk of impaired driving was significant, but low (area under the curve = 0.273, p = 0.012), and non‐significant for SART. We conclude that in our present group, none of the tests had adequate ability to predict impaired driving, questioning their use for clinical driving fitness evaluation in narcolepsy and IH. Real‐time monitoring of sleepiness while driving seems more promising in these patients. [ABSTRACT FROM AUTHOR]

Excessive daytime sleepiness or an increased need for sleep are an increasingly common reason of medical appointments. For years, the literature on sleep disorders has reported a complex two-way relationship between excessive sleepiness and mental disorders - especially mood disorders, which include winter depression in seasonal affective disorder. Assessment and effective treatment of excessive sleepiness in patients with seasonal affective disorder is an important component of the therapy. Hypersomnia is often a residual symptom of affective disorders, compromising the quality of life and daily functioning. Modafinil is an agent used in adults to treat excessive sleepiness associated with narcolepsy, with or without cataplexy. In addition to the registered indications, previous studies have shown efficacy and good tolerance of modafinil as augmentation treatment of depressive episodes in patients with residual symptoms in the form of fatigue and excessive daytime sleepiness, who received drugs from the group of serotonin reuptake inhibitors. The aim of this paper is to present the problem of excessive daytime sleepiness in the course of seasonal affective disorder and to propose modafinil therapy. [ABSTRACT FROM AUTHOR]