Insomnia affects up to 50% of hospitalized patients and is strongly associated with longer hospital stays and higher mortality rates, especially among vulnerable individuals. Despite its prevalence, it's often overlooked in clinical practice and research. Our systematic review analyzed and compared pharmacological interventions for insomnia in hospitalized patients. We searched five major databases for randomized controlled trials published before January 2024. A total of 29 trials (1913 patients, mean age 58.4 ± 9.66) were finally included. Different drug classes were evaluated, including benzodiazepines, Z-drugs, melatonin receptor agonists, antidepressants, antihistamines, alpha-2 adrenergic agonists, and dietary supplements. We conducted a network meta-analysis on drugs' efficacy across subjective sleep quality, sleep latency, total sleep duration, and nocturnal awakenings. Notably, only a minority of studies focused on fragile populations, such as geriatric and critically ill patients. Results are also discussed according to potential moderating factors (i.e., gender, age, admission setting). Our review provides a framework for the pharmacologic treatment of insomnia disorder in inpatients. Differences in study methodologies limit the generalizability of findings, highlighting the urgent need for standardized research to fill existing gaps. We therefore propose a concise protocol to guide the design of future studies on this clinically important topic.

Obstructive sleep apnea is under-diagnosed, under-reported and therefore under-treated in patients after a stroke. The aim of this meta-analysis of Randomized Control Trials (RCTs) was to investigate the effectiveness of positive airway treatment on recurrent vascular events, neurological deficit, functional independence, depression, sleepiness and cognitive function in patients post-stroke. Records identified from Embase Elsevier Database (Embase, Medline/PubMed, Preprints, PubMed-not-Medline) were searched from inception in July 2024, up to September 2024. After screening 72387 records, 21 RCTs were included with 1457 patients with stroke. Out of these 753 patients were in the PAP arm and 704 in the conventional arm. Metanalysis showed that PAP treatment reduced recurrent vascular events OR 0.45, (95 % Confidence Interval (CI) 0.28 to 0.78; p < 0.01), improved neurological deficit OR -0.30, (95 % CI -0.47 to -0.14; p < 0.01), reduced daytime sleepiness OR: -0.96, (95 % CI -1.47 to -0.45; p < 0.01), improved depression levels; OR: -0.58, (95 % CI -1.05 to -0.11; p = 0.02), improved cognitive function; OR1.10; (95 % CI 0.35 to 1.86; p = 0.02), but did not improve functional independence OR 0.25, (95 % CI -0.11 to 0.60; p = 0.17) Therefore, positive airway pressure treatment is effective in patients with stroke and can reduce recurrent vascular events and improve recovery of these patients.

Children and adolescents from racial and ethnic minority and socioeconomically disadvantaged backgrounds are at greater risk for health disparities. This meta-analysis examined the association between sleep and mental health, with attention to variations by: (a) race, ethnicity, and socioeconomic status, and (b) individual sleep parameters and mental health domains. The review included 104 studies (66 independent samples, 326,478 participants). Less optimal sleep was associated with worse mental health (r = -.20, 95% CI [-.23, -.16]). Subjective sleep quality was a stronger correlate of mental health relative to all other sleep parameters (bs ranged from .11 to .19, ps < .001). Sleep schedule was a stronger correlate than objective sleep duration and quality (bs = .08 and .07, respectively, ps < .01). Sleep consistency was also a stronger correlate than objective sleep duration (b = .05, p = .03). Socioeconomic status moderated two associations. Objective sleep quality was more strongly linked to mental health among middle- relative to mixed-SES samples (b = .11, p = .01). Sleep consistency was more strongly associated with mental health among low- compared to mixed-SES samples (b = .05, p = .002). Findings are discussed in the context of methodological challenges in studying health disparities.

Beyond sleep duration and efficiency, the day-to-day regularity of bed- and wake-times is increasingly recognized as a distinct dimension of sleep health. Whether irregular schedules independently predict adverse health outcomes remains unclear.

Poor sleep health is a significant public health issue. Population health surveillance systems are important for gathering accurate data to inform public health responses but remain underdeveloped for sleep health assessment globally. We aimed to identify sleep assessment tools and to evaluate their validity and reliability for use in population surveillance. Three databases (PubMed, EMBASE, and PsycINFO) were searched resulting in 12,350 publications as of July 2025; 187 studies met the inclusion criteria and 60 sleep assessment tools were evaluated for nine measurement properties: content validity, criterion validity, construct validity, internal consistency, reliability, agreement, floor and ceiling effects, responsiveness, and interpretability. The Insomnia Severity Index had five measurement properties rated positively, the highest among all tools. Two tools assessed all sleep health domains: the Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration (RU-SATED) scale and a 13-item composite measure of sleep health (13-SH). Most sleep assessment tools lacked adequate validation studies in the adult general population or lacked the ability to capture all dimensions of sleep health. Demonstrating criterion and construct validity of existing tools, developing new tools to measure multidimensional sleep health, or combining items from validated measures with strong measurement properties is warranted for effective sleep health surveillance.

Agenesis of the corpus callosum is a brain malformation that can lead to intellectual, behavioural, social and emotional impairments, with outcomes varying based on severity. Sleep disturbances are common in children with this disorder, and some studies have evidenced the role of corpus callosum in interhemispheric synchronisation that may influence sleep patterns. This narrative review attempted to intercept available information on sleep in patients with isolated Agenesis of the corpus callosum, partial and complete, across different ages. Since literature about this issue is underdeveloped, knowledge on callostomized individuals has been included. Corpus callosum disruption is linked to sleep disturbances, especially in early life, though the corpus callosum specific contribution remains unclear. Studies on callostomized individuals suggest that the corpus callosum plays a role in slow-wave transmission across hemispheres, which may affect sleep architecture and plasticity. The impaired transfer of brain activity between the hemispheres also seems to influence their dream experiences. The discussion pointed out that sleep problems in patients with Agenesis of the corpus callosum should be systematically assessed, as they may impact neurodevelopment and overall well-being, highlighting the need for further research and sleep interventions.

Artificial intelligence (AI) has rapidly advanced in sleep medicine, offering innovative solutions for sleep disorder management. The integration of AI technologies presents unprecedented opportunities to address longstanding challenges in diagnosis, monitoring, and treatment.

This study aimed to clarify the clinically meaningful outcomes and treatment adherence across different delivery methods of cognitive behavioral therapy for insomnia (CBT-I). CBT-I was defined as incorporating both sleep restriction and stimulus control techniques. This study included individual, group, fully automated Internet-based, and supported Internet-based formats. Remission from insomnia increased significantly across all delivery methods compared with the control group (individual: k = 36, n = 1696, odds ratio [OR] = 8.36; group: k = 22, n = 2356, OR = 4.65; fully automated Internet-based: k = 50, n = 15590, OR = 3.87; supported Internet-based: k = 19, n = 1759, OR = 8.35). After adjusting for comorbidities and types of control group, meta-regression analysis showed that the individual and supported Internet-based formats were significantly associated with higher odds of remission from insomnia compared with the fully automated Internet-based format. The completion rate for all sessions was significantly higher in the individual format (k = 8, 83.8%) than in the Internet-based formats (supported Internet-based: k = 15, 70.7%; fully automated Internet-based: k = 26, 58.4%). CBT-I is robustly effective in managing insomnia, although relatively lower treatment adherence continues to be a major challenge for Internet-based CBT-I.

Across a growing body of research, continuous positive airway pressure (CPAP) therapy has been consistently explored as a treatment for obstructive sleep apnea (OSA) due to its potential to mitigate vascular and metabolic risk factors. While the primary benefit of CPAP is its ability to alleviate symptoms of OSA, the broader physiological impacts, particularly on vascular health and metabolic profiles, have garnered increasing attention. This summary evaluates the effect of CPAP on endothelial function, as well as on lipid and glucose metabolism. Across 74 studies, CPAP therapy in adults with OSA was associated with a significant improvement in endothelial function (FMD) and modest, favorable shifts in lipid and glucose profiles. Total cholesterol, LDL-C, and triglycerides decreased; HDL-C showed no meaningful change. Fasting blood sugar declined, whereas HbA1c, insulin, and HOMA-IR generally showed directionally favorable but non-significant pooled effects. Publication bias appeared limited overall (more likely for HbA1c), and sensitivity analyses supported the robustness of the FMD benefit. Study-level moderators (age, sex, BMI, AHI, follow-up) did not consistently explain heterogeneity, although an exploratory ecological meta-regression suggested greater HbA1c reductions tracked with larger FMD gains.

Sleep problems are frequent following spinal cord injury or disease (SCI/D), however the severity of insomnia - including difficulty falling asleep and staying asleep - is not fully understood. Differing assessment methods, variations in diagnostic criteria, and the characteristics of SCI/D may also impact reported prevalence estimates. This PRISMA-guided review synthesizes the available evidence, with consideration of study-level characteristics. The CINAHL, Embase, MEDLINE and PsycINFO databases were searched on March 22nd, 2024 (updated February 12th, 2025), to identify observational studies with an adult SCI/D sample and a validated measure to assess insomnia symptom severity or aid in diagnosis. Studies were appraised (JBI Critical Appraisal tool) and effect size estimates (proportions) meta-analyzed using a random effects model. Nineteen studies (k) representing 11,879 adults with SCI/D, and reporting requisite methodological parameters, were included. Sixty-one percent (CI: 53%-69%; k = 18) endorsed symptoms of insomnia, with 15% (CI: 14%-16%, k = 1) meeting the criteria for insomnia disorder. Findings show routine sleep assessment is needed throughout the continuum of care. There is also a need to consider insomnia as a potential confound in SCI/D research through the active collection of sleep data. Protocol registered on Open Science Framework (https://osf.io/hfr4v).

The uterine microenvironment exerts a significant and lasting influence on metabolic health later in life. The incidence of sleep disorders during pregnancy is high. Sleep disorders not only increase the risk of maternal complications during pregnancy but also may lead to increased susceptibility to metabolic diseases in offspring during adulthood by influencing the fetal development environment. In this review, we explored the effects of maternal sleep disorders during pregnancy on the metabolic health of offspring, the potential mechanisms, and intervention measures, with the aim of providing more scientific guidance for pregnancy care and promoting the health of mothers and offspring.

Obesity is associated with several cardiovascular risk factors, including obstructive sleep apnea (OSA) development and poorer sleep quality. While diet-induced weight reduction can improve sleep quality, traditional dietary strategies may be challenging and restrictive to maintain. Intermittent fasting (IF) diets offer an alternative, less prescriptive intervention to improve cardiometabolic health markers, though their specific effects on sleep quality are unclear. This systematic review and meta-analysis assessed the effects of IF on sleep and cardiometabolic outcomes associated with OSA risk among adults with overweight/obesity. Eighteen randomized controlled trials (25 comparisons) that compared IF (n = 15 time-restricted eating (TRE); n = 3 alternate-day modified fasting (ADMF)), vs ad libitum eating were identified. Compared to ad libitum eating, TRE and ADMF interventions produced greater reductions in weight, BMI, fat mass, waist circumference, daily energy intake, and diastolic blood pressure. Sleep quality was assessed as a secondary outcome in 15/16 studies. No overall effects of IF on sleep relative to ad libitum eating were observed, despite improvements in weight. This analysis supports IF interventions as an alternative to continuous energy restriction for improving cardiometabolic health in populations with obesity and sleep disturbances, such as OSA. Studies are needed to specifically evaluate the effects of IF on sleep.

Non-respiratory sleep disorders, including behavioural sleep disorders (e.g., difficulty with sleep onset and sleep maintenance) affect up to 80 % of children with neurodisability (ND). Non-respiratory sleep disorders in typically developing children can be treated using a variety of behavioural strategies and interventions, however generalisability of these interventions to children with ND remains uncertain. A systematic search of databases revealed 55 papers that were included in this review. Most (69 %) studies focused on children with ASD and/or ADHD with a limited number found in other disability groups. Intervention delivery mode varied with 13 % using an online format and 87 % in person, with group (44 %) and individual (52 %) approaches exhibiting similar efficacy. Results outlined key findings; 1) The breadth of ND conditions included is limited 2) small sample size across the majority of studies 3) interventions may need to be adapted to improve effectiveness 4) while mode of delivery varied, effects were similar and 5) highest intensity programs were not the most effective. Our review shows that while sleep strategies and interventions can be effective in treating non-respiratory sleep disorders in this cohort, more evidence is required to determine how best to tailor these to address challenges that are unique to children with ND.

Patients with obstructive sleep apnea (OSA) may be at increased risk for adverse events during ambulatory otorhinolaryngologic (ear, nose, and throat, [ENT]) surgery. There remains a gap in the literature quantifying these risks. This systematic review and meta-analysis aimed to evaluate the incidence of perioperative complications among patients with OSA undergoing ambulatory ENT surgeries.

In this review, we propose a systems-motivated approach to sleep apnea, as a well characterized disorder illustrative of the sleep-wake process. We advance a framework with mechanistic underpinning of the insulin-resistant cardiometabolic effects of obesity and its putative bi-directional relationship with sleep apnea. Such a physiological construct affords an integrated perspective where pathophysiological outcomes in the brain and heart can be objectively characterized by imaging methods that index functional derangements, including those related to clinical measures of metabolism and ischemia, as well as to translational indices of neurotransmitter signaling. A provocative complexity-analysis network model is explored as a novel formalism for brain macro-phenomena, such as the sleep-wake process, as an emergent property arising from the collective interactions of its micro-constituent very large number of neurons. Clinical management is highlighted at the intersection of guideline-directed cardiometabolic- and sleep- medicine, biopsychosocial interventions, and incorporation of newer pharmacological therapeutic advancements. Together, these disparate developments herald a new functional/physiological synergistic era in sleep medicine.