Clinical and Translational Neuroscience

Editorial

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2 pages, 150 KiB

Open AccessEditorial

The Awakening of Sleep Medicine: A Global Quest for Quality Rest and Health

by Raffaele Ferri

Clin. Transl. Neurosci. 2024, 8(1), 12; https://doi.org/10.3390/ctn8010012 - 19 Feb 2024

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Abstract

The burden of sleep disorders is a global health concern that affects millions of people worldwide [...] Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

Research

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6 pages, 1606 KiB

Open AccessCommunication

The International Master of Advanced Studies (MAS) in Sleep Medicine of the Universities of Bern and Svizzera Italiana

by Claudio L. A. Bassetti, Felicitas Sohm, Antoine Adamantidis, Kaspar Schindler, Fabrizio Barazzoni and Mauro Manconi

Clin. Transl. Neurosci. 2024, 8(2), 19; https://doi.org/10.3390/ctn8020019 - 10 Apr 2024

Viewed by 1592

Abstract

Introduction: Sleep–wake circadian disorders (SWCDs) are very frequent and linked to major negative effects on the body, mental health, the brain, and on occupational and societal health. The prevention, diagnosis, and treatment of SWCDs and the promotion of sleep health require the sufficient [...] Read more.

Introduction: Sleep–wake circadian disorders (SWCDs) are very frequent and linked to major negative effects on the body, mental health, the brain, and on occupational and societal health. The prevention, diagnosis, and treatment of SWCDs and the promotion of sleep health require the sufficient education of general practitioners, specialists, and other health professionals. Unfortunately, education at pre- and postgraduate level is insufficient in most countries across the world. Aims and methods: This article describes the historical context, basic considerations, and methodological approach for the creation of the International Postgraduate Sleep Master by the University of Bern and Svizzera Italiana. Results: The postgraduate Master, which was launched in 2017, is a part-time, flexible course, taken over 2 ½ years, which targets health professionals, scientists, and technicians. After an initial introduction, which is the same for everybody (“common trunk”), the course can be individualized. The 12 modules of the Master include online lectures, schools, internships in a sleep center (in one of our 15 partner universities), case discussions and interactive sessions with students and internationally recognized experts from over 20 countries across the world, and culminates with a Master thesis. The program covers sleep–wake circadian biology; the management of SWCDs; disturbances of consciousness and sleep-related epilepsies; novel approaches in sleep medicine (e.g., clinical trials, telemedicine, data science, artificial intelligence); and topics of increasing relevance (e.g., neurodegenerative disorders, gender and diversity, sleep health, new technologies, artificial intelligence, professional and societal implications). Students are encouraged to also take “crash courses” in preparation for the national, European, and World sleep examinations. Conclusion: The Postgraduate University Sleep Master of the Universities of Bern and Svizzera Italiana offers a unique part-time, (mainly) virtual opportunity to acquire state-of the art knowledge, skills, and professional experiences to prepare for a clinical or scientific career in sleep medicine for physicians, scientists, and other health professionals. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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11 pages, 1717 KiB

Open AccessFeature PaperArticle

SPHYNCS: The Use of the Swiss Narcolepsy Scale in a New Cohort of Patients with Narcolepsy and Its Borderland and Review of the Literature

by Kseniia Zub, Jan D. Warncke, Julia van der Meer, Elena S. Wenz, Livia G. Fregolente, Panagiotis Bargiotas, Gülçin Benbir Şenel, Christian Sturzenegger, Gert Jan Lammers, Ulf Kallweit, Markus H. Schmidt, Ramin Khatami, Zhongxing Zhang, Sigrid von Manitius, Silvia Miano, Jens G. Acker, Matthias Strub and Claudio L. A. Bassetti

Clin. Transl. Neurosci. 2024, 8(1), 2; https://doi.org/10.3390/ctn8010002 - 20 Dec 2023

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Abstract

Introduction and aims: Narcolepsy type 1 (NT1) is a central disorder of hypersomnolence (CDH) characterized by excessive daytime sleepiness and cataplexy. The Swiss Narcolepsy Scale (SNS), which includes the updated and short (sSNS) versions, has recently been introduced as a reliable diagnostic tool [...] Read more.

Introduction and aims: Narcolepsy type 1 (NT1) is a central disorder of hypersomnolence (CDH) characterized by excessive daytime sleepiness and cataplexy. The Swiss Narcolepsy Scale (SNS), which includes the updated and short (sSNS) versions, has recently been introduced as a reliable diagnostic tool for identifying NT1. This study aims to assess the validity of the SNS scales in a new cohort of patients with CDH, while also introducing the French and Italian versions of the SNS and providing a summary of the existing literature on SNS. Materials and methods: The current study is based on the international Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (iSPHYNCS) which aims to identify new biomarkers for CDH. Diagnostic accuracy of the SNS was assessed by calculating sensitivity, specificity, positive predictive value, and negative predictive value. Results: In our population, 108 participants with suspected CDH (including 28 NT1 patients) and 14 healthy controls completed the scale. Original SNS, updated SNS and sSNS scores showed a high sensitivity (86%, 89% and 79%, respectively) and high specificity (96%, 90% and 95%, respectively) for diagnosing NT1 compared to other CDH. The French version was completed by 5 participants, and the Italian version by 8 participants. Regarding previous studies, the SNS has now been assessed in six different populations, involving a total of 1247 subjects (including 326 with narcolepsy with cataplexy/NT1), suggesting high sensitivity (85–100%) and specificity (86–100%) of the SNS for the diagnosis of NT1. Conclusion: The SNS is a simple screening tool validated in seven languages (German, English, French, Italian, Dutch, Turkish and Japanese), demonstrating high sensitivity and specificity for the diagnosis of NT1. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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11 pages, 283 KiB

Open AccessArticle

The Neuropsychological and Emotional Profile of Adults with Parasomnia: A Case Series

by Maria Ntafouli, Panagiotis Bargiotas, Anastasios Bonakis, Konstantinos Lourentzos, Emmanouil Vagiakis, Aliki Minaritzoglou, Dimitris Dikeos and Claudio Lino Bassetti

Clin. Transl. Neurosci. 2023, 7(4), 35; https://doi.org/10.3390/ctn7040035 - 29 Oct 2023

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Abstract

Although parasomnias are nocturnal phenomena occurring during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime dysfunction as well. However, systematic studies in this field are scarce. The aim of the current case series was to [...] Read more.

Although parasomnias are nocturnal phenomena occurring during sleep or during arousals from sleep, there is increasing evidence that they are associated with daytime dysfunction as well. However, systematic studies in this field are scarce. The aim of the current case series was to investigate the sleep–wake, neuropsychological and emotional profiles of patients with parasomnias. Thirty patients with parasomnia (13 NREM, 17 REM) and 30 healthy subjects matched for age, sex and educational status were included. All participants underwent comprehensive neuropsychological, cognitive and behavioral evaluation. We found that parasomnia patients scored higher in all neuropsychological, emotional, sleep–wake and quality of life scales compared to healthy subjects. The presence of a parasomnia was associated with major impact on daytime functioning across several domains with increased levels of fatigue (FSS > 4) in 56%, sleepiness (ESS > 10) in 47%, depressive symptoms (BDI > 20) in 17%, anxiety (PSWQ > 52) in 17%, anger expression out (STAXI A > 16) in 27% and anger expression in (STAXI B > 16) in 23%, as well as a reduced average quality of life score (RAND derived from SF-36). Sleep–wake disturbances were significantly correlated with QoL scores. In the intergroup analysis between REM/NREM, we found that the REM group had worse cognitive performance and lower levels of fatigue/energy compared to NREM patients. These findings suggest that parasomnia is associated with difficulties in several aspects of daytime functioning (cognitive, affective/emotional and physical) and, therefore, parasomnia diagnostic workup should not be limited only to nocturnal phenomena. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

10 pages, 534 KiB

Open AccessArticle

The Sleep of Shift Workers in a UK Financial Organisation and Associations with Mental, Physical, Social and Cognitive Health

by Gaby Illingworth, William R. McMahon, Dabhnait Gartland, Stephen Pereira and Russell G. Foster

Clin. Transl. Neurosci. 2023, 7(4), 33; https://doi.org/10.3390/ctn7040033 - 23 Oct 2023

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Abstract

Shift workers are vulnerable to circadian misalignment, sleep disturbance and increased risk of impaired health. Studies concerning the sleep and health of individuals working shifts in the financial sector are lacking. We investigated sleep quality, sleep duration and associations with health in a [...] Read more.

Shift workers are vulnerable to circadian misalignment, sleep disturbance and increased risk of impaired health. Studies concerning the sleep and health of individuals working shifts in the financial sector are lacking. We investigated sleep quality, sleep duration and associations with health in a UK financial organisation. Employees (n = 178; 61% male) completed an online survey comprising the SSI, PSQI, GAD-7, PHQ-9, WAFCS, EMQ-R and BMI. Three-quarters of employees reported poor sleep quality. Poorer sleep quality and shorter sleep duration were both associated with greater anxiety and depression symptoms. However, sleep quality demonstrated greater explained variance with symptom severity (anxiety: R_s² difference = 13.2%; depression: R_s² difference = 21.8%). Poorer sleep quality was associated with higher BMI, greater work-to-family conflict and poorer everyday memory (r_s = 0.26–0.29), while shorter sleep duration was only significantly associated with higher BMI. Sleep quality did not differ depending on the nightshift type (“permanent”/“other”). Sleep achieved was shorter than perceived sleep-need for all consecutive shift types—especially night shifts (40 min–1 h 24 min). This preliminary study suggests that sleep quality, and to a lesser extent sleep duration, are associated with a range of health outcomes for shift workers within the financial sector, highlighting the need to increase organisational awareness of the importance of sleep for employee health. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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6 pages, 981 KiB

Open AccessCommunication

The Swiss Narcolepsy Network (SNaNe)

by Claudio L. A. Bassetti, Ramin Khatami, Silvia Miano, Elena Wenz and Esther Werth

Clin. Transl. Neurosci. 2023, 7(4), 31; https://doi.org/10.3390/ctn7040031 - 13 Oct 2023

Cited by 1 | Viewed by 2728

Abstract

The Swiss Narcolepsy Network (SNaNe) was founded in 2017 as a non-profit organization with the vision of improving the care of patients with narcolepsy, central disorders of hypersomnolence (CDH), and rare sleep disorders. The SNaNe aims at maximizing the speed of diagnosis, minimizing [...] Read more.

The Swiss Narcolepsy Network (SNaNe) was founded in 2017 as a non-profit organization with the vision of improving the care of patients with narcolepsy, central disorders of hypersomnolence (CDH), and rare sleep disorders. The SNaNe aims at maximizing the speed of diagnosis, minimizing difficulties stemming from the rare nature of these conditions, and providing patients with optimum health care throughout the course of their disease. In addition, the SNaNe promotes education, awareness, and research on CDH and rare sleep disorders. The article reports the current structure, organization, and the following main activities of the SNaNe: (1) the discussion of complex patient cases; (2) the organization of the Swiss Narcolepsy Days; (3) the coordination of multicenter research projects (e.g., SPHYNCS and iSPHYNCS studies); (4) the establishment of an anonymous Swiss registry for CDH patients (SNaNe Data Registry); (5) the collaboration with the national patients’ organization (SNAG); and (6) the collaboration with other national and international scientific, professional, and patients’ (eNAP) organizations. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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16 pages, 1025 KiB

Open AccessFeature PaperArticle

SLEEPexpert+: Blending Internet-Based Cognitive Behavioral Therapy for Insomnia with In-Person Psychotherapy—A Feasibility Study in Routine Care

by Daniel Schmid, Simone B. Duss, Elisabeth Hertenstein, Christoph Nissen, Carlotta L. Schneider, Antoine Urech, Albrecht Vorster and Thomas Berger

Clin. Transl. Neurosci. 2023, 7(3), 27; https://doi.org/10.3390/ctn7030027 - 19 Sep 2023

Cited by 2 | Viewed by 1837 | Correction

Abstract

Insomnia is characterized by frequent and persistent difficulties initiating and maintaining sleep, along with impaired daytime functioning. Blended treatments are increasingly popular for treating psychological disorders such as depression. Blended treatments combine elements of face-to-face therapy and online interventions. A single-arm pre-post study [...] Read more.

Insomnia is characterized by frequent and persistent difficulties initiating and maintaining sleep, along with impaired daytime functioning. Blended treatments are increasingly popular for treating psychological disorders such as depression. Blended treatments combine elements of face-to-face therapy and online interventions. A single-arm pre-post study investigated the feasibility of a blended treatment combining face-to-face cognitive behavioral therapy for insomnia and internet-based cognitive behavioral therapy for insomnia (SLEEPexpert+). The findings show that the therapists have a positive attitude toward blended CBT-I (b-CBT-I) and that they feel supported by the online components of the treatment. Possible barriers to implementing blended treatments are integrating the online materials into the face-to-face sessions and adapting one’s therapeutic style to the blended treatment approach. No definitive statements about the effectiveness of the b-CBT-I treatment can be made. However, of the six presented cases, five patients showed notably higher sleep efficiency and fewer insomnia symptoms at the end of the therapy. Program usage data indicate that participants mainly used the online components at the beginning of their treatment. Future studies should investigate the effectiveness of b-CBT-I with a sufficiently powered randomized controlled trial comparing b-CBT-I with an adequate control group in routine care. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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10 pages, 1161 KiB

Open AccessArticle

To Nap or to Rest? The Influence of a Sixty-Minute Intervention on Verbal and Figural Convergent and Divergent Thinking

by René M. Müri, Magdalena Camenzind, Kathrin Chiffi, Isabel Stuber and Aleksandra K. Eberhard-Moscicka

Clin. Transl. Neurosci. 2023, 7(3), 20; https://doi.org/10.3390/ctn7030020 - 1 Aug 2023

Cited by 1 | Viewed by 1960

Abstract

Background: The relationship between sleep and creativity is a topic of much controversy. General benefits of napping have been described not only in sleep-deprived individuals and in shift workers, but also in people with sufficient night sleep. However, only few studies have investigated [...] Read more.

Background: The relationship between sleep and creativity is a topic of much controversy. General benefits of napping have been described not only in sleep-deprived individuals and in shift workers, but also in people with sufficient night sleep. However, only few studies have investigated the relationship between nap and creativity. Methods: Forty-two native German speakers (29 females, mean age = 24 years, SD = 3.3 years) took part in two experimental sessions (i.e., baseline and intervention). In both sessions, divergent and convergent verbal and figural creativity tasks were administered at the same time of the day. While the baseline session was identical for all the participants, in the second session participants were randomized into either a sixty-minute nap or a sixty-minute rest group. Results: No significant group differences were found for neither divergent nor convergent creativity thinking tasks, suggesting that the interventions had similar effects in both groups. Interestingly, the analysis of the pooled data (i.e., pooled nap and rest groups) indicated differential effects of figural versus verbal creativity tasks, such that significant post-intervention improvements were found for the figural, but not for the verbal divergent and convergent thinking tasks. Conclusions: While further studies are needed to confirm these findings, to the best of our knowledge, such a dissociation between performance of verbal and figural creativity tasks after nap/rest interventions has not been described to date. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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Review

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8 pages, 1079 KiB

Open AccessReview

“Glymphatic” Neurodegeneration: Is Sleep the Missing Key?

by Luigi Ferini-Strambi and Maria Salsone

Clin. Transl. Neurosci. 2024, 8(2), 23; https://doi.org/10.3390/ctn8020023 - 7 Jun 2024

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Abstract

Robust evidence suggests that the glymphatic system plays a key role in preserving brain health. Indeed, its activity in maintaining homeostasis by clearing neurotoxic proteins such as beta-amyloid from the human brain is essential. Sleep represents the factor that mainly influences this system, [...] Read more.

Robust evidence suggests that the glymphatic system plays a key role in preserving brain health. Indeed, its activity in maintaining homeostasis by clearing neurotoxic proteins such as beta-amyloid from the human brain is essential. Sleep represents the factor that mainly influences this system, since it is selectively active during the night, in particular during non-rapid eye movement (NREM) sleep. This is true, since the sleep head position, in particular the supine position for its relationship to the status of opening/closing of the jugular veins, appears to be determinant for the development of future neurodegeneration. Growing evidence from human and animal models highlights the neurobiological link between sleep, glymphatic dysfunction and neurodegeneration. On the other hand, several modifiable factors have been recently identified modulating (improve/reduce) glymphatic system activity, such as Omega-3 polyunsaturated fatty acids, stress, hypertension, physical activity, alcohol, gender and genetic predisposition, in particular variants of aquaporin-4 (AQP4). From this viewpoint, our ambition is to discuss how the glymphatic system works in the brain, what factors mainly impact on this activity and its strict relation with the neurodegeneration. Future directions might include the analysis of factors modulating glymphatic system activity and a personalized glymphatic profile, “glymphatom”, as a natural target for preventive neurodegenerative treatment. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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19 pages, 1977 KiB

Open AccessReview

How Adversarial REM Dreams May Facilitate Creativity, and Why We Become Aware of Them

by Nicolas Deperrois, Mihai A. Petrovici, Jakob Jordan, Lukas S. Huber and Walter Senn

Clin. Transl. Neurosci. 2024, 8(2), 21; https://doi.org/10.3390/ctn8020021 - 31 May 2024

Cited by 1 | Viewed by 1157

Abstract

The importance of sleep for healthy brain function is widely acknowledged. However, it remains unclear how the internal generation of dreams might facilitate cognitive processes. In this perspective, we review a computational approach inspired by artificial intelligence that proposes a framework for how [...] Read more.

The importance of sleep for healthy brain function is widely acknowledged. However, it remains unclear how the internal generation of dreams might facilitate cognitive processes. In this perspective, we review a computational approach inspired by artificial intelligence that proposes a framework for how dreams occurring during rapid-eye-movement (REM) sleep can contribute to learning and creativity. In this framework, REM dreams are characterized by an adversarial process that, against the dream reality, tells a discriminator network to classify the internally created sensory activity as real. Such an adversarial dreaming process is shown to facilitate the emergence of real-world semantic representations in higher cortical areas. We further discuss the potential contributions of adversarial dreaming beyond learning, such as balancing fantastic and realistic dream elements and facilitating the occurrence of creative insights. We characterize non-REM (NREM) dreams, where a single hippocampal memory is replayed at a time, as serving the complementary role of improving the robustness of cortical representations to environmental perturbations. We finally explain how subjects can become aware of the adversarial REM dreams, but less of the NREM dreams, and how content- and state-awareness in wake, dream, and lucid dreaming may appear. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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10 pages, 584 KiB

Open AccessReview

The Bidirectional Relationship between Sleep and Neurodegeneration: Actionability to Improve Brain Health

by Abubaker Ibrahim, Birgit Högl and Ambra Stefani

Clin. Transl. Neurosci. 2024, 8(1), 11; https://doi.org/10.3390/ctn8010011 - 2 Feb 2024

Cited by 2 | Viewed by 2775

Abstract

Recently, it has become increasingly clear that there is a bidirectional relationship between sleep/circadian rhythms and neurodegeneration. Knowledge about this topic further improved after the description of the glymphatic system, which is mainly active during sleep. Changes in sleep and circadian rhythms are [...] Read more.

Recently, it has become increasingly clear that there is a bidirectional relationship between sleep/circadian rhythms and neurodegeneration. Knowledge about this topic further improved after the description of the glymphatic system, which is mainly active during sleep. Changes in sleep and circadian rhythms are present not only in overt neurodegenerative diseases but also in their early, prodromal, and preclinical phases, supporting that they precede (and contribute to) the development of neurodegeneration. This narrative review provides a brief overview of sleep and circadian rhythm disruption in neurodegeneration, highlights the bidirectional relationship between sleep changes and neurodegeneration, and addresses future perspectives, in particular, whether sleep changes are able to predict neurodegeneration and the potential sleep actionability to prevent or modulate the development of neurodegenerative diseases. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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14 pages, 746 KiB

Open AccessFeature PaperReview

The Many Unknowns of Partial Sensory Disconnection during Sleep: A Review of the Literature

by Chiara Cirelli and Giulio Tononi

Clin. Transl. Neurosci. 2024, 8(1), 9; https://doi.org/10.3390/ctn8010009 - 24 Jan 2024

Cited by 1 | Viewed by 2294

Abstract

When we are asleep, we lose the ability to promptly respond to external stimuli, and yet we spend many hours every day in this inherently risky behavioral state. This simple fact strongly suggests that sleep must serve essential functions that rely on the [...] Read more.

When we are asleep, we lose the ability to promptly respond to external stimuli, and yet we spend many hours every day in this inherently risky behavioral state. This simple fact strongly suggests that sleep must serve essential functions that rely on the brain going offline, on a daily basis, and for long periods of time. If these functions did not require partial sensory disconnection, it would be difficult to explain why they are not performed during waking. Paradoxically, despite its central role in defining sleep and what sleep does, sensory disconnection during sleep remains a mystery. We have a limited understanding of how it is implemented along the sensory pathways; we do not know whether the same mechanisms apply to all sensory modalities, nor do we know to what extent these mechanisms are shared between non-rapid eye movement (NREM) sleep and REM sleep. The main goal of this contribution is to review some knowns and unknowns about sensory disconnection during sleep as a first step to fill this gap. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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9 pages, 3196 KiB

Open AccessReview

The Two-Process Model: Origin of Its Concepts and Their Implications

by Alexander Borbély and Irene Tobler

Clin. Transl. Neurosci. 2024, 8(1), 5; https://doi.org/10.3390/ctn8010005 - 30 Dec 2023

Cited by 2 | Viewed by 2971

Abstract

The two-process model of sleep regulation has served as a conceptual framework in the last four decades for understanding sleep physiology. In the 1970s, long-term recordings of sleep in rats were obtained thanks to EEG telemetry. NonREM sleep and REM sleep were found [...] Read more.

The two-process model of sleep regulation has served as a conceptual framework in the last four decades for understanding sleep physiology. In the 1970s, long-term recordings of sleep in rats were obtained thanks to EEG telemetry. NonREM sleep and REM sleep were found to differ in their time course and response to light-dark protocols. There were indications for their coupling to the circadian system, in particular the light-dark and the dark-light transitions. With the advent of quantitative EEG analysis, slow-wave activity in nonREM sleep was recognized as a sleep-wake-dependent variable. The term “sleep homeostasis” was coined to specify the regulated balance between sleep and waking. The regulatory homeostatic process was designated as “Process S”. In the two-process model, its interaction with the circadian pacemaker “Process C” can account for sleep duration under various experimental protocols. Local, use-dependent slow-wave activity changes were demonstrated in both humans and rats by the selective, unilateral activation of a cortical region prior to sleep. Finding that rest in invertebrates has sleep-like regulatory properties opened a new realm of animal studies. Comparative sleep studies in a broad variety of animal species confirmed the validity of the basic concepts of the two-process model. Recent studies have addressed sleep-related changes of brain temperature as an indicator of brain metabolism; the application of the model to Drosophila; the divergence of cortical and subcortical states; and sleep in an increasing number of species and taxa. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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15 pages, 991 KiB

Open AccessReview

Sleep and Adolescent Depression

by Chiara E. G. Castiglione-Fontanellaz and Leila Tarokh

Clin. Transl. Neurosci. 2024, 8(1), 3; https://doi.org/10.3390/ctn8010003 - 22 Dec 2023

Cited by 4 | Viewed by 2917

Abstract

Adolescence is a pivotal period of development marked by significant physiological and psychological changes, making youth particularly susceptible to mental health challenges, including depression. A growing body of research has highlighted the important role of sleep in the etiology and exacerbation of adolescent [...] Read more.

Adolescence is a pivotal period of development marked by significant physiological and psychological changes, making youth particularly susceptible to mental health challenges, including depression. A growing body of research has highlighted the important role of sleep in the etiology and exacerbation of adolescent depression. Disruptions in sleep patterns, including insomnia and irregular sleep-wake cycles, are prevalent among depressed adolescents and can exacerbate depressive symptoms. In this review, we examine alterations to sleep behavior and physiology in adolescent depression. Furthermore, we introduce a theoretical model of hypersomnia in adolescent depression. This manuscript explores the intricate relationship between sleep and adolescent depression, with a focus on future directions for research and intervention. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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12 pages, 258 KiB

Open AccessFeature PaperReview

by Nico Zobrist, Zhongxing Zhang and Ramin Khatami

Clin. Transl. Neurosci. 2024, 8(1), 1; https://doi.org/10.3390/ctn8010001 - 19 Dec 2023

Cited by 1 | Viewed by 2638

Abstract

Sleep-related eating disorder (SRED) is a relatively rare but probably underestimated disorder, where affected patients exhibit nocturnal eating episodes with impaired consciousness and subsequent amnesia. SRED has originally been classified as NREM (non-rapid eye movement) parasomnia, with an obviously high number of concomitant [...] Read more.

Sleep-related eating disorder (SRED) is a relatively rare but probably underestimated disorder, where affected patients exhibit nocturnal eating episodes with impaired consciousness and subsequent amnesia. SRED has originally been classified as NREM (non-rapid eye movement) parasomnia, with an obviously high number of concomitant sleep disorders. We suggest that SRED may represent a heterogenous disease, based on accumulating data in recent studies. Some SRED patients may be better classified as sleep-related movement disorders with an underlying dopaminergic dysfunction. Hypnotic drugs may play a crucial role in triggering amnestic SRED in both parasomnic and sleep-related movement-disordered SRED. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

13 pages, 321 KiB

Open AccessReview

Pharmacological Treatments of Sleep–Wake Disorders: Update 2023

by Marcel S. Kallweit, Nayeli P. Kallweit and Ulf Kallweit

Clin. Transl. Neurosci. 2023, 7(4), 42; https://doi.org/10.3390/ctn7040042 - 29 Nov 2023

Cited by 1 | Viewed by 4453

Abstract

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, [...] Read more.

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. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

10 pages, 712 KiB

Open AccessReview

Rocking Devices and the Role of Vestibular Stimulation on Sleep—A Systematic Review

by Abimanju Subramaniam, Aleksandra K. Eberhard-Moscicka, Matthias Ertl and Fred W. Mast

Clin. Transl. Neurosci. 2023, 7(4), 40; https://doi.org/10.3390/ctn7040040 - 28 Nov 2023

Viewed by 3073

Abstract

Rocking devices are widely used across different age groups to facilitate sleep. This review discusses the current literature on rocking devices and how passive vestibular stimulation influences sleep architecture, sleep oscillations, and cognitive performance. We included eight studies that conducted research with rocking [...] Read more.

Rocking devices are widely used across different age groups to facilitate sleep. This review discusses the current literature on rocking devices and how passive vestibular stimulation influences sleep architecture, sleep oscillations, and cognitive performance. We included eight studies that conducted research with rocking devices in humans (7) and mice (1) during daytime naps and/or nighttime sleep, respectively. Overall, vestibular stimulation during sleep induced faster sleep onset, coupled with more N2 in daytime naps or N3 in nighttime sleep. Vestibular stimulation also led to more sleep spindles and better memory consolidation. Optimal stimulation intensity was around 25 cm/s², and lower intensities led to smaller effects. The findings suggest a sweet spot for vestibular stimulation intensity, promoting deeper sleep at the cost of wakefulness or N1 sleep without compromising REM sleep. While further studies are needed to thoroughly investigate the motion parameters that drive the impact on sleep and cognitive performance, rocking devices may present a promising therapeutic tool for people with disrupted sleep patterns. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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9 pages, 542 KiB

Open AccessReview

The Past and Future of Psychiatric Sleep Research

by Thomas Pollmächer

Clin. Transl. Neurosci. 2023, 7(4), 37; https://doi.org/10.3390/ctn7040037 - 8 Nov 2023

Viewed by 1954

Abstract

Sleep studies in psychiatric disorders date back to the first half of the 20th century. So far, success in establishing disease-specific sleep-related biomarkers has been quite limited. This is particularly obvious regarding insomnia, where there is no reliable correlation between subjective complaints and [...] Read more.

Sleep studies in psychiatric disorders date back to the first half of the 20th century. So far, success in establishing disease-specific sleep-related biomarkers has been quite limited. This is particularly obvious regarding insomnia, where there is no reliable correlation between subjective complaints and physiological measures of sleep. Finally, it must be acknowledged that the physiology of sleep and wakefulness and their subjective perception are essentially independent dimensions. Still, however, these dimensions are mixed up in clinical practice and research. This creates confusion, can be harmful for patients, and is identified as a major obstacle for successful psychiatric sleep research. It is proposed here that future sleep research should treat physiological sleep as a variable in psychiatric disorders which, independently of patient perception, has a transdiagnostic value, as was already proposed a decade ago by the Research Domain Criteria. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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20 pages, 1940 KiB

Open AccessReview

Thalamic Stroke: An Opportunity to Study the Brain Mechanisms of Sleep–Wake and Cognition

by Irina Filchenko, Claudio L. A. Bassetti and Carolina Gutierrez Herrera

Clin. Transl. Neurosci. 2023, 7(4), 36; https://doi.org/10.3390/ctn7040036 - 31 Oct 2023

Viewed by 4687

Abstract

The thalamus, and its projections to the cerebral cortex, are crucial for regulating sleep rhythms, such as sleep spindles, and for maintaining arousal and sleep homeostasis. Moreover, they play a significant role in memory, executive functioning, and attention. Altered thalamocortical circuitry caused by [...] Read more.

The thalamus, and its projections to the cerebral cortex, are crucial for regulating sleep rhythms, such as sleep spindles, and for maintaining arousal and sleep homeostasis. Moreover, they play a significant role in memory, executive functioning, and attention. Altered thalamocortical circuitry caused by vascular lesions affects sleep–wake architecture and may contribute to cognitive deficits observed in thalamic stroke patients. This review summarizes the biology of the thalamus and current knowledge regarding the impact of thalamic circuitry on sleep regulation and cognition, drawing from clinical and pre-clinical studies. Furthermore, deep brain stimulation and transcranial magnetic stimulation are discussed as possible therapeutic approaches targeting thalamic circuits. Understanding the role of the thalamus in sleep and cognition opens new avenues for developing novel therapeutic strategies to improve sleep and cognitive functions in affected individuals. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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11 pages, 651 KiB

Open AccessReview

The Psychoneurobiology of Insomnia: Hyperarousal and REM Sleep Instability

by Dieter Riemann, Raphael J. Dressle, Fee Benz, Laura Palagini and Bernd Feige

Clin. Transl. Neurosci. 2023, 7(4), 30; https://doi.org/10.3390/ctn7040030 - 28 Sep 2023

Cited by 4 | Viewed by 4166

Abstract

Chronic insomnia (insomnia disorder—ID) afflicts up to 10% of the adult population, increases with age and affects more women than men. ID is associated with significant daytime impairments and an increased risk for developing major somatic and mental disorders, especially depression and anxiety [...] Read more.

Chronic insomnia (insomnia disorder—ID) afflicts up to 10% of the adult population, increases with age and affects more women than men. ID is associated with significant daytime impairments and an increased risk for developing major somatic and mental disorders, especially depression and anxiety disorders. Almost all insomnia models assume persistent hyperarousal on cognitive, emotional, cortical and physiological levels as a central pathophysiological component. The marked discrepancy between only minor objective alterations in polysomnographic parameters of sleep continuity and the profound subjective impairment in patients with insomnia is still puzzling. We and others have proposed that alterations in the microstructure of sleep, especially in REM sleep (REM sleep instability), may explain this discrepancy and be at the core of the experience of fragmented and poor sleep in ID. The REM sleep instability concept is based on evidence showing REM time to be related to subjective wake time in insomnia as well as increased micro- and macro-arousals during REM sleep in insomnia patients compared to good-sleeper controls. Our own work showed that ID patients awoken from REM sleep more frequently reported the perception of having been awake than good sleepers as well as having had more negative ideations. The continuous measurement of event-related potentials throughout the whole night demonstrated reduced P2 amplitudes specifically during phasic REM sleep in insomnia, which points to a mismatch negativity in ID reflecting automatic change detection in the auditory system and a concomitant orienting response. REM sleep represents the most highly aroused brain state during sleep and thus might be particularly prone to fragmentation in individuals with persistent hyperarousal, resulting in a more conscious-like wake experience reflecting pre-sleep concerns of patients with ID, i.e., worries about poor sleep and its consequences, thus leading to the subjective over-estimation of nocturnal waking time and the experience of disrupted and non-restorative sleep. Chronic REM sleep instability might also lead to a dysfunction in a ventral emotional neural network, including limbic and paralimbic areas activated during REM sleep. Along with a postulated weakened functioning in a dorsal executive neural network, including frontal and prefrontal areas, this might contribute to emotional and cognitive alterations and an elevated risk of developing depression and anxiety. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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10 pages, 732 KiB

Open AccessReview

Narcolepsy Type 1: Should We Only Target Hypocretin Receptor 2?

by Rolf Fronczek and Gert Jan Lammers

Clin. Transl. Neurosci. 2023, 7(3), 28; https://doi.org/10.3390/ctn7030028 - 19 Sep 2023

Cited by 1 | Viewed by 2365

Abstract

Nearly 25 years have passed since the ground-breaking discovery that hypocretin deficiency underlies human narcolepsy with cataplexy. Over time, it has become increasingly evident that hypocretin deficiency goes beyond the conventional core symptoms, or pentad, traditionally associated with narcolepsy. The emergence of hypocretin [...] Read more.

Nearly 25 years have passed since the ground-breaking discovery that hypocretin deficiency underlies human narcolepsy with cataplexy. Over time, it has become increasingly evident that hypocretin deficiency goes beyond the conventional core symptoms, or pentad, traditionally associated with narcolepsy. The emergence of hypocretin receptor 2 agonists presents an exciting opportunity, prompting us to explore the role of receptor 2 in the complete spectrum of NT1 symptoms. In this review, several clinical manifestations beyond the core symptoms will be discussed. We will outline what is currently known about the involvement of hypocretin receptors to reflect on what we expect with current knowledge from treatment with specific receptor agonists. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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19 pages, 776 KiB

Open AccessReview

Sleep Disorders in Neuromuscular Diseases: A Narrative Review

by Matthias Boentert

Clin. Transl. Neurosci. 2023, 7(3), 23; https://doi.org/10.3390/ctn7030023 - 18 Aug 2023

Cited by 3 | Viewed by 5033

Abstract

Neuromuscular disorders (NMDs) encompass a highly diverse group of conditions that affect the skeletal muscles, peripheral nervous system, or motor endplate. Depending on the underlying disease, common characteristics include progressive muscle weakness and sensory disturbances, both of which can contribute to sleep disruption. [...] Read more.

Neuromuscular disorders (NMDs) encompass a highly diverse group of conditions that affect the skeletal muscles, peripheral nervous system, or motor endplate. Depending on the underlying disease, common characteristics include progressive muscle weakness and sensory disturbances, both of which can contribute to sleep disruption. Disorders of sleep are extremely frequent in NMDs and substantially co-determine overall morbidity, quality of life, and survival. As many NMDs currently lack a cure, supportive therapy is mandatory and includes appropriate management of sleep-related symptoms. Specific sleep disorders that may arise in NMDs include insomnia due to pain or leg muscle cramps, restless legs syndrome, and sleep-disordered breathing, notably obstructive sleep apnea and hypoventilation. This review article aims to comprehensively outline the clinical spectrum of sleep disorders and sleep properties associated with NMDs. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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13 pages, 309 KiB

Open AccessReview

Update on Rapid-Eye-Movement Sleep Behavior Disorder (RBD): Focus on Its Strong Association with α-Synucleinopathies

by Carlos H. Schenck

Clin. Transl. Neurosci. 2023, 7(3), 19; https://doi.org/10.3390/ctn7030019 - 28 Jul 2023

Cited by 1 | Viewed by 3333

Abstract

REM sleep behavior disorder (RBD) is a parasomnia in which the customary generalized skeletal muscle atonia of REM sleep, “REM-atonia”, is compromised, allowing for the injurious acting-out of dreams. RBD can be idiopathic/isolated (iRBD) or symptomatic of neurological disorders, and can be triggered [...] Read more.

REM sleep behavior disorder (RBD) is a parasomnia in which the customary generalized skeletal muscle atonia of REM sleep, “REM-atonia”, is compromised, allowing for the injurious acting-out of dreams. RBD can be idiopathic/isolated (iRBD) or symptomatic of neurological disorders, and can be triggered by most antidepressants. RBD mainly affects middle-aged and older adults, and is strongly linked with alpha-synucleinopathies, mainly Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). iRBD is now known to be the earliest and strongest predictor of future PD/DLB, which has stimulated a major international clinical and basic science research effort to enroll iRBD patients for upcoming neuroprotective/disease-modifying trials and to identify the most promising interventions to test in these cohorts. This review will provide the latest pertinent information on the rapidly expanding field of RBD. The methods included a PubMed literature search that included PubCrawlers, which utilizes the NCBI (National Center for Biotechnology Information) E-utils tools for publication retrieval, using the keywords “REM sleep behavior disorder” and “RBD”. The results yielded the latest updates on iRBD as prodromal PD/DLB, with the most promising biomarkers for phenoconversion provided, along with a presentation of three clinical research consortiums that are systematically gathering patients in preparation for enrollment in upcoming clinical trials: (i) The International RBD Study Group; (ii) The North American Prodromal Synucleinopathy (NAPS and NAPS2) Consortium; and (iii) The FARPRESTO Italian multicenter RBD research consortium. In addition, updates on the Parasomnia Overlap Disorder (RBD + NREM parasomnia) and on narcolepsy-RBD are provided, along with new epidemiologic data, the latest RBD management guidelines, and updates on animal models of RBD. Emerging areas of critical RBD research are also highlighted. In conclusion, RBD is a notable example of clinical and translational neuroscience research. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

15 pages, 351 KiB

Open AccessReview

Restless Sleep Disorder and the Role of Iron in Other Sleep-Related Movement Disorders and ADHD

by Noemi Cameli, Annachiara Beatrice, Elisa Maria Colacino Cinnante, Claudia Gullace, Giuliana Lentini, Sara Occhipinti, Raffaele Ferri and Oliviero Bruni

Clin. Transl. Neurosci. 2023, 7(3), 18; https://doi.org/10.3390/ctn7030018 - 27 Jul 2023

Viewed by 10195

Abstract

In the last few years, restless sleep has been described as the key element of many clinical issues in childhood, leading to the recognition of “restless sleep disorder” (RSD) as a new proposed diagnostic category. The essential aid of video-polysomnographic recordings enables detection [...] Read more.

In the last few years, restless sleep has been described as the key element of many clinical issues in childhood, leading to the recognition of “restless sleep disorder” (RSD) as a new proposed diagnostic category. The essential aid of video-polysomnographic recordings enables detection and quantification of the “large muscle group movements” (such as limb movements and repositioning) frequently described by parents of children with RSD. Strong evidence links iron deficiency to the pathophysiology of sleep-related movement disorders such as RSD, restless legs syndrome, periodic limb movement disorder, and attention deficit hyperactivity disorder (ADHD) due to the important role played by the brain dopamine production system. Serum ferritin is the main parameter used to evaluate iron deficiency in patients with sleep-related movement disorders. Iron supplementation is recommended when the serum ferritin level is <50 ng/mL, since the literature emphasizes the correlation between lower levels of serum ferritin, serum iron, and cerebrospinal fluid ferritin, and increased symptom severity. Moreover, several studies report an improvement in symptoms when ferritin levels are kept above 50 ng/mL. In this narrative review, we discuss the role of iron in sleep-related movement disorders, as well as ADHD, highlighting not only the connection between these two conditions, but also the relevance of iron supplementation for symptom improvement. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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9 pages, 528 KiB

Open AccessOpinion

Sleep Research in the Era of AI

by Pinar Göktepe-Kavis, Florence M. Aellen, Sigurd L. Alnes and Athina Tzovara

Clin. Transl. Neurosci. 2024, 8(1), 13; https://doi.org/10.3390/ctn8010013 - 26 Feb 2024

Cited by 3 | Viewed by 2376

Abstract

The field of sleep research is both broad and rapidly evolving. It spans from the diagnosis of sleep-related disorders to investigations of how sleep supports memory consolidation. The study of sleep includes a variety of approaches, starting with the sole focus on the [...] Read more.

The field of sleep research is both broad and rapidly evolving. It spans from the diagnosis of sleep-related disorders to investigations of how sleep supports memory consolidation. The study of sleep includes a variety of approaches, starting with the sole focus on the visual interpretation of polysomnography characteristics and extending to the emergent use of advanced signal processing tools. Insights gained using artificial intelligence (AI) are rapidly reshaping the understanding of sleep-related disorders, enabling new approaches to basic neuroscientific studies. In this opinion article, we explore the emergent role of AI in sleep research, along two different axes: one clinical and one fundamental. In clinical research, we emphasize the use of AI for automated sleep scoring, diagnosing sleep-wake disorders and assessing measurements from wearable devices. In fundamental research, we highlight the use of AI to better understand the functional role of sleep in consolidating memories. While AI is likely to facilitate new advances in the field of sleep research, we also address challenges, such as bridging the gap between AI innovation and the clinic and mitigating inherent biases in AI models. AI has already contributed to major advances in the field of sleep research, and mindful deployment has the potential to enable further progress in the understanding of the neuropsychological benefits and functions of sleep. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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6 pages, 206 KiB

Open AccessCommentary

Insomnia Guidelines—The European Update 2023

by Dieter Riemann, Raphael J. Dressle and Kai Spiegelhalder

Clin. Transl. Neurosci. 2024, 8(1), 10; https://doi.org/10.3390/ctn8010010 - 26 Jan 2024

Cited by 1 | Viewed by 4721

Abstract

The last ten years have seen the development and publication of numerous national and international guidelines devoted to the diagnosis and treatment of insomnia. These include guidelines by the American College of Physicians (ACP), the American Academy of Sleep Medicine (AASM), the British [...] Read more.

The last ten years have seen the development and publication of numerous national and international guidelines devoted to the diagnosis and treatment of insomnia. These include guidelines by the American College of Physicians (ACP), the American Academy of Sleep Medicine (AASM), the British Sleep Society (BSS), the German Sleep Society (GSS), and the European Sleep Research Society (ESRS). Though coming from very diverse authors and backgrounds, these guidelines by and large agree concerning the therapeutic recommendations: cognitive behavioral treatment of insomnia (CBT-I), a multicomponent psychotherapeutic intervention, is unequivocally recommended as a first-line treatment. In this report, we will focus on the most recent guideline update from the ESRS, which was published in November 2023. After suggesting a careful diagnostic procedure, CBT-I, both applied face to face (F2F) or digitally (dCBT-I), is again recommended as a first-line treatment based on the available evidence. Hypnotic medications like benzodiazepines (BZ), benzodiazepine receptor agonists (BZRA), sedating antidepressants, and others are approved for short-term-treatment of up to four weeks. Orexin receptor antagonists (i.e., daridorexant) and prolonged release melatonin are considered as options for longer-term treatment when carefully considering the advantages and disadvantages. Both light therapy and exercise regimens were viewed as promising; however, they still lack convincing evidence for the time being. Given the fact that not every patient responds satisfactorily or even remits following CBT-I or other treatment options, the research agenda calls for the development and evaluation of new therapeutic avenues and combination therapies. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

7 pages, 222 KiB

Open AccessHypothesis

Cellular Stress, Energy Constraints and the Energy Allocation Hypothesis of Sleep

by Markus H. Schmidt and Kaspar A. Schindler

Clin. Transl. Neurosci. 2024, 8(1), 6; https://doi.org/10.3390/ctn8010006 - 10 Jan 2024

Viewed by 1726

Abstract

A growing body of literature demonstrates a critical role for sleep in upregulating diverse biological processes related to protein synthesis, immune function, and cellular housekeeping such as intracellular transport and membrane repair. The energy allocation (EA) hypothesis places sleep in a broader context [...] Read more.

A growing body of literature demonstrates a critical role for sleep in upregulating diverse biological processes related to protein synthesis, immune function, and cellular housekeeping such as intracellular transport and membrane repair. The energy allocation (EA) hypothesis places sleep in a broader context of resource optimization where sleep–wake partitioning of metabolic operations optimizes resource utilization. The EA hypothesis of sleep carries important implications in health, disease, and homeostatic mechanisms. Specifically, conditions that lead to cellular stress, energy constraints or depression of neuronal activity, such as epilepsy, ischemic stroke or cortical spreading depression, are here proposed to follow similar conserved processes that favor sleep. This review examines the role of local mechanisms, including cytokine release or the accumulation of adenosine, in downregulating wakefulness to favoring sleep, loss of functional connectivity and the upregulation sleep-coupled processes that promote survival. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

15 pages, 1205 KiB

Open AccessSystematic Review

Sleep and Stroke-Related Delirium: A Systematic Review

by Valerio Brunetti, Eleonora Rollo, Irene Scala, Jessica Marotta, Antonio Callea, Claudio Imperatori and Giacomo Della Marca

Clin. Transl. Neurosci. 2023, 7(3), 22; https://doi.org/10.3390/ctn7030022 - 15 Aug 2023

Viewed by 2561

Abstract

Study objectives: Sleep and circadian rhythms disorders are frequent in the acute stroke. Sleep modifications are likely to contribute to the development of stroke-related delirium, a common neuropsychiatric complication of acute stroke. This systematic review aimed to clarify the association between sleep [...] Read more.

Study objectives: Sleep and circadian rhythms disorders are frequent in the acute stroke. Sleep modifications are likely to contribute to the development of stroke-related delirium, a common neuropsychiatric complication of acute stroke. This systematic review aimed to clarify the association between sleep modifications and the occurrence of delirium in patients with acute stroke. Methods: The current systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was performed on PubMed and Scopus databases. Only studies that provided data concerning sleep, or pre-existing sleep disorders, in acute stroke and performed a formal evaluation of delirium were included. Results: The literature search enabled the identification of 15 studies, which exhibited high heterogeneity in terms of study design, settings, sleep assessments, delirium measures, and types of sleep intervention. In the study quality assessment, the majority of the studies were rated as weak or moderate. In most of the cases, sleep was subjectively assessed by the patients or rated by clinicians. None of the studies performed polysomnography for the evaluation of sleep. Only four of the studies assessed the impact of a sleep intervention on delirium, suggesting the potentially protective role of sleep promotion in reducing the prevalence and severity of stroke-related delirium. Conclusions: The evidence arising from the present systematic review supports that sleep disruption is a potential promoting factor for stroke-related delirium. We suggest that a formal sleep assessment and sleep promotion should be included in routine stroke care. Full article

(This article belongs to the Special Issue Sleep–Wake Medicine)

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