Effect of androgen abuse on sleep apnea in men: a prospective cohort study
Verdegaal TJ, Peeters W, Bond P, Machiels H, de Ronde W and Smit DL
Effect of androgen abuse on sleep apnea in men: a prospective cohort study
Verdegaal TJ, Peeters W, Bond P, Machiels H, de Ronde W and Smit DL
Androgen abuse has been suggested to adversely affect sleep-disordered breathing, but prospective real-world data in androgen abusers are lacking. The aim of this study was to evaluate the effects of androgen abuse on sleep-disordered breathing.
Seizure forecasting: The long and winding road to clinical translation
Karoly PJ, Stirling RE, Cook MJ, Goldenholz DM, Baud MO, Rao VR, Vieluf S and Brinkmann BH
Seizure forecasting: The long and winding road to clinical translation
Karoly PJ, Stirling RE, Cook MJ, Goldenholz DM, Baud MO, Rao VR, Vieluf S and Brinkmann BH
Seizure forecasting has progressed from theoretical aspiration to a rapidly advancing research domain, yet clinical translation remains limited. Over the past decades, advances in algorithm development, chronic electroencephalography (EEG), wearable sensors, and the characterization of seizure cycles have demonstrated that seizure risk is not random but fluctuates according to identifiable biological rhythms and patient-specific patterns. Forecasting algorithms have shown promising performance across diverse retrospective datasets, including intracranial EEG, subscalp recordings, wearable physiological signals, and even self-reported diaries. However, the clinical value of forecasting is contentious. Prospective real-world validation and regulatory approval of patient-facing forecasting systems remain rare. This review incorporates perspectives presented at the 5th International Congress on Mobile Health and Digital Technology in Epilepsy (2025). We examine barriers impeding clinical translation and current attempts to address them. Crucially, forecasting performance cannot be evaluated in isolation from intended use. Applications range from low-risk uses, like scheduling diagnostic monitoring or visualization of historical trends, to higher risk interventions, including medication titration and adaptive neuromodulation. Each application entails distinct performance thresholds, ethical considerations, and regulatory requirements. Translational challenges include reliable seizure annotation, nonstationarity dynamics of biological cycles, and practical constraints for real-time deployment. Ethical concerns center on miscalibrated reliance on low-risk states, potential anxiety associated with high-risk advisories, and the heterogeneity of patient preferences and risk tolerance. Regulatory pathways are likely to depend on clearly defined use cases and clinically meaningful endpoints, which may extend beyond seizure counts to include quality of life, anxiety, locus of control, and other patient-reported outcomes. Ultimately, translation will require rigorous prospective evaluation against transparent benchmarks, sustainable scientific-commercial partnerships, and integration of probabilistic risk information into clinical workflows. With careful implementation, seizure forecasting may evolve from proof-of-concept research into a clinically meaningful component of epilepsy management, and we remain cautiously optimistic.
Association between caregivers of dementia and sleep quality : A nationwide population-based study
Lee S and Chung JH
Association between caregivers of dementia and sleep quality : A nationwide population-based study
Lee S and Chung JH
Finding the associations between cohabitation status and sleep quality in caregivers of people with dementia (PLwD) was the goal of this study.
Late-onset and functional hypogonadism in aging men: an integrated perspective on hormonal, sleep, and metabolic dimensions
Andersen ML, Sanches JM, Alvarenga TA, Toricelli M, Vasco MB and Tufik S
Late-onset and functional hypogonadism in aging men: an integrated perspective on hormonal, sleep, and metabolic dimensions
Andersen ML, Sanches JM, Alvarenga TA, Toricelli M, Vasco MB and Tufik S
Male reproductive aging is characterized by gradual hormonal and metabolic deterioration, often described as late-onset hypogonadism (LOH) or "andropause". However, these terms remain controversial and insufficient to capture the multifaceted nature of this process. This narrative review provides an integrated perspective on the interconnected hormonal, metabolic, sleep-related, and sexual consequences of male aging, with particular attention to the distinction between LOH and functional hypogonadism.
Sleep Duration and Epilepsy Risk: Mendelian Randomization and Functional Validation of CACNA1A rs2228130-Related Inhibitory Synaptic Dysfunction
Li X, Hou Y, Ren Y and Yue W
Sleep Duration and Epilepsy Risk: Mendelian Randomization and Functional Validation of CACNA1A rs2228130-Related Inhibitory Synaptic Dysfunction
Li X, Hou Y, Ren Y and Yue W
Objectives To evaluate the causal association between sleep traits and epilepsy risk using Mendelian randomization, and to investigate the mechanism of a prioritized epilepsy-risk variant through gene-level enrichment analysis and functional validation. Methods Large-scale European GWAS datasets were analysed using multiple Mendelian randomization methods, including inverse variance weighted, MR-Egger and weighted median models, with heterogeneity and sensitivity analyses. Epilepsy-associated loci were mapped to protein-coding genes and flanking regions based on GRCh37 annotation, and primary and sensitivity-analysis gene sets were constructed from gene-level summary results for functional enrichment analysis. Guided by locus-level prioritization and the biological plausibility of CACNA1A, rs2228130 was selected for functional validation in CRISPR-ABE-edited human iPSC and knock-in mouse models to assess inhibitory synaptic transmission, sleep-related phenotypes and seizure susceptibility. Results Longer sleep duration was significantly associated with lower epilepsy risk (OR = 0.9937, p < 1 × 10⁻⁵), supporting a protective genetic causal association. The association between insomnia and epilepsy showed substantial heterogeneity (Q = 9352.91) and should be interpreted cautiously. Gene-level enrichment analysis indicated that epilepsy-associated candidate genes converged primarily on broad biological regulation, developmental processes and multicellular organismal processes, without stable dominant enrichment of GABAergic synapse or circadian rhythm pathways. Functional validation showed that rs2228130 did not affect neuronal differentiation but impaired inhibitory synaptic transmission, accompanied by abnormal network activity, altered sleep-related phenotypes and increased seizure susceptibility. Knock-in mice exhibited more frequent epileptiform discharges, reduced non-rapid eye movement sleep, decreased slow-wave activity and altered expression of rhythm-related genes. Pharmacological and sleep-related interventions partially ameliorated these abnormalities. Significance This study supports a protective genetic causal association between longer sleep duration and lower epilepsy risk, and suggests that epilepsy-related genetic risk converges primarily on broad functional networks. Within this framework, functional validation of CACNA1A rs2228130 identifies inhibitory synaptic dysfunction as a key mechanistic node linking genetic risk to sleep- and epilepsy-related phenotypes, providing a rationale for epilepsy prevention and treatment through sleep optimization and targeted modulation of critical downstream pathways. Plain Language Summary We used large-scale genetic data and experimental models to examine how sleep is related to epilepsy. Genetic evidence showed that longer sleep duration was associated with lower epilepsy risk. Although broad gene-level analyses did not identify a stable dominant signal for GABAergic synapse or circadian rhythm pathways, functional studies of the epilepsy-risk variant CACNA1A rs2228130 showed that it disrupted inhibitory synaptic transmission, altered sleep-related phenotypes and increased seizure susceptibility. In mouse models, drug treatment and sleep-related intervention partly improved these abnormalities, suggesting that sleep optimization and targeted downstream regulation may help reduce epilepsy risk.
A Standardized Multicomponent Respiratory Guidance and Nursing Care Protocol for Elderly Patients with Chronic Obstructive Pulmonary Disease
Liang Y, Cao C, Pan X, Xu Q, Pei H and Sun C
A Standardized Multicomponent Respiratory Guidance and Nursing Care Protocol for Elderly Patients with Chronic Obstructive Pulmonary Disease
Liang Y, Cao C, Pan X, Xu Q, Pei H and Sun C
This protocol describes a standardized, reproducible, multicomponent respiratory guidance and nursing care intervention for elderly patients with chronic obstructive pulmonary disease (COPD). Based on Orem's self-care deficit nursing theory, the method integrates structured breathing training, respiratory muscle training, aerobic exercise, and continuous nursing support. The intervention is delivered by trained respiratory nurses over a 12-week period in inpatient and outpatient settings. The protocol includes procedures for patient selection, group allocation, baseline assessment, and structured implementation of intervention components. Breathing training incorporates guided respiratory exercises and spirometer-assisted techniques, combined with individualized exercise programs, psychological support, and discharge planning. The protocol specifies intervention frequency, duration, supervision, safety monitoring, and adherence tracking to ensure consistency and reproducibility. Standardized outcome assessment procedures are outlined, including pulmonary function testing, arterial blood gas analysis, dyspnea evaluation, functional ability assessment, sleep quality measurement, and quality-of-life evaluation using validated clinical instruments. This protocol provides a practical and structured framework for implementing nonpharmacological respiratory care in elderly patients with COPD across clinical and rehabilitation settings.
Comparative effectiveness of oral appliances and continuous positive airway pressure: a prospective non-randomized study using a non-inferiority framework
Dieltjens M, Engelen S, Azarbarzin A, Van den Bossche K, Van Loo D, Braem MJ, Goossens R, Verbraecken J, Op de Beeck S and Vanderveken OM
Comparative effectiveness of oral appliances and continuous positive airway pressure: a prospective non-randomized study using a non-inferiority framework
Dieltjens M, Engelen S, Azarbarzin A, Van den Bossche K, Van Loo D, Braem MJ, Goossens R, Verbraecken J, Op de Beeck S and Vanderveken OM
Continuous positive airway pressure (CPAP) is the first‑line treatment for moderate-to-severe obstructive sleep apnea (OSA), while mandibular advancement devices (MAD) are an established alternative for CPAP-intolerant patients. Differences in efficacy and adherence may affect overall clinical effectiveness.
Optic Nerve Thickness Assessed by Ocular Ultrasonography in Obstructive Sleep Apnea: Association with Disease Severity and Nocturnal Hypoxemia
Kerget B, Çetin E, Aksakal A, Çetin SM and Coşkuner MB
Optic Nerve Thickness Assessed by Ocular Ultrasonography in Obstructive Sleep Apnea: Association with Disease Severity and Nocturnal Hypoxemia
Kerget B, Çetin E, Aksakal A, Çetin SM and Coşkuner MB
Obstructive sleep apnea (OSA) has been associated with various ocular complications, yet ultrasonographic evaluation of optic nerve thickness and its relationship with nocturnal hypoxemia remains poorly understood. This study aimed to evaluate optic nerve thickness and globe dimensions using ocular ultrasonography in patients with different OSA severities and to investigate their associations with polysomnographic parameters.
'I had to change my way of thinking, change my emotions, and learn how to react': A narrative study on the management of narcolepsy symptoms and coping with the disease from patients' perspectives
Hlodak J, Feketeova E, Dankulincova Veselska Z and Madarasova Geckova A
'I had to change my way of thinking, change my emotions, and learn how to react': A narrative study on the management of narcolepsy symptoms and coping with the disease from patients' perspectives
Hlodak J, Feketeova E, Dankulincova Veselska Z and Madarasova Geckova A
Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness. In NT1, cataplexy is a key symptom, involving sudden loss of muscle tone, typically triggered by strong emotions. Additional features may include sleep paralysis, hallucinations, fragmented nocturnal sleep, and vivid dreams. Symptom management is considered most effective when pharmacological (medication) and non-pharmacological (behavioural) approaches are combined. Patients' coping strategies for living with a chronic condition may influence symptom management. This study aimed to describe patients' experiences with the management of narcolepsy symptoms, coping strategies, and the role of social support.
Electroacupuncture for Menstrual-Related Migraine: Protocol for a Multicenter Single-Blinded Randomized Controlled Trial
Jiang S, Ye Q, Gu S, Li Q, Jin Q, Guo Z, Yin P and Liu L
Electroacupuncture for Menstrual-Related Migraine: Protocol for a Multicenter Single-Blinded Randomized Controlled Trial
Jiang S, Ye Q, Gu S, Li Q, Jin Q, Guo Z, Yin P and Liu L
Menstrual-related migraine (MRM) is a prevalent neurological condition affecting females, with prolonged duration, severe symptoms, and poor drug response, significantly impairing their quality of life. Electroacupuncture shows promise as a nonpharmacological intervention for migraine. However, there is a deficiency in high-quality evidence-based research assessing its efficacy in MRM. To address this gap, we present a detailed protocol to evaluate electroacupuncture's therapeutic effects in MRM.