Sleep Medicine

PAP therapy for OSA linked to lower mortality and hospitalizations in a large German cohort

In a German insurance database, 12,297 PAP-treated and 10,020 untreated adults with OSA were followed for about 4 years. All-cause mortality was lower with PAP than without (hazard ratio 0.87; 95% CI 0.77-0.98). Hospitalizations were also less frequent among 8,768 PAP users than matched controls (odds ratio 0.81; 95% CI 0.74-0.89). Analyses adjusted for demographics, socioeconomic status, comorbidities, and medications, but residual confounding remains possible. 1

Intranasal saline, not steroids, drives short-term symptom resolution in pediatric obstructive SDB

This multicenter RCT enrolled children 3–12 years with obstructive sleep-disordered breathing on ENT waitlists. After 6 weeks of once-daily intranasal saline, symptoms resolved in 29.5% of 139 completers. Among 93 children with persistent symptoms, another 6 weeks of intranasal mometasone or continued saline produced similar resolution rates (35.6% vs 36.4%). No group differences appeared in behavior, quality of life, or perceived surgical need, and no responsive subgroup was identified. 2

Modest sleep extension improves sleep health but not insulin sensitivity in short-sleeping adults with obesity

Adults with overweight/obesity, insulin resistance, and habitual sleep <7 hours were randomized to habitual sleep or sleep extension for about 6 weeks. The extension group increased time in bed and sleep duration by about 1.3 and 1.1 hours per night, respectively, versus minimal change in controls. Sleep regularity and subjective sleep health improved in the extension group without differences in multiorgan insulin sensitivity between groups. Twenty-four–hour glycemic control also did not differ, despite better sleep metrics. 3

JAMA review updates RLS diagnosis and prioritizes iron and gabapentinoids over dopamine agonists

Clinically significant restless legs syndrome affects about 3% of US adults and is associated with substantial insomnia and impaired quality of life. RLS is more frequent in multiple sclerosis, end-stage kidney disease, iron deficiency anemia, pregnancy, peripheral neuropathy, and Parkinson disease. Diagnosis is clinical; polysomnography is not recommended for routine evaluation. Iron therapy is recommended when ferritin is ≤100 ng/mL or transferrin saturation <20%, using oral ferrous sulfate or intravenous iron. 4