Sleep Medicine

Certain hypnotics improve sleep in OSA without measurable respiratory harm

This network meta-analysis pooled 32 randomized trials including 1,871 adults with obstructive sleep apnea receiving 12 hypnotics or placebo. Versus placebo, lemborexant increased total sleep time, REM sleep time, and sleep efficiency and reduced latency to persistent sleep and WASO. Daridorexant and zolpidem increased total sleep time and sleep efficiency and reduced WASO without worsening AHI or oxygen saturation measures. Overall discontinuation and adverse event–related discontinuation for these agents were similar to placebo, suggesting short-term respiratory safety in OSA. Eszopiclone improved sleep and respiratory parameters, but these effects were not robust when CPAP titration studies were excluded. 1

Exercise improves subjective sleep quality with peak benefit around 25 weeks

This meta-analysis included 200 randomized trials with 23,523 adults comparing exercise interventions to non-exercise controls. Exercise improved subjective sleep quality and produced small but significant gains in objective sleep efficiency where reported. Qigong, walking, and high-intensity interval training showed the largest benefits compared with active control conditions. Participants with worse baseline Pittsburgh Sleep Quality Index scores were more likely to achieve clinically important improvement. Benefits followed a U-shaped duration pattern, peaking at approximately 25 weeks, but overall certainty of evidence was very low. 2

NoSAS provides practical OSA screening with good sensitivity and modest specificity

This meta-analysis evaluated NoSAS diagnostic accuracy in 31 studies using polysomnography or equivalent reference standards. For mild OSA, pooled sensitivity and specificity were 71% and 66%, respectively. For moderate OSA, sensitivity and specificity were 73% and 62%, and for severe OSA, 82% and 50%, respectively. Higher BMI increased sensitivity for mild and severe OSA, while larger samples improved specificity in mild OSA. Performance was better in Caucasian and sleep-clinic cohorts than in Asian or community-based populations, with substantial heterogeneity overall. 3

CBT-I reduces cortical hyperarousal and stabilizes sleep in chronic insomnia

This multicenter study followed 98 patients with chronic insomnia disorder through 6–8 weeks of standardized CBT-I. CBT-I significantly improved Insomnia Severity Index scores and both subjective and polysomnographic sleep parameters, including sleep onset latency and sleep efficiency. Quantitative NREM EEG showed increased delta/beta ratio after treatment, indicating reduced cortical hyperarousal independent of study center. Sleep stability improved but was not correlated with delta/beta changes, suggesting partially distinct mechanisms of benefit. Patients with objectively short sleep duration demonstrated greater delta/beta improvements than those with normal sleep duration. 4