Sleep Medicine

Low-dose quetiapine in OSA: modest physiologic gains, substantial next-day impairment

In 15 patients with OSA and sleep-maintenance insomnia, 50 mg quetiapine acutely reduced AHI versus placebo and improved sleep efficiency. Quetiapine also lowered the arousal index without worsening mean overnight oxygen saturation compared with placebo. However, next-morning psychomotor vigilance was significantly impaired, with slower PVT reaction times after quetiapine. Driving simulator performance deteriorated, with increased steering deviation suggesting compromised driving safety. These findings argue against routine off-label quetiapine for insomnia in OSA, particularly in patients who must drive the next day. 1

Advanced PSG metrics scale to clinical practice and link to comorbidity profiles

This study extracted loop gain, hypoxic burden, ventilatory instability, and related metrics from 6,427 diagnostic PSGs in a health-system cohort. Endotype and burden measures showed demographic and obesity associations concordant with prior research, supporting real-world generalizability. After AHI adjustment, elevated loop gain, ventilatory burden, and hypoxic burden associated with hypertension, diabetes, and renal failure. Greater ventilatory instability related to cardiovascular disease, while reduced collapsibility and ventilatory instability associated with chronic airway obstruction. No single PSG metric predicted risk across all comorbidities, underscoring heterogeneous OSA pathophysiology and the value of multidimensional phenotyping. 2

EEG-guided nursing reduces avoidable disruptions and improves ICU sleep continuity

A quasi-experimental ICU study compared usual four-hourly nursing rounds with care guided by real-time sleep-EEG displayed outside patient rooms. Sleep-guided care significantly reduced the proportion of room entries occurring while patients were asleep. Continuous nocturnal sleep duration nearly doubled, and deep sleep also increased in the sleep-guided group versus usual care. These data support integrating real-time sleep monitoring into ICU workflows to defer non-urgent care during sleep and preserve consolidation. 3

Objective sleep signatures track clinical stages across the Alzheimer’s continuum

This systematic review and network meta-analysis evaluated subjective and objective sleep across mild cognitive impairment and Alzheimer’s dementia. Mild cognitive impairment showed reduced sleep efficiency and REM percentage, which were more pronounced in Alzheimer’s dementia. Decreased slow-wave sleep emerged in Alzheimer’s dementia but not consistently in mild cognitive impairment. Progressively abnormal PSG parameters may index active Alzheimer’s pathology and stage-related neurodegeneration. The authors propose targeting total sleep time, slow-wave sleep, and REM sleep early, including in MCI or genetically at-risk individuals. 4