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Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System
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Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 20 March 2026 | Viewed by 15476

Special Issue Editor

Prof. Dr. Mariusz Siemiński

E-Mail Website
Guest Editor
Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland
Interests: insomnia; neurology; sleep medicine; epilepsy; polysomnography; restless leg syndrome; sleep; REM sleep; sleep disorders; sleep disorders and sleep medicine

Special Issue Information

Dear Colleagues,

Sleep is a complex physiological status of the whole body resulting from sophisticated interplay between various parts of brain. Therefore, sleep disorders should be interpreted as brain disorders. Growth of knowledge on the impact of sleep disorders on brain health and of brain disorders on sleep health is exponential. Disruption of the sleep–wake cycle leads to severe complications of functioning of brain structures manifesting with presence or exacerbation of neurological symptoms. Simultaneously, disordered sleep interferes with function of other physiologic systems, e.g., resulting in cardiovascular or metabolic problems. Sleep medicine becomes a study of multiple vicious circles of medical conditions leading to disturbed sleep leading to worsening of the medical condition.

There is a need for more information on physiological and clinical interaction between sleep, brain and other systems of the human organism. I kindly invite all scientific teams working in the field of sleep medicine with an interdisciplinary approach to submit their original and review papers focusing on the role of sleep disorders in neurology and on the impact of neurologic diseases on quality of sleep.

Prof. Dr. Mariusz Siemiński
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sleep
  • neurology
  • insomnia
  • restless leg syndrome
  • REM sleep behavior disorder
  • parasomnia
  • somnambulism
  • neurodegenerative disorders
  • brain injury
  • sleep-related movement disorders

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Published Papers (6 papers)

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Research

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15 pages, 449 KB  
Article
Association Between Rest–Activity Rhythm and 27-Hydroxycholesterol (27-OH) in Patients with Amnestic Mild Cognitive Impairment (aMCI)
by Seong Jae Kim, Jung Hie Lee, Jae-Won Jang, Minseo Choi and In Bum Suh
J. Clin. Med. 2025, 14(15), 5481; https://doi.org/10.3390/jcm14155481 - 4 Aug 2025
Viewed by 649
Abstract
Background/Objectives: Rest–activity rhythm (RAR) disturbances can contribute to aging and dementia via metabolic dysregulation. Hydroxycholesterol (OH) is thought to mediate the link between hypercholesterolemia and neurodegeneration. This study compared sleep and RAR parameters between amnestic mild cognitive impairment (aMCI) patients and normal [...] Read more.
Background/Objectives: Rest–activity rhythm (RAR) disturbances can contribute to aging and dementia via metabolic dysregulation. Hydroxycholesterol (OH) is thought to mediate the link between hypercholesterolemia and neurodegeneration. This study compared sleep and RAR parameters between amnestic mild cognitive impairment (aMCI) patients and normal controls (NCs), and examined their associations with plasma 27-OH levels, reflecting peripheral cholesterol metabolism. Methods In total, 18 aMCI patients (76.6 ± 6.1 years) and 21 NCs (70.4 ± 6.7 years) underwent five-day actigraphy and dim light melatonin onset assessment. Plasma 27-OH levels were measured via high-performance liquid chromatography-mass spectrometry. Generalized linear models (GLMs) were used to analyze the relationships between sleep, RAR, and 27-OH levels. Results: The aMCI group had significantly lower 27-OH levels and 27-OH/total cholesterol ratios (p < 0.05). GLM revealed that longer sleep onset latency (SOL) was associated with higher 27-OH levels in aMCI, distinguishing them from NCs. Additionally, in aMCI, longer SOL, lower sleep efficiency (SE), and higher fragmentation index (FI) were associated with an increased 27-OH/total cholesterol ratio (p < 0.05). Higher relative amplitude of RAR was linked to lower 27-OH levels across groups (p < 0.01), but RAR parameters showed no significant association with the 27-OH/total cholesterol ratio. Sleep disturbances, including prolonged SOL, reduced SE, and increased FI, were associated with altered peripheral cholesterol oxygenation in aMCI. Conclusions: Greater RAR amplitude correlated with lower 27-OH levels, regardless of cognitive status. These findings suggest that peripheral cholesterol oxygenation in aMCI is related to both sleep disturbances and circadian rhythm dysregulation, highlighting their role in cholesterol metabolism and neurodegeneration. Full article
(This article belongs to the Special Issue Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System)
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19 pages, 3139 KB  
Article
Prevalence and Misperception: Exploring the Gap Between Objective and Subjective Assessment of Sleep Apnea in a Population at Increased Risk for Dementia
by Miren Altuna, Maite García-Sebastián, Mirian Ecay-Torres, Jon Saldias, Marta Cañada, Ainara Estanga, Carolina López, Mikel Tainta, Ane Iriondo, Maria Arriba, Naia Ros and Pablo Martínez-Lage
J. Clin. Med. 2025, 14(8), 2607; https://doi.org/10.3390/jcm14082607 - 10 Apr 2025
Cited by 2 | Viewed by 2071
Abstract
Background: Aging is a well-established independent risk factor for both cognitive impairment and sleep disorders, including obstructive sleep apnea (OSA), a modifiable yet underrecognized condition. OSA has been implicated in biological mechanisms contributing to Alzheimer’s disease, including amyloid-β accumulation, tau phosphorylation, and [...] Read more.
Background: Aging is a well-established independent risk factor for both cognitive impairment and sleep disorders, including obstructive sleep apnea (OSA), a modifiable yet underrecognized condition. OSA has been implicated in biological mechanisms contributing to Alzheimer’s disease, including amyloid-β accumulation, tau phosphorylation, and neuroinflammation. This underscores the need to optimize OSA diagnosis in individuals with an increased risk of dementia. Methods: This cross-sectional observational study enrolled adults aged 60–85 years with a CAIDE dementia risk score ≥6. Subjective sleep was evaluated using validated questionnaires (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Oviedo Sleep Questionnaire), while objective sleep data were obtained through a single-night peripheral arterial tonometry (PAT)-based wearable device, complemented by a 7-day sleep diary. Participants also completed the STOP-BANG and Berlin questionnaires, with clinically relevant findings communicated to participants. Results: Among 322 participants (48.8% women; mean age 71.4 ± 6.4 years), moderate-to-severe OSA (apnea–hypopnea index [AHI] ≥ 15) was identified in 48.49%, despite the absence of prior diagnoses. Subjective screening tools frequently underestimated OSA severity compared to objective assessments. While no significant sex-based differences were noted, higher AHI values correlated strongly with increased body mass index and elevated dementia risk scores. Conclusions: A marked discrepancy between subjective and objective sleep measurements complicates the accurate diagnosis and management of most sleep disorders, including OSA. Sleep disorders remain significantly underdiagnosed in individuals at increased risk for dementia. Integrating wearable technologies and structured tools such as sleep diaries into routine assessments can enhance diagnostic precision, enabling timely interventions for these modifiable risk factors of dementia. Full article
(This article belongs to the Special Issue Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System)
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15 pages, 1652 KB  
Article
Time-Dependent Autonomic Dysregulation and Co-Activation Induced by Periodic Limb Movements in Sleep
by Marta A. Malkiewicz, Malgorzata Grzywinska, Krzysztof S. Malinowski, Eemil Partinen, Markku Partinen, Jan Pyrzowski and Magdalena Wszedybyl-Winklewska
J. Clin. Med. 2025, 14(6), 1940; https://doi.org/10.3390/jcm14061940 - 13 Mar 2025
Viewed by 1121
Abstract
Background: Periodic limb movements in sleep (PLMS) are characterised by repetitive, involuntary limb movements that occur during sleep and are often associated with autonomic nervous system dysregulation. While it is known that PLMS influence cardiovascular parameters, the exact role of heart rate variability [...] Read more.
Background: Periodic limb movements in sleep (PLMS) are characterised by repetitive, involuntary limb movements that occur during sleep and are often associated with autonomic nervous system dysregulation. While it is known that PLMS influence cardiovascular parameters, the exact role of heart rate variability (HRV) and the balance between sympathetic and parasympathetic activity remains unclear. Previous studies have suggested that longer PLMS events may trigger more pronounced autonomic responses, but the relationship between the duration of PLMS and autonomic dynamics has yet to be fully explored. This study aims to investigate the influence of PLMS duration on autonomic co-activation and its potential cardiovascular implications. Methods: A retrospective analysis was conducted on polysomnographic, demographic, and medical data from five patients, encompassing a total of 1348 PLMS events. We measured heart rate (HR), high-frequency HRV (HF-HRV), systolic blood pressure (SBP), and diastolic blood pressure (DBP) for 10 heartbeats before and 10 heartbeats after each PLMS series. A time–frequency approach was used, employing 10 RR interval segments to analyse HF-HRV dynamics. Statistical analysis was performed using IBM SPSS Statistics (v. 28.0.0.0), and the Kruskal–Wallis test was used to assess statistically significant deviations from baseline. Results: HF-HRV increased during PLMS, indicating enhanced parasympathetic activation. No significant changes in mean DBP or SBP were observed with leg movements of <2.1 s. However, with movements of >2.1 s, significant increases in DBP and SBP were noted, suggesting sympathetic activation. Longer PLMS events were associated with greater parasympathetic activity, while the absence of HR changes indicates concurrent sympathetic activation, supporting autonomic co-activation. Conclusions: Our study indicates that PLMS events lasting >2.1 s are linked to increased parasympathetic activity, likely accompanied by sympathetic activation. This simultaneous activation of both branches of the autonomic nervous system, referred to as autonomic co-activation, could lead to autonomic dysregulation and an increased risk of cardiovascular instability, including potentially life-threatening events. Full article
(This article belongs to the Special Issue Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System)
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Review

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14 pages, 251 KB  
Review
Sundowning Syndrome in Dementia: Mechanisms, Diagnosis, and Treatment
by Michalina Reimus and Mariusz Siemiński
J. Clin. Med. 2025, 14(4), 1158; https://doi.org/10.3390/jcm14041158 - 11 Feb 2025
Viewed by 5692
Abstract
“Sundowning syndrome” refers to the evening decline in mental state among cognitively impaired patients. This phenomenon is well known, but it is not entirely understood. Its prevalence ranges from 1.6% to 66% of patients with dementia. Development of SS relies on neurodegeneration, the [...] Read more.
“Sundowning syndrome” refers to the evening decline in mental state among cognitively impaired patients. This phenomenon is well known, but it is not entirely understood. Its prevalence ranges from 1.6% to 66% of patients with dementia. Development of SS relies on neurodegeneration, the presence of sleep disorders, circadian rhythm of patients’ activities, and mood disorders. Therefore, patients with SS need very precise diagnostic workup aiming at defining the exact cause of the syndrome. Potential therapeutic modalities include behavioral and environmental interventions and pharmacological approaches. Pharmacotherapy with sedatives can by effective but is related to severe side effects. Behavioral interventions are more efficacious but require intense involvement of caregivers. This article discusses the biological processes that may underlie SS and proposes potential diagnostic procedures and therapeutic interventions. Full article
(This article belongs to the Special Issue Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System)
14 pages, 697 KB  
Review
Heart Rate Variability and Interoception in Periodic Limb Movements in Sleep: Interference with Psychiatric Disorders?
by Marta A. Małkiewicz, Krzysztof S. Malinowski, Małgorzata Grzywińska, Eemil Partinen, Markku Partinen, Jan Pyrzowski and Magdalena Wszędybył-Winklewska
J. Clin. Med. 2024, 13(20), 6129; https://doi.org/10.3390/jcm13206129 - 14 Oct 2024
Cited by 2 | Viewed by 4500
Abstract
Periodic limb movements in sleep (PLMS) are a prevalent disorder characterized by rhythmic, involuntary movements of the lower limbs, such as dorsiflexion of the ankle and extension of the big toe, occurring in periodic intervals during sleep. These movements are often linked to [...] Read more.
Periodic limb movements in sleep (PLMS) are a prevalent disorder characterized by rhythmic, involuntary movements of the lower limbs, such as dorsiflexion of the ankle and extension of the big toe, occurring in periodic intervals during sleep. These movements are often linked to disrupted autonomic nervous system (ANS) activity and altered interoception. Interoception involves perceiving internal bodily states, like heartbeat, breathing, hunger, and temperature, and plays a crucial role in maintaining homeostasis and the mind–body connection. This review explores the complex relationships between PLMS, heart rate variability (HRV), ANS dysregulation, and their impact on psychiatric disorders. By synthesizing the existing literature, it provides insights into how ANS dysregulation and altered interoceptive processes, alongside PLMS, contribute to psychiatric conditions. The review highlights the potential for integrated diagnostic and therapeutic approaches and presents a cause-and-effect model illustrating the mutual influence of psychiatric disorders, ANS dysregulation, PLMS, and interoception. Full article
(This article belongs to the Special Issue Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System)
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Other

Jump to: Research, Review

15 pages, 302 KB  
Protocol
Sleep Disturbances Across Dementias and Cognitive Decline: Study Protocol for a Systematic Review and Network Meta-Analysis of Polysomnographic Findings
by Annibale Antonioni, Arianna Della Valle, Caterina Leitner, Emanuela Maria Raho, Edward Cesnik, Jay Guido Capone, Maria Elena Flacco, Francesca Casoni, Paola Proserpio, Luigi Ferini-Strambi and Andrea Galbiati
J. Clin. Med. 2025, 14(20), 7437; https://doi.org/10.3390/jcm14207437 - 21 Oct 2025
Viewed by 621
Abstract
Sleep disturbances are increasingly recognized as early and clinically meaningful features in the pathophysiology of neurodegenerative diseases. Polysomnography (PSG), i.e., the gold standard for objectively characterizing sleep architecture, may provide non-invasive and scalable biomarkers for both early detection and differential diagnosis of dementia. [...] Read more.
Sleep disturbances are increasingly recognized as early and clinically meaningful features in the pathophysiology of neurodegenerative diseases. Polysomnography (PSG), i.e., the gold standard for objectively characterizing sleep architecture, may provide non-invasive and scalable biomarkers for both early detection and differential diagnosis of dementia. This systematic review and network meta-analysis aims to synthesize existing evidence on PSG-derived sleep alterations across the neurodegenerative continuum, including subjective cognitive impairment, mild cognitive impairment, Alzheimer’s disease, frontotemporal dementia, Lewy body dementia, and Parkinson’s disease dementia, compared to healthy controls. It will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for reporting systematic reviews that include network meta-analyses, and it has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251114418. We will include peer-reviewed studies with nocturnal PSG data from adult participants, categorized using validated diagnostic criteria, and scored according to the most recent American Academy of Sleep Medicine guidelines. Both pairwise and network meta-analyses will be conducted using standardized mean differences to quantify group-level effects. Additional analyses will explore the correlations between PSG parameters, severity of cognitive impairment, behavioral symptoms, treatments, and relevant comorbidities. Longitudinal data, where available, will be analyzed separately to evaluate prognostic value. This study will provide a comprehensive synthesis of PSG alterations across neurodegenerative disorders, offering insights into their diagnostic utility and potential as early markers for stratification in clinical trials of disease-modifying therapies. Full article
(This article belongs to the Special Issue Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System)
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