Search Results (838)

Background: Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep-related breathing disorder associated with significant systemic complications and reduced quality of life. Mandibular advancement devices (MADs) represent an established alternative therapy for patients who cannot tolerate continuous positive airway pressure (CPAP). However, concerns remain regarding their potential effects on temporomandibular disorders (TMD). Materials and Methods: This retrospective exploratory study analyzed clinical records of 26 patients (mean age 55.4 ± 5.8 years) with polysomnography-confirmed OSAS and baseline TMD-related symptoms treated with a custom-made monobloc MAD. Clinical parameters were evaluated at baseline (T0) and after approximately 6 months of therapy (T1). Outcomes included apnea–hypopnea index (AHI), Epworth Sleepiness Scale (ESS), Fonseca Anamnestic Index, and health-related quality of life assessed using the SF-36 questionnaire. Repeated measures ANOVA and linear regression analyses were performed. Results: After six months of MAD therapy, a significant reduction in AHI was observed (30 ± 13.76 vs. 10.87 ± 3.9; p < 0.00001). Daytime sleepiness significantly decreased (ESS: 9.31 ± 3.53 vs. 3.38 ± 1.77; p < 0.00001). TMD symptom severity also decreased significantly according to the Fonseca Index (33.85 ± 17.74 vs. 10.00 ± 8.94; p < 0.00001). Quality of life scores improved significantly (SF-36: 41.15 ± 9.52 vs. 65.38 ± 5.82; p < 0.00001). Linear regression analysis showed no significant association between changes in AHI and changes in TMD symptoms, ESS scores, or quality of life. Conclusions: Within the limitations of this retrospective study, MAD therapy was not associated with symptom aggravation of temporomandibular disorders in patients with pre-existing TMD symptoms. Significant improvements in respiratory parameters, daytime sleepiness, and quality of life were observed after six months of therapy. Full article

Background/Objectives: Daytime sleepiness in obstructive sleep apnea (OSA) shows substantial variability and is not fully explained by disease severity. This study aimed to evaluate whether a history of cancer is associated with subjective daytime sleepiness independently of respiratory burden. Methods: In this observational cohort study, 402 untreated patients with OSA were included. Cancer history was defined as a documented diagnosis of malignancy prior to baseline polygraphy. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Multivariable linear and logistic regression models were used to evaluate the association between cancer history and ESS (continuous and dichotomized as >10), adjusting for age, sex, body mass index, smoking status, chronic obstructive pulmonary disease, and apnea–hypopnea index (AHI). Sensitivity analyses additionally adjusted for heart disease and nocturnal hypoxic burden. Results: Sixty-two patients (15%) had a history of cancer. OSA severity and hypoxemia indices were comparable between groups. In multivariable analysis, cancer history was independently associated with modestly lower ESS scores (B = −1.66, 95% confidence interval [CI] −2.96 to −0.37; p = 0.012) and a reduced likelihood of excessive daytime sleepiness (ESS > 10) (odds ratio [OR] = 0.25, 95% CI 0.07 to 0.85; p = 0.027). Conclusions: In this real-world cohort of untreated patients with OSA, cancer history is associated with modestly lower subjective daytime sleepiness despite comparable disease severity, supporting a potential dissociation between physiological burden and symptom perception. These findings indicate that reliance on subjective sleepiness alone may contribute to under-recognition of clinically relevant OSA in patients with a cancer history. Full article

Background/Objectives: The etiology of oral lichen planus (OLP) is unknown, and the treatment is palliative. Considering the possible influence of factors related to lifestyle on the etiopathogenesis and behavior of OLP, the aim of the present study was to investigate the association of sleep quality, nutritional profile, and salivary melatonin and cortisol levels with OLP. Methods: Thirty-two OLP patients and 31 controls completed the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, and 24 h dietary recall survey. Saliva was collected to determine melatonin and cortisol levels by liquid chromatography coupled to mass spectrometry. Results: The OLP patients showed higher scores in the sleep disturbances component of PSQI (p = 0.021) and lower salivary melatonin levels (p = 0.015), whereas salivary cortisol did not differ between the groups (p = 0.402). The Control group had higher prevalence of coffee drinkers (p = 0.045), whereas the OLP group had higher consumption of protein (p = 0.011), lipids (p = 0.043), calories (p = 0.022), monounsaturated fat (p = 0.030), polyunsaturated fat (p = 0.007), saturated fat (p = 0.027), cholesterol (p = 0.041), iron (p = 0.014), zinc (p = 0.048), magnesium (p = 0.025), sodium (p = 0.008), and vitamin E (p = 0.016) compared to controls. Conclusions: The results suggest that OLP is associated with lifestyle factors related to sleep and diet, as well as with lower levels of salivary melatonin. Given the exploratory nature of the study, further research is needed to better understand these findings. Full article

Indoor carbon dioxide (CO₂) concentration significantly influences office workers’ cognitive performance, yet the neurobehavioral mechanisms linking exposure to task efficiency remain insufficiently understood. This study investigates how varying indoor CO₂ concentrations (500, 1000, and 2500 ppm) impact task efficiency (accuracy and reaction time) through neurophysiological pathways grounded in Cognitive Load Theory. Using a within-subject repeated-measures design, 20 participants performed three office tasks—numerical verification, text entry, and reading comprehension—while behavioral metrics, daytime sleepiness, and electroencephalography (EEG) signals were recorded. Results demonstrate that increasing CO₂ concentration monotonically decreased mean accuracy from 93.50% at 500 ppm to 80.89% at 2500 ppm, while mean reaction time rose from 2.00 s to 2.74 s. Daytime sleepiness significantly mediated the CO₂–accuracy relationship. Furthermore, task type significantly moderated this effect (β = −6.182, p = 0.0289), with accuracy declines being more pronounced in tasks with higher intrinsic cognitive demand. EEG spectral analysis corroborated these findings, revealing systematic reductions in beta and theta power under elevated CO₂. These findings indicate that CO₂ acts as an extraneous cognitive load interacting with intrinsic task demands, providing a neurobehavioral basis for developing cognitive-aware environmental control strategies in intelligent buildings. Full article

Aim: Female athletic performance is shaped by the convergence of menstrual-cycle timing, circadian rhythms, fatigue, and ergogenic supplementation; yet no prior study has examined these factors simultaneously in a sport-specific setting. This study investigated the independent and combined effects of acute caffeine ingestion, calendar-based testing window, time of day, and match-induced fatigue on psychophysiological, cognitive, and physical performance in trained female volleyball players. Methods: Thirteen elite eumenorrheic female volleyball players (age: 24.23 ± 4.06 years) completed a randomized, double-blind, placebo-controlled crossover protocol comprising 12 sessions corresponding to all combinations of testing window (menstrual, follicular, luteal), supplementation (caffeine 6 mg·kg⁻¹ vs. placebo), and time of day (08:00 h vs. 18:00 h). Assessments included the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Spiegel questionnaire, Profile of Mood States, Hooper Index, Stroop task, Countermovement Jump (CMJ), Modified Agility T-Test (MAT), and Reactive Agility Test (RAT), administered before and after a one-hour simulated match. Results: Significant main effects of testing window, caffeine, time of day, and fatigue state were observed across all outcome domains (all p < 0.05). Caffeine reduced daytime sleepiness (F(1,12) = 23.84, p < 0.001, ηp² = 0.665), enhanced vigor (F(1,12) = 114.10, p < 0.001, ηp² = 0.905), and improved MAT performance (F(1,12) = 33.27, p < 0.001, ηp² = 0.735). The follicular window was associated with superior cognitive, neuromuscular, and mood-related outcomes relative to the menstrual and luteal windows. Exploratory higher-order interactions suggested condition-specific caffeine benefits for MAT, RAT, and CMJ, particularly in afternoon post-fatigue conditions; these patterns require replication in larger samples. Conclusions: Acute caffeine ingestion improved several psychophysiological, cognitive, and neuromuscular outcomes in trained female volleyball players, with effects that varied across calendar-based testing windows, time of day, and fatigue state. Individualized supplementation strategies incorporating cycle timing and circadian context remain investigational; prescriptive recommendations require replication in larger, hormonally verified samples before clinical or applied adoption. Full article

Bedtime procrastination is linked to poor sleep quality, daytime sleepiness, and altered sleep timing. Identifying the factors influencing this behavior is crucial. Among them, problematic smartphone use can delay bedtime. State boredom, a multidimensional concept (high and low arousal, disengagement, inattention, and time perception), triggers problematic smartphone use as a way to cope with boredom, resulting in delayed bedtime and sleep–wake issues. This study aimed to test mediation models where state boredom predicts sleep-related outcomes both directly and indirectly through smartphone addiction and bedtime procrastination. A total of 259 participants (138 women; mean age = 38.44 years) completed an online survey, including the Mini-Sleep Questionnaire, Bedtime Procrastination Scale, Mobile Addiction Scale, Multidimensional State Boredom Scale, and measures of sleep timing on workdays and free days. Results showed significant positive associations among all variables. Mediation analyses revealed that state boredom directly predicted poor sleep quality and daytime sleepiness, and indirectly predicted smartphone addiction and bedtime procrastination. Additionally, boredom indirectly influenced sleep timing via bedtime procrastination. Overall, the findings suggest that boredom can lead to problematic smartphone use, which in turn delays bedtime, resulting in poorer sleep quality, increased daytime sleepiness, and delayed sleep timing. Full article

Introduction: Obstructive sleep apnea (OSA) is highly prevalent, affecting up to 50% of individuals over 65 years. Elderly patients often present with atypical, fewer and less severe symptoms, suggesting age-specific phenotypes. However, comprehensive clinical phenotyping that incorporates cognitive outcomes remains limited. This study aimed to characterize OSA phenotypes through cluster analysis and evaluate their association with cognitive impairment, independently of age. Materials and Methods: Between 2020 and 2024, 409 adults with moderate-to-severe OSA were enrolled and stratified into three age groups (<65, 65–74, ≥75 years). All underwent home sleep apnea testing (HSAT), comprehensive symptom assessment, Epworth Sleepiness Scale (ESS), and Montreal Cognitive Assessment (MoCA, pathological ≤ 25 pts). Hierarchical cluster analysis (Ward’s method) used AHI, T90, BMI, and ESS. Logistic regression identified independent predictors of cognitive impairment. Results: Older groups showed lower BMI, higher comorbidity burden, fewer symptoms, and greater cognitive impairment prevalence (4.5% vs. 9.7% vs. 45.9%; p < 0.001), despite comparable polysomnographic severity across age groups. Cluster analysis identified three phenotypes: Cluster 1 (classical OSA: high AHI, BMI, T90, ESS); Cluster 2 (geriatric phenotype: low AHI, BMI, T90, ESS, highest cognitive impairment rate: 27.7%); Cluster 3 (hypersymptomatic: low AHI and T90, high sleepiness and asthenia, prevalent depression). On multivariate regression, age (OR 1.155; p < 0.001), male sex (OR 2.223; p = 0.034), and Cluster 2 (OR 3.131; p < 0.001) were independent predictors of cognitive impairment. Conclusions: Three clinically distinct OSA phenotypes were identified regardless of age and severity. The geriatric phenotype was associated with three-fold increased risk of cognitive impairment, supporting routine cognitive screening and age-adapted diagnostic strategies in elderly OSA patients. Full article

Background: Obstructive sleep apnea (OSA) is common in individuals with obesity, largely due to increased soft tissue causing upper airway narrowing. However, mechanisms of OSA improvement following weight loss are incompletely understood, particularly in Asian population, where craniofacial and soft tissue characteristics differ. This study aimed to evaluate changes in upper airway anatomy before and six months after bariatric surgery. Methods: We prospectively evaluated Indian obese patients with OSA undergoing bariatric surgery. Magnetic resonance imaging (MRI) and polysomnography were performed at baseline and six months post-surgery to assess volumetric changes in upper airway structures and the apnea–hypopnoea index (AHI), respectively. Correlations between MRI-derived structural changes, weight loss, and AHI were also analyzed. Results: Ten obese patients with OSA were included. Bariatric surgery resulted in significant reductions in body weight, body mass index (BMI), Epworth Sleepiness Scale score, and AHI (p < 0.05). MRI demonstrated a significant reduction in overall pharyngeal soft tissue volume, soft palate, pterygoid and parapharyngeal fat pad volume and tongue fat fraction. However, no significant changes were observed in total upper airway volume, retroglossal and retropalatal airway volume. Furthermore, no significant correlation was noted between changes in upper airway anatomy and post-operative changes in AHI or body weight. Conclusions: Bariatric surgery was associated with significant weight loss and improvement in OSA severity, accompanied by reduction in soft tissue volumes without significant increase in airway volume in this pilot study. These findings suggest a possible role of factors other than structural airway changes in the observed improvement in OSA following bariatric surgery. Full article

Objective: The aim of this study was to explore the clinical response and tolerability of topical 1% amitriptyline in patients with burning mouth syndrome in a real-world clinical setting. Methodology: A retrospective observational study was conducted through a review of the clinical histories of patients diagnosed with burning mouth syndrome, treated at the Dental Clinic of the Morales Meseguer Hospital (Murcia, Spain). All the patients were treated with topical amitriptyline for a period of four weeks. The following parameters were evaluated at the start of the treatment and at the end of the four weeks: pain or mouth burning, through the visual analog scale (VAS); anxiety and depression, with the Hospital Anxiety and Depression (HAD) scale; sleepiness, with the Epworth Sleepiness Scale (ESS); sensation of dry mouth (VAS) and basal sialometry for the objective measurement of salivary flow. Results: Of the 32 patients that were initially included, 27 were ultimately analyzed. After 4 weeks of treatment with 1% topical amitriptyline, a significant improvement was observed in mouth pain or burning, measured with the VAS, with a decrease in the median of 7.5 (IQR 6–9) to 5 (IQR 5–7) (p < 0.001). Likewise, significant improvements were recorded in the anxiety (HAD-A) and depression (HAD-D) scores, with significant reductions after the treatment (p = 0.019 and p = 0.009, respectively). No statistically significant differences were observed in the subjective sensation of dry mouth (VAS) (p = 0.054) or in the total production of saliva (p = 0.477). Conclusions: Treatment with 1% topical amitriptyline for four weeks was associated with a reduction in pain and emotional distress in patients with burning mouth syndrome, with very few reported adverse effects. As an exploratory retrospective study with a limited sample size reflecting real-world clinical practice, these findings suggest that 1% topical amitriptyline may represent a useful therapeutic option in the management of burning mouth syndrome. However, the results should be interpreted with caution, and further prospective controlled studies are needed to confirm these findings. Full article

Background and Objectives: Obstructive sleep apnea (OSA) is a heterogeneous disease with diverse clinical presentations and high global prevalence. Obesity is a common comorbidity in OSA, but its relationship with symptom subtypes remains unclear. This study aimed to evaluate the association between OSA symptom subtypes and obesity in a clinical cohort. Methods: This observational study analyzed data from the Santiago Obstructive Sleep Apnea (SantOSA) prospective clinical cohort, including adults with OSA confirmed by home sleep apnea testing. Symptom subtypes were identified using latent class analysis. Associations between obesity and symptom subtypes were evaluated using multivariable regression models adjusted for age, sex, tobacco use, RDI, T90%, TST, hypertension, and diabetes. Statistical significance was set at p < 0.05. Results: A total of 1167 patients were included (943 men). Latent class analysis identified three symptom subtypes: non-sleepy, disturbed sleep, and excessive daytime sleepiness. Among obese patients, 30.7%, 50.0%, and 19.3% were classified into these subtypes, respectively. Obesity prevalence was 50.2%, and compared with non-obese OSA patients, obese patients showed a higher prevalence of severe OSA (46.1% vs. 26.9%), hypertension (54.4% vs. 34.9%), and diabetes (37.2% vs. 19.4%), as well as higher ESS scores and higher RDI and T90% values (all p < 0.01). In adjusted analyses, obesity remained independently associated with the excessive daytime sleepiness subtype after controlling for age, sex, tobacco use, RDI, T90%, TST, and comorbidities. Conclusions: Obesity is highly prevalent in OSA and is associated with specific symptom-defined phenotypes, particularly excessive daytime sleepiness and disturbed sleep. These findings support the relevance of considering symptom profiles alongside traditional severity metrics. Full article

Background/Objectives: Two diagnostic approaches for sleep studies are commonly used worldwide: in-laboratory polysomnography [PSG] and home sleep apnea testing [HSAT]. Although HSAT has gained increasing acceptance due to its convenience and lower cost, clinical criteria for HSAT use remain complex and cannot be inferred directly from AHI/ODI severity indices alone. The aim of the present exploratory study was to examine associations between routinely collected demographic, clinical, and symptom-related variables and objective indices of disease severity, namely the apnea–hypopnea index [AHI] and oxygen desaturation index [ODI] as an initial, hypothesis-generating step toward future patient-level model development and validation. Methods: A retrospective observational analysis was conducted in 1100 individuals who previously underwent in lab-polysomnography [PSG] at the University Hospital of Thessaly, Greece, between 2006 and 2023. Specific demographic, clinical and symptom-related variables were included in this study [six continuous and fifteen categorical], which were analyzed in relation to AHI and ODI values. A three-step process was carried out: variable selection followed a screening and backward elimination process. Multivariable linear regression models were subsequently estimated within a Bayesian framework using Hamiltonian Monte Carlo methods. Results: Out of 1100 individuals, the mean age was 51.9 years with the predominant gender being male [76%]. Obesity [65.6%] and hypertension [40.5%] were the most common comorbidities. For AHI, male gender, body mass index [BMI], Epworth Sleepiness Scale [ESS] score, reported breathing interruptions during sleep, and chronic obstructive pulmonary disease [COPD] were significant predictors. For ODI, significant predictors included male gender, BMI, ESS score, breathing interruptions during sleep, daytime sleepiness, obesity, and COPD. COPD showed an inverse association with both indices. Conclusions: These findings support the feasibility of integrating routinely available clinical variables within a Bayesian probabilistic framework to estimate disease severity pre-test probability. The current analysis may not constitute a validated tool for HSAT versus PSG selection; however, it is an initial, hypothesis-generating step toward future model development. Full article

Background: Insomnia symptoms associated with late chronotypes are prevalent among young adults, and frequently lead to sleep deprivation, morning-awakening difficulties, and excessive daytime sleepiness. These conditions are associated with psychological distress, impaired academic functioning, and reduced self-esteem. Although chronobiological behavioral interventions are effective, their accessibility remains limited. To bridge this gap, we developed a smartphone application delivering digital brief behavioral treatment for insomnia (BBT-I). We also designed a four-week program integrating the app with light therapy (LT) via wearable glasses named “Digital BBT-I + LT”. This randomized controlled trial will evaluate the efficacy of digital BBT-I with LT and digital BBT-I alone compared with a waitlist control group. Methods: This three-arm parallel-group randomized controlled trial will target young adults with insomnia symptoms and late chronotypes. Participants will be randomized to receive digital BBT-I with adjunctive LT, digital BBT-I alone, or a waitlist control condition. The primary outcome will be insomnia symptom severity, assessed using the Insomnia Severity Index. Evaluations will be conducted at baseline, weekly during the four-week intervention period (days 8, 15, 22, and 29), and at the 3-month follow-up. Discussion: Late chronotypes and insomnia significantly impair sleep and mental health in young adults. Despite the recognized importance of chronobiology-based treatments, they are rarely adopted as standard care. This highlights the need for scalable digital interventions, such as digital BBT-I. By rigorously assessing these strategies, this trial aims to provide clinical evidence regarding accessible interventions to improve sleep and mental health outcomes in this population. Full article

Background: Burning Mouth Syndrome (BMS) is a chronic pain characterized by persistent oral burning and itching sensations without identifiable organic causes. In this case series, we explored the role as non-pharmacological therapy effects of topical piperine in reducing BMS-related symptoms. Methods: BMS patients performed a 1 min mouthrinse, twice daily for 8 weeks, with 10 mg of piperine in 20 mL of water. At baseline and post-treatment, pain intensity was evaluated using the Numeric Rating Scale (NRS), while oral-health-related quality of life and sleep quality were assessed using the oral health impact profile (OHIP-14) and Epworth Sleepiness Scale (ESS) questionnaires. Results: After 8 weeks of treatment, 9 of 14 patients (64%) reported improvement in BMS symptoms. Pain intensity significantly decreased (NRS scores reduced from 5.10 ± 1.81 to 3.21 ± 2.12; p = 0.001). OHIP-14 scores also improved (from 17.6 ± 8.9 to 12.3 ± 10.4; p = 0.003), as did ESS scores (from 3.86 ± 3.16 to 2.86 ± 2.96; p = 0.008). No adverse events or symptom worsening were reported. Conclusions: Topical piperine may help relieve symptoms in BMS, but the evidence is preliminary due to the small sample size and lack of a control group. Randomized controlled trials are needed to explore its effectiveness. Full article

Background/Objectives: Sleep problems, cognitive deficits, and mood disorders are prevalent in justice-involved populations, especially among individuals with a history of traumatic brain injury (TBI), though the association between these variables remains understudied. This retrospective study examined the relationship between subjective sleepiness and mood state on neuropsychological functioning in a forensic population with self-reported TBI. Methods: Data were obtained from 419 inmates and probationers with a self-reported history of TBI using the Ohio State University Traumatic Brain Injury Identification Method and Automated Neuropsychological Assessment Metrics (ANAM). Multiple linear regression models examined associations between cognitive performance across domains (i.e., reaction time, learning, attention, processing speed, working memory, delayed memory, and inhibition) and subjective sleepiness and mood states (i.e., depression, anxiety, fatigue, restlessness, anger, happiness, and vigor) measured by self-report scales embedded in the ANAM. Results: Negative mood state was most associated with impaired performance on tests of learning, delayed memory, spatial working memory, and reaction time, as well as global neurocognitive test performance. Subjective sleepiness was predictive of poorer performance on reaction time tasks, while positive mood states were related to better performance on the same task. Regression models were statistically significant (p < 0.05), with subjective sleepiness and mood accounting for approximately 1–5% of the variance in cognitive performance. Conclusions: Subjective sleepiness and mood symptoms are significantly related to cognitive performance among justice-involved individuals with self-reported TBI. While these factors can contribute to the need for rehabilitation, they may also reduce the likelihood of successful engagement. Importantly, both sleepiness and mood are modifiable treatment targets, and adapting interventions to accommodate cognitive inefficiencies can improve engagement and overall treatment benefit. Full article

Background/Objectives: Fatigue is a frequent, disabling and difficult-to-treat symptom of multiple sclerosis (MS). Low-grade inflammation and energetic dysfunction have been proposed as mechanisms underlying the pathogenesis of this symptom. Owing to its anti-inflammatory and metabolic properties, there is a rationale for ketogenic diet (KD) application in this setting. The aim of this study was to evaluate the effects of KD on fatigue and other frequently associated symptoms in a carefully selected group of patients with MS. Methods: We conducted a single-arm open-label interventional study on a strictly selected group of 16 non-obese patients with multiple sclerosis who were prescribed KD for three months. Fatigue, sleep quality, daytime somnolence, mood, and quality of life were assessed at baseline (T0), 1 month (T1), and 3 months (T3) using validated scales. Results: With respect to baseline, at 3 months we observed a significant reduction in Fatigue Severity Scale (5.18 ± 1.02 vs. 4.16 ± 0.98; p = 0.042), Epworth Sleepiness Scale (8.46 ± 3.05 vs. 5.64 ± 2.46; p < 0.001), Pittsburgh Sleep Quality Index (5.64 ± 3.53 vs. 7.62 ± 2.59; p = 0.009), Depression Anxiety Stress Scales-21 depression (3.18 ± 2.93 vs. 6.15 ± 3.81; p = 0.036) and anxiety (5.15 ± 4.10 vs. 1.55 ± 1.92; p = 0.019) sub-scales, and an improvement in energy sub-scale of multiple sclerosis Quality of Life-54 (52.49 ± 12.83 vs. 37.43 ± 14.26; p = 0.042). Conclusions: These findings suggest that KD might be useful for the treatment of fatigue, and they raise interest in the use of KD in the treatment of other symptoms frequently encountered in multiple sclerosis. Larger randomized controlled studies are needed to confirm these preliminary results. Full article