Current evidence suggests that iron deficiency (ID) plays a key role in the pathogenesis of conditions presenting with restlessness such as attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS). In clinical practice, ID and iron supplementation are not routinely considered in the diagnostic work-up and/or as a treatment option in such conditions. Therefore, we conducted a scoping literature review of ID guidelines. Of the 58 guidelines included, only 9 included RLS, and 3 included ADHD. Ferritin was the most frequently cited biomarker, though cutoff values varied between guidelines and depending on additional factors such as age, sex, and comorbidities. Recommendations surrounding measurable iron biomarkers and cutoff values varied between guidelines; moreover, despite capturing the role of inflammation as a concept, most guidelines often did not include recommendations for how to assess this. This lack of harmonization on the interpretation of iron and inflammation biomarkers raises questions about the applicability of current guidelines in clinical practice. Further, the majority of ID guidelines in this review did not include the ID-associated disorders, ADHD and RLS. As ID can be associated with altered movement patterns, a novel consensus is needed for investigating and interpreting iron status in the context of different clinical phenotypes.

Insomnia is a serious and widespread public health problem, but is often undetected and patients do not receive needed treatment. Insomnia is often comorbid with other diseases and conditions, such as arterial hypertension, type 2 diabetes mellitus, pain syndromes, anxiety and depressive disorders, etc. A separate problem is drug-induced insomnia, when patients develop symptoms due to other diseases treatments. Insomnia has a negative effect on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and decreased quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so clinical guidelines draft for the evaluation and treatment of insomnia in multimorbid patients is proposed. Diagnostic methods are reviewed and recommendations are given for the treatment of acute and chronic insomnia and features of the treatment of insomnia in multimorbid patients. A clinical algorithm has been proposed to determine treatment tactics in multimorbid patients.
Инсомния является серьезной и широко распространенной проблемой общественного здравоохранения, но часто остается невыявленной, и пациенты не получают необходимого лечения. Инсомния часто коморбидна с артериальной гипертензией, сахарным диабетом 2-го типа, болевыми синдромами, тревожными и депрессивными расстройствами и др. Отдельной проблемой остается развитие инсомнии на фоне приема лекарственных препаратов по поводу других заболеваний. Инсомния оказывает неблагоприятное влияние на прогноз коморбидных заболеваний, включая повышение риска смерти, более тяжелое течение заболеваний и снижение качества жизни. Наличие расстройств сна затрудняет эффективное лечение основного заболевания, поэтому предложен проект клинических рекомендаций по диагностике и лечению инсомнии у полиморбидных пациентов. Рассмотрены современные методы диагностики и даны рекомендации по лечению острой и хронической инсомнии и особенности терапии инсомнии у полиморбидных пациентов. Предложен клинический алгоритм, позволяющий определить тактику лечения у полиморбидных пациентов.

BACKGROUND: Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users.
METHODS: A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies.
RESULTS: A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs.
CONCLUSIONS: The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.

BACKGROUND: Sleep bruxism (SB) and obstructive sleep apnea syndrome (OSAS) are two sleep-related conditions that have been associated with significantly conflicting results in literature. Understanding the prevalence of bruxism among OSA patients is crucial for identifying possible comorbidities and optimising treatment strategies.
OBJECTIVE: This systematic review aimed at analysing the prevalence of SB in OSAS sufferers and understanding the association between the two.
METHODS: Five online databases were searched for relevant articles in accordance with the PRISMA guidelines for conduction of systematic reviews. Studies reporting the prevalence of bruxism in OSAS patients and diagnosed through clinical assessments or polysomnography were included. Data extraction and quality assessment were performed independently by two reviewers. Methodological quality of the included studies was assessed using Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I).
RESULTS: A thorough search of literature yielded only two studies were eligible for this review. SB was found to be significantly present in the OSAS group. Despite methodological variations, the majority of studies reported higher rates of bruxism in OSAS patients compared to the general population or control groups.
CONCLUSIONS: The results of this systematic review point to a significant association between bruxism and obstructive sleep apnea. Further research is required to determine a more precise prevalence rate and investigate the potential therapeutic implications of the bruxism-OSAS association that uses a standardised assessment techniques and larger sample sizes.

Sleep disorders are becoming increasingly important due to the high comorbidity with other diseases and a significant impact on the patient\'s quality of life. Insomnia is the most common sleep disorder both in the general population and in patients with multimorbid pathology. Its prevalence in the general population is 6-15%, while in patients with somatic diseases it increases up to 20-40% and can reach 90% in patients with comorbid mental disorders. Another problem is the development of drug-induced insomnia. Insomnia has negative impact on the prognosis of comorbid diseases, including an increased risk of death, more severe disease, and a worse quality of life. The presence of sleep disorders makes it difficult to effectively treat the underlying disease, so it is extremely important to identify and correct these disorders in the early stages, therefore recommendations for the diagnosis of insomnia in polymorbid patients are proposed. Modern methods of treating acute and chronic insomnia and features of insomnia treatment in polymorbid patients are also discussed.
Проблема нарушений сна приобретает все большую актуальность в связи с их широкой распространенностью и частой коморбидностью с другими расстройствами и существенным влиянием на качество жизни пациентов. Инсомния — самое частое расстройство сна как в общей популяции, так и у пациентов с полиморбидной патологией. Ее распространенность в общей популяции составляет 6—15%, в то время как у пациентов с соматическими заболеваниями возрастает до 20—40% и может достигать 90% у пациентов с сопутствующими психическими расстройствами. Отдельной проблемой является развитие инсомнии на фоне приема лекарственных препаратов по поводу других заболеваний. Инсомния оказывает неблагоприятное влияние на прогноз коморбидных заболеваний, включая повышение риска смерти, более тяжелое течение заболеваний и снижение качества жизни. Наличие расстройств сна затрудняет эффективное лечение основного заболевания, поэтому крайне важно своевременно выявить и скорректировать эти нарушения, в связи с чем предложены рекомендации по диагностике инсомнии у полиморбидных пациентов. Также рассмотрены современные методы лечения острой и хронической инсомнии и особенности терапии инсомнии у полиморбидных пациентов.

Background: One in five individuals live with chronic pain globally, which often co-occurs with sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed with cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, and appropriate use of CBM for therapeutic purposes. Aims: We present these clinical practice guidelines to help clinicians and patients navigate appropriate CBM use in the management of chronic pain and co-occurring conditions. Materials and Methods: We conducted a systematic review of studies investigating the use of CBM for the treatment of chronic pain. Articles were dually reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical recommendations were developed based on available evidence from the review. Values and preferences and practical tips have also been provided to support clinical application. The GRADE system was used to rate the strength of recommendations and quality of evidence. Results: From our literature search, 70 articles met inclusion criteria and were utilized in guideline development, including 19 systematic reviews and 51 original research studies. Research typically demonstrates moderate benefit of CBM in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis. Conclusions: All patients considering CBM should be educated on risks and adverse events. Patients and clinicians should work collaboratively to identify appropriate dosing, titration, and administration routes for each individual. Systematic Review Registration: PROSPERO no. 135886.

Early onset sleep problems and disorders are very common in individuals with Phelan-McDermid Syndrome (PMS) with rates of up to 90%. These sleep problems and disorders cannot be taken lightly. Not only do they have a major impact on the health, behaviour, functioning and learning opportunities of affected individuals, they can also have detrimental effects on the well-being and resilience of parents and caregivers, ultimately affecting the physical health, mental health and well-being of the whole social system. In this review we aim to understand the types and frequencies of sleeping problems in PMS as the basis for recommendations on their management and treatment and to provide general guidelines for clinicians and practitioners. We conducted an in-depth literature search, summarised findings, and participated in a series of consensus meetings with other consortium members - experts on PMS and stakeholders - to agree on guidelines and recommendations. In parallel, a world-wide survey was created and distributed amongst parents to include their perspective. Our literature search found only four articles specifically focused on sleeping problems in PMS, although some other articles mentioned prevalence and associated factors. Country-specific prevalence rates ranged between 24% and 46%, whereas our parental survey reported 59%. The main problems reported involved difficulty falling asleep and numerous night awakenings, with being restless in sleep, night-time incontinence, and tooth grinding also commonly reported. Only a small number of individuals had undergone a sleep study monitored by a specialist. Bedtime resistance normally decreases with age, but sleep-onset delay, sleep anxiety, parasomnias, problems falling and remaining asleep remain throughout lifespan, with total sleep time improving during adulthood. However, this improvement was also accompanied by a substantial increase in parasomnias. Ultimately, an increase in sleep disorders in children correlates with increased sleep disorders and daytime sleepiness in parents/caregivers. No study to date has focused on the underlying causes of sleeping problems in PMS, but comorbid mental health conditions, somatic causes, or (poly)pharmacy have been proposed as triggers for sleeping disturbances. Currently there is no PMS-specific treatment for sleeping problems, and current recommendations are mostly based on individuals with intellectual disability and/or neurodevelopmental conditions.

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

BACKGROUND: Sleep disorders affect responsiveness to sensory information and can cause nocturnal polyuria and reduced sleep depth; hence, these are potentially influential in understanding the mechanism of nocturia.
OBJECTIVE: To report the systematic review (SR) and expert consensus for primary care management of nocturia in sleep disorders.
METHODS: Four databases were searched from January to April 2020. A total of 1658 titles and abstracts were screened, and 23 studies potentially applicable were included for full-text screening. The nominal group technique (NGT) was used to derive a consensus on recommendations for management using an expert panel with public involvement.
RESULTS: Thirteen studies met the SR inclusion criteria, all of which studied obstructive sleep apnoea (OSA), with ten evaluating the effect of continuous positive airway pressure. The NGT consensus discussed the assessment of OSA with other key sleep disorders, notably insomnia, restless legs syndrome/periodic limb movements of sleep, and parasomnias, including non-rapid eye movement (non-REM) parasomnias and REM sleep behaviour disorder (RBD). The NGT considered that the use of screening questions to reach a clinical diagnosis is a sufficient basis for offering conservative therapy within primary care. Reasons for referral to a sleep clinic are suspected sleep disorder with substantially impaired daytime function despite conservative treatment. Suspected RBD should be referred, and if confirmed, neurology opinion is indicated. Referrals should follow local guidelines. Persisting nocturia is not currently considered an indication for referral to a sleep clinic.
CONCLUSIONS: Sleep disorders are potentially highly influential in nocturia, but are often overlooked.
RESULTS: People with sleep disorders can experience nocturia due to easy waking or increased bladder filling. We looked at published research, and information was limited to one form of sleep disturbance-obstructive sleep apnoea. We assembled a group of experts, to develop practical approaches for assessing and treating nocturia in the potentially relevant sleep disorders.

The European guideline for the diagnosis and treatment of insomnia (1) was developed by a task force of the European Sleep Research Society, which was composed of 27 experts with clinical experience on insomnia management from different European countries and the European Insomnia Network. The guideline focused on insomnia disorder as defined by ICD-10/ICSD-3. Its starting point was the previously published guideline by the German Sleep Society, which was revised and expanded based on a review of relevant meta-analyses of insomnia therapies published through June 2016. The scope of this guideline was to provide recommendations on the treatment of chronic insomnia disorder. This guideline was selected for review by the World Sleep Society (WSS) Insomnia Task Force and the WSS International Sleep Medicine Guidelines Committee. A task force of content experts from the WSS has reviewed this guideline specifically for its relevance and applicability to the practice of sleep medicine by sleep specialists that comprise its membership.