Sleep Medicine

Fixed-pressure CPAP yields more favorable ambulatory blood pressure than auto-CPAP in hypertensive severe OSA

In this double-blind randomized crossover trial, 46 hypertensive patients with severe OSA received both fixed-pressure PAP and auto-CPAP for 4 weeks each. Among 30 completers, fixed-pressure PAP had a higher probability of lowering 24‑hour systolic blood pressure versus auto-CPAP, with a posterior median effect around −4 mmHg. Nighttime systolic blood pressure differences favored fixed-pressure PAP more strongly, and nocturnal diastolic dipping was more likely with fixed-pressure therapy. Adherence, patient satisfaction, and baseline characteristics were similar, despite higher delivered pressures with fixed-pressure PAP. Findings suggest manually titrated fixed-pressure PAP may offer superior blood pressure control compared with auto-CPAP in hypertensive OSA. 1

Atomoxetine plus oxybutynin modestly lowers AHI, with larger benefits in specific OSA endotypes

This 1‑month crossover trial randomized 58 adults with moderate‑to‑severe OSA to atomoxetine–oxybutynin versus placebo. Combination therapy produced a statistically significant but modest additional AHI reduction versus placebo when expressed as percent change from baseline. Patients with a higher arousal threshold showed substantially greater AHI improvement than those with a low arousal threshold. Point estimates suggested better responses in those with milder collapsibility and lower muscle effectiveness, though these modifiers were less definitive. Results support trait-targeted pharmacotherapy, where detailed physiologic phenotyping may identify OSA subgroups with clinically meaningful benefit. 2

Network meta-analysis links certain hypnotic regimens to impaired morning and nocturnal balance

This network meta-analysis synthesized 23 randomized trials examining hypnotics’ effects on postural stability upon awakening. Most in-label hypnotic doses showed no significant morning balance impairment compared with placebo. Zopiclone 7.5 mg impaired static and dynamic balance, especially with middle-of-the-night dosing, with large standardized mean differences. Zolpidem 6.5 mg extended-release worsened balance in older adults and with middle-of-the-night assessments; zolpidem 10 mg also impaired nocturnal postural control. Evidence quality was generally low, but results support preferring lower doses and shorter half-life agents in high fall-risk patients. 3

International roadmap redefines PLMS as heterogeneous motor activity requiring standardized measurement and outcomes research

An international multidisciplinary taskforce developed a consensus roadmap on periodic leg movements during sleep across five key domains. The group emphasizes PLMS as a spectrum of sleep-related motor activity with diverse neurophysiologic substrates, not merely a polysomnographic index. They highlight major gaps in understanding clinical significance, optimal scoring methods, treatment effects, and lifespan epidemiology. Priorities include harmonized scoring standards, validated automated and wearable detection tools, and large longitudinal, outcome-focused studies. The roadmap is intended to guide research and innovation rather than function as a clinical practice guideline. 4