[Management of patients with insomnia and polymorbidity. A draft of the clinical guidelines]. / Vedenie patsientov s insomniei pri polimorbidnoi patologii. Proekt klinicheskikh rekomendatsii. Obshcherossiiskaya obshchestvennaya organizatsiya «Rossiiskoe obshchestvo somnologov¼.

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.

[VII All-Russian Scientific and Practical Conference «Clinical Somnology¼]. / VII Vserossiiskaya nauchno-prakticheskaya konferentsiya «Klinicheskaya somnologiya¼.

On November 17-18, 2023, the VII Scientific and Practical Conference "Clinical Somnology" was held in Moscow. The conference was organized by the all-Russian public organization "Russian Society of Somnologists" (ROS). The forum discussed the issues of diagnostics and treatment of sleep disorders, also presented the topics of fundamental research, discussed new ways of studying sleep and the prospects of development of somnology as a science. The conference was attended by more than 250 participants from 38 regions. Broadcasting of the sessions of the first day of the event was watched by more than 270 listeners. Within 2 days of the conference 14 symposiums were held and 52 reports were presented.

[Psychopathological syndromes with sleep disorders in patients with type 2 diabetes mellitus]. / Psikhopatologicheskie sindromy s rasstroistvami sna u patsientov s sakharnym diabetom 2-go tipa.

Sleep disorders are very common in patients with type 2 diabetes (T2DM) and psychiatric disorders. Sleep disturbances can be both an independent condition and are one of the symptoms in the structure of a psychopathological syndrome. The negative impact of sleep disorders and mental disorders on the course of T2DM is known from numerous publications. This article presents current information on the mutual influence of mental disorders and sleep disorders on the course and prognosis of T2DM.

[Sleep regulation as a complex process]. / Regulyatsiya sna kak kompleksnyi protsess.

A retrospective analysis of views on the regulation of the «sleep-wakefulness¼ cycle from the reticular theory of sleep to the Saper's model was carried out. A modified version of the Saper's trigger made it possible to use the results of a comparative analysis of drugs used in the treatment of sleep disorders to develop new, comprehensive, effective approaches to the pharmacotherapy of the most common sleep disorders. It seems that this approach will be useful in the development of effective pharmacotherapy for sleep disorders.

[Molecular and cellular mechanisms of restorative effects of sleep]. / Molekulyarnye i kletochnye mekhanizmy vosstanovitel'nykh effektov sna.

The review article enlightens contemporary concept about a role of sleep in cellular energy metabolism, neuroplasticity and glymphatic clearance of waste products. Many researches have demonstrated that prolonged wakefulness is an energetic and a neurophysiologic issue for the brain. The article provides description of biochemical processes that are responsive for energy restoration in sleep, particularly the role of ATP, adenosine and glycogen. Energy metabolism substrates depletion leads to endoplasmic reticulum stress and unfolded protein response. At the same time the conductance of synapses increases that worsens energetic problems. Level of the glymphatic clearance during wakefulness is substantially lower in comparison with sleep, and waste products are not removed fast enough.

[Management of patients with insomnia and polymorbidity: expert consensus]. / Vedenie patsientov s insomniei pri polimorbidnoi patologii: konsensus ekspertov.

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.

[The effectiveness of remote methods of cognitive behavioral therapy for chronic insomnia and the possibilities of combined interventions]. / Effektivnost' distantsionnykh metodov kognitivno-povedencheskoi terapii khronicheskoi insomnii i vozmozhnosti primeneniya kombinirovannykh podkhodov.

Chronic insomnia is one of the most common sleep disorders in the world. The representation of chronic insomnia in the general population reaches 10-20% according to various sources. The most effective method of treating chronic insomnia with a sustained effect is cognitive behavioral therapy of insomnia (CBT-I). Among the disadvantages of CBT-I is its low availability (due to the lack of specialists) and high cost. Methods of delivered CBT-I are becoming increasingly relevant. The advantage of such type of CBT-I is the possibility of its use by a wide group of people. There are different ways of conducting delivered CBT, including those that do not require the direct participation of a specialist. The effectiveness of this method of treatment is comparable to full-time CBT-I.

[Periodic limb movements in sleep and cerebral small vessel disease progression: a prospective cohort study]. / Periodicheskie dvizheniya konechnostei vo sne i progressirovanie tserebral'noi mikroangiopatii: prospektivnoe kogortnoe issledovanie.

OBJECTIVE: To determine the predictive role of periodic limb movements in sleep (PLMS) in cerebral small vessel disease (cSVD) progression rate. MATERIAL AND METHODS: Fifty patients with cSVD, aged 60-75 y.o., were enrolled. The study protocol included MRI assessment of white matter hyperintensities (WMH), nocturnal actigraphy and cognitive assessment. Depending on the PLMS, the main (PLM index ≥15) and the control (PLM index <15) groups were formed. The second visit was carried out in one year follow-up period, the examination consisted of brain MRI and cognitive assessment under the same protocol. ANCOVA was performed to determine if PLMS influence the degree of MRI- and neuropsychological changes. RESULTS: A significant effect of PLMS on the increase in the volume of WMH was revealed, both in the form of an increase in the index by more than 15 movements per hour (p=0.03), and quantitatively in the form of a connection with the index value (p=0.048). The influence of PLMS on the progression of cognitive dysfunction has not been found, however, it has been shown that the presence of PLMS is associated with lesions in the deep white matter (r=0.42, p<0.0001), and the results of neuropsychological tests are associated with lesions in the periventricular and juxtacortical WMH (p < 0.05 for each test). CONCLUSION: PLMS predict WMH progression in cSVD.

Sleep Disorders in Post-COVID Syndrome: A Psychiatric or Neurological Problem?

The coronavirus pandemic that began in 2019 continues. COVID-19 adversely affects human health not only in the acute, but also in the long-term period of the disease: in a large percentage of cases, health is not fully restored after long periods, requires medical intervention, and is often difficult to correct. Researchers noted during the first wave of the pandemic in 2020 that about 10-20% of patients did not fully recover by three weeks from disease onset and the possible duration of the recovery period remains insufficiently clear, as do the reasons for differences in course during this period. Prolonged recovery after viral infection is not a feature exclusive to COVID-19, which does not facilitate the management of patients with post-COVID syndrome (PCS). The mental health impact of COVID-19 is significant, with at least 30% of recovered patients likely to have symptoms of anxiety and/or depression after the acute phase has passed. Since the onset of COVID-19, there has been an increase in sleep disorders by 42%, with every third COVID-19 survivor reporting sleep complaints. In PCS, this condition is referred to as coronasomnia. The success of therapy for this condition depends on identifying and correcting patients' mental disorders, as anxiety and depression are often accompanied by sleep disorders this results in a bidirectional interaction between mental disorders and sleep quality. This article presents data on the anti-anxiety drugs Noofen and Adaptol, which help to correct the manifestations of PCS with sleep disorders.

[Clinical phenomenology and pathophysiology of daytime and nighttime imperative movements]. / Klinicheskaya fenomenologiya i patofiziologicheskie mekhanizmy dnevnykh i nochnykh imperativnykh dvizhenii.

Imperative movements have an intermediate position between voluntary and involuntary movements and are also referred to as semi-voluntary, or induced. Their common characteristic is the urge, forcing the patient to perform an action that can have a different duration and degree of complexity - from a short twitch (with tics) to prolonged episodes of general motor restlessness (for example, akathisia or stereotypes). The ability to slow down this movement for a short or longer period of time by volitional effort is associated with the urge to make a movement, which predetermines the patient's perception of the degree of its imperativeness and arbitrariness. All motor syndromes based on an imperative need to make movements (akathisia, tics, restless legs syndrome, some levodopa-induced dyskinesias, tardive dyskinesia, compulsive disorders, stereotypes), despite their differences, can be conditionally combined by the term «akathisia spectrum disorders¼. In some cases, violent imperative movements are paradoxically combined with hypokinetic disorders, primarily with parkinsonism, which makes the discomfort experienced by patients particularly severe.

[Biologically active molecules and sleep]. / Biologicheski aktivnye veshchestva i son.

At present, the problem of the impact of dietary characteristics on the quality of human sleep is most acute, since it is necessary to have a sufficient level of wakefulness, which is provided by a full-length sleep, for harmonious interaction with the outside world in an urbanized society. Also, the quality of sleep is important factor too, because if the sleep is fragmented, then no matter how long it is - it will not give enough energy. For the quality of sleep, an important role is played not only by the sleep hygiene that a person adheres to, but also by the characteristics of the diet, which can affect the representation of certain phases and stages of sleep. The purpose of this review is to discuss the data of the most significant studies of the influence of dietary supplements on the quality and duration of sleep.

[Sleep disorders in post-COVID syndrome - a problem of psychiatry or neurology?] / Rasstroistva sna pri postkovidnom sindrome ­ problema psikhiatrii ili nevrologii?

The pandemic of coronavirus infection, which has begun in 2019, has not ended to this day. COVID-19 adversely affects human health not only in the acute period of the disease, but also in the long-run: in a large percentage of cases, recovery takes very long, patients require and often have problems returning to their baseline. During the first wave of the pandemic in 2020, researchers noted that about 10-20% of patients didn't fully recover three weeks after the onset of the disease. It is still not clear how long the recovery period can last, and what are the reasons of different time course of the recovery. Long-term recovery after a viral infection is a non-unique feature of COVID-19, which does not facilitate the management of patients with post-COVID syndrome. The impact on mental health after COVID-19 is significant, and at least 30% of those, who have been ill, may have symptoms of anxiety and/or depression after the acute phase of the disease. Since the emergence of the SARS-CoV-2 virus, there has been an increase in somnological disorders by 42%, while every third COVID-19 patient reports altered sleep patterns. In post-COVID-19 syndrome, this condition is referred to as Coronasomnia (COVID-somnia). The success of therapy of this condition depends on reporting and treating mental disorders in patients, as anxiety and depression are often accompanied by sleep disorders, that is, there is a bidirectional influence of mental disorders on the quality of sleep. The article provides data on two anti-anxiety drugs (noofen and adaptol) that help to treat the manifestations of post-COVID syndrome accompanied by sleep disorders.

[VI Conference of the Russian Society of Somnologists]. / VI konferentsiya Rossiiskogo obshchestva somnologov.

VI Conference of the Russian Society of Somnologists.

[Diagnosis and correction of the obstructive sleep apnea syndrome in children with tonsillar ring pathological conditions]. / Diagnostika i korrektsiya sindroma obstruktivnogo apnoe sna u detei s patologiei limfoglotochnogo kol'tsa.

OBJECTIVE: To summarize the results of a study of the clinical and polygrapic features of sleep in children with pathologic conditions of the tonsillar ring and obstructive sleep apnea. Tonsillar hypertrophy is the most common cause of obstructive sleep apnea in children. Using the data of overnight polysomnographic study and/or nocturnal pulse oximetry, groups of patients were distinguished depending on the presence and severity of their sleep breathing disorders. The effectiveness of adenotomy, adenotonsillotomy and/or adenotonsillectomy in children is demonstrated, depending on the severity of obstructive sleep apnea syndrome. Evaluation of breathing in sleeping children by polygraphic methods is necessary for early detection of obstructive sleep apnea syndrome and monitoring the effectiveness of surgical treatment.

[Exploding head syndrome]. / Sindrom vzryvayushcheisya golovy.

Exploding head syndrome (EHS) is a paroxysmal sensory parasomnia characterized by the sensation of a loud noise or «explosion in the head¼ during the wake-sleep/sleep-wake cycle. The most popular explanation for this condition is the decrease of reticular formation activity during the transition between wakefulness and sleep. The authors present a review of literature on the diagnosis and treatment of EHS and clinical observations of patients with classical signs.

Sleep and Immunity.

This review presents data on changes in measures of innate and adaptive immunity associated with the state of sleep. The effects of restricted and prolonged sleep duration on measures of morbidity, mortality, and susceptibility to infectious diseases and the effects of vaccination are discussed. Measures of immunity in patients with insomnia and changes on the background of correction of sleep impairments are presented.

[Vaccination and sleep]. / Vaktsinatsiya i son.

The current worldwide pandemic of a new coronavirus infection has posed new challenges for medicine and the human community. In particular, the issue of widespread mass vaccination and improving its effectiveness has become acute. In this regard, the contribution of sleep to innate and acquired immunity has attracted the attention of researchers. It has been shown that lack of sleep significantly increases the risk of adenovirus infection in healthy young people. For example, people who slept 5-6 hours were 4 times more likely to have a viral infection compared to those who slept 7 hours or more. Several studies have examined the effect of partial sleep deprivation on vaccine effectiveness. Subjects who adhered to a normal, 7-8-hour sleep schedule had a 2.5-fold higher antibody titer for the H1N1 influenza virus than those who slept 4 hours. Studies using polysomnography demonstrated that lack of sleep at night immediately after immunization against hepatitis A virus reduced both humoral and cellular immunity. Consequently, the need to improve sleep quality in the general population also has an epidemiological rationale.

[On the question of a primary and secondary origin of insomnia]. / K voprosu o pervichnosti i vtorichnosti insomnicheskikh rasstroistv.

Approximately 30% insomnia patients have associated somatic, neurological and psychiatric conditions. Clinician has to define causality of these conditions to determine a treatment plan. Secondary insomnia can result from the symptoms of a primary condition or form an impairment of central nervous system due to neurological disorder. Some associated conditions are characterized by high coincidence with insomnia, similar triggers and crossing genotype, neurophysiological and functional findings. This association with insomnia is observed in anxiety disorders, depression, chronic pain syndromes. The paper presents a concept of comorbid insomnia disorder which proposes the existence of a common neural structure which when affected causes the symptoms of both insomnia and comorbid disorder. Comorbid disorders can also be interconnected due to the overlap of the responsible nerve centers. Positive effect of specific pharmacological, psychotherapeutical and behavioral treatment on both conditions evidences this concept.

[The use of psychotropic medications for chronic insomnia in clinical practice]. / Primenenie psikhotropnykh preparatov pri khronicheskoi insomnii v klinicheskoi praktike.

Chronic insomnia is a common sleep disorder. In its treatment, both non-drug and drug approaches are used. The therapeutic concept is based on a three-component model of sleep regulation. Psychotropic drugs of various pharmacological groups are used for the treatment of chronic insomnia. The peculiarities of the effect of these drugs in various clinical situations are discussed.

[Periodic limb movements in sleep and clinicomorphological features of cerebral small vessel disease]. / Periodicheskie dvizheniya konechnostei vo sne i kliniko-morfologicheskie proyavleniya tserebral'noi mikroangiopatii.

OBJECTIVE: To search for the association between white matter deterioration extend as well as related cognitive dysfunction and periodic limb movements in sleep (PLMS) in patients with cerebral small vessel disease (cSVD). MATERIAL AND METHODS: Thirty-four subjects with cSVD were enrolled (12 men, 22 women, average age 66.9 y.o.). The study protocol includes nocturnal actigraphy, cardiorespiratory monitoring, cognitive assessment and brain MRI. Two groups were formed depending on PLMS index. The patients of the main group had PLMS index equal or more than 15 movements per hour, and the controls had PLMS index less than 15. RESULTS AND CONCLUSION: The significant differences between groups are shown in the executive functioning (p=0.0025 for the Frontal Assessment battery, p=0.036 for TMT-B, p=0.009 for TMT-A) and in the volume of juxtacortical white matter hyperintensities (WMH) (p=0.009). The positive correlation of PLMS features with total and periventricular volume of WMH and the negative correlation of PLMS features with cognitive performance are found as well.