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NeurologyLive® Year in Review 2022: Top Stories in Sleep Disorders - Neurology Live

In 2022, the NeurologyLive^® staff was a busy bunch, covering clinical news and data readouts from around the world across a number of key neurology subspecialty areas. From major study publications and FDA decisions to societal conference sessions and expert interviews, the team spent all year bringing the latest information to the website's front page.

Among our key focus areas is sleep disorders. Sleep medicine specialists experienced a number of FDA decisions in the past 12 months, among other progress in the existing knowledge of sleep pathology. Although major news items often appear among the top pieces our team produces, sometimes smaller stories reach those heights for other reasons—clinical impact and interest, or concerns about the small- or big-picture parts of care, for example. Whatever the reason for the attention these stories got, their place here helps provide an understanding of the themes in this field over the course of 2022.

Here, we'll highlight some of the most-read content on NeurologyLive^® this year. Click the buttons to read further into these stories.

1. Insomnia-Related Symptoms Possibly Linked to Frequency of Alcohol and Cannabis Use in Late Adolescence

In a recent longitudinal latent class analysis study conducted by Wendy Troxel, PhD, and colleagues, of 2995 late-growing adolescents, consistently poor sleep health was associated with higher levels of alcohol and cannabis use, as well as higher health consequences from substance use. The data were published in Addiction Behaviors.

2. Severe COVID-19 Could Potentially Lead to Obstructive Sleep Apnea

In an analysis done by Xiang Gao, MD, et al published in Sleep Medicine, data showed a relationship between severe COVID-19 and obstructive sleep apnea, marking this as the first study that clarifies the relationship between OSA and the risk of COVID-19 using a bidirectional, 2-sample Mendelian randomization analysis, providing a better understanding of OSA and COVID-19.

3. Presence of Insomnia Symptoms Associated With Alcohol-Related Harm

New data from a survey study of 461 college students showed that symptoms of insomnia were associated with alcohol-related harm, with the associations between drinking and acute physiological consequences from the alcohol’s effects possibly buffered by the presence of insomnia symptoms, according to Angelo M. DiBello, PhD, and colleagues, who published the findings in Addiction Behaviors.

4. Jazz Acquires Narcolepsy Hopeful DSP-0187 in Agreement With Sumitomo Pharma

According to an announcement in late spring, Jazz Pharmaceuticals and Sumitomo Pharma entered into an agreement to codevelop and cocommercialize Sumitomo’s investigational sleep disorder treatment, DSP-0187, which will be referred to as JZP441 by Jazz. The treatment has shown potential application as a therapy for narcolepsy, as well as idiopathic hypersomnia and other sleep disorders, and is initially expected to be evaluated in narcolepsy.

5. FDA Approves Daridorexant for Insomnia Treatment

In January, the FDA approved Idorsia’s daridorexant, a dual orexin receptor antagonist, for the treatment of insomnia in adults, to be marketed under the name Quviviq. The medication, which was recommended as a controlled substance by the FDA, became available in May 2022 following scheduling by the US Drug Enforcement Administration.

6. Improvements in Treating Narcolepsy, Idiopathic Hypersomnia Through Xywav

To learn more about findings presented at SLEEP 2022, as well as some of the therapeutic advantages JZP-258 brings to sleep disorders, Richard Bogan, MD, FCCP, FAASM, provided insight on the clinical management of both idiopathic hypersomnia and narcolepsy and the approach to treating them going forward.

7. FT218 Receives Tentative Approval for EDS, Cataplexy in Adults With Narcolepsy

This summer, the FDA granted tentative approval to Avadel Pharmaceuticals’ extended-release oral suspension formulation of sodium oxybate, marketed as Lumryz, for the treatment of excessive daytime sleepiness or cataplexy in adults with narcolepsy. Previously, the therapy was known as FT218.

8. IDSIQ Instrument Sensitive to Daytime Changes Experienced in Insomnia

Using a randomized, double-blind, placebo-controlled phase 3 trial (NCT03545191) of daridorexant (Quviviq; Idorsia) in adults with insomnia, the incorporation of the Insomnia Daytime Symptoms and Impacts Questionnaire, a patient-reported outcome instrument, was found to be sensitive to changes in patients who experience daytime impacts of insomnia in data presented at SLEEP 2022 by Dalma S. Kinter, PhD.

9. Pediatric Sleep Disorders: Assessment and Treatment

Yolanda A. Yu, DO, and Alon Y. Avidan, MD, MPH, provide an in-depth overview of the long-term consequences of untreated—and prevalent—sleep disorders in children and adolescents and explain how they point to a need to focus on this field of care. In this review, they discuss common pediatric sleep disorders and provide epidemiology background, clinical presentation, diagnostic evaluation, and management opportunities.

10. Pitolisant to be Evaluated in Idiopathic Hypersomnia Phase 3 Study

A newly initiated phase 3 study, dubbed INTUNE (NCT05156047), will evaluate the efficacy and safety of pitolisant (Wakix) in patients with idiopathic hypersomnia, a condition that currently has only 1 FDA-approved medication, Harmony Biosciences announced this past spring. Pitolisant, a selective histamine 3 receptor antagonist/inverse agonist, is already FDA-approved to treat excessive daytime sleepiness and cataplexy in adults with narcolepsy.

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The future of COVID-19: What we learned in 2022 and what we can expect in the new year - Denver 7 Colorado News

DENVER — Another year is putting us further from the start of the COVID-19 pandemic, as 2022 provided additional solutions. Chief medical officer Dr. Jaya Kumar at Denver's Swedish Medical Center has been at the forefront of this virus since its inception.

"We've seen an evolution, not just in the virus itself, but in the way we think of COVID-19 as an illness and the way we treat it, the way we diagnose it and how we look forward to the new year," Kumar said. "Now we have rapid sequencing of viral genomes. So any virus you see, you could sequence it, duplicate it, make a treatment or a vaccine against it; that is huge."

She points to some of the biggest advances made in 2022.

"We saw a new antiretroviral drug come in like paxlovid, which is a pill which you can give as an outpatient," Kumar said.

That is something Dr. Scott Joy, the chief medical officer of HealthOne's Physician Services Group, says has kept patients out of the hospital.

"On a weekly basis, we're doing, myself personally, about six to 10 prescriptions of paxlovid a week, and I have yet to see a patient whose been admitted really in the last six months of 2022," Joy said.

The last year has also expanded experts' knowledge.

"So, for example, so we are seeing an RSV or Flu serge. Things have become like a piece of cake for us. We know what to do," Kumar said. "And we had our surge protocol ready in 30 minutes while this would have taken us hours and hours of hard work two years ago."

However, while these successes are worth celebrating, both doctors say it's essential to acknowledge the hurdles.

"I think one of the challenges moving forward after the pandemic is patients' trust in the vaccines," Joy said. "I'm just a little concerned that vaccines are the tip of the iceberg and are going to start getting questions about data around cancer screenings and questioning about cholesterol medicines to reduce risk of heart attack and stroke and I think we've opened up a little bit of a pandora's box."

Health care staffing has become an issue too.

"I think the biggest challenge we have moving forward is really the workforce. I think that's going to be a big challenge for us in the next year or two," Joy said.

These experts emphasize that people are still not caught up on necessary medical exams and screenings, which could lead to more significant health complications.

"I do think we've held back, and we are still seeing people come in with advance stages of illnesses. We still see people in the hospitals who have postponed medical care," Kumar said. "I think we need to do a lot of catching up in the next few years."

We must pinpoint where we currently stand with COVID-19 to understand what is next.

"The concept of never getting COVID is something that we need to get over," Joy said.

"We could potentially enter into an endemic stage, but that'll take some time. An endemic stage is where you see predictable surges like flu," Kumar said. "But for now, I think people still need to be on their watch and make sure you are getting your vaccines."

The years to come will allow us to be more informed on the effects of the COVID-19 virus.

"We're still in the infancy stages of this pandemic. Although it seems like it's been years but long-term effects are still unknown," Kumar said. "So the next few years, we'll be building upon the technology, investing more in basic science research, and be better prepared for any more pandemics that we may see in the future."

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The Last Word: Can You Actually 'Boost' Your Immune System? - Everyday Health

The immune system is a network of cells, tissues, and organs that help your body fight infections, illnesses, and diseases. It works to recognize and protect against these foreign invaders that can make you sick.

When your immune system is functioning properly, it’s able to stop or fight off germs or foreign cells that can cause you harm, according to the Cleveland Clinic. So, it makes sense to want to know how to keep your immune system at peak function.

But is there anything you can do to boost your immune system, or is boosting the immune system just a concept created to market wellness products such as packaged foods, drinks, and supplements?

The Claim About Boosting Your Immune System

You’ve probably seen ads for things like supplements that claim the ingredients will boost your immune system. And in an atmosphere where we’ve seen multiple respiratory viruses (think COVID-19, RSV, and the flu) spreading at once, it can be tempting to buy into those types of claims — especially if the promise is you won’t get sick or you’ll recover from illness faster.

“The concept of boosting or strengthening the immune system is problematic because it highlights the idea that immunity is like a muscle we can strengthen and train with supplements,” says Christine Kingsley, advanced practice registered nurse and health and wellness director at the Lung Institute in Manchester, Connecticut.

The Scientific Research on Healthy Immune Systems

This belief that you can strengthen the immune system is a key reason people use nutritional supplements, according to research, but some marketing claims can be misleading.

“The immune system is a highly complex, tightly regulated system, so it’s challenging for a particular supplement or food to have a significant effect in ‘boosting’ the immune system,” says Megan Meyer, PhD, a science communications consultant based in Durham, North Carolina. She also explains that an overactive immune system shouldn’t be a goal.

Your immune system is made up of several different elements, and each plays a role in defending the body against harmful invaders that can make you ill or cause damage. According to the Cleveland Clinic, the main parts of the immune system include:

• White blood cells
• Lymph nodes
• Spleen
• Tonsils and adenoids
• Thymus
• Bone marrow
• Skin and mucus membranes
• Stomach and bowels

While you want this system to function well, you don’t necessarily need to “boost” it. And there isn’t really evidence to prove that certain actions or nutrients can boost the immune system. Kingsley says she prefers to use the term nurture the immune system, which is more in line with what we currently know about how nutrition and healthy habits impact the body’s various systems, including immunity.

The Centers for Disease Control and Prevention (CDC) and Cleveland Clinic recommend these tips to help immune system function:

The Top Nutrients for Immunity

“There are a few micro and macronutrients that can support immune health,” says Meyer.

Zinc is a nutrient found in the body that helps the immune system and metabolism function, according to Mayo Clinic. If you get enough zinc through your diet, you usually don’t need a supplement. But there is some research to suggest zinc supplements can be used to potentially prevent or decrease symptoms in a variety of health issues, including the common cold and pneumonia. Meyer recommends taking zinc supplements or using zinc lozenges at the first sign of a cold. As the National Center for Complementary and Integrative Health notes, avoid intranasal zinc, which is associated with loss of smell.

Vitamin D, which the body gets from food and direct sun exposure, also plays a role in immune system function. One study examined the potential benefits of vitamin D supplementation in U.S. veterans in reducing infection and mortality rates from COVID-19. Researchers found an association between vitamin D and reduced severity of infection and the spread of COVID-19. Study participants with low vitamin D levels had received a higher benefit from supplementation than those who had higher vitamin D levels before getting the supplement.

Omega-3 fatty acids, also known as healthy fats, are found in certain plants and fatty fish and are essential in helping the body’s cells function properly, according to Cleveland Clinic. Meyer says omega-3s may also be helpful for supporting immune health, and one review suggests omega-3 supplementation may reduce the risk COVID-19 infection and decrease the duration of symptoms.

Sleep, or lack of sleep, can also have an impact on immune function. Meyer says lack of sleep has been shown to decrease key immune cells and increase inflammation, leading to a higher risk for infection. Research supports this notion. So, if you’re not getting enough consistent quality sleep, aiming to improve sleep habits can help your body’s immune system function better.

The Final Word on Whether You Can Boost Your Immune System

Healthy habits for your body and mind, as well as certain nutrients, help your immune system do its work, but they don’t necessarily boost it — and that’s not a bad thing.

Giving your body the fuel it needs to maintain immune system function by meeting nutritional requirements should be the goal, says Kingsley. She notes that supplements are most helpful when there’s a vitamin deficiency because the body will discard excess vitamins and minerals as waste.

“The tried-and-true foods — think a variety of fruits and veggies, whole grains, lean protein, and unsaturated fats [and] oils — are going to be your best bet for keeping your immune system healthy,” says Meyer.

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Peel Public Health outlines 'preventive actions' for families over the winter break in new letter to parents - Caledon Enterprise

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Long COVID: Could mono virus or fat cells be playing roles? - CTV News

A British historian, an Italian archeologist and an American preschool teacher have never met in person, but they share a prominent pandemic bond.

Plagued by eerily similar symptoms, the three women are credited with describing, naming and helping bring long COVID into the public's consciousness in early 2020.

Rachel Pope, of Liverpool, took to Twitter in late March 2020 to describe her bedeviling symptoms, then unnamed, after a coronavirus infection. Elisa Perego in Italy first used the term "long COVID," in a May tweet that year. Amy Watson in Portland, Oregon, got inspiration in naming her Facebook support group from the trucker cap she'd been wearing, and "long hauler" soon became part of the pandemic lexicon.

Nearly three years into the pandemic, scientists are still trying to figure out why some people get long COVID and why a small portion -- including the three women -- have lasting symptoms.

Millions of people worldwide have had long COVID, reporting various symptoms including fatigue, lung problems, and brain fog and other neurological symptoms. Evidence suggests most recover substantially within a year, but recent data show that it has contributed to more than 3,500 U.S. deaths.

Here's some of the latest evidence:

WOMEN MORE AT RISK?

Many studies and anecdotal evidence suggest that women are more likely than men to develop long COVID.

There could be biological reasons.

Women's immune systems generally mount stronger reactions to viruses, bacteria, parasites and other germs, noted Sabra Klein, a Johns Hopkins professor who studies immunity.

Women are also much more likely than men to have autoimmune diseases, where the body mistakenly attacks its own healthy cells. Some scientists believe long COVID could result from an autoimmune response triggered by the virus.

Women's bodies also tend to have more fat tissue and emerging research suggests the coronavirus may hide in fat after infection. Scientists also are studying whether women's fluctuating hormone levels may increase the risks.

Another possible factor: Women are more likely than men to seek health care and often more attuned to changes in their bodies, Klein noted.

"I don't think we should ignore that," she said. Biology and behavior are probably both at play, Klein said.

It may thus be no coincidence that it was three women who helped shine the first light on long COVID.

Pope, 46, started chronicling what she was experiencing in March 2020: flu-like symptoms, then her lungs, heart and joints were affected. After a month she started having some "OK" days, but symptoms persisted.

She and some similarly ill colleagues connected with Perego on Twitter. "We started sort of coming together because it was literally the only place where we could do that," Pope said. "In 2020, we would joke that we'd get together for Christmas and have a party," Pope said. "Then obviously it went on, and I think we stopped joking."

Watson started her virtual long haulers group that April. The others soon learned of that nickname and embraced it.

MONO VIRUS

Several studies suggest the ubiquitous Epstein-Barr virus could play a role in some cases of long COVID.

Inflammation caused by coronavirus infection can activate herpes viruses, which remain in the body after causing an acute infection, said Dr. Timothy Henrich, a virus expert at the University of California, San Francisco.

Epstein-Barr virus is among the most common of these herpes viruses: An estimated 90% of the U.S. population has been infected with it. The virus can cause mononucleosis or symptoms that may be dismissed as a cold.

Henrich is among researchers who have found immune markers signaling Epstein-Barr reactivation in the blood of long COVID patients, particularly those with fatigue.

Not all long COVID patients have these markers. But it's possible that Epstein-Barr is causing symptoms in those who do, although scientists say more study is needed.

Some scientists also believe that Epstein-Barr triggers chronic fatigue syndrome, a condition that bears many similarities to long COVID, but that also is unproven.

OBESITY

Obesity is a risk factor for severe COVID-19 infections and scientists are trying to understand why.

Stanford University researchers are among those who have found evidence that the coronavirus can infect fat cells. In a recent study, they found the virus and signs of inflammation in fat tissue taken from people who had died from COVID.

Lab tests showed that the virus can reproduce in fat tissue. That raises the possibility that fat tissue could serve as a "reservoir," potentially fueling long COVID.

Could removing fat tissue treat or prevent some cases of long COVID? It's a tantalizing question, but the research is preliminary, said Dr. Catherine Blish, a Stanford infectious diseases professor and a senior author of the study.

Scientists at the University of Texas Southwestern Medical Center are studying leptin, a hormone produced by fat cells that can influence the body's immune response and promote inflammation.

They plan to study whether injections of a manufactured antibody could reduce leptin levels -- and in turn inflammation from coronavirus infections or long COVID.

"We have a good scientific basis together with some preliminary data to argue that we might be on the right track," said Dr. Philipp Scherer.

DURATION

It has been estimated that about 30% of people infected with the coronavirus will develop long COVID, based on data from earlier in the pandemic.

Most people who have lingering, recurrent or new symptoms after infection will recover after about three months. Among those with symptoms at three months, about 15% will continue to have symptoms for at least nine more months, according to a recent study in the Journal of the American Medical Association.

Figuring out who's at risk for years-long symptoms "is such a complicated question," said Dr. Lawrence Purpura, an infectious disease expert at Columbia University.

Those with severe infections seem to be more at risk for long COVID, although it can also affect people with mild infections. Those whose infections cause severe lung damage including scarring may experience breathlessness, coughing or fatigue for more than a year. And a smaller group of patients with mild initial COVID-19 infections may develop neurologic symptoms for more than a year, including chronic fatigue and brain fog, Purpura said.

"The majority of patients will eventually recover," he said. "It's important for people to know that."

It's small consolation for the three women who helped the world recognize long COVID.

Perego, 44, developed heart, lung and neurologic problems and remains seriously ill.

She knows that scientists have learned a lot in a short time, but she says "there is a gap" between long COVID research and medical care.

"We need to translate scientific knowledge into better treatment and policy," she said.

Watson, approaching 50, says she has "never had any kind of recovery." She has had severe migraines, plus digestive, nerve and foot problems. Recently she developed severe anemia.

She wishes the medical community had a more organized approach to treating long COVID. Doctors say not knowing the underlying cause or causes makes that difficult.

"I just want my life back," Watson said, "and it's not looking like that's all that possible."

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content

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