Ambra Stefani

Editorial: Understanding conscious experiences during sleep

Adriana Michalak, Claudia Picard-Deland, Giulio Bernardi, Mohamed S. Ameen

Vestibular dysfunction in patients with obstructive sleep apnea: from physiopathology to treatment

Marrakchi Jihène, Jouini Selima, Sifaoui Aymen, Driss Melek

Sleep disorders include a wide variety of conditions that can have serious consequences on general health. The most common sleep problem related to breathing is obstructive sleep apnea (OSA). The Ear, Nose, and Throat (ENT) manifestations of this pathology are numerous including balance disorders. Understanding the impact of OSA on the vestibular function in Meniere's disease, vestibular migraine, and benign paroxysmal positional vertigo ensure a systematic screening and an appropriate care.

Correction: Seafarer Fatigue: a qualitative study of customer-facing staff working on UK ferries

Frontiers Production Office

Homeopathy for the treatment of insomnia: a systematic review and meta-analysis

Abhijit Dutta, Dewan Md. Sumsuzzman, Daniel Wrzałko, Robbert van Haselen, Petra Weiermayer, Katharina Gaertner, J. A. D. S Lakshani, Sabine Klein, Stephan Baumgartner, Martin Loef

Insomnia is a prevalent disorder associated with substantial impairment. Homeopathy has been proposed as a complementary treatment for insomnia, but its clinical effects remain uncertain. This systematic review assessed the efficacy, effectiveness, and safety of homeopathic treatments for insomnia. Prospective comparative studies evaluating any homeopathic preparation for insomnia were included. Searches in MEDLINE, EMBASE, seven additional databases, and three trial registries were conducted through August 2025. Risk of bias, intervention complexity, model validity, and pragmatism were assessed using respectively RoB 2, ROBINS-I, iCAT, MVHT, and RITES. Data were synthesized using random-effects meta-analyses, and certainty of evidence was evaluated using GRADE. Eight randomized controlled trials (RCTs; n = 364 participants) and four non-randomized studies on interventions (NRSIs; n = 517) met the inclusion criteria. In adults, sleep quality (MD = −2.6 points; 95% CI −5.5 to 0.26; low certainty) and insomnia severity (MD = −3.2; 95% CI −5.68 to −0.72, moderate certainty) were reported in one RCT each. For total sleep time, the pooled MD of three RCTs was 0.65 hours (95% CI −0.9 to 2.2; low certainty). In children, one open-label RCT suggested a difference in insomnia severity, but certainty of evidence was very low. Adverse events were rarely reported, resulting in low certainty evidence. The current evidence is mainly limited by imprecision and risk of bias. The available evidence does not allow firm conclusions regarding the effects of homeopathy for insomnia. High-quality, replicated trials with systematic adverse-event monitoring are needed.

Chronic pain in narcolepsy reflects interacting neurobiological and psychological mechanisms: a mini-review

Maria Munch-Menzer, Birgitte Rahbek Kornum

Chronic pain prevalence is increased in the sleep disorder narcolepsy, but the underlying reason for this remains debated. This mini review summarizes and discusses current evidence on links between narcolepsy type 1 (NT1) and type 2 (NT2) and chronic pain, exploring whether pain is best understood as a consequence of the pathophysiology or secondary to its manifestations and comorbidities. Registry-based and self-reported data indicate a high prevalence of chronic pain in NT1, while objective pain tests show inconsistent differences between NT1 and healthy individuals. This discrepancy suggests involvement of secondary mechanisms not readily captured by experimental pain testing. Comparable pain prevalence in NT1 and NT2 also speaks against orexin deficiency as a sole driver of chronic pain in NT1. Alternatively, altered dopaminergic signaling downstream of orexin could be a shared contributor to pain in NT1 and other fatigue-related conditions. Finally, the presence of activating autoantibodies in NT1 suggests a possible immune-mediated component for some patients. Overall, chronic pain is highly prevalent in both NT1 and NT2. It likely arises from a combination of neurobiological and psychological factors, with immune mechanisms as a possible additional contributor, rather than, in NT1, orexin dysfunction alone. This perspective highlights the clinical need for more holistic treatment approaches and for future studies with improved case-control matching, larger NT1 samples, especially among patients with chronic pain, and more detailed comparisons with NT2.