The Expert Consensus on Intelligent Graded Diagnosis， Treatment， and Prognostic Assessment Criteria for Insomnia Disorder standardizes the main criteria for the diagnosis， treatment， and prognostic assessment of insomnia disorder associated with quality and safety management， including intelligent grading， as well as the principles of clinical data collection， diagnosis， assessment， grading and evaluation steps for insomnia disorders， treatment of insomnia disorders， data collection process and standardized operations， and the critical elements for data storage and management. Developed under the guidance of evidence-based medical methodology， this consensus was primarily formulated by neurology and psychiatry experts. Through systematic retrieval of clinical study data， evaluation of clinical evidence， and assessment of evidence quality， and the consensus was formulated after multiple rounds of discussions， in order to provide clinical guidance for the diagnosis， treatment， and prognostic evaluation of insomnia disorder.

Objective Sleep-related head jerks （SRHJ） are a newly recognized sleep-onset motor phenomenon that has not yet been incorporated into the ICSD-3 classification of sleep disorders， and this study aims to provide a descriptive analysis of the clinical and video polysomnography （VPSG） features of SRHJ patients. Methods A retrospective analysis was performed for the VPSG recordings collected over a 2-year period in Sleep Laboratory of Department of Neurology， Peking Union Medical College Hospital， and the patients with a neck myoclonus index of >15 events per hour during REM sleep were diagnosed with SRHJ. The clinical and VPSG features of these patients with SRHJ were analyzed， as well as the proportion of patients with SRHJ-related arousals and micro-arousals or comorbidity with other types of sleep disorders. Results There were eight patients in the SRHJ group， and the occurrence rate of SRHJ during REM sleep was 77%. The head jerk index ranged from 15 to 91.5 events/h during REM sleep and from 0.5 to 4 events/h during NREM sleep. The patients with SRHJ-related arousals and micro-arousals accounted for 44%， among whom 44% were comorbid with jerks involving other body parts （such as the upper limbs， the lower limbs， and the shoulders）. Comorbid sleep disorders included obstructive sleep apnea-hypopnea syndrome in two patients， REM sleep behavior disorder in two patients， narcolepsy in one patient， and propriospinal myoclonus in one patient. Conclusion SRHJ is a paroxysmal motor event mainly observed during REM sleep and often has a low frequency of attack， possibly due to physiological causes. However， frequent episodes may disrupt sleep stability. There are currently no diagnostic criteria for SRHJ， and its diagnosis should consider the frequency of attacks， the impact on sleep stability， and potential adverse consequences.

Objective Most patients with chronic insomnia depend on long-term medication， which may easily lead to a poor treatment outcome and adverse drug reactions， and transcranial alternating current stimulation （tACS）， as a noninvasive neuromodulation technique， can improve chronic insomnia. This study aims to investigate the clinical efficacy of tACS combined with pharmacotherapy in the treatment of chronic insomnia. Methods A total of 46 patients with chronic insomnia were enrolled and randomly divided into pharmacotherapy group with 20 patients and pharmacotherapy+tACS treatment group with 26 patients. The tACS electrodes were attached to the frontal region and the bilateral mastoids， with a frequency of 77.5 Hz and a current intensity of 15 mA， for 40 minutes each time， once a day for 10 consecutive days. The primary outcome measures were Pittsburgh Sleep Quality Index （PSQI） score and its improvement rate after 4 weeks， and the secondary outcome measures included the scores of Hamilton Depression Rating Scale （HAMD）， Hamilton Anxiety Rating Scale （HAMA）， Mini-Mental State Examination （MMSE）， and Montreal Cognitive Assessment （MoCA） and their improvement rates. Results Compared with the pharmacotherapy group， the pharmacotherapy+tACS treatment group had a significant reduction in PSQI score （P<0.05）， with an improvement rate of 37% and 21%， respectively， suggesting that the combined therapy had a better effect in improving sleep quality. The pharmacotherapy+tACS treatment group also had reductions in HAMA and HAMD scores， suggesting improvements in anxiety and depression symptoms， and there were no significant differences in MMSE and MoCA scores between the two groups. Conclusion Pharmacotherapy combined with tACS has a better effect than pharmacotherapy alone in improving sleep quality and anxiety and depression symptoms in patients with chronic insomnia， and therefore， it has good application prospects in clinical practice.

Narcolepsy （NP） is a rare nervous system disease with the typical symptoms of excessive daytime sleepiness， cataplexy， sleep paralysis， and hypnagogic hallucination. The pathophysiological mechanism of NP remains unclear， and it is currently believed that NP is an immune-related disease closely associated with HLA-DQB1*06∶02 genotype and it can be triggered by environmental factors such as infection and vaccination， while the precise neural pathways leading to degeneration/apoptosis of orexin neurons in the lateral hypothalamic area remain unknown. In recent years， an increasing number of evidence has revealed the association between sleep disturbance and gut microbiota， and in particular， the microbiota-gut-brain axis plays an important role in sleep regulation. This article systematically reviews the regulatory mechanism of gut microbiota in the central nervous system and discusses the potential interaction between gut microbiota and NP， in order to provide new perspectives for both mechanistic research and clinical management of NP.

Objective To investigate the causal association between sleep disorder-related phenotypes and cerebrovascular outcomes/complications using the two-sample Mendelian randomization （MR） method， and to determine causal orientation via directionality testing. Methods Genetic variations from genome-wide association studies were used as instrumental variables to analyze eight sleep-related phenotypes （continuous sleep， snoring， napping， insomnia， morning diurnal preference， daytime sleepiness， long sleep， and short sleep） against multiple cerebrovascular outcomes and complications （cerebral infarction， unruptured cerebral artery dissection， cerebral arteritis， cerebral amyloid angiopathy， unruptured cerebral aneurysm， cerebral atherosclerosis， intracerebral hemorrhage， vascular syndrome， and sequelae of cerebrovascular disease）. The inverse-variance weighted （IVW） method was used for primary analysis， with the assistance of the sensitivity methods such as MR-Egger， weighted median， simple mode， and weighted mode， and the Estimate value was used to characterized effect direction and magnitude， with statistical significance assessed by P value. The Steiger directionality test was used to compare the extent of variance explained by instrumental variables concerning exposure and outcome and confirm causal direction. Results The IVW analysis showed that snoring was associated with an increased risk of cerebral amyloid angiopathy （Estimate=8.08， 95% CI 1.93-14.23， P=0.01）， and long sleep duration was associated with an increased risk of cerebral atherosclerosis （Estimate=14.95， 95% CI 2.44-27.46， P=0.02）. Short sleep duration was associated with an increased risk of cerebral arteritis （Estimate=13.33， 95% CI 1.54-25.12， P=0.03）； however， inconsistent directions were observed across sensitivity methods （e.g.， MR-Egger）， and therefore， it was treated as suggestive evidence rather than a robust conclusion. The Steiger test showed R²_exposure>R²_outcome for most exposure-outcome pairs， and the key associations did not persist under reverse-direction analyses， supporting a forward causal pathway from sleep phenotypes to cerebrovascular outcomes and reducing the likelihood of reverse causation. Conclusion Genetic evidence supports a forward causal effect of sleep-related phenotypes on cerebrovascular outcomes and complications， with the most robust findings of “snoring increases the risk of cerebral amyloid angiopathy” and “long sleep duration increases the risk of cerebral atherosclerosis”. Identification and treatment of sleep-disordered breathing and avoidance of prolonged sleep may be used as potential targets for preventing cerebrovascular disease， and multi-ethnic prospective studies and interventional trials are needed to further validate these findings and clarify the underlying biological mechanisms.

This article reports the complete screening-diagnosis-rehabilitation process for an Air Force non-commissioned officer diagnosed with narcolepsy（NP） comorbid with obstructive sleep apnea （OSA） and REM sleep behavior disorder（RBD）.The patient attended the hospital due to uncontrollable daytime sleep for 3 years and one episode of cataplexy，and a confirmed diagnosis was made based on polysomnography， multiple sleep latency test （MSLT）， and imaging examination， with the exclusion of organic lesions. As for treatment， since the patient showed no response to venlafaxine alone， the treatment regimen was switched to a comprehensive regimen of behavioral interventions， traditional Chinese medicine syndrome differentiation， and pitolisant. Based on this case report and the literature review， it is proposed that the armed forces should introduce a modern diagnostic and therapeutic mode integrating routine screening （Epworth Sleepiness Scale and MSLT）， multidisciplinary dynamic assessment， and individualized comprehensive care， in order to provide evidence-based guidance for the early identification， diagnosis， and treatment of sleep disorders in military personnel.

Objective Narcolepsy type 1 （NT1） is known to be associated with low levels of hypocretin-1 （Hcrt-1） in cerebrospinal fluid （CSF）. The standard method for Hcrt-1 measurement is radioimmunoassay （RIA） with imported reagents， but this antibody-dependent method is limited to radiation safety-certified lab， gradual radioactivity degradation， and slow turn-around time. The purpose of this study is to explore a non-radioactive， faster， and antibody independent domestic method in China for Hcrt-1 detection. Methods Repeated testing of cerebrospinal fluid from 14 clinically diagnosed NT1 patients and 10 non-narcolepsy patients was performed using liquid chromatography-tandem mass spectrometry （LC-MS/MS）technology，including the establishment and optimization of fundamental methodological procedures. The main steps involved the addition of non-radioactive isotope-labeled internal standards to the cerebrospinal fluid， followed by solid-phase extraction， mass spectrometry signal acquisition， and quantitative analysis. The results were then compared with the corresponding radioimmunoassay（RIA） findings. Results The LC-MS/MS method showed faster speed， and good linearity across a wider range of synthesized standard（5~2 500 pg/ml）， and good repeatability. Although this absolute-quantitation-based LC-MS/MS method and RIA method have different reading values in Hcrt-1 quantitation， they both can segregate NT1 group from non-NT1 group well. Conclusion Although larger cohorts are needed to set up a standard method in China，LC-MS/MS method is proved to be an easier， safer， faster， and possibly more accurate method for Hcrt-1 quantitation and detection for NT1 diagnosis.

Objective To investigate the effect of Baduanjin on mood and sleep quality in patients with mild to moderate Parkinson disease （PD） and related mechanisms. Methods A total of 110 patients with Hoehn-Yahr stage 1-3 stable PD were randomly divided into Baduanjin group and control group， with 55 patients in each group. The patients in the Baduanjin group received Baduanjin exercise for 30 minutes each time， 5 days a week for 12 weeks， and those in the control group did not do any exercise. Motor function， anxiety and depression mood， and sleep quality were assessed before exercise and after exercise for 12 weeks. Results Compared with the control group， the Baduanjin group had significant improvements in UPDRS-Ⅲ score and 6-minute walk test results. There was a significant difference in Berg Balance Scale in terms of the interaction between time and intervention. There were significant differences between the two groups in HAMA14，HAMD24，and PSQI scores. Conclusions Baduanjin can improve mood and sleep quality in patients with mild to moderate PD.

Objective To investigate the association between obstructive sleep apnea hypopnea syndrome （OSAHS） and white matter lesions （WMLs）. Methods A total of 91 patients who attended Department of Neurology and Department of Epilepsy and Sleep Disorders in The Second Affiliated Hospital of Harbin Medical University from June 2019 to December 2020 and met the diagnostic criteria for WMLs were enrolled as WMLs group， and 61 patients without WMLs were enrolled as control group. All subjects underwent brain MRI and PSG examinations， and related data were collected， including demographic data， past history， personal history， laboratory examination， and imaging findings. Results The WMLs group had a prevalence rate of OSAHS of 92.3% and an AHI of （32.85±19.86） events/hour on PSG， which were significantly higher than those in the control group （P<0.05）. The Spearman rank correlation analysis showed a strong positive correlation between WMLs severity and OSAHS severity（r=0.602 52，P<0.0001）. Conclusion The WMLs group is more susceptible to OSAHS than the control group， and the severity of WMLs is positively correlated with the severity of OSAHS.

Rapid eye movement sleep behavior disorder（RBD）， as a sleep disorder with unique clinical manifestations， is currently widely regarded as a precursor marker for α-synucleinopathies （Parkinson disease， dementia with Lewy bodies， and multiple system atrophy）. In recent years， great achievements have been made in radiological studies on isolated RBD and RBD comorbid with various α-synucleinopathies. This article reviews the research findings in RBD in terms of magnetic resonance imaging and radionuclide imaging and discusses the significance of radiological features in the diagnosis and prognosis of RBD， so as to provide a reference for subsequent research and clinical practice.

Rapid eye movement sleep behavior disorder （RBD） is a type of parasomnia closely associated with neurodegenerative diseases related to α-synucleinopathies， such as Parkinson disease， dementia with Lewy bodies， and multiple system atrophy， and early diagnosis is of great importance for disease monitoring and intervention.At present， RBD is mainly diagnosed based on video polysomnography （v-PSG） and nocturnal abnormal behaviors， but the application of v-PSG is limited by its high technical demands.Various validated RBD-related scales have become essential tools for auxiliary diagnosis， which provides methods and tools for the diagnosis of RBD and the assessment of disease progression and outcomes.

Narcolepsy（NP） is a rare central sleep disorder， and it is categorized into narcolepsy type1 （NT1） and narcolepsy type2（NT2）.The main clinical symptoms of NP include daytime lethargy， cataplexy induced by emotions， and sleep paralysis， with a peak onset during adolescence （with an age of 8‒12 years）. At present， the pathogenesis of NP remains unclear and is associated with various factors such as human leucocyte antigen （HLA）， infection， and epigenetic silencing， and the selective loss of hypocretin neurons in the hypothalamus is the key pathophysiological mechanism of NP. Pharmacological intervention is currently the main treatment method， and diagnostic delay can be as long as more than 10 years， which not only affects the social activities， academic performance， and work of patients， but also leads to mental health issues such as anxiety and depression. This article reviews the latest research findings in the epidemiology， pathogenesis， and treatment of NT1 and clarifies the deficiencies and controversies in current research， so as to provide new ideas and directions for subsequent studies.

Restless legs syndrome （RLS） is a common neurological sensory-motor disorder， and the diagnosis of RLS mainly rely on the subjective clinical symptoms described by the patient， with a lack of specific auxiliary examinations or biomarkers. The diagnosis of this disease is still challenging for atypical cases. Various other diseases may have similar clinical symptoms as RLS， such as leg discomfort， leg pain and abnormal leg movement. This article summarizes the RLS mimics that might be confused with RLS symptoms， including the neurogenic， vascular， and musculoskeletal factors that might cause leg discomfort and pain， as well as the differential diagnosis of sleep-related movement disorders with symptoms overlapped with RLS， so as to help clinicians recognize RLS phenotype and provide a reference for the diagnosis of diseases that might be confused with RLS.

Cerebral small vessel disease （CSVD） is a spectrum of pathological conditions affecting intracranial small blood vessels and is associated with a variety of clinical manifestations， including cognitive impairment， gait abnormalities， and sleep disorders. In recent years， the association between CSVD and sleep disorders has attracted increasing attention. This article reviews the association of CSVD with various sleep disorders such as obstructive/central sleep apnea hypoventilation syndrome， restless legs syndrome， and insomnia， analyzes the mechanisms by which sleep disorders cause CSVD， and proposes potential directions for future research.

Sleep-related hypermotor epilepsy （SHE） is a rare type of epilepsy with a prevalence rate of approximately 1.8/100 000. This disease mainly manifests as complex motor behaviors during non-rapid eye movement sleep， such as leg kicking， arm waving， and sitting up. Since such symptoms are similar to non-epileptic disorders such as night terrors and sleepwalking and abnormal discharges may not be observed on electroencephalography， the diagnosis of SHE is quite challenging. Currently， there is still a lack of evidence from large-scale randomized controlled studies to support pharmacological treatment strategies for SHE， and related data in China remain scarce. This article reports a case of SHE， in order to provide a clinical reference for the diagnosis and medication treatment of this disease.