Intravenous (IV) iron therapy has substantially advanced the therapeutic landscape of Restless Legs Syndrome (RLS), offering potent disease-modifying benefits by directly addressing the central pathophysiology of brain iron deficiency. Consequently, ferric carboxymaltose (FCM) has rapidly emerged as the preferred formulation within sleep medicine, championed for its robust neurological efficacy and administration convenience. However, an interdisciplinary evaluation reveals a critical metabolic blind spot: FCM's unique propensity to induce intact fibroblast growth factor 23 (iFGF23)-mediated hypophosphatemia. While sleep specialists frequently dismiss this complication as a transient laboratory anomaly, extensive hematological evidence demonstrates that it precipitates severe, prolonged metabolic derangements, including osteomalacia, pathological fractures, and profound muscle weakness that clinically mimics RLS exacerbation. This perspective advocates for a paradigm shift in neuro-nutrition and sleep medicine, urging a targeted transition toward safer, equally efficacious alternatives, notably ferric derisomaltose (FDI), ferumoxytol, and low molecular weight iron dextran (LMW ID). By implementing a personalized, risk-stratified decision algorithm, clinicians can harmonize the neurological objectives of RLS treatment with the imperative of systemic metabolic safety.

Different telemedicine approaches for managing sleep disorders have been extensively researched worldwide, yet data on patients' individual willingness to adopt these protocols remain limited. This study aims to fill this gap, focusing specifically on the Italian population. A 19-item anonymous questionnaire was administered to 255 consecutive obstructive sleep apnoea (OSA) patients. Our findings indicate a substantial willingness to use telemedicine: 56.5% were unreservedly in favour of remote follow-up and 67.4% preferred comprehensive telemonitoring to PAP-only monitoring, although only 48.6% were familiar with the term "telemedicine". Attitudes towards remote consultations were more nuanced: 51.8% were unreservedly in favour, but within a combined model with telemonitoring only 40.6% would also accept them, and 45.7% considered in-person consultations irreplaceable. The need for assistance increased with age and, in multinomial logistic regression, older age was the main determinant of both refusal and perceived obstacles (odds ratios per age class 2.1-2.9), whereas educational level was not significantly associated with the response pattern after adjustment. Privacy concerns were frequent: 38.0% reported doubts or concerns, including 14.9% who were unwilling to transmit their data electronically, a response that, in exploratory analyses, was more frequent among more educated patients. Most patients (90.8%) believed that telemedicine services should be provided by the Public Health Service. In conclusion, telemedicine may be well received by Italian patients with OSA as a complement to, rather than a replacement of, in-person care; its implementation should consider public funding, tailored digital support for older patients, and robust data governance and privacy safeguards.

The wake-to-sleep transition is a physiologically vulnerable period during which benign and pathologic motor phenomena may emerge. Current sleep nosology recognizes isolated hypnic jerks, propriospinal myoclonus at sleep onset, sleep-related rhythmic movement disorder, and other minor sleep-related motor activities, but these entities may not fully explain patients with persistent, repetitive motor activation recurring across successive attempts to fall asleep. We describe eight representative cases characterized by recurrent motor events centered on sleep onset or early sleep-state transitions, associated sensory and autonomic symptoms, clinically meaningful sleep fragmentation, and absence of a more satisfactory alternative diagnosis. On the basis of these observations, we introduce sleep-state transition instability with recurrent multisystem activation (SSTI-RMA) as a provisional, hypothesis-generating phenotypic construct rather than an established diagnostic entity. The recurring clinical pattern comprises recurrent motor activation during wake-to-sleep or early sleep transitions together with variable sensory, autonomic, cardiovascular, respiratory, or other non-motor manifestations, repetition or clustering of events, difficulty initiating or stabilizing sleep, clinically significant distress or impairment, and absence of a more satisfactory alternative explanation. We conceptualize the SSTI-RMA phenotype as a possible disorder of sleep-state instability rather than as an isolated motor phenomenon, potentially involving impaired coordination among neural, autonomic, and vascular processes during sleep entry. No validated polysomnographic signature, frequency threshold, biomarker, or prevalence estimate is currently available, and the relationship of this phenotype to severe or recurrent sleep starts remains unresolved. SSTI-RMA should therefore be regarded as a descriptive research framework intended to facilitate standardized phenotyping and prospective studies capable of determining whether it represents a distinct entity, part of a continuum of established sleep-onset phenomena, or a heterogeneous phenotype with multiple causes.

Sleep is increasingly recognized as a multifaceted construct; however, most studies rely on self-reported sleep duration and overlook other key characteristics. We analyzed cross-sectional data from the REACT project, which included 738 Portuguese children (398 girls) aged 6 to 10 years, using 7-day wrist actigraphy. Latent profile analysis based on total sleep time, sleep onset, wake-up, sleep efficiency, and sleep regularity identified four profiles: "Relatively Favorable Sleepers" (45.4%), "Late Starters & Short Sleepers" (34.3%), "Long Sleepers & Late Risers" (15.6%), and "Early Risers & Poor Quality" (4.7%). Children in the "Early Risers & Poor Quality" profile had higher odds of having overweight or obesity (OR: 2.09, 95% CI: 1.03-4.22) compared to those in the "Relatively Favorable Sleepers" profile. Children in the "Long Sleepers & Late Risers" profile were more likely to meet moderate-to-vigorous physical activity (MVPA) recommendations (OR: 1.78, 95% CI: 1.05-3.03) and accumulated less sedentary time (β = -0.26, 95% CI: -0.50 to - 0.03). Conversely, the "Late Starters & Short Sleepers" profile was associated with higher sedentary time (β = 0.55, 95% CI: 0.38-0.73) and higher unhealthy diet scores (β = 0.41, 95% CI: 0.24-0.57), although no differences were observed in healthy diet scores. These findings highlight the value of multidimensional sleep assessment using objective measures for identifying pediatric subgroups at risk of adverse health outcomes.