After the Congress – Sleep Croatia

Sleep Croatia 2025: Good Sleep Becomes a Standard of Care

Sleep Croatia 2025 brought together around 200 participants from Croatia, Slovenia, the United Kingdom, the Czech Republic, Slovakia, Serbia, the Netherlands, Spain, Germany, and Greece. The event was organized by the University Psychiatric Hospital Vrapče, in cooperation with the Croatian Sleep Apnea Society of the Croatian Medical Association and the Croatian Academy of Medical Sciences. Over three days in Zagreb, the congress presented a broad picture of sleep medicine that connects neuroscience, clinical medicine, and public health with clinical protocols, with a clear focus on measurable treatment outcomes—an event that, in its reach and content, represents a true turning point for Croatian somnology.

The framework for the congress was set by four keynote speakers—child neurologist Prof. Barbara Gnidovec Stražišar (Slovenia); neurologists Prof. Karel Šonka, PhD (Czech Republic) and Prof. Leja Dolenc Grošelj, PhD, MD (Slovenia); and neuropsychiatrist Prof. Ivana Rosenzweig, PhD, MD (United Kingdom)—who summarized the latest insights into the neurophysiology of sleep, circadian rhythm disorders, and their implications for neurology, psychiatry, and public health.

From Impressions to Standardized Indicators

The public-health tone was underscored at the outset: in his lecture “How Does Croatia Sleep 2025?”, Assoc. Prof. Domagoj Vidović, PhD, compared the consumption of benzodiazepines and Z-drugs across several countries and showed that Croatia is among the larger consumers in Europe, while globally benzodiazepine use is declining and Z-drug use is increasing. The operational takeaway: we need to measure standardized indicators—CPAP adherence, PSG waiting lists, and treatment outcomes—with the aim of improving sleep centers and individual clinicians.

Neurophysiology of Sleep and Personalized Medicine

Assoc. Prof. Barbara Barun, PhD, presented the neurophysiology of sleep and links with cardiometabolic risks and cognition, emphasizing that sleep quality directly reflects on long-term outcomes. Dr. Ana Marija Šantić outlined features of sleep architecture in patients with obstructive sleep apnea (OSA) and PTSD—sleep fragmentation, reduced slow-wave sleep, and REM disruption—which affect daytime functioning and therapeutic results. Prof. Dinko Mitrečić, PhD, discussed the bidirectional relationship between sleep and neurodegeneration: sleep disorders can accelerate neurodegenerative processes, while early neurodegenerative changes alter sleep patterns—an argument for earlier recognition and targeted interventions. Building on this, Assoc. Prof. Aleksandar Savić, PhD, focused on personalized sleep medicine and the integration of sleep-focused interventions into specialized programs.

On the Front Line—Nursing and Physiotherapy

The practical segment, led by Katarina Pisk, univ. mag. med. techn., delivered a session for nurses/technicians and physiotherapists designed as a “front-line” workflow showcase. It focused on PSG/PG and MSLT/MWT protocols, CPAP patient education, early applications of AI tools in day-to-day practice, and the specificities of sleep in women. An interactive workshop with video cases and short quizzes confirmed the audience’s high level of prior knowledge, with emphasis on continually refreshing skills in rarer and differential-diagnosis topics.

From the Perspective of Pulmonology and Otolaryngology

The pulmonology–otolaryngology block addressed OSA treatment across the full spectrum: from optimizing CPAP and improving adherence, through critical reflection on AHI as the sole disease control metric and the introduction of additional measures, to nasal surgery (to reduce resistance and improve therapy tolerance) and mandibular advancement devices as a standalone option for some patients or an adjunct to CPAP. The consensus conclusion: OSA acts systemically, especially on cardiovascular risk, so therapy must be individualized and multidisciplinary.

We particularly highlight the lecture by Dr. Ana Brajdić Šćulac, pulmonologist—“Symptom Subtypes of Obstructive Sleep Apnea (OSA) and Cardiovascular Outcomes”—which showed that accurately identifying symptom subtypes enables more precise cardiovascular risk assessment, better patient stratification, and a more personalized choice of therapy with targeted outcome monitoring.

Overview of Satellite Symposia

The satellite program built concrete “bridges” between technology and the clinic: Assoc. Prof. Pedro Nogueira, PhD (Portugal), demonstrated how artificial intelligence in OSA diagnostics accelerates and standardizes PSG/PG signal analysis and helps with triage and follow-up—AI as a co-pilot with a human-in-the-loop approach: a specialist always reviews and confirms AI suggestions before a clinical decision. Assoc. Prof. Pavol Pobeha, PhD (Slovakia), illuminated hemodynamics in OHS patients and the role of PAP therapy. Tinta Visser (Germany) presented new approaches in polysomnography with beyond-AHI markers.

Dr. Nikolaos Roussos (Greece) showed how CPAP telemonitoring turns adherence oversight into a data-driven routine.

Assoc. Prof. Ivo Darko Gabrić, PhD, MD, cardiologist and head of the Cardiology Polyclinic at University Hospital Centre “Sisters of Charity,” presented tirzepatide, a dual GIP/GLP-1 agonist, as a new option in the treatment of obesity and OSA—stressing patient selection and outcome tracking as an adjunct to standard therapy.

The panel “1001 Faces of Insomnia,” with Assoc. Prof. Domagoj Vidović, PhD, and Marina Mioč, PhD, highlighted rational pharmacotherapy, the integration of non-pharmacological tools (CBT-I, education, sleep hygiene), and the importance of precisely distinguishing subtypes and comorbidities.

Sleep Disorders and Mental Health

The link between sleep and mental health ran through several talks: Prof. Prim. Petrana Brečić, PhD, MD, emphasized that insomnia in individuals at suicidal risk can be “the last straw” and underscored the need for early recognition and structured care, while neurologist Marina Mioč, PhD, analyzed insomnia from a neurological perspective with practical implications for everyday practice. Neurologist and epileptologist Assoc. Prof. Stjepan Jurić, PhD, unpacked the differential diagnosis of narcolepsy. Also highlighted were digitized CBT and AI support, the relationship between sleep disorders and depression, and the role of telemedicine (home PSG/PG, PAP/NIV telemonitoring, digital CBT-I).

A Wider Look at Sleep Disorders—from Pediatric Challenges to the Specificities of Sleep in Menopause

The final day opened with a “wider look” at sleep apnea, including central apnea and cerebrovascular risk in OSA, including cognitive and executive functions. Dr. Irena Šarc (Slovenia) presented PAP therapy in obesity hypoventilation syndrome (OHS), emphasizing hemodynamic effects and patient selection. Dr. Kristina Ziherl (Slovenia), pulmonologist and somnologist, presented new parameters for assessing OSA severity (“beyond AHI”) and their clinical application. Prof. Romana Gjergja-Juraški, PhD, MD, child neurologist and somnologist from the Children’s Hospital Srebrnjak, summarized contemporary challenges in monitoring children with sleep apnea.

Subsequent talks stepped beyond OSA into clinical routine, addressing healthcare worker sleepiness and patient safety (presented by Prof. Jasna Mesarić, PhD, MD), the glymphatic system, updated guidelines for RLS/PLMD, the differential diagnosis of nocturnal epileptic seizures, RBD, and sleep disorders in people with psychosis. Gynecologist Assoc. Prof. Ivan Bolanča, PhD, MD, discussed sleep disorders in menopause and their management in everyday practice, and the session on sleep in menopause sparked the liveliest debate—particularly on hormone therapy and its role in alleviating symptoms. Women in menopause often report difficulties falling asleep, early morning awakenings, daytime fatigue, and irritability. Sleep in this life stage deserves more attention—because sleep quality directly affects quality of life.

Professional Development in Focus

The congress concluded with a message about the future of the field: succession planning—from mentorship and competency standardization to creating clear pathways for new generations of professionals—is a prerequisite for the sustainable development of sleep medicine. In his closing remarks, Assoc. Prof. Domagoj Vidović, PhD, thanked participants and partners and invited everyone to the next edition—Sleep Croatia 2027.