UniCamillus Magazine Estate 2026 - ENG

Summer 2026

UNICAMILLUS UNI CAMILLUS Magazine

UniCamillus Magazine

Editor-in-Chief Gianni Profita Editor Giorgia Martino Graphic Design Giulia Francini Federico Calogero Images and Contributions Federica Alota Damiano Giani Giusi Condorelli Ginevra Guidoni Claudia Romano Adobe Stock

Translations University Language Center Ylenia Marcucci Faure

Printed by Tipografia Miligraf August 2026 Free Copy www.unicamillus.org

BR A I N HE A LT H : T H E R O L E O F SLEEP IN T H E B ODY AND MIND 2 Editorial Rector Gianni Profita

Summer 2026 | No. 2

30 Sleeping to protect the brain: the role of sleep in neurodegenerative diseases

6 Sleep and health: the pillars of

Interview by Claudia Romano with

physical and cognitive wellbeing

Susanna Cordone, Lecturer in Social

Professor Andrea Romigi

Psychology at UniCamillus

10 Intestines and sleep:

34 Sleep and addiction:

how the dialogue between

when sleeping pills become a

the microbiota and the brain

risk

regulates sleep

Professor Raffaele Conte

Interview by Claudia Romano with Angelo Icro Maremmani, Lecturer in

p.6

Social Psychology at UniCamillus

14 Sleep-related breathing disorders in growing children:

38 UniCamillus looks to the

the importance of early diagnosis

future and doubles its presence

Professor Paola Cozza

in Veneto

Ginevra Guidoni

Dr. Francesca Gazzani

20 Mental health and sleep: an inseparable link for brain health

Professor Stefania Chiappini

40 Sport connects people: UniCamillus celebrates a season of excitement,

p.20

dedication and victories

Giusi Condorelli

22 Brain health, sleep and social capital: the role of

44 Brain Health:

relationships in building well-

when health becomes a

being

dialogue between disciplines

Professor Vera Kopsaj

Professor Donatella Padua Professor Barbara Tavazzi

26 Changes in sleep architecture with ageing and

p.30

46 5 news

their impact on cognitive functions

48 News from uniweb

Professor Valentina Alfonsi

49 UniCamillus global health journal

50 Research | Abstract

p.44 UniCamillus Magazine | Summer

1

E ditoriale

di Gianni Profita Rettore We are constantly expected to be active, connected, and productive. Our days are getting longer, information is multiplying, and the ability to be constantly reachable has gradually reshaped our relationship with time. In this context, sleep risks being perceived as a mere pause—a space to be squeezed out when commitments pile up. Yet sleeping does not simply mean stopping; it means taking care of one of the most important biological functions for our balance and brain health.

It is from this awareness that the new issue of UniCamillus Magazine takes shape, dedicated to the theme ‘Brain health: the role of sleep in the body and mind’.

A theme that invites us to view sleep not as an isolated phenomenon, but as a dimension deeply interconnected with physical, cognitive, and mental health—as well as with nutrition, social relationships, and even the aging process.

Scientific research shows us, in fact, just how much sleep is involved in the mechanisms through which the brain maintains and renews its functions. During sleep, processes related to memory and learning are consolidated, important metabolic and neurobiological functions are regulated, and the maintenance of a balance essential for facing the challenges of daily life is supported.

Conversely, poor sleep quality can have repercussions on overall wellbeing and, in the long term, contribute to increased vulnerability to various pathological conditions.

For this reason, discussing brain health necessarily means discussing prevention as well. And it means doing so by adopting an interdisciplinary approach that brings together different areas of expertise and knowledge.

This is the perspective that characterises the indepth articles featured in this issue, drawn from the expertise and authority of our academic staff. The relationship between sleep, physical health, and cognitive functions serves as the starting point for a journey that explores nutrition and the microbiome, to understand how diet and the body’s balance can influence the quality of rest and, more broadly, overall brain health.

Another article takes us into the field of dentistry, addressing the topic of obstructive sleep apnoea and reminding us that oral health can also play a significant role in the diagnosis and management of disorders that profoundly affect quality of life.

The relationship between mental health and sleep represents another fundamental intersection.

Mind and body are not separate entities: sleep is in constant dialogue with our psychological balance, just as stress, anxiety, and mood swings can profoundly alter the quality of our rest.

Understanding this relationship therefore means strengthening a culture of health based on prevention and the ability to recognize early warning signs of distress.

Brain health is, moreover, both an individual and a collective issue. Relationships, social interaction, and a sense of belonging are essential elements of wellbeing throughout the entire lifespan.

The importance of social interaction and social connections therefore naturally forms part of this discussion, reminding us that brain health is also built through the quality of our relationships.

This topic becomes especially relevant when we consider aging. The changes in sleep architecture that accompany aging can, in fact, interact with cognitive functions and quality of life. Studying these changes means not only gaining a better understanding of the physiological processes of aging, but also identifying new opportunities for prevention and intervention.

2

UniCamillus Magazine | Summer

Interviews with our experts further broaden this perspective, delving into some highly topical questions for contemporary medicine: What is the relationship between sleep and a tendency toward addiction? And what connection exists between the quality of rest and neurodegenerative processes? These questions bring us back to the importance of prevention and the possibility of taking action—through sleep and, more broadly, through healthy lifestyles—to preserve brain health over time.

These are questions that belong not only to the realm of research but also to our daily lives.

And it is precisely here that a university like UniCamillus can play an essential role: transforming scientific knowledge into awareness, prevention, and a culture of health.

This mission is also reflected in the other pages of this issue, which are dedicated to the life of our community. From the University Championships we hosted this year to the opening of the new UniCamillus campus in Venice Mestre, the ‘Academic Life’ section showcases a university that continues to grow and create opportunities for connection, participation, and learning. Finally, the Third Mission reflects our commitment to taking knowledge beyond the confines of the classroom and the laboratory, fostering an evercloser dialogue with society.

Brain health is one of the great challenges of our time. Addressing it requires research, innovation, prevention, and above all, the ability to transcend disciplinary boundaries. But it also requires a new awareness: taking care of the brain means taking care of the person as a whole.

Sleep, too, therefore, deserves to be considered for what it truly is: not time taken away from life, but time given back to health.

UniCamillus Magazine | Summer

3

4

UniCamillus Magazine | Summer

UniCamillus Magazine | Summer

5

Sleep and health: the pillars of physical and cognitive wellbeing Professor Andrea Romigi

Associate

Professor

of

Neurology

at

UniCamillus, he graduated in Medicine and Surgery from the Catholic University of Rome and specialised in Neurology at the University of Rome Tor Vergata.

Since 2012, he has been Director of the

Sleep

Medicine

Centre

at

IRCCS

Neuromed. He serves on the editorial boards of international scientific journals and is the author of over 100 publications.

His research focuses on sleep disorders, neurodegenerative

diseases

and

the

relationship between sleep and epilepsy.

6

UniCamillus Magazine | Summer

F

or a long time, sleep medicine was considered a secondary discipline—the ‘Cinderella of medicine’—and struggled to find a place in training programmes and general clinical practice. Today, that era is over: an editorial published in The Lancet in 2022 recognised the need to integrate sleep into academic curricula and health policies. The reason is simple: sleep is not a state of passive inactivity, but an active neurobehavioural process, essential for full physical, mental and social wellbeing. It is no coincidence that the contemporary concept of health rests on four pillars—the so-called ‘fantastic four’—which have a decisive impact on longevity and all-cause mortality: diet, physical activity, social engagement and, of course, sleep. ‘Good’ sleep has specific characteristics: a morning chronotype (being an early bird), adequate duration (at least 7 hours), and the absence of insomnia, snoring and daytime sleepiness.

The impact of poor sleep But how much of an impact does poor sleep really have?

Much more than one might imagine. The consequences extend beyond simply feeling tired the next day; they also affect the brain, the heart, the immune system and metabolism. Furthermore, insufficient sleep has a significant economic impact: road traffic accidents, workplace injuries and errors have been estimated to cost between 41 and 49 billion dollars in an Australian

study. To understand how strongly a risk factor affects health, the population attributable fraction (PAF) is used, which indicates how many cases of a disease could be prevented by completely eliminating that factor.

According to the same Australian study, if daytime sleepiness were eliminated, 23% of road traffic accidents and 10% of strokes could be prevented.

The number of hours slept is also important, but the rule is ‘neither too much nor too little’.

The relationship between sleep duration and cardiovascular mortality follows a U-shaped curve: those who sleep 5 hours or less have a 66% higher cardiovascular risk, whilst those who sleep 9 hours or more have an 81% increase. The optimal balance lies at around 7 hours of sleep per night.

This is also confirmed by data from the UK Biobank, collected from around 500,000 people: sleeping less than 6 hours or more than 8 hours is associated with accelerated biological ageing of various organs and systems. The most favourable range appears to be between 6.4 and 7.8 hours.

But quantity isn’t everything: even fragmented or poor-quality sleep can have negative effects on health, regardless of the number of hours spent in bed.

These risks become even more tangible when we focus on metabolism. A meta-analysis shows that sleeping for less than six hours increases the risk of obesity by 38%, the risk of diabetes by 37%, and all-cause mortality by 12%.

The connection between sleep and obesity—often overlooked is far from trivial in an era in which

excess weight contributes to over five million deaths a year, and in which, for every 5-unit increase in body mass index, the risk of death rises by an average of 31%. It is no coincidence that, in October 2025, Italy became the first country in the world to officially recognise obesity as a chronic disease, through Law No. 149/2025, and to include its treatment within the Essential Levels of Care.

Time also plays a key role in this connection: the misalignment of our biological clock with the solar and social clocks, combined with insufficient sleep, is in itself a risk factor for obesity. So what causes sleep deprivation? Largely our habits: work patterns that push us to stay ‘connected’ even in our free time, medicines that interfere with sleep, and high screen time.

A survey of teenagers makes it clear: the greatest harm does not come from television or games consoles, but from the prolonged use of portable devices such as smartphones and tablets.

The

structure

of

sleep

and

its

functions

To understand why sleep has such a significant impact on health, we need to look at how it is organised.

Hippocrates already realised that sleeping too much or too little compromised vitality, as if there were an invisible balance between the desire to stay awake and the inevitable pull of sleep. When this balance is disrupted, cognitive functions are immediately affected: mental fog, memory loss and impaired decision-making.

This balance is regulated by orexin (or hypocretin), a neurotransmitter discovered just twenty years ago and produced by as few as 70,000 neurons. Wakefulness

depends on a sophisticated system of monoamines— histamine, serotonin, dopamine and noradrenaline—whose equilibrium is crucial for neurological stability; in this context, orexin sustains the waking state and acts as a ‘guardian’ of the boundaries between sleep and consciousness, preventing—or attempting to prevent—inappropriate intrusions of sleep during the day (as occurs in narcolepsy, which is caused precisely by a deficiency of orexin). Its action, however, extends beyond the sleep-wake cycle: orexin modulates motivated behaviours, influencing the response to food, susceptibility to substances of abuse and stress regulation. It is this multifaceted nature that makes it a pivotal element in the entire metabolic and behavioural balance.

These discoveries have effectively replaced the old idea of sleep as a general ‘shutdown’ of the brain.

Take the thalamus, for example.

For a long time, it was regarded as a simple ‘relay centre’ that sorted sensory information. Today we know that it plays a much more active role in sleep. One region of the thalamus, the reticular nucleus, generates sleep spindles—brief bursts of electrical activity that protect the brain from noise and other external stimuli, whilst also promoting memory consolidation.

Another region, the centro-medial thalamus, helps coordinate the slow waves typical of deep sleep.

The cerebral cortex, once thought to play only a minor role during sleep, also plays an important part.

In particular, certain neurons in the prefrontal cortex help regulate the need for sleep and trigger the transition from wakefulness UniCamillus Magazine | Summer

7

to sleep. There is even a form of ‘localised sleep’ involving the thalamus, hippocampus and neocortex working together: during NREM sleep, their synchronisation prepares the synaptic plasticity associated with REM sleep—the dreaming phase of sleep—by integrating new information with that already acquired.

it functions most effectively during deep NREM sleep and when lying on one’s side: during this phase, fluctuations in noradrenaline levels, the movements of blood vessels and the flow of cerebrospinal fluid (CSF) act as a pump, promoting CSF circulation within the brain and the elimination of waste products via the glymphatic system.

All this late-night work has a tangible effect on memory. This is well illustrated by the ‘sleep effect’, a phenomenon already intuited by the Latin rhetorician Quintilian, who advised his pupils to get a good night’s sleep before resuming their studies, and which was experimentally demonstrated almost 2,000 years later: sleep slows the normal rate at which memories fade, to the extent that recall of what we have learnt is better if the rest period has been spent sleeping. The mechanism is now well understood: during NREM sleep, memories temporarily stored in the hippocampus are transferred to the neocortex through the interaction between slow cortical oscillations, thalamic spindles and hippocampal sharp ripples. It is not surprising that the number of spindles correlates with cognitive performance, ranging from procedural memory to wordpair learning, right through to IQ. Finally, there is a mechanism that directly connects sleep to the prevention of neurodegenerative diseases: the glymphatic system.

It is a network of perivascular spaces which, thanks to the aquaporin-4 (AQP4) channel in astrocytes, circulates cerebrospinal fluid and clears the brain of metabolic waste—a sort of ‘separate waste-collection system’ that works mainly at night. In fact,

When this system malfunctions, the consequences can quickly become serious. It has been shown that just one night of sleep deprivation increases the accumulation of beta-amyloid, a protein involved in Alzheimer’s disease. Furthermore, people with obstructive sleep apnoea (OSA) exhibit cerebrospinal fluid changes similar to those observed in Alzheimer’s disease, with increased accumulation of betaamyloid, T-tau and P-tau. These alterations are likely driven by sleep fragmentation, reduced oxygen levels during apnoeic episodes and fluctuations in pressure within the chest cavity. Some of these changes may improve with CPAP (Continuous Positive Airway Pressure), the first-line treatment for OSA, which delivers continuous positive pressure to the airways.

8

UniCamillus Magazine | Summer

Circadian

misalignment

and

metabolism

Sleep, however, is not isolated from time: it is governed by three clocks—biological, social and solar—which do not always align.

Their misalignment gives rise to ‘social jet lag’: we tend to go to bed later and, at the weekend, to shift sleep timing by roughly half an hour, as if we were landing from an intercontinental flight every Monday. The consequences are far from trivial: social jet lag is linked

to depressive symptoms, increased consumption of caffeine, alcohol and tobacco, and a heightened risk of obesity, with the highest figures seen in adolescents (up to two and a half hours). It is also associated with increases in body mass index, body fat and metabolic syndrome, and goes hand in hand with less balanced diets and later mealtimes.

Melatonin, the regulator of sleep timing, also plays a part in this complex interplay; it influences the ‘browning’ of adipocytes— that is, the balance between white (storage) and brown (thermogenic) adipose tissue. And external factors such as daylight-saving time only serve to make the situation worse.

Conclusions Yet, despite such solid evidence, the importance of sleep remains largely under-recognised worldwide: according to an analysis of 194 WHO member states, only 24% of the population has known data on sleep quality, whilst 42% remains in an ‘unknown’ category, particularly in low-income countries. This is a missed opportunity, because promoting good sleep is one of the most effective tools in preventive medicine. To capitalise on this, three converging actions are needed: to educate and raise awareness, by incorporating sleep health into medical curricula and public health campaigns; to standardise and centralise research data, by including questions on sleep in existing population surveys; and to develop dedicated health policies, so that organisations such as the WHO recognise sleep as a priority on national agendas— with health equity as the guiding principle.

UniCamillus Magazine | Summer

9

Intestines and sleep: how the dialogue between the microbiota and the brain regulates sleep Professor Raffaele Conte

Researcher at UniCamillus, he holds a degree in Pharmaceutical Chemistry and Technology from the University of Naples Federico II and a PhD in Clinical and Experimental Medicine.

His research focuses on natural compounds for nutraceutical and therapeutic use, advanced delivery systems, sustainable biomaterials

and

the

development

of

functional foods in accordance with the principles of the circular economy and One Health.

10

UniCamillus Magazine | Summer

O

ur intestines are not merely a digestive organ. The microorganisms that inhabit them produce molecules capable of reaching the nervous system and helping to regulate sleep: a relationship that remains largely to be elucidated, but is increasingly welldocumented.

In recent years, the term ‘gut-brain axis’ has moved beyond the laboratories of neurogastroenterology and entered the public debate. This is not a metaphor: there is a physical, two-way communication network between the microorganisms that inhabit the gastrointestinal tract and the central nervous system, which is being characterised in ever greater detail at a molecular level.

One of the areas in which this relationship appears most promising concerns the regulation of sleep.

Sleep is not merely a temporary suspension of brain activity, but the window of time during which the brain eliminates metabolic by-products, consolidates memory and regulates the activity of the immune system. For this reason, chronic insomnia has consequences that go beyond daytime fatigue, as it is associated with an increased risk of neurodegenerative, metabolic and psychiatric disorders. However, it is worth noting an

epidemiological point that is often overlooked: whilst around a third of adults report at least occasional symptoms of insomnia, the chronic insomnia disorder defined by diagnostic criteria affects a smaller proportion, estimated between 6 and 15% of the population and commonly reported around 10%.

There are still two established treatment options: hypnotics to manage the symptoms and cognitive behavioural therapy, which is now the gold standard for insomnia. Alongside these, research is exploring a third, as yet preliminary, approach: the possible role of the microbiota as a modulator of sleep.

Bacterial metabolites involved in sleep: SCFAs, tryptophan and bile acids

Gut bacteria do more than simply act as a veritable ‘organ’ of digestion on the food residues with which they come into contact. Through the fermentation process, catalysed by speciesspecific enzymes, they produce signalling molecules which, once absorbed, enter the bloodstream and can reach the central nervous system or act on peripheral nerve endings.

Among these mediators, shortchain fatty acids (SCFAs)— butyrate, propionate and acetate—produced by the bacterial fermentation of fibre, are among the most widely studied in relation to sleep. In animal models, butyrate has shown marked effects: in a study on rodents (Szentirmai et al., Scientific Reports, 2019), oral administration of one of its precursors increased non-REM sleep by approximately 50% in the hours that followed, whilst direct injection into the portal

circulation increased this by up to 70%. The effect appears to involve afferent pathways of the vagus nerve, consistent with the hypothesis that these metabolic signals are detected at the hepatoportal level. However, these are preclinical data: evidence in humans is still limited. A small controlled study in patients with ulcerative colitis reported an improvement in self-reported sleep quality (PSQI questionnaire) following supplementation with sodium butyrate; however, it has not been demonstrated that the supplement prolongs deep sleep as measured instrumentally, nor that it influences evening cortisol levels.

A second key point concerns tryptophan, the amino acid precursor of serotonin, whose metabolic fate depends in part on the microbiota. When everything is in balance, certain bacteria (including Lactobacillus and Bifidobacterium) direct a proportion of tryptophan towards the production of indoles. These metabolites activate the AhR receptor, which is also present on the brain’s immune cells (microglia and astrocytes), helping to keep inflammation in the nervous system in check. The AhR (Arylhydrocarbon Receptor) protein is a transcription factor capable of binding to man-made chemicals such as halogenated and polycyclic aromatic hydrocarbons, or natural substances of microbial, plant and animal origin. It is plausible, as suggested by the study by ZivGal et al. (Sleep Med., 2013), that the AhR-dependent signalling pathway may, acting in concert with other genes regulating the circadian rhythm (e.g. CLOCK), influence sleep quality and the

onset of insomnia. Conversely, in the presence of dysbiosis or inflammation, tryptophan is diverted towards the kynurenine pathway, which generates potentially neurotoxic metabolites associated with mood disorders and more fragmented sleep.

Less well-studied, but of growing interest, are secondary bile acids.

Metabolised by gut bacteria, they bind to receptors found throughout the nervous system and have been linked to circadian rhythms and sleep quality in observational studies.

How gut signals reach the brain: the vagus nerve, the immune system and the stress axis

These molecules communicate with the brain via at least three pathways.

The fastest is the vagus nerve.

Recent studies have described so-called ‘neuropod’ cells: enteroendocrine cells in the gut that form direct synapses with vagal fibres and transmit luminal signals—such as the presence of nutrients—to the brainstem within milliseconds (Kaelberer et al., Science, 2018). From an epidemiological perspective, higher vagal tone —which can be estimated via heart rate variability—has been associated with both a more diverse microbiota and better sleep.

The second method is via the immune system, where the picture is more nuanced. A moderate and transient release of cytokines such as interleukin-1β promotes sleep: this is one of the reasons why people feel drowsy during an infection. Problems arise when the intestinal barrier becomes more permeable and allows bacterial derivatives such UniCamillus Magazine | Summer

11

as lipopolysaccharide (LPS) to pass into the bloodstream. Chronic exposure to these stimuli fuels low-grade systemic inflammation, which tends to impair sleep architecture.

The third approach is the hypothalamic–pituitary–adrenal (HPA) stress axis. In animal models, the absence or depletion of the microbiota is accompanied by a more pronounced stress response; early colonisation with specific strains such as Bifidobacterium infantis in the first few days of life reduces this excessive reactivity (Sudo et al., 2004), suggesting a role for the microbiota in modulating the stress axis.

A two-way relationship: sleep shapes the gut microbiota and vice versa

For a long time, the question has been whether dysbiosis causes insomnia or whether insomnia alters the gut microbiota. The available data suggest that both mechanisms occur simultaneously.

On the one hand, just a few nights of insufficient or fragmented sleep are enough to alter the composition of the microbiota even in healthy individuals, although the extent and reproducibility of these changes remain the subject of study. On the other hand, faecal microbiota transplantation (FMT) experiments suggest a causal role: when the microbiota of sleepdeprived animals is transferred to healthy recipient animals, the latter develop behavioural and sleep disturbances. The altered microbiota, therefore, is not merely a consequence of lost sleep, but may actively contribute to the disorder.

A clinically relevant example is obstructive sleep apnoea (OSA).

Repeated episodes of nocturnal

12

UniCamillus Magazine | Summer

hypoxia favour the development of a microbiota with a proinflammatory profile. In animal models, the transplantation of this ‘apnoea-associated’ microbiota not only worsens sleep but is associated with an increase in blood pressure (Durgan et al., Hypertension, 2016) and, according to some studies, with cognitive deficits. In this context, the microbiota becomes a factor contributing to cardiovascular damage.

Are there any effective supplements?

What do the data say?

Commercial interest in these findings has grown rapidly.

‘Psychobiotics’—strains such as Lactobacillus helveticus and Bifidobacterium longum—have been shown in some studies to have effects on anxiety and mood, whilst specific data on sleep, for example on reducing the time taken to fall asleep, are more modest and have not always been replicated. Prebiotics (fibres such as galacto-oligosaccharides) selectively promote bacteria that produce beneficial metabolites; postbiotics (purified metabolites or inactivated bacteria) are a more recent area of research.

However, prudence is required: the effects of supplements are generally modest, depend on the strain used and vary greatly from person to person. At present, there is no universal ‘bacterial sleeping pill’.

The intervention with the highest level of evidence remains the simplest: diet and regular routines. A high-fibre diet—the Mediterranean diet is a good example, as it provides the substrate for SCFA production— and meal times aligned with the

light-dark cycle help to maintain the circadian rhythm of the microbiota. Conversely, ultraprocessed foods and irregular mealtimes tend to disrupt these rhythms, with potential repercussions for sleep quality.

Towards personalised medicine The link between the gut and sleep is well-documented and, at least in part, causal, but research still has some important steps to take. We need longitudinal studies that measure sleep using electroencephalography rather than just questionnaires, and that characterise the microbiota at the strain level rather than merely at the genus level. It will also be necessary to understand why men and women respond differently—oestrogen, for example, modulates bacteria such as Akkermansia muciniphila— and how the microbiota changes over the course of a lifetime, from childhood to old age.

Gut bacteria will not replace cognitive behavioural therapy or medication for acute sleep disorders. However, they represent a previously underestimated factor and provide a further reason to consider diet as one of the factors influencing the way we sleep.

This article was produced in collaboration with Prof. Gianfranco Peluso, a lecturer at UniCamillus, and Dr Rita Paola Debri

UniCamillus Magazine | Summer

13

Sleep-related breathing disorders in growing children: the importance of early diagnosis Professor Paola Cozza, Dr Francesca Gazzani

Paola

Cozza

is

a

Odontostomatological

Full

Professor Diseases

of at

UniCamillus; she graduated in Medicine and Surgery from La Sapienza University of Rome and completed her specialisations in Odontostomatology and Orthodontics.

Francesca Gazzani is a Research Fellow at UniCamillus. She graduated in Dentistry and Dental Prosthetics from the University of Rome Tor Vergata, where she obtained a Master of Science in Orthodontics, a PhD and a specialisation in Orthodontics.

14

UniCamillus Magazine | Summer

What are sleep-related breathing disorders?

The term Sleep-Disordered Breathing (SDB) or Respiratory Syndromes refers to a group of respiratory disorders that occur in children during sleep and which encompass conditions of varying severity, ranging from primary snoring to obstructive sleep apnoea (OSA).

In children, these disorders represent a clinical issue of growing concern, as they can negatively affect sleep quality, neurocognitive functions, the child’s overall growth and, in particular, craniofacial development.

The prevalence of paediatric sleep-related breathing disorders varies considerably. The milder forms of primary snoring affect between 3% and 27% of children, whilst the prevalence of OSA is estimated to be between 1% and 5%. The incidence is highest between the ages of 2 and 6, a period during which the adenoid and tonsillar tissue reaches its maximum volume relative to the size of the upper airways. Subsequently, with the physiological regression of the lymphoid tissue, a general reduction in symptoms is typically observed.

The most serious respiratory syndromes are characterised by episodes of partial or complete obstruction of the upper airways, leading to impaired ventilation and oxygenation during sleep. Symptoms can vary greatly and depend on the degree of resistance to airflow in the upper airways. For this reason, habitual snoring in children should not be regarded as a harmless

phenomenon, particularly when associated with mouth breathing, restless sleep, breathing pauses, hyperactivity or difficulties at school. Early diagnosis is essential to prevent long-term functional and structural consequences.

How

do

respiratory

disorders

manifest themselves?

Primary snoring is the mildest form and is characterised by the presence of noises during sleep without significant changes in oxygen saturation.

In young children, it may occur physiologically during the deep stages of sleep.

UARS (Upper Airway Resistance Syndrome) is an intermediate condition in which increased resistance to airflow leads to increased respiratory effort and frequent micro-awakenings, even in the absence of true apnoeas.

Obstructive hypopnoea, on the other hand, consists of a significant reduction in airflow, often associated with oxygen desaturation.

The most severe form is OSA, characterised by repeated episodes of complete or near-complete obstruction of the upper airways during sleep. These episodes can last several seconds and recur several times throughout the night, causing sleep fragmentation and reduced oxygenation. ripetersi più volte nel corso della notte, causando frammentazione del sonno e ridotta ossigenazione.

What are the risk factors?

Among the risk factors, craniofacial abnormalities play a key role.

Conditions such as mandibular retrognathia, micrognathia, maxillary hypoplasia and a narrow palate reduce the space available

for airflow and increase the risk of airway collapse during sleep.

Soft-tissue abnormalities can also contribute to airway obstruction.

The most common cause in children is adenoid-tonsillar hypertrophy, which leads to a narrowing of the upper airways. Other associated conditions include macroglossia, nasal polyposis and soft palate hypertrophy. One systemic factor that should not be overlooked is obesity, as the accumulation of adipose tissue in the cervical and pharyngeal regions promotes airway narrowing and increases the risk of respiratory collapse during sleep.

From a functional perspective, chronic inflammatory conditions of the airways—such as allergic rhinitis and asthma—reduced muscle tone in the upper airways, and neuromuscular disorders are the main risk factors. In children with muscular hypotonia or neurological conditions, the risk of developing severe forms of OSA is higher due to their reduced ability to keep the airways open during sleep.

Several genetic syndromes are frequently associated with sleeprelated breathing disorders, the most common of which include trisomy 21 and Marfan syndrome, where craniofacial abnormalities and neuromuscular alterations often coexist, significantly increasing the risk of airway obstruction.

What are the clinical signs?

The symptoms associated with respiratory syndromes in children are often varied and are sometimes underestimated.

Nocturnal symptoms include: habitual snoring, mouth breathing, restless sleep, breathing

pauses, night sweats, frequent awakenings and abnormal sleeping positions. Unlike adults, children rarely experience marked daytime sleepiness but are prone to irritability, hyperactivity, attention deficits and difficulties at school.

Chronic mouth breathing can affect craniofacial development, leading to characteristic features such as an elongated face, a narrow and deep palate, lip incompetence and mandibular retrusion. Alterations in tongue posture and muscle tone also contribute to the development of dental malocclusions, crossbite and an increase in lower facial height.

From a systemic perspective, OSA in childhood can affect numerous systems. Sleep fragmentation and intermittent hypoxia can lead, at the neurocognitive level, to attention deficits, behavioural changes, impaired memory and a decline in learning performance.

With regard to the cardiovascular system, OSA is associated with blood pressure abnormalities, endothelial dysfunction and cardiac remodelling. In children, it can also lead to delayed growth in height and weight, linked to increased respiratory effort and impaired sleep quality, which disrupt the normal secretion of growth hormone.

Metabolic abnormalities, nocturnal enuresis and a reduced quality of life for both the child and the family are also frequently observed.

Early

diagnosis

and

treatment

strategies

The diagnosis of sleep-related breathing disorders requires a UniCamillus Magazine | Summer

15

C ase 1. A 5- year - old patient , a mouth - breather , presenting with the typical features associated with respiratory syndromes : an elongated face , enlargement of the lower third of the face , lip incompetence and difficulty maintaining an anterior lip seal . I ntraoral examination reveals skeletal constriction of the upper jaw and a tendency towards an anterior open bite .

16

UniCamillus Magazine | Summer

multidisciplinary approach that typically involves a paediatrician, an ear, nose and throat specialist and a dentist.

The medical history is the first step in diagnosis and must investigate the presence of snoring, mouth breathing, restless sleep, behavioural difficulties and academic performance.

The clinical examination must include an assessment of key factors for an accurate diagnosis, such as craniofacial morphology, nasal patency, the presence of adenotonsillar hypertrophy, occlusal abnormalities, and tongue and lip posture.

From a diagnostic perspective, polysomnography (PSG) is the gold standard. Polysomnography records various physiological parameters during sleep, including brain activity, oxygen saturation, respiratory flow and thoracoabdominal movements, enabling the calculation of the Apnoea– Hypopnoea Index (AHI), defined as the number of apnoea and hypopnoea events per hour of sleep. In paediatric patients, AHI values are commonly classified as follows: • An AHI of between 1 and 5 events per hour indicates mild OSA; • An AHI of between 5 and 10 events per hour indicates moderate OSA; • An AHI of more than 10 events per hour indicates severe OSA. Screening tools also include nocturnal pulse oximetry and validated questionnaires, such as the Paediatric Sleep Questionnaire.

The management of sleep-related breathing disorders in growing patients depends on the severity of the clinical presentation and

the aetiological factors involved.

Adenotonsillectomy is the recommended treatment option for children with significant adenotonsillar hypertrophy and leads to an improvement in respiratory symptoms, sleep quality and craniofacial development. Early correction of respiratory obstruction also promotes normalisation of facial growth patterns and a reduction in occlusal abnormalities. In the most severe cases, in patients who are not suitable for surgery, and in adults, CPAP (Continuous Positive Airway Pressure) may be used; this method keeps the airways open through continuous positive pressure ventilation.

Although effective, compliance in children may be limited due to the discomfort associated with wearing the mask.

Why consult a paediatric dentist and an orthodontist

In recent years, orthodontists have taken on a central role in the early detection and treatment of mild and moderate forms of SDB. Orthodontic treatment aims to correct craniofacial abnormalities that contribute to upper airway obstruction and thus predispose patients to the development of respiratory problems. Scientific evidence shows that certain orthodontic treatments significantly improve respiratory function.

Rapid maxillary expansion (RME) is indicated in patients with transverse skeletal constriction of the upper jaw and mouth breathing.

Opening the median palatal suture results in an increase in the diameter of the nasal cavities and a reduction in

respiratory resistance. Scientific literature has demonstrated an improvement in nasal breathing and polysomnographic parameters following orthopaedic expansion of the maxilla.

In patients with mandibular retrusion and skeletal Class II malocclusion, however, functional mandibular advancement devices are indicated.

These appliances promote the advancement of the mandible and tongue, increasing the retropharyngeal space and reducing the risk of upper airway collapse.

The interceptive orthodontic approach is particularly effective during childhood, a period of growth during which craniofacial development remains highly responsive to therapeutic guidance.

Early diagnosis and a multidisciplinary approach are essential for identifying at-risk patients at an early stage and defining an appropriate treatment plan that will lead to successful outcomes.

In this context, the paediatric dentist and the orthodontist play a key role in identifying the clinical signs associated with sleeprelated breathing disorders and in managing the related craniofacial abnormalities.

Modern interceptive orthodontic treatments, supplemented where necessary by ENT and paediatric care, help to improve respiratory function and promote harmonious development of the craniofacial region, thereby reducing the risk of future complications.

UniCamillus Magazine | Summer

17

C ase 2. A 6- year - old patient , a mouth - bre ather with maxillary constriction , mode rate crowding in both arches and a low tongue position . A latero - lateral telecra nial view reveals narrowing of the upper airways and a consequent reduction in nasal resistance .

T he hybrid interceptive

treatment involved orthopaedic expansion of the upper jaw and aligners on the lower arch to resolve the transverse problem and regain the space required to correct the existing crowding . T he correction of the transverse discrepancy and the restoration of a correct arch morphology led to an enlargement of the nasal cavities and an improvement in tongue posture .

A t the end of the orthopaedic treatment phase using a rapid palatal expander , an improvement in respiratory function can be observed , due to the widening of the airways and the consequent reduction in nasal resistance .

18

UniCamillus Magazine | Summer

C ase 3. A 6½- year - old patient with C lass II malocclusion due to mandibular retrusion . O rthopaedic treatment involving mandibular advan cement resulted in the repositioning of the mandible , associated with increased airway patency and an improvement in respiratory symptoms .

UniCamillus Magazine | Summer

19

Mental health and sleep: an inseparable link for brain health Professor Stefania Chiappini

Associate Professor at UniCamillus, she graduated in Medicine and Surgery from the Catholic University of the Sacred Heart in Rome and went on to specialise in Psychiatry and Psychotherapy and obtain a PhD in Pharmacy and Pharmacology at the University of Hertfordshire. She has gained international research experience in the field of pharmacovigilance and psychoactive

substances,

collaborating

with Italian and British academic and scientific institutions.

20

UniCamillus Magazine | Summer

S

leep is not just a pause from wakefulness— it is an active, dynamic process that plays a crucial role in keeping the brain healthy. Over the past few decades, scientific research has made it increasingly clear that sleep and mental health are deeply interconnected. Their relationship is bidirectional: poor sleep can contribute to the development of mental health disorders, while many psychiatric conditions, in turn, disrupt sleep quality.

Cognitive and emotional functions of sleep While we sleep, the brain carries out a number of essential tasks. Among the most important are consolidating memories and regulating emotions. When sleep is too short or constantly interrupted, these processes are impaired, leading to consequences that affect both cognitive performance and emotional balance.

Sleep deprivation and emotional regulation One of the clearest effects of sleep deprivation involves emotional regulation. Neuroimaging studies show that after a night without sleep, the amygdala—a key structure involved in emotional responses—becomes more reactive to negative stimuli, while the prefrontal cortex, which normally helps us control and modulate

emotions, loses part of its regulatory capacity. The result is greater vulnerability to irritability, anxiety and impulsive reactions.

Sleep

disorders

and

psychiatric

the ability to cope with it. This is particularly relevant today, when many factors—work, technology, fast-paced social rhythms—tend to squeeze the time we dedicate to rest.

disorders

It is not surprising that sleep disorders and mental health conditions are closely linked.

Sleep disturbances, for example, are among the most common symptoms of major depression— including insomnia, meaning difficulty falling or staying asleep, but also hypersomnia, characterised by excessive sleepiness.

Similarly, anxiety disorders often come with trouble falling asleep or frequent awakenings, creating a vicious cycle: the worse you sleep, the more anxiety and worry increase, and these, in turn, make sleep even harder.

Sleep and bipolar disorder More complex conditions, such as bipolar disorder, show an especially close connection with the sleep–wake cycle. Sleep disturbances can precede manic or depressive episodes, making sleep monitoring an important clinical tool for anticipating and preventing relapses. In these cases, stabilising circadian rhythms becomes a key part of treatment.

Sleep and stress resilience One aspect that is often underestimated is the impact of sleep on resilience to stress.

Getting enough sleep allows the brain to process and integrate the day’s emotional experiences, reducing the intensity of stress responses.

Conversely, sleep deprivation heightens the perception of stress and weakens

Sleep and cognitive function The relationship between sleep and mental health also extends to cognitive functioning. Attention, memory and decision-making rely heavily on good-quality sleep.

Chronic sleep deprivation can mimic—even if only mildly— some of the deficits seen in neurocognitive disorders, and over time may contribute to cognitive decline.

Circadian rhythms and light Another crucial factor is the circadian rhythm — the internal biological clock that regulates the sleep–wake cycle. This system is strongly influenced by light and daily routines. Exposure to bright screens in the evening can delay melatonin production, making it harder to fall asleep. Likewise, irregular sleep and wake times can throw the internal clock off balance, with negative effects on mood and emotional stability.

Sleep hygiene and prevention Sleep hygiene strategies also play a key role. Maintaining regular sleep schedules, reducing the use of electronic devices before bed, creating a restfriendly environment and limiting stimulants are simple yet often effective measures. However, when sleep disorders are persistent or severe, a specialist assessment is essential to identify any underlying conditions.

Sleep as a biological necessity Finally, it is worth emphasising that sleep is a biological necessity in a culture that often prioritises productivity and performance— and where sleep is frequently sacrificed as if it were ‘wasted’ time. In reality, it is precisely during sleep that the brain restores itself and prepares for the challenges of the next day. Promoting quality sleep means investing directly in psychological wellbeing and brain health. For clinicians, this means integrating sleep assessment into everyday practice; for everyone, it means recognising that sleeping well is not just a matter of rest, but an essential pillar of overall health.

Clinical interventions for sleep From a clinical perspective, addressing sleep issues is a powerful therapeutic tool. Approaches such as cognitive behavioural therapy for insomnia (CBT-I) have been shown to be effective not only in improving sleep, but also in reducing symptoms of depression and anxiety. In some cases, better sleep comes first—and mood improvement follows, suggesting a causal rather than merely correlational link.

UniCamillus Magazine | Summer

21

Brain health, sleep and social capital: the role of relationships in building well-being Professor Vera Kopsaj

Researcher at UniCamillus, she holds a double degree in Sociology from the University of Trento and the Catholic University

of

Eichstätt-Ingolstadt,

and

a PhD in Sociology and Applied Social Sciences from Sapienza University of Rome.

She has gained experience in research and teaching at Sapienza University of Rome, Universitas Mercatorum, and AUXILIUM – Faculty of Educational Sciences. She currently

collaborates

with

Sapienza’s

Department of Statistical Sciences as part of the European project “Erasmus for All”.

22

UniCamillus Magazine | Summer

I

n the current debate on brain health, sleep is predominantly studied through its biological and neurophysiological dimensions, linked to neurochemical mechanisms and circadian rhythms.

Whilst this perspective is essential, it does not fully capture the social and relational complexity that shapes brain health. A sociological lens, instead, broadens the interpretative framework, showing how cognitive wellbeing emerges from the continuous interplay between body, mind, social relationships and the organisation of collective life. In this view, the brain is not an isolated organ, but a living system deeply embedded in society.

From this perspective, Heinz von Foerster’s insight offers an extraordinarily relevant theoretical framework.

His cybernetic and systemic approach allows us to view the brain not as an empty, isolated entity, but as a mind ‘inhabited’ by relationships, memories, languages and social experiences (von Foerster, 1987 [1981]). This radically overturns the idea of a closed, autonomous mind separated from the social world. The brain appears instead as a relational hub, an open system that takes shape through interactions with others and with the environment. Emotions, cultural expectations, symbolic structures and collective experiences continually permeate mental life and help shape it.

Gordon Pask’s (1959) reflections on self-organising systems also align with this perspective. According to him, networks and organisms are not closed, immutable realities, but dynamic systems that emerge through ongoing interaction with their environment. Organisation, therefore, arises from processes of relation, adaptation and exchange.

The brain as a relational system open to society

The image proposed by von Foerster vividly illustrates this idea, showing how the mind contains not only biological processes, but also presences, connections and fragments of social life. Within the brain we find emotions, relational networks, communities, work, power, institutions, fears and desires. The mind, therefore, cannot be separated from the society that permeates and shapes it. This perspective also allows us to interpret a famous illustration published by Look Magazine in

1938 in a different light; in it, the brain was depicted as a vast factory organised into offices, control rooms and specialised operators.

The image perfectly reflected the modern, industrial mindset of the time, in which the brain was viewed as an efficient, orderly and productive machine, governed by a mechanical and centralised logic. Today, however, we know that cognitive functioning cannot be reduced to a merely technical system within the individual.

The brain is constantly shaped by social relationships, living conditions and the cultural environment. It is precisely this insight that makes it necessary to examine the link between the social aspects of life, sleep and cognitive wellbeing.

Brain health, in fact, is not simply the absence of neurological disease. The World Health Organisation defines it as a multidimensional condition that encompasses cognitive, emotional, psychological and

F igure 2 - T he mind as a factory : a mecha F igure 1 -T he brain as a relational hub H einz von F oerster (1987 - 1981)

nistic view of the brain

social aspects throughout the life course (WHO, 2022). Brain health is therefore a dynamic and continually shifting balance, influenced by the material conditions of existence, social relationships, the quality of the environment and opportunities for participation in social life.

Within this framework, the social determinants of health play a decisive role. The model developed by Dahlgren and Whitehead (1991) clearly shows how health depends on a layered structure of interconnected factors: individual lifestyles, social and community networks, housing conditions, work, education, access to services and the socio-economic structure.

When applied to brain health, this model highlights how cognitive functioning is closely linked to social opportunities. Economic, educational and geographical inequalities do not merely result in differences in income or access to healthcare, but also in unequal opportunities for cognitive development, emotional regulation and protection against decline.

The sociology of health allows us, therefore, to move beyond biological reductionism and to view the brain as a product of historical, cultural and economic contexts.

Contemporary neuroscience confirms what sociology had already identified, namely that social isolation, precariousness and chronic stress reshape neurobiological processes, alter emotional regulation and affect the quality of sleep and cognitive functions.

S ource : L ook M agazine (1938)

UniCamillus Magazine | Summer

23

F igure 3 - T he social determinants of health

Sleep, society and the rhythms of contemporary life

Sleep is one of the most obvious examples of this interdependence between biology and society.

Sleeping is not a purely natural act.

We sleep when social conditions allow us to do so. We sleep when work ends, when urban noise levels decrease, when financial worries ease, when relationships provide emotional security, and when time is not entirely consumed by productivity. Sleep is therefore a socially organised biological practice.

Contemporary society, however, is marked by a profound contradiction: we are increasingly digitally connected and, at the same time, increasingly lonely. Technological hyperconnectivity has radically transformed our relationship with time, eroding the boundaries between work, rest and private life. Smartphones, constant notifications, permanent availability and information overload generate a state of continuous activation that makes it increasingly difficult to interrupt cognitive processes and access

24

UniCamillus Magazine | Summer

rest. In this context, three closely intertwined dimensions emerge: hyper-connectivity, insomnia and isolation. Insomnia cannot be interpreted solely as an individual clinical disorder; it also represents the social symptom of an accelerated, performancedriven society oriented towards continuous efficiency. Jonathan Crary (2013) has described the contemporary world as a “24/7 society”, a system in which capitalism tends to eliminate all interruptions, imposing permanent continuity between production, consumption and connection. In this context, sleep represents one of the last forms of biological resistance to the logic of constant availability.

Sleeping means temporarily withdrawing from productivity, interrupting the ceaseless flow of stimuli, communications and performance demands imposed by the contemporary social system.

For this reason, sleep time is gradually being ‘colonised’ and squeezed, whilst rest is increasingly seen as unproductive time that must be reduced, controlled

or optimised. The culture of performance values constant availability, continuous efficiency and the ability to remain active at all times, transforming sleep deprivation almost into a badge of success and dedication.

Yet it is precisely this tension that reveals the profoundly human and irreducible nature of sleep. It is no coincidence that sleep deprivation has historically been regarded as one of the most extreme forms of torture. Depriving someone of sleep means compromising their emotional regulation, cognitive clarity, sense of self and even their relational stability. Sleep, therefore, is not merely a physiological need, but a fundamental condition for cognitive, emotional and social balance.

This shift is deeply cultural. The dominant values of contemporary societies—performance, speed, competitiveness, constant availability—contribute to the devaluation of rest. Sleeping little is often associated with dedication, success and the ability to sustain intense rhythms. This creates a persistent tension between biological needs and social expectations. Sleep thus becomes a mirror of contemporary culture and its contradictions.

Social inequalities and their impact on cognitive wellbeing

Sleep is also a matter of inequality. Not everyone has the same opportunities to rest. Material conditions have a profound impact on sleep quality, as economic insecurity, overcrowded housing, job instability, night shifts, commuting and noisy environments disrupt circadian rhythms and increase stress levels. Social inequalities

therefore also translate into cognitive inequalities. Those living in vulnerable circumstances are more exposed to sleep deprivation and, consequently, to risks to their mental and brain health.

The issue of power takes on central importance here. Having control over one’s time is a form of social privilege. Those in higher social positions generally have greater capacity to organise their schedules, choose their working patterns and protect their rest.

Conversely, people in subordinate positions are often forced to adapt to imposed temporalities. Sleep therefore also becomes a political issue, as it reflects the distribution of power within society.

Social capital and relationships as the infrastructure of brain health

Alongside these structural factors, the relational dimension emerges as a decisive element of brain health. Human beings are, by their very nature, social creatures.

Sociability—understood not merely as a tendency to be with others, but as the ability to forge belonging, support networks and meaningful relationships— constitutes a core resource for cognitive wellbeing. Émile Durkheim (1897), in his analysis of suicide, had already highlighted the protective role of social integration. The loss of bonds, belonging and collective reference points creates conditions of vulnerability and individual fragmentation. Today, we can reinterpret this insight in the light of social neuroscience, which suggests that relationships act as emotional regulators, reduce stress and continuously stimulate the brain through language, empathy and symbolic exchange.

Through the concept of social capital, Robert Putnam (2000) also demonstrated how trust, civic participation and community networks represent essential resources for collective wellbeing.

Societies with higher levels of social cohesion tend to enjoy better health, less isolation and a higher quality of life. Social interaction thus becomes a genuine social infrastructure for cognitive health.

In this sense, the brain is constantly ‘trained’ by relationships.

Social interactions promote cognitive stimulation, emotional adaptation and interpretative skills.

Social isolation, by contrast, is one of the main risk factors for cognitive decline and psychological distress.

Chronic loneliness is associated with increased vulnerability to depression, neuroendocrine changes and a deterioration in sleep quality. This creates a circular relationship between sleep and social connection. Positive relationships foster emotional security and the quality of rest; adequate sleep, in turn, improves empathy, emotional regulation and interpersonal skills. Conversely, isolation and sleep deprivation reinforce one another in a vicious cycle that undermines cognitive wellbeing.

Von Foerster’s reflections therefore enable us to understand brain health as a systemic phenomenon.

The brain is not a closed structure confined within the skull, but a reality that emerges from interactions with the environment.

Emotions, sleep, language and cognitive processes arise from dynamics of social co-construction.

The mind, in fact, is not separate from society, but constitutes one of its deepest expressions.

Promoting brain health therefore means addressing not only clinical factors, but also the social conditions that enable wellbeing. It means rethinking cultural models of productivity, reducing inequalities that compromise sleep, safeguarding time for rest, and fostering meaningful social relationships. Brain health cannot be entrusted solely to medicine, because the brain is not merely a biological organ; it thrives on the relationships we form, the experiences that transform us, the bonds that sustain us and the social conditions that shape our daily lives. Sleep, the quality of our human connections, and the time we have to rest, to be with others or simply to pause, also have a profound impact on cognitive and emotional wellbeing.

For this reason, talking about brain health also means talking about the society in which we live—its ever-accelerating pace, the inequalities and conflicts that create vulnerability, but also the capacity to build more inclusive communities, meaningful relationships and forms of social protection capable of supporting people’s wellbeing throughout their lives.

UniCamillus Magazine | Summer

25

Changes

in

sleep

architecture

with ageing and their impact on cognitive functions Professor Valentina Alfonsi

Associate Professor at UniCamillus, she holds a degree in Psychology, specialising in Cognitive Neuroscience and Psychological Rehabilitation, from Sapienza University of Rome, where she also obtained her PhD in Psychology and Cognitive Science.

She has carried out research at the Sleep Psychophysiology

Laboratory,

focusing

on the study of electroencephalographic activity and the effects of drowsiness on attentional and cognitive functions.

26

UniCamillus Magazine | Summer

S

leep is a fundamental pillar of our wellbeing.

Just think that we spend around a third of our lives sleeping and during this time the brain carries out essential functions that support our physical and mental health. These include consolidating information acquired whilst awake, regulating the metabolic and immune systems, and eliminating potentially harmful substances accumulated during the day.

Sleep and physiological changes with ageing As we grow older, sleep undergoes a number of changes.

In older adulthood, people tend to sleep fewer hours than in earlier stages of life, in line with the different developmental challenges typical of each age group.

Newborns may sleep for up to 16–17 hours a day, as sleep is essential for supporting rapid growth and brain development. During childhood and adolescence, the number of hours required gradually decreases, although it remains high, before stabilising in adulthood at around 7–9 hours per night.

In older people, the number of night-time awakenings also increases and, as a result, the perception of having slept restfully tends to decline. Furthermore, the time it takes to fall asleep―that is, the time required for the process of falling asleep to begin―also increases at this stage of life.

Sleep consists of cycles that repeat several times throughout the night and comprise two main stages: REM (Rapid Eye Movement) sleep and non-REM (NREM) sleep. REM sleep, characterised by rapid eye movements and brain activity that appears similar to wakefulness (despite muscle immobility), is often the setting for dream activity and undergoes a progressive reduction over the lifespan, reaching its lowest proportion in older adulthood. NREM sleep, on the other hand, is the deepest and most restorative stage, during which the main mechanisms of memory consolidation take place.

In older people, this type of sleep also decreases, although a larger proportion is preserved compared with REM sleep. Overall, both the duration and number of REM and NREM cycles progressively decline across the lifespan.

Therefore, both quantitative and qualitative changes― that is, those related to sleep architecture―occur naturally in the elderly population. Although these changes are physiological, they can significantly influence quality of life and affect cognitive performance, contributing to a higher risk of cognitive decline and dementia. Understanding the relationship between sleep and ageing is therefore essential for promoting healthy ageing.

Another important aspect of this change concerns circadian rhythms―the biological processes that follow a cycle of approximately 24 hours and regulate not only sleep, but also body temperature, hormone secretion and numerous other functions. In older people, a phase advance is often observed: they tend to fall asleep earlier in the

evening and wake up earlier in the morning. Furthermore, there is a reduction in the amplitude of daily fluctuations in key physiological parameters (temperature, cortisol, melatonin), unlike what occurs in adulthood.

Brain electrical activity during sleep also changes with age. In particular, there is a decrease in slow-wave sleep and sleep spindles, two electrophysiological phenomena that play a crucial role in learning and memory processes.

Slow-wave sleep characterises deep sleep and is involved in brain recovery processes. Sleep spindles, on the other hand, are brief bursts of electrical activity that support the consolidation of information learnt during the day.

Numerous studies have shown that a reduction in these phenomena is associated with a lower ability to store and retrieve memories. For this reason, sleep in older people is not simply ‘shorter’, but can become less efficient in supporting cognitive functions.

Factors and sleep disorders in older people

Many aspects of daily life can contribute to a decline in sleep quality as we age. These include: • Reduced physical activity; • Unhealthy sleep habits; • Poor diet; • Increased social isolation; • Chronic pain; • Organic diseases; • Anxiety, depression and other mental health conditions; • Use of medicines that may interfere with sleep.

These factors often combine, creating a vicious cycle that progressively disrupts sleep.

Among all sleep disorders, insomnia is the most common in the general population and also among older people. It typically manifests as difficulty falling asleep (initial insomnia), frequent awakenings during the night and an inability to maintain uninterrupted sleep (middle insomnia), or waking up too early in the morning (terminal insomnia).

Other particularly common disorders in this age group include: • obstructive sleep apnoea syndrome (OSAS), characterised by repeated episodes of apnoea during sleep; • restless legs syndrome; • circadian rhythm disorders; • excessive daytime sleepiness; • periodic limb movements during sleep.

These conditions not only compromise the quality and quantity of night-time sleep, but are also linked to the onset of problems involving attention, memory, mood and cardiovascular health.

The glymphatic system and the role of sleep in brain health

One of the most extensively studied areas of sleep research in recent years concerns the socalled ‘glymphatic system’, a specialised mechanism that clears waste from the brain. During sleep, the brain is thought to activate a sophisticated ‘cleansing’ mechanism that enables the removal of metabolic waste products and potentially toxic proteins via the cerebrospinal fluid.

Deep sleep (or ‘slow-wave’ sleep) is the primary stage in which this UniCamillus Magazine | Summer

27

mechanism occurs, contributing to the maintenance of brain health. As a result, when sleep is non-restorative or reduced, this detoxification process becomes less efficient, increasing the risk of toxic waste accumulation within the brain environment.

Sleep and Alzheimer’s disease One of the pathological conditions most frequently associated with the accumulation of neurotoxic substances in brain tissue is Alzheimer’s disease.

This condition is the most common form of dementia and is characterised by progressive memory loss and the deterioration of other cognitive functions. Its neurobiological hallmark is the accumulation of beta-amyloid plaques and neurofibrillary tangles composed of the tau protein. In older people with Alzheimer’s disease, sleep disturbances have traditionally been described as a natural consequence of the underlying condition.

We now know, however, that the relationship between sleep disturbance and Alzheimer’s is bidirectional. On the one hand, the presence of neurobiological changes associated with the disease disrupts sleep physiology, particularly reducing slowwave sleep. On the other hand, disturbed sleep can indirectly promote the accumulation of these neurotoxic proteins, accelerating neurodegenerative processes and the onset of the disease in predisposed individuals. A vicious cycle is thus triggered: the disease worsens sleep, and disturbed sleep can in turn negatively influence both the onset and progression of Alzheimer’s.

28

UniCamillus Magazine | Summer

Sleep: a protective factor for healthy ageing

Just as sleep disturbances predispose individuals to the onset of numerous disorders, goodquality sleep is associated with better cognitive performance over time. In particular, several factors have been linked to healthy ageing: • good-quality sleep; • no history of sleep disturbances; • moderate and regular sleep duration.

Sleep therefore appears to be one of the key contributors to longevity, as demonstrated by the phenomenon of the so-called ‘Super-agers’: people over the age of 80 who possess cognitive abilities comparable to individuals 20 or 30 years younger. These individuals show excellent performance in memory, attention, executive functions, language and cognitive flexibility. They also display greater social engagement, better mental health and preservation of brain structure and connectivity. Among the factors associated with this extraordinary ageing process, superior sleep quality also stands out, suggesting that sleeping well may help keep the brain young for longer.

In conclusion, ageing brings about inevitable changes in sleep.

However, these changes often coexist with other factors typical of older adulthood which, taken together, may represent risk factors for the onset of multiple diseases.

Promoting good-quality sleep through healthy lifestyles, early diagnosis of sleep disorders and targeted interventions could be one of the most effective strategies

for supporting healthy ageing and preserving cognitive function over time.

UniCamillus Magazine | Summer

29

ACADEMIC LIFE

Sleeping to protect the brain: the role of sleep in neurodegenerative diseases

W

e spend about a third of our lives sleeping.

Yet, until not so long ago, sleep was mainly considered a period of inactivity, a necessary break to recharge our batteries.

Today we know that this is not the case at all.

When we sleep, the brain continues to work: it consolidates memories, processes emotions, regulates numerous biological processes and activates mechanisms that are essential for maintaining the health of the nervous system.

But there is more. An increasing number of studies are highlighting the link between sleep quality and neurodegenerative diseases, from Alzheimer’s disease to multiple sclerosis. It is a complex, two‑way relationship: some conditions can disrupt sleep, but chronically disturbed sleep can, in turn, contribute to processes of neuroinflammation and degeneration.

Interview by Claudia Romano with Sleep could therefore be not only an indicator of the health Susanna Cordone, Lecturer in of the brain, but also a potential target for prevention and treatment.

Social Psychology at UniCamillus Professor Susanna Cordone, a lecturer in General and Occupational Psychology at UniCamillus University and a researcher into the relationship between sleep and neurodegenerative diseases, explains what happens in our brains during the night and what the current prospects for research are.

Sleep is often regarded as a time when the brain ‘rests’, but research shows that fundamental processes take place whilst we sleep. What happens to our brain whilst we sleep?

“The idea that sleep is a passive state, a sort of ‘shutdown’ of brain activity, has now been largely disproved.

Today we know that during sleep the brain is active and engaged in a genuine process of maintenance and restoration of many functions that are fundamental to our health. Specifically, during the deep sleep phases—known as non‑REM sleep—memory consolidation takes place: the brain selects the day’s important memories and transfers them to long‑term storage, discarding superfluous information. Furthermore, the so‑called glymphatic system is activated—a brain‑cleansing mechanism that removes toxins and metabolic waste accumulated whilst we are awake. During the REM phase, on the other hand, brain activity is so intense that it resembles that of wakefulness: this is the phase in which we dream the most and process our emotions”.

Is there a two-way relationship between sleep disorders and neurodegenerative diseases: could disturbed sleep be an early sign of the disease, or could it contribute to its progression?

“Absolutely, and this is one of the most important areas of current neuroscientific research, on which I have focused extensively in my recent publications. We are not dealing with a simple cause‑and‑effect relationship, but with a genuine vicious cycle, or bidirectional model. In the reviews and studies I have published in recent years, focusing on both Alzheimer’s disease and multiple sclerosis, we have analysed precisely this mechanism. On the one hand, the neurodegenerative process progressively damages the brain structures and neurochemical circuits that regulate the sleep‑wake cycle, causing insomnia or fragmented sleep.

On the other hand, chronically disturbed sleep compromises the brain’s cleansing and plasticity mechanisms,

30

UniCamillus Magazine | Summer

contributing to the accumulation of neurotoxic substances and fuelling chronic neuroinflammation. Altered sleep is therefore not merely a side effect: it is both a potential early biomarker of the disease and a factor that may contribute to its clinical progression”.

Focusing on Alzheimer’s disease: what is the current scientific evidence regarding the link between sleep disturbances and the development or progression of the condition?

“The evidence suggests that sleep deprivation promotes the accumulation — and the failure to clear—two key proteins associated with Alzheimer’s: beta‑amyloid and tau protein. When deep, slow‑wave sleep is chronically reduced or fragmented, the mechanisms involved in clearing these substances may be compromised.

In my own research focusing specifically on patients with Alzheimer’s, we used electroencephalography (EEG) to investigate how microstructural changes in sleep—such as a reduction in specific brain oscillations— are directly associated with anatomical changes in the brain, such as a reduction in cortical thickness. This suggests that the deterioration in sleep quality may both reflect and, at the same time, contribute to structural neuronal damage”.

Can sleep disturbances occur even many years before the cognitive symptoms of Alzheimer’s? Could they therefore serve as an early warning sign?

“Yes, sleep disturbances can precede the memory impairment typical of Alzheimer’s by as many as several years. This happens because neurodegenerative processes can begin at a microscopic level long before clinical manifestations appear. Early identification of these changes in sleep structure and quality therefore provides us with a clinically valuable time window. As we have highlighted in our scientific work, identifying these abnormalities before significant cognitive decline emerges can help us recognise those most at risk. Altered sleep can thus become an important biological warning sign, enabling us to consider protective strategies at a stage when neuronal damage may not yet be irreversible”.

Turning to multiple sclerosis: what are the main sleep disturbances observed in patients, and how might they affect the course of the disease and quality of life?

“Sleep disorders affect over half of patients with multiple sclerosis. In my most recent studies, published in international journals such as the Journal of Integrative Neuroscience and Autoimmunity Reviews, I have explored this link in greater depth. The most common sleep disturbances in patients include insomnia and fragmented sleep. In multiple sclerosis, poor‑quality sleep can act as a key modulator of immune function: chronic sleep disturbance can exacerbate neuroinflammation, ultimately having a negative impact on the progression of physical and cognitive disability. All of this can have significant consequences for daily quality of life and for a person’s ability to carry out their professional activities effectively”.

In multiple sclerosis, symptoms such as fatigue, pain and mood changes are often discussed. To what extent can inadequate sleep contribute to the worsening of these symptoms?

“The impact can be very significant and is at the heart of our clinical and research focus. Fatigue is perhaps the most debilitating and common symptom reported by patients with multiple sclerosis. The scientific literature highlights the existence of a complex, multifactorial interaction: non‑restorative sleep prevents adequate recovery and can exacerbate daytime exhaustion. Furthermore, sleep deprivation can lower the pain threshold and alter the neurochemical balance associated with mood disorders, such as anxiety and depression. Improving sleep therefore means addressing one of the possible elements of this vicious cycle, with the aim of simultaneously alleviating fatigue, pain and emotional vulnerability”.

UniCamillus Magazine | Summer

31

ACADEMIC LIFE How important is it to assess and treat sleep disorders in patients with neurodegenerative diseases? Can sleep become a genuine therapeutic target?

“This is precisely the key message we are seeking to promote through our scientific publications. In a systematic review I co‑authored in the journal Pharmaceuticals, we analysed therapies and interventions focused on sleep across the entire course of Alzheimer’s disease, from prevention to the treatment of the most advanced stages. The conclusion is clear: sleep should no longer be regarded as a secondary symptom or an inevitable side effect, but as a potential primary and strategic therapeutic target. Optimising sleep through targeted interventions can help support the brain’s defence mechanisms, counteract neurodegenerative processes and tangibly improve patients’ cognitive functions and independence”.

What tools are currently available for studying sleep in patients?

“Modern research is based on a multimodal and technological approach. The gold standard remains polysomnography (PSG), which simultaneously records brain activity via EEG, eye movements, muscle tone and cardiorespiratory parameters throughout the night. In laboratories, analysis goes beyond the visual interpretation of macro‑stages of sleep to include advanced quantitative analysis of the EEG signal. This makes it possible to extract and quantify specific microstructures, such as K‑complexes and sleep spindles. These microscopic parameters can serve as sensitive indicators of the state of health—or of any deterioration—of the central nervous system”.

Can a good night’s sleep really help prevent cognitive decline?

“The scientific evidence we have suggests that sleep is a fundamental pillar of prevention and neuroprotection.

In our publications, we often emphasise how regulating sleep can be a promising strategy right from the very early stages of the ageing process. Taking care of your sleep helps support the efficiency of the mechanisms that remove waste products from the brain and preserve the plasticity of our synapses. Educating the public about good sleep hygiene—an issue very close to my heart, also as a lecturer in Psychology at UniCamillus—is therefore not only a matter of general wellbeing, but can become a genuine preventive and public health measure to help combat neurodegeneration in the population”.

32

UniCamillus Magazine | Summer

«The idea that sleep is a passive state, a sort of ‘shutdown’ of brain activity, has now been largely disproved.

We now know that during sleep the brain is active and engaged in a genuine process of ‘maintenance’ and restoration of many processes that are fundamental to our health [...]

during the stages of deep sleep – known as non-REM sleep – memory consolidation takes place: the brain selects the day’s important memories and transfers them to long-term storage, discarding unnecessary information.

In the REM stage, on the other hand, brain activity is so intense that it resembles that of wakefulness: this is the stage in which we dream the most and process our emotions.»

UniCamillus Magazine | Summer

33

ACADEMIC LIFE

Sleep and addiction: when sleeping pills become a risk Sleep is a fundamental physiological function, regulated by our biological rhythms. Yet, in contemporary society, more and more people are struggling to fall asleep or to maintain a good quality of sleep.

Difficulty sleeping can lead to a search for quick fixes, including the use of hypnotic drugs. But when does therapeutic support risk turning into a problem?

We discussed this with Professor Angelo Icro Maremmani, a psychiatrist specialising in addictions and a lecturer in Psychiatry at UniCamillus.

Professor Maremmani, sleep is a natural need. Why does it often seem necessary to ‘induce’ it these days?

“Sleep is a physiological need that should follow our natural circadian rhythm. However, modern society often imposes very fast‐paced lifestyles, prolonged commitments and constant Interview by Claudia Romano with exposure to stimuli, even in the evening. As a result, we are Angelo Icro Maremmani, Lecturer not always able to follow our natural rhythms. The hustle and in Social Psychology at UniCamillus bustle of daily life, personal or work‐related worries, and the habit of staying constantly connected can keep the brain in a state of activation, making the transition from wakefulness to sleep more difficult. Just think of younger people, who tend to go to sleep later and later due to their use of smartphones and social media. In many cases, therefore, it is not sleep itself that has lost its natural rhythm: it is our habits and environmental conditions that interfere with the physiological mechanisms of falling asleep”.

People suffering from insomnia often look for an immediate solution and turn to medication.

Where is the line between appropriate use and problematic use?

“There are various medicines with a hypnotic effect, including benzodiazepines and the so‐called ‘Z‐drugs’.

These medicines can be useful in specific situations and, generally, for limited periods, in accordance with the indications given by the medical practitioner and the patient information leaflet. They can be used, for example, to temporarily manage a significant disruption to the sleep‐wake cycle or a short‐term episode of insomnia. The line between normal and problematic use is crossed when the medication becomes a habitual and ongoing solution, especially if the insomnia is a symptom of an underlying condition—such as an anxiety or depressive disorder—which is not properly recognised and treated. In such cases, the hypnotic may continue to help the person fall asleep, but it does not address the root cause of the problem.

The person may therefore come to believe that they can no longer sleep without taking it. Over time, tolerance may develop—that is, the need to increase the dose to achieve the same effect—as well as physical dependence, leading to rebound insomnia or other withdrawal symptoms upon discontinuation”.

How does a need for treatment turn into a possible addiction?

“The initial purpose of a hypnotic is certainly therapeutic: to offer relief to someone who cannot sleep.

The problem can arise when treatment is prolonged beyond the recommended period, without reassessing the causes of the insomnia and the actual need for the medication. With continued use, the body can adapt to the presence of the substance. Tolerance thus develops: the dose that was initially sufficient no longer produces the same result. At the same time, physical dependence may set in. When the medication is not

34

UniCamillus Magazine | Summer

taken, withdrawal symptoms may appear, often contrary to its therapeutic effects. In the case of hypnotics, discontinuation can therefore lead to a worsening of the insomnia itself.

In general, medicines with a very rapid onset of action and a short duration of effect are most closely associated with a risk of misuse. Precisely because the benefit is felt immediately, they can foster a particularly strong psychological association between taking the medicine and the ability to sleep. The risk, however, depends not only on the active ingredient, but also on the dose, the duration of treatment, the method of use and the individual’s characteristics”.

Are some people more vulnerable to the risk of developing an addiction?

“Some people are more vulnerable. These include those who have already developed a substance‐use disorder—particularly involving alcohol, opioids or other sedative substances—and those with a family history of addiction problems. Particular care is also needed when insomnia is associated with anxiety or depressive disorders. In such cases, the person may attribute to the medication not only the ability to promote sleep, but also that of temporarily alleviating anxiety, emotional tension or psychological distress.

This can strengthen the bond with the medication and encourage its increasingly frequent use. Vulnerability does not imply that dependence will necessarily develop, but it does suggest the need for more cautious prescribing, regular monitoring and a comprehensive assessment of the patient’s psychological health”.

Is there a two-way relationship between sleep and addiction?

“Yes, the relationship between sleep and addiction is two‐way. On the one hand, persistent insomnia can lead a person to turn to medication, alcohol or other substances more and more frequently in an attempt to fall asleep. On the other hand, the continued use of these substances can further alter the quality and architecture of sleep. A common example is alcohol. There is a common belief that excessive alcohol consumption in the evening can, to some extent, help one sleep more deeply. The reality is the opposite: alcohol tends to make sleep more fragmented, superficial and less restorative, leading to night‐time and early‐morning awakenings.

Stimulants can also profoundly disrupt the sleep‐wake cycle, whilst stopping sedatives can cause insomnia, agitation and disturbances of the autonomic nervous system”.

What signs might indicate that one’s relationship with a sleeping pill is becoming risky?

“An early sign is the shift from occasional use to daily, automatic intake. Other warning signs include the need to increase the dose, anxiety at the thought of running out of tablets, and attempts to take the medication earlier than usual. It is also significant if you are no longer able to sleep when you try to go without it.

After prolonged use, discontinuation must be planned in consultation with a medical practionner, as withdrawal symptoms can be severe and, in some cases, clinically significant”.

Is it possible to start sleeping again without medication?

“Thankfully, yes. The process can take time and must be tailored to the individual, but in most cases it is possible to gradually reduce the medication and regain a more natural sleep. The reduction must be carried out gradually and under medical supervision. Abrupt withdrawal, particularly after prolonged use or at high doses, can cause significant rebound insomnia, anxiety, agitation and other withdrawal symptoms. At the same time, it is necessary to address the underlying causes of the insomnia: poor habits, stress, anxiety or depressive disorders, disruptions to the circadian rhythm and other medical conditions. The aim is not simply to stop the medication, but to help the person regain a stable balance in their sleep‐wake cycle”.

How important are non-pharmacological approaches?

“They are essential. Cognitive behavioural therapy specifically for insomnia helps to change both the behaviours and the thoughts that perpetuate the disorder. It enables, for example, a reduction in anticipatory worry linked to the fear of not being able to sleep, and helps to re‐establish a healthy association between bed and sleep. Sleep hygiene also plays an important role. It is helpful to maintain as regular a schedule as possible, reduce evening exposure to electronic devices and intense stimuli, avoid caffeine and other stimulants later UniCamillus Magazine | Summer

35

ACADEMIC LIFE in the day, and limit afternoon naps, especially when they interfere with falling asleep in the evening. It is also important to set limits on working hours, take regular exercise and follow a balanced diet, avoiding heavy meals and alcohol consumption in the evening. These may seem like general recommendations, but when applied consistently, they make a tangible contribution to normalising autonomic nervous system rhythms”.

What are the most common mistakes made by people suffering from insomnia?

“One of the most common mistakes is to seek an immediate solution without addressing the root causes of the problem. Insomnia is often seen as an obstacle to be quickly eliminated, particularly because daily life demands efficiency and productivity. It can therefore happen that people immediately turn to medication, without assessing any underlying psychological or medical conditions. It is also risky to increase the dose on one’s own or to combine the medication with alcohol or other sedative substances”.

What is the most important piece of advice for those who fear they can no longer manage without sleeping pills?

“The first step is to discuss it with your GP or a specialist. Dependence on hypnotics should not be seen as a lack of willpower, but as a clinical condition that can be managed with the right treatment plan. It is important not to stop treatment abruptly. The medical practitioner can assess how long the medication has been taken, the dosages, any drug interactions and the presence of other conditions. The treatment plan generally involves a gradual reduction in the medication, accompanied by lifestyle changes and treatment of the conditions that have contributed to the insomnia”.

What will be the future challenges for research?

“One of the main challenges will be to recognise sleep as a central component of health rather than a secondary aspect. Sleep disturbances affect quality of life and can increase vulnerability to various psychiatric disorders and addictions. It will therefore be necessary to develop effective and safe treatments capable of improving sleep without promoting tolerance or dependence. Another key objective will be to raise awareness, both amongst patients and healthcare professionals, of the risks associated with the prolonged use of hypnotics. If insomnia persists every night, the need for treatment also becomes a daily one: what begins as an occasional treatment can, almost imperceptibly, turn into chronic use. For this reason, information, prevention and early diagnosis remain essential tools for promoting a healthier relationship with sleep and with the available treatments”.

36

UniCamillus Magazine | Summer

«One of the main challenges will be to recognise sleep as a central component of health rather than a secondary aspect. Sleep disturbances affect quality of life and can increase vulnerability to various psychiatric disorders and addictions [...]

if insomnia persists every night, the need for treatment also becomes a daily one: what begins as an occasional treatment can, almost imperceptibly, turn into long-term use.

For this reason, information, prevention and early diagnosis remain essential tools for promoting a healthier relationship with sleep and with the available treatments.»

UniCamillus Magazine | Summer

37

ACADEMIC LIFE

U ni Camillus looks to the future and doubles its presence in V eneto: a new campus focusing on medicine and healthcare professions i s b e i n g e s t a b l i s h e d i n Ve n i c e M e s t r e .

Some projects highlight how much we’ve grown. Others embody a vision. The new UniCamillus Campus in Venice Mestre falls into the second category: it is a tangible sign of a journey that began years ago and is now ready to enter a new phase, reinforcing the University’s commitment to training future healthcare professionals. Following on from Rome, Venice Lido and Cefalù, UniCamillus is further expanding its presence with a new university centre focusing on medicine and healthcare sciences. This investment reflects the University’s growth and its commitment to providing students with increasingly advanced facilities, designed to support an education based on scientific excellence, innovation and a person‐centred approach.

Ever since its foundation, UniCamillus has stood out for its clear mission: training healthcare professionals with an international outlook and a solid clinical grounding, combining research, technology and a focus on the individual. The new campus in Venice Mestre now represents a natural evolution of this journey. The growing demand for medical and healthcare education has prompted the University to design new spaces capable of accommodating an ever‐expanding university community and offering students the tools they need to meet the challenges of modern medicine.

The building, which will cover approximately 11,000 square metres of the property in Piazzale San Lorenzo Giustiniani, will be transformed into a state‐of‐the‐art university environment: 2,300 square metres of lecture theatres, 700 square metres of cutting‐edge laboratories and medical simulation facilities, and 900 square metres of study spaces and student services will create a campus designed for an increasingly experiential and innovative education. There will also be a 250‐square‐metre catering area.

Once fully operational, the new centre will be able to accommodate around 2,600 students at any one time, becoming a new hub for UniCamillus’s educational programme and strengthening the University’s ties with the Veneto region, where it already has a presence at the Lido di Venezia.

“The opening of the Venice Mestre campus, which complements our long-standing presence on the Lido of Venice, represents a crucial step in UniCamillus’s development”, explains Rector Gianni Profita.

“With this new campus, we are responding to the growing demand for student enrolment and, at the same time, helping to address the need to train more healthcare professionals in Italy”.

The new campus is therefore established with a dual mission: supporting the University’s growth and contributing to the training of the professionals who will lead the healthcare sector of the future. Because every new lecture theatre, every laboratory and every space dedicated to students is much more than just a building: they are places where skills, passion and responsibility take shape.

With Venice Mestre, UniCamillus adds a new chapter to its history. A step that looks to the future, true to its identity: building tomorrow’s medicine today by training the people who will play a leading role in it”.

by Ginevra Guidoni

38

UniCamillus Magazine | Summer

Render of the new headquarters in Venice Mestre

UniCamillus Magazine | Summer

39

ACADEMIC LIFE

Sport connects people:

T

UniCamillus celebrates a season of excitement, dedication and victories

here are evenings when trophies tell a story that goes far beyond a victory: they speak of sacrifices, training sessions, friendships established on the pitch, defeats that teach us lessons, and objectives achieved together. The awards ceremony for the 2025/2026 Rome University Championships, hosted this year by UniCamillus, was just that: a great celebration of university sport, but above all of the people who make it happen every day.

The University opened its doors to athletes, managers, coaches, representatives of institutions and students from Rome’s leading universities, becoming the beating heart of a community which, for twenty years, has found in sport a common language capable of transcending differences, faculties and team colours.

The evening began with a welcome address by Professor Barbara Tavazzi, Head of the Faculty of Medicine and Surgery at UniCamillus, who highlighted how sport represents a fundamental component of university education, instilling respect, responsibility and teamwork.

Also at the event was a panel of institutional and sporting figures who support the growth of Rome’s university sports movement every year: Marco Parlanti (Spokesperson for the Rome Universities Sports Coordination Committee), Paolo Anedda (Vice-President of CONI Lazio), Svetlana Celli (President of the Rome City Council), Simone Foglio (President of Lazio DiSCo), Damiano Lembo (National President of USAcli) and Giampaolo Morsa (President of AiCS Lazio), highlighting an increasingly strong network between universities, institutions and the world of sport.

Twenty years of a history built together One of the most significant moments of the evening was the presentation of the 20th Anniversary Trophy, a symbolic award celebrating the twentieth anniversary of the Rome University Championships and the journey undertaken by a project that has now become a point of reference for thousands of students. The award was presented to Svetlana Celli and Simone Foglio for their steadfast support of the university sports movement.

There was also a touching moment during the presentation of the special awards to Daniele Masala, an Olympic modern pentathlon champion and former UniCamillus Rector’s Delegate for sporting activities, and to student-athlete Rebecca Scagnetto of the Campus Bio-Medico University, who excelled at the World University Championships with a gold medal in the mixed 4×50‐metre relay and two bronze medals in the 200‐ and 400‐metre finswimming events.

In his speech, Masala emphasised the symbolic value of this milestone: “Twenty years ago, some of you weren’t even born yet. But today you are here to celebrate the 20th anniversary of the Rome Universities Championships. And this is important, because it means that good things must endure over time, as they convey fundamental messages. Such as the message of sport, where ‘the important thing is not winning but taking part’, in order to understand the whole world through a universal language”, he said, quoting Monsignor Ethelbert Talbot in his homily during the 1908 London Olympics.

An invitation to look at the history of the Championships not merely as an anniversary, but as a reminder of a project capable of growing and engaging different generations of students.

Behind every match there is a community The evening also paid tribute to those who often work away from the spotlight. Thanks were extended to the heads of the universities that make up the Rome Universities’ Sports Coordination Committee, the referees who officiated the finals, and the referee selectors—all key figures in ensuring the quality and fairness of an event that continues to grow year on year. Because every championship thrives not only thanks to the athletes, but also thanks to those who plan, organise and make each match possible.

40

UniCamillus Magazine | Summer

When a medal tells a story The second part of the event was dedicated to the official award ceremonies for the various disciplines: football, five‐a‐side football, basketball, mixed volleyball, tennis and padel. Teams from across Rome’s universities took to the stage: from La Sapienza to Roma Tre, from LUISS to LUMSA, from Campus Bio‐ Medico to UniCamillus, right through to international universities such as John Cabot University and The American University of Rome.

The tournament was further enriched by the Erasmus teams and mixed teams, a testament to sport’s ability to foster integration, interaction and inclusion among students from different backgrounds and countries.

A season to remember for UniCamillus Amidst the evening’s applause, UniCamillus celebrated a highly successful season. In the 20th University Football Championship, the University secured third place in both the Champions League and the Europa League. In the 10th Men’s Five‐a‐side Football Championship, the team finished second in the Europa League, whilst in the 4th Men’s Basketball Championship they achieved a splendid victory by finishing top of the Europa League. The mixed volleyball team also provided plenty of excitement: in addition to second place in the Champions League, Saul Giovanni Orsini was named Best Player and coach Emanuela Todini received an award—symbols of a team that stood out for its technical quality and strong team spirit.

These results tell a story that goes far beyond a list of honours: they tell the story of students who have managed to balance their studies with training, growing together and proudly representing their University.

Sport as a lesson for life The true meaning of the entire event was summed up by Gianni Profita, Rector of UniCamillus: “Sport at university is not a secondary activity: it is a training ground for life. Here, you learn to compete without losing respect, to fall and get back up without losing your way, and to win without forgetting others. Seeing our students on the pitch, wearing the university jersey and with eyes full of energy, confirms that education comes not only from books, but also from the character we build together. And this, for a university, is a source of true pride”.

This is perhaps the most beautiful message to come out of the evening. League tables change, seasons come to an end and trophies find their place in display cabinets. What remains, however, is the value of a community that continues to believe in sport as an opportunity for growth, inclusion and sharing. And, once again, UniCamillus has shown that it aims to be not only a centre for academic education, but also a place where one learns to become a team, both on and off the pitch.

by Giusi Condorelli

UniCamillus Magazine | Summer

41

42

UniCamillus Magazine | Summer

UniCamillus Magazine | Summer

43

TERZA MISSIONE

B rain H ealth : when health becomes a dialogue between disciplines Prof.ssa Donatella Padua

A ss o c i a t e P r o f ess o r o f G e n e r a l S o c i o l o g y a t U n i C a m i l l u s a n d D e l e g a t e f o r t h e T h i r d M i ss i o n a n d S o c i a l I m p a c t

Prof.ssa Barbara Tavazzi

F u l l P r o f ess o r o f B i o c h e m i s t r y a t U n i C a m i l l u s a n d H e a d o f t h e M a s t e r ’ s D e g r ee P r o g r a m m e i n M e d i c i n e a n d S u r g e r y

As part of the 3rd Cycle of ‘Third Mission’ Conferences, ‘Where Science Meets Society’, an important interdisciplinary discussion took place at the University, dedicated to the theme ‘Brain Health: an integrated approach combining sleep medicine, mental health, nutrition and oral health’.

The initiative provided an opportunity for scientific and cultural reflection on a topic that is increasingly central to the international debate: brain health, understood not only as the absence of neurological disease, but as a complex balance between biological, psychological, relational and social dimensions.

The meeting clearly highlighted the extent to which brain health today requires a truly integrated approach.

Neuroscience, sleep medicine, psychiatry, psychology, nutrition, dentistry and the social sciences are, in fact, converging towards a shared understanding: cognitive wellbeing depends on the continuous interplay of multiple factors that affect the individual as a whole.

Among the key topics that emerged during the discussion, particular attention was paid to sleep, which is increasingly recognised as one of the main determinants of brain health and psychological wellbeing throughout the lifespan. Sleep is not only a time for physical recovery, but also a fundamental process for regulating metabolism, the immune system, emotions and cognitive function.

Indeed, in recent years, growing scientific evidence has confirmed the existence of a bidirectional relationship between sleep quality and mental health: sleep disorders can contribute to the onset or worsening of psychiatric conditions, whilst anxiety, depression, chronic stress and other mental health conditions can also affect sleep.

Disruption to normal sleep–wake rhythms, associated with chronic insomnia, circadian rhythm disorders, alterations in REM sleep, as well as obstructive sleep apnoea, are all factors that influence mood regulation, psychological resilience and the risk of developing neurological, cardiovascular and psychological disorders, as well as neurodegenerative conditions. This is because all the interactions described involve complex neurophysiological, neurobiological, endocrine and immunological mechanisms that influence brain plasticity, emotional regulation, memory and cognitive performance.

For this reason, increasing attention must be paid to integrated preventive and therapeutic approaches, including sleep education, psychological interventions, behavioural strategies and digital innovations for sleep monitoring. Promoting healthy sleep habits not only improves quality of life, but also helps to preserve brain health and promotes long-term mental wellbeing. Sleep therefore emerges as an essential component of prevention and treatment strategies in both neurological and psychiatric care.

At the same time, the conference demonstrated that sleep should not be considered in isolation.

Its links with mental health, nutrition, the gut microbiota and oral health, in fact, paint a complex and deeply interconnected picture. The speakers’ presentations highlighted how anxiety, chronic stress, depression and addictions constantly interact with brain function and the quality of rest, contributing to changes in cognitive and emotional balance.

44

UniCamillus Magazine | Summer

In particular, it was highlighted that the bidirectional communication network known as the microbiota– gut–brain axis is capable of regulating neurological functions, sleep homeostasis and the immune response.

Furthermore, good-quality sleep combined with a healthy diet helps to prevent problems such as gut dysbiosis, cravings for junk food, and systemic inflammation that affects neurotransmitter production.

This insight paves the way for targeted therapies aimed at the microbiota, including precision probiotics, prebiotics and faecal microbiota transplantation, as new strategies for treating sleep disorders and promoting neurological health.

Last but not least are issues relating to oral health, linked above all to the prevention of bacterial neuroinflammation and sleep apnoea, which can alter the oral environment and mastication.

From a clinical and preclinical perspective, therefore, the need to move beyond a fragmented view of health has emerged strongly, promoting instead models of prevention and care capable of bringing together different areas of expertise and knowledge.

A further point for reflection concerned the relationship between brain health and contemporary society.

The fast pace of daily life, technological hyper-connectivity, work-related stress and the growing fragility of social relationships have a profound impact on mental wellbeing and sleep quality. Brain health therefore appears to be closely linked to the social, cultural and relational contexts in which people live.

The conference thus offered not only a scientific contribution, but also a space for public reflection on the way we live in our times. Discussing ‘Brain Health’ means, in fact, examining the relationship between health, quality of life, prevention and collective wellbeing. It means recognising that rest, psychological balance, human relationships and the opportunity to live in inclusive social contexts are fundamental components of health throughout the life course.

The initiative confirmed the value of the University’s Third Mission as a bridge between scientific research and the needs of society. In a historical context characterised by profound social and cultural transformations, promoting knowledge and awareness on issues such as sleep, mental health and cognitive wellbeing means contributing to the development of a more integrated, participatory and person-centred culture of health, attentive to the complexity of the individual.

UniCamillus Magazine | Summer

45

5

news from medical world

Unstable blood glucose levels after cardiac surgery: increased risk of infection A new study published on 6th August 2026 in the journal Scientific Reports highlights a possible link between unstable blood glucose levels and infections following cardiac surgery. The researchers analysed 462 patients with diabetes or perioperative hyperglycaemia who had undergone cardiac surgery. In 6.9% of cases, a surgical site infection occurred. The risk was higher in patients who experienced episodes of hypoglycaemia and significant fluctuations in blood glucose levels, regardless of their long‐term glycaemic control. The findings therefore suggest that, during the perioperative period, maintaining stable blood glucose levels and preventing hypoglycaemia may be just as important as avoiding excessively high levels.

Almost half of Italians have reservations about vaccines Almost one in two Italian adults has some form of hesitation regarding vaccinations. This is the finding of a large-scale study published in The Lancet Regional Health – Europe, based on over 52,000 adults living in Italy. The survey found that 46.09% of participants had reservations about vaccines. However, this is not just about perceptions of the risks associated with vaccines: trust in institutions, levels of health literacy, personal experiences, and political and religious views all play a significant role. The perceived support for vaccination from doctors, teachers and other key figures in the community also appears to have a significant influence.

46

UniCamillus Magazine | Summer

From the screen to the body: technology can affect sleep, eyesight, mood and metabolism Using smartphones, computers and other digital devices for many hours can have effects that go far beyond simple eye strain. A review published on 14 August in npj Digital Public Health analysed 389 studies, finding links between digital exposure and sleep disturbances, anxiety and mood changes, behavioural problems, visual fatigue, musculoskeletal pain and metabolic disorders. There are various possible mechanisms involved: light can disrupt the sleep‐wake cycle; prolonged use encourages a sedentary lifestyle and poor posture; whilst cognitive overload, social comparison and negative online interactions can affect psychological wellbeing. The authors emphasise, however, that it is not just the amount of time we spend in front of a screen that matters: the device itself, the content and how it is used can also alter the impact on health.

Transplants: Italy sets a new record with over 4,600 procedures in a year 2025 was a record year for transplants in Italy, with a total of 4,678 procedures. Figures from Italy’s National Transplant Centre, released on 4th August, show 2,367 kidney transplants, 1,753 liver transplants and 451 heart transplants, with the latter figure up by 9.2%. Living donations are also on the rise, reaching 387.

This is a significant achievement, placing Italy second amongst the major European countries in terms of donation rates. However, one critical issue remains: by the end of 2025, 8,401 people were still on the waiting list for an organ.

Ebola: Congo faces its worst-ever outbreak The Ebola outbreak caused by the rare Bundibugyo virus officially began on 15th May 2026 in the Democratic Republic of the Congo. In just three months, it has become the largest Ebola outbreak ever recorded in the country, surpassing that of 2018–2020. As of 19th August, confirmed cases had exceeded 5,000, with 2,378 deaths. The spread is particularly rapid and the virus has reached six provinces. Containment efforts are being complicated by conflicts, fragile healthcare infrastructure, difficulties in contact tracing and misinformation. For this reason, the WHO considers the outbreak still far from being under control.

UniCamillus Magazine | Summer

47

N e w s f r o m U n i We b

W a l k i n g o r r u n n i n g : w h i c h i s b e t t e r f o r h e a lt h a n d w e i g h t l o ss ?

When discussing walking versus running, the most common question is which of the two activities is better for overall health and weight loss. According to Professor Stefano Palermi—Sports Physician and Lecturer in Locomotor System Diseases at UniCamillus—there is no single answer that applies to everyone. Both activities are effective, but they act differently on the body and, above all, involve very different levels of intensity and sustainability.

Walking is an activity accessible to almost everyone, regardless of age or fitness level. Running, on the other hand, is more intense and can deliver cardiovascular and metabolic benefits more quickly, but it requires greater physical preparation and places more stress on muscles and joints.

In many cases, the best strategy is a gradual one: starting with walking, progressing to brisk walking, and only then introducing running. This approach reduces the risk of injury and increases the likelihood of maintaining the activity over time.

Therefore, the choice between walking and running should not be seen as a ‘competition’ between better or worse activities, but rather as a personalised evaluation based on one’s health status and goals.

The benefits of walking according to sports medicine Walking is often underestimated, but from a medical perspective it is one of the most complete and safest activities. The benefits of walking mainly concern the cardiovascular and metabolic systems. “Daily walking has numerous positive effects: it lowers blood pressure, improves lipid profile and insulin sensitivity, and helps reduce the risk of cardiovascular events”, explains Professor Palermi.

A particularly interesting role is played by brisk walking, which sits halfway between light activity and actual training. When performed at a sustained pace,

48

UniCamillus Magazine | Summer

the benefits of brisk walking become very similar to those of more intense activities such as running, especially in untrained individuals.

“For this reason, walking is often the first recommended approach for sedentary people, older adults, individuals who are overweight, or those with chronic conditions. It allows them to build a solid foundation without exposing them to high risks”, says Professor Palermi.

10,000 steps a day: are they really necessary?

The idea of taking 10,000 steps a day has become very popular, but it is not a scientifically mandatory threshold. Even between 6,000 and 8,000 steps per day, significant cardiovascular and metabolic benefits can already be achieved.

But how many calories do 10,000 steps actually burn? On average, this corresponds to roughly 300– 500 calories, although the exact number depends on body weight, walking speed and type of movement.

And in terms of time, how many minutes are 10,000 steps? “They correspond to about 70–100 minutes of activity, depending on the pace”, replies Professor Palermi.

TO READ THE FULL ARTICLE AND FIND OUT MORE ABOUT THE TOPICS COVERED, SCAN THE QR CODE AND VISIT THE UNICAMILLUS WEBSITES

Global Health Journal

P o t e n t i a l S o lu t i o n s a n d P o l i c y R e c o m m e n d at i o n s

In the preceding chapters, we examined the tensions between pharmaceutical patent protection and global access to essential medicines, the role of the WTO and its TRIPS Agreement, and the ethical challenges surrounding intellectual property (IP) in the context of global health. While the current IP framework has incentivized innovation, it has also created significant barriers to access, particularly for LMICs. This final chapter proposes solutions to reform the global IP system and suggests specific policy recommendations that could better balance the need for pharmaceutical innovation with the global right to health.

Rethinking the Global IP Framework for Health Emergencies The Covid-19 pandemic demonstrated that the existing IP framework is not fully equipped to address the rapid, global response required during a public health emergency. The slow distribution of vaccines and treatments to LMICs underscored the need for a more flexible IP system that can prioritize global health over exclusive rights when necessary.

Emergency Waiver Mechanisms for Future Pandemics [...]

Nei capitoli precedenti, abbiamo esaminato le tensioni tra la protezione dei brevetti farmaceutici e l’accesso globale ai medicinali essenziali, il ruolo dell’OMC e del suo accordo TRIPS e le sfide etiche che circondano la proprietà intellettuale (IP) nel contesto della salute globale. Sebbene l’attuale quadro IP abbia incentivato l’innovazione, ha anche creato notevoli barriere all’accesso, in particolare per gli LMIC. Questo capitolo finale propone soluzioni per riformare il sistema IP globale e suggerisce raccomandazioni politiche specifiche che potrebbero bilanciare meglio la necessità di innovazione farmaceutica con il diritto globale alla salute.

Ripensare il quadro IP globale per le emergenze sanitarie vLa pandemia di Covid-19 ha dimostrato che il quadro IP esistente non è completamente attrezzato per affrontare la risposta rapida e globale richiesta durante un’emergenza di salute pubblica. La lenta distribuzione di vaccini e trattamenti ai LMIC ha sottolineato la necessità di un sistema IP più flessibile che possa dare priorità alla salute globale rispetto ai diritti esclusivi quando necessario.

Meccanismi di deroga di emergenza per future pandemie [...]

TO READ THE FULL ARTICLE AND FIND OUT MORE ABOUT THE TOPICS COVERED, SCAN THE QR CODE AND DOWNLOAD THE LATEST ISSUE OF UNICAMILLUS GLOBAL HEALTH JOURNAL

UniCamillus Magazine | Summer

49

RESEARCH / ABS T RAC T A selection of the most recent and interesting research carried out by U ni C amillus researchers .

An abstract of the paper is available. To view the full text, you will need to scan the relevant QR code. Access to the research is subject to specific subscriptions or affiliations with the platforms hosting the full-text version.

Ophthalmic Antibiotic Prophylaxis as a Target for Antibiotic Stewardship: A Point Prevalence Multicentre Survey on Practices, Guideline Adherence, and Incidence of Ophthalmia Neonatorum within the ESPR Network Cinzia Auriti; Giulia Iacona; Vito Mondì; Domenico Di Lallo; Anlaug Vatne; Fiammetta Piersigilli; Eric Giannoni; María Cernada; Kirsten Glaser; Katarzyna Wróblewska-Seniuk; Claus Klingenberg; Lise Aunsholt; Christoph Härtel; Helmut Küster; Flavia Rosa-Mangeret; Katarina Matasova; Laura Timelli; Chryssoula Tzialla; Salvatore Aversa; Edit Molnar; Maria Rosaria Gualano; Emiliano Maiani; Andrea Dotta; Domenico Umberto De Rose

Dental Care Needs and Treatment Priorities in a Homeless Population in Rome: An Observational Study Roberta Lione; Francesca Chiara De Razza; Roberto Morello; Massimo Ralli; Giuseppe D’Amato; Giovanni Romano; Manuele Mancini; Paola Cozza

Federated analytics for non-communicable disease surveillance in the European health data space: a scoping review and conceptual framework Fabio Carinci 1; Stephen Fava 2; Iztok Štotl 3,4; Nicholas Nicholson 5

Elevating cerebellar theta oscillations boosts noninvasively induced motor plasticity Danny Adrian Spampinato; Valentina Pezzopane; Alex Martino Cinnera; Annibale Antonioni; Elisa Dolfini; Lucia Mencarelli; Matteo Ferraresi; Katia Botta; Andrea Casarotto; Sofia Straudi; Luciano Fagida; Giacomo Koch

50

UniCamillus Magazine | Summer

Development and external validation of AI-ECG models in athlete preparticipation screening: Performance, limitations, and clinical implications Stefano Palermi; Boroumand Zeidaabadi; Marco Vecchiato; Matteo Anselmino; Rachele Adorisio; Alessandro Biffi; Francesco Borrelli; Erica Brugin; Nicoletta Cantarutti; Elena Cavarretta; Mattia Cominacini; Marco Corsi; Flavio DAscenzi; Vittorio De Feo; Giuseppe Di Gioia; Gianluigi Dorelli; Joseph Barker; Konstantinos Patlatzoglou; Gul Rukh Khattak; Elisa Lodi; Alberto Livio; Viviana Maestrini; Guglielmo Leonardo Manfredi; Davide Mansour; Mariagrazia Modena; Daniel Neunhaeuserer; Antonia Nigro; Andrea Palerm; Alessio Pellegrino; Antonio Pelliccia; Filippo Maria Quattrini; Fabrizio Ricci; Fiammetta Scarzella; Maria Rosaria Squeo; Riccardo Tonelli; Emanuele Zanardo; Alessandro Zorzi; Nicholas S. Peters; Daniel B. Kramer; Jonathan W. Waks; Gaetano Maria De Ferrari; Fu Siong Ng; Arunashis Sau; Andrea Saglietto

Subcutaneous natalizumab administration in relapsing–remitting multiple sclerosis: results of EASIER 2 study Filippi, M., Grimaldi, L.M.E., Brescia Morra, V. et al. Subcutaneous natalizumab administration in relapsing

Preparing Europe for Recurrent Autochthonous Dengue Transmission: Public Health Implications and Preparedness Priorities Giuseppe Ippolito; Alimuddin Zumla

Nrf2/NOX2 Pathway Dysregulation and Oxidative Stress Biomarkers in Gaucher Disease–Associated Parkinsonism: Insights Into a Potential Therapeutic Target Alessio Ardizzone, Marika Lanza, Anna Paola Capra, Giovanna Casili, Maria Bulzomì, Fabiola De Luca, Irene Paterniti, Michela Campolo, Emanuela Esposito

UniCamillus Magazine | Summer

51

52

UniCamillus Magazine | Summer

UniCamillus Magazine | Summer

53

54

UniCamillus Magazine | Summer