SLEEP Conference

A recent mediation analysis shows 54% of elinzanetant's (Lynkuet) sleep benefit is independent of nighttime VMS reduction, suggesting NK1 blockade targets menopausal sleep disruption through a distinct pathway.

A recap of the top-performing, most-viewed Contemporary OB/GYN stories from June 2026, including new SMFM guidance on acetaminophen in pregnancy, ACOG's break from federal vaccine recommendations, and our coverage of SLEEP 2026 in Baltimore.

Because only one third of nocturnal wakefulness during the menopausal transition is directly linked to hot flashes, VMS-targeted therapies alone are insufficient for many women with sleep disruption—and cognitive behavioral therapy for insomnia, supported by sleep society guidelines and accessible through free digital platforms, should be part of every clinician's sleep management toolkit, according to Pauline M. Maki, PhD.

Stephanie Faubion, MD, and Fiona Baker, PhD, discuss how elinzanetant can play a role in sleep disturbances because of VMS, emerging data on the subject, and how to determine the right candidate for the NK1-3 dual-receptor antagonist.

SWAN data from 2066 women demonstrate that sleep disturbance has a greater independent effect on health-related quality of life than VMS alone, with the combination of both symptoms producing the most pronounced impact on physical functioning and energy—findings that support prioritizing sleep as a treatment target alongside vasomotor symptoms in menopausal care, according to Pauline M. Maki, PhD.

Shared decision-making around nonhormonal VMS and sleep management requires moving through contraindications, patient preferences, and monitoring burdens together, with elinzanetant's (Lynkuet) dual receptor profile making it a particularly relevant option for women with both VMS and sleep disruption—and with follow-up at 2 to 3 months essential to evaluating response, according to Stephanie S. Faubion, MD, MBA, FACP, MSCP, IF.

Fiona C. Baker, PhD, explains how menopausal sleep disturbance differs from other forms of sleep disruption, citing the role of vasomotor symptoms, hormone changes, and an increased postmenopausal risk of sleep apnea in driving nighttime awakenings.

Among SWAN participants, sleep disturbance was independently associated with lower HRQoL relating to role-physical, role-emotional, and energy/fatigue, with no change in these associations over time.

In part 2 of our discussion with Fiona Baker, PhD, she details how to interpret data from the NIRVANA study, which revealed reductions in wakefulness after sleep onset in the elinzanetant group vs placebo.

Elinzanetant produced a numerically greater reduction in PSG-measured WASO vs placebo across the 12-week NIRVANA trial, with the effect more pronounced at week 4 than week 12.

A post hoc analysis of the phase 2 NIRVANA trial presented at SLEEP 2026 found that elinzanetant reduced WASO versus placebo across in-lab PSG, home-based Sleepiz One+ monitoring, and patient-reported Sleep Diary.

Presented at SLEEP 2026, NIRVANA data show a consistent elinzanetant treatment signal across three sleep measurement modalities, extending earlier OASIS trial findings on patient-reported sleep outcomes in menopausal women.

The total treatment effect of elinzanetant on sleep disturbance relative to placebo was -4.92 (95% CI, -5.73 to -4.12), indicating a clinically meaningful reduction.

Two neurokinin receptor antagonists are now available for vasomotor symptom (VMS)-related sleep disruption, with elinzanetant's (Lynkuet) NK1 and NK3 dual-receptor profile potentially offering more targeted sleep benefit than fezolinetant's (Veozah) NK3-selective mechanism—but effective management requires systematic screening for obstructive sleep apnea, restless leg syndrome, and primary insomnia before attributing sleep disruption to VMS alone