Choroid plexus enlargement is negatively associated with cognitive performance in a DTI-ALPS-dependent manner.

Sleep is a fundamental biological process that sustains a wide spectrum of physiological and biochemical functions, including immune regulation, metabolic balance, appetite control, emotional resilience, and both endocrine and cardiovascular health (, ). Its role in enhancing physical and cognitive performance is well established. In recognition of its clinical relevance, the American Heart Association added sleep duration to its cardiovascular health metrics in 2022 (). For adults, a minimum of 7 h of sleep per night is recommended to support optimal health (, ). Duration alone does not determine sleep health; sleep quality is an important aspect of sleep. Sleep quality is assessed through parameters such as sleep latency, fragmentation, early awakenings, sleep efficiency, and sleep architecture, including slow-wave sleep (SWS) and rapid eye movement (REM) stages. These can be measured via subjective self-reports or objective tools such as polysomnography (, ). Across populations, poor sleep quality and sleep disorders are emerging as major public health concerns. Prevalence estimates for insomnia, suboptimal sleep, and excessive daytime sleepiness range from 3.9 to 45.0% (). In Indians, it has been reported that 57.2% of respondents in a COVID-era online survey experienced poor sleep quality, with an average sleep duration of 6.9 h and a sleep latency of 42.64 min (). Among schoolchildren, 38.7% reported disturbed sleep, and over 50% slept less than 7 h per night (). Adults with metabolic syndrome, particularly those with PCOS showed similar trends, with 57.9% sleeping less than 7 h daily (). In an urban cohort of 758 Mumbai-based adults, nearly half (49.9%) reported poor sleep quality, and 30% experienced excessive daytime sleepiness (). These findings point to a widespread and under-recognized sleep crisis in India.