While sleep disturbances are common among mitochondrial disease patients,54 the cause of this symptom in ECHS1D remains to be determined.54,55 Interestingly, when Echs1 is selectively knocked down in glia, it results in sleep loss in flies.56 This further supports that sleep disturbances may be directly linked to the loss of ECHS1 expression, with recent work from flies suggesting a role for glial ECHS1 activity. This evidence concerns the gene ECHS1 and mitochondrial short-chain Enoyl-Coa hydratase 1 deficiency.