Earn CME
Accepted Papers


Free Reevaluating Norms for Childhood Obstructive Sleep Apnea. 1557-1558.
Deborah M. Brooks, MD1; Lee J. Brooks, MD, FAASM2
Free Seeking the Cause of Restless Legs Syndrome in Chronic Kidney Disease. 1559-1560.
Anne Marie Morse, DO1; Sanjeev V. Kothare, MD2

Scientific Investigations

Familial Aggregation and Heritability of Obstructive Sleep Apnea Using Children Probands. 1561-1570.
Chun Ting Au, PhD1; Jihui Zhang, PhD2; Jennifa Yuk Fa Cheung, RPSGT2; Kate Ching Ching Chan, FHKAM (Paed)1; Yun Kwok Wing, FRCPsych, FHKAM (Psych)2; Albert M. Li, MD1


Current Knowledge/Study Rationale: Familial aggregation of obstructive sleep apnea (OSA) has been demonstrated in adult studies but similar evidence for children is limited. It is well known that OSA in obese and nonobese children are different but the effect of obesity on familial aggregation of OSA and heritability of OSA severity index remains unclear. This family study aimed to investigate the heritability and familial aggregation of OSA among children and their first-degree relatives and to examine how obesity would modify the association.

Study Impact: The differential results between overweight and normal weight subgroups support that childhood OSA should be divided into normal weight and overweight subtypes and the normal weight subtype may be considered as a separate disease from adult OSA.

Alpha-1 Adrenergic-Antagonist Use Increases the Risk of Sleep Apnea: A Nationwide Population-Based Cohort Study. 1571-1579.
Po-Lan Su, MD1,2; Wen-Kuei Lin, MS2; Cheng-Yu Lin, MD, PhD2,3,*; Sheng-Hsiang Lin, PhD4,5,6,*


Current Knowledge/Study Rationale: Decreased upper airway muscle responsiveness, particularly genioglossus muscle activity, is one of the phenotypes of obstructive sleep apnea. Although the use of α1-adrenergic antagonist agents has been shown to decrease genioglossus activity through suppression of hypoglossal nucleus motor neuron activity in animal studies, this concept has not yet been examined in humans because of ethical issues.

Study Impact: In this study, we conducted a large-scale population-based cohort study and found that α1-adrenergic antagonist use is associated with a higher risk of sleep apnea, both in patients with hypertension and those without hypertension. As such, early detection of sleep apnea would be beneficial for patients taking α1-adrenergic antagonist agents.

The Effect of Cleft Palate Repair on Polysomnography Results. 1581-1586.
Mathieu Bergeron, B Pharm, MD, FRCSC1,2; Aliza P. Cohen, MA1; Alexandra Maby, MD3; Haithem E. Babiker, MD, DMD4,5; Brian S. Pan, MD4,5; Stacey L. Ishman, MD, MPH1,6,7


Current Knowledge/Study Rationale: Although primary cleft palate repair is routinely performed in children, there is a hypothetical risk that this procedure will worsen or induce obstructive sleep apnea (OSA). However, there are no definitive data pertaining to this topic.

Study Impact: Overall, OSA did not develop or worsen following primary palatoplasty. However, the oAHI increased by 5 or more events/h in approximately 20% of study participants. The presence of a syndrome was the only factor predictive of worsening OSA after palatoplasty.

Technology Assisted Behavior Intervention to Extend Sleep Among Adults With Short Sleep Duration and Prehypertension/Stage 1 Hypertension: A Randomized Pilot Feasibility Study. 1587-1597.
Kelly Glazer Baron, PhD, MPH1; Jennifer Duffecy, PhD2; DeJuran Richardson, PhD3,4; Elizabeth Avery, MS4; Steven Rothschild, MD4; Johan Lane, MD5


Current Knowledge/Study Rationale: Short sleep duration contributes to poorer physical and mental health but few studies have developed interventions to extend sleep. In this study, we conducted a pilot feasibility study of a technology assisted sleep extension intervention that uses a consumer wearable, interactive smartphone app, didactic lessons and brief telephone coaching.

Study Impact: Results of this study demonstrate that this intervention was well received and can extend sleep among individuals with short sleep duration and hypertension. Extending sleep duration with this intervention reduced 24-hour ambulatory blood pressure and improved daytime functioning in this population.

Free Predicting Nondiagnostic Home Sleep Apnea Tests Using Machine Learning. 1599-1608.
Robert Stretch, MD1,2; Armand Ryden, MD1,2; Constance H. Fung, MD, MSHS1,2; Joanne Martires, MD2; Stephen Liu, MD2; Vidhya Balasubramanian, MD2; Babak Saedi, MD2; Dennis Hwang, MD3; Jennifer L. Martin, PhD1,2; Nicolás Della Penna, BA4; Michelle R. Zeidler, MD, MS1,2


Current Knowledge/Study Rationale: Patients in whom obstructive sleep apnea was diagnosed through a single home sleep apnea test represent the best-case scenario in terms of balancing the health needs of the patient with the economic and financial impact of sleep testing. Unfortunately, home sleep apnea testing alone is insufficient for a substantial proportion (9% to 35%) of patients. This adds largely underrecognized expense to the process including the direct cost of a second sleep test, as well as the indirect costs of a delayed or missed diagnosis and testing burden on the patient.

Study Impact: This study demonstrates how machine learning can help clinicians to better leverage existing sleep diagnostic modalities to improve patient and healthcare system outcomes without increasing costs.

Can CPAP Therapy in Pediatric OSA Ever Be Stopped?. 1609-1612.
Zachary King, MBBS1,2; Maree Josee-Leclerc, BN Sci1; Pat Wales, BN Sci1; Ian Brent Masters, MBBS, FRACP, PhD1,3; Nitin Kapur, MBBS, MD, FRACP, PhD1,3


Current Knowledge/Study Rationale: Continuous positive airway pressure (CPAP) has been increasingly used in treatment of pediatric obstructive sleep apnea not resolved by surgical airway intervention. It is unclear what proportion of children can be successfully taken off CPAP and the factors that govern this cessation.

Study Impact: This is one of the first studies to describe a cohort of children who are able to successfully wean off CPAP therapy. It suggests ongoing screening plays an important role in those on established therapy, as a small proportion of children can successfully be weaned.

Free Effect of Positive Airway Pressure Therapy on Drowsy Driving in a Large Clinic-Based Obstructive Sleep Apnea Cohort. 1613-1620.
Harneet K. Walia, MD1; Nicolas R. Thompson, MS2; Maeve Pascoe, BS1; Maleeha Faisal, MD1; Douglas E. Moul, MD, MPH1; Irene Katzan, MD, MS3; Reena Mehra, MD, MS1; Nancy Foldvary-Schaefer, DO, MS1


Current Knowledge/Study Rationale: Drowsy driving risk due to untreated obstructive sleep apnea (OSA) has been recognized by the American Academy of Sleep Medicine as a significant public health issue. Positive airway pressure (PAP) therapy has been shown to reduce motor vehicle accident risk in people with OSA in limited populations; our analyses were conducted to evaluate broad drowsy driving risk in a large, United States clinical cohort with OSA in relation to multiple measures of PAP adherence and self-reported sleepiness.

Study Impact: Our study, demonstrating the associations of PAP treatment and drowsy driving in patients with OSA, informs recommendations for clinical practice. Clinical care paths for patients with OSA should include more frequent drowsy driving screenings and greater efforts to optimize PAP adherence in those who report a history of drowsy driving.

Association Between Late Bedtime and Diabetes Mellitus: A Large Community-Based Study. 1621-1627.
Bin Yan, MD1,2,*; Yajuan Fan, MD2,*; Binbin Zhao, MD2; Xiaoyan He, MD2; Jian Yang, MD1; Ce Chen, MD2; Xiancang Ma, MD, PhD2,3


Current Knowledge/Study Rationale: This study was performed to investigate the role of late bedtime in the prevalence of diabetes mellitus. It is the first study to explore the association between bedtime and diabetes mellitus in a community-based population.

Study Impact: The current study found a high prevalence of diabetes mellitus among participants who slept after 12:00 am on weekdays. Our results showed that appropriate sleep timing before 12:00 am on weekdays may be a useful way to decrease the risk of diabetes mellitus.

Restless Legs Syndrome in Chronic Kidney Disease: Is Iron or Inflammatory Status To Blame?. 1629-1634.
Sandeep K. Riar, MD1; Larry A. Greenbaum, MD, PhD2; Donald L. Bliwise, PhD3; Roberta M. Leu, MD4


Current Knowledge/Study Rationale: Iron deficiency is an important risk factor for adult RLS in the general population; however, there is not a consistent relationship between RLS and iron status in children with CKD, potentially due to chronic inflammation in this population. To our knowledge, this is the first study that simultaneously examines iron status and inflammation in pediatric patients with CKD and RLS.

Study Impact: In our study, RLS prevalence was no higher in those with iron deficiency which may not be a risk factor for RLS in pediatric CKD. Pediatric CKD’s pro-inflammatory condition may play an important role in modifying risk factors traditionally associated with RLS.

Free Sexual Orientation and Sleep Behaviors in a National Sample of Adolescents Followed Into Young Adulthood. 1635-1643.
Jeremy W. Luk, PhD1,2; Kellienne R. Sita, BS1; Daniel Lewin, PhD3; Bruce G. Simons-Morton, EdD, MPH1; Denise L. Haynie, PhD, MPH1


Current Knowledge/Study Rationale: Few studies have examined sexual orientation disparities in sleep behaviors among adolescents and young adults. This study is the first nationally representative study of sleep behaviors among adolescents longitudinally followed into young adulthood.

Study Impact: Sexual orientation disparities in snoring/stop breathing and daytime sleepiness among female youth were mediated through underweight status and depressive symptoms, respectively. The epidemiologic evidence found in our study has important implications for the assessment and treatment of sleep problems among underserved minority populations.

Validation of Fitbit Charge 2 and Fitbit Alta HR Against Polysomnography for Assessing Sleep in Adults With Obstructive Sleep Apnea. 1645-1653.
Fernando Moreno-Pino1,2,*; Alejandro Porras-Segovia3,4,*; Pilar López-Esteban5; Antonio Artés1,2; Enrique Baca-García3,6,7,8,9,10


Current Knowledge/Study Rationale: Electronic wearable devices may be useful sleep assessment tools, due to their objectivity, availability to the general population and capacity to monitor sleep continuously. However, commercial wearable devices require validation in both healthy and clinical population. Here we explore the validity of two wearable devices against polysomnography in 65 patients with suspected obstructive sleep apnea (OSA).

Study Impact: This is the first study that validates Fitbit devices in patients with OSA, and the largest one performed in this population. It is also the first time Fitbit Alta HR is validated in a clinical sample. We found that this technology is still not accurate enough for clinical practice. However, the potential of these devices calls for further research, which should involve the collaboration between both developers and health care providers.

Long-Term Objective Adherence to Mandibular Advancement Device Therapy Versus Continuous Positive Airway Pressure in Patients With Moderate Obstructive Sleep Apnea. 1655-1663.
Grietje E. de Vries1,2; Aarnoud Hoekema3,4,5,6; Johannes Q.P.J. Claessen7; Cornelis Stellingsma3; Boudewijn Stegenga3,†; Huib A.M. Kerstjens1,2; Peter J. Wijkstra1,2,8


Current Knowledge/Study Rationale: Although current evidence suggests higher adherence with a mandibular advancement device (MAD) than with continuous positive airway pressure (CPAP) therapy, a direct comparison between the objective adherence profiles of both treatment modalities has not yet been performed in patients with moderate obstructive sleep apnea (OSA).

Study Impact: This study shows that objective adherence with MAD and CPAP therapy is comparable and consistent over time. Self-reported adherence is higher with MAD than with CPAP therapy, and objective adherence with CPAP is higher than self-reported adherence with CPAP. This study enhances the knowledge about adherence rates of two regularly used treatment modalities in moderate OSA. The results do not support the general idea that adherence with MAD is higher compared with CPAP therapy.

Individuals With Scleroderma May Have Increased Risk of Sleep-Disordered Breathing. 1665-1669.
Brandon T. Nokes, MD1; Hassan A. Raza, MBBS2; Rodrigo Cartin-Ceba, MD3; Phillip J. Lyng, MD2; Lois E. Krahn, MD2,4; Lewis Wesselius, MD3; Clinton E. Jokerst, MD5; Sarah B. Umar, MD6; W. Leroy Griffing, MD7; Matthew R. Neville, MS8; Atul Malhotra, MD1; James M. Parish, MD2


Current Knowledge/Study Rationale: Cardiopulmonary complications are a common manifestation of systemic sclerosis. To date, the prevalence for sleep disordered breathing may be underappreciated.

Study Impact: To our knowledge, this is the first study of this size to look at overnight oximetry data and extrapolate the potential prevalence of sleep-disordered breathing in scleroderma.

Special Articles

Free Chronic Opioid Therapy and Sleep: An American Academy of Sleep Medicine Position Statement. 1671-1673.
Ilene M. Rosen, MD, MS1; R. Nisha Aurora, MD, MHS2; Douglas B. Kirsch, MD3; Kelly A. Carden, MD4; Raman K. Malhotra, MD5; Kannan Ramar, MD6; Fariha Abbasi-Feinberg, MD7; David A. Kristo, MD8; Jennifer L. Martin, PhD9,10; Eric J. Olson, MD6; Carol L. Rosen, MD11; James A. Rowley, MD12; Anita V. Shelgikar, MD, MHPE13

Emerging Technologies

Sleep/Wake Detection by Behavioral Response to Haptic Stimuli. 1675-1681.
Katherine E. Miller, PhD1,2; Linda Bäbler, MSc3; Thomas Maillart, PhD4; Afik Faerman, MS1,5; Steven H. Woodward, PhD1


Current Knowledge/Study Rationale: Conventional actigraphy is an imprecise measure of sleep efficiency because it cannot detect movement-free waking, a common feature of insomnia. This study examined the ability of a low-cost system that collects responses to haptic stimulation of the palm to detect intercurrent wake and estimate sleep efficiency in a heterogeneous sample of individuals with sleep difficulties.

Study Impact: Responses to haptic stimuli can be collected during sleep and the method tested may augment actigraphy for estimating sleep efficiency. Improved estimation of sleep efficiency could aid clinicians in the delivery of insomnia treatments, and aid sleep researchers engaged in naturalistic studies in which sleep efficiency rather than sleep phase is the variable of interest.

Case Reports

Successful Treatment of Somnambulism With OROS-Methylphenidate. 1683-1685.
Milan Nigam, MD1,2; Antonio Zadra, PhD1,3; Soufiane Boucetta, PhD1; Steve A. Gibbs, MD, MSc1,2,4; Jacques Montplaisir, MD, PhD1,5; Alex Desautels, MD, PhD1,2,4
Late Diagnosis of Narcolepsy With Cataplexy: A Novel Case of Cataplectic Facies Presenting in an Elderly Woman. 1687-1690.
Sakh Khalsa, CSci, PhD1,2; Kasim Qureshi, BSc, MBChB1; Andrew P. Bagshaw, PhD2; Amir Rather, MBBS, MRCPsych1

Sleep Medicine Pearls

A Sleepy Patient With Frequent Falls. 1691-1693.
Aditya Chada, MD1; Swapan Dholakia, MD2; David Rye, MD1

Letters to the Editor

Free Burden of Nocturnal Hypoxia and Type of Positive Airway Pressure Therapy May Influence Markers of Acute Kidney Injury in Patients With Obstructive Sleep Apnea. 1695.
Athanasios Voulgaris, MD, MSc1; Evangelia Nena, MD, PhD2; Paschalis Steiropoulos, MD, PhD1
Free Author Response. 1697-1698.
Li-Pang Chuang, MD, PhD1,2; Shih-Wei Lin, MD1; Ning-Hung Chen, MD1,3
Free Serum Ferritin in the Pediatric Sleep Clinic: What’s Normal Anyway?. 1699-1700.
David G. Ingram, MD; Baha Al-Shawwa, MD
Free Understanding the Questions Parents Are Asking. 1701.
Timothy Barnes, PhD, MPH1; Gerald M. Rosen, MD2
Free Hashimoto Thyroiditis as a Cause or Consequence of Obstructive Sleep Apnea. 1703.
Ellen M.S. Xerfan, MD1; Anamaria S. Facina, MD1; Monica L. Andersen, PhD2; Sergio Tufik, MD2; Jane Tomimori, MD1
Free Every Patient With Acute Ischemic Stroke Should Be Screened for Sleep-Disordered Breathing. 1705-1706.
Gulcin Benbir Senel, MD; Derya Karadeniz, MD, PhD
Free Non-Contact Sensors: Need for Optimum Information Is More Important Than Convenience. 1707.
Mahadevappa Hunasikatti, MD, FCCP
Free Utility Encompasses Both Clinical Translation and Ecologic Validity. 1709.
Margeaux M. Schade, PhD1; Hawley E. Montgomery-Downs, PhD2

REM: A Publication for Residents and Fellows

Free Images: Identification and Effect of Periodic Limb Movements in End-Stage Renal Disease. 1711-1713.
Claire Kennedy, MD1,2; Thomas Kane1; Richard Costello, MD1,2; Peter Conlon, MD1,2

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2017 Impact Factor: 3.396
5-Year Impact Factor: 4.216
2017 Journal Citation Reports®
(Clarivate Analytics, 2018)

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