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Commentary

Free The (Still) Elusive Definition of Hypopnea. 1971-1972.
Kenneth R. Casey, MD, MPH; Rachna Tiwari, MBBS
Free Best and Safest Care Versus Care Closer to Home. 1973-1974.
Fauziya Hassan, MD, MS1; Lynn A. D'Andrea, MD2
Free Short Telomere Length and Endophenotypes in Sleep Medicine. 1975-1977.
Alexandros N. Vgontzas, MD; Julio Fernandez-Mendoza, PhD; Edward O. Bixler, PhD

Scientific Investigations

Potential Anatomic Markers of Obstructive Sleep Apnea in Prepubertal Children. 1979-1986.
Chun Ting Au, MPhil, RPSGT1; Kate Ching Ching Chan, FHKAM (Paed)1; Kin Hung Liu, PhD2; Winnie Chiu Wing Chu, MD2; Yun Kwok Wing, FRCPsych, FHKAM (Psych)3; Albert Martin Li, MD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: The current gold standard diagnostic test of childhood obstructive sleep apnea (OSA) remains overnight polysomnography, which is labor intensive and may not be available in all pediatric units. Tools are being developed to provide reliable screening for children at risk of OSA. This study aimed to examine anatomic factors other than enlarged lymphoid tissues as predictors for OSA.

Study Impact: Position of the hyoid bone and lateral parapharyngeal wall thickness are associated with risk and severity of OSA in prepubertal children. Future screening tools should include these two readily obtainable markers.

Free Varying Hypopnea Definitions Affect Obstructive Sleep Apnea Severity Classification and Association With Cardiovascular Disease. 1987-1994.
Christine H.J. Won, MD, MS1,2; Li Qin, PhD3; Bernardo Selim, MD4; Henry K. Yaggi, MD, MPH1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: This study was performed to assess the clinical effect of changing hypopnea definitions in the diagnosis of obstructive sleep apnea (OSA). It is the first to assess the clinical effect of varying hypopnea definitions in a sleep clinic population.

Study Impact: This study demonstrates how the different hypopnea criteria currently in use modify disease severity classification in patients with OSA, as well as capture a new population of patients with the disorder. It also demonstrates that altering hypopnea criteria can modify cardiovascular risk stratification in patients with OSA.

Objectively Measured Disrupted Sleep Is Independently and Directly Associated With Low Exercise Capacity in Males: A Structural Equation Model. 1995-2004.
Ren-Jing Huang, PhD1; Shin-Da Lee, PhD2,3,4; Ching-Hsiang Lai, PhD5; Shen-Wen Chang, RN6; Ai-Hui Chung, RN6; Chiung-Wei Chen, MD7; I-Ning Huang, MD7; Hua Ting, MD6,7,8

BRIEF SUMMARY

Current Knowledge/Study Rationale: Although life expectancy can be predicted by absolute values of maximal oxygen uptake, the underlying factors and their interactions remain elusive. We therefore hypothesized that obesity, irregular exercise, superficial sleep, sleep-disordered breathing, and impaired lung function were mutually interactive with each other, in addition to each factor being associated individually with low exercise capacity.

Study Impact: In our study of male workers, structural equation modeling is a promising method for unraveling the complex potential factors linked to low cardiorespiratory fitness. Our results suggest that objectively measured disrupted sleep is associated not only with several medical problems, as identified by previous studies, but also with low cardiorespiratory fitness. In addition, individuals with limited exercise capacity without definite causes should undertake a sleep study, particularly in those describing symptoms of sleep-disordered breathing or insomnia.

The Evolution of Sleep Apnea Six Months After Acute Ischemic Stroke and Thrombolysis. 2005-2011.
Jaana K. Huhtakangas, MD1; Tarja Saaresranta, MD, PhD2; Risto Bloigu, MSc3; Juha Huhtakangas, MD, PhD4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep apnea prevalence is high among patients who had a stroke. We studied the evolution of prevalence, type, and severity of sleep apnea among patients who had an ischemic stroke with or without thrombolysis treatment after 6 months in northern Finland.

Study Impact: Our study showed that sleep apnea prevalence remained high, obstructive apneas declined, and central apneas increased at 6-month follow-up. A novel contribution of this study is the finding that thrombolysis appears to independently associate with the lower frequency of new cases of sleep apnea after stroke.

The Accuracy of an Ambulatory Level III Sleep Study Compared to a Level I Sleep Study for the Diagnosis of Sleep-Disordered Breathing in Children With Neuromuscular Disease. 2013-2020.
Haley Fishman, MD, FRCPC1,2; Colin Massicotte, RPSGT1; Rhonda Li, RPSGT1; Weeda Zabih, MD1,2; Laura C. McAdam, MD, FRCPC, MSc1,2,3; Suhail Al-Saleh, MBBS, FRCPC, MSc1,2; Reshma Amin, MD, FRCPC, MSc1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Children with neuromuscular disease (NMD) are at a significant risk for sleep-disordered breathing (SDB). There is a paucity of sensitive and specific diagnostic tests to evaluate for the presence SDB. A level I polysomnography is the gold standard test. If diagnostically accurate, an ambulatory level III device could help manage the lengthy waiting lists for level I polysomnography.

Study Impact: We have shown that a level III device with end-tidal capnography has poor diagnostic accuracy to diagnose SDB in children with NMD. A level III device with end-tidal capnography should not yet be implemented in clinical practice as a diagnostic tool for SDB in children with NMD.

Increased Risk of Benign Paroxysmal Positional Vertigo in Patients With Non-Apnea Sleep Disorders: A Nationwide, Population-Based Cohort Study. 2021-2029.
Cheng-Ping Shih, MD, PhD1; Chih-Hung Wang, MD, PhD1; Chi-Hsiang Chung, PhD2,3; Hung-Che Lin, MD1; Hsin-Chien Chen, MD, PhD1; Jih-Chin Lee, MD, PhD1; Wu-Chien Chien, PhD2,3,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Insomnia and sleep disturbance have negative effects on physiology and daytime function. A link between dizziness and sleep disorders has been reported. Nonetheless, no studies have explored the relationship between benign paroxysmal positional vertigo (BPPV) and non-apnea sleep disorders (NSD). This study is the first population-based cohort study to delineate the association between NSD and subsequent risk of BPPV.

Study Impact: This study revealed that the patients with NSD had higher risk of development of BPPV. Among different types of NSD, chronic insomnia conferred the highest BPPV risk, followed by organic sleep disorders, sleep disturbance, and acute insomnia.

Practical Implementation of a Single-Night Split-Titration Protocol With BPAP-ST and AVAPS in Patients With Neuromuscular Disease. 2031-2035.
Salma I. Patel, MD, MPH1; Peter Gay, MD1; Timothy I. Morgenthaler, MD1; Eric J. Olson, MD1; Fadi E. Shamoun, MD2; Rahul Kashyap, MBBS3; Daniel Herold, RPSGT1; Sarah McNamara, RPSGT1; Bernardo Selim, MD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Experience in clinical protocols incorporating average volume- assured pressure support (AVAPS) to standard bilevel positive airway pressure in a spontaneous/timed mode (BPAP-ST) is scant. We evaluated the experience of patients with neuromuscular disease undergoing a polysomnography titration protocol aimed at both BPAP-ST and AVAPS in a single night.

Study Impact: This study describes the successful clinical implementation of a single-night split-titration protocol with BPAP-ST and AVAPS in patients with neuromuscular disease. This study provides a titration model to other sleep centers that seek to offer patients alternative modalities of ventilation such as volume-assured pressure support.

Long Sleep Duration, Insomnia, and Insomnia With Short Objective Sleep Duration Are Independently Associated With Short Telomere Length. 2037-2045.
Priscila Tempaku, MsC1; Camila Hirotsu, PhD1,2; Diego Mazzotti, PhD3; Gabriela Xavier, BsC4,5; Pawan Maurya, PhD6,7; Elisa Brietzke, MD, PhD6; Sintia Belangero, PhD4,5,6; Dalva Poyares, MD, PhD1; Lia Bittencourt, MD, PhD1; Sergio Tufik, MD, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Growing evidence suggests the contribution of sleep in the molecular pathways of aging related to the maintenance of telomere length. In this sense, the study aimed to verify the association between short telomere length with objective and self-reported sleep parameters, as well as sleep disorders in a general population sample.

Study Impact: Our results demonstrate that self-reported long sleep duration (> 8 hours versus 7 to 8 hours) and the presence of insomnia doubled the odds ratio of short telomere length, while the short sleep duration insomnia phenotype led to a fourfold increase in the odds ratio of short telomere length independently of age, sex, and obesity. These results suggest that longer sleepers and insomnia, especially the short sleep phenotype may play a role in the mechanisms related to biological aging.

Association of Adverse Pregnancy Outcomes With Self-Reported Measures of Sleep Duration and Timing in Women Who Are Nulliparous. 2047-2056.
Francesca L. Facco, MD1; Corette B. Parker, PhD2; Shannon Hunter, MS2; Kathryn J. Reid, PhD3; Phyllis C. Zee, MD, PhD3; Robert M. Silver, MD4; David M. Haas, MD5; Judith H. Chung, MD6; Grace W. Pien, MD7; Chia-Ling Nhan-Chang, MD, PhD8; Hyagriv N. Simhan, MD1; Samuel Parry, MD9; Ronald J. Wapner, MD8; George R. Saade, MD10; Brian M. Mercer, MD11; Caroline Torres, MD8; Jordan Knight, DO5; Uma M. Reddy, MD12; William A. Grobman, MD13

BRIEF SUMMARY

Current Knowledge/Study Rationale: Data, both from nonpregnant and pregnant cohorts, suggest that objectively measured short sleep and late sleep timing in pregnancy are both risk factors for adverse health outcomes. Yet, the use of objectively measured sleep in routine care is limited; thus, it is more practical to use self-reports in pregnancy to screen for at-risk women. Our study examined the relationship of self-reported sleep duration and timing in pregnancy to hypertension and gestational diabetes.

Study Impact: Our data suggest that short sleep duration is underreported and may not be a good marker for adverse pregnancy outcomes. However, we found that self-reports of a sleep midpoint are more accurate, and that self-reported late sleep midpoint (after 5:00 AM) is associated with an increased risk of gestational diabetes mellitus.

Comparison of Commonly Used Questionnaires to Identify Obstructive Sleep Apnea in a High-Risk Population. 2057-2064.
Kirk Kee, MBBS, FRACP1,2,3; John Dixon, MBBS, PhD, FRACGP4; Jonathan Shaw, MD, MRCP (UK), FRACP5; Elena Vulikh, BSci5; Markus Schlaich, MD6,7; David M. Kaye, MBBS, PhD, FRACP8; Paul Zimmet, MD, PhD, FRACP2,5; Matthew T. Naughton, MD, FRACP2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Obstructive sleep apnea has an important comorbidity in type 2 diabetes, obesity, hypertension, and heart failure; yet, uncertainty exists as to the reliability of questionnaires that could predict who should be considered for sleep testing.

Study Impact: We compared the STOP-BANG with the OSA50 and Berlin Questionnaires in a group of patients attending high cardiovascular risk clinics. The STOP-BANG was found to have a superior sensitivity and negative predictive values.

Oximetry as an Accurate Tool for Identifying Moderate to Severe Sleep Apnea in Patients With Acute Stroke. 2065-2073.
Shih Hao Lin, MD1; Chantale Branson, MD1; Lisa Park, BS2; Jamie Leung, BS2; Nirmita Doshi, BS2; Sanford H. Auerbach, MD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: This study evaluates whether pulse oximetry is an effective tool for early detection of sleep apnea in patients hospitalized with acute stroke.

Study Impact: To our knowledge, it is the first study that validates the use of oximetry as a cost-effective and accurate tool to identify moderate to severe sleep apnea and help guide clinical management of sleep-disordered breathing in patients with acute stroke.

Special Articles

Free Clinical Use of a Home Sleep Apnea Test: An Updated American Academy of Sleep Medicine Position Statement. 2075-2077.
Ilene M. Rosen, MD, MS1; Douglas B. Kirsch, MD2; Kelly A. Carden, MD3; Raman K. Malhotra, MD4; Kannan Ramar, MD5; R. Nisha Aurora, MD6; David A. Kristo, MD7; Jennifer L. Martin, PhD8,9; Eric J. Olson, MD5; Carol L. Rosen, MD10; James A. Rowley, MD11; Anita V. Shelgikar, MD, MHPE12

Case Reports

Adult With PHOX2B Mutation and Late-Onset Congenital Central Hypoventilation Syndrome. 2079-2081.
Ajay S. Kasi, MD1; Sheila S. Kun, RN, MS1; Thomas G. Keens, MD1,2; Iris A. Perez, MD1,2
The Value of a Well-Trained Ear: Incidental Detection of Catathrenia on Home Sleep Apnea Tests in Patients With Low Probability for Obstructive Sleep Apnea. 2083-2086.
Louis Kazaglis, MD
Evaluating Transfer of Modafinil Into Human Milk During Lactation: A Case Report. 2087-2089.
Sanjay Aurora, MD1; Nadia Aurora, MD2; Palika Datta, PhD3; Kathleen Rewers-Felkins, MS3; Teresa Baker, MD4; Thomas W. Hale, PhD3

Sleep Medicine Pearls

A Case of Nocturnal Headache. 2091-2092.
Swapan Dholakia, MD; Octavian C. Ioachimescu, MD, PhD

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2017 Impact Factor: 3.396
5-Year Impact Factor: 4.216
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