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Accepted Papers


Free Watch What You're Doing!. 301-302.
John C. Carter, MD1; Dennis Auckley, MD2
Free Doomed to Repeat History: The Burden of Trauma-Related Nightmares in Military Personnel. 303-305.
Jacob F. Collen, MD1; Scott G. Williams, MD, FAASM2; Christopher J. Lettieri, MD, FAASM1
Free Quality of Life With PAP Therapy for Obese Children. 307-308.
Tracy L. Ivy, MD; James S. Kemp, MD

Scientific Investigations

Acetazolamide Reduces Blood Pressure and Sleep-Disordered Breathing in Patients With Hypertension and Obstructive Sleep Apnea: A Randomized Controlled Trial. 309-317.
Davoud Eskandari, PhD1; Ding Zou, MD, PhD1; Ludger Grote, MD, PhD1,2; Erik Hoff, MD1,2; Jan Hedner, MD, PhD1,2


Current Knowledge/Study Rationale: A pharmacological therapy of obstructive sleep apnea (OSA) is lacking. The effectiveness of the carbonic anhydrase inhibitor acetazolamide to reduce blood pressure in patients with hypertension and OSA has not been systematically investigated.

Study Impact: In this randomized crossover study, we found that acetazolamide alone or in combination with continuous positive airway pressure (CPAP) significantly reduced blood pressure and vascular stiffness compared to CPAP in patients with moderate to severe OSA who had withdrawn antihypertensive medication. In addition, acetazolamide decreased the apnea-hypopnea index by 42% and this reduction was associated with a decrease of bicarbonate concentration. Our findings suggest that carbonic anhydrase related mechanisms may be involved in blood pressure regulation and sleep-disordered breathing in patients with OSA and comorbid hypertension.

Impact of Arterial Stiffness on WatchPAT Variables in Patients With Obstructive Sleep Apnea. 319-325.
Taku Kinoshita, MD1; Misuzu Yahaba, MD, PhD1; Jiro Terada, MD, PhD1; Takuma Matsumura, MD1; Yoriko Sakurai, MD, PhD1; Kengo Nagashima, PhD2; Seiichiro Sakao, MD, PhD1; Koichiro Tatsumi, MD, PhD1


Current Knowledge/Study Rationale: Although the current gold standard for diagnosing obstructive sleep apnea (OSA) is overnight polysomnography, the procedure is expensive and time consuming to administer. The WatchPAT is a portable device for which multiple studies have demonstrated good correlation with full polysomnography; however, the effects of arterial stiffness on WatchPAT variables still need to be elucidated.

Study Impact: This study demonstrates that arterial stiffness may affect the respiratory index measured by the WatchPAT in patients with OSA. Therefore, we believe that greater care should be taken when using the WatchPAT to diagnose OSA, especially in patients with severe arterial stiffness.

Free Continuous Positive Airway Pressure Therapy in Gestational Diabetes With Obstructive Sleep Apnea: A Randomized Controlled Trial. 327-336.
Naricha Chirakalwasan, MD1,2; Somvang Amnakkittikul, MD3; Ekasitt Wanitcharoenkul, MD3; Suranut Charoensri, MD3; Sunee Saetung, RN3; Suwannee Chanprasertyothin, MSc4; La-or Chailurkit, PhD3; Panyu Panburana, MD5; Sommart Bumrungphuet, MD5; Ammarin Takkinstian, PhD6; Sirimon Reutrakul, MD3,7


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) has been shown to increase risk of developing gestational diabetes mellitus (GDM). However, the data on the benefit of OSA treatment in GDM on glycemic control and fetomaternal outcome are currently lacking.

Study Impact: Obese pregnant females with diet-controlled GDM and who were adherent to continuous positive airway pressure (CPAP) had significantly improved β-cell function after 2 weeks. Continued use of CPAP was possibly associated with lower rates of preterm delivery, unplanned cesarean section, and neonatal intensive care unit admissions.

The Impact of a Randomized Sleep Education Intervention for College Students. 337-347.
Shelley Hershner, MD1; Louise M. O'Brien, PhD, MS2


Current Knowledge/Study Rationale: College students report inadequate sleep, daytime sleepiness, and erratic sleep schedules, which can affect academic performance and mood. Despite the known consequences of sleep deprivation few sleep education programs exist, with some programs only evaluating a change in sleep knowledge, rather than a change in sleep behaviors, whereas other programs are classroom based, which can limit access.

Study Impact: This randomized controlled study of an online sleep education intervention demonstrates both an improvement in sleep behaviors and depression scores. An effective and brief online sleep education intervention could be implemented among a large number of students without utilizing classroom resources and may improve the public health consequences of sleep deprivation, daytime sleepiness, and depression that is rampant among college students.

Free The Association Between Insomnia and Sleep Duration in Adults With Attention-Deficit Hyperactivity Disorder: Results From a General Population Study. 349-357.
Dora Wynchank, MD1; Margreet ten Have, PhD2; Denise Bijlenga, PhD1; Brenda W. Penninx, PhD3; Aartjan T. Beekman, MD, PhD3; Femke Lamers, PhD3; Ron de Graaf, PhD2; J.J. Sandra Kooij, MD, PhD1,3


Current Knowledge/Study Rationale: Insomnia and altered sleep duration are important comorbid conditions in adults with attention-deficit hyperactivity disorder (ADHD). Several cross-sectional clinical and population studies reported a prevalence of insomnia of 43% to 80% in adults with ADHD. One longitudinal study described an association between ADHD and insomnia; another did not. In a general population study, we evaluated the relationship between self-reported ADHD symptom severity, ADHD symptom dimensions, insomnia symptoms, and sleep duration in adults.

Study Impact: Clinically significant ADHD symptoms (four to six symptoms on the Adult ADHD Self-Report Screener) and the inattention and hyperactivity symptom dimensions were consistently associated with insomnia and altered sleep duration. We have confirmed that insomnia and altered sleep duration occur commonly in adults with ADHD; hence, they should be appropriate assessed and treated.

Characterization of Respiratory Events in Obstructive Sleep Apnea Using Suprasternal Pressure Monitoring. 359-369.
Martin Glos, PhD1; AbdelKebir Sabil, PhD2; Katharina Sophie Jelavic, MD1; Christoph Schöbel, MD1; Ingo Fietze, MD, PhD1; Thomas Penzel, PhD1,3


Current Knowledge/Study Rationale: For characterization of apneas during sleep, reliable recording of respiratory effort is needed. In patients with obstructive sleep apnea, suprasternal pressure monitoring by the PneaVox sensor was tested in comparison with respiratory inductance plethysmography belts and esophageal pressure.

Study Impact: Apnea characterization based on suprasternal pressure monitoring had high interscorer agreement as well as high sensitivity and specificity compared to respiratory inductance plethysmography and esophageal pressure. As an additional sensor, it could improve accuracy of obstructive sleep apnea characterization in adults.

Sleep Health and Predicted Cardiometabolic Risk Scores in Employed Adults From Two Industries. 371-383.
Orfeu M. Buxton, PhD1,2,3,4,9; Soomi Lee, PhD1; Miguel Marino, PhD5,6; Chloe Beverly, MS7; David M. Almeida, PhD8; Lisa Berkman, PhD4,9


Current Knowledge/Study Rationale: Prior research has shown that sleep deficiency (often focusing only on short sleep duration) and sleep apnea lead to the development of cardiometabolic disease. However, less is known about how positive attributes of the multidimensional aspects of sleep health predict future cardiometabolic risks in employed adult samples.

Study Impact: This study advances the literature on sleep health by examining the associations of positive attributes of sleep health with cardiometabolic risk scores, independent of and interacting with sleep apnea symptoms. Strengths of this study include the use of a variety of sleep health indicators measured by both self-reports and actigraphy and also focusing on midlife workers in the two different industry contexts (ie, information technology and extended care), which provides specific policy implications.

The Impact of Continuous Positive Airway Pressure on Circulating IGF-1 in Patients With Obstructive Sleep Apnea. 385-391.
Andreas Palm, MD1,2; Christian Berne, MD, PhD3; Helena Igelström, PhD4; Pernilla Åsenlöf, PhD4; Christer Janson, MD, PhD1; Eva Lindberg, MD, PhD1


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) is associated with decreased serum concentrations of insulin-like growth factor-1 (IGF-1) and some studies have reported an increase in concentration after treatment with continuous positive airway pressure (CPAP). The adherence to CPAP has only rarely been taken into account, and the aim of our study was to compare changes in serum IGF-1 concentration after initiation of CPAP treatment among those patients adherent to CPAP treatment and those who were not.

Study Impact: CPAP usage ≥ 4 h/night is associated with increased serum IGF-1 concentration in patients with OSA. Low serum IGF-1 concentration might not only be a surrogate marker for OSA but also a mediator between OSA and metabolic and cardiovascular disease.

Daytime Sleep Disturbance in Night Shift Work and the Role of PERIOD3. 393-400.
Philip Cheng, PhD1; Gabriel Tallent, BS1; Helen J. Burgess, PhD2; Kieulinh Michelle Tran, BS1; Thomas Roth, PhD1; Christopher L. Drake, PhD1


Current Knowledge/Study Rationale: Inadequate or disturbed sleep is a critical problem for health and safety in night shift workers. To inform the appropriate intervention strategies, this study explores the role of PER3 in predicting mechanisms of vulnerability to sleep disturbance.

Study Impact: Results suggest that PER3 genotypes may indeed differ in mechanism of vulnerability for daytime sleep disturbance. This suggests that PER3 genotype may inform intervention or prevention strategies that triage individuals for different and more targeted treatments.

Effect of Sleep-Disordered Breathing on Albuminuria in 273 Patients With Type 2 Diabetes. 401-407.
Akihiro Nishimura, MD, PhD1; Takatoshi Kasai, MD, PhD2,3; Shota Kikuno, MD1; Kaoru Nagasawa, MD, PhD1; Minoru Okubo, MD, PhD1; Koji Narui, MD2; Yasumichi Mori, MD, PhD1


Current Knowledge/Study Rationale: The results of recent studies suggest independent associations between sleep-disordered breathing (SDB) and diabetic microangiopathies in patients with type 2 diabetes mellitus. Although some studies evaluated the association between SDB and estimated glomerular filtration rate, few studies assessed the association between SDB and albuminuria in patients with type 2 diabetes mellitus.

Study Impact: Respiratory event index (REI) had an independent and significant association with albuminuria in patients with type 2 diabetes mellitus. The odds ratio for albuminuria was approximately twofold to threefold higher in patients with moderate SDB and approximately sixfold to eightfold higher in patients with severe SDB compared to patients with mild or no SDB.

Comorbid Insomnia With Obstructive Sleep Apnea: Clinical Characteristics and Risk Factors. 409-417.
Yong Won Cho, MD1; Keun Tae Kim, MD1; Hye-jin Moon, MD1,2; Valeriy R. Korostyshevskiy, PhD3; Gholam K. Motamedi, MD4; Kwang Ik Yang, MD5


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) and insomnia are very common and both have been independently associated with other serious medical conditions such as cardiovascular disease, cerebrovascular disease, depression, dementia, and cancer. There is some evidence indicating a high prevalence of coexisting insomnia in OSA; however, there are insufficient data on its epidemiology, risk factors, and possibly added risks associated with it.

Study Impact: We have studied the prevalence, associated risk factors, and potential consequences of comorbid insomnia with OSA. There are a fair number of patients with comorbid insomnia and OSA with worsened quality of life and sleep. Comorbid insomnia in OSA is linked to heart disease. Further characterization of this syndrome may help to increase awareness and promote further investigation into its pathogenesis, prevention, and treatment.

Free Nightmares in United States Military Personnel With Sleep Disturbances. 419-426.
Jennifer L. Creamer, MD1; Matthew S. Brock, MD2; Panagiotis Matsangas, PhD3; Vida Motamedi, BA4; Vincent Mysliwiec, MD2


Current Knowledge/Study Rationale: The spectrum of sleep disorders in military personnel is varied and complicated by the presence of comorbidities and psychological disorders. Currently, little is known regarding nightmares, especially trauma-related nightmares.

Study Impact: This is the first study to report on objective and subjective sleep attributes in a cohort of military personnel, determining the prevalence of nightmares and polysomnographic characteristics associated with nightmares. Clinically, this highlights the need for military and civilian health care providers to evaluate for nightmares in individuals with sleep disturbances after traumatic experiences. From a research perspective, these findings provide the basis to further address nightmares, which are associated with the pressing issues of sleep and behavioral medicine disorders and suicidality in military and veteran populations.

Obstructive Sleep Apnea Severity is Directly Related to Suicidal Ideation in Posttraumatic Stress Disorder. 427-435.
Madhulika A. Gupta, MD, FAASM, RST; Patricia Jarosz, BSc (Hon)


Current Knowledge/Study Rationale: Posttraumatic stress disorder (PTSD) is associated with suicidal ideation (SI) and a high prevalence of OSA. There are no studies that have examined the relationship of OSA diagnosed by sleep study and SI in patients with PTSD.

Study Impact: This study of 40 civilian patients with PTSD and OSA diagnosed by a home sleep apnea test presents the previously unreported finding of a direct relationship between OSA severity (measured by the respiratory disturbance index) and SI. Depression was a significant mediator in the relationship between OSA and SI across the entire range of OSA severity, with OSA-related intermittent hypoxemia possibly further contributing to the association between OSA and SI only when patients with PTSD and severe OSA were considered.

Symptom-Based Subgroups of Koreans With Obstructive Sleep Apnea. 437-443.
Jinyoung Kim, PhD, RN1,2; Brendan T. Keenan, MS2; Diane C. Lim, MD, MTR2,3,4; Seung Ku Lee, PhD5; Allan I. Pack, MB ChB, PhD2,3; Chol Shin, MD, PhD5,6


Current Knowledge/Study Rationale: Increasing evidence indicates that obstructive sleep apnea is heterogeneous in its clinical presentations and prognosis. Recently, the Icelandic Sleep Apnea Cohort study suggested three distinct symptom-based subtypes of obstructive sleep apnea: (1) disturbed sleep, presenting with insomnia symptoms but little daytime sleepiness; (2) excessively sleepy, presenting with excessive drowsiness during the daytime, but little complaints about disturbed sleep; and (3) a minimally symptomatic subtype.

Study Impact: Using similar symptom questionnaires, the current study examined whether the three subtypes are applicable to other racial/ethnic populations. We found that the three symptom subtypes are relevant in a population-based sample with lower symptom burden in Korea.

Evaluation of Cardiovascular Risk Factors and Restless Legs Syndrome in Women and Men: A Preliminary Population-Based Study in China. 445-450.
Yuqiong Liu, MS1,2; Gangqiong Liu, MD3; Ling Li, MD3; Jing Yang, MD3,4; Shengli Ma, MD5


Current Knowledge/Study Rationale: Epidemiological studies have associated restless legs syndrome (RLS) with the cardiovascular system, but the data are not consistent. This study examined the association between cardiovascular risk factors and RLS in Chinese individuals.

Study Impact: Results from this large cohort of women and men suggest that RLS is associated with the prevalence of hypertension but not with that of cardiovascular disease or coronary artery disease. Screening and diagnosis of RLS in patients with hypertension may alleviate the burden of symptoms in most cases.

Long-Term Impact of Sleep-Disordered Breathing on Quality of Life in Children With Obesity. 451-458.
Sherri L. Katz, MDCM, MSc1; Joanna E. MacLean, MD, PhD2; Nicholas Barrowman, PhD3; Lynda Hoey3; Linda Horwood, MSc4; Glenda N. Bendiak, MD, MSc5; Valerie G. Kirk, MD5; Stasia Hadjiyannakis, MD1; Laurent Legault, MD4; Bethany J. Foster, MD, MSCE4; Evelyn Constantin, MDCM, MSc(Epi)4


Current Knowledge/Study Rationale: Children with obesity and those with sleep-disordered breathing have independently been shown to have impaired quality of life, but quality of life in children with both conditions has not been well studied. The long-term effect on quality of life in this population is unknown.

Study Impact: Parent-reported quality of life in children with obesity and sleep-disordered breathing is significantly worse than prevalence reported for children with either condition alone or healthy children, and although quality of life may improve in some 1 year later, the proportion with impaired QOL is nearly unchanged. Clinicians should be aware that children with both obesity and sleep-disordered breathing may have impaired quality of life that can persist over time.

Reliability of the Structured Clinical Interview for DSM-5 Sleep Disorders Module. 459-464.
Daniel J. Taylor, PhD1; Allison K. Wilkerson, PhD2; Kristi E. Pruiksma, PhD3; Jacob M. Williams, PhD3; Camilo J. Ruggero, PhD1; Willie Hale, PhD3,4; Jim Mintz, PhD3,5; Katherine Marczyk Organek, PhD6; Karin L. Nicholson, MD7; Brett T. Litz, PhD8,9,10; Stacey Young-McCaughan, RN, PhD3; Katherine A. Dondanville, PsyD3; Elisa V. Borah, PhD3,11; Antoinette Brundige, MA3; Alan L. Peterson, PhD3,4,12


Current Knowledge/Study Rationale: Structured clinical interviews are the gold standard method for reliably and accurately assessing mental disorders in clinical research and practice. This study developed and tested the reliability of the first Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Sleep Disorders (SCISD).

Study Impact: A reliable and accurate assessment of sleep disorders is a crucial first step toward examining epidemiology and ensuring the best evidence-based interventions for disorders primarily diagnosed by self-report (eg, insomnia, restless legs syndrome, nightmare disorder). The SCISD produces reliable diagnoses for six DSM-5 sleep disorders, providing the type of measure essential for standardization and advancement of treatment efficacy trials and clinical epidemiology.

Nightmare Themes: An Online Study of Most Recent Nightmares and Childhood Nightmares. 465-471.
Michael Schredl, PhD1; Anja S. Göritz, PhD2


Current Knowledge/Study Rationale: The definition of a nightmare given in diagnostic manuals (ICSD-3, DSM-5, ICD-10) focuses on threats to survival, security, or physical integrity. However, empirical studies on nightmare content in larger samples are scarce.

Study Impact: The findings of the current study clearly indicate that current definitions of nightmare content are too narrow (ie, death/injury of close persons is also an important nightmare theme). Infrequent themes such as being the aggressor and suicide are of special interest because they might be related to waking-life psychopathology.

Case Reports

Persistent High Residual AHI After CPAP Use. 473-478.
Leay Kiaw Er, MD, MPH1,2; Shinn-Kuang Lin, MD2,3; Stephen Shei-Dei Yang, MD, PhD2,4; Chou-Chin Lan, MD, PhD2,5; Yao-Kuang Wu, MD2,5; Mei-Chen Yang, MD2,5
A Case of Narcolepsy Type 2 and Postural Tachycardia Syndrome Secondary to Lesions of the Thalamus and Amygdala. 479-481.
Paul Kim, MD1; Emmanuel During, MD1,2; Mitchell Miglis, MD1,2
Non-24-Hour Sleep-Wake Circadian Rhythm Disorder in a Sighted Male With Normal Functioning. 483-484.
Sumera Shaikh Solaiman, MD; Ritwick Agrawal, MD

Letters to the Editor

Free Objective Sleep and Personality. 485-486.
Umair Akram, PhD
Free Does Perfectionism Increase the Risk for Dropout From Cognitive Behavioral Therapy for Insomnia?. 487-488.
Anna F. Johann, MSc1,2; Dieter Riemann, PhD1; Kai Spiegelhalder, MD, PhD1
Free Time to Open Our Eyes? A Challenge to the Role of Polysomnography for Trials in Pediatric Sleep-Disordered Breathing. 489-490.
Gillian M. Nixon, MBChB, MD, FRACP1,2; Haytham Kubba, MBBS, MPhil, MD, FRCS3,4; Kirsten P. Perrett, MBBS, PhD, FRACP5,6
Free Using Nasopharyngeal Stenting Devices as a Novel Way of Surgical Planning for Obstructive Sleep Apnea. 491.
Henry Zhang1; Bhik Kotecha2

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