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Accepted Papers

Scientific Investigations

Male Patients on Peritoneal Dialysis Have a Higher Risk of Sleep Apnea. 937-945.
Yi-Che Lee, MD, PhD1,2,3; Shih-Yuan Hung, MD1,4; Hao-Kuang Wang, MD, PhD5; Chi-Wei Lin, MD, MS6; Hsi-Hao Wang, MD, MS1; Min-Yu Chang, MD, MS1; Ching-Fang Wu, MD, PhD1; Junne-Ming Sung, MD, PhD7; Yuan-Yow Chiou, MD, PhD8; Sheng-Hsiang Lin, PhD9,10,11


Current Knowledge/Study Rationale: One concern with peritoneal dialysis (PD) is that patients may have a higher risk of sleep apnea (SA) due to intra-abdominal pressure increase and worsened ultrafiltration capacity. Despite this concern, it is uncertain if the risk of SA differs between patients on PD, hemodialysis (HD), and those without uremia.

Study Impact: The patients on PD, but not HD, had a higher risk of SA than patients without uremia. Besides, male patients on PD had a significantly higher risk of SA risk than male patients on HD. In contrast, the risk of SA did not differ between female patients on PD and HD.

NightBalance Sleep Position Treatment Device Versus Auto-Adjusting Positive Airway Pressure for Treatment of Positional Obstructive Sleep Apnea. 947-956.
Richard B. Berry, MD1; Matthew L. Uhles, RPSGT2; Brian K. Abaluck, MD3; David H. Winslow, MD4; Paula K. Schweitzer, PhD5; Raymond A. Gaskins, MD6; Robert C. Doekel, MD7; Helene A. Emsellem, MD8


Current Knowledge/Study Rationale: New treatment options are needed for obstructive sleep apnea. Patients with positional obstructive sleep apnea and a nonsupine apnea-hypopnea index < 10 events/h could potentially be treated with a device preventing supine sleep.

Study Impact: This investigation suggests that the NightBalance sleep position treatment (SPT) device provides a treatment option that compares favorably with auto-adjusting positive airway pressure with respect to reduction in the apnea-hypopnea index and treatment adherence in patients with positional obstructive sleep apnea. Position treatment devices that are comfortable may be more acceptable to patients than positive airway pressure. Objective adherence monitoring capability and physician follow-up are as essential for positioning devices as for positive airway pressure treatment.

Free Nondipping Nocturnal Blood Pressure Predicts Sleep Apnea in Patients With Hypertension. 957-963.
Sophie J. Crinion, PhD1,2; Silke Ryan, PhD1,2; Jana Kleinerova, MB, BCh1; Brian D. Kent, MB, BCh1,2; Joseph Gallagher, MB, BCh3; Mark Ledwidge, MD3; Kenneth McDonald, MD2,3; Walter T. McNicholas, MD1,2,4


Current Knowledge/Study Rationale: Although the strong association of hypertension with obstructive sleep apnea (OSA) is widely recognized, there are only limited data on OSA prevalence in hypertensive cohorts comparing dippers and nondippers. We investigated this relationship in a hypertension clinic-based cohort of patients who were not screened for any pretest possibility of OSA.

Study Impact: The study finds a four-fold higher prevalence of OSA in nondipping hypertensive patients compared to dippers, which indicates that these patients are at high risk of the disorder, regardless of symptoms. These data support the recommendation that nondipping hypertensive patients should be assessed for OSA.

Associations Between the Apnea-Hypopnea Index During REM and NREM Sleep and Cognitive Functioning in a Cohort of Middle-Aged Adults. 965-971.
Maria Devita, PhD1; Paul E. Peppard, PhD2; Arthur E. Mesas, PhD3; Sara Mondini, PhD4,5; Maria Luisa Rusconi, MD, PhD6; Jodi H. Barnet, MS2; Erika W. Hagen, PhD2


Current Knowledge/Study Rationale: Although there is evidence that a higher apnea-hypopnea index (AHI) may be associated with cognitive impairment, it is not known whether the association varies by the AHI measured during rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. We also investigated whether this association varies according to the presence of the apolipoprotein E4 allele (APOE4).

Study Impact: We found that among APOE4 carriers, higher REM AHI is associated with worse psychomotor speed and higher NREM AHI is associated with worse memory retention. Our study provides the first investigation of the associations between AHI during different sleep states and cognition. Furthermore, our results suggest the possibility that exposure to AHI levels during various sleep states may affect different cognitive domains.

Free Physical Activity in Overlap Syndrome of COPD and Obstructive Sleep Apnea: Relationship With Markers of Systemic Inflammation. 973-978.
Christine M. Fitzgibbons, MD1,2; Rebekah L. Goldstein, MPH1,3; Daniel J. Gottlieb, MD1,3,4,5; Marilyn L. Moy, MD, MSc1,3,5


Current Knowledge/Study Rationale: Low physical activity (PA) is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). Comorbid obstructive sleep apnea, overlap syndrome (OVS), is highly prevalent. Little is known about PA in OVS, and its relationship with markers of systemic inflammation.

Study Impact: Persons with OVS have significantly lower levels of PA, and higher levels of inflammatory biomarkers, compared to COPD alone. Lower PA is significantly associated with higher levels of IL-6 in OVS, independent of lung function. It is important to diagnose OVS in persons with COPD and promote PA.

Effects of Medical Therapy on Mild Obstructive Sleep Apnea in Adult Patients. 979-983.
David F. Smith, MD, PhD1,2,3; Kathleen M. Sarber, MD1,2; Charlene P. Spiceland, PhD4; Stacey L. Ishman, MD, MPH1,2,3; Dianne M. Augelli, MD5; Ann M. Romaker, MD6


Current Knowledge/Study Rationale: Montelukast and intranasal steroids have demonstrated efficacy in the treatment of mild obstructive sleep apnea (OSA) in the pediatric population. In adults with mild OSA and allergic rhinitis, a small randomized control trial did show a significant reduction in the apnea-hypopnea index (AHI) with intranasal corticosteroid treatment.

Study Impact: The aim of this study was to evaluate the response of mild OSA in adults to combined therapy with montelukast and intranasal steroids versus placebo. While we demonstrated no significant change in AHI, sleep quality was improved with increased total sleep time and percentage of sleep time spent in stage R sleep.

The Feasibility and Utility of Level III Portable Sleep Studies in the Pediatric Inpatient Setting. 985-990.
Gurinder Singh, MD1; Kimberly Hardin, MD1; Heejung Bang, PhD2; Kiran Nandalike, MD3


Current Knowledge/Study Rationale: Sleep breathing problems are increasingly recognized in pediatric inpatient settings, but proper diagnosis and management is challenging given limited resources. Our study looks at the feasibility and utility of level III portable sleep studies in optimal management of pediatric sleep breathing disorders in children, especially children with complex medical conditions, in the inpatient setting.

Study Impact: Our study shows that the level III studies are feasible in the inpatient setting and the results lead to appropriate and timely intervention in children with complex medial conditions.

Use of a Transformed ECG Signal to Detect Respiratory Effort During Apnea. 991-998.
Richard B. Berry, MD1; Scott Ryals, MD1; Marie Dibra, MD1; Mary H. Wagner, MD2


Current Knowledge/Study Rationale: Recording a diaphragmatic/chest wall electromyography (EMG) signal using surface electrodes detects inspiratory effort facilitating accurate apnea classification. However, the signal is not routinely recorded in many sleep centers and may not exhibit inspiratory bursts in many patients.

Study Impact: Transformation of the signal from routinely placed electrocardiography (ECG) electrodes reveals underlying inspiratory EMG activity. The transformed ECG signal can reveal EMG bursts when they are not clearly seen in the chest wall EMG signal and complements respiratory inductance plethysmography belt detection of respiratory effort improving the accuracy of apnea classification.

Improving Daytime Functioning, Work Performance, and Quality of Life in Postmenopausal Women With Insomnia: Comparing Cognitive Behavioral Therapy for Insomnia, Sleep Restriction Therapy, and Sleep Hygiene Education. 999-1010.
David A. Kalmbach, PhD1; Philip Cheng, PhD1; J. Todd Arnedt, PhD2; Andrea Cuamatzi-Castelan, BS1; Rachel L. Atkinson, BS1; Cynthia Fellman-Couture, RN, PhD1; Timothy Roehrs, PhD1; Christopher L. Drake, PhD1


Current Knowledge/Study Rationale: Insomnia is common among women during and after menopause transition. Recent evidence shows cognitive-behavioral therapy for insomnia (CBTI) and sleep restriction therapy (SRT) to improve sleep for women with menopausal insomnia. However, insomnia is a 24-hour disorder characterized by difficulty sleeping at night and impaired function and quality of life during the day.

Study Impact: Impaired daytime function is a primary motivator for insomnia treatment-seeking, yet it remains unclear whether CBTI or SRT improve insomnia-related daytime impairment and poor quality of life in postmenopausal patients. In this trial, we showed that CBTI and SRT improve daytime fatigue and energy, quality of life, and work performance relative to sleep hygiene control. Importantly, CBTI produced even larger treatment effects than SRT in addition to improving emotional health.

Association Between Periodic Limb Movements in Sleep and Cerebrovascular Changes in Children With Sickle Cell Disease. 1011-1019.
Jenny Lin, MD1; Kerry Morrone, MD2; Deepa Manwani, MD2; Rina Chernin, PNP1; Ellen J. Silver, PhD3; Keivan Shifteh, MD4; Sanghun Sin, MS1; Raanan Arens, MD1; Katharina Graw-Panzer, MD1


Current Knowledge/Study Rationale: Children with sickle cell disease (SCD) have a higher frequency of periodic limb movements (PLMs) compared to healthy children. Recent studies noted that PLMs may contribute to adverse cardiovascular and cerebrovascular outcomes in children with SCD who are already at risk for stroke, but there is scarce research investigating this.

Study Impact: In our retrospective study, elevated periodic limb movement index (PLMI) was significantly associated with higher rates of cerebrovascular stenosis with Moyamoya disease and a trend toward significance for isolated cerebrovascular stenosis. Our findings could suggest that elevated PLMI may be associated with earlier signs of cerebrovascular compromise in children with SCD and could serve as a marker in screening for cerebrovascular disease, but further investigation with prospective studies is needed.

Sleep in ADCY5-Related Dyskinesia: Prolonged Awakenings Caused by Abnormal Movements. 1021-1029.
Aurélie Méneret, MD, PhD1,2; Emmanuel Roze, MD, PhD1,2; Jean-Baptiste Maranci, MD3; Pauline Dodet, MD3; Diane Doummar, MD4; Florence Riant, PharmD5,6; Christine Tranchant, MD, PhD7,8,9; Valérie Fraix, MD, PhD10; Mathieu Anheim, MD, PhD7,8,9; Asya Ekmen2; Eavan McGovern, MD, PhD1; Marie Vidailhet, MD1,2; Isabelle Arnulf, MD, PhD2,3; Smaranda Leu-Semenescu, MD3


Current Knowledge/Study Rationale: Some studies reported worsening of ADCY5-related dyskinesia during sleep, a feature not usually observed in other movement disorders. We aimed to characterize sleep architecture (compared to non-medicated, healthy age and sex-matched controls) and to analyze the pattern of all movements occurring during sleep to ascertain if there is a primary sleep disorder, or if the sleep disturbance is rather a consequence of the dyskinesia.

Study Impact: We found that ADCY5-related nocturnal paroxysmal dyskinesia were not elicited by sleep or due to a primary sleep disorder. The exacerbation of paroxysmal dyskinesia upon morning awakening could be the result of an imbalance between the dopamine and adenosine pathways caused by adenylyl cyclase 5 dysfunction.

Information on Bedtimes and Wake Times Improves the Relation Between Self-Reported and Objective Assessments of Sleep in Adults. 1031-1036.
Marie-Pierre St-Onge, PhD1,2,3; Ayanna Campbell, MS1; Ismel Salazar, MS1; Theresa Pizinger, MS1; Ming Liao, MS4; Brooke Aggarwal, EdD2,4


Current Knowledge/Study Rationale: Epidemiological studies utilizing self-reports to characterize total sleep time (TST) provide discordant information on the association between self-reported and objective TST. Some studies find weak or no correlations and bias in reporting of TST based on sex and body mass index, which may impact the relation between TST and chronic diseases.

Study Impact: Our study shows that calculating TST based on self-reported bedtime, wake time, and time to fall asleep provides an estimate of TST that is correlated to actigraphy-measured TST. These questions can be used in clinical settings to obtain information on sleep duration.

Emerging Technologies

Sleep Validity of a Non-Contact Bedside Movement and Respiration-Sensing Device. 1051-1061.
Margeaux M. Schade, PhD1,2; Christopher E. Bauer, PhD1,3; Billie R. Murray, BS1; Luke Gahan, MEng4; Emer P. Doheny, PhD4; Hannah Kilroy, MAI4; Alberto Zaffaroni, MEng4; Hawley E. Montgomery-Downs, PhD1

Case Reports

Steroids: A Wake-Up Call in TBI Induced Hypersomnolence. 1063-1065.
Margarita Oks, MD1; Sanjeev V. Kothare, MD2

Letters to the Editor

Free What Are the Effects of Physical Activity on Sleep Quality and Low Back Pain in Older Adults?. 1067-1068.
Priscila K. Morelhão, PhD; Sergio Tufik, MD, PhD; Monica L. Andersen, PhD

REM: A Publication for Residents and Fellows

Free Drowsy Driving Considerations in Non-Commercial Drivers for the Sleep Physician. 1069-1071.
Anand Bhat, MD1; Ann Marie Marciarille, JD2; Damien Stevens, MD1; David G. Ingram, MD3

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2017 Impact Factor: 3.396
5-Year Impact Factor: 4.216
2017 Journal Citation Reports®
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