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Scientific Investigations

Moderate to Severe Obstructive Sleep Apnea in Military Personnel Is Not Associated With Decreased Exercise Capacity. 823-829.
Tyler A. Powell, MD1; Vincent Mysliwiec, MD1; James K. Aden, PhD2; Michael J. Morris, MD2


Current Knowledge/Study Rationale: Prior research in older and less active patients with moderate to severe obstructive sleep apnea (OSA) has shown reduced exercise capacity. In this study we looked to determine whether there was an exercise decrement as reflected by VO2 max in younger and more active patients with moderate to severe OSA as would typically be encountered in the military.

Study Impact: Younger and more active patients with OSA do not have decreased exercise tolerance. It is likely that the effect of OSA on exercise tolerance is influenced by additional factors and is too small to be appreciated in this population.

Air Pollutants Are Associated With Obstructive Sleep Apnea Severity in Non-Rapid Eye Movement Sleep. 831-837.
Wan-Ju Cheng, MD, PhD1,2; Shinn-Jye Liang, MD3,4; Chun-Sen Huang, MSc4; Cheng-Li Lin, MSc5,6; Li-Chung Pien, PhD7; Liang-Wen Hang, MD, PhD3,4


Current Knowledge/Study Rationale: It has been shown that the severity of obstructive sleep apnea has seasonal patterns, but the association with ambient conditions is inconclusive. It is also unknown whether continuous positive airway pressure treatments have seasonal patterns.

Study Impact: We found that air pollutants and relative humidity were related to the apnea–hypopnea index in women and patients with severe obstructive sleep apnea but only during non-rapid eye movement sleep. Seasonal variations for continuous positive airway pressure treatment dose were not significant; therefore, an adjustment for continuous positive airway treatment dose by season is not warranted. This study identified populations vulnerable to air pollutant-related sleep apnea exacerbation and suggested that AHI in non-rapid eye movement sleep is more affected by ambient factors than AHI in REM sleep.

Free Effect of CPAP Treatment of Sleep Apnea on Clinical Prognosis After Ischemic Stroke: An Observational Study. 839-847.
José Haba-Rubio, MD1; Jelena Vujica, MD1; Yannick Franc, MSc2; Patrik Michel, MD3; Raphaël Heinzer, MD, MPH1


Current Knowledge/Study Rationale: Sleep-disordered breathing (SDB) is recognized as a cerebrovascular risk factor, but it is not completely established whether its treatment improves prognosis after stroke. The aim of our study was to determine the effect of continuous positive airway pressure (CPAP) treatment for SDB on clinical outcomes in patients with ischemic stroke.

Study Impact: Our study shows that adequate CPAP treatment in patients who have had a stroke with moderate to severe SDB is associated with lower rates of stroke recurrence and death. However, adherence in this population is low.

Anthropometric Measures and Prediction of Maternal Sleep-Disordered Breathing. 849-856.
Ghada Bourjeily, MD1,2; Alison Chambers, PhD1,3; Myriam Salameh, MD2; Margaret H. Bublitz, PhD1,2; Amanpreet Kaur, MD1,2; Alexandra Coppa, BS2; Patricia Risica, PhD4; Geralyn Lambert-Messerlian, PhD1,5


Current Knowledge/Study Rationale: Pregnancy is associated with physiological changes that may be transient; however, these changes may affect the pathogenesis of sleep-disordered breathing in pregnancy. This study examined the ability of clinical upper airway measurements to detect sleep-disordered breathing.

Study Impact: We found that a larger neck circumference was most predictive of sleep-disordered breathing in women with Mallampati class 1, despite this group having smaller average neck circumference compared to other Mallampati classes. Though counterintuitive, our findings suggest that physiological changes of pregnancy may affect the site of obstruction in pregnancy, begging for future studies examining measurements such as airway luminal areas and nasal resistance. A better understanding of this physiology can further the application of specific therapy of sleep-disordered breathing in this population.

Delayed Sleep Time in African Americans and Depression in a Community-Based Population. 857-864.
Omavi Bailey, MD, MPH1,2; Daniel Combs, MD1,2,3; Maria Sans-Fuentes, PhD1; Cody M. Havens, MPH1,4,5; Michael A. Grandner, PhD, MTR1,6; Chithra Poongkunran, MD1,2; Sarah Patel, MD1,2; Sarah Berryhill, BS1; Natalie Provencio, MS1; Stuart F. Quan, MD7,8; Sairam Parthasarathy, MD1,2,8


Current Knowledge/Study Rationale: Delayed sleep timing is well described in children and adolescents, and is associated with depression and other adverse outcomes, and may be more prevalent in certain ethnic groups. We hypothesized that delayed sleep timing is more common in African Americans, and that it is associated with depression in a community cohort of older adults.

Study Impact: African Americans were twice as likely to have delayed sleep timing compared to whites. African Americans obtained 22 minutes less sleep on weeknights compared to whites, which was related to delayed sleep timing. Additionally, individuals with delayed sleep timing were 40% more likely to have depression.

Free Toddler Bedtime Routines and Associations With Nighttime Sleep Duration and Maternal and Household Factors. 865-871.
Lauren B. Covington, PhD, RN1; Valerie E. Rogers, PhD, RN2; Bridget Armstrong, PhD3; Carla L. Storr, ScD, MPH2; Maureen M. Black, PhD3,4


Current Knowledge/Study Rationale: Toddlers from minority, low-income families are at increased risk for deficient sleep and related poor health outcomes. Bedtime routines have been associated with improved sleep in toddlers of high-income, highly educated, Caucasian families, and should be examined among toddlers of low-income minority families to better address sleep deficiencies.

Study Impact: Given the key role sleep plays in the growth and development of young children, this study suggests that mothers of toddlers living in low socioeconomic conditions could benefit from strategies to promote bedtime routines and longer nighttime sleep. Broader public health measures are needed to improve screening and treatment of maternal mental health symptoms and to eliminate food and housing insecurity, especially among families with young children.

Prescription Patterns of Sedative Hypnotic Medications in the Military Health System. 873-879.
Rosenie Thelus Jean, PhD1; Yingxin Hou, MS1; James Masterson, PharmD2; Adrian Kress, MD1; Vincent Mysliwiec, MD3


Current Knowledge/Study Rationale: Active duty service members (ADSM) are a unique population that are at high risk for sleep disturbances and the development of insomnia. Recent information on trend of pharmacological intervention that can be used to mitigate these outcomes are scarce.

Study Impact: In a comprehensive multiyear assessment of sedative hypnotic medications dispensed in the Military Healthcare System, ADSM had a consistently higher prevalence of sedative hypnotic prescriptions than non-ADSM. Most prescriptions in ADSM were for acute or intermittent treatment episodes. In this unique population, the high prevalence of sedative hypnotic medications likely correlates with their high rates of sleep disturbances and suggests the need for novel approaches to improve their sleep.

The Risk of Hospitalization for Motor Vehicle Accident Injury in Narcolepsy and the Benefits of Stimulant Use: A Nationwide Cohort Study in Taiwan. 881-889.
Nian-Sheng Tzeng, MD1,2; Shih-Chun Hsing, MSPH3,4; Chi-Hsiang Chung, PhD5,6,7; Hsin-An Chang, MD1,2; Yu-Chen Kao, MD, MSc1,8; Wei-Chung Mao, MD, PhD9,10; Cheryl C.H. Yang, PhD11,12; Terry B.J. Kuo, MD, PhD11,12; Tien-Yu Chen, MD1,11,12; Wu-Chien Chien, PhD5,6,13


Current Knowledge/Study Rationale: Narcolepsy is characterized by irresistible daytime sleepiness, and previous studies have demonstrated an association between narcolepsy and motor vehicle accident injury (MVAI). However, direct evidence of the risk of hospitalization for MVAI in narcolepsy is limited for the Asian population. We used a population-based, retrospective cohort study to examine this issue.

Study Impact: The current study demonstrates that patients with narcolepsy had an approximately 6.7-fold increased risk of hospitalization for MVAI when compared to those without narcolepsy. In addition, the use of modafinil or methylphenidate was associated with a lower risk of hospitalization for MVAI in the narcolepsy cohort, either as monotherapy or as combined treatment. Our findings could bring some insights for the regulations of traffic safety.

Prevalence, Effect on Functional Outcome, and Treatment of Sleep-Disordered Breathing in Patients With Subacute Stroke. 891-897.
Daisuke Matsuura, MD1; Yohei Otaka, MD, PhD1,2,3; Rie Kamigaichi, MD, MPH1; Kaoru Honaga, MD, PhD1; Kunitsugu Kondo, MD, PhD1; Meigen Liu, MD, PhD2


Current Knowledge/Study Rationale: Sleep-disordered breathing (SDB) is an important issue associated with subacute stroke. We investigated its prevalence and the effect of its severity on the functional outcome and feasibility of continuous positive airway pressure (CPAP) therapy in actual clinical settings.

Study Impact: Our results suggest that SDB is very common in patients with subacute stroke. Its severity exhibits an association with the severity of motor dysfunction and disability, although it is not an independent factor for the functional outcome. The high SDB prevalence and relatively good adherence to CPAP therapy after discharge suggests that appropriate SDB evaluation and CPAP administration during hospitalization is recommended to alleviate SDB-related symptoms and improve the health-related quality of life in patients who have experienced subacute stroke.

Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study. 899-905.
Caroline Bengtsson, MD1; Lars Jonsson, MD, PhD1; Mats Holmström, MD, PhD2; Johan Hellgren, MD, PhD3; Karl Franklin, MD, PhD4; Tórarinn Gíslason, MD, PhD5; Mathias Holm, MD, PhD6; Ane Johannessen, PhD7,8; Rain Jõgi, MD, PhD9; Vivi Schlünssen, MD, PhD10; Christer Janson, MD, PhD11; Eva Lindberg, MD, PhD11


Current Knowledge/Study Rationale: Chronic rhinosinusitis affects the quality of life of millions of people worldwide. The knowledge of sleep quality in chronic rhinosinusitis is limited, however. There is a need for large scale epidemiological studies to estimate the prevalence and incidence of chronic rhinosinusitis and its impact on sleep quality.

Study Impact: This 10-year follow-up study contributes to the understanding of how the development of chronic rhinosinusitis affects self-reported sleep quality. It also illuminates a possible link between insomnia symptoms and the later development of an inflammatory disorder of the respiratory airway.

The Effect of Upper Airway Surgery on Loop Gain in Obstructive Sleep Apnea. 907-913.
Yanru Li, MD1,2,3; Jingying Ye, MD1,2,4; Demin Han, MD1,2; Di Zhao, MD1,2; Xin Cao, MD1,2,4; Jeremy Orr, MD3; Rachel Jen, MD3; Naomi Deacon-Diaz, PhD3; Scott A. Sands, PhD5; Robert Owens, MD3; Atul Malhotra, MD3


Current Knowledge/Study Rationale: Unstable ventilatory control (high loop gain) is an important non-anatomical risk factor for obstructive sleep apnea (OSA). Controversy exists as to whether elevated loop gain is a cause or consequence of OSA. Studies have shown high loop gain may be acquired from long-term intermittent hypoxemia due to OSA and can decrease after continuous positive airway pressure therapy.

Study Impact: Unstable ventilatory control in patients with OSA can be improved by upper airway surgery, supporting the notion that ventilatory control abnormalities may be acquired in some patients. The results may guide future therapeutic approaches by providing insight into potential mechanisms of surgical improvement and/or failure.

Adherence to Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea in Children With Developmental Disabilities. 915-921.
Eun Kyeong Kang, MD1,2; Melissa S. Xanthopoulos, PhD1; Ji Young Kim, PhD1,3; Casandra Arevalo, MD1; Justine Shults, PhD1; Suzanne E. Beck, MD1,4; Carole L. Marcus, MBBCh1,4; Ignacio E. Tapia, MD1,4


Current Knowledge/Study Rationale: Children with developmental disabilities (DD) requiring positive airway pressure (PAP) for the treatment of obstructive sleep apnea are a growing and understudied population. Research has shown that children with DD could benefit from behavioral interventions to improve PAP adherence, but few studies have specifically analyzed PAP adherence in this group.

Study Impact: This study showed that children with DD, with adequate support, have better PAP adherence than typically developing children. The study also identified predictive factors of PAP adherence in children.

Sleep Medicine Pearls

Patient With a New Parasomnia. 929-930.
Surina Sharma, MD1; Susheela Hadigal, MD1; Mary H. Wagner, MD2; Scott Ryals, MD1; Richard B. Berry, MD1

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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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