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Scientific Investigations

Physiology-Based Modeling May Predict Surgical Treatment Outcome for Obstructive Sleep Apnea. 1029-1037.
Yanru Li, MD1,2; Jingying Ye, MD1,3; Demin Han, MD, PhD1; Xin Cao, MD1; Xiu Ding1; Yuhuan Zhang1,3; Wen Xu, MD1; Jeremy Orr, MD2; Rachel Jen, MD2; Scott Sands, PhD4,5; Atul Malhotra, MD2; Robert Owens, MD2

BRIEF SUMMARY

Current Knowledge/Study Rationale: We hypothesized that consideration of both anatomical and non-anatomical surrogates of physiological traits (such as control of breathing, arousal threshold, and upper airway muscular responsiveness) might improve the ability to predict response to upper airway surgery for obstructive sleep apnea.

Study Impact: The study showed that application of physiology, rather than reliance on unguided statistical methods, may be superior to prognosticate treatment response to upper airway surgery for the treatment of obstructive sleep apnea. Although our results may be specific to the population and intervention we studied, they provide proof of concept for this approach, which might be used in other populations and with other interventions.

Article Is Eligible For CME Credits Free Insulin Resistance and Hypertension in Obese Youth With Sleep-Disordered Breathing Treated With Positive Airway Pressure: A Prospective Multicenter Study. 1039-1047.
Sherri L. Katz, MDCM, MSc1; Joanna E. MacLean, MD, PhD2; Lynda Hoey3; Linda Horwood, MSc4; Nicholas Barrowman, PhD3; Bethany Foster, MD, MSc4; Stasia Hadjiyannakis, MD1; Laurent Legault, MD4; Glenda N. Bendiak, MD5; Valerie G. Kirk, MD5; Evelyn Constantin, MDCM, MSc4

BRIEF SUMMARY

Current Knowledge/Study Rationale: In adults with obesity and sleep-disordered breathing (SDB), treatment with positive airway pressure (PAP) improves metabolic dysfunction, hypertension, and systemic inflammation. It is not known whether these conditions are already present at SDB diagnosis in youth or whether long-term PAP therapy improves markers of cardiometabolic disease in this population.

Study Impact: This study demonstrated that cardiometabolic disease (insulin resistance [HOMA-IR], hypertension, and systemic inflammation) is highly prevalent at the time of SDB diagnosis in youth with obesity. We were unable to detect statistically significant improvements in cardiometabolic markers 1 year after prescription of PAP therapy. There were, however, clinically relevant improvements in insulin resistance and systolic blood pressure load, important predictors of future risk of cardiovascular disease.

Article Is Eligible For CME Credits Psychomotor Vigilance Test and Its Association With Daytime Sleepiness and Inflammation in Sleep Apnea: Clinical Implications. 1049-1056.
Yun Li, MD1,2; Alexandros Vgontzas, MD1; Ilia Kritikou, MD1; Julio Fernandez-Mendoza, PhD1; Maria Basta, MD1; Slobodanka Pejovic, MD1; Jordan Gaines, PhD1; Edward O. Bixler, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Daytime sleepiness is a key symptom in patients with OSA; however, determining the best method of assessing excessive daytime sleepiness (EDS) in terms of its clinical utility and ease of use is currently an open issue.

Study Impact: In this study, we demonstrate that Psychomotor Vigilance Task correlates best with subjectively measured EDS (via Epworth Sleepiness Scale) but not objectively measured EDS (via Multiple Sleep Latency Test) nor peripheral levels of IL-6. It appears that the Epworth Sleepiness Scale is a good predictor of impaired performance and associated risks, such as traffic accidents, in patients with OSA, but not of cardiometabolic risk, as assessed by inflammation. Thus, it is possible that subjective and objective EDS reflect different central nervous system processes with different underlying mechanisms.

Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). 1057-1066.
Elisha K. Josev, PhD1,2; Melinda L. Jackson, PhD2,3; Bei Bei, PhD4,5; John Trinder, PhD2; Adrienne Harvey, PhD1,6; Cathriona Clarke, BSc1; Kelli Snodgrass, MD1; Adam Scheinberg, MMed (Clin Epi)1,7,8; Sarah J. Knight, PhD1,7,9

BRIEF SUMMARY

Current Knowledge/Study Rationale: Little is known about the type and severity of sleep disturbances in the pediatric CFS/ME population, particularly in comparison with the healthy adolescent population. Poor or disordered sleep can affect future educational, cognitive, psychosocial, psychopathological, and physical health outcomes, and may exacerbate the impact of other CFS/ME symptoms.

Study Impact: This study provides objective and subjective evidence of sleep disturbances in adolescents with CFS/ME compared with healthy adolescents. Psychological factors such as anxiety do not appear to contribute to objective sleep disturbance, but may play a role in influencing adolescents' perception of their sleep quality. Both objective and subjective factors may be important for clinicians to consider when treating adolescent patients with sleep disturbance.

Free The National Healthy Sleep Awareness Project Sleep Health Surveillance Questionnaire as an Obstructive Sleep Apnea Surveillance Tool. 1067-1074.
Youngsin Jung, MD, PhD1,2; Mithri R. Junna, MD1,2; Jayawant N. Mandrekar, PhD3; Timothy I. Morgenthaler, MD1,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Untreated obstructive sleep apnea (OSA) is associated with significant cardiovascular and cerebrovascular comorbidities. This study assesses the National Healthy Sleep Awareness Project (NHSAP) Surveillance and Epidemiology Workgroup questionnaire as a risk stratification tool for clinically significant OSA.

Study Impact: Identification of individuals at risk for OSA is important for appropriate evaluation and treatment. The NHSAP questionnaire provides similar accuracy to other commonly used screening tools and can be useful for determining risk for moderate to severe OSA.

Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: An Evaluation and Comparison of Outcomes at Two Academic Centers. 1075-1079.
Colin Huntley, MD1; Thomas Kaffenberger2; Karl Doghramji, MD3; Ryan Soose, MD4; Maurits Boon, MD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: In clinical trials, upper airway stimulation has proved to be a promising alternative treatment modality for select patients with obstructive sleep apnea unable to tolerate continuous positive airway pressure. However, until this point, outcome data in the clinical realm have been limited to single center, small cohort trials.

Study Impact: With this study, we reviewed the largest cohort of patients undergoing upper airway stimulation therapy in the clinical setting and found not only improved outcomes with therapy, but reproducible results at two separate institutions.

Free Sleep Characteristics and Temperament in Preterm Children at Two Years of Age. 1081-1088.
Barbara Caravale, MD, PhD1; Stefania Sette, PhD1; Eleonora Cannoni1; Assunta Marano, PhD1; Erika Riolo1; Antonella Devescovi1; Mario De Curtis, MD2; Oliviero Bruni, MD, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Preterm birth is a risk factor for many areas of neurological and psychological development. Little is known about sleep quality and habits of preterm children beyond the neonatal period and research findings, to date, have been inconclusive. Very few studies have analyzed the relationship between sleep patterns and temperament in preterm children compared to children born full term.

Study Impact: Our findings show that preterm children with no deficit in cognitive, language, and motor areas, in the second year of life, have relatively more frequent sleep difficulties during the night and different sleep habits compared to full-term children. The temperament of preterm children seems to be characterized by a lower level of attention and more negative emotionality compared to full-term children. We observed a link between sleep pattern and temperament in preterm children and found that sleep problems were related to increased negative emotionality and decreased attention.

A Comparison of Uvulopalatopharyngoplasty and Modified Radiofrequency Tissue Ablation in Mild to Moderate Obstructive Sleep Apnea: A Randomized Clinical Trial. 1089-1096.
Amin Amali, MD1; Maziar Motiee-Langroudi, MD2; Babak Saedi, MD2; Sara Rahavi-Ezabadi, MD, MPH2; Ali Karimian, MD2; Behrooz Amirzargar, MD2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Radiofrequency tissue ablation precisely applies energy to reduce the volume of redundant tissue in the upper airway. Radiofrequency tissue ablation has been performed for years as a treatment for obstructive sleep apnea but the efficacy and long-term outcomes of this procedure have not been clearly established.

Study Impact: In this study, we performed the standard drug-induced sleep endoscopy technique to localize the specific site of airway obstruction. The aim of this study was to determine relative effectiveness of modified radiofrequency tissue ablation and uvulopalatopharyngoplasty based on subjective and objective outcomes measures in patients with mild to moderate obstructive sleep apnea.

Long Sleep Duration is Associated With Sarcopenia in Korean Adults Based on Data from the 2008–2011 KNHANES. 1097-1104.
Yu-Jin Kwon, MD1,2; Suk-Yong Jang, MD, JD3; Eun-Cheol Park, MD, PhD3; A-Ra Cho, MD1; Jae-Yong Shim, MD, PhD1; John A. Linton, MD, PhD1,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Although adequate sleep duration is an important factor of health management, few researchers have investigated the association between sleep duration and sarcopenia. We studied the association between sleep duration and sarcopenia.

Study Impact: We found that long sleep duration was associated with sarcopenia. In particular, this association was more apparent in middle-aged subjects.

Case Reports

Early Onset of Sleep-Disordered Breathing in Two Children With SEPN1-Related Myopathies. 1105-1108.
Mathilde Viprey, MD1,2; Ha Trang, MD, PhD3; Michaël Pomedio, MD1; Katia Bessaci-Kabouya, MD1; Pascal Sabouraud, MD1; Fawzia Cheliout-Heraut, MD, PhD3; Pierre Mauran, MD, PhD1,2
Restless Genital Syndrome: Differential Diagnosis and Treatment With Pramipexole. 1109-1110.
Emilia Sforza, MD, PhD; David Hupin, MD; Frédéric Roche, MD, PhD

Letters to the Editor

Free Alcohol as a Trigger Affecting Symptom Severity and Frequency of Slow Wave Sleep Disorders. 1111.
Emily L. Maschauer, MSc1; Agata Gabryelska1,2; Ian Morrison, PhD, FRCP (Edin)3; Rachael McKeown, BMedSci Hons1; Donna Fairley, RGN1; Amber Roguski, BSc1; Renata L. Riha, BMedSc, RPSGT, MBBS, FRACP, MD, FRCPE1

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