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Accepted Papers


Free Prognostic Significance of Fluctuations in End-Expiratory Lung Volume in Hunter-Cheyne-Stokes Breathing. 1227-1228.
Shahrokh Javaheri, MD, FCCP, FAASM1,2; Martin J. Tobin, MD3,4; Jerome A. Dempsey, PhD5
Free Sleep Apnea and Nocturnal Cardiac Arrhythmia: Understanding Differences Across Ethnicity. 1229-1231.
Reena Mehra, MD, MS, FCCP, FAASM
Free Infants Sleep for Brain. 1233-1234.
Madeleine M. Grigg-Damberger, MD1; Kathy M. Wolfe, MD2

Scientific Investigations

Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure. 1235-1241.
Elisa Perger, MD1,2; Toru Inami, MD1,2; Owen D. Lyons, MD1,2; Hisham Alshaer, MD, PhD1; Stephanie Smith, BSc1; John S. Floras, MD, DPhil1; Alexander G. Logan, MD1; Michael Arzt, MD3; Joaquin Duran Cantolla, MD4; Diego Delgado, MD1; Michael Fitzpatrick, MD5; John Fleetham, MD6; Takatoshi Kasai, MD, PhD7; R. John Kimoff, MD8; Richard S.T. Leung, MD, PhD9; Geraldo Lorenzi Filho, MD, PhD10; Pierre Mayer, MD11; Lisa Mielniczuk, MD12; Debra L. Morrison, MD13; Gianfranco Parati, MD14; Sairam Parthasarathy, MD15; Stefania Redolfi, MD, PhD16; Clodagh M. Ryan, MD1,2; Frederic Series, MD17; George A. Tomlinson, PhD1; Anna Woo, MD1; T. Douglas Bradley, MD1,2


Current Knowledge/Study Rationale: Cheyne-Stokes respiration is common in patients with heart failure, but there are discrepancies between studies regarding its prognostic implications. It is possible that Cheyne-Stokes respiration may not be entirely homogeneous but might have different subtypes.

Study Impact: We report for the first time the observation of two distinct patterns of hyperpnea during Cheyne-Stokes respiration in patients with heart failure, that might be related to underlying cardiac function.

Night-to-Night Sleep Variability in Older Adults With Chronic Insomnia: Mediators and Moderators in a Randomized Controlled Trial of Brief Behavioral Therapy (BBT-I). 1243-1254.
Wai Sze Chan, PhD1; Jacob Williams, MA2; Natalie D. Dautovich, PhD3; Joseph P.H. McNamara, PhD4; Ashley Stripling, PhD5; Joseph M. Dzierzewski, PhD3; Richard B. Berry, MD6; Karin J.M. McCoy, PhD7; Christina S. McCrae, PhD8


Current Knowledge/Study Rationale: High night-to-night sleep variability is prevalent in older adults who have chronic insomnia, is associated with poorer health outcomes, and may maintain insomnia. It is unclear if and how sleep variability decreases over the course of a brief behavioral therapy for insomnia (BBT-I) and whether pretreatment sleep variability moderates treatment efficacy.

Study Impact: The current findings indicate that BBT-I is efficacious in reducing sleep variability through increasing consistency of bedtime and wake time and reduced time in bed. Baseline sleep variability moderated the efficacy of BBT-I on primary sleep outcomes; individuals who had higher baseline sleep variabilities responded more positively to BBT-I. Sleep variability might be a useful measure for clinicians to identify patients who will or will not benefit from behavioral sleep interventions.

Free Impact of Sleep-Disordered Breathing Treatment on Quality of Life Measures in a Large Clinic-Based Cohort. 1255-1263.
Harneet K. Walia, MD, FAASM1; Nicolas R. Thompson, MS2; Irene Katzan, MD3,4; Nancy Foldvary-Schaefer, DO, MS1; Douglas E. Moul, MD, MPH, FAASM1; Reena Mehra, MD, MS, FAASM1


Current Knowledge/Study Rationale: Sleep-disordered breathing is associated with impaired quality of life. There are limited clinical data demonstrating changes in quality of life measures with use of positive airway pressure therapy in those with sleep-disordered breathing.

Study Impact: This study showed improvement in generic quality of life and sleep-specific quality-of- life measures after the use of positive airway pressure therapy in a sleep-disordered breathing clinical population. Older patients and those in a higher socioeconomic subgroup had better quality of life measures after positive airway pressure therapy. This information will guide clinicians in terms of expected quality of life outcomes with sleep-disordered breathing treatment.

Prevalence of Cardiac Arrhythmias in Asian Patients With Obstructive Sleep Apnea: A Singapore Sleep Center Experience. 1265-1271.
Wei Li Neo, MRCS, MBBS1; Adele C.W. Ng, MBBS1; Mahalakshmi Rangabashyam, MBBS1; Ying Hao, PhD2; Kah Leng Ho, MRCP, MBBS3; Siti Raudha Binte Senin4; Song Tar Toh, FAMS, MMed1,4,5


Current Knowledge/Study Rationale: It has been postulated that obstructive sleep apnea (OSA) may affect Asians differently compared with Caucasians. There is a lack of information on the prevalence of cardiac arrhythmias in the Asian population with OSA.

Study Impact: Our study demonstrates that cardiac arrhythmias are more common in patients with OSA in the Singaporean context. In addition, it suggests that ethnicity may play a significant role in the development of cardiovascular disease among patients with OSA.

Nocturnal Desaturation is Associated With Neurological Deterioration Following Ischemic Stroke: A Retrospective Observational Study. 1273-1279.
Tae Jung Kim, MD1; Sang-Bae Ko, MD, PhD1; Han-Gil Jeong, MD1; Chi Kyung Kim, MD, PhD2; Yerim Kim, MD3; Kiwoong Nam, MD1; Heejung Mo, MD1; Sang Joon An, MD1; H. Alex Choi4; Byung-Woo Yoon, MD, PhD1


Current Knowledge/Study Rationale: Sleep-disordered breathing has been recognized as a risk factor for worse outcome after stroke. We assessed the relationship between nocturnal oxygen desaturation using continuously monitored systemic saturation data in the stroke unit and early neurological deterioration, especially occurring at nighttime, following acute stroke.

Study Impact: This study demonstrates that nocturnal desaturation in the stroke unit was associated with early neurological deterioration, especially during nighttime after stroke. This suggests that treatment of sleep-disordered breathing could be an important factor to prevent early neurological deterioration among acute stroke patients.

Differences in Sleep Patterns and Problems by Race in a Clinical Sample of Black and White Preschoolers. 1281-1288.
Ariel A. Williamson, PhD1,2; Sonia L. Rubens, PhD3; Kristina E. Patrick, PhD4; Melisa Moore, PhD1; Jodi A. Mindell, PhD1,5


Current Knowledge/Study Rationale: Community-based research indicates that Black preschoolers exhibit more behavioral sleep problems and are at higher risk for obstructive sleep apnea (OSA) compared to White children. Little is known about differential rates of sleep disorders by race among young children who present for clinical services at outpatient pediatric sleep centers.

Study Impact: Despite few significant differences in sleep patterns, White patients were significantly more likely to present for sleep services for insomnia-related concerns, and Black children were significantly more likely to present for OSA-related concerns, even when controlling for relevant covariates. Study findings represent a first step in examining potential health disparities in referrals for and engagement in pediatric sleep services, particularly for behavioral sleep concerns.

Lemborexant, A Dual Orexin Receptor Antagonist (DORA) for the Treatment of Insomnia Disorder: Results From a Bayesian, Adaptive, Randomized, Double-Blind, Placebo-Controlled Study. 1289-1299.
Patricia Murphy, PhD1; Margaret Moline, PhD1; David Mayleben, PhD2; Russell Rosenberg, PhD3; Gary Zammit, PhD4; Kate Pinner, MSc5; Shobha Dhadda, PhD1; Quan Hong, PhD1; Luigi Giorgi, MD5; Andrew Satlin, MD1


Current Knowledge/Study Rationale: There is a need for improved efficacy and safety of prescription medications used for treating insomnia. In particular, patients would benefit if treatments showed greater efficacy in reducing wakefulness throughout the night without producing important residual morning sleepiness.

Study Impact: This study of lemborexant, a dual orexin receptor antagonist in clinical development, identified doses that showed promising activity for treatment of insomnia, while not substantially affecting either subjective or objective measures of residual morning sleepiness. These lemborexant doses will be evaluated in additional clinical trials.

Improving Sleep Quality Assessment Using Wearable Sensors by Including Information From Postural/Sleep Position Changes and Body Acceleration: A Comparison of Chest-Worn Sensors, Wrist Actigraphy, and Polysomnography. 1301-1310.
Javad Razjouyan, PhD1; Hyoki Lee, PhD1; Sairam Parthasarathy, MD2; Jane Mohler, MPH, PhD, MPH3; Amir Sharafkhaneh, MD, PhD4; Bijan Najafi, PhD1


Current Knowledge/Study Rationale: Sleep quality is an important measure for health. Although objective modalities such as wearable sensors have been proposed to measure sleep quality in out-of-laboratory conditions, conventional methods based on wrist sensors suffer from drawbacks in accurate measurement regarding time in bed, sleep posture (supine, prone, and sides), and position changes.

Study Impact: This study suggests that a chest sensor, which integrates body acceleration and position change, could more accurately detect sleep/wake epochs compared to conventional methods based on wrist sensor. As compared to the wrist sensor, the chest sensor demonstrated an improved precision and a stronger correlation with polysomnography for estimation of sleep parameters of interest. The results may open new avenues to improve the ability of wearable sensor for clinical assessment of sleep outside of sleep laboratory. It also suggests that body location other than wrist and/or additional measurable sensor-derived parameters beyond body acceleration could improve in further sleep assessment methods.

Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea. 1311-1317.
Anuja Bandyopadhyay, MD1; Heidi Harmon, MD, MS2; James E. Slaven, MS3; Ameet S. Daftary, MD, MS1


Current Knowledge/Study Rationale: Preterm infants are an at-risk population for poor neurodevelopmental outcomes as well as sleep-disordered breathing (SDB). Sleep apnea has significant developmental and behavioral implications; however, the effect of neonatal SDB on the neurodevelopmental outcomes of preterm infants is unknown.

Study Impact: Although there is a high level of SDB in preterm infants, the median score for cognitive, language and motor scores were still within one standard deviation of the published norm. Mean end-tidal CO2, independent of apnea-hypopnea index, in polysomnography may be worth consideration as a biomarker for predicting poor cognitive outcome in this high-risk population.

Free Perfectionism and Polysomnography-Determined Markers of Poor Sleep. 1319-1326.
Anna F. Johann1,2; Elisabeth Hertenstein, PhD1; Simon D. Kyle, PhD3; Chiara Baglioni, PhD1; Bernd Feige, PhD1; Christoph Nissen, MD1; Dieter Riemann, PhD1; Kai Spiegelhalder, MD, PhD1


Current Knowledge/Study Rationale: Studies on perfectionism and sleep have relied on self-reported measures of sleep. Discrepancies between subjective and objective measures of sleep have frequently been observed, especially in patients with insomnia. Subjective and objective sleep disturbances are partially independent constructs, with objective sleep disturbances being more closely associated with physiological arousal and medical morbidity. For these reasons, we investigated whether higher levels of perfectionism are linked to poor sleep, using polysomnography to measure sleep instead of self-report.

Study Impact: Our study shows that perfectionism is related to objective sleep disturbances. Thus, our results show that perfectionism warrants further investigation in order to further improve the treatment of insomnia.

A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder. 1327-1335.
Ali A. El-Solh, MD, MPH1,2,3; Gregory G. Homish, PhD3,4; Guy Ditursi, DDS, MBA1; John Lazarus, DDS1; Nithin Rao, DDS1; David Adamo, RPSGT1; Thomas Kufel, MD1,2


Current Knowledge/Study Rationale: In veterans with posttraumatic stress disorder (PTSD), the disturbed sleep can worsen the cognitive-behavioral manifestations of PTSD and contribute to poor mental and physical health outcomes. Because adherence to treatment with CPAP is less than optimal in this population, this study was undertaken to examine the clinical efficacy, compliance, and quality of sleep of mandibular advancement devices (MAD) compared to CPAP in veterans with OSA and PTSD.

Study Impact: Although CPAP is more efficacious in eliminating respiratory events, both MAD and CPAP result in similar beneficial changes in daytime sleepiness, PTSD symptomatology, and health-related quality of life measures in veterans with OSA and PTSD.

Mask Refills as a Measure of PAP Adherence. 1337-1344.
Matthew T. Scharf, MD, PhD1,2,3; Brendan T. Keenan, MS4; Allan I. Pack, MBChB, PhD1,4; Samuel T. Kuna, MD1,2,4


Current Knowledge/Study Rationale: PAP adherence monitoring is a routine aspect of clinical care in patients with OSA, but direct PAP adherence data are not uniformly available. Use of an indirect measure of PAP adherence such as mask refills could allow for PAP adherence monitoring in situations where data would be otherwise unavailable.

Study Impact: Our study demonstrates that the number of mask refills correlates with directly measured PAP adherence. This suggests that the number of mask refills could be used as a measure of PAP adherence where adherence data are otherwise unavailable.

Review Articles

Ocular Manifestations of Obstructive Sleep Apnea. 1345-1348.
Matthew Santos, BS; R. Jeffrey Hofmann, MD

Emerging Technologies

Rate My Sleep: Examining the Information, Function, and Basis in Empirical Evidence Within Sleep Applications for Mobile Devices. 1349-1354.
Peta A. Lee-Tobin, MProfPsych1,2; Rowan P. Ogeil, PhD1,2; Michael Savic, PhD1,2; Dan I. Lubman, PhD, FRANZCP, FAChAM1,2

Case Reports

Non-24-Hour Sleep-Wake Rhythm Disorder and Melatonin Secretion Impairment in a Patient With Pineal Cyst. 1355-1357.
Lorenzo Ferri, MD1; Marco Filardi, PhD1; Monica Moresco, MSc1; Fabio Pizza, MD, PhD1,2; Stefano Vandi, RPSGT1; Elena Antelmi, MD1,2; Francesco Toni, MD3; Mino Zucchelli, MD4; Giulia Pierangeli, MD, PhD1,2; Giuseppe Plazzi, MD, PhD1,2
Carbamazepine Improves Apneic Episodes in Congenital Central Hypoventilation Syndrome (CCHS) With a Novel PHOX2B Exon 1 Missense Mutation. 1359-1362.
Schaida Schirwani, MBChB, MSc, MRCP1; Karen Pysden, MBChB, MRCPCH2; Philip Chetcuti, DM, FRCPCH3; Moira Blyth, MBChB, FRCP, DM, PGDip1

Sleep Medicine Pearls

A Patient With Rapidly Progressing Early-Onset Dementia and Insomnia. 1363-1364.
Klark Turpen, MD1; Amy Thornbury, ARNP1; Mary Wagner, MD2; Richard B. Berry, MD3; Johan Barretto, MD3; Ruby Williams, MD3; Scott Ryals, MD3

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