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Accepted Papers


Free More Than the Trajectory of the Teeth, We Need to Know About the Treatment Trajectory of Patients. 7-8.
Marc Baltzan, MDCM, FRCPC, FAASM1,2,3; Dorrie Rizzo, PhD(c)4,5

Scientific Investigations

Sleep Architecture in Children With Common Phenotype of Obstructive Sleep Apnea. 9-14.
Peter Durdik, MD, PhD1; Anna Sujanska, MD, PhD1,2; Stanislava Suroviakova, MD1; Melania Evangelisti, MD2; Peter Banovcin, MD, PhD1; Maria Pia Villa, MD, PhD2


Current Knowledge/Study Rationale: In children, the effect of the common phenotype of obstructive sleep apnea (OSA) on sleep architecture is not actually adequately documented. The aim of this prospective cross-sectional study was to evaluate sleep architecture in a pediatric population with the common phenotype of OSA.

Study Impact: Our findings suggest that the most common phenotype of pediatric OSA has a negative effect on the structure of sleep, but other clinical studies are needed to confirm this result.

Comparison of Subjective Sleep Quality of Long-Term Residents at Low and High Altitudes: SARAHA Study. 15-21.
Ravi Gupta, MD, PhD1,2; Jan Ulfberg, MD3; Richard P. Allen, PhD4; Deepak Goel, DM2,5


Current Knowledge/Study Rationale: Many of the available studies that address the issue of quality of sleep at high altitude have methodological limitations (eg, lowlanders were made to ascend to high altitude; quality of sleep was measured using polysomnography, which has little correlation with subjective feeling; and small sample size). It is known that acclimatization to high altitude occurs, especially in populations native to high altitude. This study was conducted to compare subjective quality of sleep between populations native to high altitude and low altitude.

Study Impact: This study found that subjective quality of sleep was poor, compared to lowlanders, in a significant proportion of the population native to moderately high altitude—even after removing potential confounders such as chronic obstructive pulmonary disease and restless legs syndrome, perhaps because of deficient acclimatization. The acclimatization process may involve genetic as well as epigenetic factors.

Polysomnography-Detected Bruxism in Children is Associated With Somatic Complaints But Not Anxiety. 23-29.
Candice A. Alfano, PhD; Joanne L. Bower, PhD; Jessica M. Meers, MA


Current Knowledge/Study Rationale: Research examining sleep bruxism (SB) in children has relied almost exclusively on parent reports that may be biased by certain parent characteristics and/or child behaviors (eg, anxiety). We used both polysomnography (PSG) and parent reports to examine rates of SB in children with an anxiety disorder compared to healthy controls, including associations with daytime somatic symptoms and objective sleep disturbance.

Study Impact: Parent-reported and PSG-identified SB showed no association, raising concern about the reliability of subjective reports. Rates of SB were similar in the anxious and control groups suggesting that temperamental factors other than anxiety may be more closely associated with SB (eg, stress sensitivity). SB was linked with somatic symptoms and sleep disturbance in all youth.

Free The Effect of Systematic Light Exposure on Sleep in a Mixed Group of Fatigued Cancer Survivors. 31-39.
Lisa M. Wu, PhD1,2; Ali Amidi, PhD3; Heiddis Valdimarsdottir, PhD1,4; Sonia Ancoli-Israel, PhD5,6; Lianqi Liu, MD5; Gary Winkel, PhD1; Emily E. Byrne, BA1; Ana Vallejo Sefair, BA7; Alejandro Vega, BA1; Katrin Bovbjerg, BA2; William H. Redd, PhD1


Current Knowledge/Study Rationale: Systematic light exposure (sLE) using morning bright light therapy has commonly been used to treat seasonal affective disorder. More recently, it has shown promise in preventing and treating fatigue in cancer patients and survivors. In this secondary analysis, we sought to investigate the effect of sLE on sleep in a mixed group of fatigued cancer survivors following primary cancer treatment.

Study Impact: Given the difficulties that cancer survivors often have in engaging in activity that could treat sleep disturbance, bright light therapy has the potential to provide cancer survivors with an easy-to-use and inexpensive tool that could improve quality of life. Larger-scale studies to test the efficacy of sLE to treat sleep disturbances in cancer survivors are needed.

Dream Content in Patients With Sleep Apnea: A Prospective Sleep Laboratory Study. 41-46.
Franziska Di Pauli, MD1; Ambra Stefani, MD1; Evi Holzknecht, MD1; Elisabeth Brandauer, MD1; Thomas Mitterling, MD2; Brigitte Holzinger, PhD3; Birgit Högl, MD1


Current Knowledge/Study Rationale: Data on the influence of sleep apnea on dreaming are rare. We hypothesized that respiratory events in patients with a sleep-related breathing disorder may influence dream content.

Study Impact: In this study, there was no significant incorporation of potential respiratory-related dream content in subjects with sleep apnea compared to controls. Further studies are needed to determine if this indicates that sleep-related breathing disorders do not influence dreaming or if these results are due to the collection of dream content after awakening.

Neurobehavioral Impairment and CPAP Treatment Response in Mild-Moderate Obstructive Sleep Apnea. 47-56.
Melinda L. Jackson, PhD1,2; R. Doug McEvoy, MD3; Siobhan Banks, PhD4; Maree Barnes, MBBS1,5


Current Knowledge/Study Rationale: This is the largest study to compare neurobehavioral function in patients with mild to moderate OSA to an asymptomatic community sample, and to examine the dose-response relationship between CPAP use and neurobehavioral function.

Study Impact: We have demonstrated that despite significant morbidity in this patient group, the best treatment that we currently have does not return all aspects of neuropsychological function, quality of life, or mood to the functional level of community dwellers of a similar demography, nor is there a dose-response relationship between CPAP use and recovery of function in this milder end of the OSA spectrum.

Adherence to Positive Airway Therapy After Switching From CPAP to ASV: A Big Data Analysis. 57-63.
Jean-Louis D. Pépin, MD1; Holger Woehrle, MD2,3; Dongquan Liu, PhD4; Shiyun Shao, PhD4; Jeff P. Armitstead, PhD3; Peter A. Cistulli, MD5; Adam V. Benjafield, PhD6; Atul Malhotra, MD7


Current Knowledge/Study Rationale: A growing body of evidence suggests that adaptive servoventilation (ASV) might be an efficacious approach to the management of central sleep apnea (CSA) that emerges or persists during continuous positive airway pressure (CPAP) therapy. However, little is known about the effect of changes in positive airway pressure (PAP) therapy mode on adherence in patients with treatment-emergent or persistent CSA.

Study Impact: This analysis of a PAP telemonitoring database showed that a switch from CPAP to ASV in patients with lower CPAP adherence, possibly due to treatment-emergent CSA, improved adherence and device usage, and decreased the apnea-hypopnea index. This effect was greatest in patients with higher residual central apnea index in the first week of CPAP.

The MSLT is Repeatable in Narcolepsy Type 1 But Not Narcolepsy Type 2: A Retrospective Patient Study. 65-74.
Chad Ruoff, MD1; Fabio Pizza, MD2,3; Lynn Marie Trotti, MD, MSc4; Karel Sonka, MD5; Stefano Vandi, MD2,3; Joseph Cheung, MD, MS1; Swaroop Pinto, MD6,7; Mali Einen1; Narong Simakajornboon, MD6,7; Fang Han, MD8; Paul Peppard, PhD9; Sona Nevsimalova, MD5; Giuseppe Plazzi, MD, PhD2,3; David Rye, MD, PhD4; Emmanuel Mignot, MD, PhD1


Current Knowledge/Study Rationale: Recent data have demonstrated poor repeatability of the MSLT in narcolepsy type 2 and idiopathic hypersomnia. This retrospective study compared the repeatability of the MSLT in narcolepsy type 1, narcolepsy type 2, and controls according to the criteria of the International Classification of Sleep Disorders, Third Edition.

Study Impact: We demonstrated that MSLT criterion for narcolepsy in a clinical sample is a more repeatable and stable finding in narcolepsy type 1 than narcolepsy type 2, and narcolepsy type 2 is not more repeatable than controls. Additional prospective MSLT repeatability studies are needed to confirm these findings, as there are many different, and possibly opposing, reasons to repeat an MSLT in narcolepsy type 1 versus narcolepsy type 2, which were largely unknown in this retrospective study.

Free Sleep Apnea in Patients Hospitalized With Acute Ischemic Stroke: Underrecognition and Associated Clinical Outcomes. 75-80.
Nura Festic, MD; David Alejos, MD; Vikas Bansal, MBBS, MPH; Lesia Mooney, MSN; Paul A. Fredrickson, MD; Pablo R. Castillo, MD; Emir Festic, MD, MSc


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) increases risk of acute ischemic stroke (AIS). Previous studies using polysomnography suggested high prevalence of OSA in patients with stroke. We hypothesized that in “real-life” practice settings, there would be underrecognition of OSA and underutilization of positive airway pressure (PAP) therapy, which might negatively affect outcomes.

Study Impact: We confirmed that OSA is clinically underrecognized in patients with AIS and that PAP therapy is underutilized. This dictates the need for the development of systematic surveillance and intervention strategies to improve the outcome of patients after AIS. Despite having more cardiovascular disease and risk factors, some patients with OSA may experience better short-term outcomes after AIS, which we propose could be due to the “double-effect” of OSA.

Sleep and Breast Cancer in the Western New York Exposures and Breast Cancer (WEB) Study. 81-86.
Caila B. Vaughn, PhD1; Jo L. Freudenheim, PhD1; Jing Nie, PhD1; Lara Sucheston-Campbell, PhD2; Jean Wactawski-Wende, PhD1; Catalin Marian, MD, PhD3,4; Peter G. Shields, MD4; Bhaskar V. Kallakury, MD5,6; Maurizio Trevisan, MD7; Heather M. Ochs-Balcom, PhD1


Current Knowledge/Study Rationale: Night shift work is considered a risk factor for breast cancer, although there is a gap in the literature regarding the effect of sleep on breast cancer risk and aggressiveness. In a large, population-based case control study in western New York, we analyzed whether self-reported sleep disturbance was associated with breast cancer aggressiveness and mortality.

Study Impact: We found that sleep disturbance was higher for women with ER− / PR− breast tumors, compared to women with ER+ and/or PR+ tumors. This study suggests that sleep disturbance may be associated with breast cancer subtype.

Obstructive Sleep Apnea in Gestational Diabetes: A Pilot Study of the Role of the Hypothalamic-Pituitary-Adrenal Axis. 87-93.
Margaret H. Bublitz, MD1,2,3; Joao Filipe Monteiro, PhD4; Andrew Caraganis, MD3; Susan Martin3; Jeffrey Parker5; Lucia Larson, MD1,3; Margaret A. Miller, MD1,3; Ghada Bourjeily, MD1,3


Current Knowledge/Study Rationale: The prevalence of obstructive sleep apnea (OSA) in women with gestational diabetes mellitus (GDM), and the mechanisms underlying heightened insulin resistance among women with sleep-disordered breathing have not been well characterized. OSA and GDM may be related due to intermittent hypoxia and sympathetic activation, possibly leading to dysregulation of the hypothalamic-pituitary-adrenal axis.

Study Impact: This study adds to the understanding of the effect of OSA on the hypothalamic-pituitary-adrenal axis in women with GDM. Though hypoxemia burden appears to correlate with flattening of the cortisol awakening response, this effect is not likely to explain the association of OSA with GDM.

Excessive Daytime Sleepiness in Acute Ischemic Stroke: Association With Restless Legs Syndrome, Diabetes Mellitus, Obesity, and Sleep-Disordered Breathing. 95-100.
Pavel Šiarnik, MD, PhD1; Katarína Klobučníková, MD, PhD1; Pavol Šurda, MD2; Matúš Putala3; Stanislav Šutovský, MD, PhD1; Branislav Kollár, MD, PhD1; Peter Turčáni, MD, PhD1


Current Knowledge/Study Rationale: Sleep disorders are frequent in stroke patients. There are conflicting data regarding the association between excessive daytime sleepiness, sleep-disordered breathing, and restless legs syndrome. The aim of this study was to explore the association of excessive daytime sleepiness with sleep-disordered breathing, restless legs syndrome, and other clinical characteristics in patients with acute ischemic stroke.

Study Impact: Our study confirmed high prevalence of sleep disorders in patients with acute ischemic stroke. Presence of restless legs syndrome, diabetes mellitus, and body mass index were the only independent variables significantly associated with the measures of daytime sleepiness (the Epworth Sleepiness Scale). In acute ischemic stroke, restless legs syndrome, obesity, and metabolic factors seem to be the most important variables associated with the measures of daytime sleepiness, whereas the role of sleep-disordered breathing seems to be minor.

Comparing the Efficacy, Mask Leak, Patient Adherence, and Patient Preference of Three Different CPAP Interfaces to Treat Moderate-Severe Obstructive Sleep Apnea. 101-108.
Sharn Rowland, MNg1,2,3; Vinod Aiyappan, MBBS, MD, MRCP, FRACP1,3; Cathy Hennessy, Grad Dip Nsg (PCC)1,2; Peter Catcheside, PhD1,4; Ching Li Chai-Coezter, MBBS, FRACP, PhD1,3; R. Doug McEvoy, MBBS, FRACP, MD1,3,4; Nick A. Antic, MBBS, FRACP, PhD1,3


Current Knowledge/Study Rationale: The study was conducted as there are few published data regarding the clinical effect of the various types of continuous positive airway pressure (CPAP) interfaces.

Study Impact: Clinicians can use the data obtained in this study to help determine the best option for patients commencing CPAP therapy. Results also identified the effect that a change in interface style may have on the control of obstructive sleep apnea and CPAP pressure requirements.

Free Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults. 109-117.
Xiang Qian Lao, PhD1; Xudong Liu, PhD1,2; Han-Bing Deng, PhD1; Ta-Chien Chan, PhD3; Kin Fai Ho, PhD1; Feng Wang, PhD1; Roel Vermeulen, PhD4; Tony Tam, PhD5; Martin C.S. Wong, MD, MPH1; L.A. Tse, PhD1; Ly-yun Chang, PhD6,7; Eng-Kiong Yeoh, MBBS, FCRP1


Current Knowledge/Study Rationale: There is increasing evidence showing that short sleep duration and poor sleep quality are associated with cardiovascular disease. However, there is little information on the joint effects of quality and duration of sleep, despite the fact that a comprehensive sleep profile should consist of both.

Study Impact: We conducted a large, prospective cohort study to investigate the joint effects of quality and duration of sleep on the development of coronary heart disease. Our study substantially advances our understanding of the importance of considering sleep duration and sleep quality together when developing strategies to improve sleep for cardiovascular disease prevention.

Predictors of Side Effects With Long-Term Oral Appliance Therapy for Obstructive Sleep Apnea. 119-125.
Hitomi Ono Minagi, DDS, PhD; Kentaro Okuno, DDS, PhD; Kanji Nohara, DDS, PhD; Takayoshi Sakai, DDS, PhD


Current Knowledge/Study Rationale: Oral appliances are an effective treatment option for patients with obstructive sleep apnea, although dental changes may occur. To prevent the side effects of long-term oral appliance treatment, an investigation of the predictors of dental changes is needed.

Study Impact: To more safely and effectively administer long-term oral appliance treatment to patients with obstructive sleep apnea, clarifying the predictors for side effects is important. Our study found several factors that may predict overjet reduction for patients undergoing long-term oral appliance treatment.

The Incidence and Characterization of Globus Sensation, Dysphagia, and Odynophagia Following Surgery for Obstructive Sleep Apnea. 127-132.
Masanari G. Kato, BS1; Mitchell J. Isaac, BS1; M. Boyd Gillespie, MD2; Ashli K. O'Rourke, MD1


Current Knowledge/Study Rationale: Long-term swallowing complications following single-level surgery to treat obstructive sleep apnea are reported as frequent. Yet, studies have not investigated this topic in the context of multilevel surgery despite an increasing trend in this approach.

Study Impact: Subsequently, this study sought to characterize the incidence of and identify predictors for the development of subjective postoperative swallowing symptoms in patients with obstructive sleep apnea undergoing multilevel surgery. This initial investigation aims to gain further insight as a means to improve current preoperative and postoperative management of patients undergoing such surgeries.

Case Reports

Sleep-Related Orgasms in a 57-Year-Old Woman: A Case Report. 141-144.
Muna Irfan, MD1,2; Carlos H. Schenck, MD3,4
Variable Response to CPAP in a Case of Severe Obstructive Sleep Apnea: An Unusual Cause. 145-148.
Kamal Gandotra, MD1; Anna May, MD2; Dennis Auckley, MD3


Free In Memoriam: Carole L. Marcus, MBBCh, FAASM. 149-151.
Lourdes M. DelRosso, MD, MSEd, FAASM1; Susan Redline, MD, MPH2,3,4; Carol L. Rosen, MD, FAASM5; David Gozal, MD, MBA6

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