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Accepted Papers

Scientific Investigations

Validation of a New System Using Tracheal Body Sound and Movement Data for Automated Apnea-Hypopnea Index Estimation. 1123-1130.
Christoph Kalkbrenner, M. Eng.1; Manuel Eichenlaub, M. Eng.2; Stefan Rüdiger, Dr. med.3; Cornelia Kropf-Sanchen, Dr. med.3; Rainer Brucher, Dr.-lng.1; Wolfgang Rottbauer, Dr. med.3


Current Knowledge/Study Rationale: Obstructive sleep apnea is one of the most common sleep-related breathing disorders. The current gold standard for assessment of obstructive sleep apnea is the in-laboratory polysomnography. This approach has high costs and inconveniences the patient, whereas alternative ambulatory systems are limited by reduced diagnostic abilities and complicated setup.

Study Impact: The presented new sleep monitor utilizes tracheal body sound and movement data to accurately diagnose the presence and severity of sleep apnea. This allows simple setup and high comfort, reducing the effect on sleep quality in comparison with in-laboratory polysomnography while outperforming existing ambulatory diagnostic systems and previously introduced similar approaches.

Omega-3 Index and Obstructive Sleep Apnea: A Cross-Sectional Study. 1131-1136.
Janine Tittus, MD1; Marie Theres Huber1; Klaus Storck, MD2; Anton Köhler, MD1; Jan M. Köhler1; Thomas von Arnim, MD3; Clemens von Schacky, MD1,4


Current Knowledge/Study Rationale: If effective, the two marine omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) would be an attractive therapeutic approach to obstructive sleep apnea (OSA), because EPA and DHA are tolerable and safe, and improve comorbidities of OSA such as hypertension, heart failure, or major depression. Rather than assessing intake, research in EPA and DHA now focuses on blood levels, preferably in erythrocytes and using a standardized analytical method (HS-Omega-3 Index).

Study Impact: Although one epidemiologic study found an association of OSA with very low levels of EPA and DHA (< 5.0%), we did not find an association at higher levels (5.7%). Our data suggest aiming for an Omega-3 Index > 5.7% in an intervention trial with EPA and DHA in OSA; comorbidities of OSA suggest a target range of 8% to 11%.

Does Sleep Endoscopy Staging Pattern Correlate With Outcome of Advanced Palatopharyngoplasty for Moderate to Severe Obstructive Sleep Apnea?. 1137-1144.
Ying-Shuo Hsu, MD1; Ofer Jacobowitz, MD, PhD2


Current Knowledge/Study Rationale: Drug-induced sleep endoscopy (DISE) is an accepted method to localize the site of upper airway obstruction, but there are few data regarding correlation with surgical outcome. It is not known whether all sites and collapse zones identified by DISE must always be treated to achieve sufficient apnea-hypopnea index (AHI) improvement. This study assessed AHI outcome in patients who underwent palatopharyngoplasty alone regardless of unilevel or multilevel obstruction on DISE.

Study Impact: This study showed that for both unilevel or multilevel obstruction patterns on DISE, significant and similar AHI improvement can be achieved using palatopharyngoplasty techniques alone. This may indicate that some DISE obstructions are secondary and could be treated, if needed, in a staged manner for some patients.

Independent Contributions of Obstructive Sleep Apnea and the Metabolic Syndrome to the Risk of Chronic Kidney Disease. 1145-1152.
Yu-Ji Lee, MD, PhD1; Hye Ryoun Jang, MD, PhD2; Wooseong Huh, MD, PhD2; Yoon-Goo Kim, MD, PhD2; Dae Joong Kim, MD, PhD2; Ha Young Oh, MD, PhD2; Eun Yeon Joo, MD, PhD3,4; Jung Eun Lee, MD, PhD2


Current Knowledge/Study Rationale: The association between obstructive sleep apnea (OSA) and chronic kidney disease (CKD) has been suggested but this link may be mediated by metabolic syndrome (MS). This study evaluated the associations between OSA severity and CKD with a focus on the possible interaction of MS in this association.

Study Impact: OSA was independently associated with an increased prevalence of CKD only in subjects with MS. These findings suggest that OSA might be an additional burden that exacerbates the risk of CKD in subjects with MS.

Sleep Duration and Sleep Patterns in Chinese University Students: A Comprehensive Meta-Analysis. 1153-1162.
Lu Li, MSc1,2; Yuan-Yuan Wang, PhD1; Shi-Bin Wang, PhD3; Lin Li, MSc4,5; Li Lu, MSc1; Chee H. Ng, MBBS, MD6; Gabor S. Ungvari, MD, PhD7; Helen F.K. Chiu, FRCPsych8; Cai-Lan Hou, MD, PhD3; Fu-Jun Jia, MD3; Yu-Tao Xiang, MD, PhD1


Current Knowledge/Study Rationale: Short and long sleep duration and sleep patterns are usually associated with poor health outcomes. The results of patterns of sleep duration in Chinese university students have been inconsistent.

Study Impact: Short sleep duration and unhealthy sleep patterns were common in Chinese university students. Given their negative effect on health, quality of life, and intellectual performance, educational and health professionals should pay more attention to sleep patterns in this population.

Non-REM Sleep Instability in Children With Primary Monosymptomatic Sleep Enuresis. 1163-1170.
Leticia Azevedo Soster, MD, PhD1; Rosana Cardoso Alves, MD, PhD1; Simone Nascimento Fagundes, MD, PhD2; Adrienne Lebl, MD, MsC2; Eliana Garzon, MD, PhD1; Vera H. Koch, MD, PhD2; Raffaele Ferri, MD, PhD3; Oliviero Bruni, MD, PhD4


Current Knowledge/Study Rationale: Almost all data converge toward a higher arousal threshold in children with sleep enuresis linked to sleep fragmentation. No neurophysiological correlate of low arousability has been found.

Study Impact: Our findings indicate the presence of a disruption of sleep microstructure in children with sleep enuresis. The decrease of A2 and A3 indexes (ie, low and high power arousals) might reflect the impaired arousal threshold of enuretics.

Free Insomnia in Pregnancy Is Associated With Depressive Symptoms and Eating at Night. 1171-1176.
Dorota Wołyńczyk-Gmaj, MD, PhD1; Anna Różańska-Walędziak, MD, PhD2; Simon Ziemka1; Marcin Ufnal, MD, PhD3; Aneta Brzezicka, PhD4; Bartłomiej Gmaj, MD, PhD1; Piotr Januszko, MD, PhD1; Sylwia Fudalej, MD, PhD1; Krzysztof Czajkowski, MD, PhD2; Marcin Wojnar, MD, PhD1


Current Knowledge/Study Rationale: Insomnia in pregnancy is often explained by physiological changes in the mother's body. Other factors are underestimated and the scientific literature on the subject is sparse. The current study investigated behavioral factors (eg, depression or arousal) associated with insomnia during pregnancy.

Study Impact: Insomnia is more frequent in women in late pregnancy than in the general population, but is associated with similar factors. Based on the results of this study, we can hypothesize that analogous treatments as for chronic insomnia should be recommended.

Meeting ACGME and ABMS Quality Improvement Requirements in a Sleep Medicine Fellowship Program. 1177-1183.
Anita Valanju Shelgikar, MD, FAASM1; Cindy Priddy, MA2; R. Van Harrison, PhD3


Current Knowledge/Study Rationale: Continuous quality improvement (QI) in the clinical setting is a requirement for both physicians in a fellowship training program and those in practice.

Study Impact: This article describes the successful implementation of a QI curriculum into a sleep medicine fellowship. The curriculum was designed to meet QI requirements of both the Accreditation Council for Graduate Medical Education and the Multi-Specialty MOC Portfolio Program of the American Board of Medical Specialties. This article provides tips for other sleep medicine fellowship programs who seek to incorporate QI activities for their fellows.

Free Sleep Overnight Monitoring for Apnea in Patients Hospitalized with Heart Failure (SOMA-HF Study). 1185-1190.
Sunil Sharma, MD1; Paul J. Mather, MD2; Anindita Chowdhury, MD1; Suchita Gupta, MD1; Umer Mukhtar, MBBS1; Leslee Willes, MS3; David J. Whellan, MD4; Atul Malhotra, MD5; Stuart F. Quan, MD6


Current Knowledge/Study Rationale: This study evaluates whether high-resolution pulse oximetry (HRPO) is an effective screening tool for early detection of sleep apnea in patients hospitalized with decompensated heart failure (CHF).

Study Impact: To our knowledge, it is the first study that validates the use of HRPO as a cost-effective and objective screening tool to help guide clinical management of acute CHF. It also may be a useful tool in the design of subsequent clinical trials in patients with CHF.

Improving PTSD Symptoms and Preventing Progression of Subclinical PTSD to an Overt Disorder by Treating Comorbid OSA With CPAP. 1191-1198.
M. I. Ullah, MD, MPH1; Douglas G. Campbell, MD2; Rajesh Bhagat, MD2; Judith A. Lyons, PhD1,2; Sadeka Tamanna, MD, MPH2


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD) are common among United States veterans, and these two conditions often coexist with overlapping clinical symptoms. CPAP therapy has been shown to improve PTSD symptoms but its effect on subclinical PTSD is unknown.

Study Impact: Our study shows that veterans with OSA and overt PTSD respond readily to CPAP therapy with symptom improvement proportionate to the CPAP compliance level. However, those with OSA and subclinical PTSD demonstrate worsening clinical symptoms with poor CPAP compliance. This may suggest that adequate treatment of veterans with OSA by CPAP may prevent development of overt PTSD.

Special Articles

Free American Academy of Sleep Medicine Position Paper for the Use of a Home Sleep Apnea Test for the Diagnosis of OSA in Children. 1199-1203.
Valerie Kirk, MD1; Julie Baughn, MD2; Lynn D'Andrea, MD3; Norman Friedman, MD4; Anjalee Galion, MD5; Susan Garetz, MD6; Fauziya Hassan, MD, MS7; Joanna Wrede, MD8; Christopher G. Harrod, MS9; Raman K. Malhotra, MD10
Free Clinical Use of a Home Sleep Apnea Test: An American Academy of Sleep Medicine Position Statement. 1205-1207.
Ilene M. Rosen, MD, MS1; Douglas B. Kirsch, MD2; Ronald D. Chervin, MD, MS3; Kelly A. Carden, MD4; Kannan Ramar, MD5; R. Nisha Aurora, MD6; David A. Kristo, MD7; Raman K. Malhotra, MD8,9; Jennifer L. Martin, PhD10; Eric J. Olson, MD5; Carol L. Rosen, MD11; James A. Rowley, MD12

Case Reports

CPAP Treats Enuresis in Adults With Obstructive Sleep Apnea. 1209-1212.
Robert P. McInnis, MD1; Elisabeth B. Dodds, MD1; Jami Johnsen, MD2; Sanford Auerbach, MD1,3; Yelena Pyatkevich, MD1,3
Sleep-Related Rhythmic Movement Disorder and Obstructive Sleep Apnea in Five Adult Patients. 1213-1217.
Giacomo Chiaro, MD1; Michelangelo Maestri, MD1; Silvia Riccardi, MD1; José Haba-Rubio, MD2; Silvia Miano, MD, PhD1; Claudio L. Bassetti, MD, PhD3; Raphaël C. Heinzer, MD, PhD2; Mauro Manconi, MD, PhD1,3

Letters to the Editor

Free What Can Tweets Tell Us About a Person's Sleep?. 1219-1221.
Meir Kryger, MD, FRCPC

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