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Accepted Papers

Scientific Investigations

Docosahexaenoic Acid and Arachidonic Acid Supplementation and Sleep in Toddlers Born Preterm: Secondary Analysis of a Randomized Clinical Trial. 1197-1208.
Kelly M. Boone, MA1; Joseph Rausch, PhD1,2; Grace Pelak, BS1; Rui Li, MPH1,3; Abigail Norris Turner, PhD4,5; Mark A. Klebanoff, MD, MPH2,3,5,6; Sarah A. Keim, MA1,2,5


Current Knowledge/Study Rationale: Children born preterm are at increased risk of developmental delays and medical conditions that may exacerbate poor sleep quality. In animal models, DHA regulates melatonin synthesis and circadian clock functioning. Results in humans are mixed. No placebo-controlled trials have tested DHA+AA supplementation on sleep among toddlers born preterm.

Study Impact: Although no overall treatment effects of DHA+AA supplementation were observed for this preterm cohort, exploratory subgroup analyses identified important subgroups of children—males and children whose caregivers who reported depressive symptomatology—who may benefit from DHA+AA supplementation. If replicated in larger cohorts, results suggest that DHA+AA supplementation may be a readily available, cost-effective intervention for some children at risk for sleep deficiencies. Further exploration in larger samples is necessary to replicate findings.

Nightmares and Stress: A Longitudinal Study. 1209-1215.
Michael Schredl, PhD1; Maria Gilles, MD1; Isabell Wolf, PhD1; Verena Peus, MD1; Barbara Scharnholz, MD1; Marc Sütterlin, MD2; Svenja Bardtke, MA1; Tabea Sarah Send, MA1; Angelina Samaras, MA1; Michael Deuschle, MD1


Current Knowledge/Study Rationale: In nightmare etiology, trait and state factors play important roles. However, the interaction of state and trait factors has never been studied in a longitudinal design.

Study Impact: The findings of the current study showed a significant effect of previously measured nightmare frequency on current nightmare frequency—in addition to the effects of current stressors—and, thus, clearly indicate the importance of treating nightmares as soon as possible. Prevention studies in this field are warranted as the prevalence of the nightmare disorder in the general population is quite high (5%).

Presleep Cognitive Arousal and Insomnia Comorbid to Parkinson Disease: Evidence for a Serial Mediation Model of Sleep-Related Safety Behaviors and Dysfunctional Beliefs About Sleep. 1217-1224.
Cindy Lebrun, MS1; Marie-Christine Gély-Nargeot, PhD1; Khaalid Hassan Maudarbocus, MS1; Alexia Rossignol, MS2; Christian Geny, MD2; Sophie Bayard, PhD1


Current Knowledge/study Rationale: Insomnia is common among individuals with Parkinson disease (PD). In individuals free of neurological disease who are affected by insomnia disorder, cognitive and behavioral processes play a central role in both the maintenance and treatment of insomnia.

Study Impact: This study documents the high relevance of these psychological processes in the specific context of insomnia comorbid to PD. Target-oriented interventions such as cognitive behavioral therapy should be considered as a treatment approach for insomnia disorder comorbid to PD.

Increased Risk for New-Onset Psychiatric Adverse Events in Patients With Newly Diagnosed Primary Restless Legs Syndrome Who Initiate Treatment With Dopamine Agonists: A Large-Scale Retrospective Claims Matched-Cohort Analysis. 1225-1232.
Cheryl Hankin, PhD1; Daniel Lee, MD2; Diego Garcia-Borreguero, MD, PhD3; Zhaohui Wang, MS1


Current Knowledge/Study Rationale: A substantial body of research links dopamine agonist (DA) treatment for Parkinson disease (PD) with psychiatric adverse events (P-AEs); however, few studies have evaluated this risk in restless legs syndrome (RLS), for which DAs are also indicated, albeit at lower doses. We conducted a large-scale retrospective claims matched-cohort analysis among adults with newly diagnosed primary RLS without history of mental disorders or DA use, to compare risk of the development of P-AEs, overall and by severity, on follow-up between those who initiated versus those who did not initiate de novo DA treatment for RLS.

Study Impact: Adults with RLS who receive DAs may be at significantly increased risk for new-onset P-AEs across all levels of psychiatric illness severity.

The Impact of Antidepressants on the Risk of Developing Obstructive Sleep Apnea in Posttraumatic Stress Disorder: A Nationwide Cohort Study in Taiwan. 1233-1241.
Ching-En Lin, MSc1,2,3; Chi-Hsiang Chung, PhD4,5,6; Li-Fen Chen, MD7; Wu-Chien Chien, PhD3,4,6; Po-Han Chou8,9,10,11


Current Knowledge/Study Rationale: The association between obstructive sleep apnea and posttraumatic stress disorder (PTSD) have been inconsistent, and the impact of antidepressants on the risk of obstructive sleep apnea (OSA) in patients with PTSD still has not been investigated. Therefore, we used a real-world big dataset to investigate the impact of PTSD and antidepressant use on the risk of OSA development.

Study Impact: This study provides extension evidence to the existing literature about the association between PTSD and OSA. In addition, our study results have the potential to impact the development of novel management strategies for patients with PTSD and OSA.

Free Association of Positive Airway Pressure Use With Acute Care Utilization and Costs. 1243-1250.
Douglas B. Kirsch, MD1; Hongmei Yang, PhD2; Andréa L. Maslow, PhD2; Michael Stolzenbach, MHA3; Andrea McCall, MHA, RN, CPHQ4


Current Knowledge/Study Rationale: Many, though not all, research studies have demonstrated improvement in several comorbid medical conditions when treating obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy. This study was performed to assess whether the hours of use of PAP therapy for patients with moderate-severe OSA impact acute care utilization and costs

Study Impact: Improved treatment of patients with moderate-severe OSA with PAP therapy appeared to lead to reduction in acute care costs. Cost reduction has become increasingly important in the current medical economic climate, thus focus on diagnosis and effective treatment of OSA may prove valuable for both patients and health systems.

Polysomnography Parameters Assessing Gas Exchange Best Predict Postoperative Respiratory Complications Following Adenotonsillectomy in Children With Severe OSA. 1251-1259.
Helena Molero-Ramirez, MD1; Maximiliano Tamae Kakazu, MD2; Fuad Baroody, MD3; Rakesh Bhattacharjee, MD4


Current Knowledge/Study Rational: Adenotonsillectomy is the treatment of choice for children with obstructive sleep apnea related to enlarged adenoids and tonsils. Although severe obstructive sleep apnea as defined by the apnea-hypopnea index is associated with surgical risk, few studies have examined the strength of individual polysomnography parameters to predict specific surgical complications in children.

Study Impact: We found that surgical complications, particularly major respiratory complications, were only associated with polysomnography parameters assessing gas exchange rather than classic parameters such as apnea-hypopnea index. This emphasizes that precise evaluation of polysomnography should focus on measures of gas exchange to help identify children at risk for surgical complications following adenotonsillectomy.

Free The Association Between Obstructive Sleep Apnea Characterized by a Minimum 3 Percent Oxygen Desaturation or Arousal Hypopnea Definition and Hypertension. 1261-1270.
Rohit Budhiraja, MD1; Sogol Javaheri, MA, MD, MPH1; Sairam Parthasarathy, MD2; Richard B. Berry, MD3; Stuart F. Quan, MD1,2


Current Knowledge/Study Rationale: Severity of obstructive sleep apnea (OSA) is usually characterized by the apnea-hypopnea index (AHI), which in most studies requires a hypopnea definition utilizing a minimum 4% oxygen desaturation. AASM standards, however, recommend using a hypopnea definition requiring a minimum 3% oxygen desaturation or an arousal. This study analyzes the relationship between the AASM recommended AHI definition and prevalent hypertension.

Study Impact: Use of the AASM recommended definition of hypopnea as a component of the AHI is associated with the presence of hypertension. This suggests that use of a 4% O2 desaturation requirement by several third party payors to define treatable OSA is too stringent and may deny treatment to some patients with OSA.

Eye-Blink Parameters Detect On-Road Track-Driving Impairment Following Severe Sleep Deprivation. 1271-1284.
Shamsi Shekari Soleimanloo, PhD1,2; Vanessa E. Wilkinson, PhD1; Jennifer M. Cori, PhD1; Justine Westlake, BA/BAppSci (Hons)1; Bronwyn Stevens, GradDipProfPsych1; Luke A. Downey, PhD1,4; Brook A. Shiferaw, BSc (Hon)1; Shantha M. W. Rajaratnam, PhD2; Mark E. Howard, PhD1,2,3


Current Knowledge/ Study Rationale: Eye-blink parameters have shown promise for the monitoring of driver drowsiness in laboratory and on-road experiments in shift workers. These assessments have not been evaluated to non-shift-work drivers during on-road daytime drives.

Study Impact: This is the first on-road study examining the accuracy of eye-closure parameters for detecting driver drowsiness in the general population after severe sleep deprivation or a normal night’s sleep. Findings revealed that the duration of eyelid closure, percentage of time with eyes closed, and the maximum amplitude to velocity ratios of eyelid movements were impaired after sleep loss, parallel to impairment in driving performance, and could detect out-of-lane events with moderate accuracy. As such, ocular parameters could continuously monitor drowsiness-related driving impairment in the real world.

Can the Orexin Antagonist Suvorexant Preserve the Ability to Awaken to Auditory Stimuli While Improving Sleep?. 1285-1291.
Christopher L. Drake, PhD; David A. Kalmbach, PhD; Philip Cheng, PhD; Thomas Roth, PhD; Kieulinh Michelle Tran, BA; Andrea Cuamatzi-Castelan, BS; Rachel Atkinson, BS; Meeta Singh, MD; Christine V. Tonnu, BA; Cynthia Fellman-Couture, PhD


Current Knowledge/Study Rationale: This study was performed to investigate the safety of the dual orexin receptor antagonist, suvorexant, in terms of nocturnal responsivity to auditory stimuli.

Study Impact: By showing that suvorexant improves sleep while maintaining the ability to awaken to auditory stimuli, this study indicates that it has a relatively safe nocturnal responsivity profile.

Association of Obstructive Sleep Apnea With the Risk of Ménière’s Disease and Sudden Sensorineural Hearing Loss: A Study Using Data From the Korean National Health Insurance Service. 1293-1301.
Jong-Yeup Kim, MD, PhD1,2; Inseok Ko, MS2; Bum-Joo Cho, MD, PhD3,4; Dong-Kyu Kim, MD, PhD4,5


Current Knowledge/Study Rationale: Although obstructive sleep apnea (OSA) is known to contribute to serious systemic problems, such as cardiovascular events or neurocognitive deterioration, its association with the development of neuro-otologic diseases has not been fully determined. This study aimed to investigate the link between OSA and subsequent neuro-otologic diseases, such as Ménière’s disease or sudden sensorineural hearing loss (SSNHL) using a nationwide representative cohort sample.

Study Impact: Female as well as middle-aged patients with OSA were found to have a two-fold risk to develop Ménière’s disease; however, we did not discover any link between OSA and SSNHL. Further studies are needed to confirm these findings and to explore the underlying pathophysiological mechanisms.

Poor Postpartum Sleep Quality Predicts Subsequent Postpartum Depressive Symptoms in a High-Risk Sample. 1303-1310.
Katherine M. McEvoy, MB BCh1; Divya Rayapati, MD1; Katie O. Washington Cole, MD, PhD2; Courtney Erdly, BA1; Jennifer L. Payne, MD1; Lauren M. Osborne, MD1


Current Knowledge/Study Rationale: Previous research has found an association between poor sleep postpartum and concurrent depressive symptoms, but there was insufficient evidence in the literature to determine whether poor sleep in pregnancy or the early postpartum period predicted later postpartum depression. We wished to explore this relationship further, given the detrimental effects of postpartum depression on individuals and families and the ready availability of sleep interventions.

Study Impact: We found that poor sleep quality at 1 month postpartum predicted depressive symptoms at 3 months postpartum. Our findings demonstrate the importance of sleep interventions (which are low cost and readily available) to prevent a devastating illness that affects 15% to 20% of women and their children, and may inform clinical practice in both obstetric and mental health settings.

CPAP and Health-Related Quality of Life in Adults With Coronary Artery Disease and Nonsleepy Obstructive Sleep Apnea in the RICCADSA Trial. 1311-1320.
Sara Wallström, RN, PhD1,2; Baran Balcan, MD3; Erik Thunström, MD, PhD4; Axel Wolf, RN, PhD1,2; Yüksel Peker, MD, PhD4,5,6,7


Current Knowledge/Study Rationale: Health-related quality of life is impaired in patients with coronary artery disease as well as in those with obstructive sleep apnea (OSA) with daytime sleepiness. Although treatment with continuous positive airway pressure (CPAP) improves health-related quality of life in patients with sleepy OSA phenotype, its effect in nonsleepy phenotype is uncertain.

Study Impact: This study showed that assignment to CPAP treatment compared to no CPAP had no significant effect on health-related quality of life as measured by the Short-Form (SF)-36 questionnaires in nonsleepy patients with OSA. Although several components of the SF-36 scores were improved within the CPAP group, CPAP use (hours/night/all nights) was associated with a decrease in physical component summary. The improvement in mental component summary was determined by improvement in the daytime sleepiness and depressive mood.

Self-Reported Sleep Duration and Pattern in Old Order Amish and Non-Amish Adults. 1321-1328.
Man Zhang, PhD1; Kathleen A. Ryan, MS1; Emerson Wickwire, PhD2,3; Teodor T. Postolache, MD4,5; Huichun Xu, PhD1; Melanie Daue, BS1; Soren Snitker, MD1; Toni I. Pollin, PhD1; Alan R. Shuldiner, MD1; Braxton D. Mitchell, PhD1,6


Current Knowledge/Study Rationale: Sleep duration has been decreasing for many years in the U.S., and these changes have been attributed in part to technology and the modern American lifestyle that impinge upon sleep time. These trends motivated us to compare sleep duration between the overall United States population and the Old Order Amish, a culturally isolated population characterized by a very traditional culture that is much less affected by changes in the mainstream culture and artificial lighting.

Study Impact: The extent to which the modern lifestyle contributes to the increased prevalence of sleep deprivation has been difficult to discern. The comparison between Amish and the National Health and Nutrition Examination Survey could help to identify at least some of factors in modern culture that may impact sleep duration and inform strategies to improve the sleep duration and quality.

Predicting Attentional Impairment in Women With Posttraumatic Stress Disorder Using Self-Reported and Objective Measures of Sleep. 1329-1336.
Kimberly B. Werner, PhD1; Kimberly A. Arditte Hall, PhD2; Michael G. Griffin, PhD3; Tara E. Galovski, PhD2,4


Current Knowledge/Study Rationale: Sleep impairment has been cited as the most-often reported symptom of posttraumatic stress disorder (PTSD). It is associated with severe distress, impaired attention and concentration, and poorer treatment outcomes. The primary study aim was to assess the relative contributions of objective and self-reported measures of nocturnal sleep duration to objectively measured deficits in sustained attention in a sample of female interpersonal violence survivors with PTSD.

Study Impact: Results revealed that self-reported, daily estimations of sleep, but not objectively or globally measured sleep impairment, is directly related to attention in this PTSD sample. Assessing sleep impairment on a daily basis throughout treatment may provide clinically relevant information in evaluating daytime symptoms and guiding treatment decisions.

Validation of a Consumer Sleep Wearable Device With Actigraphy and Polysomnography in Adolescents Across Sleep Opportunity Manipulations. 1337-1346.
Xuan Kai Lee, BSc; Nicholas I.Y.N. Chee, BSc; Ju Lynn Ong, PhD; Teck Boon Teo, BSc; Elaine van Rijn, PhD; June C. Lo, PhD; Michael W.L. Chee, MBBS


Current Knowledge/Study Rationale: Consumer sleep trackers are an attractive alternative to expensive research actigraphs for measuring sleep. However, validation studies in adolescent populations are limited and typically conducted on only 1 night of sleep. We compared a consumer sleep/activity tracker and a research-grade actigraph with polysomnography (PSG) over different sleep opportunities and across multiple nights.

Study Impact: Sleep estimation was comparable between the consumer wearable device and research-grade actigraphy on default settings. Both underestimated sleep duration compared to PSG. Sleep estimation improved in the research actigraph by adjusting sensitivity to motion. With data-driven customization, consumer wearable devices could replace research actigraphs for large-scale total sleep measurement. Sleep staging still lags behind PSG and needs further work, particularly for assessment of stage N3 sleep.

Quantitative Evaluation of the Function of the Sensory Nerve Fibers of the Palate in Patients With Obstructive Sleep Apnea. 1347-1353.
Yunsong An, MD; Yanru Li, MD; Wei Chang, MD; Fei Gao, MD; Xiu Ding; Wen Xu, MD; Demin Han, MD, PhD


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) is a common disorder among adults and the upper airway sensory deficits in patients with OSA could predispose to upper airway collapse during sleep. Although some studies had demonstrated the signs of sensory impairment in patients with OSA, almost none of them investigated the function of different types of sensory nerve fibers of the palate in such patients.

Study Impact: This is the first study that investigated the functional integrity of different types of sensory nerve fibers of the palate in patients with OSA using a Neurometer current perception threshold (CPT) system. The CPT test could be a useful tool for the quantitative and selective assessment of sensory nerve function in patients with OSA.

Special Articles

National Expansion of Sleep Telemedicine for Veterans: The TeleSleep Program. 1355-1364.
Kathleen F. Sarmiento, MD, MPH1,2; Robert L. Folmer, PhD3,4; Carl J. Stepnowsky, PhD5,6; Mary A. Whooley, MD1,2; Eilis A. Boudreau, MD, PhD3,7; Samuel T. Kuna, MD8,9,10; Charles W. Atwood, MD11,12; Connor J. Smith, MS13; W. Claibe Yarbrough, MD14,15

Case Reports

Vitamin B12 Deficiency: A Rare Cause of Excessive Daytime Sleepiness. 1365-1367.
Imran Khawaja, MD1; Kevin Yingling, RPh, MD2; Hazim Bukamur, MD1; Waiel Abusnina, MD2
Unexpected Finding of Idiopathic REM Sleep Behavior Disorder in a Young Healthy Male With Snoring: A Case Report. 1369-1371.
Matthew S. Brock, MD1; Sean Shirley, MD1; Luis Rohena, MD2; Brian A. Moore, MA3,4; Vincent Mysliwiec, MD1

Sleep Medicine Pearls

Obstructive Sleep Apnea as the First Presentation of Juvenile Nasal Angiofibroma. 1373-1375.
Mollie Lobl, MD1; Stephanie O. Zandieh, MD, MS2

REM: A Publication for Residents and Fellows

Free Images: A Case of EEG Artifact By Proxy. 1385-1387.
Ang Li, MD1; Camilla K. Matthews, MD2; David T. Plante, MD, PhD3

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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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