Earn CME
Accepted Papers


Free Industrial Regulation of Fatigue: Lessons Learned From Aviation. 537-538.
Erin E. Flynn-Evans, PhD, MPH1; Omer Ahmed, MD2; Michael Berneking, MD3; Jacob F. Collen, MD4; Binal S. Kancherla, MD5; Brandon R. Peters, MD6; Muhammad Adeel Rishi, MD7; Shannon S. Sullivan, MD8; Raghu Upender, MD9; Indira Gurubhagavatula, MD, MPH10,11

Scientific Investigations

Insomnia Disorder Among Older Veterans: Results of a Postal Survey. 543-551.
Armand M. Ryden, MD1,2; Jennifer L. Martin, PhD2,3; Sean Matsuwaka, MD4; Constance H. Fung, MD, MSHS2,3; Joseph M. Dzierzewski, PhD5; Yeonsu Song, PhD, RN2,3; Michael N. Mitchell, PhD3; Lavinia Fiorentino, PhD6; Karen R. Josephson, MPH3; Stella Jouldjian, MSW, MPH3; Cathy A. Alessi, MD2,3


Current Knowledge/Study Rationale: There has been a wide range of estimates of insomnia in older patients. The purpose of this study was to estimate the prevalence of insomnia disorder in an older veteran population using a survey instrument designed to align with diagnostic criteria for insomnia disorder.

Study Impact: Nearly half of the community-dwelling veterans surveyed responded in a manner consistent with diagnostic criteria for insomnia disorder. Older age and better self-rated health were associated with a decreased likelihood of having insomnia disorder.

Electroencephalographic Patterns During Routine Polysomnography in Childhood and Association With Future Epilepsy Diagnosis. 553-562.
Robert C. Stowe, MD1; Daniel G. Glaze, MD2,3


Current Knowledge/Study Rationale: Interictal epileptiform discharges are commonly recorded during overnight polysomnography in children. The significance and implication of these may suggest a risk of the development of seizures and a diagnosis of epilepsy, and there are no guidelines on how to further investigate or evaluate.

Study Impact: This study at a tertiary referral center found a high incidence of interictal epileptiform discharges recorded during polysomnography in its population; however, such records had a very low association with future diagnosis of epilepsy, and the patients who received such a diagnosis had a high baseline risk of the development of seizures due to underlying neurodevelopmental disorders. Without additional clinical context or history, incidental abnormalities detected on polysomnography are a poor prognostication for future diagnosis of epilepsy.

Real-Time Identification of Upper Airway Occlusion Using Electrical Impedance Tomography. 563-571.
Young Eun Kim, MS1; Eung Je Woo, PhD1; Tong In Oh, PhD1; Sang-Wook Kim, MD, PhD2,3


Current Knowledge/Study Rationale: Information on the obstruction site and pattern of the upper airway during sleep in patients with obstructive sleep apnea can guide selection of obstruction site-specific treatments, such as upper airway surgeries, oral appliances, and hypoglossal nerve stimulation, possibly leading to improved treatment success. No real-time diagnostic technique, however, is available to identify narrowing and collapse of the upper airway during natural sleep, although some imaging techniques can be used under sedated sleep.

Study Impact: This study showed that electrical impedance tomography can quantify upper airway narrowing or collapse during natural sleep. Electrical impedance tomography could be a useful tool to monitor the upper airway narrowing or collapse in patients with obstructive sleep apnea.

Circadian Preference as a Moderator of Depression Outcome Following Cognitive Behavioral Therapy for Insomnia Plus Antidepressant Medications: A Report From the TRIAD Study. 573-580.
Lauren D. Asarnow, PhD1; Bei Bei, PhD2; Andrew Krystal, MD3; Daniel J. Buysse, MD4; Michael E. Thase, MD4; Jack D. Edinger, PhD5,6; Rachel Manber, PhD1


Current Knowledge/Study Rationale: Evening circadian preference is associated with increased vulnerability to both depression and insomnia and evidence that one of the benefits of cognitive behavioral therapy for insomnia is reduction in depressive symptom severity. Prior research indicates that eveningness may be associated with less reduction in depressive symptom severity following cognitive behavioral therapy for insomnia.

Study Impact: This is the first study to investigate the role of circadian preference in response to treatment for depression and insomnia in a randomized controlled treatment trial. The present study findings suggest that clinical care using antidepressant medications for individuals with comorbid depression and insomnia could be enhanced by (1) evaluating circadian preference and (2) augmenting antidepressant medications with cognitive behavioral therapy for insomnia for those expressing an evening circadian preference.

Effects of an Acute Bout of Light-Intensity Walking on Sleep in Older Women With Sleep Impairment: A Randomized Controlled Trial. 581-586.
Li-Jung Chen, PhD1; Clare Stevinson, PhD2; Shih-Hua Fang, PhD3; Chih-Yang Taun, PhD4; Po-Wen Ku, PhD5


Current Knowledge/Study Rationale: Previous research tended to focus on the effects of moderate- or high-intensity exercise on sleep and has been generally limited to good sleepers. This study aimed to explore the effects of a single bout of light-intensity walking on sleep in older women with mild sleep impairment.

Study Impact: Light-intensity walking can lead to modest benefits in sleep latency and efficiency in older women with sleep impairment. A single session of exercise is more effective for sleep initiation than for sleep maintenance among older adults.

Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Patients With Chronic Obstructive Pulmonary Disease. 587-596.
Yuan Chang, MD1; Liyue Xu, MD2,3; Fang Han, MD2; Brendan T. Keenan, MS3; Elizabeth Kneeland-Szanto, MBA3; Rongbao Zhang, MD2; Wei Zhang, MD4; Yongbo Yu, BS4; Yuhua Zuo, BS2; Allan I. Pack, MBChB, PhD3; Samuel T. Kuna, MD3,5


Current Knowledge/Study Rationale: Current clinical practice guidelines recommend in-laboratory polysomnography to diagnose obstructive sleep apnea in patients with major comorbidities due to lack of evidence supporting the use of home sleep apnea tests. This study evaluated the performance of a portable monitor (Nox-T3) used for home sleep apnea testing to diagnose obstructive sleep apnea in patients with chronic obstructive pulmonary disease (COPD).

Study Impact: Our results showed good agreement between home testing with in-laboratory polysomnography to diagnose obstructive sleep apnea in patients with COPD, potentially improving their access to care. However, the lower oxygen saturation levels recorded on this portable monitor than on the in-laboratory polysomnography, likely due to differences among pulse oximeters, would result in more patients with COPD being started on oxygen treatment based on this portable monitor.

Optimizing Actigraphic Estimation of Sleep Duration in Suspected Idiopathic Hypersomnia. 597-602.
Jesse D. Cook, BS1,2; Sahand C. Eftekari1; Lydia A. Leavitt, BS1; Michael L. Prairie, BS1; David T. Plante, MD, PhD1


Current Knowledge/Study Rationale: Current sleep medicine nosology considers actigraphy to be an alternative method to quantify excessive sleep duration in idiopathic hypersomnia, yet standardized setting parameters have not been established. Considering actigraphic estimates of total sleep time (TST) are highly dependent upon device settings, TST assessment in persons with suspected idiopathic hypersomnia can be enhanced by establishing an optimal parameter configuration.

Study Impact: These results demonstrate the necessity of standardized actigraphic settings for estimations of TST. The Low + 25 Epoch parameter configuration is indicated as most optimal for estimating TST for persons with suspected idiopathic hypersomnia.

Sleepless in Beirut: Sleep Difficulties in an Urban Environment With Chronic Psychosocial Stress. 603-614.
Hassan A. Chami, MD, MSc1; Amer Bechnak, MD1; Hussain Isma'eel, MD1; Farid Talih, MD2; Lara Nasreddine, PhD3; Mona Nasrallah, MD1; Hani Tamim, PhD1


Current Knowledge/Study Rationale: Data regarding sleep difficulties and disorders in the Lebanese population are lacking. This study aimed to assess insomnia and sleep apnea and examine their relationship with demographic, lifestyle, and health characteristics in a sample of the Lebanese population residing in Greater Beirut.

Study Impact: Insomnia symptoms and disorder are highly prevalent in this cohort from a low to medium income country, especially among women and individuals with disadvantaged socioeconomic status. Sleep apnea is significantly underdiagnosed. This study leads the way for further comparative research that assesses local-regional and sociocultural determinants of insomnia, and sleep apnea.

Overnight Urge Perception in Nocturia Is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Population. 615-621.
Thomas F. Monaghan, BS1,2; Donald L. Bliwise, PhD3; Nicholas R. Suss, BS1,2; Matthew R. Epstein, BS1,2; Zhan D. Wu, BS1,2; Kyle P. Michelson, BA1,2; Christina W. Agudelo, MA1; Dennis J. Robins, MD1,2; Adrian Wagg, MBBS4; Jeffrey P. Weiss, MD1,2


Current Knowledge/Study Rationale: Management of both nocturia and insomnia often fails to consider one in the context of the other. During the hours of sleep, patients seeking treatment for nocturia with a concomitant diagnosis of depression, PTSD, or anxiety may be more likely than those with no mental health history to report nocturnal convenience voiding, defined as voiding despite “no urge or desire,” thus reflecting either impaired sleep maintenance or difficulty returning to sleep originating from other causes.

Study Impact: Most nocturia, however, appears to be related to true urgency to void, and multiple physiologic causes (eg, excess urine production at night due to sleep apnea, reduced levels of arginine vasopressin resulting in nocturnal polyuria, urologic conditions) should be sought for treating the condition.

Scoring of Hypersomnolence and Fatigue in Patients With Obstructive Sleep Apnea Treated With a Titratable Custom-Made Mandibular Advancement Device. 623-628.
Elahe Kazemeini, MD1,2; Marc J. Braem, DDS, PhD1,3; Greta Moorkens, MD, PhD4; Sowjanya Balina, DDS3; Chloé Kastoer, MD, PhD1,2; Sara Op de Beeck, MSc1,2; Olivier M. Vanderveken, MD, PhD1,2,5; Marijke Dieltjens, MSc, PhD1,2,3


Current Knowledge/Study Rationale: Currently, hypersomnolence and fatigue are often assessed using the Epworth Sleepiness Scale (ESS) and no clear distinction between these two symptoms can be made. The current study is the first to apply the Checklist Individual Strength (CIS20R) as a follow-up tool for measuring fatigue during the treatment of patients with obstructive sleep apnea and to compare the results with the ESS score.

Study Impact: The results showed an excellent reliability of CIS20R and demonstrated the severity of fatigue present in the study population with obstructive sleep apnea and also the effects of 3 months of MAD treatment on fatigue. The ESS score was clearly limited to the representation of hypersomnolence.

Free A Global Comparison of Anatomic Risk Factors and Their Relationship to Obstructive Sleep Apnea Severity in Clinical Samples. 629-639.
Kate Sutherland, PhD1,2; Brendan T. Keenan, MS3; Lia Bittencourt, MD, PhD4; Ning-hung Chen, MD5; Thorarinn Gislason, MD, PhD6; Sarah Leinwand, MPH3; Ulysses J. Magalang, MD7; Greg Maislin, MS8; Diego R. Mazzotti, PhD3; Nigel McArdle, MBBS, FRACP, MD9; Jesse Mindel, MD7; Allan I. Pack, MBChB, PhD3; Thomas Penzel, PhD10; Bhajan Singh, MBBS, FRACP, PhD9; Sergio Tufik, MD, PhD4; Richard J. Schwab, MD3; Peter A. Cistulli, MD, PhD1,2


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) is a global problem, but little is known about the influence of ethnicity and sex on OSA in clinical populations. This study uses global sleep clinical populations to examine differences in associations between OSA severity and clinical anatomic risk factors.

Study Impact: In clinical populations, we found South Americans and Asians are most susceptible to effects of obesity on OSA severity, whereas African Americans are least affected. Men are more susceptible than women to obesity effects in Caucasian and South American clinical populations. Relationships between Mallampati score and OSA severity or obesity were similar among ethnic groups. Our study highlights the importance of ethnicity and sex in OSA clinical presentations, and the need for personalized strategies for OSA management.

Total Sleep Time and BMI z-score Are Associated With Physical Function Mobility, Peer Relationship, and Pain Interference in Children Undergoing Routine Polysomnography: A PROMIS Approach. 641-648.
Bharat Bhushan, PhD, CCSH1,2; Amanda Beneat, MD3; Charles Ward, MD3; Alex Satinsky, MS1; Michael L. Miller, MD4; Lauren C. Balmert, PhD5; John Maddalozzo, MD1,2


Current Knowledge/Study Rationale: The study was conducted to better understand the relationships between sleep disturbance and health-related quality of life (HR-QoL) in children undergoing routine polysomnography.

Study Impact: Associations between sleep disturbance (obstructive sleep apnea and sleep duration) and specific HR-QoL domains will identify the most appropriate and effective approach to intervention in children.

Review Articles

Free Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce. 649-657.
Nancy S. Redeker, PhD, RN1; Claire C. Caruso, PhD, RN2; Sarah D. Hashmi, MSc, MPH, MBBS3; Janet M. Mullington, PhD4; Michael Grandner, PhD, MTR5; Timothy I. Morgenthaler, MD, FAASM6

Case Reports

Tongue Stabilizing Device-Emergent Central Sleep Apnea: A Case Report. 659-662.
Waled M. Alshhrani, BDS, MS1,2; Yuuya Kohzuka, DDS, PhD3; Kentaro Okuno, DDS, PhD4; John A. Fleetham, MD5; Fernanda R. Almeida, DDS, MSc, PhD1
Autocycling During Noninvasive Positive Pressure Ventilation Producing a Prolonged Severe Apnea and Syncope. 663-665.
Susana Mu, MBBS Hons1,2; Linda Rautela, B. AppSc (Physiotherapy)1,3,4; Mark E. Howard, MBBS, FRACP, GDEB, PhD1,3,4,5; Liam Hannan, MBBS, FRACP, PhD1,2,3,4
Persistent Central Apnea and Long-Term Outcome After Posterior Fossa Decompressive Surgery for Arnold Chiari Type 1 Malformation in a Pediatric Patient. 667-671.
Abigail Strang, MD; Umakanth Katwa, MD

Sleep Medicine Pearls

Pressure Requirements With a Nasal Versus Oronasal Mask During a PAP Titration Study. 673-674.
Hao Cheng, MD1; Anita Valanju Shelgikar, MD, MHPE, FAASM2

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2017 Impact Factor: 3.396
5-Year Impact Factor: 4.216
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