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Accepted Papers


Free Too Little, but Still Great?. 907-908.
Omavi Bailey, MD, MPH1,2; Sairam Parthasarathy, MD1,2; Daniel Combs, MD1,2,3

Scientific Investigations

Insomnia Symptoms Among Female Veterans: Prevalence, Risk Factors, and the Impact on Psychosocial Functioning and Health Care Utilization. 931-939.
Kimberly A. Babson, PhD1; Ava C. Wong, MPH2; Danielle Morabito1; Rachel Kimerling, PhD1,2


Current Knowledge/Study Rationale: Symptoms of insomnia have been shown to interfere with physical, psychological, and psychosocial well-being. As the proportion of female veterans and their rate of health care utilization is growing, it is important to understand the prevalence of insomnia symptoms in this population.

Study Impact: This study found insomnia was prevalent in nearly half of female veterans enrolled in primary care at the Veterans Health Administration. Targeted treatments for insomnia should be integrated in routine care for female veterans.

The Differential Effects of Regular Shift Work and Obstructive Sleep Apnea on Sleepiness, Mood and Neurocognitive Function. 941-951.
Jennifer M. Cori, PhD1; Melinda L. Jackson, PhD1,2; Maree Barnes, MBBS1,3; Justine Westlake, BA/BAppSci (Hons)1; Paul Emerson, BSocSc1; Jacen Lee, DPsych1,4; Rosa Galante, DPsych1,5; Amie Hayley, PhD1,6,7; Nicholas Wilsmore, MBBS (Hons)1,8; Gerard A. Kennedy, PhD1,2; Mark Howard, MBBS, PhD1,3


Current Knowledge/Study Rationale: Shift work and obstructive sleep apnea (OSA) both impair sleep quality and quantity. Although similar symptomology has been described for shift work and OSA, their effect on sleepiness, mood, vigilance, and neurocognitive function has not been directly compared.

Study Impact: Patients with OSA had sleepiness and mood similar to that of regular shift workers but performed significantly worse on vigilance and neurocognitive measures. These findings suggest that the facets of sleepiness, mood, vigilance, and neurocognitive function are not uniformly affected by poor quality sleep, and that specific impairments across these domains are likely dependent on the nature of the underlying sleep disturbance.

Free Continuous Positive Airway Pressure Treatment May Improve Optic Nerve Function in Obstructive Sleep Apnea: An Electrophysiological Study. 953-958.
Claudio Liguori, MD1; Fabio Placidi, MD, PhD1; Maria Giuseppina Palmieri, MD, PhD1; Francesca Izzi, MD, PhD1; Raffaella Ludovisi, BSc1; Nicola Biagio Mercuri, MD1,2,3; Mariangela Pierantozzi, MD, PhD2


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) has been associated with optic nerve disorders. Because visual evoked potentials (VEP) are a sensitive instrument to measure optic nerve function, we evaluated VEP in patients with OSA before and after 1 year of continuous positive airway pressure (CPAP) treatment.

Study Impact: Because we documented a marked improvement of VEP responses in patients with OSA who were adherent to CPAP treatment compared to those who were not adherent, we hypothesize that CPAP may restore optic nerve function in patients with OSA. Thus, it is possible that CPAP treatment for patients with OSA could prevent optic nerve diseases.

Sleep-Related Attentional Bias for Faces Depicting Tiredness in Insomnia: Evidence From an Eye-Tracking Study. 959-965.
Umair Akram, PhD; Anna Robson, BSc; Antonia Ypsilanti, PhD


Current Knowledge/Study Rationale: Experimental research has yielded mixed evidence concerning the presence and nature of a sleep-related attentional bias in insomnia, and this is the first study to use sleep-specific faces depicting tiredness in conjunction with eye tracking to objectively examine the presence of an attentional bias in insomnia.

Study Impact: The results from this study provide novel evidence using an eye-tracking paradigm that individuals with insomnia show an attentional bias for sleep-related faces depicting a tired facial expression. It is theorized that people with insomnia attend to and monitor faces for facial cues of tiredness to confirm the physical presence of a sleep deficit.

Obstructive Sleep Apnea and Sleep Architecture in Adolescents With Severe Obesity: Effects of a 9-Month Lifestyle Modification Program Based on Regular Exercise and a Balanced Diet. 967-976.
Johanna Roche1,2,3; Valérie Gillet, MD3; Frédéric Perret, MD4; Fabienne Mougin, PhD1,2


Current Knowledge/Study Rationale: The progression of pediatric obesity is associated with the development of obstructive sleep apnea (OSA). Multidisciplinary programs with physical exercise and weight loss are the first line of obesity management. Because it is recognized that weight loss and physical exercise decrease OSA, we hypothesized that this program would contribute to reducing OSA in a severely obese adolescent population.

Study Impact: This study is the first to objectively assess both cardiorespiratory fitness and polysomnographic parameters in obese adolescents, in a context of obesity management. Our results suggest that this type of management may be insufficient to treat OSA, and point to a need for further investigations to better manage OSA, and to study the association between weight loss and changes in sleep architecture.

A Community-Based Study of Sleep and Cognitive Development in Infants and Toddlers. 977-984.
Wanqi Sun, MD, MPh1,2; Shirley Xin Li, PhD, DClinPsy, RPSGT2,3; Yanrui Jiang, MD, MPh1; Xiaojuan Xu, MD, MPh1; Karen Spruyt, PhD1,4; Qi Zhu, BAcc1; Chia-huei Tseng, PhD5; Fan Jiang, MD, PhD1


Current Knowledge/Study Rationale: There is some evidence on the effects of sleep in early development, yet the existing studies are limited by a relatively small sample size and selected clinical populations (eg, preterm babies, infants with snoring). Data on sleep and cognitive abilities in physically healthy young children remain scanty. Therefore, we conducted an epidemiological study to investigate different aspects of sleep in relation to cognitive abilities in a large representative community sample of infants and toddlers.

Study Impact: A distinct pattern of association between sleep quality (ie, frequency of nighttime awakenings) and cognitive abilities in young children at different developmental stages was found. The findings provide a developmental context for the implications of nighttime awakenings in early years and underscore the need to address frequent nighttime awakenings particularly in toddlers. Future research is warranted to develop parent-based, sleep-focused educational intervention in the community and to examine the effects of such intervention on children's early development.

High Negative Predictive Value of Normal Body Mass Index for Obstructive Sleep Apnea in the Lateral Sleeping Position. 985-990.
Łukasz Mokros, MD, PhD1; Wojciech Kuczynski, MD2; Agata Gabryelska2; Łukasz Franczak2; Jakub Spałka, MD2; Piotr Białasiewicz, MD, PhD2


Current Knowledge/Study Rationale: Patients who are not obese and who have obstructive sleep apnea generally present with a low apneahypopnea index in the lateral sleeping position. Hence, sleep-disordered breathing seems more dependent on body mass index in the lateral sleeping position than the supine sleep position. We suspect that obesity is a better predictor of sleep-disordered breathing in the lateral sleeping position.

Study Impact: Normal body mass index offers a high negative predictive value for moderate or severe obstructive sleep apnea in the lateral sleeping position. For normal body mass index, the negative predictive value for an apnea-hypopnea index < 15 events/h in the lateral sleeping position reached 97.5% and 97.1% in our retrospective and prospective studies, respectively.

Snore Sound Analysis Can Detect the Presence of Obstructive Sleep Apnea Specific to NREM or REM Sleep. 991-1003.
Shahin Akhter, PhD1; Udantha R. Abeyratne, PhD1; Vinayak Swarnkar, PhD1; Craig Hukins, MBBS, FRACP2


Current Knowledge/Study Rationale: Snoring is a symptom of obstructive sleep apnea (OSA) that can potentially be linked to NREM and REM sleep as well as upper airway collapse in patients with OSA. In this study, we test whether the analysis of snoring and breathing-related sounds can accurately identify OSA during REM and NREM sleep.

Study Impact: This study demonstrates that snoring sound can be used to estimate the presence of OSA, specific to NREM or REM sleep, at high accuracy. The noninvasive, fully automated, and low-cost nature of the technology holds promise as a potential tool for screening of the disease.

Cost-Effectiveness Analysis of the DiagnOSAS Screening Tool Compared With Polysomnography Diagnosis in Dutch Primary Care. 1005-1015.
Floris A.J. Geessinck, MSc1; Rick G. Pleijhuis, MD, PhD2; Rob J. Mentink, Eng PhD3; Job van der Palen, PhD4; Hendrik Koffijberg, PhD5


Current Knowledge/Study Rationale: Current challenges regarding the diagnostic process of obstructive sleep apnea (OSA) ask for alternatives for the current standard of care. Screening tools to rule out OSA in an early phase might be part of the solution. Health economic evaluations of such screening tools, however, are scarce. We evaluate the cost-effectiveness of DiagnOSAS, an OSA screening tool that strives to facilitate fast and well-informed referral to sleep clinics and hospitals for diagnosis.

Study Impact: When accounting for three major negative consequences of OSA, our analysis shows that integration of DiagnOSAS in the diagnostic process is likely to reduce health care cost in The Netherlands. When DiagnOSAS is able to also decrease time to diagnosis, as expected, health outcomes considerably improve as well.

Review Articles

Insomnia in the Elderly: A Review. 1017-1024.
Dhaval Patel, MD; Joel Steinberg, MD; Pragnesh Patel, MD

Special Articles

Free Change is the Only Constant in Life (and in Sleep Medicine). 1025-1030.
Ilene M. Rosen, MD, MS
Free Sleep Duration and Hypertension: Analysis of > 700,000 Adults by Age and Sex. 1031-1039.
Michael Grandner, PhD, MTR1; Janet M. Mullington, PhD2; Sarah D. Hashmi, MSc, MPH, MBBS3; Nancy S. Redeker, PhD, RN4; Nathaniel F. Watson, MD, MSc5; Timothy I. Morgenthaler, MD, FAASM6
Free Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. 1041-1055.
Timothy I. Morgenthaler, MD1; Sanford Auerbach, MD2; Kenneth R. Casey, MD, MPH3; David Kristo, MD4; Rama Maganti, MD5; Kannan Ramar, MD1; Rochelle Zak, MD6; Rebecca Kartje, MD, MSHI, MBA7

Emerging Technologies

Validation of the Sleep-Wake Scoring of a New Wrist-Worn Sleep Monitoring Device. 1057-1062.
Wilfred R. Pigeon, PhD1,2; Maddison Taylor1; Ashley Bui1; Courteney Oleynk1; Patrick Walsh, PhD1; Todd M. Bishop, PhD1,2
Free A Novel Artificial Neural Network Based Sleep-Disordered Breathing Screening Tool. 1063-1069.
Ao Li, MS1; Stuart F. Quan, MD2,3; Graciela E. Silva, PhD, MPH4; Michelle M. Perfect, PhD5; Janet M. Roveda, PhD1,6

Case Reports

Obstructive Sleep Apnea in a Severely Obese Child With Combined Central Sleep Apnea and Sleep-Related Hypoventilation Disorder Caused by a Medullary Tumor. 1071-1074.
Kazushi Fujimoto1; Hajime Kasai, MD, PhD2; Reiko Kunii3; Jiro Terada, MD, PhD2; Koichiro Tatsumi, MD, PhD2
Transient Central Sleep Apnea Runs Triggered by Disorder of Arousal in a Child. 1075-1078.
Lourdes M. DelRosso, MD, FAASM1,2; Kenneth Martin, MD2; Michelle Marcos, RRT, NPS2; Raffaele Ferri, MD3

Sleep Medicine Pearls

Good Night, Sleep Tight, Bed Bugs Continue to Bite. 1079-1080.
Mandeep Rana, MD; William DeBassio, MD, PhD

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