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Free A Meaningful Step Toward Understanding the Cause and Impact of Nightmares. 179-180.
Michael R. Nadorff, PhD1,2; Caitlin E. Titus, MS1; Ashley R. Pate, BS1
Free Distinct Disorder? Or Mash Up of Several?. 181-182.
Meagan Rizzo, MD1; Brian Robertson, MD1; Jacob F. Collen, MD2

Scientific Investigations

Effect of Three Hypopnea Scoring Criteria on OSA Prevalence and Associated Comorbidities in the General Population. 183-194.
Camila Hirotsu, PhD1; Jose Haba-Rubio, MD1; Daniela Andries1; Nadia Tobback1; Pedro Marques-Vidal, MD, PhD2; Peter Vollenweider, MD2; Gérard Waeber, MD2; Raphael Heinzer, MD, MPH1,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: The American Academy of Sleep Medicine's rules for scoring hypopneas have changed thrice over the past 20 years, but their clinical effects on the prevalence of obstructive sleep apnea and their association with hypertension, diabetes, and metabolic syndrome in the general population are unknown.

Study Impact: Our findings indicate that the method used for scoring hypopneas significantly influences the prevalence of obstructive sleep apnea and its association with cardiometabolic outcomes. We could provide predictive equations to translate the differences in apnea-hypopnea indexes within three recommended criteria of the American Academy of Sleep Medicine in a general population-based sample. Further, this study highlights the need for standardization of the scoring method to allow compatibility among epidemiological studies.

Correlation Between Oxygen Saturation and Pulse Tracing Patterns on Overnight Oximetry With Normal Desaturation Index Is an Independent Predictor of Obstructive Sleep Apnea. 195-200.
Nura Festic, MD; Muhammad Zuberi, MD; Vikas Bansal, MBBS, MPH; Paul Fredrickson, MD; Emir Festic, MD, MS

BRIEF SUMMARY

Current Knowledge/Study Rationale: The correlation of heart rate variability with sleep-disordered breathing during polysomnography has been well established. In order to assess whether this established finding could be translated to clinical practice, we studied visual correlation of heart rate variability with pulse oximetry in a cohort of patients with normal overnight pulse oximetry studies.

Study Impact: The patients with episodic heart rate variability occurring simultaneously with minimal oxygen desaturations despite normal oximetry results have five times higher odds of receiving a diagnosis of obstructive sleep apnea on a subsequent polysomnogram, when adjusted for pertinent demographic and clinical characteristics. Assessment of pulse tracing on overnight oximetry offers an additional predictive utility when screening for obstructive sleep apnea with overnight pulse oximetry.

Associations Between Obstructive Sleep Apnea and Measures of Arterial Stiffness. 201-206.
Jenny Theorell-Haglöw, PhD1,2; Camilla M. Hoyos, PhD1,3; Craig L. Phillips, PhD1,4; Brendon J. Yee, PhD1,5; Kerri L. Melehan, PhD1,5; Peter Y. Liu, PhD6; Peter A. Cistulli, PhD1,4,7; Ronald R. Grunstein, PhD1,5

BRIEF SUMMARY

Current Knowledge/Study Rationale: Obstructive sleep apnea is a risk factor for cardiovascular morbidity and mortality. Because recent large intervention trials have been negative, there is a need to focus on endpoints such as arterial stiffness to further explore the relationship. To our knowledge, no previous studies have explored the effect of different measures of sleep apnea severity on measures of arterial stiffness.

Study Impact: In a large patient group, we show associations between measures of sleep apnea severity and several aspects of arterial stiffness. The results support a relationship between sleep apnea and cardiovascular disease beyond standard peripheral blood pressure measures. Further studies on the effect of sleep apnea on arterial stiffness are needed to clarify the mechanisms for increased vascular dysfunction.

Elevated Serum Markers of Acute Kidney Injury in Patients With Obstructive Sleep Apnea. 207-213.
Li-Pang Chuang, MD, PhD1,2; Shih-Wei Lin, MD1; Li-Ang Lee, MD2,3; Chih-Hsiang Chang, MD4; Hung-yu Huang, MD1; Han-Chung Hu, MD1,6; Kuo-Chin Kao, MD1,6; Meng-Jer Hsieh, MD5,6; Cheng-Ta Yang, MD1,2; Hsueh-Yu Li, MD2,3; Ning-Hung Chen, MD1,6

BRIEF SUMMARY

Current Knowledge/Study Rationale: Previous research demonstrated a positive correlation between albuminuria and the severity of obstructive sleep apnea. However, little else has been revealed about acute kidney injury in patients with obstructive sleep apnea.

Study Impact: We recruited 75 consecutive patients with obstructive sleep apnea and found that baseline levels of albuminuria and serum markers of acute kidney injury (cystatin C, neutrophil gelatinase-associated lipocalin, and interleukin-18), had positive correlations with the severity of obstructive sleep apnea. After 6 months of continuous positive airway pressure treatment, albuminuria and interleukin-18 were decreased significantly in patients with good adherence.

Adiposity and Physical Activity Do Not Mediate the Longitudinal Association Between Sleep Quality and Arterial Thickness Among Adolescents. 215-221.
Suziane Ungari Cayres1; Luiz Carlos Marques Vanderlei, PhD2; Aristides M. Machado-Rodrigues, PhD3; André Oliveira Werneck1; Maurício Fregonesi Barbosa4; Romulo Araújo Fernandes, PhD5

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep is a behavior with the potential to affect cardiovascular health. Adiposity is associated with cardiovascular disease risk factors during growth.

Study Impact: Arterial thickness seems to be affected by sleep quality in adolescents. Trunk fat had a positive and independent effect and sleep quality a direct effect on femoral intima-media thickness among adolescents.

Temporal Analysis of Chronic Musculoskeletal Pain and Sleep in Postmenopausal Women. 223-234.
Cristina Frange, PT, PhD1; Helena Hachul, MD, PhD1,2; Camila Hirotsu, BSc, PhD1; Sergio Tufik, MD, PhD1; Monica Levy Andersen, BSc, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Pain and sleep are thought to share a reciprocal relationship. In sleep disorders such as insomnia, there is an increase in pain sensitivity and a decrease in pain thresholds. Although women who are postmenopausal often have insomnia and chronic pain, there is a lack of studies addressing these two factors in this specific population.

Study Impact: The findings highlight the association between chronic musculoskeletal pain and insomnia in women who are postmenopausal, as increased sleep duration was a predictor of increased pain intensity upon waking, and more pain at bedtime predicted both increased time in bed and sleep duration. Our results introduce a novel concept about the bidirectional relationship between pain and sleep in relation to women who are postmenopausal that should be further investigated in future studies.

Comorbidities, Health-Related Quality of Life, and Work Productivity Among People With Obstructive Sleep Apnea With Excessive Sleepiness: Findings From the 2016 US National Health and Wellness Survey. 235-243.
Carl Stepnowsky, PhD1; Kathleen F. Sarmiento, MD2,3; Shay Bujanover, MD4; Kathleen F. Villa, MS4; Vicky W. Li, MPH5; Natalia M. Flores, PhD6

BRIEF SUMMARY

Current Knowledge/Study Rationale: It is well documented that obstructive sleep apnea (OSA) is associated with negative ramifications including decreased health-related quality of life (HRQoL) and increased prevalence of various comorbid illnesses. Although a growing body of evidence suggests that excessive sleepiness (ES) in individuals with OSA imparts incremental HRQoL, comorbidity, and work productivity burdens beyond those of OSA alone, few population-based studies have explored how ES contributes to burden of illness among patients with OSA.

Study Impact: Data from participants in the annual, cross-sectional 2016 US National Health and Wellness Survey found that those with OSA with ES (n = 731) had a higher prevalence of certain comorbidities, reduced HRQoL, and greater impairment in productivity compared to participants with OSA without ES (n = 1,452) and compared to non-OSA controls (n = 86,961), even after controlling for covariates. These data reinforce the importance of addressing ES as an independent and potentially treatable symptom associated with disease burden and hindered work productivity in patients with OSA.

Free Centers for Medicare and Medicaid Services Positive Airway Pressure Adherence Criteria May Limit Treatment to Many Medicare Beneficiaries. 245-251.
Sreelatha Naik, MD1,2; Moh'd Al-Halawani, MD2,3,4; Iouri Kreinin, CCRP, CCRC2,3; Meir Kryger, MD, FRCPC2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Positive airway pressure (PAP) adherence is defined as usage of the device for at least 4 hours per night on 70% of nights during a consecutive 30-day period. We hypothesize that the adherence pattern may be established beyond this initial period, which may limit the opportunity to treat many patients.

Study Impact: Our data show that Centers for Medicare and Medicaid Services (CMS) adherence criteria affecting PAP coverage are restrictive and can result in the withholding of therapy in many patients who otherwise might become adherent. Although pathways to “restart the clock” for CMS exist, repeated testing is expensive, can be cumbersome and discouraging to patients already struggling with this therapy.

Nightmare Severity Is Inversely Related to Frontal Brain Activity During Waking State Picture Viewing. 253-264.
Louis-Philippe Marquis, BSc1,2; Sarah-Hélène Julien, BSc1,2; Andrée-Ann Baril, PhD2,3; Cloé Blanchette-Carrière, BSc2,3; Tyna Paquette, MSc2; Michelle Carr, PhD4; Jean-Paul Soucy, MD5; Jacques Montplaisir, MD, PhD2,3; Tore Nielsen, PhD2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: There is growing evidence that nightmares cause clinically significant distress and may be a risk factor for psychopathology and suicidal behavior. However, there is a paucity of research on the neural mechanisms of nightmares, especially of nontraumatic nightmares. We therefore studied individuals who frequently recalled nightmares using single photon emission computed tomography.

Study Impact: This study is among the first to investigate the neural correlates of disturbed dreaming, and the first to use nightmare frequency and distress severity measures. Negative correlations between nightmare severity and anterior cingulate/medial prefrontal cortices activity partially support a neurocognitive model emphasizing prefrontal regulatory mechanisms, whereas secondary results suggest that reduced activity in a wide brain network may be involved in nightmare production.

The Moderating Role of Parents' Dysfunctional Sleep-Related Beliefs Among Associations Between Adolescents' Pre-Bedtime Conflict, Sleep Quality, and Their Mental Health. 265-274.
Jack S. Peltz, PhD1,2; Ronald D. Rogge, PhD3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Family conflict has been shown to influence both adolescents' sleep quality and mental health. We sought to examine how both parents and adolescents' dysfunctional sleep-related cognitions moderated these associations.

Study Impact: Given the epidemic of adolescent sleep problems and its consequences, parents' dysfunctional sleep-related beliefs must be considered because of the risks that they pose to promoting a negative cascade from family conflict to poor adolescent sleep and mental health problems. These findings suggest new avenues, such as parents' beliefs or attitudes about sleep, that must be addressed to support healthy sleep and mental well-being in adolescents.

Obstructive Sleep Apnea in Children and Adolescents and the Risk of Major Adverse Cardiovascular Events: A Nationwide Cohort Study in Taiwan. 275-283.
Nian-Sheng Tzeng, MD1,2; Chi-Hsiang Chung, PhD3,4,5; Hsin-An Chang, MD1,2; Chuan-Chia Chang, MD, PhD1; Ru-Band Lu, MD6,7; Hui-Wen Yeh, RN, MSN1,8,9,10; Wei-Shan Chiang, MSc1; Yu-Chen Kao, MD, MSc1,11; Shan-Yueh Chang, MD12,13; Wu-Chien Chien, PhD3,4,14

BRIEF SUMMARY

Current Knowledge/Study Rationale: To address a gap in knowledge, we investigated the association between obstructive sleep apnea (OSA) in children and adolescents, and the risk of major adverse cardiovascular events (MACEs) on the population database. In a nationwide, matched cohort study, the selection bias could be minimized.

Study Impact: OSA in children and adolescents is associated with increased MACEs on the population database. The children and adolescents with OSA were more likely to experience MACEs (hazard ratio = 2.050; 95% confidence interval = 1.312–3.107; P = .010) when adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities.

Comparison of Apnea Detection Using Oronasal Thermal Airflow Sensor, Nasal Pressure Transducer, Respiratory Inductance Plethysmography and Tracheal Sound Sensor. 285-292.
AbdelKebir Sabil, PhD1; Martin Glos, PhD2; Alexandra Günther, MD2; Christoph Schöbel, MD2; Christian Veauthier, MD2; Ingo Fietze, MD, PhD2; Thomas Penzel, PhD2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Reliable recording of respiratory flow is needed for apnea detection. In patients with obstructive sleep apnea, tracheal sound monitoring by the PneaVox sensor was tested and its performance was compared to those of the nasal pressure and respiratory inductance plethysmography belts with respect to the thermistor.

Study Impact: Associated with nasal pressure, tracheal sound meet the oronasal flow evaluation required by the American Academy of Sleep Medicine for apnea detection. Tracheal sound can be used as a substitute for oral thermistors to reliably detect apneas.

Review Articles

Prevalence of Obstructive Sleep Apnea in Joint Hypermobility Syndrome: A Systematic Review and Meta-Analysis. 293-299.
Karim Sedky, MD, MSc1; Thomas Gaisl, MD2; David S. Bennett, PhD3
Free Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. 301-334.
Susheel P. Patil, MD, PhD1; Indu A. Ayappa, PhD2; Sean M. Caples, DO3; R. John Kimoff, MD4; Sanjay R. Patel, MD5; Christopher G. Harrod, MS6

Special Articles

Free Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. 335-343.
Susheel P. Patil, MD, PhD1; Indu A. Ayappa, PhD2; Sean M. Caples, DO3; R. John Kimoff, MD4; Sanjay R. Patel, MD5; Christopher G. Harrod, MS6

Case Reports

Trauma-Associated Sleep Disorder: A Posttraumatic Stress/REM Sleep Behavior Disorder Mash-Up?. 345-349.
John C. Feemster, BA; Kevin L. Smith, BA; Stuart J. McCarter, MD; Erik K. St. Louis, MD, MS
Polysomnographic Analysis of a Pediatric Case of Baclofen-Induced Central Sleep Apnea. 351-354.
Federica Locatelli, MD1; Francesca Formica, MD1; Sara Galbiati, MD1; Paolo Avantaggiato, MD1; Elena Beretta, MD1; Carla Carnovale, PharmD2; Marco Pozzi, PhD1; Emilio Clementi, PhD1,2; Sandra Strazzer, MD1
Night Stepping: Fitbit Cracks the Case. 355-357.
Thapanee Somboon, MD1,2; Madeleine M. Grigg-Damberger, MD3; Nancy Foldvary-Schaefer, DO, MS1

Sleep Medicine Pearls

Sleepy Preteen After Upper Airway Surgery. 359-361.
Arnaldo Reyes Esteves, MD1; Wajiha Raza, MD1; Scott Ryals, MD1; William O. Collins, MD2; Jessica Ching, MD3; Mary Wagner, MD4; Richard Berry, MD1

Letter to the Editor

Free Letter to the Editor Regarding the Updated American Academy of Otolaryngology-Head and Neck Surgery Foundation Clinical Practice Guideline on Tonsillectomy in Children. 363-365.
Robin Lloyd, MD1; Douglas B. Kirsch, MD2; Kelly A. Carden, MD3; Raman K. Malhotra, MD4; Ilene M. Rosen, MD, MS5; Kannan Ramar, MD1

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2017 Impact Factor: 3.396
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