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Accepted Papers

Scientific Investigations

Temporal Association Between Respiratory Events and Reflux in Patients With Obstructive Sleep Apnea and Laryngopharyngeal Reflux. 1397-1402.
Sandra Doria Xavier, PhD1; Claudia Alessandra Eckley, PhD1; André Campos Duprat, PhD1; Luiz Henrique de Souza Fontes, PhD2; Tomás Navarro-Rodriguez, PhD2; Julio Patrocínio, MD3; Daniela Tridente, MD4; Geraldo Lorenzi-Filho, PhD5


Current Knowledge/Study Rationale: Obstructive sleep apnea and laryngopharyngeal reflux frequently coexist but temporal association between them is not well established. The relationship between them is potentially bidirectional.

Study Impact: We performed concomitant evaluation of both reflux and apnea along a continuous period (15, 30, and 45 minutes) by using gold-standard diagnostic methods: polysomnography and multichannel intraluminal impedance-pH esophageal monitoring with no temporal association found between them. Compensatory changes in upper esophageal sphincter and gastroesophageal junction pressures may prevent reflux after an apneic event.

The Clinical Value of N-Terminal Pro B-Type Natriuretic Peptide in Evaluating Obstructive Sleep Apnea in Patients With Coronary Artery Disease. 1403-1409.
Yuanhui Liu, MD1,*; Zhihua Huang, MD1,2,*; Kaizhuang Huang, MD1,2; Guang Li, MD1; Jianfang Luo, MD1; Ying Xu, MD3; Pingyan Chen, MD3; Jiyan Chen, MD, PhD1; Ling Wang, MD1


Current Knowledge/Study Rationale: Natriuretic peptides have been identified as biomarkers of increased myocardial wall stress in the context of obstructive sleep apnea (OSA) in the general population. However, the relationship between N-terminal pro B-type natriuretic peptide (NT-proBNP) and OSA remains unclear in patients with coronary artery disease (CAD).

Study Impact: Our study demonstrated that elevated levels of NT-proBNP were independently associated with a higher likelihood of OSA in patients with CAD. Periodically screening for NT-proBNP levels may provide early identification of OSA.

Automatic Sleep Staging in Patients With Obstructive Sleep Apnea Using Single-Channel Frontal EEG. 1411-1420.
Pei-Lin Lee, MD1,2,3; Yi-Hao Huang, MS4; Po-Chen Lin, MS4; Yu-An Chiao, MS4; Jen-Wen Hou, BS4; Hsiang-Wen Liu, MD2; Ya-Ling Huang, MS2; Yu-Ting Liu, PhD5; Tzi-Dar Chiueh, PhD4,6


Current Knowledge/Study Rationale: The use of a home sleep apnea test (HSAT) has increased in the clinical diagnosis and research of obstructive sleep apnea (OSA). When an HSAT is self-applied, it can be difficult to obtain reliable data for sleep staging.

Study Impact: We developed a single-channel frontal electroencephalography (F4-M1) based automatic sleep staging system, which had a good overall validity compared with expert scoring using full-channel polysomnography. It may be integrated as part of an HSAT used by patients at risk of OSA.

Pregnancy and Contraception Experiences in Women With Narcolepsy: A Narcolepsy Network Survey. 1421-1426.
Maeve Pascoe, BS1; Lawrence P. Carter, PhD2,3; Eveline Honig, MD, MPH4; James Bena, MS5; Nancy Foldvary-Schaefer, DO, MS1


Current Knowledge/Study Rationale: Literature addressing pregnancy and contraception outcomes in women with narcolepsy of childbearing age is sparse. This survey explored knowledge and experiences of women with narcolepsy related to pharmacotherapy to address a critical clinical care gap.

Study Impact: Given the chronic, debilitating symptoms of narcolepsy, expressed need for greater information dissemination from narcolepsy providers to patients, and limitations of the current literature, data regarding narcolepsy treatment in women of reproductive age will become increasingly important for shaping clinical practice. This survey highlights the need for pregnancy and contraception counseling in women of childbearing potential and outcomes research across the pharmacotherapeutic options for the treatment of narcolepsy.

Current Practice Patterns in the Diagnosis and Management of Sleep-Disordered Breathing in Infants. 1427-1431.
Rachana Kombathula, MSIV1; David G. Ingram, MD2; Zarmina Ehsan, MD2


Current Knowledge/Study Rationale: Sleep-disordered breathing in infants has a unique pathophysiology, and universally acceptable diagnostic and management algorithms are lacking. This study assessed current practice patterns for diagnosing and managing sleep-disordered breathing in infants.

Study Impact: Pediatric sleep providers exhibit substantial variability in their approach to diagnosis and management of sleep-disordered breathing in infants. Our results highlight the importance of and need for developing practice parameters and guidelines to provide better care for these infants.

Free Rates of Mental Health Symptoms and Associations With Self-Reported Sleep Quality and Sleep Hygiene in Adolescents Presenting for Insomnia Treatment. 1433-1442.
Tori R. Van Dyk, PhD1; Stephen P. Becker, PhD2,3; Kelly C. Byars, PsyD2,3,4


Current Knowledge/Study Rationale: Adolescence is characterized by high rates of both mental health and sleep concerns. Despite the possibility that emotional and behavioral problems may exacerbate issues with sleep, little is known about the mental health of adolescents presenting to sleep treatment. This study describes types and prevalence rates of mental health symptoms, in addition to their associations with sleep behaviors, in adolescents presenting with concerns of insomnia.

Study Impact: Findings indicate these youths have high rates of mental health symptoms and these symptoms are related to increased problems with sleep. To break a potential cycle between worsening sleep and mental health, sleep providers should assess and provide options for treatment of comorbid emotional and behavioral problems.

Cumulative Childhood Lead Levels in Relation to Sleep During Adolescence. 1443-1449.
Erica C. Jansen, PhD, MPH1,2; Galit Levi Dunietz, PhD, MPH2; Aleena Dababneh, BS2; Karen E. Peterson, ScD1; Ronald D. Chervin, MD, MS2; Jonggyu Baek, PhD3; Louise O’Brien, PhD, MS2; Peter X.K. Song, PhD4; Alejandra Cantoral, ScD5; Howard Hu, ScD, MS, MPH, MD6; Martha M. Téllez-Rojo, ScD7


Current Knowledge/Study Rationale: Lead exposure has been linked to cognitive outcomes among children. Insufficient and fragmented sleep have also been related to cognitive outcomes, yet the relationship between lead exposure and sleep has rarely been examined.

Study Impact: In a cohort of youth from Mexico City, we found that children in the highest compared with the lowest quartile of cumulative childhood lead levels had a 23-minute shorter sleep duration in adolescence, whereas differences in sleep fragmentation were apparent only for younger adolescents. Shorter sleep duration conceivably could represent an as-yet unrecognized adverse consequence of lead exposure in youth.

Sleep-Disordered Breathing in Pediatric Patients With Rett Syndrome. 1451-1457.
Kathleen M. Sarber, MD1; Javier J. M. Howard, MD, MPH2; Thomas J. Dye, MD1,3,4; John E. Pascoe, MD1,4; Narong Simakajornboon, MD1,4


Current Knowledge/Study Rationale: Literature describing breathing abnormalities during wakefulness in Rett syndrome (RS) has existed since it was first identified in 1966. Since then, small series have described sleep-disordered breathing (SDB) abnormalities in RS including central and obstructive sleep apnea. The literature describing symptoms of SDB and subsequent treatment are lacking.

Study Impact: Our study reviews our institution’s cases and discusses the presenting symptoms, baseline polysomnography results, and subsequent treatment for patients with RS and SDB treated in the past 10 years. Our findings add to the growing body of literature on the clinical presentation and the types of SDB seen in patients with RS and provide our experience with treatment in this population.

The Effect of Positive Airway Pressure Treatment of Obstructive and Central Sleep Apnea on the Recurrence of Atrial Fibrillation/Flutter Postintervention. 1459-1468.
Narat Srivali, MD1; Anwar C. Chahal, MB ChB2; Meghna P. Mansukhani, MD3; Jay Mandrekar, PhD4; Virend K. Somers, MD, PhD2; Sean M. Caples, DO, MS1,3


Current Knowledge/Study Rationale: The literature on the impact of positive airway pressure (PAP) treatment on the recurrence of atrial fibrillation/atrial flutter (AF) is inconclusive.

Study Impact: This retrospective study is the largest to date examining the effect of PAP treatment of sleep disordered breathing and did not find an effect of adequate PAP use on time to first recurrence of AF post-catheter ablation or cardioversion. Further large prospective randomized-controlled trials are required to guide clinical decisions.

Obstructive Sleep Apnea in Children With Autism. 1469-1476.
Anna Tomkies, BA1; Romaine F. Johnson, MD, MPH1; Gopi Shah, MD, MPH1; Michelle Caraballo, MD2; Patricia Evans, MD, PhD3; Ron B. Mitchell, MD1


Current Knowledge/Study Rational: Children with autism spectrum disorder (ASD) have higher rates of sleep problems compared to the general pediatric population. Although currently there are few studies using polysomnography (PSG) to diagnose obstructive sleep apnea (OSA) in this patient population, we believe that children with ASD have higher rates of OSA due to increased rates of obesity and hypotonia.

Study Impact: The strength of this study is the relatively large study population of children with ASD with PSG and the surprising lack of similar studies on this subject. This study supports the general indications for PSG in children with ASD and highlights that increasing weight serves as a predictor for severe OSA in this population.

Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive Sleep Apnea. 1477-1485.
Grietje E. de Vries, MS1,2; Aarnoud Hoekema, MD, PhD3,4,5,6; Karin M. Vermeulen, PhD7; Johannes Q.P.J. Claessen, MD, PhD8; Wouter Jacobs, MD, PhD9; Jan van der Maten, MS10; Johannes H. van der Hoeven, MD, PhD11; Boudewijn Stegenga, MD, PhD3,†; Huib A. M. Kerstjens, MD, PhD1,2; Peter J. Wijkstra, MD, PhD1,2,12


Current Knowledge/Study Rationale: This randomized controlled trial compares the clinical- and cost-effectiveness of a mandibular advancement device (MAD) versus continuous positive airway pressure (CPAP) in moderate obstructive sleep apnea (OSA) as there is little evidence to aid in choosing between both therapies in this specific subgroup of OSA severity.

Study Impact: CPAP therapy is the first-choice treatment option in moderate OSA and MAD therapy may be a good alternative, particularly when patients refuse CPAP or prefer MAD therapy because of the less invasive nature of the device. Future research should focus on long-term quality of life and cardiovascular outcomes in order to provide justified treatment advice, also taking into account the initial preference of the patient to offer personalised medical care in patients with moderate OSA.

Sensitivity and Specificity of the Modified Epworth Sleepiness Scale in Children With Craniopharyngioma. 1487-1493.
Valerie McLaughlin Crabtree, PhD1; Kimberly Lauren Klages, MS1,2; April Sykes, MPH3; Merrill S. Wise, MD4; Zhaohua Lu, PhD3; Daniel Indelicato, MD5; Thomas E. Merchant, DO, PhD6; Yvonne Avent, MSN, RN7; Belinda N. Mandrell, PhD, RN7


Current Knowledge/Study Rationale: Because youth with craniopharyngioma have a high prevalence of excessive daytime sleepiness, we validated the Modified Epworth Sleepiness Scale (M-ESS) in 70 pediatric patients with craniopharyngioma as a less resource-intensive tool to monitor sleepiness compared with Multiple Sleep Latency Testing, which is the gold standard but resource intensive. The M-ESS had poor sensitivity with the established cutoff score of 10, but at a cutoff score of 6 it had improved sensitivity but missed 35% of patients with significant objective sleepiness.

Study Impact: Our findings demonstrate poor sensitivity of the M-ESS in children with craniopharyngioma. This may have implications when monitoring sleepiness in children with brain tumors or other CNS lesions.

Ten-Year Secular Trends in Sleep/Wake Patterns in Shanghai and Hong Kong School-Aged Children: A Tale of Two Cities. 1495-1502.
Guanghai Wang, PhD1,2,*; Jihui Zhang, MD, PhD3,*; Siu Ping Lam, MRCPsych, FHKAM (Psych)3; Shirley Xin Li, PhD, DClinPsy, RPSGT4,5; Yanrui Jiang, MD1,2; Wanqi Sun, PhD1,2,4,6; Ngan Yin Chan, MSc, Mphil3,4; Alice Pik Shan Kong, FRCP7; Yunting Zhang, MD1,2; Shenghui Li, MD8; Albert Martin Li, FHKCPaed, MD9; Fan Jiang, MD1,2; Xiaoming Shen, MD1,2; Yun Kwok Wing, FRCPsych3


Current Knowledge/Study Rationale: Evidence about secular trends of sleep/wake patterns in children is scarce and conflicting. No study has compared the secular trends of sleep/wake patterns in Chinese school-aged children in Hong Kong and Shanghai, which implemented two different policies that affected schools’ start time in 10 years’ time.

Study Impact: We found that Hong Kong children had later bedtime and wakeup time, and slept consistently shorter than Shanghai children. Weekday sleep duration significantly decreased for Hong Kong children, but increased for Shanghai children over the past decade. This study provides insights into the secular trends of sleep/wake patterns, subcultural difference, and population-level policy regarding healthy and adequate sleep in school-aged children.

The Effect of the Modified Jaw-Thrust Maneuver on the Depth of Sedation During Drug-Induced Sleep Endoscopy. 1503-1508.
Donghwi Park, MD1; Jung-Soo Kim, MD, PhD2; Sung Jae Heo, MD3


Current Knowledge/Study Rationale: The modified jaw-thrust maneuver (MJTM) during drug-induced sleep endoscopy (DISE) has been used to predict the success of mandibular advancement devices. However, the MJTM may have an effect on the sedation and provoke arousal by awakening patients, which could be the cause for the improvement in airway obstruction. This study was conducted to investigate the effect of the MJTM on the depth of sedation during DISE.

Study Impact: The study found that the MJTM significantly relieved airway obstruction during DISE and increased the degree of awakening during the maneuver. Therefore, the effect of the MJTM on the depth of sedation may have contributed to relieving the airway obstruction.

Evolution and Predictive Factors of Improvement of Obstructive Sleep Apnea in an Obese Population After Bariatric Surgery. 1509-1516.
Fanny Magne, MD1; Emmanuel Gomez, MD1; Olivier Marchal, PhD2; Pascale Malvestio1; Nicolas Reibel, MD3; Laurent Brunaud, PhD3; Olivier Ziegler, PhD1; Didier Quilliot, PhD4; François Chabot, PhD1,5; Ari Chaouat, PhD1,5


Current Knowledge/Study Rationale: In an obese population, weight loss is essential to treat obstructive sleep apnea (OSA) but is not always enough. For patients with moderate or severe OSA after significant weight loss, maintaining positive airway pressure (PAP) treatment is necessary to reduce morbidity-mortality. However, after bariatric surgery, few patients continue to followed up regarding OSA. Furthermore, few data are available on the predictive factors of OSA improvement after bariatric surgery. Recent studies have shown that a young age at diagnosis and a weight less than 100 kg after bariatric surgery were predictive factors for managing OSA in obese patients.

Study Impact: Our objectives were to determine the number of patients after bariatric surgery who no longer met French Ministry of Health criteria for utilizing PAP, and the predictive factors of OSA improvement.

Review Articles

Free Obstructive Sleep Apnea and Systemic Hypertension: Gut Dysbiosis as the Mediator?. 1517-1527.
Saif Mashaqi, MD, FCCP1; David Gozal, MD, MBA2

Case Reports

Free The Effects of Transgender Hormone Therapy on Sleep and Breathing: A Case Series. 1529-1533.
Brian D. Robertson, MD1; Brian S. Lerner, MD1; Jacob F. Collen, MD2; Patrick R. Smith, DO1
An Unusual Cause of CPAP Intolerance. 1535-1537.
Lotte van Loenhout, MD; Hans van der Zeijden, MD
Case of an In-Laboratory Vagal Nerve Stimulator Titration for Vagal Nerve Stimulator-Induced Pediatric Obstructive Sleep Apnea. 1539-1542.
Jeremy H.M. Chan, MD1; James W. Owens, MD, PhD1; Joanna E. Wrede, MD1,2

Sleep Medicine Pearls

A Change of Heart. 1543-1545.
Brian N. Palen, MD1,2; Ken He, MD3; Jeff Redinger, MD1,4; Elizabeth C. Parsons, MD, MS1,2
Persistent Hypoxemia in a Teen With Down Syndrome. 1547-1549.
Andrew Upchurch, MD1; Surina Sharma, MD1; Susheela Hadigal, MD1; Mary Wagner, MD2; Richard Berry, MD1
When Sleeping With Eyes Closed Is Optional. 1551-1553.
Lourdes M. DelRosso, MD, FAASM1,2; Dustin Lehnert, BS, RPSGT, RRT1; Maida Lynn Chen, MD1,2

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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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