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Accepted Papers

Scientific Investigations

Semistructured Motivational Interviews of Patients and Caregivers to Improve CPAP Adherence: A Qualitative Analysis. 1721-1730.
Nazia Naz S. Khan, MD, MS1; Adesuwa B. Olomu, MD1; Shireesha Bottu, MD1; Margaret R. Roller, MA2; Robert C. Smith, MD1


Current Knowledge/Study Rationale: There is only limited evidence that partner engagement in obstructive sleep apnea (OSA) improves adherence to positive airway pressure (PAP) therapy. This analysis evaluates patients' preferences, caregiver experiences, and barriers and facilitators to PAP adherence; it also evaluates understanding of the educational content and satisfaction with the intervention.

Study Impact: This analysis identifies several emotions experienced with the OSA diagnosis and its PAP treatment. It also emphasizes the need for patient-centered interventions to bring a positive change in the patient and caregiver experience.

Prematurity as a Risk Factor of Sleep-Disordered Breathing in Children Younger Than Two Years: A Retrospective Case-Control Study. 1731-1736.
Ido Sadras, MD1; Joel Reiter, MD1,2,3; Nitzan Fuchs, BSc3; Ira Erlichman, MD3,4; David Gozal, MD, MBA5; Alex Gileles-Hillel, MD1,2,3


Current Knowledge/Study Rationale: History of prematurity increases the risk for sleep-disordered breathing in school-aged children. At discharge from the neonatal intensive care unit, infants born premature have unstable breathing manifesting by episodes of periodic breathing and intermittent hypoxemia. Sleep-disordered breathing is associated with worse neurocognitive development.

Study Impact: Infants born premature who are aged 2 to 24 months have fourfold increased risk of sleep-disordered breathing compared to children born at term. Sleep-disordered breathing in infants born premature is often clinically silent, more likely to manifest central apneas and disturbed sleep architecture and more severe. Sleep-disordered breathing in all infants at this age group is associated with poor weight gain.

Cardiovascular Effect and Symptom Profile of Obstructive Sleep Apnea: Does Sex Matter?. 1737-1745.
Izolde Bouloukaki, MD, PhD; Charalampos Mermigkis, MD, PhD; Manolis Markakis, MD; Athanasia Pataka, MD, PhD; Ioanna Alexaki, RN; Christina Ermidou, MD; Violeta Moniaki, RN; Eleni Mauroudi, RN; Stylianos Michelakis, MD; Sophia E. Schiza, MD, PhD


Current Knowledge/Study Rationale: There are data suggesting that obstructive sleep apnea (OSA) has different cardiovascular risk and clinical presentation profile in females. This study aimed to evaluate the influence of sex on OSA-related symptoms and prevalent cardiovascular disease (CVD) in a large clinical population of patients.

Study Impact: Our results show that females referred for sleep studies were more likely to exhibit CVD and less likely to complain of typical OSA symptoms than males. Better knowledge of sex differences in OSA will help to improve the awareness and diagnosis of OSA in women, and the development and availability of therapeutic options that take into account these differences.

Phrenic Nerve Stimulation for the Treatment of Central Sleep Apnea: A Pooled Cohort Analysis. 1747-1755.
Marat Fudim, MD, MHS1,2; Andrew R. Spector, MD3; Maria-Rosa Costanzo, MD4; Sean D. Pokorney, MD1,2; Robert J. Mentz, MD1,2; Dariusz Jagielski, MD5; Ralph Augostini, MD6; William T. Abraham, MD6; Piotr P. Ponikowski, MD5,7; Scott W. McKane, MS8; Jonathan P. Piccini, MD1,2


Current Knowledge/Study Rationale: Treatment options for central sleep apnea (CSA) are limited. Early evidence with transvenous phrenic nerve stimulation demonstrates improved disease severity and quality of life in patients with central CSA.

Study Impact: Transvenous phrenic nerve stimulation significantly improves CSA severity, sleep quality, ventricular function, and quality of life regardless of heart failure status. Improvements, which are independent of patient compliance, are sustained at 1-year and are associated with acceptable safety, thus supporting clinical use.

Free Effects of a Tailored Lighting Intervention on Sleep Quality, Rest–Activity, Mood, and Behavior in Older Adults With Alzheimer Disease and Related Dementias: A Randomized Clinical Trial. 1757-1767.
Mariana G. Figueiro, PhD1; Barbara Plitnick, RN1; Charles Roohan, BS1; Levent Sahin, PhD1; Michael Kalsher, PhD2; Mark S. Rea, PhD1


Current Knowledge/Study Rationale: Older adults with Alzheimer disease and related dementias (ADRD) experience severe dysfunctions of their sleep–wake and rest–activity patterns and are at high risk for depression and agitation behavior. These disturbances can lead to their placement in controlled environments, where they experience even greater inactivity and reduced exposure to daytime circadian-effective light, further exacerbating their symptoms. A circadian-effective lighting intervention can ameliorate these symptoms.

Study Impact: Our research shows that circadian-effective light, when carefully specified and implemented, can positively impact measures of sleep, mood, and behavior in patients with ADRD living in assisted-living and long-term care facilities.

Measurement Invariance and Sleep Quality Differences Between Men and Women in the Pittsburgh Sleep Quality Index. 1769-1776.
Longfeng Li, MS; Connor M. Sheehan, PhD; Marilyn S. Thompson, PhD


Current Knowledge/Study Rationale: The Pittsburgh Sleep Quality Index (PSQI) has been widely used by researchers and clinicians to measure self-reported sleep quality and discrepant sex differences have been reported, but it remains unknown whether these sex differences may be artifacts of measurement model differences. This study examined the factorial structure of the PSQI and tested its measurement invariance and compared latent means between males and females.

Study Impact: This study provides evidence that comparisons by sex of self-reported sleep using the PSQI are valid. Importantly, by thorough evaluation of the measurement model, this study supports previous findings that women report worse sleep quality than men, which may help to understand the broader sex-based differences in health.

Oropharyngeal Microbiome in Obstructive Sleep Apnea: Decreased Diversity and Abundance. 1777-1788.
Wenbo Yang, MM*; Liang Shao, PhD*; Mulalibieke Heizhati, PhD; Ting Wu, MM; Xiaoguang Yao, PhD; Yingchun Wang, MM; Lei Wang, MM; Nanfang Li, PhD


Current Knowledge/Study Rationale: The underlying mechanism of obstructive sleep apnea (OSA) is not fully understood yet, although the role of airway inflammation in OSA was widely discussed. Recent studies suggest that changes in local microecology, especially local microbial diversity, can cause local immune system imbalance. It is still not clear in the pharyngeal inflammation whether there is a dissonance of local microbiota.

Study Impact: We found that oropharyngeal microbiota is disturbed in conditions of OSA, characterized by lowered diversity and abundance. The findings may shed new light on a possible association between oropharynx microbiota and OSA. We hope the results could provide useful information for further understanding the microbiological mechanism of OSA.

Factors Influencing the Presentation of REM Sleep Behavior Disorder: The Relative Importance of Sex, Associated Neurological Disorder, and Context of Referral to Polysomnography. 1789-1798.
Paulo Bugalho, PhD1,2; Manuel Salavisa, MD1


Current Knowledge/Study Rationale: Rapid eye movement (REM) sleep behavior disorder (RBD) has a heterogeneous presentation. Three factors could exert a significant influence on RBD features: sex, associated neurological disorder, and context in which polysomnography was required.

Study Impact: Our data suggest that male sex is associated with a higher level of muscular activity and a specific pattern of motor events during REM sleep. Having clinically isolated RBD (as opposed to secondary RBD) and being directly referred for a first consultation because of complaints compatible with RBD are associated with higher frequency and severity of motor events during REM sleep.

Effects of Pharmacotherapy Treatment on Patient-Reported Outcomes in a Narcolepsy and Idiopathic Hypersomnia Cohort. 1799-1806.
Maeve Pascoe, BS1; James Bena, MS2; Nancy Foldvary-Schaefer, DO, MS1


Current Knowledge/Study Rationale: There are limited data on real-world longitudinal outcomes in patients with narcolepsy or idiopathic hypersomnia (IH), who take pharmacotherapies alone or in combination. With new pharmacotherapeutic options for narcolepsy and IH emerging, studies exploring outcomes in real-world settings are needed to inform optimal clinical care.

Study Impact: This is the first-ever real-world central nervous system hypersomnolence cohort study exploring the effects of various pharmacotherapies with dose burden analyses on sleep-related patient-reported outcomes. This study expands existing clinical knowledge and provides a basis for future investigations of functional outcomes in patients with disorders of central nervous system hypersomnolence.

Obstructive Sleep Apnea in Patients With Fibrotic Interstitial Lung Disease and COPD. 1807-1815.
Xiao Lei Zhang, MD1,2,3,4,5; Hua Ping Dai, MD1,2,3,4; Hui Zhang, MD1,2,3; Bo Gao, MD1,2,4; Li Zhang, MD1,2,5; Teng Han, MD1,2; Chen Wang, MD1,2,3,4,5


Current Knowledge/Study Rationale: Little is known about the possible predictors of obstructive sleep apnea (OSA) and the effect of OSA on quality of life in patients with chronic respiratory diseases (CRDs). The objectives were to identify physiological and clinical parameters that predict the occurrence and severity of OSA and to investigate the effect of OSA on quality of life in patients with CRDs.

Study Impact: OSA is common and associated with worse sleep quality and less daily vitality in patients with CRDs. The STOP-BANG questionnaire with different cutoff points may help rule in or rule out OSA, and overnight oximetry can be used as a screening tool for OSA and can assist the clinical evaluation of OSA for CRDs.

Free Effect of Treatment of Central Sleep Apnea/Cheyne-Stokes Respiration on Left Ventricular Ejection Fraction in Heart Failure: A Network Meta-Analysis. 1817-1825.
Esther I. Schwarz, MD1; Frank Scherff, MD2; Sarah R. Haile, PhD3; Joerg Steier, PhD4; Malcolm Kohler, MD1,5


Current Knowledge/Study Rationale: Studies assessing the effect of continuous positive airway pressure (CPAP), adaptive servoventilation (ASV) or nocturnal oxygen on left ventricular ejection fraction (LVEF) in patients with heart failure and central sleep apnea/Cheyne-Stokes respiration (CSA/CSR) have come to contradictory findings. There is uncertainty on both type and benefit from treatment for this patient population.

Study Impact: This network meta-analysis combining direct evidence from within-trial comparisons and indirect evidence from comparisons across trials shows that both CPAP and ASV improve LVEF to the same extent in heart failure with CSA/CSR, and meta-regression has shown that treating CSA/CSR with positive pressure ventilation seems to be more effective in improving LVEF when systolic function is more impaired.

Predictors of Insomnia Severity Index Profiles in United States Veterans With Obstructive Sleep Apnea. 1827-1837.
Douglas M. Wallace, MD1,2; William K. Wohlgemuth, PhD2,3


Current Knowledge/Study Rationale: To our knowledge, prior studies about the evaluation of insomnia in individuals with obstructive sleep apnea (OSA) have not defined insomnia by empirically driven methods. In this study, we used latent profiles analysis to define Insomnia Severity Index (ISI) profiles and their predictors in veterans with OSA.

Study Impact: Five ISI profiles in United States veterans with OSA are described, with two profiles showing clinically significant comorbid insomnia (74% of sample) and three without insomnia: two with daytime impairments only and one asymptomatic group. OSA severity, patient age, and psychological comorbidities distinguished between ISI profiles. Future investigations on insomnia symptoms in individuals with OSA should consider examining ISI profiles as elevated ISI scores may be observed in those with OSA alone.

The Relationship Between Obstructive Sleep Apnea and Ruptured Intracranial Aneurysms. 1839-1848.
Oleg Y. Chernyshev, MD, PhD, FAHA1,*; Shyamal C. Bir, MD, PhD, FAHA2,*; Tanmoy K. Maiti, MD, MCh2; Devi Prasad Patra, MD, MCh2; Hai Sun, MD, PhD2; Bharat Guthikonda, MD2; Roger E. Kelley, MD1; Hugo Cuellar, MD2; Alireza Minagar, MD, FAAN; FANA1; Anil Nanda, MD, MPH, FACS2


Current Knowledge/Study Rationale: It is well known that obstructive sleep apnea (OSA) plays an important role in the progression and rupture of abdominal aortic aneurysms. However, the role of OSA in cerebral aneurysm is not well known.

Study Impact: OSA is a predictor of unfavorable outcome in patients with ruptured intracranial aneurysms. This study will bridge the fields of sleep medicine and neurosurgery to treat these complex patients with OSA and ruptured intracranial aneurysms.

Case Reports

Sleep-Related Rhythmic Movements and Sleep Terrors: A Possible Common Neurophysiological Background in a Preschool Boy. 1849-1852.
Elena Merli, MD1; Raffaele Ferri, MD2; Lourdes M. DelRosso, MD, FAASM3; Francesco Mignani, RPSGT4; Giuseppe Loddo, MD1; Annalisa Traverso, MD5; Federica Provini, MD, PhD1,4
Catathrenia and Treatment With Positive Airway Pressure in the Pediatric Population. 1853-1857.
Lacie Petitto, APRN, DNP1; Gulnur Com, MD2; Rithea Jackson, RPSGT1; Gresham Richter, MD2; Supriya Jambhekar, MD2

REM: A Publication for Residents and Fellows

Free Shift Work: A Perspective on Shift Work Disorder—Is Prevention the Answer?. 1863-1865.
Amit Gupta, MD; Thomas Roth, PhD; Timothy Roehrs, PhD; Christopher L. Drake, PhD

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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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