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Accepted Papers

Scientific Investigations

Prevalence of Pulmonary Hypertension in Pediatric Patients With Obstructive Sleep Apnea and a Cardiology Evaluation: A Retrospective Analysis. 1081-1087.
Antoinette T. Burns, DO, MPH1; Shana L. Hansen, MD1,2; Zachary S. Turner, MD2; James K. Aden3; Alexander B. Black, MD2; Daniel P. Hsu, MD1,2


Current Knowledge/Study Rationale: Pulmonary hypertension is considered to be a significant consequence of pediatric obstructive sleep apnea, yet the prevalence and risk factors for its development remain unknown. This paucity of data makes it difficult for clinicians to predict which patients would benefit from screening echocardiograms.

Study Impact: This is the largest study to use consistent polysomnogram and echocardiogram data to determine the low prevalence of pulmonary hypertension in pediatric obstructive sleep apnea. These findings may be helpful to improve screening programs, provide evidence for future guideline development, and aid future research on factors that may increase the risk of pulmonary hypertension in patients with obstructive sleep apnea.

Phenotypic Labelling Using Drug-Induced Sleep Endoscopy Improves Patient Selection for Mandibular Advancement Device Outcome: A Prospective Study. 1089-1099.
Sara Op de Beeck, MSc1,2,3; Marijke Dieltjens, PhD1,2,4; Annelies E. Verbruggen, MD, PhD1,2; Anneclaire V. Vroegop, MD, PhD1,2; Kristien Wouters, PhD5; Evert Hamans, MD, PhD1; Marc Willemen, MSc3; Johan Verbraecken, MD, PhD1,3,6; Wilfried A. De Backer, MD, PhD1; Paul H. Van de Heyning, MD, PhD1,2,3; Marc J. Braem, DDS, PhD1,4; Olivier M. Vanderveken, MD, PhD1,2,3


Current Knowledge/Study Rationale: Mandibular advancement device (MAD) treatment is a noninvasive therapy for obstructive sleep apnea (OSA) showing high patient adherence. Because treatment outcome is patient specific, improvement of upfront therapeutic response prediction would be advantageous. This study assessed the effect of drug-induced sleep endoscopy (DISE) phenotyping as identified during induced sleep, on MAD treatment outcome.

Study Impact: Our findings suggest that DISE is a promising tool to identify beneficial and adverse DISE phenotypes for upfront patient selection for MAD treatment. The results correspond to the next step in the development and application of a DISE phenotype-specific management of OSA.

On the Association Between Sleep Quality and Arterial Stiffness: A Population Study in Community-Dwelling Older Adults Living in Rural Ecuador (The Atahualpa Project). 1101-1106.
Oscar H. Del Brutto, MD1; Robertino M. Mera, MD, PhD2; Ernesto Peñaherrera, MD3; Aldo F. Costa, MD1; Rubén Peñaherrera, MD1; Pablo R. Castillo, MD4


Current Knowledge/Study Rationale: Nonbreathing sleep-related symptoms have been associated with atherosclerosis, although information is inconclusive and has not been adequately studied in remote rural settings. We aimed to assess this association in community-dwelling older adults living in rural Ecuador.

Study Impact: Multivariate models, fitted with sleep quality as the dependent variable, showed a significant association between the aortic pulse wave velocity (as a surrogate of atherosclerosis) and sleep quality (using the Pittsburgh Sleep Quality Index). This study shows a significant independent association between the aortic pulse wave velocity and poor sleep quality and provides more insights into the relevance of the effect of sleep disorders on cardiovascular diseases.

Sleep and Limb Movement Characteristics of Children With Atopic Dermatitis Coincidentally Undergoing Clinical Polysomnography. 1107-1113.
Alison D. Treister, BS, BSHS1,2; Heather Stefek, BA1,2; Daniela Grimaldi, MD, PhD3,4; Neil Rupani1,2; Phyllis Zee, MD, PhD3,4; Jeremy Yob, MS5; Stephen Sheldon, DO5; Anna B. Fishbein, MD2


Current Knowledge/Study Rationale: Atopic dermatitis (AD) is a prevalent, chronic, itchy skin condition that frequently results in sleep disturbance. Children undergoing polysomnography (PSG) may coincidentally be affected; however, characteristics of this population have never been evaluated in a retrospective chart review of patients undergoing PSG.

Study Impact: We found a population with relatively mild atopic dermatitis, yet still with increased wake after sleep onset and sleep fragmentation on PSG. Furthermore, given the frequent limb movements noted during sleep in atopic dermatitis, it should be considered when making the diagnosis of periodic limb movement disorder.

Supplemental Oxygen for Treatment of Infants With Obstructive Sleep Apnea. 1115-1123.
Justin Brockbank, MD1; Carmen Leon-Astudillo, MD2; Datian Che, MD3; Archwin Tanphaichitr, MD4; Guixia Huang, MS2; Jaime Tomko, MD2; Narong Simakajornboon, MD2


Current Knowledge/Study Rationale: Treatment of obstructive sleep apnea (OSA) in infants is challenging given the technical difficulties of administering continuous positive airway pressure to that population and given the invasive surgical treatments available. This study evaluates the effect of supplemental oxygen on sleep and respiratory parameters in infants with OSA.

Study Impact: Our study demonstrates that supplemental oxygen administration to infants with OSA reduces the frequency of obstructive respiratory events without having an adverse effect on ventilation. These findings suggest that low flow supplemental oxygen for infant OSA may be an effective treatment option.

Free Tracheal Sound Analysis Using a Deep Neural Network to Detect Sleep Apnea. 1125-1133.
Hiroshi Nakano, PhD1; Tomokazu Furukawa, PhD1; Takeshi Tanigawa, PhD2


Current Knowledge/Study Rationale: Portable monitors for home sleep apnea testing can underestimate sleep apnea severity because of inability for sleep/wake discrimination. Tracheal sound carries information about the breathing status and sleep/wake status that can be easily perceived visually if provided as a spectrogram.

Study Impact: We tried image analysis of tracheal sound spectrogram using a convolutional deep neural network (DNN). As a result, the DNN-based system could detect apnea/hypopnea events and discriminate sleep/wake status with reasonable accuracy from tracheal sound alone, indicating that this method may become a basis for an innovative sleep apnea testing device.

Free Severity of Desaturations Reflects OSA-Related Daytime Sleepiness Better Than AHI. 1135-1142.
Samu Kainulainen, MSc1,2,3; Juha Töyräs, PhD1,2,4; Arie Oksenberg, PhD5; Henri Korkalainen, MSc1,2; Sandra Sefa, MSc2; Antti Kulkas, PhD1,3; Timo Leppänen, PhD1,2


Current Knowledge/Study Rationale: Previous studies, where the effect of sleep apnea on daytime sleepiness has been investigated, have mainly focused on evaluating the effect of the number of arousals, apneas, hypopneas, or desaturations on daytime sleepiness. No previous studies have assessed the effect of the severity of individual apneas, hypopneas, and related desaturations on objectively measured daytime sleepiness.

Study Impact: The current findings indicate that the severity of apneas, hypopneas, and related desaturations has a stronger effect on daytime sleepiness than their number. This highlights the need for characterizing the severity of individual obstructive events and related desaturations when assessing the severity of obstructive sleep apnea.

Predictors of Intervention Interest Among Individuals With Short Sleep Duration. 1143-1148.
Elizabeth C. Adkins, MS1; Olivia DeYonker, MS2; Jennifer Duffecy, PhD3; Stephanie A. Hooker, PhD, MPH2; Kelly Glazer Baron, PhD, MPH, CBSM2


Current Knowledge/Study Rationale: Over one-third of United States adults sleep less than the recommended 7 hours of sleep per night, which increases risk for chronic diseases. However, little is known about short sleepers’ interest in interventions or the type of interventions preferred by this population.

Study Impact: Results of this survey demonstrate that participants with short sleep duration desire intervention and wearable technology interventions are preferred over face-to-face or telephone treatment. Participants with short sleep and sleep disturbance had the highest interest in wearable technology, despite the lack of existing validated sleep interventions using this technology.

Does Improvement of Low Serum Ferritin Improve Symptoms of Restless Legs Syndrome in a Cohort of Pediatric Patients?. 1149-1154.
Gerald M. Rosen, MD1; Sue Morrissette, RN1; Amy Larson, RN1; Pam Stading, RN1; Timothy L. Barnes, PhD, MPH2


Current Knowledge/Study Rationale: Iron deficiency is thought to be important in the pathophysiology of restless legs syndrome (RLS), but studies measuring the effects of iron supplementation on RLS symptoms have yielded mixed results. We assessed the relationship between RLS symptoms and serum ferritin in a cohort of pediatric patients and measured the effects of oral iron supplementation on ferritin levels and RLS symptoms.

Study Impact: We found that improving low serum ferritin levels modestly improved RLS symptoms in some children but did not lead to statistically significant improvement in children with definite RLS. Based on our findings, we recommend that treatment decisions regarding pharmacotherapy for RLS in children with iron deficiency and low serum ferritin levels should not be necessarily delayed, but warrant further study.

The Odds Ratio Product (An Objective Sleep Depth Measure): Normal Values, Repeatability, and Change With CPAP in Patients With OSA. 1155-1163.
Charles Gerhard Penner, MD, FRCPC1,2,3; Bethany Gerardy, RPSGT2; Rob Ryan, RRT3; Mark Williams, PhD2


Current Knowledge/Study Rationale: The current study is the first to investigate normal values for the newly described Odds Ratio Product in non-rapid eye movement sleep (ORPNR; a sleep depth scale based on the electroencephalogram signal) in healthy individuals in their home environment and finds that the normal ORPNR is ≤ 0.78. A second objective was to investigate whether ORPNR changes following treatment with CPAP in patients with OSA and finds that it decreases by a mean of 0.12.

Study Impact: The sleep depth scale is attractive in that it measures sleep depth in a single number rather than the complex way sleep is currently described in polysomnography.

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea. 1165-1172.
Clara H. Lee, BS1; Everett G. Seay, BS, RPSGT2,3; Benjamin K. Walters, MD4; Nicholas J. Scalzitti, MD4,5; Raj C. Dedhia, MD, MSCR2,3


Current Knowledge/Study Rationale: Hypoglossal nerve stimulation (HGNS) is a novel form of obstructive sleep apnea therapy, which may benefit patients with moderate-severe disease who do not tolerate positive airway pressure (PAP). However, the response rate remains suboptimal without clear predictors of success.

Study Impact: This is the first study to investigate therapeutic PAP level as a predictor of HGNS response. Although both low and high PAP groups experienced polysomnographic improvement with HGNS, the low PAP group achieved a larger apnea-hypopnea index reduction and higher response rate. Our findings suggest that therapeutic PAP levels may be used to identify optimal candidates for HGNS, with values less than 8 cm H2O predictive of success.

Effect of Yokukansan for the Treatment of Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Retrospective Analysis of Consecutive Patients. 1173-1178.
Kentaro Matsui, MD1,3; Taeko Sasai-Sakuma, PhD2,4,5; Jun Ishigooka, MD, PhD6; Katsuji Nishimura, MD, PhD1; Yuichi Inoue, MD, PhD2,3


Current Knowledge/Study Rationale: The effects of Yokukansan (YKS) on rapid eye movement sleep behavior disorder (RBD) were described in a previous case report. However, the effectiveness and safety of YKS have not been confirmed in a large population. To examine the treatment outcomes of YKS, we retrospectively reviewed the clinical outcomes of patients with RBD receiving YKS treatment using clinical records.

Study Impact: Although the responder rate for YKS combination therapy with other medication was only 21.1%, the responder rate for YKS monotherapy was 70.6% and no adverse events were observed, other than mild gastric distress in one case. These results suggest that YKS could be considered as a treatment option for patients with RBD.

Case Reports

Ticagrelor-Associated Shift From Obstructive to Central Sleep Apnea: A Case Report. 1179-1182.
Caroline Paboeuf, MD1; Pascaline Priou, MD, PhD1,2; Nicole Meslier, MD1,2; Frédéric Roulaud, MD3; Wojciech Trzepizur, MD, PhD1,2; Frédéric Gagnadoux, MD, PhD1,2

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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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