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Commentary

Free Why a Single Index to Measure Sleep Apnea Is Not Enough. 683-684.
Vishesh K. Kapur, MD, MPH, FAASM1; Lucas M. Donovan, MD, MS1,2
Free Ready for Primetime? Home Sleep Apnea Tests for Children. 685-686.
Rakesh Bhattacharjee, MD

Scientific Investigations

Free Effect of Varying Definitions of Hypopnea on the Diagnosis and Clinical Outcomes of Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis. 687-696.
Meghna P. Mansukhani, MD1; Bhanu Prakash Kolla, MD1,2; Zhen Wang, PhD3; Timothy I. Morgenthaler, MD1,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Although the American Academy of Sleep Medicine recommended using a new hypopnea definition in 2012, most sleep centers are still using the 2007 “recommended” (4% desaturation) criteria due to insurance reimbursement requirements. To facilitate understanding in clinical and research settings, it would be important to know how the differing definitions affect estimates of disease severity or prevalence.

Study Impact: In this systematic review, we examined 33 studies that directly compared different hypopnea criteria and conducted a meta-analysis comparing the diagnostic performance of the 2012 and 2007 “recommended” criteria. Clinical outcomes associated with the different hypopnea definitions are reviewed, but this area needs further study.

Free Prevalence and Sources of Errors in Positive Airway Pressure Therapy Provisioning. 697-704.
Cinthya Pena Orbea, MD1; Kara L. Dupuy-McCauley, MD2; Timothy I. Morgenthaler, MD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: The process of providing PAP therapy to patients with sleep- disordered breathing provides opportunities for error during prescribing and during device setup by durable medical equipment providers. Currently, no studies have investigated the frequency and characteristics of errors that occur during the provisioning process.

Study Impact: The overall PAP provisioning error rate was 8%, with errors most commonly occurring during setup. These data suggest a need for enhanced quality control in order to reduce errors and enhance patient safety and possibly treatment effectiveness.

The STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea in Pregnancy. 705-710.
Fiona Pearson, MBBS1; Alan M. Batterham, PhD2; Sean Cope, MBChB1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Undiagnosed obstructive sleep apnea in pregnancy can result in maternal and neonatal complications. In this study we evaluated the use of the STOP-Bang questionnaire to predict OSA in women with class III obesity during their second trimester of pregnancy. We also examined whether any individual components of the STOP-Bang questionnaire could be used as an alternative screening tool.

Study Impact: This study suggests that the STOP-Bang questionnaire can be used as a screening tool for OSA in pregnant women with class III obesity during the second trimester of pregnancy. Loud and frequent snoring alone is also a good predictor of OSA in this population.

Effects of Two-Week Sleep Extension on Glucose Metabolism in Chronically Sleep-Deprived Individuals. 711-718.
Apichart So-ngern, MD1; Naricha Chirakalwasan, MD2,3; Sunee Saetung, RN4; Suwannee Chanprasertyothin, MSc5; Ammarin Thakkinstian, PhD6; Sirimon Reutrakul, MD4,7

BRIEF SUMMARY

Current Knowledge/Study Rationale: Insufficient sleep has been linked to insulin resistance in experimental sleep restriction studies, and to incident diabetes in epidemiological studies. Scant data exist regarding the benefit of sleep extension in habitual short sleepers.

Study Impact: Sleep extension in habitual short sleepers is feasible, but more effective means are needed to help these individuals reach a physiologically meaningful amount of sleep. Glucose metabolism improved only in those who could sleep more than 6 h/night as measured objectively during sleep extension, suggesting that a critical amount of sleep is needed to benefit metabolic health.

Sleep Complaints and Sleep Quality in Spinal Cord Injury: A Web-Based Survey. 719-724.
Shirin Shafazand, MD, MS1; Kim D. Anderson, PhD2; Mark S. Nash, PhD2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Spinal cord injury (SCI) is universally recognized as a catastrophic disability affecting every aspect of life. Sleep disturbances have an important effect on quality of life. The aim of this study was to determine sleep quality, prevalence of excessive daytime sleepiness, insomnia symptoms, symptoms of restless legs, and sleep apnea risk in participants with SCI.

Study Impact: This study increases awareness that insomnia symptoms, sleep apnea, poor sleep quality, and excessive daytime sleepiness are common in individuals with chronic SCI and need to be diagnosed and addressed accordingly.

Comparison of Sleep Patterns in Vietnam Veterans With and Without Posttraumatic Stress Disorder Using Wrist Actigraphy. 725-732.
Rebecca Theal, BSc (Hons)1,2; Sarah McLeay, BSc (Hons), PhD1,2; Sarah Gleeson, MBBS, FRACP3,4; Fraser Lowrie, BAppSc, GradDipSSC3; Robyn O'Sullivan, MBBS, FRACP3,4; on behalf of the PTSD Initiative*

BRIEF SUMMARY

Current Knowledge/Study Rationale: Limited studies have used actigraphy to examine objective sleep patterns in veterans with posttraumatic stress disorder (PTSD). This study aimed to compare sleep patterns in Australian Vietnam veterans with and without PTSD using wrist actigraphy and sleep diaries to better understand the relationship between actual sleep and PTSD.

Study Impact: Compared to trauma-exposed controls, veterans with PTSD had reduced sleep latency, significantly increased overall within-individual variability in several sleep parameters, and increased sleep perception discrepancies. Further evaluation of extended sleep patterns by actigraphy in Vietnam veterans with PTSD is warranted.

Validation of the MediByte Portable Monitor for the Diagnosis of Sleep Apnea in Pediatric Patients. 733-742.
Ahmed I. Masoud, BDS, MS, PhD1; Pallavi P. Patwari, MD2,3; Pranshu A. Adavadkar, MD2; Henry Arantes, RPSGT2,3; Chang Park, PhD4; David. W. Carley, PhD4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) afflicts millions of children and leads to disrupted sleep as well as cognitive, behavioral, and developmental disturbances. In-laboratory polysomnography (PSG) is the standard test for diagnosing OSA. In pediatric patients, because of limited availability and access to PSG, there can be significant delays in the diagnosis and management of OSA. This highlights the urgent need for alternative diagnostic methods validated for use in pediatric patients.

Study Impact: This is the first study to systematically evaluate the MediByte, a portable sleep monitor, in relation to PSG in pediatric patients. Using portable sleep monitors may improve early detection and intervention for pediatric OSA, which can minimize progressive associated comorbidities.

Improvement of Parasomnias After Treatment of Restless Leg Syndrome/Periodic Limb Movement Disorder in Children. 743-748.
Neepa Gurbani, DO1,2; Thomas J. Dye, MD1,2,3; Kyle Dougherty, MD4; Sejal Jain, MD5; Paul S. Horn2,3; Narong Simakajornboon, MD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Non-rapid eye movement (NREM) sleep parasomnias have been reported to occur in children with restless leg syndrome (RLS)/periodic limb movement disorder (PLMD). Our literature review confirms that there are limited published data on the effect of treatment of RLS/PLMD with oral iron therapy on parasomnias in children.

Study Impact: This study confirms results of previous studies that have suggested the RLS/PLMD may precipitate NREM sleep parasomnias in children. In addition, the results of this study suggest that treatment of RLS/PLMD with oral iron therapy may help to improve parasomnias.

Obstructive Sleep Apnea, Sleepiness, and Glycemic Control in Type 2 Diabetes. 749-755.
R. Nisha Aurora, MD, MHS1; Naresh M. Punjabi, MD, PhD2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleepiness is a common symptom in people with type 2 diabetes mellitus as well as obstructive sleep apnea (OSA), but the association between self-reported sleepiness and glycemic control in persons with type 2 diabetes and OSA is not well described. The objective of the current study was to characterize the association between self-reported sleepiness and glycemic control in participants with both type 2 diabetes and moderate to severe OSA.

Study Impact: The findings from the current investigation demonstrate that glycemic control, as determined by hemoglobin A1c, is associated self-reported sleepiness in men who have a body mass index < 35 kg/m2. Sex and body habitus should be considered as potential effect modifiers when examining metabolic outcomes in the setting of OSA treatment.

Randomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans. 757-767.
Gerlinde C. Harb, PhD1; Joan M. Cook, PhD2; Andrea J. Phelps, PhD3; Philip R. Gehrman, PhD1,4; David Forbes, PhD3; Russell Localio, PhD4; Ilan Harpaz-Rotem, PhD2; Ruben C. Gur, PhD4; Richard J. Ross, MD, PhD1,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Imagery rehearsal (IR), the American Academy of Sleep Medicine-recommended therapy for posttraumatic stress disorder (PTSD)-associated nightmares, has been combined with components of cognitive behavioral therapy for insomnia (CBT-I) in many treatment protocols. The main aim of this dismantling study was to determine whether IR was essential to the efficacy of a treatment combining IR and CBT-I in reducing nightmare frequency and distress in military veterans with combat-related PTSD.

Study Impact: In male and female military veterans with PTSD and recurrent nightmares, the addition of IR to CBT-I did not, overall, result in greater treatment gains compared to CBT-I alone. However, adding IR may benefit veterans with lower nightmare severity and female veterans in particular.

Sleep Medicine Pearls

Sudden Improvement in PAP Download Indices Without Treatment Change. 791-793.
Susheela Hadigal, MD1; Surina Sharma, MD1; Mary H. Wagner, MD2; Scott Ryals, MD1; Richard B. Berry, MD1

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2017 Impact Factor: 3.396
5-Year Impact Factor: 4.216
2017 Journal Citation ReportsĀ®
(Clarivate Analytics, 2018)

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