Earn CME
Accepted Papers


Free Fifteen Years of JCSM, Congratulations to Everyone!. 5-7.
Nancy A. Collop, MD1; Stuart F. Quan, MD2,3


Free OSA/COPD Overlap: Convergence on a Theme?. 9-10.
Jennifer J. Dorsch, MD1; Emerson M. Wickwire, PhD, FAASM2,3
Free The Value of Digital Insomnia Therapeutics: What We Know and What We Need To Know. 11-13.
Emerson M. Wickwire, PhD, FAASM

Scientific Investigations

Cerebral Hemodynamics in Sleep Apnea and Actigraphy-Determined Sleep Duration in a Sample of the Hispanic Community Health Study/Study of Latinos. 15-21.
Dixon Yang, MD1; Tatjana Rundek, MD, PhD1; Sanjay R. Patel, MD, MS2; Digna Cabral, BS1; Susan Redline, MD, MPH3; Fernando D. Testai, MD, PhD4; Jianwen Cai, PhD5; Douglas M. Wallace, MD1; Phyllis C. Zee, MD, PhD6; Alberto R. Ramos, MD, MS1


Current Knowledge/Study Rationale: Although obstructive sleep apnea is a known independent risk factor for stroke, the mechanisms explaining the risk factor are unclear, particularly in Hispanic/Latinos who have an increased risk of cerebrovascular disease compared to non-Hispanic whites. Therefore, this study sought to evaluate potential associations between obstructive sleep apnea and cerebral hemodynamics using sonography in a cohort of Hispanic/Latino adults with no known history of stroke or cardiovascular disease.

Study Impact: This study reports possible impaired cerebral hemodynamics in Hispanics/Latinos with obstructive sleep apnea or short sleep duration, suggesting possible association between obstructive sleep apnea and stroke risk. Further studies are needed to investigate potential pathophysiologic mediators in which obstructive sleep apnea confers cerebrovascular accident risk.

Screening for Obstructive Sleep Apnea in Commercial Drivers Using EKG-Derived Respiratory Power Index. 23-32.
M. Melanie Lyons, PhD, ACNP1; Jan F. Kraemer, Dipl-Inform2; Radha Dhingra, MD3; Brendan T. Keenan, MS1; Niels Wessel, PhD2; Martin Glos, PhD4; Thomas Penzel, PhD4; Indira Gurubhagavatula, MD, MPH1,5,6


Current Knowledge/Study Rationale: In commercial motor vehicle operators (CMVOs), obstructive sleep apnea (OSA) is often undiagnosed because testing using the gold-standard measure, in-laboratory polysomnography, is expensive, not easily accessible, and time consuming for long-haul drivers who are regularly on the road. However, 28% to 60% of CMVOs have been found to have OSA and ∼30% of known CMVO accidents have been related to OSA.

Study Impact: We describe an approach that shows promise in identifying CMVOs who have severe OSA—who are likely to be at risk for a sleepiness-related crash—by using the spectral qualities of electrocardiography with portable diagnostic ability and without requiring overnight in-laboratory polysomnography. Future studies should include larger cohorts of patients.

Correlation of the Epworth Sleepiness Scale and Sleep-Disordered Breathing in Men and Women. 33-38.
Melissa C. Lipford, MD1,2; Dietlind L. Wahner-Roedler, MD3; Gail A. Welsh, MD3; Jay Mandrekar, PhD4; Prabin Thapa4; Eric J. Olson, MD1,5


Current Knowledge/Study Rationale: Commonly used screening questionnaires such as the Epworth Sleepiness Scale (ESS) use presence of sleepiness as part of the clinical assessment for likelihood of sleep-disordered breathing (SDB). Women with SDB may have different symptoms and thus the condition could be missed with this type of screening tool.

Study Impact: Our study demonstrates that level of sleepiness as measured by the ESS is not associated with presence of SDB in women. A small association was seen only in women with severe SDB. Physiologic and clinical phenotype differences are present in women with SDB compared with men. Further understanding is necessary to develop SDB screening tools specifically validated for women.

Evaluation of Home Polysomnography Findings, Quality of Sleep, and Fatigue in Inflammatory Bowel Disease: A Case Series. 39-45.
Deise Luna Paixão, MD, MSc1; Dalva Poyares, MD, PhD2,3; Marta Sevilha de Paula3; Joselmo Willamys Duarte, MSc1; Paula Midori Castelo, DDS, PhD4; Orlando Ambrogini-Júnior, MD, PhD5; Sender Jankiel Miszputen, MD, PhD5; Celina Tizuko Fujiyama Oshima, PhD1,5; Jair Ribeiro Chagas, PhD2; Ana Paula Ribeiro Paiotti, PhD1,5


Current Knowledge/Study Rationale: Sleep disorders may be potential triggers for inflammatory bowel disease as the pathogenesis of the disease is not well understood. In an attempt to gain deeper understanding, we evaluated the sleep characteristics, fatigue symptoms, and cytokine levels in patients with inflammatory bowel disease during periods of active disease and remission.

Study Impact: While we found no significant difference in the home polysomnography characteristics between the patients with active disease and those in remission, the perception of the participants with inflammatory bowel disease showed significant effect on sleep quality and fatigue symptoms.

Symptoms During CPAP Therapy Are the Major Reason for Contacting the Sleep Unit Between Two Routine Contacts. 47-53.
Heidi Avellan-Hietanen, MD; Pirkko Brander, MD, PhD; Adel Bachour, MD, PhD


Current Knowledge/Study Rationale: There is no consensus for the frequency or the way CPAP therapy follow-up should be performed. The number of patients undergoing CPAP therapy is increasing and medical resources are restricted. An alternative follow-up program could be focused on the patients who benefit the most from follow-up.

Study Impact: We showed that patients with symptoms who are undergoing CPAP therapy contact our sleep clinic significantly more often than those without symptoms. Following only patients with symptoms on demand would be an alternative follow-up method.

A Longitudinal Study of Psychological Factors as Mediators of the Relationship Between Insomnia Symptoms and Suicidal Ideation Among Young Adults. 55-63.
Melanie A. Hom, MS1; Ian H. Stanley, MS1; Carol Chu, PhD2; Michelle M. Sanabria, BS3; Kirsten Christensen, BS1; Evan A. Albury1; Megan L. Rogers, MS1; Thomas E. Joiner, PhD1


Current Knowledge/Study Rationale: Prior studies have only utilized cross-sectional designs to evaluate psychological factors underlying the association between insomnia and suicidal ideation. This longitudinal study was designed to test various psychological factors as statistical mediators of the prospective relationship between insomnia and suicidal ideation.

Study Impact: Our findings suggest that it may be clinically useful to target disgust with others and the world in order to thwart the trajectory from insomnia to suicidal ideation.

Polysomnography Findings and Sleep Disorders in Children With Alternating Hemiplegia of Childhood. 65-70.
Sujay Kansagra, MD1; Ryan Ghusayni, MD1; Bassil Kherallah, MD1; Talha Gunduz, MD1; Melissa McLean, BS1; Lyndsey Prange, MSN, APRN, CPNP-PC1; Richard M. Kravitz, MD2; Mohamad A. Mikati, MD1


Current Knowledge/Study Rationale: Alternating hemiplegia of childhood is a rare neurologic disorder with multiple comorbidities that could potentially result in sleep disorders. However, at this time, little is known about sleep pathology in this disease.

Study Impact: Understanding the risks of sleep disordered breathing and other sleep-related clinical disturbances should allow for better screening and comprehensive care of children with alternating hemiplegia of childhood.

Poor Outcomes Among Patients With Chronic Obstructive Pulmonary Disease With Higher Risk for Undiagnosed Obstructive Sleep Apnea in the LOTT Cohort. 71-77.
Lucas M. Donovan, MD, MS1,2; Laura C. Feemster, MD, MS1,2; Edmunds M. Udris, MPH1; Matthew F. Griffith, MD1,2; Laura J. Spece, MD, MS1,2; Brian N. Palen, MD1,2; Ken He, MD1,2; Sairam Parthasarathy, MD3; Kingman P. Strohl, MD4; Vishesh K. Kapur, MD, MPH1,2; David H. Au, MD, MS1,2


Current Knowledge/Study Rationale: Among those with chronic obstructive pulmonary disease (COPD) and diagnosed obstructive sleep apnea (OSA), a lack of treatment for OSA is associated with poor outcomes. However, the consequences of unrecognized OSA among those with COPD is unclear.

Study Impact: The current study finds that most of those sampled with COPD (74%) were at intermediate to high risk of undiagnosed OSA based on modified STOP-BANG criteria, and these individuals were also found to have a greater risk of poor outcomes. The results indicate a potentially high burden of undiagnosed OSA among those with COPD, and further research will be needed to evaluate the effect of identification and treatment of OSA in this population.

Early Postoperative Actigraphy Poorly Predicts Hypoactive Delirium. 79-87.
Hannah R. Maybrier, BS1; C. Ryan King, MD, PhD1; Amanda E. Crawford1; Angela M. Mickle, MS1; Daniel A. Emmert, MD, PhD1,2; Troy S. Wildes, MD1; Michael S. Avidan, MBBCh1,2; Ben Julian A. Palanca, MD, PhD, MSc1,3


Current Knowledge/Study Rationale: Delirium is associated with alterations of sleep and psychomotor activity. Immobility and activity measures derived from wrist actigraphy in the early postoperative period have unknown utility for predicting delirium in high-risk patients.

Study Impact: Markers of activity and immobility had only weak discriminative capacity for concurrent delirium and poorly predicted those with subsequent delirium. These data suggest that actigraphy within the first 24 hours after surgery is unlikely to be useful for delirium prediction.

A Conditional Inference Tree Model for Predicting Sleep-Related Breathing Disorders in Patients With Chiari Malformation Type 1: Description and External Validation. 89-99.
Álex Ferré, MD1,2,3; María A. Poca, MD, PhD3,4; María Dolores de la Calzada, MD, PhD3; Dulce Moncho, MD, PhD1,3; Aintzane Urbizu, PhD5; Odile Romero, MD1,2,6; Gabriel Sampol, MD, PhD2,6,7; Juan Sahuquillo, MD, PhD3,4


Current Knowledge/Study Rationale: Sleep studies are not routinely considered in the workup of patients with Chiari malformation. However, evidence collected over the past decade shows that sleep disorders are highly prevalent in these patients. In the routine clinical workup for patients with Chiari malformation, clinicians should therefore identify those with a high likelihood of presenting clinically relevant sleep-related breathing disorders.

Study Impact: The current study proposes an easy algorithm than can facilitate the high pretest probability of sleep-related breathing disorders in patients with Chiari malformation to decide whether to recommend sleep study.

Long-Term Effects of an Unguided Online Cognitive Behavioral Therapy for Chronic Insomnia. 101-110.
Øystein Vedaa, PhD1,2,3; Susanne Hagatun, PhD3,4; Håvard Kallestad, PhD1,2; Ståle Pallesen, PhD5,6; Otto R.F. Smith, PhD3; Frances P. Thorndike, PhD7; Lee M. Ritterband, PhD8; Børge Sivertsen, PhD1,3,9


Current Knowledge/Study Rationale: Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) is efficacious as treatment for chronic insomnia. However, the long-term effectiveness of such treatment on sleep and daytime symptoms has received little attention in previous research. We investigated whether improvements attained during Internet CBT-I on sleep and daytime functioning were maintained 18 months after the intervention period.

Study Impact: Internet CBT-I led to improved sleep and reduced symptoms of fatigue and psychological distress 18 months after the intervention period. These results add to the growing evidence verifying the efficacy of sustained improvements after self-guided Internet-delivered treatment for chronic insomnia.

Free Mother Knows Best? Comparing Child Report and Parent Report of Sleep Parameters With Polysomnography. 111-117.
Daniel Combs, MD1,2,3; James L. Goodwin, PhD4; Stuart F. Quan, MD4,5; Wayne J. Morgan, MD1,4; Chiu-Hsieh Hsu, PhD6; Jamie O. Edgin, PhD7; Sairam Parthasarathy, MD2,3


Current Knowledge/Study Rationale: Parent report and child report of total sleep time and other sleep parameters is commonly used in research and clinical practice. The validity of parent report versus child report of sleep parameter compared to polysomnography has not been reported.

Study Impact: In general, parent report and child report agree equally with polysomnography. Both parents and children tend to overestimate total sleep time, sleep latency, and sleep efficiency. In cases with high disagreement between parent report and child report, child report appeared more accurate for total sleep time and sleep efficiency, whereas parent report was more accurate for sleep latency. These results suggest that parent report and child report of sleep parameters is generally equally valid, except in cases with high disagreement.

Effects of Adaptive Servoventilation Therapy for Central Sleep Apnea on Health Care Utilization and Mortality: A Population-Based Study. 119-128.
Meghna P. Mansukhani, MD, FAASM1; Bhanu Prakash Kolla, MD, MRPCPsych1,2; James M. Naessens, ScD3; Peter C. Gay, MD, FAASM1,4; Timothy I. Morgenthaler, MD, FAASM1,4


Current Knowledge/Study Rationale: Adaptive servoventilation (ASV) is a novel form of positive airway pressure therapy, designed to treat central sleep apnea (CSA). Prior studies demonstrate that treatment of obstructive sleep apnea is associated with decreased health care utilization.

Study Impact: This study is the first assessing the impact of ASV therapy on health care utilization in patients with CSA. In multivariate analysis, no significant change was noted in health care utilization. The comorbidity burden and mortality rate was high, reflecting the ill health of those with CSA in this population-based study.

Cognitive Behavioral Therapy for Insomnia Reduces Depression in Cancer Survivors. 129-137.
Anita R. Peoples, PhD, MPH1; Sheila N. Garland, PhD2; Wilfred R. Pigeon, PhD3; Michael L. Perlis, PhD4; Julie Ryan Wolf, PhD, MPH5; Kathi L. Heffner, PhD6; Karen M. Mustian, PhD, MPH7; Charles E. Heckler, PhD, MS7; Luke J. Peppone, PhD, MPH7; Charles S. Kamen, PhD, MPH7; Gary R. Morrow, PhD, MS7; Joseph A. Roscoe, PhD7


Current Knowledge/Study Rationale: Depression is a significant and persistent side effect of cancer and its treatment. Depression is strongly correlated with insomnia, allowing for the possibility that cognitive behavioral therapy for insomnia (CBT-I) may also reduce associated depression.

Study Impact: This study shows that in cancer survivors with insomnia, CBT-I has the potential to improve not only insomnia, but also comorbid depression through improvements in insomnia severity. In addition, this study highlights the importance of screening for insomnia in cancer survivors with depression and providing access to CBT-I as a treatment option.

Short Sleep Duration Is Associated With Increased Serum Homocysteine: Insights From a National Survey. 139-148.
Tien-Yu Chen, MD1,2,3,4; John W. Winkelman, MD, PhD5; Wei-Chung Mao, MD3,6; Chin-Bin Yeh, MD, PhD1,7; San-Yuan Huang, MD, PhD1,7; Tung-Wei Kao, MD2,8; Cheryl C.H. Yang, PhD3,4; Terry B.J. Kuo, MD, PhD3,4,9; Wei-Liang Chen, MD, PhD2,7,8


Current Knowledge/Study Rationale: Both short sleep duration and increased serum homocysteine levels are associated with cardiovascular events; however, direct evidence of the relationship between sleep duration and serum homocysteine levels is limited. This study used a national database with large sample size, stratified by sex, obesity, and race to assess the association between sleep duration and serum homocysteine levels.

Study Impact: The current study demonstrates that an extremely short sleep duration (≤ 5 hours) is significantly associated with increased serum homocysteine levels. Notably, when relevant covariates were considered, the association between short sleep duration (≤ 5 hours) and higher serum homocysteine levels was true for women, individuals with obesity (body mass index ≥ 30 kg/m2), and only in non-Hispanic whites, which highlights the potential vulnerability of certain groups.

Case Reports

An Unusual Case of Noisy Breathing in an Infant. 149-152.
Carmen Leon-Astudillo, MD1; Gi Soo Lee, MD, EdM2; Umakanth Katwa, MD1
Occurrence of Stridor During Sleep in a Patient With Spinocerebellar Ataxia Type 17. 153-155.
Kyeong Joon Kim, MD1; Jong-Min Kim, MD2; Yun Jung Bae, MD3; In-Young Yoon, MD4; Yoo Sung Song, MD5; Sang Eun Kim, MD5
Sleep-Related Rhythmic Movement Disorder in Triplets: Evidence for Genetic Predisposition?. 157-158.
Helen K. Hayward-Koennecke, MD; Esther Werth, PhD; Philipp O. Valko, MD; Christian R. Baumann, MD; Rositsa Poryazova, MD

Letters to the Editor

Free Will Consumer Sleep Technologies Change the Way We Practice Sleep Medicine?. 159-161.
Nathaniel F. Watson, MD, MSc1,2,3; Colin Lawlor3; Roy J.E.M. Raymann, PhD, MSc3
Free Consumer Sleep Technologies: How to Balance the Promises of New Technology with Evidence-Based Medicine and Clinical Guidelines. 163-165.
Seema Khosla, MD1; Maryann C. Deak, MD2; Dominic Gault, MD3; Cathy A. Goldstein, MD4; Dennis Hwang, MD5; Younghoon Kwon, MD6; Daniel O'Hearn, MD7; Sharon Schutte-Rodin, MD; Michael Yurcheshen, MD8; Douglas B. Kirsch, MD9

REM: A Publication for Residents and Fellows

Free Media Review: Clinical Atlas of Polysomnography. 167.
Jenie George, MD1; Jennifer L. Marsella, MD2
Free Media Review: Sleepyhead: The Neuroscience of a Good Night's Rest by Henry Nicholls. 169.
Richard Byrne, MD; Jennifer L. Marsella, MD
Free Images: Drug-Induced Sleep Endoscopy: An Investigative Tool for Mechanisms of PAP Failure. 171-172.
Clara H. Lee, BS1; Everett G. Seay, BS, RPSGT2,3; Raj C. Dedhia, MD, MSCR2,3

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2017 Impact Factor: 3.396
5-Year Impact Factor: 4.216
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