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Accepted Papers

Scientific Investigations

The Effect of Sleeping Environment and Sleeping Location Change on Positive Airway Pressure Adherence. 1645-1652.
Han Yu S. Liou, MD1; Vishesh K. Kapur, MD, MPH2; Flavia Consens, MD3; Martha E. Billings, MD, MSc2


Current Knowledge/Study Rationale: Poor adherence undermines the effectiveness of positive airway pressure (PAP) therapy for sleep apnea, and has been associated with factors such as race/ethnicity and neighborhood socioeconomic status (SES). This study investigated home environmental factors as potential barriers to PAP adherence and explored whether they differed by SES.

Study Impact: Frequency of change in sleeping location, independent of SES, was found to be associated with PAP adherence. This novel finding has implications for treatment outcomes and physician-patient dialogue.

Effects of Increased Pharyngeal Tissue Mass Due to Fluid Accumulation in the Neck on the Acoustic Features of Snoring Sounds in Men. 1653-1660.
Shumit Saha, MSc1,2,5; Zahra Moussavi, PhD1; Peyman Hadi, MSc3; T. Douglas Bradley, MD2,4; Azadeh Yadollahi, PhD2,5


Current Knowledge/Study Rationale: Increased pharyngeal tissue mass, either by increased pharyngeal fat or fluid, can narrow the upper airway and worsen the severity of obstructive sleep apnea. Narrowing of the upper airway can cause vibrations in the pharyngeal tissue and induce snoring. We aim to investigate the effects of increased pharyngeal tissue mass on the acoustic features of snoring sounds.

Study Impact: Increased pharyngeal tissue mass caused by increased fluid was inversely correlated with the spectral centroid of snoring sounds. Our results have demonstrated the potential application of the spectral centroid of snoring sounds to access the variations of the pharyngeal tissue mass.

Breathing Irregularity Is Independently Associated With the Severity of Obstructive Sleep Apnea in Patients With Multiple System Atrophy. 1661-1667.
Hideaki Nakayama, MD, PhD1,2; Satoshi Hokari, MD, PhD2; Yasuyoshi Ohshima, MD, PhD2; Takayuki Matsuto, MD, PhD3; Takayoshi Shimohata, MD, PhD4


Current Knowledge/Study Rationale: Patients with multiple system atrophy have a high frequency of sleep-disordered breathing, especially obstructive sleep apnea, even if they are lean. We assessed the relationship between obstructive sleep apnea and breathing instability in patients with multiple system atrophy.

Study Impact: Breathing irregularity occurs in patients with multiple system atrophy and is associated with the severity of obstructive sleep apnea. In patients with multiple system atrophy, breathing instability was more involved in the development of obstructive sleep apnea, compared to obesity.

Use of Sedative-Hypnotics and Mortality: A Population-Based Retrospective Cohort Study. 1669-1677.
Jae-Won Choi1; Joonki Lee2; Sun Jae Jung3,4; Aesun Shin, MD, PhD2; Yu Jin Lee, MD, PhD5


Current Knowledge/Study Rationale: Previous studies on the association of sedative-hypnotics with mortality risk have produced controversial results. Several studies found no significant associations between sedative-hypnotics and mortality risk, but others reported a high mortality risk associated with the use of these agents. This study was designed to produce a more accurate estimate of the mortality risks associated with sedativehypnotics use by analyzing data collected by the National Health Insurance Service over a long follow-up period, while controlling for the following confounding factors: sociodemographic characteristics, physical health, and psychiatric comorbidities.

Study Impact: Individuals prescribed 30 or more defined daily doses of zolpidem per year had a significantly higher risk of mortality than that of nonusers, with a clear dose-dependent relationship.

Defining the Core Components of a Clinical Review of People Using Continuous Positive Airway Pressure Therapy to Treat Obstructive Sleep Apnea: An International e-Delphi Study. 1679-1687.
Phyllis Murphie, RGN, MSc1,2; Stuart Little, MD1; Robin Paton, BN1; Brian McKinstry, MD, PhD3; Hilary Pinnock, MD, PhD2


Current Knowledge/Study Rationale: Current sleep medicine guidelines recommend regular review in individuals using continuous positive airway pressure (CPAP) and who have obstructive sleep apnea. However, they do not collectively define the core components and frequency of such a review. We aimed to achieve consensus on essential components and frequency of review.

Study Impact: This is the first study to provide an international consensus on the most important components that may be considered when reviewing people using CPAP therapy. Our findings may inform future guideline recommendations for reviewing individuals using CPAP.

Free Insufficient Sleep Duration Is Associated With Dietary Habits, Screen Time, and Obesity in Children. 1689-1696.
Konstantinos D. Tambalis, PhD1; Demosthenes B. Panagiotakos, PhD1; Glyceria Psarra, PhD1; Labros S. Sidossis, PhD1,2


Current Knowledge/Study Rationale: This study investigated the influence of a wide range of lifestyle characteristics on sleep duration in a large representative cohort of children and adolescents. Also, it is the first one conducted among Greek children and adolescents.

Study Impact: Insufficient sleep duration among children potentially constitutes an understated health issue in westernized societies. Taking into consideration these epidemiologic findings, the authorities should promote strategies emphasizing improved sleep duration.

Randomized Controlled Trial of Melatonin for Sleep Disturbance in Dravet Syndrome: The DREAMS Study. 1697-1704.
Kenneth A. Myers, MD, PhD1,2; Margot J. Davey, MBBS3; Michael Ching, PhD4; Colin Ellis, MD1; Bronwyn E. Grinton, BSc1; Annie Roten, BSc1; Paul A. Lightfoot, RN1; Ingrid E. Scheffer, MBBS, PhD1,5,6,7


Current Knowledge/Study Rationale: Sleep disturbance is common in Dravet syndrome and frequently affects quality of life for patients and their families. There are no established therapies for sleep disturbance in Dravet syndrome, and the nature of the sleep disturbance itself remains poorly characterized.

Study Impact: A subset of patients with Dravet syndrome reported dramatic clinical improvement in sleep initiation, maintenance, and quality of life when receiving melatonin. However, melatonin did not result in measurable overall improvements in total sleep or wakefulness after sleep onset. Although definitive evidence of clinical benefit for patients with Dravet syndrome and sleep disturbance was not shown, such individuals should nevertheless consider a trial of melatonin, as some individuals appear to derive dramatic benefits.

Physical Activity Following Positive Airway Pressure Treatment in Adults With and Without Obesity and With Moderate-Severe Obstructive Sleep Apnea. 1705-1715.
Yuan Feng, MD, PhD1,2; David Maislin, BS2; Brendan T. Keenan, MS2; Thorarinn Gislason, MD3,4; Erna S. Arnardottir, PhD3,4; Bryndis Benediktsdottir, MD3,4; Julio A. Chirinos, MD, PhD2,5; Raymond R. Townsend, MD2,5; Bethany Staley, RPSGT2; Francis M. Pack, RN, CCRC2,5; Andrea Sifferman, MPH2; Allan I. Pack, MBChB, PhD2,5; Samuel T. Kuna, MD2,5,6


Current Knowledge/Study Rationale: Previous studies report that body weight of individuals with obstructive sleep apnea (OSA) increases following positive airway pressure treatment. Physical activity, a factor influencing body weight, is reported to be decreased in adults with obesity and adults with untreated OSA.

Study Impact: We found that physical activity was generally lower in participants with OSA and with obesity, compared to those without obesity, prior to positive airway pressure treatment. Following 4 months of successful treatment, physical activity increased significantly in participants without obesity and with OSA. The results indicate that treatment of OSA is not associated with a change in PA in adults with obesity and with OSA. The findings help to explain the absence of weight loss in patients with OSA on PAP treatment.

Accuracy and Reliability of Internet Resources Providing Information on Obstructive Sleep Apnea. 1717-1723.
Jongmin Lee, MD1; Woo Ho Ban, MD2; Hyun Kyung Park, MS3; Eunbyeol Na, BS3; Sug Kyung Kim, MS3; Hyeon Hui Kang, MD4; Sang Haak Lee, MD, PhD4


Current Knowledge/Study Rationale: Patients generally use the internet as a resource for health information. However, no study has evaluated the content and quality of online information on obstructive sleep apnea (OSA).

Study Impact: The results of this study demonstrate that websites related to OSA are often incomplete and inaccurate, and the low quality of online information about this condition is a significant barrier to patient education. This study highlights the need to ensure the accuracy and quality of online health information concerning OSA.

Prevalence of Sleep Disorders in Adults With Down Syndrome: A Comparative Study of Self-Reported, Actigraphic, and Polysomnographic Findings. 1725-1733.
Sandra Giménez, MD, PhD1,2,3,4; Laura Videla, MSc5; Sergio Romero, PhD6,7; Bessy Benejam, MSc5; Susana Clos, MSc2,3; Susana Fernández, MD5; Maribel Martínez2; Maria Carmona-Iragui, MD, PhD5,8,9; Rosa M. Antonijoan, MD, PhD2,3; Mercedes Mayos, MD, PhD1,10; Ana Fortuna, MD, PhD1; Patricia Peñacoba, MD1; Vicente Plaza, MD, PhD1,10; Ricardo S. Osorio, MD11; Ram A. Sharma11; Ignasi Bardés, MD5; Anne-Sophie Rebillat, MD12; Alberto Lleó, MD, PhD8,9; Rafael Blesa, MD, PhD8,9; Sebastian Videla, MD5,13; Juan Fortea, MD, PhD5,8,9


Current Knowledge/Study Rationale: The few studies to date on sleep disorders in adults with Down syndrome (DS) are mainly descriptive, based on self-reported measures only, and performed in small samples. Objective polysomnography and actigraphy studies in this setting are therefore lacking. This study determined the prevalence of sleep disorders in adults with DS using both self-reported and objective sleep measures.

Study Impact: This is an objective, community-based sleep study conducted in a large sample of adults with DS. Although the participants were not referred for sleep disorders, we observed a high prevalence of sleep disruption, obstructive sleep apnea, and napping during the day. These findings were not detected by current self-reported sleep measures or reported by caregivers.

Sleep Architecture Changed Without RBD in Patients With FTDP-17. 1735-1739.
Jia Liu, MD, PhD1; Shuqin Zhan, MD1; Chaoyang Huang, MD1; Yang Liu, MD1; Lin Liu, MD1; Liyong Wu, MD1,2; Yuping Wang, MD1


Current Knowledge/Study Rationale: Rapid eye movement sleep behavior disorder (RBD) and sleep architecture changes are common in neurodegenerative diseases. The features of sleep disorder in frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17) are still unknown and need to be investigated via polysomnography and hypnogram analysis.

Study Impact: Sleep architecture is affected even in the presymptomatic stage of FTDP-17, but RBD seems to be exempt from FTDP-17. Striatum and brainstem are the pathological lesions in FTDP-17 and may be involved in the pathophysiology of sleep alterations.

Validating the Watch-PAT for Diagnosing Obstructive Sleep Apnea in Adolescents. 1741-1747.
Ji Ho Choi, MD, PhD1; Bora Lee2; Jae Yong Lee, MD, PhD1; Hyun Jun Kim, MD, PhD3


Current Knowledge/Study Rationale: Many Watch-PAT validation studies compared to polysomnography have shown that the Watch-PAT may be useful in the diagnosis of adult obstructive sleep apnea (OSA). However, there have been few validation studies of the Watch-PAT for diagnosing OSA in adolescents.

Study Impact: The results of this prospective feasibility study suggest that the Watch-PAT may be a clinically reliable diagnostic test for OSA in adolescents.

Uvulopalatopharyngoplasty May Reduce the Incidence of Dementia Caused by Obstructive Sleep Apnea: National Insurance Service Survey 2007–2014. 1749-1755.
Jae Hoon Cho, MD, PhD1; Jeffrey D. Suh, MD2; Kyung-Do Han3; Jin-Hyung Jung3; Heung Man Lee, MD, PhD4


Current Knowledge/Study Rationale: This study sought to answer the following questions: Does obstructive sleep apnea increase the incidence of dementia? Does uvulopalatopharyngoplasty, the surgical treatment of apnea, reduce the incidence of dementia?

Study Impact: The incidence of Alzheimer disease, vascular dementia, and other types of dementia was higher among patients with obstructive sleep apnea, whereas it was similar to control levels among patients with obstructive sleep apnea who underwent uvulopalatopharyngoplasty. This finding suggests that dementia may be aggravated by obstructive sleep apnea, which could be prevented by uvulopalatopharyngoplasty.

Sleep Duration Is Associated With Testis Size in Healthy Young Men. 1757-1764.
Wenyi Zhang, MD1; Katarzyna Piotrowska, MD1; Bahman Chavoshan, MD2,3; Jeanne Wallace, MD3,4; Peter Y. Liu, MD, PhD1,3


Current Knowledge/Study Rationale: Sleep is important for neurobehavioral performance and cardiometabolic health. Increasingly it is becoming recognized that sleep may be important for reproductive health.

Study Impact: Here we show for the first time that sleep duration is related to testis size, which is a measure of male reproductive health and highly valued by men. The potential existence of an inverse U-shaped relationship suggests that there may be an optimal amount of sleep that maximizes testis volume and male reproductive potential.

Chronic Pain, Sleep, and Cognition in Older Adults With Insomnia: A Daily Multilevel Analysis. 1765-1772.
Ashley F. Curtis, PhD1; Jacob M. Williams, PhD2; Karin J.M. McCoy, PhD3; Christina S. McCrae, PhD1


Current Knowledge/Study Rationale: Both insomnia and chronic pain have been associated with worse cognitive performance. However, these conditions have not been examined together in older adults, and it is currently unclear how pain and sleep affect day to day cognitive performance.

Study Impact: Results suggest that the patterns of association between sleep, mood, daily pain, and next-day cognitive performance differ for older adults with and without a history of chronic pain. History of chronic pain should be considered in the management of cognitive disturbances in older adults with insomnia.

Sleep Apnea Evolution and Left Ventricular Recovery After Percutaneous Coronary Intervention for Myocardial Infarction. 1773-1781.
Li-Ling Tan, MBBS1; Jeanette Ting, MBBS1; Iswaree Balakrishnan, MB, Bch, BAO1; Aruni Seneviratna, MBBS1; Lingli Gong, MD2; Mark Y. Chan, MBBS, PhD1,2,3; E. Shyong Tai, MB, ChB, PhD2,4; A. Mark Richards, MD, PhD1,2,3,5; Bee-Choo Tai, PhD6; Lieng-Hsi Ling, MD1,2,3; Chi-Hang Lee, MD1,2,3


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) is a highly prevalent and under-diagnosed chronic disorder. Its reported prevalence has risen from below 10% to between 30% and 50% in the general population and to 66% in patients who present with ST-segment elevation myocardial infarction (STEMI). There are limited data on the evolution of apnea-hypopnea index (AHI) during recovery phase of STEMI.

Study Impact: In the 6 months after STEMI, alleviation of sleep apnea is associated with recovery of myocardial function and LV reverse remodeling. A decrease in AHI is correlated with an increase in left ventricular ejection fraction and a decrease in left ventricular end systolic volume. In addition, temporal evolution of sleep apnea phenotype was observed.

Review Articles

Free Smartphone Applications to Support Sleep Self-Management: Review and Evaluation. 1783-1790.
Yong K. Choi, MPH1; George Demiris, PhD2; Shih-Yin Lin, PhD, MPH, MM1; Sarah J. Iribarren, PhD, RN1; Carol A. Landis, PhD, RN1; Hilaire J. Thompson, PhD, RN, ARNP, CNRN, AGACNP-BC1; Susan M. McCurry, PhD1; Margaret M. Heitkemper, PhD, RN1; Teresa M. Ward, PhD, RN1

Emerging Technologies

An Evaluation of the NightOwl Home Sleep Apnea Testing System. 1791-1796.
Frederik Massie, MSc1; Duarte Mendes de Almeida, MSc1; Pauline Dreesen, MSc2; Inge Thijs, MSc, PhD2; Julie Vranken, MSc2; Susie Klerkx, MD3

Case Reports

Treatment of Comorbid Obstructive Sleep Apnea by Upper Airway Stimulation Results in Resolution of Debilitating Symptoms of Restless Legs Syndrome. 1797-1800.
Lukasz A. Myc, MD1; Ian T. Churnin, MD2; Mark J. Jameson, MD, PhD2; Eric M. Davis, MD1
Tachypnea Seen During Positive Airway Pressure Titration Studies: A Case Series of Four Patients. 1801-1804.
Amit Gupta, MD; Timothy Roehrs, PhD; Kenneth Moss, MD; Syed Jaffery, MD; Luisa Bazan, MD; Laura Spear, RPSGT; Larry Darnell, RPSGT; Thomas Roth, PhD
Two Cases of Sleep-Related Eating Disorder Responding Promptly to Low-Dose Sertraline Therapy. 1805-1808.
Ranji Varghese, MD1,2; Jorge Rey de Castro, MD3,4; Cesar Liendo, MD5; Carlos H. Schenck, MD1,2,6

Sleep Medicine Pearls

Roving Eye Movements. 1809-1810.
Marie N. Dibra, MD1; Richard B. Berry, MD, FAASM2,3; Mary H. Wagner, MD2,4; Scott M. Ryals, MD1

Letters to the Editor

Free Medical Cannabis and AASM Position Statement: The Don't Ask, Don't Tell Wishing Well. 1811.
Raquel M. Schears, MD, MPH, MBA, FACEP1,2; Anne C. Fischer, MD, PhD, MBA, FACS3; W. Andrew Hodge, MD, MBA, FACS3
Free Stop the Attack on Minnesota's Courageous Stance to Allow Its Residents to Sleep Safely. 1813.
Kevin M. Takakuwa, MD
Free Medical Cannabis, Synthetic Marijuana Extracts, and Obstructive Sleep Apnea. 1815-1816.
Kannan Ramar, MD1; Douglas B. Kirsch, MD2; Kelly A. Carden, MD3; Ilene M. Rosen, MD, MS4; Raman K. Malhotra, MD5
Free Twitter Discussions from a Respirology Journal Club: Role of Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Patients With Stroke. 1817.
Laura Budd, MD, FRCPC1; Matthew B. Stanbrook, MD, PhD2; Anju Anand, MD, FRCPC3
Free Obstructive Sleep Apnea and Stroke. 1819.
Anupama Gupta, MBBS, PhD; Garima Shukla, MD, DM
Free Can Sleep Problems Have a Negative Impact on Falls in Older People?. 1821-1822.
Priscila K. Morelhão, MSc1; Rafael Z. Pinto, PhD2; Cynthia Gobbi, MSc1; Sergio Tufik, PhD3; Monica L. Andersen, PhD3
Free Let's Get It Right This Time: Controversies and Now Redacted 2018 AHA Stroke Guidelines. 1823.
Gautam Ganguly, MD, FAAN, FAASM
Free PAP Treatment for Patients Who Have Had a Stroke. 1825.
Anupama Gupta, MBBS, PhD; Garima Shukla, MD, DM
Free Increasing the Visibility of Dental Sleep Disorders. 1827.
Frank Lobbezoo, DDS, PhD; Ghizlane Aarab, DDS, PhD

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2017 Impact Factor: 3.396
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