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Accepted Papers


Free Standardized Reporting for Hypoglossal Nerve Stimulation Outcomes. 1835-1836.
Raj C. Dedhia, MD, MSCR1,2; B. Tucker Woodson, MD3

Scientific Investigations

Free Untreated Obstructive Sleep Apnea Is Associated With Myocardial Injury Independent of Blood Pressure Control in Hypertension. 1841-1847.
Macy M.S. Lui, MBBS1; H.F. Tse, MD, PhD2; Judith C.W. Mak, PhD1; David C.L. Lam, MD, PhD1; Carmen W.S. Chan, MBBS2; Peony W.C. Chong, MN1; Mary S.M. Ip, MD1


Current Knowledge/Study Rationale: Individuals with hypertension requiring multiple medications have a high cardiovascular risk, and they commonly have concomitant obstructive sleep apnea (OSA). Evidence supporting the association between OSA and myocardial damage in difficult-to-control hypertension is lacking.

Study Impact: This is the first study substantiating that low-grade myocardial injury is present in patients with OSA and difficult-to-control hypertension, irrespective of blood pressure control with medications. Frequent intermittent hypoxia, aging, and loss of nocturnal dip in systolic blood pressure were predictors of higher high-sensitivity troponin level. The current study affirms the high prevalence of severe OSA in difficult-to-control hypertension, and emphasizes that in addition to controlling blood pressure with medications, it is also necessary to target the control of OSA to mitigate cardiovascular risk.

A New Single-Item Sleep Quality Scale: Results of Psychometric Evaluation in Patients With Chronic Primary Insomnia and Depression. 1849-1857.
Ellen Snyder, PhD; Bing Cai, PhD; Carla DeMuro, MS; Mary F. Morrison, MD, MS; William Ball, MD, PhD


Current Knowledge/Study Rationale: Currently available assessments of sleep quality are lengthy or require frequent administration, which may be burdensome for participants in non-sleep–related clinical trials. The single-item sleep quality scale was developed and validated to offer a practical alternative for sleep quality assessment in clinical settings.

Study Impact: The favorable measurement characteristics of the sleep quality scale demonstrated in this study (ie, strong concurrent criterion; convergent, divergent, and known-groups validity; effect size; and adequate test-retest reliability) support the reliability and validity of the sleep data derived from this sleep questionnaire and warrant its use as a sleep quality measure for assessment and treatment monitoring in clinical trials and clinical care.

Oximetry Monitoring Recommended During PAP Initiation for Sleep Apnea in Patients With Obesity or Nocturnal Hypoxemia. 1859-1863.
Victor Koivumäki, MD1; Paula Maasilta, MD, PhD2; Adel Bachour, MD, PhD2


Current Knowledge/Study Rationale: Polysomnography represents the gold standard for positive airway pressure (PAP) therapy initiation. This practice is rare and more often the therapy control relies on the self-monitoring of the PAP device.

Study Impact: Oximetry should be part of PAP initiation among patients with obesity and those with low oxygen values during sleep because relying only on PAP device monitoring is unreliable. Oximetry monitoring identified patients who need additional examination to ensure a good PAP therapy response.

Increased Sleep Disturbances and Pain in Veterans With Comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder. 1865-1878.
Nadir M. Balba, MA1,2; Jonathan E. Elliott, PhD1,3; Kris B. Weymann, PhD, RN1,4; Ryan A. Opel, BSc1; Joseph W. Duke, PhD5; Barry S. Oken, MD, PhD2,3; Benjamin J. Morasco, PhD6,7; Mary M. Heinricher, PhD1,2,8; Miranda M. Lim, MD, PhD1,2,3,9,10


Current Knowledge/Study Rationale: Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common in Veterans and are independently associated with sleep disturbances and pain, both of which can exacerbate the other and impede rehabilitation. Understanding the relationship between TBI, PTSD, sleep, and pain will help improve treatment and rehabilitation in this vulnerable population.

Study Impact: This study demonstrates that Veterans with PTSD and with both PTSD and TBI experience more sleep disturbances, but those with TBI and PTSD report significantly greater current pain intensity. These data help in the limited understanding of how Veterans with comorbid TBI and PTSD differ from Veterans with only TBI or PTSD and contribute to the development of improved therapeutic approaches for Veterans in this vulnerable population.

Awake Multimodal Phenotyping for Prediction of Oral Appliance Treatment Outcome. 1879-1887.
Kate Sutherland, PhD1,2,3; Andrew S.L. Chan, MD, PhD1,2; Joachim Ngiam, BDS(Hons), MSD, MPhil1,2; Oyku Dalci, PhD4; M. Ali Darendeliler, PhD4; Peter A. Cistulli, MD, PhD1,2,3


Current Knowledge/Study Rationale: Predicting treatment response to oral appliance therapy in patients with sleep apnea has been an ongoing challenge and robust prediction methods are needed. A variety of simple awake prediction tests have been proposed but not successfully validated. This study aimed to combine multiple simple phenotypic assessments into a single prediction model.

Study Impact: Our derived prediction models suggest that combined awake phenotyping tests do not improve prediction compared to clinical characteristics alone. This work suggests that robust prediction of oral appliance treatment response may need to include information from sleep assessments.

Predictors of Obstructive Sleep Apnea on a Home Sleep Apnea Test After a Negative Attended Polysomnography. 1889-1894.
Katie Lipatov, MD; Adam Hayek, DO; Shekhar Ghamande, MD; Carl Boethel, MD; Wencong Chen, PhD; Shirley Jones, MD


Current Knowledge/Study Rationale: A home sleep apnea test (HSAT) can be an effective tool for the diagnosis of obstructive sleep apnea (OSA); however, its use in repeat testing after a negative comprehensive in-laboratory test with polysomnography (PSG) has not been previously studied. Understanding factors associated with the diagnosis of OSA on HSAT after a negative PSG will help improve clinical judgement and decrease cost.

Study Impact: This study suggests that the use of an HSAT to repeat testing in older patients with a history of hypertension may be a reasonable option compared to repeat in-laboratory PSG. A prospective study is needed to further evaluate the use of HSAT after negative PSG.

Caregiver and Staff Perceptions of Disruptions to Pediatric Inpatient Sleep. 1895-1902.
Leah B. Peirce1; Nicola M. Orlov, MD1,2; Amarachi I. Erondu1; Samantha L. Anderson3; Michael Chamberlain1; David Gozal, MD, MBA4; Vineet M. Arora, MD, MAPP1,3


Current Knowledge/Study Rationale: Although children experience disrupted sleep in the hospital, there is a paucity of studies examining the causes of sleep disruption in hospitalized children from the perspectives of both caregivers and hospital staff. This study extends previous findings on caregiver-reported in-hospital sleep disruptions by also examining the perspectives of nurses and physicians, important stakeholders in improving pediatric sleep in the hospital.

Study Impact: The findings from this study suggest that medical interventions are the most prevalent disruptors as reported by caregivers, revealing a possible target for future pediatric sleep improvement efforts. However, the perspectives of nurses and physicians varied drastically from those of caregivers, highlighting the need for education of staff regarding top disruptors to pediatric sleep in the hospital.

Free Outdoor Artificial Nighttime Light and Use of Hypnotic Medications in Older Adults: A Population-Based Cohort Study. 1903-1910.
Jin-young Min, PhD1; Kyoung-bok Min, PhD2


Current Knowledge/Study Rationale: Few studies suggest that excessive nighttime light exposure, whether from indoor or outdoor sources, has deleterious effects on sleep. Whether nighttime light pollution exposure seriously affects sleep health remains unclear.

Study Impact: Prescription days and daily defined doses of all hypnotic drugs and certain hypotonic drugs were significantly higher in individuals living in areas with higher outdoor artificial nighttime light than those living in areas with lower artificial nighttime light. Efforts to define and minimize the adverse effects of light pollution on human health are important.

Sleep Discrepancy in Patients With Comorbid Fibromyalgia and Insomnia: Demographic, Behavioral, and Clinical Correlates. 1911-1919.
Wai Sze Chan, PhD1; Meredith P. Levsen, PhD2; Svyatoslav Puyat, MA2; Michael E. Robinson, PhD3; Roland Staud, MD4; Richard B. Berry, MD, FAASM4; Christina S. McCrae, PhD2


Current Knowledge/Study Rationale: Some patients with insomnia perceive their sleep more negatively than it is when objectively measured, a phenomenon linked to maladaptive beliefs about sleep and the maintenance of insomnia. Recent research has shown that patients with insomnia and comorbid medical conditions do not seem to have consistent negative sleep discrepancy.

Study Impact: Findings of this study show that adults with comorbid insomnia and fibromyalgia did not have consistent negative sleep discrepancy. Sleep discrepancy varied to a large extent from night to night, but the averages of diary and actigraphy estimates over 14 days were fairly concordant. Taking prescribed opioid medications was associated with greater night-to-night variability in the discrepancies of wake after sleep onset and total sleep time.

Two Independent Predictors of Nightmares in Posttraumatic Stress Disorder. 1921-1927.
Katherine E. Miller, PhD1,2; Andrea L. Jamison, PhD1; Sasha Gala, JD1; Steven H. Woodward, PhD1


Current Knowledge/Study Rationale: No previous studies have examined self-reported and objective predictors of trauma-related disturbed dreaming over many nights within persons in whom posttraumatic stress disorder has been diagnosed. The current study used two intensive, naturalistic data acquisition methods, daily ecological momentary assessments, and nightly mattress actigraphy data, along with estimation of sleep-disordered breathing.

Study Impact: These data revealed that elevated respiratory event index and lower prior-night sleep respiratory sinus arrhythmia independently predicted disturbed dreaming reports. These results provide new insights into the dynamic autonomic concomitants of disturbed dreaming, while also confirming prior associations with sleep-disordered breathing..

Risk of Cardiovascular Disease Related to Smoking Is Greater Among Women With Sleep-Disordered Breathing. 1929-1935.
Lucas M. Donovan, MD, MS1,2; Laura C. Feemster, MD, MS1,2; Martha E. Billings, MD, MS2; Laura J. Spece, MD, MS1,2; Matthew F. Griffith, MD1,2; Peter J. Rise, MS1; Elizabeth C. Parsons, MD, MS1,2; Brian N. Palen, MD1,2; Daniel J. O'Hearn, MD1,2; Susan Redline, MD, MPH3; David H. Au, MD, MS1,2; Vishesh K. Kapur, MD, MPH2


Current Knowledge/Study Rationale: Small cross-sectional studies suggest effect modification between smoking and sleep-disordered breathing in markers of cardiovascular risk, but it is unclear whether smoking augments the risk of clinically significant cardiovascular disease posed by sleep-disordered breathing.

Study Impact: The current study finds evidence that smoking increases the risks of incident cardiovascular disease associated with moderate to severe sleep-disordered breathing among women but not men in the Sleep Heart Health Study. These results indicate that smoking and sleep-disordered breathing may interact to increase risks of cardiovascular events, such as heart attacks and strokes, among women. This subgroup may benefit from further research to evaluate the mechanisms of this interaction.

Review Articles

Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis. 1937-1947.
Lie Åslund, MSc1,4; Filip Arnberg, PhD1,2; Marie Kanstrup, PhD1,3; Mats Lekander1,4

Case Reports

Polysomnographic Sleep Disturbances Due to High-Dose Zolpidem Use: A Case Report. 1949-1952.
Hayato Ohshima, MD; Nozomu Kotorii, MD, PhD; Minoru Takii, MD; Hiroshi Hiejima, MD, PhD; Mitsunari Habukawa, MD, PhD; Hiroo Kuwahara, PhD; Naohisa Uchimura, MD, PhD
Improvement in Sleep-Disordered Breathing Indices Downloaded From a Positive Airway Pressure Machine Following Conversion of Atrial Fibrillation to Sinus Rhythm. 1953-1957.
Ken Monahan, MD1; Raghu Upender, MD2; Kristen Sherman, PA3; James Sheller, MD3; Jay Montgomery, MD1; Robert L. Abraham, MD1

Sleep Medicine Pearls

A 14-Month-Old Child With Gastroesophageal Reflux and Central Apnea. 1959-1960.
Caroline V. Jackson, MD; Lourdes M. DelRosso, MD, FAASM

Letters to the Editor

Free Hypopnea Scoring Criteria: Time to Move Toward a Single Standardized Definition. 1961-1962.
Mukesh Kapoor, MD
Free Arousal-Based Scoring for Obstructive Sleep Apnea. 1963-1964.
Raman K. Malhotra, MD1; Douglas B. Kirsch, MD2; Kelly A. Carden, MD3; Ilene M. Rosen, MD, MS4; Kannan Ramar, MD5
Free The Interactions Between Obesity, Sleep Quality, and Chronic Pain. 1965-1966.
Priscila K. Morelhão, MSc1; Sergio Tufik, PhD2; Monica L. Andersen, PhD2

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