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Accepted Papers


Free Sleep Bruxism: A “Bridge” Between Dental and Sleep Medicine. 1281-1283.
Alberto Herrero Babiloni, DDS, MS; Gilles J. Lavigne, DMD, PhD, FRCD

Scientific Investigations

Sleep Hygiene Index: Psychometric Characteristics and Usefulness as a Screening Tool in a Sample of Nigerian Undergraduate Students. 1285-1292.
Champion T. Seun-Fadipe, MBChB, MSc, FMCPsych; Olutayo O. Aloba, MBChB, FWACPsych; Olakunle A. Oginni, MBBS, MSc, FWACPsych; Kolawole S. Mosaku, MBBS, MPH, FMCPsych


Current Knowledge/Study Rationale: Although the Sleep Hygiene Index (SHI) had been validated in some population in the developed countries, an extensive electronic literature search revealed no validation study or application of the instrument among the undergraduate student populations in Nigeria or Sub-Saharan Africa.

Study Impact: This study advanced the frontiers of knowledge of sleep medicine, especially in the developing world, by demonstrating the validity of the SHI for assessing sleep hygiene among the university undergraduate student population in Nigeria by performing exploratory and confirmatory factor analyses on the factors extracted in the SHI, which has not been previously done. We also demonstrated the usefulness of the SHI in identifying poor sleep quality in this population.

The Epworth Sleepiness Scale: Validation of One-Dimensional Factor Structure in a Large Clinical Sample. 1293-1301.
Brittany R. Lapin, PhD, MPH1; James F. Bena, MS1; Harneet K. Walia, MD2; Douglas E. Moul, MD2


Current Knowledge/Study Rationale: The Epworth Sleepiness Scale (ESS) is the most commonly used measure for clinicians and researchers to measure daytime sleepiness. One of the critical assumptions of measurement theory is unidimensionality, or that a set of items forming a scale all measure one common underlying trait. There has been substantial controversy surrounding ESS's dimensionality.

Study Impact: Our study confirmed unidimensionality of the ESS's factor structure through the use of a clinical sample of 10,785 patients and robust statistical methodology. Results from this study can be utilized to justify the interpretation of the ESS within clinical populations, as well as support valid comparisons between groups based on the ESS. Additionally, our findings pave the way for future work using item-response theory models.

Free Untreated Sleep Apnea: An Analysis of Administrative Data to Identify Risk Factors for Early Nonadherence. 1303-1313.
Aliza Gordon, MPH1; Sze-jung Wu, PhD1; Nicole Munns, MBA, RPSGT2; Andrea DeVries, PhD1; Thomas Power, MD, FAAC, MRCPI2


Current Knowledge/Study Rationale: Widespread nonadherence complicates the treatment of obstructive sleep apnea (OSA), resulting in suboptimal outcomes. A sleep management program requiring preauthorization for sleep testing and treatment presented a unique data environment to study patient nonadherence, and this study is original in examining barriers to initiating OSA testing and therapy even after preauthorization.

Study Impact: Prescribing provider specialty, residential region, baseline utilization patterns, and OSA severity were identified as the top risk factors of patient nonadherence. Patient education and support focused on those most at risk and delivered by those most capable will likely result in a reduction in untreated OSA through more confirmed diagnoses of OSA and improved adherence with both treatment initiation and persistence.

Free Continuous Positive Airway Pressure Therapy on Nonalcoholic Fatty Liver Disease in Patients With Obstructive Sleep Apnea. 1315-1322.
Donghee Kim, MD, PhD1; Aijaz Ahmed, MD1; Clete Kushida, MD, PhD, FAASM2


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) was associated with nonalcoholic fatty live disease (NAFLD) and NAFLD-related advanced fibrosis. However, the effect of continuous positive airway pressure (CPAP) therapy on NAFLD and advanced fibrosis is largely unknown.

Study Impact: CPAP treatment, even for a relatively short term, plays an important role in improving the serum aminotransferase activity in subjects with OSA. In addition, CPAP treatment may play a pivotal role in the improvement of NAFLD-related fibrosis.

Ambulatory Versus Laboratory Polysomnography in Obstructive Sleep Apnea: Comparative Assessment of Quality, Clinical Efficacy, Treatment Compliance, and Quality of Life. 1323-1331.
Lília Andrade, MD, MSc1; Teresa Paiva, MD, MSc2,3


Current Knowledge/Study Rationale: Ambulatory polysomnography (Amb-PSG) is often underestimated as a valuable alternative to laboratory polysomnography (Lab-PSG). This study aims to compare the quality and effectiveness of these two techniques in diagnosing obstructive sleep apnea.

Study Impact: Amb-PSG and Lab-PSG showed comparable diagnostic quality to Lab-PSG in diagnosing obstructive sleep apnea. Diagnostic effect of Amb-PSG in clinical (body mass index, blood pressure, Epworth Sleepiness Scale) and treatment follow-up (CPAP adherence and QoL) indicators was comparable to that of Lab-PSG. These data underline that Amb-PSG may have an important role in improving accessibility to testing.

Predicting Success of Oral Appliance Therapy in Treating Obstructive Sleep Apnea Using Drug-Induced Sleep Endoscopy. 1333-1337.
Colin Huntley, MD1; Jeniece Cooper, BE2; Marlind Stiles, DMD3; Ritu Grewal, MD4; Maurits Boon, MD1


Current Knowledge/Study Rationale: Oral appliance therapy is an effective means of treating obstructive sleep apnea in those patients unable to tolerate positive pressure therapy with continuous positive airway pressure or bilevel positive pressure. However, we are limited in our ability to predict which patients will succeed with oral appliance therapy.

Study Impact: With this study, we found improvement in the size of the airway with a jaw thrust maneuver during drug-induced sleep endoscopy to be predictive of improved treatment outcomes when compared to a cohort not undergoing sleep endoscopy.

Prevalence and Clinical Significance of Respiratory Effort-Related Arousals in the General Population. 1339-1345.
Adam Ogna, MD1; Nadia Tobback, RPSGT1; Daniela Andries, RPSGT1; Martin Preisig, MD2; Peter Vollenweider, MD3; Gerard Waeber, MD3; Pedro Marques-Vidal, MD, PhD3; José Haba Rubio, MD1; Raphaël Heinzer, MD, MPH1


Current Knowledge/Study Rationale: Several previous studies have tried to characterize respiratory effort-related arousals (RERAs), but their relevance as a specific disease and their cardiovascular consequences are still debated. We aimed to determine the prevalence and clinical associations of RERAs in a large, general population-based sample investigated by polysomnography.

Study Impact: The prevalence of RERAs was low (3.8%) and no association with sleepiness, hypertension, diabetes, and metabolic syndrome was found. This may be because of the current American Academy of Sleep Medicine criteria that include arousals in the definition of hypopneas.

Trans-Oral Robotic Tongue Reduction for OSA: Does Lingual Anatomy Influence the Surgical Outcome?. 1347-1351.
Giovanni Cammaroto, MD1,2; Giuseppe Meccariello, MD2; Matteo Costantini, MD3; Francesco Stomeo, MD4; Paul Hoff5; Filippo Montevecchi, MD2; Claudio Vicini, MD2,4


Current Knowledge/Study Rationale: Obstructive sleep apnea is known to be caused by anatomic and physiological factors. The aim of this study is to evaluate the influence of the base of the tongue and its histological components on the effectiveness of trans-oral robotic surgery.

Study Impact: The results highlighted by this study underlines the importance of nonanatomic factors in the genesis of obstructive sleep apnea and express the need for a better understanding of the pathology and a more precise selection of candidates for sleep surgery.

Association Between Sleep Duration, Quality and Body Mass Index in the Korean Population. 1353-1360.
Sung Keun Park, MD, PhD1; Ju Young Jung, MD, PhD2; Chang-Mo Oh, MD, PhD3; Roger S. McIntyre, MD, FRCPC4,5,6; Jae-Hon Lee, MD, PhD7


Current Knowledge/Study Rationale: There has been accumulating evidence indicating the adverse influence of insufficient sleep and poor sleep quality on obesity. It is still under scrutiny in the association of sleep duration and quality with body weight including underweight.

Study Impact: Short sleep and poor sleep quality more closely link to obesity than underweight. The proper sleep duration and improving sleep quality are necessary to prevent obesity.

Predictors of Obtaining Polysomnography Among Otolaryngologists Prior to Adenotonsillectomy for Childhood Sleep-Disordered Breathing. 1361-1367.
Derek J. Lam, MD, MPH1; Steven A. Shea, PhD2,3; Edward M. Weaver, MD, MPH4; Ron B. Mitchell, MD5


Current Knowledge/Study Rationale: Evidence examining indications among pediatric otolaryngologists for obtaining polysomnography prior to adenotonsillectomy is limited, primarily relying on provider surveys that are subject to recall and confirmation bias. This study was undertaken to objectively examine potential predictors of polysomnography among adenotonsillectomy patients, and to assess adherence to the 2011 American Academy of Otolaryngology-Head and Neck Surgery polysomnography guideline.

Study Impact: In this single-institution study, age 1 to 3 years was the only significant predictor of polysomnography with a low overall rate of obtaining polysomnography testing among pediatric adenotonsillectomy patients. This study may help to highlight awareness of published polysomnography guidelines and promote discussion regarding the benefits versus practicality of greater adherence to these guidelines.

Study of Associated Factors With Probable Sleep Bruxism Among Adolescents. 1369-1376.
Ivana Meyer Prado, MSc1; Lucas Guimarães Abreu, PhD1; Karen Simon Silveira, MSc1; Sheyla Márcia Auad, PhD1; Saul Martins Paiva, PhD1; Daniele Manfredini, PhD2; Júnia Maria Serra-Negra, PhD1


Current Knowledge/Study Rationale: Knowledge regarding sleep bruxism (SB) and its associated factors among adolescents is still poor, especially because most studies are based only on self-report. Sleep habits and temporomandibular disorders are frequently associated factors; an association with orthodontic appliance use was hypothesized in a preliminary study.

Study Impact: This study presents further data on factors that may be associated with probable SB in 12-year-old adolescents; adolescents who snored during sleep, those who did not have clicks in the temporomandibular joint when opening and closing the mouth, and those wearing fixed orthodontic appliances had more chance of being in the group with probable SB. Further research is needed to refine these findings and find a possible biological explanation.

Home Polysomnography Reveals a First-Night Effect in Patients With Low Sleep Bruxism Activity. 1377-1386.
Tomi Miettinen, MSc1,2,3; Katja Myllymaa, PhD1,3; Taina Hukkanen, BSc3; Juha Töyräs, PhD1,3; Kirsi Sipilä, DDS2,4,5,6; Sami Myllymaa, PhD1,2,3


Current Knowledge/Study Rationale: There are rather few reports assessing a first-night effect and internight variability in the activity of sleep bruxism (SB); this information is important because it would help to answer the question of how many nights of polysomnography (PSG) need to be recorded in order to reliably determine the level of ongoing SB activity.

Study Impact: The results of this study suggest that SB activity may have to be recorded for more than 1 night if one wishes to reliably diagnose patients in both clinical and research settings. In addition to influencing the methods for diagnosis in individual patients, this knowledge also has research implications (eg, in situations where the epidemiology of SB, the reliability of questionnaires or new treatment methods are being tested against PSG-quantified SB activity levels).

Free Modifying Maternal Sleep Position in Late Pregnancy Through Positional Therapy: A Feasibility Study. 1387-1397.
Jane Warland, PhD1; Jillian Dorrian, PhD2; Allan J. Kember, BSc3,4; Craig Phillips, PhD5; Ali Borazjani, PhD4; Janna L. Morrison, PhD6; Louise M. O'Brien, PhD7


Current Knowledge/Study Rationale: Research suggests that modifying maternal sleep position, especially the position in which pregnant women go to sleep, may be one way to reduce stillbirth. Positional therapy is a well-accepted means to reduce supine sleep time in the adult (nonpregnant) population with sleep-disordered breathing. However, it is not known whether positional therapy is similarly effective in the pregnant population.

Study Impact: The current study shows that wearing a customized positional therapy device significantly reduces time spent sleeping supine in late pregnancy, without significant effect on length and quality of sleep and with beneficial physiological effects for both the pregnant mother and her fetus. Future research is therefore needed to further explore the most effective means of promoting lengthy non-supine sleep in late pregnancy.

Review Articles

An Update on Dual Orexin Receptor Antagonists and Their Potential Role in Insomnia Therapeutics. 1399-1408.
Kayla Janto, BS1; J. Roxanne Prichard, PhD1; Snigdha Pusalavidyasagar, MD2

Emerging Technologies

Remotely Controlled Mandibular Positioning During Drug-Induced Sleep Endoscopy Toward Mandibular Advancement Device Therapy: Feasibility and Protocol. 1409-1413.
Chloé Kastoer, MD1,2; Marijke Dieltjens, MSc, PhD1,2,3; Sara Op de Beeck, MSc2; Marc J. Braem, DDS, PhD2,3; Paul H. Van de Heyning, MD, PhD1,2,4; Olivier M. Vanderveken, MD, PhD1,2,4

Case Reports

A Novel Treatment for Nasolacrimal Air Regurgitation Into the Eye With CPAP: The Total Face Mask. 1415-1417.
Joanna E. Wrede, MD1,2; Elizabeth C. Parsons, MD, MSc3,4; Nathaniel F. Watson, MD5,6
Case Report of Pediatric Channelopathies With UNC80 and KCNJ11 Mutations Having Abnormal Respiratory Control Treated With Positive Airway Pressure Therapy. 1419-1425.
Hanna Hong, MD1; Rory Kamerman-Kretzmer, MD1; Roberta Kato, MD1; Tena Rosser, MD2; Michele VanHirtum-Das, MD2; Sally L. Davidson Ward, MD1
Severe Positional Central Sleep Apnea in an Asymptomatic Adult With a PHOX2B Frameshift Mutation. 1427-1430.
Hennie C.J.P. Janssen, MD, PhD1; Anneke T. Vulto-van Silfhout, MD, PhD2; Marjolijn C.J. Jongmans, MD, PhD2,3; Annemieke H. van der Hout, PhD4; Sebastiaan Overeem, MD, PhD1,5

Sleep Medicine Pearls

FOXP1 Syndrome and Severe Obstructive Sleep Apnea. 1432-1434.
Ilia Kritikou, MD1; Olufunke Afolabi-Brown, MBBS1,2
A Patient With Suspicious Oxygen Desaturations at Sleep Onset. 1435-1436.
Mary Wagner, MD1; Wajiha Raza, MD2; Arnaldo Reyes Esteves, MD2; Scott Ryals, MD2; Richard Berry, MD2

REM: A Publication for Residents and Fellows

Free Perspective: Sleep at the USA Science and Engineering Festival—A New Outreach for the American Academy of Sleep Medicine. 1449-1450.
Aleksandra Kwasnik, MD; Catalina Castillo-Pedraza, MD

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