Earn CME
Accepted Papers

Scientific Investigations

Article Is Eligible For CME Credits Obstructive Sleep Apnea, Health-Related Factors, and Long Distance Heavy Vehicle Crashes in Western Australia: A Case Control Study. 413-418.
Lynn Meuleners, PhD1; Michelle L. Fraser, MPhil1; Matthew H. Govorko, MPH1; Mark R. Stevenson, PhD2


Current Knowledge/Study Rationale: Evidence suggests that heavy vehicle drivers are at increased risk of obstructive sleep apnea and other chronic conditions. However, few studies have examined the association between obstructive sleep apnea, specific health conditions, and crashes among long-haul heavy vehicle drivers.

Study Impact: This study found that long-haul heavy vehicle drivers with obstructive sleep apnea, depression and those who had not undertaken fatigue management training were at a significantly increased risk of crash involvement. More rigorous screening and subsequent treatment of OSA and depression by clinicians as well as compulsory fatigue management training may reduce crashes among heavy vehicle drivers.

Predictors for Progression of Sleep Disordered Breathing among Public Transport Drivers: A 3-Year Follow-Up Study. 419-425.
Cheng-Yu Lin, MD1,2,3; Tung-Sheng Shih, ScD4,5; Saou-Hsing Liou, MD6; Ming-Hsiu Lin, PhD5; Cheng-Ping Chang, PhD7; Tzu-Chieh Chou, PhD8,9


Current Knowledge/Study Rationale: To prevent serious chronic illness and an increased risk of motor vehicle crashes (MVCs) because of sleep disordered breathing (SDB), the progression of SDB should be understood and factors associated with disease worsening should be identified. We examined the natural evolution of SDB among public transport drivers, and identified the determinants of the three-year changes in disease severity.

Study Impact: Public transport drivers, especially those who are heavy and have moderate to severe SDB, should be closely monitored by regular follow-up to allow for early detection of worsening SDB. In addition, this study provided further evidence that drivers with SDB had significantly increased cardiovascular risk, and a large prospective cohort study should be performed to further explain the SDB and cardiovascular disease association in order to develop effective preventive strategies.

Time to Response with Sodium Oxybate for the Treatment of Excessive Daytime Sleepiness and Cataplexy in Patients with Narcolepsy. 427-432.
Richard K. Bogan, MD1; Thomas Roth, PhD2; Jonathan Schwartz, MD3; Maja Miloslavsky, PhD4


Current Knowledge/Study Rationale: Sodium oxybate is approved for the treatment of excessive daytime sleepiness and cataplexy in patients with narcolepsy. Since it is important to allow sufficient time to observe a clinically relevant response before changing a treatment strategy, this analysis determined the time to response with sodium oxybate for improvement in excessive daytime sleepiness and cataplexy.

Study Impact: Clinically meaningful improvements in excessive daytime sleepiness and cataplexy were seen within 2 months in most patients, and maximum response required a longer period. Clinicians should recognize that the time course to initial and maximum response to sodium oxybate may take weeks to months.

A Comprehensive Evaluation of a Two-Channel Portable Monitor to “Rule in” Obstructive Sleep Apnea. 433-444.
Kim L. Ward, BSc (Hons)1,2; Nigel McArdle, MBBS, FRACP, MD2,3; Alan James, MBBS, FRACP2,3,4; Alexandra P. Bremner, PhD1; Laila Simpson, PhD5; Matthew N. Cooper, BSc6; Lyle J. Palmer, PhD8; Annette C. Fedson, PhD7; Sutapa Mukherjee, MBBS, FRACP, PhD2; David R. Hillman, MBBS, FANZCA2,3


Current Knowledge/Study Rationale: The primary aim of this study was to assess the accuracy of a dual-channel PM device (type 4) as a triaging tool in a clinic population with suspected OSA, since the American Academy of Sleep Medicine (AASM) holds that there is insufficient evidence to support the use of type 4 PMs in the unattended setting. We sought to address limitations in previous studies by ensuring adequate sample size, testing in both home and laboratory environments, and assessment of night-to-night variability and order effects.

Study Impact: Our study confirms acceptable accuracy of a two-channel (type 4) PM device for the diagnosis of OSA in a sleep clinic population with a home study. Overall performance of the device is consistent with current recommended criteria for ruling in OSA (AHI ≥ 5 events/h) in this setting.

Frequency of Obstructive Sleep Apnea Syndrome in Dental Patients with Tooth Wear. 445-450.
Joaquín Durán-Cantolla, PhD1,2,3,4,6; Mohammad Hamdan Alkhraisat, PhD5; Cristina Martínez-Null, BSc1,2,3,4; Jose Javier Aguirre, MD5; Elena Rubio Guinea, DDS5; Eduardo Anitua, PhD1,5


Current Knowledge/Study Rationale: Obstructive sleep apnea syndrome (OSAS) is not adequately managed in the general population. This fact would make emphasis in identifying factors that could indicate the probability of having OSAS.

Study Impact: If confirmed, tooth wear could be a useful tool in identifying patients with OSAS. This would permit the early diagnosis and treatment of OSAS, minimizing the occurrence of medical complications associated with OSAS.

Shorter Mandibular Length is Associated with a Greater Fall in AHI with Weight Loss. 451-456.
Matthew T. Naughton, MD1,2; Brian D. Monteith, BChD, MChD3; David J. Manton, BDSc, MDSc, PhD3; Paul Dever, BSc, BDent(Hons), DCD(Ortho), MOrth, RCS(Edin)3; Linda M. Schachter, MBBS, PhD4; Paul E. O'Brien, MD4; John B. Dixon, MBBS, PhD5,6


Current Knowledge/Study Rationale: Substantial weight loss does not routinely result in resolution of obstructive sleep apnea. Craniofacial characteristics may be useful in predicting which patients have a better response.

Study Impact: A greater fall in AHI was associated with a shorter jaw length.

Article Is Eligible For CME Credits Insomnia in Shift Work Disorder Relates to Occupational and Neurophysiological Impairment. 457-465.
Ren Belcher, BA1,2; Valentina Gumenyuk, PhD1,3; Thomas Roth, PhD1


Current Knowledge/Study Rationale: Workplace accidents, lost productivity, and neurophysiologic impairment are known to be associated with night shift work. This study aimed to determine whether these problems are differently related to insomnia and to excessive sleepiness, two hallmark symptoms that are diagnostic of shift work disorder (SWD) but are not reliably comorbid.

Study Impact: Our findings suggest that treatments focusing on excessive sleepiness in SWD may not sufficiently improve work-related outcomes, as overnight occupational and neurophysiologic impairment is more strongly correlated to insomnia than it is to sleepiness. Further research is needed to evaluate the impact of insomnia therapies on workplace safety and productivity in patients with SWD.

Characteristics and Surgical and Clinical Outcomes of Severely Obese Children with Obstructive Sleep Apnea. 467-474.
Gulnur Com, MD1; John L. Carroll, MD1; Xinyu Tang, PhD2; Maria S. Melguizo, MS2; Charles Bower, MD3; Supriya Jambhekar, MD1


Current Knowledge/Study Rationale: Literature about severely obese children with obstructive sleep apnea (OSA) and their outcomes is limited. The efficacy of airway surgeries other than adenotonsillectomy for the treatment of OSA in this population is unknown.

Study Impact: Airway surgery yields significant improvement in severely obese children with OSA. Adenotonsillectomy is associated with significant improvement in AHI, and the success rate of surgery depends on the history of previous surgery, tonsil size, and OSA severity. Adherence with positive airway pressure treatment is poor.

Review Articles

Meta-analyses of the Association of Sleep Apnea with Insulin Resistance, and the Effects of CPAP on HOMA-IR, Adiponectin, and Visceral Adipose Fat. 475-485.
Imran H. Iftikhar, MD1; Camilla M. Hoyos, PhD2; Craig L. Phillips, PhD2,4; Ulysses J. Magalang, MD3

Case Reports

Behavioral Hyperventilation and Central Sleep Apnea in Two Children. 487-489.
Thomas P. Johnston, MD1; Jade Tam-Williams, MD1; Margaret Schmandt, MD1; Anand C. Patel, MD, MS1; Claudia Cleveland, RPSGT2; Ferdinand Coste, MD1; James S. Kemp, MD1

Sleep Medicine Pearls

A 69-Year-Old Man with Complex Nocturnal Visual Hallucinations. 491-493.
Melissa C. Lipford, MD; David J. Sandness, BA; Erik K. St. Louis, MD

Letters to the Editor

Stability versus Transitional Changes in the EEG: From Sleep to Wakefulness. 495.
John Zimmerman, PhD, DABSM, RPSGT
Should the Arousal Scoring Rule Be Changed?. 497-499.
Richard B. Berry, MD1; Rita Brooks, MEd, RST, RPSGT2; Charlene E. Gamaldo, MD3; Susan M. Harding, MD4; Robin M. Lloyd, MD5; Carole L. Marcus, MBBCh6; Bradley V. Vaughn, MD7
An Alternative Cause for Long Term Changes with Mandibular Advancement Devices. 501.
Melvin L. Ford, DDS1; Robert D. Vorona, MD2; J. Catesby Ware, PhD2
Obstructive Sleep Apnea and Mandibular Advancement Splints. 503-504.
Benjamin T. Pliska, DDS, MSc, FRCD(C); Hyejin Nam, DMD; Hui Chen, DMD, PhD; Alan A. Lowe, DMD, PhD, FRCD(C); Fernanda R. Almeida, DDS, PhD
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