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Accepted Papers


End of the Beginning. 1265.
Stuart F. Quan, M.D., F.A.A.S.M.
Following the Footprints of Founding Editor Stuart Quan, M.D.. 1267-1268.
Timothy I. Morgenthaler, M.D., F.A.A.S.M., F.C.C.P.

Scientific Investigations

Auto-adjusting Positive Airway Pressure Treatment for Sleep Apnea Diagnosed by Home Sleep Testing. 1269-1275.
Richard B. Berry, M.D., F.A.A.S.M.; Peruvemba Sriram, M.D.


Current Knowledge/Study Rationale: Following diagnosis of obstructive sleep apnea by home sleep testing, one treatment option is to start the patient on an auto-adjusting positive airway pressure device without a preceding titration either by polysomnography or home auto-titration. The effectiveness of this approach needs to be documented.

Study Impact: The results of this study suggest that treatment with an auto-adjusting positive airway pressure device following diagnosis of obstructive sleep apnea by home sleep testing is an effective treatment option if patients are carefully selected based on clinical characteristics and findings from the home sleep test.

Effects of Gender on the Prevalence of Obstructive Sleep Apnea in Patients with Coronary Artery Disease. 1279-1284.
Liang-Ping Zhao, M.D.1; Adeline Tan, M.B.B.S.2; Bee-Choo Tai, Ph.D.3; Germaine Loo1; Huay-Cheem Tan, M.B.B.S.1; Chi-Hang Lee, M.D.1,4


Current Knowledge/Study Rationale: Male predominance has been observed in obstructive sleep apnea studies conducted in the community and sleep clinics. We investigated the effects of gender on obstructive sleep apnea prevalence among patients with coronary artery disease.

Study Impact: Prevalence of obstructive sleep apnea is high in coronary artery disease patients with no evidence of sex predilection. Physicians considering obstructive sleep apnea screening for patients with coronary artery diseasae should be aware of the absence of male predilection in this patient cohort.

Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment. 1285-1291.
Benjamin T. Pliska, D.D.S., M.Sc.; Hyejin Nam; Hui Chen, D.M.D., Ph.D.; Alan A. Lowe, D.M.D., Ph.D.; Fernanda R. Almeida, D.D.S., Ph.D.


Current Knowledge/Study Rationale: Mandibular advancement splints are an effective treatment option for OSA patients, with changes to the dental occlusion as a common side effect. Due to the indefinite nature of OSA treatment a clear understanding of the magnitude and progression of long-term occlusal changes is needed.

Study Impact: With the longest observation period yet to be reported, the results from this study confirm that long-term MAS treatment leads to significant changes in occlusion for the majority of patients. These dental changes were found to be progressive in nature, and continue with ongoing MAS use.

Effect of CPAP Treatment for Obstructive Sleep Apnea Hypopnea Syndrome on Lipid Profile: A Meta-Regression Analysis. 1295-1302.
Rashid Nadeem, M.D., F.A.A.S.M.1; Mukesh Singh, M.D.1; Mahwish Nida, M.B.B.S.2; Sarah Kwon, B.S.1; Hassan Sajid, H.Sc.3; Julie Witkowski, B.S.1; Elizabeth Pahomov, M.S.1; Kruti Shah, B.S.1; William Park, B.S.1; Dan Champeau, B.S.1


Current Knowledge/Study Rationale: Patients with obstructive sleep apnea (OSA) frequently exhibit higher rates of dyslipidemia, a risk factors for cardiovascular and cerebrovascular disorders. Multiple studies with small sample size documented the improvement in dyslipidemia by treatment for OSA by CPAP therapy, hence the meta-regression analysis aim to estimates the effect of CPAP treatment on dyslipidemia.

Study Impact: CPAP treatment for OSA seems to improve dyslipidemia (decrease in total cholesterol and LDL, and increase in HDL). Study suggests that improvement in dyslipidemia may be the mechanism for improvement of cardiovascular and cerebrovascular disorders in patients, treated for sleep apnea by pressure therapy.

Article Is Eligible For CME Credits Does Neck-to-Waist Ratio Predict Obstructive Sleep Apnea in Children?. 1303-1308.
Sherri Lynne Katz, M.Sc., M.D.C.M.1,2; Jean-Philippe Vaccani, B.Med.Sc., M.D.1,3; Nick Barrowman, Ph.D.4; Franco Momoli, Ph.D.4,6,7; Carol L. Bradbury, M.B.B.S. (Lond)8; Kimmo Murto, M.D.1,5


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) is associated with obesity in older children. Central adiposity and large neck circumference are associated with increased OSA risk in adults but have not been evaluated in children as predictors of OSA.

Study Impact: Neck-to-waist ratio, an index of body fat distribution, predicts obstructive sleep apnea (OSA) in older children and youth, especially in those with overweight/obesity. Neck-to-waist ratio is higher in those with OSA than those without, except in those with extreme obesity (BMI > 99th percentile).

Overnight Pulse Oximetry for Evaluation of Sleep Apnea among Children with Trisomy 21. 1309-1315.
Andrea M. Coverstone, M.D.1; Merielle Bird, M.S.N.2; Melissa Sicard, M.S.N.1; Yu Tao, M.B., M.S.3; Dorothy K. Grange, M.D.1; Claudia Cleveland2; David Molter, M.D.4; James S. Kemp, M.D.1


Current Knowledge/Study Rationale: Children with trisomy 21 have a high prevalence of sleep disordered breathing. Screening for SDB by polysomnography is the standard of care for these children. This study was performed to evaluate the usefulness of oximetry scoring alone in diagnosing obstructive sleep disordered breathing in children with trisomy 21 in lieu of a full overnight polysomnogram.

Study Impact: Oximetry screening alone may be a useful tool in developing streamlined protocols for early intervention to treat OSDB in children with trisomy 21, who may be difficult to assess using full PSG. This study also indicates the importance of evaluating for central apnea in trisomy 21.

Explaining Alcohol Use and Suicide Risk: A Moderated Mediation Model Involving Insomnia Symptoms and Gender. 1317-1323.
Michael R. Nadorff, Ph.D.1,2; Taban Salem, B.A.1; E. Samuel Winer, Ph.D.1; Dorian A. Lamis, Ph.D.3; Sarra Nazem, Ph.D.4; Mitchell E. Berman, Ph.D.1


Current Knowledge/Study Rationale: Research has demonstrated that insomnia symptoms and nightmares are associated with suicide risk independent of many other risk factors. However, little research has examined whether insomnia symptoms or nightmares may explain how established suicide risk factors confer suicide risk.

Study Impact: The present study found that insomnia symptoms atemporally mediate the relation between alcohol use and suicide risk. Thus, insomnia symptoms are an important factor in explaining the mechanism by which alcohol increases suicide risk, and may also be an intervention target to reduce the suicide risk caused by alcohol use.

Pramipexole Alters Thermoregulation in Restless Legs Syndrome. 1325-1329.
Aaro V. Salminen, M.Sc.1,2; Ville Rimpilä, M.Sc.1,2; Olli Polo, M.D., Ph.D.1,2,3


Current Knowledge/Study Rationale: Recent studies have shown impaired thermoregulation in medicated patients with restless legs syndrome (RLS). We investigated the effect of pramipexole on thermoregulation in RLS.

Study Impact: Our results demonstrate that pramipexole modifies the thermoregulation in patients with RLS at the time when symptoms occur. Dopaminergic therapy should be well controlled for in future studies assessing peripheral blood flow in RLS.

Article Is Eligible For CME Credits Sleep Disturbances and Nocturnal Symptoms: Relationships with Quality of Life in a Population-Based Sample of Women with Interstitial Cystitis/Bladder Pain Syndrome. 1331-1337.
Wendy M. Troxel, Ph.D.1; Marika Booth, M.S.1; Daniel J. Buysse, M.D., F.A.A.S.M.2; Marc N. Elliott, Ph.D.1; Anne M. Suskind, Ph.D.3; J. Quentin Clemens, M.D.3; Sandra H. Berry, M.A.1


Current Knowledge/Study Rationale: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain syndrome that disproportionately affects women and is characterized by a constellation of bladder symptoms, including bladder/pelvic pain and nocturia. Although there has been a great deal of research on musculoskeletal pain conditions and sleep disturbances, there has been very little research on the nature or impact of sleep disturbances in populations with organ-specific pain conditions, such as IC/BPS.

Study Impact: In this population-based sample of women with IC/BPS symptoms, sleep problems, including short sleep duration, poor sleep quality, and disorder-specific nocturnal symptoms, were highly prevalent and were associated with greater impairment on multiple quality of life indicators. Findings suggest that augmenting IC/BPS treatment strategies with sleep-focused treatments may improve quality of life in IC/BPS patients.


To Auto-titrate or not Auto-titrate: Is the Question Answered?. 1277-1278.
Salma Batool-Anwar, M.D., M.P.H1; Stuart F. Quan, M.D., F.A.A.S.M.1,2
Think Before Sinking Your Teeth into Oral Appliance Therapy. 1293-1294.
Joachim Ngiam, B.D.S. (Hons), M.S.D., M.Phil.; Peter A. Cistulli, M.D., Ph.D.

Case Reports

Tongue Biting: A Case of Sporadic Geniospasm during Sleep. 1339-1340.
Mandana Mahmoudi, M.D.1; Sanjeev V. Kothare, M.D.2
Asenapine-Induced Restless Legs Syndrome: Differentiation from Akathisia. 1341-1342.
W. Vaughn McCall, M.D., M.S., F.A.A.S.M.1; Mary Anne Riley, M.A.1; Chelsea Hodges, M.A.1; Laryssa McCloud, Ph.D.1; Marjorie Phillips, M.S.2; Peter B. Rosenquist, M.D.1

Review Articles

Review of Diagnostic Instruments for the Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED): Critique and Recommendations. 1343-1349.
Arthur S. Walters, M.D., F.A.A.S.M.1; Birgit Frauscher, M.D.2; Richard Allen, Ph.D., F.A.A.S.M.3; Heike Benes, M.D.4; K. Ray Chaudhuri, M.D.5; Diego Garcia-Borreguero, M.D.6; Hochang B. Lee, M.D.7; Daniel L. Picchietti, M.D., F.A.A.S.M.8; Claudia Trenkwalder, M.D.9; Pablo Martinez-Martin, M.D., Ph.D.10; Glenn T. Stebbins, Ph.D.11; Anette Schrag, M.D.1213
Review of Quality of Life Instruments for the Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED): Critique and Recommendations. 1351-1357.
Arthur S. Walters, M.D., F.A.A.S.M.1; Birgit Frauscher, M.D.2; Richard Allen, Ph.D., F.A.A.S.M.3; Heike Benes, M.D.4; K. Ray Chaudhuri, M.D.5; Diego Garcia-Borreguero, M.D.6; Hochang B. Lee, M.D.7; Daniel L. Picchietti, M.D., F.A.A.S.M.8; Claudia Trenkwalder, M.D.9; Pablo Martinez-Martin, M.D., Ph.D.10; Glenn T. Stebbins, Ph.D.11; Anette Schrag, M.D.1213

Board Review Corner

A Teenager and his Mother. 1359-1360.
Sandra Horowitz, M.D., F.A.A.S.M.

Letter to the Editor

Use of a Chinstrap in Treating Sleep Disordered Breathing and Snoring. 1361.
Robert Daniel Vorona, M.D., F.A.A.S.M.; J. Catesby Ware, Ph.D., F.A.A.S.M.
Sensory Stimuli and the Restless Legs Syndrome. 1363.
Fred Burbank, M.D.1; Mark J. Buchfuhrer, M.D., F.A.A.S.M.2

Journal Club

Effects of CPAP and Weight Loss on OSA Outcomes. 1365-1367.
Robert L. Owens, M.D.1; Shirin Shafazand, M.D., M.S.2
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