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Scientific Investigations

Diagnosis and Treatment of Sleep Disordered Breathing in Hospitalized Cardiac Patients: A Reduction in 30-Day Hospital Readmission Rates. 1051-1059.
Shilpa R. Kauta, M.D.1; Brendan T. Keenan, M.S.1; Lee Goldberg, M.D.2; Richard J. Schwab, M.D.1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep disordered breathing (SDB) is known to be common in patients with underlying cardiovascular disease. We hypothesized that diagnosing and initiating treatment for SDB in hospitalized cardiac patients would improve the overall management of their underlying cardiac condition.

Study Impact: Our study identifies a model of care that can increase the diagnosis and treatment of SDB in hospitalized cardiac patients. Finding a reduced 30-day cardiac readmission rate in CPAP adherent patients is important for both improving patient care and hospital finances.

Article Is Eligible For CME Credits Risk of Sleep Apnea in Hospitalized Older Patients. 1061-1066.
Talia C. Shear, B.A.1; Jay S. Balachandran, M.D.2,3; Babak Mokhlesi, M.D., M.Sc., F.A.A.S.M.2,3; Lisa M. Spampinato, B.S.2; Kristen L. Knutson, Ph.D.2,3; David O. Meltzer, M.D., Ph.D.2; Vineet M. Arora, M.D., M.A.P.P.2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: While the prevalence of OSA in the US is estimated at approximately 25%, it is likely that the prevalence in the in-hospital population is higher. This is because OSA is associated with many medical conditions, such as congestive heart failure, cardiovascular and cerebrovascular disease, postoperative complications, and exacerbations of chronic conditions. Despite this, the prevalence of undiagnosed OSA among hospitalized patients is unknown. Moreover, studies show screening for sleep complaints does not routinely occur in either the clinic or hospital setting.

Study Impact: Understanding the prevalence of OSA as well as the relationship of OSA with inpatient sleep quality is important for recognizing high-risk inpatients as well as diagnosing and treating those who may have OSA. Also, by better understanding where physician knowledge of screening for OSA is lacking, we can hopefully increase awareness of this shortfall and train hospital staff nationwide to recognize and screen patients for sleep disorders.

Influence of Rostral Fluid Shift on Upper Airway Size and Mucosal Water Content. 1069-1074.
Takatoshi Kasai, M.D., Ph.D.1,2; Shveta S. Motwani, M.D.1; Rosilene M. Elias, M.D., Ph.D.1,2; Joseph M. Gabriel, M.Sc.1; Luigi Taranto Montemurro, M.D.1,2; Naotake Yanagisawa, Ph.D.3; Neil Spiller4; Narinder Paul, M.D.4; T. Douglas Bradley, M.D.1,2,5

BRIEF SUMMARY

Current Knowledge/Study Rationale: There is a strong relationship between frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index [AHI]) and both the amount of fluid displaced from the legs and increase in neck circumference overnight, suggesting that nuchal fluid accumulation may contribute to obstructive sleep apnea (OSA) pathogenesis. However, it is not known whether such nuchal fluid accumulation occurs mainly in the jugular veins or upper airway (UA) mucosa, and whether this is related to narrowing of the UA.

Study Impact: This study demonstrates that UA cross-sectional area decreases, and UA mucosal water content increases more in subjects with OSA than in those without OSA in response to fluid displacement from the legs by application of lower body positive pressure, whereas jugular venous volume does not change in either group. Therefore, rostral fluid shift may contribute to the pathogenesis of OSA, at least partly through narrowing of the UA due to transudation of fluid into the UA mucosa.

The Oxford Sleep Resistance test (OSLER) and the Multiple Unprepared Reaction Time Test (MURT) Detect Vigilance Modifications in Sleep Apnea Patients. 1075-1082.
Anniina Alakuijala, M.D., Ph.D.1; Paula Maasilta, M.D., Ph.D.2; Adel Bachour, M.D., Ph.D.2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Patients with obstructive sleep apnea usually demonstrate deficits in memory and attention both subjectively and objectively. The Oxford Sleep Resistance Test (OSLER) is a behavioral test that measures a subject's ability to maintain wakefulness and assesses daytime vigilance, and the multiple unprepared reaction time (MURT) test measures a subject's reaction time in response to a series of visual or auditory stimuli.

Study Impact: This study demonstrates that OSLER and MURT tests are practical and reliable tools for measuring improvement in vigilance due to CPAP therapy in professional drivers suffering from OSA. In the future, more attention ought to focus on safety in traffic and alertness-sensitive occupations, and screening for EDS in a simple and inexpensive way could be one of the keys to reaching this goal.

Does Race-Ethnicity Moderate the Relationship between CPAP Adherence and Functional Outcomes of Sleep in US Veterans with Obstructive Sleep Apnea Syndrome?. 1083-1091.
Douglas M. Wallace, M.D.1,2; William K. Wohlgemuth, Ph.D.2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Although studies have documented improvement in functional outcomes of sleep with continuous positive airway pressure (CPAP) treatment, to our knowledge, none have examined race-ethnicity as a potential moderator of the relationship between CPAP use and functional status in American samples with obstructive sleep apnea syndrome (OSAS). As race-ethnic differences exist for CPAP use and other covariates influencing functional outcomes of sleep, we performed a cross-sectional analysis to examine if race-ethnicity moderated the relationship between CPAP adherence and the functional outcomes of sleep questionnaire (FOSQ) in US veterans with OSAS.

Study Impact: After adjusting for multiple covariates, race-ethnicity moderated the relationship between CPAP adherence and the total, Social, and Intimacy FOSQ subscales. These data suggest that the impact of CPAP use on some functional outcomes of sleep may be conditional upon race-ethnicity; however, longitudinal studies are needed to replicate these findings.

A Randomized, Double-Blind, Single-Dose, Placebo-Controlled, Multicenter, Polysomnographic Study of Gabapentin in Transient Insomnia Induced by Sleep Phase Advance. 1093-1100.
Russell P. Rosenberg, Ph.D., F.A.A.S.M.1; Steven G. Hull, M.D., F.A.A.S.M.2; D. Alan Lankford, Ph.D., F.A.A.S.M.3; David W. Mayleben, Ph.D.4; David J. Seiden, M.D., F.A.A.S.M.5; Sandy A. Furey, M.D., Ph.D.6; Shyamalie Jayawardena, Ph.D.6; Thomas Roth, Ph.D.7

BRIEF SUMMARY

Current Knowledge/Study Rationale: Adults commonly report occasional disturbed sleep. A 5-h phase advance insomnia model known to impair sleep maintenance was used to evaluate the efficacy of single doses of gabapentin 250 and 500 mg on sleep parameters assessed by polysomnography and participant reports.

Study Impact: Participants with occasional disturbed sleep treated with gabapentin had significantly longer sleep duration and greater depth (versus placebo) in response to a phase advance manipulation known to disrupt sleep maintenance.

A Randomized, Double-Blind, Placebo-Controlled, Multicenter, 28-Day, Polysomnographic Study of Gabapentin in Transient Insomnia Induced by Sleep Phase Advance. 1101-1109.
Sandy A. Furey, M.D., Ph.D.1; Steven G. Hull, M.D., F.A.A.S.M.2; Mark T. Leibowitz, M.D.3; Shyamalie Jayawardena, Ph.D.1; Thomas Roth, Ph.D.4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Adults commonly report occasional disturbed sleep. Using a 5-h phase advance transient insomnia model known to impair sleep maintenance, the present study evaluated the effects of single and multiple daily doses of gabapentin 250 mg on sleep measures assessed by polysomnography (PSG) and participant reports.

Study Impact: Gabapentin 250 mg resulted in greater sleep duration as assessed by PSG and participant reports following a 5-h phase advance on the first and 28th day of treatment, with no evidence of next-day impairment. During the intervening weeks of at-home use, gabapentin 250 mg resulted in greater sleep duration and higher ratings of sleep quality, compared with placebo.

Sleep Patterns of a Primarily Obese Sample of Treatment-Seeking Children. 1111-1117.
Danielle M. Graef, M.S.1; David M. Janicke, Ph.D.1,2; Christina S. McCrae, Ph.D.1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Children who are obese are more likely to experience sleep problems than non-overweight peers, which can play an important role in child psychosocial functioning. However, there is a dearth of research examining sleep duration and sleep patterns within overweight and obese samples of children.

Study Impact: This study is one of the first to examine sleep patterns within a sample of obese children and found that roughly 88% attained less than eight hours of sleep. Obesity-related sleep difficulties are likely to affect a substantial number of children in the future, suggesting there is a need to understand how sleep may impact health, weight management, quality of life, and psychosocial functioning of children who are overweight or obese.

Longitudinal Study of Sleep Behavior in Normal Infants during the First Year of Life. 1119-1127.
Oliviero Bruni, M.D.1; Emma Baumgartner, Psy.D.1; Stefania Sette, Psy.D.1; Mario Ancona, M.D.2; Gianni Caso, M.D.3; Maria Elisabetta Di Cosimo, M.D.4; Andrea Mannini, M.D.5; Mariangela Ometto, M.D.6; Anna Pasquini, M.D.7; Antonella Ulliana, M.D.8; Raffaele Ferri, M.D.9

BRIEF SUMMARY

Current Knowledge/Study Rationale: To our knowledge, most of the data on the sleep pattern development in the previous reports were derived from longitudinal studies designed to collect different information but not exclusively intended to assess sleep structure and ecology. Our study represents the first longitudinal analysis of sleep patterns during the first year of life in the Italian population.

Study Impact: Sleep duration showed a high inter-individual variability in the first year of life, but most sleep variables showed little variation from 6 to 12 months. Our data suggest that prevention should focus to the first 3-6 months.

Trends and Determinants of Time in Bed in Geneva, Switzerland. 1129-1135.
Cédric Gubelmann1; Idris Guessous, M.D.1,2; Jean-Marc Theler, M.D.2; José Haba-Rubio, M.D.3; Jean-Michel Gaspoz, M.D.2; Pedro Marques-Vidal, M.D., Ph.D.1,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: There is conflicting data whether sleep duration has decreased in the general population. We aimed at assessing trends and socioeconomic determinants of time in bed (as a proxy for sleep duration) in a representative sample of an adult population of a Swiss canton.

Study Impact: This study adds further weight to the proponents that time in bed did not decrease in the general population. It also adds new information regarding the importance of socioeconomic traits in time in bed.

Perceived Sleep Quality Is Worse Than Objective Parameters of Sleep in Pregnant Women with a Mental Disorder. 1137-1141.
Leontien M. Van Ravesteyn, M.D.1; Joke H.M. Tulen, Ph.D.1; Astrid M. Kamperman, Ph.D.1; Monique E. Raats, M.D.1; A.J. (Tom) Schneider, M.D.3; Erwin Birnie, Ph.D.4; Eric A.P. Steegers, M.D., Ph.D.3; Witte J.G. Hoogendijk, M.D., Ph.D.1; Henning W. Tiemeier, M.D., Ph.D.1; Mijke P. Lambregtse–van den Berg, M.D., Ph.D.1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: In pregnant women with a mental disorder it is unknown whether predominantly objective or subjective sleep quality is more affected. More insight in this distinction could help clinicians to target their interventions.

Study Impact: Perinatal health care professionals should be aware that perceived, and not objective, parameters of sleep quality are significantly worse in pregnant women with a mental disorder compared to pregnant controls, and cautious use of sleep medication is warranted.

Article Is Eligible For CME Credits Trauma Associated Sleep Disorder: A Proposed Parasomnia Encompassing Disruptive Nocturnal Behaviors, Nightmares, and REM without Atonia in Trauma Survivors. 1143-1148.
Vincent Mysliwiec, M.D., F.A.A.S.M.1; Brian O'Reilly, D.O.2; Jason Polchinski, M.D.2; Herbert P. Kwon, M.D.2; Anne Germain, Ph.D.3; Bernard J. Roth, M.D.2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Disruptive nocturnal behaviors and nightmares are frequently reported by trauma survivors and their spouses but rarely documented in laboratory settings. There is no current diagnosis which encompasses these trauma engendered sleep disturbances.

Study Impact: This series of patients describes the clinical, PSG and treatment responses of patients with trauma associated sleep disturbances. Trauma associated sleep disorder (TSD) is likely a new sleep disorder which can facilitate evaluation and treatment of patients with this constellation of findings.

Commentary

Hospital Sleep Medicine: The Elephant in the Room?. 1067-1068.
Sunil Sharma, M.D., F.A.A.S.M.

Case Reports

Choking in the Night Due to NFLE Seizures in a Patient with Comorbid OSA. 1149-1152.
Michele Terzaghi, M.D.1; Ivana Sartori, M.D.2; Riccardo Cremascoli, M.D.1; Valter Rustioni, M.D.1; Raffaele Manni, M.D.1
Treatment of Kleine-Levin Syndrome with Acetazolamide. 1153-1154.
Blaire Kapson, B.A.1; Sumiti Nayar, M.D.1; Rebecca Spiegel, M.D., M.A.1,2

Review Articles

A Systematic Review of the Association between Obstructive Sleep Apnea and Ventricular Arrhythmias. 1155-1160.
Akhil Raghuram, M.D.; Ryan Clay, M.D.; Anusha Kumbam, M.D.; Larisa G. Tereshchenko, M.D., Ph.D.; Akram Khan, M.D.

Board Review Corner

A Big Problem in the ICU. 1161-1162.
Robert L. Owens, M.D.
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October 15, 2014
Volume 10, Issue 10


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