Earn CME
Accepted Papers

Scientific Investigations

Article Is Eligible For CME Credits Sleep Related Cognitions in Individuals with Symptoms of Insomnia and Depression. 847-854.
Jessica C. Levenson, PhD1; Ruth M. Benca, MD, PhD2; Meredith E. Rumble, PhD2


Current Knowledge/Study Rationale: Comorbid insomnia and depression may have a different clinical course than either condition alone, and may require specific treatment procedures. Some work has shown that pathological sleep related cognitions may contribute to a more challenging clinical course of insomnia and may differentiate insomnia subgroups, but additional work is needed to clarify this issue.

Study Impact: The findings suggest that individuals with comorbid symptoms of insomnia and depression reported more insomnia symptom-focused rumination than those with symptoms of insomnia without significant depression symptoms, even when controlling for insomnia and mental health severity. The findings highlight the need for increased clinical attention to the insomnia symptom-focused rumination reported by those with comorbid symptoms of insomnia and depression.

Relationship between Oral Flow Patterns, Nasal Obstruction, and Respiratory Events during Sleep. 855-860.
Masaaki Suzuki, MD, PhD1; Taiji Furukawa, MD, PhD2; Akira Sugimoto, MD, PhD1; Koji Katada, MD, PhD1; Ryosuke Kotani, MD1; Takayuki Yoshizawa, MD, PhD3


Current Knowledge/Study Rationale: The relationship between oral flow (OF) patterns, nasal obstruction, and obstructive respiratory events is unclear. We hypothesized that specific OF patterns are associated with different obstructive events during sleep.

Study Impact: Three distinct OF patterns were identified during sleep, termed postrespiratory event OF, during-respiratory event OF, and spontaneous arousal-related OF. The first two were related to apnea/hypopnea and were the typical patterns observed in patients with moderate to severe sleep disordered breathing (SDB);, by contrast, spontaneous arousal-related OF was associated with nasal obstruction, observed mainly in normal subjects and patients with mild SDB, and prevented apnea/hypopnea by bypassing nasal obstruction.

Oral Appliance Treatment Response and Polysomnographic Phenotypes of Obstructive Sleep Apnea. 861-868.
Kate Sutherland, PhD1,2; Hisashi Takaya, MD3; Jin Qian, MBiomedEng4; Peter Petocz, PhD5; Andrew T. Ng, MBBS, PhD4; Peter A. Cistulli, MD, PhD1,2


Current Knowledge/Study Rationale: Not all OSA patients respond to oral appliance therapy and predictors such as younger age, less obesity, female gender, milder OSA, and supine-dependent OSA have variously been associated with treatment success. Readily available demographic, anthropometric, and polysomnographic patient data may provide a simple means to triage patients for this form of therapy and requires investigation in large datasets.

Study Impact: In an analysis of a large cohort of patients treated with oral appliance through clinical trials, we find lower treatment response rates in supine and REM sleep. We confirm that patient characteristics of younger age and less obesity (but not gender) are associated with treatment response, but these prediction models do not have sufficient accuracy for clinical practice, and hence alternative prediction methods are needed, particularly as up to a quarter of severe patients could be completely treated by this therapy alone.

Psychometric Properties of the Pittsburgh Sleep Quality Index (PSQI) in a Cohort of Peruvian Pregnant Women. 869-877.
Qiu-Yue Zhong, ScM1; Bizu Gelaye, PhD, MPH1; Sixto E. Sánchez, MD, MPH2,3; Michelle A. Williams, ScD1


Current Knowledge/Study Rationale: The Pittsburgh Sleep Quality Index (PSQI) has been established as a valid scale with acceptable psychometric properties when used in men and non-pregnant women in diverse global settings. However, few studies have assessed the reliability and validity of this scale in pregnant women, among whom disturbed sleep and poor sleep quality are common complaints; even fewer have assessed the psychometric properties of the scale when used among women from low- and middle-income countries, where sleep, mood, and anxiety disorders are highly prevalent and comorbid.

Study Impact: This is the first study that evaluates the construct validity and factor structure of the Spanish-language version of the PSQI among low-income, pregnant Peruvian women. Our results indicate that the Spanish-language version of the PSQI is appropriate for clinical research use with good construct validity for pregnant women during the first trimester of pregnancy; additional research designed to more thoroughly assess the comparative effectiveness of using a three, factor-specific scoring of the PSQI versus the generally favored single global score of PSQI is indicated.

Article Is Eligible For CME Credits Adverse Effects of Daylight Saving Time on Adolescents' Sleep and Vigilance. 879-884.
Diana Medina1; Matthew Ebben, PhD1; Sara Milrad, BA1; Brianna Atkinson, BA2; Ana C. Krieger, MD, MPH1


Current Knowledge/Study Rationale: Daylight Saving Time (DST) is a common practice in the developed world. However, the potential adverse effects of DST on our increasingly sleep deprived young population have not been consistently evaluated using objective measures. The onset of DST occurs early in March in the United States. Despite its proposed economic benefits, detailed analyses of potentially adverse health effects due to DST-related sleep restriction and decreased vigilance on the subsequent days have not been previously reported.

Study Impact: Our study highlights a significant sleep loss associated with DST implementation in a group of high school students leading to decreased vigilance and increased daytime sleepiness on the post-DST weekdays as compared to pre-DST levels. Larger scale evaluations of sleep impairments related to DST are needed to further quantify this problem. If confirmed, measures to attenuate the effects of sleep loss post-DST should be implemented.

Altered Sleep Stage Transitions of REM Sleep: A Novel and Stable Biomarker of Narcolepsy. 885-894.
Yaping Liu, MD1; Jihui Zhang, MD, PhD1; Venny Lam, RPSGT1; Crover Kwok Wah Ho, RPSGT1; Junying Zhou, MD, PhD1,2; Shirley Xin Li, PhD1; Siu Ping Lam, MRCPsych, FHKAM (Psych)1; Mandy Wai Man Yu, MPH, RPSGT1; Xiangdong Tang, MD, PhD2; Yun-Kwok Wing, FRCPsych, FHKAM (Psych)1


Current Knowledge/Study Rationale: Recent data suggested that altered sleep stage transition of REM sleep might be able to differentiate narcolepsy from other hypersomnias, but its longitudinal stability and association with HLA typing are unclear.

Study Impact: Altered sleep stage transition from stage non-N2/N3 to stage R has good sensitivity and specificity in diagnosing narcolepsy especially with the help of additional sleep variables in the decision tree analysis, which suggests its clinical utility in the differential diagnosis of hypersomnias. The longitudinal stability and association with HLA DBQ1*0602 further demonstrates that altered sleep stage transition is a trait marker of the instability of NREM-REM sleep regulation in narcolepsy.

Among Metabolic Factors, Significance of Fasting and Postprandial Increases in Acyl and Desacyl Ghrelin and the Acyl/Desacyl Ratio in Obstructive Sleep Apnea before and after Treatment. 895-905.
Yuichi Chihara, MD, PhD1; Takashi Akamizu, MD, PhD2; Masanori Azuma, MD1; Kimihiko Murase, MD, PhD1; Yuka Harada, MD, PhD1; Kiminobu Tanizawa, MD, PhD3; Tomohiro Handa, MD, PhD1; Toru Oga, MD, PhD3; Michiaki Mishima, MD, PhD1; Kazuo Chin, MD, PhD3


Current Knowledge/Study Rationale: It is said that there is a reciprocal interaction between obesity and obstructive sleep apnea (OSA). A few studies have shown that the treatment of OSA with continuous positive airway pressure (CPAP) is associated with a significant reduction in body mass index (BMI), while other studies have found a significant increase in BMI following CPAP treatment. It is important to consider the changes in BMI, physical activity, and neurohormonal mechanisms that induce satiety and hunger.

Study Impact: From the simultaneous measurements of 7 appetite-related factors (acyl ghrelin (AG), desacyl ghrelin (DAG), leptin, insulin, glucose, acyl/desacyl and acyl/insulin ratios) in fasting and postprandial stages before and after CPAP treatment, it was found that ghrelin-related factors had the strongest associations with moderate-to-severe OSA. The elevations in the blood ghrelin-related factors did not improve completely following 3 months of CPAP treatments.

Preoperative Sleep Disruption and Postoperative Delirium. 907-913.
Jacqueline M. Leung, MD, MPH1; Laura P. Sands, PhD2; Stacey Newman, BA1; Gabriela Meckler, BS1; Yimeng Xie, MS2; Caryl Gay, PhD3; Kathryn Lee, RN, PhD3


Current Knowledge/Study Rationale: Sleep disruption has frequently been cited as an important etiological factor associated with the development of delirium. It is not clear if the sleep disruption began immediately after surgery or if sleep problems were preexisting.

Study Impact: Our novel finding of sleep disruption beginning before surgery provides important guidance for clinical assessment and interventions to improve sleep before surgery. Specifically, future work should target the etiology of nocturnal wake time in the period immediately before the planned surgery.

Review Articles

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?. 915-924.
Bisher Abuyassin, MSc1; Kumar Sharma, MD2; Najib T. Ayas, MD3; Ismail Laher, PhD1

Special Articles

Dealing with a Paradigm Shift. 925-929.
Allan I. Pack, MBChB, PhD
Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. 931-952.
Consensus Conference Panel: Nathaniel F. Watson, MD, MSc, Moderator1; M. Safwan Badr, MD2; Gregory Belenky, MD3; Donald L. Bliwise, PhD4; Orfeu M. Buxton, PhD5; Daniel Buysse, MD6; David F. Dinges, PhD7; James Gangwisch, PhD8; Michael A. Grandner, PhD, MSTR, CBSM7; Clete Kushida, MD, PhD9; Raman K. Malhotra, MD10; Jennifer L. Martin, PhD11; Sanjay R. Patel, MD, MSc12; Stuart F. Quan, MD12; Esra Tasali, MD13
Non-Participating Observers: Michael Twery, PhD14,*; Janet B. Croft, PhD15,*; Elise Maher, RPSGT16,*
American Academy of Sleep Medicine Staff: Jerome A. Barrett17; Sherene M. Thomas, PhD17; Jonathan L. Heald, MA17

Case Reports

Sleep Related Hypermotor Seizures with a Right Parietal Onset. 953-955.
Steve A. Gibbs, MD, PhD; Michela Figorilli, MD; Giuseppe Casaceli, MD; Paola Proserpio, MD; Lino Nobili, MD, PhD

Letter to the Editor

Social Support and Sleep Symptoms in US Adults. 957.
Clarence Glenn; Ngozi Enwerem, MD; Yewande Odeyemi, , MD; Alem Mehari, MD; Richard F. Gillum, MD

Book Review

Insomniac. 959-960.
Frank M. Ralls, MD1,3; Swala K. Abrams, MD2,4
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