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Accepted Papers

Scientific Investigations

Article Is Eligible For CME Credits Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort. 355-362.
Nathaniel S. Marshall, Ph.D.1,2; Keith K.H. Wong, MB.BS., Ph.D.1,3; Stewart R.J. Cullen, MB.BS.4; Matthew W. Knuiman, Ph.D.5; Ronald R. Grunstein, M.D., Ph.D.1,3


Current Knowledge/Study Rationale: Obstructive sleep apnea is known to increase the risk for mortality stroke and more recently cancer in studies from Spain and the USA. Further data are needed to ascertain confirm the cancer association, the significance of mild OSA and the potential long-term effects of OSA on women.

Study Impact: Sleep apnea is an important disease of public health significance that increases mortality, stroke and cancer risk in a community-based population. Mild OSA does not appear to increase mortality risk and may even protect people from the effects of other established risk factors.

Blood Pressure Improvement with Continuous Positive Airway Pressure is Independent of Obstructive Sleep Apnea Severity. 365-369.
Jessie P. Bakker, Ph.D.1; Bradley A. Edwards, Ph.D.1; Shiva P. Gautam2; Sydney B. Montesi, M.D.3; Joaquín Durán-Cantolla, M.D., Ph.D.4; Felipe Aizpuru Barandiarán, M.D.4; Ferran Barbé, M.D., Ph.D.5; Manuel Sánchez-de-la-Torre, Ph.D.5; Atul Malhotra, M.D., F.A.A.S.M.1,3


Current Knowledge/Study Rationale: The extent to which positive airway pressure therapy can reduce blood pressure has been difficult to discern based on individual randomized controlled trials. This investigation was performed in order to identify which patient subgroups are more likely to experience a substantial reduction in blood pressure with treatment.

Study Impact: Our findings suggest that patients with uncontrolled hypertension are likely to experience the largest reduction in blood pressure with positive airway pressure therapy, after controlling for disease severity and daytime sleepiness. This finding has direct clinical relevance, in that it suggests that even patients with mild/moderate disease who do not report hypersomnolence are likely to benefit from treatment.

Is Technologist Review of Raw Data Necessary after Home Studies for Sleep Apnea?. 371-375.
Devin L. Brown, M.D.1; Ronald D. Chervin, M.D., M.S., F.A.A.S.M.2; Garnett Hegeman2; Melinda A. Smith, Dr.P.H.1; Nelda M. Garcia, B.S.1; Lewis B. Morgenstern, M.D.1,2; Lynda D. Lisabeth, Ph.D.1,2


Current Knowledge/Study Rationale: The value of a polysomnographic technologist's review of raw data from a portable respiratory monitor is unknown. This study compared results from a commonly used portable respiratory monitor, the ApneaLink Plus, in stroke patients, before and after raw data were edited by a polysomnographic technologist.

Study Impact: This study showed that for cohorts of stroke patients, ApneaLink Plus data may be used without the added expense and time consumption of data review and edit by a polysomnographic technologist. However, if results of the ApneaLink Plus are to be used for decisions about an individual patient, for clinical or research purposes, edits by a polysomnographic technologist to the raw data should be undertaken, and will lead to a higher proportion of positive screening test results.

Effect of Addition of Chin Strap on PAP Compliance, Nightly Duration of Use, and Other Factors. 377-383.
Shelley R. Knowles, M.D., F.A.A.S.M.1; Daniel T. O'Brien, PA-C, MPAS, BS2; Shiling Zhang, M.A.3; Anupama Devara, M.D.3; James A. Rowley, M.D., F.A.A.S.M.4


Current Knowledge/Study Rationale: Achieving good positive airway pressure (PAP) adherence in OSA patients is a challenge. The purpose of the current study was to identify whether addition of a chin strap to PAP therapy may be beneficial in increasing PAP adherence.

Study Impact: This is the first outpatient study to specifically demonstrate the positive impact of chin strap use on leak and adherence to PAP therapy. The findings suggest that a chin strap should be routinely prescribed as part of PAP therapy, to improve adherence.

Nasopharyngeal Tube: A Simple and Effective Tool to Screen Patients Indicated for Glossopharyngeal Surgery. 385-389.
Shuhua Li, M.D.1; Dahai Wu, M.S.1; Jimin Bao, M.D.2; Jie Qin, M.S.1


Current Knowledge/Study Rationale: The glossopharyngeal airway is the second most commonly obstructed site in adult obstructive sleep apnea hypopnea syndrome (OSAHS). However, the diagnosis of glossopharyngeal obstruction is challenging. The aim of this study was to explore the diagnostic value of repeated polysomnography following insertion of a nasopharyngeal tube (NPT-PSG) in the setting of glossopharyngeal obstruction in OSAHS.

Study Impact: NPT-PSG is a simple and effective tool used to screen patients who are indicated for glossopharyngeal surgery. Patients with moderate-to-severe OSAHS diagnosed by NPT-PSG generally present with glossopharyngeal airway obstruction. Glossopharyngeal surgery can significantly improve surgical outcomes in the setting of OSAHS.

High Hypopnea/Apnea Ratio (HAR) in Extreme Obesity. 391-396.
Reeba Mathew, M.D.1,2; Richard J. Castriotta, M.D., F.A.A.S.M.1,2


Current Knowledge/Study Rationale: Different pathophysiological mechanisms may underlie the generation of apneas (static obstruction) and hypopneas (dynamic obstruction). These different mechanisms appear to be reflected in those with extreme obesity (BMI ≥ 45 kg/m2), who exhibit sleep disordered breathing with very high numbers of hypopneas and relatively few apneas.

Study Impact: This study confirms the high hypopnea/apnea ratio (HAR) in extremely obese subjects with obstructive sleep apnea. This is a consequence of very high BMI and is independent of gender, race or the presence of obesity-hypoventilation syndrome. This supports the possibility of different mechanisms in the generation of hypopneas and apneas, and may lead to specific goal-directed therapy aimed at those with hypopnea-dominated sleep disordered breathing.

Comparison of BMI, AHI, and Apolipoprotein E ε4 (APOE-ε4) Alleles among Sleep Apnea Patients with Different Skeletal Classifications. 397-402.
Jason J. Roedig, D.M.D.1; Barbara A. Phillips, M.D., M.S.P.H, F.A.A.S.M.2; Lorri A. Morford, Ph.D.1; Joseph E. Van Sickels, D.D.S.1; Gabriel Falcao-Alencar, M.S.1; David W. Fardo, Ph.D.3; James K. Hartsfield, D.M.D., M.S., M.M.Sc., Ph.D.1,2; Xiuhua Ding, M.S.3; G. Thomas Kluemper, D.M.D., M.S.1


Current Knowledge/Study Rationale: Although BMI is strongly correlated with OSA, there are individuals with other risk factors. This study was done to see if APOE-ε gene variants and/or facial profile were associated with differences in AHI or BMI in OSA patients.

Study Impact: A convex facial profile is associated with OSA even in non-obese patients, indicating that facial profile could be an important tool in risk assessment. Other non-obesity OSA factors such genetic variation need to be further explored.

Prader Willi Syndrome and Obstructive Sleep Apnea: Co-occurrence in the Pediatric Population. 403-409.
Karim Sedky, M.D., M.Sc.1; David S. Bennett, Ph.D.2; Andres Pumariega, M.D.1


Current Knowledge/Study Rationale: Prevalence rates of OSA are high among children with PWS, but vary greatly across studies. It is unknown if factors such as age, gender, body mass index, or type of genetic imprinting are related to OSA risk among children with PWS. It is not clear if AT has the same curative effects in children with PWS as compared to the general population. Thus, this study assessed changes in the prevalence of OSA following AT. Controversies about the prevalence of narcolepsy also exist in this population.

Study Impact: Since there is a high prevalence of OSA among PWS patients, routine screening for OSA by PSG is essential for early detection and treatment of this disorder. Although AT is often a curative treatment for children with OSA, it might not be as effective for children with PWS. Thus, post-AT PSG is essential to assess the OSA severity and to consider additional treatment if required. Screening for narcolepsy in this population is also essential after resolution of OSA since there is a high prevalence.

High Prevalence of Sleep Disorders and Associated Comorbidities in a Community Sample of Children with Down Syndrome. 411-419.
Claire A. Hoffmire, Ph.D.1; Caroline I. Magyar, Ph.D.2; Heidi V. Connolly, M.D., F.A.A.S.M.2; I. Diana Fernandez, M.D., Ph.D.3; Edwin van Wijngaarden, Ph.D.3


Current Knowledge/Study Rationale: Children with Down syndrome are believed to experience significant sleep problems, especially obstructive sleep apnea syndrome. Further research is needed, however, to examine a broader range of sleep problems in population-based samples of children with DS and to determine if sleep problems vary by the pattern of comorbidities a child with DS experiences.

Study Impact: This study suggests that sleep problems beyond obstructive sleep apnea, such as behavioral and sleep related movement problems greatly impact children with DS. Optimal physician monitoring of individuals with DS could benefit from more comprehensive evaluations of sleep in this population across childhood and adolescence

Article Is Eligible For CME Credits Sleep Problems and Sleep Disorders in Pediatric Primary Care: Treatment Recommendations, Persistence, and Health Care Utilization. 421-426.
Lisa J. Meltzer, Ph.D.1; Melissa R. Plaufcan, Ph.D.2; Jocelyn H. Thomas, Ph.D.3; Jodi A. Mindell, Ph.D.4


Current Knowledge/Study Rationale: Sleep issues are common in children and adolescents, yet often are overlooked in pediatric primary care. Pediatric primary care providers receive little, if any, training on the diagnosis and treatment of sleep issues.

Study Impact: Sleep disorders and sleep problems persist across time for many children, and children with untreated sleep issues have more physician contacts and visits. Additional education and resources (e.g., toolkit) are needed to assist primary pediatric health care providers in recognizing and treating common pediatric sleep issues.

The Link between Sleep Disturbance and Depression among Mexican Americans: A Project FRONTIER Study. 427-431.
Brandy M. Roane, Ph.D.1; Leigh Johnson, Ph.D.1,2,3; Melissa Edwards, M.A.2,3; James Hall, Ph.D.2,3; Sherif Al-Farra, M.D.1; Sid E. O'Bryant, Ph.D.1,2,3


Current Knowledge/Study Rationale: While the Mexican American population has grown exponentially, the literature to inform practitioners about the prevalence and comorbid conditions within this population has not kept pace. To date, little is known about sleep and its association with depression among Mexican Americans.

Study Impact: While sleep disturbance and depression rates were associated in both Mexican Americans and non-Hispanic whites, their prevalence was higher among Mexican American adults. These findings highlight the need to better understand (a) the prevalence of specific sleep disorders, (b) the relationship between disturbed sleep and mental health, and (c) how these conditions may be modified in order to improve health outcomes among Mexican Americans.

Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial. 433-439.
Shinji Shimodera, M.D., Ph.D.1; Norio Watanabe, M.D., Ph.D.2,3; Toshi A. Furukawa, M.D., Ph.D.4; Fujika Katsuki, R.N., Ph.D.5; Hirokazu Fujita, M.D., Ph.D.1; Megumi Sasaki, Ph.D.6; Michael L. Perlis, Ph.D.7


Current Knowledge/Study Rationale: The efficacy of cognitive behavioral therapy for insomnia (CBT-I) has been suggested for insomnia concomitant with depression. However, its impact on quality of life (QoL) has not been adequately evaluated.

Study Impact: For patients with insomnia in depression, adding CBT-I to TAU can produce substantive benefits in some aspects of QoL. Patients with either remitted insomnia or depression showed higher QoL scores than non-remitted patients.


Emerging from the Shadows: A Possible Link between Sleep Apnea and Cancer. 363-364.
Richard Kim, M.D.; Vishesh K. Kapur, M.D., M.P.H.

Case Reports

CPAP Therapy Reverses Weakness of Myasthenia Gravis: Role of Obstructive Sleep Apnea in Paradoxical Weakness of Myasthenia Gravis. 441-442.
Ki-Hwan Ji, M.D.1; Jong Seok Bae, M.D., Ph.D.2
Sleep-Wake Pattern Following Gunshot Suprachiasmatic Damage. 443-445.
Lourdes M. DelRosso, M.D.1,2; Romy Hoque, M.D.1; Stephanie James, M.D2; Eduardo Gonzalez-Toledo, M.D. Ph.D.1,3; Andrew L. Chesson, M.D., F.A.A.S.M.1

Special Articles

The American Academy of Sleep Medicine Inter-scorer Reliability Program: Respiratory Events. 447-454.
Richard S. Rosenberg, Ph.D., F.A.A.S.M.1; Steven Van Hout, B.S.2

Board Review Corner

Nocturnal Arousals in a Middle-Aged Woman. 455-456.
Salma Batool-Anwar, M.D., M.P.H.1; Stuart F. Quan, M.D., F.A.A.S.M.1,2

Letter to the Editor

Further Experience using Clarithromycin in Patients with Kleine-Levin Syndrome. 457-458.
Lynn Marie Trotti, M.D., M.Sc.; Donald L. Bliwise, Ph.D., F.A.A.S.M.; David B. Rye, M.D., Ph.D., F.A.A.S.M.
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April 15, 2014
Volume 10, Issue 04

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