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Commentary

Does Surgery for Obstructive Sleep Apnea Provide Value?. 509-510.
Richard Kim, MD1; Raj C. Dedhia, MD, MS1,2; Vishesh K. Kapur, MD, MPH1
And the Patient Said: “Let Me Be Able to Breathe and Dream”. 511-512.
Francesco Fanfulla, MD1; Pierluigi Carratù, MD2

Scientific Investigations

Obstructive Sleep Apnea and Posttraumatic Stress Disorder among OEF/OIF/OND Veterans. 513-518.
Peter J. Colvonen, PhD1,2; Tonya Masino, MD1; Sean P.A. Drummond, PhD1,2,3; Ursula S. Myers, MS3; Abigail C. Angkaw, PhD1,2,3; Sonya B. Norman, PhD1,2,3,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: This study examined the relationship between posttraumatic stress disorder and screening as high risk for obstructive sleep apnea in a younger veteran population. OSA prevalence is higher in individuals with PTSD than without. However there is a dearth of information on the relationship between PTSD and OSA among younger veterans with PTSD.

Study Impact: Younger veterans with PTSD screen positive for OSA at much higher rates than those seen in community studies and may not show all classic predictors of OSA (i.e., older and higher BMI). Our findings suggest making screening of younger veterans with PTSD for OSA standard care and that polysomnography and OSA intervention should be available to younger veterans.

Protective Effect of Long-Term CPAP Therapy on Cognitive Performance in Elderly Patients with Severe OSA: The PROOF Study. 519-524.
Emilie Crawford-Achour, PhD1,2; Virginie Dauphinot, PhD3; Magali Saint Martin, PhD4; Magali Tardy, MD5; Régis Gonthier, PhD2; Jean Claude Barthelemy, PhD1; Frédéric Roche, PhD1,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep apnea is underdiag-nosed and undertreated in the elderly population considering the severe induced complications. This may be partly due the lack of knowledge of CPAP therapy beneficial effects and clinical tolerance.

Study Impact: This study shows that CPAP therapy may protect cognitive functions deteriorated by OSA, particularly the similarities from the Wais III test, along with good clinical self-reported compliance.

A Cost-Effectiveness Analysis of Surgery for Middle-Aged Men with Severe Obstructive Sleep Apnea Intolerant of CPAP. 525-535.
Kelvin B. Tan, PhD1,2; Song Tar Toh, MBBS, MMED(ORL), FAMS(ORL)3; Christian Guilleminault, MD, DBiol4; Jon-Erik C. Holty, MD, MS2,5

BRIEF SUMMARY

Current Knowledge/Study Rationale: Indications for the surgical modification of the upper airway to treat OSA are controversial given modest and inconsistent post-surgical results. We evaluate the tradeoff between imperfect surgical success versus no therapy in patients intolerant of CPAP with severe OSA utilizing a cost-effectiveness model.

Study Impact: Palatopharyngeal reconstructive surgery appears cost-effective (compared to no therapy) in middle-aged men with severe OSA intolerant of CPAP (ICER $10,421/QALY), with our model utilizing a 16% PPRS cure rate, 52% success rate, 2.5% surgical complication rate, 0.2% surgical mortality rate, and an 11% annual decay rate for surgical success and/or cure.

REM Sleep Behavioral Events and Dreaming. 537-541.
Maria-Lucia Muntean, MD1,2; Claudia Trenkwalder, MD1,3; Arthur S. Walters, MD4; Brit Mollenhauer, MD1,3; Friederike Sixel-Döring, MD1,5

BRIEF SUMMARY

Current Knowledge/Study Rationale: The study was performed to further elucidate the role of motor behaviors and/or vocalizations during REM sleep not fulfilling diagnostic criteria for REM sleep behavior disorder (RBD) and therefore defined as REM sleep behavioral events (RBE) in early Parkinson disease (PD). We sought to clarify whether RBE correspond to dream enactments.

Study Impact: As REM sleep behavioral events (RBE) have been identified as a marker for early recognition of neurodegeneration, identification of RBE as enactments of non-threatening dreams will impact the search for biomarkers in pre-motor Parkinson disease (PD). Furthermore our findings support the concept of RBE as a possible precursor to REM sleep behavior disorder (RBD).

Risk of Psychiatric Disorders in Patients with Chronic Insomnia and Sedative-Hypnotic Prescription: A Nationwide Population-Based Follow-Up Study. 543-551.
Kuo-Hsuan Chung, MD1,2,3; Chung-Yi Li, PhD4,5; Shu-Yu Kuo, RN, PhD6; Trevor Sithole, RN, MSN7,8; Wen-Wei Liu, BS9; Min-Huey Chung, RN, PhD9

BRIEF SUMMARY

Current Knowledge/Study Rationale: Evidence has demonstrated that chronic insomnia may be associated with psychiatric comorbidi-ties. However, the relationship between them is complex and includes bidirectional causation. In this study, we explored if we could identify whether there is an increased risk for emergence of psychiatric disorders among insomniacs with sedative-hypnotic prescriptions.

Study Impact: To our knowledge, this is the first nationwide population study using a historical cohort design to demonstrate that chronic Insomnia with sedative-hypnotics are risk factors for most common psychiatric disorders. These results led to the concept that chronic insomnia may have a common etiological or pathogenic influence on many psychiatric disorders.

Article Is Eligible For CME Credits Sleep Disorders in Patients with Multiple Sclerosis. 553-557.
Zuzana Čarnická, MD; Branislav Kollár, MD, PhD; Pavel Šiarnik, MD; Lucia Krížová, MD; Katarína Klobučníková, MD, PhD; Peter Turčáni, MD, PhD

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep disorders remain often under-diagnosed in patients with MS, although they are frequent and have negative effect on overall health and quality of life. The aim of this study was to assess the relationship between nocturnal polysomno-graphic findings and a group of self-reported symptoms (quality of sleep, fatigue, and increased daytime sleepiness) among patients with MS.

Study Impact: Presence of restless legs syndrome seems to be the main factor determining poor sleep, fatigue, and daytime somnolence, sleep disordered breathing; its severity influences only fatigue in patients with MS. Targeted diagnosis and treatment of these disorders can help to improve overall care of MS patients.

Article Is Eligible For CME Credits Noninvasive Ventilation Improves Sleep in Amyotrophic Lateral Sclerosis: A Prospective Polysomnographic Study. 559-566.
Bart Vrijsen, PT, MSc1,2; Bertien Buyse, MD, PhD1,2; Catharina Belge, MD, PhD1,2; Wim Robberecht, MD, PhD3,4; Philip Van Damme, MD, PhD3,4,5; Marc Decramer, MD, PhD2; Dries Testelmans, MD, PhD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Previous research has shown an improvement in survival and quality of life after initiation of NIV in ALS. Until now, no improvement in objective sleep parameters has been found; however, NIV was titrated during daytime. More detailed titration with polysomnography could perhaps improve quality of sleep.

Study Impact: This study shows that NIV titration with polysomnography improves objective sleep outcomes in ALS patients. Hence, meticulous titration of NIV has an important clinical impact in this patient group. Further research is necessary to create evidence to find the correct time to start NIV in bulbar ALS patients.

Mandibular Movements Identify Respiratory Effort in Pediatric Obstructive Sleep Apnea. 567-574.
Jean-Benoît Martinot, MD1; Fréderic Senny, PhD2; Stéphane Denison, MSc1; Valérie Cuthbert, MSc1; Emmanuelle Gueulette, MD1; Hervé Guénard, MD, PhD3; Jean-Louis Pépin, MD, PhD4

BRIEF SUMMARY

Current Knowledge/Study Rationale: The aim of the study was to explore the relationship between the mandibular movements observed during sleep in children with adenotonsillar hypertrophy and the presence of a respiratory effort assessed with the pulse transit time measurement.

Study Impact: Mandibular movements analysis is helpful to detect respiratory effort during sleep in children with upper airway obstruction. It could be considered as a sensitive tool to identify and characterise sleep disordered breathing in a simple way.

Review Articles

Bone Loss in Obesity and Obstructive Sleep Apnea: A Review of Literature. 575-580.
Marlene Chakhtoura, MD1; Mona Nasrallah, MD1; Hassan Chami, MD, MSc2,3

Case Reports

Hypothalamic-Amygdalar-Brainstem Volume Reduction in a Patient with Narcolepsy Secondary to Diffuse Axonal Injury. 581-582.
Walid Yassin, BSc1; Genichi Sugihara, MD, PhD1; Naoya Oishi, MD, PhD2; Manabu Kubota, MD, PhD1; Shiho Ubukata, PhD1; Toshiya Murai, MD, PhD1; Keita Ueda, MD, PhD1
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