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Accepted Papers

Scientific Investigations

Article Is Eligible For CME Credits Impact of Windows and Daylight Exposure on Overall Health and Sleep Quality of Office Workers: A Case-Control Pilot Study. 603-611.
Mohamed Boubekri, Ph.D.1; Ivy N. Cheung, B.A.2; Kathryn J. Reid, Ph.D.2; Chia-Hui Wang1,3; Phyllis C. Zee, M.D., Ph.D., F.A.A.S.M.2


Current Knowledge/Study Rationale: Both the amount and timing of light exposure is important for physical and mental health. While research indicates possible links between light exposure in workplaces and workers' productivity and performance, less is known about the role of workplace light exposure on workers' quality of life and sleep quality.

Study Impact: Office workers with more light exposure at the workplace tended to have longer sleep duration, better sleep quality, more physical activity, and better quality of life compared to office workers with less light exposure at the workplace. Office workers' physical and mental well-being may be improved via enhanced indoor lighting for those with insufficient daylight in current offices as well as increased emphasis on light exposure in the design of future offices.

Associations between Sleep Duration, Sleep Quality, and Cognitive Test Performance among Older Adults from Six Middle Income Countries: Results from the Study on Global Ageing and Adult Health (SAGE). 613-621.
Theresa E. Gildner, M.S.1; Melissa A. Liebert, M.S.1; Paul Kowal, Pharm.D.2,3; Somnath Chatterji, M.D.2; J. Josh Snodgrass, Ph.D.1


Current Knowledge/Study Rationale: Few studies have assessed the contribution of sleep quality and quantity to cognitive performance in older adults, especially in non-Western populations. A comprehensive understanding of all factors influencing mental acuity is essential in the design of disease-modifying therapies.

Study Impact: This study evaluated associations between measures of sleep and cognitive performance using large nationally representative samples of older adults drawn from six middle-income countries, providing a unique examination of this relationship. Enhanced cognitive functioning was significantly associated with intermediate sleep duration and higher sleep quality, suggesting that sleep measures may influence cognitive performance in older individuals from different countries.

A Prospective Questionnaire Study in 100 Healthy Sleepers: Non-Bothersome Forms of Recognizable Sleep Disorders Are Still Present. 623-629.
Birgit Frauscher, M.D.1; Thomas Mitterling, M.D.1; Aleke Bode1; Laura Ehrmann, M.D.1; David Gabelia, M.D.1; Marlene Biermayr1; Arthur Scott Walters, M.D., F.A.A.S.M.2; Werner Poewe, M.D.1; Birgit Högl, M.D.1


Current Knowledge/Study Rationale: Despite several polysomnographic studies on sleep and multiple large surveys of sleep disorders in the general population, survey data on healthy sleepers are largely lacking. Further knowledge on sleep in healthy sleepers, however, would be of interest considering the significant negative impact of poor sleep on quality of life and physical health.

Study Impact: In this population of healthy sleepers, occasional snoring, non-bothersome forms of recognizable sleep-related movement disorders, and parasomnias are still surprisingly common. These findings may suggest that diagnostic criteria of sleep disorders should not only be based on the presence of symptoms but also account for a minimum frequency or discomfort.

The Effect of Continuous Positive Air Pressure (CPAP) on Nightmares in Patients with Posttraumatic Stress Disorder (PTSD) and Obstructive Sleep Apnea (OSA). 631-636.
Sadeka Tamanna, M.D., M.P.H.1,2; Jefferson D. Parker, Ph.D.1,3; Judith Lyons, Ph.D.1; M. I. Ullah, M.D., M.P.H.1,2


Current Knowledge/Study Rationale: Post-Traumatic Stress Disorder (PTSD) is increasingly prevalent among Veterans characterized by recurrent nightmares. Veterans with PTSD also have a high prevalence of obstructive sleep apnea (OSA) and untreated OSA worsens the sleep-related symptoms of PTSD.

Study Impact: Our study shows that the Veterans with concurrent PTSD and OSA, CPAP therapy reduces PTSD-associated nightmares and improves overall PTSD symptoms. Screening of all PTSD afflicted Veterans for OSA symptoms and treating them with CPAP as appropriate will improve the overall quality of life of these patients.

Adaptive Servoventilation for Treatment of Opioid-Associated Central Sleep Apnea. 637-643.
Shahrokh Javaheri, M.D., F.A.A.S.M.1; Nicholas Harris1; Joseph Howard1; Eugene Chung, M.D.2


Current Knowledge/Study Rationale: The main aim of this study was to determine the efficacy of positive airway pressure devices for treatment of sleep apnea associated with the use of opioids.

Study Impact: The results of the study show that CPAP is ineffective in treatment of CSA due to opioids, whereas new adaptive servoventilation devices are quite helpful with acceptable long-term adherence and efficacy.

Individual Variability and Predictors of Driving Simulator Impairment in Patients with Obstructive Sleep Apnea. 647-655.
Andrew Vakulin, Ph.D.1,2,3; Peter G. Catcheside, Ph.D.1,3; Stuart D. Baulk, Ph.D.1,4; Nick A. Antic, M.B.B.S., Ph.D.1,3; Siobhan Banks, Ph.D.5; Jillian Dorrian, Ph.D.5; R. Doug McEvoy, M.D.1,3


Current Knowledge/Study Rationale: Obstructive sleep apnea is linked with neurobehavioral abnormalities, poor driving performance and elevated accident risk. However there is large inter-individual variability in daytime neurobehavioral function and the proportion of patients exhibiting driving abnormalities is unclear. This makes clinical identification of patients at risk of impairment and decisions regarding driving ability and accident risk difficult on an individual patient level.

Study Impact: The majority (60%) of patients with obstructive sleep apnea appear to be “resilient” to the sleep disruption caused by OSA and perform a driving simulation task comparable to controls, even after further provocation by sleep loss or alcohol. Routine clinical measures do not discriminate between the resilient and vulnerable patient groups, although shorter self-reported weekly driving exposure and increased cortical activation, potentially in response to chronic sleep disruption, appear to predict poor driving performance.

Article Is Eligible For CME Credits Obstructive Sleep Apnea, Obesity, and the Development of Acute Respiratory Distress Syndrome. 657-662.
Lioudmila V. Karnatovskaia, M.D.1; Augustine S. Lee, M.D.1; S. Patrick Bender, M.D.2; Daniel Talmor, M.D.3; Emir Festic, M.D.1


Current Knowledge/Study Rationale: OSA and obesity are known risk factors for respiratory complications/ARDS following surgery. It is unclear whether OSA independently contributes towards the risk of ARDS among all hospitalized patients.

Study Impact: Among patients with at least one predisposing condition, diagnosis of OSA prior to hospitalization did not independently affect the risk of progression to ARDS. Obesity appeared to independently increase the risk of ARDS.

Pilot Study of Nasal Expiratory Positive Airway Pressure Devices for the Treatment of Childhood Obstructive Sleep Apnea Syndrome. 663-669.
Suraiya A. Kureshi, M.B.B.Ch.1,2; Paul R. Gallagher, M.A.3; Joseph M. McDonough, M.S.1; Mary Anne Cornaglia1; Jill Maggs, Ed.D., M.Med.Sci.1; John Samuel, B.S.1; Joel Traylor, B.S.1; Carole L. Marcus, M.B.B.Ch., F.A.A.S.M.1


Current Knowledge/Study Rationale: Alternative therapies for children with obstructive sleep apnea syndrome (OSAS) are needed since OSAS may persist after adenotonsillectomy, and suboptimal adherence occurs with continuous positive airway pressure (CPAP). We conducted a pilot study to gain preliminary data to determine the efficacy, tolerability, and adherence of nasal expiratory positive airway pressure (NEPAP) devices in children.

Study Impact: This pilot study is the first pediatric study to our knowledge that utilized NEPAP devices for the treatment of OSAS. NEPAP devices may be a potential alternative therapy for OSAS for a small subset of children with persistent OSAS following surgery or those who are not able to tolerate CPAP.

Association between Symptoms of Sleep-Disordered Breathing and Speech in Children with Craniofacial Malformations. 671-676.
Marta Moraleda-Cibrián, M.D.1,2; Mary Berger, M.S.3; Sean P. Edwards, D.D.S., M.D.2; Steven J. Kasten, M.D., M.H.P.E.3; Steven R. Buchman, M.D.3; Louise M. O'Brien, Ph.D., M.S.1,2


Current Knowledge/Study Rationale: Speech difficulties and snoring are common problems in children with craniofacial malformations. These two functions share anatomical structures and likely risk factors. Nevertheless, no study has investigated the association between resonance issues and SDB symptoms in this pediatric population.

Study Impact: Findings from this study demonstrate that children with CFM and hyponasality or reduced/absent nasal emission during speech assessment are at increased risk for SDB symptoms. Given that children with CFM are routinely assessed for speech problems, speech-language pathologists may play a role in identifying children who may benefit from evaluation for SDB.

Oxidative Stress in Children with Obstructive Sleep Apnea Syndrome. 677-681.
Riva Tauman, M.D.1; Lena Lavie, Ph.D.2; Michal Greenfeld, M.D.1; Yakov Sivan, M.D.1


Current Knowledge/Study Rationale: OSA in adults is strongly associated with oxidative stress, a major contributor to cardiovascular morbidity. Studies on oxidative stress in children with OSA are sparse and results are inconclusive.

Study Impact: The results of the present study show that childhood OSA is associated with increased lipid peroxidation, a marker of oxidative stress, and cardiovascular morbidity in a severity-dependent manner. The degree of lipid peroxidation correlates with the degree of intermittent hypoxia.

Validation of Two Depression Screening Instruments in a Sleep Disorders Clinic. 683-688.
Mandy Law, M.B.B.S., B.Med.Sc.(Hons)1; Matthew T. Naughton, M.B.B.S., M.D.1; Arup Dhar, M.B.B.Ch., B.A.O., B.Med.Sc.2; David Barton, M.B.B.S., Ph.D.2; Eli Dabscheck, M.B.B.S., M. Clin. Epi.1


Current Knowledge/Study Rationale: This study as performed be cause depression and anxiety are frequently diagnosed comorbidities in sleep disorder clinics. Despite this, commonly used screening instruments for depression and anxiety have not been validated in this setting.

Study Impact: This study found that the HADS and BDI-FS were robust screening instruments with high concurrent validity. These devices may be rapidly administered to ensure more frequent and accurate detection of psychopathology and help identifying at-risk patients who require further psychiatric evaluation and treatment.


The Epidemic of Opioid Use: Implications for the Sleep Physician. 645-646.
Joyce Lee-Iannotti, M.D.; James M. Parish, M.D.

Case Reports

Intensive Sleep Deprivation and Cognitive Behavioral Therapy for Pharmacotherapy Refractory Insomnia in a Hospitalized Patient. 689-690.
Joshua Breitstein, Psy.D.1; Brandon Penix, D.O.2; Bernard J. Roth, M.D.3; Tristin Baxter, AAS3; Vincent Mysliwiec, M.D., F.A.A.S.M.3
CPAP Treats Muscle Cramps in Patients with Obstructive Sleep Apnea. 691-692.
Andrew J. Westwood, M.D.1; Andrew R. Spector, M.D.2; Sanford H. Auerbach, M.D., F.A.A.S.M.3

Special Articles

Multidisciplinary Sleep Centers: Strategies to Improve Care of Sleep Disorders Patients. 693-697.
Anita Valanju Shelgikar, M.D., F.A.A.S.M.1; Jeffrey S. Durmer, M.D., Ph.D.2; Karen E. Joynt, M.D., M.P.H3; Eric J. Olson, M.D., F.A.A.S.M.4; Heidi Riney, M.D.2; Paul Valentine5

Board Review Corner

A Case of Insomnia in an Elderly Woman. 699-700.
Sandra Horowitz, M.D., F.A.A.S.M.1; Stuart F. Quan, M.D., F.A.A.S.M.2

Letters to the Editor

The Lumpers and Splitters Paradox. 701.
Anthony M. Masi, M.D., F.A.A.S.M.
A RERA by Any Other Name…. 703-704.
Barry Krakow, M.D.1,2,3; Victor A. Ulibarri, B.A.1,2; Natalia D. McIver, B.A.1,2
The “Paradox” Issue. 705.
Nancy Collop, M.D., F.A.A.S.M.
Association between OSA and Severe Fatigue in Patients with Multiple Sclerosis (MS). 707.
Marta Kaminska, M.D., M.Sc.1,2; Daria A. Trojan, M.D., M.Sc.3; R. John Kimoff, M.D.1
Obstructive Sleep Apnea is an Under-Recognized and Consequential Morbidity in Multiple Sclerosis. 709-710.
Tiffany J. Braley, M.D., M.S.1,2; Benjamin M. Segal, M.D.1; Ronald D. Chervin, M.D., M.S., F.A.A.S.M.2
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June 15, 2014
Volume 10, Issue 06

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