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Accepted Papers


Expediting Peer Review: Why Say Yes. 1167.
Stuart F. Quan, M.D., F.A.A.S.M.

Scientific Investigations

Article Is Eligible For CME Credits Adolescent Crash Rates and School Start Times in Two Central Virginia Counties, 2009-2011: A Follow-up Study to a Southeastern Virginia Study, 2007-2008. 1169-1177.
Robert Daniel Vorona, M.D., F.A.A.S.M.1; Mariana Szklo-Coxe, Ph.D.2; Rajan Lamichhane, Ph.D.3; J. Catesby Ware, Ph.D., F.A.A.S.M.1; Ann McNallen, Ph.D.4; David Leszczyszyn, M.D., Ph.D.5


Current Knowledge/Study Rationale: Our previous study of adolescent motor vehicle crash rates in two adjacent, demographically similar Southeastern Virginia cities with markedly different high school start times revealed that the city with earlier start times demonstrated a significantly higher adolescent crash rate for both years 2007 and 2008. Given the need for further research in this field, and to ascertain if previous findings would be replicated, we investigated, in another naturalistic study covering two school years (2009-2010, 2010-2011), whether adolescent crashes in two adjacent, demographically similar Central Virginia counties with distinctly different high school start times would differ, with higher crash rates hypothesized for the county with earlier start times.

Study Impact: Higher teen crash rates occurred in the Central Virginia county with early high school start times, thus not only replicating our earlier work, but also if both studies are considered, demonstrating increased teen crash rates in jurisdictions with earlier starting school systems for four consecutive years. This study adds to existing and emerging work supporting consideration for later high school start times and hopefully contributes to our understanding of preventable motor vehicle crashes in this susceptible population.

Armodafinil for the Treatment of Excessive Sleepiness Associated with Mild or Moderate Closed Traumatic Brain Injury: A 12-Week, Randomized, Double-Blind Study followed by a 12-Month Open-Label Extension. 1181-1191.
Stuart J. Menn, M.D., F.A.A.S.M.1; Ronghua Yang, Ph.D.2; Alan Lankford, Ph.D.3


Current Knowledge/Study Rationale: Excessive sleepiness among post acute traumatic brain injury patients can be extensive and severe, and evidence-based treatment recommendations are limited. Therefore, this study evaluated the efficacy and safety of armodafinil, a wakefulness-promoting agent, for the treatment of excessive sleepiness associated with mild or moderate closed traumatic brain injury.

Study Impact: Patients receiving armodafinil 250 mg demonstrated significant improvement in mean sleep latency from baseline to final visit (measured by the multiple sleep latency test) compared with placebo. Armodafinil treatment was generally well tolerated during the 12-week randomized trial and open-label extension, and no new treatment concerns were identified.

Article Is Eligible For CME Credits Who Is Getting Tested for Obstructive Sleep Apnea Using a Portable Recording System? Test Results from 193,221 Patients. 1193-1198.
Alyssa Cairns, Ph.D.1; Greg Poulos1; Richard Bogan, M.D., F.A.A.S.M.1,2,3


Current Knowledge/Study Rationale: To address some of the concerns about “who” has been tested for OSA using a portable recorder (PR), we aim to describe a large national sample of patients that have been tested for OSA using a leading PR. Findings from this study suggest that providers in the sleep medicine community recognize that appropriate patients to be evaluated by PR for OSA should be high pretest probability without contraindicated comorbidities.

Study Impact: This study suggests that the vast majority of patients tested for OSA using a common PR were at high risk for OSA and had test outcomes in line with said risk (AHI ≥ 5). It also adds to the body of knowledge in reference to prevalence of comorbidities and patient symptoms, and supports the notion that questionnaire-based screening for OSA should always be done in conjunction with a comprehensive sleep evaluation, as all screening instruments have limitations.

Obstructive Sleep Apnea Is Associated with Impaired Exercise Capacity: A Cross-Sectional Study. 1199-1204.
Jeremy R. Beitler, M.D.1; Karim M. Awad, M.D.4; Jessie P. Bakker, Ph.D.2; Bradley A. Edwards, Ph.D.2; Pam DeYoung, B.A.5; Ina Djonlagic, M.D.2; Daniel E. Forman, M.D.3; Stuart F. Quan, M.D., F.A.A.S.M.2,6; Atul Malhotra, M.D., F.A.A.S.M.5


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular events. Cardiopulmo-nary exercise testing aids in prognostic assessment of heart disease, raising interest in its utility for cardiovascular risk stratification in patients with OSA; however, the relationship between OSA and exercise capacity is unclear.

Study Impact: This study demonstrated that OSA is associated with impaired exercise capacity. Further study is needed to evaluate the potential role for cardiopulmonary exercise testing in cardiovascular risk assessment of patients with OSA.

Sleep Architecture Following a Weight Loss Intervention in Overweight and Obese Patients with Obstructive Sleep Apnea and Type 2 Diabetes: Relationship to Apnea-Hypopnea Index. 1205-1211.
Ari Shechter, Ph.D.1; Marie-Pierre St-Onge, Ph.D.1; Samuel T. Kuna, M.D., F.A.A.S.M.2,3; Gary Zammit, Ph.D., F.A.A.S.M.4; Arindam RoyChoudhury, Ph.D.1; Anne B. Newman, M.D.5; Richard P. Millman, M.D., F.A.A.S.M.6; David M. Reboussin, Ph.D.7; Thomas A. Wadden, Ph.D.2; John M. Jakicic, Ph.D.5; F. Xavier Pi-Sunyer, M.D.1; Rena R. Wing, Ph.D.6; Gary D. Foster, Ph.D.8


Current Knowledge/Study Rationale: A growing body of evidence supports a relationship between sleep and obesity. A long-term weight loss intervention (up to 4 years) has previously been shown to improve the severity of sleep disordered breathing in a group of over-weight and obese patients with obstructive sleep apnea (OSA) and type 2 diabetes, although the effects of the structured weight loss program on nocturnal sleep duration and architecture have not yet been explored.

Study Impact: Although the weight loss intervention was effective in reducing the severity of OSA over a 4-year period, it did not lead to changes in the various polysomnographic sleep measures, indicating that the ILI did not induce changes in sleep architecture, duration, or continuity. However, overall reductions in apnea-hypopnea index over the 4-year follow-up were found to be associated with increased REM sleep and stage 2 sleep, and decreased stage 1 sleep, which suggests that reducing OSA severity may induce improvements in nocturnal sleep architecture.

Comorbidities in Infants with Obstructive Sleep Apnea. 1213-1216.
William F. Qubty, M.D.1; Anna Mrelashvili, M.D.1; Suresh Kotagal, M.D., F.A.A.S.M.1,3; Robin M. Lloyd, M.D.2,3


Current Knowledge/Study Rationale: The clinical characteristics of obstructive sleep apnea (OSA) in infants have been insufficiently characterized. Our aim was to describe identifiable comorbidities in infants with OSA, which may assist in recognizing these patients earlier in their disease course and help improve management.

Study Impact: Obstructive sleep apnea in infants is associated with different multisystem comorbidities than older children. A multidisciplinary approach is recommended for effective management of infant OSA.

The Impact of Recent Changes to the Respiratory Scoring Rules in Pediatrics. 1217-1221.
Gillian M. Nixon, M.B.Ch.B., M.D.1,2,3; Melissa Hyde2; Sarah N. Biggs, Ph.D.1,3; Lisa M. Walter, Ph.D.1,3; Rosemary S.C. Horne, Ph.D1,3; Margot J. Davey, M.B.B.S.1,2,3


Current Knowledge/Study Rationale: Recent changes in scoring systems for respiratory events during PSG in children have included significant changes in the threshold for scoring hypopnea. This study aimed to determine the magnitude of these changes and the impact on assessment of severity of OSA.

Study Impact: The findings of this study support inclusion of respiratory events with a fall in airflow of less than 50% in the obstructive apneahypopnea index, given the body of literature that exists to support the sequelae of even mild OSA in childhood.

Hopelessness Mediates the Relation between Insomnia and Suicidal Ideation. 1223-1230.
Julie A. Woosley, M.A.1; Kenneth L. Lichstein, Ph.D.1; Daniel J. Taylor, Ph.D.2; Brant W. Riedel, Ph.D.3; Andrew J. Bush, Ph.D.4


Current Knowledge/Study Rationale: Although there is much evidence to support the notion that insomnia predicts suicidality, little is known about the mechanisms by which insomnia may lead to increased suicidality. The present study sought to address this gap in the literature by determining whether hopelessness could serve as a mediator of the insomnia-suicidal ideation link.

Study Impact: The results of this research imply that it may be helpful for clinicians who treat individuals with insomnia to screen for and treat hopelessness, as clients with insomnia and elevated levels of hopelessness may be at elevated risk for suicidal ideation. In light of the present findings with cross-sectional data, more research is needed to determine whether this mediation model can be supported longitudinally.


High School Start Times and Death on the Road. 1179-1180.
Saba Hamiduzzaman, M.D.; Barbara Phillips, M.D., M.S.P.H., F.C.C.P., F.A.A.S.M.

Review Articles

Sleep Disorders Associated with Primary Mitochondrial Diseases. 1233-1239.
Ryan J. Ramezani, B.S.1; Peter W. Stacpoole, Ph.D., M.D.1,2

Sleep Medicine Pearls

An Unorthodox CPAP Usage Pattern. 1241-1243.
Robert C. Stansbury, M.D.1; Patrick J. Strollo, M.D., F.A.A.S.M.2

Letter to the Editor

Scoring Respiratory Events in Sleep Medicine: Who Is the Driver—Biology or Medical Insurance?. 1245-1247.
Robert Joseph Thomas, M.D., M.M.Sc., F.A.A.S.M.1; Christian Guilleminault, D.M., M.D, D.Biol., F.A.A.S.M.2; Indu Ayappa, Ph.D.3; David M. Rapoport, M.D.3
Capitulation or Advocacy for Sleep Physicians and Patients?. 1249-1251.
Timothy I. Morgenthaler, M.D., F.A.A.S.M.1; Sherene M. Thomas, Ph.D.2; Richard B. Berry, M.D., F.A.A.S.M.3
Calls for an International Consensus on Sleep-Related Violence and Sexual Behavior in Sleep Are Premature. 1253.
John Rumbold, M.B.Ch.B., G.D.L.1; Ian Morrison, Ph.D.2; Renata L. Riha, M.D.3
An International Consensus on the Forensic Assessment of Sleep-Related Violence and Sexual Behavior in Sleep: If Not Now, When?. 1255-1256.
Francesca Ingravallo, Ph.D.1; Francesca Poli, Ph.D.1; Emma V. Gilmore, BA1; Fabio Pizza, Ph.D.2,3; Luca Vignatelli, Ph.D.4; Carlos H. Schenck, M.D.5; Giuseppe Plazzi, M.D.2,3

Journal Club

Commentary on CPAP vs. Oxygen for Treatment of OSA. 1257-1259.
Shirin Shafazand, M.D., M.S., F.A.A.S.M.1; M. Safwan Badr, M.D., M.B.A., F.A.A.S.M.2
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November 15, 2014
Volume 10, Issue 11

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