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Consensus Statement

Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. 591-592.
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

Scientific Investigations

Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea. 597-602.
Virginia Skiba, MD1; Cathy Goldstein, MD1; Helena Schotland, MD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: In certain patients with symptoms suggestive of obstructive sleep apnea (OSA), a single polysomnogram (PSG) may not be diagnostic for sleep disordered breathing. Esophageal manometry (Pes) is considered the gold standard to measure upper airway resistance and when added to PSG may increase sensitivity to detect OSA; however, since the introduction of the nasal pressure transducer, a repeat PSG without Pes may be sufficient to confirm a diagnosis of OSA in most patients.

Study Impact: In patients with symptoms of sleep disordered breathing and an initial PSG with AHI < 5, the majority met diagnostic criteria for OSA on second PSG by AHI alone without additional information added by Pes. Because Pes is not widely available and is somewhat invasive, a repeat study without the use of Pes may be sufficient to diagnose sleep disordered breathing.

Continuous Positive Airway Pressure Treatment Increases Serum Vitamin D Levels in Male Patients with Obstructive Sleep Apnea. 603-607.
Claudio Liguori, MD1; Andrea Romigi, PhD1; Francesca Izzi, PhD1; Nicola Biagio Mercuri, MD1,2; Alberto Cordella, MD1; Enza Tarquini, CN1; Maria Pia Giambrone, BSc1; Maria Grazia Marciani, PhD2,3; Fabio Placidi, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Vitamin D not only participates in bone metabolism and regulates calcium homeostasis, but also has pleiotropic effects, modulating numerous metabolic processes. Considering that patients with obstructive sleep apnea (OSA) suffer from vitamin D deficiency and show high serum parathyroid hormone (PTH) levels, we tested the effects of short-term continuous positive airway pressure (CPAP) on serum vitamin D and PTH levels.

Study Impact: These findings suggest that short-term CPAP therapy in male patients with OSA determines an increase of serum vitamin D levels. Therefore, the current study provides evidence that OSA seems to be an etiopathogenetic factor involved in vitamin D deficiency, which may recover after CPAP therapy in male patients.

Nocturnal Hypoxemia and Severe Obstructive Sleep Apnea are Associated with Incident Type 2 Diabetes in a Population Cohort of Men. 609-614.
Sarah L. Appleton, PhD1; Andrew Vakulin, PhD2,3; R. Doug McEvoy, MD2,4; Gary A. Wittert, MB Bch, MD1,5; Sean A. Martin, PhD5; Janet F. Grant, MPH6; Anne W. Taylor, PhD6; Nick A. Antic, MBBS, PhD2,4; Peter G. Catcheside, PhD2,4; Robert J. Adams, MBBS, MD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: The generalizability of findings from the few studies that identify OSA as a risk factor for the development of diabetes may be limited by small samples, few incident cases, and possible referral bias that may apply to clinical samples. The importance of other polysomnographic measures (e.g., oxygen desaturation) and sleepiness in the development of diabetes is also unclear.

Study Impact: The current study has identified that severe undiagnosed OSA and nocturnal intermittent hypoxemia were independently associated with the development of diabetes in a large population cohort of middle-aged and older men. Given the scale of the problem of undiagnosed OSA, improved management is required to ensure that a patient presenting with one condition is screened and treated for the other with a strategy that does not rely on the presence of excessive daytime sleepiness.

Improved Sleep Quality is Associated with Reductions in Depression and PTSD Arousal Symptoms and Increases in IGF-1 Concentrations. 615-623.
Heather L. Rusch, MS1,2; Pedro Guardado, BS1; Tristin Baxter, AAS3; Vincent Mysliwiec, MD3; Jessica M. Gill, PhD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Previous studies recognized a relationship between sleep disturbance and psychiatric morbidity; however, limited work has examined this link in military personnel, a cohort at elevated risk for both insomnia and psychopathology. The current study examines the relation between improved sleep and attenuation of depression and posttraumatic symptoms in military personnel, as well as changes in trophic factors that likely modulate these conditions.

Study Impact: Results indicate a strong association between improved sleep and reduced psychiatric symptoms, as well as enriched health-related quality of life. Sleep-focused treatments may be an effective means to facilitate psychiatric recovery. Findings highlight the importance of conducting sleep assessments in military personnel with mood and anxiety disorders.

The Association between Short or Long Sleep Times and Quality of Life (QOL): Results of the Korea National Health and Nutrition Examination Survey (KNHANES IV–V). 625-634.
Jae-Hyun Kim, BS1,2; Eun-Cheol Park, MD, PhD2,3; Ki-Bong Yoo, PhD1,2; Sohee Park, PhD2,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: While sleep times are important from the viewpoint of health management, few studies have examined the association between sleep time and health-related quality of life using well-established and commonly used generic instruments and the results have been controversial In this study, we examined the associations between self-reported total sleep times and quality of life independent of perceived health status and depressive disorder.

Study Impact: Our study found that there was an inverted U-shape association between sleep time and quality of life suggesting that inappropriate sleep time (either short or long) is related with worse quality of life. In particular, such an association was more apparent among persons whose perceived health status was poor.

Article Is Eligible For CME Credits Minimal Effect of Daytime Napping Behavior on Nocturnal Sleep in Pregnant Women. 635-643.
Rebecca M. Ebert, BS1; Annette Wood, BA1; Michele L. Okun, PhD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Pregnant women report significantly more nocturnal sleep disruption than non-pregnant women. We wanted to evaluate whether daytime naps either hindered nocturnal sleep or might be a “countermeasure” to offset poor nocturnal sleep.

Study Impact: Naps do not appear to significantly hinder nocturnal sleep in early gestation. Incorporating naps into one's sleep hygiene routine may improve quality of life as well as lessen the risk of adverse pregnancy outcomes.

Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women. 645-654.
Michele L. Okun, PhD1,3; Daniel J. Buysse, MD1,2; Martica H. Hall, PhD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Pregnant women are at increased risk for insomnia. Insomnia is associated with an increased risk for adverse health outcomes. Identifying insomnia in pregnant women using a diagnostically valid instrument could assist with the diagnosis of insomnia. Early identification may lead to early intervention, and a subsequent amelioration of risk.

Study Impact: The ISQ provides useful clinical information regarding degree and severity of insomnia symptoms. Given what we know about sleep and adverse pregnancy outcomes, use of the ISQ could help with the dissemination of the importance of sleep and sleep problems during pregnancy.

Sleep Disturbances in Essential Tremor and Parkinson Disease: A Polysomnographic Study. 655-662.
Banu Ozen Barut, MD1; Nida Tascilar, MD1,2; Armagan Varo, MD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep problems in ET and PD patients had been investigated in few studies by using subjective assessment tools like self-report questionnaires previously. This study was conducted to evaluate and to compare sleep problems in these two common movement disorders by using PSG which is an objective assessment tool.

Study Impact: This study will improve the knowledge about sleep problems in ET and PD patients. Furthermore this is the first study comparing sleep problems in ET and PD patients using PSG.

Retrospective Assessment of Home Ventilation to Reduce Rehospitalization in Chronic Obstructive Pulmonary Disease. 663-670.
Steven Coughlin, PhD1; Wei E. Liang, PhD2; Sairam Parthasarathy, MD3

BRIEF SUMMARY

Current Knowledge/Study Rationale: Healthcare systems are attempting to reduce hospital readmissions due to chronic obstructive pulmonary disease (COPD). Although there are European studies that continuous positive airway pressure (CPAP) may reduce hospitalization and mortality and non-invasive positive pressure ventilation (NIPPV) may reduce mortality in patients with stable severe COPD, whether NIPPV initiation in US Hospitals can reduce re-hospitalization in an “at-risk” COPD population is unclear.

Study Impact: In a retrospective cohort study of a QI initiative undertaken at a single center, we have observed that a multi-faceted intervention that involved initiation of nocturnal AVAPS-AE (a form of NIPPV), RT-led respiratory care, medication reconciliation, appropriate oxygen therapy initiation, and patient education led to a reduction in rehospitalization. Future studies need to undertake multi-center, adequately powered randomized controlled trials to assess the efficacy of such interventions.

Review Articles

Article Is Eligible For CME Credits Lessons Learned from Sleep Education in Schools: A Review of Dos and Don'ts. 671-680.
Sarah Blunden, PhD1; Gabrielle Rigney, BA (Hons)2

Case Reports

Worsening of Obstructive Sleep Apnea Associated with Catheter-Related Superior Vena Cava Syndrome. 681-682.
Marie Jouvenot, MD1; Serge Willoteaux, MD, PhD2; Nicole Meslier, MD1,3; Frédéric Gagnadoux, MD, PhD1,3

Sleep Medicine Pearls

A 27-Year-Old Female on Chronic Opioid Therapy. 683-687.
Mukesh Kapoor, MD; Daniel Herrick, MD
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