Earn CME
Accepted Papers


Does Anyone In Your Family Have Obstructive Sleep Apnea?. 941-942.
Gillian M. Nixon, MBChB, MD1,2,3; Garun S. Hamilton, MBBS, PhD4,5
Sleep and Weight among Our Veterans. 943-945.
Ripu D. Jindal, MD

Scientific Investigations

Decreased Symptoms without Augmented Skin Blood Flow in Subjects with RLS/WED after Vibration Treatment. 947-952.
Ulrike H. Mitchell, PhD, PT1; Sterling C. Hilton, PhD2; Erik Hunsaker1; Jan Ulfberg, MD, PhD3


Current Knowledge/Study Rationale: Tissue hypoxia has been named as a possible cause for RLS/WED, and whole body vibration is known to increase blood flow and thus decrease tissue hypoxia. This study examined the possibility of using whole body vibration as a treatment option for RLS/WED.

Study Impact: This study offers a new short term treatment option for symptoms associated with RLS/WED. It also opens new doors into further research investigating the mechanism behind the success of this modality in reducing RLS/WED symptoms.

Predicting Obstructive Sleep Apnea with Periodic Snoring Sound Recorded at Home. 953-958.
Anniina Alakuijala, MD, PhD1,2; Tapani Salmi, MD, PhD1,2


Current Knowledge/Study Rationale: With the growing number of suspected sleep apnea patients, the possibility of using easier methods than polysomnography for preliminary screening has recently been raised. We aimed to evaluate the diagnostic value of periodic snoring sound recorded in the home environment.

Study Impact: This study demonstrates that measuring periodic snoring at home is a simple and useful method for predicting the probability of obstructive sleep apnea. It is possible to set a periodic snoring threshold for the subject to advance to further sleep studies.

Pediatric Positive Airway Pressure Adherence in Obstructive Sleep Apnea Enhanced by Family Member Positive Airway Pressure Usage. 959-963.
Pooja Puri, MBBS1; Kristie R. Ross, MD, MS1; Reena Mehra, MD, MS2; James C. Spilsbury, PhD3; Hong Li, MD, MS4; Carolyn E. Levers-Landis, PhD5; Carol L. Rosen, MD1


Current Knowledge/Study Rationale: Positive airway pressure (PAP) is long term therapy for children with obstructive sleep apnea (OSA) that persists after adenotonsillectomy or who are not candidates for that surgery, but its efficacy is limited by suboptimal adherence in this age group. The study explored whether having a family member on PAP therapy was associated with better PAP adherence in the child.

Study Impact: Having a family member with OSA on PAP therapy was associated with better adherence in the child. We speculate that greater efforts to identify and engage family members on PAP therapy as role models for positive health behaviors may lead to better PAP adherence for children.

Restless Legs Syndrome in a Nigerian Elderly Population. 965-972.
Michael B. Fawale, MBBS, FMCP1; Isiaka Alani Ismaila, MBBS, FWACP2; Adekunle F. Mustapha, MBBS, FMCP3; Morenikeji A. Komolafe, MBBS, FWACP1; Tewogbade A. Adedeji, MBBS, MPH, FMCPath4


Current Knowledge/Study Rationale: Previous reports indicate that the prevalence of restless legs syndrome (RLS) in the African general population is lower compared with Caucasian populations. The prevalence and associations of RLS among elderly Africans are not known.

Study Impact: The findings of this study suggest that the prevalence of RLS among elderly Africans is low and that RLS independently increases the odds of habitual sleep curtailment in elderly individuals. Head injury may be a risk factor for future RLS; this requires further investigation as indirect evidence for a possible link between RLS and traumatic brain injury exists.

Interest in Information about Nightmares in Patients with Sleep Disorders. 973-977.
Michael Schredl, PhD1; Lara Dehmlow, cand. psych.1; Judith Schmitt, MD2


Current Knowledge/Study Rationale: Recent studies indicate that nightmares are underdiagnosed and undertreated, even in sleep medicine centers. The aim of the present study was to determine the percentage of patients who are interested in information about nightmares regarding etiology and therapy.

Study Impact: The findings of the present study clearly indicate that there is a considerable number of sleep-disordered patients in need of nightmare counseling. It is thus highly recommended that questions about nightmare frequency and nightmare distress be included in the diagnostic procedures at every sleep center.

Evolution of Obstructive Sleep Apnea in Infants with Cleft Palate and Micrognathia. 979-987.
Christopher M. Cielo, DO1; Jesse A. Taylor, MD2; Arastoo Vossough, MD, PhD3; Jerilynn Radcliffe, PhD4; Allison Thomas, MA5; Ruth Bradford6; Janet Lioy, MD7; Ignacio E. Tapia, MD1; Reza Assadsangabi, MD8; Justine Shults, PhD9; Carole L. Marcus, MBBCh1


Current Knowledge/Study Rationale: Children with cleft palate and micrognathia are labeled as high-risk for OSA, but most studies have included patients clinically referred for polysomnography. The predictors of OSA and changes in OSA over the first year of life in these populations are not well understood.

Study Impact: In a group of consecutively-consenting infants, the degree of mandibular and midface hypoplasia but not the presence of cleft palate were associated with more severe OSA. Four months after the baseline evaluation, OSA improved in infants with micrognathia after treatment and those with isolated cleft palate, before palate repair.

Use of Selective Serotonin Reuptake Inhibitors and Sleep Quality: A Population-Based Study. 989-995.
Nikkie Aarts, PhD1,2; Lisette A. Zuurbier, PhD2; Raymond Noordam, PhD1,2; Albert Hofman, MD, PhD2; Henning Tiemeier, MD, PhD2,3,4; Bruno H. Stricker, MMed, PhD1,2,5; Loes E. Visser, PharmD, PhD1,2,6


Current Knowledge/Study Rationale: Use of SSRIs is consistently associated with good subjective sleep in clinically depressed patient populations. However, to our knowledge, no population-based study investigated whether SSRIs are associated with good subjective sleep in the middle-aged and elderly population in daily practice.

Study Impact: Our results suggest that sleep quality in the middle-aged and elderly population may benefit from continued SSRI use. This is important, as a patient's own perception is relevant in the course of treatment, relief of depressive symptoms and overall well-being.

Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress. 997-1002.
Stephanie B. Mayer, MD, MHSc1,2; James R. Levy, MD1,2; Leah Farrell-Carnahan, PhD6; Michelle G. Nichols, PhD, RN4,5; Shekar Raman, MD3


Current Knowledge/Study Rationale: The confluence of sleep disorders with obesity has been well established. This study characterizes the duration and quality of sleep as well as the prevalence of risk for PTSD, restless leg syndrome, and obstructive sleep apnea in Veterans referred and presenting to a hospital-based weight loss clinic.

Study Impact: The survey results underscore the importance of querying sleep habits in patients referred to weight loss clinics. Hypothesis generating regression models suggest that attempts at improving sleep quality, including sleep latency, could potentially affect BMI and weight loss success.

Nocturnal Hot Flashes: Relationship to Objective Awakenings and Sleep Stage Transitions. 1003-1009.
Matt T. Bianchi, MD, PhD1; Semmie Kim, SB2; Thania Galvan, BA2; David P. White, MD3; Hadine Joffe, MD, MSc2,4,5


Current Knowledge/Study Rationale: It is well known that self-reported hot flashes are associated with sleep complaints in menopause. However, the impact of nocturnal hot flashes on objective sleep measures in women remains incompletely understood.

Study Impact: Most objectively measured hot flashes are associated with PSG-defined wake and N1. Objective sleep disruption is linked with the perception of hot flashes.

Article Is Eligible For CME Credits Circadian Sleep Propensity and Alcohol Interaction at the Wheel. 1011-1017.
Sergio Garbarino, PhD1; Lino Nobili, PhD2; Pierre Philip, PhD3; Giuseppe Plazzi, PhD4; Claudio Campus, PhD5; Elisa Morrone, PhD6; Fabrizio De Carli, MSc7


Current Knowledge/Study Rationale: Both alcohol consumption and sleepiness are known risk factors for motor vehicle crashes. Fields studies can provide an estimation of their actual impact and support prevention policies.

Study Impact: This study highlights the high impact of sleep propensity and alcohol consumption on crashes in a real context, showing that even low levels of alcohol concentration seriously increase their effect when associated with sleep propensity. Educational campaign and accurate reconsideration of legal limits for alcohol concentration are needed to definitely discourage driving in risky condition.

Article Is Eligible For CME Credits Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial. 1019-1026.
Sandeep P. Khot, MD1; Arielle P. Davis, MD1; Deborah A. Crane, MD2; Patricia M. Tanzi, RN1; Denise Li Lue, MD2; Edward S. Claflin, MD4; Kyra J. Becker, MD1; W.T. Longstreth, MD1; Nathaniel F. Watson, MD1; Martha E. Billings, MD3


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA), increasingly recognized as a risk factor for ischemic and hemorrhagic stroke, is also a predictor of poor functional outcome after stroke. We conducted a pilot study during inpatient rehabilitation after acute stroke to assess the feasibility of a sham-controlled CPAP trial, the adherence of CPAP in this setting and the effect of CPAP on functional outcomes.

Study Impact: This pilot trial demonstrates the feasibility of randomizing stroke rehabilitation patients into a trial of active versus sham CPAP and a potential benefit of active CPAP in recovery, especially for cognitive function. Future larger studies should examine if long-term CPAP use with high adherence has an impact on stroke recovery, recurrence, and mortality.

Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). 1027-1032.
Thomas Gaughan, BS1; Ashura Buckley, MD1; Rebecca Hommer, MD1; Paul Grant, MD1; Kyle Williams, MD, PhD2; James F. Leckman, MD, PhD3; Susan E. Swedo, MD1


Current Knowledge/Study Rationale: REM sleep behavior disorder (RBD) has been demonstrated across all ages, but has been reported to occur only rarely in childhood. Among adults, RBD is associated with neurodegenerative conditions; its significance in pediatric patient populations is unknown. Demonstrating abnormalities of sleep architecture in children with PANS may provide additional insights into the etiopathogenesis of the neuropsychiatric syndrome.

Study Impact: This case series reports on sleep-related motor disturbances among children with PANS, particularly in the REM state. Pediatric RBD is likely not generated by the same mechanisms that often predict the onset of a neurodegenerative disorder among adults, and may instead be a useful marker of transient central nervous system disturbance in select cohorts.

Sleep Pathology in Creutzfeldt-Jakob Disease. 1033-1039.
Peter Kang, MD1; Gabriela S. de Bruin, MD1; Leo H. Wang, MD, PhD2; Beth A. Ward, MD3; Beau M. Ances, MD, PhD1; Miranda M. Lim, MD, PhD4; Robert C. Bucelli, MD, PhD1


Current Knowledge/Study Rationale: Associations between sleep and neurodegenerative diseases have become increasingly evident. Our study aims to characterize the prevalence and type of sleep pathology in Creutzfeldt-Jakob disease (CJD), a rapidly progressive, fatal neurodegenerative disease.

Study Impact: Sleep pathology is common in CJD, and screening for sleep pathology is indicated in the evaluation of patients with rapidly progressive dementias. Early identification and treatment of sleep pathology may provide an intervenable target for CJD.

Review Articles

The Development of Sleep Medicine: A Historical Sketch. 1041-1052.
Hartmut Schulz, PhD1; Piero Salzarulo, MD2

Special Articles

Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network. 1053-1058.
Susan Redline, MD, MPH1,2; Si Baker-Goodwin, EdD2; Jessie P. Bakker, PhD2; Matthew Epstein, JD2; Sherry Hanes2; Mark Hanson2; Zinta Harrington, MD3; James C. Johnston, PhD2; Vishesh K. Kapur, MD, MPH2,4; David Keepnews, PhD, JD, RN2,5; Emily Kontos, ScD1,2; Andy Lowe2; Judith Owens, MD2,6; Kathy Page2; Nancy Rothstein2

Case Reports

Depression as the Primary Cause of Insomnia and Excessive Daytime Sleepiness in a Family with Multiple Cases of Spinocerebellar Ataxia. 1059-1061.
Chun-Hsien Hsu, MD1; Yen-Lin Chen, MD2; Dee Pei, MD3; Shu-Man Yu, MD, MPH1; I-Chao Liu, MD, DSc4,5

Sleep Medicine Pearls

A 16-Year-Old Boy with Refractory Epilepsy and Sleep-Disordered Breathing. 1062-1064.
Lourdes M. DelRosso, MD1,2; Romy Hoque, MD3; Mary B. Contreras, RPSGT1; Ngoc P. Ly, MD, MPH1,2
Nocturnal Arousal in a 68-Year-Old Woman. 1066-1069.
Romy Hoque, MD1; Lourdes M. DelRosso, MD2
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