Earn CME
Accepted Papers

Scientific Investigations

Article Is Eligible For CME Credits The Relationship Between Caffeine, Sleep, and Behavior in Children. 533-543.
Emily J. Watson, Bachelor of Psychology (Honors)1; Siobhan Banks, PhD1; Alison M. Coates, PhD2; Mark J. Kohler, PhD1


Current Knowledge/Study Rationale: There are limited data available regarding caffeine intake and the relationship with sleep and behavior in children. Current data in the Australian child population suggests caffeine is being consumed in children under the age of 12 years.

Study Impact: In the current study a large portion of children reported caffeine intake, with soda, coffee, and tea being primary sources and caffeine intake was associated with reduced sleep quality, which was in turn related to internalizing behavior symptoms in children aged 8 to 12 years. This study is important for clinicians who manage children reporting sleep and/or behavioral problems.

Body Fat Distribution Ratios and Obstructive Sleep Apnea Severity in Youth With Obesity. 545-550.
Amy Glicksman, MD1; Stasia Hadjiyannakis, MD2,3; Nicholas Barrowman, PhD3,4; Scott Walker, BSc2; Lynda Hoey, CCRP4; Sherri Lynne Katz, MDCM2,3


Current Knowledge/Study Rationale: Recent investigations have found that OSA risk in adults is associated with distribution of body fat directly measured using dual-energy X-ray absorptiometry. Whether a similar connection exists in obese youth is not yet well understood.

Study Impact: These study results suggest that distribution of fat rather than total adiposity is important to the development of OSA in obese youth, suggesting a pathophysiology of disease similar to that in adults. These findings also support the utility of neck-to-waist circumference ratios as a surrogate marker of body fat distribution and OSA risk.

Potential Underestimation of Sleep Apnea Severity by At-Home Kits: Rescoring In-Laboratory Polysomnography Without Sleep Staging. 551-555.
Matt T. Bianchi, MD, PhD1,2; Balaji Goparaju, MS1


Current Knowledge/Study Rationale: Limited channel at-home testing kits for sleep apnea diagnosis are increasingly available. The kits are known to underestimate sleep apnea severity, in part because of lack of sleep staging to provide total sleep time.

Study Impact: The results predict that home sleep apnea testing substantially underestimates sleep apnea indices, resulting in risk of falsely negative results and lower severity categorization that might motivate care decisions. Utilizing self-reported sleep duration does not mitigate the risk.

Depressive Symptoms Are Associated With Objectively Measured Sleep Parameters in Kidney Transplant Recipients. 557-564.
Katalin Z. Ronai, MD1; Andras Szentkiralyi, MD, PhD1,2; Alpar S. Lazar, PhD1,3; Akos Ujszaszi, MD, PhD4; Csilla Turanyi, MD, PhD1; Ferenc Gombos, MSc5; Istvan Mucsi, MD, PhD1,6; Robert Bodizs, PhD1,5; Miklos Z. Molnar, MD, PhD7,8; Marta Novak, MD, PhD1,9


Current Knowledge/Study Rationale: Depression and sleep problems are very prevalent in kidney transplant recipients. However, the association between sleep structure and subjective depressive symptoms has not been investigated in this population.

Study Impact: We demonstrate, for the first time, a connection between depressive symptoms and objectively assessed sleep macrostructure among kidney transplant recipients. These results represent an important step in the understanding of the underlying processes linking depression and sleep among these patients.

Sex-Specific Difference in the Association Between Poor Sleep Quality and Abdominal Obesity in Rural Chinese: A Large Population-Based Study. 565-574.
Ru-Qing Liu, MD, PhD1; Zhengmin Qian, MD, PhD2; Si-Quan Wang, MD3; Michael G. Vaughn, PhD4; Sarah Dee Geiger, PhD, MS5; Hong Xian, PhD6; Shao Lin, MD, PhD7; Gunther Paul, PhD8; Xiao-Wen Zeng, PhD1; Bo-Yi Yang, PhD1; Li-Wen Hu, PhD1; Shu-Li Xu, PhD1; Mo Yang, MD9; Guang-Hui Dong, MD, PhD1


Current Knowledge/Study Rationale: Existing studies on sleep quality and associated obesity are inconsistent, and few studies have prospectively evaluated the association between sleep quality and abdominal obesity among Chinese individuals. To our knowledge, the current study is the first large-scale, population-based study addressing the relationship between sleep quality and obesity in a rural Chinese population.

Study Impact: It was observed, for the first time, an association of global PSQI score with prevalence and odds of abdominal obesity in a rural Chinese population. PSQI components are also associated with abdominal obesity, with more pronounced effects among men overall.

Associations of Undiagnosed Obstructive Sleep Apnea and Excessive Daytime Sleepiness With Depression: An Australian Population Study. 575-582.
Carol J. Lang, PhD1,2; Sarah L. Appleton, PhD1,2; Andrew Vakulin, PhD3,4; R. Doug McEvoy, MD3,5; Andrew D. Vincent, PhD6; Gary A. Wittert, MD1,6; Sean A. Martin, PhD6; Janet F. Grant, MPH7; Anne W. Taylor, PhD7; Nicholas Antic, MD, PhD3,5; Peter G. Catcheside, MD3,5; Robert J. Adams, MD1


Current Knowledge/Study Rationale: A high prevalence of depressive symptoms occurs in patients with obstructive sleep apnea (OSA); however, studies investigating associations between depression and OSA have yielded mixed results. Many referred clinic studies indicate no association between the disorders and a few retrospective studies report that there is. To date, there have been very few studies undertaken in community-based populations.

Study Impact: Sleep clinicians and general health practitioners should be particularly alert to the risk of comorbid OSA and depression in the community. Although our findings indicate that the risk for depression is highest in men with both OSA and excessive daytime sleepiness who make up 2.0% of the men in our study population, the much larger group of men (11%) who have severe apnea without excessive daytime sleepiness still have an almost twofold increased risk of depression and constitute a significant problem in population health because they may be less likely to seek medical advice for their condition.

Prevalence and Associations of Obstructive Sleep Apnea in South Asians and White Europeans with Type 2 Diabetes: A Cross-Sectional Study. 583-589.
Amin Amin, MRCS1; Asad Ali, FRCP2; Quratul A. Altaf, MRCP3; Milan K. Piya, MRCP, PhD4,5; Anthony H. Barnett, FRCP, MD1,3; Neil T. Raymond, MSc6; Abd A. Tahrani, MRCP, PhD1,3


Current Knowledge/Study Rationale: Obstructive sleep apnea (OSA) is known to be common in patients with type 2 diabetes mellitus (T2DM) but the prevalence of OSA in South Asians with T2DM is unknown.

Study Impact: We found that OSA is common in South Asians with T2DM, although less common than in White Europeans. Ethnic differences in OSA prevalence were mainly due to differences in obesity and fat distribution. Other factors contributing to ethnic differences, such as upper airway structure and anatomy, need to be examined to aid screening and treatment strategies.

Insomnia and Multimorbidity in the Community Elderly in China. 591-597.
Yu-Mei Wang, MD, PhD1,2,3; Mei Song, MD1,2; Ran Wang, MD, PhD1,2; Le Shi, MD3; Jia He, MD3; Teng-Teng Fan, MD3; Wen-Hao Chen, MD3; Lan Wang, MD1,2; Lu-Lu Yu, MD1,2; Yuan-Yuan Gao, MD1,2; Xiao-Chuang Zhao, MD1,2; Na Li, MD1,2; Ying Han, PhD3; Mei-Yan Liu, MD4; Lin Lu, MD, PhD3; Xue-Yi Wang, MD1,2


Current Knowledge/Study Rationale: A total of 46% to 68% of patients who complain of insomnia have comorbid medical or psychiatric disorders. However, the prevalence of medical conditions in insomnia patients who do and do not take sleep medications has not yet been studied.

Study Impact: People who complained of insomnia had poorer physical health conditions. The incidence of arrhythmia, hypertension, and migraine was higher in individuals with insomnia who were currently taking sleep medications compared with individuals with insomnia who were not taking sleep medications.

Article Is Eligible For CME Credits Oxygen Desaturation Index Differs Significantly Between Types of Sleep Software. 599-605.
Yvonne Ng, MBBS(Hons), BMedSc, FRACP1; Simon A. Joosten, MBBS, BMedSc, FRACP, PhD1,2,3; Bradley A. Edwards, PhD4,5; Anthony Turton, BSc(Hons)1; Helen Romios, BSc (MLS)1; Thilini Samarasinghe, BBiomedSc(Hons), PhD1,6; Shane Landry, PhD4,5; Darren R. Mansfield, MBBS, FRACP, PhD1,3,5; Garun S. Hamilton, MBBS, FRACP, PhD1,2,3


Current Knowledge/Study Rationale: The oxygen desaturation index (ODI) is a commonly used metric in the assessment of obstructive sleep apnea. However, it has been unclear whether the ODI differs according to the type of system used to measure it.

Study Impact: This study highlights the significant difference in the ODI measured by two common sleep diagnostic systems, which has implications for the usage of the ODI as a diagnostic tool or marker of cardiovascular risk in obstructive sleep apnea. Further research is required to confirm whether other sleep diagnostic systems differ in their measurement of the ODI.

Vitamin D Deficiency in Patients Referred for Evaluation of Obstructive Sleep Apnea. 607-612.
Banu Salepci, MD1; Benan Caglayan, MD2; Payam Nahid, MD3; Elif Torun Parmaksiz, MD1; Nesrin Kiral, MD1; Ali Fidan, MD1; Sevda Sener Comert, MD1; Coskun Dogan, MD1; Gulten Aktin Gungor, RN1


Current Knowledge/Study Rationale: There are contradictory results about association between obstructive sleep apnea and vitamin D levels. In this study we aimed to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency.

Study Impact: In this study, we found that the majority of patients referred to the sleep center for OSA evaluation had vitamin D deficiency. The recognition that vitamin D deficiency seems common in the referred patients supports screening and potentially treatment when clinically indicated.

Review Articles

Catathrenia (Nocturnal Groaning): A Social Media Survey and State-of-the-Art Review. 613-622.
Jose Alonso, BS1; Macario Camacho, MD2,3; Dinesh K. Chhetri, MD1; Christian Guilleminault, DM, MD, DBiol3; Soroush Zaghi, MD1

Special Articles

Delaying Middle School and High School Start Times Promotes Student Health and Performance: An American Academy of Sleep Medicine Position Statement. 623-625.
Nathaniel F. Watson, MD, MS1; Jennifer L. Martin, PhD2; Merrill S. Wise, MD3; Kelly A. Carden, MD4; Douglas B. Kirsch, MD5; David A. Kristo, MD6; Raman K. Malhotra, MD7,8; Eric J. Olson, MD9; Kannan Ramar, MD9; Ilene M. Rosen, MD, MS10; James A. Rowley, MD11; Terri E. Weaver, PhD, RN12; Ronald D. Chervin, MD, MS13

Case Reports

Sleep-Related Abnormal Sexual Behaviors (Sexsomnia) Successfully Treated With a Mandibular Advancement Device: A Case Report. 627-628.
Imran S. Khawaja, MBBS, FAASM1,2; Thomas D. Hurwitz, MD3,4; Carlos H. Schenck, MD4,5

Sleep Medicine Pearls

Unusually Low Oxyhemoglobin Saturation on Polysomnography. 629-631.
Meghna P. Mansukhani, MD, FAASM1; Bhanu Prakash Kolla, MD, MRCPsych1,2; Steven I. Altchuler, MD, PhD, FAASM1,2

Emerging Technologies

Cognitive Behavioral Therapy Using a Mobile Application Synchronizable With Wearable Devices for Insomnia Treatment: A Pilot Study. 633-640.
Seung-Gul Kang, MD, PhD1; Jae Myeong Kang, MD1; Seong-Jin Cho, MD, PhD1; Kwang-Pil Ko, MD, PhD2; Yu Jin Lee, MD, PhD3; Heon-Jeong Lee, MD, PhD4; Leen Kim, MD, PhD4; John W. Winkelman, MD, PhD5

Global Practice of Sleep Medicine

Sleep Medicine in Saudi Arabia. 641-645.
Aljohara S. Almeneessier, MD1; Ahmed S. BaHammam, MD2

Letters to the Editor

The Cause of Dry Mouth During CPAP Application. 647.
Mauro Bortolotti, MD

Book Reviews

Pediatric Sleep Pearls. 649.
Eliot S. Katz, MD
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