Assessment of Multiple Health Risks in a Single Obstructive Sleep Apnea Population.
9-18.
David W. Hudgel, M.D.1; Lois E. Lamerato, Ph.D.2; Gordon R. Jacobsen, M.S.2; Christopher L. Drake, Ph.D.3
BRIEF SUMMARY
Current Knowledge/Study Rationale: Previous population- and clinic-based epidemiologic studies of obstructive sleep apnea (OSA) patient samples have examined the relationship between OSA severity and individual outcomes: mortality or acute cardiovascular (CD) event incidences. The purpose of this study was to identify demographic and clinical variables associated with the incidences of multiple outcomes: all-cause mortality, myocardial infarction, cerebral vascular accident and pulmonary embolus. We analyzed the interaction of these factors simultaneously among four groups of sleep center referral patients based on apnea hypopnea indices (AHI): < 5, 5–14, 15–29 and > 30.
Study Impact: In an urban sleep center sample, with a high concentration of obese young males, African Americans and patients with severe OSA, we found that CD histories were more often predictive of adverse outcomes than OSA severity; in young male patients, severe OSA also was predictive of mortality, which appeared to improve with CPAP use. In similar OSA populations, we propose that major health outcomes will be affected primarily by CV disease.
Sleep Disordered Breathing in Patients with Acute Coronary Syndromes.
21-26.
Sophia E. Schiza, M.D., Ph.D.1; Emmanuel Simantirakis, M.D., Ph.D.2; Izolde Bouloukaki, M.D., Ph.D.1; Charalampos Mermigkis, M.D., Ph.D.3; Eleftherios M. Kallergis, M.D.2; Stauros Chrysostomakis, M.D.2; Dimitrios Arfanakis, M.D.2; Nikolaos Tzanakis, M.D., Ph.D.1; Panos Vardas, M.D., Ph.D.2; Nikolaos M. Siafakas, M.D., Ph.D.1
BRIEF SUMMARY
Current Knowledge/Study Rationale: Several studies have shown a high prevalence of Obstructive sleep apnea/hypopnea syndrome (OSAHS) in patients with acute coronary syndromes (ACS) in the acute setting. The aim of this study was to assess the prevalence and time course of OSAHS in patients with ACS, during and after the acute cardiac event.
Study Impact: The issue on the ideal timing of investigation for OSAHS after an acute cardiovascular event remains unresolved. Based on our results, attempting to diagnose OSAHS early in patients with ACS should be done with caution, because initial polysomnography (PSG) findings in the acute phase of ACS are not necessarily indicative of an ongoing problem.
Diagnosis and Treatment of Sleep Apnea in Patients' Homes: The Rationale and Methods of the “GoToSleep” Randomized-Controlled Trial.
27-35.
Dawn M. Bravata, M.D.1,2,3,5,12; Jared Ferguson, B.S.3; Edward J. Miech, Ed.D.1,2; Rajiv Agarwal, M.D.3,12; Vincent McClain, M.D.6; Charles Austin, B.F.A., M.Div.3; Frederick Struve, Ph.D.6; Brian Foresman, D.O.3,11; Xinli Li, Ph.D., M.S.2; Zhu Wang, Ph.D.6,10; Linda S. Williams, M.D.1,2,4,5; Mary I. Dallas, P.T., Ph.D.7; Cody D. Couch, M.P.H.7; Jason Sico, M.D.7,8,9; Carlos Fragoso, M.D.8; Marianne S. Matthias, Ph.D.1,2,5,15; Neale Chumbler, Ph.D.1,2,5,13; Jennifer Myers, M.S.W.1,2; Nicholas Burrus, B.A.1,2; Archana Dube, Ph.D.13; Dustin D. French, Ph.D.2,3,5; Arlene A. Schmid, Ph.D., O.T.R.1,2,5,14; John Concato, M.D.6,8; H. Klar Yaggi, M.D.6,8
BRIEF SUMMARY
Current Knowledge/Study Rationale: This manuscript describes the rationale and methods of the GoToSleep study which seeks to evaluate a strategy of diagnosing and treating sleep apnea among veterans with cerebrovascular disease and hypertension. The intervention strategy was designed to reduce the reliance on laboratory-based sleep studies and to enhance treatment adherence by conducting diagnostic and therapeutic activities within patients' homes.
Study Impact: This manuscript describes four key elements of the GoToSleep study design that are either unique to this study or rarely employed in clinical trials: the inclusion of patients with cerebrovascular disease and hypertension without use of a measure of daytime sleepiness as an eligibility criterion; the use of portable polysomnography and auto-titrating CPAP in patients' homes rather than using sleep laboratory polysomnography with fixed pressure CPAP; the analytic approach to evaluating change in blood pressure in the context of change in antihypertensive medications; and the use of a usual care control group.
Randomized, Double-Blind Clinical Trial of Two Different Modes of Positive Airway Pressure Therapy on Adherence and Efficacy in Children.
37-42.
Carole L. Marcus, M.B.B.Ch.1; Suzanne E. Beck, M.D.1; Joel Traylor, R.Psg.T.1; Mary Anne Cornaglia1; Lisa J. Meltzer, Ph.D.2; Natalie DiFeo, C.R.N.P.1; Laurie R. Karamessinis, R.PFT.1; John Samuel, R.Psg.T.1; Jennifer Falvo, B.S.1; Michelle DiMaria, R.Psg.T.1; Paul R. Gallagher, M.A.3; Heidi Beris, B.S.N.1; Mary Kate Menello, B.S.N.1
BRIEF SUMMARY
Current Knowledge/Study Rationale: Children with the obstructive sleep apnea syndrome often have poor adherence to positive airway pressure (PAP) therapy. Some, but not all, studies have shown improved adherence to PAP in adults using pressure relief technologies; however, this technology has not been evaluated in children.
Study Impact: This study has shown that PAP use results in improved polysomnographic parameters of OSAS and decreased daytime sleepiness in children, although adherence in this population is suboptimal. However, there was no improvement in adherence or efficacy using bilevel pressure relief technology compared to continuous positive airway pressure.
A Pilot Study Assessing Adherence to Auto-Bilevel Following a Poor Initial Encounter with CPAP.
43-47.
Eric D. Powell, Ph.D.1; Peter C. Gay, M.D.2; Joseph M. Ojile, M.D.3; Mikhail Litinski, M.D.4; Atul Malhotra, M.D.4,5
BRIEF SUMMARY
Current Knowledge/Study Rationale: Despite the challenges by clinicians to maintain adequate treatment adherence, nasal CPAP therapy continues to be the primary treatment option for obstructive sleep apnea (OSA). CPAP adherence is likely related to multiple factors, such as disease severity, nasal symptoms, and pressure discomfort. It is unclear if early intervention with an auto-bilevel device would improve adherence after a poor initial in-lab encounter with CPAP.
Study Impact: Comparable and overall compliant adherence rates between the auto-bilevel and CPAP groups limited the effect size and clinical significance interpretation of this pilot study. However, poor initial experiences to PAP therapy can still lead to positive treatment outcomes through use of various device types and appropriate support.
Unilateral Hemidiaphragm Weakness Is Associated with Positional Hypoxemia in REM Sleep.
51-58.
Marcel A. Baltzan, M.D.; Adrienne S. Scott, M.Sc.; Norman Wolkove, M.D.
BRIEF SUMMARY
Current Knowledge/Study Rationale: Isolated unilateral diaphragmatic paralysis has been thought to be of little physiologic consequence and infrequently symptomatic for orthopnea. The polysomnographic characteristics have been reported for patients who also have other lung or muscle pathology.
Study Impact: Compared to matched controls, oximetry was lower in all sleep-wake stages and body positions. This was most pronounced in REM sleep, especially supine or sleeping on the side unaffected by diaphragmatic paralysis.
Objective vs. Subjective Measurements of Sleep in Depressed Insomniacs: First Night Effect or Reverse First Night Effect?.
59-65.
Catherine McCall, B.A.; W. Vaughn McCall, M.D.
BRIEF SUMMARY
Current Knowledge/Study Rationale: Actigraphy and subjective sleep reports are used to measure sleep continuity, but few studies have compared these methods in both home and laboratory environments. This study analyzed differences between sleep continuity in the laboratory and sleep at home before and after laboratory monitoring using actigraphy, PSG, and subjective sleep reports, in depressed insomniacs undergoing treatment.
Study Impact: This study found that the presence of a first night effect versus a reverse first night effect depended upon the measurement modality used. Measurement of sleep using actigraphy and sleep diaries produced contradictory patterns of sleep continuity between home and laboratory settings in this sample of depressed insomniacs.
Types of Sleep Problems in Adults Living with HIV/AIDS.
67-75.
Kathryn A. Lee, R.N., Ph.D., C.B.S.M1; Caryl Gay, Ph.D1; Carmen J. Portillo, R.N., Ph.D2; Traci Coggins, B.S1; Harvey Davis, R.N., Ph.D3; Clive R. Pullinger, Ph.D4,5; Bradley E. Aouizerat, Ph.D4,6
BRIEF SUMMARY
Current Knowledge/Study Rationale: Depending on the definition, a sleep problem is experienced by 30% to 100% of HIV-positive adults, and it remains unclear whether the problem is related to the infection itself, to HIV-specific treatment, or side effects of medications. The specific sleep problem needs to be better understood in order to provide the most effective intervention to improve sleep and quality of life.
Study Impact: Nearly half of this sample obtained less than 6 hours of sleep, without any effect on daytime function or mood. The least prevalent problem was difficulty falling asleep, but it was associated with more severe symptom experience. Since environment and sleep hygiene played a larger role in sleep problems than body weight or HIV clinical characteristics, reliance solely on medication to improve sleep should be discouraged and cognitive behavioral therapy should be considered, particularly in patient populations already burdened with multiple medications to manage their chronic illness.
State and Regional Prevalence of Sleep Disturbance and Daytime Fatigue.
77-86.
Michael A. Grandner, Ph.D.1; Nicholas J. Jackson, M.P.H.1; Wilfred R. Pigeon, Ph.D., C.B.S.M.2,3; Nalaka S. Gooneratne, M.D., M.Sc.4; Nirav P. Patel, M.D., M.P.H.5
BRIEF SUMMARY
Current Knowledge/Study Rationale: Sleep disturbance is an important public health concern. However, geographic dispersion of sleep problems, and the factors that may play a role, have been largely unexplored.
Study Impact: This study includes the first sleep maps for the USA that include data on sleep disturbance and daytime fatigue across most states/territories. In addition, this study demonstrates that not only are sleep and fatigue problems distributed differentially by state and region, but that these differences are partially explained by measurable mediators.
Sources of Variability in Epidemiological Studies of Sleep Using Repeated Nights of In-Home Polysomnography: SWAN Sleep Study.
87-96.
Huiyong Zheng, Ph.D.1; MaryFran Sowers, Ph.D.1; Daniel J. Buysse, M.D.2; Flavia Consens, M.D.3; Howard M. Kravitz, D.O., M.P.H.4; Karen A. Matthews, Ph.D.5; Jane F. Owens, Dr.P.H.2; Ellen B. Gold, Ph.D.6; Martica Hall, Ph.D.2
BRIEF SUMMARY
Current Knowledge/Study Rationale: Use of repeated polysomnography (PSG) in the home or laboratory to describe sleep behavior has substantial costs in money and time for data acquisition and data processing while potentially imposing physical and psychological burdens on the participant. In order to reduce the costs and relieve the burdens for designing and planning of future sleep studies, this report uses 3 nights' in-home PSG data from SWAN Sleep Study to evaluate night-to-night variation, information redundancy, and identify personal characteristics associated with substantially increased within-person variation in sleep behaviors.
Study Impact: Through the evaluation of sources of night-to-night variation with in-home PSG, this reported identifies elements that are essential in the design and planning of future sleep studies of multi-ethnic groups in social and physiological transition states such as the menopause. Two nights of in-home PSG assessment with an appropriate sample size can provide robust parameter estimates of sleep duration, continuity, and architecture in community samples; the identified personal characteristics associated with greater variability between first and second night measures includes smoking, obesity, and financial strain.
High-Fidelity Simulation Training for Sleep Technologists in a Pediatric Sleep Disorders Center.
97-101.
Kristin T. Avis, Ph.D., CBSM1; David J. Lozano, M.D1; Marjorie L. White, M.D., MPPM, M.Ed1,2; Amber Q. Youngblood, B.S.N., R.N2; Lynn Zinkan, M.P.H., R.N2; Julia M. Niebauer, M.D1; Nancy M. Tofil, M.D., M.Ed1,2
BRIEF SUMMARY
Current Knowledge/Study Rationale: To date, methods of training in emergent procedures for sleep technologists have not been evaluated. We assessed the impact of a high-fidelity simulation training for sleep technologists that may be faced with severe events of respiratory insufficiency.
Study Impact: Life threatening emergencies are rare in sleep centers, yet do occur. Simulation for sleep technologists may be a beneficial method of training to bridge the gap between opportunity to practice emergency management skills and reality.