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Editorials

A Restless Farewell in Changing Times: Advice for the Field of Sleep Medicine. 655-656.
Jerome A. Barrett
Urgent Need to Improve PAP Management: The Devil Is in Two (Fixable) Details. 657-664.
Robert J. Thomas, MD, MMSc1; Matt T. Bianchi, MD, PhD2
AASM Scoring Manual Updates for 2017 (Version 2.4). 665-666.
Richard B. Berry, MD1; Rita Brooks, MEd, RST, RPSGT2; Charlene Gamaldo, MD3; Susan M. Harding, MD4; Robin M. Lloyd, MD5; Stuart F. Quan, MD6,7; Matthew T. Troester, DO8; Bradley V. Vaughn, MD9

Scientific Investigations

Validity of Actigraphy in Measurement of Sleep in Young Adults With Type 1 Diabetes. 669-674.
Sarah S. Farabi, PhD1; Lauretta Quinn, PhD2; David W. Carley, PhD3,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep architecture differs in individuals with type 1 diabetes in comparison with controls. Actigraphy has not been validated for use in individuals with type 1 diabetes.

Study Impact: This study demonstrates that using the low setting for the Actiwatch2 provides the most valid results in young adults with type 1 diabetes. This is important for consideration when using the Actiwatch2 in individuals with type 1 diabetes.

Validation of the Nox-T3 Portable Monitor for Diagnosis of Obstructive Sleep Apnea in Chinese Adults. 675-683.
Liyue Xu, MD1; Fang Han, MD2; Brendan T. Keenan, MS3; Elizabeth Kneeland-Szanto, MBA3; Han Yan, MD2; Xiaosong Dong, MD2; Yuan Chang, MD1; Long Zhao, BS2; Xueli Zhang, BS2; Jing Li, BS2; Allan I. Pack, MBChB, PhD3; Samuel T. Kuna, MD3,4

BRIEF SUMMARY

Current Knowledge/Study Rationale: The purpose of this study was to evaluate the performance of a portable monitor (Nox-T3) used for home sleep testing to diagnose obstructive sleep apnea. In particular, we wanted to validate its use in Chinese adults, a less obese patient population than that evaluated in most previous studies.

Study Impact: The results show that home sleep testing using the Nox-T3 monitor has close agreement with the results of in-laboratory polysomnography. The ability to use home sleep testing rather than polysomnography to diagnose sleep apnea will improve access to care.

How Do Sleep-Related Health Problems Affect Functional Status According to Sex?. 685-692.
Allegra Boccabella, MPH; John Malouf, MBBS

BRIEF SUMMARY

Current Knowledge/Study Rationale: Men and women experience sleep-related health problems differently in terms of symptomatology, prevalence, and pathophysiology. The main aim of this study was to understand the difference in functional status between sexes when they present to general practitioners.

Study Impact: Our research shows that men and women do have different functional status on presentation to general practitioners. A larger proportion of women reported issues with depression, trouble sleeping, concentration, memory, and effect on relationships compared to men.

Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings. 693-702.
Daniel Álvarez, PhD1,2; María L. Alonso-Álvarez, MD3; Gonzalo C. Gutiérrez-Tobal, PhD2; Andrea Crespo, MD1,2; Leila Kheirandish-Gozal, MD, MSc4; Roberto Hornero, PhD2; David Gozal, MD, MBA4; Joaquín Terán-Santos, MD3; Félix Del Campo, MD, PhD1,2

BRIEF SUMMARY

Current Knowledge/Study Rationale: Increasing accessibility to the diagnosis of childhood obstructive sleep apnea (OSA) by means of simplified as well as effective techniques is a challenging task. Unattended nocturnal oximetry has been recognized as a potentially useful tool even if well-validated algorithms are still sorely needed.

Study Impact: We show that automated analysis of at-home blood oxygen saturation (SpO2) from nocturnal oximetry is a reliable and accurate alternative to home-based respiratory polygraphy in the identification of OSA in children with high pretest probability. Therefore, unattended oximetry could be an essential approach in order to develop abbreviated diagnostic tools for childhood OSA.

Article Is Eligible For CME Credits The Efficacy of Low-Level Continuous Positive Airway Pressure for the Treatment of Snoring. 703-711.
Michelle A. Guzman, BA, RPSGT1; Francis P. Sgambati, MS1; Huy Pho, BS1; Rafael S. Arias, BS1; Erin M. Hawks, MS, RPSGT1; Erica M. Wolfe, BS, RPSGT1; Tamás Ötvös, MD1; Russell Rosenberg, PhD2; Riad Dakheel, MD3; Hartmut Schneider, MD, PhD1; Jason P. Kirkness, PhD1; Philip L. Smith, MD1; Alan R. Schwartz, MD1

BRIEF SUMMARY

Current Knowledge/Study Rationale: Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea. Snoring is a manifestation of partial upper airway obstruction during sleep and can be eliminated by CPAP at levels considerably lower than those used to treat obstructive sleep apnea.

Study Impact: Snoring is a potent source of noise pollution in the bedroom that can degrade the quality of sleep in bed partners. Low-level CPAP can mitigate snoring and potentially improve the sleep quality and daytime function of bed partners.

Autotitrating CPAP as a Tool for CPAP Initiation for Children. 713-719.
Rebecca Mihai, BAppSc (Hons)1; Moya Vandeleur, MB BCh, BAO1; Sally Pecoraro1; Margot J. Davey, MBBS1,3; Gillian M. Nixon, MD1,2,3

BRIEF SUMMARY

Current Knowledge/Study Rationale: CPAP is becoming an increasingly common treatment for children with OSA. Autotitrating CPAP has the potential to streamline treatment initiation and rapidly achieve therapeutic pressure during the early phase of CPAP treatment.

Study Impact: The use of autotitrating CPAP is safe and effective as a tool in the initiation phase of treatment of OSA with CPAP in children. Automatically defined treatment pressures are close to the manually derived treatment pressure, suggesting that the AutoPAP algorithm accurately estimates therapeutic pressure in children.

Upper Airway Reflexes are Preserved During Dexmedetomidine Sedation in Children With Down Syndrome and Obstructive Sleep Apnea. 721-727.
Mohamed Mahmoud, MD1; Stacey L. Ishman, MD, MPH2,3; Keith McConnell, MS3; Robert Fleck, MD4; Sally Shott, MD2; Goutham Mylavarapu, PhD3; Ephraim Gutmark, PhD, DSc2,5; Yuanshu Zou, PhD6; Rhonda Szczesniak, PhD3,6; Raouf S. Amin, MD3

BRIEF SUMMARY

Current Knowledge/Study Rationale: The assessment of pharyngeal collapsibility under anesthesia can provide important information about dynamic patterns of airway collapse in children with obstructive sleep apnea. Dexmedetomidine provides sedative properties that parallel the physiologic changes seen during non-rapid eye movement sleep through action on alpha 2-adrenergic receptors. These properties make dexmedetomidine an attractive drug for sedating children who need dynamic upper airway evaluation.

Study Impact: The responses to airway obstruction and the association between airway collapsibility and obstructive sleep apnea severity during dexmedetomidine sedation in children were unknown. This study demonstrated that dexmedetomidine is a reasonable anesthetic option to sedate children with obstructive sleep apnea, especially those presenting for upper airway evaluation.

Nocturnal Desaturation is Associated With Atrial Fibrillation in Patients With Ischemic Stroke and Obstructive Sleep Apnea. 729-735.
Chung-Yao Chen, MD1,2; Chien-Hui Ho, MD1; Chia-Ling Chen, MD, PhD3,4; Chung-Chieh Yu, MD2,5

BRIEF SUMMARY

Current Knowledge/Study Rationale: In order to facilitate better secondary prevention of ischemic stroke, we designed this study. It determined the association between obstructive sleep apnea (OSA) and atrial fibrillation (AF) among patients with ischemic stroke.

Study Impact: We found that apnea-hypopnea index and desaturation index cannot fully represent the severity of OSA in patients with stroke. Instead, the mean desaturation value during nocturnal hypoxia must be used. After finding nocturnal hypoxia due to OSA is an independent predictor of AF in patients with subacute ischemic stroke, we conclude that the use of overnight pulse oximeter to assess nocturnal hypoxia and to predict paroxysmal AF in cryptogenic stroke patients needs further evaluation.

Review Articles

Article Is Eligible For CME Credits Patient-Reported Measures of Narcolepsy: The Need for Better Assessment. 737-744.
Ulf Kallweit, MD1; Markus Schmidt, MD, PhD2; Claudio L. Bassetti, MD1

Special Articles

Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force. 745-758.
Indira Gurubhagavatula, MD, MPH1,2; Shannon Sullivan, MD3; Amy Meoli, MD4; Susheel Patil, MD5; Ryan Olson, PhD6; Michael Berneking, MD7; Nathaniel F. Watson, MD, MS8

Case Reports

Suvorexant-Induced Dream Enactment Behavior in Parkinson Disease: A Case Report. 759-760.
Hiromitsu Tabata, MD, PhD1; Akira Kuriyama, MD, MPH2; Fusae Yamao, MD1; Hiroshi Kitaguchi, MD, PhD1; Katsuro Shindo, MD, PhD1

Letters to the Editor

Commentary on Healthy School Start Times. 761.
Judith Owens, MD, MPH1; Wendy Troxel, PhD2; Kyla Wahlstrom, PhD3
Transparency and Partnership. 763.
Timothy I. Morgenthaler, MD, FAASM1; Leslie Dort, MSc, DDS2; Janet Mullington, PhD3
Making Dollars and Sense of SAVE. 765-766.
Emerson M. Wickwire, PhD, FAASM
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