Journal of Clinical Sleep Medicine - Research & Review Articles in Sleep Medicine

Editorial

Sleep Medicine: Strategies for Change. 577-579.

Allan I. Pack, M.B.Ch.B., Ph.D.

The Future Of Sleep Medicine: Will You Be A Part Of It?. 581-582.

Nancy Collop, M.D.¹; Samuel A. Fleishman, M.D.²

Health Disparities in Sleep Medicine: Responses to the American Sleep Medicine Foundation Humanitarian Projects Award Program. 583-584.

Merrill S. Wise, M.D.¹; Timothy Morgenthaler, M.D.²; Safwan Badr, M.D.³; Reut Gruber, Ph.D.⁴; Susan Redline, M.D.⁵; Steven A. Shea, Ph.D.⁵

Scientific Investigations

Psychiatric Comorbidity in Children and Adolescents with Restless Legs Syndrome: A Retrospective Study. 587-596.

Samuel J. Pullen, D.O.¹; Christopher A. Wall, M.D.¹; Elizabeth R. Angstman, B.S.²; Gillian E. Munitz, J.D.²; Suresh Kotagal, M.D.³^,⁴

BRIEF SUMMARY

Current Knowledge/Study Rationale: Restless legs syndrome is a common sensorimotor disorder that frequently occurs in children and adolescents, and can significantly impact quality of life. Comorbid psychiatric disorders are increasingly being recognized among adults with RLS, but little is known about the prevalence of comorbid psychiatric disorders in children and adolescents with RLS. This was the primary rationale of this study.

Study Impact: Nearly two-thirds of children and adolescents diagnosed with RLS also met diagnostic criteria for one or more psychiatric disorder. This highlights the need for the sleep clinician to assess for psychiatric disturbances in this population, and conversely for the physician treating psychiatric disorders in children and adolescents to assess for RLS.

Periodic Limb Movements during Sleep in Children with Narcolepsy. 597-601.

Supriya K. Jambhekar, M.D.¹; Gulnur Com, M.D.¹; Elizabeth Jones, R.N., B.S.N.²; Rithea Jackson, B.S.²; Maria Melguizo Castro, M.S.¹; Frances Knight²; John L. Carroll, M.D.¹; May L. Griebel, M.D.¹

BRIEF SUMMARY

Current Knowledge/Study Rationale: In adults, PLMS are known to occur more frequently in patients with narcolepsy and are shown to be associated with greater sleep disruption and shorter sleep latency. This study was performed to determine if PLMS occur commonly in children with narcolepsy and whether presence of PLMS is associated with greater sleep disruption and worse daytime sleepiness.

Study Impact: This study shows that presence of PLMS in children with narcolepsy is associated with greater sleep disruption and shorter sleep latency, suggesting the need to evaluate for the presence of “any PLMS” in children with narcolepsy. This study also raises concern about the applicability of the adult threshold for normal PLMS (<5/ hr) in the pediatric population.

Pediatric Periodic Limb Movement Disorder: Sleep Symptom and Polysomnographic Correlates Compared to Obstructive Sleep Apnea. 603-609.

Jeannine L. Gingras, M.D.¹; Jane F. Gaultney, Ph.D.¹; Daniel L. Picchietti, M.D.²

BRIEF SUMMARY

Current Knowledge/Study Rationale: There is very limited medical literature on pediatric periodic limb movement disorder (PLMD) based on the current definition. In this study we identify clinical and polysomnographic features of PLMD in a pediatric sleep center referral population, and compare these to children with obstructive sleep apnea (OSA).

Study Impact: In this large clinical case series, PLMD was found to be common,14% of 468 referred children. Important correlates of pediatric PLMD included disturbed sleep, leg discomfort/pain, parasomnias, and a family history of restless legs, more so than in the children with OSA.

The Effects of Altitude Associated Central Apnea on the Diagnosis and Treatment of Obstructive Sleep Apnea: Comparative Data from Three Different Altitude Locations in the Mountain West. 610-615.

J.F. Pagel, M.S., M.D.¹; Carol Kwiatkowski, Ph.D.²; Bennet Parnes, M.D., M.P.H.³

BRIEF SUMMARY

Current Knowledge/Study Rationale: This study indicates that altitude associated central apneas increase exponentially with increasing altitude affecting the results attained from diagnostic polysomnography and leading to increasing difficulty with PAP titrations for OSA. This study documents the potential of a clinically utilized alternative O₂ > CPAP/BiPAP protocol for treating OSA patients at altitude who develop central apneas during PAP titration.

Study Impact: The higher frequency of central apnea at altitudes above 6000 ft. indicates that such altitudes may be a relative contraindication for the routine use of limited channel OSA screeners and automatic technologies that are unable to clearly differentiate between central and obstructive apneas. The difficulty of treating OSA due to central apneas occurring on treatment with PAP at altitude is likely to lead to a higher level of untreated OSA among these patients.

Severe Obstructive Sleep Apnea and Outcomes Following Myocardial Infarction. 616-621.

Chi-Hang Lee, M.D.¹^,²; See-Meng Khoo, MB.BS.¹; Mark Y. Chan, MB.BS.¹^,²; Hwee-Bee Wong, Ph.D.³; Adrian F. Low, MB.BS.¹^,²; Qian-Hui Phua, B.Sc.¹; A. Mark Richards, M.D.¹^,⁴; Huay-Cheem Tan, MB.BS.²; Tiong-Cheng Yeo, MB.BS.²

Physiological Predictors of Response to Exposure, Relaxation, and Rescripting Therapy for Chronic Nightmares in a Randomized Clinical Trial. 622-631.

Joanne L. Davis, Ph.D.; Jamie L. Rhudy, Ph.D.; Kristi E. Pruiksma, M.A.; Patricia Byrd, Ph.D.; Amy E. Williams, Ph.D.; Klanci M. McCabe, Ph.D.; Emily J. Bartley, M.A.

BRIEF SUMMARY

Current Knowledge/Study Rationale: The purpose of this randomized clinical trial was to replicate a previous study examining the impact of Exposure, Relaxation, and Rescripting Therapy on nightmares and sleep quality. This study expanded previous efforts by including a broader assessment of mental health indices, physical health symptoms, quality of life, and examined physiological correlates of treatment related change.

Study Impact: The present study supports the use of ERRT for trauma-related sleep problems and related psychopathology. Clinicians should assess for nightmares and sleep problems in trauma-exposed persons and consider utilizing interventions that directly address these problems.

Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series. 632-638.

J. Steven Poceta, M.D.

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep driving has been noted to occur after the ingestion of hypnotic sedatives. The nature and cause of this complex behavior is not widely appreciated by clinicians.

Study Impact: This unique series describes in detail the timing of drug ingestion, patient rationale, and medication blood levels in cases of sleep driving and other complex behaviors. Because of these details, clinicians can better understand and assess risk factors, differential diagnosis, and legal ramifications for zolpidem-associated complex behaviors.

A Novel Therapy for REM Sleep Behavior Disorder (RBD). 639-644A.

Michael J. Howell, M.D.¹; Patricia A. Arneson, R.N.²; Carlos H. Schenck, M.D.³

BRIEF SUMMARY

Current Knowledge/Study Rationale: Sleep related injury is common and potentially life threatening in REM sleep Behavior Disorder (RBD). However, the unique features of REM sleep, low arousal threshold and capacity for complex auditory processing, suggests that a bed alarm with voice recording could potentially halt injurious dream enactment behavior in RBD.

Study Impact: This is the first study to demonstrate a therapy to prevent sleep related injury in RBD. This treatment is most useful in the setting of medication resistent RBD or in cases associated with neurodegeneration who are unable to tolerate medical therapy.

CBT for Insomnia in Patients with High and Low Depressive Symptom Severity: Adherence and Clinical Outcomes. 645-652.

Rachel Manber, Ph.D.¹; Rebecca A. Bernert, Ph.D.¹; Sooyeon Suh, Ph.D.¹; Sara Nowakowski¹; Allison T. Siebern, Ph.D.¹; Jason C. Ong, Ph.D.²

BRIEF SUMMARY

Current Knowledge/Study Rationale: The study aimed to compare the efficacy of cognitive behavioral therapy for insomnia (CBTI) among patients with and without elevation in depressive symptom severity. The study also aimed to assess the impact of CBTI on outcomes beyond sleep, including, well-being, depressive symptom severity, and suicidal ideation.

Study Impact: The results suggest that patients with elevation in depressive severity can benefit from group CBTI, with benefits extending beyond. Results identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.

Cerebrospinal Fluid Hypocretin 1 Deficiency, Overweight, and Metabolic Dysregulation in Patients with Narcolepsy. 653-658.

Mona S. Heier, M.D., Ph.D.¹; Tine S. Jansson, B.Sc.²; Kaare M. Gautvik, M.D., Ph.D.²

BRIEF SUMMARY

Current Knowledge/Study Rationale: Several studies of patients with narcolepsy have reported increased BMI, which has been tentatively attributed to an effect of hypocretin-1 deficiency. To clarify whether increased BMI in narcolepsy is related to hypocretin-1 deficiency, this study compares BMI and leptin values of narcolepsy/cataplexy patients with normal CSF hypocretin-1 concentration to patients with low hypocretin values.

Study Impact: The study concludes with a moderate tendency to overweight and obesity in narcolepsy with cataplexy which is independent of CSF hypocretin levels, but may be connected to the narcoleptic condition by other mechanisms.

Relationship between Food Intake and Sleep Pattern in Healthy Individuals. 659-664.

Cibele Aparecida Crispim, Ph.D.¹^,²; Ioná Zalcman Zimberg, M.S.¹; Bruno Gomes dos Reis, R.D.¹; Rafael Marques Diniz, R.D.¹; Sérgio Tufik, Ph.D.¹; Marco Túlio de Mello, Ph.D.¹

BRIEF SUMMARY

Current Knowledge/Study Rationale: Few studies have analyzed if food intake promotes alterations in the sleep pattern. Therefore, the objective of this study was to analyze the correlation between habitual food intake and sleep patterns in healthy individuals.

Study Impact: This study demonstrated that a higher food intake close to the sleeping period is associated with negative aspects of sleep patterns in healthy individuals, especially in women. However, this is an area poorly explored in the literature, and more studies are necessary to elucidate the real influence of food intake upon sleep.