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Accepted Papers

Scientific Investigations

Long-Term Effectiveness and Safety of Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea. 699-708.
Scott B. Boyd, DDS, PhD1,2; Arthur S. Walters, MD1; Peter Waite, DDS, MD, MPH3; Susan M. Harding, MD4; Yanna Song, MS5


Current Knowledge/Study Rationale: Since a relatively large number of patients with severe OSA will not fully adhere to CPAP therapy—presumably leaving them at continued high risk for cardiovascular events and a diminished quality of life—it is extremely important to have alternative therapies available that can effectively treat severe OSA over a patient's lifetime. To the best of our knowledge, no studies have comprehensively and concomitantly examined the long-term effectiveness and safety of maxillomandibular advancement (MMA) as an alternative therapy to CPAP. We conducted this study to determine if MMA is a clinically effective and safe long-term treatment for OSA patients, as measured by changes in the apnea-hypopnea index (AHI), blood pressure (BP), sleepiness, and quality of life (QOL).

Study Impact: Our results show that MMA produces substantial and sustained reductions in the AHI, diastolic BP, and subjective sleepiness with concomitant improvements in QOL. Importantly, MMA has a good risk-benefit ratio, as these successful outcomes were achieved in the context of minimal long-term treatment-related adverse outcomes. The results of this study provide compelling evidence to suggest that MMA should be the alternative treatment of choice for patients with severe OSA who cannot fully adhere to CPAP.

Is There a Clinical Role For Smartphone Sleep Apps? Comparison of Sleep Cycle Detection by a Smartphone Application to Polysomnography. 709-715.
Sushanth Bhat, MD1; Ambra Ferraris, MD1; Divya Gupta, MD1; Mona Mozafarian, MD1; Vincent A. DeBari, PhD2; Neola Gushway-Henry, MD1; Satish P. Gowda, MD1; Peter G. Polos, MD, PhD1; Mitchell Rubinstein, RPSGT1; Huzaifa Seidu, MD1; Sudhansu Chokroverty, MD1


Current Knowledge/Study Rationale: There are several preexisting, widely available, inexpensive smartphone apps designed to monitor sleep, but it is unclear whether they have clinical utility. Our goal was to systematically compare the results obtained by using one such app, the Sleep Time app (Azumio, Inc.) to the gold standard, polysomnography (PSG).

Study Impact: Our study shows that the absolute parameters and sleep staging reported by the Sleep Time app (Azumio, Inc.) for iPhones correlate poorly with PSG. Further studies comparing app sleep-wake detection to actigraphy may help elucidate its potential clinical utility.

Obstructive Sleep Apnea in Obese Hospitalized Patients: A Single Center Experience. 717-723.
Sunil Sharma, MD1; Paul J. Mather, MD2; Jimmy T. Efird, PhD, MSc3,4; Daron Kahn, MD1; Kristin Y. Shiue, MPH3,4; Mohammed Cheema, MD1; Raymond Malloy, RRT1; Stuart F. Quan, MD5,6


Current Knowledge/Study Rationale: OSA in hospitalized patients has not been systematically examined. Hospitalized patients have high co-morbidities and may be at high risk for cardiovascular complications. We hypothesized that there is high prevalence and under-diagnosis of OSA in obese hospitalized patients. A clinical pathway evaluation (CPE) may be an effective tool for early recognition of this condition.

Study Impact: The study shows significant under-recognition of OSA in obese hospitalized patients. Furthermore, overnight pulse-oximetry is a simple, cost effective tool for detecting sleep apnea in hospitalized patients.

All APAPs Are Not Equivalent for the Treatment of Sleep Disordered Breathing: A Bench Evaluation of Eleven Commercially Available Devices. 725-734.
Kaixian Zhu, MS1,2,3; Gabriel Roisman, MD, PhD2; Sami Aouf, MD1; Pierre Escourrou, MD, PhD2,3


Current Knowledge/Study Rationale: Auto-titrating positive airway pressure devices are designed to adjust the therapeutic pressure to maintain the upper airway patency and treat the obstructive sleep disordered breathing. The efficacy of treatment is questioned and clinical evaluations are curtailed by the variability of disease in patients.

Study Impact: All APAPs performed differently when subjected to simulated sleep disordered breathing patterns on a bench-test. Large differences exist in the treatment efficacy and accuracy of the device report data between APAP devices.

The Role of Trauma Type in the Risk for Insomnia. 735-739.
Tyish S. Hall Brown, PhD, MHS; Ameenat Akeeb, BS; Thomas A. Mellman, MD


Current Knowledge/Study Rationale: Insomnia symptoms are common following exposure to trauma, however, there is limited research identifying risk factors associated with its development in this context. The goal of this study was to evaluate associations of insomnia with specific types of trauma in a community sample of urban African Americans exposed to a broad range of trauma types.

Study Impact: Results suggest exposure to specific types of trauma confer increased risk for insomnia and that PTSD and nocturnal fears differentially contribute to this relationship. These results point to the utility of sleep specific treatment strategies that can be used independently or in conjunction with empirically supported trauma treatments dependent on the type of trauma exposure.

Caffeine Awareness in Children: Insights from a Pilot Study. 741-746.
Tushar P. Thakre, MD, PhD1,2,3; Ketan Deoras, MD4; Catherine Griffin, MD5; Aarthi Vemana, MD6; Petra Podmore, RPSGT, REEGT4; Jyoti Krishna, MD7,8


Current Knowledge/Study Rationale: Currently, very little literature exists about the awareness among adolescents of the caffeine content in common beverages. This study was a preliminary attempt to fill this gap.

Study Impact: This study highlights the lack of knowledge among adolescents about caffeine content of common beverages. It suggests the need for developing improved tools to evaluate caffeine consumption and to educate children about the risk of inadvertent excessive caffeine intake.

Article Is Eligible For CME Credits Nightmares: Under-Reported, Undetected, and Therefore Untreated. 747-750.
Michael R. Nadorff, PhD1,2; Danielle K. Nadorff, PhD1; Anne Germain, PhD3


Current Knowledge/Study Rationale: Despite being clinically relevant, it is often believed that nightmares are under-reported and under-treated. However, there are few studies that have assessed the proportion of nightmare sufferers who have discussed nightmares with a healthcare professional.

Study Impact: Our findings suggest that a low percentage of nightmare sufferers have discussed their nightmares with a healthcare professional, thus nightmares under-identified, which likely results in nightmare treatments being under-utilized. Given these results, nightmare sufferers are unlikely to self-identify and therefore nightmare screening is warranted.

Article Is Eligible For CME Credits Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery. 751-755.
Stacey L. Ishman, MD, MPH1,2,3; Kareem O. Tawfik, MD3; David F. Smith, MD, PhD1; Kristin Cheung, MD4; Lauren M. Pringle, MD5; Matthew J. Stephen, BS6; Tiffany L. Everett, MPH6; Tracey L. Stierer, MD4


Current Knowledge/Study Rationale: It is known that children with OSA are more likely to have perioperative complications than those without OSA. In light of this, the American Society of Anesthesia (ASA) practice guidelines recommend screening all patients for OSA.

Study Impact: In this blinded observational study, we found that anesthesia providers did not routinely screen for OSA prior to ambulatory pediatric surgery and patients with undiagnosed OSA who would benefit the most from screening, were the least likely to be screened. This suggests that anesthesia providers should be educated on the importance of screening children for OSA symptoms prior to surgery.

Review Articles

Sleep Disturbances in Pediatric Chronic Fatigue Syndrome: A Review of Current Research. 757-764.
Kelli Snodgrass, BBMSc1,2; Adrienne Harvey, PhD1,2,3; Adam Scheinberg, MMed (Clin Epi)1,3,4; Sarah Knight, PhD1,2,5
Acoustic Analysis of Snoring in the Diagnosis of Obstructive Sleep Apnea Syndrome: A Call for More Rigorous Studies. 765-771.
Hui Jin, MD1; Li-Ang Lee, MD2; Lijuan Song, MD1; Yanmei Li, MD1; Jianxin Peng, MD3; Nanshan Zhong, MD4; Hsueh-Yu Li, MD2; Xiaowen Zhang, MD1

Special Articles

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015. 773-827.
Kannan Ramar, MBBS, MD1; Leslie C. Dort, DDS2; Sheri G. Katz, DDS3; Christopher J. Lettieri, MD4; Christopher G. Harrod, MS5; Sherene M. Thomas, PhD5; Ronald D. Chervin, MD6

Case Reports

Dramatic Cataplexy Improvement Following Right Parietal Surgery. 829-830.
David J. Fam, MD1,4; Prathiba Shammi, PhD2,4; Todd G. Mainprize, MD, FRCSC3,4; Brian J. Murray, MD, FRCPC, D,ABSM1,4

Sleep Medicine Pearls

Second Opinion: Does This Patient Really Have Narcolepsy?. 831-833.
Scott Ryals, MD1; Richard B. Berry, MD1; Ankur Girdhar, MD1; Mary Wagner, MD2
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